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Annals of Medicine Jun 2011This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied...
INTRODUCTION
This article summarizes the main findings of the preterm infant sub-study of the Performance, Effectiveness and Costs of Treatment episodes (PERFECT) study. We studied effects of birth hospital level and time of birth on mortality and morbidity and cost-effectiveness of care of very low gestational age (VLGA)/very low birth weight (VLBW) infants.
MATERIAL AND METHODS
The study included all infants born below 32 weeks or 1501 g in Finland in 2000-2007. Different cohorts were used depending on the time point.
RESULTS
The one-year mortality of live-born VLBW/VLGA infants was higher if born in level II versus level III hospitals, or if born during out-of-office hours in level II versus office hours in level III hospitals. Two out of three VLGA/VLBW subjects did not have any of the prematurity-related morbidities studied. The average cost of quality-adjusted life years was €19,245 by four years of age; the cost was higher in VLGA/VLBW infants with long-term morbidities.
DISCUSSION
Birth in a level III hospital improved survival of VLGA/VLBW infants. Results suggest inadequate overnight competence in small hospitals. Despite high initial costs, care of VLGA/VLBW infants was already cost-effective by four years of age. Cost-effectiveness can be improved by reducing long-term morbidities.
Topics: Cost-Benefit Analysis; Female; Finland; Humans; Infant, Newborn; Infant, Very Low Birth Weight; Male; Morbidity; Outcome and Process Assessment, Health Care; Premature Birth; Quality-Adjusted Life Years
PubMed: 21639718
DOI: 10.3109/07853890.2011.586359 -
International Journal of Epidemiology Dec 2022Maternal micronutrient status is critical for child growth and nutrition. It is unclear whether maternal multiple micronutrient supplementation (MMS) during pregnancy... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Maternal micronutrient status is critical for child growth and nutrition. It is unclear whether maternal multiple micronutrient supplementation (MMS) during pregnancy and lactation improves child growth and prevents child morbidity.
METHODS
This study aimed to determine the effects of prenatal and postnatal maternal MMS on child growth and morbidity. In this double-blind, randomized-controlled trial, 8428 HIV-negative pregnant women were enrolled from Dar es Salaam, Tanzania, between 2001 and 2004. From pregnancy (12-27 weeks of gestation) through to 6 weeks postpartum, participants were randomized to receive daily oral MMS or placebo. All women received daily iron and folic acid during pregnancy. From 6 weeks postpartum through to 18 months postpartum, 3100 women were re-randomized to MMS or placebo. Child-growth measures, haemoglobin concentrations and infectious morbidities were assessed longitudinally from birth to ≤18 months.
RESULTS
Prenatal MMS led to modest increases in weight-for-age z-scores (mean difference: 0.050; 95% confidence interval: 0.002, 0.099; p = 0.04) and length-for-age z-score (mean difference: 0.062; 95% confidence interval: 0.013, 0.111; p = 0.01) during the first 6 months of life but not thereafter. Prenatal or postnatal MMS did not have benefits for other child outcomes.
CONCLUSIONS
Whereas maternal MMS is a proven strategy to prevent adverse birth outcomes, other approaches may also need to be considered to curb the high burdens of child morbidity and growth faltering.
Topics: Female; Pregnancy; Humans; Dietary Supplements; Tanzania; Vitamins; Micronutrients; Folic Acid; Double-Blind Method; Morbidity
PubMed: 34151973
DOI: 10.1093/ije/dyab117 -
Indian Journal of Ophthalmology Sep 2014
Topics: Eye Diseases; Global Health; Humans; Morbidity; Ophthalmologic Surgical Procedures; Ophthalmology; Surveys and Questionnaires
PubMed: 25370389
DOI: 10.4103/0301-4738.143923 -
Journal of Pediatric Urology Apr 2017Pediatric lower urinary tract dysfunction (LUTD) is a common problem in childhood. Lower urinary tract symptoms in children include overactive bladder, voiding... (Review)
Review
OBJECTIVE
Pediatric lower urinary tract dysfunction (LUTD) is a common problem in childhood. Lower urinary tract symptoms in children include overactive bladder, voiding postponement, stress incontinence, giggle incontinence, and dysfunctional voiding. Gastrointestinal co-morbidities, including constipation or fecal incontinence, are commonly associated with lower urinary tract (LUT) symptoms in children, often reaching 22-34%. This review summarized the potential mechanisms underlying functional lower urinary and gastrointestinal co-morbidities in children. It also covered the current understanding of clinical pathophysiology in the pediatric population, anatomy and embryological development of the pelvic organs, role of developing neural circuits in regulation of functional co-morbidities, and relevant translational animal models.
MATERIALS AND METHODS
This was a non-systematic review of the published literature, which summarized the available clinical and translational studies on functional urologic and gastrointestinal co-morbidities in children, as well as neural mechanisms underlying pelvic organ 'cross-talk' and 'cross-sensitization'.
RESULTS
Co-morbidity of pediatric lower urinary and gastrointestinal dysfunctions could be explained by multiple factors, including a shared developmental origin, close anatomical proximity, and pelvic organ 'cross-talk'. Daily physiological activity and viscero-visceral reflexes between the lower gastrointestinal and urinary tracts are controlled by both autonomic and central nervous systems, suggesting the dominant modulatory role of the neural pathways. Recent studies have provided evidence that altered sensation in the bladder and dysfunctional voiding can be triggered by pathological changes in neighboring pelvic organs due to a phenomenon known as pelvic organ 'cross-sensitization'. Cross-sensitization between pelvic organs is thought to be mainly coordinated by convergent neurons that receive dual afferent inputs from discrete pelvic organs. Investigation of functional changes in nerve fibers and neurons sets certain limits in conducting appropriate research in humans, making the use of animal models necessary to uncover the underlying mechanisms and for the development of novel therapeutic approaches for long-term symptomatic treatment of LUTD in the pediatric population.
CONCLUSION
Pediatric LUTD is often complicated by gastrointestinal co-morbidities; however, the mechanisms linking bladder and bowel dysfunctions are not well understood. Clinical studies have suggested that therapeutic modulation of one system may improve the other system's function. To better manage children with LUTD, the interplay between the two systems, and how co-morbid GI and voiding dysfunctions can be more specifically targeted in pediatric clinics need to be understood.
Topics: Age Factors; Child; Child, Preschool; Comorbidity; Female; Gastrointestinal Diseases; Humans; Incidence; Lower Urinary Tract Symptoms; Male; Prognosis; Risk Assessment; Severity of Illness Index; Sex Factors; Urinary Tract; Urogenital System
PubMed: 28392009
DOI: 10.1016/j.jpurol.2016.04.036 -
The British Journal of General Practice... Feb 2015
Review
Topics: Climate Change; Environmental Health; Environmental Illness; General Practice; Global Health; Humans; Morbidity; Public Health
PubMed: 25624300
DOI: 10.3399/bjgp15X683773 -
Current Opinion in Pharmacology Apr 2022The COVID-19 pandemic has widespread economic and social effects on Latin America (LA) and the Caribbean (CA). This region, which has a high prevalence of chronic... (Review)
Review
The COVID-19 pandemic has widespread economic and social effects on Latin America (LA) and the Caribbean (CA). This region, which has a high prevalence of chronic diseases, has been one of the most affected during the pandemic. Multiple symptoms and comorbidities are related to distinct COVID-19 outcomes. However, there has been no explanation as to why different patients present with different arrays of clinical presentations. Studies report that similar to comorbidities, each country in LA and the CA has its own particular health issues. Moreover, economic and social features have yet to be studied in detail to obtain a complete perspective of the disease in the region. Herein, the impact of demographic and economic characteristics in LA and the CA on COVID-19 are presented in combination with symptoms and comorbidities related to the disease as important aspects that can influence management and treatment.
Topics: COVID-19; Caribbean Region; Humans; Latin America; Morbidity; Pandemics
PubMed: 35255454
DOI: 10.1016/j.coph.2022.102203 -
Biomedical and Environmental Sciences :... Mar 2022
Topics: China; Morbidity
PubMed: 35317908
DOI: 10.3967/bes2022.037 -
Journal de Gynecologie, Obstetrique Et... Dec 2011To estimate the frequency of prolonged pregnancy and study its associated maternal morbidity. (Review)
Review
OBJECTIVE
To estimate the frequency of prolonged pregnancy and study its associated maternal morbidity.
METHODS
Abstracts and articles were searched using Pubmed and Cochrane Library.
RESULTS
Nearly 15% of pregnant women in France are concerned by prolonged pregnancy (≥41(+0) weeks), whereas post-term pregnancy (≥42(+0) SA) only concern 1% of them. The post-term pregnancy frequency is heterogeneous between Europe and United States. It varies between 0.5% and 10% (EL2). In Europe, Scandinavian countries present discrepancies with high proportions of post-term pregnancies between 5 and 7%. These observations identified time variations and variations between countries. They can be explained by two factors: pregnancy datation by ultrasound and the evolution of labor induction practices. Moreover, post-term pregnancy constitute a risk factor of maternal complications as: cesarean section, postpartum haemorrhages, infections and perineum lacerations (EL2). On the contrary, limited conclusions about associations between prolonged pregnancies and labor inductions are due to insufficient data and the lack of high quality studies. Nowadays, we still ignore if labor inductions in the particular context of prolonged pregnancies are associated or not to an increase of maternal morbidities.
CONCLUSION
Prolonged pregnancy is associated with an excess of maternal morbidity.
Topics: Europe; Female; France; Humans; Incidence; Infant, Newborn; Morbidity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Prolonged; United States
PubMed: 22056182
DOI: 10.1016/j.jgyn.2011.09.006 -
The Journal of Maternal-fetal &... Dec 2023To describe trends in mortality and morbidity rates of very low birth weight infants as well as their pre-, peri- and postnatal characteristics over a period of 20...
OBJECTIVE
To describe trends in mortality and morbidity rates of very low birth weight infants as well as their pre-, peri- and postnatal characteristics over a period of 20 years' time.
METHODS
Retrospective study in all very low birth weight infants admitted to the neonatal intensive care unit of the University Hospitals Ghent from 1 January 2000, to 31 December 2020. Mortality was the primary outcome variable with major morbidities being co-primary outcome variables. Pre-, peri- and postnatal characteristics are secondary outcome variables. We compared pre-, peri- and postnatal characteristics, as well as major morbidities between different groups with comparable rates of mortality.
RESULTS
We included a total of 2037 very low birth weight infants and divided them in 3 epochs based on stepwise reductions in mortality in 2008 and 2013: 2000-2007 ( = 718), 2008-2012 ( = 506) and 2013-2020 ( = 813). Mortality decreased significantly over the years in all gestational ages, but predominantly in those with the youngest gestational age. Changes in obstetric and neonatal care were observed over time. Most significant changes were the increased use of antenatal corticosteroids, magnesium sulfate and surfactant. Intraventricular hemorrhage grade III/IV decreased significantly in all gestational ages. Significant increase in retinopathy of prematurity was observed. Bronchopulmonary dysplasia at 36 weeks and discharge home with oxygen is increasing in the total group. In those born below 26 weeks a slight increase in all major morbidities was observed especially of patent ductus arteriosus and retinopathy of prematurity. Increase of all other major morbidities seems to stabilize in epoch 3. The number of infants surviving without any major morbidity increases to almost 1/2 in all very low birth weight infants and to 1/10 in those born 24-25 weeks gestation.
CONCLUSION
Analysis of the real-life experience showed that survival in very low birth weight infants significantly increased over time. Evolution of major morbidities will have to be carefully watched in the future.
Topics: Infant, Newborn; Infant; Humans; Female; Pregnancy; Retinopathy of Prematurity; Retrospective Studies; Infant Mortality; Infant, Very Low Birth Weight; Infant, Premature, Diseases; Gestational Age; Morbidity
PubMed: 38092422
DOI: 10.1080/14767058.2023.2227311 -
BMC Public Health May 2022Despite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are...
BACKGROUND
Despite recent progress in rural economic development and food production, the prevalence of household food insecurity (FI) and use of unimproved toilet facilities are widespread in Bangladesh. Evidence regarding the consequencs of household FI and poor sanitation on child morbidity is scarce. This study aimed to understand the association of FI and unimproved toilet facility with morbidity status of under-5 children in Bangladesh.
METHODS
We used data from a cross-sectional survey that was conducted as part of an evaluation of the Maternal, Infant and Young Child Nutrition (MIYCN) Program in 9 districts of Bangladesh. The study population included children aged 6-59 months and their caregivers, identified using a two-stage cluster-sampling procedure. Child morbidity status was the outcome variable, and household FI status and type of toilet used were considered the main exposure variables in this study. We performed logistic regression, calculated adjusted odds ratios (AOR) to assess the association of child morbidity with household FI and unimproved toilet facility after adjusting for potential confounders.
RESULTS
A total of 1,728 households were eligible for this analysis. About 23% of the households were food-insecure, and a large number of households had improved toilet facilities (93.4%). In the multivariable logistic regression model, we found that children in food-insecure households with unimproved toilet facility had 5.88 (AOR: 5.88; 95% CI 2.52, 13.70) times more chance, of being morbid compared to the children of food-secure households with improved toilet facility. A similar association of FI and toilet facilities with each of the morbidity components was observed, including diarrhea (AOR:3.6; 95% CI 1.79, 7.89), fever (AOR:3.47; 95% CI 1.72, 6.99), difficult or fast breathing with cough (AOR:3.88; 95% CI 1.99, 7.59), and difficult or fast breathing with blocked or running nose (AOR:1.29; 95% CI 0.56, 2.95).
CONCLUSIONS
Our study shows that household FI and unimproved toilet facility jointly have more deteriorative effects on child morbidity than either of these conditions alone. Therefore, it is recommended to consider these two critical factors while designing a public health intervention for reducing morbidity among under-five children.
Topics: Bangladesh; Child; Cross-Sectional Studies; Female; Food Insecurity; Humans; Infant; Mothers; Prevalence; Toilet Facilities
PubMed: 35641975
DOI: 10.1186/s12889-022-13469-2