Management of childhood gastroenteritis in the community

Good evidence-based research exists for the management of gastroenteritis. However, we encountered local anecdotal evidence of wide variations in the management of gastroenteritis. In order to assess the prevailing practice in gastroenteritis management in primary care, in the Tees Health region, an anonymous questionnaire study involving general practitioners (GPs) and health visitors (HVs) was performed. Three case scenarios were presented in the questionnaire, involving a breast-fed infant, a formula-fed infant and a four-y-old child all with diarrhoea and vomiting, but able to tolerate oral fluids and not ill enough to need hospital admission. Most GPs (78.6%) and HVs (80.5%) advised continuation of breast-feeding, though the practice of giving advice to stop breast-feeding, starve the child and substitute inappropriate fluids such as flat coke, was still common. For infants who were bottle-fed, this inappropriate advice was given much more commonly (only 25.6% and 52.8% of GPs and HVs, respectively gave advice to continue bottle-feeding). This was even more true for the four-y-old, for whom advice to continue with a normal diet was very much the exception (7.7% of GPs and 19.5% of HVs). Advice given to parents of children with gastroenteritis was inconsistent and, in many cases, inappropriate. This has implications for clinical governance. There is an urgent need for the development and implementation of local guidelines.     

肿瘤辅助治疗中的止吐药研究进展

恶心呕吐是肿瘤治疗中的常见副作用,其严重影响化疗患者的依从性。该文简述肿瘤治疗中的常用止吐药的类型、机制、临床应用及新药的研究发展。     

The effect of rotavirus immunization on rotavirus gastroenteritis hospitalization rates in military dependents

We conducted a retrospective review of all U.S. military dependents less than 5 years old hospitalized with rotavirus-associated gastroenteritis from July 2003 to June 2009. The two post-vaccine seasons showed a significant reduction of 62.4% (95% CI, 58.6-65.8, P < 0.001) in rotavirus gastroenteritis hospitalization rate compared to the three pre-vaccine seasons. Infants less than 12 months old showed the greatest reduction in incidence at 75.3%. A substantial decrease was also seen in unvaccinated children as well. Vaccine efficacy against hospitalization was 86.0% (95% CI, 77.7-91.3) after just a single dose. The overwhelming majority of children hospitalized for rotavirus since the introduction of the vaccine (ranging from 91.8 to 100% per season) had not received any of the rotavirus vaccine series.     

儿童轮状病毒胃肠炎免疫预防专家共识(2020版)

A组轮状病毒(Group A rotavirus,RV)是引起中国<5岁儿童重度胃肠炎和死亡的主要病原之一。接种RV疫苗是预防控制儿童轮状病毒胃肠炎(Rotavirus gastroenteritis,RVGE)的最有效措施。本共识通过回顾RV相关文献,结合中国RV疾病监测数据、世界卫生组织(World Health Organization,WHO)RV疫苗立场文件和专家研讨意见编写而成,旨在为中国儿童RV疫苗使用提供相关科学信息,供专业技术人员在相关工作中参考使用,为制定中国儿童RVGE免疫预防策略提供循证依据。     

Costs of gastroenteritis in The Netherlands

In order to target the most important cost components of gastroenteritis in The Netherlands and to indicate which change of policy yields the largest decrease in costs, the cost of illness of gastroenteritis and the number of Disability Adjusted Life Years (DALYs) in the Dutch population in 1999 were determined. The costs of gastroenteritis were estimated using data mainly from a community-based cohort study. For calculating DALYs, data on the number of deaths due to gastroenteritis were used from Statistics Netherlands. On average, the costs for gastroenteritis were 77 Euro (euros) per case. For all patients in The Netherlands, the costs were estimated at 345 million euros (ranging between 252 and 531 million euros). Indirect costs made up 82% of this total. An estimate of costs for patients with campylobacter, salmonella or norovirus infections was, in total, 10-17% of the costs of gastroenteritis. Gastroenteritis was associated with a loss of approximately 67,000 DALYs.     

Evidence of the impact of monovalent rotavirus vaccine on childhood acute gastroenteritis hospitalization in Togo

BackgroundMonovalent rotavirus vaccine (RV1) was introduced in the immunization schedule of Togo in June 2014. We evaluated the impact of rotavirus vaccines on acute gastroenteritis (AGE) and rotavirus-associated hospitalizations in Togolese children.MethodsSentinel surveillance for AGE (defined as ≥3 liquid or semi-liquid stools/24 h lasting <7 days) hospitalizations among children <5 years of age was conducted in two sites in the capital city, Lome. ELISA was used for diagnosis of rotavirus infection in children with AGE. Additionally, review of hospitalization registers was performed at five hospitals to assess trends in AGE hospitalizations among children aged <5 years. For the vaccine impact assessment, pre-rotavirus vaccine introduction (July 2010-June 2014) and post-rotavirus vaccine introduction (July 2014-June 2016) periods were compared for annual changes in proportions of hospitalizations associated with AGE and rotavirus.ResultsDuring the pre-vaccine period, sentinel surveillance showed that 1017 patients were enrolled and 57% (range, 53–62%) tested positive for rotavirus, declining to 42% (23% reduction) in the first post-vaccine year and to 26% (53% reduction) in the second post-vaccine year; declines were most marked among infants. The patient register review showed that, compared with pre-vaccine rotavirus seasons, declines in hospitalizations due to all-cause AGE during post-vaccine rotavirus seasons were 48% among <1 year age-group in both first and second years following vaccine introduction. Among 1–4 year olds no reduction was noted in the first year and a 19% decline occurred in the second year.ConclusionsWe report rapid and marked reduction in the number of AGE hospitalizations and the proportion of AGE hospitalizations attributable to rotavirus in the first two years post- RV1 implementation in Togo. It is necessary to monitor long-term vaccine impact on rotavirus disease burden through continued surveillance.     

儿童注意力缺陷多动障碍与呼吸功能的关联性研究

目的探讨儿童注意力缺陷多动障碍(ADHD)儿童的呼吸功能,分析其注意力缺陷多动障碍的临床特征。方法以《美国精神障碍诊断与统计手册》第4版(DSM-Ⅳ)为诊断标准,选择40名ADHD儿童,按1∶1比例设对照组,采用两独立样本资料的t检验比较两组儿童的呼吸频率、幅度和最大呼气峰流速值,采用Pearson相关系数对ADHD儿童的IVA-CPT各商数与呼吸功能的关联性进行分析。结果①ADHD组儿童呼吸频率快于正常组儿童,而呼吸幅度和最大呼气峰流速值低于正常组儿童。②ADHD组儿童综合尺度反应控制商数(FSRCQ)、综合尺度注意力商数(FSAQ)、听觉反应控制商数(ARCQ)、视觉反应控制商数(VRCQ)、听觉注意力商数(AAQ)与呼吸频率呈负相关,与呼吸幅度及最大峰流速值呈正相关;而视觉注意力商数(VAQ)与频率呈负相关,与呼吸幅度呈正相关,但与最大峰流速值的相关无统计学意义。结论 ADHD与肺功能存在相关性,ADHD儿童可能存在浅快呼吸及肺容量小等缺陷,可作为ADHD的干预效果指标之一。     

Malnutrition and gastroenteritis in The Gambia

There is a strong association between failure to thrive and diarrhoeal disease in young Gambian children.The high prevalence of diarrhoeal disease seen is not due to frequent attacks of “acute infantile diarrhoea” of viral origin. The picture of protracted diarrhoea is almost certainly due to colonization of the upper bowel and the high prevalence demonstrated to be at least partly due to the environment to which the children are exposed, particularly in terms of food and water hygiene.Until this cycle of upper bowel colonization and protracted diarrhoea is broken, a diet-based nutrition programme cannot be expected to function effectively.     

The effect of childhood conduct disorder on human capital

This paper estimates the longer-term effects of childhood conduct disorder on human capital accumulation and violent and criminal behavior later in life using data of Australian twins. We measure conduct disorder with a rich set of indicators based on diagnostic criteria from psychiatry. Using ordinary least squares and twin fixed effects estimation approaches, we find that early-age (pre-18) conduct disorder problems significantly affect both human capital accumulation and violent and criminal behavior over the life course. In addition, we find that conduct disorder is more deleterious if these behaviors occur earlier in life.     

Norovirus VLPs and rotavirus VP6 protein as combined vaccine for childhood gastroenteritis

Noroviruses (NoVs) and rotaviruses (RVs) are the two most important viral causes of severe gastroenteritis in young children worldwide. Live oral RV vaccines are already part of routine childhood immunization in many countries, but may be associated with low risk of intussusception and other potential risks associated with live vaccines. NoV capsid-derived virus-like particles (VLPs) are in early phase clinical trials, but there is no vaccine available yet. We suggest that there is a need for non-live vaccines against both enteric pathogens. We have combined NoV GII-4 VLPs and human RV recombinant VP6 (rVP6) protein produced by recombinant baculovirus (BV) expression system in insect cells and used this combination vaccine to immunize BALB/c mice parenterally. Strong systemic cross-reactive and cross-blocking antibody responses towards NoV and RV were induced, and there was no interference of the immune response to either antigen given in combination. Rather, we observed an adjuvant effect of rVP6 on the NoV-specific homologous and heterologous immune responses to genotypes not included in a vaccine formulation.     

The treatment of acute gastroenteritis in children in The Netherlands

A national survey on the treatment of acute gastroenteritis in children was conducted among 10% of the Dutch general practitioners and 10% of the paediatricians. Oral Rehydration Solution was used by less than 40% of the general practitioners, while 95% of the paediatricians used it (nearly) always. About a quarter of the general practitioners used antidiarrhoeal medication in contrast to the paediatricians who hardly or never used these drugs. The refeeding period after the acute rehydration therapy showed great difference. The need for a uniform dietary advice was felt by nearly half the general practitioners. It is concluded that the internationally accepted primary treatment with O.R.S. has insufficient impact on the Dutch general practitioners. Greater knowledge on the unique features of this method is needed. The dietary advice after the primary treatment needs more uniformity.     

The role of astroviruses in viral gastroenteritis in children

The submitted paper summarizes the first data on the incidence of astroviruses in specimens of faeces of children suffering from gastroenteritis in the Slovak Republic. The presence of the astrovirus antigen was revealed in 21 specimens (11.2%) of the investigated groups comprising 188 children. Astrovirus infection only was detected in 8 specimens (4.3%) and mixed infection with astroviruses and rotaviruses in 13 samples (6.9%), incl. six from 0-11-month-old infants. The results indicate the need to extend the spectrum of enteral pathogens elucidating diarrhoeal diseases by the diagnosis of astroviruses.     

Provoking effect of promazine on EEG in childhood

The authors report on the sleep activation of the EEG-recordings by Promazine a Phenothiazine derivative that can be used also in babies and in those elder children who does not tolerate sleep deprivation. The EEG-s are much less altered then by other related compounds or by Barbiturates. The greatest efficacy could be reached in generalized epilepsies, but the method was helpful in other epilepsy forms too. It is emphasized that in no case of acute neurological symptoms of not epileptic origin showed the Promazine induced sleep a convulsive activity.     

广州市诺如病毒感染性胃肠炎疾病负担评估

目的 对广州市诺如病毒感染性胃肠炎的疾病负担进行评估,为政府制定传染性胃肠炎和食源性疾病管理决策和控制措施提供科学依据。方法 分别评估广州市诺如病毒感染性胃肠炎散发和暴发部分的疾病负担,评估指标包括伤残调整生命年、发病率、住院率、罹患率等,数据主要来源于监测医院、历史文献资料以及“突发公共卫生事件管理信息系统”中的相关数据。结果 2014年广州市腹泻总病例数约为3 092 230人次,其中由诺如病毒感染所引起的腹泻病例数约为608 860人次。广州市2014年诺如病毒感染性胃肠炎年发病率为4 655/10万,住院率为0.03%,共发生暴发疫情6起,病例942例,平均罹患率为2.63%。综合散发与暴发数据,广州市2014年诺如病毒感染性胃肠炎的疾病负担为2 212 DALYs。结论 广州市诺如病毒感染性胃肠炎疾病负担较高,相关卫生部门应重视并加强对诺如病毒感染性胃肠炎的预防、控制管理以及教育宣传,开展针对性防控。     

同胞效应与儿童哮喘的关系探讨

[目的]分析多同胞是否对儿童哮喘有保护作用.[方法]以2000～2002年德国Wilhelmshaven镇和Delmenhorst镇小学入学儿童为研究对象,共4039人.采用的问卷是国际儿童哮喘与过敏性疾病研究第一阶段问卷的核心问题.同胞数与儿童哮喘关系分别在单变量Logistic回归模型中和多元Logistic回归模型中进行验证.[结果]总的儿童哮喘患病率为12.03%;随着同胞数增加,儿童哮喘患病率下降（P＜0.05）.同时,在多元Lo-gistic回归模型中加入家族史和室内暴露因素后,对同胞效应影响小.[结论]儿童哮喘患病率受同胞效应影响,家族史和室内暴露因素对同胞效应无显著影响.