Contexte: L’hémorragie intraventriculaire néonatale est associée à des séquelles neuro-développementales, mais le risque à long terme d'autres issues est inconnu. L'association entre l'hémorragie intraventriculaire néonatale et le risque de morbidité durant l’enfance a été évaluée. Méthodes: Une cohorte longitudinale de 794,384 bébés nés entre 2006 et 2016 au Québec, Canada a été analysé. Les nouveau-nés ont été suivis jusqu'à une période de 12 ans après leur naissance, pour identifier les hospitalisations subséquentes. Dans les modèles de régression de Cox, ajustés pour les caractéristiques maternelles et néonatales, les « hazard ratios » et intervalles de confiance (IC) à 95% ont été estimés pour l'association entre l'hémorragie intraventriculaire avec l’hospitalisation ultérieure. Résultats: Au total, 1,322 nourrissons (0,2%) ont développé une hémorragie intraventriculaire de grade I à IV. L'incidence de l'hospitalisation était plus élevée chez les bébés présentant une hémorragie intraventriculaire que chez les bébés sans hémorragie (23,8 vs 5,7 par 100 personnes-années). Comparés aux bébés sans hémorragie, les bébés affectés avaient un risque d'hospitalisation 1,56 fois plus élevé (IC à 95% 1,43-1,70). Le risque était 2,81 fois plus élevé pour les grades III/IV (IC à 95% 2,23 à 3,53) comparés à ceux nés sans hémorragie. Les hémorragies intraventriculaires pré-terme était associée à 1,82 fois le risque (IC 95% 1,66-2,00) comparés aux bébés nés termes sans hémorragie. Les hémorragies intraventriculaires à terme étaient associées à 3,19 fois le risque d'hospitalisation (IC 95% 2,55-4,00), comparativement à ceux nés termes sans hémorragie. Les raisons principales des hospitalisations comprenaient les maladies du système nerveux central, ophtalmologiques, musculo-squelettiques et cardiovasculaires. Conclusion: L'hémorragie intraventriculaire, notamment de grades sévères et parmi les bébés à terme, est un déterminant important du futur risque d’hospitalisation durant l’enfance. / Background: Neonatal intraventricular hemorrhage is associated with neurodevelopmental sequelae, but the long-term risk of other outcomes is unknown. The association between neonatal intraventricular hemorrhage and the risk of childhood morbidity was assessed. Methods: A longitudinal cohort of 794,384 infants born between 2006 and 2016 in Quebec, Canada was analyzed. Infants were tracked over time to identify later hospitalizations with follow-up extending up to 12 years after birth. In Cox regression models adjusted for maternal and infant characteristics, the hazard ratios and 95% confidence intervals (CI) were estimated for the association of intraventricular hemorrhage with future hospitalization. Results: A total of 1,322 (0.2%) infants developed grade I to IV intraventricular hemorrhage. The incidence of childhood hospitalization was higher in infants with intraventricular hemorrhage than in infants without hemorrhage (23.8 vs. 5.7 per 100 person-years). Compared with no hemorrhage, infants with intraventricular hemorrhage had 1.56 times the risk of hospitalization (95% CI 1.43-1.70). The risk was 2.81 times higher for grade III/IV hemorrhage (95% CI 2.23-3.53) compared to those born without hemorrhage. Preterm intraventricular hemorrhage was associated with 1.82 times the risk (95% CI 1.66-2.00) compared to term infants born without hemorrhage. Intraventricular hemorrhage at term was associated with 3.19 times the risk of hospitalization (95% CI 2.55-4.00) compared to those born term without hemorrhaging. Primary reasons for hospitalizations included central nervous system, ophthalmologic, musculoskeletal, and cardiovascular disorders. Conclusion: Intraventricular hemorrhage, especially of higher grades and in term neonates, is an important determinant of the future risk of child hospitalization.

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18–64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

No description available.

Systemische Infektionen mit S. aureus (MSSA und MRSA) und Infektionen des Gefäßzugangs bei HD-Patienten sind eine der wichtigsten Ursachen für Morbidität und Mortalität in dieser speziellen Population. Infektionsrisikos stellen die zunehmende Verwendung von Fremdkörpern, wie Katheter und Graft als Gefäßzugänge, sowie die intensivmedizinische Behandlung bei älteren und multimorbiden Patienten dar. Unter den bakteriell bedingten Infektionen bleiben Staphylokokken der am häufigsten nachgewiesene Stamm. Mit dem zunehmenden Gebrauch von Vancomycin zur Behandlung von MSSA-Infektionen hat das Vorkommen von MRSA zugenommen. Dies macht die Entwicklung von alternativen Antibiotikaregimen nötig, die eine Selektion von MRSA-Spezies verhindern. Unter dieser Überlegung wurde auf die Behandlung mit Vancomycin bei Zugangs-bezogenen Infektionen verzichtet. Es wurde im Jahr 2000 durch ein Standardregime bestehend aus Flucloxacillin und Rifampicin ersetzt. Mithilfe eines Screeningprogramms wurde nach MSSA- (n=88) und MRSA- (n=1) Kolonisationen gesucht. Dies gelang mit Hilfe von Querschnitts-Screenings und Indikations-Screeninguntersuchungen bei Aufnahme über den Zeitraum von 2000 bis 2010. Eine Besiedlung mit MRSA wurde bei nur einem Patienten während des 10-Jahres-Screenings registriert. Die gefundenen MSSA-Kolonisationen bei HD-Patienten beeinflussten die Morbidität und Mortalität nicht. Die Anzahl an HD-Patienten mit MSSA-Kolonisation nahm während des Beobachtungszeitraums von zehn Jahren ab Behandlungen mit dem Vancomycin-freien Regime waren generell erfolgreich und resultierten in einem Rückgang der klinischen und laborativen Infektionsmarker und/oder negativen Blutkulturen. Es konnte gezeigt werden, dass mit dem Gebrauch von vancomycinfreien Antibiotikaregimen ein erfolgreiches Management von Staphylokokkus-assoziierten Zugangsinfektionen bei HD-Patienten möglich ist.

Background: This study examined the association of 25-hydroxyvitamin D (25(OH)D) and C-reactive protein (CRP) with postoperative medical complications and one year mortality of elderly patients sustaining a low-energy cervical hip fracture scheduled for surgery. We hypothesized that vitamin D deficiency and CRP in these patients might be associated with an increased 1-year mortality. Methods: The prospective single-center cohort study included 209 patients with a low-energy medial femoral neck fracture; 164 women aged over 50 years and 45 men aged over 60 years. Referring to 1-year mortality and postoperative medical complications multiple logistic regression analysis including 10 co-variables (age, sex, BMI, ASA, creatinine, CRP, leukocytes hemoglobin, 25(OH)D, vitamin D supplementation at follow-up) was performed. Results: Vitamin D deficiency was prevalent in 87 % of all patients. In patients with severe (<10 ng/ml) and moderate (10–20 ng/ml) vitamin D deficiency one year mortality was 29 % and 13 %, respectively, compared to 9 % in patients with > 20 ng/ml 25(OH)D levels (p =0.027). Patients with a mild (CRP 10–39.9 mg/l) or active inflammatory response (CRP ≥ 40 mg/l) showed a higher one year mortality of 33 % and 40 % compared to 16 % in patients with no (CRP < 10 mg/l) inflammatory response (p = 0.002). Multiple logistic regression analysis identified CRP (OR 1.01, 95 % CI 1.00- 1.02; p = 0.007), but not 25(OH)D (OR 0.97, 95 % CI 0.89-1.05; p = 0.425) as an independent predictor for one year mortality. 20 % of patients suffered in-hospital postoperative medical complications (i.e. pneumonia, thromboembolic events, etc.). 25(OH)D (OR 0.89, 95 % CI 0.81–0.97; p = 0.010), but not CRP (OR 1.01, 95 % CI 1.00-1.02; p = 0.139), was identified as an independent risk factor. Conclusion: In elderly patients with low-energy cervical hip fracture, 25(OH)D is independently associated with postoperative medical complications and CRP is an independent predictor of one year mortality.

Tuberculosis - re-established problem of European population Abstract The main objective of this study is to collect data and to provide information about current tuberculosis burden on European population and to capture the most important trends in development of spreading the infection in the European region in the period 1995-2010. A typology of the countries of the European region is performed on the base of main features of tuberculosis morbidity and mortality in the period 2008-2010. Detailed analysis of level of tuberculosis morbidity and mortality for each region was based on available data. The study also presents the plans of major world and European organizations to eliminate spread of tuberculosis.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Developing an Automatic Speech Recognition (ASR) system for the Somali language, though not novel, is not actively explored; hence there has been no success in a model for conversational speech. Neither are related works accessible as open-source. The unavailability of digital data is what labels Somali as a low resource language and poses the greatest impediment to the development of an ASR for Somali. The incentive to develop an ASR system for the Somali language is to contribute to reducing the Maternal Mortality Rate (MMR) in Somalia. Researchers acquire interview audio data regarding maternal health and behaviour in the Somali language; to be able to engage the relevant stakeholders to bring about the needed change, these audios must be transcribed into text, which is an important step towards translation into any language. This work investigates available ASR for Somali and attempts to develop a prototype ASR system to convert Somali audios into Somali text. To achieve this target, we first identified the available open-source systems for speech recognition and selected the DeepSpeech engine for the implementation of the prototype. With three hours of audio data, the accuracy of transcription is not as required and cannot be deployed for use. This we attribute to insufficient training data and estimate that the effort towards an ASR for Somali will be more significant by acquiring about 1200 hours of audio to train the DeepSpeech engine

This thesis consists of three essays in applied microeconomics: First, heat and school absence: evidence from a survey of Indian children. Second, heatwaves and short-term morbidity in India. Third, intra-family marriage and pregnancy outcomes. Chapter 1. India is the second most populous country on earth with young people representing a significant number of the population resulting in data that indicates such figures at 38 per cent. With such high numbers, major consideration must be given into developing informed and targeted policies to ensure positive educational outcomes for young people. This paper contributes to existing literature by investigating the impact of high temperatures on students’ rates of absenteeism, relying on the short-term exogenous variation in daily maximum temperatures. The paper highlights the heterogeneity of the effect of temperature by climate zone. To create data, we link information on children’s school absences from the India Human Development Survey (IHDS-II) in combination with meteorological data from the ERA-Interim archive taken from a thirty day period prior to individual interview dates. Our findings suggest that high temperatures have a substantial negative impact on students’ attendance in rural areas. However, limited evidence of such an effect is found in urban areas. Our results therefore indicate a need to implement future in-depth studies. Chapter 2. Within this chapter, we investigate the impact of prolonged heat exposure on individuals short-term morbidity rates over a thirty day period prior to the interview date. We work with a broad dataset and use an econometric model that utilizes plausibly exogenous variation in high weather temperatures. We implement the percentile-based approach and three different heatwave metrics as a innovative way of defining and capturing the impact of heatwaves on health outcomes. Our results show that heatwave intensity of the eighty-fifth percentile over the duration of three consecutive days of extensive heat has a significant adverse effect on individuals short-term morbidity. More so, our findings indicate a disparity between genders in relation to the impact of heatwaves. Finally, it can be suggested that individuals having to travel an extensive distance in order to access water are most affected by high temperatures. Chapter 3. Millions of people worldwide are married to their blood relatives, yet the resulting impact on offspring health continues to be debated. Within this paper, we provide evidence around this debate by studying the birth outcomes from a large, representative sample of Indian women in varying marital circumstances. We explore the impact of intra-family marriage on negative pregnancy outcomes including stillbirth, miscarriage, and child death after birth. We utilize an ordinary least squares model (OLS), which controls for a wide range of financial and family factors. The results show that being a woman related to her husband by blood increases the probability of experiencing negative pregnancy outcomes by 2.8 percentage points. Our finding is robust using the instrumental variable approach (IV). The instrumental variable represents the ambient level of violence against women, which positively affects the probability of consanguineous marriage. The IV approach leads to a slightly smaller adverse impact of 2.2 percentage points. In addition, the OLS results provide suggestive evidence that intra-family marriage has no heterogeneous impact across religion types.

Background: In Sweden, annually, approximately 1,5% out of 115 000 newborns are twins. Itis widely documented that multiple gestation pregnancy contributes to an increased risk of maternal morbidity. Nevertheless, the direct impact of multiple gestation on some maternal complications remains debated. The expected difference in maternal characteristics between populations may also contribute to divergent conclusions. Objective: The aim of this study is to assess the risk of maternal complications and the occurrence of different mode of delivery during pregnancy and childbirth in nulliparous women with multiple gestation. Study design: A population-based cohort study based on data from the Swedish Medical Birth Register between 1999 and 2017.Results: In total 13 014 nulliparous women with multiple gestation and 850 021 nulliparous women with single gestation were included in the study. Women with multiple gestation were slightly older and more often gave birth prematurely than single gestation counterparts. Pregnancy through IVF were almost five times as common in the multiple gestation group. These women suffered a four times increased risk of both preeclampsia and severe forms of preeclampsia. Multiple gestation in nulliparous women was, in this cohort, associated with nearly six times elevated risk of developing ICP, relative to single gestation counterparts. Intrapartal bleeding and post-partum hemorrhage were also more common in women with multiple gestation. The majority of the nulliparous women with multiple gestation had a caesarean section, elective or acute, while nulliparous women with single gestation more often delivered vaginally. An increased risk for placenta previa and GDM, as a consequence of multiple gestation, could, however, not be observed in this study. Conclusion: Multiple gestation is associated with increased risk of several obstetric complications. It is important that healthcare professionals become fully aware of these risks in the encounter with the woman in order to be able convey appropriate information and take appropriate preventive measures. Continued work to reduce multiple gestation caused by IVF is also recommended. / Bakgrund: I Sverige föds ca 115 000 barn årligen och av dessa är knappt 1,5% tvillingar. Flerbördsgraviditet innebär ökad risk för maternell morbiditet, men forskningen går isär gällande flerbörds inverkan på somliga komplikationer. Dessutom kan variationer i maternella karakteristika skilja sig åt mellan populationer. Syfte: Syftet med denna uppsats är att studera risken för maternella komplikationer samt förekomst av olika förlossningssätt under graviditet och förlossning vid flerbörd hos förstföderskor. Metod: En populationsbaserad kohortstudie utifrån data från Medicinska födelseregistret mellan åren 1999–2017.Resultat: Totalt ingick 13 014 förstföderskor gravida med flerbörd i studien och 850 021enkelbörd. Flerbördsgruppen var något äldre än de i enkelbördsgruppen och de födde oftare prematurt. Graviditet genom IVF var nästan fem gånger så vanligt i flerbördsgruppen. Preeklampsi och svår preeklampsi var fyra gånger så stor i flerbördsgruppen och risken för ICP var nästan sex gånger så stor. Även intrapartal blödning och PPH var betydligt vanligare hos kvinnorna i flerbördsgruppen. Majoriteten av personerna i flerbördsgruppen förlöstes medkejsarsnitt, planerat eller akut, medan förstföderskorna i enkelbördsgruppen i större utsträckning födde vaginalt. Ökad risk för placenta praevia och GDM kunde ej observeras. Slutsats: Att vänta flerbörd är förenat med en ökad risk för flera obstetriska komplikationer. Denna risk är viktigt att vårdpersonal är medvetna om i mötet med kvinnan för att kunna informera, förebygga och behandla. Även ett fortsatt arbete att minska flerbörd som uppkommit genom IVF rekommenderas.