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Archives of Disease in Childhood. Fetal... Nov 2022In response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design....
OBJECTIVE
In response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design. However, the assumed benefits of this emerging design remain a subject of debate. Our goal was to evaluate the impact of single-room versus open-bay care on the risk of neonatal morbidity and mortality in preterm neonates.
DESIGN
Retrospective cohort study.
SETTING
Level III NICU.
PATIENTS
Neonates born <32 weeks' gestation between 15 May 2015 and 15 May 2019.
MAIN OUTCOME MEASURES
Mortality and morbidities of a cohort of neonates admitted to a new, single-room unit (SRU) were compared with a historical cohort of neonates admitted to an open-bay unit (OBU). Group differences were evaluated and multivariable logistic regression analyses were performed.
RESULTS
Three-hundred and fifty-six and 343 neonates were admitted to the SRU and OBU, respectively. No difference in neonatal morbidities and mortality were observed between cohorts (bronchopulmonary dysplasia: OR 1.08, 95% CI 0.73 to 1.58, p=0.44; retinopathy of the prematurity stage ≥2: OR 1.36, 95% CI 0.84 to 2.22, p=0.10; intraventricular haemorrhage: OR 0.89, 95% CI 0.59 to 1.34, p=0.86; mortality: OR 1.55, 95% CI 0.75 to 3.20, p=0.28). In adjusted regression models, single-room care was independently associated with a decreased risk of symptomatic patent ductus arteriosus (adjusted OR 0.54, 95% CI 0.31 to 0.95). No independent association between single-room care and any of the other investigated outcomes was observed.
CONCLUSIONS
Implementation of single-rooms in our NICU did not lead to a significant reduction in neonatal morbidity and mortality outcomes.
Topics: Infant, Newborn; Humans; Retrospective Studies; Intensive Care Units, Neonatal; Infant, Premature, Diseases; Infant Mortality; Morbidity; Cohort Studies
PubMed: 35444004
DOI: 10.1136/archdischild-2021-323310 -
International Journal of Cardiology Apr 2017Elderly and women have been often under-represented in randomised clinical trials (RCTs) testing the effect of treatments on cardiovascular diseases (CVDs) even though... (Review)
Review
BACKGROUND
Elderly and women have been often under-represented in randomised clinical trials (RCTs) testing the effect of treatments on cardiovascular diseases (CVDs) even though these diseases highly affect both of them.
AIMS
Taking into account these issues, the aim of this review is to critically analyse the topic of under-representation of elderly and women in cardiovascular RCTs.
CONCLUSIONS
Compared to their younger counterparts, elderly have a higher incidence of disease-related morbidities, take more medicines and account for more adverse drug related events. Similarly, women present several differences in CVD pathophysiology, clinical manifestations and outcomes in comparison to their male counterparts. For these reasons, the results of RCTs obtained in younger men cannot be simply translated in elderly and women. Unfortunately, although international guidelines have been published to increase the enrolment of elderly and women, their recruitment is still insufficient. Thus, the inclusion of these subgroups in cardiovascular RCTs is a key aspect to acquire evidence-based knowledge in the understanding and management of CVDs in elderly and women.
Topics: Age Factors; Cardiovascular Agents; Cardiovascular Diseases; Clinical Trials as Topic; Female; Global Health; Humans; Incidence; Male; Morbidity; Patient Participation; Sex Factors; Survival Rate
PubMed: 28111054
DOI: 10.1016/j.ijcard.2017.01.018 -
Journal of Pediatric Ophthalmology and... 2024To explore the geographic variability of the epidemiology of pediatric uveitis, which, although rare in children, carries a significant risk of morbidity.
PURPOSE
To explore the geographic variability of the epidemiology of pediatric uveitis, which, although rare in children, carries a significant risk of morbidity.
METHODS
This was a retrospective review conducted at two tertiary referral centers in Buenos Aires, Argentina. Demographic and clinical data of patients younger than 16 years diagnosed as having uveitis between January 1, 2006 and October 1, 2014 were collected.
RESULTS
A total of 257 patients (380 eyes) were included in the study. Cases tended to be unilateral (134, 52.1%), granulomatous (146, 56.8%), and localized to the posterior segment (121, 47.1%). Toxoplasmosis was the most common etiology (98, 38.1%).
DISCUSSION
The spectrum of pediatric uveitis in Buenos Aires most closely resembles that of Colombia. Understanding these geographic variations is important to aid providers who are caring for children in an increasingly globalized world. .
Topics: Humans; Argentina; Child; Retrospective Studies; Male; Female; Uveitis; Adolescent; Child, Preschool; Infant; Incidence; Age Distribution; Morbidity
PubMed: 37882185
DOI: 10.3928/1081597X-20230829-01 -
International Journal of Molecular... Jan 2018Patients with non-transfusion-dependent thalassemia (NTDT) experience many clinical complications despite their independence from frequent transfusions. Morbidities in... (Review)
Review
Patients with non-transfusion-dependent thalassemia (NTDT) experience many clinical complications despite their independence from frequent transfusions. Morbidities in NTDT stem from the interaction of multiple pathophysiological factors: ineffective erythropoiesis, iron overload (IOL), and hypercoagulability. Ineffective erythropoiesis and hemolysis are associated with chronic hypoxia and a hypercoagulable state. The latter are linked to a high prevalence of thromboembolic and cerebrovascular events, as well as leg ulcers and pulmonary hypertension. IOL in NTDT patients is a cumulative process that can lead to several iron-related morbidities in the liver (liver fibrosis), kidneys, endocrine glands (endocrinopathies), and vascular system (vascular disease). This review sheds light on the pathophysiology underlying morbidities associated with NTDT and summarizes the mainstays of treatment and some of the possible future therapeutic interventions.
Topics: Blood Transfusion; Erythropoiesis; Humans; Iron Chelating Agents; Morbidity; Splenectomy; Thalassemia
PubMed: 29316681
DOI: 10.3390/ijms19010182 -
Scandinavian Journal of Primary Health... Jun 2022In epidemiological studies it is often necessary to describe morbidity. The aim of the present study is to construct and validate a morbidity index based on the...
OBJECTIVES
In epidemiological studies it is often necessary to describe morbidity. The aim of the present study is to construct and validate a morbidity index based on the International Classification of Primary Care (ICPC-2).
DESIGN AND SETTING
This is a cohort study based on linked data from national registries. An ICPC morbidity index was constructed based on a list of longstanding health problems in earlier published Scottish data from general practice and adapted to diagnostic ICPC-2 codes recorded in Norwegian general practice 2015 - 2017.
SUBJECTS
The index was constructed among Norwegian born people only ( = 4 509 382) and validated in a different population, foreign-born people living in Norway ( = 959 496).
MAIN OUTCOME MEASURES
Predictive ability for death in 2018 in these populations was compared with the Charlson index. Multiple logistic regression was used to identify morbidities with the highest odds ratios (OR) for death and predictive ability for different combinations of morbidities was estimated by the area under receiver operating characteristic curves (AUC).
RESULTS
An index based on 18 morbidities was found to be optimal, predicting mortality with an AUC of 0.78, slightly better than the Charlson index (AUC 0.77). External validation in a foreign-born population yielded an AUC of 0.76 for the ICPC morbidity index and 0.77 for the Charlson index.
CONCLUSIONS
The ICPC morbidity index performs equal to the Charlson index and can be recommended for use in data materials collected in primary health care.Key pointsThis is the first morbidity index based on the International Classification of Primary Care, 2 edition (ICPC-2)It predicted mortality equal to the Charlson index and validated acceptably in a different populationThe ICPC morbidity index can be used as an adjustment variable in epidemiological research in primary care databases.
Topics: Cohort Studies; Family Practice; General Practice; Humans; Morbidity; Primary Health Care
PubMed: 35822650
DOI: 10.1080/02813432.2022.2097617 -
Indian Journal of Pediatrics Feb 2021The study examined the demographic, socioeconomic, and clinical correlates of self injurious behaviors (SIBs) in a large clinical sample of children with autism spectrum...
The study examined the demographic, socioeconomic, and clinical correlates of self injurious behaviors (SIBs) in a large clinical sample of children with autism spectrum disorder (ASD). A case record review of 1252 ASD children for whom complete information on socioeconomic background variables and presence/absence of SIBs was available were included. The overall prevalence of SIBs was 22.1% and the most prevalent SIBs were head banging (47%), followed by self hitting (27.8%). Several factors including age at diagnosis (t = 2.09, P = 0.037), education of mother (χ = 14.48, P = 0.0001), presence of co-morbid medical condition (χ = 4.22, P = 0.040), intellectual disability (χ = 23.17, P = 0.0001), sensory processing abnormalities (χ = 13.01, P = 0.0001), and severity of autism (χ = 51.13, P = 0.0001) were found to be significantly associated with presence of SIBs. Logistic regression analysis revealed that severity of autism was the only significant predictor of SIBs. Intentional self harm is related with significant morbidity and needs early intervention.
Topics: Autism Spectrum Disorder; Autistic Disorder; Child; Female; Humans; Intellectual Disability; Prevalence; Self-Injurious Behavior
PubMed: 32592001
DOI: 10.1007/s12098-020-03276-1 -
World Journal of Gastroenterology Mar 2022Postoperative morbidity after curative resection for hilar cholangiocarcinoma (HCCA) is common; however, whether it has an impact on oncological prognosis is unknown.
BACKGROUND
Postoperative morbidity after curative resection for hilar cholangiocarcinoma (HCCA) is common; however, whether it has an impact on oncological prognosis is unknown.
AIM
To evaluate the influence of postoperative morbidity on tumor recurrence and mortality after curative resection for HCCA.
METHODS
Patients with recently diagnosed HCCA who had undergone curative resection between January 2010 and December 2017 at The First Affiliated Hospital of Army Medical University in China were enrolled. The independent risk factors for morbidity in the 30 d after surgery were investigated, and links between postoperative morbidity and patient characteristics and outcomes were assessed. Postoperative morbidities were divided into five grades based on the Clavien-Dindo classification, and major morbidities were defined as Clavien-Dindo ≥ 3. Univariate and multivariate Cox regression analyses were used to evaluate the risk factors for recurrence-free survival (RFS) and overall survival (OS).
RESULTS
Postoperative morbidity occurred in 146 out of 239 patients (61.1%). Multivariate logistic regression revealed that cirrhosis, intraoperative blood loss > 500 mL, diabetes mellitus, and obesity were independent risk factors. Postoperative morbidity was associated with decreased OS and RFS (OS: 18.0 mo 31.0 mo, respectively, = 0.003; RFS: 16.0 mo 26.0 mo, respectively, = 0.002). Multivariate Cox regression analysis indicated that postoperative morbidity was independently associated with decreased OS [hazard ratios (HR): 1.557, 95% confidence interval (CI): 1.119-2.167, = 0.009] and RFS (HR: 1.535, 95%CI: 1.117-2.108, = 0.008). Moreover, major morbidity was independently associated with decreased OS (HR: 2.175; 95%CI: 1.470-3.216, < 0.001) and RFS (HR: 2.054; 95%CI: 1.400-3.014, < 0.001) after curative resection for HCCA.
CONCLUSION
Postoperative morbidity (especially major morbidity) may be an independent risk factor for unfavorable prognosis in HCCA patients following curative resection.
Topics: Bile Duct Neoplasms; Humans; Klatskin Tumor; Morbidity; Neoplasm Recurrence, Local; Prognosis; Retrospective Studies
PubMed: 35317056
DOI: 10.3748/wjg.v28.i9.948 -
PLoS Medicine Sep 2018In a Guest Editorial, James Beeson and colleagues discuss the contribution of nonobstetric morbidity to mortality during and around pregnancy and what needs to be done...
In a Guest Editorial, James Beeson and colleagues discuss the contribution of nonobstetric morbidity to mortality during and around pregnancy and what needs to be done to address this global health challenge.
Topics: Developing Countries; Female; Health Services; Humans; Morbidity; Pregnancy; Pregnancy Complications; Research Design
PubMed: 30252846
DOI: 10.1371/journal.pmed.1002665 -
Health Economics Sep 2022Billions of people live in urban poverty, with many forced to reside in disaster-prone areas. Research suggests that such disasters harm child nutrition and increase...
Billions of people live in urban poverty, with many forced to reside in disaster-prone areas. Research suggests that such disasters harm child nutrition and increase adult morbidity. However, little is known about impacts on mental health, particularly of people living in slums. In this paper we estimate the effects of flood disasters on the mental and physical health of poor adults and children in urban Indonesia. Our data come from the Indonesia Family Life Survey and new surveys of informal settlement residents. We find that urban poor populations experience increases in acute morbidities and depressive symptoms following floods, that the negative mental health effects last longer, and that the urban wealthy show no health effects from flood exposure. Further analysis suggests that worse economic outcomes may be partly responsible. Overall, the results provide a more nuanced understanding of the morbidities experienced by populations most vulnerable to increased disaster occurrence.
Topics: Adult; Child; Depression; Disasters; Floods; Humans; Mental Health; Morbidity; Poverty; Urban Population; Vulnerable Populations
PubMed: 35770835
DOI: 10.1002/hec.4566 -
Experimental Biology and Medicine... Oct 2022Parasitic infections acquired by the population cause substantial morbidity worldwide, with individuals from developing countries being most affected. Some parasites... (Review)
Review
Parasitic infections acquired by the population cause substantial morbidity worldwide, with individuals from developing countries being most affected. Some parasites remain in the host for long periods, settling in different organs, manipulating the flow of nutrients and metabolites, and influencing the immune response, favoring their adaptation. The host attempts to counteract the metabolic and immunological alterations and the possible damage caused by infection. These metabolic and immunological changes experienced by the host can influence the progression of other existing morbidities or those that will be acquired in the future. Cancer and metabolic diseases are also frequent causes of morbidity in the world population. The large numbers of individuals affected by cancer and metabolic diseases and the high prevalence of morbidity caused by parasitic diseases favor the development of comorbidity involving these pathologies. This review provides an overview of major advances in research on cancer and metabolic diseases associated with parasitic infections. Information about hosts and parasites such as alterations of the immune response, metabolism and adaptation mechanisms of the parasites, and parasitic molecules with therapeutic potential is provided, as well as the beneficial results or complications related to the comorbidities discussed herein. We emphasize the need to conduct additional studies addressing comorbidities associated with parasitic infections to improve the understanding of the impact of this association on the progression of morbidities, as well as the possibility of the therapeutic use of and therapeutic approaches involving parasites.
Topics: Animals; Humans; Parasitic Diseases; Parasites; Comorbidity; Prevalence
PubMed: 35876147
DOI: 10.1177/15353702221108387