The prevalence,intensity and ecological determinants of helminth infection among children in an urban and rural community in Southern Malawi

Rapid urbanisation and poor town planning in Malawi has been associated with poor environmental hygiene and sanitation. The aim of the present study was to investigate the prevalence, intensity and some potential risk factors of intestinal helminth infections among children aged 3 – 14 years in an urban and rural community in Southern Malawi. A randomised cross-sectional survey was conducted in July, 1998. Data were collected through questionnaire interview regarding socio-demographic and environmental conditions from households in both areas. Stool samples were collected from 273 children in the urban community and 280 in the rural. There was a significant difference (p<0.001) in the prevalence of helminth infections between the urban and rural communities, 16.5% and 3.6% respectively. Most of the infections were light (93.2% for Ascaris lumbricodes, 85.7% for hookworm). Large variance to mean ratios of egg intensity within age groups and the total study population suggested a high degree of aggregation of the parasites in the communities. Multiple logistic regression analysis showed that certain groups of children in the urban community were much more likely to develop helminth infection. They included children who had pools of water/sewage around houses (OR = 3.0, 95% CI = 1.4 ñ 6.5), did not wear shoes (OR a 7.1, 95% CI = 2.7 – 19.2), did not attend school (OR = 2.8, 95% CI = 1.2 ñ 6.5), had mothers who had 4 to 8 years of education (OR = 5.2, 95% CI = 2.0 – 14.0), had mothers below 35 years of age (OR = 4.09, 95% CI = 1.39 – 16.28) and living in an urban community (OR = 5.3, 95% CI = 2.6 – 12.1). Efforts to reduce helminth infections should focus on reducing exposures.     

Risk of infections of biological and targeted drugs in patients with spondyloarthritis: meta-analysis of randomized clinical trials

Background: Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by performing a meta-analysis based on randomized controlled trials (RCTs).Methods: A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and China Biology Medicine Disc for RCTs evaluating the risk of infections of biological therapy in ...     

Detection of Human Bocavirus in Children with Acute Respiratory Tract Infections in Lanzhou and Nanjing,China

Objective The aim of this study was to explore the prevalent characteristics of HBoV1 and its co-infection.Methods PCR was used to detect HBoV1-DNA（HBoV1） and other viruses.A multivariate logistic regression model was used to explore possibility of co-detected for related viruses.Results The positivity rates in Nanjing and Lanzhou were 9.38%（74/789） and 11.62%（161/1386）,respectively（P〉0.05）.The HBoV1 positive group was younger than negative group（P〈0.05）.Seasonal differences were noted,with a higher frequency of infection in December and July.HBoV1-positive children [72.34%（169/235）] were co-infected with other respiratory viruses.Multifactorial analysis showed no correlations between HBoV1 and the clinical classification,region,gender,age,or treatment as an outpatient or in a hospital.Correlations were identified between HBoV1 infections with ADV（OR=1.53,95% CI 1.03-2.28）,RSV（OR=0.71,95% CI 0.52-0.98）,and IFVA（OR=1.77,95% CI 1.00-3.13）.Conclusions Presence of HBoV1 in nasopharyngeal aspirates did not correlate with region or gender,although the prevalence of HBoV1 was higher in younger children.There were no correlations between HBoV1 and other variables,except for the season and ADV,RSV,or IFVA infections.     

Delivery room resuscitation and short-term outcomes of extremely preterm and extremely low birth weight infants: a multicenter survey in North China

Background:Delivery room resuscitation assists preterm infants, especially extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI), in breathing support, while it potentially exerts a negative impact on the lungs and outcomes of preterm infants. This study aimed to assess delivery room resuscitation and discharge outcomes of EPI and ELBWI in China.Methods:The clinical data of EPI (gestational age [GA] <28 weeks) and ELBWI (birth weight [BW] <1000 g), admitted within 72 h of birth in 33 neonatal intensive care units from five provinces and cities in North China between 2017 and 2018, were analyzed. The primary outcomes were delivery room resuscitation and risk factors for delivery room intubation (DRI). The secondary outcomes were survival rates, incidence of bronchopulmonary dysplasia (BPD), and risk factors for BPD.Results:A cohort of 952 preterm infants were enrolled. The incidence of DRI, chest compressions, and administration of epinephrine was 55.9% (532/952), 12.5% (119/952), and 7.0% (67/952), respectively. Multivariate analysis revealed that the risk factors for DRI were GA <28 weeks (odds ratio [OR], 3.147; 95% confidence interval [CI], 2.082–4.755), BW <1000 g (OR, 2.240; 95% CI, 1.606–3.125), and antepartum infection (OR, 1.429; 95% CI, 1.044–1.956). The survival rate was 65.9% (627/952) and was dependent on GA. The rate of BPD was 29.3% (181/627). Multivariate analysis showed that the risk factors for BPD were male (OR, 1.603; 95% CI, 1.061–2.424), DRI (OR, 2.094; 95% CI, 1.328–3.303), respiratory distress syndrome exposed to ≥2 doses of pulmonary surfactants (PS; OR, 2.700; 95% CI, 1.679–4.343), and mechanical ventilation ≥7 days (OR, 4.358; 95% CI, 2.777–6.837). However, a larger BW (OR, 0.998; 95% CI, 0.996–0.999), antenatal steroid (OR, 0.577; 95% CI, 0.379–0.880), and PS use in the delivery room (OR, 0.273; 95% CI, 0.160–0.467) were preventive factors for BPD (all P < 0.05).Conclusion:Improving delivery room resuscitation and management of respiratory complications are imperative during early management of the health of EPI and ELBWI.     

Comparative effectiveness and safety of 32 pharmacological interventions recommended by guidelines for coronavirus disease 2019: a systematic review and network meta-analysis combining 66 trials

Background:The global pandemic coronavirus disease 2019 (COVID-19) has become a major public health problem and presents an unprecedented challenge. However, no specific drugs were currently proven. This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19.Methods:Medline, Embase, the Cochrane Library, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/SARS-CoV. Random-effects network meta-analysis within the Bayesian framework was performed, followed by the Grading of Recommendations Assessment, Development, and Evaluation system assessing the quality of evidence. The primary outcome of interest includes mortality, cure, viral negative conversion, and overall adverse events (OAEs). Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size.Results:Sixty-six RCTs with 19,095 patients were included, involving standard of care (SOC), eight different antiviral agents, six different antibiotics, high and low dose chloroquine (CQ_HD, CQ_LD), traditional Chinese medicine (TCM), corticosteroids (COR), and other treatments. Compared with SOC, a significant reduction of mortality was observed for TCM (OR = 0.34, 95% CI: 0.20–0.56, moderate quality) and COR (OR = 0.84, 95% CI: 0.75–0.96, low quality) with improved cure rate (OR = 2.16, 95% CI: 1.60–2.91, low quality for TCM; OR = 1.17, 95% CI: 1.05–1.30, low quality for COR). However, an increased risk of mortality was found for CQ_HD vs. SOC (OR = 3.20, 95% CI: 1.18–8.73, low quality). TCM was associated with decreased risk of OAE (OR = 0.52, 95% CI: 0.38–0.70, very low quality) but CQ_HD (OR = 2.51, 95% CI: 1.20–5.24) and interferons (IFN) (OR = 2.69, 95% CI: 1.02–7.08) vs. SOC with very low quality were associated with an increased risk.Conclusions:COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care. CQ_HD might increase the risk of mortality. CQ, IFN, and other antiviral agents could increase the risk of OAEs. The current evidence is generally uncertain with low-quality and further high-quality trials are needed.     

Age and diabetes mellitus associated with worse outcomes after percutaneous coronary intervention in a multi-ethnic Asian dialysis patient population

INTRODUCTIONThere is limited literature on clinical outcomes following percutaneous coronary intervention (PCI) in Asian dialysis patients. We evaluated the angiographic characteristics and clinical outcomes of dialysis patients treated with PCI in an Asian society.METHODSA retrospective analysis was performed of 274 dialysis patients who underwent PCI in a tertiary care institution from January 2007 to December 2012. Data on clinical and angiographic characteristics was collected. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, acute myocardial infarction (AMI) and stroke at two years.RESULTS274 patients (65.0% male, median age 62.0 years) with 336 lesions (81.8% Type B2) were treated. 431 stents (35.0% drug-eluting stents) with a mean diameter of 2.96 mm and mean length of 21.30 mm were implanted. The MACE rate was 55.8% (n = 153) at two years, from death (36.5%) and AMI (35.0%). In multivariable analysis, age and diabetes mellitus were significant predictors of both mortality (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05–1.12, p < 0.001; OR 2.65, 95% CI 1.46–4.82, p = 0.001, respectively) and MACE (OR 1.06, 95% CI 1.03–1.08, p < 0.001; OR 1.84, 95% CI 1.07–3.15, p = 0.027, respectively). Left ventricular ejection fraction (LVEF) (OR 0.97, 95% CI 0.95–0.99, p = 0.006) was a significant predictor of mortality but not MACE.CONCLUSIONAsian dialysis patients who underwent PCI had a two-year MACE rate of 55.8% due to death and AMI. Age, LVEF and diabetes mellitus were significant predictors of mortality at two years.     

重症监护病房儿童脑卒中临床特征和功能结局分析

目的 探讨儿童重症监护病房(PICU)脑卒中临床特征和分析功能结局的危险因素。方法 选取2018年7月—2022年6月复旦大学附属儿科医院PICU收住的脑卒中连续病例163例,以出院时脑功能分类量表评分(范围1～6分)≥4分为功能结局预后差。采集临床特征,通过多因素logistic回归分析,评估功能结局预后差及院内死亡的危险因素。结果 163例脑卒中患儿中男88例(54.0%),起病年龄为4.5(1.2,9.3)岁;缺血性脑卒中(IS)84例,出血性脑卒中(HS)79例,急性期总体出院病死率为16.6%,IS和HS病死率分别为8.3%(7/84)和25.3%(20/79);55例(33.7%)出院时功能结局预后差;136例出院存活患儿中,95例(69.9%)遗留残疾;收入PICU时的改良格拉斯哥昏迷评分(GCS)低(OR=0.658,95%CI:0.582～0.743,P<0.001)与出院时功能结局预后差显著相关;HS(OR=3.071,95%CI:1.121～8.417,P=0.029)和改良GCS低(OR=0.738,95%CI:0.648～0.840,P<0.001...     

Association between serum uric acid level and mortality in China

Background:Whether there is an association between serum uric acid (SUA) level and risk of mortality in the general population remains unclear. Based on the China National Survey of Chronic Kidney Disease linked to mortality data, a population-based cohort study was performed to investigate the association between SUA level and all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality in China.Methods:The survival status of participants in the cross-sectional survey was identified from January 1, 2006 to December 31, 2017. Only 33,268 individuals with complete SUA data among the 47,204 participants were included in the analysis. We determined the rates of all-cause mortality, CVD mortality, and cancer mortality. We used Cox proportional hazards regression models to evaluate the effect of the SUA level on mortality.Results:During a total of 297,538.4 person-years of follow-up, 1282 deaths occurred. In the Cox proportional hazards regression model, the rate of all-cause mortality, CVD mortality, and cancer mortality had a U-shaped association with SUA levels only in men, whereas no significant associations were detected in women. For all-cause mortality in men, the multivariable-adjusted hazard ratios (HRs) in the first, second, and fourth quartiles compared with the third quartile were 1.31 (95% confidence interval [CI] 1.04–1.67), 1.17 (95% CI 0.92–1.47), and 1.55 (95% CI 1.24–1.93), respectively. For CVD mortality, the corresponding HRs were 1.47 (95% CI 1.00–2.18), 1.17 (95% CI 0.79–1.75), and 1.67 (95% CI 1.16–2.43), respectively. For the cancer mortality rate, only a marginally significant association was detected in the fourth quartile compared with the third quartile with an HR of 1.43 (95% CI 0.99–2.08).Conclusions:The association between SUA and mortality differed by sex. We demonstrated a U-shaped association with SUA levels for all-cause and CVD mortalities among men in China.     

Intravenous thrombolysis for acute ischemic stroke with extended time window

Background:Intravenous thrombolysis (IVT) is an effective way for treating acute ischemic stroke (AIS). However, its effects have not been established among AIS patients with unclear stroke symptoms or with stroke onset for >4.5 h.Methods:We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and Google Scholar databases for randomized controlled trials that compared IVT (IVT group) and placebo or usual care (control group [CG]) in AIS patients with disease onset for >4.5 h. The outcomes of interest included the favorable functional outcome (defined as modified Rankin Scale [mRS] scores 0–1) at 90 days, the functional independence (defined as mRS scores 0–2) at 90 days, proportion of patients with symptomatic intracerebral hemorrhage (sICH) and death at 90 days. We assessed the risk of bias using the Cochrane tool. Pre-specified subgroup analyses were performed by age (≤70 years or >70 years), National Institute of Health Stroke Scale (NIHSS, ≤10 or >10) and time window (4.5–9.0 h or >9.0 h).Results:Four trials involving 848 patients were eligible. The risk of bias of included trials was low. Patients in the IVT group were more likely to achieve favorable functional outcomes (45.8% vs. 36.7%; OR 1.48, 95% CI 1.12–1.96) and functional independence (63.8% vs. 55.7%; OR 1.43, 95% CI 1.08–1.90) at 90 days, but had higher risk of sICH (3.0% vs. 0.5%; OR 5.28, 95% CI 1.35–20.68) at 90 days than those in the CG. No significant difference in death at 90 days was found between the two groups (7.0% vs. 4.1%; OR 1.80; 95% CI 0.97–3.34).Conclusions:Use of IVT in patients with extended time window may improve their functional outcomes at 90 days, although IVT may induce increased risk of sICH. Care of these patients should well balance the potential benefits and harms of IVT.     

Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China

Background:Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.     

Independent and joint association of physical activity and sedentary behavior on all-cause mortality

Backgrounds:Physical activity (PA) and sedentary behavior (SB) have been associated with mortality, while the joint association with mortality is rarely reported among Chinese population. We aimed to examine the independent and joint association of PA and SB with all-cause mortality in southern China.Methods:A cohort of 12,608 China Hypertension Survey participants aged ≥35 years were enrolled in 2013 to 2014, with a follow-up period of 5.4 years. Baseline self-reported PA and SB were collected via the questionnaire. Kaplan–Meier curves (log-rank test) and Cox proportional hazards regression were performed to evaluate the associations of PA and SB on all-cause mortality.Results:A total of 11,744 eligible participants were included in the analysis. Over an average of 5.4 years of follow-up, 796 deaths occurred. The risk of all-cause mortality was lower among participants with high PA than those with low to moderate level (5.2% vs. 8.9%; hazards ratio [HR]: 0.75, 95% confidence interval [CI]: 0.61–0.87). Participants with SB ≥ 6 h had a higher risk of all-cause mortality than those with SB <6 h (7.8% vs. 6.0%; HR: 1.37, 95% CI: 1.17–1.61). Participants with prolonged SB (≥6 h) and inadequate PA (low to moderate) had a higher risk of all-cause mortality compared to those with SB < 6 h and high PA (11.2% vs. 4.9%; HR: 1.67, 95% CI: 1.35–2.06). Even in the participants with high PA, prolonged SB (≥6 h) was still associated with the higher risk of all-cause mortality compared with SB < 6 h (7.0% vs. 4.9%; HR: 1.33, 95% CI: 1.12–1.56).Conclusions:Among Chinese population, PA and SB have a joint association with the risk of all-cause mortality. Participants with inadequate PA and prolonged SB had the highest risk of all-cause mortality compared with others.     

2008-2012年苏州地区重症社区获得性肺炎死亡危险因素分析

目的：了解苏州地区重症社区获得性肺炎（community acquired pneumonia,CAP）死亡危险因素.方法：将2008年1月1日-2012年12月30日收住儿科重症监护病房（pediatric intensive care unit,PICU）的803例重症CAP患儿的流行病学、临床和实验室以及预后资料分析比较.结果：本研究803例重症CAP患儿中82.1%在1岁以下,31.4%（252/803）存在基础疾病,死亡率为7.5%,呼吸道病原检出最多为呼吸道合胞病毒（respiratory syncytial virus,RSV）46.6%（189/406）,其次为支原体19.7%（80/406）,细菌中最多的是肺炎链球菌、流感嗜血杆菌和卡他莫拉菌,分别占12.3%（50/406）、7.9%（32/406）和3.0%（12/406）,单因素分析时,死亡危险因素为患儿出现意识改变、呼吸频率＞70次/min、呻吟、点头样呼吸、青紫、入院时动脉血氧饱和度（arterial oxygen saturation,SaO2）＜80%和血红蛋白（hemoglobin,Hb）＜8 g/dL,而通过多因素Logistic回归分析显示其死亡危险因素为患儿存在先天性心脏病、21三体综合征、脑性瘫痪和免疫缺陷.结论：年龄和基础疾病状态与重症CAP的死亡率密切相关,基础疾病状态和危重症状态的早期识别和干预对死亡率的改善可能有意义,根据当地CAP病原学谱的特点制定合适的预防接种计划可能会减少重症CAP的发生.     

Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on in-hospital mortality among patients with COVID-19: a systematic review and meta-analysis

INTRODUCTIONThere are concerns that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may worsen the outcomes of patients with COVID-19. This systematic review and meta-analysis aimed to study the in-hospital mortality among COVID-19 patients who were on ACEIs/ARBs as compared to those not on ACEIs/ARBs.METHODSWe searched PubMed, EMBASE, clinicaltrials.gov and Google Scholar between 1 January 2020 and 30 May 2020 to identify all studies that evaluated the use of ACEIs/ARBs and reported the in-hospital mortality outcomes of COVID-19 patients. Nine non-randomised studies were eligible for inclusion in the analysis. The primary outcome studied was the in-hospital mortality of COVID-19 patients who were on ACEIs/ARBs compared with those not on ACEIs/ARBs.RESULTSOf the 8,313 patients in the nine studies, 7,622 (91.7%) were from studies with all-comers, while 691 (8.3%) were from studies involving only patients with hypertension. 577 (14.6%) in-hospital deaths were observed out of a total of 3,949 patients with an outcome in the nine studies. Overall, no significant difference was observed in the in-hospital mortality between patients on ACEIs/ARBs and those not on ACEIs/ARBs (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.75–1.50; p = 0.73). Further sensitivity analysis in the hypertension group and the all-comers group showed similar results (OR 0.88, 95% CI 0.58–1.32; p = 0.53 and OR 1.85, 95% CI 1.00–3.43; p = 0.05, respectively).CONCLUSIONWe observed that ACEIs/ARBs had no significant impact on the in-hospital mortality of COVID-19 patients and can be used safely in patients with indications.     

Human papillomavirus distribution and cervical cancer epidemiological characteristics in rural population of Xinjiang,China

Background:Cervical cancer remains a major public health issue for the Uyghur women and other women living mainly in rural areas of Xinjiang. This study aims to investigate the distribution of human papillomavirus (HPV) infection and cervical cancer in rural areas of Xinjiang, China.Methods:Cervical cancer screening was performed on rural women aged 35 to 64 years from Xinjiang, China in 2017 through gynecological examination, vaginal discharge smear microscopy, cytology, and HPV testing. If necessary, colposcopy and biopsy were performed on women with suspicious or abnormal screening results.Results:Of the 216,754 women screened, 15,518 received HPV testing. The HPV-positive rate was 6.75% (1047/15,518). Compared with the age 35–44 years group, the odds ratios (ORs) of HPV positivity in the age 45–54 years and 55–64 years groups were 1.18 (95% confidence interval [CI]: 1.02–1.37) and 1.84 (95% CI: 1.53–2.21), respectively. Compared with women with primary or lower education level, the ORs for HPV infection rates of women with high school and college education or above were 1.37 (95% CI: 1.09–1.72) and 1.62 (95% CI: 1.23–2.12), respectively. Uyghur women were less likely to have HPV infection than Han women, with an OR (95% CI) of 0.78 (0.61–0.99). The most prevalent HPV types among Xinjiang women were HPV 16 (24.00%), HPV 33 (12.70%), and HPV 52 (11.80%). The detection rate of cervical intraepithelial neoplasia (CIN)2+ was 0.14% and the early diagnosis rate of cervical cancer was 85.91%. The detection rates of vaginitis and cervicitis were 19.28% and 21.32%, respectively.Conclusions:The HPV infection rate in Xinjiang is low, but the detection rate of cervical cancer and precancerous lesions is higher than the national average level. Cervical cancer is a prominent public health problem in Xinjiang, especially in southern Xinjiang.     

Long-term outcomes and independent predictors of mortality in patients presenting to emergency departments with acute heart failure in Beijing: a multicenter cohort study with a 5-year follow-up

Background:Acute heart failure (AHF) is the most common disease in emergency departments (EDs). However, clinical data exploring the outcomes of patients presenting AHF in EDs are limited, especially the long-term outcomes. The purposes of this study were to describe the long-term outcomes of patients with AHF in the EDs and further analyze their prognostic factors.Methods:This prospective, multicenter, cohort study consecutively enrolled 3335 patients with AHF who were admitted to EDs of 14 hospitals from Beijing between January 1, 2011 and September 23, 2012. Kaplan-Meier and Cox regression analysis were adopted to evaluate 5-year outcomes and associated predictors.Results:The 5-year mortality and cardiovascular death rates were 55.4% and 49.6%, respectively. The median overall survival was 34 months. Independent predictors of 5-year mortality were patient age (hazard ratio [HR]: 1.027, 95 confidence interval [CI]: 1.023–1.030), body mass index (BMI) (HR: 0.971, 95% CI: 0.958–0.983), fatigue (HR: 1.127, 95% CI: 1.009–1.258), ascites (HR: 1.190, 95% CI: 1.057–1.340), hepatic jugular reflux (HR: 1.339, 95% CI: 1.140–1.572), New York Heart Association (NYHA) class III to IV (HR: 1.511, 95% CI: 1.291–1.769), heart rate (HR: 1.003, 95% CI: 1.001–1.005), diastolic blood pressure (DBP) (HR: 0.996, 95% CI: 0.993–0.999), blood urea nitrogen (BUN) (HR: 1.014, 95% CI: 1.008–1.020), B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP) level in the third (HR: 1.426, 95% CI: 1.220–1.668) or fourth quartile (HR: 1.437, 95% CI: 1.223–1.690), serum sodium (HR: 0.980, 95% CI: 0.972–0.988), serum albumin (HR: 0.981, 95% CI: 0.971–0.992), ischemic heart diseases (HR: 1.195, 95% CI: 1.073–1.331), primary cardiomyopathy (HR: 1.382, 95% CI: 1.183–1.614), diabetes (HR: 1.118, 95% CI: 1.010–1.237), stroke (HR: 1.252, 95% CI: 1.121–1.397), and the use of diuretics (HR: 0.714, 95% CI: 0.626–0.814), β-blockers (HR: 0.673, 95% CI: 0.588–0.769), angiotensin-converting enzyme inhibitors (ACEIs) (HR: 0.714, 95% CI: 0.604–0.845), angiotensin-II receptor blockers (ARBs) (HR: 0.790, 95% CI: 0.646–0.965), spironolactone (HR: 0.814, 95% CI: 0.663–0.999), calcium antagonists (HR: 0.624, 95% CI: 0.531–0.733), nitrates (HR: 0.715, 95% CI: 0.631–0.811), and digoxin (HR: 0.579, 95% CI: 0.465–0.721).Conclusions:The results of our study demonstrate poor 5-year outcomes of patients presenting to EDs with AHF. Age, BMI, fatigue, ascites, hepatic jugular reflux, NYHA class III to IV, heart rate, DBP, BUN, BNP/NT-proBNP level in the third or fourth quartile, serum sodium, serum albumin, ischemic heart diseases, primary cardiomyopathy, diabetes, stroke, and the use of diuretics, β-blockers, ACEIs, ARBs, spironolactone, calcium antagonists, nitrates, and digoxin were independently associated with 5-year all-cause mortality.     

Research letter: Factors influencing childhood influenza immunization

FOLLOWING THE LAUNCH OF A PUBLICLY FUNDED influenza immunization program for all residents of Ontario over the age of 6 months, we evaluated 203 parents of children who presented to our emergency department between January and March of the following year (2001). Overall, 54 (27%) of the children had been vaccinated. Parents of non-immunized children were more likely to believe that immunization resulted in a flu-like illness (42% v. 17%; p = 0.001), caused side effects that were more severe than having influenza (36% v. 17%; p = 0.010) and weakened the immune system (52% v. 24%; p < 0.001). Parents of both immunized and non-immunized children incorrectly identified gastrointestinal symptoms as symptoms of influenza. The primary reason for deciding against immunization was the belief that their child was not at risk. After adjustment, children with a chronic disease were more likely than those without a chronic disease to be immunized (adjusted odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8–12.6). Children of parents who discussed immunization with a physician were more likely to be immunized than those who had not discussed immunization with a physician (OR 6.8, 95% CI 2.4–19.2).