Influenza vaccination coverage rates in five European countries-a population-based cross-sectional analysis of two consecutive influenza seasons

INTRODUCTION: Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The objective of this survey was to assess the level of influenza vaccination coverage during two consecutive influenza seasons (2002/2003 and 2003/2004) in six European countries, to understand the driving forces and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: We conducted a random-sampling, telephone-based household survey among non-institutionalised individuals representative of the population aged 14 and over. The surveys used the same questionnaire for two consecutive winters: 2002/2003 and 2003/2004 data were used for Germany, Italy, Spain and the United Kingdom. 2001/2002 and 2002/2003 data were used for France. The data were subsequently pooled. Four target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field; (3) persons suffering from chronic illness and (4) a group composed of persons aged 65 and over or working in the medical field or suffering from a chronic illness. RESULTS: The overall sample consisted of 20,118 individuals. The influenza vaccination coverage rate increased from 21.3% in the first season to 23.2% in the second season. The increase in coverage is statistically significant (p=0.01). The most frequent reasons for being vaccinated given by vaccines were: influenza, considered to be a serious illness which people wanted to avoid (55.8%), having received advice from the family doctor or nurse to be vaccinated (55.2%) and not wanting to infect family and friends (36.1%). Reasons for not being vaccinated mentioned by people who have never been vaccinated were: not expecting to catch influenza (40.4%), not having considered vaccination before (33.3%) and not having received a recommendation from the family doctor to be vaccinated (27.3%). Options encouraging influenza vaccination are: recommendation by the family doctor or nurse (53.1%), more available information on the vaccine regarding efficacy and tolerance (32.1%) and more information available about the disease (26.7%). Adjusted odds ratios for target group vaccination were between 3.6 (Germany) and 13.7 (UK). Vaccination rates among healthcare workers were generally very low. Adjusted odds ratios were between 0.7 (Germany) and 1.5 (Spain). CONCLUSION: The vaccination coverage during the second season increased in comparison to the first season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. We, therefore, suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.     

Size determination of bacterial capsular oligosaccharides used to prepare conjugate vaccines against Neisseria meningitidis groups Y and W135

The glycoconjugate vaccines against Neisseria meningitidis groups Y and W135 consist of pools of selected oligosaccharides conjugated to the protein carrier (CRM197). Consistent production of these vaccines requires control and thus determination of the average degree of polymerisation of the oligosaccharides used for conjugation. Acid hydrolysis generates group Y and W135 oligosaccharides with N-acetylneuraminic acid at the reducing end. A method, involving NaBH4 reduction and quantification of this terminal N-acetylneuraminic acid by use of high performance anion-exchange chromatography with pulsed amperometric detection (HPAEC-PAD) following acid hydrolysis (2M TFA), was developed. The average degree of polymerisation is calculated from the ratio of reduced N-acetylneuraminic acid to total N-acetylneuraminic acid. The assay was qualified by application to group C, Y and W135 oligosaccharide standards characterised by liquid chromatography, mass and NMR spectroscopy.     

Season of birth in valvular heart disease

This study demonstrates seasonal variations of birth dates in children with congenital valvular heart disease and in adults dying from valvular heart disease. The findings are based on the 1989-98 Swiss EUROCAT data, and on 1969-94 Swiss mortality records. Seasonality was tested with aggregated monthly data using Edwards' procedure. Both data sets showed excesses between December and March, consistent in different forms of valvular disease and in both sexes. Despite the decline of rheumatic heart disease, risk factors causing season of birth effects remain relevant for congenital anomalies.     

In uremia, plasma levels of anti-protein C and anti-protein S antibodies are associated with thrombosis

BACKGROUND: Vascular access thrombosis is an important cause of morbidity in patients with end-stage renal failure on maintenance hemodialysis (MHD). However, little is known about its risk factors. The present study was undertaken to evaluate the role of coagulation factors, fibrinolytic factors, and anti-phospholipid antibodies (aPL). In particular, we have evaluated the role of anti-protein C and anti-protein S antibodies in patients on MHD with and without thrombosis because no data are available in the literature. METHODS: The study group comprised 30 patients with thrombotic complications (TC), 40 patients matched for age, sex, and dialytic age with no thrombotic complications (NTC) and 400 controls. We have measured: anti-protein C antibodies, anti-protein S antibodies, anticardiolipin antibodies (ACA), anti-beta2-glycoprotein antibodies (beta2-GPI), and anti-prothrombin antibodies (aPT), along with prothrombin time, fibrinogen, plasminogen, protein C, protein S, anti-thrombin III, APC-resistance test, D-dimer, tissue-type plasminogen's activator, plasminogen activator inhibitor-1 (PAI-1), prothrombin fragment 1+2, factors of the intrinsic and extrinsic pathway, C-reactive protein, and homocysteine. RESULTS: There were no significant differences between groups for prothrombin time, fibrinogen, plasminogen, protein C, protein S, anti-thrombin III, activated protein C (APC) resistance, D-dimer, tPA, C-reactive protein, Factors II, X, and VII. The anti-beta2-GP1 and aPT were elevated in both TC and NTC patients, compared to the control group. Significant differences between TC and NTC groups were found for anti-protein C and anti-protein S antibodies, ACA-IgM, PAI-1, Factor VIII, prothrombin fragments 1+2, and homocysteine. CONCLUSION: The most novel finding was a significant elevation of anti-protein C antibodies and anti-protein S antibodies in the TC group (i.e., in patients on MHD with thrombosis of vascular access). It indicates that other pathogenetic mechanisms in addition to endothelial damage may cause hypercoagulability in uremia.     

Clinical evaluation of multisurface ART restorations

The aim of this study was to evaluate the performance of two different glass-ionomer cements: a high-density (Ketac Molar - ESPE) and a resin-modified cement (Fuji VIII - GC) using the Atraumatic Restorative Treatment technique to restore multisurface cavities in permanent teeth. A total of 60 ART restorations (30 with each material) were placed in schoolchildren (9-16 years of age) by two operators. After a period of 6 months, two independent examiners evaluated 59 restorations according to the criteria used in previous ART studies. Data were submitted to McNemar and Fischer tests. The success rate of the treatment was 98.3%. One restoration (Ketac Molar) was replaced by another material and was recorded as failure. The success rates of the restorations were 100% and 96.6% for Fuji VIII and Ketac Molar, respectively. There was no statistically significant difference in the restorations success between baseline and 6 months (p>0.05). In the same way, no significant differences were found between materials, cavity types or operators (p>0.05). The ART approach was highly appropriate and effective in restorations involving two or more tooth surfaces, after 6 months. The results showed a promising performance of the ART technique with both materials.     

The diagnostic possibilities of positron emission tomography (PET): applications in oral and maxillofacial buccal oncology

The principles of positron emission tomography (PET), recently introduced as a diagnostic procedure into the health sciences, are described. The principle clinical applications apply to a particular group of specialties: cardiology, neurology, psychiatry, and above all oncology. Positron emission tomography is a non-invasive diagnostic imaging technique with clinical applications. It is an excellent tool for the study of the stage and possible malignancy of tumors of head and neck, the detection of otherwise clinically indeterminate metastases and lymphadenopathies, and likewise for the diagnosis of relapses. The only tracer with any practical clinical application is fluor-desoxyglucosa-F18 (FDG). PET detects the intense accumulation of FDG produced in malignant tumors due to the increased glycolytic rate of the neoplastic cells. With the introduction of hybrid systems that combine computerized tomography or magnetic resonance with positron emission tomography, important advances are being made in the diagnosis and follow-up of oncologic pathology of head and neck.     

Antiproliferative and apoptotic potencies of glucocorticoids: nonconcordance with their antiinflammatory and immunosuppressive properties

Relative antiinflammatory and immunosuppressive potencies of glucocorticoids (GC) were previously well defined. Nonetheless, GC also regulate cell proliferation and programmed death (apoptosis). The aim of this study was to determine the relative potency of different GC on the modulation of cell survival. The GC-sensitive lymphoblast cell line CEM-c7/14 was submitted to 48 h-exposure to GC (dose-response curve from 10(-8) to 10(-5) M). Cell survival was analyzed employing the DimethylTiazol-Tetrazolium (MTT) test. For each GC at least 4 experiments were performed in quadruplicate. Responses to different GC at the same molarity were analyzed by ANOVA on Ranks. Cell responses to the same GC in different concentrations were tested by repeated measures ANOVA. The EC50 for each GC was calculated with the GraphPad Prism 3.0 software. The use of low concentrations (10(-8) and 10(-7) M) of hydrocortisone and methylprednisolone determined a similar effects on cell survival, which was less prominent than that observed with betamethasone, budesonide or momethasone. Momethasone was the most potent GC, inducing the most intense dexamethasone reduction on cell survival at the lowest concentration (10(-8) M). Momethasone and methylprednisolone were the two GC with the strongest impact on cell survival. Our findings suggest that antiproliferative and apoptotic potencies of GC are different from those previously reported antiinflammatory and immunosuppressive actions.