Morbidity and mortality

As the prevalence of obesity increases worldwide, so does the prevalence of associated co-morbidities type-2 diabetes, chronic obstructive sleep apnoea, cardiovascular disease (hyper-tension, coronary artery disease and congestive heart failure, stroke and peripheral vascular disease), fatty liver disease, various malignancies (Table 7.2), gallstones, subfertility, musculo-skeletal problems and depression. 

In a prospective study of over 900,000 adults in the USA, increased BMI was associated with increased death rates from all cancers combined, as well as for cancers at multiple specific sites. The authors of this study estimated that obesity and overweight in the USA could account for 14% of all deaths from cancer in men and 20% in women. As well as the substantial human cost from obesity-associated disease and premature mortality, obesity has serious consequences for the economy. In the UK, it has been estimated that obesity leads to 18 million sick days a year, 40,000 lost years of working life and shortening of life by 9 years on average. Treatment costs to the National Health Service are of the order of 0.5 billion a year and the impact on the wider economy may be as high as 2 billion.  

---

Cardiac arrhythmias are an important cause of morbidity and mortality approximately 400,000 people per year die from myocardial infarctions (MI) in the United States alone. Individuals with MI exhibit some form of dysrhythmia within 48 h. Post-mortem examinations of MI victims indicate that many die in spite of the fact that the mass of ventricular muscle deprived of its blood supply is often quite small. These data suggest that the cause of death is ventricular fibrillation and that the immediate availability of a safe and efficacious antiarrhythmic agent could have prolonged a number of Hves. The goals of antiarrhythmic therapy are to reduce the incidence of sudden death and to alleviate the symptoms of arrhythmias, such as palpitations and syncope. Several excellent reviews of the mechanisms of arrhythmias and the pharmacology of antiarrhythmic agents have been pubflshed (1,2). 

Viral infections continue to be significant causes of morbidity and mortality and at the same time continue to be resistant to treatment by small molecules. Avridine (6) is an antiviral compound which has shown some activity in a variety of animal tests apparently based upon its ability to stimulate a number of cells to produce the high molecular weight endogenous antiviral substance interferon. Thus, the compound is believed to operate indirectly by stimulating the body s own natural defenses against viral penetration into host cells. Avridine is synthesized by... 

Oxagrelate (104) is of interest as a platelet antiaggretory agent and is thus of potential value in preventing thrombus formation in blood vessels. It may also be of potential value in preventing arteriosclerotic lesions in coronary arteries - a substantial cause of morbidity and mortality in... 

Increased morbidity and mortality is associated with increases in outdoor particle concentrations (U.S. Environmental Protection Agency 1995). Of particular concern are the particles smaller than 2.5 micrometers in diameter, which are more likely to deposit deep inside the lungs (U.S. Environmental Protection Agency 1995). Some particles, biological in origin, may cause allergic or inflammatory reactions or be a source of infectious disease. 

Systolic pressure, or maximum blood pressure, occurs during left ventricular systole. Diastolic pressure, or minimum blood pressure, occurs during ventricular diastole. The difference between systolic and diastolic pressure is the pulse pressure. While diastolic blood pressure has been historically been used as the most relevant clinical blood pressure phenotype, it has now been clearly established that systolic blood pressure is the more important clinical predictor for cardiovascular morbidity and mortality. More recently, additional attention is focussed on the importance of pulse pressure, i.e. the blood pressure amplitude, as a predictive factor for cardiovascular disease. 

Morbidity and mortality may be reduced by replacing amino acids lost from tissue breakdown (eg, renal failure)... 

Anxiety is a normal part of mental life and plays a crucial role in human psychological development and other forms of learning. Although systematic studies are lacking, suppression of normal levels of anxiety could impair the development of adaptive coping mechanisms. On the other hand, disabling anxiety impairs adaptation as well and is associated with significant morbidity and mortality. 

The dramatic decrease in the morbidity and mortality of HIV-infected individnals in the last decade, due to the wide use of HAART, has been somewhat tempered by the emergence of mid-long term toxicities. A characteristic body fat redistribntion and metabolic changes, inclnding dyslipidemia and insnlin resistance, are amongst the most prevalent and worrisome consequences (Carr et al. 2003). As HIV-infected individnals have increasing life expectancies, the risk for cardiovascnlar complications has emerged as an important canse of morbidity and mortality and preventive measnres should be considered to minimize their impact (Weber et al. 2006). 

The tetrodotoxins (TTXs) and saxitoxins (STXs) have in common the ability to block sodium channels of excitable membranes (1—5), Saxitoxin and tetrodotoxin are some of the most potent non-proteinaceous neurotoxins known and are responsible for significant human morbidity and mortality (6, 7). Although for many years the biosynthetic origin(s) of TTXs and STXs has not been identified, recent evidence indicates that bacteria may be a source. 

All the above effects will ultimately lead to reduction in morbidity and mortality and an improvement in the quality of life. 

Cost-benefit analysis uses monetary valuations of the morbidity and mortality consequences of diseases or interventions. This allows estimation of the absolute and relative net social benefit of intervention, calculated as the monetary value of the consequences of an intervention minus the direct costs. Any health or social care intervention with a net social benefit greater than zero (i.e. the benefits are greater than the costs) is worth undertaking. Two approaches have typically been used to value outcomes in monetary values. The first is the human capital approach, where the monetary value of benefit represents the value of changes in the amount or type of work done or use of leisure time as... 

It is cmcial that an economic study includes the health-related consequences of morbidity and mortality. These could be measured as number of years of life lost, reductions in health status, and quality of remaining years of life due to morbidity for both patients and informal carers. These consequences should also be valued to reflect the preferences of individuals and society for changes in the length and quality of life or health. 

Paice JA, Ferrans CE et al (2000) Topical capsaicin in the management of HIV-associated peripheral neuropathy. J Pain Symptom Manage 19(l) 45-52 Palella FJ Jr, Delaney KM et al (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 338(13) 853-860... 

The severity of the disease, not only in terms of its morbidity and mortality and the... 

Woo J, Lam CW, Kay R, Wong AH, Teoh R, Nicholls MG. The influence of hyperglycemia and diabetes melhtus on immediate and 3-month morbidity and mortality after acute stroke. Arch Neurol 1990 47 1174-1177. 

Mohr JP, Sacco RL. Morbidity and mortality of stroke. In Moore, WS editor. Surgery for cerebrovascular disease. W.B. Saunders Company, 1996 p 9-15. 

Health Risk Estimates for 2,3,7,8-Tetrachlorodibenzodloxln in Soil," Centers for Disease Control, Morbidity and Mortality, Weekly Report, 1984. 

Preterm labour is the major cause of perinatal morbidity and mortality. Oxytocin antagonists offer an attractive approach to prevention. Chapter 7 reviews three decades of medicinal chemistry in this field. The peptide approach has resulted in valuable injectable products. Selectivity over the related vasopressin receptors and improvement in pharmacokinetic profile have been the key challenges for more recent non-peptide programmes, and these seem likely to yield orally available medicines. 

DAWN is a morbidity and mortality information system, funded by the National Institute on Drug Abuse, in which data are collected from a sample of more than 800 hospitals located in 27 major metropolitan areas in the continental United States, from a National panel of hospitals outside of these areas, and from medical examiners/coroners located in 26 major metropolitan areas. 

In the recently released book on worldwide compliance issues (Adherence to Long-term Therapies, Evidence for Action),7 published by the World Health Organization, researchers indicate that the problem of noncompliance is worse in countries in the developing world than in countries in the industrialized world. Many parts of the United States have similar morbidity and mortality rates as countries in the Third World.8 Specific disease states may have significant additional noncompliance ramifications due to the development of drug-resistant strains of bacteria.9 Many times what is necessary is referral to specific clinicians for individualized treatment and monitoring to enhance compliance. The case histories provided in this text will allow you to follow what others have done in similar situations to optimally help patients succeed in improving compliance rates and subsequent positive health outcomes. 

O Hypertension is widely prevalent and accounts for significant morbidity and mortality, as well as billions of dollars in direct and indirect costs. 

Hypertension is widely prevalent and accounts for significant morbidity and mortality, as well as billions of dollars in direct and indirect costs. Worldwide prevalence of hypertension is estimated to include 1 billion individuals. There are an estimated 7 million deaths per year that may be related to the diagnosis of hypertension.4 The prevalence of hypertension in the United States is estimated to include 65 million individuals and accounts for an estimated 59.7 billion dollars annually in direct and indirect costs.1... 

P-Blockers and ACE inhibitors are also indicated for post-myocardial infarction for the reduction of cardiovascular morbidity and mortality, as are aldosterone antagonists, in post-myocardial infarction patients with reduced left ventricular systolic function and diabetes or signs and symptoms of heart failure.2,48... 

Patients with asymptomatic left ventricular systolic dysfunction and hypertension should be treated with P-blockers and ACE inhibitors. Those with heart failure secondary to left ventricular dysfunction and hypertension should be treated with drugs proven to also reduce the morbidity and mortality of heart failure, including P-blockers, ACE inhibitors, ARBs, aldosterone antagonists, and diuretics for symptom control as well as antihypertensive effect. In African-Americans with heart failure and left ventricular systolic dysfunction, combination therapy with nitrates and hydralazine not only affords a morbidity and mortality benefit, but may also be useful as antihypertensive therapy if needed.66 The dihydropyridine calcium channel blockers amlodipine or felodipine may also be used in patients with heart failure and left ventricular systolic dysfunction for uncontrolled blood pressure, although they have no effect on heart failure morbidity and mortality in these patients.49 For patients with heart failure and preserved ejection fraction, antihypertensive therapies that should be considered include P-blockers, ACE inhibitors, ARBs, calcium channel blockers (including nondihydropyridine agents), diuretics, and others as needed to control blood pressure.2,49... 

---