Impact of Hepatitis A vaccination with a two-dose schedule in Panama: Results of epidemiological surveillance and time trend analysis

PurposeIn April 2007, Panama introduced Hepatitis A universal vaccination using a two-dose schedule (Havrix^® junior; GSK Vaccines, Belgium). We assessed the impact of this hepatitis A vaccine three years after it was recommended for universal mass vaccination in Panama.Materials and methodsHepatitis A vaccination impact was assessed using two different approaches. The first approach used retrospective data (incidence and number of cases for all age groups), collected from the passive surveillance of the Epidemiologic Surveillance System of the Ministry of Health of hepatitis A and unspecified hepatitis before (2000–2006) and after (2008–2010) introduction of hepatitis A vaccine. The second approach was a prospective hospital-based active surveillance for hepatitis cases conducted in subjects (0–14years) during 2009–2011 at three sentinel hospitals in Panama.ResultsOverall, the annual incidence of hepatitis A and unspecified hepatitis in 2008, 2009 and 2010 were 13.1, 7.9 and 3.7 per 100,000 subjects, lower than the baseline incidence of 51.1 per 100,000 subjects. In comparison to the mean baseline period (2000–2006), there was an 82% mean reduction in the overall hepatitis-related outcomes (hepatitis A and unspecified hepatitis) after vaccine introduction (2008–2010) in all age groups.In the hospital-based surveillance (2009–2011), of the 42 probable viral hepatitis A cases, nine cases were confirmed as acute hepatitis A (8 in 2009, 1 in 2010). Of these confirmed cases, two belonged to the targeted vaccine group (1–4 years) but were not vaccinated.ConclusionsOur study suggests that the introduction of two-dose hepatitis A vaccines in Panama has contributed to the reduction in the incidence of overall hepatitis-related outcomes for all age groups, suggesting herd protection. Additional monitoring is required to document a sustained long-term effect.     

Immunogenicity and safety of the human papillomavirus vaccine in patients with autoimmune diseases: A systematic review

Whereas safety and efficacy of HPV vaccines in healthy women have been shown in several randomised controlled clinical trials and in post marketing analyses, only few data exist in patients affected by autoimmune diseases. These issues are significant as autoimmune conditions are recognised as a risk factor for the persistence of HPV infection. Herein we review and systematise the existing literature to assess immunogenicity and safety of HPV vaccination in patients with autoimmune diseases, including systemic lupus erythematosus and juvenile idiopathic arthritis.The results of our literature revision suggest that the HPV vaccines are efficacious and safe in most of the patients affected by autoimmune diseases. Yet, some points of concern remain to be tackled, including the effects of concomitant therapies, the risk of disease exacerbation and the cost-effectiveness of such immunisation programmes in these populations.     

Vaccination against serogroup B Neisseria meningitidis: Perceptions and attitudes of parents

BackgroundA vaccine against serogroup B Neisseria meningitidis, major cause of bacterial meningitis in children and adults, has recently been developed. In a context of an increasing parental mistrust against vaccinations, understanding the reason for their choices is crucial in order to improve immunization coverage. Our study aimed at evaluating parental attitudes and perceptions towards serogroup B meningococcal invasive disease vaccination.MethodsA prospective observational study was conducted in different French independent-practice medical offices (general practitioners and paediatricians) and nurseries between May 1 and December 31, 2013, using a questionnaire distributed in electronic and paper forms to parents having at least one child between the ages of 2 months and 16 years old.Results1270 parents were included, of whom 671 (52.8%) spontaneously stated to be in favour of this vaccination. Their choice was mainly justified by the severity of the disease (63.8%) and the desire to protect their child (51.7%). In multivariate analysis, the young age of parents (OR 0.949 per additional year; p < 10⁻³), the history of vaccination against serogroup C meningococcal invasive diseases (OR 6.755; p < 10⁻³), and the prior knowledge of the vaccine (OR 2.081; p = 0.001) were associated with vaccination acceptance. The main reasons for refusal were the lack of hindsight on this new vaccine (50.6%) and the fear of side effects (45.5%). After objective information on the disease and the vaccine, only 6.3% of the entire responding population would refuse to consider vaccination.ConclusionsThe spontaneous acceptance rate of vaccination against serogroup B meningococcal invasive disease is insufficient. However, after objective information by their physician or public health authorities, only a few parents would in the end be completely resistant.     

Self-reported risk factors related to the most frequent musculoskeletal complaints among Czech dentists

The purpose of the study was to describe the occurrence of the most common complaints related to MSDs in Czech dentists and to assess the risk factors affecting them. A questionnaire survey of 581 Czech dentists (the response rate 72.6%) was conducted in 2011. The questionnaire ascertained general information about the respondents, their work habits and environment along with the occurrence of musculoskeletal disorders. The respondents filled out the questionnaires during the educational events organized by the Czech Dental Chamber. At least mild difficulties associated with the motoric system were reported by 96.9% of the respondents, with 66.3% of respondents reporting moderate or major difficulties. Back and neck pain followed by shoulder pain and headache were the most common complaints in our sample. According to our data: age, gender, length of practice, a history of serious MSDs, the occurrence of MSDs in blood relatives, the perception of work as psychologically demanding, and especially a perceived moderate/bad general health were significantly associated with the four most common musculoskeletal complaints. Some of the factors were found as protective. This study suggests that MSDs represent a significant burden for Czech dentists and further research is needed to elucidate this issue.     

Impact of Preoperative Prealbumin on Outcomes After Cardiac Surgery

Background: Preoperative malnutrition is increasingly prevalent in patients undergoing cardiac surgery. Although prealbumin is a widely used indicator of nutrition status, its use in the preoperative assessment of patients undergoing cardiac surgery is not well defined. The purpose of this study is to determine the impact of preoperative prealbumin levels on outcomes after cardiac surgery. Materials and Methods: Data were prospectively gathered from February 2013 to July 2013 on 69 patients undergoing cardiac surgery. Prealbumin levels were obtained within 24 hours of surgery. Patients were divided into 2 groups based on a prealbumin cutoff value of 20 mg/dL. Results: Of the 69 patients, 32 (46.4%) had a preoperative prealbumin ≤20 mg/dL. There was no correlation between prealbumin levels and body mass index (r = ?0.13, P = .28). Likewise, there was no correlation between preoperative albumin and prealbumin levels (r = 0.09, P = .44). Nine of 32 (28.1%) patients with low preoperative prealbumin levels had postoperative infections compared with 2 of 37 (5.4%) patients with high prealbumin levels (P = .010). Patients with low prealbumin levels also had increased risk of postoperative intubation for >12 hours (P = .010). Conclusions: Patients undergoing cardiac surgery with preoperative prealbumin levels of ≤20 mg/dL have an increased risk for postoperative infections and the need for longer mechanical ventilation. If feasible, nutrition optimization of such patients may be considered prior to cardiac surgery.     

Paths to sustainable wood supply to the pulp and paper industry in Indonesia after diseases have forced a change of species from acacia to eucalypts

In Sumatra and Kalimantan in Indonesia and Sabah in Malaysia, the spread of two diseases, aggravated by damage by fauna, and by the humid tropical environment, has forced a change of planted species from Acacia mangium to Eucalyptus pellita and related interspecific hybrids, at a scale unprecedented in the history of plantation forestry. This experience highlights the risks of relying on any single species for large contiguous plantation estates in environments with endemic biotic and abiotic stresses. There is a need to transition to multiple-species plantation forestry, adopting the opportunities for changeover of species and varieties in short-rotation systems. Industry’s responses for coping with this rapid change have been helped by earlier collaborative research on acacia which promoted management practices that conserved site resources and avoided site degradation during the critical harvesting and inter-rotation phase. The current growth rates of E. pellita and its hybrids are lower than that of A. mangium. Estimates of production from plantations and expanding capacity of the pulp and paper mills highlight a risk of significant shortfalls in wood production. Improving the quality and consistency of forest operations and revision and refocussing of research and development are critical to set and achieve realistic targets for stable, incremental improvements in productivity. Each company should consider investing systematically in contemporary adaptive research for developing and applying integrated management practices that are efficient and feasible on large scales and suitable for their circumstances. There is also a critical need for research to understand the dynamics of local human capital and its relationships with the forestry sector, with focus on improving access to a stable labour force.     

1108例高血压病患者中医体质类型与心血管危险因素分析

【目的】探讨社区高血压病患者的中医体质类型及其与心血管危险因素的相关性。【方法】对1108例高血压病患者进行中医体质判定,建立健康档案,提供常规体检,体检结束后进行数据统计分析。【结果】1108例高血压病患者中,平和体质229例(20.67%),偏颇体质879例（79.33%）;偏颇体质以痰湿质为主,占283例（25.54%）,其次为阴虚质和气虚质,分别为168例（15.16%）和146例（13.18%）,偏颇体质分布以单一偏颇体质为多,共590例（67.12%）,复合体质为289例（32．88%）,复合体质以2种复合体质多见(15.70%),复合体质兼夹的体质种类越多,分布越少;痰湿质是涉及最多心血管危险因素的一种体质,痰湿质高血压病患者体质量超重、血脂异常、心血管病家族史、缺乏体育锻炼、心电图异常的比例均最高,与其他体质比较,差异均有统计学意义（P＜0.05或P＜0.01）。【结论】痰湿质、阴虚质和气虚质是高血压病最常见的3种体质;痰湿质除了是最常见的偏颇体质外,也是涉及最多心血管危险因素的一种体质。结合中医体质特点及心血管危险因素进行防范与管理,是社区高血压病患者规范化管理的一种新思路与新方法。