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PubMed2005

Placenta praevia: maternal morbidity and place of birth.

BACKGROUND: International guidelines recommend that women with placenta praevia should be delivered by an experienced operator at a hospital with an on-site blood bank. AIM: To determine the risk factors, level of care at the birth hospital and incidence of maternal morbidity for women with placenta praevia. METHODS: Data were obtained from linked hospital separation and perinatal databases for 375,790 women giving birth in a NSW hospital, 1998-2002. We defined clinically significant placenta praevia as those women who were delivered by Caesarean section at or after 26 weeks gestation. Outcomes for women with and without placenta praevia were compared. Among women with placenta praevia, antenatal predictors of maternal morbidity were assessed. RESULTS: A total of 1612 (4.3/1000) women had significant placenta praevia. Women with placenta praevia were more likely to be older, have a prior Caesarean section, require general anaesthetic for delivery and deliver preterm. Among women with placenta praevia, 61% delivered in hospitals with 24-h on site blood banks, 33% in hospitals with on-call blood bank services after hours and 6% in hospitals with no blood bank. Two hundred and twenty three (14%) women with placenta praevia suffered a major morbidity (OR = 15.0, 95%CI 12.9-17.4). The proportion of this morbidity that occurred among women delivered electively at term was 40% in hospitals with 24 h blood banks and 55% in other hospitals (P = 0.06). CONCLUSIONS: For women with placenta praevia, the risk of major morbidity is high, yet 39% deliver in hospitals without immediate access to a 24-h blood bank. Australian guidelines on the appropriate level of care for women with placenta praevia are needed.

Adolescent↗
PubMed2003

Dual diagnosis: alcoholism and co-morbid psychiatric disorders.

Although alcohol use disorders are commonly associated with co-morbid drug use and psychiatric disorders, such co-morbidity is frequently underdiagnosed and inadequately treated. This paper reviews the epidemiological, diagnostic, and treatment literature on the co-morbidity of alcoholism, with a focus on the most common co-morbid disorders: drug abuse, mood disorders, anxiety disorders, and antisocial personality disorder. The paper goes on to describe a number of promising approaches to the treatment of these common co-morbid disorders in alcoholics. Despite the difficulties inherent in treating dual diagnosis patients, the clinician must recognize that it is possible to derive valid diagnoses and deliver efficacious treatment to such patients.

Alcoholism↗
PubMed1992

Short-term morbidity associated with cesarean delivery.

This study describes the short-term morbidity associated with cesarean delivery and women's knowledge of the reasons it was performed. It was conducted in a university teaching hospital that delivers approximately 4000 women per year. During 1986, 619 women (16%) were delivered by cesarean, 588 of whom were sent a questionnaire three months after delivery. The response rate was 76 percent. General questions were asked about the women's recovery and health state after the birth, and whether they had experienced more specific types of morbidity, including infection, backache, and depression, and the reasons for the cesarean delivery. Women's answers were then compared with the obstetric case record. In their comprehension of why the cesarean was necessary, 87 percent of women were right or partially right, 35 percent believed they had still not fully recovered, and 28 percent felt less healthy than before the pregnancy. Women experienced a wide variety of postnatal morbidity, most commonly backache (55%), constipation (49%), and depression (38%). The study showed that considerable maternal morbidity is associated with cesarean delivery, and it can persist long after the woman is discharged from hospital. Much more information is necessary about the health of women after delivery, and research is urgently required to determine the comparative rates of morbidity associated with different delivery methods.

Adult↗
PubMed2006

Quantitative MRI biomarkers of cognitive morbidity in temporal lobe epilepsy.

PURPOSE: To determine the relation between neuropsychological morbidity, quantitative magnetic resonance imaging (MRI) measures of whole brain structure, and clinical seizure factors reflecting epilepsy cause, course, and treatment. METHODS: Quantitative MRI measurements of total (whole brain) cerebrospinal fluid (CSF) and gray- and white-matter volumes and clinical seizure features were examined in relation to summary indices of cognitive morbidity in 96 patients with temporal lobe epilepsy. MRI volumes were adjusted for intracranial volume (ICV), and cognitive scores were adjusted for age, education, and gender, based on a sample of 82 healthy controls. RESULTS: Whole-brain volumes (gray, white, and CSF) were abnormal in chronic temporal lobe epilepsy patients compared with controls and were related significantly to neuropsychological morbidity, especially total CSF. Statistical modeling demonstrated that markers of total atrophy (CSF) was the primary mediator of the relation between clinical seizure variables and neuropsychological morbidity. CONCLUSIONS: Quantitative measurements of overall brain abnormality (atrophy) in temporal lobe epilepsy are clinically meaningful markers that are associated with increased cognitive morbidity. These biomarkers appear to mediate the adverse effects of some clinical seizure variables on cognition.

Adolescent↗
PubMed2005

Cardiovascular risk factors predictive for survival and morbidity-free survival in the oldest-old Framingham Heart Study participants.

OBJECTIVES: To examine whether midlife cardiovascular risk factors predict survival and survival free of major comorbidities to the age of 85. DESIGN: Prospective community-based cohort study. SETTING: Framingham Heart Study, Massachusetts. PARTICIPANTS: Two thousand five hundred thirty-one individuals (1,422 women) who attended at least two examinations between the ages of 40 and 50. MEASUREMENTS: Risk factors were classified at routine examinations performed between the ages of 40 and 50. Stepwise sex-adjusted logistic regression models predicting the outcomes of survival and survival free of morbidity to age 85 were selected from the following risk factors: systolic and diastolic blood pressure, total serum cholesterol, glucose intolerance, cigarette smoking, education, body mass index, physical activity index, pulse pressure, antihypertensive medication, and electrocardiographic left ventricular hypertrophy. RESULTS: More than one-third of the study sample survived to age 85, and 22% of the original study sample survived free of morbidity. Lower midlife blood pressure and total cholesterol levels, absence of glucose intolerance, nonsmoking status, higher educational attainment, and female sex predicted overall and morbidity-free survival. The predicted probability of survival to age 85 fell in the presence of accumulating risk factors: 37% for men with no risk factors to 2% with all five risk factors and 65% for women with no risk factors to 14% with all five risk factors. CONCLUSION: Lower levels of key cardiovascular risk factors in middle age predicted overall survival and major morbidity-free survival to age 85. Recognizing and modifying these factors may delay, if not prevent, age-related morbidity and mortality.

Academic Medical Centers↗
PubMed1980

Effect of counselling on the psychiatric morbidity associated with mastectomy.

A controlled trial was conducted to determine whether counselling by a specialist nurse prevented the psychiatric morbidity associated with mastectomy and breast cancer. Seventy-five patients were counselled by the nurse and monitored during follow-up, while 77 patients received only the care normally given by the surgical unit. Counselling failed to prevent morbidity, but the nurse's regular monitoring of the women's progress led her to recognise and refer 76% of those who needed psychiatric help. Only 15% of the control group whose condition warranted help were recognised and referred. Consequently, 12 to 18 months after mastectomy there was much less psychiatric morbidity in the counselled group (12%) than in the control group (39%). These findings highlight the high degree of psychiatric morbidity in patients who have undergone mastectomy and indicate the need to find ways of reducing this morbidity.

Anxiety Disorders↗
PubMed2004

Social position and minor psychiatric morbidity over time in the British Household Panel Survey 1991-1998.

STUDY OBJECTIVE: To examine social inequalities in minor psychiatric morbidity as measured by the GHQ-12 using lagged models of psychiatric morbidity and changing job status. DESIGN: GHQ scores were modelled using two level hierarchical regression models with measurement occasions nested within individuals. The paper compares and contrasts three different ways of describing social position: income, social advantage and lifestyle (the Cambridge scale), and social class (the new National Statistics Socio-Economic Classification), and adjusts for attrition. SETTING: Survey interviews for a nationally representative sample of adults of working age living in Britain. PARTICIPANTS: 8091 original adult respondents in 1991 who remain of working age during 1991-1998 from the British Household Panel Survey (BHPS). MAIN RESULTS: There was a relation of GHQ-12 to social position when social position was combined with employment status. This relation itself varied according to a person's psychological health in the previous year. CONCLUSIONS: The relation between social position and minor psychiatric morbidity depended on whether or not a person was employed, unemployed, or economically inactive. It was stronger in those with previously less good psychological health. Among employed men and women in good health, GHQ-12 varied little according to social class, status, or income. There was a "classic" social gradient in psychiatric morbidity, with worse health in less advantaged groups, among the economically inactive. Among the unemployed, a "reverse" gradient was found: the impact of unemployment on minor psychiatric morbidity was higher for those who were previously in a more advantaged social class position.

Adult↗
PubMed2005

Performance profile of an outcome measure: morbidity assessment index for newborns.

OBJECTIVE: Few tools have been optimised for use over the entire spectrum of neonatal morbidity and standardised for use in perinatal population and community health studies. The objective of this study was to determine the performance profile of the recently developed morbidity assessment index for newborns (MAIN score). This score was designed as a discriminative index of morbidity for the entire population of babies delivered >28 weeks gestation without a major congenital anomaly. DESIGN AND SETTING: MAIN score items were extracted retrospectively from the health records of 2892 consecutively born babies delivered beyond 28 weeks gestation in Edmonton area hospitals between June and December of 1999. MAIN RESULTS: The mean MAIN score in the general newborn population was 70.3 (95% confidence intervals 64.2 to 76.4). With the MAIN score tool, 84.6% of newborns scored from 0 to 150 (no/minimal morbidity), 11.3% from 151 to 500 (mild), 3.1% from 501 to 800 (moderate), and 1% had >800 (severe) score. The MAIN score tool was sufficiently sensitive to detect significant effects of low gestational age, low birth weight, male sex, caesarean delivery, tertiary hospital delivery, twins/triplets, non-vertex presentation, prenatal illicit drug use, and medical complications of pregnancy. CONCLUSION: The MAIN score fulfills the need for a simple, universal, yet sensitive and robust tool to provide a numerical index of early neonatal outcomes of prenatal care and adverse prenatal exposures in babies delivered beyond 28 weeks gestation. The performance of the MAIN score agrees well with the current medical awareness regarding the impact of adverse prenatal exposures on newborn morbidity.

Birth Weight↗
PubMed2002

Effects of chronic job insecurity and change in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours in British civil servants: the Whitehall II study.

STUDY OBJECTIVE: To determine the effect of chronic job insecurity and changes in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours. DESIGN: Self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours were determined in 931 women and 2429 men who responded to a question on job insecurity in 1995/96 and again in 1997/99. Self reported health status, clinical screening measures, and health related behaviours for participants whose job security had changed or who remained insecure were compared with those whose jobs had remained secure. SETTING: Prospective cohort study, Whitehall II, all participants were white collar office workers in the British Civil Service on entry to the study. MAIN RESULTS: Self reported morbidity was higher among participants who lost job security. Among those who gained job security residual negative effects, particularly in the psychological sphere were observed. Those exposed to chronic job insecurity had the highest self reported morbidity. Changes in the physiological measures were limited to an increase in blood pressure among women who lost job security and a decrease in body mass index among women reporting chronic job insecurity. There were no significant differences between any of the groups for alcohol over the recommended limits or smoking. CONCLUSION: Loss of job security has adverse effects on self reported health and minor psychiatric morbidity, which are not completely reversed by removal of the threat and which tend to increase with chronic exposure to the stressor.

Adult↗
PubMed2006

Injustice at work and incidence of psychiatric morbidity: the Whitehall II study.

BACKGROUND: Previous studies of organisational justice and mental health have mostly examined women and have not examined the effect of change in justice. AIM: To examine effects of change in the treatment of employees by supervisors (the relational component of organisational justice) on minor psychiatric morbidity, using a cohort with a large proportion of men. METHODS: Data are from the Whitehall II study, a prospective cohort of 10 308 white-collar British civil servants (3143 women and 6895 men, aged 35-55 at baseline) (Phase 1, 1985-88). Employment grade, relational justice, job demands, job control, social support at work, effort-reward imbalance, physical illness, and psychiatric morbidity were measured at baseline. Relational justice was assessed again at Phase 2 (1989-90). The outcome was cases of psychiatric morbidity by Phases 2 and 3 (1991-93) among participants case-free at baseline. RESULTS: In analyses adjusted for age, grade, and baseline physical illness, women and men exposed to low relational justice at Phase 1 were at higher risk of psychiatric morbidity by Phases 2 and 3. Adjustment for other psychosocial work characteristics, particularly social support and effort-reward imbalance, partially attenuated these associations. A favourable change in justice between Phase 1 and Phase 2 reduced the immediate risk (Phase 2) of psychiatric morbidity, while an adverse change increased the immediate and longer term risk (Phase 3). CONCLUSION: This study shows that unfair treatment by supervisors increases risk of poor mental health. It appears that the employers' duty to ensure that employees are treated fairly at work also has benefits for health.

Adult↗
PubMed2002

Increased morbidity from nasopharyngeal carcinoma and chronic pharyngitis or sinusitis among workers at a newspaper printing company.

OBJECTIVES: To determine the association between printing works and nasopharygeal carcinoma as well as other diseases. METHODS: Demographic data were obtained for those who had worked in a particular newspaper company since its establishment in 1950. Through access to the data bank of the hospital records of the Labor Insurance Bureau for 1985-94, all workers were identified who had been admitted to hospital during their employment in the newspaper company. Multiple logistic regressions were performed to estimate the adjusted morbidity odds ratio (OR) for various diseases among the printing workers with cardiovascular diseases as the reference diseases. Biopsy specimens from patients with nasopharyngeal carcinoma were all subjected to in situ hybridisation of Epstein-Barr virus (EBV), and colocalisation of EBV and secretor component protein. RESULTS: Of the 1564 people who had worked in this company, 579 of them were admitted to hospital at least once. Five out of 144 printing workers admitted to hospital were diagnosed with nasopharyngeal carcinoma compared with none of the other 435 non-printing workers admitted to hospital. The morbidity OR for nasopharyngeal carcinoma in printing workers was 57.0 (95% confidence interval (95% CI) 2.8 to 1155.3). The morbidity OR for benign skin tumours was 28.0 (95% CI 2.7 to 293.1). Chronic pharyngitis or sinusitis also showed significant relations with printing works with a morbidity OR 29.4 (95% CI 1.7 to 514.7). Using all other diseases as the reference diseases for calculation of morbidity ORs still showed a similar trend. In situ hybridisation of EBV encoded small nuclear RNA-1 (EBER-1) showed tumour cells free of the EBV in each biopsy specimen. Colocalisation of EBER-1 and secretor component showed that some tumour cells contained both secretor component and EBV signal in each case. CONCLUSION: Printing works are associated with an increased risk of nasopharyngeal carcinoma, benign skin tumours, chronic pharyngitis or sinusitis, chronic liver diseases, and mechanical injuries. Induction of the development of nasopharyngeal carcinoma is probably not related to EBV infection in these patients.

Adult↗
PubMed1994

The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood.

The morbidity associated with gross total removal of pediatric posterior fossa tumors is well recognized although it is rarely isolated from other factors that comprise the management morbidity for these tumors. This study reviews (1) the operative and postoperative complications in 105 patients and (2) the neurological morbidity in a subset of 91 patients undergoing gross total removal of their tumor between 1982 and 1992. Gross total removal was achieved in 102 patients with a single procedure. Two patients with residual tumor underwent early repeat craniotomy for excision and 1 is being followed without repeat resection. Intra- and postoperative complications occurred in 33 patients and included hematoma requiring craniotomy (3), gastrointestinal hemorrhage (2), hydrocephalus requiring shunt placement (9), wound problems (4), and pseudomeningocele formation requiring additional treatment (5). Delayed onset hydrocephalus requiring shunting occurred in 2 patients and spinal deformity in 4 patients. Worsening of preoperative deficit (new cranial nerve palsies, worsening ataxia, bulbar dysfunction including apnea, mutism and seizures) occurred in 41% of patients operated on for primitive neuroectodermal tumors (PNET) (14/34), 53% of ependymomas (10/19), and 30% of astrocytomas (15/50). No patient who had a choroid plexus tumor was worsened by the procedure. Complete recovery of new postoperative deficits occurred in 14% of PNET (2/14), 50% of ependymoma (5/10) and 47% of astrocytoma (7/15), most often within 6 months of the procedure. Residual neurological morbidity, due to persistence of preoperative symptoms or due to deficits that occurred as the result of the surgical procedure, was assessed in a subgroup of 91 patients followed for an average of 48 months (2-147 months). This assessment did not include morbidity due to adjuvant therapy. Sixty-two percent of patients continued to exhibit abnormal cerebellar or bulbar signs. Forty-three percent of the total population exhibited limitation in function due to residual deficit. Only 38% of patients were both functionally normal and had a normal neurological examination at last follow-up.

Adolescent↗
PubMedDate not supplied

Prediction of genetic risks from segregation analyses of morbid risks.

Segregation analysis provides a genetic model of disease based upon morbid risks in age-specific classes, from which the model derives genotype-specific morbid risks. In the absence of disease-specific mortality each morbid risk is a cumulative incidence (age-specific penetrance). If disease-specific mortality reduces the number of affected in the older classes, the morbid risk is less than the corresponding penetrance. When counselling individuals with a family history of disease, their genetic risk is a function of penetrances, which can be calculated from morbid risks. We have applied this method to breast, ovarian and colorectal cancer.

Genetic Diseases, Inborn↗
PubMed1997

Influence on asthma morbidity of asthma education programs based on self-management plans following treatment optimization.

The objective of this study was to evaluate the effectiveness of an asthma education program on morbidity, knowledge, and compliance with inhaled corticosteroid treatment using a prospective, randomized, controlled, one-year-before/one-year-after protocol. After rigorous optimization of asthma therapy under the care of respirologists, patients were assigned to one of three groups: Group C (control group: no formal education), Group P (education and action plan based on peak-flow monitoring), and Group S (education with action plan based on monitoring of asthma symptoms). A total of 188 subjects with moderate to severe asthma were enrolled and 149 completed the study. Asthma morbidity decreased significantly in all groups (p = 0.001). Mean values one-year-before/one-year-after in Groups C, P, and S were: unscheduled medical visits, 2.4/0.8, 2.3/0.7, and 1.9/ 0.7; hospitalizations, 0.21/0.04, 0.24/0.04, and 0.40/0.09; oral steroid treatments; 1.3/0.5, 1.2/0.7, and 1.3/0.9; absenteeism from work/school, 9.6/5.2, 8.8/2.2, and 6.3/2.9. Between-group differences did not reach statistical significance (p > 0.05). Asthma knowledge increased in both educated groups compared with the control group (p < 0.001) as did short-term compliance with inhaled corticosteroids. These results confirm that treatment optimization coupled with sustained high quality care in motivated patients can lead to a significant decrease in asthma morbidity. In such clinical settings, structured asthma education significantly improved short-term compliance with treatment and knowledge about asthma, although it could not add extra benefit with regard to morbidity. Nevertheless, this study does not refute the potential benefit of educational interventions aimed at improving asthma-related morbidity over a longer time period or in patients with less optimal care or with high-risk factors.

Absenteeism↗
PubMed2002

The role of indoor allergen sensitization and exposure in causing morbidity in women with asthma.

Longitudinal evidence that indoor allergen exposure causes morbidity in sensitized individuals with asthma is scarce. We evaluated the association of allergen sensitization and home exposure to short- and long-term morbidity in 140 women with asthma and to asthma prevalence in 458 women from metropolitan Boston. Cockroach (Blattella germanica), dust mite (Dermatophagoides farinae), and cat (Felis domesticus) allergens in home dust samples, and specific immunoglobulin E antibodies were measured at outset, and doctor-diagnosed asthma and markers of asthma morbidity were ascertained by questionnaire during a 4-year follow-up. Cat- and cockroach-sensitive (immunoglobulin E immunocap [Cap] class > or = 1) women with asthma reported greater morbidity in the past year at the start, and during follow-up, if high levels of the relevant allergen were found. Women with asthma sensitized to cat allergen and with concentrations at 8 microg/g or greater were more likely to have used steroid (adjusted odds ratio [95% confidence interval] 2.7 [1.2-6.2]) and wheezed without a cold (odds ratio 6.8 [3.3- 14.0]) during follow-up. Those sensitized and exposed to cockroach (Bla g 1 or 2 > or = 2 U/g) were at least three times more likely to have used steroid and to have attended a hospital emergency room; the size of the effect upon steroid use was maintained, but the precision was reduced and the 95% confidence interval included one (p = 0.07), with adjustment for race and poverty. We conclude that cockroach and cat allergens may contribute to asthma morbidity in sensitized women.

Adolescent↗
PubMed2006

Determinants of morbidity and intensive care unit stay after coronary surgery.

The study evaluated rates and determinants of hospital morbidity, serious morbid events, and prolonged intensive care unit stay associated with isolated coronary artery bypass. The medical records of 391 patients undergoing isolated coronary artery bypass at our center during 2003 were reviewed. The observed crude hospital mortality rate was 2.05%, similar to the EuroSCORE predicted mortality rate of 2.34%. Arrhythmia was the most frequent postoperative complication (17.6%). The serious hospital morbidity rate was 5.9%. The final logistic regression model of serious morbid events identified the following predictors: drug allergy, diabetes, and EuroSCORE. Prolonged intensive care unit stay (>/= 3 days) was observed in 9.5% of patients. Multivariable logistic regression analysis revealed age, preoperative rhythm disturbances, previous cardiac operation, and hypertension as independent predictors of prolonged intensive care unit stay. The rates of hospital mortality, morbidity, and prolonged intensive care unit stay were comparable to those of other major international cardiac surgery centers. These data can be used as a benchmark for further self- and peer-assessment quality improvement activities.

Aged↗
PubMed1998

Psychiatric morbidity in HIV patients.

OBJECTIVE: To provide an accessible source of clinical information related to the diagnosis and treatment of psychiatric morbidity associated with HIV infection. METHOD: A selective MEDLINE literature search was used to identify 225 relevant articles, 67 of which were selected for inclusion based upon the presence of psychiatric morbidity. Psychiatric morbidity was defined by the presence of a DSM-IV diagnostic code reflecting psychiatric illness. RESULTS: HIV-infected patients have high rates of psychiatric morbidity. CONCLUSION: The psychiatric evaluation and treatment of psychiatric morbidity improve the quality of life of HIV and AIDS patients.

AIDS Dementia Complex↗
PubMed2004

Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review.

The Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep-related breathing disorder characterized by repetitive obstructions of the upper airway during sleep. Modification of pharyngeal patency by Oral Appliance (OA) therapy has been suggested as an alternative to various treatment modalities for OSAHS. To determine the evidence base with respect to the efficacy and co-morbidity of OA therapy in OSAHS, we conducted a systematic review of the available literature. Primary outcome measures were the reduction in number of upper-airway obstructions and co-morbidity related to the craniomandibular or craniofacial complex, respectively. Eligible studies regarding efficacy were independently assessed by two assessors using a quality assessment scale. Effect sizes of methodologically sound studies were calculated. In identical interventions, effect sizes were pooled with the use of a random-effects model. Given the scarcity of controlled studies related to co-morbidity, appraisal was confined to a description of eligible studies. Sixteen controlled trials related to efficacy were identified. With respect to the primary outcome measure, OA therapy was clearly more effective than control therapy (pooled effect size, -0.96; 95% confidence interval [CI], -1.49 to -0.42) and possibly more effective than uvulopalatopharyngoplasty. Although patients generally preferred OA therapy, improvement of respiratory variables, such as the number of upper-airway obstructions, was usually better in Continuous Positive Airway Pressure (CPAP) therapy (pooled effect size, 0.83; 95% CI, 0.59 to 1.06). Moreover, specific aspects related to OA design may influence patient-perceived efficacy and preference. Twelve patient-series and one controlled trial related to co-morbidity were identified. Analysis of the data suggests that OA therapy may have adverse effects on the craniomandibular and craniofacial complex. Although CPAP is apparently more effective and adverse effects of OA treatment have been described, it can be concluded that OA therapy is a viable treatment for, especially, mild to moderate OSAHS. Controlled studies addressing the specific indication and co-morbidity of OA therapy are warranted.

Comorbidity↗