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Primary Exposure (primary + exposure)
Selected AbstractsProtective effect of single-dose adjuvanted pandemic influenza vaccine in childrenINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 4 2010P. G. Van Buynder Please cite this paper as: Van Buynder et al. (2010) Protective effect of single-dose adjuvanted pandemic influenza vaccine in children. Influenza and Other Respiratory Viruses 4(4), 171,178. Background, During the first wave of A/California/7/2009(H1N1) influenza, high rates of hospitalization in children under 5 years were seen in many countries. Subsequent policies for vaccinating children varied in both type of vaccine and number of doses. In Canada, children 36 months to <10 years received a single dose of 0·25 ml of the GSK adjuvanted vaccine (ArepanrixÔ) equivalent to 1·9 ,g HA. Children 6 months to 35 months received two doses as did those 36,119 months with chronic medical conditions. Method, We conducted a community-based case,control vaccine effectiveness (VE) review of children under 10 years with influenza like illness who were tested for H1N1 infection at the central provincial laboratory. Laboratory-confirmed influenza was the primary outcome, and vaccination status the primary exposure to assess VE after a single 0·25-ml dose. Results, If vaccination was designated to be effective after 14 days, no vaccinated child had laboratory-confirmed influenza compared to 38% of controls. The VE of 100% was statistically significant for children <10 years of age and <5 years considered separately. If vaccination was considered effective after 10 days, VE dropped to 96% overall but was statistically significant and over 90% in all age subgroups, including those under 36 months. Conclusions, A single 0·25-ml dose of the GSK adjuvanted vaccine (ArepanrixÔ) protects children against laboratory-confirmed pandemic influenza potentially avoiding any increased reactogenicity associated with second doses. Adjuvanted vaccines offer hope for improved seasonal vaccines in the future. [source] Association offirst-trimester low PAPP-A levels with preterm birth,,PRENATAL DIAGNOSIS, Issue 4 2010Katherine R. Goetzinger Abstract Objective To determine the association of, and predictive ability of, pregnancy-associated plasma protein A (PAPP-A), free ,-human chorionic gonadotrophin (,-hCG), and nuchal translucency (NT) with preterm birth (PTB). Methods A 5-year retrospective cohort study of women who underwent first-trimester combined screening was performed. Maternal medical, antepartum, and pregnancy outcome data were obtained. PAPP-A and ,-hCG were converted to multiples of the median (MoM), and primary exposure was defined as ,10th percentile MoM for PAPP-A. Secondary exposures were defined as , 90th percentile MoM for ,-hCG and NT values of , 20 and 25 mm. The primary outcome was PTB before 35 weeks and the secondary outcome was PTB before 32 weeks. Univariate, bivariate, multivariate, and receiver,operator analyses were used. Results Of the 2231 patients meeting inclusion criteria with complete outcome data available, 222 had a PAPP-A level ,10th percentile MoM. Abnormally low PAPP-A was associated with an increased risk for PTB < 35 weeks [adjusted odds ratio (aOR) 2.0, 1.0,3.8] and < 32 weeks (aOR 2.7, 1.1,6.4), even after adjusting for prior PTB, tobacco exposure, chronic hypertension, and body mass index. PAPP-A ,10th percentile was not sufficiently predictive of PTB < 35 weeks (area under curve = 0.63, 95% CI 0.53,0.72). Neither abnormally high ,-hCG nor increased NT was associated with an increased risk for PTB. Conclusions PAPP-A ,10th percentile is associated with an increased risk for PTB, but is not sufficiently predictive to be used clinically. Copyright © 2010 John Wiley & Sons, Ltd. [source] Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the motherBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2010JA Lykke Please cite this paper as: Lykke J, Paidas M, Damm P, Triche E, Kuczynski E, Langhoff-Roos J. Preterm delivery and risk of subsequent cardiovascular morbidity and type-II diabetes in the mother. BJOG 2010;117:274,281. Objective, Preterm delivery has been shown to be associated with subsequent maternal cardiovascular morbidity. However, the impact of the severity and recurrence of preterm delivery on the risk of specific cardiovascular events and the metabolic syndrome in the mother, have not been investigated. Design, National registry-based retrospective cohort study. Setting, Women delivering in Denmark from 1978 to 2007. Population, Women with a first singleton delivery (n = 782 287), and with a first and second singleton delivery (n = 536 419). Methods, Cox proportional hazard models, with the gestational age stratified into four groups as primary exposure. We made adjustments for maternal age, year of delivery, hypertensive pregnancy disorders, fetal growth deviation, placental abruption and stillbirth. Main outcome measures, Subsequent maternal hypertension, ischaemic heart diseases, thromboembolism and type-II diabetes. Results, After a first delivery at 32,36 completed weeks of gestation, the adjusted risk of subsequent type-II diabetes increased 1.89-fold (1.69,2.10) and the risk of thromboembolism increased 1.42-fold (1.24,1.62). Women having a preterm delivery in the first pregnancy and a term delivery in the second had a 1.58-fold (1.34,1.86) increased risk of type-II diabetes and a 1.18-fold (0.96,1.44) increased risk of thromboembolism. Women having two preterm deliveries had a 2.30-fold (1.71,3.10) increased risk of type-II diabetes and a 1.80-fold (1.29,2.50) increased risk of thromboembolism. Conclusions, Preterm delivery is independent of other pregnancy complications associated with subsequent maternal overt type-II diabetes and thromboembolism. The recurrence of preterm delivery will augment these risks. [source] The Need for Emergency Medicine Resident Training in Informed Consent for ProceduresACADEMIC EMERGENCY MEDICINE, Issue 9 2007Theodore Gaeta DO Objectives: To determine emergency medicine (EM) residents' perceptions and reported practices of obtaining informed consent for emergency department procedures. Methods: The authors performed a cross-sectional observational study of EM residents. A brief, short-answer survey was distributed that covered the following topics related to informed consent: training, confidence and comfort levels, and current practices. Data were analyzed using basic frequency displays, and descriptive statistics are reported. Results: Of the 20 programs contacted, 16 responded and agreed to distribute the invitation to their residents. A total of 402 of 490 eligible residents (82%) in the participating programs responded. The majority of EM residents (56%) had never received formal training on obtaining informed consent, and those who had reported that their primary exposure to formal training occurred during their medical school years (79%). More than half of the residents (56%) have felt uncomfortable obtaining consent for a procedure. Few residents (32%) felt very confident that they provide comprehensive information to patients, while 9% were not very confident that they disclose all pertinent risks, benefits, and alternatives to their patients. Sixty-three percent of all EM residents believed formal training is necessary, and half (52%) reported interest in receiving training (i.e., listings of risks, benefits, and alternatives as well as standards for determining which procedures need consent). The residents' current perceptions of consent requirements for commonly performed emergency department procedures (emergent and nonemergent) are also reported. Conclusions: Few residents have had formal training in informed consent, and there is wide variability in the perception of which procedures require informed consent. Residents are not confident in their knowledge of all risks and benefits of common procedures, and comfort levels in obtaining informed consent are low. Residents can benefit from additional resources that provide standardized information and formal training on the issue. [source] Associations Between Adolescent Risk Behaviors and Injury: The Modifying Role of DisabilityJOURNAL OF SCHOOL HEALTH, Issue 1 2009Sudha R. Raman PT ABSTRACT BACKGROUND:, Adolescents with disabilities are at risk for poor health outcomes including injury. The objective of this study was to examine if disability status modifies the association between risk behavior and injury among adolescents. METHODS:, The cross-sectional Health Behavior in School-Aged Children Survey was administered to a representative sample of 7235 Canadian students (grades 6-10) in 2002. Students who reported at least 1 functional difficulty due to a health condition were classified as having a disability. Engagement in up to 6 individual risk behaviors and a summative multiple risk behavior score were considered the primary exposures. Primary outcomes included medically attended injury experienced during a 12-month period. RESULTS:, Sixteen percent of students reported a disability. Almost all risk behaviors and all injury outcomes were more common among students with disabilities than in those without disabilities (eg, older age group's smoking: 17.5% vs 8.9%, p = <.01; medically attended injury: 67.4% vs 51.4%, p = <.01). Clear risk gradients were observed between engagement in multiple risk behavior and all injury outcomes. The association between multiple risk behavior and injury was accentuated by disability status among older students, particularly for students with disabilities who engaged in frequent multiple risk behavior (adjusted risk ratio 1.8, 95% CI: 1.6-1.9). CONCLUSIONS:, Canadian students with disabilities who engage in risk behaviors experience higher risks for medically attended injury than their nondisabled peers who engage in those same risk behaviors. Injury prevention programs that focus on risk-taking behavior should integrate the needs of this high-risk group of adolescents in order to prevent additional disability. [source] | ||||||||||