Stringent nonpharmaceutical interventions (NPIs) such as lockdowns and border closures are not currently recommended for pandemic influenza control. New Zealand used these NPIs to eliminate ...coronavirus disease 2019 during its first wave. Using multiple surveillance systems, we observed a parallel and unprecedented reduction of influenza and other respiratory viral infections in 2020. This finding supports the use of these NPIs for controlling pandemic influenza and other severe respiratory viral threats.
Pregnant women and newborns are at increased risk of vitamin D deficiency. Our objective was to create a global summary of maternal and newborn vitamin D status. We completed a systematic review ...(1959–2014) and meta‐analysis of studies reporting serum 25‐hydroxyvitamin D 25(OH)D concentration in maternal and newborn populations. The 95 identified studies were unevenly distributed by World Health Organization (WHO) region: Americas (24), European (33), Eastern Mediterranean (13), South‐East Asian (7), Western Pacific (16) and African (2). Average maternal 25(OH)D concentrations (nmol L−1) by region were 47–65 (Americas), 15–72 (European), 13–60 (Eastern Mediterranean), 20–52 (South‐East Asian), 42–72 (Western Pacific) and 92 (African). Average newborn 25(OH)D concentrations (nmol L−1) were 35–77 (Americas), 20–50 (European), 5–50 (Eastern Mediterranean), 20–22 (South‐East Asian), 32–67 (Western Pacific) and 27–35 (African). The prevalences of 25(OH)D <50 and <25 nmol L−1 by WHO region in pregnant women were: Americas (64%, 9%), European (57%, 23%), Eastern Mediterranean (46%, 79%), South‐East Asian (87%, not available) and Western Pacific (83%, 13%). Among newborns these values were: Americas (30%, 14%), European (73%, 39%), Eastern Mediterranean (60%, not available), South‐East Asian (96%, 45%) and Western Pacific (54%, 14%). By global region, average 25(OH)D concentration varies threefold in pregnant women and newborns, and prevalence of 25(OH)D <25 nmol L−1 varies eightfold in pregnant women and threefold in newborns. Maternal and newborn 25(OH)D concentrations are highly correlated. Addressing vitamin D deficiency in pregnant women and newborns should be a global priority. To protect children from the adverse effects of vitamin D deficiency requires appropriate interventions during both pregnancy and childhood.
Objectives To assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect.Design Systematic review and ...meta-analysis of individual participant data (IPD) from randomised controlled trials.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials.gov, and the International Standard Randomised Controlled Trials Number registry from inception to December 2015.Eligibility criteria for study selection Randomised, double blind, placebo controlled trials of supplementation with vitamin D3 or vitamin D2 of any duration were eligible for inclusion if they had been approved by a research ethics committee and if data on incidence of acute respiratory tract infection were collected prospectively and prespecified as an efficacy outcome.Results 25 eligible randomised controlled trials (total 11 321 participants, aged 0 to 95 years) were identified. IPD were obtained for 10 933 (96.6%) participants. Vitamin D supplementation reduced the risk of acute respiratory tract infection among all participants (adjusted odds ratio 0.88, 95% confidence interval 0.81 to 0.96; P for heterogeneity <0.001). In subgroup analysis, protective effects were seen in those receiving daily or weekly vitamin D without additional bolus doses (adjusted odds ratio 0.81, 0.72 to 0.91) but not in those receiving one or more bolus doses (adjusted odds ratio 0.97, 0.86 to 1.10; P for interaction=0.05). Among those receiving daily or weekly vitamin D, protective effects were stronger in those with baseline 25-hydroxyvitamin D levels <25 nmol/L (adjusted odds ratio 0.30, 0.17 to 0.53) than in those with baseline 25-hydroxyvitamin D levels ≥25 nmol/L (adjusted odds ratio 0.75, 0.60 to 0.95; P for interaction=0.006). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted odds ratio 0.98, 0.80 to 1.20, P=0.83). The body of evidence contributing to these analyses was assessed as being of high quality.Conclusions Vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Patients who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.Systematic review registration PROSPERO CRD42014013953.
Background The Beery-Buktenica Test of Visual-Motor Integration (Beery VMI) is a commonly used standardized test of visual-motor integration. Performance on the test is related to academic ...achievement, but the effect of reduced visual acuity on test results is unknown. This study determined the visual acuity demand and the spacing of the test forms for the Beery VMI and its supplemental tests and investigated the effect of induced optical blur on test results in both adults and children. Methods The overall size and critical detail size of each form and the distance between the center of each form and its adjacent crowding source were measured. The visual acuity demand and angular separation of forms were calculated. Two groups of participants (adults aged greater than or equal to18 years n = 19 and children aged 7-12 years n = 20) completed four sessions in which they performed the Beery VMI and the supplemental tests under different blur conditions (habitual near correction, monocular spherical blur, binocular spherical blur and binocular astigmatic blur) in a randomized order. Results Stroke width, overall form size and box size remained constant throughout the Beery VMI, whereas these reduced with increasing difficulty for the supplemental tests. Reduced near visual acuity from simulated blur resulted in reduced mean scores for the Beery VMI and its supplemental tests, compared with habitual near vision in both adults and children. Binocular spherical blur had the most detrimental effect (p0.001), followed by binocular astigmatic blur (p0.001) then monocular spherical blur (p = 0.022). Conclusions In individuals with uncorrected spherical or astigmatic ametropia, reduced scores on the Beery VMI and its supplemental tests may be due to impaired near visual acuity and not reflect reduced visual-motor abilities. This highlights the importance of excluding reduced near visual acuity as a cause of reduced performance before diagnosing impairment and initiating treatment strategies for visual-motor integration.
Randomised controlled trials (RCTs) exploring the potential of vitamin D to prevent acute respiratory infections have yielded mixed results. Individual participant data (IPD) meta-analysis has the ...potential to identify factors that may explain this heterogeneity.
To assess the overall effect of vitamin D supplementation on the risk of acute respiratory infections (ARIs) and to identify factors modifying this effect.
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, ClinicalTrials.gov and the International Standard Randomised Controlled Trials Number (ISRCTN) registry.
Randomised, double-blind, placebo-controlled trials of supplementation with vitamin D
or vitamin D
of any duration having incidence of acute respiratory infection as a prespecified efficacy outcome were selected.
Study quality was assessed using the Cochrane Collaboration Risk of Bias tool to assess sequence generation, allocation concealment, blinding of participants, personnel and outcome assessors, completeness of outcome data, evidence of selective outcome reporting and other potential threats to validity.
We identified 25 eligible RCTs (a total of 11,321 participants, aged from 0 to 95 years). IPD were obtained for 10,933 out of 11,321 (96.6%) participants. Vitamin D supplementation reduced the risk of ARI among all participants adjusted odds ratio (aOR) 0.88, 95% confidence interval (CI) 0.81 to 0.96; heterogeneity
< 0.001. Subgroup analysis revealed that protective effects were seen in individuals receiving daily or weekly vitamin D without additional bolus doses (aOR 0.81, 95% CI 0.72 to 0.91), but not in those receiving one or more bolus doses (aOR 0.97, 95% CI 0.86 to 1.10;
= 0.05). Among those receiving daily or weekly vitamin D, protective effects of vitamin D were stronger in individuals with a baseline 25-hydroxyvitamin D 25(OH)D concentration of < 25 nmol/l (aOR 0.30, 95% CI 0.17 to 0.53) than in those with a baseline 25(OH)D concentration of ≥ 25 nmol/l (aOR 0.75, 95% CI 0.60 to 0.95;
= 0.006). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (aOR 0.98, 95% CI 0.80 to 1.20;
= 0.83). The body of evidence contributing to these analyses was assessed as being of high quality.
Our study had limited power to detect the effects of vitamin D supplementation on the risk of upper versus lower respiratory infection, analysed separately.
Vitamin D supplementation was safe, and it protected against ARIs overall. Very deficient individuals and those not receiving bolus doses experienced the benefit. Incorporation of additional IPD from ongoing trials in the field has the potential to increase statistical power for analyses of secondary outcomes.
This study is registered as PROSPERO CRD42014013953.
The National Institute for Health Research Health Technology Assessment programme.
Respiratory syncytial virus (RSV) is increasingly recognized as an important cause of illness in adults; however, data on RSV disease and economic burden in this age group remain limited. We aimed to ...provide comprehensive estimates of RSV disease burden among adults aged ≥18 years.
During 2012-2015, population-based, active surveillance of acute respiratory infection (ARI) hospitalizations enabled estimation of the seasonal incidence of RSV hospitalizations and direct health costs in adults aged ≥18 years in Auckland, New Zealand.
Of 4,600 ARI hospitalizations tested for RSV, 348 (7.6%) were RSV positive. The median (interquartile range) length of hospital stay for RSV positive patients was 4 (2-6) days. The seasonal incidence rate (IR) of RSV hospitalizations, corrected for non-testing, was 23.6 (95% confidence intervals CI 21.0-26.1) per 100,000 adults aged ≥18 years. Hospitalization risk increased with age with the highest incidence among adults aged ≥80 years (IR 190.8 per 100,000, 95% CI 137.6-244.0). Being of Māori or Pacific ethnicity or living in a neighborhood with low socioeconomic status (SES) were independently associated with increased RSV hospitalization rates. We estimate RSV-associated hospitalizations among adults aged ≥18 years to cost on average NZD $4,758 per event.
RSV infection is associated with considerable disease and economic cost in adults. RSV disproportionally affects adult sub-groups defined by age, ethnicity, and neighborhood SES. An effective RSV vaccine or RSV treatment may offer benefits for older adults.
Aim
Pre‐school wheeze is a common hospital presentation in Australasia. The aim of this study was to describe the regional hospital presentation and cost of pre‐school wheeze.
Methods
Audit of ...children diagnosed with pre‐school wheeze at two hospitals in Auckland, New Zealand from October 2017 to September 2019. Guideline adherence was determined.
Results
One hundred and ninety‐two children made 247 pre‐school wheeze hospital presentations. Pre‐school wheeze accounted for a larger proportion of acute hospital presentations for Māori versus non‐Māori children (rate ratio 1.76, 95% confidence intervals 1.32–2.31). Hospital representations with pre‐school wheeze occurred in 38/192 (20%) children. The proportion with a pre‐school wheeze representation was larger for Māori than non‐Māori (30% vs. 16%, P = 0.02). Pre‐school wheeze event median length of stay increased as household deprivation increased (P = 0.01). Clinical severity of 247 pre‐school wheeze episodes was mild (n = 64, 26%), moderate (n = 153, 62%) and severe (n = 30, 12%). Of 244 episodes, inhaled bronchodilators only were given for 149 (61%), oxygen for 54 (22%) and intravenous treatment for 41 (17%). Hospital guideline use was evident in 164/247 (66%) episodes. Neither clinical severity nor treatment intensity varied with child sex, age or ethnicity or household deprivation. The estimated median (interquartile range) direct medical costs of each pre‐school wheeze episode were NZ$1279 (NZ$774–2158).
Conclusions
In Auckland, pre‐school wheeze accounts for a larger proportion of acute hospital presentations for Māori compared with non‐Māori and Māori children have increased odds of pre‐school wheeze readmissions. Length of hospital stay for pre‐school wheeze episodes increased with household deprivation. In this audit pre‐school wheeze guideline adherence was poor.
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