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International Journal of Environmental... Mar 2022Background: Environmentally related morbidity and mortality still remain high worldwide, although they have decreased significantly in recent decades. This study aims to...
Background: Environmentally related morbidity and mortality still remain high worldwide, although they have decreased significantly in recent decades. This study aims to forecast malaria epidemics taking into account climatic and spatio-temporal variations and therefore identify geo-climatic factors predictive of malaria prevalence from 2001 to 2019 in the Democratic Republic of Congo. Methods: This is a retrospective longitudinal ecological study. The database of the Directorate of Epidemiological Surveillance including all malaria cases registered in the surveillance system based on positive blood test results, either by microscopy or by a rapid diagnostic test for malaria was used to estimate malaria morbidity and mortality by province of the DRC from 2001 to 2019. The impact of climatic factors on malaria morbidity was modeled using the Generalized Poisson Regression, a predictive model with the dependent variable Y the count of the number of occurrences of malaria cases during a period of time adjusting for risk factors. Results: Our results show that the average prevalence rate of malaria in the last 19 years is 13,246 (1,178,383−1,417,483) cases per 100,000 people at risk. This prevalence increases significantly during the whole study period (p < 0.0001). The year 2002 was the most morbid with 2,913,799 (120,9451−3,830,456) cases per 100,000 persons at risk. Adjusting for other factors, a one-day in rainfall resulted in a 7% statistically significant increase in malaria cases (p < 0.0001). Malaria morbidity was also significantly associated with geographic location (western, central and northeastern region of the country), total evaporation under shelter, maximum daily temperature at a two-meter altitude and malaria morbidity (p < 0.0001). Conclusions: In this study, we have established the association between malaria morbidity and geo-climatic predictors such as geographical location, total evaporation under shelter and maximum daily temperature at a two-meter altitude. We show that the average number of malaria cases increased positively as a function of the average number of rainy days, the total quantity of rainfall and the average daily temperature. These findings are important building blocks to help the government of DRC to set up a warning system integrating the monitoring of rainfall and temperature trends and the early detection of anomalies in weather patterns in order to forecast potential large malaria morbidity events.
Topics: Democratic Republic of the Congo; Humans; Malaria; Morbidity; Prevalence; Retrospective Studies
PubMed: 35409494
DOI: 10.3390/ijerph19073811 -
Journal of Neonatal-perinatal Medicine 2021Micro-premature newborns, gestational age (GA) ≤ 25 weeks, have high rates of mortality and morbidity. Literature has shown improving outcomes for extremely low...
BACKGROUND
Micro-premature newborns, gestational age (GA) ≤ 25 weeks, have high rates of mortality and morbidity. Literature has shown improving outcomes for extremely low gestational age newborns (ELGANs) GA ≤ 29 weeks, but few studies have addressed outcomes of ELGANs ≤ 25 weeks.
OBJECTIVE
To evaluate the trends in outcomes for ELGANs born in New Jersey, from 2000 to 2018 and to compare two subgroups: GA 23 to 25 weeks (E1) and GA 26 to 29 weeks (E2).
METHODS
Thirteen NICUs in NJ submitted de-identified data. Outcomes for mortality and morbidity were calculated.
RESULTS
Data from 12,707 infants represents the majority of ELGANs born in NJ from 2000 to 2018. There were 3,957 in the E1 group and 8,750 in the E2 group. Mortality decreased significantly in both groups; E1, 43.2% to 30.2% and E2, 7.6% to 4.5% over the 19 years. The decline in E1 was significantly greater than in E2. Most morbidities also showed significant improvement over time in both groups. Survival without morbidity increased from 14.5% to 30.7% in E1s and 47.2% to 69.9% in E2s. Similar findings held for 501-750 and 751-1000g birth weight strata.
CONCLUSIONS
Significant declines in both mortality and morbidity have occurred in ELGANs over the last two decades. These rates of improvements for the more immature ELGANs of GA 230 to 256 weeks were greater than for the more mature group in several outcomes. While the rates of morbidity and mortality remain high, these results validate current efforts to support the micro-premature newborn.
Topics: Gestational Age; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Morbidity; New Jersey
PubMed: 33843700
DOI: 10.3233/NPM-200599 -
Blood Advances Feb 2022Hereditary thrombotic thrombocytopenic purpura (hTTP) is a rare disorder caused by severe ADAMTS13 deficiency. Major morbidities and death at a young age are common....
Hereditary thrombotic thrombocytopenic purpura (hTTP) is a rare disorder caused by severe ADAMTS13 deficiency. Major morbidities and death at a young age are common. Although replacement of ADAMTS13 can prevent morbidities and death, current regimens of plasma prophylaxis are insufficient. We identified 226 patients with hTTP in 96 reports published from 2001 through 2020. Age at diagnosis was reported for 202 patients; 117 were female and 85 were male. The difference was caused by diagnosis of 34 women during pregnancy, suggesting that many men and nulliparous women are not diagnosed. Eighty-three patients had severe jaundice at birth; hTTP was suspected and effectively treated in only 3 infants. Of the 217 patients who survived infancy, 73 (34%) had major morbidities defined as stroke, kidney injury, or cardiac injury that occurred at a median age of 21 years. Sixty-two patients had stroke; 13 strokes occurred in children age 10 years or younger. Of the 54 patients who survived their initial major morbidity and were subsequently observed, 37 (69%) had sustained or subsequent major morbidities. Of the 39 patients who were observed after age 40 years, 20 (51%) had experienced a major morbidity. Compared with an age- and sex-matched US population, probability of survival was lower at all ages beginning at birth. Prophylaxis was initiated in 45 patients with a major morbidity; in 11 (28%), a major morbidity recurred after prophylaxis had begun. Increased recognition of hTTP and more effective prophylaxis started at a younger age are required to improve health outcomes.
Topics: Adult; Child; Female; Humans; Infant; Infant, Newborn; Male; Morbidity; Plasma; Pregnancy; Purpura, Thrombotic Thrombocytopenic; Recurrence; Stroke; Young Adult
PubMed: 34807988
DOI: 10.1182/bloodadvances.2021005760 -
Spinal Cord Feb 2022Longitudinal cohort study of privately insured beneficiaries with and without traumatic spinal cord injury (SCI).
STUDY DESIGN
Longitudinal cohort study of privately insured beneficiaries with and without traumatic spinal cord injury (SCI).
OBJECTIVES
Compare the incidence of and adjusted hazards for psychological morbidities among adults with and without traumatic SCI, and examine the effect of chronic centralized and neuropathic pain on outcomes.
SETTING
Privately insured beneficiaries were included if they had an ICD-9-CM diagnostic code for traumatic SCI (n = 9081). Adults without SCI were also included (n = 1,474,232).
METHODS
Incidence of common psychological morbidities were compared at 5-years of enrollment. Survival models were used to quantify unadjusted and adjusted hazard ratios for incident psychological morbidities.
RESULTS
Adults with SCI had a higher incidence of any psychological morbidity (59.1% vs. 30.9%) as compared to adults without SCI, and differences were to a clinically meaningful extent. Survival models demonstrated that adults with SCI had a greater hazard for any psychological morbidity (HR: 1.67; 95%CI: 1.61, 1.74), and all but one psychological disorder (impulse control disorders), and ranged from HR: 1.31 (1.24, 1.39) for insomnia to HR: 2.10 (1.77, 2.49) for post-traumatic stress disorder. Centralized and neuropathic pain was associated with all psychological disorders, and ranged from HR: 1.31 (1.23, 1.39) for dementia to HR: 3.83 (3.10, 3.68) for anxiety.
CONCLUSIONS
Adults with SCI have a higher incidence of and risk for common psychological morbidities, as compared to adults without SCI. Efforts are needed to facilitate the development of early interventions to reduce risk of chronic centralized and neuropathic pain and psychological morbidity onset/progression in this higher risk population.
Topics: Adult; Humans; Incidence; Longitudinal Studies; Morbidity; Neuralgia; Spinal Cord Injuries
PubMed: 35058578
DOI: 10.1038/s41393-021-00731-4 -
Acta Orthopaedica Oct 2016Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA)... (Observational Study)
Observational Study
Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality in such patients who were operated with the fast-track methodology and compared the levels with those in patients with normal BMI. Patients and methods - This was a prospective observational study involving 13,730 procedures (7,194 THA and 6,536 TKA operations) performed in a standardized fast-track setting. Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30-day re-admission rates were around 6% for both THA (6.1%) and TKA (5.9%), without any statistically significant differences between BMI groups in univariate analysis (p > 0.4), but there was a trend of a protective effect of overweight for both THA (p = 0.1) and TKA (p = 0.06). 90-day re-admission rates increased to 8.6% for THA and 8.3% for TKA, which was similar among BMI groups, but there was a trend of lower rates in overweight and obese TKA patients (p = 0.08 and p = 0.06, respectively). When we adjusted for preoperative comorbidity, high BMI in THA patients (very obese and morbidly obese patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA. Interpretation - A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients.
Topics: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Body Mass Index; Comorbidity; Denmark; Female; Follow-Up Studies; Humans; Length of Stay; Male; Middle Aged; Morbidity; Obesity, Morbid; Osteoarthritis, Hip; Osteoarthritis, Knee; Postoperative Complications; Prognosis; Prospective Studies; Registries
PubMed: 27347785
DOI: 10.1080/17453674.2016.1203477 -
Pediatric Clinics of North America Apr 2019Infants born between 34 weeks 0 days and 36 weeks 6 days of gestation are termed late preterm. This group accounts for the majority of premature births in the United... (Review)
Review
Infants born between 34 weeks 0 days and 36 weeks 6 days of gestation are termed late preterm. This group accounts for the majority of premature births in the United States, with rates increasing in each of the last 3 years. This increase is significant given their large number: nearly 280,000 in 2016 alone. Late preterm infants place a significant burden on the health care and education systems because of their increased risk of morbidities and mortality compared with more mature infants. This increased risk persists past the newborn period, leading to the need for continued health monitoring throughout life.
Topics: Female; Hospitalization; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Monitoring, Physiologic; Morbidity; Practice Guidelines as Topic; Pregnancy; Risk Factors; United States
PubMed: 30819344
DOI: 10.1016/j.pcl.2018.12.008 -
BMC Veterinary Research Dec 2022Over the last decades, canines have experienced a marked increase in their lifespan, mirroring human populations. Several authors have pointed out the domestic dog as a...
Over the last decades, canines have experienced a marked increase in their lifespan, mirroring human populations. Several authors have pointed out the domestic dog as a suitable animal model for geropathology translational research. The aim of this study is to assess age-related morbidities and mortality in a population of 269 elderly canines (130 males and 139 females) submitted to necropsy. The organic systems exhibiting the higher number of age-related morbidities were the reproductive, cardiovascular and urinary systems and, in females, also the mammary gland. The prevalence of cardiovascular and urinary disease was significantly higher in males and mammary lesions were exclusively found in females. Urinary disease was more frequent in small breeds dogs, while peritoneum and male genital morbidities were significantly higher in larger breeds. Hyperplastic and degenerative lesions were common morbidities found in this elderly dog population. The main cause of death was neoplasia, which accounted for almost half of the deaths. Cardiovascular and urinary pathology also emerged as a frequent cause of mortality. These findings partially parallel data obtained for human species, displaying cancer and cardiovascular pathology as major causes of disease and death in elderlies. Our data reinforce the potential of the domestic dog for further translational investigations on gerontology, meeting the concept of One Health.
Topics: Humans; Female; Male; Dogs; Animals; Aged; Aging; Neoplasms; Longevity; Prevalence; Dog Diseases
PubMed: 36581919
DOI: 10.1186/s12917-022-03518-8 -
International Journal of Biometeorology Aug 2022Global climate change is leading to higher ambient temperatures and more frequent heatwaves. To date, impacts of ambient extreme heat on childhood morbidity have been... (Review)
Review
Global climate change is leading to higher ambient temperatures and more frequent heatwaves. To date, impacts of ambient extreme heat on childhood morbidity have been understudied, although-given children's physiologic susceptibility, with smaller body surface-to-mass ratios, and many years of increasing temperatures ahead-there is an urgent need for better information to inform public health policies and clinical approaches. In this review, we aim to (1) identify pediatric morbidity outcomes previously associated with extreme heat, (2) to identify predisposing co-morbidities which may make children more susceptible to heat-related outcomes, and (3) to map the current body of available literature. A scoping review of the current full-text literature was conducted using the Arksey and O'Malley framework Int J Soc Res Methodol 8:19-32, (2015). Search terms for (1) pediatric population, (2) heat exposures, (3) ambient conditions, and (4) adverse outcomes were combined into a comprehensive PubMed and Medline literature search. Of the 1753 publications identified, a total of 20 relevant studies were ultimately selected based on selection criteria of relevance to US urban populations. Most identified studies supported positive associations between high extreme temperature exposures and heat-related illness, dehydration/electrolyte imbalance, general symptoms, diarrhea and digestion disorders, infectious diseases/infections, asthma/wheeze, and injury. Most studies found no association with renal disease, cardiovascular diseases, or diabetes mellitus. Results were mixed for other respiratory diseases and mental health/psychological disorders. Very few of the identified studies examined susceptibility to pre-existing conditions; Cystic Fibrosis was the only co-morbidity for which we found significant evidence. Further research is needed to understand the nuances of associations between extreme heat and specific outcomes-particularly how associations may vary by child age, sex, race/ ethnicity, community characteristics, and other pre-existing conditions.
Topics: Child; Climate Change; Extreme Heat; Heat Stress Disorders; Hot Temperature; Humans; Morbidity
PubMed: 35751701
DOI: 10.1007/s00484-022-02310-5 -
PloS One 2022To estimate the cost of maternal morbidity for all 2019 pregnancies and births in the United States.
OBJECTIVE
To estimate the cost of maternal morbidity for all 2019 pregnancies and births in the United States.
METHODS
Using data from 2010 to 2020, we developed a cost analysis model that calculated the excess cases of outcomes attributed to nine maternal morbidity conditions with evidence of outcomes in the literature. We then modeled the associated medical and nonmedical costs of each outcome incurred by birthing people and their children in 2019, projected through five years postpartum.
RESULTS
We estimated that the total cost of nine maternal morbidity conditions for all pregnancies and births in 2019 was $32.3 billion from conception to five years postpartum, amounting to $8,624 in societal costs per birthing person.
CONCLUSION
We found only nine maternal morbidity conditions with sufficient supporting evidence of linkages to outcomes and costs. The lack of comprehensive data for other conditions suggests that maternal morbidity exacts a higher toll on society than we found.
POLICY IMPLICATIONS
Although this study likely provides lower bound cost estimates, it establishes the substantial adverse societal impact of maternal morbidity and suggests further opportunities to invest in maternal health.
Topics: Child; Pregnancy; Female; United States; Humans; Postpartum Period; Morbidity; Cost of Illness; Health Care Costs
PubMed: 36288323
DOI: 10.1371/journal.pone.0275656 -
European Journal of Trauma and... Jun 2022Femur fractures are the result of high energy injury and are associated with life-threatening complications. Therefore, we studied how body mass index (BMI) contributes...
PURPOSE
Femur fractures are the result of high energy injury and are associated with life-threatening complications. Therefore, we studied how body mass index (BMI) contributes to complications after femoral fractures.
METHODS
Using the 2016 American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) database, we stratified 41,362 patients into groups based on their BMI: Normal Weight (NW), Overweight (OW), Obese (OB), Severely Obese (SO), and Morbidly Obese (MO). We compared each BMI group to the NW cohort for differences in demographic factors, comorbidities, complications, and mechanism of injury.
RESULTS
OB, SO, and MO patients sustained higher rates of traumatic injury from high energy mechanisms, such as motor vehicle trauma, in comparison to NW patients, who sustained more injuries from falls (p < 0.05). Correspondingly, obese patients were more likely than NW patients to sustain shaft and distal end fractures (p < 0.05). At hospital admission, obese patients presented with more comorbidities, such as bleeding disorders, congestive heart failure, diabetes mellitus, and hypertension (p < 0.05). Despite these individual findings, patients with OB, SO, and MO BMI, as opposed to NW BMI, were independently associated with a higher probability of developing at least one post-trauma complication. More specifically, MO patients were associated with a 45% higher odds of developing a complication (p < 0.05).
CONCLUSION
Irrespective of presenting with more comorbidities and sustaining high energy injuries, OB, SO, and MO patients were independently associated with having a higher risk of developing complications following a femoral fracture. Overall, better clinical outcomes are observed among patients with no underlying conditions and normal BMI.
Topics: Body Mass Index; Comorbidity; Femoral Fractures; Humans; Morbidity; Obesity, Morbid; Retrospective Studies; Risk Factors
PubMed: 34642802
DOI: 10.1007/s00068-021-01787-w