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Low testosterone levels predict incident depressive illness in older men: effects of age and medical morbidity.

OBJECTIVE: Prior studies found that chronic low testosterone levels are associated with an increased risk of depression. We investigated whether low testosterone levels in older men predict depressive illness over 2 years, while controlling for age and medical morbidity. METHOD: Participants were 748 men, aged 50 years or older, without prior ICD-9-diagnosed depressive illness, with a testosterone level obtained between 1995 and 1997. Measures were age, mean total testosterone levels (low: < or = 2.5 ng/mL), medical morbidity, and incidence and time to depressive illness. RESULTS: Men with low testosterone levels had a greater 2-year incidence of depressive illness (18.5% vs. 10.4%, df = 1, p = .006) and a shorter time to onset of depressive illness (log-rank chi(2) = 8.1, df = 1, p = .004). The unadjusted hazard ratio (HR) for depressive illness in men with low testosterone levels was 1.9 (95% confidence interval [CI] = 1.2 to 3.0, p = .005). After adjustment for age and medical morbidity, men with low testosterone levels continued to have a shorter time to depressive illness (adjusted HR = 2.1; 95% CI = 1.3 to 3.2, p = .002). Due to a significant interaction between age and medical morbidity, we conducted stratified Cox regression analyses and found that low testosterone levels and high medical morbidity or an age of 50 to 65 years were associated with increased depressive illness (p = .002). CONCLUSION: Low testosterone levels are associated with an earlier onset and greater incidence of depressive illness. Men with low testosterone levels who had high medical morbidity or were aged 50 to 65 years had an increased risk for depressive illness. Further prospective studies are needed to examine the role of testosterone in depressive illness in older men.

Age Factors↗

Dynamic models of schistosomiasis morbidity.

Previous attempts to assess the health impact of schistosomiasis control programs on community morbidity have been limited by a lack of a theoretical framework that describes the dynamic relationships between infection and morbidity. In this paper, a model of schistosomal morbidity is developed and parameterized. Morbidity is divided into that due to current heavy infection, and early and late stages of chronic disease. The model was parameterized using data showing resolution of disease after treatment, correlations between prevalence of disease and intensity of infection and using age-morbidity profiles. The fitted parameters suggest that early manifestations of disease such as hepatomegaly in Schistosoma mansoni and S. japonicum infections would resolve relatively quickly following treatment whereas later forms of disease such as liver fibrosis resolve very slowly or not at all. Similar general conclusions were obtained with data on early and late forms of urinary tract morbidity in S. haematobium.

Adolescent↗

Adult asthma prevalence, morbidity and mortality and their relationships with environmental and medical care factors in Singapore.

We have conducted a series of studies on adult asthma in Singapore that describe the prevalence, morbidity and mortality and their relationships with environmental and medical care factors. There was no evidence of a temporal increase of mortality from 1976 to 1995 for adults. The prevalence rate of asthma is 2.4% in men and 2.0% in women. There is considerable morbidity among asthmatics, corticosteroids are under-used, and patients' knowledge and self-management skills is poor. Increased morbidity is significantly associated with current keeping of pets, current smoking, and the patients' knowledge and self-management skills. Occupational exposure contributes up to a third of asthma morbidity. Malays and Indians have higher rates of asthma mortality and morbidity than Chinese. They have greater exposures to airborne allergens from keeping rugs or carpets, and pets. Malays experience the most morbidity from asthma, but make less use of health services, and receive less medical attention, than Indians or Chinese.

Adolescent↗

Pulsatile tinnitus in patients with morbid obesity: the effectiveness of weight reduction surgery.

BACKGROUND: Morbid obesity is increasing in the United States population. Morbidly obese patients may have disabling pulsatile tinnitus (PT) secondary to pseudotumor cerebri syndrome and often seek treatment from otolaryngologists because of this symptom. OBJECTIVE: To determine the effectiveness of weight reduction surgery (WRS) for relief of PT in patients with morbid obesity. STUDY DESIGN: Retrospective study of morbidly obese patients with associated PT. SETTING: Academic tertiary referral center. PATIENTS: Sixteen women with morbid obesity and associated PT who underwent WRS. RESULTS: Median age was 34 years (range 24-45 years). Average preoperative body mass index was 45 kg/m2 (range 33-70 kg/m2). Average weight loss was 45+/-17 kg (range 25-99 kg). Average postoperative weight was 75+/-14 kg (range 57-105 kg). The average preoperative cerebrospinal fluid pressure was 344+/-103 mm H2O (range 220-520 mm H2O). Postoperative measurements of cerebrospinal fluid, obtained on 4 patients, revealed an average decrease in pressure of 198 mm H2O (range 120-400 mm H2O). Thirteen patients experienced complete resolution of their PT (81%). Three patients continued to have PT despite significant weight reduction. CONCLUSIONS: Weight reduction surgery was effective in relieving PT in morbidly obese patients with associated pseudotumor cerebri syndrome and should be considered when conservative management has failed.

Adult↗

[Perioperative mortality and morbidity for the year of 1999 in 466 Japanese Certified Anesthesia-training Hospitals: with special reference to ASA-physical status--report of Committee on Operating Room Safety of Japan Society of Anesthesiologists].

Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (ASA-PS). The total number of anesthetics analyzed was 655, 644. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of cardiac arrest (per 10,000 anesthetics) was 0.68, 3.76, 14.37, 67.03, 0.36, 4.68, 27.96, 206.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 8.93, 26.99, 71.30, 188.52, 8.68, 31.27, 136.16, and 790.92 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7th postoperative day) after cardiac arrest were 0.16, 0.94, 5.71, 33.51, 0.00, 1.46, 16.41 and 167.76 per 10,000 anesthetics in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.24, 1.66, 12.16, 67.03, 0.00, 3.51, 34.65 and 417.14 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthetics than in elective anesthetics. ASA-PS correlated well with overall mortality and with morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.24, 0.45, 1.47, 8.38, 0.36, 1.75, 2.43 and 11.34 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 4.92, 8.81, 14.74, 20.95, 4.34, 11.40, 15.80 and 22.67 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates after cardiac arrest totally attributable to anesthesia were 0.00, 0.00, 0.61 and 4.53 in patients with ASA-PS of I-IV, I E-II E, III E, and IV E, respectively. The overall mortality rates totally attributable to anesthesia were 0.00, 0.04, 0.18, 0.00, 0.00, 0.61 and 4.53 in patients classified to ASA-PS of I, II, III, IV, I E-II E, III E, and IV E, respectively. Only one death, due to overdose of anesthetics, was reported among patients with good physical status (ASA-PS of I, II, II E and II E). Anesthetic management was mainly responsible for critical events in patients with good physical status, while co-existing diseases were in those with poor physical status. The major co-existing diseases or conditions leading to critical events were heart diseases in elective anesthetics, and hemorrhagic shock in emergency anesthetics. We reconfirmed that ASA-PS is beneficial to predict perioperative mortality and morbidity. It also seems likely that we should make much more efforts to reduce anesthetic morbidity in patients with good physical status, and to improve preanesthetic assessment and preparation of cardiovascular conditions in those with poor physical status.

Anesthesiology↗

[Competitive morbidity ant its impact on life expectancy: evaluation and inclusion in the therapeutic decision regarding localized prostatic cancer].

OBJECTIVES: The treatment decision taken by a multidisciplinary meeting for patients with localized prostate cancer must take into account the clinical stage of the cancer and its histological characteristics, but also the patient's age, general state and any concomitant diseases, as treatment is only beneficial when it induces a reduction of morbidity and specific mortality. The specific survival with or without recurrence after treatment for localized prostate cancer is long, at least more than 10 years. Curative treatment is generally not proposed to men with localized prostate cancer when his probability of survival related to a competitive morbidity (intercurrent medical disease) is estimated to be less than 10 years. The objective of this study was to measure the increase or reduction of the survival probability of a patient with localized prostate cancer according to his competitive morbidity, based on the mean life expectancy of the general population. METHODS: Review of the literature. RESULTS: Studies describing the natural history of prostate cancer show that the impact of treatment on morbidity of the cancer (local and/or metastatic) requires a life expectancy of about 8 to 10 years. The impact of a treatment on specific survival requires a life expectancy of about 13 to 15 years. The exact prevalence of diseases coexisting with prostate cancer is unknown. In the USA, The Index of Coexisting Disease (ICD), which takes into account 14 diseases, appears to be the most reliable tool to measure the competitive morbidity in patients with localized prostate cancer. Each disease is classified into 4 levels of severity (score 0 to 3). A table indicates estimated life expectancies by age-group and by ICD score. All men with a high score (2 to 3) die within 10 years after diagnosis, men with a score of 0 have a better estimated life expectancy according to age than that of the general population. CONCLUSION: The upper age limit, theoretically set at 70 years, in order to propose curative treatment for localized prostate cancer needs to be reviewed (the mean life expectancy for a 70-year-old man is 12.9 years in France). According to the ICD, the life expectancy at 70 years is 14.8 years in the case of a score of 0 and 8.4 years in the case of a score of 2. In the case of a score of 2, the impact of curative treatment on localized prostate cancer would be real on morbidity, but not on specific mortality.

Humans↗

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

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

Adolescent↗

[Tuberculosis morbidity among the population of a large industrial center].

Tuberculosis morbidity in children, adolescents, young people and adults for the period of 1986-1990 has been analysed. Parameters of morbidity were compared with general morbidity of the population of Chelyabinsk. It was found that at the present stage of tuberculosis control parameters of general morbidity remained unchanged. Morbidity in adolescents and young people aged 18-19 years markedly decreased, while a tendency to its slow growth was revealed in children and in subjects aged 24-29 years. In contrast to other groups, parameters of morbidity in adults are the highest (32.7-37.4 per 1,000,000) and steady owing to which measures aimed at tuberculosis control should be improved.

Adolescent↗

Rheological profile in severe and morbid obesity. Preliminary results.

The association of hemorheological alterations with morbid obesity remains a question of debate. In order to ascertain whether morbid obese subjects show certain hemorheological alterations which might be involved in the higher thrombotic risk which characterizes these subjects, we determine glucose, plasma lipids, apolipoproteins, fibrinogen, hematocrit, blood viscosity (Brookfield DVIII viscosimeter), both at native and corrected hematocrit of 45%, plasma viscosity (Fresenius capillary viscosimeter), erythrocyte aggregation (Myrenne aggregometer), both at stasis and at 3 s(-1) at 45% hematocrit and erythrocyte indexes in 41 morbid obese subjects (32 female, 9 male aged 33+/-10 years), and in a well matched non-obese control group (40 female, 15 male, aged 32+/-10 years). Mean BMI in the morbid obese group was 44.9+/-6.7 kg/m2 vs 23.5+/-4.8 kg/m2 in the control group (p<0.001). Morbid obese subjects when compared with the control group showed a statistically higher glucose level (p<0.001), LDL-cholesterol (p=0.019), triglycerides (p<0.001), apoB (p=0.019), apoB/A1 (p<0.001), fibrinogen (p<0.001), erythrocyte aggregation (p<0.001), and a statistically lower HDL-cholesterol (p<0.001). No differences between both groups were observed regarding total-cholesterol, plasma viscosity, blood viscosity and hematocrit (p=0.109; p=0.690; p=0.510; p=0.950), respectively. After the adjustment for BMI, differences in glucose, LDL-cholesterol, triglycerides, apoB, apoB/A1, and erythrocyte aggregation did not reach the statistical significance, and differences in fibrinogen were borderline significant (p=0.051), showing a direct effect of BMI on the detected differences between obese and non-obese. Our results suggest that in morbid obese subjects the increased fibrinogen levels and the altered lipid profile associated with their higher BMI, could in addition to its known mechanisms on haemostasis, favour both venous and arterial thrombotic events by enhancing erythrocyte aggregation.

Adult↗

Short-term outcome after active perinatal management at 23-25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity.

AIM: To determine major neonatal morbidity in surviving infants born at 23-25 weeks, and to identify maternal and infant factors associated with major morbidity. METHODS: The medical records of 224 infants who were delivered at two tertiary care centres in 1992-1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Of the 213 liveborn infants, 140 (66%) survived to discharge. Data were analysed by gestational age and considered in three time periods. Logistic regression models were used to identify factors associated with morbidity. RESULTS: Of the survivors, 6% had intraventricular haemorrhage grade > or = 3 (severe IVH) or periventricular leukomalacia (PVL), 15% retinopathy of prematurity > or = stage 3 (severe ROP) and 36% bronchopulmonary dysplasia (BPD). On logistic regression analysis, severe IVH or PVL was associated with duration of mechanical ventilation (odds ratio, OR: 1.53 per 1-wk increment in duration; 95% confidence interval, CI: 1.01-2.33). Severe ROP was associated with the presence of a patent ductus arteriosus (PDA) (OR: 3.31; 95% CI: 1.11-9.90) and birth in time period 3 versus time periods 1 and 2 combined (OR: 6.28; 95% CI: 2.10-18.74). BPD was associated with duration of mechanical ventilation (OR: 2.71 per 1-wk increment in duration; 95% CI: 1.76-4.18) and with the presence of any obstetric complication (OR: 2.67; 95% CI: 1.07-6.65). Gestational age and birthweight were not associated with major morbidity. Of all survivors, 81% were discharged home without severe IVH, PVL or severe ROP. CONCLUSIONS: Increased survival as a result of active perinatal and neonatal management was associated with favourable morbidity rates compared with those in recent studies. Among survivors born at 23-25 weeks, neither gestational age nor birthweight was a significant determinant of major morbidity.

Analysis of Variance↗

[Total immunization of children against influenza decreases morbidity in a number of diseases among elderly persons during influenza epidemic].

Immunization of children aged 3-6 years in kindergartens and school children aged 7-17 years against influenza with inactivated influenza vaccine was carried out in two districts of the Moscow region. The comparison of morbidity in influenza-like diseases among the immunized children with that among nonimmunized children in control districts revealed that the effectiveness of immunization was 60.9% in kindergartens and 68.8% in schools. The analysis of morbidity in a number of diseases among 158,451 elderly persons not immunized against influenza demonstrated that, in comparison with the control districts, in those districts where mass immunization of children was carried out morbidity in influenza-like diseases among elderly persons was 3.4 times lower and, out of other 10 diseases under study, morbidity in 8 diseases was 1.5-2.6 times lower. As indicated by the data obtained in this study, total anti-influenza immunization of children in organized groups not only essentially decreased influenza morbidity among children, but also greatly decreased morbidity in influenza and a number of diseases, appearing as complications of influenza infection, among nonimmunized elderly persons during influenza epidemic.

Adolescent↗

Laparoscopic adjustable gastric banding for the treatment of morbidly obese patients: early outcome in a Chinese cohort.

OBJECTIVE: To evaluate the efficacy of laparoscopic adjustable gastric banding in the management of morbid obesity in a cohort of Chinese patients. DESIGN. Cohort study. SETTING: University teaching hospital, Hong Kong. PATIENTS: From August 2002 to September 2003, 10 patients (6 male, 4 female) with a median age of 34 years (range, 23-48 years) underwent laparoscopic adjustable gastric banding to treat morbid obesity. Considerable co-existing diseases were present in 90% of the cases. We instituted a team approach that allowed every patient to see our dietitian, physician, psychiatrist (if necessary), and surgeon prior to deciding on the procedure to be used. MAIN OUTCOME MEASURES: Excessive body weight loss, quality-of-life score (SF36), and co-morbidities improvement. RESULTS: The 10 patients had a median weight of 127 kg (range, 115-196 kg) and median body mass index of 47 kg/m(2) (range, 38-67 kg/m(2)). The operation was successful in all patients with a median operating time of 110 minutes (range, 75-240 minutes). The median hospital stay was 3 days (range, 3-4 days) and three of the patients required overnight observation in the intensive care unit because of severe sleep apnoea and asthma. The median follow-up period was 12 months (range, 1-18 months). The mean weight loss at 6, 12, and 18 months was 19.3, 22.4, and 25.9 kg, respectively. Mean percentage of excessive weight loss at 6, 12, and 18 months was 34.9%, 36.5%, and 40.5%, respectively. Unsatisfactory weight loss (<20 kg) occurred in three patients because of poor dietary compliance and non-follow-up. Surgery also considerably improved the patients' co-morbidities (hypertension, diabetes, and obstructive sleep apnoea) and the quality of life. CONCLUSION: In the short term, laparoscopic adjustable gastric banding is certainly an effective procedure for morbid obesity, which results in a substantial weight loss and improvement of co-existing morbidities. Longer follow-up will show whether this weight loss is maintainable.

Adult↗

[Diphtheria morbidity in Russia today].

The data on diphtheria morbidity and the occurrence of carrier state for its causative agent at the period of 2001-2002 were analyzed. The rates of morbidity and detected carrier state for these years were 0.63-0.55 and 0.65-0.64 respectively. Nevertheless, in spite of the relatively low morbidity rates the presence of the toxic forms of diphtheria (400 patients for two years) and lethal cases (with lethality rate reaching 5.4%) indicated that the epidemic situation in diphtheria remained tense. The most unfavorable situation was observed in the North-Western and Central regions of Russia. In urban areas morbidity rates were still 2- to 3-fold higher in than in rural ones, but the latter showed a higher percentage of severe cases (46.6% in 2001 and 39.7% in 2002) and lethal outcomes (13.6% and 19.2%). The latter was indicative of drawbacks in the immunoprophylaxis, diagnostics and treatment of diphtheria in rural areas. In the total structure of diphtheria patients adults prevailed: 75%. The highest morbidity rates were registered among children aged 3-6 years, among adults in the age groups of 18-19 years and 50-59 years. The epidemic process developed mainly among the immunized population, which was indicated by a high proportion of vaccinated persons among those affected by this infection (62.8-66.6%) and a mild course of the disease in the majority of them. The present epidemiological situation in diphtheria was determined by patients not vaccinated against this infection. The proportion of severe cases among nonvaccinated children was 42.4-51.6% and lethal outcomes, 12.9-15.1%. Among nonimmunized adults these figures were equal to 43.1% and 9.3% respectively. The highest percentage of children, not vaccinated during the first years of their life, was registered among those in the asocial families, refugees and homeless persons. Among adults these were persons above 50 years old, as well as jobless persons of working age, pensioners and invalids, who had limited possibilities of undergoing vaccination due to their social position. It was these social and age groups that should be regarded as risk groups with respect to the severity of the course of diphtheria and lethality. To stabilize diphtheria morbidity, the full complex of prophylactic and antiepidemic measures, and primarily the immunization of the population, should be systematically carried out.

Adolescent↗

Is chronic widespread pain a predictor of all-cause morbidity? A 3 year prospective population based study in family practice.

OBJECTIVE: To investigate whether chronic widespread pain predicts illness seen in general practice in a 3 year followup period. METHODS: A postal questionnaire was conducted in an adult family practice population sample of 3968, and there were 2606 responders (66%). From the 2296 responders who consented to their record review, we identified 184 subjects with chronic widespread pain and assessed their outcome based on the first recorded morbidity within each of 15 categories during a 3 year followup period of computerized family practice records. Psychological distress at baseline was also measured using the Hospital Anxiety and Depression scale. RESULTS: Of the survey responders, 2089 subjects (91%) completed the full 3 year followup period. Out of the 15 main morbidity categories examined, 11 were associated with pain status at baseline. The strongest associations between chronic widespread pain at baseline and subsequent morbidity, adjusted for age, sex, and social deprivation, were for musculoskeletal (MSK) disorders (rate ratio 4.36; 95% confidence interval 3.2-5.9), accidents (2.46; 95% CI 1.2-5.1), mental health disorders (2.24; 95% CI 1.5-3.3), dermatological disorders (2.16; 95% CI 1.6-2.9), and infections (1.96; 95% CI 1.3-2.9). Controlling for psychological distress reduced the strength of associations between chronic widespread pain and future morbidity, but 9 of the 11 were still statistically significant. In the 3 year followup period, an estimated 7.7% of all non-MSK and 12.6% of all MSK morbidity consultations were related to chronic widespread pain as reported at baseline. CONCLUSION: People who report chronic widespread pain subsequently consult more frequently about non-MSK and MSK problems than people with no pain, and this is not explained by psychological distress. The overall impact on healthcare use is substantial. Our study provides more evidence for overlap and links between morbidities that may be part of a larger pathological or somatization syndrome.

Adolescent↗

[Dynamics of viral hepatitis A morbidity in Minsk].

The results of the analysis of hepatitis A morbidity during the period of 1996 - 2001, are presented. The cyclic character of this morbidity in its dynamics over the period of several years was noted with the maximum morbidity level reached in 2000. The monthly dynamics of hepatitis A morbidity reflected its seasonal character with the maximum increase in autumn and winter. The virological control of drinking water revealed its contamination in spring and summer, with no subsequent rise in morbidity. The control of sewage reflected the emergence of the virus in the city collector in accordance with the increased morbidity.

Health Surveys↗

A prospective study of morbidity pattern and nutritional status of a group of healthy newborns during their first year of life in a rural area near Alexandria.

The present work was planned to study morbidity pattern and nutritional status of a group of healthy new borns in a rural area near Alexandria (Abbis II, VIII villages) through a prospective follow up approach. Eighty two infants were followed up for 12 months. Each infant was subjected to 15 visits within the first year of life. Morbidity was recorded either from mother's history, records from rural health centres or detected by the researcher and expressed as morbidity risk exposures based on a tested scoring system. Anthropometric standards issued by WHO were used to classify the children's length for age, weight for age and weight for length in terms of a cut off point of 2 SD below the median of that of the reference. Gomez classification was used to diagnose undernutrition and Waterlow system was used to diagnose growth stunting. Socioeconomic status of infants' families was also assessed. Results indicated a high prevalence of morbidity risk exposure, growth retardation and under nutrition with a tendency for gradual increase towards the end of the follow up. The results also proved that diarrheal diseases were still the most common illness among infants followed by respiratory tract infections. Investigation of the effects of socioeconomic status on morbidity risk exposure proved its significance at the end of the follow up. The results also illustrated a significant effect of morbidity risk exposure on the nutritional status at the end of the first year.

Child Welfare↗

[Morbidity studies in children's nurseries].

In 1986-1988 the indices of absence morbidity taken from monthly reports of crèches were registered in 8 crèches of Dresden and were compared with the real total morbidity, which had been registered with help of a symptom catalogue for one year. The total morbidity amounted to more than the double of absence morbidity, the total of the illness days per case amounted to 8.42 days and the days of absence morbidity amounted 7.3. The description of infection groups with help of quarters (according to Adam) on the basis of the registered total morbidity showed differences with regard to: average illness period per case (children susceptible to infections: 9.33 d; children robust to infections: 6.82 d) and average recurrence period (children susceptible to infections: 15.7 d; children robust to infections: 78.2 d). Probable causes of susceptibility to infections and conclusions hence to be drawn.

Child Day Care Centers↗

Relationships between morbidity and development in mildly to moderately malnourished Kenyan toddlers.

This study explored the extent to which morbidity in 110 mildly to moderately malnourished Kenyan toddlers was associated with developmental outcomes. Morbidity information was collected from the 18th to 30th months. Concurrent assessments of vocalization, play, and performance on the Bayley scales were obtained. At 5 years, a follow-up battery of cognitive tests was administered. Female toddlers who suffered more illness generally performed less well on developmental measures than their healthier female peers. These children vocalized and played less and performed less well on the Bayley Mental scales at 30 months and on the cognitive battery at 5 years. For the boys, development was largely independent of morbidity. Morbidity was related to patterns of care giving for both boys and girls, but it was not associated with socioeconomic status or food intake. However, girls who were ill more often were shorter and lighter. Relations between morbidity and development in the girls remained statistically significant when other variables, which were also related to development (such as care giving, socioeconomic status, parental IQ and literacy, food intake, and anthropometry) were considered. This suggests that morbidity, in these female toddlers, had an effect on development above and beyond other variables typically associated with malnutrition.

Child Development↗