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PubMed2004

Physical violence, self rated health, and morbidity: is gender significant for victimisation?

STUDY OBJECTIVE: To analyse gender differences in associations between physical violence and self rated health and self reported morbidity among a random sample of adults in Denmark. DESIGN AND SETTING: Two questions on self rated health and self reported morbidity respectively, were obtained from a cross sectional national health interview survey conducted among 12 028 adults (16 years +) in Denmark in 2000. A question on six different forms of physical violence was obtained from a supplementary self administered questionnaire given to the same sample. The reporting period for experienced physical violence was the past 12 months and for morbidity symptoms, the past 14 days. MAIN RESULTS: Men aged 16-24 years were significantly more likely to have experienced violence than women (OR = 3.2, 95% CI = 2.3 to 4.2). Female victims of physical violence were significantly more likely to rate their health as poor (OR = 2.02, 95% CI = 1.41 to 2.89) and to report anxiety (OR = 2.14, 95% CI = 1.35 to 3.37), depression (OR = 2.36, 95% CI = 1.55 to 3.60), and stomach ache (OR = 1.58, 95% CI = 1.01 to 2.47) than female non-victims. Male victims of physical violence were only significantly more likely to report stomach ache (OR = 1.73, 95% CI = 1.03 to 2.89) than male non-victims. CONCLUSIONS: Associations between physical violence and poor self rated health and self reported morbidity were found to be significant for women, but not for men. It is probable that gender differences in experiences of violence, as well as gender differences in health related self perception, contribute to a gender specific process of victimisation. Improved knowledge about the relation between gender specific violence and victimisation as a gender specific consequence is essential for targeting violence prevention.

Adolescent↗
PubMed1998

Morbidity surveillance in the British Army--the first 12 months.

This paper describes the data obtained during the first 12 months of the morbidity surveillance system used, world-wide, by the British Army in operational and non-operational settings and the economic impact of such morbidity in terms of estimated working days lost. Analysis is provided on primary health care and dental morbidity, the surveillance of patients undergoing physiotherapy and those Service personnel cared for by the NHS. The surveillance of the latter population shows a high burden of morbidity which, previously, has never been quantified. The most frequent cause of attendance within primary health care is injuries (all causes) with an annual total of 77,254--a rate per 1,000 personnel per month of 51.92. This leads to an annual loss of manpower, in terms of estimated working days lost of 127,839--a rate per 1,000 personnel per month of 85.91. Army Training Regiments (ATRs-5 sites), Infantry Training Centres (ITCs-2 sites) and the Royal Military Academy Sandhurst (RMAS) are grouped together as Selected Training Establishments (STEs) and show attendance rates higher than the mean for all causes. Summary results of Cochrane systematic reviews presenting up-to-date concise information on experimental evidence as to which preventive interventions should be used to diminish the notable impact of injuries on Army personnel are also given.

Absenteeism↗
PubMed1993

Mortality and cancer morbidity among cement workers.

OBJECTIVE: To explore associations between exposure to cement dust and cause specific mortality and tumour morbidity, especially gastrointestinal tumours. DESIGN: A retrospective cohort study. SUBJECTS AND SETTING: 2400 men, employed for at least 12 months in two Swedish cement factories. MAIN OUTCOME MEASURES: Cause specific morality from death certificates (1952-86). Cancer morbidity from tumour registry information (1958-86). Standardised mortality rates (SMRs; national reference rates) and standardised morbidity incidence rates (SIRs; regional reference rates) were calculated. RESULTS: An increased risk of colorectal cancer was found > or = 15 years since the start of employment (SIR 1.6, 95% confidence interval (95% CI) 1.1-2.3), mainly due to an increased risk for tumours in the right part of the colon (SIR 2.7, 95% CI 1.4-4.8), but not in the left part (SIR 1.0, 95% CI 0.3-2.5). There was a numerical increase of rectal cancer (SIR 1.5, 95% CI 0.8-2.5). Exposure (duration of blue collar employment)-response relations were found for right sided colon cancer. After > or = 25 years of cement work, the risk was fourfold (SIR 4.3, 95% CI 1.7-8.9). There was no excess of stomach cancer or respiratory cancer. Neither total mortality nor cause specific mortality were significantly increased. CONCLUSIONS: Diverging risk patterns for tumours with different localisations within the large bowel were found in the morbidity study. Long term exposure to cement dust was a risk factor for right sided colon cancer. The mortality study did not show this risk.

Cause of Death↗
PubMed1999

Morbidity from asthma in relation to regular treatment: a community based study.

BACKGROUND: The extent to which asthma morbidity in the community occurs in patients who are having relatively little treatment or in those on step 3 or above of the British asthma management guidelines is uncertain. We have looked at this in a community population in southern Nottinghamshire. METHODS: A cross sectional review of treatment in all patients over the age of four with diagnosed asthma was carried out in five large general practices (population 38 865) in 1995/6 using computerised general practice records. The patients' usual treatment was obtained from prescription data and categorised by the appropriate step on the British guidelines on asthma management. Two measures of morbidity, the request for 10 or more short acting beta agonist inhalers a year or the need for a course of oral corticosteroids in the last year, were related to the regular treatment of the patients. RESULTS: Of the 3373 patients (8. 7%) given a diagnosis of asthma, the percentage on steps 1, 2, 3, 4, and 5 of treatment were 54%, 22%, 11%, 3.6%, and 1%, respectively, with a further 8% having had no treatment. During the past year 13. 6% had been prescribed 10 or more beta agonist inhalers and 12.5% had received at least one course of oral corticosteroids. Both measures occurred more frequently in patients taking more prophylactic treatment (step 3 or above). Nevertheless, because most patients were on steps 1 and 2 of the treatment guidelines, more than half the patients requiring high doses of inhaled beta agonists or a course of oral prednisolone came from those taking low dose or no regular inhaled corticosteroid. CONCLUSIONS: Evidence of morbidity from asthma was found in many patients taking little or no prophylactic medication and this should be amenable to improved education. A different approach may be needed for patients with continuing morbidity who are already taking higher doses of prophylactic medication.

Adolescent↗
PubMed2001

Long-term effects of childhood obesity on morbidity and mortality.

Obesity tracks from childhood into adulthood, and the persistence of obesity rises with age among obese children. Early onset obesity was suggested as a risk factor for morbidity and mortality later in life. In both sexes, rates of diabetes, coronary heart disease, atherosclerosis, hip fracture and gout were increased in those who were overweight as adolescents. Especially in females, obesity at late adolescence was associated with several and relevant psychosocial consequences in adulthood. Finally, a higher mortality risk for all causes of death, especially atherosclerotic cerebrovascular disease and colorectal cancer, was demonstrated in males but not in females who were overweight during high school years. Although the persistence of excess adiposity from childhood to adulthood is a morbidity risk factor, it is not known if total body fat or body fat distribution is the main factor responsible. In particular, a specific role for the intra-abdominal adipose tissue (IAAT) in childhood, independently from that of total body fat, on morbidity risk in adulthood was not demonstrated yet. The association between childhood obesity and adult morbidity and mortality strongly suggests that a more effective prevention and treatment of childhood obesity should be pursued.

Aging↗
PubMed2002

Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis.

INTRODUCTION: Bacterial translocation (BT) may represent an important cause of septic morbidity in patients with acute pancreatitis. We have previously demonstrated an association between BT, septic morbidity and colonisation of the proximal GI tract. Alterations in intestinal permeability (IP) may also predispose to BT. The aim of this study was to assess the extent of gastric colonisation, measure IP in patients with acute pancreatitis and relate these to both disease severity and septic complications. METHODS: Gastric colonisation was determined by culturing a sample of nasogastric aspirate, and IP was measured using a dual sugar probe technique (lactulose/rhamnose test). Disease severity was assessed according to the modified Glasgow (Imrie) criteria. All septic complications were recorded prospectively. RESULTS: A total of 59 patients were studied (M:F ratio 32:27, median age 66 years, range 18-89), 24 (31%) of whom had severe disease. A nasogastric aspirate was obtained in 56 patients. There was a significantly higher incidence of colonisation with potentially pathogenic enteric bacteria in patients with severe disease compared to those with mild disease (57 vs. 6%, p < 0.001). Septic morbidity occurred in 29% of severe patients and 11% mild patients (p = 0.17). 33% of patients colonised with enteric organisms developed sepsis, compared to 16% with no enteric bacteria in the NG aspirate (p = 0.34). Enteric bacteria caused 77% of the septic complications. Intestinal permeability was neither associated with disease severity nor was it predictive of septic morbidity. CONCLUSIONS: There is significantly higher incidence of gastric colonisation with enteric bacteria in patients with severe acute pancreatitis, but no difference in IP. Enteric bacteria were implicated in the majority of septic complications. These findings support the gut origin of sepsis hypothesis in acute pancreatitis.

Acute Disease↗
PubMed2006

Neonatal mortality and morbidity after aggressive long-term tocolysis for preterm premature rupture of the membranes.

OBJECTIVE: To test the hypothesis that predischarge morbidity and mortality are not increased for infants admitted to our neonatal intensive care unit and whose mothers had tocolysis for >48 h plus antibiotics and steroids (aggressive long-term tocolysis) after preterm premature rupture of the membranes (PPROM) as compared with gestational age-matched infants born to mothers not treated for PPROM. METHODS: A retrospective cohort study was conducted on live preterm births ( 48 h (n=137, group 1) with singletons born to all other mothers matched for group-1 gestational age at delivery (n=628, group 2), excluding severe maternal complications such as insulin-dependent diabetes and preeclampsia in both groups. Primary outcome was the predischarge mortality and morbidity of the neonates. RESULTS: In the group with post-PPROM tocolysis which lasted for 14.4+/-14.0 days with a latency of 15.3+/-15.3 days (time from PPROM to delivery) and 14.4+/-14.0 days (time from the start of tocolysis to delivery), the predischarge mortality and morbidity was not increased compared to the non-treated group. The 1- and 10-min Apgar scores of between 1 and 7 were less frequent with tocolysis (p<0.05), and oxygen use was less frequent (26.3 vs. 36.3%, p=0.03) and shorter (8.7 vs. 19.6 days, p=0.03). However, amniotic fluid infection syndrome and latency (i.e. >1 week) are the most potential predictors of the respiratory distress syndrome in addition to gestational age at delivery in pregnancies with post-PPROM tocolysis. CONCLUSIONS: Amniotic fluid infection syndrome and a latency of >1 week achieved by aggressive post-PPROM tocolysis lessens the advantages of extended gestational age and decreased predischarge neonatal morbidity. These findings may have important implications for the clinical management of PPROM.

Adult↗
PubMed1998

Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis.

BACKGROUND AND PURPOSE: Greater availability and improvement of neuroradiological techniques have resulted in more frequent detection of unruptured aneurysms. Because prognosis of subarachnoid hemorrhage is still poor, preventive surgery is increasingly considered as a therapeutic option. Elective surgery requires reliable data on its risks. Therefore, we performed a meta-analysis on the mortality and morbidity of surgery for unruptured intracranial aneurysms. METHODS: Through Medline and additional searches by hand, we retrieved studies on clipping of unruptured (additional, symptomatic, or incidental) aneurysms published from 1966 through June 1996. Two authors independently extracted data. We used weighted linear regression for data analysis. RESULTS: We included 61 studies that involved 2460 patients (57% female; mean age, 50 years) and at least 2568 unruptured aneurysms (27% >25 mm, 30% located in the posterior circulation). Mortality was 2.6% (95% confidence interval [CI], 2.0% to 3.3%). Permanent morbidity occurred in 10.9% (95% CI, 9.6% to 12.2%) of patients. Postoperative mortality was significantly lower in more recent years for nongiant aneurysms and aneurysms with an anterior location; the last 2 characteristics were also associated with a significantly lower morbidity. CONCLUSIONS: In studies published between 1966 and 1996 on clipping of unruptured aneurysms, mortality was 2.6% and morbidity was 10.9%. In calculating the pros and cons of preventive surgery, these proportions should be taken into account.

Adolescent↗
PubMed2001

Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up.

The objective of this study was to assess the prevalence of posttraumatic stress disorder (PTSD) and symptoms of depression and anxiety in severely injured accident victims 1 yr posttrauma and to predict psychiatric morbidity by means of variables assessed shortly after the accident. The sample consisted of 106 consecutive patients with accidental injuries (mean Injury Severity Score = 21.9, mean Glasgow Coma Scale score = 14.4) admitted to the intensive care unit of a University Hospital. Patients with severe head injuries, suicide attempters, and victims of physical assault were excluded. At 1-yr follow-up, two patients (1.9%) had PTSD, and 13 (12.3%) had subsyndromal PTSD. Eighteen patients (17%) had clinically relevant symptoms of anxiety, and nine (8.5%) were depressed. Overall, 27 patients (25.5%) showed some form of psychiatric morbidity (full or subsyndromal PTSD and/or anxiety and/or depression). Logistic regression analysis, using 1-yr psychiatric morbidity status as the dependent variable, allowed correct classification of 83.8% of patients 12 mo postaccident (specificity 91.8%, sensitivity 61.5%). Biographical risk factors and a sense of death threat contributed significantly to the predictive model. We conclude that a substantial proportion of severely injured accident victims develop some form of psychiatric morbidity that can be predicted to some degree by mainly psychosocial variables.

Adaptation, Psychological↗
PubMed1996

Physical activity, the compression of morbidity, and the health of the elderly.

The Compression of Morbidity hypothesis envisions a potential reduction of overall morbidity, and of health care costs, now heavily concentrated in the senior years, by compression of morbidity between an increasing age of onset of disability and the age of death, increasing perhaps more slowly. For this scenario to be able to be widely achieved, largely through prevention of disease and disability, we need to identify variables which predict future ill health, modify these variables, and document the improvements in health that result. Physical activity is perhaps the most obvious of the variables which might reduce overall lifetime morbidity.

Aged↗
PubMedDate not supplied

Outcome of morbid obesity in the intensive care unit.

This was a retrospective chart review of consecutive obese patients admitted to the medical intensive care unit. Patients were divided into 2 groups: mild to moderately obese (group 1, body mass index =30-40 kg/m(2)) and morbidly obese (group 2, body mass index >40 kg/m(2)). Acute Physiology and Chronic Health Evaluation II scores were not significantly different between the 2 groups. Morbidly obese patients (group 2) had higher rates of mortality and nursing home admission. They also showed higher rates of intensive care unit complications including sepsis, nosocomial pneumonia, acute respiratory distress syndrome, catheter infection, tracheostomy, and acute renal failure. Their median length of mechanical ventilation was longer (2 days, range 2-12 vs 9 days, range 1-37,P = .009). In a logistic regression analysis, morbid obesity remained a significant predictor of death or disposition to nursing home even after controlling for age (P = .019, odds ratio = 7.60, 95% confidence interval = 1.39-41.6). Morbidly obese patients (body mass index >40 kg/m(2)) admitted to intensive care units have higher rates of mortality, nursing home admission, and intensive care unit complications and have longer stays in the intensive care unit and time on mechanical ventilation.

Age Distribution↗
PubMed2005

Concurrent hearing and visual impairment and morbidity in community-residing adults: the National Health Interview Survey, 1986 to 1996.

OBJECTIVE: To examine the association between the presence and severity of concurrent hearing and visual impairment (HI+VI) and morbidity. METHODS: Data for adults 45 years and older were obtained from the National Health Interview Survey, 1986 to 1996 (n = 60,997). Covariate-adjusted logistic regression analyses were used to examine associations between HI+VI and five morbidity indicators: restricted activity days, bed rest days, doctor visits, hospitalizations and self-rated health. RESULTS: Associations with morbidity indicators tended to be stronger in adults with HI+VI, and in particular, among adults with more severe HI+VI, relative to adults reporting no impairment. These associations were somewhat stronger in adults 45 to 64 years versus older adults. DISCUSSION: HI+VI is associated with morbidity, although the strength of these associations varies across subgroups. Findings indicate that an increased focus on the provision of hearing and eye care services is required. Insurance coverage for these services should also be pursued by health policy makers.

Aged↗
PubMed1983

Occupational morbidity based on social insurance records in Finland.

Daily allowances and invalidity pensions were studied in order to identify morbidity differences between different occupational groups. The highest age-standardized number of daily allowances was found in 'industry' (males 257/1 000, females 373/1 000), and the lowest in administration (males 116/1 000, females 170/1 000). The greatest number of new invalidity pensions for males was also in industry (20.3/1 000), and was 2.9 times as high as in administration. The greatest number of invalidity pensions to females was found in agriculture (18.3/1 000), and was 2.8 times as high as administration. These invalidity pension and daily allowances data measure the morbidity, which is closely associated with socio-economic development and the advances made in the insurance system of the country. Occupational differences in invalidity pensions and daily allowances can be affected by differences in working conditions or by differences in social conditions and life style. The morbidity differences are also affected by selection and survival processes. However, there were also real morbidity differences between occupational groups even after adjusting for bias and errors.

Adolescent↗
PubMed2002

Endovascular repair reduces early and late morbidity compared to open surgery for abdominal aortic aneurysm.

PURPOSE: To compare systemic complications between standard surgery and endovascular repair of abdominal aortic aneurysms (AAA) for both primary and late secondary procedures. METHODS: At a single center between July 1993 and May 2000, 297 patients (255 men; mean age 73.4 +/- 8.1 years, range 50-93) were treated with open surgical repair; beginning in 1996, 200 (166 men; mean age 73.6 +/- 8.0 years, range 45-96) patients were treated with the AneuRx stent-graft. In a comparison of the cohorts, which were similar in terms of age, gender, and aneurysm diameter, the main outcomes were early major systemic morbidity following the primary procedure to treat the aneurysm and late (>30 days) organ system morbidity for any secondary procedures. RESULTS: Mean length of follow-up for open patients was 20.1 +/- 17.1 months (range 1-150) compared to 12.4 +/- 9.6 months (range 1-60) after endovascular repair (p<0.05). There were 36 (12.1%) systemic complications after the primary open surgery and 15 (7.5%) after endovascular repair (p=NS). There were 43 (14.5%) combined primary and secondary morbidities in the open surgery group versus 15 (7.5%) for patients undergoing endovascular repair (p<0.01). The need for invasive procedures to treat these primary and secondary systemic complications was 4 times greater in the open group (17, 5.7%) than in endograft patients (3, 1.5%) (p<0.05). After secondary procedures (32 in the open group and 30 in the endovascular patients) for graft-related complications, there were 7 (21.9%) adverse events in the open group versus none (0%) for endograft patients (p<0.01). Hospital lengths of stay following both primary and secondary procedures were lower for the endograft patients (p<0.01 and p<0.001, respectively). CONCLUSIONS: Endovascular stent-graft repair compared to open surgery has reduced the early and late morbidity by half. Complications that require invasive or secondary surgical procedures and hospitalization are reduced with endovascular repair.

Adult↗
PubMedDate not supplied

Iliofemoral venous pressure correlates with intraabdominal pressure in morbidly obese patients.

Clinically, it has been observed that severely and morbidly obese individuals more often have venous leg symptoms related to venous stasis than normal-weight persons have. Obesity is associated with an increased intraabdominal pressure (IAP). The increased IAP in severely and morbidly obese patients would reasonably cause an elevated iliofemoral venous pressure (IFVP), which transmits via incompetent femoral veins, causing venous stasis in the lower limbs. The aim of this study was to determine whether the elevated IAP assessed by the urinary bladder pressure (UBP) corresponded with an increased directly measured IFVP. Fifteen women with morbid obesity were investigated with simultaneous UBP and direct iliofemoral vein pressures. Four normal-weight controls were investigated in the same manner. The obese patients had significantly higher UBP than the controls had, 19.1 and 8.5 cm H2O, respectively. They also had elevated IFVP compared with the controls, 19.7 and 7.5 cm H2O, respectively, and these IFVPs correlated well with the UBPs. The assumption that increased IAP in morbidly obese patients causes increased IFVP was consequently determined. To our knowledge, this has not previously been demonstrated in human individuals. How these elevated pressures contribute to the development of lower limb venous insufficiency is subject to further studies.

Abdomen↗
PubMed1984

Morbidity following sudden and unexpected bereavement.

With the help of data on the registered days of sickness per year, a study was made of a group of relatives (n = 32) who had suffered sudden and unexpected bereavement to determine whether this resulted in an increase in morbidity in the two-year period following the loss, compared with the previous two years. A comparison was made with a control group of relatives who had also suffered bereavement but where the deaths were not unexpected. Increased morbidity, especially psychiatric morbidity, was found following sudden and unexpected bereavement but not in the control group. It is concluded that persons exposed to sudden and unexpected loss of a close relative are subject to increased psychiatric morbidity and should be regarded as a high-risk group.

Attitude to Death↗
PubMed2002

Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life.

PURPOSE: To determine the prevalence of and contributing factors for chronic arm morbidity including lymphedema in breast cancer patients after treatment and to assess the impact of arm morbidity on quality of life (QOL). PATIENTS AND METHODS: A four-question screening questionnaire was developed and mailed to a random sample of 744 breast cancer patients treated curatively in two cancer centers from 1993 to 1997. Patients were without recurrence and at least 2 years from diagnosis. Respondents were classified as with or without arm-related symptoms on the basis of the survey. Stratified random samples from each group were then invited for a detailed assessment of their symptoms and signs, including the presence of lymphedema. Their QOL was assessed by the European Organization for Research and Treatment of Cancer QOL Questionnaire C-30 and by a detailed arm problem questionnaire that assessed various aspects of daily arm functioning. RESULTS: Approximately half of all screened patients were symptomatic and 12.5% of all assessed patients had lymphedema. Axillary dissection (AD) and axillary radiotherapy (RT) after dissection were statistically significantly related to the occurrence of arm symptoms (odds ratio for AD = 3.3, P <.001; odds ratio for RT = 3.1, P <.001). Symptomatic patients and patients with lymphedema both had impaired QOL compared with asymptomatic patients. CONCLUSION: Treatment for breast cancer is associated with considerable arm morbidity, which has a negative impact on QOL. Arm morbidity should be carefully monitored in future studies involving local treatment modalities for breast cancer.

Arm↗
PubMed2004

Macrophage inhibitory factor, plasminogen activator inhibitor-1, other acute phase proteins, and inflammatory mediators normalize as a result of weight loss in morbidly obese subjects treated with gastric restrictive surgery.

Obesity is demonstrated to be associated with an enhanced inflammatory state, which is suggested to be a cause for the development of obesity-related morbidity. It was hypothesized that a decrease in body weight in morbid obese subjects would lead to a reduction of the inflammatory state in these subjects. Weight loss was achieved by gastric restrictive surgery in 27 morbidly obese patients. Preoperative as well as 3-, 6-, 12-, and 24-month postoperative plasma concentrations of inflammatory mediators macrophage inhibitory factor, plasminogen activator inhibitor-1, lipopolysaccharide binding protein, alpha-1 acid glycoprotein, C-reactive protein, soluble TNFalpha receptors 55 and 75, and leptin were measured. Macrophage inhibitory factor levels remained low normal for 6 months, during weight loss, after which they significantly increased to normal levels at 24 months postoperatively. The other inflammatory mediators remained elevated up to minimally 3 months postoperatively; thereafter they decreased significantly. Both TNFalpha receptors remained elevated up to at least 12 months postoperatively to decrease significantly at 2 yr postoperatively. This study demonstrates that during weight loss, after gastric restrictive surgery, inflammatory mediators remain elevated for at least 3 months postoperatively, suggesting initially an ongoing inflammatory state. However, 2 yr after surgery, the inflammatory mediators reach near normal values.These findings may be an explanation for the reduced comorbidity seen in morbidly obese patients after gastric restrictive surgery.

Acute-Phase Proteins↗