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Lack of implementation of Hepatitis B Virus (HBV) vaccination policy in household contacts of HBV carriers in Italy
Paola Scognamiglio, Enrico Girardi, Mario Fusco, Pierluca Piselli, Silvana Spena, Carmela Maione, Francesco Pisanti, Diego Serraino, the Collaborating Study Group
BMC Infectious Diseases , 2009, DOI: 10.1186/1471-2334-9-86
Abstract: Between 2003 and 2006, we carried out a cross-sectional, population-based, sero-epidemiological survey on HBV infection on 4496 randomly selected individuals (aged 20 years or more) from the general population of the province of Naples. Sera were tested for antibodies to hepatitis B core antigen (anti-HBc) and to hepatitis B surface antigen (anti-HBsAg) by commercial immunoassays. Prevalence of past or current HBV infection and of HBV vaccination-induced immunity was calculated in two vaccination target populations. To analyze the association of epidemiological and socioeconomic characteristics with HBV vaccination of household contacts, we calculated crude and multiple logistic regression (MLR) odds ratio (OR).Prevalence of HBV vaccine-induced immunity (anti-HBs alone) was much lower among household contacts (25%) than among those who had been targeted for universal adolescent vaccination (81.6%). Male sex, older age, unemployment and lower education levels were associated to lower immunization rates.Understanding the different uptake of hepatitis B vaccination in these populations may provide useful information for optimizing vaccination campaigns in other contexts. Our data clearly demonstrated the need of improving the uptake of vaccination for household contacts of HBV carriers.In Italy, since 1984 HBV vaccination has been recommended and offered free of charge by the National Health Service to high-risk groups – e.g., family members of HBsAg carriers, healthcare workers. In 1991, vaccination became mandatory for all newborns and for twelve year-old adolescents [1]. According to the Acute Hepatitis National Surveillance System (SEIEVA), the incidence of acute hepatitis B decreased from 5.1 cases per 100,000 persons in 1991 to 1.3 per 100,000 persons in 2005. However, a significant proportion of cases of acute hepatitis B still occur in Italy among persons who should have been vaccinated [1].To provide further insight into missed opportunities for HBV prevention
Distribution of Major Health Risks: Findings from the Global Burden of Disease Study
Anthony Rodgers,Majid Ezzati,Stephen Vander Hoorn,Alan D Lopez,Ruey-Bin Lin,Christopher J. L Murray,Group Comparative Risk Assessment Collaborating
PLOS Medicine , 2004, DOI: 10.1371/journal.pmed.0010027
Abstract: Background Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. Methods and Findings For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%–61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1–3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. Conclusions Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden.
Oslo government district bombing and Ut?ya island shooting July 22, 2011: The immediate prehospital emergency medical service response
Stephen JM Sollid, Rune Rimstad, Marius Rehn, Anders R Nakstad, Ann-Elin Tomlinson, Terje Strand, Hans Heimdal, Jan Nilsen, M?rten Sandberg, Collaborating group
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2012, DOI: 10.1186/1757-7241-20-3
Abstract: A retrospective and observational study was conducted based on data from the EMS systems involved and the public domain. The study was approved by the Data Protection Official and was defined as a quality improvement project.We describe the timeline and logistics of the EMS response, focusing on alarm, dispatch, initial response, triage and evacuation. The scenes in the Oslo government district and at Ut?ya island are described separately.Many EMS units were activated and effectively used despite the occurrence of two geographically separate incidents within a short time frame. Important lessons were learned regarding triage and evacuation, patient flow and communication, the use of and need for emergency equipment and the coordination of helicopter EMS.On July 22, 2011, Norway was struck by two terrorist attacks. In the first attack, a car bomb exploded in the Oslo government district. The bomb comprised an ammonium nitrate/fuel oil (ANFO) mixture or "fertiliser bomb". Eight people were killed in the explosion. Two hours later, a lone gunman attacked a political youth camp on Ut?ya island, approximately 40 kilometres from Oslo, and killed 69 civilians. A single perpetrator carried out both attacks.The scale of the July 22, 2011 attacks and the resulting emergency medical service (EMS) response was unprecedented in Norway. The massive EMS response crossed jurisdictional lines and involved responders from multiple agencies throughout the region. In this paper, we describe the immediate prehospital EMS response to the July 22, 2011 attacks.The backbone of the Norwegian EMS is provided by on-call general practitioners (GPs) and ground ambulances [1]. According to national regulations, all ambulance units must be staffed by at least one certified emergency medical technician (EMT) [2]. However, most units are staffed by two EMTs, and in most urban systems, at least one EMT is a trained paramedic. The ambulance service is government-funded and organised under local healt
Pediatric Invasive Pneumococcal Disease Caused by Vaccine Serotypes following the Introduction of Conjugate Vaccination in Denmark
Zitta B. Harboe, Palle Valentiner-Branth, Helene Ingels, Jeppe N. Rasmussen, Peter H. S. Andersen, Catherine C. Bjerre, David Goldblatt, Lindsey Ashton, Mitch Haston, Helle B. Konradsen, Lotte Lambertsen, on behalf of the Danish Pneumococcal Surveillance Collaborating Group
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0051460
Abstract: A seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the Danish childhood immunization program (2+1 schedule) in October 2007, followed by PCV13 starting from April 2010. The nationwide incidence of IPD among children younger than 5 years nearly halved after the introduction of PCV7 in the program, mainly due to a decline in IPD caused by PCV7-serotypes. We report the results from a nationwide population-based cohort study of laboratory confirmed IPD cases in children younger than 5 years during October 1, 2007 to December 31, 2010 and describe the characteristics of children suspected to present with a vaccine failure. The period between April 19 and December 31, 2010 was considered a PCV7/PCV13 transitional period, where both vaccines were offered. We identified 45 episodes of IPD caused by a PCV7 serotype (23% of the total number) and 105 (55%) caused by one of the 6 additional serotypes in PCV13. Ten children had received at least one PCV7 dose before the onset of IPD caused by a PCV7 serotype. Seven children were considered to be incompletely vaccinated before IPD, but only three cases fulfilled the criteria of vaccine failure (caused by serotypes 14, 19F and 23F). One case of vaccine failure was observed in a severely immunosuppressed child following three PCV7 doses, and two cases were observed in immunocompetent children following two infant doses before they were eligible for their booster. None of the IPD cases caused by the additional PCV13 serotypes had been vaccinated by PCV13 and there were therefore no PCV13-vaccine failures in the first 8-months after PCV13 introduction in Denmark.
Periodic fever syndromes in Eastern and Central European countries: results of a pediatric multinational survey
Nata?a Toplak, Pavla Dolezalovà, Tamas Constantin, Anna Sedivà, Srdjan Pa?i?, Peter ?i?nar, Beata Wolska-Ku?nierz, Miroslav Harja?ek, Mariana Stefan, Nicolino Ruperto, Marco Gattorno, Tadej Av?in, Eastern/Central European autoinflammatory collaborating group for the Paediatric Rheumatology International Trials Organization (PRINTO) and Eurofever Project
Pediatric Rheumatology , 2010, DOI: 10.1186/1546-0096-8-29
Abstract: Two different strategies were used to collect data on patients with periodic fever syndromes from ECE countries- the Eurofever survey and collection of data with the structured questionnaire.Data from 35 centers in 14 ECE countries were collected. All together there were 11 patients reported with genetically confirmed familial Mediterranean fever (FMF), 14 with mevalonate-kinase deficiency (MKD), 11 with tumor necrosis factor receptor associated periodic syndrome (TRAPS) and 4 with chronic infantile neurological cutaneous and articular syndrome (CINCA). Significantly higher numbers were reported for suspected cases which were not genetically tested. All together there were 49 suspected FMF patients reported, 24 MKD, 16 TRAPS, 7 CINCA and 2 suspected Muckle-Wells syndrome (MWS) patients.The number of genetically confirmed patients with periodic fever syndromes in ECE countries is very low. In order to identify more patients in the future, it is important to organize educational programs for increasing the knowledge on these diseases and to establish a network for genetic testing of periodic fever syndromes in ECE countries.In the last decade the etiologic background of several monogenic autoinflammatory syndromes has been identified including FMF, MKD, TRAPS, CAPS - CINCA, FCAS and MWS, Blau syndrome and PAPA. Specific mutations of the genes encoding proteins that modulate inflammasome activity have been discovered for these syndromes. Periodic fever syndrome in which no mutation has been found so far is PFAPA syndrome [1,2]. The spectrum of autoinflammatory diseases is still expanding with continuous reports of novel genetic syndromes [3,4]. With better understanding and genetic testing the number of patients diagnosed with periodic fever syndromes is increasing but there are probably many unrecognized cases especially in countries where these diseases are rare.To our knowledge, the frequency of periodic fever syndromes in Eastern and Central European (ECE) countrie
The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis
Gitanjali M. Singh, Goodarz Danaei, Farshad Farzadfar, Gretchen A. Stevens, Mark Woodward, David Wormser, Stephen Kaptoge, Gary Whitlock, Qing Qiao, Sarah Lewington, Emanuele Di Angelantonio, Stephen vander Hoorn, Carlene M. M. Lawes, Mohammed K. Ali, Dariush Mozaffarian, Majid Ezzati, Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group; Asia-Pacific Cohort Studies Collaboration (APCSC) , Diabetes Epidemiology: Collaborative analysis of Diagnostic criteria in Europe (DECODE) , Emerging Risk Factor Collaboration (ERFC) , Prospective Studies Collaboration (PSC)
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0065174
Abstract: Background The effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available. Methods We reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models. Results Across all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55–64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09–2.24), followed by effects on both stroke subtypes (1.66; 1.39–1.98 for hemorrhagic stroke and 1.63; 1.57–1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29–1.61) for IHD and 1.20 (1.15–1.25) for ischemic stroke. The RRs for 5 kg/m2 higher BMI for ages 55–64 ranged from 2.32 (2.04–2.63) for diabetes, to 1.44 (1.40–1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08–1.29) for IHD and 1.14 (1.01–1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs. Conclusion Our results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group.
Antenatal magnesium individual participant data international collaboration: assessing the benefits for babies using the best level of evidence (AMICABLE)
Systematic Reviews , 2012, DOI: 10.1186/2046-4053-1-21
Abstract: The Antenatal Magnesium Individual Participant Data (IPD) International Collaboration: assessing the benefits for babies using the best level of evidence (AMICABLE) Group will perform an IPD meta-analysis to answer these important clinical questions.The AMICABLE Group was formed in 2009 with data collection commencing late 2010.Five trials involving a total 6,145 babies are eligible for inclusion in the IPD meta-analysis.For the infants/children: Death or cerebral palsy. For the women: Any severe maternal outcome potentially related to treatment (death, respiratory arrest or cardiac arrest).Results are expected to be publicly available in 2012.Babies born preterm compared with those born at term have a higher chance of dying in the first few weeks of life. Babies who survive have a greater risk of neurologic impairment, such as cerebral palsy, blindness, deafness, or cognitive dysfunction (either intellectual impairment or developmental delay), and a greater risk of substantial disability as a result of these neurologic impairments [1,2]. Moreover, as the rate of preterm birth in many countries has been rising, now up to 13% in the United States [3] and 8% in Australia [4], more babies are at risk of death and adverse neurological outcomes. Cerebral palsy and cognitive dysfunction are the most frequent neurologic impairments, and any therapy that can reduce their prevalence would have a substantial effect on reducing overall neurologic impairments and disabilities in surviving preterm infants.Cerebral palsy is a term which includes a number of different diseases or conditions that can arise at any time during brain development. Cerebral palsy involves a disorder of movement or posture, or both, and a disorder of motor function which is permanent but may change over time [5]. The cerebral palsies remain the most frequent cause of severe motor disability in childhood with a background prevalence of two per thousand live births [5]. Over 90% of affected children with c
A Statement on Ethics From the HEART Group
Anadolu Kardiyoloji Dergisi , 2011,
XXXI National Conference of Indian Society of Blood Transfusion and Immunohematology (ISBTI), Ahmedabad, India
Asian Journal of Transfusion Science , 2007,
Document: European Copyright Code
Wittem Group
JIPITEC : Journal of Intellectual Property, Information Technology and E-Commerce Law , 2010,
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