Can a prediction model for vaginal birth after cesarean also predict the probability of morbidity related to a trial of labor?

PubMed

Grobman, William A; Lai, Yinglei; Landon, Mark B; Spong, Catherine Y; Leveno, Kenneth J; Rouse, Dwight J; Varner, Michael W; Moawad, Atef H; Caritis, Steve N; Harper, Margaret; Wapner, Ronald J; Sorokin, Yoram; Miodovnik, Menachem; Carpenter, Marshall; O'Sullivan, Mary J; Sibai, Baha M; Langer, Oded; Thorp, John M; Ramin, Susan M; Mercer, Brian M

2009-01-01

The objective of the study was to determine whether a model for predicting vaginal birth after cesarean (VBAC) can also predict the probabilty of morbidity associated with a trial of labor (TOL). Using a previously published prediction model, we categorized women with 1 prior cesarean by chance of VBAC. Prevalence of maternal and neonatal morbidity was stratfied by probability of VBAC success and delivery approach. Morbidity became less frequent as the predicted chance of VBAC increased among women who underwent TOL (P < .001) but not elective repeat cesarean section (ERCS) (P > .05). When the predicted chance of VBAC was less than 70%, women undergoing a TOL were more likely to have maternal morbidity (relative risk [RR], 2.2; 95% confidence interval [CI], 1.5-3.1) than those who underwent an ERCS; when the predicted chance of VBAC was at least 70%, total maternal morbidity was not different between the 2 groups (RR, 0.8; 95% CI, 0.5-1.2). The results were similar for neonatal morbidity. A prediction model for VBAC provides information regarding the chance of TOL-related morbidity and suggests that maternal morbidity is not greater for those women who undergo TOL than those who undergo ERCS if the chance of VBAC is at least 70%.

Co-morbidity in Attention-Deficit Hyperactivity Disorder: A Clinical Study from India.

PubMed

Jacob, P; Srinath, S; Girimaji, S; Seshadri, S; Sagar, J V

2016-12-01

To assess the prevalence of neurodevelopmental and psychiatric co-morbidities in children and adolescents diagnosed with attention-deficit hyperactivity disorder at a tertiary care child and adolescent psychiatry centre. A total of 63 children and adolescents who were diagnosed with attention-deficit hyperactivity disorder and fulfilled the inclusion criteria were comprehensively assessed for neurodevelopmental and psychiatric co-morbidities. The tools used included the Mini-International Neuropsychiatric Interview for Children and Adolescents, Attention Deficit Hyperactivity Disorder Rating Scale IV (ADHD-RS), Children's Global Assessment Scale, Clinical Global Impression Scale, Vineland Social Maturity Scale, and Childhood Autism Rating Scale. All except 1 subject had neurodevelopmental and / or psychiatric disorder co-morbid with attention-deficit hyperactivity disorder; 66.7% had both neurodevelopmental and psychiatric disorders. Specific learning disability was the most common co-existing neurodevelopmental disorder and oppositional defiant disorder was the most common psychiatric co-morbidity. The mean baseline ADHD-RS scores were significantly higher in the group with psychiatric co-morbidities, especially in the group with oppositional defiant disorder. Co-morbidity is present at a very high frequency in clinic-referred children diagnosed with attention-deficit hyperactivity disorder. Psychiatric co-morbidity, specifically oppositional defiant disorder, has an impact on the severity of attention-deficit hyperactivity disorder. Co-morbidity needs to be explicitly looked for during evaluation and managed appropriately.

Child Health in the Peruvian Amazon: Prevalence and Factors Associated with Referred Morbidity and Health Care Access in the City of Iñapari

PubMed Central

Guimarães, Maria Gabriela Silva; Braña, Athos Muniz; Oliart-Guzmán, Humberto; Branco, Fernando Luiz Cunha Castelo; Delfino, Breno Matos; Pereira, Thasciany Moraes; Mantovani, Saulo Augusto Silva; Martins, Antonio Camargo; Santos, Ana Paula; Filgueira-Júnior, José Alcântara; Ramalho, Alanderson Alves; Guimarães, Andreia da Silva; Oliveira, Cristieli Sérgio de Menezes; de Araújo, Thiago Santos; Estrada, Carlos Hermógenes Manrique de Lara; Arróspide, Nancy; da Silva-Nunes, Mônica

2015-01-01

Introduction. Children under 5 years of age are more susceptible to developing morbidities such as diarrhea, respiratory infections, anemia, and malnutrition. The objective of the study is to evaluate the prevalence of reported morbidities in this age group in the city of Iñapari (Peru) and the access to health services in this municipality. Methods. Data collection using interviews that assessed socioeconomic and demographic conditions, child morbidity, and access to health services was performed in 2011. Statistical analysis was performed using SPSS 13.0. Results. Regarding morbidities that occurred during lifetime, 39.8% reported previous anemia and intestinal parasite infection. About 53.7% of the children reported any type of morbidities in the last 15 days before interview, being most frequent respiratory symptoms (38.9%), diarrhea (23,4%), and fever (23,1%). Only 63.1% of those reporting recent morbidities sought health care. These morbidities were associated with precarious sanitation and lack of infrastructure, the presence of other comorbidities, and poor access to health services. Conclusion. The main referred morbidities in Amazonian Peruvian children were diarrhea, respiratory symptoms, anemia, and vomiting. Incentives and improvements in the health and sanitation conditions would be important measures to improve the quality of life of the Amazonian child population. PMID:26640493

Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?

PubMed

Baldwin, Keith D; Matuszewski, Paul E; Namdari, Surena; Esterhai, John L; Mehta, Samir

2011-01-03

Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings. Copyright 2011, SLACK Incorporated.

Colorectal cancer morbidity in Poland and Japan in the years 1999–2006 – a comparison

PubMed Central

Miśkiewicz, Marta; Mik, Michał; Dziki, Adam; Utada, Mai; Kempińska-Mirosławska, Bogumiła

2014-01-01

Introduction The frequency of colorectal cancer (CRC) is dependent on sex and age. The illness more often affects men than women, and a considerable increase in morbidity is noted after 65 years of age. The aim of the study was to assess the influence of various risk factors on CRC morbidity, statistical data from countries varied in cultural, socioeconomic and biological terms need to be studied. Poland and Japan can serve as examples of such contrasts. Material and methods The basis for the analysis of CRC morbidity was statistical data from Poland and Japan gathered in the period 1999–2006. They were expressed in absolute numbers and were related to the total morbidity, as well as morbidity according to sex and age. Results In the years 1999–2006, the total morbidity in Japan was on average 2.3 times higher than in Poland. The value was 2.5 times higher among men and 2.1 times among women when compared to Poland. In both countries morbidity is closely related to age and it reaches a peak between 65 and 74 years of age. Although the change in morbidity over the period was the same for Poland and Japan, there are considerable differences concerning the sex of the patients. Conclusions There is a substantial increase in CRC morbidity in both countries, especially among elderly people, which may point to the predominant influence of environmental factors and population aging in both countries. The much higher increase in morbidity among Polish men when compared to Polish women, not observed in the Japanese population, requires further study. PMID:25097579

Monitoring childbirth morbidity using hospital discharge data: further development and application of a composite measure.

PubMed

Korst, Lisa M; Fridman, Moshe; Lu, Michael C; Mitchell, Connie; Lawton, Elizabeth; Griffin, Flojaune; Gregory, Kimberly D

2014-09-01

The purpose of this study was to evaluate the use of a childbirth composite morbidity indicator for monitoring childbirth morbidity at hospital and regional levels in California. Study data were obtained from the 2005 linked maternal and neonatal discharge dataset for California hospitals. The study population was limited to laboring women with singleton, term (≥37 weeks' gestation), inborn, and live births. Women with and without pregnancy complications were stratified into high- and low-risk groups. The composite outcome was defined as any significant morbidity of the mother or newborn infant during the childbirth admission. Submeasures for maternal and neonatal composite morbidity and for severe maternal morbidity were examined with both aggregate and hospital-level analyses. Of 377,869 eligible deliveries, 120,218 (31.8%) were categorized as high risk and 257,651 (68.2%) were categorized as low risk. High-risk women had higher morbidity rates for all comparisons. The mean childbirth composite morbidity rate was 21% overall: 28% for high-risk women and 18% for low-risk women. For high- and low-risk strata, the rates of maternal complications were 18% and 13%, and the rates of severe maternal morbidity were 1.4% and 0.5%, respectively. There was substantial variation across hospitals for all measures. The childbirth composite morbidity rate is designed to report childbirth complication rates that combine maternal and neonatal morbidity. This measure and its submeasures met the criteria for quality indicator evaluation as specified by the Agency for Healthcare Research and Quality and can be used for benchmarking or for monitoring childbirth outcomes at regional levels. Copyright © 2014. Published by Elsevier Inc.

Multi-Morbidity in Hospitalised Older Patients: Who Are the Complex Elderly?

PubMed Central

Ruiz, Milagros; Bottle, Alex; Long, Susannah; Aylin, Paul

2015-01-01

Background No formal definition for the “complex elderly” exists; moreover, these older patients with high levels of multi-morbidity are not readily identified as such at point of hospitalisation, thus missing a valuable opportunity to manage the older patient appropriately within the hospital setting. Objectives To empirically identify the complex elderly patient based on degree of multi-morbidity. Design Retrospective observational study using administrative data. Setting English hospitals during the financial year 2012–13. Subjects All admitted patients aged 65 years and over. Methods By using exploratory analysis (correspondence analysis) we identify multi-morbidity groups based on 20 target conditions whose hospital prevalence was ≥ 1%. Results We examined a total of 2788900 hospital admissions. Multi-morbidity was highly prevalent, 62.8% had 2 or more of the targeted conditions while 4.7% had six or more. Multi-morbidity increased with age from 56% (65-69yr age-groups) up to 67% (80-84yr age-group). The average multi-morbidity was 3.2±1.2 (SD). Correspondence analysis revealed 3 distinct groups of older patients. Group 1 (multi-morbidity ≤2), associated with cancer and/or metastasis; Group 2 (multi-morbidity of 3, 4 or 5), associated with chronic pulmonary disease, lung disease, rheumatism and osteoporosis; finally Group 3 with the highest level of multi-morbidity (≥6) and associated with heart failure, cerebrovascular accident, diabetes, hypertension and myocardial infarction. Conclusions By using widely available hospital administrative data, we propose patients in Groups 2 and 3 to be identified as the complex elderly. Identification of multi-morbidity patterns can help to predict the needs of the older patient and improve resource provision. PMID:26716440

Changes in co-morbidity pattern in patients starting renal replacement therapy in Europe-data from the ERA-EDTA Registry.

PubMed

Ceretta, Maria L; Noordzij, Marlies; Luxardo, Rosario; De Meester, Johan; Abad Diez, Jose M; Finne, Patrik; Heaf, James G; Couchoud, Cécile; Kramar, Reinhard; Collart, Frederic; Cases, Aleix; Palsson, Runolfur; Reisæter, Anna V; Rydell, Helena; Massy, Ziad A; Jager, Kitty J; Kramer, Anneke

2018-01-18

Patients starting renal replacement therapy (RRT) for end-stage renal disease often present with one or more co-morbidities. This study explored the prevalence of co-morbidities in patients who started RRT in Europe during the period from 2005 to 2014. Using data from patients aged 20 years or older from all 11 national or regional registries providing co-morbidity data to the European Renal Association - European Dialysis and Transplant Association Registry, we examined the prevalence of the following co-morbidities: diabetes mellitus (DM) (primary renal disease and/or co-morbidity), ischaemic heart disease (IHD), congestive heart failure (CHF), peripheral vascular disease (PVD), cerebrovascular disease (CVD) and malignancy. Overall, 70% of 7578 patients who initiated RRT in 2014 presented with at least one co-morbidity: 39.0% presented with DM, 25.0% with IHD, 22.3% with CHF, 17.7% with PVD, 16.4% with malignancy and 15.5% with CVD. These percentages differed substantially between countries. Co-morbidities were more common in men than in women, in older patients than in younger patients, and in patients on haemodialysis at Day 91 when compared with patients on peritoneal dialysis. Between 2005 and 2014 the prevalence of DM and malignancy increased over time, whereas the prevalence of IHD and PVD declined. More than two-thirds of patients initiating RRT in Europe have at least one co-morbidity. With the rising age at the start of RRT over the last decade, there have been changes in the co-morbidity pattern: the prevalence of cardiovascular co-morbidities decreased, while the prevalence of DM and malignancy increased. © The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The association between gender and pediatric respiratory morbidity.

PubMed

Ben-Shmuel, Atar; Sheiner, Eyal; Wainstock, Tamar; Landau, Daniella; Vaknin, Flear; Walfisch, Asnat

2018-06-26

To evaluate the association between newborn gender and the risk for later pediatric respiratory morbidity. A population based cohort analysis was performed by comparing the risk of long-term respiratory morbidity (until 18 years of age) according to gender. Respiratory morbidity included hospitalizations involving pneumonia, asthma, bronchitis, bronchiolitis, upper respiratory tract infection (URTI), influenza, and bronchiectasis. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Kaplan-Meier survival curves were constructed to compare cumulative respiratory morbidity. A Cox proportional hazards model controlled for confounders. During the study period 240 953 newborns met the inclusion criteria. Among them, 118 113 were females (49.0%) and 122 840 were males (51.0%). During the 18 years of follow-up, 13 719 (5.7%) different newborns were hospitalized with respiratory related morbidity. Males had significantly higher rates of respiratory morbidity as compared with females (6.4% vs 4.9% respectively, P < 0.001, OR 1.32, 95% CI 1.28-1.37). Specifically, pneumonia, bronchitis, asthma, bronchiolitis, and URTI were significantly more common in males. Males exhibited higher total cumulative respiratory morbidity (log rank P < 0.001), as well as higher cumulative morbidity in several sub-categories. These sub-categories included pneumonia, bronchitis, asthma, bronchiolitis, and URTI (P < 0.05 in all). The Cox regression model demonstrated male gender to be an independent risk factor for pediatric respiratory morbidity while adjusting for gestational age, birthweight, and other confounders (HR 1.29, 95% CI 1.25-1.34, P < 0.001). Males are at an increased risk for pediatric respiratory morbidity, independent of obstetrical characteristics such as gestational age and birthweight. © 2018 Wiley Periodicals, Inc.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia.

PubMed

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia. The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia

PubMed Central

Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

ABSTRACT Background: Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. Objective: To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. Methods: We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). Results: There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia. Conclusion: The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population. PMID:28649930

Ambient fine and coarse particulate matter pollution and respiratory morbidity in Dongguan, China.

PubMed

Zhao, Yiju; Wang, Shengyong; Lang, Lingling; Huang, Caiyan; Ma, Wenjun; Lin, Hualiang

2017-03-01

We estimated the short-term effects of particulate matter (PM) pollution with aerodynamic diameters ≤2.5 μm (PM 2.5 ) and between 2.5 and 10 μm (PM c ) on hospital outpatient visits due to overall and specific respiratory diseases, as well as the associated morbidity burden in Dongguan, a subtropical city in South China. A time-series model with quasi-Poisson link was used to examine the association between PM pollution and morbidities from respiratory diseases, COPD, asthma and pneumonia in Dongguan during 2013-2015. We further estimated the morbidity burden (population attributable fraction and attributable morbidity) due to ambient PM pollution. A total of 44,801 hospital outpatient visits for respiratory diseases were recorded during the study period. Both PM 2.5 and PM c were found to be significantly associated with morbidity of overall respiratory diseases, COPD, and asthma. An IQR (interquartile range) increase in PM 2.5 at lag 03 day was associated with 15.41% (95% CI: 10.99%, 20.01%) increase in respiratory morbidity, and each IQR increase in PM c at lag 03 corresponded to 7.24% (95% CI: 4.25%, 10.32%) increase in respiratory morbidity. We did not find significant effects of PM 2.5 and PM c on pneumonia. Using WHO's guideline (25 μg/m 3 ) as reference concentration, about 8.32% (95% CI: 5.90%, 10.86%) of respiratory morbidity (3727, 95% CI: 2642, 4867, in morbidity number) were estimated to be attributed to PM 2.5 , and 0.86% (95% CI: 0.50%, 1.23%) of respiratory morbidity, representing 385 (95% CI: 225, 551) hospital outpatient visits, could be attributed to coarse particulate pollutant. Our study suggests that both fine and coarse particulate pollutants are an important trigger of hospital outpatient visits for respiratory diseases, and account for substantial respiratory morbidity in Dongguan, China. Copyright © 2016 Elsevier Ltd. All rights reserved.

Trends in a life threatening condition: morbid obesity in dutch, Turkish and Moroccan children in The Netherlands.

PubMed

van Dommelen, Paula; Schönbeck, Yvonne; van Buuren, Stef; HiraSing, Remy A

2014-01-01

Morbid obesity can be a life threatening condition. The aim of our study is to assess the trend in morbid obesity in The Netherlands among children of Dutch origin since 1980, and among children of Turkish and Moroccan origin since 1997. Cross-sectional height and weight data of children of Dutch, Turkish and Moroccan origin aged 2-18 years were selected from three national Dutch Growth Studies performed in 1980, 1997 and 2009 (n = 54,814). Extended international (IOTF) cut-offs in childhood were used to define morbid obesity (obesity class II and III combined). The morbidity index for overweight was calculated as the prevalence of morbid obesity divided by the prevalence of overweight. Our study showed that the prevalence of morbid obesity in children of Dutch origin was 0.59% in boys and 0.53% in girls in 2009. Significant upward trends occurred since 1980 and 1997. The prevalence was three to four fold higher in Turkish children compared to Dutch children. The Turkish children also had an upward trend since 1997, but this was only statistically significant in boys. The prevalence of morbid obesity in Moroccan children was two to three fold higher than in Dutch children, but it remained almost stable between 1997 and 2009. The Dutch and Turkish children showed an upward trend in morbidity index for overweight since respectively 1980 and 1997, while the Moroccan children showed a downward trend since 1997. In 2009, children of low educated parents had the highest prevalence rates of morbid obesity; 1.06% in Dutch, 2.11% in Turkish and 1.41% in Moroccan children. An upward trend of morbid obesity in Dutch and Turkish children in The Netherlands occurred. Monitoring and reducing the prevalence of childhood morbid obesity is of high importance for these children, health care and the community.

Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death.

PubMed

Simonsen, Rikke Kildevæld; Hald, Gert Martin; Kristensen, Ellids; Giraldi, Annamaria

2016-03-01

Studies of mortality and somatic well-being after sex-reassignment surgery (SRS) of transsexual individuals are equivocal. Accordingly, the present study investigated mortality and somatic morbidity using a sample of transsexual individuals who comprised 98% (n = 104) of all surgically reassigned transsexual individuals in Denmark. To investigate somatic morbidity before and after SRS and cause of death and its relation to somatic morbidity after SRS in Danish individuals who underwent SRS from 1978 through 2010. Somatic morbidity and mortality in 104 sex-reassigned individuals were identified retrospectively by data from the Danish National Health Register and the Cause of Death Register. Somatic morbidity and cause of death. Overall, 19.2% of the sample were registered with somatic morbidity before SRS and 23.1% after SRS (P = not significant). In total, 8.6% had somatic morbidity before and after SRS. The most common diagnostic category was cardiovascular disease, affecting 18 individuals, 9 before and 14 after SRS, and 5 of those 14 who were affected after SRS had cardiovascular disease before and after SRS. Ten individuals died after SRS at an average age of 53.5 ± 7.9 years (male to female) and 53.5 ± 7.3 years (female to male). Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality. Copyright © 2016. Published by Elsevier Inc.

[A prevalence study on mild cognitive impairment among the elderly populations of Mongolian and Han nationalities in a pastoral area of Inner Mongolia].

PubMed

Hu, Riletemuer; Zhao, Shi-gang; Wang, De-sheng; Wen, Shi-rong; Niu, Guang-ming; A, Rong; Wang, Zhi-guang; Jiang, Ming-fang; Zhang, Chun-yu

2012-04-01

To understand the epidemiological characteristics and distribution of mild cognitive impairment (MCI) in elderly populations from Mongolian and Han nationalities living in the pastoral areas of Inner Mongolia Autonomous Region of China. According to the MCI clinical diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders 4th revised edition (DSM-IV) by American Psychiatric Association, the individuals under study were at the age of 55 or over, with Mongolian or Han ethnicities and living in the pastoral area of Inner Mongolia. The crude MCI morbidity rates of Mongolian and Han of the study populations in the pastoral area of Inner Mongolia Autonomous Region of China was 19.48% (1782/9146) and the standardization morbidity was 18.98%. The crude MCI morbidity rates of both Mongolian and Han ethnicities were 17.46% (the standardization morbidity was 16.99%) and 20.60% (the standardization morbidity was 19.98%), respectively. There showed a significant positive correlation between the crude morbidities and age, also significantly increasing with the latter. In the Mongolian population, the morbidity increased from 12.17% at the age 55-59 to 27.78% at 85 while in the Han population, the morbidity increased from 15.50% at the age 55-59 to 23.53% at 85. In both the populations of Mongolian and Han, there was a statistically difference found between the morbidities of MCI (χ2=13.229, P=0.000). The morbidity was higher in Hans than in the Mongolians. However, there was no statistically significant difference noticed between the morbidities of MCI in the Mongolian males and females (χ2=2.376, P=0.123). There was statistically significant difference found between the morbidities of MCI in the Han males and females, with females having higher risk than males (χ2=24.470, P=0.000). The morbidity of MCI in the elderly Mongolian and Han populations from the pastoral area of Inner Mongolia Autonomous Region of China was considered to be quite high and correlated to age and gender.

Simultaneous Prediction of New Morbidity, Mortality, and Survival Without New Morbidity From Pediatric Intensive Care: A New Paradigm for Outcomes Assessment.

PubMed

Pollack, Murray M; Holubkov, Richard; Funai, Tomohiko; Berger, John T; Clark, Amy E; Meert, Kathleen; Berg, Robert A; Carcillo, Joseph; Wessel, David L; Moler, Frank; Dalton, Heidi; Newth, Christopher J L; Shanley, Thomas; Harrison, Rick E; Doctor, Allan; Jenkins, Tammara L; Tamburro, Robert; Dean, J Michael

2015-08-01

Assessments of care including quality assessments adjusted for physiological status should include the development of new morbidities as well as mortalities. We hypothesized that morbidity, like mortality, is associated with physiological dysfunction and could be predicted simultaneously with mortality. Prospective cohort study from December 4, 2011, to April 7, 2013. General and cardiac/cardiovascular PICUs at seven sites. Randomly selected PICU patients from their first PICU admission. None. Among 10,078 admissions, the unadjusted morbidity rates (measured with the Functional Status Scale and defined as an increase of ≥ 3 from preillness to hospital discharge) were 4.6% (site range, 2.6-7.7%) and unadjusted mortality rates were 2.7% (site range, 1.3-5.0%). Morbidity and mortality were significantly (p < 0.001) associated with physiological instability (measured with the Pediatric Risk of Mortality III score) in dichotomous (survival and death) and trichotomous (survival without new morbidity, survival with new morbidity, and death) models without covariate adjustments. Morbidity risk increased with increasing Pediatric Risk of Mortality III scores and then decreased at the highest Pediatric Risk of Mortality III values as potential morbidities became mortalities. The trichotomous model with covariate adjustments included age, admission source, diagnostic factors, baseline Functional Status Scale, and the Pediatric Risk of Mortality III score. The three-level goodness-of-fit test indicated satisfactory performance for the derivation and validation sets (p > 0.20). Predictive ability assessed with the volume under the surface was 0.50 ± 0.019 (derivation) and 0.50 ± 0.034 (validation) (vs chance performance = 0.17). Site-level standardized morbidity ratios were more variable than standardized mortality ratios. New morbidities were associated with physiological status and can be modeled simultaneously with mortality. Trichotomous outcome models including both morbidity and mortality based on physiological status are suitable for research studies and quality and other outcome assessments. This approach may be applicable to other assessments presently based only on mortality.

Severe Maternal Morbidity Among Hispanic Women in New York City: Investigation of Health Disparities.

PubMed

Howell, Elizabeth A; Egorova, Natalia N; Janevic, Teresa; Balbierz, Amy; Zeitlin, Jennifer; Hebert, Paul L

2017-02-01

To investigate differences in severe maternal morbidity between Hispanic mothers and three major Hispanic subgroups compared with non-Hispanic white mothers and the extent to which differences in delivery hospitals may contribute to excess morbidity among Hispanic mothers. We conducted a population-based cross-sectional study using linked 2011-2013 New York City discharge and birth certificate data sets (n=353,773). Rates of severe maternal morbidity were calculated using a published algorithm based on diagnosis and procedure codes. Mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-standardized severe maternal morbidity rates for each hospital taking into consideration patient sociodemographic characteristics and comorbidities. Differences in the distribution of Hispanic and non-Hispanic white deliveries were assessed among these hospitals in relation to their risk-adjusted morbidity. Sensitivity analyses were conducted after excluding isolated blood transfusion from the morbidity composite. Severe maternal morbidity occurred in 4,541 deliveries and was higher among Hispanic than non-Hispanic white women (2.7% compared with 1.5%, P<.001); this rate was 2.9% among those who were Puerto Rican, 2.7% among those who were foreign-born Dominican, and 3.3% among those who were foreign-born Mexican. After adjustment for patient characteristics, the risk remained elevated for Hispanic women (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.22-1.66) and for all three subgroups compared with non-Hispanic white women (P<.001). Risk for Hispanic women was attenuated in sensitivity analyses (OR 1.17, 95% CI 1.02-1.33). Risk-standardized morbidity across hospitals varied sixfold. We estimate that Hispanic-non-Hispanic white differences in delivery location may contribute up to 37% of the ethnic disparity in severe maternal morbidity rates in New York City hospitals. Hispanic compared with non-Hispanic white mothers are more likely to deliver at hospitals with higher risk-adjusted severe maternal morbidity rates and these differences in site of delivery may contribute to excess morbidity among Hispanic mothers. Our results suggest improving quality at the lowest performing hospitals could benefit both non-Hispanic white and Hispanic women and reduce ethnic disparities in severe maternal morbidity rates.

Estimating the Hospital Delivery Costs Associated With Severe Maternal Morbidity in New York City, 2008-2012.

PubMed

Howland, Renata E; Angley, Meghan; Won, Sang Hee; Wilcox, Wendy; Searing, Hannah; Tsao, Tsu-Yu

2018-02-01

To quantify the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries over a 5-year period in New York City adjusting for other sociodemographic and clinical factors. We conducted a population-based cross-sectional study using linked birth certificates and hospital discharge data for New York City deliveries from 2008 to 2012. Severe maternal morbidity was defined using a published algorithm of International Classification of Diseases, 9 Revision, Clinical Modification disease and procedure codes. Hospital costs were estimated by converting hospital charges using factors specific to each year and hospital and to each diagnosis. These estimates approximate what it costs the hospital to provide services (excluding professional fees) and were used in all subsequent analyses. To estimate adjusted mean costs associated with severe maternal morbidity, we used multivariable regression models with a log link, gamma distribution, robust standard errors, and hospital fixed effects, controlling for age, race and ethnicity, neighborhood poverty, primary payer, number of deliveries, method of delivery, comorbidities, and year. We used the adjusted mean cost to determine the average and total hospital delivery costs associated with severe maternal morbidity in excess of nonsevere maternal morbidity deliveries from 2008 to 2012. Approximately 2.3% (n=13,502) of all New York City delivery hospitalizations were complicated by severe maternal morbidity. Compared with nonsevere maternal morbidity deliveries, these hospitalizations were clinically complicated, required more and intensive clinical services, and had a longer stay in the hospital. The average cost of delivery with severe maternal morbidity was $14,442 (95% CI $14,128-14,756), compared with $7,289 (95% CI $7,276-7,302) among deliveries without severe maternal morbidity. After adjusting for other factors, the difference between deliveries with and without severe maternal morbidity remained high ($6,126). Over 5 years, this difference resulted in approximately $83 million in total excess costs (13,502×$6,126). Severe maternal morbidity nearly doubled the cost of delivery above and beyond other drivers of cost, resulting in tens of millions of excess dollars spent in the health care system in New York City. These findings can be used to demonstrate the burden of severe maternal morbidity and evaluate the cost-effectiveness of interventions to improve maternal health.

Site of delivery contribution to black-white severe maternal morbidity disparity.

PubMed

Howell, Elizabeth A; Egorova, Natalia N; Balbierz, Amy; Zeitlin, Jennifer; Hebert, Paul L

2016-08-01

The black-white maternal mortality disparity is the largest disparity among all conventional population perinatal health measures, and the mortality gap between black and white women in New York City has nearly doubled in recent years. For every maternal death, 100 women experience severe maternal morbidity, a life-threatening diagnosis, or undergo a life-saving procedure during their delivery hospitalization. Like maternal mortality, severe maternal morbidity is more common among black than white women. A significant portion of maternal morbidity and mortality is preventable, making quality of care in hospitals a critical lever for improving outcomes. Hospital variation in risk-adjusted severe maternal morbidity rates exists. The extent to which variation in hospital performance on severe maternal morbidity rates contributes to black-white disparities in New York City hospitals has not been studied. We examined the extent to which black-white differences in severe maternal morbidity rates in New York City hospitals can be explained by differences in the hospitals in which black and white women deliver. We conducted a population-based study using linked 2011-2013 New York City discharge and birth certificate datasets (n = 353,773 deliveries) to examine black-white differences in severe maternal morbidity rates in New York City hospitals. A mixed-effects logistic regression with a random hospital-specific intercept was used to generate risk-standardized severe maternal morbidity rates for each hospital (n = 40). We then assessed differences in the distributions of black and white deliveries among these hospitals. Severe maternal morbidity occurred in 8882 deliveries (2.5%) and was higher among black than white women (4.2% vs 1.5%, P < .001). After adjustment for patient characteristics and comorbidities, the risk remained elevated for black women (odds ratio, 2.02; 95% confidence interval, 1.89-2.17). Risk-standardized severe maternal morbidity rates among New York City hospitals ranged from 0.8 to 5.7 per 100 deliveries. White deliveries were more likely to be delivered in low-morbidity hospitals: 65% of white vs 23% of black deliveries occurred in hospitals in the lowest tertile for morbidity. We estimated that black-white differences in delivery location may contribute as much as 47.7% of the racial disparity in severe maternal morbidity rates in New York City. Black mothers are more likely to deliver at higher risk-standardized severe maternal morbidity hospitals than are white mothers, contributing to black-white disparities. More research is needed to understand the attributes of high-performing hospitals and to share best practices among hospitals. Copyright © 2016 Elsevier Inc. All rights reserved.

Risk in pediatric anesthesia.

PubMed

Paterson, Neil; Waterhouse, Peter

2011-08-01

Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co-morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk. © 2010 Blackwell Publishing Ltd.

Psychiatric morbidity and non-participation in breast cancer screening.

PubMed

Jensen, Line Flytkjær; Pedersen, Anette Fischer; Bech, Bodil Hammer; Andersen, Berit; Vedsted, Peter

2016-02-01

Organised breast cancer screening is currently one of the best strategies for early-stage breast cancer detection. However, early detection has proven challenging for women with psychiatric disease. This study aims to investigate psychiatric morbidity and non-participation in breast cancer screening. We conducted an observational cohort study including women invited to the first organised screening round in the Central Denmark Region. Data on psychiatric diagnosis, psychoactive prescription medicine and consultation with private psychiatrists were obtained from Danish registries and assessed for a period of up to 10 years before the screening date. The cohort comprised 144,264 women whereof 33.0% were registered with an indication of psychiatric morbidity. We found elevated non-participation propensity among women with a psychiatric diagnosis especially for women with schizophrenia and substance abuse. Also milder psychiatric morbidity was associated with higher non-participation likelihood as women who had redeemed psychoactive prescription medicine or have had minimum one consultation with a private psychiatrist were more likely not to participate. Finally, we found that the chronicity of psychiatric morbidity was associated with non-participation and that woman who had a psychiatric morbidity defined as 'persistent' had higher likelihood of non-participation than women with recently active morbidity or inactive psychiatric morbidity. This study showed a strong association between psychiatric morbidity and an increased likelihood of non-participation in breast cancer screening in a health care system with universal and tax-funded health services. This knowledge may inform interventions targeting women with psychiatric morbidity as they have poorer breast cancer prognosis. Copyright © 2015 Elsevier Ltd. All rights reserved.

Psychiatric morbidity and subsequent divorce: a couple-level register-based study in Finland.

PubMed

Metsä-Simola, Niina; Martikainen, Pekka; Monden, Christiaan W

2018-05-02

Studies that assess the role of mental health for the risk of divorce are scarce and mostly rely on individual-level data, although divorce is a couple-level phenomenon. Using data on couples, we examine the effects of both spouses' psychiatric morbidity on the risk of divorce, and whether socio-demographic factors affect these associations. We followed 96,222 Finnish married couples for 6 years using register-based data on both spouses and their household. New incidence of psychiatric morbidity and subsequent divorce was identified from dates of prescription medication purchases and hospital admissions, and dates of registered divorce. Socio-demographic factors were measured annually for both spouses and their household. The effect of incident psychiatric morbidity on divorce risk was analyzed using Cox regression. Psychiatric morbidity in men increased the age-adjusted risk of divorce more than twofold and in women nearly twofold. The risk of divorce was particularly pronounced immediately after new incidence of psychiatric morbidity, before settling to a persistently high level. Psychiatric morbidity in both spouses increased the risk of divorce almost threefold. Adjustment for socio-economic factors had little effect on these associations. Psychiatric morbidity is a persistent risk factor of divorce. The risk is larger when both spouses experience psychiatric morbidity compared to only one spouse. The findings are consistent with the idea that poor relationship quality and dissatisfaction in couples suffering from mental health problems have long-term consequences for marital stability. Treatment of psychiatric morbidity should not focus only on the individual but on couple-level dynamics.

Morbidities, concordance, and predictors of preterm premature rupture of membranes among pregnant women at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria.

PubMed

Okeke, T C; Enwereji, J O; Adiri, C O; Onwuka, C I; Iferikigwe, E S

2016-01-01

Preterm premature rupture of membranes (PPROM) is a challenging complication of pregnancies and an important cause of perinatal morbidity and mortality. Management of morbidities associated with PPROM is fraught with controversy. However, women should be informed of these complications. This article aimed to review the morbidities, concordance, and predictors of PPROM over a 10-year period. This was a retrospective review of morbidities, concordance, and predictors of PPROM among pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria between January 1, 1999, and December 31, 2008. The morbidities, concordance, and predictors of PPROM were expressed by regression analysis output for PPROM. Primigravidae had the highest occurrence of PPROM. Increasing parity does not significantly influence the incidence of PPROM. The concordance and predictors of PPROM are maternal age (P < 0.000), gestational age at PROM (P < 0.000), latency period (P < 0.000), and birth weight (P < 0.001). PPROM is a major complication of pregnancies and an important cause of perinatal morbidity and mortality. Management of these morbidities associated with PPROM poses a great challenge. However, women should be informed of these complications.

[Epidemiological pattern of scarlet fever in recent years].

PubMed

Briko, N I; Filatov, N N; Zhuravlev, M V; Lytkina, I N; Ezhlova, E B; Brazhnikov, A Iu; Tsapkova, N N; Malyshev, N A

2003-01-01

During the period of 1953-2001 scarlet fever morbidity level fluctuated from 670.3 to 65.9 per 100,000 of the population in Moscow and from 531.9 to 35.0 per 100,000 of the population of the Russian Federation. In recent years an increased morbidity was more pronounced in Moscow than in the Russian Federation as a whole. Children formed the greater part of scarlet fever patients, the cases of scarlet fever among children in Moscow occurring more often than, on the average, in Russia. As before, annual morbidity among children attending children's institutions was higher 3- to 4-fold than among children brought up at home. This difference was most sharply pronounced among young children during the first two years of their life. In contrast to morbidity observed during previous 20-30 years, a drop in morbidity among children during the first two years of their life was registered, while morbidity level among children aged 3-6 years and 7-14 years increased. Scarlet fever morbidity had a pronounced seasonal (autumn-winter) pattern. In a group of children aged 3-5 years who attended organized groups, on the average, 78.6% of scarlet fever cases fell on seasonal morbidity, the most prolonged one.

Declining morbidity and mortality of carotid endarterectomy. The Wake Forest University Medical Center experience.

PubMed

Till, J S; Toole, J F; Howard, V J; Ford, C S; Williams, D

1987-01-01

The 30-day mortality as well as morbidity for stroke and myocardial infarction were determined by review of the charts for every carotid endarterectomy (N = 389 operations on 356 patients) performed at Wake Forest University Medical Center from 1979 through 1983 to ascertain whether the 16% morbidity and 6% mortality documented in our previous report of 1978 had changed over time. For endarterectomies performed on asymptomatic patients (n = 155), major morbidity included 2 myocardial infarctions and 1 stroke (1.9%). There were 3 fatalities--2 myocardial infarctions and 1 stroke (1.9%). For the symptomatic group (n = 234), major morbidity was 2.1%, mortality 2.6%. The combined morbidity for asymptomatic and symptomatic carotid stenosis was 2%, mortality 2.3%. Perioperative stroke rate (morbidity plus mortality) was 2.6%, 9 ipsilateral to the carotid endarterectomy, suggesting distal embolism as its probable cause. We contend that quality control measures implemented to correct the unacceptable rates reported in 1978 have contributed to dramatic and sustained reductions in complication rates.

Perioperative and acute care outcomes in morbidly obese patients with acetabular fractures at a Level 1 trauma center

PubMed Central

Vincent, Heather K.; Haupt, Edward; Tang, Sonya; Egwuatu, Adaeze; Vlasak, Richard; Horodyski, MaryBeth; Carden, Donna; Sadisivan, Kalia K.

2014-01-01

Background Controversy exists regarding obesity-related injury severity and clinical outcomes after orthopedic trauma. Purpose The purposes of this study were to expand our understanding of the effect of morbid obesity on perioperative and acute care outcomes after acetabular fracture. Methods This was a retrospective review of patients with acetabular fracture after trauma. Non-morbidly obese (BMI < 35 kg/m2) and morbidly obese (BMI ≥ 35 kg/m2; N = 81). Injury severity scores and Glasgow Coma Scale scores (GCS) were collected. Perioperative and acute care outcomes were positioning and operative time, extra fractures, estimated blood loss, complications, hospital charges, ventilator days, transfusions, length of stay (LOS) and discharge destination. Positioning and operative times were longer in morbidly obese patients (p < 0.05). No other differences existed between groups. Conclusions Orthopedic trauma surgeons and care teams can expect similar acute care outcomes in morbidly obese and non-morbidly obese patients with acetabular fracture. PMID:25104886

Evaluation of acute and late radiation morbidity in patients with gynaecologic malignancy using the RTOG criteria and Franco-Italian glossary.

PubMed

Yildirim, G; Ozsaran, Z; Yalman, D; Kamer, S; Aras, A

2008-01-01

The purpose of this study was to evaluate acute and late radiation morbidity in patients with gynaecologic malignancy using the RTOG criteria and Franco-Italian glossary, and to compare the usefulness and disadvantages of each system. Between February 2001 and February 2003, 107 patients with gynaecologic malignancy who received either radical or djuvant external radiotherapy +/- intracavitary brachytherapy or radiochemotherapy were enrolled in this study. The patients were evaluated before radiotherapy and weekly during radiotherapy for acute morbidity using the RTOG grading system and Franco-Italian glossary. Postradiotherapy evaluation was done one month after radiotherapy and at 3-month intervals thereafter. Median follow-up duration was 17 months. Morbidity was graded and recorded according to each scoring system. Median age was 46 years (range 37-82). Sixty-four patients (59.8%) had endometrial cancer. Radical radiotherapy was applied to 26 patients because of inoperability and 81 patients received postoperative radiotherapy. Biologically effective doses for the bladder, rectum and vagina were 98.39, 103.54 and 121.81, respectively, for late morbidity (BED3); 70.88, 72.84 and 80.92, respectively, for acute morbidity (BED10). According to the RTOG grading system acute morbidity rate for the genitourinary and gastrointestinal systems, and skin were 52.3%, 83.2% and 63.5%, respectively. Late morbidity rate for the bladder, colon-rectum, skin and vagina were 16.8%, 20.6%, 47.7% and 51.4%, respectively. The morbidity rate for the bladder, nonspecific abdominal, hematopoietic system, uterus-vulva-vagina, skin and rectum were 35.4%, 29.9%, 5.6%, 60.8%, 40.1% and 32.7%, respectively using the Franco-Italian glossary. In patients with carcinoma of the vulva--whose treatment fields were wider--acute morbidity rate according to RTOG criteria was higher (p = 0.057); photon energy (6 Mv rather than 1.25 MV) (p = 0.01) and treatment interruption of more than eight days (p = 0.019) were correlated with decreased long-term morbidity. According to the Franco-Italian glossary morbidity rates were higher in patients who received chemotherapy (p = 0.047), both external radiotherapy and brachytherapy (p = 0.022) and treatment interruption of less than eight days (p = 0.019). There is no common language between the RTOG grading system and Franco-Italian glossary for defining and scoring radiation morbidity. Up to date no standard and well-defined system has been developed for recording and reporting acute and late radiation morbidity in gynaecologic malignancy, but rather it depends on the subjective evaluation and experience of a radiation oncologist and subjective complaints of the patient, and sometimes on clinical findings. A standard and well-defined user friendly objective scoring system is needed to define and predict the morbidity rate more properly.

The Perspectives of Patients on Health-Care for Co-Morbid Diabetes and Chronic Kidney Disease: A Qualitative Study

PubMed Central

Lo, Clement; Ilic, Dragan; Teede, Helena; Cass, Alan; Fulcher, Greg; Gallagher, Martin; Johnson, Greg; Kerr, Peter G.; Mathew, Tim; Murphy, Kerry; Polkinghorne, Kevan; Walker, Rowan; Zoungas, Sophia

2016-01-01

Background Multi-morbidity due to diabetes and chronic kidney disease (CKD) remains challenging for current health-systems, which focus on single diseases. As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid diabetes and CKD. Methods In this qualitative study participants with co-morbid diabetes and CKD were purposively recruited using maximal variation sampling from 4 major tertiary health-services from 2 of Australia’s largest cities. Separate focus groups were conducted for patients with CKD stages 3, 4 and 5. Findings were triangulated with semi-structured interviews of carers of patients. Discussions were transcribed verbatim and thematically analysed. Results Twelve focus groups with 58 participants and 8 semi-structured interviews of carers were conducted. Factors influencing health-care of co-morbid diabetes and CKD grouped into patient and health service level factors. Key patient level factors identified were patient self-management, socio-economic situation, and adverse experiences related to co-morbid diabetes and CKD and its treatment. Key health service level factors were prevention and awareness of co-morbid diabetes and CKD, poor continuity and coordination of care, patient and carer empowerment, access and poor recognition of psychological co-morbidity. Health-service level factors varied according to CKD stage with poor continuity and coordination of care and patient and carer empowerment emphasized by participants with CKD stage 4 and 5, and access and poor recognition of psychological co-morbidity emphasised by participants with CKD stage 5 and carers. Conclusions According to patients and their carers the health-care of co-morbid diabetes and CKD may be improved via a preventive, patient-centred health-care model which promotes self-management and that has good access, continuity and coordination of care and identifies and manages psychological morbidity. PMID:26730708

Does the presence of placental basal plate myometrial fibres increase the risk of subsequent morbidly adherent placenta: a case-control study.

PubMed

Miller, E S; Linn, R L; Ernst, L M

2016-12-01

Antenatal diagnosis of morbidly adherent placenta has been shown to improve outcomes, but existing predictors lack sensitivity. Our objective was to determine whether the presence of myometrial fibres attached to the placental basal plate (BPMYO) in an antecedent pregnancy is associated with subsequent morbidly adherent placenta. A case-control study. Departments of Obstetrics and Gynecology and Pathology, Northwestern University, Chicago, IL, USA. Women who had at least two pregnancies with placental pathological evaluation. Cases were defined as women with evidence of morbidly adherent placenta (both clinically and pathologically) in their most recent pregnancy whereas women without evidence of morbidly adherent placenta served as controls. Pathological specimens of placentas from previous pregnancies were evaluated for BPMYO. The presence of BPMYO on a previous placenta was evaluated to determine whether it could be used to improve the antenatal diagnosis of morbidly adherent placenta. Of the 25 cases of morbidly adherent placenta, 19 (76%) had BPMYO present on their previous placenta compared with 41 (41%) of controls (odds ratio 4.8, 95% CI 1.8-13.0). Adding BPMYO to a regression including other risk factors for morbidly adherent placenta (i.e. maternal age, number of previous caesarean sections, placenta praevia, previous multiple gestation, any previous curettage, and ultrasonographic suspicion of placenta accreta) significantly improved the sensitivity of antenatal diagnosis of morbidly adherent placenta (61% versus 39%, P < 0.001) without a change in specificity (97% versus 97%, P = 1.00). BPMYO on previous placental pathology is associated with an increased risk of morbidly adherent placenta in a subsequent pregnancy. These findings may shed light on the pathophysiology of accreta and inform future research on predictors of accreta. Previous basal plate myometrium improves the ability to detect subsequent morbidly adherent placenta. © 2015 Royal College of Obstetricians and Gynaecologists.

[Analysis of musculoskeletal disorders, work load and working postures among manufacturing workers].

PubMed

Yu, Shan-fa; Gu, Gui-zhen; Sun, Shi-yi; Wang, Hai-sheng; Cui, Shou-ming; Yang, Xiao-fa; Yang, Shu-le; He, Li-hua; Wang, Sheng

2011-03-01

To analyze the distribution of the musculoskeletal disorders, work load and working postures in different factories, gender, education levels, age and working years among manufacturing workers. In a cross-sectional study of 5134 manufacturing workers in 12 factories, the morbidities for musculoskeletal disorders in one year period were measured with questionnaires. The morbidities for musculoskeletal disorders in body sites: waist, neck, shoulder, wrist, ankle/feet, knee, hip/buttocks and elbows were 59.7%, 47.9%, 38.1%, 33.7%, 26.9%, 25.4%, 15.2%, and 14.9%, respectively in one year period. There were significant differences of morbidities for musculoskeletal symptoms in body sites of workers among different factories (P < 0.05 or P < 0.01). The morbidities of musculoskeletal symptoms in elbows, waist, wrists and ankle/feet of the workers in refractory material and chemical fiber factories were higher than those in other factories, the morbidities for musculoskeletal symptoms of workers in garments and diamond factories were lower than those in other factories. The morbidities for musculoskeletal symptoms in neck, shoulders and wrists of female workers were significantly higher than those of male workers (P < 0.01). There were significant differences of the morbidities for musculoskeletal symptoms in body sites among workers with different educational levels (P < 0.05 or P < 0.01). There were significant differences of the morbidities for musculoskeletal symptoms in neck, shoulders, wrists, hip/buttocks and knee among groups with different age or different working years (P < 0.01), and the morbidities for musculoskeletal symptoms increased with age and working years. The proportions of unhealthy working postures and high working load among workers in refractory material and chemical fiber factories were higher; but those in garments and diamond factories were lower. The morbidities for musculoskeletal symptoms in waist, neck, shoulder and wrists of workers in manufacturing workers were higher; the gender, education level, age and working years could influenced the morbidities for musculoskeletal disorders.

Neonatal Outcomes of Low-Risk, Late-Preterm Twins Compared With Late-Preterm Singletons.

PubMed

Salem, Shimrit Yaniv; Kibel, Mia; Asztalos, Elizabeth; Zaltz, Arthur; Barrett, Jon; Melamed, Nir

2017-09-01

To test the hypothesis that the risk of neonatal morbidity among late-preterm twins is similar to that of late-preterm singletons. We conducted a retrospective cohort study of all women with twin or singleton pregnancy who gave birth during the late-preterm period in a single tertiary center between 2008 and 2015. Neonatal outcomes of low-risk, late-preterm twins were compared with those of low-risk, late-preterm singletons. The primary outcome was the same primary composite respiratory morbidity variable that was used in the randomized controlled trial of Gyamfi-Bannerman et al on the administration of antenatal corticosteroids during the late-preterm period. A total of 922 singleton and 721 twin late-preterm neonates met the inclusion criteria. The rates of composite respiratory morbidity and severe composite respiratory morbidity were similar for twins and singletons (8.3% compared with 7.4%, P=.5 and 6.8% compared with 6.0%, P=.5, respectively), but were lower than the rates of the same composite respiratory morbidity variable in the randomized controlled study described previously. The odds for respiratory morbidity were similar for twins and singletons for both composite respiratory morbidity (adjusted odds ratio [OR] 0.73, 95% CI 0.48-1.12) and severe composite respiratory morbidity (adjusted OR 0.79, 95% CI 0.50-1.24). The risk of respiratory morbidity among late-preterm twins is similar to that of late-preterm singletons. Still, the low absolute rates of the composite respiratory morbidity in our population suggest that administration of antenatal corticosteroids may be mostly justified among neonates born closer to 34 weeks of gestation.

A glance into the hidden burden of maternal morbidity and patterns of management in a Palestinian governmental referral hospital.

PubMed

Hassan, Sahar J; Wick, Laura; DeJong, Jocelyn

2015-12-01

Little is known about the burden and patterns of maternal morbidity during childbirth, particularly in the Middle East Region. Investigating the patterns of maternal morbidity can be useful in guiding improvement in the quality of maternal services, and informing policy debates on women's health. To examine the incidence, types and patterns of management of severe and non-severe maternal morbidities of Palestinian women during pregnancy, labour, delivery and up to seven days postpartum in one Palestinian hospital. A prospective hospital-based study was conducted for a 3-month period in 2011-2012, reviewing hospital records for all pregnant women (1.583) admitted to the governmental hospital in Ramallah, Palestine. Of all pregnant women included in this analysis (1.558), 419 (26.9%) women experienced one or more maternal morbidities and 15 (0.96%) women survived a life-threatening complication (near miss). Of all women who suffered morbidities, 69 (16.5%) had vaginal deliveries, 61 (14.6%) had cesarean sections, 179 (42.7%) had abortions/miscarriage, and 110 (26.3%) experienced complications during pregnancy or the post-partum. Hemorrhage during pregnancy, birth or postpartum was the most common morbidity. Of those who gave birth, women who gave birth by cesarean sections were three times more likely to suffer from morbidities than those who had vaginal delivery. The burden of maternal morbidity for Palestinian women between the ages of 16 and 48 is high. In Palestine, maternal morbidity can be prevented by promoting a rational use of cesarean section, avoiding unnecessary medicalization, reducing unwanted pregnancies and updating practices of providers related to abortion/miscarriage care. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Psoriasis and psychiatric morbidity: a profile from a tertiary care centre of eastern India.

PubMed

Sarkar, Somenath; Sarkar, Arnab; Saha, Revanta; Sarkar, Tanusree

2014-01-01

Psoriasis has an impact on psychology of the patients. There is a dearth of studies regarding this field in eastern India. The primary objective of this study is to evaluate the psychiatric morbidity in psoriasis and secondary objective is to assess the morbidity in all eight dimensions of psychosocial and physical aspects, i.e. cognitive, social, discomfort, limitations, depression, fear, embarrassment and anger. Institutional based case control study. Forty-eight patients of psoriasis and equal number of healthy controls were included in the study. Self-reporting questionnaire-24 (SRQ-24) and skindex (A 61-item survey questionnaire) were used to assess the psychiatric morbidity in both groups. "MedCalc version 10.2.0.0" (by Acacialaan 22, B-8400, Ostend, Belgium) was used as statistical software. Chi-square test was used as a test of significance. The SRQ assessed psychiatric morbidity in the study group was 62.5%, compared with 18.5% in the control group. This difference was statistically significant (P < 0.001). Guttate psoriasis had maximum association with psychiatric morbidity (100%), followed by plaque type (63.6%) and palmoplantar type (42.8%). According to the skindex, the most common psychiatric morbidity in psoriasis patients was anger (58.3%), followed by discomfort (52.08%), social problem (52.08%), cognitive impairment (50%), embarrassment (50%), physical limitation (47.91%), fear (47.91%) and depression (43.75%). The skindex observed psychiatric morbidity among the case and control group was statistically significant for all the parameters (P < 0.0001). Psoriasis has a high degree of psychiatric morbidity and the extent of this co-morbidity is even greater than hitherto thought of.

Morbidities and hospital resource use during the first 3 years of life among very preterm infants.

PubMed

Korvenranta, Emmi; Lehtonen, Liisa; Peltola, Mikko; Häkkinen, Unto; Andersson, Sture; Gissler, Mika; Hallman, Mikko; Leipälä, Jaana; Rautava, Liisi; Tammela, Outi; Linna, Miika

2009-07-01

The objective of this study was to determine how the use of hospital resources during the first 3 years of life was associated with prematurity-related morbidity in very preterm infants (gestational age of <32 weeks or birth weight of <1501 g). The study was a retrospective, national register study including all very preterm infants born alive in Finland between 2000 and 2003 (N = 2148). Infants who died before the age of 3 years (n = 264) or who had missing register data (n = 88) were excluded from the study. The relationship between 6 morbidity groups and the need for hospital care during the first 3 years of life was studied by using a negative binomial model. A total of 66.2% of the infants did not have any of the morbidities studied. Infants who were subsequently diagnosed as having cerebral palsy (6.1% of the study group), later obstructive airway disease (20.0%), hearing loss (2.5%), visual disturbances or blindness (3.8%), or other ophthalmologic problems (13.4%) had initial hospital stays that were a mean of 7, 8, 12, 17, and 3 days longer, respectively, than those for infants without these conditions. All morbidity groups were associated with increased numbers of hospital visits during either the second or third year of life, compared with infants without these morbidities. The need for hospitalizations and outpatient hospital care decreased with postnatal age for infants with later morbidities and for infants without later morbidities. Most very preterm infants born in Finland survived without severe morbidities and required relatively little hospital care after the initial discharge. However, those with later morbidities had a long initial length of stay and more readmissions and outpatient visits during the 3-year follow-up period.

Measuring reproductive health: review of community-based approaches to assessing morbidity.

PubMed Central

Sadana, R.

2000-01-01

This article begins by reviewing selected past approaches to estimating the prevalence of a range of morbidities through the use of household or community-based interview surveys in developed and developing countries. Subsequently, it reviews epidemiological studies that have used a range of methods to estimate the prevalence of reproductive morbidities. A detailed review of recent community or hospital based health interview validation studies that compare self-reported, clinical and laboratory measures is presented. Studies from Bangladesh, Bolivia, China, Egypt, India, Indonesia, Nigeria, Philippines and Turkey provide empirical evidence that self-reported morbidity and observed morbidity measure different phenomena and therefore different aspects of reproductive health and illness. Rather than estimating the prevalence of morbidity, interview-based surveys may provide useful information about the disability or burden associated with reproductive health and illness. PMID:10859858

Race/ethnicity, socioeconomic status, and lifetime morbidity burden in the women's health initiative: a cross-sectional analysis.

PubMed

Gold, Rachel; Michael, Yvonne L; Whitlock, Evelyn P; Hubbell, F Allan; Mason, Ellen D; Rodriguez, Beatriz L; Safford, Monika M; Sarto, Gloria E

2006-12-01

We sought to assess the extent to which race/ethnicity and socioeconomic status (SES) are independently and jointly related to lifetime morbidity burden by comparing the impact of SES on lifetime morbidity among women of different racial/ethnic groups: white, black, Hispanic, American Indian/Alaska Native (AIAN), and Asian/Pacific Islander (API). Using baseline data from the Women's Health Initiative (WHI), a national study of 162,000 postmenopausal women, we measured lifetime morbidity burden using a modified version of the Charlson Index, and measured SES with educational attainment and household income. In multivariable simple polytomous logistic regression models, we first assessed the effect of SES on lifetime morbidity burden among women of each racial/ethnic group, then assessed the combined effect of race/ethnicity and SES. Five percent of all women in the study population had high lifetime morbidity burden. Women with high lifetime morbidity were more likely to be AIAN or black; poor; less educated; divorced, separated, or widowed; past or current smokers; obese; uninsured or publicly insured. Lower SES was associated with higher morbidity among most women. The extent to which morbidity was higher among lower SES compared to higher SES women was about the same among Hispanic women and white women, but was substantially greater among black and AIAN women compared with white women. This study demonstrates the importance of considering race/ethnicity and class together in relation to health outcomes.

Perioperative outcomes of pancreaticoduodenectomy: Nepalese experience.

PubMed

Lakhey, Paleswan Joshi; Bhandari, Ramesh Singh; Ghimire, Bikal; Khakurel, Mahesh

2010-08-01

Pancreaticodudenectomy (PD) is a high-risk, technically demanding operation associated with substantial perioperative morbidity and mortality. This review is intended to evaluate the perioperative outcomes of PD done in a single gastrointestinal surgery unit of a university teaching hospital. A retrospective review of medical records of patients who underwent PD from April 2005 through May 2009 was done. Perioperative morbidity was defined according to the standard of the International Study Group for Pancreatic Fistula (ISGPF). The patient demographics, type of surgery, and perioperative morbidity and mortality were evaluated. The factors associated with increased morbidity were analyzed. Twenty-four patients underwent PD, and there were no perioperative deaths. The overall morbidity was 58%, with a pancreatic fistula rate of 13%. None of the associated parameters, like increasing age, the presence of co-morbidity, preoperative biliary drainage, and duration of surgery, were found to increase the morbidity. These results of PD, though a small case series, are comparable to the international standard. Better outcomes can be achieved even in low- to medium-volume centers in developing countries where a dedicated team with special interest in pancreatic surgery is in place. Although there were no deaths after PD in our series, the morbidity was higher than that observed in other high-volume centers. To decrease the morbidity associated with PD, various factors must be streamlined, among them, the operative technique and the intensive perioperative management of the patient, as well as uniform definition of complications, use of a multidisciplinary approach, and identification of associated risk factors.

Co-morbid anxiety disorders in bipolar disorder and major depression: familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder.

PubMed

Goes, F S; McCusker, M G; Bienvenu, O J; Mackinnon, D F; Mondimore, F M; Schweizer, B; Depaulo, J R; Potash, J B

2012-07-01

Co-morbidity of mood and anxiety disorders is common and often associated with greater illness severity. This study investigates clinical correlates and familiality of four anxiety disorders in a large sample of bipolar disorder (BP) and major depressive disorder (MDD) pedigrees. The sample comprised 566 BP families with 1416 affected subjects and 675 MDD families with 1726 affected subjects. Clinical characteristics and familiality of panic disorder, social phobia, specific phobia and obsessive-compulsive disorder (OCD) were examined in BP and MDD pedigrees with multivariate modeling using generalized estimating equations. Co-morbidity between mood and anxiety disorders was associated with several markers of clinical severity, including earlier age of onset, greater number of depressive episodes and higher prevalence of attempted suicide, when compared with mood disorder without co-morbid anxiety. Familial aggregation was found with co-morbid panic and OCD in both BP and MDD pedigrees. Specific phobia showed familial aggregation in both MDD and BP families, although the findings in BP were just short of statistical significance after adjusting for other anxiety co-morbidities. We found no evidence for familiality of social phobia. Our findings suggest that co-morbidity of MDD and BP with specific anxiety disorders (OCD, panic disorder and specific phobia) is at least partly due to familial factors, which may be of relevance to both phenotypic and genetic studies of co-morbidity.

Co-morbid anxiety disorders in bipolar disorder and major depression : familial aggregation and clinical characteristics of co-morbid panic disorder, social phobia, specific phobia and obsessive-compulsive disorder

PubMed Central

Goes, F. S.; McCusker, M. G.; Bienvenu, O. J.; MacKinnon, D. F.; Mondimore, F. M.; Schweizer, B.; DePaulo, J. R.; Potash, J. B.

2013-01-01

Background Co-morbidity of mood and anxiety disorders is common and often associated with greater illness severity. This study investigates clinical correlates and familiality of four anxiety disorders in a large sample of bipolar disorder (BP) and major depressive disorder (MDD) pedigrees. Method The sample comprised 566 BP families with 1416 affected subjects and 675 MDD families with 1726 affected subjects. Clinical characteristics and familiality of panic disorder, social phobia, specific phobia and obsessivecompulsive disorder (OCD] were examined in BP and MDD pedigrees with multivariate modeling using generalized estimating equations. Results Co-morbidity between mood and anxiety disorders was associated with several markers of clinical severity, including earlier age of onset, greater number of depressive episodes and higher prevalence of attempted suicide, when compared with mood disorder without co-morbid anxiety. Familial aggregation was found with co-morbid panic and OCD in both BP and MDD pedigrees. Specific phobia showed familial aggregation in both MDD and BP families, although the findings in BP were just short of statistical significance after adjusting for other anxiety co-morbidities. We found no evidence for familiality of social phobia. Conclusions Our findings suggest that co-morbidity of MDD and BP with specific anxiety disorders [OCD, panic disorder and specific phobia] is at least partly due to familial factors, which may be of relevance to both phenotypic and genetic studies of co-morbidity. PMID:22099954

Association of Postpartum Maternal Morbidities with Children's Mental, Psychomotor and Language Development in Rural Bangladesh

PubMed Central

Tofail, F.; Hilaly, A.; Mehrin, F.; Shiraji, S.; Banu, S.; Huda, S.N.

2012-01-01

Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children's development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children's developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children's milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children's development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children's language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children's development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children's development. PMID:22838161

In vivo T cell depletion regulates resistance and morbidity in murine schistosomiasis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Phillips, S.M.; Linette, G.P.; Doughty, B.L.

1987-08-01

These studies assessed the roles of subpopulations of T lymphocytes in inducing and modulating resistance to schistosomiasis and thereby influencing subsequent morbidity. C57BL/6 mice were depleted in vivo of Lyt-1+, Lyt-2+, and L3T4+ cells by the daily administration of monoclonal antibodies. The development of protective immunity, induced by exposure to irradiated Schistosoma mansoni cercariae as expressed in depleted animals, was compared to that demonstrated in undepleted, normal, and congenitally athymic C57BL/6 mice. The development of morbidity was determined by spleen weight, portal pressure and reticuloendothelial system activity. The results indicated that depletion of specific subpopulations of T lymphocytes minimally affectedmore » the primary development of parasites; however, depletion strongly influenced the development of resistance to the parasite and subsequent morbidity due to infection. Depletion of T lymphocytes by anti-Lyt-1+ or anti-L3T4+ antibody decreased the development of resistance, antibody and delayed-type hypersensitivity directed against schistosome antigens. Morbidity due to disease was increased. Depletion of Lyt-2+ cells produced opposite changes with augmented resistance and reduced morbidity. Congenitally athymic mice developed minimal resistance and morbidity. Moreover, resistance was inversely related to the morbidity shown by a given animal. These studies indicate that the development of protective immunity to S. mansoni cercariae is regulated by discrete subpopulations of T lymphocytes. The feasibility of decreasing morbidity by increasing specific immunologically mediated resistance is suggested.« less

Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study.

PubMed

Molebatsi, Keneilwe; Ndetei, David M; Opondo, Phillip R

2017-09-01

To determine levels and correlates of caregiver burden among caregivers of children and adolescents with psychiatric morbidity. Over a period of four months, a total of 252 caregivers of children and adolescents with psychiatric morbidity were recruited. Data on socio-demographic factors, psychiatric morbidity among caregivers, and level of caregiver burden was collected using a researcher-designed socio-demographic questionnaire, Mini International Neuropsychiatric Interview, and Zarit burden interview, respectively. Data was analysed using statistical package for social sciences (SPSS) version 21. Females (n = 211, 83.7%) and mothers (n = 182, 72.2%) accounted for the majority of the study participants. The majority of caregivers reported moderate to severe caregiver burden; (n = 100, 39.7%). Being single or separated (B = -6.91, p = 0.001, β = -0.18) and presence of psychiatric morbidity (B = 7.44, p = 0.009, β = 0.22) in the caregiver significantly contributed to the high levels of caregiver burden. Caregivers of children and adolescents with psychiatric morbidity suffer high levels of caregiver burden. A multidisciplinary approach to management of children with psychiatric morbidity to address challenges faced by the caregivers may alleviate the burden; thereby improving clinical outcomes of children and adolescents with psychiatric morbidity.

Co-morbidities in severe asthma: Clinical impact and management.

PubMed

Porsbjerg, Celeste; Menzies-Gow, Andrew

2017-05-01

Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD), bronchiectasis, allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatous with polyangiitis (EGPA). Furthermore, the review offers a summary of recommended diagnostic and management approaches for each co-morbidity. Finally, the review links co-morbid conditions to specific phenotypes of severe asthma, in order to guide the clinician on which co-morbidities to look for in specific patients. © 2017 Asian Pacific Society of Respirology.

Risk Factors, Co-Morbid Conditions and Epidemiology of Autism in Children

DTIC Science & Technology

2015-10-01

Award Number: W81XWH-12-2-0066 TITLE: Risk Factors, Co-morbid Conditions, and Epidemiology of Autism in Children PRINCIPAL INVESTIGATOR: Major...FINAL 3. DATES COVERED (From - To) 30 Sep 2012- 29 Sep 2015 4. TITLE AND SUBTITLE Risk Factors, Co-morbid Conditions, and Epidemiology of Autism in...provide clinicians with data to better screen and manage ASD patients. 15. SUBJECT TERMS Autism , epidemiology, risk factors, co-morbidities 16

Burnout and psychiatric morbidity in new medical graduates.

PubMed

Willcock, Simon M; Daly, Michele G; Tennant, Christopher C; Allard, Benjamin J

2004-10-04

To determine the prevalence of psychiatric morbidity and burnout in final-year medical students, and changes in these measures during the intern year. Prospective longitudinal cohort study over 18 months, with assessment of psychiatric morbidity and burnout on six occasions. All 117 students in the first graduating cohort of the University of Sydney Graduate Medical Program were invited to participate in the study; 110 consented. Psychiatric morbidity assessed with the 28-item General Health Questionnaire and burnout assessed with the Maslach Burnout Inventory. The point prevalence of participants meeting criteria for psychiatric morbidity and burnout rose steadily throughout the study period. Internship remains a stressful time for medical graduates, despite initiatives to better support them during this period. The implications for the doctors themselves and for the communities they serve warrant further attention, including programs specifically aimed at reducing the rate of psychological morbidity and burnout during internship.

[Multiple chronic conditions and morbidity burden: challenges and considerations for an organizational strategy].

PubMed

Balicer, Ran; Bitterman, Haim; Shadmi, Efrat

2012-07-01

Technological advances combined with the aging of the population bring about an increasingly growing number of patients with chronic conditions and multi-morbidity. Multi-morbidity, the co-occurrence of chronic and/or non-chronic conditions in an individual, is the norm among elderly patients, and is becoming increasingly common among younger adults. The Israeli health system, like other systems worldwide, is faced with the challenges posed by the increase in complex multi-morbidity, in an era of growing fiscal constraints, a situation that can induce financial and organizational crises. To effectively cope with such circumstances, a paradigm shift is needed. Health systems need to focus on overall morbidity burden and multi-morbidity (rather than the prevailing one disease at a time approach) and on better care integration. The Israeli health system entails many of the essential elements for addressing the challenges of integrated care, including universal health coverage and advanced health information technology systems. Yet, like other health systems, there is a need for care management support mechanisms that are more effectively tailored to meet the needs of the highly multimorbid patients. This review outlines the organizational approach required to better align care for the main customers of health care in the 21st century: patients with multi-morbidity. We focus on four domains: assessment of morbidity burden according to measures that account for the interaction and synergism amongst conditions; integration across the care continuum; enhancement of primary care and self-management support approaches; and provision of uniquely tailored care management solutions for the highest risk multi-morbid patients.

Is fetal manipulation during shoulder dystocia management associated with severe maternal and neonatal morbidities?

PubMed

Gachon, Bertrand; Desseauve, David; Fritel, Xavier; Pierre, Fabrice

2016-09-01

There is a lack of data regarding maternal morbidity and neonatal hypoxia associated with shoulder dystocia (SD), particularly with respect to whether SD is managed with our without fetal manipulation (FM). Our main objective was to compare severe maternal and neonatal morbidities associated with SD according to FM execution. We conducted a retrospective study based on a medical record analysis that included all SD cases from 2007 to 2012. SD was considered when additional maneuvers were required to complete a delivery. Severe maternal morbidity was defined as the occurrence of an obstetric anal sphincter injury. Severe neonatal morbidity was defined as the occurrence of one of these complications: permanent brachial plexus palsy, arterial cord pH < 7.1, Apgar score < 7 at 5 min. We compared severe maternal and neonatal morbidities in the FM and the no-FM group. We report an SD incidence of 2.4 % (n = 227) with 93.8 % of patients treated without FM. We identified two cases of permanent brachial plexus palsy, fifteen cases of arterial cord pH < 7.1 and six cases with an Apgar score < 7 at 5 min; all of them were from the no-FM group. There were more cases of OASI in the FM group (odd ratio = 9.2 [1.32-50.71]). No statistical differences between these groups were observed with respect to severe neonatal morbidity. Severe neonatal morbidity does not appear to be associated with FM during SD management, but severe maternal morbidity is associated with FM execution.

Co-morbid substance use behaviors among youth: any impact of school environment?

PubMed

Costello, Mary Jean E; Leatherdale, Scott T; Ahmed, Rashid; Church, Dana L; Cunningham, John A

2012-03-01

Substance use is common among youth; however, our understanding of co-morbid tobacco, alcohol and marijuana use remains limited. The school-environment may play an important role in the likelihood a student engages in high risk substance use behaviors, including co-morbid use. This study aims to: (i) describe the prevalence of co-morbid substance use behaviors among youth; (ii) identify and compare the characteristics of youth who currently use a single substance, any two substances, and all three substances; (iii) examine if the likelihood of co-morbid use varies by school and; (iv) examine what factors are associated with co-morbid use. This study used nationally representative data collected from students in grades 9 to 12 (n = 41,886) as part of the 2006-2007 Canadian Youth Smoking Survey (YSS). Demographic and behavioral data were collected including, current cigarette, alcohol and marijuana use. Results. 6.5% (n = 107,000) reported current use of all three substances and 20.3% (n = 333,000) of any two substances. Multi-level analysis revealed significant between school variability in the odds a student used all three substances and any two substances; accounting for 16.9% and 13.5% of the variability, respectively. Co-morbid use was associated with sex, grade, amount of available spending money and perceived academic performance. Co-morbid substance use is high among youth; however, not all schools share the same prevalence. Knowing the school characteristics that place particular schools at risk for student substance use is important for tailoring drug and alcohol education programs. Interventions that target the prevention of co-morbid substance use are required.

Impact of co-morbidities on self-rated health in self-reported COPD: An analysis of NHANES 2001–2008

PubMed Central

Putcha, Nirupama; Puhan, Milo A.; Hansel, Nadia N.; Drummond, M. Brad; Boyd, Cynthia M.

2015-01-01

Chronic Obstructive Pulmonary Disease (COPD) coexists with co-morbidities. While co-morbidity has been associated with poorer health status, it is unclear which conditions have the greatest impact on self-rated health. We sought to determine which, and how much, specific co-morbid conditions impact on self-rated health in current and former smokers with self-reported COPD. Using the 2001–2008 National Health and Nutrition Examination Survey we characterized the association between thirteen co-morbidities and health status among individuals self-reporting COPD. Adjusted odds ratios (ORs) were generated using ordinal logistic regression. Additionally we evaluated the impact of increasing number of co-morbidities with self-rated health. Eight illnesses had significant associations with worse self-rated health, however after mutually adjusting for these conditions, congestive heart failure (OR 3.07, 95% CI 1.69–5.58), arthritis (OR 1.69, 95% CI 1.13–2.52), diabetes (OR 1.63, 95% CI 1.01–2.64), and incontinence/prostate disease (OR 1.63, 95% CI 1.01–2.62) remained independent predictors of self-rated health. Each increase in co-morbidities was associated with a 43% higher chance of worse self-rated health (95% CI 1.27–1.62). Individuals with COPD have a substantial burden of co-morbidity, which is associated with worse self-rated health. CHF, arthritis, diabetes and incontinence/prostate disease have the most impact on self-rated health. Targeting these co-morbidities in COPD may result in improved self-rated health. PMID:23713595

Maternal morbidity in Butajira and Wukro districts, North and South central Ethiopia.

PubMed

Mekonnen, Alemayehu; Mahmoud, Emebet; Fantahun, Mesganaw; Hagos, Seifu; Assegid, Meselech

2013-10-01

Worldwide, for every woman that dies of maternal causes, there are at least 20 more women who suffer from infection, disabilities and injuries relating to pregnancy and childbirth. To determine the magnitude and the role of socio-economic, demographic and reproductive factors on the occurrence of maternal morbidity in the study population. During the months of January to February 2012, a community based cross sectional survey was conducted to assess magnitude and factors affecting maternal morbidity in selected kebeles of Wukro and Butajira districts, Tigray and Southern Nation Nationalities and People's (SNNP) regions respectively, Ethiopia. A total of 4949 women who had deliveries in the two years preceding the survey were included. Following description of variables under the study, bivariate and Multivariable statistics were used to see the relationship between different factors and maternal morbidity. A total of 688 (14.2%) women reported that they had at least one form of morbidity. The three most frequent reported maternal morbidity during antenatal period were severe headache 89 (17.2%), lower abdominal pain (15.1%) and excessive vomiting (11.4%). Of the 220 women who reported to have morbidity during labor and delivery, prolonged labor (more than 24 hours) was accounted for 89 (40.5%) followed by hemorrhage and premature rapture of membranes in 74 (33.6%) and 23 (10.5%) of the cases respectively. Lower proportion of maternal morbidity was reported in Wukro than Butajira district [AOR (95% CI) = 0.17 (0.12, 0.25)]. Poorest and poor women were more likely to report to be sick [AOR (95% CI) = 1.79 (1.10, 2.91)] and [AOR (95% CI) = 1.65 (1.10, 2.47)] respectively. Women with parity of 5-6 and > or = 7 children respectively were also more likely to be morbid [AOR (95% CI) = 1.52 (1.11, 2.09)] and [AOR (95% CI) = 2.01 (1.38, 2.91)]. Women who had facility delivery were found more likely to have reported maternal morbidity with [AOR (95% CI) = 3.73 (2.96, 4.71)] High parity, wealth status and facility delivery were found to be independent predictors of maternal morbidity. Empowering women through improving their resource generation capacity, and access to family planning services to those with high parity would diminish the likelihood of having maternal morbidity.

Major liver resection for hepatocellular carcinoma in the morbidly obese: A proposed strategy to improve outcome

PubMed Central

Barakat, Omar; Skolkin, Mark D; Toombs, Barry D; Fischer, John H; Ozaki, Claire F; Wood, R Patrick

2008-01-01

Background Morbid obesity strongly predicts morbidity and mortality in surgical patients. However, obesity's impact on outcome after major liver resection is unknown. Case presentation We describe the management of a large hepatocellular carcinoma in a morbidly obese patient (body mass index >50 kg/m2). Additionally, we propose a strategy for reducing postoperative complications and improving outcome after major liver resection. Conclusion To our knowledge, this is the first report of major liver resection in a morbidly obese patient with hepatocellular carcinoma. The approach we used could make this operation nearly as safe in obese patients as it is in their normal-weight counterparts. PMID:18783621

Complexities and Perplexities: A Critical Appraisal of the Evidence for Soil-Transmitted Helminth Infection-Related Morbidity

PubMed Central

Nery, Susana V.; Doi, Suhail A.; Gray, Darren J.; Soares Magalhães, Ricardo J.; McCarthy, James S.; Traub, Rebecca J.; Andrews, Ross M.; Clements, Archie C. A.

2016-01-01

Background: Soil-transmitted helminths (STH) have acute and chronic manifestations, and can result in lifetime morbidity. Disease burden is difficult to quantify, yet quantitative evidence is required to justify large-scale deworming programmes. A recent Cochrane systematic review, which influences Global Burden of Disease (GBD) estimates for STH, has again called into question the evidence for deworming benefit on morbidity due to STH. In this narrative review, we investigate in detail what the shortfalls in evidence are. Methodology/Principal Findings: We systematically reviewed recent literature that used direct measures to investigate morbidity from STH and we critically appraised systematic reviews, particularly the most recent Cochrane systematic review investigating deworming impact on morbidity. We included six systematic reviews and meta-analyses, 36 literature reviews, 44 experimental or observational studies, and five case series. We highlight where evidence is insufficient and where research needs to be directed to strengthen morbidity evidence, ideally to prove benefits of deworming. Conclusions/Significance: Overall, the Cochrane systematic review and recent studies indicate major shortfalls in evidence for direct morbidity. However, it is questionable whether the systematic review methodology should be applied to STH due to heterogeneity of the prevalence of different species in each setting. Urgent investment in studies powered to detect direct morbidity effects due to STH is required. PMID:27196100

Adult antisocial syndrome co-morbid with borderline personality disorder is associated with severe conduct disorder, substance dependence and violent antisociality.

PubMed

Freestone, Mark; Howard, Rick; Coid, Jeremy W; Ullrich, Simone

2013-01-01

This study tested the hypothesis that syndromal adult antisocial behaviour (AABS) co-morbid with borderline personality disorder (BPD) is a syndrome that emerges from severe conduct disorder (CD) in childhood and adolescence and is strongly associated, in adulthood, with both violence and substance dependence. In a sample of 8 580 community-resident adults screened for the presence of personality disorders, the following predictions arising from this hypothesis were tested: first, that those with AABS co-morbid with BPD would, in comparison with those showing AABS or BPD only, show a high level of antisocial outcomes, including violence; second, that adjusting for co-morbid alcohol dependence would attenuate group differences in many of the antisocial outcomes, and violence in particular; and third, that the AABS/BPD group would show both a high prevalence and a high severity of CD, and that adjusting for co-morbid CD would attenuate any association found between AABS/BPD co-morbidity and violence. Results confirmed these predictions, suggesting that AABS/BPD co-morbidity mediates the relationship between childhood CD and a predisposition to adult violence. The triad of AABS/BPD co-morbidity, alcohol dependence and severe CD is likely associated with the risk of criminal recidivism in offenders with personality disorder following release into the community. Copyright © 2012 John Wiley & Sons, Ltd.

Trends in healthy life expectancy in Hong Kong SAR 1996-2008.

PubMed

Cheung, Karen Siu Lan; Yip, Paul Siu Fai

2010-12-01

Although Hong Kong has one of the best life expectancy (LE) records in the world, second only to Japan for women, we know very little about the changes in the health status of the older adult population. Our article aims to provide a better understanding of trends in both chronic morbidity and disability for older men and women. The authors compute chronic morbidity-free and disability-free life expectancy and the proportion of both in relation to total LE using the Sullivan method to examine whether Hong Kong older adults are experiencing a compression of morbidity and disability and whether there is any gender difference in relation to mortality and morbidity. The results of this study show that Hong Kong women tend to outlive Hong Kong men but are also more likely to suffer from a 'double disadvantage', namely more years of life with more chronic morbidity and disability. There has also been a significant expansion of chronic morbidity, as chronic morbidity-free life expectancy (CMFLE) decreased substantially for both genders from 1996 to 2008. Although disability-free life expectancy (DFLE) increased during this period, it increased at a slower pace compared to LE. The proportion of life without chronic morbidity also declined remarkably during these 12 years. Among the advanced ages, the proportion of remaining life in good health without disability has decreased since 1996, indicating a relative expansion of disability.

The Cost of Morbidities in Very Low Birth Weight Infants

PubMed Central

Johnson, Tricia J.; Patel, Aloka L.; Jegier, Briana; Engstrom, Janet L.; Meier, Paula

2013-01-01

Objective The objective of this study was to determine the association between direct costs for the initial neonatal intensive care unit (NICU) hospitalization and four potentially preventable morbidities in a retrospective cohort of very low birth weight infants (VLBW; <1500g birth weight). Methods The sample included 425 VLBW infants born alive between July 2005 and June 2009 at Rush University Medical Center. Morbidities included brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and late onset sepsis. Clinical and economic data were retrieved from the institution’s system-wide data warehouse and cost accounting system. A general linear regression model was fit to determine incremental direct costs associated with each morbidity. Results After controlling for birth weight, gestational age, and socio-demographic characteristics, the presence of brain injury was associated with a $12,048 (p=0.005) increase in direct costs; necrotizing enterocolitis with a $15,440 (p=0.005) increase; bronchopulmonary dysplasia with a $31,565 (p<0.001) increase; and late onset sepsis with a $10,055 (p<0.001) increase in direct costs. The absolute number of morbidities was also associated with significantly higher costs. Conclusions This study provides the first collective estimates of the direct costs during the NICU hospitalization for these four morbidities in VLBW infants. The incremental costs associated with these morbidities were high, and these data can inform future studies evaluating interventions to prevent or reduce these costly morbidities. PMID:22910099

Ultrasonographic evaluation of urinary tract morbidity in school-aged and preschool-aged children infected with Schistosoma haematobium and its evolution after praziquantel treatment: A randomized controlled trial.

PubMed

Barda, Beatrice; Coulibaly, Jean T; Hatz, Christoph; Keiser, Jennifer

2017-02-01

Schistosoma haematobium infections are responsible for significant urinary tract (UT) complications. Schistosomiasis control programs aim to reduce morbidity, yet the extent of morbidity in preschool-aged children and the impact of treatment on morbidity reduction are not well studied. Our study was embedded in a randomized, placebo-controlled, single-blind trial in Côte d'Ivoire, which evaluated the efficacy and safety of three doses (20, 40 and 60 mg/kg) of praziquantel in school-aged (SAC) and preschool-aged (PSAC) children infected with S. haematobium. Enrolled children were invited to participate in an ultrasound examination prior and six months after treatment. At these time points 3 urine samples were collected for parasitological and clinical examinations. 162 PSAC and 141 SAC participated in the ultrasound examination at baseline, of which 128 PSAC and 122 SAC were present at follow-up. At baseline 43% (70/162) of PSAC had UT morbidity, mostly at bladder level and 7% had hydronephrosis. 67% (94/141) of SAC revealed mainly moderate UT pathology, 4% presented pseudopolyps on the bladder wall, and 6% had pyelectasis. At follow up, 45% of PSAC and 58% of SAC were S. haematobium positive, mostly harboring light infection intensities (41% and 51%, respectively). Microhematuria was present in 33% of PSAC and 42% of SAC and leukocyturia in 53% and 40% of PSAC and SAC, respectively. 50% (64/128) of PSAC and 58% (71/122) of SAC presented urinary tract morbidity, which was mainly mild. A significant correlation (p<0.05) was observed between praziquantel treatment and reversal of S. haematobium induced morbidity. Progression of UT pathology decreased with increasing praziquantel dosages. A worsening of morbidity was observed among children in the placebo group. Bladder morbidity is widespread among PSAC. Praziquantel treatment is significantly associated with the reversal of S. haematobium induced morbidity, which underscores the importance of preventive chemotherapy programs. These programs should be expanded to PSAC to prevent or decrease the prevalence of morbidity in young children. This trial is registered as an International Standard Randomized Controlled Trial, number ISRCTN15280205.

Synergistic effect of age and body mass index on mortality and morbidity in general surgery.

PubMed

Yanquez, Federico J; Clements, John M; Grauf, Dawn; Merchant, Aziz M

2013-09-01

The elderly population (aged 65 y and older) is expected to be the dominant age group in the United States by 2030. In addition, the prevalence of obesity in the United States is growing exponentially. Obese elderly patients are increasingly undergoing elective or emergent general surgery. There are few, if any, studies highlighting the combined effect of age and body mass index (BMI) on surgical outcomes. We hypothesize that increasing age and BMI synergistically impact morbidity and mortality in general surgery. We collected individual-level, de-identified patient data from the Michigan Surgical Quality Collaborative. Subjects underwent general surgery with general anesthetic, were >18 y, and had a BMI between 19 and 60. Primary and secondary outcomes were 30-d "Any morbidity" and mortality (from wound, respiratory, genitourinary, central nervous system, and cardiac systems), respectively. Preoperative risk variables included diabetes, dialysis, steroid use, cardiac risk, wound classification, American Society of Anesthesiology class, emergent cases, and 13 other variables. We conducted binary logistic regression models for 30-d morbidity and mortality to determine independent effects of age, BMI, interaction between both age and BMI, and a saturated model for all independent variables. We identified 149,853 patients. The average age was 54.6 y, and the average BMI was 30.9. Overall 30-d mortality was 2%, and morbidity was 6.7%. Age was a positive predictor for mortality and morbidity, and BMI was negatively associated with mortality and not significantly associated with morbidity. Age combined with higher BMI was positively associated with morbidity and mortality when the higher age groups were analyzed. Saturated models revealed age and American Society of Anesthesiology class as highest predictors of poor outcomes. Although BMI itself was not a major independent factor predicting 30-d major morbidity or mortality, the morbidly obese, elderly (>50 and 70 y, respectively) subgroup may have an increased morbidity and mortality after general surgery. This information, along with patient-specific factors and their comorbidities, may allow us to better take care of our patients perioperatively and better inform our patients about their risk of surgical procedures. Copyright © 2013 Elsevier Inc. All rights reserved.

Undetected psychiatric morbidity among HIV/AIDS patients attending Comprehensive Care Clinic (CCC) in Nairobi Kenya: towards an integrated mental health care.

PubMed

Ng'ang'a, Pauline W; Mathai, Muthoni; Obondo, Anne; Mutavi, Teresia; Kumar, Manasi

2018-01-01

Psychiatric morbidity is commonly associated with HIV disease and may have adverse effects. This aspect may be overlooked at comprehensive HIV care centers in Low and Middle-Income Countries. The aim of this study was to determine the prevalence of undetected psychiatric morbidity among HIV/AIDS adult patients attending Comprehensive Care Centre in a semi-urban clinic, in Nairobi, Kenya. Descriptive cross-sectional study of adult HIV patients not receiving any psychiatric treatment was conducted. The participants consisted of consecutive sample of adults ( n  = 245) attending HIV Comprehensive Care Clinic at Kangemi Health Centre, Nairobi. The Mini International Neuropsychiatric Interview (MINI) was administered to screen for undetected psychiatric morbidity. Socio-demographic characteristics were recorded in a questionnaire. Sample descriptive analysis was performed and prevalence of undetected psychiatric morbidity calculated. Chi-square test for independence was used to examine the associations between patient characteristics and undetected morbidity. Multivariable logistic regression analysis was performed to determine independent predictors of undetected psychiatric morbidity. The mean age of our participants was 37.3 years (SD 9.2) Three-quarters (75.9%) of participants were females and median duration of HIV illness was 5 years. The prevalence of (previously undetected) psychiatric morbidity was 71.4% (95% CI 65.3-77). The leading psychiatric disorders were MDD (32.2%), PTSD (18.4%), Dysthymia (17.6%), and OCD (17.6%). Overall psychiatric morbidity was associated with low income (

The morbidity experience of air traffic control personnel, 1967-1977.

DOT National Transportation Integrated Search

1978-04-01

The morbidity experience of 28,086 air traffic controllers has been examined from 1967-77 with particular emphasis given the potential effects of job demands on ATC Health. The morbidity experience of air traffic controllers does not appear excessive...

Concurrent risk-reduction surgery in patients with increased lifetime risk for breast and ovarian cancer: an analysis of the National Surgical Quality Improvement Program (NSQIP) database.

PubMed

Elmi, Maryam; Azin, Arash; Elnahas, Ahmad; McCready, David R; Cil, Tulin D

2018-05-14

Patients with genetic susceptibility to breast and ovarian cancer are eligible for risk-reduction surgery. Surgical morbidity of risk-reduction mastectomy (RRM) with concurrent bilateral salpingo-oophorectomy (BSO) is unknown. Outcomes in these patients were compared to patients undergoing RRM without BSO using a large multi-institutional database. A retrospective cohort analysis was conducted using the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) 2007-2016 datasets, comparing postoperative morbidity between patients undergoing RRM with patients undergoing RRM with concurrent BSO. Patients with genetic susceptibility to breast/ovarian cancer undergoing risk-reduction surgery were identified. The primary outcome was 30-day postoperative major morbidity. Secondary outcomes included surgical site infections, reoperations, readmissions, length of stay, and venous thromboembolic events. A multivariate analysis was performed to determine predictors of postoperative morbidity and the adjusted effect of concurrent BSO on morbidity. Of the 5470 patients undergoing RRM, 149 (2.7%) underwent concurrent BSO. The overall rate of major morbidity and postoperative infections was 4.5% and 4.6%, respectively. There was no significant difference in the rate of postoperative major morbidity (4.5% vs 4.7%, p = 0.91) or any of the secondary outcomes between patients undergoing RRM without BSO vs. those undergoing RRM with concurrent BSO. Multivariable analysis showed Body Mass Index (OR 1.05; p < 0.001) and smoking (OR 1.78; p = 0.003) to be the only predictors associated with major morbidity. Neither immediate breast reconstruction (OR 1.02; p = 0.93) nor concurrent BSO (OR 0.94; p = 0.89) were associated with increased postoperative major morbidity. This study demonstrated that RRM with concurrent BSO was not associated with significant additional morbidity when compared to RRM without BSO. Therefore, this joint approach may be considered for select patients at risk for both breast and ovarian cancer.

Lost work days in the 6 years leading to premature death from cardiovascular disease in men and women.

PubMed

Singh-Manoux, Archana; Kivimäki, Mika; Sjösten, Noora; Ferrie, Jane E; Nabi, Hermann; Pentti, Jaana; Virtanen, Marianna; Oksanen, Tuula; Vahtera, Jussi

2010-08-01

It is unclear whether individuals experience specific patterns of morbidity prior to premature death from cardiovascular disease (CVD). We examined morbidity levels in the 6 years leading up to death from CVD in 37,397 men and 113,198 women under 65 years of age from the Finnish Public Sector study, with a particular focus on gender differences. Morbidity was assessed using lost days from work, extracted from register data on sickness leave and disability pension. Data on cause-specific mortality were obtained from national health registers. During a median follow-up of 8.5 years, there were 361 CVD deaths (174 from ischaemic heart disease (ICD9 410-414, 427.5; ICD10 I21-I25, I46), 91 from stroke (ICD9 430, 431, 434; ICD10 I60-I60, I61, I63), and 96 from other diseases of circulatory system (ICD9 390-459; ICD10 I00-I99)). Women had lower morbidity than men over the 6 years preceding stroke deaths (RR for mean annual days=0.33 (95% CI 0.14-0.78)). For other causes of CVD mortality, there were no gender differences in morbidity rates prior to death. In men, those who died from CVD had substantially greater morbidity levels than matched controls through the entire 6-year period preceding death (rate ratio=3.59; 95% confidence interval 2.62-4.93). Among women, morbidity days were greater particularly in the year preceding death from stroke. Our results on working age men and women suggest no gender differences in morbidity prior to death from heart disease and lower morbidity in women prior to death from stroke. These findings challenge the widespread belief that women experience more morbidity symptoms than men. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis.

PubMed

Falah-Hassani, K; Shiri, R; Dennis, C-L

2017-09-01

To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% [95% confidence interval (CI) 7.8-11.2, 17 studies, n = 25 592] and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8-7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0-14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2-3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5-9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3-7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9-6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.

Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

PubMed Central

Bydon, Mohamad; Abt, Nicholas B.; Macki, Mohamed; Brem, Henry; Huang, Judy; Bydon, Ali; Tamargo, Rafael J.

2014-01-01

Background: Preoperative anemia may affect postoperative mortality and morbidity following elective cranial operations. Methods: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was used to identify elective cranial neurosurgical cases (2006-2012). Morbidity was defined as wound infection, systemic infection, cardiac, respiratory, renal, neurologic, and thromboembolic events, and unplanned returns to the operating room. For 30-day postoperative mortality and morbidity, adjusted odds ratios (ORs) were estimated with multivariable logistic regression. Results: Of 8015 patients who underwent elective cranial neurosurgery, 1710 patients (21.4%) were anemic. Anemic patients had an increased 30-day mortality of 4.1% versus 1.3% in non-anemic patients (P < 0.001) and an increased 30-day morbidity rate of 25.9% versus 14.14% in non-anemic patients (P < 0.001). The 30-day morbidity rates for all patients undergoing cranial procedures were stratified by diagnosis: 26.5% aneurysm, 24.7% sellar tumor, 19.7% extra-axial tumor, 14.8% intra-axial tumor, 14.4% arteriovenous malformation, and 5.6% pain. Following multivariable regression, the 30-day mortality in anemic patients was threefold higher than in non-anemic patients (4.1% vs 1.3%; OR = 2.77; 95% CI: 1.65-4.66). The odds of postoperative morbidity in anemic patients were significantly higher than in non-anemic patients (OR = 1.29; 95% CI: 1.03-1.61). There was a significant difference in postoperative morbidity event odds with a hematocrit level above (OR = 1.07; 95% CI: 0.78-1.48) and below (OR = 2.30; 95% CI: 1.55-3.42) 33% [hemoglobin (Hgb) 11 g/dl]. Conclusions: Preoperative anemia in elective cranial neurosurgery was independently associated with an increased risk of 30-day postoperative mortality and morbidity when compared to non-anemic patients. A hematocrit level below 33% (Hgb 11 g/dl) was associated with a significant increase in postoperative morbidity. PMID:25422784

The effect of health system factors on outcomes and costs after bariatric surgery in a universal healthcare system: a national cohort study of bariatric surgery in Canada.

PubMed

Doumouras, Aristithes G; Saleh, Fady; Anvari, Sama; Gmora, Scott; Anvari, Mehran; Hong, Dennis

2017-11-01

Previous data demonstrate that patients who receive bariatric surgery at a Center of Excellence are different than those who receive care at non-accredited centers. Canada provides a unique opportunity to naturally exclude confounders such as insurance status, hospital ownership, and lack of access on comparisons between hospitals and surgeons in bariatric surgery outcomes. The objective of this study was to determine the effect of hospital accreditation and other health system factors on all-cause morbidity after bariatric surgery in Canada. This was a population-based study of all patients aged ≥18 who received a bariatric procedure in Canada (excluding Quebec) from April 2008 until March 2015. The main outcomes for this study were all-cause morbidity and costs during the index admission. All-cause morbidity included any documented complication which extended length of stay by 24 h or required reoperation. Risk-adjusted hierarchical regression models were used to determine predictors of morbidity and cost. Overall, 18,398 patients were identified and the all-cause morbidity rate was 10.1%. Surgeon volume and teaching hospitals were both found to significantly decrease the odds of all-cause morbidity. Specifically, for each increase in 25 bariatric cases per year, the odds of all-cause morbidity was 0.94 times lower (95% CI 0.87-1.00, p = 0.03). Teaching hospitals conferred a 0.75 lower odds of all-cause morbidity (95% CI 0.58-0.95, p < 0.001). Importantly, formal accreditation was not associated with a decrease in all-cause morbidity within a universal healthcare system. No health system factors were associated with significant cost differences. This national cohort study found that surgeon volume and teaching hospitals predicted lower all-cause morbidity after surgery while hospital accreditation was not a significant factor.

Morbidity and mortality disparities among colonist and indigenous populations in the Ecuadorian Amazon.

PubMed

Kuang-Yao Pan, William; Erlien, Christine; Bilsborrow, Richard E

2010-02-01

Rural populations living in the northern Ecuadorian Amazon (NEA) experience the highest health burden of any region in the country. Two independent studies of colonist and indigenous groups living in the NEA are used to compare their morbidity and mortality experiences. Colonist data are from a probability sample of land plots in 1999, while indigenous data are from a representative sample of the five largest ethnicities (Quichua, Shuar, Huaorani, Cofan, Secoya) collected in 2001. Poisson regression was used to compare morbidity. Results indicate clear differences in health between populations. Indigenous groups had 30% higher probability of mortality and 63% higher incidence rate of all-cause morbidity compared to colonists. Vector-borne, chronic, gastrointestinal, and diseases of unknown origin were particularly high among indigenous groups. Factors associated with morbidity varied: morbidity rates were similar for the two youngest age groups (0-4 and 5-9), but indigenous people aged 15-39 and 40+ had almost double the morbidity compared to colonists; larger households, later months of data collection and less pollution were associated with less morbidity in both groups; better infrastructure access (electricity and roads) was generally associated with lower morbidity in both groups; and associations of land use were different by group with more cultivation of perennials and fewer annuals associated with less morbidity for colonists, but more for indigenous groups. These results demonstrate the health disparities that exist among indigenous and non-indigenous populations even when living in the same geographic region. Land use itself exemplifies the cultural and contextual differences that are evident in health, since land use decisions are related to broader demographic and economic factors that influence overall ecological and human health. Ongoing population-environment and/or environment-health research needs to recognize the broader factors involved when studying relationships between population health, development and deforestation. Copyright 2009 Elsevier Ltd. All rights reserved.

Morbidity and mortality disparities among colonist and indigenous populations in the Ecuadorian Amazon

PubMed Central

Pan, William Kuang-Yao; Erlien, Christine; Bilsborrow, Richard E

2009-01-01

Rural populations living in the northern Ecuadorian Amazon (NEA) experience the highest health burden of any region in the country. Two independent studies of colonist and indigenous groups living in the NEA are used to compare their morbidity and mortality experiences. Colonist data are from a probability sample of land plots in 1999, while indigenous data are from a representative sample of the five largest ethnicities (Quichua, Shuar, Huaorani, Cofan, Secoya) collected in 2001. Poisson regression was used to compare morbidity. Results indicate clear differences in health between populations. Indigenous groups had 30% higher probability of mortality and 63% higher incidence rate of all-cause morbidity compared to colonists. Vector-borne, chronic, gastrointestinal, and diseases of unknown origin were particularly high among indigenous groups. Factors associated with morbidity varied: morbidity rates were similar for the two youngest age groups (0–4 and 5–9), but indigenous people aged 15–39 and 40+ had almost double the morbidity compared to colonists; larger households, later months of data collection and less pollution were associated with less morbidity in both groups; better infrastructure access (electricity and roads) was generally associated with lower morbidity in both groups; and associations of land use were different by group with more cultivation of perennials and fewer annuals associated with less morbidity for colonists, but more for indigenous groups. These results demonstrate the health disparities that exist among indigenous and non-indigenous populations even when living in the same geographic region. Land use itself exemplifies the cultural and contextual differences that are evident in health, since land use decisions are related to broader demographic and economic factors that influence overall ecological and human health. Ongoing population-environment and/or environment-health research needs to recognize the broader factors involved when studying relationships between population health, development and deforestation. PMID:19906478

No evidence of morbidity compression in Spain: a time series study based on national hospitalization records.

PubMed

Walter, Stefan; Beltrán-Sánchez, Hiram; Regidor, Enrique; Gomez-Martin, Carlos; Del-Barrio, Jose Luis; Gil-de-Miguel, Angel; Subramanian, S V; Gil-Prieto, Ruth

2016-09-01

Compression of morbidity postulates that as the populations age, the age of onset of disease is postponed. The objective of this study is to test for evidence of compression of morbidity in Spain. We calculated the age and sex-specific incidence of myocardial infarction, heart failure, cerebrovascular disease, as well as bladder, prostate, breast, lung, and colon cancer among hospital discharges covering 99.5 % of the Spanish population, approximately 40 million inhabitants for two non-overlapping periods, 1997-2000 and 2007-2010, and estimated the length of life spent with disease using the Sullivan method. We found that expansion of morbidity due to an earlier age-specific onset of incident disease and increase in life expectancy was the norm in Spain. Notable exceptions were cardiovascular disease in women (-0.2 % time spent with disease) and lung cancer for men (-0.9 % time spent with disease) from 1997-2000 to 2007-2010. Compression of morbidity is often cited by policy makers when discussing adjustments to the health-care system. If morbidity is measured by age at onset of disease, the burden of morbidity has increased in Spain.

The Treatment of Achalasia in Obese Patients.

PubMed

Wesp, Julie A; Farrell, Timothy M

2018-04-01

Epidemiological studies have demonstrated that obesity is frequently associated with esophageal motility disorders. Morbid obesity and achalasia may coexist in the same patient. The management of the morbidly obese patient with achalasia is complex and the most effective treatment remains controversial. The aim of this study is to review the pathophysiology, clinical presentation, diagnostic evaluation, and treatment of achalasia in morbidly obese patients. PubMed search from January 1990 to July 2017, including the following terms: achalasia, morbid obesity, bariatric, and treatment. Achalasia in the setting of morbid obesity may be successfully treated by endoscopic or surgical methods. Surgeons may choose to add a bariatric procedure, with various strategies present in the literature. A review of the present literature suggests that the preferred approach to achalasia in the morbidly obese patient is to address both disease processes simultaneously with a laparoscopic Heller myotomy and a Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is cited by most experts as the bariatric procedure of choice, given its antireflux benefits. A well-powered study, comparing the various approaches to the treatment of achalasia in the setting of morbid obesity, is required to establish a consensus.

Early Maladaptive Schemas and Cognitive Distortions in Adults with Morbid Obesity: Relationships with Mental Health Status.

PubMed

da Luz, Felipe Q; Sainsbury, Amanda; Hay, Phillipa; Roekenes, Jessica A; Swinbourne, Jessica; da Silva, Dhiordan C; da S Oliveira, Margareth

2017-02-28

Dysfunctional cognitions may be associated with unhealthy eating behaviors seen in individuals with obesity. However, dysfunctional cognitions commonly occur in individuals with poor mental health independently of weight. We examined whether individuals with morbid obesity differed with regard to dysfunctional cognitions when compared to individuals of normal weight, when mental health status was controlled for. 111 participants-53 with morbid obesity and 58 of normal weight-were assessed with the Mini-Mental State Examination, Young Schema Questionnaire, Cognitive Distortions Questionnaire, Depression, Anxiety and Stress Scale, and a Demographic and Clinical Questionnaire. Participants with morbid obesity showed higher scores in one (insufficient self-control/self-discipline) of 15 early maladaptive schemas and in one (labeling) of 15 cognitive distortions compared to participants of normal weight. The difference between groups for insufficient self-control/self-discipline was not significant when mental health status was controlled for. Participants with morbid obesity showed more severe anxiety than participants of normal weight. Our findings did not show clinically meaningful differences in dysfunctional cognitions between participants with morbid obesity or of normal weight. Dysfunctional cognitions presented by individuals with morbid obesity are likely related to their individual mental health and not to their weight.

[Morbidity Differences by Health Insurance Status in Old Age].

PubMed

Hajek, A; Bock, J-O; Saum, K-U; Schöttker, B; Brenner, H; Heider, D; König, H-H

2018-06-01

Morbidity differences between older members of private and statutory health insurance Germany have rarely been examined. Thus, we aimed at determining these differences in old age. This study used data from 2 follow-up waves with a 3-year interval from a population-based prospective cohort study (ESTHER study) in Saarland, Germany. Morbidity was assessed by participants' GPs using a generic instrument (Cumulative Illness Rating Scale for Geriatrics). The between estimator was used which exclusively quantifies inter-individual variation. Adjusting for sex and age, we investigated the association between health insurance and morbidity in the main model. In additional models, we adjusted incrementally for the effect of education, family status and income. Regression models not adjusting for income showed that members of private health insurance had a lower morbidity score than members of statutory health insurance. This effect is considerably lower in models adjusting for income, but remained statistically significant (except for men). Observed differences in morbidity between older members of private and statutory health insurance can partly be explained by income differences. Thus, our findings highlight the role of model specification in determining the relation between morbidity and health insurance. © Georg Thieme Verlag KG Stuttgart · New York.

Placenta previa and maternal hemorrhagic morbidity.

PubMed

Gibbins, Karen J; Einerson, Brett D; Varner, Michael W; Silver, Robert M

2018-02-01

Placenta previa is associated with maternal hemorrhage, but most literature focuses on morbidity in the setting of placenta accreta. We aim to characterize maternal morbidity associated with previa and to define risk factors for hemorrhage. This is a secondary cohort analysis of the NICHD Maternal-Fetal Medicine Units Network Cesarean Section Registry. This analysis included all women undergoing primary Cesarean delivery without placenta accreta. About 496 women with previa were compared with 24,201 women without previa. Primary outcome was composite maternal hemorrhagic morbidity. Non-hemorrhagic morbidities and risk factors for hemorrhage were also evaluated. Maternal hemorrhagic morbidity was more common in women with previa (19 versus 7%, aRR 2.6, 95% CI 1.9-3.5). Atony requiring uterotonics (aRR 3.1, 95% CI 2.0-4.9), red blood cell transfusion (aRR 3.8, 95% CI 2.5-5.7), and hysterectomy (aRR 5.1, 95% CI 1.5-17.3) were also more common with previa. For women with previa, factors associated with maternal hemorrhage were pre-delivery anemia, thrombocytopenia, diabetes, magnesium use, and general anesthesia. Placenta previa is an independent risk factor for maternal hemorrhagic morbidity. Some risk factors are modifiable, but many are intrinsic to the clinical scenario.

Standardized severe maternal morbidity review: rationale and process.

PubMed

Kilpatrick, Sarah J; Berg, Cynthia; Bernstein, Peter; Bingham, Debra; Delgado, Ana; Callaghan, William M; Harris, Karen; Lanni, Susan; Mahoney, Jeanne; Main, Elliot; Nacht, Amy; Schellpfeffer, Michael; Westover, Thomas; Harper, Margaret

2014-08-01

Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of 4 or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician-gynecologists, maternal-fetal medicine subspecialists, certified nurse-midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form.

Neonatal morbidity in moderately preterm infants: a Swedish national population-based study.

PubMed

Altman, Maria; Vanpée, Mireille; Cnattingius, Sven; Norman, Mikael

2011-02-01

To determine the gestational age (GA)-specific risks for neonatal morbidity and use of interventions in infants born at 30 to 34 completed gestational weeks. A population-based Swedish study including 6674 infants born during 2004-2008. Risks for neonatal morbidity and use of interventions were investigated with respect to GA and birth weight standard deviation scores. Acute lung disorder was diagnosed in 28%, hypoglycemia in 16%, bacterial infection in 15% and hyperbilirubinemia in 59% of the infants. Thirty-eight percent had received antenatal steroid therapy, 43% nasal continuous positive airway pressure, 5.5% required mechanical ventilation, 5.2% were treated with surfactant, and 30% with antibiotic therapy. Neonatal morbidity rates increased with decreasing GA, with odds ratios for different outcomes ranging from 2.1 to 23 at 30 weeks compared with 34 weeks of GA. Low birth weight standard deviation scores was more common at lower GA and was associated with increased morbidity rates. Despite general advances in perinatal care, moderately preterm infants still have substantially increased risks for neonatal morbidity. Whereas the neonatal morbidity rate was similar to results of previous reports, management of respiratory problems differed markedly from other studies. Copyright © 2011 Mosby, Inc. All rights reserved.

Orthopedic trauma surgery in the morbidly obese patient.

PubMed

Bozzio, Anthony E; Gala, Raj J; Villasenor, Mario A; Hao, Jiandon; Mauffrey, Cyril

2014-05-01

The treatment of morbidly obese patients in orthopedic trauma differs in many ways compared to injured patients with normal body mass indices. This paper highlights key differences and ways to overcome obstacles. We present specific tips, as well as considerations for initial planning, positioning for surgery, intra-operative strategies, and a discussion on both anesthesia and imaging. Several treatment strategies have been shown to have better results in morbidly obese patients. Pre-operative planning is necessary for minimizing risk to the patient. The prevalence of morbid obesity has increased in the USA in the past quarter century. Treatment for orthopedic injuries in morbidly obese patients requires a multidisciplinary approach that addresses not only their orthopedic injuries, but also medical co-morbidities. A team of medicine doctors, anesthesiologists, X-ray technicians, physical and occupational therapists, respiratory therapists, and social workers is needed in addition to the orthopedic surgeon. Modifications in both pre-operative planning and intra-operative strategies may be necessary in order to accommodate the patient. This paper presents numerous technical tips that can aid in providing stable fixation for fractures, as well as addressing peri-operative issues specific to the morbidly obese.

Morbidity and Mortality in Sarcoidosis

PubMed Central

Gerke, Alicia K.

2015-01-01

Purpose of Review Chronic sarcoidosis is a complex disease with numerous comorbid conditions and can be fatal in some cases. Recognizing causes of morbidity and mortality is important to effectively select treatments, manage symptoms, and improve outcomes. The purpose of this review is to examine emerging knowledge on morbidity and mortality in sarcoidosis. Recent Findings Approximately one to five percent of patients with sarcoidosis die from complications of sarcoidosis. Recent population studies indicate that mortality may be increasing over the past decade. The reasons behind these trends are unclear, but could include increasing incidence, detection rates, severity of disease, or age of the population. Morbidity of sarcoidosis is reflected by a trend of increased hospitalizations over recent years and increased use of healthcare resources. Morbidity can be caused by organ damage from granulomatous inflammation, treatment complications, and psychosocial effects of the disease. Recent studies are focused on morbidity related to cardiopulmonary complications, bone health, and aging within the sarcoidosis population. Last, sarcoidosis is associated with autoimmune diseases, pulmonary embolism, and malignancy; however, the underlying mechanisms linking diseases continue to be debated. Summary Morbidity in sarcoidosis is significant and multifactorial. Mortality is infrequent, but may be increasing over the years. PMID:25029298

The John Insall Award: Morbid obesity independently impacts complications, mortality, and resource use after TKA.

PubMed

D'Apuzzo, Michele R; Novicoff, Wendy M; Browne, James A

2015-01-01

The importance of morbid obesity as a risk factor for complications after total knee arthroplasty (TKA) continues to be debated. Obesity is rarely an isolated diagnosis and tends to cluster with other comorbidities that may independently lead to increased risk and confound outcomes. It is unknown whether morbid obesity independently affects postoperative complications and resource use after TKA. The purpose of this study was to determine whether morbid obesity is an independent risk factor for inpatient postoperative complications, mortality, and increased resource use in patients undergoing primary TKA. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary TKA from October 2005 to December 2008. Morbid obesity (body mass index≥40 kg/m2) was determined using International Classification of Diseases, 9th Revision, Clinical Modification codes. In-hospital postoperative complications, mortality, costs, and disposition for morbidly obese patients were compared with nonobese patients. To control for potential confounders and comorbid conditions, each morbidly obese patient was matched to a nonobese patient using age, sex, and all 28 comorbid-defined elements in the NIS database based on the Elixhauser Comorbidity Index. Of 1,777,068 primary TKAs, 98,410 (5.5%) patients were categorized as morbidly obese. Of these, 90,045 patients (91%) were able to be matched one-to-one to a nonobese patient for the adjusted analysis. Morbidly obese patients had a higher risk of postoperative in-hospital infection (0.24% versus 0.17%; odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.7; p=0.001), wound dehiscence (0.11% versus 0.08%; OR, 1.3; 95% CI, 1.0-1.7; p=0.28), and genitourinary-related complications (0.60% versus 0.44%; OR, 1.3; 95% CI, 1.1-1.5; p<0.001). There was no increase in the prevalence of cardiovascular or thromboembolic-related complications. Morbidly obese patients were at higher risk of in-hospital death after primary TKA compared with nonobese patients (0.08% versus 0.02%; OR, 3.2; 95% CI, 2.0-5.2; p<0.001). Total hospital costs (USD 15,174 versus USD 14,715, p<0.001), length of stay (3.6 days versus 3.5 days, p<0.001), and rate of discharge to a facility (40% versus 30%, p<0.001) were all higher in morbidly obese patients. Morbid obesity appears to be independently associated with a higher risk for a small number of select in-hospital postoperative complications and mortality after matching for comorbid medical conditions linked to obesity. However, the independent impact of morbid obesity appears to be fairly modest, and morbid obesity did not appear to be an independent risk factor for many systemic complications. Continued research is necessary to identify the influence of associated comorbidities on early postoperative complications in morbidly obese patients after TKA. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Waiting for thyroid surgery: a study of psychological morbidity and determinants of health associated with long wait times for thyroid surgery.

PubMed

Eskander, Antoine; Devins, Gerald M; Freeman, Jeremy; Wei, Alice C; Rotstein, Lorne; Chauhan, Nitin; Sawka, Anna M; Brown, Dale; Irish, Jonathan; Gilbert, Ralph; Gullane, Patrick; Higgins, Kevin; Enepekides, Danny; Goldstein, David

2013-02-01

Patients with thyroid pathology tend have longer surgical wait times. Uncertainty during this wait can have negative psychologically impact. This study aims to determine the degree of psychological morbidity in patients waiting for thyroid surgery. Prospectively assessing patients pre- and postoperative psychological morbidity (level 2c). Patients waiting for thyroidectomy were mailed a sociodemographic and four psychological morbidity questionnaires: Impact of Events Scale-Revised (IES-R), Illness Intrusiveness Ratings Scale (IIRS), Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS). We assessed whether anxiety was related to length of wait and a number of clinical/sociodemographic factors. We achieved a 53% response rate over a 3-year period, with 176 patients providing complete preoperative data; and 74 (42%) completed postoperative data. The average age was 53 (± 12) years; 82% were female. Respondents with a suspicious or known malignancy waited an average of 107 days while those with benign neoplastic biopsies waited an average of 218 days for thyroidectomy. Respondents reported substantial psychological morbidity with high IES-R, IIRS, PSS, and HADS scores. There was no significant association between psychological morbidity and wait times, clinical or sociodemographic factors. Postoperative anxiety decreased significantly in all psychological morbidity measures except for the IIRS. Patients waiting for thyroid surgery have mild to moderate psychological morbidity and long wait times for surgery. These appear not to be related. Psychological morbidity decreases after surgery. Reducing wait time can potentially reduce the time that patients have to live with unnecessary stress and anxiety. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Burden of severe maternal morbidity and association with adverse birth outcomes in sub–Saharan Africa and south Asia: protocol for a prospective cohort study

PubMed Central

2016-01-01

Objectives The AMANHI morbidity study aims to quantify and describe severe maternal morbidities and assess their associations with adverse maternal, fetal and newborn outcomes in predominantly rural areas of nine sites in eight South Asian and sub–Saharan African countries. Methods AMANHI takes advantage of on–going population–based cohort studies covering approximately 2 million women of reproductive age with 1– to 3–monthly pregnancy surveillance to enrol pregnant women. Morbidity information is collected at five follow–up home visits – three during the antenatal period at 24–28 weeks, 32–36 weeks and 37+ weeks of pregnancy and two during the postpartum period at 1–6 days and after 42–60 days after birth. Structured–questionnaires are used to collect self–reported maternal morbidities including hemorrhage, hypertensive disorders, infections, difficulty in labor and obstetric fistula, as well as care–seeking for these morbidities and outcomes for mothers and babies. Additionally, structured questionnaires are used to interview birth attendants who attended women’s deliveries. All protocols were harmonised across the sites including training, implementation and operationalising definitions for maternal morbidities. Importance of the AMANHI morbidity study Availability of reliable data to synthesize evidence for policy direction, interventions and programmes, remains a crucial step for prioritization and ensuring equitable delivery of maternal health interventions especially in high burden areas. AMANHI is one of the first large harmonized population–based cohort studies being conducted in several rural centres in South Asia and sub–Saharan Africa, and is expected to make substantial contributions to global knowledge on maternal morbidity burden and its implications. PMID:27648256

Nationwide use and outcomes of ambulatory surgery in morbidly obese patients in the United States.

PubMed

Rosero, Eric B; Joshi, Girish P

2014-05-01

To compare the overall characteristics and perioperative outcomes in morbidly obese and nonobese patients undergoing ambulatory surgery in the United States. Retrospective, propensity-matched cohort study. Academic medical center. The association between duration of surgical procedures, postoperative complications, and unplanned hospital admission was assessed in a propensity-matched cohort of morbidly obese and nonobese patients derived from the 2006 National Survey of Ambulatory Surgery. Only 0.32% of the ambulatory procedures were performed on morbidly obese patients. The morbidly obese were significantly younger but had a higher burden of comorbidities, were more likely to undergo the procedure in hospital-based outpatient departments (HOPD; 80.1% vs 56.5%; P = 0.004), and had significantly shorter procedures than the nonobese (median [interquartile range], 28 [21-38] vs 42 [22-65] min; P < 0.0001). The incidences of postoperative hypertension, hypotension, hypoxia, cancellation of surgery, and unplanned hospital admissions did not differ significantly between groups. Similarly, adjusted rates of delayed discharge were similar in morbidly obese and nonobese patients (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.18 - 1.15; P = 0.09). In contrast, morbid obesity was associated with decreased odds of postoperative nausea and vomiting (OR, 0.27; CI, 0.09 - 0.84; P = 0.01). In 2006 in the U.S., the prevalence of ambulatory surgery in the morbidly obese was low, with most of the procedures being performed in the HOPD facilities, suggesting a conservative patient selection. The incidence of adverse postoperative outcomes and delayed discharge, as well as unplanned hospital admission after ambulatory surgery in the morbidly obese, was similar to that reported in the nonobese. Copyright © 2014 Elsevier Inc. All rights reserved.

Maternal morbidity measurement tool pilot: study protocol.

PubMed

Say, Lale; Barreix, Maria; Chou, Doris; Tunçalp, Özge; Cottler, Sara; McCaw-Binns, Affette; Gichuhi, Gathari Ndirangu; Taulo, Frank; Hindin, Michelle

2016-06-09

While it is estimated that for every maternal death, 20-30 women suffer morbidity, these estimates are not based on standardized methods and measures. Lack of an agreed-upon definition, identification criteria, standardized assessment tools, and indicators has limited valid, routine, and comparable measurements of maternal morbidity. The World Health Organization (WHO) convened the Maternal Morbidity Working Group (MMWG) to develop standardized methods to improve estimates of maternal morbidity. To date, the MMWG has developed a definition and provided input into the development of a set of measurement tools. This protocol outlines the pilot test for measuring maternal morbidity in antenatal and postnatal clinical populations using these new tools. In each setting, the tools will be piloted on approximately 250 women receiving antenatal care (ANC) (at least 28 weeks pregnant) and 250 women receiving postpartum care (PPC) (at least 6 weeks postpartum). The tools will be administered by trained health care workers. Each tool has three modules as follows: 1. personal history - socio-economic information, and risk-factors (such as violence and substance abuse) 2. patient symptoms - WHO Disability Assessment Schedule (WHODAS) 12-item, and mental health questionnaires, General Anxiety Disorder, 7-item (GAD-7) and Personal Health Questionnaire, 9-item (PHQ-9) 3. physical examination - signs, laboratory tests and results. This pilot (planned for Jamaica, Kenya and Malawi) will allow for comparing the types of morbidities women experience between and across settings, and determine the feasibility, acceptability and utility of using a modified, streamlined tool for routine measurement and summary estimates of morbidity to inform resource allocation and service provision. As part of the post-2015 Sustainable Development Goals (SDGs) estimating and measuring maternal morbidity will be essential to ensure appropriate resources are allocated to address its impact and improve well-being.

The relationship between psychosocial factors and asthma morbidity in inner-city children with asthma.

PubMed

Weil, C M; Wade, S L; Bauman, L J; Lynn, H; Mitchell, H; Lavigne, J

1999-12-01

Children living in the inner city are affected disproportionately by asthma morbidity and mortality. Previous research has shown that behavioral and psychosocial factors affect asthma morbidity in children. The National Cooperative Inner-City Asthma Study investigated the factors that contribute to asthma morbidity among inner-city children. This article examines the relationship between psychosocial factors and asthma morbidity in this population. A total of 1528 English- and Spanish-speaking children 4 to 9 years of age with asthma and their primary caretakers were recruited from 8 research centers in 7 metropolitan inner-city areas in the United States. Psychosocial variables were assessed at baseline and included measures of child and caretaker mental health, caretaker's problems with alcohol, life stress, social support, and parenting style. Morbidity measures were evaluated at baseline and at 3-, 6-, and 9-month follow-up intervals. These included number of hospitalizations and unscheduled visits for asthma in the past 3 months and number of days of wheeze and functional status in the previous 2-week period. Of the psychosocial variables assessed, mental health had the strongest relationship to children's asthma morbidity. Children whose caretakers had clinically significant levels of mental health problems were hospitalized for asthma at almost twice the rate as children whose caretakers did not have significant mental health problems. Children with clinically significant behavior problems had significantly more days of wheeze and poorer functional status in the follow-up period. Psychosocial factors, particularly the mental health of children and caretakers, are significant factors in predicting asthma morbidity. They may need to be included in intervention programs aimed at decreasing asthma morbidity in inner-city children with asthma in order for these programs to be successful.

Obsessive–compulsive disorder: subclassification based on co-morbidity

PubMed Central

Nestadt, G.; Di, C. Z.; Riddle, M. A.; Grados, M. A.; Greenberg, B. D.; Fyer, A. J.; McCracken, J. T.; Rauch, S. L.; Murphy, D. L.; Rasmussen, S. A.; Cullen, B.; Pinto, A.; Knowles, J. A.; Piacentini, J.; Pauls, D. L.; Bienvenu, O. J.; Wang, Y.; Liang, K. Y.; Samuels, J. F.; Roche, K. Bandeen

2011-01-01

Background Obsessive–compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes. Method Seven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated. Results Two and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive disorder (MDD) is the most frequent additional disorder; (2) an OCD co-morbid tic-related class, in which tics are prominent and affective syndromes are considerably rarer; and (3) an OCD co-morbid affective-related class in which PD and affective syndromes are highly represented. The OCD co-morbid tic-related class is predominantly male and characterized by high conscientiousness. The OCD co-morbid affective-related class is predominantly female, has a young age at onset, obsessive–compulsive personality disorder (OCPD) features, high scores on the ‘taboo’ factor of OCD symptoms, and low conscientiousness. Conclusions OCD can be classified into three classes based on co-morbidity. Membership within a class is differentially associated with other clinical characteristics. These classes, if replicated, should have important implications for research and clinical endeavors. PMID:19046474

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue.

PubMed

Friedman, Alexander M; Ananth, Cande V; Huang, Yongmei; D'Alton, Mary E; Wright, Jason D

2016-12-01

In the setting of persistently high risk for maternal death and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. The objectives of this analysis were (1) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States and (2) to characterize, by hospital volume, the risk for death in the setting of severe obstetric morbidity, a concept known as failure to rescue. This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998-2010. The main outcome measures were (1) severe morbidity that was defined as a composite of any 1 of 15 diagnoses that are representative of acute organ injury and critical illness and (2) failure to rescue that was defined as death in the setting of severe morbidity. The prevalence of severe morbidity rose from 471.2-751.5 cases per 100,000 deliveries from 1998-2010, which was an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models that were adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared with other factors was relatively small. Although low-and high-delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in the determination of outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data

PubMed Central

2011-01-01

Background Co-morbidity information derived from administrative data needs to be validated to allow its regular use. We assessed evolution in the accuracy of coding for Charlson and Elixhauser co-morbidities at three time points over a 5-year period, following the introduction of the International Classification of Diseases, 10th Revision (ICD-10), coding of hospital discharges. Methods Cross-sectional time trend evaluation study of coding accuracy using hospital chart data of 3'499 randomly selected patients who were discharged in 1999, 2001 and 2003, from two teaching and one non-teaching hospital in Switzerland. We measured sensitivity, positive predictive and Kappa values for agreement between administrative data coded with ICD-10 and chart data as the 'reference standard' for recording 36 co-morbidities. Results For the 17 the Charlson co-morbidities, the sensitivity - median (min-max) - was 36.5% (17.4-64.1) in 1999, 42.5% (22.2-64.6) in 2001 and 42.8% (8.4-75.6) in 2003. For the 29 Elixhauser co-morbidities, the sensitivity was 34.2% (1.9-64.1) in 1999, 38.6% (10.5-66.5) in 2001 and 41.6% (5.1-76.5) in 2003. Between 1999 and 2003, sensitivity estimates increased for 30 co-morbidities and decreased for 6 co-morbidities. The increase in sensitivities was statistically significant for six conditions and the decrease significant for one. Kappa values were increased for 29 co-morbidities and decreased for seven. Conclusions Accuracy of administrative data in recording clinical conditions improved slightly between 1999 and 2003. These findings are of relevance to all jurisdictions introducing new coding systems, because they demonstrate a phenomenon of improved administrative data accuracy that may relate to a coding 'learning curve' with the new coding system. PMID:21849089

Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data.

PubMed

Januel, Jean-Marie; Luthi, Jean-Christophe; Quan, Hude; Borst, François; Taffé, Patrick; Ghali, William A; Burnand, Bernard

2011-08-18

Co-morbidity information derived from administrative data needs to be validated to allow its regular use. We assessed evolution in the accuracy of coding for Charlson and Elixhauser co-morbidities at three time points over a 5-year period, following the introduction of the International Classification of Diseases, 10th Revision (ICD-10), coding of hospital discharges. Cross-sectional time trend evaluation study of coding accuracy using hospital chart data of 3'499 randomly selected patients who were discharged in 1999, 2001 and 2003, from two teaching and one non-teaching hospital in Switzerland. We measured sensitivity, positive predictive and Kappa values for agreement between administrative data coded with ICD-10 and chart data as the 'reference standard' for recording 36 co-morbidities. For the 17 the Charlson co-morbidities, the sensitivity - median (min-max) - was 36.5% (17.4-64.1) in 1999, 42.5% (22.2-64.6) in 2001 and 42.8% (8.4-75.6) in 2003. For the 29 Elixhauser co-morbidities, the sensitivity was 34.2% (1.9-64.1) in 1999, 38.6% (10.5-66.5) in 2001 and 41.6% (5.1-76.5) in 2003. Between 1999 and 2003, sensitivity estimates increased for 30 co-morbidities and decreased for 6 co-morbidities. The increase in sensitivities was statistically significant for six conditions and the decrease significant for one. Kappa values were increased for 29 co-morbidities and decreased for seven. Accuracy of administrative data in recording clinical conditions improved slightly between 1999 and 2003. These findings are of relevance to all jurisdictions introducing new coding systems, because they demonstrate a phenomenon of improved administrative data accuracy that may relate to a coding 'learning curve' with the new coding system.

Compression of Morbidity and Mortality: New Perspectives1

PubMed Central

Stallard, Eric

2017-01-01

Compression of morbidity is a reduction over time in the total lifetime days of chronic disability, reflecting a balance between (1) morbidity incidence rates and (2) case-continuance rates—generated by case-fatality and case-recovery rates. Chronic disability includes limitations in activities of daily living and cognitive impairment, which can be covered by long-term care insurance. Morbidity improvement can lead to a compression of morbidity if the reductions in age-specific prevalence rates are sufficiently large to overcome the increases in lifetime disability due to concurrent mortality improvements and progressively higher disability prevalence rates with increasing age. Compression of mortality is a reduction over time in the variance of age at death. Such reductions are generally accompanied by increases in the mean age at death; otherwise, for the variances to decrease, the death rates above the mean age at death would need to increase, and this has rarely been the case. Mortality improvement is a reduction over time in the age-specific death rates and a corresponding increase in the cumulative survival probabilities and age-specific residual life expectancies. Mortality improvement does not necessarily imply concurrent compression of mortality. This paper reviews these concepts, describes how they are related, shows how they apply to changes in mortality over the past century and to changes in morbidity over the past 30 years, and discusses their implications for future changes in the United States. The major findings of the empirical analyses are the substantial slowdowns in the degree of mortality compression over the past half century and the unexpectedly large degree of morbidity compression that occurred over the morbidity/disability study period 1984–2004; evidence from other published sources suggests that morbidity compression may be continuing. PMID:28740358

Complication Rates of Ostomy Surgery Are High and Vary Significantly Between Hospitals

PubMed Central

Sheetz, Kyle H.; Waits, Seth A.; Krell, Robert W.; Morris, Arden M.; Englesbe, Michael J.; Mullard, Andrew; Campbell, Darrell A.; Hendren, Samantha

2014-01-01

Structured Abstract Background Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement. Objective To evaluate the variation in outcomes after ostomy creation surgery within Michigan in order to identify targets for quality improvement. Design Retrospective cohort study. Setting The 34-hospital Michigan Surgical Quality Collaborative (MSQC). Patients Patients undergoing ostomy creation surgery between 2006-2011. Main outcome measures We evaluated hospitals' morbidity and mortality rates after risk-adjustment (age, comorbidities, emergency v. elective, procedure type). Results 4,250 patients underwent ostomy creation surgery; 3,866 (91.0%) procedures were open and 384 (9.0%) were laparoscopic. Unadjusted morbidity and mortality rates were 43.9% and 10.7%, respectively. Unadjusted morbidity rates for specific procedures ranged from 32.7% for ostomy-creation-only procedures to 47.8% for Hartmann's procedures. Risk-adjusted morbidity rates varied significantly between hospitals, ranging from 31.2% (95%CI 18.4-43.9) to 60.8% (95%CI 48.9-72.6). There were five statistically-significant high-outlier hospitals and three statistically-significant low-outlier hospitals for risk-adjusted morbidity. The pattern of complication types was similar between high- and low-outlier hospitals. Case volume, operative duration, and use of laparoscopic surgery did not explain the variation in morbidity rates across hospitals. Conclusions Morbidity and mortality rates for modern ostomy surgery are high. While this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an opportunity to identify quality improvement practices that could be disseminated among hospitals. PMID:24819104

Depression and anxiety in multisomatoform disorder: prevalence and clinical predictors in primary care.

PubMed

Muller, Jacqueline E; Wentzel, Ignatius; Nel, Daniel G; Stein, Dan J

2008-06-01

Multisomatoform disorder (MSD) is characterised by > or = 3 medically inexplicable, troublesome physical symptoms, together with a > or = 2-year history of somatisation. The aim of this study was to evaluate the prevalence of depressive and anxiety disorders in a South African sample MSD, and to compare demographic and clinical outcomes in those patients with and without co-morbidity. Fifty-one adult outpatients with MSD were recruited from primary care clinics in the Cape Town metropolitan area. Participants were assessed for the presence of co-morbid depressive and anxiety disorders using the Mini Neuropsychiatric Interview-Plus (MINI-Plus). Outcomes included somatic symptom severity, disability, reported sick days and health care visits, pain experience, patient satisfaction with health services, and clinician-experienced difficulty. A current co-morbid depressive disorder was present in 29.4% (N = 15) of patients, and a current co-morbid anxiety disorder in 52.9% (N = 27). MSD patients with a co-morbid depressive disorder (current or lifetime) had significantly higher physical symptom counts, greater functional impairment, higher unemployment rates, more clinician-reported difficulties, and more dissatisfaction with health care services than those without the disorder. A larger number of co-morbid disorders was associated with greater overall disability. High rates of co-morbid depressive and anxiety disorders were present in a South African sample of primary care patients with MSD. Not all patients had co-morbidity, which is consistent with the view that MSD should be viewed as an independent disorder. However, co-morbid depressive disorders were associated with increased symptom severity and functional impairment, consistent with previous reports from developing countries, emphasising the importance of comorbidity in MSD.

Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality.

PubMed

Simonsen, Rikke Kildevæld; Giraldi, Annamaria; Kristensen, Ellids; Hald, Gert Martin

2016-01-01

There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978-2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978-2010. Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.

A descriptive model of preventability in maternal morbidity and mortality.

PubMed

Geller, S E; Cox, S M; Kilpatrick, S J

2006-02-01

To develop a descriptive model of preventability for maternal morbidity and mortality that can be used in quality assurance and morbidity and mortality review processes. This descriptive study was part of a larger case-control study conducted at the University of Illinois at Chicago in which maternal deaths were cases and women with severe maternal morbidity served as controls. Morbidities and mortalities were classified by a team of clinicians as preventable or not preventable. Qualitative analysis of data was conducted to identify and categorize different types of preventable events. Of 237 women, there were 79 women with preventable events attributable to provider or system factors. The most common types of preventable events were inadequate diagnosis/recognition of high-risk (54.4%), treatment (38.0%), and documentation (30.7%). A descriptive model was illustrated that can be used to categorize preventable events in maternal morbidity and mortality and can be incorporated into quality assurance and clinical case review to enhance the monitoring of hospital-based obstetric care and to decrease medical error.

A prospective study of morbidity patterns in a petroleum refinery and chemical plant.

PubMed Central

Tsai, S P; Dowd, C M; Cowles, S R; Ross, C E

1992-01-01

This study examined the morbidity experience from 1981 to 1988 of a prospective cohort of 3422 refinery and petrochemical plant employees from the Shell Deer Park manufacturing complex. The morbidity data for this study, which include all illness and absence records in excess of five days, were extracted from the morbidity section of the Shell health surveillance system. Standardised morbidity ratios (SMRs) of disease prevalence in this cohort were calculated using an internal comparison group of all manufacturing employees of the Shell Oil Company. Among production employees, the overall morbidity was statistically significantly higher (SMR = 109) than that of the comparison group. Illness due to hypertension (SMR = 144), haemorrhoids (SMR = 149), diseases of the nervous system (SMR = 120), respiratory system (SMR = 108), and digestive system (SMR = 117) were also raised for this group. The increased risk due to these medical conditions does not appear to be associated with occupational factors. Lymphatic and haematopoietic tissue neoplasms were raised (SMR = 124), but were based on only four cases. PMID:1637713

Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults.

PubMed

Schoenberg, Nancy E; Kim, Hyungsoo; Edwards, William; Fleming, Steven T

2007-08-01

On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults. We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiple-morbidity constellations on these expenses. We paid particular attention to the most common disease constellations - hypertension, arthritis, and heart disease. An increasing prevalence of multiple morbidity (58% compared with 70% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-of-pocket expenditures (2,164 dollars in 1998, increasing by 104% to 3,748 dollars in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41%, 85%, and 100%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations. Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders.

Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review.

PubMed

Reilly, J J; Kelly, J

2011-07-01

The last systematic review on the health consequences of child and adolescent obesity found little evidence on consequences for adult health. The present study aimed to summarize evidence on the long-term impact of child and adolescent obesity for premature mortality and physical morbidity in adulthood. Systematic review with evidence searched from January 2002 to June 2010. Studies were included if they contained a measure of overweight and/or obesity between birth and 18 years (exposure measure) and premature mortality and physical morbidity (outcome) in adulthood. Five eligible studies examined associations between overweight and/or obesity, and premature mortality: 4/5 found significantly increased risk of premature mortality with child and adolescent overweight or obesity. All 11 studies with cardiometabolic morbidity as outcomes reported that overweight and obesity were associated with significantly increased risk of later cardiometabolic morbidity (diabetes, hypertension, ischaemic heart disease, and stroke) in adult life, with hazard ratios ranging from 1.1-5.1. Nine studies examined associations of child or adolescent overweight and obesity with other adult morbidity: studies of cancer morbidity were inconsistent; child and adolescent overweight and obesity were associated with significantly increased risk of later disability pension, asthma, and polycystic ovary syndrome symptoms. A relatively large and fairly consistent body of evidence now demonstrates that overweight and obesity in childhood and adolescence have adverse consequences on premature mortality and physical morbidity in adulthood.

Nomogram for 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.

PubMed

Nieuwenhuyzen-de Boer, G M; Gerestein, C G; Eijkemans, M J C; Burger, C W; Kooi, G S

2016-01-01

Extensive surgical procedures to achieve maximal cytoreduction in patients with advanced stage epithelial ovarian cancer (EOC) are inevitably associated with postoperative morbidity and mortality. This study aimed to identify preoperative predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC and to develop a nomogram for individual risk assessment. Patients in The Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007. All peri- and postoperative complications within 30 days after surgery were registered and classified. To investigate predictors of 30-day morbidity, a Cox proportional hazard model with backward stepwise elimination was utilized. The identified predictors were entered into a nomogram. The main outcome was to identify parameters that predict operative risk. 293 patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. Thirty-day morbidity was seen in 99 (34%) patients. Morbidity could be predicted by age (p = 0.033; OR 1.024), preoperative hemoglobin (p = 0.194; OR 0.843), and WHO performance status (p = 0.015; OR 1.821) with a optimism-corrected c-statistic of 0.62. Determinants co-morbidity status, serum CA125 level, platelet count, and presence of ascites were comparable in both groups. Thirty-day morbidity after primary cytoreductive surgery for advanced stage EOC could be predicted by age, hemoglobin, and WHO performance status. The generated nomogram could be valuable for predicting operative risk in the individual patient.

Prediction of survival without morbidity for infants born at under 33 weeks gestational age: a user-friendly graphical tool.

PubMed

Shah, Prakesh S; Ye, Xiang Y; Synnes, Anne; Rouvinez-Bouali, Nicole; Yee, Wendy; Lee, Shoo K

2012-03-01

To develop models and a graphical tool for predicting survival to discharge without major morbidity for infants with a gestational age (GA) at birth of 22-32 weeks using infant information at birth. Retrospective cohort study. Canadian Neonatal Network data for 2003-2008 were utilised. Neonates born between 22 and 32 weeks gestation admitted to neonatal intensive care units in Canada. Survival to discharge without major morbidity defined as survival without severe neurological injury (intraventricular haemorrhage grade 3 or 4 or periventricular leukomalacia), severe retinopathy (stage 3 or higher), necrotising enterocolitis (stage 2 or 3) or chronic lung disease. Of the 17 148 neonates who met the eligibility criteria, 65% survived without major morbidity. Sex and GA at birth were significant predictors. Birth weight (BW) had a significant but non-linear effect on survival without major morbidity. Although maternal information characteristics such as steroid use, improved the prediction of survival without major morbidity, sex, GA at birth and BW for GA predicted survival without major morbidity almost as accurately (area under the curve: 0.84). The graphical tool based on the models showed how the GA and BW for GA interact, to enable prediction of outcomes especially for small and large for GA infants. This graphical tool provides an improved and easily interpretable method to predict survival without major morbidity for very preterm infants at the time of birth. These curves are especially useful for small and large for GA infants.

Forecast Model Analysis for the Morbidity of Tuberculosis in Xinjiang, China

PubMed Central

Zheng, Yan-Ling; Zhang, Li-Ping; Zhang, Xue-Liang; Wang, Kai; Zheng, Yu-Jian

2015-01-01

Tuberculosis is a major global public health problem, which also affects economic and social development. China has the second largest burden of tuberculosis in the world. The tuberculosis morbidity in Xinjiang is much higher than the national situation; therefore, there is an urgent need for monitoring and predicting tuberculosis morbidity so as to make the control of tuberculosis more effective. Recently, the Box-Jenkins approach, specifically the autoregressive integrated moving average (ARIMA) model, is typically applied to predict the morbidity of infectious diseases; it can take into account changing trends, periodic changes, and random disturbances in time series. Autoregressive conditional heteroscedasticity (ARCH) models are the prevalent tools used to deal with time series heteroscedasticity. In this study, based on the data of the tuberculosis morbidity from January 2004 to June 2014 in Xinjiang, we establish the single ARIMA (1, 1, 2) (1, 1, 1)12 model and the combined ARIMA (1, 1, 2) (1, 1, 1)12-ARCH (1) model, which can be used to predict the tuberculosis morbidity successfully in Xinjiang. Comparative analyses show that the combined model is more effective. To the best of our knowledge, this is the first study to establish the ARIMA model and ARIMA-ARCH model for prediction and monitoring the monthly morbidity of tuberculosis in Xinjiang. Based on the results of this study, the ARIMA (1, 1, 2) (1, 1, 1)12-ARCH (1) model is suggested to give tuberculosis surveillance by providing estimates on tuberculosis morbidity trends in Xinjiang, China. PMID:25760345

Preoperative factors influencing mortality and morbidity in peptic ulcer perforation.

PubMed

Sivaram, P; Sreekumar, A

2018-04-01

Perforated peptic ulcer is one of the most common surgical emergencies worldwide. With the improvement in medical therapy for peptic ulcers, the number of elective surgical procedures has come down. However, the incidence of perforated peptic ulcer is still increasing and remains as a substantial health problem with significant postoperative morbidity and mortality. This study aimed to find out the association between various preoperative and intraoperative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation. This prospective observational study had a time based sample of 101 perforation peritonitis cases admitted to the surgical wards of a tertiary care center from February 2015 to January 2016 who underwent laparotomy, diagnosed to have peptic ulcer perforation and underwent simple closure with an omental patch. Data regarding age, gender, presenting complaints, time elapsed from the onset of symptoms to surgery, physical examination findings, comorbid diseases, laboratory and imaging findings, intraoperative findings, length of hospital stay, postoperative morbidity, and mortality were recorded and analyzed. Female gender, older age group, perforation surgery interval more than 36 h, and size of perforation more than 1 cm 2 were found to be significant factors influencing postoperative mortality and morbidity. Postoperative morbidity was also associated with comorbid diseases. Abnormal renal function on presentation was identified as an additional risk factor for postoperative morbidity and longer hospital stay. An understanding of these factors, identification of patients at risk and early intervention can help in reducing the postoperative morbidity and mortality in peptic ulcer perforation.

Increased detection of co-morbidities with evaluation at a dedicated adult Turner syndrome clinic.

PubMed

Vincent, A J; Nguyen, H H; Ranasinha, S; Vollenhoven, B

2017-10-01

Turner syndrome (TS), resulting from complete/partial X chromosomal monosomy, is associated with multiple co-morbidities and increased mortality. Although multidisciplinary management is recommended, TS women's health care is sub-optimal. This study evaluates a multidisciplinary adult TS service. Retrospective cohort study of 82 patients attending the quarterly TS clinic from December 2003 to December 2014. Evaluation included (1) demographics, (2) TS standardized co-morbidity screening, and (3) estrogen therapy use. Data analysis involved frequency statistics, T tests and polychoric correlation analysis. Median age at TS diagnosis was 14 years (range 0-65 years), with 12% of women aged >18 years. Median age at initial consultation was 31 years (range 16-65 years). Only 14% of patients were transition program referrals. XO karyotype occurred in 30%. Primary amenorrhea predominated; however, 37% of TS women were not taking estrogen therapy. The proportion of patients not previously screened (44-76%) and those with positive screening diagnoses (5-53%) varied according to co-morbidity. The mean (± standard deviation) number of co-morbidities identified increased following TS clinic screening (7.0 ± 2.6 post-screening vs. 4.4 ± 2.3 pre-screening; p < 0.0001). Polychoric correlation analysis identified particular co-morbidity groupings (including metabolism-related) and increased co-morbidities with primary amenorrhea. A multidisciplinary adult TS clinic improves health surveillance with increased identification of co-morbidities and initiation of estrogen therapy.

Analysis of risk factors for postoperative morbidity in perforated peptic ulcer.

PubMed

Kim, Jae-Myung; Jeong, Sang-Ho; Lee, Young-Joon; Park, Soon-Tae; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Ha, Woo-Song

2012-03-01

Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications. While several studies have investigated the impact of perioperative risk factors and underlying diseases on the postoperative morbidity after abdominal surgery, only a few have analyzed their role in perforated peptic ulcer disease. The purpose of this study was to determine any possible associations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 142 consecutive patients, who underwent surgery for perforated peptic ulcer, at a single institution, between January 2005 and October 2010 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. The postoperative morbidity rate associated with perforated peptic ulcer operations was 36.6% (52/142). Univariate analysis revealed that a long operating time, the open surgical method, age (≥60), sex (female), high American Society of Anesthesiologists (ASA) score and presence of preoperative shock were significant perioperative risk factors for postoperative morbidity. Significant comorbid risk factors included hypertension, diabetes mellitus and pulmonary disease. Multivariate analysis revealed a long operating time, the open surgical method, high ASA score and the presence of preoperative shock were all independent risk factors for the postoperative morbidity in perforated peptic ulcer. A high ASA score, preoperative shock, open surgery and long operating time of more than 150 minutes are high risk factors for morbidity. However, there is no association between postoperative morbidity and comorbid disease in patients with a perforated peptic ulcer.

Surgery for prosthetic valve endocarditis: associations between morbidity, mortality and costs†

PubMed Central

Grubitzsch, Herko; Christ, Torsten; Melzer, Christoph; Kastrup, Marc; Treskatsch, Sascha; Konertz, Wolfgang

2016-01-01

OBJECTIVES Surgery for prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality as well as with increased resource utilization and costs. For risk and cost reduction, an understanding of contributing factors and interrelations is essential. METHODS Out of 1080 heart valve procedures performed between January 2010 and December 2012, 41 patients underwent surgery for PVE. Complete economic data were available for 30 of them (study cohort). The patients' mean age was 64 ± 12 years (range 37–79 years), and 73% were men. The clinical course was reviewed and morbidity, mortality and costs as well as associations between them were analysed. The cost matrix for each individual patient was obtained from the Institute for the Hospital Remuneration System (InEK GmbH, Germany). The median follow-up was 2.6 years [interquartile range (IQR) 3.7 years; 100% complete]. RESULTS Preoperative status was critical (EuroSCORE II >20%) in 43% of patients. Staphylococci were the most common infecting micro-organisms (27%). The operative mortality rate (≤30 days) was 17%. At 1 year, the overall survival rate was 71 ± 9%. At least one disease- or surgery-related complication affected 21 patients (early morbidity 70%), >1 complication affected 12 patients (40%). There was neither a recurrence of endocarditis, nor was a reoperation required. The mean total hospital costs were 42.6 ± 37.4 Thousand Euro (T€), median 25.7 T€, IQR 28.4 T€ and >100 T€ in 10% of cases. Intensive care unit/intermediate care (ICU/IMC) and operation accounted for 40.4 ± 18.6 and 25.7 ± 12.1% of costs, respectively. There was a significant correlation (Pearson's sample correlation coefficient) between total costs and duration of hospital stay (r = 0.83, P < 0.001) and between ICU/IMC costs and duration of ICU/IMC stay (r = 0.97, P < 0.001). The median daily hospital costs were 1.8 T€/day, but >2.4 T€/day in 25% of patients (upper quartile). The following pattern of associations was identified (P < 0.05). Early mortality was related to preoperative morbidity and postoperative renal failure. Early morbidity was associated with preoperative morbidity and urgency. Total costs were mainly explained by preoperative morbidity, postoperative morbidity and urgency. High EuroSCORE II, complex surgery, need for mechanical circulatory support as well as postoperative mortality and morbidity increased daily costs. CONCLUSIONS The timely diagnosis and treatment of these patients must be a priority, as preoperative morbidity is the major contributor towards mortality, morbidity and costs after surgery for PVE. PMID:26965513

REDUCTION IN ASTHMA MORBIDITY IN CHILDREN AS A RESULT OF HOME REMEDIATION AIMED AT MOISTURE SOURCES

EPA Science Inventory

Objective: Home dampness, presence of mold and allergens have been associated with asthma morbidity. We examined changes in asthma morbidity in children as a result of home remediation aimed at moisture sources.

Design: Prospective, randomized controlled trial.

Part...

[Study of allergic morbidity in children of female workers from various fields of national economy].

PubMed

Khakimova, R F; Dautov, F F; Iusupova, N Z

2007-01-01

To study the factors contributing to the development of allergic disease in children has recently become of current importance. To determine the indirect influence of maternal working environmental factors on allergic morbidity in children, the authors have examined the working conditions and morbidity of female workers engaged in that or that field of national economy and the health status and allergic diseases in children. The variance analysis was made. The proposed guidelines allow one to study the indirect influence of working environmental factors on allergic morbidity in children.

[The morbidity of population temporary disability in the Russian Federation].

PubMed

Shchepin, V O

2012-01-01

The article presents the results of calculation and analysis of structure and rate of temporary disability morbidity in the Russian Federation in 2007-2010. The quality assessment of the indicators of temporary disability morbidity is given. The financial volumes of work losses and costs of medical care and disease social insurance are established. The significant gender differences in rate and temporary disability duration are demonstrated. The issues demanding a specific approach during the development of activities targeted to prevention and decrease of temporary disability morbidity are discussed.

Treating co-morbid chronic medical conditions and anxiety/depression.

PubMed

Cimpean, D; Drake, R E

2011-06-01

This systematic review examines interventions for care of people with co-morbid chronic medical illness and anxiety/depression disorders--a group with high risks for morbidity and mortality. Systematic search of Medline 1995 to January 2011 for randomized controlled trials of treatment interventions designed for adult outpatients with diagnosed chronic medical illness (diabetes mellitus, cardiovascular disorders, and chronic respiratory disorders) and anxiety/depression disorders. Six trials studied complex interventions based on the chronic care model, and eight trials studied psychosocial interventions. Most interventions addressed the mental health aspect of the co-morbidity and showed improvements in anxiety/depression but not in the co-morbid medical disorder. Further research might focus on interventions integrating mental health treatment with enhanced medical care components, incorporating shared-decision making and information technology advances.

Experiences with severe maternal morbidity: a qualitative study on the perception of women.

PubMed

Silva, Daniela Vitti Ribeiro da; Silveira, Maria de Fátima de Araújo; Gomes-Sponholz, Flávia Azevedo

2016-01-01

to know and analyze the experiences of women who developed an episode of Severe Maternal Morbidity. this is a qualitative study, in which we interviewed 16 women admitted to a tertiary level hospital, as a result of this morbid state. We used content analysis in data processing. two categories were identified: "Understanding maternal morbidity as a negative presence" and "Moving ahead: on constant alert". The interviewees mentioned negative aspects, such as treatment difficulties and hospitalization, feelings of fear, concern for the fetus, frustration with the idealized pregnancy, trauma; and positive aspects, such as learning and the expression of the divine will in the experience of illness. effective care during the prenatal period, delivery and postpartum period should provide adequate support for the prevention and assistance in Severe Maternal Morbidity.

Gender Differences in the Association Between Morbidity and Mortality Among Middle-Aged Men and Women

PubMed Central

Guéguen, Alice; Ferrie, Jane; Shipley, Martin; Martikainen, Pekka; Bonenfant, Sébastien; Goldberg, Marcel; Marmot, Michael

2008-01-01

Objectives. We examined gender differences in mortality, morbidity, and the association between the 2. Methods. We used health data from 2 studies of middle-aged men and women: the British Whitehall II cohort of employees from 20 civil service departments in London and the 1989 French GAZEL (this acronym refers to the French gas and electric companies) of employees of France's national gas and electricity company. Participants were aged 35 to 55 years when assessed for morbidity and followed up for mortality over 17 years. Results. Male mortality was higher than female mortality in Whitehall II (hazard ratio [HR] = 1.56; 95% confidence interval [CI] = 1.28, 1.91) and the GAZEL cohort (HR = 1.99; CI = 1.66, 2.40). Female excess morbidity was observed for some measures in the Whitehall II data and for 1 measure in the GAZEL data. Only self-reported sickness absence in the Whitehall II data was more strongly associated with mortality among men (P = .01). Conclusions. Mortality was lower among women than among men, but morbidity was not consistently higher. The lack of gender differences in the association between morbidity and mortality suggests that this is not a likely explanation for the gender paradox, which refers to higher morbidity but lower mortality among women than among men. PMID:18235071

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study.

PubMed

Neves, Amanda Gonçalves; Kasawara, Karina Tamy; Godoy-Miranda, Ana Carolina; Oshika, Flávio Hideki; Chaim, Elinton Adami; Surita, Fernanda Garanhani

2017-10-01

The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.

Independent predictors of morbidity and mortality in blunt colon trauma.

PubMed

Ricciardi, R; Paterson, C A; Islam, S; Sweeney, W B; Baker, S P; Counihan, T C

2004-01-01

We sought to determine the impact of (1) grade of the colon injury, (2) the formation of an ostomy, and (3) associated injuries on outcomes such as morbidity and mortality after blunt colon injuries. We retrospectively reviewed 16,814 cases of blunt abdominal trauma. Patients with colonic injuries were selected and charts reviewed for demographic, clinical, and outcomes data. Injuries were grouped by the Colon Injury Scale (grades I-V). Independent risk factors of morbidity included spine and lung injuries, as well as increased age. A higher grade of colon injury trended toward a significant association with intra-abdominal complications. Independent risk factors of mortality included liver, heart, and lung injuries, as well as intracerebral blood and female gender. The grade of colon injury, the formation of an ostomy, and management of the colon trauma did not independently predict increased intra-abdominal complications, morbidity, or mortality. These results indicate that patients afflicted with blunt colon trauma experience a high rate of morbidity and mortality from associated injuries and or increased age. Treatment regimens directed at these factors will be most helpful in reducing the high morbidity and mortality after blunt colon trauma. Factors such as ostomy formation and management strategy are not associated with increased morbidity or mortality after blunt colon trauma.

Changes in morbidity and medical care utilization after the recent economic crisis in the Republic of Korea.

PubMed

Kim, Hanjoong; Chung, Woo Jin; Song, Young Jong; Kang, Dae Ryong; Yi, Jee Jeon; Nam, Chung Mo

2003-01-01

To examine and quantify the impact of the recent economic crisis on morbidity and medical care utilization in the Republic of Korea. 22 675 people from 6791 households and 43 682 people from 12 283 households were questioned for two nationwide surveys that took place in 1995 and 1998, respectively. A separate sample pretest-posttest design was used and we conducted c2 test and logistic regression analysis after controlling for the maturation effect of the morbidity and medical care utilization. The morbidity rates of chronic disease and acute disease increased significantly by 27.1% and 9.5%, respectively, whereas the utilization rates of outpatient and inpatient services decreased by 15.1% and 5.2%, respectively. In particular, the pace of decline in the utilization rate of outpatient services varied depending on the type of disease: morbidity rates for mental and behavioural disorders were 13.7%; for cardiovascular disease, 7.1%; and for injury, 31.6%. After the Republic of Korean economic crisis, the morbidity and medical care utilization rates changed significantly but the degree of change depended on the type of disease or service. The time-dependent relationship between the national economy and the morbidity and medical care utilization rates needs to be further investigated.

Early Maladaptive Schemas and Cognitive Distortions in Adults with Morbid Obesity: Relationships with Mental Health Status

PubMed Central

da Luz, Felipe Q.; Sainsbury, Amanda; Hay, Phillipa; Roekenes, Jessica A.; Swinbourne, Jessica; da Silva, Dhiordan C.; da S. Oliveira, Margareth

2017-01-01

Dysfunctional cognitions may be associated with unhealthy eating behaviors seen in individuals with obesity. However, dysfunctional cognitions commonly occur in individuals with poor mental health independently of weight. We examined whether individuals with morbid obesity differed with regard to dysfunctional cognitions when compared to individuals of normal weight, when mental health status was controlled for. 111 participants—53 with morbid obesity and 58 of normal weight—were assessed with the Mini-Mental State Examination, Young Schema Questionnaire, Cognitive Distortions Questionnaire, Depression, Anxiety and Stress Scale, and a Demographic and Clinical Questionnaire. Participants with morbid obesity showed higher scores in one (insufficient self-control/self-discipline) of 15 early maladaptive schemas and in one (labeling) of 15 cognitive distortions compared to participants of normal weight. The difference between groups for insufficient self-control/self-discipline was not significant when mental health status was controlled for. Participants with morbid obesity showed more severe anxiety than participants of normal weight. Our findings did not show clinically meaningful differences in dysfunctional cognitions between participants with morbid obesity or of normal weight. Dysfunctional cognitions presented by individuals with morbid obesity are likely related to their individual mental health and not to their weight. PMID:28264484

[Human papillomavirus infection and cervical intraepithelial neoplasia morbidity of women from different occupations in Shenzhen city, China].

PubMed

Tang, Hui-ru; Zhou, Yan-qiu; Wu, Lan-na; Liu, Zhi-hong; Zhang, Li-jie; Wu, Rui-fang

2007-10-01

To investigate the human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) morbidity of women from different occupations in Shenzhen city. 2045 women of five kinds of occupation in Shenzhen city, including 130 teachers, 385 workers, 316 service women, 199 poverish women, 420 doctors or nurses and 595 general residents were included. We screened these women by methods of detecting high risk HPV of hc2 combing with LCT. Women with screening positive results were diagnosed CIN by colposcopic biopsy. (1) High risk factors on HPV infection rate in different occupations were different with the highest in service occupation (19.3%) while the lowest appeared in medical workers (11.9%). (2) In those 2045 women, we found 199 cervical lesions including pathological HPV infection, CIN1, 2, 3 and cervical cancers, with morbidity rates as 4.11%, 3.28%, 1.67%, 0.54% and 0.15% respectively. Along with the progress of the cervical lesions, the morbidity decreased. (3) The morbidity rates of CIN in different occupations were different, with the highest of HSIL in service occupation and the lowest in teachers. Women of different occupations in Shenzhen city had different high risk HPV infection rates and CIN morbidity. The HPV infection rate and HSIL morbidity were highest among women having service related jobs.

Perceived gynecological morbidity among young ever-married women living in squatter settlements of Karachi, Pakistan.

PubMed

Sajan, F; Fikree, F F

1999-04-01

Community-based information on obstetric and gynecological morbidity in developing countries is meager and nearly non-existent in Pakistan. To estimate the prevalence of specific gynecological morbidities and investigate the predictors of pelvic inflammatory disease. Users [404] and non-users [313] of modern contraceptives were identified from eight squatter settlements of Karachi, Pakistan and detailed information on basic demographics, contraceptive use, female mobility, decision-making and gynecological morbidities were elicited. The perceived prevalence of menstrual disorders were 45.3%, uterine prolapse 19.1%, pelvic inflammatory disease 12.8% and urinary tract infection 5.4%. The magnitude of gynecological morbidity was high with about 55% of women reporting at least one gynecological morbidity though fewer [20%] reported at least two gynecological morbidities. Significant predictors of pelvic inflammatory disease were intrauterine contraceptive device users (OR = 3.1; 95% CI 1.7-5.6), age < or = 20 years (OR = 2.3; 95% CI 1.1-4.8) and urban life style (OR = 2.1; 95% CI 1.0-4.6). There is an immense burden of reproductive ill-health and a significant association between ever users of intrauterine contraceptive device and pelvic inflammatory disease. We therefore suggest improvement in the quality of reproductive health services generally, but specifically for family planning services.

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease

PubMed Central

Taş, İlhan; Ülger, Burak Veli; Önder, Akın; Kapan, Murat; Bozdağ, Zübeyir

2015-01-01

Objective: Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. Material and Methods: Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. Results: The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. Conclusion: Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation. PMID:25931940

Risk factors influencing morbidity and mortality in perforated peptic ulcer disease.

PubMed

Taş, İlhan; Ülger, Burak Veli; Önder, Akın; Kapan, Murat; Bozdağ, Zübeyir

2015-01-01

Peptic ulcer perforation continues to be a major surgical problem. In this study, risk factors that influence morbidity and mortality in perforated peptic ulcer disease were examined. Files of 148 patients who were included in the study due to peptic ulcer perforation between January 2006 and December 2010 were retrospectively analyzed. Data regarding age, gender, complaints, time elapsed between onset of symptoms and hospital admission, physical examination findings, co-morbid diseases, laboratory and imaging findings, length of hospital stay, morbidity and mortality were recorded. The study group included 129 (87.2%) male and 19 (12.8%) female patients. The mean age was 51.7±20 (15-88) years. Forty five patients (30.4%) had at least one co-morbid disease. In the postoperative period, 30 patients (20.3%) had complications. The most common complication was wound infection. Mortality was observed in 27 patients (18.2%). The most common cause of mortality was sepsis. Multivariate analysis revealed age over 60 years, presence of co-morbidities and Mannheim peritonitis index as independent risk factors for morbidity. Age over 60 years, time to admission and Mannheim peritonitis index were detected as independent risk factors for mortality. Early diagnosis and proper treatment are important in patients presenting with peptic ulcer perforation.

Psychiatric morbidity and its correlates among informal caregivers of older adults.

PubMed

Vaingankar, Janhavi Ajit; Chong, Siow Ann; Abdin, Edimansyah; Picco, Louisa; Shafie, Saleha; Seow, Esmond; Pang, Shirlene; Sagayadevan, Vathsala; Chua, Boon Yiang; Chua, Hong Choon; Subramaniam, Mythily

2016-07-01

This present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions. Data from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who 'knew the older adult best' and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ score

Congenital syphilis: trends in mortality and morbidity in the United States, 1999 through 2013.

PubMed

Su, John R; Brooks, Lesley C; Davis, Darlene W; Torrone, Elizabeth A; Weinstock, Hillard S; Kamb, Mary L

2016-03-01

Congenital syphilis (CS) results when an infected pregnant mother transmits syphilis to her unborn child prior to or at delivery. The severity of infection can range from a delivery at term without signs of infection to stillbirth or death after delivery. We sought to describe CS morbidity and mortality during 1999 through 2013. National CS case data reported to Centers for Disease Control and Prevention during 1999 through 2013 were analyzed. Cases were classified as dead (stillbirths and deaths up to 12 months after delivery), morbid (cases with strong [physical, radiographic, and/or nonserologic laboratory] evidence of CS), and nonmorbid (cases with a normal physical examination reported, without strong evidence of infection). Annual rates of these cases were calculated. Cases were compared using selected maternal and infant criteria. During 1999 through 2013, 6383 cases of CS were reported: 6.5% dead, 33.6% morbid, 53.9% nonmorbid, and 5.9% unknown morbidity; 81.8% of dead cases were stillbirths. Rates of dead, morbid, and nonmorbid cases all decreased over this time period, but the overall proportions that were dead or morbid cases did not significantly change. The overall case fatality ratio during 1999 through 2013 was 6.5%. Among cases of CS, maternal race/ethnicity was not associated with increased morbidity or death, although most cases (83%) occurred among black or Hispanic mothers. No or inadequate treatment for maternal syphilis, <10 prenatal visits, and maternal nontreponemal titer ≥1:8 increased the likelihood of a dead case; risk of a dead case increased with maternal nontreponemal titer (χ(2) for trend P < .001). Infants with CS born alive at <28 weeks' gestation (relative risk, 107.4; P < .001) or born weighing <1500 g (relative risk, 43.9; P < .001) were at greatly increased risk of death. CS remains an important preventable cause of perinatal morbidity and mortality, with comparable case fatality ratios during 1999 through 2013 (6.5%) and 1992 through 1998 (6.4%). Detection and treatment of syphilis early during pregnancy remain crucial to reducing CS morbidity and mortality. Published by Elsevier Inc.

Prevalence and Impact of Co-morbidity Burden as Defined by the Charlson Co-morbidity Index on 30-Day and 1- and 5-Year Outcomes After Coronary Stent Implantation (from the Nobori-2 Study).

PubMed

Mamas, Mamas A; Fath-Ordoubadi, Farzin; Danzi, Gian B; Spaepen, Erik; Kwok, Chun Shing; Buchan, Iain; Peek, Niels; de Belder, Mark A; Ludman, Peter F; Paunovic, Dragica; Urban, Philip

2015-08-01

Co-morbidities have typically been considered as prevalent cardiovascular risk factors and cardiovascular diseases rather than systematic measures of general co-morbidity burden in patients who underwent percutaneous coronary intervention (PCI). Charlson co-morbidity index (CCI) is a measure of co-morbidity burden providing a means of quantifying the prognostic impact of 22 co-morbid conditions on the basis of their number and prognostic impact. The study evaluated the impact of the CCI on cardiac mortality and major adverse cardiovascular events (MACE) after PCI through analysis of the Nobori-2 study. The prognostic impact of CCI was studied in 3,067 patients who underwent PCI in 4,479 lesions across 125 centers worldwide on 30-day and 1- and 5-year cardiac mortality and MACE. Data were adjusted for potential confounders using stepwise logistic regression; 2,280 of 3,067 patients (74.4%) had ≥1 co-morbid conditions. CCI (per unit increase) was independently associated with an increase in both cardiac death (odds ratio [OR] 1.47 95% confidence interval [CI] 1.20 to 1.80, p = 0.0002) and MACE (OR 1.29 95% CI 1.14 to 1.47, p ≤0.0011) at 30 days, with similar observations recorded at 1 and 5 years. CCI score ≥2 was independently associated with increased 30-day cardiac death (OR 4.25, 95% CI 1.24 to 14.56, p = 0.02) at 1 month, and this increased risk was also observed at 1 and 5 years. In conclusion, co-morbid burden, as measured using CCI, is an independent predictor of adverse outcomes in the short, medium, and long term. Co-morbidity should be considered in the decision-making process when counseling patients regarding the periprocedural risks associated with PCI, in conjunction with traditional risk factors. Copyright © 2015 Elsevier Inc. All rights reserved.

Socio-economic correlates of relapsed patients admitted in a Nigerian mental health institution.

PubMed

Gbiri, Caleb A; Badru, Fatai A; Ladapo, Harry T O; Gbiri, Adefolakemi A

2011-03-01

Relapse in psychiatric disorders is highly distressing, costly and engenders burn-out syndrome among mental-health workers. To study the socio-economic factors associated with relapse in individual admitted with psychiatric disorders and the pattern of socio-economic impact of relapse in those groups. A cross-sectional survey of all relapsed patients without cognitive deficit admitted into the federal Neuro-Psychiatric Hospital, Lagos, Nigeria between June and October 2007 was conducted using a self-validated Structured Interview Schedule (Relapse Socio-economic Impact Interview Schedule) and Key Informant Interview Guide. Secondary data were elicited from the patient folders, case notes, ward admission registers and nominal rolls. Data were summarised using mean, standard deviation, frequency and percentiles. Pearson's moment correlation coefficient was used to test the association among variables. The Mann-Whitney U-test was used to compare the pre-morbid and the post-morbid states. This study involved 102 respondents. Their mean age was 36.5 ± 9.8 years, mainly of male gender (72.5%) suffering from schizophrenic disorder (37.8%). Relapse and re-admission ranged between 2 and 12. Unemployment rate, marital separation and divorce increased more than 5-fold from pre-morbid to morbid states. Few (4.9%) could still settle their hospital/drug bills on their own, while most (95.1%) depended on family, philanthropist and government/waivers to pay for their bills. Their social relationships were negatively influenced with most of them expressing social isolation and low quality of life. There were significant relationships (P<0.05) between age, sex, number of relapses, number of admissions, pre-morbid marital status, morbid state marital status, pre-morbid state occupational status and morbid state occupational status. There was significant change (P= 0.00) in the quality of life, societal integration/acceptability, economic status, employment status and marital status of the respondents between the pre-morbid and post-morbid periods. The illness significantly affected the emotional status of the participants. Relapse and readmission in psychiatric patients have a negative impact on socio-economic well-being of patients, family and the society. Efforts should be taken to provide early interventions.

Thromboxane production in morbidly obese subjects.

PubMed

Graziani, Francesca; Biasucci, Luigi M; Cialdella, Pio; Liuzzo, Giovanna; Giubilato, Simona; Della Bona, Roberta; Pulcinelli, Fabio M; Iaconelli, Amerigo; Mingrone, Geltrude; Crea, Filippo

2011-06-01

Postmortem studies have demonstrated that morbidly obese subjects, surprisingly, have less coronary atherosclerosis than obese subjects. However, the reasons for this apparent protection from atherosclerosis are not yet clear. Thromboxane A2, a marker of platelet activation, is greater in obese subjects than in lean subjects, and this might be a clue to their increased cardiovascular risk. However, data on thromboxane A2 in morbidly obese subjects are lacking; therefore, we hypothesized that lower levels of thromboxane A2 in morbidly obese subjects might play a role in their lower atherothrombotic burden. We measured the serum levels of thromboxane B2 (TxB2), a stable metabolite of thromboxane A2, high-sensitivity C-reactive protein (hs-CRP) and leptin in 17 lean subjects (body mass index [BMI] 22.9 ± 1.6 kg/m(2)), 25 obese subjects (BMI 32.6 ± 2.4 kg/m(2)), and 23 morbidly obese subjects (BMI 48.6 ± 7.1 kg/m(2)), without insulin resistance, diabetes, or overt cardiovascular disease. The serum TxB2 levels were lower in the lean subjects than in the obese subjects (p = 0.046) and in the morbidly obese subjects than in the lean and obese subjects (p = 0.015 and p <0.001, respectively). In contrast, the hs-CRP and leptin levels were greater in the obese than in the lean subjects (hs-CRP, p <0.001; leptin, p <0.001) and in the morbidly obese subjects than in the lean subjects (p <0.001 for both). Leptin was also higher in the morbidly obese subjects than in the obese subjects (p <0.001). TxB2 negatively correlated with leptin and BMI. hs-CRP correlated with leptin, and both also correlated with waist circumference, BMI, and homeostasis model assessment of insulin-resistance. In conclusion, insulin-sensitive morbidly obese subjects had lower levels of TxB2 than the obese subjects and lean subjects, suggesting that reduced platelet activation could play a role in the paradoxical protection of morbidly obese subjects from atherosclerosis, despite the greater levels of leptin. Copyright © 2011 Elsevier Inc. All rights reserved.

Gastric Fluid Volume Change After Oral Rehydration Solution Intake in Morbidly Obese and Normal Controls: A Magnetic Resonance Imaging-Based Analysis.

PubMed

Shiraishi, Toshie; Kurosaki, Dai; Nakamura, Mitsuyo; Yazaki, Taiji; Kobinata, Satomi; Seki, Yosuke; Kasama, Kazunori; Taniguchi, Hideki

2017-04-01

Although preoperative fluid intake 2 hours before anesthesia is generally considered safe, there are concerns about delayed gastric emptying in obese subjects. In this study, the gastric fluid volume (GFV) change in morbidly obese subjects was investigated after ingesting an oral rehydration solution (ORS) and then compared with that in nonobese subjects. GFV change over time after the ingestion of 500 mL of ORS containing 2.5% carbohydrate (OS-1) was measured in 10 morbidly obese subjects (body mass index [BMI], >35) scheduled for bariatric surgery and 10 nonobese (BMI, 19-24) using magnetic resonance imaging. After 9 hours of fasting, magnetic resonance imaging scans were performed at preingestion, 0 min (just after ingestion), and every 30 minutes up to 120 minutes. GFV values were compared between morbidly obese and control groups and also between preingestion and postingestion time points. The morbidly obese group had a significantly higher body weight and BMI than the control group (mean body weight and BMI in morbidly obese, 129.6 kg and 46.3 kg/m, respectively; control, 59.5 kg and 21.6 kg/m, respectively). GFV was significantly higher in the morbidly obese subjects compared with the control group at preingestion (73 ± 30.8 mL vs 31 ± 19.9 mL, P = .001) and at 0 minutes after ingestion (561 ± 30.8 mL vs 486 ± 42.8 mL; P < .001). GFV declined rapidly in both groups and reached fasting baseline levels by 120 minutes (morbidly obese, 50 ± 29.5 mL; control, 30 ± 11.6 mL). A significant correlation was observed between preingestion residual GFV and body weight (r = .66; P = .001). Morbidly obese subjects have a higher residual gastric volume after 9 hours of fasting compared with subjects with a normal BMI. However, no differences were observed in gastric emptying after ORS ingestion in the 2 populations, and GFVs reached baseline within 2 hours after ORS ingestion. Further studies are required to confirm whether the preoperative fasting and fluid management that are recommended for nonobese patients could also be applied to morbidly obese patients.

Non-cancer morbidity among Estonian Chernobyl cleanup workers: a register-based cohort study

PubMed Central

Rahu, Kaja; Bromet, Evelyn J; Hakulinen, Timo; Auvinen, Anssi; Uusküla, Anneli; Rahu, Mati

2014-01-01

Objective To examine non-cancer morbidity in the Estonian Chernobyl cleanup workers cohort compared with the population sample with special attention to radiation-related diseases and mental health disorders. Design Register-based cohort study. Setting Estonia. Participants An exposed cohort of 3680 men (cleanup workers) and an unexposed cohort of 7631 men (population sample) were followed from 2004 to 2012 through the Population Registry and Health Insurance Fund database. Methods Morbidity in the exposed cohort compared with the unexposed controls was estimated in terms of rate ratio (RR) with 95% CIs using Poisson regression models. Results Elevated morbidity in the exposed cohort was found for diseases of the nervous system, digestive system, musculoskeletal system, ischaemic heart disease and for external causes. The most salient excess risk was observed for thyroid diseases (RR=1.69; 95% CI 1.38 to 2.07), intentional self-harm (RR=1.47; 95% CI 1.04 to 2.09) and selected alcohol-related diagnoses (RR=1.25; 95% CI 1.12 to 1.39). No increase in morbidity for stress reactions, depression, headaches or sleep disorders was detected. Conclusions No obvious excess morbidity consistent with biological effects of radiation was seen in the exposed cohort, with the possible exception of benign thyroid diseases. Increased alcohol-induced morbidity may reflect alcohol abuse, and could underlie some of the higher morbidity rates. Mental disorders in the exposed cohort were probably under-reported. The future challenge will be to study mental and physical comorbidities in the Chernobyl cleanup workers cohort. PMID:24833681

The Influence of Co-Morbidity and Other Health Measures on Dental and Medical Care Use among Medicare beneficiaries 2002

PubMed Central

Chen, Haiyan; Moeller, John; Manski, Richard J.

2011-01-01

Objective To assess the impact of co-morbidity and other health measures on the use of dental and medical care services among the community-based Medicare population with data from the 2002 Medicare Current Beneficiary Survey. Methods A co-morbidity index is the main independent variable of our study. It includes oral cancer as a co-morbidity condition and was developed from Medicare claims data. The two outcome variables indicate whether a beneficiary had a dental visit during the year and whether the beneficiary had an inpatient hospital stay during the year. Logistic regressions estimated the relationship between the outcome variables and co-morbidity after controlling for other explanatory variables. Results High scores on the co-morbidity index, high numbers of self-reported physical limitations, and fair or poor self-reported health status were correlated with higher hospital use and lower dental care utilization. Similar results were found for other types of medical care including medical provider visits, outpatient care, and prescription drugs. A multiple imputation technique was used for the approximate 20% of the sample with missing claims, but the resulting co-morbidity index performed no differently than the index constructed without imputation. Conclusions Co-morbidities and other health status measures are theorized to play either a predisposing or need role in determining health care utilization. The study’s findings confirm the dominant role of these measures as predisposing factors limiting access to dental care for Medicare beneficiaries and as need factors producing higher levels of inpatient hospital and other medical care for Medicare beneficiaries. PMID:21972460

[WHO programs "Acute Myocardial Infarction Register", MONICA: thirty years (1977-2006) of epidemiological studies of myocardial infarction in a high-risk population].

PubMed

Gafarov, V V; Gafarova, A V

2011-01-01

To reveal 30 year (1977-2006) trends of myocardial infarction (MI) morbidity, lethality and mortality in population of the West Siberia megapolis (Novosibirsk). WHO programs "Acute Myocardial Infarction Register (AMIR) and MONICA covered 3 districts of Novosibirsk. MI morbidity in 25-64 year old population of Novosibirsk (high-risk population) in Russia is one of the highest in the world. MI morbidity was stable for 30 years excluding in 1988, 1994 and 1998 when it rose and in 2002-2004, 2006 when it lowered. Changes in mortality and lethality resemble changes in morbidity trend excluding 1977-1978 (fall) and 2002-2005 (rise). Prehospital mortality and lethality were much higher than those in hospital. Mortality and lethality in 1988, 1994, 1998 and 2002-2005 increased due to prehospital lethality and mortality, while it decreased in 1977-1978 due to hospital one. Reduction of mortality and lethality in stable MI morbidity shows improvement of medical care for MI patients, increased lethality and mortality in MI morbidity decline reflect deterioration of such care. Changes in behavioral and somatic factors of cardiovascular risk in population of Novosibirsk for 30 years were not observed while psychosocial risk factors gain a significant importance. By indirect indications, MI morbidity, mortality and lethality mark growing social stress in the population. MI mortality is 2-3 times higher than that of alcohol and is a basic factor of mortality increase in the population of Russia. MI morbidity, mortality and lethality are markers of social stress in population.

A review of co-morbid tobacco and cannabis use disorders: possible mechanisms to explain high rates of co-use.

PubMed

Rabin, Rachel Allison; George, Tony Peter

2015-03-01

Tobacco and cannabis are among the most commonly used psychoactive substances worldwide, and are often used in combination. Evidence suggests that tobacco use contributes to an increased likelihood of becoming cannabis dependent and similarly cannabis use promotes transition to more intensive tobacco use. Further, tobacco use threatens cannabis cessation attempts leading to increased and accelerated relapse rates among cigarette smokers. Given that treatment outcomes are far from satisfactory among individuals engaged in both tobacco and cannabis use highlights the need for further exploration of this highly prevalent co-morbidity. Therefore, this review will elucidate putative neurobiological mechanisms responsible for facilitating the link between co-morbid tobacco and cannabis use. We performed an extensive literature search identifying published studies that examined co-morbid tobacco and cannabis use. Evidence of both synergistic and compensatory effects of co-morbid tobacco and cannabis use have been identified. Following, co-morbid use of these substances will be discussed within the context of two popular theories of addiction: the addiction vulnerability hypothesis and the gateway hypothesis. Lastly, common route of administration is proposed as a facilitator for co-morbid use. While, only a paucity of treatment studies addressing co-morbid tobacco and cannabis use have been conducted, emerging evidence suggests that simultaneously quitting both tobacco and cannabis may yield benefits at both the psychological and neurobiological level. More research is needed to confirm this intervention strategy and future studies should consider employing prospective systematic designs. © American Academy of Addiction Psychiatry.

Analysis of Risk Factors for Postoperative Morbidity in Perforated Peptic Ulcer

PubMed Central

Kim, Jae-Myung; Jeong, Sang-Ho; Park, Soon-Tae; Choi, Sang-Kyung; Hong, Soon-Chan; Jung, Eun-Jung; Ju, Young-Tae; Jeong, Chi-Young; Ha, Woo-Song

2012-01-01

Purpose Emergency operations for perforated peptic ulcer are associated with a high incidence of postoperative complications. While several studies have investigated the impact of perioperative risk factors and underlying diseases on the postoperative morbidity after abdominal surgery, only a few have analyzed their role in perforated peptic ulcer disease. The purpose of this study was to determine any possible associations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. Materials and Methods In total, 142 consecutive patients, who underwent surgery for perforated peptic ulcer, at a single institution, between January 2005 and October 2010 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. Results The postoperative morbidity rate associated with perforated peptic ulcer operations was 36.6% (52/142). Univariate analysis revealed that a long operating time, the open surgical method, age (≥60), sex (female), high American Society of Anesthesiologists (ASA) score and presence of preoperative shock were significant perioperative risk factors for postoperative morbidity. Significant comorbid risk factors included hypertension, diabetes mellitus and pulmonary disease. Multivariate analysis revealed a long operating time, the open surgical method, high ASA score and the presence of preoperative shock were all independent risk factors for the postoperative morbidity in perforated peptic ulcer. Conclusions A high ASA score, preoperative shock, open surgery and long operating time of more than 150 minutes are high risk factors for morbidity. However, there is no association between postoperative morbidity and comorbid disease in patients with a perforated peptic ulcer. PMID:22500261

Morbidity and Mortality Weekly Report. Volume 60, Number 23

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2011

2011-01-01

The "Morbidity and Mortality Weekly Report" ("MMWR") Series is prepared by the Centers for Disease Control and Prevention (CDC). Data presented by the Notifiable Disease Data Team and 122 Cities Mortality Data Team in the weekly "MMWR" are provisional, based on weekly reports to CDC by state health departments. This issue of "Morbidity and…

Suicide Attempts and Severe Psychiatric Morbidity among Former Child Welfare Clients--A National Cohort Study

ERIC Educational Resources Information Center

Vinnerljung, Bo; Hjern, Anders; Lindblad, Frank

2006-01-01

Background: Few large sample studies have examined psychiatric morbidity among former child welfare/protection clients. In this study, risks for suicide attempts and severe psychiatric morbidity in younger years were assessed for former child welfare clients in ten national birth cohorts, comparing them with general population peers and…

Perioperative morbidity associated with abdominal myomectomy compared with total abdominal hysterectomy for uterine fibroids.

PubMed

Pundir, J; Walawalkar, R; Seshadri, S; Khalaf, Y; El-Toukhy, T

2013-10-01

The aim of the study was to systematically review and summarise existing evidence related to the perioperative morbidity associated with abdominal myomectomy in comparison with abdominal hysterectomy for uterine fibroids. A review of MEDLINE and EMBASE was carried out. The primary outcome was the major morbidity rate and secondary outcomes were uterine size, estimated blood loss, blood transfusion, operating time and duration of hospital stay. The results identified six observational studies including 1520 participants. All studies scored moderately on the N-OQA scale and were limited to a uterine size of up to 18 weeks. There was no significant difference in the rate of major morbidity (RR 0.94; 95% CI = 0.31, 2.81; p = 0.91) between the two operations. It was concluded that based on variable quality data from retrospective cohort studies, abdominal myomectomy and hysterectomy appear to have similar major morbidity rates for the uterine size up to 16-18 weeks. Well-designed trials with a standardised morbidity outcome and including uterine size greater than 18 weeks are required.

A one-year community study of under-fives in rural Ethiopia: health and behavioural determinants of morbidity.

PubMed

Muhe, L; Byass, P; Freij, L; Sandström, A; Wall, S

1996-07-01

Based on a one-year weekly home surveillance study, morbidity patterns of 1,304 children under five years of age in a rural Ethiopian community were measured, together with nutritional and health behavioural determinants. Using Poisson regression models, the study showed that nutritional and health care factors make a significant impact on under-five morbidity. Gastroenteritis was particularly associated with child care factors, while acute respiratory infections were particularly associated with nutritional factors. Lack of immunization, low birthweight and pre-term delivery (more than one month early) were not found to have any independent effect on morbidity. Breast feeding was universal, but the introduction of supplementary foods was found to protect from excess morbidity. The study concludes by discussing possible applications of the results in intervention programmes.

Understanding levels of morbidity and hospitalization in Kerala, India.

PubMed Central

Dilip, T. R.

2002-01-01

The prevalence of ailments and hospitalization in Kerala was examined using data from the 52 nd National Sample Survey Data on Health Care in Kerala in 1995-6. The survey included 24401 people from 4928 households. Age and seasonality had considerable effects on the morbidity of individuals. The burden of ill health was higher in rural areas than in urban areas. People who were more likely to have a better lifestyle had a higher level of morbidity and hospitalization. Regional differences were seen, with levels of morbidity and hospitalization higher in the comparatively developed regions of Southern Kerala than in Northern Kerala. Factors like physical accessibility of health care services and capacity to seek health care services could create artificial differences in morbidity and hospitalization among different subgroups of the population in Kerala. PMID:12378294

Morbidity profile of elderly outpatients attending selected sub-district Siddha health facilities in Tamil Nadu, India

PubMed Central

Selvaraj, Kalaiselvi; Srinivasan, Manikandan; Duraisamy, Venkatachalam; Ramaswamy, Gomathi; Venugopal, Vinayagamurthy; Chinnakali, Palanivel

2016-01-01

Background: Recently, under National Health Mission alternate systems of Medicine are mainstreamed in public health care system. Effective action plan generation, logistic arrangement and roll out of these alternate systems of Medicine needs understanding on profile of morbidities among attendees who come to these facilities. Objectives: This study was planned to report profile of morbidities, age and sex differentials in specific morbidities among geriatric attendees in secondary level siddha health facilities. Materials and Methods: A facility based cross sectional study was conducted among elderly person (60 years and above) attending Siddha outpatient department (OPD) from two of the randomly selected sub district level siddha facilities in Erode district, Tamil Nadu, India. Information on socio-demographic variables like age, gender, education and clinical profile (diagnosis) were collected from records already maintained in the siddha OPD. Morbidities were summarized in terms of proportions based on age and gender. Age and sex specific differentials on specific morbidities were compared using ‘z’ test. Results: Of 2710 patients who visited these two siddha facilities during the reference period, 763 (28.1%) patients were elderly. Arthritis (45.2%), neuritis (8.8%), diabetes (6.6%), bronchial asthma (5.2%), hemiplegia (3.7%) were the top five morbidities diagnosed and treated among elderly attending the siddha OPD. There was a predilection towards elderly male for morbidities such as bronchial asthma and hemiplegia compared to elderly female. Similarly, higher proportions of lumbar spondylosis, hypertension and fungal skin diseases were reported among aged 80 years or more compared to elderly aged 60-79 years. Conclusion: Elderly constitute more than one fourth of outpatients load from siddha health facilities. Degenerative diseases like arthritis and non-communicable diseases were the common morbidities in this age group. Geriatric clinics and mobile clinics under siddha system may help in improving health care services. PMID:27621518

Activity Behaviours in Lean and Morbidly Obese Pregnant Women.

PubMed

Fazzi, Caterina; Mohd-Shukri, Nor; Denison, Fiona C; Saunders, David H; Norman, Jane E; Reynolds, Rebecca M

2018-05-17

Interventions to increase physical activity in pregnancy are challenging for morbidly obese women. Targeting sedentary behaviours may be a suitable alternative to increase energy expenditure. We aimed to determine total energy expenditure, and energy expended in sedentary activities in morbidly obese and lean pregnant women. We administered the Pregnancy Physical Activity Questionnaire PPAQ (non-objective) and the Actical accelerometer (objective) to morbidly obese (BMI≥40kg/m²) and lean (BMI≤25Kg/M²) pregnant women recruited in early (<24 weeks), and late (≥24 weeks) gestation. Data are mean (SD). Morbidly obese pregnant women reported expending significantly more energy per day in early (n=140 vs 109; 3198.4 (1847.1) vs 1972.3 (10284.8) Kcal/day, p<0.0001) and late (n=104 vs 64; 3078.2 (1356.5) vs 1947.5 (652.0) Kcal/day, p<0.0001) pregnancy, and expended significantly more energy in sedentary activities, in early (816.1 (423.5) vs 540.1 (244.9) Kcal/day, p<0.0001) and late (881.6 (455.4) vs 581.1 (248.5) Kcal/day, p<0.0001) pregnancy, than lean pregnant women. No differences were observed in the proportion of energy expended sedentary between lean and morbidly obese pregnant women. The greater total energy expenditure in morbidly obese pregnant women was corroborated by Actical accelerometer in early (n=14 per group, obese 1167.7 (313.6) Kcal; lean 781.1 (210.1) Kcal, p<0.05), and in late (n=14 per group, obese 1223.6 (351.5) Kcal; lean 893.7 (175.9) Kcal, p<0.05) pregnancy. In conclusion, non-objective and objective measures showed morbidly obese pregnant women expended more energy per day than lean pregnant. Further studies are needed to determine whether sedentary behaviours are a suitable target for intervention in morbidly obese pregnancy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The Physiologic Effects of Pneumoperitoneum in the Morbidly Obese

PubMed Central

Nguyen, Ninh T.; Wolfe, Bruce M.

2005-01-01

Objective: To review the physiologic effects of carbon dioxide (CO2) pneumoperitoneum in the morbidly obese. Summary Background Data: The number of laparoscopic bariatric operations performed in the United States has increased dramatically over the past several years. Laparoscopic bariatric surgery requires abdominal insufflation with CO2 and an increase in the intraabdominal pressure up to 15 mm Hg. Many studies have demonstrated the adverse consequences of pneumoperitoneum; however, few studies have examined the physiologic effects of pneumoperitoneum in the morbidly obese. Methods: A MEDLINE search from 1994 to 2003 was performed using the key words morbid obesity, laparoscopy, bariatric surgery, pneumoperitoneum, and gastric bypass. The authors reviewed papers evaluating the physiologic effects of pneumoperitoneum in morbidly obese subjects undergoing laparoscopy. The topics examined included alteration in acid-base balance, hemodynamics, femoral venous flow, and hepatic, renal, and cardiorespiratory function. Results: Physiologically, morbidly obese patients have a higher intraabdominal pressure at 2 to 3 times that of nonobese patients. The adverse consequences of pneumoperitoneum in morbidly obese patients are similar to those observed in nonobese patients. Laparoscopy in the obese can lead to systemic absorption of CO2 and increased requirements for CO2 elimination. The increased intraabdominal pressure enhances venous stasis, reduces intraoperative portal venous blood flow, decreases intraoperative urinary output, lowers respiratory compliance, increases airway pressure, and impairs cardiac function. Intraoperative management to minimize the adverse changes include appropriate ventilatory adjustments to avoid hypercapnia and acidosis, the use of sequential compression devices to minimizes venous stasis, and optimize intravascular volume to minimize the effects of increased intraabdominal pressure on renal and cardiac function. Conclusions: Morbidly obese patients undergoing laparoscopic bariatric surgery are at risk for intraoperative complications relating to the use of CO2 pneumoperitoneum. Surgeons performing laparoscopic bariatric surgery should understand the physiologic effects of CO2 pneumoperitoneum in the morbidly obese and make appropriate intraoperative adjustments to minimize the adverse changes. PMID:15650630

Experience with 161 cases of anterior exposure of the thoracic and lumbar spine in an acute care surgery model: impact of exposure level and underlying pathology on morbidity.

PubMed

Seoudi, Hani; Laporta, Matthew; Griffen, Margaret; Rizzo, Anne; Pullarkat, Ranjit

2013-08-15

Retrospective chart review. To evaluate the outcomes of anterior exposure of the thoracic and lumbar spine by an acute care surgery service. Spine surgeons typically require an "approach surgeon" to provide anterior exposure of the thoracic and lumbar spine. We hypothesized that a dedicated acute care surgery service can perform those operations with acceptable morbidity and mortality. A retrospective review of 161 trauma and nontrauma patients was performed. All cases were performed at a level I trauma center with a dedicated acute care surgery service. In-hospital morbidity and mortality were evaluated. A brief description of the operative techniques used by our group is also provided. Of the 161 patients, 59 (37%) were trauma patients. Ninety-three patients (58%) had anterolateral retroperitoneal exposure of the thoracic and lumbar spine. Sixty-eight patients (42%) had anterior retroperitoneal midline exposure of the lumbar and lumbosacral spine. Total morbidity was 9.3% (7.4% for trauma patients and 1.8% for non trauma patients). Morbidity was highest in patients who had anterolateral exposure of the thoracic and lumbar spine (6.8%). Morbidity in patients who had midline exposure of L4 to S1 was 0%. Total mortality was 1.2% (3.3% for trauma patients and 0% for nontrauma patients). The acute care surgery service gained 3141 physician work relative value units (RVU) by performing those operations. Anterior exposure of the thoracic and lumbar spine both for trauma and nontrauma related indications can be performed with acceptable morbidity and mortality by a dedicated acute care surgery service. Morbidity and mortality were higher in trauma patients and in those who underwent thoracolumbar procedures. Patients who had midline exposure of L4 to S1 for degenerative disc disease had the lowest morbidity. 4.

Tobacco use and self-reported morbidity among rural Indian adults.

PubMed

Barik, Anamitra; Rai, Rajesh Kumar; Chowdhury, Abhijit

2016-09-01

Aim To measure the prevalence of self-reported morbidity and its associated factors among adults (aged ⩾15 years) in a select rural Indian population. Self-reporting of smoking has been validated as population-based surveys using self-reported data provide reasonably consistent estimates of smoking prevalence, and are generally considered to be sufficiently accurate for tracking the general pattern of morbidity associated with tobacco use in populations. However, to gauge the true disease burden using self-reported morbidity data requires cautious interpretation. During 2010-2011, a cross-sectional survey was conducted under the banner of the Health and Demographic Surveillance System, Birbhum, an initiative of the Department of Health and Family Welfare, Government of West Bengal, India. With over 93.6% response rate from the population living in 12 300 households, this study uses the responses from 16 354 individuals: 8012 smokers, and 8333 smokeless tobacco users. Smokers and smokeless tobacco users were asked whether they have developed any morbidity symptoms due to smoking, or smokeless tobacco use. Bivariate, as well as multivariate logistic regression analyses were deployed to attain the study objective. Findings Over 20% of smokers and over 9% of smokeless tobacco users reported any morbidity. Odds ratio (OR) with 95% confidence interval (CI) estimated using logistic regression shows that women are less likely to report any morbidity attributable to smoking (OR: 0.69; CI: 0.54-0.87), and more likely to report any morbidity due to smokeless tobacco use (OR: 1.68; CI: 1.36-2.09). Non-Hindus have higher odds, whereas the wealthiest respondents have lower odds of reporting any morbidity. With a culturally appropriate intervention to change behaviour, youth (both men and women) could be targeted with comprehensive tobacco cessation assistance programmes. A focussed intervention could be designed for unprocessed tobacco users to curb hazardous effects of tobacco use.

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

PubMed Central

Zhang, Ao; Liu, Tingting; Zheng, Kaiyuan; Liu, Ningbo; Huang, Fei; Li, Weidong; Liu, Tong; Fu, Weihua

2017-01-01

Abstract Laparoscopic colorectal surgery had been widely used for colorectal cancer patient and showed a favorable outcome on the postoperative morbidity rate. We attempted to evaluate physiological status of patients by mean of Estimation of physiologic ability and surgical stress (E-PASS) system and to analyze the difference variation of postoperative morbidity rate of open and laparoscopic colorectal cancer surgery in patients with different physiological status. In total 550 colorectal cancer patients who underwent surgery treatment were included. E-PASS and some conventional scoring systems were reviewed to examine their mortality prediction ability. The preoperative risk score (PRS) in the E-PASS system was used to evaluate the physiological status of patients. The difference of postoperative morbidity rate between open and laparoscopic colorectal cancer surgeries was analyzed respectively in patients with different physiological status. E-PASS had better prediction ability than other conventional scoring systems in colorectal cancer surgeries. Postoperative morbidities were developed in 143 patients. The parameters in the E-PASS system had positive correlations with postoperative morbidity. The overall postoperative morbidity rate of laparoscopic surgeries was lower than open surgeries (19.61% and 28.46%), but the postoperative morbidity rate of laparoscopic surgeries increased more significantly than in open surgery as PRS increased. When PRS was more than 0.7, the postoperative morbidity rate of laparoscopic surgeries would exceed the postoperative morbidity rate of open surgeries. The E-PASS system was capable to evaluate the physiological and surgical risk of colorectal cancer surgery. PRS could assist preoperative decision-making on the surgical method. Colorectal cancer patients who were assessed with a low physiological risk by PRS would be safe to undergo laparoscopic surgery. On the contrary, surgeons should make decisions prudently on the operation method for patient with a high physiological risk. PMID:28816959

Severe maternal morbidity and comorbid risk in hospitals performing <1000 deliveries per year.

PubMed

Hehir, Mark P; Ananth, Cande V; Wright, Jason D; Siddiq, Zainab; D'Alton, Mary E; Friedman, Alexander M

2017-02-01

While research has demonstrated increasing risk for severe maternal morbidity in the United States, risk at lower volume hospitals remains poorly characterized. More than half of all obstetric units in the United States perform <1000 deliveries per year and improving care at these hospitals may be critical to reducing risk nationwide. We sought to characterize maternal risk profiles and severe maternal morbidity at low-volume hospitals in the United States. We used data from the Nationwide Inpatient Sample to evaluate trends in severe maternal morbidity and comorbid risk during delivery hospitalizations in the United States from 1998 through 2011. Comorbid maternal risk was estimated using a comorbidity index validated for obstetric patients. Severe maternal morbidity was defined as the presence of any 1 of 15 diagnoses representative of acute organ injury and critical illness. A total of 2,300,279 deliveries occurred at hospitals with annual delivery volume <1000, representing 20% of delivery hospitalizations overall. There were 7849 cases (0.34%) of severe morbidity in low-volume hospitals and this risk increased over the course of the study from 0.25% in 1998 through 1999 to 0.49% in 2010 through 2011 (P < .01). The risk in hospitals with ≥1000 deliveries increased from 0.35-0.62% during the same time periods. The proportion of patients with the lowest comorbidity decreased, while the proportion of patients with highest comorbidity increased the most. The risk of severe morbidity increased across all women including those with low comorbidity scores. Risk for severe morbidity associated with obstetric hemorrhage, infection, hypertensive diseases of pregnancy, and medical conditions all increased during the study period. Our findings demonstrate increasing maternal risk at hospitals performing <1000 deliveries per year broadly distributed over the patient population. Rates of morbidity in centers with ≥1000 deliveries have also increased. These findings suggest that maternal safety improvements are necessary at all centers regardless of volume. Copyright © 2016 Elsevier Inc. All rights reserved.

Validation of a prediction model for predicting the probability of morbidity related to a trial of labour in Quebec.

PubMed

Chaillet, Nils; Bujold, Emmanuel; Dubé, Eric; Grobman, William A

2012-09-01

Pregnant women with a history of previous Caesarean section face the decision either to undergo an elective repeat Caesarean section (ERCS) or to attempt a trial of labour with the goal of achieving a vaginal birth after Caesarean (VBAC). Both choices are associated with their own risks of maternal and neonatal morbidity. We aimed to determine the external validity of a prediction model for the success of trial of labour after Caesarean section (TOLAC) that could help these women in their decision-making. We used a perinatal database including 185,437 deliveries from 32 obstetrical centres in Quebec between 2007 and 2011 and selected women with one previous Caesarean section who were eligible for a TOLAC. We compared the frequency of maternal and neonatal morbidity between women who underwent TOLAC and those who underwent an ERCS according to the probability of success of TOLAC calculated from a published model of prediction. Of 8508 eligible women, including 3113 who underwent TOLAC, both maternal and neonatal morbidities became less frequent as the predicted chance of VBAC increased (P < 0.05). Women undergoing a TOLAC were more likely to have maternal morbidity than those who underwent an ERCS when the predicted probability of VBAC was less than 60% (relative risk [RR] 2.3; 95% CI 1.4 to 4.0); conversely, maternal morbidity was not different between the two groups when the predicted probability of VBAC was at least 60% (RR 0.8; 95% CI 0.6 to 1.1). Neonatal morbidity was similar between groups when the probability of VBAC success was 70% or greater (RR 1.2; 95% CI 0.9 to 1.5). The use of a prediction model for TOLAC success could be useful in the prediction of TOLAC success and perinatal morbidity in a Canadian population. Neither maternal nor neonatal morbidity are increased with a TOLAC when the probability of VBAC success is at least 70%.

Complication rates of ostomy surgery are high and vary significantly between hospitals.

PubMed

Sheetz, Kyle H; Waits, Seth A; Krell, Robert W; Morris, Arden M; Englesbe, Michael J; Mullard, Andrew; Campbell, Darrell A; Hendren, Samantha

2014-05-01

Ostomy surgery is common and has traditionally been associated with high rates of morbidity and mortality, suggesting an important target for quality improvement. The purpose of this work was to evaluate the variation in outcomes after ostomy creation surgery within Michigan to identify targets for quality improvement. This was a retrospective cohort study. The study took place within the 34-hospital Michigan Surgical Quality Collaborative. Patients included were those undergoing ostomy creation surgery between 2006 and 2011. We evaluated hospital morbidity and mortality rates after risk adjustment (age, comorbidities, emergency vs elective, and procedure type). A total of 4250 patients underwent ostomy creation surgery; 3866 procedures (91.0%) were open and 384 (9.0%) were laparoscopic. Unadjusted morbidity and mortality rates were 43.9% and 10.7%. Unadjusted morbidity rates for specific procedures ranged from 32.7% for ostomy-creation-only procedures to 47.8% for Hartmann procedures. Risk-adjusted morbidity rates varied significantly between hospitals, ranging from 31.2% (95% CI, 18.4-43.9) to 60.8% (95% CI, 48.9-72.6). There were 5 statistically significant high-outlier hospitals and 3 statistically significant low-outlier hospitals for risk-adjusted morbidity. The pattern of complication types was similar between high- and low-outlier hospitals. Case volume, operative duration, and use of laparoscopic surgery did not explain the variation in morbidity rates across hospitals. This work was limited by its retrospective study design, by unmeasured variation in case severity, and by our inability to differentiate between colostomies and ileostomies because of the use of Current Procedural Terminology codes. Morbidity and mortality rates for modern ostomy surgery are high. Although this type of surgery has received little attention in healthcare policy, these data reveal that it is both common and uncommonly morbid. Variation in hospital performance provides an opportunity to identify quality improvement practices that could be disseminated among hospitals.

Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis.

PubMed

Kontopantelis, Evangelos; Mamas, Mamas A; van Marwijk, Harm; Ryan, Andrew M; Bower, Peter; Guthrie, Bruce; Doran, Tim

2018-02-14

Primary care provides the foundation for most modern health-care systems, and in the interests of equity, it should be resourced according to local need. We aimed to describe spatially the burden of chronic conditions and primary medical care funding in England at a low geographical level, and to measure how much variation in funding is explained by chronic condition prevalence and other patient and regional factors. We used multiple administrative data sets including chronic condition prevalence and management data (2014/15), funding for primary-care practices (2015-16), and geographical and area deprivation data (2015). Data were assigned to a low geographical level (average 1500 residents). We investigated the overall morbidity burden across 19 chronic conditions and its regional variation, spatial clustering and association with funding and area deprivation. A linear regression model was used to explain local variation in spending using patient demographics, morbidity, deprivation and regional characteristics. Levels of morbidity varied within and between regions, with several clusters of very high morbidity identified. At the regional level, morbidity was modestly associated with practice funding, with the North East and North West appearing underfunded. The regression model explained 39% of the variability in practice funding, but even after adjusting for covariates, a large amount of variability in funding existed across regions. High morbidity and, especially, rural location were very strongly associated with higher practice funding, while associations were more modest for high deprivation and older age. Primary care funding in England does not adequately reflect the contemporary morbidity burden. More equitable resource allocation could be achieved by making better use of routinely available information and big data resources. Similar methods could be deployed in other countries where comparable data are collected, to identify morbidity clusters and to target funding to areas of greater need.

Surgery for prosthetic valve endocarditis: associations between morbidity, mortality and costs.

PubMed

Grubitzsch, Herko; Christ, Torsten; Melzer, Christoph; Kastrup, Marc; Treskatsch, Sascha; Konertz, Wolfgang

2016-06-01

Surgery for prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality as well as with increased resource utilization and costs. For risk and cost reduction, an understanding of contributing factors and interrelations is essential. Out of 1080 heart valve procedures performed between January 2010 and December 2012, 41 patients underwent surgery for PVE. Complete economic data were available for 30 of them (study cohort). The patients' mean age was 64 ± 12 years (range 37-79 years), and 73% were men. The clinical course was reviewed and morbidity, mortality and costs as well as associations between them were analysed. The cost matrix for each individual patient was obtained from the Institute for the Hospital Remuneration System (InEK GmbH, Germany). The median follow-up was 2.6 years [interquartile range (IQR) 3.7 years; 100% complete]. Preoperative status was critical (EuroSCORE II >20%) in 43% of patients. Staphylococci were the most common infecting micro-organisms (27%). The operative mortality rate (≤30 days) was 17%. At 1 year, the overall survival rate was 71 ± 9%. At least one disease- or surgery-related complication affected 21 patients (early morbidity 70%), >1 complication affected 12 patients (40%). There was neither a recurrence of endocarditis, nor was a reoperation required. The mean total hospital costs were 42.6 ± 37.4 Thousand Euro (T€), median 25.7 T€, IQR 28.4 T€ and >100 T€ in 10% of cases. Intensive care unit/intermediate care (ICU/IMC) and operation accounted for 40.4 ± 18.6 and 25.7 ± 12.1% of costs, respectively. There was a significant correlation (Pearson's sample correlation coefficient) between total costs and duration of hospital stay (r = 0.83, P < 0.001) and between ICU/IMC costs and duration of ICU/IMC stay (r = 0.97, P < 0.001). The median daily hospital costs were 1.8 T€/day, but >2.4 T€/day in 25% of patients (upper quartile). The following pattern of associations was identified (P < 0.05). Early mortality was related to preoperative morbidity and postoperative renal failure. Early morbidity was associated with preoperative morbidity and urgency. Total costs were mainly explained by preoperative morbidity, postoperative morbidity and urgency. High EuroSCORE II, complex surgery, need for mechanical circulatory support as well as postoperative mortality and morbidity increased daily costs. The timely diagnosis and treatment of these patients must be a priority, as preoperative morbidity is the major contributor towards mortality, morbidity and costs after surgery for PVE. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Obstetrical referrals by traditional birth attendants.

PubMed

Mustafa, Rozina; Hashmi, Haleema; Mustafa, Rubina

2012-01-01

In Pakistan 90% of births are conducted by TBA's. In most cases, TBA's are unable to diagnose the complications and are often unable to take decisions on timely referral. The objective of this study was to determine the prevalence, nature and outcome of life threatening obstetrical conditions in referrals by Traditional Birth Attendants (TBAs). This Observational, Descriptive study was conducted from January to December 2007, in the obstetrical unit of Fatima Hospital, Baqai Medical University, a tertiary care community based hospital. The study included patients referred by TBA's who developed life threatening obstetric conditions (LTOCs). Total 64 patients were referred by TBA's. The prevalence was 7.8%. Out of them, 53 (82.8%) patients admitted with life threatening obstetric conditions. The near-miss morbidities and mortalities were 45 (84.9%) and 8 (15%) respectively. Maternal mortality to Near-miss morbidity ratio was 1:6. Obstructed labour caused near-miss morbidity in 32 (60.3%) patients with no mortality. Postpartum haemorrhage as life threatening condition developed in 16 (30.1%) patients with 10 (18.8%) near-miss morbidities and 6 (11.3%) mortalities. Puerperal sepsis accounted for 1 (1.88%) near-miss morbidity and 2 (3.76%) mortalities. The mortality index for puerperal sepsis is (66.6%) almost double of postpartum haemorrhage (37.5%). Mortality to near miss morbidity ratio is high. Misidentification and late referrals of complicated cases by TBA's were responsible for near-miss morbidities and mortalities.

Childhood obesity as a predictor of morbidity in adulthood: a systematic review and meta-analysis.

PubMed

Llewellyn, A; Simmonds, M; Owen, C G; Woolacott, N

2016-01-01

Obese children are at higher risk of being obese as adults, and adult obesity is associated with an increased risk of morbidity. This systematic review and meta-analysis investigates the ability of childhood body mass index (BMI) to predict obesity-related morbidities in adulthood. Thirty-seven studies were included. High childhood BMI was associated with an increased incidence of adult diabetes (OR 1.70; 95% CI 1.30-2.22), coronary heart disease (CHD) (OR 1.20; 95% CI 1.10-1.31) and a range of cancers, but not stroke or breast cancer. The accuracy of childhood BMI when predicting any adult morbidity was low. Only 31% of future diabetes and 22% of future hypertension and CHD occurred in children aged 12 or over classified as being overweight or obese. Only 20% of all adult cancers occurred in children classified as being overweight or obese. Childhood obesity is associated with moderately increased risks of adult obesity-related morbidity, but the increase in risk is not large enough for childhood BMI to be a good predictor of the incidence of adult morbidities. This is because the majority of adult obesity-related morbidity occurs in adults who were of healthy weight in childhood. Therefore, targeting obesity reduction solely at obese or overweight children may not substantially reduce the overall burden of obesity-related disease in adulthood. © 2015 World Obesity.

Economic Benefits and Costs of Human Milk Feedings: A Strategy to Reduce the Risk of Prematurity-Related Morbidities in Very-Low-Birth-Weight Infants123

PubMed Central

Johnson, Tricia J.; Patel, Aloka L.; Bigger, Harold R.; Engstrom, Janet L.; Meier, Paula P.

2014-01-01

Infants born at very low birth weight (VLBW; birth weight <1500 g) are at high risk of mortality and are some of the most expensive patients in the hospital. Additionally, VLBW infants are susceptible to prematurity-related morbidities, including late-onset sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and retinopathy of prematurity, which have short- and long-term economic consequences. The incremental cost of these morbidities during the neonatal intensive care unit (NICU) hospitalization is high, ranging from $10,055 (in 2009 US$) for late-onset sepsis to $31,565 for BPD. Human milk has been shown to reduce both the incidence and severity of some of these morbidities and, therefore, has an indirect impact on the cost of the NICU hospitalization. Furthermore, human milk may also directly reduce NICU hospitalization costs, independent of the indirect impact on the incidence and/or severity of these morbidities. Although there is an economic cost to both the mother and institution for providing human milk during the NICU hospitalization, these costs are relatively low. This review describes the total cost of the initial NICU hospitalization, the incremental cost associated with these prematurity-related morbidities, and the incremental benefits and costs of human milk feedings during critical periods of the NICU hospitalization as a strategy to reduce the incidence and severity of these morbidities. PMID:24618763

Economic benefits and costs of human milk feedings: a strategy to reduce the risk of prematurity-related morbidities in very-low-birth-weight infants.

PubMed

Johnson, Tricia J; Patel, Aloka L; Bigger, Harold R; Engstrom, Janet L; Meier, Paula P

2014-03-01

Infants born at very low birth weight (VLBW; birth weight <1500 g) are at high risk of mortality and are some of the most expensive patients in the hospital. Additionally, VLBW infants are susceptible to prematurity-related morbidities, including late-onset sepsis, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis, and retinopathy of prematurity, which have short- and long-term economic consequences. The incremental cost of these morbidities during the neonatal intensive care unit (NICU) hospitalization is high, ranging from $10,055 (in 2009 US$) for late-onset sepsis to $31,565 for BPD. Human milk has been shown to reduce both the incidence and severity of some of these morbidities and, therefore, has an indirect impact on the cost of the NICU hospitalization. Furthermore, human milk may also directly reduce NICU hospitalization costs, independent of the indirect impact on the incidence and/or severity of these morbidities. Although there is an economic cost to both the mother and institution for providing human milk during the NICU hospitalization, these costs are relatively low. This review describes the total cost of the initial NICU hospitalization, the incremental cost associated with these prematurity-related morbidities, and the incremental benefits and costs of human milk feedings during critical periods of the NICU hospitalization as a strategy to reduce the incidence and severity of these morbidities.

An examination of perceptions of individuals with an intellectual disability, with and without co-morbid schizophrenia: effects of labels on stigma.

PubMed

Rasdale, A R; Warman, D M; Phalen, P L

2018-06-01

Research demonstrates negative perceptions of individuals with intellectual disabilities (ID) and individuals with schizophrenia, but no study has examined ID with a co-morbid psychiatric disorder. The present study examined the social distance desired from and perceptions of dangerousness of ID, schizophrenia and co-morbid schizophrenia and ID and examined the impact of providing a label for the behaviours presented in a vignette. A total of 160 participants, all university students, were randomly assigned to one of six vignettes detailing a person with schizophrenia, ID, or a person with both presenting problems. Half of the participants were randomly assigned to read vignettes that had a label provided for the behaviours of the target. Participants desired more social distance from the unlabelled than labelled targets. Presence of schizophrenia resulted in increased social distance, but co-morbid ID and schizophrenia elicited less desire for social distance than schizophrenia alone. Schizophrenia resulted in more perceived danger, but labelled co-morbid schizophrenia and ID resulted in little perceived danger. Labels resulted in positive outcomes, particularly, when ID was co-morbid with schizophrenia. Schizophrenia stigma appears to be impacted by an ID label, indicating educating the public about the spectrum of co-morbidity may be useful. © 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Antidepressant Prescription Pattern in the Presence of Medical Co-morbidity: REAP-AD 2013 Study.

PubMed

Grover, S; Avasthi, A; Tripathi, A; Tanra, A J; Chee, K Y; He, Y L; Chiu, H Fk; Kuga, H; Lee, M S; Chong, M Y; Udormatn, P; Kanba, S; Yang, S Y; Si, T M; Sim, K; Tan, C H; Shen, W W; Xiang, Y T; Sartorius, N; Shinfuku, N

2015-09-01

To evaluate the prescription pattern of antidepressants in patients with medical co-morbidity from major psychiatric centres in Asia. The Research on Asian Psychotropic Prescription Pattern for Antidepressants (REAP-AD 2013) collected data from 42 psychiatric centres in 10 Asian countries and regions. Antidepressant prescriptions of 2320 patients with various psychiatric disorders were evaluated. Of these, 370 patients who had specified medical co-morbidities formed the study cohort. Escitalopram (20%) and mirtazapine (20%) were the most commonly prescribed antidepressants in patients with medical co-morbidity followed by sertraline (16%), trazodone (15%), and paroxetine (12%). Overall, more than half (52%; 247/476) of prescriptions comprised selective serotonin reuptake inhibitors. Slightly less than two-thirds (63%; n = 233) of patients received at least 1 selective serotonin reuptake inhibitor. In addition, 79% of patients were prescribed only 1 antidepressant. The mean number of antidepressants used per patient was 1.25 (standard deviation, 0.56). There were subtle differences in the most preferred antidepressant across medical illnesses such as diabetes mellitus, liver dysfunction, acid peptic disease, and cerebrovascular disease. Differences were also seen in prescription patterns across different countries. Although selective serotonin reuptake inhibitors formed the bulk of antidepressant prescriptions in the presence of medical co-morbidity, mirtazapine was also commonly used in the presence of medical co-morbidities. Specified medical morbidities do influence the selection of antidepressants.

New equations for predicting postoperative risk in patients with hip fracture.

PubMed

Hirose, Jun; Ide, Junji; Irie, Hiroki; Kikukawa, Kenshi; Mizuta, Hiroshi

2009-12-01

Predicting the postoperative course of patients with hip fractures would be helpful for surgical planning and risk management. We therefore established equations to predict the morbidity and mortality rates in candidates for hip fracture surgery using the Estimation of Physiologic Ability and Surgical Stress (E-PASS) risk-scoring system. First we evaluated the correlation between the E-PASS scores and postoperative morbidity and mortality rates in all 722 patients surgically treated for hip fractures during the study period (Group A). Next we established equations to predict morbidity and mortality rates. We then applied these equations to all 633 patients with hip fractures treated at seven other hospitals (Group B) and compared the predicted and actual morbidity and mortality rates to assess the predictive ability of the E-PASS and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems. The ratio of actual to predicted morbidity and mortality rates was closer to 1.0 with the E-PASS than the POSSUM system. Our data suggest the E-PASS scoring system is useful for defining postoperative risk and its underlying algorithm accurately predicts morbidity and mortality rates in patients with hip fractures before surgery. This information then can be used to manage their condition and potentially improve treatment outcomes. Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

[Morbidity observed in a health area: Impact on professionals and funding].

PubMed

de Miguel, Pablo; Caballero, Isabel; Rivas, Francisco Javier; Manera, Jaime; de Vicente, María Auxiliadora; Gómez, Ángel

2015-05-01

To analyze morbidity, in the context of a health area, and broken down by health centre, of patients who made contact with healthcare services, in order to propose an adjustment to finance the payment per capita. A descriptive study of morbidity observed in citizens assigned a health area during year 2010. SITE: Health Area 9. Autonomous Community of Madrid. Formed by the municipalities of Fuenlabrada, Humanes, and Moraleja de Enmedio. All levels of health care included. All citizens with health card assigned to a health center in the area who has maintained contact with the public health service's own area. Coded contact of patients are grouped using the Population Grouping Clinical Risk 3M TM Software (CRG). Each patient is included in a homogeneous and exclusive group with a numerical morbidity and clinical sense. Through the health card is known primary care centre, physician, age and sex. The distribution of morbidity is obtained by primary care centre, primary care physician, age and sex analyzing differences and combinations. It was found that the average values of the population morbidity are different in each primary care centre. In order to maintain the principle of equity in health care, it is suggested that an adjustment is made to the per capita payment based on the morbidity rate of the population. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Pattern of emergency neurologic morbidities in children.

PubMed Central

Ofovwe, Gabriel E.; Ibadin, Michael O.; Okunola, Peter O.; Ofoegbu, Bibian

2005-01-01

Neurologic morbidities seen in the children's emergency facility of the University of Benin Teaching Hospital, Nigeria, over a five-year period (July 1996-June 2001) was evaluated to determine the pattern and outcome. Notes and ward records of patients with neurologic morbidities were retrieved. Data obtained from these sources include age, sex principal diagnosis, duration of stay and outcome. Six-hundred-four out of 3,868 patients (15.6%) had neurologic morbidity. Children five years of age and under were 466 (77.2%), and modal age group was 1-2 years. Febrile convulsion was the most common neurologic morbidity seen (35.1%) followed by cerebral malaria (28.0%) and then meningitis (27.0%). An increased incidence of cases occurred during the rainy season. Sixty-four out of 406 with complete records (15.8%) died. Forty-seven (67.2%) died within 24 hours of admission. Cerebral malaria and meningitis accounted for all the deaths. Preventable infectious diseases are the major causes of emergency neurologic morbidities and mortality. The majority die within 24 hours largely due to a delay in presentation to the hospital. Effective malaria control and prevention of meningitis would reduce the incidence of neurologic morbidities and, if this is coupled with health education of the populace on the importance of attending health facility early, mortality from these causes would be greatly reduced. PMID:15871144

Morbidity and Hospitalizations of Adults with Down Syndrome

ERIC Educational Resources Information Center

Tenenbaum, Ariel; Chavkin, Maor; Wexler, Isaiah D.; Korem, Maya; Merrick, Joav

2012-01-01

Over the last decade a significant increase in the life expectancy of people with Down syndrome (DS) has been observed, which has caused a higher incidence of morbidity as they age. However, there is a lack of literature regarding morbidity and hospitalization of adults with DS. Analysis of 297 hospitalizations of 120 adults with DS aged 18-73…

Burden of Common Multiple-Morbidity Constellations on Out-of-Pocket Medical Expenditures among Older Adults

ERIC Educational Resources Information Center

Schoenberg, Nancy E.; Kim, Hyungsoo; Edwards, William; Fleming, Steven T.

2007-01-01

Purpose: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults. Design and Methods: We analyzed Health and Retirement Study data, determining…

Perinatal Morbidity and Mortality in Offsprings of Diabetic Mothers in Qatif, Saudi Arabia.

ERIC Educational Resources Information Center

Al-Dabbous, Ibrahim A. Al-; And Others

1995-01-01

Studied perinatal and neonatal morbidity and mortality of diabetic mothers and their offspring in Qatif, Saudi Arabia. Suggests diabetes mellitus in pregnancy may be a common problem in Saudi Arabia, as poor maternal diabetic control results in high perinatal morbidity and mortality. Results suggest that health education and improved coverage of…

Survival after postoperative morbidity: a longitudinal observational cohort study.

PubMed

Moonesinghe, S R; Harris, S; Mythen, M G; Rowan, K M; Haddad, F S; Emberton, M; Grocott, M P W

2014-12-01

Previous studies have suggested that there may be long-term harm associated with postoperative complications. Uncertainty exists however, because of the need for risk adjustment and inconsistent definitions of postoperative morbidity. We did a longitudinal observational cohort study of patients undergoing major surgery. Case-mix adjustment was applied and morbidity was recorded using a validated outcome measure. Cox proportional hazards modelling using time-dependent covariates was used to measure the independent relationship between prolonged postoperative morbidity and longer term survival. Data were analysed for 1362 patients. The median length of stay was 9 days and the median follow-up time was 6.5 yr. Independent of perioperative risk, postoperative neurological morbidity (prevalence 2.9%) was associated with a relative hazard for long-term mortality of 2.00 [P=0.001; 95% confidence interval (CI) 1.32-3.04]. Prolonged postoperative morbidity (prevalence 15.6%) conferred a relative hazard for death in the first 12 months after surgery of 3.51 (P<0.001; 95% CI 2.28-5.42) and for the next 2 yr of 2.44 (P<0.001; 95% CI 1.62-3.65), returning to baseline thereafter. Prolonged morbidity after surgery is associated with a risk of premature death for a longer duration than perhaps is commonly thought; however, this risk falls with time. We suggest that prolonged postoperative morbidity measured in this way may be a valid indicator of the quality of surgical healthcare. Our findings reinforce the importance of research and quality improvement initiatives aimed at reducing the duration and severity of postoperative complications. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

Antenatal risk factors associated with neonatal morbidity in large for gestational age infants: an international prospective cohort study.

PubMed

Vieira, Matias C; McCowan, Lesley Me; North, Robyn A; Myers, Jenny E; Walker, James J; Baker, Philip N; Dekker, Gustaaf A; Kenny, Louise C; Poston, Lucilla; Pasupathy, Dharmintra

2018-05-12

Large for gestational age (LGA) infants are associated with increased risk of neonatal morbidity and mortality, however most of them will not have adverse outcomes. Our aim was to identify antenatal clinical factors associated with neonatal morbidity in LGA infants. Nulliparous women from the Screening for Pregnancy Endpoints (SCOPE) study were included. We compared maternal and fetal factors between LGA infants (birthweight >90 th customized centile) with and without neonatal morbidity, defined as admission to neonatal intensive care unit or severe neonatal morbidity. Factors were selected based on a-priori hypotheses of association and included maternal demography, anthropometric measures and self-reported physical activity (15 and 20 weeks), fetal biometry (20 weeks), and clinical information. Multivariable logistic regression was used to identify risk factors. Stratified analyses were performed by maternal obesity and physical activity. Amongst term pregnancies, prevalence of LGA infants was 9.3% (491/5,255), with 11.8% (58/491) prevalence of neonatal morbidity. Random glucose at 20 weeks (OR 1.52; 95% CI1.17 to 1.97, per 1mmol/L increase) and no regular physical activity at 20 weeks (3.93; 1.75 to 8.83) were associated with increased risk of neonatal morbidity after adjustment for birthweight, gestational age at delivery and gestational diabetes. The increased risk associated with higher glucose levels was not evident in women with regular physical activity or without obesity. Regular physical activity in mid-pregnancy is associated with lower risk for neonatal morbidity in LGA infants and seems to offer protection against the increased risk associated with higher maternal glucose levels. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Non-cancer morbidity among Estonian Chernobyl cleanup workers: a register-based cohort study.

PubMed

Rahu, Kaja; Bromet, Evelyn J; Hakulinen, Timo; Auvinen, Anssi; Uusküla, Anneli; Rahu, Mati

2014-05-14

To examine non-cancer morbidity in the Estonian Chernobyl cleanup workers cohort compared with the population sample with special attention to radiation-related diseases and mental health disorders. Register-based cohort study. Estonia. An exposed cohort of 3680 men (cleanup workers) and an unexposed cohort of 7631 men (population sample) were followed from 2004 to 2012 through the Population Registry and Health Insurance Fund database. Morbidity in the exposed cohort compared with the unexposed controls was estimated in terms of rate ratio (RR) with 95% CIs using Poisson regression models. Elevated morbidity in the exposed cohort was found for diseases of the nervous system, digestive system, musculoskeletal system, ischaemic heart disease and for external causes. The most salient excess risk was observed for thyroid diseases (RR=1.69; 95% CI 1.38 to 2.07), intentional self-harm (RR=1.47; 95% CI 1.04 to 2.09) and selected alcohol-related diagnoses (RR=1.25; 95% CI 1.12 to 1.39). No increase in morbidity for stress reactions, depression, headaches or sleep disorders was detected. No obvious excess morbidity consistent with biological effects of radiation was seen in the exposed cohort, with the possible exception of benign thyroid diseases. Increased alcohol-induced morbidity may reflect alcohol abuse, and could underlie some of the higher morbidity rates. Mental disorders in the exposed cohort were probably under-reported. The future challenge will be to study mental and physical comorbidities in the Chernobyl cleanup workers cohort. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese.

PubMed

Yoo, Taehwan; Starr, Jean E; Go, Michael R; Vaccaro, Patrick S; Satiani, Bhagwan; Haurani, Mounir J

2017-08-01

Ultrasound-guided thrombin injection (UGTI) is a well-established practice for the treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese. This is a retrospective cohort study in which all patients who underwent UGTI at The Ohio State University Ross Heart Hospital from 2009 to 2014 were analyzed for patient characteristics and stratified by body mass index (BMI). Patients with BMI ≥ 35 were considered morbidly obese and were compared to patients with a BMI < 35. Outcome was failed treatment resulting in residual pseudoaneurysm. Our cohort consisted of 54 patients who underwent thrombin injection. There were 41 nonmorbidly obese and 13 morbidly obese patients. Mean age was 64.5 years. The cohort was 44.4% male. There were 6 failures, of which 1 underwent successful repeat injection and 5 underwent open surgical repair. There was no statistically significant difference in failure between nonmorbidly obese and morbidly obese patients (9.8% vs 15.4%, P = .45). There were no embolic/thrombotic complications. Ultrasound-guided thrombin injection is a safe and effective therapy in the morbidly obese for the treatment of femoral artery pseudoaneurysm. In the hands of experienced sonographers and surgeons with adequate visualization of the pseudoaneurysm sac, UGTI should remain a standard therapy in the morbidly obese.

Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study

PubMed Central

Jowsey, Tanisha; Jeon, Yun-Hee; Dugdale, Paul; Glasgow, Nicholas J; Kljakovic, Marjan; Usherwood, Tim

2009-01-01

Background In response to the escalating burden of chronic illness in Australia, recent health policies have emphasised the promotion of patient self-management and better preventive care. A notable omission from these policies is the acknowledgment that patients with chronic illness tend to have co-morbid conditions. Our objectives were: to identify the common challenges co-morbidity poses to patients and carers in their experiences of self-management; to detail the views and perceptions of health professionals about these challenges; and to discuss policy options to improve health care for people with co-morbid chronic illness. The method included semi-structured interviews and focus groups with 129 purposively sampled participants. Participants were people with Type 2 diabetes, chronic obstructive pulmonary disease and/or chronic heart failure as well as carers and health care professionals. Content analysis of the interview data was conducted using NVivo7 software. Results Patients and their carers found co-morbidity influenced their capacity to manage chronic illness in three ways. First, co-morbidity created barriers to patients acting on risk factors; second, it complicated the process of recognising the early symptoms of deterioration of each condition, and third, it complicated their capacity to manage medication. Conclusion Findings highlight challenges that patients with multiple chronic conditions face in relation to preventive care and self-management. Future clinical policy initiatives need to move away from single illness orientation toward strategies that meet the needs of people with co-morbid conditions and strengthen their capacity to self-manage. These patients will benefit directly from specialised education and services that cater to the needs of people with clusters of co-morbidities. PMID:19735576

Moving towards the New International Study Group for Pancreatic Surgery (ISGPS) definitions in pancreaticoduodenectomy: a comparison between the old and new.

PubMed

Tan, Winson Jianhong; Kow, Alfred Wei Chieh; Liau, Kui Hin

2011-08-01

The International Study Group for Pancreatic Surgery (ISGPS) has proposed several definitions for postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE) and post-pancreatectomy haemorrhage (PPH). We assessed the effects of implementing these definitions on predicting outcomes. A database of 77 patients who underwent pancreaticoduodenectomy between January 2005 and December 2009 was analysed. Morbidities were defined and classified using the ISGPS definitions and recalculated based on the definitions adopted by our institution ('Old' definitions) prior to the implementation of ISGPS definitions. Data for the two groups were then compared. The morbidity rate rose to 70.1% from 27.2% when ISGPS rather than Old definitions were used to define morbidities (P < 0.001). Incidences of DGE, POPF and PPH were 20.7%, 39.0% and 10.4%, respectively. Rates of DGE and POPF were significantly higher according to ISGPS definitions than to Old definitions (20.7% vs. 5.2% [P= 0.001] and 39.0% vs. 15.6% [P= 0.004], respectively). According to the ISGPS definitions, all of the 12 additional patients with DGE and 12 of the 18 additional patients with POPF had grade A morbidities. Patients with ISGPS-defined morbidity had a longer intensive care unit (ICU) stay, longer postoperative stay and longer total stay (P= 0.030, P= 0.007 and P= 0.001, respectively). The morbidity rate more than doubled when ISGPS definitions were applied (an additional 42.9% of patients demonstrated morbidities). The majority of patients with DGE and POPF had grade A morbidities. The ISGPS definitions correlate well with ICU stay, postoperative stay and total length of stay. © 2011 International Hepato-Pancreato-Biliary Association.

Burnout, psychological morbidity and use of coping mechanisms among palliative care practitioners: A multi-centre cross-sectional study.

PubMed

Koh, Mervyn Yong Hwang; Chong, Poh Heng; Neo, Patricia Soek Hui; Ong, Yew Jin; Yong, Woon Chai; Ong, Wah Ying; Shen, Mira Li Juan; Hum, Allyn Yin Mei

2015-07-01

The prevalence of burnout, psychological morbidity and the use of coping mechanisms among palliative care practitioners in Singapore have not been studied. We aimed to study the prevalence of burnout and psychological morbidity among palliative care practitioners in Singapore and its associations with demographic and workplace factors as well as the use of coping mechanisms. This was a multi-centre, cross-sectional study of all the palliative care providers within the public healthcare sector in Singapore. The study was conducted in hospital palliative care services, home hospice and inpatient hospices in Singapore. The participants were doctors, nurses and social workers. The prevalence of burnout among respondents in our study was 91 of 273 (33.3%) and psychological morbidity was 77 (28.2%). Working >60 h per week was significantly associated with burnout (odds ratio: 9.02, 95% confidence interval: 2.3-35.8, p = 0.002) and psychological morbidity (odds ratio: 7.21, 95% confidence interval: 1.8-28.8, p = 0.005). Home hospice care practitioners (41.5%) were more at risk of developing psychological morbidity compared to hospital-based palliative care (17.5%) or hospice inpatient care (26.0%) (p = 0.007). Coping mechanisms like physical well-being, clinical variety, setting boundaries, transcendental (meditation and quiet reflection), passion for one's work, realistic expectations, remembering patients and organisational activities were associated with less burnout. Our results reveal that burnout and psychological morbidity are significant in the palliative care community and demonstrate a need to look at managing long working hours and promoting the use of coping mechanisms to reduce burnout and psychological morbidity. © The Author(s) 2015.

Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health Service.

PubMed

Hoolahan, Bryan; Kelly, Brian; Stain, Helen J; Killen, Didi

2006-08-01

In 2003 the New South Wales (NSW) Centre for Rural and Remote Mental Health (CRRMH) conducted an analysis of co-morbid drug and alcohol (D&A) and mental health issues for service providers and consumers in a rural NSW Area Health Service. This paper will discuss concerns raised by rural service providers and consumers regarding the care of people with co-morbid D&A and mental health disorders. Current literature on co-morbidity was reviewed, and local area clinical data were examined to estimate the prevalence of D&A disorders within the mental health service. Focus groups were held with service providers and consumer support groups regarding strengths and gaps in service provision. A rural Area Health Service in NSW. Rural health and welfare service providers, consumers with co-morbid D&A and mental health disorders. Data for the rural area showed that 43% of inpatient and 20% of ambulatory mental health admissions had problem drinking or drug-taking. Information gathered from the focus groups indicated a reasonable level of awareness of co-morbidity, and change underway to better meet client needs; however, the results indicated a lack of formalised care coordination, unclear treatment pathways, and a lack of specialist care and resources. Significant gaps in the provision of appropriate care for people with co-morbid D&A and mental health disorders were identified. Allocation of service responsibly for these clients was unclear. It is recommended that D&A, mental health and primary care services collaborate to address the needs of clients so that a coordinated and systematic approach to co-morbid care can be provided.

Tandem mass spectrometry determined maternal cortisone to cortisol ratio and psychiatric morbidity during pregnancy-interaction with birth weight.

PubMed

Hellgren, Charlotte; Edvinsson, Åsa; Olivier, Jocelien D; Fornes, Romina; Stener-Victorin, Elisabet; Ubhayasekera, S J Kumari A; Skalkidou, Alkistis; Bergquist, Jonas; Sundström-Poromaa, Inger

2016-07-01

Maternal serum cortisol has been suggested to be influenced by psychiatric morbidity, and may also influence fetal growth. However, several studies found equal cortisol levels in depressed and healthy pregnant women. Placental 11-β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) shields the fetus from maternal cortisol by conversion to cortisone, a function that may be compromised by maternal stress. We aimed to compare the serum ratio of cortisone to cortisol, in women with and without psychiatric morbidity during pregnancy. A secondary aim was to investigate whether fetal growth, approximated by infant birth weight, was associated with the cortisone to cortisol ratio. We performed tandem mass spectrometry analysis of serum cortisol and cortisone in late pregnancy in 94 women with antenatal psychiatric morbidity and 122 controls (cohort 1). We also compared the placental gene expression of HSD11B1 and 2 in another group of 69 women with psychiatric morbidity and 47 controls (cohort 2). There were no group differences in cortisol to cortisone ratio, absolute levels of cortisone and cortisol (cohort 1), or expression of HSD11B1 or 2 (cohort 2). However, cortisone to cortisol ratio was positively associated with birth weight in women with psychiatric morbidity, also after adjustment for gestational length, fetal sex, maternal height, smoking, SSRI use, and time of blood sampling (standardized β=0.35, p<0.001), with no association in the healthy controls Thus, the maternal serum cortisone to cortisol ratio does not seem to be affected by psychiatric morbidity, but psychiatric morbidity may increase fetal exposure to cortisol or other metabolic factors influencing fetal growth. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

The impact of socioeconomic position on severe maternal morbidity outcomes among women in Australia: a national case-control study.

PubMed

Lindquist, A; Noor, N; Sullivan, E; Knight, M

2015-11-01

Studies in other developed countries have suggested that socioeconomic position may be a risk factor for poorer pregnancy outcomes. This analysis aimed to explore the independent impact of socioeconomic position on selected severe maternal morbidities among women in Australia. A case-control study using data on severe maternal morbidities associated with direct maternal death collected through the Australasian Maternity Outcomes Surveillance System. Australia. 623 cases, 820 controls. Logistic regression analysis to investigate differences in outcomes among different socioeconomic groups, classified by Socio-Economic Indexes for Areas (SEIFA) quintile. Severe maternal morbidity (amniotic fluid embolism, placenta accreta, peripartum hysterectomy, eclampsia or pulmonary embolism). SEIFA quintile was statistically significantly associated with maternal morbidity, with cases being twice as likely as controls to reside in the most disadvantaged areas (adjusted OR 2.00, 95%CI 1.29-3.10). Maternal age [adjusted odds ratio (aOR) 2.20 for women aged 35 or over compared with women aged 25-29, 95%CI 1.64-3.15] and previous pregnancy complications (aOR 1.30, 95%CI 1.21-1.87) were significantly associated with morbidity. A parity of 1 or 2 was protective (aOR 0.58, 95%CI 0.43-0.79), whereas previous caesarean delivery was associated with maternal morbidity (aOR 2.20 for women with one caesarean delivery, 95%CI 1.44-2.85, compared with women with no caesareans). The risk of severe maternal morbidity among women in Australia is significantly increased by social disadvantage. This study suggests that future efforts in improving maternity care provision and maternal outcomes in Australia should include socioeconomic position as an independent risk factor for adverse outcome. © 2014 Royal College of Obstetricians and Gynaecologists.

Postoperative dental morbidity in children following dental treatment under general anesthesia.

PubMed

Hu, Yu-Hsuan; Tsai, Aileen; Ou-Yang, Li-Wei; Chuang, Li-Chuan; Chang, Pei-Ching

2018-05-10

General anesthesia has been widely used in pediatric dentistry in recent years. However, there remain concerns about potential postoperative dental morbidity. The goal of this study was to identify the frequency of postoperative dental morbidity and factors associated with such morbidity in children. From March 2012 to February 2013, physically and mentally healthy children receiving dental treatment under general anesthesia at the Department of Pediatric Dentistry of the Chang Gung Memorial Hospital in Taiwan were recruited. This was a prospective and observational study with different time evaluations based on structured questionnaires and interviews. Information on the patient demographics, anesthesia and dental treatment performed, and postoperative dental morbidity was collected and analyzed. Correlations between the study variables and postoperative morbidity were analyzed based on the Pearson's chi-square test. Correlations between the study variables and the scale of postoperative dental pain were analyzed using the Mann-Whitney U test. Fifty-six pediatric patients participated in this study, with an average age of 3.34 ± 1.66 years (ranging from 1 to 8 years). Eighty-two percent of study participants reported postoperative dental pain, and 23% experienced postoperative dental bleeding. Both dental pain and bleeding subsided 3 days after the surgery. Dental pain was significantly associated with the total number of teeth treated, while dental bleeding, with the presence of teeth extracted. Patients' gender, age, preoperative dental pain, ASA classification, anesthesia time, and duration of the operation were not associated with postoperative dental morbidity. Dental pain was a more common postoperative dental morbidity than bleeding. The periods when parents reported more pain in their children were the day of the operation (immediately after the procedure) followed by 1 day and 3 days after the treatment.

Spatio-temporal heterogeneity of malaria morbidity in Ghana: Analysis of routine health facility data

PubMed Central

Malm, Keziah; Peprah, Nana Yaw; Silal, Sheetal P.

2018-01-01

Background Malaria incidence is largely influenced by vector abundance. Among the many interconnected factors relating to malaria transmission, weather conditions such as rainfall and temperature are known to create suitable environmental conditions that sustain reproduction and propagation of anopheles mosquitoes and malaria parasites. In Ghana, climatic conditions vary across the country. Understanding the heterogeneity of malaria morbidity using data sourced from a recently setup data repository for routine health facility data could support planning. Methods Monthly aggregated confirmed uncomplicated malaria cases from the District Health Information Management System and average monthly rainfall and temperature records obtained from the Ghana Meteorological Agency from 2008 to 2016 were analysed. Univariate time series models were fitted to the malaria, rainfall and temperature data series. After pre-whitening the morbidity data, cross correlation analyses were performed. Subsequently, transfer function models were developed for the relationship between malaria morbidity and rainfall and temperature. Results Malaria morbidity patterns vary across zones. In the Guinea savannah, morbidity peaks once in the year and twice in both the Transitional forest and Coastal savannah, following similar patterns of rainfall at the zonal level. While the effects of rainfall on malaria morbidity are delayed by a month in the Guinea savannah and Transitional Forest zones those of temperature are delayed by two months in the Transitional forest zone. In the Coastal savannah however, incidence of malaria is significantly associated with two months lead in rainfall and temperature. Conclusion Data captured on the District Health Information Management System has been used to demonstrate heterogeneity in the dynamics of malaria morbidity across the country. Timing of these variations could guide the deployment of interventions such as indoor residual spraying, Seasonal Malaria Chemoprevention or vaccines to optimise effectiveness on zonal basis. PMID:29377908

[Laparoscopy for perfored duodenal ulcer : conversion and morbidity factors: retrospective study of 290 cases].

PubMed

Ben Abid, Sadreddine; Mzoughi, Zeineb; Attaoui, Mohamed Amine; Talbi, Ghofrane; Arfa, Nafaa; Gharbi, Lassaad; Khalfallah, Mohamed Taher

2014-12-01

feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent. This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity Methods: Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors. 290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance. Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease.

Spatio-temporal heterogeneity of malaria morbidity in Ghana: Analysis of routine health facility data.

PubMed

Awine, Timothy; Malm, Keziah; Peprah, Nana Yaw; Silal, Sheetal P

2018-01-01

Malaria incidence is largely influenced by vector abundance. Among the many interconnected factors relating to malaria transmission, weather conditions such as rainfall and temperature are known to create suitable environmental conditions that sustain reproduction and propagation of anopheles mosquitoes and malaria parasites. In Ghana, climatic conditions vary across the country. Understanding the heterogeneity of malaria morbidity using data sourced from a recently setup data repository for routine health facility data could support planning. Monthly aggregated confirmed uncomplicated malaria cases from the District Health Information Management System and average monthly rainfall and temperature records obtained from the Ghana Meteorological Agency from 2008 to 2016 were analysed. Univariate time series models were fitted to the malaria, rainfall and temperature data series. After pre-whitening the morbidity data, cross correlation analyses were performed. Subsequently, transfer function models were developed for the relationship between malaria morbidity and rainfall and temperature. Malaria morbidity patterns vary across zones. In the Guinea savannah, morbidity peaks once in the year and twice in both the Transitional forest and Coastal savannah, following similar patterns of rainfall at the zonal level. While the effects of rainfall on malaria morbidity are delayed by a month in the Guinea savannah and Transitional Forest zones those of temperature are delayed by two months in the Transitional forest zone. In the Coastal savannah however, incidence of malaria is significantly associated with two months lead in rainfall and temperature. Data captured on the District Health Information Management System has been used to demonstrate heterogeneity in the dynamics of malaria morbidity across the country. Timing of these variations could guide the deployment of interventions such as indoor residual spraying, Seasonal Malaria Chemoprevention or vaccines to optimise effectiveness on zonal basis.

Association of psychiatric co-morbidity and efficacy of treatment in chronic daily headache in Indian population.

PubMed

Singh, Ajai Kumar; Shukla, Rakesh; Trivedi, Jitendra Kumar; Singh, Deepti

2013-04-01

To study the prevalence of psychiatric co-morbidity in patients of chronic daily headache (CDH) and compare the efficacy of treatment between various type of headache associated with psychiatric co-morbidity. Prospective case control cohort study, 92 consecutive patients of CDH meeting eligibility criteria. The diagnosis of various subtypes of CDH was made according to the IHS criteria. Age, sex, educational, marital and socioeconomic status, matched controls were also selected. Patients were evaluated with the Mini International Neuropsychiatric Interview (MINI) scale at the time of enrolment and at 3 months. CDH accounted for 28% of all headache patients. The mean age of presentation was 30.2 ± 10.3 years, male: Female ratio of 28:64 and mean duration of 4.56 ± 0.56 years. Chronic migraine (CM) accounted for 59 patients, chronic tension type headache (CTTH) 22 patients, new daily persistent headache (NDPH) 3 patients and miscellaneous 8 patients. Psychiatric co-morbidity was present in 53.3% patients with CDH, and was more common in CM (62.7%) as compared to CTTH (36.4%). Single psychiatric co-morbidity was seen in 26 patients, while 23 patients had multiple co-morbidity. Major depressive episode, anxiety disorder, agoraphobia and dysthymia were significant psychiatric co-morbidities. Patients with CM were treated with topiramate or divalproex sodium ER and CTTH were treated with amitriptyline. 55 patients came for follow up at 3 months, improvement in headache was seen in 29 patients. Psychiatric co-morbidity was present in more than 50% patients with CDH and its presence along with a duration of ≥2 years was associated with a poor response to treatment.

The impact of co-morbidity on health-related quality of life in breast cancer survivors and controls.

PubMed

Schoormans, Dounya; Czene, Kamila; Hall, Per; Brandberg, Yvonne

2015-05-01

The objective of this study was: 1) to compare health-related quality of life (HRQoL) scores of breast cancer survivors to matched controls; and 2) to examine the relative impact (explained variance) of the type and number of co-morbidities on HRQoL. Data from the KARMA project was used in this cross-sectional study. For each woman diagnosed with breast cancer (n = 2552) there were two healthy age- and geographically matched females (n = 5104). Breast cancer survivors were categorized according to time since diagnosis: recently diagnosed (0-1 year), short- (2-5 years), mid- (6-10 years), and long-term survivors (> 10 years). Women completed a questionnaire addressing demographics (age, educational level, and geographical location), lifestyle factors (body mass index (BMI) and smoking), co-morbidities, and HRQoL. The difference in explained variance in six HRQoL-domains between demographics, lifestyle factors, and co-morbidity in women with breast cancer and matched controls was examined by hierarchical regression analyses. Women recently diagnosed (n = 63), reported the worst HRQoL followed by short-term survivors (2-5 years, n = 863). Thereafter, HRQoL scores further improved (6-10 years, n = 726), and were comparable to healthy females after 10 years (n = 893). Co-morbidity has a negative impact on HRQoL, which increased with time after diagnosis. Cardiovascular disease and depression were the strongest associates. Breast cancer survivors report clinically significant improvement in HRQoL scores six years after diagnosis. Co-morbidity has a negative impact on HRQoL, which increases with time after diagnosis, even though the number of co-morbidities remains stable. In long-term survivors there should be increasing awareness of co-morbidity and its impact on HRQoL.

Prevalence and Patterns of Multi-Morbidity in Serbian Adults: A Cross-Sectional Study

PubMed Central

Jovic, Dragana; Vukovic, Dejana; Marinkovic, Jelena

2016-01-01

Introduction Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within such public health issue, multi-morbidity requires a special attention. Aims This study investigated the prevalence of multi-morbidity in the Serbia population and assessed the co-occurrence of chronic diseases by age and gender. Methods We analyzed data from the 2013 National Health Survey, which included 13,103 individuals ≥ 20 years old. Multi-morbidity patterns were identified by exploratory factor analysis of data on self-reported chronic diseases, as well as data on measured body weight and height. The analysis was stratified by age and gender. Results Multi-morbidity was present in nearly one-third of respondents (26.9%) and existed in all age groups, with the highest prevalence among individuals aged 65 years and older (47.2% of men and 65.0% of women). Six patterns of multi-morbidity were identified: non-communicable, cardio-metabolic, respiratory, cardiovascular, aggregate, and mechanical/mental/metabolic. The non-communicable pattern was observed in both genders but only in the 20–44 years age group, while the aggregate pattern occurred only in middle-aged men. Cardio-metabolic and respiratory patterns were present in all age groups. Cardiovascular and mechanical/mental/metabolic patterns showed similar presentation in both men and women. Conclusions Multi-morbidity is a common occurrence among adults in Serbia, especially in the elderly. While several patterns may be explained by underlying pathophysiologies, some require further investigation and follow-up. Recognizing the complexity of multi-morbidity in Serbia is of great importance from both clinical and preventive perspectives given that it affects one-third of the population and may require adjustment of the healthcare system to address the needs of affected individuals. PMID:26871936

Impact of very preterm birth on health care costs at five years of age.

PubMed

Korvenranta, Emmi; Lehtonen, Liisa; Rautava, Liisi; Häkkinen, Unto; Andersson, Sture; Gissler, Mika; Hallman, Mikko; Leipälä, Jaana; Peltola, Mikko; Tammela, Outi; Linna, Miika

2010-05-01

We assessed the effects of very preterm birth (gestational age <32 weeks or birth weight <1501 g) and prematurity-related morbidities on health care costs during the fifth year of life. The study population consisted of 588 very preterm children and 176 term control subjects born in 2001-2002. Costs of hospitalizations, visits to health care professionals and therapists, and the use of other social welfare services were assessed during the fifth year of life. Hospital visits were derived from register data and other health care contacts, and the use of social welfare services were derived from parental reports. The effects of 6 prematurity-related morbidities (cerebral palsy [CP], seizure disorder, obstructive airway disease, hearing loss, visual disturbances or blindness, and other ophthalmologic problems) on the costs of health care were studied. The average health care costs during the fifth year of life were 749 euro in the term control subjects, 1023 euro in the very preterm children without morbidities, and 3265 euro in those with morbidities. The costs of social welfare services and therapies exceeded the hospitalization costs in all groups. Among children who were born preterm, CP was associated with 5125 euro higher costs, whereas later obstructive airway diseases increased the costs by 819 euro compared with individuals without these morbidities. The health care costs during the fifth year of life in very preterm children with morbidities were 4.4-fold and in those without morbidities 1.4-fold compared with those of term control subjects. This emphasizes the importance of prevention of morbidities, especially CP, to reduce the long-term costs of prematurity.

Intelligent postoperative morbidity prediction of heart disease using artificial intelligence techniques.

PubMed

Hsieh, Nan-Chen; Hung, Lun-Ping; Shih, Chun-Che; Keh, Huan-Chao; Chan, Chien-Hui

2012-06-01

Endovascular aneurysm repair (EVAR) is an advanced minimally invasive surgical technology that is helpful for reducing patients' recovery time, postoperative morbidity and mortality. This study proposes an ensemble model to predict postoperative morbidity after EVAR. The ensemble model was developed using a training set of consecutive patients who underwent EVAR between 2000 and 2009. All data required for prediction modeling, including patient demographics, preoperative, co-morbidities, and complication as outcome variables, was collected prospectively and entered into a clinical database. A discretization approach was used to categorize numerical values into informative feature space. Then, the Bayesian network (BN), artificial neural network (ANN), and support vector machine (SVM) were adopted as base models, and stacking combined multiple models. The research outcomes consisted of an ensemble model to predict postoperative morbidity after EVAR, the occurrence of postoperative complications prospectively recorded, and the causal effect knowledge by BNs with Markov blanket concept.

Mortality and Morbidity Risks and Economic Behavior

PubMed Central

Stoler, Avraham; Meltzer, David

2012-01-01

There are theoretical reasons to expect that high risk of mortality or morbidity during young adulthood decreases investment in human capital. However, investigation of this hypothesis is complicated by a variety of empirical challenges, including difficulties in inferring causation due to omitted variables and reverse causation. For example, to compare two groups with substantially different mortality rates, one typically has to use samples from different countries or time periods, making it difficult to control for other relevant variables. Reverse causation is important because human capital investment can affect mortality and morbidity. To counter these problems, we collected data on human capital investments, fertility decisions, and other economic choices of people at risk for Huntington’s disease. Huntington’s disease is a fatal genetic disorder that introduces a large and exogenous risk of early mortality and morbidity. We find a strong negative relation between mortality and morbidity risks and human capital investment. PMID:22308067

Morbidity, Self-Perceived Health and Mortality Among non-Western Immigrants and Their Descendants in Denmark in a Life Phase Perspective.

PubMed

Jervelund, Signe Smith; Malik, Sanam; Ahlmark, Nanna; Villadsen, Sarah Fredsted; Nielsen, Annemette; Vitus, Kathrine

2017-04-01

To enable preventive policies to address health inequity across ethnic groups, this review overviews the current knowledge on morbidity, self-perceived health and mortality among non-Western immigrants and their descendants in Denmark. A systematic search in PUBMED, SCOPUS, Embase and Cochrane as well as in national databases was undertaken. The final number of publications included was 45. Adult immigrants had higher morbidity, but lower mortality compared to ethnic Danes. Immigrant children had higher mortality and morbidity compared to ethnic Danes. Immigrants' health is critical to reach the political goals of integration. Despite non-Western immigrants' higher morbidity than ethnic Danes, no national strategy targeting immigrants' health has been implemented. Future research should include elderly immigrants and children, preferably employing a life-course perspective to enhance understanding of parallel processes of societal adaptation and health.

The health transition: the cultural inflation of morbidity during the decline of mortality.

PubMed

Johansson, S R

1991-04-01

It has become commonplace to observe that as mortality falls, morbidity levels rise. The question is why? The explanation offered here stresses the multidimensional nature of morbidity, and the important role that diverse cultural forces have on the patterns of behaviour which underlie reporting behaviour during modernization. These forces involve rising health expectations on the part of ordinary people, including their ability to perceive illness and their willingness to seek professional help, and institutional pressures on medical professionals which reward them for discovering and treating an ever-growing set of non-fatal diseases. Since non-Western developing countries are training physicians to practice scientific medicine, are educating their citizens to think about disease along modern lines, and measure morbidity as developed countries do, there is every reason to suppose that as mortality falls in these countries, morbidity will rise, just as it has done in the developed world.

Mortality, morbidity and health in developed societies: a review of data sources.

PubMed

Wunsch, Guillaume; Gourbin, Catherine

2018-01-01

The purpose of this paper is to review the major sources of data on mortality, morbidity and health in Europe and in other developed regions in order to examine their potential for analysing mortality and morbidity levels and trends. The review is primarily focused on routinely collected information covering a whole country. No attempt is made to draw up an inventory of sources by country; the paper deals instead with the pros and cons of each source for mortality and morbidity studies in demography. While each source considered separately can already yield useful, though partial, results, record linkage among data sources can significantly improve the analysis. Record linkage can also lead to the detection of possible causal associations that could eventually be confirmed. More generally, Big Data can reveal changing mortality and morbidity trends and patterns that could lead to preventive measures being taken rather than more costly curative ones.

Informal Care Networks in the Context of Multimorbidity: Size, Composition, and Associations With Recipient Psychological Well-Being.

PubMed

Andersson, Matthew A; Monin, Joan K

2018-04-01

We evaluate how the size and composition of care networks change with increasing morbidity count (i.e., multimorbidity) and how larger care networks relate to recipient psychological well-being. Using the National Health and Aging Trends study (NHATS; N = 7,026), we conduct multivariate regressions to analyze size and compositional differences in care networks by morbidity count and recipient gender, and to examine differences in recipient psychological well-being linked to care network size. Women report larger and more diverse care networks than men. These gender differences strengthen with increasing morbidity count. Larger care networks are associated with diminished psychological well-being among care recipients, especially as morbidity increases. These findings reveal how increasing morbidity translates differently to care network size and diversity for men and women. They also suggest that having multiple caregivers may undermine the psychological well-being of care recipients who face complex health challenges.

[Obesity surgery in patients suffering from monogenetic adipositas].

PubMed

Korenkov, M; Kohlschmidt, N; Zechner, U; Haaf, T; Junginger, T

2007-06-01

Surgical treatment of patients suffering from monogenetic forms of morbid obesity is considered to be the poorest investigated theme in bariatric surgery. This review article presents aspects of genetic disorders in morbid obesity as well as some aspects of surgical treatment in patients with monogenetic forms of morbid obesity (Prader-Willi-Syndrome). Gastric restrictive procedures such as vertical banded gastroplasty or adjustable gastric banding as well as malabsorptive and mix procedures such as biliopancreatic diversion or Roux-en-Y gastric bypass are used for treatment, similar to polygenetic forms of morbid obesity. Until to now there is no evidence-based data because of the small number of published cases. Decisions about the indication to operation and about the choice of surgical procedures are based on the empiric fundament. It is to suggest that the use of growth hormones in patients with monogenetic forms of morbid obesity could positively influence the results of bariatric surgery in these patients.

[National health fund and morbidity-based risk structure equalization with focus on haemophilia].

PubMed

König, T

2010-11-01

The Gesundheitsfonds (national health fund) was established in Germany on January 1st, 2009, in combination with the morbidity-based risk structure equalization (RSA) in order to manage the cash flow between the statutory health insurances. The RSA equalizes income differences due to the varying levels of contributory income of the members of a health insurance (basic wage totals) and expenditure differences due to varying distribution of morbidity risks across different health insurances, as well as the varying numbers of non-contributing insured family members. Additionally, insured persons are allocated to morbidity groups according to a classification model based upon diagnoses and prescriptions anticipating medical expenses in the subsequent year. Haemophilia falls, among 80 disease entities, in the morbidity group which generates the highest risk supplement. Matching of prescribed drugs with disease entities facilitates disease grading and improves the accuracy of risk supplements.

Risk factors for operative morbidity and mortality in gastric cancer patients undergoing total gastrectomy

PubMed Central

Gong, Dao-Jun; Miao, Chao-Feng; Bao, Qi; Jiang, Ming; Zhang, Li-Fang; Tong, Xiao-Tao; Chen, Li

2008-01-01

AIM: To study the risk factors for morbidity and mortality following total gastrectomy. METHODS: We retrospectively reviewed the records of 125 consecutive patients who underwent total gastrectomy for gastric cancer at the Second Affiliated Hospital of Zhejiang University School of Medicine between January 2003 and March 2008. RESULTS: The overall morbidity rate was 20.8% (27 patients) and the mortality rate was 3.2% (4 patients). Morbidity rates were higher in patients aged over 60 [odds ratio (OR) 4.23 (95% confidence interval (CI) 1.09 to 12.05)], with preoperative comorbidity [with vs without, OR 1.25 (95% CI 1.13 to 8.12)], when the combined resection was performed [combined resection vs total gastrectomy only, OR 2.67 (95% CI 1.58 to 5.06)]. CONCLUSION: Age, preoperative comorbidity and combined resection were independently associated with the rate of morbidity after total gastrectomy for gastric cancer. PMID:19030212

Nicotine dependence, use of illegal drugs and psychiatric morbidity.

PubMed

Martínez-Ortega, José María; Jurado, Dolores; Martínez-González, Miguel Angel; Gurpegui, Manuel

2006-09-01

The purpose of this study was to examine the association of smoking and nicotine dependence with psychiatric morbidity, controlling for the potential confounding effect of smoking on the relationship between the use of other substances and psychiatric morbidity. A sample of 290 adults were interviewed at a primary health centre (patients, 58%; patients' relatives, 34%; staff, 8%) to inquire about their tobacco, caffeine, alcohol, and illegal drug consumption. Psychiatric morbidity, defined by a score >6 on the General Health Questionnaire (GHQ-28), showed a strong direct association with nicotine dependence. The use of illegal drugs, but not of alcohol, was also strongly associated with psychiatric morbidity, after controlling for smoking. Both smoking and high nicotine dependence were also associated with use of caffeine, alcohol, cannabis and cocaine. High nicotine dependence may be considered as an expression of individual psychopathologic vulnerability. Tobacco may have a central facilitating role in the use of caffeine, alcohol, and illegal drug.

Valuing morbidity effects of wildfire smoke exposure from the 2007 Southern California wildfires

Treesearch

Ikuho Kochi; Patricia A. Champ; John B. Loomis; Geoffrey H. Donovan

2016-01-01

This study estimated the economic costs associated with morbidity from the wildfires that occurred in 2007 in southern California. We used the excess number of hospital admissions and emergency department visits to quantify the morbidity effects and used medical costs to estimate the economic impact. With data from 187 hospital facilities and 140 emergency departments...

Adult Co-morbidity Evaluation 27 scores of head and neck cancer patients using touch-screen technology: patient satisfaction and clinical verification.

PubMed

Brammer, C; Dawson, D; Joseph, M; Tipper, J; Jemmet, T; Liew, L; Spinou, C; Grew, N; Pigadas, N; Rehman, K

2017-05-01

This study aimed to assess head and neck cancer patient satisfaction with the use of a touch-screen computer patient-completed questionnaire for assessing Adult Co-morbidity Evaluation 27 co-morbidity scores prior to treatment, along with its clinical reliability. A total of 96 head and neck cancer patients were included in the audit. An accurate Adult Co-morbidity Evaluation 27 co-morbidity score was achieved via patient-completed questionnaire assessment for 97 per cent of participants. In all, 96 per cent of patients found the use of a touch-screen computer acceptable and would be willing to use one again, and 62 per cent would be willing to do so without help. Patients were more likely to be willing to use the computer again without help if they were aged 65 years or younger (χ2 test; p = 0.0054) or had a performance status of 0 or 1 (χ2 test; p = 0.00034). Use of a touch-screen computer is an acceptable approach for assessing Adult Co-morbidity Evaluation 27 scores at pre-treatment assessment in a multidisciplinary joint surgical-oncology clinic.

Social Determinants of Health, Disaster Vulnerability, Severe and Morbid Obesity in Adults: Triple Jeopardy?

PubMed Central

2017-01-01

Severe and morbid obesity are associated with highly elevated risks of adverse health outcomes and the prevalence of severe obesity is increasing globally. To date, disaster literature has not considered severe and morbid obesity as a specific vulnerability, despite reports of people being left behind during disasters because of their body size, shape or weight. The complex causes of obesity are associated with the social determinants of health and one’s potential vulnerability to disasters. The absence of appropriate considerations may lead to people being exposed to disproportionate and potentially avoidable risk. The intersection of the social determinants of health, disaster vulnerability, severe and morbid obesity is explored. Previously identified vulnerable groups are also represented in severe and morbid obesity data. This poses the prospect for ‘triple jeopardy’ compounding the social determinants of health, disaster vulnerability and considerations with and for people with morbid obesity. When working to reduce disaster risk for vulnerable groups, the author proposes specific consideration is required to ensure ‘all-of-society engagement and partnership’ in an inclusive, accessible and non-discriminatory manner, to ensure no one is left behind.

PSYCHIATRIC MORBIDITY AND PERSONALITY PROFILE IN DIVORCE SEEKING COUPLES

PubMed Central

Batra, Lalit; Gautam, Shiv

1995-01-01

To what extent psychiatric morbidity and personality factors contribute to marital disharmony and decision to divorce is still an unanswered question in Indian setting. This study was undertaken with aims to find out (1) the prevalence of psychiatric morbidity in persons seeking divorce; (2) the prevalence of psychiatric morbidity in persons who had good marital adjustment; (3) the nature of psychiatric morbidity observed in these subjects, and (4) the personality profile of these subjects. Fifty randomly selected divorce seeking couples (n=100) from the matrimonial court of Jaipur City and thirty couples with good marital adjustment (n=60) selected from the community were studied. Probable psychiatric cases identified by administering GHQ (Hindi version) were diagnosed according to ICD-10 and personality profile of all cases was studied by using 16 PF. High psychiatric morbidity (50%) was found among divorce seeking couples in comparison to control group (13%). There was a high prevalence of neurone disorders (22%) and mood disorders (16%) in experimental group. Schizophrenia and related disorders (10%) and substance abuse disorder (2%) were seen only in the experimental group. Specific personality factors related to divorce seeking individuals and persons with stable marriage have been identified. The implications of this study are highlighted. PMID:21743746

[Medical and ecological assessment of climate effects on urolithiasis morbidity in population of Primorsky territory].

PubMed

Koval'chuk, V K

2004-01-01

The article presents medicoecological estimation of quantitative relations between monsoon climate and urolithiasis primary morbidity in the Primorsky Territory. Quantitative estimation of the climate was performed by V. I. Rusanov (1973) who calculated daily meteorological data for 1 p.m. throughout 1991-1999. Primary urolithiasis morbidity for this period of time was provided by regional health department. The data were processed by methods of medical mapping and paired correlation analysis. In the Territory, mapping revealed the same location of the zones with high frequency of discomfortable weather of class V and VI causing chilblain in positive air temperatures and zones with elevated primary urolithiasis morbidity in children and adults. Correlation analysis confirmed mapping results and determined significant negative correlations between frequency of relatively comfortable moment weather classes II-IV and morbidity of children and adults, positive correlation between frequency of discomfortable class VI and adult morbidity. Thus, high frequency of days per year with discomfortable classes of moment weather in low positive air temperatures may be one of the factors of urolithiasis risk in population of the Primorsky Territory. Climatic factors should be taken into consideration in planning primary prophylaxis of this disease in the Primorsky Territory.

Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study.

PubMed

Norhayati, Mohd Noor; Nik Hazlina, Nik Hussain; Aniza, Abd Aziz; Sulaiman, Zaharah

2016-07-26

Knowledge on the factors associated with severe maternal morbidity enables a better understanding of the problem and serves as a foundation for the development of an effective preventive strategy. However, various definitions of severe maternal morbidity have been applied, leading to inconsistencies between studies. The objective of this study was to identify the sociodemographic characteristics, medical and gynaecological history, past and present obstetric performance and the provision of health care services as associated factors for severe maternal morbidity in Kelantan, Malaysia. A comparative cross-sectional study was conducted in two tertiary referral hospitals in 2014. Postpartum women with severe morbidity and without severe morbidity who fulfilled the inclusion and exclusion criteria were eligible as cases and controls, respectively. The study population included all postpartum women regardless of their age. Pregnancy at less than 22 weeks of gestation, more than 42 days after the termination of pregnancy and non-Malaysian citizens were excluded. Consecutive sampling was applied for the selection of cases and for each case identified, one unmatched control from the same hospital was selected using computer-based simple random sampling. Simple and multiple logistic regressions were performed using Stata Intercooled version 11.0. A total of 23,422 pregnant women were admitted to these hospitals in 2014 and 395 women with severe maternal morbidity were identified, of which 353 were eligible as cases. An age of 35 or more years old [Adj. OR (95 % CI): 2.6 (1.67, 4.07)], women with past pregnancy complications [Adj. OR (95 % CI): 1.7 (1.00, 2.79)], underwent caesarean section deliveries [Adj. OR (95 % CI): 6.8 (4.68, 10.01)], preterm delivery [Adj. OR (95 % CI): 3.4 (1.87, 6.32)] and referral to tertiary centres [Adj. OR (95 % CI): 2.7 (1.87, 3.97)] were significant associated factors for severe maternal morbidity. Our study suggests the enhanced screening and monitoring of women of advanced maternal age, women with past pregnancy complications, those who underwent caesarean section deliveries, those who delivered preterm and the mothers referred to tertiary centres as they are at increased risk of severe maternal morbidity. Identifying these factors may contribute to specific and targeted strategies aimed at tackling the issues related to maternal morbidity.

Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands.

PubMed

Faber, Adrianne; Kalverdijk, Luuk J; de Jong-van den Berg, Lolkje T W; Hugtenburg, Jacqueline G; Minderaa, Ruud B; Tobi, Hilde

2010-02-01

This study aimed at investigating the use of psychosocial interventions and psychotropic co-medication among stimulant-treated children with attention-deficit hyperactivity disorder (ADHD) in relation to the presence of psychiatric co-morbidity. Stimulant users younger than 16 years were identified in 115 pharmacies and a questionnaire was sent to their stimulant prescribing physician. Of 773 questionnaires sent out, 556 were returned and were suitable for analysis (72%). The results are based on 510 questionnaires concerning stimulant-treated children for whom a diagnosis of ADHD was reported. Of the 510 children diagnosed with ADHD, 31% had also received one or more other psychiatric diagnoses, mainly pervasive developmental disorder or oppositional defiant disorder/conduct disorder. We found an association between the presence of co-morbidity and the use of psychosocial interventions for the child (P < 0.001) and the parents (P < 0.001). In the ADHD-only group, 26% did not receive any form of additional interventions, while psychosocial interventions varied from 8 to 18% in children with ADHD and psychiatric co-morbidity. The presence of diagnostic co-morbidity was also associated with the use of psychotropic co-medication (overall, P = 0.012) and antipsychotics (P < 0.001). Stimulant-treated youths with ADHD and psychiatric co-morbidity received more psychosocial interventions and psychotropic co-medication than children with ADHD-only. The type of psychosocial interventions and psychotropic co-medication received by the children and their parents, depended on the specific co-morbid psychiatric disorder being present.

Taming the green-eyed monster: temporal responsivity to cognitive behavioural and cognitive analytic therapy for morbid jealousy.

PubMed

Kellett, Stephen; Totterdell, Peter

2013-03-01

Credible evaluations of the psychological treatment of morbid jealousy are rare. The aim of this study was to evaluate temporal responsivity to cognitive behavioural therapy (CBT) and cognitive analytic therapy (CAT) for morbid jealousy. The methodology involved matched A/B single-case experimental designs (SCED) with extended follow-up, in which two patients and their partners completed daily jealousy target symptom items across the phases of the study. Patients also completed traditional psychometric outcome measures at assessment, post-therapy, and at final follow-up. Both patients received the same number of assessment (n = 3), treatment (n = 13), and follow-up (n = 1) sessions.  Autoregressive Integrated Moving Average (ARIMA) models of the patients' daily target symptom jealousy SCED data indicate the effectiveness of the CAT intervention and the ineffectiveness of the CBT intervention, but both therapies produced large effect sizes. The partner of the CBT patient felt less controlled following therapy, whilst the partner of CAT patient did not perceive any change to his partner. The discussion calls for a stronger evidence base for the psychological treatment of morbid jealousy to be constructed and debates the routine measurement of outcomes for partners of morbidly jealous patients. Measuring outcomes for partners of jealous patients is indicated.   CAT shows promise as an intervention for morbid jealousy. The evidence base for the treatment of morbid jealousy requires further development. © 2011 The British Psychological Society.

State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses.

PubMed

Owusu-Edusei, K; Cramer, R; Chesson, H W; Gift, T L; Leichliter, J S

2017-06-01

In this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. Longitudinal study. We obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. For over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. We found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners. Published by Elsevier Ltd.

Keep it simple? Predicting primary health care costs with clinical morbidity measures

PubMed Central

Brilleman, Samuel L.; Gravelle, Hugh; Hollinghurst, Sandra; Purdy, Sarah; Salisbury, Chris; Windmeijer, Frank

2014-01-01

Models of the determinants of individuals’ primary care costs can be used to set capitation payments to providers and to test for horizontal equity. We compare the ability of eight measures of patient morbidity and multimorbidity to predict future primary care costs and examine capitation payments based on them. The measures were derived from four morbidity descriptive systems: 17 chronic diseases in the Quality and Outcomes Framework (QOF); 17 chronic diseases in the Charlson scheme; 114 Expanded Diagnosis Clusters (EDCs); and 68 Adjusted Clinical Groups (ACGs). These were applied to patient records of 86,100 individuals in 174 English practices. For a given disease description system, counts of diseases and sets of disease dummy variables had similar explanatory power. The EDC measures performed best followed by the QOF and ACG measures. The Charlson measures had the worst performance but still improved markedly on models containing only age, gender, deprivation and practice effects. Comparisons of predictive power for different morbidity measures were similar for linear and exponential models, but the relative predictive power of the models varied with the morbidity measure. Capitation payments for an individual patient vary considerably with the different morbidity measures included in the cost model. Even for the best fitting model large differences between expected cost and capitation for some types of patient suggest incentives for patient selection. Models with any of the morbidity measures show higher cost for more deprived patients but the positive effect of deprivation on cost was smaller in better fitting models. PMID:24657375

Bowel morbidity following radiochemotherapy and image-guided adaptive brachytherapy for cervical cancer: Physician- and patient reported outcome from the EMBRACE study.

PubMed

Jensen, Nina Boje Kibsgaard; Pötter, Richard; Kirchheiner, Kathrin; Fokdal, Lars; Lindegaard, Jacob Christian; Kirisits, Christian; Mazeron, Renaud; Mahantshetty, Umesh; Jürgenliemk-Schulz, Ina Maria; Segedin, Barbara; Hoskin, Peter; Tanderup, Kari

2018-06-01

This study describes late bowel morbidity prospectively assessed in the multi-institutional EMBRACE study on MRI-guided adaptive brachytherapy in locally advanced cervical cancer (LACC). A total of 1176 patients were analyzed. Physician reported morbidity (CTCAE v.3.0) and patient reported outcome (PRO) (EORTC QLQ C30/CX24) were assessed at baseline and at regular follow-up. At 3/5 years the actuarial incidence of bowel morbidity grade 3-4 was 5.0%/5.9%, including incidence of stenosis/stricture/fistula of 2.0%/2.6%. Grade 1-2 morbidity was pronounced with prevalence rates of 28-33% during follow-up. Diarrhea and flatulence were most frequently reported, significantly increased after 3 months and remained elevated during follow-up. Incontinence gradually worsened with time. PRO revealed high prevalence rates. Diarrhea ≥"a little" increased from 26% to 37% at baseline to 3 months and remained elevated, difficulty in controlling bowel increased from 11% to 26% at baseline to 3 months gradually worsening with time. Constipation and abdominal cramps improved after treatment. Bowel morbidity reported in this large cohort of LACC patients was limited regarding severe/life-threatening events. Mild-moderate diarrhea, flatulence and incontinence were prevalent after treatment with PROs indicating a considerable and clinically relevant burden. Critical knowledge based on the extent and manifestation pattern of treatment-related morbidity will serve future patient management. Copyright © 2018 Elsevier B.V. All rights reserved.

Influenza vaccine coverage, influenza-associated morbidity and all-cause mortality in Catalonia (Spain).

PubMed

Muñoz, M Pilar; Soldevila, Núria; Martínez, Anna; Carmona, Glòria; Batalla, Joan; Acosta, Lesly M; Domínguez, Angela

2011-07-12

The objective of this work was to study the behaviour of influenza with respect to morbidity and all-cause mortality in Catalonia, and their association with influenza vaccination coverage. The study was carried out over 13 influenza seasons, from epidemiological week 40 of 1994 to week 20 of 2007, and included confirmed cases of influenza and all-cause mortality. Two generalized linear models were fitted: influenza-associated morbidity was modelled by Poisson regression and all-cause mortality by negative binomial regression. The seasonal component was modelled with the periodic function formed by the sum of the sinus and cosines. Expected influenza mortality during periods of influenza virus circulation was estimated by Poisson regression and its confidence intervals using the Bootstrap approach. Vaccination coverage was associated with a reduction in influenza-associated morbidity (p<0.001), but not with a reduction in all-cause mortality (p=0.149). In the case of influenza-associated morbidity, an increase of 5% in vaccination coverage represented a reduction of 3% in the incidence rate of influenza. There was a positive association between influenza-associated morbidity and all-cause mortality. Excess mortality attributable to influenza epidemics was estimated as 34.4 (95% CI: 28.4-40.8) weekly deaths. In conclusion, all-cause mortality is a good indicator of influenza surveillance and vaccination coverage is associated with a reduction in influenza-associated morbidity but not with all-cause mortality. Copyright © 2011 Elsevier Ltd. All rights reserved.

What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman?

PubMed

Gehrig, Paola A; Cantrell, Leigh A; Shafer, Aaron; Abaid, Lisa N; Mendivil, Alberto; Boggess, John F

2008-10-01

Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for staging the obese and morbidly obese woman with endometrial cancer. Consecutive robotic endometrial cancer staging procedures were collected from 2005-2007 and were compared to consecutive laparoscopic cases (2000-2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time (p=0.0004), less blood loss (p<0.0001), increased lymph node retrieval (p=0.004) and shorter hospital stay (p=0.0119). Robotic surgery is a useful minimally invasive tool for the comprehensive surgical staging of the obese and morbidly obese woman with endometrial cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.

Burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists.

PubMed

Zhou, Xinyu; Pu, Juncai; Zhong, Xiaoni; Zhu, Dan; Yin, Dinghong; Yang, Lining; Zhang, Yuqing; Fu, Yuying; Wang, Haiyang; Xie, Peng

2017-05-02

To investigate the prevalence of and personal and professional characteristics associated with burnout, psychological morbidity, job stress, and job satisfaction in Chinese neurologists. The China Neurologist Association conducted a national cross-sectional study from September 2014 to March 2015. A questionnaire including the Maslach Burnout Inventory, the 12-item General Health Questionnaire, the Consultants' Mental Health Questionnaire, and questions assessing personal and professional characteristics, career satisfaction, and current doctor-patient relationships was administered. A total of 693 directors of neurology departments and 6,111 neurologists in 30 Chinese provinces returned surveys. Overall, 53.2% of responding neurologists experienced burnout, 37.8% had psychological morbidity, 50.7% had high levels of job stress, 25.7% had low levels of job satisfaction, 76.9% had poor doctor-patient relationships, and 58.1% regretted becoming a doctor. Factors independently associated with burnout were lower income, more hours worked per week, more nights on call per month, working in public hospitals, psychological morbidity, high levels of job stress, low levels of job satisfaction, and poor doctor-patient relationships. Factors independently associated with psychological morbidity included lower income, more nights on call per month, working in enterprise-owned hospitals, burnout, high levels of job stress, and low levels of job satisfaction. Burnout and psychological morbidity are common in Chinese neurologists. Burnout is the single greatest predictor of neurologists' psychological morbidity, high job stress, and low job satisfaction. © 2017 American Academy of Neurology.

Adjusting for reverse causation to estimate the effect of obesity on mortality after incident heart failure in the Atherosclerosis Risk in Communities (ARIC) study.

PubMed

Shakiba, Maryam; Soori, Hamid; Mansournia, Mohammad Ali; Nazari, Seyed Saeed Hashemi; Salimi, Yahya

2016-01-01

The lower mortality rate of obese patients with heart failure (HF) has been partly attributed to reverse causation bias due to weight loss caused by disease. Using data about weight both before and after HF, this study aimed to adjust for reverse causation and examine the association of obesity both before and after HF with mortality. Using the Atherosclerosis Risk in Communities (ARIC) study, 308 patients with data available from before and after the incidence of HF were included. Pre-morbid and post-morbid obesity were defined based on body mass index measurements at least three months before and after incident HF. The associations of pre-morbid and post-morbid obesity and weight change with survival after HF were evaluated using a Cox proportional hazard model. Pre-morbid obesity was associated with higher mortality (hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.04 to 2.49) but post-morbid obesity was associated with increased survival (HR, 0.57; 95% CI, 0.37 to 0.88). Adjusting for weight change due to disease as a confounder of the obesity-mortality relationship resulted in the absence of any significant associations between post-morbid obesity and mortality. This study demonstrated that controlling for reverse causality by adjusting for the confounder of weight change may remove or reverse the protective effect of obesity on mortality among patients with incident HF.

Pregnancy outcomes in women with bariatric surgery as compared with morbidly obese women.

PubMed

Abenhaim, Haim A; Alrowaily, Nouf; Czuzoj-Shulman, Nicholas; Spence, Andrea R; Klam, Stephanie L

2016-11-01

Pregnancies among morbidly obese women are associated with serious adverse maternal and neonatal outcomes. Our study objective is to evaluate the effect of bariatric surgery on obstetrical outcomes. We carried out a retrospective cohort study using the healthcare cost and utilization project - Nationwide Inpatient Sample from 2003 to 2011 comparing outcome of births among women who had undergone bariatric surgery with births among women with morbid obesity. Logistic regression was used to estimate the adjusted effect of bariatric surgery on maternal and newborn outcomes. There were 8 475 831 births during the study period (221 580 (2.6%) in morbidly obese women and 9587 (0.1%) in women with bariatric surgery). Women with bariatric surgery were more likely to be Caucasian and ≥35 years old as compared with morbidly obese women. As compared with women with morbid obesity, women with bariatric surgery had lower rates of hypertensive disorders, premature rupture of membrane, chorioamnionitis, cesarean delivery, instrumental delivery, postpartum hemorrhage, and postpartum infection. Induction of labor, postpartum blood transfusions, venous thromboembolisms, and intrauterine fetal growth restriction were more common in the bariatric surgery group. There were no differences observed in preterm births, fetal deaths, or reported congenital anomalies. In general, women who undergo bariatric surgery have improved pregnancy outcomes as compared with morbidly obese women. However, the bariatric surgery group was more likely to have venous thromboembolisms, to require a blood transfusion, to have their labor induced and to experience fetal growth restriction.

Modeling the impact of climate variability on diarrhea-associated diseases in Taiwan (1996-2007).

PubMed

Chou, Wei-Chun; Wu, Jiunn-Lin; Wang, Yu-Chun; Huang, Hsin; Sung, Fung-Chang; Chuang, Chun-Yu

2010-12-01

Diarrhea is an important public health problem in Taiwan. Climatic changes and an increase in extreme weather events (extreme heat, drought or rainfalls) have been strongly linked to the incidence of diarrhea-associated disease. This study investigated and quantified the relationship between climate variations and diarrhea-associated morbidity in subtropical Taiwan. Specifically, this study analyzed the local climatic variables and the number of diarrhea-associated infection cases from 1996 to 2007. This study applied a climate variation-guided Poisson regression model to predict the dynamics of diarrhea-associated morbidity. The proposed model allows for climate factors (relative humidity, maximum temperature and the numbers of extreme rainfall), autoregression, long-term trends and seasonality, and a lag-time effect. Results indicated that the maximum temperature and extreme rainfall days were strongly related to diarrhea-associated morbidity. The impact of maximum temperature on diarrhea-associated morbidity appeared primarily among children (0-14years) and older adults (40-64years), and had less of an effect on adults (15-39years). Otherwise, relative humidity and extreme rainfall days significantly contributed to the diarrhea-associated morbidity in adult. This suggested that children and older adults were the most susceptible to diarrhea-associated morbidity caused by climatic variation. Because climatic variation contributed to diarrhea morbidity in Taiwan, it is necessary to develop an early warning system based on the climatic variation information for disease control management. Copyright © 2010 Elsevier B.V. All rights reserved.

Behavior of respiratory muscle strength in morbidly obese women by using different predictive equations.

PubMed

Pazzianotto-Forti, Eli M; Peixoto-Souza, Fabiana S; Piconi-Mendes, Camila; Rasera-Junior, Irineu; Barbalho-Moulim, Marcela

2012-01-01

Studies on the behavior of respiratory muscle strength (RMS) in morbidly obese patients have found conflicting results. To evaluate RMS in morbidly obese women and to compare the results by using different predictive equations. This is a cross-sectional study that recruited 30 morbidly obese women and a control group of 30 normal-weight women. The subjects underwent anthropometric and maximal respiratory pressure measurement. Visual inspection of the Bland-Altman plots was performed to evaluate the correlation between the different equations, with a p value lower than 0.05 considered as statistically significant. The obese women showed a significant increase in maximal inspiratory pressure (MIP) values (-87.83±21.40 cmH(2)O) compared with normal-weight women (-72±15.23 cmH(2)O) and a significant reduction of MIP (-87.83±21.40 cmH(2)O) according to the values predicted by the EHarik equation (-130.71±11.98 cmH(2)O). Regarding the obtained maximal expiratory pressure (MEP), there were no between-group differences (p>0.05), and no agreeement was observed between obtained and predicted values of MEP and the ENeder and ECosta equations. Inspiratory muscle strength was greater in the morbidly obese subjects. The most appropriate equation for calculating the predicted MIP values for the morbidly obese seems to be Harik-Khan equation. There seem to be similarities between the respiratory muscle strength behavior of morbidly obese and normal-weight women, however, these findings are still inconclusive.

Weight Loss Surgery Reduces Healthcare Resource Utilization and All-Cause Inpatient Mortality in Morbid Obesity: a Propensity-Matched Analysis.

PubMed

Krishna, Somashekar G; Rawal, Varun; Durkin, Claire; Modi, Rohan M; Hinton, Alice; Cruz-Monserrate, Zobeida; Conwell, Darwin L; Hussan, Hisham

2018-06-21

There is a lack of population studies evaluating the impact of bariatric surgery (BRS) on all-cause inpatient mortality. We sought to determine the impact of prior BRS on all-cause mortality and healthcare utilization in hospitalized patients. We analyzed the National Inpatient Sample database from 2007 to 2013. Participants were adult (≥ 18 years) inpatients admitted with a diagnosis of morbid obesity or a history of BRS. Propensity score-matched analyses were performed to compare mortality and healthcare resource utilization (hospital length of stay and cost). There were 9,044,103 patient admissions with morbid obesity and 1,066,779 with prior BRS. A propensity score-matched cohort analysis demonstrated that prior BRS was associated with decreased mortality (OR = 0.58; 95% CI [0.54, 0.63]), shorter length of stay (0.59 days; P < 0.001), and lower hospital costs ($2152; P < 0.001) compared to morbid obesity. A subgroup of propensity score-matched analysis among patients with high-risk of mortality (leading ten causes of mortality in morbid obesity) revealed a consistently significant reduction in odds of mortality for patients with prior BRS (OR = 0.82; 95% CI [0.72, 0.92]). Hospitalized patients with a history of BRS have lower all-cause mortality and healthcare resource utilization compared to those who are morbidly obese. These observations support the continued application of BRS as an effective and resource-conscious treatment for morbid obesity.

Respiratory Morbidity among Rice Mill Workers in an Urban Area of Burdwan District, West Bengal: A Cross-sectional Study.

PubMed

Rana, Madhab Ch; Naskar, Somnath; Roy, Ramaprasad; Das, Dilip Kr; Das, Soumya

2018-01-01

Rice mill workers constitute a special group from the perspective of occupational health. Unprotected dust exposure among them adversely affects their respiratory health, which needs to be evaluated. Adequate evidence is still lacking in many parts of India including West Bengal. Burdwan is one of the main rice-producing districts in the state with abundant rice mills. The aim of the study was to find out the prevalence and pattern of respiratory morbidity and associated background characteristics of rice mill workers. A descriptive cross-sectional study was conducted at Burdwan municipality area during July-December 2016. Considering 44.2% prevalence, 95% confidence interval, 15% allowable error, 10% non-response, a sample of 252 directly engaged rice mill workers were selected through multistage random sampling. With prior consent, the subjects were interviewed, clinically examined, and underwent spirometry; relevant records were also reviewed using a pre-designed schedule. Any abnormal spirometry finding was considered as respiratory morbidity. Ethical approval was obtained from institutional ethics committee. Data were analyzed using SPSS version 20. Chi-square test and multiple logistic regression were applied. Prevalence of respiratory morbidity was 40.73% with obstructive and restrictive respiratory morbidity being 24.60% and 16.13%, respectively. Non-use of any protective measure, duration (years) of working in rice mill and average daily working hours were significant predictors of respiratory morbidity. Respiratory morbidity is quite high in the area. Proper health education and provision of personal protective equipments need to be provided.

Sleep disturbance and its relationship to psychiatric morbidity after Hurricane Andrew.

PubMed

Mellman, T A; David, D; Kulick-Bell, R; Hebding, J; Nolan, B

1995-11-01

Sleep disturbance is an important dimension of posttraumatic stress disorder (PTSD), but most of the limited available data were obtained years after the original traumatic event. This study provides information on sleep disturbance and its relationship to posttraumatic morbidity from evaluations done within a year after the trauma. Sleep and psychiatric symptoms of 54 victims (12 men and 42 women) of Hurricane Andrew who had no psychiatric illness in the 6 months before the hurricane were evaluated. A subset of hurricane victims with active psychiatric morbidity (N = 10) and nine comparison subjects who were unaffected by the hurricane were examined in a sleep laboratory. A broad range of sleep-related complaints were rated as being greater after the hurricane, and psychiatric morbidity (which was most commonly PTSD, followed by depression) had a significant effect on most of the subjective sleep measures. In addition, subjects with active morbidity endorsed greater frequencies of "bad dreams" and general sleep disturbances before the hurricane. Polysomnographic results for the hurricane victims revealed a greater number of arousals and entries into stage 1 sleep. REM density correlated positively with both the PTSD symptom of reexperiencing trauma and global distress. Subjects affected by Hurricane Andrew reported sleep disturbances, particularly those subjects with psychiatric morbidity. Tendencies to experience bad dreams and interrupted sleep before a trauma appear to mark vulnerability to posttraumatic morbidity. Results of sleep laboratory evaluations suggested brief shifts toward higher arousal levels during sleep for PTSD subjects and a relationship of REM phasic activity and symptom severity.

Morbidity of "DSM-IV" Axis I Disorders in Patients with Noncardiac Chest Pain: Psychiatric Morbidity Linked with Increased Pain and Health Care Utilization

ERIC Educational Resources Information Center

White, Kamila S.; Raffa, Susan D.; Jakle, Katherine R.; Stoddard, Jill A.; Barlow, David H.; Brown, Timothy A.; Covino, Nicholas A.; Ullman, Edward; Gervino, Ernest V.

2008-01-01

The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV"; American…

Brief Report: Children with ADHD without Co-Morbid Autism Do Not Have Impaired Motor Proficiency on the Movement Assessment Battery for Children

ERIC Educational Resources Information Center

Papadopoulos, Nicole; Rinehart, Nicole; Bradshaw, John L.; McGinley, Jennifer L.

2013-01-01

Motor proficiency was investigated in a sample of children with Attention Deficit Hyperactivity Disorder-Combined type (ADHD-CT) without autism. Accounting for the influence of co-morbid autistic symptoms in ADHD motor studies is vital given that motor impairment has been linked to social-communication symptoms in children who have co-morbid ADHD…

PTSD Trajectory, Co-morbidity, and Utilization of Mental Health Services among National Guard Forces

DTIC Science & Technology

2011-10-01

constructed a survey for initial data collection as well as subsequent waves that contains modules on (1) risk or protective factors for psychological ...morbidity over the life course (general traumas, psychological resources, life and family concerns), (2) mental health (depression, PTSD, emotional...protective factors for psychological morbidity among National Guard force members, (b) mental health, and (c) service utilization patterns among

Favorable Cardiovascular Health, Compression of Morbidity, and Healthcare Costs: Forty-Year Follow-Up of the CHA Study (Chicago Heart Association Detection Project in Industry).

PubMed

Allen, Norrina B; Zhao, Lihui; Liu, Lei; Daviglus, Martha; Liu, Kiang; Fries, James; Shih, Ya-Chen Tina; Garside, Daniel; Vu, Thanh-Huyen; Stamler, Jeremiah; Lloyd-Jones, Donald M

2017-05-02

We examined the association of cardiovascular health at younger ages with the proportion of life lived free of morbidity, the cumulative burden of morbidity, and average healthcare costs at older ages. The CHA study (Chicago Heart Association Detection Project in Industry) is a longitudinal cohort of employed men and women 18 to 74 years of age at baseline examination in 1967 to 1973. Baseline measurements included blood pressure, cholesterol, diabetes mellitus, body mass index, and smoking. Individuals were classified into 1 of 4 strata of cardiovascular health: favorable levels of all factors, 0 factors high but ≥1 elevated risk factors, 1 high risk factor, and ≥2 high risk factors. Linked Medicare and National Death Index data from 1984 to 2010 were used to determine morbidity in older age. An individual's all-cause morbidity score and cardiovascular morbidity score were calculated from International Classification of Disease, Ninth Revision codes for each year of follow-up. We included 25 804 participants who became ≥65 years of age by 2010, representing 65% of all original CHA participants (43% female; 90% white; mean age, 44 years at baseline); 6% had favorable levels of all factors, 19% had ≥1 risk factors at elevated levels, 40% had 1 high risk factor, and 35% had ≥2 high risk factors. Favorable cardiovascular health at younger ages extended survival by almost 4 years and postponed the onset of all-cause and cardiovascular morbidity by 4.5 and 7 years, respectively, resulting in compression of morbidity in both absolute and relative terms. This translated to lower cumulative and annual healthcare costs for those in favorable cardiovascular health ( P <0.001) during Medicare eligibility. Individuals in favorable cardiovascular health in early middle age live a longer, healthier life free of all types of morbidity. These findings provide strong support for prevention efforts earlier in life aimed at preserving cardiovascular health and reducing the burden of disease in older ages. © 2017 American Heart Association, Inc.

Co-morbid depression is associated with poor work outcomes in persons with cardiovascular disease (CVD): A large, nationally representative survey in the Australian population

PubMed Central

2012-01-01

Background Co-morbid major depressive disorder (MDD) and cardiovascular disease (CVD) is associated with poor clinical and psychological outcomes. However, the full extent of the burden of, and interaction between, this co-morbidity on important vocational outcomes remains less clear, particularly at the population level. We examine the association of co-morbid MDD with work outcomes in persons with and without CVD. Methods This study utilised cross-sectional, population-based data from the 2007 Australian National Survey of Mental Health and Wellbeing (n = 8841) to compare work outcomes of individuals with diagnostically-defined MDD and CVD, MDD but not CVD, CVD but not MDD, with a reference group of "healthy" Australians. Workforce participation was defined as being in full- or part-time employment. Work functioning was measured using a WHO Disability Assessment Schedule item. Absenteeism was assessed using the 'days out of role' item. Results Of the four groups, those with co-morbid MDD and CVD were least likely to report workforce participation (adj OR:0.4, 95% CI: 0.3-0.6). Those with MDD only (adj OR:0.8, 95% CI:0.7-0.9) and CVD only (adj OR:0.8, 95% CI: 0.6-0.9) also reported significantly reduced odds of participation. Employed individuals with co-morbid MDD and CVD were 8 times as likely to experience impairments in work functioning (adj OR:8.1, 95% CI: 3.8- 17.3) compared with the reference group. MDD was associated with a four-fold increase in impaired functioning. Further, individuals with co-morbid MDD and CVD reported greatest likelihood of workplace absenteeism (adj. OR:3.0, 95% CI: 1.4-6.6). Simultaneous exposure to MDD and CVD conferred an even greater likelihood of poorer work functioning. Conclusions Co-morbid MDD and CVD is associated with significantly poorer work outcomes. Specifically, the effects of these conditions on work functioning are synergistic. The development of specialised treatment programs for those with co-morbid MDD and CVD is required. PMID:22257700

Acute surgical treatment of perforated peptic ulcer in the elderly patients.

PubMed

Su, Yen-Hao; Yeh, Chi-Chuan; Lee, Chih-Yuan; Lin, Mong-Wei; Kuan, Chen-Hsiang; Lai, I-Rue; Chen, Chiung-Nien; Lin, Hong-Mau; Lee, Po-Huang; Lin, Ming-Tsan

2010-01-01

Emergency abdominal surgery is associated with high morbidity and mortality rates, especially in the elderly patients, but prompt diagnoses and treatment should not be delayed. We conducted a retrospective review (1) to identify risk factors for morbidity and mortality among elderly patients admitted for emergent surgery of perforated peptic ulcers; and (2) to determine whether there were any differences between those who are 70-79 years old and those 80 years old and older. 94 patients who were older than 70 years old and underwent emergency surgery for perforated peptic ulcer between 2000 and 2004 in our institution were reviewed retrospectively. The following variables were followed: age, sex, comorbidity, previous medications, time from onset of symptoms/signs to surgery, time from arrival in emergent room to surgery, perioperative risks, operative findings, type of operation, morbidity, mortality and length of hospital stay. The age, morbidity, mortality and the length of intensive care unit stay were increased in Group 2 (>80 yrs) than Group 1 (70 to 79 yrs), but they did not achieve significant differences statistically. Time from symptoms/signs to emergency room over 24 hours, American Society of Anesthesiologist grade over IV and limited procedure showed significant contributions to postoperative morbidity on univariate analysis. Comorbidity, time from emergency room to operation room over 12 hours, American Society of Anesthesiologists grade over IV, peri-operative blood transfusion, postoperative morbidity and duration of ICU stays over 5 days were significant factors contributed to mortality on univariate analysis. Further analysis showed comorbidity, peri-operative blood transfusion, and postoperative morbidity were independent and predictive factors of mortality on multivariate model. Although perforated peptic ulcer in the elderly patients is associated with high morbidity and mortality, we should not delay the surgical intervention for patients with advanced age. Timely diagnosis and early surgical management of perforated peptic ulcers was imperative for elderly patients. The abdominal computer tomography was recommended in elderly patients for who had vague and atypical clinical symptoms/signs of perforated peptic ulcer. In addition, more attention should be paid to patients with preoperative comorbidities, peri-operative blood transfusion and post-operative morbidity for which were associated with high post-operative mortality.

Using multiple decrement models to estimate risk and morbidity from specific AIDS illnesses. Multicenter AIDS Cohort Study (MACS).

PubMed

Hoover, D R; Peng, Y; Saah, A J; Detels, R R; Day, R S; Phair, J P

A simple non-parametric approach is developed to simultaneously estimate net incidence and morbidity time from specific AIDS illnesses in populations at high risk for death from these illnesses and other causes. The disease-death process has four-stages that can be recast as two sandwiching three-state multiple decrement processes. Non-parametric estimation of net incidence and morbidity time with error bounds are achieved from these sandwiching models through modification of methods from Aalen and Greenwood, and bootstrapping. An application to immunosuppressed HIV-1 infected homosexual men reveals that cytomegalovirus disease, Kaposi's sarcoma and Pneumocystis pneumonia are likely to occur and cause significant morbidity time.

Area variations in multiple morbidity using a life table methodology.

PubMed

Congdon, Peter

Analysis of healthy life expectancy is typically based on a binary distinction between health and ill-health. By contrast, this paper considers spatial modelling of disease free life expectancy taking account of the number of chronic conditions. Thus the analysis is based on population sub-groups with no disease, those with one disease only, and those with two or more diseases (multiple morbidity). Data on health status is accordingly modelled using a multinomial likelihood. The analysis uses data for 258 small areas in north London, and shows wide differences in the disease burden related to multiple morbidity. Strong associations between area socioeconomic deprivation and multiple morbidity are demonstrated, as well as strong spatial clustering.

Psychological well-being of parents and family caregivers of children with hearing impairment in south India: influence of behavioural problems in children and social support.

PubMed

van Driessche, Anne; Jotheeswaran, A T; Murthy, G V S; Pilot, Eva; Sagar, Jayanthi; Pant, Hira; Singh, Vivek; Dpk, Babu

2014-08-01

Parents of children with hearing impairment are at increased risk of mental health morbidities. We examined the predictive factors associated with caregiver's strain and psychological morbidities in parents and family caregivers of children with hearing impairment. In total, n = 201 parents and family caregivers of children with and without hearing impairment aged 3 to 16 years were recruited. Caregiver's strain and psychological morbidities were measured using the Zarit Burden scale and the World Health Organization's Self-Reporting Questionnaire (SRQ-20). Presence of behavioural problems in children was measured using the Strengths and Difficulties Questionnaire. After adjustment, low educational attainment and domestic violence were found to be associated with caregiving strain, whereas dissatisfaction with social support from family, behavioural problems in children, and domestic violence strongly predicted psychological morbidities. Addressing the mental healthcare needs of parents may help in downsizing the impact of psychological morbidities on the well-being of children with hearing impairment.

POSSUM and P-POSSUM for risk assessment in general surgery in the elderly.

PubMed

Igari, Kimihiro; Ochiai, Takanori; Yamazaki, Shigeru

2013-09-01

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) use preoperative and intraoperative factors to evaluate risk. We examined our surgical results to investigate predictive factors for morbidity and mortality, and evaluate the accuracy of the POSSUM and P-POSSUM. Patients (n = 593) aged ≥80 years, undergoing general surgical procedures were enrolled. Logistic regression analysis was used to determine the independent predictors. The predicted outcomes using POSSUM and P-POSSUM were also compared with actual outcomes. Physiological score (PS) and operative severity score (OS) were independent predictors of morbidity and mortality. Using POSSUM, the observed/expected (O/E) morbidity ratio was 1.44 and O/E mortality ratio was 0.98. Using P-POSSUM, the O/E mortality ratio was 1.0. Even though POSSUM tended to underestimate the morbidity rate, POSSUM and P-POSSUM accurately predicted the mortality rate after general surgical procedures.

[The Morbidity of Students Conditioned by Diet Character in Modern Condition of Education].

PubMed

Novokhatskaya, E A; Yakovleva, T P; Kalitina, M A

2017-09-01

The article considers characteristics of nervous psychic adaptation, morbidity and character of diet of students of the Russian state social university. The main incentives of combination of university studies and work are analyzed. The impact of combining of studies and work, regimen and diet quality on health are investigated. The psychological studies were implemented using computerized techniques of psychological testing and data collection with blank technique. The morbidity of students was discovered using questionnaire. It is established that students combining studies and work, have optimal indices of nervous psychic adaptation. however, level of their morbidity is twice higher than morbidity of students not combining studies and work. The analysis of regimen and diet character of students established deviations in regimen and structure of diet. The ration of proteins, fats and carbohydrates in day ration of students was imbalanced (1.0:1.4:6.1) at the expense of surplus of content of fat and especially carbohydrates that afterwards can results in development of diseases related to irregular diet.

Medical Students' Stress, Psychological Morbidity, and Coping Strategies: a Cross-Sectional Study from Pakistan.

PubMed

Imran, Nazish; Tariq, Khaula Fatima; Pervez, Muhammad Ijaz; Jawaid, Masood; Haider, Imran Ijaz

2016-02-01

The authors studied the prevalence of psychological morbidity, sources and severity of stresses, as well as coping strategies in Pakistani medical students. Medical students in Lahore, Pakistan, completed a cross-sectional, self-administered questionnaire in 2013 on the sources and severity of various stressors. The General Health Questionnaire-12 (GHQ-12) and Brief COPE assessed the psychological morbidity and coping strategies. Out of 1500 students, 527 responded to the survey. The prevalence of psychological morbidity was 23.3%; 52.3% respondents showed evidence of distress. By logistic regression analysis, GHQ-12 caseness was associated with being male and occurrence of health-related stressors. The most common stressors were related to academic concerns. Coping strategies showed variation by GHQ-caseness. The significant psychological morbidity and distress warrants establishing support systems to support students and bringing about evidence-based changes to teaching and evaluation systems. Adequate counseling facilities should be made available and students encouraged to seek help.

A patient with coexisting narcolepsy and morbid jealousy showing favourable response to fluoxetine.

PubMed Central

Wing, Y. K.; Lee, S.; Chiu, H. F.; Ho, C. K.; Chen, C. N.

1994-01-01

A 37 year old Chinese man suffered from coexisting narcolepsy and morbid jealousy which were precipitated by head injury 5 years previously. Fluoxetine 20 mg/day reduced his narcoleptic symptoms and morbid jealousy but not his sleepiness. On defaulting treatment, the patient's symptoms and marital problem recurred. A common central serotonin disturbance might be involved in mediating the sleep disorder and associated psychopathology. PMID:8140016

The Design and Analysis of Pediatric Vaccine Formularies: Theory and Practice

DTIC Science & Technology

2006-06-22

Schedule—United States. Morbidity and Mortality Weekly Report; 54(52):Q1-Q4. Centers for Disease Control and Prevention. 2005. Recommended...Childhood and Adolescent Immunization Schedule—United States. Morbidity and Mortality Weekly Report; 53:Q1-Q3. Centers for Disease Control and Prevention... Mortality Weekly Report; 52(RR-1);34-36. Centers for Disease Control and Prevention. 2002. General Recommendations on Immunization. Morbidity and

Sodium pentothal hypnosis: a procedure for evaluating medical patients with suspected psychiatric co-morbidity.

PubMed

Russo, M B; Brooks, F R; Fontenot, J P; Dopler, B M; Neely, E T; Halliday, A W

1997-03-01

The cases presented here were patients referred for neurologic disability evaluations. They met the three selection criteria presented and underwent the four-phase pentothal hypnosis procedure described and at the conclusion were diagnosed as having psychiatric morbidity. We recommend that the sodium pentothal hypnosis procedure be considered for use whenever there is concern for psychiatric co-morbidity in a patient with presumed physiologic disease.

Is the impact of depressive complaints on the use of general health care services dependent on severity of somatic morbidity?

PubMed

Koopmans, Gerrit T; Lamers, Leida M

2006-07-01

The aim of this study was to examine the effects of depressive complaints and chronic medical illnesses on prospective somatic health care utilization and the possible heterogeneity of the effect of depressive complaints across levels of medical illness severity. Data from a community-based sample of adults (n=9428) were used, of whom a health survey and claims data, indicating health care use, were available. Assessments of depressive complaints and somatic illnesses were based on self-report. Binomial regression analyses were used to study the expected relations. Depressive complaints and somatic morbidity were both positively related to general health care utilization. Somatic morbidity has an attenuating effect on the impact of depressive complaints: If it becomes more severe, the impact of depressive complaints on utilization is reduced. Depressive complaints are especially related to the use of paramedic services, use of prescription drugs, and consultations of medical specialists. Depressive complaints predict somatic health care utilization, but somatic morbidity attenuates this relation. Future research on this subject should include interaction effects of depressive complaints and somatic morbidity. Interventions aiming to reduce excess use related to mental distress should be primarily targeted on subjects with mental distress who have no comorbid somatic morbidity.

Listing Practices for Morbidly Obese Patients at Liver Transplantation Centers in the United States.

PubMed

Halegoua-De Marzio, Dina L; Wong, She-Yan; Fenkel, Jonathan M; Doria, Cataldo; Sass, David A

2016-12-01

The effect of morbid obesity on liver transplant outcomes has yielded mixed results. The aim of this study was to determine listing practices for morbidly obese patients at liver transplant centers in the United States. A 19-item survey was created to assess liver transplant evaluation and listing practices for morbidly obese patients. All adult liver transplant medical and surgical directors in the United States were contacted by e-mail, which provided an Internet link to an online survey. We sent a total of 187 surveys by e-mail, with responses received from 46 physicians (24.7% response rate). A policy on evaluation and listing of obese patients was present at 70.5% of institutions, with most (54.5%) reporting that their body mass index cutoff for transplant was 40 kg/m2, but a range of 35 kg/m2 to unlimited was noted. Most respondents agreed that patients with high body mass index were less likely to be evaluated for transplant. Respondents reported increased complication rates among obese patients, with the most common being poor wound healing and increased infection rates. Most medical and surgical liver transplant directors have a strong appreciation of the possible morbidity risks associated with performing liver transplants in morbidly obese patients and have policies in effect to minimize these risks.

Growth and Morbidity of Gambian Infants are Influenced by Maternal Milk Oligosaccharides and Infant Gut Microbiota

PubMed Central

Davis, Jasmine C. C.; Lewis, Zachery T.; Krishnan, Sridevi; Bernstein, Robin M.; Moore, Sophie E.; Prentice, Andrew M.; Mills, David A.; Lebrilla, Carlito B.; Zivkovic, Angela M.

2017-01-01

Human milk oligosaccharides (HMOs) play an important role in the health of an infant as substrate for beneficial gut bacteria. Little is known about the effects of HMO composition and its changes on the morbidity and growth outcomes of infants living in areas with high infection rates. Mother’s HMO composition and infant gut microbiota from 33 Gambian mother/infant pairs at 4, 16, and 20 weeks postpartum were analyzed for relationships between HMOs, microbiota, and infant morbidity and growth. The data indicate that lacto-N-fucopentaose I was associated with decreased infant morbidity, and 3′-sialyllactose was found to be a good indicator of infant weight-for-age. Because HMOs, gut microbiota, and infant health are interrelated, the relationship between infant health and their microbiome were analyzed. While bifidobacteria were the dominant genus in the infant gut overall, Dialister and Prevotella were negatively correlated with morbidity, and Bacteroides was increased in infants with abnormal calprotectin. Mothers nursing in the wet season (July to October) produced significantly less oligosaccharides compared to those nursing in the dry season (November to June). These results suggest that specific types and structures of HMOs are sensitive to environmental conditions, protective of morbidity, predictive of growth, and correlated with specific microbiota. PMID:28079170

[Surgical treatment of colonic volvulus. 10-year experience at the Instituto Nacional de la Nutrición Salvador Zubirán].

PubMed

Remes-Troche, J M; Pérez-Martínez, C; Rembis, V; Arch Ferrer, J; Ayala González, M; Takahashi, T

1997-01-01

To analyze morbidity-mortality and results of surgical treatment for colonic volvulus. Retrospective review of 33 patients who underwent surgical treatment for colonic volvulus from 1986 through 1996. Mean age was 62 +/- 20 years (SD) with predominance of female sex (2:1). There were 25 cases of sigmoid volvulus (76%), 7 in the cecum (21%) and 1 in the transverse colon (3%). Colonic necrosis and/or perforation were most frequently seen in the right and transverse colon (50%) than in the sigmoid (4%) (P < 0.002). Operative morbidity was 45% with mortality of 21%. Age was the only variable statistically significant for operative morbidity (52 +/- 23 years in patients without morbidity vs 71 +/- 17 years in patients with morbidity, P = 0.02). Surgical procedures for sigmoid volvulus were resection in 13 and fixation in 12. Recurrence after fixation was 38% to 12 months and 69% to 24 months (Kaplan-Meier), with associated mortality of 50%. There was no recurrence after resections. Treatment for cecal volvulus was cecopexy in 4 cases, with one recurrence; and right hemicolectomy without recurrence. The results should encourage resective procedures in sigmoid volvulus because the risk of recurrence after fixation is high and the morbidity-mortality is similar. Elderly patients are more susceptible to complications.

Placenta previa and long-term morbidity of the term offspring.

PubMed

Walfisch, Asnat; Beharier, Ofer; Shoham-Vardi, Ilana; Sergienko, Ruslan; Landau, Daniella; Sheiner, Eyal

2016-08-01

The long-term impact of placenta previa on term infants is unknown. We aimed to investigate whether abnormal placentation increases the risk for long-term morbidity of the term offspring. A population-based cohort study compared the incidence of long-term hospitalizations up to the age of 18 due to cardiovascular, endocrine, neurological, hematological, respiratory and urinary morbidity of children born at term in pregnancies diagnosed with placenta previa and those without. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies, and fetal congenital malformations were excluded. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence over time. A multivariable generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters. During the study period 233,123 term deliveries met the inclusion criteria; 0.2% (n=502) of the children were born to mothers with placenta previa. During the follow-up period, children born to mothers with placenta previa did not have an increased risk for long-term cardiovascular, endocrine, hematological, neurological, respiratory, and urinary morbidity. Term offsprings of mothers diagnosed with placenta previa do not appear to be at an increased risk for long-term morbidity up to the age of 18. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Trends in bariatric surgery for morbid obesity in Wisconsin: a 6-year follow-up.

PubMed

Henkel, Dana S; Remington, Patrick L; Athens, Jessica K; Gould, Jon C

2010-02-01

The prevalence of morbid obesity is increasing throughout Wisconsin and the United States. In 2004, we published a study, "Trends in Bariatric Surgery for Morbid Obesity in Wisconsin." We determined that surgery rates were increasing but felt the demand exceeded the capacity of the surgeons. This is a 6-year follow-up. Data was gathered from 3 sources: the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, the Wisconsin Hospital Association, and a survey administered to Wisconsin bariatric surgeons. From 2003-2008, an average of 2.8% of Wisconsin adults were morbidly obese. Although the number of bariatric surgeries performed in Wisconsin remained steady (1311 surgeries in 2003 and 1343 in 2008), the types of procedures shifted from open gastric bypass (73% in 2003) to laparoscopic gastric bypass (80% in 2008). The rate of surgery was 1 for every 100 morbidly obese adults. The majority of surgeons surveyed (70%) report that a lack of insurance benefits is the biggest barrier to performing bariatric surgery. The prevalence of morbid obesity continues to increase in Wisconsin compared to our previously published data. Bariatric surgery volumes have remained stable but the type of procedure has changed. Approximately 1% of bariatric surgery candidates have surgery each year.

[Neonatal Morbidity and Gestational Diabetes: Coincidence or Consequence of the 2011 Protocol].

PubMed

Mimoso, Gabriela; Oliveira, Guiomar

2017-09-29

Gestational diabetes is one of the diseases associated with pregnancy with higher rate of complications. Despite being a transitory condition, short and long term complications related to gestational diabetes have been described. There is scientific evidence to say that good metabolic control decreases perinatal complications. In 2011, new criteria was proposed for its diagnosis, which made possible its diagnosis during the 1st trimester of pregnancy. The aim of this study is to compare neonatal morbidity in two groups of women with gestational diabetes diagnosis before and after the latest Portuguese guidelines for diabetes and pregnancy were published (February 2011). We included all newborns born in Maternidade Bissaya Barreto whose mother, followed at our maternity between 2008 and 2013, had unifetal pregnancy complicated by diabetes. We used a perinatal database and analysed the impact of the new guidelines in perinatal morbidity over two periods of three years. There were 774 women who met the inclusion criteria. We found that gestational diabetes was diagnosed earlier, insulin therapy was more frequent. Neonatal morbidity was increased, and there were more cases of neonatal hypoglycemia and congenital anomalies, and newborns became smaller for gestational age. The increase in neonatal morbidity was associated with early diagnosis and rigorous metabolic control. To analyse national data will be fundamental to understand this unexpected increase in morbidity.

The neural representation of typical and atypical experiences of negative images: comparing fear, disgust and morbid fascination

PubMed Central

Lindquist, Kristen A.; Adebayo, Morenikeji; Barrett, Lisa Feldman

2016-01-01

Negative stimuli do not only evoke fear or disgust, but can also evoke a state of ‘morbid fascination’ which is an urge to approach and explore a negative stimulus. In the present neuroimaging study, we applied an innovative method to investigate the neural systems involved in typical and atypical conceptualizations of negative images. Participants received false feedback labeling their mental experience as fear, disgust or morbid fascination. This manipulation was successful; participants judged the false feedback correct for 70% of the trials on average. The neuroimaging results demonstrated differential activity within regions in the ‘neural reference space for discrete emotion’ depending on the type of feedback. We found robust differences in the ventrolateral prefrontal cortex, the dorsomedial prefrontal cortex and the lateral orbitofrontal cortex comparing morbid fascination to control feedback. More subtle differences in the dorsomedial prefrontal cortex and the lateral orbitofrontal cortex were also found between morbid fascination feedback and the other emotion feedback conditions. This study is the first to forward evidence about the neural representation of the experimentally unexplored state of morbid fascination. In line with a constructionist framework, our findings suggest that neural resources associated with the process of conceptualization contribute to the neural representation of this state. PMID:26180088

Self-reported adherence to treatment: a study of socioeconomic factors and psychiatric morbidity among male and female patients with HIV infection in Sokoto, Nigeria. Running title: Treatment adherence, socioeconomic factors and psychiatric morbidity in HIV patients.

PubMed

Yunusa, Mufutau A; Njoku, Chibueze H; Obembe, Ayo

2014-01-01

Adherence to treatment is important and relevant in HIV treatment. Previous studies in sub Sahara Africa and south western Nigeria reported that psychiatric morbidity influence treatment adherence. The present study was to examine treatment adherence among the male and the female patients with HIV infection and the effect of socioeconomic factors and psychiatric morbidity on treatment adherence. A total of 159 patients which comprised of 48 male and 111 female who were eligible for this cross sectional prospective study were included having given their consent to participate. Questionnaire relating to socioeconomic factors and treatment adherence were administered. Psychiatric morbidity was assessed using HADS. Data was analyzed with SPSS for windows version 16.0. Treatment adherence was poor in 5.3% of the patients. The male patients had slightly better adherence than the female patients. Factors associated with poor treatment adherence include poor clinic attendance, presence of anxiety symptoms in males and poor education attainment in females. Treatment adherence is related to socioeconomic factors and psychiatric morbidity. Treatment protocol in which mental health and detailed socioeconomic circumstance of patient is an integral part should be encouraged.

Growth and Morbidity of Gambian Infants are Influenced by Maternal Milk Oligosaccharides and Infant Gut Microbiota

NASA Astrophysics Data System (ADS)

Davis, Jasmine C. C.; Lewis, Zachery T.; Krishnan, Sridevi; Bernstein, Robin M.; Moore, Sophie E.; Prentice, Andrew M.; Mills, David A.; Lebrilla, Carlito B.; Zivkovic, Angela M.

2017-01-01

Human milk oligosaccharides (HMOs) play an important role in the health of an infant as substrate for beneficial gut bacteria. Little is known about the effects of HMO composition and its changes on the morbidity and growth outcomes of infants living in areas with high infection rates. Mother’s HMO composition and infant gut microbiota from 33 Gambian mother/infant pairs at 4, 16, and 20 weeks postpartum were analyzed for relationships between HMOs, microbiota, and infant morbidity and growth. The data indicate that lacto-N-fucopentaose I was associated with decreased infant morbidity, and 3‧-sialyllactose was found to be a good indicator of infant weight-for-age. Because HMOs, gut microbiota, and infant health are interrelated, the relationship between infant health and their microbiome were analyzed. While bifidobacteria were the dominant genus in the infant gut overall, Dialister and Prevotella were negatively correlated with morbidity, and Bacteroides was increased in infants with abnormal calprotectin. Mothers nursing in the wet season (July to October) produced significantly less oligosaccharides compared to those nursing in the dry season (November to June). These results suggest that specific types and structures of HMOs are sensitive to environmental conditions, protective of morbidity, predictive of growth, and correlated with specific microbiota.

The present and future disease burden of hepatitis C virus infections with today's treatment paradigm - volume 3.

PubMed

Sibley, A; Han, K H; Abourached, A; Lesmana, L A; Makara, M; Jafri, W; Salupere, R; Assiri, A M; Goldis, A; Abaalkhail, F; Abbas, Z; Abdou, A; Al Braiki, F; Al Hosani, F; Al Jaberi, K; Al Khatry, M; Al Mulla, M A; Al Quraishi, H; Al Rifai, A; Al Serkal, Y; Alam, A; Alavian, S M; Alashgar, H I; Alawadhi, S; Al-Dabal, L; Aldins, P; Alfaleh, F Z; Alghamdi, A S; Al-Hakeem, R; Aljumah, A A; Almessabi, A; Alqutub, A N; Alswat, K A; Altraif, I; Alzaabi, M; Andrea, N; Babatin, M A; Baqir, A; Barakat, M T; Bergmann, O M; Bizri, A R; Blach, S; Chaudhry, A; Choi, M S; Diab, T; Djauzi, S; El Hassan, E S; El Khoury, S; Estes, C; Fakhry, S; Farooqi, J I; Fridjonsdottir, H; Gani, R A; Ghafoor Khan, A; Gheorghe, L; Gottfredsson, M; Gregorcic, S; Gunter, J; Hajarizadeh, B; Hamid, S; Hasan, I; Hashim, A; Horvath, G; Hunyady, B; Husni, R; Jeruma, A; Jonasson, J G; Karlsdottir, B; Kim, D Y; Kim, Y S; Koutoubi, Z; Liakina, V; Lim, Y S; Löve, A; Maimets, M; Malekzadeh, R; Matičič, M; Memon, M S; Merat, S; Mokhbat, J E; Mourad, F H; Muljono, D H; Nawaz, A; Nugrahini, N; Olafsson, S; Priohutomo, S; Qureshi, H; Rassam, P; Razavi, H; Razavi-Shearer, D; Razavi-Shearer, K; Rozentale, B; Sadik, M; Saeed, K; Salamat, A; Sanai, F M; Sanityoso Sulaiman, A; Sayegh, R A; Sharara, A I; Siddiq, M; Siddiqui, A M; Sigmundsdottir, G; Sigurdardottir, B; Speiciene, D; Sulaiman, A; Sultan, M A; Taha, M; Tanaka, J; Tarifi, H; Tayyab, G; Tolmane, I; Ud Din, M; Umar, M; Valantinas, J; Videčnik-Zorman, J; Yaghi, C; Yunihastuti, E; Yusuf, M A; Zuberi, B F; Schmelzer, J D

2015-12-01

The total number, morbidity and mortality attributed to viraemic hepatitis C virus (HCV) infections change over time making it difficult to compare reported estimates from different years. Models were developed for 15 countries to quantify and characterize the viraemic population and forecast the changes in the infected population and the corresponding disease burden from 2014 to 2030. With the exception of Iceland, Iran, Latvia and Pakistan, the total number of viraemic HCV infections is expected to decline from 2014 to 2030, but the associated morbidity and mortality are expected to increase in all countries except for Japan and South Korea. In the latter two countries, mortality due to an ageing population will drive down prevalence, morbidity and mortality. On the other hand, both countries have already experienced a rapid increase in HCV-related mortality and morbidity. HCV-related morbidity and mortality are projected to increase between 2014 and 2030 in all other countries as result of an ageing HCV-infected population. Thus, although the total number of HCV countries is expected to decline in most countries studied, the associated disease burden is expected to increase. The current treatment paradigm is inadequate if large reductions in HCV-related morbidity and mortality are to be achieved. © 2015 John Wiley & Sons Ltd.

Transradial access for visceral endovascular interventions in morbidly obese patients: safety and feasibility.

PubMed

Biederman, Derek M; Marinelli, Brett; O'Connor, Paul J; Titano, Joseph J; Patel, Rahul S; Kim, Edward; Tabori, Nora E; Nowakowski, Francis S; Lookstein, Robert A; Fischman, Aaron M

2016-05-07

Transradial access (TRA) has been shown to lower morbidity and bleeding complications compared to transfemoral access in percutaneous coronary interventions. Morbid obesity, commonly defined as a body mass index (BMI) ≥40 kg/m2, has been shown to be a risk factor for access site complications irrespective of access site. This study evaluates the safety and feasibility of performing visceral endovascular interventions in morbidly obese patients via TRA. Procedural details, technical success, and 30-day major and minor access site, bleeding, and neurological adverse events were prospectively recorded in a database of 1057 procedures performed via the radial artery. From this database we identified 22 visceral interventions performed with TRA in 17 morbidly obese patients (age: 53 ± 11 years, female: 71%) with a median BMI of 42.7 kg/m2. Interventions included radio-embolization (n = 7, 31.8%), chemo-embolization (n = 6, 27.3%), uterine fibroid embolization (n = 4, 18.2%), renal embolization (n = 2, 9.1%), hepatic embolization (n = 1, 4.5%), lumbar artery embolization (n = 1, 4.5%), and renal angioplasty (n = 1, 4.5%). The technical success was 100%. There were no major or minor adverse access site, bleeding, or neurological complications at 30 days. This study suggests visceral endovascular interventions performed in morbidly obese patients are safe and feasible.

Shoulder-arm morbidity in patients with sentinel node biopsy and complete axillary dissection--data from a prospective randomised trial.

PubMed

Helms, G; Kühn, T; Moser, L; Remmel, E; Kreienberg, R

2009-07-01

Axillary lymph node dissection (ALND) as part of surgical treatment in breast cancer has been the standard procedure for many decades. However, patients frequently develop shoulder-arm morbidity postoperatively. Recently, sentinel node (SN) biopsy has been established as a new standard of care for axillary staging in breast cancer. This study compares postoperative morbidity between ALND and SN biopsy. The results are compared with the existing literature. Between November 2000 and September 2002, 181 women with early stage breast cancer underwent primary surgery following preoperative randomisation into two groups, a "standard group" (SN biopsy was followed by ALND) and a study group (surgical procedure consisting of only SN biopsy when histologically metastasis-free SN was present). Follow-up data (362 sessions; 6 months to 3 years after primary surgery) were available from 150 patients. A summary morbidity score was calculated from four subjective (arm-strength, arm-mobility, arm swelling, pain) and four objective (arm-strength, arm-mobility, lymphedema, sensitivity) criteria. Fifty seven patients underwent SN biopsy only. Ninety three patients underwent ALND, 57 of which had lymph nodes free of metastasis and 36 had lymph nodes with metastasis and axillary clearing. Shoulder-arm morbidity was significantly different between the groups. Patients treated with SN biopsy only scored better on subjective and objective criteria. Postsurgical shoulder-arm morbidity is a major long-term problem in patients undergoing surgical treatment for breast cancer. This prospective study showed significantly less severe shoulder-arm morbidity following SN biopsy compared to patients undergoing ALND.

Morbidity in ≤1500-Gram Births in Spain, 1993-2011: Study of a Sample of 1200 Cases

PubMed Central

Gómez Esteban, Concepción; Sánchez Carrión, Juan J.; García Selgas, Fernando J.; Segovia Guisado, José M.

2017-01-01

Background and Objective. Preterm birth has a major impact on growth, and very preterm birth is associated with disabilities in numerous developmental domains. This article describes and quantifies morbidities in a sample of 1200 ≤1500-g births in Spain between 1993 and 2011 based on parent information, and it highlights several variables that influence these morbidities. Methods. Multiple method surveys using computer-assisted telephones interviewing and computer-assisted web interviewing methods. Sample design was intentional. Most subjects were contacted via their referral hospitals. Data collection was done from April 2013 to June 2014. Prior to the survey, extensive qualitative fieldwork was conducted, including nonparticipant observation in neonatal units and the design and analysis of discussion groups and interviews with professionals and families, including preterm adolescents. Results. A total of 44.2% of the sample were experiencing morbidity (mean: 1.788 morbidities per child). The most prevalent types were learning difficulties (34.4%) and attention deficit/hyperactivity disorder (31.5%). The most influential variables were male gender, age, lower birthweight, private hospital admission for birth, scarcity of health resources in the family’s residential area, non-Spanish maternal birthplace, and emotional distress in the primary carer. Conclusions. Overall, the total percentage of very low birth weight children with morbidities has decreased moderately between 1993 and 2011, thanks to major socio-sanitary improvements during this period. Biological and medical variables, rather than family factors, explain more accurately the presence of morbidities in children with birth weight ≤1500 g. PMID:28989948

What do individuals with morbid obesity report as a usual dietary intake? A narrative review of available evidence.

PubMed

Harbury, Cathy M; Verbruggen, Elisabeth E; Callister, Robin; Collins, Clare E

2016-06-01

In several developed countries, as obesity prevalence doubles it has quadrupled for morbid obesity (BMI ≥ 40 kgm -2 ). As more individuals with morbid obesity present for weight loss treatment there is a greater need to understand their dietary habits. No reviews were found in the literature, therefore this systematic review aims to identify and describe the existing evidence on the usual dietary intake of individuals with morbid obesity including those from a general population and those seeking treatment such as weight loss surgery. A literature search of ten databases from 1980 to June 2014 was conducted to identify original research of adults with morbid obesity (aged 18-60 years) that reported a usual dietary intake. Ten studies met all inclusion criteria and reported energy intake, most reported macronutrient composition, two assessed micronutrient intake, and one reported food-based outcomes. Other dietary outcomes were related to surgical intervention. The most plausible energy intake data suggest high intakes, >4000 Kcal/day for those weight stable at the highest levels of morbid obesity (up to BMI 97 kgm -2 ). Fat intakes are also high, around 40% of energy intake and up to 57% for some individuals. Suboptimal intakes of iron and calcium are reported. This review draws attention to a limited evidence base, offers preliminary insight suggesting individuals with morbid obesity are prone to consuming poor quality diets similar to those reported for obese populations, and highlights challenges for future research. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Heat Waves and Morbidity: Current Knowledge and Further Direction-A Comprehensive Literature Review

PubMed Central

Li, Mengmeng; Gu, Shaohua; Bi, Peng; Yang, Jun; Liu, Qiyong

2015-01-01

In the past few decades, several devastating heat wave events have significantly challenged public health. As these events are projected to increase in both severity and frequency in the future, it is important to assess the relationship between heat waves and the health indicators that can be used in the early warning systems to guide the public health response. Yet there is a knowledge gap in the impact of heat waves on morbidity. In this study, a comprehensive review was conducted to assess the relationship between heat waves and different morbidity indicators, and to identify the vulnerable populations. The PubMed and ScienceDirect database were used to retrieve published literature in English from 1985 to 2014 on the relationship between heat waves and morbidity, and the following MeSH terms and keywords were used: heat wave, heat wave, morbidity, hospital admission, hospitalization, emergency call, emergency medical services, and outpatient visit. Thirty-three studies were included in the final analysis. Most studies found a short-term negative health impact of heat waves on morbidity. The elderly, children, and males were more vulnerable during heat waves, and the medical care demand increased for those with existing chronic diseases. Some social factors, such as lower socioeconomic status, can contribute to heat-susceptibility. In terms of study methods and heat wave definitions, there remain inconsistencies and uncertainties. Relevant policies and guidelines need to be developed to protect vulnerable populations. Morbidity indicators should be adopted in heat wave early warning systems in order to guide the effective implementation of public health actions. PMID:25993103

Efficacy of loop colostomy construction for acute left-sided colonic obstructions: a cohort analysis.

PubMed

Amelung, Femke J; Mulder, Charlotte L J; Broeders, Ivo A M J; Consten, Esther C J; Draaisma, Werner A

2017-03-01

Acute primary resection as treatment for left-sided colonic obstruction (LSCO) is notorious for its high morbidity and mortality rates. Both stenting and loop colostomy construction can serve as a bridge to surgery, hereby avoiding the high morbidity and mortality rates associated with emergency resections. This study aims to investigate the safety of a loop colostomy in patients presenting with acute LSCO. Retrospective analysis of all patients that received a loop colostomy for LSCO between 2003 and 2015 was performed. Primary outcomes were mortality, major morbidity (Clavien-Dindo grades III-IV) and minor morbidity (Clavien-Dindo grades I-II). One hundred forty-six patients presenting with acute LSCO received a diverting colostomy. After colostomy construction, mortality occurred in four patients (2.7%) and major complications were reported in 20 patients (13.7%). In 61 patients, the diverting colostomy served as a palliative measure, because of metastatic disease or unfitness for major surgery. The remaining 85 patients all underwent delayed resection, resulting in an overall mortality, major morbidity and minor morbidity of 6.9% (n = 6), 14.0% (n = 12) and 26.7% (n = 23), respectively. Diverting colostomy construction is a minimally invasive and safe treatment option for LSCO. It can serve as a definite palliative measure, as well as a bridge to elective surgery. A diverting colostomy as a bridge to surgery might even be a valid alternative for emergency resections, since mortality and morbidity rates following colostomy construction and delayed resection appear lower than reported outcomes following primary resection.

Prediction of 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.

PubMed

Gerestein, C G; Nieuwenhuyzen-de Boer, G M; Eijkemans, M J; Kooi, G S; Burger, C W

2010-01-01

Treatment in advanced stage epithelial ovarian cancer (EOC) is based on primary cytoreductive surgery followed by platinum-based chemotherapy. Successful cytoreduction to minimal residual tumour burden is the most important determinant of prognosis. However, extensive surgical procedures to achieve maximal debulking are inevitably associated with postoperative morbidity and mortality. The objective of this study is to determine predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC. All patients in the South Western part of the Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007 were identified from the Rotterdam Cancer Registry database. All peri- and postoperative complications within 30 days after surgery were registered and classified according to the definitions of the National Surgical Quality Improvement Programme (NSQIP). To investigate independent predictors of 30-day morbidity, a Cox proportional hazards model with backward stepwise elimination was utilised. The identified predictors were entered into a nomogram. Two hundred and ninety-three patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. 30-day morbidity was seen in 99 (34%) patients. Postoperative morbidity could be predicted by age (P=0.007; odds ratio [OR] 1.034), WHO performance status (P=0.046; OR 1.757), extent of surgery (P=0.1308; OR=2.101), and operative time (P=0.017; OR 1.007) with an optimism corrected c-statistic of 0.68. 30-day morbidity could be predicted by age, WHO performance status, operative time and extent of surgery. The generated nomogram could be valuable for predicting operative risk in the individual patient.

Can gender difference in prescription drug use be explained by gender-related morbidity?: a study on a Swedish population during 2006.

PubMed

Skoog, Jessica; Midlöv, Patrik; Borgquist, Lars; Sundquist, Jan; Halling, Anders

2014-04-08

It has been reported that there is a difference in drug prescription between males and females. Even after adjustment for multi-morbidity, females tend to use more prescription drugs compared to males. In this study, we wanted to analyse whether the gender difference in drug treatment could be explained by gender-related morbidity. Data was collected on all individuals 20 years and older in the county of Östergötland in Sweden. The Johns Hopkins ACG Case-Mix System was used to calculate individual level of multi-morbidity. A report from the Swedish National Institute of Public Health using the WHO term DALY was the basis for gender-related morbidity. Prescription drugs used to treat diseases that mainly affect females were excluded from the analyses. The odds of having prescription drugs for males, compared to females, increased from 0.45 (95% confidence interval (CI) 0.44-0.46) to 0.82 (95% CI 0.81-0.83) after exclusion of prescription drugs that are used to treat diseases that mainly affect females. Gender-related morbidity and the use of anti-conception drugs may explain a large part of the difference in prescription drug use between males and females but still there remains a difference between the genders at 18%. This implicates that it is of importance to take the gender-related morbidity into consideration, and to exclude anti-conception drugs, when performing studies regarding difference in drug use between the genders.

Placenta previa without morbidly adherent placenta: comparison of characteristics and outcomes between planned and emergent deliveries in a tertiary center.

PubMed

Erfani, Hadi; Kassir, Elias; Fox, Karin A; Clark, Steven L; Karbasian, Niloofar; Salmanian, Bahram; Shamshirsaz, Amir A; Espinoza, Jimmy; Nassr, Ahmed A; Eppes, Catherine S; Belfort, Michael A; Shamshirsaz, Alireza A

2017-11-05

The objective of this study is to compare patient outcomes between planned and emergent cesarean deliveries for placenta previa without morbidly adherent placenta. All patients with confirmed, persistent placenta previa (without morbidly adherent placentation) who underwent the surgery between January 2010 and April 2016 were included in this retrospective study. Primary outcome was composite maternal morbidity defined as the presence of at least one of the followings: death, red blood cell (RBC) transfusion, hysterectomy, reoperation, hospital stay >7 d, ureteral injury, bowel injury, or cystotomy. Three hundred and four patients with placenta previa were identified during the study period, of whom 154 (50.65%) had an antenatal and 10 (3.28%) had an intraoperative diagnosis of morbidly adherent placenta. One hundred and forty patients met the inclusion criteria. Eighty (57.1%) underwent planned cesarean delivery (planned cesarean delivery (PCD) group), and 60 (42.8%) required emergent cesarean delivery due to uterine contractions and/or bleeding (emergent cesarean delivery (ECD) group). Baseline characteristics were similar between the two groups except for the gestational age at delivery (36.0 weeks (36.0, 37.0) in PCD versus 34.0 weeks (32.0, 36.0) in ECP, p < .001). Composite maternal morbidity was not significantly different between two groups: 11 (18.3%) in ECD and 10 (12.5%) in PCD (p = .35) Conclusions: In our referral tertiary centre, emergent and planned cesarean deliveries for placenta previa without morbidly adherent placenta have similar maternal outcomes. In patients without significant hemorrhage, delivery may be safely deferred until 36-37 weeks.

Morbidly adherent placenta previa in current practice: prediction and maternal morbidity in a series of 23 women who underwent hysterectomy.

PubMed

Alchalabi, Haifa'a; Lataifeh, Isam; Obeidat, Basil; Zayed, Faheem; Khader, Yousef S; Obeidat, Nail

2014-11-01

To assess the prediction and maternal morbidity of morbidly adherent placenta previa (PP) when currently available management options are used. This is a retrospective study of all women with PP/morbidly adherent placenta previa (MAPP) delivered at our hospital over a period of 9 years. Data were obtained through hospital registry and medical records search. A total of 81 PP were identified, 23 (28.4%) of them had MAPP. All MAPP had previous lower segment cesarean section (LSCS). The following are associated with increased odds of MAPP versus PP, LSCS (OR for each additional LSCS was 2.9 (95% confidence interval: 1.8, 4.5, p ≤ 0.005), age ≥35 years (OR 4.3 (95% CI: 1.4, 12.7, p = 0.008). Anterior or central placenta (OR = 11.6; p = 0.028). Women with previous PP were at risk. Fifteen women were diagnosed by ultrasound [sensitivity 0.65 (0.43, 0.83) and PPV 0.79 (0.54, 0.93)]. MAPP was associated with risk of massive transfusion, bladder injury, DIC and admission to intensive care unit (ICU) (p < 0.005, 0.008, 0.036 and 0.008, respectively). One maternal death was reported in the MAPP group. MAPP is associated with high morbidity and mortality. As the diagnosis is often not certain before delivery, we recommend that all PP and previous LSCS are assumed to be morbidly adherent, and should be managed in properly equipped centers.

Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study.

PubMed

Palacio, Montse; Bonet-Carne, Elisenda; Cobo, Teresa; Perez-Moreno, Alvaro; Sabrià, Joan; Richter, Jute; Kacerovsky, Marian; Jacobsson, Bo; García-Posada, Raúl A; Bugatto, Fernando; Santisteve, Ramon; Vives, Àngels; Parra-Cordero, Mauro; Hernandez-Andrade, Edgar; Bartha, José Luis; Carretero-Lucena, Pilar; Tan, Kai Lit; Cruz-Martínez, Rogelio; Burke, Minke; Vavilala, Suseela; Iruretagoyena, Igor; Delgado, Juan Luis; Schenone, Mauro; Vilanova, Josep; Botet, Francesc; Yeo, George S H; Hyett, Jon; Deprest, Jan; Romero, Roberto; Gratacos, Eduard

2017-08-01

Prediction of neonatal respiratory morbidity may be useful to plan delivery in complicated pregnancies. The limited predictive performance of the current diagnostic tests together with the risks of an invasive procedure restricts the use of fetal lung maturity assessment. The objective of the study was to evaluate the performance of quantitative ultrasound texture analysis of the fetal lung (quantusFLM) to predict neonatal respiratory morbidity in preterm and early-term (<39.0 weeks) deliveries. This was a prospective multicenter study conducted in 20 centers worldwide. Fetal lung ultrasound images were obtained at 25.0-38.6 weeks of gestation within 48 hours of delivery, stored in Digital Imaging and Communication in Medicine format, and analyzed with quantusFLM. Physicians were blinded to the analysis. At delivery, perinatal outcomes and the occurrence of neonatal respiratory morbidity, defined as either respiratory distress syndrome or transient tachypnea of the newborn, were registered. The performance of the ultrasound texture analysis test to predict neonatal respiratory morbidity was evaluated. A total of 883 images were collected, but 17.3% were discarded because of poor image quality or exclusion criteria, leaving 730 observations for the final analysis. The prevalence of neonatal respiratory morbidity was 13.8% (101 of 730). The quantusFLM predicted neonatal respiratory morbidity with a sensitivity, specificity, positive and negative predictive values of 74.3% (75 of 101), 88.6% (557 of 629), 51.0% (75 of 147), and 95.5% (557 of 583), respectively. Accuracy was 86.5% (632 of 730) and positive and negative likelihood ratios were 6.5 and 0.3, respectively. The quantusFLM predicted neonatal respiratory morbidity with an accuracy similar to that previously reported for other tests with the advantage of being a noninvasive technique. Copyright © 2017. Published by Elsevier Inc.

Causes of morbidity in wild raptor populations admitted at a wildlife rehabilitation centre in Spain from 1995-2007: a long term retrospective study.

PubMed

Molina-López, Rafael A; Casal, Jordi; Darwich, Laila

2011-01-01

Morbidity studies complement the understanding of hazards to raptors by identifying natural or anthropogenic factors. Descriptive epidemiological studies of wildlife have become an important source of information about hazards to wildlife populations. On the other hand, data referenced to the overall wild population could provide a more accurate assessment of the potential impact of the morbidity/mortality causes in populations of wild birds. The present study described the morbidity causes of hospitalized wild raptors and their incidence in the wild populations, through a long term retrospective study conducted at a wildlife rehabilitation centre of Catalonia (1995-2007). Importantly, Seasonal Cumulative Incidences (SCI) were calculated considering estimations of the wild population in the region and trend analyses were applied among the different years. A total of 7021 birds were analysed: 7 species of Strigiformes (n = 3521) and 23 of Falconiformes (n = 3500). The main causes of morbidity were trauma (49.5%), mostly in the Falconiformes, and orphaned/young birds (32.2%) mainly in the Strigiformes. During wintering periods, the largest morbidity incidence was observed in Accipiter gentillis due to gunshot wounds and in Tyto alba due to vehicle trauma. Within the breeding season, Falco tinnunculus (orphaned/young category) and Bubo bubo (electrocution and metabolic disorders) represented the most affected species. Cases due to orphaned/young, infectious/parasitic diseases, electrocution and unknown trauma tended to increase among years. By contrast, cases by undetermined cause, vehicle trauma and captivity decreased throughout the study period. Interestingly, gunshot injuries remained constant during the study period. Frequencies of morbidity causes calculated as the proportion of each cause referred to the total number of admitted cases, allowed a qualitative assessment of hazards for the studied populations. However, cumulative incidences based on estimated wild raptor population provided a more accurate approach to the potential ecological impact of the morbidity causes in the wild populations.

Morbidity of curative cancer surgery and suicide risk.

PubMed

Jayakrishnan, Thejus T; Sekigami, Yurie; Rajeev, Rahul; Gamblin, T Clark; Turaga, Kiran K

2017-11-01

Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well studied. To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors. Retrospective cohort study using Surveillance, Epidemiology, and End Results data from 2004 to 2011; multilevel systematic review. General US population. Participants were 482 781 patients diagnosed with malignant neoplasm between 2004 and 2011 who underwent curative cancer surgeries. Death by suicide or self-inflicted injury. Among 482 781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person-years [95% confidence interval, CI, 14.54-18.82]). Factors significantly associated with suicide risk included male sex (incidence rate [IR], 27.62; 95% CI, 23.82-31.86) and age >65 years (IR, 22.54; 95% CI, 18.84-26.76). When stratified by 30-day overall postoperative morbidity, a significantly higher incidence of suicide was found for high-morbidity surgeries (IR, 33.30; 95% CI, 26.50-41.33) vs moderate morbidity (IR, 24.27; 95% CI, 18.92-30.69) and low morbidity (IR, 9.81; 95% CI, 7.90-12.04). Unit increase in morbidity was significantly associated with death by suicide (odds ratio, 1.01; 95% CI, 1.00-1.03; P = .02) and decreased suicide-specific survival (hazards ratio, 1.02; 95% CI, 1.00-1.03, P = .01) in prognosis-adjusted models. In this sample of cancer patients in the Surveillance, Epidemiology, and End Results database, patients that undergo high-morbidity surgeries appear most vulnerable to death by suicide. The identification of this high-risk cohort should motivate health care providers and particularly surgeons to adopt screening measures during the postoperative follow-up period for these patients. Copyright © 2016 John Wiley & Sons, Ltd.

Causes of Morbidity in Wild Raptor Populations Admitted at a Wildlife Rehabilitation Centre in Spain from 1995-2007: A Long Term Retrospective Study

PubMed Central

Molina-López, Rafael A.; Casal, Jordi; Darwich, Laila

2011-01-01

Background Morbidity studies complement the understanding of hazards to raptors by identifying natural or anthropogenic factors. Descriptive epidemiological studies of wildlife have become an important source of information about hazards to wildlife populations. On the other hand, data referenced to the overall wild population could provide a more accurate assessment of the potential impact of the morbidity/mortality causes in populations of wild birds. Methodology/Principal Findings The present study described the morbidity causes of hospitalized wild raptors and their incidence in the wild populations, through a long term retrospective study conducted at a wildlife rehabilitation centre of Catalonia (1995–2007). Importantly, Seasonal Cumulative Incidences (SCI) were calculated considering estimations of the wild population in the region and trend analyses were applied among the different years. A total of 7021 birds were analysed: 7 species of Strigiformes (n = 3521) and 23 of Falconiformes (n = 3500). The main causes of morbidity were trauma (49.5%), mostly in the Falconiformes, and orphaned/young birds (32.2%) mainly in the Strigiformes. During wintering periods, the largest morbidity incidence was observed in Accipiter gentillis due to gunshot wounds and in Tyto alba due to vehicle trauma. Within the breeding season, Falco tinnunculus (orphaned/young category) and Bubo bubo (electrocution and metabolic disorders) represented the most affected species. Cases due to orphaned/young, infectious/parasitic diseases, electrocution and unknown trauma tended to increase among years. By contrast, cases by undetermined cause, vehicle trauma and captivity decreased throughout the study period. Interestingly, gunshot injuries remained constant during the study period. Conclusions/Significance Frequencies of morbidity causes calculated as the proportion of each cause referred to the total number of admitted cases, allowed a qualitative assessment of hazards for the studied populations. However, cumulative incidences based on estimated wild raptor population provided a more accurate approach to the potential ecological impact of the morbidity causes in the wild populations. PMID:21966362

Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Ryan P., E-mail: smithrp@upmc.edu; Jones, Heather A.; Beriwal, Sushil

2011-11-01

Purpose: Cesium-131 is a newer radioisotope being used in prostate brachytherapy (PB). This study was conducted to determine the predictors of urinary morbidity with Cs-131 PB. Methods and Materials: A cohort of 159 patients underwent PB with Cs-131 at our institution and were followed by using Expanded Prostate Cancer Index Composite (EPIC) surveys to determine urinary morbidity over time. EPIC scores were obtained preoperatively and postoperatively at 2 and 4 weeks, and 3 and 6 months. Different factors were evaluated to determine their individual effect on urinary morbidity, including patient characteristics, disease characteristics, treatment, and dosimetry. Multivariate analysis of covariancemore » was carried out to identify baseline determinants affecting urinary morbidity. Factors contributing to the need for postoperative catheterization were also studied and reported. Results: At 2 weeks, patient age, dose to 90% of the organ (D90), bladder neck maximum dose (D{sub max}), and external beam radiation therapy (EBRT) predicted for worse function. At 4 weeks, age and EBRT continued to predict for worse function. At the 3-month mark, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT predicted for worse urinary morbidity. At 6 months, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT were predictive of increased urinary problems. High bladder neck D{sub max} and poor preoperative urinary function predicted for the need for catheterization. Conclusions: The use of EBRT plus Cs-131 PB predicts for worse urinary toxicity at all time points studied. Patients should be cautioned about this. Age was a consistent predictor of worsened morbidity immediately following Cs-131 PB, while bladder D{sub max} was the only consistent dosimetric predictor. Paradoxically, patients with better preoperative urinary function had worse urinary morbidity at 3 and 6 months, consistent with recently published literature.« less

The Association of Sleep Duration and Morbid Obesity in a Working Population: The Baptist Health South Florida Employee Study.

PubMed

Aziz, Muhammad; Osondu, Chukwuemeka U; Younus, Adnan; Malik, Rehan; Rouseff, Maribeth; Das, Sankalp; Guzman, Henry; Maziak, Wasim; Virani, Salim; Feldman, Theodore; Agatston, Arthur S; Veledar, Emir; Aneni, Ehimen C; Nasir, Khurram

2017-03-01

The current study aimed to determine the relationship between self-reported sleep duration and morbid obesity in an employee population. Baptist Health South Florida conducts an annual Health Risk Assessment (HRA) for its employees. Data for this cross-sectional study was collected via this HRA in 2014, and included information on self-reported sleep duration, height and weight for body mass index (BMI), and other biometric measures. Average sleep duration was categorized as short sleep (<6 hr), optimal sleep (6-7.9 hr), and long sleep duration (≥8 hr), while obesity status was categorized as nonobese (BMI <30 kg/m 2 ), obese (30-34.9 kg/m 2 ), and morbid obese (≥35 kg/m 2 ). A total of 9505 participants (mean age 42.8 ± 12.1 years, 75% females, and 55% Hispanic) were included in this study. Prevalence of morbid obesity was about 24% among employees who were sleeping for less than 6 hr compared to 13% and 14% among those sleeping for 6-7.9 hours, and 8 or more hours respectively. In regression analyses, persons who slept less than 6 hr had almost twice the odds of morbid obesity compared to those who slept 6-7.9 hr (odds ratio = 1.8; 1.5-2.2). Our finding that short sleep duration (<6 hr) is significantly associated with a higher risk of morbid obesity should facilitate the development of workplace-based programs that focus on improving sleep among at-risk employees, especially those who work in shift duties to reduce the risk of morbid obesity and other comorbid conditions. Future studies are needed to further explore the relationship of sleep duration and morbid obesity in employee populations.

Translating the WHO 25×25 goals into a UK context: the PROMISE modelling study

PubMed Central

Cobiac, Linda J; Scarborough, Peter

2017-01-01

Objective Model the impact of targets for obesity, diabetes, raised blood pressure, tobacco use, salt intake, physical inactivity and harmful alcohol use, as outlined in the Global Non-Communicable Disease Action Plan 2013–2020, on mortality and morbidity in the UK population. Design Dynamic population modelling study. Setting UK population. Participants Not available. Main outcome measures Mortality and morbidity (years lived with disability) from non-communicable diseases (NCDs) that are averted or delayed. Probability of achieving a 25% reduction in premature mortality from NCDs by 2025 (current WHO target) and a 33% reduction by 2030 (proposed target). Results The largest improvements in mortality would be achieved by meeting the obesity target and the largest improvements in morbidity would be achieved by meeting the diabetes target. The UK could achieve the 2025 and 2030 targets for reducing premature mortality with only a little additional preventive effort compared with current practice. Achieving all 7 risk targets could avert a total of 300 000 deaths (95% uncertainty interval 250 000 to 350 000) and 1.3 million years lived with disability (1.2–1.4 million) from NCDs by 2025, with the majority of health gains due to reduced mortality and morbidity from heart disease and stroke, and reduced morbidity from diabetes. Potential reductions in morbidity from depression and in morbidity and mortality from dementia at older ages are also substantial. Conclusions The global premature mortality targets are a potentially achievable goal for countries such as the UK that can capitalise on many decades of effort in prevention and treatment. High morbidity diseases and diseases in later life are not addressed in the Global NCD Action Plan and targets, but must also be considered a priority for prevention in the UK where the population is ageing and the costs of health and social care are rising. PMID:28377390

Decline in infection-related morbidities following drug-mediated reductions in the intensity of Schistosoma infection: A systematic review and meta-analysis

PubMed Central

Andrade, Gisele; Bertsch, David J.; Gazzinelli, Andrea

2017-01-01

Background Since 1984, WHO has endorsed drug treatment to reduce Schistosoma infection and its consequent morbidity. Cross-sectional studies suggest pre-treatment correlation between infection intensity and risk for Schistosoma-related pathology. However, evidence also suggests that post-treatment reduction in intensity may not reverse morbidity because some morbidities occur at all levels of infection, and some reflect permanent tissue damage. The aim of this project was to systematically review evidence on drug-based control of schistosomiasis and to develop a quantitative estimate of the impact of post-treatment reductions in infection intensity on prevalence of infection-associated morbidity. Methodology/Principal findings This review was registered at inception with PROSPERO (CRD42015026080). Studies that evaluated morbidity before and after treatment were identified by online searches and searches of private archives. Post-treatment odds ratios or standardized mean differences were calculated for each outcome, and these were correlated to treatment-related egg count reduction ratios (ERRs) by meta-regression. A greater ERR correlated with greater reduction in odds of most morbidities. Random effects meta-analysis was used to derive summary estimates: after treatment of S. mansoni and S. japonicum, left-sided hepatomegaly was reduced by 54%, right-sided hepatomegaly by 47%, splenomegaly by 37%, periportal fibrosis by 52%, diarrhea by 53%, and blood in stools by 75%. For S. haematobium, hematuria was reduced by 92%, proteinuria by 90%, bladder lesions by 86%, and upper urinary tract lesions by 72%. There were no consistent changes in portal dilation or hemoglobin levels. In sub-group analysis, age, infection status, region, parasite species, and interval to follow-up were associated with meaningful differences in outcome. Conclusion/Significance While there are challenges to implementing therapy for schistosomiasis, and praziquantel therapy is not fully curative, reductions in egg output are significantly correlated with decreased morbidity and can be used to project diminution in disease burden when contemplating more aggressive strategies to minimize infection intensity. PMID:28212414

Pretransplant cachexia and morbid obesity are predictors of increased mortality after heart transplantation.

PubMed

Lietz, K; John, R; Burke, E A; Ankersmit, J H; McCue, J D; Naka, Y; Oz, M C; Mancini, D M; Edwards, N M

2001-07-27

Extremes in body weight are a relative contraindication to cardiac transplantation. We retrospectively reviewed 474 consecutive adult patients (377 male, 97 female, mean age 50.3+/-12.2 years), who received 444 primary and 30 heart retransplants between January of 1992 and January of 1999. Of these, 68 cachectic (body mass index [BMI]<20 kg/m2), 113 overweight (BMI=>27-30 kg/m2), and 55 morbidly obese (BMI>30 kg/m2) patients were compared with 238 normal-weight recipients (BMI=20-27 kg/m2). We evaluated the influence of pretransplant BMI on morbidity and mortality after cardiac transplantation. Kaplan-Meier survival distribution and Cox proportional hazards model were used for statistical analyses. Morbidly obese as well as cachectic recipients demonstrated nearly twice the 5-year mortality of normal-weight or overweight recipients (53% vs. 27%, respectively, P=0.001). An increase in mortality was seen at 30 days for morbidly obese and cachectic recipients (12.7% and 17.7%, respectively) versus a 30-day mortality rate of 7.6% in normal-weight recipients. Morbidly obese recipients experienced a shorter time to high-grade acute rejection (P=0.004) as well as an increased annual high-grade rejection frequency when compared with normal-weight recipients (P=0.001). By multivariable analysis, the incidence of transplant-related coronary artery disease (TCAD) was not increased in morbidly obese patients but cachectic patients had a significantly lower incidence of TCAD (P=0.05). Cachectic patients receiving oversized donor hearts had a significantly higher postoperative mortality (P=0.02). The risks of cardiac transplantation are increased in both morbidly obese and cachectic patients compared with normal-weight recipients. However, the results of cardiac transplantation in overweight patients is comparable to that in normal-weight patients. Recipient size should be kept in mind while selecting patients and the use of oversized donors in cachectic recipients should be avoided.

Physician's first clinical impression of emergency department patients with nonspecific complaints is associated with morbidity and mortality.

PubMed

Beglinger, Bettina; Rohacek, Martin; Ackermann, Selina; Hertwig, Ralph; Karakoumis-Ilsemann, Julia; Boutellier, Susanne; Geigy, Nicolas; Nickel, Christian; Bingisser, Roland

2015-02-01

The association between the physician's first clinical impression of a patient with nonspecific complaints and morbidity and mortality is unknown. The aim was to evaluate the association of the physician's first clinical impression with acute morbidity and mortality. We conducted a prospective observational study with a 30-day follow-up. This study was performed at the emergency departments (EDs) of 1 secondary and 1 tertiary care hospital, from May 2007 to February 2011. The first clinical impression ("looking ill"), expressed on a numerical rating scale from 0 to 100, age, sex, and the Charlson Comorbidity Index (CCI) were evaluated. The association was determined between these variables and acute morbidity and mortality, together with receiver operating characteristics, and validity. Of 217,699 presentations to the ED, a total of 1278 adult nontrauma patients with nonspecific complaints were enrolled by a study team. No patient was lost to follow-up. A total of 84 (6.6%) patients died during follow-up, and 742 (58.0%) patients were classified as suffering from acute morbidity. The variable "looking ill" was significantly associated with mortality and morbidity (per 10 point increase, odds ratio 1.23, 95% confidence interval [CI] 1.12-1.34, P < 0.001, and odds ratio 1.19, 95% CI 1.14-1.24, P < 0.001, respectively). The combination of the variables "looking ill," "age," "male sex," and "CCI" resulted in the best prediction of these outcomes (mortality: area under the curve [AUC] 0.77, 95% CI 0.72-0.82; morbidity: AUC 0.68, 95% CI 0.65-0.71). The physician's first impression, with or without additional variables such as age, male sex, and CCI, was associated with morbidity and mortality. This might help in the decision to perform further diagnostic tests and to hospitalize ED patients.

Differences in resuscitation in morbidly obese burn patients may contribute to high mortality.

PubMed

Rae, Lisa; Pham, Tam N; Carrougher, Gretchen; Honari, Shari; Gibran, Nicole S; Arnoldo, Brett D; Gamelli, Richard L; Tompkins, Ronald G; Herndon, David N

2013-01-01

The rising number of obese patients poses new challenges for burn care. These may include adjustments in calculations of burn size, resuscitation, ventilator wean, nutritional goals as well as challenges in mobilization. The authors have focused this observational study on resuscitation in the obese patient population in the first 48 hours after burn injury. Previous trauma studies suggest a prolonged time to reach end points of resuscitation in the obese compared to nonobese injured patients. The authors hypothesize that obese patients have worse outcomes after thermal injury and that differences in the response to resuscitation contribute to this disparity. The authors retrospectively analyzed data prospectively collected in a multicenter trial to compare resuscitation and outcomes in patients stratified by National Institutes of Health/World Health Organization body mass index (BMI) classification (BMI: normal weight, 18.5-24.9; overweight, 25-29.9, obese, 30-39.9; morbidly obese, ≥40). Because of the distribution of body habitus in the obese, total burn size was recalculated for all patients by using the method proposed by Neaman and compared with Lund-Browder estimates. The authors analyzed patients by BMI class for fluids administered and end points of resuscitation at 24 and 48 hours. Multivariate analysis was used to compare morbidity and mortality across BMI groups. The authors identified 296 adult patients with a mean TBSA of 41%. Patient and injury characteristics were similar across BMI categories. No significant differences were observed in burn size calculations by using Neaman vs Lund-Browder formulas. Although resuscitation volumes exceeded the predicted formula in all BMI categories, higher BMI was associated with less fluid administered per actual body weight (P = .001). Base deficit on admission was highest in the morbidly obese group at 24 and 48 hours. Furthermore, the morbidly obese patients did not correct their metabolic acidosis to the extent of their lower BMI counterparts (P values .04 and .03). Complications and morbidities across BMI groups were similar, although examination of organ failure scores indicated more severe organ dysfunction in the morbidly obese group. Compared with being normal weight, being morbidly obese was an independent risk factor for death (odds ratio = 10.1; confidence interval, 1.94-52.5; P = .006). Morbidly obese patients with severe burns tend to receive closer to predicted fluid resuscitation volumes for their actual weight. However, this patient group has persistent metabolic acidosis during the resuscitation phase and is at risk of developing more severe multiple organ failure. These factors may contribute to higher mortality risk in the morbidly obese burn patient.

[Fundamentals of socio-hygienic monitoring of environmental conditions for students of higher education schools].

PubMed

Blinova, E G; Kuchma, V R

2012-01-01

Socioeconomic transformations and the poor environment of an industrial megalopolis negatively affected quality of life and morbidity rates in students (n = 2160). Academic intensity contributed to an increase in overall morbidity and morbidity from nervous system involvement. The regional sociohygienic monitoring of high-school training conditions within the framework of the surveillance system substantiates programs to prevent worse health and life quality in high school students.

Systemic lupus erythematosus presenting as morbid jealousy.

PubMed Central

Ravindran, A.; Carney, M. W.; Denman, A. M.

1980-01-01

A patient fulfilling the diagnostic criteria for systemic lupus erythematosus and presenting with morbid jealousy is described. There was evidence of cerebral lupus. Her physical and mental symptoms responded to a combination of chlorpromazine and steroids. The morbid mental process was probably caused by her physical condition while the content of her disordered thought and behaviour was determined by her introverted premorbid personality, religiosity, unhappy childhood experiences and frustrated desire for children. PMID:7413541

Facets of morbid jealousy: With an anecdote from a historical Tamil romance

PubMed Central

Somasundaram, O.

2010-01-01

SUMMARY Morbid jealousy is a symptom which occurs in many psychiatric conditions. The complex emotional aspects of jealousy have been discussed by earlier authors. The clinical, cultural, social, and forensic aspects, are touched upon. Morbid jealousy is a favourite topic among novelists and dramatists. “Othello” is a classic example. This topic is covered in one of the famous historical romances of the Tamil author, Kalki. PMID:21180423

Comparative Effectiveness of Acupuncture for Chronic Pain and Co-morbid Conditions in Veterans

DTIC Science & Technology

2016-10-01

AWARD NUMBER: W81XWH-15-1-0245 TITLE: Comparative Effectiveness of Acupuncture for Chronic Pain and Co- morbid Conditions in Veterans PRINCIPAL...2015 - 29 Sep 2016 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Comparative Effectiveness of Acupuncture for Chronic Pain and Co-morbid Conditions in...acupuncture Comparative Effectiveness (PEACE) trial is to investigate EA and BFA (a form of auricular acupuncture) to guide the personalized delivery of

Cultural aspects of morbid fears in Qatari women.

PubMed

el-Islam, M F

1994-05-01

The contents of morbid fears are patterned by cultural factors that decide the nature of the objects of the fears. Common factors in Western cultures do not obtain in local culture, which provides other objects for morbid fears in predisposed individuals. In the muslim community in Qatar, after-death fears dominated panic attacks, agoraphobia was rare, social phobias mirrored shame rather than guilt about failure to fulfil socially accepted norms of social behaviour, and obsessional fears revolved around fears of failure to control devil-induced impulses to harm self or others. Hypochondriacal fears of disease thrived because somatically oriented physicians colluded with somatizing patients in an endless search for presumed organic aetiology. Generalized anxiety fears were not encountered independently of other morbid fears.

Recent advances in environmental controls outside the home setting.

PubMed

Hauptman, Marissa; Phipatanakul, Wanda

2016-04-01

It has been well studied that aeroallergen, mold, and airborne pollutant exposure in the inner-city home environment is associated with significant childhood asthma morbidity. Although the home environment has been extensively studied, the school environment is less well understood. In this article, we discuss the relationship between environmental exposures within the school and daycare environment and pediatric asthma morbidity and novel environmental interventions designed to help mitigate pediatric asthma morbidity. Studies assessing environmental exposures outside the home environment and interventions to mitigate these exposures have the potential to reduce pediatric asthma morbidity. Further study in this area should focus on the complex cost benefit analyses of environmental interventions outside the home setting, while controlling for the home environment.

CHD associated with syndromic diagnoses: peri-operative risk factors and early outcomes

PubMed Central

Landis, Benjamin J.; Cooper, David S.; Hinton, Robert B.

2016-01-01

CHD is frequently associated with a genetic syndrome. These syndromes often present specific cardiovascular and non-cardiovascular co-morbidities that confer significant peri-operative risks affecting multiple organ systems. Although surgical outcomes have improved over time, these co-morbidities continue to contribute substantially to poor peri-operative mortality and morbidity outcomes. Peri-operative morbidity may have long-standing ramifications on neurodevelopment and overall health. Recognising the cardiovascular and non-cardiovascular risks associated with specific syndromic diagnoses will facilitate expectant management, early detection of clinical problems, and improved outcomes – for example, the development of syndrome-based protocols for peri-operative evaluation and prophylactic actions may improve outcomes for the more frequently encountered syndromes such as 22q11 deletion syndrome. PMID:26345374

Bariatric Arterial Embolization for Obesity: A Review of Early Clinical Evidence.

PubMed

Zhong, Bin-Yan; Abiola, Godwin; Weiss, Clifford R

2018-06-05

Obesity is a worldwide public health epidemic that leads to increased morbidity, mortality, and cost burden to health care. Although bariatric surgery has been recognized as a standard invasive treatment for obesity, it is accompanied by relatively high morbidity and cost burden, as well as limited treatment outcome. Therefore, alternative treatments with lower morbidity and cost for surgery that target patients who are obese, but not morbidly obese, are needed. A minimally invasive trans-catheter procedure, named bariatric arterial embolization or bariatric embolization (BAE), has been identified as a potential solution, based on its safety and preliminary efficacy profiles. The purpose of this review is to introduce up-to-date clinical data and discuss future directions for BAE for the treatment of obesity.

Gender Differences in Respiratory Morbidity and Mortality of Preterm Neonates

PubMed Central

Townsel, Courtney Denise; Emmer, Sawyer F.; Campbell, Winston A.; Hussain, Naveed

2017-01-01

For the past century, researchers have underscored the “disadvantage” observed in respiratory morbidity and mortality of male newborns. In this contemporary review, we examine gender differences in preterm infant respiratory morbidity and mortality specifically appraising differences in the very low birth weight (VLBW) population as well as the late preterm (LPT) population. In the era of postnatal surfactant and antenatal corticosteroids, the gender gap in neonatal outcomes has not narrowed. Structural, physiologic, and hormonal sex differences may be at the root of this disparity. Further exploration into the origin of gender differences in respiratory morbidity and neonatal mortality will shape future therapies. These therapies may need to be gender specific to close the gender gap. PMID:28194395

Can 3-dimensional power Doppler indices improve the prenatal diagnosis of a potentially morbidly adherent placenta in patients with placenta previa?

PubMed

Haidar, Ziad A; Papanna, Ramesha; Sibai, Baha M; Tatevian, Nina; Viteri, Oscar A; Vowels, Patricia C; Blackwell, Sean C; Moise, Kenneth J

2017-08-01

Traditionally, 2-dimensional ultrasound parameters have been used for the diagnosis of a suspected morbidly adherent placenta previa. More objective techniques have not been well studied yet. The objective of the study was to determine the ability of prenatal 3-dimensional power Doppler analysis of flow and vascular indices to predict the morbidly adherent placenta objectively. A prospective cohort study was performed in women between 28 and 32 gestational weeks with known placenta previa. Patients underwent a two-dimensional gray-scale ultrasound that determined management decisions. 3-Dimensional power Doppler volumes were obtained during the same examination and vascular, flow, and vascular flow indices were calculated after manual tracing of the viewed placenta in the sweep; data were blinded to obstetricians. Morbidly adherent placenta was confirmed by histology. Severe morbidly adherent placenta was defined as increta/percreta on histology, blood loss >2000 mL, and >2 units of PRBC transfused. Sensitivities, specificities, predictive values, and likelihood ratios were calculated. Student t and χ 2 tests, logistic regression, receiver-operating characteristic curves, and intra- and interrater agreements using Kappa statistics were performed. The following results were found: (1) 50 women were studied: 23 had morbidly adherent placenta, of which 12 (52.2%) were severe morbidly adherent placenta; (2) 2-dimensional parameters diagnosed morbidly adherent placenta with a sensitivity of 82.6% (95% confidence interval, 60.4-94.2), a specificity of 88.9% (95% confidence interval, 69.7-97.1), a positive predictive value of 86.3% (95% confidence interval, 64.0-96.4), a negative predictive value of 85.7% (95% confidence interval, 66.4-95.3), a positive likelihood ratio of 7.4 (95% confidence interval, 2.5-21.9), and a negative likelihood ratio of 0.2 (95% confidence interval, 0.08-0.48); (3) mean values of the vascular index (32.8 ± 7.4) and the vascular flow index (14.2 ± 3.8) were higher in morbidly adherent placenta (P < .001); (4) area under the receiver-operating characteristic curve for the vascular and vascular flow indices were 0.99 and 0.97, respectively; (5) the vascular index ≥21 predicted morbidly adherent placenta with a sensitivity and a specificity of 95% (95% confidence interval, 88.2-96.9) and 91%, respectively (95% confidence interval, 87.5-92.4), 92% positive predictive value (95% confidence interval, 85.5-94.3), 90% negative predictive value (95% confidence interval, 79.9-95.3), positive likelihood ratio of 10.55 (95% confidence interval, 7.06-12.75), and negative likelihood ratio of 0.05 (95% confidence interval, 0.03-0.13); and (6) for the severe morbidly adherent placenta, 2-dimensional ultrasound had a sensitivity of 33.3% (95% confidence interval, 11.3-64.6), a specificity of 81.8% (95% confidence interval, 47.8-96.8), a positive predictive value of 66.7% (95% confidence interval, 24.1-94.1), a negative predictive value of 52.9% (95% confidence interval, 28.5-76.1), a positive likelihood ratio of 1.83 (95% confidence interval, 0.41-8.11), and a negative likelihood ratio of 0.81 (95% confidence interval, 0.52-1.26). A vascular index ≥31 predicted the diagnosis of a severe morbidly adherent placenta with a 100% sensitivity (95% confidence interval, 72-100), a 90% specificity (95% confidence interval, 81.7-93.8), an 88% positive predictive value (95% confidence interval, 55.0-91.3), a 100% negative predictive value (95% confidence interval, 90.9-100), a positive likelihood ratio of 10.0 (95% confidence interval, 3.93-16.13), and a negative likelihood ratio of 0 (95% confidence interval, 0-0.34). Intrarater and interrater agreements were 94% (P < .001) and 93% (P < .001), respectively. The vascular index accurately predicts the morbidly adherent placenta in patients with placenta previa. In addition, 3-dimensional power Doppler vascular and vascular flow indices were more predictive of severe cases of morbidly adherent placenta compared with 2-dimensional ultrasound. This objective technique may limit the variations in diagnosing morbidly adherent placenta because of the subjectivity of 2-dimensional ultrasound interpretations. Copyright © 2017 Elsevier Inc. All rights reserved.

Optimal visualization of the fetal four-chamber and outflow tract views with transabdominal ultrasound in the morbidly obese: Are we there yet?

PubMed

Adekola, Henry; Soto, Eleazar; Dai, Jing; Lam-Rachlin, Jennifer; Gill, Navleen; Leon-Peters, Jocelyn; Puder, Karoline; Abramowicz, Jacques S

2015-01-01

To compare optimal visualization of the four-chamber and outflow-tract views of the fetal heart on sonographic examination between morbidly obese (body mass index [BMI] ≥ 40 kg/m(2) ) and nonobese (BMI < 25 kg/m(2) ) pregnant women. In this retrospective cohort study, we included records and images from 509 pregnant women who had first undergone sonographic examination between 18 and 36 weeks' fetal gestational age. Compared with the nonobese women, morbidly obese women had lower optimal visualization of the four-chamber and outflow-tract heart views: four-chamber view, morbidly obese, 83/186 (44.6%), versus nonobese, 283/323 (87.6%), and outflow-tract view, morbidly obese, 80/186 (43%) versus nonobese, 258/290 (89%); p < 0.0001 for each comparison. Similar outcomes were observed when the results from each subcategory of morbidly obese women (ie, BMI 40-49.9, 50-59.9, and ≥60 kg/m(2) ) were compared with that from nonobese women; p < 0.0001 for each comparison. These outcomes remained the same regardless of whether this comparison was made among those who had their examination before or at 19 weeks' or more gestational age. Among the morbidly obese women, there was no difference in optimal visualization of the four-chamber or outflow-tract views regardless of whether the examination was performed at <23 weeks' or at ≥23 weeks' gestational age: four-chamber view <23 weeks, 44.8% (78/174), versus four-chamber view ≥23 weeks, 41.7% (5/12); p = 0.8, and outflow-tract view <23 weeks, 43.1% (75/174), versus outflow-tract view ≥23 weeks, 41.7% (5/12); p = 0.9. After controlling for maternal age and race, the odds of visualizing the four-chamber and outflow-tract views in the morbidly obese were reduced compared with those in their nonobese counterparts: odds ratio (OR) for four-chamber, 0.13; 95% confidence interval (CI), 0.08-0.21, and OR for outflow-tract, 0.11; 95% CI, 0.07-0.17. Optimal visualization of the fetal four-chamber and outflow-tract views was achieved in less than 50% of morbidly obese women, compared with almost 90% in nonobese women. © 2015 Wiley Periodicals, Inc.

A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder

PubMed Central

2012-01-01

Background The incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women’s experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms. Methods Relevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", “pregnancy complications” “puerperal disorders”, "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia”. Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools. Results Eleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its symptoms, an association possibly mediated by other factors such as fetal/neonatal condition. Conclusions Despite the absence of robust evidence regarding the relationship between severe maternal morbidity and PTSD/PTSD symptoms, it is crucially important that clinicians and policy makers are aware of a potential higher risk of PTSD among women who experience severe morbidity. Further studies are now needed to confirm this risk as well as to understand underlying mechanisms in order to minimise the longer term psychiatric impact of severe maternal morbidity. PMID:23140343

A systematic review of the relationship between severe maternal morbidity and post-traumatic stress disorder.

PubMed

Furuta, Marie; Sandall, Jane; Bick, Debra

2012-11-10

The incidence of severe maternal morbidity is increasing in high-income countries as a consequence, in part, of increased obstetric intervention and increasingly complex medical needs of women who become pregnant. Access to emergency obstetric care means that for the majority of women in these countries, an experience of severe maternal morbidity is unlikely to result in loss of life. However, little is known about the subsequent impact on postnatal psychological health resulting in an evidence gap to support provision of appropriate care for these women. There has recently been increasing recognition that childbirth can be a cause of post-traumatic stress disorder (PTSD). The combination of experiencing a life-threatening complication and its management may culminate in psychological trauma. This systematic review examined the association between women's experience of severe maternal morbidity during labour, at the time of giving birth or within the first week following birth, and PTSD and its symptoms. Relevant literature was identified through multiple databases, including MEDLINE, PsycINFO, EMBASE, CINAHL, British Nursing Index, Web of Science, Cochrane library and the British Library, using predetermined search strategies. The search terms included "post-traumatic stress disorder", "PTSD", "stress disorders, post-traumatic", "maternal morbidity", "pregnancy complications" "puerperal disorders", "obstetric labo(u)r complication", "postpartum h(a)emorrhage", "eclampsia". Studies identified were categorised according to pre-defined inclusion and exclusion criteria. The quality of included studies was assessed using the relevant CASP appraisal tools. Eleven primary studies met review criteria. Evidence of a relationship between severe maternal morbidity and PTSD/PTSD symptoms was inconsistent and findings varied between studies. Nevertheless, there is some evidence that severe pre-eclampsia is a risk factor for PTSD and its symptoms, an association possibly mediated by other factors such as fetal/neonatal condition. Despite the absence of robust evidence regarding the relationship between severe maternal morbidity and PTSD/PTSD symptoms, it is crucially important that clinicians and policy makers are aware of a potential higher risk of PTSD among women who experience severe morbidity. Further studies are now needed to confirm this risk as well as to understand underlying mechanisms in order to minimise the longer term psychiatric impact of severe maternal morbidity.

[The impact of harmful occupational factors on the morbidity rate of workers of the railway-car repair plant].

PubMed

Sudeikina, N A; Kurenkova, G V; Lemeshevskaya, E P

The rail transport is the one of the leading sectors of the national economy. More than 50% of the employees of the enterprises of the railway complex work under the unfavourable impact of hazardous and dangerous substances and occupational factors. In the literature issues of working conditions and health of employees of railway carrepairing plant are hardly highlighted. The aim of the study is the evaluation of the morbidity rate shaped under the influence of harmful occupational factors for the elaboration of preventive measures. In the work there were used generally accepted methods of hygienic studies, analysis of morbidity rate with temporary disability (TD), according to records of periodic medical examinations, occupational prevalence. The railway car-repairing plant was established to be characterized by the complex of harmful factors of the working environment and labor process: noise, local vibration, industrial aerosols of complex composition, chemicals, low light, hardness of the labor process. The levels of incidence with temporal disability in the studied groups, depending on the work seniority in the harmful labor conditions, significantly decrease with the experience from 5 to 9 years and increase with the experience more than 10 years. Executed in-depth analysis as of the both morbidity rate and TD, as well results of periodic medical examinations of workers of main shops shows that overall indices of the morbidity rate and TD are significantly higher than in the comparison group; levels of the morbidity rate and TD in the observed groups significantly decline depending on the length of service in hazardous working conditions with a length of the experience offrom 5 to 9 years and increase with the increase in the length of experience of 10 years or more. In the structure of morbidity and TD leading positions are occupied by diseases of the respiratory system, musculoskeletal system and connective tissue, circulatory system and digestive system, diseases of the eye and its appendages. The health damage risk coefficients in the studied groups of workers and the average losses of working time due to the morbidity with TD per 1 employee in all shops are higher than those in the comparison group. The level of the occupational morbidity rate is very low. Harmful working conditions contribute to the development of general and occupationally related diseases.

Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria

PubMed Central

2010-01-01

Background Infants born to diabetic women have certain distinctive characteristics, including large size and high morbidity risks. The neonatal mortality rate is over five times that of infants of non diabetic mothers and is higher at all gestational ages and birth weight for gestational age (GA) categories. The study aimed to determine morbidity and mortality pattern amongst infants of diabetic mothers (IDMS) admitted into the Special Care Baby Unit of University of Port Harcourt Teaching Hospital. Methods This was a study of prevalence of morbidity and mortality among IDMs carried out prospectively over a two year period. All IDMs (pregestational and gestational) admitted into the Unit within the period were recruited into the study. Data on delivery mode, GA, birth weight, other associated morbidities, investigation results, treatment, duration of hospital stay and outcome were collated and compared with those of infants of non diabetic mothers matched for GA and birth weight admitted within the same period. Maternal data were reviewed retrospectively. Data were analyzed using SPSS 16.0. Results Sixty percent of the IDMs were born to mothers with gestational diabetes, while 40% were born to mothers with pregestational DM. 38 (74.3%) were born by Caesarian section (CS), of which 20 (52.6%) were by emergency CS. There was no significant difference in emergency CS rates, when compared with controls, but non-IDMs were more likely to be delivered vaginally. The mean GA of IDMs was 37.84 weeks ± 1.88. 29 (61.7%) of them were macrosomic. The commonest morbidities were Hypoglycemia (significantly higher in IDMs than non-IDMs) and hyperbilirubinaemia in 30 (63.8%) and 26 (57.4%) respectively. There was no difference in morbidity pattern between infants of pre- gestational and gestational diabetic mothers. Mortality rate was not significantly higher in IDMs Conclusions The incidence of macrosomia in IDMs was high but high rates of emergency CS was not peculiar to them. Hypoglycaemia and hyperbilirubinaemia were the commonest morbidities in IDMs. Referring women with unstable metabolic control to specialized centers improves pre- and post- natal outcomes. Maternal-Infant centers for management of diabetes in pregnancy are advocated on a national scale to reduce associated morbidity and mortality PMID:21138582

Household food insecurity and its association with morbidity report among school adolescent in Jimma zone, Ethiopia.

PubMed

Tamiru, Dessalegn; Belachew, Tefera

2018-01-13

Background Household food insecurity has a substantial contribution to poor health outcomes among young children and adolescents. Food insecurity also affects optimal cognitive development and physiological function of these vulnerable groups. There is a gap of documented data regarding the association of food insecurity and morbidity among school adolescents in Ethiopia. Objective The aim of this study is to assess the interrelationship of household food insecurity and morbidity report among school adolescent in Jimma zone, Ethiopia. Methods A community based cross-sectional study was done from October to November, 2013. Data were gathered using structured questionnaires through interview of students and their caregivers. A total of 1000 students were selected by using simple random sampling methods using their rosters as a frame. Data were also checked for missing values and outliers, and analyzed using SPSS version 16.0. Regression analyses were used to see the strength of association between independent and dependent variables using odds ratios and 95% of confidence intervals. Results Adolescents from food insecure households had more reported illness (39.3%) than adolescents from food secure households (24.7%) (p < 0.001). Adolescents from food insecure households were two times more exposed to morbidity [AOR = 2.04(1.32, 3.14)] than adolescents from food secure households. This study also showed that males had 48% less reported illness [AOR = 0.52(0.01, 0.23)] than females. Adolescents who had attended health education had less reported illness [AOR = 0.57(0.38, 0.86)] than those who did not ever attend. This study also showed that having a farmer [AOR = 0.46(0.28, 0.74)] and government employee [AOR = 0.33 (0.17, 0.64)] father were inversely associated with adolescent morbidity. Conclusion The findings of this study showed that household food insecurity, female gender and lack of attending health education had a significant contribution to adolescent morbidity. Therefore, there is a need to improve household income earning capacity and strengthen school based health and nutrition education to prevent adolescent morbidity. The findings of this study can also be used to lead the development of programs aimed at preventing adolescent morbidity by notifying policymakers and other stakeholders about the association of morbidity with household food insecurity.

Reliability of risk-adjusted outcomes for profiling hospital surgical quality.

PubMed

Krell, Robert W; Hozain, Ahmed; Kao, Lillian S; Dimick, Justin B

2014-05-01

Quality improvement platforms commonly use risk-adjusted morbidity and mortality to profile hospital performance. However, given small hospital caseloads and low event rates for some procedures, it is unclear whether these outcomes reliably reflect hospital performance. To determine the reliability of risk-adjusted morbidity and mortality for hospital performance profiling using clinical registry data. A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program, 2009. Participants included all patients (N = 55,466) who underwent colon resection, pancreatic resection, laparoscopic gastric bypass, ventral hernia repair, abdominal aortic aneurysm repair, and lower extremity bypass. Outcomes included risk-adjusted overall morbidity, severe morbidity, and mortality. We assessed reliability (0-1 scale: 0, completely unreliable; and 1, perfectly reliable) for all 3 outcomes. We also quantified the number of hospitals meeting minimum acceptable reliability thresholds (>0.70, good reliability; and >0.50, fair reliability) for each outcome. For overall morbidity, the most common outcome studied, the mean reliability depended on sample size (ie, how high the hospital caseload was) and the event rate (ie, how frequently the outcome occurred). For example, mean reliability for overall morbidity was low for abdominal aortic aneurysm repair (reliability, 0.29; sample size, 25 cases per year; and event rate, 18.3%). In contrast, mean reliability for overall morbidity was higher for colon resection (reliability, 0.61; sample size, 114 cases per year; and event rate, 26.8%). Colon resection (37.7% of hospitals), pancreatic resection (7.1% of hospitals), and laparoscopic gastric bypass (11.5% of hospitals) were the only procedures for which any hospitals met a reliability threshold of 0.70 for overall morbidity. Because severe morbidity and mortality are less frequent outcomes, their mean reliability was lower, and even fewer hospitals met the thresholds for minimum reliability. Most commonly reported outcome measures have low reliability for differentiating hospital performance. This is especially important for clinical registries that sample rather than collect 100% of cases, which can limit hospital case accrual. Eliminating sampling to achieve the highest possible caseloads, adjusting for reliability, and using advanced modeling strategies (eg, hierarchical modeling) are necessary for clinical registries to increase their benchmarking reliability.

[Comparison of diagnostic criteria for the metabolic syndrome among Japanese university faculty].

PubMed

Hayashi, Emi; Dote, Tomotaro; Nakayama, Shin; Imanishi, Masafumi; Hirota, Chika; Mitsui, Go; Ohnishi, Keiko; Sugiura, Yumiko; Tanimoto, Yoshimi; Watanabe, Misuzu; Inoue, Sumie; Iida, Norihiko; Kono, Koichi

2011-04-01

Diagnostic criteria for the metabolic syndrome (Mets) in Japan have been set by the Medical Committee of the Japanese Association of Medical Sciences (Med), the National Health and Nutrition Examination Survey (Nat), specific health checkups (Ckup), and second medical examination by Worker's Accident Compensation Insurance System (Wor). The purpose of this study was to compare classification of the metabolic syndrome by different organizational criteria and to investigate underlying differences. All faculty members of a university in Osaka, Japan, underwent mandatory health checkups in September 2008. The demographic distribution included 769 males (mean age, 49 +/- 12 years) and 415 females (mean age, 43 +/- 10 years). Using the Med, Nat, Ckup and Wor criteria, individuals were assessed for the MetS and pre-metabolic syndrome (pre-Mets), strongly suspected metabolic syndrome (S-Mets) and assumed pre-metabolic syndrome (A-pre-Mets), as well as a positive support level (PSL) and a motivational support level (MSL). All faculty members were categorized into a morbid group (Mets, S-Mets, PSL, and FB) or a pre-morbid group (pre-Mets, A-pre-Mets, and MSL) based on medical data and smoking habits. The incidence of morbid and pre-morbid individuals was compared across the four criteria and analyzed based on gender and age (under 40 and 40 or over). Male incidences for the morbid and pre-morbid classifications were 17% and 20% with Med, 9% and 23% with Nat, 27% and 14% with Ckup, and 1.4% and 0% with Wor. There were significant differences across criteria sets in both the morbid and pre-morbid groups, with significantly greater numbers of males than females, and higher prevalences in those aged 40 or over than in their younger counterparts. Males aged under 40 classified into the pre-morbid group comprised 18% in Med, 16% in Nat, and 13% in Ckup. The different disease incidences found between Med and Ckup data in males aged 40 or over might be attributed to varying criteria for blood glucose levels, while Wor data may be influenced by the higher level of blood pressure set as a criterion with this approach. It will be important to continuously validate currently established criteria to identify the actual prevalence of MetS in Japan. Furthermore, incorporation of waist circumference and BMI for females, and a positive approach for young males, may be critical for future developments.

Sources of stress and psychological morbidity among undergraduate physiotherapy students.

PubMed

Walsh, J M; Feeney, C; Hussey, J; Donnellan, C

2010-09-01

Professional education can be a stressful experience for some individuals, and may impact negatively on emotional well-being and academic performance. Psychological morbidity and associated sources of stress have not been investigated extensively in physiotherapy students. This study explored sources of stress, psychological morbidity and possible associations between these variables in undergraduate physiotherapy students. A questionnaire-based survey. The Undergraduate Sources of Stress Questionnaire was used to identify sources of stress, and the General Health Questionnaire-12 (GHQ-12) was used to rate the prevalence of psychological morbidity, using a conservative GHQ threshold of 3 to 4 to determine probable 'cases'. Uni- and multivariate tests of correlation were used to analyse the data. An Irish educational institution. One hundred and twenty-five physiotherapy undergraduate students. More than one-quarter of all students (27%) scored above the GHQ threshold, indicating probable psychological morbidity. This is higher than the level of psychological morbidity reported by the general population. Regression analysis showed that academic (beta=0.31, P<0.001) and personal (beta=0.50, P<0.001) sources of stress subscales were significant coefficients, explaining 48% of the variance in psychological morbidity after controlling for part-time employment and hours spent studying. Individual significant items from these subscales were stressful events (beta=0.24, P=0.004), mood (beta=0.43, P< or =0.001) and overall level of stress (beta=0.35, P< or =0.001). The results highlighted the emotional vulnerability of a significant proportion of physiotherapy students, with academic and personal issues being the greatest concern. While personal causes of stress such as stressful events and mood are more difficult to control, manipulation of curricular factors may have positive effects on academic sources of stress. Copyright 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Impacts of floods on dysentery in Xinxiang city, China, during 2004-2010: a time-series Poisson analysis.

PubMed

Ni, Wei; Ding, Guoyong; Li, Yifei; Li, Hongkai; Jiang, Baofa

2014-01-01

Xinxiang, a city in Henan Province, suffered from frequent floods due to persistent and heavy precipitation from 2004 to 2010. In the same period, dysentery was a common public health problem in Xinxiang, with the proportion of reported cases being the third highest among all the notified infectious diseases. We focused on dysentery disease consequences of different degrees of floods and examined the association between floods and the morbidity of dysentery on the basis of longitudinal data during the study period. A time-series Poisson regression model was conducted to examine the relationship between 10 times different degrees of floods and the monthly morbidity of dysentery from 2004 to 2010 in Xinxiang. Relative risks (RRs) of moderate and severe floods on the morbidity of dysentery were calculated in this paper. In addition, we estimated the attributable contributions of moderate and severe floods to the morbidity of dysentery. A total of 7591 cases of dysentery were notified in Xinxiang during the study period. The effect of floods on dysentery was shown with a 0-month lag. Regression analysis showed that the risk of moderate and severe floods on the morbidity of dysentery was 1.55 (95% CI: 1.42-1.670) and 1.74 (95% CI: 1.56-1.94), respectively. The attributable risk proportions (ARPs) of moderate and severe floods to the morbidity of dysentery were 35.53 and 42.48%, respectively. This study confirms that floods have significantly increased the risk of dysentery in the study area. In addition, severe floods have a higher proportional contribution to the morbidity of dysentery than moderate floods. Public health action should be taken to avoid and control a potential risk of dysentery epidemics after floods.

Impacts of floods on dysentery in Xinxiang city, China, during 2004–2010: a time-series Poisson analysis

PubMed Central

Ni, Wei; Ding, Guoyong; Li, Yifei; Li, Hongkai; Jiang, Baofa

2014-01-01

Background Xinxiang, a city in Henan Province, suffered from frequent floods due to persistent and heavy precipitation from 2004 to 2010. In the same period, dysentery was a common public health problem in Xinxiang, with the proportion of reported cases being the third highest among all the notified infectious diseases. Objectives We focused on dysentery disease consequences of different degrees of floods and examined the association between floods and the morbidity of dysentery on the basis of longitudinal data during the study period. Design A time-series Poisson regression model was conducted to examine the relationship between 10 times different degrees of floods and the monthly morbidity of dysentery from 2004 to 2010 in Xinxiang. Relative risks (RRs) of moderate and severe floods on the morbidity of dysentery were calculated in this paper. In addition, we estimated the attributable contributions of moderate and severe floods to the morbidity of dysentery. Results A total of 7591 cases of dysentery were notified in Xinxiang during the study period. The effect of floods on dysentery was shown with a 0-month lag. Regression analysis showed that the risk of moderate and severe floods on the morbidity of dysentery was 1.55 (95% CI: 1.42–1.670) and 1.74 (95% CI: 1.56–1.94), respectively. The attributable risk proportions (ARPs) of moderate and severe floods to the morbidity of dysentery were 35.53 and 42.48%, respectively. Conclusions This study confirms that floods have significantly increased the risk of dysentery in the study area. In addition, severe floods have a higher proportional contribution to the morbidity of dysentery than moderate floods. Public health action should be taken to avoid and control a potential risk of dysentery epidemics after floods. PMID:25098726

Psychological rumination and recovery from work in intensive care professionals: associations with stress, burnout, depression and health.

PubMed

Vandevala, Tushna; Pavey, Louisa; Chelidoni, Olga; Chang, Nai-Feng; Creagh-Brown, Ben; Cox, Anna

2017-01-01

The work demands of critical care can be a major cause of stress in intensive care unit (ICU) professionals and lead to poor health outcomes. In the process of recovery from work, psychological rumination is considered to be an important mediating variable in the relationship between work demands and health outcomes. This study aimed to extend our knowledge of the process by which ICU stressors and differing rumination styles are associated with burnout, depression and risk of psychiatric morbidity among ICU professionals. Ninety-six healthcare professionals (58 doctors and 38 nurses) who work in ICUs in the UK completed a questionnaire on ICU-related stressors, burnout, work-related rumination, depression and risk of psychiatric morbidity. Significant associations between ICU stressors, affective rumination, burnout, depression and risk of psychiatric morbidity were found. Longer working hours were also related to increased ICU stressors. Affective rumination (but not problem-solving pondering or distraction detachment) mediated the relationship between ICU stressors, burnout, depression and risk of psychiatric morbidity, such that increased ICU stressors, and greater affective rumination, were associated with greater burnout, depression and risk of psychiatric morbidity. No moderating effects were observed. Longer working hours were associated with increased ICU stressors, and increased ICU stressors conferred greater burnout, depression and risk of psychiatric morbidity via increased affective rumination. The importance of screening healthcare practitioners within intensive care for depression, burnout and psychiatric morbidity has been highlighted. Future research should evaluate psychological interventions which target rumination style and could be made available to those at highest risk. The efficacy and cost effectiveness of delivering these interventions should also be considered.

Sweet sins: frequency and psychiatric motivation for theft among adolescents with type 1 diabetes.

PubMed

Butwicka, Agnieszka; Fendler, Wojciech M; Zalepa, Adam; Szadkowska, Agnieszka; Gmitrowicz, Agnieszka; Młynarski, Wojciech M

2011-06-01

Behavioral problems are an issue among adolescents with type 1 diabetes (T1D). The authors hypothesize that theft, possibly because of an underlying psychiatric morbidity, may be a way of procuring sweets leading to worse glycemic control. To evaluate psychiatric morbidity and the association of theft and metabolic control among children and adolescents with T1D, using data from an interim analysis of an ongoing quality-of-life and psychiatric comorbidity study. One hundred and nine consecutively hospitalized individuals aged 8-18 years with T1D were asked about incidents of theft. The data on psychiatric morbidity were taken from an ongoing longitudinal study using semi-structured diagnostic interview (KSADS-PL). Overall, 10 children (9%) reported that they had committed theft. Primary motivation for theft was reported as either direct or indirect gain of sweets. Patients who admitted to theft were more likely to have worse metabolic control expressed by glycated hemoglobin (HbA1c) [10.4% (interquartile range 9.8-11.8) vs. 7.7% (6.9-8.8); p < 0.0001] and higher odds of having psychiatric morbidity (odds ratio 8.2; 95% confidence interval 1.9-34.2) than their peers. In the subgroup analysis of patients with psychiatric morbidity, HbA1c was significantly higher if having committed a theft was reported [10.2% (9.4-11.9) vs. 8.1% (7.2-9.2); p < 0.001]. No significant differences in socioeconomic status, clinical factors, or rates of complications were found. Theft may be a factor negatively affecting metabolic control in children with T1D and underlying psychiatric co-morbidity. Psychiatric morbidity is more frequent among patients with T1D and a history of theft. © 2011 John Wiley & Sons A/S.

Morbid obesity increases risk of morbidity and reoperation in resection of benign cranial nerve neoplasms.

PubMed

Murphy, Meghan E; McCutcheon, Brandon A; Kerezoudis, Panagiotis; Porter, Amanda; Rinaldo, Lorenzo; Shepherd, Daniel; Rayan, Tarek; Maloney, Patrick R; Carter, Bob S; Bydon, Mohamad; Gompel, Jamie J Van; Link, Michael J

2016-09-01

Obesity has been associated with increased risk for postoperative CSF leak in patients with benign cranial nerve tumors. Other measures of postoperative morbidity associated with obesity have not been well characterized. Patients enrolled in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) from 2007 to 2013 with a diagnosis code of a benign neoplasm of a cranial nerve were included. The primary outcome of postoperative morbidity was analyzed as well as secondary outcomes of readmission and reoperation. The main covariate of interest was body mass index (BMI). A total of 561 patients underwent surgery for a benign cranial nerve neoplasm between 2007 and 2013. Readmission data, available for 2012-2013(n=353), revealed hydrocephalus, facial nerve injury, or CSF leak requiring readmission or reoperation occurred in 0.85%, 1.42%, and 3.12%, respectively. Composite morbidity included wound complications, infection, respiratory insufficiency, transfusion requirement, stroke, venous thromboembolism, coma and cardiac arrest. On multivariable analysis patients with class I (BMI 30-34.9) and II (BMI 35-39.9) obesity showed trends towards increasing return to operating room, though not significant, but there was no trend for composite complications in class I and II obesity patients. However, class III obesity, BMI≥40, was associated with increased odds of composite morbidity (OR 4.40, 95% CI 1.24-15.88) and return to the operating room (OR 5.97, 95% CI 1.20-29.6) relative to patients with a normal BMI, 18.5-25. Obesity is an independent and important risk factor for composite morbidity in resection of benign cranial nerve neoplasms, and as such, merits discussion during preoperative counseling. Copyright © 2016 Elsevier B.V. All rights reserved.

Male gender preference, female gender disadvantage as risk factors for psychological morbidity in Pakistani women of childbearing age - a life course perspective

PubMed Central

2011-01-01

Background In Pakistan, preference for boys over girls is deeply culturally embedded. From birth, many women experience gendered disadvantages; less access to scarce resources, poorer health care, higher child mortality, limited education, less employment outside of the home and circumscribed autonomy. The prevalence of psychological morbidity is exceptionally high among women. We hypothesise that, among women of childbearing age, gender disadvantage is an independent risk factor for psychological morbidity Methods A cross-sectional catchment area survey of 525 women aged 18 to 35 years living in Islamabad and Rawalpindi. The effect of gender disadvantage was assessed as a latent variable using structural equation modelling. Indicators were parental gender preference, low parental care, parental overprotection, limited education, early age at marriage, marital dissatisfaction and low autonomy. Psychological morbidity was assessed using the 20 item Self Reporting Questionnaire (SRQ). Results Gender disadvantage was independently predictive of psychological morbidity. Among married women, socio-economic status did not predict psychological morbidity, and the effect of education was mediated through gender disadvantage rather than socioeconomic status (SES). The women's own preference for a male child was strongly predicted by their perceptions of having been disadvantaged by their gender in their families of origin. Conclusions The high prevalence of psychological morbidity among women in Pakistan is concerning given recently reported strong associations with low birth weight and infant stunting. Social action, public policies and legislation are indicated to reduce culturally embedded preferences. Neglect of these fundamentals will entrench consequent inequities including gender bias in access to education, a key millennium development goal. PMID:21958069

Definitive surgical closure of enterocutaneous fistula: outcome and factors predictive of increased postoperative morbidity.

PubMed

Ravindran, P; Ansari, N; Young, C J; Solomon, M J

2014-03-01

Enterocutaneous fistula (ECF) presents a complex management problem with significant mortality and morbidity. The aim of this study was to assess the outcome of patients undergoing surgical cure for ECF and to predict factors that might relate to increased postoperative morbidity. Medical records of all patients who underwent definitive surgery for cure of an ECF within our colorectal surgery unit between 2000 and 2010 were reviewed. Forty-one patients (18 male) were identified, in whom 44 definitive procedures were performed. The median age was 54 (17-81) years. The median postoperative length of stay in hospital was 14 (2-213) days. Half (50%) of the ECFs occurred as a postoperative complication followed by spontaneous fistulation in Crohn's disease (36%). The interval to definitive surgery was influenced by the aetiology of the fistula. The median time to surgery after formation of postoperative fistula was 240 days (7.9 months). There was no 30-day postoperative mortality. There were two (4.5%) recurrences at 3 months. Thirty-eight (86%) patients suffered postoperative morbidity as defined by the Clavien-Dindo classification. High-grade morbidity occurred in 32% of patients. On univariate analysis, factors identified as being significantly associated with high-grade morbidity included a fistula output of > 500 ml/day (P = 0.004) in patients with postoperative ECF, malnutrition at presentation (P = 0.04) and a serum albumin value of < 30 g/l (P = 0.02) in patients with spontaneous ECF due to Crohn's disease. The majority of persistent complex ECFs can be cured surgically with low mortality and recurrence in a multidisciplinary setting. Postoperative morbidity, however, remains a significant burden. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

Using a composite morbidity score and cultural survey to explore characteristics of high proficiency neonatal intensive care units.

PubMed

Kaempf, Joseph W; Wang, Lian; Dunn, Michael

2018-01-03

Continuous quality improvement (CQI) collaboration has not eliminated the morbidity variability seen among neonatal intensive care units (NICUs). Factors other than inconstant application of potentially better practices (PBPs) might explain divergent proficiency. Measure a composite morbidity score and determine whether cultural, environmental and cognitive factors distinguish high proficiency from lower proficiency NICUs. Retrospective analysis using a risk-adjusted composite morbidity score (Benefit Metric) and cultural survey focusing on very low birth weight (VLBW) infants from 39 NICUs, years 2000-2014. The Benefit Metric and yearly variance from the group mean was rank-ordered by NICU. A comprehensive survey was completed by each NICU exploring whether morbidity variance correlated with CQI methodology, cultural, environmental and/or cognitive characteristics. 58 272 VLBW infants were included, mean (SD) age 28.2 (3.0) weeks, birth weight 1031 (301) g. The 39 NICU groups' Benefit Metric improved 40%, from 80 in 2000 to 112 in 2014 (P<0.001). 14 NICUs had composite morbidity scores significantly better than the group, 16 did not differ and 9 scored below the group mean. The 14 highest performing NICUs were characterised by more effective team work, superior morale, greater problem-solving expectations of providers, enhanced learning opportunities, knowledge of CQI fundamentals and more generous staffing. Cultural, environmental and cognitive characteristics vary among NICUs perhaps more than traditional CQI methodology and PBPs, possibly explaining the inconstancy of VLBW infant morbidity reduction efforts. High proficiency NICUs foster spirited team work and camaraderie, sustained learning opportunities and support of favourable staffing that allows problem solving and widespread involvement in CQI activities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Metasynthesis: Experiences of Women with Severe Maternal Morbidity and Their Perception of the Quality of Health Care

PubMed Central

Norhayati, Mohd Noor

2015-01-01

Aim To explore the experiences of women with severe maternal morbidity and their perception of the quality of health care. Background The exploration of factors associated with severe maternal morbidity has emerged as an alternative strategy in reducing maternal mortality. This approach is useful for the evaluation and improvement of maternal health services. Design Included a comprehensive search, appraisal of reports of qualitative studies, the classification of studies and the synthesis of findings. Data Sources A literature search was conducted through nine databases for articles published between January 1980 and August 2013. Review Methods The quality of included studies was assessed with a modified Critical Appraisal Skills Program tool. The synthesis applied a meta-ethnographic approach. It involved (1) identifying and comparing the findings; (2) creating a parsimonious thematic structure and (3) searching for disconfirming data. Results Nine studies published between 2005 and 2012, involving 292 women with severe maternal morbidity, were included. Three key themes were identified: 'provision of care', 'severe maternal morbidity' and 'health care seeking behavior'. Barriers to the access and utilization of heath care services were identified. Conclusion The findings appear to suggest that mental and physical health outcomes of women who experienced severe maternal morbidity were poor. There is a need to identify the persistence and severity of these outcomes over a longer period of time. More realistic and less biased information may be obtained in community-based interviews. The impact of potential negative fetal outcomes would be a strong influencing factor for the women. These findings may help to increase awareness of the non-physical components of severe maternal morbidity and provide guidance for professionals regarding preventive measures. PMID:26132107

Longitudinal study on morbidity and mortality in white veal calves in Belgium

PubMed Central

2012-01-01

Background Mortality and morbidity are hardly documented in the white veal industry, despite high levels of antimicrobial drug use and resistance. The objective of the present study was to determine the causes and epidemiology of morbidity and mortality in dairy, beef and crossbred white veal production. A total of 5853 calves, housed in 15 production cohorts, were followed during one production cycle. Causes of mortality were determined by necropsy. Morbidity was daily recorded by the producers. Results The total mortality risk was 5,3% and was significantly higher in beef veal production compared to dairy or crossbreds. The main causes of mortality were pneumonia (1.3% of the calves at risk), ruminal disorders (0.7%), idiopathic peritonitis (0.5%), enterotoxaemia (0.5%) and enteritis (0.4%). Belgian Blue beef calves were more likely to die from pneumonia, enterotoxaemia and arthritis. Detection of bovine viral diarrhea virus at necropsy was associated with chronic pneumonia and pleuritis. Of the calves, 25.4% was treated individually and the morbidity rate was 1.66 cases per 1000 calf days at risk. The incidence rate of respiratory disease, diarrhea, arthritis and otitis was 0.95, 0.30, 0.11 and 0.07 cases per 1000 calf days at risk respectively. Morbidity peaked in the first three weeks after arrival and gradually declined towards the end of the production cycle. Conclusions The present study provided insights into the causes and epidemiology of morbidity and mortality in white veal calves in Belgium, housed in the most frequent housing system in Europe. The necropsy findings, identified risk periods and differences between production systems can guide both veterinarians and producers towards the most profitable and ethical preventive and therapeutic protocols. PMID:22414223

Survival and Morbidity Outcomes of Very Low Birth Weight Infants with Down Syndrome

PubMed Central

Boghossian, Nansi S.; Hansen, Nellie I.; Bell, Edward F.; Stoll, Barbara J.; Murray, Jeffrey C.; Laptook, Abbot R.; Shankaran, Seetha; Walsh, Michele C.; Das, Abhik; Higgins, Rosemary D.

2010-01-01

OBJECTIVE Individuals with Down syndrome (DS) are at increased risk of several morbidities with lifelong health consequences. Little is known about mortality or morbidity risks in early infancy among very-low-birth-weight (VLBW) infants with DS. Our objective was to compare survival and neonatal morbidities between VLBW infants with DS and VLBW infants with other non-DS chromosomal anomalies, other non-chromosomal birth defects, and VLBW infants without major birth defects. METHODS Data were collected prospectively for infants weighing 401-1500 grams born and/or cared for at one of the study centers participating in the NICHD Neonatal Research Network from 1994 through 2008. Risk of death and morbidities including patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), late onset sepsis (LOS), retinopathy of prematurity (ROP), and bronchopulmonary dysplasia (BPD), were compared between VLBW infants with DS and infants in the other groups. RESULTS Infants with DS were at increased risk of death (adjusted relative risk [RR] 2.47, 95% confidence interval [CI] 2.00-3.07), PDA, NEC, LOS, and BPD relative to infants with no birth defects. Decreased risk of death (RR 0.40, 95% CI 0.31-0.52) and increased risks of NEC and LOS were observed when comparing infants with DS to infants with other non-DS chromosomal anomalies. Relative to infants with non-chromosomal birth defects, infants with DS were at increased risk of PDA and NEC. CONCLUSION The increased risk of morbidities among VLBW infants with DS provides useful information for counseling parents and for caretakers in anticipating the need for enhanced surveillance for prevention of these morbidities. PMID:21098157

Trajectories of physical and mental health among persons with morbid obesity and persons with COPD: a longitudinal comparative study.

PubMed

Bonsaksen, Tore; Fagermoen, May Solveig; Lerdal, Anners

2016-01-01

Morbid obesity and chronic obstructive pulmonary disease (COPD) are prevalent diseases associated with impaired health-related quality of life (HRQoL). Research generally indicates that persons with morbid obesity increase their HRQoL following intervention, whereas evidence of increases in HRQoL in persons with COPD is mixed. Examining the patterns of change over time instead of merely examining whether HRQoL changes will add to the knowledge in this field. A sample of persons with morbid obesity and persons with COPD was recruited from learning and mastery courses and rehabilitation centers in Norway. The data were collected by self-report questionnaires at the start of patient education and at four subsequent time points during the 1-year follow-up. HRQoL was measured with the Short Form 12, version 2, and repeated measures analysis of variance was employed in the statistical analysis. Participants with morbid obesity linearly increased their physical HRQoL during the 1-year follow-up, whereas participants with COPD showed no change. None of the groups changed their mental HRQoL during follow-up. In all subdomains of HRQoL, the participants with morbid obesity showed favorable, linearly increasing trajectories across the follow-up period. Among the participants with COPD, no change patterns occurred in the subdomains of HRQoL, except for a fluctuating pattern in the mental health domain. Age, sex, and work status did not influence the trajectories of HRQoL in any of the domains. A more favorable trajectory of HRQoL was found for persons with morbid obesity than for persons with COPD, possibly due to the obese persons' better chances of recovery.

Metasynthesis: Experiences of Women with Severe Maternal Morbidity and Their Perception of the Quality of Health Care.

PubMed

Norhayati, Mohd Noor; Surianti, Sukeri; Nik Hazlina, Nik Hussain

2015-01-01

To explore the experiences of women with severe maternal morbidity and their perception of the quality of health care. The exploration of factors associated with severe maternal morbidity has emerged as an alternative strategy in reducing maternal mortality. This approach is useful for the evaluation and improvement of maternal health services. Included a comprehensive search, appraisal of reports of qualitative studies, the classification of studies and the synthesis of findings. A literature search was conducted through nine databases for articles published between January 1980 and August 2013. The quality of included studies was assessed with a modified Critical Appraisal Skills Program tool. The synthesis applied a meta-ethnographic approach. It involved (1) identifying and comparing the findings; (2) creating a parsimonious thematic structure and (3) searching for disconfirming data. Nine studies published between 2005 and 2012, involving 292 women with severe maternal morbidity, were included. Three key themes were identified: 'provision of care', 'severe maternal morbidity' and 'health care seeking behavior'. Barriers to the access and utilization of heath care services were identified. The findings appear to suggest that mental and physical health outcomes of women who experienced severe maternal morbidity were poor. There is a need to identify the persistence and severity of these outcomes over a longer period of time. More realistic and less biased information may be obtained in community-based interviews. The impact of potential negative fetal outcomes would be a strong influencing factor for the women. These findings may help to increase awareness of the non-physical components of severe maternal morbidity and provide guidance for professionals regarding preventive measures.

Risk Factors for Death and Major Morbidity in Guatemalan Children with Acute Bacterial Meningitis.

PubMed

Olson, Daniel; Lamb, Molly M; Gaensbauer, James T; Todd, James K; Halsey, Neal A; Asturias, Edwin J

2015-07-01

Acute bacterial meningitis (ABM) remains a significant cause of pediatric illness and death in low and middle income countries. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcomes. Data from a prospective surveillance study for ABM in children aged 0-59 months admitted to 3 referral hospitals in Guatemala City from 2000 to 2007 were analyzed. ABM was defined as positive cerebrospinal fluid (CSF) culture, positive latex agglutination or CSF white blood cell greater than 100 cells/mL. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed, along with validation of the predictive Herson-Todd score (HTS). Of 809 children with ABM episodes, 221 (27.3%) survived with major morbidity and 192 (23.7%) died. Among 383 children with nonmissing data, the most significant multivariate predictors for death or major morbidity were seizure [odds ratio (OR), 101.5; P < 0.001], CSF glucose less than 20 mg/dL (OR, 5.3; P = 0.0004), symptom duration more than 3 days (OR, 3.7; P = 0.003) and coma (OR, 6.3; P = 0.004). Of 221 children with a HTS greater than 5, 204 (92%) died or suffered major morbidity (OR, 10.3; P < 0.0001). ABM is a cause of considerable morbidity and mortality in Guatemala. Several clinical risk factors and the composite HTS predicted death or major morbidity. These predictors could help clinicians in low and middle income country guide medical care for ABM and could contribute to the public health impact assessment in preventing meningitis with vaccines.

Maternal health care initiatives: Causes of morbidities and mortalities in two rural districts of Upper West Region, Ghana.

PubMed

Sumankuuro, Joshua; Crockett, Judith; Wang, Shaoyu

2017-01-01

Maternal and neonatal morbidities and mortalities have received much attention over the years in sub-Saharan Africa; yet addressing them remains a profound challenge, no more so than in the nation of Ghana. This study focuses on finding explanations to the conditions which lead to maternal and neonatal morbidities and mortalities in rural Ghana, particularly the Upper West Region. Mixed methods approach was adopted to investigate the medical and non-medical causes of maternal and neonatal morbidities and mortalities in two rural districts of the Upper West Region of Ghana. Survey questionnaires, in-depth interviews and focus group discussions were employed to collect data from: a) 80 expectant mothers (who were in their second and third trimesters, excluding those in their ninth month), b) 240 community residents and c) 13 healthcare providers (2 district directors of health services, 8 heads of health facilities and 3 nurses). Morbidity and mortality during pregnancy is attributed to direct causes such urinary tract infection (48%), hypertensive disorders (4%), mental health conditions (7%), nausea (4%) and indirect related sicknesses such as anaemia (11%), malaria, HIV/AIDS, oedema and hepatitis B (26%). Socioeconomic and cultural factors are identified as significant underlying causes of these complications and to morbidity and mortality during labour and the postnatal period. Birth asphyxia and traditional beliefs and practices were major causes of neonatal deaths. These findings provide focused targets and open a window of opportunity for the community-based health services run by Ghana Health Service to intensify health education and promotion programmes directed at reducing risky economic activities and other cultural beliefs and practices affecting maternal and neonatal morbidity and mortality.

Postoperative ileus-related morbidity profile in patients treated with alvimopan after bowel resection.

PubMed

Wolff, Bruce G; Weese, James L; Ludwig, Kirk A; Delaney, Conor P; Stamos, Michael J; Michelassi, Fabrizio; Du, Wei; Techner, Lee

2007-04-01

Postoperative ileus (POI), an interruption of coordinated bowel motility after operation, is exacerbated by opioids used to manage pain. Alvimopan, a peripherally acting mu-opioid receptor antagonist, accelerated gastrointestinal (GI) recovery after bowel resection in randomized, double-blind, placebo-controlled, multicenter phase III POI trials. The effect of alvimopan on POI-related morbidity for patients who underwent bowel resection was evaluated in a post-hoc analysis. Incidence of POI-related postoperative morbidity (postoperative nasogastric tube insertion or POI-related prolonged hospital stay or readmission) was analyzed in four North American trials for placebo or alvimopan 12 mg administered 30 minutes or more preoperatively and twice daily postoperatively until hospital discharge (7 or fewer postoperative days). GI-related adverse events and opioid consumption were summarized for each treatment. Estimations of odds ratios of alvimopan to placebo and number needed to treat (NNT) to prevent one patient from experiencing an event of POI-related morbidity were derived from the analysis. Patients receiving alvimopan 12 mg were less likely to experience POI-related morbidity than patients receiving placebo (odds ratio = 0.44, p < 0.001). Fewer patients receiving alvimopan (alvimopan, 7.6%; placebo, 15.8%; NNT = 12) experienced POI-related morbidity. There was a lower incidence of postoperative nasogastric tube insertion, and other GI-related adverse events on postoperative days 3 to 6 in the alvimopan group than the placebo group. Opioid consumption was comparable between groups. Alvimopan 12 mg was associated with reduced POI-related morbidity compared with placebo, without compromising opioid-based analgesia in patients undergoing bowel resection. Relatively low NNTs are clinically meaningful and reinforce the potential benefits of alvimopan for the patient and health care system.

Taking it one day at a time: African American women aging with HIV and co-morbidities.

PubMed

Warren-Jeanpiere, Lari; Dillaway, Heather; Hamilton, Pilar; Young, Mary; Goparaju, Lakshmi

2014-07-01

Self-managing HIV/AIDS presents challenges for anyone infected. These challenges may be further complicated for older HIV-infected African American women who acquired the disease at younger ages and now have co-morbidities. Little is known regarding how women's age identity, social responsibilities, co-morbidities, and romantic relationship status influence their HIV self-management. Five focus groups were conducted in Washington DC, with HIV-positive African American women aged 52-65. Topics included HIV and co-morbidity self-management, social support needs, medication adherence, and future plans for old age. A constant comparison approach was applied during data analysis. Co-morbidities, including diabetes and hypertension, were perceived to be more difficult to self-manage than HIV. This difficulty was not attributed to aging but to daily struggles such as lack of income and/or health insurance, an inflexible work schedule, and loneliness. Social responsibilities, including caring for family, positively impacted participants' ability to self-manage HIV by serving as motivation to stay healthy in order to continue to help family members. In contrast, inflexible work schedules negatively impacted women's ability to sustain medication adherence. Overall, this study demonstrates that HIV and co-morbidity self-management are inextricably linked. We can no longer afford to view engagement in HIV care as a single-disease issue and hope to attain optimal health and well-being in our HIV-affected populations. Optimal HIV self-management must be framed within a larger context that simultaneously addresses HIV and co-morbidities, while considering how social and cultural factors uniquely intersect to influence older African American women's self-management strategies.

Association between pediatric asthma care quality and morbidity and English language proficiency in Ohio.

PubMed

Montgomery, Martha P; Allen, Elizabeth D; Thomas, Olivia; Robinson, Byron F; Clark, Donnie; Connelly, Ann; Mott, Joshua A; Conrey, Elizabeth

2018-05-08

Limited English proficiency can be a barrier to asthma care and is associated with poor outcomes. This study examines whether pediatric patients in Ohio with limited English proficiency experience lower asthma care quality or higher morbidity. We used electronic health records for asthma patients aged 2-17 years from a regional, urban, children's hospital in Ohio during 2011-2015. Community-level demographics were included from U.S. Census data. By using chi-square and t-tests, patients with limited English proficiency and bilingual English-speaking patients were compared with English-only patients. Five asthma outcomes-two quality and three morbidity measures-were modeled using generalized estimating equations. The study included 15 352 (84%) English-only patients, 1744 (10%) patients with limited English proficiency, and 1147 (6%) bilingual patients. Pulmonary function testing (quality measure) and multiple exacerbation visits (morbidity measure) did not differ by language group. Compared with English-only patients, bilingual patients had higher odds of ever having an exacerbation visit (morbidity measure) (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.2-1.6) but lower odds of admission to intensive care (morbidity measure) (aOR, 0.3; 95% CI, 0.2-0.7), while patients with limited English proficiency did not differ on either factor. Recommended follow-up after exacerbation (quality measure) was higher for limited English proficiency (aOR, 1.8; 95% CI, 1.4-2.3) and bilingual (aOR, 1.6; 95% CI, 1.3-2.1), compared with English-only patients. In this urban, pediatric population with reliable interpreter services, limited English proficiency was not associated with worse asthma care quality or morbidity.

Development of a Risk Prediction Model and Clinical Risk Score for Isolated Tricuspid Valve Surgery.

PubMed

LaPar, Damien J; Likosky, Donald S; Zhang, Min; Theurer, Patty; Fonner, C Edwin; Kern, John A; Bolling, Stephen F; Drake, Daniel H; Speir, Alan M; Rich, Jeffrey B; Kron, Irving L; Prager, Richard L; Ailawadi, Gorav

2018-02-01

While tricuspid valve (TV) operations remain associated with high mortality (∼8-10%), no robust prediction models exist to support clinical decision-making. We developed a preoperative clinical risk model with an easily calculable clinical risk score (CRS) to predict mortality and major morbidity after isolated TV surgery. Multi-state Society of Thoracic Surgeons database records were evaluated for 2,050 isolated TV repair and replacement operations for any etiology performed at 50 hospitals (2002-2014). Parsimonious preoperative risk prediction models were developed using multi-level mixed effects regression to estimate mortality and composite major morbidity risk. Model results were utilized to establish a novel CRS for patients undergoing TV operations. Models were evaluated for discrimination and calibration. Operative mortality and composite major morbidity rates were 9% and 42%, respectively. Final regression models performed well (both P<0.001, AUC = 0.74 and 0.76) and included preoperative factors: age, gender, stroke, hemodialysis, ejection fraction, lung disease, NYHA class, reoperation and urgent or emergency status (all P<0.05). A simple CRS from 0-10+ was highly associated (P<0.001) with incremental increases in predicted mortality and major morbidity. Predicted mortality risk ranged from 2%-34% across CRS categories, while predicted major morbidity risk ranged from 13%-71%. Mortality and major morbidity after isolated TV surgery can be predicted using preoperative patient data from the STS Adult Cardiac Database. A simple clinical risk score predicts mortality and major morbidity after isolated TV surgery. This score may facilitate perioperative counseling and identification of suitable patients for TV surgery. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Assessment and quantification of post-weaning multi-systemic wasting syndrome severity at farm level.

PubMed

Alarcon, Pablo; Velasova, Martina; Werling, Dirk; Stärk, Katharina D C; Chang, Yu-Mei; Nevel, Amanda; Pfeiffer, Dirk U; Wieland, Barbara

2011-01-01

Post-weaning multi-systemic wasting syndrome (PMWS) causes major economic losses for the English pig industry and severity of clinical signs and economic impact vary considerably between affected farms. We present here a novel approach to quantify severity of PMWS based on morbidity and mortality data and presence of porcine circovirus type 2 (PCV2). In 2008-2009, 147 pig farms across England, non-vaccinating for PCV2, were enrolled in a cross-sectional study. Factor analysis was used to generate variables representing biologically meaningful aspects of variation among qualitative and quantitative morbidity variables. Together with other known variables linked to PMWS, the resulting factors were included in a principal component analysis (PCA) to derive an algorithm for PMWS severity. Factor analysis resulted in two factors: Morbidity Factor 1 (MF1) representing mainly weaner and grower morbidity, and Morbidity Factor 2 (MF2) which mainly reflects variation in finisher morbidity. This indicates that farms either had high morbidity mainly in weaners/growers or mainly in finishers. Subsequent PCA resulted in the extraction of one component representing variation in MF1, post-weaning mortality and percentage of PCV2 PCR positive animals. Component scores were normalised to a value range from 0 to 10 and farms classified into: non or slightly affected farms with a score <4, moderately affected farms with scores 4-6.5 and highly affected farms with a score >6.5. The identified farm level PMWS severities will be used to identify risk factors related to these, to assess the efficacy of PCV2 vaccination and investigating the economic impact of potential control measures. Copyright © 2010 Elsevier B.V. All rights reserved.

Obstructive Sleep Apnea: Differences between Normal-Weight, Overweight, Obese, and Morbidly Obese Children.

PubMed

Scott, Brian; Johnson, Romaine F; Mitchell Md, Ron B

2016-05-01

The severity of obstructive sleep apnea in children determines perioperative management and is an indication for postoperative polysomnography. The relationship between increasing weight and sleep apnea severity in children remains unclear. To compare demographic, clinical, and polysomnography parameters in normal-weight, overweight, obese, and morbidly obese children, as well as identify demographic factors that predict sleep apnea severity. Case series with chart review. Academic children's hospital. A retrospective chart review of 290 children aged 2 to 18 years who underwent polysomnography at an academic children's hospital was performed. Demographics, clinical findings, and polysomnographic parameters were recorded. Children were categorized as normal weight, overweight, obese, or morbidly obese. Differences were assessed using linear and logistical regression models. Significance was set at P < .05. Morbidly obese were older than normal-weight children (mean, 8.0 ± 0.5 years vs 5.8 ± 0.3 years; P < .001) and less likely to have a normal polysomnogram (16% vs 48%; P = .02). There were no differences in sex, ethnicity, birth status (term or preterm), or tonsil size between normal-weight, overweight, obese, and morbidly obese children. Sleep efficiency and percentage of time in rapid eye movement were decreased in morbidly obese compared with other children (P < .05). The apnea-hypopnea index was positively correlated with increasing body mass index z score only as a function of increasing age (P < .001). Obstructive sleep apnea severity is correlated with a combination of increasing age and weight but not with either variable independently. This study suggests that obese and morbidly obese older children are most likely to have severe obstructive sleep apnea. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Transfemoral transcatheter aortic valve insertion-related intraoperative morbidity: Implications of the minimalist approach.

PubMed

Greason, Kevin L; Pochettino, Alberto; Sandhu, Gurpreet S; King, Katherine S; Holmes, David R

2016-04-01

Transfemoral transcatheter aortic valve insertion may be performed in a catheterization laboratory (ie, the minimalist approach). It seems reasonable when considering this approach to avoid it in patients at risk for intraoperative morbidity that would require surgical intervention. We hypothesized that it would be possible to associate baseline characteristics with such morbidity, which would help heart teams select patients for the minimalist approach. We reviewed the records of 215 consecutive patients who underwent transfemoral transcatheter aortic valve insertion with a current commercially available device from November 2008 through July 2015. Demographic characteristics of the patients included a mean age of 78.9 ± 10.6 years, female sex in 73 patients (34.0%), and a mean Society of Thoracic Surgeons predicted risk of mortality of 8.7% ± 5.4%. Valve prostheses were balloon-expandable in 126 patients (58.6%) and self-expanding in 89 patients (41.4%). Significant intraoperative morbidity occurred in 22 patients (10.2%) and included major vascular injury in 12 patients (5.6%), hemodynamic compromise requiring cardiopulmonary bypass support in 4 patients (1.9%), cardiac tamponade requiring intervention in 3 patients (1.4%), ventricular valve embolization in 2 patients (0.9%), and inability to obtain percutaneous access requiring open vascular access in 1 patient (0.5%). Intraoperative morbidity was similarly distributed across all valve types (P = .556) and sheath sizes (P = .369). There were no baseline patient characteristics predictive of intraoperative morbidity. Patient and valve characteristics are not predictive of significant intraoperative morbidity during transfemoral transcatheter aortic valve insertion. The finding has implications for patient selection for the minimalist approach. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Effects of depression and anxiety on mortality in a mixed cancer group: a longitudinal approach using standardised diagnostic interviews.

PubMed

Chan, Caryn Mei Hsien; Wan Ahmad, Wan Azman; Yusof, Mastura M D; Ho, Gwo-Fuang; Krupat, Edward

2015-06-01

Distress and psychiatric morbidity in cancer patients are associated with poorer outcomes including mortality. In this study, we examined the prevalence of psychiatric morbidity and its association with cancer survival over time. Participants were 467 consecutive adult cancer patients attending oncology follow-ups at a single academic medical centre. Assessment consisted of the Hospital Anxiety and Depression Scale and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision. Comparison between co-morbid psychiatric cases and non-cases was made in follow-ups of up to 24 months. Of the 467 patients, 217 of 220 patients with elevated total Hospital Anxiety and Depression Scale scores (≥16) met the criteria for an Axis I disorder at 6 months follow-up, with 102 of the follow-up sample having a persistent diagnosable psychiatric disorder after 1 year. The most frequent initial diagnoses were minor depression (17.6%), major depressive disorder (15.8%) and adjustment disorder (15.8%). Cancer patients without psychiatric morbidity had a survival benefit of 2.24 months or 67 days. Mean survival at 24 months was 20.87 months (95% CI 20.06-21.69) for cancer patients with psychiatric morbidity versus 23.11 months (95% CI 22.78-23.43) for those without (p < 0.001 for log rank). After adjusting for demographics and cancer stage on a Cox proportional hazards model, psychiatric morbidity remained associated with worse survival (hazard ratio 4.13, 95% CI 1.32-12.92, p = 0.015). This study contributes to the growing body of evidence linking psychiatric morbidity to cancer mortality. Treating underlying psychiatric conditions in cancer may therefore improve not just quality of life but also survival. Copyright © 2014 John Wiley & Sons, Ltd.

ATM Mutations and the Development of Severe Radiation-Induced Morbidity Following Radiotherapy for Breast Cancer

DTIC Science & Technology

2005-07-01

repair of radiation-induced damage. Furthermore, cells possessing a mutated copy of this gene are more radiosensitive than cells from individuals with...AD Award Number: DAMD17-02-1-0503 TITLE: ATM Mutations and the Development of Severe Radiation-Induced Morbidity Following Radiotherapy for Breast...2005 Annual 1 Jul 2004 - 30 Jun 2005 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER ATM Mutations and the Development of Severe Radiation-Induced Morbidity

Arthritis Impact on U.S. Life Quality: Morbidity and Mortality Effects from National Health Interview Survey Data 1986-1988 And 1994 Using Qwbx1 Estimates of Well-Being

ERIC Educational Resources Information Center

Anderson, John P.; Kaplan, Robert M.; Ake, Christopher F.

2004-01-01

Objective: To estimate the impact of arthritis using a general health index and National Health Interview Survey (NHIS) data. Methods: Morbidity data came from NHIS Public Use data, from the years 19861988 and 1994. The data are 423 400 cases, representing 975 421 153 person-years. Quality of Well-being Scale (QWB) morbidity scores were imputed…

Changes in SCD gene DNA methylation after bariatric surgery in morbidly obese patients are associated with free fatty acids

PubMed Central

Morcillo, Sonsoles; Martín-Núñez, Gracia Mª; García-Serrano, Sara; Gutierrez-Repiso, Carolina; Rodriguez-Pacheco, Francisca; Valdes, Sergio; Gonzalo, Montserrat; Rojo-Martinez, Gemma; Moreno-Ruiz, Francisco J.; Rodriguez-Cañete, Alberto; Tinahones, Francisco; García-Fuentes, Eduardo

2017-01-01

Stearoyl CoA Desaturase-1 (SCD) is considered as playing an important role in the explanation of obesity. The aim of this study was to evaluate whether the DNA methylation SCD gene promoter is associated with the metabolic improvement in morbidly obese patients after bariatric surgery. The study included 120 subjects with morbid obesity who underwent a laparoscopic Roux-en Y gastric by-pass (RYGB) and a control group of 30 obese subjects with a similar body mass index (BMI) to that found in morbidly obese subjects six months after RYGB. Fasting blood samples were obtained before and at six months after RYGB. DNA methylation was measured by pyrosequencing technology. DNA methylation levels of the SCD gene promoter were lower in morbidly obese subjects before bariatric surgery but increased after RYGB to levels similar to those found in the control group. Changes of DNA methylation SCD gene were associated with the changes of free fatty acids levels (r = −0.442, p = 0.006) and HOMA-IR (r = −0.249, p = 0.035) after surgery. RYGB produces an increase in the low SCD methylation promoter levels found in morbidly obese subjects. This change of SCD methylation levels is associated with changes in FFA and HOMA-IR. PMID:28393901

Validation of Boey's score in predicting morbidity and mortality in peptic perforation peritonitis in Northwestern India.

PubMed

Agarwal, Abhishek; Jain, Sanchit; Meena, L N; Jain, Sumita A; Agarwal, Lakshman

2015-01-01

The major complications of peptic ulcer are hemorrhage, perforation and gastric outlet obstruction with perforation occurring in about 2-10% of patients. Patients with perforated peptic ulcer still have a high rate of morbidity and mortality and to improve the outcomes it is important to stratify the patients into different categories. To evaluate the accuracy of Boey scoring system in predicting postoperative morbidity and mortality in patients operated for peptic perforation. It was a prospective observational single centre study conducted at SMS Medical College and Hospital, Jaipur, from October 2011 to October 2012 on 180 patients undergoing open surgery for peptic ulcer perforation. Postoperative outcomes in terms of recovery and complications were studied. For prediction of morbidity and mortality by Boey risk stratification, the odds ratio (OR) and 95% confidence interval (95% CI) of each risk score were compared with the outcomes of "0" risk score. The mortality rate increased progressively with increasing numbers of the Boey score: 1.9%, 7.1%, 31.7% and 40% for 0, 1, 2, and 3 scores, respectively (p < 0.001). The morbidity rates for 0, 1, 2, and 3 Boey scores were 13%, 45.7%, 70.7% and 73.3% respectively (p < 0.001). Boey score is a useful tool for assessing the prognosis of operated cases of peptic perforation and helps in the assessment of mortality and morbidity of these patients.

Does a maternal-fetal medicine-centered labor and delivery coverage model put the 'M' back in MFM?

PubMed

Brandt, Justin S; Srinivas, Sindhu K; Elovitz, Michal E; Bastek, Jamie A

2014-04-01

Maternal morbidity is increasing in the United States. Our objectives were to examine whether a labor and delivery (L&D) provider model with regular maternal-fetal medicine (MFM) coverage decreases the rates of maternal morbidity during delivery hospitalizations and has an impact on obstetrician-gynecologist residents' perceptions of safety and education. We performed a retrospective cohort study to compare the rates of maternal morbidity before and after the implementation of an MFM-centered coverage model on L&D. Outcomes were identified using International Classification of Diseases, ninth revision, codes. The primary outcome was a composite of severe maternal morbidity. Additionally, obstetrician-gynecologist residents completed an anonymous survey asking them to compare coverage models, and their Council on Resident Education in Obstetrics and Gynecology examination scores were compared. Data from 4715 deliveries were included. There were no differences in composite morbidity or individual adverse outcomes. Most residents (81.3%) preferred the new provider model, with median 5-point Likert scores indicating perceived increases in safety and education. Mean Council on Resident Education in Obstetrics and Gynecology scores improved in the 18 residents exposed to both models. Although the MFM-centered provider model appears to have had a positive impact on residents' perceptions of safety and education, it was not associated with significant changes in severe maternal morbidity. Copyright © 2014 Mosby, Inc. All rights reserved.

Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study.

PubMed

Norhayati, Mohd Noor; Nik Hazlina, Nik Hussain; Sulaiman, Zaharah; Azman, Mohd Yacob

2016-03-05

Severe maternal conditions have increasingly been used as alternative measurements of the quality of maternal care and as alternative strategies to reduce maternal mortality. We aimed to study severe maternal morbidity and maternal near miss among women in two tertiary hospitals in Kota Bharu, Kelantan, Malaysia. A cross-sectional study with record review was conducted in 2014. Severe maternal morbidity and maternal near miss were classified using the new World Health Organization criteria. Health indicators for obstetric care were calculated and descriptive analyses were performed using SPSS version 22.0. In total, 21,579 live births, 395 women with severe maternal morbidity, 47 women with maternal near miss and two maternal deaths were analysed. The severe maternal morbidity incidence ratio was 18.3 per 1000 live births and the maternal near miss incidence ratio was 2.2 per 1000 live births. The maternal near miss mortality ratio was 23.5 and the mortality index was 4.1 %. The process indicators for essential interventions were almost 100.0 %. Haemorrhagic disorders were the most common event for severe maternal morbidity (68.6 %) and maternal near miss (80.9 %) and management-based criteria accounted for 85.1 %. Comprehensive emergency care and intensive care as well as overall improvements in the quality of maternal health care need to be achieved to substantial reduce maternal death.

Health after childbirth: patterns of reported postpartum morbidity from Lebanon.

PubMed

Kabakian-Khasholian, Tamar; Shayboub, Rawan; Ataya, Alexandra

2014-03-01

The postpartum period is under-researched in low and middle income countries. The scarce literature reveals heavy burden of ill health experienced in that period and under utilisation of health services. Understanding the postpartum morbidity burden and identifying the care-seeking behaviours is essential to improve service delivery. This paper examines reported postpartum morbidity, care seeking behaviour and whether postpartum morbidity is associated with method of birth. A cross sectional study of women delivering in 18 private hospitals from two regions in Lebanon was undertaken. Women in their second or third trimester of pregnancy, visiting private obstetric clinics affiliated with participating hospitals were interviewed for baseline information. Reported postpartum morbidity was assessed in an interview conducted at women's homes from 40 days up to six months postpartum. Of the 269 women recruited, physical postpartum health problems were reported by 93.6% and psychological health problems by 84.4% of women, with more health problems being reported beyond two months postpartum. Women were less likely to seek professional care for psychological health problems. Reporting postpartum health problems was not associated with method of birth. A heavy burden of postpartum morbidity is experienced by women with gaps in utilisation of relevant health services. Efforts should be directed towards the organisation and delivery of comprehensive maternity care services. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Treatment of the residual cavity during hepatic hydatidosis surgery: a cohort study of capitonnage vs. omentoplasty.

PubMed

Manterola, Carlos; Roa, Juan Carlos; Urrutia, Sebastián

2013-12-01

To determine the efficacy of omentoplasty (OP) and capitonnage (CA) in residual cavity management during the hepatic hydatidosis (HH) surgery in terms of the postoperative morbidity. Prospective cohort study. Patients with non-complicated HH treated with subtotal pericystectomy in the Department of Surgery of the Temuco Regional Hospital between 2001 and 2008 were studied. We compared those managed with CA with those managed with OP. A sample size of 40 patients in each group was estimated to be needed to adequately compare the outcomes of the approaches. The primary endpoint was postoperative morbidity. Descriptive statistics, bivariate analyses and logistic regression models were applied. The absolute risk (AR) and relative risk (RR) were calculated. The cohorts comprised 88 patients (CA 40 and OP 48), with a median age of 40 years (15-84), and 62.5 % were females. A general postoperative morbidity rate of 11.4 % was noted after a median follow-up of 60 months (12-84 months). Significant differences in postoperative morbidity were found (p = 0.044). Logistic regression models verified that there were no confounding variables. The AR of the postoperative morbidity for the CA and PO cohorts was 0.025 and 0.1875, respectively, and the RR was 0.13 [0.03, 0.70] 95 % CI. Residual cavity management with CA is associated with a lower postoperative morbidity risk than OP.

NOSE laparoscopic gastrectomies for early gastric cancer may reduce morbidity and hospital stay: early results from a prospective nonrandomized study.

PubMed

Hüscher, Cristiano G S; Lirici, Marco Maria; Ponzano, Cecilia

2017-04-01

Natural orifice specimen extraction - NOSE laparoscopy is a promising technique that avoids mini-laparotomy, possibly reducing postoperative pain, wound infections and hospital stay. Recent systematic reviews have shown that postoperative morbidity associated with laparoscopically assisted gastrectomies is similar to that after open gastrectomies. More specifically, there is no difference in wound infection rate. The study objective was to evaluate whether postoperative morbidity and hospital stay may be reduced by transoral specimen extraction after laparoscopically assisted gastrectomy for early gastric cancer (EGC). A prospective, nonrandomized study was carried out starting in August 2012. Data from all patients operated on during the first year, with minimum 18 months follow-up, were collected to assess feasibility, oncologic results, postoperative morbidity, hospital stay and functional results. Overall, 14 patients were included and followed-up. After gastric resection, a 3 cm opening was created on the gastric stump, and the specimen, divided into three segments stitched one to each other, was sutured to the gastric tube and retrieved through the mouth. Postoperative morbidity was 7.14% (1/14): one case of pneumonia. No wound infection occurred. The mean postoperative hospital stay was 4.7 ± 1.0 days. NOSE laparoscopic subtotal gastrectomy is feasible and safe, with similar oncologic results as LAG, but decreased morbidity and hospital stay.

Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery.

PubMed

West, M A; Parry, M G; Lythgoe, D; Barben, C P; Kemp, G J; Grocott, M P W; Jack, S

2014-08-01

This study investigated the relationship between objectively measured physical fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after rectal cancer surgery. Patients scheduled for rectal cancer surgery underwent preoperative CPET (reported blind to patient characteristics) with recording of morbidity (recorded blind to CPET variables). Non-parametric receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity. Of 105 patients assessed, 95 (72 men) were included; ten patients had no surgery and were excluded (3 by choice, 7 owing to unresectable metastasis). Sixty-eight patients had received neoadjuvant treatment. ROC curve analysis of oxygen uptake (V˙o2 ) at estimated lactate threshold (θ^L ) and peak V˙o2 gave an area under the ROC curve of 0·87 (95 per cent confidence interval 0·78 to 0·95; P < 0·001) and 0·85 (0·77 to 0·93; P < 0·001) respectively, indicating that they can help discriminate patients at risk of postoperative morbidity. The optimal cut-off points identified were 10·6 and 18·6 ml per kg per min for V˙o2 at θ^L and peak respectively. CPET can help predict morbidity after rectal cancer surgery. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Neuropathic Pain and Psychological Morbidity in Patients with Treated Leprosy: A Cross-Sectional Prevalence Study in Mumbai

PubMed Central

Lasry-Levy, Estrella; Hietaharju, Aki; Pai, Vivek; Ganapati, Ramaswamy; Rice, Andrew S. C.; Haanpää, Maija; Lockwood, Diana N. J.

2011-01-01

Background Neuropathic pain has been little studied in leprosy. We assessed the prevalence and clinical characteristics of neuropathic pain and the validity of the Douleur Neuropathique 4 questionnaire as a screening tool for neuropathic pain in patients with treated leprosy. The association of neuropathic pain with psychological morbidity was also evaluated. Methodology/Principal Findings Adult patients who had completed multi-drug therapy for leprosy were recruited from several Bombay Leprosy Project clinics. Clinical neurological examination, assessment of leprosy affected skin and nerves and pain evaluation were performed for all patients. Patients completed the Douleur Neuropathique 4 and the 12-item General Health Questionnaire to identify neuropathic pain and psychological morbidity. Conclusions/Significance One hundred and one patients were recruited, and 22 (21.8%) had neuropathic pain. The main sensory symptoms were numbness (86.4%), tingling (68.2%), hypoesthesia to touch (81.2%) and pinprick (72.7%). Neuropathic pain was associated with nerve enlargement and tenderness, painful skin lesions and with psychological morbidity. The Douleur Neuropathique 4 had a sensitivity of 100% and specificity of 92% in diagnosing neuropathic pain. The Douleur Neuropathique 4 is a simple tool for the screening of neuropathic pain in leprosy patients. Psychological morbidity was detected in 15% of the patients and 41% of the patients with neuropathic pain had psychological morbidity. PMID:21408111

Impact of climate change on ozone-related mortality and morbidity in Europe.

PubMed

Orru, Hans; Andersson, Camilla; Ebi, Kristie L; Langner, Joakim; Aström, Christofer; Forsberg, Bertil

2013-02-01

Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change. Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with the model of atmospheric transport and chemistry (MATCH)-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied under greenhouse gas emission scenarios A2 and A1B, respectively. We applied a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity. Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, the Netherlands and the UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increases in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal, with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected. The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

Gender Differences in Compulsive Buying Disorder: Assessment of Demographic and Psychiatric Co-Morbidities

PubMed Central

Kim, Hyoun S.; Requião, Marinalva G.; Marasaldi, Renata F.; Filomensky, Tatiana Z.; Hodgins, David C.; Tavares, Hermano

2016-01-01

Compulsive buying is a common disorder found worldwide. Although recent research has shed light into the prevalence, etiology and clinical correlates of compulsive buying disorder, less is known about gender differences. To address this empirical gap, we assessed potential gender differences in demographic and psychiatric co-morbidities in a sample of 171 compulsive buyers (20 men and 151 women) voluntarily seeking treatment in São Paulo, Brazil. A structured clinical interview confirmed the diagnosis of compulsive buying. Of the 171 participants, 95.9% (n = 164) met criteria for at least one co-morbid psychiatric disorder. The results found that male and female compulsive buyers did not differ in problem severity as assessed by the Compulsive Buying Scale. However, several significant demographic and psychiatric differences were found in a multivariate binary logistic regression. Specifically, male compulsive buyers were more likely to report being non-heterosexual, and reported fewer years of formal education. In regards to psychiatric co-morbidities, male compulsive buyers were more likely to be diagnosed with sexual addiction, and intermittent explosive disorder. Conversely, men had lower scores on the shopping subscale of the Shorter PROMIS Questionnaire. The results suggest that male compulsive buyers are more likely to present with co-morbid psychiatric disorders. Treatment planning for compulsive buying disorder would do well to take gender into account to address for potential psychiatric co-morbidities. PMID:27907082

Gender Differences in Compulsive Buying Disorder: Assessment of Demographic and Psychiatric Co-Morbidities.

PubMed

Nicoli de Mattos, Cristiana; Kim, Hyoun S; Requião, Marinalva G; Marasaldi, Renata F; Filomensky, Tatiana Z; Hodgins, David C; Tavares, Hermano

2016-01-01

Compulsive buying is a common disorder found worldwide. Although recent research has shed light into the prevalence, etiology and clinical correlates of compulsive buying disorder, less is known about gender differences. To address this empirical gap, we assessed potential gender differences in demographic and psychiatric co-morbidities in a sample of 171 compulsive buyers (20 men and 151 women) voluntarily seeking treatment in São Paulo, Brazil. A structured clinical interview confirmed the diagnosis of compulsive buying. Of the 171 participants, 95.9% (n = 164) met criteria for at least one co-morbid psychiatric disorder. The results found that male and female compulsive buyers did not differ in problem severity as assessed by the Compulsive Buying Scale. However, several significant demographic and psychiatric differences were found in a multivariate binary logistic regression. Specifically, male compulsive buyers were more likely to report being non-heterosexual, and reported fewer years of formal education. In regards to psychiatric co-morbidities, male compulsive buyers were more likely to be diagnosed with sexual addiction, and intermittent explosive disorder. Conversely, men had lower scores on the shopping subscale of the Shorter PROMIS Questionnaire. The results suggest that male compulsive buyers are more likely to present with co-morbid psychiatric disorders. Treatment planning for compulsive buying disorder would do well to take gender into account to address for potential psychiatric co-morbidities.

Ventilation/Perfusion distribution abnormalities in morbidly obese subjects before and after bariatric surgery.

PubMed

Rivas, Eva; Arismendi, Ebymar; Agustí, Alvar; Sanchez, Marcelo; Delgado, Salvadora; Gistau, Concepción; Wagner, Peter D; Rodriguez-Roisin, Roberto

2015-04-01

Obesity is a global and growing public health problem. Bariatric surgery (BS) is indicated in patients with morbid obesity. To our knowledge, the effects of morbid obesity and BS on ventilation/perfusion (V.a/Q.) ratio distributions using the multiple inert gas elimination technique have never before been explored. We compared respiratory and inert gas (V.a/Q. ratio distributions) pulmonary gas exchange, breathing both ambient air and 100% oxygen, in 19 morbidly obese women (BMI, 45 kg/m2), both before and 1 year after BS, and in eight normal-weight, never smoker, age-matched, healthy women. Before BS, morbidly obese individuals had reduced arterial Po2 (76 ± 2 mm Hg) and an increased alveolar-arterial Po2 difference (27 ± 2 mm Hg) caused by small amounts of shunt (4.3% ± 1.1% of cardiac output), along with abnormally broadly unimodal blood flow dispersion (0.83 ± 0.06). During 100% oxygen breathing, shunt increased twofold in parallel with a reduction of blood flow to low V.a/Q. units, suggesting the development of reabsorption atelectasis without reversion of hypoxic pulmonary vasoconstriction. After BS, body weight was reduced significantly (BMI, 31 kg/m2), and pulmonary gas exchange abnormalities were decreased. Morbid obesity is associated with mild to moderate shunt and V.a/Q. imbalance. These abnormalities are reduced after BS.

Effect of Esophagus Position on Surgical Difficulty and Postoperative Morbidities After Thoracoscopic Esophagectomy.

PubMed

Yoshida, Naoya; Baba, Yoshifumi; Shigaki, Hironobu; Shiraishi, Shinya; Harada, Kazuto; Watanabe, Masayuki; Iwatsuki, Masaaki; Kurashige, Junji; Sakamoto, Yasuo; Miyamoto, Yuji; Ishimoto, Takatsugu; Kosumi, Keisuke; Tokunaga, Ryuma; Yamashita, Yasuyuki; Baba, Hideo

2016-01-01

The objective include thoracoscopic esophagectomy for the deep-seated (left-sided) esophagus has several technical difficulties, which may affects the intraoperative or postoperative outcomes. However, no previous studies have focused on the correlation between the position of the esophagus and short-term outcome after thoracoscopic esophagectomy. Of 470 esophagectomies between April 2005 and April 2015 in Kumamoto University Hospital, 112 patients who underwent thoracoscopic esophagectomy for esophageal cancer were examined. The position of the esophagus was divided into 2 types: deep-seated esophagus or another type based on computed tomographic images in the supine position. In results, the deep-seated esophagus was associated with a longer operation time in the thorax and high incidence of severe morbidity of Clavien-Dindo classification ≥IIIb, pneumonia, and any pulmonary morbidity. The deep-seated esophagus was also an independent risk factor for severe morbidity (hazard ratio [HR] = 5.37, 95% CI: 1.307-22.03; P = 0.020), pneumonia (HR = 9.23, 95% CI: 2.150-39.60; P = 0.003), and any pulmonary morbidity (HR = 10.3, 95% CI: 2.714-38.78; P < 0.001). In conclusion, the position of the esophagus had a strong influence on the difficulty of thoracoscopic esophagectomy and the incidence of postoperative morbidities. Surgeons would be well advised to keep a careful watch perioperatively for patients with a deep-seated esophagus. Copyright © 2016 Elsevier Inc. All rights reserved.

Co-morbidity of Diabetes Mellitus and Orodental Diseases in Nigeria.

PubMed

Anyasodor, Anayochukwu Edward; Nwose, Ezekiel Uba; Richards, Ross Stuart; Bwititi, Phillip Taderera; Digban, Kester Awharentomah; Mudiaga, Luke Itietie; Aganbi, Eferhire; Ojodeme, Okuguni

2017-01-01

Although several epidemiological studies have reported an association between diabetes mellitus (DM) and orodental health. However, the occurrence of the co-morbidity of both diseases has been more of suspicion than evidence-based. DM is a serious public health concern globally, and in Nigeria. Studies have separately documented the prevalence of DM and orodental diseases, but data lack to adequately rationalise co-morbidity of both diseases. The study aimed to report evidence of co-morbidity of DM and orodental diseases in Nigeria. Data published between December, 1970 and June, 2015 were used in writing the review. These data were collated from electronic literature archives and databases. This review suggests evidence of the association of DM and orodental diseases. It revealed that both diseases are densely distributed in South-East, South-South and South-West geopolitical zones of Nigeria, and sparsely spread across other regions of the country. Co-morbidity of both diseases holds promise that will favour public health practice, especially in Nigeria. It is hoped that the association may lead to the establishment of a cost-effective DM screening protocol in Nigeria. Again, screening of DM in dentistries and vice versa may be possible through the relationship of both diseases. It is recommended that the driving force of the co-morbidity be investigated. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Cannabis and Depression: A Twin Model Approach to Co-morbidity.

PubMed

Smolkina, M; Morley, K I; Rijsdijk, F; Agrawal, A; Bergin, J E; Nelson, E C; Statham, D; Martin, N G; Lynskey, M T

2017-07-01

Cannabis use disorder (CUD) co-occurs with major depressive disorder (MDD) more frequently than would be expected by chance. However, studies to date have not produced a clear understanding of the mechanisms underlying this co-morbidity. Genetically informative studies can add valuable insight to this problem, as they allow the evaluation of competing models of co-morbidity. This study uses data from the Australian Twin Registry to compare 13 co-morbidity twin models initially proposed by Neale and Kendler (Am J Hum Genet 57:935-953, 1995). The analysis sample comprised 2410 male and female monozygotic and dizygotic twins (average age 32) who were assessed on CUD and MDD using the SSAGA-OZ interview. Data were analyzed in OpenMx. Of the 13 different co-morbidity models, two fit equally well: CUD causes MDD and Random Multiformity of CUD. Both fit substantially better than the Correlated Liabilities model. Although the current study cannot differentiate between them statistically, these models, in combination, suggest that CUD risk factors may causally influence the risk to develop MDD, but only when risk for CUD is high.

Morbidity predicting factors of penetrating colon injuries.

PubMed

Mickevicius, A; Valeikaite, G; Tamelis, A; Saladzinskas, Z; Svagzdys, S; Pavalkis, D

2010-01-01

To analyze patients suffering from penetrating colon injuries management, clinical outcomes and factors, which predict higher morbidity and complications rate. this was a retrospective analysis of prospectively collected data from patients with injured colon from 1995 to 2008. Age, time till operation, systolic blood pressure, part of injured colon, fecal contamination, PATI were registered. Monovariate and multivariate logistic regression was performed to determine higher morbidity predictive factors. 61 patients had penetrating colon injuries. Major fecal contamination of the peritoneal cavity and systolic blood pressure lower than 90 mmHg are independent factors determining the fecal diversion operation. Primary repair group analysis establish that major fecal contamination and systolic blood pressure lower than 90 mmHg OR = 4.2 and 0.96 were significant risk factors, which have contributed to the development of postoperative complications. And systolic blood pressure lower than 90 mmHg and PATI 20 predict OR = 0.05 and 2.61 higher morbidity. Fecal contamination of the peritoneal cavity and hypotension were determined to be crucial in choice of performing fecal diversion or primary repair. But the same criteria and PATI predict higher rate of postoperative complications and higher morbidity.

Effects of duloxetine in treatment-refractory men with posttraumatic stress disorder.

PubMed

Walderhaug, E; Kasserman, S; Aikins, D; Vojvoda, D; Nishimura, C; Neumeister, A

2010-03-01

Although there is evidence that selective serotonin reuptake inhibitors provide some benefit in the treatment of post-traumatic stress disorder (PTSD), most meta-analytical reviews have concluded that effect sizes are small and, moreover, that there may be relatively little benefit for some populations (e. g., combat veterans with co-morbid major depression, MDD). This study aimed to evaluate the effectiveness and tolerability of the dual reuptake inhibitor duloxetine in the treatment of PTSD and co-morbid MDD. Twenty-one treatment refractory, male, combat-related patients with PTSD and co-morbid MDD were enrolled in a naturalistic study and twenty completed the trial. Duloxetine was given between 60 and 120 mg daily over 8 weeks. Duloxetine led to a significant improvement of PTSD-characteristic symptoms as well as co-morbid MDD. Duloxetine effectively reduced nightmares, which is important because decreasing nightmares has been associated with improved sleep in PTSD. The results of this naturalistic study suggest that duloxetine is an effective and well-tolerated treatment for patients with PTSD and co-morbid MDD. These initial results need to be extended to the study of women with PTSD.

Factors affecting morbidity and mortality on-farm and on-station in the Ethiopian highland sheep.

PubMed

Bekele, T; Woldeab, T; Lahlou-Kassi, A; Sherington, J

1992-12-01

Factors affecting morbidity and mortality of the Ethiopian highland sheep were studied both on-farm and on-station at Debre Berhan between 1989 and 1990. Primary causes of infectious origin resulted in high proportional morbidity (88.4% on-farm) and mortality (72.9% on-farm and 71.8% on-station) rates. Nutritional and managemental factors were also responsible for mortalities in lambs. The most frequent secondary causes of morbidity and/or mortality were ectoparasites and nasal myiasis. Health management interventions on-station were not high enough to produce performance improvements above the on-farm levels. However, the occurrence of gastrointestinal parasites significantly (P < 0.05) differed between the two management systems. The frequency of some of the major causes of morbidity and mortality such as pneumonia, fasciolasis and enteritis were significantly (P < 0.01) affected by season and age of an animal. In order to alleviate the major health constraints identified in this study, a proper health management intervention involving vaccination, strategic anthelmintic treatment and feeding management are suggested.

School exposure and asthma.

PubMed

Esty, Brittany; Phipatanakul, Wanda

2018-05-01

To provide a comprehensive overview of common school exposures and the association between school exposures and pediatric asthma morbidity. A comprehensive literature review was performed using PubMed. Full-length, peer-reviewed studies published in English were considered for review. In vivo, in vitro, and animal studies were excluded. Studies of school exposure to cockroach, mouse, dust mite, dog, cat, molds, pollution, and endotoxin associated with asthma and asthma morbidity were considered. The current literature establishes an association between school exposure and pediatric asthma morbidity. There is a need for ongoing research to evaluate the effects of school-based environmental interventions on asthma morbidity. It is evident that the indoor school environment is a significant reservoir of allergens, molds, pollutants, and endotoxin and that there is an association between school exposure and pediatric asthma morbidity. School-based interventions have the potential for substantial individual, community, and public health benefit. It is important that researchers continue to study the health effects associated with school exposures and assess cost-effectiveness of multifaceted school-based interventions. Copyright © 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Coping style as a mediator between attachment and mental and physical health in patients suffering from morbid obesity.

PubMed

Aarts, Floor; Hinnen, Chris; Gerdes, Victor E A; Acherman, Yair; Brandjes, Dees P M

2014-01-01

The presence of mental health problems and limitations in physical functioning is high in patients suffering from morbid obesity. The purpose of the current study was to examine the mediating role of coping style in the relationship between attachment representations and mental health and physical functioning in a morbidly obese population. A total of 299 morbidly obese patients who were referred to the Slotervaart bariatric surgery unit in Amsterdam, the Netherlands, completed self-report questionnaires assessing adult attachment style (Experiences in Close Relationship-Revised Questionnaire), coping style (Utrecht Coping List), and patients physical functioning and mental health (Short Form-36). Attachment anxiety (beta = -.490, p < .001) and attachment avoidance (3 = -.387, p < .001) were both found to be related to mental health. In addition, attachment anxiety was also found to be related to physical functioning (beta = - .188,p < .001). Coping style partly mediated these associations. Findings suggest that coping mediates the association between attachment anxiety and attachment avoidance on the one hand and mental health and physical functioning in patients with morbid obesity on the other hand.

Ureaplasma-associated prenatal, perinatal, and neonatal morbidities.

PubMed

Silwedel, Christine; Speer, Christian P; Glaser, Kirsten

2017-11-01

Ureaplasma species (spp.) have been acknowledged as major causative pathogens in chorioamnionitis and prematurity, but may also contribute to key morbidities in preterm infants. Several epidemiological and experimental data indicate an association of neonatal Ureaplasma colonization and/or infection with bronchopulmonary dysplasia. Furthermore, a potential causal relation with other inflammation-induced morbidities, such as intraventricular hemorrhage, white matter injury, necrotizing enterocolitis, and retinopathy of prematurity, has been debated. Areas covered: This review will summarize current knowledge on the role of Ureaplasma spp. in prenatal, perinatal, and neonatal morbidities, while furthermore examining mutual underlying mechanisms. We try to elaborate who is at particular risk of Ureaplasma-induced inflammation and subsequent secondary morbidities. Expert commentary: Most likely by complex interactions with immunological processes, Ureaplasma spp. can induce pro-inflammation, but may also downregulate the immune system. Tissue damage, possibly causing the above mentioned complications, is likely to result from both ways: either directly cytokine-associated, or due to a higher host vulnerability to secondary impact factors. These events are very likely to begin in prenatal stages, with the most immature preterm infants being most susceptible and at highest risk.

Health and morbidity survey, Seychelles, 1956-57

PubMed Central

Spitz, A. J. W.

1960-01-01

Adequate knowledge of existing health and morbidity conditions is the basis for all planning of future health services. For this reason, a health and morbidity survey of the population of the Seychelles was carried out in 1956-57 under the joint auspices of the Seychelles Government and the World Health Organization. Statistical sampling methods were used and the information was obtained by the household interview method. Health, morbidity and relevant demographic data were thus disclosed for the first time for Seychelles. Basic information was obtained on: general morbidity of the population, including dental and nutritional status, malnutrition, incidence of intestinal diseases and other easily diagnosable conditions; growth and weight curves of children up to the age of 16; haemoglobin levels; erythrocyte sedimentation rates; general living conditions such as housing and overcrowding, social status and latrine arrangements; the connexion of soil pollution with the incidence of amoebiasis and helminthiasis; and lastly, the incidence of the sickle cell trait, eosinophilia and positive serological reactions to the Chediak test (for manifest or latent syphilis). The findings are presented with a minimum of remarks and interpretation. PMID:13833401

Physical co-morbidity among treatment resistant vs. treatment responsive patients with major depressive disorder.

PubMed

Amital, D; Fostick, L; Silberman, A; Calati, R; Spindelegger, C; Serretti, A; Juven-Wetzler, A; Souery, D; Mendlewicz, J; Montgomery, S; Kasper, S; Zohar, J

2013-08-01

Co-morbid physical illness has been suggested to play an important role among the factors contributing to treatment resistance in patients with major depressive disorder. In the current study we compared the rate of physical co-morbidity, defined by ICD-10, among a large multicenter sample of 702 patients with major depressive disorder. A total of 356 of the participants were defined as treatment resistant depression (TRD) patients-having failed two or more adequate antidepressant trials. No significant difference was found between TRD and non-TRD participants in the prevalence of any ICD-10 category. This finding suggests that although physical conditions such as diabetes, thyroid dysfunction, hypertension, ischemic heart disease, and peptic diseases are often accompanied by co-morbid MDD, they do not necessarily have an impact on the course of MDD or the likelihood to respond to treatment. Marginally higher rates of co-morbid breast cancer, migraine and glaucoma were found among TRD participants. Possible explanations for these findings and their possible relation to TRD are discussed. Copyright © 2012 Elsevier B.V. and ECNP. All rights reserved.

Early detection of emerging zoonotic diseases with animal morbidity and mortality monitoring.

PubMed

Bisson, Isabelle-Anne; Ssebide, Benard J; Marra, Peter P

2015-03-01

Diseases transmitted between animals and people have made up more than 50% of emerging infectious diseases in humans over the last 60 years and have continued to arise in recent months. Yet, public health and animal disease surveillance programs continue to operate independently. Here, we assessed whether recent emerging zoonotic pathogens (n = 143) are known to cause morbidity or mortality in their animal host and if so, whether they were first detected with an animal morbidity/mortality event. We show that although sick or dead animals are often associated with these pathogens (52%), only 9% were first detected from an animal morbidity or mortality event prior to or concurrent with signs of illness in humans. We propose that an animal morbidity and mortality reporting program will improve detection and should be an essential component of early warning systems for zoonotic diseases. With the use of widespread low-cost technology, such a program could engage both the public and professionals and be easily tested and further incorporated as part of surveillance efforts by public health officials.

Predictors of in-hospital mortality in a cohort of elderly Egyptian patients with acute upper gastrointestinal bleeding.

PubMed

Elsebaey, Mohamed A; Elashry, Heba; Elbedewy, Tamer A; Elhadidy, Ahmed A; Esheba, Noha E; Ezat, Sherif; Negm, Manal Saad; Abo-Amer, Yousry Esam-Eldin; Abgeegy, Mohamed El; Elsergany, Heba Fadl; Mansour, Loai; Abd-Elsalam, Sherief

2018-04-01

Acute upper gastrointestinal bleeding (UGIB) affects large number of elderly with high rates of morbidity and mortality. Early identification and management of the factors predicting in-hospital mortality might decrease mortality. This study was conducted to identify the causes of acute UGIB and the predictors of in-hospital mortality in elderly Egyptian patients.286 elderly patients with acute UGIB were divided into: bleeding variceal group (161 patients) and bleeding nonvariceal group (125 patients). Patients' monitoring was done during hospitalization to identify the risk factors that might predict in-hospital mortality in elderly.Variceal bleeding was the most common cause of acute UGIB in elderly Egyptian patients. In-hospital mortality rate was 8.74%. Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding were the predictors of in-hospital mortality.Increasing age, hemodynamic instability at presentation, co-morbidities (especially liver cirrhosis associated with other co-morbidity) and failure to control bleeding should be considered when triaging those patients for immediate resuscitation, close observation, and early treatment.

The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates.

PubMed

Oatley, H K; Blencowe, H; Lawn, J E

2016-05-01

Neonatal hypothermia is an important risk factor for mortality and morbidity, and is common even in temperate climates. We conducted a systematic review to determine whether plastic coverings, used immediately following delivery, were effective in reducing the incidence of mortality, hypothermia and morbidity. A total of 26 studies (2271 preterm and 1003 term neonates) were included. Meta-analyses were conducted as appropriate. Plastic wraps were associated with a reduction in hypothermia in preterm (⩽29 weeks; risk ratio (RR)=0.57; 95% confidence interval (CI) 0.46 to 0.71) and term neonates (RR=0.76; 95% CI 0.60 to 0.96). No significant reduction in neonatal mortality or morbidity was found; however, the studies were underpowered for these outcomes. For neonates, especially preterm, plastic wraps combined with other environmental heat sources are effective in reducing hypothermia during stabilization and transfer within hospital. Further research is needed to quantify the effects on mortality or morbidity, and investigate the use of plastic coverings outside hospital settings or without additional heat sources.

Questionable validity of left ventricular hypertrophy cutoff values in morbidly and super-morbidly obese patients.

PubMed

Domienik-Karłowicz, Justyna; Rymarczyk, Zuzanna; Lisik, Wojciech; Kurnicka, Katarzyna; Ciurzyński, Michał; Bielecki, Maksymilian; Kosieradzki, Maciej; Pruszczyk, Piotr

2018-06-17

Current diagnostic ECG criteria of left ventricular hypertrophy in obese patients are still lacking. To assess the current ECG diagnostic criteria of LVH, and to validate our previously proposed criteria in a group of patients with morbid obesity. A group of consecutive 429 obese patients (MOP) with BMI of at least 35 kg/m 2 (mean age 38.6 ± 8.9 years, BMI 48.7 ± 9.0 kg/m 2 ; 323 females, 106 males) were included. The diagnosis of LVH in MOPs was confirmed only by RaVL of 7.5 mm, Cornell index of 12.5 mm; Cornell index × QRS duration of 1,125 mm × ms and Romhilt-Estes score of 1. None of the criteria proposed to date is appropriate in super-morbidly obese patients. Our study confirmed that none of the currently used voltage-based ECG criteria is appropriate for diagnosing LVH in morbidly obese patients. Further studies are required. © 2018 Wiley Periodicals, Inc.

The effect of coverings, including plastic bags and wraps, on mortality and morbidity in preterm and full-term neonates

PubMed Central

Oatley, H K; Blencowe, H; Lawn, J E

2016-01-01

Neonatal hypothermia is an important risk factor for mortality and morbidity, and is common even in temperate climates. We conducted a systematic review to determine whether plastic coverings, used immediately following delivery, were effective in reducing the incidence of mortality, hypothermia and morbidity. A total of 26 studies (2271 preterm and 1003 term neonates) were included. Meta-analyses were conducted as appropriate. Plastic wraps were associated with a reduction in hypothermia in preterm (⩽29 weeks; risk ratio (RR)=0.57; 95% confidence interval (CI) 0.46 to 0.71) and term neonates (RR=0.76; 95% CI 0.60 to 0.96). No significant reduction in neonatal mortality or morbidity was found; however, the studies were underpowered for these outcomes. For neonates, especially preterm, plastic wraps combined with other environmental heat sources are effective in reducing hypothermia during stabilization and transfer within hospital. Further research is needed to quantify the effects on mortality or morbidity, and investigate the use of plastic coverings outside hospital settings or without additional heat sources. PMID:27109095

Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders.

PubMed

McCarthy, Jane; Hemmings, Colin; Kravariti, Eugenia; Dworzynski, Katharina; Holt, Geraldine; Bouras, Nick; Tsakanikos, Elias

2010-01-01

We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N=124) as compared to adults with ID only (N=562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD. Copyright 2009 Elsevier Ltd. All rights reserved.

Co-morbidity and age-related prevalence of psoriasis: Analysis of health insurance data in Germany.

PubMed

Augustin, Matthias; Reich, Kristian; Glaeske, Gerd; Schaefer, Ines; Radtke, Marc

2010-03-01

Epidemiological studies indicate an increased risk of co-morbidities and an association with other inflammatory diseases in psoriasis. However, most analyses have been performed on small samples of patients. The aim of this study was to evaluate the prevalence of co-morbidities in psoriasis based on a large set of health insurance data. The database of 1.3 million patients in a German nationwide statutory health insurance scheme was analysed. Data-sets of patients with confirmed psoriasis were extracted and analysed for co-morbidities. Of 1,344,071 subjects, 33,981 had a diagnosis of psoriasis (prevalence 2.5%). Metabolic syndrome was 2.9-fold more frequent among these patients. The most common diagnoses were arterial hypertension (35.6% in psoriasis vs. 20.6% in controls) and hyperlipidaemia (29.9% vs. 17.1%). The frequencies of rheumatoid arthritis (prevalence ratio (PR) 3.8), Crohn's disease (PR 2.1) and ulcerative colitis (PR 2.0) were also increased among patients with psoriasis. In conclusion, psoriasis is associated with significant co-morbidities that imply an elevated risk of severe complications.

Perinatal Depression – the Fourth Inflammatory Morbidity of Pregnancy? Theory and Literature Review

PubMed Central

Osborne, Lauren M.; Monk, Catherine

2015-01-01

Perinatal depression is one of the leading causes of maternal morbidity and mortality. The biological etiology of this disorder remains in question, despite considerable research into the contributions of hormonal imbalance, the role of monoamines, and dysregulation of the HPA axis. Because inflammation is known to be associated with major depression in men and non-perinatal women as well as with other important morbidities of pregnancy (such as preeclampsia, preterm birth, and gestational diabetes), and because these morbidities may correlate with perinatal depression, inflammation may be a common physiological pathway that can also help explain perinatal depression. In this paper, we review the theoretical background of inflammation in perinatal depression and then review the literature concerning immune and inflammatory factors in the etiology and course of perinatal depression. We close with recommendations for future studies in this still relatively unexplored area. Identification and understanding of a common pathophysiology between other pregnancy morbidities and perinatal depression would link physical and mental well-being, likely leading to better treatment and prevention. PMID:23608136

‘Everything’s from the inside out with PCOS’: Exploring women’s experiences of living with polycystic ovary syndrome and co-morbidities through Skype™ interviews

PubMed Central

Sheffield, David; Knibb, Rebecca C

2015-01-01

Polycystic ovary syndrome is an endocrine disorder affecting 1 in 10 women. Women with polycystic ovary syndrome can experience co-morbidities, including depressive symptoms. This research explores the experience of living with polycystic ovary syndrome and co-morbidities. Totally, 10 participants with polycystic ovary syndrome took part in Skype™ interviews and analysed using thematic analysis. Four themes emerged from the data: change (to life plans and changing nature of condition); support (healthcare professionals, education and relationships); co-morbidities (living with other conditions and depression, self-harm and suicidal ideation) and identity (feminine identity and us and them). The findings highlight the need for screening of women with polycystic ovary syndrome for depressive disorders. PMID:28070371

Morbidly Adherent Placenta: Interprofessional Management Strategies for the Intrapartum Period.

PubMed

Baird, Suzanne McMurtry; Troiano, Nan H; Kennedy, Margaret Betsy Babb

"Morbidly adherent placenta" is a term that describes the continuum of placenta accreta, increta, and percreta. The incidence of this type of abnormal placentation has increased significantly over recent decades. The reason is probably multifactorial but, partly, because of factors such as the increasing number of cesarean births. Women at greatest risk are those who have myometrial damage caused by a previous cesarean birth, with either anterior or posterior placenta previa overlying the uterine scar. This condition poses significant risks of morbidity and/or mortality to the pregnant woman and her fetus. A multidisciplinary approach to care throughout pregnancy is essential. This article describes the classification of morbidly adherent placenta, risk factors, methods of diagnosis, potential maternal and fetal complications, and intrapartum clinical management strategies to optimize outcomes.

Antisocial personality disorder and anxiety disorder: a diagnostic variant?

PubMed

Coid, Jeremy; Ullrich, Simone

2010-06-01

Antisocial personality disorder (ASPD) with co-morbid anxiety disorder may be a variant of ASPD with different etiology and treatment requirements. We investigated diagnostic co-morbidity, ASPD criteria, and anxiety/affective symptoms of ASPD/anxiety disorder. Weighted analyses were carried out using survey data from a representative British household sample. ASPD/anxiety disorder demonstrated differing patterns of antisocial criteria, co-morbidity with clinical syndromes, psychotic symptoms, and other personality disorders compared to ASPD alone. ASPD criteria demonstrated specific associations with CIS-R scores of anxiety and affective symptoms. Findings suggest ASPD/anxiety disorder is a variant of ASPD, determined by symptoms of anxiety. Although co-morbid anxiety and affective symptoms are the same as in anxiety disorder alone, associations with psychotic symptoms require further investigation. Copyright 2010 Elsevier Ltd. All rights reserved.

Medical Surveillance Monthly Report (MSMR). Volume 12, Number 9, December 2006

DTIC Science & Technology

2006-12-01

497-504. 3. State-specific prevalence of obesity among adults – US, 2005. Morbidity and Mortality Weekly Report (MMWR) 2006 Sep 15;55(36):985-8. 4...2003. Morbidity and Mortality Weekly Report 2005 (January 21); 54(02);36-39. 1998 1999 2000 2001 2002 2003 2004 2005 2006 Cases Cases Cases Cases Cases...Environ Med 2002 Aug;73(8):812-6. 8. White MR, McNally MS. Morbidity and mortality in U.S. Navy personnel from exposures to hazardous materials, 1974

'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: "inserting new ideas into a timeless wine skin".

PubMed

Mwaniki, Michael K; Baya, Evaline J; Mwangi-Powell, Faith; Sidebotham, Peter

2016-01-25

Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS.

An Introduction to a Head and Neck Cancer-Specific Frailty Index and Its Clinical Implications in Elderly Patients: A Prospective Observational Study Focusing on Respiratory and Swallowing Functions

PubMed Central

Kwon, Minsu; Kim, Shin-Ae; Lee, Sang-Wook; Kim, Sung-Bae; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

2016-01-01

Introduction. Frailty refers to a decreased physiologic reserve in geriatric patients and its importance in terms of treatment planning and outcome prediction has been emphasized in oncologic practices for older patients with cancer. We investigated the clinical implications of a head and neck cancer (HNC)-specific frailty index suggested by prospective clinical and functional evaluations of HNC patients. Materials and Methods. We analyzed data on 165 elderly patients with HNC who were prospectively enrolled in our hospital from 2010 to 2013. Pretreatment functional evaluations were performed according to all comprehensive geriatric assessment (CGA) domains. We additionally evaluated the patients’ respiratory and swallowing functions using pulmonary function tests, voice handicap index (VHI), MD Anderson Dysphagia Inventory (MDADI), and other associated tests. Factors affecting the 2-year morbidity and mortality were also analyzed. Results. Respiratory and swallowing problems were major causes of 2-year morbidity. Pretreatment performance status, VHI ≥8, MDADI <70, dental problems, and chemotherapy were significantly associated with early morbidity and mortality (all p < .05). CGA-assessed frailty was found in 72 patients (43.6%) and was significantly associated with 2-year mortality (p = .027) but not with morbidity (p = .716). The high-risk group according to our new HNC-specific frailty index that included functional evaluations of respiration and swallowing showed significantly higher 2-year morbidity (p = .043) and mortality (p < .001). Conclusion. Pretreatment functional disabilities related to respiration and swallowing were significantly associated with early morbidity and mortality. The suggested index would be more useful for assessing frailty in elderly HNC patients. Implications for Practice: This study is the first report in terms of suggesting a new frailty index focusing on respiratory and swallowing functions in elderly patients with head and neck cancer. This study shows that functional disabilities associated with respiration and swallowing significantly affected early morbidity and mortality in these elderly patients. The head and neck cancer-specific frailty index described in this report, which includes functional evaluations of respiration and swallowing, significantly predicted both early morbidity and mortality. PMID:27368883

Perinatal and maternal morbidity and mortality after attempted operative vaginal delivery at midpelvic station

PubMed Central

Muraca, Giulia M.; Sabr, Yasser; Lisonkova, Sarka; Skoll, Amanda; Brant, Rollin; Cundiff, Geoffrey W.; Joseph, K.S.

2017-01-01

BACKGROUND: Increased use of operative vaginal delivery (i.e., forceps or vacuum application), of which 20% occurs at midpelvic station, has been advocated to reduce the rate of cesarean delivery. We aimed to quantify severe perinatal and maternal morbidity and mortality associated with attempted midpelvic operative vaginal delivery. METHODS: We studied all term singleton deliveries in Canada between 2003 and 2013, by attempted midpelvic operative vaginal or cesarean delivery with labour (with and without prolonged second stage). The primary outcomes were composite severe perinatal morbidity and mortality (e.g., convulsions, assisted ventilation, severe birth trauma and perinatal death), and composite severe maternal morbidity and mortality (e.g., severe postpartum hemorrhage, shock, sepsis, cardiac complications, acute renal failure and death). RESULTS: The study population included 187 234 deliveries. Among women with dystocia and prolonged second stage of labour, midpelvic operative vaginal delivery was associated with higher rates of severe perinatal morbidity and mortality compared with cesarean delivery (forceps, adjusted odds ratio [AOR] 1.81, 95% confidence interval [CI] 1.24 to 2.64; vacuum, AOR 1.81, 95% CI 1.17 to 2.80; sequential instruments, AOR 3.19, 95% CI 1.73 to 5.88), especially with higher rates of severe birth trauma. Rates of severe maternal morbidity and mortality were not significantly different after operative vaginal delivery, although rates of obstetric trauma were higher (forceps, AOR 4.51, 95% CI 4.04 to 5.02; vacuum, AOR 2.70, 95% CI 2.35 to 3.09; sequential instruments, AOR 4.24, 95% CI 3.46 to 5.19). Among women with fetal distress, similar associations were seen for severe birth trauma and obstetric trauma, although vacuum was associated with lower rates of severe maternal morbidity and mortality (AOR 0.52, 95% CI 0.33 to 0.80). Associations tended to be stronger among women without a prolonged second stage. INTERPRETATION: Midpelvic operative vaginal delivery is associated with higher rates of severe birth trauma and obstetric trauma, whereas overall rates of severe perinatal and maternal morbidity and mortality vary by indication and operative instrument. PMID:28584040

Trends in the Prevalence of Morbid and Severe Obesity in Australian Children Aged 7-15 Years, 1985-2012

PubMed Central

Garnett, Sarah P.; Baur, Louise A.; Jones, Aimee M. D.; Hardy, Louise L.

2016-01-01

Objective Children with severe obesity have greater risk of adverse health outcomes. The purpose of this study was to assess trends in the prevalence of morbid and severe obesity in Australian children between 1985 and 2012. Methods Secondary analysis of four national Australian cross-sectional surveys of measured height/weight in 7–15 year olds: Australian Health and Fitness Survey 1985 (n = 8,486), National Nutrition Survey 1995 (n = 1,541), the National Children’s Nutrition and Physical Activity Survey 2007 (n = 2,585) and the National Health Survey 2012 (n = 2,940). International Obesity Taskforce cut-point was used for morbid obesity (equivalent to a BMI ≥35kg/m2 at age 18 years). Severe obesity class 2 was defined as BMI ≥120% and <140% of the 95th percentile of the CDC 2000 growth charts or a BMI ≥35 and <40, and severe obesity class 3 as BMI ≥140% of the 95th percentile or a BMI ≥40. Results Between 1985 and 2012 the prevalence of morbid obesity increased from 0.2% to 1.8%, class 2 severe obesity from 0.3% to 2.0%, and class 3 from 0.1% to 0.5%. Children with morbid obesity represented 11.3% of children with obesity in 1985 and increased to 22.5% in 2012 (P = 0.005). Children with severe obesity represented 19.3% of children with obesity in 1985 and increased to 32.0% in 2012 (P = 0.016). The greatest increase was observed between 1995 and 2007. The proportion of children who were classified as morbidly or severely obese was not significantly different between 2007 and 2012, nor was it significantly different between age and sex groups. Conclusion Prevalence of morbid and severe obesity among children is low, but has significantly increased between 1985 and 2012. In contrast to overweight and obese children, children with morbid obesity require tertiary intervention. Failure to treat these children will have significant implications for the individual child and community. PMID:27171503

Health service provider education and/or training in infant male circumcision to improve short- and long-term morbidity outcomes: protocol for systematic review.

PubMed

Gyan, Thomas; Strobel, Natalie; McAuley, Kimberley; Shannon, Caitlin; Newton, Sam; Tawiah-Agyemang, Charlotte; Amenga-Etego, Seeba; Owusu-Agyei, Seth; Forbes, David; Edmond, Karen

2016-03-01

There has been an expansion of circumcision services in Africa as part of a long-term HIV prevention strategy. However, the effect of infant male circumcision on morbidity and mortality still remains unclear. Acute morbidities associated with circumcision include pain, bleeding, swelling, infection, tetanus or inadequate skin removal. Scale-up of circumcision services could lead to a rise in these associated morbidities that could have significant impact on health service delivery and the safety of infants. Multidisciplinary training programmes have been developed to improve skills of health service providers, but very little is known about the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes. This review aims to evaluate the effectiveness of health service provider education and/or training for infant male circumcision on short- and long-term morbidity outcomes. The review will include studies comparing health service providers who have received education and/or training to improve their skills for infant male circumcision with those who have not received education and/or training. Randomised controlled trials (RCTs) and cluster RCTs will be included. The outcomes of interest are short-term morbidities of the male infant including pain, infection, tetanus, bleeding, excess skin removal, glans amputation and fistula. Long-term morbidities include urinary tract infection (UTI), HIV infection and abnormalities of urination. Databases such as MEDLINE (OVID), PsycINFO (OVID), EMBASE (OVID), CINAHL, Cochrane Library (including CENTRAL and DARE), WHO databases and reference list of papers will be searched for relevant articles. Study selection, data extraction and synthesis and risk of bias assessment using the Cochrane risk of bias assessment tool will be conducted. We will calculate the pooled estimates of the difference in means and risk ratios using random effects models. If insufficient data are available, we will present results descriptively. This review appears to be the first to be conducted in this area. The findings will have important implications for infant male circumcision programmes and policy. PROSPERO CRD42015029345.

State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality

PubMed Central

Jarlenski, Marian; Hutcheon, Jennifer A; Bodnar, Lisa M; Simhan, Hyagriv N

2017-01-01

Objective To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the U.S. Methods We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,016,845). State-level Medicaid coverage of medically necessary abortion for each year was determined from Guttmacher Institute reports. We used multivariable logistic regression to examine the association between state Medicaid coverage of abortion and severe maternal morbidity and in-hospital maternal mortality, overall and stratified by payer. Results The unadjusted rate of severe maternal morbidity was lower among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, relative to those in states without such coverage (62.4 vs. 69.3 per 10,000). Among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, there were 8.5 per 10,000 fewer cases (95% CI 4.0,16.5) of severe maternal morbidity in adjusted analyses, relative to those in states without such Medicaid coverage. Similarly, there were 10.3 per 10,000 fewer cases (95% CI 3.5,17.2) of severe maternal morbidity in adjusted analyses among private insurance-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, relative to those in states without such Medicaid coverage. The adjusted rate of in-hospital maternal mortality was not different for Medicaid-paid hospitalizations in states with and without Medicaid coverage of medically necessary abortion (9.2 and 9.0 per 100,000, respectively), nor for private-insurance paid hospitalizations (5.6 and 6.1 per 100,000, respectively). Conclusions State Medicaid coverage of medically necessary abortion was associated with an average 16% decreased risk of severe maternal morbidity. An association between state Medicaid coverage of medically necessary abortion and a reduced risk of severe maternal morbidity was observed in women covered by both Medicaid and private insurance. Results suggest that Medicaid coverage of medically necessary abortion is not harmful to maternal health. PMID:28383380

State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality.

PubMed

Jarlenski, Marian; Hutcheon, Jennifer A; Bodnar, Lisa M; Simhan, Hyagriv N

2017-05-01

To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the United States. We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,016,845). State-level Medicaid coverage of medically necessary abortion for each year was determined from Guttmacher Institute reports. We used multivariable logistic regression to examine the association between state Medicaid coverage of abortion and severe maternal morbidity and in-hospital maternal mortality, overall and stratified by payer. The unadjusted rate of severe maternal morbidity was lower among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such coverage (62.4 compared with 69.3 per 10,000). Among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, there were 8.5 per 10,000 fewer cases (95% confidence interval [CI] 4.0-16.5) of severe maternal morbidity in adjusted analyses relative to those in states without such Medicaid coverage. Similarly, there were 10.3 per 10,000 fewer cases (95% CI 3.5-17.2) of severe maternal morbidity in adjusted analyses among private insurance-paid hospitalizations in states with Medicaid coverage of medically necessary abortion relative to those in states without such Medicaid coverage. The adjusted rate of in-hospital maternal mortality was not different for Medicaid-paid hospitalizations in states with and without Medicaid coverage of medically necessary abortion (9.2 and 9.0 per 100,000, respectively) nor for private insurance-paid hospitalizations (5.6 and 6.1 per 100,000, respectively). State Medicaid coverage of medically necessary abortion was associated with an average 16% decreased risk of severe maternal morbidity. An association between state Medicaid coverage of medically necessary abortion and a reduced risk of severe maternal morbidity was observed in women covered by both Medicaid and private insurance. Results suggest that Medicaid coverage of medically necessary abortion is not harmful to maternal health.

Reoperative surgery: a critical risk factor for complications inadequately captured by operative reporting and coding of lysis of adhesions.

PubMed

Aloia, Thomas A; Cooper, Amanda; Shi, Weiming; Vauthey, Jean-Nicolas; Lee, Jeffrey E

2014-07-01

Reoperative surgery is suspected, but not proven, to increase postoperative complication rates. In the absence of a specific definition for reoperative surgery, the American College of Surgeons NSQIP has proposed using procedural coding for lysis of adhesions (LOA) as a surrogate for reoperative surgery to risk adjust hospitals. We hypothesized that coding of reoperative surgery will be associated with worse 30-day outcomes and, for abdominal procedures, will be more accurate than operative dictation and coding of "lysis of adhesions." Reoperative surgery was categorized at the time of data abstraction from February 2012 to December 2012 for all NSQIP cases collected at a single institution by independent surgical clinical reviewers. Reoperative surgery classification and coding of LOA were compared with each other and with 30-day outcomes. The setting was a tertiary cancer center, multispecialty NSQIP model. During the study period, 1,289 operations were classified as nonreoperative (n = 793), regionally reoperative (n = 39; prior surgery in an adjacent area of current operation), or locally reoperative (n = 457; prior surgery at same site or organ). In the multispecialty cohort, the non-risk-adjusted rates of overall 30-day morbidity, serious morbidity, and mortality were 21.5%, 17.7%, and 0.5%. Compared with nonreoperative surgery (overall 30-day morbidity 16.8%, serious morbidity 13.9%, and mortality .38%), both regionally reoperative surgery (overall 30-day morbidity 30.8%, serious morbidity 28.2%, and mortality 2.5%) and locally reoperative surgery (overall 30-day morbidity 28.9%, serious morbidity 23.4%, and mortality .66%) were associated with worse outcomes (p < 0.001). One hundred ninety-nine of the 327 gastrointestinal/laparotomy cases were recorded as reoperative, but only of 20 of these were CPT coded as LOA (sensitivity = 10%). Reoperative surgery is frequent, increases the risk of complications, and can be captured. Operative LOA coding vastly under reports reoperative surgery and, therefore, is not an adequate surrogate for this important risk factor. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Licit prescription drug use in a Swedish population according to age, gender and socioeconomic status after adjusting for level of multi-morbidity

PubMed Central

2012-01-01

Background There is a great variability in licit prescription drug use in the population and among patients. Factors other than purely medical ones have proven to be of importance for the prescribing of licit drugs. For example, individuals with a high age, female gender and low socioeconomic status are more likely to use licit prescription drugs. However, these results have not been adjusted for multi-morbidity level. In this study we investigate the odds of using licit prescription drugs among individuals in the population and the rate of licit prescription drug use among patients depending on gender, age and socioeconomic status after adjustment for multi-morbidity level. Methods The study was carried out on the total population aged 20 years or older in Östergötland county with about 400 000 inhabitants in year 2006. The Johns Hopkins ACG Case-mix was used as a proxy for the individual level of multi-morbidity in the population to which we have related the odds ratio for individuals and incidence rate ratio (IRR) for patients of using licit prescription drugs, defined daily doses (DDDs) and total costs of licit prescription drugs after adjusting for age, gender and socioeconomic factors (educational and income level). Results After adjustment for multi-morbidity level male individuals had less than half the odds of using licit prescription drugs (OR 0.41 (95% CI 0.40-0.42)) compared to female individuals. Among the patients, males had higher total costs (IRR 1.14 (95% CI 1.13-1.15)). Individuals above 80 years had nine times the odds of using licit prescription drugs (OR 9.09 (95% CI 8.33-10.00)) despite adjustment for multi-morbidity. Patients in the highest education and income level had the lowest DDDs (IRR 0.78 (95% CI 0.76-0.80), IRR 0.73 (95% CI 0.71-0.74)) after adjustment for multi-morbidity level. Conclusions This paper shows that there is a great variability in licit prescription drug use associated with gender, age and socioeconomic status, which is not dependent on level of multi-morbidity. PMID:22846625

Manifestation Pattern of Early-Late Vaginal Morbidity After Definitive Radiation (Chemo)Therapy and Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer: An Analysis From the EMBRACE Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kirchheiner, Kathrin, E-mail: kathrin.kirchheiner@meduniwien.ac.at; Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna; Nout, Remi A.

2014-05-01

Background and Purpose: Brachytherapy in the treatment of locally advanced cervical cancer has changed substantially because of the introduction of combined intracavitary/interstitial applicators and an adaptive target concept, which is the focus of the prospective, multi-institutional EMBRACE study ( (www.embracestudy.dk)) on image-guided adaptive brachytherapy (IGABT). So far, little has been reported about the development of early to late vaginal morbidity in the frame of IGABT. Therefore, the aim of the present EMBRACE analysis was to evaluate the manifestation pattern of vaginal morbidity during the first 2 years of follow-up. Methods and Materials: In total, 588 patients with a median follow-up timemore » of 15 months and information on vaginal morbidity were included. Morbidity was prospectively assessed at baseline, every 3 months during the first year, and every 6 months in the second year according to the Common Terminology Criteria for Adverse Events, version 3, regarding vaginal stenosis, dryness, mucositis, bleeding, fistula, and other symptoms. Crude incidence rates, actuarial probabilities, and prevalence rates were analyzed. Results: At 2 years, the actuarial probability of severe vaginal morbidity (grade ≥3) was 3.6%. However, mild and moderate vaginal symptoms were still pronounced (grade ≥1, 89%; grade ≥2, 29%), of which the majority developed within 6 months. Stenosis was most frequently observed, followed by vaginal dryness. Vaginal bleeding and mucositis were mainly mild and infrequently reported. Conclusion: Severe vaginal morbidity within the first 2 years after definitive radiation (chemo)therapy including IGABT with intracavitary/interstitial techniques for locally advanced cervical cancer is limited and is significantly less than has been reported from earlier studies. Thus, the new adaptive target concept seems to be a safe treatment with regard to the vagina being an organ at risk. However, mild to moderate vaginal morbidity is still pronounced with currently applied IGABT, and it needs further attention.« less

Effectiveness of Using Cellular Phones to Transmit Real-Time Shelter Morbidity Surveillance Data After Hurricane Sandy, New Jersey, October to November, 2012.

PubMed

Shumate, Alice M; Yard, Ellen E; Casey-Lockyer, Mary; Apostolou, Andria; Chan, Miranda; Tan, Christina; Noe, Rebecca S; Wolkin, Amy F

2016-06-01

Timely morbidity surveillance of sheltered populations is crucial for identifying and addressing their immediate needs, and accurate surveillance allows us to better prepare for future disasters. However, disasters often create travel and communication challenges that complicate the collection and transmission of surveillance data. We describe a surveillance project conducted in New Jersey shelters after Hurricane Sandy, which occurred in November 2012, that successfully used cellular phones for remote real-time reporting. This project demonstrated that, when supported with just-in-time morbidity surveillance training, cellular phone reporting was a successful, sustainable, and less labor-intensive methodology than in-person shelter visits to capture morbidity data from multiple locations and opened a two-way communication channel with shelters. (Disaster Med Public Health Preparedness. 2015;10:525-528).

Reducing the burden of maternal and child morbidity and mortality in the Eastern Mediterranean Region? Yes, we can.

PubMed

Fathalla, Mahmoud Fahmy

2014-02-11

Maternal and child morbidity and mortality are a major public health, development and human rights challenge globally and in the WHO Eastern Mediterranean Region. The Region is diverse, with high-, middle- and low- income countries, many suffering from political instability, conflicts and other complex development challenges. Although progress has been made towards Millennium Development Goals 4 and 5, it has been uneven both between and within countries. This paper makes an analysis of the strengths, weaknesses, opportunities and threats to improving maternal and child mortality and morbidity with a focus on the Region. In answer to the question whether we can reduce the burden of maternal and child morbidity and mortality in the Region: yes, we can. However, commitment and collaboration are needed at the country, regional and international levels.

[Tuberculosis and diabetes co-morbidity: an unresolved problem].

PubMed

Ugarte-Gil, César; Moore, David A J

2014-01-01

Co-morbidity between tuberculosis and diabetes has been described since the early 20th century. In developed countries, where there has been a decrease of infectious diseases with an increase of non-communicable diseases, as well as those countries who still have a high prevalence of infectious diseases but an increase of non-communicable diseases, it is observed that the prevalence of co-morbidity between tuberculosis and diabetes is increasing, making clinical management and control at the public health level a new challenge for health systems. This review aims to show the current available evidence that can inform research lines being developed to understand the problem. In countries like Peru, where there is an epidemiological transition, further research could allow us to understand and describe in a better way the characteristics and impact of this co-morbidity.

Sociodemographic status and self-reported BMI-related morbidity in Koreans.

PubMed

Lee, Kayoung

2010-03-01

This study examined whether the relationship between body mass index (BMI) and the morbidity of chronic diseases differs by marital status, education, and income level. From a nationally representative sample of 5,526 adults from the third Korean National Health and Nutrition Examination Survey (2005), data regarding measured height and weight to classify BMI category (< 23, 23-24.9, > or = 25), self-reported sociodemographics (marital status, education, income, age, sex, and residence area), health behaviors (smoking, alcohol use, exercise, sleep, stress perception, and depression), and morbidity from at least one chronic disease were collected. Education, income, and marital status were significantly associated with morbidity regardless of adjustment for BMI and health behaviors. After adjusting for BMI, other sociodemographic factors, and health behaviors, the odds ratio (95% confidence interval) of morbidity was 2.9 (2.4-3.7) for those in the married group and 2.9 (2.1-4.0) for those in the separated/divorced/widowed group, 2.0 (1.6-2.5) for those in the lowest education group, and 1.3 (1.2-1.6) for those in the lowest income group. When the BMI category and sociodemographic factors were combined, the odds ratios were elevated for those in the combination group with higher BMI and lower sociodemographic position. Korean subjects who were married, in the lowest education group, or in the lowest income level had a higher risk of morbidity in relation to BMI.

Differences in the management of hypertension, diabetes mellitus and dyslipidemia between obesity classes.

PubMed

Martínez-St John, D R J; Palazón-Bru, A; Gil-Guillén, V F; Sepehri, A; Navarro-Cremades, F; Orozco-Beltrán, D; Carratalá-Munuera, C; Cortés, E; Rizo-Baeza, M M

2016-01-01

We did not find any paper that assessed clinical inertia in obese patients. Therefore, no paper has compared the clinical inertia rates between morbidly and nonmorbidly obese patients. A cross-sectional observational study was carried out. We analysed 8687 obese patients ⩾40 years of age who attended their health-care center for a checkup as part of a preventive program. The outcome was morbid obesity. Secondary variables were as follows: failure in the management of high blood pressure (HBP), high blood cholesterol (HBC) and high fasting blood glucose (HFBG); gender; personal history of hypertension, dyslipidemia, diabetes, smoking and cardiovascular disease; and age (years). We analysed the association between failures and morbid obesity by calculating the adjusted odds ratio (OR). Of 8687 obese patients, 421 had morbid obesity (4.8%, 95% confidence interval (CI): 4.4-5.3%). The prevalence rates for failures were as follows: HBP, 34.7%; HBC, 35.2%; and HFBG, 12.4%. Associated factors with morbid obesity related with failures were as follows: failure in the management of HBP (OR=1.42, 95% CI: 1.15-1.74, P=0.001); failure in the management of HBC (OR=0.73, 95% CI: 0.58-0.91, P=0.004); and failure in the management of HFBG (OR=2.24, 95% CI: 1.66-3.03, P<0.001). Morbidly obese patients faced worse management for HBP and HFBG, and better management for HBC. It would be interesting to integrate alarm systems to avoid this problem.

Psychiatric morbidity in asymptomatic human immunodeficiency virus patients.

PubMed

Chauhan, V S; Chaudhury, Suprakash; Sudarsanan, S; Srivastava, Kalpana

2013-07-01

Psychiatric morbidity in human immunodeficiency virus (HIV) patients is being studied all over the world. There is paucity of Indian literature particularly in asymptomatic HIV individuals. The aim of the following study is to establish the prevalence and the determinants of psychiatric morbidity in asymptomatic HIV patients. A cross-sectional study was undertaken to assess psychiatric morbidity as per ICD-10 dacryocystorhinostomy criteria in 100 consecutive asymptomatic seropositive HIV patients and an equal number of age, sex, education, economic and marital status matched HIV seronegative control. All subjects were assessed with the general health questionnaire (GHQ), mini mental status examination, hospital anxiety and depression scale (HADS) and sensation seeking scale (SSS) and the scores were analyzed statistically. Asymptomatic HIV positive patients had significantly higher GHQ caseness and depression but not anxiety on HADS as compared to HIV seronegative controls. On SSS asymptomatic HIV seropositive subjects showed significant higher scores in thrill and adventure seeking, experience seeking and boredom susceptibility as compared to controls. HIV seropositive patients had significantly higher incidence of total psychiatric morbidity. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. Psychiatric morbidity is higher in asymptomatic HIV patients when compared to HIV seronegative controls. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. High sensation seeking and substance abuse found in HIV seropositive patients may play a vital role in engaging in high-risk behavior resulting in this dreaded illness.

Morbid obesity and the transition from welfare to work.

PubMed

Cawley, John; Danziger, Sheldon

2005-01-01

This paper utilizes a rich longitudinal data set--the Women's Employment Study (WES)--to investigate whether obesity, which is common among women of low socioeconomic status, is a barrier to employment and earnings for current and former welfare recipients. We find that former welfare recipients who are both White and morbidly obese have been less successful in transitioning from welfare to work. These women are less likely to work at any survey wave, spend a greater percentage of months between waves receiving cash welfare, and have lower monthly earnings at each wave. The magnitude of the difference in labor market outcomes between the morbidly obese and those who are less heavy is in some cases similar in magnitude to the differences in these labor market outcomes between high school dropouts and graduates. In contrast, we find no such labor market differences associated with morbid obesity for African-American respondents. This paper documents the relationship between weight and labor market outcomes for the first time among the welfare population. In addition, it investigates whether the correlation for White females is due to unobserved heterogeneity. We find that after controlling for individual fixed effects, the point estimate of the correlation of morbid obesity and each of the labor market outcomes falls considerably and is no longer statistically significant. These results are consistent with unobserved heterogeneity causing the correlation between morbid obesity and labor market outcomes. Findings are similar after controlling for the respondent's mental and physical health.

Prognostic Factors in Peptic Ulcer Perforations: A Retrospective 14-Year Study

PubMed Central

Unver, Mutlu; Fırat, Özgür; Ünalp, Ömer Vedat; Uğuz, Alper; Gümüş, Tufan; Sezer, Taylan Özgür; Öztürk, Şafak; Yoldaş, Tayfun; Ersin, Sinan; Güler, Adem

2015-01-01

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study. PMID:26011220

Federal funding for reporting cases of HIV infection in the United States, 2006.

PubMed

Page, Matthew J; Harrison, Kathleen McDavid; Wei, Xiangming; Hall, H Irene

2010-01-01

The Centers for Disease Control and Prevention (CDC) provides funding for human immunodeficiency virus (HIV) surveillance in 65 areas (states, cities, and U.S. dependent areas). We determined the amount of CDC funding per reported case of HIV infection and examined factors associated with differences in funding per reported case across areas. We derived HIV data from the HIV/AIDS Reporting System (HARS) database. Budget numbers were based on award letters to health departments. We performed multivariate linear regression for all areas and for areas of low, moderate, and moderate-to-high morbidity. Mean funding per case reported was $1,520, $441, and $411 in areas of low, moderate, and moderate-to-high morbidity, respectively. In low morbidity areas, funding per case decreased as log total cases increased (p < 0.001). For moderate and moderate-to-high morbidity areas, funding per case fell as log total cases increased (p < 0.001), but increased in accordance with an area's population (p < 0.05) and the proportion of that population residing in an urban setting (p < 0.05). The models for low, moderate, and moderate-to-high morbidity predicted funding per case as $1490, $423, and $390, respectively. Economies of scale were evident. The amount of CDC core surveillance funding per case reported was significantly associated with the total number of cases in an area and, depending on morbidity, with total population and percentage of that population residing in an urban setting.

The Relationship of Hypochondriasis to Anxiety, Depressive, and Somatoform Disorders

PubMed Central

Scarella, Timothy M.; Laferton, Johannes A. C.; Ahern, David K.; Fallon, Brian A.; Barsky, Arthur

2015-01-01

Background Though the phenotype of anxiety about medical illness has long been recognized, there continues to be debate as to whether it is a distinct psychiatric disorder and, if so, to which diagnostic category it belongs. Our objective was to investigate the pattern of psychiatric co-morbidity in hypochondriasis and to assess the relationship of health anxiety to anxiety, depressive, and somatoform disorders. Methods Data were collected as part of a clinical trial on treatment methods for hypochondriasis. 194 participants meeting criteria for DSM-IV hypochondriasis were assessed by sociodemographic variables, results of structured diagnostic interviews, and validated instruments for assessing various symptom dimensions of psychopathology. Results The majority of individuals with hypochondriasis had co-morbid psychiatric illness; the mean number of co-morbid diagnoses was 1.4, and 35.1% had hypochondriasis as their only diagnosis. Participants were more likely to have only co-morbid anxiety disorders than only co-morbid depressive or somatoform disorders. Multiple regression analysis of continuous measures of symptoms revealed the strongest correlation of health anxiety with anxiety symptoms, and a weaker correlation with somatoform symptoms; in multiple regression analysis, there was no correlation between health anxiety and depressive symptoms. Conclusion Our findings suggest that the entity of health anxiety (Hypochondriasis in DSM-IV, Illness Anxiety Disorder in DSM-5) is a clinical syndrome distinct from other psychiatric disorders. Analysis of co-morbidity patterns and continuous measures of symptoms suggest its appropriate classification is with anxiety rather than somatoform or mood disorders. PMID:26785798

Prognostic factors in peptic ulcer perforations: a retrospective 14-year study.

PubMed

Unver, Mutlu; Fırat, Özgür; Ünalp, Ömer Vedat; Uğuz, Alper; Gümüş, Tufan; Sezer, Taylan Özgür; Öztürk, Şafak; Yoldaş, Tayfun; Ersin, Sinan; Güler, Adem

2015-05-01

Regarding the complications of peptic ulcer, a perforation remains the most important fatal complication. The aim of our retrospective study was to determine relations between postoperative morbidity and comorbid disease or perioperative risk factors in perforated peptic ulcer. In total, 239 patients who underwent emergency surgery for perforated peptic ulcer in Ege University General Surgery Department, between June 1999 and May 2013 were included in this study. The clinical data concerning the patient characteristics, operative methods, and complications were collected retrospectively. One hundred seventy-five of the 239 patients were male (73.2%) and 64 were female (26.8%). Mean American Society of Anesthesiologists (ASA) score was 1 in the patients without morbidity, but mean ASA score was 3 in the morbidity and mortality groups. Primary suture and omentoplasty was the selected procedure in 228 of the patients. Eleven patients underwent resection. In total, 105 patients (43.9%) had comorbidities. Thirty-seven patients (67.3%) in the morbidity group had comorbid diseases. Thirteen (92.9%) patients in the mortality group had comorbid diseases. Perforation as a complication of peptic ulcer disease still remains among the frequent indications of urgent abdominal surgery. Among the analyzed parameters, age, ASA score, and having comorbid disease were found to have an effect on both mortality and morbidity. The controversial subject in the present study is regarding the duration of symptoms. The duration of symptoms had no effect on mortality nor morbidity in our study.

Prevalence of psychiatric morbidity at Mobile Health Clinic in an urban community in North India.

PubMed

Salve, Harshal; Goswami, Kiran; Nongkynrih, Baridalyne; Sagar, Rajesh; Sreenivas, V

2012-01-01

The objective was to estimate the prevalence of psychiatric morbidity amongst patients attending Mobile Health Clinic (MHC) in an urban community in South Delhi. Adult subjects were recruited by systematic random sampling at outpatient MHC. Primary Care Evaluation of Mental Disorder Patient Health Questionnaire (PHQ) was used for screening, and Mini International Neuropsychiatric Interview (M.I.N.I.) was used for the confirmation of diagnosis of psychiatric disorder of all PHQ-positive and 20% of PHQ-negative patients. Association of selected sociodemographic factors with psychiatric morbidity was also assessed. In total, 350 subjects were recruited, out of which 92 (26.3%) [95% confidence interval (CI) 21.7-31.0] were found to be PHQ positive. M.I.N.I. was administered to 141 subjects (92 PHQ positives and 52 PHQ negatives). Total estimated magnitude of psychiatric morbidity by M.I.N.I. was 25.4% (95% CI 20.9-29.9). Depression (15.7%) was observed to be the most common psychiatric disorder followed by generalized anxiety disorder (11.1%) and phobic disorders (10.1%). Suicidal ideation was reported by 37 (10.6%) patients. Literate status [odds ratio (OR)=0.43] and duration of migration >20 years to study area (OR=1.27) were found to be significantly associated with psychiatric morbidity. In resource-poor country like India, high psychiatric morbidity at MHC justifies the use of MHC for providing outreach mental health services in difficult areas. Copyright © 2012 Elsevier Inc. All rights reserved.

Morbidity and mortality in first-degree relatives of C282Y homozygous probands with clinically detected haemochromatosis compared with the general population: the HEmochromatosis FAmily Study (HEFAS).

PubMed

Jacobs, E M G; Hendriks, J C M; Marx, J J M; van Deursen, C Th B M; Kreeftenberg, H G; de Vries, R A; Stalenhoef, A F H; Verbeek, A L M; Swinkels, D W

2007-12-01

Family screening has been suggested as a sophisticated model for the early detection of HFE-related hereditary haemochromatosis (HH). However, until now, controlled studies on the morbidity and mortality in families with HH are lacking. Data on iron parameters, morbidity and mortality were collected from 224 dutch C282Y-homozygous probands with clinically overt HH and 735 of their first-degree family members, all participating in the HEmochromatosis fAmily study (HEfAs). These data were compared with results obtained from an age- and gender-matched normal population. HEfAs and controls filled in similar questionnaires on demographics, lifestyle factors, health, morbidity and mortality. A significantly higher proportion of the HEfAs first-degree family members reported to be diagnosed with haemochromatosis-related diseases: 45.7 vs 19.4% of the matched normal population (McNemar p<0.001). Mortality among siblings, children and parents in the HEFAS population was similar to that in the relatives of matched control. In this study we show that, morbidity among first-degree family members of C282Y-homozygous probands previously diagnosed with clinically proven HH is higher than that in an age- and gender-matched normal population. Further studies are needed to definitely connect these increase morbidity figures to increase prevalenc of the C282Y mutated HFE-gene and elevated serum iron indices.

Vocal cord paralysis post patent ductus arteriosus ligation surgery: risks and co-morbidities.

PubMed

Rukholm, Gavin; Farrokhyar, Forough; Reid, Diane

2012-11-01

1. To determine the prevalence of left vocal cord paralysis (LVCP) post patent ductus arteriosus (PDA) ligation at a Tertiary Care Centre. 2. To identify risk factors associated with LVCP. 3. To identify co-morbidities associated with LVCP. 4. To determine the frequency of pre- and post-operative nasopharyngolaryngoscopic (NPL) examination in this patient population. Retrospective chart review of all infants who underwent PDA ligation surgery at a tertiary care academic hospital between July 2003 and July 2010. Data on patient age, gender, weight, method of PDA ligation, and results of NPL scoping were collected, as well as patient co-morbidities post PDA ligation. One hundred and fifteen patients underwent PDA ligation surgery. Four patients were excluded due to bilateral vocal cord paralysis. Of the remaining 111 patients, nineteen patients (17.1%) were found to have LVCP. Low birth weight was identified as a significant risk factor for LVCP (p=0.002). Gastroesophageal reflux was identified as a significant co-morbidity associated with LVCP post PDA ligation (p=0.002). Only 0.9% of patients were scoped pre-operatively, and 27.9% were scoped postoperatively. LVCP is associated with multiple morbidities. The authors strongly recommend routine post-operative scoping of all patients post PDA ligation surgery, and preoperative scoping when possible. A prospective study is warranted, in order to confirm the prevalence of LVCP as well as risk factors and associated co-morbidities. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

Health-related productivity losses increase when the health condition is co-morbid with psychological distress: findings from a large cross-sectional sample of working Australians.

PubMed

Holden, Libby; Scuffham, Paul A; Hilton, Michael F; Ware, Robert S; Vecchio, Nerina; Whiteford, Harvey A

2011-05-31

The health condition of workers is known to impact on productivity outcomes. The relationship between health and productivity is of increasing interest amid the need to increase productivity to meet global financial challenges. Prevalence of psychological distress is also of growing concern in Australia with a two-fold increase in the prevalence of psychological distress in Australia from 1997-2005. We used the cross-sectional data set from the Australian Work Outcomes Research Cost-benefit (WORC) study to explore the impacts of health conditions with and without co-morbid psychological distress, compared to those with neither condition, in a sample of approximately 78,000 working Australians. The World Health Organisation Health and Performance Questionnaire was used which provided data on demographic characteristics, health condition and working conditions. Data were analysed using negative binomial logistic regression and multinomial logistic regression models for absenteeism and presenteeism respectively. For both absenteeism and presenteeism productivity measures there was a greater risk of productivity loss associated when health conditions were co-morbid with psychological distress. For some conditions this risk was much greater for those with co-morbid psychological distress compared to those without. Co-morbid psychological distress demonstrates an increased risk of productivity loss for a range of health conditions. These findings highlight the need for further research to determine whether co-morbid psychological distress potentially exacerbates lost productivity.

Ocular morbidity prevalence among school children in Shimla, Himachal, North India.

PubMed

Gupta, Madhu; Gupta, Bhupinder P; Chauhan, Anil; Bhardwaj, Ashok

2009-01-01

Data on eye diseases among school children is not readily available. Considering the fact that one-third of India's blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important. To estimate the prevalence of ocular morbidity among school children of age 6-16 years. Government and private coeducational schools in urban area of Shimla. Cross-sectional. Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination. The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level. Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%), refractive errors 22% (CI=21.1-22.8%), squint 2.5% (CI=2.4-2.6%), color blindness 2.3% (CI=2.2-2.4%), vitamin A deficiency 1.8 % (CI=1.7-1.9%), conjunctivitis 0.8% (CI=0.79-0.81%). Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P< 0.5) more in government schools. A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders.

[Morbidity of textile industry workers in Kaunas].

PubMed

Ustinaviciene, Rūta; Piesine, Loreta

2007-01-01

According to the Department of Statistics at the beginning of 2003, 551 textile industry and garment enterprises operated in Lithuania. The purpose of the study was to evaluate morbidity among workers in textile industry enterprises in Kaunas and analyze the data obtained in relation to sex, age, profession, and occupational health hazards. A sick-leave-based case-control study was conducted in the units of four textile enterprises where 1842 workers were employed. Data were categorized in relation to sex, profession, and kind of sickness. Age was grouped in the following way: under 29 years, 30-39 years, 40-49 years, and over 50 years. In the period of survey, 1482 cases of sick leave were reported in the enterprises where 1842 workers were employed. The main cause of absence because of sickness was respiratory diseases--37.3% (30.27 cases per 100 workers), nursing took the second place--17.0% (13.76 cases per 100 workers). Accidents and injuries made up 9.3% (7.5 cases per 100 workers), musculoskeletal and connective tissue disorders--7.9% (6.4 cases per 100 workers). Data were analyzed using statistical programs SPSS 97, Epi-Info 6.0. Main morbidities reported included respiratory diseases (37.3%), nursing (17.0%), accidents and injuries (9.3%), musculoskeletal and connective tissue disorders (7.9%). The incidence of morbidity among workers engaged in workplace where occupational risk factors exceeded hygienic standards was higher. The rate of morbidity also increased with age and sex; morbidity among women was 1.5 higher than among men.

Differences in resuscitation in morbidly obese burn patients may contribute to high mortality

PubMed Central

Rae, Lisa; Pham, Tam N.; Carrougher, Gretchen; Honari, Shari; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Tompkins, Ronald G.; Herndon, David N.

2013-01-01

Objective The rising number of obese patients poses new challenges for burn care. These may include adjustments in calculations of burn size, resuscitation, ventilator wean, nutritional goals as well as challenges in mobilization. We have focused this observational study on resuscitation in the obese patient population in the first 48 hours after burn injury. Prior trauma studies suggest a prolonged time to reach end points of resuscitation in the obese compared to non-obese injured patients. We hypothesize that obese patients have worse outcomes after thermal injury and that differences in the response to resuscitation contribute to this disparity. Methods We retrospectively analyzed data prospectively collected in a multi-center trial to compare resuscitation and outcomes in patients stratified by NIH/WHO BMI classification (BMI: normal weight 18.5-24.9, overweight 25-29.9, Obese 30-39.9, morbidly obese ≥40). Due to distribution of body habitus in the obese, total burn size was recalculated for all patients using the method proposed by Neaman and compared to Lund-Browder estimates. We analyzed patients by BMI class for fluids administered and end points of resuscitation at 24 and 48 hours. Multivariate analysis was used to compare morbidity and mortality across BMI groups. Results We identified 296 adult patients with a mean TBSA of 41%. Patient and injury characteristics were similar across BMI categories. There were no significant differences in burn size calculations using Neaman vs. Lund-Browder formulas. Although resuscitation volumes exceeded the predicted formula in all BMI categories, higher BMI was associated with less fluid administered per actual body weight (p=0.001). Base deficit on admission was highest in the morbidly obese group at 24 and 48 hours. Furthermore, these patients did not correct their metabolic acidosis as well as lower BMI groups (p-values 0.04 and 0.03). Complications and morbidities across BMI groups were similar, although examination of organ failure scores indicated more severe organ dysfunction in the morbidly obese group. Compared to normal weight patients, being morbidly obese was an independent risk factor for death (OR = 10.1; CI 1.94-52.5, p= 0.006). Conclusions Morbidly obese patients with severe burns tend to receive closer to predicted fluid resuscitation volumes for their actual weight. However, this patient group has persistent metabolic acidosis during the resuscitation phase and is at-risk of developing more severe multiple organ failure. These factors may contribute to higher mortality risk in the morbidly obese burn patient. PMID:23966116

Morbid obesity is associated with fear of movement and lower quality of life in patients with knee pain-related diagnoses.

PubMed

Vincent, Heather K; Lamb, Kelley M; Day, Tim I; Tillman, Susan M; Vincent, Kevin R; George, Steven Z

2010-08-01

To compare fear of movement in patients with different body mass index (BMI) values referred for rehabilitative care of the knee and to examine whether this fear contributed to self-reported knee-related function. We hypothesized that fear of movement would be elevated with increasing BMI and that fear would correspond with lower self-report knee-related function and lower quality of life (QOL). Retrospective cross-sectional study. Outpatient therapy clinic affiliated with a tertiary care hospital. Patients with knee pain diagnoses (n = 278) were stratified into 4 BMI groups (in < or =25 kg/m(2) nonobese; 25-29.9 kg/m(2) overweight; 30-39.9 kg/m(2) obese; > or =40 kg/m(2) morbidly obese). The Tampa Scale of Kinesiophobia (TSK; fear of movement), International Knee Documentation (IKDC; knee function), and Short-Form 8 (SF-8; QOL) scores were main outcomes. Pain and straight leg raise test scores also were collected. After review of the medical records, descriptive statistics and nonparametric tests were performed, and TSK, QOL, and SF-8 scores were compared. Hierarchical regression modeling determined the contribution of TSK scores to the variance of IKDC scores. Pain scores were greatest in the nonobese group and lowest in the morbidly obese group (7.5 +/- 2.6 points vs 4.8 +/- 3.1 points; P < .05). TSK scores in morbidly obese patients were greater than in nonobese patients (27.1 +/- 7.7 points vs 22.0 +/- 6.6 points; P = .002). The SF-8 mental-physical subscores were 27% to 32% lower in the morbidly obese than nonobese patients (both P < .0001). IKDC scores were lower in the morbidly obese than nonobese patients (32.1 +/- 19.2 points vs 50.9 +/- 23.8 points; P = .0001). Pain severity and TSK scores contributed 28.6% and 7.1% to the variance of the IKDC scores (overall R(2) = 68.6). Morbid obesity is associated with elevated fear of movement. Pain was the strongest predictor of IKDC scores, and fear of movement enhanced this predictive value of the regression model. Despite lower absolute pain severity in the morbidly obese group, this fear may influence IKDC scores in this population. Morbidly obese patients might benefit from rehabilitation activities that reduce fear of movement to optimize participation in rehabilitation activity. Copyright © 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Dose constraints in the rectum and bladder following carbon-ion radiotherapy for uterus carcinoma: a retrospective pooled analysis.

PubMed

Okonogi, Noriyuki; Fukahori, Mai; Wakatsuki, Masaru; Ohkubo, Yu; Kato, Shingo; Miyasaka, Yuhei; Tsuji, Hiroshi; Nakano, Takashi; Kamada, Tadashi

2018-06-25

Carbon-ion radiotherapy (C-ion RT) provides better dose distribution in cancer treatment compared to photons. Additionally, carbon-ion beams provide a higher biological effectiveness, and thus a higher tumor control probability. However, information regarding the dose constraints for organs at risk in C-ion RT is limited. This study aimed to determine the predictive factors for late morbidities in the rectum and bladder after carbon-ion C-ion RT for uterus carcinomas. Between June 1995 and January 2010, 134 patients with uterus carcinomas were treated with C-ion RT with curative intent; prescription doses of 52.8-74.4 Gy (relative biological effectiveness) were delivered in 20-24 fractions. Of these patients, 132 who were followed up for > 6 months were analyzed. We separated the data in two subgroups, a 24 fractions group and a 20 fractions group. Late morbidities, proctitis, and cystitis were assessed according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria. The correlations of clinical and dosimetric parameters, V10-V60, D 5cc , D 2cc , and Dmax, with the incidence of ≥grade 1 morbidities were retrospectively analyzed. In the 24 fractions group, the 3-year actuarial occurrence rates of ≥grade 1 rectal and bladder morbidities were 64 and 9%, respectively. In addition, in the 20 fractions group, the 3-year actuarial occurrence rates of ≥grade 1 rectal and bladder morbidities were 32 and 19%, respectively. Regarding the dose-volume histogram data on the rectum, the D 5cc and D 2cc were significantly higher in patients with ≥grade 1 proctitis than in those without morbidity. In addition, the D 5cc for the bladder was significantly higher in patients with ≥grade 1 cystitis than in those without morbidity. Results of univariate analyses showed that D 2cc of the rectum was correlated with the development of ≥grade 1 late proctitis. Moreover, D 5cc of the bladder was correlated with the development of ≥grade 1 late cystitis. The present study identified the dose-volume relationships in C-ion RT regarding the occurrence of late morbidities in the rectum and bladder. Assessment of the factors discussed herein would be beneficial in preventing late morbidities after C-ion RT for pelvic malignancies. Retrospectively registered ( NIRS: 16-040 ).

Preventing cold-related morbidity and mortality in a changing climate

PubMed Central

Conlon, Kathryn C; Rajkovich, Nicholas B; White-Newsome, Jalonne L; Larsen, Larissa; Neill, Marie S O

2011-01-01

Winter weather patterns are anticipated to become more variable with increasing average global temperatures. Research shows that excess morbidity and mortality occurs during cold weather periods. We critically reviewed evidence relating temperature variability, health outcomes, and adaptation strategies to cold weather. Health outcomes included cardiovascular-, respiratory-, cerebrovascular-, and all-cause morbidity and mortality. Individual and contextual risk factors were assessed to highlight associations between individual- and neighborhood- level characteristics that contribute to a person’s vulnerability to variability in cold weather events. Epidemiologic studies indicate that the populations most vulnerable to variations in cold winter weather are the elderly, rural and, generally, populations living in moderate winter climates. Fortunately, cold-related morbidity and mortality are preventable and strategies exist for protecting populations from these adverse health outcomes. We present a range of adaptation strategies that can be implemented at the individual, building, and neighborhood level to protect vulnerable populations from cold-related morbidity and mortality. The existing research justifies the need for increased outreach to individuals and communities for education on protective adaptations in cold weather. We propose that future climate change adaptation research couple building energy and thermal comfort models with epidemiological data to evaluate and quantify the impacts of adaptation strategies. PMID:21592693

Glutaric aciduria type 1: neuroimaging features with clinical correlation.

PubMed

Mohammad, Shaimaa Abdelsattar; Abdelkhalek, Heba Salah; Ahmed, Khaled A; Zaki, Osama K

2015-10-01

Glutaric aciduria type 1 is a rare neurometabolic disease with high morbidity. To describe the MR imaging abnormalities in glutaric aciduria type 1 and to identify any association between the clinical and imaging features. MRI scans of 29 children (mean age: 16.9 months) with confirmed diagnosis of glutaric aciduria type 1 were retrospectively reviewed. Gray matter and white matter scores were calculated based on a previously published pattern-recognition approach of assessing leukoencephalopathies. Hippocampal formation and opercular topography were assessed in relation to the known embryological basis. MRI scores were correlated with morbidity score. The most consistent MRI abnormality was widened operculum with dilatation of the subarachnoid spaces surrounding underdeveloped frontotemporal lobes. Incomplete hippocampal inversion was also seen. The globus pallidus was the most frequently involved gray matter structure (86%). In addition to the central tegmental tract, white matter abnormalities preferentially involved the central and periventricular regions. The morbidity score correlated with the gray matter abnormality score (P = 0.004). Patients with dystonia had higher gray matter and morbidity scores. Morbidity is significantly correlated with abnormality of gray matter, rather than white matter, whether secondary to acute encephalopathic crisis or insidious onset disease.

Independent risk factors of morbidity in penetrating colon injuries.

PubMed

Girgin, Sadullah; Gedik, Ercan; Uysal, Ersin; Taçyildiz, Ibrahim Halil

2009-05-01

The present study explored the factors effective on colon-related morbidity in patients with penetrating injury of the colon. The medical records of 196 patients were reviewed for variables including age, gender, factor of trauma, time between injury and operation, shock, duration of operation, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), site of colon injury, Colon Injury Score, fecal contamination, number of associated intra- and extraabdominal organ injuries, units of transfused blood within the first 24 hours, and type of surgery. In order to determine the independent risk factors, multivariate logistic regression analysis was performed. Gunshot wounds, interval between injury and operation > or =6 hours, shock, duration of the operation > or =6 hours, PATI > or =25, ISS > or =20, Colon Injury Score > or = grade 3, major fecal contamination, number of associated intraabdominal organ injuries >2, number of associated extraabdominal organ injuries >2, multiple blood transfusions, and diversion were significantly associated with morbidity. Multivariate logistic regression analysis showed diversion and transfusion of > or =4 units in the first 24 hours as independent risk factors affecting colon-related morbidity. Diversion and transfusion of > or =4 units in the first 24 hours were determined to be independent risk factors for colon-related morbidity.

The impact of posttraumatic stress symptoms, posttraumatic stress cognitions and interpersonal dependency on psychological co-morbidities following relationship dissolution among college students.

PubMed

Fang, Siqi; Chung, Man Cheung; Watson, Clare

2018-02-13

Relationship dissolution is a distressing experience which can result in the emergence of posttraumatic stress (i.e. post-dissolution PTSS) and other psychological symptoms among college students. Little is known, however, whether posttraumatic stress cognitions and interpersonal dependency may influence the severity of these distress outcomes. This study examined the interrelationship between posttraumatic stress symptoms (PTSS), posttraumatic stress cognitions, interpersonal dependency and psychological co-morbidities following relationship dissolution. One hundred and eighty college students (M = 69, F = 111) who had experienced relationship dissolution completed the Posttraumatic Stress Diagnostic Scale, Posttraumatic Stress Cognition Inventory, Interpersonal Dependency Inventory and General Health Questionnaire-28. Posttraumatic stress symptoms following relationship dissolution (post-dissolution PTSS) were associated with increased psychological co-morbidities. Negative view of oneself and self-blame mediated between PTSS and psychological co-morbidities. Assertion of autonomy moderated the mediational effects of negative cognitions on psychological co-morbidities. People can develop PTSSs and other psychological symptoms following the dissolution of a romantic relationship. Their concept of self and tendency to seek independence and control played a key role in determining the severity of distress symptoms.

Orthopaedic co-morbidities in the elderly haemophilia population: a review.

PubMed

Stephensen, D; Rodriguez-Merchan, E C

2013-03-01

Due to improvements in the treatment and medical care of haemophilia, the life expectancy of individuals with haemophilia has approached that of the general population. To review the main co-morbidities of the musculoskeletal system in elderly persons with haemophilia, we have performed a review of the literature on the musculoskeletal problems of elderly haemophiliacs. Chronic arthropathy is the main co-morbidity in the ageing person with haemophilia. Age-related orthopaedic co-morbidities include degenerative joint changes, osteoporosis, muscle atrophy or sarcopenia, muscle weakness and disturbance of gait and balance. Increased pain, muscle weakness and atrophy along with an increased risk of falling are key features of advanced haemophilic arthropathy and ageing. An ageing haemophilia population in which arthropathy continues to be the primary co-morbidity is a current challenge for those responsible for their care. Exercise programmes undertaken two to three times per week for at least 12 weeks seem most effective in reducing the impact of age-related changes on the musculoskeletal system. Establishing effective exercise programmes and strategies to identify individuals who would benefit from early surgical intervention together with presurgical physiotherapy prehabilitation is a priority for future research. © 2012 Blackwell Publishing Ltd.

aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities: a simplified auditing tool for community-acquired gastrointestinal surgical emergencies.

PubMed

Villodre, Celia; Rebasa, Pere; Estrada, José Luís; Zaragoza, Carmen; Zapater, Pedro; Mena, Luís; Lluís, Félix

2016-11-01

In a previous study, we found that Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) overpredicts morbidity risk in emergency gastrointestinal surgery. Our aim was to find a POSSUM equation adjustment. A prospective observational study was performed on 2,361 patients presenting with a community-acquired gastrointestinal surgical emergency. The first 1,000 surgeries constituted the development cohort, the second 1,000 events were the first validation intramural cohort, and the remaining 361 cases belonged to a second validation extramural cohort. (1) A modified POSSUM equation was obtained. (2) Logistic regression was used to yield a statistically significant equation that included age, hemoglobin, white cell count, sodium and operative severity. (3) A chi-square automatic interaction detector decision tree analysis yielded a statistically significant equation with 4 variables, namely cardiac failure, sodium, operative severity, and peritoneal soiling. A modified POSSUM equation and a simplified scoring system (aLicante sUrgical Community Emergencies New Tool for the enUmeration of Morbidities [LUCENTUM]) are described. Both tools significantly improve prediction of surgical morbidity in community-acquired gastrointestinal surgical emergencies. Copyright © 2016 Elsevier Inc. All rights reserved.

Challenges that nurses face in caring for morbidly obese patients in the acute care setting.

PubMed

Drake, Daniel; Dutton, Kathy; Engelke, Martha; McAuliffe, Maura; Rose, Mary Ann

2005-01-01

Despite increasing numbers of morbidly obese patients admitted to acute care facilities for surgery or treatment of nonsurgical conditions, there is little evidence of the problems nurses face in providing care to these patients. Anecdotal evidence suggests that the care of these patients is more demanding than the care of nonobese patients. The objective of this study was to describe nurses' perceptions of the challenges that they face when caring for morbidly obese patients. Focus groups of nurses from a tertiary care facility were convened. A trained facilitator posed questions to the group concerning various aspects of care for morbidly obese patients. Comments of respondents were categorized using NVIVO software. Nurses reported concerns about the increased staffing needs required for care of these patients and the particular challenges of the physical care. Concerns also included the availability, placement, and use of specialized equipment. Room size and the absence of some equipment were also problematic. Finally, nurses perceived safety issues, both for themselves and their patients. Morbidly obese patients in the acute care setting require specialized nursing care in terms of techniques, levels of staffing required, and the use of specialized equipment.

Burden Assessment, Psychiatric Morbidity, and Their Correlates in Caregivers of Patients with Intellectual Disability.

PubMed

Bhatia, M S; Srivastava, S; Gautam, P; Saha, R; Kaur, J

2015-12-01

Intellectual disability in a child places great stress on a family and caregiver and this leads to significant socio-occupational dysfunction and impaired quality of life for caregivers. This study aimed to assess socio-demographic characteristics, burden, and psychiatric morbidity of the caregivers of persons with intellectual disability, as well as to determine the variables that correlated with burden and psychiatric morbidity. An observational study was carried out in an outpatient psychiatric unit of a tertiary care teaching hospital in India from October 2014 to April 2015. A total of 100 caregivers of intellectually impaired individuals were assessed for burden and psychiatric morbidity. In all, 39% of the caregivers had a high burden score, 46% perceived mild-to-moderate burden severity, and 15% perceived no to mild burden. Mild-to-moderate depressive symptoms were present in 23% and 16% had severe-to-extremely severe depressive symptoms. Mild-to-moderate anxiety symptoms were evident in 19% of caregivers and a further 19% had severe-to-extremely severe anxiety symptoms. Routine assessment of burden and psychiatric morbidity in the caregiver will help to reduce their burden and thus help them care for their children more appropriately and efficiently.

Estimating true hospital morbidity of complications associated with mumps outbreak, England, 2004/05

PubMed Central

Yung, CF; Ramsay, M

2016-01-01

Mumps outbreaks in highly vaccinated populations continue to be reported globally. Therefore, quantifying the burden of mumps morbidity accurately will be necessary to better assess the impact of mumps vaccination programmes. We aim to estimate the true morbidity resulting from mumps complications in terms of hospitalised orchitis, meningitis, oophoritis and pancreatitis in England during the outbreak in 2004/05. This outbreak in England led to a clear increase in hospitalisations coded to mumps for complications of orchitis in those born in the 1970s and 1980s and possibly for meningitis in those born in the 1980s. A simple statistical model, based on analysing time trends for diagnosed complications in hospital databases with routine laboratory surveillance data, found that the actual morbidity was much higher. There were 2.5 times (166 cases) more mumps orchitis cases in the 1970s cohort and 2.0 times (708 cases) more mumps orchitis cases in the 1980s cohort than complications coded to mumps in hospital databases. Our study demonstrated that the mumps outbreak in England 2004/05 resulted in a substantial increase in hospitalised mumps complications, and the model we used can improve the ascertainment of morbidity from a mumps outbreak. PMID:27562958

[Advances in medical care for extremely low birth weight infants worldwide].

PubMed

Chen, Chun; Zhang, Qian-Shen

2013-08-01

Dramatic advances in neonatal medicine over recent decades have resulted in decreased mortality and morbidity rates for extremely low birth weight infants. However, the survival of these infants is associated with short- and long-term morbidity, including severe intraventricular hemorrhage, periventricular leukomalacia, nosocomial infection and necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity and adverse long-term neurodevelopmental sequelae. This article reviewed the latest advances in the medical care for extremely low birth weight infants including survival rate, ethical issues and short- and long-term morbidity, domestically and abroad.

Health and morbidity among Bedouin women in southern Israel: a descriptive literature review of the past two decades.

PubMed

Treister-Goltzman, Yulia; Peleg, Roni

2014-08-01

In this paper we describe health and morbidity characteristics of Bedouin women in southern Israel, based on papers published over the past 20 years. This is a unique population whose customs, tradition, singular circumstances as a population "in transit", and underprivileged socio-economic status are reflected in mental illness, pregnancy course, perinatal morbidity and mortality rates, and acute and chronic disease. Recognition of these characteristics can help the medical team treat various health problems in this population as well as other populations with similar characteristics.

Measuring severe maternal morbidity: validation of potential measures.

PubMed

Main, Elliott K; Abreo, Anisha; McNulty, Jennifer; Gilbert, William; McNally, Colleen; Poeltler, Debra; Lanner-Cusin, Katarina; Fenton, Douglas; Gipps, Theresa; Melsop, Kathryn; Greene, Naomi; Gould, Jeffrey B; Kilpatrick, Sarah

2016-05-01

Both maternal mortality rate and severe maternal morbidity rate have risen significantly in the United Sates. Recently, the Centers for Disease Control and Prevention introduced International Classification of Diseases, 9th revision, criteria for defining severe maternal morbidity with the use of administrative data sources; however, those criteria have not been validated with the use of chart reviews. The primary aim of the current study was to validate the Centers for Disease Control and Prevention International Classification of Diseases, 9th revision, criteria for the identification of severe maternal morbidity. This analysis initially required the development of a reproducible set of clinical conditions that were judged to be consistent with severe maternal morbidity to be used as the clinical gold standard for validation. Alternative criteria for severe maternal morbidity were also examined. The 67,468 deliveries that occurred during a 12-month period from 16 participating California hospitals were screened initially for severe maternal morbidity with the presence of any of 4 criteria: (1) Centers for Disease Control and Prevention International Classification of Diseases, 9th revision, diagnosis and procedure codes; (2) prolonged postpartum length of stay (>3 standard deviations beyond the mean length of stay for the California population); (3) any maternal intensive care unit admissions (with the use of hospital billing sources); and (4) the administration of any blood product (with the use of transfusion service data). Complete medical records for all screen-positive cases were examined to determine whether they satisfied the criteria for the clinical gold standard (determined by 4 rounds of a modified Delphi technique). Descriptive and statistical analyses that included area under the receiver operating characteristic curve and C-statistic were performed. The Centers for Disease Control and Prevention International Classification of Diseases, 9th revision, criteria had a reasonably high sensitivity of 0.77 and a positive predictive value of 0.44 with a C-statistic of 0.87. The most important source of false-positive cases were mothers whose only criterion was 1-2 units of blood products. The Centers for Disease Control and Prevention International Classification of Diseases, 9th revision, criteria screen rate ranged from 0.51-2.45% among hospitals. True positive severe maternal morbidity ranged from 0.05-1.13%. When hospitals were grouped by their neonatal intensive care unit level of care, severe maternal morbidity rates were statistically lower at facilities with lower level neonatal intensive care units (P < .0001). The Centers for Disease Control and Prevention International Classification of Diseases, 9th revision, criteria can serve as a reasonable administrative metric for measuring severe maternal morbidity at population levels. Caution should be used with the use of these criteria for individual hospitals, because case-mix effects appear to be strong. Copyright © 2016 Elsevier Inc. All rights reserved.

Depression and Anxiety as Risk Factors for Morbidity and Mortality after Organ Transplantation: A Systematic Review and Meta-Analysis1

PubMed Central

Dew, Mary Amanda; Rosenberger, Emily M.; Myaskovsky, Larissa; DiMartini, Andrea F.; DeVito Dabbs, Annette J.; Posluszny, Donna M.; Steel, Jennifer; Switzer, Galen E.; Shellmer, Diana A.; Greenhouse, Joel B.

2015-01-01

Background Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks post-transplant. If such associations exist, additional risk reduction strategies may be needed. Methods Four bibliographic databases were searched from 1981 through September, 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for post-transplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. Results Twenty-seven studies (10 heart, total n=1,738; 6 liver, n=1,063; 5 kidney, n=49,515; 4 lung, n=584; 1 pancreas, n=80; 1 mixed recipient sample, n=205) were identified. In each, depression and/or anxiety were typically measured pre- or early post-transplant. Follow-up for outcomes was a median of 5.8 years (range:0.50–18.0). Depression increased the relative risk (RR) of mortality by 65% (RR=1.65, 95% CI:1.34,2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (v. did not) control for potential confounders(p=.032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR=1.65, CI:1.21,2.26, 3 studies). Depression was not associated with other morbidities (each morbidity assessed in 1–4 studies). Anxiety did not significantly increase mortality risk (RR=1.39, CI:0.85,2.27, 6 studies) or morbidity risks (assessed in single studies). Conclusions Depression increases risk for post-transplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce post-transplant mortality requires study. PMID:26492128

Ethnic Variations in Severe Maternal Morbidity in the UK– A Case Control Study

PubMed Central

Nair, Manisha; Kurinczuk, Jennifer J.; Knight, Marian

2014-01-01

Background Previous studies showed a higher risk of maternal morbidity amongst black and other minority ethnic (BME) groups, but were unable to investigate whether this excess risk was concentrated within specific BME groups in the UK. Our aim was to analyse the specific risks and to investigate reasons for any disparity. Methods Unmatched case-control analysis using data from the United Kingdom Obstetric Surveillance System (UKOSS), February 2005-January 2013. Cases were 1,753 women who experienced severe morbidity during the peripartum period. Controls were 3,310 women who delivered immediately before the cases in the same hospital. Multivariable logistic regression modelling was used to adjust for known confounders and to understand their effects. Results Compared with white European women, the odds of severe maternal morbidity were 83% higher among black African women (adjusted odds ratio (aOR) = 1.83; 95% Confidence Interval (CI) = 1.39–2.40), 80% higher among black Caribbean (aOR = 1.80; 95% CI = 1.14–2.82), 74% higher in Bangladeshi (aOR = 1.74; 95% CI = 1.05–2.88), 56% higher in other non-whites (non-Asian) (aOR = 1.56; 95% CI = 1.05–2.33) and 43% higher among Pakistani women (aOR = 1.43; 95% CI = 1.07–1.92). There was no evidence of substantial confounding. Anaemia in current pregnancy, previous pregnancy problems, inadequate utilisation of antenatal care, pre-existing medical conditions, parity>3, and being younger and older were independent risk factors but, the odds of severe maternal morbidity did not differ by socioeconomic status, between smokers and non-smokers or by BMI. Discussion This national study demonstrates an increased risk of severe maternal morbidity among women of ethnic minority backgrounds which could not be explained by known risk factors for severe maternal morbidity. PMID:24743879

Ethnic variations in severe maternal morbidity in the UK- a case control study.

PubMed

Nair, Manisha; Kurinczuk, Jennifer J; Knight, Marian

2014-01-01

Previous studies showed a higher risk of maternal morbidity amongst black and other minority ethnic (BME) groups, but were unable to investigate whether this excess risk was concentrated within specific BME groups in the UK. Our aim was to analyse the specific risks and to investigate reasons for any disparity. Unmatched case-control analysis using data from the United Kingdom Obstetric Surveillance System (UKOSS), February 2005-January 2013. Cases were 1,753 women who experienced severe morbidity during the peripartum period. Controls were 3,310 women who delivered immediately before the cases in the same hospital. Multivariable logistic regression modelling was used to adjust for known confounders and to understand their effects. Compared with white European women, the odds of severe maternal morbidity were 83% higher among black African women (adjusted odds ratio (aOR) = 1.83; 95% Confidence Interval (CI) = 1.39-2.40), 80% higher among black Caribbean (aOR = 1.80; 95% CI = 1.14-2.82), 74% higher in Bangladeshi (aOR = 1.74; 95% CI = 1.05-2.88), 56% higher in other non-whites (non-Asian) (aOR = 1.56; 95% CI = 1.05-2.33) and 43% higher among Pakistani women (aOR = 1.43; 95% CI = 1.07-1.92). There was no evidence of substantial confounding. Anaemia in current pregnancy, previous pregnancy problems, inadequate utilisation of antenatal care, pre-existing medical conditions, parity>3, and being younger and older were independent risk factors but, the odds of severe maternal morbidity did not differ by socioeconomic status, between smokers and non-smokers or by BMI. This national study demonstrates an increased risk of severe maternal morbidity among women of ethnic minority backgrounds which could not be explained by known risk factors for severe maternal morbidity.

Gastrointestinal Injuries in Blunt Abdominal Traumas.

PubMed

Gönüllü, D; Ilgun, S; Gedik, M L; Demiray, O; Öner, Z; Er, M; Köksoy, F N

2015-01-01

To discuss the efficiency of RTS (Revised TraumaScore), ISS (Injury Severity Score), and factors that affect mortality and morbidity in gastrointestinal injuries due to blunt trauma.Method and methods: Patients with gastrointestinal injuries due to blunt trauma operated within the last six years have been studied retrospectively in terms of demographics,injury mechanism and localization, additional injuries, RTS and ISS, operative technique, morbidity, mortality and duration of hospitalization. Of the eighteen cases, cause of injury was a traffic accident for 11 (61.1%), fall from height for 5 (27%) and physical attack for 2 (11%). Among the eighteen patients,there were 21 gastrointestinal injuries (11 intestinal, 6 colon,3 duodenum, 1 stomach). 10 (55.6%) had additional intraabdominal injuries while the number for extra-abdominal injuries were 12 (66.7%). Primary suture (10), segmentary resection (9) and pyloric exclusion (2) were the operations performed for the twenty-one gastrointestinal injuries.Although statistically not significant, 13(72.2%) patients with additional injuries compared with 5 (27.8%) patients with isolated gastrointestinal injuries, were found to have lower RTS (7.087/7.841), higher ISS (19.4/12.2), longer duration of hospitalization (11.5/8.4 day) as well as higher morbidity (7/1) and mortality (2/0) rates. Comparing the RTS (7.059/7.490) of patients who have and have not developed morbidity revealed no significant difference.However, ISS (23.9/12.2) was significantly higher in patients who have developed morbidity (p=0.003). RTS (6.085 7.445) and ISS (39.5/14.6) of patients who have survived were significantly different than patients who have not(p=0.037 and p=0.023, respectively) Additional injuries in patients with gastrointestinal injury due blunt abdominal traumas increases, although not significantly, morbidity, mortality and duration of hospitalization even when operated early. High ISS is significantly related to the risk of both morbidity and mortality while low RTS is significantly related only to the mortality risk. Celsius.

Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes.

PubMed

Charles, Eric J; Johnston, Lily E; Herbert, Morley A; Mehaffey, J Hunter; Yount, Kenan W; Likosky, Donald S; Theurer, Patricia F; Fonner, Clifford E; Rich, Jeffrey B; Speir, Alan M; Ailawadi, Gorav; Prager, Richard L; Kron, Irving L

2017-10-01

Thirty-one states approved Medicaid expansion after implementation of the Affordable Care Act. The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. Data from the Virginia (nonexpansion state) Cardiac Services Quality Initiative and the Michigan (expanded Medicaid, April 2014) Society of Thoracic and Cardiovascular Surgeons Quality Collaborative were analyzed to identify uninsured and Medicaid patients undergoing coronary bypass graft or valve operations, or both. Demographics, operative details, predicted risk scores, and morbidity and mortality rates, stratified by state and compared across era (preexpansion: 18 months before vs postexpansion: 18 months after), were analyzed. In Virginia, there were no differences in volume between eras, whereas in Michigan, there was a significant increase in Medicaid volume (54.4% [558 of 1,026] vs 84.1% [954 of 1,135], p < 0.001) and a corresponding decrease in uninsured volume. In Virginia Medicaid patients, there were no differences in predicted risk of morbidity or mortality or postoperative major morbidities. In Michigan Medicaid patients, a significant decrease in predicted risk of morbidity or mortality (11.9% [8.1% to 20.0%] vs 11.1% [7.7% to 17.9%], p = 0.02) and morbidities (18.3% [102 of 558] vs 13.2% [126 of 954], p = 0.008) was identified. Postexpansion was associated with a decreased risk-adjusted rate of major morbidity (odds ratio, 0.69; 95% confidence interval, 0.51 to 0.91; p = 0.01) in Michigan Medicaid patients. Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Impact of ambient temperature on morbidity and mortality: An overview of reviews.

PubMed

Song, Xuping; Wang, Shigong; Hu, Yuling; Yue, Man; Zhang, Tingting; Liu, Yu; Tian, Jinhui; Shang, Kezheng

2017-05-15

The objectives were (i) to conduct an overview of systematic reviews to summarize evidence from and evaluate the methodological quality of systematic reviews assessing the impact of ambient temperature on morbidity and mortality; and (ii) to reanalyse meta-analyses of cold-induced cardiovascular morbidity in different age groups. The registration number is PROSPERO-CRD42016047179. PubMed, Embase, the Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health were systematically searched to identify systematic reviews. Two reviewers independently selected studies for inclusion, extracted data, and assessed quality. The Assessment of Multiple Systematic Reviews (AMSTAR) checklist was used to assess the methodological quality of included systematic reviews. Estimates of morbidity and mortality risk in association with heat exposure, cold exposure, heatwaves, cold spells and diurnal temperature ranges (DTRs) were the primary outcomes. Twenty-eight systematic reviews were included in the overview of systematic reviews. (i) The median (interquartile range) AMSTAR scores were 7 (1.75) for quantitative reviews and 3.5 (1.75) for qualitative reviews. (ii) Heat exposure was identified to be associated with increased risk of cardiovascular, cerebrovascular and respiratory mortality, but was not found to have an impact on cardiovascular or cerebrovascular morbidity. (iii) Reanalysis of the meta-analyses indicated that cold-induced cardiovascular morbidity increased in youth and middle-age (RR=1.009, 95% CI: 1.004-1.015) as well as the elderly (RR=1.013, 95% CI: 1.007-1.018). (iv) The definitions of temperature exposure adopted by different studies included various temperature indicators and thresholds. In conclusion, heat exposure seemed to have an adverse effect on mortality and cold-induced cardiovascular morbidity increased in the elderly. Developing definitions of temperature exposure at the regional level may contribute to more accurate evaluations of the health effects of temperature. Copyright © 2017 Elsevier B.V. All rights reserved.

Impact of Sexual Orientation Identity on Medical Morbidities in Male-to-Female Transgender Patients.

PubMed

Gaither, Thomas W; Awad, Mohannad A; Osterberg, E Charles; Romero, Angelita; Bowers, Marci L; Breyer, Benjamin N

2017-02-01

We aim to describe the relationship between sexual orientation identity and medical morbidities in a large sample of male-to-female (MTF) transgender patients. We reviewed medical records of patients presenting for MTF sex reassignment surgery (SRS) by a single, high-volume surgeon from 2011 to 2015. Sexual attraction to men (heterosexual), women (lesbian), or both (bisexual) was asked of each patient. We examined 16 medical morbidities for this analysis. During the study period, 330 MTF transgender patients presented for SRS. The average age at the time of surgery was 38.9 (range 18-76). One hundred and one patients (32%) reported being heterosexual, 110 patients (34%) reported being lesbian, and 108 patients (34%) reported being bisexual. Lesbian patients presented for SRS at older ages (mean = 43 years old) compared with heterosexual patients (mean = 36 years old) and bisexual patients (mean = 37), P < 0.01. No differences were found in the majority of coexisting medical morbidities by sexual orientation identity. Lesbian patients had greater odds of having a history of depression, age-adjusted odds ratio (aOR) = 2.36, 95% confidence interval (CI) 1.26-4.40, compared with heterosexual patients. Lesbian patients had higher odds of being married or partnered, aOR = 2.31, 95% CI (1.27-4.19), compared with heterosexual patients. Heterosexual patients had higher odds of having human immunodeficiency virus (HIV), aOR = 9.07, 95% CI (1.08-76.5) compared with lesbian patients. Sexual orientation identity in MTF transgender patients is variable. The majority of medical morbidities are not associated with sexual orientation identity. Although HIV and depression are common morbidities among MTF patients seeking SRS, the prevalence of these morbidities differs by sexual orientation identity, but these findings need replication. Counseling and future research initiatives in transgender care should incorporate sexual orientation identity and associated risk behavior.

Depression and Anxiety as Risk Factors for Morbidity and Mortality After Organ Transplantation: A Systematic Review and Meta-Analysis.

PubMed

Dew, Mary Amanda; Rosenberger, Emily M; Myaskovsky, Larissa; DiMartini, Andrea F; DeVito Dabbs, Annette J; Posluszny, Donna M; Steel, Jennifer; Switzer, Galen E; Shellmer, Diana A; Greenhouse, Joel B

2015-05-01

Depression and anxiety are common mental health problems in transplant populations. There is mixed evidence concerning whether they increase morbidity and mortality risks after transplantation. If such associations exist, additional risk reduction strategies may be needed. Four bibliographic databases were searched from 1981 through September 2014 for studies prospectively examining whether depression or anxiety (determined with diagnostic evaluations or standardized symptom scales) affected risk for posttransplant mortality, graft loss, acute graft rejection, chronic rejection, cancer, infection, and rehospitalization. Twenty-seven studies (10 heart, total n = 1738; 6 liver, n = 1063; 5 kidney, n = 49515; 4 lung, n = 584; 1 pancreas, n = 80; 1 mixed recipient sample, n = 205) were identified. In each, depression and/or anxiety were typically measured before or early after transplantation. Follow-up for outcomes was a median of 5.8 years (range, 0.50-18.0). Depression increased the relative risk (RR) of mortality by 65% (RR, 1.65; 95% confidence interval [95% CI], 1.34-2.05; 20 studies). Meta-regression indicated that risk was stronger in studies that did (vs did not) control for potential confounders (P = .032). Risk was unaffected by type of transplant or other study characteristics. Depression increased death-censored graft loss risk (RR, 1.65; 95% CI, 1.21-2.26, 3 studies). Depression was not associated with other morbidities (each morbidity was assessed in 1-4 studies). Anxiety did not significantly increase mortality risk (RR, 1.39; 95% CI, 0.85-2.27, 6 studies) or morbidity risks (assessed in single studies). Depression increases risk for posttransplant mortality. Few studies considered morbidities; the depression-graft loss association suggests that linkages with morbidities deserve greater attention. Depression screening and treatment may be warranted, although whether these activities would reduce posttransplant mortality requires study.

Trial of Labor Compared With Cesarean Delivery in Superobese Women.

PubMed

Grasch, Jennifer L; Thompson, Jennifer L; Newton, J Michael; Zhai, Amy W; Osmundson, Sarah S

2017-11-01

To examine whether labor compared with planned cesarean delivery is associated with increased maternal and neonatal morbidity. We conducted a retrospective cohort study of all women with body mass indexes (BMIs) at delivery of 50 or greater delivering a live fetus at 34 weeks of gestation of greater between January 1, 2008, and December 31, 2015. Pregnancies with multiple gestations and major fetal anomalies were excluded. The primary outcome was a composite of maternal and neonatal morbidity and was estimated to be 50% in superobese women based on institutional data. A sample size of 338 women determined the study period and was selected to show a 30% difference in the incidence of the primary outcome between the two groups. Multivariate logistic regression adjusted for potential confounders. There were 344 women with BMIs of 50 or greater who met eligibility criteria, of whom 201 (58%) labored and 143 (42%) underwent planned cesarean delivery. Women who labored were younger, more likely to be nulliparous, and less likely to have pre-existing diabetes. Among women who labored, 45% underwent a cesarean delivery, most commonly for labor arrest (61%) or nonreassuring fetal status (28%). Composite maternal and neonatal morbidity was reduced among women who labored even after adjusting for age, parity, pre-existing diabetes, and prior cesarean delivery (adjusted odds ratio 0.42, 95% CI 0.24-0.75). In the subgroup of women (n=234) who underwent a cesarean delivery, whether planned (n=143) or after labor (n=91), there were no differences in maternal and neonatal morbidity except that severe maternal morbidity was increased in women (n=12) who labored (8.8% compared with 2.1%, relative risk 4.2, 95% CI 1.14-15.4). Despite high rates of cesarean delivery in women with superobesity, labor is associated with lower composite maternal and neonatal morbidity. Severe maternal morbidity may be higher in women who require a cesarean delivery after labor.

Factors associated with seeking treatment for postpartum morbidities in rural India

PubMed Central

Singh, Aditya; Kumar, Abhishek

2014-01-01

OBJECTIVES: To understand the prevalence of postpartum morbidities and factors associated with treatment-seeking behaviour among currently married women aged 15-49 residing in rural India. METHODS: We used data from the nationally representative District Level Household Survey from 2007-2008. Cross-tabulation was used to understand the differentials for the prevalence of postpartum morbidities and treatment-seeking behaviours across selected background characteristics. Two-level binary logistic regression was applied to understand the factors associated with treatment-seeking behaviour. RESULTS: Approximately 39.8% of rural women suffered from at least one of the six postpartum morbidities including high fever, lower abdominal pain, foul-smelling vaginal discharge, excessive bleeding, convulsions, and severe headache. Morbidities were more prevalent among poor, illiterate, Muslim, and high-parity women. About 55.1% of these rural women sought treatment/consultation for their problems. The odds of seeking treatment/consultation increased as economic status and years of schooling among both the woman and her husband increased. Poor, uneducated, unemployed, Hindu, and tribal women were less likely to seek treatment/consultation for postpartum morbidities than their counterparts were. The odds of seeking treatment/consultation decreased as the distance to the nearest private health facility increased. Most women visited a private hospital (46.3%) or a friend/family member’s home (20.8%) for treatment/consultation. Only a small percentage visited publicly funded health institutions such as a primary health centre (8.8%), community health centre (6.5%), health sub-centre (2.8%), or district hospital (13.1%). Rural women from the northeast region of India were 50% less likely to seek treatment/consultation than women from the central region were. CONCLUSIONS: Providing antenatal and delivery care, and ensuring nearby government healthcare facilities are available to serve rural women might increase the likelihood of care-seeking for postpartum morbidities. Targeted interventions for vulnerable groups should be considered in future policies to increase the likelihood women will seek treatment or advice postpartum. PMID:25358467

Surgical resident involvement is safe for common elective general surgery procedures.

PubMed

Tseng, Warren H; Jin, Leah; Canter, Robert J; Martinez, Steve R; Khatri, Vijay P; Gauvin, Jeffrey; Bold, Richard J; Wisner, David; Taylor, Sandra; Chen, Steven L

2011-07-01

Outcomes of surgical resident training are under scrutiny with the changing milieu of surgical education. Few have investigated the effect of surgical resident involvement (SRI) on operative parameters. Examining 7 common general surgery procedures, we evaluated the effect of SRI on perioperative morbidity and mortality and operative time (OpT). The American College of Surgeons National Surgical Quality Improvement Program database (2005 to 2007) was used to identify 7 cases of nonemergent operations. Cases with simultaneous procedures were excluded. Logistic regression was performed across all procedures and within each procedure incorporating SRI, OpT, and risk-stratifying American College of Surgery National Surgical Quality Improvement Program morbidity and mortality probability scores, which incorporate multiple prognostic individual patient factors. Procedure-specific, SRI-stratified OpTs were compared using Wilcoxon rank-sum tests. A total of 71.3% of the 37,907 cases had SRI. Absolute 30-day morbidity for all cases with SRI and without SRI were 3.0% and 1.0%, respectively (p < 0.001); absolute 30-day mortality for all cases with SRI and without SRI were 0.1% and 0.08%, respectively (p < 0.001). After multivariate analysis by specific procedure, SRI was not associated with increased morbidity but was associated with decreased mortality during open right colectomy (odds ratio 0.32; p = 0.01). Across all procedures, SRI was associated with increased morbidity (odds ratio 1.14; p = 0.048) but decreased mortality (odds ratio 0.42; p < 0.001). Mean OpT for all procedures was consistently lower for cases without SRI. SRI has a measurable impact on both 30-day morbidity and mortality and OpT. These data have implications to the impact associated with surgical graduate medical education. Further studies to identify causes of patient morbidity and prevention strategies in surgical teaching environments are warranted. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Estimating lifetime healthcare costs with morbidity data.

PubMed

Carreras, Marc; Ibern, Pere; Coderch, Jordi; Sánchez, Inma; Inoriza, Jose M

2013-10-25

In many developed countries, the economic crisis started in 2008 producing a serious contraction of the financial resources spent on healthcare. Identifying which individuals will require more resources and the moment in their lives these resources have to be allocated becomes essential. It is well known that a small number of individuals with complex healthcare needs consume a high percentage of health expenditures. Conversely, little is known on how morbidity evolves throughout life. The aim of this study is to introduce a longitudinal perspective to chronic disease management. Data used relate to the population of the county of Baix Empordà in Catalonia for the period 2004-2007 (average population was N = 88,858). The database included individual information on morbidity, resource consumption, costs and activity records. The population was classified using the Clinical Risk Groups (CRG) model. Future morbidity evolution was simulated under different assumptions using a stationary Markov chain. We obtained morbidity patterns for the lifetime and the distribution function of the random variable lifetime costs. Individual information on acute episodes, chronic conditions and multimorbidity patterns were included in the model. The probability of having a specific health status in the future (healthy, acute process or different combinations of chronic illness) and the distribution function of healthcare costs for the individual lifetime were obtained for the sample population. The mean lifetime cost for women was €111,936, a third higher than for men, at €81,566 (all amounts calculated in 2007 Euros). Healthy life expectancy at birth for females was 46.99, lower than for males (50.22). Females also spent 28.41 years of life suffering from some type of chronic disease, a longer period than men (21.9). Future morbidity and whole population costs can be reasonably predicted, combining stochastic microsimulation with a morbidity classification system. Potential ways of efficiency arose by introducing a time perspective to chronic disease management.

Estimating lifetime healthcare costs with morbidity data

PubMed Central

2013-01-01

Background In many developed countries, the economic crisis started in 2008 producing a serious contraction of the financial resources spent on healthcare. Identifying which individuals will require more resources and the moment in their lives these resources have to be allocated becomes essential. It is well known that a small number of individuals with complex healthcare needs consume a high percentage of health expenditures. Conversely, little is known on how morbidity evolves throughout life. The aim of this study is to introduce a longitudinal perspective to chronic disease management. Methods Data used relate to the population of the county of Baix Empordà in Catalonia for the period 2004–2007 (average population was N = 88,858). The database included individual information on morbidity, resource consumption, costs and activity records. The population was classified using the Clinical Risk Groups (CRG) model. Future morbidity evolution was simulated under different assumptions using a stationary Markov chain. We obtained morbidity patterns for the lifetime and the distribution function of the random variable lifetime costs. Individual information on acute episodes, chronic conditions and multimorbidity patterns were included in the model. Results The probability of having a specific health status in the future (healthy, acute process or different combinations of chronic illness) and the distribution function of healthcare costs for the individual lifetime were obtained for the sample population. The mean lifetime cost for women was €111,936, a third higher than for men, at €81,566 (all amounts calculated in 2007 Euros). Healthy life expectancy at birth for females was 46.99, lower than for males (50.22). Females also spent 28.41 years of life suffering from some type of chronic disease, a longer period than men (21.9). Conclusions Future morbidity and whole population costs can be reasonably predicted, combining stochastic microsimulation with a morbidity classification system. Potential ways of efficiency arose by introducing a time perspective to chronic disease management. PMID:24156613

The prevalence of COPD co-morbidities in Serbia: results of a national survey

PubMed Central

Nagorni-Obradovic, Ljudmila M; Vukovic, Dejana S

2014-01-01

Background: Research studies have found different prevalence rates for co-morbidities in patients with chronic obstructive pulmonary disease (COPD). Aims: The aim of our study was to investigate the prevalence of co-morbidities as well as functional limitations in subjects with COPD. Methods: The study was based on a nationally representative sample of the population of Serbia. Information on the health of the population was obtained from interviews and anthropometric measurements. In this study we analysed a total of 10,013 respondents aged 40 years or older. There were 653 subjects with COPD and 9,360 respondents without COPD. Results: Out of the 10,013 respondents, 5,377 were aged 40–59 years and 4,636 were 60 years or older. The prevalence of COPD was 5.0% in respondents aged 40–59 years and 8.3% in those aged 60 years or older; the total prevalence was 6.5%. The most prevalent co-morbidities among respondents with COPD were hypertension (54.5%) and dyslipidaemia (26.5%). The prevalence of all analysed co-morbidities was higher in respondents with COPD and the difference was highly statistically significant, except for stroke and malignancies, for which the difference was significant. Analysis showed that respondents with COPD had a higher prevalence of all analysed clinical factors (dizziness, obesity, anaemia and frailty) and functional impairments (mobility and hearing and visual impairment) compared with respondents without COPD. For those aged 40–59 years the difference was highest for mobility difficulty (four times higher prevalence in COPD patients) and anaemia (three times higher in COPD patients). Conclusion: Our analysis showed that the most prevalent co-morbidities in COPD were hypertension, dyslipidaemia, chronic renal disease and anxiety/depression. The finding suggests that health professionals should actively assess co-morbidities in patients with COPD. PMID:24921714

A current profile and assessment of north american cholecystectomy: results from the american college of surgeons national surgical quality improvement program.

PubMed

Ingraham, Angela M; Cohen, Mark E; Ko, Clifford Y; Hall, Bruce Lee

2010-08-01

Cholecystectomy is among the most common surgical procedures performed in the United States. The current state of cholecystectomy outcomes, including variations in hospital performance, is unclear. The objective of this study is to compare the risk factors, indications, and 30-day outcomes, as well as variations in hospital performance associated with laparoscopic (LC) versus open cholecystectomy (OC) at 221 hospitals during a 4-year period. Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database (2005-2008), patients were identified who underwent cholecystectomy and related procedures (cholangiogram and/or common bile duct exploration). Four outcomes were studied, ie, 30-day overall morbidity, serious morbidity, surgical site infections, and mortality. Forward stepwise logistic regressions yielded patient-level predicted probabilities, and hospital-level observed-to-expected ratios were determined. Of 65,511 patients, 58,659 (89.5%) underwent LC; 6,852 (10.5%) underwent OC. OC patients were considerably older with a higher comorbidity burden. LC patients were less likely to experience any morbidity (3.1% versus 17.8%; p < 0.0001), a serious morbidity (1.4% versus 11.1%; p < 0.0001), or a surgical site infection (1.3% versus 8.4%; p < 0.0001), and less likely to die (0.3% versus 2.8%; p < 0.0001). Observed-to-expected ratios for overall morbidity ranged from 0 to 3.55; for serious morbidity, 0 to 3.23; for surgical site infection, 0 to 7.02; for mortality, 0 to 13.05. Although overall incidence of adverse events is low after LC, substantial morbidity and mortality are associated with OC. Additionally, controlling for patient- and operation-related factors, considerable variations exist in hospital performance when evaluating 30-day outcomes after cholecystectomy. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Estimating mortality, morbidity and disability due to malaria among Africa's non-pregnant population.

PubMed Central

Snow, R. W.; Craig, M.; Deichmann, U.; Marsh, K.

1999-01-01

The contribution of malaria to morbidity and mortality among people in Africa has been a subject of academic interest, political advocacy, and speculation. National statistics for much of sub-Saharan Africa have proved to be an unreliable source of disease-specific morbidity and mortality data. Credible estimates of disease-specific burdens are required for setting global and national priorities for health in order to rationalize the use of limited resources and lobby for financial support. We have taken an empirical approach to defining the limits of Plasmodium falciparum transmission across the continent and interpolated the distributions of projected populations in 1995. By combining a review of the literature on malaria in Africa and models of acquired functional immunity, we have estimated the age-structured rates of the fatal, morbid and disabling sequelae following exposure to malaria infection under different epidemiological conditions. PMID:10516785

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ispen, J.; Deane, M.; Ingenito, F.E.

Comparison was made of industrial morbidity and absenteeism from upper respiratory disease with various measures of pollution and weather. Tests were conducted of workers visiting dispensaries of two plants in metropolitan Philadelphia and those working for the telephone company. Weekly morbidity was significantly correlated with temperature (r = -0.614), smoke shade (r = 0.556), particulate SO/sub 4/ (r = 0.289), and particulate matter (r = 0.264). Seasonal variation was in all variables. Pollution measures were inversely related to temperature. Particulate and SO/sub 4/ were inversely related to rainfall. SO/sub 4/ was inversely related to wind velocity. Daily correlations show day-of-weekmore » effect with lower morbidity and pollution on weekends. Higher prevalence/incidence ratio in winter was found. High morbidity was preceded by a week with low temperatures, high relative humidity, high wind velocity, and high pollutant levels, and accompanied by low temperatures, high relative humidity, and high wind.« less

[Preoperative risk assessment with the ASA classification. A prospective study of morbidity and mortality in various ASA classes in 2,937 patients in general surgery].

PubMed

Menke, H; John, K D; Klein, A; Lorenz, W; Junginger, T

1992-12-01

The value of ASA classification in assessment of perioperative risk, i.e. especially postoperative morbidity, was analyzed prospectively using the data of 2937 patients. The analysis took into account the criteria validity, reliability, and sensitivity. The incidence of post-operative morbidity after elective surgery rose from 3.9% in ASA class I to 36% in ASA class IV. Mortality was 0.6% in ASA class II, whereas 9.3% died in ASA class IV. Morbidity, mortality respectively, after emergency surgery was 10.2% in ASA class II compared to 69% in class IV, mortality 1.4% compared to 21.5%. Differences between the ASA classes were confirmed (p-value < 0.05) considering separate kinds of complications and different periods. Furthermore, ASA classification was a valuable reference to length of stay and severity of necessary therapy at the ICU.

Rubbing ointments and asthma morbidity in adolescents.

PubMed

Reznik, Marina; Sharif, Iman; Ozuah, Philip O

2004-12-01

To determine the relationship between the use of rubbing ointments and asthma morbidity in adolescents. Cross-sectional study. Inner-city high school in the Bronx, New York. 165 adolescents with asthma. Asthma morbidity, defined as emergency department (ED) use for asthma in the past year and over the lifetime. While 127 (77%) of subjects used albuterol as the first treatment for their last asthma attack, 18 (11%) used rubbing ointments. The rubs and albuterol groups were similar in asthma severity, mean age, gender, and ethnicity. However, subjects in the the rubs group were less likely than subjects in the albuterol group to have made an ED visit over the past 12 months or over their lifetime. Regression analysis revealed that, after controlling for asthma severity, use of rubs independently predicted less lifetime ED use. After controlling for asthma severity, use of rubs by adolescents with asthma was associated with lower asthma morbidity as measured by ED use.

Two studies of psychiatric morbidity among motor vehicle accident survivors 1 year after the crash.

PubMed

Blanchard, Edward B; Hickling, Edward J; Freidenberg, Brian M; Malta, Loretta S; Kuhn, Eric; Sykes, Mark A

2004-05-01

We assessed the psychiatric co-morbidity associated with chronic posttraumatic stress disorder (PTSD) (1-2 years) secondary to personal injury motor vehicle accidents (MVAs) in two studies. In Study 1, we compared the results of SCID assessments for 75 treatment-seeking MVA survivors (51 with PTSD and 24 with symptoms but no PTSD). In Study 2, we compared similar results among 132 MVA survivors who had been followed prospectively for 12+ months after their accidents (19 with PTSD, 32 who had PTSD but who had remitted, and 81 who never met criteria for PTSD). We found comparable levels of current co-morbid major depression (53%), any mood disorder (62-68%), generalized anxiety disorder (26%) and any anxiety disorder (42%) for both groups of participants with chronic PTSD. These rates of co-morbidity were higher than those found in non-PTSD comparison groups with similar MVA histories.

[Incidence of fetal macrosomia: maternal and fetal morbidity].

PubMed

Rodríguez-Rojas, R R; Cantú-Esquivel, M G; Benavides-de la Garza, L; Benavides-de Anda, L

1996-06-01

The macrosomia is an obstetric eventuality associated to high maternal-fetal morbidity-mortality. This assay was planned in order to know the incidence of macrosomia in our institution, the relation between vaginal and abdominal deliveries and the fetal-maternal morbidity we reviewed 3590 records and we found 5.6% incidence of macrosomia in the global obstetric population. There was 58% of vaginal deliveries, 68% of the newborn were male. The main complications were in the C. sections, 2 laceration of the hysterectomy, and 2 peroperative atonias. In the vaginal deliveries, the lacerations of III and IV grade were 9 of each grade. The main fetal complications were 5 slight to severe asphyxia and 4 shoulder dystocias. This assay concludes that the macrosomia in our service is similar to the already published ones, a 42% were C. section and the maternal-fetal morbidity was low.

Compression of Morbidity 1980–2011: A Focused Review of Paradigms and Progress

PubMed Central

Fries, James F.; Bruce, Bonnie; Chakravarty, Eliza

2011-01-01

The Compression of Morbidity hypothesis—positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability—was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based “healthy aging” interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity. PMID:21876805

Compression of morbidity 1980-2011: a focused review of paradigms and progress.

PubMed

Fries, James F; Bruce, Bonnie; Chakravarty, Eliza

2011-01-01

The Compression of Morbidity hypothesis-positing that the age of onset of chronic illness may be postponed more than the age at death and squeezing most of the morbidity in life into a shorter period with less lifetime disability-was introduced by our group in 1980. This paper is focused upon the evolution of the concept, the controversies and responses, the supportive multidisciplinary science, and the evolving lines of evidence that establish proof of concept. We summarize data from 20-year prospective longitudinal studies of lifestyle progression of disability, national population studies of trends in disability, and randomized controlled trials of risk factor reduction with life-style-based "healthy aging" interventions. From the perspective of this influential and broadly cited paradigm, we review its current history, the development of a theoretical structure for healthy aging, and the challenges to develop coherent health policies directed at reduction in morbidity.

Could the improvement of obesity-related co-morbidities depend on modified gut hormones secretion?

PubMed Central

Finelli, Carmine; Padula, Maria Carmela; Martelli, Giuseppe; Tarantino, Giovanni

2014-01-01

Obesity and its associated diseases are a worldwide epidemic disease. Usual weight loss cures - as diets, physical activity, behavior therapy and pharmacotherapy - have been continuously implemented but still have relatively poor long-term success and mainly scarce adherence. Bariatric surgery is to date the most effective long term treatment for morbid obesity and it has been proven to reduce obesity-related co-morbidities, among them nonalcoholic fatty liver disease, and mortality. This article summarizes such variations in gut hormones following the current metabolic surgery procedures. The profile of gut hormonal changes after bariatric surgery represents a strategy for the individuation of the most performing surgical procedures to achieve clinical results. About this topic, experts suggest that the individuation of the crosslink among the gut hormones, microbiome, the obesity and the bariatric surgery could lead to new and more specific therapeutic interventions for severe obesity and its co-morbidities, also non surgical. PMID:25469034

Child morbidity and care-seeking in Nairobi slum settlements: the role of environmental and socio-economic factors.

PubMed

Ndugwa, Robert Peter; Zulu, Eliya M

2008-12-01

The aim of this study was to investigate factors that influence morbidity patterns and health-seeking decisions in an urban slum community. Data were collected between May and August 2003 as part of the ongoing Nairobi urban demographic surveillance system and were analysed to identify factors that influence morbidity patterns and health-seeking decisions. The results show that the factors that influenced morbidity were the child's age, ethnicity and type of toilet facility. Predictors for seeking health care were the child's age, type and severity of illness, survival of father and mother, mother's education, mother's work status and wealth class. The conclusions drawn show that economic resources fall short in preventing child illnesses where children live in poor environmental conditions. However, by enhancing access to health care services, socio-economic status is critical for mitigating disease burden among children in slum settlements.

The relationship between hypochondriasis and medical illness.

PubMed

Barsky, A J; Wyshak, G; Latham, K S; Klerman, G L

1991-01-01

Forty-one Diagnostic and Statistical Manual of Mental Disorders-III-Revised hypochondriacs were accrued from a primary care practice. Seventy-five control subjects were selected at random from among the remainder of the patients in the same clinic. All subjects completed a structured diagnostic interview and standardized self-report questionnaires. Medical morbidity was assessed with a medical record audit and with primary physicians' ratings. The hypochondriacal and comparison samples did not differ in aggregate medical morbidity, although the hypochondriacal sample had more undiagnosed complaints and nonspecific findings in their medical records. Within the comparison sample, higher levels of medical morbidity were associated with higher levels of hypochondriacal symptoms. This occurred primarily because the most serious medical disorders were associated with more bodily preoccupation, disease conviction, and somatization. Within the hypochondriacal sample, no correlation was found between the degree of hypochondriasis and the extent of medical morbidity.

Meta-analysis of surgical safety checklist effects on teamwork, communication, morbidity, mortality, and safety.

PubMed

Lyons, Vanessa E; Popejoy, Lori L

2014-02-01

The purpose of this study is to examine the effectiveness of surgical safety checklists on teamwork, communication, morbidity, mortality, and compliance with safety measures through meta-analysis. Four meta-analyses were conducted on 19 studies that met the inclusion criteria. The effect size of checklists on teamwork and communication was 1.180 (p = .003), on morbidity and mortality was 0.123 (p = .003) and 0.088 (p = .001), respectively, and on compliance with safety measures was 0.268 (p < .001). The results indicate that surgical safety checklists improve teamwork and communication, reduce morbidity and mortality, and improve compliance with safety measures. This meta-analysis is limited in its generalizability based on the limited number of studies and the inclusion of only published research. Future research is needed to examine possible moderating variables for the effects of surgical safety checklists.

Spinal and temporo-mandibular disorders in male workers of the State Police.

PubMed

Sancini, Angela; Tomei, Francesco; Tomei, Gianfranco; Caciari, Tiziana; Capozzella, Assunta; Di Famiani, Manuela; Samperi, Ilaria; Scala, Barbara; Fiaschetti, Maria; Cetica, Carlotta; Ciarrocca, Manuela

2013-01-01

The aims of this study are to evaluate the prevalence of disorders of the lumbar region and the temporo-mandibular district co-morbidity in drivers and workers of the State Police employed for different office activities. The study population included 103 drivers as cases and 100 police officers as controls. The study was carried out through questionnaire and clinical evaluation of the spine and temporo-mandibular region. At clinical examination, the drivers were found to have a higher prevalence (p < 0.05) of both symptoms and clinical signs at the spine and temporo-mandibular joint (TMJ), when compared with the controls. The results also showed a higher prevalence (p < 0.05) of co-morbidity in the two districts among the drivers, when compared with the controls. These results confirm that morbidity related to back and TMJ and increase in co-morbidity between the two districts are higher in professional drivers.

Inter-Pregnancy Intervals and Maternal Morbidity: New Evidence from Rwanda.

PubMed

Habimana-Kabano, Ignace; Broekhuis, Annelet; Hooimeijer, Pieter

2015-09-01

The effects of short and long pregnancy intervals on maternal morbidity have hardly been investigated. This research analyses these effects using logistic regression in two steps. First, data from the Rwanda Demographic and Health Survey 2010 are used to study delivery referrals to District hospitals. Second, Kibagabaga District Hospital's maternity records are used to study the effect of inter-pregnancy intervals on maternal morbidity. The results show that both short and long intervals lead to higher odds of being referred because of pregnancy or delivery complications. Once admitted, short intervals were not associated with higher levels of maternal morbidity. Long intervals are associated with higher risks of third trimester bleeding, premature rupture of membrane and lower limb edema, while a higher age at conception is associated with lower risks. Poor women from rural areas and with limited health insurance are less often admitted to a hospital, which might bias the results.

How best to capture the respiratory consequences of prematurity?

PubMed

Ciuffini, Francesca; Robertson, Colin F; Tingay, David G

2018-03-31

Chronic respiratory morbidity is a common complication of premature birth, generally defined by the presence of bronchopulmonary dysplasia, both clinically and in trials of respiratory therapies. However, recent data have highlighted that bronchopulmonary dysplasia does not correlate with chronic respiratory morbidity in older children born preterm. Longitudinally evaluating pulmonary morbidity from early life through to childhood provides a more rational method of defining the continuum of chronic respiratory morbidity of prematurity, and offers new insights into the efficacy of neonatal respiratory interventions. The changing nature of preterm lung disease suggests that a multimodal approach using dynamic lung function assessment will be needed to assess the efficacy of a neonatal respiratory therapy and predict the long-term respiratory consequences of premature birth. Our aim is to review the literature regarding the long-term respiratory outcomes of neonatal respiratory strategies, the difficulties of assessing dynamic lung function in infants, and potential new solutions. Copyright ©ERS 2018.

Antenatal care and morbidity profile of pregnant women in an urban resettlement colony of Delhi, India.

PubMed

Rustagi, N; Prasuna, J G; Vibha, M D

2011-06-01

The burden of antenatal morbidities and health care services utilization during antenatal period serve an important role in defining service needs and to assess reproductive health status of women. To evaluate the burden of antenatal morbidities in women and to assess the health care utilization by study subjects during antenatal period. A community based follow up study was carried out in an urban resettlement colony of Delhi. All pregnant women in the study area were enrolled and followed for two more visits to collect information about morbidities suffered and health care services utilized during pregnancy. Appropriate tests of significance were applied. Of 358 women enrolled, three hundred could be followed for two more visits. Majority of women (80.3%) suffered one or more morbidities during their current pregnancy but overall care sought for illness during pregnancy was poor. Visits for routine preventive check up was made by most of women (95% and above) but recommended three antenatal visits was significantly low among women of age more than thirty (OR=16.6; 2.2-125.9), of lower middle socio economic status (OR=2.84; 1.16-6.93) and parity three or more (OR=4.37; 1.07-17.83). Women with education status of high school and above had significantly lower odd ratio (OR=0.33; 0.11-0.99) for having less than three antenatal visits. Care sought for antenatal morbidities is still poor among women of urban resettlement colonies and age, parity and education of women has a significant bearing on antenatal visits.

Risk-adjusted hospital outcomes for children's surgery.

PubMed

Saito, Jacqueline M; Chen, Li Ern; Hall, Bruce L; Kraemer, Kari; Barnhart, Douglas C; Byrd, Claudia; Cohen, Mark E; Fei, Chunyuan; Heiss, Kurt F; Huffman, Kristopher; Ko, Clifford Y; Latus, Melissa; Meara, John G; Oldham, Keith T; Raval, Mehul V; Richards, Karen E; Shah, Rahul K; Sutton, Laura C; Vinocur, Charles D; Moss, R Lawrence

2013-09-01

BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program-Pediatric was initiated in 2008 to drive quality improvement in children's surgery. Low mortality and morbidity in previous analyses limited differentiation of hospital performance. Participating institutions included children's units within general hospitals and free-standing children's hospitals. Cases selected by Current Procedural Terminology codes encompassed procedures within pediatric general, otolaryngologic, orthopedic, urologic, plastic, neurologic, thoracic, and gynecologic surgery. Trained personnel abstracted demographic, surgical profile, preoperative, intraoperative, and postoperative variables. Incorporating procedure-specific risk, hierarchical models for 30-day mortality and morbidities were developed with significant predictors identified by stepwise logistic regression. Reliability was estimated to assess the balance of information versus error within models. In 2011, 46 281 patients from 43 hospitals were accrued; 1467 codes were aggregated into 226 groupings. Overall mortality was 0.3%, composite morbidity 5.8%, and surgical site infection (SSI) 1.8%. Hierarchical models revealed outlier hospitals with above or below expected performance for composite morbidity in the entire cohort, pediatric abdominal subgroup, and spine subgroup; SSI in the entire cohort and pediatric abdominal subgroup; and urinary tract infection in the entire cohort. Based on reliability estimates, mortality discriminates performance poorly due to very low event rate; however, reliable model construction for composite morbidity and SSI that differentiate institutions is feasible. The National Surgical Quality Improvement Program-Pediatric expansion has yielded risk-adjusted models to differentiate hospital performance in composite and specific morbidities. However, mortality has low utility as a children's surgery performance indicator. Programmatic improvements have resulted in actionable data.

Multi-morbidity, dependency, and frailty singly or in combination have different impact on health outcomes.

PubMed

Woo, Jean; Leung, Jason

2014-04-01

Multi-morbidity, dependency, and frailty were studied simultaneously in a community-living cohort of 4,000 men and women aged 65 years and over to examine the independent and combined effects on four health outcomes (mortality, decline in physical function, depression, and polypharmacy). The influence of socioeconomic status on these relationships is also examined. Mortality data was documented after a mean follow-up period of 9 years, while other health outcomes were documented after 4 years of follow-up. Fifteen percent of the cohort did not have any of these syndromes. Of the remaining participants, nearly one third had multi-morbidity and frailty (pre-frail and frail), while all three syndromes were present in 11 %. All syndromes as well as socioeconomic status were significantly associated with all health outcomes. Mortality was only increased for age, being male, frailty status, and combinations of syndromes that included frailty. Both multi-morbidity and frailtymale was protective. Only a combination of all three syndromes, and age per se, increased the risk of depressive symptoms at 4 years while being male conferred reduced risk. Multi-morbidity, but not frailty status or dependency, and all syndrome combinations that included multi-morbidity were associated with use of ≥ four medications. Decline in homeostatic function with age may thus be quantified and taken into account in prediction of various health outcomes, with a view to prevention, management, formulation of guidelines, service planning, and the conduct of randomized controlled trials of interventions or treatment.

Investigating the Effectiveness of Current and Modified World Health Organization Guidelines for the Control of Soil-Transmitted Helminth Infections.

PubMed

Farrell, Sam H; Coffeng, Luc E; Truscott, James E; Werkman, Marleen; Toor, Jaspreet; de Vlas, Sake J; Anderson, Roy M

2018-06-01

Considerable efforts have been made to better understand the effectiveness of large-scale preventive chemotherapy therapy for the control of morbidity caused by infection with soil-transmitted helminths (STHs): Ascaris lumbricoides, Trichuris trichiura, and the 2 hookworm species, Necator americanus and Ancylostoma duodenale. Current World Health Organization (WHO) guidelines for STH control include mass drug administration (MDA) programs based on prevalence measurements, aiming at reducing morbidity in pre-school-aged children (pre-SAC) and school-aged children (SAC) by lowering the prevalence of moderate- to heavy-intensity infections to <1%. We project the likely impact of following the current WHO guidelines and assess whether the WHO morbidity goals will be achieved across a range of transmission settings. We also investigate modifications that could be made to the current WHO treatment guidelines, and project their potential impacts in achieving morbidity and transmission control. While the standard guidelines are sufficient at low transmission levels, community-wide treatment (ie, involving pre-SAC, SAC, and adults) is essential if WHO morbidity goals are to be met in moderate- to high-transmission settings. Moreover, removing the recommendation of decreasing the treatment frequency at midline (5-6 years after the start of MDA) further improves the likelihood of achieving morbidity control in SAC. We meld analyses based on 2 mathematical models of parasite transmission and control by MDA for the dominant STH species, to generate a unified treatment approach applicable across all settings, regardless of which STH infection is most common. We recommend clearly defined changes to the current WHO guidelines.

Are self-reports of health and morbidities in developing countries misleading? Evidence from India

PubMed Central

Subramanyam, Malavika A; Selvaraj, Sakthivel; Kawachi, Ichiro

2009-01-01

Self reported measures of poor health and morbidities from developing countries tend to be viewed with considerable skepticism. Examination of the social gradient in self-reported health and morbidity measures provides a useful test of the validity of self-reports of poor-health and morbidities. The prevailing view, in part influenced by Amartya Sen, is that socially disadvantaged individuals will fail to perceive and report the presence of illness or health-deficits because an individual’s assessment of their health is directly contingent on their social experience. In this study, we tested whether the association between self-reported poor-health/morbidities and socioeconomic status (SES) in India follows the expected direction or not. Cross sectional logistic regression analyses were carried out on a nationally representative population based sample from the 1998–99 Indian National Family Health Survey (INFHS); and 1995–96 and 2004 Indian National Sample Survey (INSS). Four binary outcomes were analyzed: any self-reported morbidity; self-reported sickness in the last 15 days; self-reported sickness in the past year; and poor self-rated health. In separate adjusted models, individuals with no education reported higher levels of any self-reported, self-reported sickness in the last 15 days, self-reported sickness in the last year, and poor self-rated health compared to those with most education. Contrary to the prevailing thesis, we find that the use of self-rated ill health has face validity as assessed via its relationship to SES. A less dismissive and pessimistic view of health data obtained through self-reports seems warranted. PMID:19019521

Are self-reports of health and morbidities in developing countries misleading? Evidence from India.

PubMed

Subramanian, S V; Subramanyam, Malavika A; Selvaraj, Sakthivel; Kawachi, Ichiro

2009-01-01

Self-reported measures of poor health and morbidities from developing countries tend to be viewed with considerable skepticism. Examination of the social gradient in self-reported health and morbidity measures provides a useful test of the validity of self-reports of poor health and morbidities. The prevailing view, in part influenced by Amartya Sen, is that socially disadvantaged individuals will fail to perceive and report the presence of illness or health-deficits because an individual's assessment of their health is directly contingent on their social experience. In this study, we tested whether the association between self-reported poor health/morbidities and socioeconomic status (SES) in India follows the expected direction or not. Cross-sectional logistic regression analyses were carried out on a nationally representative population-based sample from the 1998 to 1999 Indian National Family Health Survey (INFHS); and 1995-1996 and 2004 Indian National Sample Survey (INSS). Four binary outcomes were analyzed: any self-reported morbidity; self-reported sickness in the last 15 days; self-reported sickness in the past year; and poor self-rated health. In separate adjusted models, individuals with no education reported higher levels of any self-reported, self-reported sickness in the last 15 days, self-reported sickness in the last year, and poor self-rated health compared to those with most education. Contrary to the prevailing thesis, we find that the use of self-rated ill-health has face validity as assessed via its relationship to SES. A less dismissive and pessimistic view of health data obtained through self-reports seems warranted.

[EVALUATION OF A COMPREHENSIVE PROGRAM OF FOUR MONTHS OF DURATION ON THE PREOPERATIVE CONDITIONS OF OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY].

PubMed

Delgado Floody, Pedro; Cofré Lizama, Alfonso; Alarcón Hormazábal, Manuel; Osorio Poblete, Aldo; Caamaño Navarrete, Felipe; Jerez Mayorga, Daniel

2015-09-01

in the morbidly obese there is preoperative background that must be improved to reduce the risk of morbidity and mortality. to evaluate the effects of a multidisciplinary treatment on anthropometric parameters, fasting glucose, physical condition and levels of depression and anxiety of morbidly obese patients with co-morbidities and obese candidates for bariatric surgery. four men and ten women between 21 and 55 year old candidates for bariatric surgery, with morbidly (n = 5) or obesity and comorbidities (diabetes mellitus type II, hypertension, dyslipidemia, insulin resistance) (n = 9) they underwent multidisciplinary treatment such as; Interval exercise, counseling and nutrition education, three times a week for four months. Before and 72 hours after the last intervention session was evaluated (≥ 12 hours fasting): body mass, body fat percentage (% fat), body mass index (BMI), waist circumference (WC), and glycemia basal. Besides fitness and levels of depression and anxiety were evaluated. significant decreases were evident in variable weight (p = 0.004), BMI (p = 0.000),% FM (p = 0.001), baseline glycemia (p = 0.02), WC (p = 0.000), the condition physical significantly increased (p = 0.000), in the psychological, levels of depression decreased significantly (p = 0.014), whereas the levels of anxiety as a state; transitory emotional condition and trait anxiety; anxious propensity relatively stable, there were no significant changes (p > 0.05). four months of treatment improve preoperative conditions of obese candidates for bariatric surgery and reduce the risk of morbidity and mortality. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

A multifaceted community-based asthma intervention in Chicago: effects of trigger reduction and self-management education on asthma morbidity.

PubMed

Turyk, Mary; Banda, Elizabeth; Chisum, Gay; Weems, Dolores; Liu, Yangyang; Damitz, Maureen; Williams, Rhonda; Persky, Victoria

2013-09-01

Home-based, multifaceted interventions have been effective in reducing asthma morbidity in children. However, identification of independent components that contribute to outcomes and delineating effectiveness by level of asthma symptoms would help to refine the intervention and target appropriate populations. A community health educator led asthma intervention implemented in a low-income African-American neighborhood included asthma management education, individually tailored low-cost asthma home trigger remediation, and referrals to social and medical agencies, when appropriate. Changes in asthma morbidity measures were assessed in relation to implementation of individual intervention components using multivariable logistic regression. Among the 218 children who completed the year-long program, there were significant reductions in measures of asthma morbidity, including symptoms, urgent care visits, emergency department (ED) visits, hospitalizations, missed school days, and missed work days for caretakers. We also found significant decreases in the prevalence of many home asthma triggers and improvements in asthma management practices. Improvement in caretaker's ability to manage the child's asthma was associated with reduction in ED visits for asthma and uncontrolled asthma. Specific home interventions, such as repair of water leaks and reduced exposure to plants, dust, clutter and stuffed toys, may be related to reduction in asthma morbidity. This program was effective in reducing asthma morbidity in low-income African-American children and identified specific interventions as possible areas to target in future projects. Furthermore, the intervention was useful in children with persistent asthma symptoms as well as those with less frequent asthma exacerbations.

Central bank interest rate decisions, household indebtedness, and psychiatric morbidity and distress: Evidence from the UK.

PubMed

Boyce, Christopher J; Delaney, Liam; Ferguson, Eamonn; Wood, Alex M

2018-07-01

Central banks set economy-wide interest rates to meet exclusively economic objectives. There is a strong link between indebtedness and psychiatric morbidity at the individual level, with interest rates being an important factor determining ability to repay debt. However, no prior research has explored whether central bank interest rate changes directly influence mental health, nor whether this varies by levels of indebtedness. We use British data (N = 93,255) to explore whether the Bank of England base-rate affected how perceived burden of non-mortgage debt (low, medium, and high) influenced psychiatric morbidity. Psychiatric morbidity was measured using the General Health Questionnaire (GHQ-12). Our primary outcome measure was a binary indicator of "psychiatric caseness" (>3 on a 0-12 scale). We also used the GHQ-12 as a continuous measure of distress. When interest rates are high (low) there is an increased (decreased) risk of psychiatric morbidity only among those with a high debt burden (b = 0.026, p =  0.02). This result was robust to alternative explanations. Thus a 1 percentage point base-rate increase is associated with a 2.6% increase that someone with a high debt burden will experience psychiatric morbidity. Our study uses subjective indicators of debt burden. We were unable to determine the mechanism behind our effect. Changes in central bank interest rates to meet economic objectives pose a threat to mental health. Mental health support is needed for those in debt and central banks may need to consider how their decisions influence population mental health. Copyright © 2018. Published by Elsevier B.V.

A Meta-Analysis of the Effect of Preoperative Biliary Stenting on Patients With Obstructive Jaundice

PubMed Central

Sun, Chengyi; Yan, Guirong; Li, Zhiming; Tzeng, Chi-Meng

2014-01-01

Abstract The goal of this study was to systematically review the effects of biliary stenting on postoperative morbidity and mortality of patients with obstructive jaundice. PubMed, Embase, Cochrane Library, and other relevant databases were searched by computer and manually for published and unpublished studies on the impact of preoperative biliary drainage on patients with obstructive jaundice from 2000 to the present day. Two investigators independently selected the studies according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of the selected studies. Meta-analysis was performed to compare postoperative morbidity and mortality of patients between the drainage and nondrainage groups. Compared with the nondrainage group, the overall mortality, overall morbidity, infectious morbidity, incidence of wound infection, intra-abdominal abscess, pancreatic fistulas, bile leak, and delayed gastric emptying in the drainage group were not significantly different. Compared with the nondrainage group, the drainage group had a drainage time of <4 weeks with an increased overall morbidity by 7% to 23%; however, the overall morbidity of the drainage group with a drainage time >4 weeks was not significantly different. Compared with the nondrainage group, the overall mortality of the drainage group using metal stents and plastic stents as internal drainage devices was reduced by 0.5% to 6%, whereas that of the drainage group using plastic stent devices was not significantly different. In summary, preoperative drainage should be applied selectively. The drainage time should be >4 weeks, and metal stents should be used for internal drainage. PMID:25474436

Non-operative management of blunt hepatic trauma: Does angioembolization have a major impact?

PubMed

Bertens, K A; Vogt, K N; Hernandez-Alejandro, R; Gray, D K

2015-02-01

A paradigm shift toward non-operative management (NOM) of blunt hepatic trauma has occurred. With advances in percutaneous interventions, even severe liver injuries are being managed non-operatively. However, although overall mortality is decreased with NOM, liver-related morbidity remains high. This study was undertaken to explore the morbidity and mortality of blunt hepatic trauma in the era of angioembolization (AE). A retrospective cohort of trauma patients with blunt hepatic injury who were assessed at our centre between 1999 and 2011 were identified. Logistic regression was undertaken to identify factors increasing the likelihood of operative management (OM) and mortality. We identified 396 patients with a mean ISS of 33 (± 14). Sixty-two (18%) patients had severe liver injuries (≥ AAST grade IV). OM occurred in 109 (27%) patients. Logistic regression revealed high ISS (OR 1.07; 95% CI 1.05-1.10), and lower systolic blood pressure on arrival (OR 0.98; 95% CI 0.97-0.99) to be associated with OM. The overall mortality was 17%. Older patients (OR 1.05; 95% CI 1.03-1.07), those with high ISS (OR 1.11; 95% CI 1.08-1.14) and those requiring OM (OR 2.89; 95% CI 1.47-5.69) were more likely to die. Liver-related morbidities occurred in equal frequency in the OM (23%) and AE (29%) groups (p = 0.32). Only 3% of those with NOM experienced morbidity. The majority of patients with blunt hepatic trauma can be successfully managed non-operatively. Morbidity associated with NOM was low. Patients requiring AE had morbidity similar to OM.

Influence of educational attainments on long term glucose control and morbid events in patients with type 2 diabetes receiving integrated care from 15 China urban communities: The Beijing Community Diabetes Study 11.

PubMed

Yang, Guang-Ran; Yuan, Shen-Yuan; Fu, Han-Jing; Wan, Gang; Zhu, Liang-Xiang; Yuan, Ming-Xia; Lv, Yu-Jie; Zhang, Jian-Dong; Du, Xue-Ping; Li, Yu-Ling; Ji, Yu; Zhou, Li; Li, Yue

2015-12-01

To investigate the effects of educational attainment on glucose control and morbid events in patients with type 2 diabetes in Beijing communities. In this prospective multi-center study, 2866 type 2 diabetes patients receiving integrated care from 15 Beijing urban communities were investigated. Educational attainment was categorized into three levels: low, medium, and high. After a 42-month management, glucose control parameters and morbid events were analyzed. At baseline, the percentages of patients with good glucose control (HbA1c ≤ 7.0%) in the low, medium and high educational groups were 49.09%, 54.82% and 62.59%, respectively (P<0.001). After the 42-month management, fasting plasma glucose and HbA1c values were the highest in the low educational group (7.51 ± 2.05 mmol/l and 7.20 ± 1.27%, respectively). Percentages of patients with good glucose control in the three groups were 49.6%, 55.83% and 67.23%, respectively, and the incidences of combined morbid events were 4.5%, 2.4% and 1.5%, respectively. Cox regression analysis showed that educational level was related to the incidence of combined morbid events (medium level, HR=0.572; high level, HR=0.351; P<0.05). Educational level was associated with long-term glucose control, and seemed to be related to the incidence of combined morbid events in people with type 2 diabetes. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Validation of risk assessment scoring systems for an audit of elective surgery for gastrointestinal cancer in elderly patients: an audit.

PubMed

Wakabayashi, Hisao; Sano, Takanori; Yachida, Shinichi; Okano, Keiichi; Izuishi, Kunihiko; Suzuki, Yasuyuki

2007-10-01

The goal of this study was to validate the usefulness of risk assessment scoring systems for a surgical audit in elective digestive surgery for elderly patients. The validated scoring systems used were the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and the Portsmouth predictor equation for mortality (P-POSSUM). This study involved 153 consecutive patients aged 75 years and older who underwent elective gastric or colorectal surgery between July 2004 and June 2006. A retrospective analysis was performed on data collected prior to each surgery. The predicted mortality and morbidity risks were calculated using each of the scoring systems and were used to obtain the observed/predicted (O/E) mortality and morbidity ratios. New logistic regression equations for morbidity and mortality were then calculated using the scores from the POSSUM system and applied retrospectively. The O/E ratio for morbidity obtained from POSSUM score was 0.23. The O/E ratios for mortality from the POSSUM score and the P-POSSUM were 0.15 and 0.38, respectively. Utilizing the new equations using scores from the POSSUM, the O/E ratio increased to 0.88. Both the POSSUM and P-POSSUM over-predicted the morbidity and mortality in elective gastrointestinal surgery for malignant tumors in elderly patients. However, if a surgical unit makes appropriate calculations using its own patient series and updates these equations, the POSSUM system can be useful in the risk assessment for surgery in elderly patients.

Using audit to enhance quality of maternity care in resource limited countries: lessons learnt from rural Tanzania.

PubMed

Nyamtema, Angelo S; de Jong, Alise Bartsch; Urassa, David P; van Roosmalen, Jos

2011-11-16

Although clinical audit is an important instrument for quality care improvement, the concept has not yet been adequately taken on board in rural settings in most resource limited countries where the problem of maternal mortality is immense. Maternal mortality and morbidity audit was established at Saint Francis Designated District Hospital (SFDDH) in rural Tanzania in order to generate information upon which to base interventions. Methods are informed by the principles of operations research. An audit system was established, all patients fulfilling the inclusion criteria for maternal mortality and severe morbidity were reviewed and selected cases were audited from October 2008 to July 2010. The causes and underlying factors were identified and strategic action plans for improvement were developed and implemented. There were 6572 deliveries and 363 severe maternal morbidities of which 36 women died making institutional case fatality rate of 10%. Of all morbidities 341 (94%) had at least one area of substandard care. Patients, health workers and administration related substandard care factors were identified in 50% - 61% of women with severe morbidities. Improving responsiveness to obstetric emergencies, capacity building of the workforce for health care, referral system improvement and upgrading of health centres located in hard to reach areas to provide comprehensive emergency obstetric care (CEmOC) were proposed and implemented as a result of audit. Our findings indicate that audit can be implemented in rural resource limited settings and suggest that the vast majority of maternal mortalities and severe morbidities can be averted even where resources are limited if strategic interventions are implemented.

Cardiovascular risk factors predictive for survival and morbidity-free survival in the oldest-old Framingham Heart Study participants.

PubMed

Terry, Dellara F; Pencina, Michael J; Vasan, Ramachandran S; Murabito, Joanne M; Wolf, Philip A; Hayes, Margaret Kelly; Levy, Daniel; D'Agostino, Ralph B; Benjamin, Emelia J

2005-11-01

To examine whether midlife cardiovascular risk factors predict survival and survival free of major comorbidities to the age of 85. Prospective community-based cohort study. Framingham Heart Study, Massachusetts. Two thousand five hundred thirty-one individuals (1,422 women) who attended at least two examinations between the ages of 40 and 50. Risk factors were classified at routine examinations performed between the ages of 40 and 50. Stepwise sex-adjusted logistic regression models predicting the outcomes of survival and survival free of morbidity to age 85 were selected from the following risk factors: systolic and diastolic blood pressure, total serum cholesterol, glucose intolerance, cigarette smoking, education, body mass index, physical activity index, pulse pressure, antihypertensive medication, and electrocardiographic left ventricular hypertrophy. More than one-third of the study sample survived to age 85, and 22% of the original study sample survived free of morbidity. Lower midlife blood pressure and total cholesterol levels, absence of glucose intolerance, nonsmoking status, higher educational attainment, and female sex predicted overall and morbidity-free survival. The predicted probability of survival to age 85 fell in the presence of accumulating risk factors: 37% for men with no risk factors to 2% with all five risk factors and 65% for women with no risk factors to 14% with all five risk factors. Lower levels of key cardiovascular risk factors in middle age predicted overall survival and major morbidity-free survival to age 85. Recognizing and modifying these factors may delay, if not prevent, age-related morbidity and mortality.

Role of physical activity, physical fitness, and chronic health conditions on the physical independence of community-dwelling older adults over a 5-year period.

PubMed

Pereira, Catarina; Baptista, Fátima; Cruz-Ferreira, Ana

2016-01-01

The variability in the individual characteristics and habits could help determine how older adults maintain independence. The impact of the variability in physical activity, physical fitness, body composition, and chronic health conditions (co-morbidities) on the independence of older adults, especially over time, is seldom examined. This study aims to analyze quantitatively the impact of baseline values and changes in physical activity, physical fitness, body composition, and co-morbidities on the physical independence of community-dwelling, older adults over a 5-year period. Data from 106 and 85 community-dwelling adults (≥60 years) were collected at baseline and after five years, respectively. Linear regression selected the main predictors of changes in physical independence as follows: the baseline physical independence (β=0.032, R(2)=9.9%) and co-morbidities (β=-0.191, R(2)=6.3%) and the changes in co-morbidities (β=-0.244, R(2)=10.8%), agility (β=-0.288, R(2)=6.7%), aerobic endurance (β=0.007, R(2)=3.2%), and walking expenditure (β=0.001, R(2)=5.1%) (p<0.05). In conclusion, baseline physical independence, baseline co-morbidities, and changes in co-morbidities, walking, agility, and aerobic endurance predicted physical independence over five years regardless of age and gender. Gains of up to 8.3% in physical independence were associated with improvements in these variables, which corresponds to regaining independence for performing one or two activities of daily living. Copyright © 2016. Published by Elsevier Ireland Ltd.

Contrasting patterns of hot spell effects on morbidity and mortality for cardiovascular diseases in the Czech Republic, 1994-2009

NASA Astrophysics Data System (ADS)

Hanzlíková, Hana; Plavcová, Eva; Kynčl, Jan; Kříž, Bohumír; Kyselý, Jan

2015-11-01

The study examines effects of hot spells on cardiovascular disease (CVD) morbidity and mortality in the population of the Czech Republic, with emphasis on differences between ischaemic heart disease (IHD) and cerebrovascular disease (CD) and between morbidity and mortality. Daily data on CVD morbidity (hospital admissions) and mortality over 1994-2009 were obtained from national hospitalization and mortality registers and standardized to account for long-term changes as well as seasonal and weekly cycles. Hot spells were defined as periods of at least two consecutive days with average daily air temperature anomalies above the 95 % quantile during June to August. Relative deviations of mortality and morbidity from the baseline were evaluated. Hot spells were associated with excess mortality for all examined cardiovascular causes (CVD, IHD and CD). The increases were more pronounced for CD than IHD mortality in most population groups, mainly in males. In the younger population (0-64 years), however, significant excess mortality was observed for IHD while there was no excess mortality for CD. A short-term displacement effect was found to be much larger for mortality due to CD than IHD. Excess CVD mortality was not accompanied by increases in hospital admissions and below-expected-levels of morbidity prevailed during hot spells, particularly for IHD in the elderly. This suggests that out-of-hospital deaths represent a major part of excess CVD mortality during heat and that for in-hospital excess deaths CVD is a masked comorbid condition rather than the primary diagnosis responsible for hospitalization.

[Health status of physicians in Hungary: a representative study].

PubMed

Gyorffy, Zsuzsa; Adám, Szilvia; Kopp, Mária

2005-06-26

A growing body of evidence in the international literature suggests that the prevalence of psychiatric morbidity including suicide is high among physicians. In addition, data published by Hungarian researchers in the early 1990-ies showed high prevalence of somatic morbidity in this population. Based on these data, it is hypothesised that the prevalence of psychiatric and somatic morbidity is higher among physicians in Hungary compared to the white collar population. To assess the psychiatric and somatic health status of physicians as well as the prevalence of role conflict among female physicians in Hungary using a representative sample. Data for this epidemiological study were collected from 407 physicians using questionnaires. 1752 white collar female and male workers from a representative survey (Hungarostudy 2002) served as controls. It is found that the prevalence of chronic somatic morbidity among both female and male physicians was significantly higher than that in the respective control groups. The prevalence of malignancies, diabetes, renal impairment, hypertension, myocardial infarction and cardiovascular diseases, and gastrointestinal ulcers was higher among male physicians compared to control. Female physicians exhibited higher prevalence of malignant diseases, hypertension, myocardial infarction, bronchial asthma, other pulmonary and cardiovascular diseases, allergies, gastrointestinal diseases including ulcer, ophthalmologic and gynaecological disorders compared with the normative population. This study is the first in Hungary to report a significantly higher prevalence of maternal reproductive morbidity including miscarriage, therapeutic termination of pregnancy, high-risk pregnancy among female physicians compared to women in the control group. Correlation analyses confirmed a significant relationship between high prevalence of morbidity and long working hours (> 8 hours), severe anxiety and stress, and role conflict.

Patient selection for day case-eligible surgery: identifying those at high risk for major complications.

PubMed

Mathis, Michael R; Naughton, Norah N; Shanks, Amy M; Freundlich, Robert E; Pannucci, Christopher J; Chu, Yijia; Haus, Jason; Morris, Michelle; Kheterpal, Sachin

2013-12-01

Due to economic pressures and improvements in perioperative care, outpatient surgical procedures have become commonplace. However, risk factors for outpatient surgical morbidity and mortality remain unclear. There are no multicenter clinical data guiding patient selection for outpatient surgery. The authors hypothesize that specific risk factors increase the likelihood of day case-eligible surgical morbidity or mortality. The authors analyzed adults undergoing common day case-eligible surgical procedures by using the American College of Surgeons' National Surgical Quality Improvement Program database from 2005 to 2010. Common day case-eligible surgical procedures were identified as the most common outpatient surgical Current Procedural Terminology codes provided by Blue Cross Blue Shield of Michigan and Medicare publications. Study variables included anthropometric data and relevant medical comorbidities. The primary outcome was morbidity or mortality within 72 h. Intraoperative complications included adverse cardiovascular events; postoperative complications included surgical, anesthetic, and medical adverse events. Of 244,397 surgeries studied, 232 (0.1%) experienced early perioperative morbidity or mortality. Seven independent risk factors were identified while controlling for surgical complexity: overweight body mass index, obese body mass index, chronic obstructive pulmonary disease, history of transient ischemic attack/stroke, hypertension, previous cardiac surgical intervention, and prolonged operative time. The demonstrated low rate of perioperative morbidity and mortality confirms the safety of current day case-eligible surgeries. The authors obtained the first prospectively collected data identifying risk factors for morbidity and mortality with day case-eligible surgery. The results of the study provide new data to advance patient-selection processes for outpatient surgery.

Injustice at work and incidence of psychiatric morbidity: the Whitehall II study.

PubMed

Ferrie, J E; Head, J; Shipley, M J; Vahtera, J; Marmot, M G; Kivimäki, M

2006-07-01

Previous studies of organisational justice and mental health have mostly examined women and have not examined the effect of change in justice. To examine effects of change in the treatment of employees by supervisors (the relational component of organisational justice) on minor psychiatric morbidity, using a cohort with a large proportion of men. Data are from the Whitehall II study, a prospective cohort of 10 308 white-collar British civil servants (3143 women and 6895 men, aged 35-55 at baseline) (Phase 1, 1985-88). Employment grade, relational justice, job demands, job control, social support at work, effort-reward imbalance, physical illness, and psychiatric morbidity were measured at baseline. Relational justice was assessed again at Phase 2 (1989-90). The outcome was cases of psychiatric morbidity by Phases 2 and 3 (1991-93) among participants case-free at baseline. In analyses adjusted for age, grade, and baseline physical illness, women and men exposed to low relational justice at Phase 1 were at higher risk of psychiatric morbidity by Phases 2 and 3. Adjustment for other psychosocial work characteristics, particularly social support and effort-reward imbalance, partially attenuated these associations. A favourable change in justice between Phase 1 and Phase 2 reduced the immediate risk (Phase 2) of psychiatric morbidity, while an adverse change increased the immediate and longer term risk (Phase 3). This study shows that unfair treatment by supervisors increases risk of poor mental health. It appears that the employers' duty to ensure that employees are treated fairly at work also has benefits for health.

Network for Surveillance of Severe Maternal Morbidity: a powerful national collaboration generating data on maternal health outcomes and care.

PubMed

Cecatti, J G; Costa, M L; Haddad, S M; Parpinelli, M A; Souza, J P; Sousa, M H; Surita, F G; Pinto E Silva, J L; Pacagnella, R C; Passini, R

2016-05-01

To identify cases of severe maternal morbidity (SMM) during pregnancy and childbirth, their characteristics, and to test the feasibility of scaling up World Health Organization criteria for identifying women at risk of a worse outcome. Multicentre cross-sectional study. Twenty-seven referral maternity hospitals from all regions of Brazil. Cases of SMM identified among 82 388 delivering women over a 1-year period. Prospective surveillance using the World Health Organization's criteria for potentially life-threatening conditions (PLTC) and maternal near-miss (MNM) identified and assessed cases with severe morbidity or death. Indicators of maternal morbidity and mortality; sociodemographic, clinical and obstetric characteristics; gestational and perinatal outcomes; main causes of morbidity and delays in care. Among 9555 cases of SMM, there were 140 deaths and 770 cases of MNM. The main determining cause of maternal complication was hypertensive disease. Criteria for MNM conditions were more frequent as the severity of the outcome increased, all combined in over 75% of maternal deaths. This study identified around 9.5% of MNM or death among all cases developing any severe maternal complication. Multicentre studies on surveillance of SMM, with organised collaboration and adequate study protocols can be successfully implemented, even in low-income and middle-income settings, generating important information on maternal health and care to be used to implement appropriate health policies and interventions. Surveillance of severe maternal morbidity was proved to be possible in a hospital network in Brazil. © 2015 Royal College of Obstetricians and Gynaecologists.

Ocular morbidity prevalence among school children in Shimla, Himachal, North India

PubMed Central

Gupta, Madhu; Gupta, Bhupinder P; Chauhan, Anil; Bhardwaj, Ashok

2009-01-01

Background Data on eye diseases among school children is not readily available. Considering the fact that one-third of India's blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important. Aim To estimate the prevalence of ocular morbidity among school children of age 6-16 years. Settings Government and private coeducational schools in urban area of Shimla. Design Cross-sectional Materials and Methods Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination. Statistical analysis The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level. Results Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%), refractive errors 22% (CI=21.1-22.8%), squint 2.5% (CI=2.4-2.6%), color blindness 2.3% (CI=2.2-2.4%), vitamin A deficiency 1.8 % (CI=1.7-1.9%), conjunctivitis 0.8% (CI=0.79-0.81%). Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P<0.5) more in government schools. Conclusion A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders. PMID:19237787

Assessment of morbidity due to Schistosoma japonicum infection in China

PubMed Central

2014-01-01

This paper presents a historical assessment of morbidity due to the Schistosoma japonicum infection in China. Due to the socio-economic situation, which did not allow for a control program to be implemented until the early 1950s, morbidity was serious and mortality was high before this. Based on a few investigations and published papers, it can be said that the disease caused millions of deaths, and destroyed numerous families and villages. Since the 1950s, there has been a national control program, intensive control and prevention work has been carried out, and consequently the disease is being controlled. At present, both the prevalence and the morbidity of the disease have been decreasing substantially. The morbidity of the three phases of the disease is outlined in this paper. Comparatively higher morbidity is seen in the acute and advanced phases of the disease. The four major forms of advanced schistosomiasis i.e., ascites, megalosplenia, dwarfism, and colonic tumoroid proliferation, are outlined with their characteristic clinical presentations; their proportions are different during various periods of the national control program. Ectopic schistosomiasis and the relationship between the S. japonicum infection and colorectal cancer are also discussed. Post-transmission schistosomiasis is briefly discussed (which can happen even if the disease reaches the criteria of elimination, and the infection and transmission have stopped, but yet it still develops). The problem of mammalian reservoir hosts of S. japonicum makes the epidemiology and control of schistosomiasis in China even more complicated and arduous, and the control progress in animal reservoirs is briefly presented. PMID:24529186

Prevalence and correlates of depression and anxiety disorder in a sample of inmates in a Nigerian prison.

PubMed

Osasona, Samuel O; Koleoso, Olaide N

2015-01-01

Prisoners tend to be marginalized and deprived of the rights and privileges that other citizens in the community enjoy. Their separation from families, adverse effects on health of prison environment, and the uncertainty about the future place a great psychological burden on them which can lead to the development of mental illness. The aim of this study was to determine the prevalence of psychiatric morbidity (depression and anxiety) and the associated factors among a sample of the prison inmates. The study was descriptive and cross-sectional in design; it was conducted in a medium security prison in Benin City, Nigeria. Participants were interviewed with the Self-Reporting Questionnaire-20, the Hospital Anxiety and Depression Scale, and a socio-demographic questionnaire. Two hundred and fifty-two prisoners who were selected by systematic sampling techniques participated in the study and the data were analyzed using the 16th version of the SPSS with the statistical level of significance set at p < 0.05. Data were presented in tables; frequencies and percentages were calculated. Chi-square and logistic regression statistical tests were performed to determine variables that have relationship with psychiatric morbidity. The mean age of the respondents was 33.6 years (SD ± 9.29), and the majority of the respondents (43.7%) were in the age range 21-30 years. The prevalence of general psychiatric morbidity (SRQ-20 caseness) was 80.6%, while 72.6% and 77.8% were found to be positive for depression and anxiety symptoms respectively on the HADS. Overall, 84.5% of the respondents had at least one type of psychiatric morbidity. Age, marital status, self-reported physical and mental health, previous mental illness, imprisonment status, prison accommodation, prison meal, and health care services were found to be significantly associated with depression, anxiety or general psychiatric morbidity. Self-reported poor current mental health was the only variable that predicted all the three types of psychiatric morbidity. Prisoners in this study, and as in previous reports, had high prevalence rates of psychiatric morbidity. Thus, prisoners have a need for regular psychiatric screening and treatment. The consequences of untreated psychiatric morbidity and the need for improved health care services and infrastructure in the prison were discussed. © The Author(s) 2015.

The relationship between severe maternal morbidity and psychological health symptoms at 6–8 weeks postpartum: a prospective cohort study in one English maternity unit

PubMed Central

2014-01-01

Background The incidence of severe maternal morbidity is increasing in high-income countries. However, little has been known about the impact on postnatal morbidity, particularly on psychological health outcomes. The objective of this study was to assess the relationship between severe maternal morbidity (ie. major obstetric haemorrhage, severe hypertensive disorders or intensive care unit/obstetric high dependency unit admission) and postnatal psychological health symptoms, focusing on post-traumatic stress disorder (PTSD) symptoms at 6–8 weeks postpartum. Method A prospective cohort study was undertaken of women who gave birth over six months in 2010 in an inner city maternity unit in England. Primary outcomes were prevalence of PTSD symptoms namely: 1) intrusion and 2) avoidance as measured using the Impact of Event Scale at 6 – 8 weeks postpartum via a self-administered postal questionnaire. Secondary outcomes included probable depression. Data on incidence of severe maternal morbidity were extracted from maternity records. Multivariable logistic regression analysis examined the relationship between severe maternal morbidity and PTSD symptoms taking into account factors that might influence the relationship. Results Of women eligible to participate (n=3509), 52% responded. Prevalence of a clinically significant level of intrusion and avoidance were 6.4% (n=114) and 8.4% (n=150) respectively. There was a higher risk of PTSD symptoms among women who experienced severe maternal morbidity compared with women who did not (adjusted OR = 2.11, 95%CI = 1.17-3.78 for intrusion; adjusted OR = 3.28, 95%CI = 2.01-5.36 for avoidance). Higher ratings of reported sense of control during labour/birth partially mediated the risk of PTSD symptoms. There were no statistically significant differences in the prevalence or severity of symptoms of depression. Conclusion This is one of the largest studies to date of PTSD symptoms among women who had recently given birth. Findings showed that an experience of severe maternal morbidity was independently associated with symptoms of PTSD. Individually tailored care that increases women’s sense of control during labour may be a protective factor with further work required to promote effective interventions to prevent these symptoms. Findings have important implications for women’s health and the content and organisation of maternity services during and after the birth. PMID:24708797

Self-Harm Thoughts Postpartum as a Marker for Long-Term Morbidity.

PubMed

Iliadis, Stavros I; Skalkidou, Alkistis; Ranstrand, Hanna; Georgakis, Marios K; Axfors, Cathrine; Papadopoulos, Fotios C

2018-01-01

Postpartum depression predisposes to maternal affective and somatic disorders. It is important to identify which women are at an increased risk of subsequent morbidity and would benefit from an intensified follow-up. Self-harm thoughts (SHTs), with or without other depressive symptomatology, might have prognostic value for maternal health beyond the postpartum period. This study is to investigate the somatic and psychiatric morbidity of postpartum women with SHTs, with or without other depressive symptoms, over a 7-year follow-up period. The subjects for this study are derived from a population-based Swedish cohort of women who gave birth at Uppsala University Hospital (May 2006-June 2007) and who answered the Edinburgh Postnatal Depression Scale (EPDS) at 5 days, 6 weeks, and 6 months postpartum. Three groups were included: women reporting SHTs (SHT group, n  = 107) on item 10 of the EPDS; women reporting depressive symptoms, i.e., EPDS ≥ 12 at 6 weeks and/or 6 months postpartum, without SHTs (DEP group, n  = 94); and randomly selected controls screening negatively for postpartum depression (CTL group, n  = 104). The number of diagnostic codes for somatic and psychiatric morbidity according to the International Statistical Classification of Diseases and Related Health Problems system, and the number of medical interventions were retrieved from medical records over 7 years following childbirth and were used as the outcome measures, together with any prescription of antidepressants and sick leave during the follow-up. The SHT group had the highest psychiatric morbidity of all groups and more somatic morbidity than controls. Affective disorders were more common in the SHT and the DEP groups compared with controls, as well as antidepressant prescriptions and sick leave. One-fifth of women with SHTs did not screen positive for depressive symptoms; nevertheless, they had more somatic and psychiatric morbidity than the control group. Women reporting thoughts of self-harm in the postpartum period are at an increased risk of somatic and psychiatric morbidity during a follow-up of 7 years after delivery, and this increased risk may not be fully attributed to depressive symptoms. Results underline the importance of screening for self-harm symptoms postpartum and point to a need for individualized follow-up.

Psychiatric Manifestation of Patients with Epilepsy in Mosul, Iraq.

PubMed

Sultan, Khalid Omar; Mahmood, Bashar Shaker; Najim, Zainab; Al-Habboo, Dhiher Jameel; Najim, Hellme

2017-09-01

It has been proven that physical morbidity is related to psychiatric illness. Some physical illnesses are more related to psychiatric morbidity compared to others. Epilepsy is considered one of them, as patients who suffer from epilepsy has disturbances of consciousness and this leads to a variety of psychological disturbance in addition to the psychological and social impact of the illness. To identify risk factors and psychiatric morbidity in epilepsy, in order to try to manage it and improve outcome of this illness and enhance quality of life. Patients who were referred to the department of Neurology at Mosul Teaching hospital from primary care centres between October 2012 and February 2013 and consented to participate in the study, were checked and if they fulfilled the criteria for the diagnosis of epilepsy, they were interviewed and their sociodemographic data were recorded, the hospital anxiety and depression questionnaire (HAD) was administered. Results were input in a computer programme and software statistical programme Minitab version 14.1 was utilised to analyse these data. The whole sample was 100 patients. 55 females and 45 males were included. Mean age was 30 years. Mean duration of illness was 5.5 years. Mean HAD score was 17. Male patients were a little bit older but there was no statistically significant difference compared to females and they both scored similar HAD score. There was no difference between urban and rural population with regards to HAD score. The results showed statistically significant correlation between age and duration of the illness and HAD score. The present study showed that there is a correlation between epilepsy and psychiatric morbidity. It has confirmed that females are more affected compared to males, which is expected as compared to the general population. It has also confirmed that psychiatric morbidity is positively related to epilepsy as it showed that the duration of illness has increased the psychiatric morbidity. Psychiatric morbidity is a neglected area in the management and care of physical illnesses, especially, epilepsy, where patients may get stigmatised and traumatised in the society. They may live in constant fear of having a fit. Assessing and managing the psychiatric morbidity of such patients will be reflected on the outcome of the illness and improve the quality of life of patients.

PARTICULATE MATTER (PM) AND HOSPITAL ADMISSIONS AMONG U.S. VETERANS

EPA Science Inventory

Epidemiological studies have consistently demonstrated that exposure to particulate matter (PM) can result in increased mortality and morbidity. The susceptible population, the nature of morbidity and cause of death, however, have not been clearly identified. To accomplish these ...

Psychiatric and Physical Morbidity Effects of Dementia Caregiving: Prevalence, Correlates, and Causes.

ERIC Educational Resources Information Center

Schultz, Richard; And Others

1995-01-01

Assesses the prevalence and magnitude of psychiatric and physical morbidity effects among dementia caregivers, identifies individual and contextual correlates of reported health effects and their underlying causes, and examines the policy relevance of observed findings. (JPS)

Estimating and Valuing Morbidity in a Policy Context: Proceedings of June 1989 AERE Workshop (1989)

EPA Pesticide Factsheets

Contains the proceedings for the 1989 Association of Environmental and Resource Economists Workshop on valuing reductions in human health morbidity risks. Series of papers and discussions were collected and reported in the document.

Prevalence of psychiatric morbidity in visually impaired children.

PubMed

Bakhla, Ajay Kumar; Sinha, Vinod Kumar; Verma, Vijay; Sarkhel, Sujit

2011-03-01

This study was done to measure psychiatric morbidity and associated sociodemographic variables among visually impaired children. 92 students of age range 6 to 20 years from four schools for the blind, in Ranchi, were screened with verbal Hindi translation of General Health Questionnaire 60. Diagnostic Interview Schedule Parent version was applied to establish psychiatric diagnosis on primary caretakers of those who scored above cutoff. Fourteen scored above cut off and psychiatric diagnoses of 8 children were established. The prevalence of psychiatric morbidity among visually impaired children was found to be 8.69% No sociodemographic variable was associated with the occurrence of psychiatric illness.

[Mathematical modeling for conditionality of cardiovascular disease by housing conditions].

PubMed

Meshkov, N A

2014-01-01

There was studied the influence of living conditions (housing area per capita, availability of housing water supply, sewerage and central heating) on the morbidity of the cardiovascular diseases in child and adult population. With the method of regression analysis the morbidity rate was established to significantly decrease with the increase in the area of housing, constructed models are statistically significant, respectively, p = 0.01 and p = 0.02. There was revealed the relationship of the morbidity rate of cardiovascular diseases in children and adults with the supply with housing central heating (p = 0.02 and p = 0.009).

[Environmental and demographic variables associated with psychiatric morbidity in former prisoners of war].

PubMed

Dethienne, F; Donnay, J M

1976-01-01

In this study, present psychiatric morbidity of 100 former prisoners of war is related to 28 environmental and demographic variables grouped in 3 periods: before, during and after WW2. With the exception of the invalidity percentage, all statistically significant relations concern variables of the first two periods. The present results are discussed at the light of former publications by the authors. It appears among others that the age variable has to be taken in consideration in the explanation of psychiatric sequels of captivity, and that the condition "invalid of war" poorly reflects the degree of psychiatric morbidity.

Cushing’s Disease – Quality of Life, Recurrence and Long-term Morbidity

PubMed Central

Ntali, Georgia; Grossman, Ashley; Karavitaki, Niki

2015-01-01

Abstract Cushing’s disease (CD) is a rare disorder caused by an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma. Chronic exposure to hypercortisolism leads to significant morbidities, which may be only partially reversible after remission of the disease, as well as to impairment of the health-related quality of life (HRQoL) and an increase in mortality. Transsphenoidal surgery (TSS) is the treatment of choice, and recurrence rates vary widely, confirming the need for lifelong follow-up. This review summarises the studies performed on HRQoL, recurrence rates and morbidities in patients who have CD. PMID:29632565

Autoimmunity and autoimmune co-morbidities in psoriasis.

PubMed

Furue, Kazuhisa; Ito, Takamichi; Tsuji, Gaku; Kadono, Takafumi; Nakahara, Takeshi; Furue, Masutaka

2018-05-01

Psoriasis is characterized by widespread scaly erythematous plaques that cause significant physical and psychological burdens for the affected individuals. Accelerated inflammation driven by the tumour necrosis factor-α/interleukin-23/interleukin-17 axis is now known to be the major mechanism in the development of psoriasis. In addition, psoriasis has an autoimmune nature that manifests as autoreactive T cells and is co-morbid with other autoimmune diseases, such as autoimmune bullous diseases, vitiligo, alopecia and thyroiditis. In this article, we review the recent topics on autoimmunity and autoimmune co-morbidities in psoriasis. © 2018 John Wiley & Sons Ltd.

[Association of cardiovascular autonomic neuropathy and prolonged QT interval with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus].

PubMed

Ticse Aguirre, Ray; Villena, Jaime E

2011-03-01

In order to evaluate the relationship between cardiovascular autonomic neuropathy and corrected QT interval (QTc) with cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus, we followed up for 5 years 67 patients attending the outpatient Endocrinology Service. 82% completed follow-up and cardiovascular events occurred in 16 patients. We found that long QTc interval was the only variable significantly associated with cardiovascular morbidity and mortality in the multiple logistic regression analysis (RR: 13.56, 95% CI: 2.01-91.36) (p = 0.0074).

Mast Cells Can Enhance Resistance to Snake and Honeybee Venoms

NASA Astrophysics Data System (ADS)

Metz, Martin; Piliponsky, Adrian M.; Chen, Ching-Cheng; Lammel, Verena; Åbrink, Magnus; Pejler, Gunnar; Tsai, Mindy; Galli, Stephen J.

2006-07-01

Snake or honeybee envenomation can cause substantial morbidity and mortality, and it has been proposed that the activation of mast cells by snake or insect venoms can contribute to these effects. We show, in contrast, that mast cells can significantly reduce snake-venom-induced pathology in mice, at least in part by releasing carboxypeptidase A and possibly other proteases, which can degrade venom components. Mast cells also significantly reduced the morbidity and mortality induced by honeybee venom. These findings identify a new biological function for mast cells in enhancing resistance to the morbidity and mortality induced by animal venoms.

Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients.

PubMed

Hancı, Deniz; Altun, Huseyin; Altun, Hasan; Batman, Burcin; Karip, Aziz Bora; Serin, Kursat Rahmi

2016-03-01

Olfactory abilities of the patients are known to be altered by eating and metabolic disorders, including obesity. There are only a number of studies investigating the effect of obesity on olfaction, and there is limited data on the changes in olfactory abilities of morbidly obese patients after surgical treatment. Here we investigated the changes in olfactory abilities of 54 morbidly obese patients (M/F, 22/32; age range 19-57 years; body mass index (BMI) range 30.5-63.0 kg/m(2)) after laparoscopic sleeve gastrectomy. A laparoscopic sleeve gastrectomy was performed by the same surgeon using five-port technique. Olfactory abilities were tested preoperatively and 1, 3, and 6 months after the surgery using a standardized Sniffin' Sticks Extended Test kit. Analyses of variance indicated statistically significant improvement in T, D, and I scores of morbidly obese patients within time factors (preoperative vs. 1, 3, and 6 months; 1 vs. 3 and 6 months; and 3 vs. 6 months; p < 0.001 for all). There was a statistically significant improvement in overall TDI scores with an increase from 25 to 41 during the 6 months follow-up period (p < 0.001 for all). Here, for the first time in literature, we were able to show the significant improvement in olfactory abilities of morbidly obese patients after laparoscopic sleeve gastrectomy.

Treatment of obsessive morbid jealousy with cognitive analytic therapy: An adjudicated hermeneutic single-case efficacy design evaluation.

PubMed

Curling, Louise; Kellett, Stephen; Totterdell, Peter; Parry, Glenys; Hardy, Gillian; Berry, Katherine

2018-03-01

The evidence base for the treatment of morbid jealousy with integrative therapies is thin. This study explored the efficacy of cognitive analytic therapy (CAT). An adjudicated hermeneutic single-case efficacy design evaluated the cognitive analytic treatment of a patient meeting diagnostic criteria for obsessive morbid jealousy. A rich case record was developed using a matrix of nomothetic and ideographic quantitative and qualitative outcomes. This record was then debated by sceptic and affirmative research teams. Experienced psychotherapy researchers acted as judges, assessed the original case record, and heard the affirmative-versus-sceptic debate. Judges pronounced an opinion regarding the efficacy of the therapy. The efficacy of CAT was supported by all three judges. Each ruled that change had occurred due to the action of the therapy, beyond any level of reasonable doubt. This research demonstrates the potential usefulness of CAT in treating morbid jealousy and suggests that CAT is conceptually well suited. Suggestions for future clinical and research directions are provided. The relational approach of CAT makes it a suitable therapy for morbid jealousy. The narrative reformulation component of CAT appears to facilitate early change in chronic jealousy patterns. It is helpful for therapists during sessions to use CAT theory to diagrammatically spell out the patterns maintaining jealousy. © 2017 The British Psychological Society.

Risk factors for respiratory morbidity in infancy after very premature birth.

PubMed

Greenough, A; Limb, E; Marston, L; Marlow, N; Calvert, S; Peacock, J

2005-07-01

To determine the occurrence of respiratory morbidity during infancy after very premature birth and to identify risk factors. Prospective follow up study. The United Kingdom oscillation study. 492 infants, all born before 29 weeks gestation. Structured questionnaires were completed by local paediatricians when the infants were seen in outpatients at 6 and 12 months of age corrected for prematurity. Cough, wheeze, and treatment requirements and the composite measure of respiratory morbidity (cough, frequent cough, cough without infection, wheeze, frequent wheeze, wheeze without infection, and use of chest medicine) and their relation to 13 possible explanatory variables. At 6 and 12 months of corrected age, 27% of the infants coughed and 6% had frequent (more than once a week) cough, and 20% and 3% respectively had wheeze or frequent wheeze. At 6 and 12 months, 14% of infants had taken bronchodilators and 8% inhaled steroids. After adjustment for multiple outcome testing, four factors were associated with increased respiratory morbidity: male sex, oxygen dependency at 36 weeks postmenstrual age, having older siblings aged less than 5 years, and living in rented accommodation. Male infants are particularly vulnerable to respiratory morbidity in infancy after very premature birth. It is important to identify a safe and effective strategy to prevent chronic oxygen dependency.

Estimating true hospital morbidity of complications associated with mumps outbreak, England, 2004/05.

PubMed

Yung, C F; Ramsay, M

2016-08-18

Mumps outbreaks in highly vaccinated populations continue to be reported globally. Therefore, quantifying the burden of mumps morbidity accurately will be necessary to better assess the impact of mumps vaccination programmes. We aim to estimate the true morbidity resulting from mumps complications in terms of hospitalised orchitis, meningitis, oophoritis and pancreatitis in England during the outbreak in 2004/05. This outbreak in England led to a clear increase in hospitalisations coded to mumps for complications of orchitis in those born in the 1970s and 1980s and possibly for meningitis in those born in the 1980s. A simple statistical model, based on analysing time trends for diagnosed complications in hospital databases with routine laboratory surveillance data, found that the actual morbidity was much higher. There were 2.5 times (166 cases) more mumps orchitis cases in the 1970s cohort and 2.0 times (708 cases) more mumps orchitis cases in the 1980s cohort than complications coded to mumps in hospital databases. Our study demonstrated that the mumps outbreak in England 2004/05 resulted in a substantial increase in hospitalised mumps complications, and the model we used can improve the ascertainment of morbidity from a mumps outbreak. This article is copyright of The Authors, 2016.

Low birth weight and fetal anaemia as risk factors for infant morbidity in rural Malawi.

PubMed

Kalanda, Boniface; Verhoeff, Francine; le Cessie, Saskia; Brabin, John

2009-06-01

Low birth weight (LBW) and fetal anaemia (FA) are common in malaria endemic areas. To investigate the incidence of infectious morbidity in infants in rural Malawi in relation to birth weight and fetal anaemia, a cohort of babies was followed for a year on the basis of LBW (<2500) and FA (cord haemoglobin < 12.5 g/dl). A matched group of normal birth weight (NBW), non-anaemic (NFA) new-borns were enrolled as controls. Morbidity episodes were recorded at 4-weekly intervals and at each extra visit made to a health centre with any illness. Infants in the NBW NFA group experienced an average of 1.15 (95% C.I. 0.99, 1.31), 1.04 (0.89, 1.19), 0.92 (0.73, 1.11) episodes per year of malaria, respiratory infection and diarrhoea respectively. Corresponding values for the LBW FA group were 0.83 (0.5, 1.16), 0.82 (0.5, 1.16) and 0.76 (0.33, 1.19). FA was not associated with a higher incidence of morbidity, but was significantly associated with a shorter time to first illness episode (p = 0.014). LBW was not a significant risk factor for higher morbidity incidence. LBW and FA were not significant risk factors for incidence of illness episodes in infants.

Morbidity Patterns and Health Care Seeking Behavior among Older Widows in India

PubMed Central

Agrawal, Gopal; Keshri, Kunal

2014-01-01

In the process of health transition, India is facing rapid pace of demographic aging. Rapid increase in older adult population posed serious concerns regarding health and health care utilization for them. However, very limited research documented resultant implications of demographic aging for health and health care use in the nexus of marital status and gender. With this perspective, the present study examined patterns in morbidity prevalence and health seeking behaviour among older widows in India. Multivariate logistic regression models were estimated to examine the effects of socio-demographic conditions on morbidity prevalence among older widows and their health care seeking behavior. Data from the latest 60th round of National Sample Survey (NSS), 2004 was used. Overall, morbidity prevalence was 13% greater among older widows compared to older widowers. Adjusted prevalence of communicable and non-communicable diseases was found 74 and 192 per 1000 older widows respectively. At the same time, likelihood of seeking health care services for reported morbidities was substantially lower among older widows. The findings of this study are important to support policy makers and health care providers in identifying individuals ‘at risk’ and could be integrated into the current programs of social, economic and health security for the older persons. PMID:24718291

Effects of reproductive morbidity on women's lives and costs of accessing treatment in Yemen.

PubMed

Dejong, Jocelyn; Bahubaishi, Najia; Attal, Bothaina

2012-12-01

Research on the consequences of reproductive morbidity for women's lives and their economic and social roles is relatively under-developed. There is also a lack of consensus on appropriate conceptual frameworks to understand the social determinants of reproductive morbidity as well as their social and economic implications. We report here on an exploratory study in Yemen using quantitative (n=72 women) and qualitative methods (n=35 women), in 2005 and 2007 respectively, with women suffering from uterine prolapse, infertility or pelvic inflammatory disease (PID). It explored women's views on how reproductive morbidity affected their lives, marital security and their households, and the burden of paying for treatment. We also interviewed six health professionals about women's health care-seeking for these conditions. Sixty per cent of women reported that treatment was not affordable, and 43% had to sell assets or take out a loan to pay for care. Prolapse and PID interfered particularly in subsistence and household activities while infertility created social pressure. Reproductive morbidity is not a priority in Yemen, given its multiple public health needs and low resources, but by failing to provide comprehensive and affordable services for women, the country incurs developmental losses. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

The Dubai Community Psychiatric Survey: acculturation and the prevalence of psychiatric disorder.

PubMed

Ghubash, R; Hamdi, E; Bebbington, P

1994-02-01

Dubai, an Emirate in the Gulf region, has experienced spectacular social change as a result of the exploitation of its oil reserves. The Dubai Community Psychiatric Survey was designed to study the effects of this social change on the mental health of female nationals. In this paper, we approach the problem by quantifying social change in two main ways: the first focused on social change at the individual level as measured by the Socio-cultural Change Questionnaire (Bebbington et al. 1993). The second examined the effect of social change at the community level by identifying areas of residence at different levels of development. We hypothesized that attitudes and behaviours markedly at odds with traditional prescriptions would be associated with high rates of psychiatric morbidity. On the individual level, the association between psychiatric morbidity and the amount of social change reflected in the behaviours and views of the subjects was not significant. However, there was a significant association between morbidity and between social attitudes and behaviours. At the community level, in contrast, the relationship between psychiatric morbidity and social change was significant: there was more psychiatric morbidity in areas at the extremes of the social change continuum. The hypothesis put forward in this study must be modified accordingly.

The work of case managers as experienced by older persons (75+) with multi-morbidity - a focused ethnography.

PubMed

Hjelm, Markus; Holst, Göran; Willman, Ania; Bohman, Doris; Kristensson, Jimmie

2015-12-17

Complex health systems make it difficult for older persons (75+) with multi-morbidity to achieve continuity of care. Case management could be one way to address this difficulty. Currently, there is a need to extend the knowledge regarding case management as experienced by those utilising the services, namely older persons (75+) with multi-morbidity. The study aimed to explore older persons' (75+) with multi-morbidity experiences of case managers. The study design was qualitative and used a focused ethnographic approach. Data was collected through individual interviews with 13 older persons and by participant observations with accompanying field notes, all conducted in 2012-2013. The data revealed four themes illustrating the older persons' experiences of case managers: 1) Someone providing me with a trusting relationship; 2) Someone assisting me; 3) Someone who is on my side; and 4) Someone I do not need at present. This study illustrates the importance of establishing trusting relationships between older persons and their case managers in order to truly provide assistance. The older persons valued the case managers acting as informed but unbiased facilitators. The findings could be of help in the development of case management interventions better designed for older persons with multi-morbidity.

Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients

PubMed Central

BALDESSARINI, ROSS J.; TONDO, LEONARDO; VAZQUEZ, GUSTAVO H.; UNDURRAGA, JUAN; BOLZANI, LORENZA; YILDIZ, AYSEGUL; KHALSA, HARI-MANDIR K.; LAI, MASSIMO; LEPRI, BEATRICE; LOLICH, MARIA; MAFFEI, PIER MARIO; SALVATORE, PAOLA; FAEDDA, GIANNI L.; VIETA, EDUARD; MAURICIO, TOHEN

2012-01-01

Early onset in bipolar disorder (BPD) has been associated with greater familial risk and unfavorable clinical outcomes. We pooled data from seven international centers to analyze the relationships of family history and symptomatic as well as functional measures of adult morbidity to onset age, or onset in childhood (age <12), adolescence (12-18), or adulthood (19-55 years). In 1,665 adult, DSM-IV BPD-I patients, onset was 5% in childhood, 28% in adolescence, and 53% at peak ages 15-25. Adolescent and adult onset did not differ by symptomatic morbidity (episodes/year, percentage of months ill, co-morbidity, hospitalization, suicide attempts) or family history. Indications of favorable adult functional outcomes (employment, living independently, marriage and children, and a composite measure including education) ranked, by onset: adult > adolescent > child. Onset in childhood versus adolescence had more episodes/year and more psychiatric co-morbidity. Family history was most prevalent with childhood onset, similar over onset ages 12-40 years, and fell sharply thereafter. Multivariate modeling sustained the impression that family history and poor functional, but not symptomatic, outcomes were associated with younger, especially childhood onset. Early onset was more related to poor functional outcomes than greater symptomatic morbidity, with least favorable outcomes and greater family history with childhood onset. PMID:22295008

Relationship between Acute Phase Proteins and Serum Fatty Acid Composition in Morbidly Obese Patients

PubMed Central

Fernandes, Ricardo; Beserra, Bruna Teles Soares; Cunha, Raphael Salles Granato; Hillesheim, Elaine; Camargo, Carolina de Quadros; Pequito, Danielle Cristina Tonello; de Castro, Isabela Coelho; Fernandes, Luiz Cláudio; Nunes, Everson Araújo; Trindade, Erasmo Benício Santos de Moraes

2013-01-01

Background. Obesity is considered a low-grade inflammatory state and has been associated with increased acute phase proteins as well as changes in serum fatty acids. Few studies have assessed associations between acute phase proteins and serum fatty acids in morbidly obese patients. Objective. To investigate the relationship between acute phase proteins (C-Reactive Protein, Orosomucoid, and Albumin) and serum fatty acids in morbidly obese patients. Methods. Twenty-two morbidly obese patients were enrolled in this study. Biochemical and clinical data were obtained before bariatric surgery, and fatty acids measured in preoperative serum. Results. Orosomucoid was negatively correlated with lauric acid (P = 0.027) and eicosapentaenoic acid (EPA) (P = 0.037) and positively with arachidonic acid (AA) (P = 0.035), AA/EPA ratio (P = 0.005), and n-6/n-3 polyunsaturated fatty acids ratio (P = 0.035). C-Reactive Protein (CRP) was negatively correlated with lauric acid (P = 0.048), and both CRP and CRP/Albumin ratio were negatively correlated with margaric acid (P = 0.010, P = 0.008, resp.). Albumin was positively correlated with EPA (P = 0.027) and margaric acid (P = 0.008). Other correlations were not statistically significant. Conclusion. Our findings suggest that serum fatty acids are linked to acute phase proteins in morbidly obese patients. PMID:24167354

Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?

PubMed

Hakkennes, Sharon; Hill, Keith D; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2013-01-01

This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke. Multi-site prospective observational cohort study. Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation. Rehabilitation assessors completed a questionnaire, rating the importance (10 point visual analogue scale) and direction (positive, negative or neutral) of 15 patient related and 2 organisational items potentially affecting their decision regarding patients' acceptance to rehabilitation. Of the 75 patients referred to rehabilitation and included in this study 61 (81.3%) were accepted for inpatient rehabilitation. The items considered to be most important in the decision to accept the patient for rehabilitation were pre-morbid cognition, pre-morbid mobility and pre-morbid communication. For those not accepted the most important items were current mobility, social support and current cognition. Factor analysis revealed 3 underlying factors, interpreted as post-stroke status, pre-morbid status, and social attributes, accounting for 61.8% of the total variance. All were independently associated with acceptance for rehabilitation (p < 0.05). This study highlights the importance of pre-morbid function and social factors in addition to post-stroke function in the decision making process for acceptance to rehabilitation following severe stroke. Future models for selection for rehabilitation should consider inclusion of these factors.

Iron and infection: An investigation of the optimal iron hypothesis in Lima, Peru.

PubMed

Dorsey, Achsah F; Thompson, Amanda L; Kleinman, Ronald E; Duggan, Christopher P; Penny, Mary E

2018-02-19

This article explores the optimal iron hypothesis through secondary data analysis of the association between hemoglobin levels and morbidity among children living in Canto Grande, a peri-urban community located on the outskirts of Lima, Peru. Risk ratios were used to test whether lower iron status, assessed using the HemoCue B-Hemoglobin System, was associated with an increased relative risk of morbidity symptoms compared to iron replete status, controlling for infant age, sex, weight for height z-score, maternal education, and repeated measures in 515 infants aged 6-12 months. Infants with fewer current respiratory and diarrheal morbidity symptoms had a lower risk of low iron deficiency compared to participants who were iron replete (P < .10). Infants with fewer current respiratory infection symptoms had a statistically significant (P < .05) reduction in risk of moderate iron deficiency compared to infants who were iron replete. In this study, morbidity status was not predictive of iron deficient status over a six-month interval period, but nonreplete iron status was shown to be associated with current morbidity symptoms. These results support investigating iron status as an allostatic system that responds to infection adaptively, rather than expecting an optimal preinfection value. © 2018 Wiley Periodicals, Inc.

Socioeconomic inequalities in morbidity among the elderly; a European overview.

PubMed

Huisman, Martijn; Kunst, Anton E; Mackenbach, Johan P

2003-09-01

There is some evidence on socioeconomic inequality in morbidity among elderly people, but this evidence remains fragmentary. This study aims to give a comprehensive overview of educational and income inequalities in morbidity among the elderly of eleven European countries. Data from the first wave of 1994 of the European Community Household Panel were used. The study population comprised a total of 14,107 men and 17,243 women, divided into three age groups: 60-69, 70-79 and 80+. Three health indicators were used: self-assessed health, cut down in daily activities due to a physical or mental problem, and long-term disability. The results indicate that socioeconomic inequalities in morbidity by education and income exist among the elderly in Europe, in all the countries in this study and all age groups, including the oldest old. Inequalities decline with age among women, but not always among men. Greece, Ireland, Italy and The Netherlands most often show large inequalities among men, and Greece, Ireland and Spain do so among women. To conclude, inequalities in morbidity decrease with age, but a substantive part persists in old age. To improve the health of elderly people it is important that the material, social and cultural resources of the elderly are improved.

[Morbidity and mortality rates in relation to the "surgeon factor" after duodenopancreatectomy].

PubMed

Targarona, Javier; Pando, Elizabeth; Garatea, Rafael; Vavoulis, Alexandra; Montoya, Eduardo

2007-10-01

The present study was designed to determine whether the surgeon factor has an independent effect on morbidity and mortality rates after duodenopancreatectomy. Between October 2002 and December 2006, we performed a study of 119 patients who underwent duodenopancreatectomy. The surgeons were divided into 3 groups according to the number of interventions they performed each year: a low volume group (three Whipple procedures per year), a medium volume group (four to 10 Whipple procedures per year) and a high volume group (> 10 Whipple procedures per year). The morbidity rate was higher in the low volume group (82%) than in the high volume group (35%). Length of hospital stay was clearly longer in the low and medium volume groups (27 days, and 21 days) than in the high volume group (17 days). Comparison of the results of the 3 groups revealed that the group performing three or less interventions per year (low volume) had the highest mortality rate (47%), while the group performing more than 10 interventions per year (high volume) had a very low mortality rate (4%). We found that the volume-to-surgeon ratio was inversely proportional to morbidity, length of hospital stay, return to oral intake, and mortality rates. Therefore, increasing surgical volume could improve morbidity and mortality rates.

Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003.

PubMed

Marr, Leslie; Lennox, Christopher; McFadyen, Angus K

2014-06-01

Since 2003, a continuous audit of severe maternal morbidity in Scotland has been conducted, collecting data on consistently defined events in all the consultant-led maternity units within Scotland. This review summarizes the methodology of the audit and describes some of the main results accumulated in the 10 years audited [2003-2012 (The 2012 Scottish Confidential Audit of Severe Maternal Morbidity report is yet to be published. This article refers to extracts from 2012 data where available, but on other occasions refers to data from 2003 to 2011.)]. Although most causes of severe maternal morbidity have decreased during the audit, major obstetric haemorrhage, the most common cause of severe maternal morbidity, has increased. Some key findings are as follows: admission to an ICU is required for 1 woman in every 700 births; major obstetric haemorrhage is experienced by 1 in 172 women; cases of eclampsia have decreased during the audit; there were deficiencies in antenatal risk identification and action planning; and the direct involvement of consultant obstetricians and anaesthetists in the care of women was below those recommended by the guidelines. The audit has demonstrated changes in clinical practice and in adherence to clinical guidelines over time. The information has been used to inform clinical practice within the Scottish maternity units.

[Somatic and mental morbidity of young female physicians. Does emotional exhaustion constitute the missing link?].

PubMed

Győrffy, Zsuzsa; Adám, Szilvia

2013-01-06

The high prevalence of morbidity among female physicians in Hungary is well documented, however, little is known about the prevalence of that in certain age groups. To assess the prevalence of somatic and psychiatric morbidity in two age cohorts (Cohort 1: age 24-43 and Cohort 2: age 44-76) of female physicians and to explore the relationship between morbidity and potential risk factors including work-related stressors. Representative, cross-sectional, quantitative survey among representative samples of female physicians (N = 408). Physicians in Cohort 1 reported more frequent night shift rotation, less leisure time, and fewer days off compared to physicians in Cohort 2. Physicians in Cohort 1 were less satisfied with their work, workplace, reported less support from their colleagues, and received lower salary compared to physicians in Cohort 2. Physicians in Cohort 1 scored significantly higher on the emotional exhaustion and the personal accomplishment scales MBI as compared to Cohort 2 physicians. In Cohort 1 emotional exhaustion and personal accomplishment were associated with high depression scores and frequent suicidal ideation. The role of emotional exhaustion is decisive of young physicians' well-being. Future research should focus on understanding the psycho-social, individual, organizational, and societal correlates of the high prevalence of morbidity among young female physicians in Hungary.

[METHODOLOGY FOR THE ASSESSMENT OF THE IMPACT OF THE ATMOSPHERIC AIR POLLUTION ON THE FORMATION OF THE LEVELS OF OVERALL MORBIDITY RATE OF BRONCHIAL ASTHMA].

PubMed

Veremchuk, L V; Cherpack, N A; Gvozdenko, T A; Volkova, M V

2015-01-01

In large cities with strong air pollution the formation of the levels of morbidity rate of bronchial asthma has a complex causation that requires the search for informative methods for identification of causes and consequences of this dependence. Method for the assessment of the dependence of overall levels of morbidity rate of bronchial asthma on the degree of air pollution allows you to select a "useful information" of the direct impact of air pollution on a background of random processes and latent relationship between human and environment. The use of the method of the information entropy analysis allowed us to estimate the total and the individual contribution of the separate components of air pollution on the formation of levels of total morbidity rate of bronchial asthma in the population of the city of Vladivostok. Levels of total incidence of this pathology were established to differ in various age groups. The adult population is more adapted to air pollution, but retains a high sensitivity to the impact of nitrogen dioxide. Levels of overall l morbidity rate of bronchial asthma in children and adolescents depend on the total air pollution with some dominance of the influence of suspended matter and carbon monoxide.

Safety and feasibility of liver resection with continued antiplatelet therapy using aspirin.

PubMed

Monden, Kazuteru; Sadamori, Hiroshi; Hioki, Masayoshi; Ohno, Satoshi; Saneto, Hiromi; Ueki, Toru; Yabushita, Kazuhisa; Ono, Kazumi; Sakaguchi, Kousaku; Takakura, Norihisa

2017-07-01

Aspirin is widely used for the secondary prevention of ischemic stroke and cardiovascular disease. Perioperative aspirin may decrease thrombotic morbidity, but may also increase hemorrhagic morbidity. In particular, liver resection carries risks of bleeding, leading to higher risks of hemorrhagic morbidity. Our institution has continued aspirin therapy perioperatively in patients undergoing liver resection. This study examined the safety and feasibility of liver resection while continuing aspirin. We retrospectively evaluated 378 patients who underwent liver resection between January 2010 and January 2016. Patients were grouped according to preoperative aspirin prescription: patients with aspirin therapy (aspirin users, n = 31); and patients without use of aspirin (aspirin non-users, n = 347). Aspirin users were significantly older (P < 0.001), with a higher proportion of males (P < 0.001) and higher frequencies of hypertension (P  = 0.004) and diabetes mellitus (P < 0.001). No significant differences were observed in intraoperative parameters. Although the frequency of major morbidity tended to be higher among aspirin users than among aspirin non-users, no significant difference was identified. No postoperative hemorrhage was seen among aspirin users. Liver resection can be safely performed while continuing aspirin therapy without increasing hemorrhagic morbidity. Our results suggest that interruption of aspirin therapy is unnecessary for patients undergoing liver resection. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Travel-associated infection presenting in Europe (2008-12): an analysis of EuroTravNet longitudinal, surveillance data, and evaluation of the effect of the pre-travel consultation.

PubMed

Schlagenhauf, Patricia; Weld, Leisa; Goorhuis, Abraham; Gautret, Philippe; Weber, Rainer; von Sonnenburg, Frank; Lopez-Vélez, Rogelio; Jensenius, Mogens; Cramer, Jakob P; Field, Vanessa K; Odolini, Silvia; Gkrania-Klotsas, Effrossyni; Chappuis, Francois; Malvy, Denis; van Genderen, Perry J J; Mockenhaupt, Frank; Jauréguiberry, Stéphane; Smith, Catherine; Beeching, Nicholas J; Ursing, Johan; Rapp, Christophe; Parola, Philippe; Grobusch, Martin P

2015-01-01

Travel is important in the acquisition and dissemination of infection. We aimed to assess European surveillance data for travel-related illness to profile imported infections, track trends, identify risk groups, and assess the usefulness of pre-travel advice. We analysed travel-associated morbidity in ill travellers presenting at EuroTravNet sites during the 5-year period of 2008-12. We calculated proportionate morbidity per 1000 ill travellers and made comparisons over time and between subgroups. We did 5-year trend analyses (2008-12) by testing differences in proportions between subgroups using Pearson's χ(2) test. We assessed the effect of the pre-travel consultation on infection acquisition and outcome by use of proportionate morbidity ratios. The top diagnoses in 32 136 patients, ranked by proportionate morbidity, were malaria and acute diarrhoea, both with high proportionate morbidity (>60). Dengue, giardiasis, and insect bites had high proportionate morbidity (>30) as well. 5-year analyses showed increases in vector borne infections with significant peaks in 2010; examples were increased Plasmodium falciparum malaria (χ(2)=37·57, p<0·001); increased dengue fever (χ(2)=135·9, p<0·001); and a widening geographic range of acquisition of chikungunya fever. The proportionate morbidity of dengue increased from 22 in 2008 to 36 in 2012. Five dengue cases acquired in Europe contributed to this increase. Dermatological diagnoses increased from 851 in 2008 to 1102 in 2012, especially insect bites and animal-related injuries. Respiratory infection trends were dominated by the influenza H1N1 pandemic in 2009. Illness acquired in Europe accounted for 1794 (6%) of all 32 136 cases-mainly, gastrointestinal (634) and respiratory (357) infections. Migration within Europe was associated with more serious infection such as hepatitis C, tuberculosis, hepatitis B, and HIV/AIDS. Pre-travel consultation was associated with significantly lower proportionate morbidity ratios for P falciparum malaria and also for acute hepatitis and HIV/AIDS. The pattern of travel-related infections presenting in Europe is complex. Trend analyses can inform on emerging infection threats. Pre-travel consultation is associated with reduced malaria proportionate morbidity ratios and less severe illness. These findings support the importance and effectiveness of pre-travel advice on malaria prevention, but cast doubt on the effectiveness of current strategies to prevent travel-related diarrhoea. European Centre for Disease Prevention and Control, University Hospital Institute Méditerranée Infection, US Centers for Disease Control and Prevention, and the International Society of Travel Medicine. Copyright © 2015 Elsevier Ltd. All rights reserved.

Presence of central nervous system, cardiovascular and overall co-morbidity burden in patients with overactive bladder disorder in a real-world setting.

PubMed

Asche, Carl V; Kim, Jaewhan; Kulkarni, Amit S; Chakravarti, Paula; Andersson, Karl-Erik

2012-02-01

•  To determine the proportion of patients with overactive bladder (OAB) potentially at risk for adverse events by assessing their pre-existing central nervous system (CNS), cardiovascular (CV) and other co-morbidities. •  The GE Centricity Electronic Medical Record database was utilized to identify patients with a diagnosis of OAB using International Classification of Diseases, Ninth Revision (ICD-9) codes or a prescription between 1 January 1996 and 30 March 2007 for an OAB anti-muscarinic agent. •  Matched non-OAB patients were assigned the same index date as the corresponding OAB patient. Based on the presence of ≥ one pharmacy claim for an OAB anti-muscarinic agent, the OAB cohort was stratified as treated or untreated. A random sample of age- and gender-matched patients formed a non-OAB control cohort. •  An additional and separate analysis focusing on all co-morbidities was performed examining non-OAB patients who were matched to OAB patients on 1:1 propensity score matching, based on age, body mass index (BMI) and gender at baseline. •  Charlson Comorbidity Index (CCI), using ICD-9 codes, and the Chronic Disease Score (CDS), using prescribed drugs, were calculated. •  When compared with non-OAB patients (N= 77,272; 83.2% women; median age 64 years), OAB patients (N= 41,440; 83.6% women; median age 65 years) had more overall CNS co-morbidities (45.4 vs 29.0%; P < 0.001). •  In addition, OAB patients had a higher use of medications with anti-muscarinic effects (39.6 vs 25.4%; P < 0.001). OAB patients were also more likely to have CV co-morbidities (57.6 vs 44.6%; P < 0.001). •  CNS co-morbidities were slightly more common in untreated (n= 8 106) than in treated (n= 33 334) OAB patients (47.2 vs 45.0%; P < 0.001). CV co-morbidities were higher in treated OAB patients (58.8 vs 53.7%; P < 0.001). •  In the additional separate analysis, which focused on all co-morbidities, patients with OAB had higher mean CCI and CDS scores than patients without OAB (CCI: 1.17 vs 1.11 [P < 0.001]; CDS: 2.95 vs 1.74 [P < 0.001]). •  After controlling for other covariates, the linear regressions (n= 22,544) showed that OAB patients had higher CCI and CDS than patients without OAB. •  Among OAB patients, CNS, CV and all co-morbidities were more prevalent than in non-OAB patients. •  Prior exposure to CNS medications was more prevalent in OAB patients who received anti-muscarinic treatment than in those who did not. •  Co-morbidities and concomitant medications affecting the CNS and the CV system should be taken into account when making the decision on the most appropriate OAB treatment option for each individual patient. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative.

PubMed

Main, Elliott K; Cape, Valerie; Abreo, Anisha; Vasher, Julie; Woods, Amanda; Carpenter, Andrew; Gould, Jeffrey B

2017-03-01

Obstetric hemorrhage is the leading cause of severe maternal morbidity and of preventable maternal mortality in the United States. The California Maternal Quality Care Collaborative developed a comprehensive quality improvement tool kit for hemorrhage based on the national patient safety bundle for obstetric hemorrhage and noted promising results in pilot implementation projects. We sought to determine whether these safety tools can be scaled up to reduce severe maternal morbidity in women with obstetric hemorrhage using a large maternal quality collaborative. We report on 99 collaborative hospitals (256,541 annual births) using a before-and-after model with 48 noncollaborative comparison hospitals (81,089 annual births) used to detect any systemic trends. Both groups participated in the California Maternal Data Center providing baseline and rapid-cycle data. Baseline period was the 48 months from January 2011 through December 2014. The collaborative started in January 2015 and the postintervention period was the 6 months from October 2015 through March 2016. We modified the Institute for Healthcare Improvement collaborative model for achieving breakthrough improvement to include the mentor model whereby 20 pairs of nurse and physician mentors experienced in quality improvement gave additional support to small groups of 6-8 hospitals. The national hemorrhage safety bundle served as the template for quality improvement action. The main outcome measurement was the composite Centers for Disease Control and Prevention severe maternal morbidity measure, for both the target population of women with hemorrhage and the overall delivery population. The rate of adoption of bundle elements was used as an indicator of hospital engagement and intensity. Compared to baseline period, women with hemorrhage in collaborative hospitals experienced a 20.8% reduction in severe maternal morbidity while women in comparison hospitals had a 1.2% reduction (P < .0001). Women in hospitals with prior hemorrhage collaborative experience experienced an even larger 28.6% reduction. Fewer mothers with transfusions accounted for two thirds of the reduction in collaborative hospitals and fewer procedures and medical complications, the remainder. The rate of severe maternal morbidity among all women in collaborative hospitals was 11.7% lower and women in hospitals with prior hemorrhage collaborative experience had a 17.5% reduction. Improved outcomes for women were noted in all hospital types (regional, medium, small, health maintenance organization, and nonhealth maintenance organization). Overall, 54% of hospitals completed 14 of 17 bundle elements, 76% reported regular unit-based drills, and 65% reported regular posthemorrhage debriefs. Higher rate of bundle adoption was associated with improvement of maternal morbidity only in hospitals with high initial rates of severe maternal morbidity. We used an innovative collaborative quality improvement approach (mentor model) to scale up implementation of the national hemorrhage bundle. Participation in the collaborative was strongly associated with reductions in severe maternal morbidity among hemorrhage patients. Women in hospitals in their second collaborative had an even greater reduction in morbidity than those approaching the bundle for the first time, reinforcing the concept that quality improvement is a long-term and cumulative process. Copyright © 2017 Elsevier Inc. All rights reserved.

Social phobia and quality of life in morbidly obese patients before and after bariatric surgery.

PubMed

Mirijello, Antonio; D'Angelo, Cristina; Iaconelli, Amerigo; Capristo, Esmeralda; Ferrulli, Anna; Leccesi, Laura; Cossari, Anthony; Landolfi, Raffaele; Addolorato, Giovanni

2015-07-01

Morbidly obesity is characterized by physical and psychological comorbidities which are associated with reduced quality of life. Bariatric surgery has been linked to a reduction of psychopathology other than to a reduction of weight and improvement in physical functioning. Aim of the present study was to compare psychological features of two groups of morbidly obese patients, before and after bariatric surgery, assessing social phobia and quality of life. A total of 46 morbidly obese patients were enrolled in the study. Of them, 20 were waiting for bilio-pancreatic diversion (group A), while 26 had already undergone surgical procedure (group B). Psychometric evaluation assessed social phobia, fear for the body-shape and quality of life, using appropriate psychometric tests. The percentage of patients showing social phobia was significantly higher compared to a sample of healthy controls (p=0.004), both in group A (p=0.003) and in group B (p=0.029). No differences in percentage of patients affected by social phobia were found between groups. A significantly higher percentage of patients affected by distress about the body (p<0.0001) was found in group A with respect to group B. A reduction of quality of life was found in both groups. The present study shows a high prevalence of social phobia in a population of morbidly obese patients, both before and after surgery. A general reduction of quality of life was also observed, with a partial improvement after surgery. Future studies are needed to clarify the relationship between social phobia and quality of life in surgically-treated morbidly obese patients. Copyright © 2015 Elsevier B.V. All rights reserved.

[Chronic disease, mortality and disability in an elderly Spanish population: the FRADEA study].

PubMed

Alfonso Silguero, Sergio A; Martínez-Reig, Marta; Gómez Arnedo, Llanos; Juncos Martínez, Gema; Romero Rizos, Luis; Abizanda Soler, Pedro

2014-01-01

The objective of this study was to analyse the relationships between the major chronic diseases and multiple morbidity, with mortality, incident disability in basic activities of daily living, and loss of mobility in the elderly. A total of 943 participants were selected from the FRADEA Study, using available baseline data of chronic diseases, and at the follow-up visit of mortality, incident disability, and loss of mobility. The analysis was made of the unadjusted and adjusted association between the number of chronic diseases, the number of 14 pre-selected diseases, and the presence of two or more chronic diseases (multiple morbidity) with adverse health events recorded. Participants with a higher number of diseases (OR 1.11; 95% CI: 1.02-1.22), and 14 pre-selected diseases (OR 1.19; 95% CI: 1.03-1.38) had a higher adjusted mortality risk, but not a higher incident disease or mobility loss risk. Subjects with multiple morbidity had a higher non-significant mortality risk (HR 1.45; 95% CI: 0.87-2.43), than those without multiple morbidity. Disability-free mean time in participants with and without multiple morbidity was 846±34 and 731±17 days, respectively (Log-rank χ(2) 7.45. P=.006), and with our without mobility loss was 818±32 and 696±13 days, respectively (Log rank χ(2) 10.99. P=.001). Multiple morbidity was not associated with mortality, incident disability in ADL, or mobility loss in adults older than 70 years, although if mortality is taken into account, the number of chronic diseases is linear. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

Associations between life conditions and multi-morbidity in marginalized populations: the case of Palestinian refugees.

PubMed

Habib, Rima R; Hojeij, Safa; Elzein, Kareem; Chaaban, Jad; Seyfert, Karin

2014-10-01

Evidence suggests that higher multi-morbidity rates among people with low socioeconomic status produces and maintains poverty. Our research explores the relationship between socioeconomic deprivation and multi-morbidity among Palestinian refugees in Lebanon, a marginalized and impoverished population. A representative sample of Palestinian refugees in Lebanon was surveyed, interviewing 2501 respondents (97% response rate). Multi-morbidity was measured by mental health, chronic and acute illnesses and disability. Multinomial logistic regression models assessed the association between indicators of poverty and multi-morbidities. Findings showed that 14% of respondents never went to school, 41% of households reported water leakage and 10% suffered from severe food insecurity. Participants with an elementary education or less and those completing intermediate school were more than twice as likely to report two health problems than those with secondary education or more (OR: 2.60, CI: 1.73-3.91; OR: 2.47, CI: 1.62-3.77, respectively). Those living in households with water leakage were nearly twice as likely to have three or more health reports (OR = 1.88, CI = 1.45-2.44); this pattern was more pronounced for severely food insecure households (OR = 3.41, CI = 1.83-6.35). We identified a positive gradient between socioeconomic status and multi-morbidity within a refugee population. These findings reflect inequalities produced by the health and social systems in Lebanon, a problem expected to worsen following the massive influx of refugees from Syria. Ending legal discrimination and funding infrastructural, housing and health service improvements may counteract the effects of deprivation. Addressing this problem requires providing a decent livelihood for refugees in Lebanon. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association.

Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity

PubMed Central

2013-01-01

Background A growing proportion of people are living with long term conditions. The majority have more than one. Dealing with multi-morbidity is a complex problem for health systems: for those designing and implementing healthcare as well as for those providing the evidence informing practice. Yet the concept of multi-morbidity (the presence of >2 diseases) is a product of the design of health care systems which define health care need on the basis of disease status. So does the solution lie in an alternative model of healthcare? Discussion Strengthening generalist practice has been proposed as part of the solution to tackling multi-morbidity. Generalism is a professional philosophy of practice, deeply known to many practitioners, and described as expertise in whole person medicine. But generalism lacks the evidence base needed by policy makers and planners to support service redesign. The challenge is to fill this practice-research gap in order to critically explore if and when generalist care offers a robust alternative to management of this complex problem. We need practice-based evidence to fill this gap. By recognising generalist practice as a ‘complex intervention’ (intervening in a complex system), we outline an approach to evaluate impact using action-research principles. We highlight the implications for those who both commission and undertake research in order to tackle this problem. Summary Answers to the complex problem of multi-morbidity won’t come from doing more of the same. We need to change systems of care, and so the systems for generating evidence to support that care. This paper contributes to that work through outlining a process for generating practice-based evidence of generalist solutions to the complex problem of person-centred care for people with multi-morbidity. PMID:23919296

The companion dog as a model for human aging and mortality.

PubMed

Hoffman, Jessica M; Creevy, Kate E; Franks, Alexander; O'Neill, Dan G; Promislow, Daniel E L

2018-06-01

Around the world, human populations have experienced large increases in average lifespan over the last 150 years, and while individuals are living longer, they are spending more years of life with multiple chronic morbidities. Researchers have used numerous laboratory animal models to understand the biological and environmental factors that influence aging, morbidity, and longevity. However, the most commonly studied animal species, laboratory mice and rats, do not experience environmental conditions similar to those to which humans are exposed, nor do we often diagnose them with many of the naturally occurring pathologies seen in humans. Recently, the companion dog has been proposed as a powerful model to better understand the genetic and environmental determinants of morbidity and mortality in humans. However, it is not known to what extent the age-related dynamics of morbidity, comorbidity, and mortality are shared between humans and dogs. Here, we present the first large-scale comparison of human and canine patterns of age-specific morbidity and mortality. We find that many chronic conditions that commonly occur in human populations (obesity, arthritis, hypothyroidism, and diabetes), and which are associated with comorbidities, are also associated with similarly high levels of comorbidity in companion dogs. We also find significant similarities in the effect of age on disease risk in humans and dogs, with neoplastic, congenital, and metabolic causes of death showing similar age trajectories between the two species. Overall, our study suggests that the companion dog may be an ideal translational model to study the many complex facets of human morbidity and mortality. © 2018 The Authors. Aging Cell published by the Anatomical Society and John Wiley & Sons Ltd.

Chronic Obstructive Pulmonary Disease heterogeneity: challenges for health risk assessment, stratification and management.

PubMed

Roca, Josep; Vargas, Claudia; Cano, Isaac; Selivanov, Vitaly; Barreiro, Esther; Maier, Dieter; Falciani, Francesco; Wagner, Peter; Cascante, Marta; Garcia-Aymerich, Judith; Kalko, Susana; De Mas, Igor; Tegnér, Jesper; Escarrabill, Joan; Agustí, Alvar; Gomez-Cabrero, David

2014-11-28

Heterogeneity in clinical manifestations and disease progression in Chronic Obstructive Pulmonary Disease (COPD) lead to consequences for patient health risk assessment, stratification and management. Implicit with the classical "spill over" hypothesis is that COPD heterogeneity is driven by the pulmonary events of the disease. Alternatively, we hypothesized that COPD heterogeneities result from the interplay of mechanisms governing three conceptually different phenomena: 1) pulmonary disease, 2) systemic effects of COPD and 3) co-morbidity clustering, each of them with their own dynamics. To explore the potential of a systems analysis of COPD heterogeneity focused on skeletal muscle dysfunction and on co-morbidity clustering aiming at generating predictive modeling with impact on patient management. To this end, strategies combining deterministic modeling and network medicine analyses of the Biobridge dataset were used to investigate the mechanisms of skeletal muscle dysfunction. An independent data driven analysis of co-morbidity clustering examining associated genes and pathways was performed using a large dataset (ICD9-CM data from Medicare, 13 million people). Finally, a targeted network analysis using the outcomes of the two approaches (skeletal muscle dysfunction and co-morbidity clustering) explored shared pathways between these phenomena. (1) Evidence of abnormal regulation of skeletal muscle bioenergetics and skeletal muscle remodeling showing a significant association with nitroso-redox disequilibrium was observed in COPD; (2) COPD patients presented higher risk for co-morbidity clustering than non-COPD patients increasing with ageing; and, (3) the on-going targeted network analyses suggests shared pathways between skeletal muscle dysfunction and co-morbidity clustering. The results indicate the high potential of a systems approach to address COPD heterogeneity. Significant knowledge gaps were identified that are relevant to shape strategies aiming at fostering 4P Medicine for patients with COPD.

Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States.

PubMed

Ditkowsky, Jared; Shah, Khushal H; Hammerschlag, Margaret R; Kohlhoff, Stephan; Smith-Norowitz, Tamar A

2017-02-18

Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the United States (U.S.) [1] and remains a major public health problem. We determined the cost- benefit of screening all pregnant women aged 15-24 for Chlamydia trachomatis infection compared with no screening. We developed a decision analysis model to estimate costs and health-related effects of screening pregnant women for C. trachomatis in a high burden setting (Brooklyn, NY). Outcome data was from literature for pregnant women in the 2015 US population. A virtual cohort of 6,444,686 pregnant women, followed for 1 year was utilized. Using outcomes data from the literature, we predicted the number of C. trachomatis cases, associated morbidity, and related costs. Two comparison arms were developed: pregnant women who received chlamydia screening, and those who did not. Costs and morbidity of a pregnant woman-infant pair with C. trachomatis were calculated and compared. Cost and benefit of screening relied on the prevalence of C. trachomatis; when rates are above 16.9%, screening was proven to offer net cost savings. At a pre-screening era prevalence of 8%, a screening program has an increased expense of $124.65 million ($19.34/individual), with 328 thousand more cases of chlamydia treated, and significant reduction in morbidity. At a current estimate of prevalence, 6.7%, net expenditure for screening is $249.08 million ($38.65/individual), with 204.63 thousand cases of treated chlamydia and reduced morbidity. Considering a high prevalence region, prenatal screening for C. trachomatis resulted in increased expenditure, with a significant reduction in morbidity to woman-infant pairs. Screening programs are appropriate if the cost per individual is deemed acceptable to prevent the morbidity associated with C. trachomatis.

Psychological Health of First-Year Health Professional Students in a Medical University in the United Arab Emirates

PubMed Central

Gomathi, Kadayam G; Ahmed, Soofia; Sreedharan, Jayadevan

2012-01-01

Objectives: The aim of this study was to assess the psychological health of first-year health professional students and to study sources of student stress. Methods: All first-year students (N = 125) of the Gulf Medical University (GMU) in Ajman, United Arab Emirates (UAE), were invited to participate in a voluntary, anonymous, self-administered, questionnaire-based survey in January 2011. Psychological health was assessed using the 12-item General Health Questionnaire. A 24-item questionnaire, with items related to academic, psychosocial and health domains was used to identify sources of stress. Pearson’s chi-squared test and the Mann-Whitney U-test were used for testing the association between psychological morbidity and sources of stress. Results: A total of 112 students (89.6%) completed the survey and the overall prevalence of psychological morbidity was found to be 33.6%. The main academic-related sources of stress were ‘frequency of exams’, ‘academic workload’, and ‘time management’. Major psychosocial stressors were ‘worries regarding future’, ‘high parental expectations’, ‘anxiety’, and ‘dealing with members of the opposite sex’. Health-related issues were ‘irregular eating habits’, ‘lack of exercise’, and ‘sleep-related problems’. Psychological morbidity was not significantly associated with any of the demographic factors studied. However, total stress scores and academics-related domain scores were significantly associated with psychological morbidity. Conclusion: Psychological morbidity was seen in one in three first-year students attending GMU. While worries regarding the future and parental expectations were sources of stress for many students, psychological morbidity was found to be significantly associated with only the total stress and the academic-related domain scores. PMID:22548140

The Burden of COPD Morbidity Attributable to the Interaction between Ambient Air Pollution and Temperature in Chengdu, China.

PubMed

Qiu, Hang; Tan, Kun; Long, Feiyu; Wang, Liya; Yu, Haiyan; Deng, Ren; Long, Hu; Zhang, Yanlong; Pan, Jingping

2018-03-11

Evidence on the burden of chronic obstructive pulmonary disease (COPD) morbidity attributable to the interaction between ambient air pollution and temperature has been limited. This study aimed to examine the modification effect of temperature on the association of ambient air pollutants (including particulate matter (PM) with aerodynamic diameter <10 μm (PM 10 ) and <2.5 μm (PM 2.5 ), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon monoxide (CO) and ozone (O₃)) with risk of hospital admissions (HAs) for COPD, as well as the associated morbidity burden in urban areas of Chengdu, China, from 2015 to 2016. Based on the generalized additive model (GAM) with quasi-Poisson link, bivariate response surface model and stratification parametric model were developed to investigate the potential interactions between ambient air pollution and temperature on COPD HAs. We found consistent interactions between ambient air pollutants (PM 2.5 , PM 10 and SO₂) and low temperature on COPD HAs, demonstrated by the stronger associations between ambient air pollutants and COPD HAs at low temperatures than at moderate temperatures. Subgroup analyses showed that the elderly (≥80 years) and males were more vulnerable to this interaction. The joint effect of PM and low temperature had the greatest impact on COPD morbidity burden. Using WHO air quality guidelines as reference concentration, about 17.30% (95% CI: 12.39%, 22.19%) and 14.72% (95% CI: 10.38%, 19.06%) of COPD HAs were attributable to PM 2.5 and PM 10 exposures on low temperature days, respectively. Our findings suggested that low temperature significantly enhanced the effects of PM and SO₂ on COPD HAs in urban Chengdu, resulting in increased morbidity burden. This evidence has important implications for developing interventions to reduce the risk effect of COPD morbidity.

The association of lymph node dissection with 30-day perioperative morbidity among men undergoing minimally invasive radical prostatectomy: analysis of the National Surgical Quality Improvement Program (NSQIP).

PubMed

Brito, Joseph; Pereira, Jorge; Moreira, Daniel M; Pareek, Gyan; Tucci, Christopher; Guo, Ruiting; Zhang, Zheng; Amin, Ali; Mega, Anthony; Renzulli, Joseph; Golijanin, Dragan; Gershman, Boris

2018-06-01

The incremental morbidity of lymph node dissection (LND) among men undergoing radical prostatectomy remains uncertain. We therefore evaluated  the association of LND with perioperative morbidity among men undergoing minimally invasive radical prostatectomy (MIRP). We identified 29,012 men aged 35-89 who underwent MIRP from 2010-2015 in the National Surgical Quality Improvement Program (NSQIP) database, of whom 47% underwent concomitant LND. The associations of LND with 30-day perioperative morbidity and mortality were evaluated using logistic regression, adjusted for patient features. Median age at surgery was 63 (IQR 57, 67) years. There were statistically significant, but clinically insignificant, differences in several baseline characteristics stratified by performance of LND, including older age at surgery (p < 0.001), higher American Society of Anesthesiology (ASA) class (p < 0.001), and longer operative time (p < 0.001) for men who underwent LND. Overall, 30-day complications occurred in 4.3% of patients. There were no statistically significant differences in rates of 30-day complications (4.2 vs. 4.4%, p = 0.44), perioperative blood transfusion (1.7 vs. 1.7%, p = 0.99), hospital readmission (3.6 vs. 4.0%, p = 0.09), reoperation (1.1 vs. 1.1%, p = 0.80), or 30-day mortality (0.1 vs. 0.2%, p = 0.56) between patients who underwent MIRP alone or MIRP with LND, respectively. On multivariable analysis, LND was not significantly associated with an increased risk of perioperative morbidity or 30-day mortality. LND at the time of MIRP does not appear to be associated with an increased risk of perioperative morbidity.

Risk Factors for Thirty-Day Morbidity and Mortality in Extradural Lumbar Spine Tumor Resection.

PubMed

Sarkiss, Christopher A; Hersh, Eliza H; Ladner, Travis R; Lee, Nathan; Kothari, Parth; Lakomkin, Nikita; Caridi, John M

2018-06-01

Epidural tumors in the lumbar spine represent a unique cohort of lesions with individual risks and challenges to resection. Knowledge of modifiable risk factors are important in minimizing postoperative complications. To determine the risk factors for 30-day morbidity and mortality in patients undergoing extradural lumbar tumor resection. A retrospective study of prospectively collected data using the American College of Surgeons National Quality Improvement Program database was performed. Adults who underwent laminectomy for excision of lumbar spine tumors between 2011 and 2014 were included in the study. Demographics and medical comorbidities were collected, along with morbidities and mortalities within 30 postoperative days. A multivariate binary logistic analysis of these clinical variables was performed to determine covariates of morbidity and mortality. The database search yielded 300 patients, of whom 118 (39.3%) were female. Overall, complications within 30 days of surgery occurred in 102 (34%) patients. Significant risk factors for morbidity included preoperative anemia (P < 0.0001), the need for preoperative blood transfusion (P = 0.034), preoperative hypoalbuminemia (P = 0.002), American Society of Anesthesiologists score 3 or 4 (P = 0.0002), and operative time >4 hours (P < 0.0001). Thirty-day mortality occurred in 15 (5%) patients and was independently associated with preoperative anemia (odds ratio 3.4, 95% confidence interval 1.8-6.5) and operative time >4 hours (odds ratio 2.6, 95% confidence interval 1.1-6.0). Excision of epidural lumbar spinal tumors carries a relatively high complication rate. This series reveals distinct risk factors that contribute to 30-day morbidity and mortality, which may be optimized preoperatively to improve surgical safety. Copyright © 2018 Elsevier Inc. All rights reserved.

Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis.

PubMed

Pucher, Philip H; Brunt, L Michael; Davies, Neil; Linsk, Ali; Munshi, Amani; Rodriguez, H Alejandro; Fingerhut, Abe; Fanelli, Robert D; Asbun, Horacio; Aggarwal, Rajesh

2018-05-01

Laparoscopic cholecystectomy (LC), one of the most commonly performed surgical procedures, remains associated with significant major morbidity including bile leak and bile duct injury (BDI). The effect of changes in practice over time, and of interventions to improve patient safety, on morbidity rates is not well understood. The aim of this review was to describe current incidence rates and trends for BDI and other complications during and after LC, and to identify risk factors and preventative measures associated with morbidity and BDI. PubMed, MEDLINE, and Web of Science database searches and data extraction were conducted for studies which reported individual complications and complication rates following laparoscopic cholecystectomy in a representative population. Outcomes data were pooled. Meta-regression analysis was performed to assess factors associated with conversion, morbidity, and BDI rates. One hundred and fifty-one studies reporting outcomes for 505,292 patients were included in the final quantitative synthesis. Overall morbidity, BDI, and mortality rates were 1.6-5.3%, 0.32-0.52%, and 0.08-0.14%, respectively. Reported BDI rates reduced over time (1994-1999: 0.69(0.52-0.84)% versus 2010-2015 0.22(0.02-0.40)%, p = 0.011). Meta-regression analysis suggested higher conversion rates in developed versus developing countries (4.7 vs. 3.4%), though a greater degree of reporting bias was present in these studies, with no other significant associations identified. Overall, trends suggest a reduction in BDI over time with unchanged morbidity and mortality rates. However, data and reporting are heterogenous. Establishment of international outcomes registries should be considered.

Review: An Australian model of care for co-morbid diabetes and chronic kidney disease.

PubMed

Lo, Clement; Zimbudzi, Edward; Teede, Helena; Cass, Alan; Fulcher, Greg; Gallagher, Martin; Kerr, Peter G; Jan, Stephen; Johnson, Greg; Mathew, Tim; Polkinghorne, Kevan; Russell, Grant; Usherwood, Tim; Walker, Rowan; Zoungas, Sophia

2018-02-05

Diabetes and chronic kidney disease (CKD) are two of the most prevalent co-morbid chronic diseases in Australia. The increasing complexity of multi-morbidity, and current gaps in health-care delivery for people with co-morbid diabetes and CKD, emphasise the need for better models of care for this population. Previously, proposed published models of care for co-morbid diabetes and CKD have not been co-designed with stake-holders or formally evaluated. Particular components of health-care shown to be effective in this population are interventions that: are structured, intensive and multifaceted (treating diabetes and multiple cardiovascular risk factors); involve multiple medical disciplines; improve self-management by the patient; and upskill primary health-care. Here we present an integrated patient-centred model of health-care delivery incorporating these components and co-designed with key stake-holders including specialist health professionals, general practitioners and Diabetes and Kidney Health Australia. The development of the model of care was informed by focus groups of patients and health-professionals; and semi-structured interviews of care-givers and health professionals. Other distinctives of this model of care are routine screening for psychological morbidity; patient-support through a phone advice line; and focused primary health-care support in the management of diabetes and CKD. Additionally, the model of care integrates with the patient-centred health-care home currently being rolled out by the Australian Department of Health. This model of care will be evaluated after implementation across two tertiary health services and their primary care catchment areas. Copyright © 2018 John Wiley & Sons, Ltd. This article is protected by copyright. All rights reserved.

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study.

PubMed

Keller, Roberta L; Feng, Rui; DeMauro, Sara B; Ferkol, Thomas; Hardie, William; Rogers, Elizabeth E; Stevens, Timothy P; Voynow, Judith A; Bellamy, Scarlett L; Shaw, Pamela A; Moore, Paul E

2017-08-01

To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). We enrolled ELGANs (<29 weeks' gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks' postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months' corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks' postmenstrual age were assessed for predictive accuracy. Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks' gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year. ClinicalTrials.gov: NCT01435187. Copyright © 2017 Elsevier Inc. All rights reserved.

[Odontoid process fracture in elderly patients over 70 years: morbidity, handicap, and role of surgical treatment in a retrospective series of 27 cases].

PubMed

Lefranc, M; Peltier, J; Fichten, A; Desenclos, C; Toussaint, P; Le Gars, D

2009-12-01

Odontoid process fractures of the axis are frequent in elderly patients. However, the impact in terms of handicap and morbidity in this particular population are unknown. The role of surgical treatment remains controversial. We present a retrospective series of patients aged 70 years or older with odontoid fractures treated in our department between 1998 and 2006. Two cohorts were defined (surgery versus conservative) and compared. Morbidity, handicap, and radiographic fusion were analyzed. Twenty-seven patients were treated. The mean age was 80.67 years. Five patients died early during hospitalization. Fractures were type II in 66.7% of the cases and type III in 33.3%. Orthopedic treatment was chosen in 44.4% of the cases. A non-union at the fracture site was found in 33% of the cases and morbidity in 41.7% of the cases was found after a 1-year follow-up. Surgery was performed in 40.7% of the cases. There was 18% non-union and no morbidity after 1-year of follow-up. Morbidity was statistically lower in the surgery group (p=0.037), particularly in cases of type II fracture (p=0.0063); no statistically significant difference was found for non-union at the fracture site (p=0.64) except for type II fractures (p=0.028). Odontoid fractures in the elderly are a very frequent problem. Immediate mortality is still high but appears correlated to associated lesions. Today's treatments must preserve autonomy for these patients. For elderly patients, the treatment must be chosen in relation to the fracture analysis. In our opinion, surgical management is the treatment of choice for unstable fractures (type II). Conservative management is indicated for stable fractures.

Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.

PubMed

Davenport, Daniel L; Henderson, William G; Mosca, Cecilia L; Khuri, Shukri F; Mentzer, Robert M

2007-12-01

Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality. Surveys were administered to staff on general/vascular surgery services during a year. Surveys included multiitem scales measuring OCSFs. Additionally, perceived levels of communication and collaboration with coworkers were assessed. The National Surgical Quality Improvement Program was used to assess risk-adjusted morbidity and mortality. Correlations between outcomes and OCSFs were calculated and between outcomes and communication/collaboration with attending and resident doctors, nurses, and other providers. Fifty-two sites participated in the survey: 44 Veterans Affairs and 8 academic medical centers. A total of 6,083 surveys were returned, for a response rate of 52%. The OCSF measures of teamwork climate, safety climate, working conditions, recognition of stress effects, job satisfaction, and burnout demonstrated internal validity but did not correlate with risk-adjusted outcomes. Reported levels of communication/collaboration with attending and resident doctors correlated with risk-adjusted morbidity. Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity. This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.

Morbidity and Mortality Conferences: A Narrative Review of Strategies to Prioritize Quality Improvement.

PubMed

Giesbrecht, Vanessa; Au, Selena

2016-11-01

The morbidity and mortality conference (MMC) provides a valuable opportunity to review patient care processes and safety concerns, aligning with a growing quality improvement (QI) mandate. Yet the structure, processes, and aims of many MMCs are often ill-defined. This review summarizes strategies employed by medical, surgical, and critical care departments in the development of patient safety-centered MMCs. A structured narrative review of literature was conducted using combinations of the search terms "morbidity and mortality conference(s)," "morbidity and mortality meetings," or "morbidity and mortality round(s)." The titles and abstracts of 250 returned articles were screened; 76 articles were reviewed in full, with 32 meeting the full inclusion criteria. The literature review elicited a number of methods used by medical, surgical, and critical care MMCs to emphasize QI and patient safety outcomes. A list of actionable changes made in each article was compiled. Five themes common to QI-centered MMCs were identified: (1) defining the role of the MMC, (2) involving stakeholders, (3) detecting and selecting appropriate cases for presentation, (4) structuring goal-directed discussion, and (5) forming recommendations and assigning follow-up. Innovative methods to pair adverse event screening with MMCs were superior to nonstructured voluntary reporting and case selection for overall morbidity detection. Structured case review, discussion, and follow-up were more likely to lead to implementing systems-based change, and interdisciplinary MMCs were associated with a greater likelihood of forming an action item. The modern patient safety-centered MMC shares common themes of practices that can be adopted by institutions looking to create a venue for analysis of care processes, a platform to launch QI initiatives, and a culture of safety. Copyright 2016 The Joint Commission.

Relationship of exclusive breast-feeding to infections and growth of Tanzanian children born to HIV-infected women

PubMed Central

Mwiru, Ramadhani S; Spiegelman, Donna; Duggan, Christopher; Peterson, Karen; Liu, Enju; Msamanga, Gernard; Aboud, Said; Fawzi, Wafaie W

2012-01-01

Objective We examined the relationships between exclusive breast-feeding and the risks of respiratory, diarrhoea and nutritional morbidities during the first 2 years of life among children born to women infected with HIV-1. Design We prospectively determined the incidence of respiratory illnesses, diarrhoea, fever, hospitalizations, outpatient visits and nutritional morbidities. Generalized estimating equations were used to estimate the relative risks for morbidity episodes and Cox proportional hazards models to estimate the incidence rate ratios of nutritional morbidities. Setting Dar es Salaam, Tanzania. Subjects The sample consisted of 666 children born to HIV-infected women. Results The 666 children were followed for 2 years. Exclusive breast-feeding was associated with lower risk for cough (rate ratio (RR) = 0·49, 95 % CI 0·41, 0·60, P < 0·0001), cough and fever (RR = 0·44, 95 % CI 0·32, 0·60, P < 0·0001) and cough and difficulty breathing or refusal to feed (RR = 0·31, 95 % CI 0·18, 0·55, P < 0·0001). Exclusive breast-feeding was also associated with lower risk of acute diarrhoea, watery diarrhoea, dysentery, fever and outpatient visits during the first 6 months of life, but showed no effect at 6–24 months of life. Exclusive breast-feeding did not significantly reduce the risks of nutritional morbidities during the first 2 years of life. Conclusions Exclusive breast-feeding is strongly associated with reductions in the risk of respiratory and diarrhoea morbidities during the first 6 months of life among children born to HIV-infected women. PMID:21324223

Older Age Confers a Higher Risk of 30-Day Morbidity and Mortality Following Laparoscopic Bariatric Surgery: an Analysis of the Metabolic and Bariatric Surgery Quality Improvement Program.

PubMed

Haskins, Ivy N; Ju, Tammy; Whitlock, Ashlyn E; Rivas, Lisbi; Amdur, Richard L; Lin, Paul P; Vaziri, Khashayar

2018-04-17

There is a paucity of literature describing the association of age with the risk of adverse events following bariatric surgery. The purpose of this study is to investigate the association of age with 30-day morbidity and mortality following laparoscopic bariatric surgery using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. All adult patients undergoing laparoscopic Roux-en-Y gastric bypass (RNGYB) or sleeve gastrectomy (SG) were identified within the MBSAQIP database. Patients were divided into five equal age quintiles. Binary outcomes of interest, including cardiac, pulmonary, wound, septic, clotting, and renal events, in addition to the incidence of related 30-day unplanned reintervention, related 30-day mortality, and a composite morbidity and mortality outcome were compared across the age quintiles and procedures. A total of 266,544 patients met inclusion criteria. Older age was associated with an increased risk of all morbidity outcomes except venous thromboembolism events, 30-day mortality, and the composite morbidity and mortality outcome. Patients who underwent Roux-en-Y gastric bypass had worse outcomes per quintile for almost every outcome of interest when compared to patients who underwent sleeve gastrectomy. Older patients and patients who undergo Roux-en-Y gastric bypass are at an increased risk of perioperative morbidity and mortality following laparoscopic bariatric surgery. Additional studies are needed to determine the association of age with long-term weight loss and cardiometabolic comorbidity resolution following bariatric surgery in order to determine if the increased perioperative risk is offset by improved long-term outcomes in older patients undergoing bariatric surgery.

Flourishing or floundering? Prevalence and correlates of anxiety and depression among a population-based sample of adult cancer survivors 6months after diagnosis.

PubMed

Boyes, Allison W; Girgis, Afaf; D'Este, Catherine; Zucca, Alison C

2011-12-01

To describe the prevalence of anxiety, depression and comorbid anxiety-depression among adult cancer survivors six months following diagnosis, and identify the individual, disease, health behaviour, psychological and social factors associated with psychological morbidity. A population-based sample of adult cancer survivors was recruited from two state-based cancer registries in Australia. Data for 1323 survivors were obtained by self-report questionnaire and linkage with registry data. Anxiety and depression were assessed by the 14-item Hospital Anxiety and Depression Scale (HADS). The prevalence of psychological morbidity was 28% (95% CI: 23%-33%). Specifically, 24% (95% CI: 19%-29%) of survivors were identified as cases on anxiety (irrespective of depression), 14% (95% CI: 9%-19%) as cases on depression (irrespective of anxiety) and 10% (95% CI: 5%-15%) as cases on comorbid anxiety-depression. In addition to mental health history prior to cancer, modifiable health behaviours (physical activity, smoking status), psychological (helplessness-hopelessness, anxious preoccupation coping) and social (low positive social interaction) characteristics were stronger indicators of psychological morbidity than survivors' individual or disease characteristics. Psychological morbidity was assessed by self-report screening instrument rather than clinical interview. The extent to which psychological morbidity is age-related versus cancer-related cannot be determined without a gender- and age-matched control group. Although lower than previously reported, psychological morbidity is prevalent six months after a cancer diagnosis and emphasises the need for routine psychosocial assessment throughout the cancer trajectory to identify those at increased risk or in need of immediate intervention. Physical activity, smoking cessation and coping skills training interventions warrant further exploration. Copyright © 2011 Elsevier B.V. All rights reserved.