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...

Increased Circulating Levels of Alpha-Ketoglutarate in Morbidly Obese Women with Non-Alcoholic Fatty Liver Disease.

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Gemma Aragonès

Full Text Available Non-alcoholic fatty liver disease (NAFLD causes a wide spectrum of liver damage, ranging from simple steatosis to cirrhosis. However, simple steatosis (SS and steatohepatitis (NASH cannot yet be distinguished by clinical or laboratory features. The aim of this study was to assess the relationship between alpha-ketoglutarate and the degrees of NAFLD in morbidly obese patients.We used a gas chromatography-quadruple time-of-flight-mass spectrometry analysis to quantify alpha-ketoglutarate in serum from normal-weight subjects (n = 30 and morbidly obese women (n = 97 with or without NAFLD.We found that serum levels of alpha-ketoglutarate were significantly higher in morbidly obese women than in normal-weight women. We showed that circulating levels of alpha-ketoglutarate were lower in lean controls and morbidly obese patients without NAFLD. We also found that alpha-ketoglutarate serum levels were higher in both SS and NASH than in normal liver of morbidly obese patients. However, there was no difference between SS and NASH. Moreover, we observed that circulating levels of alpha-ketoglutarate were associated with glucose metabolism parameters, lipid profile, hepatic enzymes and steatosis degree. In addition, diagnostic performance of alpha-ketoglutarate has been analyzed in NAFLD patients. The AUROC curves from patients with liver steatosis exhibited an acceptable clinical utility. Finally, we showed that the combination of biomarkers (AST, ALT and alpha-ketoglutarate had the highest accuracy in diagnosing liver steatosis.These findings suggest that alpha-ketoglutarate can determine the presence of non-alcoholic fatty liver in morbidly obese patients but it is not valid a biomarker for NASH.

Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery.

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Lee, Yeri; Kim, Hyun-Joo; Choi, Suk-Joo; Oh, Soo-Young; Kim, Jung-Sun; Roh, Cheong-Rae; Kim, Jong-Hwa

2015-03-01

To test if there is a stepwise difference in neonatal outcomes according to the stage (or grade) of histological inflammatory response in the chorioamniotic membranes and umbilical cords of preterm premature rupture of membranes (PPROM). This retrospective study included singleton pregnancies diagnosed as PPROM and delivered prior to 34 weeks of gestation (n=339). Acute histological chorioamnionitis and funisitis were subdivided into stages (or grade) as defined by Redline et al. Neonatal composite morbidities and mortality were also monitored. Univariate and multivariate analyses were conducted. Increasing stage (or grade) of acute histological chorioamnionitis and funisitis was significantly associated with an earlier gestational age at membrane rupture and delivery. Among neonatal outcomes, respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, retinopathy of prematurity, and composite morbidity showed incremental incidence according to increased stage (or grade) of acute chorioamnionitis, while periventricular leukomalacia and necrotizing enterocolitis did not. Only RDS, BPD, and composite morbidity showed similar incremental incidences associated with severity of funisitis stage. However, the incremental trends of each neonatal outcome were found to be nonsignificant by multivariate analysis adjusting confounding variables including gestational age at delivery. Higher incidences of neonatal morbidity according to increased stage (or grade) of either acute histological chorioamnionitis or funisitis were due to an earlier gestational age at delivery.

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

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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.

Independent predictors of morbidity and mortality in blunt colon trauma.

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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.

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

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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.

Weight loss after bariatric surgery reverses insulin-induced increases in brain glucose metabolism of the morbidly obese.

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Tuulari, Jetro J; Karlsson, Henry K; Hirvonen, Jussi; Hannukainen, Jarna C; Bucci, Marco; Helmiö, Mika; Ovaska, Jari; Soinio, Minna; Salminen, Paulina; Savisto, Nina; Nummenmaa, Lauri; Nuutila, Pirjo

2013-08-01

Obesity and insulin resistance are associated with altered brain glucose metabolism. Here, we studied brain glucose metabolism in 22 morbidly obese patients before and 6 months after bariatric surgery. Seven healthy subjects served as control subjects. Brain glucose metabolism was measured twice per imaging session: with and without insulin stimulation (hyperinsulinemic-euglycemic clamp) using [18F]fluorodeoxyglucose scanning. We found that during fasting, brain glucose metabolism was not different between groups. However, the hyperinsulinemic clamp increased brain glucose metabolism in a widespread manner in the obese but not control subjects, and brain glucose metabolism was significantly higher during clamp in obese than in control subjects. After follow-up, 6 months postoperatively, the increase in glucose metabolism was no longer observed, and this attenuation was coupled with improved peripheral insulin sensitivity after weight loss. We conclude that obesity is associated with increased insulin-stimulated glucose metabolism in the brain and that this abnormality can be reversed by bariatric surgery.

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

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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.

Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy.

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Tee, May C; Ubl, Daniel S; Habermann, Elizabeth B; Nagorney, David M; Kendrick, Michael L; Sarr, Michael G; Truty, Mark J; Que, Florencia G; Reid-Lombardo, Kmarie; Smoot, Rory L; Farnell, Michael B

2016-01-01

In patients undergoing elective partial pancreatectomy, our aim was to evaluate the effect of metabolic syndrome (MS) on postoperative mortality, morbidity, and utilization of hospital resources. Our hypothesis was that MS is associated with worse surgical outcomes after pancreatectomy. Fifteen thousand eight hundred thirty-one patients undergoing elective pancreatectomy from 2005 to 2012 were identified in the Participant User File of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Univariable and multivariable analyses were performed examining the association of MS (defined as body mass index ≥30 kg/m(2), hypertension requiring medications, and diabetes requiring medications and/or insulin) and risk of 30-day mortality, morbidity, and utilization of hospital resources (risk of blood transfusion in the first 72 h after pancreatectomy and prolonged hospital stay, defined as ≥13 days, which was the 75th percentile of this cohort). Multivariable logistic regression models controlled for age, sex, race, pancreatectomy type (distal versus proximal), smoking status, alcohol consumption, functional status, dyspnea, cardiovascular disease, hematocrit, INR, serum albumin, bilirubin, and creatinine. Stratified analyses were conducted by type of pancreatectomy and indication for pancreatectomy (benign versus malignant). On univariate analysis, 1070 (6.8%) patients had MS. MS was associated with increased postoperative morbidity, major morbidity, surgical site infection, septic shock, cardiac event, respiratory failure, pulmonary embolism, blood transfusion, and prolonged duration of hospital stay (P pancreatectomy (P = 0.465). When stratified by distal versus proximal pancreatectomy and benign versus malignant disease, the effect of MS on outcomes appears to be modified by type of pancreatectomy and indication with poorer outcomes observed for distal pancreatectomies and benign indications for resection. MS is an under

Occurrence and significance of Mallory bodies in morbidly obese patients. An immunohistochemical study

DEFF Research Database (Denmark)

Gluud, C; Christoffersen, Pernille Yde; Andersen, T

1984-01-01

Liver biopsies from 61 consecutive patients with morbid obesity (less than 60% overweight) and from 48 patients with alcoholic liver disease were examined for the presence of Mallory bodies. For the detection both routine haematoxylin and eosin stained sections and sections exposed to an immunohi......Liver biopsies from 61 consecutive patients with morbid obesity (less than 60% overweight) and from 48 patients with alcoholic liver disease were examined for the presence of Mallory bodies. For the detection both routine haematoxylin and eosin stained sections and sections exposed...... to an immunohistochemical technique were employed. The latter uses an antiserum which recognizes antigenic determinants in Mallory bodies. Using haematoxylin and eosin staining. Mallory bodies were not detected in any of the biopsies from the obese patients, but found to be present in 63% of the patients with alcoholic...

Morbidity of curative cancer surgery and suicide risk.

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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.

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

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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.

Tourette syndrome, co-morbidities and quality of life.

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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

Post-Traumatic Stress Disorder and severe maternal morbidity: is there an association?

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Angelini, Carina R; Pacagnella, Rodolfo C; Parpinelli, Mary A; Silveira, Carla; Andreucci, Carla B; Ferreira, Elton C; Santos, Juliana P; Zanardi, Dulce M; Souza, Renato T; Cecatti, Jose G

2018-01-01

To evaluate the occurrence of Post-Traumatic Stress Disorder among women experiencing a severe maternal morbidity event and associated factors in comparison with those without maternal morbidity. In a retrospective cohort study, 803 women with or without severe maternal morbidity were evaluated at 6 months to 5 years postpartum for the presence of Post-Traumatic Stress Disorder. Interviews were conducted by telephone and electronic data was stored. Data analysis was carried out by using χ2, Fisher's Exact test, and logistic regression analysis. There was no significant change in the prevalence of Post-Traumatic Stress Disorder related to a previous severe maternal morbidity experience. There were also no differences in diagnostic criteria for severe maternal morbidity (hypertensive syndromes, hemorrhage, surgical intervention or intensive care unit admission required, among other management criteria). Low parity (2.5-fold risk) and increasing age were factors associated with Post-Traumatic Stress Disorder. A severe maternal morbidity episode is not associated with Post-Traumatic Stress Disorder symptoms within five years of the severe maternal morbidity event and birth. However, a more advanced maternal age and primiparity increased the risk of Post-Traumatic Stress Disorder. This does not imply that women who had experienced a severe maternal morbidity event did not suffer or need differentiated care.

Co-morbidities of vertiginous diseases.

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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.

Co-morbidities of vertiginous diseases

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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.

Rotavirus Gastroenteritis is Associated with Increased Morbidity and Mortality in Children with Inherited Metabolic Disorders

LENUS (Irish Health Repository)

Smith, A

2017-04-01

Rotavirus is the leading cause of infantile diarrhoea worldwide in children <5 years1. Although mortality rates are low in Ireland, certain populations are more susceptible to the associated morbidity and mortality of infection. A retrospective chart review of 14 patients with confirmed IMDs who were admitted to Temple Street Children’s Hospital between 2010 to 2015 with rotavirus infection were compared with 14 randomly selected age matched controls. The median length of stay was 7 days (SD25.3) in IMD patients versus 1.5 days (SD 2.1) in the controls. IV fluids were required on average for 4.5 days (range 0-17) in IMD patients versus 0.63 days (range 0-3) in controls. This report highlights the increased morbidity of rotavirus infection in patients with IMD compared to healthy children. This vulnerable population are likely to benefit from the recent introduction of the rotavirus oral vaccination in October 2016.

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...

Preoperative factors influencing mortality and morbidity in peptic ulcer perforation.

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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.

[Light pollution increases morbidity and mortality rate from different causes in male rats].

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Bukalev, A V; Vinogradova, I A; Zabezhinskiĭ, M A; Semenchenko, A V; Anisimov, V N

2012-01-01

The influence of different light regimes (constant light--LL; constant darkness--DD; standard light regime--LD, 12 hours light 12 hours darkness; natural lightening of the North-West of Russia--NL) on the dynamics of life's morbidity rate, spontaneous tumorigenesis and frequency of some kinds of non-tumor pathology revealed at the post-mortem examination of male rats was studied. It was found out that the maintenance of animals at LL and NL conditions led to the increase of the number of infectious diseases, substantially faster development of spontaneous tumors and the increase of non-tumor diseases in comparison with the animals kept at LD (standard light) regime. Light deprivation (DD) led to substantial reduction of development of new growth, of non-tumor and infectious diseases in comparison with the similar parameters in standard light regime.

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

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Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p Indonesia. The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.

Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies.

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Lin, Xiaoti; Chen, Weiyu; Wei, Fengqin; Ying, Mingang; Wei, Weidong; Xie, Xiaoming

2015-11-01

Night-shift work (NSW) has previously been related to incidents of breast cancer and all-cause mortality, but many published studies have reported inconclusive results. The aim of the present study was to quantify a potential dose-effect relationship between NSW and morbidity of breast cancer, and to evaluate the association between NSW and risk of all-cause mortality. The outcomes included NSW, morbidity of breast cancer, cardiovascular mortality, cancer-related mortality, and all-cause mortality. Sixteen investigations were included, involving 2,020,641 participants, 10,004 incident breast cancer cases, 7185 cancer-related deaths, 4820 cardiovascular end points, and 2480 all-cause mortalities. The summary risk ratio (RR) of incident breast cancer for an increase of NSW was 1.057 [95% confidence interval (CI) 1.014-1.102; test for heterogeneity p = 0.358, I(2) = 9.2%]. The combined RR (95% CI) of breast cancer risk for NSW vs daytime work was: 1.029 (0.969-1.093) in the 20-year exposure lengths. The overall RR was 1.089 (95% CI 1.016-1.166) in a fixed-effects model (test for heterogeneity p = 0.838, I(2) = 0%) comparing rotating NSW and day work. Night-shift work was associated with an increased risk of cardiovascular death (RR 1.027, 95% CI 1.001-1.053), and all-cause death 1.253 (95% CI 0.786-1.997). In summary, NSW increased the risk of breast cancer morbidity by: 1.9% for 5 years, 2.5% for 5-10 years, 7.4% for 10-20 years, and 8.8% for >20-years of NSW. Additionally, rotating NSW enhanced the morbidity of breast cancer by 8.9%. Moreover, NSW was associated with a 2.7% increase in cardiovascular death. Copyright © 2015. Published by Elsevier B.V.

Household mold and dust allergens: Exposure, sensitization and childhood asthma morbidity

International Nuclear Information System (INIS)

Gent, Janneane F.; Kezik, Julie M.; Hill, Melissa E.; Tsai, Eling; Li, De-Wei; Leaderer, Brian P.

2012-01-01

Background: Few studies address concurrent exposures to common household allergens, specific allergen sensitization and childhood asthma morbidity. Objective: To identify levels of allergen exposures that trigger asthma exacerbations in sensitized individuals. Methods: We sampled homes for common indoor allergens (fungi, dust mites (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1) and cockroach (Bla g 1)) for levels associated with respiratory responses among school-aged children with asthma (N=1233) in a month-long study. Blood samples for allergy testing and samples of airborne fungi and settled dust were collected at enrollment. Symptoms and medication use were recorded on calendars. Combined effects of specific allergen sensitization and level of exposure on wheeze, persistent cough, rescue medication use and a 5-level asthma severity score were examined using ordered logistic regression. Results: Children sensitized and exposed to any Penicillium experienced increased risk of wheeze (odds ratio [OR] 2.12 95% confidence interval [CI] 1.12, 4.04), persistent cough (OR 2.01 95% CI 1.05, 3.85) and higher asthma severity score (OR 1.99 95% CI 1.06, 3.72) compared to those not sensitized or sensitized but unexposed. Children sensitized and exposed to pet allergen were at significantly increased risk of wheeze (by 39% and 53% for Fel d 1>0.12 μg/g and Can f 1>1.2 μg/g, respectively). Increased rescue medication use was significantly associated with sensitization and exposure to Der p 1>0.10 μg/g (by 47%) and Fel d 1>0.12 μg/g (by 32%). Conclusion: Asthmatic children sensitized and exposed to low levels of common household allergens Penicillium, Der p 1, Fel d 1 and Can f 1 are at significant risk for increased morbidity. - Highlights: ► Few studies address concurrent allergen exposures, sensitization and asthma morbidity. ► Children with asthma were tested for sensitivity to common indoor allergens. ► Homes were sampled for these allergens and asthma

Health-related productivity losses increase when the health condition is co-morbid with psychological distress: findings from a large cross-sectional sample of working Australians.

Science.gov (United States)

Holden, Libby; Scuffham, Paul A; Hilton, Michael F; Ware, Robert S; Vecchio, Nerina; Whiteford, Harvey A

2011-05-31

The health condition of workers is known to impact on productivity outcomes. The relationship between health and productivity is of increasing interest amid the need to increase productivity to meet global financial challenges. Prevalence of psychological distress is also of growing concern in Australia with a two-fold increase in the prevalence of psychological distress in Australia from 1997-2005. We used the cross-sectional data set from the Australian Work Outcomes Research Cost-benefit (WORC) study to explore the impacts of health conditions with and without co-morbid psychological distress, compared to those with neither condition, in a sample of approximately 78,000 working Australians. The World Health Organisation Health and Performance Questionnaire was used which provided data on demographic characteristics, health condition and working conditions. Data were analysed using negative binomial logistic regression and multinomial logistic regression models for absenteeism and presenteeism respectively. For both absenteeism and presenteeism productivity measures there was a greater risk of productivity loss associated when health conditions were co-morbid with psychological distress. For some conditions this risk was much greater for those with co-morbid psychological distress compared to those without. Co-morbid psychological distress demonstrates an increased risk of productivity loss for a range of health conditions. These findings highlight the need for further research to determine whether co-morbid psychological distress potentially exacerbates lost productivity.

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...

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.

Increased psychiatric morbidity before and after the diagnosis of hypothyroidism: a nationwide register study.

Science.gov (United States)

Thvilum, Marianne; Brandt, Frans; Almind, Dorthe; Christensen, Kaare; Brix, Thomas Heiberg; Hegedüs, Laszlo

2014-05-01

Thyroid hormones are necessary for fetal brain development, and 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. This is an observational cohort study. On the basis of record linkage between different Danish health registers, 2822 hypothyroid singletons each matched with 4 nonhypothyroid 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 regression models were used to assess the risk of psychiatric morbidity before and after the diagnosis of hypothyroidism, respectively. Before the diagnosis of hypothyroidism, such individuals had an increased prevalence of diagnoses with psychiatric disorders (odds ratio, OR, 1.51; 95% confidence interval [CI 1.12-2.04]) and increased prevalence of treatment with antipsychotics (OR 1.49 [CI 1.29-1.73]), antidepressants (OR 1.50 [CI 1.35-1.67]), and anxiolytics (OR 1.28 [CI 1.16-1.41]). After the diagnosis of hypothyroidism, patients had a higher risk of being diagnosed with a psychiatric disorder (hazard ratio, HR, 2.40 [CI 1.81-3.18]), and an increased risk of being treated with antidepressants (HR 1.30 [CI 1.15-1.47]) and anxiolytics (HR 1.27 [CI 1.10-1.47]), but not antipsychotics (HR 1.13 [CI 0.91-1.41]). On the basis of the twin data, we could not demonstrate genetic confounding. Subjects with hypothyroidism have an increased risk of being diagnosed with a psychiatric disorder as well as being treated with antidepressants, antipsychotics, and anxiolytics both before

Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations.

Science.gov (United States)

Jahangiri, Arman; Wagner, Jeffrey; Han, Sung Won; Zygourakis, Corinna C; Han, Seunggu J; Tran, Mai T; Miller, Liane M; Tom, Maxwell W; Kunwar, Sandeep; Blevins, Lewis S; Aghi, Manish K

2014-07-01

, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13% vs 35% [p = 0.001]; and CSF leak, 0.3% vs 9% [p = 0.0009]). Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.

Strongyloides stercoralis is associated with significant morbidity in rural Cambodia, including stunting in children.

Science.gov (United States)

Forrer, Armelle; Khieu, Virak; Schär, Fabian; Hattendorf, Jan; Marti, Hanspeter; Neumayr, Andreas; Char, Meng Chuor; Hatz, Christoph; Muth, Sinuon; Odermatt, Peter

2017-10-01

Strongyloides stercoralis is a soil-transmitted nematode that can replicate within its host, leading to long-lasting and potentially fatal infections. It is ubiquitous and highly prevalent in Cambodia. The extent of morbidity associated with S. stercoralis infection is difficult to assess due to the broad spectrum of symptoms and, thus, remains uncertain. Clinical signs were compared among S. stercoralis infected vs. non-infected participants in a cross-sectional survey conducted in 2012 in eight villages of Northern Cambodia, and before and after treatment with a single oral dose of ivermectin (200μg/kg BW) among participants harboring S. stercoralis. Growth retardation among schoolchildren and adolescents was assessed using height-for-age and thinness using body mass index-for-age. S. stercoralis prevalence was 31.1% among 2,744 participants. Urticaria (55% vs. 47%, OR: 1.4, 95% CI: 1.1-1.6) and itching (52% vs. 48%, OR: 1.2, 95% CI: 1.0-1.4) were more frequently reported by infected participants. Gastrointestinal, dermatological, and respiratory symptoms were less prevalent in 103 mono-infected participants after treatment. Urticaria (66% vs. 11%, OR: 0.03, 95% CI: 0.01-0.1) and abdominal pain (81 vs. 27%, OR: 0.07, 95% CI: 0.02-0.2) mostly resolved by treatment. S. stercoralis infection was associated with stunting, with 2.5-fold higher odds in case of heavy infection. The morbidity associated with S. stercoralis confirmed the importance of gastrointestinal and dermatological symptoms unrelated to parasite load, and long-term chronic effects when associated with malnutrition. The combination of high prevalence and morbidity calls for the integration of S. stercoralis into ongoing STH control measures in Cambodia.

The importance of extreme weight percentile in postoperative morbidity in children.

Science.gov (United States)

Stey, Anne M; Moss, R Lawrence; Kraemer, Kari; Cohen, Mark E; Ko, Clifford Y; Lee Hall, Bruce

2014-05-01

Anthropometric data are important indicators of child health. This study sought to determine whether anthropometric data of extreme weight were significant predictors of perioperative morbidity in pediatric surgery. This was a cohort study of children 29 days up to 18 years of age undergoing surgical procedures at participating American College of Surgeons' NSQIP Pediatric hospitals in 2011 and 2012. The primary outcomes were composite morbidity and surgical site infection. The primary predictor of interest was weight percentile, which was divided into the following categories: ≤5(th) percentile, 6(th) to 94(th), or ≥95(th) percentile. A hierarchical multivariate logistic model, adjusting for procedure case mix, demographic, and clinical patient characteristic variables, was used to quantify the relationship between weight percentile category and outcomes. Children in the ≤5th weight percentile had 1.19-fold higher odds of overall postoperative morbidity developing than children in the nonextreme range (95% CI, 1.10-1.30) when controlling for clinical variables. Yet these children did not have higher odds of surgical site infection developing. Children in the ≥95(th) weight percentile did not have a significant increase in overall postoperative morbidity. However, they were at 1.35-fold increased odds of surgical site infection compared with those in the nonextreme range when controlling for clinical variables (95% CI, 1.16-1.57). Both extremely high and extremely low weight percentile scores can be associated with increased postoperative complications after controlling for clinical variables. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

Reilly, J J; Kelly, J

2011-07-01

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

Health-related productivity losses increase when the health condition is co-morbid with psychological distress: findings from a large cross-sectional sample of working Australians

Directory of Open Access Journals (Sweden)

Vecchio Nerina

2011-05-01

Full Text Available Abstract Background The health condition of workers is known to impact on productivity outcomes. The relationship between health and productivity is of increasing interest amid the need to increase productivity to meet global financial challenges. Prevalence of psychological distress is also of growing concern in Australia with a two-fold increase in the prevalence of psychological distress in Australia from 1997-2005. Methods We used the cross-sectional data set from the Australian Work Outcomes Research Cost-benefit (WORC study to explore the impacts of health conditions with and without co-morbid psychological distress, compared to those with neither condition, in a sample of approximately 78,000 working Australians. The World Health Organisation Health and Performance Questionnaire was used which provided data on demographic characteristics, health condition and working conditions. Data were analysed using negative binomial logistic regression and multinomial logistic regression models for absenteeism and presenteeism respectively. Results For both absenteeism and presenteeism productivity measures there was a greater risk of productivity loss associated when health conditions were co-morbid with psychological distress. For some conditions this risk was much greater for those with co-morbid psychological distress compared to those without. Conclusions Co-morbid psychological distress demonstrates an increased risk of productivity loss for a range of health conditions. These findings highlight the need for further research to determine whether co-morbid psychological distress potentially exacerbates lost productivity.

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.

Household mold and dust allergens: Exposure, sensitization and childhood asthma morbidity

Energy Technology Data Exchange (ETDEWEB)

Gent, Janneane F., E-mail: janneane.gent@yale.edu [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Kezik, Julie M., E-mail: julie.colburn@yale.edu [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Hill, Melissa E., E-mail: melissa.hill@yale.edu [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Tsai, Eling, E-mail: tsai.umiami@gmail.com [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States); Li, De-Wei, E-mail: DeWei.Li@ct.gov [Connecticut Agricultural Experiment Station, Valley Laboratory, 153 Cook Hill Road, Windsor, CT 06095 (United States); Leaderer, Brian P., E-mail: brian.leaderer@yale.edu [Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510 (United States)

2012-10-15

Background: Few studies address concurrent exposures to common household allergens, specific allergen sensitization and childhood asthma morbidity. Objective: To identify levels of allergen exposures that trigger asthma exacerbations in sensitized individuals. Methods: We sampled homes for common indoor allergens (fungi, dust mites (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1) and cockroach (Bla g 1)) for levels associated with respiratory responses among school-aged children with asthma (N=1233) in a month-long study. Blood samples for allergy testing and samples of airborne fungi and settled dust were collected at enrollment. Symptoms and medication use were recorded on calendars. Combined effects of specific allergen sensitization and level of exposure on wheeze, persistent cough, rescue medication use and a 5-level asthma severity score were examined using ordered logistic regression. Results: Children sensitized and exposed to any Penicillium experienced increased risk of wheeze (odds ratio [OR] 2.12 95% confidence interval [CI] 1.12, 4.04), persistent cough (OR 2.01 95% CI 1.05, 3.85) and higher asthma severity score (OR 1.99 95% CI 1.06, 3.72) compared to those not sensitized or sensitized but unexposed. Children sensitized and exposed to pet allergen were at significantly increased risk of wheeze (by 39% and 53% for Fel d 1>0.12 {mu}g/g and Can f 1>1.2 {mu}g/g, respectively). Increased rescue medication use was significantly associated with sensitization and exposure to Der p 1>0.10 {mu}g/g (by 47%) and Fel d 1>0.12 {mu}g/g (by 32%). Conclusion: Asthmatic children sensitized and exposed to low levels of common household allergens Penicillium, Der p 1, Fel d 1 and Can f 1 are at significant risk for increased morbidity. - Highlights: Black-Right-Pointing-Pointer Few studies address concurrent allergen exposures, sensitization and asthma morbidity. Black-Right-Pointing-Pointer Children with asthma were tested for sensitivity to common indoor allergens

Health impact assessment of increasing public transport and cycling use in Barcelona: a morbidity and burden of disease approach.

Science.gov (United States)

Rojas-Rueda, D; de Nazelle, A; Teixidó, O; Nieuwenhuijsen, M J

2013-11-01

Quantify the health impacts on morbidity of reduced car trips and increased public transport and cycling trips. A health impact assessment study of morbidity outcomes related to replacing car trips in Barcelona metropolitan (3,231,458 inhabitants). Through 8 different transport scenarios, the number of cases of disease or injuries related to physical activity, particulate matter air pollution public transport and cycling trips resulted in annual reductions of 127 cases of diabetes, 44 of cardiovascular diseases, 30 of dementia, 16 minor injuries, 0.14 major injuries, 11 of breast cancer and 3 of colon-cancer, amounting to a total reduction of 302 Disability Adjusted Life Years per year in travelers. The reduction in PM2.5 exposure in the general population resulted in annual reductions of 7 cases of low birth weight, 6 of preterm birth, 1 of cardiovascular disease and 1 of lower respiratory tract infection. Transport policies to reduce car trips could produce important health benefits in terms of reduced morbidity, particularly for those who take up active transportation. © 2013.

Zonulin transgenic mice show altered gut permeability and increased morbidity/mortality in the DSS colitis model.

Science.gov (United States)

Sturgeon, Craig; Lan, Jinggang; Fasano, Alessio

2017-06-01

Increased small intestinal permeability (IP) has been proposed to be an integral element, along with genetic makeup and environmental triggers, in the pathogenies of chronic inflammatory diseases (CIDs). We identified zonulin as a master regular of intercellular tight junctions linked to the development of several CIDs. We aim to study the role of zonulin-mediated IP in the pathogenesis of CIDs. Zonulin transgenic Hp2 mice (Ztm) were subjected to dextran sodium sulfate (DSS) treatment for 7 days, followed by 4-7 days' recovery and compared to C57Bl/6 (wild-type (WT)) mice. IP was measured in vivo and ex vivo, and weight, histology, and survival were monitored. To mechanistically link zonulin-dependent impairment of small intestinal barrier function with clinical outcome, Ztm were treated with the zonulin inhibitor AT1001 added to drinking water in addition to DSS. We observed increased morbidity (more pronounced weight loss and colitis) and mortality (40-70% compared with 0% in WT) at 11 days post-DSS treatment in Ztm compared with WT mice. Both in vivo and ex vivo measurements showed an increased IP at baseline in Ztm compared to WT mice, which was exacerbated by DSS treatment and was associated with upregulation of zonulin gene expression (fourfold in the duodenum, sixfold in the jejunum). Treatment with AT1001 prevented the DSS-induced increased IP both in vivo and ex vivo without changing zonulin gene expression and completely reverted morbidity and mortality in Ztm. Our data show that zonulin-dependent small intestinal barrier impairment is an early step leading to the break of tolerance with subsequent development of CIDs. © 2017 New York Academy of Sciences.

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

Science.gov (United States)

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

2011-08-18

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

[Is the morbid obesity surgery profitable in times of crisis? A cost-benefit analysis of bariatric surgery].

Science.gov (United States)

Sánchez-Santos, Raquel; Sabench Pereferrer, Fátima; Estévez Fernandez, Sergio; del Castillo Dejardin, Daniel; Vilarrasa, Nuria; Frutos Bernal, Dolores; Ruiz de Adana, Juan Carlos; Masdevall Noguera, Carlos; Torres García, Antonio

2013-10-01

Morbid obesity is a serious health problem whose prevalence is increasing. Expensive co-morbidities are associated to these patients, as well as a reduction in the survival. Bariatric surgery resolves the co-morbidities (type 2 diabetes mellitus, 86.6%; cardiovascular risk, 79.0%; obstructive sleep apnea syndrome, 83.6%; hypertension, 61.7%), reduces the mortality rate (among 31-40%), and increases the morbid obese patients survival over a 10-years period. It provides significant savings for the National Health System. The obese patients consume a 20% plus of health resources and 68% plus of drugs than general population. Bariatric surgery requires an initial investment (diagnosis-related group cost: 7,468 €), but it is recovered in a cost-effectiveness ratio of 2.5 years. Significant savings are obtained from the third year. To the direct economic benefits associated with reduced health expenditures it should be added an increase in tax collection (sick leave and unemployment reduction is estimated in 18%, with a productivity increase of 57% for self-employed people). Bariatric surgery is one of the most cost-effective procedures in the healthcare system. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

Morbid obese adults increased their sense of coherence 1 year after a patient education course: a longitudinal study

Directory of Open Access Journals (Sweden)

Fagermoen MS

2015-03-01

Full Text Available May Solveig Fagermoen,1 Glenys Hamilton,2 Anners Lerdal1,3 1Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway; 2GAH Consulting, Boston, MA, USA; 3Department of Research, Lovisenberg Diakonale Hospital, Oslo, Norway Background: Personal factors are key elements to understand peoples' health behavior. Studies of such factors are important to develop targeted interventions to improve health. The main purpose of this study is to explore sense of coherence (SOC in a sample of persons with morbid obesity before and after attending a patient education course and to explore the association between SOC and sociodemographic and other personal factors. Methods: In this longitudinal purposely sampled study, the participants completed questionnaires on the first day of the course and 12 months after course completion. Sixty-eight participants had valid scores on the selected variables at follow-up: SOC, self-esteem, and self-efficacy. Relationships were assessed with correlation analyses and paired and independent samples t-tests and predictors with linear regression analyses. Results: From baseline to follow-up, the total SOC score and the subdimension scores comprehensibility, manageability, and meaningfulness all increased significantly. At both time points, the SOC scores were low compared to the general population but similar to scores in other chronically ill. At baseline, a multivariate analysis showed that older age, having paid work, and higher self-esteem were directly related to higher total SOC score after controlling for other sociodemographic factors and the participants' level of self-efficacy. Multivariate analyses of the relationship between baseline predictors of SOC at 12-month follow-up, controlling for baseline SOC scores or sociodemographic or personal factors, revealed that none of these variables independently predicted SOC scores at follow-up. Conclusion: The total SOC score and its

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.

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

Quality of life and psychological morbidity in women with polycystic ovary syndrome: body mass index, age and the provision of patient information are significant modifiers.

Science.gov (United States)

Ching, H L; Burke, V; Stuckey, B G A

2007-03-01

Polycystic ovary syndrome (PCOS) has clinical features and implications for long-term health that may lead to decreased quality of life (QoL) and psychological morbidity. We studied QoL in women with PCOS, compared the findings with population norms and assessed whether they correlated with reported quality of patient information received. Cross-sectional study. Women with PCOS by National Institutes of Health (NIH) criteria, diagnosis confirmed by one endocrinologist. Four questionnaires were mailed: the Short Form-36 (SF-36), the Quality-of-Life Questionnaire for Women with Polycystic Ovary Syndrome (PCOSQ), the General Health Questionnaire-28 (GHQ-28) and an assessment of information quality and sources, the Patient Information Questionnaire (PIQ). Questionnaires were sent to 443 women with PCOS from one endocrinologist's database; 203 women aged 15-65 years agreed to participate. To compare with Australian population norms, data from those women aged 18-44 years (n = 173) were used. Of these, 64% were obese, 18% overweight and 18% of normal weight. The demographics, socioeconomic status and untreated biochemistry of the responders and the total patient group were not significantly different. SF-36 scores were significantly lower than the age- and sex-matched Australian population (P PCOSQ was similar to other published studies. GHQ-28 identified psychological morbidity in 62.4%, compared with 26.4% in a matched Australian population (P < 0.0001). Body mass index (BMI) was negatively correlated with QoL (P < 0.01). There was a positive association between the psychological domain of QoL and the subjective assessment of the quality of health-related information in general (P < 0.001), for hirsutism (P < 0.01) and for menstrual irregularity (P < 0.05). We have shown impaired QoL and increased prevalence of psychological morbidity in PCOS compared with population norms. The perception of inadequate information about the condition correlated with poorer QoL scores

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...

Scope and Significance of Eating Disorders.

Science.gov (United States)

Mitchell, James E.; Eckert, Elke D.

1987-01-01

Describes the increasing prevalence of anorexia nervosa and bulimia in many industrialized societies, and their association with significant morbidity and mortality. Discusses the genetic risks for the development of anorexia nervosa, and treatment strategies. Of these, pharmacotherapy and psychotherapy, particularly those incorporating…

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.

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....

Factors influencing incidence of acute grade 2 morbidity in conformal and standard radiation treatment of prostate cancer

International Nuclear Information System (INIS)

Hanks, Gerald E.; Schultheiss, Timothy E.; Hunt, Margie A.; Epstein, Barry

1995-01-01

Purpose: The fundament hypothesis of conformal radiation therapy is that tumor control can be increased by using conformal treatment techniques that allow a higher tumor dose while maintaining an acceptable level of complications. To test this hypothesis, it is necessary first to estimate the incidence of morbidity for both standard and conformal fields. In this study, we examine factors that influence the incidence of acute grade 2 morbidity in patients treated with conformal and standard radiation treatment for prostate cancer. Methods and Materials: Two hundred and forty-seven consecutive patients treated with conformal technique are combined with and compared to 162 consecutive patients treated with standard techniques. The conformal technique includes special immobilization by a cast, careful identification of the target volume in three dimensions, localization of the inferior border of the prostate using the retrograde urethrogram, and individually shaped portals that conform to the Planning Target Volume (PTV). Univariate analysis compares differences in the incidence of RTOG-EORTC grade two acute morbidity by technique, T stage, age, irradiated volume, and dose. Multivariate logistic regression includes these same variables. Results: In nearly all categories, the conformal treatment group experienced significantly fewer acute grade 2 complications than the standard treatment group. Only volume (prostate ± whole pelvis) and technique (conformal vs. standard) were significantly related to incidence of morbidity on multivariate analysis. When dose is treated as a continuous variable (rather than being dichotomized into two levels), a trend is observed on multivariate analysis, but it does not reach significant levels. The incidence of acute grade 2 morbidity in patients 65 years or older is significantly reduced by use of the conformal technique. Conclusion: The conformal technique is associated with fewer grade 2 acute toxicities for all patients. This

Infectious precipitants of acute hyperammonemia are associated with indicators of increased morbidity in patients with urea cycle disorders.

Science.gov (United States)

McGuire, Peter J; Lee, Hye-Seung; Summar, Marshall L

2013-12-01

To prospectively characterize acute hyperammonemic episodes in patients with urea cycle disorders (UCDs) in terms of precipitating factors, treatments, and use of medical resources. This was a prospective, longitudinal observational study of hyperammonemic episodes in patients with UCD enrolled in the National Institutes of Health-sponsored Urea Cycle Disorders Consortium Longitudinal Study. An acute hyperammonemic event was defined as plasma ammonia level >100 μmol/L. Physician-reported data regarding the precipitating event and laboratory and clinical variables were recorded in a central database. In our study population, 128 patients with UCD experienced a total of 413 hyperammonemia events. Most patients experienced between 1 and 3 (65%) or between 4 and 6 (23%) hyperammonemia events since study inception, averaging fewer than 1 event/year. The most common identifiable precipitant was infection (33%), 24% of which were upper/lower respiratory tract infections. Indicators of increased morbidity were seen with infection, including increased hospitalization rates (P = .02), longer hospital stays (+2.0 days; P = .003), and increased use of intravenous ammonia scavengers (+45%-52%; P = .003-.03). Infection is the most common precipitant of acute hyperammonemia in patients with UCD and is associated with indicators of increased morbidity (ie, hospitalization rate, length of stay, and use of intravenous ammonia scavengers). These findings suggest that the catabolic and immune effects of infection may be a target for clinical intervention in inborn errors of metabolism. Published by Mosby, Inc.

A study of psychiatric morbidity in patients of peptic ulcer diseases

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Jagpal Singh Klair

2012-01-01

Full Text Available Aims and Objectives: To study the prevalence of psychiatric morbidity among patients of peptic ulcer disease and to study the patients of peptic ulcer disease with psychiatric morbidity in comparison to patients of peptic ulcer disease without psychiatric morbidity on following variables: sociodemographic variables and attributes/risk factors of peptic ulcer disease. Materials and Methods: Fifty cases of clinically proven acid peptic diseases and 30 cases of the control group were screened in department of General Medicine, outdoor as well as indoor patients. Instruments applied for the purpose of the study were Personal Bio-data Performa (Appendix-I, (SCL- 80 (Appendix-II, Hamilton rating scale for anxiety and depression, (P.S.L.E.; clinical diagnosis of psychiatric disorders was made as per ICD- 10 criteria. Data collected shall be subjected to statistical analysis. Results and Findings: The psychiatric morbidity was significantly (P10 years, compared to 23.80% in patients without psychiatric morbidity. Lastly, 48.27% of patients with psychiatric morbidity had significantly (P<0.01 stronger family history of acid peptic disease compared to 9.52% in patients without psychiatric morbidity. Conclusions: There is a significant relationship between the peptic ulcer disease and the various psychiatric morbidity factors as illustrated from the findings of this study.

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.

Co-Morbidities in psoriatic versus non-psoriatic patients

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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.

Does resident participation influence otolaryngology-head and neck surgery morbidity and mortality?

Science.gov (United States)

Abt, Nicholas B; Reh, Douglas D; Eisele, David W; Francis, Howard W; Gourin, Christine G

2016-10-01

Patients may perceive resident procedural participation as detrimental to their outcome. Our objective is to investigate whether otolaryngology-head and neck surgery (OHNS) housestaff participation is associated with surgical morbidity and mortality. Case-control study. OHNS patients were analyzed from the American College of Surgeons National Surgical Quality Improvement Program 2006 to 2013 databases. We compared the incidence of 30-day postoperative morbidity, mortality, readmissions, and reoperations in patients operated on by resident surgeons with attending supervision (AR) with patients operated on by an attending surgeon alone (AO) using cross-tabulations and multivariable regression. There were 27,018 cases with primary surgeon data available, with 9,511 AR cases and 17,507 AO cases. Overall, 3.62% of patients experienced at least one postoperative complication. The AR cohort had a higher complication rate of 5.73% than the AO cohort at 2.48% (P < .001). After controlling for all other variables, there was no significant difference in morbidity (odds ratio [OR] = 1.05 [0.89 to 1.24]), mortality (OR = 0.91 [0.49 to 1.70]), readmission (OR = 1.29 [0.92 to 1.81]), or reoperation (OR = 1.28 [0.91 to 1.80]) for AR compared to AO cases. There was no difference between postgraduate year levels for adjusted 30-day morbidity or mortality. There is an increased incidence of morbidity, mortality, readmission, and reoperation in OHNS surgical cases with resident participation, which appears related to increased comorbidity with AR patients. After controlling for other variables, resident participation was not associated with an increase in 30-day morbidity, mortality, readmission, or reoperation odds. These data suggest that OHNS resident participation in surgical cases is not associated with poorer short-term outcomes. 3b Laryngoscope, 126:2263-2269, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Morbidity and mortality following poliomyelitis - a lifelong follow-up.

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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.

Admission Hypothermia in Very Preterm Infants and Neonatal Mortality and Morbidity

DEFF Research Database (Denmark)

Wilson, Emilija; Maier, Rolf F; Norman, Mikael

2016-01-01

-28 days (risk ratio 1.79; 1.15-2.78) but not after 28 days of age. We found no associations between admission temperature and neonatal morbidity. CONCLUSION: Admission hypothermia after very preterm birth is a significant problem in Europe, associated with an increased risk of early and late neonatal...

General morbidity prevalence in the Delhi slums

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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.

Social anxiety disorder and alcohol use disorder co-morbidity in the National Epidemiologic Survey on Alcohol and Related Conditions.

Science.gov (United States)

Schneier, F R; Foose, T E; Hasin, D S; Heimberg, R G; Liu, S-M; Grant, B F; Blanco, C

2010-06-01

To assess the prevalence and clinical impact of co-morbid social anxiety disorder (SAD) and alcohol use disorders (AUD, i.e. alcohol abuse and alcohol dependence) in a nationally representative sample of adults in the United States. Data came from a large representative sample of the US population. Face-to-face interviews of 43093 adults residing in households were conducted during 2001-2002. Diagnoses of mood, anxiety, alcohol and drug use disorders and personality disorders were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule - DSM-IV version. Lifetime prevalence of co-morbid AUD and SAD in the general population was 2.4%. SAD was associated with significantly increased rates of alcohol dependence [odds ratio (OR) 2.8] and alcohol abuse (OR 1.2). Among respondents with alcohol dependence, SAD was associated with significantly more mood, anxiety, psychotic and personality disorders. Among respondents with SAD, alcohol dependence and abuse were most strongly associated with more substance use disorders, pathological gambling and antisocial personality disorders. SAD occurred before alcohol dependence in 79.7% of co-morbid cases, but co-morbidity status did not influence age of onset for either disorder. Co-morbid SAD was associated with increased severity of alcohol dependence and abuse. Respondents with co-morbid SAD and alcohol dependence or abuse reported low rates of treatment-seeking. Co-morbid lifetime AUD and SAD is a prevalent dual diagnosis, associated with substantial rates of additional co-morbidity, but remaining largely untreated. Future research should clarify the etiology of this co-morbid presentation to better identify effective means of intervention.

Co-morbidity in a cystic fibrosis population attending a regional clinic.

LENUS (Irish Health Repository)

Healy, F

2010-11-01

Pulmonary disease remains the major cause of morbidity in patients with cystic fibrosis (CF). However, of 115 patients attending a regional CF clinic we noted 16 cases (14%) with co-morbid conditions. Of this group, 4 of 115 patients (3.5%) had renal problems including both structural and functional defects and 4 (3.5%) had neurological disorders, 3 of which were types of epilepsy. Notably, 3 of 115 patients (2.6%) had different forms of neoplasia, all of which required significant surgical and\\/or chemotherapeutic intervention. There is now increasing evidence of the association between digestive tract malignancy and CF, which further complicates management of these already complex cases.

Melatonin reduces cardiac morbidity and markers of myocardial ischemia after elective abdominal aortic aneurism repair

DEFF Research Database (Denmark)

Gögenür, Ismail; Kücükakin, Bülent; Panduro Jensen, Leif

2014-01-01

The aim was to examine the effect of perioperative melatonin treatment on clinical cardiac morbidity and markers of myocardial ischemia in patients undergoing elective surgery for abdominal aortic aneurism. Reperfusion injury results in increased cardiac morbidity in patients undergoing surgery...... for abdominal aortic aneurisms (AAA). A randomized, placebo-controlled, clinical trial including patients undergoing surgery for AAA was performed. The patients received by infusion over a 2-hr period either, 50 mg melatonin or placebo intra-operatively, and 10 mg melatonin or placebo orally, the first three...... by Holter monitoring. A total of 26 patients received melatonin, while 24 received placebo. A significant reduction in cardiac morbidity was seen in the melatonin-treated patients compared with those given placebo [4% versus 29% (P = 0.02)]. Five patients (19%) who received melatonin had increased Tp...

Neonatal Morbidities and Developmental Delay in Moderately Preterm-Born Children

NARCIS (Netherlands)

Kerstjens, J.M.; Bocca-Tjeertes, I.F.; de Winter, A.F.; Reijneveld, S.A.; Bos, A.F.

BACKGROUND AND OBJECTIVE: Children born moderately preterm (32-35(6/7) weeks' gestation) are at increased risk of both neonatal morbidities and developmental delays in early childhood. It is unknown whether neonatal morbidities contribute to the increased risk of developmental delay. The objective

Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity

Science.gov (United States)

Gerritsen, Arja; Wennink, Roos A W; Besselink, Marc G H; van Santvoort, Hjalmar C; Tseng, Dorine S J; Steenhagen, Elles; Borel Rinkes, Inne H M; Molenaar, I Quintus

2014-01-01

Objective The aim of this study was to evaluate whether a change in the routine feeding strategy applied after pancreatoduodenectomy (PD) from nasojejunal tube (NJT) feeding to early oral feeding improved clinical outcomes. Methods An observational cohort study was performed in 102 consecutive patients undergoing PD. In period 1 (n = 51, historical controls), the routine postoperative feeding strategy was NJT feeding. This was changed to a protocol of early oral feeding with on-demand NJT feeding in period 2 (n = 51, consecutive prospective cohort). The primary outcome was time to resumption of adequate oral intake. Results The baseline characteristics of study subjects in both periods were comparable. In period 1, 98% (n = 50) of patients received NJT feeding, whereas in period 2, 53% (n = 27) of patients did so [for delayed gastric empting (DGE) (n = 20) or preoperative malnutrition (n = 7)]. The time to resumption of adequate oral intake significantly decreased from 12 days in period 1 to 9 days in period 2 (P = 0.015), and the length of hospital stay shortened from 18 days in period 1 to 13 days in period 2 (P = 0.015). Overall, there were no differences in the incidences of complications of Clavien–Dindo Grade III or higher, DGE, pancreatic fistula, postoperative haemorrhage and mortality between the two periods. Conclusions The introduction of an early oral feeding strategy after PD reduced the time to resumption of adequate oral intake and length of hospital stay without negatively impacting postoperative morbidity. PMID:24308458

[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.

Heartburn during sleep: a clinical marker of gastro-oesophageal reflux disease in morbidly obese patients.

Science.gov (United States)

Fornari, F; Madalosso, C A S; Callegari-Jacques, S M; Gurski, R R

2009-02-01

Gastro-oesophageal reflux disease (GORD) and morbid obesity are entities with increasing prevalence. New clinical strategies are cornerstones for their management. The aim of this study was to assess the prevalence of heartburn during sleep (HDS) and whether this symptom predicts the presence of objective GORD parameters and increased heartburn perception in morbidly obese patients. Ninety-one consecutive morbidly obese patients underwent clinical evaluation, upper gastrointestinal endoscopy and oesophageal pH monitoring. HDS was characterized when patients replied positively to the question, 'Does heartburn wake you from sleep?'. A General Score for Heartburn (GSH) ranging between 0 and 5 was assessed with the question 'How bad is your heartburn?'. HDS was reported by 33 patients (36%). More patients with HDS had abnormal acid contact time or reflux oesophagitis than patients without HDS (94%vs 57%, P heartburn preceded by acid reflux in diurnal (39%vs 9%; P heartburn. HDS occurs in a significant minority of patients with morbid obesity and has high positive predictive value for GORD. Symptomatic reflux during the sleep seems to be a marker of increased heartburn perception in this population.

The Avalanche Hypothesis and Compression of Morbidity: Testing Assumptions through Cohort-Sequential Analysis.

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Jordan Silberman

Full Text Available The compression of morbidity model posits a breakpoint in the adult lifespan that separates an initial period of relative health from a subsequent period of ever increasing morbidity. Researchers often assume that such a breakpoint exists; however, this assumption is hitherto untested.To test the assumption that a breakpoint exists--which we term a morbidity tipping point--separating a period of relative health from a subsequent deterioration in health status. An analogous tipping point for healthcare costs was also investigated.Four years of adults' (N = 55,550 morbidity and costs data were retrospectively analyzed. Data were collected in Pittsburgh, PA between 2006 and 2009; analyses were performed in Rochester, NY and Ann Arbor, MI in 2012 and 2013. Cohort-sequential and hockey stick regression models were used to characterize long-term trajectories and tipping points, respectively, for both morbidity and costs.Morbidity increased exponentially with age (P<.001. A morbidity tipping point was observed at age 45.5 (95% CI, 41.3-49.7. An exponential trajectory was also observed for costs (P<.001, with a costs tipping point occurring at age 39.5 (95% CI, 32.4-46.6. Following their respective tipping points, both morbidity and costs increased substantially (Ps<.001.Findings support the existence of a morbidity tipping point, confirming an important but untested assumption. This tipping point, however, may occur earlier in the lifespan than is widely assumed. An "avalanche of morbidity" occurred after the morbidity tipping point-an ever increasing rate of morbidity progression. For costs, an analogous tipping point and "avalanche" were observed. The time point at which costs began to increase substantially occurred approximately 6 years before health status began to deteriorate.

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...

[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

Gas revenue increasingly significant

International Nuclear Information System (INIS)

Megill, R.E.

1991-01-01

This paper briefly describes the wellhead prices of natural gas compared to crude oil over the past 70 years. Although natural gas prices have never reached price parity with crude oil, the relative value of a gas BTU has been increasing. It is one of the reasons that the total amount of money coming from natural gas wells is becoming more significant. From 1920 to 1955 the revenue at the wellhead for natural gas was only about 10% of the money received by producers. Most of the money needed for exploration, development, and production came from crude oil. At present, however, over 40% of the money from the upstream portion of the petroleum industry is from natural gas. As a result, in a few short years natural gas may become 50% of the money revenues generated from wellhead production facilities

Parkinson's disease: the reliability of morbidity and mortality statistics in the Russian Federation

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Krivonos O.V.

2013-12-01

Full Text Available The aim of the research was to study the significance of morbidity of Parkinson's disease (PD and mortality in Russian Federation in international comparisons. Material and Methods: In accordance with the purpose of the study the morbidity and mortality were analyzed in the Russian Federation on the basis of volumes "Morbidity in Russia" of the Ministry of Health of the Russian Federation in 2009-2012, "Human resources for health care institutions" of the Ministry of Health of the Russian Federation in 2012, tables С 51 about the mortality of subjects of the Russian Federation in 2012, data of mortality from Parkinson's disease in different countries in 2011, published by WHO. Results. The analysis of data on the morbidity patterns showed that in the Russian Federation in 2009-2012 there was an increase in general morbidity of adult patients with PD from 75.1 to 87.7 per thousand of populations. The data of primary morbidity in the adult population of the Russian Federation from PD also tend to increase from 8.0 to 8.5 per thousand of populations. The sharp fluctuations of mortality's data were revealed in subject of Russian Federation that was related of unreliable data. Mortality from PD in Russian Federation in 2012 was 0.31 per thousand of populations. Conclusion. The values in the study of general and primary PD's morbidity in the Russian Federation were lower than performance in international comparisons. PD's mortality in Russia was also lower than in other developed countries. Abidance by rules of selecting the primary cause of death (PCOD, confirmed by an automated system, where one of the causes is PD will make mortality statistics of PD reliable and internationally comparable.

Early and late radiotherapeutic morbidity in 442 consecutive patients with locally advanced carcinoma of the uterine cervix

International Nuclear Information System (INIS)

Pedersen, D.; Bentzen, S.M.; Overgaard, J.

1994-01-01

The purpose of this study was to evaluate the early and late radiotherapeutic morbidity after combined external and intracavitary radiotherapy to the uterine cervix. Early morbidity was most frequently seen in the rectosigmoideum (61%) and urinary bladder (27%). Medication for early morbidity was required 68% and hospitalization in 10% of the patients. The frequencies of each late morbidity grade did not differ in relation to FIGO State while the actuarial estimates increased significantly with increasing stage. This reflects the poor prognosis in the more advanced stages, where few patients survived to develop late morbidity, and also points to the importance of latency in reporting late radiotherapeutic morbidity. In Stage IVA patients, the ratios between the actuarial estimate and the frequency of late severe rectosigmoid and urinary bladder morbidity were as high as 2.5 and 3, respectively. The highest 5-year risk (± 1 SE of the estimate) of late severe morbidity were found for the rectosignoideum (28% ± 3), small intestine (13% ± 2) and urinary bladder (10% ± 2). Rectosigmoid and urinary bladder complications constituted the most important part of the combined organ morbidity. Almost half of the patients developing late moderate rectosigmoid and one-third of those developing late moderate bladder complications, did so within one year after radiotherapy. Almost all complications were developed within 3 to 4 years after radiotherapy. The probability of surviving without recurrence and/or severe combined rectosigmoid and urinary bladder morbidity was low (23% ± 2). Actuarial estimates rather than frequencies should be reported to avoid underestimation of the risk of late radiotherapeutic morbidity in long-term survivors. 29 refs., 5 figs. 7 tabs

Risk and Cost of 90-Day Complications in Morbidly and Superobese Patients After Total Knee Arthroplasty.

Science.gov (United States)

Meller, Menachem M; Toossi, Nader; Johanson, Norman A; Gonzalez, Mark H; Son, Min-Sun; Lau, Edmund C

2016-10-01

This study investigated the risk and cost of postoperative complications associated with morbid and super obesity after total knee arthroplasty (TKA). A retrospective cohort study was conducted of patients who underwent TKA using Medicare hospital claims data. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code V85.4x was used to identify morbidly obese patients (body mass index [BMI] ≥40 kg/m(2)) and superobese patients (BMI ≥50 kg/m(2)) in 2011-2013. Patients without any BMI-related diagnosis codes were used as controls. Twelve complications occurred in the 90-day period after TKA were analyzed using multivariate Cox models, adjusting for patient demographic, morbidity, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through subsequent 90 days. Morbidly obese patients showed a significantly elevated risk in most complications examined, with a 2-fold or higher risk in dislocation and wound dehiscence. In addition, death, periprosthetic joint infection, acute renal failure, and knee revision had significant hazard ratios between 1.5 and 2.0. However, risk of deep vein thrombosis and acute myocardial infarction did not increase for the morbidly obese patients. Superobese patients had significant increase in risk of infection, wound dehiscence, acute renal failures, revisions, death, and readmission compared with patients with BMI 40-49 kg/m(2). Significant dose-response trend was found between the level of BMI and risk for death, dislocation, implant failure, infection, readmission, revision, wound dehiscence, and acute renal failure. Controlling for patient and institutional factors, each TKA had an average total hospital charges of $75,884 among superobese patients, compared to $65,118 for the control group, a difference of $10,767. Medicare payment for the superobese patients was also higher, but only by $2703. Morbidly obese patients pose a significantly

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.

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.

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

Science.gov (United States)

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

2013-09-01

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

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.

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

Science.gov (United States)

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

2003-01-01

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

Clarithromycin for stable coronary heart disease increases all-cause and cardiovascular mortality and cerebrovascular morbidity over 10years in the CLARICOR randomised, blinded clinical trial

DEFF Research Database (Denmark)

Winkel, Per; Hilden, Jørgen; Hansen, Jørgen Fischer

2015-01-01

-cause mortality (hazard ratio (HR): 1.10, 95% confidence interval (CI): 1.00-1.21) and cerebrovascular disease during 10years (HR: 1.19, 95% CI: 1.02-1.38). The increased mortality and morbidity were restricted to patients not on statin at entry (HR: 1.16, 95% CI: 1.04-1.31, and HR: 1.25, 95% CI: 1...... death outside hospital and cerebrovascular morbidity in patients with stable coronary heart disease who were not on statin. The increased cardiovascular mortality was years later compensated, likely through frailty attrition.......BACKGROUND: The CLARICOR trial reported that clarithromycin compared with placebo increased all-cause mortality in patients with stable coronary heart disease. This study investigates the effects of clarithromycin versus placebo during 10years follow up. METHODS: The CLARICOR trial is a randomised...

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

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

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.

Type and Extent of Somatic Morbidity before and after the Diagnosis of Hypothyroidism. A Nationwide Register Study

Science.gov (United States)

Thvilum, Marianne; Brandt, Frans; Almind, Dorthe; Christensen, Kaare; Brix, Thomas Heiberg; Hegedüs, Laszlo

2013-01-01

Background Hypothyroidism has been linked with an increased risk of other morbidities, such as cardiovascular diseases and diabetes mellitus. However, the temporal relationship between these diseases and the diagnosis of hypothyroidism is not well illuminated. Such information may provide insight into causal relationships between hypothyroidism and other morbidities. Aim To investigate the type and extent of somatic morbidity before and after a diagnosis of hypothyroidism. Methods Observational cohort study. From official Danish health registers, 2822 hypothyroid singletons were identified and matched 1:4 with non-hypothyroid controls and observed over a mean period of 6 years. Frequency of different morbidities was obtained by person-to-person linking in the registers. Logistic and Cox regression models were used to assess the risk of morbidity before and after the diagnosis of hypothyroidism, respectively. Results Prior to the diagnosis of hypothyroidism there was a significantly increased risk of being diagnosed with cardiovascular diseases (odds ratio (OR) 1.37; 95% confidence interval (CI): 1.19–1.58), lung diseases (OR 1.25; 95% CI: 1.13–1.39), diabetes mellitus (OR 1.92; 95% CI: 1.61–2.29), as well as malignant diseases (OR 1.24; 95% CI: 1.06–1.45). Following the diagnosis of hypothyroidism there was a significantly increased risk of being diagnosed with cardiovascular diseases (hazard ratio (HR) 1.36; 95% CI: 1.15–1.60); lung diseases (HR 1.51; 95% CI: 1.30–1.75); and diabetes mellitus (HR 1.40; 95% CI: 1.11–1.77). Conclusions Prior to the diagnosis of hypothyroidism there is an excess risk of being diagnosed with cardiovascular diseases, lung diseases, diabetes mellitus, and malignant diseases. Following the diagnosis of hypothyroidism we demonstrate an increased frequency of cardiovascular diseases, lung diseases, and diabetes mellitus. PMID:24066186

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....

Neither high-dose nor low-dose brachytherapy increases flap morbidity in salvage treatment of recurrent head and neck cancer

Directory of Open Access Journals (Sweden)

Peter W. Henderson

2016-08-01

Full Text Available Purpose: While brachytherapy is often used concurrently with flap reconstruction following surgical ablation for head and neck cancer, it remains unclear whether it increases morbidity in the particularly high risk subset of patients undergoing salvage treatment for recurrent head and neck cancer (RH&NC. Material and methods : A retrospective chart review was undertaken that evaluated patients with RH&NC who underwent flap coverage after surgical re-resection and concomitant brachytherapy. The primary endpoint was flap viability, and the secondary endpoints were flap and recipient site complications. Results : In the 23 subjects included in series, flap viability and skin graft take was 100%. Overall recipient site complication rate was 34.8%, high-dose radiation (HDR group 50%, and low-dose radiation (LDR group 29.4%. There was no statistically significant difference between these groups. Conclusions : In patients who undergo flap reconstruction and immediate postoperative radiotherapy following salvage procedures for RH&NC, flap coverage of defects in combination with brachytherapy remains a safe and effective means of providing stable soft tissue coverage.

PSYCHOSOCIAL MORBIDITY IN PATIENTS UNDERGOING MASTECTOMY FOR BREAST CANCER

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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.

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...

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

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.

Pre-morbid glycemic control modifies the interaction between acute hypoglycemia and mortality.

Science.gov (United States)

Egi, Moritoki; Krinsley, James S; Maurer, Paula; Amin, Devendra N; Kanazawa, Tomoyuki; Ghandi, Shruti; Morita, Kiyoshi; Bailey, Michael; Bellomo, Rinaldo

2016-04-01

To study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit (ICU) patients and subsequent hospital mortality in critically ill patients. We performed a multicenter, multinational, retrospective observational study of patients with available HbA1c levels within the 3-month period preceding ICU admission. We separated patients into three cohorts according to pre-admission HbA1c levels (<6.5, 6.5-7.9, ≥8.0%, respectively). Based on published data, we defined a glucose concentration of 40-69 mg/dL (2.2-3.8 mmol/L) as moderate hypoglycemia and <40 mg/dL (<2.2 mmol/L) as severe hypoglycemia. We applied logistic regression analysis to study the impact of pre-morbid glycemic control on the relationship between acute hypoglycemia and mortality. A total of 3084 critically ill patients were enrolled in the study. Among these patients, with increasing HbA1c levels from <6.5, to 6.5-7.9, and to ≥8.0%, the incidence of both moderate (3.8, 11.1, and 16.4%, respectively; p < 0.001) and severe (0.9, 2.5, and 4.3%, respectively; p < 0.001) hypoglycemia progressively and significantly increased. The relationship between the occurrence of hypoglycemic episodes in the ICU and in-hospital mortality was independently and significantly affected by pre-morbid glucose control, as assessed by adjusted odds ratio (OR) and 95 % confidence interval (CI) for hospital mortality: (1) moderate hypoglycemia: in patients with <6.5, 6.5-7.9, and ≥8.0 % of HbA1c level-OR 0.54, 95% CI 0.25-1.16; OR 0.82, 95 % CI 0.33-2.05; OR 3.42, 95 % CI 1.29-9.06, respectively; (2) severe hypoglycemia: OR 1.50, 95% CI 0.42-5.33; OR 1.59, 95% CI 0.36-7.10; OR 23.46, 95% CI 5.13-107.28, respectively (interaction with pre-morbid glucose control, p = 0.009). We found that the higher the glucose level before admission to the ICU, the higher the mortality risk when patients experienced hypoglycemia. In critically ill patients, chronic pre-morbid

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....

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.

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

Prevalence of ocular morbidity in rural population of eastern Uttar Pradesh, India

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Anupama Kumar

2016-09-01

Full Text Available Background: Ocular morbidity is a significant problem in rural areas of India as it remains undiagnosed and neglected. Aims & Objectives:  To determine the prevalence of ocular morbidity in the rural population of Barabanki, Uttar Pradesh. Material & Methods: A community based cross-sectional study was conducted in the villages around RHTC Satrikh of HIMS Barabanki. Ocular examination and vision testing was done among 812 people using ophthalmoscopic instruments. Information was collected using pre-tested questionnaire. Analysis was done using SPSS and appropriate Statistical tests. Results: Of the total 812 individuals interviewed, the prevalence of ocular morbidity was 41.3% (335 subjects had one or more ocular morbidity; with 88.8% elderly affected (age >65 years.   Myopia was the most common ocular morbidity 14.8%, followed by cataract (14.3% and hypermetropia (12.8%.  Allergic and infective conjunctivitis affected 5.8% and 3.9%, respectively.  The prevalence of Vitamin A deficiency disorder (including night blindness and bitot spots was 1.3%.  Higher ocular morbidity was present in houses with higher SES. Environmental conditions had no significant relation to ocular morbidity.  Conclusion: The prevalence of ocular diseases among the elderly was highest and requires prompt attention.  Myopia was the most common ocular morbidity having a prevalence of 14.8%, followed by cataract (14.3% and hypermetropia (12.8%.

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...

Delay in treatment of biliary disease during pregnancy increases morbidity and can be avoided with safe laparoscopic cholecystectomy.

Science.gov (United States)

Muench, J; Albrink, M; Serafini, F; Rosemurgy, A; Carey, L; Murr, M M

2001-06-01

Recent reports indicate that laparoscopic cholecystectomy in pregnancy is safe. The aim of this study was to evaluate whether delays in definitive treatment of symptomatic cholelithiasis increase morbidity. We reviewed the records of 16 women who underwent laparoscopic cholecystectomy during pregnancy between 1992 and 1999. Mean age was 24 +/- 5 years (mean +/- standard error). Symptom onset was during the first trimester in nine patients, second trimester in six patients, and third trimester in one patient. Patients had abdominal pain (93%), nausea (93%), emesis (80%), and fever (66%) for a median of 45 days (range 1-195 days) before cholecystectomy. Nine of 11 women who underwent cholecystectomy more than 5 weeks after onset of symptoms experienced recurrent attacks necessitating 15 hospital admissions and four emergency room visits. Moreover four women who developed symptoms in the first and second trimesters but whose operations were delayed to the third trimester had 11 hospital admissions and four emergency room visits; three of those four (75%) women developed premature contractions necessitating tocolytics. Cholecystectomy was completed laparoscopically in 14 women. There was no hospital infant or maternal mortality or morbidity. We recommend prompt laparoscopic cholecystectomy in pregnant women with symptomatic biliary disease because it is safe and it reduces hospital admissions and frequency of premature labor.

Psychiatric morbidity and non-participation in breast cancer screening.

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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.

in the assessment of the rate of disability in patients with morbid obesity – pilot study

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Krystyn Sosada

2017-06-01

Full Text Available Background. Due to the constant increase in the number of morbidly obese patients, an adequate tool for assessing the functioning and disability of these patients is being sought. The International Classification of Functioning, Disability and Health (IC F could be that tool. Objectives. The aim of this study is to examine the usefulness of the IC F scale in assessing the functioning of morbidly obese patients in two selected areas in reference to recognized scales. Material and methods . The study group included 76 patients with morbid obesity qualified for bariatric treatment. The ICF was applied to assess the function and limitations of each individual. Two domains of the IC F were selected: Body Functions and Structures and Activities and Participation. The usefulness of the IC F was compared to that of the Barthel and EPQ-R scales. Results . In morbidly obese patients, a correlation between motor functions and IC F and BMI, as well as age, was observed. A significant correlation was observed between BMI and psychomotor control, appropriateness and range of emotions experienced, age and amount of sleep, quality of sleep, memory retrieval and psychomotor functions. Women’s mental functions were significantly worse than those of men. In terms of interpersonal relations, a correlation between BMI and regulating behavior within interactions was observed. Conclusions . The IC F is a useful tool for the study and description of the functioning of patients with morbid obesity. The selected domains are described better than by the previously used Barthel scale. Women with morbid obesity tend to have more impaired mental functioning than morbidly obese men.

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

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

2017-08-01

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

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

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

2015-05-01

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

Racial Disparities in Asthma Morbidity Among Pediatric Patients Seeking Asthma Specialist Care.

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Mitchell, Stephanie J; Bilderback, Andrew L; Okelo, Sande O

2016-01-01

To elucidate whether there may be a higher morbidity threshold for African American versus white children to be referred to or seek asthma specialist care. Secondary analysis of registry data captured from children presenting for an initial routine outpatient asthma consultation. Parents completed standard survey instruments, and spirometry was conducted when deemed appropriate by the provider. Wilcoxon rank sum tests revealed that African American patients had been hospitalized twice as often and admitted to the intensive care unit or intubated significantly more than 1½ times more frequently than their white patient counterparts. t tests indicated African American patients' forced expiratory volume in 1 second (FEV1) percentage predicted was significantly worse than that of whites, but there was no significant difference for FEV1/forced vital capacity ratio. t tests suggested that African American patients had statistically worse asthma control than did white patients at the time of initial presentation to the pulmonologist, but there was no difference in the distribution of asthma severity categories. Multivariate regression models indicated that racial differences in parent education did not explain the disparities in asthma morbidity. African American patients had significantly worse asthma morbidity than their white counterparts, including higher rates of hospitalization and intensive care unit admission and poorer lung functioning. Given that receipt of asthma specialist care can improve those outcomes that are disparately experienced by African American children, methods of increasing their access to and use of asthma specialist care need to be developed. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

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

Arm morbidity following sentinel lymph node biopsy or axillary lymph node dissection: a study from the Danish Breast Cancer Cooperative Group

DEFF Research Database (Denmark)

Husted, Madsen A.; Haugaard, K.; Soerensen, J.

2008-01-01

BACKGROUND: Sentinel lymph node biopsy was implemented in the treatment of early breast cancer with the aim of reducing shoulder and arm morbidity. Relatively few prospective studies have been published where the morbidity was assessed by clinical examination. Very few studies have examined...... lymph node biopsy with node negative patients having a lymph node dissection of levels I and II of the axilla, we found significant increase in arm volume among the patients who had an axillary dissection. Only minor, but significant, differences in shoulder mobility were observed comparing the two...... groups of node negative patients. Highly significant difference was found comparing sensibility. Comparing the morbidity in node positive patients who had a one-step axillary dissection with patients having a two-step procedure (sentinel lymph node biopsy followed by delayed axillary dissection) revealed...

Psychiatric morbidity and people's experience of and response to social problems involving rights.

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Balmer, Nigel J; Pleasence, Pascoe; Buck, Alexy

2010-11-01

Psychiatric morbidity has been shown to be associated with the increased reporting of a range of social problems involving legal rights ('rights problems'). Using a validated measure of psychiatric morbidity, this paper explores the relationship between psychiatric morbidity and rights problems and discusses the implications for the delivery of health and legal services. New representative national survey data from the English and Welsh Civil and Social Justice Survey (CSJS) surveyed 3040 adults in 2007 to explore the relationship between GHQ-12 scores and the self reported incidence of and behaviour surrounding, rights problems. It was found that the prevalence of rights problems increased with psychiatric morbidity, as did the experience of multiple problems. It was also found the likelihood of inaction in the face of problems increased with psychiatric morbidity, while the likelihood of choosing to resolve problems without help decreased. Where advice was obtained, psychiatric morbidity was associated with a greater tendency to obtain a combination of 'legal' and 'general' support, rather than 'legal' advice alone. The results suggest that integrated and 'outreach' services are of particular importance to the effective support of those facing mental illness. © 2010 Blackwell Publishing Ltd.

The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

Science.gov (United States)

Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

2017-08-01

Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

Morbidity before and after the Diagnosis of Hyperthyroidism: A Nationwide Register-Based Study

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Brandt, Frans; Thvilum, Marianne; Almind, Dorthe; Christensen, Kaare; Green, Anders; Hegedüs, Laszlo; Brix, Thomas Heiberg

2013-01-01

Background 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. Methods Observational cohort study. From nationwide Danish health registers 2631 hyperthyroid singletons and 375 twin pairs discordant for hyperthyroidism were identified and followed for an average of 6 years (range 0–13). Data on the occurrence of cardiovascular diseases, lung diseases, diabetes mellitus, rheumatic diseases and malignant diseases was obtained by person-to-person record linkage with the National Danish Patient Register and/or the Danish National Prescription Registry (lung diseases and diabetes mellitus). Logistic and Cox regression models were used to assess the risk of morbidity before and after the diagnosis of hyperthyroidism, respectively. All Cox regression analyses were adjusted for the degree of co-morbidity preceding the diagnosis of hyperthyroidism, using the Charlson score. Results Hyperthyroid individuals had a significantly higher risk of being diagnosed with cardiovascular diseases (odds ratio (OR) 1.65; 95% confidence interval (CI): 1.45–1.87), lung diseases (OR 1.53; 95% CI: 1.29–1.60), and diabetes mellitus (OR 1.43, 95% CI: 1.20–1.72), but not with malignant diseases (OR 1.16, 95% CI: 0.99–1.36) prior to the diagnosis of hyperthyroidism. After the diagnosis of hyperthyroidism, subjects had a significantly higher risk of being diagnosed with cardiovascular diseases (hazard ratio (HR) 1.34; 95% CI: 1.15–1.56), lung diseases (HR 1.28; 95% CI: 1.10–1.49), and diabetes mellitus (HR 1.46; 95% CI: 1.16–1.84), but not with rheumatic diseases (HR 1.39, 95% CI: 0.92–2.09) or malignant diseases (HR 1.18, 95% CI 0.97–1.42). Conclusions We demonstrate a significantly increased

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...

A model for morbidity after lung resection in octogenarians.

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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

Children With Morbid Obesity Benefit Equally as Children With Overweight and Obesity From an Ongoing Care Program.

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Rijks, J M; Plat, J; Mensink, R P; Dorenbos, E; Buurman, W A; Vreugdenhil, A C E

2015-09-01

Despite stabilization of childhood overweight and obesity prevalence, there is a shift toward more severe degrees of obesity, which results in an increasing prevalence of children with morbid obesity. Prior studies demonstrated that lifestyle modification without ongoing treatment has only a modest and not sustainable effect in children with morbid obesity. This suggests that a chronic care model is necessary for long-term effects on weight management and health. This study aimed to evaluate the effect of an ongoing lifestyle intervention in children with morbid obesity in comparison with children with overweight and obesity. This was a nonrandomized prospective intervention study with 12- and 24-month followup at the Centre for Overweight Adolescent and Children's Healthcare. Children and adolescents (n = 100 females and 72 males) with overweight, obesity, or morbid obesity were given long-term, outpatient, tailored lifestyle intervention. Body mass index (BMI) z score was measured. In children with morbid obesity, 12- and 24-month interventions resulted in a decrease of BMI z score of -0.13 ± 0.25 (P = .001) and -0.23 ± 0.32 (P = .01) respectively, whereas weight status category improved to obese in 21% and 25% of the children. Cardiovascular risk parameters including serum total cholesterol, low-density lipoprotein cholesterol, glycosylated hemoglobin (HbA1c), and diastolic blood pressure significantly improved after 1-year intervention in the complete group. Most important, BMI z score as well as cardiovascular risk parameters improved to a similar degree in children with overweight, obesity, and morbid obesity. Children with overweight, obesity, and morbid obesity benefit equally from an ongoing, outpatient, tailored lifestyle intervention, and demonstrate significant weight loss and improvement of cardiovascular risk parameters.

Diabetic mothers and their newborn infants - rooming-in and neonatal morbidity

DEFF Research Database (Denmark)

Stage, E; Mathiesen, E R; Emmersen, P B

2010-01-01

As a result of increased neonatal morbidity, the infants of diabetic mothers have routinely been admitted to a neonatal special care unit (NSCU). We therefore investigated whether the offer of rooming-in diabetic mothers and their newborn infants has an effect on neonatal morbidity....

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

International Nuclear Information System (INIS)

Phillips, S.M.; Linette, G.P.; Doughty, B.L.; Byram, J.E.; Von Lichtenberg, F.

1987-01-01

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

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

Science.gov (United States)

Balicer, Ran; Bitterman, Haim; Shadmi, Efrat

2012-07-01

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

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.

Ocular morbidity prevalence among school children in Shimla, Himachal, North India.

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Gupta, Madhu; Gupta, Bhupinder P; Chauhan, Anil; Bhardwaj, Ashok

2009-01-01

Data on eye diseases among school children is not readily available. Considering the fact that one-third of India's blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important. To estimate the prevalence of ocular morbidity among school children of age 6-16 years. Government and private coeducational schools in urban area of Shimla. Cross-sectional. Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination. The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level. Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%), refractive errors 22% (CI=21.1-22.8%), squint 2.5% (CI=2.4-2.6%), color blindness 2.3% (CI=2.2-2.4%), vitamin A deficiency 1.8 % (CI=1.7-1.9%), conjunctivitis 0.8% (CI=0.79-0.81%). Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P< 0.5) more in government schools. A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders.

Reduction of halo pin site morbidity with a new pin care regimen.

Science.gov (United States)

Kazi, Hussain Anthony; de Matas, Marcus; Pillay, Robin

2013-06-01

A retrospective analysis of halo device associated morbidity over a 4-year period. To assess the impact of a new pin care regimen on halo pin site related morbidity. Halo orthosis treatment still has a role in cervical spine pathology, despite increasing possibilities of open surgical treatment. Published figures for pin site infection range from 12% to 22% with pin loosening from 7% to 50%. We assessed the outcome of a new pin care regimen on morbidity associated with halo spinal orthoses, using a retrospective cohort study from 2001 to 2004. In the last two years, our pin care regimen was changed. This involved pin site care using chlorhexidene & regular torque checking as part of a standard protocol. Previously, povidone iodine was used as skin preparation in theatre, followed by regular sterile saline cleansing when pin sites became encrusted with blood. There were 37 patients in the series, the median age was 49 (range, 22-83) and 20 patients were male. The overall infection rate prior to the new pin care protocol was 30% (n=6) and after the introduction, it dropped to 5.9% (n=1). This difference was statistically significant (p<0.05). Pin loosening occurred in one patient in the group prior to the formal pin care protocol (3%) and none thereafter. Reduced morbidity from halo use can be achieved with a modified pin cleansing and tightening regimen.

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

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.

Indications and Morbidity of Reoperative Thyroid Surgeries in a Military Hospital of Senegal

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Abdou Sy

2017-01-01

Full Text Available Objectives. To describe reoperative thyroid surgeries in our department. Study Design. Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal, over a period of eight and a half years. Methods. The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results. 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%. Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67% followed by neck hematoma (20%. Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33% followed by haemostasis (20%. During reoperation, we found active bleeding (20%, textiloma (6.67%, and fourth branchial cleft fistula (3.33%. The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion. We did not find an increased risk of postoperative morbidity after reintervention.

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

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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.

Likelihood Estimation of the Systemic Poison-Induced Morbidity in an Adult North Eastern Romanian Population

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Cătălina Lionte

2016-12-01

Full Text Available Purpose: Acute exposure to a systemic poison represents an important segment of medical emergencies. We aimed to estimate the likelihood of systemic poison-induced morbidity in a population admitted in a tertiary referral center from North East Romania, based on the determinant factors. Methodology: This was a prospective observational cohort study on adult poisoned patients. Demographic, clinical and laboratory characteristics were recorded in all patients. We analyzed three groups of patients, based on the associated morbidity during hospitalization. We identified significant differences between groups and predictors with significant effects on morbidity using multiple multinomial logistic regressions. ROC analysis proved that a combination of tests could improve diagnostic accuracy of poison-related morbidity. Main findings: Of the 180 patients included, aged 44.7 ± 17.2 years, 51.1% males, 49.4% had no poison-related morbidity, 28.9% developed a mild morbidity, and 21.7% had a severe morbidity, followed by death in 16 patients (8.9%. Multiple complications and deaths were recorded in patients aged 53.4 ± 17.6 years (p .001, with a lower Glasgow Coma Scale (GCS score upon admission and a significantly higher heart rate (101 ± 32 beats/min, p .011. Routine laboratory tests were significantly higher in patients with a recorded morbidity. Multiple logistic regression analysis demonstrated that a GCS < 8, a high white blood cells count (WBC, alanine aminotransferase (ALAT, myoglobin, glycemia and brain natriuretic peptide (BNP are strongly predictive for in-hospital severe morbidity. Originality: This is the first Romanian prospective study on adult poisoned patients, which identifies the factors responsible for in-hospital morbidity using logistic regression analyses, with resulting receiver operating characteristic (ROC curves. Conclusion: In acute intoxication with systemic poisons, we identified several clinical and laboratory variables

Epidemiology, morbidity, and treatment of overweight and obesity.

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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.

Minimization of heatwave morbidity and mortality.

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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.

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.

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

Is it possible to reduce the surgical mortality and morbidity of peptic ulcer perforations?

Science.gov (United States)

Hut, Adnan; Tatar, Cihad; Yıldırım, Doğan; Dönmez, Turgut; Ünal, Akın; Kocakuşak, Ahmet; Akıncı, Muzaffer

2017-01-01

Peptic ulcer perforation is a life-threatening situation requiring urgent surgical treatment. A novel vision in peptic ulcer perforation is necessary to fill the gaps created by antiulcer medication, aging of the patients, and presentation of resistant cases in our era. In this study, we aimed to share our findings regarding the effects of various risk factors and operative techniques on the mortality and morbidity of patients with peptic ulcer perforation. Data from 112 patients presenting at our Training and Research Hospital Emergency Surgery Department between January 2010 and December 2015 who were diagnosed with PUP through physical examination and laboratory and radiological tests and operated at the hospital have been retrospectively analyzed. Patients were divided into three groups based on morbidity (Group 1), mortality (Group 2), and no complication (Group 3). Of the 112 patients included in the study, morbidity was observed in 21 (18.8%), mortality in 11 (9.8%), and no complication was observed in 80 (71.4%), who were discharged with cure. The differences between group for the average values of the perforation diameter and American Society of Anesthesiologists, Acute Physiology and Chronic Health Evaluation II, and Mannheim Peritonitis Index scores were statistically significant (p<0.001 for each). The average values for the group with mortality were significantly higher than those of the other groups. In this study where we investigated risk factors for increased morbidity and mortality in PUPs, there was statistically significant difference between the average values for age, body mass index, perforation diameter, and Acute Physiology and Chronic Health Evaluation II and Mannheim Peritonitis Index scores among the three groups, whereas the amount of subdiaphragmatic free air did not differ.

Sociocultural variability in the Latino population: Age patterns and differences in morbidity among older US adults

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Catherine Garcia

2018-05-01

Full Text Available Background: The US Latino population is rapidly aging and becoming increasingly diverse with respect to nativity and national origin. Increased longevity along with medical advancements in treatment have resulted in a higher number of older Latinos living with morbidity. Therefore, there is a need to understand variability in Latino health among older adults. Objective: This paper documents mid- and late-life health differences in morbidity by race/ethnicity, nativity, and country of origin among adults aged 50 and older. Methods: We use data from the 2000-2015 National Health Interview Survey to calculate age- and gender-specific proportions based on reports of five morbidity measures: hypertension, heart disease, stroke, cancer, and diabetes among non-Latino Whites and seven Latino subgroups. Results: The foreign-born from Mexico, Cuba, and Central/South America, regardless of gender, exhibit an immigrant advantage for heart disease and cancer in comparison to non-Latino Whites across all age categories. Conversely, island-born Puerto Ricans are generally characterized with higher levels of morbidity. Similarly, US-born Puerto Ricans and Mexicans exhibit morbidity patterns indicative of their minority status. Latinos, regardless of gender, were more likely to report diabetes than non-Latino Whites. Hypertension and stroke have significant variability in age patterns among US- and foreign-born Latinos. Conclusions: Recognizing the importance of within-Latino heterogeneity in health is imperative if researchers are to implement social services and health policies aimed at ameliorating the risk of disease. Contribution: Considering intersectional ethnic, nativity, and country-of-origin characteristics among older Latinos is important to better understand the underlying causes of racial/ethnic disparities in morbidity across the life course.

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...

New morbidity of the young

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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

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

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

2015-11-01

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

Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity

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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

Prevalence of cardiovascular morbidities in Myanmar.

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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.

Colonoscopia: morbidade negligenciada Colonoscopy: neglected morbidity

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Fernanda Bellotti Formiga

2009-09-01

indication of exam was post-operative. Three exams were inconclusive due to bad colonic preparation. From the rest, 36,53% were normal exams and the majority of the abnormal ones were polyps, adenomatous predominantly. In relation of morbidities, 48,82% of patients present some morbidity, Arterial Hypertension as the most common. Only 22,94% of patients have been some adverse event with the intestinal preparation. Colonic preparation was clean on 65,88% of exams and when compared with morbidity there were significant relation. Other significant factor was the presence of endoscopic procedures (44,7% of exams, the majority polypectomies. Morbidity was 16,47%, with dehydration more prevalent. There was no mortality. CONCLUSION: Quality of intestinal preparation and endoscopic procedures are factors directed related with colonoscopy morbidity.

Recipient characteristics and morbidity and mortality after liver transplantation.

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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

Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity?

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Benedix, Frank; Benedix, Diana D; Knoll, Christian; Weiner, Rudolf; Bruns, Christiane; Manger, Thomas; Stroh, Christine

2014-10-01

Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern. Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered. Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate. The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.

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...

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.

Ocular morbidity prevalence among school children in Shimla, Himachal, North India

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Gupta Madhu

2009-01-01

Full Text Available Background: Data on eye diseases among school children is not readily available. Considering the fact that one-third of India′s blind lose their eyesight before the age of 20 years and many of them are under five when they become blind, early detection and treatment of ocular morbidity among children is important. Aim: To estimate the prevalence of ocular morbidity among school children of age 6-16 years. Settings: Government and private coeducational schools in urban area of Shimla. Design: Cross-sectional Materials and Methods: Government and private coeducational schools selected by stratified random sampling. About 1561 school children, studying in elementary through secondary class in these schools were examined from August 2001 to January 2002 in Shimla. A doctor did visual acuity and detailed ophthalmic examination. Statistical analysis: The Chi-square test was used to test differences in proportions. Differences were considered to be statistically significant at the 5% level. Results: Prevalence of ocular morbidity was 31.6% (CI=29.9-32.1%, refractive errors 22% (CI=21.1-22.8%, squint 2.5% (CI=2.4-2.6%, color blindness 2.3% (CI=2.2-2.4%, vitamin A deficiency 1.8 % (CI=1.7-1.9%, conjunctivitis 0.8% (CI=0.79-0.81%. Overall prevalence of ocular morbidity in government and private schools did not show any statistical significant difference. Prevalence of conjunctivitis was significantly (P< 0.5 more in government schools. Conclusion: A high prevalence of ocular morbidity among high-school children was observed. Refractive errors were the most common ocular disorders.

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...

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 ...

Psychiatric morbidity in perimenopausal women

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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.

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

Science.gov (United States)

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

2017-01-01

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

Relationship between Acute Phase Proteins and Serum Fatty Acid Composition in Morbidly Obese Patients

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Fernandes, Ricardo; Beserra, Bruna Teles Soares; Cunha, Raphael Salles Granato; Hillesheim, Elaine; Camargo, Carolina de Quadros; Pequito, Danielle Cristina Tonello; de Castro, Isabela Coelho; Fernandes, Luiz Cláudio; Nunes, Everson Araújo; Trindade, Erasmo Benício Santos de Moraes

2013-01-01

Background. Obesity is considered a low-grade inflammatory state and has been associated with increased acute phase proteins as well as changes in serum fatty acids. Few studies have assessed associations between acute phase proteins and serum fatty acids in morbidly obese patients. Objective. To investigate the relationship between acute phase proteins (C-Reactive Protein, Orosomucoid, and Albumin) and serum fatty acids in morbidly obese patients. Methods. Twenty-two morbidly obese patients were enrolled in this study. Biochemical and clinical data were obtained before bariatric surgery, and fatty acids measured in preoperative serum. Results. Orosomucoid was negatively correlated with lauric acid (P = 0.027) and eicosapentaenoic acid (EPA) (P = 0.037) and positively with arachidonic acid (AA) (P = 0.035), AA/EPA ratio (P = 0.005), and n-6/n-3 polyunsaturated fatty acids ratio (P = 0.035). C-Reactive Protein (CRP) was negatively correlated with lauric acid (P = 0.048), and both CRP and CRP/Albumin ratio were negatively correlated with margaric acid (P = 0.010, P = 0.008, resp.). Albumin was positively correlated with EPA (P = 0.027) and margaric acid (P = 0.008). Other correlations were not statistically significant. Conclusion. Our findings suggest that serum fatty acids are linked to acute phase proteins in morbidly obese patients. PMID:24167354

The impact of co-morbidity burden on appropriate implantable cardioverter defibrillator therapy and all-cause mortality

DEFF Research Database (Denmark)

Ruwald, Anne Christine; Vinther, Michael; Gislason, Gunnar H

2017-01-01

-ICD indication-related co-morbidities including atrial fibrillation, diabetes, chronic obstructive pulmonary disease, chronic renal disease, liver disease, cancer, chronic psychiatric disease, and peripheral and/or cerebrovascular disease, and divided into four groups (co-morbidity burden 0, 1, 2, and ≥3......). Through Cox models, we assessed the impact of co-morbidity burden on appropriate ICD therapy and mortality. Increasing co-morbidity burden was not associated with increased risk of appropriate therapy, irrespective of implant indication [all hazard ratios (HRs) 1.0-1.4, P = NS]. Using no co...

Modified Le Bag Pouch after Radical Cystectomy: Continence, Uro dynamic Results and Morbidity

International Nuclear Information System (INIS)

Nassar, O.A.H.

2010-01-01

To revaluate ileocolonic pouch for ortho-topic neobladder reconstruction, a cohort of patients with bladder cancer was selected to undergo radical cystectomy and modified Le Bag pouch. Evaluation concentrates on continence and associated morbidity observed on close follow-up. Patients and Methods: A total of 37 patients including 16 females with T2 3 bladder cancer (19 transitional, 15 : squamous and 3 adenocarcinoma) were treated by radical cystectomy and totally detubularized ileocolic neobladder. Post operative morbidity, continence and urodynamic studies were evaluated. Mean time to have full daytime continence was tested against age, gender, postoperative complications, technique of pouch creation either stapler or hand suture and adjuvant irradiation. Results: Cystometry 12 months post surgery showed 493 ml median capacity with basal and maximum reservoir median pressures of 16 and 38 cm H 2 O respectively. Uro-flowmetry had maximum voiding volume of 370ml, voiding time 45s and maximum flow rate of 11.6ml/s. Within the first 2 months post operative 44% were continent by day, 33% by night and 67% had stress incontinence. By 12 months post surgery 89% were continent by day, 73% by night and 27% had stress incontinence. Two years post surgery 94% were continent by day and 81 % had complete day and night control of uri-ne. Urinary leakage was the most frequent early complication (10.8%). Late complications were urinary tract infection (13.5%), metabolic acidosis (13.5%) and reflux (10.8%). Pouch over distension (5.4%) was consistent with bladder neck obstruction. Patient's gender and postoperative morbidity were statistically significant factors to increase the mean time to continence; whereas, age, use of stapler and adjuvant radiotherapy had no significant effect. Conclusion: Modified Le Bag pouch is a simple technique with adequate pouch capacity that offers excellent slowly progressing continence rates with minor morbidity rate. Post operative morbidity and

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

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

2015-01-01

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

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

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Milagros Ruiz

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

Morbidity Status Of Slum Dwelling Children Of Lucknow City

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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.

Sarcopenia is not associated with morbidity, mortality, or recurrence after esophagectomy for cancer.

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Siegal, Steve R; Dolan, James P; Dewey, Elizabeth N; Guimaraes, Alexander R; Tieu, Brandon H; Schipper, Paul H; Hunter, John G

2018-05-01

Sarcopenia is associated with increased morbidity and mortality in hepatic, pancreatic and colorectal cancer. We examined the effect of sarcopenia on morbidity, mortality, and recurrence after resection for esophageal cancer. Retrospective review of consecutive esophagectomies from 2010 to 2015. Computed tomography studies were analyzed for sarcopenia. Morbidity was analyzed using Fischer's test and survival data with Kaplan Meier curves. The sarcopenic group (n = 127) had lower BMI, later stage disease, and higher incidence of neoadjuvant radiation than those without sarcopenia (n = 46). There were no differences in morbidity or mortality between the groups (p = .75 and p = .31, respectively). Mean length of stay was similar (p = .70). Disease free and overall survival were similar (p = .20 and p = .39, respectively). There is no association between sarcopenia and increased morbidity, mortality and disease-free survival in patients undergoing esophagectomy for cancer. Sarcopenia in esophageal cancer may not portend worse outcomes that have been reported in other solid tumors. Copyright © 2018 Elsevier Inc. All rights reserved.

Radiologic findings and weight loss following gastroplasty for morbid obesity

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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.

Self-reported long-term cardiac morbidity in breast cancer patients: a retrospective cohort study in Germany (PASSOS Heart Study).

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Wollschläger, Daniel; Merzenich, Hiltrud; Schwentner, Lukas; Janni, Wolfgang; Wiegel, Thomas; Bartkowiak, Detlef; Wöckel, Achim; Schmidt, Marcus; Schmidberger, Heinz; Blettner, Maria

2017-06-01

Improved survival after locoregional breast cancer has increased the concern about late adverse effects after therapy. In particular, radiotherapy was identified as a risk factor for major cardiac events in women treated until the 1990s. While modern radiotherapy with computerized planning based on 3D-imaging can help spare organs at risk, heart exposure may remain substantial. In a retrospective cohort study of women treated for locoregional breast cancer, we investigated whether current radiotherapy is associated with an elevated long-term cardiac morbidity risk. The study included 11,982 women diagnosed with breast cancer in Germany in 1998-2008. After an individual mortality follow-up, 9338 questionnaires on cardiac events before or after therapy and on associated risk factors were sent out in 2014. Based on 4434 questionnaires from women with radiotherapy, we used Cox regression to analyze the association between self-reported cardiac morbidity and breast cancer laterality as a surrogate measure of radiation exposure. After a median follow-up of 8.3 years, there was no significant association of tumor laterality with cardiac morbidity in irradiated patients (458 events, hazard ratio for left-sided vs. right-sided tumors 1.07, 95% CI 0.89-1.29). Significant risk factors for any cardiac event included age at diagnosis, chemotherapy, hypertension, hypercholesteremia, and chronic kidney disease. For contemporary radiotherapy, we found no evidence for a significantly elevated cardiac morbidity risk in left-sided versus right-sided breast cancer. Possible reasons for failing to confirm earlier reports on increased risk include shorter follow-up, application of newer radiotherapy techniques, and improved health monitoring.

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

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

2016-01-01

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

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

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

2016-01-01

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

Impact of climate change on ozone-related mortality and morbidity in Europe.

Science.gov (United States)

Orru, Hans; Andersson, Camilla; Ebi, Kristie L; Langner, Joakim; Aström, Christofer; Forsberg, Bertil

2013-02-01

Ozone is a highly oxidative pollutant formed from precursors in the presence of sunlight, associated with respiratory morbidity and mortality. All else being equal, concentrations of ground-level ozone are expected to increase due to climate change. Ozone-related health impacts under a changing climate are projected using emission scenarios, models and epidemiological data. European ozone concentrations are modelled with the model of atmospheric transport and chemistry (MATCH)-RCA3 (50×50 km). Projections from two climate models, ECHAM4 and HadCM3, are applied under greenhouse gas emission scenarios A2 and A1B, respectively. We applied a European-wide exposure-response function to gridded population data and country-specific baseline mortality and morbidity. Comparing the current situation (1990-2009) with the baseline period (1961-1990), the largest increase in ozone-associated mortality and morbidity due to climate change (4-5%) have occurred in Belgium, Ireland, the Netherlands and the UK. Comparing the baseline period and the future periods (2021-2050 and 2041-2060), much larger increases in ozone-related mortality and morbidity are projected for Belgium, France, Spain and Portugal, with the impact being stronger using the climate projection from ECHAM4 (A2). However, in Nordic and Baltic countries the same magnitude of decrease is projected. The current study suggests that projected effects of climate change on ozone concentrations could differentially influence mortality and morbidity across Europe.

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences.

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van der Molen, Thys

2010-12-01

In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other co-morbidities not directly related to COPD are major causes of excess morbidity and mortality. This review sets out to explore the most frequent co-morbidities in COPD and their implications for treatment. Review of the literature on co-morbidities of COPD. Co-morbidities are frequent, but often remain undiagnosed in the COPD patient. In order to provide the best possible care for people with COPD, the physician should be aware of all potential co-morbidities that may arise, and the critical role that effective management of these co-morbidities can play in improving patient outcomes. Increased awareness of the potential co-morbidities of COPD, although potentially adding to the general practitioner's work burden, may provide insights into this difficult disease state and possibly improve each individual's prospects for effective management.

Morbidity and Mortality in 7,684 Women According to Personal Hair Dye Use

DEFF Research Database (Denmark)

Vedel-Krogh, Signe; Nielsen, Sune F; Schnohr, Peter

2016-01-01

BACKGROUND: Permanent hair dye contains aromatic amines which are carcinogenic, and can cause allergic skin reactions. In the long term personal use of hair dye might therefore influence both morbidity and mortality. OBJECTIVES: We tested the hypothesis that personal use of hair dye in women...... is associated with increased morbidity and mortality in the general population. METHODS: We included 7,684 women from the Copenhagen City Heart Study with information on the use of personal hair dye. We assessed the risk of cancer, skin diseases, other morbidities, and mortality during a median follow-up of 27...... years (range 0-37). RESULTS: The multivariable adjusted hazard ratio for malignant melanoma in women with versus without personal use of hair dye was 2.07 (95% confidence interval 1.25-3.42). There was no increased risk of other cancer types. For other skin diseases and other major causes of morbidity...

Lateral rectal shielding reduces late rectal morbidity after high dose three-dimensional conformal radiation therapy for clinically localized prostate cancer: further evidence for a dose effect

Energy Technology Data Exchange (ETDEWEB)

Lee, W Robert; Hanks, Gerald E; Hanlon, Alexandra; Schultheiss, Timothy E

1995-07-01

Purpose: Using conventional treatment methods for the treatment of clinically localized prostate cancer central axis doses must be limited to 65-70 Gy to prevent significant damage to nearby normal tissues. A fundamental hypothesis of three-dimensional conformal radiation therapy (3DCRT) is that, by defining the target organ(s) accurately in three dimensions, it is possible to deliver higher doses to the target without a significant increase in normal tissue complications. This study examines whether this hypothesis holds true and whether a simple modification of treatment technique can reduce the incidence of late rectal morbidity in patients with prostate cancer treated with 3DCRT to minimum planning target volume (PTV) doses of 71-75 Gy. Materials and Methods: 257 patients with clinically localized prostate cancer completed 3DCRT by December 31, 1993 and received a minimum PTV dose of 71-75 Gy. The median follow-up time was 22 months (range 4-67 months) and 98% of patients had followup of longer than 12 months. The calculated dose at the center of the prostate was <74 Gy in 19 patients, 74-76 Gy in 206 patients and >76 Gy in 32 patients. Late rectal morbidity was graded according to the LENT scoring system. Eighty-eight consecutive patients were treated with a rectal block added to the lateral fields. In these patients the posterior margin from the prostate to the block edge was reduced from the standard 15 mm to 7.5 mm for the final 10 Gy which reduced the dose to portions of the anterior rectal wall by approximately 4-5 Gy. Estimates of rates for rectal morbidity were determined by Kaplan-Meier actuarial analyses. Differences in morbidity percentages were evaluated by the Pearson chi square test. Results: Grade 2-3 rectal morbidity developed in 46 of 257 patients (18%) and in the majority of cases consisted of rectal bleeding. No patient has developed grade 4 or 5 rectal morbidity. The actuarial rate of grade 2-3 morbidity is 22% at 24 months and the median

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

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

2016-12-01

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

Psychiatric morbidity in patients with chronic whiplash-associated disorder.

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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.

Promoted relationship of cardiovascular morbidity with air pollutants in a typical Chinese urban area.

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Ling Tong

Full Text Available BACKGROUND: A large number of studies about effects of air pollutants on cardiovascular mortality have been conducted; however, those investigating association between air pollutants and cardiovascular morbidity are limited, especially in developing countries. METHODS: A time-series analysis on the short-term association between outdoor air pollutants including particulate matter (PM with diameters of 10 µm or less (PM10, sulfur dioxide (SO2 and nitrogen dioxide (NO2 and cardiovascular morbidity was conducted in Tianjin, China based on 4 years of daily data (2008-2011. The morbidity data were stratified by sex and age. The effects of air pollutants during the warm season and the cool season were also analyzed separately. RESULTS: Each increase in PM10, SO2, and NO2 by increments of 10 µg/m3 in a 2-day average concentration was associated with increases in the cardiovascular morbidity of 0.19% with 95 percent confidence interval (95% CI of 0.08-0.31, 0.43% with 95% CI of 0.03-0.84, and 0.52% with 95% CI of -0.09-1.13, respectively. The effects of air pollutants were more evident in the cool season than those in the warm season, females and the elderly were more vulnerable to outdoor air pollution. CONCLUSIONS: All estimated coefficients of PM10, SO2 and NO2 are positive but only the effect of SO2 implied statistical significance at the 5% level. Moreover, season, sex and age might modify health effects of outdoor air pollutants. This work may bring inspirations for formulating local air pollutant standards and social policy regarding cardiovascular health of residents.

Psychiatric Morbidity among Subjects with Leprosy and Albinism in South East Nigeria: A Comparative Study

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Attama, CM; Uwakwe, R; Onyeama, GM; Igwe, MN

2015-01-01

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 with leprosy and 100 with albinism were interviewed. Sociodemographic questionnaire and General Health Questionnaire (GHQ-28) assessed the sociodemographic characteristics and psychiatric morbidity, respectively. GHQ positive cases and 10% of noncases for each group were interviewed with Mini International Neuropsychiatric Inventory for specific ICD-10 diagnoses. Results: Fifty-five percent (55/100) subjects with leprosy were GHQ positive cases while 41% (41/100) with albinism were GHQ positive cases. The risk of developing psychiatric morbidity was significantly higher in subjects with leprosy than in subjects with albinism (OR = 1.76, CI = 1.00 – 3.08, P = 0.04). The prevalence of specific psychiatric disorders among subjects with leprosy were depression 49% (49/100), generalized anxiety disorder (GAD) 18% (18/100), alcohol/drug abuse 16% (16/100), whereas in albinism depression was 51% (51/100), GAD 27% (27/100), and alcohol/drug abuse 7% (7/100). Male, married and uneducated subjects with leprosy had significantly higher psychiatric morbidity than the male, married and uneducated subjects with albinism, respectively. Conclusion: Psychiatric morbidity was higher in subjects with leprosy than in subjects with albinism. Male, married and uneducated subjects with leprosy significantly had higher morbidity than male, married and uneducated subjects with albinism respectively. PMID:26097762

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

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

2012-07-01

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

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

Science.gov (United States)

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

2015-02-01

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

Prevalence of psychiatric and physical morbidity in an urban geriatric population

OpenAIRE

Seby, K.; Chaudhury, Suprakash; Chakraborty, Rudraprosad

2011-01-01

Background: With a rapidly increasing population of older aged people, epidemiological data regarding the prevalence of mental and physical illnesses are urgently required for proper health planning. However, there is a scarcity of such data from India. Aims: To study the frequency and pattern of psychiatric morbidity present and the association of physical illness with psychiatric morbidity in an elderly urban population. Settings and Design: Cross-sectional, epidemiological study. Materials...

Association of postpartum maternal morbidities with children's mental, psychomotor and language development in rural Bangladesh.

Science.gov (United States)

Hamadani, J D; Tofail, F; Hilaly, A; Mehrin, F; Shiraji, S; Banu, S; Huda, S N

2012-06-01

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

Primary tetralogy of Fallot repair: predictors of intensive care unit morbidity.

Science.gov (United States)

Egbe, Alexander C; Uppu, Santosh C; Mittnacht, Alexander J C; Joashi, Umesh; Ho, Deborah; Nguyen, Khanh; Srivastava, Shubhika

2014-09-01

Primary repair of tetralogy of Fallot has low surgical mortality, but some patients still experience significant postoperative morbidity. Our objectives were to review our institutional experience with primary tetralogy of Fallot repair, and identify predictors of intensive care unit morbidity. We reviewed all patients with tetralogy of Fallot who underwent primary repair in infancy from 2001 to 2012. Preoperative, operative, and postoperative demographic and morphologic data were analyzed. Intensive care unit morbidity was defined as prolonged intensive care unit stay (≥ 7 days) and/or prolonged duration of mechanical ventilation (≥ 48 h). 97 patients who underwent primary surgical repair during the study period were included in the study. The median age was 4.9 months (range 1-9 months) and the median weight was 5.3 kg (range 3.1-9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median intensive care unit stay was 6 days (range 2-21 days) and the median duration of mechanical ventilation was 19 h (range 0-136 h). Age and weight were independent predictors of intensive care unit stay, while surgical era predicted the duration of mechanical ventilation. Primary tetralogy of Fallot repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery were significant predictors of morbidity. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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

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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

Global Morbidity and Mortality of Leptospirosis: A Systematic Review.

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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

Psychological Morbidity in Students of Medical College and Science and Art College Students - A Comparative Study

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Priyanka Mahawar

2011-07-01

Full Text Available Considering the importance of quality of life in medical students we have conducted a cross sectional & descriptive study on screening of mental illness of 60 medical students of prefinal year and comparing it with 60 students of third year of Science and Art College. Students were selected via random sampling. GHQ-12 was used as a screening tool and after obtaining scores students were graded in 3 categories - individuals screened positive for psychological morbidity were of Grades 2 and 3 and individuals screened negative for psychological morbidity were of Grade 1 and they were compared according to college, gender & residence. Students screened positive for psychological morbidity as per GHQ-12 were found higher in medical college (87% as compared to Science and Art College (45% and a statistically significant association was found between psychological morbidity and medical students. Psychological morbidity was not significantly associated with residence and gender.

Associations between vascular co-morbidities and depression in insulin-naive diabetes patients

DEFF Research Database (Denmark)

Koopmans, B; Pouwer, F; de Bie, Rob A

2009-01-01

AIMS/HYPOTHESIS: The aim of the study was to determine the prevalence of depression in insulin-naive diabetes patients and to investigate the associations between different forms of vascular co-morbidity and depression. METHODS: Cross-sectional data were used from a primary-care sample of 1......,269 insulin-naive (i.e. not using insulin therapy) diabetes patients participating in the DIAZOB Primary Care Diabetes study. Demographics, vascular co-morbidities, clinical and lifestyle characteristics, and psychosocial factors were assessed. Depression symptoms were measured with the Edinburgh Depression.......2% vs 10.0%). Single vascular co-morbidities were not associated with increased rates of depression. The final model predicting depression included: having multiple vascular co-morbidities compared with none; having less social support; having experienced a recent stressful life event; female sex...

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

Independent risk factors of morbidity in penetrating colon injuries.

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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.

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.

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

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.

Measurement of subcutaneous adipose tissue blood flow in the morbidly obese using a laser Doppler velocimeter

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Klassen, Gerald A.; Paton, Barry E.; Maksym, Geoff; Janigan, David; Perey, Bernard

1992-08-01

Using a laser Doppler velocimeter (LDV) subcutaneous adipose tissue blood flow (AF) was recorded in the upright and supine positions in the upper and lower abdomen in 22 morbidly obese patients before gastroplasty. Age was 42 +/- 3 (mean +/- SEM), weight 135 +/- 7 kg, and body mass index (BMI) 51 +/- 3. Adipose flow expressed as mV was: supine, upper abdomen 647 +/- 23, lower abdomen 604 +/- 24; upright, upper abdomen 621 +/- 27, lower abdomen 607 +/- 29. AF was significantly more in the upper than lower abdomen (supine position) and AF was significantly lower in the lower abdomen upright than the upper abdomen supine. Regression analysis of age indicates that blood flow decreases in the lower abdomen so that in the supine position the difference between upper and lower abdomen AF increases. Similar analysis of BMI did not indicate significant trends. These data indicate that with morbid obesity there is lower tissue blood flow to the lower abdomen. This may explain why such patients may develop areas of painful ischemic necrosis in the dependent region of their anterior abdominal pannus.

Long-term associations of morbidity with air pollution: A catalog and synthesis.

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Lipfert, Frederick W

2018-01-01

I searched the National Institutes of Health MEDLINE database through January 2017 for long-term studies of morbidity and air pollution and cataloged them with respect to cardiovascular, respiratory, cancer, diabetes, hospitalization, neurological, and pregnancy-birth endpoints. The catalog is presented as an online appendix. Associations with PM 2.5 (particulate matter with an aerodynamic diameter pollutant significance (yes, no), duration of exposure, and publication date. I found statistically significant pollutant relationships (P pollutant effect estimates, 396 are statistically significant. Pollutant associations with cardiovascular indicators, lung function, respiratory symptoms, and low birth weight are more likely to be significant than with disease incidence, heart attacks, diabetes, or neurological endpoints. Elemental carbon (EC), traffic, and PM 2.5 are most likely to be significant for cardiovascular outcomes; TSP, EC, and ozone (O 3 ) for respiratory outcomes; NO 2 for neurological outcomes; and PM 10 for birth/pregnancy outcomes. Durations of exposure range from 60 days to 35 yr, but I found no consistent relationships with the likelihood of statistical significance. Respiratory studies began ca. 1975; studies of diabetes, cardiovascular, and neurological effects increased after about 2005. I found 72 studies of occupational air pollution exposures; 40 reported statistically significant adverse health effects, especially for respiratory conditions. I conclude that the aggregate of these studies supports the existence of nonlethal physiological effects of various pollutants, more so for non-life-threatening endpoints and for noncriteria pollutants (TSP, EC, PM 2.5 metals). However, most studies were cross-sectional analyses over limited time spans with no consideration of lag or disease latency. Further longitudinal studies are thus needed to investigate the progress of disease incidence in association with air pollution exposure. Relationships of

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

Science.gov (United States)

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

2014-05-14

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

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

Science.gov (United States)

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

2016-03-01

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

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....

The relationship between various measures of obesity and arterial stiffness in morbidly obese patients

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Røislien J

2011-02-01

Full Text Available Abstract Background Obesity is associated with increased risk of cardiovascular disease. Arterial stiffness assessed by carotid femoral pulse wave velocity (PWV is an independent predictor of cardiovascular morbidity and mortality. We aimed to investigate how various measures of body composition affect arterial stiffness. Methods This is an analysis of cross-sectional baseline data from a controlled clinical trial addressing changes in arterial stiffness after either surgery or lifestyle intervention in a population of morbidly obese patients. High-fidelity applanation tonometry (Millar®, Sphygmocor® was used to measure pulse wave velocity (PWV. Carotid femoral PWV is a direct measure of arterial stiffness and is considered to be the gold standard method. The Inbody 720 Body Composition Analyzer was used for bioelectrical impedance analysis (BIA. Spearman's correlation, independent samples t-test, chi-square tests, Fisher's exact test and multiple linear regression analyses were used as statistical methods. Results A total of 133 patients (79 women, with a mean (SD age of 43 (11 years were included in the study. Men had a significantly higher prevalence of obesity related comorbidities and significantly higher PWV, 9.1 (2.0 m/s vs. 8.1 (1.8 m/s, p = 0.003, than women. In the female group, PWV was positively correlated with WC, WHtR, BMI and visceral fat area. In the male group, PWV was negatively correlated with BMI. Multiple linear regression analysis showed that increasing BMI, WC, WHtR, visceral fat area and fat mass were independently associated with higher PWV in women, but not in men, after adjustment for age, hypertension and type 2 diabetes. Conclusion Most measures of general and abdominal obesity were predictors of arterial stiffness in female morbidly obese patients. Trial registration ClinicalTrials.gov Identifier NCT00626964

Risk factors for morbidity in infants undergoing tetralogy of fallot repair

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Alexander C Egbe

2014-01-01

Full Text Available Background: Primary repair of tetralogy of Fallot (TOF has low surgical mortality, but some patients still experience significant postoperative morbidity. Aim: To review our institutional experience with primary TOF repair, and identify predictors of intensive care unit (ICU morbidity. Settings and Design: Medium-sized pediatric cardiology program. Retrospective study. Subjects and Methods: We retrospectively reviewed all the patients with TOF and pulmonic stenosis who underwent primary repair in infancy at our institution from January 2001 to December 2012. Preoperative, operative, and postoperative demographic and morphologic data were analyzed. ICU morbidity was defined as prolonged ICU stay (≥7 days, and/or prolonged duration of mechanical ventilation (≥48 h. Statistical Analysis Used: Multiple logistic regression analysis. Results: Ninety-seven patients underwent primary surgical repair during the study period. The median age was 4.9 months (1-9 months and the median weight was 5.3 kg (3.1-9.8 kg. There was no early surgical mortality. Incidence of junctional ectopic tachycardia (JET and persistent complete heart block was 2 and 1%, respectively. The median length of ICU stay was 6 days (2-21 days and median duration of mechanical ventilation was 19 h (0-136 h. By multiple regression analysis, age and weight were independent predictors of length of ICU stay, while surgical era was an independent predictor of duration of mechanical ventilation. Conclusion: Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.

A Patient-Assessed Morbidity to Evaluate Outcome in Surgically Treated Vestibular Schwannomas.

Science.gov (United States)

Al-Shudifat, Abdul Rahman; Kahlon, Babar; Höglund, Peter; Lindberg, Sven; Magnusson, Måns; Siesjo, Peter

2016-10-01

Outcome after treatment of vestibular schwannomas can be evaluated by health providers as mortality, recurrence, performance, and morbidity. Because mortality and recurrence are rare events, evaluation has to focus on performance and morbidity. The latter has mostly been reported by health providers. In the present study, we validate 2 new scales for patient-assessed performance and morbidity in comparison with different outcome tools, such as quality of life (QOL) (European Quality of Life-5 dimensions [EQ-5D]), facial nerve score, and work capacity. There were 167 total patients in a retrospective (n = 90) and prospective (n = 50) cohort of surgically treated vestibular schwannomas. A new patient-assessed morbidity score (paMS), a patient-assessed Karnofsky score (paKPS), the patient-assessed QOL (EQ-5D) score, work capacity, and the House-Brackmann facial nerve score were used as outcome measures. Analysis of paMS components and their relation to other outcomes was done as uni- and multivariate analysis. All outcome instruments, except EQ-5D and paKPS, showed a significant decrease postoperatively. Only the facial nerve score (House-Brackmann facial nerve score) differed significantly between the retrospective and prospective cohorts. Out of the 16 components of the paMS, hearing dysfunction, tear dysfunction, balance dysfunction, and eye irritation were most often reported. Both paMS and EQ-5D correlated significantly with work capacity. Standard QOL and performance instruments may not be sufficiently sensitive or specific to measure outcome at the cohort level after surgical treatment of vestibular schwannomas. A morbidity score may yield more detailed information on symptoms that can be relevant for rehabilitation and occupational training after surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

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...

PREVALENCE OF OCCULT DEPRESSION IN ELDERLY WITH CHRONIC CO - MORBIDS

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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

High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants

Science.gov (United States)

Taha, Dalal K.; Kornhauser, Michael; Greenspan, Jay S.; Dysart, Kevin C.; Aghai, Zubair H.

2017-01-01

Objective To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP). Study design This is aretrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤ 1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis. Results A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P < .05). Similarly, adjusted odds of developing BPD or death was greater in the HFNC ± CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035–1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group. Conclusions In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants. PMID:27004673

High Flow Nasal Cannula Use Is Associated with Increased Morbidity and Length of Hospitalization in Extremely Low Birth Weight Infants.

Science.gov (United States)

Taha, Dalal K; Kornhauser, Michael; Greenspan, Jay S; Dysart, Kevin C; Aghai, Zubair H

2016-06-01

To determine differences in the incidence of bronchopulmonary dysplasia (BPD) or death in extremely low birth weight infants managed on high flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP). This is a retrospective data analysis from the Alere Neonatal Database for infants born between January 2008 and July 2013, weighing ≤1000 g at birth, and received HFNC or CPAP. Baseline demographics, clinical characteristics, and neonatal outcomes were compared between the infants who received CPAP and HFNC, or HFNC ± CPAP. Multivariable regression analysis was performed to control for the variables that differ in bivariate analysis. A total of 2487 infants met the inclusion criteria (941 CPAP group, 333 HFNC group, and 1546 HFNC ± CPAP group). The primary outcome of BPD or death was significantly higher in the HFNC group (56.8%) compared with the CPAP group (50.4%, P CPAP group compared with the CPAP group (OR 1.085, 95% CI 1.035-1.137, P = .001). The number of ventilator days, postnatal steroid use, days to room air, days to initiate or reach full oral feeds, and length of hospitalization were significantly higher in the HFNC and HFNC ± CPAP groups compared with the CPAP group. In this retrospective study, use of HFNC in extremely low birth weight infants is associated with a higher risk of death or BPD, increased respiratory morbidities, delayed oral feeding, and prolonged hospitalization. A large clinical trial is needed to evaluate long-term safety and efficacy of HFNC in preterm infants. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

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

Directory of Open Access Journals (Sweden)

Rikke Kildevæld Simonsen, MA

2016-03-01

Conclusion: Of 98% of all Danish transsexuals who officially underwent SRS from 1978 through 2010, one in three had somatic morbidity and approximately 1 in 10 had died. No significant differences in somatic morbidity or mortality were found between male-to-female and female-to-male individuals. Despite the young average age at death and the relatively larger number of individuals with somatic morbidity, the present study design does not allow for determination of casual relations between, for example, specific types of hormonal or surgical treatment received and somatic morbidity and mortality.

Resident-Specific Morbidity Reduced Following ACS NSQIP Data-Driven Quality Program.

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Turrentine, Florence E; Hanks, John B; Tracci, Megan C; Jones, R Scott; Schirmer, Bruce D; Smith, Philip W

2018-04-16

The Accreditation Council for Graduate Medical Education Milestone Project for general surgery provided a more robust method for developing and tracking residents' competence. This framework enhanced systematic and progressive development of residents' competencies in surgical quality improvement. A 22-month interactive, educational program based on resident-specific surgical outcomes data culminated in a quality improvement project for postgraduate year 4 surgery residents. Self- assessment, quality knowledge test, and resident-specific American College of Surgeons National Surgical Quality Improvement Program Quality In-Training Initiative morbidity were compared before and after the intervention. Quality in-training initiative morbidity decreased from 25% (82/325) to 18% (93/517), p = 0.015 despite residents performing more complex cases. All participants achieved level 4 competency (4/4) within the general surgery milestones improvement of care, practice-based learning and improvement competency. Institutional American College of Surgeons National Surgical Quality Improvement Program general surgery morbidity improved from the ninth to the sixth decile. Quality assessment and improvement self-assessment postintervention scores (M = 23.80, SD = 4.97) were not significantly higher than preintervention scores (M = 19.20, SD = 5.26), p = 0.061. Quality Improvement Knowledge Application Tool postintervention test scores (M = 17.4, SD = 4.88), were not significantly higher than pretest scores (M = 13.2, SD = 1.92), p = 0.12. Sharing validated resident-specific clinical data with participants was associated with improved surgical outcomes. Participating fourth year surgical residents achieved the highest score, a level 4, in the practice based learning and improvement competency of the improvement of care practice domain and observed significantly reduced surgical morbidity for cases in which they participated. Copyright © 2018. Published by Elsevier Inc.

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...

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)

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...

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

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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.

Diagnosis trajectories of prior multi-morbidity predict sepsis mortality

DEFF Research Database (Denmark)

Beck, Mette Kristina; Jensen, Anders Boeck; Nielsen, Annelaura Bach

2016-01-01

Sepsis affects millions of people every year, many of whom will die. In contrast to current survival prediction models for sepsis patients that primarily are based on data from within-admission clinical measurements (e.g. vital parameters and blood values), we aim for using the full disease histo...... of disease history to scoring based on within-admission clinical measurements emphasizing the value of long term data in novel patient scores that combine the two types of data.......Sepsis affects millions of people every year, many of whom will die. In contrast to current survival prediction models for sepsis patients that primarily are based on data from within-admission clinical measurements (e.g. vital parameters and blood values), we aim for using the full disease history...... recurrent trajectories of time-ordered co-morbidities had significantly increased sepsis mortality compared to those who did not follow a trajectory. We identified trajectories which significantly altered sepsis mortality, and found three major starting points in a combined temporal sepsis network: Alcohol...

Adiponectin but not leptin is involved in early hepatic disease in morbidly obese patients.

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Hindle, Anna Katharine; Edwards, Claire; Mendonsa, Alisha; Rojkind, Marcos; McCaffrey, Tim; Fu, Sidney; Brody, Fred

2010-07-01

Pathologic changes in the liver are common in morbidly obese patients, and insulin resistance may potentiate the progression of nonalcoholic steatohepatitis to fibrosis and cirrhosis. This study investigates the impact of leptin and adiponectin in morbidly obese diabetic and nondiabetic patients with regard to histopathologic changes in the liver. Thirty-seven morbidly obese patients who underwent bariatric surgery with liver biopsies were enrolled in the study. Fourteen were diabetic and 23 were nondiabetic. Intraoperative liver tissue was sent for histopathologic analysis and extraneous intraoperative tissue was snap-frozen in liquid nitrogen. Total RNA was extracted and RNA was reverse transcribed to cDNA. Real-time quantitative PCR was performed to determine relative gene expression levels. The data were analyzed using a logarithmic transformation and normalized by 18S ribosome expression. Student's t test was used for statistical analysis with p < or = 0.05 as significant. Adiponectin expression was downregulated 4.4-fold (p < or = 0.05) in liver samples with evidence of inflammation on pathology. When hepatic inflammation was evaluated separately, there were no statistically significant differences in adiponectin levels between the diabetic and nondiabetic patients. However, overall adiponectin levels in hepatic samples of diabetic patients were 3.8-fold higher than those of nondiabetic patients (p < or = 0.05). There were no significant differences in leptin levels regardless of hepatic pathology or diabetic status. This study illustrates that there is a downregulation of adiponectin in morbidly obese patients with inflammatory infiltrates in the liver. Variations in adiponectin levels could be an indicator of disease progression since inflammatory infiltrates are commonly associated with nonalcoholic steatohepatitis (NASH) in morbidly obese patients. Currently, we are using human myofibroblasts derived from livers of morbidly obese people to further

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 ...

Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid.

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Keet, Corinne A; Matsui, Elizabeth C; McCormack, Meredith C; Peng, Roger D

2017-09-01

Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the United States is not known. This study sought to examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma who are enrolled in Medicaid. Children aged 5 to 19 enrolled in Medicaid in 2009 to 2010 were included. Asthma was defined by at least 1 outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2-year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty, and race/ethnicity on rates of asthma outpatient visits, ED visits, and hospitalizations. This study included 16,860,716 children (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but it was associated with significantly more asthma-related ED visits and hospitalizations among those with asthma in crude analyses (risk ratio, 1.48; 95% CI, 1.24-1.36; and 1.97; 95% CI, 1.50-1.72, respectively) and when adjusted for race/ethnicity, age, and sex (adjusted risk ratio, 1.23; 95% CI, 1.08-1.15; and 1.62; 95% CI, 1.26-1.43). Residence in urban or poor areas and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma-related ED visits and hospitalizations. Residence in poor and urban areas is an important risk factor for asthma morbidity, but not for prevalence, among low-income US children. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

Furuta, Marie; Sandall, Jane; Bick, Debra

2012-11-10

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

Morbidity pattern and its sociodemographic determinants among elderly population of Raichur district, Karnataka, India

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Leyanna Susan George

2017-01-01

Full Text Available Context: India is an “aging nation” with 7.7% of its population being above 60 years of age. It has resulted in a rise of both physical and mental health morbidities. Aims: This study aimed to gather information regarding the morbidity pattern and its sociodemographic determinants among the elderly residing in the rural villages of Raichur, to understand the need for geriatric health-care facilities. Settings and Design: This community-based cross-sectional study was carried out in six rural villages of Raichur District, of which 230 elderly were selected randomly. Subjects and Methods: The data were collected using a questionnaire, clinical history, examination, and cross-checking of medical records. Statistical Analysis Used: Data were analyzed using Epi Info version-3.5.3. Results: The prevalence of morbidity was 91.7% with an average of 3/person. Females (58.9% had more morbidities than men (41.1%. The 3 most common morbidities were orthopedic (50.5%, cataract (50.4%, and respiratory (31.3%. 26.6% suffered from gastrointestinal morbidities while 23.9% had dental problems. 20.9% had hypertension with equal prevalence among both sexes. Only 17.4% were diabetics with majority being women. Central nervous system morbidities were 14.2% while 9.6% suffered from hearing loss and varicose veins. 8.2% had genitourinary-urinary morbidities and incontinence (1.7% was common among both sexes. Depression (71.1% and dermatological morbidities (4.7% were prevalent among women. Only 3.5% suffered from cardiac morbidity and 0.4% from cancer. Significant association was found between age and morbidity and also between socioeconomic class and morbidity pattern. Conclusions: Geriatric care should become an integral part of primary health care. Regular screening and Information, Education, and Communication activities need to be provided early in life for ensuring healthy aging.

Lack of effect of a moderate hypocaloric diet on visfatin levels in morbid obese patients: relationship with insulin resistance.

Science.gov (United States)

De Luis, D A; Gonzalez Sagrado, M; Conde, R; Aller, R; Izaola, O; Castro, M J; Romero, E

2010-12-01

The insulin-mimetic adipocytokine visfatin has been related to obesity. The aim of this study was to examine whether weight loss could change visfatin concentrations in morbidly obese patients and its relationship with insulin resistance. This was an interventional study analyzing a population of 41 morbidly obese patients. A biochemical analysis was realized before and after 2 months on a hypocaloric diet. After weight loss (average 4.41%), BMI, weight, fat mass, fat free mass, waist circumference, systolic blood pressure, serum glucose, total cholesterol, insulin and HOMA decreased. The serum concentrations of visfatin did not decrease (43.5 + 30.8 vs. 47.1 + 38.1 ng/ml). In the multivariate analysis visfatin concentrations as a dependent variable, only C reactive protein remained as an independent predictor in the model before diet, with an increase of 1.82 ng/ml (CI 95%: 0.02 - 3.61) basal visfatin concentrations with each increase of 1 mg/dl of CRP. Only HOMA remained as an independent predictor in the model after diet, with an increase of 11.4 ng/ml (CI 95%: 1.76 - 21.11) posttreatment visfatin concentrations with each increase of 1 unit HOMA. Weight reduction after a 2 months on a hypocaloric diet is not associated with a significant change in circulating visfatin in morbidly obese patients.

Significant Lactic Acidosis from Albuterol

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Deborah Diercks

2018-03-01

Full Text Available Lactic acidosis is a clinical entity that demands rapid assessment and treatment to prevent significant morbidity and mortality. With increased lactate use across many clinical scenarios, lactate values themselves cannot be interpreted apart from their appropriate clinical picture. The significance of Type B lactic acidosis is likely understated in the emergency department (ED. Given the mortality that sepsis confers, a serum lactate is an important screening study. That said, it is with extreme caution that we should interpret and react to the resultant elevated value. We report a patient with a significant lactic acidosis. Though he had a high lactate value, he did not require aggressive resuscitation. A different classification scheme for lactic acidosis that focuses on the bifurcation of the “dangerous” and “not dangerous” causes of lactic acidosis may be of benefit. In addition, this case is demonstrative of the potential overuse of lactates in the ED.

Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

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Tabasi Z.

2010-01-01

Full Text Available AbstractBackground and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003, analgesic consumption (P=0.0003 and time of operation (P=0.004. In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.Conclusion: The Findings showed that non-closure of peritoneal layers as a shorter and simpler procedure has no influence on increasing post cesarean morbidity. Therefore, due to maternal health promotion and early neonatal breastfeeding, non closure of peritoneal

Childhood Obesity: A Review of Increased Risk for Physical and Psychological Co-morbidities

Science.gov (United States)

Pulgarón, Elizabeth R.

2013-01-01

Background Worldwide estimates of childhood overweight/obesity are as high as 43 million and rates continue to increase each year. Researchers have taken interest in the childhood obesity epidemic and the impact of this condition across health domains. The consequences of childhood and adolescent obesity are extensive, including both medical and psychosocial comorbidities. Objective The purpose of this review was to consolidate and highlight the recent literature on the comorbidities associated with childhood obesity, both nationally and internationally. Methods PubMed and PsychINFO searches were conducted on childhood obesity and co-morbidities. Results The initial search of the terms “obesity” and “comorbidity” yielded over 5000 published articles. Limits were set to include studies on children and adolescents that were published in peer-reviewed journals from 2002 to 2012. These limits narrowed the search to 938. Review of those articles resulted in 79 that are included in this review. The major medical comorbidities associated with childhood obesity in the current literature are metabolic risk factors, asthma, and dental health issues. Major psychological comorbidities include internalizing and externalizing disorders, ADHD, and sleep problems. Conclusions The high prevalence rates of childhood obesity have resulted in extensive research in this area. Limitations to the current childhood obesity literature include differential definitions of weight status and cut off levels for metabolic risk factors across studies. Additionally, some results are based on self-report of diagnoses rather than chart reviews or physician diagnosis. Even so, there is substantial support for metabolic risk factors, internalizing disorders, ADHD, and decreased health related quality of life as comorbidities to obesity in childhood. Additional investigations on other diseases and conditions that may be associated with childhood obesity are warranted and intervention research

Influence of various factors on oncology morbidity in Republic of Belarus

International Nuclear Information System (INIS)

Novikova, N.M.

2001-01-01

Increasing of quantity diseases of cancers caused only Chernobyl accident aren't revealed. Because increase of the oncology morbidity in Republic of Belarus is stimulated and of radiation and both of environmental contamination carcinogen factor and of factors acted on organism level

Renal function during pregnancy may predict risk of future hospitalization due to atherosclerotic-related morbidity.

Science.gov (United States)

Wolak, Talya; Shoham-Vardi, Ilana; Sergienko, Ruslan; Sheiner, Eyal

2016-02-01

This study aims to examine whether renal function during pregnancy can serve as a surrogate marker for the risk of developing atherosclerotic-related morbidity. A case-control study, including women who gave birth at a tertiary referral medical centre during 2000-2012. This population was divided into cases of women who were subsequently hospitalized for atherosclerotic morbidity during the study period and age-matched controls. From the study population, we retrieved two groups: the creatinine (Cr) group: women who had at least one Cr measurement (4945 women) and the urea group: women who had at least one urea measurement (4932 women) during their pregnancies. In the Cr and urea group, there were 572 and 571 cases and 4373 and 4361 controls, respectively. The mean follow-up period in the Cr and urea group was 61.7 ± 37.0 and 57.3 ± 36.0 months, respectively. Cox proportional hazards models (controlling for confounders: gestational hypertension, gestational diabetes, obesity, maternal age, creatinine level (for urea), and gestational week) were used to estimate the adjusted hazard ratios (HR) for hospitalizations. A significant association was documented between renal function during pregnancy and long-term atherosclerotic morbidity. Multivariate analysis, showed that Cr at pregnancy index of ≥89 μmol/L was associated with a significant increased risk for hospitalization due to cardiovascular (CVS) events (adjusted HR = 2.91 CI 1.37-6.19 P = 0.005) and urea level ≤7 mmol/L was independently associated with reduced prevalence of CVS hospitalization (adjusted HR = 0.62 CI 0.57-0.86 P = 0.001). Renal function abnormality during pregnancy may reveal occult predisposition to atherosclerotic morbidity years after childbirth. © 2015 Asian Pacific Society of Nephrology.

Physical activity patterns in morbidly obese and normal-weight women.

Science.gov (United States)

Kwon, Soyang; Mohammad, Jamal; Samuel, Isaac

2011-01-01

To compare physical activity patterns between morbidly obese and normal-weight women. Daily physical activity of 18 morbidly obese and 7 normal-weight women aged 30-58 years was measured for 2 days using the Intelligent Device for Energy Expenditure and Activity (IDEEA) device. The obese group spent about 2 hr/day less standing and 30 min/day less walking than did the normal-weight group. Time spent standing (standing time) was positively associated with time spent walking (walking time). Age- and walking time-adjusted standing time did not differ according to weight status. Promoting standing may be a strategy to increase walking.

Elective caesarean section and respiratory morbidity in the term and near-term neonate

DEFF Research Database (Denmark)

Hansen, Anne Kirkeby; Wisborg, Kirsten; Uldbjerg, Niels

2007-01-01

in English on elective caesarean section and respiratory morbidity in the newborn. We included studies that compared elective caesarean section to vaginal or intended vaginal delivery, with clear definition of outcome measures and information about gestational age. RESULTS: Nine eligible studies were......-analysis with a pooled risk estimate because of a variety of methodological differences between the studies. The overall risk for respiratory morbidity, however, seemed to increase about 2 to 3 times, though some studies presented much higher risk estimates. A decreasing risk with increasing gestational age was shown...

Pressure sores significantly increase the risk of developing a Fournier's gangrene in patients with spinal cord injury.

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Backhaus, M; Citak, M; Tilkorn, D-J; Meindl, R; Schildhauer, T A; Fehmer, T

2011-11-01

Retrospective chart review. The aim of our study was to evaluate the mortality rate and further specific risk factors for Fournier's gangrene in patients with spinal cord injury (SCI). Division of Spinal Cord Injury, BG-University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Germany. All patients with a SCI and a Fournier's gangrene treated in our hospital were enrolled in this study. Following parameters were taken form patients medical records: age, type of SCI, cause of Fournier's gangrene, number of surgical debridements, length of hospital and intensive care unit stay, co morbidity factors and mortality rate. In addition, laboratory parameter including the laboratory risk indicator for necrotizing fasciitis (LRINEC) score and microbiological findings were analyzed. Clinical diagnosis was made via histological examination. A total of 16 male patients (15 paraplegic and one tetraplegic) were included in the study. In 81% of all cases, the origin of Fournier's gangrene was a pressure sore. The median LRINEC score on admission was 6.5. In the vast majority of cases, a polybacterial infection was found. No patient died during the hospital stay. The mean number of surgical debridements before soft tissue closure was 1.9 and after a mean time interval of 39.1 days wound closure was performed in all patients. Pressure sores significantly increase the risk of developing Fournier's gangrene in patients with SCI. We reported the results of our patients to increase awareness among physicians and training staff working with patients with a SCI in order to expedite the diagnosis.

Ageing in Puducherry, South India: An overview of morbidity profile

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Dharamvir Ranjan Bharati

2011-01-01

Full Text Available Background : The geriatric health problems are related to chronic disease as a result of increasing life expectancy. Objective : This study was undertaken to assess the health problems of the elderly in Puducherry. Materials and Methods : This cross-sectional study was carried out on 214 elderly persons from the age group of 60 years and above using a pre-designed and pre-tested questionnaire that addressed the disease magnitude in comparison with the socioeconomic variables. Results : Overall, 43% of the participants were diabetic, 47.7% hypertensive, 86% anemic and 68.2% visually impaired. All the morbidities were noted to be higher in the 70-79 years age group. Diabetes was significantly higher in participants from urban areas, with family history and increasing waist-hip ratio, but significantly lower in the below poverty line areas. Hypertension risk was significantly higher among females, among those leading sedentary life, those eating vegetarian food, those addicted to tobacco and with abdominal obesity. Anemia was significantly lower among urban vegetarians. Overweight and obese were noted in 31% of the participants, and were higher in females (87.5%. Rural residence, female sex, living in joint family, literacy, sedentary life style, decreasing per capita income and decreasing body mass index (BMI were significantly associated with visual impairment. Conclusion : This study highlights the burden of health problems of elderly individuals in South India.

Ageing in Puducherry, South India: An overview of morbidity profile.

Science.gov (United States)

Bharati, Dharamvir Ranjan; Pal, Ranabir; Rekha, R; Yamuna, T V; Kar, Sumit; Radjou, Angeline Neetha

2011-10-01

The geriatric health problems are related to chronic disease as a result of increasing life expectancy. This study was undertaken to assess the health problems of the elderly in Puducherry. This cross-sectional study was carried out on 214 elderly persons from the age group of 60 years and above using a pre-designed and pre-tested questionnaire that addressed the disease magnitude in comparison with the socioeconomic variables. Overall, 43% of the participants were diabetic, 47.7% hypertensive, 86% anemic and 68.2% visually impaired. All the morbidities were noted to be higher in the 70-79 years age group. Diabetes was significantly higher in participants from urban areas, with family history and increasing waist-hip ratio, but significantly lower in the below poverty line areas. Hypertension risk was significantly higher among females, among those leading sedentary life, those eating vegetarian food, those addicted to tobacco and with abdominal obesity. Anemia was significantly lower among urban vegetarians. Overweight and obese were noted in 31% of the participants, and were higher in females (87.5%). Rural residence, female sex, living in joint family, literacy, sedentary life style, decreasing per capita income and decreasing body mass index (BMI) were significantly associated with visual impairment. This study highlights the burden of health problems of elderly individuals in South India.

Vocal cord paralysis post patent ductus arteriosus ligation surgery: risks and co-morbidities.

Science.gov (United States)

Rukholm, Gavin; Farrokhyar, Forough; Reid, Diane

2012-11-01

1. To determine the prevalence of left vocal cord paralysis (LVCP) post patent ductus arteriosus (PDA) ligation at a Tertiary Care Centre. 2. To identify risk factors associated with LVCP. 3. To identify co-morbidities associated with LVCP. 4. To determine the frequency of pre- and post-operative nasopharyngolaryngoscopic (NPL) examination in this patient population. Retrospective chart review of all infants who underwent PDA ligation surgery at a tertiary care academic hospital between July 2003 and July 2010. Data on patient age, gender, weight, method of PDA ligation, and results of NPL scoping were collected, as well as patient co-morbidities post PDA ligation. One hundred and fifteen patients underwent PDA ligation surgery. Four patients were excluded due to bilateral vocal cord paralysis. Of the remaining 111 patients, nineteen patients (17.1%) were found to have LVCP. Low birth weight was identified as a significant risk factor for LVCP (p=0.002). Gastroesophageal reflux was identified as a significant co-morbidity associated with LVCP post PDA ligation (p=0.002). Only 0.9% of patients were scoped pre-operatively, and 27.9% were scoped postoperatively. LVCP is associated with multiple morbidities. The authors strongly recommend routine post-operative scoping of all patients post PDA ligation surgery, and preoperative scoping when possible. A prospective study is warranted, in order to confirm the prevalence of LVCP as well as risk factors and associated co-morbidities. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

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

Science.gov (United States)

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

2018-05-10

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

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

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

1995-11-01

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

Injustice at work and incidence of psychiatric morbidity: the Whitehall II study.

Science.gov (United States)

Ferrie, J E; Head, J; Shipley, M J; Vahtera, J; Marmot, M G; Kivimäki, M

2006-07-01

Previous studies of organisational justice and mental health have mostly examined women and have not examined the effect of change in justice. To examine effects of change in the treatment of employees by supervisors (the relational component of organisational justice) on minor psychiatric morbidity, using a cohort with a large proportion of men. Data are from the Whitehall II study, a prospective cohort of 10 308 white-collar British civil servants (3143 women and 6895 men, aged 35-55 at baseline) (Phase 1, 1985-88). Employment grade, relational justice, job demands, job control, social support at work, effort-reward imbalance, physical illness, and psychiatric morbidity were measured at baseline. Relational justice was assessed again at Phase 2 (1989-90). The outcome was cases of psychiatric morbidity by Phases 2 and 3 (1991-93) among participants case-free at baseline. In analyses adjusted for age, grade, and baseline physical illness, women and men exposed to low relational justice at Phase 1 were at higher risk of psychiatric morbidity by Phases 2 and 3. Adjustment for other psychosocial work characteristics, particularly social support and effort-reward imbalance, partially attenuated these associations. A favourable change in justice between Phase 1 and Phase 2 reduced the immediate risk (Phase 2) of psychiatric morbidity, while an adverse change increased the immediate and longer term risk (Phase 3). This study shows that unfair treatment by supervisors increases risk of poor mental health. It appears that the employers' duty to ensure that employees are treated fairly at work also has benefits for health.

The Impact of HIV on Maternal Morbidity in the Pre-HAART Era in Uganda

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Harriet Nuwagaba-Biribonwoha

2012-01-01

Results. Major morbidity was observed in 46/129 (36% and 104/390 (27% of the HIV-infected and HIV-uninfected women, respectively, who remained in followup. In the multivariable analysis, major morbidity was independently associated with HIV infection, adjusted odds ratio (AOR 1.7 (1.1 to 2.7, nulliparity (AOR 2.0 (1.3 to 3.0, and lack of, or minimal, formal education (AOR 2.1 (1.1 to 3.8. Conclusions. HIV was associated with a 70% increase in the odds of major maternal morbidity in these Ugandan mothers.

Mortality Risk from Co-Morbidities independent of Triple-Negative Breast Cancer Status: NCI SEER-based Cohort Analysis

Science.gov (United States)

Swede, Helen; Sarwar, Amna; Magge, Anil; Braithwaite, Dejana; Cook, Linda S.; Gregorio, David I.; Jones, Beth A; Hoag, Jessica; Gonsalves, Lou; Salner, Andrew; Zarfos, Kristen; Andemariam, Biree; Stevens, Richard G; Dugan, Alicia; Pensa, Mellisa; Brockmeyer, Jessica

2017-01-01

Purpose A comparatively high prevalence of co-morbidities among African-American/Blacks (AA/B) has been implicated in disparate survival in breast cancer. There is a scarcity of data, however, if this effect persists when accounting for the adverse triple-negative breast cancer (TNBC) subtype which occurs at three-fold the rate in AA/B compared to white breast cancer patients. Methods We reviewed charts of 214 white and 202 AA/B breast cancer patients in the NCI-SEER Connecticut Tumor Registry who were diagnosed in 2000-07. We employed the Charlson Co-Morbidity Index (CCI), a weighted 17-item tool to predict risk of death in cancer populations. Cox Survival Analyses estimated hazard ratios (HR) for all-cause mortality in relation to TNBC and CCI adjusting for clinicopathological factors. Results Among patients with SEER-Local Stage, TNBC increased the risk of death (HR=2.18, 95% CI 1.14-4.16), which was attenuated when the CCI score was added to the model (Adj. HR=1.50, 95% CI 0.74-3.01). Conversely, the adverse impact of the CCI score persisted when controlling for TNBC (Adj. HR=1.49, 95% CI 1.29-1.71; per one point increase). Similar patterns were observed in SEER-Regional Stage but estimated HRs were lower. AA/B patients with a CCI score of ≥3 had a significantly higher risk of death compared to AA/B patients without comorbidities (Adj. HR=5.65, 95% CI 2.90-11.02). A lower and non-significant effect was observed for whites with a CCI of ≥3 (Adj. HR=1.90, 95% CI 0.68-5.29). Conclusions Co-morbidities at diagnosis increase risk of death independent of TNBC, and AA/B patients may be disproportionately at risk. PMID:27000206

Bariatric Surgery vs. Conventional Dieting in the Morbidly Obese.

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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.

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...

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

Modifier 22 for acetabular fractures in morbidly obese patients: does it affect reimbursement?

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Bergin, Patrick F; Kneip, Christopher; Pierce, Christine; Hendrix, Stephen T; Porter, Scott E; Graves, Matthew L; Russell, George V

2014-11-01

Modifier 22 in the American Medical Association's Current Procedural Terminology (CPT®) book is a billing code for professional fees used to reflect an increased amount of skill, time, and work required to complete a procedure. There is little disagreement that using this code in the setting of surgery for acetabulum fractures in the obese patient is appropriate; however, to our knowledge, the degree to which payers value this additional level of complexity has not been determined. We asked whether (1) the use of Modifier 22 increased reimbursements in morbidly obese patients and (2) there was any difference between private insurance and governmental payer sources in treatment of Modifier 22. Over a 4-year period, we requested immediate adjudication with payers when using Modifier 22 for morbidly obese patients with acetabular fractures. We provided payers with evidence of the increased time and effort required in treating this population. Reimbursements were calculated for morbidly obese and nonmorbidly obese patients. Of the 346 patients we reviewed, 57 had additional CPT® codes or modifiers appended to their charges and were excluded, leaving 289 patients. Thirty (10%) were morbidly obese and were billed with Modifier 22. Fifty-three (18%) were insured by our largest private insurer and 69 (24%) by governmental programs (Medicare/Medicaid). Eight privately insured patients (15%) and seven governmentally insured patients (10%) were morbidly obese and were billed with Modifier 22. For our primary question, we compared reimbursement rates between patients with and without Modifier 22 for obesity within the 289 patients. We then performed the same comparison for the 53 privately insured patients and the 69 governmentally insured patients. Overall, there was no change in mean reimbursement when using Modifier 22 in morbidly obese patients, compared to nonmorbidly obese patients (USD 2126 versus USD 2149, p Level IV, economic and decision analyses. See Instructions

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...

Early Contralateral Shoulder-Arm Morbidity in Breast Cancer Patients Enrolled in a Randomized Trial of Post-Surgery Radiation Therapy

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Nele Adriaenssens

2012-01-01

Full Text Available Introduction Shoulder/arm morbidity is a common complication of breast cancer surgery and radiotherapy (RT, but little is known about acute contralateral morbidity. Methods Patients were 118 women enrolled in a RT trial. Arm volume and shoulder mobility were assessed before and 1–3 months after RT. Correlations and linear regression were used to analyze changes affecting ipsilateral and contralateral arms, and changes affecting relative interlimb differences (RID. Results Changes affecting one limb correlated with changes affecting the other limb. Arm volume between the two limbs correlated (R = 0.57. Risk factors were weight increase and axillary dissection. Contralateral and ipsilateral loss of abduction strongly correlated (R = 0.78. Changes of combined RID exceeding 10% affected the ipsilateral limb in 25% of patients, and the contralateral limb in 18%. Aromatase inhibitor therapy was significantly associated with contralateral loss of abduction. Conclusions High incidence of early contralateral arm morbidity warrants further investigations.

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...

Comparison of morbidity of elderly patients in August and November in Attica, Greece: a prospective study.

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Theocharis, G; Mavros, M N; Vouloumanou, E K; Peppas, G; Barbas, S G; Spiropoulos, T; Falagas, M E

2012-01-01

In our clinical practice, we have experienced a consistent increase in the morbidity of elderly in Greece during August. We prospectively analysed and compared the morbidity of elderly patients (≥ 75 years old) between August and November of the same year (2010), using data from the SOS Doctors (a network of physicians performing house call visits). We analysed data on 739 and 738 elderly patient house-calls in August and November, respectively. Overall, the most common diagnoses were cardiovascular (17.6%), musculoskeletal (10.7%), gastrointestinal (9.5%), respiratory (8.5%), renal/genitourinary (8.1%), and neurologic/psychiatric (7.9%). In August, patients were older (p elderly visited in August was significantly higher compared to November (5% vs. 2%, p bedridden status [adjusted odds ratio (OR) = 5.59, 95% confidence intervals (CI) 2.83-11.06, p bedridden status [OR = 1.45 (1.07, 1.97), p elderly patients was significantly higher in August compared with November, substantiating the informal term 'Augustitis' for the Greek elderly. Large, prospective population-based studies are warranted to further enlighten this field. © 2011 Blackwell Publishing Ltd.

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...

Short-term effects of air quality and thermal stress on non-accidental morbidity-a multivariate meta-analysis comparing indices to single measures.

Science.gov (United States)

Lokys, Hanna Leona; Junk, Jürgen; Krein, Andreas

2018-01-01

Air quality and thermal stress lead to increased morbidity and mortality. Studies on morbidity and the combined impact of air pollution and thermal stress are still rare. To analyse the correlations between air quality, thermal stress and morbidity, we used a two-stage meta-analysis approach, consisting of a Poisson regression model combined with distributed lag non-linear models (DLNMs) and a meta-analysis investigating whether latitude or the number of inhabitants significantly influence the correlations. We used air pollution, meteorological and hospital admission data from 28 administrative districts along a north-south gradient in western Germany from 2001 to 2011. We compared the performance of the single measure particulate matter (PM10) and air temperature to air quality indices (MPI and CAQI) and the biometeorological index UTCI. Based on the Akaike information criterion (AIC), it can be shown that using air quality indices instead of single measures increases the model strength. However, using the UTCI in the model does not give additional information compared to mean air temperature. Interaction between the 3-day average of air quality (max PM10, max CAQI and max MPI) and meteorology (mean air temperature and mean UTCI) did not improve the models. Using the mean air temperature, we found immediate effects of heat stress (RR 1.0013, 95% CI: 0.9983-1.0043) and by 3 days delayed effects of cold stress (RR: 1.0184, 95% CI: 1.0117-1.0252). The results for air quality differ between both air quality indices and PM10. CAQI and MPI show a delayed impact on morbidity with a maximum RR after 2 days (MPI 1.0058, 95% CI: 1.0013-1.0102; CAQI 1.0068, 95% CI: 1.0030-1.0107). Latitude was identified as a significant meta-variable, whereas the number of inhabitants was not significant in the model.

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...

Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders.

Science.gov (United States)

McCarthy, Jane; Hemmings, Colin; Kravariti, Eugenia; Dworzynski, Katharina; Holt, Geraldine; Bouras, Nick; Tsakanikos, Elias

2010-01-01

We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N=124) as compared to adults with ID only (N=562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD. Copyright 2009 Elsevier Ltd. All rights reserved.

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

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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.

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

Science.gov (United States)

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

2014-05-01

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

Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity

Energy Technology Data Exchange (ETDEWEB)

Carucci, Laura R. [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)]. E-mail: lcarucci@vcu.edu; Turner, Mary Ann [Department of Radiology, Virginia Commonwealth University Medical Center, P.O. Box 980615, Richmond, VA 23298-0615 (United States)

2005-03-01

Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies.

Radiologic evaluation following Roux-en-Y gastric bypass surgery for morbid obesity

International Nuclear Information System (INIS)

Carucci, Laura R.; Turner, Mary Ann

2005-01-01

Morbid obesity is an increasing health problem, and bariatric surgery is becoming a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical postoperative findings of the Roux-en-Y gastric bypass (RYGBP) procedure for morbid obesity on upper gastrointestinal (UGI) series are presented. An overview of the potential complications that may be diagnosed with contrast studies and computed tomography (CT) is provided in addition to a description of potential pitfalls in interpreting these studies

[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.

Co-morbidity and drug treatment in Alzheimer's disease. A cross sectional study of participants in the Dementia Study in Northern Norway

Directory of Open Access Journals (Sweden)

Halvorsen Dag S

2011-10-01

Full Text Available Abstract Background Inappropriate medical treatment of co-morbidities in Alzheimer's disease (AD is an increasing concern in geriatric medicine. The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway. Methods Setting: Nine rural municipalities with 70 000 inhabitants in Northern Norway. Participants: Participants with and without AD recruited in general practice and by population based screening. 187 participants with a recent diagnosis of AD were recruited among community dwellers. Of 791 respondents without cognitive symptoms, 500 were randomly selected and invited to further clinical and cognitive testing. The final control group consisted of 200 cognitively healthy individuals from the same municipalities. Demographic characteristics, data on medical history and current medication were included, and a physical and cognitive examination was performed. The statistical analyses were carried out by independent sample t-test, chi-square, ANCOVA and logistic regression. Results A co-morbidity score was significantly higher in AD participants compared to controls. The mean number of drugs was higher for AD participants compared to controls (5.1 ± 3.6 and 2.9 ± 2.4 respectively, p Conclusions AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls, even after adjustment for co-morbidity. An inappropriate use of anticholinergic and sedative drugs was identified, especially among nursing home residents with AD. The drug burden and the increased risk of adverse reactions among individuals suffering from AD need more attention from prescribing doctors.

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

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Simonsen, Rikke Kildevæld; Giraldi, Annamaria; Kristensen, Ellids

2016-01-01

the period of 1978–2010. Method: Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. Results: Overall, 27.9% of the sample were registered...... as deceased post-SRS with an average age of death of 53.5 years. Conclusions: No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric...... diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals...

Liver-related morbidity and mortality in patients with chronic hepatitis C and cirrhosis with and without sustained virologic response

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Hallager, Sofie; Ladelund, Steen; Christensen, Peer Brehm

2017-01-01

Background: Chronic hepatitis C (CHC) causes liver cirrhosis in 5%-20% of patients, leading to increased morbidity and mortality. This study aimed to estimate liver-related morbidity and mortality among patients with CHC and cirrhosis in Denmark with and without antiviral treatment and sustained......, and 233 of 519 treated patients achieved SVR. Alcohol overuse and hepatitis C virus genotype 3 were associated with an increased incidence rate (IR) of HCC, whereas diabetes and alcohol overuse were associated with increased IRs of decompensation. Achieving SVR reduced all-cause mortality (adjusted...... elevated in patients with alcohol overuse after SVR. Conclusion: Alcohol overuse, hepatitis C genotype 3, and diabetes were associated with liver-related morbidity in patients with CHC and cirrhosis. SVR markedly reduced liver-related morbidity and mortality; however, special attention to patients...

MANAGEMENT OF ENDOCRINE DISEASE: Morbidity in polycystic ovary syndrome.

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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.

Pattern of mental ill health morbidities following hysterectomy for benign gynaecological disorders among Nigerian women

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Morhason-Bello Imran O

2009-07-01

Full Text Available Abstract Objective to compare the pre and post hysterectomy mental ill health (MIH status and also, to determine whether there is any association with the surgical indication. Methodology An observational study, conducted among women scheduled for hysterectomy at the University College Hospital, Ibadan from January till June 2005. The MIH morbidities were assessed using a validated general health questionnaire (GHQ before and after the surgery by trained research assistant. The score of 4 and above was used as the cut off. Cross tabulations were performed to detect any association and also to compare pre and post hysterectomy mental health status. The level of statistical significance was set at P Results Of the 50 women recruited, 45 participated in the study. The age range of the participants was 35 to 63 years with a mean of 48.6 (SD = 0.6 years. Anxiety related disorder was present in 20 (44.4%, and depression in 3 (6.7% before hysterectomy. Post surgery, there was significant increase in those with anxiety by 6.8% and a reduction in the proportion of depressive illness by 2.3%. Uterine fibroid as a preoperative diagnosis, had significant association among those with anxiety related disorder (68.4% and depression (10.5%. Conclusion This study suggests that mental ill health may complicates hysterectomy for benign uterine pathology among Nigerian women, and that anxiety related disorders increases after operation with the highest proportion in those with clinical diagnosis of Uterine Fibroid. We recommend adequate preoperative counseling using properly trained psychologists when affordable to minimize these morbidities.

Work participation among the morbidly obese seeking bariatric surgery: an exploratory study from Norway.

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Hernæs, Ulrikke J V; Andersen, John R; Norheim, Ole F; Våge, Villy

2015-02-01

The aim of this study is to assess the rate of work participation and disability pension, and identify predictors for sickness absence and disability pension, among morbidly obese individuals. The data were collected from the Obesity Surgery Registry at Førde Central Hospital and consists of patients undergoing bariatric surgery between April 2001 and February 2013. Multivariate logistic regression was performed to identify predictors of sickness absence and disability pension. The sample consisted of 576 patients (63.9 % females) with a mean (range, SD) age of 41.7 (18-66, 10.6) and a mean body mass index (BMI) of 47.7 (32.5-80.8, 7.7). Patients working full- or part-time comprised 55.6 % of the sample and 29.7 % received a disability pension; only 46.4 % of the sample received an income from paid work without additional benefits. Having a BMI above 50, lower levels of education, and suffering from four or more comorbidities were significant predictors of sickness absence. Female gender, psychiatric disorders, lower levels of education, asthma, heart failure and suffering from four or more comorbidities were significant predictors of disability pension. The proportion of the work participation and disability pension among this morbidly obese population is of substantial concern, as work participation has proven important for the health-related quality of life. This, combined with the fact that these patients are significantly less educated than the general population, can potentially have grave socioeconomic consequences. Increased knowledge of obesity development and the work history of these patients are needed to implement policies that ensure increased rates of work participation.

Ankle fractures and alcoholism. The influence of alcoholism on morbidity after malleolar fractures

DEFF Research Database (Denmark)

Tønnesen, H; Pedersen, A; Jensen, M R

1991-01-01

diseases, age, weight, smoking habits, anaesthesia and duration of surgery. The alcohol abusers developed significantly more early complications, especially infections, after surgery. Follow-up at six, nine and 12 weeks after surgery also revealed a significantly higher morbidity among the alcoholics....

Full investigation of patients with polycystic ovary syndrome (PCOS) presenting to four different clinical specialties reveals significant differences and undiagnosed morbidity.

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Sivayoganathan, Dhakshana; Maruthini, Deivanayagam; Glanville, Julie M; Balen, Adam H

2011-12-01

This study aimed to compare the spectrum of polycystic ovary syndrome (PCOS) symptoms in patients from four different specialist clinics. A prospective cross-sectional observational study. The study was conducted at the infertility, gynaecology, endocrine and dermatology clinics at Leeds General Infirmary, U.K. Seventy women presenting with features of PCOS: 20 from infertility, 17 from gynaecology, 17 from dermatology and 16 from endocrine clinics. Participants were assessed for symptoms and signs of PCOS and underwent a full endocrine and metabolic profile and a pelvic ultrasound scan. All subjects had experienced menstrual problems, 81% were overweight, 86% had polycystic ovaries on ultrasound, 56% had hirsutism, 53% had acne, 23% had acanthosis nigricans, 16% had alopecia and 38% had previously undiagnosed impaired glucose tolerance (IGT) or diabetes. A significant difference between the four clinic groups existed with regard to menstrual patterns (p = 0.0234), frequency distribution of presenting symptoms and the percentages of patients with PCOS who had already been diagnosed as having PCOS (p = 0.0088). This study emphasizes the importance of understanding the full spectrum of PCOS as presented to different specialty clinics. Not only is the syndrome under diagnosed but also are the significant associated morbidities such as IGT and type 2 diabetes. Different specialists need to appreciate the spectrum of health problems for women with PCOS that may extend beyond the specific symptoms that precipitated the initial referral.

Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome.

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Glintborg, Dorte; Hass Rubin, Katrine; Nybo, Mads; Abrahamsen, Bo; Andersen, Marianne

2015-05-01

The prevalence of type 2 diabetes is increased in polycystic ovary syndrome (PCOS), but the prevalence of other diseases is not clarified. We aimed to investigate morbidity and medicine prescriptions in PCOS. A National Register-based study. Patients with PCOS (PCOS Denmark and an embedded cohort; PCOS Odense University Hospital (OUH)) and one control population. Premenopausal women with PCOS underwent clinical and biochemical examination (PCOS OUH, n=1217). PCOS Denmark (n=19 199) included women with PCOS in the Danish National Patient Register. Three age-matched controls were included per patient (n=57 483). Diagnosis codes and filled prescriptions. The mean (range) age of the PCOS Denmark group and controls was 30.6 (12-60) years. Patients in PCOS Denmark had higher Charlson index, higher prevalence of diabetes, dyslipidemia, and hypertension than controls. PCOS was associated with a two times increased risk of stroke and thrombosis, whereas the risk of other cardiovascular diseases was not increased. Thyroid disease, asthma, migraine, and depression were more prevalent in PCOS Denmark vs controls, whereas fractures were rarer. Infertility was increased in patients compared with controls, but the mean number of births was higher in PCOS. Medicine prescriptions within all diagnosis areas were significantly higher in PCOS patients than in controls.In PCOS OUH, polycystic ovaries (PCO) and irregular menses were associated with a more adverse metabolic risk profile, but individual Rotterdam criteria were not associated with cardiometabolic diagnoses. Cardiometabolic and psychiatric morbidity were significantly increased in a Danish population with PCOS. Medical diseases are frequent also in young patients with PCOS. © 2015 European Society of Endocrinology.

Co-morbid disorders and sexual risk behavior in Nigerian adolescents with bipolar disorder

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Bakare Muideen O

2009-06-01

Full Text Available Abstract Background Adolescent onset bipolar disorder often presents with co-morbid disorders of which psychoactive substance use disorders are notable. Mania symptoms and co-morbid psychoactive substance use disorders prone adolescents with bipolar disorder to impulsivity, impaired judgment, and risk taking behavior which often includes sexual risk behavior. There are dearth of information on pattern of co-morbid disorders and sexual risk behavior in adolescent onset bipolar disorder in Nigeria. This study assessed the prevalence and pattern of co-morbid disorders and determined associated factors of sexual risk behavior among adolescents with bipolar disorder. Methods Socio-demographic information was obtained from the adolescents using socio-demographic questionnaire. Clinical interview, physical examination and laboratory investigations were employed to establish co-morbid disorders in these adolescents during the outpatient follow up visits over a one year period. Results A total of forty six (46 adolescents with bipolar disorder were followed up over a one year period. Twenty two (47.8% of the adolescents had co-morbid disorders with cannabis use disorders, alcohol use disorders, conduct disorder with or without other psychoactive substance use accounting for 23.9%, 8.7%, 13.0% respectively and HIV infection, though a chance finding accounting for 2.2%. Twenty one (45.7% of the adolescents had positive history of sexual risk behavior, which was significantly associated with presence of co-morbid disorders (p = 0.003, level of religion activities in the adolescents (p = 0.000, and marital status of the parents (p = 0.021. Conclusion When planning interventions for children and adolescents with bipolar disorder, special attention may need to be focused on group of adolescents with co-morbid disorders and propensity towards impulsivity and sexual risk behavior. This may help in improving long term outcome in this group of adolescents.

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

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

2011-07-12

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

Total donor ischemic time: relationship to early hemodynamics and intensive care morbidity in pediatric cardiac transplant recipients.

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Rodrigues, Warren; Carr, Michelle; Ridout, Deborah; Carter, Katherine; Hulme, Sara Louise; Simmonds, Jacob; Elliott, Martin; Hoskote, Aparna; Burch, Michael; Brown, Kate L

2011-11-01

Single-center studies have failed to link modest increases in total donor ischemic time to mortality after pediatric orthotopic heart transplant. We aimed to investigate whether prolonged total donor ischemic time is linked to pediatric intensive care morbidity after orthotopic heart transplant. Retrospective cohort review. Tertiary pediatric transplant center in the United Kingdom. Ninety-three pediatric orthotopic heart transplants between 2002 and 2006. Total donor ischemic time was investigated for association with early post-orthotopic heart transplant hemodynamics and intensive care unit morbidities. Of 43 males and 50 females with median age 7.2 (interquartile range 2.2, 13.0) yrs, 62 (68%) had dilated cardiomyopathy, 20 (22%) had congenital heart disease, and nine (10%) had restrictive cardiomyopathy. The mean total donor ischemic time was 225.9 (sd 65.6) mins. In the first 24 hrs after orthotopic heart transplant, age-adjusted mean arterial blood pressure increased (p total donor ischemic time was significantly associated with lower mean arterial blood pressure (p care unit (p = .004), and longer post-orthotopic heart transplant stay in hospital (p = .02). Total donor ischemic time was not related to levels of mean pulmonary arterial pressure (p = .62), left atrial pressure (p = .38), or central venous pressure (p = .76) early after orthotopic heart transplant. Prolonged total donor ischemic time has an adverse effect on the donor organ, contributing to lower mean arterial blood pressure, as well as more prolonged ventilation and intensive care unit and hospital stays post-orthotopic heart transplant, reflecting increased morbidity.

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)....

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.

Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

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Z Tabasi

2012-05-01

Full Text Available

Background and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.

Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.

Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003, analgesic consumption (P=0.0003 and time of operation (P=0.004. In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.