Response to influenza virus vaccination in vertical HIV infection

OBJECTIVE: To assess the antibody response to influenza vaccine of children vertically infected with HIV. DESIGN: Prospective study in HIV infected children vaccinated during the winter of 1994-5. SETTING: Family HIV clinic at St Mary's Hospital, Paddington. SUBJECTS: 25 children, aged 1-11 years, vertically infected with HIV. MAIN OUTCOME MEASURES: Responses to influenza antigens (H1N1-A/Taiwan/1/86, H3N2-A/Shandong/9/93, B/Panama/45/ 90) were tested by haemagglutination inhibition. Antibody responses were assessed according to clinical symptoms and immune function, stratified according to the 1994 revised classification for HIV infection in children. RESULTS: 23 children (92%) had either very low or no detectable antibody before vaccination. New protective antibody responses were made by 10 children (40%): in seven to a single antigen, in two to two antigens, and in one to all three antigens. For each antigen there was an overall small increase in the mean geometric titre of antibody produced, but this only reached a protective level for antigen H1N1 and for children with minimal symptoms. Less symptomatic children were significantly more likely to produce a protective antibody response to influenza vaccination. No association was found between immune function, as measured by CD4 count, and vaccine response. CONCLUSIONS: Only vaccination of the least symptomatic HIV infected children against influenza is likely to be effective. This will not only protect them against influenza, but will also protect other more immunosuppressed and vulnerable members of their families.     

Correlates of STI testing among vocational school students in the Netherlands

Background  

Adolescents are at risk for acquiring sexually transmitted infections (STIs). However, test rates among adolescents in the Netherlands are low and effective interventions that encourage STI testing are scarce. Adolescents who attend vocational schools are particularly at risk for STI. The purpose of this study is to inform the development of motivational health promotion messages by identifying the psychosocial correlates of STI testing intention among adolescents with sexual experience attending vocational schools.     

The impact of accelerometer wear location on the relationship between step counts and arterial stiffness in adults treated for hypertension and diabetes

Objectives

Accelerometer placement at the wrist is convenient and increasingly adopted despite less accurate physical activity (PA) measurement than with waist placement. Capitalizing on a study that started with wrist placement and shifted to waist placement, we compared associations between PA measures derived from different accelerometer locations with a responsive arterial health indicator, carotid-femoral pulse wave velocity (cfPWV).

Clinical subtypes of schizophrenic disorders: a cluster analytic study

Two hundred and fifty-five psychiatric inpatients with a definite diagnosis of DSM-IV schizophrenic disorder were examined by means of the Structured Clinical Interview and rated on the 30 main items of the Positive and Negative Syndrome Scale (PANSS). Patients' scores were subjected to a cluster analysis, using Ward's method. Cluster analysis indicated the existence of five groups. The first group (n = 46) comprised patients with overall psychopathology of minimal severity, the second group (n = 39) patients with severe positive symptoms along with symptoms of psychomotor excitement, the third group (n = 58) patients with severe positive psychopathology only, the fourth group (n = 34) patients with severe positive negative depressive and cognitive symptoms and, finally, the fifth group (n = 78) patients with severe negative symptoms only. Patients in the first and third groups were older and their illnesses were of longer duration compared to those of the remaining groups. With respect to DSM-IV clinical types of schizophrenic disorders, the paranoid type predominated in the second and the third groups, whereas the disorganized and catatonic types were markedly overpresented in the fifth group.     

Nasal continuous positive airway pressure (nCPAP) treatment for obstructive sleep apnea, road traffic accidents and driving simulator performance: a meta-analysis

We used meta-analysis to synthesize current evidence regarding the effect of nasal continuous positive airway pressure (nCPAP) on road traffic accidents in patients with obstructive sleep apnea (OSA) as well as on their performance in driving simulator. The primary outcomes were real accidents, near miss accidents, and accident-related events in the driving simulator. Pooled odds ratios (ORs), incidence rate ratios (IRRs) and standardized mean differences (SMDs) were appropriately calculated through fixed or random effects models after assessing between-study heterogeneity. Furthermore, risk differences (RDs) and numbers needed to treat (NNTs) were estimated for real and near miss accidents. Meta-regression analysis was performed to examine the effect of moderator variables and publication bias was also evaluated. Ten studies on real accidents (1221 patients), five studies on near miss accidents (769 patients) and six studies on the performance in driving simulator (110 patients) were included. A statistically significant reduction in real accidents (OR = 0.21, 95% CI = 0.12–0.35, random effects model; IRR = 0.45, 95% CI = 0.34–0.59, fixed effects model) and near miss accidents (OR = 0.09, 95% CI = 0.04–0.21, random effects model; IRR = 0.23, 95% CI = 0.08–0.67, random effects model) was observed. Likewise, a significant reduction in accident-related events was observed in the driving simulator (SMD = −1.20, 95% CI = −1.75 to −0.64, random effects). The RD for real accidents was −0.22 (95% CI = −0.32 to −0.13, random effects), with NNT equal to five patients (95% CI = 3–8), whereas for near miss accidents the RD was −0.47 (95% CI = −0.69 to −0.25, random effects), with NNT equal to two patients (95% CI = 1–4). For near miss accidents, meta-regression analysis suggested that nCPAP seemed more effective among patients entering the studies with higher baseline accident rates. In conclusion, all three meta-analyses demonstrated a sizeable protective effect of nCPAP on road traffic accidents, both in real life and virtual environment.