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ABSTRACTIntroductionObesity is associated with a number of chronic diseases such as cardiovascular diseases and cancers. The association of obesity with occupational accidents has been suggested although the evidence is less convincing. The objective of the study is to analyse the relationship between BMI values and ergonomic accidents in a large University Hospital.MethodsThe relationship between body mass index (BMI) and the incidence of ergonomic occupational accidents over a period of 8 years was investigated in a cohort of employees of a large University Hospital, covering almost 27,000 person-years of observation. This relationship was stratified according to the variables age, gender, functional status within the organization and work schedule (part-time or full time). Height and weight were objectively measured, demographic data were obtained from the human resource department and the registration of ergonomic accidents was carried out by the safety and prevention department of the hospital.ResultsThe number of ergonomic accidents, expressed as number/1000 person-years was higher for female employees compared to male employees, increased with age and markedly increased from functional class A (leading or expert function and higher educational level) to D (executive function in patient care and technical department). However, the incidence of ergonomic accidents accompanied by loss of working time was not significantly associated with BMI, independently of age and gender. In addition, the type of accident and the severity of the accidents expressed as the number of days absent from work were unrelated to BMI.ConclusionNo independent relationship between BMI and the incidence of ergonomic accidents could be identified in our cohort. Tailoring working conditions to individual BMI levels is not recommended.

J Epidemiol Community Health 2004;58:47-52 Study objective: To ascertain, whether, conventional risk factors and readiness of coronary patients to modify their behaviour and to comply with recommended medication were associated [...]

Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men.

Background Despite the fact that subjects with established coronary heart disease (CHD) are at high risk of further events and deserve meticulous secondary prevention, current audits such as EUROASPIRE show poor control of major risk factors. Ongoing monitoring is required. We present a new risk factor audit system, SURF (Survey of Risk Factor management), that can be conducted much more quickly and easily than existing audit systems and has the potential to allow hospitals of all sizes to participate in a unified international audit system that will complement EUROASPIRE. Initial experience indicates that SURF is truly simple to undertake in an international setting, and this is illustrated with the results of a substantive pilot project conducted in Europe and Asia.Methods The data collection system was designed to allow rapid and easy data collection as part of routine clinic work. Consecutive patients (aged 18 and over) with established CHD attending outpatient cardiology clinics were included. Information on demographics, previous coronary medical history, smoking history, history of hypertension, dyslipidaemia or diabetes, physical activity, attendance at cardiac rehabilitation, cardiac medications, lipid and glucose levels (and HbA1c in diabetics) if available within the last year, blood pressure, heart rate, body mass index, and waist circumference were collected using a one-page data collection sheet. Years spent in full time education was added as an additional question during the pilot phase.Results Three European countries − Ireland (n= 251), Belgium (n= 122), and Croatia (n= 124) − and four Asian countries − Singapore (n= 142), Taiwan (n= 334), India (n= 97), and Korea (n= 45) − were included in the pilot study. The results of initial field testing were confirmed in that it proved possible to collect data within 60−90 seconds per subject. There was poor control of several risk factors including high levels of physical inactivity (41−45%), overweight and obesity (59−78%), and ongoing smoking (15%). There were lower levels of individuals attending cardiac rehabilitation in Asia. More Europeans than Asians reached the low-density lipoprotein cholesterol target of <2.5mmol/l (66 vs. 59%) reflecting differences in medication usage. However, blood pressure control was superior in Asia, with 71% <140/90 compared with 66% of Europeans (NS).Conclusions This phase of SURF has confirmed its ease of use which should allow wide participation and the collection of representative risk factor data in subjects with CHD as well as ongoing data collection to monitor secular trends in risk factor control. Notwithstanding that this is a pilot study, the results suggest that risk factor control, particularly for lifestyle-related measures, is poor in both Europe and Asia.

New-onset diabetes after transplantation (NODAT) is a frequent complication and has an impact on patient and graft survival. Hypomagnesemia is common in both renal transplant recipients and in diabetics. This study examines the relationship between hypomagnesemia, NODAT and the type of immunosuppression in renal transplant recipients.

To address the issue whether deficient acquisition of bone during maturation or adult‐onset bone loss is primarily to blame for idiopathic osteoporosis in men, we assessed indices of bone mineral density and size, as well as biochemical markers of bone turnover in 61 probands (ages 20–65 years) with idiopathic osteoporosis (z‐score ≤ −2.0 at the spine or hip), their first‐degree relatives (n= 130), and age‐matched controls. There was no indication of accelerated bone loss. Indeed, in probands, the observed bone deficit versus controls was unrelated to the age of probands, and indices of bone turnover were not significantly different from controls. On the other hand, a specific deficit in bone acquisition was suggested by findings of lower bone mineral density values in three generations of male and female relatives of the probands, including their offspring; bone turnover in relatives was not different from controls. The bone mineral density deficit was more pronounced in male compared with female relatives; approximately 60% of the sons had a spinal bone mineral density z‐score of less than −2.0. There also was a skeletal site‐specificity in probands and their male relatives with a larger areal bone mineral density deficit at the spine compared with the hip and the forearm. The deficit at the spine corresponded to a reduction of both volumetric bone mineral density and bone size; a similar less pronounced deficit in volumetric bone mineral density, but not in bone size, was observed at the femoral neck. These findings in probands and their first‐degree relatives point toward a major contributory role of a genetically determined maturational defect in bone acquisition in the pathogenesis of idiopathic osteoporosis in men.

ObjectiveTo obtain accurate estimates of the prevalence of ECG abnormalities in the general population and to describe them in relation to age, sex, and some lifestyle related factors.DesignThe results were obtained from the records of 47 358 men and women participating in four large Belgian epidemiological studies during the past 30 years. All tracings were read and coded by two trained cardiologists on the basis of Minnesota code criteria.ResultsPrevalences of coronary heart disease and abnormal ECG findings rose exponentially with age in both sexes, with the exception of atrioventricular block and the Wolff-Parkinson-White (WPW) syndrome. Major ECG findings were observed in 6.0% of all men and 4.3% of women, resulting in a significant adjusted sex ratio of 1.66 (95% confidence interval 1.46 to 1.88). The prevalence of minor ECG changes was slightly higher among men (10.4% v 9.5% in women). The occurrence of ischaemia-like findings on the ECG was comparable between men and women (9.0% v 9.8%). Independent of age, smoking, obesity, diabetes, employment status, positive history of angina or infarction, and region, there were significantly higher prevalences of Q/QS patterns, left ventricular hypertrophy, left axis deviation, arrhythmias, and atrial fibrillation or flutter in men than in women. Right bundle branch block and WPW syndrome both occurred 3.5 times more often in men, while the prevalence of left bundle branch block was comparable between the sexes.ConclusionsThe large sample size allowed a precise description of the most important ECG abnormalities. These are not rare in the adult population and most are strongly age related. Sex differences occur with some, but not all, abnormalities. The less common ECG abnormalities were more often observed among men.

Background and methods: Changes over time of mortality rates from cutaneous malignant melanoma (CMM) in Belgium were analysed, based on people (n = 3695) aged 25-84 years, who died of CMM from 1954 to 1992. All data were collected from the Belgian National Institute of Statistics, For the log-linear analysis and calculation of the average annual change, only the data from 1973 to 1992 were considered.Results: The age-adjusted mortality rates (per 105) for the age group 25-84 years old increased from 0.5 in 1954 to 3.0 in 1992 in men, and from 0.8 in 1954 to 2.2 in 1992 in women. The average annual percentage change in men (-0.03%) was stable over the period 1973-1982, and increased to 4.4% over the period 1983-1992. In women, the average annual increase was 4.6% over the period 1973-1982, and continued to increase to 6.8% over the period 1983-1992. Log-linear analysis showed that the change in rates for both men and women was mainly due to an age-'drift' effect, contrary to the results of the average annual percentage in men.Conclusion: The risk of dying from CMM increased in men and women continuously over the while period irrespective of birth cohort. In both men and women, there was approximately a 20% increase in CMM mortality per 5-year period.Key words: Age-period-cohort models, time trends, epidemiological method, cutaneous malignant melanoma, mortality rates, Belgium

Abstract: Objective: To study, in institutionalized mentally retarded patients, the prevalence of regular laxative use, and to identify its correlates. Methods: Twenty-one of the 22 institutions for the mentally retarded in Flanders (Belgium) provided the setting for the study, which included a population of 3712 residents with an IQ of <50. This was a descriptive cross-sectional study of a random sample of 20 patients per institution, consisting of a structured interview of the personnel responsible for daily care of the selected patients. The study population consisted of 420 mentally retarded patients. Their median age was 29 years (range 2–72 years). Twenty-six percent of patients had an IQ of 35–49, 40% an IQ of 20–34 and 34% an IQ of <20. Sixteen percent of the patients were non-ambulant. Results: Regular laxative use was found in 26.4% (111/420) of the residents. In addition, occasional laxative use was found in 2% (10/420) of the residents. Oral laxatives were used daily by 13% (56/420) and oral laxatives daily in combination with enemas were used by 9% (39/420). Enemas but no oral laxatives were used by 3% (11/420); manual evacuation in combination with oral laxatives and enemas was used by 1% (5/420). Seventy-eight percent (78/100) of the oral laxative users used them for more than 1 year. Seventy-one percent (71/100) used one laxative, 23% two and 6% three. Thirty different brands of oral laxatives were used. Sixty-seven percent (67/100) used osmotic laxatives alone or in combination, 30% used stimulant laxatives, 19% used bulk forming laxatives and 19% mineral oil. Oral laxatives were always prescribed by attending physicians, while enemas were also initiated by nurses in 35% (18/52). Laxative use was positively and independently correlated with female gender, with being non-ambulant, with oral motor dysfunction and with the use of medication other than laxatives. It did not correlate with age. Within the institutions, laxative use varied from one to 15 users out of the 20 randomly selected patients (median 4/20). Conclusion: Laxative use is frequent in institutions for the mentally retarded, with a large inter-institution variation, indicating that constipation is an important problem and underlining the need for research into cost-effective treatment.

SettingAs part of the WHO-MONICA study, acute coronary events have been registered from 1983 until 1992 in the general population aged 25-69 years in two Belgian cities--Ghent in the northern Dutch speaking part of Belgium and Charleroi in the southern French speaking part. Registration of events was done according to an international standard protocol.ObjectiveTo study trends in total, fatal and non-fatal event rates and trends in case fatality rates in these two cities.Main resultsIncidence of CHD was on average 50% higher in Charleroi compared with Ghent in both men and women (attack rate ratio Charleroi/Ghent was 1.5 in both sexes). In both men and women, diverging trends were observed between the two cities for total and non-fatal event rates, while parallel declining trends were observed in fatal event rates and in case fatality rates. In both sexes, total attack rates showed a significant decrease in Ghent and a significant increase in Charleroi. Also in the two sexes, attack rates of non-fatal events increased significantly in Charleroi and remained stable in Ghent. Attack rates of fatal events decreased significantly in men and women in Ghent and in men in Charleroi. Both "total" and "in hospital" case fatality rates declined significantly in both sexes in the two cities.ConclusionsImportant differences in coronary heart disease (CHD) incidence and CHD trends between Ghent and Charleroi were observed. These differences and trends are interpreted in the context of existing and still growing differences in the overall socioeconomic situation between the north and the south of the country. On the other hand, the efficacy of medical treatment of CHD is comparable in the two regions, as reflected by similar figures and trends for case fatality rates.

Repetition of psychiatric emergency department use by a relatively small number of patients constitutes a major problem for clinicians and service providers. This study aimed at the identification of risk factors for repetition by addressing the time interval between the first and second visits to the emergency department. The purpose was to investigate what patient characteristics and referral circumstances determine this interval. Over a two year period, data on all psychiatric emergency referrals to the emergency department of four public hospitals were collected with a standardized form. Data collected during the index referral of all patients were used for estimating the risk for repetition using survival analysis techniques. A large proportion of repeaters revisits the emergency department within a short time interval. Younger, male patients who present themselves spontaneously are more likely to repeat than others. Previous inpatient service use and the presence of a diagnosis of substance abuse disorder or psychotic disorder at the first visit further increases the risk for repetition. Previous service use and, to a lesser degree, demographic and clinical characteristics of psychiatric patients are useful in the prediction of variations in time between first and second referrals to the emergency department

Data from 5,817 men and 5,215 women (age range, 25-74 years) who participated in the Belgian Interuniversity Research on Nutrition and Health were used to determine prevalences and associated variables of different abnormalities on the resting electrocardiogram. Electrocardiographic abnormalities were coded according to the Minnesota classification system. About one third of the subjects showed one or more abnormalities on their electrocardiogram. Major abnormalities occurred in 7.3% of the men and in 4.6% of the women. The prevalence of minor abnormalities was twice as high. Minnesota codes 4 (ST abnormalities) and 5 (T wave changes) were found to be the most prevalent in both sexes (9.6 and 10.5% respectively in women and 8.4 and 9.1% respectively in men), while code 2 (QRS axis deviation, 7.9%) and code 7 (ventricular conduction defect, 8.7%) were quite common in men. Most prevalences were rather log-linearly related with age, except codes 6 (atrioventricular conduction defect) and 9 (miscellaneous items). In the asymptomatic subjects, blood pressure showed the strongest positive correlation with minor ST-T abnormalities in both men and women independent of other factors. Other correlates identified by multivariate analyses were serum potassium, serum phosphor, and serum uric acid levels, as well as the intake of diuretics. However, any major, minor, and ST-T abnormalities were, according to sex, differently related to those correlates.

A series of 146 consecutive patients who underwent tricuspid valve replacement at the University Brugmann Hospital between 1967 and 1987 was reviewed. Mean age at operation was 51.4 years (+/- 12.1 years). Different types of prostheses were implanted including porcine and bovine pericardial bioprostheses and older and bileaflet mechanical valves. Most patients were severely disabled by their cardiac disease before operation, with 30.1% in New York Heart Association functional class III and 69.9% in class IV. Operative mortality and hospital mortality rates (30 days) were high (16.4%). Incremental risk factors for hospital death included icterus (p < 0.005), preoperative hepatomegaly (p = 0.012), and New York Heart Association functional class IV (p = 0.013). Multivariate analysis only selected preoperative icterus (p < 0.01) as being independently significantly related to hospital mortality. The hospital survivors were followed up for a median of 94 months. A complete follow-up was available for all patients except two for 30 months or more. At 30 months the only two significant parameters were the type of myocardial protection (p = 0.024) and the year of operation (before 1977 or after [precardioplegia era or after], p = 0.011). There were 70 late deaths during the entire follow-up period. The univariate (log-rank statistics) incremental risk factor for late death was the type of tricuspid prosthesis (Smeloff-Cutter and Kay-Shiley versus St. Jude Medical versus bioprosthesis) (p = 0.04). A trend was observed for the type of operative myocardial protection (normothermia and coronary perfusion) (p = 0.06) and preoperative New York Heart Association functional class IV (p = 0.055). Actuarial survival was 74% at 60 months and 23.4% at 180 months. Cumulative follow-up added up to 1015 patient-years. In a more detailed analysis of the effect on survival of the type of tricuspid prosthesis, a significant difference was observed between the bioprostheses and some older mechanical prostheses (Smeloff-Cutter and Kay-Shiley) (p = 0.04) but not between the bioprostheses and the bileaflet valves (p = 0.15). When the follow-up period was stratified according to less than 7 years and more than 7 years of follow-up, no difference was observed for the first period, but for the late follow-up the new mechanical prostheses did better than the bioprostheses (p = 0.05), suggesting a degradation of the bioprostheses after 7 years and favoring mechanical prostheses for those patients with a good long-term prognosis. (J THORAC CARDIOVASC SURG 1995;110:672-9)

In the framework of an extensive health survey 123 male viscose rayon workers exposed to hydrogen sulphide (H2S) and/or carbon disulphide (CS2) and 67 referents not exposed to either of these chemicals answered questions on eye irritation complaints in a self-administered questionnaire. Personal exposure varied from 4 to 112 mg m−3for CS2and from 0.2 to 8.9 mg m−3for H2S. A combined exposure measure was calculated using principal component analysis. The exposed subjects had a significantly higher prevalence of eye pain, burning and photophobia. Adjustment for age and smoking in logistic regression revealed significantly more eye complaints for all workers that were highly exposed. In a postal survey one-third of the ex-workers of the same viscose rayon factory reported having left the factory because of eye complaints, indicating that their occurrence may be underestimated in the cross-sectional study.

A total of 129 workers exposed to carbon disulphide (CS2) and 81 non-exposed controls were asked about their current use of pharmaceuticals, using a self-administered questionnaire. In all, 31% of the exposed and 19.8% of the non-exposed used some medicine (P = 0.08). The average number of pharmaceuticals per subject amounted to 0.71 in the exposed vs. 0.36 in the non-exposed (P = 0.049). Predominant types of medicines used were analgesics (12.4% in the exposed vs. 8.6% in the non-exposed,P = 0.50) and sedatives/hypnotics (10.1% in the exposed vs. 4.9% in the non-exposed,P = 0.21). The pharmaceuticals consumed can cause numerous (side) effects that are similar to the toxic effects of CS2. To take into account these possibly confounding agents, a classification system for possible (side) effects of pharmaceuticals was developed, taking the dose into account. According to this method, many (side) effects of pharmaceuticals that could occur were recorded with higher frequency and intensity in the exposed subjects. Potential (side) effects that occurred significantly more frequently in the exposed than in the non-exposed were: tiredness, sedation, dizziness (20.9% vs. 4.9%,P = 0.001), excitation, anxiety (10.9% vs. 2.5%,P = 0.03), vision disturbances (7.0% vs. 0%,P = 0.01), and erection decrease (5.4% vs. 0%,P = 0.045). The implications of these findings for epidemiological studies are discussed.

Background: The risk stratification of chronic heart failure (CHF) patients can be performed using echocardiographic markers of left ventricle (LV) dysfunction, such as the ejection fraction (EF). LV global longitudinal strain (GLS) showed to be a sensitive measure of myocardium deformation. However, its role as prognostic marker in CHF patients with exclusively systolic dysfunction is still poorly addressed. Objectives: This study sought to evaluate the incremental prognostic role of two-dimensional (2D) LV GLS in CHF outpatients. Methods: Fifty-five patients with CHF and LVEF ≤45% performed a 2D echocardiogram with assessment of conventional parameters and GLS by speckle tracking (STE) imaging averaged from apical 4-chamber, 3-chamber and 2-chamber views. A clinical follow-up of 12 months was performed to assess the occurrence of composite endpoint of overall mortality and nonfatal cardiovascular events. Results: We included 55 patients (mean age 55 ± 12 years, 80% males, 30% with CHF of ischemic etiology, with mean LVEF of 27 ± 9%, median BNP levels 162 [P25-75 56-542] pg/ml). The mean GLS was – 10.35 ± 3.14%. GLS was significantly correlated with NYHA functional class (R=0.41, p=0.002) and BNP levels (r=0.47, p=0.001) and showed a good correlation with LVEF (r=-0.687, p<0.001). The logistic regression analysis showed that GLS (OR 1.548 [95% CI 1.169-2.051]) and LVEF (OR 0.895 [95% CI 0.822-0.976]) were significantly associated with the composite end-point. Other variables that were significantly related with GLS included NYHA functional class (OR 7.333 [95% CI 2.084-25.809]) and BNP levels (OR 1.003 [95% CI 1.001-1.005]). Multivariated regression analysis, including GLS and LVEF, showed an independent association of GLS with adverse outcome (OR 1.460 [95% CI 1.036-2.058]). The area under the receiver operating characteristic (ROC) curve to predict the occurrence of the composite endpoint was 0.798 [0.678-0.919] with an optimal thresholds of -9.5 (80% sensitivity, 70% specificity, p=0.001), while EF had an area under the ROC curve of 0.276 [0.138-0.414]. Conclusions: GLS was strongly associated with severity disease status and predicted the occurrence of adverse outcomes. Quantifying LV GLS in CHF outpatients with systolic dysfunction provides greater accuracy for cardiovascular risk stratification than LVEF.

Background: Age-induced alterations in arterial impedance and wave reflection contribute to elevated systolic and pulse pressure. Surrogate indices such as the augmentation index (AIx), suggest increased susceptibility for wave reflection in women. Methods and Results: Carotid pressure and central flow waveforms were acquired non-invasively in 2132 apparently healthy subjects (1093 F/1039 M), aged between 35 and 55 at inclusion (a subgroup of the ‘Asklepios’ population). Input impedance, reflection coefficient |Γ1| and the ratio of backward-to-forward pressure amplitude, Pb/Pf, both direct measures of wave reflection, were derived. AIx was assessed using (automated) identification of characteristic points on the pressure waveform, and the effective length of the arterial tree, Leff, was calculated from the timing of the reflected wave and pulse wave velocity. In addition, we calculated AIx* and Leff* where information from pressure andflow was used to obtain the timing of the reflected wave (through wave separation analysis). Both |Γ1| (from 0.4143±0.0033 at age 38 to 0.4618±0.0048 at 54; mean±SEM) and Pb/Pf(0.4491±0.0033 to 0.5038±0.0044) increased with age (P &lt; 0.001) without gender differences. AIx also increased with age, but was persistently higher in women (P &lt; 0.001), while Leffspuriously increased with age. Interestingly, while still increasing with age, there was virtually no gender difference in AIx* and Leff* demonstrated the anticipated shift of reflection sites towards the heart. Conclusion: With ageing, wave reflection increases to a similar degree in middle-aged healthy men and women. Analysis of wave reflection, using a modified AIx*, appears to yield more consistent results than conventional AIx.

Background The association between fibrinogen and smoking behaviour, age, body mass index, blood pressure, heart rate and plasma lipid profile, was assessed in a cohort of middle-aged working men. Methods Seven hundred and forty five subjects were examined as part of a health intervention programme at the worksite. Nine subjects were excluded from the study because of prevalent diabetes. Correlates of plasma fibrinogen concentrations were evaluated through univariate and multivariate methods Results In multiple regression analysis fibnnogen correlated with age, smoking behaviour, apolipoprotein B (apo B) apolipoprotein A-l (apo A-l) and lipoprotein (a) (Lp(a)) levels, which together explained 11% of the variation in fibrinogen concentration. From this model, fibrinogen concentration was associated with an increase of 13.6 mg/dl for every 10 years' increase in age, 28.2 mg/dl if a person smoked, and 4.6 mg/dl and 3.8 mg/dl with a 20 mg/dl rise in respectively apo B and Lp(a). A 20 mg/dl increase in apo A-l concentrations was estimated to be associated with a 6.0 mg/dl lower fibrinogen level. Conclusions The data indicate that both biochemical and lifestyle factors are related to the plasma fibnnogen concentration; these interactions may explain partly the relationship between fibrinogen and cardiovascular disease.

Vanhoorne M (Department of Hygiene and Social Medicine, State University of Ghent, University Hospital, De Pintelaan 185, 9000 Ghent, Belgium), De Bacquer D and De Backer G. Epidemiological study of the cardiovascular effects of carbon disulphide. International Journal of Epidemiology 1992; 21: 745–752. In an extensive health survey 115 male viscose rayon workers exposed to carbon disulphide (CS2 and 76 referents not exposed to this chemical were interviewed using the WHO cardiovascular questionnaire and responded to a self-administered questionnaire. A 12-tead ECG was taken and coded using the Minnesota code. Blood pressure (BP) was measured electronically and blood was examined for lipoproteins. In the viscose rayon factory the working conditions had not changed since 1932. Personal monitoring performed in 17 jobs, showed exposures varying from 4 to 112 mg/m3. For each individual a CS2 cumulative exposure index (CS2 index) was calculated. There were no significant differences between exposed and referents concerning the prevalence of angina, history of myocardial infarction, intermittent claudication and ECG signs of ischaemia. Blood pressure, low density lipoprotein (LDL)-cholesterol and the apolipoproteins A1 and B rose while high density lipoprotein (HDL)-cholesterol, the HDL-cholesterol/apolipoprotein A1 and the LDL-cholesterol/apolipoprotein B ratios decreased significantly with increasing exposure. Adjustment for age, body mass index, smoking, alcohol consumption, stress and tension at work, shift work, noise exposure and educational level in multiple linear regression analysis showed significant effects of the CS2 index on systolic BP, diastolic BP, cholesterol, HDL-cholesterol, LDL-cholesterol, apolipoprotein Al, apolipoprotein B, the LDL cholesterol/apolipoprotein B and HDL cholesterol/apolipoprotein A1 ratios; there were no significant effects on the triglycerides.

A retrospective analysis of 48 patients with documented or probable invasive aspergillosis (IA) prior to bone marrow transplantation (BMT) was conducted in 16 centers. Treatment of primary IA was medical in all 48 patients and surgical in 20; clinicoradiological resolution of IA occurred in 30 of 48 patients. Pretransplantation risk factors for relapse IA, total mortality, and IA-related mortality were analyzed by multivariate logistic regression with the following dichotomous risk factors: surgery as part of the initial treatment, resolution of IA by the time of BMT, donor type, conditioning regiment, total-body irradiation, T cell depletion, immunosuppressive therapy, type of antifungal prophylaxis, and growth factor prophylaxis. Conditioning with busulfan/cyclophosphamide was associated with a beneficial outcome for total survival and reduced IA-related mortality. Posttransplantation risk factors such as the development of graft-vs.-host disease (GVHD), therapy for GVHD, and the duration of neutropenia did not have a significant effect on relapse IA, IArelated mortality, or total mortality. The overall incidence of relapse IA was lower than expected (33% [16 of 48 patients]), but the mortality rate among relapsed patients was 88% (14 of 16). Patients receiving prophylaxis with absorbable or intravenous antifungals had less relapses of IA than did those not receiving prophylaxis (12 of 41 vs. four of seven, respectively). This finding reflects the need for better prophylaxis and new antifungal treatments for patients undergoing BMT who have a history of IA.