Poor General Health Status Research Articles

Normative values for the oro‐facial Esthetic Scale in Sweden

This study reports the findings and challenges of the assessment of oro-facial aesthetics in the Swedish general population and the development of normative values for the self-reporting Orofacial Esthetic Scale (OES). In a Swedish national sample of 1406 adult subjects (response rate: 47%), OES decile norms were established. The influence of sociodemographics (gender, age, and education), oral health status and general health status on OES scores was analysed. Mean ± standard deviation of OES scores was 50.3 ± 15.6 units (0, worst score; 70, best score); <1% of the subjects had the minimum score of 0, and 11% had the maximum score of 70 OES units. Orofacial Esthetic Scale score differences were (i) substantial (>5 OES units) for subjects with excellent/very good versus good to poor oral or general health status; ii) small (2 units), but statistically significant for gender (P = 0.01) and two age groups (P = 0.02), and (iii) absent for subjects with college versus no college education (P = 0.31) or with and without dentures (P = 0.90). To estimate normative values for a self-reporting health status, instrument is considered an important step in standardisation, and the developed norms provide a frame of reference in the general population to interpret the Orofacial Esthetic Scale scores.

Timeliness of care and prognosis in patients with lung cancer

Timeliness of care is an important dimension of health care quality. The determining factors of less timely care and their influence on the survival of patients with lung cancer (LC) remain uncertain. To analyse the delays in the diagnosis and treatment of LC in our health area, the factors associated with the timeliness of care and their possible relationship with the survival of these patients. A retrospective study was conducted on all patients with a cytohistologically confirmed diagnosis of LC between 1 June 2005 and 31 May 2008. The time delays for consultation (specialist delay), diagnosis (diagnosis delay), and treatment (treatment delay), were analysed, as well as the factors associated with these delays and the influence of the timeliness of care on survival. A total of 307 cases were included (87 % males). The mean specialist delay was 53.6 days (median 35 days), diagnosis delay 31.5 days (median 18 days), treatment delay 23.5 days (median 14 days). The greater age of the patient and a more advanced stage were associated with a shorter specialist delay. Male sex, a more advanced stage, and poor general status were associated with a shorter treatment delay. The survival is longer in patients with a longer treatment delay. The delay in the diagnosis in our population seems to be excessively long. The greater the age, a more advanced tumour stage, male sex, and poor general health status are associated with shorter delays. A longer treatment delay is associated with a longer survival.

Analysis of Feasibility and Toxicity of Radiotherapy in Centenarians

To the Editor: Life expectancy has progressively increased over past decades concomitantly with advances in medicine and with improvements in standards of living in developed countries. It is estimated that there could be 200,000 centenarians in France by the middle of the 21st century.1 Although it has been said that cancer in centenarians frequently has modest life-threatening potential, cancer can be a significant cause of morbidity.2 There are few studies on anticancer therapies in these individuals, and the feasibility of radiotherapy (RT) has never been reported. A multicenter experience with RT in the management of skin cancer in centenarians is briefly described. Between June 2009 and August 2012, 10 centenarians receiving RT for a histologically confirmed carcinoma were identified, accounting for 0.05% of approximately 12,000 individuals treated in four institutions (two university hospitals, two private centers). One received pelvic RT for a bladder carcinoma, and another received RT for bone metastases from prostate cancer. The eight remaining individuals, who received nine RT courses for a cutaneous carcinoma, were studied. Median age was 101.0 (range 99.8–106.7). Most of the individuals presented with poor general health status and were living in institutions. All tumors were in the head and neck area. Treatment was delivered with palliative intent in half of the subjects. All RT courses were delivered using a high-voltage linear accelerator. Median total dose was 30 Gy (range 20–49 Gy). All but one individual received hypofractionated RT (HFRT). The median number of fractions was 6 (range 4–13 fractions). Total treatment duration was 17 days (range 3–29 days). Median dose per fraction was 5.75 Gy (range 2.25–8 Gy). For each individual, the total biologically equivalent dose in 2 Gy fractions (EQD2) was calculated using the linear quadratic model and an alpha/beta of 10 Gy for tumors. Total EQD2 was 37.5 Gyα/β = 10 (range 25–64 Gyα/β = 10). Acute toxicities were scored according to the National Cancer Institute Common Toxicity Criteria, version 3, which displays Grade 1 (mild adverse effect) to 5 (death related to adverse effect).3 Most toxicities were mild to moderate, with high-grade toxicity requiring treatment disruption reported in only one subject, all toxicities being epithelitis. Three subjects received no follow-up from their radiation oncologist, and median follow-up was 8 weeks in the remaining subjects. Two subjects had more than 6 months of follow-up without delayed toxicity. All subjects were living at last follow-up, and only one experienced tumor progression (Table 1). Although some data suggest that RT is feasible in nonagenarians, this is the first report focusing on RT in centenarians.4-6 It showed that cutaneous tumors are the most frequently irradiated tumors, which is not the case in younger individuals. Analysis of the literature suggests that these long-living individuals could be protected from other cancer-related disorders through genetic specificities (low insulin-like growth factor-1–mediated response, high level of anti-inflammatory cytokines).7 Moreover, this study reflects clinical practice in unselected individuals. Most participants were managed at a late stage of their disease, with tumor-related symptoms. Because of the extreme vulnerability of centenarians, physicians are usually reluctant to perform invasive surgery requiring further reconstruction. Three subjects were treated with RT as single treatment modality; the remaining subjects underwent surgery and then were treated with RT, as adjuvant or for recurrent disease. Because of insufficient follow-up, local efficacy could not be thoroughly examined. These subjects frequently presented with poor general health status and ambulatory difficulties, and most of them followed up with their dermatologist. The study showed that RT was feasible, with low acute toxicity. HFRT is frequently proposed as an alternative to standard fractionation in elderly adults.8-10 Although hypofractionation can increase long-term toxicity, this is not a significant concern in this population. RT parameters (e.g., total dose, dose per fraction, target volumes) should be chosen carefully because they are associated with acute toxicity. Concurrent radiosensitizers agents are also not recommended because they may increase toxicity. Total equivalent dose was approximately 33% lower than usually recommended in these tumors according the evidence-based guidelines from the National Comprehensive Cancer Network. This study showed that a nonstandard RT scheme is frequently proposed, with lower total doses and frequent use of fractionation, based on the subjective analysis of the physician. Although elderly adults have low physiological reserves and geriatric vulnerabilities, there is no evidence of a relationship between age and local toxicity. Prospective data are required to refine the optimal treatment modality in elderly adults through an integrative oncogeriatric approach. Conflict of Interest: The authors report no conflict of interest relative to this work. Author Contributions: Chargari, Moriceau, Auberdiac, Guy, Assouline, Eddekkaoui, Annede, Trone, Jacob, Pacaut, Bauduceau, Vedrine, Magne: acquisition, analysis, and interpretation of data. Chargari, Magne: preparation of manuscript. Sponsor's Role: No sponsorship.

Factors Associated with the Use of Different Treatment Modalities among Patients with Upper Airway Diseases in Taiwan: A Cross-Sectional Survey Study

Rhinitis is a common upper airway disease and can have great impact on patients' quality of life. Factors associated with the use of common treatment modalities among 279 Taiwanese rhinitis patients from the outpatient department of otolaryngology in a medical center were investigated using a cross-sectional survey study. Results from multiple logistic regression analysis, adjusted for etiologies of rhinitis, revealed that males were associated with surgical intervention (OR = 2.11, P = 0.009). Lower educational level was associated with oral (OR = 2.31, P = 0.024) and topical medications (OR = 2.50, P = 0.005). Poor or fair general health status was associated with topical medications (OR = 4.47, P = 0.001), whereas very good or excellent general health status was inversely associated with surgical intervention (OR = 0.32, P = 0.002). Smoking was associated with the use of nasal irrigation (OR = 2.72, P = 0.003). Worse disease-specific quality of life was associated with oral medications (OR = 2.46, P = 0.010) and traditional Chinese medicine (OR = 5.43, P < 0.001). In conclusion, the use of different treatment modalities for rhinitis was associated with different combinations of independent factors.

Minority Stress and Physical Health Among Sexual Minorities

Lesbian, gay, and bisexual (LGB) individuals suffer serious mental health disparities relative to their heterosexual peers, and researchers have linked these disparities to difficult social experiences (e.g., antigay victimization) and internalized biases (e.g., internalized homophobia) that arouse stress. A recent and growing body of evidence suggests that LGB individuals also suffer physical health disparities relative to heterosexuals, ranging from poor general health status to increased risk for cancer and heightened diagnoses of cardiovascular disease, asthma, diabetes, and other chronic conditions. Despite recent advances in this literature, the causes of LGB physical health problems remain relatively opaque. In this article, we review empirical findings related to LGB physical health disparities and argue that such disparities are related to the experience of minority stress—that is, stress caused by experiences with antigay stigma. In light of this minority stress model, we highlight gaps in the current literature and outline five research steps necessary for developing a comprehensive knowledge of the social determinants of LGB physical health.

Women report increased anxiety, distress and poor general health status compared to men in patients with nonsignificant coronary artery disease; the TweeSteden Mild Stenosis TWIST study

Women report increased anxiety, distress and poor general health status compared to men in patients with nonsignificant coronary artery disease; the TweeSteden Mild Stenosis TWIST study

Management of refractory angina in the contemporary era

This editorial refers to ‘Long-term survival in patients with refractory angina’[†][1], by T.D. Henry et al. , on page 2683 Refractory angina pectoris is a debilitating disease characterized by angina resistant to conventional therapies for coronary artery disease including drug therapy, percutaneous coronary interventions, and/or coronary artery bypass grafting. Individuals with refractory angina may suffer severely impaired quality of life, with recurrent and sustained chest pain, poor general health status, psychological distress, impaired role functioning and productivity, and restricted ability to perform activities. The European Society of Cardiology (ESC) Joint Study group on the Treatment of Refractory Angina emphasized that refractory angina is a clinical diagnosis (i.e. based on a combinations of history, physical examination, and investigations) and states that refractory angina pectoris is a chronic condition characterized by the presence of angina caused by coronary insufficiency in the presence of coronary artery disease which cannot be controlled by a combination of medical therapy, angioplasty, and coronary bypass surgery.1 The presence of reversible myocardial ischaemia should be clinically established to be the cause of the symptoms. Chronicity is defined as a duration of >3 months. The ESC Joint Study group further states that the diagnosis of refractory angina requires a cardiological and cardiothoracic surgical assessment that the patient has angina of ischaemic origin and that revascularization is not feasible. Despite these robust definitions, the … [1]: #fn-2

THU0378 Predictors of One-Year Mortality in Elderly Hip Fracture Patients

BackgroundThere is growing evidence that devastating consequences of hip fracture can possibly be counteracted with multidisciplinary inpatient rehabilitation3. Recognition of variables that influence mortality at an early stage is needed...

Non-infectious endophthalmitis after vitrectomy

Background Non-infectious endophthalmitis was reported to occur after cataract surgery or intravitreal injections. This study reported a series of patients having non-infectious endophthalmitis after pars plana vitrectomy in the same two operation rooms during the same period to estimate the risk factors for non-infectious endophthalmitis after vitrectomy. Methods Medical records of patients who presented with severe non-infectious endophthalmitis following vitrectomy between May 13 and June 8, 2011, were reviewed. The presenting symptoms and signs were collected, including visual acuity, intraocular pressure, cornea and anterior chamber activity. The treatments and results of microbiology examination were also recorded and analyzed. Results Ten patients were identified with severe non-infectious endophthalmitis, presenting 1 day after pars plana vitrectomy. Three eyes (30%) had previous intraocular surgeries, four (40%) had proliferative diabetic retinopathy, and one (10%) got pars plana vitrectomy combinded with phacoemulsification and intraocular lens implantation. All the patients were initially treated with topical and/or oral steroids. Only two patients had intravenous antibiotics because of the atypical presentation. One eye had paracentesis because of high intraocular pressure and the aqueous sample was sent for microbiological examination. The culture of the aqueous, air in the operation room, the swab from hand of surgeons, infusion fluid, and vitrectomy effluent were all negative for bacteria and fungi. The inflammation regressed rapidly after the initial treatment. Conclusions Intraocular surgery history, poor general health status, longer operation time, and more surgical procedures are the risk factors for non-infectious endophthalmitis after vitrectomy. It responds well to steroids.

Assessment of trade-offs made by people due to financial stress from medical care in the USA

Objectives This study aims to understand how do socio-demographic and personal factors impact the trade-offs people make in daily life in the USA due to problems in paying medical bills. Methods This study used the 2007 wave of the Health Tracking Household Survey (HTHS) data. The unit of analysis was an individual. The dependent variable was the level of trade-off. A cumulative logit model measured the effect of independent variables on the dependent variable, which was ordinal. Key findings Pre-tax family income, out-of-pocket spending for medical care during past 12 months, perceived health status, type of family, ethnicity and age had significant impact on level of trade-off experienced by individuals. Odds of making severe trade-offs increased significantly for people with low income, poor self-reported general health status, higher out-of pocket medical expenditure and single parents. Compared to white people, African-Americans were worse affected because of problems in paying medical bills. Younger people made a higher level of trade-off compared to older people because of medical debt. Conclusions Problems in paying medical bills forced people to forgo basic necessities of life, which could impact the nutritional status, access to health care and living condition of people. A higher level of trade-offs in daily life could potentially affect the health of an individual in the long run. Poor people were worst affected because of medical debt. This study could prompt policy makers to provide more support to indigent people, people with higher out-of-pocket medical expenses and those with poor health conditions to ensure adequate access to basic necessities of life.

Comparison of EuroQol-5D and Short Form-6D Utility Scores in Multiethnic Asian Patients with Psoriatic Arthritis: A Cross-sectional Study

To compare EuroQol-5D (EQ-5D) and Short Form-6D (SF-6D) utility scores in multiethnic Asian patients with psoriatic arthritis (PsA). Consecutive patients fulfilling the Classification Criteria for Psoriatic Arthritis attending a rheumatology outpatient clinic were recruited and completed the EQ-5D and SF-6D questionnaires. Comparisons were performed by score distribution, mean, median, and the Outcome Measures in Rheumatology filter: i.e., truth, discrimination, and feasibility. Eighty-six patients were enrolled (69 English-speaking and 17 Chinese-speaking; male:female ratio 0.91). The score distribution of SF-6D was normal, while that of EQ-5D was bimodal. A ceiling effect was observed in 20% of patients for EQ-5D and none for SF-6D. There were moderate correlations (Spearman's rho = 0.59, p < 0.0001) between the 2 scores, but poor agreements on scatterplot, intraclass correlation (ICC 0.43 and standardized ICC 0.21), and Bland-Altman plots. EQ-5D generated lower utility scores than SF-6D in the poorer health subgroup. SF-6D had stronger correlation with the general health status and other external measures of health; and it distinguished better between good and poor general health status, with better effect size and relative efficiency statistics. EQ-5D demonstrated higher patient acceptability. EQ-5D and SF-6D instruments generated different utility scores in PsA. SF-6D may be superior because of normal scaling distribution and the absence of ceiling and floor effects. SF-6D also had better construct validity and better discrimination of poor health status. More studies are required for cost-utility analysis in PsA.

Oral health‐related quality of life among Brazilian preschool children

The purpose of this study was to evaluate the impact of oral health conditions on oral health-related quality of life (OHRQoL) in population-based sample of Brazilian preschool children. A further aim was to identify the influence of socio-demographic profile and perceptions regarding general health and oral health status on OHRQoL. An epidemiological survey was carried out at public and private preschools in the city of Belo Horizonte, Brazil. The sample consisted of 1632 5-year-old male and female preschoolers randomly selected using a multi-stage sampling technique and their parents/caregivers. Oral examinations of the children were performed by a single, previously calibrated examiner for the assessment of dental caries experience, malocclusion, traumatic dental injury and developmental defects of enamel. Caregivers were asked to complete the Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) and a form on socio-demographic data. Descriptive, bivariate and adjusted Poisson regression model analyses were carried out. In the child section of the B-ECOHIS, OHRQoL was negatively impacted by decayed, missing and filled teeth [prevalence ratios (PR) = 2.18; 95% CI, 1.88-2.52], position of the child among siblings in the family (PR = 1.20; 95% CI, 1.04-1.39), type of preschool (PR = 1.36; 95% CI, 1.10-1.69), age of parents/caregivers (PR = 1.18; 95% CI, 1.04-1.34), monthly household income (PR = 1.48; 95% CI, 1.18-1.85) and perception of the child's general health status (PR = 1.26; 95% CI, 1.06-1.51). In the family section, the adjusted results demonstrated a negative impact on OHRQoL associated with dental caries experience (PR = 3.40; 95% CI, 2.83-4.08), age of parents/caregivers (PR = 1.16; 95% CI, 1.01-1.33) and monthly household income (PR = 1.41; 95% CI, 1.16-1.72). Dental caries experience was the only normative criteria with a negative impact on OHRQoL. Families with low income and younger parents reported a greater impact on quality of life. According to parents' perceptions, a poor general health status rating was related to poorer quality of life among the children.

Chronic bronchitis: an objective diagnosis of exclusion

To the Editors: In their recent, very interesting study, Montes de Oca et al . [1] suggested that chronic bronchitis is associated with increased morbidity and poorer general health status in both chronic obstructive pulmonary disease (COPD) and non-COPD subjects. Although the term “chronic bronchitis phenotype” is mentioned in the title, we feel that the differentiation between the phenotype and the actual diagnosis should be highlighted. …

322 Self-Management Training For Chronic Stable Angina

Cardiac pain arising from chronic stable angina (CSA) has a major negative impact on health-related quality of life (HRQL) including pain, poor general health status, psychological distress, and inability to self-manage. We used meta-analysis to assess the effectiveness of self-management training interventions for improving stable angina symptoms, health-related quality of life (HRQL) and psychological well-being. Nine trials, involving 1,282 participants in total, were included. We used standard inverse-variance random-effects meta-analysis to combine the trials. Heterogeneity between trials was evaluated using chi-square tests for the tau-squared statistic and was quantified using the I2 statistic. There was a significant improvement in the frequency of angina symptoms across trials, standardized mean difference (SMD) = 0.31 (95% Confidence interval [CI], 0.15 to 0.47). Self-management training also resulted in significant reduction in the use of sublingual (SL) nitrates, SMD= -0.45 (95% CI (-0.67, -0.22). A significant HRQL improvement (Seattle Angina Questionnaire) for physical limitation was also found, SMD= 0.38 (95% CI, 0.20 to 0.55). Self-management training did not improve other HRQL dimensions including disease perception and treatment satisfaction. There was no significant statistical heterogeneity across trials, I2 range= 0% to 17%. Self-management training interventions significantly reduce the frequency of angina symptoms and related use of SL nitrates. The inability of these interventions to impact other dimensions of HRQL may be due to the magnitude of the psychological burden imposed by chronic angina.

Management of Patients With Refractory Angina: Canadian Cardiovascular Society/Canadian Pain Society Joint Guidelines

Refractory angina (RFA) is a debilitating disease characterized by cardiac pain resistant to conventional treatments for coronary artery disease including nitrates, calcium-channel and β-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary interventions, and coronary artery bypass grafting. The mortality rate of patients living with RFA is not known but is thought to be in the range of approximately 3%. These individuals suffer severely impaired health-related quality of life with recurrent and sustained pain, poor general health status, psychological distress, impaired role functioning, and activity restriction. Effective care for RFA sufferers in Canada is critically underdeveloped. These guidelines are predicated upon a 2009 Canadian Cardiovascular Society (CCS) Position Statement which identified that underlying the problem of RFA management is the lack of a formalized, coordinated, interprofessional strategy between the cardiovascular and pain science/clinical communities. The guidelines are therefore a joint initiative of the CCS and the Canadian Pain Society (CPS) and make practice recommendations about treatment options for RFA that are based on the best available evidence. Concluding summary recommendations are also made, giving direction to future clinical practice and research on RFA management in Canada.

Estratégia ventilatória protetora e manobra de recrutamento alveolar em paciente com síndrome do desconforto respiratório agudo por leptospirose

Leptospirosis is an infectious disease that is characterized by vasculitis, the underlying cause of the clinical manifestations being capillary endothelial cell injury. Leptospirosis can involve multiple organ systems and cause renal tubular dysfunction, hepatic dysfunction, myocarditis, and alveolar hemorrhage.(1) Pulmonary involvement can manifest as acute respiratory distress syndrome (ARDS), in which the need for mechanical ventilation is associated with a mortality rate of 30-60%.(2) The controversy regarding the various alveolar recruitment maneuvers (ARMs) and their role in patients with ARDS motivated us to describe the case of a patient with ARDS secondary to leptospirosis, in whom a CT-guided ARM with sustained high pressure was successfully performed.(3,4) A previously healthy 21-year-old male patient was admitted to the emergency room with a one-week history of headache, myalgia, and fever (39 °C), as well as with a two-day history of progressive dyspnea. The patient developed respiratory failure requiring orotracheal intubation and ventilatory support, being transferred to our hospital. He reported occupational exposure to soil during gardening activities. The patient presented with poor general health status, being on mechanical ventilation and hemodynamically stable without the use of vasoactive drugs. He also presented with right conjunctival hemorrhagic suffusion. The initial laboratory test results were as follows: • hematocrit, 29.8% • hemoglobin, 11 g/dL • leukocytes, 14,000 cells/mm3 (12,082 segmented neutrophils and 1,040 lymphocytes) • platelets, 145,000 cells/mm3 • C-reactive protein, 95.1 mg/L • sodium, 143 mEq/L • potassium, 3.1 mEq/L • urea, 38 mg/dL • creatinine, 1.2 mg/dL • indirect bilirubin, 0.66 mg/dL • direct bilirubin, 1.65 mg/dL • prothrombin time, 1.19 • activated partial thromboplastin time, 111% • albumin, 2.5 g/dL • glutamic-oxaloacetic transaminase, 96 U/L • glutamic-pyruvic transaminase, 43 U/L • lactate dehydrogenase, 883 U/L • creatine phosphokinase, 995 U/L • urinalysis, normal Arterial blood gas analysis results were as follows: pH, 7.34; PaO2, 79.8 mmHg; PaCO2, 55.3 mmHg; bicarbonate, 29.2 mEq/L; SaO2, 95.1%; FiO2, 0.8; and PaO2/FiO2 ratio, 99. A chest X-ray revealed bilateral homogeneous diffuse opacity. An echocardiogram revealed normal cardiac function. The patient was started on antibiotic therapy with ceftriaxone, clarithromycin, and oxacillin for severe community-acquired pneumonia. Because the patient was suspected of having influenza A (H1N1) infection, he was started on antiviral treatment with oseltamivir. Because the patient presented with refractory hypoxemia, a CT scan was taken. During the procedure, an ARM was performed. The patient remained properly sedated and was hemodynamically stable. He was submitted to pressure-controlled ventilation (PCV), as follows: RR, 15 breaths/min; inspiratory time, 2 s; inhalation/exhalation ratio, 1:1; FiO2, 1; and pressure, 15 cmH2O above a positive end-expiratory pressure (PEEP) of 25 cmH2O for 2 min. The functional and radiological responses were evaluated immediately before the ARM Protective ventilation and alveolar recruitment maneuver in a patient with leptospirosis-induced acute respiratory distress syndrome

Relationship Between Elderly Depression and Health Status in Male Veterans

Elderly depression affects the overall health and quality of life of institutionalized men. This study explored the relationship between depression and health status in institutionalized male veterans in Taiwan. This survey study used a cross-sectional research design and recruited 152 elderly male residents of a veterans' home in northern Taiwan. A validated questionnaire assessed depression, health status, and demographic characteristics. More than one fifth of the subjects (21.7%) exhibited depression. Those with poor general health status (odds ratio [OR] = 7.9, p < .001), relatively high levels of dependence on others for daily physical activities (OR = 4.6, p = .002), or self-perceived negative influences of chronic diseases on daily living (OR = 11.7, p < .001) faced the highest prevalence of depression. Subjects with hypertension (OR = 2.3, p = .034), cataracts (OR = 3.7, p = .007), or liver disease (OR = 8.1, p = .006) had the highest prevalence of depression. Identified risk factors of depression among the elderly male veterans included self-perceived negative influence of chronic diseases on daily living (adjusted OR = 10.2, p < .001) and cataracts (adjusted OR = 4.3, p = .023). Geriatrician nurses should develop strategies to maintain general patient health and reduce the negative impact of chronic diseases and cataracts on daily life to reduce depression in institutionalized male veterans.

Oral and general health status in patients treated in a dental consultation clinic of a geriatric ward in Bern, Switzerland

This audit reports on the oral and general health of patients who were treated in a dental consultation clinic of a geriatric hospital. Dental and medical records were obtained from 112 female and 80 male patients (mean age, 83.7 ± 8.2 years) who attended a dental consultation. Data analysis included the general health [American Society of Anesthesiologists (ASA) classification, number of diagnoses, cognitive function] and dental state in the age strata 60-69, 70-79, 80-89 and 90-99 years. Seventy-four per cent of patients were aged over 80 years. The prevalence of ASA-P4 and P3 varied between age groups. Most patients (>86%) had more than three chronic diseases. Cognitive impairment was present in almost half of both older age cohorts (43 and 50%). Half of the patients (52%) were edentulous. In dentate patients, the average number of teeth was 12 ± 6 and differed in the maxilla significantly between age groups (p = 0.005). There was no significant association between dental state, ASA classification and systemic conditions. The profile of this cohort reflects a poor oral and general health status. The results underline the importance of an interdisciplinary consultation in a geriatric ward where oral health care is an integral part.

Is anemia at admission related to short-term outcomes of elderly hip fracture patients?

Abstract Hip fracture in elderly people is associated with high morbidity and mortality. Therefore, it is important to identify risk factors that potentially influence outcomes after hip surgery. The main purpose of this study was to evaluate the relationship of anemia at admission and short-term outcomes after hip fracture. We studied 343 community-dwelling patients who underwent surgery for hip fracture from March 2009 to March 2010. Functional mobility at discharge, postoperative complications, hospital length of stay and in-hospital mortality were analyzed in respect to presence and severity of anemia at admission. Anemia (defined as hemoglobin levels &lt; 13.0 g/dl for men and &lt; 12.0g/dl for women) was present in 185 (53.9%) patients, of whom 54 (29.2%) were severely anemic (defined as hemoglobin level 10.0g/dl or below). In multivariate analysis anemia was associated with age, gender (female), type of fracture (intertrochanteric) and American Society of Anesthesiologists (ASA) classification (3 or 4), while severity of anemia was associated with recovery of ambulatory ability at discharge. There was no difference in the incidence of postoperative complication, in-hospital mortality and length of hospital stay between the groups at discharge. Overall anemia at admission is an indicator of poor general health status. Ambulatory recovery in hip fracture patients is independently related to severity of anemia at admission.

1705 REPAIR OF OBSTRUCTED LABOUR GENITO-URINARY FISTULA

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology1 Apr 20111705 REPAIR OF OBSTRUCTED LABOUR GENITO-URINARY FISTULA Tarek Osman, Hassan Shaker, Ahmad Saafan, and Sherif Mourad Tarek OsmanTarek Osman Cairo, Egypt More articles by this author , Hassan ShakerHassan Shaker Cairo, Egypt More articles by this author , Ahmad SaafanAhmad Saafan Cairo, Egypt More articles by this author , and Sherif MouradSherif Mourad Cairo, Egypt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1896AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To present our experience in repair of OLFs (obstructed labor fistula). METHODS During the period from February 2003 &endash; June 2010 we repaired 312 cases of OLF. 224 cases were 1ry OLF and 88 were recurrent OLF. Management was done during our campaigns for fistula repairs in African countries. Obstructed labour fistula result from prolonged compression of the vesico-vaginal complex between the head of the fetus and the pelvic wall in obstructed 2nd stage of labour when proper obstetric care is lacking. This will result eventually in varying degrees of ischemic necrosis of the bladder base, bladder neck and proximal urethra and fistulation with the vagina. Fistula repair entails first dissection of the vaginal mucosa off the vesico-urethral complex and each layer is separately closed mostly with non opposing suture lines. An interposition MIF (Martius interposition labial flap) was applied in 167 cases. RESULTS Primary success of fistula closure was achieved in 208 (93%) of the primary OLFs and 54 (61%) of the recurrent OLFs. The main factors related to failure were prior failed repair, non use of interposition flaps and poor general health and nutritional status of the patient. CONCLUSIONS The first attempt of repair of OLF is associated with the best results. The use of Martius interposition flap is essential for successful repair of these extensive injuries. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e685-e686 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek Osman Cairo, Egypt More articles by this author Hassan Shaker Cairo, Egypt More articles by this author Ahmad Saafan Cairo, Egypt More articles by this author Sherif Mourad Cairo, Egypt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...