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PubMed1980

[Calculation of trends in typhoid morbidity in different regions of the country].

The relationship linearity criterion and its derivatives were used in processing the mass of official statistical data on typhoid morbidity throughout the whole territory of the USSR and in the union republics during the period 1950-1976. In the majority of the union republics (the RSFSR, the Ukrainian, Byelorussian, Georgian, Armenian, Moldavian, Lithuanian, Latvian and Estonian SSR) the time course of typhoid morbidity was found to have a linear character and could be adequately described by the exponential function. The calculation of the average rate of annual decrease in typhoid morbidity in the above-mentioned union republics and the extrapolation of the tendencies of morbidity decrease for the last 20 years indicated that the morbidity level in the USSR would decrease by 6.14%, varying from 3.09% to 9.89% in individual union republics. The authors believe that similar rates of decrease in typhoid morbidity in different regions of the country can be attributed to reduced circulation of the causative agent of this infection and to the constant radical improvement of the sanitary and hygienic conditions of the Soviet people.

Epidemiologic Methods↗
PubMedDate not supplied

[Morbidity and mortality related to gastroenteroanastomosis in advanced gastric cancer].

OBJECTIVE: Determination of the postoperative morbidity and mortality after gastroenterostomy in patients with unresectable gastric cancer. STUDY DESIGN: Retrospective review of clinical records of all patients with obstructive distal gastric cancer who underwent gastroenterostomy at the Instituto de Enfermedades Neoplásicas between 1980 and 1993. The following factors were analyzed: age, sex, hemoglobin, albumin, preoperative risk, ascites, extent of disease, operative time, hospital stay, morbidity and mortality. RESULTS: 198 gastroenterostomy were done with a morbidity and mortality rates of 20% and 10%, respectively. Pneumonia was the principal cause of postoperative morbidity and mortality. High operative risk, adjacent organ invasion by the tumor and peritoneal metastasis were factors associated with increased postoperative morbidity (p > 0.05). High operative risk was the only prognostic factor for postoperative mortality (p < 0.01). CONCLUSIONS: Because of high postoperative morbidity and mortality, gastroenterostomy should not be done in patients with unresectable gastric cancer and high preoperative risk.

Adult↗
PubMed1976

[The pre-morbid personality of schizophrenics in the literature of the last hundred years (author's transl)].

A survey of the literature on the primary personality of schizophrenics shows that the essential concepts derive from Kraepelin (1893), E. Bleuler (who also introduced the technical term "schizoid", 1911) and C.G. Jung introversion; 1913). E Kretschmer (1921) adopted these preliminary findings and integrated them into his system of "Constitution" which greatly stimulated research in this field. Most of the following investigations confirmed his hypotheses on the basis of clinical impressions. A few only criticised his teaching, particularly as a theoretical concept. The musculo-somatotonic type apart, Sheldon's (1940) research agrees with Kretschmer to a large degree. Later investigators, however, could not sufficiently support Sheldon's constitutional biology on empirical grounds. No further pre-morbid types were developed in the following years, if one discards the somewhat rare "stormy" character (Arieti, 1955). All attempts to discover differences between the pre-morbid development of personality and the subheadings of schizophrenia failed. Pre-morbid sexual development is not typical, but the disturbances of contact are in the foreground. Whether schizophrenics differ later in their intelligence is still undecided. But it appears certain that, even before the start of their illness, they achieve a lower social status than their siblings. There exists a large experimental psychologic literature on relationships between the original personality, symptoms and psychophysiologic correlates in which it is confirmed again and again that bad pre-morbid adaptation corresponds closely with the severity of symptoms and loss of achievement. There are no consonant result of investigations into the frequency of schizoid structures in schizophrenics, in psychiatric control groups and in the normal population. Psychometric techniques have been used only rarely, but existing publications confirm in principle that schizophrenics are markedly more schizoid than control groups. As with schizophrenia, there are contrasting ideas as to the cause and pathogenesis of the pre-morbid personality. Psycho- and socio-genetic, behavioral, genetic and neurochemical hypotheses have their adherents. According to recent studies of adoption the genetic factor appears to predominate. The clinician relies on pre-morbid development of the personality in his search for a "kink in the life line" or in his assessment of the quality of remissions. There is general agreement that a schizoid primary personality has an unfavorable influence on the long-term prognosis. This is still true today, in spite of modern possibilities of treatment and rehabilitation. Prophylactic aspects have been discussed for a long time but have remained unhelpful clinically. Often it may be difficult to distinguish between schizoids and mild hebephrenias. In spite of this the clinical concept "schizoid" should never be used for "mild schizophrenia"...

Adoption↗
PubMed1995

Somatic presentation of psychiatric morbidity in general practice.

BACKGROUND: Twenty per cent of new illnesses in general practice, and 3% of consecutive attenders, are incident cases of 'pure' somatization. AIM: This study set out to estimate the prevalence of consultations by patients with psychiatric morbidity who present only somatic symptoms (somatic presentation), and to compare this with the likely prevalence of pure somatization. METHOD: A cross-sectional survey of consecutive general practice attenders was carried out. Psychiatric morbidity was measured using the general health questionnaire. Pure somatization was defined as medical consultation for somatic symptoms that were judged by a psychiatrist during an interview to be aetiologically attributable to an underlying psychiatric disorder but which were not recognized as such by the patient. RESULTS: Of attenders 25% were identified as somatic presenters. Of the somatic presenters interviewed one in six were estimated to be pure somatizers, which would extrapolate to 4% of attenders. Though all somatic presenters were probable cases of psychiatric disorder, subjects in this group had lower scores on the general health questionnaire than those who presented with psychological symptoms. General practitioner recognition of psychiatric morbidity was significantly lower among somatic presenters than for other subjects with psychiatric morbidity. CONCLUSION: General practitioner recognition of psychiatric morbidity could be improved for all types of somatic presentation, regardless of the aetiology of patients' somatic symptoms. There is a danger that concentrating attention on pure somatization may mean that psychiatric morbidity in the more common undifferentiated form of somatic presentation will be overlooked.

Adult↗
PubMed1994

Relation between economic disadvantage and psychosocial morbidity in children.

OBJECTIVE: To examine the relation between low income and child psychosocial morbidity cross-sectionally and longitudinally. DESIGN: Cross-sectional survey with follow-up. SETTING: Ontario. PARTICIPANTS: Children aged 4 to 16 years from families selected by means of stratified, clustered and random sampling of 1981 Canada Census data. Results were based on the responses of 2503 children interviewed in 1983 and 1076 re-interviewed in 1987. OUTCOME MEASURES: Prevalence rates of psychiatric disorders, poor school performance and social impairment. RESULTS: There was a significant relation between low income and psychosocial morbidity, with a threshold at an income level of less than $10,000. Poor children 4 to 11 years of age were at greater risk of morbidity than poor children 12 to 16, but there were no significant age differences. Logistic regression revealed that low income and noneconomic factors (low maternal education and family dysfunction) shared significant independent influences on the prevalence of psychosocial morbidity. CONCLUSIONS: Low income is strongly associated with psychosocial morbidity in children. Both economic and noneconomic factors showed independent influences on morbidity. These findings have important clinical, scientific and policy implications.

Adolescent↗
PubMedDate not supplied

[Morbidity from hemoblastosis in the Rovenskiĭ district of Ukraine before and after the accident at the Chernobyl Nuclear Power Station].

Hemoblastosis morbidity in children and adult populations and its structure were studied during the period of 1981-1992 at Rovensky district of Ukraine, 6 northern districts of which were affected by radionuclides after Chernobyl AES accident. Primary documentation, actual and archival records were the object of study: registration diaries, records and ambulatory cards. Expeditional method of investigation. During the last 11 years a rise of hemoblastosise morbidity was stated in Rovensky district, especially after the accident, and it was confirmed by a profound statistical analysis of data on leukemia morbidity before and after the accident. Among different nosological forms after the accident the rate of leukemia morbidity as well as myeloma disease and malignant lymphoma morbidity, rose markedly. No significant difference was marked in hemoblastoses (excluding acute leukemia) in non-contaminated and contaminated with radionuclides regions of the district, and in contaminated zones depending on effective equivalent doze. Acute leukemia morbidity in contaminated regions after the accident was statistically reliably higher.

Accidents↗
PubMed1995

Surgical mortality and morbidity in malignant obstructive jaundice: a prospective multivariate analysis.

OBJECTIVE: To construct prognostic scores using multivariate analysis for morbidity and mortality in jaundiced patients with malignant biliary obstruction. DESIGN: Prospective study. SETTING: 16 university and 12 general hospitals affiliated to the French Association for Surgical Research. MAIN OUTCOME MEASURES: Results of application of severity indexes for mortality and morbidity constructed from 17 variables. That for mortality was: 0.0497 x age + 0.9219 x American Society of Anesthesiologists' (ASA) grade + 0.0037 x serum bilirubin concentration minus 0.0239 x prothrombin time + 0.0001 x white cell count minus 5.593. That for morbidity was: minus 0.7499 x ASA grade + 0.0294 x prothrombin time + 1.4220 x cause (0 = carcinoma of bile duct, 1 = pancreatic cancer) minus 1.5080 x operation (0 = bypass, 1 = resection) minus 1.537. RESULTS: The scores correctly predicted mortality in 77% and morbidity in 65% (infective morbidity in 73%). CONCLUSIONS: We recommend that when the mortality index is negative operation should be the treatment of choice, and when it is positive the patient should be advised to have non-surgical palliative treatment. When the morbidity index is negative the risk of complications is high, and when it is positive the risk is low. The application of these indexes allows for better choice of patients suitable for operative treatment of malignant biliary obstruction.

Adult↗
PubMedDate not supplied

[Mortality and morbidity of small premature infants (<1,500 g) in relation to presentation and delivery mode].

It is generally recommended in the literature that small premature babies with an expected weight of < 1500 g or < 32 WOP be delivered by cesarean section. The development of some of these small babies from the uterine muscle is very time-consuming and rough. For this reason, we have established the mode of the delivery at the Nuremberg Women's Hospital on the basis of the criteria which also applies to the delivery of mature term babies irrespective of the gestational age and irrespective of their presentation. Of a total number of 10542 babies delivered, 219 babies < 1500 g in weight (2.07%) were born from 1987 to 1991. The extent to which differences in the mode of deliveries spontaneous/cesarean section result from the presentation of the small premature babies was investigates after five years. The mortality and morbidity were calculated separately for babies the weighing between 1500 g and 1000 g and for babies of < or = 999 g. Besides the perinatal and neonatal mortality, the mortality after the 29th day of life was also determined. The following parameters of early morbidity were established: 1. Respiratory distress syndrome++ (none/grade I-grade IV) 2. Intracranial hemorrhages (none/grade I-grade IV) Furthermore, the following parameters of late infant morbidity were determined after the first year of life. 1. Movement capacity (normal/hyperkinetic/apathic) 2. Development of the baby (corresponding to age/ slightly/severely retarded) Severely retarded fetuses with a gestational age of more than 32 weeks and a birth rate of < 1500 g were excluded from all calculations, so that ultimately 176 babies were included in the overall analysis. The total mortality of the children < 1500 g in weight was 14.3%, 15.7% were in the group between 1500 g and 1000 g and 25% were the mortality with regard to the presentation and the mode of delivery. The morbidity results indicate that only the group of babies between 1500 g and 1000 g in weight with breech presentation benefit from cesarean section. In the group of babies < or = 999 g, there are no differences in morbidity with regard to the mode of delivery and the presentation. The results found show that frequencies of cesarean section in excess of 40% improve neither the mortality nor the morbidity of small premature babies. The decision to carry out cesarean section is based more on individual influences and the situation in the hospital in which the delivery takes place than on mortality of the baby or the mother.

Birth Weight↗
PubMed1995

Asthma self care efficacy and morbidity in polyclinic outpatients.

The new guidelines for the management of asthma require patients to participate in the management of their condition by exercising a high level of decision-making skills in self treatment. We evaluated the self care efficacy and morbidity of 198 asthmatic patients in primary care clinics and examined the factors likely to influence these management outcomes. About 70% of the patients were considered by conventional criteria to have significant morbidity requiring medical supervision. The most significant factors determining morbidity were knowledge of medications and attack management skills. Only a minority of the patients had satisfactory levels of these skills and knowledge. A high level of stigmatization from asthma was generally present among the patients but most of them appeared to possess a high level of self-confidence in the management of their asthma. These factors were also associated with asthma morbidity, but they were as likely to have resulted from morbidity as to have influenced it. The patients' attitude towards medications were mostly negative but their confidence in their doctors and their level of family support were high; none of these factors, however, were associated with morbidity. Attack management skills as a behavioural measure of self care efficacy was not significantly predicted by any of these personal or psychosocial factors. A practical implication of these findings is that asthma self management should focus on developing specific knowledge and skills in the self treatment of asthma attacks.

Adult↗
PubMedDate not supplied

[Clinical considerations regarding co-morbidity in childhood and adolescent anxiety disorders].

In the first part, the difficulties and deficiencies of the DSM-III and DSM-IV diagnostic manuals of the APA, and ICD-9 and ICD-10 of the WHO for this clinical field are discussed. The terms transversal and longitudinal or evolutional, nondirectional and bidirectional, co-morbidity, primary and secondary disorder, clinical co-belonging, concurrence, criteria of validity for clinical constructs, etc., are defined. The exaggerated frequency of co-morbidity is discussed, as well as some of its causes, artifacts and proposals for solution, their usefulness and importance. In the second part are analyzed changes in the different groups and forms of anxiety disorders and the consequences of changes in diagnostic criteria. The third part reviews the rates of prevalence of anxiety disorders in current bibliography. The fourth part reviews the bibliography on the co-morbidity of childhood and adolescent anxiety disorders with regard to the six clinical forms evaluated and mutual morbidity among these forms or types. Finally, the relations between the prevalence of these six types of disorder is examined in terms of age. There is a high frequency of transversal co-morbidity in the overanxiousness disorder and the other types of anxiety disorders, and it is postulated as a longitudinal co-morbidity expression of a possible evolutional relation between separation anxiety disorder and panic disorder with agoraphobia, which in turn is associated with depressive disorders.

Adolescent↗
PubMed1998

[Neonatal morbidity associated with meconial amniotic fluid].

BACKGROUND: The significance of meconium-stained amniotic fluid (MSAF) is discussed, both in regards to obstetric and pediatric management. The primary concerns regarding MSAF have been its significance as a sign of fetal distress/perinatal asphyxia and the prevention of associated morbidity such as meconium aspiration syndrome. The objectives of our study were: (1) To know the incidence and type of MSAF, (2) to study the associated morbidity in newborns with MSAF admitted to the Neonatal Care Unit (NCU), and (3) to analyze the perinatal differences between newborns with moderate versus thick MSAF. PATIENTS AND METHODS: A retrospective study was performed to know the incidence of MSAF in all of the deliveries in our hospital during a 4 year period. The consistency of meconium was classified into 3 classes, thin (light), moderate or thick (heavy). On the other hand, a prospective analysis was undertaken to determine the morbidity of all meconium-stained neonates admitted to our NCU during this period, mainly in relation to perinatal asphyxia, pulmonary, gastrointestinal and infectious pathology and neonatal mortality. RESULTS: The presence of MASF complicates 18% of all of our deliveries with it being mild in 10.8%, moderate in 4.4% and severe in 2.8%. Of all newborns with MSAF, one third were admitted to the NCU, mainly for two reasons, association with perinatal asphyxia (124 cases) and observation of a risk of meconium aspiration syndrome (85 cases). The main neonatal morbidities associated with MSAF in our populations were perinatal asphyxia in 56.1% (32 cases of severe perinatal asphyxia and 92 non-severe), pulmonary pathology in 34% (meconium aspiration syndrome in 32 cases and other respiratory abnormalities in 43) and gastrointestinal pathology in 30.5% (transitory feeding intolerance in all cases). Four cases of meconium-stained neonates were exitus. The neonatal morbidity is significantly more frequent in relation to thick meconium and also if perinatal asphyxia is associated to MSAF. CONCLUSIONS: Although the relationship between MSAF and perinatal asphyxia is controversial, their association increases neonatal morbidity. In accordance with our results, thick meconium is implicated as a risk factor influencing the well being during the intrapartum and postpartum periods.

Birth Weight↗
PubMed1998

Morbidity and mortality of early postoperative intraperitoneal chemotherapy as adjuvant therapy for gastric cancer.

Intraperitoneal chemotherapy (IC) is emerging as a valuable adjuvant therapeutic modality in patients with gastric cancer. The purpose of this study was to assess morbidity and mortality of early postoperative IC (EPIC) in gastric cancer patients. Two hundred forty-eight gastric cancer patients thought to have resectable cancer were randomized intraoperatively to receive EPIC with mitomycin C on postoperative day 1 and 5-fluorouracil on postoperative days 2 to 5 versus surgery only. Sixty-four patients who were stage IV at histopathologic examination remain in the analysis. Morbidity and mortality were compared using Fisher's exact test. All patients completed the therapy. In the study group, overall morbidity was higher than in the control group (28.8% versus 20.3%, respectively), although the difference was not significant (P = 0.121). Intra-abdominal sepsis without anastomotic leak (P = 0.008) and bleeding (P = 0.002) occurred significantly more often in the study group. Also, 37.6 per cent of patients who received EPIC experienced a variety of minor complications attributable to EPIC. Postoperative mortality was higher in the study group (5.6%) than in controls (0.8%), but not significantly (P = 0.299). Patients treated with EPIC stayed in the hospital an average of 4 days longer (P = 0.002); in patients with morbidity, however, there was no difference with the control group. A period analysis of the morbidity demonstrated that it followed the pattern of a learning curve. Surgery with EPIC tended to increase the postoperative morbidity and mortality. The therapy-associated risk must be justified by a significant improvement in survival of treated patients with stage III disease. Selective application of perioperative IC may be indicated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1993

General and HIV-1-associated morbidity in a rural Ugandan community.

OBJECTIVES: The AIDS epidemic in sub-Saharan Africa affects whole communities, adding to the already high burden of morbidity. Reports of AIDS cases are usually from hospital attenders, often diagnosed using the World Health Organization (WHO) clinical case definition. Little is known about the extent of HIV-associated morbidity in the general population. The objectives of this study were to describe the prevalence of (1) markers of general morbidity and (2) the criteria of the WHO clinical case definition for AIDS and (3) to determine the association between these markers and HIV-1 serostatus in a rural Ugandan community. METHODS: A survey was conducted among the adult population (aged > or = 13 years) of 15 neighbouring villages in Masaka District, south-west Uganda. The survey included medical history, physical examination and testing for HIV-1 antibodies. RESULTS: The HIV-1 seroprevalence among 4175 out of 5278 (79%) eligible adults was 8.2%. Current health problems were reported by 57.6% of adults, with increased rates in HIV-1-positive subjects, women and older people. Five of the 10 most common complaints showed significant associations with HIV-1 status, as did reported genital ulcer and vaginal discharge. The crude HIV-1 attributable disease burden in the population was 1.2% for current illness, 4.3% for previous serious illness and 9.9% for illness leading to hospital admission. Overall, 11 (3.3%) of the HIV-1-positive and nine (0.2%) of the HIV-1-negative subjects had AIDS as defined by the clinical case definition. The positive and negative predictive values and specificity were 55.0, 92.0%, and 99.8%, respectively. CONCLUSIONS: Against a background of high general morbidity, we observed a relatively small population attribution of HIV-1-associated morbidity. The results indicate that the clinical AIDS case definition may provide a useful tool for population surveys.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Nebulizer use in inner-city children with asthma: morbidity, medication use, and asthma management practices.

OBJECTIVE: To assess the frequency of nebulizer use, describe morbidity and patterns of medication administration, and examine the potential relationships between inhaled anti-inflammatory medication administration, asthma morbidity, and asthma management practices in children with asthma using a nebulizer compared with children with asthma not using a nebulizer. RESEARCH DESIGN: A cross-sectional, descriptive survey of previous events. SETTING: Elementary schools and participants' homes in Baltimore, Md, and Washington, DC. PARTICIPANTS: Six hundred eighty-six families of children aged 5 to 12 years with a diagnosis of at least mild, persistent asthma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Asthma morbidity, health care utilization, pattern of asthma medication administration, nebulizer use, and asthma management data were collected by telephone survey administered to caregivers. Nebulizer use was defined as use at least 1 or more days per month during the last 6 months. Of 686 children identified, 231 (33%) reported current nebulizer use. Nebulizer users had significantly increased lifetime hospital admissions, hospitalizations, and emergency department visits in the last 6 months compared with nonnebulizer users. Inhaled corticosteroid administration was low for both groups (nonnebulizer users, 8%; nebulizer users, 15%). In the nebulizer users group, administration of inhaled anti-inflammatory medications was associated with increased asthma morbidity (increased hospitalizations, days and nights with symptoms, and oral steroid use). CONCLUSIONS: Nebulizer use by inner-city children with asthma is higher than anticipated but is not associated with reduced asthma morbidity. This group of high-risk children was undertreated with inhaled corticosteroids for long-term control of asthma despite reports of adequate monitoring by a primary care physician.

Administration, Inhalation↗
PubMed2005

Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study.

HYPOTHESIS: Better knowledge of independent risk factors might decrease mortality and morbidity rates following colorectal surgery. DESIGN: Prospective multicenter study. INTERVENTIONS: From June to September 2002, consecutive patients undergoing open or laparoscopic surgery (electively or on an emergent basis) for colorectal cancers or diverticular disease were prospectively included. Exclusion criteria were colectomy for other causes (eg, inflammatory bowel diseases, benign polyps). The structured sheet of data collection included more than 200 items on all perioperative data concerning the patient, the disease, and the operating surgeons. Postoperative mortality and morbidity were defined as in-hospital death and complications. RESULTS: Among 1421 patients, the in-hospital death rate was 3.4% and the overall morbidity rate was 35%. Four independent preoperative risk factors of mortality were found: emergency surgery, loss of more than 10% of weight, neurological comorbidity, and age older than 70 years. Six independent risk factors of morbidity were found: age older than 70 years, neurologic comorbidity, hypoalbuminemia, cardiorespiratory comorbidity, long duration of operation, and peritoneal contamination. CONCLUSION: Colorectal resection in France is associated with a 3.4% mortality rate and a 35% morbidity rate. Knowledge of the risk factors could help surgeons manage cases.

Age Factors↗
PubMed2006

Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis.

HYPOTHESIS: Outcome following laparoscopic adjustable gastric banding (LAGB) in super morbidly obese patients is significantly worse compared with the standard laparoscopic Roux-en-Y gastric bypass (LRYGB). DESIGN: Prospective case series. SETTING: Community teaching hospital (490 beds). PATIENTS: A prospectively maintained database identified patients who underwent operative treatment for morbid obesity between February 2001 and June 2004. The study group included super morbidly obese patients (body mass index >50 [calculated as weight in kilograms divided by the square of height in meters]) following LAGB and LRYGB. INTERVENTIONS: Among 106 patients with super morbid obesity, 60 (57%) and 46 (43%) underwent LAGB and LRYGB, respectively. MAIN OUTCOME MEASURES: Patient demographics, weight loss, percentage of excess weight loss, change in body mass index, early (<30 days) and late (> or =30 days) complications, reoperations, medical comorbidity, and patient satisfaction were studied. Analysis was performed using the t test and Pearson chi 2 analysis. RESULTS: Overall median follow-up was 16.2 months (range, 1-40 months). Preoperative factors of patient age, sex, weight, body mass index, and medical comorbidity were similar between the 2 groups. Compared with LRYGB, patients who underwent LAGB experienced a greater incidence of late complications (P < .05), reoperations (P < .04), less weight loss (P<.001), and decreased overall satisfaction (P < .006). Likewise, patients who underwent LRYGB had a greater resolution of concomitant diabetes mellitus (P < .05) and sleep apnea (P<.01) compared with the LAGB group. Furthermore, postoperative adjustments to achieve consistent weight loss for LAGB recipients ranged from 1 to 15 manipulations. Our single mortality was in the LAGB group. CONCLUSIONS: In super morbidly obese patients, LAGB is significantly associated with more late complications, reoperations, less weight loss, less reduction of medical comorbidity, and patient dissatisfaction compared with LRYGB. Further evaluation of LAGB in this patient population appears warranted.

Adolescent↗
PubMedDate not supplied

Effects of placental delivery method and intraoperative glove changing on postcesarean febrile morbidity.

This study was designed to evaluate the effects of the placental delivery methods and intraoperative glove changing on postcesarean febrile morbidity. In this randomized controlled trial, consenting patients were randomized to one of four management protocols: Group A (n = 26)--no glove change with manual placental delivery; Group B (n = 27)--no glove change with expressed placental delivery; Group C (n = 27)--glove change with manual placental delivery; and Group D (n = 28)--glove change with expressed placental delivery. Glove change was performed by removal of a second glove after delivery of the fetal head. Variables examined included febrile morbidity, endometritis, maximums and durations of elevated temperatures, as well as other demographic, intrapartum, and postpartum variables. Febrile morbidity and endometritis rates were not significantly different between the four groups. When the groups were combined so as to compare no glove change versus glove change (Groups A and B vs. C and D) and manual versus expressed placental delivery (Groups A and C vs. B and D), there were no significant differences in either febrile morbidity (relative risk: 0.7, 95% CI: 0.3-1.4 and relative risk: 1.4, 95% CI: 0.6-3.5) or endometritis (relative risk: 1.2, 95% CI: 0.5-2.8 and relative risk: 1.5, 95% CI: 0.6-3.6), respectively. There were no statistically significant differences in measures of postcesarean febrile morbidity based on placental delivery method or intraoperative glove change.

Cesarean Section↗
PubMed2003

Surgery for morbid obesity.

BACKGROUND: Obesity is associated with increased morbidity and mortality. Surgery for morbid obesity may be considered when other conventional measures have failed, and a number of procedures are available. However, the effects of these surgical procedures compared with medical management and with each other are uncertain. OBJECTIVES: To assess the effects of surgery for morbid obesity on weight, comorbidities and quality of life. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (issue 4, 2001), Medline (SilverPlatter) up to 2001, PubMed (Internet) 01/01/01-19/10/01, Embase (SilverPlatter) up to 09/2001, PsychINFO up to 10/2001, CINAHL (SilverPlatter) up to 07/2001, Science and Social Sciences Citation Index up to 10/12001, British Nursing Index up to 07/2001, Web of Science Proceedings up to 06/2001, BIOSIS up to10/2001, AMED up to 07/2001, National Research Register (issue 2, 2001), reference lists of relevant articles, and handsearched relevant journals. We also contacted experts in the field. Date of the most recent searches: October 2001. SELECTION CRITERIA: Randomised controlled trials comparing different surgical procedures, and randomised controlled trials and non-randomised controlled trials comparing surgery with non-surgical management for morbid obesity. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked independently by two reviewers. Two reviewers independently assessed trial quality. MAIN RESULTS: 18 trials involving 1891 people were included. One randomised controlled trial and one non-randomised controlled trial compared surgery with non-surgical management, and 11 randomised controlled trials compared different surgical procedures. The overall quality of the trials was variable, with just one trial having adequate allocation concealment. A meta-analysis was not possible due to differences in the surgical procedures performed, measures of weight change and length of follow-up. Compared with conventional management, surgery resulted in greater weight loss (23-28 kg more weight loss at two years), with improvements in quality of life and comorbidities. Some complications of surgery occurred, such as wound infection. Gastric bypass was associated with greater weight loss and fewer revisions, reoperations and/or conversions than gastroplasty, but had more side-effects. Greater weight loss and fewer side-effects and reoperations occurred with adjustable gastric banding than vertical banded gastroplasty, while vertical banded gastroplasty was associated with greater weight loss but more vomiting than horizontal gastroplasty. Some postoperative deaths occurred in the studies. Weight loss was similar between open and laparoscopic procedures. Fewer serious complications occurred with laparoscopic surgery. Laparoscopic surgery had a longer operative time, but resulted in reduced blood loss, reduced proportion of patients requiring intensive care unit stay, reduced length of hospital stay, reduced days to return to activities of daily living and reduced days to return to work. REVIEWER'S CONCLUSIONS: The limited evidence suggests that surgery is more effective than conventional management for weight loss in morbid obesity. The comparative safety and effectiveness of different surgical procedures is unclear.

Gastric Bypass↗