Preterm birth and prescriptions for cardiovascular, antiseizure, antibiotics and antiasthmatic medication in children up to 10 years of age::A population-based data linkage cohort study across six European regions

OBJECTIVES: Preterm children are exposed to many medications in neonatal intensive care units, but little is known about the effect of prematurity on medication use throughout infancy and childhood. We examined prescriptions of cardiovascular medication (CVM), antiseizure medication (ASM), antiasthmatic medication and antibiotics issued/dispensed in the first 10 years of life for very and moderately preterm children compared with term. DESIGN: Population-based data linkage cohort study linking information from birth records to prescription records. SETTING: Six registries from five countries in the EUROlinkCAT study. PARTICIPANTS: The study population included 1 722 912 children, of whom 10 820 (0.6%) were very preterm (<32 weeks gestational age (GA)), 92 814 (5.4%) were moderately preterm (32–36 weeks GA), 1 606 643 (93.3%) were born at term (≥37 weeks GA) and 0.7% had missing GA. Children with major or minor congenital anomalies were excluded (including patent ductus arteriosus). MAIN OUTCOME MEASURES: Relative risk (RR) of receiving a prescription for CVM, ASM, antiasthmatic and antibiotics. RESULTS: Very preterm children had a higher RR of receiving a prescription for CVM and ASM than preterm children. For all preterm children, the RR of having a CVM prescription was 3.58 (95% CI 2.06 to 6.23); 2.06 (95% CI 1.73 to 2.41) for ASM; 1.13 (95% CI 0.99 to 1.29) for antiasthmatics and 0.96 (95% CI 0.93 to 0.99) for antibiotics in the first year of life. Increased prescription of CVM, ASM and antiasthmatics persisted for all 10 years of follow-up. Although the RR was highest for CVM and ASM, in absolute numbers more children received prescriptions for antibiotics (42.34%, 95% CI 38.81% to 45.91%) and antiasthmatics (28.40%, 95% CI 16.07% to 42.649%) than for CVM (0.18%, 95% CI 0.12% to 0.25%) and ASM (0.16%, 95% CI 0.13% to 0.20%) in the first year of life. CONCLUSION: Preterm children had a higher risk of being prescribed/dispensed CVM, ASM and antiasthmatics up to age 10. This study highlights a need for further research into morbidity beyond age 10

Gastrostomy and congenital anomalies - a European population-based study

OBJECTIVE: To report and compare the proportion of children with and without congenital anomalies undergoing gastrostomy for tube feeding in their first 5 years. METHODS: A European, population-based data-linkage cohort study (EUROlinkCAT). Children up to 5 years of age registered in nine EUROCAT registries (national and regional) in six countries and children without congenital anomalies (reference children) living in the same geographical areas were included. Data on hospitalisation and surgical procedures for all children were obtained by electronic linkage to hospital databases. RESULTS: The study included 91 504 EUROCAT children and 1 960 272 reference children. Overall, 1200 (1.3%, 95% CI 1.2% to 1.6%) EUROCAT children and 374 (0.016%, 95% CI 0.009% to 0.026%) reference children had a surgical code for gastrostomy within the first 5 years of life. There were geographical variations across Europe with higher rates in Northern Europe compared with Southern Europe. Around one in four children with Cornelia de Lange syndrome and Wolf-Hirschhorn syndrome had a gastrostomy. Among children with structural anomalies, those with oesophageal atresia had the highest proportion of gastrostomy (15.9%). CONCLUSIONS: This study including almost 2 million reference children in Europe found that only 0.016% of these children had a surgery code for gastrostomy before age 5 years. The children with congenital anomalies were on average 80 times more likely to need a gastrostomy before age 5 years than children without congenital anomalies. More than two-thirds of gastrostomy procedures performed within the first 5 years of life were in children with congenital anomalies

Hospital care in the first ten years of life of children with congenital anomalies in six European countries: Data from the EUROlinkCAT Cohort linkage study

Objective To quantify the hospital care for children born with a major congenital anomaly up to 10 years of age compared with children without a congenital anomaly.Design, setting and patients 79 591 children with congenital anomalies and 2 021 772 children without congenital anomalies born 1995–2014 in six European countries in seven regions covered by congenital anomaly registries were linked to inpatient electronic health records up to their 10th birthday.Main outcome measures Number of days in hospital and number of surgeries.Results During the first year of life among the seven regions, a median of 2.4% (IQR: 2.3, 3.2) of children with a congenital anomaly accounted for 18% (14, 24) of days in hospital and 63% (62, 76) of surgeries. Over the first 10 years of life, the percentages were 17% (15, 20) of days in hospital and 20% (19, 22) of surgeries. Children with congenital anomalies spent 8.8 (7.5, 9.9) times longer in hospital during their first year of life than children without anomalies (18 days compared with 2 days) and 5 (4.1–6.1) times longer aged, 5–9 (0.5 vs 0.1 days). In the first year of life, children with gastrointestinal anomalies spent 40 times longer and those with severe heart anomalies 20 times longer in hospital reducing to over 5 times longer when aged 5–9.Conclusions Children with a congenital anomaly consume a significant proportion of hospital care resources. Priority should be given to public health primary prevention measures to reduce the risk of congenital anomalies

Risk factors for mortality in infancy and childhood in children with major congenital anomalies: a European population-based cohort study

BACKGROUND: Preterm birth and young maternal age are known risk factors for infant and childhood mortality. There is limited knowledge of the impact of these risk factors in children born with major congenital anomalies (CAs), who have inherently higher risks of death compared with other children.OBJECTIVES: To investigate the risk factors for mortality up to age 10 years in children born with specific major CAs.METHODS: This population-based cohort study involved 150,198 livebirths from 1995 to 2014 in 13 European CA registries linked to mortality data. Cox proportional hazards models estimated the association of gestational age, maternal age and child's sex with death &lt;1 year and 1-9 years for the whole cohort and by CA subgroup. Hazard ratios (HR) from each registry were pooled using multivariate meta-analysis.RESULTS: Preterm birth had a dose-response association with mortality; compared with infants born at 37+ weeks gestation, those born at &lt;28, 28-31 and 32-36 weeks had 14.88 (95% CI 12.57, 17.62), 8.39 (95% CI 7.16, 9.85) and 3.88 (95% CI 3.40, 4.43) times higher risk of death &lt;1 year, respectively. The corresponding risks at 1-9 years were 4.99 (95% CI 2.94, 8.48), 3.09 (95% CI 2.28, 4.18) and 2.04 (95% CI 1.69, 2.46) times higher, respectively. Maternal age &lt;20 years (versus 20-34 years) was a risk factor for death &lt;1 year (HR 1.30, 95% CI 1.09, 1.54) and 1-9 years (HR 1.58, 95% CI 1.19, 2.10). Females had 1.22 (95% CI: 1.07, 1.39) times higher risk of death between 1 and 9 years than males.CONCLUSION: Preterm birth was associated with considerably higher infant and childhood mortality in children with CAs, comparable to estimates reported elsewhere for the background population. Additional risk factors included young maternal age and female sex. Information on risk factors could benefit clinical care and guide counselling of parents following CA diagnoses.</p

Analysis of Brain Functions in Men with Prostate Cancer under Androgen Deprivation Therapy: A One-Year Longitudinal Study

The relationship between cognitive decline and androgen deprivation therapy (ADT) under luteinizing hormone-releasing hormone (LHRH) analogues is unclear, and there is a scarcity of longitudinal studies considering the interaction between cognition, depressive symptoms and sleep quality in men with prostate cancer (PCa) treated with ADT. This study aimed to determine if there were differences in the scores obtained in cognitive assessment, depressive symptoms, and sleep quality after one year of ADT and determine the interrelations between sleep, mood, and cognitive status. A prospective longitudinal observational study was designed, in which a cohort of men (mean age was 70.8 years) newly treated with androgen-deprivation therapy was assessed in the first six months of treatment and 12 months later. Analysis of cognitive function by the Mini-Mental State Examination (MMSE) scores indicated a significant (p &lt; 0.05) increase after one year of treatment and by the Brief Scale for Cognitive Evaluation (BCog) scores indicated no changes in the scores before and after one year of treatment. Analysis of depressive symptoms with the Geriatric Depression Scale and sleep quality with the Athens Insomnia Scale (AIS) scores showed significant (p &lt; 0.05) changes after one year of treatment with ADT, with men describing more depressive symptoms and more sleep disturbances. No statistically significant differences were found in the cognitive performance between men with impaired sleep or depression results and those without them. Our study showed no clinical evidence of the relationship between ADT under luteinizing hormone-releasing hormone (LHRH) analogues and cognitive deterioration in 1-year follow-up, but there are impairments in the sleep quality in men with PCa undergoing ADT and an increase in depressive symptoms which has important implications for clinicians as they would impair quality of life and adherence to treatment

Manual de procesos para gestión de aulas virtuales: Especificación del funcionamiento del sistema y de sus procesos

La Facultad de Ciencias Exactas, Físicas y Naturales de la Universidad Nacional de San Juan ha realizado una planificación estratégica para la gradual incorporación de propuestas a distancia para sumar a su tradicional oferta presencial. Esta gradualidad contempla la incorporación de módulos de asignaturas, asignaturas completas, y oferta de post-grado. Para asegurar la calidad de esa oferta se planificaron tareas relativas a la configuración de la organización que permitiera llevar adelante las acciones definiendo procesos, actores y funciones. Para ello, en el transcurso del año 2006 se llevaron a cabo los ?Talleres de Modelado de la Organización ExactasAD? Se realizaron 5 sesiones de trabajo en las que la totalidad de los miembros, aproximadamente 15, se abocaron al análisis y producción de los procesos implicados en una organización de Educación a Distancia. Esas acciones permitieron definir y enunciar: ? Estructura Orgánica ExactasAD ? Políticas y Funciones Generales ExactasAD ? Responsabilidades de Áreas y Puestos de Trabajo y Relaciones ExactasAD En estos Talleres de Modelado de la Organización ExactasAD, los miembros llevaron adelante un proceso de análisis de sus propios roles, status e interacciones inter-grupos de trabajo necesarias para cristalizar un proyecto de propuesta académica a distancia. Tuvieron la oportunidad de reflexionar y vivenciar a través de mecanismos de simulación, los procesos, flujos de trabajo y protocolos de comunicación implicados. Se logró la identificación de los procesos, los actores y actividades, lo cual permitió definir una estructura de Áreas generales y equipos de trabajo para cada área, todo lo cual quedó plasmado en el Manual de Procesos y Manual de Organización Versión 1.0.-A partir de ese primer modelo de organización siguieron sucesivos esfuerzos de los equipos de trabajo en pos de lograr la organización más adecuada que facilitara las acciones para brindar oferta académica en la modalidad a distancia en un marco de calidad, los cuales quedaron plasmados en sucesivas versiones de esos Manuales. Esta versión 7.0 del Manual de Procesos de la Unidad de Educación a Distancia de la Facultad de Ciencias Exactas, UEAD-Exactas es el fruto de la experiencia e investigación del equipo de investigadores del Programa Permanente de Investigación Educación a Distancia de la FCEFyN de la Universidad Nacional de San Juan. En la versión que presentamos hemos profundizado en la identificación de los procesos Estratégicos, Clave y de Soporte. Se describe cada proceso, se profundiza en los indicadores de resultados, se presentan los instrumentos de seguimiento para cada uno de ellos.Fil: Cattapan, Adela Beatriz. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Orellano, Hugo. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Llarena, Myriam Gladys. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentina. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Pontoriero, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentina. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: García, Laura. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Pósito, Rosa Maria. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: Villodre, Silvia Lydia. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; ArgentinaFil: de Luca, Adriana Jorgelina. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales; Argentin

Timing of Cardiac Surgical Interventions and Postoperative Mortality in Children With Severe Congenital Heart Defects Across Europe: Data From the EUROlinkCAT Study

Background The purpose of this study was to evaluate the timing of the first cardiac surgery, the number of cardiac surgeries performed, and 30‐day postoperative mortality rate for children with severe congenital heart defects (sCHDs) in their first 5 years of life. Methods and Results This was a population‐based data linkage cohort study linking information from 9 European congenital anomaly registries to vital statistics and hospital databases. Data were extracted for 5693 children with sCHDs born from 1995 to 2004. Subgroup analyses were performed for specific types of sCHD. Children with sCHDs underwent their first surgical intervention at a median age of 3.6 (95% CI, 2.6–4.5) weeks. The timing of the first surgery for most subtypes of sCHD was consistent across Europe. In the first 5 years of life, children with hypoplastic left heart underwent the most cardiac surgeries, with a median of 4.4 (95% CI, 3.1–5.6). The 30‐day postoperative mortality rate in children aged <1 year ranged from 1.1% (95% CI, 0.5%–2.1%) for tetralogy of Fallot to 23% (95% CI, 12%–37%) for Ebstein anomaly. The 30‐day postoperative mortality rate was highest for children undergoing surgery in the first month of life. Overall 5‐year survival for sCHD was <90% for all sCHDs, except transposition of the great arteries, tetralogy of Fallot, and coarctation of the aorta. Conclusions There were no major differences among the 9 regions in the timing, 30‐day postoperative mortality rate, and number of operations performed for sCHD. Despite an overall good prognosis for most congenital heart defects, some lesions were still associated with substantial postoperative death

Survival of children with rare structural congenital anomalies: a multi-registry cohort study

Background Congenital anomalies are the leading cause of perinatal, neonatal and infant mortality in developed countries. Large long-term follow-up studies investigating survival beyond the first year of life in children with rare congenital anomalies are costly and sufficiently large standardized cohorts are difficult to obtain due to the rarity of some anomalies. This study aimed to investigate the survival up to 10 years of age of children born with a rare structural congenital anomaly in the period 1995–2014 in Western Europe. Methods Live births from thirteen EUROCAT (European network for the epidemiological surveillance of congenital anomalies) population-based registries were linked to mortality records. Survival for 12,685 live births with one of the 31 investigated rare structural congenital anomalies (CAs) was estimated at 1 week, 4 weeks and 1, 5 and 10 years of age within each registry and combined across Europe using random effects meta-analyses. Differences between registries were evaluated for the eight rare CAs with at least 500 live births. Results Amongst the investigated CAs, arhinencephaly/holoprosencephaly had the lowest survival at all ages (58.1%, 95% Confidence Interval (CI): 44.3–76.2% at 1 week; 47.4%, CI: 36.4–61.6% at 1 year; 35.6%, CI: 22.2–56.9% at 10 years). Overall, children with rare CAs of the digestive system had the highest survival (> 95% at 1 week, > 84% at 10 years). Most deaths occurred within the first four weeks of life, resulting in a 10-year survival conditional on surviving 4 weeks of over 95% for 17 out of 31 rare CAs. A moderate variability in survival between participating registries was observed for the eight selected rare CAs. Conclusions Pooling standardised data across 13 European CA registries and the linkage to mortality data enabled reliable survival estimates to be obtained at five ages up to ten years. Such estimates are useful for clinical practice and parental counselling