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PubMed1991

Screening for psychiatric morbidity in men and women.

This paper describes the use of the general health questionnaire (GHQ) to screen a random sample of men for psychiatric morbidity. The results are contrasted with those from the earlier Otago Women's Health Survey, an investigation into the sociodemographic determinants of psychiatric morbidity in Otago women. The level of psychiatric morbidity found in the men was equal to that found in the women which is in contrast to most overseas studies where men have been found to have lower levels of psychiatric morbidity to women. Significant differences were found in male and female demographic subgroups. High GHQ scores were found in separated, widowed and divorced men, men in higher socioeconomic status groups and those unemployed. High GHQ scores were found among the women aged 18-34, women who had never married, those in lower socioeconomic status groups and those unemployed. This study illustrates that gender needs to be considered alongside traditional sociodemographic factors when studying psychiatric morbidity and symptomatology.

Adult↗
PubMedDate not supplied

[An assessment of the helminthiasis situation in Belorussia by the dynamics of the mean multiyear indices of population morbidity].

The study of population morbidity with helminthiasis prevalence in Byelorussia has revealed 11 nosological entities and has established that in 99.9% these were cases of ascariasis, trichocephaliasis and enterobiasis. In 1981-1989 dynamics of ascariasis and trichocephaliasis morbidity was characterized by a marked tendency towards its decrease, while there was a tendency towards moderate growth in enterobiasis morbidity. The values of the (intensive) rates of helminthiasis morbidity during the examination of hundreds of thousands people does not considerably depend on the fluctuations of the number of persons examined on the presence of helminths. To elaborate systems for epidemiologic surveys of helminthiasis it is necessary to increase the volume and improve the quality of information on the morbidity rates.

Helminthiasis↗
PubMed1991

Triplet pregnancy: changes in morbidity and mortality.

The outcome of 13 sets of triplet infants delivered between January 1, 1981, and December 31, 1988, is analyzed with specific regard to immediate neonatal morbidity. Thirty-nine viable infants were born with no perinatal deaths. Overall, 80% of triplet infants incurred some morbidity, including hyperbilirubinemia (51.3%), hypoglycemia (30.8%), respiratory distress syndrome (28.2%), respiratory compromise (23.1%), anemia (17.9%), patent ductus arteriosus (15.4%), and intraventricular hemorrhage (10.3%). All morbidities occurred in infants who averaged less than 2,000 g and 35 weeks' gestation at birth. As a background to understanding these observations, a review of reports of triplet morbidity and mortality in the United States and Europe is presented. Over the past 80 years, a continual decline in triplet perinatal mortality has occurred despite no change in the average gestational age at delivery over the past 40 years. The triplet perinatal mortality rate is now less than 10%, and prematurity is no longer as influential on perinatal mortality as it is on morbidity. Improvement in neonatal resuscitation and care and delivery by cesarean section are felt to be responsible for lower mortality rates. We believe that the optimum level of care for triplet gestations includes antenatal and neonatal care at tertiary perinatal centers and, except for special circumstances, delivery by cesarean section.

Adult↗
PubMed1986

[Infectious morbidity in children of both sexes during the 1st 7 years of life].

General morbidity in infectious diseases, morbidity in the main groups of infections and in individual nosological forms was dynamically studied in children born in 1971-1973 during the first 7 years of life in connection with their sex. In a vast majority of cases of infection boys showed a higher morbidity rate, starting already from the first 6 months of life, the maximum differences in morbidity rate for individual diseases being observed at different age. In some diseases (whooping cough, chickenpox, rubella) morbidity rate was higher among girls.

Age Factors↗
PubMed1985

[Infectious morbidity of children up to 7 years of age in relation to the season of their birth].

The total morbidity in infectious diseases and morbidity in the main groups of infections and in individual nosological forms among 1174 children born in 1971-1972 during the first 7 years of their life were studied. The morbidity rates noted among the children during the first and second six-month periods of their life were found to be related to the season when they were born, and the morbidity level in the first year of their life greatly determined morbidity in all subsequent years.

Child↗
PubMed1987

Occupational class, psychosocial stress and morbidity.

The association between stress and morbidity was studied in an industrial population, which consisted of both white-collar and blue-collar workers (n = 902). Information about living and working conditions, health behaviour, mental well-being and morbidity were obtained by questionnaires, interviews, clinical examinations, and physiological and biochemical measurements. The same cohort was re-examined after five and ten years. Comparison of occupational classes showed consistently that living and working conditions, psychosocial stress, and health and sickness behaviour were more deleterious among blue-collar workers and their morbidity and mortality rates were higher than among white-collar workers. The effect of stress on health was examined both cross-sectionally and longitudinally. Psychosocial stressors at work were related to mental strain, perceived health, and absenteeism. Stress symptoms were strongly associated with perceived health, locomotor symptoms, smoking, drinking, and absenteeism. None of the stress indicators were related to blood pressure. In the follow-up the baseline indicators of stress predicted future chronic illness and angina pectoris, but not hypertension or myocardial infarction. Blood pressure changes were not related to psychosocial factors. Stress did not predict mortality in the ten year follow-up. The study suggests that psychosocial stress is mostly related and may be causally linked to such indicators of morbidity as perceived health, bodily symptoms and sickness behaviour. The aetiological contribution of stress to biologically defined morbidity may be weak.

Attitude to Health↗
PubMed1986

A path model of factors influencing morbidity and mortality in Ontario feedlot calves.

The principles of path analysis and causal modelling are discussed. Path analysis was applied to three data sets to assess the relationship between group characteristics (number per group and "mixing" subgroups of cattle, feeding-management of the group and processing factors (vaccination and prophylactic antimicrobials) and subsequent morbidity and mortality in feedlot cattle. The major findings agree with previously reported results but the timing and pathways of the effects are elaborated. In general, morbidity in week 1 was correlated with morbidity in week 2, which was correlated with morbidity in weeks 3-5. The same was generally true for mortality. In general, morbidity was not strongly correlated with mortality. Lots (unmixed groups) did not arrive in better condition, but experienced fewer subsequent health problems than mixed groups. (Silage-fed lots appeared to do poorly, however this was apparently due to the positive association between lots and vaccination, the latter being detrimental to mortality rates.) The more cattle per group, the greater the health problems in weeks 3-5 postarrival. Prophylactic antimicrobials in the water supply on arrival lead to increased health problems in the three to five week postarrival period. Antibiotic containing starter rations had a beneficial effect on health status in this period. This effect appeared to be partly due to delaying making silage the major ration component in silage-fed cattle receiving antimicrobial containing starter rations. Vaccination against respiratory disease in either of the first two weeks postarrival had detrimental direct and indirect effects on subsequent health status. Vaccination during weeks 3-5 postarrival was not significantly related to health status in that period.

Animal Feed↗
PubMed1985

Hypertension in middle-aged men. Management, morbidity and prognostic factors during long-term hypertensive care.

The effects of long-term (10 years) management at a special out-patient hypertension clinic with respect to dropout rate, side effects, blood pressure (BP) control, target organ involvement, prognostic factors and cardiovascular morbidity have been studied in 686 middle-aged male hypertensives. The impact of antihypertensive treatment, as one ingredient of multiple risk factor intervention, on mortality and morbidity in an urban, male population have been analysed. The hypertensive patients were derived from a random sample of men, aged 47-54 years at entry, constituting the intervention group (n = 7,455) of a multifactorial primary prevention trail. The whole population sample was studied regarding the effect of treatment on morbidity. The 10-year drop-out rate (declined follow-up/unknown reasons) was low (5%) being highest during the first year. The frequency of severe adverse drug effects was low (3% per year) after the initial period when treatment was started. An acceptable BP reduction was achieved in the majority of patients, but in many cases first after a few years' treatment and requiring combination drug therapy. Two-thirds of the patients achieved the goal BP (i.e. less than 160/95 mm Hg). These results are attributed to the organisation of the clinic and emphasise the need for frequent check-ups during the early phase of treatment and an easy accessibility to nurses and physicians. Except for a significant regression of ST- and T-wave changes on the conventional ECG during the first treatment year signs of heart (conventional ECG, chest X-ray) and kidney (albuminuria, serum creatinine) involvement remained unchanged or increased slightly during follow-up. Angina pectoris (AP), intermittent claudication (IC) and congestive heart failure (CHF) were common complications. The prevalence increased steadily with an average annual incidence of 1.3% (AP), 0.6% (IC) and 0.6% (CHF). ECG signs indicating subclinical heart disease were risk factor for AP and CHF. Smoking was an independent risk factor for any one of these cardiovascular disorders. The 10-year incidence of total mortality was 11.1%, and of CHD and stroke morbidity 12.2% and 4.1%, respectively. Independent risk factors (entry variables) for CHD were diastolic BP, smoking, serum cholesterol, AP and proteinuria. A previous stroke, smoking and proteinuria were independently associated with stroke morbidity. Hence, the risk factor pattern was similar to that known to operate in the general population.(ABSTRACT TRUNCATED AT 400 WORDS)

Antihypertensive Agents↗
PubMed1981

A two-phase study of the reliability of computerized morbidity data.

This paper reports the results of a detailed examination of morbidity data collected at the Department of Family Medicine, Brown University Program in Medicine. The reliability study was conducted in two phases, spanning five years, with two distinct aims: (1) to assess the extent of consistency between morbidity data stored in the computer and those data abstracted from medical records, and (2) to determine the impact on data reliability of a standardized, precoded encounter form. This form was implemented between the first and second phases of the study. It was found that morbidity data stored in the computer represents 80 to 85 percent of identifiable morbidity in the medical records. In addition, approximately 8 percent of the computer stored health problems were either incorrectly coded or not found in the medical records. The data reliability improved between the two phases, which points to a positive impact of the encounter form in this setting. Several important methodological issues related to identification and coding of health problems surfaced during the study. These issues are discussed and are relevant to all researchers working with computerized morbidity data in family practice.

Computers↗
PubMed1993

Hispanic children with asthma: morbidity.

Hispanic children represent a large and growing segment of the poor and disadvantaged children in our country. Asthma and other chronic respiratory diseases have a significant impact on poor children. Yet there are few descriptions of the specific morbidities and barriers to health that Hispanic children with asthma encounter, and data on predictors of morbidity among these children are unavailable. The purpose of this study is to describe the morbidity associated with asthma in Hispanic children and to identify factors that predict morbidity. A group of Hispanic children with moderate asthma followed in the clinics of the University of Texas Health Science Center at San Antonio were studied. Children aged 6 to 16 years with at least two acute-care visits or one hospitalization for asthma during the previous year were enrolled. Data sources included standardized questionnaires, spirometry, medical records, and school attendance records. Seventy-eight Hispanic children were enrolled in the study (mean age = 9.4 +/- 2.7 [SD]; 62% male). Fifty-two (67%) of children had been hospitalized previously. The other morbidity variables (mean +/- SD) were number of days/week impaired (1.1 +/- 1.2), number of days absent from school per year (13 +/- 9.6), number of acute-care visits per year (3.3 +/- 2.4), and number of hospital admissions per year (0.6 +/- 0.8). The mean forced expiratory volume in 1 second/forced vital capacity was 79.3% (+/- 9.1) and the mean forced expiratory flow, mid-expiratory phase, percent predicted was 69.9% (+/- 25.1). Thirty-four children (44%) were exposed to cigarette smoke in the home.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗
PubMed1993

[Morbidity and mortality after elective Billroth II gastric resection in duodenal ulcer. Authors' experience].

A retrospective study was carried out those patients who underwent elective Billroth II gastric resection for pyloric or duodenal ulcer at the Surgical Division of the Scientific Institute of Gastroenterology of Castellana Grotte between 1974 and 1989. The aim of the study was to asses the incidence of postoperative morbidity and mortality. A total of 526 patients were included in the study (mean age 49 years +/- 12 years; 451 males (86%) and 75 females (14%). Morbidity was 20.7% and mortality 1.5%. These findings are in line with those reported in the literature and confirm that gastric resection for duodenal ulcer, even when performed electively, has a far from negligible morbidity and mortality rate. It is well known that, in comparison to more conservative operations such as vagotomy, gastric resection for peptic ulcer presents a high rate of postoperative morbidity and mortality, but a lower incidence of ulcerous recidivation. Unless there are valid preoperative criteria on which to base the choice of one or other techniques, the surgeon will usually choose the method with which the is most familiar. until studies have been carried out to identify the risk factors leading to postoperative morbidity and mortality, the authors suggest that gastric resection is reserved for those patients presenting a low operative risk.

Adult↗
PubMed1993

[Angina morbidity in an organized collective with a periodic turnover of its personnel].

The article studies the average angina morbidity in the military unit during 9 years which resulted in 48.4% (scarlet fever--0.34%). Laboratory diagnostics is needed to make the estimation of streptococcal infection which has an acute respiratory infectious character during its clinical course. Among the whole number of patients 89.2% have come through this illness for one time, 9% twice, and 4.8%--three times. The dynamics of the angina morbidity had a periodical cycle of 2-3 years which was independent from the morbidity cycle of local civilian population. The authors show a statistic dependency between average morbidity index and the quantity of servicemen in one dormitory, its square and volume per one man. Application of "time before illness" index for 24 months made it possible to disclose the phase character in the development of streptococcal infection among personnel of the same call-up period. The general tendency towards reduction of the morbidity index was accompanied with regular upgrades of the infection after each spring or autumn renovation of personnel.

Adolescent↗
PubMed1995

[Somatization disorders in primary care: differential clinical aspects. Study Group of Psychic and Psychosomatic Morbidity of Zaragoza, Primary Care Section].

BACKGROUND: To identify specific sociodemographic and psychopathological features of somatization disorder (SD) patients in relation to other patients with psychiatric and organic morbidity in primary care (PC) setting. METHODS: A group of SD patients from PC was compared with other two control groups: the first one made of patients with psychiatric morbidity (with or without organic disease) and the second group of patients with only organic disease without psychiatric morbidity. Polivalent standardized psychiatric interview (PSPI), a specific psychiatric interview for PC settings, was used as diagnostic instrument. RESULTS: 1) there is a female predominance in SD statistically significant compared with organic patients and with a trend to significance in relation to psychiatric patients. Age, marital status and educational level show no significant differences among the groups; 2) in relation to psychopathology, SD patients show, in relation with organic patients, statistically higher levels in all items measured by PSPI. On the contrary, SD overwhelmed psychiatric patients in just four items: somatic symptoms, fatigue, reported anxiety and hystrionism as well as sexual problems and lack of social support, and 3) high psychiatric morbidity (85%) in SD, most of them affective and anxiety diagnosis, make it difficult to differentiate from the other patients suffering from psychiatric morbidity in PC. CONCLUSION: Patients with SD show a very different profile compared with those with organic disease in relation to psychiatric symptoms and social problems. On the other hand, when compared with patients with psychiatric disorders, differences are rather scarce. In addition, affective and anxiety comorbidity associated make it difficult the diagnosis. For this reason, the use of screening instruments for SD seems mandatory.

Adult↗
PubMed1995

Psychosocial morbidity in bone marrow transplant recipients: a prospective study.

Previous work has demonstrated that psychosocial morbidity may occur following bone marrow transplantation (BMT), but few prospective quantitative data are available, especially in adults. We have conducted a prospective psychological assessment of 36 patients accepted onto our BMT programme, of whom 31 proceeded to transplant. Patients were assessed shortly before admission for BMT and again at about 4 and 8 months after the procedure, using the following tools: Hospital Anxiety and Depression Scale (HAD), Social Adjustment Scale-Self Report and the Present State Examination (PSE). A 54% incidence of psychosocial morbidity (as assessed by either an abnormal HAD or PSE result) was found among those cases assessed both before and at least once after BMT. Significant psychosocial morbidity was still present 6-9 months following BMT. Cases scoring abnormally following BMT in general also scored abnormally before transplant, suggesting a predictive value of pre-BMT psychological assessment. Psychological morbidity was unrelated to the type of transplant. Patients with chronic myeloid leukaemia had a higher incidence of post-BMT psychosocial morbidity than patients with other diagnoses; it is suggested that this may be due to their lack of previous experience of intensive haematological therapy. Psychological evaluation may help in identifying patients at risk of post-BMT psychosocial problems.

Adolescent↗
PubMedDate not supplied

Psychiatric morbidity among dermatology inpatients.

BACKGROUND: Research on psychiatric morbidity among patients with dermatological diseases generally focuses on outpatients and questionnaire-based surveys. The aim of this study was to determine the prevalence and nature of psychiatric morbidity among dermatological inpatients with diagnosis being made by psychiatric interview, and ascertain whether demographic and clinical details in dermatological inpatients with psychiatric morbidity differed from those without it. METHODS: Charts of all inpatients admitted by the dermatology department between 1 January 1991 and 31 July 1995 were analysed for socio-demographic data, clinical features, treatment and course in hospital. For those patients who were referred to a psychiatrist, all records of the psychiatric consultation were obtained and analysed. RESULTS: A total of 1073 patients were admitted during the study period. Ninety-eight patients (9%) were diagnosed to have a psychiatric illness. Patients with psychiatric illness were likely to have had more admissions and longer duration of hospital stay. The most common psychiatric diagnoses were depressive episodes (34%) and adjustment disorders (29%). The highest rates of psychiatric morbidity were found among patients with chronic urticaria, exfoliative dermatitis and sexually transmitted diseases, including human immunodeficiency virus infection. The prevalence of psychiatric disorders was significantly higher in those who had received long term (more than six weeks) treatment with high-dose steroids (more than 1 mg/kg body weight of prednisolone). CONCLUSION: Some dermatology inpatients have psychiatric morbidity, which affects the course of the dermatological condition as well as the duration of hospitalization. The availability of psychiatric consultation at dermatology clinics and regular liaison between psychiatrists and dermatologists are essential for appropriate management.

Adjustment Disorders↗
PubMed1997

Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial.

OBJECTIVE: To assess the relationship between body temperature and cardiac morbidity during the perioperative period. DESIGN: Randomized controlled trial comparing routine thermal care (hypothermic group) to additional supplemental warming care (normothermic group). SETTING: Operating rooms and surgical intensive care unit at an academic medical center. SUBJECTS: Three hundred patients undergoing abdominal, thoracic, or vascular surgical procedures who either had documented coronary artery disease or were at high risk for coronary disease. OUTCOME MEASURE: The relative risk of a morbid cardiac event (unstable angina/ischemia, cardiac arrest, or myocardial infarction) according to thermal treatment. Cardiac outcomes were assessed in a double-blind fashion. RESULTS: Mean core temperature after surgery was lower in the hypothermic group (35.4+/-0.1 degrees C) than in the normothermic group (36.7+/-0.1 degrees C) (P<.001) and remained lower during the early postoperative period. Perioperative morbid cardiac events occurred less frequently in the normothermic group than in the hypothermic group (1.4% vs 6.3%; P=.02). Hypothermia was an independent predictor of morbid cardiac events by multivariate analysis (relative risk, 2.2; 95% confidence interval, 1.1-4.7; P=.04), indicating a 55% reduction in risk when normothermia was maintained. Postoperative ventricular tachycardia also occurred less frequently in the normothermic group than in the hypothermic group (2.4% vs 7.9%; P=.04). CONCLUSION: In patients with cardiac risk factors who are undergoing noncardiac surgery, the perioperative maintenance of normothermia is associated with a reduced incidence of morbid cardiac events and ventricular tachycardia.

Aged↗
PubMed1997

Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

CONTEXT: Intrauterine infection is thought to be one cause of preterm premature rupture of the membranes (PPROM). Antibiotic therapy has been shown to prolong pregnancy, but the effect on infant morbidity has been inconsistent. OBJECTIVE: To determine if antibiotic treatment during expectant management of PPROM will reduce infant morbidity. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: University hospitals of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. PATIENTS: A total of 614 of 804 eligible gravidas with PPROM between 24 weeks' and 0 days' and 32 weeks' and 0 days' gestation who were considered candidates for pregnancy prolongation and had not received corticosteroids for fetal maturation or antibiotic treatment within 1 week of randomization. INTERVENTIONS: Intravenous ampicillin (2-g dose every 6 hours) and erythromycin (250-mg dose every 6 hours) for 48 hours followed by oral amoxicillin (250-mg dose every 8 hours) and erythromycin base (333-mg dose every 8 hours) for 5 days vs a matching placebo regimen. Group B streptococcus (GBS) carriers were identified and treated. Tocolysis and corticosteroids were prohibited after randomization. MAIN OUTCOME MEASURES: The composite primary outcome included pregnancies complicated by at least one of the following: fetal or infant death, respiratory distress, severe intraventricular hemorrhage, stage 2 or 3 necrotizing enterocolitis, or sepsis within 72 hours of birth. These perinatal morbidities were also evaluated individually and pregnancy prolongation was assessed. RESULTS: In the total study population, the primary outcome (44.1 % vs 52.9%; P=.04), respiratory distress (40.5% vs 48.7%; P=.04), and necrotizing enterocolitis (2.3% vs 5.8%; P=.03) were less frequent with antibiotics. In the GBS-negative cohort, the antibiotic group had less frequent primary outcome (44.5% vs 54.5%; P=.03), respiratory distress (40.8% vs 50.6%; P=.03), overall sepsis (8.4% vs 15.6%; P=.01), pneumonia (2.9% vs 7.0%; P=.04), and other morbidities. Among GBS-negative women, significant pregnancy prolongation was seen with antibiotics (P<.001). CONCLUSIONS: We recommend that women with expectantly managed PPROM remote from term receive antibiotics to reduce infant morbidity.

Adult↗
PubMed1997

The health care cost of drug-related morbidity and mortality in nursing facilities.

BACKGROUND: Preventable drug-related morbidity and mortality within nursing facilities represent a serious problem urgently requiring expert medical attention. The health care costs of drug-related problems can be both immense and avoidable. However, the research to date has been narrow in scope, focusing on the drug costs avoided and failing to consider the wider range of possible negative outcomes and potential drug-related problems. OBJECTIVES: To develop a model of therapeutic outcomes resulting from drug therapy within nursing facilities, to estimate the magnitude of the cost of drug-related morbidity and mortality within nursing facilities in the United States, and to assess the impact of pharmacist-conducted, federally mandated, monthly, retrospective review of nursing facility residents' drug regimens in reducing the cost of drug-related morbidity and mortality. METHODS: Using decision analysis techniques, a probability pathway model was developed to estimate the cost of drug-related problems within nursing facilities. An expert panel consisting of consultant pharmacists and physicians with practice experience in nursing facilities and geriatric care was surveyed to determine conditional probabilities of therapeutic outcomes attributable to drug therapy. Health care utilization and associated costs derived from negative therapeutic outcomes were estimated. RESULTS: Baseline estimates indicate that the cost of drug-related morbidity and mortality with the services of consultant pharmacists was $4 billion compared with $7.6 billion without the services of consultant pharmacists. CONCLUSIONS: Drug-related morbidity and mortality in nursing facilities represent a serious economic problem. For every dollar spent on drugs in nursing facilities, $1.33 in health care resources are consumed in the treatment of drug-related problems. With the current federally mandated drug regimen review, it is estimated that consultant pharmacists help to reduce health care resources attributed to drug-related problems in nursing facilities by $3.6 million.

Cost of Illness↗