Subcutaneous diphtheria and tetanus vaccines in children with haemophilia: A pilot study and review of the literature.

INTRODUCTION: Subcutaneous (SQ) vaccination has emerged as standard of care in children with severe bleeding disorders to reduce unnecessary factor exposure and avoid provoking an intramuscular bleed, but little is known about comparative immunogenicity to intramuscular (IM) vaccination. AIM: To confirm immunogenicity of Diphtheria Tetanus acellular Pertussis (DTaP) vaccines administered SQ to individuals <6 years old with haemophilia. METHODS: We performed a retrospective and prospective pilot study of tetanus and diphtheria antibody titres among patients evaluated at our Haemophilia Treatment Centre between 2015-2016. Children with haemophilia who had received three to four doses of DTaP containing vaccine administered SQ were eligible. RESULTS: Eight children met inclusion criteria. The mean age at the time of diphtheria and tetanus antibody testing was 21.1±17.8 months. All children who received SQ diphtheria and tetanus developed a positive antibody titre to both antigens. There was no statistically significant difference in distribution of titre values. The average time between the last dose of vaccine and antibody testing was 6.6±3.9 months among SQ vaccinated subjects. Minor injection site reactions were common with SQ vaccines. CONCLUSION: SQ administration of diphtheria and tetanus vaccination appears to be immunogenic in a pilot study of Haemophilia patients and supports this practice as the standard of care for this population.

Empirical fear profiles among American youth.

Fears among children can range from relatively innocuous fears of simple objects to significant phobias that affect youths' everyday functioning in the home, school, or community environments. This study investigated empirically derived fear profiles among American youth ages 7-19 (N=556). Based upon youths' scores on the 5 factors of the Fear Survey Schedule for Children-II (FSSC-II; Burnham & Gullone (Behav Res Ther, 35, 1997)), multistage Euclidean grouping was applied and produced 5 replicable fear cluster profiles with unique contours. Logistic regression odds ratios revealed specific associations of profile group membership with demographic characteristics such as child age, sex, and ethnicity.

What patient characteristics make clinicians recommend brief treatment?

OBJECTIVE: Assessing self-rated items that might have an impact on clinicians recommending brief treatment (BT) over unlimited or long-term treatment (ULT). METHOD: On the basis of patient self-report data we compared patients referred by clinicians to BT (n=71) with those referred to ULT (n=145). RESULTS: The final multiple logistic regression model indicates that the chance of being allocated to BT increases with: more satisfaction with support, higher self-esteem, primary education or less, and high desire for support as an intervention. With regard to desire to confess in treatment, low and high scores make the chance of being allocated to BT lower. This is also the case for daily hassles. Finally, some specific target complaints, in particular anxiety, lower the chance of being allocated to BT. CONCLUSION: Using data about patient's complaints and symptoms, stress and support, personality and coping, and request for type of intervention, we built a regression-model that classified 80% of the patients correctly with regard to allocation to BT or ULT.

Learning-related behaviours versus cognitive ability in the academic performance of Vincentian children.

BACKGROUND: The few studies of children's academic performance in developing countries have largely focused on effects of early risks and cognitive ability and usually neglected other factors such as attention and anxiety. Previously, we reported that scores on the Learning Behaviour Scale (LBS) and the Revised Behaviour Problem Checklist (RBPC) were correlated with academic scores and achievement test scores for village children in St Vincent, the West Indies. AIMS: We examined the stability of LBS and RBPC scores and their ability to predict academic and achievement scores in the same population. SAMPLE: Vincentian village children, ages 6-12, participated in the study: 65 participated in the one-year sample and 68 participated in the two-year sample. METHOD: Children completed a curriculum-based achievement test and the Raven Coloured Progressive Matrices. Teachers completed the LBS and an adjusted RBPC and reported children's academic scores in 1998 and 1999. RESULTS: LBS scores were stable over one year and RBPC scores were stable over two years. LBS, RBPC, and Raven scores predicted achievement and academic scores. For both academic scores and achievement test scores, the greatest improvement in prediction came when the RBPC's attention and anxiety subscales were added to regression models. CONCLUSIONS: Results provide additional support for the finding that Caribbean village children's academic performance is greatly influenced by attention and anxiety problems, not just their cognitive ability. Despite cultural differences, LBS and RBPC scores were as predictive of academic performance in this population as in American populations. The best way to improve academic performance for these children may be to reduce attention problems.