Psychological stress,smoking, and hazardous drinking behaviors in South Korea: findings from the Korea National Health and Nutrition Examination Survey

ABSTRACT

Introduction: There is growing attention to mental health as a contributor to behavioral health in South Korea. We investigated the prevalence of psychological stress and its associations with cigarette smoking and drinking behaviors among a nationally representative sample of South Korean adults.

Methods: Using data from 14,855 adults aged ≥19 years who participated in the 2013–2016 Korea National Health and Nutrition Examination Survey (KNHANES), we performed weighted logistic regression to examine the associations between stress and three binary outcome variables: cigarette smoking, heavy episodic drinking, and frequent drinking.

Results: 27.2% of the participants reported high stress. Controlling for sociodemographic covariates, high stress was associated with 1.54 times the odds (p < .001) of being a smoker, 1.25 times the odds (p < .001) of being a heavy episodic drinker, and 1.23 times the odds (p < .001) of being a frequent drinker. There was evidence of effect modification by gender and occupation, such that the effects of stress on these behaviors were particularly stronger among women and pink-collar (service industry) workers (compared to men and white-collar workers).

Conclusions: Future policies that aim to address smoking and drinking behaviors in South Korea should consider stress reduction and coping strategies, especially among women and pink-collar workers.     

High prevalence of the risk factors for QT interval prolongation and associated drug–drug interactions in coronary care units

Objectives: Patients admitted in coronary care units are susceptible to QT interval prolongation due to numerous risk factors. The purpose of this study was to identify the prevalence of risk factors for QT interval prolongation; QT prolonging medications; drug–drug interactions; their predictors; and torsades de pointes risks of drugs.

Methods: After obtaining approval, this cross-sectional study was carried out during one-year period in coronary care units of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. The Arizona Center for Education and Research on Therapeutics QT drugs lists and Micromedex DrugReax® were used to identify the QT prolonging medications and QT prolonging drug–drug interactions.

Results: Total 649 patients were included in this study. The most frequent QT prolonging risk factors included use of ≥ 1 QT prolonging drugs (74.9%) and myocardial infarction (61.3%). Total 181 patients were presented with 361 QT prolonging drug–drug interactions. There was significant association of the occurrence of QT prolonging drug–drug interactions with female gender (p = 0.01), 9–10 prescribed medications (p = 0.001), and > 10 prescribed medications (p < 0.001).

Conclusions: The majority of patients presented with multiple risk factors for QT prolongation in coronary care units which may precipitate lethal outcomes.     

Video assisted patient education improves compliance with follow up and depression scores in Inflammatory Bowel Diseases

Objectives: Patients with inflammatory bowel diseases (IBD) have to deal with a poor quality of life (QOL) and psychomorbidity resulting from an incurable illness. We aimed to study the effect of patient education on QOL, compliance, anxiety and depression in IBD.

Methods: Patients were prospectively enrolled over two years beginning July 2014 and divided into an interventional and usual care group. Both received the standard of care, but the former in addition received an 8 min session of video-assisted education. Compliance to drugs was defined as drug intake of > 80% of the prescribed dose, and adherence to scheduled follow up visits were also compared. Self-administered questionnaires namely Short IBD questionnaire (SIBDQ), Beck Anxiety and Depression Inventory (BAI, BDI-II), Hospital Anxiety and Depression Scale (HADS) were used to assess QOL, anxiety and depression respectively at baseline, 6 months and 1 year.

Results: Of the 91 patients enrolled, 84 [92.3%; male = 66 (78.57%)] completed the follow up. Significantly more patients were compliant to follow up visits in the intervention and usual care groups respectively at 6 months (88.4% versus 65.8% respectively; p < 0.01) and 1 year (72.1% versus 46.3% respectively; p < 0.01). The median (IQR) scores for HADS-Depression over 1 year were significantly better in the interventional group than usual care (p < 0.049). The differences in SIBDQ, BDI-II, BAI, HADS-Anxiety and compliance to drug therapy between the groups did not reach statistical significance.

Conclusion: Video assisted patient education improved compliance to follow up visits and depression scores in IBD. Further modifications in the educational video content and delivery might improve compliance to drug therapy, QOL and anxiety scores.     

Efficacy-based Contraceptive Counseling for Women Experiencing Homelessness in Iowa City,Iowa

ABSTRACT

This study evaluated homeless women’s contraception knowledge and demonstrated improved knowledge following efficacy-based contraceptive counseling. Women were surveyed using a pre-test then post-test following standardized efficacy-based contraceptive counseling. 47 women participated. 13/19 (68.4%) of reproductive-aged women were not using contraception. After education there was significant increase in good-excellent self-rated knowledge (35, 75.5% vs 44, 93.6%; p < .001) and correct identification of most effective contraception OR 5.90 (95% CI = 2.31–15.02; p < .001). In conclusion, homeless women overestimated their understanding of contraception. Following education, there was significantly increased understanding of efficacy. While most did not desire pregnancy, few were using effective contraception and may benefit from education.

Abbreviations: SH: Shelter House; LARC: Long-Acting Reversible Contraception; IUD: Intra-Uterine Device; ACOG: American College of Obstetricians and Gynecologists     

Factors Associated with Transition Planning in Autism and Other Developmental Disabilities

Objective

To determine whether functional self-care skills and presence of behavior problems in youth with developmental disabilities are associated with parents planning for the youth’s transition to adulthood.

Methods

This multi-site study consisted of 167 parents of youth aged 10–22 years with autism spectrum disorder, ADHD and/or other developmental disabilities who completed a questionnaire on transition to adulthood. Parent-rated child self-care status was measured using a six-item scale that had excellent reliability (Cronbach’s alpha=0.90).

Results

Multivariable logistic regression models revealed that parents were less likely to plan for the youth’s transition to adulthood if their child needed more assistance with functional self-care skills (OR 0.78, 95% CI 0.63–0.96, p=.021). Despite this unexpected finding, greater child need for assistance with self-care was associated with lower parental expectations that their children would live independently by age 22 (OR 0.40, 95%CI 0.24–0.66, p<.001) and 35 (OR 0.47, 95%CI 0.35–0.63, p<.001). The presence of behavioral problems (aggression, sexual behaviors and safety issues) was also associated with lower odds of parental expectations that their child would live independently in adulthood.

Conclusions

Despite this unexpected finding, greater child need for assistance with self-care was associated with lower parental expectations that their children would live independently by age 22 (OR 0.40, 95%CI 0.24–0.66, p<.001) and 35 (OR 0.47, 95%CI 0.35–0.63, p<.001). The presence of behavioral problems (aggression, sexual behaviors and safety issues) was also associated with lower odds of parental expectations that their child would live independently in adulthood. Despite parents’ awareness of the difficulties their children will face, less youth independence with self-care skills was associated with lower odds of plans for transition to adulthood and expectations for independent living. Results support the need for continued interventions targeted at improving daily living skills to achieve functional independence in adulthood, as well as interventions focused on aggression, safety and sexuality of the individuals.

     

3D augmented reality mirror visual feedback therapy applied to the treatment of persistent,unilateral upper extremity neuropathic pain: a preliminary study

Objective: We assessed whether or not pain relief could be achieved with a new system that combines 3D augmented reality system (3DARS) and the principles of mirror visual feedback.

Methods: Twenty-two patients between 18 and 75 years of age who suffered of chronic neuropathic pain. Each patient performed five 3DARS sessions treatment of 20 mins spread over a period of one week. The following pain parameters were assessed: (1) visual analogic scale after each treatment session (2) McGill pain scale and DN4 questionnaire were completed before the first session and 24 h after the last session.

Results: The mean improvement of VAS per session was 29% (p < 0.001). There was an immediate session effect demonstrating a systematic improvement in pain between the beginning and the end of each session. We noted that this pain reduction was partially preserved until the next session. If we compare the pain level at baseline and 24 h after the last session, there was a significant decrease (p < 0.001) of pain of 37%. There was a significant decrease (p < 0.001) on the McGill Pain Questionnaire and DN4 questionnaire (p < 0.01).

Conclusion: Our results indicate that 3DARS induced a significant pain decrease for patients who presented chronic neuropathic pain in a unilateral upper extremity. While further research is necessary before definitive conclusions can be drawn, clinicians could implement the approach as a preparatory adjunct for providing temporary pain relief aimed at enhancing chronic pain patients’ tolerance of manual therapy and exercise intervention.

Level of Evidence: 4.     

Thriving through relationships: assistance dogs’ and companion dogs’ perceived ability to contribute to thriving in individuals with and without a disability

Abstract

Purpose: Companion dogs can provide psychosocial benefits for their owners. Assistance dogs reportedly provide similar benefits, while also performing specific tasks. These psychosocial benefits may increase their handler’s quality of life and ability to thrive – defined as having the ability to grow and flourish, especially in the face of adversity. Currently, no studies compare assistance dogs’ effectiveness to companion dogs’ in assisting their handler/owner to thrive, an important comparison given that companion dogs are typically less expensive to acquire, and more readily available.

Methods: The Thriving Through Relationships (TTR) theory was used to inform the development of a human-dog relationship survey, which was distributed through assistance dog organizations and to the general public.

Results: Participants were divided into three groups: persons with a disability who had an assistance dog (n?=?165), persons with a disability who had a companion dog (n?=?249) and persons with no disability who had a companion dog (n?=?198). Perceived overall support was statistically different between the three groups, F (2, 394)?=?14.45, p?<?.001. Assistance dog handlers reported receiving significantly higher levels of support than companion dog owners with disabilities (p?<?.01) or without disabilities (p?<?.001). In fact, assistance dogs were reported to provide more support (p?<?.017) than companion dogs on nine out of ten separate indicators of thriving.

Conclusion: Overall, dogs are perceived to provide support that improves their handler/owner’s ability to thrive. Most importantly, however, assistance dogs may provide greater support than companion dogs for persons with a disability and, therefore, may be worth the additional time and financial cost.

• Implications for Rehabilitation

• Assistance dogs could assist rehabilitation by improving coping skills, especially during times of adversity, as demonstrated through the ten indicators of thriving.

• Assistance dogs and companion dogs are not inter-changeable when it comes to providing support for individuals with a disability.

     

Factors associated with HIV risk perception among people who inject drugs: Findings from a cross-sectional behavioral survey in Kermanshah,Iran

Background: In Iran there are limited data regarding HIV risk perceptions among people who inject drugs (PWID). The objective of this study was to explore HIV risk perception and to examine factors associated with the perception of HIV risk among PWID in Iran.

Methods: We surveyed 433 PWID in Kermanshah concerning demographic characteristics, sexual risk behaviors, HIV risk perception, and drug-related risk behaviors in the month prior to the study. Two classes of HIV risk perception (high vs. low) were identified. We used logistic regression to identify factors associated with high HIV risk perception.

Result: Of 433 PWID who participated in this study, 36% (95% confidence interval; CI95%: 25.3%, 42.2%) of participants reported high HIV risk perception. Methamphetamine use (adjusted odds ration; AOR = 3.7, p < 0.05), or use of multiple drugs at the same time (AOR = 1.7, p < 0.05) was associated with higher HIV risk perception. Moreover, PWID who were NSP users had 2.8 times the odds of high risk perception compared with non-Needle and Syringe Program (NSP) users (AOR = 2.8) .

Conclusion: This study implies that initiating drug use at a younger age, using methamphetamine, polydrug use, and needle- and syringe-exchange program utilization were predictors of higher HIV risk perception among PWID in Iran.     

Recognition of Stroke by EMS is Associated with Improvement in Emergency Department Quality Measures

Objective: Hospital arrival via Emergency Medical Services (EMS) and EMS prenotification are associated with faster evaluation and treatment of stroke. We sought to determine the impact of diagnostic accuracy by prehospital providers on emergency department quality measures. Methods: A retrospective study was performed of patients presenting via EMS between September 2009 and December 2012 with a discharge diagnosis of transient ischemic attack (TIA), ischemic stroke (IS), or intracerebral hemorrhage (ICH). Hospital and EMS databases were used to determine EMS impression, prehospital and in-hospital time intervals, EMS prenotification, NIH stroke scale (NIHSS), symptom duration, and thrombolysis rate. Results: 399 cases were identified: 14.5% TIA, 67.2% IS, and 18.3% ICH. EMS providers correctly recognized 57.6% of cases. Compared to cases missed by EMS, correctly recognized cases had longer median on-scene time (17 vs. 15 min, p = 0.01) but shorter transport times (12 vs. 15 min, p = 0.001). Cases correctly recognized by EMS were associated with shorter door-to-physician time (4 vs. 11 min, p < 0.001) and shorter door-to-CT time (23 vs. 48 min, p < 0.001). These findings were independent of age, NIHSS, symptom duration, and EMS prenotification. Patients with ischemic stroke correctly recognized by EMS were more likely to receive thrombolytic therapy, independent of age, NIHSS, symptom duration both with and without prenotification. Conclusion: Recognition of stroke by EMS providers was independently associated with faster door-to-physician time, faster door-to-CT time, and greater odds of receiving thrombolysis. Quality initiatives to improve EMS recognition of stroke have the potential to improve hospital-based quality of stroke care.     

Effects of Transcultural Nursing Education on the Professional Values,Empathic Skills,Cultural Sensitivity and Intelligence of Students

ABSTRACT

Purpose: To examine the effect of Transcultural Nursing education on nursing students’ Professional Values, Empathic Skills, Cultural Sensitivity and Intelligence.

Design: A posttest quasi-experimental study with a control group.

Methods: The participants were second year nursing students (n = 125). The experiment group was composed of students who had enrolled in the Transcultural Nursing course (n = 65). The control group consisted of students who did not enroll in this course (n = 60).

Findings: The posttest scores of the experiment group in the scales were significantly higher than those in the control group (p < .01).

Conclusion: Transcultural nursing course is an effective method to increase the professional values, empathic skills, cultural sensitivity and intelligence of students.     

The relative risk to the femoral nerve as a function of patient positioning: potential implications for trigger point dry needling of the iliacus muscle

ABSTRACT

Objectives: Prudent dry needling techniques are commonly practiced with the intent to avoid large neurovascular structures, thereby minimizing potential excessive bleeding and neural injury. Patient position is one factor thought to affect the size of the safe zone during dry needling of some muscles. This study aimed to compare the size of the needle safe zone of the iliacus muscle during two different patient positions using ultrasound imaging.

Methods: The distance from the anterior inferior iliac spine (AIIS) to the posterior pole of the femoral nerve was measured in 25 healthy participants (11 male, 14 female, mean age = 40) in both supine and sidelying positions using a Chison Eco1 musculoskeletal ultrasound unit. The average distance was calculated for each position and a two-tailed, paired t-test (α < 0.05) was used to examine the difference between positions.

Results: The mean distance from the AIIS to the posterior pole of the femoral nerve was statistically greater with participants in the sidelying position (mean[SD] = 35.7 [6.2] mm) than in the supine position (mean[SD] = 32.1 [7.3] mm, p < .001).

Discussion: Although more study is needed, these results suggest that patient positioning is one of several potential variables that should be considered in the optimization of patient safety/relative risk when performing trigger point dry needling.

Level of Evidence: Level 4 (Pre-Post Test)     

A Controlled Trial to Compare the Teaching Quality of Clinical-Skills Training Faculty: The Clinician-Educator Career Path in China

Background: Full-time clinician educators are becoming more predominant in China, yet their effect is unknown. Purposes: The purpose of this study was to compare the teaching quality of full-time (FT) faculty with that of part-time (PT) faculty in one Chinese medical school. Methods: In 3 consecutive years, 881 3rd year medical students were enrolled and randomly distributed into two groups, being taught by either a FT faculty member or a PT faculty member. Their teaching quality was evaluated with student performance on a written exam, the standardized patient exam, and student satisfaction. Results: The students in the FT group always scored better on the written exam (1st year = 79.82 ± 9.2 vs. 81.26 ± 8.2, p < .188; 2nd year = 73.10 ± 9.8 vs. 76.51 ± 7.9, p = .001; 3rd year = 75.15 ± 9.0 vs. 79.51 ± 8.7, p < .0001). In the standardized patient exam, the students from FT groups always showed better performance in history taking and physical examination. Students continually gave higher evaluations to FT faculty in questionnaires (1st year = 76.8 ± 6.5 vs. 84.3 ± 2.2; 2nd year = 78.6 ± 3.9 vs. 89.7 ± 4.2; 3rd year = 75.8 ± 3.9 vs. 88.5 ± 3.5, all ps < .001). Conclusions: The teaching quality of FT faculty in clinical-skills training is better than PT faculty in this study.     

Smoking is associated with a high prevalence of microalbuminuria in hypertensive high-risk patients: data from I-SEARCH

Background

Microalbuminuria (MAU) is a marker of endothelial dysfunction and a predictor of cardiovascular events. The effects of cigarette smoking on the prevalence of MAU in a high-risk population with arterial hypertension are unclear.

Methods

The International Survey Evaluating Microalbuminuria Routinely by Cardiologists in patients with Hypertension (I-SEARCH) documented the clinical profile of 20,364 patients with arterial hypertension and cardiovascular risk factors. In this population, 13,690 patients had no history of smoking, 4,057 patients were former smokers and 2,617 patients were current smokers.

Results

The prevalence of MAU was associated with the smoking status. Consumption of 1–20 cigarettes per day leads to an increase of 6.8% in the prevalence of MAU compared to non-smokers (P < 0.001). Smoking of >20 cigarettes per day was associated with a 12.5% higher prevalence of MAU compared to non-smokers, while former smokers had a 4.7% higher prevalence of MAU. Multivariable analysis revealed that smoking was independently associated with MAU [odds ratio (OR) smoking vs. non-smoking 1.16; 95% confidence interval (CI) 1.01–1.33; P < 0.05]. Particularly, a consumption of >20 cigarettes per day was associated with high odds for MAU (OR 1.33; CI 1.01–1.75; P < 0.05). Interestingly, independently of blood pressure, the use of an angiotensin receptor blocker and an ACE was associated with significantly reduced odds ratio for MAU in the smoking group, while there was no significant association in the non-smoking group.

Conclusion

The prevalence of MAU in hypertensive patients is higher in smokers than in non-smokers with a strong dose dependency.     

Influence of patient related factors on number of mesenchymal stromal cells reached after in vitro culture expansion for clinical treatment

Background: Number of stromal cells injected in patients with ischaemic heart disease (IHD) may be of importance for the treatment efficacy, which in turn may be influenced by various patient-related factors. In this study, we investigate whether patient-related factors influence the number of autologous stromal cells reached after in vitro culture expansion for clinical therapy.

Methods: Culture expansion data from 111 patients with IHD treated with autologous stromal cells in three clinical trials were used. We correlated the final cell count after two passages of cultivation with different patient factors.

Results: There was a significant relation between body mass index (BMI) and the number of adipose derived stromal cells (ASCs) reached after culture expansion and for all patients included into the three studies (r?=?0.375, p?=?.019 and r?=?0.200, p?=?.036, respectively). Moreover, there was a significantly higher number of ASCs reached in patients with hypertension compared to those without hypertension and for all patients overall (68.8?±?39.6?×?10⁶ vs. 39.1?±?23.6?×?10⁶, p?=?.020 and 62.0?±?55.0?×?10⁶ vs. 29.0?±?19.3?×?10⁶, p?<?.001, respectively). The same tendency was seen with bone marrow derived mesenchymal stromal cells (MSCs) in patients with hypertension compared to those without hypertension (58.4?±?61.8?×?10⁶ vs. 22.6?±?13.3?×?10⁶, p?<?.001) and in males compared to females (56.4?±?61.5?×?10⁶ vs. 30.9?±?27.9?×?10⁶, p?=?.041). Moreover, a significant negative correlation between left ventricular ejection fraction and number of MSCs was found (r?=??0.287, p?=?.017).

Conclusions: Patient related factors such as BMI, hypertension and gender may influence the number of MSCs reached after in vitro culture expansion.     

Impact of treatment modality on clinical outcome in metastatic colorectal cancer patients stratified by metastatic sites

Objectives: To investigate the impact of location of metastases, and therapeutic modality on clinical outcomes in patients with metastatic colorectal cancer (CRC).

Methods: Data for metastatic CRC patients were sourced from the Surveillance, Epidemiology, and End Results (SEER) database (SEER ID: 15309-Nov2017). Patients were classified as follows: Group 1 patients had only liver metastasis; Group 2 patients had liver and lung metastasis; Group 3 patients had more than two metastasis sites. Patients were treated with surgery alone, radiation alone, or surgery plus radiation. The main study outcomes were (1) cancer-specific mortality and (2) survival benefit associated with treatment modality.

Results: A total number of 15,510 patients were included in this study. In Groups 1 and 2, patients treated with surgery plus radiation had a higher cumulative survival compared to other treatment groups (p-value <.001). Group 3 patients showed no significant difference in cumulative survival between the different treatment modalities (p-value = .218). Group 1 patients who received surgery plus radiation had a significantly lower risk of mortality compared to the other treatment groups (p-value <.001), and Group 2 patients who either received radiation treatment alone or surgery plus radiation had a significantly lower risk for mortality than patients who received other treatment modalities (p-value <.001). Multivariate analysis adjusting for known prognostic factors such as tumor sidedness and race did not alter the observed risk conferred by metastasis sites and treatment modalities.

Conclusion: Stratification by metastases sites, and by treatment modality can help multidisciplinary teams to reach a treatment consensus for metastatic CRC.     

Effects of smoking and paroxetine on stress-induced craving and withdrawal symptoms

Background: When smokers relapse, many cite stressful circumstances as the cause. Most smoking cessation medications do not prevent stress-induced increases in craving and withdrawal symptom severity; however, the effect of smoking prior to stress exposure on symptom severity is unclear.

Methods: We examined how smoking a cigarette immediately prior to a stressful task affects craving and withdrawal symptom severity by analyzing data from a double-blind, crossover study assessing paroxetine’s effects on the physiological response to the combination of stress and smoking. Measures were obtained prior to and following smoking/stress exposure and following a subsequent 30-min period at two laboratory sessions (i.e., after 1 month each of paroxetine and placebo).

Results: Among study completers (n = 63), severity of craving decreased from the beginning of the session to immediately following the smoking/stress exposure (p < 0.01) and severity of smoking urges decreased from the beginning to the end of the laboratory session (p < 0.001). Withdrawal symptoms were less severe while taking paroxetine vs. placebo (p < 0.05) but no treatment × time effects were observed.

Conclusions: Additional research is needed to identify interventions that could similarly decrease stress-induced craving in order to determine if smoking cessation rates can be increased.     

Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study

Abstract

Objectives: The primary purpose of the current study was to assess the effects of a mindfulness-based stress reduction (MBSR) program, facilitated by non-psychologist clinicians, for improving psychosocial well-being. A secondary purpose of the current study was to explore the role of self-compassion as a potential underlying factor for improvements in emotional distress. Application of these findings to a physical therapy setting is provided.

Methods: One hundred and thirty participants with a variety of medical complaints completed an eight-week MBSR program at Vanderbilt University’s Osher Center for Integrative Medicine. Prior to the intervention and at the eight-week time point, participants completed measures for emotional distress (Brief Symptom Inventory), stress (Perceived Stress Scale-10), mindfulness (Mindfulness Attention and Awareness Scale), and self-compassion (Self-Compassion Scale). Wilcoxon signed-rank test was used to evaluate changes in outcomes after MBSR. Linear model estimation using ordinary least squares was used to evaluate the association between changes in self-compassion with changes in emotional distress.

Results: Following MBSR, participants reported significant reductions in emotional distress (p < 0.001). Additionally, participants reported improvements in mindfulness and self-compassion (p < 0.001). Linear regression model revealed that changes in self-compassion were significantly associated with changes in emotional distress (p < 0.001).

Discussion: An MBSR program conducted by non-psychologist clinicians was associated with improvements in emotional distress, stress, and self-compassion. MBSR is a promising adjunct intervention in which principles can be integrated within a physical therapy approach for chronic conditions.

Level of Evidence: 3B     

Invasive pulmonary aspergillosis in patients with solid tumours: risk factors and predictors of clinical outcomes

Abstract

Background: The characteristics and management of invasive pulmonary aspergillosis (IPA) in patients with hematologic malignancies are well known, but IPA in patients with solid tumours is not well described.

Methods: We retrospectively reviewed all Aspergillus-positive cultures at a tertiary cancer center during 2004–2017. We identified 101 patients with IPA and solid tumours. We analyzed the association between clinical features and treatment and 12-week mortality and response to antifungal therapy.

Results: Fifty-one patients had lung cancer, 77 had underlying lung disease, 47 received chest radiation and 33 had chronic obstructive pulmonary disease. Aspergillus fumigatus was the most common type isolated (71%); 68 patients (70%) were treated with voriconazole monotherapy. Independent risk factors for 12-week mortality included receiving steroids within 30 days of diagnosis (hazard ratio 2.2, 95% confidence interval [CI]: 1.1–4.6; p?=?.03) and chest radiotherapy (hazard ratio 2.6, 95% CI: 1.2–5.5; p?=?.01). In multivariate analysis, a positive fungal stain was associated with lower odds of a successful response (odds ratio 0.2; 95% CI: 0.05–0.75; p?=?.02), whereas voriconazole treatment was associated with higher odds (odds ratio 10.1; 95% CI: 2.1–48.5; p?<?.01).

Conclusions: IPA should be considered in patients with solid tumours, particularly those with underlying lung disease.

• Key messages

• Invasive pulmonary aspergillosis should be considered in patients with solid tumours, particularly those with underlying lung disease, lung cancer and those who received chest radiotherapy.

• Most of the patients with invasive pulmonary aspergillosis and solid tumours presented with nonspecific symptoms and signs as well as nonspecific CT findings. Unlike patients with hematologic malignancies, fever and hemoptysis were not predominant symptoms and the classical halo sign and the air-crescent sign were not described.

• Independent risk factors for 12-week mortality included receiving steroids within 30 days of diagnosis and chest radiotherapy. In multivariate analysis, a positive fungal stain was associated with lower odds of a successful response to antifungal therapy, whereas voriconazole treatment was associated with higher odds.