Comorbidity burden conditions the prognostic performance of D-dimer in elderly patients with acute pulmonary embolism

Introduction

The prognostic accuracy of D-dimer for risk assessment in acute Pulmonary Embolism (APE) patients may be hampered by comorbidities. We investigated the impact of comorbidity burden (CB) by using the Charlson Comorbidity Index (CCI), on the prognostic ability of D-dimer to predict 30 and 90-day mortality in hemodynamically stable elderly patients with APE.

Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survival

Purpose

In the present study, we analyzed sociodemographical and clinical factors, and the Eastern Cooperative Oncology Group performance status (ECOG-PS) scale in head and neck squamous cell carcinoma (HNSCC) patients. We evaluated the impact of a range of variables on overall survival.

Methods

We investigated a sample of HNSCC patients (n?=?671), using sociodemographical and clinical information, and survival data collected from a review of epidemiological, clinical, and treatment reports. Statistical associations were analyzed by bivariate and multivariate statistical tests. Statistical significance was set at p?<?0.05.

Results

Of patients 85.4% recorded good ECOG-PS scores. Poor ECOG-PS scores were associated with the covariates indicative of dysphagia [odd ratios (OR)?=?2.660, CI 95%?=?1.661–4.260, p?=?0.000] and large-size malignant disease (T3–T4; OR?=?5.337, CI 95%?=?2.251–12.652, p?=?0.000). Overall survival analysis revealed that ECOG-PS scores (OR?=?1.879, CI 95%?=?1.162–3.038, p?=?0.010), tumor size (OR?=?1.665, CI 95%?=?1.035–2.680, p?=?0.036), and the presence of cervical metastasis (OR?=?3.145, CI 95%?=?2.008–4.926, p?=?0.000) were independent predictors.

Conclusion

Evaluation of physical consumption in head and neck cancer patients at diagnosis may indicate a more aggressive type of malignant disease. Thus, the ECOG-PS scale may help to identify HNSCC patients in need of rapid referral, who may benefit from specific therapeutic and rehabilitative interventions.     

Treatment-related side effects and quality of life in cancer patients

Background

Cancer leads to a complicated pattern of change in quality of life (QoL).

Objective

The aims of this study were to assess the impact of treatment-related side effects on QoL in cancer patients and to explore which other factors, and to what extent, contribute to explain low QoL scores.

Methods

One hundred twenty-three cancer patients receiving chemotherapy completed the self-administered questionnaires (Medical Outcomes Short-Form-36 (SF-36) and 12-item General Health Questionnaire). Multiple regression analyses were conducted with the SF-36 physical component summary (PCS) and SF-36 mental component summary (MCS) scores as the dependent variables and demographic and clinical factors as independent variables.

Results

Seventy-two percent of patients experienced treatment-related side effects, and 32% resulted positive for psychiatric diseases. Two multivariate analyses showed that worse PCS scores, like worse MCS scores, were significantly and independently predicted by treatment-related side effects (odds ratio (OR)?=?5.00, 95%CI 1.29–19.45; OR?=?8.08, 95%CI 2.03–32.22, respectively) and changes in health over the last 12?months (OR =2.34, 95%CI 1.47–3.76; OR?=?3.21, 95%CI 1.90–5.41, respectively), after adjustment for age, gender, years of school, time from cancer diagnosis, and psychiatric disease.

Conclusions

Given the new emphasis on QoL, we suggest that physicians have a responsibility to openly discuss therapy efficacy, prognosis as well as the potential for adverse events with their patients. Changes in health, as perceived by patient, should also be monitored at follow-up.     

Metastatic epidural spinal cord compression among elderly patients with advanced prostate cancer

Background

A recent randomized trial demonstrated that for metastatic epidural spinal cord compression (MESCC), a complication of advanced prostate cancer, surgical decompression may be more effective than external beam radiation therapy (RT). We investigated predictors of MESCC, its treatment, and its impact on hospital length of stay for patients with advanced prostate cancer.

Methods

We used the SEER-Medicare database to identify patients >65 years with stage IV (n?=?14,800) prostate cancer. We used polytomous logistic regression to compare those with and without MESCC and those hospitalized for treatment with surgical decompression and/or RT.

Results

MESCC developed in 711 (5 %) of patients, among whom 359 (50 %) received RT and 107 (15 %) underwent surgery?±?RT. Median survival was 10 months. MESCC was more likely among patients who were black (OR 1.75, 95 %CI 1.39–2.19 vs. white) and had high-grade tumors (OR 3.01, 95 %CI 1.14–7.94), and less likely in those younger; with prior hormonal therapy (OR 0.73, 95 %CI 0.62–0.86); or with osteoporosis (OR 0.63, 95 %CI 0.47–0.83). Older patients were less likely to undergo either RT or surgery, as were those with ≥1 comorbidity. Patients with high-grade tumors were more likely to undergo RT (OR 1.92, 95 %CI 1.25–2.96). Those who underwent RT or surgery spent an additional 11 and 29 days, respectively, hospitalized.

Conclusions

We found that black men with metastatic prostate cancer are more likely to develop MESCC than whites. RT was more commonly utilized for treatment than surgery, but the elderly and those with comorbidities were unlikely to receive either treatment.     

Predictors of sexual well-being after endometrial cancer: results of a national self-report survey

Purpose

We examined whether sociodemographic, physical, reproductive, psychological and clinical factors at the time of diagnosis were related to women’s sexual well-being 3–5 years following treatment for endometrial cancer.

Methods

Of the 1,399 women in the Australian National Endometrial Cancer Study, 644 completed a follow-up questionnaire 3–5 years after diagnosis. Of these, 395 women completed the Sexual-Function Vaginal Changes Questionnaire, which was used to assess sexual well-being. Based on two questions assessing worry and satisfaction with their sexuality, women were classified into lower and higher sexual well-being. Multivariable-adjusted logistic regression models were used to examine sexual well-being 3–5 years following cancer treatment and the factors associated with this at diagnosis and at follow-up.

Results

Of the 395 women, 46 % (n?=?181) were categorized into the “higher” sexual well-being group. Women who were older (odds ratio [OR]?=?1.97; 95 % confidence limit [CI], 1.23–3.17), high school educated (OR?=?1.75; 95 % CI, 1.12–2.73), who reported good mental health at the time of diagnosis (OR?=?2.29; 95 % CI, 1.32–3.95) and whose cancer was treated with surgery alone (OR?=?1.93; 95 % CI, 1.22–3.07) were most likely to report positive sexual well-being. At 3–5 years post-diagnosis, women with few symptoms of anxiety (OR?=?2.28; 95 % CI, 1.21–4.29) were also most likely to report positive sexual well-being.

Conclusions

Psychological, sociodemographic and treatment factors are important to positive sexual well-being post-cancer. Care that focuses on maintaining physical and psychosocial aspects of women’s lives will be more effective in promoting positive sexual well-being than care that focuses solely on physical function.     

Which transfers can we avoid: Multi-state analysis of factors associated with discharge home without procedure after ED to ED transfer for traumatic injury

Objective

Among injured patients transferred from one emergency department (ED) to another, we determined factors associated with being discharged from the second ED without procedures, or admission or observation.

Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room

Purpose

To identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA.

Methods

Physicians in the emergency department of a tertiary care hospital completed a questionnaire before CTPA after being trained about diagnosing PE and completing questionnaires.

Results

Nine hundred patients received a CTPA during 3?years. For 328 CTPAs performed during the 1-year study period, 140 (43?%) questionnaires were completed. The most frequent reasons for ordering a CTPA were to confirm/rule out PE (93?%), elevated D-dimers (66?%), fear of missing PE (55?%), and Wells/simplified revised Geneva score (53?%). A positive answer for “fear of missing PE” was inversely associated with positive CTPA (OR 0.36, 95?% CI 0.14–0.92, p?=?0.033), and “Wells/simplified revised Geneva score” was associated with positive CTPA (OR 3.28, 95?% CI 1.24–8.68, p?=?0.017). The proportion of positive CTPA was higher if a questionnaire was completed, compared to the 2-year comparison period (26.4 vs. 14.5?%, OR 2.12, 95?% CI 1.36–3.29, p?p?=?0.067).

Conclusion

Reasons for CTPA reflecting defensive behavior—such as “fear of missing PE”—were frequent, and were associated with a decreased odds of positive CTPA. Defensive behavior might be modifiable by training in using guidelines.     

Glucocorticoid-induced diabetes mellitus in patients with lymphoma treated with CHOP chemotherapy

Purpose

Glucocorticoid-induced diabetes mellitus (GDM) is a major complication arising from corticosteroid administration, but there is lack of studies on GDM attributing to CHOP chemotherapy. We studied the incidence and risk factors for GDM development in patients with lymphoma during CHOP chemotherapy.

Methods

We analyzed 80 patients with lymphoma treated with a CHOP regimen with or without rituximab between 2004 and 2012 at the University of Tsukuba hospital. Patients with a known history of DM were excluded. Diagnosis of DM was performed according to the American Diabetes Association’s criteria.

Results

Among the 80 patients, 26 (32.5 %) developed GDM. We found that age ≥60 years, glycated hemoglobin (HbA1c) levels >6.1 %, body mass index (BMI) >30 kg/m², prednisolone administration prior to chemotherapy, history of hypertension or hypertension at admission, and the presence of metabolic syndrome were significant (p?≤?0.05) factors associated with GDM development by univariate analysis. Multivariate analysis revealed that age ≥60 years [p?<?0.05; hazard ratio (HR)?=?3.59; 95 % confidence interval (CI), 1.22–10.51], HbA1c levels >6.1 % (p?<?0.05; HR?=?9.35; 95%CI, 1.45–60.34), and BMI >30 kg/m² (p?=?0.052; HR?=?6.27; 95%CI, 0.98–40.00) were independently significant association factors.

Conclusion

The results suggest a guideline for plasma glucose monitoring during CHOP chemotherapy in patients with no history of DM.     

A descriptive study of persistent oxaliplatin-induced peripheral neuropathy in patients with colorectal cancer

Background

Prolonged neurotoxicity after systemic chemotherapy has the potential to impact on quality of life. We explored the frequency of persistent peripheral neuropathy in patients who received oxaliplatin for colorectal cancer at two local centres.

Patients and methods

Questionnaires were sent to patients who completed treatment with oxaliplatin for colorectal cancer at least 20 months prior to entering the study. Neuropathy questions were adapted from the FACT/GOG-Ntx (V.4) questionnaire.

Results

Of the 56 eligible patients, 27 returned the questionnaire. Twenty-five patients (93 %) experienced neuropathic symptoms during their treatment; 11 had grade-2, and two had grade-3 symptoms. At the time of completing the questionnaire, 17 patients (63.0 %; 95%CI 43.9–79.4 %) were still symptomatic with 12 patients (44.4 %; 95%CI 26.8–63.3) having grade-2 or grade-3 symptoms and three patients (11.1 %; 95%CI 2.9–27.3) having grade-3 neuropathic symptoms. Participants who received more than 900 mg/m² oxaliplatin had a significantly higher risk of persistent grade-2 or grade-3 neuropathy (p?=?0.031, RR?=?8.3 95%CI?=?1.2–57.4). There was a trend toward increased risk of persistent neuropathy of any grade among participants with a history of regular alcohol use (p?=?0.051; RR?=?1.7 95%CI 1.0–2.8).

Conclusion

Persistent oxaliplatin-induced neuropathy is not as uncommon as previously suggested, and the rate of grade-2 and grade-3 symptoms could be considerably higher than previous reports.     

In-hospital outcomes after elective and non-elective percutaneous coronary interventions in hospitals with and without on-site cardiac surgery backup

Background

Guidelines recommend on-site surgery backup (SB) when elective percutaneous coronary intervention (PCI) is performed. The evidence for this recommendation is however weak.

Objectives

The objective of the present study was to compare clinical outcomes in patients undergoing PCI in hospitals with SB or without surgery backup (non-SB).

Methods

Prospective German PCI registry in 36 hospitals throughout Germany. Consecutive procedures were collected and analyzed centrally.

Results

In 2006, a total of 23,148 patients were included; 12,465 patients (53.8%) in 11 hospitals with SB and 10,683 patients (46.2%) in 25 hospitals without on-site cardiac SB. Both patient groups were well-balanced with regard to age and gender. SB hospitals had more patients with ACS (OR 1.29; 95%CI 1.23–1.36) and less patients with stable angina (OR 0.78; 95%CI 0.74–0.82) than non-SB hospitals. There was no indication of a clinically relevant differential outcome for in-hospital death, MACE, non-fatal MI, non-fatal stroke/TIA, or emergency CABG between SB and non-SB hospitals for neither patients with ACS nor stable angina except for emergency CABG in ACS patients (more frequent in SB hospitals, OR 2.29; 95%CI 1.02–5.13).

Conclusions

There was no evidence of an excess risk associated with PCI-procedures performed in non-SB hospitals.     

Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study

Purpose

The recent increase in drug-resistant micro-organisms complicates the management of hospital-acquired bloodstream infections (HA-BSIs). We investigated the epidemiology of HA-BSI and evaluated the impact of drug resistance on outcomes of critically ill patients, controlling for patient characteristics and infection management.

Methods

A prospective, multicentre non-representative cohort study was conducted in 162 intensive care units (ICUs) in 24 countries.

Results

We included 1,156 patients [mean?±?standard deviation (SD) age, 59.5?±?17.7?years; 65?% males; mean?±?SD Simplified Acute Physiology Score (SAPS)?II score, 50?±?17] with HA-BSIs, of which 76?% were ICU-acquired. Median time to diagnosis was 14 [interquartile range (IQR), 7–26] days after hospital admission. Polymicrobial infections accounted for 12?% of cases. Among monomicrobial infections, 58.3?% were gram-negative, 32.8?% gram-positive, 7.8?% fungal and 1.2?% due to strict anaerobes. Overall, 629 (47.8?%) isolates were multidrug-resistant (MDR), including 270 (20.5?%) extensively resistant (XDR), and 5 (0.4?%) pan-drug-resistant (PDR). Micro-organism distribution and MDR occurrence varied significantly (p?<?0.001) by country. The 28-day all-cause fatality rate was 36?%. In the multivariable model including micro-organism, patient and centre variables, independent predictors of 28-day mortality included MDR isolate [odds ratio (OR), 1.49; 95?% confidence interval (95?%CI), 1.07–2.06], uncontrolled infection source (OR, 5.86; 95?%CI, 2.5–13.9) and timing to adequate treatment (before day?6 since blood culture collection versus never, OR, 0.38; 95?%CI, 0.23–0.63; since day?6 versus never, OR, 0.20; 95?%CI, 0.08–0.47).

Conclusions

MDR and XDR bacteria (especially gram-negative) are common in HA-BSIs in critically ill patients and are associated with increased 28-day mortality. Intensified efforts to prevent HA-BSIs and to optimize their management through adequate source control and antibiotic therapy are needed to improve outcomes.     

Neurologic complications in neonates supported with extracorporeal membrane oxygenation. An analysis of ELSO registry data

Background

Neurologic complications in neonates supported with extracorporeal membrane oxygenation (ECMO) are common and diminish their quality of life and survival. An understanding of factors associated with neurologic complications in neonatal ECMO is lacking. The goals of this study were to describe the epidemiology and factors associated with neurologic complications in neonatal ECMO.

Patients and methods

Retrospective cohort study of neonates (age ≤30 days) supported with ECMO using data reported to the Extracorporeal Life Support Organization during 2005–2010.

Results

Of 7,190 neonates supported with ECMO, 1,412 (20 %) had neurologic complications. Birth weight <3 kg [odds ratio (OR): 1.3; 95 % confidence intervals (CI): 1.1–1.5], gestational age (<34 weeks; OR 1.5, 95 % CI 1.1–2.0 and 34–36 weeks: OR 1.4, 95 % CI 1.1–1.7), need for cardiopulmonary resuscitation prior to ECMO (OR 1.7, 95 % CI 1.5–2.0), pre-ECMO blood pH ≤ 7.11 (OR 1.7, 95 % CI 1.4–2.1), pre-ECMO bicarbonate use (OR 1.3, 95 % CI 1.2–1.5), prior ECMO exposure (OR 2.4, 95 % CI 1.6–2.6), and use of veno-arterial ECMO (OR 1.7, 95 % CI 1.4–2.0) increased neurologic complications. Mortality was higher in patients with neurologic complications compared to those without (62 % vs. 36 %; p < 0.001).

Conclusions

Neurologic complications are common in neonatal ECMO and are associated with increased mortality. Patient factors, pre-ECMO severity of illness, and use of veno-arterial ECMO are associated with increased neurologic complications. Patient selection, early ECMO deployment, and refining ECMO management strategies for vulnerable populations could be targeted as areas for improvement in neonatal ECMO.     

Association between hyperkalemia at critical care initiation and mortality

Purpose

To investigate the association between potassium concentration at the initiation of critical care and all-cause mortality.

Methods

We performed a retrospective observational study on 39,705 patients, age?≥18?years, who received critical care between 1997 and 2007 in two tertiary care hospitals in Boston, Massachusetts. The exposure of interest was the highest potassium concentration on the day of critical care initiation and categorized a priori as 4.0–4.5, 4.5–5.0, 5.0–5.5, 5.5–6.0, 6.0–6.5, or?≥6.5?mEq/l. Logistic regression examined death by days 30, 90, and 365 post-critical care initiation, and in-hospital mortality. Adjusted odds ratios were estimated by multivariable logistic regression models.

Results

The potassium concentration was a strong predictor of all-cause mortality 30?days following critical care initiation with a significant risk gradient across potassium groups following multivariable adjustment: K?=?4.5–5.0?mEq/l OR 1.25 (95?% CI, 1.16–1.35; P?<?0.0001); K?=?5.0–5.5?mEq/l OR 1.42 (95?% CI, 1.29–1.56; P?<?0.0001); K?=?5.5–6.0?mEq/l OR 1.67 (95?% CI, 1.47–1.89; P?<?0.0001); K?=?6.0–6.5?mEq/l OR 1.63 (95?% CI, 1.36–1.95; P?<?0.0001); K?>?6.5?mEq/l OR 1.72 (95?% CI, 1.49–1.99; P?<?0.0001); all relative to patients with K?=?4.0–4.5?mEq/l. Similar significant associations post multivariable adjustments are seen with in-hospital mortality and death by days 90 and 365 post-critical care initiation. In patients whose hyperkalemia decreases?≥1?mEq/l in 48?h post-critical care initiation, the association between high potassium levels and mortality is no longer significant.

Conclusions

Our study demonstrates that a patient's potassium level at critical care initiation is robustly associated with the risk of death even at moderate increases above normal.     

Predictive value of bronchoscopy after infant cardiac surgery: a prospective study

Background and aims

Airway evaluation following infant cardiac surgery often reveals evidence of tracheobronchial narrowing. We studied the association between airway narrowing and extubation failure (EF) in this population.

Methods

Prospective cohort study of infants (age ≤6?months) from March–September 2009. Flexible bronchoscopy (FB) evaluations were obtained using a standardised protocol after operative intervention. The primary endpoint was the development of extubation failure (EF; defined as the need for invasive mechanical ventilation ≤48?h after primary extubation) and several secondary endpoints.

Results

Fifty-three patients were evaluated at a median age of 81 [interquartile range (IQR) 13–164] days and weight of 4.2 (IQR 3.2–6.0) kg; 13 (25?%) of the patients had single ventricle palliations and two subsequently underwent heart transplantation. Significant airway narrowing was noted in 15 of 30 [50 %, 95 % confidence interval (CI) 31–69?%] patients who underwent FB; ten of the 53 patients (19 %, 95 %CI 10–32?%) subsequently developed EF. Narrowed airway calibre on bronchoscopy had a sensitivity and specificity of 50 % (95 %CI 28–71 %) and 50 % (95 %CI 28–71 %), respectively, for EF. The single greatest predictor of EF by univariate analysis was the need for preoperative ventilation [odds ratio (OR)?6.5, 95 %CI 1.3–33.2, p?=?0.03]. Patients with EF had a greater likelihood of intensive care readmission (OR?4.8, 95 %CI 1.1–21, p?<?0.04) during the same hospital admission.

Conclusions

Airway narrowing on FB is noted frequently after infant cardiac surgery. Overall assessment and presence of narrowing on bronchoscopy had poor sensitivity and specificity for EF in our cohort. Expert assessment of tracheobronchial narrowing on FB has poor to moderate inter-rater reliability.     

Outcomes in children with refractory pneumonia supported with extracorporeal membrane oxygenation

Purpose

To review the use of extracorporeal membrane oxygenation (ECMO) in severe paediatric pneumonia and evaluate factors that may affect efficacy of this treatment.

Methods

Retrospective study of the ECMO database of a tertiary paediatric intensive care unit and chart review of all patients who were managed with ECMO during their treatment for severe pneumonia over a 23-year period. The main outcome measures were survival to hospital discharge, and ICU and hospital length of stay. We compared the groups of culture-positive versus culture-negative pneumonia, venoarterial (VA) versus venovenous (VV) ECMO, community- versus hospital-acquired cases, and cases before and after 2005.

Results

Fifty patients had 52 cases of pneumonia managed with ECMO. Community-acquired cases were sicker with higher oxygenation index (41.5?±?20.5 versus 26.8?±?17.8; p?=?0.031) and higher inotrope score [20 (5–37.5) versus 7.5 (0–18.8); p?=?0.07]. Use of VA compared with VV ECMO was associated with higher inotrope scores [20 (10–50) versus 5 (0–20); p?=?0.012]. There was a trend towards improved survival in the VV ECMO group (82.4 versus 62.9?%; p?=?0.15). Since 2005, patients have been older [4.7 (1–8) versus 1.25 (0.15–2.8)?years; p?=?0.008] and survival has improved (88.2 versus 60.0?%; p?=?0.039).

Conclusions

Survival in children with pneumonia requiring ECMO has improved over time and is now 90?% in the modern era. Risk factors for death include performing a circuit change [odds ratio (OR) 5.0; 95?% confidence interval (CI) 1.02–24.41; p?=?0.047] and use of continuous renal replacement therapy (OR 4.2; 95?% CI 1.13–15.59; p?=?0.032).     

Evaluation of a mobile phone-based, advanced symptom management system (ASyMS©) in the management of chemotherapy-related toxicity

Objectives

To evaluate the impact of a mobile phone-based, remote monitoring, advanced symptom management system (ASyMS^©) on the incidence, severity and distress of six chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand–foot syndrome and diarrhoea) in patients with lung, breast or colorectal cancer.

Design

A two group (intervention and control) by five time points (baseline, pre-cycle 2, pre-cycle 3, pre-cycle 4 and pre-cycle 5) randomised controlled trial.

Setting

Seven clinical sites in the UK; five specialist cancer centres and two local district hospitals.

Participants

One hundred and twelve people with breast, lung or colorectal cancer receiving outpatient chemotherapy.

Interventions

A mobile phone-based, remote monitoring, advanced symptom management system (ASyMS^©).

Main outcome measures

Chemotherapy-related morbidity of six common chemotherapy-related symptoms (nausea, vomiting, fatigue, mucositis, hand–foot syndrome and diarrhoea).

Results

There were significantly higher reports of fatigue in the control group compared to the intervention group (odds ratio?=?2.29, 95%CI?=?1.04 to 5.05, P?=?0.040) and reports of hand–foot syndrome were on average lower in the control group (odds ratio control/intervention?=?0.39, 95%CI?=?0.17 to 0.92, P?=?0.031).

Conclusion

The study demonstrates that ASyMS^© can support the management of symptoms in patients with lung, breast and colorectal cancer receiving chemotherapy.     

Factors predictive of alcohol consumption among senior high school students in Phayao province,Thailand

Abstract

Objectives: To identify factors predictive of alcohol consumption among senior high school students in Phayao province, Thailand, where there is a high prevalence of alcohol consumption among adolescents.

Methods: A cross-sectional study in which 317 grade 11 senior high school students participated in a survey during June 2012. Data were collected by face-to-face interviews. Chi-square and multivariate logistic regression were used to determine the factors predictive of alcohol consumption among the subjects.

Results: Over two-thirds of the students (66.9%) had consumed alcohol in their lifetime, 58.7% in the previous year and 17.4% in the previous month. Following univariate analysis, seven factors – gender, age, GPA, allowance, first age of drinking, peer drinking and alcohol knowledge were identified as being significantly associated with drinking (p?<?0.05). Multivariate analysis revealed four factors to be predictive of alcohol among high school students: peer drinking (OR?=?3.59, 95%CI?=?1.99–6.44), alcohol knowledge (OR?=?2.64, 95%CI?=?1.47–4.72), GPA?≥?2.5 (OR?=?0.32, 95%CI?=?0.16–0.64) and allowance (OR?=?0.15, 95%CI?=?0.04–0.58).

Conclusion: Peer drinking was the strongest predictor of adolescent alcohol consumption, while alcohol knowledge had negative correlation with alcohol consumption. Hence, peer influence and appropriate alcohol knowledge should be considered as key areas in attempts to reduce alcohol consumption among senior high school students.     

Nationwide population-based cohort study on the association of acute coronary syndrome in patients with malignancies

Aims/introduction

Patients with malignancy are suggestive of having a tendency toward an association with vascular thrombosis risk. The aim of this study was to evaluate the possible relationship between malignancy and the risk of acute coronary syndrome (ACS) in Taiwan.

Materials and methods

We used data from the National Health Insurance (NHI) system of Taiwan to assess the issue. Cox proportional hazards regression analysis was conducted to estimate the effects of malignancy on the risk of ACS.

Results

ACS risk in patients with malignancies was marginally significantly greater when adjusted for age, sex (hazard ratio (HR)?=?1.09, 95 % confidence interval (CI)?=?0.99–1.20), and comorbidities (HR?=?1.03, 95 % CI?=?0.93–1.13). A subgroup analysis indicated that patients with prostate cancer and head and neck cancer (HEENT) had a significantly higher risk of ACS (HR?=?1.30, 95 % CI?=?1.01–1.67; HR?=?3.03, 95 % CI?=?1.47–6.50).

Conclusions

We suggest careful surveillance of ACS symptoms and regular electrocardiography during follow-up of these patients. However, further large-scale studies for patients with prostate and HEENT cancer and cancer survivors (especially from post-hormone or radiotherapy) are needed.