Cold weather and GP consultations for respiratory conditions by elderly people in␣16 locations in the UK

Background: Cold weather is associated with increases in mortality and demands on hospital services in the UK, particularly by the elderly. Less is known about the relationship with patterns of consultation in primary care. We wished to determine the magnitude and consistency of associations between cold temperature and consultations for respiratory conditions in primary care settings at different sites in the UK. Methods: Time series analysis of any short-term effects of temperature on daily general practitioner (GP) consultations made by elderly people (65+ years) for lower and upper respiratory tract infections (LRTI, URTI) over a 10-year period, 1992–2001. Practices were situated in 16 urban locations across the UK where a Met Office monitoring station was in operation. Results: An association between low temperatures and an increase in LRTI consultations was observed in all 16 locations studied. The biggest increase was estimated for the Norwich practices for which a 19.0% increase in LRTI consultations (95% CI 13.6, 24.7) was associated with every 1 °C drop in mean temperature below 5 °C observed 0–20 days before the day of consultation. Slightly weaker relationships were observed in the case of URTI consultations. A north/south gradient, with larger temperature effects in the north, was in evidence for both LRTI and URTI consultations. Conclusions: An effect that was consistent and generally strongest in populations in the north was observed between cold temperature and respiratory consultations. Better understanding of the mechanisms by which cold weather is associated with increases in consultations for respiratory infections could lead to improved strategies for prevention and reduced burdens for health services.     

Better newborn vitamin D status lowers RSV-associated bronchiolitis in infants

Each year 1.5 million children under the age of 5 years die from pneumonia. In the United States, respiratory syncytial virus (RSV) is the number one cause of bronchiolitis and pneumonia in children under 1 year of age. Low serum 25(OH)D is associated with an increased risk of lower respiratory tract infections (LRTI). Two recent studies have provided important information concerning the association between cord blood 25(OH)D and subsequent risk of developing respiratory infection in very young children. These findings support the need in future studies to determine the extent to which an intervention to change the vitamin D status of mothers during pregnancy can reduce the risk of RSV-associated LRTI in their offspring. An answer to this question would have significant worldwide public health importance given the high prevalence of low vitamin D status worldwide and the high mortality burden accompanying infectious lung diseases in young children.     

Self-reported prevalence of warts in children and GP consultation

Objective: Respiratory infections are a frequent causes of medical attendance. Influenza viruses increases this phenomena. The aim of this study was to prospectively identify GPs’ increased work in terms of visits and time. Methods: Over a period of five months 5 GPs recorded sex, age, number and place of visits, telephone consultations of the patients visited for acute respiratory disease (ARD)which included acute respiratory infections (ARI), influenza (FLU) and Influenza-like illness (ILI). Upper respiratory tract infections (URTI) were classified as sinusitis, rhinitis, otitis, tonsillitis, pharyngitis, laryngitis, Lower respiratory tract infections (LRTI) were classified as tracheitis, bronchitis, pneumonia, bronchopneumonia, acute episodes of chronic obstructive pulmonary disease (COPD) and asthma. FLU and ILI were considered two different entities on the basis of symptoms. Results: Acute respiratory disease increase of 22 patients attending every GP's office monthly (from 176 to 198 total visits). 6542 patients were observed. The incidence of ARD was 33.5% (2191: 1091 female and 1100 males). URTI affected 944 patients, LRTI 739, FLU 328 and ILI 180. The increase in home visits grew from 10 to 36. Each home visit took from 15 to 45 minutes. In a high number of cases (236), home visits were necessary for sick-leave certificates. FLU (54%) and LRTI (37.5%) required more attention, and they were the primary causes for visits. Telephone consultations took place for all ILI or FLU of minor severity and in young people.

Conclusion: During the winter there is an increased work-load for GPs due to the diffusion of influenza virus and respiratory tract diseases. “Burn out syndrome” is increasing among the GPs. Territorial GPs’ action is highly efficacious. Patients self-certification should be evaluated. Vaccine therapy could be more effective if done on a larger population. More research is needed.     

Portrait of outpatient visits and hospitalizations for acute infections in Nunavik preschool children

OBJECTIVE: Inuit children from around the world are burdened by a high rate of infectious diseases. The objective of this study was to evaluate the incidence rate of infections in Inuit preschool children from Nunavik (Northern Québec). METHODS: The medical chart of 354 children from a previously recruited cohort was reviewed for the first five years of life. All outpatient visits that led to a diagnosis of acute infection and all admissions for acute infections were recorded. RESULTS: Rates of outpatient visits for acute otitis media (AOM) were 2314, 2300, and 732 events/1000 child-years for children 0-11 months, 12-23 months, and 2-4 years, respectively. Rates of outpatient visits for lower respiratory tract infections (LRTI) were 1385, 930, and 328 events/1000 child-years, respectively. Rates of hospitalization for pneumonia were 198, 119, and 31 events/1000 child-years, respectively. CONCLUSION: Inuit children from Nunavik have high rates of AOM and LRTI. Such rates were higher than that of other non-native North-American populations previously published. Admission for LRTI is up to 10 times more frequent in Nunavik compared to other Canadian populations.     

Upper respiratory tract infection in children, domestic temperatures, and humidity.

STUDY OBJECTIVE--The aim of the study was to seek for a possible association between the incidence of upper respiratory tract infections and air temperature and humidity in the home. DESIGN--Recordings of temperature and relative humidity were made in living rooms and children's bedrooms over a six month period and related to incidence of upper respiratory tract infection. SETTING--The study was carried out in one general practice of 10,000 patients. PATIENTS--297 children aged 24-59 months were studied, selected in random order from the practice age-sex register. MEASUREMENTS AND MAIN RESULTS--Temperature and humidity recordings were made with thermohygrograph recorders over six days. Upper respiratory tract infections were recorded (a) retrospectively over the previous 12 months, and (b) during the study period. Past history of acute otitis media and recent family history of respiratory infection were also obtained. No significant association was found between the variables, although the bedrooms of children with reported upper respiratory tract infections were cooler overnight than those of non-infected children (mean difference 0.8 degrees C, 95% confidence limits 0.7 degrees C). No association was found between reported or recorded upper respiratory tract infections and age or type of home, family size, level of occupancy, social class, or smoking habits. Only 15 children (5%) were identified by their parents as having had asthma, but 58 (19.5%) had had a "wheezy chest". A greater proportion of children who wheezed slept in cooler bedrooms, had gas fires rather than central heating, and had more smokers in the house. CONCLUSIONS--No association between upper respiratory tract infection and domestic temperature or humidity levels could be shown in this study. Since dampness is repeatedly presented as a health risk, further study is required.     

北京儿童医院下呼吸道感染住院患儿血清腺病毒抗体检测分析

目的了解北京儿童医院急性下呼吸道感染住院患儿的腺病毒（ADV）感染情况。方法研究对象为北京儿童医院2004年10月至2005年12月临床诊断为肺炎或支气管炎的住院患儿。每例患儿的血清标本采用间接酶联免疫吸附试验检测ADV—IgM抗体。如果任意一种其他病毒抗体阳性（包括巨细胞病毒、EB病毒、单纯疱疹病毒、肠道病毒等），则不做ADV检测。结果738例其他病原检测阴性的下呼吸道住院患儿中，ADV—IgM阳性87例，阳性率11．8％。ADV下呼吸道感染占同期病例的8．3％（87／1046）。其中〈1岁的患儿32例（6、2％）；1～6岁42例（29、8％）；〉6岁13例（16．9％）。ADV感染全年散发，冬春季节相对较多。结论ADV是5岁以下儿童急性呼吸道疾病的主要病原之一；6月龄至3岁的儿童为易感人群。     

Impact of the 10-valent pneumococcal conjugate vaccine on hospital admissions in children under three years of age in Iceland

IntroductionPneumococcus is an important respiratory pathogen. The 10-valent pneumococcal vaccine (PHiD-CV) was introduced into the Icelandic vaccination programme in 2011. The aim was to estimate the impact of PHiD-CV on paediatric hospitalisations for respiratory tract infections and invasive disease.MethodsThe 2005–2015 birth-cohorts were followed until three years of age and hospitalisations were recorded for invasive pneumococcal disease (IPD), meningitis, sepsis, pneumonia and otitis media. Hospitalisations for upper- and lower respiratory tract infections (URTI, LRTI) were used as comparators. The 2005–2010 birth-cohorts were defined as vaccine non-eligible cohorts (VNEC) and 2011–2015 birth-cohorts as vaccine eligible cohorts (VEC). Incidence rates (IR) were estimated for diagnoses, birth-cohorts and age groups, and incidence rate ratios (IRR) between VNEC and VEC were calculated assuming Poisson variance. Cox regression was used to estimate the hazard ratio (HR) of hospitalisation between VNEC and VEC.Results51,264 children were followed for 142,315 person-years, accumulating 1,703 hospitalisations for the respective study diagnoses. Hospitalisations for pneumonia decreased by 20% (HR 0.80, 95%CI:0.67–0.95) despite a 32% increase in admissions for LRTI (HR 1.32, 95%CI:1.14–1.53). Hospital admissions for culture-confirmed IPD decreased by 93% (HR 0.07, 95%CI:0.01–0.50) and no hospitalisations for IPD with vaccine-type pneumococci were observed in the VEC. Hospitalisations for meningitis and sepsis did not change. A decrease in hospital admissions for otitis media was observed, but did not coincide with PHiD-CV introduction.ConclusionFollowing the introduction of PHiD-CV in Iceland, hospitalisations for pneumonia and culture confirmed IPD decreased. Admissions for other LRTIs and URTIs increased during this period.     

商州地区5岁以下小儿下呼吸道感染1 200例病原学检测分析

目的 分析商州地区1 200例5岁以下小儿下呼吸道感染患儿的病原学检测结果,为临床诊治提供参考依据。 方法 对商州地区1 200例5岁以下下呼吸道感染患儿呼吸道分泌物进行病原学鉴定和药敏试验,并对检测结果进行统计学分析。 结果 <3个月的下呼吸道感染的患儿病原检测阳性率最高,高达75.9%(309/407),病原检测的阳性率随患儿年龄增大逐渐降低。3岁以下患儿以感染呼吸道合胞病毒最常见。患儿细菌感染以肺炎克雷伯菌最常见,肺炎链球菌和大肠埃希菌次之。肺炎球菌对于头孢类药物以及非常规使用的抗生素诸如利福平、氯霉素、万古霉素等敏感性好。肺炎克雷伯菌以及大肠埃希菌对于亚胺培南均有很高的敏感性。 结论 病毒学检测、细菌学检测以及细菌药敏试验对于下呼吸道感染的诊断及治疗均有着重要的意义。     

The risk of lower respiratory tract infection following influenza virus infection: A systematic and narrative review

BackgroundLower respiratory tract infections (LRTI) are a major cause of morbidity and mortality worldwide, particularly in young children and older adults. Influenza is known to cause severe disease but the risk of developing LRTI following influenza virus infection in various populations has not been systematically reviewed. Such data are important for estimating the impact specific influenza vaccine programs would have on LRTI outcomes in a community. We sought to review the published literature to determine the risk of developing LRTI following an influenza virus infection in individuals of any age.Methods and findingsWe conducted a systematic review to identify prospective studies that estimated the incidence of LRTI following laboratory-confirmed influenza virus infection. We searched PubMed, Medline, and Embase databases for relevant literature. We supplemented this search with a narrative review of influenza and LRTI. The systematic review identified two prospective studies that both followed children less than 5 years. We also identified one additional pediatric study from our narrative review meeting the study inclusion criteria. Finally, we summarized recent case-control studies on the etiology of pneumonia in both adults and children.ConclusionsThere is a dearth of prospective studies evaluating the risk of developing LRTI following influenza virus infection. Determining the burden of severe LRTI that is attributable to influenza is necessary to estimate the benefits of influenza vaccine on this important public health outcome. Vaccine probe studies are an efficient way to evaluate these questions and should be encouraged going forward.     

Early-Life Exposure to Outdoor Air Pollution and Respiratory Health,Ear Infections,and Eczema in Infants from the INMA Study

Background: Prenatal and early-life periods may be critical windows for harmful effects of air pollution on infant health.Objectives: We studied the association of air pollution exposure during pregnancy and the first year of life with respiratory illnesses, ear infections, and eczema during the first 12–18 months of age in a Spanish birth cohort of 2,199 infants.Methods: We obtained parentally reported information on doctor-diagnosed lower respiratory tract infections (LRTI) and parental reports of wheezing, eczema, and ear infections. We estimated individual exposures to nitrogen dioxide (NO₂) and benzene with temporally adjusted land use regression models. We used log-binomial regression models and a combined random-effects meta-analysis to estimate the effects of air pollution exposure on health outcomes across the four study locations.Results: A 10-µg/m³ increase in average NO₂ during pregnancy was associated with LRTI [relative risk (RR) = 1.05; 95% CI: 0.98, 1.12] and ear infections (RR = 1.18; 95% CI: 0.98, 1.41). The RRs for an interquartile range (IQR) increase in NO₂ were 1.08 (95% CI: 0.97, 1.21) for LRTI and 1.31 (95% CI: 0.97, 1.76) for ear infections. Compared with NO₂, the association for an IQR increase in average benzene exposure was similar for LRTI (RR = 1.06; 95% CI: 0.94, 1.19) and slightly lower for ear infections (RR = 1.17; 95% CI: 0.93, 1.46). Associations were slightly stronger among infants whose mothers spent more time at home during pregnancy. Air pollution exposure during the first year was highly correlated with prenatal exposure, so we were unable to discern the relative importance of each exposure period.Conclusions: Our findings support the hypothesis that early-life exposure to ambient air pollution may increase the risk of upper and lower respiratory tract infections in infants.     

Incidence of GP-diagnosed respiratory tract infections according to age, gender and high-risk co-morbidity: the Second Dutch National Survey of General Practice

BACKGROUND: Figures on GP-diagnosed respiratory tract infections (RTI) are outdated because of demographic changes and increase in co-morbid conditions, respiratory vaccination programmes and change in illness behaviour. OBJECTIVE: To determine the incidence of RTI in patients presenting to the GP according to age, gender and common high-risk co-morbidity in primary care. METHODS: In the Second Dutch National Survey of General Practice 90 computerized general practices with 358,008 patients recorded all consecutive patient contact by use of the ICPC coding system in a year. Incidences were calculated using the mid-year population in the denominator and RTI episodes as the nominator. RESULTS: In all, 4.2% of the patient population were diagnosed with RTI with an incidence rate of 144 per 1000 person-years. Upper RTI were more common in children of 0-4 years than in other year-cohorts [392 versus 80 per 1000; relative risk 4.9, 95% confidence interval (95% CI) 4.8-5.0]. An U-shape association was observed between age and lower RTI (78 and 70 per 1000 in children and persons aged 75 years or over, respectively, versus 23 per 1000 in other age-categories). Females had slightly higher incidence rates of URTI (relative risk 1.4, 95% CI 1.35-1.45) and similar rates for LRTI. Patients with chronic medical conditions as pulmonary and cardiac disease, and diabetes. DISCUSSION: A small proportion of the patient population present themselves to the GP with a RTI. RTI are more common among children, elderly persons and patients with pulmonary and cardiac disease, and diabetes of the ICPC coding system.     

Validation of the diagnosis of childhood morbidity using maternal health interviews

The diagnosis of childhood illness by maternal health interview surveys is widely used to estimate the prevalence of childhood morbidity in developing countries. To determine the validity of interview-based diagnoses, and to define simple, sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers during structured interviews with physicians' diagnoses for 271 children on the Philippine island of Cebu. The 271 children had 318 physician diagnosed illnesses: 105 acute lower respiratory infections (ALRI), 121 diarrhoeas, 36 measles, 50 upper respiratory infections (URTI), 5 roseola infantums and one milaria rubria. An algorithm for measles (age greater than or equal to 120 days, rash and fever greater than or equal to 3 days and fading of rash) had a sensitivity and specificity of 94%. For ALRI an algorithm of cough, dysponea and fever had a sensitivity of 82%, but specificity was lower in comparison with URTI (58%) than with children who had no respiratory illness (79%). Inclusion of signs of respiratory distress (flaring of nostrils, intercostal retraction) raised the specificity to 83-84%, but reduced sensitivity to 68%. Diagnosis of diarrhoea based on frequent loose or liquid stools had a sensitivity of 95-97% and specificity of 80% in children with or without concomitant non-diarrhoeal illnesses. Addition of questions on numbers of stools (greater than or equal to 6 per day), and no signs of dehydration increased specificity to 95% but reduced the sensitivity to 84-86%. However, specific signs of dehydration were not well reported by the mothers.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of asthma and other respiratory symptoms in children living near and away from opencast coal mining sites.

BACKGROUND: Public concern about respiratory conditions prompted the investigation of asthma and other respiratory diseases in children living near and away from opencast coal mining sites. METHODS: We selected all 4860 children aged 1--11 years from five socioeconomically matched pairs of communities close to (OC) and away from (CC) active opencast sites. A postal questionnaire collected data on health and lifestyle. Outcomes were the cumulative and period prevalence (2 and 12 months) of wheeze, asthma, bronchitis and other respiratory symptoms. RESULTS: The cumulative prevalence of wheeze varied from 30% to 40% across the ten communities, it was 36% in OC and 37% in CC. The cumulative prevalence of asthma was 22% in both OC and CC, varying between 12% and 24%. We found little evidence for associations between living near an opencast site and an increased prevalence of respiratory illnesses, or asthma severity. Some outcomes such as allergies, hayfever, or cough varied little across the study communities. Others, such as the use of asthma medication, the number of severe wheezing attacks in the past year or tonsillitis showed large variation. These similarities and variations were not explained by differences in lifestyle factors or differences in health services delivery and remain unexplained. CONCLUSIONS: There was little evidence of an association between residential proximity to opencast mining sites and cumulative or period prevalence of respiratory illness, or asthma severity. Some variations in health outcomes between communities remained unexplained.     

Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children,Kenya

Severe lower respiratory tract infection (LRTI) in infants caused by respiratory syncytial virus (RSV) has been associated with later pneumonia hospitalization among children. To determine risk for pneumonia after RSV hospitalization in infancy, we conducted a retrospective cohort analysis of 2,813 infants admitted to a hospital in Kenya and identified readmissions for pneumonia among this group during early childhood (<60 months of age). Incidence of readmission for pneumonia was higher for children whose first admission as infants was for LRTI and who were <3 months of age than for children who were first admitted as infants for non-LRTI, irrespective of RSV status. Incidence of readmission for pneumonia with wheeze was higher for children whose first admission involved RSV compared with those who had non-RSV LRTI. Excess pneumonia risk persisted for 2 years after the initial hospitalization. Close postdischarge follow-up of infants with LRTI, with or without RSV, could help prevent severe pneumonia later in childhood.     

Human Bocavirus and KI/WU Polyomaviruses in Pediatric Intensive Care Patients

We evaluated the prevalence of human bocavirus and KI and WU polyomaviruses in pediatric intensive care patients with and without lower respiratory tract infection (LRTI). The prevalence of these viruses was 5.1%, 0%, and 2.6%, respectively, in children with LRTI and 4.8%, 4.8%, and 2.4%, respectively, in those without LRTI.     

周口市240名0～3岁儿童佝偻病患病情况调查及血25(OH)D_3水平分析

目的:了解周口市0～3岁小儿佝偻病患病情况,分析25(OH)D3与骨碱性磷酸酶(BALP)在佝偻病诊断中的价值。方法:抽取周口市0～3岁小儿样本240例,采用问卷调查方法对小儿营养状况、既往病史、饮食习惯、生活环境、户外活动等情况进行调查,并测定小儿身高、体重、血清钙、磷、25(OH)D3和BALP水平。结果:240例小儿中患佝偻病25例,患病率为10.42%,其中0～6个月龄患病率最高为20.97%,明显高于其他年龄段患病率(P<0.05)。佝偻病患病率与小儿喂养方式、居住环境、饮食习惯、户外活动和反复呼吸道感染有关,差异有统计学意义(P<0.01)。佝偻病患儿血清25(OH)D3和BALP水平明显低于非佝偻病小儿(P<0.01)。结论:0～6个月龄是小儿佝偻病高发段,儿童佝偻病患病与喂养方式、居住环境、饮食习惯、户外活动和反复呼吸道感染有关,其血清25(OH)D3和BALP明显低于健康儿童。     

Pandemic (H1N1) 2009 infection in patients with hematologic malignancy

To assess outcomes of patients with hematologic malignancy and pandemic (H1N1) 2009 infection, we reviewed cases during June-December 2009 at the University of California San Francisco Medical Center. Seventeen (63%) and 10 (37%) patients had upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI), respectively. Cough (85%) and fever (70%) were the most common signs; 19% of patients had nausea, vomiting, or diarrhea. Sixty-five percent of URTI patients were outpatients; 35% recovered without antiviral therapy. All LRTI patients were hospitalized; half required intensive care unit admission. Complications included acute respiratory distress syndrome, pneumomediastinum, myocarditis, and development of oseltamivir-resistant virus; 3 patients died. Of the 3 patients with nosocomial pandemic (H1N1) 2009, 2 died. Pandemic (H1N1) 2009 may cause serious illness in patients with hematologic malignancy, primarily those with LRTI. Rigorous infection control, improved techniques for diagnosing respiratory disease, and early antiviral therapy can prevent nosocomial transmission and optimize patient care.     

关于对本刊统一使用"结核分枝杆菌"名称的建议

分枝杆菌属（Mycobacterium）是一类细长或稍弯的杆菌，因有分枝生长的趋势而得名。Lehmann和Neumann在1896年第一次建立了“Mycobacterium”一词。结核分枝杆菌（Mycobacterium tuberculosis）是引发人类结核病的病原菌。根据词义和细菌形态学特点，     

Impact of infection on the growth of children from 0 to 2 years in an urban West African community

To determine the relationship between growth and morbidity in the first 2 y of life, we studied a cohort of 126 newborns in a Gambian township. Mean weight-for-age exceeded the National Center for Health Statistics (NCHS) standards in the first half of infancy but there was a mean deficit of 1.2 kg by age 1 y. Only two diseases contributed significantly to weight faltering: diarrheal diseases were estimated to cause one-half of the deficit and lower respiratory tract infections (LRTI) one-quarter. LRTI reduced weight gain in young children by 14.7 g/d of infection and diarrheal diseases in weaning infants by 14.4 g/d. Diarrhea had no significant impact on the growth of exclusively breast-fed infants. Growth velocity was normal in the second year of life, despite continuing infections.     

Nitrogen dioxide is not associated with respiratory infection during the first year of life

BACKGROUND: Nitrogen dioxide (NO(2)) has been related to respiratory infections in experimental studies but its role remains controversial in general population studies of children. We aim to assess the association between indoor NO(2) and lower respiratory tract infections (LRTI) during the first year of life in a multicentre prospective cohort study. METHODS: Children (n = 1611) were recruited prior to birth for the Asthma Multicentre Infants Cohort Study (AMICS). Three concurrent cohorts (Ashford, Kent [UK]; Barcelona city, and Menorca Island [Spain]) followed the same research protocol. NO(2) was measured with passive diffusion tubes placed in the living room for 2 weeks when infants were approximately 3 months old. Doctor-diagnosed LRTI during the first year of life (as well as antibiotic use) were measured by questionnaire, and in Ashford validated by the examination of clinical records. In Barcelona, direct measurements using nasopharyngeal lavage and cultures within a continuous surveillance system were done. RESULTS: The cumulative rates of LRTI (39% in Ashford, 28% in Barcelona, and 45% in Menorca) were unrelated to NO(2) levels (corresponding medians 6, 46, and 12 ppb, respectively) in all three centres (all odds ratios being around 1). Similarly, the rates of LRTI in Barcelona measured with the continuous record showed no association with NO(2) (all rate ratios being below 1). In addition, there was no association between rate of antibiotics courses per year per child (2.4 in Ashford, 1.7 in Barcelona, 0.9 in Menorca) and NO(2) levels. CONCLUSIONS: Indoor NO(2) at current levels does not seem to be involved in increasing respiratory infections by itself in infants, suggesting that the effects observed in studies on outdoor air are probably due to other copollutants.