Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MORBIDITY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources
PubMed1998

Surgical correction of stress incontinence in morbidly obese women.

PURPOSE: Obesity is a contributing factor to the development of stress urinary incontinence in women, in addition to surgical technical factors which may make some urologists reticent to offer operative therapy. We reviewed our series of morbidly obese women who underwent anti-incontinence surgery to determine if they were at higher risk for surgical failure. MATERIALS AND METHODS: The records of our operative series of female stress urinary incontinence were reviewed and 16 women were considered morbidly obese. Transvaginal bladder neck suspension was performed in 4 women and sling procedures in 12, depending on preoperative urodynamic findings. RESULTS: Bladder neck suspension procedures failed in 2 cases, and no sling procedures failed. There was no recurrent or new pelvic floor deficit. The operations were somewhat more difficult to perform due to the body habitus of these patients but there were no intraoperative complications and only 1 minor wound infection postoperatively. CONCLUSIONS: Morbidly obese women with stress urinary incontinence can undergo operations for this disorder with a good chance of success. We recommend complete evaluation including urodynamics to ensure proper classification of stress incontinence. Sling operations may be the procedure of choice for stress incontinence in morbidly obese women.

Female↗
PubMed1993

Extracorporeal shock wave lithotripsy in morbidly obese patients.

Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to nonobese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to nonobese patients), difficulty may be encountered in positioning the patient so that the stone is situated at the F2 focal point of the lithotriptor. Using various aids, such as the extended shock pathway and abdominal compression, we treated 81 patients weighing more than 300 pounds using the Medstone STS tubless second generation lithotriptor. The stone-free rate at 3 months or longer was 68%, with another 10% having asymptomatic fragments of 4 mm. or less in diameter. Thus, a clinical stone-free rate of 78% was achieved. The retreatment rate was 11% and the post-lithotripsy secondary procedures rate was 3%. Since these results are comparable to those obtained when treating patients less than 300 pounds, extracorporeal shock wave lithotripsy can be used successfully to treat urolithiasis in morbidly obese patients.

Humans↗
PubMed1991

Prospective evaluation of vertical banded gastroplasty as the primary operation for morbid obesity.

Our previous experience with vertical (nonbanded) gastroplasty proved disappointing because of unsatisfactory maintenance of weight loss. Vertical banded gastroplasty seemed to be an attractive alternative operation because it provided an externally reinforced (banded) stoma that would not enlarge over time. In this study, our aim was to determine prospectively the results of vertical banded gastroplasty used as a primary, weight-reducing procedure in patients with morbid obesity. Seventy consecutive patients with morbid obesity (mean weight, 139 kg), all of whom had obesity-related complications, underwent vertical banded gastroplasty and prospective follow-up. The hospital mortality was nil, and substantial morbidity occurred in 3% (two patients). Long-term achievement and maintenance of satisfactory weight loss, however, were variable. The median weight loss at 1 year after operation was 36.7 kg or 48% of excess body weight. At 3 years postoperatively, however, weight loss was only 32.4 kg or 40% of excess body weight, and only 38% of patients had achieved and maintained a weight loss of 50% or more of their preoperative excess body weight. Vertical banded gastroplasty caused major changes in eating habits, and many patients were unable to eat red meat or untoasted bread; moreover, approximately 30 to 50% of patients continued to vomit once or more per week. Despite theoretically attractive advantages as a weight-reduction operation, vertical banded gastroplasty does not seem to be the optimal procedure for most patients with morbid obesity.

Adult↗
PubMed1996

A one-year community study of under-fives in rural Ethiopia: health and behavioural determinants of morbidity.

Based on a one-year weekly home surveillance study, morbidity patterns of 1,304 children under five years of age in a rural Ethiopian community were measured, together with nutritional and health behavioural determinants. Using Poisson regression models, the study showed that nutritional and health care factors make a significant impact on under-five morbidity. Gastroenteritis was particularly associated with child care factors, while acute respiratory infections were particularly associated with nutritional factors. Lack of immunization, low birthweight and pre-term delivery (more than one month early) were not found to have any independent effect on morbidity. Breast feeding was universal, but the introduction of supplementary foods was found to protect from excess morbidity. The study concludes by discussing possible applications of the results in intervention programmes.

Age Distribution↗
PubMed1996

Effect of anaemia and cardiovascular disease on surgical mortality and morbidity.

BACKGROUND: Guidelines have been offered on haemoglobin thresholds for blood transfusion in surgical patients. However, good evidence is lacking on the haemoglobin concentrations at which the risk of death or serious morbidity begins to rise and at which transfusion is indicated. METHODS: A retrospective cohort study was performed in 1958 patients, 18 years and older, who underwent surgery and declined blood transfusion for religious reasons. The primary outcome was 30-day mortality and the secondary outcome was 30-day mortality or in-hospital 30-day morbidity. Cardiovascular disease was defined as a history of angina, myocardial infarction, congestive heart failure, or peripheral vascular disease. FINDINGS: The 30-day mortality was 3.2% (95% CI 2.4-4.0). The mortality was 1.3% (0.8-2.0) in patients with preoperative haemoglobin 12 g/dL or greater and 33.3% (18.6-51.0) in patients with preoperative haemoglobin less than 6 g/dL. The increase in risk of death associated with low preoperative haemoglobin was more pronounced in patients with cardiovascular disease than in patients without (interaction p < 0.03). The effect of blood loss on mortality was larger in patients with low preoperative haemoglobin than in those with a higher preoperative haemoglobin (interaction p < 0.001). The results were similar in analyses of postoperative haemoglobin and 30-day mortality or in-hospital morbidity. INTERPRETATION: A low preoperative haemoglobin or a substantial operative blood loss increases the risk of death or serious morbidity more in patients with cardiovascular disease than in those without. Decisions about transfusion should take account of cardiovascular status and operative blood loss as well as the haemoglobin concentration.

Adult↗
PubMedDate not supplied

The compression of morbidity debate in aging: an empirical test using the gerontological and geriatric population studies in Göteborg, Sweden (H70).

The H70 longitudinal study of aging, Göteborg, Sweden is used to empirically test the compression of morbidity theory advanced by. We reconceptualize compression as postponement of morbidity in the sense of decreasing amounts of illness for increasingly long life spans. Operationally, morbidity is defined as the average number of hospital days in the last year of life. The date of death and the date of 1-year prior to death define the risk period. The linear regression model with age at death, age at death squared, year of birth, and sex are statistically significant with the oldest having the fewest hospital days. The findings offer partial support for the compression of morbidity theory.

Aged↗
PubMed2000

Compression of morbidity in the elderly.

The Compression of morbidity paradigm envisions reduction in cumulative lifetime morbidity through primary prevention by postponing the age of onset of morbidity to a greater amount than life expectancy is increased, largely by reducing the lifestyle health risks which cause morbidity and disability. Recent data document slowly improving age-specific health status for seniors, indicate that postponement of the onset of disability by at least 10 years is feasible, and prove effectiveness of some lifestyle interventions by randomized controlled trials. Human aging is increasingly represented by frailty, with declining reserve function of many organ systems, including the immune system. Enhancement of immune function in this setting raises medical, ethical, and social issues which are sometimes in conflict.

Aged↗
PubMed2003

Socioeconomic inequalities in morbidity among the elderly; a European overview.

There is some evidence on socioeconomic inequality in morbidity among elderly people, but this evidence remains fragmentary. This study aims to give a comprehensive overview of educational and income inequalities in morbidity among the elderly of eleven European countries. Data from the first wave of 1994 of the European Community Household Panel were used. The study population comprised a total of 14,107 men and 17,243 women, divided into three age groups: 60-69, 70-79 and 80+. Three health indicators were used: self-assessed health, cut down in daily activities due to a physical or mental problem, and long-term disability. The results indicate that socioeconomic inequalities in morbidity by education and income exist among the elderly in Europe, in all the countries in this study and all age groups, including the oldest old. Inequalities decline with age among women, but not always among men. Greece, Ireland, Italy and The Netherlands most often show large inequalities among men, and Greece, Ireland and Spain do so among women. To conclude, inequalities in morbidity decrease with age, but a substantive part persists in old age. To improve the health of elderly people it is important that the material, social and cultural resources of the elderly are improved.

Activities of Daily Living↗
PubMed2003

Association between measures of morbidity and locomotor disability: diagnosis alone is not enough.

This study examines the relationship between different measures of morbidity and locomotor disability in early old age. Data from a community health survey of 858 people aged approximately 58 years living in the West of Scotland were examined for associations between morbidity and locomotor disability. The relationships between presence of chronic conditions, severity and pain from chronic conditions, reported symptoms, self-reported health and locomotor disability were examined using logistic regression. After adjusting for several measures of morbidity, sex and social class, frequency of pain from cardiovascular conditions (OR 5.49, 95%CI 2.64-11.39), frequency of pain from musculo-skeletal conditions (OR 2.79, 95% CI 1.76-4.44) and self-assessed health compared to other people the same age (OR 2.76, 95% CI 1.64-4.65) were the most important predictors of locomotor disability. Inclusion of frequency of pain greatly increased the strength of associations of chronic conditions with locomotor disability. Simple measures of morbidity may mask important associations between particular conditions and locomotor disability. In particular the findings suggest that for surveys of the correlates of locomotor disability, collateral information on the frequency of pain associated with chronic conditions and self-reported health relative to other people of the same age provides additional explanatory power.

Cardiovascular Diseases↗
PubMedDate not supplied

Predicting unsuccessful cardiopulmonary resuscitation (CPR): a comparison of three morbidity scores.

The aim of the study was to assess the usefulness of three different morbidity scores in predicting unsuccessful resuscitation. We reviewed the records of adult patients who underwent CPR between September 1994 and June 1996 in The Royal Hampshire County Hospital, Winchester. Demographic data and enough clinical data to calculate the Pre-Arrest Morbidity score (PAM), the Prognosis After Resuscitation score (PAR) and the Modified PAM Index (MPI) were collected. During the study period 264 consecutive adult patients underwent inpatient CPR. Twenty-eight (11%) of the patients survived to discharge from hospital. Patients who died had significantly higher morbidity scores than those who survived. No patient with a PAM score greater than 6/25, PAR greater than 7/28 or MPI greater than 6/24 survived. There were 47/264 patients who scored above this threshold for the PAM score giving a sensitivity for predicting unsuccessful CPR of 20%. The sensitivity of the PAR was 29% and MPI was 22%. Each score identified a different group of patients for whom CPR was unsuccessful. Using all three scores in combination identified 42% of the unsuccessful CPR attempts. Morbidity scores are likely to need further refinement in order to be a useful bedside tool for predicting success for individual patient resuscitation attempts.

Adult↗
PubMed2002

Breech presentation at term: morbidity and mortality according to the type of delivery at Port Royal Maternity hospital from 1993 through 1999.

OBJECTIVE: To compare neonatal morbidity and mortality at Port Royal Maternity between 1993 and 1999 for infants with a singleton breech presentation born after 37 weeks, according to planned mode of delivery. STUDY DESIGN: Retrospective study of 501 patients of whom vaginal delivery was planned in 322 (64%) or/and cesarean in 179 (36%). RESULTS: Severe neonatal morbidity was similar in the two groups (13/322, 4.0% versus 8/179, 4.5%; P=0.82); severe trauma morbidity was not significantly higher in the "planned vaginal delivery" group (3/322, 0.9% versus 1/179, 0.06%; P=0.16); there were no long-term sequelae. Mortality was not higher when vaginal delivery was planned. CONCLUSION: We have not found in this series any excess of morbidity or mortality attributable to vaginal delivery of breech presentations. This work does not indicate that we should change our obstetrical practice in the light of other recently-published studies.

Apgar Score↗
PubMed2002

Patient self-reporting questionnaire on urological morbidity and bother after radical retropubic prostatectomy.

OBJECTIVES: We assessed the incidence of morbidity and bother on quality-of-life (QL) after radical retropubic prostatectomy for prostate cancer. METHODS: At least 12 months after surgery, self-reporting questionnaires were completed and returned by 368 (77.8%) of 473 eligible patients. Surgery related morbidity was evaluated by adhoc constructed questions. QL was assessed by the European Organization for Research and Treatment of Cancer QL core questionnaire (EORTC QLQ-C30). Multivariate and univariate analysis as well as regression analysis were used to assess the bother factors. RESULTS: Postoperative urinary incontinence significant enough for the patient to use some kind of protection was reported by 27.2%. After surgery, 14.2% of preoperative potent men were able to get and maintain an erection sufficient enough for sexual intercourse without any aid. Overall 10.6% of respondents had undergone surgery for anastomotic stricture and 23.6% reported on adjuvant therapy. Furthermore, 43.2% reported on fear of not being cured from cancer. Postoperative urinary incontinence and fear of not being cured were associated with significant lower global QL scores and turned out as independent predictors for global QL. In contrast, postoperative erectile dysfunction, anastomotic stricture and adjuvant therapy were not independent predictors. In addition, 82.1% would vote for surgery again. CONCLUSION: The majority of the patients would opt for surgical treatment again, although morbidity is common after radical prostatectomy and may impair QL. Particularly urinary incontinence and fear of not being cured are independent predictors for global QL after surgery. Therefore, surgical techniques with a low morbidity are requested as well as some kind of psychological support in order to cope with existential fear.

Aged↗
PubMed2001

The morbidity of treatment for patients with Stage I endometrial cancer: results from a randomized trial.

PURPOSE: To compare the treatment complications for patients with Stage I endometrial cancer treated with surgery and pelvic radiotherapy (RT) or surgery alone in a multicenter randomized trial. METHODS AND MATERIALS: The Postoperative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial included patients with endometrial cancer confined to the uterine corpus, either Grade 1 or 2 with more than 50% myometrial invasion, or Grade 2 or 3 with less than 50% myometrial invasion. Surgery consisted of an abdominal hysterectomy and oophorectomy, without lymphadenectomy. After surgery, patients were randomized to receive pelvic RT (46 Gy), or no further treatment. A total of 715 patients were randomized. Treatment complications were graded using the French-Italian glossary. RESULTS: The analysis was done at a median follow-up duration of 60 months. 691 patients were evaluable. Five-year actuarial rates of late complications (Grades 1-4) were 26% in the RT group and 4% in the control group (p < 0.0001). Most were Grade 1 complications, with 5-year rates of 17% in the RT group and 4% in the control group. All severe (Grade 3-4) complications were observed in the RT group (3%). Most complications were of the gastrointestinal tract. The symptoms resolved after some years in 50% of the patients. Grade 1-2 genitourinary complications occurred in 8% of the RT patients, and 4% of the controls. Bone complications occurred in 4 RT patients (1%). Seven patients (2%) discontinued their RT due to acute RT-related symptoms. Patients with acute morbidity had an increased risk of late RT complications (p = 0.001). The 4-field box technique was associated with a lower risk of late complications (p = 0.06). CONCLUSION: Pelvic RT increases the morbidity of treatment in Stage I endometrial cancer. In the PORTEC trial, severe complications occurred in 3% of treated patients, and over 20% experienced mild (mostly Grade 1) symptoms. Patients with acute RT-related morbidity had an increased risk of late complications. As pelvic RT in Stage I endometrial carcinoma was shown to significantly reduce the rate of locoregional recurrence, but without a survival benefit, its use in the adjuvant setting requires careful patient selection (treating those at increased risk of relapse), and the use of treatment schemes with the lowest risk of morbidity.

Aged↗
PubMed1997

Proton therapy for pediatric cranial tumors: preliminary report on treatment and disease-related morbidities.

PURPOSE: Accelerated protons were used in an attempt to limit treatment-related morbidity in children with tumors in or near the developing brain, by reducing the integral dose to adjacent normal tissues. METHODS AND MATERIALS: Children treated with protons at Loma Linda University Medical Center between August 1991 and December 1994 were analyzed retrospectively. Twenty-eight children, aged 1 to 18 years, were identified as at risk for brain injury from treatment. Medical records, physical examinations, and correspondence with patients, their parents, and referring physicians were analyzed. The investigators tabulated post-treatment changes in pre-treatment signs and symptoms and made judgments as to whether improvement, no change, or worsening related to disease or treatment had supervened. Magnetic resonance images were correlated with clinical findings and radiographic impressions were tabulated. RESULTS: Follow-up ranged from 7 to 49 months (median 25 months). Four instances of treatment-related morbidity were identified. Forty-one instances of site-specific, disease-related morbidity were identified: 15 improved or resolved and 26 remained unchanged after treatment. Four patients had radiographic evidence of local failure. Three of these patients, including two with high-grade glioma, have died. CONCLUSION: Early treatment-related morbidity associated with proton therapy is low. Tumor progression remains a problem when treating certain histologies such as high-grade glioma. Escalating the dose delivered to target volumes may benefit children with tumors associated with poor rates of local control. Long-term follow-up, including neurocognitive testing, is in progress to assess integral-dose effects on cognitive, behavioral and developmental outcomes in children with cranial tumors.

Adolescent↗
PubMed1998

Reduced morbidity and mortality rates of the heparin-induced thrombocytopenia syndrome.

PURPOSE: We reported a 61% morbidity rate and a 23% mortality rate for the heparin-induced thrombocytopenia (HIT) syndrome in 1983. We subsequently reported in 1987 that with early recognition, immediate cessation of the administration of heparin, and platelet function inhibition, the morbidity rate could be reduced to 23% and the mortality rate to 12%. One hundred recent cases of patients with heparin-associated antiplatelet antibodies (HAAb) have been reviewed to determine whether aggressive screening, early diagnosis, and alternate management could further reduce morbidity and mortality rates. METHODS: The consecutive records of 100 patients with positive platelet aggregation tests were reviewed. Sixty-six patients were male. The patients' ages ranged from 23 days to 92 years. The patients were from vascular (28), cardiothoracic (42), and other (30) services. HIT was suspected in patients who received heparin and had falling platelet counts, platelet counts less than 100,000/mm3, or new thromboembolic or hemorrhagic events. RESULTS: Heparin was not offered to six patients with known HAAb. Twelve patients were successfully treated with antiplatelet therapy and limited reexposure to heparin, and 75 patients were successfully treated with early diagnosis and prompt cessation of heparin. Alternate forms of anticoagulation therapy were used selectively. Seven patients had 11 complications. Three of the seven patients were treated successfully with warfarin anticoagulation and aspirin (2) or with aspirin alone (1). A fourth patient was treated with thrombectomy, hematoma evacuation, and aspirin. A fifth patient underwent thrombolysis and coronary angioplasty in addition to receiving warfarin and aspirin. The sixth patient required two thrombectomies and warfarin. A seventh patient required two thrombectomies and aspirin. HIT was responsible for one of 17 deaths. CONCLUSION: A 7.4% morbidity rate and a 1.1% mortality rate have been achieved in patients with HAAb by aggressive screening, early recognition of HIT, and prompt cessation of the administration of heparin. Platelet function inhibitors and other anticoagulants, including nonreacting low molecular weight heparin, are important adjuncts in the management of the thromboembolic disorders associated with HIT.

Adolescent↗
PubMed2003

Women are more disabled in basic activities of daily living than men only in very advanced ages: a study on disability, morbidity, and mortality from the Kungsholmen Project.

OBJECTIVE: We explored the effect of morbidity, mortality, and occurrence of new disability on gender differences in activities of daily living (ADL) functioning in different age groups in the elderly population. METHODS: All 77+-year-old members of a community-based cohort were clinically examined by physicians, assessed by psychologists, and interviewed by nurses at baseline and after a 3-year interval. Diseases were diagnosed according to ICD-9 and the DSM-III-R criteria for dementia. The Katz index of ADL was used to measure basic functional status. RESULTS: After adjustment for socio-demographic characteristics, the oldest women (90+ years) had higher disability prevalence and a tendency for higher long-term disability incidence. Women aged 85+ years also had higher morbidity prevalence. Mortality among disabled subjects was similar for both genders, whereas higher mortality was found in younger nondisabled men (77-84 years). CONCLUSION: We conclude that gender differences in disability, morbidity, and mortality vary with age in the elderly population. Gender differences in morbidity and basic functional dependence were evident only in the oldest old. Based on current and previous findings, we speculate that more women may be at higher risk of developing severe disability than men in the advanced ages due to longer survival with slight disability earlier in adult life.

Activities of Daily Living↗
PubMed2004

Prediction of postoperative morbidity after lung resection using an artificial neural network ensemble.

OBJECTIVE: To propose an ensemble model of artificial neural networks (ANNs) to predict cardio-respiratory morbidity after pulmonary resection for non-small cell lung cancer (NSCLC). METHODS: Prospective clinical study was based on 489 NSCLC operated cases. An artificial neural network ensemble was developed using a training set of 348 patients undergoing lung resection between 1994 and 1999. Predictive variables used were: sex of the patient, age, body mass index, ischemic heart disease, cardiac arrhythmia, diabetes mellitus, induction chemotherapy, extent of resection, chest wall resection, perioperative blood transfusion, tumour staging, forced expiratory volume in 1s percent (FEV(1)%), and predicted postoperative FEV(1)% (ppoFEV(1)%). The analysed outcome was the occurrence of postoperative cardio-respiratory complications prospectively recorded and codified. The artificial neural network ensemble consists of 100 backpropagation networks combined via a simple averaging method. The probabilities of complication calculated by ensemble model were obtained to the actual occurrence of complications in 141 cases operated on between January 2000 and December 2001 and a receiver operating characteristic (ROC) curve for this method was constructed. RESULTS: The prevalence of cardio-respiratory morbidity was 0.25 in the training and 0.30 in the validation series. The accuracy for morbidity prediction (area under the ROC curve) was 0.98 by the ensemble model. CONCLUSION: In this series an artificial neural network ensemble offered a high performance to predict postoperative cardio-respiratory morbidity.

Aged↗
PubMed2006

Histologic spectrum of nonalcoholic fatty liver disease in morbidly obese adolescents.

BACKGROUND & AIMS: To characterize the spectrum of nonalcoholic fatty liver disease (NAFLD) in morbidly obese adolescents, we correlated liver histology with clinical features and compared findings with reported adult data. We hypothesized that NAFLD would be less severe as a result of younger age and shorter duration of obesity, but portal inflammation and fibrosis would be more prevalent. METHODS: Cross-sectional study was made of 41 adolescent subjects, 13-19 years old (mean, 16 years), 61% female, 83% non-Hispanic white, mean body mass index 59 kg/m(2), undergoing gastric bypass with liver biopsy. Liver biopsies were graded and staged as proposed by the NASH Clinical Research Network. Data were analyzed by using descriptive statistics, analysis of variance, and Fisher exact tests. RESULTS: Eighty-three percent had NAFLD: 24% steatosis alone, 7% isolated fibrosis with steatosis, 32% nonspecific inflammation and steatosis, and 20% nonalcoholic steatohepatitis (NASH). Twenty-nine percent had fibrosis; none had cirrhosis. Abnormal ALT (P = .05) and AST (P = .01) were more prevalent in NASH. Mean fasting glucose was significantly higher in NASH (P = .05), but prevalence of the metabolic syndrome was not significantly different. CONCLUSIONS: NAFLD was very prevalent in morbidly obese adolescents, but severe NASH was uncommon. In contrast to morbidly obese adults, lobular inflammation, significant ballooning, and perisinusoidal fibrosis were rare, whereas portal inflammation and portal fibrosis were more prevalent, even in those who did not meet criteria for NASH. These findings might support use of a modified scoring system for pediatric NASH. Presence of the metabolic syndrome in morbidly obese adolescents did not distinguish NASH from steatosis alone.

Adolescent↗