scholarly journals Incidence of VTE in asymptomatic children with deficiencies of antithrombin, protein C, and protein S: a prospective cohort study

2020 ◽  
Vol 4 (21) ◽  
pp. 5442-5448
Author(s):  
Daniela Tormene ◽  
Elena Campello ◽  
Chiara Simion ◽  
Giacomo Turatti ◽  
Michelangelo Marobin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Protein C ◽  
Protein S ◽  
Healthy Children ◽  
Thrombotic Risk ◽  
Asymptomatic Children ◽  
Risk Period

Abstract Although antithrombin, protein C, and protein S defects are well-recognized inherited risk factors for venous thromboembolism (VTE) in adults, whether they predispose children to these vascular disorders as well is undefined. In a prospective cohort study, we assessed the incidence of spontaneous and risk period–related VTE in children who were family members of adults who, after an episode of symptomatic VTE, had then been identified as carriers of these abnormalities. A total of 134 children from 87 families were enrolled. Seventy (51.5%) of these children were carriers of an inherited defect, and the remaining 64 were not; the mean observation period was 4 years (range, 1-16 years) and 3.9 years (range, 1-13), respectively. Sixteen risk periods were experienced by carriers, and 9 by noncarriers. Six VTE occurred in the 70 carriers during 287 observation-years, accounting for an annual incidence of 2.09% patient-years (95% confidence interval, 0.8-4.5), compared with none in the 64 noncarriers during 248 observation-years. Of the 14 children with thrombophilia who experienced a risk period for thrombosis, 4 (28.6%) developed a VTE episode. The overall incidence of risk-related VTE was 25% per risk period (95% confidence interval, 6.8-64). In conclusion, the thrombotic risk in otherwise healthy children with severe inherited thrombophilia does not seem to differ from that reported for adults with the same defects. Screening for thrombophilia in children who belong to families with these defects seems justified to identify those who may benefit from thromboprophylaxis during risk periods for thrombosis.

The incidence of venous thromboembolism in thrombophilic children: a prospective cohort study

Blood ◽  
2002 ◽  
Vol 100 (7) ◽  
pp. 2403-2405 ◽  
Author(s):  
Daniela Tormene ◽  
Paolo Simioni ◽  
Paolo Prandoni ◽  
Francesca Franz ◽  
Patrizia Zerbinati ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Factor V Leiden ◽  
Healthy Children ◽  
Factor V Leiden Mutation ◽  
Thrombotic Risk ◽  
Asymptomatic Children ◽  
Risk Period

Antithrombin and protein C and S defects, factor V Leiden mutation, and G20210A prothrombin gene mutation are well-recognized risk factors for venous thromboembolism (VTE) in adults, especially during circumstantial situations such as trauma, immobilization, surgery, or oral contraceptive treatment. The relevance of these defects in predisposing children to VTE is still undefined. In a prospective cohort study we assessed the incidence of spontaneous and risk period–related VTE in asymptomatic children (aged 1-14 years), who were family members of a proband with an objectively diagnosed venous thromboembolic event and a documented single thrombophilic abnormality. We enrolled 143 children from 63 families. Of them, 81 (56.6%) were carriers of an inherited defect, whereas the remaining 62 were free from known genetic or acquired causes of thrombophilia. The mean observation period was 5 years (range, 1-8 years) in each group. Thirty-one risk periods occurred in the carriers group and 20 in noncarriers. Neither spontaneous nor risk period–related VTE occurred in either group during 395 and 296 observation years, respectively. However, circumstances where most of the pediatric thromboses occur (insertion of central venous lines, cancer, and cardiovascular surgery) were not encountered. In conclusion, the thrombotic risk in otherwise healthy children with a single identified thrombophilic defect appears to be very low. Common triggering conditions for VTE in thrombophilic adults do not seem to increase the thrombotic risk in children carrying the same inherited defect. Accordingly, screening for thrombophilia in otherwise healthy children younger than 15 years who belong to families with inherited defects predisposing to thrombosis seems unjustified.

scholarly journals 5-Hydroxyvitamin D concentration in paediatric cancer patients from Scotland: a prospective cohort study

2016 ◽  
Vol 116 (11) ◽  
pp. 1926-1934 ◽  
Author(s):  
Raquel Revuelta Iniesta ◽  
Ilenia Paciarotti ◽  
Isobel Davidson ◽  
Jane M. McKenzie ◽  
Celia Brand ◽  
...  
Keyword(s):  
Cohort Study ◽  
Relative Risk ◽  
Cancer Patients ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Vitamin D Supplementation ◽  
Healthy Children ◽  
Paediatric Cancer ◽  
Hydroxyvitamin D ◽  
Nutritional Data

AbstractChildren with cancer are potentially at a high risk of plasma 25-hydroxyvitamin D (25(OH)D) inadequacy, and despite UK vitamin D supplementation guidelines their implementation remains inconsistent. Thus, we aimed to investigate 25(OH)D concentration and factors contributing to 25(OH)D inadequacy in paediatric cancer patients. A prospective cohort study of Scottish children aged <18 years diagnosed with, and treated for, cancer (patients) between August 2010 and January 2014 was performed, with control data from Scottish healthy children (controls). Clinical and nutritional data were collected at defined periods up to 24 months. 25(OH)D status was defined by the Royal College of Paediatrics and Child Health as inadequacy (<50 nmol/l: deficiency (<25 nmol/l), insufficiency (25–50 nmol/l)), sufficiency (51–75 nmol/l) and optimal (>75 nmol/l). In all, eighty-two patients (median age 3·9, interquartile ranges (IQR) 1·9–8·8; 56 % males) and thirty-five controls (median age 6·2, IQR 4·8–9·1; 49 % males) were recruited. 25(OH)D inadequacy was highly prevalent in the controls (63 %; 22/35) and in the patients (64 %; 42/65) at both baseline and during treatment (33–50 %). Non-supplemented children had the highest prevalence of 25(OH)D inadequacy at every stage with 25(OH)D median ranging from 32·0 (IQR 21·0–46·5) to 45·0 (28·0–64·5) nmol/l. Older age at baseline (R −0·46; P<0·001), overnutrition (BMI≥85th centile) at 3 months (P=0·005; relative risk=3·1) and not being supplemented at 6 months (P=0·04; relative risk=4·3) may have contributed to lower plasma 25(OH)D. Paediatric cancer patients are not at a higher risk of 25(OH)D inadequacy than healthy children at diagnosis; however, prevalence of 25(OH)D inadequacy is still high and non-supplemented children have a higher risk. Appropriate monitoring and therapeutic supplementation should be implemented.

scholarly journals Association between maternal gluten intake and type 1 diabetes in offspring: national prospective cohort study in Denmark

BMJ ◽  
2018 ◽  
pp. k3547 ◽  
Author(s):  
Julie C Antvorskov ◽  
Thorhallur I Halldorsson ◽  
Knud Josefsen ◽  
Jannet Svensson ◽  
Charlotta Granström ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cohort Study ◽  
Confidence Interval ◽  
Prospective Cohort Study ◽  
Food Frequency Questionnaire ◽  
Prospective Cohort ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Food Frequency

Abstract Objective To examine the association between prenatal gluten exposure and offspring risk of type 1 diabetes in humans. Design National prospective cohort study. Setting National health information registries in Denmark. Participants Pregnant Danish women enrolled into the Danish National Birth Cohort, between January 1996 and October 2002, Main outcome measures Maternal gluten intake, based on maternal consumption of gluten containing foods, was reported in a 360 item food frequency questionnaire at week 25 of pregnancy. Information on type 1 diabetes occurrence in the participants’ children, from 1 January 1996 to 31 May 2016, were obtained through registry linkage to the Danish Registry of Childhood and Adolescent Diabetes. Results The study comprised 101 042 pregnancies in 91 745 women, of whom 70 188 filled out the food frequency questionnaire. After correcting for multiple pregnancies, pregnancies ending in abortions, stillbirths, lack of information regarding the pregnancy, and pregnancies with implausibly high or low energy intake, 67 565 pregnancies (63 529 women) were included. The average gluten intake was 13.0 g/day, ranging from less than 7 g/day to more than 20 g/day. The incidence of type 1 diabetes among children in the cohort was 0.37% (n=247) with a mean follow-up period of 15.6 years (standard deviation 1.4). Risk of type 1 diabetes in offspring increased proportionally with maternal gluten intake during pregnancy (adjusted hazard ratio 1.31 (95% confidence interval 1.001 to 1.72) per 10 g/day increase of gluten). Women with the highest gluten intake versus those with the lowest gluten intake (≥20 v <7 g/day) had double the risk of type 1 diabetes development in their offspring (adjusted hazard ratio 2.00 (95% confidence interval 1.02 to 4.00)). Conclusions High gluten intake by mothers during pregnancy could increase the risk of their children developing type 1 diabetes. However, confirmation of these findings are warranted, preferably in an intervention setting.

A Prospective Cohort Study of Load and Wellness (Sleep, Fatigue, Soreness, Stress, and Mood) in Elite Junior Australian Football Players

2019 ◽  
Vol 14 (6) ◽  
pp. 829-840 ◽  
Author(s):  
Timothy J.H. Lathlean ◽  
Paul B. Gastin ◽  
Stuart V. Newstead ◽  
Caroline F. Finch
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Perceived Exertion ◽  
Training Session ◽  
Load Ratio ◽  
Rating Of Perceived Exertion ◽  
Football Players ◽  
Australian Football

Purpose:To investigate associations between load (training and competition) and wellness in elite junior Australian Football players across 1 competitive season.Methods:A prospective cohort study was conducted during the 2014 playing season in 562 players from 9 teams. Players recorded their training and match intensities according to the session-rating-of-perceived-exertion (sRPE) method. Based on sRPE player loads, a number of load variables were quantified, including cumulative load and the change in load across different periods of time (including the acute-to-chronic load ratio). Wellness was quantified using a wellness index including sleep, fatigue, soreness, stress, and mood on a Likert scale from 1 to 5.Results:Players spent an average of 85 (21) min in each match and 65 (31) min per training session. Average match loads were 637 (232) arbitrary units, and average training loads were 352 (233) arbitrary units. Over the 24 wk of the 2014 season, overall wellness had a significant linear negative association with 1-wk load (B = −0.152; 95% confidence interval, −0.261 to −0.043;P = .006) and an inverseU-curve relationship with session load (B = −0.078; 95% confidence interval, 0.143 to 0.014;P = .018). Mood, stress, and soreness were all found to have associations with load.Conclusions:This study demonstrates that load (within a session and across the week) is important in managing the wellness of elite junior Australian Football players. Quantifying loads and wellness at this level will help optimize player management and has the potential to reduce the risk of adverse events such as injury.

scholarly journals Test Characteristics of Perirectal and Rectal Swab Compared to Stool Sample for Detection of Fluoroquinolone-Resistant Escherichia coli in the Gastrointestinal Tract

2005 ◽  
Vol 49 (2) ◽  
pp. 798-800 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Anthony D. Harris ◽  
Eli N. Perencevich ◽  
Irving Nachamkin ◽  
Pam Tolomeo ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Cohort Study ◽  
Gastrointestinal Tract ◽  
Confidence Interval ◽  
Stool Sample ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Rectal Swab ◽  
Test Characteristics ◽  
Gut Colonization

ABSTRACT Among 63 patients enrolled in a prospective cohort study of gut colonization with fluoroquinolone-resistant Escherichia coli, the sensitivity of perirectal swab compared to stool sample was 90% (95% confidence interval [CI], 70 to 99%) and the specificity was 100% (95% CI, 91 to 100%). For rectal swab, the sensitivity was 90% (95% CI, 68 to 99%) and the specificity was 100% (95% CI, 91 to 100%).

Learning in children and sleep disordered breathing: Findings of the Tucson Children's Assessment of Sleep Apnea (TuCASA) Prospective Cohort Study

2003 ◽  
Vol 9 (7) ◽  
pp. 1016-1026 ◽  
Author(s):  
KRIS L. KAEMINGK ◽  
ALICE E. PASVOGEL ◽  
JAMES L. GOODWIN ◽  
SHELAGH A. MULVANEY ◽  
FERNANDA MARTINEZ ◽  
...  
Keyword(s):  
Cohort Study ◽  
Sleep Apnea ◽  
Learning And Memory ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Apnea Hypopnea Index ◽  
Healthy Children ◽  
Immediate Recall ◽  
Respiratory Disturbance ◽  
Stage 1

We examined the relationship between nocturnal respiratory disturbance and learning and compared learning in children with and without nocturnal respiratory disturbance. Subjects were 149 participants in a prospective cohort study examining sleep in children ages 6–12: The Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep was assessed via home polysomnography. Intelligence, learning and memory, and academic achievement were assessed. Parents rated attention. Group comparisons were used to test the hypothesis that the group with an apnea/hypopnea index (AHI) of 5 or more (n = 77) would have weaker performance than the group with AHI less than 5 (n = 72). The group with AHI of 5 or more had weaker learning and memory though differences between groups decreased when arousals were taken into account. There was a greater percentage of Stage 1 sleep in the AHI 5 or more group, and Stage 1 percentage was negatively related to learning and memory in the sample (n = 149). There were negative relationships between AHI and immediate recall, Full Scale IQ, Performance IQ, and math achievement. Hypoxemia was associated with lower Performance IQ. Thus, findings suggest that nocturnal respiratory disturbance is associated with decreased learning in otherwise healthy children, that sleep fragmentation adversely impacts learning and memory, and that hypoxemia adversely influences nonverbal skills. (JINS, 2003, 9, 1016–1026.)

scholarly journals Comparison of Two Hepatitis B Vaccination Strategies Targeting Vertical Transmission: A 10-Year Japanese Multicenter Prospective Cohort Study

Vaccines ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 58
Author(s):  
Koji Nishimura ◽  
Keiji Yamana ◽  
Sachiyo Fukushima ◽  
Kazumichi Fujioka ◽  
Hiroshi Miyabayashi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatitis B ◽  
Confidence Interval ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Virus Transmission ◽  
Vaccination Strategies ◽  
Multicenter Prospective Cohort Study ◽  
Multicenter Prospective Cohort ◽  
Immunogenic Response

In 1985, a hepatitis B (HB) vaccination strategy against vertical HB virus transmission was introduced in Japan that recommended vaccination of infants at two, three, and five months of age (delayed strategy). This schedule was revised in 2013, recommending to vaccinate at birth and at 1 and 6 months of age (non-delayed strategy). We aimed to compare the vertical HB virus transmission rates and immunogenic responses between these two vaccination strategies. This Japanese multicenter prospective cohort study included 222 infants born between 2008 and 2017 to serum hepatitis B surface (HBs) antigen (HBsAg)-positive mothers. During the study period, 136 and 86 infants received delayed and non-delayed strategies, respectively. A positive vertical HB virus transmission was defined as a positive serum HBsAg status. Seropositive immunogenic response was defined as a serum anti-HBs titer of ≥10 mIU/mL. Post-vaccination serum HBsAg positivity rates did not differ significantly between the delayed (0/136 [0.0%, 95% confidence interval, 0.0–2.7%]) and non-delayed (2/86 [2.3%, 95% confidence interval, 0.3–8.1%]) strategy groups. Seropositive immunogenic response rates were 100.0% (136/136) and 97.7% (84/86), respectively. Although this study was under-powered to detect a statistically significant result, no vertical HB virus transmission was observed in the delayed strategy.

scholarly journals Effects of Contact Precautions on Patient Perception of Care and Satisfaction: A Prospective Cohort Study

2013 ◽  
Vol 34 (10) ◽  
pp. 1087-1093 ◽  
Author(s):  
Preeti Mehrotra ◽  
Lindsay Croft ◽  
Hannah R. Day ◽  
Eli N. Perencevich ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Cohort Study ◽  
Patient Satisfaction ◽  
Confidence Interval ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Odds Ratio ◽  
Coordination Of Care ◽  
Primary Analysis ◽  
Contact Precautions ◽  
Standardized Interview

Objective.Contact precautions decrease healthcare worker-patient contact and may impact patient satisfaction. To determine the association between contact precautions and patient satisfaction, we used a standardized interview for perceived issues with care.Design.Prospective cohort study of inpatients, evaluated at admission and on hospital days 3, 7, and 14 (until discharged). At each point, patients underwent a standardized interview to identify perceived problems with care. After discharge, the standardized interview and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey were administered by telephone. Responses were recorded, transcribed, and coded by 2 physician reviewers.Participants.A total of 528 medical or surgical patients not admitted to the intensive care unit.Results.A total of 528 patients were included in the primary analysis, of whom 104 (20%) perceived some issue with their care. On multivariable logistic regression, contact precautions were independently associated with a greater number of perceived concerns with care (odds ratio, 2.05 [95% confidence interval, 1.31–3.21]; P<.01), including poor coordination of care (P = .02) and a lack of respect for patient needs and preferences (P = .001). Eighty-eight patients were included in the secondary analysis of HCAHPS. Patients under contact precautions did not have different HCAHPS scores than those not under contact precautions (odds ratio, 1.79 [95% confidence interval, 0.64–5.00]; P = .27).Conclusions.Patients under contact precautions were more likely to perceive problems with their care, especially poor coordination of care and a lack of respect for patient preferences.

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