Prevalence of febrile seizures in Dutch schoolchildren

During a scheduled visit to the school physician, the number of children with a history of febrile seizures was determined in 3570 children attending primary schools in the suburban area of the city of Rotterdam. At the age of 6 years, 140 had experienced at least one febrile seizure (3.9%, 95% confidence interval 3.3% to 4.5%). Of these, 19 (14%) had experienced a recurrent seizure during the same febrile illness. Recurrent seizures in subsequent fever episodes occurred in 26%. The median age at onset was 18 months. One-third of the children had visited the hospital directly after the seizure, and 6% had used anticonvulsant drugs for at least 6 months. Of all the children, 5.4% had a positive first-degree family history of febrile seizures. Children with a positive family history were at a 4.5-fold increased risk of experiencing febrile seizures. Since in this study a generally accepted definition of febrile seizures was used, the estimated prevalence in Dutch school-children may well be compared with prevalence rates found in the United States and Great Britain.     

Prevalence of febrile seizures in Dutch schoolchildren

Summary. During a scheduled visit to the school physician, the number of children with a history of febrile seizures was determined in 3570 children attending primary schools in the suburban area of the city of Rotterdam. At the age of 6 years, 140 had experienced at least one febrile seizure (3.9%, 95% confidence interval 3.3% to4.5%). Of these, 19 (14%) had experienced a recurrent seizure during the same febrile illness. Recurrent seizures in subsequent fever episodes occurred in 26%. The median age at onset was 18 months. One-third of the children had visited the hospital directly after the seizure, and 6% had used anticonvulsant drugs for at least 6 months. Of all the children, 5.4% had a positive first-degree family history of febrile seizures. Children with a positive family history were at a 4.5-fold increased risk of experiencing febrile seizures. Since in this study a generally accepted definition of febrile seizures was used, the estimated prevalence in Dutch schoolchildren may well be compared with prevalence rates found in the United States and Great Britain.     

Febrile seizures and epilepsy: the contributions of epidemiology

In the past, febrile seizures were considered to be a sign of epilepsy, a disorder characterised by recurrent unprovoked seizures. Currently, febrile seizures are considered to be a benign seizure syndrome that is distinct from epilepsy. This distinction has been possible largely because of the epidemiological evidence which is presented here in the form of a two-part argument. If febrile seizures are epilepsy one might expect that: (1) following a first febrile seizure, the risk of a second febrile seizure should be similar to the risk of an unprovoked seizure (in fact, the risk of a recurrent febrile seizure is approximately 34%, whereas the risk of an unprovoked seizure after having had a febrile seizure is approximately 2% to 3%); (2) the factors that predict recurrent febrile seizures should also predict subsequent unprovoked seizures. From the available literature, young age at the time of the first febrile seizure and a family history of febrile seizures predict recurrent febrile seizures, but do not predict subsequent unprovoked seizures. By contrast, a family history of epilepsy, complex febrile seizures and neurological abnormality are associated with an increased risk of subsequent epilepsy but are not consistently associated with the risk of a recurrent febrile seizure.     

Risk of febrile seizures in childhood in relation to prenatal maternal cigarette smoking and alcohol intake

The case-control study of febrile seizures in childhood described here, comprising 472 case-control pairs in western Washington, was designed to investigate the importance of prenatal exposures as risk factors for febrile seizures and to determine the degree to which two clinical subtypes of febrile seizures (simple and complex) have different risk factors. Maternal cigarette smoking and alcohol intake during pregnancy were associated with the risk of a febrile seizure in the child. Prenatal maternal cigarette smoking was associated with a twofold increase in the risk of a simple febrile seizure (95% confidence interval 1.2-3.4), and a strong dose-response relation was found. This association could not be explained by maternal demographic variables, maternal alcohol intake, child's birth weight, or childhood medical history variables. Prenatal maternal alcohol intake was associated with a twofold increase in the risk of a complex febrile seizure (95% confidence interval 1.3-3.8), and a strong dose-response relation was present. This association could not be explained by maternal age, race, education, or cigarette smoking. These results suggest that curtailment of smoking and alcohol consumption during pregnancy, a measure already widely prescribed during pregnancy, may also be an effective means of preventing childhood febrile seizures.     

The risk of febrile seizures following influenza and 13-valent pneumococcal conjugate vaccines

BackgroundEvidence on the risk of febrile seizures after inactivated influenza vaccine (IIV) and 13-valent pneumococcal conjugate vaccine (PCV13) is mixed. In the FDA-sponsored Sentinel Initiative, we examined risk of febrile seizures after IIV and PCV13 in children 6–23 months of age during the 2013–14 and 2014–15 influenza seasons.MethodsUsing claims data and a self-controlled risk interval design, we compared the febrile seizure rate in a risk interval (0–1 days) versus control interval (14–20 days). In exploratory analyses, we assessed whether the effect of IIV was modified by concomitant PCV13 administration.ResultsAdjusted for age, calendar time and concomitant administration of the other vaccine, the incidence rate ratio (IRR) for risk of febrile seizures following IIV was 1.12 (95% CI 0.80, 1.56) and following PCV13 was 1.80 (95% CI 1.29, 2.52). The attributable risk for febrile seizures following PCV13 ranged from 0.33 to 5.16 per 100,000 doses by week of age.The age and calendar-time adjusted IRR comparing exposed to unexposed time was numerically larger for concomitant IIV and PCV13 (IRR 2.80, 95% CI 1.63, 4.83), as compared to PCV13 without concomitant IIV (IRR 1.54, 95% CI 1.04, 2.28), and the IRR for IIV without concomitant PCV13 suggested no independent effects of IIV (IRR 0.94, 95% CI 0.63, 1.42). Taken together, this suggests a possible interaction between IIV and PCV13, though our study was not sufficiently powered to provide a precise estimate of the interaction.ConclusionsWe found an elevated risk of febrile seizures after PCV13 vaccine but not after IIV. The risk of febrile seizures after PCV13 is low compared to the overall risk in this population of children, and the risk should be interpreted in the context of the importance of preventing pneumococcal infections.     

Risk factors of febrile seizures among preschool children in Alexandria

The study design was a case control study to identify the risk factors of febrile seizures. Total sample of 28 children, their ages ranging from 12 to 60 months, with febrile seizure were matched with control group of 60 children of the same age group with fever without seizure. The peak age of first febrile seizure was between 6 and 12 months. The significant risk factors were upper respiratory tract infection (p < 0.05), family history of febrile seizures (p < 0.0001). Prematurity (p < 0.005), problems during gestation (p < 0.005), family history of epilepsy (p < 0.005) and problem during labour (p < 0.0005).     

Binge Drinking During Pregnancy and Risk of Seizures in Childhood: A Study Based on the Danish National Birth Cohort

Seizures are often found in children with fetal alcohol syndrome,but it is not known whether binge drinking during pregnancyby nonalcoholic women is associated with an increased risk ofseizure disorders in children. The authors conducted a population-basedcohort study of 80,526 liveborn singletons in the Danish NationalBirth Cohort (1996–2002). Information on maternal bingedrinking (intake of 5 drinks on a single occasion) was collectedin 2 computer-assisted telephone interviews during pregnancy.Children were followed for up to 8 years. Information on neonatalseizures, epilepsy, and febrile seizures was retrieved fromthe Danish National Hospital Register. Results showed that exposureto binge drinking episodes during pregnancy was not associatedwith an increased risk of seizure disorders in children, exceptfor those exposed at 11–16 gestational weeks. These childrenhad a 3.15-fold increased risk of neonatal seizures (95% confidenceinterval: 1.37, 7.25) and a 1.81-fold increased risk of epilepsy(95% confidence interval: 1.13, 2.90). These findings suggestthat maternal binge drinking during a specific time period ofpregnancy may be associated with an increased risk of specificseizure disorders in the offspring. The results are exploratory,however, and need to be replicated. cohort studies; epilepsy; fetal alcohol syndrome; infant, newborn; prenatal exposure delayed effects; seizures, febrile     

Risk factors for the occurrence of recurrent convulsions following an initial febrile convulsion]

The results of a follow up study of 155 Dutch children who visited the emergency room of an urban paediatric hospital after experiencing their first febrile seizure are presented. Median follow up time was 38 months (range 27-60). Of these 155 initially untreated children 58 (37%) suffered at least one, 47 (30%) at least two and 27 (17%) at least three recurrent seizures. The recurrence hazard after any seizure was highest in the first six months, and dropped markedly after 6 months without seizures. The effect of the various postulated risk factors on the occurrence of any recurrent seizure and three or more recurrences was assessed. A first degree family history of febrile or nonfebrile seizures appears to be a predictor of multiple recurrences; an age of at least 30 months and a temperature of 40.0 degrees C or higher at the initial seizure are associated with a decreased risk. Several factors act together on the risk of recurrent seizures, sometimes in opposite directions. By considering the action of all relevant factors (age at onset, family history and features of the initial febrile seizure) subgroups of children with one year seizure recurrence rates as low as 15% and as high as 48% were identified.     

The Forgotten Griever: A Nationwide Follow-up Study of Mortality Subsequent to the Death of a Sibling

Previous findings have suggested that the loss of a family member is associated with mortality among bereaved family members. The least-studied familial relationship in the bereavement literature is that of siblings, although loss of a sibling may also involve health consequences. The authors conducted a follow-up study based on data from the Swedish total population register, covering the period 1981-2002. Using Cox regression, mortality risk ratios for bereaved and nonbereaved persons aged 18-69 years were estimated. All-cause mortality and cause-specific mortality (unnatural causes, natural causes, cardiovascular disease, cancer, suicide, accidents, and all other causes) were examined. In men, the mortality risk for bereaved persons versus nonbereaved persons was 1.26 (95% confidence interval: 1.22, 1.30), and in women it was 1.33 (95% confidence interval: 1.28, 1.39). An elevated mortality risk associated with a sibling's death was found in all age groups studied, but the association was generally stronger at younger ages and could be observed predominantly after more than 1 year of follow-up. There was also an increased mortality risk if the sibling had died from a discordant main cause, which may strengthen the possibility that the association observed is not due to confounding alone.     

Leisure time and occupational physical activity: risk of death from ischemic heart disease

The relation of leisure time and occupational physical activity to the risk of death from ischemic heart disease was investigated in a cohort of 15,088 persons aged 30-59 years who had no history of cardiovascular disease or other condition which hindered physical activity. Two population samples were randomly chosen from eastern Finland. During a six-year follow-up, persons who were sedentary in leisure time (relative risk = 1.3, 95% confidence interval (CI) = 1.1-1.6) or at work (relative risk = 1.3, 95% CI = 1.1-1.6) had an excess risk of ischemic heart disease death when adjusted for age, health status, family history, and body mass index in multivariate logistic models. Adjustment for years of education, social network participation, cigarette consumption, serum cholesterol level, and blood pressure level weakened the residual association of low leisure time physical activity with the risk of ischemic heart disease death (relative risk = 1.2, 95% CI = 1.0-1.5), whereas the association for low occupational physical activity remained unchanged. The lack of leisure time physical activity and a sedentary occupation are associated with an increased risk of ischemic heart disease death, and the excess risk due to lack of leisure time physical activity is, in part, accounted for by other ischemic heart disease risk factors.     

Association of malnutrition and diarrhea in children aged under five years. A prospective follow-up study in a rural Sudanese community

Results are reported from a one-year follow-up study conducted in 1983 and 1984 of 445 Sudanese children aged under five years that was designed to address the hypothesis that malnutrition increases the incidence of diarrheal disease. Children were weighed and measured at two-month intervals ("child intervals") and diarrhea incidence was ascertained during biweekly house visits. During child intervals that followed a prior episode of diarrhea, underweight (weight-for-age less than 90% of expected) was associated with a higher incidence of diarrhea after adjusting for the potential confounding effects of age and socioeconomic factors (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.1-2.8). During child intervals with no history of diarrhea in the preceding interval, the association with underweight was less (OR = 1.2, 95% CI = 0.9-1.6); among these children, stunting (height-for-age less than 95% of expected) was significantly associated with diarrhea (OR = 1.4, 95% CI = 1.0-1.8). Moderate malnutrition (weight-for-age less than 75% of expected) was associated with a twofold increased risk of multiple episodes of diarrhea during a follow-up interval whether or not diarrhea had occurred in the preceding interval (OR = 2.0, 95% CI = 1.2-3.5) after adjusting for age, socioeconomic factors, and diarrhea in preceding interval. Age, rainy season, and history of diarrhea in preceding interval were found to be strongly associated with incidence of diarrhea. These data are consistent with the hypothesis that malnutrition increases the risk of childhood diarrhea.     

Effects of environmental tobacco smoke on lower respiratory system of children under 5 years of age

OBJECTIVE: To determine the effects of second-hand smoke in the respiratory system of children under 5 years old. METHODS: A cross sectional study of a total of 1,104 children under 5 years old. Information about respiratory symptoms and illness, family history of respiratory diseases, smoking habits of household members and housing conditions were assessed by home interviews with the children's parents. RESULTS: We studied 546 boys and 558 girls. Among 611 children exposed to second-hand smoke, 82% had respiratory problems (odds ratio = 1.64; 95% confidence interval: 1.21-2.20). Children whose parents were smokers at the time of the survey were more likely to experience wheezing than children of nonsmoking parents (odds ratio = 1.66; 95% confidence interval: 1.21-2.27), shortness of breath (odds ratio = 1.91; 95% confidence interval: 1. 36-2.67), morning and day time or night coughs (odds ratio = 1.58; 95% confidence interval: 1.09-2.28). The odds ratio for asthma, bronchitis and pneumonia was greater for children exposed to second-hand smoke (odds ratio = 1.60; 95% confidence interval: 1. 11-2.31). CONCLUSIONS: Maternal smoking, paternal smoking, family history of respiratory diseases, and housing conditions are considered risk factors for respiratory diseases in children.     

Validation of a questionnaire for epilepsy diagnosis in primary care services]

OBJECTIVE: To evaluate the usefulness of a questionnaire in primary health care services for establishing the diagnosis of epilepsy in children from 1 to 10 years old and for classifying their epileptic seizures. METHODS: This cross-sectional observational study was conducted in 2004. There were 204 children in the study (102 diagnosed with epilepsy and 102 without epilepsy). The children were randomly selected at the Regional Center of Epilepsies and the Vincent Corral Moscoso Hospital, which are both in the city of Cuenca, Ecuador. For the study, each child with epilepsy was matched with a child without epilepsy, in two age groups: 1 to 5 years old and 6 to 10 years old. Four students who were in their last academic year in the School of Medicine of Cuenca and who did not know the child's diagnosis utilized the questionnaire with a family member or other guardian of the child. The validity, sensitivity, specificity, positive predictive value, and negative predictive value of the questionnaire were calculated, with 95% confidence intervals (95% CIs). The clinical diagnosis carried out by specialists was used as the gold standard. RESULTS: The assessment showed that the questionnaire had good sensitivity (95.10%; 95% CI: 94.58%-95.61%) and good specificity (97.06%; 95% CI: 96.58%-97.59%). Validity was 96.08% (95% CI: 95.84%-96.36%), with a positive predictive value of 97.00% (95% CI: 96.48%-97.52%) and a negative predictive value of 95.19% (95% CI: 94.74%-95.74%). The level of agreement in the classification of the epileptic seizures carried out by the neurologists and by the medical students who used the questionnaire was satisfactory for the generalized seizures (kappa = 0.67). Upon testing for interobserver agreement among the specialists, the kappa value for the diagnoses was 0.80 among the neurologists and 0.89 among the pediatricians. CONCLUSIONS: The diagnostic questionnaire that was assessed has good sensitivity and adequate specificity, and, after brief training, primary health care general practitioners can use it to help them diagnose epileptic seizures.     

A cohort study of thyroid cancer and other thyroid diseases after the Chornobyl accident: dose-response analysis of thyroid follicular adenomas detected during first screening in Ukraine (1998-2000)

The Chornobyl (Chernobyl) accident in 1986 exposed many individuals to radioactive iodines, chiefly (131)I, the effects of which on benign thyroid diseases are largely unknown. To investigate the risk of follicular adenoma in relation to radiation dose after Chornobyl, the authors analyzed the baseline data from a prospective screening cohort study of those exposed as children or adolescents. A stratified random sample was selected from all individuals who were younger than 18 years, had thyroid radioactivity measurements taken within 2 months after the accident, and resided in the three heavily contaminated areas in Ukraine. This analysis is based on the 23 cases diagnosed in 12,504 subjects for whom personal history of thyroid diseases was known. The dose-response relation was linear with an excess relative risk of 2.07 per gray (95% confidence interval: 0.28, 10.31). The risk was significantly higher in women compared with men, with no clear modifying effects of age at exposure. In conclusion, persons exposed to radioactive iodines as children and adolescents have an increased risk of follicular adenoma, though it is smaller than the risk of thyroid cancer in the same cohort. Compared with results from other studies, this estimate is somewhat smaller, but confidence intervals overlap, suggesting compatibility.     

Age at menopause and childbearing patterns in relation to mortality

Several studies have reported increased mortality risk with early natural menopause. More recently, mortality risk was reported to be reduced among women who gave birth at age > or =40 years. The association between reproductive history and mortality was explored among 826 women in a prospective study involving 18,959 person-years of follow-up (from age 50 to 1990-1991) and 108 deaths. After adjustment for age and other covariates, the risk ratio among parous women was 1.53 (95% confidence interval: 0.58, 4.07) for natural menopause at age < or =45 years compared with > or =51 years. In contrast to a previous report, however, the highest estimated mortality risk was seen among women who gave birth in their forties (adjusted risk ratio = 2.14, 95% confidence interval: 1.05, 4.38) compared with having a last birth at ages 30-34 years.     

The epidemiology of interpandemic and pandemic influenza in Vietnam, 2007-2010: the Ha Nam household cohort study I

Prospective community-based studies have provided fundamental insights into the epidemiology of influenza in temperate regions, but few comparable studies have been undertaken in the tropics. The authors conducted prospective influenza surveillance and intermittent seroprevalence surveys in a household-based cohort in Vietnam between December 2007 and April 2010, resulting in 1,793 person-seasons of influenza surveillance. Age- and sex-standardized estimates of the risk of acquiring any influenza infection per season in persons 5 years of age or older were 21.1% (95% confidence interval: 17.4, 24.7) in season 1, 26.4% (95% confidence interval: 22.6, 30.2) in season 2, and 17.0% (95% confidence interval: 13.6, 20.4) in season 3. Some individuals experienced multiple episodes of infection with different influenza types/subtypes in the same season (n = 27) or reinfection with the same subtype in different seasons (n = 22). The highest risk of influenza infection was in persons 5-9 years old, in whom the risk of influenza infection per season was 41.8%. Although the highest infection risk was in school-aged children, there were important heterogeneities in the age of infection by subtype and season. These heterogeneities could influence the impact of school closure and childhood vaccination on influenza transmission in tropical areas, such as Vietnam.     

The association between the purchase of a handgun and homicide or suicide.

OBJECTIVES: The purpose of this study was to determine whether purchase of a handgun from a licensed dealer is associated with the risk of homicide or suicide and whether any association varies in relation to time since purchase. METHODS: A case-control study was done among the members of a large health maintenance organization. Case subjects were the 353 suicide victims and 117 homicide victims among the members from 1980 through 1992. Five control subjects were matched to each case subject on age, sex, and zip code of residence. Handgun purchase information was obtained from the Department of Licensing. RESULTS: The adjusted relative risk of suicide was 1.9 (95% confidence interval [CI] = 1.4, 2.5) for persons with a history of family handgun purchase from a registered dealer. The adjusted relative risk for homicide, given a history of family handgun purchase, was 2.2 (95% CI = 1.3, 3.7). For both suicide and homicide, the elevated relative risks persisted for more than 5 years after the purchase. CONCLUSIONS: Legal purchase of a handgun appears to be associated with a long-lasting increased risk of violent death.     

Antibiotic exposure by 6 months and asthma and allergy at 6 years: Findings in a cohort of 1,401 US children

Many studies have reported that antibiotic use may be associated with increased risk of childhood asthma. Respiratory tract infections in small children may be difficult to distinguish from early symptoms of asthma, and studies may have been confounded by "protopathic" bias, where antibiotics are used to treat early symptoms of asthma. These analyses of a cohort including 1,401 US children assess the association between antibiotic use within the first 6 months of life and asthma and allergy at 6 years of age between 2003 and 2007. Antibiotic exposure was associated with increased risk of asthma (adjusted odds ratio = 1.52, 95% confidence interval (CI): 1.07, 2.16). The odds ratio if asthma was first diagnosed after 3 years of age was 1.66 (95% CI: 0.99, 2.79) and, in children with no history of lower respiratory infection in the first year of life, the odds ratio was 1.66 (95% CI: 1.12, 3.46). The adverse effect of antibiotics was particularly strong in children with no family history of asthma (odds ratio = 1.89, 95% CI: 1.00, 3.58) (P(interaction) = 0.03). The odds ratio for a positive allergy blood or skin test was 1.59 (95% CI: 1.10, 2.28). The results show that early antibiotic use was associated with asthma and allergy at 6 years of age, and that protopathic bias was unlikely to account for the main findings.     

Signal identification and evaluation for risk of febrile seizures in children following trivalent inactivated influenza vaccine in the Vaccine Safety Datalink Project, 2010-2011

In fall 2010 in the southern hemisphere, an increased risk of febrile seizures was noted in young children in Australia in the 24 h after receipt of trivalent inactivated influenza vaccine (TIV) manufactured by CSL Biotherapies. Although the CSL TIV vaccine was not recommended for use in young children in the US, during the 2010-2011 influenza season near real-time surveillance was conducted for febrile seizures in the 0-1 days following first dose TIV in a cohort of 206,174 vaccinated children ages 6 through 59 months in the Vaccine Safety Datalink Project. On a weekly basis, surveillance was conducted with the primary approach of a self-controlled risk interval design and the secondary approach of a current vs. historical vaccinee design. Sequential statistical methods were employed to account for repeated analyses of accumulating data. Signals for seizures based on computerized data were identified in mid November 2010 using a current vs. historical design and in late December 2010 using a self-controlled risk interval design. Further signal evaluation was conducted with chart-confirmed febrile seizure cases using only data from the primary approach (i.e. self-controlled risk interval design). The magnitude of the incidence rate ratio and risk difference comparing risk of seizures in the 0-1 days vs. 14-20 days following TIV differed by receipt of concomitant 13-valent pneumococcal conjugate vaccine (PCV13). Among children 6-59 months of age, the incidence rate ratio (IRR) for TIV adjusted for concomitant PCV13 was 2.4 (95% CI 1.2, 4.7) while the IRR for PCV13 adjusted for concomitant TIV was 2.5 (95% CI 1.3, 4.7). The IRR for concomitant TIV and PCV13 was 5.9 (95% CI 3.1, 11.3). Risk difference estimates varied by age due to the varying baseline risk for seizures in young children, with the highest estimates occurring at 16 months (12.5 per 100,000 doses for TIV without concomitant PCV13, 13.7 per 100,000 doses for PCV13 without concomitant TIV, and 44.9 per 100,000 doses for concomitant TIV and PCV13) and the lowest estimates occurring at 59 months (1.1 per 100,000 doses for TIV without concomitant PCV13, 1.2 per 100,000 doses for PCV13 without concomitant TIV, and 4.0 per 100,000 doses for concomitant TIV and PCV13). Incidence rate ratio and risk difference estimates were lower for children receiving TIV without concomitant PCV13 or PCV13 without concomitant TIV. Because of the importance of preventing influenza and pneumococcal infections and associated complications, our findings should be placed in a benefit-risk framework to ensure that population health benefits are maximized.     

儿童热性惊厥复发危险因素临床分析

目的 探讨儿童热性惊厥（FS）复发的危险因素。方法 选取2008年1月至2015年8月初次诊断为FS的患儿为研究对象,回顾性收集临床资料,采用单因素分析导致FS复发的影响因素,采用非条件多因素Logistic回归分析确定导致FS复发的独立危险因素。 结果 1 261例初诊为FS的病例纳入研究,按是否复发将患儿分为复发组（n = 453）及非复发组（n = 808）,2组患儿性别构成比、原发疾病、惊厥2周后脑电图变化等比较,差异无统计学意义（P＞0.05）,单因素分析结果显示复杂性FS、年龄小、惊厥时的体温低、次数多、持续时间长、发作前发热时间短、有家族FS史、缺铁性贫血、低钠血症、生活环境差异、围生期损害等11项指标与FS复发存在相关性,差异有统计学意义（P ＜0.05）。非条件多因素Logistic回归分析结果显示发病年龄小、发作时体温低、复杂性FS、发作前发热时间≤1 h、有家族FS史、合并症(缺铁性贫血/低钠血症)是导致FS复发的独立危险因素。结论 儿童FS易复发,首发时应评估危险因素,给予适当的干预措施并密切随访。