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PubMed2005

Postpartum maternal morbidity requiring hospital admission in Lusaka, Zambia - a descriptive study.

BACKGROUND: Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented. METHODS: Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions. RESULTS: Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity. CONCLUSIONS: In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity.

Journal Article↗
PubMed1994

Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing.

BACKGROUND: The aim was to study the effect of brief counselling and psychological debriefing following a trauma on subsequent morbidity. METHOD: We investigated psychological morbidity in 62 British soldiers whose duties included the handling and identification of dead bodies of allied and enemy soldiers during the Gulf War. Of these soldiers, 69% received a psychological debriefing on completion of their duties. The subjects completed by post a demographic questionnaire, the General Health Questionnaire (GHQ-28) and the Impact of Events Scale. RESULTS: After nine months 50% had evidence of some psychological disturbance suggestive of posttraumatic stress disorder (PTSD); 18% had sought professional help; 26% reported relationship difficulties. Neither prior training nor the psychological intervention appeared to make any difference to subsequent psychiatric morbidity. Morbidity at nine months was more likely in those with a history of psychological problems and those who believed their lives had been in danger in the Gulf. CONCLUSIONS: These findings show that a psychological debriefing following a series of traumatic events or experiences does not appear to reduce subsequent psychiatric morbidity and highlights the need for further research in military and civilian settings.

Adult↗
PubMed1994

Psychiatric morbidity in primary health care in Santiago, Chile. Preliminary findings.

BACKGROUND: The aims were to determine the prevalence of psychiatric morbidity among primary care attenders in a poor suburb of Santiago and to study the relationship with health service use. METHOD: A cross-sectional survey was made of 163 consecutive attenders to a primary care clinic. RESULTS: Eleven per cent of the sample gave a psychological reason for consultation and the prevalence of psychiatric morbidity was 53%, defined using the revised Clinical Interview Schedule. Women and those of lower socio-economic status were at higher risk. Physicians recognised 14% of the psychiatric morbidity. Attenders with psychiatric morbidity consulted more frequently. CONCLUSIONS: There is a need to improve the recognition and management of psychiatric morbidity in primary care in Chile and other less developed countries. This could lead to the more efficient use of scarce health care resources in primary care.

Adult↗
PubMed1996

Morbid risk of schizophrenia in first-degree relatives of white and African-Caribbean patients with psychosis.

BACKGROUND: The high rate of schizophrenia among the second-generation African-Caribbean population in Britain has prompted much concern and speculation. Sugarman and Craufurd have reported that the morbid risk in the siblings of second-generation African-Caribbean schizophrenic patients was unusually high compared with that of the siblings of White patients. METHOD: We sought to replicate these findings by comparing the morbid risk for schizophrenia in the first-degree relatives of 111 White and 73 African-Caribbean psychotic probands. The latter comprised 35 first-generation (born in the Caribbean) and 38 second-generation (born in Britain) probands. RESULTS: The morbid risk for schizophrenia was similar for the parents and siblings of White and first-generation African-Caribbean patients, and for the parents of the second-generation African-Caribbean probands. However, the siblings of second-generation African-Caribbean psychotic probands had a morbid risk for schizophrenia that was seven times that of their White counterparts (P = 0.007); similarly, the siblings of second-generation African-Caribbean schizophrenic probands had a morbid risk for schizophrenia that was four times that of their White counterparts (P = 0.05). CONCLUSIONS: These findings replicate those of the earlier report of Sugarman and Craufurd, and suggest either that the second-generation African-Caribbean population in Britain is particularly vulnerable to some environmental risk factors for schizophrenia, or that some environmental factors act selectively on this population in Britain.

Adult↗
PubMed2004

Predicting asthma morbidity in Harlem emergency department patients.

OBJECTIVES: To determine predictors of asthma morbidity in African American patients with asthma. Proxies for asthma morbidity were emergency department (ED) visits for asthma and hospitalizations for asthma. METHODS: This was a prospective observational study that evaluated baseline predictors of asthma morbidity in adults in an urban, predominantly African American community in New York City. Potential predictors of asthma morbidity evaluated were education, gender, employment status, current smoking status, asthma severity, duration of asthma, daily use of a peak flow meter, presence or absence of pets at home, presence or absence of a significant other, presence or absence of medical insurance, and previous hospitalization for asthma in the past year. Follow-up consisted of a repeat questionnaire obtained between nine and 15 months after the baseline questionnaire. Follow-up data collection was limited to the last three-month history of ED visits or hospitalizations before the follow-up visit. At follow-up, the baseline predictors were related to the presence or absence of ED visits for asthma or hospitalizations for asthma. All predictors were evaluated individually (crude odds ratio [OR]) and simultaneously (adjusted OR) in a logistic regression model with the dichotomous outcome variable ED visits or hospitalization. RESULTS: Return ED visits on follow-up were more likely to occur in asthma patients hospitalized in the previous year (adjusted OR, 3.9; 95% confidence interval [CI] = 1.7 to 9.0) and were less likely to occur in asthma patients with pets (OR, 0.4; 95% CI = 0.2 to 0.9). Patients with moderate/severe asthma, relative to patients with mild asthma, were more likely to be seen in the ED on follow-up on initial analysis (crude OR, 2.4; 95% CI = 1.1 to 1.5), but the adjusted OR was not significant. Follow-up hospitalizations were significantly more likely to occur only in subjects reporting daily use of a peak flow meter (OR, 6.8; 95% CI = 1.3 to 34.5). Subjects hospitalized for asthma in the previous year were more likely to be hospitalized subsequently on initial analysis (crude OR, 2.9; 95% CI = 1.0 to 8.1), but the adjusted OR was not significant. CONCLUSIONS: It appears that African American patients with asthma who had previous hospitalizations for asthma within the past year or use a peak flow meter daily (a marker for more severe asthma) are more likely to visit the ED in the future or to be hospitalized for asthma, respectively. These patients need to be targeted and treated more aggressively to improve asthma care and decrease morbidity. The apparent protective effect of the presence of pets on reducing ED visits is unclear at this time, and the findings need to be replicated and evaluated further.

Adult↗
PubMed2001

Bony morbidity in children treated for acute lymphoblastic leukemia.

PURPOSE: Corticosteroids are widely used in the treatment of acute lymphoblastic leukemia (ALL). To determine the frequency of corticosteroid-associated bony morbidity in children with ALL, we retrospectively evaluated the incidence of fractures and osteonecrosis (ON) on two consecutive pediatric ALL protocols. PATIENTS AND METHODS: One hundred seventy-six consecutive children were treated for ALL between 1987 and 1995 at the Dana-Farber Cancer Institute and Children's Hospital. Prednisone was used as the corticosteroid during postremission therapy from 1987 to 1991, and dexamethasone was used from 1991 to 1995. Medical records for all patients were reviewed to assess the occurrence of fractures and ON. RESULTS: With a median follow-up of 7.6 years, the 5-year cumulative incidence (CI) +/- SE of any bony morbidity for the 176 patients was 30% +/- 4%, with a 5-year CI of fractures of 28% +/- 3% and of ON of 7% +/- 2%. With multivariate analysis, independent predictors of bony morbidity included age 9 to 18 years at diagnosis (P <.01), male sex (P <.01), and treatment with dexamethasone (P =.01). Dexamethasone was associated with a higher risk of fractures (5-year CI, 36% +/- 5% v 20% +/- 4% with prednisone; P =.04), but not ON (P =.40). The 5-year event-free survival for the 176 patients was 79% +/- 3%. CONCLUSION: Children treated for ALL had a high incidence of fractures and ON. Older children, boys, and patients receiving dexamethasone were at increased risk for the development of bony morbidity. Future studies should attempt to minimize corticosteroid-associated bony morbidity without compromising clinical efficacy.

Adolescent↗
PubMed2003

The morbidity of Guillain-Barré syndrome admitted to the intensive care unit.

Patients with severe forms of Guillain-Barré syndrome (GBS) require intensive care. Specific treatment, catheterization, and devices may increase morbidity in the intensive care unit (ICU). To understand the spectrum of morbidity associated with ICU care, the authors studied 114 patients with GBS. Major morbidity occurred in 60% of patients. Complications were uncommon if ICU stay was less than 3 weeks. Respiratory complications such as pneumonia and tracheobronchitis occurred in half of the patients and were linked to mechanical ventilation. Systemic infection occurred in one-fifth of patients and was more frequent with increasing duration of ICU admission. Direct complications of treatment and invasive procedures occurred infrequently. Life-threatening complications such as gastrointestinal bleeding and pulmonary embolism were very uncommon. Pulmonary morbidity predominates in patients with severe GBS admitted to the ICU. Attention to management of mechanical ventilation and weaning is important to minimize this complication of GBS. Other causes of morbidity in a tertiary center ICU are uncommon.

Adolescent↗
PubMed2006

The impact of gender on in-hospital mortality and morbidity after isolated aortic valve replacement.

The objective of our retrospective investigation was to examine the influence of gender on in-hospital mortality and morbidity after isolated aortic valve replacement (AVR). Between January 1993 and June 2002, 2212 patients (782 females, 1430 males) underwent AVR. Propensity matching was used to adjust for numerous differences in baseline characteristics and perioperative variables between groups. Unadjusted in-hospital mortality was higher in females (27 [3.5%] females versus 23 [1.6%] males; P = 0.005). An analysis using 1:1 matching by propensity score did not find a significant difference in in-hospital mortality [OR (95% confidence intervals), 1.0 [0.4, 2.6]; P = 0.99) or overall morbidity (1.4 [0.7, 2.5]; P = 0.29) between groups. Further analyses, including classification of women and men into quintile groups by propensity scores and logistic regression models with propensity score adjustment, found that females were at increased risk for cardiac morbidity [OR (95% CI), 3.4 [1.1, 10.8]; P = 0.038), but not mortality (0.9 [0.3, 2.5]; P = 0.88) nor other morbidities. These results suggest that there is no greater than a 2.5-fold increase in risk for females compared with males undergoing AVR. Female gender, however, may impart increased risk for cardiac morbidity after AVR.

Aged↗
PubMed1995

Cure, morbidity, and mortality associated with embolization of brain arteriovenous malformations: a review of 1246 patients in 32 series over a 35-year period.

Published reports of cure, morbidity, and mortality associated with the embolization of 1246 brain arteriovenous malformations during the last 35 years were reviewed. Embolization resulted in cure in 5% of arteriovenous malformations. The cure rates of embolization were 4% in reports of 708 patients published before 1990 and 5% in reports of 538 patients published since 1990 (P = not significant). Temporary morbidity from embolization was 10%, and permanent morbidity was 8%. Permanent morbidity was 9% before 1990 and 8% since 1990 (P = not significant). Death after embolization of brain arteriovenous malformations occurred in 1% of patients. Mortality associated with the embolization was 2% before 1990 and 1% since 1990 (P = not significant). Long-term morbidity associated with the use of neurotoxic embolization materials is worrisome but has never been proven.

Bucrylate↗
PubMed2004

Treatment of unruptured cerebral aneurysms by embolization with guglielmi detachable coils: case-fatality, morbidity, and effectiveness in preventing bleeding--a systematic review of the literature.

OBJECTIVE: Guglielmi detachable coils (GDCs) increasingly are being used to treat unruptured cerebral aneurysms (UCAs). We systematically reviewed the literature to assess the case-fatality and permanent morbidity rates of GDC embolization of UCAs and the postembolization bleeding rate. METHODS: Through a MEDLINE search of the English, Italian, and French literature from January 1990 through December 2002, we retrieved studies on GDC embolization of aneurysms and extracted data on UCAs. Inclusion criteria were: 1) attempted GDC embolization of at least five consecutive patients with UCAs, 2) reported percentage of at least either case-fatality or permanent morbidity rate or crude data allowing an independent calculation. When data on UCAs could not be characterized with certainty among data on other, different lesions, the study was rejected. RESULTS: We included 30 studies. One thousand three hundred seventy-nine patients were available for the calculation of the case-fatality rate, 794 for the permanent morbidity rate, and 703 for the bleeding rate. The case-fatality rate was 0.6% (95% confidence interval, 0.2-1%), the permanent morbidity rate was 7% (95% confidence interval, 5.3-8.7%), and the bleeding rate was 0.9% per year (95% confidence interval, 0.41-1.4%). Only incompletely coiled UCAs of 10 mm or more accounted for the bleeding events. Morbidity decreased from 8.6% to 4.5% (P < 0.05) when the midyear of study (average calendar year of treatment) was 1995 or later. CONCLUSION: GDC embolization of UCAs is relatively safe, and the outcome is progressively improving. Partial embolization of UCAs of 10 mm or more is unlikely to provide an acceptable protection. Most of the source publications suffer from methodological weaknesses. Prospective studies with longer follow-up periods are needed to definitively assess the effectiveness of GDCs on UCAs.

Aneurysm, Ruptured↗
PubMed1987

Neurological morbidity of arch and carotid arteriography in cerebrovascular disease. The influence of contrast medium and radiologist.

A prospective study of 230 arch and carotid arteriograms in 229 patients with symptomatic cerebrovascular disease revealed that neurological morbidity was not significantly affected by patient age, nature of neurological symptoms, duration of procedure, volume of contrast medium or degree of arterial stenosis. The total neurological morbidity of 132 examinations carried out with non-ionic contrast medium (iohexol) was slightly lower than that of 98 examinations carried out with ionic contrast medium (meglumine and sodium iothalamate) but the difference was not statistically significant. However, the morbidity of 185 examinations performed by an experienced vascular radiologist was significantly lower (p less than 0.025) than the morbidity of 45 examinations performed by a series of radiologists in training and the mean time required for the procedure was 18 min longer in the latter group (p less than 0.001). These findings suggest that the neurological morbidity of arch and carotid arteriography in patients with cerebrovascular disease depends largely upon catheter technique and will not be significantly reduced by the use of non-ionic contrast medium.

Cerebral Angiography↗
PubMed2005

Intravenous fluid-associated morbidity in postoperative patients.

INTRODUCTION: There is marked variation in postoperative fluid prescribing which may contribute to postoperative morbidity. However, there are few data regarding the overall incidence of fluid associated morbidity in postoperative patients. PATIENTS AND METHODS: Data regarding fluid and electrolyte prescription, fluid balance and intravenous fluid associated morbidity were prospectively collected from 71 patients representing 173 patient days of intravenous fluid therapy. RESULTS: There was no correlation between fluid and electrolytes prescription and pre-operative weight, serum electrolyte levels or ongoing fluid losses. 17% of patients developed significant fluid associated morbidity. 7 patients developed a tachyarrhythmia, which was associated with the prescription of inadequate maintenance potassium. 5 patients developed fluid overload, associated with excessive fluid volume and sodium administration. CONCLUSIONS: Surgical house-staff do not appear to use the available fluid balance information when prescribing. The introduction of fluid prescribing protocols may improve practice. This study provides an accurate measure of fluid-associated morbidity in order to measure the efficacy of such protocols.

Aged↗
PubMedDate not supplied

The relationship of life stressors and maternal depression to pediatric asthma morbidity in a subspecialty practice.

OBJECTIVE: To examine the relationships among demographic characteristics, caregiver life stressors, and depressive symptoms of mothers and their children's asthma morbidity. SETTING: Three pediatric asthma subspecialty programs, 2 in the inner city and 1 in the suburbs. DESIGN: Cross-sectional census sample of caregivers of children with asthma: interviews mostly with mothers (N = 123) regarding their children's asthma symptoms and health care utilization. Information collected on demographics and caregivers' own recent life stressors and depressive symptoms. SUBJECTS: Caregivers of children ages 18 months to 12 years with asthma at their subspecialty visit. MEASURES: Structured interviews: a survey instrument prepared for this study and standardized instruments for depression (Center for Epidemiologic Studies--Depression) and life stressors (Crisis in Family Systems). RESULTS: A total of 32% of respondents' children had high asthma morbidity, 28% intermediate, and 40% low. Caregiver life stressors and depression and the children's sex showed the strongest relationships to asthma morbidity in a model that also included race, residence, and Medicaid status. Children were more likely to have high morbidity if they had caregivers with more depressive symptoms and negative life stressors and if they were female. CONCLUSIONS: Respondents experienced many life stressors and symptoms of depression while managing their children's illness. Caregivers' lives may affect their children's asthma morbidity, offering empirical evidence for the potential value of targeted case management for children in subspecialty care.

Analysis of Variance↗
PubMed1994

Taste Acuity of the Morbidly Obese before and after Gastric Bypass Surgery.

Obese individuals have an increased preference for high caloric foods, such as sweets and fats. However, following gastric bypass (GBP) surgery, morbidly obese patients tend to avoid these foods. We hypothesize that this aversion may occur, in part, from permutations in taste acuity. To test this hypothesis, taste detection and recognition thresholds for the four basic tastes (salt, sweet, sour, and bitter) were assessed using a modification of the Henkin forced choice three stimulus technique. Taste acuity measurements were obtained at baseline and at 30, 60, and 90 days post-operative for six morbidly obese GBP women and ten non-surgical, lean female controls. We found nonsignificant differences in taste detection and recognition thresholds between morbidly obese and lean control study subjects at baseline, and no significant correlation between taste acuity and body size. Furthermore, in our study population of lean and obese women, ages 26 to 52, there were no significant interrelationships between baseline taste thresholds and known effectors of taste acuity, i.e., zinc levels, glycemic status, liver and kidney function, or age. Following GBP surgery, a significant up-regulation in taste acuity for bitter and sour was observed along with a trend toward a reduction in salt and sweet detection and recognition thresholds. These findings would suggest the following: (1) taste acuity does not influence taste preferences of the obese individual who has not had bariatric surgery; (2) taste effectors such as zinc, when within the range of normal values, do not alter thresholds of the 4 basic tastes; and (3) weight loss following gastric bypass surgery is associated with an up-regulation in taste acuity in the morbidly obese. Studies are currently under investigation at our center to identify the specific etiology of taste acuity upregulation in the morbidly obese following GBP surgery.

Journal Article↗
PubMed2001

Asthma symptoms, morbidity, and antiinflammatory use in inner-city children.

BACKGROUND: Asthma is a major cause of morbidity that disproportionately affects inner-city children. For children with persistent asthma, defined as having asthma symptoms 3 or more days per week or 3 or more nights per month, national guidelines recommend the use of daily antiinflammatory agents. Despite these recommendations, antiinflammatory agents remain underused, particularly in inner-city children with high asthma morbidity. OBJECTIVES: The objectives of our study were to determine: 1) whether persistent asthma symptoms in inner-city children are related to acute care utilization and to the frequency of acute exacerbations; 2) whether children with persistent asthma are receiving recommended daily antiinflammatory agents; and 3) whether antiinflammatory medication use relates to sociodemographic factors, caretaker self-efficacy, the frequency of primary care visits, and/or measures of quality asthma care. DESIGN AND METHODS: A 64-item telephone survey was administered between July 1996 and June 1997 to 219 parental caretakers of 2- to 12-year-old children who had been hospitalized with asthma at an inner-city medical center between January 1995 and February 1996. Persistent asthma symptoms were assessed by inquiring about the frequency of daily and nocturnal asthma symptoms over the last 4 weeks. Children's asthma severity was classified by applying the 1997 National Asthma Education and Prevention Program (NAEPP) Asthma Guidelines' severity classification scheme based on the frequency of asthma symptoms. Asthma morbidity was defined as the frequency of acute asthma exacerbations, emergency department visits and hospitalizations. Daily antiinflammatory medication use was compared by sociodemographic factors, caretaker self-efficacy, frequency of primary care visits, and measures of quality asthma home management. RESULTS: In this sample, quantifying persistent asthma symptoms and applying the NAEPP symptom criteria identified 17% of the children with mild intermittent asthma, 27% with mild persistent asthma and 56% with moderate to severe persistent asthma. There were no differences in the age of the children in the 3 groups (mean age: 6 years). Asthma morbidity, as measured by the number of asthma exacerbations in the last 6 months, was significantly higher in the children with moderate to severe persistent asthma compared with children with mild intermittent asthma (9.8 vs 3.5) or mild persistent asthma (9.8 vs 4.5). In addition, there were significantly more emergency department visits in the moderate to severe group than in the mild persistent (3.05 vs 1.69) or mild intermittent group (3.05 vs 1.76). Lastly, as asthma symptom frequency increased, there were trends toward more hospitalizations and more days hospitalized. Overall, 35% of the 219 families reported giving daily antiinflammatory medications to their child (mostly cromolyn sodium). Of the 181 children (83%) who met NAEPP symptom criteria for persistent asthma, only 39% were receiving daily antiinflammatory treatment. Of the children with symptoms of moderate to severe asthma, only 15% were receiving inhaled steroids in contrast to the guidelines' recommendations. Use of antiinflammatory agents was not related to caretaker sociodemographic factors or self-efficacy scores. Measures of quality asthma home management, which included use of mattress covers, written plans, and peak flow meters, correlated positively with use of antiinflammatory agents. Children whose families reported using daily antiinflammatory medications had more primary care visits in the last 6 months than those children not receiving antiinflammatory medications. CONCLUSION: Questioning parents about the frequency of their child's asthma symptoms is an important, inexpensive, and readily accessible bedside and office tool that may aid in the detection of persistent symptoms and help direct therapy. Our study suggests that classifying asthma severity by quantifying persistent asthma symptoms, as defined in the NAEPP Guidelines, is a clinically useful tool that relates to asthma morbidity. In our sample of previously hospitalized children with asthma, 83% met 1997 NAEPP symptom criteria for persistent asthma, and yet only 35% were receiving daily antiinflammatory agents. Use of antiinflammatory agents correlated positively with other indicators of quality asthma home management. Additional work is necessary to increase appropriate use of antiinflammatory agents in this population, and in particular, to increase inhaled steroid use for children with moderate or severe symptoms.

Administration, Inhalation↗
PubMed2003

Morbidity patterns among low-income wheezing infants.

OBJECTIVE: This study describes morbidity attributable to wheezing illness in a multi-ethnic sample of low-income infants younger than age 2, and examines biological, environmental, and psychosocial correlates of morbidity indexes. METHOD: Infants 9 to 24 months old, considered at risk for developing asthma on the basis of having had 3 or more health care contacts with documented wheezing, received comprehensive evaluations as part of an environmental intervention study. Baseline evaluations with the infants, their families, and their home environments focused on biological, environmental, and psychosocial factors that would potentially increase asthma risk for the children. At study entry, prior morbidity attributable to wheezing illness was assessed with caregiver reports of symptom frequency and severity and medication use, caregiver quality of life, and medical record documentation of hospitalizations and emergency department (ED) visits. RESULTS: Forty-six percent of the infants had 1 or more hospitalizations and 59% had 2 or more ED visits since birth for wheezing illness. Foreign-born Hispanic families had significantly more ED visits for their children's wheezing illness than US-born Hispanic families, whites, or blacks, although they used fewer controller medications and they reported less illness severity. Multivariate analyses showed 3 biological factors, respiratory syncytial virus, elevated child IgE, and cockroach allergen in the home, were independently associated with hospitalizations within this sample. Similar analyses showed that ED visits were not associated with biological variables, but rather with caregivers with single parent status and smokers. Caregiver reports of wheezing illness severity were correlated with ED visits, but not with hospitalizations. Severity ratings were higher for children of mothers with asthma and for those whose caregivers had higher anxiety and stress. The only correlate of caregiver ratings of poor quality of life was high caregiver anxiety. CONCLUSIONS: Ethnic and immigrant status was an important factor in morbidity attributable to infant wheezing illness. In addition to respiratory infection, both allergic processes and social variables were associated with morbidity as measured by health care utilization. Caregiver reports of illness severity were significantly correlated with psychosocial factors.

Adult↗
PubMed2005

Morbidity of chin bone transplants used for reconstructing alveolar defects in cleft patients.

OBJECTIVE: The aim of this study was to evaluate the objective and subjective morbidity of symphyseal chin bone harvesting used for reconstruction of alveolar defects in young cleft patients. DESIGN: All patients who had undergone chin bone harvesting for alveolar cleft reconstruction in the period from 1992 through 2000 at the Department of Oral and Maxillofacial Surgery of the University Hospital Groningen, Groningen, The Netherlands, were invited to participate in this retrospective study.Patients' acceptance, perioperative and postoperative morbidity were evaluated. A survey of the medical records was performed. In addition, the patients completed a questionnaire for their appreciation of the procedure. They were also subjected to a clinical and radiographic examination. PATIENTS: Thirty patients (21 males and 9 females; mean age 11.8 +/- 3.6 years) participated in this study. RESULTS: Neither the medical records nor the experiences of the patients showed significant morbidity. The procedure was appreciated with 6.8 +/- 3.5 (scale 0 to 10). Postoperative pain was scored as 1.2 +/- 2.5 (scale 0 to 10). Three patients reported transient sensory disturbances at the donor site. Two patients showed a slight sensibility disorder in the symphyseal region. In three patients, an endodontic problem had developed in a lower incisor. CONCLUSION: This study showed that chin bone harvesting for reconstructing alveolar cleft in young patients is a well-accepted procedure with low objective and subjective morbidity. Notwithstanding this low morbidity, the patients (and their parents) have to be informed about the risk of objective and subjective disturbances of the sensibility in the donor region and the risk of dental pulp necrosis.

Adolescent↗
PubMed2006

Interstitial Cystitis: Cost, treatment and co-morbidities in an employed population.

INTRODUCTION: Recent literature indicates that interstitial cystitis (IC) may affect 20% of women and a smaller proportion of men, although many individuals with IC may be misdiagnosed or remain undiagnosed. Factors that can contribute to the cost of IC include medical and drug utilisation related to treatment and diagnosis of IC and associated conditions (e.g. depression), as well as employee work loss. This study assesses the direct medical cost and indirect cost of work loss for IC patients in the first year after diagnosis, and evaluates IC treatment patterns and prevalence of co-morbidities. METHODS: Data for patients under the age of 65 years with at least one diagnosis of IC (n = 749) were drawn from a de-identified, administrative database of approximately 2 million beneficiaries that included medical, drug and disability claims for 1999-2002. A 2 : 1 matched control sample of patients without an IC diagnosis (non-IC sample) was randomly selected based on patient characteristics. Indirect costs were calculated from a subgroup of 152 IC patients (plus their matched controls) who had disability information available. Costs incurred in the first year after IC diagnosis and co-morbidities were compared between IC patients and the non-IC sample, with the difference in costs defined as 'excess costs' of IC patients. Treatment patterns were profiled in the 2 months following initial diagnosis of IC. Descriptive statistics are presented. A multivariate two-part model was applied to estimate the IC direct medical cost, indirect cost and total cost to adjust for observed patient demographics and co-morbidities. Statistical significance was evaluated by the bootstrap method. RESULTS: The average IC patient had 130% higher direct costs (p < 0.05) and the average IC employee patient had 84% higher indirect costs than the average non-IC control individual. IC patients also had a higher diagnostic prevalence of prostatitis (relative risk [RR] = 40.0), endometriosis (RR = 7.4), vulvodynia (RR = 6.9), chronic pelvic pain (RR = 5.8) and urinary tract infections (RR = 5.1) [all p < 0.05]. IC patients were also more likely to report depression (RR = 2.8) and anxiety (RR = 4.5 ) than non-IC controls (all p < 0.05). Seventeen percent of IC patients received pentosan polysulfate therapy, the only US FDA-approved oral drug therapy indicated for treating IC, within the first 2 months after diagnosis. Of these patients, 69% received at least one 'other' drug from the non-approved oral medications studied. Approximately one-third of IC patients received only 'other' drug therapies, and almost half of IC patients received no drug treatment within the first 2 months after the initial diagnosis. CONCLUSIONS: IC is a costly disease associated with co-morbidities. Following diagnosis, patients with IC are commonly untreated or treated with non-approved drug therapies. It is possible that more accurate diagnosis and earlier and more appropriate treatment of IC would lead to better management (or even prevention) of co-morbidities and reduce healthcare costs, and this should be investigated in future studies.

Adolescent↗