Socio-economic disparity in risk of undergoing emergency laparotomy and postoperative mortality

2019 ◽  
Vol 48 (3) ◽  
pp. 250-258
Author(s):  
Sanne Pagh Møller ◽  
Maja Mønster Jeppesen ◽  
Ismail Gögenur ◽  
Lau Caspar Thygesen
Keyword(s):  
Elementary School ◽  
Access To Care ◽  
Early Retirement ◽  
Postoperative Mortality ◽  
Emergency Laparotomy ◽  
Retirement Pension ◽  
Economic Disparities ◽  
Co Morbidity ◽  
Elementary School Education ◽  
One Year

Aims: Socio-economic disparities in health and access to care are well documented, but socio-economic disparities in surgical care and outcomes have received less attention. The aim of the study was to determine if there are socio-economic disparities in the risk of undergoing emergency laparotomy and postoperative mortality in a universal health-care system with free and equal access to care. Methods: This was a nationwide case-control study including patients undergoing non-malignant emergency laparotomy involving resection, ostomy or open drainage between 2003 and 2014 and population references matched 1:1 on age and sex. Socio-economic disparities in one-year postoperative mortality were explored through a cohort study including all patients. Exposure measures were register-based household disposable income, educational level and employment status. Analyses were adjusted by age, sex, country of origin, marital status and co-morbidity. Results: A total of 11,962 cases and 11,962 population references were included. The highest odds ratios (OR) for undergoing surgery were found among those with the lowest income (OR=1.51; 95% confidence interval (CI) 1.39–1.63), those with elementary school education (OR=1.33; 95% CI 1.22–1.46) and those on early-retirement pension (OR=3.49; 95% CI 3.07–3.98). One-year postoperative mortality was highest among those with lowest income (hazard ratio (HR)=1.51; 95% CI 1.35–1.69), those with elementary school education (HR=1.39; 95% CI 1.22–1.59) and those on early-retirement pension (HR=2.12; 95% CI 1.73–2.61). Conclusions: Socio-economic disparities in health exist in relation to non-malignant emergency laparotomies and still exist after adjustment for confounders, including co-morbidity, indicating that mechanisms other than differences in disease burden are involved. There is a substantial need for exploration of mechanisms and preventive measures.

scholarly journals Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

2020 ◽  
Vol 9 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Mattias Skielta ◽  
Lars Söderström ◽  
Solbritt Rantapää-Dahlqvist ◽  
Solveig W Jonsson ◽  
Thomas Mooe
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Congestive Heart Failure ◽  
Cox Regression Analysis ◽  
Co Morbidity ◽  
One Year ◽  
Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

Atrial Fibrillation and Mortality in the Oldest Old after Surgery for Hip Fractures

Gerontology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Amit Frenkel ◽  
Vladimir Zeldetz ◽  
Roni Gat ◽  
Yair Binyamin ◽  
Asaf Acker ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Hip Fractures ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Oldest Old ◽  
Postoperative Mortality ◽  
Patient Characteristics ◽  
One Year

Introduction: One-year mortality following hip fractures increases steeply with age, from 2% in the 60- to 69-year-old population up to 28% in the oldest old (older than 90 years). Of the various factors that contribute to hip fractures, atrial fibrillation (AF) is an independent risk factor at any age. Objective: The objective of this study was to assess the association of AF with mortality among the oldest old with hip fractures. Method: This is a retrospective cohort study of 701 persons above age 90 years who underwent orthopedic repair for a hip fracture during 2000–2018. Of them, 218 (31%) had AF at hospital admission. The primary outcome was survival following surgery. We compared patient characteristics and 30-day, 180-day, 1-year, and 3-year survival between patients with and without AF. Results: The adjusted odds ratio for 30-day postoperative mortality for those with AF versus without AF group was 1.03 (95% confidence interval [CI] 0.63–1.66). Survival estimates were higher among those without AF than with AF at 180 days postoperative: 0.85 (95% CI 0.82–0.89) versus 0.68 (95% CI 0.61–0.74), p < 0.001; at 1 year postoperative: 0.68 (95% CI 0.63–0.72) versus 0.48 (95% CI 0.42–0.55), p < 0.001; and at 3 years postoperative: 0.47 (95% CI 0.42–0.52) versus 0.28 (95% CI 0.27–0.34), p < 0.001. Conclusions: Among individuals aged >90 years, operated for hip fractures, mortality was similar for those with and without AF at 30 days postoperative. However, the survival curves diverged sharply after 180 days. Our findings suggest that AF is not an immediate surgical risk factor, but rather confers increased long-term risk in this population.

Abstract 3635: Weight Loss Reverses Left Ventricular Structural Changes In Subjects With Severe Uncomplicated Obesity. A One year Follow Up Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Oliver J Rider ◽  
Jane M Francis ◽  
Mohammed K Ali ◽  
Monique R Robinson ◽  
Stefan Neubauer
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Structural Changes ◽  
Total Body Weight ◽  
Cardiac Risk ◽  
Left Ventricular ◽  
Cardiac Risk Factors ◽  
Co Morbidity ◽  
Lv Mass ◽  
One Year

Objective Obesity has been linked to a spectrum of cardiovascular abnormalities from subclinical changes in cardiac structure to overt heart failure. Uncomplicated obesity (i.e. obesity without any other co-morbidity or cardiovascular risk factors) has been shown to cause increased LV mass and LV dilatation. Our hypothesis was that these changes are, at least in part, reversible following significant weight loss over one year. Method Forty-one obese (BMI 37.7 ± 7.4 SD) and 12 age, sex matched controls (BMI 21.6 ± 1.8 SD) with no identifiable cardiac risk factors underwent cardiac MR imaging for the assessment of LV Mass (g), LV end-diastolic volume (EDV; ml), stroke volume (SV; ml) and LV EF (%). Fourteen obese subjects underwent repeat imaging after a one year period of weight loss, averaging 14.6 ± 11.5 % total body weight. Results Obesity per se was associated with elevated LV mass (125 ± 27 vs 89 ± 23g; p<0.001), LV mass indexed to height (74.4 ± 14.3 vs 52.3 ± 11.4g/m; p<0.001) and EDV (147 ± 28 vs 119 ± 24 ml; p<0.001). ESV and SV were also elevated in obesity (47 ± 12 vs 39 ± 12ml; p=0.05, and 100 ± 14 vs 80 ± 18 ml; p<0.001, respectively). LV EF was similar between groups (p=0.83). After weight loss, there was a significant reduction in LV mass (by 16 ± 11g; 135 ± 31 vs 119 ± 28g; p<0.001), LV mass indexed to height (76.4 ± 15.7 vs 68.9 ± 12 g/m; p<0.001). EDV and ESV were significantly smaller after weight loss (146 ± 25 vs 133 ± 23 ml; p<0.001, and 43 ± 12 vs 41 ± 10 ml; p<0.001 respectively). LV EF and SV did not change significantly. Conclusion In subjects with obesity in the absence of identifiable cardiac risk factors, LV hypertrophy and LV dilatation were partially reversible after a one year period of weight loss.

scholarly journals Dissociative disorders: A study of clinico-demographic profile and associated stressors

2015 ◽  
Vol 3 (2) ◽  
pp. 25-30
Author(s):  
R Thapa
Keyword(s):  
Life Events ◽  
Stressful Life Events ◽  
Age Of Onset ◽  
Dissociative Disorders ◽  
Stressful Life ◽  
Psychosocial Stressors ◽  
Motor Disorder ◽  
Demographic Profile ◽  
Co Morbidity ◽  
One Year

Objectives: To study relevant clinico-demographic profile and stressors of dissociative disorders.  Methods: this is a case control study of 39 cases of dissociative disorders and compared with 39 controls using a self designed questionnaire and G. Singh’s Presumptive Stressful Life Events Scale (PSLE). Results: The mean age of the cases was 21.23 years. Cases of Dissociative motor disorders had significantly higher age (26.4 yrs) as compared to dissociative convulsion (18.8 yrs) and dissociative stupor (20.6 yrs). (38.5%).Two thirds of the cases had comorbid neuro-psychiatric illness, the commonest one being depression (35.9%). The cases had more stressful life events in the past one year as well as whole life when compared to controls. Family conflict was seen to be the commonest precipitating stress.Conclusions: Dissociative disorder mainly affects young people. Dissociative motor disorder is a distinct subtype with a higher age of onset. Presence of neuro-psychiatric co-morbidity is the rule rather than exception. Psychosocial stressors play an important role in disease production.J Psychiatric Association of Nepal Vol .3, No.2, 2014, pp: 25-30DOI: http://dx.doi.org/10.3126/jpan.v3i2.12386 

scholarly journals Communicative Constitution of Organization for Elementary School in Pandemic Covid-19

2021 ◽  
Vol 1 (4) ◽  
pp. 183-189
Author(s):  
Sigit Tri Pambudi ◽  
Basuki Agus Suparno
Keyword(s):  
Elementary School ◽  
Organizational Development ◽  
Teaching And Learning ◽  
Learning Processes ◽  
Important Thing ◽  
The Public ◽  
Communication Events ◽  
Communicative Constitution ◽  
One Year ◽  
The Way

This study focuses on an organizational development especially for an elementary school in which try to stabilize and adopt the changes of teaching and learning processes in relate to pandemic Covid 19 since it has been prevailing one year ago. Through Communicative Constitution of Organization (CCO) approach, it stressed on how elementary school as organization develop and adapt toward the uncertainty situation affected by pandemic covid 19. There are four locations which represent communication events in organization. First, membership negotiation, portraits how member of organization interact each other. Second, self- structuring, reflects how organization norms and culture were internalized within member of organization. Third, activity coordination- the way assignment was conducted and accomplished. It is an important thing in determine organization being successful. And finally, position of institution determines organization to the public. All has important roles to shape and develop organization being success.

scholarly journals Acute presentation of ruptured ovarian cyst secondary to torsion with ipsislateral concomitant ectopic pregnancy: A case report

2014 ◽  
Vol 3 (2) ◽  
pp. 54-56
Author(s):  
Mahendra R Pandey ◽  
Neeva Ojha
Keyword(s):  
Acute Abdomen ◽  
Ovarian Cyst ◽  
Emergency Laparotomy ◽  
Hospital Emergency ◽  
Obstetrics And Gynaecology ◽  
History Of ◽  
Gestational Sac ◽  
One Year ◽  
The Right ◽  
Urine Pregnancy Test

Twenty-one year unmarried regularly menstruating lady without history of amenorrhea presented with acute abdomen in TU Teaching Hospital –Emergency Department. On evaluation urine pregnancy test was positive. Urgent ultrasound revealed multiloculated cystic lesion measuring 8.5 x 8 x 6.7 cms in the right adnexa anterolateral to the uterus with no intrauterine gestational sac. She underwent emergency laparotomy with right salpingo-oophorectomy. On laparotomy there was twisted and ruptured right ovarian cyst with unruptured ampullary pregnancy on the same side. There was coexistence of these two conditions which presented as acute abdomen. DOI: http://dx.doi.org/10.3126/njog.v3i2.10834 Nepal Journal of Obstetrics and Gynaecology Vol.3(2) 2008; 54-56

scholarly journals A Teaching Strategies to Enhance Students’ Creativity in English Profession Subject during the Covid-19 Pandemic

2021 ◽  
Vol 5 (2) ◽  
pp. 119-125
Author(s):  
Diani Nurhajati
Keyword(s):  
Elementary School ◽  
Teaching Strategies ◽  
Video Game ◽  
Industrial Revolution ◽  
Teaching Strategy ◽  
Project Based Learning ◽  
University Graduates ◽  
School Students ◽  
Elementary School Education ◽  
The Right

During the Covid-19 pandemic, the learning process must be carried on from home. In fact, all of the university graduates should be equipped with a number skills needed to face the Industrial Revolution 4.0. Therefore, lecturers are expected to find the solution to train the skills, including creativity. One of the solutions is selecting the right teaching strategy. This research was carried out to answer the questions: “What are the teaching strategies employed by the lecturer English Profession to promote creativity?” and “How do the strategies enhance the students’ creativity?” This descriptive qualitative study took 60 students as the subjects. They were the students who took English Profession Subject at the Elementary School Education, University of Nusantara PGRI Kediri. The techniques of collecting data were observation checklist and questionnaire. The findings of the research show that the lecturer employed Project Based Learning in which the students were assigned to create some projects, namely video, game manual, and English book for elementary school students.

Abstract 17352: Differences in Clinical Characteristics, Risk Factors, Rate of Recurrence and 1-year Outcome Between Acute Heart Failure Patients With Stroke or TIA and Those Without This Co-morbidity. Results From the Gulf aCute heArt failuRe rEgistry (gulf Care)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Mohammed A Al Hashemi ◽  
Kadhim Sulaiman ◽  
Jassim Al-Suwaidi ◽  
Khalid F AlHabib ◽  
Husam AlFaleh ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Heart Failure ◽  
Clinical Characteristics ◽  
De Novo ◽  
Stroke Patients ◽  
Lv Dysfunction ◽  
Co Morbidity ◽  
History Of ◽  
One Year ◽  
Ischemic Attack

Background: Chronic heart failure (CHF) is a known risk for stroke and morbidities and mortalities are known to be higher in CHF patients compared to stroke patients without CHF we here study the prevalence and the clinical significance in a group of patient with stroke or transient ischemic attack (TIA) who were admitted to hospital with acute heart failure (AHF) compared to those without stroke and are admitted with acute heart failure Methods: Data were derived from a prospective, multicenter, multinational study of 5005 patients hospitalized with AHF from February 2013 to November 2012. Data were analyzed according to the presence or absence of Stroke or bronchial TIA. Demographic, management, in-hospital and 1-year outcomes were compared Results: Stroke patients were likely to have a decompensation of chronic failure rather than De-Novo AHF when compared to those without Stroke/TIA (see table). Stroke patients were older; more likely to be female, have history of DM, HTN, dyslipidemia and CKD. Stroke patients were likely to have Atrial fibrillation, PVD, systolic LV dysfunction as well as CAD when compared to those without Stroke, they were also more likely receive NIV, IV inotropes and likely to have had cardiac PCI prior to this admission with AHF. Stroke patients had higher recurrence of stroke and one-year mortality rates. Conclusion: Patients who presented with AHF and history of stroke/TIA were having different clinical characteristics as well as comorbidities as compared to those without Stroke, with worse in-hospital and one-year outcome. The current study underlies the need to aggressively manage these high-risk patients.

Mass Psychogenic Illness in Haraza Elementary School, Tigray, Northern Ethiopia: Investigation to the nature of an Episode.

2020 ◽  
Author(s):  
Kiros Fenta ◽  
Tewolde Wubayehu ◽  
Nega Mamo Bezabih ◽  
Yrgalem Meles ◽  
Goitom Mehari ◽  
...  
Keyword(s):  
Elementary School ◽  
Cross Sectional Study ◽  
Northern Ethiopia ◽  
Community Members ◽  
Cross Sectional ◽  
School Activities ◽  
Co Morbidity ◽  
Facility Level ◽  
Psychogenic Illness ◽  
Study Participants

Abstract Background Mass psychogenic illness has been documented for more than 600 years in a variety of culture, ethnic, and religious settings. The aim of this study was to assess the nature and characteristics of mass psychogenic illness in Tigray, Northern Ethiopia, Methods School based cross-sectional study was conducted in haraza elementary school from January –February, 2020. Students who were victims of an episode were subjects of the study. A total of twelve students were investigated using semi-structured questionnaire for quantitative study. Seven key informant interviews were conducted using guiding questionnaires. Quantitative data was analyzed using XL sheet while qualitative data was analyzed manually. Result the mean age of study participants was 14 years (SD±1.3). Majority (87%) were teenage female students. The incident was unspecified disease with psychiatric disorder, migraine and syncope with no plausible organic causes. An important feature of migraine and syncope was their co-morbidity with mass psychogenic illness. The community perceived that Evil-devil force and blaming as being an evil-eye were common causes for the occurrence of an episode. Conclusion lack of empirical knowledge and awareness about its management and prevention among community members and health professionals resulted exaggerated rumor that would perceived as newly emerging disease that affected school activities. Integrating MPI in PHEM package at health facility level, advocacy workshops for media and other relevant stakeholders will minimize its impact for the future.

Sign in / Sign up

Export Citation Format

Share Document