A case control study was carried out in order to evaluate the various factors which may influence the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) infections in a skilled nursing home. From April 1991 to March 1994, bacterial cultures were performed in 55 out of 102 residents in a nursing home based on various clinical aspects.We divided 102 residents into following three groups ; (1) the MRSA group (n=1 0), residents whose materials for bacterial culture were positive for MRSA, (2) the non-MRSA group (n=45), residents whose specimens were negative for MRSA but positive for other bacteria, (3) the control group (n=47), residents who did not have to undergo a bacterial culture because they were free from moderate and severe infectious diseases.Compared with the control group, the activities of daily living score and the serum albumin level were significantly lower in the MRSA group and the non-MRSA group at the beginning of the study. In contrast, the number of antibiotics used prior to the bacterial culture and the proportion of hospitalization within 6 months prior to the bacterial culture were significantly larger in the MRSA group than in either the non-MRSA group, or the control group. These results thus suggest that a low activities of daily living score, the use of many kinds of antibiotics and a recent previous hospitalization may be risk factors of MRSA infection in a nursing home environment.

A cohort study consisting of 4,291 residents of a Japanese community has been conducted since 1987. The associations between stressful feelings measured by Stress Arousal Checklist (SACL) and mortality of all causes and cancer were examined. The relative risks (RRs) for mortality for 7 years for high stressful state (SACL score:7-17) and moderate stressful state (3-6) subjects compared with low stressful state subjects (0-2) were 1.1 (95% CI=0.69-1.68), 1.3 (95% CI=0.85-2.00) for all causes and 1.5 (95% CI=0.80-2.99), 1.3 (95% CI=0.67-2.61) for cancer respectively, after being adjusted for sex, age, smoking, drinking, exercise and medical care use. When each item of the SACL was examined independently, six out of 17 items of SACL which were "not comfortable", "not contented", "not cheerful", "dejected", "nervous", "not pleasant" showed elevated RRs for all causes of mortality with statistical significance (RRs: 1.4, 1.4, 1.7, 1.7, 1.5, 1.5, respectively), after being adjusted for the possible confounding factors stated above. Especially, the adjusted RRs of "not cheerful" and "dejected" for all causes was 1.7 (95% CI=1.20-2.33), 1.7 (95% CI=1.17-2.46), respectively. The results suggested that stressful feelings of "not cheerful" and "dejected" might increase mortality.

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