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PubMed1994

Influence of co-morbidity on mortality and morbidity in patients treated with hemodialysis.

It has been established that mortality among US end-stage renal disease patients is higher than in many other developed countries. The explanation for this apparent difference in outcome results has caused considerable concern. The explanations for this difference are complex and could include differences in case mix as well as indices of severity of illness. To evaluate potential patient-based explanations for these discrepancies, we have evaluated existing reports as well as the available database at the Regional Kidney Disease Program at Hennepin County Medical Center, with particular emphasis on medical co-morbidity present in US end-stage renal disease patients. These data indicate that increasing age, a greater prevalence of diabetes mellitus patients, and a greater proportion of end-stage renal disease patients with complex medical co-morbidity contribute to the higher mortality seen in US patients receiving hemodialytic therapies.

Comorbidity↗
PubMed1996

Collecting morbidity data in general practice: the Somerset morbidity project.

OBJECTIVE: To collect a valid, complete, continuous, and representative database of morbidity presenting to primary care and to use the data to help commission services on the basis of local need and effectiveness. SETTING: Computerised general practices in Somerset. METHODS: Participating general practices were selected to be representative of the district health authority population for general practice and population characteristics. All conditions presented at face to face consultations were assigned a Read code and episode type and the data were regularly validated. Data were sent by modem from the practices via a third party to the health authority each week. MAIN OUTCOME MEASURES: Proportion of consultations coded and accuracy of coding. RESULTS: 11 practices agreed to participate. Validations for completeness during April 1994 to March 1995 revealed that 96.4% of the records were coded; 94% of the 1090 records validated had appropriate episode types and 87% appropriate Read codes. The results have been used to help formulate the health authority's purchasing plans and have enabled a change in the local contracts for surgery for glue ear. CONCLUSIONS: The project has shown the feasibility of establishing a network of practices recording and reporting the morbidity seen in primary care. Early indications are that the data can be useful in evidence based purchasing.

Adolescent↗
PubMed2001

Quality-of-life assessment of morbidly obese patients who have undergone a Lap-Band operation: 2-year follow-up study. Is the MOS SF-36 a useful instrument to measure quality of life in morbidly obese patients?

BACKGROUND: Quality of life (QoL) was tested in a 2-year postoperative study using the Medical Outcome Study Short Form 36 (MOS SF-36) to assess preoperative and 1 and 2 year postoperative QoL among one group of female patients (group 1, n = 42) and a 2 year postoperative QoL study in a second group of female patients (group 2, n = 9) who underwent a stomach reduction operation involving open surgical placement of a Lap-Band during the year 1997. METHODS: The QoL of 42 patients (group 1) was assessed at most 20 hours before surgery and 1 and 2 years (12 and 24 months) postoperatively using a randomized pre-test/post-test design. The QoL of 9 patients (group 2) was assessed 2 years (24 months) postoperatively using a randomized post-test design only. The results were compared with the standardized Dutch norm datascale. Statistical data were analyzed with SPSS versions 10.0. RESULTS: The placement of a Lap-Band in group 1 resulted in a significant reduction in Body Mass Index (BMI) in the first and second-year follow-up. Mean BMI declined significantly from 40.7 kg/m2 preoperatively to 33.1 kg/m2 at the 1-year follow-up, to 31.3 kg/m2 at 2-year follow-up. In group 2 BMI also declined significantly from 43.0 kg/m2 preoperatively to 34.2 kg/m2 at 1-year follow-up to 32.1 kg/m2 at the 2-year follow-up. Compared to the MOS SF-36 standardized Dutch norm data, a significant improvement in the QoL was seen on the effect variable bodily pain, mental health and general health perceptions in group 1. Although the bodily pain, general health and mental health perceptions increased significantly 2 years postoperatively (group 1) compared with the Dutch standardized norm data, the preoperative general health and mental health perceptions of morbidly obese patients were, like all other preoperative effect variables, not significantly different from the scores on the Dutch standardized norm scale. CONCLUSION: Although other authors found that QoL improves after surgical-induced weight loss, showing significant improvements on patients' perception of their health status, these findings were not confirmed in the present study. The findings show only a significant difference in bodily pain, general health and mental health perception before and after surgical intervention and preoperatively in group 1 compared to the Dutch standardized norm data. Because of small sample size (n = 9), no significant results were found in group 2 compared to the Dutch Standardized norm data. Based on earlier and present findings, further study is recommended to ascertain whether the MOS SF-36 is valid in morbidly obese patients and whether the response set has an influence on QoL studies of these patients.

Adult↗
PubMed1991

Changes in practice morbidity between the 1970 and 1981 national morbidity surveys.

The primary aim of the study was to evaluate practice differences in reported morbidity in the second and third national morbidity surveys (1970/71, 1981/82) and to discuss their cause. A secondary aim concerned the validation of trends identified from analysis of the data from the total populations in the practices. Altogether 19 practices participated in both surveys. Annual prevalences (that is, the number of patients attending the general practitioner with a condition per 1000 persons at risk) were examined for: all conditions; each of three categories of seriousness of disease; diseases aggregated by chapter of the International classification of diseases; and each of 130 rubrics of the disease classification. Annual prevalence for 'all conditions' was approximately the same for males in both surveys, whereas for females there was an increase. In both sexes, annual prevalence for 'serious conditions' increased slightly and for 'trivial conditions' increased substantially. For 'intermediate conditions', there was a modest decrease in males. In the analysis at ICD chapter level, substantial increases in prevalence occurred in infectious diseases, nervous system diseases, circulatory diseases, genitourinary diseases, musculoskeletal diseases, symptoms, signs and ill-defined conditions, injuries and poisonings. Decreases were found in blood diseases, mental disorders and digestive diseases. Among 130 individual conditions examined, increased annual prevalence was found for mumps, fungal infections, hypothyroidism, diabetes, gout, senile dementia, angina, left heart failure, catarrh, hay fever and asthma, orchitis, acne, osteoarthritis and for some symptoms. Decreases were found for iron deficiency anaemia, anxiety state, refractive errors, haemorrhoids, chronic bronchitis, functional disorders of the stomach, carbuncle and skin infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Glutamine supplementation for preventing morbidity in preterm infants.

BACKGROUND: The amino acid glutamine is the preferred respiratory fuel for rapidly proliferating cells under normal conditions. Recent research has suggested a number of roles for glutamine during critical illness. This research has been largely performed in experimental animals and in adults in a variety of disease settings. There is little information on the role of glutamine in children and infants, or whether glutamine supplementation is beneficial in preterm babies. OBJECTIVES: To determine the effects of glutamine supplementation on morbidity and weight gain in preterm babies. SEARCH STRATEGY: Searches were made using Medline and Embase electronic databases and specific handsearching in the English language. The search strategy followed the guidelines of the Neonatal Cochrane Review Group. SELECTION CRITERIA: Randomised controlled trials comparing glutamine supplementation to no glutamine supplementation in preterm babies at any time from birth to discharge from hospital. DATA COLLECTION AND ANALYSIS: Data regarding clinical outcomes including duration of parenteral nutrition, time to full enteral nutrition, rate of weight gain, rate of positive blood cultures and duration of hospital stay were extracted by both reviewers. Analysis was performed by the primary reviewer (TRJT) in accordance with the standards of the Cochrane Neonatal Review Group. MAIN RESULTS: Three trials met the selection criteria. Data on proportion of babies having one or more of positive blood cultures were available from all three studies. Meta-analysis showed no significant difference between glutamine-supplemented and non-supplemented babies; RR = 0.73 (95% CI 0.44, 1.23), RD = -8.8% (95% CI -23.2, 5.5). Data for other outcome variables were pooled from two studies. There were no significant differences between glutamine-supplemented and non-supplemented babies for days to full enteral nutrition (WMD 0.42, 95% CI -3.0, 3.8), rate of weight gain (WMD 0.6 g/kg/d, 95% CI -1.6, 2.8) or days of hospital stay (WMD -2.4, 95% CI -14.9, 10.2). REVIEWER'S CONCLUSIONS: There is no evidence to support the routine use of parenteral or enteral glutamine supplementation in preterm babies. A large randomised controlled trial should be performed to determine whether or not glutamine supplementation enhances gut integrity and reduces sepsis rate.

Dietary Supplements↗
PubMed2001

Early volume expansion for prevention of morbidity and mortality in very preterm infants.

BACKGROUND: Reduced perfusion of organs such as the brain, heart, kidneys and the gastrointestinal tract may lead to acute dysfunction and be associated with permanent injury. Various strategies have been used to provide cardiovascular support to preterm infants including inotropes, corticosteroids and volume expansion. OBJECTIVES: In very preterm infants, does early volume expansion reduce morbidity and mortality. If volume expansion is effective, what type of volume expansion is most effective. SEARCH STRATEGY: The standard search strategy of the Neonatal Review Group was used. Searches were conducted of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register, MEDLINE, previous reviews including cross references, abstracts and conference proceedings. SELECTION CRITERIA: Randomised trials of early volume expansion with normal saline, fresh frozen plasma, albumin, plasma substitutes or blood compared to no treatment or another form of volume expansion in preterm infants < 32 weeks gestation or < 1500g were included. Volume expansion was defined as at least 10 mls/kg given in the first 72 hours of life. DATA COLLECTION AND ANALYSIS: Standard methods of the Neonatal Review Group with use of relative risk (RR), risk difference (RD) and weighted mean difference (WMD). The fixed effects model using RevMan 4.1 was used for meta-analysis. Data from individual studies were only eligible for inclusion if a least 80% of infants were reported for that outcome. MAIN RESULTS: Seven studies were included. Five studies, four with data for mortality, compared volume to no treatment. Most studies enrolled very preterm infants on the basis of gestation or birthweight. Two studies comparing different types of volume expansion enrolled very preterm infants with hypotension. No study enrolled infants on the basis of low blood flow. One study examined the effect of volume expansion on blood flow but in normotensive very preterm infants. Comparing volume and no treatment, 4 studies with a total of 940 very preterm infants reported no significant difference in mortality (RR 1.11, 95% CI 0.88, 1.40). The large NNNI 1996 study reported no significant difference in severe disability (RR 0.80, 95% CI 0.52, 1.23), cerebral palsy (RR 0.76, 95% CI 0.48, 1.20) and combined death or severe disability (RR 1.00, 95% CI 0.80, 1.24). Although one small study (Beverley 1985) reported reduced P/IVH with volume expansion, this was not supported by any other study. No significant difference was reported in grade 3-4 P/IVH and combined death or grade 3-4 P/IVH. One study (NNNI 1996) reported no significant difference in the incidence of hypotension. The finding of decreased necrotising enterocolitis and increased sepsis in infants who received fresh frozen plasma compared to a gelatin-based plasma substitute or no treatment in one study should be treated with caution. No significant differences in mortality or disability were found in this study. In one small study, there were no significant differences in outcomes between hypotensive infants who received colloid (albumin) or crystalloid (saline). REVIEWER'S CONCLUSIONS: There is no evidence from randomised trials to support the routine use of early volume expansion in very preterm infants without cardiovascular compromise. There is insufficient evidence to determine whether infants with cardiovascular compromise would benefit from volume expansion. There is insufficient evidence to determine what type of volume expansion should be used in preterm infants (if at all) or for the use of early red cell transfusions. The trial comparing colloid (albumin) and crystalloid (saline) in hypotensive preterm infants found no benefit in using a more expensive blood product compared to saline, but is insufficiently powered to detect an important clinical difference.

Blood Volume↗
PubMed2000

Kangaroo mother care to reduce morbidity and mortality in low birthweight infants.

BACKGROUND: Kangaroo mother care (KMC), defined as skin-to-skin contact between a mother and her newborn, frequent and exclusive or nearly exclusive breastfeeding, and early discharge from hospital, has been proposed as an alternative to conventional neonatal care for low birthweight (LBW) infants. OBJECTIVES: To determine whether there is evidence to support the use of KMC in LBW infants as an alternative to conventional care after the initial period of stabilization with conventional care. SEARCH STRATEGY: We used the standard search strategy of the Neonatal Review Group of the Cochrane Collaboration. MEDLINE, EMBASE, LILACS, POPLINE and CINAHL databases, and the Cochrane Controlled Trials Register (Cochrane Library) up to Issue 2, 2000, were searched using the key words terms "kangaroo mother care" or "kangaroo mother method" or "skin-to-skin contact" and "infants" or "low birthweight infants". SELECTION CRITERIA: Randomised trials comparing KMC and conventional neonatal care in LBW infants. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. Statistical analysis was conducted using the standard Cochrane Collaboration methods. MAIN RESULTS: Three studies, involving 1362 infants, were included. All the trials were conducted in developing countries. The studies were of moderate to poor methodological quality. The most common shortcomings were in the areas of blinding procedures for those who collected the outcomes measures, handling of drop outs, and completeness of follow-up. The great majority of results consist of results of a single trial. KMC was associated with the following reduced risks: nosocomial infection at 41 weeks' corrected gestational age (relative risk 0.49, 95% confidence interval 0.25 to 0.93), severe illness (relative risk 0.30, 95% confidence interval 0.14 to 0.67), lower respiratory tract disease at 6 months follow-up (relative risk 0.37, 95% confidence interval 0.15 to 0.89), not exclusively breastfeeding at discharge (relative risk 0.41, 95% confidence interval 0.25 to 0.68), and maternal dissatisfaction with method of care (relative risk 0.41, 95% confidence interval 0.22 to 0.75). KMC infants had gained more weight per day by discharge (weighted mean difference 3.6 g/day, 95% confidence interval 0.8 to 6.4). Scores on mother's sense of competence according to infant stay in hospital and admission to NICU were better in KMC than in control group (weighted mean differences 0.31 [95% confidence interval 0.13 to 0.50] and 0.28 [95% confidence interval 0.11 to 0.46], respectively). Scores on mother's perception of social support according to infant stay in NICU were worse in KMC group than in control group (weighted mean difference -0.18 (95% confidence interval -0.35 to -0.01). There was no evidence of a difference in infant mortality. However, serious concerns about the methodological quality of the included trials weaken credibility in these findings. REVIEWER'S CONCLUSIONS: Although KMC appears to reduce severe infant morbidity without any serious deleterious effect reported, there is still insufficient evidence to recommend its routine use in LBW infants. Well designed randomized controlled trials of this intervention are needed.

Breast Feeding↗
PubMed2004

Background morbidity of headache in an adult general population. Results of the Austrian SERMO (Self-Reported Morbidity) study.

STUDY OBJECTIVE: To assess period and point prevalence of headache in Austria and the influence of sociodemographic factors and seasonal variations. DESIGN: Data for the prevalence of headache were drawn from the database of seven representative surveys in the SERMO study (Self-Reported Morbidity Study). The aims of the SERMO study are to describe and monitor the characteristics of background morbidity in the Austrian population. The study is based on face-to-face interviews. Headache/migraine was one of 36 disorders the interviewed persons were asked about. SETTING: The representative samples of the Austrian general population were selected by the "quota-procedure". Thus each cross sectional sample is representative for the entire Austrian population. PARTICIPANTS: The study population consisted of 7,162 Austrian people over 15 years of age. RESULTS: About one fifth (20.1%) of the Austrian adult population reported having headaches during the year (prevalence 26.4% in women vs. 13.0% in men, p<0.001). Period prevalences varied from 19.6% in August to 23.1% in October 1995. Mean point prevalence in the general population was 5.7% (3.6% in men vs. 7.7% in women, p<0.001). The highest point prevalence (8.0%) was observed among people over 60. Whereas period prevalence showed no trend with age or education, we found increasing point prevalence with age and lower levels of education. In general, significantly more people with self-reported headache suffered from stress (39.1% vs. 33.7%, p<0.001) and chronic diseases (33.6% vs. 23.2%, p<0.001) and took drugs regularly (all kinds of medication: 44.3% vs. 26.8%, p<0.001). CONCLUSIONS: Headache is one of the most commonly experienced symptoms in Austria. The most common concomitant disease in the study population as a whole was hypertension. People with headache had a higher prevalence of hypertension, rheumatic diseases, venous diseases, diabetes and a higher consumption of drugs. Therefore, headache, as one aspect of multimorbidity or a symptom of other diseases, could be an indicator of impaired well-being and poor health.

Adolescent↗
PubMed1986

Long-term morbidity and mortality in morbidly obese adolescents after jejunoileal bypass.

To evaluate the long-term results of jejunoileal bypass in the treatment of morbidly obese adolescents, we studied 11 patients who underwent surgery between 1972 and 1974. More than 10 years after surgery, 45% of the patients had extremely satisfactory results (correction of morbid obesity). Three patients died within the year after surgery, two of them under extenuating clinical circumstances. There have been no subsequent deaths. All eight survivors were found to have metabolic abnormalities to various degrees. Two patients had a total of five pregnancies; each had one healthy infant, and three pregnancies ended in abortion (one spontaneous). Two patients had significant medical problems related to the procedure but basically remained in good health, whereas three patients had severe symptoms requiring reanastomosis. Of the five patients who continue with the bypass, none has become significantly obese. They have all maintained a weight loss of between 45 and 90 kg, and as adults express strong feelings in favor of the procedure. This series demonstrates that, although significant weight loss was maintained, and improvement in the quality of life for half of our patients was dramatic, side effects and complications continue to develop, mandating careful follow-up for an indefinite time.

Adaptation, Psychological↗
PubMed1997

Psychiatric morbidity in primary public health care: a multicentre investigation. Part II. Hidden morbidity and choice of treatment.

A total of 1,281 patients were examined during consultation with their GP in a Nordic multicentre study focusing on the prevalence of psychiatric illness, hidden psychiatric morbidity, treatment and pathways to specialized care. The methodology and prevalence were reported in an accompanying paper. The present paper presents results concerning the variables hidden psychiatric morbidity, treatment and pathways to specialized care. The GPs detected 44% of the psychiatric cases compared with the result of a diagnostic interview (PSE). The distinction between psychosis and non-psychosis did not influence the GPs' ability to detect a mental illness. According to the GPs' assessment the majority of patients suffering from a mental disorder consulted their GP about physical complaints. The GPs treated the patients themselves, and only a limited number of cases were referred to psychiatrists or psychologists.

Adolescent↗
PubMed2000

Respiratory morbidity in primary care. A population based study, using practices from the Scottish Continuous Morbidity Recording Research Database.

OBJECTIVE: To elucidate the patterns and period prevalences of respiratory disease with special reference to asthma (including wheezing) in view of its increasing reported prevalence. DESIGN: Observational study based on prospectively entered data. SETTING/SUBJECTS: Fifty five Continuous Morbidity Recording (CMR) practices with 290,000 patients located throughout Scotland. RESULTS: Respiratory problems accounted for a large proportion (17%) of total general practice workload. Upper respiratory tract infections were the commonest presentation in pre-school children, followed by asthma but with an ever increasing proportion of consultations for bronchitis and lower respiratory tract infections with advancing adult age. There was no significant correlation between deprivation and the incidence of asthma. CONCLUSIONS: Observed rates and patterns of disease for CMR practices, were similar to previously reported studies. The large number of presentations by patients in early childhood with minor respiratory illnesses and in particular upper respiratory tract infections are likely to reflect a heightened level of parental anxiety where interpretation of clinical signs and separation of simple and significant illness can be difficult. CMR has also been shown to be of use in helping to investigate links between deprivation and disease incidence or severity. Potential uses for CMR include the study of whole population morbidity and utilisation of primary care services.

Database Management Systems↗
PubMed1989

Morbidity from subarachnoid spinal anaesthesia--a prospective study on the post-operative morbidity from subarachnoid spinal anaesthesia.

A clinical survey was conducted on 274 patients who had surgery under subarachnoid spinal anaesthesia. The anaesthetic was performed with either a 23 gauge or 25 gauge needle. All patients were interviewed on the second and sixth post-operative days. Data on morbidity (especially post-dural puncture headache and backache) was collated and analysed with respect to needle gauge. Backache was the most common complaint (20.5%). Using the finer needle did not reduce this aspect of morbidity. Post-dural puncture headache on the other hand was significantly reduced by the use of the finer 25 gauge needle (from 12.3% to 4.9%).

Adolescent↗
PubMed1992

The Hawaii EMS-C project data: I. Reducing pediatric emergency morbidity and mortality; II. Statewide pediatric emergency registry to monitor morbidity and morality.

During a 12-month period ending on 11/30/88, data were collected on 16,010 pediatric patients who visited a pediatric emergency department (ED). These ED patients prospectively fell into one of the target areas for further study, including wheezing (15%), trauma (excluding burns; 29%), burns (1%), water-related injuries (1%), ingestions and toxic substance exposures (2%), child abuse (3%), handicapping conditions (5%), preventable incidents (33%), and ambulance arrivals (7%). Handicapped patients were more likely to require an ambulance. Younger patients, males, and patients with handicaps, wheezing, and Medicaid insurance were more likely to visit the ED on multiple occasions. Primary care physicians could be identified in 77% of the cohort. Large-scale interventions to reduce preventable pediatric morbidity and mortality have suffered from difficulties in documenting their effect in a population-based sample. A statewide pediatric emergency encounter registry is proposed.

Adolescent↗
PubMed2006

Anesthetic management of morbidly obese and super-morbidly obese patients undergoing bariatric operations: hospital course and outcomes.

BACKGROUND: Although the implications for the anesthetic and perioperative care of severely obese patients undergoing weight loss operations are considerable, current anesthetic management of super-obese (SO) patients (BMI > or =50 kg/m(2)), including super-super-obese (BMI > or =60) derives from experience with morbidly obese (MO) patients (BMI 40-49.9 kg/m(2)). We compared anesthetic and perioperative data of SO patients and MO patients undergoing weight loss operations to evaluate if anesthetic management influenced outcome. METHODS: A retrospective analysis was performed on data from 150 consecutive patients (119 MO, 31 SO) undergoing bariatric surgery between May 2000 and March 2005. Data analyzed included preoperative anesthetic assessment, anesthetic management, postoperative care, and intra- or postoperative complications. RESULTS: There were no differences in anesthetic management or in postoperative course or outcome between MO and SO patients. Intraoperative surgical complications occurred in 26% (n=8) in the SO group and 14% (n=15) in the MO group (P<0.01). CONCLUSIONS: No differences in outcome occurred between MO and SO patients undergoing bariatric operations under similar anesthetic management. Anesthesia for weight loss surgery can be safely performed on SO patients with the understanding that these patients are not at risk per se due to their higher BMI. The degree of obesity influenced only the incidence of intraoperative surgical complications.

Adult↗
PubMed2000

The National Morbidity, Mortality, and Air Pollution Study. Part II: Morbidity and mortality from air pollution in the United States.

BACKGROUND: Epidemiologic time-series studies conducted in a number of cities have identified, in general, an association between daily changes in concentration of ambient particulate matter (PM) and daily number of deaths (mortality). Increased hospitalization (a measure of morbidity) among the elderly for specific causes has also been associated with PM. These studies have raised concerns about public health effects of particulate air pollution and have contributed to regulatory decisions in the United States. However, scientists have pointed out uncertainties that raise questions about the interpretation of these studies. One limitation to previous time-series studies of PM and adverse health effects is that the evidence for an association is derived from studies conducted in single locations using diverse analytic methods. Statistical procedures have been used to combine the results of these single location studies in order to produce a summary estimate of the health effects of PM. Difficulties with this approach include the process by which cities were selected to be studied, the different analytic methods applied to each single study, and the variety of methods used to measure or account for variables included in the analysis. These individual studies were also not able to account for the effects of gaseous air pollutants in a systematic manner.

Adolescent↗
PubMed1992

The compression of morbidity hypothesis: promise and pitfalls of using record-linked data bases to assess secular trends in morbidity and mortality.

Individuals who are 65 years of age and older have exhibited unprecedented declines in mortality over the past few decades in the United States. Whether this increased survival has been accompanied by delays in the onset of disease or greater age-specific morbidity remains unanswered because of a paucity of reliable information on secular trends in age-specific disease incidence and survival. The Rochester Epidemiology Project (REP) is one of a few existing medical record linkage systems that offer promise of providing some of the necessary information. Several examples are presented that illustrate the potential of medical record-linked data bases for examining secular trends in the association between age at onset of disease and age at death.

Age Factors↗
PubMedDate not supplied

[Certain methodological problems concerning the study of occupational morbidity and morbidity related to work].

Research on occupational and occupationally-related morbidity is essential for setting up a system of measures designed to promote health and well-being in industrial workers. The right conclusions can only be drawn and the adequate decisions made after data on occupational and occupationally-related diseases have been accurately stored, processed, interpreted and evaluated. Starting from the vast amount of information collected in some branches of national economy and yielded by routine statistic procedures, the author attempts to assess systems of storage and retrieval currently used for decision-oriented data. It is suggested that essential changes could be effected in today's system for analysing data on occupational and occupationally-related diseases on the basis of decentralized evidence.

Bulgaria↗
PubMed1981

Under five's morbidity & mortality in Dacca Medical College Hospital & morbidity pattern at P.G. hospital & Lionhati Health Project.

The present study was carried out in OPD of PGH, LHP., ID and OPD of DMCH in an attempt to identify the major determinants of health, nutritional and environmental problems which are being faced by children below age five in the urban and rural areas of Bangladesh. The mean age of the children who suffer from infectious disease are between 2-3 years old. Children between 1 and 2 year suffer from acute disease and die frequently. Female children attend less in these centres than the fellow male children. Due to socio-economic reasons, traditional joint family system is changing to nuclear type. Static health care institutions are less utilised by rural people. Educated fathers seek care quickly. Low income groups attend more in DMCH (OPD). Mean family size above 6. The sleeping rooms are overcrowded. Immunization is not popular in rural areas. Rural women receive less care related to pregnancy, childbirth and puerperium. Height and weight of these children however, are similar to the national nutrition survey results. The leading cases of morbidity and mortality are from infectious diseases. The study gives an account of health status of rural and urban community.

Bangladesh↗