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PubMed2000

Diagnosis and treatment of sleep disorders caused by co-morbid disease.

Sleep disorders, both insomnia and hypersomnia, are commonly associated with various co-morbid conditions, including general medical and neurologic disorders, psychiatric illnesses, and secondary or symptomatic restless legs syndrome/periodic limb movements in sleep. Diagnosis of the co-morbidity is the first step in treatment, followed by an assessment of the sleep disturbance. This begins with a complete history and physical examination, followed by laboratory testing such as polysomnography, multiple sleep latency testing, and actigraphy. The treatment of sleep disorders caused by co-morbid conditions is discussed under seven categories, including the use of general measures (e.g., sleep hygiene, encouraging patients to develop good sleep habits, medication), treatment of the co-morbid condition, treatment of insomnia, treatment of excessive daytime somnolence, treatment of parasomnias, treatment of sleep-wake schedule disorders, and treatment of secondary or symptomatic restless legs syndrome.

Comorbidity↗
PubMed1979

Prophylaxis of minor febrile and major infectious morbidity following hysterectomy.

A retrospective analysis was conducted of 668 consecutive cases using T-tube suction drainage and/or prophylactic antibiotics as infection prophylaxis for hysterectomy. The data are analyzed for the incidence of minor febrile morbidity (temperature greater than 100.4 for 2 days) and for major infection (hospital stay more than 14 days, reoperation or readmission for the management of pelvic abscess or pelvic thrombophlebitis). The study also compares a minor febrile and major infection group with a noninfected group by measuring parameters of patient discomfort, medical staff effort, and financial costs. It is concluded that 1) minor febrile morbidity frequently follows abdominal (20--30%) and vaginal (30--50%) hysterectomy; 2) minor febrile morbidity has temporary but significant consequences in the form of increased patient discomfort, medical staff effort, and financial costs; 3) major infections are rare following abdominal hysterectomy (less than 0.5%) and uncommon following vaginal hysterectomy (1--4%); 4) suction drainage used alone, prophylactic antibiotics used alone, or a combination of suction drainage and antibiotic prophylaxis is each associated with a statistically significant reduction in the incidence of minor febrile morbidity following both abdominal and vaginal hysterectomy (P = less than 0.01); and 5) such infection prophylaxis may also reduce the incidence of major infection following vaginal hysterectomy.

Abscess↗
PubMedDate not supplied

[General and oncologic morbidity in Moscow municipal transport drivers].

A case study was undertaken to examine general and cancer mortality rates and cancer morbidity among municipal transport drivers in Moscow. The mortality and cancer morbidity in 1969 to 1988 were followed up among 2528 men and 212 women. In this period, male mortality rates due to malignant neoplasms, cardiovascular diseases and all causes taken together were statistically lower than the expected rates. Male cancer morbidity rates were also lower the expected ones. In the past decade 42 cases of gastric cancer were revealed in the cohort, which was statistically greater than the expected figures (29.8). In the first decade, prostatic cancer mortality was statistically significantly higher in bus drivers with length of service of over 20 years. Among women, there were only 12 deaths, with significantly decreased mortality rates. Esophageal cancer was detected in women who had worked as drivers for 20-29 years. The lower morbidity and mortality rates may be associated with the "healthy worker effect", i.e. with the fact that staff is strictly selected for this job.

Automobile Driving↗
PubMed2001

[Arm morbidity after axillary dissection for breast cancer].

INTRODUCTION: Axillary dissection for breast cancer is known to leave the patient with arm morbidity. The aim of this study was to describe the occurrence of lymphoedema, subjective swelling, abnormal sensations, and pain in a consecutive group of patients operated for breast cancer. METHODS: From April to October 1992, 140 consecutive women underwent an operation for breast cancer with axillary dissection at levels one and two. Patients with bilateral breast cancer or radiotherapy towards the axilla were excluded. The surviving 124 patients were invited to an investigation on arm morbidity and a questionnaire on subjective complaints was sent to them. Medical records and pathology reports were reviewed. Ninety-five patients (77%) were examined. Oedema of the arm was assessed by circumference measurements at three points. RESULTS: Objective oedema was found in six patients (6%). Subjective swelling was reported by 24 women (25%). Of these, 14 women reported slight swelling, seven had moderate swelling, and three had severe swelling of the arm. Pain within the three months preceding the examination was reported by 31 (33%). Analgesics were taken by 13 women (14%), of whom five used analgesics daily. Abnormal sensations in the ipsilateral arm was reported by 62 (65%). Young patients in the low risk group, with removal of more than ten lymph nodes, suffered a higher degree of arm morbidity. CONCLUSIONS: The only modifiable risk factor identified is the number of lymph nodes removed in axillary dissection. Other methods of staging could probably lessen arm morbidity.

Arm↗
PubMed1975

Development of two indices of postoperative morbidity.

Two indices of postoperative morbidity, Nursing Assessment Index and Observed Treatment Index, are described and evaluated in this study of 4,182 consecutive anesthetics. The use of these indices in studies of the quality and effectiveness of surgical and anesthetic care should increase the economy and precision with which the causes of unsatisfactory outcome are identified. Specific illustrations of the relationship of the preanesthetic status of patients to their postoperative morbidity as measured by these indices and mortality rates are given. In addition these two indices of morbidity measured on the seventh postoperative day are shown to be strongly co-related with subsequent in-hospital deaths. Thus, of the 100 patients with a Nursing Assessment Index worse than 3, 19 percent died; only 0.4 percent of the 550 patients who had no morbidity as measured by this index died. Although they ultimately survive, about an equal number of patients become seriously ill as die follow operations.

Anesthesia↗
PubMed2001

Relationship between morbidity and body mass index of mariners in the Japan Maritime Self-Defense Force Fleet Escort Force.

To establish a practical weight management program for mariners in the Japan Maritime Self-Defense Force (JMSDF) Fleet Escort Force, the relationship between morbidity and body mass index (BMI) was studied. To estimate morbidity, 10 medical problems were used as indices (hyperlipidemia, hyperuricemia, diabetes mellitus, lung disease, heart disease, upper gastrointestinal tract disease, hypertension, renal disease, liver disease, and anemia). A curvilinear relationship was found between morbidity and BMI, in which a BMI of 17.5 was associated with the lowest morbidity. This curvilinear pattern was more complex than a curve reported previously for Japanese civilians. Using the present curve and aiming for a BMI of 17.5 will help in the design and implementation of a practical management program for health promotion in the JMSDF.

Adipose Tissue↗
PubMedDate not supplied

[Infectious diseases in natural reservoirs: epidemic situation and morbidity in the Russian Federation and prophylactic measures].

The analysis of morbidity in infections with natural foci in Russia for the period of 1999-2000 indicates that a rise in the number of cases of hemorrhagic fever with the renal syndrome, tick-borne encephalitis, Crimean hemorrhagic fever and West Nile fever with a high proportion of urban population among the patients is registered annually. An increase in the epizootic activity of the natural foci of plague is noted in the absence of morbidity among humans. The appearance of the outbreaks of tularemia is linked nor only with the increased activity of the natural foci, but also with the reduced coverage of the population with prophylactic immunization in endemic regions. This analysis infers that morbidity prognosis in infections with natural foci for 2001 remains unfavorable. The growth of morbidity in these infections is mainly due to the reduction of measures for controlling their vectors both is open nature and in settlements, as well as to low coverage with prophylactic immunization. Urgent complex measures which may ensure effective antiepidemic and prophylactic work for controlling infections with natural foci are presented.

Animals↗
PubMed2001

Alzheimer's dementia: morbidity and mortality.

OBJECTIVES: To evaluate the morbidity and mortality of Alzheimer's disease in early onset and late onset disease. BACKGROUND: Comprehensive literature review to provide historic and demographic background on the disease as well as to determine the pertinent factors for risk assessment. METHODS: Abstract mortality methodology is employed to develop mortality ratios and life expectancies on those with early onset as well as late onset disease. RESULTS: Mortality ratios and morbidity are high in the early onset disease. The late onset disease has high mortality ratios in the more severe forms of the disease. Mild disease is not associated with high mortality ratios. CONCLUSIONS: Alzheimer's disease is an important impairment in an elderly individual. Early onset disease is uncommon and associated with high mortality and morbidity. The late onset disease is common and is associated with much less morbidity and mortality. Risk factors are useful in identifying high-risk individuals.

Aged↗
PubMedDate not supplied

[Long-term dynamics and prognosis for tularemia and pseudotuberculosis morbidity in the Iaroslavl region].

The trends and main factors influencing the fluctuations of the levels of tularemia and pseudotuberculosis morbidity in the Iaroslavl region were revealed by the methods of mathematical statistics (regress analysis, time-series analysis, etc.). Tularemia morbidity was 0.467 +/- 0.216 cases (1950-1997) and pseudotuberculosis morbidity was 0.979 +/- 0.297 cases (1979-1997) per 100,000 of the population. The multiple regression equations permitting the prognostication of tularemia and pseudotuberculosis morbidity in the Iaroslvl region were derived.

Humans↗
PubMedDate not supplied

[Morbidity and prophylaxis of hemorrhagic fever with renal syndrome in the Republic of Bashkortostan].

The brief retrospective analysis of morbidity, epizootological data and preventive measures with respect to haemorrhagic fever with renal syndrome (HFRS) during the whole period of its registration on the territory of the Republic of Bashkortostan along with the structure of HFRS morbidity during epidemic seasons of 1998 and 1999 is presented. The main causes of decreased HFRS morbidity in 1998, its rise in 1999 as well as prognosis for the year 2000 were detected. The level of HFRS morbidity among the population was found to be directly related to the number of rodents and their infection rate. The basic strategy of epidemic control interventions has been proposed.

Animals↗
PubMedDate not supplied

Morbidity and mortality following abdominoperineal resection for low rectal adenocarcinoma.

BACKGROUND: Abdominoperineal resection (APR) has been the standard treatment of low rectal cancer, but it is associated with significant morbidity and mortality. AIM: To analyze the morbidity and mortality rates associated with this surgical procedure performed at a tertiary-level cancer center. MATERIALS AND METHODS: From 1995-1999, 137 patients with rectal cancer located between 0 and 8 cm from the anal verge underwent APR. Covariates were analyzed mean chi 2 and those favorable or adverse covariates affecting the perineal infection and recurrences were analyzed by logistic regression analysis. RESULTS: There were 78 males and 59 females, with a mean age of 57.4 +/- 14.6 years. Mean intraoperative hemorrhage was 739 +/- 547 mL; 51 (37.2%) patients received blood transfusion. Seventy-two patients received preoperative radiotherapy (PRT): 22, postoperative chemo-radiation therapy; 21, PRT + chemotherapy, and 22, APR only. Seventeen patients (12.4%) had major complications and 47 (34.3%) had minor complications. Twenty patients (14.6%) developed perineal wound infection. The main factors influencing these complications were administration of PRT +/- chemotherapy and age over 55 years. Operative mortality was 0.7%. Median follow-up was 32 months. Twelve patients (8.8%) had local recurrence and 35 (25.7%) had distant recurrence. Overall five-year survival was 75%. CONCLUSIONS: APR is a surgical procedure associated with significant morbidity but low postoperative surgical mortality. The main cause of morbidity was perineal would infection influenced by administration of PRT +/- chemotherapy and age over 55 years. However, this treatment association is linked with low rate of local recurrence.

Abdomen↗
PubMed1998

[Effect of selenium status on the morbidity of interstitial pneumonia in rats infected with mycoplasma].

To investigate the effect of selenium(Se) status on morbidity and process of interstitial pneumonia, we used the Wistar rats as the animal model infected with Mycoplasma Pneumonia (MP). The rats were maintained on the based diets with different doses of Se, infected with MP and exposed to sodium selenite(1.5-2.0 ml/day, containing Se 2 micrograms/ml) or 0.9% NaCl (1.5-2.0 ml/d) by gavage for different time. The experimental rats were divided into five groups, group A, feeding with normal control diet and without infected MP, group B with adequate Se diet and infected MP, group C with Se deficiency diet infected MP and added Se at the same time, group D with Se deficiency diet and added Se after suffered with MP, and group E with Se deficiency diet and infected MP. The results showed that the MP morbidity of the rats fed with high Se diet was significantly lower than that of the rats fed with low Se diet. The pathological change was significant in the low Se group and relatively mild in the high Se group. After infected with MP, the supplementation of sodium selenite to the low Se rats might decrease the MP morbidity and shorten the disease course compared with the group without supplementing Se. The incidence of myocarditis in the infected group with normal Se level diet or in the infected group with Se supplement was lower than that in the group without Se supplementation. The concentrations of Se in plasma and glutathione peroxidase in plasma and white blood cells decreased to a certain level after infection. The present study indicated a positive influence of Se supplement on the morbidity, disease course, and state of interstitial pneumonia in rats.

Animals↗
PubMed2002

[Neonatal morbidity and mortality in very low birth weight infants according to exposure to chorioamnionitis].

OBJECTIVES: To study differences in the incidence of neonatal morbidity and mortality among newborns weighing less than 1,500 g according to exposure to chorioamnionitis (CA). PATIENTS AND METHODS: A case-control study of 135 newborns weighing less than 1,500 g at birth and born between 1988 and 1998 was performed. The case group was composed of 45 newborns exposed to clinical or subclinical levels of maternal CA. Each newborn in the case group was matched with two controls, both weighing less than 1,500 g, one of them born immediately before and the other one immediately after. Perinatal records, neonatal morbidity and mortality were analyzed. RESULTS: The mean gestational age was 28.5 weeks (range: 24-38 weeks) with a mean weight of 1,131 g (range: 520-1,500 g). The time of membrane rupture was significantly greater in the case group (176 h vs 57 h; p < 0.001). Forty percent of the cases presented sepsis in the first 72 h of life compared with 10 % of the controls (p < 0.0001). No significant differences in morbidity or mortality were found between the groups, although chronic lung disease (20 % vs 13 %) and intraventricular hemorrhage (24 % vs 17 %) were more frequent in infants exposed to CA. Resuscitation (77.8 % vs 45.6 %; p 0.001) and mechanical ventilation (73 % vs 50 %; p 0.016) were required by a great number of cases than controls. CONCLUSIONS: The presence of CA was associated with a higher risk of early onset infection and the need for neonatal resuscitation and mechanical ventilation. No significant differences were found in morbidity or mortality.

Case-Control Studies↗
PubMed2002

[Effect of birth weight on neonatal and maternal morbidity in expectant management of post-term pregnancy].

OBJECTIVE: In the retrospective study to evaluate whether the number of newborns over 4000 grams weight is greater under expectative management of post-term pregnancy and explain its influence on perinatal and maternal morbidity and mortality. DESIGN: Retrospective study. SETTING: Gynaecology and Obstetric Clinic, Medical Faculty, Masaryk University, Brno. METHODS: Two groups were compared. Group I includes 1906 women, who delivered in the year 1996 under the active management of the post-term pregnancy with induction of labour in the 41st week. Group II includes 2008 parturients who delivered under the expectative management of the post-term pregnancy with induction of labour at the end of 42nd week. Perinatal mortality, brachial plexus injuries, clavicle fractures, Caesarean section rate for cephalopelvic dysproportion and injuries in mothers were evaluated. Students T test and chi square test were used for statistical purposes. RESULTS: In the group with expectative management of the post-term pregnancy there was significantly higher number of newborns over 4000 grams. Perinatal mortality and morbidity did not differ between the two groups. There is no difference in maternal morbidity as well. CONCLUSIONS: Our results of expectative management in post-term pregnancies with newborns over 4000 grams did not confirm our worries about higher morbidity both in newborns and mothers. There is no need to consider the expectative management of the post-term pregnancies to be dangerous.

Birth Injuries↗
PubMed2002

[Assessment of plasma lipid profile oxysterols and vitamin E concentration in morbidity obese patients with coexisting arterial hypertension and non-insulin dependent diabetes mellitus].

Morbid obesity (BMI > or = 40 kg/m2) is accompanied by lipid disturbances which may be involved in the increased incidence of arterial hypertension and non-insulin dependent diabetes mellitus. The aim of the study was to assess plasma concentrations of total cholesterol (TC), HDL-cholesterol, LDL-cholesterol, triglycerides (TG) and two parameters of oxidation stress--vitamin E and oxysterols, in morbidly obese patients with coexisting arterial hypertension and non-insulin dependent diabetes mellitus. Studies were performed in 37 morbidly obese patients divided into three groups: group I--without coexisting diseases, group II--with arterial hypertension, and group III--with arterial hypertension and non-insulin dependent diabetes mellitus. In all groups there was an increase in TG concentration, a decrease in HDL-cholesterol level, and normal values of TC and LDL-cholesterol. The concentrations of 7-hydroxycholesterols (7-OH) in group II (602.65 +/- 264.46 ng/ml) and group III (570.94 +/- 210.59 ng/ml) were significantly higher compared to that in group I (336.09 +/- 220.74 ng/ml). There were no differences between groups in concentrations of 7-ketocholesterols (7-K), TC, HDL-cholesterol, LDL-cholesterol, TG, vitamin E and vitamin E/(TC + TG) ratio. In all groups TC concentration correlated positively with TG concentration, and negatively with vitamin E/(TC + TG) ratio. Moreover, the positive correlation between TG and HDL-cholesterol concentrations, and negative correlation between plasma vitamin E and 7-K concentrations were demonstrated. In conclusion, although the study demonstrates similar disturbances in lipid profile and oxidation stress parameters in all groups, with significant differences in 7-OH only, the role of cholesterol oxidation products in pathogenesis of arterial hypertension and non-insulin dependent diabetes mellitus in morbidly obese patients cannot be excluded.

Adult↗
PubMed1992

[Morbidity with temporary loss of work capacity in the workers of the Belmeken-Sestrimo hydroelectric cascade].

The present work presents the results from the analysis on the morbidity with temporary disability from cascade "Belmeken-Sestrimo" (n = 94, men 73, women 21). By means of personnel method are studied the cases of morbidity with temporary disability and defined the basic and enlarged number of indices, analysed in sex, age, length of service, nosological structure and dynamics for a period of 3 years (1987-1989) for the 3 sites of hydroelectric cascade "Belmeken-Sestrimo", water-power station "Momina Klisura", hydroelectric station "Sestrimo" and water-power station "Belmeken". The results point out to low and average levels of morbidity with temporary disability, with traditional arrangement of their nosological affiliations (diseases of the upper respiratory ways, cardio-vascular system, nervous system etc.). The relative part of "frequently and long suffering persons" is low, but to this group as potential source for increase of the level, structure and dynamics of morbidity with temporary disability is necessary to apply purposeful undertakings.

Absenteeism↗
PubMed1992

[Cardiac morbidity and fatalities in patients with vascular surgery. Identification of risk groups].

Incidence and type of cardiac complications in 701 patients undergoing arterial vascular surgery were prospectively investigated to identify high-risk groups. Cardiac morbidity was 10.1%. Cardiac complications were responsible for 28 deaths (57%). Using logistic regression analysis, age (cardiac morbidity greater than 7017.3%), impaired renal function (19.8%), and congestive heart failure (17.3%) were the main independent risk factors. In addition, 4 risk factors (arrhythmia, coronary artery disease, anemia, emergency surgery) showed significant individual association with cardiac complications. Cardiac morbidity increased to 27.8% in patients with more than 2 of these 7 risk factors. A further association could be demonstrated between the degree of peripheral vascular disease and cardiac morbidity, but not with the extent of the operation. Based on our results a distinction between three groups of different cardiac risk can be made. A clinical algorithm for further cardiac assessment in high-risk patients is presented.

Adolescent↗
PubMed2003

[Establishment and preliminary evaluation of the General Practitioners' Morbidity Sentinel Stations Program in Hungary. Prevalence of hypertension, diabetes mellitus and liver cirrhosis].

STUDY OBJECTIVE: To develop, introduce and test a methodology, which provides valid data about the prevalence and incidence of chronic, non-communicable diseases of great public health importance. DESIGN: The School of Public Health, University of Debrecen, Hungary and the National Public Health and Medical Officer Service the first time launched a morbidity sentinel stations network of general practitioners in four counties in Hungary in May 1998. Within the framework of this program the participating general practitioners reported the prevalence data of cardiovascular diseases, diabetes mellitus, liver cirrhosis, and major malignant diseases at the beginning, and from than on continuously report the incidence of these diseases. The authors built quality assurance into the program at different levels in order to ensure high quality data. PATIENTS: The study population consists of people belonging to the participating general practitioners' practices at any time, selected in a way to represent the eastern and western part of the country as well as the participating practices in the counties (Gyór-Moson-Sopron, Hajdú-Bihar, Szabolcs-Szatmár-Bereg, Zala) would give a geographically and according to settlement size representative sample of general practitioners in those counties. Eighty general practitioners were approached in the four counties by the county offices and overall 73 of them, 1.4% of the total practices in Hungary (5212), agreed to participate in the study, therefore information can be collected on 1.37% of the Hungarian population's (138,088 people) morbidity status. MAIN RESULTS: The population of practices participating in the program gives a representative sample of the counties population by age and sex. The prevalence of hypertension, diabetes mellitus and liver cirrhosis is high in all the counties involved. In most of the selected diseases the authors have found differences in the prevalence between the eastern and western part of Hungary with higher values in the western counties. The differences were most apparent in the older age groups in both sexes. CONCLUSIONS: The development and sustainability of primary care based, sentinel stations type, euroconform morbidity data collection system is undoubtedly justified in Hungary. The collected and thoroughly analysed data provide not only a valid and comprehensive basis to describe some aspects of the health status of the Hungarian population but also gives an opportunity to continuously monitor the changes in morbidity of the selected diseases. Thus, the program serves an important basis for health care capacity building, priority setting and the evaluation of the effectiveness of public health interventions.

Adolescent↗