Risk of subsequent attention-deficit/hyperactivity disorder among children and adolescents with amalgam restorations: A nationwide longitudinal study.

OBJECTIVES: Dental amalgam has been used as a common restorative material since the 1800s, but concerns have been raised regarding its purported neuropsychological effects due to the neurotoxicity of mercury. In this study, a nationwide population-based database was employed to investigate the association of dental amalgam restoration with the risk of attention-deficit/hyperactivity disorder (ADHD). METHODS: After matching, 88 068 young people with at least one tooth restoration during 2002-2010 and no ADHD history before 2001 were selected and then collected the further information until the end of 2011. Cox proportional hazard models were employed to estimate the possible effect of amalgam restorations on the risk of ADHD during the period of 2002-2011. Subgroup analyses were performed according to age, sex and number of amalgam restorations. RESULTS: In total, 2073 people (2.4%) received an ADHD diagnosis during the study period, yielding an incidence rate of 32.4 per 100 000 person-years. Those who had 6 or more amalgam restorations had a higher risk of future ADHD in the unadjusted Cox proportional hazard regression model (hazard ratio=1.20, 95% confidence interval [CI]=1.04-1.38, P=.015) than those who had received composite resin or glass ionomer restorations. However, after adjustment for potential confounding factors, the result was found to be confounded by age. CONCLUSIONS: The univariate analysis results showed that those who had 6 or more amalgam restorations had a 20% higher risk of future ADHD; however, the association disappeared after the model was adjusted for age. Despite this study analysing a larger sample than those analysed in previous studies, no association was observed between young patients' having received amalgam restorations and a future ADHD diagnosis. Further research aimed at evaluating the association between dental amalgam and other subsequent neuropsychological effects is warranted, especially for people who are vulnerable to mercury exposure.

Comparison of invasive pneumococcal disease caused by serotype 19A and non-19A pneumococci in children: more empyema in serotype 19A invasive pneumococcal disease.

OBJECTIVE: To delineate whether serotype 19A invasive pneumococcal disease (IPD) comprised significantly more necrotizing pneumonia and empyema in children, we compared the clinical characteristics between serotype 19A and non-19A IPD. METHODS: Between January 2007 and December 2011, cases of children with IPD who were treated at the National Taiwan University Hospital were reviewed. Patients were assigned to the 19A group or the non-19A group based on the serotype. Their demographic data, clinical course, laboratory results, diagnosis, complications, and sequelae were collected and analyzed. RESULTS: Overall, 27 patients were included in the 19A group and 29 patients in the non-19A group. Compared with non-19A group, serotype 19A tended to cause IPD in patients without major underlying diseases (p = 0.015). Bacteremia without pneumonia or meningitis was found more frequently in the non-19A group (45% vs. 11%, p = 0.01), and pneumonia with or without empyema occurred significantly more frequently in the 19A group (89% vs. 52%, p = 0.006). Patients in the19A group had longer duration of fever (12 vs. 3 days, p = 0.01), and required more intensive care (78% vs. 41%, p = 0.01) and more video-assisted thoracoscopic surgery (74% vs. 28%, p = 0.001). CONCLUSION: In comparison with the other serotypes, serotype 19A IPD has significantly more empyema which required more video-assisted thoracoscopic surgery and more intensive care.

Adenovirus serotype 3 and 7 infection with acute respiratory failure in children in Taiwan, 2010-2011.

OBJECTIVE: Increased incidence of adenovirus infection in children was noticed since September 2010 in Taiwan and severe cases requiring intensive care were noted later. We did this study to find the clinical characteristics and risk factors associated with severe adenovirus infection. PATIENTS AND METHODS: We collected cases of severe adenovirus infection between November 2010 and June 2011 to analyze their clinical characteristics in two medical centers in northern Taiwan. Severe adenovirus infection was defined as laboratory-confirmed adenovirus cases with required intensive care. Hexon gene sequencing was performed for molecular genotyping. RESULTS: 45 patients were included, 22 cases (49%) were infected with serotype 7, 19 (42%) with serotype 3, and 4 with serotype 2. The median age (range) was 2.75 years (0.08-15.43 years); 87% were below 5 years. Male to female ratio was 1.65 (28 to 17). Of these patients, 56% had underlying neurological diseases, 50% experienced fever higher than 40°C and 69% suffered fever longer than one week. The clinical diagnosis included pneumonia in 40 (89%) patients, bronchopneumonia in 5 (11%), and encephalitis in 7 (16%). At least 22 patients had pleural effusion. They had complications of respiratory failure (53%), acute respiratory distress syndrome (24%), hypotension (40%), and 6 (13%) patients needed extracorporeal membranous oxygenation. Ten (22%) patients died, all with underlying major systemic diseases and 7 (70%) infected with serotype 7. CONCLUSIONS: Adenovirus serotype 7 and 3 can cause severe disease-even death-in children, especially those with underlying neurological diseases. Patients infected with adenovirus serotype 7 tended to have a higher case-fatality rate.

Community outbreak of adenovirus, Taiwan, 2011.

In 2011, a large community outbreak of human adenovirus (HAdV) in Taiwan was detected by a nationwide surveillance system. The epidemic lasted from week 11 through week 41 of 2011 (March 14-October 16, 2011). Although HAdV-3 was the predominant strain detected (74%), an abrupt increase in the percentage of infections caused by HAdV-7 occurred, from 0.3% in 2008-2010 to 10% in 2011. Clinical information was collected for 202 inpatients infected with HAdV; 31 (15.2%) had severe infection that required intensive care, and 7 of those patients died. HAdV-7 accounted for 10%, 12%, and 41% of infections among outpatients, inpatients with nonsevere infection, and inpatients with severe infection, respectively (p<0.01). The HAdV-7 strain detected in this outbreak is identical to a strain recently reported in the People's Republic of China (HAdV7-HZ/SHX/CHN/2009). Absence of circulating HAdV-7 in previous years and introduction of an emerging strain are 2 factors that caused this outbreak.