Quadrivalent versus trivalent influenza vaccine: clinical outcomes in two influenza seasons, historical cohort study.

OBJECTIVES: The quadrivalent influenza vaccine (QIV) contains two influenza B antigens (one of each B lineage), while the trivalent vaccine (TIV) contains solely one. As a result, a mismatch between the circulating B lineage and the lineage in the TIV occurs frequently. We aimed to compare the frequency of clinically significant outcomes in a large cohort of vaccinees receiving either TIV or QIV. METHODS: Historical cohort study of all inactivated influenza vaccinees (aged 3 years and older) in a Health Maintenance Organization insuring 1.2 million individuals, over two influenza seasons in which both vaccines were provided non-selectively. Primary outcome was hospital admissions during the influenza season. Multivariate analysis was performed using logistic regression to adjust for relevant covariates. RESULTS: Our cohort included 150 518 and 168 296 vaccinees in the first (S1) and second season (S2), respectively. The two influenza seasons were characterized by high Influenza B activity. Of those vaccinated with QIV, 2074 of 49 726 (4.2%) and 6563 of 121 741 (5.4%) were hospitalized compared with 7378 of 100 792 (7.3%) and 3372 of 46 555 (7.2%) of those vaccinated with TIV (S1 and S2, respectively). After multivariate analysis adjusting for several covariates (gender, age, socioeconomic status, chronic morbidity, timing of vaccination), compared with TIV recipients, QIV vaccinees had lower odds for hospitalization (OR = 0.92, 95% CI 0.87-0.98 and OR = 0.89, 95% CI 0.85-0.93) or emergency department visit (OR = 0.91, 95% CI 0.87-0.95 and OR = 0.84, 95% CI 0.81-0.87) in S1 and S2, respectively (p < 0.001). Lower odds of mortality and influenza-like illness were also observed in S2 (OR = 0.61, 95% CI 0.50-0.75 and OR = 0.92, 95% CI 0.90-0.95, respectively). CONCLUSIONS: In seasons with relatively high influenza B activity, QIV appeared more protective than TIV in Israel.

Children injured following TV tipovers in Israel, 1997-2003.

BACKGROUND: According to the US Consumer Product Safety Commission, about 7000 children, many under age five, are treated annually at emergency rooms for injuries associated with unintentional tipping of television (TV) and furniture. However, the professional literature does not reflect much inquiry regarding this source of risk. In Israel, cases of children injured following TV tipover are reported in newspapers but no studies were conducted in Israel on this issue. The aim of this report is to present data regarding frequency and characteristics of children injured following a falling TV in Israel during recent years, in order to provide more specific information for advising policymakers and raising awareness about this growing danger. METHODS: Data were obtained from the Israeli National Trauma Registry, and included injured children (0-17) hospitalized between 1997 and 2003, because of TV-related injury. Demographic information, Injury Severity Score (ISS), injured body region, surgical intervention, admission to the intensive care unit, length of hospital stay, destination at discharge and mortality were analysed. RESULTS: There were 116 children injured following TV tipover during the years analysed, increasing from nine in 1997 to 27 in 2003. Over half of the children (54.3%) were aged 1-2 years; 57.8% were boys. Three-quarters of the TV-related injuries were head and neck injuries; nearly one-fifth had ISS scores of over 15. The mean was 4.3 (median = 2 days); 15 children (12.9%) required surgery and four children died in the hospital. CONCLUSION: The findings reflect the fact that TV tipover is a growing source of danger that can be serious and should be brought to the attention of the public, health professionals and policymakers. Specific, age-related recommendations should be proposed, such as placing TVs on low and stable surface and not placing the remote controls on the top of the set.

Trends in youth mortality in Israel, 1984-1995.

BACKGROUND: Investigation of causes of death can help inform intervention policy aimed at reducing preventable mortality. OBJECTIVES: To assess mortality causes and trends over time and identify target groups with excessive mortality rates among Israeli youth aged 10-24, in order to formulate an intervention policy for prevention of adolescent mortality. METHODS: Mortality data for Israeli residents aged 10-24 were extracted from the Central Bureau of Statistics computerized death certificate file for the period 1984-95. Trends were evaluated by cause of death and demographic characteristics. RESULTS: The crude mortality rate among Israeli youth aged 10-24, during 1993-1995, was 39.6 per 100,000. Rates were 2.7 times higher among males, increased with age, and reached a peak among 18-21 year olds. Rates were 1.4 times higher among Arabs than among Jews. The sharp increase in mortality among Jewish males of military service age (18-21 years) was due mainly to motor vehicle crashes and suicide. Although overall mortality decreased by 9.4% from 1984-86 to 1993-95, the gap between the subgroups increased. MVC-related mortality increased over time by 100% among Arab males. The rate of completed suicide among Jewish males increased by 110%. Although injury-related mortality is lower in Israel compared with the U.S., similar demographic differentials and trends were found in both countries. CONCLUSIONS: Suicide among Jewish males of military service age, as well as MVC fatalities among Arab males, present a growing public health issue. Intervention strategies should therefore be targeted towards these subgroups in order to minimize the rates of preventable death.

[Interactive health databases on the Internet].

In order to obtain reliable, comprehensive and current data, information systems which enable flexible presentation or analysis are necessary, as opposed to static tables. On-line and interactive numeric health databases on the Internet are increasingly available. Interactive tables can be produced in many fields, e.g., mortality, hospitalizations, cancer incidence, or motor vehicle accidents. The query screens are user-friendly and they can access remote, computerized data. Thus, it is possible to receive immediate responses to specific questions from national or international datasets, which can then be compared with local data--all without leaving one's chair. The aim of this review is to increase awareness of the existence of numeric health databases on the Internet, and their contribution to epidemiological research.

Using a health concerns checklist as a bridge from reason for encounter to diagnosis of girls attending an adolescent health service.

OBJECTIVE: We assessed the extent to which a health concerns checklist (HCC) helps bridge the gap between the reason for encounter (RFE) described by girls entering an adolescent health service and the ultimate diagnosis. METHODS: The sample, 547 consecutive 12- to 18-year-old girls visiting an adolescent health service, first underwent a structured intake procedure, including a self-administered form on which they described their RFEs and other health concerns, as well as a psychosocial interview and medical evaluation performed by staff members. The RFEs, HCC items, and diagnoses, grouped into somatic, sexuality-related, and psychosocial categories, were then compared. RESULTS: Among the 399 girls expressing specific RFEs on entering the clinic, one-third were diagnosed with psychosocial disorders and one-fifth with sexuality-related concerns. Of the patients receiving a sexuality-related diagnosis, 57% presented with a sexuality-related request; another 26% noted it on the checklist. For those diagnosed with psychosocial problems, 22% stated this as the RFE, and another 50% indicated it on the HCC. The contribution of the HCC to the diagnosis was higher among adolescents not stating a specific RFE. CONCLUSION: The findings highlight the HCC's contribution in identifying health problems, especially among adolescents who find it difficult to verbalize sensitive issues.