scholarly journals Risk Factors For Perioperative Venous Thromboembolism in Patients With Gynecological Malignancies

2021 ◽  
Author(s):  
Yi Yang ◽  
Se-Ge Ma ◽  
Yan Huang ◽  
Jun Zhu
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Serum Albumin ◽  
Clinical Data ◽  
Laboratory Tests ◽  
Conditional Logistic Regression ◽  
Perioperative Period ◽  
Case Control ◽  
Gynecologic Malignancies ◽  
Gynecological Malignancies

Abstract Introduction：Venous thromboembolism (VTE), is a frequent postoperative complication of gynecologic malignancies during perioperative period.Although a number of risk factors for perioperative VTE with gynecological malignancies have been reported, the findings are diverse or even contradictory .In addition, most of the existing studies were retrospective case-control studies with small sample sizes .This study was a prospectively matched case-control study and aimed to specifically explore the risk factors related to surgery for perioperativeVTE in gynecologic malignancies.Material and methods：Overall,734 patients with gynecologic malignancies were enrolled in this study.54 patients who developed VTE were included as the case group. A total of 270 non-VTE patients matched in a ratio of 1:5 as a control group with the matched principle of the same ethnicity and similar date of surgery (difference ± 3 days). The demographic characteristics, clinical data, laboratory tests, surgical data, and data related to the occurrence of VTE were collected during the follow-up period. Conditional logistic regression models were used for univariate and multifactorial analyses. Factors related to surgical treatment, especially those could be intervened and prevented, were used as target factors, which were gradually corrected by demographic data, clinical data, laboratory tests and other factors related to surgery, and sensitivity analysis was performed.Results:The results of univariate analysis showed that age, place of residence, occupation, high-fat diet, menopause, comorbid chronic diseases, duration of upper extremity indwelling needle retention, disease diagnosis, sleep during hospitalization, admission albumin, surgical approach , duration of intensive care unit(ICU)admission, start of anticoagulant use, time to resume postoperative anal evacuation, duration of bed rest, duration of drinking abstinence, difference between postoperative and admission Caprini scores,duration of abdominal drainage tube retention, and intraoperative bleeding were risk factors for VTE in patients with perioperative gynecologic malignancies (P<0.05). Stepwise corrected multifactorial conditional logistic regression analysis showed that admission albumin<46.40 g/L and large difference between postoperative and admission Caprini scores were risk factors for the development of VTE in patients with gynecologic malignancies in the perioperative period, and the risk of VTE in patients with admission serum albumin<46.40 g/L was 4.885 times higher than that in patients with admission serum albumin≥46.40 g/L; The larger difference between postoperative and admission Caprini scores, the higher the risk of VTE, and a 1-point increase in the difference between postoperative and admission Caprini scores was associated with a 2.174-fold increase in the risk of VTE (95% CI: 1.255 to 3.766, P= 0.006).Conclusions: The main risk factors for perioperative VTE in gynecologic malignancies are serum albumin lower than 46.40 g/L and large difference between postoperative and admission Caprini scores. More attention should be paid to the dynamic changes of serum albumin and Caprini scores of patients in the perioperative period and those factors should be targeted to intervene in order to reduce the perioperative VTE.

scholarly journals Risk factors of primary open-angle glaucoma: the first case-control hospital-based study in Vietnam

2019 ◽  
Author(s):  
Anh Van Bui ◽  
Tung Thanh Hoang ◽  
Ngoc Bich Nguyen ◽  
Anh Kim Le ◽  
Jennifer L. Patnaik
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Open Angle ◽  
Over The Counter ◽  
Vietnamese Population ◽  
History Of

Abstract Purpose: To identify risk factors for primary open-angle glaucoma (POAG) in a Vietnamese population. Methods: A matched case-control study was conducted at Vietnam National Institute of Ophthalmology. Cases were patients clinically diagnosed with POAG. Controls were caregivers of patients with other eye diseases, free from any ocular and systemic abnormalities, and were selected and then matched with the cases by gender and age. Cases and controls were examined by a glaucoma specialist to confirm presence or absence of POAG. Data on demographic, ophthalmic and medical conditions were collected via interview at time of examination. Associations between POAG and potential factors were examined by univariate conditional logistic regression analysis (OR – Odd Ratios) and multivariate conditional logistic regression (AOR – Adjusted Odd Ratios) with level of significance is 0.05. Results: In total, 128 cases with POAG and 128 controls were recruited. Multivariate conditional (fixed-effects) logistic regression analysis resulted in several significant risk factors, including hypertension AOR =4.7 (95% CI: 1.8–12.0; p=0.002); family history of glaucoma AOR = 6.4 (95% CI: 1.3 – 32.2; p = 0.026); over–the–counter eye medication AOR = 3.1 (95% CI: 1.5 – 6.5; p = 0.006), and a protective role for marriage AOR = 0.2 (95% CI: 0.1 – 0.7; p = 0.006) and weekly exercise AOR = 0.3 (95% CI: 0.1 – 0.8; p = 0.021). Conclusions: Hypertension, family history of glaucoma and over–the–counter eye medication were risk factors while marriage and weekly exercise were protective factors for POAG in Vietnamese population.

Characteristics of Adenocarcinoma of the Gallbladder Following Cholecystectomies in the Hispanic Population

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S64-S65
Author(s):  
David Gustafson ◽  
Osvaldo Padilla
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Incidental Finding ◽  
Conditional Logistic Regression ◽  
Gallbladder Disease ◽  
Predictor Variables ◽  
Wall Thickening ◽  
Conditional Logistic Regression Analysis

Abstract Introduction Gallbladder adenocarcinoma (GBC) is a rare malignancy. Frequency of incidental adenocarcinoma of the gallbladder in the literature is approximately 0.2% to 3%. Typically, GBC is the most common type and is discovered late, not until significant symptoms develop. Common symptoms include right upper quadrant pain, nausea, anorexia, and jaundice. A number of risk factors in the literature are noted for GBC. These risk factors are also more prevalent in Hispanic populations. This study sought to compare patients with incidental gallbladder adenocarcinomas (IGBC) to those with high preoperative suspicion for GBC. Predictor variables included age, sex, ethnicity, radiologic wall thickening, gross pathology characteristics (wall thickness, stone size, stone number, and tumor size), histologic grade, and staging. Methods Cases of GBC were retrospectively analyzed from 2009 through 2017, yielding 21 cases. Data were collected via Cerner EMR of predictor variables noted above. Statistical analysis utilized conditional logistic regression analysis. Results The majority of patients were female (n = 20) and Hispanic (n = 19). There were 14 IGBCs and 7 nonincidental GBCs. In contrast with previous research, exact conditional logistic regression analysis revealed no statistically significant findings. For every one-unit increase in AJCC TNM staging, there was a nonsignificant 73% reduction in odds (OR = 0.27) of an incidental finding of gallbladder carcinoma. Conclusion This study is important in that it attempts to expand existing literature regarding a rare type of cancer in a unique population, one particularly affected by gallbladder disease. Further studies are needed to increase predictive knowledge of this cancer. Longer studies are needed to examine how predictive power affects patient outcomes. This study reinforces the need for routine pathologic examination of cholecystectomy specimens for cholelithiasis.

scholarly journals Diabetes mellitus, anti-secretory drugs and other risk factors for campylobacter gastro-enteritis in adults: a case-control study

1997 ◽  
Vol 119 (3) ◽  
pp. 307-311 ◽  
Author(s):  
K. R. NEAL ◽  
R. C. B. SLACK
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Postal Questionnaire ◽  
Foreign Travel ◽  
Drinking Milk ◽  
Campylobacter Infection ◽  
Control Study

The epidemiology of notified cases of campylobacter gastroenteritis in adults in Nottingham Health District was investigated using a case-control study with a postal questionnaire to ascertain data on risk factors. Over a 14-month period 531 cases (a 73% response rate of all laboratory confirmed cases) and 512 controls replied.Conditional logistic regression analysis was used to determine independent associations with infection. These included foreign travel (odds ratio (OR) 3·4; 95% confidence intervals (CI) 2·0–5·7), diabetes mellitus (OR 4·1, CI 1·1–17), medication with omeprazole (OR 3·5, CI 1·1–12) and H2 and H2 antagonists (OR 3·7, CI 1·3–15), contact with puppies (OR11·3, CI1·2–105), eating chicken (OR 1·4, CI 1·1–1·8) and drinking milk from bottles with tops damaged by a bird (OR 3·3, CI 1·0–11). Preparing main meals (OR 0·9, CI 0·8–1·0) and drinking delivered milk (OR 0·6, CI 0·4–0·9) were associated with a reduced risk of campylobacter infection.Foreign travel was reported in 25% of cases and another 15% had significant associations with other risk factors. The majority of cases, 60%, remained unexplained, indicating the need for further evolution of sporadic cases.

Risk factors and outcomes of postoperative emergency response team activation: a matched case-control study

2020 ◽  
Vol 22 (1) ◽  
pp. 6-14
Author(s):  
Matthew I Hardman ◽  
◽  
S Chandralekha Kruthiventi ◽  
Michelle R Schmugge ◽  
Alexandre N Cavalcante ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Postoperative Complications ◽  
Emergency Response ◽  
Case Control Study ◽  
Case Control ◽  
Multiple Logistic Regression ◽  
Increased Risk ◽  
Response Team ◽  
Control Study

OBJECTIVE: To determine patient and perioperative characteristics associated with unexpected postoperative clinical deterioration as determined for the need of a postoperative emergency response team (ERT) activation. DESIGN: Retrospective case–control study. SETTING: Tertiary academic hospital. PARTICIPANTS: Patients who underwent general anaesthesia discharged to regular wards between 1 January 2013 and 31 December 2015 and required ERT activation within 48 postoperative hours. Controls were matched based on age, sex and procedure. MAIN OUTCOME MEASURES: Baseline patient and perioperative characteristics were abstracted to develop a multiple logistic regression model to assess for potential associations for increased risk for postoperative ERT. RESULTS: Among 105 345 patients, 797 had ERT calls, with a rate of 7.6 (95% CI, 7.1–8.1) calls per 1000 anaesthetics (0.76%). Multiple logistic regression analysis showed the following risk factors for postoperative ERT: cardiovascular disease (odds ratio [OR], 1.61; 95% CI, 1.18–2.18), neurological disease (OR, 1.57; 95% CI, 1.11–2.22), preoperative gabapentin (OR, 1.60; 95% CI, 1.17–2.20), longer surgical duration (OR, 1.06; 95% CI, 1.02–1.11, per 30 min), emergency procedure (OR, 1.54; 95% CI, 1.09–2.18), and intraoperative use of colloids (OR, 1.50; 95% CI, 1.17–1.92). Compared with control participants, ERT patients had a longer hospital stay, a higher rate of admissions to critical care (55.5%), increased postoperative complications, and a higher 30-day mortality rate (OR, 3.36; 95% CI, 1.73–6.54). CONCLUSION: We identified several patient and procedural characteristics associated with increased likelihood of postoperative ERT activation. ERT intervention is a marker for increased rates of postoperative complications and death.

scholarly journals Potential risk factors for multiple sclerosis in Rio de Janeiro: a case-control study

2009 ◽  
Vol 67 (2a) ◽  
pp. 229-234 ◽  
Author(s):  
Kátia Regina Penha da Silva ◽  
Regina Maria Papais Alvarenga ◽  
Oscar Fernandez y Fernandez ◽  
Hélcio Alvarenga ◽  
Luiz Claudio Santos Thuler
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Potential Risk ◽  
Rio De Janeiro ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Potential Risk Factors ◽  
Epidemiological Characteristics ◽  
Control Study

PURPOSE: To evaluate potential risk factors for the development of multiple sclerosis in Brazilian patients. METHOD: A case control study was carried out in 81 patients enrolled at the Department of Neurology of the Hospital da Lagoa in Rio de Janeiro, and 81 paired controls. A standardized questionnaire on demographic, social and cultural variables, and medical and family history was used. Statistical analysis was performed using descriptive statistics and conditional logistic regression models with the SPSS for Windows software program. RESULTS: Having standard vaccinations (vaccinations specified by the Brazilian government) (OR=16.2; 95% CI=2.3-115.2), smoking (OR=7.6; 95% CI=2.1-28.2), being single (OR=4.7; 95% CI=1.4-15.6) and eating animal brain (OR=3.4; 95% CI=1.2-9.8) increased the risk of developing MS. CONCLUSIONS: RESULTS of this study may contribute towards better awareness of the epidemiological characteristics of Brazilian patients with multiple sclerosis.

scholarly journals Ecological and behavioural risk factors of scrub typhus in central Vietnam: a case-control study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hanh Thi Duc Tran ◽  
Jan Hattendorf ◽  
Hung Manh Do ◽  
Thanh Tien Hoang ◽  
Hang Thi Hai Hoang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Scrub Typhus ◽  
Conditional Logistic Regression ◽  
Febrile Illness ◽  
Case Control ◽  
Enzyme Linked Immunosorbent Assay ◽  
Protective Equipment ◽  
Related Factors ◽  
Control Study

Abstract Background The risk factors for scrub typhus in Vietnam remain unknown. Scrub typhus caused by Orientia tsutsugamushi often presents as an undifferentiated febrile illness and remains under appreciated due to the limited availability of diagnostic tests. This tropical rickettsial illness is increasingly recognized as an important cause of non-malaria acute undifferentiated fever in Asia. This study aimed to investigate behavioural and ecological related risk factors of scrub typhus to prevent this potentially life-threatening disease in Vietnam. Methods We conducted a clinical hospital-based active surveillance study, and a retrospective residence-enrolment date-age-matched case–control study in Khanh Hoa province, Vietnam, from August 2018 to March 2020. Clinical examinations, polymerase chain reaction and enzyme-linked immunosorbent assay IgM tests were applied to define cases and controls. All enrolled participants filled out a questionnaire including demographic socio-economic status, personal behaviors/protective equipment, habitat connections, land use, and possible exposure to the vector. Multivariable conditional logistic regression was used to define the scrub typhus associated risk factors. Results We identified 44 confirmed cases and matched them with 152 controls. Among cases and controls, the largest age group was the 41–50 years old and males accounted for 61.4% and 42.8%, respectively. There were similarities in demographic characteristics between the two groups, with the exception of occupation. Several factors were significantly associated with acquisition of scrub typhus, including sitting/laying directly on household floor [adjusted OR (aOR) = 4.9, 95% CI: 1.6–15.1, P = 0.006], household with poor sanitation/conditions (aOR = 7.9, 95% CI: 1.9–32.9, P = 0.005), workplace environment with risk (aOR = 3.0, 95% CI: 1.2–7.6, P = 0.020), always observing mice around home (aOR = 3.7, 95% CI: 1.4–9.9, P = 0.008), and use of personal protective equipment in the field (aOR = 0.4, 95% CI: 0.1–1.1, P = 0.076). Conclusions Ecological and household hygiene-related factors were more associated with scrub typhus infection, than individual-level exposure activities in the hyper-endemic area. These findings support local education and allow people to protect themselves from scrub typhus, especially in areas with limitations in diagnostic capacity. Graphical abstract

scholarly journals Risk Factors for Violent Injuries and Their Severity Among Men in The Gambia

2018 ◽  
Vol 12 (6) ◽  
pp. 2116-2127
Author(s):  
Paul Bass ◽  
Edrisa Sanyang ◽  
Mau-Roung Lin
Keyword(s):  
Risk Factors ◽  
Physical Violence ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
The Gambia ◽  
Emergency Rooms ◽  
Severe Injuries ◽  
Physically Abused ◽  
The Past ◽  
Outpatient Departments

A matched case-control study was conducted to identify risk factors for injury from physical violence and its severity in Gambian men. Study participants were recruited from eight emergency rooms and outpatient departments in two health administrative regions. Cases were male patients aged ⩾15 years who had been violently injured. A control patient for each case, matched for the hospital or health center, date of injury, gender, and age, was selected from those injured due to nonviolence causes. In total, 447 case-control pairs were recruited. Results of the conditional logistic regression analysis showed that case patients who worked as businessmen (odds ratio [OR], 1.93; 95% confidence interval [CI] [1.16, 3.20]), had monthly household income of ⩾US$311 (OR, 2.12; 95% CI [1.06, 4.24]), had two or more male siblings (OR, 2.20; 95% CI [1.15, 4.21]), had consumed alcohol in the past week (OR, 3.32; 95% CI [1.25, 8.84]), and had been physically abused (OR, 5.10; 95% CI [2.71, 9.62]) or verbally abused (OR, 1.63; 95% CI [1.04, 2.56]) in the past 12 months were significantly associated with the occurrence of injury from physical violence. Severe injuries during the violence were significantly associated with events that took place in public spaces, with certain injury mechanisms (being stabbed/cut/pierced, struck by an object, assaulted by fist punching/leg kicking/head-butting, and scalded/stoned), having injuries to the upper extremities, and smoked cigarettes in the past week. Specific public health programs aimed at preventing physical violence and severe injuries against men should be developed in The Gambia based on modifications of the identified risk factors.

A Case-Control Study of the Association of the Polymorphisms of MTHFR and APOE with Risk Factors and the Severity of Coronary Artery Disease

Cardiology ◽  
2019 ◽  
Vol 142 (3) ◽  
pp. 149-157 ◽  
Author(s):  
Yan Long ◽  
Xiao-Tao Zhao ◽  
Chang Liu ◽  
Yuan-Yuan Sun ◽  
Yin-Ting Ma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Sanger Sequencing ◽  
Case Control Study ◽  
Case Control ◽  
Chinese Han ◽  
Han Population ◽  
Control Study

Objectives: To explore the association between single-nucleotide polymorphisms (SNPs) in MTHFR and APOE and the risk of CAD and, more importantly, the severity of CAD and the profile of serum lipids, we performed a case-control study in a Chinese Han population. Methods: A total of 1,207 cases of consecutive CAD-suspected inpatients were recruited, and 406 CAD cases and 231 non-CAD controls were enrolled for the final analysis after screening for exclusion criteria. All subjects had undergone coronary angiography, and the severity of CAD was evaluated by 2 cardiologists according to the Gensini scores. The genotypes of MTHFR and APOEwere detected using real-time PCR, and then verified by Sanger sequencing. Environmental risk factors, such as age, sex, smoking, alcohol consumption, hypertension, diabetes, dyslipidemia, and BMI were collected. Statistical analyses (the χ2 test, binary logistic regression analysis, and ordinal polytomous logistic regression analysis) were performed with SPSS v16.0. Results: The genotypes ofall the subjects included in the CAD and non-CAD groups in this study were successfully detected, with an agreement of 100% with Sanger sequencing. The distributions of genotypes CT and TT at MTHFR C667T were higher in CAD cases than in non-CAD controls (OR 1.99, 95% CI 1.34–2.95; OR 1.77, 95% CI 1.18–2.67; p < 0.05), whereas genotype AC at MTHFR A1298Cwas lower in CAD cases (OR 0.71, 95% CI 0.50–1.02; p < 0.05). A significant association was observed in genotypes CT and TT at MTHFR C667T and the risk of CAD (OR 1.44, 95% CI 1.27–3.67; OR 1.56, 95% CI 0.88–2.78; p < 0.05). Both genotypes and alleles of APOE were comparable in the CAD cases and non-CAD controls (p > 0.05). The genotype TT at MTHFR C667T and ε4+ at APOE were more likely to be found in the CAD subgroup with a Gensini score ≥72 (p = 0.040 and p = 0.028, respectively). Meanwhile, in the patients with genotype TT,a higher level of serum Hcy was detected, while genotype ε4+ patients possessed higher levels of serum apolipoprotein E (ApoE) and low-density lipoprotein cholesterol (LDL-C) than other genotypes. Conclusion: This study revealed that the SNP site of MTHFR C667Tis associatedwith the risk of CAD in this Chinese Han population. In addition, the genotypes of TT in MTHFR C667T and ε4+in APOE may increase the severity of CAD, and higher Hcy, LDL-C, and ApoE levels may be involved in this pathogenic process.

scholarly journals Investigating the Synergistic Interaction of Diabetes, Tobacco Smoking, Alcohol Consumption, and Hypercholesterolemia on the Risk of Pancreatic Cancer: A Case-Control Study in Italy

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Giuseppe La Torre ◽  
Antonella Sferrazza ◽  
Maria Rosaria Gualano ◽  
Chiara de Waure ◽  
Gennaro Clemente ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Cancer ◽  
Alcohol Consumption ◽  
Case Control Study ◽  
Smoking Status ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Synergistic Interaction ◽  
Independent Risk Factors ◽  
Control Study

The aims of the present research are to investigate the possible predictors of pancreatic cancer, in particular smoking status, alcohol consumption, hypercholesterolemia, and diabetes mellitus, in patients with histologically confirmed pancreatic carcinoma and to examine the synergism between risk factors. A case-control study (80 patients and 392 controls) was conducted at the Teaching Hospital “Agostino Gemelli” in Rome. A conditional logistic regression was used for the statistical analysis and results were presented as odds ratio (OR) and 95% confidence intervals (95% CI). We also investigated the possible interactions between risk factors and calculated the synergism index (SI). The multivariate analysis revealed that hypercholesterolemia and alcohol consumption resulted in important risk factors for pancreatic cancer even after the adjustment for all variables (OR: 5.05, 95% CI: 2.94–8.66; OR: 2.25, 95% CI: 1.30–3.89, resp.). Interestingly, important synergistic interactions between risk factors were found, especially between ever smoking status and alcohol consumptions (SI = 17.61) as well as alcohol consumption and diabetes (SI = 17.77). In conclusion, the study confirms that hypercholesterolemia and alcohol consumption represent significant and independent risk factors for pancreatic cancer. Moreover, there is evidence of synergistic interaction between diabetes and lifestyle factors (drinking alcohol and eating fatty foods).

scholarly journals An outbreak of haemorrhagic fever with renal syndrome linked with mountain recreational activities in Zagreb, Croatia, 2017

2018 ◽  
Vol 146 (10) ◽  
pp. 1236-1239
Author(s):  
Z. Lovrić ◽  
B. Kolarić ◽  
M. L. Kosanović Ličina ◽  
M. Tomljenović ◽  
O. Đaković Rode ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Conditional Logistic Regression ◽  
Hantavirus Infection ◽  
Haemorrhagic Fever ◽  
Recreational Activity ◽  
Odds Ratios ◽  
Recreational Activities

AbstractIn 2017 Zagreb faced the largest outbreak of haemorrhagic fever with renal syndrome (HFRS) to date. We investigated to describe the extent of the outbreak and identify risk factors for infection. We compared laboratory-confirmed cases of Hantavirus infection in Zagreb residents with the onset of illness after 1 January 2017, with individually matched controls from the same household or neighbourhood. We calculated adjusted matched odds ratios (amOR) using conditional logistic regression. During 2017, 104 cases were reported: 11–81 years old (median 37) and 71% (73) male. Compared with 104 controls, cases were more likely to report visiting Mount Medvednica (amOR 60, 95% CI 6–597), visiting a forest (amOR 46, 95% CI 4.7–450) and observing rodents (amOR 20, 95% CI 2.6–159). Seventy per cent of cases (73/104) had visited Mount Medvednica prior to infection. Among participants who had visited Mount Medvednica, cases were more likely to have drunk water from a spring (amOR 22, 95% CI 1.9–265), observed rodents (amOR 17, 95% CI 2–144), picked flowers (amOR 15, 95% CI 1.2–182) or cycled (amOR 14, 95% CI 1.6–135). Our study indicated that recreational activity around Mount Medvednica was associated with HFRS. We recommend enhanced surveillance of the recreational areas during an outbreak.

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