Background: The Air Force Health Study collected reproductive outcomes for live-born children of male Air Force veterans of the Vietnam War. Methods: Dioxin values for participants were obtained from blood samples. An...Background: The Air Force Health Study collected reproductive outcomes for live-born children of male Air Force veterans of the Vietnam War. Methods: Dioxin values for participants were obtained from blood samples. Analyses were conducted of occurrence of 16 specific categories of birth defects and developmental disabilities. Children were categorized as conceived before and after the start of participants’ Vietnam War service. Children conceived before the start of Vietnam War service were treated as being conceived when their fathers had unquantifiable dioxin values. Children conceived after the start of Vietnam War service for participants with missing dioxin values were excluded from primary analyses, but were used to assess the impact of their exclusion on conclusions. Correlation between values for specific categories for multiple children fathered by the same participant was accounted for. The dose-response relationship was treated as a step function increasing for dioxin values larger than adaptively identified individual thresholds changing with the specific category. Results: For 15 of 16 specific categories, the probability of occurrence increased substantially for a sufficiently high dioxin level above identified thresholds. Exclusion of children due to missing dioxin likely did not affect these results. Conclusions: Results supported the conclusion of substantial adverse effects on a wide variety of specific categories of birth defects and developmental disabilities due to sufficiently high exposures to dioxin, a toxic contaminant of Agent Orange used for herbicide spraying in the Vietnam War. Results may hold more generally, but might also have been affected by a variety of limitations.展开更多
Background Despite global efforts to reduce preventable childhood illness by distributing infant vaccines,immunization coverage in sub-Saharan African settings remains low.Further,timely administration of vaccines at ...Background Despite global efforts to reduce preventable childhood illness by distributing infant vaccines,immunization coverage in sub-Saharan African settings remains low.Further,timely administration of vaccines at birth—tuberculosis(Bacille Calmette-Guerin[BCG])and polio(OPV0)—remains inconsistent.As countries such as Democratic Republic of the Congo(DRC)prepare to add yet another birth-dose vaccine to their immunization schedule,this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe.Methods The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B(HepB3)immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels.The assessment leveraged survey data collected during a continuous quality improvement study(NCT03048669)conducted in 105 maternity centers throughout Kinshasa Province,DRC.The final sample included 2398(BCG analysis)and 2268(HepB3 analysis)women-infant dyads living with HIV.Results Between 2016 and 2020,1981 infants(82.6%)received the BCG vaccine,and 1551(68.4%)received the first dose of HepB3 vaccine.Of those who received the BCG vaccine,26.3%,43.5%,and 12.8%received BCG within 24 h,between one and seven days,and between one and 14 weeks,respectively.Of infants who received the HepB3 vaccine,22.4%received it within six weeks,and 46%between six and 14 weeks of life.Many factors were positively associated with BCG uptake,including higher maternal education,household wealth,higher facility general readiness score,and religious-affiliated facility ownership.The factors influencing HepB3 uptake included older maternal age,higher education level,household wealth,transport by taxi to a facility,higher facility general and immunization readiness scores,and religious-affiliated facility ownership.Conclusions This study demonstrated that the study participants’uptake of vaccines was consistent with the country average,but not in a timely manner.Various factors were associated with timely uptake of BCG and HepB3 vaccines.These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.展开更多
The effects of pituitary suppression with one-third depot of long-acting gonadotropin-releasing hormone（Gn RH） agonist in Gn RH agonist long protocol for in vitro fertilization（IVF）/intracytoplasmic sperm injectio...The effects of pituitary suppression with one-third depot of long-acting gonadotropin-releasing hormone（Gn RH） agonist in Gn RH agonist long protocol for in vitro fertilization（IVF）/intracytoplasmic sperm injection（ICSI） were investigated. A retrospective cohort study was performed on 3186 cycles undergoing IVF/ICSI with Gn RH agonist long protocol in a university-affiliated infertility center. The pituitary was suppressed with depot triptorelin of 1.25 mg or 1.875 mg. There was no significant difference in live birth rate between 1.25 mg triptorelin group and 1.875 mg triptorelin group（41.2% vs. 43.7%）. The mean luteinizing hormone（LH） level on follicle-stimulating hormone（FSH） starting day was significantly higher in 1.25 mg triptorelin group. The mean LH level on the day of human chorionic gonadotrophin（h CG） administration was slightly but statistically higher in 1.25 mg triptorelin group. There was no significant difference in the total FSH dose between the two groups. The number of retrieved oocytes was slightly but statistically less in 1.25 mg triptorelin group than in 1.875 mg triptorelin group（12.90±5.82 vs. 13.52±6.97）. There was no significant difference in clinical pregnancy rate between the two groups（50.5% vs. 54.5%）. It was suggested that one-third depot triptorelin can achieve satisfactory pituitary suppression and produce good live birth rates in a long protocol for IVF/ICSI.展开更多
The 7-valent pneumococcal conjugate vaccine (PCV) was introduced in Uruguay in March 2008. In April 2010, it was replaced by PCV13. Surveillance of both vaccines was performed on hospitalized children with consolidate...The 7-valent pneumococcal conjugate vaccine (PCV) was introduced in Uruguay in March 2008. In April 2010, it was replaced by PCV13. Surveillance of both vaccines was performed on hospitalized children with consolidated pneumonia. The effect of different number of vaccine doses was evaluated in 2008 and 2010 birth cohorts vaccinated with PCV7 and PCV13 respectively. The study aims to estimate the effects of PCV7 and PCV13 different number of doses on consolidated pneumonia, through the study of hospitalized children from 2008 and 2010 birth cohorts. Vaccination records of every child were available providing precise vaccination data;therefore a new approach was used to estimate PCVs effect. Incidence rate was calculated for each year of the study and for the different number of vaccine doses used each year. Exposure was calculated as person per year and rate ratio values determined the decrease of consolidated pneumonias. This decrease in percentage was estimated as the difference between the incidence with no vaccine and the incidence of every one of the doses. Incidence rate ratio revealed significant values for the three vaccine doses of PCVs for both cohorts. Upon comparing incidences, significant reduction percentages of consolidated pneumonia admissions were found. The reduction percentage of consolidated pneumonia for fully vaccinated (3 doses) patients was 69.3% and 84.6 % for PCV7 and PCV13, respectively. These results confirm that PCV7 and PCV13 are highly effective for reducing pediatric hospitalizations due to consolidated pneumonia, as reported by other national publications and demonstrated by international researchers.展开更多
目的分析新生儿出生后24h内乙型肝炎疫苗(Hepatitis B Vaccine,HepB)首针(HepB1)及时接种的影响因素,为提高HepB1及时接种率提供依据。方法以调查地类型、住院分娩、监护人职业、文化程度、民族、是否知道接种疫苗、是否主动带孩子接种...目的分析新生儿出生后24h内乙型肝炎疫苗(Hepatitis B Vaccine,HepB)首针(HepB1)及时接种的影响因素,为提高HepB1及时接种率提供依据。方法以调查地类型、住院分娩、监护人职业、文化程度、民族、是否知道接种疫苗、是否主动带孩子接种疫苗等指标建立Logistic回归方程,分析影响HepB1及时接种的因素。结果852名调查儿童中,HepB1及时接种234名,及时接种率27.46%。其中在县级及以上医院出生的儿童HepB1及时接种率54.05%,在乡级卫生院出生的儿童HepB1及时接种率46.86%,在家中出生的儿童HepB1及时接种率6.71%。多因素分析显示,住院分娩、儿童监护人的文化程度是影响HepB1及时接种的因素,调查地类型、监护人职业、民族、是否知道接种疫苗、是否主动带孩子接种疫苗等虽与HepB1及时接种有关联,但并不是影响因素。结论提高住院分娩率,加大素质教育的投入,是提高HepB1及时接种率的主要措施。展开更多
目的探索提高边远少数民族地区新生儿乙型肝炎(乙肝)疫苗(Hepatitis B Vaccine,HepB)首剂(First Dose)(HepB1)及时接种率的有效策略。方法选择HepB1接种率较低的阿坝藏族羌族自治州和凉山彝族自治州,进行HepB1及时接种、未接种或未及时...目的探索提高边远少数民族地区新生儿乙型肝炎(乙肝)疫苗(Hepatitis B Vaccine,HepB)首剂(First Dose)(HepB1)及时接种率的有效策略。方法选择HepB1接种率较低的阿坝藏族羌族自治州和凉山彝族自治州,进行HepB1及时接种、未接种或未及时接种的原因等问卷调查,分析影响HepB1及时接种的因素,并开展健康教育、专业培训和督导,加强与妇幼保健机构及医院合作等干预措施,评价干预措施效果。结果采取干预措施后,HepB1及时接种率由干预前的49.19%提高到67.83%,儿童家长/监护人乙肝防治知识知晓率由15.41%提高到31.57%,乡村级医务人员乙肝防治知识知晓率由47.39%提高到82.54%,差异均有统计学意义。结论积极开展社会宣传动员和基层医务人员乙肝知识培训,加强与妇幼保健机构及医院合作,能够提高边远少数民族地区HepB1及时接种率。今后还需加大对孕产妇住院分娩优惠政策的宣传力度,逐步提高住院分娩率,同时邀请宗教领袖向公众宣传HepB1及时接种的知识。展开更多
文摘Background: The Air Force Health Study collected reproductive outcomes for live-born children of male Air Force veterans of the Vietnam War. Methods: Dioxin values for participants were obtained from blood samples. Analyses were conducted of occurrence of 16 specific categories of birth defects and developmental disabilities. Children were categorized as conceived before and after the start of participants’ Vietnam War service. Children conceived before the start of Vietnam War service were treated as being conceived when their fathers had unquantifiable dioxin values. Children conceived after the start of Vietnam War service for participants with missing dioxin values were excluded from primary analyses, but were used to assess the impact of their exclusion on conclusions. Correlation between values for specific categories for multiple children fathered by the same participant was accounted for. The dose-response relationship was treated as a step function increasing for dioxin values larger than adaptively identified individual thresholds changing with the specific category. Results: For 15 of 16 specific categories, the probability of occurrence increased substantially for a sufficiently high dioxin level above identified thresholds. Exclusion of children due to missing dioxin likely did not affect these results. Conclusions: Results supported the conclusion of substantial adverse effects on a wide variety of specific categories of birth defects and developmental disabilities due to sufficiently high exposures to dioxin, a toxic contaminant of Agent Orange used for herbicide spraying in the Vietnam War. Results may hold more generally, but might also have been affected by a variety of limitations.
基金supported by the President’s Emergency Plan for AIDS Relief(PEPFAR)the National Institute of Health and Child Development(NIHCD 1R01H087993)+1 种基金supported by the National Institutes of Health(NIAID U01AI096299,NICHD R01HD105526)The funders had no role in study design,data collection,data analysis and interpretation,preparation of the manuscript,or decision to submit.PT is funded by a grant from the NIH(NIAID K08AI148607).
文摘Background Despite global efforts to reduce preventable childhood illness by distributing infant vaccines,immunization coverage in sub-Saharan African settings remains low.Further,timely administration of vaccines at birth—tuberculosis(Bacille Calmette-Guerin[BCG])and polio(OPV0)—remains inconsistent.As countries such as Democratic Republic of the Congo(DRC)prepare to add yet another birth-dose vaccine to their immunization schedule,this study aims to improve current and future birth-dose immunization coverage by understanding the determinants of infants receiving vaccinations within the national timeframe.Methods The study used two ordered regression models to assess barriers to timely BCG and first round of the hepatitis B(HepB3)immunization series across multiple time points using the Andersen Behavioral Model to conceptualize determinants at various levels.The assessment leveraged survey data collected during a continuous quality improvement study(NCT03048669)conducted in 105 maternity centers throughout Kinshasa Province,DRC.The final sample included 2398(BCG analysis)and 2268(HepB3 analysis)women-infant dyads living with HIV.Results Between 2016 and 2020,1981 infants(82.6%)received the BCG vaccine,and 1551(68.4%)received the first dose of HepB3 vaccine.Of those who received the BCG vaccine,26.3%,43.5%,and 12.8%received BCG within 24 h,between one and seven days,and between one and 14 weeks,respectively.Of infants who received the HepB3 vaccine,22.4%received it within six weeks,and 46%between six and 14 weeks of life.Many factors were positively associated with BCG uptake,including higher maternal education,household wealth,higher facility general readiness score,and religious-affiliated facility ownership.The factors influencing HepB3 uptake included older maternal age,higher education level,household wealth,transport by taxi to a facility,higher facility general and immunization readiness scores,and religious-affiliated facility ownership.Conclusions This study demonstrated that the study participants’uptake of vaccines was consistent with the country average,but not in a timely manner.Various factors were associated with timely uptake of BCG and HepB3 vaccines.These findings suggest that investment to strengthen the vaccine delivery system might improve timely vaccine uptake and equity in vaccine coverage.
基金supported by grants from Milstein Medical Asian American Partnership Foundation Fellowship Award in Reproductive Medicine,National Natural Science Foundation of China(No.81170574 and No.81401177)Guangdong Province Natural Science Foundation of China(No.2015A030313286)Nanfang Hospital High-level Project Matching Funds in 2012(No.G201206)and 2014(No.G2014005)
文摘The effects of pituitary suppression with one-third depot of long-acting gonadotropin-releasing hormone（Gn RH） agonist in Gn RH agonist long protocol for in vitro fertilization（IVF）/intracytoplasmic sperm injection（ICSI） were investigated. A retrospective cohort study was performed on 3186 cycles undergoing IVF/ICSI with Gn RH agonist long protocol in a university-affiliated infertility center. The pituitary was suppressed with depot triptorelin of 1.25 mg or 1.875 mg. There was no significant difference in live birth rate between 1.25 mg triptorelin group and 1.875 mg triptorelin group（41.2% vs. 43.7%）. The mean luteinizing hormone（LH） level on follicle-stimulating hormone（FSH） starting day was significantly higher in 1.25 mg triptorelin group. The mean LH level on the day of human chorionic gonadotrophin（h CG） administration was slightly but statistically higher in 1.25 mg triptorelin group. There was no significant difference in the total FSH dose between the two groups. The number of retrieved oocytes was slightly but statistically less in 1.25 mg triptorelin group than in 1.875 mg triptorelin group（12.90±5.82 vs. 13.52±6.97）. There was no significant difference in clinical pregnancy rate between the two groups（50.5% vs. 54.5%）. It was suggested that one-third depot triptorelin can achieve satisfactory pituitary suppression and produce good live birth rates in a long protocol for IVF/ICSI.
文摘The 7-valent pneumococcal conjugate vaccine (PCV) was introduced in Uruguay in March 2008. In April 2010, it was replaced by PCV13. Surveillance of both vaccines was performed on hospitalized children with consolidated pneumonia. The effect of different number of vaccine doses was evaluated in 2008 and 2010 birth cohorts vaccinated with PCV7 and PCV13 respectively. The study aims to estimate the effects of PCV7 and PCV13 different number of doses on consolidated pneumonia, through the study of hospitalized children from 2008 and 2010 birth cohorts. Vaccination records of every child were available providing precise vaccination data;therefore a new approach was used to estimate PCVs effect. Incidence rate was calculated for each year of the study and for the different number of vaccine doses used each year. Exposure was calculated as person per year and rate ratio values determined the decrease of consolidated pneumonias. This decrease in percentage was estimated as the difference between the incidence with no vaccine and the incidence of every one of the doses. Incidence rate ratio revealed significant values for the three vaccine doses of PCVs for both cohorts. Upon comparing incidences, significant reduction percentages of consolidated pneumonia admissions were found. The reduction percentage of consolidated pneumonia for fully vaccinated (3 doses) patients was 69.3% and 84.6 % for PCV7 and PCV13, respectively. These results confirm that PCV7 and PCV13 are highly effective for reducing pediatric hospitalizations due to consolidated pneumonia, as reported by other national publications and demonstrated by international researchers.
文摘目的分析新生儿出生后24h内乙型肝炎疫苗(Hepatitis B Vaccine,HepB)首针(HepB1)及时接种的影响因素,为提高HepB1及时接种率提供依据。方法以调查地类型、住院分娩、监护人职业、文化程度、民族、是否知道接种疫苗、是否主动带孩子接种疫苗等指标建立Logistic回归方程,分析影响HepB1及时接种的因素。结果852名调查儿童中,HepB1及时接种234名,及时接种率27.46%。其中在县级及以上医院出生的儿童HepB1及时接种率54.05%,在乡级卫生院出生的儿童HepB1及时接种率46.86%,在家中出生的儿童HepB1及时接种率6.71%。多因素分析显示,住院分娩、儿童监护人的文化程度是影响HepB1及时接种的因素,调查地类型、监护人职业、民族、是否知道接种疫苗、是否主动带孩子接种疫苗等虽与HepB1及时接种有关联,但并不是影响因素。结论提高住院分娩率,加大素质教育的投入,是提高HepB1及时接种率的主要措施。
文摘目的探索提高边远少数民族地区新生儿乙型肝炎(乙肝)疫苗(Hepatitis B Vaccine,HepB)首剂(First Dose)(HepB1)及时接种率的有效策略。方法选择HepB1接种率较低的阿坝藏族羌族自治州和凉山彝族自治州,进行HepB1及时接种、未接种或未及时接种的原因等问卷调查,分析影响HepB1及时接种的因素,并开展健康教育、专业培训和督导,加强与妇幼保健机构及医院合作等干预措施,评价干预措施效果。结果采取干预措施后,HepB1及时接种率由干预前的49.19%提高到67.83%,儿童家长/监护人乙肝防治知识知晓率由15.41%提高到31.57%,乡村级医务人员乙肝防治知识知晓率由47.39%提高到82.54%,差异均有统计学意义。结论积极开展社会宣传动员和基层医务人员乙肝知识培训,加强与妇幼保健机构及医院合作,能够提高边远少数民族地区HepB1及时接种率。今后还需加大对孕产妇住院分娩优惠政策的宣传力度,逐步提高住院分娩率,同时邀请宗教领袖向公众宣传HepB1及时接种的知识。
