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PubMed1998

The public health significance of urinary schistosomiasis as a cause of morbidity in two districts in Mali.

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It is concluded that S. haematobium-related morbidity is frequent in Mali, but passive case detection for treatment would not cover a great deal of early stages of the disease; active intervention using reagent strip testing for microhematuria at the most peripheral levels would be an efficient system for morbidity control and monitoring of control operations.

Adolescent↗
PubMed2000

The influence of zinc supplementation on morbidity due to Plasmodium falciparum: a randomized trial in preschool children in Papua New Guinea.

Zinc is crucial for normal immune function and can reduce morbidity from multiple infectious diseases. To determine the influence of zinc on malaria morbidity we conducted a randomized placebo-controlled trial of daily zinc supplementation in children residing in a malaria endemic region of Papua New Guinea. A total of 274 preschool children aged 6 to 60 months were given 10 mg elemental zinc (n = 136) or placebo (n = 138) for 6 days a week for 46 weeks. Slide-confirmed malaria episodes were detected by surveillance of cases self-reporting to a local health center. Cross-sectional surveys were conducted at the beginning, middle, and end of the study to assess infection rates, parasite density, spleen enlargement, and hemoglobin levels. Zinc supplementation resulted in a 38% (95% CI 3-60, P = 0.037) reduction in Plasmodium falciparum health center-based episodes, defined as parasitemia > or = 9200 parasites/microl with axial temperature > or = 37.5 degreesC or reported fever. Episodes accompanied by any parasitemia were also reduced by 38% (95% CI 5-60, P = 0.028), and episodes with parasitemia > or = 100,000/microl were reduced by 69% (95% CI 25-87, P = 0.009). There was no evidence of the effects of zinc on Plasmodium vivax morbidity or on health center attendance for causes other than P. falciparum. Zinc had no consistent effect on cross-sectional malariometric indices. Although P. falciparum prevalence tended to be lower at the end of the study in children given the placebo, such changes were absent at the mid-study survey. These results suggest that improved dietary zinc intake may reduce morbidity due to P. falciparum.

Animals↗
PubMed2002

Randomized comparison of low-dose versus standard-dose praziquantel therapy in treatment of urinary tract morbidity due to Schistosoma haema tobium infection.

At present, anthelmintic therapy with praziquantel at a dose of 40 mg/kg of body weight is the recommended treatment for control of urinary tract morbidity caused by Schistosoma haematobium. Although this standard regimen is effective, drug cost may represent a significant barrier to implementation of large-scale schistosomiasis control programs in developing areas. Previous comparison trials have established that low-dose (20-30 mg/kg) praziquantel regimens can effectively suppress the intensity of S. haematobium infection in endemic settings. However, the efficacy of these low-dose regimens in controlling infection-related morbidity has not been determined in a randomized field trial. The present random allocation study examined the relative efficacy of a 20 mg/kg dose versus a 40 mg/kg dose of praziquantel in control of hematuria and bladder and renal abnormalities associated with S. haematobium infection in an endemic area of Coast Province, Kenya. After a nine-month observation period, the results indicated an advantage to the standard 40 mg/kg praziquantel dose in terms of reduction of infection prevalence and hematuria after therapy (P < 0.01 and P < 0.005, respectively). However, the two treatment groups were equally effective in reducing structural urinary tract morbidity detected on ultrasound examination. We conclude that in certain settings, a 20 mg/kg dose of praziquantel may be sufficient in providing control of morbidity due to urinary schistosomiasis in population-based treatment programs.

Adolescent↗
PubMed2005

Quality of life in morbid obesity.

INTRODUCTION: Morbid obesity (MO) is a chronic disease that is reaching epidemic proportions and becoming an increasing health problem in developed countries. Obesity-related comorbidities reduce both the quality and expectancy of life. OBJECTIVES: To validate the GIQLI (Gastrointestinal Quality of Life Index) test as a reliable and effective tool for the evaluation of quality of life in morbidly obese patients. PATIENTS AND METHODS: The GIQLI test is made up of 36 individually scored items, the addition of which give up a final score. A higher score correlates with a better quality of life. Items can be separated into five groups or dimensions: digestive symptoms, emotional status, effects of treatment, and physical as well as social dysfunction. The GIQLI test was administered to a randomized sample of 1990 morbidly obese patients who fulfilled the indication criteria for bariatric surgery, and to a control group of 100 healthy individuals with no known medical, functional or psychiatric disease. Overall test and specific dimension scores were evaluated for each group. RESULTS: Overall test and specific dimension scores were significantly lower in patients with MO when compared to the control group. The overall GIQLI score decreased as age increased, as did the number of associated comorbidities. CONCLUSIONS: The GIQLI test proved to be a rather useful tool to evaluate quality of life in morbidly obese patients. These patients present a poorer quality of life not only because of the presence of digestive symptoms but also because of their emotional, physical, and social status.

Adult↗
PubMed1998

Morbidity among farm workers in a desert country in relation to long-term exposure to pesticides.

OBJECTIVES: Farm workers chronically exposed to low levels of pesticides seldom show signs and symptoms of clinical significance. This study investigates subclinical morbidity patterns among male farm workers in a desert country. METHODS: Migrant-established farm workers (N=226) were compared with referents (N=226) and with new farm workers (N=92) who had just entered the country to work on farms. Acetylcholinesterase activity was measured, the aiming test and digit symbol test were applied, and a morbidity profile was collected with a questionnaire. RESULTS: The erythrocyte acetylcholinesterase activity and hemoglobin-adjusted erythrocyte acetylcholinesterase activity were significantly depleted in the established farm workers. The results of the aiming and digit symbol tests were also significantly lower for the established farm workers. For the morbidity profile, irritated conjunctiva (47.3%), watery eyes (52.2%), blurred vision (63.3%), dizziness (55.2%), headache (63.7%), muscular pain (61.1%), and weakness (76.6%) were reported by established farm workers in statistically significantly higher numbers than by the referents and new farm workers. CONCLUSIONS: Morbidity patterns, such as the health complaints and objective parameters suggested in this study, would be suitable as criteria for identifying farm workers most at risk from pesticide toxicity and as criteria for initiating measures to control and reduce exposure.

Acetylcholinesterase↗
PubMed2004

Cardiovascular morbidity and mortality in patients with diabetes mellitus type I after kidney transplantation: a case-control study.

BACKGROUND: The proportion of diabetics among patients requiring renal replacement therapy continues to increase in most western countries. The acceptance rate for renal transplantation varies among transplant centers and is influenced by the current opinion on the outcome of transplantation in diabetics. Controlled data on patient and graft survival in type I diabetics, however, are scarce. METHODS: We performed a retrospective case-control analysis on patient and graft survival and the cardiovascular morbidity of patients with type I diabetes after renal transplantation versus carefully matched non-diabetic transplant recipients. Match criteria were duration of previous hemodialysis, age and date of renal transplantation. Moreover, risk factors for cardiovascular disease in uremic patients were evaluated at the time of registration for renal transplantation and at the end of the observation period. RESULTS: Seventy-seven matched pairs were enclosed. Patient survival was significantly worse in the diabetic patients, graft survival was comparable in both groups, when graft loss because of patient's death was censored. In the diabetic patients, risk of death (odds ratio: 4.38) as well as the prevalence of cardiovascular morbidity (odds ratio: 4.47) were significantly higher than in the matched nondiabetic controls. Cox regression analysis showed that diabetes mellitus was an independent risk factor for patient survival; no association was found with hypertension, hyperlipidemia, hyperparathyroidism, calcium x phosphate product, body mass index and HbA1c. Cardiovascular morbidity, however, was already significantly higher in the diabetic group at the time of registration. CONCLUSIONS: Diabetes mellitus type I has a dominant impact on morbidity and mortality after renal transplantation and is associated with an approximately 4-fold higher risk of death. Cardiovascular disease accounts for the significantly worse long-term outcome of diabetic patients after renal transplantation.

Adult↗
PubMed2002

Autopsy findings following gastric bypass surgery for morbid obesity.

BACKGROUND: Roux-en-Y gastric bypass, currently the most frequently performed surgical procedure for morbid obesity, has a low but significant mortality rate. There are limited data documenting the findings at necropsy in patients who have died following this procedure. OBJECTIVE: To determine cause of death and pathologic processes present in obese subjects dying after gastric bypass surgery. PATIENTS: We studied 10 patients who underwent autopsy following gastric bypass surgery for morbid obesity between the years 1994 and 2000. RESULTS: There were 6 men and 4 women. The mean age of the patients was 48 years (range, 28-62 years). The mean preoperative weight was 162 kg (range, 112-245 kg), and the mean body mass index was 54 kg/m(2) (range, 39-76 kg/m(2)), similar to all patients undergoing gastric bypass at our institution during the same period. Five deaths were directly attributable to technical complications. Five deaths were attributed to underlying comorbid conditions. One patient died of cirrhosis and one of pulmonary hemorrhage. Three patients died from pulmonary embolism. However, 8 of 10 patients had microscopic evidence of pulmonary emboli, despite prophylaxis for deep vein thrombosis. Most patients had some degree of steatohepatitis and hepatic fibrosis (80% and 70%, respectively). There were no deaths from primary cardiac events. CONCLUSIONS: In patients who die after Roux-en-Y gastric bypass, half die due to technical complications, whereas the other half die of complications of their obesity. Clinically, only 20% of patients were suspected to have pulmonary emboli, yet at autopsy, 80% of patients had pulmonary emboli. In morbidly obese patients undergoing Roux-en-Y gastric bypass, there is an unexpectedly high rate of clinically silent pulmonary emboli contributing to morbidity and mortality.

Adult↗
PubMed2003

Measuring and monitoring success in compressing morbidity.

The Compression of Morbidity paradigm, introduced in 1980, maintains that if the average age at first infirmity, disability, or other morbidity is postponed and if this postponement is greater than increases in life expectancy, then cumulative lifetime morbidity will decrease-compressed between a later onset and the time of death. The National Long-Term Care Survey, the National Health Interview Survey, and other data now document declining disability trends beginning in 1982 and accelerating more recently. The decline is about 2% per year, contrasted with a decline in mortality rates of about 1% per year, thereby documenting compression of morbidity in the United States at the population level. Longitudinal studies now link good health risk status with long-term reductions in cumulative lifetime disability; persons with few behavioral health risks have only one-fourth the disability of those who have more risk factors, and the onset of disability is postponed from 7 to 12 years, far more than any increases in longevity in the groups. Randomized, controlled trials of health enhancement programs in elderly populations show reduction in health risks, improved health status, and decreased medical care utilization. Health policy initiatives now being undertaken have promise of increasing and consolidating health gains for the elderly.

Cost of Illness↗
PubMed2002

Morbidity and mortality of reptiles admitted to the Wildlife Center of Virginia, 1991 to 2000.

Medical records from 694 reptiles admitted to the Wildlife Center of Virginia (WCV; Waynesboro, Virginia, USA) from 1991 to 2000 were reviewed to determine causes of morbidity and mortality. Eighteen species were represented but the majority of cases were four species; eastern box turtle (Terrapene carolina) (66%), eastern painted turtle (Chrysemys picta) (11%), common snapping turtle (Chelydra serpentina) (10%), and rat snake (Elaphe sp.) (6%). There was a significant increase in reptile cases during the study period both in absolute number and in proportion to the total caseload. Trauma (74%) was the most frequent cause of morbidity and mortality followed by unknown or undetermined (13%), aural abscessation (7%), infectious diseases (2%), and one nutritional disorder (0.1%). In addition, 3% of the cases were healthy animals that had been removed from the wild and consequently brought to the WCV. Causes of morbidity and mortality differed between the four most numerous species. Impact with a motor vehicle was the most frequent cause of trauma for eastern box turtles, eastern painted turtles, and common snapping turtles; however, garden-equipment-related trauma was the most frequent cause for rat snakes. Aural abscessation was only seen in eastern box turtles. Eighty percent of cases occurred between May and September and 65% occurred within the five counties closest to the WCV. The majority of morbidity and mortality was the result of human activities. The expanding human population in Virginia likely will continue to have an impact on the health of wild reptiles.

Abscess↗
PubMed1991

The health transition: the cultural inflation of morbidity during the decline of mortality.

It has become commonplace to observe that as mortality falls, morbidity levels rise. The question is why? The explanation offered here stresses the multidimensional nature of morbidity, and the important role that diverse cultural forces have on the patterns of behaviour which underlie reporting behaviour during modernization. These forces involve rising health expectations on the part of ordinary people, including their ability to perceive illness and their willingness to seek professional help, and institutional pressures on medical professionals which reward them for discovering and treating an ever-growing set of non-fatal diseases. Since non-Western developing countries are training physicians to practice scientific medicine, are educating their citizens to think about disease along modern lines, and measure morbidity as developed countries do, there is every reason to suppose that as mortality falls in these countries, morbidity will rise, just as it has done in the developed world.

Adult↗
PubMed1999

[The trends in infectious morbidity in servicemen].

Analysing the morbidity situation in the Armed Forces the authors introduce the term "relative risk of morbidity ratio" as a means of calculation when comparing morbidity rates among military personnel and civilian population in a given district to formulate a morbidity rate forecast to help ships' or units' medics in preventive health care organisation.

Bacterial Infections↗
PubMed1997

[The role of nitrates in the genesis of goiter morbidity].

Epidemiologic study was carried out concerning the level of goitrous morbidity in the growing up individuals aged from 3 to 14 years, permanently living in a settlement with increased nitrate content in the drinking water and natural Iodine deficiency. The data for the incidence of the goitrous morbidity were compared with those of a control group of children. The investigation included a total of 325 children. A high percentage of goitrous morbidity was recorded in the observed by us settlement with increased nitrate content in the drinking water, respectfully 35% versus 8.1% in the control settlement. Low degree of juvenile goiter predominated with slight prevalence of the female sex. A statistically reliable difference (p < 0.001) in the incidence of goitrous morbidity in the observed by us settlement and the control settlement.

Adolescent↗
PubMed1998

Severe obstetric morbidity of the third trimester, delivery and early puerperium in Niamey (Niger).

Epidemiological data about maternal morbidity are rare. The present study, carried out in Niamey, capital of Niger, was designed to measure the incidence of maternal morbidity among women delivering in hospital. Severe complications occurred in 232 of the 4,081 deliveries during the study period (6,450/100,000 live births). Maternal morbidity ratio was 11 times higher than the maternal mortality ratio. Incidence rates of the major morbidities (per 100,000 live births) were: obstructed labour 3,614, hypertensive disorders of pregnancy 1,159, haemorrhage 855, and puerperal sepsis 220. The incidence and case fatality rates of severe complications were both high, suggesting a lack of efficiency of maternal health services in spite of a high concentration of health personnel and a large accessibility to services in Niamey.

Adolescent↗
PubMed1999

Morbidity and mortality amongst southern Sudanese in Koboko refugee camps, Arua District, Uganda.

OBJECTIVE: To determine the causes of morbidity, mortality and assess the nutritional status of children under five years, in Koboko refugee camps, Arua District, Uganda. DESIGN: Review and analysis of refugee treatment records between 1992 and 1994 from Maracha and Koboko hospitals and cross sectional nutritional survey of children under five years in camps. SETTING: Between June 1992 and March 1994, an estimated 70,000 Sudanese refugees were encamped in five transit camps in Koboko county, Arua district. Koboko field hospital was immediately established and Maracha hospital designated the referral hospital for refugees. PARTICIPANTS: Hospitalised refugees between 1992 and 1994 in Koboko and Maracha hospitals and children under five years in the camps formed the study populations. INTERVENTIONS: Health facilities and therapeutic nutrition centres were established in the camps. Fortnightly general food distribution and therapeutic feeding programmes were instituted. Severe medical and surgical conditions were referred to Maracha hospital. MAIN OUTCOME MEASURES: Outcome variables considered were morbidity, mortality, case fatality rates; weight/height, weight/age and height/age. RESULTS: Out of 1476 refugees hospitalised in Koboko and Maracha hospitals, 267 died giving a case fatality rate of 18%. The leading causes of morbidity were diarrhoeal diseases (26.9%), ARI (13.6%), malaria (10.2%), trauma (7.6%) and malnutrition (5.0%). The main causes of mortality were similar, that is, diarrhoeal diseases (35.9%), ARI (23.9%), anaemia (7.2%) and HIV/AIDS (6.8%). Conditions associated with high overall case fatality rates were ARI (31.3%), HIV/AIDS (30.0%) and cardiac failure (29.3%) respectively. Nearly half of the children (48.6%), H/A -2SD were stunted, over a third (36.7%), W/A -2SD were underweight and (8.5%), W/H -2SD wasted. CONCLUSION: Communicable diseases are the predominant causes of morbidity and mortality during the emergency phase of encampment. Timely and effective management of communicable diseases including malnutrition and trauma are crucial to avoid high mortality amongst refugees, coupled with the provision of essential requirements and services such as water, sanitation, food, shelter and immunisation.

Adolescent↗
PubMed1999

Objective assessment of axillary morbidity in breast cancer treatment.

Historically, axillary lymph node dissection (ALND) was a critical aspect of the operative management of breast cancer. Recently, the role of ALND has been questioned, with postoperative morbidity possibly overshadowing patient benefit. Our objective was to quantitatively assess the long-term morbidity of ALND in patients with breast cancer. We conducted a cross-sectional study of patients being followed by the Breast Surgery Clinic at a university-affiliated urban hospital. Ninety-five patients with unilateral breast cancer who had undergone ALND were evaluated at routine follow-up visits in the latter half of 1998. A questionnaire was used to quantify the degree of subjective findings, including arm swelling, chest wall pain, decreased mobility, and weakness. Upper extremity strength, active range of motion, and circumference were measured. Overall, 70 per cent of patients had at least one complaint, with 18 per cent having moderate to severe symptoms. Twenty-one per cent had notable decrements in strength or range of motion, 9.3 per cent of patients required chronic compression garments for lymphedema, and 6.4 per cent changed their vocational status because of surgical morbidity. We conclude that adverse effects from ALND occur commonly. Objective findings are less common, perhaps causing clinicians to underappreciate postoperative morbidity. A significant subset of patients had enduring disability.

Adult↗
PubMed1999

Psychosocial correlates of morbidity in women with systemic lupus erythematosus.

OBJECTIVE: Modifiable psychosocial factors that are associated with health outcomes may provide new opportunities for treatment. We investigated the associations of various psychosocial factors with 3 measures of morbidity in women with systemic lupus erythematosus (SLE). METHODS: We collected information on 16 social, psychological, behavioral, and medical care factors in a cross sectional survey of 100 women with SLE, and related these to measures of physical disability (assessed by the Health Assessment Questionnaire Disability Index), SLE activity (assessed by the Systemic Lupus Activity Measure), and cumulative organ damage (assessed by the SLICC/ACR Damage Index). RESULTS: In multivariate analyses, greater physical disability was significantly associated with higher depression scale scores and higher body mass indexes. Greater SLE activity was associated with less adequate social support. Greater cumulative organ damage was associated with lower self-esteem and a time orientation that favored the present over the future. Financial barriers to medical care, knowledge about SLE, health locus of control, marital status, and health behaviors including compliance with medications, smoking, alcohol use, and exercise, were not significantly associated with any measure of morbidity. CONCLUSION: Selected psychosocial factors are associated with morbidity in SLE, but differ with the measure of morbidity examined.

Adolescent↗
PubMed1999

Hospital morbidity and mortality and changes in quality of life following mitral valve surgery in the elderly.

BACKGROUND AND AIM OF THE STUDY: An increasing number of elderly patients are now requiring mitral valve surgery (MVS). However, due to a perceived increase in risk of morbidity and mortality following cardiac surgery, many elderly patients tend to be neglected or not referred for surgery. METHODS: The outcome of MVS in terms of hospital morbidity and mortality, length of intensive care unit (ICU) and hospital stays, and change in NYHA functional class and quality of life following surgery was assessed in 43 elderly patients (18 males, 25 females; median age 77 years (IQR 75-82 years)) who underwent primary open mitral valve repair (MVRr) or replacement (MVR) between November 1994 and September 1997. Their preoperative clinical characteristics, incidence of hospital morbidity, hospital mortality and length of ICU and hospital stays following MVS were recorded. At follow up, NYHA class was assessed and quality of life parameters monitored using the SF-36 questionnaire. RESULTS: At surgery, 69% of patients were in NYHA class III/IV, 36% underwent non-elective surgery and 44% had symptoms of more than three years' duration. Among patients, 80% presented with mitral incompetence and MVRr was undertaken in 51%. The median bypass and cross-clamp times for MVRr were significantly longer than for MVR. After surgery, 98% of patients required inotropic support, 9% renal dialysis, and 42% ventilatory support for >24 h. In addition, 37% developed respiratory complications, 12% renal failure, 19% needed re-exploration for bleeding, and 5% suffered a stroke. The mean ICU stay after surgery was three days; average in-hospital stay was 10 days. The 30-day mortality rate was 22.7% after MVRr and 38% after MVR. There was a significant improvement in energy, and role limitation due to physical and mental health after MVS. CONCLUSIONS: Elderly patients underwent MVS, usually after a degree of clinical deterioration. Although morbidity and mortality following mitral valve surgery were high, at follow up there was a significant improvement in both symptoms and quality of life of survivors.

Aged↗
PubMed1999

Correlates of psychiatric morbidity and case identification in Ibadan, Nigeria.

OBJECTIVE: To determine the correlates of psychiatric morbidity and the factors that may influence the recognition of psychiatric cases in primary care. DESIGN: In the cross-sectional survey, the sample was selected by systematic sampling technique. Each subject was interviewed in sequence by a research nurse, a psychiatrist and a general practitioner (GP). SETTING: The primary care facility at the University College Hospital, Ibadan. SUBJECTS: Eight GPs and 414 (44% males, 56% females) patients were selected. INTERVENTION: A socio-demographic questionnaire, the present state examination (PSE), and clinical interview were administered to the subjects. Eysench personality questionnaire (EPQ) was completed by GPs. The research nurses scored each GP on an enthusiasm scale. MAIN OUTCOME MEASURES: The diagnosis by psychiatrist and GPs recorded on doctors' information sheet: the PSE scores of subjects, the EPQ scores of GPs and their observed enthusiasm ratings among others were the main measures. RESULTS: The psychiatric morbidity rate was 43.4% in the centre. GPs accuracy was 0.7 and Kappa score was 0.44. EPQ Neuroticism and Psychoticism scores correlated negatively with GPs ability to recognise cases, whereas enthusiasm correlated positively. GPs had difficulty in recognising minor psychiatric disorders accounting for 94.4% of morbidity in the primary care. Morbidity was significantly associated with female sex, age 45-54 years, self-employment, low level of education and being currently married. Females and the self-employed were over-represented among GPs' cases. CONCLUSION: More data from similar studies across cultures would provide useful insight into strategies that could bring about early recognition and treatment of minor psychiatric disorders in the primary health care.

Adolescent↗