Risk Factors for Asthmatic Patients Requiring Intubation. I. Observations in Children

There are significant concerns regarding the increased mortality of patients with asthma. Indeed the paradox of improved pharmacotherapy but worsening prognosis has been explored in depth in several studies including observations in epidemiology, access to medical care, and drug toxicity. Because of our ability to track all admissions to a tertiary-care hospital, we attempted to define the demographic data from a population of asthmatic children admitted for asthma in order to identify risk factors for intubation. We performed a retrospective cohort study of all asthma admissions excluding patients with cystic fibrosis. This study included all asthmatics aged 5-12 years admitted over a 10-year period (1984-1994) to the University of California at Davis Medical Center, Sacramento. A total of 300 such asthma admissions were reviewed, involving 135 girls and 165 boys, mean age 7.7 ± 2.4 years. Of this group, 166 children were black, 70 were Caucasian, 49 were Hispanic, 14 were Asian, and 1 was an American Indian. By National Heart, Lung, and Blood Institute guidelines, this group included 147 mild, 117 moderate, and 36 severe cases. Thirteen children required intubation for their asthma. Significant risk factors indentified for children requiring intubation, compared to those who did not require intubation, were secondhand smoke exposure [odds ratio (O.R.) 22.4; 95% confidence interval (C.I.) 7.4, 68.0], psychosocial problems (O.R. 13.5; 95% C.I. 5.1, 36.0), family dysfunction (O.R. 13.0; 95% C.I. 3.9, 43.9), upper respiratory infection (O.R. 10.2; 95% C.I. 3.4, 28.1), little formal education (O.R. 8.7; 95% C.I. 2.4, 31.6), prior asthma emergency room visit in past year (O.R. 7.2; 95% C.I. 1.9, 27.1), prior asthma hospitalization in past year (O.R. 7.1; 95% C.I. 2.2, 22.2), crowding (O.R. 6.9; 95% C.I. 2.5, 19.1), low socioeconomic status (O.R. 6.5; 95% C.I. 2.1, 20.8), steroid-dependent (O.R. 3.8; 95% C.I. 1.2, 12.1), parental history of allergy or asthma (O.R. 3.4; 95% C.I. 1.1, 10.0), and language barrier (O.R. 3.3; 95% C.I. 1.1, 10.6). Nonsignificant mild risk factors included inhaled cromolyn (O.R. 2.7; 95% C.I. 0.7, 10.0), atopy (O.R. 1.9; 95% C.I. 0.6, 5.9), and prior intubation (O.R. 1.6; 95% C.I. 0.2, 13.1). These risk parameters may be important determinants of baseline risk for asthma deaths and their recognition may have a significant impact on preventive measures.     

Risk Factors for Heart Failure in Young Adults

Heart failure (HF) is now recognized as a progressive disorder that typically begins with an asymptomatic state in patients with risk factors (Stage A), proceeds to developing structural abnormalities (Stage B), following which symptoms commonly develop (Stages C and D) unless treatment is initiated. Risk factors for developing HF include hypertension, diabetes mellitus, obesity, and risk factors for coronary artery disease including smoking and hypercholesterolemia. Although the incidence of HF in young adults is very low, they have a high lifetime incidence of developing HF (approximately one in five). The landmark CARDIA study found that risk factors for HF in young adults were similar to those seen in older adults. To decrease the future burden of HF it is essential to identify and intervene in those patients at risk, namely those in Stages A and B.     

Modifiable Risk Factors in Young Adults With First Myocardial Infarction

Background

Modifiable risk factors (RFs) play an important role in the development and prognosis of acute myocardial infarction (AMI).

青年卒中的病因和危险因素

研究发现，青年卒中的发病率有逐渐增高的趋势，但其病因和危险因素极为复杂。文章对该领域的国内外临床研究进展进行了综述。     

青年卒中的病因和危险因素

研究发现,青年卒中的发病率有逐渐增高的趋势,但其病因和危险因素极为复杂。文章对该领域的国内外临床研究进展进行了综述。     

Factors Associated with Denture Non-use in Older Adults Requiring Long-Term Care

BackgroundEvidence suggests that denture non-use is significantly associated with activities of daily living, oral function, and cognitive decline. Few studies have focused on the possibility that the indications for denture use may differ depending on the cognitive and physical functions in older adults requiring long-term care.ObjectivesThe aim of this study was to elucidate the factors associated with denture non-use in older adults requiring long-term care.MethodsThis cross-sectional study comprised 201 older adults (45 men and 156 women; average age = 86.2 ± 7.1 years) requiring long-term care in Japan. Those who did not require denture treatment were classified by dentists into denture-use and denture non-use groups. The severity of dementia was assessed using the Clinical Dementia Rating scale. Multiple logistic regression analyses were conducted to detect the factors significantly associated with denture non-use.ResultsThe proportion of participants without dentures was 58.2%. Multiple logistic regression analyses revealed that a moderate dementia (odds ratio [OR], 4.44; 95% confidence interval [CI] 1.18–16.71, p=0.027) and rinsing ability (OR 3.00; 95% CI 1.12–8.06; p=0.030) were significant factors related to the non-use of dentures.ConclusionSeverity of dementia and rinsing ability were significantly associated with non-use of dentures. These findings indicate the necessity of evaluating oral and cognitive functions while planning denture treatment in older adults requiring long-term care.     

不同心血管风险因素对年轻人急性心肌梗死患者冠状动脉的影响

目的评价年轻人急性心肌梗死的风险因素以及对冠状动脉病变的影响。方法选取年龄≤45岁,并行冠状动脉造影的年轻急性心肌梗死患者36例成为年轻组;同时,连续选取同时间段50例50～70岁急性心肌梗死患者作为对照组。记录患者的临床病史、风险因素(吸烟史、高胆固醇血症、高血压、糖尿病、家族史)以及冠状动脉造影结果并进行分析。结果年轻组男性占91.7%,而对照组为72.0%;年轻组吸烟史占83.3%,家族史占47.2%,高胆固醇血症占44.4%,而对照组高血压占54.0%,糖尿病占42.0%,吸烟史占40.0%,高胆固醇血症占38.0%;年轻组罪犯血管在前降支占58.3%,右冠状动脉38.9%,回旋支为0,对照组前降支、右冠状动脉、回旋支所占比例分别为56.0%、42.0%,22.0%;年轻组单支、双支、三支血管病变分别为63.9%、27.8%、8.3%,对照组为42.0%、40.0%、18.0%。年轻组单支血管病变者平均风险因素为1.64±0.40个,而多支血管病变者为2.78±0.56个。结论吸烟、家族史、高胆固醇血症是年轻人急性心肌梗死的主要危险因素;年轻患者以单支血管病变占多,没有发现以回旋支为罪犯血管,没有发现住院死亡;多支血管病变者较单支血管病变者有更多风险因素。     

Nontraditional Risk Factors for Progression Through Chronic Kidney Disease Risk Categories: The Coronary Artery Risk Development in Young Adults Study

BackgroundThere may be nontraditional pathways of chronic kidney disease (CKD) progression that are complementary to classical pathways. Therefore, we aimed to examine nontraditional risk factors for incident CKD and its progression.MethodsWe used the generally healthy population (n = 4382) starting at age 27-41 years in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort, which is an observational longitudinal study. Nontraditional risk factors included forced vital capacity, inflammation, serum urate, and serum carotenoids. CKD risk category was classified using the estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) measured in 1995-1996 and repeated every 5 years for 20 years: No CKD, low risk, moderate risk, high risk, and very high risk.ResultsAt baseline, 84.8% had no CKD (eGFR ≥60 mL/min/1.73 m² and UACR <10 mg/g), 10.3% were in the low risk (eGFR ≥60 and UACR 10-29), and 4.9% had CKD (eGFR <60 and/or UACR ≥ 30). Nontraditional risk factors were significantly associated with the progression of CKD to higher categories. Hazard ratios per standard deviation of the predictor for incident CKD and its progression from the No CKD and low and moderate risk into CKD were inverse for forced vital capacity and serum carotenoids and positive for serum urate, GlycA, and C-reactive protein, the first 3 even after adjustment for conventional risk factors.ConclusionSeveral nontraditional markers were significantly associated with an increased risk of progression to higher CKD categories in generally healthy young to middle-aged adults.     

Interplay of Risk Factors and Coronary Artery Calcium for CHD Risk in Young Patients

ObjectivesThe aim of this study was to examine prevalence, predictors, and impact of coronary artery calcium (CAC) across different risk factor burdens on the prevalence of obstructive coronary artery disease (CAD) and future coronary heart disease (CHD) risk in young patients.BackgroundThe interplay of risk factors and CAC for predicting CHD in young patients aged ≤45 years is not clear.MethodsThe study included 3,691 symptomatic patients (18-45 years of age) from the WDHR (Western Denmark Heart Registry) undergoing coronary computed tomographic angiography. CHD events were myocardial infarction and late revascularization.ResultsDuring a median of 4.1 years of follow-up, 57 first-time CHD events occurred. In total, 3,180 patients (86.1%) had CAC = 0 and 511 patients (13.9%) had CAC >0. Presence of CAC increased with number of risk factors (odds ratio: 4.5 [95% CI: 2.7-7.3] in patients with >3 vs 0 risk factors). The prevalence of obstructive CAD at baseline and the rate of future CHD events increased in a stepwise manner with both higher CAC and number of risk factors. The CHD event rate was lowest at 0.5 (95% CI: 0.1-3.6) per 1,000 person-years in patients with 0 risk factors and CAC = 0. Among patients with >3 risk factors, the event rate was 3.1 (95% CI: 1.0-9.7) in patients with CAC = 0 compared with 36.3 (95% CI: 17.3-76.1) in patients with CAC >10.ConclusionsIn young patients, there is a strong interplay between CAC and risk factors for predicting the presence of obstructive CAD and for future CHD risk. In the presence of risk factors, even a low CAC score is a high-risk marker. These results demonstrate the importance of assessing risk factors and CAC simultaneously when assessing risk in young patients.     

Environmental Risk Factors for Community-Acquired Pneumonia Hospitalization in Older Adults

OBJECTIVES: To investigate the risk of hospitalization for pneumonia in older adults in relation to biophysical environmental factors.
DESIGN: Population-based case control study with collection of personal interview data.
SETTING: Hamilton, Ontario, and Edmonton, Alberta, Canada.
PARTICIPANTS: Seven hundred seventeen people aged 65 and older hospitalized for community-acquired pneumonia (CAP) from September 2002 to April 2005 and 867 controls aged 65 and older randomly selected from the same communities as the cases.
MEASUREMENTS: Odds ratios (ORs) for risk of pneumonia in relation to environmental and other variables.
RESULTS: Exposure to secondhand smoke in the previous month (OR=1.73, 95% confidence interval (CI)=1.04–2.90); poor nutritional score (OR=1.83, 95% CI=1.19–2.80); alcohol use per month (per gram; OR=1.69, 95% CI=1.08–2.61); history of regular exposure to gases, fumes, or chemicals at work (OR=3.69, 95% CI=2.37–5.75); history of regular exposure to fumes from solvents, paints, or gasoline at home (OR=3.31, 95% CI=1.59–6.87); and non-English language spoken at home (OR=5.31, 95% CI=2.60–10.87) were associated with a greater risk of pneumonia hospitalization in multivariable analysis. Age, congestive heart failure, chronic obstructive lung disease, dysphagia, renal disease, functional status, use of immunosuppressive disease medications, and lifetime history of smoking of more than 100 cigarettes were other variables associated with hospitalization for pneumonia.
CONCLUSION: In elderly people, present and past exposures in the physical environmental are associated with hospitalization for CAP.     

Risk Factors Associated With Requiring a Stoma for the Management of Anal Cancer

PURPOSE Combination chemotherapy and radiation therapy has become the standard of care for epidermoid carcinoma of the anus. This treatment modality has allowed for preservation of the anus in most patients, sparing them the morbidity of a stoma. Some patients will ultimately require a stoma as a result of salvage surgery or to manage complications of chemoradiotherapy. We hypothesized that tumor characteristics and radiation dose had an impact on the requirement for stoma formation.METHODS Data on all patients with epidermoid carcinoma of the anal canal who were treated with chemoradiation with curative intent at Ochsner Clinic Foundation were entered into a prospective registry. We excluded four patients who were lost to follow-up and one patient who died during chemoradiation therapy.RESULTS Fifty-one patients were followed for an average of 5.6 years. Primary tumor size average was 3.9 cm. Six patients had Stage I disease, 33 patients had Stage II disease, and 12 patients had Stage III disease (N+ disease). The average radiation dose was 57 ± 17 Gy. Univariate analysis revealed pretreatment tumor size to be the only significant factor associated with the need for a stoma (P = 0.01). Radiation dose was not an important factor (P = 0.38). An additional finding was that the pretreatment tumor size and N+ disease were significant predictors of mortality; however, logistic-regression analysis revealed that N+ disease was the only independent predictor of mortality (P = 0.02).CONCLUSIONS Patients who have large tumors on presentation should be made aware of the possibility of requiring salvage surgery to treat persistent or recurrent disease. Toxicities from chemoradiotherapy do arise, but patients are not at increased risk for requiring a stoma.     

青年缺血性脑卒中病因及相关危险因素的分析研究

目的探讨青年缺血性脑卒中的常见病因及危险因素。方法回顾性分析51例18～45岁青年脑卒中患者病例资料,并与74例45岁以上老年脑卒中患者进行对照研究,探讨青年患者发病的病因及危险因素。结果青年组非动脉粥样硬化性血管病变及无明显血管病变的比例高于老年组,常见危险因素包括血脂异常(尤其总胆固醇、三酰甘油及脂蛋白-A)、高血压及吸烟。空腹血糖、低密度脂蛋白和纤维蛋白原等指标与老年脑卒中有关。结论青年脑卒中病因及危险因素多样,且有特殊性,不明原因的病例占较大比例,明确病因有赖于完善各项检查。     

Reasons for Drinking and Alcohol Use in Young Adults at High Risk and at Low Risk for Alcoholism

This study examined the relationship of attitudes towards the use of alcohol and alcohol consumption among young adult offspring of alcoholic (N=130) and non-alcoholic (N = 75) parents. No differences were found between the two samples in the subjects’reported reasons for drinking or reasons for limiting consumption. In general, the greater the total amount of alcohol consumed, the more important were social enhancement and relief of unpleasant affect as reasons for drinking. Further, reasons for limiting alcohol consumption did not distinguish the high risk and low risk groups. Across both samples, lower consumption was associated with not wanting to become intoxicated, not liking the alcohol effect and not liking the taste. The associations found between reasons for not drinking and decreased consumption were smaller than the associations found between reasons for drinking and increased consumption.     

住院患者静脉血栓栓塞危险因素的分析

目的 通过对住院期间发生静脉血栓栓塞症（Venous thromboembolism,VTE）患者危险因素的分析,探讨VTE发生的高危因素。探索应用Caprini风险评估模型评估住院患者VTE发生风险的有效性。方法 对2012年1月1日至2012年12月31日在煤炭总院及朝阳医院确诊为VTE的住院患者进行研究。287例符合入选条件的被纳入研究。收集患者的一般资料、VTE危险因素、相关实验室检查及影像学检查结果等。分析VTE与各危险因素之间的关系。应用Caprini风险评估模型患者进行VTE风险评估。随访患者出院后VTE复发情况及生存状态。结果 1.287例患者中,92例（32.1％）患者仅患有DVT,93例（32.4％）患者仅患有PTE,102例（35.5％）患者同时患有DVT及PTE。155例为内科患者,132例为外科患者。2.VTE患者危险因素排在前五位的依次是：BMI>25 kg/m2（63.2％）,蛋白C或蛋白S缺乏（52.4%）,血清同型半胱氨酸升高（50%）,长期卧床136例（47.4％）,严重肺部疾病132例（46.0％）。3.与内科患者相比,Caprini模型评估外科患者VTE发生风险更为有效,且差异有统计学意义（风险评估分值在内科患者6.68±3.27,外科患者7.84±3.45,P=0.004）。4. 随访中,48例患者复发性VTE,复发率为18.5%。其中极高危患者的复发率最高（29.0％）,其次为高危患者（6.5％）,低中危患者无VTE复发。生存曲线显示极高危患者VTE复发风险最高,且差异有统计学意义（P=0.021）。结论 1.住院患者VTE的高危因素包括：BMI>25kg/m2,蛋白C或蛋白S缺乏,血清同型半胱氨酸升高,长期卧床,严重肺部疾病。2. Caprini模型评估外科患者VTE发生风险较内科患者更为有效,并且为预测VTE复发风险提供参考。