Recommendation for the use of newly introduced Tdap vaccine in Korea

Pertussis is an acute respiratory infection characterized by paroxysmal cough and inspiratory whoop for over 2 weeks. The incidence of pertussis has decreased markedly after the introduction of DTwP/DTaP vaccine, but the incidence of pertussis has increased steadily among young infant and among adolescents and adults in many countries. Td vaccine was used in this age group but the increase in pertussis has lead to the development of a Tdap vaccine. The Tdap vaccine is a Td vaccine with a pertussis vaccine added and is thought to decrease the incidence and transmission of pertussis in the respective age group. In Korea, two products are approved by the KOREA FOOD & DRUG ADMINISTRATION, which are ADACEL™ (Sanofi-Pasteur, Totonto, Ontario, Canada) and BOOSTRIX® (GlaxoSmithKline Biologicals, Rixensart, Belgium) for those aged between 11-64. This report summarizes the recommendations approved by the Committee on Infectious Diseases, the Korean Pediatric Society

Förskollärares erfarenheter gällande barn och skilsmässor - en intervjustudie

Studiens syfte var att studera förskollärares erfarenheter kring barn och skilsmässor samt undersöka om det finns något medvetet arbetssätt gällande bemötandet av barn vars föräldrar genomgår skilsmässa. Vi var även intresserade av att studera vilken betydelse föräldrasamverkan har i dessa sammanhang. För att uppnå studiens syfte har vi valt semistrukturerande intervjuer som datainsamlingsmetod. Vi intervjuade åtta stycken förskollärare, detta för att belysa deras sätt att se på barn i skilsmässosituationer. Resultatet visade att det varken i forskning eller ute i förskolans verksamhet finns något rekommenderat arbetssätt gentemot barn i skilsmässosituationer. Det vi kunnat urskilja är däremot betydelsen av att vara lyhörd och observant i relation till det enskilda barnets upplevelser av skilsmässan. Resultatet visade också på några betydelsefulla aspekter i mötet med barn i skilsmässosituationer, nämligen arbetet med samtal och föräldrasamverkan samt vikten av att bevara förskolans vardagliga rutiner

Obesity is associated with coronary artery stenosis independently of metabolic risk factors : The population-based SCAPIS study

BACKGROUND AND AIMS: Previous studies reported divergent results on whether metabolically healthy obesity is associated with increased coronary artery calcium and carotid plaques. We investigated this in a cross-sectional fashion in a large, well-defined, middle-aged population using coronary CT angiography (CCTA) and carotid ultrasound. METHODS: In the SCAPIS study (50-65 years, 51% female), CCTA and carotid artery ultrasound were performed in 23,674 individuals without clinical atherosclerotic disease. These subjects were divided into six groups according to BMI (normal weight, overweight, obese) and the presence of metabolic syndrome (MetS) according to the NCEP consensus criteria. RESULTS: The severity of coronary artery stenosis was increased in individuals with obesity without MetS compared to normal-weight individuals without MetS (OR 1.47, 95%CI 1.34-1.62; p < 0.0001), even after adjusting for non-HDL-cholesterol and several lifestyle factors. Such difference was not observed for the presence of carotid artery plaques (OR 0.94, 95%CI 0.87-1.02; p = 0.11). Obese or overweight individuals without any MetS criteria (except the waist criterion) showed significantly more pronounced stenosis in the coronary arteries as compared to the normal-weight individuals, while one criterion was needed to show increased plaque prevalence in the carotid arteries. High blood pressure was the most important single criterion for increased atherosclerosis in this respect. CONCLUSIONS: Individuals with obesity without MetS showed increased severity of coronary artery stenosis, but no increased occurrence of carotid artery plaques compared to normal-weight individuals without MetS, further emphasizing that obesity is not a benign condition even in the absence of MetS

Bias due to composite reference standards in diagnostic accuracy studies

Composite reference standards (CRSs) have been advocated in diagnostic accuracy studies in the absence of a perfect reference standard. The rationale is that combining results of multiple imperfect tests leads to a more accurate reference than any one test in isolation. Focusing on a CRS that classifies subjects as disease positive if at least one component test is positive, we derive algebraic expressions for sensitivity and specificity of this CRS, sensitivity and specificity of a new (index) test compared with this CRS, as well as the CRS-based prevalence. We use as a motivating example the problem of evaluating a new test for Chlamydia trachomatis, an asymptomatic disease for which no gold-standard test exists. As the number of component tests increases, sensitivity of this CRS increases at the expense specificity, unless all tests have perfect specificity. Therefore, such a CRS can lead to significantly biased accuracy estimates of the index test. The bias depends on disease prevalence and accuracy of the CRS. Further, conditional dependence between the CRS and index test can lead to over-estimation of index test accuracy estimates. This commonly-used CRS combines results from multiple imperfect tests in a way that ignores information and therefore is not guaranteed to improve over a single imperfect reference unless each component test has perfect specificity, and the CRS is conditionally independent of the index test. When these conditions are not met, as in the case of C. trachomatis testing, more realistic statistical models should be researched instead of relying on such CRSs. Copyright © 2015 John Wiley & Sons, Ltd