Childhood seizures after prenatal exposure to maternal influenza infection: A population-based cohort study from Norway, Australia and Canada

Objective To assess whether clinical and/or laboratory-confirmed diagnosis of maternal influenza during pregnancy increases the risk of seizures in early childhood. Design Analysis of prospectively collected registry data for children born between 2009 and 2013 in three high-income countries. We used Cox regression to estimate country-level adjusted HRs (aHRs); fixed-effects meta-analyses were used to pool adjusted estimates. Setting Population-based. Participants 1 360 629 children born between 1 January 2009 and 31 December 2013 in Norway, Australia (New South Wales) and Canada (Ontario). Exposure Clinical and/or laboratory-confirmed diagnosis of maternal influenza infection during pregnancy. Main outcome measures We extracted data on recorded seizure diagnosis in secondary/specialist healthcare between birth and up to 7 years of age; additional analyses were performed for the specific seizure outcomes epilepsy' and febrile seizures'. Results Among 1 360 629 children in the study population, 14 280 (1.0%) were exposed to maternal influenza in utero. Exposed children were at increased risk of seizures (aHR 1.17, 95% CI 1.07 to 1.28), and also febrile seizures (aHR 1.20, 95% CI 1.07 to 1.34). There was no strong evidence of an increased risk of epilepsy (aHR 1.07, 95% CI 0.81 to 1.41). Risk estimates for seizures were higher after influenza infection during the second and third trimester than for first trimester. Conclusions In this large international study, prenatal exposure to influenza infection was associated with increased risk of childhood seizures

Risk management and its practical application: lessons from the British Army

This study explores, using predominately qualitative data, the risk management approaches of British Army officers in operational theatre. Risks within an operational context are particularly challenging for the British Army to manage due to external constraints such as its adherence to various rules of engagement and international conventions such as the Geneva Convention . The British Army’s centralised and highly structured control and regulation mechanisms are the product of over 300 years of traditions. Few companies can draw on this history, but we argue that the historical successes of the British Army suggest that contemporary civilian organisations have much to learn from the military approach to risk management. Keywords: risk management, British Army, learning