Background: Routine influenza vaccination for children aged 6-23 months has r ecently been recommended in the United States. Accurate assessment of influenza related burden of illness in children could support similar...Background: Routine influenza vaccination for children aged 6-23 months has r ecently been recommended in the United States. Accurate assessment of influenza related burden of illness in children could support similar recommendations in o ther settings. However, routinely available data underestimate the role of influ enza in causing hospitalisation, and indirect estimation methods face difficulti es controlling for the concurrent circulation of respiratory syncytial virus (RS V). Recent studies from Hong Kong and the United States have used differing meth ods to estimate the true burden of influenza related hospitalisation, with dispa rate results. Methods: Retrospective population based study of children less tha n 18 years of age from Sydney, Australia, 1994 to 2001. Using two previously rep orted methods, estimates of annual hospitalisation rates attributable to influen za were derived by comparison of mean hospitalisation rates for acute respirator y disease during periods of high influenza activity and low RSV activity (define d using virological surveillance data) and periods where both influenza and RSV activity were low. These estimates were compared to rates of hospitalisation whe re influenza was recorded as the principal discharge diagnosis. Results: Hospita lisation rates attributable to influenza were up to 11 times higher, depending o n the age group and method used, compared to rates calculated from principal dis charge diagnosis codes. Conclusions: Although there remains considerable uncerta inty in estimating influenza related morbidity by methods using excess hospitali sations, even minimum estimates of disease burden warrant consideration of routi ne influenza immunisation for all children less than 2 years of age. Such estima tes, derived from principal discharge diagnosis codes, are available in most set tings.展开更多
Objective: To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas. Design: Randomised controlled...Objective: To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas. Design: Randomised controlled trial. Setting: 47 general practices in Nottingham. Participants: 3428 families with children under 5. Intervention: A standardised safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks. Main outcome measures: Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices. Results: No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95%confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years’follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small. Conclusions: The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates.展开更多
文摘Background: Routine influenza vaccination for children aged 6-23 months has r ecently been recommended in the United States. Accurate assessment of influenza related burden of illness in children could support similar recommendations in o ther settings. However, routinely available data underestimate the role of influ enza in causing hospitalisation, and indirect estimation methods face difficulti es controlling for the concurrent circulation of respiratory syncytial virus (RS V). Recent studies from Hong Kong and the United States have used differing meth ods to estimate the true burden of influenza related hospitalisation, with dispa rate results. Methods: Retrospective population based study of children less tha n 18 years of age from Sydney, Australia, 1994 to 2001. Using two previously rep orted methods, estimates of annual hospitalisation rates attributable to influen za were derived by comparison of mean hospitalisation rates for acute respirator y disease during periods of high influenza activity and low RSV activity (define d using virological surveillance data) and periods where both influenza and RSV activity were low. These estimates were compared to rates of hospitalisation whe re influenza was recorded as the principal discharge diagnosis. Results: Hospita lisation rates attributable to influenza were up to 11 times higher, depending o n the age group and method used, compared to rates calculated from principal dis charge diagnosis codes. Conclusions: Although there remains considerable uncerta inty in estimating influenza related morbidity by methods using excess hospitali sations, even minimum estimates of disease burden warrant consideration of routi ne influenza immunisation for all children less than 2 years of age. Such estima tes, derived from principal discharge diagnosis codes, are available in most set tings.
文摘Objective: To assess the effectiveness of safety advice and safety equipment in reducing unintentional injuries for families with children aged under 5 years and living in deprived areas. Design: Randomised controlled trial. Setting: 47 general practices in Nottingham. Participants: 3428 families with children under 5. Intervention: A standardised safety consultation and provision of free and fitted stair gates, fire guards, smoke alarms, cupboard locks, and window locks. Main outcome measures: Primary outcome measures were whether a child in the family had at least one injury that required medical attendance and rates of attendance in primary and secondary care and of hospital admission for injury over a two year period. Secondary outcome measures included possession of safety equipment and safety practices. Results: No significant difference was found in the proportion of families in which a child had a medically attended injury (odds ratio 1.14, 95%confidence interval 0.98 to 1.50) or in the rates of attendance in secondary care (incidence rate ratio 1.02, 0.90 to 1.13) or admission to hospital (1.02, 0.70 to 1.48). However, children in the intervention arm had a significantly higher attendance rate for injuries in primary care (1.37, 1.11 to 1.70, P = 0.003). At both one and two years’follow up, families in the intervention arm were significantly more likely to have a range of safety practices, but absolute differences in the percentages were relatively small. Conclusions: The intervention resulted in significant improvements in safety practices for up to two years but did not reduce injuries that necessitated medical attendance. Although equipment was provided and fitted free of charge, the observed changes in safety practices may not have been large enough to affect injury rates.
