Demographic risk factors of self-immolation: A case–control study

ObjectiveTo investigate demographic risk factors for self-immolation patients.MethodsIn a case–control study, 30 consecutive cases of deliberate self-inflicted burns admitted to the regional Burn centre (Imam Khomeini hospital in Kermanshah province, Iran) were compared with 30 controls who were selected from the community and matched by gender, age, and living area. All cases and controls were reviewed for demographic variables, including: age, gender, living area, family size, marital status, bearing and number of children, Body Mass Index (BMI), birth order, employment state, educational status, early school drop-out, and parent/guardian employment status.ResultsTwo variables emerged as related to risk of self-immolation. Being the first or last child in family birth order was associated with increased risk of self-immolation. Moreover, among the married participants, having children was associated with decreased risk of self-immolation. The comparisons of other variables were not statistically significant. In multivariate analyses, none of the variables predicted risk for self-immolation.ConclusionThis study suggests that being the first or last child of a family might be a risk factor for self-immolation. For married persons, having children might serve as a protective factor from self-immolation. Other variables such as family size, marital status, number of children, BMI, employment state, educational status, early school drop-out, and parent/guardian employment status did not play a role as individually protective or risk factors for self-immolation.     

A pilot case–control study on the alveolar bone density measurement in risk assessment for bisphosphonate-related osteonecrosis of the jaw

Summary

Alveolar bone mineral density (BMD) measured by radiography standardized by aluminum step wedge pasted on the film and digitized by a computer system was significantly higher around osteonecrosis lesions than in control cases in a pilot case–control study. High alveolar bone density appears useful as a local risk factor for bisphosphonate-related osteonecrosis of the jaw (BRONJ).

Introduction

In an attempt to find a reliable test method predicting the occurrence of BRONJ in addition to various risk factors suggested, an increase of alveolar bone density near the necrotic lesions was found by computerized radiogrammetry using dental films pasted with an aluminum step wedge (Bone Right?, Dentalgraphic?Com Company, Himeji) in six cases of BRONJ.

Methods

The bone mineral density surrounding the osteonecrosis lesions showed distinctly higher density in BRONJ cases compared with age-matched controls. In one subject on bisphosphonate treatment in whom two extractions were simultaneously carried out, BRONJ occurred only at the location with extremely high alveolar bone density, but not at the other site with normal density.

Conclusion

This method may be useful in detecting a rise of alveolar BMD frequently occurring near the necrotic lesion in subjects with impending risk for BRONJ.     

Surgical site infection in orthopedic trauma: A case–control study evaluating risk factors and cost

Background

With the shift of our healthcare system toward a value-based system of reimbursement, complications such as surgical site infections (SSI) may not be reimbursed. The purpose of our study was to investigate the costs and risk factors of SSI for orthopedic trauma patients.

Methods

Through retrospective analysis, 1819 patients with isolated fractures were identified. Of those, 78 patients who developed SSIs were compared to 78 uninfected control patients. Patients were matched by fracture location, type of fracture, duration of surgery, and as close as possible to age, year of surgery, and type of procedure. Costs for treatment during primary hospitalization and initial readmission were determined and potential risk factors were collected from patient charts. A Wilcoxon test was used to compare the overall costs of treatment for case and control patients. Costs were further broken down into professional fees and technical charges for analysis. Risk factors for SSIs were analyzed through a chi-squared analysis.

Results

Median cost for treatment for patients with SSIs was $108,782 compared to $57,418 for uninfected patients (p < 0.001). Professional fees and technical charges were found to be significantly higher for infected patients. No significant risk factors for SSIs were determined.

Conclusions

Our findings indicate the potential for financial losses in our new healthcare system due to uncompensated care. SSIs nearly double the cost of treatment for orthopedic trauma patients. There is no single driver of these costs. Reducing postoperative stay may be one method for reducing the cost of treating SSIs, whereas quality management programs may decrease risk of infection.     

Risk factors for prosthetic valve endocarditis—A case control study

Objective  

Prosthetic valve endocarditis is a catastrophic complication of cardiac valve replacement associated with significant morbidity and high mortality. The aim of this study was to assess the risk factors leading to the development of prosthetic valve endocarditis.     

A multicenter case–control study of diagnostic tests for urinary tract infection in the presence of urolithiasis

Urinary stone disease (USD) alone can cause much morbidity, but when present in conjunction with urinary tract infection, complications and morbidity increase even more. This study investigated the clinical and laboratory findings in patients who had USD with and without infection and evaluated the most suitable diagnostic value for urinary tract infection parameters before urine culture results were available. In a prospective fashion, patients who presented to the emergency department with a complaint of colicky flank pain (with or without hematuria) and who were diagnosed as having urolithiasis with ultrasound were evaluated for 1 year. The gold standard for the diagnosis of urinary tract infection was urine culture. The most suitable diagnostic value for urinary tract infection parameters was determined by receiver operating characteristic (ROC) curves. Logistic regression was used to identify independent variables that predicted a positive urine culture. Of the 192 eligible patients, 177 agreed to participate in the study. Of the clinical and laboratory characteristics analyzed, urine WBC, blood WBC, and fever were significantly different between culture positive and negative patients (p < 0.001, p = 0.04 p = 0.012, respectively). Using ROC curve analysis, pyuria (over 10 WBCs per HPF), fever over 37.9°C, and leucocytosis over 11,300 were the best predictors of a positive culture result. The logistic regression model for leukocytosis >11,300 (OR 2.1), pyuria (OR 2.8), and temperature >37.9°C (OR 3.1) showed a significantly increased risk of having a positive urine culture (correct class 87.9%). While a single physical examination or laboratory finding cannot predict urinary tract infection in USD patients with complete reliability, the presence of pyruria, fever, and leukocytosis significantly increases the odds of a positive urine culture.     

Biomarkers and risk factors for sepsis in stage 5 chronic kidney disease: a retrospective case–control study

International Urology and Nephrology - To assess the predictive value of procalcitonin (PCT) in the risk of sepsis in patients with stage 5 chronic kidney disease (CKD). A total of 373 inpatients...     

Risk factors for hip fracture in older adults: a case–control study in Taiwan

Summary  

We conducted a matched case–control study of hip fracture in older adults. Our findings suggest that hip fracture risk was determined by multiple factors. Older women characterized by low consumption of milk, peak flow rate, grip strength, and bone mineral density (BMD) had increased risk of hip fracture. Older men with impaired cognitive function and low BMD were also at higher risk of hip fracture.     

Risk factors for hospital-acquired urinary tract infection: a case–control study

The objective is to assess risk factors and microbiological aspects of hospital-acquired urinary tract infection (HAUTI) on six wards of a general regional hospital in Serbia. A case–control study was nested within prospective cohort HAUTIs study conducted from January 1 to December 31, 2007. Three controls were identified for each patient with HAUTI, being chronologically the next three patients surveyed who did not develop HAUTI. The patients and controls were matched by sex and age (±5 years). Assessment of 8,467 patients during the study period revealed HAUTI in 125 (116 symptomatic and 9 asymptomatic). The overall incidence rate of HAUTI was 14.8 cases/1,000 admissions. The mean age (range) of cases and controls was 64.9 (18–85) and 65.2 (17–86), respectively. Multivariate logistic regression analysis showed that duration of catheterization >5 days (OR = 51.91; 95% CI = 23.46–114.82) and the ASA score (OR = 13.42; 95% CI = 2.14–84.30) were independently associated with increased risk of HAUTIs. The most frequently isolated Gram-negative bacteria were Enterobacter, Klebsiella sp., Proteus mirabilis and Escherichia coli. Enterococcus sp. was the most frequent Gram-positive bacteria.     

The implications of the foot health status in Parkinson patients: A case–control study

Parkinson's disease (PD) is a neurodegenerative disorder that affects both health of the feet, as to gait patterns. This study aimed to find out about foot problems and their impact on self-perceived quality of life and related to foot health in Parkinson's patients compared to a group of healthy subjects and to measure it with Spanish Podiatry Health Questionnaire (PHQ-S). It is about a case–control study in a sample of Parkinson's patients n = 62, healthy controls n = 62. The PHQ-S was reported, it describes perception the subject has in each of podiatric 6 dimensions consulted, assessing appreciation of health status of interviewee's feet and a self-rated the foot health score on the visual analog scale (VAS). There were statistically significant differences (P < 0.05) in the dimensions that assessed problems with walking and moving, nail trimming, concern feet state, and affectation of quality of life related foot health. Regarding the self-perception of state of their feet, Parkinson's patients perceive a worse state of health of their feet than healthy subjects. The mean value was 4.8 (SD 2.2) for Parkinson's patients and 3.8 (SD 2.3) for healthy subjects. In conclusion, patients with PD have problems in walking or moving, foot pain, difficulties in foot hygiene and in cutting for their nails, as well as the concern they suffer from deterioration in state of their feet affect them and decrease their quality of life. Podiatric problems in Parkinson's patients have a great impact in reducing quality of life related to foot health.     

Risk factors for scald injury in children under 5 years of age: A case–control study using routinely collected data

Scald injury is common, accounting for half of all burns in pre-school children. Most scalds are preventable and health professionals can play an important role in targeting interventions to those at greatest risk. However, the potential for routinely collected medical data to be used to identify high risk children has not been well explored.     

Antidepressants and the risk of abnormal bleeding during spinal surgery: a case–control study

Introduction

Antidepressant medications are widely used by patients requiring spinal surgery. In spite of a generally favorable safety profile of newer antidepressants, several prior studies have suggested an association between use of serotonergic antidepressants and excessive bleeding. This study was designed to determine if there was any association between antidepressant use and the risk of excessive intraoperative blood loss during spinal surgery, and whether particular types of antidepressants were specifically associated with this increased blood loss.

Materials and methods

A retrospective case control study was conducted utilizing a population of 1,539 patients who underwent elective spinal fusion by a single surgeon at one medical center. Of the included patients, 213 used antidepressant medication and 1,326 patients did not use any type of antidepressant medication. Of patients taking antidepressants, 37 patients were excluded based on exclusion criteria, leaving 176 patients suitable for inclusion. The study group (176 patients) consisted of all patients who used an antidepressant medication for at least a 2-week period prior to spinal surgery. A control group of 352 patients were assembled from a random sample of 1,326 patients operated on by the same surgeon during the same time period in a two-to-one ratio with study group. Intraoperative blood loss was the primary outcome variable and was compared between the study and control group and between individuals in the study group taking serotonergic (SSRIs or SNRIs) or non-serotonergic antidepressants. Other variables, including length of hospital stay and surgical category, were also collected and analyzed separately.

Results

Overall, the mean blood loss (BL) for the antidepressant group was 298 cc, 23% more than the 241 cc lost by the procedure- and level-matched control group (p = 0.01). Patients taking serotonergic antidepressants also had statistically significant higher blood loss than the matched control group as a whole (334 vs. 241 cc, p = 0.015). This difference was also found in subgroups of patients who underwent anterior cervical discectomy and fusion, lumbar instrumented fusion, or anterior/posterior lumbar fusion. Blood loss was also higher in the subgroup of patients taking bupropion (708 cc, p = 0.023) compared with the control group. The mean length of hospital stay was 33.3% greater in patients on antidepressant medications compared to patients not taking an antidepressant (mean of 4 vs. 3 days, respectively, p = 0.0001). Antidepressant medications may be associated with increased intraoperative blood loss during spinal surgery, although the magnitude of the increased blood loss may not be clinically significant in all cases. The increase was greatest in patients undergoing anterior/posterior lumbar fusions, in whom the intraoperative blood loss was 2.5 times greater than that in the matched control group.

Conclusion

Clinicians treating patients who are planning to undergo elective spinal surgery and are on an antidepressant medication should be aware of this potential effect and should consider tapering off the serotonergic antidepressant prior to surgery.     

The association of red meat,poultry, and egg consumption with risk of hip fractures in elderly Chinese: A case–control study

Background/purposeThe epidemiological evidence that the consumption of red meat, poultry or eggs may be associated with the risk of hip fractures is inconsistent and no studies have differentiated between types of red meat or poultry. We evaluated the association between the consumption of red meat, poultry or eggs and the risk of hip fracture.MethodsA 1:1 age- (± 3 years) and gender-matched case–control study of 646 pairs (female/male: 484/162) of elderly Chinese was conducted between June 2009 and January 2013 in Guangdong, China. Information on meat and egg consumption was collected using a 79-item food frequency questionnaire administered in face-to-face interviews. Conditional logistic regression was used to test the relationship between intake of red meat, poultry, and eggs and the risk of hip fracture. Multivariate ORs and their 95% CIs were estimated.ResultsAfter adjusting for potential confounders, risk of hip fracture was found to be positively associated with total red meat consumption (P for trend < 0.001), but not with total poultry or egg consumption. The adjusted ORs (95% CIs) for hip fractures, comparing extreme quartiles, were 2.94 (1.82, 4.76) for total red meat, 1.11 (0.74, 1.66) for total poultry, and 0.99 (0.63, 1.56) for eggs. Subtype analyses indicated that the unfavorable effect of total red meat was primarily associated with the consumption of fatty pork and organ meat, whereas fatty and lean poultry had opposite effects. Men with higher fatty pork intake tended to have greater risk than women (P interaction = 0.019).ConclusionsOur findings suggest that greater consumption of fatty, but not lean, red meat and poultry may increase the risk of hip fracture. These results provide preliminary evidence for the feasibility of a dietary program for the prevention of hip fractures, which should be confirmed by further studies.     

Incidence,risk factors and potential timing of occurrence of pulmonary embolism in fatal trauma: An autopsy based case–control study on 2705 victims

BackgroundPulmonary embolism (PE) following trauma is a potentially preventable but highly lethal complication. We sought to investigate the incidence, risk factors and potential timing of occurrence of post-traumatic PE in a large cohort of trauma fatalities.MethodsA case–control study on 9266 consecutive trauma fatalities (between 1996 and 2005) from a regional autopsy-based trauma registry. Injuries were classified according to the Abbreviated Injury Scale-1990 edition (AIS-90) and the Injury Severity Score (ISS) was calculated. Hospitalized victims were categorized according to the presence or absence of PE on autopsy. Univariate comparisons and multivariate logistic regression analysis for probabilities of association (odds ratios-OR) were performed.ResultsOut of 2705 subjects who met the inclusion criteria, 116 had autopsy findings of PE and constituted the PE group (incidence of 4,3%), while the remaining victims formed the control group. The survival time of the PE group ranged from 0.66 to 104.73 days. Victims in the PE group were older (median age 69.5 vs 59), had lower ISS values (median 16 vs 26) and longer post-injury survival times (median 13.6 vs 5.7 days). Positively associated risk factors were AIS2-5 pelvic ring injuries (OR:2.23) and secondary deaths following an uneventful hospital discharge (OR:3.97), while AIS2-5 head (OR:0.33) and abdominal injuries (OR:0.23) showed a reverse association.ConclusionsTrauma fatalities with autopsy findings of PE were associated with less severe trauma indicating that PE was likely detrimental to the fatal outcome. Both the early and delayed occurrence of PE was reaffirmed. Prophylactic measures should be initiated promptly and extended post discharge for high risk patients to prevent secondary deaths.     

Diet-quality scores and risk of hip fractures in elderly urban Chinese in Guangdong,China: a case–control study

Summary

This case–control study compared the associations of four widely used diet-quality scoring systems with the risk of hip fractures and assessed their utility in elderly Chinese. We found that individuals avoiding a low-quality diet have a lower risk of hip fractures in elderly Chinese.

Introduction

Few studies examined the associations of diet-quality scores on bone health, and no studies were available in Asians and compared their validity and utility in a study. We assessed the associations and utility of four widely used diet-quality scoring systems with the risk of hip fractures.

Methods

A case–control study of 726 patients with hip fractures (diagnosed within 2 weeks) aged 55–80 years and 726 age– (within 3 years) and gender-matched controls was conducted in Guangdong, China (2009–2013). Dietary intake was assessed using a 79-item food frequency questionnaire with face-to-face interviews, and the Healthy Eating Index-2005 (HEI-2005, 12 items), the alternate Healthy Eating Index (aHEI, 8 items), the Diet Quality Index-International (DQI-I, 17 items), and the alternate Mediterranean Diet Score (aMed, 9 items) (the simplest one) were calculated.

Results

All greater values of the diet-quality scores were significantly associated with a similar decreased risk of hip fractures (all p trends <0.001). The multivariate-adjusted odds ratios (ORs) and 95 % confidential intervals (95 % CIs) comparing the extreme groups of diet-quality scores were 0.29 (0.18, 0.46) (HEI-2005), 0.20 (0.12, 0.33) (aHEI), 0.25 (0.16, 0.39) (DQI-I), and 0.28 (0.18, 0.43) (aMed) in total subjects; and the corresponding ORs ranged from 0.04 to 0.27 for men and from 0.26 to 0.44 for women (all p trends <0.05), respectively.

Conclusions

Avoiding a low-quality diet is associated with a lower risk of hip fractures, and the aMed score is the best scoring system due to its equivalent performance and simplicity for the user.     

Oxalobacter formigenes reduce the risk of kidney stones in patients exposed to oral antibiotics: a case–control study

International Urology and Nephrology - This is the first prospective study to investigate the association between kidney stones, bone mineral density, serum testosterone, colon cancer and O....     

Antipsychotic use and the risk of hip/femur fracture: a population-based case–control study

Summary  This case–control study showed that current use of conventional antipsychotics, but not atypical antipsychotics, seems to be associated with an increased risk of a hip/femur fracture, possibly related to the pharmacological properties of conventional antipsychotics. Furthermore, no evidence for a dose effect was found. Introduction  The aim of this study was to assess the risk of hip/femur fracture associated with antipsychotic use, with particular reference to any difference in risk with conventional versus atypical antipsychotics, dose, and pharmacological properties. Methods  A case–control study was conducted using data from the PHARMO Record Linkage System among individuals aged 18 years and older between 1991 and 2002. Cases had a record of a hip or femur fracture, while controls had no evidence of ever having sustained any fracture. Results  Most cases were elderly (77.6% aged ≥70 years). We found an increased risk for hip/femur fracture associated with the use of antipsychotic drugs. The risk for current users (OR_adj 1.68 [1.43, 1.99]) was significantly greater than with past use (OR_adj 1.33 [1.14, 1.56]; p = 0.036). Current use of conventional antipsychotics (OR_adj 1.76 [1.48, 2.08]) but not atypical antipsychotics (OR_adj 0.83 [0.42, 1.65]) was associated with an increased risk. We did not find evidence for a dose effect. Conclusion  The use of conventional, but not atypical antipsychotics, seems to be associated with an increased risk of hip/femur fracture, possibly related to the pharmacological properties of conventional antipsychotics. However, the numbers of atypical antipsychotic users were small, and therefore this observation needs further attention in other study populations.