Permanent pacemaker and implantable cardioverter defibrillator infection: a population-based study.

BACKGROUND: The incidence of cardiac device infection is not well understood. Bloodstream infection (BSI) in patients with permanent pacemakers or implantable cardioverter-defibrillators (hereafter, defibrillators) may reflect device infection. METHODS: Retrospective, population-based cohort study of all adult patients with cardiac devices who resided in Olmsted County, Minnesota, from 1975 to 2004. The medical linkage-system of the Rochester Epidemiology Project and standardized criteria were used to identify all cases of BSI and device infection. The incidence of device infection was calculated with person-years of follow-up after device implantation. RESULTS: A total of 1524 patients with cardiac devices were included in the cohort. Total person-time of follow-up was 7578 years. The incidence of definite device infection was 1.9 per 1000 device-years (95% confidence interval [CI], 1.1-3.1). The incidence of pocket infection without BSI was 1.37 per 1000 device-years (95% CI, 0.62-3.05), and pocket infection with BSI or device-related endocarditis 1.14 per 1000 device years (95% CI, 0.47-2.74). The cumulative probability of device infection was higher among patients with defibrillators compared with those with pacemakers, P<.001. Twelve (54.6%) of 22 cases of Staphylococcus aureus BSI had definite or possible cardiac device infection vs 3 (12.0%) of 25 cases of bloodstream infection due to gram-negative bacilli (P = .004). CONCLUSIONS: To our knowledge, this is the first population-based study to describe the incidence of cardiac device infection. Device infection was common during episodes of S aureus BSI. The rate of cardiac device infection was higher in patients with defibrillators than in those with pacemakers.

Risk factor analysis of permanent pacemaker infection.

Background. Several host- and procedure-related factors have been reported to increase the risk of permanent pacemaker (PPM) infection on the basis of descriptive analyses of case series. The purpose of this study is to assess the risk factors for PPM infection using case-control study methods.Methods. All patients who had a PPM implanted at our institution from January 1991 to December 2003 were retrospectively reviewed. Each patient who experienced a PPM infection was matched with 2 control subjects by age, sex, year of implantation, and duration of follow-up. Univariate and multivariable analyses were performed to identify significant risk factors for PPM infection.Results. Twenty-nine case patients and 58 control subjects met inclusion criteria. The majority (83%) of case patients presented with a pocket infection; a minority (10%) had PPM-related endocarditis. Staphylococcus species (69%) were the most common pathogens. On univariate analysis, previous PPM infection, malignancy, long-term corticosteroid use, multiple device revisions, a permanent central venous catheter, the presence of >2 pacing leads, and a lack of antibiotic prophylaxis at the time of PPM placement were associated with an increased risk of PPM infection. A multivariable logistic regression model identified long-term corticosteroid use (odds ratio [OR], 13.90; 95% confidence interval [CI], 1.27-151.7; P=.03) and the presence of >2 pacing leads versus 2 leads (OR, 5.41; 95% CI, 1.44-20.29; P=.01) as independent risk factors for PPM infection. In contrast, use of antibiotic prophylaxis prior to PPM implantation had a protective effect (OR, 0.087; 95% CI, 0.016-0.48; P=.005).Conclusions. These findings should assist clinicians in identifying patients who are at increased risk of PPM infection, as well as in developing strategies to minimize the modifiable risks.

Assessing attitudes toward laxative preparation in colorectal cancer screening and effects on future testing: potential receptivity to computed tomographic colonography.

OBJECTIVE: To investigate whether removal of the laxative preparation would improve colorectal cancer (CRC) screening rates. RESPONDENTS AND METHODS: Data are from a mixed-mode mail and telephone survey of 1636 noninstitutionalized Minnesota residents who were 18 years or older that was conducted from July 15 through October 25, 2005. The overall response rate was 49%. Analysis focused on the 759 respondents who were 50 years or older. RESULTS: One third (32%) of the respondents identified the laxative preparation as the most troublesome part of CRC screening. Overall, the self-reported likelihood and anticipated timing of examination increase when the laxative preparation is removed. Both univariate and multivariate analysis showed that the odds of being "much more likely" to undergo screening in the future with a test that does not include a laxative preparation are greatest among those who have been tested previously, regard the laxative preparation as a big problem, or both. CONCLUSION: In this prospective survey, laxative preparation appeared to be a major disincentive to CRC screening. Emerging data suggest that performance of laxative-free computed tomographic colonography may represent an attractive option that removes this relatively common disincentive to CRC screening participation.

Selected questionnaire size and color combinations were significantly related to mailed survey response rates.

OBJECTIVE: To determine the degree to which mailed survey response rates, response times, and nonresponse bias are affected by questionnaire size and color. STUDY DESIGN AND SETTING: Questionnaires were mailed to a random sample of 2,000 Mayo Clinic patients in one of four size/color "test" groups. One thousand three hundred nine surveys were completed, approximately two-thirds in each group. RESULTS: A small (6 (1/8) x 8 (1/4) in) questionnaire booklet on white paper had a higher response rate (68.4%) than a similarly sized questionnaire on blue paper (62.3%). A large (8 (1/4) x 11 in) questionnaire on white paper had a 62.7% rate, whereas a large, blue questionnaire had a response rate of 68.6%. Median response times did not differ by questionnaire size/color. No evidence of differential nonresponse bias was observed across the four test groups. CONCLUSION: This study supports the use of a small/white questionnaire format advocated by the Total Design Method advanced by Don Dillman at Washington State University. We observed a favorable response rate for a large questionnaire printed on blue paper; however, if time and resources are limited, use of a small/white questionnaire appears preferable.

Development and feasibility of a parental support intervention for adolescent smokers.

The aim of this investigation was to develop and evaluate the feasibility and acceptability of a parental support intervention. A new measure of perceived parental support for stopping smoking was also developed. The sample included 59 adolescent-parent pairs recruited from a mid-sized Midwestern town during 2000-2003. The mean +/- SD age of the participants (32 males, 27 females) was 16.3 +/- 0.9 (range 14-18) years and 86% were Caucasian, 7% American Indian, 5% African American, and 2% Hispanic. Participants were randomized to parental support or minimum behavioral intervention. Severity of nicotine dependence was evaluated using the Fagerström Tolerance Questionnaire, and perceived social support was evaluated using the Family Environment Scale and the new measure of perceived parent support for stopping smoking that was developed as part of this investigation. Treatment attendance, adherence, and acceptability were also evaluated. The parental support intervention was feasible but not superior to the minimum behavioral intervention with respect to attendance, retention, or change in support. This study expands on the knowledge of treating adolescent smokers and presents a new assessment measure. The study's limitations are noted. This investigation was funded by NICHHD.

The relationship of body image dissatisfaction to cigarette smoking in college students.

This study examined the association of cigarette smoking status and body image dissatisfaction as measured by the Multidimensional Body-Self Relations Questionnaire (MBSRQ), in 1575 young adult college students, 18-24 years of age. Respondents were current cigarette smokers (N = 482) or never tobacco users (N = 1093). Smoking status was found to be significantly associated with 5 of the 10 MBSRQ subscales, with current smokers having lower scores on Fitness Orientation, Health Evaluation and Health Orientation (all p < 0.001) and higher scores on Appearance Orientation (p = 0.01) and Overweight Preoccupation (p = 0.03) compared with never tobacco users. Furthermore, among current smokers, a higher number of days smoked in the last 30 days were associated with lower scores on all MBSRQ subscales, except Self-Classified Weight. In terms of clinical implications, interventions for smoking cessation among college students might benefit from inclusion of components for addressing body image dissatisfaction and improving health beliefs.