Body mass index is a risk factor for postoperative morbidity after laparoscopic hepatectomy of hepatocellular carcinoma: a multicenter retrospective study.

PURPOSE: The aim of this study was to determine whether preoperative body mass index (BMI) was associated with postoperative morbidity after laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC). METHODS: A total of three groups of patients were categorized based on preoperative BMI: low-BMI (≤ 18.4 kg/m2), normal-BMI (18.5-24.9 kg/m2) and high-BMI (≥ 25.0 kg/m2). Baseline clinicopathological characteristics, operative variables, and postoperative 30-day mortality and morbidity were recorded and compared among the three groups. The independent risk factors for postoperative morbidity, including surgical site infection (SSI), were identified using univariate and multivariate analyses. RESULTS: Among 226 included patients, 20 (8.8%), 122 (54%), and 84 (37.2%) patients had low, normal, and high BMI, respectively. There were no significant differences in postoperative 30-day mortality rates in patients with low BMI and high BMI compared with those with normal BMI (5% and 1.2% vs. 0%, P = 0.141 and P = 0.408, respectively). However, postoperative morbidity rates were significantly higher in patients with low BMI and high BMI compared to those with normal BMI (40% and 32.1% vs. 17.2%, P = 0.032 and P = 0.020, respectively). According to multivariate analysis, both low and high BMI were independent risk factors of increased postoperative morbidity (OR: 5.03, 95% CI: 1.02-25.6, P = 0.047, and OR: 4.53, 95% CI: 1.75-12.8, P = 0.003, respectively). Low and high BMI were also identified as independent risk factors of increased postoperative SSI rates (OR: 6.25, 95% CI: 1.60-23.8, P = 0.007, and OR: 2.89, 95% CI: 1.04-8.77, P = 0.047, respectively). CONCLUSION: A higher incidence of postoperative morbidity including SSI after LLR for HCC was found in low-BMI and high-BMI patients compared to normal-BMI patients. CLINICAL TRIALS REGISTRATION: Not applicable because this is a retrospective observational study.

A comparative analysis of postoperative morbidity and alveolar bone regeneration following surgical extraction of impacted lower third molar teeth using piezosurgery and conventional instruments: a split-mouth clinical investigation.

BACKGROUND-OBJECTIVE(S): This randomized, split-mouth study aimed to compare postoperative complications following the surgical extraction of impacted lower third molars using piezosurgery versus conventional rotary instruments. MATERIALS AND METHODS: Twenty-one patients, aged 18-35 years, with bilaterally and symmetrically impacted lower third molars, were randomly assigned to undergo extraction using piezosurgery on one side and conventional rotary instruments on the other. RESULTS: The piezosurgery method required a longer operation time. However, it resulted in quicker resolution of postoperative swelling by the 7th day compared to the conventional method, where swelling persisted longer. Mandibular angle-tragus measurements were significantly higher with the conventional method on the 1st, 3rd, and 7th postoperative days. Although mouth opening decreased significantly after piezosurgery, it returned to preoperative levels by the 7th day, outperforming the conventional method. Postoperative pain was notably higher with the conventional method during the first four days but showed no significant difference from the 5th day onward. Alveolar bone healing was significantly better with piezosurgery at the 3rd and 6th months. Temporary paresthesia occurred in one patient from the conventional group, resolving within four weeks. Neither method resulted in alveolar osteitis. CONCLUSION(S): Within the study's limitations, piezosurgery demonstrated a reduction in postoperative discomfort, suggesting its advantage in enhancing patient recovery following lower third molar extractions. CLINICAL SIGNIFICANCE: Piezosurgery, when used appropriately, can reduce postoperative complications compared to conventional methods. Clinicians should be aware of its indications, benefits, and potential challenges. Trial registration This study was registered as a clinical trial to the ClinicalTrials.gov, and the registration ID is NCT06262841 ( https://clinicaltrials.gov/study/NCT06262841 ).

Mortality and morbidity in critically ill COVID-19 patients: A systematic review and meta-analysis.

BACKGROUND: The COVID-19 pandemic has caused 14.83 million deaths globally. This systematic review and meta-analysis aimed to provide a pooled estimate of the overall mortality and morbidity of critically ill COVID-19 patients. METHOD: Four electronic databases, Medline/PubMed, the Cochrane Library, the WHO COVID-19 database, and the Web of Science, were used to identify relevant studies. Two authors independently screened the studies, evaluated the eligibility criteria and resolved discrepancies through discussion with the third author. The pooled effect size was computed using STATA software version 14. The Cochran Q test and I2 test were utilized to assess heterogeneity across the studies. Additionally, subgroup analysis, sensitivity analysis, and publication bias were evaluated. It is registered in Prospero with Prospero ID CRD42020212146. RESULTS: A total of 1003 published articles were screened from various databases, and 24 studies involving a total of 142,291 critically ill COVID-19 participants were selected for inclusion in the review. Among the participants, 67 % were male, and the mean age was 63.43 + SD3.33 years. The mortality rate reported in the individual studies ranged from 4.5 % to 69.5 %. The findings from the analysis revealed that the overall pooled mortality rate was 34 % (95 % confidence interval: 31 %-37 %). Additionally, the findings showed that 62 % of critically ill COVID-19 patients required mechanical ventilation, while 68.7 % of these patients had chronic disease comorbidities. CONCLUSION: Critically ill COVID-19 patients face a high-risk risk of death, with an estimate of about one in three patients dying from the virus. Notably, a substantial portion of critically ill COVID-19 patients (62 %) require mechanical ventilation; surprisingly, more than two-thirds of patients with COVID-19 have chronic disease comorbidities, highlighting the importance of managing comorbidities in this population.

A Poisson regression approach for assessing morbidity risk and determinants among under five children in Nigeria.

In this paper, we have provided more insights on the relationship between under five morbidity in Nigeria and some background characteristics using a Poisson regression model and the most recent 2018 NDHS data on Acute Respiratory Infection (ARI), diarrhoea and fever. Some of our results are that children 36-47 months old have the highest risk of ARI [OR = 1.45; CI (1.31,1.60)] while children less than 6 months old have the lowest risk of ARI [OR = 0.14; CI (0.11,0.17)]. The prevalence of diarrhoea is generally high among children under 48-59 months old but highest among children 6-11 months old [OR = 4.34; CI (3.69,5.09)]. Compared to children 48-59 months old, children in all other age categories except 24-34 months old have a high risk of fever [OR = 0.95; CI (0.73,1.24)]. ARI is more prevalent among female children [OR = 8.88; CI (8.02,9.82)] while diarrhoea [OR = 21.75; (19.10,24.76)] and fever [OR = 4.78; CI (4.31,5.32)] are more prevalent among male children. Children in urban areas are more likely to suffer ARI [OR = 9.49; CI (8.31,10.85)] while children in rural areas are more likely to suffer both diarrhoea [OR = 21.75; CI (19.10,24.76)] and fever [OR = 4.90; CI (4.26,5.63)]. Children in the South-South have the highest risk of ARI [OR = 4.03; CI (3.65,4.454)] while children in the North Central have the lowest risk of ARI [OR = 1.55; CI (1.38,1.74)] and highest risk of diarrhoea [OR = 3.34; CI (2.30,5.11)]. Children in the Northeast have the highest risk of fever [OR = 1.30; CI (1.14,1.48)]. In the Northcentral region, Kogi state has the highest prevalence of fever [OR = 2.27; CI (1.62,3.17)], while Benue state has the lowest [OR = 0.35; CI (0.20,0.60)]. Children in Abuja state face similar risks of fever and diarrhoea [OR = 0.84; CI (0.55,1.27)], with the risk of diarrhoea in Abuja being comparable to that in Plateau state [OR = 1.57; CI (0.92,2.70)]. Nasarawa state records the highest incidence of diarrhoea in the Northcentral [OR = 5.12; CI (3.03,8.65)], whereas Kogi state reports the lowest [OR = 0.29; CI (0.16,0.53)]. In the Northeast, Borno state has the highest rate of fever [OR = 3.28; CI (2.80,3.84)], and Bauchi state the lowest [OR = 0.38; CI (0.29,0.50)]. In Adamawa state, the risks of fever and diarrhoea are nearly equivalent [OR = 1.17; CI (0.97,1.41)], and the risk of fever there is similar to that in Taraba state [OR = 0.92; CI (0.75,1.12)]. Diarrhoea is most prevalent in Yobe state [OR = 3.17; CI (2.37,4.23)] and least prevalent in Borno state [OR = 0.26; CI (0.20,0.33)]. In the Northwest, the risk of fever is similarly high in Zamfara and Kebbi states [OR = 1.04; CI (0.93,1.17)], with Kastina state showing the lowest risk [OR = 0.39; CI (0.34,0.46)]. Children in Zamfara state experience notably different risks of fever and diarrhoea [OR = 0.07; CI (0.05,0.10)]. Kaduna state reports the highest incidence of diarrhoea [OR = 21.88; CI (15.54,30.82)], while Kano state has the lowest [OR = 2.50; CI (1.73,3.63)]. In the Southeast, Imo state leads in fever incidence [OR = 8.20; CI (5.61,11.98)], while Anambra state has the lowest [OR = 0.40; CI (0.21,0.78)]. In Abia state, the risk of fever is comparable to that in Enugu state [OR = 1.03; CI (0.63,1.71)], but the risks of fever and diarrhoea in Abia differ significantly [OR = 2.67; CI (1.75,4.06)]. Abia state also has the highest diarrhoea rate in the Southeast [OR = 2.67; CI (1.75,4.06)], with Ebonyi state having the lowest [OR = 0.05; CI (0.03,0.09)]. In the South-South region, Bayelsa and Edo states have similar risks of fever [OR = 1.28; CI (0.84,1.95)], with Akwa Ibom state reporting the highest fever rate [OR = 4.62; CI (3.27,6.52)] and Delta state the lowest [OR = 0.08; CI (0.02,0.25)]. Children in Bayelsa state face distinctly different risks of fever and diarrhoea [OR = 0.56; CI (0.34,0.95)]. Rivers state shows the highest incidence of diarrhoea in the South-South [OR = 10.50; CI (4.78,23.06)], while Akwa Ibom state has the lowest [OR = 0.30; CI (0.15,0.57)]. In the Southwest, Lagos and Osun states have similar risks of fever [OR = 1.00; CI (0.59,1.69)], with Ogun state experiencing the highest incidence [OR = 3.47; CI (2.28,5.28)] and Oyo state the lowest [OR = 0.18; CI (0.07,0.46)]. In Lagos state, the risks of fever and diarrhoea are comparable [OR = 0.96; CI (0.57,1.64)], and the risk of diarrhoea is similar to those in Ekiti, Ogun, and Ondo states. Oyo state has the highest diarrhoea rate in the Southwest [OR = 10.99; CI (3.81,31.67)], with Ogun state reporting the lowest [OR = 0.77; CI (0.42,1.42)]. Children of mothers with more than secondary education are significantly less likely to suffer ARI [OR = 0.35; CI (0.29,0.42)], whereas children of mothers without any education run a higher risk of diarrhoea [OR = 2.12; CI (1.89,2.38)] and fever [OR = 2.61; CI (2.34,2.91)]. Our analysis also indicated that household wealth quintile is a significant determinant of morbidity. The results in this paper could help the government and non-governmental agencies to focus and target intervention programs for ARI, diarrhoea and fever on the most vulnerable and risky under five groups and populations in Nigeria.

Anesthesia's Influence on Postoperative In-Hospital Morbidity-Mortality in Proximal Femoral Fractures in the Elderly.

Background and Objectives: The incidence of proximal femoral fractures (PFFs) is rising, causing significant morbidity and mortality. Regional anesthesia (RA)'s benefits include the avoidance of intubation and mechanical ventilation, decreased blood loss, and improved analgesia. General anesthesia (GA) offers improved hemodynamic stability. This study examines the in-hospital post-surgical morbidity and mortality seen in PFFs in a cohort of the elderly undergoing GA or RA. Materials and Methods: This is a retrospective cohort study of 319 PFF patients older than 65 years over a single year. Results: In total, 73.7% of patients underwent GA. The patient characteristics were identical between groups, except for smoking. Hypertension was the most frequent comorbidity, followed by hyperlipidemia, NIDDM, and IHD. The overall patient complication rate was 11.4%. Pneumonia was the most common complication (5.1% in GA, 8.4% in RA). A total of 0.9% of patients required ICU admission. Overall, the in-hospital mortality rate was 2.3%, with no statistically significant difference between GA and RA. The GA and RA cohorts were similar in terms of their patient demographics, medical history, and preoperative parameters. In total, 73% of surgeries were under GA. No statistically significant differences were found in total anesthesia time or complication rates. Conclusions: We did not find a difference between general and spinal anesthesia regarding complication rates, anesthesia time, or morbidity. General anesthesia remains best suited for patients receiving anticoagulation treatment and undergoing semi-urgent surgery, but, other than that, the mode of anesthesia administered remains up to the anesthesiologist's preference.

Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018.

Importance: Historically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes. Objective: To examine if historical redlining and contemporary gentrification is associated with increased severe maternal morbidity (SMM) odds. Design, Setting, and Participants: This cross-sectional study used data from a statewide population-based sample of all live hospital births at 20 weeks' gestation or more between 2005 and 2018 in California. Analysis was conducted from March 2023 to January 2024. Exposure: Redlining (as characterized by the federal Home Owners' Loan Corporation mortgage security maps) and displacement (using present-day sociodemographic and housing market information). Main Outcomes and Measures: Mixed-effects logistic regression models were used to assess the association of census tract-level exposure to historical redlining and contemporary gentrification with increased SMM odds, adjusting for sociodemographic and pregnancy related factors. Outcome classification was based on the Centers for Disease Control and Prevention SMM index, which defines SMM as having any of the 21 procedures and diagnoses based on the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Results: The study sample included 1 554 837 births (median [SD] maternal age, 29.0 [6.4] years; 3464 American Indian or Alaskan Native [0.2%], 224 774 Asian [14.5%], 132 240 Black [8.5%], 880 104 Hispanic [56.6%], 312 490 White [20.1%]), with 22 993 cases of SMM (1.4%). Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaskan Native. Independent of individual-level characteristics, SMM odds were greater for individuals living in redlined neighborhoods that experienced displacement (OR, 1.21; 95% CI, 1.14-1.28) and in redlined neighborhoods undergoing gentrification (OR, 1.21; 95% CI, 1.13-1.29) compared with those in continuously advantaged neighborhoods. Conclusions and Relevance: Findings from this cross-sectional study demonstrate that the legacies of redlining, intertwined with current dynamics of displacement and gentrification, affect SMM. Place-based sociopolitical mechanisms that inequitably distribute resources may be important intervention points to address structural drivers of adverse pregnancy outcomes and their racial inequities.

Surgeon Perceptions and Variations in Surgical Morbidity and Mortality Conference: Report of a Survey from the American College of Surgeons Board of Governors.

OBJECTIVE: To highlight the evolution of surgical morbidity and mortality conferences (MMCs) from the early 20th century as a means of identifying surgeon error into current practices as identifying hospital-based system factors that contribute to adverse patient events. Further, to elucidate differences in the perception of MMCs between trainees and attending surgeons as well as differences in the structure of MMCs geographically and by institution type. DESIGN: We developed a survey that was distributed to current American College of Surgeon members through Survey Monkey. SETTING: Survey-based study. PARTICIPANTS: Current members of the American College of Surgeons, including Board of Governors, surgeons, and trainees. RESULTS: There were a total of 1,396 responses to the survey, 814 (58%) from surgical trainees and 582 (42%) from attending surgeons. Both surgical trainees and attending surgeons noted that the most common day for MMCs was Wednesday and that the most common time for MMCs was before 7:30 AM. Further, most surgical trainees and attending surgeons noted that there was no structured format to their institution's MMCs and that increased attending surgeon engagement would make MMCs more educational. Significant variations in MMCs existed across both geographic region and by institution type. CONCLUSION: The results from this survey highlight key aspects of MMCs that contribute to their educational value. Staff engagement was noted to be the most educational aspect of MMCs. While geographic and institutional differences will likely persist, efforts should be made to increase staff engagement at MMCs in addition to a more structured approach.

Pregnancy and Postpartum Experiences in Chicago Neighborhoods With Increased Adverse Maternal Outcomes: A Qualitative Study.

BACKGROUND: Black birthing people are three to four times more likely to die from pregnancy-related causes than White birthing people. OBJECTIVE: We aimed to better understand the pregnancy and postpartum experiences with health care, support, and maternal morbidity and mortality (MMM) of Black pregnant and parenting people living in neighborhoods with increased rates of MMM in Chicago, Illinois. METHODS: This was a rapid qualitative analysis in Chicago, Illinois based on principles of community-based participa-tory research. Community partners recruited Black pregnant and parenting individuals living in neighborhoods with higher rates of MMM. Four focus groups from February 2021 to October 2021 were led by community health workers and covered pregnancy and postpartum experiences. Transcripts were deductively and inductively coded by paired-analyst teams and thematically analyzed. RESULTS: This study included 31 participants from eight neighborhoods. Key themes related to pregnancy and the postpartum period included the: (1) a need for social and mental health support during and after pregnancy, (2) a preference for multiple sources of health information, (3) a need for strengthened connection with medical providers and health care systems, (4) a lack of clarity regarding MMM and the postpartum period, and (5) a difference in language between patients and health care providers. CONCLUSIONS: Further research and interventions are needed to evaluate how to best support pregnant and postpartum people, to implement patient-centered language when communicating about pregnancy and postpartum complications, and to demonstrate investment by health care workers in Black birthing people. Crucial to further research and interventions is communication with and input from communities most affected by MMM.

Increased cardiovascular morbidity and reduced life expectancy in a large Italian cohort of patients with resistance to thyroid hormone ß (RTHß).

OBJECTIVE: Decreased survival and higher cardiovascular morbidity have been recently reported in a UK cohort of 61 RTHß patients, but there is no evidence from other countries. DESIGN: Retrospective cohort study from an historical group of 284 Italian RTHß patients, diagnosed between 1984 and 2023. METHODS: We collected data on diagnosis of 284 cases and longitudinal data of 249 RTHß who carried heterozygous pathogenic variants in the THRB gene. We studied how thyroid function and recognized risk factors for cardiovascular disease, such as hypertension and diabetes, affected overall mortality and major cardiovascular events. RESULTS: The cumulative prevalence of sinus/supraventricular tachycardia and atrial fibrillation was 40% and 18%, respectively. FT4 values 57% higher than the upper limit of normal were associated with premature cardiovascular manifestations. Major cardiovascular events (MACEs) occurred in RTHß patients at a median age (IQR) of 59.4 years (50.4-66.4) and early mortality resulted in a mean of 11 years of life lost. While at univariable analysis hypertension, dyslipidemia, high fasting glucose/diabetes were also associated with MACEs, at multivariable analysis only age at diagnosis, increased fT4 levels, and male gender remained significantly associated with MACEs and age at diagnosis and higher fT4 levels with mortality. Previous thyroidectomy or radioiodine therapy had no statistically significant effect in the prevention of major cardiovascular events or all-cause mortality. CONCLUSIONS: These data should raise the general awareness on the cardiovascular risk and prompt a proactive cardiovascular monitoring in RTHß, especially in men and those with fT4 levels above 30 pmol/L.

Recomendaciones ALAT para el uso de vacunas respiratorias. Guía de práctica clínica basada en evidencias / ALAT Recommendations for the Use of Respiratory VaccinesEvidence-Based Clinical Practice Guideline

Introducción: Las infecciones respiratorias son las enfermedades respiratorias con mayor mortalidad en el mundo. Las causadas por Streptococcus pneumoniae, virus de influenza, Bordetella pertussis, SARS-CoV-2 y el Virus Sincitial Respiratorio, cuentan hoy día con vacunas seguras y efectivas. Este documento representa una guía de práctica clínica (GPC) de la Asociación Latinoamericana de Tórax (ALAT), elaborada por iniciativa de los departamentos de enfermedades infecciosas y pediatría, con el objetivo de establecer recomendaciones sobre vacunas respiratorias, utilizando la evidencia disponible. Método: Se estableció un grupo de desarrollo de las guías conformado por cinco médicos responsables globales del proyecto, se crearon cinco subgrupos de trabajo, uno por cada vacuna, con expertos neumólogos de adulto, pediatras e infectólogos invitados, que generaron preguntas clínicas. Se trabajó con un grupo de expertos metodólogos que transformaron preguntas clínicas en preguntas PICO, seleccionándose nueve preguntas por método DELPHI. Luego, se utilizó el sistema GRADE (Grading of Recommendations Assessment, Development and Evaluation) para evaluar la evidencia disponible. Resultados: Se obtuvieron recomendaciones para población adulta y pediátrica de las vacunas de neumococo, influenza, tos ferina, COVID-19 y Virus Respiratorio Sincitial basadas en preguntas PICO. También se agregaron recomendaciones basadas en preguntas narrativas relacionadas al uso de vacunas respiratorias en población con enfermedades respiratorias crónicas como asma, EPOC y fibrosis pulmonar.

Introduction: Respiratory infections are the leading cause of respiratory disease-related mortality worldwide. Infections caused by Streptococcus pneumoniae, influenza virus, Bordetella pertussis, SARS-CoV-2 and Respiratory Syncytial Virus (RSV) now have safe and effective vaccines available.This document represents a Clinical Practice Guideline (CPG) by the Latin American Thoracic Association (ALAT), developed through the initiative of the departments of in-fectious diseases and pediatrics, with the goal of establishing recommendations on respiratory vaccines using the available evidence. Method: A guideline development group was established, composed of five lead physicians responsible for the overall project. Five working subgroups were created, one for each vaccine, involving invited experts in adult pulmonology, pediatrics, and infectious diseases, who formulated clinical questions. A group of expert methodologists then transformed these clinical questions into PICO questions, with nine questions selected using the DELPHI method. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was then used to assess the available evidence. Results: Recommendations were obtained for the adult and pediatric populations for pneumococcal, influenza, pertussis, COVID-19 and Respiratory Syncytial Virus vaccines based on PICO questions. Additionally, recommendations based on narrative questions related to the use of respiratory vaccines in populations with chronic respiratory diseases such as asthma, COPD, and pulmonary fibrosis were included.

Absolute and relative morbidity burdens attributable to various illnesses and injuries among non-service member beneficiaries of the Military Health System, 2023.

The Military Health System (MHS) is a global, integrated health delivery system tasked with ensuring the medical readiness of the U.S. Armed Forces while fulfilling the individual health care needs of eligible military personnel and their dependents. The MHS network comprises military hospitals and clinics that ensure the medical readiness of the force, which are complemented by programs that enable beneficiary care in the private sector through the TRICARE insurance program. Mental health disorders accounted for the largest proportions of the morbidity and health care burdens that affected the pediatric and younger adult beneficiary age groups of nonservice member beneficiaries of the Military Health System in 2023. Among adults aged 45-64 years and adults aged 65 years and older, musculoskeletal diseases accounted for the most morbidity and health care burdens. With almost all health care for Medicare-eligible beneficiaries aged 65 years and older at private sector medical facilities, over 91% of health care encounters among non-service member beneficiaries (TRICARE-eligible and Medicare-eligible) occurred at non-military medical facilities.

Quantitative Measurement of the Direct Public Health Impact of Medicines Withdrawals in Europe: Development of a Modelling Method and Proof-of-Concept Study to Estimate the Morbidity and Mortality Prevented by Regulatory Action.

PURPOSE: Removing medicines from market may benefit public health by preventing adverse drug reactions (ADRs), which should be quantified. This study's aim was to identify a model to quantify the impact of medicines' marketing authorisation (MA) withdrawal and revocation in terms of preventing morbidity and mortality. METHODS: MA withdrawals and revocations for safety reasons in France, Germany and/or the United Kingdom between July 2012 and December 2016 were identified for prescription medicines. Annual exposure was estimated for each medicine, using IQVIA Medical Research Data (IMRD)-France, IMRD-Germany and IMRD-UK primary care electronic health record databases. European Medicines Agency records provided reasons for regulatory action for each medicine. Absolute risks of ADRs which led to MA withdrawal were estimated for patients exposed to each medicine by systematic review of quantitative research. Public health impact, expressed as annual number of ADRs avoided, was estimated by modelling exposure and ADR risk. RESULTS: Four MA withdrawals and two revocations met study inclusion criteria. Each product's usage decreased following MA withdrawal or revocation. Absolute risk for ADRs was 0.1%-41.25%. To estimate impact of each withdrawal or revocation, its average annual exposure within each IMRD population was multiplied by the absolute risk to give the crude number of ADRs prevented annually due to regulatory action. CONCLUSIONS: This model quantifies the public health impact of MA withdrawal and revocation in terms of serious morbidity, resulting from eliminated or reduced usage of medicines. This method can be applied to products in other settings to quantify the impact of other pharmacovigilance actions.

Overview of Available Functioning Data in Switzerland: Supporting the Use of Functioning as a Health Indicator Alongside Mortality and Morbidity.

Objectives: To identify official sources that routinely collect data on functioning in Switzerland, to provide an overview of the existing data and its comparability, and to assess the extent to which the data is suitable for developing a functioning metric and indicator. Methods: Data sources were identified through an iterative search. Standardized rules were applied to map the functioning information assessed by the sources using a current WHO functioning and disability survey as a reference framework for the content comparison. Results: Four sources were identified: the Swiss Survey of Health, Ageing and Retirement in Europe (SHARE), the Swiss Health Survey (SHS), the Lausanne cohort 65+ (Lc65+), and the Swiss Household Panel (SHP). All tools addressed sleep functions, energy level, emotional functions, and sensation of pain. Additionally, nine functioning categories were common across three sources. Conclusion: Population data sources in Switzerland routinely collect comparable functioning data, which can serve as the basis for creating a functioning indicator. Among others, this indicator is relevant to complement mortality and morbidity data and to support both the estimation of rehabilitation and long-term care needs.

Morbidity burden of imported chronic schistosomiasis among West African migrants.

BACKGROUND: Past exposure to schistosomiasis is frequent among migrants from endemic countries, and chronic untreated infection may lead to long-term morbidities. METHODS: We carried out a prospective population-based cross-sectional study among migrants from endemic Sub-Saharan countries living in Barcelona, Spain. Participants had not been previously diagnosed or treated for schistosomiasis. Clinical signs and symptoms were scrutinised through a systematic revision of electronic medical records and an on-site standardised questionnaire, and blood and urine samples were screened for Schistosoma. FINDINGS: We recruited 522 eligible participants, 74.3% males, mean age 42.7 years (SD=11.5, range 18-76), Overall, 46.4% were from Senegal and 23.6% from Gambia. They had lived in the European Union for a median of 16 years (IQR 10-21). The prevalence of a Schistosoma-positive serology was 35.8%. S. haematobium eggs were observed in urine samples in 6 (1.2%) participants. The most prevalent symptoms among Schistosoma-positive participants were chronic abdominal pain (68.8%, OR=1.79; 95%CI 1.2-2.6), eosinophilia (44.9%, OR=2.69; 95%CI 1.8-4.0) and specific symptoms associated with urinary schistosomiasis, like self-reported episodes of haematuria (37.2%; OR=2.47; 95%CI 1.6-3.8), dysuria (47.9%, OR=1.84; 95%CI=1.3-2.7) and current renal insufficiency (13.4%; OR=2.35; 95%CI=1.3-4.3). We found a significant prevalence of gender-specific genital signs and symptoms among females (mainly menstrual disorders) and males (erectile dysfunction and pelvic pain). Individuals typically presented with a multitude of interconnected symptoms, most commonly chronic abdominal pain, which are often disregarded. CONCLUSIONS: Despite the lack of urine parasite identification, the high incidence of clinical signs and symptoms strongly correlated with a positive schistosomiasis serology suggests the existence of a heavy clinical burden among long-term West African migrants living for years/decades in the study region. More research is urgently required to determine whether these symptoms are the result of long-term sequelae or a persistent active Schistosoma infection.

The Economic Burden of Childhood Ocular Morbidity in Bangladesh.

INTRODUCTION: Childhood eye morbidity is a great public health problem, especially in low-income countries. This study aimed to determine the economic burden of childhood ocular morbidity on attending tertiary hospitals in Bangladesh. This study also assessed the catastrophic health expenditure (CHE) for childhood ocular morbidity in Bangladesh. METHODS: A cross-sectional mixed method was used for this study from April to October 2023 at two tertiary hospitals in Bangladesh, one government-funded and one private. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers/parents and in-depth interviews (IDIs) were conducted among the same respondents of these two hospitals, and a workshop was conducted with the stakeholders during the study period. RESULTS: This was the first study in Bangladesh to determine the cost of pediatric ocular morbidity. Among 335 patients, the total median direct cost at a single time was 3740 ± 18,285 BDT (34 ± 166.2 USD) at the government hospital and 7300 ± 40,630 BDT (66.36 ± 369.36 USD) at the private hospital. The disease-specific median overall cost from diagnosis of the disease was 65,000 BDT (591 USD) for squint, 50,000 BDT (454.54 USD) for cataract, and 30,000 BDT (272.72 USD) for eye injury. Almost 90% of the caregivers/parents faced CHE due to different pediatric ocular morbidity. CONCLUSIONS: These cost estimates can be used as an initial basis for financial decisions that aim to enhance access to care, management, and follow-up of children with ocular morbidity. These cost estimates also offer helpful information for organizational and financial sustainability initiatives. Policymakers can consider serious immediate interventions for securing ocular health services in Bangladesh and prevent families from CHE.

[The trends in morbidity of children aged 15-17 years: problems and actual challenges].

The article presents results of analysis of morbidity rates in children aged 15-17 years in the Russian Federation, the Volga Federal Okrug, the Udmurt Republic, the Kirov Oblast and the Republic of Bashkortostan in 2014-2022. According to research data, in the Russian Federation there is an increase of general and primarily detected (primary) morbidity by 24.0% (from 229,468.3 to 231,505.5) and by 22.3% (from 143,109.3 to 149,143.8), respectively. In the morbidity structure, the greatest increase was noted for such diseases as obesity (24.0 and 27.8%, respectively), diabetes mellitus (30.9 and 32.8%, respectively) and diabetes mellitus type I (31.9 and 30.8%, respectively). The data of statistical reports on general and primarily detected (primary) morbidity of the Central Research Institute for Health Organization and Informatics of Minzdrav of Russia were used. The study established general and primarily detected morbidity in the Russian Federation. However, forecast for 2027, as compared with 2014, is marked by decline of total morbidity by 8.3% and primarily detected (primary) morbidity by 5.2%. Due to the unfavorable forecast for morbidity in the Russian Federation for 2027, further scientific studies are needed concerning children aged 15-17 years in order to develop preventive measures at population, group and individual levels, considering regional characteristics.

Peri- and postoperative morbidity and mortality in older patients with non-small cell lung cancer: a matched-pair study.

BACKGROUND: Reports from case series suggest that operative outcomes are comparable amongst different age groups following surgery with curative intent for non-small cell lung cancer (NSCLC). The purpose of this study was to compare morbidity and mortality after NSCLC surgery in older patients (≥ 75 years) versus younger patients (< 75 years) and identify independent predictive risk factors. METHODS: We identified 2015 patients with postoperative stages IA to IIIA according to AJCC/UICC 7th edition who had undergone NSCLC surgery with curative intent at a single specialized lung cancer center from January 2010 to December 2015. A matched-pair analysis was performed on 227 older patients and corresponding 227 younger patients. Short-term surgical outcomes were postoperative morbidity, length of hospital stay, 30-day and 90-day mortality. Long-term operative outcomes were disease-free and overall survival. RESULTS: 454 patients were included in the matched-pair analysis. 36% of younger patients developed postoperative complications versus 42% in older patients (p = 0.163). Age was not significantly associated with the occurrence of postoperative complications. Median length of hospital stay was 14 days in older patients and 13 days in younger patients (p = 0.185). 90-day mortality was 2.2% in younger patients compared to 4% in older patients (p = 0.424). In patients aged 75 and older impaired performance status (ECOG ≥ 1) was associated with decreased overall survival (HR = 2.15, CI 1.34-3.46), as were preoperative serum C-reactive protein / albumin ratio ≥ 0.3 (HR = 1.95, CI 1.23-3.11) and elevated preoperative serum creatinine levels ≥ 1.1 mg/dl (HR = 1.84, CI 1.15-2.95). In the younger cohort male sex (HR = 2.26, CI 1.17-4.36), postoperative stage III disease (HR 4.61, CI 2.23-9.54) and preoperative anemia (hemoglobin < 12 g/dl) (HR 2.09, CI 1.10-3.96) were associated with decreased overall survival. CONCLUSIONS: Lung resection for NSCLC in older patients is associated with postoperative morbidity and mortality comparable to those of younger patients. In older patients, physical activity, comorbidities and nutritional status are related to survival and should influence the indication for surgery rather than age alone.