Rotavirus vaccination: a risk factor for intussusception?

Recently published pharmacoepidemiological studies associate the currently authorized Rotavirus (RV) vaccines with intussusception (IS). We aimed at investigating whether, in Germany, there are excess IS cases in RV vaccinees compared with the background incidence before market authorization in 2006. Suspected cases of IS following receipt of RV vaccines reported to the Paul-Ehrlich-Institut (PEI) from 2006 to 2010 were reviewed and validated against the criteria of the Brighton Collaboration's definition for IS. An observed-versus-expected analysis was conducted using standardized morbidity ratio (SMR) methods based on age-specific incidence rates for IS ranging from 19.2 to 98.5 per 100,000 person-years. A total of 27 cases of suspected IS in RV vaccinees were reported to the PEI. No excess of IS cases could be detected 1-7 days after receipt of either RV vaccine after any dose in the first year of life; however, in infants aged 3-5 months, a significantly increased SMR for IS was found in a risk window of 1-7 days after the first dose of either RV vaccine [SMRs: Rotarix® 4.6 (95% CI 1.5-10.7); RotaTeq® 5.8 (95% CI 1.2-17.1)]. A significantly increased risk of IS in a risk window of 1-7 days after RV vaccination was not found when the first dose was administered earlier. Therefore, it is recommended to start the vaccination course at 6-12 weeks of age.

Use of electronic data capture in a clinical trial on infant feeding.

BACKGROUND/OBJECTIVE: The European Childhood Obesity Project is a multi-centre double-blind randomised clinical trial in five countries testing whether protein intake in early life is related to later obesity risk. We use electronic data capture (EDC) in this trial and report here on our experience with the method. SUBJECTS/METHODS: Data capture for the first two study years was done with 10 notebooks, which were installed with the RDE (Remote Data Entry) programme Clindoc. RESULTS: We here exemplary report our experiences in 1 of the 11 study centres. A total of 205 of 760 visits (27.0%) were documented with interim paper-based case report forms, whereas 555 (73.0%) visits were recorded with electronic case report forms (eCRF). The need for after-trial plausibility checks of anthropometric data is significantly reduced in visits done by eCRF in comparison with visits done by paper-based CRFs (14.05% versus 35.61%). CONCLUSION: EDC reduces significantly the need for after-trial data checks but the planning and implementation process before starting the trial is more time-consuming.

Childhood asthma and continuous exposure to cats since the first year of life with cats allowed in the child's bedroom.

BACKGROUND: There are controversial data as to interdependencies of exposure to furred pets in infancy and the prevalence of asthma and hay fever in children. Does the timing, intensity and type of pet exposure matter? METHODS: Cross-sectional questionnaire data on 8216 German schoolchildren aged 5-7 years not living on a farm in ten rural districts in Bavaria in 1997 were analysed. The diagnosis of asthma and hay fever was ascertained with the International Study of Asthma and Allergies in Childhood (ISAAC) core questions. Wheeze and asthma were classified as 'atopic' in children who also had hay fever or atopic dermatitis. Prevalence and intensity of exposure to pets in the first year of life and at present were assessed via questionnaire. RESULTS: Although the study was of considerable size we found no convincing association between atopic disease and pet exposure in general. Exposure to cats from the first year of life to school entry, however, was associated with a reduced prevalence of atopic asthma, if cats were allowed to be in the child's bedroom: no case of atopic asthma in 296 children exposed and an aOR 0.11 (95% CI:0.01-0.52) for atopic wheeze in the last 12 months. CONCLUSIONS: Allowing cats to be in the child's bedroom from the first year of life onwards may be an indicator of intensive exposure to cats and appears to prevent the development of childhood asthma.

Foetal growth restriction in children with prothrombotic risk factors.

Placental infarction is frequently observed in low birth weight children. To evaluate whether low birth weight in healthy term neonates is associated with foetal inherited prothrombotic risk factors this retrospective study was conducted. Outcome measures were "birth weight in the lowest quartile" and "birth weight in the lowest decile" in singletons with a gestational age of > or =37 weeks. The analyses were based on 375 Caucasian children screened at the Monster childhood thrombophilia centre with complete data for all prothrombotic risk factors (factor V G1691A, prothrombin G20210A, elevated lipoprotein (a), protein C-, protein S-, antithrombin-deficiency). The proportion of children in the lowest birth weight quartile increased from 23.7% to 30.5% to 48.0% for children with no, only single heterozygous and multiple or homozygous defects respectively. The respective adjusted odds ratios (95% confidence intervals) of thrombophilia for birth weight in the lowest quartile (lowest decile) were 1.53 (0.76-3.08) in carriers of one prothrombotic risk factor and 4.01 (1.48-10.84) in subjects carrying multiple or homozygous defects. We identified foetal thrombophilia as an additional cause of low birth weight.

[European public health professionals express ten priorities for the European Union...to be followed]. / Des professionnels de santé publique européens pour experimer dix priorités pour l'Union européenne ... à suivre.

Even if the European Union acquired explicit competencies in public health with the Maastricht and Amsterdam Treaties (articles 129 and 152), public health professionals still have not had their word in the definition of public health priorities. Yet it is they, whatever their mission, who must take into consideration the new constraints imposed by Community directives. The French Society for Public Health (FSPH) took the initiative of running a project, financed by the European Commission, aiming to shed light on some of the public health problems considered priority in the 15 member states, and to provide suggestions for facing them. The FSPH adopted a resolutely participative and pragmatic process. At each step (definition of priorities and compiling arguments), the intention of the SFPH was more to allow different, even diverging, points of view to be expressed, than to aim for a hypothetical representativeness. The undertaken themes are the social gradients in health, alcohol, illicit drugs, tobacco, surveillance of health issues, quality of care, older persons, mental health, the environment, nutrition and food security. This work marks the wish of the FSPH for international openness toward Europe. The FSPH hopes that this work becomes a platform for the development of a reinforced dialogue between public health professionals and European decision makers.

[Evaluation of an educational action on accident prevention in children]. / Evaluation d'une action éducative contre les accidents d'enfants.

A health education action for childhood injuries prevention took place from october 1988 to march 1989 in the town of Chambéry (Savoie), a town of 95,000 inhabitants. The health education concerned 21,950, 0 to 15 years old children and their close relatives (parents or educators). Two assessment means were applied: 1) a questionnaire submitted to the parents and the children before and after the intervention; 2) a comparison with the evolution of chosen indicators in a control town (Annecy, Haute-Savoie, 112,000 inhabitants), the informations being supplied by private doctors, hospital, clinics, pupils insurance and anti poison centres. The comparison between the action and the control areas shows a tendency towards a decrease in the action area of the frequency of home accidents and calls to the anti-poison centres. However the overall impact of the action looks weak and possible variations appears difficult to ascertain. This work highlights the methodological difficulties of the evaluation of community health education actions.

Coronary blood-flow responses during successful percutaneous transluminal coronary angioplasty.

With the use of thermodilution techniques, changes in coronary sinus blood flow were measured during balloon catheter dilation of a high-grade stenosis within the left anterior descending coronary artery. Postdilation increases in flow occurred in a patient who experienced complete relief from previously incapacitating angina pectoris.