Morbidity

This analysis of the Austrian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health-system performance. The Austrian health system provides universal coverage for a wide range of benefits and high-quality care. Free choice of providers and unrestricted access to all care levels (general practitioners, specialist physicians and hospitals) are characteristic features of the system. Unsurprisingly, population satisfaction is well above EU average. Income-related inequality in health has increased since 2005, although it is still relatively low compared to other countries. The health-care system has been shaped by both the federal structure of the state and a tradition of delegating responsibilities to self-governing stakeholders. On the one hand, this enables decentralized planning and governance, adjusted to local norms and preferences. On the other hand, it also leads to fragmentation of responsibi...

The aim of our study was to examine psychosocial changes associated with participation in a camp for children with cardiac defects. We enrolled 29 children with cardiac defects aged from 8 to 18 years, along with their parents. Both the parents and the children completed measures of expectations for the camp and anxiety. Analyses of repeated measures indicated that levels of anxiety amongst the children decreased significantly at the end of camp when compared to its beginning. Levels of anxiety amongst the children were not statistically different at follow-up. Anxiety amongst the parents concerning the separation from their children also decreased at follow-up when compared to before the camp. Higher levels of anxiety reported by the children prior to the camp were associated with greater anxiety amongst the parents concerning the anticipated separation, more negative parental expectations of the camp, fewer experiences of separation from their children, and lower expectations by t...

This report reviews the risks and consequences associated with childhood and adolescent obesity. Although no consensus definition of childhood obesity exists, the various measures encountered in the literature are moderately well correlated. The paper is organized in three parts. The first section reviews childhood obesity sequelae that occur during childhood. These short-term risks, for orthopedic, neurological, pulmonary, gasteroenterological, and endocrine conditions, although largely limited to severely overweight children, are becoming more common as the prevalence of severe overweight rises. The social burden of pediatric obesity, especially during middle childhood and adolescence, may have lasting effects on self-esteem, body image and economic mobility. The second section examines the intermediate consequences, such as the development of cardiovascular risk factors and persistence of obesity into adulthood. These mid-range effects of early obesity presage later adult disease...

Malaria is the leading cause of morbidity and mortality in Uganda especially in children under five years. Transmission of malaria is perennial though there are seasonal exacerbations. Up to 70 per cent of outpatient cases and over 50 per cent of inpatient admissions in the under fives are malaria cases. It is responsible for a specific death rate among this age group of 37/1000 and 18/1000 live births in high and low malaria endemic areas respectively or a total of 70,000–110,000 child health deaths annually. It is also the major killer of refugees and internally displaced people in Uganda. Malaria cases increased from 1,444,352 in 1995 to 2,923,620 in 1999. There is considerable malaria morbidity due to repeated low level and mostly non-febrile infections with the parasites resulting into chronic anaemia in children and pregnant women particularly primigravidae. Severe malarial anaemia is responsible for a case fatality rate of 8–25 per cent among paediatric admissions. It is resp...

During the past 35 years Oman has undergone a rapid socioeconomic and epidemiological transition leading to a steep reduction in child and adult mortality and morbidity due to the decline of various communicable diseases, including vaccine-preventable diseases. Good governance and planning, together with leadership and commitment by the government, has been a critical factor in this reduction. However, with increasing prosperity, lifestyle-related noncommunicable diseases have emerged as new health challenges to the country, with cardiovascular diseases, diabetes and obesity in the lead among other chronic conditions. Appropriate prevention strategies for reducing the burden of noncommunicable diseases are discussed.

This research was designed to provide an in-depth exploration of the perceptions of optometrists relating to the challenges of glaucoma case finding in the Irish health-care system. A survey was developed, piloted and distributed for anonymous completion by optometrists registered to practise in Ireland. The survey included 10 five-level Likert items exploring potential barriers to glaucoma detection and a free-text box for participants to comment more broadly. One hundred and ninety-nine optometrists (27 per cent of registrants) responded to the survey. Among the barriers identified, there was notable agreement (71 per cent) with the need for extra training on glaucoma detection. Logistic regression showed that optometrists without postgraduate qualifications were more likely to agree with the need for extra training (OR 3.2, 95 per cent CI 1.3-8.1). Respondents largely agreed (61 per cent) that patient unwillingness to pay additional fees for supplementary glaucoma-specific tests ...

To determine the possible association between anemia and clinical and echocardiographic cardiac disease, a cohort of 432 end-stage renal disease patients (261 on hemodialysis and 171 on peritoneal dialysis) who started dialysis therapy between 1982 and 1991 were followed prospectively for an average of 41 months. Baseline demographic, clinical, and echocardiographic assessments were performed, as well as monthly serial clinical and laboratory tests while the patients were on dialysis therapy. The mean (+/-SD) hemoglobin level during dialysis therapy was 8.8 +/- 1.5 g/dL. After adjusting for age, diabetes, and ischemic heart disease, as well as for blood pressure and serum albumin levels measured serially, each 1 g/dL decrease in mean hemoglobin was independently associated with the presence of left ventricular dilatation on repeat echocardiogram (odds ratio, 1.46; P = 0.018) and the development of de novo (relative risk [RR] = 1.28; P = 0.018) and recurrent (RR = 1.20; P = 0.046) cardiac failure. In addition, each 1 g/dL decrease in the mean hemoglobin level was independently associated with mortality while the patients were on dialysis therapy (RR = 1.14; P = 0.024). Anemia had no independent association with the development of ischemic heart disease while the patients were on dialysis therapy. Anemia, an easily reversible feature of end-stage renal disease, is an independent risk factor for clinical and echocardiographic cardiac disease, as well as mortality in end-stage renal disease patients.

This study examined differences in perinatal outcomes of Southeast Asian (SEA) women compared with non-Hispanic white women in Washington. Using linked birth certificate and hospitalization discharge records for the years 1993–2006, we compared singleton births of Cambodian (3,858), Laotian (2,223), and Vietnamese (12,949) women with a random sample of white women (35,581). Associations between maternal nativity and perinatal outcomes were

Work is an important yet understudied life domain for adolescents that has important implications for their development and well-being. Work relationships, particularly with supervisors and coworkers, are critical influences on teens. To the extent these relationships are negative, as evidenced in workplace bullying, the impact on teens can be wide-ranging and enduring. In this article, research on workplace bullying and its effects is briefly summarized and used as a context for exploring adolescent experiences with bullying on the job, both in terms of their vulnerability to exposure and unique impacts. Implications of these findings for health professionals in the assessment and treatment of teens exposed to workplace bullying are discussed.

Complex humanitarian emergencies have been a major political, security and public health feature of the post-Cold War world. These man-made disasters account for more morbidity and mortality than all natural and technological disasters combined. In order to deliver effective aid during complex humanitarian emergencies, international relief agencies must have a solid understanding of the political and social climates in which they are operating. In addition, they should base their health interventions on objective epidemiological data, especially standardized rates of morbidity and mortality. Most deaths during complex humanitarian emergencies are due to preventable causes, especially increased rates of infectious diseases malnutrition and violent trauma. The most appropriate health interventions are therefore based on the models of public health and primary health care, emphasizing disease prevention and health promotion. The field of humanitarian assistance has become increasingly professionalized in recent years, with its own professional standards, literature, research agenda and training opportunities. It is an unfortunate reflection on the current state of international affairs that the number of complex humanitarian emergencies and the enormous levels of suffering associated with them are unlikely to decline in the foreseeable future.

OBJECTIVE: To determine the percentiles of weight for age in cerebral palsy according to gender and Gross Motor Function Classification System (GMFCS) level and to identify weights associated with negative health outcomes. PATIENTS AND METHODS: This study consists of a total of 102 163 measurements of weight from 25 545 children with cerebral palsy who were clients of the California Department of Developmental Services from 1988 through 2002. Percentiles were estimated using generalized additive models for location, scale, and shape. Numbers of comorbidities were compared using t tests. The effect of low weight on mortality was estimated with proportional hazards regression. RESULTS: Weight-for-age percentiles in children with cerebral palsy varied with gender and GMFCS level. Comorbidities were more common among those with weights below the 20th percentile in GMFCS levels I through IV and level V without feeding tubes (P < .01). For GMFCS levels I and II, weights below the 5th p...

Abstract. The relationship between quantitative Plasmodium falciparum or P. vivax parasitemia and clinical illness has not been defined in Pakistan or in other areas where malaria transmission is not highly endemic. Standardized questionnaires were given to and physical examinations and parasitologic tests were performed in 8,941 subjects seen in outpatient clinics in 4 villages for 13 consecutive months in the Punjab region of Pakistan. The results, based on multivariable analysis, showed that a clinical diagnosis of malaria, a history of fever, rigors, headache, myalgia, elevated temperature, and a palpable spleen among children were all strongly associated with the presence and density of P. falciparum or P. vivax malaria in a monotonic dose-response fashion. The malaria attributable fraction of a clinical diagnosis of malaria, and the same symptoms and signs also increased with increasing P. falciparum and, to a lesser extent, P. vivax, parasitemia. Unlike in sub-Saharan Africa,...

Schistosoma haematobium-related morbidity was studied in the perennial irrigation area of Office du Niger and the small reservoirs area of Plateau Dogon in Mali. Questionnaire, clinical, parasitologic, and ultrasound examination data were collected from 1,041 individuals at the baseline survey in 1991; 705 were re-examined one year after treatment. At baseline, the overall prevalence of S. haematobium infection was 55.2%; half of those infected had no clinical symptoms and 30% had pathologic lesions. Both infection and morbidity were more frequent in children than in adults, with a peak prevalence at 7-14 years of age. The rates of lesions were more than twice as high in those heavily infected as in lightly infected individuals. Reagent strip testing for microhematuria was more sensitive in detecting individuals with pathologic lesions than in detecting individuals with infection. One year after treatment with praziquantel, more than 80% of the urinary tract lesions had cleared. It ...

CONTEXT: Ready-to-use therapeutic foods (RUTFs) are an important component of effective outpatient treatment of severe wasting. However, their effectiveness in the population-based prevention of moderate and severe wasting has not been evaluated. OBJECTIVE: To evaluate the effect of a 3-month distribution of RUTF on the nutritional status, mortality, and morbidity of children aged 6 to 60 months in Niger. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial of 12 villages in Maradi, Niger. Six villages were randomized to intervention and 6 to no intervention. All children in the study villages aged 6 to 60 months were eligible for recruitment. INTERVENTION: Children with weight-for-height 80% or more of the National Center for Health Statistics reference median in the 6 intervention villages received a monthly distribution of 1 packet per day of RUTF (92 g [500 kcal/d]) from August to October 2006. Children in the 6 nonintervention villages received no preventive supplementation. Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 study villages from August 2006 to March 2007. MAIN OUTCOME MEASURES: Changes in weight-for-height z score (WHZ) according to the World Health Organization Child Growth Standards and incidence of wasting (WHZ <-2) over 8 months of follow-up. RESULTS: The number of children with height and weight measurements in August, October, December, and February was 3166, 3110, 2936, and 3026, respectively. The WHZ difference between the intervention and nonintervention groups was -0.10 z (95% confidence interval [CI], -0.23 to 0.03) at baseline and 0.12 z (95% CI, 0.02 to 0.21) after 8 months of follow-up. The adjusted effect of the intervention on WHZ from baseline to the end of follow-up was thus 0.22 z (95% CI, 0.13 to 0.30). The absolute rate of wasting and severe wasting, respectively, was 0.17 events per child-year (140 events/841 child-years) and 0.03 events per child-year (29 events/943 child-years) in the intervention villages, compared with 0.26 events per child-year (233 events/895 child-years) and 0.07 events per child-year (71 events/1029 child-years) in the nonintervention villages. The intervention thus resulted in a 36% (95% CI, 17% to 50%; P < .001) reduction in the incidence of wasting and a 58% (95% CI, 43% to 68%; P < .001) reduction in the incidence of severe wasting. There was no reduction in mortality, with a mortality rate of 0.007 deaths per child-year (7 deaths/986 child-years) in the intervention villages and 0.016 deaths per child-year (18 deaths/1099 child-years) in the nonintervention villages (adjusted hazard ratio, 0.51; 95% CI, 0.25 to 1.05). CONCLUSION: Short-term supplementation of nonmalnourished children with RUTF reduced the decline in WHZ and the incidence of wasting and severe wasting over 8 months. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00682708.