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PubMed1999

Morbidity, deprivation, and antidepressant prescribing in general practice.

BACKGROUND: Although the link between depression, unemployment, and measures of deprivation and morbidity has been previously documented, the relationship between general practice prescribing of antidepressants, morbidity, and the social demography of general practice populations is poorly understood. AIM: To consider whether morbidity and the social demography of general practice populations influence the prescribing costs of individual practices. METHOD: Data were analysed, using a forward stepwise regression procedure, of all 78 practices served by the Cornwall and Isles of Scilly Health Authority. Data on prescribing for antidepressants were provided by the Prescription Pricing Authority for the period from July to December 1995 and converted into defined daily doses (DDDs) to standardize for the variation in prescribing practice between general practitioners. RESULTS: A significant positive correlation exists between the rates of prescribing DDDs of antidepressants by general practices and the prevalence of permanent sickness in the areas in which these practices serve. CONCLUSION: Demonstrating an association between morbidity and prescribing rates for depression may prove helpful in setting prescribing budgets.

Antidepressive Agents↗
PubMed2000

[Dynamics of major constituents of tuberculosis morbidity in the population of Novosibirsk region].

After processing the dynamic series of tuberculosis morbidity in the population of the Novosibirsk region by the smooth component methods, two major constituents were defined in morbidity dynamics. In total, they make up about half the total variability of tuberculosis morbidity. The first constituent is due to socioeconomic causes that are common for the whole region. The second one shows rather evident 10-year fluctuations. The same 10-year fluctuations are observed in the dynamics of tuberculosis morbidity among the cattle of the Novosibirsk region by out-stripping that in the population in the northern and eastern areas by 1-3 years.

Animals↗
PubMedDate not supplied

[Experience in using correlation analysis for evaluating the synchronism of the fluctuations in the level of infectious morbidity in individual areas].

The possibility of using correlation analysis for evaluating the synchronism of changes in infectious morbidity rate on different territories was studied. The study demonstrated that the intensity of correlative relationships was mainly influenced by the degree of manifestation and the direction of prolonged tendencies in the changes of infectious morbidity on the territories under study. The presence of prolonged pronounced tendencies towards growth or decrease in the compared curves characterizing prolonged morbidity dynamics was found to limit the use of correlation analysis for the evaluation of synchronism of changes in morbidity rate.

Communicable Diseases↗
PubMedDate not supplied

[The cyclicity and prognosis of shigellosis morbidity in Russia].

The epidemic process (EP) of shigellosis morbidity proceeds in cycles. As shown in this study, cyclic curves are the sum of polyharmonic fluctuations, being the axis of EP. The duration of one cycle is 18 years, and its configuration is stably retained for a long time. In Nizhny Novgorod shigellosis morbidity is strongly correlated with air temperature is summer at the peak of cyclic rises and moderately correlated in the years of low morbidity. In some cities of the Russian Federation fluctuations of air temperature have been found of occur synchronously with disturbances of the magnetic field of the earth. The character and stability of EP cycles provide grounds for the prognostication of shigellosis morbidity. The current cycle will end in the year 2000, and then natural preconditions for a new cyclic rise will appear.

Disease Outbreaks↗
PubMedDate not supplied

[Morbidity and mortality in acute viral hepatitides in a hyperendemic region. The role of viral hepatitis E].

Official annual statistical data on morbidity in acute viral hepatitides (AVH), including the number of lethal cases, for 1985-1995 were analyzed. Mortality rates per 100,000 of the population at the period of 11 years were calculated for different age groups, sex and the place of residence. 396 and 99 patients were examined for the presence of serological markers of hepatitides A, B and E, respectively, at the periods of epidemic rises in morbidity and satisfactory epidemic situation. In the course of 11 years AVH caused the death of 22,405 persons. In 1985-1987 the average mortality level (ML) reached 12.3-17.8 per 100,000 of the population (with morbidity being 1,200-1,400 and was essentially higher among the rural population in comparison with the urban population. During these years the highest ML, was registered among children aged 0-2 years (190-50 per 100,000) and, among adults, mainly among women aged 20-29 years (21.4-19.6 per 100,000). During the years when the epidemic of AVH was absent, ML among these groups was essentially lower: 40-20 among children aged 0-2 years and 4-5 among women aged 20-29 years. In 1987 in the Fergana Valley hepatitis E was detected in 72.2% of all examined patients, and in the southern areas of the country in 68.7%. A sharp rise on mortality among women of the productive age at the period of the epidemic rise of AVH morbidity in the endemic region indicated that this epidemic was linked with hepatitis E. High ML among young children may be indicative of a highly unfavorable course of hepatitis E in the group of infants, which had never been registered before. This newly established regularity may be used for the retrospective diagnostics of the outbreak of hepatitis E.

Acute Disease↗
PubMed2000

[Quality control during ultrasonographic evaluation of morbidity due to Schistosoma haematobium in Niger].

Within the framework of a campaign to control urinary schistosomiasis in Niger, a quality control audit was performed on ultrasonographic assessment of morbidity due to Schistosoma haematobium. The purpose of this audit was to determine variance and reproductibility of epidemiological data provided by two trained independent observers. Three parameters were studied, i.e.,: interobserver variability on matched data, interobserver variance at the community level on the same or different subjects, including some after treatment with praziquantel, and intra-observer variance. A total of 1750 ultrasound examinations were carried out on 1416 inhabitants from 10 hyperendemic villages (70 p. 100 schoolchildren) according to a slightly modified version of the WHO Cairo protocol. Inter-observer variance at the individual level was high for some elementary abnormalities of the bladder. Variance was around 20 p. 100 for the 2 main indicators, i.e. presence of at least one bladder lesion and dilatation of the upper urinary tract. At the community level, inter-observer variance was moderate and the two observers' global assessment of morbidity due to Schistosoma haematobium was the same. Variations of morbidity related to level of endemicity were given perceived in parallel. Similar findings were noted for the intra-observer variability at the individual or community level. Ultrasound examination is supposed to furnish reliable morbidity data for selecting communities at risk and scheduling treatments during schistosomiasis control programs. The results of this study show that the level of inter- and intra-observer variance in ultrasonographic assessment in Niger is compatible with this critical role.

Child↗
PubMed2000

[Accidental morbidity in adolescence: a retrospective study in 12 to 15 year-old school children in Switzerland] .

Mortality and morbidity from injuries in the adolescent population is substantial in Switzerland as all over the world. The estimation of morbidity from injuries is difficult and depends on the design of the study. Little information is available on morbidity between ages 12 and 15. The Health Behaviour in School-Aged Children (HBSC) study is an international survey based on a self-administered questionnaire for which the Swiss Institute for Prevention of Alcohol and Drug Problems (SIPA) is responsible in Switzerland. 7196 schoolchildren aged 12 to 15 participated in the 1998 survey. Questions covered subjects such as health and health behaviour. A few questions covered injuries, with reference to frequency, context and consequences. 45.3% of adolescents have been treated at least once by a nurse or a doctor for an injury during the past 12 months. It can be deduced that nearly 149,000 adolescents aged between 12 and 15 are injured in more than 260,000 accidents in Switzerland. The rate of injury is 793 per 1000 adolescents per year. Furthermore, one adolescent out of ten injures himself three times or more per year. In conclusion, morbidity due to injuries in adolescents aged 12 to 15 in Switzerland is therefore considerable. This study demonstrates the high prevalence of repeated injuries in adolescents.

Accidents↗
PubMed2001

Diarrhoeal morbidity among young children in Eritrea: environmental and socioeconomic determinants.

Diarrhoeal diseases are still a major cause of morbidity and mortality among children in many developing countries, particularly in sub-Saharan Africa. In Eritrea, diarrhoeal disease is one of the most frequent causes of illness and a major contributor to mortality among children. Yet, except for some descriptive reports by the National Statistics Office of Eritrea, no systematic study of the factors that influence the prevalence of diarrhoeal morbidity among young children in Eritrea was carried out. This study examined the effects of some environmental and socioeconomic factors that were associated with childhood diarrhoea in Eritrea. The study used data collected by the Demographic and Health Survey (DHS) in Eritrea in 1995. Results of the study showed that the environmental and socioeconomic conditions of the population were significant predictors of diarrhoeal morbidity. The study also found an important association of diarrhoeal morbidity with the age and the number of children, particularly with high prevalence of diarrhoea at the age of weaning and in households with a large number of children.

Age Factors↗
PubMedDate not supplied

Predictors for morbidity and mortality following non-traumatic splenectomy at the University Hospital, Jeddah, Saudi Arabia.

OBJECTIVE: To determine the pre-operative predictors of morbidity and mortality of patients undergoing elective splenectomy for non-trauma indications. METHODS: Analysis of 123 patients who underwent splenectomy at King Abdulaziz University Hospital, Jeddah, Saudi Arabia between 1986-1996. Data collected included patients' demographic data, indication for splenectomy, laboratory data, details of operative procedure and postoperative events for morbidity and mortality. Statistical analysis was carried out using the Chi-square test. RESULTS: Of the patients, 69% were males and 31% females with ages ranging from 13-72 years (mean 39 years). Portal hypertension constituted 55% of the indications and benign hematological conditions 26%. The morbidity rate was 27.6% and the commonest complication was chest and wound infection in 6.6% and 5.7%, respectively. Age of >50 years, pre- and postoperative haematocrit of <33%, thoraco-abdominal approach and operative time of >120 min had P values of < 0.05, <0.002, <0.03 and <0.03, respectively for postsplenectomy mortality. CONCLUSIONS: According to this study, age of >50 years is a significant predictor for morbidity following splenectomy, whereas age >50 years, pre- and postoperative haematocrit of <33%, thoraco-abdominal approach and operative duration >120 min were significant predictors of postsplenectomy mortality.

Adolescent↗
PubMed2001

[Comorbidity and physical complaints in morbid obesity].

The prevalence of obesity is increasing world wide, resulting in morbidity, mortality, and reduced quality of life. The aim of this study was to assess comorbidities and complaints of subjects with morbid obesity in comparison to milder forms of overweight. Therefore, 299 patients visiting our obesity consultation were examined and surveyed prospectively. 41% of the subjects were morbidly obese showing a significantly higher prevalence of arterial hypertension, edema, dyspnea, eczema and depression. Additionally, sleepiness, reduced work capacity, physical inactivity, disadvantages in social life and disturbed eating habits were observed more frequent. Evaluation of subjects with morbid obesity should include a large spectrum of complications, in order to be able to offer a comprehensive support and treatment.

Adult↗
PubMed2001

[Plasma oxysterols and vitamin E concentrations and lipid profile in morbidly obese women].

Morbid obesity (BMI > or = 40 kg/m2) is accompanied by lipid disturbances which may be involved in the increased incidence of atherosclerosis, arterial hypertension and non-insulin-dependent diabetes mellitus. The aim of the study was to assess concentrations of total cholesterol (TC), HDL-cholesterol, LDL-cholesterol, triglycerides (TG), products of cholesterol peroxidation--oxysterols, and the major lipophilic antioxidant--vitamin E, in morbidly obese women without coexisting diseases. The study was performed in 11 morbidly obese women (BMI 42.21 +/- 2.21 kg/m2) and 11 healthy volunteers (BMI 23.0 +/- 2.31 kg/m2). Obese women demonstrated higher concentrations of TG (2.03 +/- 0.78 vs. 0.99 +/- 0.37 mmol/l; p < 0.05), 7-ketocholesterol (7-K) (89.85 +/- 63.03 vs. 41.90 +/- 17.33 ng/ml; p < 0.05) and 7-hydroxycholesterol (7-OH) (456.04 +/- 199.22 vs. 132.37 +/- 53.96 ng/ml; p < 0.05), and lower HDL-cholesterol level (0.74 +/- 0.10 vs. 1.30 +/- +/- 0.17 mmol/l; p < 0.05) compared to the control group, while there were no significant differences between the two groups in concentrations of TC, LDL-cholesterol and vitamin E. Plasma vitamin E/(TC + TG) ratio was lower in obese women (6.42 +/- 2.61 vs. 10.76 +/- 4.57 mumol/mmol; p < 0.05). Tocoferols concentration correlated positively with TG (r = 0.45; p < 0.05) and negatively with 7-OH (r = -0.44; p < 0.05) levels. Moreover, concentration of 7-K correlated positively with the level of HDL (r = 0.54; p < 0.05). In conclusion, despite normal TC and LDL-cholesterol concentrations, there are disturbances in cholesterol peroxidation processes, with the rise in oxysterol levels and the decrease in vitamin E concentration in lipoproteins, which may be involved in the increased incidence of cardiovascular diseases in morbidly obese women.

Adult↗
PubMed2002

Obstetric morbidity and socio-demographic factors in rural West Bengal, India.

The impact of selected socio-demographic factors on reported obstetric morbidity during antepartum and postpartum periods was studied through a cross-sectional retrospective survey carried out in rural areas of three districts of West Bengal, India. During their most recent live births, 56.6% of mothers reported at least one morbid condition. Mothers with higher levels of education reported fewer overall problems. Factors such as age and pregnancy order affect obstetric morbidity differently in different religious groups. More mothers reported postpartum than antepartum problems, and very few sought treatment. The present study provides an insight into various factors affecting obstetric morbidity in a developing country.

Adolescent↗
PubMed2002

[Annual report of perioperative mortality and morbidity for the year 2000 at certified training hospitals of Japanese Society of Anesthesiologists: with a special reference to anesthetic methods--report of the Japanese Society of Anesthesiologists Committee on Operating Room Safety].

The Committee on Operating Room Safety of Japan Society of Anesthesiologists (JSA) sends annually confidential questionnaires of perioperative mortality and morbidity (cardiac arrest, severe hypotension, severe hypoxia) to Certified Training Hospitals of JSA. This report is a special reference to anesthetic methods in perioperative mortality and morbidity in 2000. Five hundreds and twenty hospitals reported perioperative mortality and morbidity referred to anesthetic methods and total numbers of reported cases were 910,007. The percentage of cases reported by each anesthetic method was as follows; inhalation anesthesia 45.47%, total intravenous anesthesia (TIVA) 6.15%, inhalation anesthesia + epidural or spinal or conduction block 24.48%, TIVA + epidural or spinal or conduction block 6.33%, spinal with continuous epidural block (CSEA) 3.67%, epidural anesthesia 1.92%, spinal anesthesia 10%, conduction block 0.47% and others 1.49%. The incidence of cardiac arrest per 10,000 cases due to all etiology (anesthetic management, preoperative complications, intraoperative complications, surgery, others) is estimated to be 6.55 cases in average; 5.36 cases in inhalation anesthesia, 30.72 cases in total intravenous anesthesia (TIVA), 4.62 cases in inhalation anesthesia + epidural or spinal or conduction block, 2.6 cases in TIVA + epidural or spinal or conduction block, 1.2 cases in spinal with continuous epidural block (CSEA), 0.57 cases in epidural anesthesia, 1.65 cases in spinal anesthesia, 2.36 cases in conduction block and 46.38 cases in other methods. However, the incidence of cardiac arrest per 10,000 cases totally attributable to anesthetic management is estimated to be 0.54 cases in average; 0.34 cases in inhalation anesthesia, 1.07 cases in TIVA, 0.58 cases in inhalation anesthesia + epidural or spinal or conduction block, 0.17 cases in TIVA + epidural or spinal or conduction block, 0.9 cases in CSEA, 0.57 cases in epidural anesthesia, 0.99 cases in spinal anesthesia, zero case in conduction block and 1.47 cases in other methods. The incidence of severe hypotension per 10,000 cases due to all etiology is estimated to be 11.14 cases in average; 11.31 cases in inhalation anesthesia, 36.61 cases in TIVA, 9.29 cases in inhalation anesthesia + epidural or spinal or conduction block, 6.59 cases in TIVA + epidural or spinal or conduction block, 3.59 cases in CSEA, 6.3 cases in epidural anesthesia, 4.39 cases in spinal anesthesia, 2.36 cases in conduction block and 23.56 cases in other methods. On the other hand, the incidence of severe hypotension per 10,000 cases totally attributable to anesthetic management is estimated to be 1.25 cases in average; 0.97 cases in inhalation anesthesia, 0.89 cases in TIVA, 1.39 cases in inhalation anesthesia + epidural or spinal or conduction block, 1.39 cases in TIVA + epidural or spinal or conduction block, 2.09 cases in CSEA, 3.44 cases in epidural anesthesia, 1.87 cases in spinal anesthesia, zero case in conduction block and zero case in other methods. The incidence of severe hypoxia per 10,000 cases due to all etiology is estimated to be 4.8 cases in average; 6.35 cases in inhalation anesthesia, 9.64 cases in TIVA, 3.82 cases in inhalation anesthesia + epidural or spinal or conduction block, 2.26 cases in TIVA + epidural or spinal or conduction block, 0.3 cases in CSEA, 1.15 case in epidural anesthesia, 1.21 cases in spinal anesthesia, zero case in conduction block and 5.89 cases in other methods. On the other hands, the incidence of severe hypoxia per 10,000 cases totally attributable to anesthetic management is estimated to be 1.98 cases in average; 3.09 cases in inhalation anesthesia, 2.32 cases in TIVA, 1.3 cases in inhalation anesthesia + epidural or spinal or conduction block, 0.87 cases in TIVA + epidural or spinal or conduction block, zero case in CSEA, zero case in epidural anesthesia, 0.55 cases in spinal anesthesia, zero case in conduction block and zero case in other methods. The mortality rate of cardiac arrest within 7 postoperative days per 10,000 cases due to all etiology is estimated to be 3.55 (54.2%) cases in average; 3.12 (58.1%) cases in inhalation anesthesia, 19.29 (62.8%) cases in TIVA, 1.17 (25.2%) cases in inhalation anesthesia + epidural or spinal or conduction block, 0.52 (20%) cases in TIVA + epidural or spinal or conduction block, zero cases in CSEA, zero case in epidural anesthesia, 0.33 (20%) cases in spinal anesthesia, zero case in conduction block and 39.76 (85.7%) cases in other methods. On the other hands, the mortality rate of cardiac arrest per 10,000 cases totally attributable to anesthesia is estimated to be 0.07 (12.2%) case in average, 0.07 (21.4%) case in inhalation anesthesia, 0.18 (16.8%) case in TIVA, zero case in inhalation anesthesia + epidural or spinal or conduction block, zero case in TIVA + epidural or spinal or conduction block, zero case in CSEA, zero case in epidural anesthesia, 0.11 (11.1%) case in spinal anesthesia, zero case in conduction block and 0.74 (50%) case in other methods. Five major combinations of listed critical incidents, causes and anesthetic methods were as follows: 18.93 cases in TIVA, preoperative complications and severe hypotension; 18.75 cases in TIVA, preoperative complications and cardiac arrest; 11.07 cases in TIVA, surgery and severe hypotension; 6.79 cases in TIVA, surgery and cardiac arrest; 5.24 cases in inhalation anesthesia, preoperative complications and severe hypotension. In summary: 1. There was no significant difference with regard to perioperative mortality and morbidity due to anesthetic management among anesthetic methods. 2. The percentage of each anesthetic method in 2000 was not different significantly from that in 1999 in spite of increased cases reported. 3. Incidence of severe hypotension due to all etiology of TIVA in 2000 decreased significantly compared with that in 1999 (P < 0.05). This may be attributed to the decreased incidence in preoperative complication (shock) and massive bleeding due to surgery.

Anesthesia↗
PubMed2002

[A comment on five reports concerning perioperative mortality and morbidity of the year 1999 in Japanese Society of Anesthesiologists certified training hospitals].

Japanese Society of Anesthesiologists (JSA) has conducted an annual survey concerning anesthesia-related morbidity and mortality in JSA certified training hospitals. This survey was conducted through confidential questionnaires sent by mail to the hospitals. In 'Survey 1999', 60.3% of the hospitals responded to the questionnaire. The results were published in five separate reports: with special reference to ASA-physical status, age, anesthetic methods, operative regions, and 'outline'. However, overall morbidity and mortality differed among the reports. For example, overall anesthesia-related morbidity in the report with special reference to ASA-PS was 0.08 (5/655,644) per 10,000 cases, although it was 0.13 (11/793,847) in a report 'outline'. This difference was caused by imperfect answers from some hospitals. Some hospitals only reported the total number of patients in 1999 and total cases with cardiac arrest or other critical events, without details of distribution as to ASA-physical status, age, anesthetic methods, and/or operative regions. As a result, a part of critical incidents was reflected in the calculation of overall mortality and morbidity in the 'outlines', but not in that of ASA-physical status, age, anesthetic methods, and/or operative regions. In 'Survey 2000', however this type of confusion was reduced, because increasing number of hospitals had answered the questionnaire completely.

Anesthesia↗
PubMed2002

Understanding levels of morbidity and hospitalization in Kerala, India.

The prevalence of ailments and hospitalization in Kerala was examined using data from the 52 nd National Sample Survey Data on Health Care in Kerala in 1995-6. The survey included 24401 people from 4928 households. Age and seasonality had considerable effects on the morbidity of individuals. The burden of ill health was higher in rural areas than in urban areas. People who were more likely to have a better lifestyle had a higher level of morbidity and hospitalization. Regional differences were seen, with levels of morbidity and hospitalization higher in the comparatively developed regions of Southern Kerala than in Northern Kerala. Factors like physical accessibility of health care services and capacity to seek health care services could create artificial differences in morbidity and hospitalization among different subgroups of the population in Kerala.

Adolescent↗
PubMed2002

[Surgery of morbid obesity in the adult: clinical efficacy of different surgical procedures].

Obesity is defined as morbid when the Body Mass Index (BMI) exceeds 40 kg/m(2). The initial approach should be a multidisciplinary medical assessment. The three principal surgical interventions practiced in France are: placement of an adjustable gastroplasty ring, vertical banded gastroplasty, and Roux-en-Y gastric bypass (short circuit). The indications for surgical therapy are those defined by recent consensus conferences: Morbid Obesity (BMI 40), Major Obesity (BMI 35) with associated factors of co-morbidity, or stable or worsening obesity of five years duration resistant to multidisciplinary medical management for a least a year. Studies of these three surgical techniques with at least one year of follow-up shows significant average weight loss on the order of 20-50 kg. Studies of adjustable ring gastroplasty show an average loss of 45% of excess weight at one year; maintenance of weight loss beyond one year is not yet well documented. Long term results of vertical banded gastroplasty and gastric bypass are better defined. Initial weight loss for vertical banded gastroplasty is about 61%; some patients maintain this weight loss and others tend to regain some of their excess weight. For gastric bypass, the initial weight loss is about 68% of excess weight and there is a greater tendency to maintain this weight loss. Comparative studies, mostly from North America and of variable methodologic quality, conclude that weight loss with gastric bypass is superior to that with vertical banded gastroplasty. The indications for the respective techniques vary according to the severity of the obesity (BMI), and to the patient's eating habits. Gastric bypass which has the best short and long term results may be best reserved for patients with the most severe obesity or co-morbid conditions.

Adult↗
PubMed1996

[Ultrasonographic evaluation of Schistosoma mansoni morbidity: comparison of Cairo/WHO and Managil-Hannover classifications].

A ultrasonographical survey of morbidity in schistosomiasis mansoni was carried out in two villages of an endemic area of Madagascar. Using the Managil-Hannover classification, the overall prevalence of morbidity in the first village was of 49.4% and of 39.4% in the second one, while modified Cairo/WHO classification found 9.1% and 1.9% respectively. Thus, results given by the two classifications for a same individual are often discordant. This discrepancy is essentially observed in the lower stage of morbidity while advanced cases are generally well-staged by either of these two methods. These differences in the sonographical assessment of morbidity related to hepatosplenic schistosomiasis make it necessary to continue investigations in order to establish a classification that will have the agreement of everybody.

Adolescent↗
PubMedDate not supplied

Forceps or vacuum extraction: a comparison of maternal and neonatal morbidity.

To compare maternal and neonatal morbidity associated with forceps and vacuum delivery, data on 150 women delivered by forceps and 420 delivered by vacuum extraction between 1995 and 1999 at Queen Ala Hospital, Jordan were compared. Data included parity, gestational age, infant birthweight, Apgar score, presentation and station of fetal head, indications for forceps and vacuum deliveries, delivery success rate, and maternal and neonatal morbidity. Maternal birth canal and genital tract lacerations were significantly more common in forceps delivery, and there was significantly increased morbidity in infants delivered by vacuum extraction (caput, jaundice, cephalohaematoma). Serous neonatal morbidity was rare for both groups.

Adult↗