Epilepsy as a Risk Factor for Submersion Injury in Children

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 612-616 ◽  
Author(s):  
Douglas S. Diekema ◽  
Linda Quan ◽  
Victoria L. Holt
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Confidence Interval ◽  
Retrospective Cohort ◽  
Population Based ◽  
King County ◽  
Relative Risks ◽  
Increased Risk

The purpose of this study was to determine the risk of submersion injury and drowning among children with epilepsy and to define further specific risk factors. In a population-based retrospective cohort study the authors identified and reviewed records of all 0- through 19-year-old residents of King County Washington, who suffered a submersion incident between 1974 and 1990. Children with epilepsy were compared with those without epilepsy with regard to age, sex, site of incident, supervision, outcome, and presence of preexisting handicap. Relative risks were determined using population-based estimates of epilepsy prevalence. Of 336 submersions, 21 (6%) occurred among children with epilepsy. Children with epilepsy were more likely to be greater than 5 years old (86% vs 47%) and more likely to submerge in a bathtub (38% vs 11%). The relative risk of submersion for children with epilepsy was 47 (95% confidence interval [CI] 22 to 100) in the bathtub and 18.7 (95% CI 9.8 to 35.6) in the pool. The relative risk of drowning for children with epilepsy was 96 (95% CI 33 to 275) in the bathtub and 23.4 (95% CI 7.1 to 77.1) in the pool. These data support an increased risk of submersion and drowning among children with epilepsy.

scholarly journals Parvovirus Enteritis and Other Risk Factors Associated With Persistent Gastrointestinal Signs in Dogs Later in Life: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Kanae Takada ◽  
Anne M. Flemming ◽  
Maarten J. Voordouw ◽  
Anthony P. Carr
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Health Problems ◽  
Organ Systems ◽  
Increased Risk

Abstract Background: Parvoviral enteritis is a viral gastrointestinal (GI) infection of dogs. Recovery from PE has been associated with persistent GI signs. The objectives of this study were: (i) To determine whether dogs that have recovered from PE (post-parvo dogs) had an increased risk of persistent GI signs compared to uninfected controls. (ii) To investigate the lifestyle and clinicopathologic factors that are associated with persistent GI signs in post-parvo dogs. Methods: Eighty-six post-parvo dogs and 52 age-matched control dogs were enrolled in this retrospective cohort study. The owners were interviewed about the health and habits of their dogs using a questionnaire. We used logistic regression to test whether parvovirus enteritis and other risk factors are associated with general health problems in all dogs and with persistent GI signs in post-parvo dogs.Results: The prevalence of persistent GI signs was significantly higher in post-parvo dogs compared to control dogs (57% vs 25%, P < 0.001). Markers of disease severity such as neutropenia, low body temperature, and treatment with an antiemetic medication (metoclopramide) were significant risk factors for persistent GI signs in post-parvo dogs. Persistent GI signs in post-parvo dogs was a risk factor for health problems in other organ systems.Conclusions: Parvovirus enteritis is a significant risk factor for persistent GI signs in dogs highlighting the importance of prevention. The risk factors identified in the present study may guide future investigations on the mechanisms that link parvovirus enteritis to chronic health problems in dogs.

scholarly journals HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study

BMJ ◽  
2019 ◽  
pp. l4894 ◽  
Author(s):  
Marcus Lind ◽  
Aldina Pivodic ◽  
Ann-Marie Svensson ◽  
Arndis F Ólafsdóttir ◽  
Hans Wedel ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Relative Risk ◽  
Confidence Interval ◽  
Severe Hypoglycaemia ◽  
Population Based ◽  
Duration Of Diabetes ◽  
Increased Risk

AbstractObjectiveTo evaluate if the lowest target level for glycated haemoglobin (HbA1c) of <6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes.DesignPopulation based cohort study.SettingSwedish National Diabetes Registry, 1 January 1998 to 31 December 2017.Participants10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017.Main outcome measuresRelative risk (odds ratios) for retinopathy and nephropathy for different mean levels of HbA1c.ResultsMean age of participants was 14.7 years (43.4% female), mean duration of diabetes was 1.3 years, and mean HbA1c level was 8.0% (63.4 mmol/mol). After adjustment for age, sex, duration of diabetes, blood pressure, blood lipid levels, body mass index, and smoking, the odds ratio for mean HbA1c <6.5% (<48 mmol/mol) compared with 6.5-6.9% (48-52 mmol/mol) for any retinopathy (simplex or worse) was 0.77 (95% confidence interval 0.56 to 1.05, P=0.10), for preproliferative diabetic retinopathy or worse was 3.29 (0.99 to 10.96, P=0.05), for proliferative diabetic retinopathy was 2.48 (0.71 to 8.62, P=0.15), for microalbuminuria or worse was 0.98 (0.60 to 1.61, P=0.95), and for macroalbuminuria was 2.47 (0.69 to 8.87, P=0.17). Compared with HbA1c levels 6.5-6.9%, HbA1c levels 7.0-7.4% (53-57 mmol/mol) were associated with an increased risk of any retinopathy (1.31, 1.05 to 1.64, P=0.02) and microalbuminuria (1.55, 1.03 to 2.32, P=0.03). The risk for proliferative retinopathy (5.98, 2.10 to 17.06, P<0.001) and macroalbuminuria (3.43, 1.14 to 10.26, P=0.03) increased at HbA1c levels >8.6% (>70 mmol/mol). The risk for severe hypoglycaemia was increased at mean HbA1c <6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005).ConclusionsRisk of retinopathy and nephropathy did not differ at HbA1c levels <6.5% but increased for severe hypoglycaemia compared with HbA1c levels 6.5-6.9%. The risk for severe complications mainly occurred at HbA1c levels >8.6%, but for milder complications was increased at HbA1c levels >7.0%.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Proton pump inhibitors versus histamine-2 receptor blockers for stress ulcer prophylaxis in patients with sepsis: a retrospective cohort study

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110251
Author(s):  
Minqiang Huang ◽  
Ming Han ◽  
Wei Han ◽  
Lei Kuang
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Stress Ulcer ◽  
Increased Risk ◽  
Ulcer Prophylaxis

Objective We aimed to compare the efficacy and risks of proton pump inhibitor (PPI) versus histamine-2 receptor blocker (H2B) use for stress ulcer prophylaxis (SUP) in critically ill patients with sepsis and risk factors for gastrointestinal bleeding (GIB). Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care III Clinical Database to identify critically ill adult patients with sepsis who had at least one risk factor for GIB and received either an H2B or PPI for ≥48 hours. Propensity score matching (PSM) was conducted to balance baseline characteristics. The primary outcome was in-hospital mortality. Results After 1:1 PSM, 1056 patients were included in the H2B and PPI groups. The PPI group had higher in-hospital mortality (23.8% vs. 17.5%), GIB (8.9% vs. 1.6%), and pneumonia (49.6% vs. 41.6%) rates than the H2B group. After adjusting for risk factors of GIB and pneumonia, PPI use was associated with a 1.28-times increased risk of in-hospital mortality, 5.89-times increased risk of GIB, and 1.32-times increased risk of pneumonia. Conclusions Among critically ill adult patients with sepsis at risk for GIB, SUP with PPIs was associated with higher in-hospital mortality and higher risk of GIB and pneumonia than H2Bs.

Systemic sclerosis portends increased risk of conduction and rhythm abnormalities at diagnosis and during disease course: A US population-based cohort

2021 ◽  
pp. 239719832110340
Author(s):  
Yasser A Radwan ◽  
Reto D Kurmann ◽  
Avneek S Sandhu ◽  
Edward A El-Am ◽  
Cynthia S Crowson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Confidence Interval ◽  
Cumulative Incidence ◽  
Disease Onset ◽  
Population Based ◽  
Hazard Ratio ◽  
Conduction Disorders ◽  
Increased Risk

Objectives: To study the incidence, risk factors, and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis versus nonsystemic sclerosis comparators. Methods: An incident cohort of patients with systemic sclerosis (1980–2016) from Olmsted County, MN, was compared to age- and sex-matched nonsystemic sclerosis subjects (1:2). Electrocardiograms, Holter electrocardiograms, and a need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results: Seventy-eight incident systemic sclerosis cases and 156 comparators were identified (mean age 56 years, 91% female). The prevalence of any conduction disorder before systemic sclerosis diagnosis compared to nonsystemic sclerosis subjects was 15% versus 7% ( p = 0.06), and any rhythm disorder was 18% versus 13% ( p = 0.33). During a median follow-up of 10.5 years in patients with systemic sclerosis and 13.0 years in nonsystemic sclerosis comparators, conduction disorders developed in 25 patients with systemic sclerosis with cumulative incidence of 20.5% (95% confidence interval: 12.4%–34.1%) versus 28 nonsystemic sclerosis patients with cumulative incidence of 10.4% (95% confidence interval: 6.2%–17.4%) (hazard ratio: 2.57; 95% confidence interval: 1.48–4.45), while rhythm disorders developed in 27 patients with systemic sclerosis with cumulative incidence of 27.3% (95% confidence interval: 17.9%–41.6%) versus 43 nonsystemic sclerosis patients with cumulative incidence of 18.0% (95% confidence interval: 12.3%–26.4%) (hazard ratio: 1.62; 95% confidence interval: 1.00–2.64). Age, pulmonary hypertension, and smoking were identified as risk factors. Conclusion: Patients with systemic sclerosis have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to nonsystemic sclerosis patients. These findings warrant increased vigilance and screening for electrocardiogram abnormalities in systemic sclerosis patients with pulmonary hypertension.

Increased risk of pyogenic liver abscess in patients with alcohol intoxication: A population-based retrospective cohort study

Alcohol ◽  
2017 ◽  
Vol 64 ◽  
pp. 23-28 ◽  
Author(s):  
Yao-Chien Wang ◽  
Kai-Wei Yang ◽  
Tien-Ying Peter Lee ◽  
Cheng-Li Lin ◽  
Geng-Wang Liaw ◽  
...  
Keyword(s):  
Cohort Study ◽  
Liver Abscess ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Alcohol Intoxication ◽  
Pyogenic Liver Abscess ◽  
Population Based ◽  
Increased Risk

Anxiety and depression in parents 4–9 years after the loss of a child owing to a malignancy: a population-based follow-up

2004 ◽  
Vol 34 (8) ◽  
pp. 1431-1441 ◽  
Author(s):  
ULRIKA KREICBERGS ◽  
UNNUR VALDIMARSDÓTTIR ◽  
ERIK ONELÖV ◽  
JAN-INGE HENTER ◽  
GUNNAR STEINECK
Keyword(s):  
Psychological Distress ◽  
Relative Risk ◽  
Confidence Interval ◽  
Stressful Life Event ◽  
Population Based ◽  
Anxiety And Depression ◽  
Control Group ◽  
Bereaved Parents ◽  
Increased Risk ◽  
Loss Of A Child

Background. Some consider the loss of a child as the most stressful life event. When the death is caused by a malignancy, the parents are commonly exposed not only to their own loss, but also to the protracted physical and emotional suffering of the child. We investigated parental risk of anxiety and depression 4–9 years after the loss of a child owing to a malignancy.Method. In 2001, we attempted to contact all parents in Sweden who had lost a child due to a malignancy during 1992–1997. We used an anonymous postal questionnaire and utilized a control group of non-bereaved parents with a living child.Results. Participation among bereaved parents was 449/561 (80%); among non-bereaved 457/659 (69%). We found an increased risk of anxiety (relative risk 1·5, 95% confidence interval 1·1–1·9) and depression (relative risk 1·4, 95% confidence interval 1·1–1·7) among bereaved parents compared with non-bereaved. The risk of anxiety and depression was higher in the period 4–6 years after bereavement than in the 7–9 years period, during which the average excess risks approached zero. Psychological distress was overall higher among bereaved mothers and loss of a child aged 9 years or older implied an increased risk, particularly for fathers.Conclusions. Psychological morbidity in bereaved parents decreases to levels similar to those among non-bereaved parents 7–9 years after the loss. Bereaved mothers and parents who lose a child 9 years or older have on average an excess risk for long-term psychological distress.

First norovirus outbreaks associated with consumption of green seaweed (Enteromorpha spp.) in South Korea

2014 ◽  
Vol 143 (3) ◽  
pp. 515-521 ◽  
Author(s):  
J. H. PARK ◽  
H. S. JEONG ◽  
J. S. LEE ◽  
S. W. LEE ◽  
Y. H. CHOI ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Case Control Study ◽  
Case Control ◽  
Green Seaweed ◽  
Norovirus Gii ◽  
Control Study

SUMMARYIn February 2012, an outbreak of gastroenteritis was reported in school A; a successive outbreak was reported at school B. A retrospective cohort study conducted in school A showed that seasoned green seaweed with radishes (relative risk 7·9, 95% confidence interval 1·1–56·2) was significantly associated with illness. Similarly, a case-control study of students at school B showed that cases were 5·1 (95% confidence interval 1·1–24·8) times more likely to have eaten seasoned green seaweed with pears. Multiple norovirus genotypes were detected in samples from students in schools A and B. Norovirus GII.6 isolated from schools A and B were phylogenetically indistinguishable. Green seaweed was supplied by company X, and norovirus GII.4 was isolated from samples of green seaweed. Green seaweed was assumed to be linked to these outbreaks. To our knowledge, this is the first reported norovirus outbreak associated with green seaweed.

scholarly journals Maternal and child gluten intake and risk of type 1 diabetes: The Norwegian Mother and Child Cohort Study

2019 ◽  
Author(s):  
Nicolai A Lund-Blix ◽  
German Tapia ◽  
Karl Mårild ◽  
Anne Lise Brantsaeter ◽  
Pål R Njølstad ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Confidence Interval ◽  
Population Based ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Pregnancy Cohort ◽  
Increased Risk ◽  
Mother And Child

ABSTRACTOBJECTIVETo examine the association between maternal and child gluten intake and risk of type 1 diabetes in children.DESIGNPregnancy cohortSETTINGPopulation-based, nation-wide study in NorwayPARTICIPANTS86,306 children in The Norwegian Mother and Child Cohort Study born from 1999 through 2009, followed to April 15, 2018.MAIN OUTCOME MEASURESClinical type 1 diabetes, ascertained in a nation-wide childhood diabetes registry. Hazard ratios were estimated using Cox regression for the exposures maternal gluten intake up to week 22 of pregnancy and child’s gluten intake when the child was 18 months old.RESULTSDuring a mean follow-up of 12.3 years (range 0.7-16.0), 346 children (0.4%) developed type 1 diabetes (incidence rate 32.6 per 100,000 person-years). The average gluten intake was 13.6 grams/day for mothers during pregnancy, and 8.8 grams/day for the child at 18 months of age. Maternal gluten intake in mid-pregnancy was not associated with the development of type 1 diabetes in the child (adjusted hazard ratio 1.02 (95% confidence interval 0.73 to 1.43) per 10 grams/day increase in gluten intake). However, the child’s gluten intake at 18 months of age was associated with an increased risk of later developing type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake).CONCLUSIONSThis study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the risk of type 1 diabetes in the child.WHAT IS ALREADY KNOWN ON THIS TOPICA national prospective cohort study from Denmark found that a high maternal gluten intake during pregnancy could increase the risk of type 1 diabetes in the offspring (adjusted hazard ratio 1.31 (95% confidence interval 1.001 to 1.72) per 10 grams/day increase in gluten intake). No studies have investigated the relation between the amount of gluten intake by both the mother during pregnancy and the child in early life and risk of developing type 1 diabetes in childhood.WHAT THIS STUDY ADDSIn this prospective population-based pregnancy cohort with 86,306 children of whom 346 developed type 1 diabetes we found that the child’s gluten intake at 18 months of age was associated with the risk of type 1 diabetes (adjusted hazard ratio 1.46 (95% confidence interval 1.06 to 2.01) per 10 grams/day increase in gluten intake). This study suggests that the child’s gluten intake at 18 months of age, and not the maternal intake during pregnancy, could increase the child’s risk of type 1 diabetes.

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