Maternal influenza vaccination and child mortality: Longitudinal,population-based linked cohort study

Influenza vaccination is recommended to protect mothers and their infants from influenza. Few studies have evaluated the association between maternal influenza vaccination and child mortality. We aimed to evaluate the association between in utero exposure to seasonal inactivated influenza vaccine (IIV) and mortality among young children. This longitudinal, population-based cohort study included 191,247 maternal-child pairs in Western Australia between April 2012 and December 2017. Maternal vaccine information was obtained from a state-wide antenatal vaccination database. Mortality was defined as a record of a death registration. We used Cox proportional hazard models, weighted by the inverse-probability of treatment (vaccination), to estimate the hazard ratio of child mortality associated with in utero exposure to seasonal IIV. This study found no association between in utero exposure to seasonal IIV and mortality through age five years.     

WTO成员国医药化妆品领域技术性贸易措施通报内容分析

目的:为完善我国医药政策和推动医药产业发展提供借鉴。方法:通过查询中国技术性贸易措施网数据库,对世界贸易组织(WTO)成员国2000年1月1日至2012年12月31日在医药化妆品领域技术性贸易措施(TBT)的通报情况进行统计,就主要通报国家、通报产品类型(药品、医疗器械、化妆品)和内容进行分析。结果:全球针对药品、医疗器械和化妆品的通报数量呈上升趋势,其中药品通报数量最多(511件),化妆品通报数量较少(155件);且各国差异较大,以阿根廷、巴西、韩国、加拿大、美国、欧盟、日本的通报数量占据绝对优势,美国、欧盟、加拿大、日本、韩国等的通报数量总体呈上升趋势,但2010年后通报数量趋于稳定,反映出这些国家的医药政策变化趋于稳定。结论:TBT已成为世界各国调整贸易利益的重要手段。我国应在积极发展医药产业的同时,合理利用TBT建立更加完善的医药政策。     

Pharmacy based surveillance for identifying missing tuberculosis cases: A mixed methods study from South India

BackgroundNo Indian studies have assessed the implementation of recent policy on pharmacy based surveillance and its contribution in TB notification. So, this study was conducted with objectives to describe: a) pharmacy based TB surveillance and TB notification, and b) experiences of pharmacy based surveillance implementation from the programme managers and pharmacists perspective.MethodsA mixed methods study—quantitative (cross-sectional) and qualitative (in-depth interviews) in two selected districts Dharmapuri and Salem districts of Tamil Nadu State, India.ResultsIn 2018, 45 (11%) of 397 pharmacies in Dharmapuri and 90 (6%) of 1457 pharmacies in Salem districts reported sale of anti-TB drugs to 1307 and 1673 persons respectively. Upon validation through direct patient contact 942 (72%) persons in Dharmapuri and 863 (52%) persons were identified as previously ‘un-notified’ TB patients. These patients constituted 20% and 29% of the total TB cases notified in Dharmapuri and Salem respectively. The enablers for implementing this activity were: understanding the importance of notification, availability of resources (manpower, computers) to record, report and validate the patient data, repeated trainings and partnerships. The barriers were: patients' hesitancy to share their details to pharmacists (confidentiality), cumbersome recording and reporting process, difficulties in recording patient details during high workload busy business hours.ConclusionThis process contributed about one-fourth of the TB patients notified in these districts. Its implementation needs to be strengthened and should be scaled up in other parts of the country.     

Trends and sub-national disparities in TB notifications in India: Insights from HMIS data

Background/objectivesTuberculosis (TB) is a public health crisis across the globe, especially in the developing world including India. Around 27% of 10 million TB cases and 33% of 1.2 million TB deaths were contributed from India alone during 2018. Present study aims to estimate TB notification rates at national and sub-national levels up to District administrative blocks, which is very important with policy perspective.MethodsThe study mainly uses data from India's Health Management Information System (HMIS) for three consecutive years, 2017-18, 2018-19 and 2019-20. TB notification rates were calculated for India up to the lowest administrative level of health Districts. GIS maps were being used for mapping District-wise TB notification rates for 2017-18 and 2019-20.ResultsResults show that TB notification rates have increased from 152/lakh population in 2017-18 to 197 in 2019-20, an increase of 30%. Similarly, the increasing trends in TB notification rates were also observed at State as well as District level. However, wide rural-urban and public-private differences were observed in TB notification rates. Further, results illustrated huge inter-State and inter-District variations; and half of the TB cases in India were contributed only by six larger States.ConclusionsThe findings of the study shows the increasing notification in India since 2017-18, which is a clear indication of the efforts put in the TB program to achieve targets and goals committed to end TB by 2025. In this regard present estimates based on HMIS data significantly contributes to the policy formulation even at the lowest administrative level of health Districts.     

Significant but weak spousal concordance of metabolic syndrome components in Japanese couples

Objective

This study was initiated to investigate if spousal concordance in metabolic syndrome (MS) components exist in Japan.

Methods

In all, 756 couples (mean age: 48.9 and 47.3 years for husbands and wives, respectively) were identified. Each subject was classified as an MS, MS reserves (MSRES) or no risk of MS (NonMS) case after Japanese Ministry of Health, Labour and Welfare (JMHLW) criteria. Criteria of the National Cholesterol Education Program and of the Joint Interim Statement were also applied.

Results

With Japanese Ministry of Health, Labor and Welfare (JMHLW) criteria, MS, MSRES and NonMS cases accounted for 11.9, 14.7 and 73.4 % in husbands and 1.6, 3.7 and 94.7 % in wives. Waist circumference (WC), body mass index (BMI), systolic blood pressure (SBP) and hemoglobin A1c (HbA1c) showed significant correlation (p < 0.01). Correlation was also significant (p < 0.05) for mean blood pressure (MBP) and fasting plasma glucose (FPG). When adjusted for age, correlations were significant only for WC, BMI and HbA1c. Furthermore, none of the correlation coefficients were greater than 0.2. Logistic regression analyses did not suggest significant mutual influence in MS status between the couples.

Conclusions

Spousal concordance in MS components was detected for WC, BMI, SBP, MBP, FPG and HbA1c, but the correlation was generally weak and modest in Japanese couples.     

Marital support,spousal contact and the course of mild hypertension

OBJECTIVE AND METHODS: To define marital support (MS) and its correlates in a sample of mild hypertensives where marital adjustment (by Dyadic Adjustment Scale, DAS) was related to 3-year left ventricular mass, a secondary analysis was performed on 103 men and women who underwent 24-h ambulatory BP (ABP) monitoring, M-mode echocardiography and completed psychosocial questionnaires at baseline and 3 years. RESULTS: MS, defined as the presence of both marital satisfaction and cohesion (upper quartiles of DAS subscales) at baseline, predicted 3-year left ventricular mass (P=.007), which decreased 8% in the MS group and increased 6.26% in the low MS group. The MS group also had lower 24-h diastolic BP over 3 years (P=.016) than the low MS group. Based on the amount of spousal contact during ABP, MS subjects spent much more time together after 3 years than at baseline (P=.008) and compared to the low MS group (P=.027). CONCLUSION: MS, a construct of both the quality and quantity of contact between spouses, was related to improved 3-year outcome in mild hypertension. Prospective clarification of the role of MS in mild hypertension is required.     

Effectiveness of rotavirus vaccines in an Australian population: A case-control study

ObjectiveTwo rotavirus vaccines (RV1 and RV5) were included in the publicly funded National Immunisation Program in Australia from July 2007. The programme in Western Australia initially provided RV1 (at ages 2 and 4 months) and then switched to RV5 (at ages 2, 4 and 6 months) from July 2009. This retrospective case-control study was conducted to assess the effectiveness of rotavirus vaccine against laboratory confirmed and notified cases of rotavirus infection among children aged <5 years.MethodsCase-subjects were identified as vaccine-eligible children (born from 1 May 2007) who were notified as having rotavirus infection during the period 2009–2011. The control group was vaccine-eligible children notified as having Campylobacter or Salmonella infection during the same period. Individual rotavirus immunisation status was ascertained from a population-based immunisation register. Full-dose and partial-dose vaccine effectiveness (VE) were calculated for both vaccines using the adjusted odds ratio (OR) of vaccination for cases versus controls (VE = (1 − OR)*100%).ResultsOverall, 282 cases and 883 controls were included. The adjusted VE for a full course of either rotavirus vaccine was 72% (95% CI: 56–82) and 71% (95% CI: 50–84) for partial vaccination (one dose of RV1 or one/two doses of RV5). The VE for a complete 3-dose course of RV5 was 82% (95% CI: 59–92) and for a full 2-dose course of RV1 was 73% (95% CI: 55–83).ConclusionsRV1 and RV5 were both effective in preventing laboratory confirmed and notified rotavirus infections among children aged <5 years. Even incomplete courses of vaccination conferred good protection.     

Written notification of test results: Meanings, comprehension and implication on patients’ health behavior

Objective

Mailing test results are frequently used to provide patients with information about their medical condition and enhancing their participation in subsequent management. This study explores patients’ experiences of the written notification process and its implications.

Methods

Telephone interviews were conducted with 128 patients who had undergone endoscopic examinations in two gastroenterology clinics after the received of their mailed biopsies results. The interviews (open and closed questions) focused on patients’ perceptions and emotions while waiting, and after reading the reports.

Results

The findings are divided to emotions experienced, comprehension and behavioral implications. The reports arrived 6–33 days later than promised. Many patients were dissatisfied but most did nothing to hasten the process. Over half of them were unable to understand the information in the letters and the future steps needed to be taken. Explanatory covering letters, sent by the hospital clinic, enhanced comprehension and diminished confusion.

Conclusions

Mailed biopsy reports frequently failed to enhance patient understanding and participation in decisions. Incomprehensibility of written information, and unmet expectations, evoked negative emotional responses.

Practice implications

Improving readability with simple, non-technical information; and verification of understanding and fulfillment of recommendations using a follow-up call are critical for accomplishing the goals of mailed biopsy reports.     

论药品不良反应信息通报制度的目的与作用

目的:利用《药品不良反应(ADR)信息通报》,进一步发挥药物警戒与干预的作用,有效避免或减少ADR。方法:收集国家ADR监测中心自2001年11月～2009年5月发布的共22期《ADR信息通报》,运用Excel软件进行数据分类统计,探讨《ADR信息通报》制度的目的与作用。结果:《ADR信息通报》的定期公布,使ADR病例报告数量显著提高,但同时也存在政府监管部门与临床用药单位信息反馈滞缓,部分药品反复通报但ADR仍重复发生与蔓延等现象。被通报药品中,中药ADR居多,占25%以上;重复通报的14个药品中,中药高达50%。结论:需进一步采取多种形式加强ADR的宣传与培训,使医务人员有效利用《ADR信息通报》,确保公众用药安全。     

Risk Factors for Transfusion Transmissible Infections Elicited on Post Donation Counselling in Blood Donors: Need to Strengthen Pre-donation Counselling

Donor notification and counselling transforms the legal and ethical requirement of disclosure of transfusion transmissible infection (TTI) in a blood donor into practice. The present study was done to assess the response to the disclosure of TTI reactivity results in blood donors, assess the risk factors in blood donors and follow the compliance of the disclosure and clinical referral in a population of blood donors who are difficult to convince that they may be harbouring infections apparently in a healthy state today but with possible clinical disease consequences in the future. A retrospective study was conducted from April 2011 to November 2012. Screening was done using third generation ELISA kits used according to the manufacturer’s directions; these kits were approved for use in blood banks by the Drug Controller General of India. Those testing repeat reactive were referred for further confirmation and management. The total number of TTI reactive donors was 787 (0.93 %, N = 83,865). The observed response rate in the present study is 21.6 % (167, N = 787). The risk factors for acquiring infections in TTI reactive donors were statistically significant history of high risk behaviour (20.3 %) for human immunodeficiency virus infection and history of jaundice in themselves, family or close contacts (16.1 %) for hepatitis B virus infection. One hundred and ten (65.8 %) of the referred donors were on outpatient clinical care when post-referral follow up was conducted. The study emphasises on continuing sensitization of blood donation camp organisers to the need of privacy during blood donor selection. The study also stresses the need to strengthen the pre-donation counselling at outdoor blood donation at the same time raise awareness amongst blood donors about the importance of post-donation counselling and follow up.