Surgical site infections in ambulatory surgery: a 5-year experience

OBJECTIVES: To evaluate the ambulatory surgical site infection rate and risk factors associated with surgical site infection. METHODS: We conducted a case-control analysis of all ambulatory surgeries between January 1, 1993, and December 31, 1997. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis. SETTING: A 140-bed tertiary-care teaching hospital for adult patients with cancer. RESULTS: The study followed 1350 outpatient surgeries. Thirty-eight patients had a surgical site infection (rate per 100 surgeries: 2.8). The risk factors statistically associated with surgical site infection were postoperative antibiotics (OR = 7.5; 95% CI, 2.5-23.0), and surgical time >35 minutes (OR = 2.4; 95% CI, 1.1-5.5). CONCLUSIONS: The surgical site infection rate for same-day surgery at our hospital is within the limits reported in the literature and below the rates reported previously for inpatient surgeries at our hospital. Full review of medical records and microbiology reports at day 30 allowed us to identify infections that otherwise would have been missed. Postoperative antibiotics may increase the risk of infection.     

Risk factors for surgical site infections in older people

OBJECTIVES: To identify risk factors for surgical site infection (SSI) in older people and to test a priori hypotheses regarding particular variables and SSI risk. DESIGN: Case-control study. SETTING: Duke University Medical Center and seven community hospitals in North Carolina and Virginia. PARTICIPANTS: Elderly patients (> or =65) who underwent surgery between 1991 and 2002 at the study hospitals. Cases were elderly patients with SSI; controls were elderly operative patients without SSI. Infection control practitioners prospectively identified patients. MEASUREMENTS: Data were collected retrospectively. Case patients who developed SSI were compared with control patients who did not develop SSI. RESULTS: Five hundred sixty-nine SSI cases were identified, and 589 uninfected controls were selected. In multivariate analysis, independent predictors of SSI included obesity (odds ratio (OR)=1.77, 95% confidence interval (CI)=1.34-2.32), chronic obstructive pulmonary disease (COPD) (OR=1.66, 95% CI=1.17-2.34), and a wound class classified as contaminated or dirty (OR=1.65, 95% CI=1.01-2.72). Having private insurance was associated with lower risk (OR=0.29, 95% CI=0.12-0.68). CONCLUSION: This study identified several independent predictors of SSI in older people, including comorbid conditions (COPD and obesity), perioperative variables (wound class), and socioeconomic factors (private insurance, which was associated with lower risk). The results from this study can be used to design and implement interventions for SSI prevention in high-risk older people.     

A prospective study of surgical site infections in a pediatric hospital in Mexico City

BACKGROUND: Pediatric surgical site infection (SSI) rates in the United States range from 2.5% to 4.4%. There is little data regarding their risk factors among children. We quantified SSI rates and identified risk factors of SSI in a tertiary care pediatric teaching hospital in Mexico City. METHODS: All neurosurgical, cardiovascular, and general surgical patients who underwent operation between Aug 1, 1998, and Jan 31, 1999, were followed-up daily during hospitalization. On postoperative day 30, a full review of microbiology reports and medical records was performed. Univariate and multivariate analyses were done to identify risk factors. RESULTS: Four hundred twenty-eight of 530 children completed follow-up. The overall SSI rate was 18.7%. Forty percent of SSI were superficial incisional, 21% were deep incisional, and 39% were organ/space infections. For clean, clean-contaminated, contaminated, and dirty procedures, SSI infection rates were 12.4%, 24.4%, 14.3%, and 32.4%, respectively. Open drains (OR = 2.3; 95% CI = 1.3-4.2; P <.005) and surgery that lasted 90 or more minutes (OR = 2.9; 95% CI = 1.6-5.1; P <.001) were associated with infection. CONCLUSIONS: Our rates are greater than comparable reported data among children. Duration of surgery and use of open drains were associated with SSI.     

Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: metabolic significance of nonalcoholic fatty liver disease in nonobese adults

BACKGROUND: The prevalence of nonalcoholic fatty liver disease (NAFLD) is rarely reported in Taiwan. GOALS: To determine the prevalence and risk factors of NAFLD in an adult population of Taiwan. STUDY: The cross-sectional community study examined 3245 adults in a rural village of Taiwan. The diagnostic criteria for NAFLD included no excessive alcohol intake, no chronic viral hepatitis, no known etiologies of liver disease, and ultrasonography consistent with fatty liver. RESULTS: The prevalence of NAFLD was 11.5% (372/3245). The risk factors for NAFLD in the general population were male sex [odds ratio (OR), 1.44; 95% confidence interval (CI), 1.09-1.90], elevated alanine aminotransferase (ALT) (OR, 5.66; 95% CI, 3.99-8.01), obesity (OR, 7.21; 95% CI, 5.29-9.84), fasting plasma glucose > or =126 mg/dL (OR, 2.08; 95% CI, 1.41-3.05), total cholesterol > or =240 mg/dL (OR, 1.50; 95% CI, 1.06-2.13), triglyceride > or =150 mg/dL (OR, 1.76; 95% CI, 1.32-2.35), and hyperuricemia (OR, 1.53; 95% CI, 1.16-2.01). Age > or =65 years was inversely related to NAFLD (OR, 0.53; 95% CI, 0.36-0.77). The only NAFLD risk factors among nonobese subjects were age between 40 and 64 years (OR, 2.35; 95% CI, 1.34-4.11, P=0.003), elevated ALT (OR, 15.45; 95% CI, 8.21-29.09, P<0.001), and triglyceride > or =150 mg/dL (OR, 2.48; 95% CI, 1.42-4.32, P=0.001). In subjects with NAFLD, the prevalence of elevated ALT in the presence of each metabolic risk factor, such as obesity, fasting plasma glucose > or =126 mg/dL, total cholesterol > or =240 mg/dL, triglyceride > or =150 mg/dL, and hyperuricemia, did not differ from that of subjects with normal ALT levels. CONCLUSIONS: NAFLD is closely associated with elevated ALT, obesity, diabetes mellitus, hypercholesterolemia, hypertriglyceridemia, and hyperuricemia. Among the metabolic disorders, only hypertriglyceridemia was related to NAFLD in nonobese subjects. Serum ALT level was not a good predictor of metabolic significance in subjects with NAFLD.     

Risk factors for ICU-acquired methicillin-resistant Staphylococcus aureus infections

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide, and MRSA infections are frequent in intensive care units (ICUs). OBJECTIVE: A prospective study was implemented to investigate the risk factors for ICU-acquired MRSA infections. METHODS: This study was conducted in surgical and neurologic ICUs from May to November 2003. The patients staying in ICUs more than 48 hours were included in the study. All of the patients were visited daily, and data were recorded on individual forms for each patient until discharge or death. Nasal swab cultures were done within 48 hours of ICU admission and repeated every week until the patients colonized with MRSA or were discharged from ICUs. ICU-acquired MRSA infection was diagnosed when MRSA was isolated from the infected site. RESULTS: Overall, 249 patients were followed during the study. MRSA infection was detected in 21 (8.4%) of these patients. The most frequent infection was primary bloodstream infection (10/21, 47%). It was followed by pneumonia (8/21, 38%) and surgical site infection (3/21, 14%). Nasal MRSA colonization was detected in 59 (23.7%) patients, and 12 of them (20.3%) developed MRSA infection. In univariate analysis, hospitalization period in an ICU, intraabdominal and orthopedic pathologies, mechanical ventilation, central venous catheter insertion, total parenteral nutrition, previous antibiotic use, surgical ICU stay, nasal MRSA colonization, and presence of more than 2 patients having nasal colonization in the same ICU at the same time were found significant for MRSA infections. In multivariate analysis; hospitalization period in an ICU (OR, 1.090; 95% CI: 1.038-1.144, P = .001), central venous catheter insertion (OR, 1.822; 95% CI: 1.095-3.033, P = .021), previous antibiotic use (OR, 2.337; 95% CI: 1.326-4.119, P = .003) and presence of more than 2 patients having nasal colonization in the same ICU at the same time (OR, 1.398; 95% CI: 1.020-1.917, P = .037) were independently associated with MRSA infections. CONCLUSION: According to the our results, hospitalization period in an ICU, presence of patients colonized with MRSA in the same ICU at the same time, previous antibiotic use, and central venous catheter insertion are independent risk factors for ICU-acquired MRSA infections. Detection of these factors helps to decrease the rate of MRSA infections in the ICUs.     

Risk factors for intrahepatic cholangiocarcinoma： A casecontrol study in China

AIM： To carry out a hospital-based case-control study to investigate risk factors for intrahepatic cholangiocarcinoma （ICC） in China. METHODS： A total of 312 ICC cases and 438 matched controls were included in the study. The presence of diabetes mellitus, hypertention, hepatolithiasis, primary sclerosing cholangitis, liver fluke infection （Clonorchis sinensis）, was investigated through clinical records. Blood from all participants was tested for hepatitis B surface antigen （HBsAg） and anti-HCV antibodies. Odds ratios （OR） and 95% confidence intervals （95% CI） were estimated using conditional logistic regression. RESULTS： Compared with controls, ICC patients had a higher prevalence of HBsAg seropositivity （48.4% vs 9.6%, P 〈 0.000）, and hepatolithiasis （5.4% vs 1.1%, P = 0.001）. By multivariate analysis, the significant risk factors for development of ICC were HBsAg seropositivity （adjusted OR, 8.876, 95% CI, 5.973-13.192）, and hepatolithiasis （adjusted OR, 5.765, 95% CI, 1.972-16.851）. The prevalence of anti-HCV seropositivity, diabetes mellitus, hypertention, cigarette smoking, and alcohol consumption were not significantly different between cases and controls. CONCLUSION： These findings suggest that HBV infection and hepatolithiasis are strong risk factors for development of ICC in China.     

Prevalence and risk factors of gallstone disease in an adult population of Taiwan: an epidemiological survey

BACKGROUND AND AIMS: The aim of this study was to determine the prevalence and risk factors of gallstone disease (GSD) in an adult population of Taiwan through a population-based screening study. METHODS: A cross-sectional community study in a rural village of Taiwan was conducted in 3333 Chinese adults (aged > or = 18 years) undergoing ultrasonography. A questionnaire on personal history was completed to ascertain whether the removed gallbladder contained stones in all cholecystectomized subjects, the dietary habits (vegetarian/non-vegetarian diet), the history of GSD in the participant's first-degree relatives, the history of gastrointestinal surgery (vagotomy, gastrectomy for peptic ulcer disease, or ileal resection), parity, and use of oral contraceptives. The demographic characteristics and biochemical parameters were recorded. RESULTS: The overall prevalence of GSD was 5.0% (4.6% in men, 5.4% in women) with no significant sex differences (men/women: odds ratio [OR] 0.71, 95% confidence interval [CI] 0.50-1.01, P = 0.058). Logistic regression analysis showed that increasing age (men: 40-64 years, OR 7.38, 95% CI 2.59-21.01, P < 0.001 and > or = 65 years, OR 14.16, 95% CI 4.84-41.47, P < 0.001; women: 40-64 years, OR 4.08, 95% CI 1.90-8.75, P < 0.001 and > or = 65 years, OR 6.78, 95% CI 2.97-15.46, P < 0.001) and the presence of fatty liver evidenced by ultrasonography (men: OR 2.24, 95% CI 1.32-3.80, P = 0.003; women: OR 2.13, 95% CI 1.33-3.42, P = 0.002) were risk factors for GSD. Additionally, fasting plasma glucose > or = 126 mg/dL (OR 2.11, 95% CI 1.16-3.83, P = 0.014), history of GSD in the first-degree relatives (OR 7.47, 95% CI 2.22-25.12, P = 0.001), and use of oral contraceptives (OR 10.71, 95% CI 3.06-37.49, P < 0.001) were risk factors for GSD in women, but fasting plasma glucose > or = 126 mg/dL was only correlated to GSD without controlling for other confounding factors in men. Other demographic characteristics and biochemical parameters, such as high body mass index (> or = 25 kg/m2), increased parity, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, hepatitis C infection and cirrhosis, did not exhibit any correlation to GSD in logistic regression analysis, although they appeared to be related to GSD in women in univariate analysis. CONCLUSIONS: Age and fatty liver in both sexes were found to be risk factors for GSD in the study population. The finding of a correlation between fatty liver and GSD is an important addition to the literature concerning the risk factors of GSD. Diabetes mellitus, history of GSD in the first-degree relatives, and use of oral contraceptives were also risk factors for GSD in women.     

Etiologic factors of gastric cardiac adenocarcinoma among men in Taiwan

AIM: To elucidate etiologic associations between Helicobacter pylori ( H pylori), lifestyle, environmental factors and gastric cardiac adenocarcinoma (GCA) among men.METHODS: A hospital-based case-control study was conducted in Taiwan from 2000 to 2009.All cases were newly confirmed as primary GCA.Five controls were selected matching with age, sex, and admission date to each case.Participants were informed of potential risk factors with a structured questionnaire by trained interviewers during hospitalization and provided a blood sample for the determination of H pylori infection.Odds ratio (OR) and 95% confidence interval (95% CI) were used to evaluate risk, and a multivariate conditional logistic regression model was performed.RESULTS: All participants recruited for this study were men, consisting of 41 cases and 205 controls.Results of the univariate analysis showed that significant factors associated with the etiology of GCA included H pylori (OR = 2.69, 95% CI = 1.30-5.53), cigarette smoking (OR = 2.28, 95% CI = 1.05-4.96), working or exercising after meals (OR = 3.26, 95% CI = 1.31-8.11), salted food (OR = 2.51, 95%CI = 1.08-6.11), fresh vegetables (OR = 0.28, 95% CI = 0.09-0.80), fruits (OR = 0.19, 95% CI = 0.04-0.89), and rice as principal food (OR = 0.53, 95% CI = 0.30-0.85).Multivariate conditional logistic regression models indicated that a significantly elevated risk of contracting GCA was associated with working or exercising after meals (OR = 3.18, 95% CI = 1.23-9.36) and H pylori infection (OR = 2.93, 95% CI = 1.42-6.01).In contrast, the consumption of fresh vegetables (OR = 0.22, 95% CI = 0.06-0.83), fruits (OR = 0.28, 95% CI = 0.09-0.79) and rice as principal food (OR = 0.48, 95% CI = 0.24-0.93) remained as significant beneficial factor associated with GCA.CONCLUSION: Working or exercising after meals and H pylori infection increase the risk of GCA, but higher intakes of rice, fresh vegetables and fruits reduce the risk.     

Depression after stroke: a prospective epidemiological study

OBJECTIVES: To elucidate the relationship between stroke and depressive symptoms and to determine whether disability or cerebrovascular risk factors mediate that relationship. DESIGN: A prospective longitudinal epidemiological survey. SETTING: The mid-Monongahela Valley, a rural, nonfarm, low-socioeconomic-status community. PARTICIPANTS: Random sample of 1,134 subjects aged 65 and older. MEASUREMENTS: The dependent variable was clinically significant depressive symptoms, as defined by five or more symptoms on the modified Center for Epidemiological Studies Depression scale. The independent variables were demographics (age, sex, education), stroke, number of impaired instrumental activities of daily living (IADLs), diabetes mellitus, hypertension, atherosclerotic heart disease, and smoking. Logistic regression analyses were conducted for cross-sectional and longitudinal models examining whether stroke was associated with or predicted depressive symptoms, with other associated factors included as covariates. RESULTS: Clinically significant depressive symptoms were cross-sectionally associated with stroke (odds ratio (OR)=3.5, 95% confidence interval (CI)=1.4-8.3), diabetes mellitus (OR=2.8, 95% CI=1.7-4.6; P相似文献   

Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission

BACKGROUND: Community-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) seem to be increasing. Characteristics permitting recognition of patients with such strains would aid infection control efforts and choice of empiric therapy pending culture and susceptibility results. METHODS: Retrospective review of medical records for all adults seen in the Emergency Care Center at Grady Memorial Hospital, Atlanta, Georgia, whose blood cultures taken within 24 hours of entry yielded S. aureus. Risk factors for the presence of methicillin resistance in S. aureus isolates recovered from patients with staphylococcal bacteremia were assessed. RESULTS: S. aureus isolates from 118 (40%) of 297 study patients with bacteremia at the time of admission were methicillin-resistant. Multivariate analysis identified hospitalization in the 6 months preceding admission [odds ratio (OR) = 4.4; 95% CI, 2.0-9.8], receipt of antimicrobial agents in the past 3 months (OR = 5.6; 95% CI, 2.6-11.9], presence of indwelling urinary catheter (OR = 7.3; CI, 2.5-20.9), and nursing home residence (OR = 9.9; 95% CI, 3.9-25.6) to be independently associated with the presence of methicillin resistance. All but 4 of the 118 patients with methicillin-resistant strains had at least 1 of these factors and the proportion of resistant isolates progressively increased as more of these features were present. CONCLUSIONS: The presence of these risk factors should be considered when making decisions about isolation and other infection control procedures as well as empiric antimicrobial therapy with vancomycin for patients with suspected staphylococcal infection at the time of hospital admission. Similar studies could guide practices for dealing with such patients in other centers, because the occurrence of MRSA infections at the time of admission may vary widely by geographic area.     

Risk factors for surgical site infections and other complications in elective surgery in patients with rheumatoid arthritis with special attention for anti-tumor necrosis factor: a large retrospective study

OBJECTIVE: To identify risk factors for surgical site infection (SSI) in patients with rheumatoid arthritis (RA) with special attention for anti-tumor necrosis factor (anti-TNF) treatment. METHODS: All patients with RA who had undergone elective orthopedic surgery since introduction of anti-TNF were included in a retrospective parallel-cohort study with a one-year followup. Primary endpoint was a SSI according to the 1992 Centers for Disease Control and Prevention criteria and/or antibiotic use. Cohort 1 did not use anti-TNF, cohort 2 used anti-TNF but had either stopped (2A) or continued anti-TNF preoperatively (2B), the cutoff point being set at 4 times the half-life time of the drug. Infection rates were compared between cohorts, and logistic regression analysis was performed to examine risk factors. RESULTS: In total, 1219 (768 patients) procedures were included, and crude infection risks were 4.0% (41/1023), 5.8% (6/104), and 8.7% (8/92) in cohorts 1, 2A, and 2B, respectively. Elbow surgery (OR 4.1, 95% CI 1.6-10.1), foot/ankle surgery (OR 3.2, 95% CI 1.6-6.5), and prior skin or wound infection (OR 13.8, 95% CI 5.2-36.7) were associated with increased risk of SSI, whereas duration of surgery (OR 0.42, 95% CI 0.23-0.78) and sulfasalazine use (OR 0.21, 95% CI 0.05-0.89) were associated with decreased risk. Perioperative use of anti-TNF was not significantly associated with an increase in SSI rates (OR 1.5, 95% CI 0.43-5.2). CONCLUSION: The most important risk factor for SSI is history of SSI or skin infection. Although our study was not powered to detect small differences in infection rates, perioperative continuation of anti-TNF does not seem to be an important risk factor for SSI.     

Serological markers and risk factors for hepatitis B and C viruses in patients infected with human immunodeficiency virus

Both hepatitis B and hepatitis C viruses (HBV and HCV) infection are common in HIV-infected individuals as a result of shared risk factors for acquisition. A serological study for HBV and HCV was performed in 251 HIV-positive individuals from Medellín, Colombia. A qualitative RT-PCR for HCV was done in 90 patients with CD4+ T-cell count < 150 per mm(3). Serological markers for HBV infection were present in 97 (38.6%) patients. Thirty six of them (37.1%) had isolated anti-HBc. A multivariate analysis indicated that the following risk factors were significantly associated with the presence of these markers: age (OR = 1.05, 95% CI: 1.01-1.08), pediculosis pubis (OR = 1.83, 95% CI: 1.01-3.33), men who have sex with men and women (OR = 3.23, 95% CI: 1.46-7.13) and men who have sex only with men (OR = 3.73, 95% CI: 1.58-8.78). The same analysis restricted to women showed syphilis as the only significant risk factor. Thus, HBV infection was considerably associated with high risk sexual behavior. HCV was present in only two (0.8%) of HIV patients. Both of them were positive by RT-PCR and anti-HCV. This low frequency of HIV/HCV coinfection was probably due to the uncommon intravenous drug abuse in this population. The frequent finding of isolated anti-HBc warrants molecular approaches to rule out the presence of cryptic HBV infection.     

Surgical site infections following spinal surgery at a tertiary care center in Lebanon: incidence, microbiology, and risk factors

Surgical site infections (SSIs) following spinal surgery are associated with significant morbidity and long-term complications. The epidemiology of these infections has not been previously studied in Lebanon. This nested case-control study was conducted between 2001 and 2003 at the American University of Beirut Medical Center. Cases were defined as patients who developed surgical site infection within 30 d of surgery. Controls were patients with no evidence of infection. There were 27 cases of surgical site infections among 997 surgeries with an incidence of 2.7%. Compared to controls, cases were older (mean age 59 vs 47 y, p=0.001), and were more likely to have diabetes (OR = 4.0; 95% CI 1.2-12.8) and foreign body implantation (OR = 3.4; 95% CI 1.3-9.3). Antibiotic prophylaxis was given for a range of 0-6 d in cases and 0-7 d in controls. Coagulase-negative staphylococci were the most commonly isolated organisms. Hospital stay was significantly longer in cases than controls. The rates of surgical site infections following spinal surgery at our center are comparable to worldwide rates. There is unjustified overuse of prophylactic antibiotics in our patients that has the potential of inducing emergence of antimicrobial resistance.     

Association of CagA+ Helicobacter pylori infection with aortic atheroma

BACKGROUND: To investigate possible association between infection with CagA(+) strains of Helicobacter pylori and aortic atheroma diagnosed by transesophageal echocardiography. METHODS AND RESULTS: One hundred and eighty-eight consecutive subjects prospectively examined for presence of aortic atheroma (localized intimal thickening of >/=3mm) by transesophageal echocardiography were tested for serum IgG antibodies against H. pylori (enzyme-linked immunosorbent assay) and CagA protein (Western blot assay). The association between infection with H. pylori, CagA status of the infecting H. pylori strains, and aortic atherosclerosis was evaluated after adjusting for coronary artery disease risk factors. There was a linear trend for presence of atheroma in subjects with CagA-positive H. pylori infection (51/81, 63%) compared to subjects with CagA-negative H. pylori infection (21/45, 46.7%) and uninfected subjects (18/62, 29%) (p=0.003). H. pylori seropositivity was not associated with aortic atheroma (OR 2.9; 95% CI, 0.8-10.3; p=0.11) when CagA status is not taken into account. On multivariate analysis, parameters associated with risk of aortic atheroma were CagA-positive H. pylori seropositivity (OR 4.4; 95% CI, 1.4-14.7; p=0.01), older age (OR 1.2; 95% CI, 0.9-14.7; p=0.01), having ever smoked cigarettes (OR 3.6; 95% CI, 1.3-10.0; p<0.001), and elevated serum triglyceride level (OR 3.4; 95% CI, 1.3-9.4; p=0.02). CONCLUSIONS: After controlling for H. pylori infection and coronary artery disease risk factors, infection with a CagA-positive strain of H. pylori was independently associated with aortic atherosclerosis. This study suggests a gradient of atherosclerosis between uninfected individuals and patients with CagA-positive H. pylori infection and should prompt research into the role of CagA-positive H. pylori infection in the inflammatory atherosclerotic process.     

Risk factors for hepatitis C virus infection in United States blood donors. NHLBI Retrovirus Epidemiology Donor Study (REDS)

Injection drug use (IDU) is a known risk factor for hepatitis C virus (HCV) infection, but the strength of other parenteral and sexual risk factors is unclear. In 1997, we performed a case-control study of 2,316 HCV-seropositive blood donors and 2,316 seronegative donors matched on age, sex, race/ethnicity, blood center, and first-time versus repeat-donor status. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Questionnaires were returned by 758 (33%) HCV(+) and 1,039 (45%) control subjects (P =.001). The final multivariate model included only the following independent HCV risk factors: IDU (OR = 49.6; 95% CI: 20.3-121.1), blood transfusion in non-IDU (OR = 10.9; 95% CI: 6.5-18.2), sex with an IDU (OR = 6.3; 95% CI: 3.3-12.0), having been in jail more than 3 days (OR = 2.9; 95% CI: 1.3-6.6), religious scarification (OR = 2.8; 95% CI: 1.2-7. 0), having been stuck or cut with a bloody object (OR = 2.1; 95% CI: 1.1-4.1), pierced ears or body parts (OR = 2.0; 95% CI: 1.1-3.7), and immunoglobulin injection (OR = 1.6; 95% CI: 1.0-2.6). Although drug inhalation and a high number of lifetime sex partners were significantly more common among HCV seropositives, they were not associated with HCV after controlling for IDU and other risk factors. IDU, blood transfusion among non-IDU, and sex with an IDU are strong risk factors for HCV among United States blood donors. Weaker associations with incarceration, religious scarification, being stuck or cut with a bloody object, pierced ears or body parts, and immunoglobulin injection must be interpreted with caution.     

甘肃陇西县35岁及以上人群高血压流行病学现况调查

目的调查甘肃陇西县≥35岁的居民高血压的患病现况,分析其相关危险因素。方法整群分层随机抽取陇西县5个社区≥35岁的居民共12040例,对所选对象进行问卷调查,测量身高、体质量指数(BMI)、腰围、血压,并测定空腹血糖及血脂。计算不同年龄及性别的调查对象高血压及相关疾病的患病率,分析高血压的相关危险因素。结果标化后高血压患病率为26.8%,男性为28.3%,女性为21.4%。Logistic逐步回归分析结果表明,盐摄入量(OR=2.403,95%CI2.066～2.759)、超重(OR=1.566,95%CI1.417～1.730)、高血糖(OR=1.700,95%CI1.303～2.217)、总胆固醇(OR=2.617,95%CI2.294～2.986)、三酰甘油(OR=2.147,95%CI1.960～2.351)、脑力劳动(OR=0.640,95%CI0.490～0.830)、吸烟(烟龄>10年)(OR=1.567,95%CI1.413～1.738)、饮酒(每周>2次)(OR=1.372,95%CI1.340～1.479)是高血压的独立危险因素。结论陇西县35岁以上居民中高血压患病率较高,年龄、男性、高盐饮食、超重及肥胖、高血糖、腰围超标、血脂异常、高三酰甘油是高血压的危险因素。     

Determinants of peripheral arterial disease in the elderly: the Rotterdam study

OBJECTIVE: To examine which atherosclerotic risk factors are determinants for peripheral arterial disease (PAD), we performed a population-based study in 6450 subjects (40% men, 60% women) aged 55 years and older. METHODS: The presence of PAD was assessed by measuring the ankle-arm systolic blood pressure index (AAI); PAD was considered present if the AAI was lower than 0.90 in either leg. In addition, a threshold AAI of 0.70 in either leg defined severe PAD. RESULTS: Determinants strongly and independently associated with PAD were age of at least 75 years (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0-1.6), fibrinogen level (OR, 1.5; 95% CI, 1.3-1.7), cigarette smoking (OR, 2.8; 95% CI, 2.3-3.4), diabetes mellitus (OR, 2.0; 95% CI, 1.6-2.5), and systolic blood pressure (OR, 1.2; 95% CI, 1.1-1.2). An inverse relation of high-density lipoprotein cholesterol level with PAD (OR, 0.7; 95% CI, 0.5-0.8) was found. Similar results were demonstrated for severe PAD. Separate analyses for men and women did not demonstrate differences in risk factors for PAD. CONCLUSIONS: Assessment of a wide range of atherosclerotic risk factors enabled us to quantify the relative importance of each factor as determinant for PAD. In total, 69% of the occurrence of PAD is attributable to cardiovascular risk factors measured in our study; smoking accounted for most (etiologic fraction, 18.1%). The results suggest that preventive management of PAD should be directed at systolic blood pressure, fibrinogen level, smoking, high-density lipoprotein cholesterol level, and diabetes mellitus. Arch Intern Med. 2000;160:2934-2938     

Obesity reduces the risk of pressure ulcers in elderly hospitalized patients

BACKGROUND: Both underweight and obesity have been suggested as risk factors for pressure ulcers (PU) development, although data are limited. Our aim was to evaluate the odds of PU in underweight and obese, relative to optimal weight patients. METHODS: Secondary data analysis of a prospective cohort study of risk factors for PU on admission or by hospital day 3 in 3214 elderly patients admitted during 1998-2001 to two hospitals in Philadelphia, Pennsylvania. RESULTS: Patients who were underweight had greater odds of developing PU (adjusted odds ratio [OR] = 1.8, 95% confidence interval [CI], 1.2-2.6). Patients who were obese had reduced odds (adjusted OR = 0.7, 95% CI, 0.4-1.0), and those with severe obesity had the lowest odds of PU (adjusted OR = 0.1, 95% CI, 0.01-0.6). CONCLUSIONS: These data suggest that extra body fat reduces the risk of PU in elderly hospitalized patients.     

Risk factors for high-grade dysplasia or carcinoma in colorectal adenoma cases treated with endoscopic polypectomy

OBJECTIVE: Our aim is to establish the risk factors for carrying high-grade dysplasia or carcinoma by analyzing endoscopically treated adenoma cases. METHODS: Patients who underwent endoscopic polypectomy at our hospitals between January 2003 and August 2004 were analyzed. RESULTS: A total of 889 patients (mean age: 63+/-11 years), and 1486 adenomas resected from these patients, were included in the analysis. Seventy-five adenomas (5%) from 72 patients (8%) were found to have high-grade dysplasia or carcinoma. Among patient factors, female sex [odds ratio (OR) 2.25, 95% confidence intervals (CI)=1.34-3.76], presence of multiple adenomas (OR=2.15, 95% CI=1.15-4.00), older age (OR=1.02, 95% CI=1.00-1.04), and rectal bleeding as the indication for colonoscopy (OR=2.57, 95% CI=1.34-4.92) were identified as the significant risk factors for carrying high-grade dysplasia or carcinoma using the multivariate analysis. In addition, a size of > or = 10 mm (OR=10.83, 95% CI=5.86-20.0), flat appearance (OR=3.91, 95% CI=2.20-6.95), and location on the left side of the colon (OR=1.80, 95% CI=1.03-3.13) were identified as tumor risk factors. CONCLUSION: Distinct factors were proved to be associated with high-grade dysplasia or carcinoma. These results are useful to select lesions that require immediate treatment. Moreover, female sex as a risk factor raises an interesting problem regarding the progression from adenoma to carcinoma.     

Cardiovascular and disease-related predictors of depression in systemic lupus erythematosus

Objective

Depression and cardiovascular disease are common and debilitating comorbidities associated with systemic lupus erythematosus (SLE). In this study, history of cardiovascular events, cardiovascular risk factors, and SLE disease‐related factors were evaluated as longitudinal predictors of depression in a large cohort of patients with SLE.

Methods

Data were derived from 663 adult participants in the 2004–2008 Lupus Outcomes Study, who were followed for up to 5 annual interviews. Multivariate logistic regression analyses using generalized estimating equations were used to determine predictors of the development of increased depressive symptom severity over a 12‐month period (Center for Epidemiologic Studies Depression Scale [CES‐D] score of 23 or greater), yielding 2,224 paired observations. Predictors included sociodemographics, traditional cardiovascular risk factors (reported presence of heart disease, history of stroke or myocardial infarction, hypertension, hypercholesterolemia, diabetes mellitus, obesity, smoking status, and family history), and SLE‐specific risk factors (glucocorticoid use, renal involvement, disease duration, and disease activity).

Results

The annual incidence of depression was 12% in this cohort. Multivariate predictors of new‐onset depression included younger age (ages 20–39 years: odds ratio [OR] 2.3, 95% confidence interval [95% CI] 1.3–3.9; ages 40–59 years: OR 1.8, 95% CI 1.1–2.7), Hispanic/Latino ethnicity (OR 1.8, 95% CI 1.2–2.8), having some college education (OR 1.8, 95% CI 1.1–3.0), baseline CES‐D score (OR per point 1.1, 95% CI 1.1–1.2), presence of diabetes mellitus (OR 1.8, 95% CI 1.1–2.8), and baseline SLE disease activity (OR 1.2, 95% CI 1.1–1.4).

Conclusion

These results suggest that, in addition to known sociodemographic factors, the presence of diabetes mellitus and SLE disease activity may play a role in the development of depression in SLE.