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PubMed2005

An investigation of district spatial variations of childhood diarrhoea and fever morbidity in Malawi.

Although diarrhoea and malaria are among the leading causes of child mortality and morbidity in Sub-Saharan Africa, few detailed studies have examined the patterns and determinants of these ailments in the most affected communities. In this paper, we investigate the spatial distribution of observed diarrhoea and fever prevalence in Malawi using individual data for 10,185 children from the 2000 Malawi Demographic and Health survey. We highlight inequalities in child health by mapping the residual district spatial effects using a geo-additive probit model that simultaneously controls for spatial dependence in the data and potential nonlinear effects of covariates. The residual spatial effects were modelled via a Bayesian approach. For both ailments, we were able to identify a distinct district pattern of childhood morbidity. In particular, the results suggest that children living in the capital city are less affected by fever, although this is not true for diarrhoea, where some urban agglomerations are associated with a higher childhood morbidity risk. The spatial patterns emphasize the role of remoteness as well as climatic, environmental, and geographic factors on morbidity. The fixed effects show that for diarrhoea, the risk of child morbidity appears to be lower among infants who are exclusively breastfed than among those who are mixed-fed. However, exclusive breastfeeding was not found to have a protective effect on fever. An important socio-economic factor for both diarrhoea and fever morbidity was parental education, especially maternal educational attainment. Diarrhoea and fever were both observed to show an interesting association with child's age. We were able to discern the continuous worsening of the child morbidity up to 8-12 months of age. This deterioration set in right after birth and continues, more or less linearly until 8-12 months, before beginning to decline thereafter. Independent of other factors, a separate spatial process produces district inequalities in child's health.

Breast Feeding↗
PubMed1989

Morbidity and mortality of local failure after definitive therapy for prostate cancer.

We reviewed our experience with morbidity and mortality associated with clinical local failure after definitive therapy for adenocarcinoma of the prostate by interstitial 125iodine implantation, external beam radiation therapy or radical prostatectomy. Morbid complications included unilateral ureteral obstruction; bladder obstruction and/or incontinence requiring treatment by transurethral resection, or placement of a urethral or suprapubic catheter; hematuria requiring intervention for clot evacuation or fulguration, and perineal and/or pelvic pain. Lethal complications included bilateral ureteral obstruction or bowel obstruction. We treated 108 patients with 125iodine, 178 with external beam radiotherapy and 67 with radical prostatectomy. Clinical local failure occurred in 26 per cent of the 125iodine, 17 per cent of the external beam radiotherapy and 12 per cent of the radical prostatectomy groups. The total incidence of local failure with 125iodine was statistically higher than for radical prostatectomy. Stage C and poorly differentiated tumors were associated with a statistically higher incidence of local failure compared to lower stage and grade tumors. However, within each stage and grade there was no significant difference in local failure between treatment modalities. There was negligible morbidity or mortality secondary to local failure associated with stage A2, stage B1 or well differentiated tumors regardless of treatment modality. There was no difference in the morbidity and mortality between treatment modalities for stage C or poorly differentiated tumors. However, for stage B2 or moderately differentiated tumors treated by 125iodine implantation there was a statistically greater incidence of morbidity and mortality than that associated with external beam radiotherapy and radical prostatectomy. Our observations with regard to selection of primary monotherapy options that provide local tumor control are as follows. Stage A2, stage B1 or well differentiated tumors can be well controlled by all 3 treatment modalities. 125Iodine is associated with local failure-related morbidity and mortality for stage B2 or moderately differentiated tumors, which are statistically higher than for external beam radiotherapy and radical prostatectomy, and therefore, these latter are the preferred treatment. Radical prostatectomy and 125iodine for stage C tumors are associated with a trend to higher local failure, and related morbidity and mortality than is external beam radiotherapy. However, longer followup of the external beam radiotherapy series is necessary to confirm this observation.

Adenocarcinoma↗
PubMed2001

Morbidity of transrectal ultrasound-guided prostate needle biopsy in patients receiving immunosuppression.

OBJECTIVES: To prospectively evaluate the safety and early and delayed morbidity of transrectal ultrasound-guided needle biopsies in patients receiving immunosuppressive therapy. METHODS: A total of 59 men receiving immunosuppressive agents after kidney transplantation, with a total prostate-specific antigen level between 4 and 10 ng/mL, were prospectively studied. All patients underwent transrectal ultrasound (TRUS)-guided sextant biopsy plus two additional transition zone biopsies. Biopsy samples were also obtained from suspicious areas identified during TRUS and digital rectal examination. The immediate and delayed morbidity, patient satisfaction, and complication rates were recorded and compared with the morbidity data recorded in the same period from 1051 men in the European Prostate Cancer Detection study. RESULTS: Of the 59 subjects, prostate cancer was detected in 17; 231 men were found to have cancer in the European Prostate Cancer Detection Study. Minor or no discomfort was observed in 88% and 92% of the transplant recipients and controls, respectively (P = 0.31). Twelve percent versus 8% experienced pain. Early morbidity included rectal bleeding (2.6% versus 2.1%, P = 0.19), severe hematuria (0.8% versus 0.7%, P = 0.08), and moderate to severe vasovagal episodes (1.9% versus 2.8%, P = 0.04). Late morbidity included fever (3.5% versus 2.9%, P = 0.1), hematospermia (11.0% versus 9.8%, P = 0.1), recurrent mild hematuria (17.4% versus 16.8%, P = 0.08), persistent dysuria (6.4% versus 7.2%, P = 0.2), and urinary tract infections (12.0% versus 10.9%, P = 0.08). Major complications were rare: urosepsis (0% versus 0.1%). CONCLUSIONS: The results of our study demonstrate that TRUS-guided biopsy of the prostate is generally well tolerated, with minor morbidity, in patients receiving immunosuppression. No differences were noted in pain apprehension or early and delayed morbidity, suggesting that TRUS-guided biopsies can be performed safely in these patients.

Aged↗
PubMed1999

The effect on morbidity of variability in deprivation and population stability in England and Wales: an investigation at small-area level.

We seek to determine whether variability in deprivation at small area level, and population stability, influence standardised morbidity ratios in England and Wales. A regression analysis was conducted with data from the 1991 British Census, in order to explain variation in morbidity. Both an area deprivation score (for electoral wards) and the within-area variability of deprivation scores were examined as possible determinants of morbidity (self-reported, limiting, long-term illness). Particular attention was focused on a spatially-sensitive measure of the variability of deprivation scores within a wider 'locality'. There was a significant, positive relationship between age-standardised limiting, long-term illness and deprivation. The variation in area deprivation scores within the small areas themselves was also significant and positive. However, the variation in deprivation scores calculated for both an electoral ward and its contiguous neighbours (the locality) was slightly more significant. Areas with higher relative levels of in-migration also had significantly lower standardised morbidity ratios. Multivariate models showed that the deprivation score, the variation in deprivation scores for the broader locality, and the measure of migration, were all significant in combination. Residual analysis showed that many areas in London had lower levels of morbidity than expected, while electoral wards in the coal mining valleys of South Wales had higher levels than expected. We conclude that, for small areas (wards) in England and Wales, morbidity is related to deprivation, variation in deprivation within and surrounding each area, and the proportion of the population that are migrants. Variations in deprivation influence standardised morbidity rates, and policies which widen inequalities will influence health outcomes. Resource allocation based simply on measures of deprivation, which ignore population change within the area and variations in deprivation in the locality, may be inefficient.

Censuses↗
PubMed2002

American Brachytherapy Society recommendations for reporting morbidity after prostate brachytherapy.

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

Brachytherapy↗
PubMed2003

Is it necessary to eliminate the posterior dose margin in prostate brachytherapy to achieve an acceptably low risk of late rectal morbidity?

PURPOSE: The use of a posterior dose margin in (125)I prostate brachytherapy is controversial. The posterior margin is often eliminated to lower the risk of late rectal morbidity (Radiation Therapy Oncology Group protocols 9805 and P-0019), but this may compromise the posterior prostate dose coverage. The purpose of this work is to determine whether it is necessary to eliminate the posterior margin to achieve an acceptably low risk of Grade 2 (bleeding/ulceration) late rectal morbidity. METHODS AND MATERIALS: The present work is an extension of a previous study in which we reported the probability of Grade 2 late rectal morbidity (bleeding/ulceration) as a function of the maximum rectal dose. Here, we define the relationship between the maximum rectal dose and the width of the posterior dose margin. From this relationship, and the probability of late morbidity determined earlier, we assessed the probability of late rectal morbidity as a function of the width of the posterior dose margin. The present work was based on the preplans of 15 permanent (125)I prostate seed implants having volumes ranging from 19 to 78 cm(3). All used peripheral loading with (125)I sources in the range 0.35-0.45 mCi. The maximum rectal dose was taken to be the isodose line coincident with the posterior edge of the prostate. The maximum rectal dose and the corresponding margin width were determined from the isodose distribution. The sensitivity of the relationship between the maximum rectal dose and the margin width to the prostate volume, the seed density, and the distance of the most posterior seeds from the posterior edge of the prostate was investigated. RESULTS: The maximum rectal dose is directly proportional to the margin width. This relationship is relatively insensitive to the prostate volume and the seed density, but is sensitive to the location of the posterior seeds relative to the posterior edge of the gland. Moving the seeds from 5 mm to 3 mm from the edge typically increased the maximum rectal dose by 17%. With the posterior seeds 3 mm from the edge, the maximum rectal doses that corresponded to 1 mm, 2 mm, 3 mm, 4 mm, and 5 mm margins were 187 +/- 6 Gy, 222 +/- 8 Gy, 257 +/- 11 Gy, 292 +/- 14 Gy, and 327 +/- 17 Gy, respectively. The corresponding probabilities that a patient will experience late rectal morbidity are < or =1%, < or =2%, < or =3%, < or =5%, and < or =7%, respectively. CONCLUSIONS: Our results indicate that a 2-3-mm posterior dose margin can be used in prostate brachytherapy with a relatively low (2-3%) risk of Grade 2 (bleeding/ulceration) late rectal morbidity, provided the sources in the posterior row are implanted at least 3 mm from the edge of the prostate. A practical guideline is to keep the maximum rectal dose below 150% of the target dose.

Brachytherapy↗
PubMed2001

Utility of standardized exercise oximetry to predict cardiopulmonary morbidity after lung resection.

OBJECTIVES: To evaluate if desaturation, measured by finger oximetry on standardized exercise, accurately predicts cardiopulmonary morbidity after pulmonary resection. METHODS: A prospective observational clinical study was carried out on 81 consecutive lung carcinoma patients scheduled for pulmonary resection from February 1998 to March 1999. Finger oximetry was monitored during an incremental to exhaustion cycle exercise test. The presence or absence of desaturation (cut-off value 90%) during exercise was recorded. Other independent analyzed variables were: age of the patient (over 75th percentile), body-mass index (BMI) (over 75th percentile), presence of major cardiovascular co-morbidity, and calculated postoperative FEV1% (under 25th percentile) according to the number of resected segments (ppoFEV1%). Postoperative cardiopulmonary morbidity was the evaluated dependent outcome. Fisher's exact test and risk calculation on contingency tables were used for statistical analysis. RESULTS: A lobectomy was performed in 62 cases, a pneumonectomy was performed in 16 cases, and a segmentectomy was performed in three cases. The mean age of the patients was 63.6 years (SD 10.3, range 34-79 years, 75th percentile 72 years), the mean BMI was 25.9 (SD 4.9, range 16.9-38.1, 75th percentile 29.3), and the mean ppoFEV1% was 64.1 (SD 2016.1, range 29.5-98.6, 25th percentile 50.5). In 14 patients exercise desaturation was registered. Postoperative cardiopulmonary morbidity was presented in 32 cases (five deaths). No correlation was found between postoperative morbidity and any of the following variables: age of the patient, BMI, and co-morbidity. On univariate analysis only low ppoFEV1% (P<0.001) was associated with the outcome, so no multivariate analysis has been carried out. CONCLUSIONS: We have shown that desaturation during standardized exercise in this series adds no relevant information to predict postoperative cardiorespiratory morbidity after lung resection.

Adenocarcinoma↗
PubMed2004

Utility of preoperative scores for predicting morbidity after cholecystectomy in patients with cirrhosis.

BACKGROUND & AIMS: Patients with cirrhosis have an increased risk for cholelithiasis but also have an increased risk for morbidity and mortality after cholecystectomy. Current preoperative assessment of surgical risk is imprecise. Our aims were to identify preoperative factors that would accurately predict the risk for cholecystectomy in patients with cirrhosis. METHODS: Preoperative clinical or biochemical parameters were determined for 33 patients with cirrhosis and 31 age- and sex-matched patients without cirrhosis. The use of these parameters and of the Child-Pugh and model for end-stage liver disease (MELD) scores as preoperative predictors of outcome after surgery were assessed. RESULTS: There were 2 deaths, both in cirrhotic patients. The overall risk for morbidity or mortality was increased in cirrhotic patients compared with controls. Postoperative morbidity was significantly associated with preoperative increases of international normalized ratio >1.2, bilirubin >1.0 mg/dL, creatinine >1.4 mg/dL, and a decreased platelet count <150 x 10(3) /mL. The MELD and Child-Pugh scores accurately predicted postoperative morbidity, with an area under the curve of 0.938 and 0.839, respectively. A preoperative MELD score of > or =8 had a sensitivity of 91% and a specificity of 77% for predicting postoperative morbidity. Persons with a MELD score of > or =8 had increased 30- and 90-day global charges and increased blood product usage. CONCLUSIONS: Preoperative biochemical parameters, international normalized ratio, bilirubin, platelets, and creatinine can predict increased morbidity in cirrhotic patients. A MELD score of > or =8 identifies a group at high risk for postoperative morbidity after cholecystectomy.

Area Under Curve↗
PubMed1996

Lifetime co-morbidity of panic attacks and major depression in a population-based study: age of onset.

We used survival analysis to test for a suspected effect of co-morbidity of DIS/DSM-III major depression and panic attack on the age of onset of each of these disorders, in a population-based sample from four sites of the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program (N = 12668). The possible effects of gender and presence of a co-morbid disorder on age of onset of the single disorders were analysed using the Cox proportion-hazard-model, with gender as an explanatory variable and the co-morbid disorders as time-dependent covariates. The disorders begin earlier in life when they are co-morbid than when they occur singly. The occurrence of one disorder increases the chance of occurrence of the other. Females have from 1.7 to almost twice the risk for developing panic and/or depression compared with men, even if the co-morbid disorder precedes the index disorder or is lifetime co-morbid. These findings are compatible with a hypothesis of a higher severity in co-morbid cases when compared with a single disorder.

Adolescent↗
PubMed2001

Treatment resistant depression and axis I co-morbidity.

BACKGROUND: Treatment resistant depression (TRD) continues to present a formidable challenge to clinicians, accounts for over half of the annual costs associated with treatment for depression and causes great frustration to patients. Although there have been studies attempting to define TRD, little information is available as to the cause of TRD. One suggestion is that patients with TRD have a greater frequency of co-morbid psychiatric disorders, which explains their resistance to standard antidepressant treatments. The objective of this study was to compare the co-morbidity of Axis I disorders between a sample of TRD patients and a sample of non-TRD patients. METHODS: TRD and non-TRD patients, recruited from two separate antidepressant treatment studies, were assessed for Axis I co-morbidity using the SCID-P for the DSM-III-R. Patients for the two samples were then matched for baseline HAM-D-17 total score and gender. RESULTS: Results reveal that non-TRD patients had a higher rate of both lifetime and current generalized anxiety disorder co-morbidity than did the TRD patients. No other statistically significant differences in Axis I co-morbidity were found. CONCLUSIONS: These findings do not support the idea that current or lifetime Axis I co-morbidity is more common in TRD than non-TRD patients. In fact, the only statistical difference showed non-TRD patients with higher co-morbidity rates.

Adolescent↗
PubMed2002

Inter-episodic morbidity and drop-out under carbamazepine and lithium in the maintenance treatment of bipolar disorder.

BACKGROUND: Evaluation of mood-stabilizing treatment strategies usually focuses on their efficacy in preventing recurrences. The aim of this study is to supplement evaluation by two important aspects: inter-episodic morbidity and drop-out. METHODS: Using a global outcome measure, response to prophylactic lithium and carbamazepine was evaluated in N = 171 bipolar patients (DSM-IV) participating in a randomized controlled trial with an observation period of 2 1/2 years (MAP study). RESULTS: The rates of re-hospitalization were similar for both treatments. However, the percentage of good clinical response (i.e. patients with a low score of inter-episodic morbidity and without both re-hospitalization and drop-out during the observation period) was significantly higher in patients randomized to lithium (40% v. 24%). This superiority of lithium resulted essentially from a lower drop-out rate in patients without re-hospitalization (17% v. 42%). Regarding severity of inter-episodic morbidity, no clear difference between the drugs was found. For both medications the predominant symptomatology was minor depressive (but not manic, mixed or schizoaffective) symptoms. In the lithium group, inter-episodic morbidity in patients without re-hospitalization significantly decreased during the first 10 months and remained on the lower level for the rest of the observation period. For carbamazepine, reduction of inter-episodic morbidity over time did not reach statistical significance. Inter-episodic morbidity was significantly related to drop-out and to re-hospitalization for both medications. CONCLUSION: Taking inter-episodic morbidity, drop-out and re-hospitalization into consideration, the response rate in bipolar patients (DSM-IV) was higher for prophylactic lithium than for carbamazepine. The global outcome parameter used appears to be a valuable measure of clinical response to mood stabilizing drugs.

Adult↗
PubMed2004

Neuroticism, a central link between somatic and psychiatric morbidity: path analysis of prospective data.

BACKGROUND: Neuroticism and somatic complaints are linked, and the aim of this study is to disentangle which mechanisms may be responsible for this association. METHOD: In a stratified sample of 7076 adults (18-65 years), neuroticism, 22 self-reported chronic somatic conditions and five broad CIDI-diagnosed psychiatric syndromes were assessed at baseline and, in 3625 (51%) subjects, 3 years later. Using path analysis we examined whether neuroticism has direct links with future somatic morbidity and, conversely, whether morbidity at baseline is linked with higher neuroticism later on. RESULTS: Neuroticism at baseline is associated with psychiatric and somatic morbidity at follow-up after 3 years (31% and 24%, respectively, are direct associations, i.e. unmediated by each other or neuroticism at follow-up and independent of morbidity at baseline). Conversely, somatic and psychiatric morbidity at baseline are associated with increased neuroticism at follow-up (27% and 15%, respectively, are direct associations). CONCLUSIONS: Neuroticism raises risk for psychiatric and somatic morbidity but also results from them. It represents a central nexus in the process of morbidity accumulation.

Adult↗
PubMed2005

The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies.

BACKGROUND: Co-morbidity within anxiety disorders, and between anxiety disorders and depression, is common. According to the theory of Gray and McNaughton, this co-morbidity is caused by recursive interconnections linking the brain regions involved in fear, anxiety and panic and by heritable personality traits such as neuroticism. In other words, co-morbidity can be explained by one disorder being an epiphenomenon of the other and by a partly shared genetic etiology. The aim of this paper is to evaluate the theory of Gray and McNaughton using the results of genetic epidemiological studies. METHOD: Twenty-three twin studies and 12 family studies on co-morbidity are reviewed. To compare the outcomes systematically, genetic and environmental correlations between disorders are calculated for the twin studies and the results from the family studies are summarized according to the method of Klein and Riso. RESULTS: Twin studies show that co-morbidity within anxiety disorders and between anxiety disorders and depression is explained by a shared genetic vulnerability for both disorders. Some family studies support this conclusion, but others suggest that co-morbidity is due to one disorder being an epiphenomenon of the other. CONCLUSIONS: Discrepancies between the twin and family studies seem partly due to differences in used methodology. The theory of Gray and McNaughton that neuroticism is a shared risk factor for anxiety and depression is supported. Further research should reveal the role of recursive interconnections linking brain regions. A model is proposed to simultaneously investigate the influence of neuroticism and recursive interconnections on co-morbidity.

Anxiety↗
PubMed1999

Job strain and psychiatric morbidity.

BACKGROUND: This study examined the association between job strain and psychiatric morbidity using interview-based assessments of mental health. We assessed the prevalence of neurotic disorder in high job strain (high demand, low control) and low job strain (low demand, high control) school teachers, and compared these rates with data from individuals with similar educational qualifications from the National Psychiatric Morbidity Survey of Great Britain. METHODS: One hundred and sixty primary and secondary school teachers were selected from a larger survey on the basis of high or low job strain, and were assessed for psychiatric morbidity using the Revised Clinical Interview Schedule (CIS-R). The prevalence of neurotic symptoms and a total psychiatric morbidity score were calculated. RESULTS: After adjusting for age, gender and occupational grade, the prevalence of psychiatric morbidity was greater in high job strain than low job strain individuals. The prevalence of severe anxiety, worry and fatigue symptoms was significantly greater in the high job strain teachers. In comparison with the British psychiatric morbidity survey, the prevalence of neurotic disorders was greater in the high job strain, but not in low job strain teachers. Individuals in the low job strain group were more likely to report severe anxiety, irritability and fatigue in the week prior to interview, than comparably educated individuals in the national survey. CONCLUSION: Job strain is associated with psychiatric morbidity. The high levels of neurotic psychopathology among teachers is consistent with previous research that has found teaching to be a highly stressful occupation.

Adult↗
PubMed1989

Psychiatric morbidity associated with screening for breast cancer.

The 28-item GHQ was used to assess psychiatric morbidity in 302 women attending for routine breast cancer screening, 300 women attending for further investigation of a positive screening result and 150 women referred for investigation of breast symptoms. The GHQ-28 was administered on arrival at the relevant clinic and three months later. Medical records were used to determine the outcome of the clinic attendance. Women were classified into routinely screened women, women with false positive screening results, symptomatic women with a benign diagnosis, newly diagnosed cancer patients and previously treated cancer patients. When tested on arrival at the clinic, 25% of routinely screened, 30% of women with false positive results and 35% of symptomatic women with benign conditions were probable cases of psychiatric morbidity. The only statistically significant difference was between the routinely screened and symptomatic benign groups. Levels of anxiety were significantly higher in those with false positive results and in the symptomatic benign group than in the routinely screened. Three months later the prevalence of probable psychiatric morbidity had fallen to 19% in both the routinely screened and those with false positive results but remained significantly higher in the symptomatic benign group (31%). Probable cases of psychiatric morbidity among newly detected cancer patients rose from 34 to 46% over the 3-month period. Among women who had had breast cancer diagnosed in the past prevalence remained at 21%. The prevalence of probable psychiatric morbidity in screened women is similar to that in the general population. Among women referred for further investigation because of a false positive screening result prevalence was only slightly increased and there was no evidence of a sustained increase in anxiety. Provided that delays are kept to a minimum and that women are kept informed, a breast cancer screening programme does not increase psychiatric morbidity. Further research is required in cancer patients to determine whether those diagnosed in asymptomatic women have a higher and more sustained degree of psychiatric morbidity than those diagnosed in women who are aware of symptoms.

Aged↗
PubMed2003

Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review.

AIMS: Breast cancer treatment may result in long-term upper limb morbidity: reduced range of motion of the shoulder, muscle weakness of the arm and hand, lymph edema, pain and numbness. Relationship of this late morbidity with activities of daily life (ADL) and quality of life (QOL) is infrequently described and the strength of this relationship is not clear. METHODS: A systematic review was performed to evaluate the results of studies, analyzing late morbidity of breast cancer treatment in relationship with ADL and/or QOL. A literature search over the last 20 years (1980-2000) was performed in the databases MEDLINE, EMBASE, PSYCHLIT and CANCERLIT. Methodological quality of selected articles was assessed and additional, aspects of treatment related late morbidity and the relationship to ADL and/or QOL were summarized. RESULTS: From the 1642 yielded articles 15 fulfilled our primary selection criteria. Only six articles could be selected due to the inappropriate methodological quality. There was high variation in prevalence of pain (12-51%), impairments in range of motion (2-51%), edema (6-43%) and decreased muscle strength (17-33%). Four articles reported significant relationships between late morbidity of the upper limb and perceived disabilities in ADL/QOL. The strength of these relationships was rather low. CONCLUSIONS: Few studies investigated the relationship between late morbidity of the upper limb after treatment of early breast cancer and ADL/QOL. Significant relationship between late morbidity and restrictions of daily activities and poorer QOL was reported, however, the strength of this relationship was rather low.

Activities of Daily Living↗
PubMed2000

Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas.

OBJECTIVE: The aim of this study was to compare the perioperative morbidity associated with abdominal myomectomy with that of hysterectomy. STUDY DESIGN: This was a retrospective cohort study of 394 women at an academic medical center. Main outcome measured was perioperative morbidity, with the following secondary outcomes: febrile morbidity, hemorrhage, unintended major surgical procedures, life-threatening events, and rehospitalization. RESULTS: Morbidity was associated with myomectomy and hysterectomy in 39% and 40% of cases, respectively. The crude odds ratio for morbidity of myomectomy with respect to hysterectomy was 0.93 (95% confidence interval, 0.63-1.40). Women who underwent myomectomy were significantly younger, weighed less, and had a smaller preoperative uterine size. In a multivariable analysis that accounted for these differences the odds ratio increased to 1.46 (95% confidence interval, 0.77-2.77) but still was not statistically elevated. The study had >90% power to detect a clinically relevant 15% absolute difference in overall morbidity between the 2 groups. CONCLUSION: No clinically significant difference in perioperative morbidity between myomectomy and hysterectomy was detected. Myomectomy should be considered a safe alternative to hysterectomy.

Abdomen↗
PubMed2004

Early and late treatment-related morbidity following radical cystectomy.

OBJECTIVE: To evaluate treatment-related morbidity following cystectomy in a cohort of consecutive bladder cancer patients. The impact of age, comorbid condition, previous pelvic radiotherapy and type of urinary diversion was analysed. MATERIAL AND METHODS: Between 1992 and 1998 the treatment-related early (<30 days after cystectomy) and late morbidity was recorded in 268 consecutive bladder cancer patients (median age 65 years) undergoing cystectomy and the following types of urinary diversion: ileal conduit, n = 195; orthotopic neobladder, n = 36; continent reservoir, n = 33; and ureterocutaneous diversion, n = 4. Twenty-four patients had received previous pelvic radiotherapy and 79 had pre-existing morbidity. The median follow-up period was 5.4 years. RESULTS: The postoperative mortality rate was 2%. Age >70 years and pre-existing morbidity (especially cardiovascular disease) significantly increased the mortality rate. No relationship was found between early complication (57%) and re-exploration rates (17%) and either age, previous radiotherapy, pre-existing morbidity or type of urinary diversion. Patients undergoing orthotopic neobladder or continent reservoir had a significantly increased risk of calculus formation as well as cystectomy-related surgical procedures compared to patients undergoing ileal conduit. Age had a significant impact on vitamin B12 deficiency and renal deterioration, whereas previous pelvic irradiation significantly increased the probability of ureteroenteric stricture and lost renal function. Age and urinary diversion had no impact on hernia, ureteroenteric stricture or pyelonephritis. CONCLUSION: The risk of treatment-related morbidity was high and careful patient selection before cystectomy seems important. The lack of standard criteria regarding how to report morbidity makes comparison with other studies difficult.

Aged↗