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This article considers the impact of occupation on mortality using a dataset of over 9,000 male postal workers who can be traced from retirement to death. For each worker, we know their demographic characteristics, occupation, location, and cause of retirement. The article uses these data to model the impact of postal work on survival post-retirement, showing that type of occupation and cause of retirement had significant effects on survival for those pensioners who retired for medical reasons. Different occupations were exposed to varying risks, which led to occupationally distinct patterns of medical causes of retirement. These differing causes of retirement, in turn, led to different survival chances after a worker retired. The article demonstrates how a long-term view can improve our understanding of adult mortality in the United Kingdom in the nineteenth and twentieth centuries.
To characterize morbidity, health care-seeking, and medication-related needs among survivors of Hurricane Katrina.
Methods
We used a two-stage sampling method to survey and interview 210 Hurricane Katrina survivors in Louisiana from 2006 to 2007. Interviews assessed injury, illness, environmental exposures, disaster-related damage, medication use, and health care-seeking behavior. Descriptive statistics were calculated.
Results
Nearly 25% of respondents reported direct contact with hurricane-related floodwater. Nearly all experienced substantial property damage; wind (75.6%) and floodwater (67.5%) were the most common causes of damage. Before Hurricane Katrina, 70% of respondents reported good/excellent health; afterward, 35% reported worse health. Physical injury was reported by 17% of participants, emotional injury by 85%, and illness by 32%. Among those reporting injury/illness, 64% sought care for physical injuries, 21% for emotional injuries, and 63% for illnesses. Medication provision was common among those receiving care (70%-88%). Notably, 47% of respondents reported using at least one medication before the disaster, and 42% were unable to identify the specific medication they were taking.
Conclusions
Hurricane-related morbidity extends beyond health care system encounters and is likely underestimated by facility-based surveillance alone. Medication continuity and health care access represent important but understudied dimensions of disaster-related morbidity that remain relevant in contemporary disaster preparedness and response efforts.
This study provides the first comprehensive analysis of morbidity and mortality in Dalmatian Pelican Pelecanus crispus and Great White Pelican P. onocrotalus in Greece. Data were collected over a 24-year period (1998–2021), using specific questionnaires to highlight the temporospatial, age and aetiological causes of morbidity and mortality to advance conservation efforts. Overall, 316 incidents of morbidity/mortality and 23 mass mortality events were recorded while the two species differed significantly in all parameters of morbidity/mortality. Annual rate of mortality was higher in Dalmatian Pelican (44.5 deaths per annum) than the Great White Pelican (2.4 deaths per annum). Dalmatian Pelican mortality tended to occur more during late winter/early spring and late summer/autumn, while Great White Pelican mortality occurred during autumn, matching with the presence of pre-migratory concentrations and migration. Dalmatian Pelican tended to be found dead in areas where pelicans congregated (e.g. colonies, feeding, wintering) while Great White Pelican were equally found in both areas with and without pelican congregations. A total of 30% of Great White Pelican mortality/morbidity happened in south Greece away from pelican areas and along the migration route whilst adult Dalmatian Pelicans and juvenile Great White Pelicans were the prevalent age groups. In Dalmatian Pelicans, 70% of mortality accumulated in the mass mortality events, while the sympatric Great White Pelican was unaffected during these events. Dalmatian Pelican mortality was mostly attributed to environmental (biotoxin) and infectious (viral/avian influenza) causes, while Great White Pelican mostly to anthropogenic (trauma/illegal shooting). Specific causes in Dalmatian Pelican mortality showed significant seasonal variation with viral causes in spring, biotoxin and entrapment in autumn, and illegal shooting and emaciation in winter. In Great White Pelicans, illegal shooting tended to occur in spring. A total of 25% of rescued Dalmatian Pelicans were released. Limitations of this study were that only 1% of the dead pelicans underwent a veterinary post-mortem investigation, in 26% of the dead pelicans the cause was completely unknown, the sex was not determined, and the age remained unidentified in a high percentage (43-46%) of individuals. In future, more veterinary input and a national preparedness plan for mass mortality events are needed.
This chapter explores why and how health should be measured at the population level. It introduces generic health measures – such as disability-adjusted life years (DALYs) and health-adjusted life expectancy – as tools to quantify overall health, enabling comparison across diseases, populations and time. We highlight conceptual and methodological challenges in health measurement, including how to define health boundaries and how to weight and compare different health states and conditions. The topics discussed include performance vs. capacity, observed vs. reported measures and the valuation of future vs. present health outcomes. The chapter also discusses ethical concerns around using health metrics for priority setting, particularly at the population level. Recent developments in this field have focused on ethical considerations around fairness and equity, and on how to better incorporate broader determinants of health into current measures of population health.
This paper presents the results of a targeted survey conducted among UK pension consultancies, insurers and reinsurers to explore current actuarial practices and challenges in modelling the impact on mortality and morbidity of climate perils. The responses reveal several recurring themes, including varying degrees of climate risk integration, plus significant data and methodological limitations. This is against a background of growing regulatory and stakeholder pressure to incorporate climate considerations into actuarial models. While a small number of organisations have made substantive progress, many are at a preliminary stage, relying primarily on qualitative or scenario-based approaches. Respondents identified a pressing need for standardised methodologies, improved data sources and practical guidance to support consistent and credible modelling. The findings highlight a clear need for profession-led guidance, improved access to climate-health data and practical frameworks to support the consistent integration of climate-related mortality and morbidity risks into actuarial work. Respondents expressed strong support for collaborative development of standardised scenarios, illustrative modelling approaches and case studies to bridge the gap between public-health research and actuarial application. The paper concludes with practical recommendations for practitioners and identifies priority areas for future research and professional guidance.
Infectious diseases are caused by pathogenic agents, such as bacteria, viruses, fungi or parasites. These agents may infect a human directly from contaminated air, water, or food. The agents may also be spread from infected animals or infected humans, called vectors, to a healthy human. An epidemic is a major increase or upswing of an infectious disease in an area that results in a large number of cases, followed then by a decline. Many infections and contagious diseases have become epidemic, including scarlet fever, chicken pox, measles, influenza, and cholera, among others.
Enhanced Recovery After Surgery (ERAS) protocols were first developed for colorectal surgery. The American Society for Enhanced Recovery (ASER) provides protocols and support. Reduction of morbidity results in shorter length of stay of about 3 days, and cost reduction by about 20%. A multimodal approach to opioid-sparing pain control, goal directed fluid management and nutrition and physical therapy are important, among over 25 other possible protocols. National Surgical Quality Improvement Program (NSQIP) is a data repository with hundreds of preoperative risk factors and outcomes for each surgery. Before and after ERAS implementation, outcomes can be compared to discover the highest yield items, for example surgical site infections. Most important is engagement of nurses, physicians, and patients during construction of a local hospital’s protocol.
Survivors of critical illness are at risk for severe negative health outcomes, including an increased risk for mortality in the first several years following their index hospitalization and an increased risk for hospital readmission. recovery trajectories among survivors of critical illness vary considerably, with some patients recovering to near baseline functional status and others entering a cycle of readmissions, disease exacerbations, and prolonged chronic critical illness. Moreover, critical illness has been found to be associated with an increased risk of the development of new chronic diseases, including cardiovascular, pulmonary, neuroloigcal, and renal diseases, as well as worsesning of pre-existing chronic conditions. Given these increased risks, it is no wonder that survivors of critical illness–many of whom may spend more time in a hospital-like setting than at home–have high rates of healthcare utilization. Recognizing these risks can provide a basis for early diagnostic testing and referral for specialty care as needed. Understanding the association of critical illness with subsequent mortality, chronic illness, and healthcare utilization can provide a foundation for the skilled care of survivors of critical illness.
To describe the results of the Federal Center for Disaster Medicine field hospital work in an outpatient setting in Aleppo, Syria, during the delayed period after the earthquake (from days 33 to 67) for 35 days.
Methods
A retrospective analysis of routinely collected patient data from March 10 to April 13, 2023, was conducted. Descriptive statistics were used to summarize patient demographics, disease spectrum (according to ICD-10), and procedures.
Results
6812 patients were examined and consulted by various specialists. Of all patients, 40.6% were under the age of 18. In adults, the most commonly diagnosed conditions were diseases of the musculoskeletal system (27.1%), eye diseases (12.0%), circulatory diseases (10.1%), and respiratory diseases (10.0%). Among children, the most common reasons for admission were infectious diseases (68.9%), with respiratory tract infections being the most frequent (48.0%). Surgical interventions were performed in 150 cases; 61 patients required hospitalization.
Conclusions
During disasters, the needs of the population for various types of medical care vary significantly. The main causes of variability, in our opinion, are the time period of work from the disaster onset; the situation in the country and in the healthcare system, preceding the disaster; the climatic conditions during work; and the local endemicity of diseases.
Physiologic changes in the peripartum period put women with CHD at increased risk for morbidity. This study examines factors associated with peripartum complications and length of stay compared to patients without CHD.
Methods:
This single-institution retrospective case-control study included women with CHD (2000–2017) and a control population without CHD. A review of clinical and echocardiographic data was used to assign baseline characteristics, disease severity, and adverse outcomes. Primary outcomes were composite variables of cardiac and obstetric adverse events, along with peripartum length of stay. The relationship between maternal CHD, baseline characteristics, and peripartum adverse events was evaluated by multivariable regression.
Results:
The cohort and control groups included 162 deliveries among 113 women and 321 deliveries among 321 women, respectively. Cardiac complications, including arrhythmia, heart failure, pulmonary oedema, and thromboembolic events, occurred in 8.6% of the cohort (RR 2.52, 95% CI 1.17–5.42), with the most common event being arrhythmia. Obstetric events, such as caesarean delivery, assisted vaginal delivery, preterm birth, and pre-eclampsia, occurred in 67.9% versus 56.1% in the control group (RR 1.21, 95% CI 1.05–1.40). In multivariable models, increasing age was associated with increased composite cardiac events. Length of stay was longer in the cohort group (p < 0.001) and significantly associated with modified World Health Organization classification (p = 0.016).
Conclusions:
Women with CHD experience increased cardiac and obstetric morbidity compared to controls during peripartum admission. Those with CHD have longer hospital stays around delivery, which is associated with disease severity.
The presence of children in eighteenth-century English voluntary hospitals is an area of increasing interest and attention. The Northampton Infirmary admission records detail inpatient and outpatient ages from 1744 to 1804, allowing for longitudinal investigations of children in the institution. The most common distempers affecting children were surgical infections, infectious diseases, and skin diseases; fifty-six per cent of the child patients were male and 43.3 per cent were female. Nearly seventy-five per cent of children left the hospital ‘cured’. This article outlines the Northampton Infirmary Eighteenth Century Child Admission Database, and demonstrates how the patterning of distempers within and among children provides insight into the health journeys of eighteenth-century children through the lens of their bodies, their parents, and their institutional recommenders.
For the first time, a question relating to certain long-term health conditions was asked in the 2021 Australian population census. The conditions included arthritis, asthma, cancer (including remission), dementia (including Alzheimer’s), diabetes (excluding gestational diabetes), heart disease (including heart attack or angina), kidney disease, lung condition (including COPD or emphysema), mental health condition (including depression or anxiety), and stroke. Respondents could indicate either none or any number of these conditions. In this paper, the data on these conditions have been analysed to compare the self-reported prevalence of diseases among the 23.4 million Australians who responded to this question (median age 39 years), of whom 3.2% were Aboriginal and Torres Strait Islander peoples (median age 24 years). Standardised Morbidity Ratios for each disease were calculated for the Aboriginal and Torres Strait Islander peoples by using the relevant age-disease specific morbidity rates for the total population as the ‘standard’. Findings of this research revealed that the prevalence of diseases was much higher among the Aboriginal and Torres Strait Islander peoples compared to the total population. The only exception was cancer, where the rates for the two groups were not much different. Gaps in prevalence of diseases in the two groups generally increased with age. The higher rates among the Aboriginal and Torres Strait Islander peoples emphasise the need for continued action on health equity and the development of more nuanced and focused initiatives to reduce the gaps between the Aboriginal and Torres Strait Islander peoples vis-à-vis the total population of Australia. Findings in this paper were consistent with similar studies (albeit largely surveys) on health of the Indigenous peoples in Canada and the Maoris in New Zealand.
A fundamental problem in descriptive epidemiology is how to make meaningful and robust comparisons between different populations, or within the same population over different periods. The problem has several dimensions. First, the data we have to work with (e.g. incident and prevalent cases, and deaths) is rarely usable in its raw form. We must therefore transform it in some way before undertaking the comparison itself. Second, our data usually tells us about fundamentally different attributes of the populations we are seeking to compare. If we are only ever interested in comparing any one of these attributes at a time (mortality, for example), then one of several simple and well-established transformations is all that is typically required. Increasingly, however, epidemiologists are being asked to bring these attributes together into more integrated and meaningful comparisons.
This study aimed to assess whether frailty (measured using the 5-Item Modified Frailty Index) was associated with increased morbidity following surgical tracheostomy.
Methods
A single-centre retrospective cohort study analysed a prospectively maintained database between 2022 and 2023. Univariable and multivariable regressions were used to determine factors (including frailty) associated with increased morbidity.
Results
A total of 174 patients underwent surgical tracheostomy in the study period with 28 patients determined as frail (16.1 per cent). Overall, 21 patients (12.1 per cent) suffered a tracheostomy-specific complication. Multivariable regression found an association between frail patient status and increased tracheostomy-specific complications (odds ratio 4.09, 95 per cent confidence interval 1.51–11.11; p = 0.006) and longer hospital length of stay (β 15.76 days, 95 per cent confidence interval 1.06–30.44; p = 0.036).
Conclusion
Frailty was associated with increased morbidity and longer hospital stay following tracheostomy. Assessment of frailty may guide decision making and patient discussions when planning tracheostomy.
Childhood morbidity is a precursor and contributor to under-five child mortality. Community-based primary healthcare programs are culturally responsive and low-cost strategies for delivering maternal and child health services in rural communities.
Aim:
To evaluate the equity effect of the Ghana Essential Health Intervention Program (GEHIP) – a five-year community-based primary healthcare program – on childhood morbidity.
Methods:
GEHIP was implemented in the Upper East region of Northern Ghana. Household baseline and end line surveys conducted in 2010/2011 and 2014/2015, respectively, from both intervention and comparison districts were used to assess three childhood morbidity conditions: maternal recall of neonatal illness, the incidence of diarrhoea, and fever. Difference-in-differences analysis, mean comparison test, and multivariate logistic regressions are used to assess the effect of GEHIP exposure on these three childhood morbidity conditions.
Results:
Baseline sample data of 2,911 women and end line sample of 2,829 women were included in this analysis. There was generally more reduction in all three childhood morbidity conditions in intervention communities relative to comparison communities. Diarrhoea and fever had a statistically significant treatment effect (AOR = 0.95, p-value<0.01 and AOR = 0.94, p-value<0.001). Results of equity analysis indicate significant mean reductions for both the poor and non-poor for neonatal illness and diarrhea, while only the intervention group had a significant reduction for both poor and non-poor for fever. Regression analysis shows no significant equity/inequity effects of GEHIP on the incidence of diarrhoea and fever. Neonatal illness, however, shows significant effects of wealth within the intervention group.
Conclusion:
This study shows that GEHIP contributed significantly to childhood morbidity reduction. This implies that community-based strategies have the potential to improve child health and contribute to the attainment of the United Nations sustainable development goal related to child health. Specific targeted measures are recommended to ensure both the poor and relatively better-off benefit from interventions.
The sutureless repair technique has been favoured due to its purported reduction in post-operative pulmonary venous obstruction rates. This study aims to compare the outcomes of conventional versus sutureless repair techniques in Total Anomalous Pulmonary Venous Drainage.
Methods:
In this retrospective single-centre analysis (2012–2022), we evaluated children who underwent conventional or sutureless repair for isolated total anomalous pulmonary venous drainage, excluding complex cardiac anomalies and incomplete data. Patients were categorised into conventional (Group C, n = 58) and sutureless (Group S, n = 41) groups. Primary outcomes included mortality, morbidity, and post-operative complications. Statistical analysis included Mann–Whitney U, chi-square, and Fisher’s exact tests where appropriate.
Results:
Supracardiac type predominated in both groups (53.4% in Group C and 70.7% in Group S), with higher cardiac type frequency in Group C (24.1% versus 2.4%, p = 0.016). Early complications occurred in 58.5% versus 53.4% of cases in Groups S and C, respectively (p = 0.767). The mortality rate (17.2% versus 14.6%, p = 0.944) and post-operative pulmonary venous obstruction (21.2% versus 19.0%, p = 0.809) were higher in Group C, though not significantly. Mean cardiopulmonary bypass times were comparable between groups (105 versus 89 minutes, p = 0.424).
Conclusions:
In this comprehensive analysis of paediatric Total Anomalous Pulmonary Venous Drainage repair, both conventional and sutureless techniques demonstrated comparable safety profiles and clinical outcomes. These findings suggest that surgical approach selection should be individualised based on patient characteristics and surgeon expertise. Further prospective studies with larger cohorts are needed to validate these observations.
The normative principle that every individual is equally entitled to continued life is a subject of debate in ethics, health economics and policy. We reconsider this principle in the context of setting priorities for healthcare interventions. When applied without restriction, the principle overlooks quality of life concerns entirely. However, we contend that it remains ethically relevant in certain situations, particularly when patients suffer from conditions unrelated to the therapeutic areas and treatments under consideration. Thus, we defend the principle while also emphasizing the need for its application within tight limits.
An introduction and overview of the mental health conditions relevant to people with intellectual disability. The chapter focuses on the evidence base to support or refute whether they suffer greater rates of mental health problems, Psychiatric classification and prescribing; Comparison tables of international classification of diseases (ICD) versions 10 and 11; and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) 4 and 5 and DC-LD.
Wildfires have escalated into a global threat with profound impacts on health, society, and the environment. The increasing frequency and intensity of these disasters, influenced by climate change and urban expansion, necessitate a comprehensive understanding of their direct health consequences.
Methods
This study conducted a retrospective analysis of global wildfire disasters from January 2000 to December 2023, utilizing data from the Emergency Events Database (EM-DAT). The analysis focused on the direct health outcomes—mortalities and injuries—excluding indirect effects such as smoke inhalation. Data were meticulously cleaned, categorized, and analyzed using quantitative methods, with statistical tests employed to validate the findings.
Results
The study identified 309 significant wildfire disasters, with forest fires accounting for 80% of these events. These incidents resulted in 1890 fatalities and 14 360 injuries, with the highest tolls observed in Southern Europe, Northern America, and the Australia-New Zealand region. A notable rise in wildfire incidents was observed over the study period, underscoring the critical intersections between climate change, urban expansion, and wildfire risks. The analysis highlighted significant geographical and temporal patterns, emphasizing the regions and factors contributing to heightened wildfire vulnerability.
Conclusions
The findings underscore the urgent need for robust disaster preparedness and effective mitigation strategies. Integrating advanced early warning systems and Traditional Ecological Knowledge into wildfire management practices is essential. The study calls for proactive public health measures and interdisciplinary approaches to address the multifaceted challenges posed by wildfires. Continuous research and policy formulation are crucial to protect vulnerable communities and mitigate the increasing threat of wildfires globally.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
This chapter emphasises the importance of the physical health history to holistic psychiatric case assessment. It describes the general approach to this and sets this particularly in the context of patients with serious or severe mental illness. Such patients have substantially increased morbidity and mortality from physical causes compared to the general population, and this increased mortality has been clearly documented for nearly two hundred years. A practical, collaborative and optimistic multilevel approach to attempting to make a difference to these outcomes is described, concluding with fourteen broad, practical areas for achievable interventions.