Other morbidity

Possible long-term neural damage linked to heavy use of ecstasy is a growing concern. 

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The risk factors for dry eye are listed in Table 60-8. Of interest, the use of caffeine is associated with a decreased risk of dry eye. Dry eye that is left untreated can cause loss of vision or other morbidities over time.30... 

Control groups have one major purpose to allow discrimination of patient outcomes (for example, changes in symptoms, signs, or other morbidity) caused by the test treatment from outcomes caused by other factors, such as the natural progression of the disease, observer or patient expectations, or other treatment. ... 

Schmidt-Nowara WW, Coultas DB, Wiggins C, Skipper BE, Samet JM. Snoring in a Hispanic-American population risk factors and association with hypertension and other morbidity. Arch Intern Med 1990 150(3) 597-601. 

Rush also maintained that crimes were diseases. This idea is often credited, falsely, to modern psychiatrists. One of the classes of mental illnesses he devised he called derangements in the will. Murder and theft are symptoms of this disease-complex. I have selected, Rush writes, those two symptoms of this disease (for they are not vices) from its other morbid effects, in order to rescue persons affected with them from the arm of the law, and to render them the subjects of the kind and lenient hand of medicine. Just how kind and lenient Rush s hand was we shall see presently. It is worth noting that in the foregoing passage Rush admits, perhaps unwittingly, that he considers murder and theft diseases not because they are diseases, but to justify the transfer of murderers and thieves from the control of policemen and judges to that of physicians and the keepers of madhouses. 

TTie effect of age on the pharmacokinetics of oxycodone has been reviewed [52 ]. The concentration of oxycodone in patients aged 70-90 was twice as high as in younger adults at 12 hours after ingestion, and mean exposure was 50-80% higher. Other morbidities, such as hepatic dysfunction and renal impairment, also affect oxycodone concentrations. In hepatic dysfunction, clearance is reduced by 75%, volume of distribution increased by 50%, and half-life prolonged from 3 to 14 hours. In renal dysfunction, distribution volume is increased and half-life prolonged. 

CBA relies heavily on the costs of environmental impacts. Some impacts may be easily expressed in monetary values, like crop loss or even increased morbidity among people. Others, like impact on biodiversity and the depletion of natural resources, are more difficult to describe in terms of monetary values. Large time scales and global impacts also complicate the methodology and confuse the understanding of the results. Some of the environmental consequences of today s activities appear only after several hundred or thousand yeats. Even low interest rates tend to diminish these types of impact, even if they are very large. 

NSAIDs are used as the first-line treatment of rheumatoid arthritis, osteoarthritis, systemic lupus erythematosis and other inflammatory diseases, and are thus amongst the most widely used dtugs in the developed world. This widespread use inevitably entailed a considerable associated morbidity, in particular a high incidence of gastric toxicity. In the USA alone, perforations, ulcers and bleeds lead to the hospitalisation of 100,000 patients per year, and about 15% of these die while under intensive care. 

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. 

HIV/AIDS-induced mortality and morbidity of workers can result in significant economic loss to business, including direct cost due to increased insurance premiums paid by employers, costs due to increased benefits paid by employers, indirect costs due to lost time due to illness, lost and reduced productivity, and other costs, like cost to new training and hiring of staff. Famham and Gorsky (1994) used a Markov model to calculate the expected medical, disability, employee replacement, life insurance, and pension costs to a business firm in the US for an HIV-infected... 

People known to be at risk for anaphylaxis should wear up-to-date medical identification such as a bracelet or other jewelry, or carry an Anaphylaxis Wallet Card listing their confirmed trigger factor(s), relevant co-morbidities such as asthma, and concurrent medications [45]. 

The usually accepted prevalences for generalized anxiety disorder (GAD) are around 1.6% for current, 3.1% for 1 year and 5.1% lifetime (Roy-Byrne, 1996). The condition is twice as common in women as in men (Pigott, 1999). A small minority (10%) have GAD alone, and about the same proportion suffer from mixed anxiety and depression. Morbidity is high. About a half of those with uncomplicated GAD seek professional help, but two-thirds of those with comorbid GAD do so. Up to a half take medication at some point. The condition may coexist with other anxiety disorders such as phobias, with affective disorders, or with medical conditions such as unexplained chest pain and irritable bowel syndrome. 

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. 

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... 

Patients with diarrhea should be questioned about the onset of symptoms, recent travel, diet, source of water, and medication use. Other important considerations include duration and severity of the diarrhea along with an accounting of the presence of associated abdominal pain or vomiting, blood in the stool, stool consistency, stool appearance, stool frequency, and weight loss. Although most cases of diarrhea are self-limited, infants, children, elderly persons, and immunocompromised patients are at risk for increased morbidity. 

Infections are an important cause of morbidity and mortality in patients receiving hemodialysis. The cause of infection is usually related to organisms found on the skin, namely Staphylococcus epidermidis and S. aureus. Other organisms have also been found to cause access-related infections. The greatest risk to patients receiving hemodialysis is the development of... 

Anxiety disorders are among the most frequent mental disorders encountered by clinicians. Anxiety disorders often are missed or attributed incorrectly to other medical illnesses, with most patients being treated inadequately. The burden of detection and diagnosis most often falls to primary-care clinicians, to whom most patients present in the context of other complaints. Untreated anxiety disorders may result in increased healthcare utilization, morbidity and mortality, and poorer quality of life. 

Patients receiving LT4 therapy who are not maintained in a euthyroid state are at risk for long-term adverse sequelae. In general, overtreatment and a suppressed TSH is more common than undertreatment27 with an elevated TSH. Patients with long-term overtreatment may be at higher risk for atrial fibrillation and other cardiovascular morbidities, depression, and post-menopausal osteoporosis. Patients who are undertreated are at higher risk for hypercholesterolemia and other cardiovascular problems, depression, and obstetric complications. 

Hyperlipidemia is seen in up to 60% of heart, lung, and renal transplant patients and greater than 30% of liver transplant patients.64 66 As a result of elevated cholesterol levels, transplant recipients are not only at an increased risk of atherosclerotic events, but emerging evidence also shows an association between hyperlipidemia and allograft vasculopathy.66 Hyperlipidemia, along with other types of cardiovascular disease, is now one of the primary causes of morbidity and mortality in long-term transplant survivors.67... 

The discovery of antimicrobials is among the greatest medical achievements of the twentieth century. Prior to the antimicrobial era, patients who contracted common infectious diseases developed significant morbidity or perished. The discovery of penicillin in 1927, followed by the subsequent discovery of other antimicrobials, contributed to a significant decline in infectious disease-related mortality during the next five decades. However, since 1980, infectious diseases related mortality in the United States have begun to increase, in part owing to increases in antimicrobial resistance. 

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