Caregiving burden and quality of life of pneumoconiosis caregivers in Hong Kong

Objective

Silicosis is the most common type of pneumoconiosis in Hong Kong. This study explored the clinical correlates of the caregiving burden and quality of life (QOL) among pneumoconiosis caregivers in Hong Kong.

Methods

The study sample included 112 patients with pneumoconiosis and their caregivers. Caregiving burden was measured using the Caregiving Burden Scale (CBS), and caregivers' QOL was assessed using the physical and mental components (PCS and MCS, respectively) of the Medical Outcomes Short Form-36. Pearson's correlation coefficient and Spearman's ρ were calculated to examine the relationship between CBS, PCS, and MCS scores and caregivers' and patients' sociodemographic variables. Stepwise regression analyses were performed to determine the independent correlates of CBS, PCS, and MCS scores.

Results

Caregiving burden was correlated with certain patient characteristics (duration of disease, severity of dyspnea, exercise tolerance, depressive symptoms, daily functioning, and community living skills) and with caregivers' variables (depressive symptoms and availability of family support). Regression analysis showed that patients' daily functioning (β = −.345), caregivers' depressive symptoms (β = .509), and the availability of family support (β = .240) were independent correlates of caregiving burden, explaining 45% of the variance. The independent correlates of PCS included patients' severity of coexisting diseases (β = −.179) and caregivers' depressive symptoms (β = −.521). Both patients' (β = −.155) and caregivers' (β = −.633) depressive symptoms and patients' severity of dyspnea (β = −.183) were independent correlates of the MCS.

Conclusion

Caring for pneumoconiosis patients entails a significant caregiving burden for caregivers, and adversely affects their QOL. Caregivers' depressive symptoms are related to both their caregiving burden and QOL.     

Depressive symptoms and poor social support have a synergistic effect on event-free survival in patients with heart failure

Background

Depressive symptoms and poor social support are predictors of increased morbidity and mortality in patients with heart failure (HF). However, the combined contribution of depressive symptoms and social support event-free survival of patients with HF has not been examined.

Objective

To compare event-free survival in 4 groups of patients with HF stratified by depressive symptoms and perceived social support (PSS).

Method

A total of 220 patients completed the Beck Depression Inventory-II and the Multidimensional Perceived Social Support Scale and were followed for up to 4 years to collect data on death and hospitalizations.

Results

Depressive symptoms (hazard ratio = 1.73, P = .008) and PSS (hazard ratio = 1.51, P = .048) were independent predictors of event-free survival. Depressed patients with low PSS had 2.1 times higher risk of events than non-depressed patients with high PSS (P = .003).

Conclusion

Depressive symptoms and poor social support had a negative additive effect on event-free survival in patients with HF.     

Antral localization worsens the efficacy of enteral stents in malignant digestive tumors

Background and aims

Malignant gastric outlet obstruction can be treated by means of enteral stenting or surgical gastrojejunalanatomosis. We evaluated in a prospective and multicentre study the efficacy of the enteral stent on food intake, the quality of life impact, and the relationship between efficacy and determined clinical and technical parameters.

Patients and methods

Seventy one patients affected by symptoms arising from gastroduodenal obstruction due to malignant tumors, with criteria of irresecability, metastatic disease or very high surgical risk, were treated by means of self expanding metal stents. We used the GOOSS index to evaluate efficacy, and the Euro Qol-5D index to evaluate quality of life.

Results

Before stenting patients with GOOSS 0 and 1 were 68 (98.5%). After stenting patients with GOOSS 2 and 3 (semisolid and solid food) were 58 (84,1%) (P<.0001). The Euro Qol-5D index measured before and a month after stenting were 10.17 and 10.04 respectively (P=.6). The median survival was 91 days (9-552). The enteral stents for localised tumors in the duodenum and the gastrojejunalanastomosis were effective in 26 patients (70.2%) and 13 patients respectively (86.6%), while the enteral stents of tumors in the antrum were effective in only 5 patients (29.4%).

Conclusions

The palliative treatment of malignant gastric outlet obstruction with a uncovered metal stent produces a significant improvement of oral food intake and maintains the overall quality of life index. The antral localization is associated with a lower efficacy of the procedure.     

Effects of a home walking exercise program on functional status and symptoms in heart failure

Background

Hospital-based exercise programs using a bicycle ergometer or a combination of exercise modalities have shown positive benefits in heart failure, but may not be readily accessible to many patients. Thus, we sought to evaluate the effects of a 12-week home walking exercise program on functional status and symptoms in patients with heart failure.

Methods

A randomized controlled trial comparing a 12-week progressive home walking exercise program (n = 42) to a “usual activity” control group (n = 37) was conducted in patients with heart failure (78 [99%] male; mean age 62.6 ± 10.6 years; ejection fraction 27% ± 8.8%; 63 [80%] New York Heart Association class II; 15[20%] New York Heart Association class III-IV) from a Veterans Affairs medical center and a university-affiliated medical center. Functional status (peak oxygen consumption via cardiopulmonary exercise testing, 6-minute walk test, the Heart Failure Functional Status Inventory), and symptoms (Dyspnea-Fatigue Index score with a postglobal rating of symptoms) were measured at baseline and 12 weeks.

Results

No adverse events related to exercise training occurred. Overall mean compliance to training was 74 ± 37%. Peak oxygen consumption and the Heart Failure Functional Status Inventory were unchanged with training. Compared to the usual activity group, the training group had significantly longer walking distances measured by the 6-minute walk test (1264 ± 255 vs 1337 ± 272 feet, P = .001), and improved postglobal rating of symptoms (P = .03).

Conclusion

In patients with heart failure, a progressive home walking exercise program is acceptable, increases walking distance, and decreases global rating of symptoms.     

Staphylococcus aureus bacteremia in patients with prosthetic devices: costs and outcomes

Purpose

Although Staphylococcus aureus is a leading cause of nosocomial infection, little is known about the impact of S. aureus bacteremia on patients with prosthetic devices. This investigation sought to define the clinical outcome, health care resource use, and infection-associated costs of S. aureus bacteremia in patients with prostheses.

Subjects and methods

All hospitalized patients with a prosthetic device and S. aureus bacteremia during the 96-month study period were identified prospectively. Clinical data were collected at the time of hospitalization. Data regarding infection-related resource utilization and infection-related costs within 12 weeks of the initial bacteremia were also recorded.

Results

298 patients with ≥1 prosthesis and S. aureus bacteremia were identified (cardiovascular device—122 patients, orthopedic device—73 patients, long-term catheter—71 patients, and other devices—32 patients). Overall, 58% of patients underwent surgery as a consequence of the infection. Infection-related complications occurred in 41% and the overall 12-week mortality was 27%. The mean infection-related cost was $67 439 for patients with hospital-acquired S. aureus bacteremia and $37 868 for community-acquired S. aureus bacteremia (cost difference $29 571; 95% confidence interval, $14 370-$49 826). Rates of device infection, complications, 12-week mortality, and mean cost varied by prosthesis type.

Conclusion

S. aureus bacteremia in patients with prosthetic devices is associated with frequent complications, substantial cost, and significant health care resource utilization.     

Factors affecting the quality of life of family caregivers of patients with heart failure: A cross-sectional study

Heart failure is a chronic disease requiring lifetime self-management at home by patients, who often require additional support. However, the long-term nature of this self-management presents great challenges for both heart failure patients and their family caregivers. The role of family caregivers is critical, but little is known about the relationship between the burden, stress, depressive symptoms, and quality of life in the family caregivers of heart failure patients. We aimed to explore caregiver burden, stress, depressive symptoms, and quality of life in both patients with heart failure and their family caregivers and identify the factors associated with family caregivers’ quality of life.The sample included 120 participants (60 heart failure patients and 60 corresponding family caregivers) from cardiovascular outpatient clinics at 2 university-affiliated hospitals in South Korea from September 2018 to July 2019. The mean ages of the heart failure patients and their caregivers were 72.72 (SD = 12.73) and 57.03 (SD = 13.42) years, respectively. Caregiver burden (r = −0.601, P < .001) and caregiver depressive symptoms (r = -0.535, P < .001) were negatively correlated with the caregivers’ quality of life. The result of the hierarchical multiple regression analysis identified 3 significant factors related to the family caregivers’ quality of life: caregiver’s age (β = −0.257, P = .012), caregiver burden (β = −0.408, P = .002) and caregiver depressive symptoms (β = −0.298, P = .018), with overall explanatory power of 47.5%.It is necessary to develop practical strategies to improve family caregivers’ quality of life by alleviating their burden and depressive symptoms. Healthcare providers should be engaged with not only heart failure patients but also their family caregivers during the disease management process to improve patients’ outcomes.     

Association between family caregivers and depressive symptoms among community-dwelling older adults in Japan: A cross-sectional study during the COVID-19 pandemic

ObjectivesNovel coronavirus disease (COVID-19) pandemic could increase the mental health burden of family caregivers of older adults, but related reports are limited. We examined the association between family caregiving and changes in the depressive symptom status during the pandemic.MethodsThis cross-sectional study included 957 (mean age [standard deviation] = 80.8 [4.8] years; 53.5% females) community-dwelling older adults aged ≥ 65 years from a semi-urban area of Japan, who completed a mailed questionnaire. Based on the depressive symptom status assessed with the Two-Question Screen between March and October 2020, participants were classified into four groups: “non-depressive symptoms,” “incidence of depressive symptoms,” “remission from depressive symptoms,” or “persistence of depressive symptoms.” Participants were assessed in October 2020 for the family caregiving status, caregiving role, the severity of care recipients’ needs, and increased caregiver burden during the pandemic, each with the simple question. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs) for changes in depressive symptom status.ResultsCompared to non-caregivers, family caregivers were associated with the incidence (OR [95% CI] = 3.17 [1.55–6.51], p < 0.01) and persistence of depressive symptoms (OR [95% CI] = 2.39 [1.30–4.38], p < 0.01). Primary caregivers, caregivers for individuals with severe care needs, and caregivers with increased burden during the pandemic had a high risk of depressive symptoms.ConclusionsFamily caregivers had a high risk of depressive symptoms during the pandemic. Our findings highlight the need for a support system for family caregivers.     

Impact of cardiac rehabilitation on depression and its associated mortality

Purpose

Depression following major cardiac events is associated with higher mortality, but little is known about whether this can be reduced through treatment including cardiac rehabilitation and exercise training. We evaluated the impact of cardiac rehabilitation on depression and its associated mortality in coronary patients.

Patients and Methods

We evaluated 522 consecutive coronary patients (381 men, 141 women; aged 64 ± 10 years) enrolled in cardiac rehabilitation from January 2000 to July 2005 and a control group of 179 patients not completing rehabilitation. Depressive symptoms were assessed by questionnaire at baseline and following rehabilitation, and mortality was evaluated after a mean follow-up of 1296 ± 551 days.

Results

Prevalence of depressive symptoms decreased 63% following rehabilitation, from 17% to 6% (P <.0001). Depressed patients following rehabilitation had an over 4-fold higher mortality than nondepressed patients (22% vs 5%, P = .0004). Depressed patients who completed rehabilitation had a 73% lower mortality (8% vs 30%; P = .0005) compared with control depressed subjects who did not complete rehabilitation. Reductions in depressive symptoms and its associated mortality were related to improvements in fitness; however, similar reductions were noted in those with either modest or marked increases in exercise capacity.

Conclusion

In patients following major coronary events, cardiac rehabilitation is associated with both reductions in depressive symptoms and the excess mortality associated with it. Moreover, only mild improvements in levels of fitness appear to be needed to produce these benefits on depressive symptoms and its associated mortality.     

Oxidative stress and severe walking disability among older women

Background

Oxidative stress has been implicated in sarcopenia and the loss of muscle strength with aging, but the relationship between oxidative stress and decrease in muscle strength and physical performance has not been well characterized. Serum protein carbonyls are markers of oxidative damage to proteins and are caused by oxidative stress.

Methods

Serum protein carbonyls were measured at baseline and compared with a decrease in walking speed and development of severe walking disability (inability to walk or walking speed <0.4 m/sec) over 36 months of follow-up in 545 moderately to severely disabled women, aged ≥65 years, living in the community in Baltimore, Maryland (the Women’s Health and Aging Study I).

Results

After adjusting for age, body mass index, smoking, and chronic diseases, log_e protein carbonyls (nmol/mg) were associated with a decrease in walking speed over 36 months (P = .002). During follow-up, 154 women (28.2%) developed severe walking disability. After adjusting for the same potential confounders, log_e protein carbonyls were associated with incident severe walking disability (hazards ratio 1.42, 95% confidence interval, 1.02-1.98, P = .037).

Conclusion

High oxidative stress, as indicated by oxidative damage to proteins, is an independent predictor of decrease in walking speed and progression to severe walking disability among older women living in the community.     

The Effect of a Hypertension Self-Management Intervention on Diabetes and Cholesterol Control

Background

Most patient chronic disease self-management interventions target single-disease outcomes. We evaluated the effect of a tailored hypertension self-management intervention on the unintended targets of glycosylated hemoglobin (HbA_1c) and low-density lipoprotein cholesterol (LDL-C).

Methods

We evaluated patients from the Veterans Study to Improve the Control of Hypertension, a 2-year randomized controlled trial. Patients received either a hypertension self-management intervention delivered by a nurse over the telephone or usual care. Although the study focused on hypertension self-management, we compared changes in HbA_1c among a subgroup of 216 patients with diabetes and LDL-C among 528 patients with measurements during the study period. Changes in these laboratory values over time were compared between the 2 treatment groups using linear mixed-effects models.

Results

For the patients with diabetes, the hypertension self-management intervention resulted in a 0.46% reduction in HbA_1c over 2 years compared with usual care (95% confidence interval, 0.04%-0.89%; P = .03). For LDL-C, there was a minimal 0.9 mg/dL between-group difference that was not statistically significant (95% confidence interval, −7.3-5.6 mg/dL; P = .79).

Conclusions

There was a significant effect of the self-management intervention on the unintended target of HbA_1c,but not LDL-C. Chronic disease self-management interventions might have “spill-over” effects on patients' comorbid chronic conditions.     

Factors associated with uncontrolled hypertension in patients with and without cardiovascular disease

Introduction and objectives

Hypertension is one of the most prevalent and poorly controlled risk factors, especially in patients with established cardiovascular disease (CVD). The aim of this study was to describe the rate of blood pressure (BP) control and related risk factors.

Methods

Multicenter, cross-sectional and observational registry of patients with hypertension recruited from cardiology and primary care outpatient clinics. Controlled BP defined as <140/90 mmHg.

Results

55.4% of the 10 743 patients included had controlled BP and these had a slightly higher mean age. Patients with uncontrolled BP were more frequently male, with a higher prevalence of active smokers, obese patients, and patients with diabetes. The rate of controlled BP was similar in patients with or without CVD. Patients with uncontrolled BP had higher levels of blood glucose, total cholesterol, low density lipoproteins and uric acid. Patients with uncontrolled BP were receiving a slightly higher mean number of antihypertensive drugs compared to patients with controlled BP. Patients with CVD were more frequently receiving a renin-angiotensin-aldosterone axis inhibitor: 83.5% vs. 73.2% (P<.01). Multivariate analysis identified obesity and current smoking as independently associated with uncontrolled BP, both in patients with or without CVD, as well as relevant differences between the two groups on other factors.

Conclusions

Regardless of the presence of CVD, 55% of hypertensive patients had controlled BP. Lifestyle and diet, especially smoking and obesity, are independently associated with lack of BP control.Full English text available from: www.revespcardiol.org     

The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction

Introduction

The Tpeak-Tend interval (TpTe) has been linked to increased arrhythmic risk. TpTe was investigated before and after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI).

Method

Patients with first-time STEMI treated with pPCI were included (n = 101; mean age 62 years; range 39-89 years; 74% men). Digital electrocardiograms were taken pre- and post-PCI, respectively. Tpeak-Tend interval was measured in leads with limited ST-segment deviation. The primary end point was all-cause mortality during 22 ± 7 months (mean ± SD) of follow-up.

Results

Pre- and post-PCI TpTe were 104 milliseconds [98-109 milliseconds] and 106 milliseconds [99-112 milliseconds], respectively (mean [95% confidence interval], P = .59). A prolonged pre-PCI TpTe was associated with increased mortality (hazard ratio, 10.5 [1.7-20.4] for a cutoff value of 100 milliseconds). Uncorrected QT and heart rate-corrected QT intervals (Fridericia-corrected QT) were prolonged after PCI (QT: 401 vs 410 milliseconds, P = .022, and Fridericia-corrected QT: 430 vs 448 milliseconds, P < .0001).

Conclusion

In patients with STEMI undergoing pPCI, pre-PCI TpTe predicted subsequent all-cause mortality, and the QT interval was increased after the procedure.     

Types of social support and their relationships to physical and depressive symptoms and health-related quality of life in patients with heart failure

Objectives

To examine the various types of social support associated with physical and depressive symptoms and health-related quality of life (HRQOL) in patients with heart failure (HF) and the mediating effects of symptoms on the relationship between social support and HRQOL.

Background

Patients with HF have a high burden of physical and depressive symptoms, along with poor HRQOL. Social support may improve symptoms and HRQOL.

Methods

Data on social support (marital status, family relationships, relationships with health care providers, social networks, emotional support, and instrumental support), symptoms, and HRQOL were collected from 71 patients. Hierarchical regression was used to analyze the data.

Results

Emotional support was related to all physical and depressive symptoms and HRQOL. Physical and depressive symptoms mediated the relationship between emotional support and HRQOL.

Conclusions

Further studies are needed to identify ways to improve emotional support and determine whether the improvement leads to improvements in symptoms and HRQOL.     

Depression and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease

Background

Prior research on the risk of depression in chronic obstructive pulmonary disease (COPD) has yielded conflicting results. Furthermore, we have an incomplete understanding of how much depression versus respiratory factors contributes to poor health-related quality of life.

Methods

Among 1202 adults with COPD and 302 demographically matched referents without COPD, depressive symptoms were assessed using the 15-item Geriatric Depression Score. We measured COPD severity using a multifaceted approach, including spirometry, dyspnea, and exercise capacity. We used the Airway Questionnaire 20 and the Physical Component Summary Score to assess respiratory-specific and overall physical quality of life, respectively.

Results

In multivariate analysis adjusting for potential confounders including sociodemographics and all examined comorbidities, COPD subjects were at higher risk for depressive symptoms (Geriatric Depression Score ≥6) than referents (odds ratio [OR] 3.6; 95% confidence interval [CI], 2.1-6.1; P <.001). Stratifying COPD subjects by degree of obstruction on spirometry, all subgroups were at increased risk of depressive symptoms relative to referents (P <.001 for all). In multivariate analysis controlling for COPD severity as well as sociodemographics and comorbidities, depressive symptoms were strongly associated with worse respiratory-specific quality of life (OR 3.6; 95% CI, 2.7-4.8; P <.001) and worse overall physical quality of life (OR 2.4; 95% CI, 1.8-3.2; P <.001).

Conclusions

Patients with COPD are at significantly higher risk of having depressive symptoms than referents. Such symptoms are strongly associated with worse respiratory-specific and overall physical health-related quality of life, even after taking COPD severity into account.     

Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II

Background

Selection of patients for diagnostic tests for acute pulmonary embolism requires recognition of the possibility of pulmonary embolism on the basis of the clinical characteristics. Patients in the Prospective Investigation of Pulmonary Embolism Diagnosis II had a broad spectrum of severity, which permits an evaluation of the subtle characteristics of mild pulmonary embolism and the characteristics of severe pulmonary embolism.

Methods

Data are from the national collaborative study, Prospective Investigation of Pulmonary Embolism Diagnosis II.

Results

There may be dyspnea only on exertion. The onset of dyspnea is usually, but not always, rapid. Orthopnea may occur. In patients with pulmonary embolism in the main or lobar pulmonary arteries, dyspnea or tachypnea occurred in 92%, but the largest pulmonary embolism was in the segmental pulmonary arteries in only 65%. In general, signs and symptoms were similar in elderly and younger patients, but dyspnea or tachypnea was less frequent in elderly patients with no previous cardiopulmonary disease. Dyspnea may be absent even in patients with circulatory collapse. Patients with a low-probability objective clinical assessment sometimes had pulmonary embolism, even in proximal vessels.

Conclusion

Symptoms may be mild, and generally recognized symptoms may be absent, particularly in patients with pulmonary embolism only in the segmental pulmonary branches, but they may be absent even with severe pulmonary embolism. A high or intermediate-probability objective clinical assessment suggests the need for diagnostic studies, but a low-probability objective clinical assessment does not exclude the diagnosis. Maintenance of a high level of suspicion is critical.     

Comparable efficacy of self-monitoring of quantitative urine glucose with self-monitoring of blood glucose on glycaemic control in non-insulin-treated type 2 diabetes

Aim

To assess whether self-monitoring of quantitative urine glucose or blood glucose is effective, convenient and safe for glycaemic control in non-insulin treated type 2 diabetes.

Methods

Adults with non-insulin treated type 2 diabetes were recruited and randomized into three groups: Group A, self-monitoring with a quantitative urine glucose meter (n = 38); Group B, selfmonitoring with a blood glucose meter (n = 35); Group C, the control group without selfmonitoring (n = 35). All patients were followed up for six months, during which identical diabetes care was provided.

Results

There was a significant decrease in HbA1c within each group (p < 0.05). At the study conclusion, mean changes in HbA1c from baseline were −1.9% for Group A, −1.5% for Group B and −1.0% for Group C, and the proportion of patients achieving HbA1c≤6.5% were 38.9%, 35.3% and 20.0% respectively. However, no significant differences between the groups were found. The average monitoring frequency was significantly higher in Group A than in Group B. The incidence of hypoglycaemia and quality of life scores were similar between the groups.

Conclusions

This study suggests that self-monitoring of urine glucose has comparable efficacy on glycaemic control, and facilitates better compliance than blood self monitoring, without influencing the quality of life or risk of hypoglycaemia.     

Metabolic syndrome and coronary angiographic disease progression: the Women's Angiographic Vitamin & Estrogen trial

Background

The metabolic syndrome is a cluster of clinical characteristics thought to be associated with increased coronary risk. This analysis evaluates angiographic progression of coronary disease in women who are postmenopausal with and without the metabolic syndrome enrolled in the Women’s Angiographic Vitamin & Estrogen (WAVE) trial, a randomized, controlled trial of hormone therapy and antioxidant vitamins.

Methods

A total of 425 women who are postmenopausal and have angiographic coronary disease were enrolled at 7 clinics between July 1997 and August 1999. Women were categorized as having the metabolic syndrome when they met the National Cholesterol Education Program Adult Treatment Panel III definition. Coronary angiograms were performed at baseline and after 2.8 ± 0.9 years (mean ± SD). Quantitative coronary angiographic analysis was performed at a core laboratory.

Results

Women with the metabolic syndrome (177/294, 60%) were more likely to be taking cholesterol-lowering medication (65% vs 51%, P = .01) and had higher body mass index (33 ± 6 vs 28 ± 6 kg/m², P <.001). The mean reduction in minimum lumen diameter was greater (−0.041 ± 0.151 vs −0.023 ± 0.148 mm/year, P = .33) and new lesions were more frequent (34% vs 23%, P = .054) in women with the metabolic syndrome. In multivariate analysis, the metabolic syndrome was not an independent predictor of angiographic disease progression. However, clinical events (myocardial infarction, stroke, or coronary death) were more frequent among women with the metabolic syndrome (P = .02).

Conclusion

The metabolic syndrome was prevalent among postmenopausal women with coronary disease enrolled in the WAVE trial. Having the metabolic syndrome was not independently associated with changes in minimum lumen diameter or the development of new or progressing coronary lesions, but did confer an increased risk of clinical cardiovascular events.     

Staphylococcus Aureus Bacteremia Among Patients with Health Care-associated Fever

Background

Although Staphylococcus aureus bacteremia is a common, serious infection, accurately identifying febrile patients with this diagnosis at the time of initial evaluation is difficult. The purpose of this investigation was to define clinical characteristics present at the time of the initial recognition of fever that were associated with the presence of any bloodstream infection and, in particular, with S. aureus bacteremia.

Methods

All patients ≥18 years of age with a new episode of health care-associated fever (temperature ≥38°C) and at least one blood culture drawn were eligible for enrollment into this prospective multicenter cohort study. Multivariable analyses were conducted and internally validated scoring systems were developed to categorize the risk of bacteremia.

Results

Of 1015 patients enrolled, 181 patients (17.8%) had clinically significant bacteremia, including 77 patients (7.6%) with S. aureus bacteremia. Clinical characteristics associated with S. aureus bacteremia were the presence of a hemodialysis graft or shunt (odds ratio [OR] 3.22; 95% confidence interval [CI], 1.85-5.61), chills (OR 2.38; 95% CI, 1.43-3.98), and a history of S. aureus infection (OR 2.68; 95% CI, 1.38-5.20). Peripheral vascular catheters were inversely associated with S. aureus bacteremia (OR 0.42; 95% CI, 0.26-0.69). Clinical characteristics associated with any bloodstream infection were central venous access, chills, history of S. aureus infection, and hemodialysis access.

Conclusions

Among patients with health care-associated fever, the presence of easily recognizable clinical characteristics at the time of obtaining the initial blood cultures can help to identify patients at increased risk for any bloodstream infection, in particular for S. aureus bacteremia.     

Enquête sur le poids de la rhinite allergique en France

Background

This paper presents the results from France of a prospective, cross-sectional, international survey conducted among patients and physicians to identify symptom perception and the impact of allergic rhinitis on health-related quality of life.

Methods

Data about the presence, severity and impact of symptoms were recorded by 504 patients and matched with data from their physicians. Health-related quality of life was assessed using the Mini Rhinoconjunctivitis Quality of Life Questionnaire.

Results

According to the physicians’ assessments, a large proportion (71%) of patients had moderate or severe disease, persistent disease (48.3%), and comorbidities such as asthma (32.3%) and anxiety (19%). Persistent disease was present in 55.3% of patients with perennial allergic rhinitis and 44.9% with seasonal allergic rhinitis. Physicians tended to underestimate the incidence of some symptoms reported by the patients, most notably cough, headache, and itchy eyes. Health-related quality of life was negatively correlated with disease severity and number of symptom-free days. Allergic rhinitis had a significantly greater impact on patients with more persistent disease compared with those with intermittent disease (2.0 ± 1.3 versus 1.8 ± 1.2; p < 0.05); nevertheless, 73.9% of patients with intermittent disease reported some impairment of their daily life.

Conclusions

Allergic rhinitis remains a significant health problem in France due to the high prevalence of moderate or severe, persistent disease in patients presenting during routine care as well as to the impact of the disease on health-related quality of life. Patients and physicians differed significantly in their perception of disease severity and in the reporting of some symptoms, including ocular symptoms and cough.