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Milani GP, Alberti I, Abodi M, Lakoumentas J, Konstantinou GN, Papadopoulos NG, Pop RM, Bocsan IC, Cassimos D, Kull I, Bettocchi S, Corsello A, Cugliari M, Ciliberti L, Spolidoro GCI, Agostoni C, Vlieg Boerstra B, Venter C, O'Mahony L, Vassilopoulou E. A systematic review and meta-analysis on nutritional and dietary interventions for the treatment of acute respiratory infection in pediatric patients: An EAACI taskforce. Allergy 2024; 79:1687-1707. [PMID: 38174413 DOI: 10.1111/all.15997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/11/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024]
Abstract
Acute respiratory infections are a major cause of morbidity and mortality in children worldwide. Dietary and nutritional interventions, including minerals and vitamin supplementation, have been explored as potential treatments for these infections. However, the evidence on their efficacy is limited and inconclusive. This systematic review and meta-analysis aim to provide a comprehensive summary of the available evidence on the effectiveness of dietary and nutritional interventions for treating acute respiratory tract infections in children. A systematic review was conducted according to the PRISMA 2020 guidelines in April 2022 and updated in April 2023. Clinical trials focusing on dietary or nutritional interventions, including supplementations, in children with acute respiratory tract infections were included. The selection of interventions and outcomes was based on biological plausibility. Data were extracted using a standardized form, and the risk of bias was assessed using the Cochrane Risk of Bias Tool. Meta-analysis was performed using random-effect models. A total of 50 studies were included in the review. Four trials were conducted in low, 32 in lower-middle, 12 in upper-middle, and only two in high-income countries. The studies evaluated various dietary interventions, including zinc, vitamin A, vitamin E, vitamin D, and probiotics. The results of individual studies on the efficacy of these interventions were mixed, with some showing positive effects on clinical outcomes such as duration of symptoms, while others showed no significant impact. Meta-analysis was conducted for zinc supplementation in children with pneumonia, and the pooled results suggested a potential limited benefit in terms of reduced hospital length of stay but not time to recovery. Meta-analyses on vitamin D did not show any effect in children with pneumonia. This systematic review fills a critical gap in the literature by synthesizing the available evidence on the efficacy and safety of nutritional or dietary interventions for acute respiratory tract infections in children. The findings indicate no dietary or nutritional intervention can currently be recommended for the routine treatment of respiratory tract infections in children based on single supplement studies. The metanalysis suggests that zinc supplementation might have a beneficial effect on length of hospitalization in children with pneumonia. New studies are needed to establish more conclusive evidence for pediatric acute respiratory diseases especially for children living in a context of high-income countries.
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Affiliation(s)
- Gregorio P Milani
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Ilaria Alberti
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Abodi
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - John Lakoumentas
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | | | - Raluca M Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Ioana C Bocsan
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Dimitrios Cassimos
- Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Silvia Bettocchi
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Corsello
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Marco Cugliari
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Letizia Ciliberti
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Giulia C I Spolidoro
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Berber Vlieg Boerstra
- Department of Pediatrics, OLVG Hospital, Amsterdam, The Netherlands
- Rijnstate Allergy Centre, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carina Venter
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Liam O'Mahony
- Department of Medicine and School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Emilia Vassilopoulou
- Pediatric Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
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Lian D, Tang Q, Wu L, Liao X. Using targeted second-generation sequencing technique to guide clinical diagnosis and the effect of medication on the therapeutic effect and prognosis of respiratory tract infection in children: An observational study. Medicine (Baltimore) 2024; 103:e37757. [PMID: 38701307 PMCID: PMC11062728 DOI: 10.1097/md.0000000000037757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 03/08/2024] [Indexed: 05/05/2024] Open
Abstract
To explore the effect of targeted second-generation sequencing technique to guide clinical diagnosis and medication on the therapeutic effect and prognosis of respiratory tract infection (RTI) in children. During January 2021 to June 2022, 320 children with RTI cured were selected in our hospital as the object of this retrospective study. The control group accepted empirical broad-spectrum antibacterial therapy and the observation group accepted targeted second-generation sequencing technique to guide diagnosis and medication. The therapeutic effect, improvement time of clinical symptom index, laboratory-related index, level of inflammatory factors, incidence of complications, and parents' treatment satisfaction were compared. The observation group was considerably more efficacious (91.25%) versus the controlled group (72.50%). The duration of enhancement of fever, nasal congestion, tonsillar congestion, and cough symptoms was shorter in the observation group (P < .05). Serum levels of iron, IgA, IgG as well as IgM were substantially elevated in the observation group. The levels of IL-4 and IL-10 were markedly reduced in the observation group after treatment. The prevalence of complications was considerably below that of the comparison group (21.25%) in the observation group (8.75%). Parental satisfaction with therapy was markedly higher in the observation group (92.50%) than in the control group (66.25%). The application of targeted second-generation sequencing technology to guide clinical diagnosis and drug use can elevate the RTIs efficacy and prognosis in childhood. Targeted second-generation sequencing can achieve precise treatment, reduce drug resistance of drug-resistant strains, and improve the efficacy. It has high promotion and application value.
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Affiliation(s)
- Di Lian
- Respiratory Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
| | - Qiuyu Tang
- Respiratory Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
| | - Ling Wu
- Infection Diseases Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
| | - Xing Liao
- Infection Diseases Ward, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou 350005, Fujian, China
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Paduchová Z, Nagyová Z, Wang D, Muchová J. The impact of probiotics and vitamin C on the prevention of upper respiratory tract symptoms in two preschool children cohorts. Nutr Res Pract 2024; 18:98-109. [PMID: 38352209 PMCID: PMC10861338 DOI: 10.4162/nrp.2024.18.1.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/16/2023] [Accepted: 11/16/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND/OBJECTIVES The efficacy of Lab4 probiotic and vitamin C combination on the prevention of upper respiratory tract infections (URTIs) was investigated in two studies with children. Our objective was to pool dataset of 57 preschool children from the PROCHILD study (ISRCTN28722693) and the dataset of 50 preschool matched cohort from the PROCHILD-2 study (ISRCTN26587549) to evaluate the impact of probiotic/vitamin C combination on the prevention of upper respiratory tract symptoms and provide a more robust assessment of effect using detailed individual level data. SUBJECTS/METHODS The children were supplemented daily for 6 months with either the multistrain probiotic (1.25×1010 cfu/tablet consisting of two strains of Lactobacillus acidophilus CUL21 and CUL60, Bifidobacterium bifidum CUL20 and Bifidobacterium animalis subsp. lactis CUL34) plus 50 mg vitamin C or a placebo. RESULTS In the pooled analysis of the individual participant data (per protocol population), significant reductions were observed for the incidence (-25%; 95% confidence interval [CI], 0.66, 0.85; P < 0.0001) and duration (-14.9 days; 95% CI, -24.8, -5.1; P = 0.0030) of typical URTI symptoms in the active group compared with the placebo. The incidence rates of absenteeism from preschool (IR ratio, 0.75; 95% CI, 0.66, 0.86; P < 0.0001), paediatric visits (IR ratio, 0.56; 95% CI, 0.47; 0.68; P < 0.0001) and antibiotic usage (IR ratio, 0.53; 95% CI, 0.39, 0.71; P < 0.0001) were also significantly reduced. CONCLUSION The pooled analysis findings of comparable preschool cohorts from two studies indicate that the supplementation with probiotic and vitamin C combination is beneficial in the prevention and management of URTI symptoms.
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Affiliation(s)
- Zuzana Paduchová
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia
| | - Zuzana Nagyová
- JuvenaliaA Paediatric Centre, 929 01 Dunajská Streda, Slovakia
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - Jana Muchová
- Institute of Medical Chemistry, Biochemistry and Clinical Biochemistry, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia
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Gill PJ, Onakpoya IJ, Buchanan F, Birnie KA, Van den Bruel A. Treatments for cough and common cold in children. BMJ 2024; 384:e075306. [PMID: 38272497 DOI: 10.1136/bmj-2023-075306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Peter J Gill
- The Hospital for Sick Children, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igho J Onakpoya
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary
- Alberta Children's Hospital Research Institute, Calgary
| | - Ann Van den Bruel
- Academic Centre for Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
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Kostev K, van den Boom L, Tanislav C, Jacob L. Changes in the Prescription of Antibiotics and Phytopharmaceuticals in Children Treated for Acute Upper and Lower Respiratory Tract Infections in Pediatric Practices in Germany in 2013, 2018, and 2022. Antibiotics (Basel) 2023; 12:1491. [PMID: 37887192 PMCID: PMC10604680 DOI: 10.3390/antibiotics12101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Background: Little is known about the recent trends in antibiotic and phytopharmaceutical prescribing for acute upper (URIs) and lower respiratory tract infections (LRIs) in children and adolescents. Therefore, this study investigated changes in the prescription of antibiotics and phytopharmaceuticals in children diagnosed with acute URIs and LRIs in pediatric practices in Germany in 2013, 2018, and 2022. Methods: The present retrospective study included children aged 2-12 years diagnosed with acute URIs or LRIs in one of 180 pediatric practices in 2013, 2018, and 2022. The URIs included nasopharyngitis, sinusitis, pharyngitis, tonsillitis, laryngitis and tracheitis, and upper respiratory infections of multiple and unspecified sites, while the LRIs corresponded to bronchitis. The primary outcomes were the proportion of children being prescribed antibiotics and the proportion of those being prescribed phytopharmaceuticals. Results: A total of 120,894 children were diagnosed with acute URIs or LRIs in 2013 compared to 116,844 in 2018 and 127,821 in 2022. The prevalence of antibiotic prescription decreased for all diagnoses between 2013 and 2022. This decrease was statistically significant for both 2013-2018 and 2018-2022 for nasopharyngitis, pharyngitis, and bronchitis. Meanwhile, there was a significant increase in the use of phytopharmaceuticals for all diagnoses between 2013 and 2018. The prevalence of phytopharmaceutical prescription decreased slightly between 2018 and 2022, but this decrease was generally not statistically significant. Conclusions: The prescription of antibiotics has decreased and that of phytopharmaceuticals has increased in children diagnosed with acute URIs and LRIs in Germany over the last decade. More data are needed to corroborate these findings in other settings.
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Affiliation(s)
- Karel Kostev
- Epidemiology, IQVIA, 60549 Frankfurt, Germany
- University Clinic, Philipps-Universität Marburg, 35043 Marburg, Germany
| | - Louisa van den Boom
- Division of Pediatrics/Pediatric Diabetology, DRK Hospital, 57548 Kirchen, Germany
- Division of Pediatric Diabetology, Endocrinology, Metabolism and Obesity, Children’s Hospital, University of Bonn, 53127 Bonn, Germany
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling, 57074 Siegen, Germany;
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
- AP-HP, Université Paris Cité, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, 75010 Paris, France
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Mancak Karakuş M, Tapısız A, Mutlu Karakaş N, Deniz M, Koca Çalışkan U. Use of Herbal Tea/Herbal Preparations for Children with Symptoms of Viral Upper Respiratory Infections. Turk J Pharm Sci 2023; 20:8-15. [PMID: 36862009 PMCID: PMC9986947 DOI: 10.4274/tjps.galenos.2022.65475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives Respiratory tract infections (RTIs) are common in children. To treat the symptoms of simple health problems, individuals look for natural healing methods that can be easily prepared at home. The aim of this study was to determine the plants and herbal products used by the parents of children suffering from viral upper respiratory tract symptoms by questionaire. In the study, applications and products, other than plants used by families for their children were also investigated. Materials and Methods This study is a cross-sectional survey conducted at Faculty of Medicine, Gazi University (Ankara, Türkiye). A questionnaire form was used by scanning the existing literature and reviewed with the patients face to face by the researchers. The data obtained from the study were analyzed with the Statistical Package for the Social Sciences (SPSS) statistical program. Results About half of the participants reported that they used non-chemical drug practices for their children with upper RTIs. The most common practice was to prepare herbal tea (30.5%), followed by mandarin/orange and/or their juice (26.9%) for oral application. The most used herbal tea for upper RTIs is with linden (Tilia sp.). Patients who used linden usually prepared it as tea, in other words by infusion, and served their children 1-2 cups/1-3 times a week. Except for herbal tea, the participants mostly used honey (19.0%) for their children's symptoms. Conclusion Where available, appropriate doses and dosage forms of herbal supplement products with scientifically proven efficacy and safety should be determined for the pediatric population. Parents should use these products based on the recommendations of their pediatrician.
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Affiliation(s)
| | - Anıl Tapısız
- Gazi University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Türkiye
| | - Nazmi Mutlu Karakaş
- Gazi University, Faculty of Medicine, Department of Pediatrics, Ankara, Türkiye
| | - Melis Deniz
- Gazi University, Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara, Türkiye
| | - Ufuk Koca Çalışkan
- Gazi University, Faculty of Pharmacy, Department of Pharmacognosy, Ankara, Türkiye.,Düzce University, Faculty of Pharmacy, Department of Pharmacognosy, Düzce, Türkiye
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Simões EAF, Madhi SA, Muller WJ, Atanasova V, Bosheva M, Cabañas F, Baca Cots M, Domachowske JB, Garcia-Garcia ML, Grantina I, Nguyen KA, Zar HJ, Berglind A, Cummings C, Griffin MP, Takas T, Yuan Y, Wählby Hamrén U, Leach A, Villafana T. Efficacy of nirsevimab against respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: a pooled analysis of randomised controlled trials. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:180-189. [PMID: 36634694 PMCID: PMC9940918 DOI: 10.1016/s2352-4642(22)00321-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In a phase 2b trial and the phase 3 MELODY trial, nirsevimab, an extended half-life, monoclonal antibody against respiratory syncytial virus (RSV), protected healthy infants born preterm or at full term against medically attended RSV lower respiratory tract infection (LRTI). In the MEDLEY phase 2-3 trial in infants at higher risk for severe RSV infection, nirsevimab showed a similar safety profile to that of palivizumab. The aim of the current analysis was to assess the efficacy of nirsevimab using a weight-banded dosing regimen in infants born between 29 weeks gestational age and full term. METHODS Infants enrolled in the phase 2b and MELODY trials were randomised (2:1) to receive a single intramuscular injection of nirsevimab (infants weighing <5 kg received 50 mg; those weighing ≥5 kg received 100 mg) or placebo before the RSV season. Infants in MEDLEY were randomised (2:1) to receive one dose of nirsevimab (infants weighing <5 kg received 50 mg; those weighing ≥5 kg received 100 mg) followed by four monthly placebo doses, or five once-a-month intramuscular doses of palivizumab. We report a prespecified pooled efficacy analysis assessing the weight-banded dosing regimen proposed on the basis of the phase 2b and MELODY trials, in addition to extrapolated efficacy in infants with chronic lung disease, congenital heart disease, or extreme preterm birth (<29 weeks' gestational age) based on pharmacokinetic data from the phase 2-3 MEDLEY safety trial. For the pooled efficacy analysis, the primary endpoint was incidence of medically attended RSV LRTI through 150 days post-dose. The secondary efficacy endpoint was number of admissions to hospital for medically attended RSV LRTI. The incidence of very severe RSV LRTI was an exploratory endpoint, defined as cases of hospital admission for medically attended RSV LRTI that required supplemental oxygen or intravenous fluids. We also did a prespecified exploratory analysis of medically attended LRTI of any cause (in the investigator's judgement) and hospital admission for respiratory illness of any cause (defined as any upper respiratory tract infection or LRTI leading to hospital admission). Post hoc exploratory analyses of outpatient visits and antibiotic use were also done. Nirsevimab serum concentrations in MEDLEY were assessed using population pharmacokinetic methods and the pooled data from the phase 2b and MELODY trials. An exposure target was defined on the basis of an exposure-response analysis. To successfully demonstrate extrapolation, more than 80% of infants in MEDLEY had to achieve serum nirsevimab exposures at or above the predicted efficacious target. FINDINGS Overall, 2350 infants (1564 in the nirsevimab group and 786 in the placebo group) in the phase 2b and MELODY trials were included in the pooled analysis. Nirsevimab showed efficacy versus placebo with respect to the primary endpoint of medically attended RSV LRTI (19 [1%] nirsevimab recipients vs 51 [6%] placebo recipients; relative risk reduction [RRR] 79·5% [95% CI 65·9-87·7]). Consistent efficacy was shown for additional endpoints of RSV LRTI hospital admission (nine [1%] nirsevimab recipients vs 21 [3%] placebo recipients; 77·3% [50·3-89·7]) and very severe RSV (five [<1%] vs 18 [2%]; 86·0% [62·5-94·8]). Nirsevimab recipients had fewer hospital admissions for any-cause respiratory illness (RRR 43·8% [18·8-61·1]), any-cause medically attended LRTI (35·4% [21·5-46·9]), LRTI outpatient visits (41·9% [25·7-54·6]), and antibiotic prescriptions (23·6% [3·8-39·3]). Among infants with chronic lung disease, congenital heart disease, or extreme preterm birth in MEDLEY, nirsevimab serum exposures were similar to those found in the pooled data; exposures were above the target in more than 80% of the overall MEDLEY trial population (94%), including infants with chronic lung disease (94%) or congenital heart disease (80%) and those born extremely preterm (94%). INTERPRETATION A single dose of nirsevimab protected healthy infants born at term or preterm from medically attended RSV LRTI, associated hospital admission, and severe RSV. Pharmacokinetic data support efficacy extrapolation to infants with chronic lung disease, congenital heart disease, or extreme prematurity. Together, these data suggest that nirsevimab has the potential to change the landscape of infant RSV disease by reducing a major cause of infant morbidity and the consequent burden on caregivers, clinicians, and health-care providers. FUNDING AstraZeneca and Sanofi.
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Affiliation(s)
| | - Shabir A Madhi
- South African Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - William J Muller
- Ann & Robert H Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Miroslava Bosheva
- University Multiprofile Hospital for Active Treatment Sv Georgi Medical University, Plovdiv, Bulgaria
| | | | | | | | | | | | - Kim A Nguyen
- Hospices Civils de Lyon, Neonatal Intensive Care Units and CIC 1407, Lyon, France
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Anna Berglind
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Celeste Cummings
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Durham, NC, USA
| | - M Pamela Griffin
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Therese Takas
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Yuan Yuan
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Ulrika Wählby Hamrén
- Clinical Pharmacology and Quantitative Pharmacology, R&D, AstraZeneca, Gothenburg, Sweden
| | - Amanda Leach
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Tonya Villafana
- Clinical Development, Vaccines & Immune Therapies, Biopharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA.
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Racial Disparities and Common Respiratory Infectious Diseases in Children of the United States: A Systematic Review and Meta-Analysis. Diseases 2023; 11:diseases11010023. [PMID: 36810537 PMCID: PMC9944874 DOI: 10.3390/diseases11010023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Due to the lack of sufficient data on the relationship between racial disparities and the occurrence of infectious respiratory diseases in children, the aim of this systematic review and meta-analysis is to evaluate the presence of racial gaps in the occurrence of respiratory infectious diseases in children. This study follows the PRISMA flow guidelines for systematic reviews and the standards of meta-analysis for 20 quantitative studies conducted from 2016 to 2022 including 2,184,407 participants. As evidenced from the review, in the U.S., racial disparities are present among children, with Hispanic and Black children carrying the burden of infectious respiratory disease occurrence. Several factors are contributory to these outcomes among Hispanic and Black children, including higher rates of poverty; higher rates of chronic conditions, such as asthma and obesity; and seeking care outside of the home. However, vaccinations can be used to reduce the risk of infection among Black and Hispanic children. Whether a child is very young or a teen, racial disparities are present in occurrence rates of infectious respiratory diseases, with the burden resting among minorities. Therefore, it is important for parents to be aware of the risk of infectious diseases and to be aware of resources, such as vaccines.
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Leung MW, O’Donoghue M, Suen LKP. Personal and Household Hygiene Measures for Preventing Upper Respiratory Tract Infections among Children: A Cross-Sectional Survey of Parental Knowledge, Attitudes, and Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:229. [PMID: 36612552 PMCID: PMC9819782 DOI: 10.3390/ijerph20010229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Personal and household hygiene measures are important for preventing upper respiratory tract infections (URTIs) and other infectious diseases, including coronavirus disease 2019 (COVID-19). An online survey recruited 414 eligible parents in Hong Kong to study their hygiene knowledge, attitudes, and practices (KAPs) regarding the prevention of URTIs among their children. The average knowledge score was high (10.2/12.0), but some misconceptions were identified. The majority of the participants agreed that good personal hygiene (93.5%) and good environmental hygiene (92.8%) can prevent URTIs. The average score for hand hygiene practices was high (3.78/4.00), but only 56.8% of the parents always performed hand hygiene before touching their mouths, noses, or eyes. In terms of environmental hygiene, only some household items were disinfected with disinfectants (door handles in 69.8% of the households, toilet seats in 60.4% of the households, the floor in 42.8% of the households, dining chairs in 24.2% of the households, and dining tables in 20.5% of the households). A higher knowledge score was associated with parents having tertiary educational levels or above, working as healthcare professionals, living in private residential flats or staff quarters, or having household incomes of HKD 70,000 or above. The results of multiple regression analyses also indicated that parents who were healthcare professionals and with higher household income had a better parental knowledge of hygiene measures after adjusting the attitude score. For hand hygiene, parents who achieved higher attitude scores obtained higher practice scores. Under the fifth wave of the COVID-19 epidemic, there were some misconceptions regarding hygiene among parents. Any health promotion program should target parents regarding taking proper personal and household hygienic measures, especially for those who had relatively lower socio-economic status and/or from a non-healthcare background. Motivating attitudes toward hand hygiene can lead to better practices.
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Affiliation(s)
- Man-Wai Leung
- Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
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Rombach I, Wang K, Tonner S, Grabey J, Harnden A, Wolstenholme J. Quality of life, healthcare use and costs in 'at-risk' children after early antibiotic treatment versus placebo for influenza-like illness: within-trial descriptive economic analyses of the ARCHIE randomised controlled trial. BMJ Open 2022; 12:e049373. [PMID: 35428613 PMCID: PMC9014043 DOI: 10.1136/bmjopen-2021-049373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To characterise the quality of life, healthcare use and costs associated with early antibiotic treatment of influenza-like illness (ILI) in 'at-risk' children. DESIGN Economic analysis of a two-arm double-blind parallel group pragmatic randomised controlled trial. SETTING Children were recruited from community-based healthcare settings, including general practices, walk-in centres and hospital ambulatory care. PARTICIPANTS Children with risk factors for influenza-related complications, including respiratory, cardiac and neurological conditions, who presented within the first 5 days of an ILI. INTERVENTIONS Co-amoxiclav 400/57 suspension or placebo. OUTCOME MEASURES This economic analysis focused on quality of life measured by the EQ-5D-Y, symptoms assessed by the Canadian Acute Respiratory Infection and Flu Scale (CARIFS), healthcare use and costs including medication, hospital visits and admissions, general practitioner and nurse contacts. Outcomes were assessed for up to 28 days post randomisation. RESULTS Information on resource use, EQ-5D-Y (day 28) and CARIFS (day 7) was available for 265 (98%), 72 (27%) and 123 (45%) out of 271 participants, respectively. Average costs in the co-amoxiclav group were £25 lower (95% CI -£113 to £65), but this difference was not statistically significant (p=0.566). The difference in EQ-5D-Y scores between groups was also not statistically significant (-0.014 (95% CI -0.124 to 0.096), p=0.798). However, day 7 CARIFS scores were 3.5 points lower in the co-amoxiclav arm (95% CI -6.9 to -0.1, p=0.044). CONCLUSIONS Our findings did not show evidence that early co-amoxiclav treatment improves quality of life or reduces healthcare use and costs in 'at-risk' children with ILI, but may reduce symptom severity though confirmation from further research would be important. Reliable data collection from children's parents/carers was challenging, and resulted in high levels of missing data, which is common in pragmatic trials involving children with acute respiratory tract infections. TRIAL REGISTRATION NUMBER ISRCTN70714783; EudraCT 2013-002822-21.
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Affiliation(s)
- Ines Rombach
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sharon Tonner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jenna Grabey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Sitaresmi MN, Indraswari BW, Rozanti NM, Sabilatuttaqiyya Z, Wahab A. Health-related quality of life profile of Indonesian children and its determinants: a community-based study. BMC Pediatr 2022; 22:103. [PMID: 35193530 PMCID: PMC8862365 DOI: 10.1186/s12887-022-03161-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background Assessing health-related quality of life (HRQOL) and its determinants in children may provide a comprehensive view of child health. The study aimed to assess the HRQOL in Indonesian children and its determinants. Methods We conducted a community-based cross-sectional study in the Sleman District of Yogyakarta Special Province, Indonesia, from August to November 2019. We recruited children aged 2 to 18 years old using the Sleman Health and Demography Surveillance System sample frame. We used the validated Indonesian version of Pediatric Quality of life Inventory™ (Peds QL™) 4.0 Generic core scale, proxy-reports, and self-reports, to assess the HRQOL. Results We recruited 633 proxies and 531 children aged 2–18 years. The mean total score of self-report and proxy-report were 89.9+ 8.5 and 93.3 + 6.4. There was a fair to moderate correlation between self-reports and proxy-reports, with intra-class correlation ranging from 0.34 to 0.47, all p < 0.001. Half of the children (49.4% from proxy-report and 50.1% from self-report) reported having acute illness during the last month. Based on proxy-reports, multivariate regression analysis demonstrated lower HRQOL for children with acute health problems, younger age, history of low birth weight, abnormal delivery, lower fathers’ educational level, and government-paid insurance for low-income families. Conclusion Sociodemographic determinants of a child’s HRQOL, acute health problems, and low birth weight were associated with lower HRQOL in the general pediatric population. In low- and middle-income countries where acute infections and low birth weight are still prevalent, its prevention and appropriate interventions should improve child health.
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Affiliation(s)
- Mei Neni Sitaresmi
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (UGM)/ RSUP DR Sardjito, Jalan Farmako Sekip Utara, Yogyakarta, 55281, Indonesia.
| | - Braghmandita Widya Indraswari
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (UGM)/ RSUP DR Sardjito, Jalan Farmako Sekip Utara, Yogyakarta, 55281, Indonesia
| | - Nisrina Maulida Rozanti
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (UGM), Yogyakarta, Indonesia
| | - Zena Sabilatuttaqiyya
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (UGM), Yogyakarta, Indonesia
| | - Abdul Wahab
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada (UGM), Yogyakarta, Indonesia
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12
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Azor-Martinez E, Garcia-Mochon L, Lopez-Lacort M, Strizzi JM, Muñoz-Vico FJ, Jimenez-Lorente CP, Fernandez-Campos MA, Bueno-Rebollo C, Del Castillo-Aguas G, Balaguer-Martinez JV, Gimenez-Sanchez F. Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections. Pediatrics 2021; 148:183449. [PMID: 34814193 DOI: 10.1542/peds.2021-052496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. METHODS A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. RESULTS There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. CONCLUSIONS Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.
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Affiliation(s)
| | - Leticia Garcia-Mochon
- Escuela Andaluza de Salud Pública, University of Granada, Granada, Spain.,Center for Biomedical Research Network in Epidemiology and Public Health, Madrid, Spain.,Institute of Biomedical Research Granada, University Hospitals of Granada, University of Granada, Granada, Spain
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Use of Complementary and Alternative Medicine in Pediatric Respiratory Diseases. Holist Nurs Pract 2021; 35:92-97. [PMID: 33555722 DOI: 10.1097/hnp.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In this study, our purpose was to determine prevalence of complementary and alternative medicine (CAM) in pediatric respiratory diseases and methods of CAM use accordingly. Each of the CAM treatment has a special risk/benefit combination and it is absolutely crucial for health care professionals to question those methods.
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Wang K, Semple MG, Moore M, Hay AD, Tonner S, Galal U, Grabey J, Carver T, Perera R, Yu LM, Mollison J, Little P, Farmer A, Butler CC, Harnden A. The early use of Antibiotics for at Risk CHildren with InfluEnza-like illness (ARCHIE): a double-blind randomised placebo-controlled trial. Eur Respir J 2021; 58:13993003.02819-2020. [PMID: 33737410 DOI: 10.1183/13993003.02819-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/18/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The UK government stockpiles co-amoxiclav to treat bacterial complications during influenza pandemics. This pragmatic trial examines whether early co-amoxiclav use reduces re-consultation due to clinical deterioration in "at risk" children presenting with influenza-like illness (ILI) in primary or ambulatory care. METHODS "At risk" children aged 6 months to 12 years presenting within f5 days of ILI onset were randomly assigned to oral co-amoxiclav 400/57 or placebo twice daily for 5 days (dosing based on age±weight). "At risk" groups included children with respiratory, cardiac, and neurological conditions. Randomisation was stratified by region and used a non-deterministic minimisation algorithm to balance age and current seasonal influenza vaccination status. Our target sample size was 650 children, which would have allowed us to detect a reduction in the proportion of children re-consulting due to clinical deterioration from 40% to 26% with 90% power and 5% two-tailed alpha error, including allowance for 25% loss to follow-up and an inflation factor of 1.041. Participants, caregivers and investigators were blinded to treatment allocation. Intention-to-treat analysis included all randomised participants with primary outcome data on re-consultation due to clinical deterioration within 28 days. Safety analysis included all randomised participants. TRIAL REGISTRATION ISRCTN 70714783. EudraCT 2013-002822-21. RESULTS We recruited 271 children between February 11, 2015 and April 20, 2018. Primary outcome data were available for 265 children. Only 61/265 children (23.0%) re-consulted due to clinical deterioration. No evidence of a treatment effect was observed for re-consultation due to clinical deterioration (co-amoxiclav 33/133 (24.8%), placebo 28/132 (21.2%), adjusted risk ratio [RR] 1.16, 95% confidence interval [CI] 0.75 to 1.80). There was also no evidence of a difference between groups in the proportion of children for whom one or more adverse events were reported (co-amoxiclav 32/136 (23.5%), placebo 22/135 (16.3%), adjusted RR 1.45, 95% CI 0.90 to 2.34). Sixty-six adverse events were reported in total (co-amoxiclav n=37, placebo n=29). Nine serious adverse events were reported per group; none were considered related to study medication. CONCLUSION Our trial did not find evidence that treatment with co-amoxiclav reduces risk of re-consultation due to clinical deterioration in "at risk" children who present early with ILI during influenza season. Our findings therefore do not support early co-amoxiclav use in children with seasonal ILI.
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Affiliation(s)
- Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.,Department of Respiratory Medicine, Alder Hey Children's Hospital, Eaton Road, Liverpool, L12 2AP, UK
| | - Michael Moore
- Academic Unit, Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sharon Tonner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Ushma Galal
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Jenna Grabey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Tricia Carver
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Jill Mollison
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Paul Little
- Academic Unit, Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care, Woodstock Road, Oxford, OX2 6GG, UK
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