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PubMed2005

Early death, morbidity, and need of treatment among extremely premature infants.

OBJECTIVE: To determine outcomes, in terms of perinatal and early death, need for treatment, and morbidity at the time of discharge home, among extremely preterm infants. DESIGN: A prospective observational study of all infants with a gestational age (GA) of 22 to 27 completed weeks or a birth weight of 500 to 999 g who were born in Norway in 1999 and 2000. RESULTS: Of 636 births, 174 infants (27%) were stillborn or died in the delivery room, 86 (14%) died in the NICU, and 376 (59%) were discharged from the hospital. The risk of being registered as stillborn or not being resuscitated increased with decreasing GA below 25 weeks. The survival rates for all births and for infants admitted to a NICU were, respectively, 0% for <23 weeks, 16% and 39% for 23 weeks, 44% and 60% for 24 weeks, 66% and 80% for 25 weeks, 72% and 84% for 26 weeks, 82% and 93% for 27 weeks, and 69% and 90% for >27 weeks. For the survivors, days of mechanical ventilation decreased from a median of 37 days to 3 days and the proportion in need of oxygen at 36 weeks' postconceptional age decreased from 67% to 26% at 23 and 27 weeks' GA, respectively. At 40 weeks' postconceptional age, the respective figures were 11% and 6%. The proportion with retinopathy of prematurity (ROP) requiring treatment decreased from 33% for GA of 23 weeks to 0% for >25 weeks. Periventricular hemorrhage of more than grade 2 occurred for 6% of the survivors and significant periventricular leukomalacia occurred for 5%, with no significant association with GA. The proportion of survivors without severe neurosensory or pulmonary morbidity increased from 44% for 23 weeks' to 86% for 27 weeks' GA. Apart from ROP, the morbidity rate was not associated with GA. CONCLUSIONS: The survival rate was high and the morbidity rate at discharge home was low in the present study, compared with previous population-based studies. With the exception of ROP, the morbidity rates among the survivors were not higher at the lowest GAs, possibly because withholding treatment was considered more acceptable for the most immature infants. The need for intensive care increased markedly for survivors with the lowest GAs.

Female↗
PubMed2002

Effect of change in body mass index on morbidity in non-obese university graduates.

To establish the actual serial changes in body weight in Japanese people and to elucidate the influence of changes in BMI on morbidity, we conducted a historical cohort study of university graduates from 1955 to 1990 using questionnaires and BMI data. The subjects of this study were 3,675 university graduates aged 26-62 years in whom BMI was determined at the time of enrollment in the university (Pre-BMI), 5 to 40 years earlier. Morbidity (one or more system diseases or obesity-related system diseases) was analyzed according to current age, sex, current BMI, deltaBMI (difference between current BMI and pre-BMI), and various lifestyle variables. The proportion of overweight subjects at enrollment to university was higher in recent male students compared to old students, but not in female graduates, and the BMI in both genders increased progressively after graduation, especially in recent male graduates. Pre-BMI correlated negatively and significantly with deltaBMI. The percentages of obese (BMI > or = 30 kg/m2) males and females were 1.6% and 0.5%, respectively, and high morbidity was observed in 56.1% and 42.2% of males and females, respectively. Stepwise regression analysis showed that in subjects with normal BMI at enrollment, prospective morbidity was dependent on ABMI in addition to age. Our results indicate that in subjects with normal body weight, prospective morbidity is determined by increment of ABMI, and suggest that maintenance of BMI at the late adolescence level is an important factor in preventing future disease.

Adult↗
PubMed2006

Mortality and morbidity in elderly patients with fracture neck of femur treated by hemiarthroplasty.

OBJECTIVE: To determine mortality and morbidity in elderly patients with fracture neck of femur treated by hemiarthroplasty (Austin Moore Prosthesis) during one year postoperatively. STUDY DESIGN: Descriptive, analytical study. PLACE AND DURATION OF STUDY: Department of Orthopaedics, Postgraduate Medical Institute/Hayatabad Medical Complex, Peshawar, from June 2001 to May 2002. PATIENTS AND METHODS: During the study period, all patients with fracture neck of femur, who were 65 years of age or above and treated by Austin Moore Prosthesis (AMP), were included. The patients were followed for one year at intervals of 2 weeks, 4 weeks, 6 months, and one year. All surviving patients were assessed for complications, both general and mechanical, related to the implant. The mortality and morbidity were compared for various age subgroups, and in patients with and without systemic co-morbidities.Chi square test was applied to see the significance of results. RESULTS: The total number of patients was 46 with average age of 70 years. Male to female ratio was 1:2. There were 70% patients who had one or more associated systemic disease. The mortality at 2 weeks was 4.3%, 17.4% at 6 months and 26% at one year. The overall dislocation rate was 4.3%. Two patients had infection and 17.4% patients had thigh pain at one year. The mortality and morbidity was high in patients with systemic co-morbidities, and those above 70 years of age, but this was statistically not significant (p value >0.05). The functional assessment of surviving patients at one year was graded as excellent or good in 76.4% of patients. CONCLUSION: In this series, Austin Moore Prosthesis in elderly patients was associated with dislocation, infection and thigh pain in short-term follow-up. The postoperative mortality was high, but it was age and systemic co-morbidity-related rather than due to the surgical procedure. The functional assessment of hip at one year was excellent or good in majority of surviving patients.

Aged↗
PubMed1998

Total knee arthroplasty in morbidly obese patients.

We reviewed the clinical outcomes of fifty primary total knee arthroplasties that had been performed with cement in forty patients who were considered morbidly obese (a Quetelet index of more than forty). These results were compared with those of 1768 similar procedures, performed during the same time-period by the same surgeon, in 1539 patients who were not morbidly obese (controls). At a mean of approximately five years postoperatively, there was a significant difference between the morbidly obese patients and the control group with regard to the knee and functional scores (84 and 53 points compared with 92 and 67 points; p < 0.00005 for both scores). No significant difference was detected, with the numbers available, with regard to the range of motion or the radiographic score (p = 0.77). The rate of perioperative complications was significantly higher in the morbidly obese patients (p < 0.00005). Of the fifty knees in these patients, eleven (22 percent) had a wound complication, five (10 percent) had an infection, and four (8 percent) had an avulsion of the medial collateral ligament. The five infections developed within twenty weeks after the operation, and three were associated with a wound complication. In comparison, thirty-five (2 percent) of the 1768 knees in the control group had a wound complication, eleven (0.6 percent) had an infection, and none had an avulsion of the medial collateral ligament. We concluded that total knee arthroplasty in morbidly obese patients can be successful but is associated with an increased rate of perioperative complications, including problems with wound-healing, infection, and avulsion of the medial collateral ligament. Alterations in the operative technique for soft-tissue closure and protection of the medial collateral ligament have decreased the rates of complications related to wound-healing and the medial collateral ligament.

Arthroplasty, Replacement, Knee↗
PubMed2003

Harmonisation of national influenza surveillance morbidity data from EISS: a simple index.

The European Influenza Surveillance Scheme is a collaboration with 18 member countries (2001/02) which monitors the activity and impact of influenza by collecting morbidity and virological data in primary care facilities throughout the winter season each year. Despite being in principle similar in the surveillance concept, the indicators used and observations made are very different. Different healthcare systems and organisational needs (eg a certificate of illness for the employer) influence the consultation behaviour. Furthermore, and partly as a result of differences in the healthcare systems, the definitions used for the numerator and denominator when calculating morbidity rates are different. Thus comparative interpretation of participating countries' morbidity data is extremely difficult. Reporting 'harmonisation' by using equivalent numerators and denominators is one option but is difficult to achieve in the short term. Moreover, several additional issues would need to be considered, for example, the need for continuity of surveillance and whether such steps would indeed result in direct comparability etc. A simple index was tested, through which the impact of influenza morbidity in any one year is compared with what is considered a 'usual' epidemic in that country. The index in principle describes numerically the extent to which the influenza-attributable excess morbidity in the current epidemic in each country is within, exceeds, or is less than a range typical for an influenza epidemic. In this pilot study, the usefulness of such an index is explored with the example of eight countries for the seasons 1999/2000 and 2000/01. A fine tuning of the methods has not yet been performed.

Belgium↗
PubMed2000

Psychosocial morbidity among women with nausea and vomiting of pregnancy: prevalence and association with anti-emetic therapy.

Unlike severe nausea and vomiting of pregnancy (NVP), it is not known whether milder forms of NVP have been associated with psychosocial morbidity. We undertook the study to explore the prevalence of psychosocial morbidity by severity of NVP, and determine whether, after correction for severity of nausea/vomiting, there is a relationship between psychosocial morbidity and women's decisions to take anti-emetics as a reflection of their distress due to NVP. From 1996-97, an NVP Healthline was advertised. Callers underwent semi-structured interviews about both their NVP and associated psychosocial morbidity in a previous pregnancy. Most of the 3201 callers resided in Canada, worked outside the home, reported on planned pregnancy (a median of) 4 years before, and described severe (> 5 episodes/day of) nausea and vomiting. More severe nausea/vomiting was associated with more frequent feelings of depression, consideration of termination of pregnancy, adverse effects on women's relationships with their partners or their partners' everyday lives, and the perceived likelihood that NVP would harm their baby (p < 0.0001). However, all psychosocial factors were reported by a clinically important proportion of women with mild nausea/vomiting (0-1 episodes/day). The severity of vomiting was most closely related to women's decisions to take anti-emetics, but other psychosocial factors were also independently associated with anti-emetic therapy. We conclude that psychosocial morbidity is evident across the spectrum of severity of nausea and vomiting among women with NVP. The severity of nausea or vomiting does not appear adequately to reflect the distress caused by NVP, as reflected by women's decisions to take anti-emetic therapy.

Adult↗
PubMedDate not supplied

Pattern of morbidity among pre-school children attending the children's outpatient clinic of Federal Medical Centre Owerri, Nigeria.

BACKGROUND: Several interventional programmes which sought broadly to promote the health of the child and also prevent diseases were introduced globally in the latter period of the last century. This study set to describe the pattern of morbidity among pre-school children attending the children's outpatient clinic of the Federal Medical Centre, Owerri. METHOD: The case records of pre-school children who presented at the clinic between January and April 2004 were collected and entered into a spread sheet. The age, sex and diagnosis made were extracted from the records. In cases where more than two diagnoses were made, the most likely two following a review of presenting complaints and findings on examination were chosen. RESULT: Eight hundred and twenty nine patients consisting of 468 (56.2%) males and 361 (43.5%) females met the inclusion criteria. Patients aged 0-11 months constituted 47.8% while those between 48 and 59 months accounted for 1%. The five commonest causes of morbidity were malaria (60.7%), acute respiratory infection (35.8%), diarrhoeal disease (7.4%), skin infection (6.8%) and urinary tract infection (3.6%). The prevalence of malaria and acute respiratory disease were highest in patients aged between 12-23 months while diarrhoea was highest in the group 0-11 months. The prevalence of vaccine preventable diseases such as measles and tuberculosis were low accounting for 1.1% and 1% of morbidity respectively. CONCLUSION: This study shows that morbidity from vaccine preventable diseases is low, which is likely a reflection of the increased emphasis on immunization programmes. The major causes of morbidity in pre-school children in Owerri are still common diseases that have been around for a while and are basically preventable.

Child, Preschool↗
PubMed1999

Measuring morbidity in adult asthmatics.

SETTING: Whereas prevalence studies usually involve a general population sample, morbidity studies often involve the evaluation of factors that affect asthma severity within an asthmatic population. OBJECTIVE: To review methods of measuring morbidity in adult asthmatics, and to assess the appropriateness of the available methods in a variety of research contexts. FINDINGS: As in prevalence studies, symptoms are the cornerstone of studies of asthma morbidity. These may be supplemented by physiological measures including daily peak flow measurement, but bronchial hyper-responsiveness (BHR) testing is usually impractical, and there is no simple relationship between current asthma severity and current levels of BHR in individuals. Health service and medication usage are often taken as measures of asthma morbidity, but they may be inappropriate in studies in which increased contact with the health services is an intended or unintended effect of participation. Measures of quality of life can be a useful complement to more 'objective' methods. CONCLUSIONS: In studies of morbidity in adult asthmatics, the emphasis should be on using 'appropriate methodology', and methods that may be appropriate in one context may be completely inappropriate in another.

Adult↗
PubMed1999

Post-cesarean section morbidity in HIV-positive women.

BACKGROUND: The present work is an audit of post-cesarean section morbidity in HIV-positive women in the tertiary teaching hospital La Fé, Valencia, Spain. STUDY DESIGN: Retrospective case-control study. SUBJECTS: Forty-five HIV-positive pregnant women and 90 appropriately matched controls, delivered by cesarean section in the same hospital and managed using a uniform protocol. MAIN OUTCOME MEASURES: The duration of stay in hospital after cesarean section, the need for postoperative antibiotics and the incidence of major and minor puerperal complications. Baseline characteristics of HIV-positive women were also analyzed in relation to the morbidity after surgery. STATISTICAL ANALYSIS: Chi-square analysis for categorical data and parametric and non-parametric tests for numerical data, where appropriate. RESULTS: Most HIV-positive women (86.7%) had a complicated recovery after surgery. A longer duration of stay in hospital (p<0.0005) and a greater incidence of major (p<0.003) and minor (p<0.00001) postoperative complications were observed in the HIV-positive group compared to the control group. HIV-positive women with > or =500 CD4 lymphocytes/mm3 had less post-cesarean section morbidity CONCLUSIONS: A greater post-cesarean section morbidity was found in HIV-positive women compared to the control women. Immunological status of HIV-positive women may be important in predicting puerperal morbidity after surgery.

Adolescent↗
PubMed1999

Laparoscopic total abdominal hysterectomy in morbidly obese women. A pilot-phase report.

OBJECTIVE: To establish the consecutive steps in and evaluate the safety and effectiveness of laparoscopic total abdominal hysterectomy (L-TAH) (hysterectomy completed via laparoscopy, with no transvaginal approach by the suturing technique) in a group of morbidly obese women and to compare the results to a group of nonobese women with clinically similar characteristics and indications for hysterectomy. STUDY DESIGN: Eleven morbidly obese women were subjected to a L-TAH with no vaginal approach. The operation was executed by suturing and tying an extracorporeal sliding knot and by using intracorporeal two-turn flat square knot methods. The consecutive steps of the operation were changed from the original to facilitate this procedure. The group of morbidly obese women was compared to a group of nonobese women. RESULTS: All the subjects exceeded their ideal body weight by 100%. Their actual weight ranged from 118.9 to 139.8 kg, and their height ranged from 58 to 69 in. All the planned surgery was completed, and no intraoperative or postoperative complications were observed. There was no conversion from the laparoscopic approach to a laparotomy or transvaginal path. When compared to that in the control group, the mean operating time was significantly longer in morbidly obese subjects. CONCLUSION: L-TAH is safe and effective for morbidly obese women.

Adult↗
PubMed2000

Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates.

Data on maternal morbidity make it possible to assess how many women are likely to need essential obstetric care, and permit the organization, monitoring and evaluation of safe motherhood programmes. In the present paper we propose operational definitions of severe maternal morbidity and report the frequency of such morbidity as revealed in a population-based survey of a cohort of 20,326 pregnant women in six West African countries. The methodology and questionnaires were the same in all areas. Each pregnant woman had four contacts with the obstetric survey team: at inclusion, between 32 and 36 weeks of amenorrhoea, during delivery and 60 days postpartum. Direct obstetric causes of severe morbidity were observed in 1215 women (6.17 cases per 100 live births). This ratio varied significantly between areas, from 3.01% in Bamako to 9.05% in Saint-Louis. The main direct causes of severe maternal morbidity were: haemorrhage (3.05 per 100 live births); obstructed labour (2.05 per 100), 23 cases of which involved uterine rupture (0.12 per 100); hypertensive disorders of pregnancy (0.64 per 100), 38 cases of which involved eclampsia (0.19 per 100); and sepsis (0.09 per 100). Other direct obstetric causes accounted for 12.2% of cases. Case fatality rates were very high for sepsis (33.3%), uterine rupture (30.4%) and eclampsia (18.4%); those for haemorrhage varied from 1.9% for antepartum or peripartum haemorrhage to 3.7% for abruptio placentae. Thus at least 3-9% of pregnant women required essential obstetric care. The high case fatality rates of several complications reflected a poor quality of obstetric care.

Adult↗
PubMed2000

Measuring reproductive health: review of community-based approaches to assessing morbidity.

This article begins by reviewing selected past approaches to estimating the prevalence of a range of morbidities through the use of household or community-based interview surveys in developed and developing countries. Subsequently, it reviews epidemiological studies that have used a range of methods to estimate the prevalence of reproductive morbidities. A detailed review of recent community or hospital based health interview validation studies that compare self-reported, clinical and laboratory measures is presented. Studies from Bangladesh, Bolivia, China, Egypt, India, Indonesia, Nigeria, Philippines and Turkey provide empirical evidence that self-reported morbidity and observed morbidity measure different phenomena and therefore different aspects of reproductive health and illness. Rather than estimating the prevalence of morbidity, interview-based surveys may provide useful information about the disability or burden associated with reproductive health and illness.

Community Health Services↗
PubMedDate not supplied

Swedish adjustable gastric band (SAGB) implanted laparoscopically in the treatment of morbid obesity--the first experience in Poland.

Surgical treatment of morbid obesity is a recognized method of proceedings in patients who did not obtain any positive results in conservative therapy. In October and November 1998 laparoscopic implantation of the SAGB was performed among ten morbid obesity patients with mean BMI of 41.9 +/- 3.6 kg/m2. It was the first experience in Poland. In this group we observed also non-insulin dependent diabetes mellitus in five, hyperlipidemia in eight and hypertension in three patients. In this series, there was no mortality and no perioperative morbidity. The mean operation time was 158 +/- 51 min. The mean hospital stay was four days after the operation. Median BMI reduction after four months was 4.7 +/- 1.6 kg/m2. Parallel to the reduction in body weight, there occurred a significant reduction in plasma concentration of glucose (111.0 +/- 38.5 vs. 90.2 +/- 20.8 p < 0.01), total cholesterol (223.8 +/- 42.0 vs. 192.7 +/- 21.3 p < 0.005), and LDL-cholesterol (140.4 +/- 34.0 vs. 121.7 +/- 25.2 p < 0.01). Hypertension was still observed only in one patient. Nowadays laparoscopic gastric banding represents the least invasive surgical treatment of morbid obesity. In our series laparoscopic implantation of SAGB seems to be an effective surgical method for the treatment of obesity. Substantial reduction in body weight was associated with improvement in metabolic control. Absence of mortality and morbidity is one of the main aims in bariatric surgery which was achieved in our study. The results of the present, first in Poland, preliminary study confirm previous observations that gastric banding is an effective treatment of obesity.

Adult↗
PubMed2000

Surgical treatment of morbid obesity: role of the gastroenterologist.

AIM: Obesity is an increasing medical problem with associated disorders such as type 2 diabetes mellitus, cardiovascular disorders and many others. The chance to develop co-morbidity is related to the body mass index (BMI) (weight in kg divided by height in metres2) and increases exponentially when the BMI is above 40 (morbid obesity). Permanently effective treatment of morbid obesity is necessary to prevent the development of co-morbidities and to improve the life expectancy of these patients. To date, surgical intervention is the only treatment that can provide the required long-lasting reduction of the excess weight. DISCUSSION: Two types of surgical intervention are currently used, restrictive (including vertical banded gastroplasty (VBG) and adjustable gastric banding) and malabsorptive procedures (gastric bypass, biliopancreatic diversion (BPD)). These interventions effectively reduce weight, with on average a permanent reduction of the excess weight by 60% after gastric restrictive procedures. However, long-term follow-up has shown that up to 30-40% of patients require additional surgical interventions to maintain the acquired weight loss. Long-term failures are dependent on the primary intervention. After VBG the most common problems are occlusion of the outlet by a foreign body, vertical staple line disruption, band stenosis and band erosion. For the adjustable silicone gastric band outlet problems similar to the VBG, band erosion and particularly pouch dilation or slippage have been reported. Failure of the gastric bypass are mainly due to stenosis of the gastro-jejunostomy and stoma ulcers, whereas BPD mainly has metabolic long-term complications. CONCLUSION: The gastroenterologist has an important role in the diagnosis (stoma stenosis, band erosion, staple line disruption, foreign body) and treatment (dilatation, removal of foreign body) of the complications associated with surgical procedures for morbid obesity. In light of the increasing number of procedures performed, a basic knowledge of the currently used techniques and the associated complications is important.

Gastric Bypass↗
PubMed2001

Perioperative factors as predictors of operative mortality and morbidity in pneumonectomy.

Pneumonectomy for lung cancer is associated with significant morbidity and mortality. Risk factors for the morbidity and mortality have been reported, but consistent conclusive data are undetermined. Current accepted 30-day mortality rates for pneumonectomy range from 7 to 11 per cent. The objective of this study is to determine whether various perioperative factors can serve as predictors of morbidity and mortality in pneumonectomy patients and to review outcome data on patients undergoing pneumonectomy for lung cancer. A total of 105 patients undergoing pneumonectomy for lung cancer from 1988 through 1998 are studied in a retrospective chart review. The main outcome measure is the 30-day operative mortality and morbidity. Complications occurring in 10 per cent or more of the patients included atrial fibrillation (33.3%), respiratory failure (23.8%), pneumonia (21.9%), and bronchopleural fistula (12.4%). The 30-day mortality rate was 10.5 per cent (11 deaths). By Fisher's exact test for Chi-square only three statistically significant mortality factors were identified: respiratory failure (P < 0.021), sepsis (P < 0.008), and male sex (P < 0.031); respiratory failure, sepsis, and sex were predictors of death. Significant correlation could not be made to predict postoperative morbidity. Overall long-term clinical outcome for pneumonectomy as lung cancer treatment was poor. Clinical judgment remains an essential factor when considering pneumonectomy as an option for lung cancer treatment.

Adult↗
PubMed2001

Long-term morbidity and mortality in Chinese insurance applicants infected with the hepatitis B virus.

BACKGROUND: Worldwide, there are approximately 350 million carriers of the hepatitis B virus (HBV). The protracted course of HBV infection makes it difficult to estimate morbidity and mortality risk in an insured lives population that is chronically infected with HBV because most studies on this topic have been based on older patients with advanced disease who were treated at tertiary centers that specialize in care of patients with liver disease. Data from these reports bias risk estimates toward severe cases and are not appropriate indicators of what might be expected in an insurance context. This article discusses use of a Markov model to estimate long-term morbidity and mortality risk associated with chronic HBV infection in otherwise healthy Chinese insurance applicants. RESULTS: The model was validated by comparing results to population data published in Taiwan, Hong Kong, Shanghai, Singapore, and Korea. For males, mortality ratios were in the range of 150-175% for underwriting ages 20, 30, and 40 and slightly lower for age 50. For females, mortality ratios were in the range of 125-150% and slightly higher for age 50. Higher mortality ratios in males were related to the fourfold higher hepatocellular carcinoma (HCC) incidence rate. Mortality ratios varied with the extent of the underwriting evaluation. Liver-related morbidity incidence increased with age at underwriting for males and females. HBeAg (hepatitis B "e" antigen)/anti-HBe status was not a major factor for differentiating risk in an insurance context. CONCLUSION: Morbidity and mortality are within the insurable range for the majority of HBV-infected Chinese applicants. Risk varies with the extent of the underwriting evaluation and the percentage of applicants with significant liver fibrosis or early cirrhosis that are detected during the underwriting process. HBeAg/anti-HBe status is not a major factor for differentiating risk in an insurance context. Morbidity and mortality estimates provided by the model can be generalized to other populations and individuals where HBV infection occurs at birth or during early childhood, although some modification in insurance risk might be required in non-Asian markets.

Adult↗
PubMed2001

Morbidity patterns of non-urgent patients attending accident and emergency departments in Hong Kong: cross-sectional study.

OBJECTIVES: To study the morbidity patterns of non-urgent patients utilising accident and emergency services and compare these patients with 'true' accident and emergency cases. To analyse the morbidity pattern of non-urgent cases over different time periods, and across different age groups. DESIGN: A cross-sectional study completed over a 1-year period. SETTING: Four accident and emergency departments in Hong Kong. PATIENTS: Two thousand, four hundred and ten patients randomly selected from four accident and emergency departments. MAIN OUTCOME MEASURES: The morbidity patterns by body system, according to the International Classification of Primary Care, were tabulated and analysed for 'true' accident and emergency cases versus non-urgent cases. The ten most frequent diagnoses for the 'true' accident and emergency and non-urgent cases were also compared. Further analysis of accident and emergency service utilisation was conducted comparing different age groups, and also different time periods. RESULTS: Significantly more cases presenting to the accident and emergency service with respiratory and digestive problems were found to be non-urgent, rather than appropriate accident and emergency cases. In contrast, significantly more cases presenting with circulatory and neurological problems were appropriate cases for accident and emergency department management. The morbidity pattern for the ten most frequent diagnoses seen in non-urgent cases was noted to be similar to the Hong Kong general practice morbidity pattern for self-limiting conditions. Utilisation of accident and emergency services for acute self-limiting conditions was more marked in the late evening, and also among children and the younger population in general. CONCLUSION: The utilisation of accident and emergency services by patients requiring a general practice service only, reflects problems in the primary health care delivery system. These may be solved by appropriate interfacing between general practitioners and other service providers, with the aim of providing seamless health care. Without revision of primary health care services, accident and emergency departments will continue to be used inappropriately by patients as an alternative to general practice care.

Accidents↗
PubMed2002

Isolated rib fractures in elderly patients: mortality and morbidity.

OBJECTIVES: To describe the management, morbidity and mortality seen with isolated rib fractures in elderly patients and assess the need for hospitalization. DESIGN: A case series. SETTING: A tertiary care centre in Tel Aviv. METHODS: Hospital records of 77 elderly patients (age 65 yr and older) admitted with isolated rib fractures were reviewed over a 9-year period. MAIN OUTCOME MEASURES: Demographic, medical and hospitalization data, blood hemoglobin and oxygen saturation levels. RESULTS: The number of fractured ribs was found to correlate with the morbidity (p = 0.027) and mortality (p = 0.006). There were no significant differences in these rates with respect to comorbidity except for diabetes (higher morbidity) and congestive heart failure (higher mortality). Twenty-eight patients (36%) had pulmonary complications and 1 had cardiac complications. Pulmonary complications were fatal in 6 patients (7.8%). Multivariate analysis of the factors related to morbidity demonstrated that only oxygen saturation (p = 0.0009) and diabetes (p = 0.03) correlated significantly. CONCLUSIONS: In spite of significant morbidity and mortality in elderly patients with isolated rib fractures, prediction of the prognosis for these patients is presently not possible. Admission for observation and treatment is therefore justified and beneficial.

Aged↗