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PubMed1998

Prevalence of co-morbidity in lung cancer patients and its relationship with treatment: a population-based study.

BACKGROUND: With the rising mean age of lung cancer patients, the number of patients with serious co-morbidity at diagnosis is increasing. As a result, co-morbidity may become an important factor in both the choice of treatment and survival. We studied the prevalence of serious co-morbidity among newly diagnosed lung cancer patients and its association with morphology, stage and treatment. PATIENTS: A total of 3864 lung cancer patients registered in the population-based registry of the Comprehensive Cancer Centre South between 1993 and 1995. RESULTS: During the study period, the mean age of patients was 67 years (range: 29-93). The most frequent concomitant diseases were cardiovascular diseases (23%), chronic obstructive pulmonary diseases (COPD) (22%) and other malignancies (15%). The prevalence of concomitant diseases was highest for men (60%), patients with squamous-cell carcinoma (64%) and those with a localised tumour (66%). The resection rate for patients < 70 years, with a localised non-small-cell lung tumour, was especially low for those with COPD (67%) or diabetes (64%) compared with patients without concomitant diseases (94%). The association between co-morbidity and chemotherapy for patients with small-cell lung cancer was limited. CONCLUSIONS: The prevalence of co-morbidity, especially cardiovascular diseases and COPD, among lung cancer patients is about twice as high as in the general population. Co-morbidity seems to be associated with earlier diagnosis of lung cancer, but it may also lead to less accurate staging and less aggressive treatment. Thus, prognosis is likely to be negatively influenced by co-morbidity.

Adult↗
PubMed1996

A model that predicts morbidity and mortality after coronary artery bypass graft surgery.

OBJECTIVES: This study was performed to develop a method for identifying patients at increased risk for morbidity or mortality after coronary artery bypass graft surgery. BACKGROUND: Postoperative morbidity is more common than mortality and is important because of its relation to cost. METHODS: Univariate and forward stepwise logistic regression analysis was used to retrospectively analyze a group of 1,567 consecutive patients who underwent bypass surgery between July 1991 and December 1992. We developed a model that predicted postoperative morbidity or mortality, or both, which was then prospectively validated in a group of 1,235 consecutive patients operated on between January 1993 and April 1994. A clinical risk score was derived from the model to simplify utilization of the data. RESULTS: The following factors, listed in decreasing order of significance, were found to be significant independent predictors: cardiogenic shock, emergency operation, catheterization-induced coronary artery closure, severe left ventricular dysfunction, increasing age, cardiomegaly, peripheral vascular disease, chronic renal insufficiency, diabetes mellitus, low body mass index, female gender, reoperation, anemia, cerebrovascular disease, chronic obstructive pulmonary disease, renal dysfunction, low albumin, elevated blood urea nitrogen, congestive heart failure and atrial arrhythmias. Observed morbidity and mortality for the validation group fell within the 95% confidence interval of that predicted by the model. Costs were closely related to the incidence of postoperative morbidity. CONCLUSIONS: Analysis of preoperative patient variables can predict patients at increased risk for morbidity or mortality, or both, after bypass surgery. Increased morbidity results in higher costs. Different strategies for high and low risk patients should be used in cost reduction efforts.

Aged↗
PubMed2000

Protein-energy malnutrition as a risk factor for increased morbidity in long-term hemodialysis patients.

This prospective nonintervention single-center study was undertaken to investigate the role of protein-energy malnutrition (PEM) as a risk factor for morbidity in patients on long-term hemodialysis. Thirty-seven patients from the renal unit of Tygerberg Hospital, Tygerberg, South Africa, were studied for a mean period of 26 months. Morbidity was the main outcome and was defined as the number of hospitalizations and days of hospitalization per patient per year. Investigations included 4-monthly determinations of interdialytic protein catabolic rate (PCR), dietary intake of protein and energy, blood levels of albumin and urea, lymphocyte count, adequacy of dialysis (Kt/V), body weight, intradialytic weight loss, fat mass (FM), fat-free mass (FFM), body mass index (BMI), and bone-free arm muscle area (BF-AMA). A PEM composite score was derived from postdialysis serum albumin, BF-AMA, FM, FFM, and BMI. All-cause morbidity as defined by number of hospitalizations (see text for other definitions of morbidity) showed a significant correlation with the mean and baseline PEM score (P <.01), and a negative correlation with predialysis and postdialysis serum albumin (P <.05) and age (P <.05). There was no significant relationship with PCR, percentage intradialytic weight loss, Kt/V, reuse of dialyzer, period on maintenance hemodialysis, sex, race, and type of dialyzer membrane. When "only infection-related" morbidity was considered, the factors that showed a significant correlation were the mean (P <. 001) and baseline PEM score (P <.01), and percentage intradialytic weight loss (P <.01). There was no significant deterioration in the nutritional status of patients followed up for at least 24 months. It is concluded that infection-related morbidity was associated most strongly with the PEM score and the percentage intradialytic weight loss. The results suggest that PEM is one of the important contributing factors to morbidity, possibly via an effect on the immune system and infection.

Adult↗
PubMed1997

Psychosocial sequelae of the 1989 Newcastle earthquake: II. Exposure and morbidity profiles during the first 2 years post-disaster.

BACKGROUND: A sample of 1089 Australian adults was selected for the longitudinal component of the Quake Impact Study, a 2-year, four-phase investigation of the psychosocial effects of the 1989 Newcastle earthquake. Of these, 845 (78%) completed a survey 6 months post-disaster as well as one or more of the three follow-up surveys. METHODS: The phase 1 survey was used to construct dimensional indices of self-reported exposure to threat the disruption and also to classify subjects by their membership of five 'at risk' groups (the injured; the displaced; owners of damaged small businesses; helpers in threat and non-threat situations). Psychological morbidity was assessed at each phase using the 12-item General Health Questionnaire (GHQ-12) and the Impact of Event Scale (IES). RESULTS: Psychological morbidity declined over time but tended to stabilize at about 12 months post-disaster for general morbidity (GHQ-12) and at about 18 months for trauma-related (IES) morbidity. Initial exposure to threat and/or disruption were significant predictors of psychological morbidity throughout the study and had superior predictive power to membership of the targeted 'at risk' groups. The degree of ongoing disruption and other life events since the earthquake were also significant predictors of morbidity. The injured reported the highest levels of distress, but there was a relative absence of morbidity among the helpers. CONCLUSIONS: Future disaster research should carefully assess the threat and disruption experiences of the survivors at the time of the event and monitor ongoing disruptions in the aftermath in order to target interventions more effectively.

Adult↗
PubMed2000

Variation in the gene for human peroxisome proliferator activated receptor gamma (PPARgamma) does not play a major role in the development of morbid obesity.

OBJECTIVE: To determine the extent of variation in the gene for peroxisome proliferator activated receptor gamma (PPARgamma) in patients with morbid obesity. SUBJECTS: Two hundred morbidly obese patients who underwent gastric banding surgery and 192 healthy blood donors. Diabetics were excluded. EXPERIMENTAL: The frequency of the P115Q and P12A variants in the PPARgamma gene was determined. Single strand conformational polymorphism (SSCP) analysis was performed on all exons, exon/intron boundaries and part of the promoter of the PPARgamma gene on a sub-group of 67 morbid obese patients. RESULTS: None of the morbid patients or the blood donors were carriers of the P115Q mutation. The frequency of the P12A polymorphism did not differ significantly between morbid obese patients and controls and there was no statistically significant association between P12A and BMI. Male blood donors who were A12A homozygotes had statistically significant higher serum leptin concentrations (P = 0.001). Mutation screening revealed that one patient had a T -->G transversion at -208 in the promoter of PPARgamma-2, two had silent mutations, one a T-->C transition in the third base of codon 144 and the other a C-->T transition in codon 297. The fourth patient had a CGC-->TGC transition in codon 316 resulting in the replacement of an arginine with a cysteine. This mutation was not found in any other morbidly obese patient. CONCLUSION: Variation in the PPARgamma gene is unlikely to play a major role in the development of morbid obesity.

Adult↗
PubMed2000

Prevalence and mechanisms of diurnal hypercapnia in a sample of morbidly obese subjects with obstructive sleep apnoea.

It is well known that obstructive sleep apnoea is especially frequent in the morbidly obese. In these subjects diurnal chronic hypercapnia, whose mechanism is still debated, may be present. Our study was performed to evaluate the prevalence and the mechanism of diurnal hypercapnia in the morbidly obese affected by obstructive sleep apnoea. From a population referred to our centre because of suspicion of sleep related breathing disorders, we selected 285 subjects without cardiopulmonary, neuromuscular or endocrinological diseases: 89 (36 M and 53 F, aged 46+/-13 years) had body mass index (BMI) > or = 40 kg m(-2) (MO group: morbidly obese subjects) and 196 (99 M and 97 F, aged 48+/-16 years) had BMI <40 kg m(-2) (NMO group: non-morbidly obese subjects). Then the MO group was divided into three subgroups: normocapnic subjects without obstructive sleep apnoea, normocapnic subjects with obstructive sleep apnoea, hypercapnic subjects with obstructive sleep apnoea; while we found no hypercapnic subject without obstructive sleep apnoea. All subjects underwent anthropometric evaluations and bioelectrical impedance analyses, respiratory function tests and arterial blood gas analysis, a modified version of the Sleep and Healthy questionnaire and a full night polysomnography. Our results showed that hypercapnia (PaCO2 > or = 45 mm Hg) associated with obstructive sleep apnoea [respiratory disturbance index (RDI) > or = 10 h(-1)] was found in 27% of the morbidly obese subjects, but only in 11% of the nonmorbidly obese ones (P<0.01). The comparison among the three subgroups, in which we divided the morbidly obese subjects, shows that those with hypercapnia and obstructive sleep apnoea had significantly more important ventilatory restrictive defects [forced vital capacity (FVC)% of pred 73.27+/-14 81 vs. 82.37+/-16.93 vs. 87.25+/-18.14 respectively; total lung capacity (TLC)% of pred 63.83+/-16.35 vs. 79.11+/-14.15 vs. 87.01+/-10.5], a significantly higher respiratory disturbance index (RDI 46.34+/-26.90 vs. 31.79+/-22.47 vs. 4.98+/-3.29) a longer total sleep time with oxyhaemoglobin saturation<90% [total sleeptime (TST)SaO2<90% 63.40+/-33.86 vs. 25.95+/-29.34 vs. 8.22+/-22.12] and a lower rapid eye movement (REM) stage (9.5+/-1.2 vs. 14.0+/-0.9 vs. 17.05+/-1.2) than normocapnic subjects with obstructive sleep apnoea or subjects without obstructive sleep apnoea. The best model to predict PaCO2 resulted from a combination of TSTSaO2<90% (r2 = 0.22, P<0.001), forced expiratory volume in 1 sec (FEV1)% of pred (r2 = 0.09, P<0.01), FVC % of pred (r2 = 0.075, P<0.01). In conclusion our study suggests that diurnal hypercapnia is frequently associated with obstructive sleep apnoea in the morbidly obese without chronic obstructive pulmonary disorder (COPD) and that ventilatory restriction and sleep related respiratory disturbances correlate to diurnal hypercapnia.

Adult↗
PubMed1998

The reliability and validity of doctor-recorded morbidity data in active data collection systems.

OBJECTIVE: To test the reliability and validity of morbidity data recorded by general practitioners (family physicians) on structured recording forms in active data collection systems. DESIGN: The consulting general practitioner recorded the problems managed at 347 video-taped doctor-patient contacts. Two observers independently viewed the video-tapes and completed a recording form for each. Problems were centrally coded, using the International Classification of Primary Care (ICPC). SETTING: Primary health care. MAIN OUTCOME MEASURES: Overall distribution of the morbidity; positive agreement regarding the morbidity managed at matched contacts at three levels of specificity (chapter; chapter-component; specific rubric); agreement taking negative agreement into account using Cohen's Kappa. RESULTS: Overall distribution of morbidity did not differ between observers. Positive mean agreement was 78.8% at chapter level, 69.6% at chapter-component, and 55.9% at rubric level. Kappa statistics showed agreement better than chance in all chapters, but failed to reach significance at rubric level in three chapters. CONCLUSION: Morbidity data actively collected by GPs provide a reliable overview of morbidity managed in general practice. At a specific contact the morbidity recorded is reliable and valid at chapter level, and in most cases, at chapter-component level. At rubric level variance between practitioners in labelling the problem calls into question the validity and reliability of the data.

Australia↗
PubMed2004

Hierarchical bivariate time series models: a combined analysis of the effects of particulate matter on morbidity and mortality.

In this paper we develop a hierarchical bivariate time series model to characterize the relationship between particulate matter less than 10 microns in aerodynamic diameter (PM10) and both mortality and hospital admissions for cardiovascular diseases. The model is applied to time series data on mortality and morbidity for 10 metropolitan areas in the United States from 1986 to 1993. We postulate that these time series should be related through a shared relationship with PM10. At the first stage of the hierarchy, we fit two seemingly unrelated Poisson regression models to produce city-specific estimates of the log relative rates of mortality and morbidity associated with exposure to PM10 within each location. The sample covariance matrix of the estimated log relative rates is obtained using a novel generalized estimating equation approach that takes into account the correlation between the mortality and morbidity time series. At the second stage, we combine information across locations to estimate overall log relative rates of mortality and morbidity and variation of the rates across cities. Using the combined information across the 10 locations we find that a 10 microg/m3 increase in average PM10 at the current day and previous day is associated with a 0.26% increase in mortality (95% posterior interval -0.37, 0.65), and a 0.71% increase in hospital admissions (95% posterior interval 0.35, 0.99). The log relative rates of mortality and morbidity have a similar degree of heterogeneity across cities: the posterior means of the between-city standard deviations of the mortality and morbidity air pollution effects are 0.42 (95% interval 0.05, 1.18), and 0.31 (95% interval 0.10, 0.89), respectively. The city-specific log relative rates of mortality and morbidity are estimated to have very low correlation, but the uncertainty in the correlation is very substantial (posterior mean = 0.20, 95% interval -0.89, 0.98). With the parameter estimates from the model, we can predict the hospitalization log relative rate for a new city for which hospitalization data are unavailable, using that city's estimated mortality relative rate. We illustrate this prediction using New York as an example.

Air Pollutants↗
PubMed1998

Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme.

BACKGROUND: This paper describes morbidity differences according to occupational class among men from France, Switzerland, (West) Germany, Great Britain, the Netherlands, Denmark, and Sweden. METHODS: Data were obtained from national health interview surveys or similar surveys between 1986 and 1992. Four morbidity indicators were included. For each country, individual-level data on occupation were recorded according to one standard occupational class scheme: the Erikson-Goldthorpe social class scheme. To describe the pattern of morbidity by occupational class, odds ratios (OR) were calculated for each class using the average of the population as a reference. The size of morbidity differences was summarized by the OR of two broad hierarchical classes. All OR were age-adjusted. RESULTS: For all countries, a lower than average prevalence of morbidity was found for higher and lower administrators and professionals as well as for routine nonmanual workers, whereas a higher than average prevalence was found for skilled and unskilled manual workers and agricultural workers. Self-employed men were in general healthier than the average population. The relative health of farmers differed between countries. The morbidity difference between manual workers and the class of administrators and professionals was approximately equally large in all countries. Consistently larger inequality estimates, with no or slightly overlapping confidence intervals, were only found for Sweden in comparison with Germany. CONCLUSIONS: Thanks to the use of a common social class scheme in each country, a high degree of comparability was achieved. The results suggest that morbidity differences according to occupational class among men are very similar between different European countries.

Adult↗
PubMed2001

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

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

Adult↗
PubMed2006

Morbidity after flap reconstruction of hypopharyngeal defects.

OBJECTIVES: Laryngopharyngeal reconstruction continues to challenge in terms of operative morbidity and optimal functional results. The primary aim of this study is to determine whether complications can be predicted on the basis of reconstruction in patients undergoing pharyngectomy for tumors involving the hypopharynx. In addition, we detail a reconstructive algorithm for management of partial and total laryngopharyngectomy defects. METHOD: A retrospective review was performed of 153 patients undergoing flap reconstruction for 85 partial and 68 circumferential pharyngectomies at a single institution over a 10-year period. There were 118 males and 35 females, the median age was 62 years, and mean follow up was 3.1 years. Pharyngectomy was performed for recurrence after radiotherapy in 80 patients and as primary surgery in 73. Free flap reconstruction was used in 42%, with 30 jejunal, 15 radial forearm, 11 anterolateral thigh, five rectus abdominis, and three gastro-omental flaps. Gastric transposition and pectoralis major pedicle flap was used in 14% and 44% of patients, respectively. Morbidity was analyzed according to extent of defect, regional versus free flap, enteric versus fasciocutaneous free flap reconstruction, and the effect of laparotomy. RESULTS: The total operative morbidity and mortality rate was 71% and 3%, respectively. The most common complications were hypocalcemia in 45%, pharyngocutaneous fistula in 33%, and wound complications in 25%. The late complication and stricture rate was 26% and 15%, respectively. On univariate analysis, circumferential defects were associated with increased total (P=.046) and flap-related morbidity (P=.037), hypocalcemia (P<.001), late complications (P=.003), and stricture (P=.009). Gastric transposition had increased total (P=.007), flap-related (P=.035), late complications (P=.034), and hypocalcemia (P=.001). Pharyngocutaneous fistula was increased in patients undergoing salvage pharyngectomy for radiation failure (P=.048) compared with primary surgery. On multivariate analysis, gastric transposition independently predicted for wound complications (P=.014) and fistula (P=.012). Circumferential defects predicted for flap-related morbidity (P=.030), hypocalcemia (P=.017), and late complications (P=.042). Tracheoesophageal speech was the method of voice restoration in 44% of patients. Oral diet was achieved in 93% of patients; however, 16% required gastrostomy tube feeds for either total or supplemental nutrition. CONCLUSION: The operative morbidity associated with pharyngeal reconstruction is substantial in terms of early and late complications. We were able to predict morbidity by defect extent and reconstruction type and initial treatment modality. Swallowing function is acceptable; however, less than half of the patients undergoing pharyngectomy had tracheoesophageal puncture voice restoration.

Adult↗
PubMed2006

Soluble CD40L in patients with morbid obesity: significant reduction after bariatric surgery.

BACKGROUND: Morbid obesity is associated with increased cardiovascular morbidity and mortality. Recent studies suggest that soluble CD40 Ligand (sCD40L) may play a pathogenetic role in atherothrombotic complications in cardiovascular disease as well as in inflammation and thrombosis. As morbid obesity is closely associated with chronic inflammation and insulin resistance (IR), it was of interest to study sCD40L in patients with morbid obesity before and after massive weight loss induced by bariatric surgery. PATIENTS AND METHODS: A total of 34 patients (mean age 40 +/- 12 years) with morbid obesity were studied before and 27.2 months after bariatric surgery. High sensitivity assays were used to measure concentrations of fasting sCD40L, monocyte-chemoattractant-protein-1 (MCP-1) and high-sensitive C-reactive protein (hsCRP). To investigate the associations of concentration changes of the parameters studied, differences between pre- and post-operative data were assessed and tested by univariate and multivariate linear regression analysis. RESULTS: After a mean weight loss of 33.1 +/- 18.4 kg, circulating sCD40L decreased significantly from (3.7 +/- 1.5) ng mL(-1) to (2.2 +/- 0.7) ng mL(-1), (P < 0.001). The decline in sCD40L after weight loss correlated significantly with the decrease in fasting insulin, 2-h insulin, HOMA insulin resistance (HOMA-IR), triglycerides, and the inflammatory biomarkers MCP-1 and hsCRP. CONCLUSIONS: We have shown a marked decrease in circulating sCD40L in association with an improvement of both insulin resistance and chronic inflammation in morbidly obese patients after bariatric surgery. As high sCD40L was shown to predict cardiovascular death and myocardial infarction in several prospective studies, the observed marked lowering of sCD40L might be of clinical relevance in morbidly obese patients.

Adult↗
PubMed1996

Acute morbidity of radiation therapy for prostate carcinoma.

The acute morbidity of high dose radiation therapy for carcinoma of the prostate in a group of 169 patients treated between February 1993 and April 1994 was examined. Morbidity was determined at the start of therapy, then weekly during therapy and at 1, 2, 3, 6 and 12 months after therapy. Morbidity was examined from the view of the treating doctor and the patients. Morbidity was found to peak at the end of the treatment. From the radiation oncologist's perspective, 80-85% of patients experienced significant bladder and bowel morbidity. The level of acute morbidity was acceptable and there was only one patient that was admitted to hospital for symptomatic control of his acute reaction. Recovery was practically complete after 3 months for both bladder and bowel morbidity. Fifty per cent of patients experienced dysuria, 75% perianal discomfort and 87% frequency at the end of the treatment. Most of the individual factors recovered following radiation but urinary frequency and perianal discomfort were the most persistent problems.

Acute Disease↗
PubMed2006

Morbidity and older persons' perceptions of the quality of their primary care.

OBJECTIVES: To quantify the association between community-dwelling older persons' level of morbidity and their perceptions of the quality of their primary care. DESIGN: Cross-sectional study. SETTING: Urban primary care practice. PARTICIPANTS: A sample of community-dwelling members of a capitated health plan aged 65 and older who were patients of four general internists in one urban practice (N = 120). MEASUREMENTS: The Johns Hopkins Adjusted Clinical Groups case-mix system was used to designate a person's aggregate morbidity level as moderate or high depending on the number and types of chronic conditions they had. Aspects of quality of primary care (physician-patient communication, interpersonal treatment, knowledge of patient, integration of care, and trust in physician) were assessed using the Primary Care Assessment Survey. RESULTS: All participants were classified as having moderate (41%) or high morbidity (59%). Older adults with high morbidity assigned a lower rating to all aspects of quality of primary care (physician-patient communication (P = .001), interpersonal treatment (P = .002), knowledge of patient (P = .03), integration of care (P = .004), and trust in physician (P = .01)) than those with moderate morbidity. The differences in quality of primary care remained statistically significant after controlling for age, sex, race, and education level. CONCLUSION: Older persons with multiple chronic conditions report inadequate quality of primary care and dissatisfaction with their care. Those with high morbidity levels experience poorer quality of primary care than those with moderate morbidity in all five aspects measured here.

Aged↗
PubMed1997

Survival prognostic factors and markers of morbidity in Spanish patients with systemic sclerosis.

OBJECTIVE: To identify survival prognostic factors and markers of morbidity among patients with systemic sclerosis (SSc). PATIENTS AND METHODS: The study included 72 patients diagnosed with SSc. According to the extent of skin involvement, three groups of patients were established: group 1, without sclerosis and with sclerosis of fingers and neck; group 2, with sclerosis of face and distal to elbows and knees; group 3, with generalised sclerosis including the trunk. All patients were included in a study protocol to determine visceral involvement. Cumulative survival after first symptom has been estimated according to the Kaplan-Meier method. The association between a hypothetical prognostic factor and cumulative survival after first symptom was assessed by log rank test. The association between a hypothetical risk factor and the prevalence of severe morbidity was assessed by the odds ratio. Multiple logistic regression models were used to identify the main predictors of severe morbidity. RESULTS: Survival was estimated to be 85% 10 years after first SSc symptom. Survival was higher among SSc patients with skin involvement distal to elbows and knees than among the rest of patients; a forced vital capacity (FVC) on spirometry lower than 70% of expected value was associated with a shorter survival, even after adjustment for diffuse SSc. Skin involvement proximal to elbows or knees was associated with a higher prevalence of severe morbidity (OR = 46.57; p < 0.001). According to a multiple logistic regression, severe morbidity was higher among patients with skin involvement proximal to knees or elbows (OR = 40.92; p < 0.001) or among patients with pulmonary hypertension detected by Doppler echocardiography (OR = 23.66 p < 0.001). CONCLUSIONS: In patients with SSc the extent of skin sclerosis was found to be a determining factor on the prognosis. According to skin sclerosis extent two main subsets of SSc patients with different survival incidence and degree of morbidity could be clearly established: limited SSc, formed by patients with no skin sclerosis or with sclerosis distal to elbows and knees and diffuse SSc, formed by patients with skin sclerosis distal and proximal to elbows and knees. Moreover, lung involvement (FVC < 70% on survival study and pulmonary hypertension on morbidity study) was an important and independent prognostic factor.

Adolescent↗
PubMed1995

Cost and determinants of morbidity from work related disabling injuries in Taiwan.

OBJECTIVES: To estimate the cost and determinants of morbidity from work related disabilities. METHODS: 114 people who lived in metropolitan Taipei and who had received disability compensation from the Labor Insurance Bureau from March to June, 1991 were randomly selected. There were 77 workers interviewed through a questionnaire that inquired about possible loss of productivity including the duration of morbidity, the ability to return to work, and any change in monthly income upon returning to work. RESULTS: The mean (SD) duration of a stay in hospital was 29 (39) days, median: 15 days. The average duration between discharge from the hospital and returning to work was 111 (146) days, median: 45 days. The main determinants of the duration of the stay in hospital were the number of stays in hospital and the severity of the injury. A multivariate linear analysis showed that old age and the severity of injury determine the durations of morbidity. An ordinal logistic regression analysis showed that the severity of injury, size of the factory, and age determined the magnitude of future productivity loss. Based on these models, it was estimated that the total duration of morbidity (in hospital and at home) due to occupational disability was 660,000 person-days each year. When the percentage of the decrease in income because of permanent disability was converted into a loss of work days, the annual morbidity costs were about 19,000-26,000 person-years between 1985-1990. CONCLUSION: The morbidity cost was about five times as high as the lump sum payment that a worker usually received for disability compensation. We conclude that morbidity cost should be evaluated carefully in the future for the establishment of accurate and fair disability compensation payments.

Accidents, Occupational↗
PubMed1992

Prevalence of mental disorder in 88 morbidly obese bariatric clinic patients.

OBJECTIVE: The authors sought to determine the association between mental disorder and morbid obesity, defined as weight at least 100% or 100 lb over ideal body weight. METHOD: Eighty-eight morbidly obese subjects who had come to a tertiary care center surgery clinic requesting vertical banded gastroplasty were systematically interviewed with the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and the Structured Interview for DSM-III Personality Disorders. A comparison group of 76 psychiatrically normal subjects who were matched in age (within 5 years) and gender to the morbidly obese subjects were also interviewed. RESULTS: Most of the morbidly obese subjects were women, were of low socioeconomic status as indicated by method of payment for medical care, weighed more than 300 lb, and had been obese for more than 14 years. The morbidly obese subjects were more likely than the comparison group to have a lifetime history of mood disorders, anxiety disorders, bulimia, and tobacco dependence. The morbidly obese subjects were also more likely to meet diagnostic criteria for one or more personality disorders. CONCLUSIONS: Substantial psychopathology exists in morbidly obese individuals requesting gastroplasty, a finding that has important clinical implications.

Comorbidity↗
PubMed2004

An audit of neonatal respiratory morbidity following elective caesarean section at term.

UNLABELLED: Studies have suggested that a reduction in neonatal respiratory morbidity may be achieved by delaying elective caesarean section until 39 weeks gestation. In 1997 staff at the Glasgow Royal Maternity Hospital were concerned at the level of neonatal respiratory morbidity following elective caesarean section. AIMS: To determine the extent of neonatal respiratory morbidity following elective caesarean section at term. Then to present the findings, make recommendations and perform a repeat analysis. METHODS: A retrospective analysis of all elective caesarean sections at term between October 1996 and October 1997 was performed. Labour ward, operating theatre and SCBU records were examined, followed by maternal and infant case note review. The gestational age at the time of caesarean section and any neonatal respiratory morbidity was recorded. The results were subsequently presented at a perinatal morbidity meeting and a recommendation made to delay elective sections until 39 weeks gestation. The audit was repeated between June 1999 and June 2000. RESULTS: The first cycle of the audit showed significantly lower rates of neonatal admissions with advancing gestation (p < 0.001). There was also a reduction in the number of infants requiring oxygen (p = 0.001), the number of infants requiring intensive care admission (p = 0.001) and ventilation (p = 0.003) with advancing gestation. In the second cycle of the audit there was a significant decrease in the number of elective caesarean sections performed prior to 39 weeks gestation (51% vs. 26%) (p < 0.0001). There were fewer neonatal admissions with respiratory morbidity between the two phases of the audit (26/292 vs. 18/327) (RR = 0.62, 95% CI 0.34-1.1). There was also a reduction in the number of infants requiring oxygen (RR = 0.5, 95% CI 0.23-1.06) the number of infants requiring intensive care admission (RR = 0.45, 95% CI 0.15-1.29) and the number of infants requiring ventilation (RR = 0.38, 95% CI 0.1-1.47). CONCLUSION: A reduction in neonatal respiratory morbidity can be achieved by delaying elective caesarean section until 39 weeks gestation.

Cesarean Section↗