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PubMed1991

[Local administration of metronidazole before hysterectomy--effect on infectious morbidity. A prospective study].

A prospective clinical trial was designed to examine the influence of a local application of metronidazole on postoperative infectious morbidity in 134 women undergoing vaginal and in 108 women undergoing abdominal hysterectomy. 116 patients received on the evening before hysterectomy a vaginal suppository of metronidazole (500 mg). The control group (126 patients) had no metronidazole prophylaxis. All patients, who underwent vaginal hysterectomy, were given additionally a single-shot prophylaxis with 1500 mg cefuroxim. With regard to febrile morbidity, urinary tract infection and abdominal wound or pelvic infection, there was a significant decrease in infectious morbidity. In women undergoing vaginal hysterectomy the infectious morbidity was reduced from 35.7% to 20.3% (p less than 0.05) in spite of systemic prophylaxis. In cases with abdominal hysterectomy, we saw a decrease from 64.3% to 26.9% (p less than 0.001). There was no effect on the incidence of urinary tract infections. Local prophylaxis with metronidazole in abdominal hysterectomy and additional to a systemic prophylaxis in vaginal hysterectomy reduces the infectious morbidity in our patients.

Administration, Intravaginal↗
PubMed1999

Birth weight in relation to morbidity and mortality among newborn infants.

BACKGROUND: At any given gestational age, infants with low birth weight have relatively high morbidity and mortality. It is not known, however, whether there is a threshold weight below which morbidity and mortality are significantly greater, or whether that threshold varies with gestational age. METHODS: We analyzed the neonatal outcomes of death, five-minute Apgar score, umbilical-artery blood pH, and morbidity due to prematurity for all singleton infants delivered at Parkland Hospital, Dallas, between January 1, 1988, and August 31, 1996. A distribution of birth weights according to week of gestation at birth was created. Infants in the 26th through 75th percentiles for weight served as the reference group. Data on preterm infants (those born at 24 to 36 weeks of gestation) were analyzed separately from data on infants delivered at term (37 or more weeks of gestation). RESULTS: A total of 122,754 women and adolescents delivered singleton live infants without malformations between 24 and 43 weeks of gestation. Among the 12,317 preterm infants who were analyzed, there was no specific birth-weight percentile at which morbidity and mortality increased. Among 82,361 infants who were born at term and whose birth weights were at or below the 75th percentile, however, the rate of neonatal death increased from 0.03 percent in the reference group (26th through 75th percentile for weight) to 0.3 percent for those with birth weights at or below the 3rd percentile (P<0.001). The incidence of five-minute Apgar scores of 3 or less and umbilical-artery blood pH values of 7.0 or less was approximately doubled for infants at or below the 3rd birth-weight percentile (P=0.003 and P<0.001, respectively). The incidence of intubation at birth, seizures during the first day of life, and sepsis was also significantly increased among term infants with birth weights at or below the 3rd percentile. These differences persisted after adjustment for the mother's race and parity and the infant's sex. CONCLUSIONS: Mortality and morbidity are increased among infants born at term whose birth weights are at or below the 3rd percentile for their gestational age.

Adolescent↗
PubMed2003

Asthma morbidity during pregnancy can be predicted by severity classification.

BACKGROUND: The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy. OBJECTIVE: The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations. METHODS: Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation. RESULTS: Initial asthma classification (mild, moderate, or severe) was significantly related to subsequent asthma morbidity during pregnancy (hospitalizations, unscheduled visits, corticosteroid requirements, and asthma symptoms during labor and delivery). Exacerbations during pregnancy occurred in 12.6% of patients initially classified as mild, 25.7% of patients classified as moderate, and 51.9% of patients classified as severe (P <.001). Asthma morbidity was similar, whether patients were classified as moderate or severe by symptoms and spirometry or by medication requirement. Thirty percent of initially mild patients were reclassified as moderate-severe during pregnancy, and 23% of the initially moderate-severe patients were reclassified as mild later in pregnancy; asthma morbidity in these patients changed accordingly. CONCLUSION: The National Asthma Education Program Working Group on Asthma and Pregnancy classification of asthma severity, adapted to include medication use, predicts subsequent asthma morbidity during pregnancy.

Adult↗
PubMed2001

Pneumonectomy for malignant disease: factors affecting early morbidity and mortality.

OBJECTIVE: The purpose of this report is to analyze factors affecting morbidity and mortality after pneumonectomy for malignant disease. METHODS: We retrospectively reviewed the cases of all patients who underwent pneumonectomy for malignancy at the Mayo Clinic. Between January 1, 1985, and September 30, 1998, 639 patients (469 men and 170 women) were identified. Median age was 64 years (range 20 to 86 years). Indication for pneumonectomy was primary lung cancer in 607 (95.0%) patients and metastatic disease in 32 (5.0%). Factors affecting morbidity and mortality were analyzed by univariate and multivariate analysis. RESULTS: Cardiopulmonary complications occurred in 245 patients (38.3%; 95% confidence interval 34.6%-42.2%). Factors adversely affecting morbidity with univariate analysis included age (P <.0001), male sex (P =.04), associated respiratory (P =.02) or cardiovascular disease (P <.0001), cigarette smoking (P =.02), decreased vital capacity (P =.01), forced expiratory volume in 1 second (P <.0001), forced vital capacity (P =.002), diffusion capacity of the lung to carbon monoxide (P =.005), oxygen saturation (P <.05), arterial PO (2) (P =.007), preoperative radiation (P =.02), bronchial stump reinforcement (P =.007), crystalloid infusion (P =.01), and blood transfusion (P =.02). Factors adversely affecting morbidity with multivariate analysis included age (P =.0001), associated cardiovascular disease (P =.001), and bronchial stump reinforcement (P =.0005). There were 45 deaths (7.0%; 95% confidence intervals 5.2%-9.3%). Factors adversely affecting mortality with univariate analysis included associated cardiovascular (P <.0001) or hematologic disease (P <.005), lower preoperative serum hemoglobin level (P =.004), preoperative chemotherapy (P =.01), decreased diffusion capacity of lung to carbon monoxide (P =.002), right pneumonectomy (P =.0006), extended resection (P =.04), bronchial stump reinforcement (P =.007), and crystalloid infusion (P =.01). Factors affecting mortality with multivariate analysis included hematologic disease (P =.01), lower preoperative serum hemoglobin (P =.003), and completion pneumonectomy (P =.01). CONCLUSION: Multiple factors adversely affected morbidity and mortality after pneumonectomy for malignant disease. Appropriate selection and meticulous perioperative care are paramount to minimize risks in those patients who require pneumonectomy.

Adult↗
PubMed1990

Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery.

Associated coronary artery disease is the critical factor that influences early and late mortality after abdominal aortic aneurysm surgery. Dipyridamole-thallium 201 scintigraphy, left ventricular ejection fraction, and Goldman risk factor analysis have been suggested as preoperative noninvasive screening methods to detect significant coronary artery disease. In this series of 95 elective abdominal aortic aneurysm repairs dipyridamole-thallium 201 scintigraphy was highly predictive of the absence of perioperative cardiac morbidity (96% specificity, 44/46 normal scans, no cardiac morbidity), whereas ejection fraction (73% specificity, 31/42 normal ejection fraction, no cardiac morbidity) and Goldman risk factor analysis (84% specificity, 44/51 class I, no cardiac morbidity) were less. Furthermore, thallium redistribution on dipyridamole-thallium 201 scintigraphy leading to coronary angiography identified a significant number of patients with occult coronary artery disease who required preoperative coronary revascularization (8%, 8/95) and might have remained undetected on the basis of left ventricular ejection fraction or Goldman risk factor analysis. Finally, fixed thallium deficit, which some investigators have interpreted as a low probability finding for cardiac morbidity, was associated with a higher than expected incidence of cardiac complications. Forty-six percent (7/15) of all postoperative cardiac complications (three myocardial infarctions, three ischemic events, one death) occurred in patients with abdominal aortic aneurysms with fixed deficits. This suggests that patients with fixed deficits on dipyridamole-thallium 201 scintigraphy should be considered for later "delayed" (4 hours) thallium images or coronary angiography or both.

Aged↗
PubMed2003

The association between respiratory distress and nonpulmonary morbidity at 34 to 36 weeks' gestation.

OBJECTIVE: The study was undertaken to determine whether respiratory distress syndrome (RDS) is associated with an increased risk of nonpulmonary morbidity in neonates born between 34 to 36 weeks' gestation. STUDY DESIGN: We performed a matched case-control study of 75 infants with (cases) and 75 without (controls) RDS, delivered between 34 and 36 weeks' gestation. Infants with RDS and no other causes for respiratory failure (anomalies, hydrops, asphyxia) were included. Controls were matched for gestational age at birth, year of care, gender, plurality, and race. Inpatient records were reviewed for the incidence of nonpulmonary morbidities before discharge. McNemar test and conditional logistic regression were used to evaluate differences between cases and controls. RESULTS: Our study cohort was 69% male, 48% white, 33% African American, and 19% Hispanic. Cases had longer hospital (11 vs 7days) and neonatal intensive care unit stays (10 vs 7 days), and more frequent apnea-bradycardia (30% vs 5%), pneumonia (12% vs 1%), and suspected sepsis diagnoses (27% vs 3%), P <or=.008 for each. Antibiotic use (96% vs 45%), transfusion (20% vs 0%), phototherapy (57% vs 29%), and hyperalimentation (57% vs 4%) were more common in the RDS group, P <or=.002 for each. Other major morbidities (intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis, bronchopulmonary dysplasia) were uncommon in cases and controls. Similar results were obtained when controlling for mode of delivery and antenatal steroid use. CONCLUSION: RDS at 34 to 36 weeks is associated with increased morbidity and neonatal interventions. In the absence of RDS, major morbidity is uncommon.

Apnea↗
PubMed2006

Mortality and major morbidity in premature infants less than 31 weeks gestational age in the decade after introduction of surfactant.

OBJECTIVE: Population- but also center-based mortality and major morbidity rates of premature infants are essential for prenatal counseling and quality control. METHODS: Records of all infants <30 + 6 weeks (n=674) admitted (1991-2000) to a single neonatal intensive care unit were reviewed and compared to the state-wide mortality. RESULTS: Six hundred and ninety-one infants were born in or transferred to the hospital and 600 infants (89%) survived. The mean (SD) birth weight was 1018 g (+/-314) and the mean gestational age 27+5 weeks (+/-2.0). Mortalityand morbidity did not change significantly over the 10-year period but correlated inversely with gestational age from 45% at 23(0/7) weeks to 5% at 30(6/7) weeks. Study center mortality rate for extremely low birth weight infants with birth weight <750 g was significantly lower than reported for the entire state (local 25%; Bavaria 36% p = 0.0003). Thirty-four per cent (251/600) of the survivors had one or more major complications: intracranial hemorrhage III-IV 8% (88/600), periventricular leucomalacia 6% (41/600), bronchopulmonary dysplasia with oxygen requirement at 36 weeks 20% (128/600), necrotizing enterocolitis 6% (43/600), and retinopathy of prematurity grade III-IV 9% (55/600). Survival without major morbidity increased from 32% at 23 weeks to 92% at 30 weeks. CONCLUSIONS: Despite changes in obstetric and neonatal care during the 1990s, mortality and major morbidity rates did not change significantly after the introduction of surfactant in 1991. Comparison of local, regional, national, and international mortality and morbidity rates are becoming more important in allocating resources and in decision-making at the limits of viability.

Bronchopulmonary Dysplasia↗
PubMed2006

Audit of severe maternal morbidity in Uganda--implications for quality of obstetric care.

BACKGROUND: For every maternal death, there are probably 100 or more morbidities, but the quality of health care for these women who survive has rarely been an issue. The purpose of this study is to explore audit of severe obstetric morbidity and the concept of near miss in four referral hospitals in Uganda. METHODS: This was an exploratory systematic enquiry into the care of a subset of women with severe morbidity designated as near miss cases by organ failure or dysfunction. Patient factors and environmental factors were also explored. Data were abstracted from clinical records and from interviews with patients, relatives, and health workers. RESULTS: Records of 685 women with severe maternal morbidity were examined and 229 cases fulfilled the criteria for near miss cases. Obstetric hemorrhage, rupture of the uterus, puerperal sepsis, and abortion complications were the major conditions leading to the near miss state in more than three quarters of the patients. Nearly half the cases were at home when the events occurred. More than half the cases delayed to seek care, because the patients were unwilling, or relatives were not helpful. Similar proportion also experienced substandard care in the hospitals. CONCLUSIONS: A systemic analysis found substandard care and records, and patient-related factors in more than half the cases of severe maternal morbidity. Audit of near miss cases might offer a non-threatening stimulus for improving the quality of obstetric care.

Adolescent↗
PubMed1993

A community-based randomized trial of praziquantel to control schistosomiasis morbidity in schoolchildren in Zambia.

A community-based, double-blind, randomized trial of praziquantel was carried out in an area of Zambia endemic for schistosomiasis. The aim of the study was to assess the impact of the treatment on Schistosoma mansoni morbidity. A total of 377 infected children, aged seven to 19 years, was randomized into two groups: one of 190 (group A) and one of 187 (group B). All children were treated with 40 mg praziquantel/kg at the start of the study. Six months later, the children in group A were re-treated with the same dose of praziquantel, while the children in group B were given placebos. All children were followed up three, six and 12 months after the initial treatment, morbidity being clinically evaluated at the six- and 12-month follow-ups. The results show that, in both groups of children, there were significant reductions in splenomegaly, hepatomegaly, and subjective symptoms of morbidity six and 12 months after initial treatment. However, there were no significant differences, between the two groups, in the prevalences of these symptoms of morbidity. It therefore appears that once-yearly treatment of children, in this and similar endemic areas, is sufficient to reduce schistosomiasis morbidity to, and maintain it at, a tolerable level.

Adolescent↗
PubMed2001

Perioperative morbidity of hysterectomy for benign gynaecological disease.

This study reviews the perioperative surgical and associated morbidity of abdominal and vaginal hysterectomy for benign gynaecological disease. Over a 5-year period, 199296, there were 2088 hysterectomies; 1244 (60%) abdominal and 844 (40%) vaginal. The surgical morbidity for abdominal hysterectomy (6.2%) was twice that of vaginal hysterectomy (3.2%). The associated morbidity for abdominal hysterectomy (4.0%) was four times that of vaginal hysterectomy (0.9%). Additional surgical procedures (other than salpingo-oophorectomy) performed at the time of hysterectomy increased morbidity by 20% in association with abdominal hysterectomy and by 46% with vaginal hysterectomy. Serious morbidity associated with hysterectomy for benign disease was low.

Journal Article↗
PubMed2001

Integration of vitamin A supplementation with the Expanded Programme on Immunization: lack of impact on morbidity or infant growth.

UNLABELLED: Vitamin A deficiency is associated with increased morbidity and mortality from diarrheal disease, measles, and malaria. It has been proposed that vitamin A supplementation could be linked with childhood immunization programs to improve child health. We conducted a randomized, double-blind, placebo-controlled clinical trial to evaluate the impact of linking vitamin A supplementation with the Expanded Programme on Immunization on morbidity and child growth. In West Java, Indonesia, 467 six-week-old infants were randomized to receive 7.5 mg retinol equivalent (RE), 15 mg RE, or placebo with childhood immunization contacts at 6, 10, and 14 wks and 9 mo of age. Child growth was assessed through anthropometry, and morbidity histories were obtained. Vitamin A supplementation had no apparent impact upon linear or ponderal growth or infectious disease morbidity in the first 15 mo of age when integrated with the Expanded Programme on Immunization. CONCLUSION: Although improving vitamin A nutriture is of general importance in reducing diarrheal and measles morbidity and mortality in developing countries, this clinical trial showed no apparent benefit of vitamin A capsules for infant health when given through childhood immunization programs.

Child Development↗
PubMedDate not supplied

The National Psychiatric Morbidity Surveys of Great Britain--strategy and methods.

This paper describes the rationale and methodology of the first National Psychiatric Morbidity Surveys to be carried out in Great Britain. The objectives of the surveys were to estimate the prevalence of psychiatric morbidity among adults aged 16-64 living in Great Britain; to identify the nature and extent of social disabilities associated with psychiatric morbidity; to describe the use of health and social services by people with psychiatric morbidity and to investigate the association between mental illness and potential environmental risk factors in a household sample. Four separate surveys were carried out in order to meet the objectives; a private household sample (n = 10,108), a sample of institutions caring for the mentally ill (n = 1191), a sample of homeless people (n = 1166), and a supplementary sample of patients with psychosis living in private households (n = 350). A two-stage assessment procedure was used, in which all subjects were given the Revised Clinical Interview Schedule (CIS-R) administered by lay interviewers to assess neurotic symptoms and disorders and a psychosis screen, including the Psychosis Screening Questionnaire. Those who were positive on the psychosis screen were then interviewed by psychiatrists using the SCAN (incorporating the tenth edition of the Present State Examination). Large scale national surveys such as this augment the inadequate data on psychiatric morbidity that are routinely available and are, therefore, an important source of information upon which to base policy and generate aetiological hypotheses. These surveys provide a possible model for similar surveys in other countries.

Adolescent↗
PubMed2001

Parental self-efficacy and morbidity in pediatric asthma.

This study investigated the relationship between parental self-efficacy and asthma-related morbidity. Participants included 139 parents of children (ages 5-8) who were diagnosed with asthma and were primarily from lower-income and minority backgrounds. Parents completed a 22-item measure of self-efficacy; factor analysis was conducted on this measure, yielding two factors: learned helplessness and self-efficacy. Correlational analyses indicated that higher scores on the learned helplessness factor were significantly related to increased asthma-related morbidity for the majority of morbidity variables. The self-efficacy factor was significantly related to days of school missed. Regression analyses conducted with the factor scores and the morbidity variables provide further support that the learned helplessness factor accounts for a significant amount of the variance in asthma morbidity for many of the variables studied, while the self-efficacy factor was related to only a few. Although improving health outcomes of children with asthma is a multifaceted process, the results of this study suggest that targeting parental self-efficacy, particularly with parents who are experiencing high levels of perceived learned helplessness, may be a helpful component of an intervention program with this population.

Asthma↗
PubMed2004

Increased ratio of tumor necrosis factor-alpha to interleukin-10 production is associated with Schistosoma haematobium-induced urinary-tract morbidity.

Bladder and kidney disease, which affect approximately 25%-30% of subjects infected with Schistosoma haematobium, are mediated by T cell-dependent granulomatous responses to schistosome eggs. To determine why only some infected subjects develop disease, we examined the hypothesis that infected Kenyan subjects with ultrasound-detected urinary-tract morbidity (n=49) had dysregulated cytokine production leading to enhanced granulomatous responses, compared with subjects of similar age and intensity of infection without morbidity (n=100). Peripheral blood mononuclear cells from subjects with morbidity produced 8-fold greater levels of egg antigen-driven tumor necrosis factor (TNF)-alpha and had a 99-fold greater mean TNF-alpha:interleukin (IL)-10 ratio, compared with subjects without disease. No differences in cytokine response to non-egg-derived schistosome antigens were observed between groups. Subjects with morbidity had increased TNF-alpha production in response to endotoxin, suggesting an innate hyperresponsiveness. These results indicate that increased TNF-alpha production, relative to that of IL-10, is associated with developing bladder-wall morbidity with S. haematobium infection.

Adolescent↗
PubMed1998

Febrile morbidity in severe and critical ovarian hyperstimulation syndrome: a multicentre study.

The objective of this study was to define the incidence of febrile morbidity and its causes in severe and critical ovarian hyperstimulation syndrome (OHSS). For this purpose, we reviewed the medical records of all OHSS patients hospitalized in 16 out of 19 tertiary medical centres in Israel between January 1987 and December 1996. Febrile morbidity was defined as at least one episode of temperature rise above 38 degrees C lasting > or =24 h. A total of 2902 patients (3305 hospitalizations) with OHSS was identified, of whom 196 had severe, and 13 critical, OHSS. Among the 209 patients investigated the incidence of febrile morbidity was 82.3%, of which 20.5% was attributed to urinary tract infection, 3.8% to pneumonia, 3.3% to upper respiratory tract infection, 2.0% to intravenous line phlebitis, 1.0% to cellulitis at an abdominal puncture site, 1.0% to postoperative wound infections and 0.5 % to gluteal abscess at the site of progesterone injection. Non-typical organisms were frequently isolated, such as Pseudomonas, Proteus, Klebsiella and Enterobacter species. No infectious aetiology was found in 105 patients (50.2%). Hypoglobulinaemia was recorded in most patients, while ascitic and pleural fluids aspirated from these patients contained high globulin concentrations. We conclude that infection-related febrile morbidity in severe and critical OHSS is high, and may be attributed to some degree of immunodeficiency associated with loss of plasma globulins to the third space. However, non-infection-related febrile morbidity is even higher and may be attributed to endogenous pyrogenic mechanisms.

Adult↗
PubMed2006

Pediatric asthma morbidity: the importance of symptom perception and family response to symptoms.

OBJECTIVE: To determine whether family response to asthma symptoms mediates the relationship between child symptom perception and morbidity. METHODS: A total of 122 children with asthma, aged between 7 and 17 years (47% females; 25% ethnic minorities), were recruited from three sites. Participants completed a family asthma management interview and 5-6 weeks of symptom perception assessment. RESULTS: Family response to symptoms mediated the relationship between child underestimation of symptoms and asthma morbidity and partially mediated the relationship between accurate symptom perception and morbidity. In contrast, although child overestimation of symptoms and family response to symptoms were independently related to asthma morbidity, a mediational model was not supported. CONCLUSIONS: Our study found support for the role of family response to symptoms in mediating the relationship between child symptom perception and morbidity, particularly with regard to underestimation of symptoms, underscoring the need for behavioral tools to accurately recognize and optimally respond to exacerbations.

Activities of Daily Living↗
PubMed2007

Multiple urban and asthma-related risks and their association with asthma morbidity in children.

OBJECTIVE: To determine whether a multi-dimensional cumulative risk index (CRI) is a stronger predictor of asthma morbidity in urban, school-aged children with asthma, than poverty or severity alone. METHODS: A total of 163 children with asthma, ages 7-15 years (42% female; 69% ethnic minority) and their primary caregivers completed interview-based questionnaires, focusing on potential cultural, contextual, and asthma-specific risks that can impact asthma morbidity. RESULTS: Higher levels of cumulative risks were associated with more asthma morbidity, after controlling for poverty level or asthma severity. Analyses by ethnic group and subgroup also supported the relationship between the CRI and specific indices of asthma morbidity. CONCLUSIONS: This study demonstrates the utility of multiple-dimensional risk models for predicting variations in asthma morbidity in urban children. Research efforts with urban families who have children with asthma need to consider the context of urban poverty as it relates to children's cultural backgrounds and specific asthma outcomes.

Adolescent↗
PubMed1998

Informal care and psychiatric morbidity.

BACKGROUND: We aimed to examine and quantify the relationship between psychiatric morbidity and the provision of informal care in the community. METHODS: The study involved a comparison of carers and non-carers in a mixed urban and rural community (Morecambe Bay Health Authority). Data were collected by postal survey for 4550 adults; 10.9 per cent of respondents were identified as carers. Subjects were selected by quasi-random methods from the Family Health Services Authority (FHSA) registers. Potential psychiatric morbidity was defined as three or more symptoms on a standardized measure, the General Health Questionnaire (12-item version). RESULTS: The prevalence of morbidity was significantly higher in people who care for others in their own homes, even after adjustment for other known risk factors for psychiatric morbidity (odds ratio 1.51, 95 per cent confidence interval 1.11-2.05). In contrast, there was no significant relationship between morbidity and care outside the home in these data. CONCLUSION: Health Authorities need to review support for carers and to consider ways to improve monitoring.

Adult↗