The aim of the present study was to identify risk factors for community-acquired pneumonia (CAP), with special emphasis on modifiable risk factors and those applicable to the general population.A population-based, case-control study was conducted, with a target population of 859,033 inhabitants aged .14 yrs. A total of 1,336 patients with confirmed CAP were matched to control subjects by age, sex and primary centre over 1 yr.In the univariate analysis, outstanding risk factors were passive smoking in never-smokers aged .65 yrs, heavy alcohol intake, contact with pets, households with .10 people, contact with children, interventions on the upper airways and poor dental health. Risky treatments included amiodarone, N-acetylcysteine and oral steroids. Influenza and pneumococcal vaccine, and visiting the dentist were protective factors. Multivariable analysis confirmed cigarette smoking, usual contact with children, sudden changes of temperature at work, inhalation therapy (particularly containing steroids and using plastic pear-spacers), oxygen therapy, asthma and chronic bronchitis as independent risk factors.Interventions for reducing community-acquired pneumonia should integrate health habits and lifestyle factors related to household, work and community, together with individual clinical conditions, comorbidities and oral or inhaled regular treatments. Prevention would include vaccination, dental hygiene and avoidance of upper respiratory colonisation.

a study was performed in a mixed residential-industrial urban population of the "Maresme" region in Barcelona, Spain. All subjects $14 yrs of age (annual average population size 74,368 inhabitants) with clinically suspected community-acquired pneumonia were registered. All cases were re-evaluated by chest radiographs on the 5th day of illness and at monthly intervals until complete recovery. Urine and blood samples were obtained for culture and antigen detection. When lower respiratory tract secretions were obtained, these were also cultured.There were 241 patients with community-acquired pneumonia, with an annual incidence rate of 1.62 cases (95% confidence interval, 1.42±1.82) per 1,000 inhabitants. Incidence rates increased by age groups and were higher in males than in females. Of 232 patients with aetiological data, 104 had an identifiable aetiology. A total of 114 pathogens were found (single pathogen 94, two pathogens 10). There were 81 episodes of bacterial infection and 33 of viral infection. The most common pathogens were Streptococcus pneumoniae, Chlamydia pneumoniae, and influenza A and B viruses. No case of Hantavirus infection was found. The rate of hospital admission was 61.4% with a mean SD length of 11.7 10.1 days, a mean period of 23.0 14.3 days inactivity, and an overall mortality rate of 5%.The high rate of hospital admission, prolonged stay in hospital, and long period of inactivity all continue to constitute a social and health care burden of communityacquired pneumonia. Eur Respir J 2000; 15: 757±763.

Risk factors for community-acquired pneumonia in adults: a population-based case± control study. J. Almirall, I. BolõÂ bar, X. Balanzo Â, C.A. Gonza Âlez. #ERS Journals Ltd 1999. ABSTRACT: Although community-acquired pneumonia (CAP) remains a major cause of hospitalization and death, few studies on risk factors have been performed. A population-based case±control study of risk factors for CAP was carried out in a mixed residential±industrial urban area of 74,610 adult inhabitants in the Maresme (Barcelona, Spain) between 1993 and 1995.All patients living in the area and clinically suspected of having CAP at primary care facilities and hospitals were registered. In total, 205 patients with symptoms, signs and radiographic infiltrate compatible with acute CAP participated in the study. They were matched by municipality, sex and age with 475 controls randomly selected from the municipal census. Risk factors relating the subject's characteristics and habits, housing conditions, medical history and treatments were investigated by means of a questionnaire.In the univariate analysis, an increased risk of CAP was associated with low body mass index, smoking, respiratory infection, previous pneumonia, chronic lung disease, lung tuberculosis, asthma, treated diabetes, chronic liver disease, and treatments with aminophiline, aerosols and plastic pear-spacers. In multivariate models, the only statistically significant risk factors were current smoking of >20 cigarettes . day -1 (odds ratio (OR)=2.77; 95% confidence interval (CI) 1.14±6.70 compared with never-smokers), previous respiratory infection (OR=2.73; 95% CI 1.75±4.26), and chronic bronchitis (OR=2.22; 95% CI 1.13±4.37). Benzodiazepines were found to be protective in univariate and multivariate analysis (OR=0.46; 95% CI 0.23±0.94).This population-based study provides new and better established evidence on the factors associated with the occurrence of pneumonia in the adult community. Eur Respir J 1999; 13: 349±355. Although community-acquired pneumonia (CAP) remains a major cause of hospitalization and a common cause of death in developed countries, few population-based studies on its incidence and risk factors have been published. In the USA the incidence of CAP has been estimated as 15 episodes for every 1,000 persons per year [1]. Approximately 15% of pneumonia cases require hospitalization and the mortality rate reaches 24.1 per 100,000 inhabitants, in fifth place after cardiovascular, neoplastic, cerebrovascular and chronic bronchitic (CB) diseases [2,3]. The incidence of CAP is lower in Europe: 5 per 1,000 in people aged 15±79 yrs in England [4], 9 per 1,000 inhabitants >14 yrs in Finland [5] and 2.6 per 1,000 persons >13 yrs in Spain [6]. Hospitalization rates in these studies were 42, 13 and 50%, respectively. The incidence of CAP [5,7] and the length of hospital stay [8] are higher in the elderly than in young adults; hence, the current demographic ageing will lead to worsening of the problem.Respiratory host defences, through mechanical, humoral and cellula...

PRP may improve the healing of foot ulcers associated with diabetes, but this conclusion is based on low quality evidence from two small RCTs. It is unclear whether PRP influences the healing of other chronic wounds. The overall quality of evidence of autologous PRP for treating chronic wounds is low. There are very few RCTs evaluating PRP, they are underpowered to detect treatment effects, if they exist, and are generally at high or unclear risk of bias. Well designed and adequately powered clinical trials are needed.

We performed a systematic review of the literature to establish conclusive evidence of risk factors for community-acquired pneumonia (CAP). Observational studies (cross-sectional, case-control, and cohort studies) the primary outcome of which was to assess risk factors for CAP in both hospitalized and ambulatory adult patients with radiologically confirmed pneumonia were selected. The Newcastle-Ottawa Scale specific for cohort and case-control designs was used for quality assessment. Twenty-nine studies (20 case-control, 8 cohort, and 1 cross-sectional) were selected, with 44.8% of them focused on elderly subjects ≥65 years of age and 34.5% on mixed populations (participants' age >14 years). The median quality score was 7.44 (range 5-9). Age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease, asthma, functional impairment, poor dental health, immunosuppressive therapy, oral steroids, and treatment with gastric acid-suppressive drugs were definitive risk factors for CAP. Some of these factors are modifiable. Regarding other factors (e.g., gender, overweight, alcohol use, recent respiratory tract infections, pneumococcal and influenza vaccination, inhalation therapy, swallowing disorders, renal and liver dysfunction, diabetes, and cancer) no definitive conclusion could be established. Prompt assessment and correction of modifiable risk factors could reduce morbidity and mortality among adult CAP patients, particularly among the elderly.