Septic Dermatitis of the Neonatal Scalp and Maternal Endomyometritis with Intrapartum Internal Fetal Monitoring

During a 3-month period, 1,062 mother-infant pairs were studied for infections following internal fetal monitoring during labor. Six infants (0.56%) developed septic scalp dermatitis at the site of the spiral electrode application. Factors associated with septic scalp dermatitis included the number of vaginal examinations, the use of an intrauterine pressure catheter or of more than one spiral electrode, and fetal scalp blood sampling. Maternal diabetes and endomyometritis were also associated with an increased risk of scalp infection. The duration of spiral electrode use and duration of ruptured membranes were not significant risk factors. Endomyometritis was documented in 41 mothers, an overall incidence of 3.9%. In women whose babies were delivered by cesarean section, the incidence of endomyometritis was 28/117 (23.9%). Using multivariate analysis by logistic regression, endomyometritis was associated with the number of vaginal examinations during labor but not with the duration of internal monitoring, duration of labor, or duration of ruptured membranes.

Download Full-text

Postoperative Venous Thromboembolism in Children Is Increased in Setting of Cancer or Infection

Blood ◽

10.1182/blood.v128.22.2391.2391 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2391-2391

Author(s):

Harold J. Leraas ◽

Jina Kim ◽

Zhifei Sun ◽

Uttara P. Nag ◽

Brian D. Ezekian ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Venous Thromboembolism ◽

Pediatric Patients ◽

Conflicts Of Interest ◽

Significant Risk ◽

The United States ◽

Improvement Program ◽

Thrombotic Risk ◽

Factors Associated

Abstract Background: Venous thromboembolism (VTE) is an uncommon but clinically significant postoperative complication in children. Incidence of VTE in pediatric patients ranges from 34-58 per 10,000 hospitalized children1. Due to rarity of these events, there is limited information about the factors predisposing children to VTE after surgery. We queried a national surgical database to identify risks and outcomes associated with VTE in pediatric surgical patients. Methods: The National Surgical Quality Improvement Program-Pediatric (NSQIP) is a prospectively collected database that records pediatric surgical information, surgical approaches, and 30 day patient outcomes. The database was queried for the years 2012-2013 to identify pediatric patients (age < 18) who had received surgical intervention and were diagnosed with postoperative VTE. Because of their separate coding in NSQIP, we defined VTE as including venous thromboembolism, or pulmonary embolism (PE) diagnosed radiographically within 30 days of operation. To reduce non-random differences between patients we used propensity scores based on age, sex, race, BMI, and ASA classification to match patients in a 1:2 ratio using the nearest neighbor method. Using univariate and multivariate analysis, we identified preoperative risk factors associated with VTE. Results: In total, 130 patients were identified who developed VTE postoperatively (VTE n=122, PE n=7, BOTH PE + VTE n= 1) from this database of 114,395 patients. There were 104 patients with VTE that also had complete entries and were subsequently analyzed in this study. Surgical specialties treating patients in this analysis included cardiothoracic surgery, general surgery, neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, and urology. Eighty-one unique operative CPT codes were identified for patients with VTE. Patients who developed VTE had increased operative time, anesthesia time, and total length of stay (all p < 0.001). Multivariate analysis demonstrated that pneumonia (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.3 - 2.29), Central Line Associated Bloodstream Infection (CLABSI) (OR 1.69, 95% CI 1.18 - 2.42), sepsis (OR 1.47, 95% CI 1.18 - 1.82), septic shock (OR 1.36, 95% CI 1.06 - 1.75), and current solid or hematologic malignancy or active treatment of malignancy (OR 1.30, 95% CI 1.08 - 1.58) were all statistically significant risk factors associated with development of VTE (all p < 0.05). Conclusions: Postoperative VTE risk is significantly increased in children with malignancy or severe infections. Further research is needed to understand the mechanism between malignancy, systemic inflammation, and VTE risk in children. These findings may help to identify patients in need of prophylactic treatment in order to reduce postoperative thrombotic risk in pediatric patients. References: 1. Raffini L, Huang YS, Witmer C, Feudtner C. Dramatic increase in venous thromboembolism in children's hospitals in the United States from 2001 to 2007. Pediatrics. 2009;124(4):1001-1008. Disclosures No relevant conflicts of interest to declare.

Download Full-text

A retrospective case-control study to investigate horse and jockey level risk factors associated with horse falls in Irish Point-to-Point races

Comparative Exercise Physiology ◽

10.3920/cep190054 ◽

2020 ◽

Vol 16 (3) ◽

pp. 225-234

Author(s):

L.J. Smith ◽

G. Tabor ◽

J. Williams

Keyword(s):

Risk Factors ◽

Fall Risk ◽

Model Building ◽

Significant Risk ◽

Case Control ◽

Future Research ◽

Factors Associated ◽

Increased Risk ◽

Matched Case ◽

Point To Point

Horse racing as a high-risk sport can pose a significant risk to equine welfare. There have been limited epidemiological reviews of fall risk specific to point-to-point racing. This study aimed to identify horse and jockey level risk factors associated with horse falls and compare these to published findings for Hurdle and Steeplechase racing. The study used a retrospective matched case-control design. Relevant variables were identified, and information was collated for all races in the 2013/2014 and 2014/2015 seasons. Cases and controls were matched with a 1:3 ratio. Controls (n=2,547) were selected at random from all horses that completed in the same race (n=849). Horse and jockey level variables were analysed through univariable analysis to inform multivariable model building. A final matched case-control multivariable logistic regression model was refined, using fall/no fall as the dependent variable, through a backward stepwise process. Horse age was associated with an increased risk of horse falls. For every 1 unit increase in age there was a 1.2 times increased fall risk. The number of races ran within 12 months was associated with a decreased risk of falling. The jockeys previous seasons percentage wins was associated with the risk of horse falls. Jockeys who had 0-4% wins and 5-9% wins had an increase in risk compared to those who had over 20% wins/runs. The jockeys previous seasons percentage of falls (F) or unseating of the rider (UR) was associated with the risk of horse falls with jockeys who had over 20% F/UR having a 50% increased chance of falling compared to those who had 0-4% F/UR. Retrospective analysis of horse and jockey falls has exposed risk factors that have been previously identified in hurdle and steeplechase racing. Identification of risk factors is essential when considering future research and interventions aimed at improving horse and jockey safety.

Download Full-text

Risk Factors for Prolonged Opioid Use After Ankle Fracture Surgery

Foot & Ankle Specialist ◽

10.1177/19386400211029123 ◽

2021 ◽

pp. 193864002110291

Author(s):

Matthew S. Broggi ◽

Philip O. Oladeji ◽

Corey Spenser ◽

Rishin J. Kadakia ◽

Jason T. Bariteau

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Odds Ratio ◽

Ankle Fracture ◽

Significant Risk ◽

Patient Characteristics ◽

Low Back ◽

Opioid Use ◽

Increased Risk ◽

Fracture Surgery

Background The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. Methods The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. Results In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). Conclusion Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. Levels of Evidence Prognostic, Level III

Download Full-text

Overweight is Associated With Increased Incidence of Minor Complications After Reduction Mammoplasty: A Retrospective Analysis of 453 Consecutive Cases

Scandinavian Journal of Surgery ◽

10.1177/1457496917748225 ◽

2018 ◽

Vol 107 (3) ◽

pp. 230-235 ◽

Cited By ~ 2

Author(s):

M. Sutinen ◽

E. Eskelinen ◽

M. Kääriäinen

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Multivariate Analysis ◽

Retrospective Analysis ◽

Body Mass ◽

Significant Risk ◽

Reduction Mammoplasty ◽

Tertiary Referral Center ◽

Major Complications ◽

Increased Risk

Background and Aims: Reduction mammoplasty alleviates macromastia symptoms and improves quality of life. We investigated a large series of consecutive reduction mammoplasties to assess various risk factors for both minor and major complications after the procedure. Materials and Methods: A retrospective analysis of 453 consecutive reduction mammoplasties was performed between 2007 and 2010 at an academic tertiary referral center to evaluate risk factors and complications. Results: The incidence of minor and major complications was 40.5% and 8.8%, respectively. Patients with minor complications had both a significantly higher mean body mass index (30.2 vs 28.0) and sternal notch to nipple distance (33.9 vs 32.4 cm) than patients who recovered without complications (p < 0.001 for both comparisons), as well as more visits to the outpatient clinic (p < 0.001). In the multivariate analysis, body mass index was found to be the only significant risk factor for minor complications (p < 0.001). Furthermore, patients with body mass index higher than 27 had a 2.6-fold greater risk of minor complications (p < 0.001). An increase of one unit in body mass index increased the probability of minor complications by 14.1% (p < 0.001). 22 (4.9%) patients developed a hematoma requiring evacuation in the operating room. The mean body mass index of patients who developed a hematoma was 26.4, a value lower than that of patients without this complication (mean 29.0; p = 0.003). This finding was significant also in the multivariate analysis (p = 0.002). Conclusion: A higher body mass index was strongly associated with an increased risk of minor complications after reduction mammoplasty. It is important to inform obese patients about the increased risk of complications and to encourage them to lose weight before surgery.

Download Full-text

“You’re Ganja Have a Good Time”: Investigating the Roots of Blunt Use Among a National Sample of Hispanic Adults

Hispanic Health Care International ◽

10.1177/1540415319882665 ◽

2019 ◽

Vol 18 (1) ◽

pp. 20-26

Author(s):

R. Andrew Yockey ◽

Keith A. King ◽

Rebecca A. Vidourek

Keyword(s):

Risk Factors ◽

Substance Use ◽

Significant Risk ◽

Public Health Problem ◽

The United States ◽

Good Time ◽

Assistance Program ◽

Factors Associated ◽

Increased Risk ◽

Hispanic Adults

Blunt use is a pressing public health problem in the United States. While most studies have focused on African American youth, there remains a paucity of research examining blunt use among Hispanic individuals. Previous findings, which are quite limited, suggest mixed results, thus warranting further investigation regarding the prevalence of blunt use among Hispanic individuals and factors associated with such use. In accord with Jessor’s problem behavior theory, we hypothesized that prior use of illicit substances and certain psychosocial risk factors pose an increased risk for blunt use among Hispanic adults. A secondary analysis examined prior substance use and psychosocial factors of 10,216 Hispanic lifetime blunt users participating in the 2017 National Survey on Drug Use and Health. Findings revealed that one in five (20.5%) Hispanic individuals reported lifetime blunt use. Significant risk factors associated with blunt use were age (18+ years or older), participation in a government assistance program, prior illicit substance use, and changes in appetite or weight. Additional research on other risk factors, prevention mechanisms, and treatment interventions for Hispanic individuals who use blunts is warranted.

Download Full-text

Risk factors and protective factors of depression in older people 65+. A systematic review

PLoS ONE ◽

10.1371/journal.pone.0251326 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251326

Author(s):

Alexander Maier ◽

Steffi G. Riedel-Heller ◽

Alexander Pabst ◽

Melanie Luppa

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Older People ◽

Smoking Behavior ◽

Significant Risk ◽

Female Gender ◽

Assessment Tools ◽

Mobility Impairment ◽

Increased Risk ◽

Potential Risk Factors

Objectives Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required. Design A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized. Results Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results. Limitations Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results. Conclusion Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.

Download Full-text

Genetic Factors and Delayed TSB Monitoring and Treatment as Risk Factors Associated with Severe Hyperbilirubinemia in Term Neonates Admitted for Phototherapy

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa016 ◽

2020 ◽

Vol 66 (6) ◽

pp. 569-582

Author(s):

Nem-Yun Boo ◽

Shwe Sin ◽

Seok-Chiong Chee ◽

Maslina Mohamed ◽

Anita Kaur Ahluwalia ◽

...

Keyword(s):

Risk Factors ◽

Genetic Variants ◽

Serum Bilirubin ◽

Organic Anion ◽

Significant Risk ◽

Total Serum ◽

Feeding Practice ◽

Term Neonates ◽

Factors Associated ◽

Increased Risk

Abstract Objectives This study aimed to determine whether maternal–fetal blood group isoimmunization, breastfeeding, birth trauma, age when first total serum bilirubin (TSB) was measured, age of admission, and genetic predispositions to hemolysis [due to genetic variants of glucose-6-phosphate dehydrogenase (G6PD) enzyme], and reduced hepatic uptake and/or conjugation of serum bilirubin [due to genetic variants of solute carrier organic anion transporter protein family member 1B1 (SLCO1B1) and uridine diphosphate glucuronosyltransferase family 1 member A1 (UGT1A1)] were significant risk factors associated with severe neonatal hyperbilirubinemia (SNH, TSB ≥ 342µmol/l) in jaundiced term neonates admitted for phototherapy. Methods The inclusion criteria were normal term neonates (gestation ≥ 37 weeks). Parents/care-givers were interviewed to obtain data on demography, clinical problems, feeding practice and age when first TSB was measured. Polymerase chain reaction-restriction fragment length polymorphism method was used to detect common G6PD, UGT1A1 and SLCO1B1 variants on each neonate’s dry blood specimens. Results Of 1121 jaundiced neonates recruited, 232 had SNH. Logistic regression analysis showed that age (in days) when first TSB was measured [adjusted odds ratio (aOR) = 1.395; 95% confidence interval (CI) 1.094–1.779], age (in days) of admission (aOR = 1.127; 95% CI 1.007–1.260) and genetic mutant UGT1A1 promoter A(TA)7TAA (aOR = 4.900; 95% CI 3.103–7.739), UGT1A1 c.686C>A (aOR = 6.095; 95% CI 1.549–23.985), SLCO1B1 c.388G>A (aOR = 1.807; 95% CI 1.242–2.629) and G6PD variants and/or abnormal G6PD screening test (aOR = 2.077; 95% CI 1.025–4.209) were significantly associated with SNH. Conclusion Genetic predisposition, and delayed measuring first TSB and commencing phototherapy increased risk of SNH.

Download Full-text

Risk Factors for Hyperlactataemia in HIV-Infected Patients, Aquitaine Cohort, 1999–2003

Antiviral Chemistry and Chemotherapy ◽

10.1177/095632020501600106 ◽

2005 ◽

Vol 16 (1) ◽

pp. 63-67 ◽

Cited By ~ 18

Author(s):

Fabrice Bonnet ◽

Eric Balestre ◽

Elise Bernardin ◽

Jean-Luc Pellegrin ◽

Didier Neau ◽

...

Keyword(s):

Risk Factors ◽

Renal Function ◽

Multivariate Analysis ◽

Serum Lactate ◽

Cd4 Count ◽

Plasma Lactate ◽

Plasma Triglycerides ◽

Factors Associated ◽

Increased Risk ◽

Over Time

The objectives of our study were to describe the characteristics of a subset of patients who had been prescribed serum lactate in clinical practice within a large cohort of HIV-infected patients and to determine the factors associated with hyperlactataemia. Hyperlactataemia (⩾T2 mmol/l) was found in 219 [29% (95% confidence interval: 25.3–31.7)] of the 768 HIV-infected participants. In multivariate analysis (logistical regression), an increased risk of hyperlactataemia was associated with increasing age, CD4 count <500/mm3, triglycerides >2.2 mmol/L, lipoatrophy and stavudine use. In a second model coding for the NRTI-based drug combinations, only those including stavudine were associated with an increased risk of hyperlactataemia. In a third model including exposure duration to NRTIs, we estimated a 20% increased risk of hyperlactataemia per year of exposure to didanosine or stavudine. The risk of hyperlactataemia could increase over time in patients treated with these drugs and is also closely associated with increased age, decreased CD4 count, lipodystrophy and increased plasma triglycerides. It could be proposed that patients having one or more of these risk factors undergo regular monitoring of plasma lactate and renal function to prevent lactic acidosis.

Download Full-text

Risk Factors Associated with Major Complications after Ultrasound-Guided Percutaneous Renal Biopsy of Native Kidneys

Kidney & Blood Pressure Research ◽

10.1159/000504544 ◽

2019 ◽

Vol 45 (1) ◽

pp. 122-130 ◽

Cited By ~ 4

Author(s):

Beatriz Pombas ◽

Eva Rodríguez ◽

Juan Sánchez ◽

Aleksandar Radosevic ◽

Javier Gimeno ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Blood Transfusion ◽

Renal Biopsy ◽

Categorical Variables ◽

Ultrasound Guided ◽

Factors Associated ◽

Percutaneous Renal Biopsy ◽

Major Complications ◽

Increased Risk

Introduction: Percutaneous renal biopsy (PRB) of native kidneys is an important tool for diagnosis and management of renal disease. In this study, we analyzed the success, safety, and risk complications of PRB in our center. Methods: A retrospective review of ultrasound-guided PRB done at our institution from January 1998 to December 2017 was performed. Clinical and laboratory data were collected for 661 PRBs. Statistical analysis was performed using the Mann-Whitney U test for continuous variable and chi-square test for categorical variables. Multivariate analysis using logistic regression was performed to assess factors associated with increased risk of complications after PRB. Results: The median age was 56 (42–68) years old, the majority were male (64%) and white (82%). Ten glomeruli were present in 63.5% of PRBs. Overall, the rate of complications was 16.6%, where 15.1% of them were minor complications and 1.5% were major complications. Perinephritic hematoma accounted for the minor complication that occurred most frequently, whereas the need of a blood transfusion was the prevalent for major complications. By multivariate analysis, increased activated partial thromboplastin time (aPTT; OR 1.11, 95% CI 1.035–1.180) and prebiopsy lower hemoglobin (Hgb; OR 1.61, 95% CI 1.086–2.304) were identified as independent risk factors for major complications. In addition, older patients (OR 1.057, 95% CI 1.001–1.117) were identified as an independent risk factor for blood transfusion requirement. Conclusion: The current risk of complications after native PRB is low. Major complications are most common in case of increased aPTT and decreased Hgb baseline level.

Download Full-text

Risk factors of major depression in the elderly

European Psychiatry ◽

10.1016/j.eurpsy.2004.09.036 ◽

2005 ◽

Vol 20 (3) ◽

pp. 199-204 ◽

Cited By ~ 37

Author(s):

Reinhard Heun ◽

Sandra Hein

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Depressive Episode ◽

Memory Impairment ◽

Somatoform Disorders ◽

Significant Risk ◽

The Elderly ◽

Subjective Memory ◽

Subjective Memory Impairment ◽

Increased Risk

AbstractBackgroundSeveral risk factors of depression have been identified in retrospective as well as some prospective studies in the elderly. Confirmation in independent samples is needed. The present follow-up study prospectively investigated risk factors of depression in an elderly German sample.MethodsOne thousand four hundred and thirty-one subjects from a family study were re-investigated after 4.7 ± 2.5 years. Bivariate and multivariate forward logistic regression analyses were used to identify risk factors of the development of new depression in the elderly.ResultsRisk factors of a new depressive episode in 1408 elderly without current depression were age, female gender, a previous depression, subjective memory impairment, previous anxiety and somatoform disorders. The presence of dementia or mild cognitive impairment were significant risk factors in bivariate, but not multivariate analysis controlling for possible confounding. Risk factors of a first geriatric depressive episode were age, gender and subjective memory impairment; age remained the only significant risk factor in multivariate analysis.ConclusionsThis investigation confirms previous studies from other countries concerning the relevance of risk factors for depression in the elderly. The knowledge of risk factors might help identify subjects at increased risk of depression for early intervention approaches. Elderly with a history of previous depression carry the highest risk.

Download Full-text