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PubMed2004

Deployment morbidity among search-and-rescue dogs used after the September 11, 2001, terrorist attacks.

OBJECTIVES: To determine characteristics, variables associated with deployment morbidity, and injuries and illnesses of search-and-rescue dogs associated with the Sept 11, 2001, terrorist attacks. DESIGN: Historical cohort study. ANIMALS: 96 dogs. PROCEDURE: Data collected included previous medical or surgical history, physical attributes of dogs, type and number of years of training, site of deployment, shift and hours worked, and number of days deployed. Combined morbidity was defined as 1 or more abnormalities of body systems, including traumatic injuries. RESULTS: Handlers of 96 of the 212 dogs responded to the surveys. Fifty-nine dogs were deployed by the Federal Emergency Management Agency, 10 by police forces, and 27 as members of other search-and-rescue teams. Sixty-five dogs (incidence rate, 17 events/1,000 dog search hours) had combined morbidity during deployment. System-specific morbidity rates included gastrointestinal tract signs (5 events/1,000 dog search hours), cuts and abrasions mostly on the feet (5 events/1,000 dog search hours), fatigue (6 events/1,000 dog search hours), change in appetite (6 events/1,000 dogs search hours), dehydration (5 events/1,000 dog search hours), respiratory tract problems (2 events/1,000 dog search hours), heat exhaustion (2 events/1,000 dog search hours), and orthopedic or back problems (2 events/1,000 dog search hours). Dogs deployed to the World Trade Center were 6.6 times more likely to have combined morbidity, compared with dogs at the Pentagon. CONCLUSIONS AND CLINICAL RELEVANCE: Injury and illnesses occurred in most dogs and affected several organ systems, but all were minor.

Animals↗

PubMed1995

Effectiveness of a specialized asthma clinic in reducing asthma morbidity in an inner-city minority population.

Asthma is the most common chronic disease of childhood and a leading cause of morbidity in adults. Despite significant advances in medical therapy, asthma morbidity and mortality rates have risen dramatically over the past two decades, especially in minority and socioeconomically disadvantaged populations. Numerous intervention programs have been designed in an attempt to reduce asthma morbidity but few have targeted poor or minority populations. The purpose of this study was to assess whether an outpatient intervention program specifically targeted at a high-minority population in East Harlem, in New York City, was successful in reducing asthma morbidity. A retrospective chart review of 84 patient records was conducted. The patients were divided into two groups, an intervention group (n = 45), who were followed by an asthma specialist (allergist/immunologist), and a nonintervention group, followed by a general internist or pediatrician. Outcome variables including clinic walk-in visits, emergency room visits, and hospitalizations were determined and compared in the pre- and postintervention period in both groups. Patients in the intervention group had reduced total walk-in visits (73 vs. 27, p < 0.001), emergency room visits (30 vs. 5, p < 0.001), and hospitalizations (16 vs. 2, p < 0.001). In contrast, patients in the nonintervention group had no change in total walk-in visits (88 vs. 72), increased emergency visits (7 vs. 22, p < 0.05), and no change in hospitalizations (5 vs. 2), respectively. The outpatient intervention program has been successful in reducing asthma morbidity in the high-risk minority community of East Harlem. Future larger studies are warranted to extend this pilot program to other high-risk minority populations.

Adolescent↗

PubMed2000

Transparahippocampal selective amygdalohippocampectomy in children and adolescents: efficacy of the procedure and cognitive morbidity in patients.

OBJECT: Unilateral resection of the hippocampus and amygdala can be used to treat medically intractable mesial temporal lobe seizures. To date seizure outcome and the extent of cognitive morbidity have been unknown in children following the transparahippocampal variation of selective amygdalohippocampectomy (TSA), which prompted the present prospective study. METHODS: Preoperative examinations and outcomes in 22 consecutive children and adolescents who underwent TSA were studied. Cognitive and psychological morbidity were assessed using standard neuropsychological instruments. The authors evaluated relationships between seizure control and cognitive morbidity and 13 and nine clinical variables, respectively. Seizure control was achieved in 11 (65%) of 17 patients (>2 years follow up). Among 13 clinical variables, the only preoperative finding that had a significant bearing on seizure control was the presence of unilateral hypometabolism, which could be observed on [18F]fluorodeoxyglucose-positron emission tomography scans (p<0.001). Patients with seizure control showed significant improvements in verbal and full scale intelligence quotients (both p = 0.05). Patients with longer preoperative durations of seizures exhibited more cognitive impairment that persisted postoperatively. Cognitive outcome analysis based on nine clinical factors revealed no significant difference in cognitive parameters postoperatively, except that significant improvement occurred in rote verbal memory scores among patients who underwent right-sided TSA (p = 0.01). Individually, 81% of the children achieved significant improvement in at least one of seven cognitive parameters, and 52% had stable or improved scores in all parameters. CONCLUSIONS: The results indicate that TSA is a safe effective approach for the treatment of medically intractable mesial temporal lobe seizures in children with minimum effect on cognitive morbidity. Given that the literature suggests that children suffer progressive cognitive morbidity from persistent seizures, the results of this study support early surgical intervention for this group of children.

Adolescent↗

PubMed2001

Perinatal morbidity at the Moi Teaching and Referral Hospital, Eldoret.

BACKGROUND: Perinatal morbidity (PNM) is highest in the developing countries including Kenya. Studies on the perinatal morbidity in Moi Teaching and Referral Hospital (MTRH) have not been carried out. Furthermore, factors associated with PNM are unknown at the MTRH. OBJECTIVE: To establish the causes and incidence of perinatal morbidity at the MTRH NewBorn Unit (NBU). DESIGN: A retrospective study using case notes. SETTING: The NBU of the MTRH in Eldoret, Kenya. SUBJECTS: Babies who were admitted to the MTRH's Newborn Unit from January to December 1997. RESULTS: The perinatal morbidity was 667 per 1000 babies admitted to the NBU. The most common reason for admission was mother under anaesthesia. The most common cause of morbidity was asphyxia. The mean maternal age was 24 years. The mean level of education was 1.7 years. More than fifty five per cent of the mothers were housewives. The mean birthweight was 2.75 kg (+/- 0.9 SD), 55.9% had normal birthweight, 37% were low birthweight and three per cent were large babies. The mean duration of stay in the NBU was 3.8 days. CONCLUSION: Most of the admissions were Caesarean section babies who did not require admission. Younger mothers were more likely to have babies with neonatal sepsis, convulsions, pneumonia and asphyxia.

Adult↗

PubMed2004

Burnout and psychiatric morbidity in new medical graduates.

OBJECTIVE: To determine the prevalence of psychiatric morbidity and burnout in final-year medical students, and changes in these measures during the intern year. DESIGN: Prospective longitudinal cohort study over 18 months, with assessment of psychiatric morbidity and burnout on six occasions. PARTICIPANTS: All 117 students in the first graduating cohort of the University of Sydney Graduate Medical Program were invited to participate in the study; 110 consented. OUTCOME MEASURES: Psychiatric morbidity assessed with the 28-item General Health Questionnaire and burnout assessed with the Maslach Burnout Inventory. RESULTS: The point prevalence of participants meeting criteria for psychiatric morbidity and burnout rose steadily throughout the study period. CONCLUSIONS: Internship remains a stressful time for medical graduates, despite initiatives to better support them during this period. The implications for the doctors themselves and for the communities they serve warrant further attention, including programs specifically aimed at reducing the rate of psychological morbidity and burnout during internship.

Adult↗

PubMed1991

Role of umbilical Doppler velocimetry in the biophysical assessment of the growth-retarded fetus. Answers from neonatal morbidity and mortality.

We compared umbilical Doppler velocimetry with biophysical parameters, obstetrical management, and neonatal morbidity. The study of 85 pregnancies was prospective and blind both to the obstetric and pediatric staff. Our results show that under the same biophysical diagnosis, ie, abnormal fetal growth, oligohydramnios, and nonreactive cardiotocographics, the prevalence of neonatal morbidity was significantly higher in fetuses with associated abnormal umbilical pulsatility index (PI) in utero. Newborns with abnormal PI were delivered earlier, mostly for fetal indication, and were smaller and more asymmetrical than newborns with a normal PI in utero. The analysis of morbidity for homogeneous classes of weight showed that in the group of newborns between 1500 and 2500 g, newborns with normal umbilical PI did show only metabolic disturbances and one respiratory distress syndrome. On the contrary, newborns of the same gestational age and of the same weight with abnormal PI had more severe morbid episodes. In the class of weight between 1500 and 1000 g not only the severity but also the prevalence of neonatal morbidity was significantly higher in newborns with an abnormal PI in utero. None of the newborns delivered below 1000 g had a normal umbilical PI. Five died in the early neonatal period. Three suffered from mild neuromotor sequelae. Practical consequences of these findings on fetal management are the scheduled frequency of biophysical examinations, which must be closer and on an inpatient basis whenever abnormal, and the interpretation of other abnormal biophysical parameters, which must be considered as more severe whenever associated with an abnormal umbilical velocimetry.

Biophysical Phenomena↗

PubMed1999

[Coloplasty after esophagectomy in cancer. A retrospective study of morbidity and mortality].

Aim of this study has been to evaluate retrospectively morbidity and mortality of 42 colon substitutions after resection for esophageal cancer. Colon substitution was the intervention of first choice in six patients. In the other patients the stomach was useless, because of previous gastric surgery (n = 14), of gastric involvement by the tumor (n = 21) or technical problem (n = 1). Patients have been separated in 2 groups: from 1969 to 1983 (group A, n = 22), and from 1983 to 1997 (group B, n = 20). Mortality and morbidity (all eventful postoperative course) have been collected for the 30 postoperative days. Total morbidity has been 57% as 77% in group A and 35% in group B (p < 0.05). Cervical and colo-colic leak have been the most common complications. Total mortality has been 14% as 22% in group A and 5% in group B (p < 0.1). In group A 3 patients died from anastomosis leak (intrathoracic or intraabdominal) and 2 from medical complications. In group B 1 patient died from unexplained sepsis. Our results show significative decrease of morbidity and mortality in group B. These results can be compared to those of gastroplasty for cancer or coloplasty for benign disease. In cancer of the esophagus, if stomach can not be used as substitutes, colon substitution is the best alternative, which can be used without increase of mortality and morbidity.

Adenocarcinoma↗

PubMed1979

[Analysis of the trends in typhoid-paratyphoid morbidity in the USSR].

Mathematico-statistical analysis of typhoid-paratyphoid infection morbidity in the USSR during 1900--1940 revealed a regular many-year cyclic recurrence of the changes in the morbidity level. The intensity of the morbidity level reduction at the periods of decline--in 1900--1917, 1920--1928, and in 1932--1939--was similar. A successive reduction of morbidity of this group of infections, by 6.45% on the average, annually, occurred in 1930--1976. The character of reduction of typhoid-paratyphoid infections morbidity level in the USSR during that period is well described by the exponential function.

Disease Outbreaks↗

PubMed2001

Morbidity and mortality during renal replacement therapy: dialysis versus transplantation.

AIM: Many patients with end-stage renal disease are eligible for renal transplantation. To enable a patient to choose between transplantation or to remain on dialysis comparable data on morbidity and mortality should be available. METHODS: Data were collected retrospectively from the medical records of all patients on the waiting list for renal transplantation and of transplanted patients during the period January 1, 1990, to January 1, 1997. All patients were dialyzed in the Kennemer Gasthuis and renal transplantation was performed in the Leiden University Medical Center (LUMC). Morbidity and mortality in both groups were compared. Morbidity was assessed by studying number, length and cause of hospital admissions. RESULTS: During the study period 102 patients had been on the waiting list and 54 patients had been transplanted in the LUMC. Mean length of stay on the waiting list before transplantation was 37 months. During the follow-up period 11 patients (10.8%) died on the waiting list and 6 patients (11.1%) died after renal transplantation. The mean length of stay on the waiting list of these two groups was much longer, being 55 months and 62 months, respectively. Length of hospitalization was significantly different between both patient groups during the first 6 months of treatment (13.24 days for those on the waiting list versus 40.75 days transplanted patients) and after 6 months (32.4 days for those on the waiting list versus 13.1 days transplanted patients). The number of hospital admissions did not differ significantly. Dialysis-related admissions constituted 47% of the total of admissions in the waiting list group and transplantation-related admissions were 43% in the transplanted group. CONCLUSION: In the present study we revealed no difference in overall mortality. However, mortality was influenced by length of stay on the waiting list. Morbidity was increased during the first 6 months after transplantation. Therapy modality greatly influenced the specific cause of morbidity.

Female↗

PubMed2001

[More moderate neonatal morbidity in the case of non-randomized vaginal delivery of term breech pregnancies].

OBJECTIVE: To compare the outcome of term breech pregnancies by planned caesarean section or by planned vaginal delivery at the Department of Obstetrics and Gynaecology, Atrium Medisch Centrum Heerlen, the Netherlands, with the findings in the so-called 'Term breech trial' (TBT). DESIGN: Randomised and descriptive non-randomised clinical trial. METHOD: During the period of participation in the TBT prospective data were collected on all deliveries of a term baby in breech presentation. The pregnant women who were included in the TBT (n = 35) were randomised in a planned caesarean section (CS) group and a planned vaginal delivery (VD) group. All women with a child in term breech presentation who did not join the trial constituted the non-randomised group (n = 201) and were divided in a primary CS group (n = 48) and a started VD group (n = 153). Neonatal and maternal mortality and morbidity were analysed according to the intended mode of delivery. RESULTS: Neither neonatal nor maternal mortality occurred in any of the groups. No significant differences in serious neonatal and maternal morbidity were observed between both subgroups in either the randomised or non-randomised group. However, in the non-randomised group who were allowed to start a vaginal delivery, moderate neonatal morbidity was significantly higher (25/153) than in the primary CS group (2/48). CONCLUSION: The differences in serious neonatal morbidity as observed in the TBT were not confirmed in this study. However, there were disadvantageous differences in the moderate neonatal morbidity for the non-randomised group who were allowed to start a vaginal delivery. In addition to the TBT results, these findings might be discussed with women with a term breech presentation.

Adult↗

PubMed2001

Mortality and morbidity trends in ischemic heart disease in the autonomous region of Madeira in the ten-year period 1987-1996.

The increase in absolute number of deaths from ischemic heart disease (IHD) in the population aged > or = 65 years, in both sexes, in Madeira, when comparing the years 1987 and 1996, led to significant increases in the corresponding standardized death rates that go against the stabilization seen at national level. Significant increases in these rates for the same years were also seen in the district of Beja and in the Azores. The aim of this study was to ascertain the trends for the incidence, morbidity and mortality from acute myocardial infarction (AMI) in patients admitted in Madeira and its contribution to the increase in these rates, particularly in the population aged < 65 years of both sexes, which the number of deaths from ischemic heart disease did not increase. We studied 119 pts with AMI admitted in 1987 (year A), of whom 53 were aged < 65 years, and 186 pts with AMI admitted in 1996 (year B), of whom 72 were aged < 65 years, whose data were included in the Madeira Ischemic Heart Disease Register (RECIMA), an IHD hospital register that covers 1792 patients admitted with AMI in the Coronary Intensive Care Unit of the Department of Medical and Surgical Cardiology of Funchal Hospital over a period of 15 years (1984-1998). Mortality by the 28th day (fatal AMI admissions) in all ages fell slightly in both sexes in the two years studied (A = 19.3%; B = 16.1%). The number of fatal AMI admissions rose among females in the two age groups considered A = 11; B = 20; delta% = +45) and fell among males (A = 12; B = 10; delta% = -20). In males aged > or = 65 years, this number remained the same (A = 7; B = 7) and fell in males aged > or = 65 years (A = 5; B = 3; delta% = -40). The number of pts who survived to the 28th day (non-fatal AMI admissions) rose in all age groups for both sexes (A = 96; B = 156; delta% = +38.46), as did the ratios with deaths from IHD. These increases were roughly double in the group of patients aged 65 years compared to patients aged < 65 years. We found highly significant positive correlations in the population aged < 65 years between the number of non-fatal AMI admissions (morbidity data) and the number of deaths from IHD (mortality data) recorded in every year of the 10-year period 1987-96, these values being highly significant in both sexes (r = 0.89; p < 0.0001), in males (r = 0.87; p < 0.0001) and in females (r = 0.77; p < 0.0001). Since our study was carried out on an island on which all AMI cases are admitted to a single treatment center, we can conclude that these positive correlations represent a trend towards worsening of morbidity and mortality from IHD in Madeira in the population aged < 65 years, even though the number of deaths from IHD did not rise. The establishment of IHD registers similar to RECIMA in other regions of the country would help to identify trends in morbidity, mortality, and morbidity plus mortality in this population that would be useful in improving the orientation of resources allocated to the prevention and treatment of cardiovascular diseases.

Age Distribution↗

PubMed2001

High prevalence of psychiatric morbidity in a medical intensive care unit.

This study seeks to determine the prevalence of psychiatric morbidity within a medical intensive care unit, examine its correlation with the various physiological parameters and delineate any clinical predictors for psychiatric morbidity. Seventy-seven patients who gave informed consent were administered the General Health Questionnaire (GHQ), Acute Physiological And Chronic Health Evaluation II (APACHE II) and thyroid function tests were performed. A high prevalence of psychiatric morbidity was found (36.4%). However, no statistically significant association was found between psychiatric morbidity and gender, age, APACHE II scores and thyroid function indices. Nevertheless, it is hoped that the index of suspicion for psychiatric morbidity can be raised in order to optimise the clinical management of patients within this setting.

APACHE↗

PubMed1975

[Critical analysis of a high percentage of caesarean section, particularly with regard to infantile morbidity (author's transl)].

UNLABELLED: In 354 Caesarean section deliveries during 1972 to 1974 the data of history, course of pregnancy, delivery and postoperative period including cardiotocography before and during birth and the condition of the newborn up to the 7th day were analyzed with a computer. RESULTS: In two thirds of the cases three or more risks determined the indication for Caesarean section. Identical combinations of risks were rare. After section the infantile morbidity is higher than after spontaneous delivery. Classification of Caesarean sections according to indication: preventive without fetal distress, with signs of chronic, subacute or acute fetal distress or emergency operation, showed the following distribution: Infantile morbidity is highest after emergency operations, less so in preventive operations with fetal distress, chronic, subacute or acute (38% of all sections). Where there was no fetal distress (62% of all sections), infantile morbidity is the same as after spontaneous delivery. A high percentage of the group with fetal distress and high infantile morbidity shows an increase in pre-or intrapartal risks and prepartal pathologic FHF changes. A reduction in the number of Caesarean sections would be possible only in the group without signs of fetal distress provided that this would not lead to a considerable increase in Caesarean section for fetal distress and infantile morbidity.

Acid-Base Equilibrium↗

PubMed2002

[Maternal morbidity and qualification of health-care workers: comparison between two different populations in Senegal].

OBJECTIVE: High fertility rates and high maternal mortality ratios have led most cooperation agencies to place high priority on health of women and children. The objective of this study was to compare maternal morbidity and mortality tin two populations with widely contrasting availability of health care in order to test the hypothesis that differences in maternal outcome mainly result from the qualification of health carers. METHODS: This population-based study included a cohort of pregnant women which was part of a multicenter study of maternal morbidity in six countries in West Africa (MOMA). We compared health outcome in two different populations of Senegal (Saint-Louis and Kaolack).3,777 pregnant women were follow through pregnancy, delivery and pureperium. Maternal morbidity was assessed from the women's recall at each visit of the investigator and from obstetric complications diagnosed by the birth attendant within health facilities. RESULTS: Maternal mortality was higher in the Kaolack area where women gave birth mainly in district health care centers, most often assisted by traditional birth attendants, than in Saint-Louis where women giving birth in health facilities were principally referred to the regional hospital and were generally assisted by midwives (874 and 151 maternal deaths per 100,000 live births respectively, p<0.01). Diagnosed maternal morbidity, however, was higher in Saint-Louis than in the Kaolack area, especially for births in health facilities (9.50 and 4.84 episodes of obstetric complications per 100 lie births respectively, p<0.01). Univariate and multivariate analyses showed that diagnosed morbidity was mainly associated with degree of training of the health attendant in facility deliveries and that antenatal care had no effect. DISCUSSION: Midwives in health facilities appear to detect more obstetric complications than traditional birth attendants. Immediate detection leads to immediate care and to a lower case-fatality rate. This could explain the differences in maternal outcome between two urban centers with contrasting health care availability. CONCLUSION: These results suggest that one of the strongest weapons in the fight against maternal mortality is the employment of the most qualified personnel possible for monitoring labor.

Adult↗

PubMed2002

[Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic].

This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1: 1. 71.950% of participants were married, 22.62% in free union, 4.98% single and 0.45% separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95% confidence limits: 0.40 < OR < 1.03, p = 0.0510600) concerning desired pregnancy in favor to controls. Appropriate reproductive information had an OR = 0.34 (Cornfield 95% confidence limits: 0.21 < OR < 0.54 p = 0.0000014). Ideal cumulated fertility offered an OR 0.62 (Cornfield 95% confidence limits: 0.39 < OR < 0.98, p = 0.0298500). These results show an association between the social-cultural factors and the presence of maternal or perinatal morbidity and/or mortality in the studied adolescents. Desired pregnancy, appropriate reproductive information and ideal cumulated fertility are protection factors to maternal or perinatal morbidity and/or mortality.

Adolescent↗

PubMed2003

Alcohol abuse and postoperative morbidity.

Patients who drink too much have more complications after surgery. The aim of this thesis was to evaluate the evidence, possible mechanisms, and prevention of the increased postoperative morbidity in alcohol abusers, defined by a consumption of at least five drinks per day. The literature could be criticised for several methodological flaws. Nevertheless, the results are in agreement showing moderate to strong evidence of increased postoperative morbidity after surgical procedures on alcohol abusers. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re-operation. The personal and economic consequences are tremendous. The incidence of alcohol abusers undergoing surgery was 7% to 49%, according to gender and diagnosis. They have been identified by a self-reported alcohol intake, which implies the possibility of underestimation. Alcohol markers could be used for a more precise identification of alcohol abuse. However, the inability of the questionnaires to detect short-term changes in intake and abuse without dependence, the inconsistent predictive values of the biological markers, and the lack of evidence of an association to postoperative morbidity reduces their usefulness. A detailed alcohol history is therefore recommended. The pathophysiology may include alcohol-induced organ dysfunctions. We demonstrated that subclinical cardiac insufficiency, immune incompetence, and haemostatic imbalance were already present preoperatively. A relation between the various lesions remains to be investigated. The surgical stress response was greater in alcohol abusers, which may further compromise the already dysfunctioning organs, thus leading to the documented increase in postoperative morbidity. Withdrawal from alcohol reverses organic dysfunction in non-surgical patients. Haemostasis normalises after one to four weeks, cardiac function after one month, immune function after two months, and response to external stress after three months. Accordingly, our small randomised investigation has shown that one month of abstinence before surgery improves several organic dysfunctions and reduces postoperative morbidity. We have demonstrated that prevention before surgery is possible. The study has methodological flaws, so further studies are required before final recommendations can be given. However, in the meantime clinical guidelines for alcohol abusers undergoing surgery should include up-to-date patient information and four weeks of abstinence before surgery, in accordance with the evidence-based association, the potential prevention attained by preoperative abstinence, and the best clinical practice. Implementation should be monitored in the clinical databases. In future, all patients admitted to surgery should be offered a health promoting dialogue with the surgeon, anaesthesiologist, general practitioner, or other health professionals, which focuses on alcohol among other risk factors in relation to the operative treatment, diagnosis and prognosis. A beneficial effect attainable from this multi-modal prevention and fast track surgery should be investigated among the alcohol abusers.

Alcoholism↗

PubMed2000

Long term valve-related morbidity following open-heart surgery at the Kenyatta National Hospital.

OBJECTIVE: To determine the incidence of valve morbidity associated with post-operative valve patients at the Kenyatta National Hospital, Nairobi. DESIGN: A combined retrospective and prospective study. Restrospective period from 1973 to 31st July 1977 and prospective period from there on to 31st July 1998. SETTING: Cardiothoracic outpatient clinic at Kenyatta National Hospital, Nairobi. PATIENTS: All valve replacement patients attending the cardiothoracic outpatient clinic on follow up following discharge from the ward. OUTCOME MEASURES: Morbidity was assessed by incidence of: stroke, thromboembolism, valve thrombosis, bleeding episodes, valve endocarditis and re-operation for valve failure. RESULTS: For all valve surgery combined the overall follow up rate equalled 476.3 patient years. The linearised occurrence rate for thromboembolism for all valves was 1.04% per patient year. For the mechanical valves this incidence was 1.32% per patient year. The stroke free rate at one year and five years was 97.7% and 95.9% respectively. The linearised incidence rate for stroke was 0.84% per patient year for all valves. The incidence of bleeding episodes, excluding menorrhagia, for mechanical valves was 0.79% per patient year. Three episodes of valve thrombosis were observed in this study group, all occurring with mechanical valves. For mechanical valves the incidence equalled 0.79% per patient year. The incidence of prosthetic valve endocarditis equalled 0.42% per patient year for all valves combined, or 0.53% per patient year for mechanical valves. Three patients in the series had redo surgery due to valve failure (0.63%). The commutative occurrence of valve related morbidity for the study population for all valves analysed was 2.73% per patient year. CONCLUSION: The incidence of the various valve morbidity at the Kenyatta National Hospital are below the internationally quoted figures in the literature for other centres. The high incidence of drop out to clinic follow up is likely to be the main reason for this with a lot of morbidity occurring outside the hospital environment and therefore not documented. The exact estimation of this incidence is difficult to assess. To help ascertain this occurrence an accurate patient database with accurate (real time) contacts needs to be put into place.

Adolescent↗

PubMed2003

[Early maternal and neonatal morbidity after spontaneous and surgically-assisted vaginal delivery].

OBJECTIVE: To evaluate the differences in early maternal and neonatal morbidity after spontaneous delivery, forceps delivery and vacuum-extraction. DESIGN: Retrospective clinical study. SETTING: Department of Obstetrics and Gynecology, University Hospital, Palacký University, Olomouc. METHODS: The database of 8196 deliveries at our department in the time period from January 1995 till September 2000 revealed 183 of forceps deliveries and 217 of vacuum-extractions. The control group included 200 randomly selected parturients with spontaneous vaginal delivery. The early maternal morbidity was evaluated according to the following parameters: perineal tears of the IIIrd + IVth degree, duration of hospitalization, average blood loss, the need of analgetics, dehiscence of episiotomy requiring resuture, febrilies and administration of antibiotics. The early neonatal morbidity evaluation was based on the incidence of cephalhematomas, the incidence of hyperbilirubinaemia, duration of hospitalization, signs of fetal hypoxia (pH, Apgar score), gestational age, birthweight and the presence of intracranial and retinal bleeding. The statistical significance of the differences in the frequency of the above parameters was evaluated. RESULTS: Spontaneous deliveries were associated with lower maternal morbidity according to the most of studied parameters. Vacuum-extraction had a lower frequency of maternal postpartum complications compared to forceps deliveries. Statistically valid differences were however found only at perineal tears of the IIIrd + IVth degree and at administration of analgetic and antibiotics. The use of vacuum-extraction seems to be connected with a higher risk of cephalhematomas (p = 0.0051) and longer duration of hospitalization. CONCLUSIONS: From the point of view of early maternal morbidity the assisted vaginal delivery by vacuumextraction gives better results than by forceps. However vacuum-extraction increases the risk of cephalhematomas at newborn.

Extraction, Obstetrical↗