Categories Of Morbidity Research Articles

CDC-WONDER Database Analysis of Maternal Morbidity in Florida [ID 2683410

INTRODUCTION: The CDC's WONDER Natality database was updated in 2016 to include comprehensive pregnancy data, encompassing maternal morbidity, a growing concern in the United States. Using the WONDER Natality database, we can better understand risk factors and trends associated with maternal morbidity. The aim of this research is to investigate the variations in maternal morbidity in Florida, focusing on maternal demographics and pregnancy characteristics. METHODS: This cross-sectional descriptive study used results from the CDC’s WONDER Natality 2016–2021 expanded-results database. Five categories of maternal morbidity were analyzed. Maternal morbidity and pregnancy characteristics were analyzed for statistical significance using χ2 and unpaired t-tests. RESULTS: 92,680 (1.04%) births in Census Region 3 (the South) were found to be associated with maternal morbidity. This prompted an in-depth examination of this region, with a particular focus on Florida. Notably, Asian mothers experienced the highest rate of maternal morbidity (1.49%), whereas Black mothers faced the lowest statistical rate (0.67%). Asian mothers experiencing maternal morbidity tended to be older, have lower pre-pregnancy body mass indexes, more prenatal visits, and shorter intervals since their last live births. CONCLUSION: This study underscores statistically significant maternal morbidity disparities in Florida, with Asian mothers being particularly vulnerable. It identifies several pregnancy characteristics linked to increased morbidity. Further exploration, including a county-level analysis in Florida and examination of other states in Census Region 3, could reveal or consolidate emerging trends. Moreover, the absence of a universally accepted definition for severe maternal morbidity calls for the establishment of a clear standard to guide future research and obstetric practices.

Epidemiology of Birth Defects in Very Low Birth Weight Infants in Japan

To evaluate the mortality and morbidity of very low birth weight (VLBW) preterm infants with birth defects in Japan. Data were collected prospectively for infants weighing <1501g and born at <37weeks of gestation admitted to centers of the Neonatal Research Network of Japan during 2003-2016. We compared outcomes of infants with and without birth defects using Pearson χ2 test, Wilcoxon rank-sum test, log-rank test, nominal logistic regression analysis, and stratified analysis by birth defect subgroups. This study was approved by the Ethics Committee of Kyoto University Graduate School and Faculty of Medicine. Among 57 730 VLBW preterm infants, 3557 infants (6.2%) were born with birth defects. Chromosomal abnormalities, congenital heart defects, and congenital malformation of the digestive system were the most common categories. Among diseases, Trisomy 18, Down syndrome, and cleft palate were the most prevalent. There were significant differences between perinatal characteristics of infants with and without birth defects. Most categories of morbidity occurred more frequently in infants with birth defects compared with those without birth defects. The aOR for mortality during the neonatal intensive care unit admission was 10.6 (95% CI 9.5-11.7) for infants with birth defects. A stratified analysis identified birth defect categories with good, moderate, and poor prognoses. This detailed information about mortality and morbidity of preterm VLBW infants with birth defects should be useful for genetic counseling as well as prenatal and neonatal care, with the limitation that we lacked information about the timing of diagnosis, abortion, or stillbirth.

Prevalence of Morbidity at Extreme Old Age in Germany: An Observational Study Using Health Claims Data.

We assessed the prevalence of morbidity in long-lived individuals according to age and age at death and explored the association between dementia and other diseases and surviving to age 90 and 100. Using health claims data from the largest German health insurer from 2004 to 2013, we followed birth cohorts from 1908 to 1913 from age 95 until death or survival to age 100 (n=2,865) and compared them with birth cohorts from 1918 to 1923 and their survival from age 85 to age 90 (n=17,013). We observed their exact date of death and main categories of morbidity based on International Classification of Diseases, Tenth Revision, diagnoses. For all diseases studied, when differentiated according to age at death, prevalence continued to increase with age. Nonagenarians and centenarians had significantly lower disease prevalence at each age. Dementia was associated with the highest risk of dying before becoming a centenarian (hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.50-1.78), followed closely by the residual category other chronic heart disease (HR=1.42, 95% CI=1.30-1.56). Results were even stronger for the younger cohort. Our study shows that exceptionally long-lived individuals are different in terms of good health. Survival at these high ages depends primarily on the absence of dementia and chronic heart disease, with acute heart disease and pneumonia playing important roles as diseases leading directly to death.

The relationship between General Practice metrics of multi-morbidity and secondary healthcare utilisation in Wales, UK

ObjectivesMulti-morbidity and polypharmacy are increasing and interrelated phenomena but are poorly understood. The aim of this study is to contribute to the understanding of these issues, measure the changing prevalence’s of multimorbidity/ polypharmacy and explore the relationship between multimorbidity as recorded in primary care and the use of outpatient services.&#x0D; MethodsThe Secure Anonymised Information Linkage (SAIL) Databank facilitated linkage techniques to create population based e-cohorts of de-identified Welsh residents. Individuals were registered to a SAIL providing General Practice (GP) for at least 360 days in 2000 and 2014. Categories of morbidity were created using the 13 Read drug code chapters. In an initial cross sectional exploratory analysis proportional odds and cumulative logit models were used to relate GP recorded morbidities to outpatient attendance patterns in the same year.&#x0D; FindingsThe GP e-cohorts included 1.6 million (2000) and 2.1 million (2001) people, with 56.6% and 73.4% having ≥1 recorded morbidity for 2000 and 2014, respectively. In 2014, groups with 5+ morbidities were most prevalent (61.3%) in 85+ year olds and least (2.7%) in 5-9 year olds. Some 35% of individuals attended ≥1 outpatient specialty in 2014; 22.4% in 5-9 year olds and 63.2% for 80-84 year olds.&#x0D; Results from preliminary models showed the number of GP recorded morbidities was strongly related to increasing outpatient attendances at different specialties, OR=15.3 (95%CI:15.1-15.4) of being in a higher outpatient attendance category for the 5+ morbidity group relative to the zero morbidity group.&#x0D; ConclusionPreliminary analysis has shown large increases in GP recorded multimorbidity across Wales over fifteen years and strong relationships and NHS service utilisation in cross-sectional analyses. Further work will include creating more refined definitions for multimorbidity metrics, linkage to hospital admission data, comparisons across healthcare settings and the development of longitudinal models.

849: The association between Maternal GroupB Streptococcus colonization and offspring Gastro-Intestinal morbidity

Maternal Group B Streptococcus (GBS) colonization is associated with peripartum complications. We sought to evaluate the association between maternal GBS colonization and long-term gastrointestinal (GI) morbidity in the offspring. A population based retrospective cohort study was conducted in a tertiary medical center, serving a population of one million inhabitants. The risk for pediatric GI morbidity of offspring (up to the age of 18 years) was compared among two study groups: exposed and unexposed to maternal rectovaginal GBS colonized mothers, based on perinatal hospitalization databases. All singleton vaginal deliveries occurring between the years 1991-2014 were included. Offspring with congenital malformations were excluded. GI morbidities were based on a pre defined set of ICD-9 codes, as recorded in the hospital computerized files. Kaplan Meier survival curves were used to compare the cumulative risks among the two study groups, and Cox multivariable survival models were used to adjusted for confounding variables. During the study period, 195,457 newborns met the inclusion criteria; 4820 parturient had a proven diagnosis of GBS colonization. Selected categories of GI morbidity are presented in the Table. Total GI morbidity rate was higher in the GBS positive group as compared with the comparison group (7.69 vs. 5.03/ 1000-person years; Table). Offspring of GBS positive mothers had significantly higher rates of gastroduodenal diseases (0.69 vs. 0.51/1000-person years, p=0.005; Table) and of inflammatory bowel diseases (IBD), 3.03 vs. 1.26/1000 person years, p=0.023). The Kaplan-Meier survival curve demonstrated GBS positive offspring to have a significantly higher cumulative incidence of total GI morbidity (log rank, p=0.002; Figure). The association between maternal GBS and offspring GI morbidity remained significant in the Cox model, which adjusted for maternal age, diabetes, hypertensive disorders and gestational age (adjusted HR=1.2; 95% CI 1.1- 1.2). Maternal GBS colonization is an independent risk factor for long-term GI morbidity in the offspring, and specifically for gastroduodenal diseases and IBD. The exact mechanism leading to these findings, whether fetal microbiome changes or immunological alterations due to peripartum antibiotic exposure, awaits further investigations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

729: Maternal obesity and offspring pediatric cardiovascular morbidity- Results from a population based cohort study

Maternal obesity rates have increased dramatically over the last 3 decades, along with the associated chronic illnesses including cardiovascular diseases. We aimed to investigate a possible association between maternal obesity (BMI>30) and the long-term risk for cardiovascular diseases in the offspring during a follow- up period of up to 18 years. A population based cohort analysis was performed comparing both total as well as different subtypes of cardiovascular morbidity leading to hospitalization among children (up to the age of 18 years) in obese and non-obese mothers. Data on pregnancy course and outcome, mode of delivery, and later offspring hospitalizations were collected from two different databases in a single regional tertiary medical center. All singleton deliveries between the years 1991-2014 were included in the analysis. Exclusion criteria were congenital malformations. Kaplan-Meier survival curve was constructed to compare cumulative cardiovascular related hospitalization incidence stratified by maternal obesity, and a Weibull survival hazard model was used to control for confounders. During the study period, 242,342 newborns met the inclusion criteria: 3,290 were born to obese mothers, and 239,052 to non-obese mothers. During the follow up period (0-18 years, median 10.53), 36 (1.1%) versus 1,467 (0.6%) were hospitalized (at least once) due to cardiovascular morbidity among the obese and non-obese mothers, respectively (OR= 1.8, 95%CI 1.3-2.5; Log rank p=0.002, Figure). Selected categories of cardiovascular morbidity are presented in the Table. The association between maternal obesity and long-term pediatric cardiovascular morbidity remained significant in the Weibull hazards model controlled for maternal age, gestational age, pregnancy related diabetes and hypertension (adjusted HR 1.8; 95% CI 1.3-2.4). Maternal obesity is independently associated with an increased risk for offspring pediatric cardiovascular morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk Factors for 30-Day Postoperative Complications and Mortality Following Open Reduction Internal Fixation of Distal Radius Fractures

To identify the incidence and risk factors for 30-day postoperative morbidity and mortality following operative treatment of distal radius fractures in a multicenter cohort. We retrospectively queried the American College of Surgeons National Surgical Quality Improvement Program database for the years 2005-2011 for cases of closed distal radius fractures treated operatively with internal fixation. Patient demographics, comorbidities, and operative characteristics were analyzed. Thirty-day postoperative complications were identified and separated into categories of major morbidity or mortality, minor morbidity, and any complication. Risk factors were identified using univariate and multivariate analyses. We identified 1,673 cases of closed distal radius fractures managed with internal fixation. The overall incidence of having any early complication was 3%. Major morbidity was 2.1%, which included 4 patient deaths, and minor morbidity was 1%. The most common major morbidity was a return to the operating room (16 patients). The most common minor morbidity was urinary tract infection (6 patients). The multivariate analysis demonstrated ASA class III or IV, dependent functional status, hypertension, and myocardial infarction/congestive heart failure to be significant risk factors for any early complication. There was a 10.0% complication rate in the inpatient group and a 1.3% complication rate in the outpatient group. The incidence of early complications following internal fixation for closed distal radius fractures was low, especially in the outpatient group. In the setting of an isolated injury to the distal radius, the data presented here can provide prognostic information for patients during informed consent for what is considered to be an elective procedure. Surgeons should consider risk of morbidity and mortality when considering surgery for patients with noteworthy cardiopulmonary disease, increased ASA class, or poor functional status. Prognostic II.

PPO.02 Severe maternal morbidity in Ireland

ObjectiveTo assess the incidence of severe maternal morbidity (SMM) and examine associated factors in Ireland.MethodsIn 2011, 67,806 maternities were reported from 19 maternity units, representing 93% of maternities in Ireland....

Historical resonances of the DSM-5 dispute

This article begins with arguments evident at the time of writing about the 5th revision of the Diagnostic and Statistical Manual of the American Psychiatric Association. The historical lineages of those arguments are international and not limited to the USA (the current focus in the DSM-5 controversy). The concern with psychiatric diagnosis both internationally and in the USA came to the fore at the end of the Second World War with the construction of the American Psychiatric Association’s Diagnostic and Statistical Manual ( DSM-I) and the World Health Organization’s classification of ‘Diseases, Injuries and Causes of Death’ (ICD-6). However, the linkage between categories of morbidity, assumptions about natural biological categories and treatment specificity with ‘magic bullets’ emerged in the middle of the 19th century in physical medicine. This article explores the legitimacy of current psychiatric diagnoses in the light of that international, not national, history of medical knowledge. In conclusion it explores judgements about current cultural imperialism (at times made about US psychiatry) and an older picture of Eurocentrism, which is now being refracted in more recent globalizing knowledge-claims about mental disorder.

Impact of deprivation on occurrence, outcomes and health care costs of people with multiple morbidity

ObjectiveThis study aimed to estimate the impact of deprivation on the occurrence, health outcomes and health care costs of people with multiple morbidity in England.MethodsCohort study in the UK Clinical Practice Research Datalink, using deprivation quintile (IMD2010) at individual postcode level. Incidence and mortality from diabetes mellitus, coronary heart disease, stroke and colorectal cancer, and prevalence of depression, were used to define multidisease states. Costs of health care use were estimated for each state from a two-part model.ResultsData were analysed for 141,535 men and 141,352 women aged ≥30 years, with 33,862 disease incidence events, and 13,933 deaths. Among incidences of single conditions, 22% were in the most deprived quintile and 19% in the least deprived; dual conditions, most deprived 26%, least deprived 16% and triple conditions, most deprived 29%, least deprived 14%. Deaths in participants without disease were distributed most deprived 22%, least deprived 19%; in participants with single conditions, most deprived 24%, least deprived 18%; dual conditions, most deprived 27%, least deprived 15%, and triple conditions, most deprived 33%, least deprived 17%. The relative rate of depression in most deprived participants with triple conditions, compared with least deprived and no disease, was 2.48 (1.74 to 3.54). Costs of health care use were associated with increasing deprivation and level of morbidity.ConclusionsThe higher incidence of disease, associated with deprivation, channels deprived populations into categories of multiple morbidity with a greater prevalence of depression, higher mortality and higher costs. This has implications for the way that resources are allocated in England’s National Health Service.

Risk Factors for Thirty-Day Morbidity and Mortality Following Knee Arthroscopy

Knee arthroscopy is among the most common orthopaedic surgical procedures. However, the incidence and risk factors for postsurgical morbidity and mortality remain poorly defined. The American College of Surgeons National Surgical Quality Improvement Program prospectively collects thirty-day morbidity and mortality data from more than 258 hospitals around the United States. We used Current Procedural Terminology codes to retrospectively query the database and identified 12,271 cases of elective knee arthroscopy performed from January 1, 2005, to December 31, 2010. Postoperative complications were divided into categories of minor morbidity, major morbidity or mortality, or any complication. The potential risk factors for complications were analyzed with use of univariate and multivariate analyses. The overall incidence of any complication was 1.6% (199 patients). The major morbidity was 0.76% (ninety-three patients), which included one patient death (0.008%), and the minor morbidity was 0.86% (106 patients). The most frequent major complication was a return to the operating room. The most common minor complication was deep venous thrombosis or thrombophlebitis. The risk factors identified in the univariate analysis for any complication included black race, prior operation within thirty days, American Society of Anesthesiologists class, and operative time of >1.5 hours as compared with ≤1.5 hours (p < 0.05 for each). The independent risk factors identified in the multivariate analysis for any complication included black race (odds ratio, 1.81 [95% confidence interval, 1.13 to 2.89]), prior operation within thirty days (odds ratio, 6.33 [95% confidence interval, 1.45 to 27.66]), operative time of >1.5 hours (odds ratio, 1.84 [95% confidence interval, 1.21 to 2.78]), and age of forty to sixty-five years (odds ratio, 1.46 [95% confidence interval, 1.01 to 2.11]). The incidence of complication following elective knee arthroscopy is low. The data presented here should be useful for providing prognostic information to patients during informed consent. Surgeons should be encouraged to minimize operative time whenever possible, and may wish to delay elective arthroscopy in patients who have had other recent surgical procedures.

Incidence of severe acute maternal morbidity associated with abortion: a systematic review

To systematically review articles describing complications of abortion in settings where abortions are thought to be unsafe and to determine the incidence of severe acute maternal morbidity (SAMM) attributed to abortion at the population level. We searched relevant databases using search terms related to abortion and complications. We included population-representative studies that listed complications of abortion. We extracted data on the definitions and numbers of severe complications and SAMM, and we report abortion complication rates (per 100 000 women of reproductive age) and ratios (per 100 000 live births) for SAMM, severe complications and any complications. We included 15 studies representing eleven countries (six in Africa, four in Asia and one in Latin America). We found a median abortion ratio of SAMM of 237 (range 91-1892) per 100 000 live births and a median abortion ratio of severe complications of 596 (range 435-5298). There was a great degree of heterogeneity between definitions and study populations. The burden of SAMM attributed to abortion is much greater than what is reported for deaths caused by abortion. However, the great heterogeneity in definitions makes it difficult to draw firm conclusions. We call for future work on the burden of unsafe abortion to use strict definitions of SAMM.

Editorial: Trigeminal neuralgia in the elderly

Rughani et al.1 used the Nationwide Inpatient Sample to access information on 3273 patients to evaluate the relationship between age, mortality rate, and morbidity in microvascular decompression (MVD) for trigeminal neuralgia (TN) between 1999 and 2008. Based on data from this large sample, they showed that an increase in both morbidity and death is associated with age following this operation. Categories of morbidity analyzed included cardiac, pulmonary, thromboembolic, and cerebrovascular disease, CNS infection, and wound complication. All patients were coded similarly, so that there should be no age-related bias in coding. This strength is offset by the limits of data abstraction by medical coders, the limited clinical and radiographic information available in the data set, and the incomplete follow-up, particularly in the immediate postoperative period. As the authors discuss, it is certainly conceivable that certain complications might have been over-coded by data abstractors and that some complications that would occur following discharge might be underreported. There is no reason to suspect that either error would be more prevalent in the older patient population. The authors’ main conclusion was that acute perioperative complications associated with MVD in patients over the age of 65 years (1032 patients) and over 75 years (350 patients) were those associated with conditions that may be expected to increase with patient age for any surgical procedure performed under general anesthesia (for example, those for myocardial infarction, pulmonary embolism, or stroke), but that other more surgery-specific complications, like wound healing and bacterial meningitis, were not significantly elevated. More importantly, the inpatient mortality rate was 0.68% in patients 65 years and older and 1.16% for those 75 years and older. These rates compare with a mortality of 0.13% for patients younger than 65 years. Seven of the 10 inpatient deaths in the sample occurred in patients 65 years and older. Of the 7 patients older than 65 who died, 5 had a cerebrovascular complication, whereas only 2 had systemic causes. Other downstream effects of age were perhaps more subtle: the duration of the hospital stay was higher and the chance of discharge to home was lower in the older patient groups. While these parameters fall outside the normal definition of morbidity, they are substantial issues for patients, families, and hospitals. As a mnemonic device, the authors suggest that we include in our discussions of MVD with older TN patients, the statistic that in patients over the age of 65 an overall complication rate of about 7% and an in-hospital mortality rate of about 0.7% are first approximations. Furthermore, in patients over the age of 75 years, a complication rate of about 10% and an in-hospital mortality rate of about 1% are reasonable estimates. There are a host of surgical alternatives for older patients with medically refractory TN. Other possibilities include radiofrequency gangliolysis, radiosurgery, glycerol injection, balloon compression, and even peripheral trigeminal neurectomy. The principles of an informed patient and a thoughtful decision still apply. Ultimately, it is the patient’s choice. The option of MVD for patients older than 65 remains viable if the neurosurgeon possesses the requisite surgical skill and experience and if the patient is fully informed of the procedure, alternatives, and risks.

Overview of Maternal Morbidity During Hospitalization for Labor and Delivery in the United States

To assess progress toward meeting the U.S. Healthy People 2010 objective of reducing the rate of maternal morbidity at delivery hospitalization by comparing National Hospital Discharge Survey data from two time periods. Using data from the National Hospital Discharge Survey, we estimated rates of intrapartum morbidity defined by obstetric complications, preexisting medical conditions, and cesarean delivery during 2001-2005 and compared them with rates published for 1993-1997. We calculated and compared the rates for categories of morbidity as well as rates for the summary groups of morbidity. Between the two time periods, the rate of obstetric complications remained unchanged at 28.6%; the prevalence of preexisting medical conditions at delivery increased from 4.1% to 4.9%. Rates of chronic hypertension and preeclampsia, gestational and preexisting diabetes, asthma, and postpartum hemorrhage increased, whereas rates of third- and fourth-degree lacerations and various types of infection decreased. The cesarean delivery rate increased from 21.8% to 28.3%. Between 1993-1997 and 2001-2005, the rate of intrapartum morbidity associated with obstetric complications was unchanged and the rate of pregnancies complicated by preexisting medical conditions increased.

Burden of diseases: A micro level analysis for selected districts of Karnataka

This paper presents a methodology for estimating the burden of diseases in monetary terms instead of a demographic indicator. The purpose was to ascertain the financial burden arising out of various categories of morbidity in the community. The disease-wise burden would act as a pointer for the policy maker to assign priority while allocating resources to different programmes within the health sector budget. The empirical study was carried out by CMDR, Dharwad under the sponsorship of IDRC, Canada, in four selected districts, viz. Belgaum, Bijapur, Dharwad and Dakshina Kannada of Karnataka with a sample size of 2039 households and 1156 patients. High share of unavoidable components of direct costs, viz. expenditure on medicines and doctors’ fees, makes morbidity all the more burdensome particularly for the poor people. Such results highlight the need for a specific policy about drug prices, charges for doctors’ services, discriminating pricing, etc. The study highlights that the nature of interventions about different permutations and combinations of preventive, promotive and curative care, or about the institutions of health care delivery (liberal, private, public, mix, on payment or free, etc), have to be consistent with the resource costs, incidence pattern of morbidity, socio-economic background of the morbid population and such other factors. Exercises of ranking of diseases according to total resource costs would aid adoption of an “eclectic cost-effectiveness approach”. Though the precision of the estimates from any empirical study may not be beyond dispute, the issues raised and new directions in thinking suggested, from the empirical study, deserve a serious consideration. The modest attempts made in this study to estimate resource costs should also be considered in that spirit, as issues of policy relevance in the health sector are raised from the present exercise.

Validation of the Chinese Version of the SF-36 Health Survey Questionnaire in People Undergoing Physical Examinations

Objectives. The SF-36 is a generic measure of health status and has gained popularity as a measure of outcome in a wide variety of patient groups and surveys. The Chinese version of SF- 36 was introduced in 1995 and its reliability and validity in the general population has been reported. However, the reliability and validity has never been reported in clinical settings. Therefore, we provide estimates of the reliability and test validity of the Chinese SF-36 in people undergoing physical examinations. Methods. A cross-sectional study was conducted among individuals who underwent physical examinations in the China Medical University Hospital in 1996. A total of 434 individuals over the age of 18 years were recruited. The overall completion rate was 68.7%. Outcome was evaluated by the Short Form 36 (SF-36), a short questionnaire with 36 items measuring eight multi-item variables: physical functioning, social functioning, role limitation due to physical problems, role limitation due to emotional problems, mental health, vitality, pain and general health. Results. All variables passed tests for item-internal consistency and item-discriminant validity. Analyses of internal consistency coefficients ranged from a low of 0.66 for the bodily pain variable to a high of 0.89 for social and physical functioning variables. Validation by factor analysis yielded results remarkably similar to those proposed by the authors who developed the SF-36. We found significant differences in physical-related variables such as physical functioning, and bodily pain between different age groups, and significant differences in all variables except for bodily pain in different categories of minor psychiatric morbidity. Conclusions. In general, the Chinese version of the SF-36 is reliable and valid for measuring health status in people undergoing physical examination.

Quantifying severe maternal morbidity: a Scottish population study.

To quantify the incidence of severe maternal morbidity in Scotland and determine the feasibility of doing so. Prospective observational study. All 22 consultant led maternity units in Scotland, between 1 October 2001 and 30 September 2002. Women during pregnancy and the puerperium. Definitions for 13 categories of severe maternal morbidity were developed from published work. Recruitment of maternity units, and training of staff, took place at a national meeting. Each month, every unit reported cases meeting the agreed definitions, the category of incident and date. Data were collated centrally and analysed to determine the frequency of incidents. The number of maternal deaths occurring in Scotland over the same period was obtained from the Confidential Enquiry into Maternal Deaths. Number and rate of defined events being reported. A subjective view of the feasibility of collecting national data routinely. Severe morbidity was reported in 196 women, out of 51,165 deliveries in Scotland (rate 3.8 per 1000 deliveries). Thirty percent of cases fell into more than one defined category. Major obstetric haemorrhage accounted for 50% of events. Only a third of identified patients were admitted to intensive care units. Four relevant maternal deaths occurred. Categories of severe maternal morbidity can be defined and may provide a useful measure of the quality of maternity services, particularly in developed countries where maternal mortality is very rare. It appears feasible to set up a national reporting system for maternal morbidity, as well as mortality.

Injuries in the military: A review and commentary focused on prevention

Background: In November 1996, the Armed Forces Epidemiological Board (AFEB) Injury Prevention and Control Work Group issued a report that cited injuries as the leading cause of morbidity and mortality among military service members. This article reviews the types and categories of military morbidity and mortality data examined by the AFEB work group and the companion Department of Defense (DoD) Injury Surveillance and Prevention Work Group. This article further uses the injury data reviewed to illustrate the role of surveillance and research in injury prevention. The review provides the context for discussion of the implications of the AFEB work group’s findings for the prevention of injuries in the military. Methods: The AFEB work group consisted of 11 civilian injury epidemiologists, health professionals and scientists from academia, and other non-DoD government agencies, plus six military liaison officers. Injury data from medical databases were provided to the civilian experts on the AFEB work group by the all-military DoD Injury Surveillance and Prevention Work Group. The AFEB work group assessed the value of each database to the process of prevention and made recommendations for improvement and use of each data source. Results: Both work groups found that injuries were the single leading cause of deaths, disabilities, hospitalizations, outpatient visits, and manpower losses among military service members. They also identified numerous data sources useful for determining the causes and risk factors for injuries. Those data sources indicate that training injuries, sports, falls, and motor vehicle crashes are among the most important causes of morbidity for military personnel. Conclusions: While the work group recommends ways to prevent injuries, they felt the top priority for injury prevention must be the formation of a comprehensive medical surveillance system. Data from this surveillance system must be used routinely to prioritize and monitor injury and disease prevention and research programs. The success of injury prevention will depend not just on use of surveillance but also partnerships among the medical, surveillance, and safety agencies of the military services as well as the military commanders, other decision makers, and service members whose direct actions can prevent injuries and disease.

The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based

Phenomena of trauma to be dealt with scientifically must be based not on descriptive categorizations, but on etiologic ones. How this is happening and what it means are discussed in...

PATHOPHYSIOLOGY, EVALUATION, AND TREATMENT OF THE DIFFICULT AIRWAY

Respiratory compromise accounts for the single largest class of adverse outcomes in the American Society of Anesthesiologists (ASA) Closed Claims Project (762 of the 2046 cases, 37%). 40 Inadequate ventilation, esophageal intubation, and difficult tracheal intubation are the most common mechanisms of these respiratory-related adverse outcomes. Other less common but important categories of respiratory-related morbidity include airway trauma and obstetric airway mishaps. Throughout this article, greatest emphasis is placed on the nonobvious elements or new principles of difficult airway pathophysiology, evaluation, and treatment. Obvious and well-understood considerations may be only briefly mentioned for completeness.