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Sample records for prevent unnecessary morbidity

  1. Does the addition of saline infusion sonohysterography to transvaginal ultrasonography prevent unnecessary hysteroscopy in premenopausal women with abnormal uterine bleeding?

    Science.gov (United States)

    Short, John; Sharp, Benjamin; Elliot, Nikki; McEwing, Rachael; McGeoch, Graham; Shand, Brett; Holland, Kieran

    2016-08-01

    This observational case series in 65 premenopausal women with abnormal uterine bleeding evaluated whether transvaginal ultrasound followed by saline infusion sonohysterography (SIS) prevented unnecessary hysteroscopy. Although SIS indicated that hysteroscopy was unnecessary in eight women, this benefit was offset by the invasive nature of the scan, the number of endometrial abnormalities falsely detected by SIS and the cost of the additional investigation. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  2. Neonatal adrenal hemorrhage manifesting as acute scrotum: timely diagnosis prevents unnecessary surgery.

    Science.gov (United States)

    Avolio, Luigi; Fusillo, Mario; Ferrari, Giovanna; Chiara, Alberto; Bragheri, Romano

    2002-04-01

    Neonatal adrenal hemorrhage presenting as scrotal swelling has been reported in 17 cases, with unnecessary surgical exploration in 7. We report 2 new cases, emphasizing the knowledge of this clinical association and the role of ultrasonography in the differential diagnosis for this specific condition and in all cases of neonatal acute scrotum.

  3. The value of a poison control center in preventing unnecessary ED visits and hospital charges: A multi-year analysis.

    Science.gov (United States)

    Tak, Casey R; Malheiro, Marty C; Bennett, Heather K W; Crouch, Barbara I

    2017-03-01

    The purpose of this study is to determine the economic value of the Utah Poison Control Center (UPCC) by examining its contribution to the reduction of unnecessary emergency department (ED) visits and associated charges across multiple years. A multi-year (2009-2014) analysis of cross-sectional data was performed. Callers were asked what they would do for a poison emergency if the UPCC was not available. Healthcare charges for ED visits averted were calculated according to insurance status using charges obtained from a statewide database. Of the 10,656 survey attempts, 5018 were completed. Over 30,000 cases were managed on-site each year. Using the proportion of callers who noted they would call 911, visit an ED, or call a physician's office, between 20.0 and 24.2 thousand ED visits were potentially prevented each year of the survey. Between $16.6 and $24.4 million dollars in unnecessary healthcare charges were potentially averted annually. Compared to the cost of operation, the service UPCC provides demonstrates economic value by reducing ED visits and associated charges. As the majority of patients have private insurance, the largest benefit falls to private payers. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. A comparison of laws preventing unnecessary canine cosmetic surgery in Italy and in the Czech Republic

    Directory of Open Access Journals (Sweden)

    Valeria Quartarone

    2012-01-01

    Full Text Available Many invasive procedures, including surgery (ear cropping, tail docking, and debarking in the dog, are performed on dogs for purely cosmetic reasons or convenience. These procedures, also known as “cosmetic surgery”, fall into a variety of categories from the questionably unethical to the undoubtedly criminal, because they are mostly carried out solely to alter a dog’s physical appearance. Although in several European countries these procedures are banned, except when performed by a veterinarian for medical reasons, veterinarians are often requested to perform them for various reasons. Though controversial, canine cosmetic surgery continues to be performed, reaching epidemic proportions. The authors summarize legislation, individual positions and veterinary attitudes regarding cosmetic surgery in Italy and the Czech Republic. Additionally, they explain the ways in which the law is being used in the two countries to prevent these unnecessary procedures, and how current and future anti-cruelty laws can stop unethical use of cosmetic surgery.

  5. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review.

    Science.gov (United States)

    Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

    2014-04-01

    Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, pSMD) in catheterisation duration (days) was -1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD -0.37; pSMD, -1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits.

  6. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

    Science.gov (United States)

    Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

    2014-01-01

    Background Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. Methods To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. Results 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. Conclusions UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits. PMID:24077850

  7. Prevention of unnecessary pregnancy terminations by counselling women on drug, chemical, and radiation exposure during the first trimester

    International Nuclear Information System (INIS)

    Koren, G.; Pastuszak, A.

    1990-01-01

    As part of a new approach to counselling pregnant women concerned about antenatal exposure to drugs, chemicals, or radiation, we measured their tendency to terminate their pregnancy by using a visual analogue scale (VAS). Analysis of 78 cases where women had less than 50% tendency to continue pregnancy before they were advised by us reveals that 61 decided to continue their pregnancy after the consultation (57 normal, healthy infants, four miscarriages) and 17 terminated. Women who continued their pregnancy significantly changed their tendency after we discussed relevant information with them (from 34.3 +/- 2.5% to 84.5 +/- 3.3%, P less than 0.00001), whereas most of those who eventually terminated pregnancy did not change their tendency to continue pregnancy beyond the 50% mark (from 24.8 +/- 5.4% to 45.1 +/- 9.8%) (P greater than 0.1). Only two of the women who terminated their pregnancy were exposed to teratogenic drugs; however, in most other cases, other obvious reasons, unrelated to the exposure in question, were identified by the women as leading reasons for termination. An appropriate intervention in early pregnancy can prevent unnecessary pregnancy terminations by correcting misinformation and thereby decreasing the unrealistically high perception of risk by women exposed to nonteratogens

  8. Double-blind placebo-controlled food challenges in children with alleged cow's milk allergy: prevention of unnecessary elimination diets and determination of eliciting doses.

    Science.gov (United States)

    Dambacher, Wendy M; de Kort, Ellen H M; Blom, W Marty; Houben, Geert F; de Vries, Esther

    2013-02-08

    Children with cow's milk allergy (CMA) need a cow's milk protein (CMP) free diet to prevent allergic reactions. For this, reliable allergy-information on the label of food products is essential to avoid products containing the allergen. On the other hand, both overzealous labeling and misdiagnosis that result in unnecessary elimination diets, can lead to potentially hazardous health situations. Our objective was to evaluate if excluding CMA by double-blind placebo-controlled food challenge (DBPCFC) prevents unnecessary elimination diets in the long term. Secondly, to determine the minimum eliciting dose (MED) for an acute allergic reaction to CMP in DBPCFC positive children. All children with suspected CMA under our care (Oct'05-Jun'09) were prospectively enrolled in a DBPCFC. Placebo and verum feedings were administered on two randomly assigned separate days. The MED was determined by noting the 'lowest observed adverse effect level' (LOAEL) in DBPCFC-positive children. Based on the outcomes of the DBPCFC a dietary advice was given. Parents were contacted by phone several months later about the diet of their child. 116 children were available for analysis. In 76 children CMA was rejected. In 60 of them CMP was successfully reintroduced, in 2 the parents refused introduction, in another 3 the parents stopped reintroduction. In 9 children CMA symptoms reappeared. In 40 children CMA was confirmed. Infants aged ≤ 12 months in our study group have a higher cumulative distribution of MED than older children. Excluding CMA by DBPCFC successfully stopped unnecessary elimination diets in the long term in most children. The MEDs form potential useful information for offering dietary advice to patients and their caretakers.

  9. Morbidity Pattern among under Five Children and Preventive ...

    African Journals Online (AJOL)

    The general distribution of ailments was malaria with 271 cases, diarrhea with 92 cases, pneumonia with 27 cases and upper respiratory tract infection with 30 cases. About 101(24.6%) of the children are wasted. and 309(75.2%) of the studied under five children were not. Knowledge about predisposing factors to morbidity ...

  10. Risk assessment for prevention of morbidity and mortality: lessons for pressure ulcer prevention.

    Science.gov (United States)

    Reynolds, T M

    2008-11-01

    Medicine has changed from being a reactive process that attempts to alleviate disease only when it is clinically evident to a proactive one in which it is hoped that early intervention may reduce the impact of disease or even it developing at all. In moving the focus of treatment, this inevitably means that a greater number of individuals with lesser disease burdens are treated. The logical end-point of this process is to provide preventative measures for the entire population but this can only be done if the economic costs and negative effects of treatment are out-weighed by the benefits. In the case of pressure ulcers, it is self-evident that prevention is extremely beneficial to patients. However, the cost of some of the equipment used for prevention can be high, and therefore, the balance between the optimum level of provision, the purposes of prevention and the available funding becomes critical. Consequently a screening mechanism to better match susceptible patients with resources is essential. There are, however, many problems with such screening techniques. By looking at other specialties, we can see that it is vital to know the natural history of the disease: PSA testing reveals many men who would have died never having known they had prostate cancer, thus giving them years of worry and morbidity they would probably not previously have suffered; cardiovascular risk screening is so imprecise that risk estimates are of questionable utility; antenatal Down's syndrome risk screening is prone to data-related problems that can unexpectedly reduce the effectiveness of the test. In pressure ulcer screening, there are many tools currently in use, but few (possibly none) are really effective. Finally, this paper details some suggestions for future research to combine risk tests that may offer a prospect for improving ulcer risk screening tools.

  11. Time to foster a rational approach to preventing cardiovascular morbid events.

    Science.gov (United States)

    Cohn, Jay N; Duprez, Daniel A

    2008-07-29

    Efforts to prevent atherosclerotic morbid events have focused primarily on risk factor prevention and intervention. These approaches, based on the statistical association of risk factors with events, have dominated clinical practice in the last generation. Because the cardiovascular abnormalities eventuating in morbid events are detectable in the arteries and heart before the development of symptomatic disease, recent efforts have focused on identifying the presence of these abnormalities as a more sensitive and specific guide to the need for therapy. Advances in noninvasive techniques for studying the vasculature and the left ventricle now provide the opportunity to use early disease rather than risk factors as the tool for clinical decision making. A disease scoring system has been developed using 10 tests of vascular and cardiac function and structure. More extensive data to confirm the sensitivity and specificity of this scoring system and to demonstrate its utility in tracking the response to therapy are needed to justify widespread application in clinical practice.

  12. Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis.

    Science.gov (United States)

    Yang, Lu; Zhu, Yuchun; Tang, Zhuang; Chen, Yongji; Gao, Liang; Liu, Liangren; Han, Ping; Li, Xiang; Wei, Qiang

    2015-05-01

    To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs). A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared effects of empiric antibiotics with no treatment or placebo on lowering PSA levels and minimizing unnecessary PBs in patients with moderately increased PSA levels. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. The inclusion criteria for the study were met by 6 RCTs (1 placebo controlled and 5 no treatment controlled) involving 656 patients. The synthesized data from these RCTs indicated that there were no significant differences between the antibiotic and control groups in the PSA levels after treatment (mean difference [MD] = 0.15, 95% CI:-0.50 to 0.81, P = 0.65], number of patients with decreased PSA levels after treatment (relative risk [RR] = 1.22, 95% CI: 0.90-1.65, P = 0.20], prostate-specific antigen density levels after treatment (MD =-0.04, 95% CI:-0.15 to 0.07, P = 0.47), f/t% PSA after treatment (MD =-1.47, 95% CI:-4.65 to 1.71, P = 0.37), number of patients with responsive PSA (RR = 1.02, 95% CI: 0.58-1.81, P = 0.94), and individual Pca-positiverate in these patients (RR = 1.07, 95% CI: 0.53-2.16, P = 0.86), and Pca-positiverates (RR = 0.85, 95% CI: 0.48-1.50, P = 0.57). However, the antibiotic group had a significant change in the net PSA decrease after treatment compared with the control group (MD = 1.44, 95% CI: 0.70-2.17, P = 0.0001). The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Severe maternal morbidity due to sepsis: The burden and preventability of disease in New Zealand.

    Science.gov (United States)

    Lepine, Sam; Lawton, Beverley; Geller, Stacie; Abels, Peter; MacDonald, Evelyn J

    2018-02-20

    Sepsis is a life-threatening systemic condition that appears to be increasing in the obstetric population. Clinical detection can be difficult and may result in increased morbidity via delays in the continuum of patient care. To describe the burden of severe maternal morbidity (SMM) caused by sepsis in New Zealand and investigate the potential preventability. A multidisciplinary expert review panel was established to review cases of obstetric sepsis admitted to intensive care or high-dependency units over an 18 month span in New Zealand. Cases were then analysed for the characteristics of infection and their preventability. Fifty cases met the inclusion criteria, most commonly due to uterine, respiratory or kidney infection. Fifty per cent (25) of these cases were deemed potentially preventable, predominantly due to delays in diagnosis and treatment. A high index of suspicion, development of early recognition systems and multi-disciplinary training are recommended to decrease preventable cases of maternal sepsis. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  14. Dietary Protein in the Prevention of Diet-Induced Obesity and Co-Morbidities

    DEFF Research Database (Denmark)

    Tastesen, Hanne Sørup

    mice were fed obesity‐promoting diets with protein from different sources, in different forms and at different levels to evaluate the affect on development of obesity, glucose intolerance and dyslipidemia. Results: In the present study the dietary level of protein, 16 versus 32 percent energy from...... protein, was found to be negligible in development of obesity and co‐morbidities in mice. Seafood protein with high endogenous taurine and glycine contents was found to prevent diet‐induced adiposity and dyslipidemia, both in ad libitum and pair‐fed settings. The ability of seafood proteins to prevent...... that the source and form of protein has great impact on development and prevention of diet‐induced adiposity, dyslipidemia, hyperinsulinemia and impairment of glucose tolerance through modulations of voluntary locomotor activity, energy expenditure and energy substrate metabolism in mice...

  15. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

    Science.gov (United States)

    Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara

    2016-01-01

    The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

  16. Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

    Directory of Open Access Journals (Sweden)

    Mathieu Boulin

    Full Text Available The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.An economic (decision-tree analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services and Canadian public health payer perspectives were adopted.Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

  17. Is it possible to prevent morbidity on post cardiovascular surgery applying low level laser therapy?

    Science.gov (United States)

    Pinto, Nathali C.; Baptista, Ivany Machado d. C.; Pereira, Mara Helena C.; Serrão, Nelson F.; Pomerantzeff, Pablo M. A.; Chavantes, Maria Cristina

    2014-03-01

    Background and Objective: Complications following cardiovascular surgery incision are common in mediastinitis and wound dehiscence form, a 47% mortality rate remaining. Low Level Laser Therapy (LLLT) has been employed mainly to its effectiveness analgesic and anti-inflammatory actions, aiding the tissue repair process. The aim of this study was to evaluate infrared LLLT onto surgical incision in patients submitted to cardiovascular surgery. Materials and Methods: 40 patients were divided in two groups: Placebo Group (G1) - conventional therapy + "Laser pointer" and Laser Group (G2) - conventional therapy + Infrared Laser irradiation on surgical incision. Diode Laser was employed, C.W. mode, around the surgical wound bed, on immediate Post Operative (PO), 1st PO and 3rd PO with the following parameters: wavelength (λ): 830nm, P=35mW, E=0,75J. Results: G2 didn't present any complication and 5% of patients in G1 developed incision dehiscence and infection. On 7thPO, still a large amount of G1 patients showed pain and unquestionable inflammatory signs surrounding the surgical wound, when compared to G2. Besides, hospital stay in Laser Group was 2 times shorter than in Placebo Group (p-value=0.001). Conclusion: Infrared Laser denoted to be safe and exceptionally valuable tools in preventing morbidities on post cardiovascular surgeries.

  18. [Preventable drug-related morbidity: determining valid indicators for primary care in Portugal].

    Science.gov (United States)

    Guerreiro, Mara Pereira; Cantrill, Judith A; Martins, Ana Paula

    2007-01-01

    Preventable drug-related morbidity (PDRM) indicators are operational measures of therapeutic risk management. These clinical indicators, which cover a wide range of drugs, combine process and outcome in the same instrument. They were developed in the US and have been validated for primary care settings in the US, UK and Canada. This study is part of a research programme; it aimed to determine a valid set of PDRM indicators for adult patients in primary care in Portugal. Face validity of 61 US and UK-derived indicators translated to Portuguese was preliminarily determined by means of a postal questionnaire using a purposive sample of four Portuguese pharmacists with different backgrounds. Preliminary content validity of indicators approved in the previous stage was determined by cross-checking each definition of PDRM with standard drug information sources in Portugal. Face and content validity of indicators yielded by preliminary work were then established by a 37 expert panel (20 community pharmacists and 17 general practitioners) using a two-round Delphi survey. Data were analysed using SPSS release 11.5. Nineteen indicators were ruled out in preliminary validation. Changes were made in the content of eight of the remaining 42 indicators; these were related to differences in the drugs being marketed and patterns of drug monitoring between countries. Thirty-five indicators were consensus approved as PDRM for adult patients in Portuguese primary care by the Delphi panel.

  19. Morbidity management and disability prevention for lymphatic filariasis in Sri Lanka: Current status and future prospects.

    Science.gov (United States)

    Chandrasena, Nilmini; Premaratna, Ranjan; Gunaratna, Indeewarie E; de Silva, Nilanthi R

    2018-05-01

    Sri Lanka was acknowledged to have eliminated lymphatic filariasis (LF) as a public health problem in 2016, largely due to its success in Mass Drug Administration (MDA) to interrupt disease transmission. Analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the national Morbidity Management and Disability Prevention (MMDP) program, the other pillar of the LF control program, was carried out with the objective of evaluating it and providing recommendations to optimize the use of available resources. A situation analysis of the MMDP activities provided by the state health sector was carried out using published records, in-depth interviews with key informants of the Anti Filariasis Campaign, site-visits to filariasis clinics with informal discussions with clinic workforce and personal communications to identify strengths and weaknesses; and opportunities to overcome weaknesses and perceived threats to the program were explored. The principal strength of the MMDP program was the filariasis clinics operational in most endemic districts of Sri Lanka, providing free health care and health education to clinic attendees. The weaknesses identified were the low accessibility of clinics, incomplete coverage of the endemic region and lack of facilities for rehabilitation. The perceived threats were diversion of staff and resources for control of other vector-borne infections, under-utilization of clinics and non-compliance with recommended treatment. Enhanced high level commitment for MMDP, wider publicity and referral systems, integration of MMDP with other disease management services and collaboration with welfare organizations and research groups were identified as opportunities to overcome weaknesses and challenges. The recommended basic package of MMDP was functional in most of the LF-endemic region. The highlighted weaknesses and challenges, unless addressed, may threaten program sustainability. The identified opportunities for improvement of the

  20. Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

    Science.gov (United States)

    Blessberger, Hermann; Kammler, Juergen; Domanovits, Hans; Schlager, Oliver; Wildner, Brigitte; Azar, Danyel; Schillinger, Martin; Wiesbauer, Franz; Steinwender, Clemens

    2018-03-13

    Randomized controlled trials have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in unselected patients remains a controversial issue. The objective of this review was to systematically analyse the effects of perioperatively administered beta-blockers for prevention of surgery-related mortality and morbidity in patients undergoing any type of surgery while under general anaesthesia. We identified trials by searching the following databases from the date of their inception until June 2013: MEDLINE, Embase , the Cochrane Central Register of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File, Science Citation Index Expanded, Life Sciences Collection, Global Health and PASCAL. In addition, we searched online resources to identify grey literature. We included randomized controlled trials if participants were randomly assigned to a beta-blocker group or a control group (standard care or placebo). Surgery (any type) had to be performed with all or at least a significant proportion of participants under general anaesthesia. Two review authors independently extracted data from all studies. In cases of disagreement, we reassessed the respective studies to reach consensus. We computed summary estimates in the absence of significant clinical heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and mean differences (MDs) were used for continuous outcomes. We performed subgroup analyses for various potential effect modifiers. We included 88 randomized controlled trials with 19,161 participants. Six studies (7%) met the highest methodological quality criteria (studies with overall low risk of bias: adequate sequence generation, adequate allocation concealment, double/triple-blinded design with a placebo group, intention-to-treat analysis

  1. PREVENTION OF OCULAR MORBIDITY AMONG MEDICAL STUDENTS BY PREVALENCE ASSESSMENT OF ASTHENOPIA AND ITS RISK FACTORS

    Directory of Open Access Journals (Sweden)

    Harpal

    2016-02-01

    Full Text Available PURPOSE To determine the prevalence of asthenopia and to identify modifiable risk factors in medical students. Therefore, as to provide with necessory instruction and precaution to reduce the occurrence of the ocular morbidity. METHODS A cross sectional observational study was conducted amongst 200 medical students who are using smart phone, laptop and computer to determine the relationship between asthenopia and related risk factors. Data were based on demographic features, type and duration of electronic items used and asthenopic symptoms was collected by self-administered questionnaire. The data was compiled and entered into excel sheet and analyzed by using appropriate statistical test. Statistical analysis was done using SPSS Version 20. RESULTS We found out of96% students, 51.56% had moderate asthenopic symptoms. Most of the students had more than one asthenopic symptoms, in which headache (56.77% was found to be the most common symptom followed by eye strain (50.52%, blurring of vision (40.62% and redness (23.95%. Those who were using electronic devices for4-10 hours, had more moderate to severe asthenopic symptoms about 85%. The ocular morbidity was found to be more among the smartphone users followed by laptops. There was association between ocular symptoms and type of electronic devices (χ2= 14.6, p < 0.006 and duration (χ2= 25.6, p<0.001 of its use. CONCLUSION With this study we can identify the modifiable risk factors and excess use of electronic devices, therefore we can guide the students to limit the risk factors so that we can reduce the ocular morbidity

  2. Prophylactic ampicillin versus cefazolin for the prevention of post-cesarean infectious morbidity in Rwanda.

    Science.gov (United States)

    Mivumbi, Victor N; Little, Sarah E; Rulisa, Stephen; Greenberg, James A

    2014-03-01

    To evaluate the efficacy of ampicillin versus cefazolin as prophylactic antibiotics prior to cesarean delivery in Rwanda. In a prospective, randomized, open-label, single-site study conducted between March and May 2012, the effects of prophylactic ampicillin versus cefazolin were compared among women undergoing cesarean delivery at the Centre Hospitalier Universitaire de Kigali, Rwanda. Postoperatively, participants were evaluated daily for infectious morbidity while in the hospital. Follow-up was done by phone and by appointment at the hospital within 2 weeks of delivery. During the study period, there were 578 total deliveries and 234 cesarean deliveries (40.4%). Overall, 132 women were enrolled in the study and randomized to receive either ampicillin (n=66) or cefazolin (n=66). No women were lost to follow-up. The overall infection rate was 15.9% (21/132). The infection rate in the ampicillin group and the cefazolin group was 25.8% (17/66) and 6.1% (4/66), respectively. Implementing a universal protocol in Rwanda of prophylactic cefazolin prior to cesarean delivery might reduce postoperative febrile morbidity, use of postoperative antibiotics, and number of postoperative days in hospital. Copyright © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Specialist teams for neonatal transport to neonatal intensive care units for prevention of morbidity and mortality.

    Science.gov (United States)

    Chang, Alvin S M; Berry, Andrew; Jones, Lisa J; Sivasangari, Subramaniam

    2015-10-28

    Maternal antenatal transfers provide better neonatal outcomes. However, there will inevitably be some infants who require acute transport to a neonatal intensive care unit (NICU). Because of this, many institutions develop services to provide neonatal transport by specially trained health personnel. However, few studies report on relevant clinical outcomes in infants requiring transport to NICU. To determine the effects of specialist transport teams compared with non-specialist transport teams on the risk of neonatal mortality and morbidity among high-risk newborn infants requiring transport to neonatal intensive care. We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 7), MEDLINE (1966 to 31 July 2015), EMBASE (1980 to 31 July 2015), CINAHL (1982 to 31 July 2015), conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. randomised, quasi-randomised or cluster randomised controlled trials. neonates requiring transport to a neonatal intensive care unit. transport by a specialist team compared to a non-specialist team. any of the following outcomes - death; adverse events during transport leading to respiratory compromise; and condition on admission to the neonatal intensive care unit. The methodological quality of the trials was assessed using the information provided in the studies and by personal communication with the author. Data on relevant outcomes were extracted and the effect size estimated and reported as risk ratio (RR), risk difference (RD), number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) and mean difference (MD) for continuous outcomes. Data from cluster randomised trials were not combined for analysis. One trial met the inclusion criteria of this review but was considered ineligible owing to

  4. Ethamsylate for the prevention of morbidity and mortality in preterm or very low birth weight infants.

    Science.gov (United States)

    Hunt, Rod; Hey, Edmund

    2010-01-20

    Ethamsylate decreases blood loss in certain clinical situations such as menorrhagia and following some surgical procedures. This potential to reduce bleeding has led to the hypothesis that it may have a role to play in reducing intraventricular haemorrhage in preterm infants. To determine if ethamsylate, when compared to placebo or no treatment, reduces morbidity and/or mortality in preterm infants. We searched the Cochrane Neonatal Group Trials Register (24 August 2009), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2009, Issue 2), MEDLINE and EMBASE (January 1966 to July 2009) and the Oxford Database of Perinatal Trials. Randomised controlled trials or quasi-randomised trials comparing ethamsylate with placebo or no treatment. The initial search for trials enrolling infants born less than 32 weeks gestation was subsequently expanded to include trials enrolling preterm infants ethamsylate and controls. Infants treated with ethamsylate had significantly less intraventricular haemorrhage than controls at ethamsylate identified from this systematic review. Preterm infants treated with ethamsylate showed no reductions in mortality or neurodevelopmental impairment despite the reduction in any grade of intraventricular haemorrhage seen in infants < 35 weeks gestation.

  5. Preoperative prediction of potentially preventable morbidity after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Petersen, Morten Aa; Kehlet, Henrik

    2016-01-01

    . DESIGN: Prospective observational study. SETTING: Elective primary unilateral total hip and knee arthroplasty with prospectively collected preoperative patient characteristics; similar standardised fast-track protocols; evaluation of complications through discharge and medical records; and complete 90...... days follow-up through nationwide databases. PARTICIPANTS: 8373 consecutive unselected total hip arthroplasty (THA) and knee arthroplasty from January 2010 to November 2012. RESULTS: There were 557 procedures (6.4%) followed by potentially preventable complications resulting in hospitalisation >4 days...

  6. Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants.

    Science.gov (United States)

    Woodgate, P G; Davies, M W

    2001-01-01

    Experimental animal data and uncontrolled, observational studies in human infants have suggested that hyperventilation and hypocapnia may be associated with increased pulmonary and neurodevelopmental morbidity. Protective ventilatory strategies allowing higher levels of arterial CO2 (permissive hypercapnia) are now widely used in adult critical care. The aggressive pursuit of normocapnia in ventilated newborn infants may contribute to the already present burden of lung disease. However, the safe or ideal range for PCO2 in this vulnerable population has not been established. To assess whether, in mechanically ventilated neonates, a strategy of permissive hypercapnia improves short and long term outcomes (esp. mortality, duration of respiratory support, incidence of chronic lung disease and neurodevelopmental outcome). Standard strategies of the Cochrane Neonatal Review Group were used. Searches were made of the Oxford Database of Perinatal Trials, MEDLINE, CINAHL, and Current Contents. Searches were also made of previous reviews including cross-referencing, abstracts, and conference and symposia proceedings published in Pediatric Research. All randomised controlled trials in which a strategy of permissive hypercapnia was compared with conventional strategies aimed at achieving normocapnia (or lower levels of hypercapnia) in newborn infants who are mechanically ventilated were eligible. Standard methods of the Cochrane Neonatal Review Group were used. Trials identified by the search strategy were independently reviewed by each author and assessed for eligibility and trial quality. Data were extracted separately. Differences were compared and resolved. Additional information was requested from trial authors. Only published data were available for review. Results are expressed as relative risk and risk difference for dichotomous outcomes, and weighted mean difference for continuous variables. Two trials involving 269 newborn infants were included. Meta-analysis of

  7. Nitrates for the prevention of cardiac morbidity and mortality in patients undergoing non-cardiac surgery.

    Science.gov (United States)

    Zhao, Na; Xu, Jin; Singh, Balwinder; Yu, Xuerong; Wu, Taixiang; Huang, Yuguang

    2016-08-04

    Cardiac complications are not uncommon in patients undergoing non-cardiac surgery, especially in patients with coronary artery disease (CAD) or at high risk of CAD. Perioperative cardiac complications can lead to mortality and morbidity, as well as higher costs for patient care. Nitrates, which are among the most commonly used cardiovascular drugs, perform the function of decreasing cardiac preload while improving cardiac blood perfusion. Sometimes, nitrates are administered to patients undergoing non-cardiac surgery to reduce the incidence of cardiac complications, especially for patients with CAD. However, their effects on patients' relevant outcomes remain controversial. • To assess effects of nitrates as compared with other interventions or placebo in reducing cardiac risk (such as death caused by cardiac factors, angina pectoris, acute myocardial infarction, acute heart failure and cardiac arrhythmia) in patients undergoing non-cardiac surgery.• To identify the influence of different routes and dosages of nitrates on patient outcomes. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Chinese BioMedical Database until June 2014. We also searched relevant conference abstracts of important anaesthesiology or cardiology scientific meetings, the database of ongoing trials and Google Scholar.We reran the search in January 2016. We added three potential new studies of interest to the list of 'Studies awaiting classification' and will incorporate them into our formal review findings for the review update. We included randomized controlled trials (RCTs) comparing nitrates versus no treatment, placebo or other pharmacological interventions in participants (15 years of age and older) undergoing non-cardiac surgery under any type of anaesthesia. We used standard methodological procedures as expected by Cochrane. Two review authors selected trials, extracted data from included studies and assessed risk of bias. We

  8. Indicadores de riesgo de morbilidad prevenible causada por medicamentos Risk indicators of preventable morbidity related to drug utilization

    Directory of Open Access Journals (Sweden)

    Ana Dago Martínez

    2007-02-01

    Full Text Available Objetivos: Seleccionar y estudiar la aceptabilidad, en términos de relevancia y pertinencia, de ciertas situaciones clínicas que puedan usarse como indicadores de riesgo de morbilidad prevenible causada por medicamentos y que sean utilizables en las farmacias comunitarias. Método: Método Delphi, en 2 rondas, con un panel de 14 expertos médicos y farmacéuticos que valoraron la relevancia y pertinencia de 68 tipos de situaciones clínicas como indicadores de morbilidad potencial relacionada con medicamentos, detectable por el profesional en su medio, con evidencia científica de resultado adverso previsible, frecuentes en el medio ambulatorio y con causa y resultado controlables. Resultados: Se consideraron utilizables y pertinentes 43 de los 68 indicadores estudiados, que se referían a 3 ámbitos: tipo de medicamento (medicamentos de estrecho margen terapéutico, con dosis individualizada y con reacciones adversas frecuentes y graves, problema de salud (problemas crónicos, especialmente asma, enfermedad cardíaca, tiroidea, prostática y dolor y tipo de paciente (ancianos y/o polimedicados. Los farmacéuticos sobrevaloraron sistemáticamente ciertos indicadores en relación con los médicos, aunque las diferencias no fueron significativas. Conclusiones: Se identificaron 43 indicadores de morbilidad potencial relacionada con los medicamentos e identificables por los profesionales en su entorno.Objective: To select clinical situations that can be used as risk indicators of preventable morbidity caused by drugs at the community pharmacies, and to study their acceptability, in terms of pertinence and relevance. Methods: We used the Delphi technique, in 2 rounds, by a panel of 14 medical doctors and pharmacists experts, to study the relevance of 68 types of clinical situations as risk indicators of preventable morbidity related to drug utilization used by health professionals in community pharmacies, with scientific evidence of foreseeable

  9. Inequities in incidence, morbidity and expenditures on prevention and treatment of malaria in southeast Nigeria

    Directory of Open Access Journals (Sweden)

    Uzochukwu Benjamin S

    2009-09-01

    Full Text Available Abstract Background Malaria places a great burden on households, but the extent to which this is tilted against the poor is unclear. However, the knowledge of the level of the burden of malaria amongst different population groups is vital for ensuring equitable control of malaria. This paper examined the inequities in occurrence, economic burden, prevention and treatment of malaria. Methods The study was undertaken in four malaria endemic villages in Enugu state, southeast Nigeria. Data was collected using interviewer-administered questionnaires. An asset-based index was used to categorize the households into socio-economic status (SES quartiles: least poor; poor; very poor; and most poor. Chi-square analysis was used to determine the statistical significance of the SES differences in incidence, length of illness, ownership of treated nets, expenditures on treatment and prevention. Results All the SES quartiles had equal exposure to malaria. The pattern of health seeking for all the SES groups was almost similar, but in one of the villages the most poor, very poor and poor significantly used the services of patent medicine vendors and the least poor visited hospitals. The cost of treating malaria was similar across the SES quartiles. The average expenditure to treat an episode of malaria ranged from as low as 131 Naira ($1.09 to as high as 348 Naira ($2.9, while the transportation expenditure to receive treatment ranged from 26 Naira to 46 Naira (both less than $1. The level of expenditure to prevent malaria was low in the four villages, with less than 5% owning untreated nets and 10.4% with insecticide treated nets. Conclusion Malaria constitutes a burden to all SES groups, though the poorer socio-economic groups were more affected, because a greater proportion of their financial resources compared to their income are spent on treating the disease. The expenditures to treat malaria by the poorest households could lead to catastrophic health

  10. [Unnecessary routine laboratory tests in patients referred for surgical services].

    Science.gov (United States)

    Mata-Miranda, María del Pilar; Cano-Matus, Norberto; Rodriguez-Murrieta, Margarita; Guarneros-Zapata, Idalia; Ortiz, Mario

    2016-01-01

    To question the usefulness of the lab analysis considered routine testing for the identification of abnormalities in the surgical care. To determine the percentage of unnecessary laboratory tests in the preoperative assessment as well as to estimate the unnecessary expenses. A descriptive, cross-sectional study of patients referred for surgical evaluation between January 1st and March 31st 2013. The database of laboratory testing and electronic files were reviewed. Reference criteria from surgical services were compared with the tests requested by the family doctor. In 65% of the patients (n=175) unnecessary examinations were requested, 25% (n=68) were not requested the tests that they required, and only 10% of the patients were requested laboratory tests in accordance with the reference criteria (n=27). The estimated cost in unnecessary examinations was $1,129,552 in a year. The results were similar to others related to this theme, however, they had not been revised from the perspective of the first level of attention regarding the importance of adherence to the reference criteria which could prevent major expenditures. It is a priority for leaders and operational consultants in medical units to establish strategies and lines of action that ensure compliance with institutional policies so as to contain spending on comprehensive services, and which in turn can improve the medical care. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  11. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants.

    Science.gov (United States)

    Davis, P G; Henderson-Smart, D J

    2003-01-01

    CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV. Implication for research: further definition of the gestational age and weight groups in whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.

  12. Unnecessary work tasks and mental health

    DEFF Research Database (Denmark)

    Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne

    2014-01-01

    OBJECTIVES: According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated...... with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association...... is modified by sex, age, occupational position, and baseline mental health status. METHODS: The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed...

  13. Prebiotic and probiotic fortified milk in prevention of morbidities among children: community-based, randomized, double-blind, controlled trial.

    Directory of Open Access Journals (Sweden)

    Sunil Sazawal

    Full Text Available BACKGROUND: Recent reviews suggest common infectious diseases continue to be a major cause of death among preschool children in developing countries. Identification of feasible strategies to combat this disease burden is an important public health need. We evaluated the efficacy of adding prebiotic oligosaccharide and probiotic Bifidobacterium lactis HN019 to milk, in preventing diarrhea, respiratory infections and severe illnesses, in children aged 1-4 years as part of a four group study design, running two studies simultaneously. METHODS AND FINDINGS: In a community based double-masked, randomized controlled trial, children 1-3 years of age, willing to participate, were randomly allocated to receive either control milk (Co; n = 312 or the same milk fortified with 2.4 g/day of prebiotic oligosaccharide and 1.9x10(7 colony forming unit (c.f.u/day of probiotic Bifidobacterium lactis HN019 (PP; n = 312. Children were followed up for 1 year providing data for 1-4 years. Biweekly household surveillance was conducted to gather information on compliance and morbidity. Both study groups were comparable at baseline; compliance to intervention was similar. Overall, there was no effect of prebiotic and probiotic on diarrhea (6% reduction, 95% Confidence Interval [CI]: -1 to 12%; p = 0.08. Incidence of dysentery episodes was reduced by 21% (95% CI: 0 to 38%; p = 0.05. Incidence of pneumonia was reduced by 24% (95% CI: 0 to 42%; p = 0.05 and severe acute lower respiratory infection (ALRI by 35% (95% CI: 0 to 58%; p = 0.05. Compared to children in Co group, children in PP group had 16% (95% CI: 5 to 26%, p = 0.004 and 5% (95% CI: 0 to 10%; p = 0.05 reduction in days with severe illness and high fever respectively. CONCLUSIONS/SIGNIFICANCE: Milk can be a good medium for delivery of prebiotic and probiotic and resulted in significant reduction of dysentery, respiratory morbidity and febrile illness. Overall, impact of diarrhea was not significant. These

  14. '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".

    Science.gov (United States)

    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

  15. Re-evaluating the relationships among filtering activity, unnecessary storage, and visual working memory capacity.

    Science.gov (United States)

    Emrich, Stephen M; Busseri, Michael A

    2015-09-01

    The amount of task-irrelevant information encoded in visual working memory (VWM), referred to as unnecessary storage, has been proposed as a potential mechanism underlying individual differences in VWM capacity. In addition, a number of studies have provided evidence for additional activity that initiates the filtering process originating in the frontal cortex and basal ganglia, and is therefore a crucial step in the link between unnecessary storage and VWM capacity. Here, we re-examine data from two prominent studies that identified unnecessary storage activity as a predictor of VWM capacity by directly testing the implied path model linking filtering-related activity, unnecessary storage, and VWM capacity. Across both studies, we found that unnecessary storage was not a significant predictor of individual differences in VWM capacity once activity associated with filtering was accounted for; instead, activity associated with filtering better explained variation in VWM capacity. These findings suggest that unnecessary storage is not a limiting factor in VWM performance, whereas neural activity associated with filtering may play a more central role in determining VWM performance that goes beyond preventing unnecessary storage.

  16. Morbidity and mortality risk among patients with screening-detected severe hypertension in the Malmö Preventive Project.

    Science.gov (United States)

    Westerdahl, Christina; Zöller, Bengt; Arslan, Eren; Erdine, Serap; Nilsson, Peter M

    2014-12-01

    Screening of hypertension has been advocated for early detection and treatment. Severe hypertension (grade 3 hypertension) is a strong predictor for cardiovascular disease. This study aimed to evaluate not only the risk factors for developing severe hypertension, but also the prospective morbidity and mortality risk associated with severe hypertension in a population-based screening and intervention programme. In all, 18,200 individuals from a population-based cohort underwent a baseline examination in 1972-1992 and were re-examined in 2002-2006 in Malmö, Sweden. In total, 300 (1.6%) patients with severe hypertension were identified at re-examination, and predictive risk factors from baseline were calculated. Total and cause-specific morbidity and mortality were followed in national registers in all severe hypertension patients, as well as in age and sex-matched normotensive controls. Cox analyses for hazard ratios were used. Men developing severe hypertension differed from matched controls in baseline variables associated with the metabolic syndrome, as well as paternal history of hypertension (P < 0.001). Women with later severe hypertension were characterized by elevated BMI and a positive maternal history for hypertension at baseline. The risk of mortality, coronary events, stroke and diabetes during follow-up was higher among severe hypertension patients compared to controls. For coronary events, the risk remained elevated adjusted for other risk factors [hazard ratio 2.31, 95% confidence interval (CI) 1.22-4.40, P = 0.011]. Family history and variables associated with metabolic syndrome are predictors for severe hypertension after a long-term follow-up. Severe hypertension is associated with increased mortality, cardiovascular morbidity and incident diabetes in spite of treatment. This calls for improved risk factor control in patients with severe hypertension.

  17. Principal Results of a Prospective Randomised Controlled Study: Morbidity and Mortality after Stroke — Eprosartan Compared with Nitrendipine for Secondary Prevention (MOSES

    Directory of Open Access Journals (Sweden)

    Stephan Lüders

    2005-03-01

    Full Text Available The morbidity and mortality after stroke — eprosartan compared with nitrendipine for secondary prevention (MOSES trial compared the effects of two antihypertensive agents in secondary prevention of stroke. The hypothesis of the trial was that in hypertensive stroke patients, for the same level of blood pressure (BP control, eprosartan would be more effective than nitrendipine in reducing cerebrovascular and cardiovascular morbidity and mortality.A total of 710 patients were assigned to an eprosartan-based regimen and 695 to a nitrendipine-based regimen.These patients had hypertension requiring treatment and documented cerebral ischaemia or haemorrhage. They were well matched at baseline in general characteristics, BP and concomitant disease. BP was lowered to the same extent in both treatment arms, with a very similar timeframe. A high proportion of patients in both treatment arms achieved target BP.The combined primary endpoint was a composite of total mortality and total number of cardiovascular and cerebrovascular events, including recurrent events.There were 206 endpoints in the eprosartan group and 255 endpoints in the nitrendipine group.This represents a statistically significant 21% risk reduction in favour of eprosartan. Eprosartan also had advantages over nitrendipine in respect of all cerebrovascular events and first cardiovascular events.

  18. Effect of preventive supplementation with zinc and other micronutrients on malaria and diarrhoeal morbidity in African children

    NARCIS (Netherlands)

    Veenemans, J.

    2011-01-01

    Background: Zinc is important for innate and adaptive immune responses
    to infection. Preventive zinc supplementation has been shown to reduce
    the incidence of acute diarrhoea by 20%. Few trials have evaluated its effect
    against malaria. Because trial results for both outcomes are

  19. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age

    NARCIS (Netherlands)

    Imdad, Aamer; Herzer, Kurt; Mayo-Wilson, Evan; Yakoob, Mohammad Yawar; Bhutta, Zulfiqar A.

    2010-01-01

    Background Vitamin A deficiency (VAD) is a major public health problem in low and middle income countries affecting 190 million children under 5. VAD can lead to many adverse health consequences, including death. Objectives To evaluate the effect of vitamin A supplementation (VAS) for preventing

  20. Medical innovation laws: an unnecessary innovation.

    Science.gov (United States)

    Richards, Bernadette

    2016-06-01

    Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position

  1. The impact of indicated prevention and early intervention on co-morbid eating disorder and depressive symptoms: a systematic review.

    Science.gov (United States)

    Rodgers, Rachel F; Paxton, Susan J

    2014-01-01

    Depressive and eating disorder symptoms are highly comorbid. To date, however, little is known regarding the efficacy of existing programs in decreasing concurrent eating disorder and depressive symptoms. We conducted a systematic review of selective and indicated controlled prevention and early intervention programs that assessed both eating disorder and depressive symptoms. We identified a total of 26 studies. The large majority of identified interventions (92%) were successful in decreasing eating disorder symptoms. However fewer than half (42%) were successful in decreasing both eating disorder and depressive symptoms. Intervention and participant characteristics did not predict success in decreasing depressive symptoms. Indicated prevention and early intervention programs targeting eating disorder symptoms are limited in their success in decreasing concurrent depressive symptoms. Further efforts to develop more efficient interventions that are successful in decreasing both eating disorder and depressive symptoms are warranted.

  2. Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers.

    Science.gov (United States)

    Madsen, Ida E H; Tripathi, Manisha; Borritz, Marianne; Rugulies, Reiner

    2014-11-01

    According to the "stress-as-offense-to-self" perspective, work tasks that are considered unnecessary or unreasonable - so-called "illegitimate work tasks" - are likely to elicit stress-reactions. Previous studies, mostly cross-sectional, have shown that illegitimate tasks are associated with increased self-reported stress, cortisol, and counterproductive work behavior. In this article, we examine the prospective association between unnecessary work tasks, one type of illegitimate work tasks, and mental health among Danish human service workers. Further, we explore whether this association is modified by sex, age, occupational position, and baseline mental health status. The data were obtained from self-administered questionnaires from 1351 Danish human service workers in three waves of data-collection during 1999-2005. We measured unnecessary work tasks by a single item, and assessed mental health using the 5-item mental health inventory from the Short form 36 questionnaire. We analyzed data using multi-level modeling, adjusting for potential confounding by sex, age, cohabitation, occupational position, and baseline mental health. Unnecessary work tasks were prospectively associated with a decreased level of mental health. This association was stronger for employees with poor baseline mental health and tended to be more pronounced among older employees. Among participants with poor baseline mental health, the association was explained by neither psychological demands nor decision latitude. Our findings suggest that the prevention of unnecessary work tasks may benefit employee mental health, particularly among employees with pre-existing mental health problems.

  3. 33 CFR 117.11 - Unnecessary opening of the draw.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Unnecessary opening of the draw. 117.11 Section 117.11 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS General Requirements § 117.11 Unnecessary opening of the draw. No...

  4. Preventive home visits for mortality, morbidity, and institutionalization in older adults: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Evan Mayo-Wilson

    Full Text Available Home visits for older adults aim to prevent cognitive and functional impairment, thus reducing institutionalization and mortality. Visitors may provide information, investigate untreated problems, encourage medication compliance, and provide referrals to services.Ten databases including CENTRAL and Medline searched through December 2012.Randomized controlled trials enrolling community-dwelling persons without dementia aged over 65 years. Interventions included visits at home by a health or social care professional that were not related to hospital discharge.Two authors independently extracted data. Outcomes were pooled using random effects.Mortality, institutionalization, hospitalization, falls, injuries, physical functioning, cognitive functioning, quality of life, and psychiatric illness.Sixty-four studies with 28642 participants were included. Home visits were not associated with absolute reductions in mortality at longest follow-up, but some programs may have small relative effects (relative risk = 0.93 [0.87 to 0.99]; absolute risk = 0.00 [-0.01 to 0.00]. There was moderate quality evidence of no overall effect on the number of people institutionalized (RR = 1.02 [0.88 to 1.18] or hospitalized (RR = 0.96 [0.91 to 1.01]. There was high quality evidence for number of people who fell, which is consistent with no effect or a small effect (odds ratio = 0.86 [0.73 to 1.01], but there was no evidence that these interventions increased independent living. There was low and very low quality evidence of effects for quality of life (standardised mean difference = -0.06 [-0.11 to -0.01] and physical functioning (SMD = -0.10 [-0.17 to -0.03] respectively, but these may not be clinically important.Home visiting is not consistently associated with differences in mortality or independent living, and investigations of heterogeneity did not identify any programs that are associated with consistent benefits. Due to poor reporting

  5. Fibrin glue instillation under skin flaps to prevent seroma-related morbidity following breast and axillary surgery.

    Science.gov (United States)

    Sajid, Muhammad S; Hutson, Kristian H; Rapisarda, Ignazio F; Bonomi, Riccardo

    2013-05-31

    Fibrin glue (FG) combines fibrinogen and thrombin, under the presence of factor XIII and calcium chloride, and produces a 'fibrin clot' as would occur through the natural clotting cascade. FG is thought to close over any small vessels including lymphatics that are too small for conventional surgical closure, thereby reducing seroma formation, seroma incidence and related comorbidities. To assess the evidence on the effectiveness of FG in people undergoing breast and axillary surgery and to establish whether FG is an efficient modality to prevent postoperative seroma and seroma-related outcomes. We searched the Cochrane Breast Cancer Group's (CBCG) Specialised Register (9 December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1 2012), MEDLINE (9 December 2011), EMBASE (9 December 2011), LILACS (22 October 2012), SCI-E (22 October 2012), the World Health Organization's International Clinical Trial Registry (9 December 2011) and ClinicalTrials.gov (22 October 2012). Randomised controlled trials (RCTs) comparing the effectiveness of FG in terms of reducing the postoperative seroma incidence and related comorbidities in people undergoing breast and axillary surgery. At least two review authors independently scrutinised search results, selected eligible studies and extracted the data. The pooled analysis of the extracted data was achieved by the statistical analysis on Review Manager software. The quality of studies was assessed using The Cochrane Collaboration's 'Risk of bias' tool. The search of four standard electronic databases yielded 119 potentially relevant studies but only 18 RCTs involving 1252 people were found suitable for statistical analysis. There was significant heterogeneity among trials and the majority of trials were of poor quality. The use of FG under skin flaps following breast and axillary surgery failed to reduce the incidence of postoperative seroma (risk ratio (RR) 1.02; 95% Confidence Interval (CI) 0.90 to 1.16, P

  6. Immunostimulation asa method limiting unnecessary antibiotic therapy

    Directory of Open Access Journals (Sweden)

    Agnieszka Szczukocka-Zych

    2015-12-01

    Full Text Available Recurring respiratory tract infections are typical of childhood. This results from the fact that children are exposed to pathogens, usually in groups of people, and from the immaturity of the immune system. Most upper and lower respiratory tract infections are caused by viruses. Nevertheless, antibiotics, which target bacteria, are often prescribed. Antibiotic overuse leads to increased microbial resistance to these drugs, resulting in their inefficacy. Improper treatment of respiratory infections with antibiotics ultimately leads to treatment failure. An increase in antibiotic resistance of many bacterial strains is becoming a serious global problem and makes treatment much more difficult. It is a responsibility of each physician to use antibiotics properly and implement adequate prevention of recurring respiratory tract infections. For many years, it has been attempted to find effective agents that improve immunity in children. The pharmaceutical market offers various preparations advertised as immunostimulants, such as bacterial lysates, vitamins, dietary supplements, probiotics or herbal, animal and homeopathic products. The role of immunomodulatory substances is to promote the immune system to fight pathogens, reduce the frequency of infections and decrease the demand for antibiotics. Unfortunately, most immunomodulators do not have sufficiently reliable clinical trials that would confirm their efficacy.

  7. Bright light therapy versus physical exercise to prevent co-morbid depression and obesity in adolescents and young adults with attention-deficit / hyperactivity disorder: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Mayer, J.S.; Hees, K.; Medda, J.; Grimm, O.; Asherson, P.; Bellina, M.; Colla, M.; Ibanez, P.; Koch, E.; Martinez-Nicolas, A.; Muntaner-Mas, A.; Rommel, A.; Rommelse, N.N.J.; Ruiter, S.W. de; Ebner-Priemer, U.W.; Kieser, M.; Ortega, F.B.; Thome, J.; Buitelaar, J.K.; Kuntsi, J.; Ramos-Quiroga, J.A.; Reif, A.; Freitag, C.M.

    2018-01-01

    BACKGROUND: The risk for major depression and obesity is increased in adolescents and adults with attention-deficit / hyperactivity disorder (ADHD) and adolescent ADHD predicts adult depression and obesity. Non-pharmacological interventions to treat and prevent these co-morbidities are urgently

  8. [The unnecessary application of central venous catheterization in surgical patients].

    Science.gov (United States)

    Uemura, Keiko; Inoue, Satoki; Kawaguchi, Masahiko

    2018-04-06

    Perioperative physicians occasionally encounter situations where central venous catheters placed preoperatively turn out to be unnecessary. The purpose of this retrospective study is to identify the unnecessary application of central venous catheter placement and determine the factors associated with the unnecessary application of central venous catheter placement. Using data from institutional perioperative central venous catheter surveillance, we analysed data from 1,141 patients who underwent central venous catheter placement. We reviewed the central venous catheter registry and medical charts and allocated registered patients into those with the proper or with unnecessary application of central venous catheter according to standard indications. Multivariate analysis was used to identify factors associated with the unnecessary application of central venous catheter placement. In 107 patients, representing 9.38% of the overall population, we identified the unnecessary application of central venous catheter placement. Multivariate analysis identified emergencies at night or on holidays (odds ratio [OR] 2.109, 95% confidence interval [95% CI] 1.021-4.359), low surgical risk (OR=1.729, 95% CI 1.038-2.881), short duration of anesthesia (OR=0.961/10min increase, 95% CI 0.945-0.979), and postoperative care outside of the intensive care unit (OR=2.197, 95% CI 1.402-3.441) all to be independently associated with the unnecessary application of catheterization. Complications related to central venous catheter placement when the procedure consequently turned out to be unnecessary were frequently observed (9/107) compared with when the procedure was necessary (40/1034) (p=0.032, OR=2.282, 95% CI 1.076-4.842). However, the subsequent multivariate logistic model did not hold this significant difference (p=0.0536, OR=2.115, 95% CI 0.988-4.526). More careful consideration for the application of central venous catheter is required in cases of emergency surgery at night or on

  9. "Unnecessary suffering": the cornerstone of animal protection legislation considered.

    Science.gov (United States)

    Radford, M

    1999-09-01

    Causing "unnecessary suffering" has been widely adopted in legislation to define criminal liability in respect of the treatment of animals. This article examines the way in which the term has been interpreted and applied by the courts, and considers its effectiveness in affording animals protection from abuse.

  10. Removing Unnecessary Variables from Horn Clause Verification Conditions

    Directory of Open Access Journals (Sweden)

    Emanuele De Angelis

    2016-07-01

    Full Text Available Verification conditions (VCs are logical formulas whose satisfiability guarantees program correctness. We consider VCs in the form of constrained Horn clauses (CHC which are automatically generated from the encoding of (an interpreter of the operational semantics of the programming language. VCs are derived through program specialization based on the unfold/fold transformation rules and, as it often happens when specializing interpreters, they contain unnecessary variables, that is, variables which are not required for the correctness proofs of the programs under verification. In this paper we adapt to the CHC setting some of the techniques that were developed for removing unnecessary variables from logic programs, and we show that, in some cases, the application of these techniques increases the effectiveness of Horn clause solvers when proving program correctness.

  11. Escalating Health Care Cost due to Unnecessary Diagnostic Testing

    Directory of Open Access Journals (Sweden)

    MUHAMMAD AZAM ISHAQUE CHAUDHARY

    2017-07-01

    Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.

  12. Reducing unnecessary lab testing in the ICU with artificial intelligence.

    Science.gov (United States)

    Cismondi, F; Celi, L A; Fialho, A S; Vieira, S M; Reti, S R; Sousa, J M C; Finkelstein, S N

    2013-05-01

    To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1-3]. Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the likely information to be gained from proposed future

  13. Effective diagnostic DAQ systems to reduce unnecessary data in KSTAR

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Taegu, E-mail: glory@nfri.re.kr; Lee, Woongryol; Hong, Jaesic; Park, Kaprai

    2016-11-15

    Highlights: • When plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. • To overcome this problem, some KSTAR’s library were upgraded to monitor the plasma status in real-time. • With the real-time information of plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. • We were able to reduce the refuse data of approximately 698 GByte in the KSTAR 7th campaign. • It was a very effective way to store useful data, and it was helpful to analysts after shot. - Abstract: The plasma status of Korea Superconducting Tokamak Advanced Research (KSTAR) is measured by various diagnostics systems. The measured data size has been increasing every year due to increasing plasma pulse lengths, higher diagnostics operating frequencies, the additions of new diagnostic systems, and an increasing number of diagnostics channels. At times, when plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. In addition, the analysis time was affected, as these data need to be separated from the relevant data set. To overcome this problem, KSTAR’s Standard Framework (SFW), Real Time Monitoring (RTMON), and Pulse Automation and Scheduling System (PASS) were upgraded to monitor the plasma status in real-time. When the plasma current is less than 200kA, RTMON sends the plasma status information every second to the SFW via EPICS Channel Access. With the real-time information on plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. This paper describes a method for reducing the storage of unnecessary data and its results in the KSTAR 7th campaign.

  14. Reducing unnecessary lab testing in the ICU with artificial intelligence

    Science.gov (United States)

    Cismondi, F.; Celi, L.A.; Fialho, A.S.; Vieira, S.M.; Reti, S.R.; Sousa, J.M.C.; Finkelstein, S.N.

    2017-01-01

    Objectives To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Design Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Patients Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Main results Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1–3]. Conclusions Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the

  15. [For active dermatocosmetics and free of unnecessary animal experimentation].

    Science.gov (United States)

    Piérard, G E; Piérard-Franchimont, C

    1998-06-01

    At the dawn of this century, dermocosmetology is at cross-roads because new European regulations are changing its face. The proof of claims must be given and the entire composition of the product must be released. In addition, animal testing is about to be banned. Such new regulations incite to search for and validate predictive tests aiming at the objective evaluation of the activity and tolerance claimed by dermocosmetic products. Such tests must be an alternative to unnecessary animal experimentation. These aspects are scrutinized scientifically by the EEMCO experts in combination with the ECVAM and COLIPA organizations.

  16. Campaign for the prevention of maternal mortality and morbidity. Abortion: we shall no longer be silent about it] Sixth call for action, International Day of Action for Women's Health, May 28, 1993.

    Science.gov (United States)

    1993-01-01

    The annual Campaign for the Prevention of Maternal Mortality and Morbidity to be held on May 28 will focus upon abortion-related maternal mortality with the goal of mobilizing women to discuss abortion and turn it into an issue of public debate. First, however, people must stop blaming women for abortion. People say women are responsible for abortion because they failed to use contraception, they had sexual intercourse outside of marriage, they were behaving immorally, and/or they violated religious precepts. However, blaming women for abortion simply denies reality. This paper explains what is known and not known about abortion and its related maternal morbidity and mortality, and counters some myths about the criminalization and legalization of abortion, religious prohibition of abortion, who has abortions, whether women will always be traumatized by an abortion, the health risks of induced abortion, and the need for abortion services. The history of the campaign is also described.

  17. Bright light therapy versus physical exercise to prevent co-morbid depression and obesity in adolescents and young adults with attention-deficit / hyperactivity disorder: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Mayer, Jutta S; Hees, Katharina; Medda, Juliane; Grimm, Oliver; Asherson, Philip; Bellina, Mariano; Colla, Michael; Ibáñez, Pol; Koch, Elena; Martinez-Nicolas, Antonio; Muntaner-Mas, Adrià; Rommel, Anna; Rommelse, Nanda; de Ruiter, Saskia; Ebner-Priemer, Ulrich W; Kieser, Meinhard; Ortega, Francisco B; Thome, Johannes; Buitelaar, Jan K; Kuntsi, Jonna; Ramos-Quiroga, J Antoni; Reif, Andreas; Freitag, Christine M

    2018-02-26

    The risk for major depression and obesity is increased in adolescents and adults with attention-deficit / hyperactivity disorder (ADHD) and adolescent ADHD predicts adult depression and obesity. Non-pharmacological interventions to treat and prevent these co-morbidities are urgently needed. Bright light therapy (BLT) improves day-night rhythm and is an emerging therapy for major depression. Exercise intervention (EI) reduces obesity and improves depressive symptoms. To date, no randomized controlled trial (RCT) has been performed to establish feasibility and efficacy of these interventions targeting the prevention of co-morbid depression and obesity in ADHD. We hypothesize that the two manualized interventions in combination with mobile health-based monitoring and reinforcement will result in less depressive symptoms and obesity compared to treatment as usual in adolescents and young adults with ADHD. This trial is a prospective, pilot phase-IIa, parallel-group RCT with three arms (two add-on treatment groups [BLT, EI] and one treatment as usual [TAU] control group). The primary outcome variable is change in the Inventory of Depressive Symptomatology total score (observer-blinded assessment) between baseline and ten weeks of intervention. This variable is analyzed with a mixed model for repeated measures approach investigating the treatment effect with respect to all three groups. A total of 330 participants with ADHD, aged 14 - obesity, ADHD symptoms, general psychopathology, health-related quality of life, neurocognitive function, chronotype, and physical fitness are explored after the end of the intervention and at the 12-week follow-up. This is the first pilot RCT on the use of BLT and EI in combination with mobile health-based monitoring and reinforcement targeting the prevention of co-morbid depression and obesity in adolescents and young adults with ADHD. If at least medium effects can be established with regard to the prevention of depressive symptoms and

  18. Prevention of health care-associated infections.

    Science.gov (United States)

    Hsu, Vincent

    2014-09-15

    Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, and hand hygiene and isolation precautions. Prevention of central line- or catheter-associated infections begins with avoidance of unnecessary insertion, adherence to aseptic technique when inserting, and device removal when no longer necessary. Specific recommendations for preventing central line-associated bloodstream infections include use of chlorhexidine for skin preparation, as a component of dressings, and for daily bathing of patients in intensive care units. Catheter-associated urinary tract infections are the most common device-related health care-associated infection. Maintaining a closed drainage system below the patient reduces the risk of infection. To prevent ventilator-associated pneumonia, which is associated with high mortality, mechanically ventilated patients should be placed in the semirecumbent position and receive antiseptic oral care. Prevention of surgical site infections includes hair removal using clippers, glucose control, and preoperative antibiotic prophylaxis. Reducing transmission of Clostridium difficile and multidrug-resistant organisms in the hospital setting begins with hand hygiene and contact precautions. Institutional efforts to reduce unnecessary antibiotic prescribing are also strongly recommended. Reducing rates of methicillin-resistant Staphylococcus aureus infection can be achieved through active surveillance cultures and decolonization therapy with mupirocin.

  19. Catheter Associated Urinary Tract Infection Prevention bundle

    Directory of Open Access Journals (Sweden)

    O. Zarkotou

    2017-01-01

    Full Text Available Catheter-associated urinary tract infections (CAUTI are among the most common healthcare-associated infections, and potentially lead to significant morbidity and mortality. Multifaceted infection control strategies implemented as bundles can prevent nosocomial infections associated with invasive devices such as CAUTIs. The components of the CAUTI bundle proposed herein, include appropriate indications for catheterization and recommendations for the procedures of catheter insertion and catheter maintenance and care. Avoiding unnecessary urinary catheter use is the most effective measure for their prevention. To minimize the risk of CAUTI, urinary catheters should be placed only when a clinical valid indication is documented and they should be removed as soon as possible; alternatives to catheterization should also be considered. Aseptic insertion technique, maintenance of closed drainage system and strict adherence to hand hygiene are essential for preventing CAUTI. The successful implementation of the bundle requires education and training for all healthcare professionals and evaluation of surveillance data.

  20. Alcohol abuse and postoperative morbidity

    DEFF Research Database (Denmark)

    Tønnesen, Hanne

    2003-01-01

    Patients who drink too much have more complications after surgery. The aim of this thesis was to evaluate the evidence, possible mechanisms, and prevention of the increased postoperative morbidity in alcohol abusers, defined by a consumption of at least five drinks per day. The literature could...... be criticised for several methodological flaws. Nevertheless, the results are in agreement showing moderate to strong evidence of increased postoperative morbidity after surgical procedures on alcohol abusers. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re......-operation. The personal and economic consequences are tremendous. The incidence of alcohol abusers undergoing surgery was 7% to 49%, according to gender and diagnosis. They have been identified by a self-reported alcohol intake, which implies the possibility of underestimation. Alcohol markers could be used for a more...

  1. Cost-effectiveness of rosuvastatin 20 mg for the prevention of cardiovascular morbidity and mortality: a Swedish economic evaluation of the JUPITER trial.

    Science.gov (United States)

    Ohsfeldt, Robert L; Olsson, Anders G; Jensen, Marie M; Gandhi, Sanjay K; Paulsson, Thomas

    2012-01-01

    This study estimated the long-term health outcomes, healthcare costs, and cost-effectiveness of rosuvastatin 20 mg therapy in primary prevention of major cardiovascular disease (CVD) in a Swedish population. Based on data from the JUPITER trial, long-term CVD outcomes with rosuvastatin vs no active treatment were estimated for patients with an elevated baseline CVD risk (Framingham CVD score >20%, sub-population of JUPITER population) and for a population similar to the total JUPITER population. Using a decision-analytic model, trial CVD event rates were combined with epidemiological and cost data specific for Sweden. First and subsequent CVD events and death were estimated over a lifetime perspective. The observed relative risk reduction was extrapolated beyond the trial duration. Incremental effectiveness was measured as life-years gained (LYG) and quality-adjusted life-years (QALYs) gained. Treating 100,000 patients with rosuvastatin 20 mg was estimated to avoid 14,692 CVD events over the lifetime (8021 non-fatal MIs, 3228 non-fatal strokes, and 4924 CVD deaths) compared to placebo. This translated into an estimated gain of 42,122 QALYs and 36,865 total life years (LYG). Rosuvastatin was both more effective and less costly over a lifetime perspective, and rosuvastatin is subsequently a dominant alternative compared to no treatment in the assessed population. Using the overall JUPITER population, rosuvastatin was dominant for the lifetime horizon. In the sensitivity analysis, rosuvastatin was the dominant treatment strategy over a 20-year time horizon, and cost-effective with an incremental cost-effectiveness ratio (cost per QALY) of SEK 1783 over a 10-year time horizon. Some model inputs were derived from literature or other data sources, but uncertainty was controlled by sensitivity analyses. Results indicate that rosuvastatin 20 mg treatment is a cost-effective option vs no-treatment in patients with Framingham CVD risk >20% in Sweden and might even be

  2. Hyperthyroidism and psychiatric morbidity

    DEFF Research Database (Denmark)

    Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind

    2014-01-01

    Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity.......Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. We aimed to investigate the association and temporal relation between hyperthyroidism and psychiatric morbidity....

  3. How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

    NARCIS (Netherlands)

    Vegting, I.L.; van Beneden, M.; Kramer, M.H.H.; Thijs, A.; Kostense, P.J.; Nanayakkara, P.W.B.

    2012-01-01

    Background: The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic

  4. NDT: Replication avoids unnecessary replacement of power plant components

    International Nuclear Information System (INIS)

    Neubauer, B.; Wedel, U.

    1984-01-01

    Effective fracture prevention for components operating at high temperatures can be achieved without sacrificing useful life. This is done by nondestructive-metallographic examination at crack-susceptible locations of the components. Creep microcracks approximately one micron in size can be detected. RWTUV experience shows that, in general, the components need not be replaced or repaired until these microcracks have grown to form small creep macrocracks. The long prewarning period before macrocracks form provides assurance of safe operation for the full useful life of the components tested. The economic benefit achieved is considerable. Replication techniques have been widely applied by the authors in operating power plants since 1977. This nondestructive-evaluation method involves polishing small areas of selected piping-system components, preparing replicas of the polished areas, and examining the replicas under microscope for evidence of cavities, microcracks, or macrocracks

  5. [An initiative to reduce the use of unnecessary medication in infants with bronchiolitis in primary care].

    Science.gov (United States)

    Montejo Fernández, Marta; Benito Manrique, Iñaki; Montiel Eguía, Arantza; Benito Fernández, Javier

    2018-05-23

    Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged initiative may be applied to the settings where the majority of infants with acute bronchiolitis are attended in western countries. Copyright © 2018. Publicado por Elsevier España, S.L.U.

  6. Decreasing asthma morbidity

    African Journals Online (AJOL)

    1994-12-12

    Dec 12, 1994 ... Apart from the optimal use of drugs, various supplementary methods have been tested to decrease asthma morbidity, usually in patients from reiatively affluent socio-economic backgrounds. A study of additional measures taken in a group of moderate to severe adult asthmatics from very poor socio- ...

  7. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa.

    Science.gov (United States)

    Sigaloff, Kim C E; Hamers, Raph L; Wallis, Carole L; Kityo, Cissy; Siwale, Margaret; Ive, Prudence; Botes, Mariette E; Mandaliya, Kishor; Wellington, Maureen; Osibogun, Akin; Stevens, Wendy S; van Vugt, Michèle; de Wit, Tobias F Rinke

    2011-09-01

    This study aimed to investigate the consequences of using clinicoimmunological criteria to detect antiretroviral treatment (ART) failure and guide regimen switches in HIV-infected adults in sub-Saharan Africa. Frequencies of unnecessary switches, patterns of HIV drug resistance, and risk factors for the accumulation of nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were evaluated. Cross-sectional analysis of adults switching ART regimens at 13 clinical sites in 6 African countries was performed. Two types of failure identification were compared: diagnosis of clinicoimmunological failure without viral load testing (CIF only) or CIF with local targeted viral load testing (targeted VL). After study enrollment, reference HIV RNA and genotype were determined retrospectively. Logistic regression assessed factors associated with multiple thymidine analogue mutations (TAMs) and NRTI cross-resistance (≥2 TAMs or Q151M or K65R/K70E). Of 250 patients with CIF switching to second-line ART, targeted VL was performed in 186. Unnecessary switch at reference HIV RNA <1000 copies per milliliter occurred in 46.9% of CIF only patients versus 12.4% of patients with targeted VL (P < 0.001). NRTI cross-resistance was observed in 48.0% of 183 specimens available for genotypic analysis, comprising ≥2 TAMs (37.7%), K65R (7.1%), K70E (3.3%), or Q151M (3.3%). The presence of NRTI cross-resistance was associated with the duration of ART exposure and zidovudine use. Clinicoimmunological monitoring without viral load testing resulted in frequent unnecessary regimen switches. Prolonged treatment failure was indicated by extensive NRTI cross-resistance. Access to virological monitoring should be expanded to prevent inappropriate switches, enable early failure detection and preserve second-line treatment options in Africa.

  8. [Morbidity among forestry workers].

    Science.gov (United States)

    Rafalski, H; Bernacki, K

    1981-01-01

    The past and presently diagnosed diseases (excluding vibration disease and occupational hearing impairment) were analysed in 1105 sawers operating combustion drive mechanic saws and in 295 controls. The greatest rate, both in the sawers and controls, was that of the diseases of respiratory tract, circulatory system and osseo -- articulo -- muscular system, nervous system and sense organs. These constituted 86% of all diseases that afflicted sawers and controls. No specific general morbidity accompanying vibration disease or occupational hearing impairment was found in the sawers exposed to noise and vibration.

  9. Prevention

    DEFF Research Database (Denmark)

    Halken, S; Høst, A

    2001-01-01

    , breastfeeding should be encouraged for 4-6 months. In high-risk infants a documented extensively hydrolysed formula is recommended if exclusive breastfeeding is not possible for the first 4 months of life. There is no evidence for preventive dietary intervention neither during pregnancy nor lactation...... populations. These theories remain to be documented in proper, controlled and prospective studies. Breastfeeding and the late introduction of solid foods (>4 months) is associated with a reduced risk of food allergy, atopic dermatitis, and recurrent wheezing and asthma in early childhood. In all infants....... Preventive dietary restrictions after the age of 4-6 months are not scientifically documented....

  10. Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report.

    Science.gov (United States)

    Huh, Jong-Ki; Shin, Su-Jung

    2013-08-01

    This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

  11. Mortality, Morbidity, and Developmental Outcomes in Infants Born to Women Who Received Either Mefloquine or Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy: A Cohort Study.

    Directory of Open Access Journals (Sweden)

    María Rupérez

    2016-02-01

    Full Text Available Little is known about the effects of intermittent preventive treatment of malaria in pregnancy (IPTp on the health of sub-Saharan African infants. We have evaluated the safety of IPTp with mefloquine (MQ compared to sulfadoxine-pyrimethamine (SP for important infant health and developmental outcomes.In the context of a multicenter randomized controlled trial evaluating the safety and efficacy of IPTp with MQ compared to SP in pregnancy carried out in four sub-Saharan countries (Mozambique, Benin, Gabon, and Tanzania, 4,247 newborns, 2,815 born to women who received MQ and 1,432 born to women who received SP for IPTp, were followed up until 12 mo of age. Anthropometric parameters and psychomotor development were assessed at 1, 9, and 12 mo of age, and the incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were determined until 12 mo of age. No significant differences were found in the proportion of infants with stunting, underweight, wasting, and severe acute malnutrition at 1, 9, and 12 mo of age between infants born to women who were on IPTp with MQ versus SP. Except for three items evaluated at 9 mo of age, no significant differences were observed in the psychomotor development milestones assessed. Incidence of malaria, anemia, hospital admissions, outpatient visits, and mortality were similar between the two groups. Information on the outcomes at 12 mo of age was unavailable in 26% of the infants, 761 (27% from the MQ group and 377 (26% from the SP group. Reasons for not completing the study were death (4% of total study population, study withdrawal (6%, migration (8%, and loss to follow-up (9%.No significant differences were found between IPTp with MQ and SP administered in pregnancy on infant mortality, morbidity, and nutritional outcomes. The poorer performance on certain psychomotor development milestones at 9 mo of age in children born to women in the MQ group compared to those in the SP group may deserve

  12. 77 FR 29579 - Removing Unnecessary Office on Violence Against Women Regulations

    Science.gov (United States)

    2012-05-18

    ... now unnecessary STOP VAIW Program regulations. Higher Education Amendments of 1998 Violence against... Office on Violence Against Women Regulations AGENCY: Office on Violence Against Women, Justice. ACTION: Proposed rule. SUMMARY: This rule proposes to remove the regulations for the STOP Violence Against Indian...

  13. Estimation of morbidity effects

    International Nuclear Information System (INIS)

    Ostro, B.

    1994-01-01

    Many researchers have related exposure to ambient air pollution to respiratory morbidity. To be included in this review and analysis, however, several criteria had to be met. First, a careful study design and a methodology that generated quantitative dose-response estimates were required. Therefore, there was a focus on time-series regression analyses relating daily incidence of morbidity to air pollution in a single city or metropolitan area. Studies that used weekly or monthly average concentrations or that involved particulate measurements in poorly characterized metropolitan areas (e.g., one monitor representing a large region) were not included in this review. Second, studies that minimized confounding ad omitted variables were included. For example, research that compared two cities or regions and characterized them as 'high' and 'low' pollution area were not included because of potential confounding by other factors in the respective areas. Third, concern for the effects of seasonality and weather had to be demonstrated. This could be accomplished by either stratifying and analyzing the data by season, by examining the independent effects of temperature and humidity, and/or by correcting the model for possible autocorrelation. A fourth criterion for study inclusion was that the study had to include a reasonably complete analysis of the data. Such analysis would include an careful exploration of the primary hypothesis as well as possible examination of te robustness and sensitivity of the results to alternative functional forms, specifications, and influential data points. When studies reported the results of these alternative analyses, the quantitative estimates that were judged as most representative of the overall findings were those that were summarized in this paper. Finally, for inclusion in the review of particulate matter, the study had to provide a measure of particle concentration that could be converted into PM10, particulate matter below 10

  14. Typhoid fever and paratyphoid fever: Systematic review to estimate global morbidity and mortality for 2010

    Directory of Open Access Journals (Sweden)

    Geoffrey C. Buckle

    2012-06-01

    Full Text Available Typhoid and paratyphoid fever remain important causes of morbidity worldwide. Accurate disease burden estimates are needed to guide policy decisions and prevention and control strategies.

  15. Prevalence of cardiovascular morbidities in Myanmar.

    Science.gov (United States)

    Zaw, Ko Ko; Nwe, Nwe; Hlaing, Su Su

    2017-02-15

    Cardiovascular diseases (CVDs) are now in a rising trend in South East Asia including Myanmar due to increase in major cardiovascular risk factors in both urban and rural areas, such as smoking, obesity and diabetes mellitus. It is necessary to determine CVD morbidities in Myanmar for planning of prevention and control activities for CVDs. The cross-sectional household survey was conducted in 2012 with 600 people aged 40 years and above in four townships (Kyauk-Tan, Mawlamyaing, Pathein and Pyay) and used face-to-face interview with standard questionnaire [Rose Angina Questionnaire and Questionnaire by European Cardiovascular Indicators Surveillance Set (EUROCISS) Research Group] to determine the level of reported CVD morbidities in adult population. Age of the study population ranged from 40 to 99 years with the mean age of 56 years. Seventy-one percent of the study population was women. Nine percent of the study population have suffered from angina according to Rose Angina Questionnaire. Prevalence of possible heart attack, stroke and heart failure was 7.5, 1.5 and 2.8%. Prevalence of hypertension was 51%. The CVD morbidities are high. There is a need for strengthening prevention and control activities of CVDs.

  16. Co-morbidity in psoriasis

    DEFF Research Database (Denmark)

    Lønnberg, Ann Sophie; Skov, Lone

    2017-01-01

    for the clinic to be able to recognize such co-morbidities. Areas covered: This is a review of studies investigating and discussing co-morbidities of psoriasis and screening. Literature was retrieved by searching on the PubMed database using individual and combined search terms related to relevant co...

  17. New morbidity of the young

    Directory of Open Access Journals (Sweden)

    Stanković Biljana

    2002-01-01

    Full Text Available In the present phase of epidemiological transition, the most frequent causes of youth morbidity are disorders in reproductive health, mental disorders and injuries which are not life threatening. This, so-called new youth morbidity, is most often caused by their risky behavior, which in the field of sexuality often leads to unplanned pregnancies and abortions, as well as sexually transmitted infections. Misuse of tobacco, alcohol and narcotics, which is most commonly started in adolescence, has an unfavorable short-term and long-term influence on the psycho-physical health of the young. All research, in the world and in our country, indicate gradual yet constant growth of sexual activity of the youth and the age decrease of its starting point, especially when girls are in question. Due to insufficient maturity and inadequate knowledge and consciousness on the necessity of protecting reproductive health, sexual behavior of young people can often be characterized as insufficiently responsible and not supplemented with the usage of adequate protective measures. The result is frequently abortion, which terminates 90% of unplanned and unwanted pregnancies in this age. This creates health and psychosocial risks, as well as giving birth in adolescence which is contrary to the modern health concepts that giving birth should not be performed too early, while the young are still developing. A significant increase in the frequency of sexually transmitted diseases is also present, to which the youth are especially susceptible due to the specific development period in which they are in. A serious medical and sociopathological problem of contemporary society represents the greater and greater misuse of psychoactive substances among the young people, with a tendency of decreasing the average age they are consumed for the first time, as well as the use of drugs and alcohol. With the increase of the anti-smoking campaign and restrictive measures in highly

  18. Implementing intermittent preventive treatment for malaria in pregnancy

    DEFF Research Database (Denmark)

    Mubyazi, Godfrey Martin; Magnussen, Pascal; Goodman, Catherine

    2008-01-01

    and other discriminatory socio-cultural values on pregnancy; target users, perceptions and attitudes towards SP, malaria, and quality of ANC; supply and cost of SP at health facilities; understaffing and demoralised staff; ambiguity and impracticability of user-fee exemption policy guidelines on essential...... and cost-effectiveness analyses of the randomised controlled trials carried out in selected geographical settings. Such studies fail to elucidate the economic, psychosocial, managerial, organization and other contextual systemic factors influencing the operational effectiveness, compliance and coverage...... in Africa. RESULTS: The importance of IPTp in preventing unnecessary anaemia, morbidity and mortality in pregnancy and improving childbirth outcomes is highly acknowledged, although the following factors appear to be the main constraints to IPTp service delivery and uptake: cost of accessing ANC; myths...

  19. Morbidity of severe obesity.

    Science.gov (United States)

    Kral, J G

    2001-10-01

    Although obesity is an easy diagnosis to make, its etiologies, pathophysiology, and symptomatology are extraordinarily complex. Progress in surgical technique and anesthesiological management has substantially improved the safety of performing operations on the severely obese in the last 20 years. These improvements have occurred more or less empirically, without a full understanding of etiology or pathophysiology, although this has advanced concomitantly with improvements in practice. This review has attempted to provide a framework to facilitate progress in the neglected areas of patient selection and choice of operation, in an effort to improve long-term outcome. Despite the disparate etiologies of obesity and its diverse comorbidities and complications, there are unifying interdependent pathogenetic mechanisms of great relevance to the practice of antiobesity surgery. The rate of eating, whether driven by HPA dysfunction, ambient stress, or related hereditary susceptibility factors including the increased energy demands of an expanded body fat mass, participates in a cycle that results in disordered satiety (see Fig. 3). This leads to substrate overload, causing extensive metabolic abnormalities such as atherogenesis, insulin resistance, thrombogenesis, and carcinogenesis. This interpretation of the pathophysiology of obesity ironically accords with the original meaning of the word obesity: "to overeat." The ultimate solution to the problem of obesity--preventing it--will not be forthcoming until the food industry is forced to lower production and change its marketing strategies, as the liquor and tobacco industries in the United States were compelled to do. This cannot occur until the large and fast-growing populations of industrialized nations become educated in the personal implications of the energy principle. Regardless of whether school curricula are modified to prioritize health education, the larger problems of cultural and economic change remain for

  20. Preoperative alcoholism and postoperative morbidity

    DEFF Research Database (Denmark)

    Tonnesen, H; Kehlet, H

    1999-01-01

    BACKGROUND: Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention. METHODS: A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity...... in alcohol abusers were used to evaluate the evidence. RESULTS: Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications...... to postoperative morbidity. CONCLUSION: Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration...

  1. New morbidity of the young

    OpenAIRE

    Stanković Biljana

    2002-01-01

    In the present phase of epidemiological transition, the most frequent causes of youth morbidity are disorders in reproductive health, mental disorders and injuries which are not life threatening. This, so-called new youth morbidity, is most often caused by their risky behavior, which in the field of sexuality often leads to unplanned pregnancies and abortions, as well as sexually transmitted infections. Misuse of tobacco, alcohol and narcotics, which is most commonly started in adolescence, h...

  2. Minimization of heatwave morbidity and mortality.

    Science.gov (United States)

    Kravchenko, Julia; Abernethy, Amy P; Fawzy, Maria; Lyerly, H Kim

    2013-03-01

    Global climate change is projected to increase the frequency and duration of periods of extremely high temperatures. Both the general populace and public health authorities often underestimate the impact of high temperatures on human health. To highlight the vulnerable populations and illustrate approaches to minimization of health impacts of extreme heat, the authors reviewed the studies of heat-related morbidity and mortality for high-risk populations in the U.S. and Europe from 1958 to 2012. Heat exposure not only can cause heat exhaustion and heat stroke but also can exacerbate a wide range of medical conditions. Vulnerable populations, such as older adults; children; outdoor laborers; some racial and ethnic subgroups (particularly those with low SES); people with chronic diseases; and those who are socially or geographically isolated, have increased morbidity and mortality during extreme heat. In addition to ambient temperature, heat-related health hazards are exacerbated by air pollution, high humidity, and lack of air-conditioning. Consequently, a comprehensive approach to minimize the health effects of extreme heat is required and must address educating the public of the risks and optimizing heatwave response plans, which include improving access to environmentally controlled public havens, adaptation of social services to address the challenges required during extreme heat, and consistent monitoring of morbidity and mortality during periods of extreme temperatures. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Study protocol. IDUS - Instrumental delivery & ultrasound: a multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery.

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-01-01

    Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 - 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice.

  4. Reply to: Mounting evidence indicates that escalating doses of allopurinol are unnecessary for cardiovascular protection.

    Science.gov (United States)

    Coburn, Brian W; Michaud, Kaleb; Bergman, Debra A; Mikuls, Ted R

    2018-05-08

    We thank Dr. Bredemeier for his comments regarding our manuscript on allopurinol dose escalation and mortality. He raises important evidence to consider in support of an interesting hypothesis that dose escalation may be unnecessary for allopurinol's cardiovascular (CV) protection and may actually be related to adverse CV outcomes. While we agree that evidence exists suggesting that low doses of allopurinol may be sufficient for CV protection, we believe that the studies cited highlight a number of areas where knowledge gaps remain which preclude any definitive conclusions about the effect of dose escalation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. Thoracic splenosis. Know it-avoid unnecessary investigations, interventions, and thoracotomy

    International Nuclear Information System (INIS)

    Khan, A.M.; Manzoor, K.; Malik, Z.; Yasim, A.; Shim, C.

    2011-01-01

    Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a 99m Tc-sulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy. (author)

  6. Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

    Science.gov (United States)

    Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M

    2016-03-01

    To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.

  7. DOJ News Release: West Palm Beach Sellers of Unnecessary Septic Tank Products Plead Guilty to Wire Fraud

    Science.gov (United States)

    Moore, Nouerand and Lincoln, in concert with other employees of FBK Products, LLC., knowingly participated in a scheme to fraudulently market and sell an unnecessary and unneeded septic treatment product to residents of various states across the country.

  8. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    Morbidly obese patients present with excess fatty tissue externally on the breast, neck, thoracic wall and abdomen and internally in the mouth, pharynx and abdomen. This excess tissue tends to make access (intubation, tracheostomy) to and patency (during sedation or mask ventilation) of the upper...... in morbidly obese patients and should be followed by actions to counteract atelectasis formation. The decision as to weather to use a rapid sequence induction, an awake intubation or a standard induction with hypnotics should depend on the thorough airway examination and comorbidity and should not be based...... solely on whether morbid obesity is present or not. It is important to ensure sufficient depth of anaesthesia before initiating manipulation of the airway because inadequate anaesthesia depth predisposes to aspiration if airway management becomes difficult. The intubating laryngeal mask airway is more...

  9. Maternal age and child morbidity

    DEFF Research Database (Denmark)

    Hviid, Malene Meisner; Skovlund, Charlotte Wessel; Mørch, Lina Steinrud

    2017-01-01

    the association between maternal age and overall child morbidity according to main diagnosis groups. MATERIAL AND METHODS: We conducted a national cohort study including 352 027 live firstborn singleton children. The children were born between Jan 1994 and Dec 2009 and followed to Dec 2012. Children were divided...... into groups according to maternal age: 15-24, 25-29, 30-34, and 35+ years. Poisson regression analyses calculated adjusted incidence rate ratios (IRR) of child morbidities according to main diagnoses groups A-Q of the International Classification of Disease 10 with adjustment for year of birth, body mass...... index, smoking, and mother's level of education. RESULTS: Average follow-up time was 11 years. Compared to children born to women 25-29 years, firstborn children to mothers aged 35+ had higher child morbidity in 8 of 19 main diagnosis groups and firstborn children to mothers 15-24 years had higher child...

  10. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria

    OpenAIRE

    Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J.; Main, Cheryl; Mertz, Dominik

    2015-01-01

    Background Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. Objective To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Design Quasi-experimental study with a control group. Setting Two tertiary teaching adult care hospitals. Participants Consec...

  11. Study Protocol. IDUS -- Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    LENUS (Irish Health Repository)

    Murphy, Deirdre J

    2012-09-13

    AbstractBackgroundInstrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice.Methods\\/DesignA multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha.DiscussionIt is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries.Trial registrationCurrent Controlled Trials ISRCTN72230496

  12. Study Protocol. IDUS – Instrumental delivery & ultrasound. A multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery

    Directory of Open Access Journals (Sweden)

    Murphy Deirdre J

    2012-09-01

    Full Text Available Abstract Background Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 – 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. Methods/Design A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. Discussion It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Trial registration Current Controlled Trials ISRCTN72230496

  13. Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program.

    Science.gov (United States)

    Sadana, Divyajot; Pratzer, Ariella; Scher, Lauren J; Saag, Harry S; Adler, Nicole; Volpicelli, Frank M; Auron, Moises; Frank, Steven M

    2018-01-01

    Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized. We review the most recent transfusion practice guidelines and the evidence supporting these guidelines. We also discuss several medical societies' Choosing Wisely campaigns to reduce or eliminate overuse of transfusions. A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice.

  14. A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

    Science.gov (United States)

    Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

    2018-03-01

    Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Liver morphology in morbid obesity

    DEFF Research Database (Denmark)

    Andersen, T; Gluud, C

    1984-01-01

    Literature on liver morphology in untreated obesity reveals varying prevalences of various pathological findings. The purpose of this literature study was to summarize and evaluate the published observations and to discuss discrepant findings. A complete search was aimed at utilizing bibliographic...... methods including a computerized survey. Forty-one original articles were included, comprising information on liver morphology in 1515 morbidly obese patients. Liver biopsy was considered normal in 12 per cent of the cases. The most frequent abnormality reported was fatty change, present in 80 per cent...... of obesity, age, sex, alcohol consumption, diabetes mellitus) does not point towards a single causal factor. Co-influence of additional pathogenetic factors are likely in the development of liver changes in morbid obesity....

  16. Laryngeal morbidity after tracheal intubation

    DEFF Research Database (Denmark)

    Sørensen, M K; Rasmussen, N; Kristensen, M S

    2013-01-01

    BACKGROUND: Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower...... with the Endoflex tube than with the conventional endotracheal tube with stylet because of less rigidity. METHODS: This randomised trial included 130 elective surgical patients scheduled for general anaesthesia with endotracheal intubation. Pre- and post-operative assessment of hoarseness, vocal fold pathology......% with the Endoflex tube and 55% with the endotracheal tube with stylet at 24 h after extubation (P = 0.44). Post-operative vocal fold injury was present in 23% in the Endoflex tube group and in 36% in the endotracheal tube with stylet group (P = 0.13). The increase in shimmer, the voice analysis variable reflecting...

  17. Cancer morbidity in alcohol abusers

    DEFF Research Database (Denmark)

    Tønnesen, H; Møller, Henrik; Andersen, J R

    1994-01-01

    Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared with th...... and the liver are confirmed. In addition, this study indicates an increased occurrence of cancer of the prostate gland, pleura and uterine cervix in alcohol abusers.......Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared...... with that of the total Danish population. On average the 15,214 men were observed for 12.9 years and the 3,093 women for 9.4 years. The overall morbidity of cancer was increased significantly. Of the men, 1,441 developed cancer [relative risk (RR) = 1.6; 95% confidence interval (CI) = 1.5-1.7], while 182 women did (RR...

  18. Psychiatric morbidity in perimenopausal women

    Directory of Open Access Journals (Sweden)

    Biswajit L Jagtap

    2016-01-01

    Full Text Available Background: Women in the perimenopausal period are reported to be vulnerable to psychiatric disorders. Aim: To assess the psychiatric morbidity in perimenopausal women aged 45–55 years. Materials and Methods: This cross-sectional, observational, hospital-based study was conducted at the Department of Psychiatry in a tertiary care hospital attached to a medical college. The study sample consisted of consecutive women in perimenopause as diagnosed by a gynecologist and written informed consent for inclusion in the study. Women with a previous history of psychiatric illnesses, with a major medical illness, or who had undergone surgical menopause were excluded from the study. All women were evaluated with a brief questionnaire for collecting demographic and clinical information and the Mini International Neuropsychiatric Interview for assessing psychiatric disorders. Results: Of the 108 women in perimenopause included in the study, 31% had depressive disorder, 7% had anxiety, while 5% had depressive disorder with anxiety features. Psychiatric morbidity was significantly more in women having lesser education, from rural background, with a history of psychiatric illness in the family, a later age of menarche, and in the late stage of perimenopause. Conclusions: Women in the perimenopause affected by psychiatric morbidity were most commonly diagnosed with depression. As perimenopause is a time of vulnerability in women, attention to signs and symptoms of depression may be required so that they may lead a more productive life.

  19. Comparison of pacing algorithms to avoid unnecessary ventricular pacing in patients with sick sinus node syndrome: a single-centre, observational, parallel study.

    Science.gov (United States)

    Poghosyan, Hermine R; Jamalyan, Smbat V

    2012-10-01

    Reduction of unnecessary ventricular pacing (uVP) is an essential component in the treatment strategy in any pacing population in general. The aim of this study was to evaluate the efficacy of different algorithms to reduce uVP in an adult population with sick sinus syndrome (SSS) treated outside of clinical trials. Evaluation of the relationship between different types of pacing algorithms and clinical outcomes is also provided. This was a single-centre, observational, parallel study, based on retrospective analysis of the Arrhythmology Cardiology Center of Armenia electronic clinical database. This study evaluated atrial pacing percentage (AP%), ventricular pacing percentage (VP%), and the incidence of atrial high rate episodes in 56 patients with SSS using three different pacing strategies: managed VP, search atrioventricular (AV), and fixed long AV. We did not find statistically significant differences in the amount of VP between the groups. Although the atrial high rate percentage (AHR%) tended to be higher in the fixed long AV group, this difference was not statistically significant. Mean VP% and AP% were similar in all three groups. In our study, all three programmed strategies produced the same mean AP% and VP%, and were equally efficient in uVP reduction. There was no relationship between chosen algorithms and the incidence of pacemaker syndrome, hospitalizations, or change in New York Heart Association class. The percentage of AHR was not associated with pacing strategy or co-morbidities but showed borderline correlation with left atrial size.

  20. Routine preoperative blood group and save testing is unnecessary for elective laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Tandon, A.; Shahzad, K.; Nunes, Q.; Shrotri, M.; Lunevicius, R.

    2017-01-01

    Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes. (author)

  1. A case of autoimmune cholangitis misdiagnosed for cholangiocarcinoma: How to avoid unnecessary surgical intervention?

    Directory of Open Access Journals (Sweden)

    Ignjatović Igor I.

    2015-01-01

    Full Text Available Introduction. Autoimmune cholangitis or immunoglobulin G4-associated cholangitis (IAC has been recently regarded as a new clinical and histopathological entity and is a part of a complex autoimmune disorder - IgG4-related systemic disease (ISD. ISD is an autoimmune disease with multi-organic involvement, characterized with IgG4-positive plasmocytic infiltration of various tissues and organs with a consequent sclerosis, which responds well to steroid therapy. Most commonly affected organs are the pancreas (autoimmune pancreatitis, [AIP] and the common bile duct (IAC. IAC and cholangiocarcinoma (CCA share many clinical, laboratory and imaging findings. Case Outline. We present a case of a 60-year-old male with a biliary stricture of a common bile duct, which was clinically considered as a bile duct carcinoma and treated surgically. Definite histopathological findings and immunohistochemistry revealed profound chronic inflammation, showing lymphoplasmacytic IgG-positive infiltration of a resected part of a common bile duct, highly suggestive for the diagnosis of IAC. In addition, postoperative IgG4 serum levels were also increased. Conclusion. It is of primary clinical importance to make a difference between IAC and CCA, in order to avoid unnecessary surgical intervention. Therefore, IAC should be considered in differential diagnosis in similar cases.

  2. Decision analysis for the cost effectiveness of Sestamibi Scintimammography in minimizing unnecessary biopsies

    International Nuclear Information System (INIS)

    Allen, M.W.; Hendi, P.; Schwimmer, J.; Gambhir, S.S.; Bassett, L.

    2000-01-01

    The purpose of this study was to assess if breast cancer screening using sestamibi scintimammography (SSMM) in conjunction with mammography (MM) is cost effective in avoiding biopsies in healthy patients. Quantitative decision tree sensitivity analysis was used to compare the conventional MM alone strategy (strategy A) with two decision strategies for screening with SSMM; SSMM after an indeterminate mammogram (strategy B) or SSMM after both a positive and an indeterminate mammogram (strategy C). Cost effectiveness was measured by calculating the expected cost per patient and the average life expectancy per patient for baseline values as well as over a range of values for all of the variables of each strategy. Based on Medicare reimbursement values, strategies B and C showed a cost savings of $9 and $20 per patient respectively as compared to strategy A. This translates into respective savings of $189 and $420 million per year assuming 21 million females undergo screening each year. Strategies B and C did however have a loss of mean life expectancy of 0.000178 and 0.000222 years respectively as compared to strategy A due to interval progression of breast cancer in a small number of women. Strategies B and C significantly lowered the number of biopsies performed on healthy patients in the screening population by 750,063 and 1,557,915 biopsies respectively as compared to strategy A. These results quantitatively verify the potential utility of using SSMM in avoiding unnecessary biopsies

  3. Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.

    Science.gov (United States)

    Malmartel, A; Dutron, M; Ghasarossian, C

    2017-09-01

    About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.

  4. Airway management and morbid obesity

    DEFF Research Database (Denmark)

    Kristensen, Michael S

    2010-01-01

    Morbidly obese patients present with excess fatty tissue externally on the breast, neck, thoracic wall and abdomen and internally in the mouth, pharynx and abdomen. This excess tissue tends to make access (intubation, tracheostomy) to and patency (during sedation or mask ventilation) of the upper...... airway and the function of the lungs (decreased residual capacity and aggravated ventilation perfusion mismatch) worse than in lean patients. Proper planning and preparation of airway management is essential, including elevation of the patient's upper body, head and neck. Preoxygenation is mandatory...

  5. Evaluation of morbidity from mortality.

    Science.gov (United States)

    Damiani, P; Massé, H; Aubenque, M

    1983-01-01

    The authors have attempted to measure morbidity involved in mortality, from French regional statistics of causes of death, for the 1968-1970 period. Particularly, they have estimated prevalence rates (proportion of patients at a given moment) and incidence rates (annual proportion of new patients). These rates have been assessed by sex, and for age groups: 15-44 years, 45-64 years, 65-74 years, 75 years and more, and for 18 leading causes of death, according to the International Classification of Diseases (1965). Statistics of causes of deaths have been corrected to take into account non specified causes of death.

  6. The benefits of reduced morbidity

    Energy Technology Data Exchange (ETDEWEB)

    Krupnick, A; Hood, C; Harrison, K

    1994-07-01

    Morbidity benefits refer to increases in utility arising from reductions in incidents of acute health impairments and from increases in the probability of developing chronic diseases. The impairments would run the gamut from a cough-day to a bed-disability-day, while the chronic diseases include classic pollution-related diseases, such as cancer, to in utero effects and learning disabilities. As with mortality benefits, there could be benefits to oneself and family and friends as well as benefits based on altruism. A major difference between the mortality and morbidity valuation literatures is that while estimates of the former are always based on risk (one is never trying to obtain values for avoiding certain death), estimates of the latter generally are not. That is, most of the theory and empirical estimates are based on models where the effect to be avoided is certain. This assumption holds reasonably well for estimating common acute effects, for example, the willingness to pay (WTP) for one less cough-day. It works less well, if at all, for chronic illness endpoints, where benefits seem to be appropriately expressed in terms of reduced risk of developing a disease or impairment.

  7. The benefits of reduced morbidity

    International Nuclear Information System (INIS)

    Krupnick, A.; Hood, C.; Harrison, K.

    1994-01-01

    Morbidity benefits refer to increases in utility arising from reductions in incidents of acute health impairments and from increases in the probability of developing chronic diseases. The impairments would run the gamut from a cough-day to a bed-disability-day, while the chronic diseases include classic pollution-related diseases, such as cancer, to in utero effects and learning disabilities. As with mortality benefits, there could be benefits to oneself and family and friends as well as benefits based on altruism. A major difference between the mortality and morbidity valuation literatures is that while estimates of the former are always based on risk (one is never trying to obtain values for avoiding certain death), estimates of the latter generally are not. That is, most of the theory and empirical estimates are based on models where the effect to be avoided is certain. This assumption holds reasonably well for estimating common acute effects, for example, the willingness to pay (WTP) for one less cough-day. It works less well, if at all, for chronic illness endpoints, where benefits seem to be appropriately expressed in terms of reduced risk of developing a disease or impairment

  8. Jealous love and morbid jealousy.

    Science.gov (United States)

    Maggini, Carlo; Lundgren, Eva; Leuci, Emanuela

    2006-12-01

    Jealous love and morbid jealousy, although inextricably linked, cannot be considered the same: jealous love (trait jealousy) is the behavioral and cognitive-affective precondition of morbid jealousy (state jealousy). Love is jealous when it is devoured by the desire for the exclusive and total possession of the partner, whose unconditional and continued presence is avidly requested. This type of love, in addition, is permeated by the need to know what the other is thinking, in order to scrutinize every minimal flaw in the faithfulness of the partner even in his or her innermost thoughts and fantasies; in it, jealousy is virtually always present, even in the absence of a triggering event, because captative love, by its very nature, includes the expectation of a conflict which inevitably actually takes place in reality. Finally, jealousy emerges as an emotional event (jealous flash) in response to a more or less significant change in the behavior of the partner, and reveals to the jealous individual a dimension which was previously latent or inexistent. This intense and brief experience, leaves a more or less blurred memory behind, and tends to progressively repeat itself and take root as a feeling.

  9. Re: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

    Science.gov (United States)

    Durand-Moreau, Quentin; Loddé, Brice; Dewitte, Jean-Dominique

    2015-03-01

    Madsen et al (1) recently published a secondary analysis on data provided by the Project on Burnout, Motivation and Job Satisfaction (PUMA). The aim of their study, published in the Scandinavian Journal of Work, Environment & Health was to examine the associations between unnecessary work tasks and a decreased level of mental health. Though the topic was quite novel, reading this work proved disturbing and raised issues. Based on the results of this study, the authors stated that there is an association between unnecessary work tasks (assessed by a single question) and a decreased level of mental health, idem [assessed by the Mental Health Inventory (MHI-5)], in the specific population included in this PUMA survey. The authors point out a limitation of the study, namely that unnecessary work tasks were evaluated using one single question: "Do you sometimes have to do things in your job which appear to be unnecessary?". Semmer defines unnecessary work task as "tasks that should not be carried out at all because they do not make sense or because they could have been avoided, or could be carried out with less effort if things were organized more efficiently" (2). De facto, qualifying what an unnecessary task is requires stating or explaining whether the task makes sense. Making sense or not is not an objective notion. It is very difficult for either a manager or an employee to say if a task is necessary or not. Most important is that it makes sense from the worker's point of view. Making sense and being necessary are not synonyms. Some tasks do not make sense but are economically necessary (eg, when, as physicians, we are reporting our activity using ICD-10 on computers instead of being at patients' bedsides or reading this journal). Thus, there is a wide gap between Semmer's definition and the question used by the authors to evaluate his concept. A secondary analysis based on a single question is not adequate to evaluate unnecessary tasks. Nowadays, the general trend

  10. Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations

    Energy Technology Data Exchange (ETDEWEB)

    Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2017-03-15

    Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)

  11. "No zone" approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations.

    Science.gov (United States)

    Ibraheem, Kareem; Khan, Muhammad; Rhee, Peter; Azim, Asad; O'Keeffe, Terence; Tang, Andrew; Kulvatunyou, Narong; Joseph, Bellal

    2018-01-01

    The most recent management guidelines advocate computed tomography angiography (CTA) for any suspected vascular or aero-digestive injuries in all zones and give zone II injuries special consideration. We hypothesized that physical examination can safely guide CTA use in a "no zone" approach. An 8-year retrospective analysis of all adult trauma patients with penetrating neck trauma (PNT) was performed. We included all patients in whom the platysma was violated. Patients were classified into three groups as follows: hard signs, soft signs, and asymptomatic. CTA use, positive CTA (contrast extravasation, dissection, or intimal flap) and operative details were reported. Primary outcomes were positive CTA and therapeutic neck exploration (TNE) (defined by repair of major vascular or aero-digestive injuries). A total of 337 patients with PNT met the inclusion criteria. Eighty-two patients had hard signs and all of them went to the operating room, of which 59 (72%) had TNE. One hundred fifty-six patients had soft signs, of which CTA was performed in 121 (78%), with positive findings in 12 (10%) patients. The remaining 35 (22%) underwent initial neck exploration, of which 14 (40%) were therapeutic yielding a high rate of negative exploration. Ninty-nine patients were asymptomatic, of which CTA was performed in 79 (80%), with positive findings in 3 (4%), however, none of these patients required TNE. On sub analysis based on symptoms, there was no difference in the rate of TNE between the neck zones in patients with hard signs (P = 0.23) or soft signs (P = 0.51). Regardless of the zone of injury, asymptomatic patients did not require a TNE. Physical examination regardless of the zone of injury should be the primary guide to CTA or TNE in patients with PNT. Following traditional zone-based guidelines can result in unnecessary negative explorations in patients with soft signs and may need rethinking. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Long Detection Programming in Single-Chamber Defibrillators Reduces Unnecessary Therapies and Mortality: The ADVANCE III Trial.

    Science.gov (United States)

    Gasparini, Maurizio; Lunati, Maurizio G; Proclemer, Alessandro; Arenal, Angel; Kloppe, Axel; Martínez Ferrer, Josè B; Hersi, Ahmad S; Gulaj, Marcin; Wijffels, Maurits C E; Santi, Elisabetta; Manotta, Laura; Varma, Niraj

    2017-11-01

    This study sought to evaluate the effects of programming a long detection in single-chamber (VVI) implantable cardioverter-defibrillators (ICDs) in the multicenter prospective ADVANCE III (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III) trial. Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs. A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length functions enabled. Therapies delivered were compared using a negative binomial regression model. A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm. Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175). Copyright © 2017 The Authors. Published by Elsevier Inc. All

  13. Morbidity figures from general practice: sex differences in traumatology.

    Science.gov (United States)

    Lagro-Janssen, Toine; Grosicar, Janja

    2010-08-01

    Trauma prevention starts with to find out the extent of the problem and who it affects. Insight into morbidity figures is therefore necessary. To explore sex differences in traumatology and secondary medical care utilization in primary care related to age and socio-economic status (SES). Data were obtained from an academic continuous morbidity registration project in the Netherlands in the period from 1996 to 2006, in which 13,000 patients were followed in 10 successive years. Sex differences showed a male excess from childhood to 45 years and women showing almost double trauma rates in the elderly. Low SES was associated with the greatest incidence of traumas. The largest sex difference in incidence above 65 years appeared in the high SES with more traumas in women compared with men. From this age on, female morbidity in traumatology outnumbered male morbidity regardless of SES. Considering use of referrals, we found that in the age group 15-45 years men made a greater use of secondary medical care. However, the vastest gender influence in medical care utilization was noticed in the age group over 65 years, outnumbered with women. Young men and old women are the most at risk for traumatic health problems: men presenting with traumata of the skull, the tibia and ocular trauma's and women with fractures of the femur, humerus and wrist. For both men and women the greatest incidence is in the low SES. Family physicians can play a pivotal role in prevention to focus on their patients with high risks.

  14. Co-morbid disorders in Tourette syndrome

    DEFF Research Database (Denmark)

    Debes, Nanette Marinette Monique

    2013-01-01

    in persons with TS. Both in clinical cohorts and in population-based cohorts the prevalence of co-morbidities is high. The presence of co-morbid ADHD and/or OCD has an impact on psychosocial, educational, and neuropsychological consequences of TS and it is associated with higher rates of other co......-morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS...

  15. Cancer morbidity in alcohol abusers

    DEFF Research Database (Denmark)

    Tønnesen, H; Møller, Henrik; Andersen, J R

    1994-01-01

    Data on the association between alcohol abuse and cancer morbidity are scarce in large cohorts of non-hospitalised alcoholic men and women. Of 18,368 alcohol abusers who entered an outpatient clinic in Copenhagen during 1954-87, 18,307 were followed and their cancer incidence was compared...... colonic (RR = 1.0; 95% CI 0.8-1.3) or rectal cancer (RR = 1.0; CI 0.7-1.3) than expected. The risk of breast cancer in women was slightly increased (RR = 1.3; 95% CI 0.9-1.7), but not statistically significant. Thus, the associations between alcohol and cancer of the upper digestive and respiratory tract...... and the liver are confirmed. In addition, this study indicates an increased occurrence of cancer of the prostate gland, pleura and uterine cervix in alcohol abusers....

  16. The effects of bariatric surgery: will understanding its mechanism render the knife unnecessary?

    Science.gov (United States)

    Browning, Kirsteen N; Hajnal, Andras

    2014-01-01

    The incidence of obesity is increasing worldwide at a dramatic rate, accompanied by an associated increase in comorbid conditions. Bariatric surgery is the most effective treatment for morbid obesity with Roux-en-Y gastric bypass being the most commonly performed procedure, yet the underlying mechanisms by which it induces a wide-array of beneficial effects remains obscure. From basic science as well as clinical standpoints, there are several areas of current interest that warrant continued investigation. Several major focus areas have also emerged in current research that may guide future efforts in this field, particularly with regards to using novel, non-surgical approaches to mimic the success of bariatric surgery while minimizing its adverse side effects.

  17. Hereditary haemorrhagic telangiectasia: a cause of preventable morbidity and mortality.

    LENUS (Irish Health Repository)

    Brady, A P

    2012-01-31

    Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant condition whose effects are mediated through deficient blood vessel formation and regeneration, with multisystem involvement. Patients are usually aware of resulting skin telangiectasia and epistaxis, but are also exposed to dangers posed by occult vascular malformations in other organs. About 15-35% of HHT patients have pulmonary AVMs (PAVMs), 10% have cerebral AVMs (CAVMs), 25-33% suffer significant GI blood loss from GI tract telangiectasia, and an unknown but high percentage have liver involvement. In total, 10% of affected individuals die prematurely or suffer major disability from HHT, largely because of bleeding from CAVMs and PAVMs, or paradoxical embolization through PAVMs. Screening for and early intervention to treat occult PAVMs and CAVMs can largely eliminate these risks, and should be undertaken in a specialist centre. The National HHT Center in The Mercy University Hospital in Cork is the referral centre for HHT screening in Ireland.

  18. Morbidity among Israeli paediatric travellers.

    Science.gov (United States)

    Rabinowicz, Shira; Schwartz, Eli

    2017-09-01

    International travel, particularly to developing countries, is becoming increasingly common among the Israeli population, including an increase in the number of travelling children. Since children are a distinct travellers' population, data about their post-travel morbidity are needed. A retrospective study which examined all children (0-19 years old) who presented to our centre after international travel from 1999 to 2015. About 314 children were seen. The mean age was 10 years (SD ± 5.8). Most of the patients (80.6%) were tourists, and the rest were expatriates. The main destinations visited were South-Asia (46.5%), Sub-Saharan Africa (33.4%), Latin-America (7%) and Europe (6.4%). Overall, the most common diagnoses were gastrointestinal (GI) (mainly chronic) disorders (30.6%), followed by febrile diseases (26.4%), among which 18.1% of patients were diagnosed with dengue fever and 12% with malaria. Dermatologic conditions accounted for 25.2%. Additional diagnoses were schistosomiasis (6.4%) and neuropsychiatric symptoms (2.2%). A substantial part, 10.8%, had eosinophilia, either symptomatic or asymptomatic. Travellers to Asia, compared to travellers to Africa, presented more commonly with GI illness (OR 2.02, 95% confidence interval 1.13-3.61), and dermatologic conditions (OR 1.94, 95% confidence interval 1.05-3.61). Morbidity was associated with a variety of transmission modes, such as food-borne illnesses (30.9%), bite and sting wounds (10.2%), mosquito-borne infections (8%), freshwater contact (6.7%) and tick-borne infections (2.2%). The main conditions seen in paediatric returning travellers were GI, febrile and dermatologic illnesses, some may be rare in their country of origin. Targeting care for the suspected pathogens based on updated knowledge of epidemiology and thorough travel history is essential. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  19. Laparoscopic surgery for morbid obesity.

    Science.gov (United States)

    Hallerbäck, B; Glise, H; Johansson, B; Johnson, E

    1998-01-01

    Morbid obesity, defined as a body mass index (BMI), i.e. weight (kg)/height (m2) over 36 for males and 38 for females, is a common condition and a threat for health, life and individual well being. Hitherto, surgery is the only effective treatment for weight reduction. Surgical methods can be malabsorptive, reducing the patients ability to absorb nutrients, or restrictive, reducing the capacity of food intake. Exclusively malabsorptive methods have been abandoned due to severe side effects. Restrictive methods, gastroplasties, reduces the compliance capacity of the stomach. Two types are performed laparoscopically, the vertical banded gastroplasty and the adjustable gastric banding. The proximal gastric by pass is also performed laparoscopically and is a combination of a restrictive proximal gastroplasty and a malabsorptive Roux-en-Y gastro-jejunal anastomosis. With laparoscopic adjustable gastric banding mean BMI was reduced from 41 kg/m2 to 33 kg/m2 (n = 43) after one year. Two years after surgery mean BMI was 30 kg/m2 (n = 16). The different operative techniques are further discussed in this paper.

  20. Co-morbidities of vertiginous diseases

    OpenAIRE

    Warninghoff, Jan C; Bayer, Otmar; Ferrari, Uta; Straube, Andreas

    2009-01-01

    Abstract Background Co-morbidities of vertiginous diseases have so far not been investigated systematically. Thus, it is still unclear whether the different vertigo syndromes (e.g. benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), vestibular migraine and phobic vertigo (PPV)) have also different spectrums of co-morbidities. Methods All patients from a cohort of 131 participants were surveyed using a standardised questionnaire about the co-morbidities hypertension, diabetes ...

  1. Alcohol-related hand injuries: an unnecessary social and economic cost.

    OpenAIRE

    Marston, R. A.

    1992-01-01

    Severe hand injuries constitute the largest number of acute referrals to this plastic surgery unit, the admission of these patients often displacing routine admissions due to bed shortages, thus increasing waiting list time. This study showed that a high percentage of these injuries were alcohol-related and were therefore preventable. The economic cost to the unit is discussed.

  2. Morbidity and GH deficiency: a nationwide study

    DEFF Research Database (Denmark)

    Stochholm, K.; Laursen, T.; Green, A.

    2008-01-01

    identified in the National Patient Registry. Lag time until first admission was used as a measure of morbidity. Patients were divided into childhood onset (CO) and adult onset (AO), discriminated by an age cut-off of 18 years at onset of GHD. Method: Sex- and cause-specific hazard ratios (HRs) in CO and AO......Objective: To estimate morbidity in Denmark in all patients with GH deficiency (GHD). Design: Morbidity was analyzed in 1794 GHD patients and 8014 controls matched on age and gender. All records in the GHD patients were studied and additional morbidity noted. Diagnoses and dates of admissions were...

  3. A decision aid to rule out pneumonia and reduce unnecessary prescriptions of antibiotics in primary care patients with cough and fever

    Directory of Open Access Journals (Sweden)

    Hunziker Roger

    2011-05-01

    Full Text Available Abstract Background Physicians fear missing cases of pneumonia and treat many patients with signs of respiratory infection unnecessarily with antibiotics. This is an avoidable cause for the increasing worldwide problem of antibiotic resistance. We developed a user-friendly decision aid to rule out pneumonia and thus reduce the rate of needless prescriptions of antibiotics. Methods This was a prospective cohort study in which we enrolled patients older than 18 years with a new or worsened cough and fever without serious co-morbidities. Physicians recorded results of a standardized medical history and physical examination. C-reactive protein was measured and chest radiographs were obtained. We used Classification and Regression Trees to derive the decision tool. Results A total of 621 consenting eligible patients were studied, 598 were attending a primary care facility, were 48 years on average and 50% were male. Radiographic signs for pneumonia were present in 127 (20.5% of patients. Antibiotics were prescribed to 234 (48.3% of patients without pneumonia. In patients with C-reactive protein values below 10 μg/ml or patients presenting with C-reactive protein between 11 and 50 μg/ml, but without dyspnoea and daily fever, pneumonia can be ruled out. By applying this rule in clinical practice antibiotic prescription could be reduced by 9.1% (95% confidence interval (CI: 6.4 to 11.8. Conclusions Following validation and confirmation in new patient samples, this tool could help rule out pneumonia and be used to reduce unnecessary antibiotic prescriptions in patients presenting with cough and fever in primary care. The algorithm might be especially useful in those instances where taking a medical history and physical examination alone are inconclusive for ruling out pneumonia

  4. The criteria for the decision of transrectal US-guided prostate biopsy: Can we reduce the number of unnecessary biopsies?

    International Nuclear Information System (INIS)

    Cho, Joon Hyung; Cho, Jae Ho; Ahn, Jay Hong; Chang, Jay Chun

    2001-01-01

    To establish the criteria which can safely reduce the number of unnecessary biopsies by comparing the transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and prostate specific antigen density (PSAD) in the decision of criteria for the prostatic biopsy using TRUS. Two hundred and twenty patients underwent TRUS- guided prostate biopsy due to elevated PSA and/or focal nodule on TRUS were included. Sixty five (27.5%) patients were confirmed as prostate cancer, and remained 155 (70.5%) patients were reported as benign diseases including benign prostate hyperplasia. The sensitivity, specificity and accuracy of TRUS, PSA and PSAD were evaluated and the single criterion or the combination of the criteria which can safely reduce the unnecessary biopsies without missing prostatic cancer were investigated. The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4 ng/ml) and PSAD (cut-off level, 0.2 ng/ml/cm 3 ) were 78.5%/95.4%/95.4%/27.8%/51.6%/64/5%, 42.7%/64.5%/73.6%, respectively. PSAD cut-off level 0.2 ng/ml/cm 3 was the most excellent single criterion for the decision of prostatic biopsy and the number of unnecessary biopsies was 100 cases. But 3 cases of prostatic cancer which the PSAD level was below 0.2 ng/ml/cm 3 were included and in all these 3 cases, a focal nodule was detected on TRUS. Therefore, we applied these two criteria at once and the biopsies of 30 cases (13.6%) are unnecessary. With the single criterion, we could not obtain the satisfactory results but by the combinations of criteria (TRUS and PSAD), 30 (13.6%) cases are unnecessary biopsies without missing cancer. We think that the short term follow-up may be a substitute for the immediate when nodular lesion is suspicious on TRUS and serum PSAD level is below 0.2 ng/ml/cm 3 .

  5. Barium swallow for hiatal hernia detection is unnecessary prior to primary sleeve gastrectomy.

    Science.gov (United States)

    Goitein, David; Sakran, Nasser; Rayman, Shlomi; Szold, Amir; Goitein, Orly; Raziel, Asnat

    2017-02-01

    Hiatal hernia (HH) is common in the bariatric population. Its presence imposes various degrees of difficulty in performing laparoscopic sleeve gastrectomy (LSG). Preoperative upper gastrointestinal evaluation consists of fluoroscopic and or endoscopic studies OBJECTIVES: To evaluate the efficacy of routine, preoperative barium swallow in identifying HH in patients undergoing LSG, and determine if such foreknowledge changes operative and immediate postoperative course regarding operative time, intraoperative adverse events, and length of hospital stay (LOS). In addition, to quantify HH prevalence in these patients and correlate preoperative patient characteristics with its presence. High-volume bariatric practice in a private hospital in Israel METHODS: Retrospective analysis of prospectively collected data between October 2010 and March 2015: anthropometrics, co-morbidities, previous barium swallow, preoperative HH workup (type and result), operative and immediate postoperative course. Primary LSG was performed in 2417 patients. The overall prevalence of HH was 7.3%. Preoperative diagnosis of gastroesophageal reflux disease and female gender were independent risk factors for HH presence. Operative times were significantly longer when HH was concomitantly repaired but "foreknowledge" thereof did not assist in shortening this time. Looking for an HH that was suggested in preoperative upper gastrointestinal evaluation slightly prolonged surgery. LOS was not changed in a significant fashion by HH presence and repair, whether suspected or incidentally found. Routine, pre-LSG barium swallow does not seem to offer an advantage over selective intraoperative hiatal exploration, in the discovery and management of HH. Conversely, when preoperative workup yields a false-positive result, surgery is slightly prolonged. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  6. Sexual Activity and Urological Morbidities Among Nigerian ...

    African Journals Online (AJOL)

    Background: Menopause represents the end of women reproductive career and it is at this time they begin to manifest morbidities such as urinary incontinence. Aim: To document proximate determinants of sexual activity and urological morbidities of menopausal women. Subjects and Methods: This was a community survey ...

  7. Intubation of the morbidly obese patient

    DEFF Research Database (Denmark)

    Ydemann, Mogens; Rovsing, Marie Louise; Lindekaer, A L

    2012-01-01

    Several potential problems can arise from airway management in morbidly obese patients, including difficult mask ventilation and difficult intubation. We hypothesised that endotracheal intubation of morbidly obese patients would be more rapid using the GlideScope(®) (GS) (Verathon Inc Corporate H...... Headquarters, Bothell, WA, USA) than with the Fastrach™ (FT) (The Laryngeal Mask Company Ltd, Le Rocher, Victoria, Mahe, Seychelles)....

  8. Self-reported skin morbidity in Denmark

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Zarchi, Kian; Ellervik, Christina

    2016-01-01

    Skin diseases are thought to be common in the general population. In 2004, a cross-sectional study in Norway, using a validated questionnaire for 18,770 individuals, revealed a high prevalence of skin diseases in the general population. To describe the prevalence of self-reported skin morbidities...... questionnaire. In total, 17.2% self-reported skin complaints. The most prominent self-reported skin complaint was itch with an overall prevalence of 6.5%. The skin morbidity most influenced by age was pimples. There was a uniform pattern showing fewer skin complaints with increasing education. Women reported...... skin morbidities more frequently than men. Participants in employment reported fewer skin morbidities compared to unemployed participants. Skin morbidities in Denmark are common, and the distribution of prevalence estimates in the Danish population parallel those of the Norwegian population, although...

  9. Triple surveillance: a proposal for an integrated strategy to support and accelerate birth defect prevention.

    Science.gov (United States)

    Botto, Lorenzo D; Mastroiacovo, Pierpaolo

    2018-02-01

    Preventing neural tube defects (NTDs) easily qualifies as a high-value opportunity to improve childhood survival and health: the unmet need is significant (major preventable burden), the intervention is transformative (providing sufficient folic acid), and delivery strategies (e.g., fortification) are effective in low-resource countries. Yet, NTD prevention is lagging. Can public health surveillance help fix this problem? Critics contend that surveillance is largely unnecessary, that limited resources are best spent on interventions, and that surveillance is unrealistic in developing countries. The counterargument is twofold: (1) in the absence of surveillance, interventions will provide fewer benefits and cost more and (2) effective surveillance is likely possible nearly everywhere, with appropriate strategies. As a base strategy, we propose "triple surveillance:" integrating surveillance of cause (folate insufficiency), of disease occurrence (NTD prevalence), and of health outcomes (morbidity, mortality, and disability). For better sustainability and usefulness, it is crucial to refocus and streamline surveillance activities (no recreational data collection), weave surveillance into clinical care (integrate in clinical workflow), and, later, work on including additional risk factors and pediatric outcomes (increase benefits at low marginal cost). By doing so, surveillance becomes not a roadblock but a preferential path to prevention and better care. © 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

  10. Morbidity, including fatal morbidity, throughout life in men entering adult life as obese

    DEFF Research Database (Denmark)

    Zimmermann, Esther; Holst, Claus; Sørensen, Thorkild I A

    2011-01-01

    The association between obesity in adults and excess morbidity and mortality is well established, but the health impact throughout adult life of being obese in early adulthood needs elucidation. We investigated somatic morbidity, including fatal morbidity, throughout adulthood in men starting adult...... life as obese....

  11. Unrealistic Hope and Unnecessary Fear: Exploring How Sensationalistic News Stories Influence Health Behavior Motivation.

    Science.gov (United States)

    Nabi, Robin L; Prestin, Abby

    2016-09-01

    In light of the inherent conflict between the nature of science (slow, subject to correction) and the nature of news (immediate, dramatic, novel), this study examines the effect of emotional health news coverage on intentions to engage in protective health behaviors. One hundred seventy-seven students read news stories designed to evoke either fear or hope about human papillomavirus (HPV) followed by different levels of response efficacy information regarding an impending HPV vaccine. Results indicated no main effects for emotion frame or response efficacy, but a significant interaction suggested that emotionally-consistent presentations (fear/low efficacy; hope/high efficacy) boosted intentions to engage in protective actions relative to emotionally-inconsistent, sensationalized presentations (fear/high efficacy, hope/low efficacy). Consistent with the emotion-as-frame perspective, this effect was moderated by perceived knowledge about HPV prevention. Effects of the sensationalized story constructions on trust in health news were also evidenced. Implications for the role of emotional health news coverage in priming prior knowledge about preventative health behaviors, along with future research directions, are discussed.

  12. Maternal morbid obesity and obstetric outcomes.

    LENUS (Irish Health Repository)

    Farah, Nadine

    2012-02-01

    OBJECTIVE: The purpose of this retrospective cohort study was to review pregnancy outcomes in morbidly obese women who delivered a baby weighing 500 g or more in a large tertiary referral university hospital in Europe. METHODS: Morbid obesity was defined as a BMI > or =40.0 kg\\/m2 (WHO). Only women whose BMI was calculated at their first antenatal visit were included. The obstetric out-comes were obtained from the hospital\\'s computerised database. RESULTS: The incidence of morbid obesity was 0.6% in 5,824 women. Morbidly obese women were older and were more likely to be multigravidas than women with a normal BMI. The pregnancy was complicated by hypertension in 35.8% and diabetes mellitus in 20.0% of women. Obstetric interventions were high, with an induction rate of 42.1% and a caesarean section rate of 45.3%. CONCLUSIONS: Our findings show that maternal morbid obesity is associated with an alarmingly high incidence of medical complications and an increased level of obstetric interventions. Consideration should be given to developing specialised antenatal services for morbidly obese women. The results also highlight the need to evaluate the effectiveness of prepregnancy interventions in morbidly obese women.

  13. Trial Manufacture and Evaluation of a Hologram with an unnecessary development process at 1.55 μm

    OpenAIRE

    大島, 茂

    2016-01-01

    A holographic optical element (HOE) for optical fiber coupling has been investigated. The hologram with an unnecessary development process has been manufactured at wavelength of 1.55μm. Diimonium organic dye was used for photosensitive material. Because diimonium organic dye did not stick to a plate glass, acrylic resin was used for binder resin. The thin film of the organic dye was exposed by improved equipment for high power light irradiation at wavelength of 1.55μm. The thin film became th...

  14. Implementing Statewide Severe Maternal Morbidity Review: The Illinois Experience.

    Science.gov (United States)

    Koch, Abigail R; Roesch, Pamela T; Garland, Caitlin E; Geller, Stacie E

    2018-03-07

    Severe maternal morbidity (SMM) rates in the United States more than doubled between 1998 and 2010. Advanced maternal age and chronic comorbidities do not completely explain the increase in SMM or how to effectively address it. The Centers for Disease Control and Prevention and American College of Obstetricians and Gynecologists have called for facility-level multidisciplinary review of SMM for potential preventability and have issued implementation guidelines. Within Illinois, SMM was identified as any intensive or critical care unit admission and/or 4 or more units of packed red blood cells transfused at any time from conception through 42 days postpartum. All cases meeting this definition were counted during statewide surveillance. Cases were selected for review on the basis of their potential to yield insights into factors contributing to preventable SMM or best practices preventing further morbidity or death. If the SMM review committee deemed a case potentially preventable, it identified specific factors associated with missed opportunities and made actionable recommendations for quality improvement. Approximately 1100 cases of SMM were identified from July 1, 2016, to June 30, 2017, yielding a rate of 76 SMM cases per 10 000 pregnancies. Reviews were conducted on 142 SMM cases. Most SMM cases occurred during delivery hospitalization and more than half were delivered by cesarean section. Hemorrhage was the primary cause of SMM (>50% of the cases). Facility-level SMM review was feasible and acceptable in statewide implementation. States that are planning SMM reviews across obstetric facilities should permit ample time for translation of recommendations to practice. Although continued maternal mortality reviews are valuable, they are not sufficient to address the increasing rates of SMM and maternal death. In-depth multidisciplinary review offers the potential to identify factors associated with SMM and interventions to prevent women from moving along the

  15. Population Pharmacokinetics and Pharmacodynamics of Meropenem in Nonobese, Obese, and Morbidly Obese Patients.

    Science.gov (United States)

    Chung, Eun Kyoung; Cheatham, S Christian; Fleming, Megan R; Healy, Daniel P; Kays, Michael B

    2017-03-01

    The study objective was to evaluate meropenem population pharmacokinetics and pharmacodynamics in nonobese, obese, and morbidly obese patients. Forty adult patients-11 nonobese (body mass index [BMI] calculate probability of target attainment (PTA) for 5 dosing regimens, infused over 0.5 and 3 hours, using fT>MIC of 40%, 54%, and 100% of the dosing interval. A 2-compartment linear-elimination model best described the serum concentration-time data, and creatinine clearance was significantly associated with systemic clearance. Pharmacokinetic parameters were not significantly different among patient groups. In patients with creatinine clearances ≥50 mL/min, all simulated dosing regimens achieved >90% PTA at 40% fT>MIC in all patient groups at MICs ≤2 mg/L. Only 500 mg q8h, infused over 0.5 hour, did not achieve >90% PTA at 54% fT>MIC in nonobese and morbidly obese patients. At 100% fT>MIC, 1 g q6h and 2 g q8h, infused over 3 hours, reliably achieved >90% PTA in all patient groups. Meropenem pharmacokinetics are comparable among nonobese, obese, and morbidly obese patients. Standard dosing regimens provide adequate pharmacodynamic exposures for susceptible pathogens at 40% and 54% fT>MIC, but prolonged infusions of larger doses are needed for adequate exposures at 100% fT>MIC. Dosage adjustments based solely on body weight are unnecessary. © 2016, The American College of Clinical Pharmacology.

  16. Ocular Morbidity among Children Attending Government and Private Schools of Kathmandu Valley

    Directory of Open Access Journals (Sweden)

    R K Shrestha

    2011-12-01

    Full Text Available Introduction: Children from the developing world are more prone to going blind from avoidable and preventable causes. In Nepal, children in private schools are reported to have a higher ocular morbidity than those in government schools, with myopia being the major cause of the morbidity. This study was designed to evaluate ocular morbidity in students from both types of school. Methods: This was a cross-sectional, comparative study among students from government and private schools of Kathmandu. Eye examination was carried out evaluating visual acuity, color vision, refractive status, binocular vision status, and anterior and posterior segment findings. Results: A total of 4,228 students from government and private schools were evaluated. The prevalence of ocular morbidity was 19.56 % with refractive error (11.9 % being the major cause of the morbidity, followed by strabismus and infective disorders. No signifi cant difference in the prevalence of ocular morbidity and refractive status was found in the students from government and private schools. Conclusions: A signifi cant number of children of school-going age have ocular morbidity with no signifi cant difference in the prevalence in the students from government and private schools. Research exploring the effect of various risk factors in the progression of myopia would be helpful to investigate the refractive status in children from these different types of schools. Keywords: Myopia, ocular morbidity, school Students

  17. EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm.

    Science.gov (United States)

    Sharratt, C L; Gilbert, C J; Cornes, M C; Ford, C; Gama, R

    2009-08-01

    Potassium ethylenediaminetetraacetic acid (EDTA) is a sample tube anticoagulant used for many laboratory analyses. Gross potassium EDTA contamination of blood samples is easily recognised by marked hyperkalaemia and hypocalcaemia. However, subtle contamination is a relatively common, often unrecognised erroneous cause of spurious hyperkalaemia. Potassium EDTA contamination may also cause hypomagnesaemia and hypozincaemia. There are, however, no data on the prevalence of EDTA contamination as a cause of hypocalcaemia, hypomagnesaemia and hypozincaemia. Following a recent service evaluation, we measure EDTA in serum samples from patients with unexplained hyperkalaemia (serum potassium > 6.0 mmol/l). In addition, over a 1-month period EDTA concentrations were measured in hypocalcaemic (serum adjusted calcium samples. Ethylenediaminetetraacetic acid contamination was detected in 31 samples, nine of which were detected by our routine screening programme. The remaining 22 samples represented 14.3% (19/133) of hypocalcaemic samples, 4.8% (5/104) of hypomagnesaemic samples and 1.4% (2/139) of hypozincaemic samples. A total of 25/31 (80.6%) of patients were re-bled, of which 23/25 (92%) results normalised. Factitious hyperkalaemia, hypocalcaemia and hypomagnesaemia caused by potassium EDTA contamination in our studies are relatively common, and if unrecognised may adversely affect patient care and waste scarce healthcare resources. Correct order of draw of blood samples, improved education and routine laboratory screening of EDTA are necessary to prevent and identify EDTA contamination.

  18. CDC WONDER: Sexually Transmitted Disease (STD) morbidity

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Sexually Transmitted Disease (STD) Morbidity online databases on CDC WONDER contain case reports reported from the 50 United States and D.C., Puerto Rico, Virgin...

  19. CDC WONDER: Sexually Transmitted Disease (STD) Morbidity

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Sexually Transmitted Disease (STD) Morbidity online databases on CDC WONDER contain case reports reported from the 50 United States and D.C., Puerto Rico, Virgin...

  20. Morbidity And Mortality Following Emergency Obstetric ...

    African Journals Online (AJOL)

    Morbidity And Mortality Following Emergency Obstetric Hysterectomy In Calabar, Nigeria. ... Nigerian Journal of Clinical Practice ... in 15 (33.3%) of the case and hysterectomy for puerperal sepsis was an indication in 3 (6.7%) of the cases

  1. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    International Nuclear Information System (INIS)

    Golding, Lauren P.; Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn; Gyr, Bettina M.; Gardner, Alison

    2015-01-01

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  2. Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

    Energy Technology Data Exchange (ETDEWEB)

    Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)

    2015-08-15

    Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

  3. Systemic lupus erythematosus presenting as morbid jealousy.

    Science.gov (United States)

    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

  4. Environmental Pollution: Causing High Morbidity and Mortality

    OpenAIRE

    , E. Laho; , G. Koduzi; , D. Osmanlli; , F. Aliu

    2016-01-01

    The environmental pollution which is increasing, it is a concerning issue for the community, and when it comes to big cities like Elbasan this is a hot spot. The relevant experience has shown that the more industrial and urban pollution an area has, the higher the pulmonary morbidity is and more cases of mortality from tumoral diseases are. To investigate and show the morbidity and mortality rate from respiratory diseases, cancer etc In our investigation which is a retrospective statistical r...

  5. The Relationship Between the Status of Unnecessary Accommodations Being Made to Unconfirmed Food Allergy Students and the Presence or Absence of a Doctor’s Diagnosis

    Directory of Open Access Journals (Sweden)

    Yurika Ganaha

    2015-06-01

    Full Text Available The present study investigated the current state of unnecessary children food allergy accommodation and the medical efforts to confirm the existence of food allergies in school lunch service kitchens in Okinawa, Japan, including kitchens accommodating food allergy students by requiring medical documentation at the start and during provisions being made (Double Diagnosis, requiring medical documentation at the start only (Single Diagnosis, and with no medical documentation (Non-Diagnosis. Unnecessary accommodations are being made to unconfirmed food allergy students, wherein the more medical consultation was required, the lower the food allergy incident rate was and the more food allergens were diagnosed (Non-Diagnosis > Single Diagnosis > Double Diagnosis. This study suggests the possibility that unconfirmed food allergy students may be receiving unnecessary food allergy accommodations per school lunches, and the number of unnecessary food allergy provisions being made could be reduced by requiring medical documentation at the start and during these provisions.

  6. Morbidity and mortality of very low birth weight infants in Taiwan—Changes in 15 years: A population based study

    Directory of Open Access Journals (Sweden)

    Yi-Yu Su

    2016-12-01

    Conclusion: Although the mortality and most of the morbidity of VLBW infants improved over time, the incidence of ROP remained constant. This requires us to further evaluate our strategy for preventing ROP in the future.

  7. Pain Catastrophizing in Borderline Morbidly Obese and Morbidly Obese Individuals with Osteoarthritic Knee Pain

    Directory of Open Access Journals (Sweden)

    Tamara J Somers

    2008-01-01

    Full Text Available OBJECTIVE: There is limited information about how morbidly obese osteoarthritis (OA patients cope with the pain they experience. Pain catastrophizing is an important predictor of pain and adjustment in persons with persistent pain. This may be particularly relevant in the morbidly obese (body mass index [BMI] of 40 kg/m2 or greater OA population at risk for increased pain. The present study first examined whether borderline morbidly obese and morbidly obese OA patients report higher levels of pain catastrophizing than a sample of OA patients in the overweight and obese category (BMI between 25 kg/m2 and 34 kg/m2. Next, it examined how pain catastrophizing is related to important indexes of pain and adjustment in borderline morbidly obese and morbidly obese OA patients.

  8. Maternal morbidities affect tens of millions.

    Science.gov (United States)

    Finger, W R

    1994-02-01

    Various separate studies indicate maternal morbidity is more common than had been believed. A Safe Motherhood Survey was conducted in 1993 in the Philippines among 9000 women, as part of efforts to study women's language and perceptions about pregnancy and symptoms of morbidity. In El Salvador, interviews were conducted among 2000 women on morbidity issues. Preliminary results from a Family Health International (FHI) five-country survey of 16,000 women revealed that 7 out of every 10 women reported a health problem related to maternity or chronic conditions stemming from pregnancy or childbirth. Conditions ranged from obstructed labor, complications from unsafe abortions, and bacterial infections, to anemia, hemorrhage, and eclampsia. The quality of care determines whether the health problems are life threatening. Less serious morbidity cases involve fatigue or back pain, which is exacerbated by poor nutrition and hard physical labor. Other reproductive morbidities are sexually transmitted diseases, side effects from contraceptives, and general gynecological problems. The FHI results from Ghana, Indonesia, and Egypt showed 240-300 morbidities for every maternal death; maternal mortality worldwide is estimated at 500,000 annually. A study of fistula (an injury during labor to the vagina and bladder that results in urinary or fecal incontinence) found that Nigerian community norms and limited access to emergency health care were factors. The women reported costs, poor roads, and transportation problems. A study in Ethiopia found that, in an Addis Ababa hospital between 1983-88, 600 fistulas were repaired every year, of which almost 66% occurred at first delivery. A study in Cairo in 1988 found that nearly 6 out of every 10 women reported a prolapsed uterus. Women in the studies were able to talk openly and willingly about their problems, when concepts and language were appropriate and interviewers were trained. A small study in India confirmed the correlation between

  9. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

    Science.gov (United States)

    Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J; Main, Cheryl; Mertz, Dominik

    2015-01-01

    Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Quasi-experimental study with a control group. Two tertiary teaching adult care hospitals. Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline) and January 30th and April 30th, 2013 (intervention). In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly) on one clinical teaching unit (CTU) at one hospital site, with the CTU of the other hospital serving as the control. During the baseline period, 160/341 (46.9%) positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8%) were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3), absence of a catheter (OR 2.5, 1.2-5), bacteriuria versus candiduria (OR 10.6, 3.8-29.4), pyuria (OR 2.0, 1.1-3.8), and positive nitrites (OR 2.2, 1.1-4.5). In 2013, only 2/24 (8%) of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52%) on the control CTU (OR 0.10; 95% CI 0.02-0.49). A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7) with no significant change noted on the control CTU (OR 0.47, 0.13-1.7). A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

  10. A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

    Directory of Open Access Journals (Sweden)

    Neal Irfan

    Full Text Available Asymptomatic bacteriuria (ABU should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice.To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU.Quasi-experimental study with a control group.Two tertiary teaching adult care hospitals.Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline and January 30th and April 30th, 2013 (intervention.In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly on one clinical teaching unit (CTU at one hospital site, with the CTU of the other hospital serving as the control.During the baseline period, 160/341 (46.9% positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8% were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3, absence of a catheter (OR 2.5, 1.2-5, bacteriuria versus candiduria (OR 10.6, 3.8-29.4, pyuria (OR 2.0, 1.1-3.8, and positive nitrites (OR 2.2, 1.1-4.5. In 2013, only 2/24 (8% of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52% on the control CTU (OR 0.10; 95% CI 0.02-0.49. A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7 with no significant change noted on the control CTU (OR 0.47, 0.13-1.7.A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

  11. The role of parental health care utilization in children's unnecessary utilization in China: evidence from Shaanxi province.

    Science.gov (United States)

    Zhang, Yi; Zhou, Zhongliang; Si, Yafei

    2017-03-09

    China has a large population of children under 18 years of age, whose health is of great concern to the Chinese health care system. However, few studies have been conducted to analyze the factors associated with children's unnecessary health care utilization in China. The objective of this study is to provide some empirical evidence on this issue by investigating the role of parental health care utilization in children's unnecessary health care use. The data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. We employed three dependent variables to measure children's health care utilization: the number of children's outpatient visits during the past 2 weeks, whether or not infusion was used if the child had any outpatient visits during the past 2 weeks, and the number of children's inpatient visits during last year. Based on specific characteristics of these outcome variables, negative binomial models were used for the non-negative numbers of outpatient and inpatient visits, while a probit model was used for the zero-one indicator variable showing whether infusion was used during outpatient visits. Based on a sample of 11,024 children, our results of multivariate analysis showed that children whose parents used outpatient care were estimated to have a larger number of outpatient visits than those whose parents did not have outpatient visits in the past 2 weeks (with a difference of 0.0393 visits). Among children having outpatient visits in the last 2 weeks, the probability of obtaining infusion was 57.01 percentage points higher for children whose parents used infusion in the past 2 weeks than the probability for those whose parents did not use infusion. The predicted number of inpatient visits was higher for children whose parents used inpatient services in the last year, compared with the group whose parents did not use (with a difference of 0.0567 visits). Moreover, we noted that the positive association between parental and

  12. Co-morbidities of vertiginous diseases.

    Science.gov (United States)

    Warninghoff, Jan C; Bayer, Otmar; Ferrari, Uta; Straube, Andreas

    2009-07-07

    Co-morbidities of vertiginous diseases have so far not been investigated systematically. Thus, it is still unclear whether the different vertigo syndromes (e.g. benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), vestibular migraine and phobic vertigo (PPV)) have also different spectrums of co-morbidities. All patients from a cohort of 131 participants were surveyed using a standardised questionnaire about the co-morbidities hypertension, diabetes mellitus, BMI (body mass index), migraine, other headache, and psychiatric diseases in general and the likelihood of a depression in particular. We noted hypertension in 29.0% of the cohort, diabetes mellitus in 6.1%, migraine in 8.4%, other headache in 32.1%, psychiatric diseases in 16.0%, overweight and obesity in 33.6% and 13.7% respectively, as well as a clinical indication for depression in 15.9%. In general, we did not detect an increased prevalence of the co-morbidities diabetes mellitus, arterial hypertension, migraine, other headache and obesity compared to the general population. There was an increased prevalence of psychiatric co-morbidity in patients with PPV, and the prevalence of hypertension was elevated in patients with MD.

  13. Co-morbidities of vertiginous diseases

    Directory of Open Access Journals (Sweden)

    Ferrari Uta

    2009-07-01

    Full Text Available Abstract Background Co-morbidities of vertiginous diseases have so far not been investigated systematically. Thus, it is still unclear whether the different vertigo syndromes (e.g. benign paroxysmal positional vertigo (BPPV, Meniere's disease (MD, vestibular migraine and phobic vertigo (PPV have also different spectrums of co-morbidities. Methods All patients from a cohort of 131 participants were surveyed using a standardised questionnaire about the co-morbidities hypertension, diabetes mellitus, BMI (body mass index, migraine, other headache, and psychiatric diseases in general and the likelihood of a depression in particular. Results We noted hypertension in 29.0% of the cohort, diabetes mellitus in 6.1%, migraine in 8.4%, other headache in 32.1%, psychiatric diseases in 16.0%, overweight and obesity in 33.6% and 13.7% respectively, as well as a clinical indication for depression in 15.9%. Conclusion In general, we did not detect an increased prevalence of the co-morbidities diabetes mellitus, arterial hypertension, migraine, other headache and obesity compared to the general population. There was an increased prevalence of psychiatric co-morbidity in patients with PPV, and the prevalence of hypertension was elevated in patients with MD.

  14. Morbidity ranking of U.S. workers employed in 206 occupations: the National Health Interview Survey (NHIS) 1986-1994.

    Science.gov (United States)

    Lee, David J; Fleming, Lora E; Gómez-Marín, Orlando; LeBlanc, William G; Arheart, Kristopher L; Caban, Alberto J; Christ, Sharon L; Chung-Bridges, Katherine; Pitman, Terry

    2006-02-01

    The objective of this study was to rank U.S. occupations by worker morbidity. From 1986 through 1994, morbidity information was collected on over 410,000 U.S. workers who participated in the National Health Interview Survey, an annual household survey representative of the U.S. civilian noninstitutionalized population. A multivariate adjusted logistic regression morbidity summary score was created for each worker group based on seven indicators: days of restricted activity, bedrest, and missed work in the previous 2 weeks; doctor visits and hospitalizations in the previous 12 months; reported health conditions; and health status. Worker groups reporting the greatest morbidity included social workers, inspectors, postal clerks, psychologists, and grinding machine operators; worker groups reporting the least morbidity included dentists, pilots, physicians, pharmacists, and dietitians. These findings aid in the identification of worker groups that require increased attention for morbidity research and prevention.

  15. The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns.

    Science.gov (United States)

    Kahvecioglu, Dilek; Erdeve, Omer; Alan, Serdar; Cakir, Ufuk; Yildiz, Duran; Atasay, Begum; Arsan, Saadet

    2014-11-01

    Almost 95% of the platelet transfusions (PTs) conducted in the neonatal intensive care unit (NICU) are prophylactic transfusions. Guidelines for prophylactic PTs are based on platelet counts, but not on platelet functions. Nowadays, in order to reduce unnecessary transfusions, utilizing platelet mass index (PMI) was investigated. The aim of study is to find out whether PTs performed in our NICU during last 2 years were in accordance with the current guideline and to evaluate whether the frequency of PTs should be reduced if PMI was considered. Forty-three infants who received 96 prophylactic PTs were enrolled in the study. The guideline utilized in our NICU advocate keeping the platelet count: (a) >100 000 in pre/post-operative, (b) >50 000 in unstable and (c) >20 000 in stable patients. According to PMI criteria, PT should be performed if PMI: (a) platelet functions into account may yield lower transfusion rate, lower costs and better conservation of blood bank resources.

  16. The 'cultural inflation of morbidity' during the English mortality decline: a new look.

    Science.gov (United States)

    Gorsky, Martin; Guntupalli, Aravinda; Harris, Bernard; Hinde, Andrew

    2011-12-01

    This article contributes to the debate about using insurance records to reconstruct historical experiences of sickness during the Western mortality transition. Critics regard these sources as problematic as they measure morbidity indirectly through absences from work; these might be determined not by timeless biological criteria but by more contingent factors, notably shifting norms surrounding the sick role and responses to economic incentives (for which we adopt the generic term 'cultural inflation of morbidity'). We review historical demographers' contributions to this literature and discuss the concepts of moral hazard and the principal/agent problem as developed by health economists. This leads us to frame three empirical tests for 'cultural inflation' which allow us to assess the validity of insurance records for deriving morbidity trends: was there an increasing frequency of claims for complaints of diminishing severity; were unduly prolonged claims noticeable, particularly by older people for whom sickness benefit may have compensated for income insecurity; and did the insurer satisfactorily manage the agency problem to ensure reliable physician gatekeeping? We analyse records of the Hampshire Friendly Society, an exceptionally well-documented fund operational in Southern England, 1825-1989. Findings are based on a dataset of individual sickness histories of a sample of 5552 men and on qualitative documentary analysis of administrative records. On each count our results fail to demonstrate a cultural inflation of morbidity, except perhaps for those aged over 65. However, occasional discussion in the administrative records of economic incentives encouraging unnecessary prolongation of claims means we cannot rule it out entirely. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Lymphoscintigraphy and triangulated body marking for morbidity reduction during sentinel node biopsy in breast cancer.

    Science.gov (United States)

    Krynyckyi, Borys R; Shafir, Michail K; Kim, Suk Chul; Kim, Dong Wook; Travis, Arlene; Moadel, Renee M; Kim, Chun K

    2005-11-08

    Current trends in patient care include the desire for minimizing invasiveness of procedures and interventions. This aim is reflected in the increasing utilization of sentinel lymph node biopsy, which results in a lower level of morbidity in breast cancer staging, in comparison to extensive conventional axillary dissection. Optimized lymphoscintigraphy with triangulated body marking is a clinical option that can further reduce morbidity, more than when a hand held gamma probe alone is utilized. Unfortunately it is often either overlooked or not fully understood, and thus not utilized. This results in the unnecessary loss of an opportunity to further reduce morbidity. Optimized lymphoscintigraphy and triangulated body marking provides a detailed 3 dimensional map of the number and location of the sentinel nodes, available before the first incision is made. The number, location, relevance based on time/sequence of appearance of the nodes, all can influence 1) where the incision is made, 2) how extensive the dissection is, and 3) how many nodes are removed. In addition, complex patterns can arise from injections. These include prominent lymphatic channels, pseudo-sentinel nodes, echelon and reverse echelon nodes and even contamination, which are much more difficult to access with the probe only. With the detailed information provided by optimized lymphoscintigraphy and triangulated body marking, the surgeon can approach the axilla in a more enlightened fashion, in contrast to when the less informed probe only method is used. This allows for better planning, resulting in the best cosmetic effect and less trauma to the tissues, further reducing morbidity while maintaining adequate sampling of the sentinel node(s).

  18. Taiwan experience suggests that RhD typing for blood transfusion is unnecessary in southeast Asian populations.

    Science.gov (United States)

    Lin, Marie

    2006-01-01

    The high frequency of RhD (D) antigen among Taiwanese persons (99.67%) often imposes unnecessary risks of under-transfusion on D- patients awaiting D- blood. Also because of the rare occurrence of anti-D among Taiwanese persons, routine pretransfusion D typing has been discontinued in the Mackay Memorial Hospital since 1988. This report is the retrospective evaluation of the outcome of abolishing RhD typing for Taiwanese. More than 10 years of alloantibody data at Mackay Memorial Hospital Blood Bank were reviewed. The cases with anti-D were further used to analyze the potency of D antigen and to observe whether there were differences in the incidence of anti-D before and after discontinuation of routine D typing among Taiwanese individuals. The incidence of anti-D before and after discontinuation of routine pretransfusion D typing has remained unchanged. The immunogenicity of D and "Mi(a)" in Taiwanese persons is found to be similar. In terms of opportunity for immunization, however, the "Mi(a)" antigen (phenotype frequency 7.3% in Taiwanese persons) has become the most important blood group antigen in Taiwan. The results strongly support the exclusion of D typing from routine compatibility testing for individuals of Taiwanese origin. Because the low incidence of D- and relatively high incidence of "Mi(a)"+ phenotypes are common findings throughout southeast Asia, and because a population genetic study revealed that the Taiwanese people are genetically related to southern Asian populations, it is suggested that RhD typing for blood transfusion is unnecessary among southeast Asian populations.

  19. Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

    Science.gov (United States)

    Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

    2018-03-01

    Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

  20. Author response to letter. Ref: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

    Science.gov (United States)

    Madsen, Ida Eh; Rugulies, Reiner

    2015-03-01

    We read with interest the letter from Drs Durand-Moreau, Loddé, and Dewitte (1) regarding our article on unnecessary work tasks and mental health (2). The authors argue that: (i) the article is flawed by an imprecise one-item exposure measurement, (ii) the results may be affected by reverse causality, and (iii) ultimately the elimination of unnecessary work tasks may increase "psychic suffering". We would like to take this opportunity to address their concerns. We acknowledge, as we did in the article itself, that measuring unnecessary work tasks using only one item is less than ideal and could have increased measurement error in our analyses. The item we used to measure unnecessary work tasks assesses the employee's overall evaluation regarding the extent to which they must conduct work tasks that they, for whatever reason, deem unnecessary. We are unconvinced by the claim by Drs Durand-Moreau, Loddé, and Dewitte that this phenomenon is somehow unrelated to Semmer's definition of unnecessary tasks (3, 4), regardless of the sense-making processes underlying an individual employee's evaluation of a particular work task as unnecessary. Regarding the issue of reverse causality, the analyses were longitudinal and the effect estimates were adjusted for the baseline mental health level of the participants. Consequently, we examined changes in mental health over time, and our results cannot be explained by poorer mental health making workers think "that what they're doing is useless" as claimed in the commentary. Although causal inference is always a delicate issue when applying observational research methods, the adjustment for baseline mental health should account for reverse causality at least. Drs Durand-Moreau, Loddé, and Dewitte question that our findings suggest that the elimination of unnecessary work tasks may be beneficial to employee mental health. Instead they propose that unnecessary work tasks may be conducive to mental health because "some tasks may seem

  1. Ocular morbidity among children attending government and private schools of Kathmandu valley.

    Science.gov (United States)

    Shrestha, R K; Joshi, M R; Ghising, R; Rizyal, A

    2011-01-01

    Children from the developing world are more prone to going blind from avoidable and preventable causes. In Nepal, children in private schools are reported to have a higher ocular morbidity than those in government schools, with myopia being the major cause of the morbidity. This study was designed to evaluate ocular morbidity in students from both types of school. This was a cross-sectional, comparative study among students from government and private schools of Kathmandu. Eye examination was carried out evaluating visual acuity, color vision, refractive status, binocular vision status, and anterior and posterior segment findings. A total of 4,228 students from government and private schools were evaluated. The prevalence of ocular morbidity was 19.56 % with refractive error (11.9 %) being the major cause of the morbidity, followed by strabismus and infective disorders. No significant difference in the prevalence of ocular morbidity and refractive status was found in the students from government and private schools. A significant number of children of school-going age have ocular morbidity with no significant difference in the prevalence in the students from government and private schools. Research exploring the effect of various risk factors in the progression of myopia would be helpful to investigate the refractive status in children from these different types of schools.

  2. Co-morbidities in severe asthma

    DEFF Research Database (Denmark)

    Porsbjerg, Celeste; Menzies-Gow, Andrew

    2017-01-01

    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...

  3. Explaining excess morbidity amongst homeless shelter users

    DEFF Research Database (Denmark)

    Benjaminsen, Lars; Birkelund, Jesper Fels

    2018-01-01

    AIMS: This article analyses excess morbidity amongst homeless shelter users compared to the general Danish population. The study provides an extensive control for confounding and investigates to what extent excess morbidity is explained by homelessness or other risk factors. METHODS: Data set...... includes administrative micro-data for 4,068,926 Danes who were 23 years or older on 1 January 2007. Nationwide data on shelter use identified 14,730 individuals as shelter users from 2002 to 2006. Somatic diseases were measured from 2007 to 2011 through diagnosis data from hospital discharges. The risk...... of somatic diseases amongst shelter users was analysed through a multivariate model that decomposed the total effect into a direct effect and indirect effects mediated by other risk factors. RESULTS: The excess morbidity associated with shelter use is substantially lower than in studies that did not include...

  4. Thromboxane production in morbidly obese subjects.

    Science.gov (United States)

    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 lean subjects (hs-CRP, p lean subjects (p 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.

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

    Science.gov (United States)

    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.

  6. Prevention of COPD exacerbations

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Lange, Peter

    2015-01-01

    Exacerbations have significant impact on the morbidity and mortality of patients with chronic obstructive pulmonary disease. Most guidelines emphasise prevention of exacerbations by treatment with long-acting bronchodilators and/or anti-inflammatory drugs. Whereas most of this treatment is eviden...

  7. Early prevention of obesity

    OpenAIRE

    Claudio Maffeis

    2014-01-01

    Childhood obesity is the metabolic disorder with the highest prevalence in both children and adults. Urgency to treat and prevent childhood obesity is based on the clear evidence that obesity tends to track from childhood to adulthood, is associated to morbidity also in childhood and to long-term mortality. Early life, i.e., intrauterine life and the first two years, is a sensitive window for prevention. Anatomical and functional maturation of the hypothalamic structures devoted to regulating...

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

    Science.gov (United States)

    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 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

  9. Prevalence of reproductive morbidity amongst males in an urban slum of north India

    Directory of Open Access Journals (Sweden)

    Uppal Y

    2007-01-01

    Full Text Available Background: Studies assessing the prevalence of reproductive morbidity among males in India have chiefly focused on prevalence of Reproductive Tract Infections/Sexually Transmitted Infections (RTIs/STIs among males attending Sexually Transmitted Disease clinics, blood donors and other selected population groups, with only few focused on the magnitude and the type of reproductive morbidity amongst Indian males at community level. Objective: To estimate prevalence of reproductive morbidity including (RTIs/STIs among males in the age group of 20-50 years residing in an urban slum of Delhi. Methods: Out of 268 males in the targeted age group, selected by systematic random sampling, residing in an urban sum of Delhi, 260 males were subjected to clinical examination and laboratory investigations for diagnosis of reproductive morbidity. Laboratory investigations were done for diagnosis of Hepatitis B and C, Syphilis, Gonorrhoea, Non gonococcal urethritis and urinary tract infection. Results: A total of 90 (33.6% of 268 study subjects reported one or more perceived symptoms of reproductive tract / sexual morbidity in last six months. Overall reproductive morbidity based on clinical and laboratory diagnosis was present in 76 (29.2% study subjects and of this sexually acquired morbidity accounted for 21.2% cases. Hepatitis B was most common (10.3% reproductive morbidity followed by Urinary Tract Infection (5.0%, scabies (3.5% and congenital anomalies (3.5%. Conclusion: High prevalence of reproductive morbidity (29.2% amongst males in an urban slum highlights the need for more studies in different settings. There is a need for developing interventions in terms of early diagnosis and treatment and prevention.

  10. PPO.02 Severe maternal morbidity in Ireland

    NARCIS (Netherlands)

    Manning, E.; Lutomski, J.E.; O'Connor, L.; Corcoran, P.; Greene, R.

    2014-01-01

    OBJECTIVE: To assess the incidence of severe maternal morbidity (SMM) and examine associated factors in Ireland. METHODS: In 2011, 67,806 maternities were reported from 19 maternity units, representing 93% of maternities in Ireland. SMM was classified as the presence of one or more of 15 categories

  11. Childhood respiratory morbidity and cooking practices among ...

    African Journals Online (AJOL)

    Background: Household air pollution is a leading risk factor for respiratory morbidity and mortality in developing countries where biomass fuel is mainly used for cooking. Materials and Method: A household cross-sectional survey was conducted in a predominantly rural area of Ghana in 2007 to determine the prevalence of ...

  12. Neonatal morbidity associated with shoulder dystocia maneuvers.

    Science.gov (United States)

    Spain, Janine E; Frey, Heather A; Tuuli, Methodius G; Colvin, Ryan; Macones, George A; Cahill, Alison G

    2015-03-01

    We sought to examine neonatal morbidity associated with different maneuvers used among term patients who experience a shoulder dystocia. We conducted a retrospective cohort study of all women who experienced a clinically diagnosed shoulder dystocia at term requiring obstetric maneuvers at a single tertiary care hospital from 2005 through 2008. We excluded women with major fetal anomaly, intrauterine death, multiple gestation, and preterm. Women exposed to Rubin maneuver, Wood's screw maneuver, or delivery of the posterior arm were compared to women delivered by McRoberts/suprapubic pressure only, which served as the reference group. The primary outcome was a composite morbidity of neonatal injury (defined as clavicular or humeral fracture or brachial plexus injury) and neonatal depression (defined as Apgar dystocia, defined as time from delivery of fetal head to delivery of shoulders. Among the 231 women who met inclusion criteria, 135 were delivered by McRoberts/suprapubic pressure alone (57.9%), 83 women were exposed to Rubin maneuver, 53 women were exposed to Wood's screw, and 36 women were exposed to delivery of posterior arm. Individual maneuvers were not associated with composite morbidity, neonatal injury, or neonatal depression after adjusting for nulliparity and duration of shoulder dystocia. We found no association between shoulder dystocia maneuvers and neonatal morbidity after adjusting for duration, a surrogate for severity. Our results demonstrate that clinicians should utilize the maneuver most likely to result in successful delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Morbidity and Infant Development: A Hypothesis.

    Science.gov (United States)

    Pollitt, Ernesto

    1983-01-01

    Results of a study conducted in 14 villages of Sui Lin Township, Taiwan, suggest the hypothesis that, under conditions of extreme economic impoverishment and among children within populations where energy protein malnutrition is endemic, there is an inverse relationship between incidence of morbidity in infancy and measures of motor and mental…

  14. Sexual Activity and Urological Morbidities Among Nigerian ...

    African Journals Online (AJOL)

    factors, quality of information at their disposal as well as economic factors.[3] Studies have shown a wide range of opinion of women on the interpretation of menopause, associated morbidities and possible intervention to cope with the state.[4,5] Sexual activity during menopause has been reported with conflicting results.

  15. Endovascular Interventions for the Morbidly Adherent Placenta

    Directory of Open Access Journals (Sweden)

    Claire Kaufman

    2018-05-01

    Full Text Available Morbidly adherent placentas are a spectrum of abnormalities ranging from placental invasion of the myometrium to invasion past the myometrium and muscular layers into adjacent structures. This entity is becoming more prevalent recently with increased number of cesarean deliveries. Given the high risk of morbidity and mortality, this was traditionally treated with pre-term planned cesarean hysterectomy. However, recently, uterine preservation techniques have been implemented for those women wishing to preserve future fertility or their uterus. Early identification is crucial as studies have shown better outcomes for women treated at tertiary care facilities by a dedicated multidisciplinary team. Interventional radiologists are frequently included in the care of these patients as there are several different endovascular techniques which can be implemented to decrease morbidity in these patients both in conjunction with cesarean hysterectomy and in the setting of uterine preservation. This article will review the spectrum of morbidly adherent placentas, imaging, as well as the surgical and endovascular interventions implemented in the care of these complex patients.

  16. General morbidity prevalence in the Delhi slums

    Directory of Open Access Journals (Sweden)

    Marimuthu P

    2009-01-01

    Full Text Available Research Question: What is the sickness prevalence in the slums of a metropolitan city? Objectives: To estimate the morbidity prevalence with reference to a socio-economic and demographic perspective of the slum population of Delhi. Study Design: A cross-sectional study was conducted and data were collected by a two-stage random sampling method. In the first stage, slum locations were selected and in the second stage households were selected. Participants: Data were collected from 1049 households consisting of 5358 individuals′ information. Results: The overall morbidity prevalence is 15.4%. It is 14.7 and 16.3% for males and females, respectively but the differences are not statistically significant. The reported higher morbidity prevalence and the illiteracy status are significantly associated. Diseases of the respiratory system appear to be very high among slum dwellers. Conclusion: From this study, it can be concluded that the number of years of staying in the slum area, presence of a separate kitchen, type of house, it being Pucca or Kuccha, types of toilet pits or open defecation are the important environmental factors for the reports of higher morbidity patterns from the slum area.

  17. Women's experience of maternal morbidity: a qualitative analysis.

    LENUS (Irish Health Repository)

    Meaney, S

    2016-07-01

    Maternal morbidity refers to pregnancy-related complications, ranging in severity from acute to chronic. In Ireland one in 210 maternities will experience a severe morbidity. Yet, how women internalize their experience of morbidity has gone largely unexplored. This study aimed to explore women\\'s experiences of maternal morbidity.

  18. Myocardial infarction and other co-morbidities in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Dahl, Morten; Nordestgaard, Børge G

    2011-01-01

    Myocardial infarction is nominally the most important co-morbidity in patients with chronic obstructive pulmonary disease, and the one with the greatest potential for treatment and prevention to improve the overall prognosis of chronic obstructive pulmonary disease patients. We assessed the extent...

  19. Major decline in malaria morbidity and mortality in the Union of ...

    African Journals Online (AJOL)

    Major decline in malaria morbidity and mortality in the Union of Comoros between 2010 and 2014: The effect of a combination of prevention and control ... malaria incidence and case fatality rates for all age groups, including under-5 children and pregnant women, were analysed using Microsoft Excel and SPSS version 16.

  20. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  1. The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain.

    Science.gov (United States)

    Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun

    2018-06-01

    The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.

  2. Cardiovascular morbidity and mortality risk factors in peritoneal dialysis patients

    Directory of Open Access Journals (Sweden)

    Jovanović Dijana B.

    2008-01-01

    Full Text Available Cardiovascular (CVS morbidity and mortality in the endstage renal disease (ESRD patients on peritoneal dialysis therapy is 10-30 folds higher than in general population. The prevalence of well known traditional risk factors such as age, sex, race, arterial hypertension, hyperlipidaemia, diabetes, smoking, physical inactivity is higher in the uraemic patients. Besides these, there are specific, nontraditional risk factors for dialysis patients. Mild inflammation present in peritoneal dialysis (PD patients which can be confirmed by specific inflammatory markers is the cause of CVS morbidity and mortality in these patients. Hypoalbuminaemia, hyperhomocysteinaemia and a higher level of leptin are important predictors of vascular complications as well as CVS events in the PD patients. Plasma norepinephrine, an indicator of sympathetic activity, is high in the ESRD patients and higher in the PD patients than in the patients on haemodialysis (HD. Therefore, norepinephrine may be a stronger risk factor in the PD patients. The same applies to asymmetric dimethylargine (ADMA, an endogenous inhibitor of nitric oxide synthase, which is an important risk factor of CVS morbidity and mortality 15 % higher in the PD than the HD patients. Hyperphosphataemia, secondary hyperparathyroidism and high calcium x phosphate product have been associated with the progression of the coronary artery calcification and valvular calcifications and predict all-cause CVS mortality in the PD patients. Residual renal function (RRF declines with time on dialysis but is slower in the PD than the HD patients. RRF decline is associated with the rise of proinflammatory cytokines and the onset of hypervolaemia and hypertension which increase the risk of CVS diseases, mortality in general and CVS mortality. In conclusion, it is very important to establish all CVS risk factors in the PD patients to prevent CVS diseases and CVS mortality in this population.

  3. Selecting K compatible blood components for transfusion can prevent anti-K immunization in women of childbearing age.

    Directory of Open Access Journals (Sweden)

    Andreja Hrašovec-Lampret

    2016-07-01

    Full Text Available With selecting K compatible blood for transfusion, we prevent K immunization and many unnecessary prenatal testing and gynecological examinations for at least 78% of pregnant women with K negative partners, whose fetus is not at risk of hemolytic disease of fetus and newborn. Abstract  Background Kell antibodies are beside RhD and c antibodies one of most clinically important antibodies that can cause severe hemolytic disease of the fetus and newborn (HDFN in pregnancy,which is still remaining one of the major causes of perinatal morbidity and mortality. Therefore, pregnant women with eryhrocyte alloantibodies anti-K need many prenatal testing and gynecological examinations. The major cause for anti-K immunisation is transfusion of incompatible blood in the past.    Methods We analysed retrospectively the data of 71 pregnant woman with alloantibodies anti-K, which were followed in Blood Transfusion Centre of Slovenia from 2004 -2014. We collected data of partner´s phenotype and woman´s transfusion history. Data were statistically analyzed with basic statistical methods.   Results 61 out of 71 partners were tested (86% and 48 were K negative (78%.The transfusion history was available for only 23 women (32%. The transfusion history was available for 23 out of 48 women with K negative partner (48%. All of them were transfused. 78% received incompatible-K positive blood, for the rest 22% women donations they received were not K typed.    Conclusions From the obtained data, we found that in 78% of cases cause for K alloimunnization is transfusion of K incompatible blood in past. With selecting K compatible blood for transfusion, we can prevent K immunization and many unnecessary prenatal testing and gynecological examinations for 78% pregnant women with K negative partners . 

  4. Reduction in unnecessary red blood cell folate testing by restricting computerized physician order entry in the electronic health record.

    Science.gov (United States)

    MacMillan, Thomas E; Gudgeon, Patrick; Yip, Paul M; Cavalcanti, Rodrigo B

    2018-05-02

    Red blood cell folate is a laboratory test with limited clinical utility. Previous attempts to reduce physician ordering of unnecessary laboratory tests, including folate, have resulted in only modest success. The objective of this study was to assess the effectiveness and impacts of restricting red blood cell folate ordering in the electronic health record. This was a retrospective observational study from January 2010 to December 2016 at a large academic healthcare network in Toronto, Canada. All inpatients and outpatients who underwent at least 1 red blood cell folate or vitamin B12 test during the study period were included. Red blood cell folate ordering was restricted to clincians in gastroenterology and hematology and was removed from other physicians' computerized order entry screen in the electronic health record in June 2013. Red blood cell folate testing decreased by 94.4% during the study, from a mean of 493.0 (SD 48.0) tests/month before intervention to 27.6 (SD 10.3) tests/month after intervention (P<.001). Restricting red blood cell folate ordering in the electronic health record resulted in a large and sustained reduction in red blood cell folate testing. Significant cost savings estimated at over a quarter-million dollars (CAD) over three years were achieved. There was no significant clinical impact of the intervention on the diagnosis of folate deficiency. Copyright © 2018. Published by Elsevier Inc.

  5. Health hazard of the Tokai mura nuclear accident. Unnecessary fear and improper health checks should be eliminated

    International Nuclear Information System (INIS)

    Takebe, Hiraku

    2000-01-01

    Three workers were heavily exposed to radiations in the Tokai mura nuclear accident, and one of them died due to the acute effects of radiations. Doses for the heavily exposed persons were estimated to be 2.5, 10 and 18 Sv, according to the Science and Technology Agency. Workers who tried to stop the chain reaction by breaking the water pipe were estimated to have been exposed up to 120 mSv. Possible doses for other workers and residents in the neighborhoods were estimated to be less than 10 mSv, with a few workers with slightly higher film badge records. After the accident, many reports in mass-media warned that the exposed persons may develop cancers and leukemias in future and follow-up healthcare should be needed. Judging from our knowledge of the extensive epidemiological survey of the atomic bomb survivors in Hiroshima and Nagasaki, these reports are very misleading. There would be absolutely no or extremely small possibility of developing any health hazard among the workers and the residents except for the three unfortunate heavily exposed workers. If so-called follow-up health checks would involve x-ray diagnosis for cancers, the radiation doses by the diagnosis would exceed the exposure by the accident. Also, the test for the DNA damage applied to some workers and residents is not reliable at all, and could cause unnecessary fear among the persons who were mistakingly said to be of high-risk. (author)

  6. Liver AMP-Activated Protein Kinase Is Unnecessary for Gluconeogenesis but Protects Energy State during Nutrient Deprivation.

    Directory of Open Access Journals (Sweden)

    Clinton M Hasenour

    Full Text Available AMPK is an energy sensor that protects cellular energy state by attenuating anabolic and promoting catabolic processes. AMPK signaling is purported to regulate hepatic gluconeogenesis and substrate oxidation; coordination of these processes is vital during nutrient deprivation or pathogenic during overnutrition. Here we directly test hepatic AMPK function in regulating metabolic fluxes that converge to produce glucose and energy in vivo. Flux analysis was applied in mice with a liver-specific deletion of AMPK (L-KO or floxed control littermates to assess rates of hepatic glucose producing and citric acid cycle (CAC fluxes. Fluxes were assessed in short and long term fasted mice; the latter condition is a nutrient stressor that increases liver AMP/ATP. The flux circuit connecting anaplerosis with gluconeogenesis from the CAC was unaffected by hepatic AMPK deletion in short and long term fasting. Nevertheless, depletion of hepatic ATP was exacerbated in L-KO mice, corresponding to a relative elevation in citrate synthase flux and accumulation of branched-chain amino acid-related metabolites. L-KO mice also had a physiological reduction in flux from glycogen to G6P. These results demonstrate AMPK is unnecessary for maintaining gluconeogenic flux from the CAC yet is critical for stabilizing liver energy state during nutrient deprivation.

  7. Cardiac morbidity risk and depression and anxiety

    DEFF Research Database (Denmark)

    Tully, Phillip J; Pedersen, Susanne S.; Winefield, Helen R

    2011-01-01

    The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity....... Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom.......3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted...

  8. Leukaemia mortality and morbidity in Bavaria

    International Nuclear Information System (INIS)

    Grosche, B.; Hinz, G.; Tsavachidis, C.

    1987-01-01

    Two studies dealing with leukaemia in Bavaria/FRG are presented: a mortality study (1972-1978) and a morbidity study (1976-1981). Both were conducted as ecological studies, i.e. under inclusion of environmental factors. Major point of view is first the amount of natural background radiation and second the sites of nuclear reactors, which are six. Mortality and incidence is described. Calculations were made on the influence of migration on patterns of regional distribution. (author)

  9. [Employment during pregnancy and neonatal morbidity].

    Science.gov (United States)

    Fricker, H S; Bruppacher, R

    1984-01-01

    Neonatal morbidity was higher among the babies of 521 women who were gainfully employed during pregnancy compared to those of 475 non working women of the same area (Aarau, Switzerland). The difference was lower (6%) in the part time employed than in those working full time (11%.) It was almost entirely due to the higher number of primiparae and of smokers among those women who were working during pregnancy.

  10. Extrahepatic biliary obstruction; postoperative morbidity and mortality

    International Nuclear Information System (INIS)

    Hussain, Z.; Khan, K.I.; Vaseem, M.; Rana, S.H.

    2010-01-01

    The objectives of this study are to evaluate the surgical management, both definitive and palliative, in selected patients with biliary obstruction and to find out the postoperative morbidity and mortality in these patients. Duration of the study is two years conducted from June 2002 to May 2004. The study was carried out at. the surgical. unit 4 of the Combined Military Hospital and surgical department of the Military Hospital. Thirty eight cases of biliary obstruction were included. A convenient sampling technique was followed. Data analyzed by using SPSS version 10.0 for windows on computer. Descriptive statistics like frequency, percentage, average etc were computed for data presentation. Any inferential test-was not found to be applicable for this descriptive type case series. We selected 38 patients with features of extrahepatic biliary obstruction. Out of these (n 38) 15 patients (39.5%) suffered from benign diseases while those having malignant diseases were 23 (60.5%). 19 (50%) patients died within two years of follow up while 19 (50%) were the survivors. Mortality was maximum for the malignant cases. In benign cases only one patient died. Maximum deaths 6 (31.6%) occurred in the period of up to one month of operation. 20 patients had one or another complication of operation and hence the morbidity came out to be 52%. According to our results the mortality and morbidity related to extrahepatic biliary obstruction in our patients was higher compared to other studies which can only be reduced by early detection and treatment. (author)

  11. Morbidity follow-up feasibility study

    International Nuclear Information System (INIS)

    Carpenter, M.

    1988-02-01

    The report reviews the available sources of data within Canada for undertaking morbidity follow-up studies to both supplement and complement studies using Canadian mortality data. Such studies would permit earlier detection and more sensitive measures of differences in risk for exposures to radiation and allow timely measures to be taken to minimize any occupational and environmental health risk to radiation workers. The technical feasibility of using these sources was reviewed using the criteria of adequate personal identifying information, automation of data records, file size and the accuracy of the morbidity diagnosis information. At the present time certain of the provincial cancer registry files meet these criteria best. A work plan was prepared suggesting a morbidity pilot study to clarify the role of occupational factors in the incidence of cancer among radiation workers using the Alberta Cancer Registry file and the National Dose Registry (NDR) file of radiation workers. For the longer term a full cohort study using the National Cancer Incidence Reporting System (NCIRS) and the NDR workers as the study population would provide information on all radiation workers on a national basis. A work plan was prepared and some initial format conversion of historical data was undertaken to begin developing the NCIRS into a data base suitable for long-term health studies

  12. Prostatic cancer: intolerance and morbidity of external radiotherapy

    International Nuclear Information System (INIS)

    Douchez, J.; Fregevu, Y.; Allain, Y.M.; Cellier, P.; Fenton, J.; Hay, M.; Le Bourgeois, J.P.; Vincent, F.

    1985-01-01

    The pertherapeutic intolerance and morbidity are analyzed in a groupe of 597 patients with localized prostatic carcinoma treated by definitive radiotherapy between 1975 and 1982. Minimum follow-up is 2 years, median is 46 months. The results are compared to following parameters: associated diseases, associated surgical treatments, doses and irradiated target volumes. Pertherapeutic intolerance manifestations were found in 73% of patients and lead to complications. Urinary incontinence and chronic cystitis were more frequent after transurethral resection or prostatic target volume and by split course irradiation. Chronic diarrhea was more frequent when using large target volume. Leg edema was closely associated with pelvic lymphadenectomy. The control of pertherapeutic manifestations and the prevention of complications should improve survival in patients treated by external radiotherapy [fr

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

    Science.gov (United States)

    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.

  14. MRI-only lesions: application of diffusion-weighted imaging obviates unnecessary MR-guided breast biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio; Pinker-Domenig, Katja; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna (AKH), General Hospital Vienna, Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Wien (Austria); Rudas, Margaretha [Medical University of Vienna (AKH), Clinical Institute of Pathology, Wien (Austria)

    2014-06-15

    To assess if the application of diffusion-weighted imaging (DWI) obviates unnecessary MR-guided biopsies in suspicious breast lesions visible only on contrast-enhanced MRI (CE-MRI). This institutional review board (IRB)-approved, retrospective, single-centre study included 101 patients (mean age, 49.5; SD 13.9 years) who underwent additional DWI at 1.5 T prior to MRI-guided biopsy of 104 lesions classified as suspicious for malignancy and visible on CE-MRI only. An experienced radiologist, blinded to histopathologic and follow-up results, measured apparent diffusion coefficient (ADC) values obtained from DWI. Diagnostic accuracy was investigated using receiver operating characteristics (ROC) analysis. Histopathology revealed 20 malignant and 84 benign lesions. Lesions were masses in 61 (15 malignant, 24.6 %) and non-masses in 43 cases (five malignant, 11.6 %). Mean ADC values were 1.53 ± 0.38 x 10{sup -3} mm{sup 2}/s in benign lesions and 1.06 ± 0.27 x 10{sup -3} mm{sup 2}/s in malignant lesions. ROC analysis revealed exclusively benign lesions if ADC values were greater than 1.58 x 10{sup -3} mm{sup 2}/s. As a consequence, 29 false-positive biopsies (34.5 %) could have been avoided without any false-negative findings. Both in mass and in non-mass lesions, rule-in and rule-out criteria were identified using flexible ADC thresholds based on ROC analysis. Additional application of DWI in breast lesions visible only on MRI can avoid false-positive, MR-guided biopsies. Thus, DWI should be an integral part of breast MRI protocols. (orig.)

  15. High-Risk Breast Lesions: A Machine Learning Model to Predict Pathologic Upgrade and Reduce Unnecessary Surgical Excision.

    Science.gov (United States)

    Bahl, Manisha; Barzilay, Regina; Yedidia, Adam B; Locascio, Nicholas J; Yu, Lili; Lehman, Constance D

    2018-03-01

    Purpose To develop a machine learning model that allows high-risk breast lesions (HRLs) diagnosed with image-guided needle biopsy that require surgical excision to be distinguished from HRLs that are at low risk for upgrade to cancer at surgery and thus could be surveilled. Materials and Methods Consecutive patients with biopsy-proven HRLs who underwent surgery or at least 2 years of imaging follow-up from June 2006 to April 2015 were identified. A random forest machine learning model was developed to identify HRLs at low risk for upgrade to cancer. Traditional features such as age and HRL histologic results were used in the model, as were text features from the biopsy pathologic report. Results One thousand six HRLs were identified, with a cancer upgrade rate of 11.4% (115 of 1006). A machine learning random forest model was developed with 671 HRLs and tested with an independent set of 335 HRLs. Among the most important traditional features were age and HRL histologic results (eg, atypical ductal hyperplasia). An important text feature from the pathologic reports was "severely atypical." Instead of surgical excision of all HRLs, if those categorized with the model to be at low risk for upgrade were surveilled and the remainder were excised, then 97.4% (37 of 38) of malignancies would have been diagnosed at surgery, and 30.6% (91 of 297) of surgeries of benign lesions could have been avoided. Conclusion This study provides proof of concept that a machine learning model can be applied to predict the risk of upgrade of HRLs to cancer. Use of this model could decrease unnecessary surgery by nearly one-third and could help guide clinical decision making with regard to surveillance versus surgical excision of HRLs. © RSNA, 2017.

  16. Morbidity, including fatal morbidity, throughout life in men entering adult life as obese.

    Directory of Open Access Journals (Sweden)

    Esther Zimmermann

    Full Text Available BACKGROUND: The association between obesity in adults and excess morbidity and mortality is well established, but the health impact throughout adult life of being obese in early adulthood needs elucidation. We investigated somatic morbidity, including fatal morbidity, throughout adulthood in men starting adult life as obese. METHODS: Among 362,200 Danish young men, examined for military service between 1943 and 1977, all obese (defined as BMI≥31.0 kg/m(2, and, as controls, a random 1% sample of the others was identified. In the age range of 18-25 years, there were 1,862 obese, which encompass the men above the 99.5 percentile, and 3,476 controls. Information on morbidity was obtained via national registers. Cox regression models were used to estimate the relative morbidity assessed as first incidence of disease, occurrence of disease in the year preceding death and prevalent disease at time of death. RESULTS: From age 18 through 80 years the obese had an increased risk of becoming diseased by or die from a broad range of diseases. Generally, the incidence of first event, occurrence in the year prior to death, and prevalence at time of death showed the same pattern. As an example, the relative hazard of type 2 diabetes was constant throughout life at 4.9 (95% confidence intervals [CI]: 4.1-5.9, 5.2 (95% CI: 3.6-7.5, and 6.8 (95% CI: 4.6-10.1, respectively. CONCLUSIONS: Our findings strongly support the continued need to avoid beginning adult life as obese, as obese young men experience an increased morbidity, including fatal morbidity, from many diseases throughout life.

  17. Assessment of anti-factor Xa activity of enoxaparin for venous thromboembolism prophylaxis in morbidly obese surgical patients

    Directory of Open Access Journals (Sweden)

    Nouf Al Otaib

    2017-01-01

    Conclusions: Weight-based enoxaparin dose led to the anticipated peak anti-Xa levels (0.2–0.6 IU/mL in most of the morbidly obese study patients undergoing surgery without any evidence of major side effects. The weight-based dosing of enoxaparin was also effective in preventing VTE in all patients. Although these results are promising, further comparative trials are needed in the setting of morbidly obese surgical patients.

  18. Colonoscopia: morbidade negligenciada Colonoscopy: neglected morbidity

    Directory of Open Access Journals (Sweden)

    Fernanda Bellotti Formiga

    2009-09-01

    Full Text Available OBJETIVO: Avaliar fatores de risco que determinam morbidade ao exame de colonoscopia. MÉTODOS: No período de março a junho de 2009 foram analisados prospectivamente 170 pacientes submetidos a exame colonoscópico. Fatores de risco como idade, sexo, indicação, exame ambulatorial/internado, efeitos adversos e qualidade do preparo intestinal, procedimento endoscópico, diagnóstico e intercorrência peri-procedimento foram relacionados. RESULTADOS: A média de idade da amostra foi 60,16 ± 14,69 anos, com predominância do sexo feminino. A indicação mais prevalente do exame foi seguimento pós-operatório. Três exames foram inconclusivos por mau preparo. Do restante, 36,53% foram normais e a maioria dos alterados apresentou pólipos, adenomatosos predominantemente. Quanto as comorbidades, 48,82% dos pacientes possuíam alguma comorbidade, sendo Hipertensão Arterial Sistêmica a mais prevalente. Apenas 22,94% dos pacientes apresentaram algum efeito adverso ao preparo. O preparo foi limpo em 65,88% dos exames, mostrando significância quando comparado a morbidade. Outro fator de significância estatística foi a realização de procedimentos (44,7% dos exames, sendo a maioria polipectomias. A morbidade chegou a 16,47%, sendo a desidratação a mais prevalente. Não houve mortalidade. CONCLUSÃO: A qualidade do preparo intestinal e a realização de procedimento endoscópico são fatores diretamente relacionados a morbidade do exame de colonoscopia.OBJECTIVE: The objective of this study is to analyze risks factors of morbidity on colonoscopy. METHOD: From March to June of 2009, 170 patients were examined and analyzed prospectively. Risks factors as age, sex, indication of exam, ambulatory or hospital exam, adverse events and quality of intestinal preparation, endoscopic procedure, diagnoses and incident before, during or after procedure were analyzed. RESULTS: The average age was 60,16±14,69 years old, with majority of female. The prevalent

  19. Co-morbidities of Interstitial Cystitis

    Directory of Open Access Journals (Sweden)

    Gisela eChelimsky

    2012-08-01

    Full Text Available Introduction: This study aimed to estimate the proportion of patients with Interstitial Cystitis/Painful Bladder Syndrome (IC/BPS with systemic dysfunction associated co-morbidities such as irritable bowel syndrome (IBS and fibromyalgia (FM. Material and Methods: Two groups of subjects with IC/BPS were included: 1 Physician diagnosed patients with IC/BPS and 2 Subjects meeting NIDDK IC/PBS criteria based on a questionnaire (ODYSA. These groups were compared to healthy controls matched for age and socio-economic status. NIDDK criteria required: pain with bladder filling that improves with emptying, urinary urgency due to discomfort or pain, polyuria > 11 times/24 hrs, and nocturia > 2 times/night. The ODYSA instrument evaluates symptoms pertaining to a range of disorders including chronic fatigue, orthostatic intolerance, syncope, IBS, dyspepsia, cyclic vomiting syndrome, headaches and migraines, sleep, Raynaud’s syndrome and chronic aches and pains. Results: IC/BPS was diagnosed in 26 subjects (mean age 47 +/- 16 yrs, 92% females, 58 had symptoms of IC/BPS by NIDDK criteria, (mean age 40 +/- 17 yrs, 79% females and 48 were healthy controls (mean age 31+/- 14 yrs, mean age 77%. Co-morbid complaints in the IC/BPS groups included gastrointestinal symptoms suggestive of IBS and dyspepsia, sleep abnormalities with delayed onset of sleep, feeling poorly refreshed in the morning, waking up before needed, snoring, severe chronic fatigue and chronic generalized pain, migraines and syncope. Discussion: Patients with IC/BPS had co-morbid central and autonomic nervous system disorders. Our findings mirror those of others in regard to IBS, symptoms suggestive of FM, chronic pain and migraine. High rates of syncope and functional dyspepsia found in the IC/BPS groups merit further study to determine if IC/BPS is part of a diffuse disorder of central, autonomic and sensory processing affecting multiple organs outside the bladder.

  20. Plasma fibronectin concentrations in morbidly obese patients

    DEFF Research Database (Denmark)

    Dejgaard, A; Andersen, T; Christoffersen, Pernille Yde

    1984-01-01

    Plasma fibronectin concentrations and liver morphology were investigated in 45 morbidly obese subjects (median overweight 88%) and in 42 normal weight controls, matched for sex and age. A significantly (P less than 0.01) raised plasma fibronectin concentration (median 464 mg/l, range 276-862 mg...... in their liver biopsies (r = 0.33, P less than 0.05). Significantly (P less than 0.05) elevated plasma fibronectin concentrations even in obese subjects without hepatic fatty change indicate that liver fat accumulation is no prerequisite of the obesity-related elevation of plasma fibronectin. Raised plasma...

  1. Morbidity and mortality of complex spine surgery

    DEFF Research Database (Denmark)

    Karstensen, Sven; Bari, Tanvir; Gehrchen, Martin

    2016-01-01

    requiring revision. METHODS: All patients undergoing spinal surgery at an academic tertiary referral center in the study period were prospectively included. The newest version of SAVES system was used, and a research coordinator collected all intraoperative and perioperative data prospectively. Once a week...... adverse events (AEs). PURPOSE: This study aimed to determine the mortality and examine the incidence of morbidity in patients undergoing complex spinal surgery, including pediatric patients, and to validate the SAVES system in a European population. STUDY DESIGN: A prospective, consecutive cohort study...

  2. STUDY ON PSYCHIATRIC CO - MORBIDITY IN PSORIASIS

    Directory of Open Access Journals (Sweden)

    Shrikant B.

    2015-06-01

    Full Text Available BACKGROUND: Psoriasis is relatively common , chronic inflammatory and hyper - proliferative skin disease that affects 1.4% to 2.0% of the population. Presence of itching , chronic recurrent course of disease and incomplete cure may contribute to great deal of psychiatric co - morbidity in these patients. the most persuasive indications of a link between stress and psoriasis comes from patients themselves , with studies illustrating that the majority of patients believe that stress or psychological distress is a factor in the manifestations of their condition . Depression and anxiety are the most common disorders that are associated with psoriasis , but the proportion of patient also having other psychiatric co - morbid diseases which include social phobia , generalize anxiety disorder , panic disorder , psychotic diso rder , etc. Moreover , symptoms of psoriasis , especially pruritus , are related to depression. OBJECTIVES : To evaluate different psychiatric illnesses their prevalence and severity in psoriasis patients. METHODOLOGY : This was cross - sectional observational stu dy comprised of 70 consecutive patients of psoriasis attending the out - patient department of Dermatology. All the patients were subjected to detailed examinations including the elicitation of dermatological and psychiatric profile after getting written con sent for study . Data was collected using self - developed , pre tested , semi structured Pro format by interview method. RESULTS : The profile of psychiatric diagnoses obtained in the present study depressive disorder 31.4% {18.57% depression , 12.85% Depression with anxiety symptoms} , anxiety disorder 25.7% (7.14% GAD , 8.17% panic disorder , 5.71% social phobia , 4.28 specific phobia. Severity of major depressive disorder was determined with HAM - D score 53.8% had mild depression , 30.7% moderate depression and 15. 5% severe depression. Similarly when HAM - A scale was used to determined severity of generalized

  3. Anaesthetic and Obstetric challenges of morbid obesity in ...

    African Journals Online (AJOL)

    Anaesthetic and Obstetric challenges of morbid obesity in caesarean ... in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. ... This mirrors a World Health Organisation report published in the World Health ...

  4. Ocular morbidity among porters at high altitudes.

    Science.gov (United States)

    Gnyawali, Subodh; Shrestha, Gauri Shankar; Khanal, Safal; Dennis, Talisa; Spencer, John C

    2017-01-01

    High altitude, often characterized by settings over 2400m, can be detrimental to the human body and pose a significant risk to ocular health. Reports concerning various ocular morbidities occurring as a consequence of high altitude are limited in the current literature. This study was aimed at evaluating the ocular health of porters working at high altitudesof Himalayas in Nepal. A mobile eye clinic was set up in Ghat and patient data were collected from its out- patient unit by a team of seven optometrists which was run for five days. Ghat is a small village in north-eastern Nepal, located at 2860 m altitude. Travellers walking through the trekking route were invited to get their eyes checked at the clinic. Comprehensive ocular examinations were performed, including visual acuities, objective and subjective refraction, anterior and posterior segment evaluations, and intraocular pressure measurements; blood pressure and blood glucose levels were also measured as required. Ocular therapeutics, prescription glasses, sunglasses and ocular health referrals were provided free of cost as necessary. A total of 1890 people visited the eye clinic, among which 57.4% (n=1084) were porters. Almost half of the porters had an ocular morbidity. Correctable refractive error was most prevalent, with other ocular health-related complications, including dry eye disease, infectious disorders, glaucoma and cataract. Proper provision of regular and effective eye care services should be made more available for those residing at these high altitudes in Nepal. © NEPjOPH.

  5. Gonadal dysfunction in morbidly obese adolescent girls.

    Science.gov (United States)

    Chin, Vivian; Censani, Marisa; Lerner, Shulamit; Conroy, Rushika; Oberfield, Sharon; McMahon, Donald; Zitsman, Jeffrey; Fennoy, Ilene

    2014-04-01

    To describe gonadal dysfunction and evaluate polycystic ovary syndrome (PCOS) and its association with metabolic syndrome (MeS) among girls in a morbidly obese adolescent population. In a cross-sectional study of 174 girls, height, weight, waist circumference, Tanner stage, reproductive hormones, carbohydrate and lipid markers, drug use, and menstrual history were obtained at baseline. Exclusion criteria were menarcheal age PCOS or MeS classification. University medical center outpatient clinic. Ninety-eight girls ages 13-19.6 years, Tanner 5, average body mass index of 46.6 kg/m(2), menarche at 11.4 years, and average menarcheal age of 5 years. None. Polycystic ovary syndrome and MeS. Ninety-eight girls were divided into four groups: PCOS by National Institutes of Health criteria (PCOSN, n = 24), irregular menses only (n = 25), elevated T (≥55 ng/dL) only (n = 6), and obese controls (n = 43). Metabolic syndrome by modified Cook criteria affected 32 girls or 33% overall: 6 of 24 PCOSN, 7 of 25 irregular menses only, 4 of 6 elevated T only, and 15 of 43 obese controls. Polycystic ovary syndrome by National Institutes of Health criteria and its individual components were not associated with MeS after adjusting for body mass index. Unlike obese adults, PCOSN and its individual components were not associated with MeS in the untreated morbidly obese adolescent population. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  6. Standardized morbidity ratio for leptospirosis mapping in Malaysia

    Science.gov (United States)

    Awang, Aznida Che; Samat, Nor Azah

    2017-05-01

    Leptospirosis is a worldwide zoonotic disease that affects human health in many parts of the world including Malaysia. Leptospirosis is a disease caused by the infection of pathogenic Leptospira genus called Spirochaetes. Leptospirosis can be transmitted directly or indirectly from rats to human. The human infection is usually caused by human contact with urine or tissues of infected animal. This disease can be spread through mucus membrane such as mouth, nose and eyes, ingestion of contaminated food and water and also exposed injured skin to contaminated water or soil. There is still no vaccine currently available for the prevention or treatment of leptospirosis disease but this disease can be treated if it is diagnosed early. Therefore, the aim of this study is to estimate the relative risk for leptospirosis disease based initially on the most common statistic used in the study of disease mapping called Standardized Morbidity Ratio (SMR). We then apply SMR to leptospirosis data obtained in Malaysia. The results show that the states of Melaka have very high risk areas. The states of Kedah, Terengganu and Kelantan are identified as high risk areas. The states of Perak, Perlis, Sabah and Sarawak showed medium risk areas. This is followed by low risk by other states except Pahang, Johor and Labuan with very low risk areas. In conclusion, SMR method is the best method for mapping leptospirosis because by referring to the relative risk maps, the states that deserve closer look and disease prevention can be identified.

  7. MORBIDITY PROFILE OF WOMEN DURING PREGNANCY: A HOSPITAL RECORD BASED STUDY IN WESTERN UP

    Directory of Open Access Journals (Sweden)

    Ranjana Singh

    2012-12-01

    Full Text Available Objective: To study the morbidity pattern and relationship of these morbidities with socio-economic and demographic factors. Material and method: Present study was conducted at the Saraswathi Institute of Medical Sciences,Hapur,(U.P. among pregnant patients during the study period of one year. Data were analyzed using SPSS 16, using tabulation with percentage and Pearson's chi-square test was used for testing the crude associations. Results: In the present study a total of 338 pregnant women were included for the study material, out of which 67.46% of the antenatal women reported illness during antenatal period and majority 277(81.95% of the pregnant women were anemic.Thecommon non-obstetric morbidities reported were gastrointestinal disorder (24.68%, genital tuberculosis (16.88%, renal & gall bladder disease (7.79% and congenital anomaly (6.49% ect. (ii The obstetric morbidities included were pre-eclampsia(14.56%, urinary tract infection(9.71%, rupture of membrane(8.74%,hyperemesis gravidarum(9.22%and abnormal presentation in (2.43%patients . Conclusion: Maternal morbidity is notably high, although most of the common problems were not life-threatening. They are more likely to have marked influence on their wellbeing and health status in the long run. Most conditions could be addressed through provision of health promotion and preventive interventions.

  8. MORBIDITY PROFILE OF WOMEN DURING PREGNANCY: A HOSPITAL RECORD BASED STUDY IN WESTERN UP.

    Directory of Open Access Journals (Sweden)

    Ranjana Singh

    2013-01-01

    Full Text Available Objective: To study the morbidity pattern and relationship of these morbidities with socio-economic and demographic factors. Material and method: Present study was conducted at the Saraswathi Institute of Medical Sciences,Hapur,(U.P. among pregnant patients during the study period of one year. Data were analyzed using SPSS 16, using tabulation with percentage and Pearson's chi-square test was used for testing the crude associations. Results: In the present study a total of 338 pregnant women were included for the study material, out of which 67.46% of the antenatal women reported illness during antenatal period and majority 277(81.95% of the pregnant women were anemic.Thecommon non-obstetric morbidities reported were gastrointestinal disorder (24.68%, genital tuberculosis (16.88%, renal & gall bladder disease (7.79% and congenital anomaly (6.49% ect. (ii The obstetric morbidities included were pre-eclampsia(14.56%, urinary tract infection(9.71%, rupture of membrane(8.74%,hyperemesis gravidarum(9.22%and abnormal presentation in (2.43%patients . Conclusion: Maternal morbidity is notably high, although most of the common problems were not life-threatening. They are more likely to have marked influence on their wellbeing and health status in the long run. Most conditions could be addressed through provision of health promotion and preventive interventions.

  9. Morbidity and mortality of firearm injury in peshawar region

    International Nuclear Information System (INIS)

    Shah, M.M.; Arif, M.; Seema, N.

    2008-01-01

    Firearm injuries cause significant morbidity and mortality among its victims. The present study, carried out at a major tertiary care hospital of Peshawar, Pakistan was aimed at highlighting the extent and severity of firearm-related morbidity and resultant mortality despite expert medical care. All victims of firearm injury brought to the Lady Reading Hospital Peshawar Emergency Department and thereafter admitted to hospital wards during the period mid-2006 to mid- 2007 were included in the study prospectively regardless of age, gender or socio-economic status. Data relevant to the background of firearm use, type of firearm used, types and extents of injuries, clinical condition of the patients and final outcome were collected on performas and entered into SPSS 15.0 for analysis. Seventy-four cases of firearm injury were recorded during the study period, with a predominant male to female ratio (9.6:1). Most victims (79.7%) were in the age group of 15-35 years. Although there were more cases from Peshawar (28.4%), there was no major referral pattern noted. High velocity weapons were used in 95.9% of cases and homicide was the main motive for injury (60.8%). Injuries were sustained most frequently in the abdomen and pelvis (44.6%) and 67.6% of victims sustained internal injuries. There were only 5 (6.8%) deaths from firearm injuries. It is concluded, the young males of the population must be targeted for lifestyle adjustments such as training to refrain from anger or disputes (usually over petty things) and to prevent the easy access of firearms as a weapon to settle disputes. (author)

  10. Kleptomania and Co-morbid addictive disorders.

    Science.gov (United States)

    Kim, Hyoun S; Christianini, Aparecida Rangon; Bertoni, Daniela; de Oliveira, Maria do Carmo Medeiros; Hodgins, David C; Tavares, Hermano

    2017-04-01

    We examined the association between kleptomania and addictive disorders, including behavioral addictions. Fifty-three individuals with a diagnosis of kleptomania completed measures of kleptomania severity, semi-structured clinical interviews to assess co-morbid diagnosis of addictive disorders, and the Shorter PROMIS Questionnaire (SPQ) assessing an array of addictive behaviors. 20.75% of the sample met criteria for an addictive disorder; four for a substance use disorder and four for a behavioral addiction. Kleptomania severity was significantly associated with compulsive work and shopping measured by the SPQ. The results suggest the need to assess a wide array of addictive behaviors in individuals with kleptomania. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

    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.

  12. Morbidity and mortality associated with obstetric hysterectomy

    International Nuclear Information System (INIS)

    Shaikh, N.B.; Shaikh, S.; Shaikh, J.M.

    2010-01-01

    Background: Obstetric hysterectomy still complicates a substantial number of pregnancies in third world countries and is a significant cause of obstetric morbidity and mortality. This study was carried out to evaluate in our setup the frequency of obstetric hysterectomy, its indication, risk factors, complication, morbidity, mortality and avoidable factors. Methods: A descriptive study of all patients who under went obstetric hysterectomy was conducted from May 1, 2004 to October 31, 2005 at Gynaecology and Obstetric Unit-II, III of Liaquat University of Medical and Health Science Hospital, Hyderabad. After collecting the data on pre-designed proforma the data was fed to SPSS in the form of frequency distribution tables and percentages were calculated. Statistical analysis of data was performed by using Chi-square test. The level of significance was taken as p<0.05. Results: During the study time period there were total 6495 deliveries and 41 cases of obstetric hysterectomy were identified, giving a frequency of 0.63% or 1 in 158 deliveries. Most of patients were from rural areas (82.92%), un-booked 73.17%), uneducated (95%), lower socio economical class (92.69%), 25-29 years age (48.78%) multiparae (56.10%), have to travel a distance of <100 km to reach hospital and referred late (51%) by health care providers (doctors). Majority of hysterectomies were performed due to ruptured uteri (51.21%). There were 5 maternal and 26 perinatal deaths; all were due to severity of conditions necessitating hysterectomy. Conclusion: Incidence of obstetric hysterectomy in our woman is very high. The reason being many avoidable factors such as high parity, inadequate maternity and family planning services, lack of proper referral system, un-booked status, mismanaged labour, illiteracy on the part of woman herself, family and health care providers are not taken care of during pregnancy, labour and puerperium. (author)

  13. Psychiatric morbidity develops after onset of pediatric multiple sclerosis

    DEFF Research Database (Denmark)

    Spangsberg Boesen, Magnus; Thygesen, Lau Caspar; Uldall, Peter Vilhelm

    2018-01-01

    BACKGROUND: Pediatric-onset multiple sclerosis (MS) affects life at a stage vital for social and educational achievements and psychiatric co-morbidity is common after MS onset. Few studies have examined psychiatric morbidity before MS onset. METHODS: In this nationwide study, detailed case...... with psychiatric morbidity as exposure and MS as outcome, and a matched cohort study with MS as exposure and psychiatric co-morbidity as outcome. Hazard ratios (HR) including 95% confidence intervals (CI) were estimated using Cox regression. RESULTS: We identified 212 children with MS and 1060 controls....... No association between psychiatric morbidity and the rate of MS was found before MS onset. After MS onset, children with MS had two times higher hazard for psychiatric co-morbidity compared with children without MS (HR=2.0; 95% CI=1.3-3.1; pPsychiatric morbidity seems to commence after MS...

  14. Are unnecessary follow-up procedures induced by computer-aided diagnosis (CAD) in mammography? Comparison of mammographic diagnosis with and without use of CAD

    International Nuclear Information System (INIS)

    Marx, Christiane; Malich, Ansgar; Facius, Mirjam; Grebenstein, Uta; Sauner, Dieter; Pfleiderer, Stefan O.R.; Kaiser, Werner A.

    2004-01-01

    Objective: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. Materials and methods: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers=group 1; 49 histologically proven benign lesions=group 2 and 100 screening cases (4 years-follow up=group 3). Mammograms were evaluated by a CAD system (Second Look [reg] , CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). Results: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. Conclusion: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid

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

    Science.gov (United States)

    Tamiru, Dessalegn; Belachew, Tefera

    2018-01-13

    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.

  16. Comparative dynamic analysis of morbidity in various age groups in Russian Federation

    Directory of Open Access Journals (Sweden)

    Vera A. Pogodina

    2016-09-01

    Conclusion ― Rate of healthcare visits in Russian Federation was higher for children aged 0-14 years and population older than 18 years. Morbidity increase rate was higher in children aged 0-14 years and women older than 55 years and men older than 60 years. Structural differences in disease groups were detected, which may be taken into account when planning preventive measures according to population age.

  17. [Indications of efficacy of bariatric surgery in the management of morbid obesity].

    Science.gov (United States)

    Pascual, J M; Rodilla, E

    2006-09-01

    Its indications should only be considered in patients with morbid obesity (BMI>40 kg/m2) or severe obesity (BMI>35 kg/m2) with serious associated comorbidity. In general, significant weight loss with marked improvement of the cardiovascular comorbidity is obtained. There are still no studies that show long term survival. It must be stressed that the patients should follow a subsequent and continuous medical monitoring to prevent important secondary metabolic complications.

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

    Science.gov (United States)

    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

  19. PSYCHOSOCIAL MORBIDITY IN PATIENTS UNDERGOING MASTECTOMY FOR BREAST CANCER

    Directory of Open Access Journals (Sweden)

    Kavitha Konnakkaparambil Ramakrishnan

    2018-02-01

    Full Text Available BACKGROUND Breast Cancer is the most common female cancer worldwide and carries significant psychosocial morbidity. The diagnosis of the disease and the treatment modalities like surgery and chemotherapy contribute to the morbidity. The recognition of the psychosocial morbidity associated with mastectomy can help us formulate effective counselling strategies. The objectives of this study were- to assess the psychosocial morbidity in patients undergoing mastectomy for carcinoma breast, to identify the preoperative variables that predict the morbidity and to find out the correlation between degree of neuroticism of the individual and morbidity. MATERIALS AND METHODS 35 female patients who had mastectomy for breast cancer were evaluated at three time-points, preoperatively, immediately after surgery and 2 months after surgery. Anxiety and depression was assessed using Hospital Anxiety and Depression Scale (HADS, psychological distress was measured using General Health Questionnaire (GHQ-12 and neuroticism was assessed by Eysenck Personality Inventory Neuroticism subscale (EPI-N. RESULTS There was a high level of anxiety, depression and GHQ scores preoperatively with a further worsening of these over the three interviews. Age, marital status and menopausal status were factors which had an influence on psychosocial morbidity. Preoperative EPI-N scores positively correlated with psychosocial morbidity. CONCLUSION There is a high level of psychosocial morbidity in patients undergoing mastectomy for breast cancer and mastectomy seems to worsen it in the first two months after surgery. Our study shows that psychosocial morbidity is affected by age, marital status, menopausal status and level of neuroticism.

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

    Science.gov (United States)

    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 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.

  1. Severe maternal morbidity: A population-based study of an expanded measure and associated factors.

    Directory of Open Access Journals (Sweden)

    Victoria Lazariu

    Full Text Available Severe maternal morbidity conditions such as sepsis, embolism and cardiac arrest during the delivery hospitalization period can lead to extended length of hospital stays, life-long maternal health problems, and high medical costs. Most importantly, these conditions also contribute to the risk of maternal death. This population-based observational study proposed and evaluated the impact of expanding the Centers for Disease Control and Prevention (CDC measure of severe maternal morbidity by including additional comorbidities and intensive care admissions during delivery hospitalizations and examined associated factors. A New York State linked hospitalization and birth record database was used. Study participants included all New York State female residents, ages 10 to 55 years, who delivered a live infant in a New York acute care hospital between 2008 and 2013, inclusive. Incidence trends for both severe maternal morbidity measures were evaluated longitudinally. Associations between covariates and the two severe maternal morbidity measures were examined with logistic regression models, solved using generalized estimating equations and stratified by method of delivery. The New York expanded severe maternal morbidity measure identified 34,478 cases among 1,352,600 hospital deliveries (estimated incidence 2.55% representing a 3% increase in the number of cases compared to the CDC measure. Both estimates increased over the study period (p 1.5 included most measured comorbidities (e.g., pregnancy-induced hypertension, placentation disorder, multiple births, preterm birth, no prenatal care, hospitalization prior to delivery, higher levels of perinatal care birthing facilities and race/ethnicity. Expanding the measure for severe maternal morbidity during delivery to capture intensive care admissions provides a more sensitive estimate of disease burden. Perinatal regionalization in New York appears effective in routing high risk pregnancies to higher

  2. Prevalence of ocular morbidity in school going children in West Uttar Pradesh

    Directory of Open Access Journals (Sweden)

    Veer Singh

    2017-01-01

    Full Text Available Aim of the Study: This study aims to evaluate the prevalence and to make a comparison between the ocular morbidity pattern in school going children of urban and rural areas of West Uttar Pradesh. Materials and Methods: A school-based cross-sectional study design was adopted to examine children aged 5–15 years in randomly selected urban and rural schools of West Uttar Pradesh from June 2012 to August 2014. An optometrist did the vision and refraction, and a detailed ophthalmic examination was done by an ophthalmologist. Children needing further assessment were referred to a higher center. Interpretation and analysis of the data were done using Epi Info Software and t-test. Results: A total of 4838 students (2271 males and 2567 females were screened. The prevalence of ocular morbidity was 29.35% (28.65% urban, 30.05% rural. Refractive error (17.36% was the major cause of ocular morbidity followed by convergence insufficiency (2.79%, blepharitis (2.11%, Vitamin A deficiency (2.09%, allergic conjunctivitis (1.92%, bacterial conjunctivitis (0.95%, amblyopia (0.41%, stye (0.31% and squint (0.27%. There was an increase in ocular morbidity with age, especially in refractive error and convergence insufficiency. On comparing urban and rural schools, Vitamin A deficiency showed a significantly higher prevalence (P < 0.05% in the rural (3.03% as compared to the urban sector (1.15%. The prevalence of visual impairment was 4.9/1000 children, and prevalence of blindness was 0.62/1000 children. Conclusion: This study was the first of its kind in West Uttar Pradesh, reporting a considerable high prevalence (29.35% of pediatric ocular morbidity, which was more in rural as compared to the urban sector. Since most of this morbidity is either preventable or treatable, school screening forms an effective method to reduce this load.

  3. Prevalence of ocular morbidity in school going children in West Uttar Pradesh

    Science.gov (United States)

    Singh, Veer; Malik, K P S; Malik, V K; Jain, Kirti

    2017-01-01

    Aim of the Study: This study aims to evaluate the prevalence and to make a comparison between the ocular morbidity pattern in school going children of urban and rural areas of West Uttar Pradesh. Materials and Methods: A school-based cross-sectional study design was adopted to examine children aged 5–15 years in randomly selected urban and rural schools of West Uttar Pradesh from June 2012 to August 2014. An optometrist did the vision and refraction, and a detailed ophthalmic examination was done by an ophthalmologist. Children needing further assessment were referred to a higher center. Interpretation and analysis of the data were done using Epi Info Software and t-test. Results: A total of 4838 students (2271 males and 2567 females) were screened. The prevalence of ocular morbidity was 29.35% (28.65% urban, 30.05% rural). Refractive error (17.36%) was the major cause of ocular morbidity followed by convergence insufficiency (2.79%), blepharitis (2.11%), Vitamin A deficiency (2.09%), allergic conjunctivitis (1.92%), bacterial conjunctivitis (0.95%), amblyopia (0.41%), stye (0.31%) and squint (0.27%). There was an increase in ocular morbidity with age, especially in refractive error and convergence insufficiency. On comparing urban and rural schools, Vitamin A deficiency showed a significantly higher prevalence (P < 0.05%) in the rural (3.03%) as compared to the urban sector (1.15%). The prevalence of visual impairment was 4.9/1000 children, and prevalence of blindness was 0.62/1000 children. Conclusion: This study was the first of its kind in West Uttar Pradesh, reporting a considerable high prevalence (29.35%) of pediatric ocular morbidity, which was more in rural as compared to the urban sector. Since most of this morbidity is either preventable or treatable, school screening forms an effective method to reduce this load. PMID:28643716

  4. Malaria in Pregnancy: Morbidities and Management | Yakasai ...

    African Journals Online (AJOL)

    control of malaria in the African Subregion during pregnancy has been recommended by the World Health Organization (WHO). These include intermittent preventive treatment (IPT), use of insecticide treated nets (ITNs) and access to effective case management for malaria illness and anemia. Keywords: malaria in ...

  5. Adolescent Obesity: its correlates and associated morbidity

    Directory of Open Access Journals (Sweden)

    Sonali Sain

    2013-01-01

    Full Text Available Obesity is currently one of the major public health problems, in both developed and developing countries. Obesity is a risk factor for metabolic syndrome. Increasing rates of childhood obesity and more sedentary lifestyles has led to an age shift in metabolic syndrome which now occurs at an earlier age. Thus, the present study was conducted to get an idea about the occurrence of obesity among adolescent school children, risk factors associated with the condition and the related morbidity among them. MATERIALS AND METHODS: A cross-sectional descriptive study carried out in two higher secondary government girl schools with the help of a pre- designed and pre-tested questionnaire. RESULTS: Out of 245 students 16.73% were overweight and 6.54% were obese. Among overweight students, 59.65% exercised less than 4 hours a week, 61.4% watched TV ≥ 4 hours per week, 87.72% consumed junk food ≥ 4 days per week and 45.61% skipped meals. Puberty related menstrual irregularities, hypothyroidism, acne and stria were more commonly found in overweight students CONCLUSION: The rapidly increasing prevalence of obesity accompanied by unhealthy lifestyle habits among adolescents is one of the most challenging dilemmas of public health importance.

  6. Adolescent Obesity: its correlates and associated morbidity

    Directory of Open Access Journals (Sweden)

    Sonali Sain

    2013-11-01

    Full Text Available ABSTRACT: Obesity is currently one of the major public health problems, in both developed and developing countries. Obesity is a risk factor for metabolic syndrome. Increasing rates of childhood obesity and more sedentary lifestyles has led to an age shift in metabolic syndrome which now occurs at an earlier age. Thus, the present study was conducted to get an idea about the occurrence of obesity among adolescent school children, risk factors associated with the condition and the related morbidity among them. MATERIALS AND METHODS: A cross-sectional descriptive study carried out in two higher secondary government girl schools with the help of a pre-designed and pre-tested questionnaire. RESULTS: Out of 245 students 16.73% were overweight and 6.54% were obese. Among overweight students, 59.65% exercised less than 4 hours a week, 61.4% watched TV ≥ 4 hours per week, 87.72% consumed junk food ≥ 4 days per week and 45.61% skipped meals. Puberty related menstrual irregularities, hypothyroidism, acne and stria were more commonly found in overweight students CONCLUSION: The rapidly increasing prevalence of obesity accompanied by unhealthy lifestyle habits among adolescents is one of the most challenging dilemmas of public health importance.

  7. [Monogenic and syndromic symptoms of morbid obesity. Rare but important].

    Science.gov (United States)

    Wiegand, S; Krude, H

    2015-02-01

    Monogenic and syndromic obesity are rare diseases with variable manifestation. Therefore diagnosis is difficult and often delayed. The purpose of this work was to develop a clinical diagnostic algorithm for earlier diagnosis. Available publications for clinical symptoms and molecular defects of monogenic and syndromic obesity cases were evaluated. Monogenic and syndromic obesity can be expected in cases with early manifestation before the age of 5 years and a BMI above 40 or above the 99th percentile. Syndromic cases are mostly associated with a low IQ and dwarfism. Monogenic cases are associated with additional endocrine defects. Measurement of serum leptin proves the treatable leptin deficiency. Sequencing of the melanocortin-4 receptor gene (MC4R) allows diagnosis of the most frequent monogenic form of obesity. Treatment with a melanocyte-stimulating hormone (MSH) analog can be expected in the future. Early treatment of children with Prader-Willi syndrome can prevent severe obesity. Because in some cases treatment is available, monogenic and syndromic obesity should be diagnosed early. Based on the disease symptoms, serum leptin, and MC4R sequencing, a diagnostic algorithm is proposed, which can be used to diagnose cases of morbid obesity.

  8. Morbidity and mortality of hospitalized hip fractures in chronic hemodialysis

    Directory of Open Access Journals (Sweden)

    Georgios Vlachopanos

    2018-01-01

    Full Text Available Abnormal bone architecture contributes to high incidence of hip fractures in chronichemodialysis (HD patients. Their clinical epidemiology is incompletely described. We conducted a retrospective cohort study to assess the implications ofhospitalization with hip fracture in HD patients compared to the nonchronic kidney disease population. Thirty-three chronic HD patients admitted with hip fracture overfiveyears were age- and sex-matched on a 1:1 ratio with controls that had hip fracture and normal renal function. Demographic characteristics, deaths, and readmissions atsixmonths,hospitalization length, time to operation, and laboratory resultswere recorded from electronic health files. Datawere compared betweenthe two groups usingpairedt-test for continuous variables and McNemar's test for categoricalvariables. The compositeendpoint of deathand/or readmission at6 months was higher in HD patients (12.1% vs. 6.2%, P<0.001. Furthermore, mean time tooperationwas more delayed due to comorbidities (4.7 vs. 2.9 days, p = 0.04. HD patients had anemia more frequently at presentation (hemoglobin below 10 mg/dL, 32.1% vs. 12.5%, P = 0.003. Finally, they were more likely to be considered toofrail for surgery and not be operated (21.2% vs. 6.2%, P<0.001. Hip fractures are associated with increased morbidity and mortality and represent an important health-care burden for chronic HD patients. Future research is needed to identify definite predictors of adverse outcomes and to implement prevention strategies.

  9. Impact of morbid obesity on medical expenditures in adults.

    Science.gov (United States)

    Arterburn, D E; Maciejewski, M L; Tsevat, J

    2005-03-01

    Morbid obesity (body mass index (BMI) > or =40 kg/m2) is associated with substantially increased morbidity and mortality from chronic health conditions and with poorer health-related quality of life; however, less is known about the impact of morbid obesity on healthcare expenditures. To examine the impact of morbid obesity on healthcare expenditures using a nationally representative sample of US adults. We performed a cross-sectional analysis of 16 262 adults from the 2000 Medical Expenditure Panel Survey, a nationally representative survey of the noninstitutionalized civilian population of the United States. Per capita healthcare expenditures were calculated for National Institutes of Health BMI categories, based on self-reported height and weight, using a two-part, multivariable model adjusted for age, gender, race, income, education level, type of health insurance, marital status, and smoking status. Odds of incurring any healthcare expenditure and per capita healthcare expenditures associated with morbid obesity in 2000. When compared with normal-weight adults, the odds of incurring any healthcare expenditure in 2000 were two-fold greater among adults with morbid obesity. Per capita healthcare expenditures for morbidly obese adults were 81% (95% confidence interval (CI): 48-121%) greater than normal-weight adults, 65% (95% CI: 37-110%) greater than overweight adults, and 47% (95% CI: 11-96%) greater than adults with class I obesity. Excess costs among morbidly obese adults resulted from greater expenditures for office-based visits, outpatient hospital care, in-patient care, and prescription drugs. Aggregate US healthcare expenditures associated with excess body weight among morbidly obese US adults exceeded $11 billion in 2000. The economic burden of morbid obesity among US adults is substantial. Further research is needed to identify interventions to reduce the incidence and prevalence of morbid obesity and improve the health and economic outcomes of morbidly

  10. The association between gender and pediatric respiratory morbidity.

    Science.gov (United States)

    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 respiratory morbidity (log rank P respiratory morbidity while adjusting for gestational age, birthweight, and other confounders (HR 1.29, 95% CI 1.25-1.34, P respiratory morbidity, independent of obstetrical characteristics such as gestational age and birthweight. © 2018 Wiley Periodicals, Inc.

  11. Perinatal Depression – the Fourth Inflammatory Morbidity of Pregnancy? Theory and Literature Review

    Science.gov (United States)

    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

  12. Relationship between Body Image and Psychological Well-being in Patients with Morbid Obesity.

    Science.gov (United States)

    Yazdani, Negar; Hosseini, Sayed Vahid; Amini, Masood; Sobhani, Zahra; Sharif, Farkhondeh; Khazraei, Hajar

    2018-04-01

    Morbid obesity is rising around the world. It can cause unpleasant appearance and body image. Most of the studies have aimed to evaluate the psychopathology of overweight and obesity and paying attention to mental well-being in morbid obese individuals is rare. Therefore, this study aimed to assess the relationship between body image and psychological well-being in morbid obese patients. This cross-sectional study, using simple random sampling method, was done on 124 morbid obese patients who referred to obesity clinic in Shiraz from 2016 to 2017. The data were collected by body image index and psychological well-being questionnaire. Results were analyzed using descriptive statistics, Pearson correlation coefficient test, ANOVA, and Regression analysis. The results showed a significant relationship between body image and psychological well-being (r=0.43) (Pimage and all the subscales of psychological well-being except autonomy and purpose in life (Pimage (Pimage and those of psychological well-being in different categories of body mass index (BMI) (P>0.05). Final results indicated that body image defects caused by obesity could lie in negative psychological well-being in all aspects. This study can promote health clinicians' knowledge in supporting of mental status of obese individuals. It is suggested that preventing and supporting intervention should be performed as effective methods for encountering and coping with psychological effects of obesity.

  13. Relationship between Body Image and Psychological Well-being in Patients with Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Negar Yazdani

    2018-04-01

    Full Text Available Background: Morbid obesity is rising around the world. It can cause unpleasant appearance and body image. Most of the studies have aimed to evaluate the psychopathology of overweight and obesity and paying attention to mental well-being in morbid obese individuals is rare. Therefore, this study aimed to assess the relationship between body image and psychological well-being in morbid obese patients. Methods: This cross-sectional study, using simple random sampling method, was done on 124 morbid obese patients who referred to obesity clinic in Shiraz from 2016 to 2017. The data were collected by body image index and psychological well-being questionnaire. Results were analyzed using descriptive statistics, Pearson correlation coefficient test, ANOVA, and Regression analysis. Results: The results showed a significant relationship between body image and psychological well-being (r=0.43 (P0.05. Conclusion: Final results indicated that body image defects caused by obesity could lie in negative psychological well-being in all aspects. This study can promote health clinicians’ knowledge in supporting of mental status of obese individuals. It is suggested that preventing and supporting intervention should be performed as effective methods for encountering and coping with psychological effects of obesity.

  14. Youth Risk Behavior Surveillance--United States, 2005. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 55, Number SS-5

    Science.gov (United States)

    Eaton, Danice K.; Kann, Laura; Kinchen, Steve; Ross, James; Hawkins, Joseph; Harris, William A.; Lowry, Richard; McManus, Tim; Chyen, David; Shanklin, Shari; Lim, Connie; Grunbaum, Jo Anne; Wechsler, Howell

    2006-01-01

    Problem: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable. Reporting Period Covered: October 2004-January 2006. Description of the System: The Youth Risk…

  15. Youth Risk Behavior Surveillance--United States, 2007. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 57, Number SS-4

    Science.gov (United States)

    Eaton, Danice K.; Kann, Laura; Kinchen, Steve; Shanklin, Shari; Ross, James; Hawkins, Joseph; Harris, William A.; Lowry, Richard; McManus, Tim; Chyen, David; Lim, Connie; Brener, Nancy D.; Wechsler, Howell

    2008-01-01

    Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable. Reporting Period Covered: January-December 2007. Description of the System: The…

  16. Youth Risk Behavior Surveillance--United States, 2009. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 59, Number SS-5

    Science.gov (United States)

    Eaton, Danice K.; Kann, Laura; Kinchen, Steve; Shanklin, Shari; Ross, James; Hawkins, Joseph; Harris, William A.; Lowry, Richard; McManus, Tim; Chyen, David; Lim, Connie; Whittle, Lisa; Brener, Nancy D.; Wechsler, Howell

    2010-01-01

    Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable. Reporting Period Covered: September 2008-December 2009. Description of the…

  17. Youth Risk Behavior Surveillance--United States, 2011. Morbidity and Mortality Weekly Report. Surveillance Summaries. Volume 61, Number 4

    Science.gov (United States)

    Eaton, Danice K.; Kann, Laura; Kinchen, Steve; Shanklin, Shari; Flint, Katherine H.; Hawkins, Joseph; Harris, William A.; Lowry, Richard; McManus, Tim; Chyen, David; Whittle, Lisa; Lim, Connie; Wechsler, Howell

    2012-01-01

    Problem: Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable. Reporting Period Covered: September 2010-December 2011. Description of the…

  18. Premenstrual Syndrome and Psychiatric Co-morbidities.

    Directory of Open Access Journals (Sweden)

    Ziba Taghizadeh

    2009-04-01

    Full Text Available "n    "nObjective: Premenstrual syndrome (PMS is a common disorder with prevalence rate of approximately 30%; its concurrence with psychiatric symptoms will make it a disabling condition that resists usual treatment. Objective: This study was enrolled to assess the co-morbidity of PMS and psychiatric disorders in a sample of girls with PMS compared to those without PMS. "n    "nMaterial and method : This study was conducted through a cross sectional method with 362 participants (166 with PMS and 196 healthy girls who were selected randomly and completed the demographic questionnaire, premenstrual syndrome symptom daily record scale and the symptom checklist 90-revised (SCL-90-R. "n    "nResult: According to the result of the independent t test, the mean score of all the psychiatric symptoms in the PMS group was significantly higher than those in healthy group (P<0.001. According to SCL-90-R measurement, most of the participants in the PMS group were categorized as extremely sick for somatization (44% ,obsessive-compulsive (59%, depression (58.4%, anxiety (64.5%, hostility (47% and psychoticism (69.3%; most of the participants were diagnosed as having borderline severity of disorders for interpersonal sensitivity (44.6% and paranoid (42.8% and most of the respondents with PMS (46.4% were diagnosed as healthy only for phobic anxiety. "n    "nConclusion: There is a considerable relationship between PMS and different psychiatric symptoms that can complicate the diagnosis of PMS and its treatment for the health care providers. Therefore, all health care providers who are in contact with women in their reproductive age should be sensitive to mental health status in women with PMS.

  19. Physical injury: Is it inevitable or preventable? an experience from a Tertiary Care Hospital of Kolkata, West Bengal

    Directory of Open Access Journals (Sweden)

    Bobby Paul

    2017-01-01

    Full Text Available Introduction: Injuries are not random events – they have identifiable precipitating factors, and are therefore among public health's winnable battles. Substantial data-based study can help identify measures to prevent the occurrence of physical injury. Our objective was to find out the injury profile of patients attending a tertiary care hospital and assess their perception toward preventability of the event in light of their causation. Materials and Methods: This cross-sectional study was conducted on patients attending selected Outpatient and Inpatient Departments of Institute of Postgraduate Medical Education and Research, Kolkata, from February to March 2014. 216 patients who had suffered any form of physical injury and admitted/attending the selected departments were included in the study by complete enumeration method, after exclusion of unwilling and severely moribund patients. Pearson's Chi-square test was performed using Epi Info software version 3.2. Results: Highest proportion of physical injuries (24.07% occurred among 30–40 years age group. Road traffic accidents (RTAs were the most common type of injury (38.8% followed by falls (34.7%. 38.6% of the falls occurred inside victim's homes and 25.3% occurred on road. Electricity caused 55.1% burn injuries. Faulty driving attributed to 47% of the RTAs as perceived by its victims. Majority of the victims (60.2% opined that their injuries were not preventable. Conclusion: Raising public awareness that injury is preventable to a great extent, would help in averting such incidents, and thereby reduce unnecessary injury-related morbidity and mortality.

  20. Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Beets-Tan, R.G.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Essers, B.A.B. [Maastricht University Medical Centre, Department of Epidemiology and Medical Technology, Maastricht (Netherlands); Breukink, S.; Beets, G.L. [Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Cappendijk, V.C. [Jeroen Bosch Hospital, Department of Radiology, ' s Hertogenbosch (Netherlands)

    2015-05-01

    To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 EUR from 2,482 to 1,888 EUR (CL:-1081; -143). Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. (orig.)

  1. Travel and migration associated infectious diseases morbidity in Europe, 2008

    Directory of Open Access Journals (Sweden)

    Lopez-Velez Rogelio

    2010-11-01

    Full Text Available Abstract Background Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks. Methods To investigate the morbidity of travel associated infectious diseases in European travellers, we analysed diagnoses with demographic, clinical and travel-related predictors of disease, in 6957 ill returned travellers who presented in 2008 to EuroTravNet centres with a presumed travel associated condition. Results Gastro-intestinal (GI diseases accounted for 33% of illnesses, followed by febrile systemic illnesses (20%, dermatological conditions (12% and respiratory illnesses (8%. There were 3 deaths recorded; a sepsis caused by Escherichia coli pyelonephritis, a dengue shock syndrome and a Plasmodium falciparum malaria. GI conditions included bacterial acute diarrhea (6.9%, as well as giardiasis and amebasis (2.3%. Among febrile systemic illnesses with identified pathogens, malaria (5.4% accounted for most cases followed by dengue (1.9% and others including chikungunya, rickettsial diseases, leptospirosis, brucellosis, Epstein Barr virus infections, tick-borne encephalitis (TBE and viral hepatitis. Dermatological conditions were dominated by bacterial infections, arthropod bites, cutaneous larva migrans and animal bites requiring rabies post-exposure prophylaxis and also leishmaniasis, myasis, tungiasis and one case of leprosy. Respiratory illness included 112 cases of tuberculosis including cases of multi-drug resistant or extensively drug resistant tuberculosis, 104 cases of influenza like illness, and 5 cases of Legionnaires disease. Sexually transmitted infections (STI accounted for 0.6% of total diagnoses and included HIV infection and syphilis. A total of 165 cases of potentially vaccine preventable diseases were reported. Purpose of travel and destination specific risk factors was identified for several

  2. Laparoscopic colectomy in the obese, morbidly obese, and super morbidly obese: when does weight matter?

    Science.gov (United States)

    Champagne, Bradley J; Nishtala, Madhuri; Brady, Justin T; Crawshaw, Benjamin P; Franklin, Morris E; Delaney, Conor P; Steele, Scott R

    2017-10-01

    Previous studies have demonstrated that obese patients (BMI >30) undergoing laparoscopic colectomy have longer operative times and increased complications when compared to non-obese cohorts. However, there is little data that specifically evaluates the outcomes of obese patients based on the degree of their obesity. The aim of this study was to evaluate the impact of increasing severity of obesity on patients undergoing laparoscopic colectomy. A retrospective review was performed of all patients undergoing laparoscopic colectomy between 1996 and 2013. Patients were classified according to their BMI as obese (BMI 30.0-39.9), morbidly obese (BMI 40.0-49.9), and super obese (BMI >50). Main outcome measures included conversion rate, operative time, estimated blood loss, post-operative complications, and length of stay. There were 923 patients who met inclusion criteria. Overall, 604 (65.4%), 257 (27.9%), and 62 (6.7%) were classified as obese (O), morbidly obese (MO), and super obese (SO), respectively. Clinicopathologic characteristics were similar among the three groups. The SO group had significantly higher conversion rates (17.7 vs. 7 vs. 4.8%; P = 0.031), longer average hospital stays (7.1 days vs. 4.9 vs. 3.4; P = 0.001), higher morbidity (40.3 vs. 16.3 vs. 12.4%; P = 0.001), and longer operative times (206 min vs. 184 vs. 163; P = 0.04) compared to the MO and O groups, respectively. The anastomotic leak rate in the SO (4.8%; P = 0.027) and MO males (4.1%; P = 0.033) was significantly higher than MO females (2.2%) and all obese patients (1.8%). Increasing severity of obesity is associated with worse perioperative outcomes following laparoscopic colectomy.

  3. [Remuneration distribution - should morbidity-dependent overall remuneration also be distributed after adjustments for morbidity?].

    Science.gov (United States)

    Walendzik, A; Trottmann, M; Leonhardt, R; Wasem, J

    2013-04-01

    In the 2009 reform of the German collective remuneration system for outpatient medical care, on the level of overall remuneration, the morbidity risk was transferred to the health funds fulfilling a long-term demand of physicians. Nevertheless not transferring morbidity adjustment to the levels of physician groups and singular practices can lead to budgets not related to patient needs and to incentives for risk selection for individual doctors. The systematics of the distribution of overall remuneration in the German remuneration system for outpatient care are analysed focusing on the aspect of morbidity adjustment. Using diagnostic and pharmaceutical information of about half a million insured subjects, a risk adjustment model able to predict individual expenditures for outpatient care for different provider groups is presented. This model enables to additively split the individual care burden into several parts attributed to different physician groups. Conditions for the use of the model in the distribution of overall remuneration between physician groups are developed. A simulation of the use of diagnoses-based risk adjustment in standard service volumes then highlights the conditions for a successfull installation of standard service volumes representing a higher degree of risk adjustment. The presented estimation model is generally applicable for the distribution of overall remuneration to different physician groups. The simulation of standard service volumes using diagnosis-based risk adjustment does not provide a more accurate prediction of the expenditures on the level of physician practices than the age-related calculation currently used in the German remuneration system for outpatient medical care. Using elements of morbidity-based risk adjustment the current German collective system for outpatient medical care could be transformed towards a higher degree of distributional justice concerning medical care for patients and more appropriate incentives

  4. Morbidity and Mortality Patterns among Neurological Patients in the ...

    African Journals Online (AJOL)

    Background/Objective: The morbidity and mortality of neurological patients managed in the intensive care unit reflect the causes of neurological disorders and the effectiveness of management. Method: The morbidity and mortality patterns of neurological patients admitted into the intensive care unit of the University of Benin ...

  5. Soluble TWEAK and Cardiovascular Morbidity and Mortality in ...

    African Journals Online (AJOL)

    Introduction: Cardiovascular disease (CVD) is a major cause of morbidity and mortality in chronic kidney patients (CKD). The aim of this study was to demonstrate the role of soluble tumor necrosis factor (TNF) weak inducer of apoptosis (sTWEAK) as a marker of cardiovascular morbidity and mortality in CKD patients.

  6. Morbidity and mortality in patients with craniopharyngioma after surgery.

    LENUS (Irish Health Repository)

    Crowley, R K

    2010-10-01

    Craniopharyngioma (CP) is a benign tumour of the suprasellar region that is associated with increased morbidity and mortality in comparison with other causes of hypopituitarism. We aimed to establish the rate and causes of mortality and morbidity in patients with CP who attended our centre.

  7. Morbidity before and after the diagnosis of hyperthyroidism

    DEFF Research Database (Denmark)

    Brandt, Frans; Thvilum, Marianne; Pedersen, Dorthe Almind

    2013-01-01

    Hyperthyroidism has been linked with different morbidities, like atrial fibrillation, stroke and diabetes mellitus. However, our knowledge regarding the extent and temporal relation between hyperthyroidism and other diseases is fragmented. Here, we aimed at evaluating various morbidities before...... and after the diagnosis of hyperthyroidism....

  8. Severe acute maternal morbidity and maternal death audit - a rapid ...

    African Journals Online (AJOL)

    Severe acute maternal morbidity and maternal death audit - a rapid diagnostic tool for evaluating maternal care. L Cochet, R.C. Pattinson, A.P. Macdonald. Abstract. Objective. To analyse severe acute maternal morbidity (SAMM) and maternal mortality in the Pretoria region over a 2-year period (2000 - 2001). Setting.

  9. Co-Morbidities in psoriatic versus non-psoriatic patients

    Directory of Open Access Journals (Sweden)

    Rana Omar Al Houssien

    2018-01-01

    Conclusion: Patients with psoriasis were found to have an increased risk of developing major co-morbid disorders including diabetes, liver and renal function profile abnormalities. This indicates the importance of checking if this group of patients have co-morbid disorders.

  10. Child Morbidity and Mortality in Slum Environments along Nairobi ...

    African Journals Online (AJOL)

    The problem that guided this study was that child mortality and morbidity disparities continue to be observed in the era of improved expansion of the provision of health care services. Some areas have low mortality and morbidity while others such as the slums of Nairobi have high. Various factors may account for this ...

  11. Diabetes mellitus morbidity in Chernobyl clean-up workers

    International Nuclear Information System (INIS)

    Tolstaya, E.V.; Ermakova, D.P.; Glinskaya, T.N.

    2016-01-01

    Acute and total diabetes mellitus morbidity in Chernobyl clean-up workers was examined during 1995-2014 period. During all the period of investigations levels of acute and total morbidity were higher in clean-up workers, than in total Belarusian population. (authors)

  12. Preoperative anemia increases postoperative morbidity in elective cranial neurosurgery

    Science.gov (United States)

    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 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

  13. A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions

    Energy Technology Data Exchange (ETDEWEB)

    Woitek, Ramona; Spick, Claudio; Schernthaner, Melanie; Kapetas, Panagiotis; Bernathova, Maria; Furtner, Julia; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria)

    2017-09-15

    To assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI. This retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients. There were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%). Using the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. (orig.)

  14. [Caries morbidity in the odonto-stomatologic services in Yaounde, Cameroon].

    Science.gov (United States)

    Bengondoi, M C; Ngoa, S; Onana, J; Ewo, C; Bengono, G

    2006-06-01

    In our regions, it is believed that dental decay is an illness without prestige or danger for the life. It's the reason of teeth loss and many complications. The objective of this study was to valuate the morbidity of this pathology in odonto-stomatology services. With an average of 4.5 teeth decays per person and a morbidity index of 0.15; dental carie concern all socio-professional levels, without distinction of age or sex. Women seem more vulnerable to teeth decay, and they consult services more than men. We are potential edentulous because of dental decay, if preventive and training measures in mouth and tooth healths are not taken in our country.

  15. Investigation of the morbidity of dry eye among special crowd in Shunde district

    Directory of Open Access Journals (Sweden)

    Zhi-Hui Li

    2013-08-01

    Full Text Available AIM: To investigate the morbidity of dry eye in policeman of Shunde district, and to analyze the related factors and proposed methods of preventing and treating dry eye.METHODS:Totally 650 policemen who came for physical examination in Shunde district recived questionnaire survey. The patients with dye eye disease were finally diagnosed through slit lamp examination, Schirmer test, tear film break-up time(BUTmeasurement and keratoconjunctival fluorescent staining. The morbidity among different policemen was further analyzed and stasticed.RESULTS:The results showed that 152 in 650 policemen suffered from dry eye disease, the ratio was 23.4%. Comparied with security police and crimanl police, the ratio in traffic police, patrolman,and back office police was significantly higher. The prevalence was higher when the ages were greater than 40.CONCLUSION: Unsuitable working environment, air contamination are high risk factors of dry eye disease.

  16. Antenatal care and morbidity profile of pregnant women in an urban resettlement colony of Delhi, India.

    Science.gov (United States)

    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.

  17. Multi-morbidity, dependency, and frailty singly or in combination have different impact on health outcomes.

    Science.gov (United States)

    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.

  18. Isiris: A Novel Method of Removing Foreign Bodies from the Lower Urinary Tract to Avoid Unnecessary Hospitalization and Anesthesia.

    Science.gov (United States)

    Smith, Peter Mark; Harbias, Aman; Robinson, Richard; Palmer, Anne; Grey, Benjamin Robin

    2016-01-01

    Polyembolokoilamania refers to the practice of inserting foreign bodies (FBs) into natural orifices. A FB within the urethra is a relatively rare phenomenon with 646 cases recorded last year in the United Kingdom. Management of these patients presents technical challenges and complexities because of underlying psychiatric disorders that are often associated. This case illustrates a novel way of removing FBs from the genitourinary tract, requiring less resources, preventing hospital admission, and attempts to break the cycle of behavior, leading to recurrent attendance with polyembolokoilamania. A 38-year-old Caucasian male prisoner, with psychiatric history presented to the emergency department (ED) with a history of inserting FBs into his urethra on 12 different occasions over a 6-week period. Of these 12 attendances, 3 resulted in admission and 2 required emergency intervention in theater under general anesthesia. After the third attendance in 5 days, it was decided to use Isiris™, a single-use flexible cystoscopy device with a built-in ureteral stent grasper, to remove the FBs and check the integrity of the urethra. The procedure was performed within the ED, without the need for admission to a ward bed or general anesthesia. Furthermore, only two members of staff were required to remove all of the urethral FBs. Isiris, although marketed as a stent removal device, enabled us to remove all the patient's FBs in one procedure. Isiris is an easy to use device, similar to a flexible cystoscope, that a specialist nurse or resident would be familiar using. It allows efficient and safe removal of lower urinary tract FBs, even out of hours. It requires minimal staffing support and can be done in the ED. It has the potential to reduce associated sequela of urethral polyembolokoilamania, saving resources while preserving the availability of the emergency theater.

  19. The effect of different public health interventions on longevity, morbidity, and years of healthy life

    Directory of Open Access Journals (Sweden)

    Cai Liming

    2007-04-01

    Full Text Available Abstract Background Choosing cost-effective strategies for improving the health of the public is difficult because the relative effects of different types of interventions are not well understood. The benefits of one-shot interventions may be different from the benefits of interventions that permanently change the probability of getting sick, recovering, or dying. Here, we compare the benefits of such types of public health interventions. Methods We used multi-state life table methods to estimate the impact of five types of interventions on mortality, morbidity (years of life in fair or poor health, and years of healthy life (years in excellent, very good, or good health. Results A one-shot intervention that makes all the sick persons healthy at baseline would increase life expectancy by 3 months and increase years of healthy life by 6 months, in a cohort beginning at age 65. An equivalent amount of improvement can be obtained from an intervention that either decreases the probability of getting sick each year by 12%, increases the probability of a sick person recovering by 16%, decreases the probability that a sick person dies by 15%, or decreases the probability that a healthy person dies by 14%. Interventions aimed at keeping persons healthy increased longevity and years of healthy life, while decreasing morbidity and medical expenditures. Interventions focused on preventing mortality had a greater effect on longevity, but had higher future morbidity and medical expenditures. Results differed for older and younger cohorts and depended on the value to society of an additional year of sick life. Conclusion Interventions that promote health and prevent disease performed well, but other types of intervention were sometimes better. The value to society of interventions that increase longevity but also increase morbidity needs further research. More comprehensive screening and treatment of new Medicare enrollees might improve their health and

  20. Elderly patient's mortality and morbidity following trochanteric fracture. A prospective study of 100 cases.

    Science.gov (United States)

    Mnif, H; Koubaa, M; Zrig, M; Trabelsi, R; Abid, A

    2009-11-01

    Trochanteric fractures are a major source of mortality, morbidity and functional impairment in the elderly. Morbidity is closely related to the degree of instability and comminution and is substantially influenced by the quality of reduction and internal fixation. Advanced age and associated co-morbidities are two decisive factors of mortality secondary to trochanteric fracture. This prospective study examined the epidemiological profile of trochanteric fractures and assessed mortality and morbidity with the aim of establishing management guidelines and improving prevention strategies. One hundred patients were included; 60% were male. Mean age was 76 years (range, 60-96 yrs). One, or more than one, co-morbidities were present in 68% of cases. The fractures were caused by a simple fall in 90% of cases. Fractures were classified according to the criteria of Ramadier and the ones of Ender. Sixty-five percent of these fractures were unstable. A dynamic hip screw was systematically used as the standard means of internal fixation. Anatomic and functional results were analyzed in 82 patients (18 had died within the first year following fracture occurrence). Mean follow-up period was 24 months (range, 12-36 months). Bone healing was achieved in 96% of cases. There were numerous postoperative complications (four cases of thromboembolism, fourteen immobility-related complications, two infections, six secondary displacement combined to loss of fixation, four non-unions, and nine malunions). At 2 years follow-up, 28 patients had died. Mortality was strongly correlated with older age (over 90 years), associated co-morbidity and fracture instability. Good functional outcomes (72%) correlated with younger age (60-74 years), fracture stability, adequate reduction and internal fixation. In stable trochanteric fractures, osteosynthesis by dynamic screw-plate is more effective than alternative techniques (blade-plate, nail-plate, Ender nail or even trochanteric nail). In unstable

  1. Cholesterol testing among men and women with disability: the role of morbidity

    Directory of Open Access Journals (Sweden)

    Lofters AK

    2016-09-01

    Full Text Available Aisha K Lofters,1–3,* Sara JT Guilcher,1,3,4,* Lauren Webster,1 Richard H Glazier,1–3 Susan B Jaglal,1 Ahmed M Bayoumi,1,3 1Institute for Clinical Evaluative Sciences, 2Department of Family and Community Medicine, St Michael’s Hospital, University of Toronto, 3Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, 4Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada *These authors contributed equally to this work Purpose: Despite more frequent use of health services by people living with disability, the quality of preventive care received may be suboptimal. In this retrospective cohort study, we used administrative data to examine the relationship between cholesterol testing and levels of disability and morbidity among women and men in Ontario, Canada. Methods: We linked multiple provincial-level databases in this study. In stratified analyses for women and men, we used multivariable logistic regression to examine differences in cholesterol testing, and we tested for an interaction effect between disability and morbidity. In a secondary analysis, we tested for a three-way interaction between sex, disability, and morbidity on the entire cohort. Results: There was an interaction between morbidity and disability for both women and men. Women and men with no chronic conditions appeared to be least likely to be up-to-date on cholesterol testing, and among this group, those with moderate disability were more likely to be up-to-date on cholesterol testing than those with no disability (adjusted odds ratio [AOR] =1.51; 95% confidence interval [CI] 1.20–1.90 for women; AOR =1.16; 95% CI 1.00–1.34 for men. Among women and men who had one chronic condition, having severe disability put them at significant disadvantage versus those with no disability. Only 58.5% of men with no disability and no chronic conditions were up-to-date on cholesterol testing. Conclusion: An intermediate level

  2. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

    Directory of Open Access Journals (Sweden)

    Tripat Bindra

    2011-01-01

    Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

  3. The role of morbidity and mortality meetings in interventional radiology

    International Nuclear Information System (INIS)

    Mok, Philip S.; Tan, Eva Y.; Baerlocher, Mark O.; Athreya, Sriharsha

    2012-01-01

    Purpose: To understand the current practice of interventional radiology (IR) morbidity and mortality (M and M) meetings among interventional radiologists in Europe, and to develop a set of results-based recommendations to increase the prevalence of IR M and M meetings. Materials and methods: Online electronic surveys were sent to members of the Cardiovascular and Interventional Radiology Society of Europe (CIRSE). Each survey consisted of 18 questions pertaining to IR M and M meetings. Results: A total of 150 CIRSE members responded to the survey. Approximately 47% of respondents held IR M and M meetings in their departments. Among those who held IR M and M meetings, 42% held them monthly and 68% rated the quality of the meetings as good or excellent. Of those who did not have M and M meetings, 94% were interested in incorporating M and M meetings into their future practice. The most common reasons for not holding IR M and M meetings were lack of time (68%) and small IR practice groups (43%). A total of 85% were interested in learning more about IR M and M meetings. The preferred method of education about M and M meetings included annual radiology meetings (44%), peer-reviewed articles in radiology journals (31%), websites (26%), and newsletters (15%). Conclusions: The data demonstrate that although current practice of M and M meetings in European IR departments is limited, the majority of respondents believe that M and M meetings are beneficial to their practice. There is a need for guidelines or standards of practice to incorporate such meetings in IR departments to prevent medical errors, which may ultimately lead to enhanced patient safety and outcomes.

  4. [Mortality and morbidity worldwide, now and tomorrow: what is known?].

    Science.gov (United States)

    Valleron, Alain-Jacques

    2008-12-01

    The knowledge of the global distribution of death, diseases and risk factors is important to make clear to the general public and to governments that health inequalities are incredibly high, at the dawn of this 21(st) century, and to help fight these. More than 20% of the 56 millions of deaths in 2001 were of children less than 5 years old. There are at least 1 million deaths per year from malaria. Diarrhoea kill more than 1.5 million, and measles more than half a million. The large majority of deaths by infectious diseases occur in underdeveloped countries. Moreover, chronic diseases kill an increasing number in underdeveloped countries, because populations are aging, because expansive health care which is needed to prevent and control these diseases is unavailable, and because the inhabitants are increasingly exposed to risk factors. In particular, smoking is increasing dramatically in underdeveloped countries as a result of the aggressive marketing of tobacco companies, the delay in implementing antismoking regulations, and because the public perception of the risk of smoking is still low. More than 4 million deaths per year are presently attributed to smoking, and reports forecast a death toll of 10 million in 2030. The WHO, Harvard University and the World Bank are at the origin of comprehensive data analyses on the "global burden of diseases" which help to identify health priorities. Unfortunately, global data are still scarce and of low quality, particularly in those underdeveloped countries where they would be most useful. Precise knowledge of the variations of mortality, morbidity and exposure to risk factors would be essential to monitor the improvements, or failures of health care progress. The optimal interpretation of the available data requires expertise in demography, epidemiology, statistics, and computer sciences, which are rarely found in this area. Thus, improvements in the collection of data and in the research effort in this field are necessary.

  5. Preoperative factors influencing mortality and morbidity in peptic ulcer perforation.

    Science.gov (United States)

    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.

  6. Psychiatric morbidity and non-participation in breast cancer screening.

    Science.gov (United States)

    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.

  7. Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

    Science.gov (United States)

    Jacobs, Jac J W M; Jacobs, Jan P A M; van Sonderen, Eric; van der Molen, Thys; Sanderman, Robbert

    2015-05-06

    Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

  8. Using a structured morbidity and mortality meeting to understand the ...

    African Journals Online (AJOL)

    2013-11-04

    Nov 4, 2013 ... Several authors have attempted to use the morbidity and mortality meeting to highlight error ... mortality meeting that focuses on assessing the contribution of error in its totality to .... accounting equally for the remaining. 23.2%.

  9. Travel and migration associated infectious diseases morbidity in Europe, 2008

    NARCIS (Netherlands)

    Field, Vanessa; Gautret, Philippe; Schlagenhauf, Patricia; Burchard, Gerd-Dieter; Caumes, Eric; Jensenius, Mogens; Castelli, Francesco; Gkrania-Klotsas, Effrossyni; Weld, Leisa; Lopez-Velez, Rogelio; de Vries, Peter; von Sonnenburg, Frank; Loutan, Louis; Parola, Philippe; Simon, Fabrice; Weber, Rainer; Cramer, Jakob; Pérignon, Alice; Odolini, Silvia; Carosi, Giampiero; Chappuis, François

    2010-01-01

    Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks. To investigate the morbidity of travel associated infectious diseases in European travellers, we

  10. Travel and migration associated infectious diseases morbidity in Europe, 2008

    NARCIS (Netherlands)

    Field, V.; Gautret, P.; Schlagenhauf, P.; Burchard, G.D.; Caumes, E.; Jensenius, M.; Castelli, F.; Gkrania-Klotsas, E.; Weld, L.; Lopez-Velez, R.; de Vries, P.; von Sonnenburg, F.; Loutan, L.; Parola, P.

    2010-01-01

    Background: Europeans represent the majority of international travellers and clinicians encountering returned patients have an essential role in recognizing, and communicating travel-associated public health risks. Methods: To investigate the morbidity of travel associated infectious diseases in

  11. Community Based Survey on Psychiatric Morbidity in Eastern Nepal

    Directory of Open Access Journals (Sweden)

    Pramod Mohan Shyangwa

    2014-12-01

    Conclusions: Community prevalence rate of some common psychiatric disorders is high which calls for special attention to address depressive and alcohol related disorder from all quarters of society particularly from government. Keywords: community survey; mental illness; psychiatric morbidity.

  12. Psychiatric morbidity in two urban communities in nigeria

    African Journals Online (AJOL)

    2008-08-08

    Aug 8, 2008 ... psychiatric illness significantly differentiates cases from non-cases on all measures of morbidity. Conclusion:the ..... with the onerous task of sifting out several variables .... strategy in providing services targeted to high-risk.

  13. Nicotine dependence, use of illegal drugs and psychiatric morbidity.

    Science.gov (United States)

    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.

  14. A Descriptive Study of the Morbidity Pattern of Older Persons ...

    African Journals Online (AJOL)

    2014-12-31

    Dec 31, 2014 ... presenting morbidities at this geriatric health centre were mostly noncommunicable diseases. ... dietetics, geriatric lifestyle, ophthalmology, geriatric dentistry ... level of education, employment status, religion, smoking history ...

  15. Study on morbidity pattern among elderly in urban population of ...

    African Journals Online (AJOL)

    McRoy

    to a steady rise in life expectancy and reduction in fertility. Aim: To know the ... common health conditions affecting the elderly and evaluate the differences in the morbidity pattern ... occupation, education, religion, type of family, duration of stay ...

  16. Psychiatric morbidity in a Nigerian neurology clinic | Ajiboye | East ...

    African Journals Online (AJOL)

    Psychiatric morbidity in a Nigerian neurology clinic. ... Log in or Register to get access to full text downloads. ... The study supports previous reports that psychiatric disorders are quite common among patients with neurological disorders.

  17. Motorcycle accidents: morbidity and associated factors in a city of ...

    African Journals Online (AJOL)

    Motorcycle accidents: morbidity and associated factors in a city of northeast of Brazil. Alessandro L. Cavalcanti, Belchior Lucena, Iris S. Rodrigues, Amanda L. Silva, Taua T. Lima, Alidianne Fabia C. Xavier ...

  18. Prevalence and Prevention of Malaria in Pregnancy in Edo State ...

    African Journals Online (AJOL)

    Erah

    Prevention used against malaria in pregnancy is a sure safe guard against maternal morbidity/mortality and should be ... This acquired anti- malarial immunity ... her family by reducing malaria related ... complications arising during pregnancy,.

  19. Obsessive–compulsive disorder: subclassification based on co-morbidity

    Science.gov (United States)

    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

  20. Forgotten Ureteral Stents: An Avoidable Morbidity

    International Nuclear Information System (INIS)

    Murtaza, B.; Alvi, S.

    2016-01-01

    Objective: To assess the clinical presentation of forgotten ureteral stents and highlight the etiological factors resulting in the retention of these stents. Study Design: Observational study. Place and Duration of Study: Department of Urology, Armed Forces Institute of Urology, Rawalpindi, from January 2010 to Jun 2011. Methodology: Thirty-eight patients, with forgotten ureteral stents, retained for more than 6 months duration, were enrolled. A detailed evaluation was performed, along with the questions regarding the patients' opinion about the ureteral stents. They were specially asked whether they knew about the stents or were they formally informed regarding the stents. Subsequently, the patients were managed according to their clinical condition. Results: The male to female ratio was 2.1:1 aged 23 - 69 years, mean being 40.24 ± 12.59 years. The time of presentation after the ureteral stenting was 7 - 180 months (mean = 28.89 ± 33.435 years). Seven patients (18.4 percentage) reported with chronic kidney disease, including ESRD in two cases. Recurrent UTI was seen in 28 cases (73.6 percentage), calculus formed over the stents in 20 cases (52.6 percentage), and stent fragmented in 5 patients (13.1 percentage). Majority of patients, (n = 23, 60.5 percentage), were not even aware of the placement of these stents while 8 (21.0 percentage) knew but were reluctant about its removal. In 3 cases (7.8 percentage), the relatives knew about the stent but never informed the patients. The stent had been removed in 2 cases (5.2 percentage), but the other broken fragment was missed. One case (2.6 percentage) each had a misconception about the permanent placement of the stents like cardiac stents and regarding degradation of the stents in situ. Conclusion: Forgotten ureteral stents produce clinical features ranging from recurrent UTI to ESRD. This preventable urological complication is primarily due to the unawareness or ignorance of the patients and their relatives

  1. Independent predictors of morbidity and mortality in blunt colon trauma.

    Science.gov (United States)

    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.

  2. Activity Behaviours in Lean and Morbidly Obese Pregnant Women.

    Science.gov (United States)

    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 (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, plean 893.7 (175.9) Kcal, plean 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.

  3. Orthopedic trauma surgery in the morbidly obese patient.

    Science.gov (United States)

    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.

  4. Association of personal hygiene with common morbidities among upper primary school children in rural Odisha.

    Science.gov (United States)

    Paul, Kalyan Kumar; Panigrahi, Sandeep Kumar; Soodi Reddy, Arun Kiran; Sahu, Trilochan

    2017-01-01

    In India, children of upper primary school receive less attention from health-care providers. The majority of their health problems are preventable through hygienic practices. The aim of this study was to find out the association of personal hygiene with common morbidities among upper primary school children. A cross-sectional study conducted in a rural upper primary school of Odisha. A semi-structured schedule based on the Global School Health Survey Questionnaire and necessary instruments for clinical examination were used. Data were entered in Microsoft Excel 2007 and analyzed by SPSS version 20 software. Of 90 participants, 58 (64.4%) were girls. The mean age was 11.8 (±1.01) years. The mean body mass index of females was significantly higher than males (16.95 vs. 14.72; P = 0.001). More than 90% of children maintained good personal hygiene such as clean tongue, clean hair, handwashing, and using footwear. The most common morbidities found were dental caries (38.9%), history of worms in stool and lethargy (20%). A mean score of 6.14 ± 0.11 (out of 8) was seen for personal hygiene and not associated with any particular morbidity or gender. Brushing daily was significantly associated with reduced dental caries (χ 2 = 8.7; P personal hygiene. School health services should also focus on upper primary school children for improvement of personal hygiene.

  5. [Morbidity-mortality review in psychiatry: suicide or suicide attempts].

    Science.gov (United States)

    Thomas, A; Combalbert, N; Fay, J; Paquis, J

    2010-06-01

    Further to the occurrence of three cases of suicide attempts or suicides within a few months, a psychiatric team introduced a method of evaluation of the professional practices on this subject. The objective aimed by the team was to collectively identify the risk factors of the acting out and the strategies to prevent it. The analysis and the treatment of unwanted events require an approach per problem. Because of the obligation for the doctors to perform an evaluation of their professional practices, a proposition to use a method presented by the High Authority of Health was looked for. Considering the necessity of favoring the exchanges between team members, the articulation of two methods was proposed: a morbidity mortality review (MMR) and an analysis of the detailed causes. The objective of the MMR is to analyze the deaths of certain predetermined morbid accidents within a service. The aim of the MMR is to highlight actions for improvement. The analysis of the causes allows the professionals to list all the causes of the problem identified, without limiting themselves to the immediate causes. In this case, a simple method was chosen: the Ishikawa diagram (or fishbone diagram, or also cause-and-effect diagram). A specific Ishikawa diagram for suicide was created by the coordinating physician and was proposed to the team. In the term of the first MMR, the tool was improved by the collective clinical experience and served as support of analysis for the studied events. Three cases related to the evaluation were prepared beforehand by the referent doctor and later presented by him in MMR sessions. For each case, approximately a dozen of professionals were invited to fill in the biography of the patient. A discussion was then engaged by the external doctor on the circumstances of self injuries or suicide attempts. The three detailed analyses of cases were transcribed into a virgin Ishikawa diagram. Furthermore, several points were discussed on the safety aspects

  6. Mortality and morbidity in the 21st century.

    Science.gov (United States)

    Case, Anne; Deaton, Angus

    2017-01-01

    there any evidence in the European data that mortality trends match income trends, in spite of sharply different patterns of median income across countries after the Great Recession. We propose a preliminary but plausible story in which cumulative disadvantage from one birth cohort to the next, in the labor market, in marriage and child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education. This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65. This is in contrast to an account in which resources affect health contemporaneously, so that those in midlife now can expect to do better in old age as they receive Social Security and Medicare. None of this implies that there are no policy levers to be pulled; preventing the over-prescription of opioids is an obvious target that would clearly be helpful.

  7. Can atopic dermatitis be prevented?

    Science.gov (United States)

    Gómez-de la Fuente, E

    2015-05-01

    Atopic dermatitis has become a health problem in our setting due to its rising prevalence, impact on quality of life, associated costs, and role in the progression to other atopic diseases. Furthermore, atopic dermatitis has no definitive cure and therefore preventive measures are important. In this article, we review the latest advances in both primary prevention (reduction of the incidence of atopic dermatitis) and secondary prevention (reduction of associated morbidity and reduction of the atopic march). We analyze the different preventive strategies available, including modification of the immune system through microbial exposure, induction of immune tolerance through antigen exposure, and restoration of skin barrier function to halt the atopic march. Dermatologists need to be familiar with these strategies in order to apply them where necessary and to accurately inform patients and their relatives to prevent misguided or inappropriate actions. Copyright © 2014 Elsevier España, S.L.U. and AEDV. All rights reserved.

  8. Long term complications of diabetes and co-morbidities contributing to atherosclerosis in diabetic population of Mirpur, Azad Kashmir

    International Nuclear Information System (INIS)

    Tariq, C.; Afzal, W.

    2013-01-01

    Objective: To ascertain the prevalence of diabetes mellitus and its chronic complications along with co-morbidities contributing to atherosclerosis in the diabetic population of Mirpur, Azad Kashmir. Methods: The cross-sectional study and was carried out at the Divisional Headquarter Hospital, Mirpur, Azad Kashmir, between January and August 2012. The patients selected were established diabetics. Data was collected through special questionnaire. SPSS version 14 was used to analyse the data. Results: A total 3602 patients were interviewed initially. Of them 318 were diabetics; the prevalence rate being 8.83%. Of the 318 study subjects, 24 (7.3%) had a history of stroke; 4 (1.3%) had history of transient ischaemic attack; 17 (5.3%) had history of myocardial infarction; 27 (8.5%) and had a history of angina. Foot ulcers were present in 22 (6.9%) and 3 (0.9%) had an amputation. Diabetic retinopathy was found in 95 (29.9%), diabetic nephropathy in 25 (7.9%) and diabetic neuropathy in 126 (39.6%). Co-morbid hypertension was found in 153 (48.1%) of cases whereas co-morbid hypercholesterolaemia was found in 66 (20.8%) and 56.9% had family history of diabetes mellitus. Overall, 34 (10.7%) were smokers. Conclusion: Diabetes is responsible for significant morbidity and mortality. Co-morbidities like hypertension and hypercholesterolaemia must be aggressively treated to prevent coronary heart disease. (author)

  9. Listening to women's voices: the quality of care of women experiencing severe maternal morbidity, in Accra, Ghana.

    Directory of Open Access Journals (Sweden)

    Ozge Tunçalp

    Full Text Available BACKGROUND: Women who survive severe obstetric complications can provide insight into risk factors and potential strategies for prevention of maternal morbidity as well as maternal mortality. We interviewed 32 women, in an urban facility in Ghana, who had experienced severe morbidity defined using a standardized WHO near-miss definition and identification criteria. Women provided personal accounts of their experiences of severe maternal morbidity and perceptions of the care they received. METHODS AND FINDINGS: The study took place in a referral facility in urban Accra, and semi-structured interviews were conducted with women who had either a maternal near miss (n = 17 or a potentially life-threatening complication (n = 15. The most common themes surrounding the traumatic delivery were the fear of dying and concern over the potential (or actual loss of the baby. For many women, the loss of a baby negatively influenced how they viewed and coped with this experience. Women's perceptions of the quality of the care highlighted several key factors such as the importance of information, good communication and attitudes, and availability of human (i.e., more doctors and physical resources (i.e., more beds, water at the facility. CONCLUSIONS: Our results suggest that experiences of women with severe maternal morbidity may inform different aspects of quality improvement in the facilities, which in turn have a positive impact on future health seeking behavior, service utilization and reduction in maternal morbidity and mortality.

  10. Managing social awkwardness when caring for morbidly obese patients in intensive care: A focused ethnography.

    Science.gov (United States)

    Hales, Caz; de Vries, Kay; Coombs, Maureen

    2016-06-01

    Critically ill morbidly obese patients pose considerable healthcare delivery and resource utilisation challenges in the intensive care setting. These are resultant from specific physiological responses to critical illness in this population and the nature of the interventional therapies used in the intensive care environment. An additional challenge arises for this population when considering the social stigma that is attached to being obese. Intensive care staff therefore not only attend to the physical and care needs of the critically ill morbidly obese patient but also navigate, both personally and professionally, the social terrain of stigma when providing care. To explore the culture and influences on doctors and nurses within the intensive care setting when caring for critically ill morbidly obese patients. A focused ethnographic approach was adopted to elicit the 'situated' experiences of caring for critically ill morbidly obese patients from the perspectives of intensive care staff. Participant observation of care practices and interviews with intensive care staff were undertaken over a four month period. Analysis was conducted using constant comparison technique to compare incidents applicable to each theme. An 18 bedded tertiary intensive care unit in New Zealand. Sixty-seven intensive care nurses and 13 intensive care doctors involved with the care and management of seven critically ill patients with a body mass index ≥40kg/m(2). Interactions between intensive care staff and morbidly obese patients were challenging due to the social stigma surrounding obesity. Social awkwardness and managing socially awkward moments were evident when caring for morbidly obese patients. Intensive care staff used strategies of face-work and mutual pretence to alleviate feelings of discomfort when engaged in aspects of care and caring. This was a strategy used to prevent embarrassment and distress for both the patients and staff. This study has brought new understandings

  11. Musculoskeletal morbidity among construction workers: A cross-sectional community-based study.

    Science.gov (United States)

    Reddy, Gopireddy M M; Nisha, B; Prabhushankar, Thangaraj G; Vishwambhar, V

    2016-01-01

    Construction industry is one of the stable growing industries in India. People working in construction industries are at a risk of various occupational diseases. Musculoskeletal disorder (MSD) is the single largest cause of work-related illness, accounting for over 33% of all newly reported occupational illnesses in the general population and approximately 77% in construction workers. In spite of the high prevalence and wide range of adverse consequences, the studies highlighting the burden and impact of musculoskeletal morbidities are very scarce in India. The current study is aimed at filling this vital gap in the current knowledge. To assess the musculoskeletal morbidities among construction workers using the modified Nordisk Scale. A cross-sectional community-based study was conducted by 30 × 10 multistage cluster random sampling method in Chennai Metropolitan city. Out of the 308 participants included in the final analysis, majority were 21-40 years. Working hours ranged from 8 to 12 hours. Duration of work ranged from 2 months to 20 years. Out of 308 participants, 104 workers (33.8%) had musculoskeletal problems. Three most common disorders discovered were low backache seen in 64 (20.8%), shoulder pain seen in 36 (11.7%), and wrist pain seen in 36 (11.7%) participants. The proportion of hospitalized participants in the last 1 year was 7.8%. Total duration in the construction field, duration of work hours, and higher age had statistically significant impact on musculoskeletal morbidity. The prevalence of musculoskeletal morbidity was very high in construction workers, with resulting adverse impact on the workers. Immense attention, in the form of appropriate prevention measures, is needed to effectively address this public health problem.

  12. Are English CT departments and radiographers prepared for the morbidly obese patient?

    International Nuclear Information System (INIS)

    Wiles, R.; Meredith, S.M.; Mullany, J.P.; Wiles, T.

    2017-01-01

    Introduction: Morbid obesity is increasing in England, as is the use of CT scanning. All CT scanners have weight and body width limits. It is imperative that the radiographer performing the scan is aware of these limits, particularly in an emergency. This study aim was to determine whether radiographers are aware of their scanner limits, where they may be able to send a patient who exceeds these limits and whether a formal protocol exists. The secondary aim of the study was to determine capacities of scanners in acute trusts throughout England. Methods: CT radiographers from 86 English Hospital Trusts with Emergency Departments were contacted and asked questions regarding their CT scanners and their practice of CT scanning morbidly obese patients. Results: 21% of CT radiographers did not know the maximum width capacity of their scanner. Only 24% knew where a nearby larger capacity scanner was located and only 3% had a formal protocol for scanning obese patients. Weight capacities ranged from 147 to 305 kg. Width capacities ranged from 55 to 100 cm. 70% had weight capacity 226 kg or less and 70% had size capacity of 78 cm or less. Conclusion: Patients over 226 kg or 78 cm may not be accommodated in most (70%) trusts in England. Lack of knowledge of scanner capacities and alternative scanners for morbidly obese patients could have consequences for these patients, particularly in an emergency. The authors advise that all acute trusts have a protocol regarding CT scanning morbidly obese to prevent delays in accessing imaging. - Highlights: • Radiographer knowledge about CT scan capacity is somewhat lacking, potentially delaying emergency management. • Most CT scanners in England will not accommodate patients over 226 kg or 78 cm. • Most centres do not have a formal protocol for CT scanning obese patients. • Animal CT scanners are not likely to be useful alternatives for most patients.

  13. Morbidity and Mortality conference as part of PDCA cycle to decrease anastomotic failure in colorectal surgery.

    Science.gov (United States)

    Vogel, Peter; Vassilev, Georgi; Kruse, Bernd; Cankaya, Yesim

    2011-10-01

    Morbidity and Mortality meetings are an accepted tool for quality management in many hospitals. However, it is not proven whether these meetings increase quality. It was the aim of this study to investigate whether Morbidity and Mortality meetings as part of a PDCA cycle (Plan, Do, Check, Act) can improve the rate of anastomotic failure in colorectal surgery. From January 1, 2004, to December 31, 2009, data for all anastomotic failures in patients operated on for colorectal diseases in the Department of Surgery (Klinikum Friedrichshafen, Germany) were prospectively collected. The events were discussed in Morbidity and Mortality meetings. On the basis of these discussions, a strategy to prevent anastomotic leaks and a new target were defined (i.e. 'Plan'). This strategy was implemented in the following period (i.e. 'Do') and results were prospectively analysed. A new strategy was established when the results differed from the target, and a new standard was defined when the target was achieved (i.e. 'Check, Act'). The year 2004 was set as the base year. In 2005 and 2006, new strategies were established. Comparing this period with the period of strategy conversion (2007-2009), we found a significant decrease in the anastomotic failure rate in colorectal surgery patients (5.7% vs 2.8%; p = 0.05), whereas the risk factors for anastomotic failure were unchanged or unfavourable. If Morbidity and Mortality meetings are integrated in a PDCA cycle, they can decrease anastomotic failure rates and improve quality of care in colorectal surgery. Therefore, the management tool 'PDCA cycle' should be considered also for medical issues.

  14. Hope as determinant for psychiatric morbidity in family caregivers of advanced cancer patients.

    Science.gov (United States)

    Rumpold, T; Schur, S; Amering, M; Ebert-Vogel, A; Kirchheiner, K; Masel, E; Watzke, H; Schrank, B

    2017-05-01

    Home care of advanced cancer patients often has adverse effects on physical and mental health of family caregivers. Little is known about the long-term effects of continuous caregiving on mental health as compared with the effects of bereavement. The objectives of this study were to describe the course of psychiatric morbidity in family caregivers over time, to identify the impact of the patients' death on caregivers, and to explore possible predictor variables for psychiatric morbidity. This multi-institutional, prospective study included 80 family caregivers of 80 advanced cancer patients for baseline and 9 months follow-up assessment. Possible psychiatric disorders (ie, depression, anxiety, posttraumatic stress disorder, and alcohol abuse/dependence) as well as potentially predictive factors (ie, sociodemographic factors, burden, hope, and coping mechanisms) were assessed. Follow-up assessment was conducted on average 9.2 months (±2.9) after baseline assessment. Prevalence rates of anxiety and posttraumatic stress disorder decreased significantly over time, whereas depression and alcoholism remained stable. Bereavement was experienced by 53% of caregivers in the follow-up period. The patients' death had no influence on psychiatric morbidity at follow-up. Predictors for the development of a psychiatric disorder varied according to condition, with hope and emotion-oriented coping identified as important influences, especially for anxiety and depression. Family caregivers with certain psychiatric disorders might need targeted psychosocial support to ensure their mental well-being and prevent long-term disability. Supporting hope and functional coping strategies early after the patient's diagnosis might limit development and extent of psychiatric morbidity. Copyright © 2016 John Wiley & Sons, Ltd.

  15. Association between childhood abuse and psychiatric morbidities among hospitalized patients

    Directory of Open Access Journals (Sweden)

    Kshirod Kumar Mishra

    2016-01-01

    Full Text Available Background: Childhood abuse has been linked with increased risk of adult psychiatric disorders including major depression, substance abuse, anxiety disorders, posttraumatic stress disorder, and personality disorders. However, only a few from India attempted to study long-term consequences of childhood abuse. Our study aimed to understand the role of physical, sexual, and emotional abuse along with psychiatric co-morbidities in hospitalized patients. Materials and Methods: Patients admitted to psychiatric inpatient services in the age group of 14-45 years for the 1 st time were evaluated for a history of physical, sexual, and emotional abuse on the basis of retrospective chart review. Semi-structured Performa was used to evaluate the patient with a history of child abuse, and they were diagnosed according to International Classification of Diseases-10 diagnostic criteria. Result: The prevalence of child abuse in our inpatient services was 43.29%; emotional abuse (61.9% was most commonly reported among patient followed by physical (21.43% and sexual abuse (16.67%. We observed a significant difference in terms of length of hospital stay between abuse (10.29 ± 6.01 days and nonabuse group (5.90 ± 2.43 days (t = 4.902, df = 95, P < 0.0001. The boys experienced physical abuse at a younger age (7.43 ± 2.50 years than girls (13.50 ± 0.70 years. The sexual abuse and emotional abuse were reported at a younger age in girls than boys. We found high prevalence of substance use disorders (40.47%, psychosis (19.04%, and mood disorder (28.57% among abuse group. Conclusions: The study findings highlight the developing importance of the different forms of abuse on adult psychiatric diagnosis in India. The abused patients are at high risk of the development of psychiatric disorder than the nonabuse group. The increased length of hospitalization among abused group reflects severity and complexity of child abuse. The early detection of social factors

  16. Acoustics SIMOPS: managing the unnecessary

    Energy Technology Data Exchange (ETDEWEB)

    Hanton, Samuel John [Nautronix Marine Technology Solutions, Rio de Janeiro, RJ (Brazil)

    2012-07-01

    Time is money, and offshore operations are expensive. The desire therefore, is to increase efficiency through the condensing of schedules. This inevitably leads to SIMOPS of some degree, and this paper discusses SIMOPS along with, more specifically, the challenges they provide to acoustic positioning. (author)

  17. [Trends in pertussis mortality and morbidity in Colombia, 2002-2012].

    Science.gov (United States)

    Cardona, Doris; Garzón, María Osley; Calle, Mateo; Agudelo, Maite Catalina; Segura, Ángela

    2016-09-01

    Whooping cough is a public health problem that mainly affects children under one year of age with highly lethal outcomes. It is a re-emerging disease, which is preventable by immunization. Objective: To analyze mortality and morbidity trends of whooping cough in Colombia between 2002 and 2012. Materials and methods: We conducted a quantitative descriptive study of deaths by pertussis between 2002 and 2012 using data from death certificates registered by the Departamento Administrativo Nacional de Estadística, and cases reported to the Sistema Nacional de Vigilancia en Salud Pública, 2005-2012. Frequency measurements, morbidity and mortality ratios and female increased mortality were calculated. Results: Fifty one point two percent of the deaths occurred in women; the year with more deaths was 2012; 67.3% occurred in urban areas, and 43.5% of the subjects were affiliated to the subsidized health regime. The risk of illness was 1.88 per 1,000 live births with increased risk in Vaupés and Vichada. The risk of death was 0.02 per 1,000 live births; there was a decrease in the lethality trend. Conclusions: Pertussis has reemerged with increasing mortality and morbidity. Since this is a preventable disease through vaccination, it is advisable to increase control and enhance vaccination coverage in both children and adults, who are an important reservoir of the disease. The effective control of pertussis demands continued work aimed at early identification. It is also necessary to carry out actions to improve data quality in order to facilitate its analysis and the generation of more valid information.

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

    Science.gov (United States)

    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.

  19. Sources of stress and psychological morbidity among undergraduate physiotherapy students.

    Science.gov (United States)

    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, Pphysiotherapy 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.

  20. PSYCHIATRIC MORBIDITY AND PERSONALITY PROFILE IN DIVORCE SEEKING COUPLES

    Science.gov (United States)

    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

  1. Ethnicity-specific birthweight distributions improve identification of term newborns at risk for short-term morbidity.

    Science.gov (United States)

    Hanley, Gillian E; Janssen, Patricia A

    2013-11-01

    We aimed to determine whether ethnicity-specific birthweight distributions more accurately identify newborns at risk for short-term neonatal morbidity associated with small for gestational age (SGA) birth than population-based distributions not stratified on ethnicity. We examined 100,463 singleton term infants born to parents in Washington State between Jan. 1, 2006, and Dec. 31, 2008. Using multivariable logistic regression models, we compared the ability of an ethnicity-specific growth distribution and a population-based growth distribution to predict which infants were at increased risk for Apgar score distributions had the highest rates of each of the adverse outcomes assessed-more than double those of infants only considered SGA by the population-based standards. When controlling for mother's age, parity, body mass index, education, gestational age, mode of delivery, and marital status, newborns considered SGA by ethnicity-specific birthweight distributions were between 2 and 7 times more likely to suffer from the adverse outcomes listed above than infants who were not SGA. In contrast, newborns considered SGA by population-based birthweight distributions alone were at no higher risk of any adverse outcome except hypothermia (adjusted odds ratio, 2.76; 95% confidence interval, 1.68-4.55) and neonatal intensive care unit admission (adjusted odds ratio, 1.40; 95% confidence interval, 1.18-1.67). Ethnicity-specific birthweight distributions were significantly better at identifying the infants at higher risk of short-term neonatal morbidity, suggesting that their use could save resources and unnecessary parental anxiety. Copyright © 2013 Mosby, Inc. All rights reserved.

  2. [Tuberculosis and diabetes co-morbidity: an unresolved problem].

    Science.gov (United States)

    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.

  3. [Incidence of fetal macrosomia: maternal and fetal morbidity].

    Science.gov (United States)

    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.

  4. Morbidly Adherent Placenta: Interprofessional Management Strategies for the Intrapartum Period.

    Science.gov (United States)

    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.

  5. Possibly preventable cardiac arrest in a morbidly obese patient - a comment on the 2015 ERC guidelines.

    Science.gov (United States)

    Hans, Felix Patricius; Hoeren, Claudia Johanna Maria; Kellmeyer, Phillipp; Hohloch, Lisa; Busch, Hans-Jörg; Bayer, Jörg

    2016-10-04

    The incidence of overweight and obesity has been steadily on the rise and has reached epidemic proportions in various countries and this represents a well-known major health problem. Nevertheless, current guidelines for resuscitation do not include special sequences of action in this subset of patients. The aim of this letter is to bring this controversy into focus and to suggest alterations of the known standard cardiopulmonary resuscitation in the obese. An obese patient weighing 272 kg fell to the floor, afterwards being unable to get up again. Thus, emergency services were called for assistance. There were no signs or symptoms signifying that the person had been harmed in consequence of the fall. Only when brought into a supine position the patient suffered an immediate cardiac arrest. Cardiopulmonary resuscitation was performed but there was no return of a stable spontaneous circulation until the patient was brought into a full lateral position. In spite of immediate emergency care the patient ultimately suffered a lethal hypoxic brain damage. A full lateral position should be considered in obese patients having a cardiac arrest as it might help to re-establish stable circulatory conditions.

  6. Preventing infant and child morbidity and mortality due to maternal depression.

    Science.gov (United States)

    Surkan, Pamela J; Patel, Shivani A; Rahman, Atif

    2016-10-01

    This review provides an overview of perinatal depression and its impacts on the health of mothers, their newborns, and young children in low- and middle-income countries (LMICs). We define and describe the urgency and scope of the problem of perinatal depression for mothers, while highlighting some specific issues such as suicidal ideation and decreased likelihood to seek health care. Pathways through which stress may link maternal depression to childhood growth and development (e.g., the hypo-pituitary axis) are discussed, followed by a summary of the adverse effects of depression on birth outcomes, parenting practices, and child growth and development. Although preliminary studies on the association between maternal depressive symptoms and maternal and child mortality exist, more research on these topics is needed. We describe the available interventions and suggest strategies to reduce maternal depressive symptoms in LMICs, including integration of services with existing primary health-care systems. Copyright © 2016. Published by Elsevier Ltd.

  7. Morbidity, self-perceived health and mortality among non-Western Immigrants and their descendants in Denmark in a life phase perspective

    DEFF Research Database (Denmark)

    Jervelund, Signe Smith; Malik, Sanam; Ahlmark, Nanna

    2017-01-01

    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...

  8. Intragastric balloon for morbid obesity causing chronic gastric dilatation

    Energy Technology Data Exchange (ETDEWEB)

    Pretolesi, F.; Derchi, L.E. [Dept. of Radiology, University of Genoa (Italy); Redaelli, G.; Papagni, L. [IRCCS, Ist. Auxologico Italiano, Milan (Italy)

    2001-04-01

    We describe the radiographic findings observed in a morbidly obese and diabetic patient with an intragastric air-filled balloon introduced as a therapeutic measure to reduce food intake. The balloon was associated with chronic gastric dilatation and had to be removed 3 months after insertion. However, together with diet and behavioural therapy, it proved effective in reducing body weight and ameliorating glycaemic control. Although rarely used, intragastric balloons for the treatment of morbid obesity are still encountered in radiological practice. Radiologists must be able to recognize them and to understand their complications. (orig.)

  9. Morbidity Status Of Slum Dwelling Children Of Lucknow City

    Directory of Open Access Journals (Sweden)

    Anish Khanna

    1995-09-01

    Full Text Available The presen study was carried out to find out the level of morbidity among slum childreni aged 5-14 years, It was found tha t46.4% of children were ill at the lime of study. The prevalence of various illnesses hcu studied. An aiuilysis of morbidity with social variables mi not found to be significant. 19.3% children has dental disorders and 45.8% children has parasites infestation of llieG I Tract. 57.6% of children vere having one or the other be­havioural problems.

  10. Hepatic effects of dietary weight loss in morbidly obese subjects

    DEFF Research Database (Denmark)

    Andersen, T; Gluud, C; Franzmann, Magnus

    1991-01-01

    = 0.026). Liver biochemistry, which was of no individual diagnostic value, improved. It is concluded that morbidly obese subjects with a high degree of hepatic fatty change are at risk of developing portal inflammation and fibrosis when undergoing very fast dietary weight reductions.......This prospective study was carried out in order to evaluate the influence on liver morphology and function of a very-low-calorie formula diet. Fourty-one morbidly obese, non-alcoholic subjects had liver biopsy performed before and after a median weight loss of 34 kg. Fatty change improved (p less...

  11. Influence of alcoholism on morbidity after transurethral prostatectomy

    DEFF Research Database (Denmark)

    Tønnesen, H; Schütten, B T; Tollund, L

    1988-01-01

    Morbidity after transurethral resection of the prostate gland was retrospectively investigated by comparing 73 alcoholics with 73 controls (daily alcohol consumption greater than or equal to 60 g vs. less than 25 g). The compared groups derived from 1,172 patients and were matched for diagnosis......, age, weight, smoking habits, treatment for cardiovascular, pulmonary or endocrine diseases, anaesthesia and weight of resected tissue. The postoperative morbidity was significantly higher in the alcohol group than in the controls (62% vs. 20%). Follow-up at 1, 3 and 12 months revealed significantly...... more complications among the alcoholics and also more frequent requirement of supplementary procedures than in the controls....

  12. The lived experiences of being physically active when morbidly obese

    DEFF Research Database (Denmark)

    Toft, Bente Skovsby; Uhrenfeldt, Lisbeth

    2015-01-01

    The aim is to identify facilitators and barriers for physical activity (PA) experienced by morbidly obese adults in the Western world. Inactivity and a sedentary lifestyle have become a major challenge for health and well-being, particularly among persons with morbid obesity. Lifestyle changes may...... lead to long-term changes in activity level, if facilitators and barriers are approached in a holistic way by professionals. To develop lifestyle interventions, the perspective and experiences of this group of patients are essential for success. The methodology of the systematic review followed...... active....

  13. Tourette syndrome, co-morbidities and quality of life.

    Science.gov (United States)

    Eapen, Valsamma; Snedden, Corina; Črnčec, Rudi; Pick, Anna; Sachdev, Perminder

    2016-01-01

    Tourette syndrome is often associated with attention deficit hyperactivity disorder, obsessive compulsive disorder and other co-morbidities, the presence of which can reduce health-related quality of life. The relationship between the number and type of co-morbidities and tic severity upon health-related quality of life has been insufficiently examined in Tourette syndrome populations and not at all in the Australian context. We hypothesised that an increased number of co-morbid diagnoses would be inversely related to health-related quality of life and that the presence of attention deficit hyperactivity disorder and obsessive compulsive disorder in particular would negatively impact health-related quality of life. In all, 83 people with a previously established diagnosis of Tourette syndrome, who responded to a letter of invitation sent to the Tourette Syndrome Association of Australia past-member database, formed the study sample. Participants completed the Gilles de la Tourette Syndrome-Quality of Life Scale and a short form of the National Hospital Interview Schedule to assess tics and related behaviours. Participants with pure-Tourette syndrome had significantly better health-related quality of life than those with Tourette syndrome and three or more co-morbid diagnoses. Few differences were observed between the pure-Tourette syndrome and Tourette syndrome and one or two co-morbid diagnoses groups. Analysis of the impact of individual co-morbid disorders and Tourette syndrome symptoms on health-related quality of life indicated that attention deficit hyperactivity disorder exerted a significant negative effect, as did the presence of complex tics, especially coprolalia and copropraxia. When these variables were examined in multiple regression analysis, number of co-morbidities and the presence of coprophenomena emerged as significant predictors of health-related quality of life. While tics are the defining feature of Tourette syndrome, it appears to be the

  14. Intragastric balloon for morbid obesity causing chronic gastric dilatation

    International Nuclear Information System (INIS)

    Pretolesi, F.; Derchi, L.E.; Redaelli, G.; Papagni, L.

    2001-01-01

    We describe the radiographic findings observed in a morbidly obese and diabetic patient with an intragastric air-filled balloon introduced as a therapeutic measure to reduce food intake. The balloon was associated with chronic gastric dilatation and had to be removed 3 months after insertion. However, together with diet and behavioural therapy, it proved effective in reducing body weight and ameliorating glycaemic control. Although rarely used, intragastric balloons for the treatment of morbid obesity are still encountered in radiological practice. Radiologists must be able to recognize them and to understand their complications. (orig.)

  15. Parental rheumatoid arthritis and long-term child morbidity

    DEFF Research Database (Denmark)

    Rom, Ane Lilleøre; Wu, Chun Sen; Olsen, Jørn

    2015-01-01

    OBJECTIVE: To estimate the influence of parental rheumatoid arthritis (RA) on child morbidity. DESIGN: Nationwide cohort study. SETTING: Individual linkage to nationwide Danish registries. PARTICIPANTS: All singletons born in Denmark during 1977-2008 (n=1 917 723) were followed for an average of 16...... years. MAIN OUTCOME MEASURES: Adjusted HRs for child morbidity; that is, 11 main diagnostic groups and specific autoimmune diseases within the International Classification of Diseases 8th and 10th versions. RESULTS: Compared with unexposed children, children exposed to maternal RA ('clinical...

  16. Ureaplasma species: role in neonatal morbidities and outcomes.

    Science.gov (United States)

    Viscardi, Rose Marie

    2014-01-01

    The genital mycoplasma species, Ureaplasma parvum and Ureaplasma urealyticum are the most common organisms isolated from infected amniotic fluid and placentas, and they contribute to adverse pregnancy outcomes including preterm birth and neonatal morbidities. In our institution, almost half of the preterm infants of less than 32 weeks gestation are Ureaplasma-positive in one or more compartment (respiratory, blood and/or cerebrospinal fluid), indicating that these organisms are the most common pathogens affecting this population. This review will focus on the compelling epidemiological and experimental evidence linking perinatal Ureaplasma species exposure to important morbidities of prematurity, such as bronchopulmonary dysplasia, intraventricular haemorrhage and necrotising enterocolitis.

  17. Cancer morbidity among workers in the telecommunications industry.

    Science.gov (United States)

    Vågerö, D; Ahlbom, A; Olin, R; Sahlsten, S

    1985-03-01

    A retrospective cohort study of 2918 workers in the telecommunications industry in Sweden recorded the cancer morbidity for the period 1958-79. Cases of cancer were collected from the Swedish Cancer Registry for this period and information on work characteristics was collected for the entire period of employment. The total cancer morbidity was as expected. There was no excess risk of lung cancer but an excess risk of malignant melanoma of the skin was detected (SMR = 2.6, 12 cases). This excess risk was particularly associated with work environments where soldering was practised. Estimates of the SMR became larger with the assumption of a longer induction/latency period.

  18. Trials and projects on cervical cancer and human papillomavirus prevention in sub-Saharan Africa.

    Science.gov (United States)

    Adefuye, Peter O; Broutet, Nathalie J; de Sanjosé, Silvia; Denny, Lynette A

    2013-12-29

    Cervical cancer is the leading cause of cancer morbidity and mortality in women in sub-Saharan Africa (SSA), accounting for about 50,000 deaths annually. Until recently, cytology was the gold standard for screening and prevention of cervical cancer. This method of screening has not been successful in SSA due to a lack of human, financial and material resources and poor health care infrastructure. It is estimated that less than 5% of at risk women have ever being screened. In the past two decades alternative approaches to cytology for cervical cancer screening have been evaluated in low- and medium-income countries. Visual inspection with acetic acid (VIA) and/or Lugol's iodine (VILI) have been shown to have adequate sensitivity, although low specificity, in a number of cross-sectional research and demonstration projects. Visual inspection methods require minimal resources, are technologically accessible, and are feasible for screening for precancerous lesions. Linking screening with VIA/VILI to treatment with cryotherapy may enable screening and treatment to take place in one visit, but this is likely to result in large numbers of women being subjected to unnecessary treatment. A number of studies have shown that cryotherapy is not associated with significant side effects or complications and is well tolerated. Creating the infrastructure for screening of older women is considered desirable, despite the limitations of visual inspection methods as screening tests. Understanding the role of human papillomavirus (HPV) infection in the etiology of cervical cancer and the discovery of HPV rapid test kits, as well as the development of vaccines against the HPV oncogenic types, have created new opportunities for prevention of cervical cancer. Trials and projects have established (and are still ongoing) the feasibility of using these molecular tests for screening. The ultimate in prevention method is primary prevention, offered by the advent of prophylactic vaccines

  19. Reducing unnecessary culturing: a systems approach to evaluating urine culture ordering and collection practices among nurses in two acute care settings

    Directory of Open Access Journals (Sweden)

    Robert Redwood

    2018-01-01

    Full Text Available Abstract Background Inappropriate ordering and acquisition of urine cultures leads to unnecessary treatment of asymptomatic bacteriuria (ASB. Treatment of ASB contributes to antimicrobial resistance particularly among hospital-acquired organisms. Our objective was to investigate urine culture ordering and collection practices among nurses to identify key system-level and human factor barriers and facilitators that affect optimal ordering and collection practices. Methods We conducted two focus groups, one with ED nurses and the other with ICU nurses. Questions were developed using the Systems Engineering Initiative for Patient Safety (SEIPS framework. We used iterative categorization (directed content analysis followed by summative content analysis to code and analyze the data both deductively (using SEIPS domains and inductively (emerging themes. Results Factors affecting optimal urine ordering and collection included barriers at the person, process, and task levels. For ED nurses, barriers included patient factors, physician communication, reflex culture protocols, the electronic health record, urinary symptoms, and ED throughput. For ICU nurses, barriers included physician notification of urinalysis results, personal protective equipment, collection technique, patient body habitus, and Foley catheter issues. Conclusions We identified multiple potential process barriers to nurse adherence with evidence-based recommendations for ordering and collecting urine cultures in the ICU and ED. A systems approach to identifying barriers and facilitators can be useful to design interventions for improving urine ordering and collection practices.

  20. Implementation of a Computerized Order Entry Tool to Reduce the Inappropriate and Unnecessary Use of Cardiac Stress Tests With Imaging in Hospitalized Patients.

    Science.gov (United States)

    Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Balderston, Jessica R; Litwack, Andrew J; Goldberg, Lee R

    2016-10-15

    The rising use of imaging cardiac stress tests has led to potentially unnecessary testing. Interventions designed to reduce inappropriate stress testing have focused on the ambulatory setting. We developed a computerized order entry tool intended to reduce the use of imaging cardiac stress tests and improve appropriate use in hospitalized patients. The tool was evaluated using preimplementation and postimplementation cohorts at a single urban academic teaching hospital. All hospitalized patients referred for testing were included. The co-primary outcomes were the use of imaging stress tests as a percentage of all stress tests and the percentage of inappropriate tests, compared between the 2 cohorts. There were 478 patients in the precohort and 463 in the postcohort. The indication was chest pain in 66% and preoperative in 18% and was not significantly different between groups. The use of nonimaging stress tests increased from 4% in the pregroup to 15% in the postgroup (p nonimaging stress tests increased from 7% to 25% (p nonimaging cardiac stress tests and reduced the use of imaging tests yet was not able to reduce inappropriate use. Our study highlights the differences in cardiac stress testing between hospitalized and ambulatory patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Importance of diagnostic laboratory methods of beta hemolytic streptococcus group A in comparison with clinical findings in the diagnosis of streptococcal sore throat and unnecessary antibacterial therapy

    Directory of Open Access Journals (Sweden)

    Peiman Eini

    2012-04-01

    Full Text Available Background: Streptococcus Pyogenes (group A streptococcus, GAS is the most important cause of bacterial pharyngitis in children and adolescents. Acute pharyngitis is one of the most common conditions in all ages but it is most common in children. Over diagnosis of acute pharyngitis represents one of the major causes of antibiotic abuse. The goal of this study is to make an estimate of the frequency of group A streptococcus in sore throat patients in Farshchian hospital emergency department and clinic in Hamadan. Methods: For estimation of the clinical features role in diagnosis of streptococcal sore throat, we took samples of 100 patients with average age of 32.96±29.86 years with sore throat. We took samples from pharynx and used standard methods of bacteriology in order to detect streptococcus. Results: Group A Streptococcus (GAS accounts for 3 percent of all cases of pharyngitis. Clinically, all of the patients had sore throat. The percent breakdowns are as follows: 30% had exudate, 78% had fever, 8% had lymphadenopathy and 7.7 percent of exudative pharyngitis was streptococcal. The cost for unnecessary antibiotic therapy for every single patient who had negative pharynx culture was approximately 32160 Rails. Conclusion: The low frequency of streptococcus pharyngitis in treated patients reveal that diagnosis based on clinical features is not reliable. We recommend use of other diagnostic methods such as Rapid Antigen Detection Tests (RATs. Only reliable and scientific protocols for antibiotic to therapy.

  2. Spontaneous preterm birth : prevention, management and outcome

    NARCIS (Netherlands)

    Vermeulen, Gustaaf Michiel

    1999-01-01

    Preterm birth (birth before 37 completed weeks of pregnancy) is a major cause of perinatal morbidity and mortality. Strategies to prevent and adequately treat preterm labour, in order to postpone birth and to identify risk factors for neonatal damage due to preterm birth, have to be developed by

  3. . ORIGINAL ARTICLES Prevention and treatment of cardiovascular ...

    African Journals Online (AJOL)

    Reasons for high morbidity and mortality associated with ... particular reference to the management of haemodynainic instability. S Afr Med! ... (iii) the performance of both anaesthesia and surgery by the ... Safe practice of spinal anaesthesia includes both prevention of ... Despite a prior obstetric or general medical work-.

  4. Salmonella Prevention

    Science.gov (United States)

    ... and in vegetable and fruit harvesting and packing operations may help prevent salmonellosis caused by contaminated foods. Better education of food industry workers in basic food safety and restaurant inspection procedures may prevent cross-contamination and other ...

  5. A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain

    Directory of Open Access Journals (Sweden)

    Descarreaux Martin

    2011-02-01

    preventive phase of the trial. This hypothesis was not supported by the study results. Lack of a treatment specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies. Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to NCNP. Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP. Trial registration ClinicalTrials.gov: NCT00566930

  6. Influence of alcoholism on morbidity after transurethral prostatectomy

    DEFF Research Database (Denmark)

    Tønnesen, H; Schütten, B T; Tollund, L

    1988-01-01

    , age, weight, smoking habits, treatment for cardiovascular, pulmonary or endocrine diseases, anaesthesia and weight of resected tissue. The postoperative morbidity was significantly higher in the alcohol group than in the controls (62% vs. 20%). Follow-up at 1, 3 and 12 months revealed significantly...

  7. Independent risk factors of morbidity in penetrating colon injuries.

    Science.gov (United States)

    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.

  8. Psychiatric morbidity in patients with chronic whiplash-associated disorder.

    Science.gov (United States)

    Kivioja, Jouko; Själin, Mikael; Lindgren, Urban

    2004-06-01

    Prospective cohort with age- and gender-matched controls. To compare psychiatric morbidity between two groups: patients having chronic symptoms after a whiplash injury and patients who recovered completely. Psychiatric morbidity may influence the outcome of somatic diseases, and it has been suggested that psychological factors are often involved in the development of chronic symptoms after whiplash injuries, but there is no study assessing psychiatric morbidity in whiplash-associated disorder (WAD) using the Structured Clinical Interview for DSM-IV. We studied a consecutive sample of 278 patients with a whiplash injury. Eighty-five had persisting neck pain after 1 year, and 38 of these participated in this study. For each patient with chronic neck pain at the 1 year follow-up, a gender- and age-matched recovered patient was selected from the study cohort of 278 cases. Psychiatric morbidity was determined using the Structured Clinical Interview for DSM-IV (SCID). The interview was conducted at 1 year after the accident (360 days, SD 2 days). The chronic WAD group had a significantly (P factor for chronic symptoms after a whiplash injury. The development of chronic symptoms after awhiplash injury seems to be associated with psychiatric vulnerability.

  9. Post induced abortion morbidity and mortality in Oleh, Nigeria ...

    African Journals Online (AJOL)

    The aim of this retrospective study was to determine the maternal morbidity and mortality among 87patient treated at the Central Hospital, Oleh, Delta State, Nigeria, for complications of induced abortion from January 1st 2004 to December 31st 2008. The total number of maternal admissions and deaths, over the period ...

  10. Profile of Co-morbidities in the Obese

    Directory of Open Access Journals (Sweden)

    Salati SA

    2015-07-01

    Full Text Available Objective: To study the profile of co-morbidities in obese patients reporting for bariatric surgical procedures. Methods: A retrospective study was conducted at the Bariatric Surgery Unit of Department of Surgery of the College of Medicine, Qassim University, Saudi Arabia. The records of all the obese patients (with Body Mass Index greater than 30, evaluated in the department over the period of two years from Jan 2012 to Dec 2014, were studied and co-morbidities were sought in all subjects. Results: Of the 172 subjects, 76.2% (n=131 were female and 23.8% (n=41 male. The age ranged from 17–49 years (Mean 29.9 years; Mode 28 years. The weight ranged from 82 kg–146kg and BMI ranged from 33–54 (mean BMI 44.7 kg/m. Out of the total of 172 patients, 96 (56 % including 72 females and 24 males had one or more co-morbidities. Conclusion: A wide range of co-morbidities occur in obese patients that have the potential to decrease the quality of life and the life span.

  11. Using perinatal morbidity scoring tools as a primary study outcome.

    Science.gov (United States)

    Hutcheon, Jennifer A; Bodnar, Lisa M; Platt, Robert W

    2017-11-01

    Perinatal morbidity scores are tools that score or weight different adverse events according to their relative severity. Perinatal morbidity scores are appealing for maternal-infant health researchers because they provide a way to capture a broad range of adverse events to mother and newborn while recognising that some events are considered more serious than others. However, they have proved difficult to implement as a primary outcome in applied research studies because of challenges in testing if the scores are significantly different between two or more study groups. We outline these challenges and describe a solution, based on Poisson regression, that allows differences in perinatal morbidity scores to be formally evaluated. The approach is illustrated using an existing maternal-neonatal scoring tool, the Adverse Outcome Index, to evaluate the safety of labour and delivery before and after the closure of obstetrical services in small rural communities. Applying the proposed Poisson regression to the case study showed a protective risk ratio for adverse outcome following closures as compared with the original analysis, where no difference was found. This approach opens the door for considerably broader use of perinatal morbidity scoring tools as a primary outcome in applied population and clinical maternal-infant health research studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Constipation and Colonic Transit Times in Children With Morbid Obesity

    NARCIS (Netherlands)

    van der Baan-Slootweg, Olga H.; Liem, Olivia; Bekkali, Noor; van Aalderen, Wim M. C.; Rijcken, Tammo H. Pels; Di Lorenzo, Carlo; Benninga, Marc A.

    2011-01-01

    Objectives: The aim of the study was to determine the frequency of functional constipation according to the Rome III criteria in children with morbid obesity and to evaluate by measuring colonic transit times (CTTs) whether decreased colonic motility is present in these children. Patients and

  13. Morbidity And Quality Of Life Among Head And Neck Cancer ...

    African Journals Online (AJOL)

    Objectives: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy. Design: A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi. Subjects: Thirty eight patients comprising 28 males and ...

  14. Laparoscopic Sleeve Gastrectomy Improves Olfaction Sensitivity in Morbidly Obese Patients.

    Science.gov (United States)

    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.

  15. Psychiatric Morbidity among Subjects with Leprosy and Albinism in ...

    African Journals Online (AJOL)

    Background: Skin, which is the largest organ in the body, carries immense psychological significance. Disfiguring skin disorders may impact negatively on the mental health of individuals. Aim: This study compared the psychiatric morbidity of subjects with leprosy and albinism. Subjects and Methods: One hundred subjects ...

  16. Shoulder morbidity after non-surgical treatment of the neck

    International Nuclear Information System (INIS)

    Wouwe, Merian van; Bree, Remco de; Kuik, Dirk J.; Goede, Cees J.T. de; Verdonck-de Leeuw, Irma M.; Doornaert, Patricia; Rene Leemans, C.

    2009-01-01

    Background and purpose: Reports on shoulder function after non-surgical treatment are not available. In the present study shoulder morbidity after surgical and non-surgical treatment of the neck is determined and compared. Materials and methods: In 100 head and neck cancer patients 174 neck sides were treated by surgery (n = 51) or (chemo)radiation (n = 123). Abduction, anteflexion, endorotation and exorotation were assessed. Subjective measurements were performed using the Visual Analogue Scale for pain, the Shoulder Disability Questionnaire (SDQ) and stiffness reporting. Results: Predictive factors for SDQ-score > 0 (n = 54) were VAS pain score, stiffness, abduction, anteflexion, physiotherapy, low shoulder position and surgical treatment. The SDQ, stiffness and pain scores were significantly higher in the surgically treated group than in the non-surgical group (p < 0.01). Anteflexion, abduction and exorotation were less impaired in the non-surgically treated group than in the surgically treated group (p < 0.01). No differences between neck dissection and neck dissection with post-operative radiotherapy, and radiotherapy and chemoradiation were found for these movements. Conclusions: Shoulder morbidity is often present after non-surgical treatment of the neck, but to a lesser extent compared to surgical treatment. Radiotherapy adds no morbidity to neck dissection and chemotherapy does not add extra morbidity to primary radiation

  17. Morbidity prior to a Diagnosis of Sleep-Disordered Breathing

    DEFF Research Database (Denmark)

    Jennum, Poul; Ibsen, Rikke Falkner; Kjellberg, Jakob

    2013-01-01

    Sleep-disordered breathing (SDB) causes burden to the sufferer, the healthcare system, and society. Most studies have focused on cardiovascular diseases (CVDs) after a diagnosis of obstructive sleep apnea (OSA) or obesity hypoventilation syndrome (OHS); however, the overall morbidity prior...

  18. Interleukin-17A Gene Expression in Morbidly Obese Women

    Directory of Open Access Journals (Sweden)

    Fernando Zapata-Gonzalez

    2015-07-01

    Full Text Available Data from recent studies conducted in rodent models and humans suggest that interleukin-17A (IL-17A plays a role in the induction of inflammation in adipose tissue during obesity. The aim of this study was to assess the gene expression of IL-17A in adipose tissue of morbidly obese patients. We used RT-PCR to evaluate the expression of IL-17A and several adipo/cytokines in the visceral adipose tissue (VAT and subcutaneous adipose tissue (SAT of 10 normal-weight control women (BMI < 25 kg/m2 and 30 morbidly obese women (MO, BMI > 40 kg/m2. We measured serum levels of IL-17A and adipo/cytokines in MO and normal weight women. IL-17A expression was significantly higher in VAT than in SAT in MO patients (p = 0.0127. It was very low in normal-weight controls in both VAT and SAT tissues. We found positive correlations between IL-17A and IL-6, lipocalin-2 and resistin in VAT of MO patients. The circulating level of IL-17A was higher in the normal-weight group than the MO patients (p = 0.032, and it was significantly related to adiponectin and TNFRII levels. In conclusion, IL-17A expression in VAT is increased in morbidly obese women, which suggests a link between obesity and innate immunity in low-grade chronic inflammation in morbidly obese women.

  19. Urban air pollution, climate and its impact on asthma morbidity

    Directory of Open Access Journals (Sweden)

    Lyudmila Vasilievna Veremchuk

    2016-01-01

    Conclusions: We determined that asthma morbidity depends from general air pollution (in the range of 18.3%. It was detected that the highest age-specific dependence is associated with the content of particulate matter, carbon monoxide and nitrogen dioxide in air.

  20. Delusional patterns and its pre-morbid personality linkages in ...

    African Journals Online (AJOL)

    DSM IVTR, psychological tests: MMPI, SCL-90R and clinical observations were used for the diagnosis of the patients according to the centre policy. Two recording scales designed by the researchers were used to assign the participants to different types of delusions and pre-morbid personalities. The study design was a ...

  1. Morbidity and Mortality of Hartmann's Procedure for Sigmoid ...

    African Journals Online (AJOL)

    Background: The restoration of intestinal continuity following Hartmann's procedure is associated with high morbidity and mortality rates and low restoration rate. Objective: To determine the causes of complications and deaths associated with Hartmann's procedure and the secondary restoration of digestive continuity for ...

  2. Duodenal Obstruction: Etiology, Morbidity and Mortality among Edo ...

    African Journals Online (AJOL)

    Duodenal obstruction in children is associated with poor outcome which has improved in developed but remained poor in developing countries. The objective of this study was to ascertain the etiology, morbidity, mortality and factors that contributed to poor outcome in a developing country. Retrospective analysis of pediatric ...

  3. The Diabetic Postoperative Mortality and Morbidity (DIPOM) trial

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Wetterslev, Jørn; Kofoed-Enevoldsen, Allan

    2004-01-01

    Recent trials suggest that perioperative beta-blockade reduces the risk of cardiac events in patients with a risk of myocardial ischemia who are undergoing noncardiac surgery. Patients with diabetes mellitus are at a high-risk for postoperative cardiac morbidity and mortality. They may, therefore...

  4. Renal tubular acidosis secondary to jejunoileal bypass for morbid obesity

    DEFF Research Database (Denmark)

    Schaffalitzky de Muckadell, O B; Ladefoged, Jens; Thorup, Jørgen Mogens

    1985-01-01

    Renal handling of acid and base was studied in patients with persistent metabolic acidosis 3-9 years after jejunoileal bypass for morbid obesity. Excretion of acid was studied before and after intravenous infusion of NH4Cl and excretion of bicarbonate after infusion of NaHCO3. Bypass patients...

  5. Alcohol-related morbidity and mortality within siblings

    DEFF Research Database (Denmark)

    Søndergaard, Grethe; Osler, Merete; Andersen, Anne-Marie Nybo

    2015-01-01

    AIMS: To estimate the association between educational status and alcohol-related somatic and non-somatic morbidity and mortality among full siblings in comparison with non-related individuals. DESIGN: Cohort study. SETTING: Denmark. PARTICIPANTS: Approximately 1.4 million full siblings born in De...

  6. Psychiatry Morbidity and Mortality Rounds: Implementation and Impact

    Science.gov (United States)

    Goldman, Stuart; Demaso, David R.; Kemler, Beth

    2009-01-01

    Objective: This study assessed the implementation of psychiatry morbidity and mortality rounds (M&Ms) on the clinical and educational practice in a children's hospital. Methods: Attendees to monthly M&Ms between July 2005 and May 2007 included staff and trainees from psychiatry, psychology, nursing, and social work. Cases were selected based on a…

  7. The correlates of stress, coping styles and psychiatric morbidity in ...

    African Journals Online (AJOL)

    The correlates of stress, coping styles and psychiatric morbidity in the first year of medical education at a Nigerian University. ... African Journal of Psychiatry ... used included socio demographic, sources of stress, the general health questionnaire-12 (GHQ-12), Maslachfs burnout inventory (MBI), and Brief COPE. Data were ...

  8. Prevalence of psychiatric morbidity among medical practitioners in ...

    African Journals Online (AJOL)

    Background: Mental health problems can affect anybody including Doctors. It can be related to nature of our work and personal factors. Mental ill health includes a range of conditions like depression, bipolar disorder, anxiety and psychosis. Objective: To determine the prevalence of psychiatric morbidity among Medical ...

  9. Psychiatric Morbidity Patterns in Referred Inpatients of Other Specialties

    Directory of Open Access Journals (Sweden)

    Ajay Risal

    2013-03-01

    Conclusions: Psychiatric consultation was sought mostly by medical ward that had maximum number of patients presenting with self-poisoning. The commonest diagnosis seen in the referred in-patients was depression and anxiety disorder. Keywords: consultation-liaison psychiatry; in-patient referral; psychiatric morbidity.

  10. Management of co-morbidity of depression and chronic non ...

    African Journals Online (AJOL)

    Methods: The study used an action research design involving a research team of 14 health care professionals to collaboratively identify existing protocols or interventions for managing co-morbidity of depression and NCDs in Rwanda. Focus group discussion using a structured interview guide was used to collect qualitative ...

  11. Anaesthesia for a morbidly obese patient with schizophrenia and ...

    African Journals Online (AJOL)

    We report the case of a morbidly obese woman with schizophrenia and intellectual disability who underwent dental treatment using general anaesthesia. The 38-year-old patient was 156 cm tall and weighed 140 kg, with a body mass index of 57.5 kg.m-2. Her developmental age was less than five or six years. She had ...

  12. Morbidity and mortality patterns of post-neonatal paediatric medical ...

    African Journals Online (AJOL)

    Journal of Medicine and Biomedical Research ... This study was conducted to determine the morbidity and mortality pattern in children admitted into a mission hospital and to compare the results with those obtained from public ... Overall, mortality rate was 4.1%, with under-fives accounting for 92.0% of these deaths.

  13. Early morbidity after simultaneous and staged bilateral total knee arthroplasty

    DEFF Research Database (Denmark)

    Lindberg-Larsen, Martin; Jørgensen, Christoffer Calov; Husted, Henrik

    2015-01-01

    PURPOSE: The aim of this nationwide study was to investigate the early morbidity after bilateral simultaneous and staged total knee arthroplasty (TKA) in order to clarify potential benefits of a well-established fast-track regime. METHODS: The Danish National Patient Registry was searched for all...

  14. Major depressive disorder as a co-morbid diagnosis in ...

    African Journals Online (AJOL)

    The purpose of this article is to focus on the importance of depressive symptoms in patients suffering from schizophrenia, and the dilemma posed by hierarchical classification methods, which exclude co-morbid diagnoses such as Major Depressive Disorder in patients with schizophrenia. The question arises that if Major ...

  15. Morbidity after total abdominal hysterectomy | Van Coeverden De ...

    African Journals Online (AJOL)

    ... the main parameters of postoperative morbidity. The four factors found to be important in minimizing postoperative complications of TAH were: (i) the experience of the surgeon; (ii) the use of the Pfannenstiel rather than the subumbilical midline incision; (iii) closure of the skin with Dermalon rather than with black silk; and ...

  16. Neonatal Morbidity And Mortality In Calabar, Nigeria: A Hospital ...

    African Journals Online (AJOL)

    Background: The morbidity and mortality pattern amongst neonates admitted into the University of Calabar Teaching Hospital were reviewed from 1st June 2003 to 30th November 2004. Results: The major indications for admission for inborn babies were infections (27.4%), jaundice (21%) and low birth weight (LBW) ...

  17. Factors contributing to morbidity and mortality among preterm ...

    African Journals Online (AJOL)

    Objective: Prematurity is one of the highest global health challenges of the 21st century and has been named the first killer of young children. In Rwanda, it is the leading cause of death in neonates. It is expedient to explore the factors contributing to the observed high morbidity and mortality to plan appropriate interventions.

  18. Defining malaria burden from morbidity and mortality records, self ...

    African Journals Online (AJOL)

    Abstract: Malaria morbidity and mortality data from clinical records provide essential information .... Babati District is one of the eight sentinel sites in Tanzania for monitoring anti- ... treatment given before leaving the health facility was documented. ..... Targett, G. (1999) Vaccine efficacy, and immunity affecting transmission.

  19. Post-operative morbidity of the obese patient undergoing posterior ...

    African Journals Online (AJOL)

    Outcome measures: Post-operative morbidity measures – infection, seroma, pulmonary embolism, urinary tract infection, neurological injury and dural tears. Methods: One hundred consecutive patients undergoing posterior lumbar spine surgery were enrolled in the study. Three fellowship trained attending orthopaedic ...

  20. The morbidity, mortality, and costs associated with Clostridium difficile infection.

    Science.gov (United States)

    Kwon, Jennie H; Olsen, Margaret A; Dubberke, Erik R

    2015-03-01

    Clostridium difficile infection (CDI) is the most common cause of infectious health care-associated diarrhea and is a major burden to patients and the health care system. The incidence and severity of CDI remain at historically high levels. This article reviews the morbidity, mortality, and costs associated with CDI. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. The co-morbidity of depression and other chronic non ...

    African Journals Online (AJOL)

    Background: Non-communicable diseases are the most common causes of death worldwide. Alongside mortality, noncommunicable diseases also cause high rates of morbidity and disability. The common comorbidity issues of depression worldwide are not a rare occurrence and as depression is chronic in nature it would ...

  2. A study of geriatric depression and co- morbidities among primary ...

    African Journals Online (AJOL)

    Depression in the elderly is very common but diagnostic rates among primary care physicians is poor. This is attributed to both patient and physician related factors. The patient factors include co-morbidities, aging and psychological mindedness which is culture related. Generally, there's paucity of psychological complaints ...

  3. Morbidity Pattern among the Elderly Population in a Nigerian ...

    African Journals Online (AJOL)

    The present study also sought to determine the relationships between morbidity and socio-demographic and health characteristics in Nigerian elderly hospital attendees at University of Ilorin Teaching Hospital. A hospital based ... Nutritional status indicated a relatively high prevalence (42.6%) of malnutrition. Women ...

  4. Morbidity of the neck after head and neck cancer therapy

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    Background. Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. Methods. Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of

  5. Psychiatric morbidity in two urban communities in Nigeria | Mba ...

    African Journals Online (AJOL)

    Background: There is a welter of evidence for an inverse relationship between socio-economic status (SES) and mental health. The relationship is grossly under researched in the developing countries. Objective: To ascertain rates of gross psychiatric morbidity and some demographic correlations in two communities with ...

  6. Shoulder morbidity after non-surgical treatment of the neck.

    NARCIS (Netherlands)

    van Wouwe, V.; de Bree, R.; Kuik, D.J.; de Goede, C.J.T.; de Leeuw, I.M.; Leemans, C.R.

    2009-01-01

    Background and purpose: Reports on shoulder function after non-surgical treatment are not available. In the present study shoulder morbidity after surgical and non-surgical treatment of the neck is determined and compared. Materials and methods: In 100 head and neck cancer patients 174 neck sides

  7. Psychiatric Morbidity in HIV-infected Male Prisoners

    Science.gov (United States)

    Peng, Eugene Yu-Chang; Lee, Ming-Been; Morisky, Donald Edward; Yeh, Ching-Ying; Farabee, David; Lan, Yu-Ching; Chen, Yi-Ming Arthur; Lyu, Shu-Yu

    2011-01-01

    Background/Purpose The seroincidence of human immunodeficiency virus (HIV) in Taiwan has drastically increased since 2004, particularly among injection drug users and prisoners. The major purpose of this study was to explore the prevalence and correlates of psychiatric morbidity among HIV-infected male prisoners. Methods In 2006, data were collected from all of HIV-infected male prisoners (n = 535) in seven prisons in Taiwan. This collection was performed using a self-administered, anonymous questionnaire in group settings directed by our interviewers. Psychiatric morbidity was measured using the five-item Brief Symptom Rating Scale in 535 participants, which represented an 85% response rate. After excluding incomplete data, 479 participants were included in the analysis. Results Psychiatric morbidity was present in 46% of participants. Multivariate logistic regression revealed that correlates of the five-item Brief Symptom Rating Scale defined cases included the following: being a recidivist, having poor self-rated health status, and having experienced psychiatric symptoms in one’s lifetime (e.g. significant physical pain or discomfort, depression for 2 weeks or longer, serious anxiety or tension, trouble understanding, concentrating, or remembering, and serious thoughts of suicide), with a Nagelkerke R2 equal to 0.365. Conclusion Psychiatric morbidity is prevalent among HIV-infected male prisoners. Tailored HIV/AIDS education related to mental health is therefore suggested for inclusion as part of a comprehensive HIV/AIDS training program among incarcerated populations. PMID:20434025

  8. Ureaplasma-associated prenatal, perinatal, and neonatal morbidities.

    Science.gov (United States)

    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.

  9. Psychological predictors of outcome after gastric banding for morbid obesity

    NARCIS (Netherlands)

    Larsen, J.K.

    2004-01-01

    Obesity has become a major public health problem in Western societies. Although surgery is considered the treatment of choice in morbid obesity, the outcome is variable and weight regain may occur in the long-term postoperative period. The aim of this thesis was to examine psychological predictors

  10. American Brachytherapy Society recommendations for reporting morbidity after prostate brachytherapy

    International Nuclear Information System (INIS)

    Nag, Subir; Ellis, Rodney J.; Merrick, Gregory S.; Bahnson, Robert; Wallner, Kent; Stock, Richard

    2002-01-01

    Purpose: To standardize the reporting of brachytherapy-related prostate morbidity to guide ongoing clinical practice and future investigations. Methods: Members of the American Brachytherapy Society (ABS) with expertise in prostate brachytherapy performed a literature review and, guided by their clinical experience, formulated specific recommendations for reporting on morbidity related to prostate brachytherapy. Results: The ABS recommends using validated, patient-administered health-related quality-of-life instruments for the determination of baseline and follow-up data regarding bowel, urinary, and sexual function. Both actuarial and crude incidences should be reported, along with the temporal resolution of specific complications, and correlated with the doses to the normal tissues. The International Prostate Symptom Score is recommended to assess urinary morbidity, and any dysuria, gross hematuria, urinary retention, incontinence, or medication use should be quantified. Likewise, the ''Sexual Health Inventory for Men,'' which includes the specific erectile questions of the International Index of Erectile Function, is the preferred instrument for reporting sexual function, and the loss of sexual desire, incidence of hematospermia, painful orgasm (orgasmalgia), altered orgasm intensity, decreased ejaculatory volume, use of erectile aids, and use of hormones for androgen deprivation should be quantified. The ABS recommends adoption of the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer acute and late radiation morbidity scoring scheme for reporting rectal morbidity and noting the incidence of rectal steroid, laser, or antidiarrheal use. Conclusion: It is important to focus on health-related quality-of-life issues in the treatment of prostate cancer, because the control rates are very similar between appropriate treatment modalities. The ABS recommends using the International Prostate Symptom Score, International Index of

  11. Global Morbidity and Mortality of Leptospirosis: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Federico Costa

    Full Text Available Leptospirosis, a spirochaetal zoonosis, occurs in diverse epidemiological settings and affects vulnerable populations, such as rural subsistence farmers and urban slum dwellers. Although leptospirosis is a life-threatening disease and recognized as an important cause of pulmonary haemorrhage syndrome, the lack of global estimates for morbidity and mortality has contributed to its neglected disease status.We conducted a systematic review of published morbidity and mortality studies and databases to extract information on disease incidence and case fatality ratios. Linear regression and Monte Carlo modelling were used to obtain age and gender-adjusted estimates of disease morbidity for countries and Global Burden of Disease (GBD and WHO regions. We estimated mortality using models that incorporated age and gender-adjusted disease morbidity and case fatality ratios. The review identified 80 studies on disease incidence from 34 countries that met quality criteria. In certain regions, such as Africa, few quality assured studies were identified. The regression model, which incorporated country-specific variables of population structure, life expectancy at birth, distance from the equator, tropical island, and urbanization, accounted for a significant proportion (R(2 = 0.60 of the variation in observed disease incidence. We estimate that there were annually 1.03 million cases (95% CI 434,000-1,750,000 and 58,900 deaths (95% CI 23,800-95,900 due to leptospirosis worldwide. A large proportion of cases (48%, 95% CI 40-61% and deaths (42%, 95% CI 34-53% were estimated to occur in adult males with age of 20-49 years. Highest estimates of disease morbidity and mortality were observed in GBD regions of South and Southeast Asia, Oceania, Caribbean, Andean, Central, and Tropical Latin America, and East Sub-Saharan Africa.Leptospirosis is among the leading zoonotic causes of morbidity worldwide and accounts for numbers of deaths, which approach or exceed those

  12. Morbidity of curative cancer surgery and suicide risk.

    Science.gov (United States)

    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.

  13. Psychiatric morbidity in asymptomatic human immunodeficiency virus patients

    Directory of Open Access Journals (Sweden)

    V S Chauhan

    2013-01-01

    Full Text Available Background: 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. Aim: The aim of the following study is to establish the prevalence and the determinants of psychiatric morbidity in asymptomatic HIV patients. Materials and Methods: 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. Results: 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. Conclusion: 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.

  14. Health expectancy and the problem of substitute morbidity.

    Science.gov (United States)

    Van de Water, H P

    1997-12-29

    During the past century, the developed world has not only witnessed a dramatic increase in life expectancy (ageing), but also a concomitant rise in chronic disease and disability. Consequently, the tension between 'living longer' on the one hand and health-related 'quality of life' on the other has become an increasingly important health policy problem. The paper deals with two consequences of this so-called epidemiological transition in population health. The first one concerns the question of how--given the impressive changes--population health can be measured in an adequate and policy relevant present-day fashion. The second one is the so-called phenomenon of 'substitute morbidity and mortality': more and more acute fatal diseases are replaced by non-fatal delayed degenerative diseases like dementia and arthritis. How the phenomenon of substitute morbidity and mortality affects the development of population health is illustrated with the epidemiological transitions, worldwide shifts in the main causes of death, assumptions used in models, adverse consequences of medical technologies and some results from intervention trials. Substitute morbidity and mortality may thwart our disease-specific expectations of interventions and asks for a shift to a 'total population health' perspective when judging potential health gains of interventions. Better understanding of the dynamics that underly the changes in population health is necessary. Implications for data collections are more emphasis on morbidity data and their relation with mortality, more longitudinal studies, stricter requirements for intervention trials and more use of modelling as a tool. A final recommendation is the promotion of integrative measures of population health. For the latter several results are presented suggesting that, although the amount of morbidity and disability is growing with an increasing life expectancy, this is mild unhealthiness in particular. This finding supports the 'dynamic

  15. A model for morbidity after lung resection in octogenarians.

    Science.gov (United States)

    Berry, Mark F; Onaitis, Mark W; Tong, Betty C; Harpole, David H; D'Amico, Thomas A

    2011-06-01

    Age is an important risk factor for morbidity after lung resection. This study was performed to identify specific risk factors for complications after lung resection in octogenarians. A prospective database containing patients aged 80 years or older, who underwent lung resection at a single institution between January 2000 and June 2009, was reviewed. Preoperative, histopathologic, perioperative, and outcome variables were assessed. Morbidity was measured as a patient having any perioperative event as defined by the Society of Thoracic Surgeons General Thoracic Surgery Database. A multivariable risk model for morbidity was developed using a panel of established preoperative and operative variables. Survival was calculated using the Kaplan-Meier method. During the study period, 193 patients aged 80 years or older (median age 82 years) underwent lung resection: wedge resection in 77, segmentectomy in 13, lobectomy in 96, bilobectomy in four, and pneumonectomy in three. Resection was accomplished via thoracoscopy in 149 patients (77%). Operative mortality was 3.6% (seven patients) and morbidity was 46% (89 patients). A total of 181 (94%) patients were discharged directly home. Postoperative events included atrial arrhythmia in 38 patients (20%), prolonged air leak in 24 patients (12%), postoperative transfusion in 22 patients (11%), delirium in 16 patients (8%), need for bronchoscopy in 14 patients (7%), and pneumonia in 10 patients (5%). Significant predictors of morbidity by multivariable analysis included resection greater than wedge (odds ratio 2.98, p=0.006), thoracotomy as operative approach (odds ratio 2.6, p=0.03), and % predicted forced expiratory volume in 1s (odds ratio 1.28 for each 10% decrement, p=0.01). Octogenarians can undergo lung resection with low mortality. Extent of resection, use of a thoracotomy, and impaired lung function increase the risk of complications. Careful evaluation is necessary to select the most appropriate approach in

  16. Maternal Super Obesity and Neonatal Morbidity after Term Cesarean Delivery.

    Science.gov (United States)

    Smid, Marcela C; Vladutiu, Catherine J; Dotters-Katz, Sarah K; Manuck, Tracy A; Boggess, Kim A; Stamilio, David M

    2016-10-01

    Objective To estimate the association between maternal super obesity (body mass index [BMI] ≥ 50 kg/m(2)) and neonatal morbidity among neonates born via cesarean delivery (CD). Methods Retrospective cohort of singleton neonates delivered via CD ≥ 37 weeks in the Maternal-Fetal Medicine Unit Cesarean Registry. Maternal BMI at delivery was stratified as 18.5 to 29.9 kg/m(2), 30 to 39.9 kg/m(2), 40 to 49.9 kg/m(2), and ≥ 50 kg/m(2). Primary outcomes included acute (5-minute Apgar score neonatal injury, and/or transient tachypnea of the newborn) and severe (grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, seizure, respiratory distress syndrome, hypoxic ischemic encephalopathy, meconium aspiration, ventilator support ≥ 2 days, sepsis and/or neonatal death) neonatal morbidity. Odds of neonatal morbidity were estimated for each BMI category adjusting for clinical and operative characteristics. Results Of 41,262 maternal-neonatal dyads, 36% of women were nonobese, 49% had BMI of 30 to 39.9 kg/m(2), 12% had BMI of 40 to 49.9 kg/m(2), and 3% were super obese. Compared with nonobese women, super obese women had twofold odds of acute (5 vs. 10%; adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.59-2.73) and severe (3 vs. 6%; aOR: 2.08; 95% CI: 1.59-2.73) neonatal morbidity. Conclusion Among term infants delivered via CD, maternal super obesity is associated with increased risk of neonatal morbidity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Relationship of personal hygiene with nutrition and morbidity profile: A study among primary school children in South Kolkata

    Directory of Open Access Journals (Sweden)

    Deb Soumya

    2010-01-01

    Full Text Available Background: Majority of the health problems affecting school children are preventable by promotion of hygienic practices through proper health education by the teachers, who are the first contacts. Objectives: The study was undertaken to find out the status of nutrition and personal hygiene among primary school children and their association with their varied morbidity profiles. Materials and Methods: A descriptive, observational, cross-sectional study was conducted in a primary school situated in the largest slum of Kolkata. Results: The participants included 103 boys and 81 girls, with a mean age of 6.2 years. The mean personal hygiene score of the girls (4.15 ± 0.98 was significantly higher than that of boys (3.2 ± 1.4 [P<0.05]. Most of the boys (54.37% and girls (74.07% were normally nourished as per the CDC growth chart. Over 70% of the children were suffering from one or more morbidities, the most common morbidity in both the sexes being pallor, followed by worm infestation. Personal hygiene scores were significantly higher (P<0.05 among those children who were normally nourished as well as those who did not suffer from any morbidity in the last 15 days. Conclusions: Care should be taken to improve the pitiable state of personal hygiene and poor sanitary practices of these school children through coordinated and concerted health education measures by teachers as well as parents.

  18. Impact of radical nephrectomy on renal functional outcome in patients with no other co-morbidity as determined by 24-h urinary creatinine clearance

    Directory of Open Access Journals (Sweden)

    H.H. Qureshi

    2015-12-01

    Conclusion: The results from this study show that RN is associated with a decrease in CrCl in one third of the study population. Therefore it is recommended that patients undergoing RN should be strictly monitored for occult renal failure and managed promptly to prevent serious morbidity of frank renal failure.

  19. Combined Clinical Parameters and Multiparametric Magnetic Resonance Imaging for Advanced Risk Modeling of Prostate Cancer-Patient-tailored Risk Stratification Can Reduce Unnecessary Biopsies.

    Science.gov (United States)

    Radtke, Jan Philipp; Wiesenfarth, Manuel; Kesch, Claudia; Freitag, Martin T; Alt, Celine D; Celik, Kamil; Distler, Florian; Roth, Wilfried; Wieczorek, Kathrin; Stock, Christian; Duensing, Stefan; Roethke, Matthias C; Teber, Dogu; Schlemmer, Heinz-Peter; Hohenfellner, Markus; Bonekamp, David; Hadaschik, Boris A

    2017-12-01

    Multiparametric magnetic resonance imaging (mpMRI) is gaining widespread acceptance in prostate cancer (PC) diagnosis and improves significant PC (sPC; Gleason score≥3+4) detection. Decision making based on European Randomised Study of Screening for PC (ERSPC) risk-calculator (RC) parameters may overcome prostate-specific antigen (PSA) limitations. We added pre-biopsy mpMRI to ERSPC-RC parameters and developed risk models (RMs) to predict individual sPC risk for biopsy-naïve men and men after previous biopsy. We retrospectively analyzed clinical parameters of 1159 men who underwent mpMRI prior to MRI/transrectal ultrasound fusion biopsy between 2012 and 2015. Multivariate regression analyses were used to determine significant sPC predictors for RM development. The prediction performance was compared with ERSPC-RCs, RCs refitted on our cohort, Prostate Imaging Reporting and Data System (PI-RADS) v1.0, and ERSPC-RC plus PI-RADSv1.0 using receiver-operating characteristics (ROCs). Discrimination and calibration of the RM, as well as net decision and reduction curve analyses were evaluated based on resampling methods. PSA, prostate volume, digital-rectal examination, and PI-RADS were significant sPC predictors and included in the RMs together with age. The ROC area under the curve of the RM for biopsy-naïve men was comparable with ERSPC-RC3 plus PI-RADSv1.0 (0.83 vs 0.84) but larger compared with ERSPC-RC3 (0.81), refitted RC3 (0.80), and PI-RADS (0.76). For postbiopsy men, the novel RM's discrimination (0.81) was higher, compared with PI-RADS (0.78), ERSPC-RC4 (0.66), refitted RC4 (0.76), and ERSPC-RC4 plus PI-RADSv1.0 (0.78). Both RM benefits exceeded those of ERSPC-RCs and PI-RADS in the decision regarding which patient to receive biopsy and enabled the highest reduction rate of unnecessary biopsies. Limitations include a monocentric design and a lack of PI-RADSv2.0. The novel RMs, incorporating clinical parameters and PI-RADS, performed significantly better

  20. Does reducing unnecessary right ventricular pacing improve sympathetic activity and innervation of heart in sinus node disease patients? MVP and SafeR study.

    Science.gov (United States)

    Miyamoto, Mihoko; Kimura, Yuichiro; Hosoda, Junya; Matsumoto, Katsumi; Matsushita, Kohei; Ishikawa, Toshiyuki; Umemura, Satoshi

    2012-01-01

    Ventricular desynchronization imposed by ventricular pacing causes regional disturbances of adrenergic innervation in the left ventricular myocardium and increases the risk of heart failure and atrial fibrillation (AF) in patients with sinus node disease (SND). As a result, decreased iodine-123 metaiodobenzylguanidine (I-(123 )MIBG) uptake occurs in patients with an implanted permanent pacemaker. Fourteen SND patients with an implanted pacemaker equipped with an algorithm for reducing unnecessary right ventricular pacing (RURVP) were enrolled. Pacemakers were programmed to RURVP mode for the first 12 weeks, and then reprogrammed to DDD for the last 12 weeks. At the end of each mode, data on cumulative percent ventricular pacing (%Vp), atrial high rate episodes (%AHR), I-(123 )MIBG myocardial scintigraphy, brain natriuretic peptide (BNP), human atrial natriuretic peptide (hANP), and myocardial damage indices typified by troponin T and C-reactive protein (CRP) were collected. %Vp was lower in RURVP than in DDD (0.2% versus 95.7%, P = 0.00098). BNP, hANP, troponin T, and CRP did not differ significantly between the pacing modes. However, I-(123 )MIBG findings of patients with full ventricular pacing in DDD improved in RURVP. In contrast, among patients without full ventricular pacing in DDD, their I-(123 )MIBG findings did not differ significantly between the pacing modes. In SND patients with normal cardiac function and intact atrioventricular conduction, the reduction of %Vp in RURVP was due to the reduction of ineffective pacing and fusion pacing in DDD. Therefore, these 2 types of pacing do not affect cardiac pump function.

  1. Clinical application of 'Justification' and 'Optimization' principle of ALARA in pediatric CT imaging: "How many children can be protected from unnecessary radiation?".

    Science.gov (United States)

    Sodhi, Kushaljit S; Krishna, Satheesh; Saxena, Akshay K; Sinha, Anindita; Khandelwal, Niranjan; Lee, Edward Y

    2015-09-01

    Practice of ALARA (as low as reasonably achievable) principle in the developed world is currently well established. However, there is striking lack of published data regarding such experience in the developing countries. Therefore, the goal of this study is to prospectively evaluate CT request forms to assess how many children could be protected from harmful radiation exposure if 'Justification' and 'Optimization' principles of ALARA are applied before obtaining CT imaging in a developing country. This can save children from potential radiation risks including development of brain cancer and leukemia. Consecutive CT request forms over a six month study period (May 16, 2013 to November 15, 2013) in a tertiary pediatric children's hospital in India were prospectively reviewed by two pediatric radiologists before obtaining CT imaging. First, 'Justification' of CT was evaluated and then 'Optimization' was applied for evaluation of appropriateness of the requested CT studies. The number (and percentage) of CT studies avoided by applying 'Justification' and 'Optimization' principle of ALARA were calculated. The difference in number of declined and optimized CT requests between CT requests from inpatient and outpatient departments was compared using Chi-Square test. A total of 1302 consecutive CT request forms were received during the study period. Some of the request forms (n=86; 6.61%) had requests for more than one (multiple) anatomical regions, hence, a total of 1392 different anatomical CT requests were received. Based on evaluation of the CT request forms for 'Justification' and 'Optimization' principle of ALARA by pediatric radiology reviewers, 111 individual anatomic part CT requests from 105 pediatric patients were avoided. Therefore, 8.06% (105 out of 1302 pediatric patients) were protected from unnecessary or additional radiation exposure.The rates of declined or optimized CT requests from inpatient department was significantly higher than that from outpatient

  2. Radiation induced cancer: risk assessment and prevention

    International Nuclear Information System (INIS)

    Shore, R.E.

    1984-01-01

    A number of factors have to be considered in defining the cancer risk from ionizing radiation. These include the radiation sensitivity of the target tissue(s), the temporal pattern of risk, the shape of the dose-incidence curve, the effects of low dose rates, host susceptibility factors, and synergism with other environmental exposures. For the population as a whole the largest sources of radiation exposure are natural background radiation and medical/dental radiation. Radiation exposures in the medical field make up the largest volume of occupational exposures as well. Although new technologies offer opportunities to lower exposures, worker training, careful exposure monitoring with remedial feedback, and monitoring to prevent unnecessary radiodiagnostic procedures may be even more important means of reducing radiation exposure. Screening of irradiated populations can serve a useful preventive function, but only for those who have received very high doses

  3. Discriminability of personality profiles in isolated and Co-morbid marijuana and nicotine users.

    Science.gov (United States)

    Ketcherside, Ariel; Jeon-Slaughter, Haekyung; Baine, Jessica L; Filbey, Francesca M

    2016-04-30

    Specific personality traits have been linked with substance use disorders (SUDs), genetic mechanisms, and brain systems. Thus, determining the specificity of personality traits to types of SUD can advance the field towards defining SUD endophenotypes as well as understanding the brain systems involved for the development of novel treatments. Disentangling these factors is particularly important in highly co morbid SUDs, such as marijuana and nicotine use, so treatment can occur effectively for both. This study evaluated personality traits that distinguish isolated and co-morbid use of marijuana and nicotine. To that end, we collected the NEO Five Factor Inventory in participants who used marijuana-only (n=59), nicotine-only (n=27), both marijuana and nicotine (n=28), and in non-using controls (n=28). We used factor analyses to identify personality profiles, which are linear combinations of the five NEO Factors. We then conducted Receiver Operating Characteristics (ROC) curve analysis to test accuracy of the personality factors in discriminating isolated and co-morbid marijuana and nicotine users from each other. ROC curve analysis distinguished the four groups based on their NEO personality patterns. Results showed that NEO Factor 2 (openness, extraversion, agreeableness) discriminated marijuana and marijuana+nicotine users from controls and nicotine-only users with high predictability. Additional ANOVA results showed that the openness dimension discriminated marijuana users from nicotine users. These findings suggest that personality dimensions distinguish marijuana users from nicotine users and should be considered in prevention strategies. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  4. Association of personal hygiene with common morbidities among upper primary school children in rural Odisha

    Directory of Open Access Journals (Sweden)

    Kalyan Kumar Paul

    2017-01-01

    Full Text Available Context: In India, children of upper primary school receive less attention from health-care providers. The majority of their health problems are preventable through hygienic practices. Aims: The aim of this study was to find out the association of personal hygiene with common morbidities among upper primary school children. Settings and Design: A cross-sectional study conducted in a rural upper primary school of Odisha. Subjects and Methods: A semi-structured schedule based on the Global School Health Survey Questionnaire and necessary instruments for clinical examination were used. Statistical Analysis Used: Data were entered in Microsoft Excel 2007 and analyzed by SPSS version 20 software. Results: Of 90 participants, 58 (64.4% were girls. The mean age was 11.8 (±1.01 years. The mean body mass index of females was significantly higher than males (16.95 vs. 14.72; P = 0.001. More than 90% of children maintained good personal hygiene such as clean tongue, clean hair, handwashing, and using footwear. The most common morbidities found were dental caries (38.9%, history of worms in stool and lethargy (20%. A mean score of 6.14 ± 0.11 (out of 8 was seen for personal hygiene and not associated with any particular morbidity or gender. Brushing daily was significantly associated with reduced dental caries (χ2 = 8.7; P < 0.005 and foul-smelling breath (χ2 = 4.93; P < 0.05. Fungal infections were significantly less in children who bathed daily (χ2 = 28.7; <0.005 and wore clean clothes (χ2 = 5.06; P < 0.05. Conclusion: Dental caries, foul-smelling breath, and fungal infections were significantly associated with poor personal hygiene. School health services should also focus on upper primary school children for improvement of personal hygiene.

  5. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients.

    Science.gov (United States)

    Garg, Harshit; Vigneshwaran, Balasubiramaniyan; Aggarwal, Sandeep; Ahuja, Vineet

    2017-01-01

    The aim of this study was to analyse the impact of hiatal hernia repair (HHR) on gastro-oesophageal reflux disease (GERD) in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG). It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS) questionnaire and anti-reflux medications. Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80%) showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH) during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.

  6. Impact of concomitant laparoscopic sleeve gastrectomy and hiatal hernia repair on gastro-oesophageal reflux disease in morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Harshit Garg

    2017-01-01

    Full Text Available Background: The aim of this study was to analyse the impact of hiatal hernia repair (HHR on gastro-oesophageal reflux disease (GERD in morbidly obese patients with hiatus hernia undergoing laparoscopic sleeve gastrectomy (LSG. Materials and Methods: It is a retrospective study involving ten morbidly obese patients with large hiatus hernia diagnosed on pre-operative endoscopy who underwent LSG and simultaneous HHR. The patients were assessed for symptoms of GERD using a Severity symptom score (SS questionnaire and anti-reflux medications. Results: Of the ten patients, five patients had GERD preoperatively. At the mean follow-up of 11.70 ± 6.07 months after surgery, four patients (80% showed complete resolution while one patient complained of persistence of symptoms. Endoscopy in this patient revealed resolution of esophagitis indicating that the persistent symptoms were not attributable to reflux. The other five patients without GERD remained free of any symptom attributable to GERD. Thus, in all ten patients, repair of hiatal hernia (HH during LSG led to either resolution of GERD or prevented any new onset symptom related to GER. Conclusion: In morbidly obese patients with HH with or without GERD undergoing LSG, repair of the hiatus hernia helps in amelioration of GERD and prevents any new onset GER. Thus, the presence of HH should not be considered as a contraindication for LSG.

  7. Varicella zoster virus-associated morbidity and mortality in Africa - a systematic review.

    Science.gov (United States)

    Hussey, Hannah; Abdullahi, Leila; Collins, Jamie; Muloiwa, Rudzani; Hussey, Gregory; Kagina, Benjamin

    2017-11-14

    Varicella zoster virus (VZV) causes varicella and herpes zoster. These vaccine preventable diseases are common globally. Most available data on VZV epidemiology are from industrialised temperate countries and cannot be used to guide decisions on the immunization policy against VZV in Africa. This systematic review aims to review the published data on VZV morbidity and mortality in Africa. All published studies conducted in Africa from 1974 to 2015 were eligible. Eligible studies must have reported any VZV epidemiological measure (incidence, prevalence, hospitalization rate and mortality rate). For inclusion in the review, studies must have used a defined VZV case definition, be it clinical or laboratory-based. Twenty articles from 13 African countries were included in the review. Most included studies were cross-sectional, conducted on hospitalized patients, and half of the studies used varying serological methods for diagnosis. VZV seroprevalence was very high among adults. Limited data on VZV seroprevalence in children showed very low seropositivity to anti-VZV antibodies. Co-morbidity with VZV was common. There is lack of quality data that could be used to develop VZV control programmes, including vaccination, in Africa. PROSPERO 2015: CRD42015026144 .

  8. [Impact of simulation to reduce neonatal and maternal morbidity of shoulder dystocia].

    Science.gov (United States)

    Legendre, G; Bouet, P-E; Sentilhes, L

    2015-12-01

    To assess the role of simulation in reducing morbidity and mortality of shoulder dystocia. A systematic literature review was conducted in the Medline database. Regarding the prevention of complications of shoulder dystocia, practical training using mannequin is associated with improvements in management shoulder dystocia than training using video tutorial (EL2). Practical training using simulation for shoulder dystocia allows an improvement for manoeuvres mainly for trainees, but simulation seems to benefit to all caregivers for the communication (EL3). The effect of training sessions using simulation for learning writing the medical observation allows only a modest improvement in the medical record transcription (EL3). The interest of a specific grid for reporting shoulder dystocia seems interesting to increase the amount of information transcribed by the caregiver (EL3). The establishment of a practical training using simulation and concerning all caregivers of the delivery room is associated with a significant reduction in neonatal injury (EL3). The establishment of a training program using simulation does not seem to decrease maternal morbidity in case of shoulder dystocia (EL3). A teaching using simulation for the management of shoulder dystocia is encouraged for the initial and continuing formation of different actors in the delivery room (professional agreement). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. Varicella zoster virus-associated morbidity and mortality in Africa – a systematic review

    Directory of Open Access Journals (Sweden)

    Hannah Hussey

    2017-11-01

    Full Text Available Abstract Background Varicella zoster virus (VZV causes varicella and herpes zoster. These vaccine preventable diseases are common globally. Most available data on VZV epidemiology are from industrialised temperate countries and cannot be used to guide decisions on the immunization policy against VZV in Africa. This systematic review aims to review the published data on VZV morbidity and mortality in Africa. Methods All published studies conducted in Africa from 1974 to 2015 were eligible. Eligible studies must have reported any VZV epidemiological measure (incidence, prevalence, hospitalization rate and mortality rate. For inclusion in the review, studies must have used a defined VZV case definition, be it clinical or laboratory-based. Results Twenty articles from 13 African countries were included in the review. Most included studies were cross-sectional, conducted on hospitalized patients, and half of the studies used varying serological methods for diagnosis. VZV seroprevalence was very high among adults. Limited data on VZV seroprevalence in children showed very low seropositivity to anti-VZV antibodies. Co-morbidity with VZV was common. Conclusion There is lack of quality data that could be used to develop VZV control programmes, including vaccination, in Africa. Trial registration PROSPERO 2015: CRD42015026144 .

  10. Intermaxillary Fixation Screw Morbidity in Treatment of Mandibular Fractures

    DEFF Research Database (Denmark)

    Florescu, Vlad-Andrei; Kofod, Thomas; Pinholt, Else Marie

    2016-01-01

    Purpose The aim of the present retrospective study was to investigate the morbidity of screws used for intermaxillary fixation (IMF) in the treatment of mandibular fractures. A review of the published data was also performed for a comparison of outcomes. Our hypothesis was that the use of screws...... for IMF of mandibular fractures would result in minimal morbidity. Materials and Methods Patients treated for mandibular fractures from 2007 to 2013, using screws for IMF, using the international diagnosis code for mandibular fracture, DS026, were anonymously selected (Department of Oral and Maxillofacial...... Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark). The fracture type, radiographic findings, treatment modality, screw type and number, and root damage were recorded. For the outcome comparison, a review of the published data regarding iatrogenic dental root damage caused...

  11. Morbidity in early Parkinson's disease and prior to diagnosis

    DEFF Research Database (Denmark)

    Frandsen, Rune; Kjellberg, Jakob; Ibsen, Rikke

    2014-01-01

    BACKGROUND: Nonmotor symptoms are probably present prior to, early on, and following, a diagnosis of Parkinson's disease. Nonmotor symptoms may hold important information about the progression of Parkinson's disease. OBJECTIVE: To evaluated the total early and prediagnostic morbidities in the 3......, poisoning and certain other external causes, and other factors influencing health status and contact with health services. It was negatively associated with neoplasm, cardiovascular, and respiratory diseases. CONCLUSIONS: Patients with a diagnosis of Parkinson's disease present significant differences...

  12. Morbidities in rapid eye movement sleep behavior disorder

    DEFF Research Database (Denmark)

    Jennum, Poul; Mayer, Geert; Ju, Yo-El

    2013-01-01

    Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD, RBD without any obvious comorbid major neurological disease), is strongly associated with numerous comorbid conditions. The most prominent is that with neurodegenerative disorders, especially synuclein-mediated disorders, above all...... function, neuropsychiatric manifestations and sleep complaints. Furthermore, patients with PD and RBD may have worse prognosis in terms of impaired cognitive function and overall morbidity/mortality; in dementia, the presence of RBD is strongly associated with clinical hallmarks and pathological findings...

  13. Gene polymorphisms and increased DNA damage in morbidly obese women.

    Science.gov (United States)

    Luperini, B C O; Almeida, D C; Porto, M P; Marcondes, J P C; Prado, R P; Rasera, I; Oliveira, M R M; Salvadori, D M F

    2015-06-01

    Obesity is characterized by increased adipose tissue mass resulting from a chronic imbalance between energy intake and expenditure. Furthermore, there is a clearly defined relationship among fat mass expansion, chronic low-grade systemic inflammation and reactive oxygen species (ROS) generation; leading to ROS-related pathological events. In the past years, genome-wide association studies have generated convincing evidence associating genetic variation at multiple regions of the genome with traits that reflect obesity. Therefore, the present study aimed to evaluate the relationships among the gene polymorphisms ghrelin (GHRL-rs26802), ghrelin receptor (GHSR-rs572169), leptin (LEP-rs7799039), leptin receptor (LEPR-rs1137101) and fat mass and obesity-associated (FTO-rs9939609) and obesity. The relationships among these gene variants and the amount of DNA damage were also investigated. Three hundred Caucasian morbidly obese and 300 eutrophic (controls) women were recruited. In summary, the results demonstrated that the frequencies of the GHRL, GHSR, LEP and LEPR polymorphisms were not different between Brazilian white morbidly obese and eutrophic women. Exceptions were the AA-FTO genotype and allele A, which were significantly more frequent in obese women than in the controls (0.23% vs. 0.10%; 0.46 vs. 0.36, respectively), and the TT-FTO genotype and the T allele, which were less frequent in morbidly obese women (p<0.01). Furthermore, significant differences in the amount of genetic lesions associated with FTO variants were observed only in obese women. In conclusion, this study demonstrated that the analyzed SNPs were not closely associated with morbid obesity, suggesting they are not the major contributors to obesity. Therefore, our data indicated that these gene variants are not good biomarkers for predicting risk susceptibility for obesity, whereas ROS generated by the inflammatory status might be one of the causes of DNA damage in obese women, favoring

  14. [Mortality and morbidity in surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Banke, A.B.; Andersen, Jakob Steen; Heslet, L.

    2008-01-01

    Care Unit's (ICU) Critical Information System, a blood bank and the database of a vascular surgery unit. RESULTS: The perioperative mortality was 8%, ICU mortality 22%, postoperative mortality 33% and 30-day mortality 39%. The ICU mortality for patients with renal failure and septic shock...... was significantly higher than the overall ICU mortality. The ICU mortality and morbidity increased with the amount of postoperative blood loss. Patients with an initial serum creatinine concentration of

  15. Elderly woman with multiple morbidities presenting with a funny ...

    African Journals Online (AJOL)

    Multi morbidity is the occurrence of more than one concurrant chronic diseases in a patient1,2. It is very common in the elderly and common to both sexes2.It is more or less the norm in Family Practice than the exception. Its importance lies in the fact that it not only affects the patient's quality of life, it poses a big challenge to ...

  16. Morbidity and mortality following poliomyelitis - a lifelong follow-up.

    Science.gov (United States)

    Kay, L; Nielsen, N M; Wanscher, B; Ibsen, R; Kjellberg, J; Jennum, P

    2017-02-01

    In the world today 10-20 million people are still living with late effects of poliomyelitis (PM), but the long-term consequences of the disease are not well known. The aim of this study was to describe lifelong morbidity and mortality among Danes who survived PM. Data from official registers for a cohort of 3606 Danes hospitalized for PM in the period 1940-1954 were compared with 13 762 age- and gender-matched controls. Compared with controls, mortality was moderately increased for both paralytic as well as non-paralytic PM cases; Hazard Ratio, 1.31 (95% confidence interval, 1.18-1.44) and 1.09 (95% confidence interval, 1.00-1.19), respectively. Hospitalization rates were approximately 1.5 times higher among both paralytic and non-paralytic PM cases as compared with controls. Discharge diagnoses showed a broad spectrum of diseases. There were no major differences in morbidities between paralytic and non-paralytic PM cases. Poliomyelitis has significant long-term consequences on morbidity and mortality of both paralytic and non-paralytic cases. © 2016 EAN.

  17. Semen Quality as a Predictor of Subsequent Morbidity

    DEFF Research Database (Denmark)

    Latif, Tabassam; Jensen, Tina Kold; Mehlsen, Jesper

    2017-01-01

    Semen quality has been suggested to be a biologicalmarker of long-term morbidity and mortality; however, few studies have been conducted on this subject. We identified 5,370 men seen for infertility at Frederiksberg Hospital, Denmark, during 1977-2010, and 4,712 of thesemen were followed in the D......Semen quality has been suggested to be a biologicalmarker of long-term morbidity and mortality; however, few studies have been conducted on this subject. We identified 5,370 men seen for infertility at Frederiksberg Hospital, Denmark, during 1977-2010, and 4,712 of thesemen were followed......million/mL and all-cause hospitalizations (hazard ratio = 1.5, 95% confidence interval: 1.4, 1.6) and cardiovascular disease (hazard ratio = 1.4, 95% confidence interval: 1.2, 1.6), compared with men with a concentration above 40million/ mL. The probabilities for hospitalizations were also higher...... with a low total sperm count and low motility. Men with a sperm concentration of 195-200million/mL were, on average, hospitalized for the first time 7 years later than were men with a sperm concentration of 0-5million/mL. Semen quality was associated with long-term morbidity, and a significantly higher risk...

  18. PREVALENCE OF OCCULT DEPRESSION IN ELDERLY WITH CHRONIC CO - MORBIDS

    Directory of Open Access Journals (Sweden)

    Sachin

    2015-02-01

    Full Text Available BACKGROUND: Growth in elderly population has led to an increase in age related diseases and mainly depression which is affecting the quality of life. Depression is more prevalent amongst elderly individuals with medical illnesses and emerging public health problem leading to increased morbidity and disability worldwide. AIMS AND OBJE CTIVES: To assess the prevalence of occult depression in elderly patients with chronic co - morbid medical conditions. MATERIALS AND METHODS: It was a cross - sectional study conducted in tertiary hospital. Total 100 elderly patients with underlying chronic me dical illnesses were included. Depression in study population was assessed by geriatric depression scale and analyzed. RESULT: Out of 100 patients 23(23% had depression. Females 12/39(30.76% were affected more than males 11/61 (18.03%. Depression was mo re prevalent among patients with 3 or more co - morbid conditions (45.4% as compared to <3 (11.9%. CONCLUSION: Elderly patients with multiple chronic medical illnesses may have associated occult depression. Screening of these patients for depression couple d with appropriate psychiatric referral should be an integral part of Geriatric service

  19. A Comparative Study Of Psychiatric Morbidity In Dermatological Patients

    Directory of Open Access Journals (Sweden)

    Sharma Neelu

    2003-01-01

    Full Text Available The psychiatric morbidity in five chronic and disfiguring diseases, namely psoriasis, chronic urticaria, leprosy, vitiligo and lichen simplex chronicus (LSC was assessed and compared using the standardized Hindi (Vernacular languages version of General Health Questionnaire (GHQ-H. Thirty new untreated patients of each of the above skin diseases between the age group of 18-60 years were included in the study. The overall prevalence of the psychiatric morbidity was found to be 39%, depression and anxiety were present in 13% and 10.66% of the patients and suicidal ideations and somatisation in 16% and 13% of the patients respectively. Prevalence of interpersonal conflict and suicidal attempt were 10% and 2.6% respectively. On comparative analysis of psychiatric morbidity, significant difference was observed between vitiligo and other disorders (p=0.0028, i.e., chronic urticaria (p=0.0242 and psoriasis and other disorders (p=0.0028, however no significant difference could be elicited between psoriasis and leprosy or leprosy and vitiligo. Comparative analysis of anxiety revealed statistically significant difference between the patients of LSC and vitiligo (p=0.02 or vitiligo and chronic urticaria (p=0.04 but no significant difference was observed for vitiligo and leprosy of psoriasis and leprosy. The prevalence of somatic complaints showed significant difference between the patients of LSC and Leprosy.

  20. Acute hepatitis e viral infection in pregnancy and maternal morbidity

    International Nuclear Information System (INIS)

    Khaskheli, M.N.; Baloch, S.

    2015-01-01

    To determine the maternal morbidity in pregnant women with acute hepatitis E viral infection. Study Design: Observational, cross-sectional study. Place and Duration of Study: Departments of Obstetrics and Gynaecology and Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Red Crescent General Hospital and Saint Elizabeth Hospital, Hyderabad, from January 2011 to December 2013. Methodology: The study population was pregnant women with acute hepatitis E infection confirmed by ELIZA technique. Pregnant women with other hepatic viral infections were excluded. All medical and obstetric conditions, and mortality were noted on the predesigned proforma. Results: Out of the total 45 admitted pregnant women with hepatitis E viral infection, 22 women (48.9%) had severe morbidity. The most common were hepatic coma in 8 (36.36%) cases and disseminated intravascular coagulation in 14 (63.63%) cases. Highest mortality rate was seen in women with hepatic coma (100%), while in those with disseminated intravascular coagulation, one out of the 14 cases (7.14%) died. Conclusion: The acute viral hepatitis E infection in pregnant women is associated with maternal morbidities and high mortality rate. (author)

  1. Psychological Co-morbidity in Children with Specific Learning Disorders.

    Science.gov (United States)

    Sahoo, Manoj K; Biswas, Haritha; Padhy, Susanta Kumar

    2015-01-01

    Children under 19 years of age constitute over 40% of India's population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs) exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder) is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common) to depression, anxiety, suicide etc., to substance abuse (least common). Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most) given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind.

  2. Prevention: Exercise

    Medline Plus

    Full Text Available ... Steroid Injections Lumbar Zygapophysical (Facet) Joint Injections PREVENTION Lifestyle Choices 10 Tips for a Healthy Back Smoking Weight Patient Safety Exercise Strengthening Strengthen ...

  3. Is there evidence showing that salt intake reduction reduces cardiovascular morbidity and mortality risk?

    Directory of Open Access Journals (Sweden)

    Fernando Lanas

    2012-02-01

    Full Text Available A recent systematic review of Cochrane collaboration about the effect of reducing dietary salt concluded that “there is still insufficient power to exclude clinically important effects of reduced dietary salt on mortality or cardiovascular morbidity in normotensive or hypertensive populations”. This conclusion has generated an important debate, because the estimation that salt reduction can prevent 24% of strokes and 18% of myocardial infarctions has decided the health authorities of several nations to implement salt consumption reduction programs. The review of ecological studies and clinical trials allow to conclude that a reduction in salt consumption reduces blood pressure and methodological well conducted cohort studies has shown that cardiovascular events risk decreases progressively with lower levels of blood pressure. Combining this two finding we can assume that population should benefice from a decrease on salt consumption although there are no studies that shown a reduction in cardiovascular events in population with high sodium intake when dietary salt is reduced.

  4. Rates and risks for co-morbid depression in patients with Type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Pouwer, F; Beekman, Aartjan T F; Nijpels, G

    2003-01-01

    factors of co-morbid depression in a community-based sample of older adults, comparing Type 2 diabetic patients with healthy control subjects. METHODS: A large (n=3107) community-based study in Dutch adults (55-85 years of age) was conducted. Pervasive depression was defined as a CES-D score greater than...... could play an essential role in the development of depression in Type 2 diabetes. These findings can enable clinicians and researchers to identify high-risk groups and set up prevention and treatment programs.......AIMS/HYPOTHESIS: There is accumulating evidence that depression is common in people with Type 2 diabetes. However, most prevalence-studies are uncontrolled and could also be inaccurate from selection-bias, as they are conducted in specialized treatment settings. We studied the prevalence and risk...

  5. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, growth, and morbidity of Peruvian infants.

    Science.gov (United States)

    López de Romaña, Guillermo; Cusirramos, Sandra; López de Romaña, Daniel; Gross, Rainer

    2005-03-01

    Anemia, micronutrient deficiencies, and growth faltering are still common in Peru. The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure, anemia, and micronutrient deficiencies in Peruvian infants. Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind, masked, controlled trial in which they were randomly assigned to receive either a daily dose of iron (DI), a daily dose of multiple micronutrients (DMM), a weekly dose of multiple micronutrients, or a placebo (P) for 6 mo. None of the supplements tested prevented growth faltering or the morbidities common during infancy. Anemia and plasma homocysteine concentrations fell significantly in all groups during the study, but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups, and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups. Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron (DI and DMM). There were no significant differences among groups in mean final values or changes in plasma zinc, retinol, tocopherol, or riboflavin. Although the DMM intervention was the most efficacious for preventing anemia, iron, and zinc deficiencies, 15%, 20%, and 50% of this group still remained anemic, zinc deficient, and iron deficient, respectively, at the end of the study. Further research thus should investigate whether higher doses of iron and zinc, together with infection control measures, are more efficacious.

  6. Factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal: Nepal pediatric ocular disease study.

    Science.gov (United States)

    Adhikari, Srijana; Shrestha, Mohan Krishna; Adhikari, Kamala; Maharjan, Nhukesh; Shrestha, Ujjowala Devi

    2014-10-23

    Nepal Pediatric Ocular Diseases Study is a three year longitudinal population based study. Here we present the baseline survey report which aims to investigate various risk factors associated with childhood ocular morbidity and blindness in three ecological regions of Nepal. This baseline survey is a population based cross sectional study. The investigation was conducted in a district from each of the following regions: Terai, Hill and Mountain. The Village Development Committees (VDCs) from each district were selected by random sampling. Three Community health workers were given training on vision screening and identification of abnormal ocular signs in children. They conducted a house to house survey in their respected districts examining the children and gathering a standardized set of data variables. Children with abnormal vision or ocular signs were then further examined by pediatric ophthalmologists. A total of 10950 children aged 0-10 years (5403 from Terai, 3204 from the hills, 2343 from the mountains) were enrolled in the study. However 681 (6.2%) were non responders. The male to female ratio was 1.03. The overall prevalence of ocular morbidity was 3.7% (95% CI of 3.4%-4%) and blindness was 0.07% (95% CI of 0.02%-0.12%). Ocular morbidity was more prevalent in the mountain region whereas blindness was more prevalent in the Terai region.Children from the Terai region were more likely to suffer from congenital ocular anomalies compared to the other regions. Children whose mother smoked, drank alcohol, or was illiterate were significantly afflicted with ocular diseases (p Blindness was more prevalent in children who suffered from a systemic illness. Females and under-nourished children were more likely to have ocular morbidity and blindness. It was found that childhood blindness was more prevalent in the Terai region, the undernourished, females and in those with co-morbid systemic illnesses. This study strongly suggests that prevention of childhood

  7. Trends in injury morbidity in China, 1993-2013: A longitudinal analysis of population-based survey data.

    Science.gov (United States)

    Ning, Peishan; Cai, Min; Cheng, Peixia; Zhang, Yaoguang; Schwebel, David C; Yang, Yang; Zhang, Wei; Cheng, Xunjie; Gao, Yuyan; Ling, Xu; Hu, Guoqing

    2018-04-01

    Understanding long-term trends in injury morbidity is critical to prevention and intervention planning. The aim of this study was to assess long-term trends in injury morbidity rates in China from 1993 to 2013. Using data from the National Health Service Survey (NHSS), which is conducted every five years, crude and age-standardized prevalence during the previous two weeks and hospitalization rates in the last 12 months with 95% confidence intervals (CI) were calculated. The Rao-Scott Chi-square test examined injury morbidity differences across the five survey years by location (urban/rural), sex, age group, and household income. Percent changes in morbidity rate were approximated using logistic regressions. Sampling weights were applied to all analyses. In 2013, crude two-week injury prevalence in China was 0.46% (95% CI: 0.40%, 0.52%) and 12-month crude hospitalization rate was 0.70% (95% CI: 0.63%, 0.77%). Age-standardized injury prevalence increased 31.4% (95% CI: 7.6%, 60.6%) between 1993 and 2013 (29.4%, 95% CI: 6.7%, 56.9% from 1993-2003; 1.6%, 95% CI: -14.8%, 21.0% from 2003-2013), and age-standardized hospitalization rates rose 107.2% (95% CI: 75.1%, 145.2%) from 1993 to 2013 (-9.5%, 95% CI: -24.6%, 8.6% from 1993-2003 and 129.0%, 95% CI: 93.9%, 170.4% from 2003-2013). Subgroup analyses showed similar trends over time. The leading cause of injury was dislocation, sprain or strain for prevalence, and fractures for hospitalization. In conclusion, injury morbidity increased substantially from 1993 to 2013 in China. Inconsistent changes in two-week prevalence and 12-month hospitalization rate merit attention from researchers and policy-makers. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Multi-morbidity, disability and adaptation strategies among community-dwelling adults aged 75 years and older.

    Science.gov (United States)

    Yuen, Hon K; Vogtle, Laura K

    2016-10-01

    The impact of multi-morbidity and disability on the use of adaptation strategies in older adults has not been well researched. This study investigated categories of adaptation strategies that community-dwelling older adults use to complete their daily activities, identified factors that are associated with the use of behavioral adaptations, and examined the relationship among multi-morbidity, disability and adaptation strategies in this population. A mixed methods research design was used. 105 community-dwelling older adults with ages ranging from 75 to 94 years completed a questionnaire and semi-structured interview on types of chronic illnesses (multi-morbidity), amount of difficulty in completing daily activities (degree of disability), and types of behavioral efforts made to complete daily activities that are challenging (adaptation strategies). The model of selective optimization with compensation (SOC) was used to categorize these strategies. The findings revealed that older adults use a wide range of adaptations with compensation and selection the most (40.4%) and least (16.5%) frequently reported respectively. Degree of disability was uniquely associated with the frequency of using SOC strategies while controlling for other factors. Furthermore, degree of disability was a mediator for multi-morbidity in predicting frequency of using SOC strategies. The findings support that older adults using behavioral adaptations to cope with functional decline is prevalent. Knowing the types of adaptation that older adults employed and the indirect relationship between multi-morbidity and frequency of using SOC strategies, with degree of disability as the mediator will be helpful in planning interventions and prevention programs for educating older adults. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Morbidity and injury recurrence in victims of firearm injuries.

    Science.gov (United States)

    Ponzer, S; Bergman, B; Brismar, B

    1996-01-01

    Civilian violence has become an increasing problem in the industrial world. Gunshot wounds, fatal or non-fatal, are often considered as acute trauma episodes. However, our previous study, based on 820 firearm injuries, showed that this group of patients was characterized by a high mortality rate and a pronounced involvement in criminality when compared to a control group. The aim of this study was to determine the general morbidity in the same group of firearm victims. Our hypotheses were that these patients consume a considerable amount of hospital care due to recurring trauma episodes and that their general morbidity is raised. Information was collected concerning all episodes of in-patient care for victims of firearm injuries from 1972-1992 in Stockholm, Sweden. The victims were compared with a sex- and age-matched control group. During the study period, 69.9% of the 820 firearm victims were treated for other reasons than gunshot injuries, compared to 45.5% of the 820 controls. The former group was hospitalized 3,703 times and the latter on 1,512 occasions. The firearm injury group showed an higher morbidity in almost all diagnostic subgroups according to ICD-9. The trauma recurrence rate was high and suicide, homicide and assault were relatively more common in this group. We suggest that the gunshot episode may be regarded as one expression of a "chronic trauma syndrome'. Patients exhibiting this "syndrome' are characterized by recurrent episodes of trauma, a risk-taking and destructive behavior, high morbidity and mortality as well as anti-social traits. Medical, social and legal complications are common making these patients extremely costly for society and their identification a matter of concern. It is probable that this "syndrome' also exists in other groups of trauma patients. Since hospitalization affords a unique opportunity of reaching patients who have a "chronic trauma syndrome' risk profile, we believe, that these patients should not only be treated

  10. Can Prostate Imaging Reporting and Data System Version 2 reduce unnecessary prostate biopsies in men with PSA levels of 4-10 ng/ml?

    Science.gov (United States)

    Xu, Ning; Wu, Yu-Peng; Chen, Dong-Ning; Ke, Zhi-Bin; Cai, Hai; Wei, Yong; Zheng, Qing-Shui; Huang, Jin-Bei; Li, Xiao-Dong; Xue, Xue-Yi

    2018-05-01

    To explore the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS v2) for predicting prostate biopsy results in patients with prostate specific antigen (PSA) levels of 4-10 ng/ml. We retrospectively reviewed multi-parameter magnetic resonance images from 528 patients with PSA levels of 4-10 ng/ml who underwent transrectal ultrasound-guided prostate biopsies between May 2015 and May 2017. Among them, 137 were diagnosed with prostate cancer (PCa), and we further subdivided them according to pathological results into the significant PCa (S-PCa) and insignificant significant PCa (Ins-PCa) groups (121 cases were defined by surgical pathological specimen and 16 by biopsy). Age, PSA, percent free PSA, PSA density (PSAD), prostate volume (PV), and PI-RADS score were collected. Logistic regression analysis was performed to determine predictors of pathological results. Receiver operating characteristic curves were constructed to analyze the diagnostic value of PI-RADS v2 in PCa. Multivariate analysis indicated that age, PV, percent free PSA, and PI-RADS score were independent predictors of biopsy findings, while only PI-RADS score was an independent predictor of S-PCa (P PSA, and PI-RADS score were 0.570, 0.430, 0.589 and 0.836, respectively. The area under the curve for diagnosing S-PCa with respect to PI-RADS score was 0.732. A PI-RADS score of 3 was the best cutoff for predicting PCa, and 4 was the best cutoff for predicting S-PCa. Thus, 92.8% of patients with PI-RADS scores of 1-2 would have avoided biopsy, but at the cost of missing 2.2% of the potential PCa cases. Similarly, 83.82% of patients with a PI-RADS score ≤ 3 would have avoided biopsy, but at the cost of missing 3.3% of the potential S-PCa cases. PI-RADS v2 could be used to reduce unnecessary prostate biopsies in patients with PSA levels of 4-10 ng/ml.

  11. Developing a nomogram based on multiparametric magnetic resonance imaging for forecasting high-grade prostate cancer to reduce unnecessary biopsies within the prostate-specific antigen gray zone.

    Science.gov (United States)

    Niu, Xiang-Ke; Li, Jun; Das, Susant Kumar; Xiong, Yan; Yang, Chao-Bing; Peng, Tao

    2017-02-01

    .001, respectively). The nomogram based on multiparametric magnetic resonance imaging (mp-MRI) for forecasting HGPCa is effective, which could reduce unnecessary prostate biopsies in patients with PSA 4-10 ng/ml and nomogram-based risk-score could provide a more robust parameter of assessing the aggressiveness of HGPCa in PSA gray zone.

  12. The evaluation of enhanced feedback interventions to reduce unnecessary blood transfusions (AFFINITIE): protocol for two linked cluster randomised factorial controlled trials.

    Science.gov (United States)

    Hartley, Suzanne; Foy, Robbie; Walwyn, Rebecca E A; Cicero, Robert; Farrin, Amanda J; Francis, Jill J; Lorencatto, Fabiana; Gould, Natalie J; Grant-Casey, John; Grimshaw, Jeremy M; Glidewell, Liz; Michie, Susan; Morris, Stephen; Stanworth, Simon J

    2017-07-03

    Blood for transfusion is a frequently used clinical intervention, and is also a costly and limited resource with risks. Many transfusions are given to stable and non-bleeding patients despite no clear evidence of benefit from clinical studies. Audit and feedback (A&F) is widely used to improve the quality of healthcare, including appropriate use of blood. However, its effects are often inconsistent, indicating the need for coordinated research including more head-to-head trials comparing different ways of delivering feedback. A programmatic series of research projects, termed the 'Audit and Feedback INterventions to Increase evidence-based Transfusion practIcE' (AFFINITIE) programme, aims to test different ways of developing and delivering feedback within an existing national audit structure. The evaluation will comprise two linked 2×2 factorial, cross-sectional cluster-randomised controlled trials. Each trial will estimate the effects of two feedback interventions, 'enhanced content' and 'enhanced follow-on support', designed in earlier stages of the AFFINITIE programme, compared to current practice. The interventions will be embedded within two rounds of the UK National Comparative Audit of Blood Transfusion (NCABT) focusing on patient blood management in surgery and use of blood transfusions in patients with haematological malignancies. The unit of randomisation will be National Health Service (NHS) trust or health board. Clusters providing care relevant to the audit topics will be randomised following each baseline audit (separately for each trial), with stratification for size (volume of blood transfusions) and region (Regional Transfusion Committee). The primary outcome for each topic will be the proportion of patients receiving a transfusion coded as unnecessary. For each audit topic a linked, mixed-method fidelity assessment and cost-effectiveness analysis will be conducted in parallel to the trial. AFFINITIE involves a series of studies to explore how A

  13. Prophylactic and therapeutic management of acute radiation related morbidity of the skin and mucosa. Part I. Results of a German multicenter questionnaire

    International Nuclear Information System (INIS)

    Zimmermann, J.S.; Wilhelm, R.; Niehoff, P.; Schneider, R.; Kovacs, G.; Kimmig, B.

    1998-01-01

    In this work, it was to evaluate the remedies, which are used for prevention and therapeutic management of acute radiation related morbidity of the skin and mucosa (mouth, pharynx, esophagus, small and large bowel, rectum and vagina). A questionnaire was sent to 130 radiotherapeutic departments in Germany in Juli 1995. The questionnaire had been designed with 22 open questions concerning the preventive and therapeutic management of acute radiation related morbidity of skin and mucosal sites. From 130 questionnaires, 89 (68.4%) were sent back till August 1995. All of them were evaluable. The recommendations showed a broad spectrum for each site. Especially the oral mucositis was treated in many different ways and combinations. The prevention and therapy of complicating superinfections seem to be the joint principle of most of the recommendations. The management of the acute radiation related morbidity has a wide clinical spectrum among different radiation therapy centers. Systematic prospectively designed investigations are necessary in order to achieve a further reduction in the radiation related acute morbidity. Therefore, a multicenter collaborative working group has been founded. (orig./MG) [de

  14. Preventative Maintenance.

    Science.gov (United States)

    Migliorino, James

    Boards of education must be convinced that spending money up front for preventive maintenance will, in the long run, save districts' tax dollars. A good program of preventive maintenance can minimize disruption of service; reduce repair costs, energy consumption, and overtime; improve labor productivity and system equipment reliability; handle…

  15. Impact of Age at Smoking Initiation on Smoking-Related Morbidity and All-Cause Mortality.

    Science.gov (United States)

    Choi, Seung Hee; Stommel, Manfred

    2017-07-01

    Using a nationally representative sample of U.S. adults, the aims of this study were to examine the impact of early smoking initiation on the development of self-reported smoking-related morbidity and all-cause mortality. National Health Interview Survey data from 1997 through 2005 were linked to the National Death Index with follow-up to December 31, 2011. Two primary dependent variables were smoking-related morbidity and all-cause mortality; the primary independent variable was age of smoking initiation. The analyses included U.S. population of current and former smokers aged ≥30 years (N=90,278; population estimate, 73.4 million). The analysis relied on fitting logistic regression and Cox proportional hazards models. Among the U.S. population of smokers, 7.3% started smoking before age 13 years, 11.0% at ages 13-14 years, 24.2% at ages 15-16 years, 24.5% at ages 17-18 years, 14.5% at ages 19-20 years, and 18.5% at ages ≥21 years. Early smoking initiation before age 13 years was associated with increased risks for cardiovascular/metabolic (OR=1.67) and pulmonary (OR=1.79) diseases as well as smoking-related cancers (OR=2.1) among current smokers; the risks among former smokers were cardiovascular/metabolic (OR=1.38); pulmonary (OR=1.89); and cancers (OR=1.44). Elevated mortality was also related to early smoking initiation among both current (hazard ratio, 1.18) and former smokers (hazard ratio, 1.19). Early smoking initiation increases risks of experiencing smoking-related morbidities and all-cause mortality. These risks are independent of demographic characteristics, SES, health behaviors, and subsequent smoking intensity. Comprehensive tobacco control programs should be implemented to prevent smoking initiation and promote cessation among youth. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  16. Cancer morbidity in one of the regions of the ecological disaster

    International Nuclear Information System (INIS)

    Tsyb, A.F.; Bul'bulya, M.A.; Shevchenko, V.N.

    1992-01-01

    A study was made of cancer morbidity (1989) of the population of the Chelyabinsk Region and on 5 territories, exposed to radioactive contamination. As compared to the whole of Russia, total cancer morbidity rates for Chelyabinsk are significantly high, including those of rectal, lung and skin cancer both in men and women. The rates of breast cancer and hemoblatosis morbidity in women were also high. Total cancer morbidity rates on the study territories were lower than the mean district indices. On the tentative territories lip cancer morbidity both in mean and women was higher than the mean district indices; esophageal cancer morbidity rates in women on the same territories was rather high

  17. Management and Prevention of Dystocia.

    Science.gov (United States)

    Funnell, Bethany J; Hilton, W Mark

    2016-07-01

    Dystocia is an inevitable challenge in the livestock industries, particularly with primiparous female animals. Prevention and appropriate management will decrease cow and calf morbidity and mortality, which will improve the economic status of the beef or dairy operation. Early identification and proper intervention improves outcomes, and the use of selection tools to decrease the potential for dystocia will have positive returns. Assisted reproductive technologies present a unique set of challenges to the calving process that both the producer and practitioner should be prepared to address. Published by Elsevier Inc.

  18. PREVENTIVE PAEDIATRICS — NEW CHALLENGES

    Directory of Open Access Journals (Sweden)

    A. A. Baranov

    2012-01-01

    Full Text Available The article takes up priority directions of preventive paediatrics concerning health formation of rising generation, organization of health care for children, decrease of morbidity, disability and mortality rate. The authors mention the importance of vaccination in control of the most common infections, base the necessity of complex rehabilitation health care system organization for disable children and need of wide spreading of developed and used in practical Russian health care types and methods of prophylaxis of rare (orphan diseases. The ways of prophylaxis, maintenance, strengthening and recovery of children’s health are suggested in this article.

  19. Preventive analgesia

    DEFF Research Database (Denmark)

    Dahl, Jørgen B; Kehlet, Henrik

    2011-01-01

    This paper will discuss the concepts of pre-emptive and preventive analgesia in acute and persistent postsurgical pain, based on the most recent experimental and clinical literature, with a special focus on injury-induced central sensitization and the development from acute to chronic pain. Recent...... of preventive analgesia for persistent postoperative pain are promising. However, clinicians must be aware of the demands for improved design of their clinical studies in order to get more conclusive answers regarding the different avenues for intervention. Summary: The concept of preventive analgesia is still...

  20. A low morbidity surgical approach to the sheep femoral trochlea

    Directory of Open Access Journals (Sweden)

    Orth Patrick

    2013-01-01

    Full Text Available Abstract Background The ovine stifle joint is an important location for investigations on the repair of articular cartilage defects in preclinical large animals. The classical medial parapatellar approach to the femoral trochlea is hazardous because of the high risk of postoperative patellar luxation. Here, we describe a low morbidity surgical exposure of the ovine trochlea without the necessity for intraoperative patellar luxation. Methods Bilateral surgical exposure of the femoral trochlea of the sheep stifle joint was performed using the classical medial parapatellar approach with intraoperative lateral patellar luxation and transection of the medial patellar retinaculum in 28 ovine stifle joints. A low morbidity approach was performed bilaterally in 116 joints through a mini-arthrotomy without the need to transect the medial patellar retinaculum or the oblique medial vastus muscle nor surgical patellar luxation. Postoperatively, all 72 animals were monitored to exclude patellar luxations and deep wound infections. Results The novel approach could be performed easily in all joints and safely exposed the distal two-thirds of the medial and lateral trochlear facet. No postoperative patellar luxations were observed compared to a postoperative patellar luxation rate of 25% experienced with the classical medial parapatellar approach and a re-luxation rate of 80% following revision surgery. No signs of lameness, wound infections, or empyema were observed for both approaches. Conclusions The mini-arthrotomy presented here yields good exposure of the distal ovine femoral trochlea with a lower postoperative morbidity than the classical medial parapatellar approach. It is therefore suitable to create articular cartilage defects on the femoral trochlea without the risk of postoperative patellar luxation.

  1. Psychological co-morbidity in children with specific learning disorders

    Directory of Open Access Journals (Sweden)

    Manoj K Sahoo

    2015-01-01

    Full Text Available Children under 19 years of age constitute over 40% of India′s population and information about their mental health needs is a national imperative. Children with specific learning disorders (SLDs exhibit academic difficulties disproportionate to their intellectual capacities. Prevalence of SLD ranges from 2% to 10%. Dyslexia (developmental reading disorder is the most common type, affecting 80% of all SLD. About 30% of learning disabled children have behavioral and emotional problems, which range from attention deficit hyperactivity disorder (most common to depression, anxiety, suicide etc., to substance abuse (least common. Co-occurrence of such problems with SLD further adds to the academic difficulty. In such instances, diagnosis is difficult and tricky; improvement in academics demands comprehensive holistic treatment approach. SLD remains a large public health problem because of under-recognition, inadequate treatment and therefore merits greater effort to understand the co-morbidities, especially in the Indian population. As the literature is scarce regarding co-morbid conditions in learning disability in Indian scenario, the present study has tried to focus on Indian population. The educational concessions (recent most given to such children by Central Board of Secondary Education, New Delhi are referred to. The issues to be addressed by the family physicians are: Low level of awareness among families and teachers, improper dissemination of accurate information about psychological problems, available help seeking avenues, need to develop service delivery models in rural and urban areas and focus on the integration of mental health and primary care keeping such co-morbidity in mind.

  2. Breastfeeding and the risk for diarrhea morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Victora Cesar

    2011-04-01

    Full Text Available Abstract Background Lack of exclusive breastfeeding among infants 0-5 months of age and no breastfeeding among children 6-23 months of age are associated with increased diarrhea morbidity and mortality in developing countries. We estimate the protective effects conferred by varying levels of breastfeeding exposure against diarrhea incidence, diarrhea prevalence, diarrhea mortality, all-cause mortality, and hospitalization for diarrhea illness. Methods We systematically reviewed all literature published from 1980 to 2009 assessing levels of suboptimal breastfeeding as a risk factor for selected diarrhea morbidity and mortality outcomes. We conducted random effects meta-analyses to generate pooled relative risks by outcome and age category. Results We found a large body of evidence for the protective effects of breastfeeding against diarrhea incidence, prevalence, hospitalizations, diarrhea mortality, and all-cause mortality. The results of random effects meta-analyses of eighteen included studies indicated varying degrees of protection across levels of breastfeeding exposure with the greatest protection conferred by exclusive breastfeeding among infants 0-5 months of age and by any breastfeeding among infants and young children 6-23 months of age. Specifically, not breastfeeding resulted in an excess risk of diarrhea mortality in comparison to exclusive breastfeeding among infants 0-5 months of age (RR: 10.52 and to any breastfeeding among children aged 6-23 months (RR: 2.18. Conclusions Our findings support the current WHO recommendation for exclusive breastfeeding during the first 6 months of life as a key child survival intervention. Our findings also highlight the importance of breastfeeding to protect against diarrhea-specific morbidity and mortality throughout the first 2 years of life.

  3. Physical and Psychological Morbidity in Adolescents With Atypical Anorexia Nervosa.

    Science.gov (United States)

    Sawyer, Susan M; Whitelaw, Melissa; Le Grange, Daniel; Yeo, Michele; Hughes, Elizabeth K

    2016-04-01

    Adolescents with atypical anorexia nervosa (AN) have lost significant weight but are not underweight. This study aimed to describe the physical and psychological morbidity of adolescents diagnosed with atypical AN, and to compare them with underweight adolescents with AN. All first presentations of atypical AN (n = 42) and full-threshold AN (n = 118) to a specialist pediatric eating disorder program between July 2010 and June 2014 were examined. Diagnosis was assessed by using the Eating Disorder Examination and anthropometric measurement. Psychological morbidity measures included eating and weight concerns, bingeing, purging, compulsive exercise, and psychiatric comorbidity. Compared with AN, more adolescents with atypical AN were premorbidly overweight or obese (71% vs 12%). They had lost more weight (17.6 kg vs 11.0 kg) over a longer period (13.3 vs 10.2 months). There was no significant difference in the frequency of bradycardia (24% vs 33%;) or orthostatic instability (43% vs 38%). We found no evidence of a difference in frequency of psychiatric comorbidities (38% vs 45%) or suicidal ideation (43% vs 39%). Distress related to eating and body image was more severe in atypical AN. Atypical AN considerably affects physical and psychological functioning, despite adolescents presenting within or above the normal weight range. There was little evidence that the morbidity of adolescents with atypical AN was any less severe than that of adolescents with full-threshold AN. The findings support the need for vigilance around weight loss in adolescents, regardless of body size. Copyright © 2016 by the American Academy of Pediatrics.

  4. Psychiatric morbidity in dermatology patients: Frequency and results of consultations

    Directory of Open Access Journals (Sweden)

    Seyhan Muammer

    2006-01-01

    Full Text Available BACKGROUND: Dermatological patients quite commonly depict psychiatric morbidity. PURPOSES: To study the psychiatric morbidity among skin patients of our clinic. METHODS: In the present study, the patients who were treated in the Dermatology Clinic of Inonu University Medical Faculty were evaluated retrospectively. The age, gender, marital status, habits, dermatological and systemic diseases, previously used drugs, current therapy and psychiatric diagnosis of each patient were recorded. FINDINGS: Of 636 patients involved in the study, 15.3% had psychopathological problems, which were depression (32.0%, adjustment difficulty (15.5%, anxiety (13.4%, psychosomatic disorders (10.3%, obsessive-compulsive disorder and conversion (5.1%, dysthymic disorder (4.1%, attention deficit and hyperactivity disorder (2.1%, panic attack (1.0%, premenstrual syndrome, schizophrenia, somatization disorder, insomnia, alcohol dependency, bipolar affective disorder, mental retardation, agoraphobia, social phobia and dementia. The dermatological diseases defined for the patients with psychopathology diagnosis were chronic urticaria (25.8%; psoriasis (15.5%; alopecia areata, totalis and iniversalis (11.3%; acute urticaria, neurodermatitis and Behcet′s disease (5.1%; atopic dermatitis and drug eruptions (4.1%; pemphigus (3.1%; angioedema, contact dermatitis and generalized pruritus (2.1%; folliculitis and the others (1.0%. CONCLUSIONS: Psychiatric morbidity has an affect on the course of dermatological diseases. When required, psychiatric consultation should be sought by dermatology clinics and patients should be followed with the cooperation of dermatologists and psychiatrists. LIMITATION: The indoor-based study had not included any control group and any domicillary patient.

  5. Hysterectomy as a Management Option for Morbidly Adherent Placenta

    International Nuclear Information System (INIS)

    Ansar, A; Shuja, S.; Khan, S.; Malik, T.

    2014-01-01

    Objective: To determine the outcome of interval (delayed) hysterectomy as compared to cesarean (immediate) hysterectomy in cases of placental invasion in previous cesarean sections. Study Design: Comparative study. Place and Duration of Study: Department of Obstetrics and Gynecology, Unit II, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from January 2008 to June 2011. Methodology: The study subjects included 28 women with history of previous cesarean section who had low lying as well as morbidly adherent placenta (MAP) of variable degree. Patients were classified into two groups (group A and B) according to whether cesarean or interval hysterectomy was needed at time of delivery. Demographic data, obstetrical risk factors such as parity and number of previous cesarean sections were compared as well as radiological and histopathological findings, and details of the management. Chi-square, Fisher's exact and t-tests were used to compare proportions and mean values. Results: The frequency of MAP in previous cesarean sections turned out to be 1.83/1000 (28/15,340) deliveries. Mean maternal age (26.54 vs. 29.13 years, p=0.05), mean gestational age (33.8 vs. 36 weeks, p=0.05), estimated blood loss (2615.38 vs. 1506.6 mL, p=0.001), volume of blood transfused (9.76 vs. 2.9 pints, p=0.001) and the duration of hospital stay (10.69 vs. 32.86 days, p=0.001) differed significantly between group A and group B. One maternal death occurred in each group. Eight patients had other complications in group A compared to 3 patients in group B. Three neonatal deaths occurred in group A compared to nil in group B. Conclusion: The frequency of morbidly adherent placenta was 1.83/1000 deliveries. The management and outcome differed markedly according to emergency and scheduled antenatal diagnosis. Counselling and antenatal radiological screening can reduce the high morbidity and mortality associated with it. (author)

  6. The liver in consecutive patients with morbid obesity

    DEFF Research Database (Denmark)

    Andersen, T; Christoffersen, Pernille Yde; Gluud, C

    1984-01-01

    consumption and only one was diabetic. Four biopsies (7 per cent) showed normal liver tissue, while fatty change was the main diagnosis in most cases (85 per cent). Increasing degrees of fatty change was significantly (P less than 0.02) associated with presence of lipogranulomas (found in 54 per cent......Liver morphology and biochemistry were investigated in 61 morbidly obese subjects selected by defined criteria. Median overweight was 82 per cent (range 61 to 170 per cent), and median duration of overweight was 20 years (range two to 45 years). No patient had more than a moderate alcohol...

  7. Surgery for Gastroesophageal Reflux Disease in the Morbidly Obese Patient.

    Science.gov (United States)

    Duke, Meredith C; Farrell, Timothy M

    2017-01-01

    The prevalence of gastroesophageal reflux disease (GERD) has mirrored the increase in obesity, and GERD is now recognized as an obesity-related comorbidity. There is growing evidence that obesity, specifically central obesity, is associated with the complications of chronic reflux, including erosive esophagitis, Barrett's esophagus, and esophageal adenocarcinoma. While fundoplication is effective in creating a competent gastroesophageal junction and controlling reflux in most patients, it is less effective in morbidly obese patients. In these patients a bariatric operation has the ability to correct both the obesity and the abnormal reflux. The Roux-en-Y gastric bypass is the preferred procedure.

  8. Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity

    Energy Technology Data Exchange (ETDEWEB)

    Sant Anna Junior, Maurício de [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Departamento de Fisioterapia do Centro Universitário Anhanguera Niterói - UNIAN, Niterói, RJ (Brazil); Programa de pós-graduação em Ciências Médicas, Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Carneiro, João Regis Ivar; Carvalhal, Renata Ferreira [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Torres, Diego de Faria Magalhães [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Departamento de Fisioterapia da Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Cruz, Gustavo Gavina da; Quaresma, José Carlos do Vale [Programa de Tratamento Multidisciplinar da Obesidade do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro, RJ (Brazil); Lugon, Jocemir Ronaldo [Divisão de Nefrologia - Faculdade de Medicina da Universidade Federal Fluminense - UFF, Niterói, RJ (Brazil); Guimarães, Fernando Silva, E-mail: fguimaraes_pg@yahoo.com.br [Departamento de Fisioterapia da Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, RJ (Brazil); Programa de pós-graduação em Ciências da Reabilitação - Centro Universitário Augusto Motta, Rio de Janeiro, RJ (Brazil)

    2015-12-15

    Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation. This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals. Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student’s t-test, with a level of significance of 5%. Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013). morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction.

  9. Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity

    Science.gov (United States)

    de Sant Anna Junior, Maurício; Carneiro, João Regis Ivar; Carvalhal, Renata Ferreira; Torres, Diego de Faria Magalhães; da Cruz, Gustavo Gavina; Quaresma, José Carlos do Vale; Lugon, Jocemir Ronaldo; Guimarães, Fernando Silva

    2015-01-01

    Background Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation. Objective This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals. Methods Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student’s t-test, with a level of significance of 5%. Results Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013). Conclusion morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction. PMID:26536979

  10. Morbidity of Cushing's Syndrome and Impact of Treatment.

    Science.gov (United States)

    Webb, Susan M; Valassi, Elena

    2018-06-01

    Cortisol excess in Cushing's syndrome is associated with metabolic, cardiovascular, and cognitive alterations, only partially reversible after resolution of hypercortisolism. Elevated cardiovascular risk may persist after eucortisolism has been achieved. Fractures and low bone mineral density are also described in Cushing's syndrome in remission. Hypercortisolism may induce irreversible structural and functional changes in the brain, leading to neuropsychiatric disorders in the active phase of the disease, which persist. Sustained deterioration of the cardiovascular system, bone remodeling, and cognitive function along with neuropsychological impairment are associated with high morbidity and poor quality of life before and after remission. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Recipient characteristics and morbidity and mortality after liver transplantation.

    Science.gov (United States)

    Asrani, Sumeet K; Saracino, Giovanna; O'Leary, Jacqueline G; Gonzales, Stevan; Kim, Peter T; McKenna, Greg J; Klintmalm, Goran; Trotter, James

    2018-02-15

    Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States. We sought to identify an easily applicable set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within five years after liver transplantation. We collected national (n = 31,829, 2002-2015) and center-specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0-5. Recipient factors associated with graft failure included: ventilator support (five patients; hazard ratio [HR] 1.59; 95% CI 1.48-1.72); recipient age >60 years (three patients; HR 1.29; 95% CI 1.23-1.36); hemodialysis (three patients; HR 1.26; 95% CI 1.16-1.37); diabetes (two patients; HR 1.20; 95% CI 1.14-1.27); or serum creatinine ≥1.5 mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09-1.22). Graft survival within five years based on points (any combination) was 77.2% (0-4), 69.1% (5-8) and 57.9% (>8). In recipients with >8 points, graft survival was 42% (model for end-stage liver disease [MELD] score recipients receiving grafts from donors with a donor risk index >1.7. In center-specific data within the first year, subjects with ≥5 points (vs. 0-4) had longer hospitalization (11 vs. 8 days, p need to be reassessed. The proposed clinical tool may be helpful for center-specific assessment of risk of graft failure in non-HCV patients and for discussion regarding relevant morbidity in selected subsets. Over the last decade, liver transplantation of sicker, older patient with multiple co-morbidities has increased. In this study, we show that a set of recipient factors (recipient age >60 years, ventilator status, diabetes, hemodialysis and creatinine >1.5 mg/dl) can help identify patients that may not do well after transplant. Transplanting sicker organs in patients with certain combinations of these

  12. Pouch emptying of solid foods after gastroplasty for morbid obesity

    DEFF Research Database (Denmark)

    Andersen, T; Pedersen, B H; Henriksen, Jens Henrik Sahl

    1985-01-01

    To obtain information on possible determinants of weight loss after horizontal gastroplasty, pouch emptying was prospectively investigated in 27 morbidly obese patients. A scintigraphic method was used. Examinations were carried out every 6 months until 2 years after surgery. Pouch emptying...... was described by means of delay, time until half emptying, mean transit time, and emptying rate. The measures all showed a significant (p less than 0.05) acceleration of pouch emptying during the first 6 months after gastroplasty. Thereafter pouch emptying was unaltered. No significant association could...

  13. [Morbidity among mothers and infants after ambulatory deliveries].

    Science.gov (United States)

    Kierkegaard, O

    1991-07-29

    Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

  14. Tuberculosis disease mapping in Kedah using standardized morbidity ratio

    Science.gov (United States)

    Diah, Ijlal Mohd; Aziz, Nazrina; Kasim, Maznah Mat

    2017-10-01

    This paper presents the results of relative risk estimation that applied to TB data in Kedah using the most common approach, Standardized Morbidity Ratio (SMR). Disease mapping has been recognized as one of the methods that can be used by government and public health in order to control diseases since it can give a clear picture of the risk areas. To get good disease mapping, relative risk estimation is an important issue that need to be considered. TB risk areas will be recognized through the map. From the result, Kulim shows the lowest risk areas of contracting TB while Kota Setar has the highest risk area.

  15. Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity

    International Nuclear Information System (INIS)

    Sant Anna Junior, Maurício de; Carneiro, João Regis Ivar; Carvalhal, Renata Ferreira; Torres, Diego de Faria Magalhães; Cruz, Gustavo Gavina da; Quaresma, José Carlos do Vale; Lugon, Jocemir Ronaldo; Guimarães, Fernando Silva

    2015-01-01

    Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation. This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals. Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student’s t-test, with a level of significance of 5%. Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013). morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction

  16. Easing the strain of unnecessary antibiotic requests. Physicians called on to change patient expectations about antibiotic use; experts say it's about communication.

    Science.gov (United States)

    Hertz, Beth Thomas

    2014-01-10

    Antibiotic resistance is one of the world's major public health challenges, according to the Centers for Disease Control and Prevention. While medical providers are heeding the call, patient pressure about receiving antibiotic prescriptions remains a significant influencer, says the National Committee for Quality Assurance.

  17. Prevention: Exercise

    Medline Plus

    Full Text Available ... Tips for a Healthy Back Smoking Weight Patient Safety Exercise Strengthening Strengthen Your Core! Stretching/Flexibility Aerobic ... Strength Training for the Elderly Other Back Pack Safety Pregnancy and Back Pain Preventing Osteoporosis Back Pain ...

  18. Preventing Rejection

    Science.gov (United States)

    ... After the transplant Preventing rejection Post-transplant medications Types of immunosuppressants Switching immunosuppressants Side effects Other medications Generic and brand name drugs Post-transplant tests Infections and immunity Lifestyle changes Health concerns Back to work or ...

  19. Prevent Cyberbullying

    Science.gov (United States)

    ... Tips for Teachers Report Cyberbullying Print Share Prevent Cyberbullying Be Aware of What Your Kids are Doing ... Signs a Child is Being Cyberbullied or is Cyberbullying Others Many of the warning signs that cyberbullying ...

  20. Preventing Suicide

    Science.gov (United States)

    ... protective factors listed below: Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes Effective ... 2017 Page last updated: August 9, 2017 Content source: National Center for Injury Prevention and Control, Division ...

  1. Prevention: Exercise

    Medline Plus

    Full Text Available ... A SPECIALIST Prevention Strengthening Exercise Committee Exercise Committee Core Strengthening Many popular forms of exercise focus on ... acute pain, you should stop doing it. Transverse Core Strengthening This strengthens the muscles that cross from ...

  2. Prevention: Exercise

    Medline Plus

    Full Text Available ... Training for the Elderly Other Back Pack Safety Pregnancy and Back Pain Preventing Osteoporosis Back Pain Basics ... increases your back pain after five repetitions, or causes acute pain, you should stop doing it. Transverse ...

  3. Preventing accidents

    Science.gov (United States)

    2005-08-01

    As the most effective strategy for improving safety is to prevent accidents from occurring at all, the Volpe Center applies a broad range of research techniques and capabilities to determine causes and consequences of accidents and to identify, asses...

  4. Prevention: Exercise

    Medline Plus

    Full Text Available ... 10 Tips for a Healthy Back Smoking Weight Patient Safety Exercise Strengthening Strengthen Your Core! Stretching/Flexibility ... Pain Preventing Osteoporosis Back Pain Basics Book RESOURCES Patient Information Feature Articles Patient Q&A Success Stories ...

  5. Prevention: Exercise

    Medline Plus

    Full Text Available ... Preventing Osteoporosis Back Pain Basics Book RESOURCES Patient Information Feature Articles Patient Q&A Success Stories Definitions Anatomy of the Spine Definitions A-Z Spine Specialists Videos 9 ...

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

    Science.gov (United States)

    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...

  7. HIV Prevention

    Centers for Disease Control (CDC) Podcasts

    2012-02-01

    Dr. Kevin Fenton, Director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, talks about steps people can take to protect their health from HIV.  Created: 2/1/2012 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 2/1/2012.

  8. Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants

    NARCIS (Netherlands)

    Buchholz, Ulrike; Kobbe, Robin; Danquah, Ina; Zanger, Philipp; Reither, Klaus; Abruquah, Harry H.; Grobusch, Martin P.; Ziniel, Peter; May, Jürgen; Mockenhaupt, Frank P.

    2010-01-01

    Intermittent preventive treatment in infants with sulphadoxine-pyrimethamine (IPTi-SP) reduces malaria morbidity by 20% to 33%. Potentially, however, this intervention may compromise the acquisition of immunity, including the tolerance towards multiple infections with Plasmodium falciparum.

  9. Multiplicity of Plasmodium falciparum infection following intermittent preventive treatment in infants

    NARCIS (Netherlands)

    Buchholz, U.; Kobbe, R.; Danquah, I.; Zanger, P.; Reither, K.; Abruquah, H.H.; Grobusch, M.P.; Ziniel, P.; May, J.; Mockenhaupt, F.P.

    2010-01-01

    Background: Intermittent preventive treatment in infants with sulphadoxine-pyrimethamine (IPTi-SP) reduces malaria morbidity by 20% to 33%. Potentially, however, this intervention may compromise the acquisition of immunity, including the tolerance towards multiple infections with Plasmodium

  10. Tracheostomy in the Morbidly Obese: Difficulties and Challenges.

    Science.gov (United States)

    Fattahi, Tirbod; Chafin, Christopher; Bunnell, Anthony

    2017-07-01

    This study evaluated the difficulties and challenges associated with open tracheostomy in the morbidly obese patient (body mass index [BMI] ≥30 kg/m 2 ). Forty patients met all the inclusion criteria. A retrospective chart review was performed to evaluate indications for tracheostomy, duration of intubation before tracheostomy, history of tracheostomy, duration of operative procedure, duration in the operating room, and all perioperative complications. Complications were classified as intraoperative (5%) and postoperative (17.5%). The average BMI was 46 kg/m 2 (range, 31.1 to 75.3 kg/m 2 ). The average duration of intubation before tracheostomy was 11 days. Ten patients (25%) previously underwent tracheostomy. The average operating time was 60 minutes (range, 20 to 95 minutes). The average total time in the operating room was 100 minutes (range, 45 to 146 minutes). This study shows that although open tracheostomy in the morbidly obese patient is increasing in demand, the procedure can be predictably performed albeit at a much longer duration and a higher perioperative complication rate compared with the traditional tracheostomy. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Prenatal docosahexaenoic acid supplementation and infant morbidity: randomized controlled trial.

    Science.gov (United States)

    Imhoff-Kunsch, Beth; Stein, Aryeh D; Martorell, Reynaldo; Parra-Cabrera, Socorro; Romieu, Isabelle; Ramakrishnan, Usha

    2011-09-01

    Long-chain polyunsaturated fatty acids such as docosahexaenoic acid (DHA) influence immune function and inflammation; however, the influence of maternal DHA supplementation on infant morbidity is unknown. We investigated the effects of prenatal DHA supplementation on infant morbidity. In a double-blind randomized controlled trial conducted in Mexico, pregnant women received daily supplementation with 400 mg of DHA or placebo from 18 to 22 weeks' gestation through parturition. In infants aged 1, 3, and 6 months, caregivers reported the occurrence of common illness symptoms in the preceding 15 days. Data were available at 1, 3, and 6 months for 849, 834, and 834 infants, respectively. The occurrence of specific illness symptoms did not differ between groups; however, the occurrence of a combined measure of cold symptoms was lower in the DHA group at 1 month (OR: 0.76; 95% CI: 0.58-1.00). At 1 month, the DHA group experienced 26%, 15%, and 30% shorter duration of cough, phlegm, and wheezing, respectively, but 22% longer duration of rash (all P ≤ .01). At 3 months, infants in the DHA group spent 14% less time ill (P DHA group experienced 20%, 13%, 54%, 23%, and 25% shorter duration of fever, nasal secretion, difficulty breathing, rash, and "other illness," respectively, but 74% longer duration of vomiting (all P DHA supplementation during pregnancy decreased the occurrence of colds in children at 1 month and influenced illness symptom duration at 1, 3, and 6 months.

  12. PSYCHIATRIC CO - MORBIDITY IN PERSONS WITH HANSEN’S DISEASE

    Directory of Open Access Journals (Sweden)

    Anita

    2015-05-01

    Full Text Available OBJECTIVE: To estimate prevalence of psychiatric co - morbidity and its effect on quality of life in persons with Hansen’s disease. METHOD: The study was conducted on around 80 persons above 18 year age with Hansen’s disease in out - patient department dermatology and i n leprosy home. Participants were diagnosed cases of Hansen’s disease, selected randomly and were evaluated with socio demographic questionnaire, Duke’s general health questionnaire, DSM - 5 self rated level 1 cross cutting symptom measure – adult and WHO - QO L - BREF. The period of data collection was from October 2014 to March 2015. RESULTS: The assessment showed that prevalence of at least one psychiatric co morbidity was 83.75% (67/80 patients and of these 67 patients 18(26.86% have one diagnosis, 26(38.80% have two diagnoses and 23(34.32% have 3 or more psychiatric diagnoses. Among all depression was most prevalent (28.35% mental disorder; followed by anxiety disorder (23.88%. Quality of life was significantly impaired in almost all persons with Hansen’ s disease. CONCLUSION: Persons with Hansen’s disease have significantly high prevalence of mental disorders which have much impact on their quality of life which were under diagnosed and thus remained untreated

  13. Analysis of ante-partum maternal morbidity in rural Bangladesh.

    Science.gov (United States)

    Chakraborty, Nitai; Islam, M Ataharul; Chowdhury, Rafiqul Islam; Bari, Wasimul

    2003-01-01

    This paper presents the results of a prospective study of maternal morbidity during the ante-partum period in rural areas of Bangladesh. The data came from a survey of Maternal Morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT) during the period from November 1992 to December 1993. Since then no such national level survey has been conducted in Bangladesh. This paper employs multiple-decrement life table technique, a convenient way of analysing the risks of different types of disease conditions that women experience during the antenatal period for different age categories. The high-risk complications such as ante-partum haemorrhage, excessive vomiting, fits/convulsion and oedema were considered in this study. In this study a cause specific model was applied to explore the differences in the risks exerted at different ages of reproductive life attributable to some selected complications of pregnancy. The results of this study indicate that women of age 25-29 years are less susceptible to most of the selected life-threatening and high-risk complications during pregnancy such as haemorrhage, fits/convulsion and oedema. However, younger women (age or = 30 years) are at greater risk of haemorrhage, fits/convulsion and oedema.

  14. Neonatal morbidity and early outcome of very preterm infants

    Directory of Open Access Journals (Sweden)

    Heljić Suada

    2013-03-01

    Full Text Available Background: Although the mortality rate for preterm infants and the gestational age-specific mortality rate have dramatically improved over the last 3 to 4 decades, infants born preterm remain vulnerable to many complications, including respiratory distress syndrome, chronic lung disease, necrotizing enterocolitis, a compromised immune system, cardiovascular disorders, hearing and vision problems, and brain lesions. The aim is to determine mortality and morbidity rates and selected outcome variables for preterm infant’s grade 3 IVH or PVL 16.6%, NEC Bell stages II or III 9.8%, BPD 25/72 (33.3% of infants who survived to 36 weeks postmenstrual age. In 38 (37.2% infants, episodes of infections were noticed (one or more episodes in 25 infants, half of them were caused by Gram positive bacteria, most frequent coagulasa negative staphylococci. Klebsiella pneumoniae was the most frequent organism among Gram negative bacteria. One patient had invasive candidiasis caused by Candida albicans. In 5 infants (4.9% early onset of sepsis was documented. Conclusion: Very preterm infants remain very vulnerable group of population, and interventions to reduce the morbidity and mortality of preterm babies include tertiary interventions such as regionalized care, transportation in uterus, and treatment with antenatal steroids.

  15. Residency education through the family medicine morbidity and mortality conference.

    Science.gov (United States)

    Kim, Curi; Fetters, Michael D; Gorenflo, Daniel W

    2006-09-01

    The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.

  16. Perioperative morbidity and mortality after lumbar trauma in the elderly.

    Science.gov (United States)

    Winkler, Ethan A; Yue, John K; Birk, Harjus; Robinson, Caitlin K; Manley, Geoffrey T; Dhall, Sanjay S; Tarapore, Phiroz E

    2015-10-01

    OBJECT Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal trauma. Lumbar spine trauma in the elderly is a growing public health problem with relatively little evidence to guide clinical management. The authors sought to characterize the complications, morbidity, and mortality associated with surgical and nonsurgical management in elderly patients with traumatic fractures of the lumbar spine. METHODS Using the National Sample Program of the National Trauma Data Bank, the authors performed a retrospective analysis of patients ≥ 55 years of age who had traumatic fracture to the lumbar spine. This group was divided into middle-aged (55-69 years) and elderly (≥ 70 years) cohorts. Cohorts were subdivided into nonoperative, vertebroplasty or kyphoplasty, noninstrumented surgery, and instrumented surgery. Univariate and multivariable analyses were used to characterize and identify predictors of medical and surgical complications, mortality, hospital length of stay, ICU length of stay, number of days on ventilator, and hospital discharge in each subgroup. Adjusted odds ratios, mean differences, and associated 95% CIs were reported. Statistical significance was assessed at p elderly is associated with increased morbidity. In particular, instrumented fusion is associated with periprocedural complications, prolonged hospitalization, and a decreased likelihood of being discharged home. However, fusion surgery is also associated with reduced mortality. Age alone should not be an exclusionary factor in identifying surgical candidates for instrumented lumbar spinal fusion. Future studies are needed to confirm these findings.

  17. Psychiatric co-morbidity in chronic pain disorder

    International Nuclear Information System (INIS)

    Yaqoob, N.; Sharif, A.; Shoaib, A.

    2013-01-01

    Objective: To determine the psychiatric co-morbidity in patients with chronic pain disorder in hospital setting. Design: Cross sectional descriptive study. Place and duration of study: This study was conducted at Combined Military Hospital (CMH) Okara from June 2011 to May 2012. Patients and Methods: A purposive sample of 400 patients (males=117; females=283) gathered from pain clinic and other outpatient departments of the hospital and were interviewed in detail and Present State Examination was carried out. Demographic variables were scored using descriptive statistics and results were analyzed using correlation methods. Results: It was revealed that psychiatric illness in overall sample prevailed among 266 participants (67%). Among which 164 participants (62%) were diagnosed with depression, 67 patients (25.2%) of chronic pain were diagnosed with anxiety disorders, 28 patients (11%) with adjustment disorder and 1.5% and 1.1% diagnosed with drug dependence and somatization disorder, respectively. Conclusion: Psychiatric co-morbidity especially the incidence of depression, anxiety and adjustment disorders were high amongst patients suffering from chronic pain disorder. (author)

  18. Ophthalmic Morbidity in School Children in Hilly Areas of Uttarakhand

    Directory of Open Access Journals (Sweden)

    Surekha Kishore

    2014-03-01

    Full Text Available Introduction: School children constitute about one fourth of population of India. Early detection and treatment of various eye diseases helps in avoiding many complications. The magnitude of blindness is 3-4 times greater in developing countries. Very few studies have been conducted in Uttarakhand revealing the ophthalmic morbidity in school children or general population. Hilly areas especially the remote ones face various problems like, poor transportation facilities, distant health facilities, use of traditional methods for treatment, faith healing, customs and belief system, lack of information.  Moreover   water supply, poor personal hygiene and other factors also add up to these problems. Aim: To study the ophthalmic morbidities in school children in 3 schools of Thatyur block. Methodology: It was a cross sectional study. Result: A total of 705 students were enrolled. Permission from school authorities was seeked before the start of study. Schools were visited twice in a week current and preliminary information was taken from the students & teacher regarding education, occupation, income etc. General examination and ophthalmic examination was done with day & torch light along with refraction, with the help of standard Snellen’s chart. Each eye was examined separately. A vision of 6/6 was considered as normal. Near vision was tested with new vision Snellen’s chart at 12-14 inches away from eye.

  19. Ophthalmic Morbidity in School Children in Hilly Areas of Uttarakhand

    Directory of Open Access Journals (Sweden)

    Surekha Kishore

    2014-03-01

    Full Text Available Introduction: School children constitute about one fourth of population of India. Early detection and treatment of various eye diseases helps in avoiding many complications. The magnitude of blindness is 3-4 times greater in developing countries. Very few studies have been conducted in Uttarakhand revealing the ophthalmic morbidity in school children or general population. Hilly areas especially the remote ones face various problems like, poor transportation facilities, distant health facilities, use of traditional methods for treatment, faith healing, customs and belief system, lack of information.  Moreover   water supply, poor personal hygiene and other factors also add up to these problems. Aim: To study the ophthalmic morbidities in school children in 3 schools of Thatyur block. Methodology: It was a cross sectional study. Result: A total of 705 students were enrolled. Permission from school authorities was seeked before the start of study. Schools were visited twice in a week current and preliminary information was taken from the students & teacher regarding education, occupation, income etc. General examination and ophthalmic examination was done with day & torch light along with refraction, with the help of standard Snellen’s chart. Each eye was examined separately. A vision of 6/6 was considered as normal. Near vision was tested with new vision Snellen’s chart at 12-14 inches away from eye.

  20. Sensory symptom profiles and co-morbidities in painful radiculopathy.

    Directory of Open Access Journals (Sweden)

    Friederike Mahn

    Full Text Available Painful radiculopathies (RAD and classical neuropathic pain syndromes (painful diabetic polyneuropathy, postherpetic neuralgia show differences how the patients express their sensory perceptions. Furthermore, several clinical trials with neuropathic pain medications failed in painful radiculopathy. Epidemiological and clinical data of 2094 patients with painful radiculopathy were collected within a cross sectional survey (painDETECT to describe demographic data and co-morbidities and to detect characteristic sensory abnormalities in patients with RAD and compare them with other neuropathic pain syndromes. Common co-morbidities in neuropathic pain (depression, sleep disturbance, anxiety do not differ considerably between the three conditions. Compared to other neuropathic pain syndromes touch-evoked allodynia and thermal hyperalgesia are relatively uncommon in RAD. One distinct sensory symptom pattern (sensory profile, i.e., severe painful attacks and pressure induced pain in combination with mild spontaneous pain, mild mechanical allodynia and thermal hyperalgesia, was found to be characteristic for RAD. Despite similarities in sensory symptoms there are two important differences between RAD and other neuropathic pain disorders: (1 The paucity of mechanical allodynia and thermal hyperalgesia might be explained by the fact that the site of the nerve lesion in RAD is often located proximal to the dorsal root ganglion. (2 The distinct sensory profile found in RAD might be explained by compression-induced ectopic discharges from a dorsal root and not necessarily by nerve damage. These differences in pathogenesis might explain why medications effective in DPN and PHN failed to demonstrate efficacy in RAD.

  1. MANAGEMENT OF ENDOCRINE DISEASE: Morbidity in polycystic ovary syndrome.

    Science.gov (United States)

    Glintborg, Dorte; Andersen, Marianne

    2017-02-01

    Polycystic ovary syndrome (PCOS) is the most prevalent endocrine condition in premenopausal women. The syndrome is characterized by hyperandrogenism, irregular menses and polycystic ovaries when other etiologies are excluded. Obesity, insulin resistance and low vitamin D levels are present in more than 50% patients with PCOS, these factors along with hyperandrogenism could have adverse effects on long-term health. Hyperinflammation and impaired epithelial function were reported to a larger extent in women with PCOS and could particularly be associated with hyperandrogenism, obesity and insulin resistance. Available data from register-based and data linkage studies support that metabolic-vascular and thyroid diseases, asthma, migraine, depression and cancer are diagnosed more frequently in PCOS, whereas fracture risk is decreased. Drug prescriptions are significantly more common in PCOS than controls within all diagnose categories including antibiotics. The causal relationship between PCOS and autoimmune disease represents an interesting new area of research. PCOS is a lifelong condition and long-term morbidity could be worsened by obesity, sedentary way of life, Western-style diet and smoking, whereas lifestyle intervention including weight loss may partly or fully resolve the symptoms of PCOS and could improve the long-term prognosis. In this review, the possible implications of increased morbidity for the clinical and biochemical evaluation of patients with PCOS at diagnosis and follow-up is further discussed along with possible modifying effects of medical treatment. © 2017 European Society of Endocrinology.

  2. Early prevention of obesity

    Directory of Open Access Journals (Sweden)

    Claudio Maffeis

    2014-06-01

    Full Text Available Childhood obesity is the metabolic disorder with the highest prevalence in both children and adults. Urgency to treat and prevent childhood obesity is based on the clear evidence that obesity tends to track from childhood to adulthood, is associated to morbidity also in childhood and to long-term mortality. Early life, i.e., intrauterine life and the first two years, is a sensitive window for prevention. Anatomical and functional maturation of the hypothalamic structures devoted to regulating energy intake and expenditure and body size mainly occurs in the first 1,000 days of life. Therefore, factors affecting the foetal exposition to maternal metabolic environment and early postnatal nutrition are crucial in modulating the definition of the metabolic programming processes in the brain. Maternal diseases, mainly malnutrition for defect or excess, obesity and diabetes, placental disorders and dysfunctions, maternal use of alcohol and drugs, smoking, affect long term metabolic programming of the foetus with lifelong consequences. Similarly, early nutrition contributes to complete the long-term metabolic regulating framework initiated in the uterus. Breastfeeding, adequate weaning, attention to portion size and diet composition are potential tools for reducing the obesity risk later in childhood. Longitudinal randomized controlled studies are needed for exploring the efficacy of obesity prevention strategies initiated after conception.Proceedings of the 10th International Workshop on Neonatology · Cagliari (Italy · October 22nd-25th, 2014 · The last ten years, the next ten years in Neonatology Guest Editors: Vassilios Fanos, Michele Mussap, Gavino Faa, Apostolos Papageorgiou

  3. Review Of Prevention Techniques For Denial Of Service DOS Attacks In Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    Poonam Rolla

    2015-08-01

    Full Text Available Wireless Sensor Networks comprised of several tiny sensor nodes which are densely deployed over the region to monitor the environmental conditions. These sensor nodes have certain design issues out of which security is the main predominant factor as it effects the whole lifetime of network. DDoS Distributed denial of service attack floods unnecessary packets in the sensor network. A review on DDoS attacks and their prevention techniques have been done in this paper.

  4. Morbidity pattern and health-seeking behavior of aged population residing in Shimla hills of north India: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Deepak Sharma

    2013-01-01

    Full Text Available Background: Population aging is a global phenomenon. In India, the size of the elderly population is growing fast. Many older adults have multiple medical conditions. Understanding elderly health problems and health-seeking behavior is prerequisite for proving comprehensive geriatric care to them. Objectives: To assess the morbidity pattern and study the health-seeking behavior of the elderly people of Shimla district in Himachal Pradesh. Materials and Methods: A total of 400 elderly people aged 60 years and above were selected from urban and rural areas of Shimla hills in North India by simple random sampling. Statistical software Epi info software version 3.2 was used for analyzing data. Descriptive statistics were used to describe sociodemographic and morbidity variables. Results: The most common morbidity identified among them were musculoskeletal problems (55.0% followed by hypertension (40.5%. Two third were seeking treatment for their health problems. Among older persons not seeking treatment for their medical condition, most considered these morbidities as an age-related phenomenon. Many perceived that the health services were too far. Conclusion: The high morbidity load among elderly in the present study stresses for efforts to provide better health care to them and thus ensure that they remain active members of our society. Residence emerged out to be most significant determinant of healthcare-seeking behavior. Policy makers must focus on rural elderly and their beliefs which prevent them from seeking healthcare.

  5. Role of the primary health care team in preventing accidents to children.

    OpenAIRE

    Kendrick, D

    1994-01-01

    Accidents are the most common cause of mortality in children and account for considerable childhood morbidity. The identification of risk factors for childhood accidents suggests that many are predictable and therefore preventable. Numerous interventions have been found to be effective in reducing the morbidity and mortality from childhood accidents. The scope for accident prevention within the primary care setting and the roles of the members of the primary health care team are discussed. Fi...

  6. [Can gene technology in agriculture prevent hunger in the world?].

    Science.gov (United States)

    Goewie, E A

    2002-03-01

    The world population grows rapidly: the number of mouths to feed increases. Is an agriculture without gene technology able to produce sufficiently in order to prevent hunger? Research indicates that hunger is not the result of short comings in agricultural outputs. It is however the result of poverty. This problem will not be solved by gene technology based agricultural production. This article explains the basic principles of mainstream and organic farming. Literature shows that the production potentials of both kinds of farming are, by far most, not yet exhausted. Gene technology is therefore unnecessary.

  7. Cancer prevention.

    Science.gov (United States)

    Tubiana, M

    1999-01-01

    Over 70% of human cancers are associated with lifestyle and about half of cancer deaths could be prevented by relatively simple individual actions: no smoking, moderate consumption of alcohol, increased consumption of fruit and vegetables, avoidance of sunbathing, obesity and a too high consumption of saturated lipids. Most of these efforts would also markedly decrease the incidence of cardiovascular and respiratory diseases. However, the concept of prevention is currently neither well accepted nor understood by the medical community and the general public. It is often felt that it restricts freedom, imposes a choice between pleasure and duty, and that passing judgement on lifestyle is a form of intolerance. The case of tobacco illustrates the difficulties encountered by prevention, notably among adolescents. The fight against smoking requires information, a societal approach (ban on advertising, increase in price), and a reduction of the example given by adult smoking (parents, peers, teachers, physicians, TV presenters, movie stars, have a great influence on adolescents), while tobacco cessation programs must be promoted. The various approaches should be integrated into a global program of health prevention, including health education at school from 5 to 12 years of age. The efficacy of each of the global program's components should be evaluated. Misconceptions such as overestimation of the impact of pollution on health should also be corrected. Health is created and experienced by people within the setting of their daily lives, in particular during childhood. Prevention is the responsibility of individual members of the community but also of the community as a whole.

  8. Geographic Variation in Morbidity and Mortality of Cerebrovascular Diseases in Korea during 2011-2015.

    Science.gov (United States)

    Lee, Juyeon; Bahk, Jinwook; Kim, Ikhan; Kim, Yeon-Yong; Yun, Sung-Cheol; Kang, Hee-Yeon; Lee, Jeehye; Park, Jong Heon; Shin, Soon-Ae; Khang, Young-Ho

    2018-03-01

    Little is known about within-country variation in morbidity and mortality of cerebrovascular diseases (CVDs). Geographic differences in CVD morbidity and mortality have yet to be properly examined. This study examined geographic variation in morbidity and mortality of CVD, neighborhood factors for CVD morbidity and mortality, and the association between CVD morbidity and mortality across the 245 local districts in Korea during 2011-2015. District-level health care utilization and mortality data were obtained to estimate age-standardized CVD morbidity and mortality. The bivariate Pearson correlation was used to examine the linear relationship between district-level CVD morbidity and mortality Z-scores. Simple linear regression and multivariate analyses were conducted to investigate the associations of area characteristics with CVD morbidity, mortality, and discrepancies between morbidity and mortality. Substantial variation was found in CVD morbidity and mortality across the country, with 1074.9 excess CVD inpatients and 73.8 excess CVD deaths per 100,000 between the districts with the lowest and highest CVD morbidity and mortality, respectively. Higher rates of CVD admissions and deaths were clustered in the noncapital regions. A moderate geographic correlation between CVD morbidity and mortality was found (Pearson correlation coefficient = .62 for both genders). Neighborhood level indicators for socioeconomic disadvantages, undersupply of health care resources, and unhealthy behaviors were positively associated with CVD morbidity and mortality and the relative standing of CVD mortality vis-à-vis morbidity. Policy actions targeting life-course socioeconomic conditions, equitable distribution of health care resources, and behavioral risk factors may help reduce geographic differences in CVD morbidity and mortality in Korea. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Nutritional status and morbidity pattern in school age children in Nepal

    Directory of Open Access Journals (Sweden)

    N Bhandari

    2012-09-01

    Full Text Available School Health has been regarded as a high priority intervention in developing countries. However it has not been prioritized in Nepal for many years. The objectives of the study are to find out the nutritional status and morbidity pattern in school age children. To arouse importance of personal hygiene and healthful surrounding through information, education and communication (IEC. This cross-sectional study was administered in two schools located in Bolde phedeche and Mahure of Kavrepalanchowk. From the selected schools, a total number of 160 students studying from Grade 1 to V were enumerated in the study using census survey method. Among 160 students, the most important three problems were pediculosis 42(26.2 %, dental caries 29(18.1%, and waxy ear 27(17.1 %. Thus the school health education should put more emphasis on oral care, nutrition, personal hygiene and others. Applying classification of Indian Academy of Pediatrics: based on weight for age, 36(55.3% boys and 34(35.8% girls fall under 1st degree malnutrition and 15(23.07% boys and 44(46.3% girls fall under IInd degree malnutrition, 7(7.2 % girls fall under IIIrd degree malnutrition.The health and nutritional standards of school children in this study were found to be unsatisfactory. Among different morbidity pediculosis is found more in girls. The present study put more emphasis on the need for initiation of school health program in the school with more on improving personal hygiene, prevention of disease like parasitic infection/infestation and improvement of their nutritional status. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 12-16 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6832

  10. Frequency of Werner helicase 1367 polymorphism and age-related morbidity in an elderly Brazilian population

    Directory of Open Access Journals (Sweden)

    M.A.C. Smith

    2005-07-01

    Full Text Available Werner syndrome (WS is a premature aging disease caused by a mutation in the WRN gene. The gene was identified in 1996 and its product acts as a DNA helicase and exonuclease. Some specific WRN polymorphic variants were associated with increased risk for cardiovascular diseases. The identification of genetic polymorphisms as risk factors for complex diseases affecting older people can improve their prevention, diagnosis and prognosis. We investigated WRN codon 1367 polymorphism in 383 residents in a district of the city of São Paulo, who were enrolled in an Elderly Brazilian Longitudinal Study. Their mean age was 79.70 ± 5.32 years, ranging from 67 to 97. This population was composed of 262 females (68.4% and 121 males (31.6% of European (89.2%, Japanese (3.3%, Middle Eastern (1.81%, and mixed and/or other origins (5.7%. There are no studies concerning this polymorphism in Brazilian population. These subjects were evaluated clinically every two years. The major health problems and morbidities affecting this cohort were cardiovascular diseases (21.7%, hypertension (83.7%, diabetes (63.3%, obesity (41.23%, dementia (8.0%, depression (20.0%, and neoplasia (10.8%. Their prevalence is similar to some urban elderly Brazilian samples. DNA was isolated from blood cells, amplified by PCR and digested with PmaCI. Allele frequencies were 0.788 for the cysteine and 0.211 for the arginine. Genotype distributions were within that expected for the Hardy-Weinberg equilibrium. Female gender was associated with hypertension and obesity. Logistic regression analysis did not detect significant association between the polymorphism and morbidity. These findings confirm those from Europeans and differ from Japanese population.

  11. Psychiatric morbidity among adult patients in a semi-urban primary care setting in Malaysia

    Directory of Open Access Journals (Sweden)

    Omar Khairani

    2009-06-01

    Full Text Available Abstract Background Screening for psychiatric disorders in primary care can improve the detection rate and helps in preventing grave consequences of unrecognised and untreated psychiatric morbidity. This is relevant to the Malaysian setting where mental health care is now also being provided at primary care level. The aim of this paper is to report the prevalence of psychiatric illness in a semi-urban primary care setting in Malaysia using the screening tool Patient Health Questionnaire (PHQ. Methods This is a cross-sectional study carried out in a semi-urban primary healthcare centre located south of Kuala Lumpur. Systematic random sampling was carried out and a total of 267 subjects completed the PHQ during the study period. Results The proportion of respondents who had at least one PHQ positive diagnosis was 24.7% and some respondents had more than one diagnosis. Diagnoses included depressive illness (n = 38, 14.4%, somatoform disorder (n = 32, 12.2%, panic and anxiety disorders (n = 17, 6.5%, binge eating disorder (n = 9, 3.4% and alcohol abuse (n = 6, 2.3%. Younger age (18 to 29 years and having a history of stressors in the previous four weeks were found to be significantly associated (p = 0.036 and p = 0.044 respectively with PHQ positive scores. Conclusion These findings are broadly similar to the findings of studies done in other countries and are a useful guide to the probable prevalence of psychiatric morbidity in primary care in other similar settings in Malaysia.

  12. Diabetes mellitus: a predictor for late radiation morbidity

    International Nuclear Information System (INIS)

    Herold, David M.; Hanlon, Alexandra L.; Hanks, Gerald E.

    1999-01-01

    Purpose: Given the high frequency of diabetes, as well as prostate cancer in the elderly population, we sought to determine whether diabetic patients treated with three-dimensional conformal external-beam radiotherapy (3DCRT) had an increased risk of late gastrointestinal (GI) or genitourinary (GU) complications. Methods and Materials: Nine-hundred forty-four prostate cancer patients were treated between April 1989 and October 1996 using 3DCRT. Median patient age was 69 years (range 48-89), median center of prostate dose was 7211 cGy (range 6211-8074) and median follow-up was 36 months (range 2-99). Patients were evaluated every 6 months with digital rectal examinations, serum PSAs and symptom questionnaires. Radiation morbidity was quantified using Radiation Therapy Oncology Group (RTOG) and modified Late Effects Normal Tissue Task Force (LENT) scales. Patients with a preexisting history of either Type I or Type II diabetes mellitus were coded as diabetics. Results: One hundred twenty-one patients had diabetes (13% of total). Rates of acute morbidity did not differ between diabetics and nondiabetics; however, diabetics experienced significantly more late grade 2 GI toxicity (28% vs. 17%, p = 0.011) and late grade 2 GU toxicity (14% vs. 6%, p 0.001). There was a trend toward increased late grade 3 and 4 GI complications in diabetics, but not for late grade 3 and 4 GU complications; however, the total number of recorded events for these categories was small. Examining the onset of late toxicity, diabetics developed GU complications earlier than nondiabetics (median: 10 months vs. 24 months, p = 0.02). Considering age, dose, rectal blocking, field size, and history of diabetes in a stepwise multivariate regression model for late grade 2 GI toxicity, dose (p 0.0001), diabetes (p = 0.0110), and rectal blocking (p = 0.0163) emerged independently predictive for complications. For late grade 2 GU toxicity, only the presence of diabetes remained independently significant

  13. NEONATAL MORBIDITY AND EARLY OUTCOME OF VERY PRETERM INFANTS

    Directory of Open Access Journals (Sweden)

    Heljić Suada

    2013-01-01

    Full Text Available Background: Although the mortality rate for preterm infants and the gestational age-specific mortality rate have dramatically improved over the last 3 to 4 decades, infants born preterm remain vulnerable to many complications, including respiratory distress syndrome, chronic lung disease, necrotizing enterocolitis, a compromised immune system, cardiovascular disorders, hearing and vision problems, and brain lesions.The aim is to determine mortality and morbidity rates and selected outcome variables for preterm infant’s < 30 weeks’ gestation, who were admitted to the NICU. Patients and methods: This study enrolled 102 infants with gestational age less than 30 weeks’ gestation, hospitalized in Neonatal Intensive Care Unit, Pediatric Hospital, Clinical University Center Sarajevo, from Jan. 2010 to Dec. 2010. Parameters taken at admission were: birth weight, gestational age, Apgar score, excess base and CRIB score. Early outcome is considered as a survival at discharge or common preterm morbidities presented during hospitalizationResults: The mean BW of evaluated preterm infants was 1086 ± 250 g, the mean GA27.89 ± 1.97, Apgar score 5.41 ± 1.76, excess base at admission 6.39 ± 1.74 and mean CRIB score 3.72 ± 3.16. The overall survival rate was 70.5%. Selected outcomes at discharge were: RDS with 70.5% infants treated with natural surfactant, PDA treated with NSAIDS (23.5%, brain injury ( ≥ grade 3 IVH or PVL 16.6%, NEC Bell stages II or III 9.8%, BPD 25/72 (33.3% of infants who survived to 36 weeks postmenstrual age. In 38 (37.2% infants, episodes of infections were noticed (one or more episodes in 25 infants, half of them were caused by Gram positive bacteria, most frequent coagulasa negative staphylococci. Klebsiella pneumoniae was the mostfrequent organism among Gram negative bacteria. One patient had invasive candidiasis caused by Candida albicans. In 5 infants (4.9% early onset of sepsis was documented. Conclusion: Very preterm

  14. Missed injury – decreasing morbidity and mortality: A literature review

    African Journals Online (AJOL)

    Advanced Trauma Life Support®), although they may also be inju- ries identified after a defined .... highly recommended for practice quality assurance. ... when injuries are missed, continuous audit is essential in prevent- ing repeated errors!

  15. Worldwide application of prevention science in adolescent health

    Science.gov (United States)

    Catalano, Richard F; Fagan, Abigail A; Gavin, Loretta E; Greenberg, Mark T; Irwin, Charles E; Ross, David A; Shek, Daniel T L

    2015-01-01

    The burden of morbidity and mortality from non-communicable disease has risen worldwide and is accelerating in low-income and middle-income countries, whereas the burden from infectious diseases has declined. Since this transition, the prevention of non-communicable disease as well as communicable disease causes of adolescent mortality has risen in importance. Problem behaviours that increase the short-term or long-term likelihood of morbidity and mortality, including alcohol, tobacco, and other drug misuse, mental health problems, unsafe sex, risky and unsafe driving, and violence are largely preventable. In the past 30 years new discoveries have led to prevention science being established as a discipline designed to mitigate these problem behaviours. Longitudinal studies have provided an understanding of risk and protective factors across the life course for many of these problem behaviours. Risks cluster across development to produce early accumulation of risk in childhood and more pervasive risk in adolescence. This understanding has led to the construction of developmentally appropriate prevention policies and programmes that have shown short-term and long-term reductions in these adolescent problem behaviours. We describe the principles of prevention science, provide examples of efficacious preventive interventions, describe challenges and potential solutions to take efficacious prevention policies and programmes to scale, and conclude with recommendations to reduce the burden of adolescent mortality and morbidity worldwide through preventive intervention. PMID:22538180

  16. Seven challenges in modeling vaccine preventable diseases

    Directory of Open Access Journals (Sweden)

    C.J.E. Metcalf

    2015-03-01

    Full Text Available Vaccination has been one of the most successful public health measures since the introduction of basic sanitation. Substantial mortality and morbidity reductions have been achieved via vaccination against many infections, and the list of diseases that are potentially controllable by vaccines is growing steadily. We introduce key challenges for modeling in shaping our understanding and guiding policy decisions related to vaccine preventable diseases.

  17. Visceral Blood Flow Modulation: Potential Therapy for Morbid Obesity

    Energy Technology Data Exchange (ETDEWEB)

    Harris, Tyler J., E-mail: tjharris@gmail.com [University of California, Los Angeles, Department of Vascular and Interventional Radiology (United States); Murphy, Timothy P.; Jay, Bryan S. [Rhode Island Hospital, Brown University, Department of Diagnostic Imaging, Vascular Disease Research Center (United States); Hampson, Christopher O.; Zafar, Abdul M. [University of Texas Health Science Center at San Antonio, Department of Radiology (United States)

    2013-06-15

    We present this preliminary investigation into the safety and feasibility of endovascular therapy for morbid obesity in a swine model. A flow-limiting, balloon-expandable covered stent was placed in the superior mesenteric artery of three Yorkshire swine after femoral arterial cutdown. The pigs were monitored for between 15 and 51 days after the procedure and then killed, with weights obtained at 2-week increments. In the two pigs in which the stent was flow limiting, a reduced rate of weight gain (0.42 and 0.53 kg/day) was observed relative to the third pig (0.69 kg/day), associated with temporary food aversion and signs of mesenteric ischemia in one pig.

  18. Bariatric Surgery vs. Conventional Dieting in the Morbidly Obese.

    Science.gov (United States)

    Greenstein; Rabner; Taler

    1994-02-01

    Weight loss and psychosocial events have been compared between low calorie conventional diet (n = 11) or following obesity surgery (n = 17). Interviews were >/= 9 months following initiation of treatment. After surgery significantly less hunger was experienced (surgery 76% [13/17] vs diet 18% [2/11] p employed (surgery 76% [13/17] vs diet 18% [2/11) p appearance improvements (surgery 94% [15/16] vs diet 50% [5/10] p Physical activity improved (surgery 73% [11/15] vs diet 18% [2/11] p Physical activity increases, and satisfaction with weight loss method is greater, after surgery. Employment is greater (probably self selection) in the post-surgical group. We found that comparing >/= 9 months following surgery or beginning a conventional diet, the morbidly obese have a more positive response to surgery.

  19. Epidemiology, morbidity, and treatment of overweight and obesity.

    Science.gov (United States)

    Aronne, L J

    2001-01-01

    Although still considered more of a cosmetic problem by both the general public and some areas of the medical community, overweight and obesity have reached epidemic proportions worldwide. Overweight and obesity have not only a significant psychological impact but also result in an increased risk for development of numerous chronic and sometimes fatal diseases. The morbidity from obesity-associated disorders increases with higher body mass index and begins within the normal weight range. The costs (direct and indirect) associated with treating obesity and its comorbid conditions are notable and increasing. Obesity rates in patients with schizophrenia are at least as high, if not higher, than in the general population. This article reviews the epidemiology and burden of obesity and its associated comorbid disorders. The guidelines from the National Heart, Lung, and Blood Institute of the National Institutes of Health for diagnosing and treating obesity are also discussed.

  20. AHRR (cg05575921) hypomethylation marks smoking behaviour, morbidity and mortality

    DEFF Research Database (Denmark)

    Bojesen, Stig E; Timpson, Nicholas; Relton, Caroline

    2017-01-01

    was associated with former and current smoking status, high daily and cumulative smoking, short time since smoking cessation (all p values 7×10-31), and the smoking-related CHRN3A genotype (-0.48% per T-allele, p=0.002). The multifactorially adjusted HRs for the lowest versus highest methylation quintiles were...... in the lowest and highest methylation quintiles were 3.7% and 0.0% (p=2×10-7), whereas predicted PLCOM2012 6-year risks were similar (4.3% and 4.4%, p=0.77). CONCLUSION: AHRR (cg05575921) hypomethylation, a marker of smoking behaviour, provides potentially clinical relevant predictions of future smoking-related...... morbidity and mortality. METHODS: From the Copenhagen City Heart Study representing the Danish general population, we studied 9234 individuals. Using bisulphite treated leucocyte DNA, AHRR (cg05575921) methylation was measured. Rs1051730 (CHRN3A) genotype was used to evaluate smoking heaviness. Participants...

  1. Temporal resolution of urinary morbidity following prostate brachytherapy

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Lief, Jonathan H.; Dorsey, Anthony T.

    2000-01-01

    Purpose: To report the short-term urinary morbidity for prostate brachytherapy patients without a preimplant history of a transurethral resection of the prostate gland and who received prophylactic and prolonged α-blockers. α-blockers may decrease radiation-induced urethritis and increase urinary flow. Multiple clinical and treatment parameters were evaluated to identify factors associated with increased acute urinary morbidity. Materials and Methods: One hundred seventy consecutive patients without a prior history of a transurethral resection of the prostate gland underwent transperineal ultrasound guided prostate brachytherapy for clinical T1c-T3a carcinoma of the prostate gland. For all patients, an α-blocker was initiated prior to implantation and continued at least until the international prostate symptom score (IPSS) returned to baseline levels. Clinical parameters evaluated for short-term urinary morbidity included patient age, clinical T stage, preimplant IPSS (obtained within 3 weeks of implantation), and prostate ultrasound volume. Treatment parameters included the utilization of neoadjuvant hormonal manipulation, the utilization of moderate dose external beam radiation therapy before implantation, the choice of isotope, the urethral dose, the total implant activity in millicuries, and a variety of dosimetric quality indicators (D 90 and V 100 /V 150 /V 200 ). Catheter dependency and the duration of α-blocker dependency was also evaluated. On average, 11.2 IPSS surveys were obtained for each patient. Results: One hundred fifty of the 170 patients (88.2%) had the urinary catheter permanently removed on day 0. Only one patient required an urinary catheter for > 5 days. Two patients (1.2%) required a subsequent transurethral resection of the prostate gland because of prolonged obstructive/irritative symptoms. To date, no patient has developed an urinary stricture or urinary incontinence. The IPS score on average peaked at 2 weeks following implantation

  2. Morbidity and mortality of middle-aged and elderly narcoleptics

    DEFF Research Database (Denmark)

    Jennum, Poul; Thorstensen, Eva Wiberg; Pickering, Line

    2017-01-01

    . In the NPR, all morbidities are grouped into major WHO classes. RESULTS: Middle-aged and elderly patients had more health contacts before and after their narcolepsy diagnosis with respect to several disease domains: infections, neoplasm, endocrine/metabolic diseases/diabetes, mental/psychiatric, neurological...... (including epilepsy), eye, cardiovascular (hypertension, ischemic heart disease), respiratory (upper-airway infections, sleep apnea), gastrointestinal, musculoskeletal (including discopathies) and skin diseases. Narcolepsy patients had lower reproductive rates. Furthermore, patients showed significantly more...... health contacts due to the evaluation and control contacts for disease and symptoms. Patients suffered from significantly more multiple diseases than did controls. The 17-year hazard ratio mortality rates were 1.35 (95% CI, 0.94-1.95, p = 0.106) among 20-59 year-olds, and 1.38 (1.12-1.69, p = 0...

  3. General characteristics of dental morbidity in children against orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Kovach I.V.

    2016-03-01

    Full Text Available A wide spread of orthodontic treatment showed a fairly high risk of complications developed from the use of various devices. The aim of our study was to determine the general characteristics of dental morbidity in children with orthodontic treatment. According to the survey the most common pathologies in children with orthodontic problems are dental caries (87,8-92,9% and chronic catarrhal gingivitis (81.2-84.1%. The prevalence of different types of diseases of the mucous membrane and soft tissues of the oral cavity in children surveyed was 30.5-32.9%. Non-caries lesions of dental hard tissues occurred in 39.5-40.9% of the children surveyed, local enamel hypoplasia was observed in 42.9%, systemic enamel hypoplasia made up 17.8%, signs of hypersensitivity of enamel were found in 9.6%, and the wedge defects – in two children.

  4. Visceral Blood Flow Modulation: Potential Therapy for Morbid Obesity

    International Nuclear Information System (INIS)

    Harris, Tyler J.; Murphy, Timothy P.; Jay, Bryan S.; Hampson, Christopher O.; Zafar, Abdul M.

    2013-01-01

    We present this preliminary investigation into the safety and feasibility of endovascular therapy for morbid obesity in a swine model. A flow-limiting, balloon-expandable covered stent was placed in the superior mesenteric artery of three Yorkshire swine after femoral arterial cutdown. The pigs were monitored for between 15 and 51 days after the procedure and then killed, with weights obtained at 2-week increments. In the two pigs in which the stent was flow limiting, a reduced rate of weight gain (0.42 and 0.53 kg/day) was observed relative to the third pig (0.69 kg/day), associated with temporary food aversion and signs of mesenteric ischemia in one pig.

  5. Increased psychiatric morbidity before and after the diagnosis of hypothyroidism

    DEFF Research Database (Denmark)

    Thvilum, Marianne; Brandt, Frans; Pedersen, Dorthe Almind

    2014-01-01

    Background: Thyroid hormones are necessary for fetal brain development, while hypothyroidism in adults has been associated with mood symptoms and reduced quality of life. Nevertheless, our knowledge regarding the association and temporal relation between hypothyroidism and mental disorders...... is ambiguous. Our objective was to investigate, at a nationwide level, whether a diagnosis of hypothyroidism is associated with psychiatric morbidity. Methods: Observational cohort study. Based on record-linkage between different Danish health registers, 2822 hypothyroid singletons each matched with 4 non......-hypothyroid controls were identified and followed over a mean period of 6 years (range 1-13). Additionally, we included 385 same sex twin pairs discordant for hypothyroidism. Diagnoses of psychiatric disorders as well as treatment with antidepressants, antipsychotics and anxiolytics were recorded. Logistic and cox...

  6. Radiologic findings and weight loss following gastroplasty for morbid obesity

    Energy Technology Data Exchange (ETDEWEB)

    Miskowiak, J.; Fleckenstein, P.; Andersen, B.

    Gastroplasty aimed at treatment of morbid obesity creates a small proximal pouch and a narrow stoma to the remainder of the stomach. In 11 consecutive obese patients subjected to gastroplasty radiologic examinations of the stomach were performed before operation and one week, 3 and 12 months postoperatively. All stomachs were normal before operation. A significant decrease in pouch area and increase in stoma diameter were registered over the observation period. There were no statistically significant correlations between postoperative weight loss and stoma diameter or pouch area. Nor was retention in the pouch one week after gastroplasty related to weight loss. Radiographic evidence of gastroesophageal reflux was present in only one patient. The described method of follow-up is evidently not suited to predict the outcome of gastroplasty.

  7. Risk of Cardiovascular Morbidity and Mortality in Relation to Temperature

    Science.gov (United States)

    Mathes, Robert; Ito, Kazuhiko; Matte, Thomas

    2013-01-01

    Objective To examine the effects of temperature on cardiovascular-related (CVD) morbidity and mortality among New York City (NYC) residents. Introduction Extreme temperatures are consistently shown to have an effect on CVD-related mortality [1, 2]. A large multi-city study of mortality demonstrated a cold-day and hot-day weather effect on CVD-related deaths, with the larger impact occurring on the coldest days [3]. In contrast, the association between weather and CVD-related morbidity is less clear [4, 5]. The purpose of this study is to characterize the effect of temperature on CVD-related emergency department (ED) visits, hospitalizations, and mortality on a large, heterogeneous population. Additionally, we conducted a sensitivity analysis to determine the impact of air pollutants, specifically fine particulates (PM2.5) and ozone (O3), along with temperature, on CVD outcomes. Methods We analyzed daily weather conditions, ED visits classified as CVD-related based on chief complaint text, hospitalizations, and natural cause deaths that occurred in NYC between 2002 and 2006. ED visits were obtained from data reported daily to the city health department for syndromic surveillance. Inpatient admissions were obtained from the Statewide Planning and Research Cooperative System, a data reporting system developed by New York State. Mortality data were obtained from the NYC Office of Vital Statistics. Data for PM2.5 and O3 were obtained from all available air quality monitors within the five boroughs of NYC. To estimate risk of CVD morbidity and mortality, we used generalized linear models using a Poisson distribution to calculate relative risks (RR) and 95% confidence intervals (CI). A non-linear distributed lag was used to model mean temperature in order to allow for its effect on the same day and on subsequent days. Models were fit separately for cold season (October through March) and warm season (April through September) given season may modify the effect on CVD

  8. [Morbidity rate of obesity in children in ukraine. Overweight as noncontagious disease risk factor].

    Science.gov (United States)

    Заболотна, Ірина Е

    The upsurge of prevalence rate of obesity and overweight that in the majority of cases traces back to childhood is a risk factor of the most common noncontagious diseases in adults. The aim was to analyze prevalence of obesity in children in Ukraine and to conduct the pilot study of medical condition of overweight children. Official state statistics of prevalence rate of obesity in kids and screening data of anthropometric characteristics, arterial tension levels, physical performance decrement and medical condition of children (boys - 50, girls - 90, average age - 15,1±0,1 years) was used in research. Data calculation performed by Statistica v. 6.0 software. Over the past few decades, the morbidity rate of obesity in children in Ukraine has greatly increased, especially in year class 15-17. Insufficient diagnosis of obesity in children is the consequence of the inadequacy of the existing system of preventive care and monitoring survey of decease risk factors. Children with body mass index (BMI) above normal have a risk of work decrement in 5,2 times (odds ratio, OR=5,2, CI95%: 1,7-10,6). Such children have higher risk of development of the diseases of the respiratory system (OR=8,1; CI95%: 3,9-13,6) and allergic dermatitis (OR=7,7; CI95%: 3,7-12,9). The odds ratio of arterial hypertension in such children is equal to 3,46±0,3 (95%CI: 2,0-5,9). According to prediction calculations, the situation with the increase of prevalence rate of obesity in children in Ukraine is unfavorable. The introduction of measures aimed at finding children with obesity, their registration and monitoring of patients' health with due regard to decease risk factors at the primary care level would conduce to improving prevention of obesity and prevention of alimentary diseases progression.

  9. Epidemiology, morbidity and mortality from fall-related injuries in the United Arab Emirates

    Science.gov (United States)

    2014-01-01

    Background Unintentional falls are a major cause of morbidity and mortality with a significant burden on victims, families, and societies. We aimed to study the mechanism, risk factors, and outcome of hospitalized patients with fall-related injuries in order to propose preventive measures. Methods Fall-related injured patients who were admitted to Al Ain Hospital, United Arab Emirates (UAE) for more than 24 hours or who died after arrival to the hospital, were studied over 3 years. Demography, location and time of injury, affected body regions, hospital and ICU stay, and outcome were analyzed. Results 882 patients were studied, 82% were males, and 22% were less than 19 years old. Majority were from the Indian subcontinent. The most common location for fall injuries was work. Patients injured at work were older and mainly non-UAE nationals (p < 0.0001) when compared with those injured at home. Patients falling from height, when compared with those falling from same level, were older (p = 0.017), had more males (p < 0.001), were mainly from the Indian subcontinent (p < 0.001), had higher ISS (p = 0.011) and longer total hospital stay (p < 0.001). Conclusions Falls are a major health problem in the UAE. Falls at work can be prevented by safety education tailored to different ethnic groups, and proper legislation and regulation. Environmental modification using evidence-based architectural design may prevent falls among vulnerable risk groups. PMID:25178823

  10. Environmental allergies and respiratory morbidities in cystic fibrosis.

    Science.gov (United States)

    Collaco, Joseph M; Morrow, Christopher B; Green, Deanna M; Cutting, Garry R; Mogayzel, Peter J

    2013-09-01

    Cystic fibrosis (CF) is characterized by recurrent respiratory infections and progressive lung disease. Although environmental factors account for 50% of the variation in CF lung function, few specific exposures have been identified. Studies using small study samples focusing on environmental allergies in CF have had inconsistent results. Our objective was to examine the role of environmental allergies in upper and lower respiratory tract morbidities in CF. A total of 1,321 subjects with CF were recruited through the U.S. CF Twin-Sibling Study. Questionnaires were used to determine the presence/absence of environmental allergies. Questionnaires, chart review, and U.S. CF Foundation Patient Registry data were used to track outcomes. Within the study sample 14% reported environmental allergies. Environmental allergies were associated with a higher risk of sinus disease (adjusted OR: 2.68; P allergies were also associated with a more rapid decline in lung function (additional -1.1%/year; P = 0.001). However, allergies were associated with a later median age of acquisition of Pseudomonas aeruginosa (6.6 years vs. 4.4 years; log rank P = 0.027). The reported use of common allergy medications, anti-histamines and leukotriene inhibitors, did not alter the frequency of respiratory morbidities. Environmental allergies are associated with an increased risk of sinus disease and nasal polyps and a more rapid decline in CF lung function, but may have a protective effect against the acquisition of P. aeruginosa. Prospective studies are needed to confirm these associations which have implications for more aggressive management of allergies. Copyright © 2012 Wiley Periodicals, Inc.

  11. Reconstruction in oral malignancy: Factors affecting morbidity of various procedures

    Science.gov (United States)

    Chakrabarti, Suvadip; Chakrabarti, Preeti Rihal; Desai, Sanjay M.; Agrawal, Deepak; Mehta, Dharmendra Y.; Pancholi, Mayank

    2015-01-01

    Aims and Objective: (1) To study the age and sex distribution of patient with oral malignancies. (2) To analyze various types of surgery performed. (3) Evaluation of reconstruction and factors affecting complications and its relation to the type of reconstruction. Materials and Methods: Cases of oral malignancies, undergoing surgery for the same in Sri Aurobindo Medical College and PG Institute, Indore from the period from October 1, 2012, to March 31, 2015. Results: Out of analysis of 111 cases of oral malignancy, 31 (27.9%) cases were in the fifth decade of life with male to female ratio 1.9:1. The commonest site of cancer was buccal mucosa. Forty-seven cases (43.2%) were in stage IVa. Diabetes was the most common co-morbidity reported, accounting for 53.9% of cases with reported morbidity. Tobacco chewing was the common entity in personal habits. All the cases underwent neck dissection along with resection of the primary. Hemimandibulectomy was the most preferred form of primary resection accounting for 53.15% (59 cases), followed by wide resection of primary 27% (30 cases). Pectoralis major myocutaneous (PMMC) flap only was the most common reconstruction across the study population. PMMC alone accounted for 38.7% (43 cases). The infection rate was 16.21%. PMMC alone accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. PMMC + deltopectoral accounted for 5 out of 18 (27.8%) of total infection rate, and 4.5% of the total study population. Conclusion: PMMC is a major workhorse for reconstruction with better functional outcome and acceptance among operated patients. PMID:26981469

  12. Psychiatric morbidity among physically injured Syrian refugees in Turkey.

    Science.gov (United States)

    Al-Nuaimi, Saleem; Aldandashi, Samer; Easa, Abdul Kadir Saed; Saqqur, Maher

    2018-01-01

    To the best of our knowledge, the mental health status of physically injured Syrian refugees has not yet been investigated. The aim of this study was to examine the prevalence of psychiatric morbidity among physically injured Syrian refugees in Turkey receiving treatment at the main rehabilitation centre near the Syrian border. This is a cross sectional study. Information was collected from consenting injured Syrian refugees at Dar-el-Shefa'a Hospital in Reyhanlı (Turkey) during a one week period in December 2012 and another one week period in August 2013. A clinical psychiatric interview was conducted to determine a diagnosis according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR. A total of 40 refugees consented and completed a clinical psychiatric interview. All refugees in this study did not have a significant past psychiatric history. The most prevalent current diagnosis was major depressive disorder (22.5%), adjustment disorder (20%), and post-traumatic stress disorder (15%). Five (12.5%) patients had no evidence of a psychiatric disorder. The prevalence of psychiatric morbidity among injured Syrian refugees in our study was extremely high. This may help guide the treatment and management of this select population. This study had a low number of participants. The method of assessment was not standardized with a validated tool. This study may help guide the treatment and management of this select population, both in neighbouring countries and as resettled refugees in Western host countries. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Hospital morbidity among Guarani Indians in Southeastern and Southern Brazil.

    Science.gov (United States)

    Cardoso, Andrey Moreira; Coimbra, Carlos E A; Tavares, Felipe Guimarães

    2010-03-01

    Studies on hospital morbidity among Brazilian indigenous peoples are relatively recent, show limited coverage, and lack data sources capable of generating specific indicators according to ethnic group. The current study describes hospital morbidity in the indigenous population living in 83 Guarani villages in Southern and Southeastern Brazil (N=6,483), based on primary data obtained from a hospital admissions surveillance system implemented in 2007-2008, specifically for a case-control study on acute respiratory infections (ARI) in Guarani children. During the study period there were 666 hospitalizations in a total of 497 individuals, the majority under 5 years of age (71.9%). Respiratory illnesses were the main causes of hospitalization (64.6%), especially in children (<5 years: 77.6%; <1 year: 83.4%) and exceeded the proportions of hospital admissions from these causes in other indigenous groups. The overall hospitalization rate (per 100 person-years) was 8.8, or 71.4 under 1 year and 21.0 from 1 to 4 years of age. The ARI hospitalization rate (5.3) was 6.5 and 2.0 times higher than for diarrhea and other causes, respectively, while in children under 5 years of age (ARI=23.7) these differences were 7.4 and 5.4 times, respectively. The standardized Guarani hospitalization rate exceeded the standardized rates for the South and Southeast of Brazil by 40% and 210%, respectively. Hospitalization for primary care sensitive conditions and the high ARI rates indicate the need for studies to understand the epidemiology of ARI and investments to upgrade primary health care for the Guarani.

  14. Influence of cortisol on zinc metabolism in morbidly obese women.

    Science.gov (United States)

    Mota Martins, Luana; Soares de Oliveira, Ana Raquel; Clímaco Cruz, Kyria Jayanne; Borges de Araújo, Camila Guedes; de Oliveira, Francisco Erasmo; Santos de Sousa, Gustavo; do Nascimento Nogueira, Nadir; do Nascimento Marreiro, Dilina

    2014-01-01

    The accumulation of visceral fat affects the metabolism of hormones and some nutrients, but these mechanisms remain unclear. To assess the influence of cortisol on the metabolism of zinc in morbidly obese women. Cross-sectional, case-control study involving 80 women aged between 20 and 59 years. The participants were divided into two groups: experimental (morbidly obese, n = 40) and control (normal weight, n = 40). Zinc concentrations were determined by atomic absorption spectroscopy and serum and urinary cortisol by chemiluminescence method. Zinc intake was significantly different between groups. Mean plasma zinc was lower in obese compared to control group. Mean values for erythrocyte zinc were 44.52 ± 7.84 µg/gHb and 40.17 ± 6.71 µg/gHb for obese and control groups, respectively. Urinary excretion of this mineral was higher in obese compared to control subjects (p cortisol were 9.58 ± 4.86 µg/dL for obese and 9.89 ± 5.61 µg/dL for control groups. Mean values for urinary cortisol were 163.00 ± 100.35 µg/dL and 109.71 ± 34.88 µg/dL for obese and control groups, respectively (p > 0.05). The correlation analysis between cortisol and zinc was not significant (p > 0.05). Obese patients have hypozincemia and high erythrocyte zinc levels. The correlation between zinc parameters and cortisol concentration showed no influence of this hormone on zinc metabolism.

  15. Posttraumatic stress disorder (ptsd and co-morbidity

    Directory of Open Access Journals (Sweden)

    Ifeta Ličanin

    2002-02-01

    Full Text Available Posttraumatic Stress Disorder (PTSD very often occurs accompanied with other psychiatric disorders such as: Alcohol and Drug abuse, Personality Disorder, General Anxiety Disorder, Obsessive Compulsive Disorder, Schizophrenia etc. Sometimes it might be a problem for clinicians to differ PTSD symptoms from symptoms of coexisting psychic disorders. The aim of this study was to present the most common PTSD coexisting psycho-disorders. This research was conducted during the period from April 1998 to October 1999. Participants were divided in two groups each containing 30 examinees. The first group consisted of 30 participants with symptoms of PTSD only while the second group included participants who suffered from both PTSD and other psychic disorders (co-morbidity. Both groups were quite similar regarding participants gender and age. The scientific tools used in the research were: Standard Psychiatric Interview, Harvard Trauma Questionnaire (HTQ, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Drug and Alcohol Abuse Checklist. Our research results are indicating that PTSDsymptoms are most common in middle-aged persons, regardless of their gender and age. We have found following coexisting psychic disorders: personality disorder 46.6% (from which 13.3% is permanent personality disorder after the traumatic experience; depression 29.9% (depression without psychotic symptoms 23.3% and depression with coexisting psychotic symptoms 6.6%; drug abuse 13.3; alcohol abuse 6.7% and dissociative (conversion disorder 3.3%. The results of our work are suggesting that co-morbid psychic symptoms have significant regressive influence on PTSD course and prognosis.

  16. Is hyperglycemia a risk factor for neonatal morbidity and mortality?

    International Nuclear Information System (INIS)

    Gul, R.; Waheed, K. A. I.; Sheikh, M.; Javaid, S.; Haroon, F.; Fatima, S. T.

    2017-01-01

    Objective: To determine the extent of morbidity and mortality in newborns with neonatal hyperglycemia where published data are limited. Study Design: Observational case control study. Place and Duration of Study: Department of Neonatology, the Children'Hospital and the Institute of Child Health Lahore, from 1st May to 31st Oct 2015. Material and Methods: A prospective, observational case control study was conducted in the Department of Neonatology, the Children'Hospital and the Institute of Child Health, Lahore, from 1st May till 31st October 2015. The sample size was 192, with 96 babies each in ‘study’ and ‘control’ groups. All neonates fulfilling the inclusion criteria were enrolled in the ‘study group’ while ‘control group’ consisted of euglycemic babies matched for age, weight, gestational age and clinical status. All babies were monitored for morbidity intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), infections and outcome (duration of hospital stay, discharged or expired). Results: The data analysis showed that 74 percent neonates, of study group, had hyperglycemia during first week of their lives. Moreover, 84.4 percent babies were less than 2.5 kg. Significant high number of babies in the study group developed complications (p<0.001). These complications included IVH (p<0.001), NEC (p=0.024) and infections (p=0.019). As regards outcome, the neonates in the study group had significantly prolonged hospital stay (p=0.028), lower discharge rate (p=0.040) and higher mortality (p=0.040). Conclusion: Hyperglycemia not only significantly increases risk of IVH, NEC and infections, but also prolongs hospital stay and contributes to mortality among newborns. (author)

  17. Psychiatric morbidity in psoriasis: A case-control study

    Directory of Open Access Journals (Sweden)

    Sunil Goyal

    2017-01-01

    Full Text Available Objective: Psoriasis is a chronic, relapsing and disfiguring dermatological disorder with a significant effect on occupational, social, and other areas of functioning. Psychological stress has been known to have a significant role in the onset and exacerbation of this illness. To study the prevalence of psychiatric morbidity in psoriasis and the influence of specified demographic, psychological, social and illness-related variables. Methods: The study was carried out at a tertiary care hospital in a large urban setup. In this case–control study, 100 cases of psoriasis were studied in comparison with healthy controls who were matched for sociodemographic profile. The participants were given a sociodemographic questionnaire, clinical profile sheet, and psoriasis area and severity index (PASI. General Health Questionnaire-12 (GHQ-12 was used to screen for psychological distress, and subsequently, Hospital Anxiety and Depression Scale for screening for depression and anxiety and World Health Organization Quality of Life-BREF scale for assessing the quality of life (QOL were administered. The results obtained were analyzed for evaluating the psychiatric morbidity and its various correlates. Appropriate statistical analysis was done using SPSS 21. Results: Using GHQ-12 cutoff score (≥3 for psychological distress, the overall prevalence of psychological distress was significantly more in cases of in comparison to healthy controls with an odds ratio of 8.54 (95% confidence interval 3.16–23.07, P < 0.0001. Statistical analysis showed a statistically significant correlation of educational status with QOL and severity of skin lesions (PASI with anxiety level. Severe skin lesions, more so on visible body parts were associated more commonly with psychological distress. Conclusions: All patients of psoriasis should be educated about the nature of the illness and screened for psychological distress. Dermatologists and family members should be educated to

  18. Resistin expression correlates with steatohepatitis in morbidly obese patients.

    Science.gov (United States)

    Edwards, Claire R; Hindle, A Katharine; Latham, Patricia S; Fu, Sidney W; Brody, Fred J

    2013-04-01

    Morbidly obese patients are at risk for nonalcoholic steatohepatitis (NASH) even in the absence of risk factors for liver disease. Unfortunately, NASH is usually not clinically evident, and a definitive, noninvasive test for NASH does not exist. Resistin, a cytokine originating from adipose tissue, is involved in insulin resistance and also initiates proinflammatory signaling from hepatic stellate cells. This study explores the relationship between resistin expression and liver pathology in bariatric surgery patients. Blood samples from 30 patients undergoing bariatric surgery were collected. Total RNA was extracted and cDNA was synthesized. Quantitative RT-PCR was used to quantify relative gene expression using 18s rRNA gene as an internal control. Wedge liver biopsies from these patients were sectioned and stained. Based on a previously published scoring method, biopsies were assigned an overall NASH severity score and subscores for steatosis, inflammation, and fibrosis. Results were analyzed by using Student's t test. Resistin mRNA levels ranged from 0.5 to 9.7. A group of five patients with very high resistin expression (>4) was identified. These patients had a significantly higher average NASH score compared with the rest of the group (7.9 vs. 4.48, p = 0.019). Steatosis and inflammation scores were significantly higher in the high-resistin group (p < 0.05 for both comparisons). There also was a trend toward higher fibrosis score in this group, which approached statistical significance (p = 0.051). In morbidly obese patients, high resistin expression in serum is associated with hepatic steatosis, inflammation, and fibrosis. The development of elevated resistin expression may represent a link between obesity and the onset of steatohepatitis.

  19. Parental psychosocial stress and asthma morbidity in Puerto Rican twins

    Science.gov (United States)

    Lange, Nancy E.; Bunyavanich, Supinda; Silberg, Judy L.; Canino, Glorisa; Rosner, Bernard A.; Celedón, Juan C.

    2010-01-01

    Background Little is known about paternal psychosocial factors and childhood asthma. Objective To examine the link between maternal and paternal psychosocial stress and asthma outcomes in young children. Methods Parents of 339 pairs of Puerto Rican twins were interviewed individually about their own psychosocial stress and about asthma in their children at age 1 and again about their child’s asthma at age 3. Fathers were asked about symptoms of post-traumatic stress disorder (PTSD), depression, and anti-social behavior. Mothers were asked about depressive symptoms. Outcomes assessed in children included recent asthma symptoms, oral steroid use and hospitalizations for asthma in the prior year, and asthma diagnosis. Generalized estimated equation models were used for the multivariate analysis of parental psychosocial stress and asthma morbidity in childhood. Results After multivariable adjustment, paternal PTSD symptoms, depression, and anti-social behavior were each associated with increased asthma symptoms at age 1 (e.g., OR =1.08 for each 1-point increase in PTSD score, 95% CI=1.03–1.14). Maternal depressive symptoms were associated with an increased risk of asthma hospitalizations at age 1 year. At age 3 years, maternal depressive symptoms were associated with asthma diagnosis and hospitalizations for asthma (OR for each 1-point increase in symptoms=1.16, 95% CI=1.00–1.36]). In an analysis combining 1 and 3 year outcomes, paternal depression was associated with oral steroid use, maternal depressive symptoms were associated with asthma hospitalizations and asthma diagnosis, and parental depression was associated with hospitalizations for asthma. Conclusions Both paternal and maternal psychosocial factors may influence asthma morbidity in young Puerto Rican children. PMID:21194742

  20. Maternal morbidity and risk of death at delivery hospitalization.

    Science.gov (United States)

    Campbell, Katherine H; Savitz, David; Werner, Erika F; Pettker, Christian M; Goffman, Dena; Chazotte, Cynthia; Lipkind, Heather S

    2013-09-01

    To examine the effect of underlying maternal morbidities on the odds of maternal death during delivery hospitalization. We used data that linked birth certificates to hospital discharge diagnoses from singleton live births at 22 weeks of gestation or later during 1995-2003 in New York City. Maternal morbidities examined included prepregnancy weight more than 114 kilograms (250 pounds), chronic hypertension, pregestational or gestational diabetes mellitus, chronic cardiovascular disease, pulmonary hypertension, chronic lung disease, human immunodeficiency virus (HIV), and preeclampsia or eclampsia. Associations with maternal mortality were estimated using multivariate logistic regression. During the specified time period, 1,084,862 live singleton births and 132 maternal deaths occurred. Patients with increasing maternal age, non-Hispanic black ethnicity, self-pay or Medicaid, primary cesarean delivery, and premature delivery had higher rates of maternal mortality during delivery hospitalization. From the entire study population, 4.1% had preeclampsia or eclampsia (n=44,004), 1.8% had chronic hypertension (n=19,647), 1.1% of patients were classified as obese (n=11,936), 0.7% had pregestational diabetes (n=7,474), 0.4% had HIV (n=4,665), and 0.01% had pulmonary hypertension (n=166). Preeclampsia or eclampsia (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 5.5-12.1), chronic hypertension (adjusted OR, 7.7; 95% CI 4.7-12.5), underlying maternal obesity (adjusted OR, 2.9; 95% CI 1.1-8.1), pregestational diabetes (adjusted OR, 3.3; 95% CI 1.3-8.1), HIV (adjusted OR, 7.7; 95% CI 3.4-17.8), and pulmonary hypertension (adjusted OR, 65.1; 95% CI 15.8-269.3) were associated with an increased risk of death during the delivery hospitalization. The presence of maternal disease significantly increases the odds of maternal mortality at the time of delivery hospitalization. II.