Background: The interest in obstetrical complications that culminate with maternal death and the urgent need for improvement in these indexes led to the development of the concept of maternal near miss. From a normal situation, the patients are in a continuum that can evolve with the development of moderate and severe situations of health. Severe acute maternal morbidity (SAMM) (situation less severe) and near miss (NM) (situation more severe) are two degrees of situation immediately before maternal death. The main advantage of studying these cases is higher frequency when comparing with maternal deaths cases and that the determining factors are the same. This study aims to determine the ocurrence of SAMM and NM situations in two maternities of reference of the state of Sergipe, determine the prevalence of the event and describe the risk factors associated. Casuistic and methods: A cross sectional study with double controls was conducted in patients who were pregnant sometime and were hospitalized in two reference maternities of Sergipe state. The patients answered a survey about issues relevant to the subject. For categorical variables was used Fisher s exact test. For normal continuous variables was applied the Student t test and for the not normal, the U-Mann-Whitey test. Odds ratio and confidence interval were used whenever possible. Multivariate analysis was performed and p <0,05. Results: There were 16,243 live birth deliveries, and occurred 1102 SAMM, 77 NM and 17 maternal deaths cases. The prevalence of SAMM + NM founded were, respectively, 7.6 cases/1000 LB, the mortality index was 18% (4.5 cases for each death) The main causes of SAMM and NM were respectively: 67.5% by hypertensive causes and 87.1% by necessity of invasive procedures. High age, low income, absence of prenatal, high rates of cesarean section, previous abortion and low weight of the baby at birth with unfavorable perinatal prognosis were statistically significant for the study group. Multivariate analysis showed that the number of eligibility criteria for NM was related with the severity of the situation. Conclusions: The situations of SAMM and NM in the two maternities studied reached significant values. Study NM can be the most efficiently way of conducting internal audits for the improving of the quality of services. Protocols based on adverse situations like these, where the detection can be made on the exact point of failure, can recommend conducts and interventions able to save lives. / Introdução: O interesse por complicações em obstetrícia que culminassem com morte materna e a necessidade urgente da melhora desses índices resultou no desenvolvimento do conceito de near miss materno. A partir de uma situação normal, a paciente insere-se em um continuum que pode evoluir com o desenvolvimento de situações de gravidade moderada e intensa. Morbidade materna grave (MMG) e near miss (NM) são duas denominações dadas às situações imediatamente anteriores ao óbito materno. A grande vantagem em se estudar esses casos é justamente a sua frequência superior em relação aos casos de morte materna (MM) e que os fatores determinantes são os mesmos. Este estudo tem por objetivos: determinar a ocorrência de situações de MMG e NM em duas maternidades de referência do estado de Sergipe, determinar a prevalência do evento nesses locais e descrever os fatores de risco associados. Casuística e métodos: Foi realizado estudo do tipo transversal com duplo controle em pacientes que em algum momento estiveram gestantes e permaneceram internadas em situações de risco nas duas maternidades de referência do Estado de Sergipe no período de um ano. As pacientes responderam a um questionário que continham questões sobre o assunto. Para a análise estatística das variáveis categóricas foi utilizado o teste exato de Fisher. Para as variáveis contínuas normais e para tabelas 2x2 foi aplicado o teste t de Student e para tabelas maiores o teste do qui-quadrado. Para as tabelas não-normais foi aplicado o teste de U-Mann-Whitey. Cálculo do Odds ratio e intervalo de confiança foram utilizados sempre que possível. Neste estudo foi realizada análise multivariada e o valor de p< 0,05 foi considerado. Resultados: Dos 16.243 partos, ocorreram 1102 casos de MMG, 77 casos de NM e 17 MM. A prevalência de MMG + NM foi de 72,6 casos /1000 NV, o índice de mortalidade foi de 18% (4,5 casos para cada morte). As principais causas de MMG e NM foram respectivamente: 67,5% por causas hipertensivas e 87,1% devido à necessidade de realização de procedimentos invasivos. Idade elevada, baixa renda, a não realização de pré natal, maior índice de parto cesáreo, antecedentes obstétricos de aborto anterior e cesárea anterior, baixo peso do RN ao nascer com prognóstico perinatal desfavorável mostraram-se estatisticamente significantes para o grupo estudado. A análise multivariada demonstrou que a quantidade de critérios de elegibilidade de NM esteve relacionada à gravidade do quadro. Conclusões: As situações de NM + MMG nas duas maternidades estudadas atingiram valores expressivos. Estudar NM pode ser o modo mais eficiente de realização de auditorias internas na busca da melhora da qualidade dos serviços. Protocolos baseados em situações adversas como estas, onde pode ser feita a detecção exata do ponto de falha, podem recomendar condutas e intervenções possivelmente capazes de salvar vidas.

Orientadores: Jose Guilherme Cecatti, Ellen Hardy / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-06T20:37:00Z (GMT). No. of bitstreams: 1 Sousa_MariaHelenade_D.pdf: 3645996 bytes, checksum: 2da8a09da4948fa1321c12c5e8548c1c (MD5) Previous issue date: 2006 / Resumo: Objetivos: inicialmente o objetivo foi identificar os óbitos registrados como maternos no ¿Sistema de Informações sobre Mortalidade¿ (SIM), os nascimentos no ¿Sistema de Informações sobre Nascidos Vivos¿ (SINASC), obter as Razões de Mortalidade Materna (RMM) e identificar diagnósticos e procedimentos aproximados pelos critérios mais conhecidos de morbidade materna grave, analisando as mortes de mulheres residentes nas capitais brasileiras no ¿Sistema de Informações Hospitalares¿ (SIH) em 2002. Posteriormente o objetivo foi identificar no SIH todos os registros de mulheres no período grávido-puerperal que tivessem informações indicativas de morbidade materna grave; descrever os diagnósticos e procedimentos utilizados, propor a definição de um escore de morbidade materna e identificar as variáveis associadas à morte materna. Método: Estudo descritivo, populacional, análise de dados secundários. Inicialmente utilizaram-se dois sistemas vitais e o hospitalar, para as 26 capitais estaduais e o Distrito Federal do Brasil, em 2002. Para a primeira etapa foram obtidas as RMM e informações básicas das mortes maternas declaradas. A partir dessas mortes relacionou-se probabilisticamente o SIM com o SINASC e, em seguida, com o SIH, utilizando-se o programa ¿Reclink II¿, com estratégia de blocagem em múltiplos passos. Em seguida, realizou-se análise descritiva simples. Para a segunda etapa, as principais variáveis foram o diagnóstico principal e secundário e o procedimento solicitado e realizado durante a internação. Houve uma seleção inicial de registros de mulheres de 10 a 49 anos de idade, seguida de uma seleção daquelas que apresentaram pelo menos um item indicativo de morbidade materna grave (near miss). Para os relacionamentos do SIH com o SIM e do SIH com ele mesmo, estabeleceu-se estratégia de blocagem em três passos independentes. Para a análise dos dados foram calculadas as razões de near miss, descritos os diagnósticos e procedimentos, utilizada a técnica multivariada de componentes principais e ajustado o modelo de regressão logística. Resultados: Foram identificadas 339 mortes maternas em 2002, com RMM oficial e ajustada, respectivamente, de 46,4 e 64,9 (mortes por 100.000 nascidos vivos). Com o primeiro relacionamento foi possível localizar 46,5% das mortes maternas e, com o segundo, localizaram-se 55,2% das mortes. O diagnóstico mais freqüente foi o de infecção (13,9%), e o procedimento com maior porcentagem (39,0%) foi o de admissão à UTI. Para a segunda etapa, a RNM para o total dos municípios foi de 44,3/ 1.000 nascidos vivos. Foram identificadas 154 mortes maternas dentre os registros indicativos de near miss. A análise descritiva apontou como mais freqüentes os critérios graves relativos a infecção, pré-eclâmpsia e hemorragia. A análise por regressão logística resultou em 12 variáveis, entre elas quatro interações significativas. Conclusões: Os diagnósticos e procedimentos relatados no SIH mostraram a gravidade da condição mórbida materna em 66% dos óbitos maternos declarados, apesar das inconsistências entre os diversos sistemas. Para a segunda etapa, conclui-se que, apesar das limitações existentes no SIH, é promissora a perspectiva de utilizá-lo de forma rotineira, mas com esforços no sentido de melhorar a qualidade da AIH / Abstract: Objectives: initially the objective was to identify maternal deaths in the ¿Mortality Information System¿ (SIM), births in the ¿Live Births Information System¿ (SINASC), to obtain the Maternal Mortality Ratios (MMR) and to identify diagnosis and procedures related with the most common criteria of severe maternal morbidity, evaluating the deaths of women living in Brazilian capitals in the ¿Hospital Information System¿ (SIH) in 2002. Sequentially the objective was to identify in SIH all registers from women during pregnancy, delivery and post partum period who had information indicating severe maternal morbidity; to describe the diagnosis and procedures used; to propose a score of maternal morbidity and to identify variables associated to maternal death. Method: A population descriptive study, secondary data analysis. For the first step two vital systems and hospital system for the 26 capitals and the Federal District of Brazil, in 2002, were used. The MMR and basic information on maternal deaths were obtained. Using data available for these deaths, SIM was probabilistically linked with SINASC and after with SIH, using the software ¿Reclink II¿, with a multiple steps blocking strategy. Simple descriptive analysis was then performed. For the second step the main variables were the primary and secondary diagnosis and the requested and performed procedure during hospitalization. Initially there was a selection of registries of women between 10 and 49 years of age, followed by a selection of those presenting at least one criteria indicating severe maternal morbidity (near miss). For the linkages of SIH with SIM and with itself, a three independent steps blockage strategy was established. For data analysis the Near Miss Ratios were calculated and the diagnosis and procedures were described; the multivariate technique of principal components was used and then a logistic regression model was adjusted. Results: 339 maternal deaths were identified in 2002 with an official and adjusted MMR of respectively 46.4 and 64.9 (maternal deaths per 100.000 live births). With the first linkage it was possible to find 46.5% of the maternal deaths and 55.2% with the second one. The most frequent diagnosis was infection (13.9%) and the most frequent procedure was admission to ICU (39.0%). For the second step, the NMR for the total municipalities was 44,3/ 1.000 live births. Among the registries indicating near miss, 154 maternal deaths were identified. The descriptive analysis pointed out as more frequent the severe criteria related to infection, pre-eclampsia and hemorrhage. The analysis with logistic regression resulted in 12 variables, among them four significant interactions. Conclusions: The diagnosis and procedures informed in the SIH showed the severity of maternal morbidity in 66% of the deaths certified as maternal, despite the inconsistencies among the different systems. For the second step, although the existing limitations in the SIH, the perspective of using it routinely is promising, but only with efforts in order to improve the quality of the document which provides information for the registry / Doutorado / Ciencias Biomedicas / Doutor em Tocoginecologia

O Homem é parte integrante do sistema Ambiental. O ambiente cria impactos Nele e por sua vez ele também pode provocar impactos no Ambiente. O objetivo da tese foi identificar qual a intensidade e freqüência do impacto que a poluição atmosférica e a variabilidade das variáveis meteorológicas na saúde da população da Área Metropolitana do Porto (Portugal), através de um estudo epidemiológico ecológico. Escolheu-se o período de 2002 a 2005 para estudar um conjunto de cidades que contam com espaços urbanos, suburbanos e industriais mesclados, perto do litoral Atlântico com clima Mediterrânico. Usando como métodos a análise descritiva e multivariada (ACP), de correlação e regressão múltipla (RM), assim como índices de conforto térmico (ID, H, Te e Tev), trabalharam-se dados de admissões hospitalares (4 hospitais públicos) de doenças cardiovasculares (DCV) (401-405, Hipertensão; 410-414, DCV Isquêmica, 426-428, Insuficiência Cardíaca) e respiratórias (490-496, Asma/Bronquite; 500-507, Pneumoconioses), informações meteorológicas do Instituto de Meteorologia de Portugal (Temperatura, Umidade, Precipitação e Pressão) e valores diários e mensais do índice de Oscilação do Atlântico Norte (OAN), da NOAA, assim como, saídas de normais de pressão e médias de velocidade de vento do modelo NOAA e de 10 estações fixas de qualidade do ar pertencentes à Agencia Portuguesa do Ambiente (O3; NO2, NO, CO, SO2, PM10, PM2,5). Identificaram-se alguns períodos de temperaturas elevadas (38°C) durante o verão e inversões térmicas durante o inverno (2004/05), as quais criaram situações de estresse térmico por calor e muito frio (dos 1461 mais de 930 dias -24°C< TEv tmin Urmáx vmáx < 0°C), por um lado, e aumento da poluição, por outro. Esse aumento da poluição contribuiu para se observar maior número de casos por doenças respiratórias por Asma/bronquite (lag 3 dias durante inverno 2004/05 correlação com PM2,5=0,33), doenças Cardíacas Hipertensivas (regressão multivariada para Primavera, para PM10 com Beta=0,80, R2ajustado=0,076), e Insuficiências Cardíacas (regressão para Outono NO2 Beta = 0,42 com R2ajustado= 0,060). Encontrou-se também relação significativa e forte entre a variabilidade da Oscilação do Atlântico Norte (OAN) e de alguns poluentes durante o inverno (ex: correlação PM10=0,71, em 2003; PM2,5= 0,91, em 2005; SO2=0,45, em 2004). Uma importante conclusão, também sugerida por outros autores, é que as mudanças climáticas podem modificar a intensidade e regularidade da OAN, afetando assim a circulação atmosférica o que terá impacto direto na dispersão dos poluentes em pequena escala e conseqüentemente irá influenciar a saúde publica. / Humans are part of environmental system. Environment impacts on Humans and we so can impact on earth ecosystems. The thesis aims identify the intensity and frequency of air pollution and meteorological impact on Porto Metropolitan Area (PMA) public health, although a ecological epidemiological study. The 2002- 2005 period was select to study climatologically Mediterranean seaside cities with typical urban, suburban and industrial mixed spaces. The statistical methods used were: descriptive and multivariate (ACP) analyze, correlation and multiple regression, as well as, discomfort indices (ID, Te, Tev, H). Data set from 3 different institutions was analyzed: admission from 4 public hospitals referent to heart (401-405, Hypertension; 410-414, Ischemic cardiac, 426-428, Heart Insufficiency) and respiratory diseases (490-496, Asthma/Bronchitis; 500-507, Pneumoconioses), meteorological information from Meteorological Institute of Portugal.(Temperature, Humidity, Precipitation, Wind speed, Pressure) and daily and monthly North Atlantic Oscillation index values, from NOAA, as well as, pressure daily normal and wind velocity daily mean NOAA model output and from 10 fixed air quality stations (Environmental Portuguese Agency) the pollutants (O3; NO2, NO, CO, SO2, PM10, PM2,5) time series. Some high temperature (38°C) periods was identified during summertime and thermal inversions in the wintertime (2004 and 2005), which provoked stress for heat and cold (from 1461 days, 930 days the thermal sensation was -24°C< TEv tmin Urmáx vmáx < 0°C), and pollution increase. The air pollution increased the hospital admissions for respiratory diseases special Asthma/bronquitis (lag 3 days during 2004/05 Winter correlation PM2.5= 0.33), Cardiac Hypertension (Spring multivariate regression Beta= 0.80, R2ajusted= 0.076), and Heart insufficiency (Autumn multivariate regression NO2 Beta = 0.42 with R2ajustaded= 0.060). Significant and strong association was found between North Atlantic Oscillation (NAO) and some pollutants during Wintertime (eg.: correlation PM10=0.71, 2003; PM2.5=0.91, 2005; SO2=0.45, 2004). ). It is important to notice that some studies have already suggested that climate change can modify the intensity and regularity of the NAO, affecting the atmospheric general circulation and it could have a direct impact on pollutants dispersion in small scale and on public health.

Master of Science / Department of Animal Sciences and Industry / Christopher D. Reinhardt / Angus steers (n = 17,919) fed at a single feedlot in southwestern Kansas between 1997 and 2007 were used to evaluate the effects of various demographic and phenotypic characteristics (season of arrival, geographic origin, health status, rate of gain, quality grade, and yield grade) on feedlot health, performance, and carcass traits. Cattle were not commingled and were predominantly preconditioned and backgrounded prior to shipment to the feedlot. Season of arrival was categorized as winter (December, January, and February), spring (March, April, and May), summer (June, July, and August), or fall (September, October, and November). Regions were: SC = Texas, Oklahoma, and New Mexico; C = Colorado and Kansas; NC = Montana, Nebraska, and Wyoming; and SE = Georgia, Mississippi, South Carolina, Tennessee, Virginia, and West Virginia. Steers that originated in SC had the poorest ADG (P < 0.01) and those originating in C had the greatest ADG, HCW, and quality grade (P < 0.01). Steers that arrived during fall had the lowest ADG and those arriving during the summer had the greatest morbidity (P < 0.01). Morbidity decreased and performance increased with increasing initial BW; quality grade was only minimally related to arrival BW in steers which were not treated for disease. After accounting for yield grade differences, the association between morbidity and carcass quality and between quality grade and heavier final BW and HCW were diminished, although ungraded cattle had lower ADG, final BW, and HCW (P < 0.01). Increasing yield grade from 1 and 2 to yield grade 3 increased percentage Choice by 12.1 points (P < 0.01); there was no additional gain in quality grade moving to yield grade 4 and 5. More rapidly gaining steers were heavier and fatter at marketing; this translated to greater quality grade in all but steers with initial BW > 375 kg. Performance was very similar among cattle which graded Prime, Choice, and Select, suggesting that producers do not need to choose between performance and quality grade; instead, much of the difference in quality grade can be explained by differences in yield grade.

Master of Science / Department of Agricultural Economics / Kevin C. Dhuyvetter / When purchasing feeder calves, bulls are typically discounted relative to steers. Most would agree that a discount is warranted but determining the appropriate discount to apply is considerably more difficult. Being able to calculate this discount under varying conditions would help stock operators maintain a certain level of profitability or recognize opportunities to make more profit when excessive discounts are being applied. The goals of this study were to determine how castration timing affects performance (as measured by average daily gain), morbidity, and carcass quality and how morbidity affects performance and carcass quality. Ordinary Least Squares regression and logit models were estimated to quantify the effects of various management and environmental factors on performance, morbidity, and carcass quality. These model estimates of production variables along with price and cost assumptions were used to calculate breakeven purchase prices and price discounts for bulls relative to steers, accounting for the possibility of contracting bovine respiratory disease, if owned for a short background period or if ownership is retained through slaughter. Model results confirm that late-castrated steers do indeed exhibit diminished performance and increased morbidity probabilities relative to early-castrated steers. Increased morbidity also decreases average daily gain. However, this study found that castration timing and morbidity during the backgrounding period have minimal effects on carcass quality, with morbidity only impacting hot carcass weight and castration timing significantly affecting days to market and only tending to impact hot carcass weight. Ultimately, based on 2009 market conditions, bulls should be discounted at feeder calf sales compared to steers. The average calf arrived at 459 pounds, and at this weight bulls should be discounted $4.69/cwt relative to the same weight steers. The discount increases to $5.37/cwt for 400 pound calves and drops to $4.20/cwt for 500 pound calves. If ownership is retained through slaughter, required discounts will change to $6.77/cwt, $4.91/cwt, and $7.55/cwt, respectively.

The aims of the studies underlying this thesis were to assess the exposure to quartz in Swedish iron foundries and to determine the cancer morbidity for Swedish foundry workers. A cohort of 3,045 foundry workers and a final measurement database of 2,333 number of samples was established. The exposure measurements showed high levels of respirable quartz, in particular for fettlers and furnace and ladle repair workers with individual 8 hr TWA (GM=0.041 and 0.052 mg/m3; range 0.004-2.1 and 0.0098-0.83 mg/m3). In our database, the quartz concentrations as 8hr TWAs of current and historical data varied between 0.0018 and 4.9 mg/m3, averaging 0.083 mg/m3, with the highest exposures for fettlers (0.087 mg/m3) and furnace and ladle repair workers (0.42 mg/m3). The exposure for workers using respirators assuming full effect when used were assessed quantitatively, revealing workers with actual exposure exceeding the occupational exposure limits. Overall cancer morbidity was not increased, but the incidence of lung cancer was significantly elevated (SIR 1.61; 95 % CI 1.20-2.12). In the cohort study, significant associations between lung cancer and cumulative quartz exposure were detected for quartz doses of 1-2 mg/m3 * year (SIR 2.88; 95 % CI 1.44-5.16) and &gt;2 mg/m3 * year (SIR 1.68; 95 % CI 1.07- 2.52). These findings were not confirmed in the case-control analysis. The agreement between the estimated exposure in our early historical model and the development model showed a regression coefficient of 2.42, implying an underestimation of the historical exposure when using the development model data. The corresponding comparison between the development and the validation model based on our survey data showed a B of 0.31, implying an overestimation of present exposures when using data from the validation model. The main conclusions of the thesis are that certain foundry workers are still exposed to high levels of quartz, and the overall excess lung cancer could not be confirmed in the exposure-response analysis.

Human population-based studies of longitudinal design observe that higher intelligence in youth confers protection from premature mortality in adulthood. This field of study (“cognitive epidemiology”; Deary & Batty, 2007) has firmly established associations between intelligence and health outcomes, and has begun to address the likely mechanisms involved. The present thesis assessed some social, educational, and lifestyle factors that potentially confound and/or mediate the intelligence-mortality link. First, I carried out a systematic review of longitudinal cohort studies reporting intelligence differences in youth in relation to adult mortality risk, and in meta-analysis I aggregated the effect sizes from 16. A one SD advantage in intelligence scores was associated with 24% (95% CI 23% to 25%) lower risk of death, during 17- to 69-year follow-up; this magnitude showed no sex differential. Socioeconomic status in early life did not explain the effect. Rather, the person’s own occupational status in adulthood and educational attainment explained a third and a half of the association, respectively. One issue in controlling for education, in such models, is its strong correlation with intelligence test performance, which could lead to statistical overadjustment. A second aspect of this thesis, therefore, addressed the nature of the intelligence-education covariance in two behaviour-genetic studies of large general population-based samples of schoolchildren from England and The Netherlands. Previous studies that reported intelligence—education genetic covariances were potentially biased in their use of twin self-selection or pre-selection sampling. Moreover, the analysis in this thesis used a novel statistical approach, and included non-twin data to represent fully the variance in performance scores of a population. Analysis of the English cohort confirmed the top end of estimates from previous studies: 76% to 88% of the phenotypic correlation was due to heritability. The Dutch cohort showed greater variance for equivalent estimates (33% to 100%). The results indicate a limit to the extent to which education and intelligence might be causative of one another suggesting caution in interpreting some of the substantive attenuation effects by education reported in the literature. Third, I investigated pathways from intelligence to cardiovascular disease risk factors, given the consistent and robust finding that an advantage in intelligence relates to lower cardiovascular disease-outcomes. I used data from the 1958 National Child Development Study to investigate age-11 intelligence in association with inflammatory and haemostatic biomarker status at age 46 years. The results replicated inverse associations previously reported in an older age sample, and a one SD advantage in intelligence related to a 1.1mg/L decrease in C-reactive protein. The effect was largely mediated by lifestyle factors, including smoking, occupational status and abdominal obesity. In two further studies I used the west of Scotland Twenty-07 cohort, to investigate processing speeds among 16, 36 and 56 year-olds in relation to: (1) Inflammation, and (2) metabolic-risk, after 20 years. The advantage of experimental rather than psychometric measures of cognitive ability is their reduced cultural and social bias. Faster reaction time predicted lower systemic inflammation in the youngest male cohort, which appeared to be partially confounded by baseline smoking and socioeconomic status. Furthermore, advantage in reaction time performance in the young and middle-aged cohorts significantly predicted reduced metabolic risk. This was partially explained by occupational status, but retained statistical significance in some fully-adjusted models. A one SD advantage in age 16 simple reaction time variability, related to the 21% (95% CI 12% to 30%) reduced odds of metabolic syndrome by age 36 in the basic model, and this effect remained unchanged after controlling for all covariates. The growing evidence for specific social and behavioural factors that mediate intelligence-to-mortality pathways are discussed, in respect of indirect evidence that underlying system integrity or early life confounding may contribute incrementally to the effect.

Peritoneal adhesions occur in up to 93% of adults after peritoneal trauma during surgery. Most adhesions are asymptomatic but can cause female infertility, small bowel obstruction (SBO) and chronic abdominal pain. Adhesion prophylaxis is needed to reduce the significant morbidity and increased health care costs resulting from peritoneal adhesions. This thesis aims to establish a relevant and reproducible experimental adhesion model to simultaneously study the healing processs and adhesion formation and later to examine whether carbazate-activated polyvinyl alcohol (PVAC), an aldehyde-carbonyl scavenger, can reduce adhesion formation or not; and, in a long-term follow-up, to investigate the incidence of and identify risk factors for adhesive SBO requiring surgical treatment after laparotomy during infancy and to survey the prevalence of self-reported chronic abdominal pain and female infertility. Male Sprague-Dawley rats were subjected to laparotomy, cecal abrasion, and construction of a small bowel anastomosis and examined at various time points after surgery. Early elevation of IL-6, IL-1β and TNF-α concentrations in peritoneal fluid but not in plasma correlate to adhesion formation in this rodent adhesion model, indicating that anti-adhesion treatment should be early, local and not systemic. The animals were treated with either peritoneal instillation of PVAC, or the anastomosis was sutured with PVAC-impregnated resorbable polyglactin sutures. At day 7, bursting pressure of the anastomosis was measured and adhesions were blindly evaluated using Kennedy- and Nair scoring systems. PVAC-impregnated sutures reduced adhesion formation without reducing bursting pressure. Infants who underwent laparotomy between 1976 and 2011 were identified (n=1185) and 898 patients were included with a median follow-up time of 14.7 (range 0.0-36.0) years. The median age at first laparotomy was 6 (range 1.0-365.0) days. There were 113 patients (12.6%) with adhesive SBO, with the highest incidence found in patients with Hirschsprung’s disease (19 of 65, 29%), malrotation (13 of 45, 29%), intestinal atresia (11 of 40, 28%) and necrotizing enterocolitis (16 of 64, 25%). Lengthy duration of surgery (hazard ratio (HR) 1.25, 95% CI, 1.07 to 1.45), stoma formation (HR 1.72, 1.15 to 2.56) and postoperative complications (HR 1.81, 1.12 to 2.92) were independent risk factors. Chronic abdominal pain was reported in 180 (24.0%) of 750 patients, and 17 (13.8%) of 123 women reported infertility. The morbidity after laparotomy in neonates and infants is high. Awareness of the risk factors may promote changes in surgical practice.

A population based cross-sectional time series analysis was conducted using three Ontario administrative databases, to assess trends over time in the surgical management of kidney stone disease. All kidney stone treatments performed with extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy between July 1, 1991 and December 31, 2010, were included. Time series modeling with exponential smoothing and autoregressive integrated moving average models demonstrated a significant increase in the utilization of URS over time (23.69% to 59.98%, p<0.0001), with a reciprocal significant decrease in the utilization of SWL (68.77% to 33.36%, p<0.0001). As a result of this shift in treatment paradigm, time series modeling also demonstrated an associated significant decrease in the need for ancillary treatment over time (22.12% to 16.01%, p<0.0001) and a significant increase in the need for hospital readmission (8.01% to 10.85%, p<0.0001) or emergency room visit (7.58% to 9.95%, p=0.0024) within 7 days following treatment.

A population based cross-sectional time series analysis was conducted using three Ontario administrative databases, to assess trends over time in the surgical management of kidney stone disease. All kidney stone treatments performed with extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS) and percutaneous nephrolithotomy between July 1, 1991 and December 31, 2010, were included. Time series modeling with exponential smoothing and autoregressive integrated moving average models demonstrated a significant increase in the utilization of URS over time (23.69% to 59.98%, p<0.0001), with a reciprocal significant decrease in the utilization of SWL (68.77% to 33.36%, p<0.0001). As a result of this shift in treatment paradigm, time series modeling also demonstrated an associated significant decrease in the need for ancillary treatment over time (22.12% to 16.01%, p<0.0001) and a significant increase in the need for hospital readmission (8.01% to 10.85%, p<0.0001) or emergency room visit (7.58% to 9.95%, p=0.0024) within 7 days following treatment.