643 research outputs found
A clinician’s guide to management of intra-abdominal hypertension and abdominal compartment syndrome in critically ill patients
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901
Adult obesity and the burden of disability throughout life
OBJECTIVE: To analyze the prevalence of disability throughout life and
life expectancy free of disability, associated with obesity at ages 30 to
49 years. RESEARCH METHODS AND PROCEDURES: We used 46 and 20 years of
mortality follow-up, respectively, for 3521 Original and 3013 Offspring
Framingham Heart Study participants 30 to 49 years and classified as
normal weight, overweight, or obese at baseline. Disability measures were
available between 36 and 46 years of follow-up for 1352 Original
participants and at 20 years of follow-up for 2268 Offspring participants.
We measured the odds of disability in the Original cohort after 46 years
follow-up, and we estimated life expectancy with and without disability
from age 50. Two disability measures were used, one representing
limitations with mobility only and the second representing limitations
with activities of daily living (ADL). RESULTS: Obesity at ages 30 to 49
years was associated with a 2.01-fold increase in the odds of ADL
limitations 46 years later. Nonsmoking adults who were obese between 30
and 49 years lived 5.70 (95% confidence interval, 4.11 to 7.35) (men) and
5.02 (95% confidence interval, 3.36 to 6.61) (women) fewer years free of
ADL limitations from age 50 than their normal-weight counterparts. There
was no significant difference in the total number of years lived with
disability throughout life between those obese or normal weight, due to
both higher disability prevalence and higher mortality in the obese
population. DISCUSSION: Obesity in adulthood is associated with an
increased risk of disability throughout life and a reduction in the length
of time spent free of disability, but no substantial change in the length
of time spent with disability
Synchronous Laparoscopic Radical Nephrectomy Left and Contralateral Right Hemicolectomy during the Same Endoscopic Procedure
Synchronous renal cell carcinoma in patients with colorectal carcinoma is reported in various percentages ranging from 0.03 up to 4.85% (Halak et al. (2000), Capra et al. (2003)). When surgical treatment is indicated usually two separate operations are planned for resection. In open surgery, in such cases simultaneous resection is recommended if possible. Few reports have described the resection of colorectal and renal cell carcinoma in a single laparoscopic procedure. We have shown that combining left radical nephrectomy and right hemicolectomy is technically feasible, safe and that overall operative time can be limited. In our case operative time was 210 minutes, blood loss 100 milliliters, and duration of hospital stay was 8 days. Adequate port placement, preoperative scheduling, and surgical experience are essential to achieve this goal
Physical activity and life expectancy with and without diabetes: life table analysis of the Framingham Heart Study
OBJECTIVE: Physical activity is associated with a reduced risk of
developing diabetes and with reduced mortality among diabetic patients.
However, the effects of physical activity on the number of years lived
with and without diabetes are unclear. Our aim is to calculate the
differences in life expectancy with and without type 2 diabetes associated
with different levels of physical activity. RESEARCH DESIGN AND METHODS:
Using data from the Framingham Heart Study, we constructed multistate life
tables starting at age 50 years for men and women. Transition rates by
level of physical activity were derived for three transitions: nondiabetic
to death, nondiabetic to diabetes, and diabetes to death. We used hazard
ratios associated with different physical activity levels after adjustment
for age, sex, and potential confounders. RESULTS: For men and women with
moderate physical activity, life expectancy without diabetes at age 50
years was 2.3 (95% CI 1.2-3.4) years longer than for subjects in the low
physical activity group. For men and women with high physical activity,
these differences were 4.2 (2.9-5.5) and 4.0 (2.8-5.1) years,
respectively. Life expectancy with diabetes was 0.5 (-1.0 to 0.0) and 0.6
(-1.1 to -0.1) years less for moderately active men and women compared
with their sedentary counterparts. For high activity, these differences
were 0.1 (-0.7 to 0.5) and 0.2 (-0.8 to 0.3) years, respectively.
CONCLUSIONS: Moderately and highly active people have a longer total life
expectancy and live more years free of diabetes than their sedentary
counterparts but do not spend more years with diabetes
The risk and burden of vertebral fractures in Sweden
The aim of this study was to determine the risk and burden of vertebral fractures judged as those coming to clinical attention and as morphometric fractures. Incidence and utility loss were computed from data from Malmo, Sweden. Clinical fractures accounted for 23% of all vertebral deformities in women and for 42% in men. The average 10-year fracture probability for morphometric fractures increased with age in men from 2.9% at the age of 50 years (7.2% in women) to 8.4 at the age of 85 years (26.7% in women). As expected, probabilities increased with decreasing T-score for hip BMD. Cumulative utility loss from a clinical vertebral fracture was substantial and was 50-62% of that due to a hip fracture depending on age. When incidence of fractures in the population was weighted by disutility, all spine fractures accounted for more morbidity than hip fracture up to the age of 75 years. We conclude that vertebral fractures have a major personal and societal impact that needs to be recognised in algorithms for assessment of risk and in health economic strategies for osteoporosis
Intervention thresholds for osteoporosis in men and women: A study based on data from Sweden
The aim of this study was to determine the threshold of fracture probability at which interventions became cost-effective in men and women, based on data from Sweden. We modeled the effects of a treatment costing 200-500/year). Data on costs and risks were from Sweden. Costs included direct costs, but excluded indirect costs due to morbidity. A threshold for cost-effectiveness of approximately 500 per year; 35% efficacy) treatment in women was cost-effective with a 10-year hip fracture probability that ranged from 1.2% at the age of 50 years to 7.4% at the age of 80 years. Similar results were observed in men except that the threshold for cost-effectiveness was higher at younger ages than in women (2.0 vs 1.2%, respectively, at the age of 50 years). Intervention thresholds were sensitive to the assumed effectiveness and intervention cost. The exclusion of osteoporotic fractures other than hip fracture significantly increased the cost-effectiveness ratio because of the substantial morbidity from such other fractures, particularly at younger ages. We conclude that the inclusion of all osteoporotic fractures has a marked effect on intervention thresholds, that these vary with age, and that available treatments can be targeted cost-effectively to individuals at moderately increased fracture risk
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