[Show abstract][Hide abstract] ABSTRACT: Background:
In recent years the role of vitamin D status in early life on the development of allergic disease has generated much interest. The aim of this study was to determine whether cord blood vitamin D concentrations were associated with risk of early childhood allergic disease.
Measurements of cord blood 25-hydroxyvitamin D [25(OH)D] concentrations were available in 270 mother-child pairs who were participating in the allergy follow-up (n = 706) of the Docosahexaenoic Acid to Optimise Mother Infant Outcome randomised controlled trial. All of the children had a hereditary risk of allergic disease. The diagnosis of allergic disease was made during medical assessments at 1 and 3 years of age.
The mean (standard deviation) standardised cord blood 25(OH)D concentration was 57.0 (24.1) nmol/L. The cumulative incidence of eczema to 3 years of age, n = 101/250 (40 %) was associated with standardised cord blood 25(OH)D concentration, with a 10 nmol/L rise in 25(OH)D concentration reducing the risk of eczema by 8 % (relative risk 0.92, 95 % confidence interval 0.86-0.97; P = 0.005). This association was stronger at 1 year of age, when a 10 nmol/L rise in standardised cord blood 25(OH)D concentration reduced the risk of eczema by 12 % (relative risk 0.88, 95 % confidence interval 0.81-0.96; P = 0.002). No associations between cord blood 25(OH)D concentrations and development of allergic sensitisation, allergic rhinitis or asthma in early childhood were found.
In children with a family history of allergic disease, a higher cord blood 25(OH)D concentration appears to be associated with reduced risk of eczema in early childhood.
Australian New Zealand Clinical Trials Registry ACTRN12610000735055 (DOMInO trial: ACTRN12605000569606).
World Allergy Organization Journal 12/2015; 8(1). DOI:10.1186/s40413-015-0077-9
[Show abstract][Hide abstract] ABSTRACT: Background
Informative birth size occurs when the average outcome depends on the number of infants per birth. Although analysis methods have been proposed for handling informative birth size, their performance is not well understood. Our aim was to evaluate the performance of these methods and to provide recommendations for their application in randomised trials including infants from single and multiple births.Methods
Three generalised estimating equation (GEE) approaches were considered for estimating the effect of treatment on a continuous or binary outcome: cluster weighted GEEs, which produce treatment effects with a mother-level interpretation when birth size is informative; standard GEEs with an independence working correlation structure, which produce treatment effects with an infant-level interpretation when birth size is informative; and standard GEEs with an exchangeable working correlation structure, which do not account for informative birth size. The methods were compared through simulation and analysis of an example dataset.ResultsTreatment effect estimates were affected by informative birth size in the simulation study when the effect of treatment in singletons differed from that in multiples (i.e. in the presence of a treatment group by multiple birth interaction). The strength of evidence supporting the effectiveness of treatment varied between methods in the example dataset.Conclusions
Informative birth size is always a possibility in randomised trials including infants from both single and multiple births, and analysis methods should be pre-specified with this in mind. We recommend estimating treatment effects using standard GEEs with an independence working correlation structure to give an infant-level interpretation.
[Show abstract][Hide abstract] ABSTRACT: A randomised controlled trial (RCT) of high-dose v. low-dose fish oil in recent-onset rheumatoid arthritis (RA) demonstrated that the group allocated to high-dose fish oil had increased remission and decreased failure of disease-modifying anti-rheumatic drug (DMARD) therapy. This study examines the relationships between plasma phospholipid levels of the n-3 fatty acids in fish oil, EPA and DHA, and remission and DMARD use in recent-onset RA. EPA and DHA were measured in blood samples from both groups of the RCT. The data were analysed as a single cohort, and Cox proportional hazards models were used to examine relationships between plasma phospholipid (PL) EPA and DHA and various outcome measures. When analysed as a single cohort, plasma PL EPA was related to time to remission, with a one unit increase in EPA (1 % total fatty acids) associated with a 12 % increase in the probability of remission at any time during the study period (hazard ratio (HR)=1·12; 95 % CI 1·02, 1·23; P=0·02). Adjustment for smoking, anti-cyclic citrullinated peptide antibodies and 'shared epitope' HLA-DR allele status did not change the HR. Plasma PL EPA, adjusted for the same variables, was negatively related to time to DMARD failure (HR=0·85; 95 % CI 0·72, 0·99; P=0·047). The HR for DHA and time to remission or DMARD failure were similar in magnitude to those for EPA, but not statistically significant. Biomarkers of n-3 status, such as plasma PL EPA, have the potential to predict clinical outcomes relevant to standard drug treatment of RA patients.
The British journal of nutrition 08/2015; 114(06):1-6. DOI:10.1017/S0007114515002718 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: The intention-to-treat principle states that all randomised participants should be analysed in their randomised group. The implications of this principle are widely discussed in relation to the analysis, but have received limited attention in the context of handling errors that occur during the randomisation process. The aims of this article are to (1) demonstrate the potential pitfalls of attempting to correct randomisation errors and (2) provide guidance on handling common randomisation errors when they are discovered that maintains the goals of the intention-to-treat principle.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to quantify the magnitude of association between incremental increases in body mass index (BMI) and the development of incident, post-operative, and post-ablation atrial fibrillation (AF).
[Show abstract][Hide abstract] ABSTRACT: Six Year Follow Up of Children at High Hereditary Risk of Allergy, Born To Mothers Supplemented With Docosahexaenoic Acid (DHA) in the DOMInO Trial
Best K1,2, Sullivan T6,Gold M1, Kennedy D4,5, Martin J4,5, Palmer D1,7, Makrides M1,2,3
1Women’s & Children’s Health Research Institute, University of Adelaide, North Adelaide, Australia
2School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
³Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
4Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
5 Department of Respiratory and Sleep Medicine, Women’s & Children’s Hospital, North Adelaide, Australia
6 School of Population Health, University of Adelaide, Adelaide, Australia
7 School of Paediatrics and Child Health, University of Western Australia, Subiaco, Australia
Background: Dietary omega-3 (n-3) long chain polyunsaturated fatty acids (LCPUFA) modulate neonatal markers of the immune response but there is uncertainty regarding the effect on clinical allergy outcomes. This double blind, randomised controlled trial aimed to determine whether supplementation with DHA rich fish oil during pregnancy to women with a fetus at high risk of allergic disease, will reduce the risk of allergy in the child.
Method: Between 2005 and 2008, pregnant women between 18-21 weeks gestation were randomly assigned to consume capsules containing ~1 g/d of DHA or a blended vegetable oil (no DHA) until birth, the DOMInO trial. From 2012-2014, 603 children (90% of eligible) born to mothers in the DOMInO trial, with a family history of allergic disease completed a six year of age follow up assessment . History of asthma, allergic rhinitis and eczema were assessed, along with food and aero-allergen sensitisation by skin prick testing.
Results: Preliminary results show no difference in the overall percentage of children with IgE-mediated allergic disease between the DHA and control groups (75/279 (26.8%) vs 79/263 (30.0%); RR 0.95; 95% CI 0.73,1.23; P=0.69), although there were fewer children with parent reported hay fever in the DHA group (68/314 (21.6%) vs 84/289 (29.1%); RR 0.75; 95%CI 0.57, 0.99; P=0.04) and fewer children were sensitised to house dust mite, D.Farinae, in the DHA group 31/246 (12.6%) vs 49/231 (21.2%) control; RR 0.61 (0.41, 0.92); P=0.019.
Conclusions: DHA supplementation in pregnancy did not reduce the overall incidence of IgE-mediated allergies at six years of age although parent reported hay fever and D.Farinae sensitisation were lower.
Perinatal Society of Australia and New Zealand; 04/2015
[Show abstract][Hide abstract] ABSTRACT: To determine if improvements in cognitive outcome detected at 18 months' corrected age (CA) in infants born <33 weeks' gestation receiving a high-docosahexaenoic acid (DHA) compared with standard-DHA diet were sustained in early childhood.
Follow-up of a multicentre randomised controlled trial. Randomisation was stratified for sex, birth weight (<1250 vs ≥1250 g) and hospital.
Five Australian tertiary hospitals from 2008 to 2013.
626 of the 657 participants randomised between 2001 and 2005 were eligible to participate.
High-DHA (≈1% total fatty acids) enteral feeds compared with standard-DHA (≈0.3% total fatty acids) from age 2-4 days until term CA.
Full Scale IQ of the Wechsler Abbreviated Scale of Intelligence (WASI) at 7 years CA. Prespecified subgroup analyses based on the randomisation strata (sex, birth weight) were conducted.
604 (92% of the 657 originally randomised) consented to participate (291 high-DHA, 313 standard-DHA). To address missing data in the 604 consenting participants (22 for primary outcome), multiple imputation was performed. The Full Scale IQ was not significantly different between groups (high-DHA 98.3, SD 14.0, standard-DHA 98.5, SD 14.9; mean difference adjusted for sex, birthweight strata and hospital -0.3, 95% CI -2.9 to 2.2; p=0.79). There were no significant differences in any secondary outcomes. In prespecified subgroup analyses, there was a significant sex by treatment interaction on measures of parent-reported executive function and behaviour. Scores were within the normal range but girls receiving the high-DHA diet scored significantly higher (poorer outcome) compared with girls receiving the standard-DHA diet.
Supplementing the diets of preterm infants with a DHA dose of approximately 1% total fatty acids from days 2-4 until term CA showed no evidence of benefit at 7 years' CA.
Australian New Zealand Clinical Trials Registry: ACTRN12606000327583.
Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BMJ Open 03/2015; 5(3):e007314. DOI:10.1136/bmjopen-2014-007314 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives Multiple births are an important subgroup to consider in trials aimed at reducing preterm birth or its consequences. Including multiples results in a unique mixture of independent and clustered data, which has implications for the design, analysis and reporting of the trial. We aimed to determine how multiple births were taken into account in the design and analysis of recent trials involving preterm infants, and whether key information relevant to multiple births was reported.
Design We conducted a systematic review of multicentre randomised trials involving preterm infants published between 2008 and 2013. Information relevant to multiple births was extracted.
Results Of the 56 trials included in the review, 6 (11%) excluded multiples and 24 (43%) failed to indicate whether multiples were included. Among the 26 trials that reported multiples were included, only one (4%) accounted for clustering in the sample size calculations and eight (31%) took the clustering into account in the analysis of the primary outcome. Of the 20 trials that randomised infants, 12 (60%) failed to report how infants from the same birth were randomised.
Conclusions Information on multiple births is often poorly reported in trials involving preterm infants, and clustering due to multiple births is rarely taken into account. Since ignoring clustering could result in inappropriate recommendations for clinical practice, clustering should be taken into account in the design and analysis of future neonatal and perinatal trials including infants from a multiple birth.
Archives of Disease in Childhood - Fetal and Neonatal Edition 11/2014; 100(2). DOI:10.1136/archdischild-2014-306239 · 3.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
The origins of cardiovascular and renal disease in type 1 diabetes begin during childhood. We aimed to evaluate carotid (cIMT) and aortic intima-media thickness (aIMT) and their relationship with cardiovascular risk factors and urinary albumin excretion in adolescents with type 1 diabetes in the Adolescent Type 1 Diabetes cardio-renal Intervention Trial (AdDIT).
Research design and methods:
A total of 406 adolescents with type 1 diabetes, who were 14.1 ± 1.9 years old with type 1 diabetes duration of 6.7 ± 3.7 years, and 57 age-matched control subjects provided clinical and biochemical data and ultrasound measurements of vascular structure (cIMT and aIMT). Vascular endothelial and smooth muscle function was also measured in 123 of 406 with type 1 diabetes and all control subjects.
In type 1 diabetic subjects, mean/maximal aIMT (P < 0.006; <0.008), but not mean/maximal cIMT, was greater than in control subjects. Mean/maximal aIMT related to urinary albumin-to-creatinine ratio (multiple regression coefficient [SE], 0.013 [0.006], P = 0.03; 0.023 [0.007], P = 0.002), LDL cholesterol (0.019 [0.008], P = 0.02; 0.025 [0.011], P = 0.02), and age (0.010 [0.004], P = 0.004; 0.012 [0.005], P = 0.01), independent of other variables. Mean/maximal cIMT was greater in males (0.023 [0.006], P = 0.02; 0.029 [0.007], P < 0.0001), and mean cIMT related independently to systolic blood pressure (0.001 [0.001], P = 0.04). Vascular smooth muscle function related to aIMT and cIMT but not to urinary albumin excretion.
aIMT may be a more sensitive marker of atherosclerosis than cIMT in type 1 diabetes during mid-adolescence. Higher urinary albumin excretion, even within the normal range, is associated with early atherosclerosis and should direct clinical attention to modifiable cardiovascular risk factors.
Diabetes Care 07/2014; 37(11). DOI:10.2337/dc14-0700 · 8.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Randomised controlled trials (RCT) examining the effects of fish oil supplementation on cardiac outcomes have yielded varying results over time. Although RCT are placed at the top of the evidence hierarchy, this methodology arose in the framework of pharmaceutical development. RCT with pharmaceuticals differ in important ways from RCT involving fish oil interventions. In particular, in pharmaceutical RCT, the test agent is present only in the intervention group and not in the control group, whereas in fish oil RCT, n-3 fats are present in the diet and in the tissues of both groups. Also, early phase studies with pharmaceuticals determine pharmacokinetics and pharmacodynamics to design the dose of the RCT intervention so that it is in a predicted linear dose-response range. None of this happens in fish oil RCT, and there is evidence that both baseline n-3 intake and tissue levels may be sufficiently high in the dose-response range that it is not possible to demonstrate a clinical effect with a RCT. When these issues are considered, it is possible that the changing pattern of fish consumption and fish oil use over time, especially in cardiac patients, can explain the disparity where benefit was observed in the early fish oil trials but not in the more recent trials.
British Journal Of Nutrition 06/2014; 112(05):1-9. DOI:10.1017/S0007114514001408 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Partial weight bearing is often prescribed for patients with orthopedic injuries. Patients’ ability to accurately reproduce partial weight bearing orders is variable, and its impact on clinical outcomes is unknown. This observational study measured patients’ ability to reproduce partial weight bearing orders, factors influencing this, patients’ and physiotherapists’ ability to gauge partial weight bearing accuracy, and the effect of partial weight bearing accuracy on long-term clinical outcomes. Fifty-one orthopedic inpatients prescribed partial weight bearing were included. All received standard medical/nursing/physiotherapy care. Physiotherapists instructed patients in partial weight bearing using the hand-under-foot, bathroom scales, and/or verbal methods of instruction. Weight bearing was measured on up to 3 occasions during hospitalization using a force-sensitive insole. Factors that had the potential to influence partial weight bearing accuracy were recorded. Patients and their physiotherapists rated their perception of partial weight bearing accuracy. Three-month clinical follow-up data were retrieved from medical records. The majority of patients (72% or more) exceeded their target load, with mean peak weight bearing as high as 19.3 kg over target load (285% of target load). Weight bearing significantly increased over the 3 measurement occasions (P<.001) and was significantly associated with greater body weight (P=.04). Patients and physiotherapists were unable to accurately gauge partial weight bearing accuracy. The incidence of clinically important complications at 3 months was 9% and not significantly associated with partial weight bearing accuracy during hospitalization (P≥.45). Patients are unable to accurately reproduce partial weight bearing orders when trained with the hand-under-foot, bathroom scales, or verbal methods of instruction.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND A recent review concluded that general health checks fail to reduce mortality in adults. AIM This review focuses on general practice-based health checks and their effects on both surrogate and final outcomes. DESIGN AND SETTING Systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials. METHOD Relevant data were extracted from randomised trials comparing the health outcomes of general practice-based health checks versus usual care in middle-aged populations. RESULTS Six trials were included. The end-point differences between the intervention and control arms in total cholesterol (TC), systolic and diastolic blood pressure (SBP, DBP), and body mass index (BMI) were -0.13 mmol/l (95% confidence interval [CI] = -0.19 to -0.07), -3.65 mmHg (95% CI = -6.50 to -0.81), -1.79 mmHg (95% CI = -2.93 to -0.64), and -0.45 kg/m(2) (95% CI = -0.66 to -0.24), respectively. The odds of a patient remaining at 'high risk' with elevated TC, SBP, DBP, BMI or continuing smoking were 0.63 (95% CI = 0.50 to 0.79), 0.59 (95% CI = 0.28 to 1.23), 0.63 (95% CI = 0.53 to 0.74), 0.89 (95% CI = 0.81 to 0.98), and 0.91 (95% CI = 0.82 to 1.02), respectively. There was little evidence of a difference in total mortality (OR 1.03, 95% CI = 0.90 to 1.18). Higher CVD mortality was observed in the intervention group (OR 1.30, 95% CI = 1.02 to 1.66). CONCLUSION General practice-based health checks are associated with statistically significant, albeit clinically small, improvements in surrogate outcome control, especially among high-risk patients. Most studies were not originally designed to assess mortality.
British Journal of General Practice 02/2014; 64(618):e47-53. DOI:10.3399/bjgp14X676456 · 2.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: -Surviving myocytes within scar may form channels that support ventricular tachycardia (VT) circuits. There is little data on the properties of channels that comprise VT circuits and those which are non-VT supporting channels.
-In 22 patients with ischemic cardiomyopathy and VT, high-density mapping was performed with the PentaRay™ catheter and Ensite NavX™ system during sinus rhythm. A channel was defined as a series of matching pace-maps with a stimulus (S) to QRS time of ≥40ms. Sites were determined to be part of a VT channel if there were matching pace-maps to the VT morphology. This was confirmed with entrainment mapping when possible. Of the 238 channels identified, 57 channels corresponded to an inducible VT. Channels that were part of a VT circuit were more commonly located within dense scar than non-VT channels (97% vs 82%, p=0.036). VT supporting channels were of greater length (mean±SEM 53±5 vs 33±4mm), had higher longest S-QRS (130±12 vs 82±12ms), longer conduction time (103±14 vs 43±13ms) and slower conduction velocity (0.87±0.23 vs 1.39±0.21m/s) than non-VT channels (p<0.001). Of all the fractionated, late and very late potentials located in scar, only 21%, 26% and 29% respectively were recorded within VT channels.
-High-density mapping shows substantial differences among channels in ventricular scar. Channels supporting VT are more commonly located in dense scar, longer than non-VT channels, and have slower conduction velocity. Only a minority of scar related potentials participate in the VT supporting channels.
[Show abstract][Hide abstract] ABSTRACT: The safety and nutritional adequacy of goat milk infant formulas have been questioned. The primary aim of the present study was to compare the growth and nutritional status of infants fed a goat milk infant formula with those of infants fed a typical whey-based cow milk infant formula. The secondary aim was to examine a range of health- and allergy-related outcomes. A double-blind, randomised controlled trial with 200 formula-fed term infants randomly assigned to receive either goat or cow milk formula from 2 weeks to at least 4 months of age was conducted. A cohort of 101 breast-fed infants was included for comparison. Weight, length and head circumference were measured at 2 weeks and 1, 2, 3, 4, 6 and 12 months of age. Nutritional status was assessed from serum albumin, urea, creatinine, Hb, ferritin, and folate and plasma amino acid concentrations at 4 months. Z-scores for weight, length, head circumference and weight for length were not different between the two formula-fed groups. There were differences in the values of some amino acids and blood biomarkers between the formula-fed groups, but the mean values for biomarkers were within the normal reference range. There were no differences in the occurrence of serious adverse events, general health, and incidence of dermatitis or medically diagnosed food allergy. The incidence of parentally reported blood-stained stools was higher in the goat milk formula-fed group, although this was a secondary outcome and its importance is unclear. Goat milk formula provided growth and nutritional outcomes in infants that did not differ from those provided by a standard whey-based cow milk formula.
The British journal of nutrition 02/2014; 111(09):1-11. DOI:10.1017/S0007114513004212 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose: Current substrate based ablation strategies for ventricular tachycardia (VT) advocate targeting all excitable abnormal ventricular electrograms within the scar. However only a fraction of these electrograms populate the VT supporting channels. We hypothesized that the electrogram properties in the standard model can identify information content specific to the location of VT supporting channels and lead intent and focused substrate ablation.
Methods: Study was conducted in three stages. Firstly, patients with ischemic cardiomyopathy (ICM; n=16) and multiple inducible VT (n=58) undergoing catheter ablation were evaluated. Left ventricular endocardial mapping was performed with high-density PentaRay™ catheter and NavX™ system. VT channel was defined as series of matching pacemaps with stimulus to QRS interval ≥40ms. Entrainment mapping confirmed pace map findings whenever feasible. In the blinded second stage, the standard model was applied to all SR maps. The timing of local activation was determined as mean of activation times of all electrogram peak deflections, and dispersion was quantified by their standard deviation. Shannon entropy (ShEn) was calculated as an index of electrogram amplitude distribution. A VT channel region was identified in the model by assemblage of node of latest mean activation and proximate low ShEn in a zone of high dispersion with adjoining interface of low dispersion. Channel locations built on this model were compared with VT channels developed in the first stage. Finally, for the test of concept, performance of this model was examined prospectively in 3 additional ICM patients to lead catheter ablation.
Results: Mean 763±203 sampling points were taken, 451±145 points in dense scar (≤0.5mV). From 1770 pacemaps, 174 channels were identified, 47 corresponded to inducible VTs. Of all the fractionated (mean 114±85), late (mean10±5) and very-late (mean 3±3) potentials, only 18%, 23% and 35%, respectively were recorded in the VT channels. Channels built on the model had high agreement with VT channels [κ =0.89, 95% CI 0.84 to 0.94] with high sensitivity (86%, 95% CI 76 to 93), specificity (100%, 95% CI 99.8 to 100), positive (93%, 95% CI 84 to 98) and negative (100%, 95% CI 99 to 100) predictive value for localizing an inducible VT channel. Finally, focused ablation in 3 patients within the postulated channel regions eliminated 6/8 inducible VTs.
Conclusion: The standard model can hasten identification of VT channels compared to other frequently employed electrogram characteristics. This will reduce the difficulties in the current substrate based ablation strategies.
[Show abstract][Hide abstract] ABSTRACT: (1) To investigate the association between temperature and work-related injuries and (2) to identify groups of workers at high risk of work-related injuries in hot environments in Adelaide, South Australia.
Workers' compensation claims in Adelaide, South Australia for 2001-2010 were used. The relationship between temperature and daily injury claims was estimated using a generalised estimating equation model. A piecewise linear spline function was used to quantify the effect of temperature on injury claims below and above thresholds.
Overall, a 1°C increase in maximum temperature between 14.2°C and 37.7°C was associated with a 0.2% increase in daily injury claims. Specifically, the incidence rate ratios (IRRs) for male workers and young workers aged ≤24 were (1.004, 95% CI 1.002 to 1.006) and (1.005, 95% CI 1.002 to 1.008), respectively. Significant associations were also found for labourers (IRR 1.005, 95% CI 1.001 to 1.010), intermediate production and transport workers (IRR 1.003, 95% CI 1.001 to 1.005) and tradespersons (IRR 1.002, 95% CI 1.001 to 1.005). Industries at risk were agriculture, forestry and fishing (IRR 1.007, 95% CI 1.001 to 1.013), construction (IRR 1.006, 95% CI 1.002 to 1.011), and electricity, gas and water (IRR 1.029, 95% CI 1.002 to 1.058).
There is a significant association between injury claims and temperature in Adelaide, South Australia, for certain industries and groups. Relevant adaptation and prevention measures are required at both policy and practice levels to address occupational exposure to high temperatures.
Occupational and environmental medicine 12/2013; 71(4). DOI:10.1136/oemed-2013-101584 · 3.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A new meningococcal serogroup B (Men B) vaccine has been licensed in the European Union (EU) and Australia. This study aimed to assess community and parental attitudes to introduction of new Men B vaccines and identify facilitators and barriers to vaccine implementation.
Cross-sectional survey including face-to-face interviews with adolescents, parents and adults from randomly selected households in South Australia in 2012. Survey data were weighted to the age, gender and geographical area profile of the population.
3055 interviews were conducted with individuals aged 15-97 years, including 966 parents. Participation rate was 66.4%. 82.5% (95% CI 79.7-85.4) of parents (797/966) wanted their child to receive the Men B vaccine, with 12.2% (9.7-14.7) (118/966) unsure. Main parental concerns included potential side effects (41.3% (26.7-46.0)) and adequate vaccine testing (11.7% (9.4-14.1)). Potential for an extra injection at an immunisation visit resulted in 15.7% (12.8-18.5) of parents (n=152/966) less likely to have their child immunised. Potential redness/swelling at the injection site or mild/moderate fever resulted in only 8.5% (6.3-10.7) and 10.8% (8.5-13.2) of parents, respectively, less likely to have their child immunised. Children being up to date with vaccinations and recommendation from family physician were the strongest independent predictors of parents agreeing their children should be immunised with Men B vaccine (OR=6.58; p=0.006 and OR=4.15; p<0.001, respectively). Only 16.4% (14.9-17.9) of adults (501/3055) stated that they would not want to receive a Men B vaccine, with family physician recommendation the strongest independent predictor of acceptance (OR=3.81; p<0.001).
There is strong community support for introduction of Men B vaccines, with parental willingness to have children immunised, impacted more by number of injections than potential for adverse events such as local reactions or fever.
[Show abstract][Hide abstract] ABSTRACT: -Atrial fibrillation (AF) ablation is an established therapy; however, limited data is available on associated complications. This systematic review determines the incidence and potential predictors of acute complications.
-Electronic searches were conducted in MEDLINE and EMBASE for English scientific literature up to the 18(th) June 2012. 2065-references were retrieved and evaluated for relevance. Reference lists of retrieved studies and review articles were examined to ensure all relevant studies were included. Data was extracted from 192-studies, total of 83,236-patients. The incidence of peri-procedural complications for catheter ablation of AF was 2.9% (95%CI, 2.6-3.2). There was a significant decrease in the acute complication rate in 2007-2012 compared to 2000-2006 (2.6% versus 4.0%, P=0.003). The complication rates reported were higher in prospective studies compared to those that retrospectively described complications (3.5% vs 2.7%, P= 0.03). There were no significant associations between procedure duration, ablation time, or ablation strategy, and acute complication rate.
-Catheter ablation of AF has a low incidence of peri-procedural complications. The acute complication rate has decreased significantly in recent years. This may reflect improved catheter technology and experience. The use of different strategies across centers worldwide appears to be safe with no established relationship between procedural variables and complication rate.