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PubMed2004

Comparison of laparoscopic radical renal surgery in morbidly obese and non-obese patients.

BACKGROUND AND PURPOSE: Laparoscopic radical nephrectomy is rapidly becoming accepted as the preferred management of low-stage renal masses not amenable to partial nephrectomy. Minimally invasive surgery is advantageous to decrease perioperative and postoperative morbidity and allows patients to return to normal activities faster. Obesity has been a relative contraindication to this technique, and these patients have traditionally undergone open surgery. We present a review of 23 morbidly obese patients in comparison with patients who were not morbidly obese who underwent radical laparoscopic nephrectomy and nephroureterectomy at our institution. PATIENTS AND METHODS: Hospital charts between April 2001 and October 2003 were reviewed for morbidly obese patients undergoing transperitoneal laparoscopic renal surgery who were compared with age- and sex-matched control patients who underwent laparoscopic renal surgery in the same institution for similar indications. The data were collected at the time of the surgery. RESULTS: Twenty-three patients with a mean BMI of 42.2 kg/m2 underwent successful transperitoneal laparoscopic surgery. The mean specimen mass was 865 g, which was significantly larger than in the control group. The mean operative time was 200 minutes, which was around half an hour longer than in the matched group. The mean estimated blood loss was 243 mL, which was comparable to that of the controls. There were two perioperative complications, and the mean hospital stay was 4.5 days, 1 day longer than in the control group. CONCLUSIONS: Laparoscopic transperitoneal renal surgery is technically more difficult in morbidly obese patients but is a feasible, effective, minimally invasive method of removing renal malignancies. It offers decreased respiratory and cardiac morbidity in this higher-risk population. This study showed a complication profile similar to that in non-obese patients.

Aged↗
PubMed2005

The role of morbidity in the mortality decline of the nineteenth century: evidence from the military population at Gibraltar 1818-1899.

The causes of the nineteenth-century decline of mortality, characterized by lower mortality rates and increased longevity, have been the subject of debate among researchers for the past half-century. Because of a paucity of reliable data, little is understood about the role of morbidity, or illness episodes, in the mortality decline. This article introduces the results of a study that looks at the relationship of morbidity in the mortality decline during this portion of the epidemiological transition. The data are comprised of hospital admissions and deaths collected by the British army on the soldiers of the Gibraltar garrison from 1819 to 1899. Morbidity dropped during this period, but at a slower rate than mortality, and all categories of disease did not fall in concert; in some categories, morbidity rose as mortality dropped. Statistical modeling is used to analyze the categories of diseases that were most influential in the decline of mortality in this group. This research shows that there are discernible relationships between morbidity and mortality and that the two parameters are responding to different driving forces. Because changes within the military medical system may have had an effect on the relationship of the morbidity and mortality rates of the soldiers, surviving medical reports are used to reconstruct the medical care of the troops during the study period.

Adult↗
PubMed2004

Bioinformatical assay of human gene morbidity.

Only a fraction of eukaryotic genes affect the phenotype drastically. We compared 18 parameters in 1273 human morbid genes, known to cause diseases, and in the remaining 16 580 unambiguous human genes. Morbid genes evolve more slowly, have wider phylogenetic distributions, are more similar to essential genes of Drosophila melanogaster, code for longer proteins containing more alanine and glycine and less histidine, lysine and methionine, possess larger numbers of longer introns with more accurate splicing signals and have higher and broader expressions. These differences make it possible to classify as non-morbid 34% of human genes with unknown morbidity, when only 5% of known morbid genes are incorrectly classified as non-morbid. This classification can help to identify disease-causing genes among multiple candidates.

Computational Biology↗
PubMed1999

How does the prevalence of specific morbidities compare with measures of socio-economic status at small area level?

BACKGROUND: Evidence from other studies has show large, systematic differences between the health of social groups. It is not clear whether this relationship applies equally to all areas of health need. We assess whether a variety of areas of ill health show positive correlations with increasing socioeconomic disadvantage, and whether there are indicators of socio-economic disadvantage that are better than others at predicting the prevalence of specific morbidities at a population level. METHODS: The prevalence of a range of common morbidities was determined by a postal questionnaire sent to 16,750 subjects (response rate 79 per cent), and compared with socio-economic information obtained from the 1991 Census. RESULTS: There was substantial variation in the degree to which the various morbidities were related to the socioeconomic variables. When compared with socio-economic variables, long-term limiting illness, respiratory conditions and depression had high correlations of +0.8 or more. Cardiovascular conditions were less related (r = +0.60 to +0.79). None of the disorders of the gastrointestinal system showed a high correlation with socio-economic variables. There was also substantial variation in the degree of correlation of the socio-economic measures with each area of morbidity. The measures that showed the highest correlations were in respect of household characteristics such as car ownership and single parent households. Variables describing household amenities such as lacking a bath or central heating were least related to the morbidity measures. CONCLUSIONS: Some areas of morbidity show strong associations with socio-economic disadvantage, but others show only modest or no relationship. The optimum choice of socio-economic variable as a proxy for health need depends on the area of illness being considered.

Adolescent↗
PubMed2005

Excess winter morbidity among older people at risk of cold homes: a population-based study in a London borough.

BACKGROUND: Fuel poverty frequently affects older low-income households, in homes that are difficult to heat. Excess winter deaths occurring in Britain are widely attributed to effects of cold. This pilot study examined the demonstrability of a relationship between older people's health and fuel poverty risk, using morbidity data. METHODS: An observational, population-based study was made of 25,000 residents aged >or=65 years in the London Borough of Newham (LBN). Using Hospital Episode Statistics (HES) data over 1993-1997, anonymized at enumeration district (ED) level, we calculated excess winter morbidity, based on emergency hospital episodes for all respiratory diagnosis codes. EDs were variously aggregated after ranking against a proposed Fuel Poverty Risk Index (FPR), including factors of energy inefficient housing, low income, householder age and under occupation. RESULTS: FPR is a predictor of excess winter morbidity. In particular, FPR was observed showing a significant relationship with high winter morbidity counts for 2 of 4 years studied. Using FPR as a two-level factor (high and non-high), the model provides odds ratios: for 1993, winter/summer morbidity ratio for high FPR is 1.7 higher than the corresponding ratio for non-high FPR [95% confidence interval (CI)=1.1-2.7], and for 1996, the odds ratio is 1.6 (95% CI=0.9-2.8). In a regression with grouped EDs, having allowed for FPR, no other variables in our set contribute to the difference between winter and summer morbidity counts. CONCLUSIONS: Results may indicate supporting evidence of a relationship between energy inefficient housing and winter respiratory disease among older people, with public health implications for increasing health-driven energy efficiency housing interventions.

Aged↗
PubMed1998

Agreement between clinical examination and parental morbidity histories for children in Nepal.

Parental histories are often used to estimate the prevalence and the impact of interventions on child morbidity, but few studies have examined the agreement between parental histories and clinical examination. We compared clinical findings with a same-day parental morbidity history for pre-school-age children in rural Nepal. A 15 per cent sample of children from 40 wards in Sarlahi district, Nepal, was selected for participation and 814 same-day morbidity histories were obtained from parents. A clinician, masked to the parent's history, visited the household 2-4 h later and examined the child for signs of morbidity symptoms about which the parent had previously been questioned. Signs included measurement of temperature, respiratory rate, examination of stools, ear discharge, and presence of persistent cough. Agreement between the history and clinical examination was excellent for ear infection (kappa = 0.75) and history of measles rash (kappa = 0.74), moderate to poor for diarrhoea (kappa = 0.21) and fever (kappa = 0.31), and there was no evidence of agreement for dysentery (kappa = -0.01), rapid breathing (kappa = 0.06), and cough (kappa = 0.09). The prevalence of dysentery, fever, cough, and rapid breathing was lower if clinical signs rather than histories were used. The prevalence of diarrhoea was higher if the presence of a loose stool in a cup rather than a history was used. The prevalence of ear infections and measles was comparable with both methods. The agreement between histories and clinical examination varies by morbidity type, as does the prevalence of morbidity estimated by one or other method.

Adult↗
PubMed1994

Perioperative predictors of morbidity following hepatic resection for neoplasm. A multivariate analysis of a single surgeon experience with 105 patients.

OBJECTIVE: Factors that predict mortality or morbidity risk in consecutive hepatic resections for neoplasm were examined, with controlled variables of surgical technique and experience. SUMMARY BACKGROUND DATA: Hepatic resection has become the therapy of choice for the management of metastatic or primary neoplasms of the liver. Although mortality for this procedure has steadily decreased, associated morbidity remains high. METHODS: One hundred five patients undergoing hepatic resection for malignancy over a 4-year period by a single surgeon to identify preoperative, intraoperative, or postoperative predictors of morbid outcomes were studied. Variables were analyzed using multiple regression in a stepwise, logistic model. RESULTS: Sixty-day hospital mortality was 2.8%, with morbidity occurring in 33%. A significant preoperative predictor of morbidity was serum bilirubin (p > 0.005). Notably, preoperative renal function, or medical illness, did not increase morbid risk. Operative variables increasing risk included extent of resection, blood loss, and operative time (p > 0.005). CONCLUSIONS: Complex hepatic resection can be performed with low mortality, and serum bilirubin is the single most powerful predictor of postoperative complication.

Bilirubin↗
PubMed2003

Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism.

PURPOSE: To determine if CT variables predict in-hospital morbidity and mortality in patients with pulmonary embolism (PE). MATERIALS AND METHODS: CT scans and charts of 173 patients with CT scans positive for PE were reviewed. CT scans were reviewed for leftward ventricular septal bowing, increased right ventricle (RV) to left ventricle (LV) diameter ratio, clot burden, increased pulmonary artery to aorta diameter ratio, and oligemia. Charts were reviewed for severe morbidity and mortality outcomes: death from pulmonary emboli or any cause, and cardiac arrest. Charts were also reviewed for milder morbidity outcomes: intubation, vasopressor use, or admission to an intensive care unit (ICU) and for multiple comorbidities. RESULTS: No CT predictor was significantly associated with severe morbidity or mortality outcomes. Ventricular septal bowing and increased RV/LV diameter ratio were both associated with subsequent admission to an ICU (P = 0.004 and P = 0.025, respectively). Oligemia (either lung) was associated with subsequent intubation; right lung oligemia was associated with the subsequent use of vasopressors. After controlling for history of congestive heart failure, ischemic heart disease, and pulmonary disease, both septal bowing and an increased RV/LV diameter ratio remained associated with admission to an ICU. CONCLUSION: No CT variables predicted severe in-hospital morbidity and mortality (death from pulmonary embolism, death from any cause, or cardiac arrest) in patients with PE. However, ventricular septal bowing and increased RV/LV diameter ratio were both strongly predictive of less severe morbidity, namely, subsequent ICU admission, and oligemia was associated with subsequent intubation and vasopressor use.

Acute Disease↗
PubMed2001

Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity.

STUDY DESIGN: A prospective study was conducted to examine bone graft donor site morbidity in 106 consecutive patients undergoing posterior spinal fusion. OBJECTIVES: To perform a prospective analysis of donor site morbidity, to document the incidence of major complications, and to collect information on the impact of autologous bone graft harvesting from the posterior iliac crest on the overall outcome of spinal surgery. SUMMARY OF BACKGROUND: Bone graft harvesting from the posterior iliac crest for spinal fusion is a source of significant morbidity. Previous retrospective case studies indicate that minor complications are common, but they do not define the natural history and complications of posterior iliac crest bone graft harvesting. METHODS: A standardized harvesting technique was used. At 3, 6, and 12 months after surgery, the patients completed a proforma questionnaire rating symptoms on a visual analog scale and underwent a postoperative examination by the surgeon. Finally, overall surgical outcome was assessed at 12 months. RESULTS: The major component of morbidity is donor site pain. Mean pain scores were 1.640 at 3 months, 1.812 at 6 months, and 1.207 at 12 months. The pain at 12 months was significantly less than at 3 and 6 months (P = 0.005), with a trend toward the highest scores at 6 months. A pain score of 0 was reported by 55% of the patients. Local sensory loss was found in 10% of the patients. Outcome assessment showed significant differences in morbidity for surgery performed at different spinal levels (P = 0.001), with lumbosacral surgery resulting in worse outcomes than either cervical (P < 0.05) or thoracolumbar (P < 0.05) surgery. Significantly higher visual analog scores were observed at 6 months in patients with poorer overall outcomes. CONCLUSIONS: According to this study, it is reasonable to reassure patients that a good result from spinal surgery will not be compromised by severe symptoms or major morbidity secondary to posterior iliac crest bone graft donation. Before surgery, patients may be advised concerning the risks of donor site pain, which improves significantly by 12 months, local tenderness, and uncommonly localized sensory loss.

Adolescent↗
PubMed2006

Obstetric outcomes after in vitro fertilization in obese and morbidly obese women.

OBJECTIVE: In addition to numerous health detriments caused by obesity, fertility and pregnancy success may also be compromised. The aims of this study were to compare the effects of obesity and morbid obesity on in vitro fertilization (IVF) outcomes. We also investigated the effects of obesity on obstetric outcomes after IVF treatment. METHODS: Retrospective study of women less than 38 years of age during their first fresh IVF cycle (January 1995 to April 2005). RESULTS: A total of 1,293 women were included in the study, with 236 obese women (body mass index [BMI] = 30-39.9) and 79 morbidly obese women (BMI > or = 40). The morbidly obese group had a 25.3% IVF cycle cancellation rate compared with 10.9% in normal-weight women (odds ratio 2.73, 95% confidence interval 1.49-5.0), P < .001). Morbidly obese women without polycystic ovarian syndrome had an even higher cancellation rate (33%). Women with higher BMI required significantly more days of gonadotropin stimulation but had lower peak estradiol levels (P < .001). There were no significant differences in clinical pregnancy or delivery rates between the four BMI groups. Of the women who delivered, there was a significant linear trend for risk of preeclampsia, gestational diabetes, and cesarean delivery with increasing BMI (P < .03). CONCLUSION: We report a significantly higher risk for IVF cycle cancellation in morbidly obese patients with no effect of BMI on clinical pregnancy or delivery rate. However, obese and morbidly obese subjects had a significantly higher risk for obstetric complications. This target population should be aggressively counseled regarding their increased obstetric risk and offered treatment options for weight reduction before the initiation of fertility therapy. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2006

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

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

Adolescent↗
PubMed2004

Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases.

OBJECTIVE: During the last 14 years, living donor liver transplantation (LDLT) has evolved to an indispensable surgical strategy to minimize mortality of adult and pediatric patients awaiting transplantation. The crucial prerequisite to performing this procedure is a minimal morbidity and mortality risk to the healthy living donor. Little is known about the learning curve involved with this type of surgery. PATIENTS AND METHODS: From January 1991 to August 2003, a total of 165 LDLTs were performed in our center. Of these, 135 were donations of the left-lateral lobe (LL, segments II and III), 3 were of the left lobe (L, segments II-IV), 3 were full-left lobes (FL, segments I-IV), and 24 were of the full-right lobe (FR, segments V-VIII). We divided the procedures into 3 periods: period 1 included the years 1991 to 1995 (LL, n = 49; L, n = 2; FR, n = 1), period 2 covered 1996 to 2000 (LL, n = 47), and period 3 covered 2001 to August 2003 (LL, n = 39; FR, n = 23; FL, n = 3; L, n = 1). Perioperative mortality and morbidity were assessed using a standardized classification. Length of stay in intensive care unit, postoperative hospital stay, laboratory results (bilirubin, INR, and LFTs), morbidity, and the different types of grafts in the 3 different periods were compared. RESULTS: One early donor death was observed in period 1 (03/07/93, case 30; total mortality, 0.61.%). Since 1991, the perioperative morbidity has continually declined (53.8% vs. 23.4% vs. 9.2%). In period 1, 28 patients had 40 complications. In period 2, 11 patients had 12 complications, and in period 3, 6 patients had 9 complications. Within the first period, 1 donor underwent relaparotomy because of bile leakage. Postoperative hospital stay was 10 days, 7 days, and 6 days, respectively. Donation of the full right lobe, in comparison with that of the left lateral lobe, resulted in a significantly diminished liver function (bilirubin and INR) during the first 5 days after donation but did not increase morbidity. One donor from period 1 experienced late death caused by amyotrophic lateral sclerosis. CONCLUSIONS: In a single center, morbidity after living liver donation strongly correlates to center experience. Despite the additional risks associated with temporary reduction of liver function, this experience enabled the team to bypass part of the learning curve when starting right lobe donation. Specific training of the surgical team and coaching by an experienced center should be implemented for centers offering this procedure to avoid the learning curve.

Adult↗
PubMed2005

Smoking-associated fetal morbidity among older gravidas: a population study.

BACKGROUND: We set out to assess the influence of advanced maternal age on fetal morbidity associated with smoking during pregnancy in a population-based retrospective study of 7 792 990 singleton live births between 1995 and 1997 in the United States with documented maternal smoking habit. METHODS: The study group consisted of infants born to mothers aged>or=40 years (older mothers). Two maternal age categories (20-29, "younger mothers"; 30-39, "mature mothers") were constructed as comparison groups. Adjusted odds ratios (ORs) generated from logistic regression models were used to compare fetal morbidity indices associated with smoking across maternal age categories. Main outcome measures included preterm, very preterm, and small for gestational age (SGA). RESULTS: The prevalence of smoking was 13.1%, and decreased with increasing maternal age. Regardless of maternal age, the risk for fetal morbidity was significantly elevated if the mother smoked. The risks for preterm and SGA associated with smoking were significantly higher among older gravidas as compared to younger mothers while mature mothers had risk estimates comparable to those of older mothers. Among smoking mothers only, the risk pattern for fetal morbidity was J-shaped, with babies of older smokers having significantly higher fetal morbidity indices, while those of mature smokers showed lower levels of risk as compared to younger mothers. CONCLUSION: In an era of relatively lower prevalence of smoking during pregnancy, advanced maternal age still increases the risk of smoking-associated fetal morbidity. Our findings reveal new information of elevated risk for very preterm births among older smoking mothers.

Adult↗
PubMed1996

The morbidity attributable to Schistosoma japonicum infection in 3 villages in Dongting Lake region, Hunan province, PR China.

In common with other helminth infections, symptoms associated with Schistosoma japonicum infection have a low specificity, and many infections are asymptomatic. The presence of the parasite in a sick individual from an endemic area does not mean that S. japonicum is the aetiological agent. However, estimates of the proportion of all symptomatic episodes in a community attributable to S. japonicum infection can be used to determine its public health impact. Using parasitological and morbidity survey data from 3 villages in China, the fractions of diarrhoea, bloody stool, and abdominal pain episodes that were attributable to S. japonicum infection were estimated. The association between hepatomegaly and S. japonicum infection was also assessed. For all morbidity indicators, it was found that individuals with higher infection intensities were at greater risk of morbidity. The highest risk indicator of morbidity associated with S. japonicum infection was bloody stools. Logistic regression revealed that factors related to village and sex were important confounders of the relation between infection and the risk of morbidity. The fraction of the population in each village estimated to be suffering morbidity attributable to S. japonicum infection was low, due to the low prevalence of infection. However, the results suggest that some sick individuals may have been diagnosed as false negatives for S. japonicum infection.

Adolescent↗
PubMed1992

Socioeconomic correlates of mortality and hospital morbidity differentials by Local Government Area in Sydney 1985-1988.

OBJECTIVE: To determine the magnitude of differentials in mortality and hospital morbidity by Local Government Area (LGA) in Sydney (1985-1988), and to correlate these with LGA indicators of socioeconomic status. DESIGN: Cross-sectional group-based comparative study of mortality and hospital separations, and a group-based correlations analysis in relation to socioeconomic indicators. OUTCOME MEASURES: Mortality--life expectancy at birth, infant mortality, 0- to 4-year mortality, age-standardised 15- to 64-year mortality (all-cause and various causes), sex-specific (except infant and 0- to 4-year mortality). Hospital morbidity rates--0- to 4-year hospital separations, age-standardised 15- to 64-year hospital separations (all-cause and various causes), sex-specific. STUDY FACTORS: Census-derived LGA proportions of immigrants, Aborigines, professionals, unskilled workers, unemployed persons, those with a university degree and those having no qualifications, and the composite Ross Indicator. RESULTS: Considerable differences in mortality and hospital morbidity by LGA in Sydney were found. Males had higher mortality and lower rates of hospital separation than females. LGA differentials were most obvious for adults, with little variation noted for infants or children. Most socioeconomic indicators were highly correlated with adult mortality and hospital morbidity in the expected direction, particularly indicators of low socioeconomic status. The unemployment rate, proportion Aboriginal, proportion unskilled, proportion unqualified, and the Ross Indicator were the most highly correlated variables. CONCLUSIONS: There are persistent differentials by LGA in mortality and hospital morbidity in Sydney which are strongly associated with socioeconomic status. The Ross Indicator was found to be a useful composite indicator. The high correlations of mortality and hospital morbidity with the unemployment rate raise the question of to what extent this is due to illness and premature mortality in the unemployed. Monitoring of health status differentials needs to continue if progress towards Health For All targets is to be evaluated.

Adolescent↗
PubMed1987

Measuring morbidity for resource allocation.

The RAWP (Resource Allocation Working Party) report used population weightings based on standardised mortality ratios (SMRs) as a proxy measure of differences in morbidity (and therefore in the need for health care resources) that existed between geographical areas after allowing for the age and sex structure of their populations. The adequacy of SMRs as a proxy for morbidity has aroused controversy, particularly from RAWP losers in London, and is one of the main themes of the National Health Service Management Board's current review of RAWP. Critics have argued, firstly, that the nature of the relation between morbidity and mortality is unknown; and, secondly, that SMRs are incomplete because they fail to take account of the effect of social deprivation on the need for health care. As a result several alternative proxies for morbidity based on social indicators have been proposed. One of their principal drawbacks is that their use is justified by their relation to measures of use of services known to be affected by the prevailing level of supply. Furthermore, the evidence suggests that mortality data actually correlate quite well with the available measures of both morbidity and social deprivation. But without access to comprehensive morbidity data the SMR debate is bound to remain inconclusive. As measures of health need, however, SMRs have the twin merits of being (a) independent of supply, and (b) more direct measures of health state than social indicators.

Health Resources↗
PubMed1990

Childhood morbidity and adulthood ill health.

STUDY OBJECTIVE: The aim of the study was to investigate the relationship between the state of health in childhood and ill health in early adult life. DESIGN: The study used data collected as part of the National Child Development Study and related health at 7 years of age to that at 23. A wide range of information on child health in the cohort was available, which was used to construct a broader measure of health status than selected diagnostic categories. SETTING: The survey population was nationwide. PARTICIPANTS: The study population included all children born in the week 3-9 March 1958. They were followed up at 7, 11, 16, and 23 years. Of the target population of 17,733 births, 12,537 (76%) were retraced and interviewed at 23. MEASUREMENTS AND MAIN RESULTS: Children at age 7 were allocated to 13 morbidity groups; 20% of children had reported no ill-health apart from the common infectious diseases, but 10% were included in four or more of the morbidity groups. Children with no reported morbidity retained their health advantage into early adulthood: ratios of observed to expected ill health for four of the five indices examined at age 23 were all significantly below one (self rated health 0.81, asthma and/or wheezy bronchitis 0.63, allergies 0.79, emotional health 0.75). Children with more morbidity at age 7 had higher ratios of ill health in adulthood. A chronic condition in childhood was associated not only with excess morbidity in the short term but also with a poor health rating in early adult life (ratio = 1.38). Morbidity was significantly increased for most of the adulthood indices among children with asthma and/or wheezy bronchitis. However most ill health in young adulthood occurred in study members with a relatively healthy childhood. CONCLUSIONS: Although the state of health in childhood has long term implications, it does not form a substantial contribution to ill health in early adult life.

Acute Disease↗
PubMed1993

Another British disease? A recent increase in the prevalence of psychiatric morbidity.

AIMS AND OBJECTIVE: To examine trends in the prevalence of psychiatric morbidity in Britain between 1977 and 1985. DESIGN: Secondary analysis of two cross sectional population based surveys. SETTING: The first survey was conducted in 1977 in West London and the second in 1984-85 throughout Great Britain. PARTICIPANTS: Members of the public randomly selected from the electoral register. MEASUREMENTS AND MAIN RESULTS: The main outcome was the prevalence of psychiatric morbidity assessed using the General Health Questionnaire, a self administered measure of neurotic symptoms. There was an increase of at least 8% (95% confidence interval 6.6, 9.8) in the prevalence of psychiatric morbidity between the times of the two surveys and this difference persisted after adjustment for any changes in the sex, age, employment status, marital status, social class, and housing tenancy between the two samples. When the analysis was restricted to the Greater London respondents of the Health and Lifestyle Survey a larger increase in psychiatric morbidity was seen. CONCLUSIONS: It is likely that there was an increase in the prevalence of psychiatric morbidity in Great Britain between these two surveys. Psychiatric morbidity is a public health problem of some importance and the causes of this increase require further study.

Adolescent↗