Deep neck space infections in end-stage renal disease patients: Prevalence and mortality.

Deep neck space infections (DNSI) are severe infections within the layers of neck fascia that are known to be associated with underlying immunocompromised states. Although uremia associated with kidney disease is known to cause immune system dysfunction, DNSI in patients with kidney disease has been poorly studied. This study investigated the prevalence of DNSI and the associated risk of mortality within the United States end-stage renal disease (ESRD) population, using a retrospective cohort study design and the United States Renal Data System database of patients (ages 18-100) who initiated dialysis therapy between 2005 and 2019. International Classification of Disease-9 and -10 codes were used to identify the diagnosis of DNSI and comorbid conditions. Of the 705,891 included patients, 2.2% had a diagnosis of DNSI. Variables associated with increased risk of DNSI were female sex, black compared to white race, catheter, or graft compared to arteriovenous fistula (AVF) access, autoimmune disease, chronic tonsillitis, diagnoses in the Charlson Comorbidity Index (CCI), tobacco use, and alcohol dependence. DNSI diagnosis was an independent risk factor for mortality, which was also associated with other comorbidity factors such as older age, catheter or graft compared to AVF access, comorbidities in the CCI, tobacco use, and alcohol dependence. Because of the increased mortality risk of DSNI in the ESRD population, health professionals should encourage good oral hygiene practices and smoking cessation, and they should closely monitor these patients to reduce poor outcomes.

Risk factors and mortality in patients with listeriosis and end-stage renal disease.

BACKGROUND: End-stage renal disease (ESRD) is a known immunocompromising status that predisposes patients to developing infections. Disease from Listeria monocytogenes may affect any host but tends to be more severe in the immunocompromised. METHODS: We used a large population of patients with ESRD to identify risk factors for listeriosis and mortality. Patients with a diagnosis of Listeria and other risk factors for listeriosis were identified using claims data from the United States Renal Data System database from 2004-2015. Demographic parameters and risk factors associated with Listeria were modeled using logistic regression while association with mortality was assessed with Cox Proportional Hazards modeling. RESULTS: A diagnosis of Listeria was identified in 291 (0.01%) of a total 1,071,712 patients with ESRD. Cardiovascular disease, connective tissue disease, upper gastrointestinal ulcerative disease, liver disease, diabetes, cancer, and human immunodeficiency virus were all associated with an increased risk of Listeria. Patients with Listeria had an increased risk of death relative to patients without Listeria (adjusted hazard ratio=1.79; 95% confidence interval 1.52-2.10). CONCLUSIONS: Incidence of listeriosis in our study population was over 7 times higher than what has been reported for the general population. The independent association of a Listeria diagnosis with increased mortality is also consistent with the disease's high mortality in the general population. Due to limitations with diagnosis, providers should maintain high clinical suspicion for listeriosis when patients with ESRD present with a compatible clinical syndrome. Further prospective study may help precisely quantify the increased risk of listeriosis in patients with ESRD.

A content analysis of Camel Snus advertisements in print media.

INTRODUCTION: Researchers have questioned whether the R.J. Reynolds Tobacco Company is marketing Camel Snus as a product for nontobacco users, smokeless-tobacco users, or cigarette smokers. The objective of this study was to examine advertisements of Camel Snus in print media to determine the most likely audience of intent. METHODS: A content analysis was conducted among Camel Snus advertisements printed in newspaper and consumer magazines between July 2007 and August 2010. The advertisements (n = 83 distinct; N = 458 total) were identified from a comprehensive search of a proprietary database maintained by TNS Media Intelligence. RESULTS: Results indicated that all advertisements, published between July 2007 and September 2009, were intended to promote a tobacco product for cigarette smokers. A shift in marketing strategy occurred from October 2009 to the present time with publication of the "Break Free" magazine advertisements, characterized by an ambiguous message that could conceivably appeal to any group, including nontobacco users (e.g., adolescents), smokeless-tobacco users, and/or cigarette smokers. However, an examination of the consumer magazines advertising Camel Snus indicated a demographically diverse readership in terms of gender, age, and education, suggesting that the advertisements are less likely to be intended for smokeless-tobacco users. CONCLUSIONS: These findings validate other reports and editorials, suggesting that Camel Snus was being marketed as a product for smokers at the time of the product's national debut. The recent shift to the "Break Free" marketing campaign may reflect an attempt to enhance the image of the Camel brand in order to attract a broader spectrum of consumers.