Pediatric vaccination errors: Application of the “5 Rights” framework to a national error reporting database

Little is known about vaccination errors. We analyzed 607 outpatient pediatric vaccination error reports from MEDMARX, a nationwide, voluntary medication error reporting system, occurring from 2003 to 2006. We used the “5 Rights” framework (right vaccine, time, dose, route, and patient) to determine whether vaccination error types were predictable. We found that “wrong vaccine” errors were more common among look-alike/sound-alike groups than among vaccines with no look-alike/sound-alike group. Scheduled vaccines were more often involved in “wrong time” errors than seasonal and intermittent vaccines. “Wrong dose” errors were more common for vaccines whose dose is weight-based and age-based than for vaccines whose dose is uniform. “Wrong route” and “wrong patient” errors were rare. In this largest-ever analysis of pediatric vaccination errors, error types were associated with predictable vaccine-related human factors challenges. Efforts to reduce pediatric vaccination errors should focus on these human factors.     

Alcohol-drinking patterns and metabolic syndrome risk: the 2007 Korean National Health and Nutrition Examination Survey

Alcohol consumption has been known to be related to the prevalence of metabolic syndrome (MS). Although some studies have revealed that mild to moderate alcohol consumption reduces the risk of MS, most of these studies have focused the effect of alcohol consumption amount on MS. We examined the association between alcohol-drinking patterns and MS by using the alcohol use disorders identification test (AUDIT) questionnaire to study 1,768 alcohol drinkers (847 men, 921 women) aged 20-75 years from Korean National Health and Nutrition Examination Survey in 2007. When compared with the subjects in the reference group (AUDIT score ≤7), the odds ratios (ORs, 95% confidence intervals [CIs]) for MS of subjects in the highest group (AUDIT score ≥16) were 3.92 (2.40-6.22) in men and 2.27 (0.87-5.89) in women after adjusting for confounding variables. Among the items of the AUDIT score, several alcohol-drinking patterns, including “drinking frequency,” “usual drinking quantity,” “frequency of high-risk drinking,” “frequency of inability to stop drinking,” “frequency of feeling guilty after drinking,” and “frequency of inability to remember after drinking” were strongly associated with the prevalence of MS in men. In women, there were significant relationships between MS and “usual drinking quantity,” “frequency of feeling guilty after drinking,” and “frequency of inability to stop drinking.” In summary, AUDIT score was strongly associated with MS in Korean adults, particularly in men. Accordingly, in addition to the amount of daily alcohol consumption, alcohol-drinking patterns should be addressed in the prevention and treatment of MS.     

Le risque mycotoxique dans la chaîne alimentaire en France

Mycotoxins are toxic metabolites produced by molds or fungi growing on plants all along the food chain, from the field until their consumption by humans and animals. They are found all along the food chain since they can be carried over in their native form or metabolites into the biological fluids or tissues of livestock animals, and in processed food. Intake of animal products can give an “indirect intoxication”. However, it must be considered that animals play a major “filter role“ since only 1-6% of ingested mycotoxins are transferred into the animal products. Mycotoxins have various toxic effects. Some are carcinogenic, and others are teratogenic or immunosuppressive. Acute mycotoxicoses are rare, whereas chronic intoxications are probably frequent but difficult to diagnose.     

Self-rated health between psychology and biology. A response to Huisman and Deeg

In their commentary on my article “What is self-rated health and why does it predict mortality? Towards a unified conceptual model”, Martin Huisman and Dorly Deeg argue, first, that the model I suggest may exaggerate the rational elements in the process of assessment and ignore the irrational and illogical influences; and, second, that self-rated health should be best understood not as a measure of “true health”, but as a measure of people's perceptions about their health. My response to these comments attempts to clarify the nature of the model as a tool for describing the conceptual and logical structure of the evaluation, not the empirical process itself. Psychological and external influences, including “irrational” elements, can be understood as belonging to the contextual framework of evaluation. There is no question that self-rated health represents individual self-perceptions, but to explain its association with mortality it is crucial to understand its relationship to the biological and physiological states of the organism.     

家蝇转录组丝氨酸蛋白酶抑制因子分析

目的为了寻求有效控制家蝇的分子靶标,对家蝇丝氨酸蛋白酶抑制因子的主要种类进行初步探讨。方法从家蝇转录组数据库中,筛查出所有注释为丝氨酸蛋白酶抑制因子的Unigenes,利用生物信息学分析技术,对这些Unigenes序列做比对、聚类与结构功能特点分析,并参照已报道的其他物种的丝氨酸蛋白酶抑制因子,对家蝇丝氨酸蛋白酶抑制因子进行初步分类。结果从家蝇转录组库中共筛选出133条注释为丝氨酸蛋白酶抑制因子的Unigenes,其中,值得分析的序列有59条,具有典型丝氨酸蛋白酶抑制因子结构域的有22条,它们被初步分成11类。结论本研究首次鉴定了11种家蝇丝氨酸蛋白酶抑制因子基因,为生物控制家蝇提供了重要的候选靶标。     

Barriers of enrolment in HIV vaccine trials: a review of HIV vaccine preparedness studies

Barriers to participation in an HIV vaccine trial have been examined in many HIV vaccine preparedness studies (VPS). These barriers can be understood in terms of the locus of the barrier (personal vs. social) and the nature of the barrier (risk vs. cost). Another type of barrier is perceived misconceptions. In this systematic review, we categorize barriers, and compare these barriers between the Organization for Economic Co-operation and Development (OECD) countries and the non-OECD countries. In the OECD countries, we retrieved 25 studies reporting personal risks (PR), 9 studies reporting social risks (SR), 10 studies reporting personal costs (PC), and 16 studies reporting misconceptions. In the non-OECD countries, we retrieved 27 studies reporting PR, 19 studies reporting SR, 18 studies reporting PC, 1 study reporting social costs (SC), and 13 studies reporting misconceptions. Important PR were “adverse effects” and “vaccine-induced seropositivity”, “distrust of institutions”, and “temptation to have unsafe sex” in men who have sex with men (MSM). “Discrimination” was a common SR. “Time commitment” was an important PC, and “family commitments” were a SC in one non-OECD country. “HIV infection from the vaccine” was a common misconception. Both the OECD and the non-OECD countries have similar barriers, and people's decisions to participate in a clinical trial involve multiple barriers. However, these barriers apply to hypothetical HIV vaccine trials, and barriers for actual vaccine trials need further assessment.     

Evaluation of murine bone marrow-derived dendritic cells loaded with inactivated virus as a vaccine against Japanese encephalitis virus

Japanese encephalitis (JE) is a serious infectious disease in southern and eastern Asia. Design and development of safer and more efficacious vaccines against Japanese encephalitis virus (JEV) is a high-priority target in the world. Dendritic cells (DCs) are the most potent professional antigen-presenting cells (APCs) playing a central and unique role in the generation of primary T-cell responses, and are considered attractive “live adjuvants” for vaccination and immunotherapy against cancer and infectious diseases. In this study, mouse bone marrow-derived dendritic cells (bmDCs were generated and stimulated with inactivated JEV in vitro. BALB/c mice were immunized with stimulated bmDCs and then challenged with JEV wild-type strain. The neutralization antibody, interferon gamma (IFN-γ), tumor necrosis factors alpha (TNF-α) or interleukin-6 (IL-6), and virus-specific CD8+ cytotoxic T-lymphocyte (CTL) levels, as well as survival rates, were analyzed and compared with inactivated vaccine and DCs control groups. The results demonstrated that intravenous (i.v.) injection of 2 × 10⁵ JEV-pulsed bmDCs into each mouse produced notable levels of JEV-specific neutralizing antibodies and higher levels of CD8+ CTL, IFN-γ and TNF-α compared with JEV-inactivated vaccine. Furthermore, stimulated bmDCs could elicit a highly protective efficacy (90%) against JEV challenge. It suggests that stimulated bmDCs can be considered as an attractive “live adjuvant” for vaccination against JEV infection.     

The path traveled and the path ahead for the allostatic framework: A rejoinder on the framework's importance and the need for further work related to theory,data, and measurement

Ideas related to the newly introduced allostatic framework have caught on in the scientific community, and not without good reason. This short report highlights what we have gained from the framework by discussing the term “allostasis” in comparison to “homeostasis” and “homeostatic mechanisms,” and by outlining key ideas behind the phrase “allostatic load.” In terms of how allostatic theory can be strengthened, this piece delves into the need for the theory to be clearer about what is meant by load that is “cumulative” and the need to incorporate results from research work on hormesis demonstrating the salutary, not damaging, effects of a moderate amount of stress. Lastly, some space in the rejoinder is devoted to how we can better operationalize the allostatic load construct and how new waves of biomarker-containing surveys are poised to collect yet more physiological information and are now more comprehensively measuring, in what is surely a difficult task, stress over the life course.     

Rangeland degradation in North China: Perceptions of pastoralists

Rangeland degradation, a worldwide problem, is serious in China, especially in the Northern provinces. To assess the pastoralists’ perceptions toward rangeland trend and degradation, a survey was conducted in Ningxia, North China. Data were collected from a total of 284 pastoralists in six Ningxia counties. Findings showed that the majority of respondents believe the rangelands in Ningxia have been degraded, although there are some disparities among the counties that illustrate differing severity of degradation. Findings also clarified that the pastoralists have more knowledge about the “technical” and “supportive” aspects of conditions, while remaining less aware of “economic” and “management” factors of this issue. Yet, a high disparity was revealed between pastoralists’ perceptions among the counties in this study. The correlation matrix showed that most of their perceptions do not act independently. Findings also showed that those pastoralists who believe that their rangeland trend is “improved” have broader management and social perceptions than those who believe their rangeland is “degraded”. Finally, correlation analysis showed that the management and social perceptions have a negative correlation with degradation severity. Based on the findings, recommendations for possible interventions through extension/educational programs to diminish rangeland degradation are made. The programs are suggested to be presented in three packages including “management”, “social”, and “economic” issues in rangeland degradation.     

“Survivors” and “victims”: Long-term HIV positive individuals and the ethos of self-empowerment

Recent research on contemporary processes of self-construction has suggested that the concepts of “self”, “health”, “morality” and “responsibility” have become inextricably interconnected, to the extent that the “pursuit of health has become the pursuit of moral personhood” [R. Crawford (1994) The boundaries of the self and the unhealthy other: reflections on health, culture and AIDS, Social Science & Medicine38(10), 1347–1365]. What happens then when a person becomes “diseased”? Are they doomed to the stagnant mire of “illness” and “immorality”, to the role of undesirable “other”? What if the disease is HIV infection? Is it the case of HIV = AIDS = DEATH = “OTHER” par excellence? This paper addresses these issues by examining the constructions of “self” and “other” used by HIV positive individuals themselves. By reference to a specific group of people living with long-term HIV positive diagnoses, it demonstrates how unhealthy HIV infected “others”, as perceived by “healthy” members of society, create their own conceptions of “self” and “other” which microcosmically mirror typical processes of identity construction. The content, function and potential advantages and disadvantages of these processes are highlighted.     

Life course socioeconomic position is associated with inflammatory markers: The Framingham Offspring Study

Associations between life course socioeconomic position (SEP) and novel biological risk markers for coronary heart disease such as inflammatory markers are not well understood. Most studies demonstrate inverse associations of life course SEP with C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen, however little is known about associations between life course SEP and other inflammatory markers including intercellular adhesion molecule-1 (ICAM-1), tumor necrosis factor II (TNFR2), lipoprotein phospholipase A₂ (Lp-PLA₂) activity, monocyte chemoattractant protein-1 (MCP-1) or P-selectin. The objectives of this analysis were to determine whether three life course SEP frameworks (“accumulation of risk”, “social mobility” and “sensitive periods”) are associated with the aforementioned inflammatory markers. We examined 1413 Framingham Offspring Study participants (mean age 61.2 ± 8.6 years, 54% women), using multivariable regression analyses. In age- and sex-adjusted regression analyses, cumulative SEP (“accumulation of risk” SEP framework), for low vs. high SEP, was inversely associated with CRP, IL-6, ICAM-1, TNFR2, Lp-PLA₂ activity, MCP-1 and fibrinogen. We found that there were few consistent trends between social mobility trajectories and most inflammatory markers. Own educational attainment was inversely associated with 7 of 8 studied inflammatory markers, while father’s education, father’s occupation and own occupation were inversely associated with 4, 5 and 4 inflammatory markers, respectively, in age- and sex-adjusted analyses. The strengths of association between SEP and inflammatory markers were typically substantially accounted for by CHD risk markers (smoking, body mass index, systolic blood pressure, total:HDL cholesterol ratio, fasting glucose, medications, depressive symptomatology) suggesting these may be important mechanisms that explain associations between SEP and the studied inflammatory markers.     

Influenza vaccination coverage one year after the A(H1N1) influenza pandemic, France, 2010-2011

We report influenza vaccination coverage in target groups for the 2010-2011 influenza season, one year after the A(H1N1) pandemic. Data were collected through a one-stage cross-sectional national random telephone survey conducted in January 2011 among a sample of the population of mainland France connected to a land telephone line. Influenza vaccination coverage was below 75%, ranging from 28% for health professionals to 71% in the “65+” group with an underlying condition. Coverage was higher in the “65+” compared to the “<65” with an underlying condition. It was not significantly lower compared to the previous season. Our results do not suggest that the controversies related to the pandemic vaccination campaign of 2009-2010 have had a negative impact on subsequent seasonal influenza vaccination coverage.     

Association of dietary pattern and physical activity level with triglyceride to high-density lipoprotein cholesterol ratio among adults in Jiangsu,China: a cross-sectional study with sex-specific differences

Our study aims to explore the association between dietary patterns and physical activity levels (PAL) with a triglyceride–to–high-density lipoprotein cholesterol (TG/HDL-C) ratio, and to examine whether the association is sex dependent among Chinese adults. In this cross-sectional study, data were collected through questionnaires, anthropometric measurement, and biochemical tests. Four food patterns (“meat,” “healthy,” “high-energy,” and “traditional Chinese”) were established through factor analysis. Physical activity level was categorized as “active,” “moderate,” and “inactive.” Logistic regression models were used to determine the associations between food patterns and PAL with TG/HDL-C ratio. Compared with quartile 1, quartiles 2 and 3 of meat pattern among men were found to be associated with lower risk of high TG/HDL-C ratio (the highest quartile of TG/HDL-C ratio). Similar decreased risk of high TG/HDL-C ratio was also observed in the highest quartile 4 of healthy pattern among women. Active PAL was protective against high TG/HDL-C ratio among both men (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.55-0.86) and women (OR, 0.77; 95% CI, 0.62-0.96). Although no statistically significant interaction was observed, we found that individuals with active PAL and low healthy diet had a similar OR with those with inactive PAL and high healthy diet (0.62 vs 0.68). In conclusion, dietary patterns were associated with TG/HDL-C ratio in a sex-specific way, and active PAL was consistently related to decreased risk of high TG/HDL-C ratio across genders.     

Optimal vaccination choice,vaccination games,and rational exemption: An appraisal

A threat for vaccination policies might be the onset of “rational” exemption, i.e. the family's decision not to vaccinate children after a seemingly rational comparison between the perceived risk of infection and the perceived risk of vaccine side effects. We study the implications of rational exemption by models of vaccination choice. By a simple model of individual choice we first prove the “elimination impossible” result in presence of informed families, i.e. aware of herd immunity, and suggest that limited information might explain patterns of universal vaccination. Next, we investigate vaccination choice in a game-theoretic framework for communities stratified into two groups, “pro” and “anti” vaccinators, having widely different perceived costs of infection and of vaccine side effects. We show that under informed families neither a Nash nor a Stackelberg behaviour (characterized, respectively, by players acting simultaneously and by an asymmetric situation with a “leader” and a “follower) allow elimination, unless “pro-vaccinators” assign no costs to vaccine side effects. Elimination turns out to be possible when cooperation is encouraged by a social planner, provided, however, he incorporates in the “social loss function” the preferences of anti-vaccinators only. This allows an interpretation of the current Italian vaccination policy.     

Treatments effects from randomized trials and propensity score analyses were similar in similar populations in an example from cardiac surgery

Objective

Analyses comparing randomized to nonrandomized clinical trials suffer from the fact that the study populations are usually different. We aimed for a comparison of randomized clinical trials (RCTs) and propensity score (PS) analyses in similar populations.

Study Design and Setting

In a systematic review, we “meta-matched” RCTs and PS analyses that compared the off- and the on-pump technique in coronary artery bypass grafting. “Meta-confounders” were summarized in a “meta-propensity score” and were used for “meta-matching.” We compared treatment effects between RCTs and PS analyses for 10 previously defined binary clinical outcomes in this “meta-matched” population as differences in “meta-odds ratios.”

Results

For all clinical outcomes, the estimated differences in “meta-odds ratios” were below an absolute value of 0.15, all confidence intervals included the null.

Conclusions

In our example, treatment effects of off-pump versus on-pump surgery from RCTs and PS analyses were very similar in a “meta-matched” population of studies, indicating that only a small remaining bias is present in PS analyses.     

Studies of ethynodiol diacetate and mestranol on blood glucose and plasma insulin II. Twelve month oral glucose tolerance test

Blood glucose and plasma insulin levels were measured during an oral glucose tolerance test in sixty-seven women. Each was tested before and after twelve months of using a combination type oral contraceptive containing ethynodiol diacetate and mestranol. The fasting blood glucose values were unchanged. At one year there were significant elevations of the glucose and insulin levels during the test in the “normal” women but not for those with an initial abnormal glucose curve. In the “normal” subgroup, 40.7% of the tolerances deteriorated after one year as 29.6% became “borderline abnormal” and 11.1% became “abnormal”.     

Une typologie des consommateurs à partir de l’enquête Baromètre santé nutrition 2002

The purpose of this article is to define various consumers’ profiles based on the Health Barometer survey data about the consumption of different foods within the previous 15 days. This typology is based on factorial analysis and classification methods. Seven profiles were identified: “hedonist”, “not concerned”, “concerned”, “practical”, “traditional”, “aware”, “small eater”. These seven groups are described according to social and demographic variables as well as the behavioral and life style variables associated with eating habits. This study contributes to an improved knowledge of different eating behaviours in the French population and provides elements for defining specific groups towards whom prevention strategies should be implemented.