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PubMed1992

Factors affecting morbidity and mortality on-farm and on-station in the Ethiopian highland sheep.

Factors affecting morbidity and mortality of the Ethiopian highland sheep were studied both on-farm and on-station at Debre Berhan between 1989 and 1990. Primary causes of infectious origin resulted in high proportional morbidity (88.4% on-farm) and mortality (72.9% on-farm and 71.8% on-station) rates. Nutritional and managemental factors were also responsible for mortalities in lambs. The most frequent secondary causes of morbidity and/or mortality were ectoparasites and nasal myiasis. Health management interventions on-station were not high enough to produce performance improvements above the on-farm levels. However, the occurrence of gastrointestinal parasites significantly (P < 0.05) differed between the two management systems. The frequency of some of the major causes of morbidity and mortality such as pneumonia, fasciolasis and enteritis were significantly (P < 0.01) affected by season and age of an animal. In order to alleviate the major health constraints identified in this study, a proper health management intervention involving vaccination, strategic anthelmintic treatment and feeding management are suggested.

Age Factors↗
PubMed1987

Influenza: quantifying morbidity and mortality.

Because of their dramatic impact, morbidity and mortality associated with influenza have been recognized since at least the time of Elizabeth I of England. Excess mortality has been documented since 1889, and the infamous 1918 outbreak confirmed that influenza was truly one of the last major plagues. Despite the clear recognition of large clusters of influenza activity, it is still difficult to quantify precisely the total impact of influenza morbidity and mortality, since laboratory confirmation is required for exact diagnosis. Many methods have been developed to provide estimates of the mortality associated with influenza. These methods are usually predicated on establishing expected baseline rates of mortality. Deaths in excess of these rates are then calculated--and attributed to the circulating influenza virus. In this way, groups at high risk of mortality have been defined as the elderly and those with chronic conditions. Special-risk groups, such as those in institutions, have also been identified. The quantification of morbidity has required different approaches, and here community and family studies have made major contributions. In contrast to mortality, morbidity is most pronounced in children and young adults, and the diseases, although self-limited, are often quite severe. Although the size of the outbreaks varies, influenza infection can be documented annually. Thus, each year must be considered an influenza year.

Adolescent↗
PubMed1980

Puerperal infectious morbidity: relationship to route of delivery and to antepartum Chlamydia trachomatis infection.

We investigated the relationship of route of delivery and of antepartum Chlamydia trachomatis cervical infection to selected forms of puerperal infectious morbidity, including intrapartum fever, or early (less than 48 hours) postpartum fever not attributable to infections of sites outside the uterus and late (48 hours to 6 weeks) postpartum endometritis. Infectious morbidity occurred in 27 (44%) of 62 women who underwent cesarean section and in 33 (10%) of 329 who underwent vaginal delivery (p less than 0.001). Postsection infectious morbidity was not correlated with C. trachomatis infection and was largely limited to early postpartum fever. Among women who underwent vaginal delivery, infectious morbidity occurred in 10 (34%) of 29 women with and in 23 (8%) of 300 without C. trachomatis infection (p less than 0.001), and chlamydial infection was associated only with intrapartum fever and late postpartum endometritis. Separate matched case-control analyses confirmed that cesarean section was associated with an increased risk of early postpartum fever (p = 4 x 10(-8)); whereas among women who underwent vaginal delivery, antepartum C trachomatis infection was associated with an increased risk of development of intrapartum fever or late postpartum endometritis (p = 0.002).

Cesarean Section↗
PubMed1996

Early and late morbidity in patients undergoing pulmonary resection with low diffusion capacity.

BACKGROUND: We sought to determine whether low diffusion capacity of the lung to carbon monoxide (DLCO) is a predictor of high postoperative mortality and morbidity after major pulmonary resection and whether major pulmonary resection in patients with low DLCO results in substantial long-term morbidity. METHODS: Sixty-two major pulmonary resections were performed in 61 patients with low DLCO (DLCO < or = 60% predicted for pneumonectomy or bilobectomy; < or = 50% predicted for lobectomy). Contemporaneously, 262 other patients underwent 263 major pulmonary resections (group II). Long-term morbidity was assessed in subsets of patients with low (n = 24) and high (n = 22; DLCO > 60% predicted) DLCO. RESULTS: The hospital mortality rates were equivalent (4.8% low DLCO versus 4.9% group II), whereas respiratory complications were more frequent in patients with low DLCO (18% versus 9.5%; p = 0.05). In the subgroup analyses, patients with low DLCO had more hospitalizations for respiratory compromise and worse median dyspnea scores. Analysis of patients with substantial dyspnea revealed an association with extended pulmonary resection and postoperative radiation therapy in patients with low DLCO. CONCLUSIONS: Patients with low DLCO underwent major pulmonary resection with a low mortality rate and an acceptable, but increased, respiratory complication rate. Long-term respiratory morbidity was increased in patients with low DLCO; however, the extent of pulmonary resection and the use of postoperative radiation therapy may have contributed to the development of dyspnea in these patients.

Aged↗
PubMed1990

Neonatal neurological morbidity in relation to obstetrical and social conditions in Grenada (Caribbean).

Neonatal morbidity, in particular neurological morbidity is a more relevant measure of the effectiveness of obstetrical care than perinatal mortality. Neurological morbidity was assessed in a birth cohort in Grenada, and appeared to be lower than in a reference group examined in Groningen, the Netherlands, in 1975-1978. Perinatal mortality, however, was higher. The results support the thesis that some children may have died who, if they would have survived, would have been neurologically abnormal. It is concluded that whereas a decrease in perinatal deaths is an essential goal in Grenada, a concomitant increase in morbidity should be carefully avoided.

Adolescent↗
PubMed1989

The recognition of psychiatric morbidity on a medical oncology ward.

The Generalised Health Questionnaire and Standardised Psychiatric Interview were used to determine psychiatric morbidity among 126 patients consecutively admitted to a medical oncology unit. Senior house officers and nurses also rated anxiety and depression. 36 (29%) patients were psychiatrically ill and affective disorders (29, 23%) predominated. Psychiatric morbidity was associated with feeling moderately or severely physically ill, and previous psychiatric illness, but not with awareness of having cancer or lack of a confiding tie. The General Health Questionnaire identified 79% of affective disorders at the cost of a 34% false positive rate. Doctors and nurses recognised only 49% of the depressed group; more of those with morbid anxiety (79%) were identified but only because they assumed most patients were anxious. Training in interviewing skills could substantially improve the identification and referral rates of patients with psychiatric morbidity.

Anxiety Disorders↗
PubMed1994

Heterosexuals and HIV disease: a controlled investigation into the psychosocial factors associated with psychiatric morbidity.

The aim of the study was to evaluate the prevalence of current and past psychiatric morbidity among HIV seropositive and HIV seronegative heterosexual men and women and to identify the psychosocial factors associated with psychiatric morbidity. Twenty-four asymptomatic HIV seropositive and twenty-six HIV seronegative heterosexuals were included in the study. Outcome measures included socio-demographic data, psychiatric history, current psychological status (Zung Self-Report Anxiety Scale, Zung Self-Report Depression Scale, Symptom Check List 90-R), Social Supports and Locus of Control Scales, and information on changes in work, social, and sexual life after HIV testing. There were no significant differences between HIV seropositive heterosexuals and HIV seronegative controls on any of the outcome measures. Levels of psychiatric morbidity were generally low and similar to those expected in a general out-patient medical population. Multiple regression analyses showed that degree of social support was the only significant factor associated with psychiatric morbidity. The implications of the findings are discussed.

Adult↗
PubMed1990

Morbidity after temporomandibular joint arthrography is lower than after removal of lower third molars.

The morbidity after temporomandibular joint arthrography was studied as the amount of pain, use of pain medicine, and disturbed sleep and was compared with the morbidity after removal of lower third molars. The morbidity was substantially higher after surgery than after arthrography. It was concluded that the morbidity after arthrography can be kept at a low level and that it should not restrict the indications for this examination.

Adult↗
PubMed1994

Morbidity from anterior ilium bone harvest. A comparative study of lateral versus medial surgical approach.

The morbidity of bone harvest was compared between anterior lateral and medial surgical approaches in a randomized prospective study. Forty consecutive patients, each requiring a minimum 40 cc of loose corticocancellous bone for maxillofacial reconstruction, were randomly placed into two equal groups. Morbidity vectors assessed included bone volume, blood loss, length of surgery, length of hospital stay, incidence of seroma, incidence of anterior thigh paresthesia, postoperative pain, and gait disturbance. The results demonstrated no significant difference in morbidity between these two approaches; therefore selection of either approach is the surgeon's personal preference. A thorough understanding of the osseous anatomy of the anterior ilium and its muscular attachments, a good surgical technique, an efficient surgical team, and a continuous flow of required surgical instruments are essential to reduce the morbidity of bone harvest.

Adult↗
PubMed1986

Effect of iron prophylaxis on morbidity due to infectious disease: report on clinical studies in Papua New Guinea.

A controlled trial of iron prophylaxis (3 ml intramuscular iron dextran) to two-month-old infants was carried out on the north coast of Papua New Guinea where there is high transmission of malaria. The initial hypothesis was that iron deficiency increased susceptibility to infections and thus iron supplementation in a situation of actual or potential iron deficiency would diminish this susceptibility. Findings detailed elsewhere indicate that the placebo control group became relatively iron deficient and that the iron dextran group had adequate iron stores and a higher mean haemoglobin; however, prevalence of malaria recorded in the field was higher in the iron dextran group. Analysis of field and hospital infectious morbidity in the trial indicated a deleterious effect of iron dextran for all causes and for respiratory infections (the main single reason for admission). Total duration of stay in hospital was significantly increased in the iron dextran group. Analysis of other factors showed a deleterious effect of low weight for height at the start of the trial; a significant positive correlation between birth haemoglobin and hospital morbidity rates and a positive interaction between haemoglobin and iron dextran on hospital morbidity. A possible association between malarial experience and other infectious morbidity is discussed.

Body Weight↗
PubMedDate not supplied

The morbidity of schistosomiasis mansoni in the highland focus of Lake Cohoha, Burundi.

Morbidity due to infection with Schistosoma mansoni was investigated in a recently discovered highland focus around Lake Cohoha, Burundi. The distribution of the infection was very focal and morbidity patterns in populations from an endemic area A (prevalence 38%, mean egg load of positive subjects 231 eggs per gram [epg]), a less affected area B (16%, 90 epg) and a virtually non-endemic area C (5%, 45 epg), were compared; apart from schistosomiasis, the profiles of these populations were highly similar. The overall frequencies of diarrhoea were 36%, 25%, and 19%, respectively; of abdominal pain 86%, 78%, and 83%; of fatigue 7%, 2%, and 1%; of left lobe hepatomegaly 30%, 18%, and 9%; of right lobe hepatomegaly 18%, 10%, and 5%; of splenomegaly 18%, 10%, and 7%. Organomegaly was generally mild, even in area A. Within area A, the association between the presence of infection and diarrhoea, fatigue, hepatomegaly and splenomegaly was significant, but far less impressive than the results of the community-based comparison with areas B and C. The correlation with intensity was limited to an increased prevalence of diarrhoea and fatigue in the highest egg count group, and a more gradual increase (varying with age) in hepatomegaly and splenomegaly. The data are compared to other morbidity studies in subsaharan Africa, in particular one in the nearby Rusizi Plain. The lesser impact of malaria, the higher egg loads, the recent establishment of the focus and possibly parasite strain differences may account for the more apparent and more important schistosomiasis morbidity in the Cohoha focus.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1985

Assessment of morbidity and mortality in primary cytoreductive surgery for advanced ovarian carcinoma.

Even with wider application of cytoreductive surgery for advanced ovarian cancer, there is still a lack of adequate documentation concerning morbidity and mortality associated with this surgery. The purpose of this paper is to provide such information. This report is based on a retrospective analysis of 60 patients with Stage III and IV disease who had maximal cytoreductive surgery at the Long Island Jewish-Hillside Medical Center between January 1975 and February 1982. This analysis was focused on variables related to morbidity and mortality associated with the procedure. The results indicated that operating time, blood loss, intraoperative and postoperative complications, postoperative morbidity, and the length of hospital stay were acceptable. Only one operative mortality was encountered. The presence of a gynecologic oncologist in the operating room was crucial in carrying out optimal cytoreductive surgery. It is concluded that morbidity and mortality in primary maximal cytoreductive surgery for advanced ovarian carcinoma are acceptable and the surgery should be performed if feasible.

Castration↗
PubMed1990

Morbidity and survival patterns in patients after radical hysterectomy and postoperative adjuvant pelvic radiotherapy.

Morbidity and survival patterns were reviewed in 50 patients who underwent radical hysterectomy, pelvic lymphadenectomy, and adjuvant postoperative pelvic radiotherapy for invasive cervical cancer. Ninety percent of the patients were FIGO stage IB, and 10% were clinical stage IIA or IIB. Indications for adjuvant radiotherapy included pelvic lymph node metastasis, large volume, deep stromal penetration, lower uterine segment involvement, or capillary space involvement. Seventy-two percent of the patients had multiple high-risk factors. An average of 4700 cGy of whole-pelvis radiotherapy was administered. Ten percent of the patients suffered major gastrointestinal complications, 14% minor gastrointestinal morbidity, 12% minor genitourinary complications, one patient a lymphocyst, and one patient lymphedema. Of the five patients with major gastrointestinal morbidity, all occurred within 12 months of treatment. Three patients required intestinal bypass surgery for distal ileal obstructions and all are currently doing well and free of disease. All of the patients who developed recurrent disease had multiple, high-risk factors. The median time of recurrence was 12 months. All patients recurred within the radiated field. Actuarial survival was 90% and disease-free survival 87% at 70 months. It is our opinion that the morbidity of postoperative pelvic radiotherapy is acceptable, and benefit may be gained in such a high-risk patient population.

Adenocarcinoma↗
PubMed1990

Simple estimation of ideal body weight from body mass index with the lowest morbidity.

Body mass index (BMI) is expressed by the body weight (kg) divided by height (m) squared. Therefore, if we know ideal BMI, ideal body weight (kg) of each individual can be calculated by a formula: Ideal BMI x height (m)2. In order to estimate ideal BMI, we investigated average BMI with the lowest morbidity using 4565 Japanese men and women aged 30 to 59 years. Their BMI distributed widely with the highest frequency at 23 in men and 21 in women. The morbidity was evaluated by the number of medical problems that the subjects with each BMI have. The BMI associated with the lowest morbidity was calculated to be 22.2 kg/m2 in men and 21.9 kg/m2 in women according to the quadratic regression curves derived from the relation between BMI and morbidity. From these data, we propose that an ideal body weight in Japanese is 22 x height (m)2.

Adult↗
PubMed1996

The epidemiology of morbidity of schistosomiasis.

The epidemiology of schistosomiasis is changing because treatment of chronically infected individuals is often followed by reinfection. As a major goal of schistosomiasis control is the reduction of morbidity, direct assessment of disease is essential because infection status is a relatively poor indication of morbidity. Introduction of ultrasonography to the study of schistosomiasis and the increased appreciation of the effects of schistosomiasis on growth and development in children have greatly enhanced our understanding of schistosome-induced morbidity in endemic communities. Peter Wiest here reviews the changes in the assessment of schistosomiasis-induced morbidity.

Journal Article↗
PubMed1992

High frequency-low morbidity mechanical complications of tube feeding: a prospective study.

Because of preferential use of the enteral route for nutritional support, a prospective study of mechanical complications was done in 109 consecutive patients. One hundred seventy-two nasogastric tubes were placed in 60 patients, 42 esophagostomies in 28 patients, 32 gastrostomies in 22 patients and 9 jejunostomies in 8 patients. Data show that the use of enteral feeding tubes is not without complications. The complications fell into two major categories. There were 15 low frequency mechanical complications, of which four (2 carotid artery blowouts, 1 gastrointestinal perforation, and 1 aspiration) were of high morbidity and 11 of low morbidity. There were 132 high frequency-low morbidity complications with the use of 255 tubes. These consisted mainly of unplanned and untimely removal of feeding tubes with interruption of feedings and necessitating tube replacement. Data indicate that the main problems related to the use of enteral nutrition are not the dramatic complications which create notoriety but those related to the ordinary mechanical complications occurring daily and which command little attention because of their low mortality. These can assume importance because of their high frequency and as such are characterized as high frequency-low morbidity complications.

Journal Article↗
PubMed1988

Morbidity from bone harvest in major jaw reconstruction: a randomized trial comparing the lateral anterior and posterior approaches to the ilium.

A randomized prospective study was done to compare bone harvest morbidity in the lateral anterior versus the lateral posterior approach to the ilium. One hundred consecutive patients, requiring at least 60 ml of bone for continuity defects of the mandible, were randomly placed in equal groups in these two categories. Assessment of morbidity vectors included pain, ambulation, seroma, and blood loss. Results, in part, identified the posterior ilium harvest to have decreased morbidity in all variables. The reduced morbidity encountered, and the greater quantity of available bone, are both related to the anatomic differences between the anterior and posterior ilium. Accepted disadvantages were increased operating time and the need to turn the patient.

Adolescent↗
PubMed1995

Three dimensional conformal radiotherapy for the treatment of prostate cancer: low risk of chronic rectal morbidity observed in a large series of patients.

PURPOSE: Three dimensional conformal radiotherapy (3D CRT) may provide a technique to increase the dose delivered to target tissues while sparing uninvolved normal structures. To evaluate the role of 3D treatment in reducing the treatment toxicity, we analyzed the chronic rectal morbidity observed in a large group of patients undergoing radiotherapy for prostate cancer. METHODS AND MATERIALS: From 1987 through 1992, 721 prostate cancer patients were treated with 3D CRT at the University of Michigan or Providence Hospital. All had axial computed tomography (CT) specifically for RT planning, multiple structures contoured on the axial images, and beam's-eye-view conformal beams edited to provide 3D dose coverage. Using current American Joint Commission (AJCC) staging, 537 patients had T1-T2 tumors, 123 had T3-T4 tumors, and 60 were treated postprostatectomy. Pelvic lymph nodes were treated in 462 patients. Prostate boosts were delivered with four-field axial, six-field axial, or four-field oblique, nonaxial fields. The median dose was 68.40 Gy (range 59.4-80.4). Median follow-up was 20.4 months; 175 were followed more than 3 years. All complications have been graded conservatively using the RTOG system. RESULTS: Using a Cox proportional hazard's model, patient age, T-stage, prescribed dose, pelvic treatment, and boost technique were analyzed. The factor most strongly related to risk of morbidity was dose (p = 0.05); however, the boost technique was also related: the four-field oblique field had the lowest relative risk. Most episodes of rectal morbidity have been mild: 82 Grade 1 or 2. There have been only 14 more serious complications including 12 Grade 3 and 2 Grade 4. The actuarial risk of a Grade 3 or 4 complication is 3% at 3 and 5 years. CONCLUSIONS: A very small proportion of patients treated with 3D CRT had significant rectal morbidity related to RT, supporting the use of conformal treatment planning and dose delivery as a mechanism to minimize complications in the treatment of prostate cancer.

Adenocarcinoma↗