Influenza vaccination for immunocompromised patients: systematic review and meta-analysis from a public health policy perspective.

Immunocompromised patients are vulnerable to severe or complicated influenza infection. Vaccination is widely recommended for this group. This systematic review and meta-analysis assesses influenza vaccination for immunocompromised patients in terms of preventing influenza-like illness and laboratory confirmed influenza, serological response and adverse events

Exclusive breastfeeding duration and determinants among Brazilian children under two years of age

OBJECTIVE: The present study described the duration and identified the determinants of exclusive breastfeeding. METHODS: The study used data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher 2006 (National Demographic and Health Survey on Women and Children 2006). Data were collected using questionnaires administered by trained professionals and refer to a subsample of 1,704 children aged less than 24 months. The estimated durations of exclusive breastfeeding are presented according to socioeconomic, demographic and epidemiological variables. Kaplan Meier estimator curves were used to produce valid estimates of breastfeeding duration and the Cox's proportional hazards model was fitted to identify risks. RESULTS: The median estimated duration of exclusive breastfeeding was 60 days. The final Cox model consisted of mother's age <20 years (hazard ratio=1.53, 95% confidence interval=1.11-1.48), use of pacifier (hazard ratio=1.53, 95% confidence interval=1.37-1.71), not residing in the country's southeast region (hazard ratio=1.22, 95% confidence interval=1.07-1.40) and socioeconomic status (hazard ratio=1.28, 95% confidence interval=1.06-1.55). CONCLUSION: The Kaplan Meier estimator corrected the underestimated duration of breastfeeding in the country when calculated by the current status methodology. Despite the national efforts done in the last decades to promote breastfeeding, the results indicate that the duration of exclusive breastfeeding is still half of that recommended for this dietary practice to promote health. Ways to revert this situation would be ongoing educational activities involving the educational and health systems, associated with advertising campaigns on television and radio mainly targeting young mothers with low education level and low income, identified as those at high risk of weaning their children early.OBJETIVO: Descrever a duração e identificar determinantes do aleitamento materno exclusivo. MÉTODOS: Foram utilizados dados da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher 2006. As informações foram obtidas por meio de questionários aplicados por pesquisadores treinados e referem-se à sub-amostra de 1.704 crianças com idade inferior a 24 meses. As estimativas do tempo de aleitamento materno exclusivo são apresentadas segundo variáveis socioeconômicas, demográficas e epidemiológicas. Visando produzir estimativas válidas do tempo de aleitamento materno, foram aplicadas curvas do estimador de Kaplan Meier; para identificação dos riscos, foi ajustado um modelo de razão de riscos de Cox. RESULTADOS: A mediana do tempo de aleitamento materno exclusivo foi estimada em 60 dias. Compuseram o modelo final de Cox: idade da mãe <20 anos (razão de riscos=1,53, intervalo de confiança 95%=1,11-1,48), uso de chupeta (razão de riscos=1,53, intervalo de confiança 95%=1,37-1,71), não residir na Região Sudeste (razão de riscos=1,22, intervalo de confiança 95%=1,07-1,40) e situação socioeconômica (razão de riscos=1,28, intervalo de confiança 95%=1,06-1,55). CONCLUSÃO: A utilização do estimador de Kaplan Meier resultou na correção da subestimativa do tempo de aleitamento materno no País quando calculado a partir da metodologia do current status. Os resultados indicam que, apesar dos esforços empreendidos nas últimas décadas para promover o aleitamento no País, o tempo de aleitamento materno exclusivo é ainda metade do recomendado para realização do potencial dessa prática alimentar na promoção da saúde. Um modo de reverter tal situação seria a utilização de atividades continuadas de educação que envolvessem os sistemas de ensino e de saúde e que estivessem associadas à campanhas publicitárias veiculadas na rede de televisão e rádio, dirigidas prioritariamente a mães jovens, com pouca escolaridade, e de baixa renda, identificadas como as de risco aumentado para o desmame precoce.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de NutrologiaUniversidade Federal de Juiz de Fora Faculdade de MedicinaUNIFESP, EPM, Depto. de NutrologiaSciEL

Influenza vaccination for immunocompromised patients: summary of a systematic review and meta-analysis

Vaccination of immunocompromised patients is recommended in many national guidelines to protect against severe or complicated influenza infection. However, due to uncertainties over the evidence base, implementation is frequently patchy and dependent on individual clinical discretion. We conducted a systematic review and meta‐analysis to assess the evidence for influenza vaccination in this patient group. Healthcare databases and grey literature were searched and screened for eligibility. Data extraction and assessments of risk of bias were undertaken in duplicate, and results were synthesised narratively and using meta‐analysis where possible. Our data show that whilst the serological response following vaccination of immunocompromised patients is less vigorous than in healthy controls, clinical protection is still meaningful, with only mild variation in adverse events between aetiological groups. Although we encountered significant clinical and statistical heterogeneity in many of our meta‐analyses, we advocate that immunocompromised patients should be targeted for influenza vaccination

In-Hospital Formula Use Increases Early Breastfeeding Cessation Among First-Time Mothers Intending to Exclusively Breastfeed

OBJECTIVE: To evaluate in-hospital formula supplementation among first time mothers who intended to exclusively breastfeed and determined if in-hospital formula supplementation shortens breastfeeding duration after adjusting for breastfeeding intention. STUDY DESIGN: We assessed strength of breastfeeding intentions prenatally in a diverse cohort of expectant primiparae and followed infant feeding practices through day 60. Among mothers planning to exclusively breastfed their healthy term infants for ≥1 week, we determined predictors, reasons, and characteristics of in-hospital formula supplementation; and calculated the intention-adjusted relative risk (ARR) of not fully breastfeeding days 30–60 and breastfeeding cessation by day 60 with in-hospital formula supplementation (n=393). RESULTS: 210 (53%) infants exclusively breastfed during the maternity stay and 183 (47%) received in-hospital formula supplementation. The most prevalent reasons mothers cited for inhospital formula supplementation were: perceived insufficient milk supply (18%), signs of inadequate intake (16%), and poor latch or breastfeeding (14%). Prevalence of not fully breastfeeding days 30–60 was 67.8% vs 36.7%, ARR 1.8 [95% CI, 1.4–2.3], in-hospital formula supplementation vs exclusively breastfed groups respectively, and breastfeeding cessation by day 60 was 32.8% vs 10.5%, ARR 2.7 [95% CI,1.7–4.5]. Odds of both adverse outcomes increased with more in-hospital formula supplementation feeds (not fully breastfeeding days 30–60, P=.003 and breastfeeding cessation, P=.011). CONCLUSIONS: Among women intending exclusively breastfed, in-hospital formula supplementation was associated with nearly 2-fold greater risk of not fully breastfeeding days 30–60 and nearly 3-fold risk of breastfeeding cessation by day 60, even after adjusting for strength of breastfeeding intentions. Strategies should be sought to avoid unnecessary in-hospital formula supplementation and to support breastfeeding when in-hospital formula supplementation is unavoidable