Poor General Health Status Research Articles

P02-110 - Depression among final year medical students in universiti sains malaysia (USM): associated, risk and determinant factors

ObjectiveThis study interested in gathering data on the prevalence of depression and its contributing factors among final year medical students in USM.MethodsA cross-sectional study was done. A total of 187 final year medical students of the 2007/2008 batch were selected as in study subjects. The Malay Beck's Depression Inventory (M-BDI_ was administered to identify depressed students. Data were collected during housemanship course, one week after their final summative examination.ResultA total of 92 (49.2%) students responded to this survey. The percentage of depression among the students was 21.7%: approximately 19.5% with mild depression and 2.2% with moderate depression respectively. The mean M-BDI scores were found to be significantly increased among female medical students (p < 0.05), those in difficulties with peer and love relationships (p < 0.01), and those with poor general health status (p < 0.001). Logistic regression showed female students, those in difficulties with love relationship and those with poor general health were at higher risk to develop depression (X2 (df) = 26.59 (3), p < 0.001). Multi-factorial ANOVA analysis showed that two factors contribute to depression among final year medical students which were gender and general health status (F (df) = 5.934 (13), p < 0.001).ConclusionThe prevalence of depression among medical student was high. Female medical students, those in difficulties with love relationship, and poor general health status were at high risk to develop depression. Gender and general health status were determinant factors of depression among USM final year medical students.

Widespread Pain in Temporomandibular Disorders

SUMMARYChronic widespread pain (CWP) represents pain involving several regions of the body. Various psychological and social risk factors such as poor general health status, sleep disturbance, fatigue and high psychological distress have been identified for the development of CWP. Numerous chronic pain conditions are comorbid, resulting in the development of CWP in many of these patients. Temporomandibular disorder is one of the most extensively studied chronic musculoskeletal pain condition in terms of its comorbidity with CWP and fibromyalgia. It has been proposed that these comorbid pain disorders share common denominators, including exposure to certain environmental events, elevated psychological distress, pain amplification and genetic predisposition. Increased awareness of CWP is important for improved diagnoses and more effective pain management. Patients with CWP can be effectively managed in multidisciplinary pain clinics.

C-B1-03: The Association of Optimal Lifestyle Adherence with Emotional Health Indicators Among Active Employees

Background and Aims: Adherence to an optimal lifestyle defined as adequate physical activity (=150 minutes per week), no use of tobacco, moderate alcohol use (=1 drink/d for women or =2 drinks/d for men), and eating five servings of fruits and vegetables per day has been associated with as much as 14 years of increased longevity and improved functional health status. Unfortunately, adherence to these four behaviors is relatively low in the United States. Furthermore, it is unclear the extent to which adherence to these health behaviors among working adults is associated with emotional health indicators such as self-reported stress, depression, depression risk, overall emotional health, and self-perceived general health. Improved understanding of this impact may hold significant potential for population health improvement strategies implemented via the worksite. The purpose of this investigation was to define the association of varying levels of self-reported optimal lifestyle with self-reported emotional health risks. Methods: All data were self-reported and collected as part of a health assessment process implemented through employer-sponsored programs during the year 2007. The number of subjects (N total=28,897) reporting from zero to 4 behaviors were 77; 1,294; 8,162; 15,085; and, 4,279 respectively. Emotional health variables included self-reported stress concerns, depression, depression risk based on personal history of depression, emotional health concerns, and self-perceived general health status. Results: The ratio of the percentage of the population with a positive response if no optimal lifestyles are practiced/the percentage of the population with a positive response if 4 optimal lifestyles are practiced is 3.8 for stress concerns, 1.9 for depression, 14.2 for high risk for depression, 5.3 for emotional health concerns and 5.6 for self-perceived poor general health status. Conclusions: Adherence to an optimal lifestyle is associated with lower rates of self-reported stress, depression, and poor perceived health status. The relationship is most likely bi-directional. If it is, enhanced focus and attention to population-based strategies that improve adherence to these four behaviors may positively affect a variety of emotional health outcomes, and addressing issues of emotional health may help individuals adhere to healthy lifestyles.

Pre-operative pulmonary assessment for patients with hip fracture

Hip fracture is a common injury among the elderly. Although patients who receive hip fracture surgery carry the best functional recovery compared to other treatment modalities, the presence of postoperative pulmonary complications, such as atelectasis, pneumonia, and pulmonary thromboembolism, may contribute to increased length of hospital stay, perioperative morbidity, and mortality. This review aims to provide evidence-based recommendations for preoperative assessment and perioperative strategies to reduce the risk of pulmonary complications after hip fracture surgery. Clinical assessment and basic laboratory results are sufficient to stratify the risk of postoperative pulmonary complications. Well-documented risk factors for pulmonary complications include advanced age, poor general health status, current infections, pre-existing cardiopulmonary diseases, hypoalbuminemia, and impaired renal function. Apart from optimizing the patient's medical conditions, interventions such as lung expansion maneuvers and thromboprophylaxis have been proven to be effective in reducing the risk of pulmonary complications after hip fracture surgery.

Enteropathy-associated T-cell lymphoma: A review on clinical presentation, diagnosis, therapeutic strategies and perspectives

Enteropathy-associated T-cell lymphoma (EATL) is a rare complication of celiac disease (<1% of lymphomas) and has a poor prognosis. International literature review with PubMed search (up to January 2009) of pathophysiological, clinical and therapeutic data. EATL is found in patients with a mean age of 59 years, often with a complication that signals its diagnosis. Refractory celiac disease (RCD), equivalent to low-grade intraepithelial T-cell lymphoma, could be an intermediary between celiac disease and high-grade invasive T-cell lymphoma. The median survival is 7 months, with no significant difference between stages; the cumulative 5-year survival is less than 20%. The poor prognosis is determined by disease that has often spread before it is diagnosed (50%), multifocal involvement of the small bowel (50%), poor general health status and undernutrition, and recurrence of complications (infections, perforations, gastrointestinal haemorrhages, occlusions), thus delaying the chemotherapy and contributing to frequent chemotherapy resistance. There is currently no effective and consensual treatment: preventive surgery for complications is controversial, and the results of chemotherapy are disappointing. The classic CHOP protocol (combination of doxorubicin-cyclophosphamide-vincristine-prednisone) does not have satisfactory results and survival remains poor, especially in patients with underlying RCD. High-dose chemotherapy with autotransplantion seems to only improve the prognosis in localised forms. Allogeneic bone marrow transplantation was not evaluated. In all, 1/3 of patients, being unfit for treatment, die before 3 months and half of treated patients stop chemotherapy prematurely due to inefficacy, intolerance and/or complications. Improvement of the prognosis requires collaboration in order to compose a national cohort, to evaluate new diagnostic and therapeutic strategies and to define prognostic factors.

The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people.

INTRODUCTION: Chronic fatigue syndrome, termed myalgic encephalomyelitis in the United Kingdom (CFS/ME), is a debilitating condition involving severe exhaustion, cognitive difficulties, educational and vocational losses, and disruption of social activities and relationships. CFS/ME may affect volition (that is, value, interest and sense of competence). PURPOSE: To test Model of Human Occupation (MOHO) concepts by comparing young people with and without CFS/ME in terms of occupational participation, volition and health-related quality of life during infection and over time. METHOD: Three hundred and one people (12-18 years old) diagnosed with glandular fever were evaluated at the time of acute infection (baseline). Six months following diagnosis, 39 of them met the criteria for CFS/ME. A further 39 who recovered were randomly selected and matched to CFS/ME participants. Both groups were re-evaluated at 12 months and 24 months. The Occupational Self Assessment and the Child General Health Questionnaire were used to compare occupational participation. RESULTS: Those with CFS/ME reported lower levels of perceived competency, more difficulties with physical functioning and poorer general health status than those who recovered. CONCLUSION: Those with CFS/ME report lower perceived competency, and compromises in physical functioning, school performance, social activities, emotional functioning and general health. This supports the MOHO assertion that impairments affect volition and quality of life.

Sinonasal mucormycosis: Case report

To present and discuss the case of a diabetic patient admitted with acidoketotic coma, with inner canthus tumefaction due to mucormycosis. A 38-year-old diabetic man was admitted with acidoketotic coma and poor general health status. Clinical examination found right inner canthus tumefaction and mucopurulent rhinorrhea. Endoscopy of the nasal fossae found medial meatus sphaceluses. Sinus CT scan found a bilateral ethmoid infiltrating and osteolytic infectious process. Emergency endoscopic bilateral ethmoidectomy was performed. Mucormycosis was diagnosed, and liposomal amphotericin B was administered intravenously for 1 month then replaced by posaconazole. The patient was followed up monthly; the antifungal treatment was terminated after 8 months, the disease appearing to have resolved. Mucormycosis is one of the most rapidly fatal fungal infections. Facial and cerebral CT scan is essential and is systematically abnormal in case of sinonasal mucormycosis. Emergency multidisciplinary treatment should address the diabetes and include rapid surgical debridement and effective antifungal medication. The reference antifungal is amphotericin B, to be administered at maximal dose (3 to 5 mg/kg per day). Posaconazole, available in Europe since July 2005, proved successful in the present case.

California Wellness Study

This paper identifies the prevalence and predictors of obesity among California's American Indian adults. A cross-sectional study was conducted at 13 rural sites. Indian healthcare clinics served as the sampling frame and were selected because of their proximity and access to the target population. Four-hundred and fifty adult American Indians participated; 74 percent were female and 26 percent were male. The average age was 40, ranging from 18-74. Measures included socio-demographics, general health, BMI, type 2 diabetes, exercise and dietary habits. Eighty-two percent were overweight, obese or morbidly obese. Chi-square tests revealed three variables significantly associated with BMI categories: having type 2 diabetes, female gender and poor general health status. A logistic regression model for obese/morbidly obese (BMI > 30) versus overweight/normal (BMI < 30) persons found gender and diabetes status as significant predictors, while general health status showed trend. Females had 1.59 greater odds of being obese than males (p=0.04). Those that do not have diabetes are less likely to be obese (p=0.02). Those that do not have good general health were 2.5 times more likely to be obese than those that have good general health (p=0.06). Overall goodness of fit was significant (p=0.0009). It is important to identify individuals and population who are normal/overweight, obese/morbidly obese so support and interventions can be planned and implemented.

Recommendations for advancing the care of Canadians living with refractory angina pectoris: A Canadian Cardiovascular Society position statement

Refractory angina (RFA) is a debilitating disease characterized by severe, unremitting cardiac pain (1,2). This pain or discomfort, by definition, is resistant to all conventional treatments for coronary artery disease (CAD) including nitrates, calcium channel and beta-adrenoceptor blockade, vasculoprotective agents, percutaneous coronary interventions and coronary artery bypass grafting (1,2). Patients living with RFA have a low annual mortality rate of 3% but suffer from a severely impaired health-related quality of life (3). They typically experience recurrent and sustained pain, poor general health status, psychological distress, impaired role functioning, activity restriction and inability to self-manage (4–7). As more patients survive primary and subsequent cardiac events, the global prevalence of RFA is ever increasing (1,2,8,9).

Disseminated Nocardiosis: A Rare Infectious Complication Following Non–Heart-Beating Donor Liver Transplantation

Nocardiosis is an infrequent disease that affects patients who display a cellular immunodeficiency, such as transplant recipients on immunosuppressive treatment, but uncommonly associated with high morbidity and mortality rates. Disseminated Nocardiosis affecting the central nervous system (CNS), abdomen, skin, and lungs has been described in bone marrow, lung, and kidney transplant recipients. However, to our knowledge, no cases involving all of these structures have been reported in liver transplant recipients. Herein, we have reported a case of CNS, pulmonary, and cutaneous nocardiosis in a liver transplant recipient who experienced hepatitis C virus-related cirrhosis and hepatocellular carcinoma and received the organ from a non-heart-beating donor. At posttransplantation month 7 the patient was admitted to the emergency department with poor general health status, fever, edema, and subcutaneous nodules in the legs. A computed tomography scan revealed multiple nodules disseminated through both lungs, abdomen, brain, and subcutaneous tissue. A needle biopsy was performed into one of the subcutaneous nodules. Cultures of the material tested positive for Nocardia farcinica. Thus, we started treatment with intravenous sulfamethoxazole-trimethoprim (SMZ-TMP), shifting after 1 month to oral therapy. Radiological examination performed after 2 weeks of treatment showed a 70% reduction in subcutaneous, pulmonary, and cerebral lesions. After 6 months of SMZ-TMP treatment, the patient remained free of the symptoms with involution of the subcutaneous nodules and significant radiological improvement. Among opportunistic infections appearing in liver transplant recipients, Nocardia species should have special consideration according to the success of early treatment and the bad prognosis in cases of delayed diagnosis.

Neumotórax catamenial secundario a endometriosis torácica

We report the case of a 27-year-old tertipara, with one caesarean, with menarche at the age of 13 years, regular cycles, disabling dysmenorrhea twice a year, and one sexual partner, who reported mild dyspareunia and was referred to our hospital, which serves a rural population in Jalisco (Mexico). The patient showed poor general health status, with severe dyspnea, and reported that she had experienced the same symptoms twice before in the previous 4 months. The patient showed a pneumothorax size of 40%. A closed chest drainage system was placed, producing substantial improvement in the 3 subsequent days with respect to admission. Pulmonary tomography 3 days later showed no abnormalities. CA125 determination revealed 102 U/ml and pelvic ultrasound showed a positive anechoic, 4×5-cm image in the left annex. Pelvic laparotomy was performed, revealing mild endometriosis with lesions in the posterior uterine wall and no diaphragmatic lesions. Thoracoscopy showed two endometriotic foci of approximately 1×1 cm, and another of 1×0.5 cm. The histological diagnosis was endometrial tissue in the lung parenchyma.

High mortality after pelvis and lower limb fractures in ESRD.

Sir, The high mortality rate associated with hip fracture in the general population, as well as in the end-stage renal disease (ESRD) population, is well described. However, the mortality associated with pelvis and lower limb fractures in ESRD patients remains unknown. We reviewed the medical records of all chronic haemodialysis or peritoneal dialysis patients hospitalized at Maisonneuve-Rosemont Hospital for a fracture from 1 July 1995 to 1 February 2007. Femoral neck, pelvis, femoral condyle, tibial plateau, patella, tibia and malleolus fractures were considered. Femoral neck and pelvis fractures were analysed separately, while the other fractures were analysed together as lower limb fractures. All patients who died during the study period were identified and mortality rates were calculated. During the 127-month-long study period, 60 dialysis patients were hospitalized for a total of 68 fractures. Seven patients had two fracture episodes, and one patient had three fracture episodes. The three most common fracture sites were hip (40 cases), pelvis (13 cases) and malleolus (8 cases) (Table 1). The 1-year mortality rate after a hip fracture was 42.5% (17 patients), with an in-hospital mortality rate of 20%. Two patients died during their hospitalization for a pelvis or lower limb fracture. One-year mortality rates were 30.8% after a pelvis fracture and 20% after a lower limb fracture. Median survival during the observation period was 427 days after a pelvis fracture and 581 days after a lower limb fracture. Hip fracture is associated with a 1-year mortality rate of 24% in the general population [1]. In ESRD, the 1-year mortalityrateafterahipfractureapproximates50%[2].Our results are consistent with previously reported mortality rates. Few studies have described the mortality associated with pelvis or lower limb fractures in the general population. In a British study, the 1-year mortality rates were 8.7% after pelvis fracture and 2.4% after a lower limb fracture [3]. In our ESRD cohort, the 1-year mortality rates for pelvis and lower limb fractures were increased 3.5- and 8.3-fold, respectively. In fact, the impact of pelvis and lower limb fractures on mortality in ESRD patients appears very similar to the impact of hip fracture in the general population. Like hip fractures [4,5], pelvis and lower limb fractures are probably markers of poor nutritional and general health status in this population. With a 1-year mortality rate similar to that of hip fracture in the general population, our data delineate for the first time the poor outcomes associated with pelvis and lower limb fractures in ESRD patients. The incidence, risk factors, clinical and functional outcomes of such fractures in ESRDpatientsneedtobeevaluatedinlarger,registry-based studies.

Randomized Controlled Trial of a Psychoeducation Program for the Self-Management of Chronic Cardiac Pain

Cardiac pain arising from chronic stable angina (CSA) is a cardinal symptom of coronary artery disease and has a major negative impact on health-related quality of life (HRQL), including pain, poor general health status, and inability to self-manage. Current secondary prevention approaches lack adequate scope to address CSA as a multidimensional ischemic and persistent pain problem. This trial evaluated the impact of a low-cost six-week angina psychoeducation program, entitled The Chronic Angina Self-Management Program (CASMP), on HRQL, self-efficacy, and resourcefulness to self-manage anginal pain. One hundred thirty participants were randomized to the CASMP or three-month wait-list usual care; 117 completed the study. Measures were taken at baseline and three months. General HRQL was measured using the Medical Outcomes Study 36-Item Short Form and the disease-specific Seattle Angina Questionnaire (SAQ). Self-efficacy and resourcefulness were measured using the Self-Efficacy Scale and the Self-Control Schedule, respectively. The mean age of participants was 68 years, 80% were male. Analysis of variance of change scores yielded significant improvements in treatment group physical functioning [ F = 11.75(1,114), P < 0.001] and general health [ F = 10.94(1,114), P = 0.001] aspects of generic HRQL. Angina frequency [ F = 5.57(1,115), P = 0.02], angina stability [ F = 7.37(1,115), P = 0.001], and self-efficacy to manage disease [ F = 8.45(1,115), P = 0.004] were also significantly improved at three months. The CASMP did not impact resourcefulness. These data indicate that the CASMP was effective for improving physical functioning, general health, anginal pain symptoms, and self-efficacy to manage pain at three months and provide a basis for long-term evaluation of the program.

Rekonstrukcja części szyjnej przełyku techniką gastric pull-up w przebiegu wznowy raka gardła dolnego i krtani

Patient with hypopharyngeal cancer are difficult to treat because they usually present with advanced disease, poor general health status and severe nutritional problems. Because of the poor prognosis, careful consideration has to be given regarding the choice of the correct surgical approach for respirato-digestive tract reconstruction. The authors present a case of recurrent hypopharyngeal cancer with cervical esophagus infiltration successfully treated with total laryngectomy and esophagectomy and gastric pull up reconstruction. Indications for technique, method of reconstruction and complications are, discussed. As most authors we consider the gastric transposition method as the preferred approach to restore digestive continuity after total esophagectomy. As the method is the single stage procedure it provides the best palliation of dysphagia and allows early resumption of an oral diet.

Complication rare de l’acidocétose diabétique : le pneumomédiastin

Pneumomediastinum is a rare condition with an incidence of 1/33,000. It can be a rare complication of diabetic acidoketosis. We present the cases of two diabetic patients and review the literature, focusing our analysis on the interrelationships between these two diseases. Both patients were young subjects, a 21-year-old woman and an 18-year-old man with type 1 diabetes who were admitted for acidoketosis. Clinically, the patients presented the cardinal signs of diabetes and a flu-like syndrome associated with dyspnea and chest pain. Physical examination revealed a poor general health status, tachycardia and polymnea, as well as a painful diffuse tumefaction of the neck with subcutaneous emphysema. Blood tests disclosed elevated glycemia and urine was positive for acetone. The diagnosis of severe metabolic acidosis was retained. The chest x-ray demonstrated the subcutaneous emphysema and air in the anterior mediastinum. On the computed tomography scan obtained in the second patient, the heart was silhouetted with a hyperlucent zone laterally. Treatment consisted in strict bed rest with oxygen therapy, fluid replacement, insulin and heparin. The pneumomediastinum resolved in both patients within three days on average. The causal effect of diabetic acidoketosis in the development of pneumomediastinum in our two patients was retained after ruling out all other potential causes, including chest trauma and asthma.

Risk Indicators for Missing Teeth in Working‐Age Pomeranians – An Evaluation of High‐Risk Populations

The goal of this study was to examine whether psychosocial conditions for general health described in the public health literature are also reflected in tooth loss. The relation of psychosocial factors to missing teeth was evaluated among 2,501 individuals aged 25 to 59 years from the population-based cross-sectional Study of Health in Pomerania using logistic regression analyses. The case group included 15 percent of participants of each 5-year age group with the highest number of missing teeth. Unemployment, dose-dependent current and former smoking, a poor general health status, and a longer time since the last dental appointment were significant risk indicators for missing teeth. Alcohol consumption, use of interdental cleaning products, and checkup as the reason for the last dental visit were protective. Women with low education and low income were identified as a high-risk group for missing teeth by the three-way interaction between gender, school education, and household income. The effect of marital status was modified by gender: being single was a risk indicator for men but it was protective for women. The study supports the hypothesis that psychosocial conditions that affect health status as described in the general public health literature also have an effect on tooth loss. Strategies to prevent tooth loss may be expeditiously implemented in combination with approaches to prevent other health-related problems.

Results from the International Cataract Surgery Outcomes Study

Results from the International Cataract Surgery Outcomes Study

Self-perceived oral health status and influencing factors of the elderly residents of a peri-urban area of La Paz, Bolivia

To assess the self-perceived oral health status of the elderly in Bolivia and explore the relationship between the socio-demographic and subjective factors that influence such perception. A cross sectional study. Pampahasi, peri-urban area of La Paz, Bolivia. A 22.5% (300) sample was selected randomly from the total population (1,336) of 60 years and above. Of the participants, 293 agreed to participate in the survey. Information was collected by interviews at home. The mean age was 70 years (SD = 7.7), with more females (57%) than males. Sixty per cent of subjects categorised their oral health as poor. Logistic regression analysis showed that poor self-perceived oral health was associated significantly with not going to school, no/ fair satisfaction with economic status, poor chewing ability, perception of need for dental treatment, and poor self-perceived general health status. Socio-economic factors seem to contribute to poor oral health among the elderly in Bolivia. Considering that these factors are associated with bad oral health behaviour and few visits to dental clinics, there is a need to design dental education programmes and enhance accessibility to dental clinics for elderly people living in the peri-urban areas of La Paz, Bolivia.

Infection-related hypoglycemia in institutionalized demented patients: A comparative study of diabetic and nondiabetic patients

Hypoglycemia is common in elderly community dwelling patients and may accompany episodes of acute infection. We analyzed the interrelations of clinical variables with infection-related hypoglycemia (IRH) and its outcome in institutionalized demented elderly patients, with and without diabetes mellitus (DM). This is a retrospective cohort study involving residents of a large long term-care facility. We measured demographic, clinical, functional, nutritional and cognitive data as well as blood counts and chemistry analysis. We identified 65 elderly patients with IRH and compared data of 33 diabetic patients with 32 nondiabetic patients. Mean age of patients was 77.7 years and mean Mini-Mental score of 1.8. Diabetic patients were younger, more cognitively impaired, had a lower functional score (nonsignificant differences), but presented with more comorbidities, compared with nondiabetics ( p = 0.004). Mean blood glucose levels in diabetics and nondiabetics were 53.2 and 54.3 mg/dl, respectively. Only 22% of the patients showed clinical signs indicating hypoglycemia. Multivariate analysis showed that, in groups, comorbidity and functional status, creatinine, albumin, C-reactive protein (CRP) and total cholesterol were all associated with IRH. During a 6 months period, 58% (38/65) of the patients died, out of whom 47% (18/38) died within one month following the documentation of IRH. There were no statistically significant differences in short and late mortality rates between patients with and without DM. we conclude that asymptomatic IRH in institutionalized demented elderly is frequently associated with common respiratory and urinary infections, in both diabetic and nondiabetic patients. IRH seems to indicate a poor general health status rather than being the cause of death. Blood glucose needs to be screened in this population during common infections, also in nondiabetics, to identify patients at high risk.

An Outcomes Analysis of Patients Undergoing Body Contouring Surgery after Massive Weight Loss

Although published reports about technical management of massive weight loss patients are beginning to appear, risk factors for complications following body contouring operations are not known. A retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and October of 2004 was performed. Demographic and surgical factors were analyzed. Outcome measures included seroma, wound dehiscence, thromboembolic complications, blood transfusion after surgery, and extended lengths of stay (>2 days). A total of 139 patients were analyzed; 82.7 percent of them were female; mean age was 41 years. On multiple logistic regression, male gender was associated with significant risks for wound dehiscence (odds ratio, 6.4; p = 0.01). There were also trends toward increased risk for wound dehiscence with hypothyroidism (odds ratio, 4.3; p = 0.06) and Ehlers-Danlos syndrome (odds ratio, 18.7; p = 0.05). In terms of risk of blood transfusion, asthma and having three or more procedures were the two variables that emerged with significant association (odds ratio, 16.8 and 13.7, respectively; both p < 0.01). Increased length of stay to greater than 2 days was also significantly associated with having three or more procedures (odds ratio, 4.72; p < 0.01). Male gender, hypothyroidism, and Ehlers-Danlos syndrome may be risk factors for wound dehiscence following body contour operations for massive weight loss. Asthma may be a marker of poor general health status, and asthmatic patients are at increased risk for requiring blood transfusions. Having three or more procedures is associated with an increased risk of blood transfusion and increased length of stay.