Episodes Of Illness Research Articles

The impact of the number of previous illness episodes on early response to electroconvulsive therapy (ECT) in psychosis, mania, depression, psychotic depression, and catatonia: A naturalistic transdiagnostic analysis

Electroconvulsive Therapy (ECT) is an effective treatment for mood and psychotic disorders but there is growing evidence of treatment resistant to ECT. Our study aimed to investigate the relationship between the number of previous illness episodes and the symptomatic improvement after acute ECT treatment. We conducted a retrospective naturalistic cohort analysis of patients’ ECT registry data from March 2017 to February 2023. We categorized the number of previous illness episodes into “0–3″ and “>3 episodes”, paired T-tests were used to compare the changes in scores of clinical assessments, generalized linear models were used to analyze the association between the number of previous illness episodes and change in symptomatic scores. A total of 1137 patients were included for analysis. There was a significant global improvement in psychiatric symptoms (CGI) after 6 ECT treatments across five indications. We observed that compared to patients with less previous illness episodes, patients with more than 3 previous illness episodes had 30% lower chance of response to acute ECT treatment. Thus, our study suggests that use ECT earlier in the course of illness is associated with greater response and support offering ECT earlier in the disease course.

Effectiveness of BNT162b2 BA.4/5 bivalent mRNA vaccine against a range of COVID-19 outcomes in a large health system in the USA: a test-negative case–control study

XBB-related omicron sublineages have recently replaced BA.4/5 as the predominant omicron sublineages in the USA and other regions globally. Despite preliminary signs of immune evasion of XBB sublineages, few data exist describing the real-world effectiveness of bivalent COVID-19 vaccines, especially against XBB-related illness. We aimed to investigate the effectiveness of the Pfizer--BioNTech BNT162b2 BA.4/5 bivalent vaccine against both BA.4/5-related and XBB-related disease in adults aged 18 years or older. In this test-negative case-control study, we estimated the effectiveness of the BNT162b2 BA.4/5 bivalent vaccine using data from electronic health records of Kaiser Permanente Southern California health system members aged 18 years or older who received at least two doses of the wild-type COVID-19 mRNA vaccines. Participants sought care for acute respiratory infection between Aug 31, 2022, and April 15, 2023, and were tested for SARS-CoV-2 via PCR tests. Relative vaccine effectiveness (≥2 doses of wild-type mRNA vaccine plus a BNT162b2 BA.4/5 bivalent booster vs ≥2 doses of a wild-type mRNA vaccine alone) and absolute vaccine effectiveness (vs unvaccinated individuals) was estimated against critical illness related to acute respiratory infection (intensive care unit [ICU] admission, mechanical ventilation, or inpatient death), hospital admission, emergency department or urgent care visits, and in-person outpatient encounters with odds ratios from logistic regression models adjusted for demographic and clinical factors. We stratified vaccine effectiveness estimates for hospital admission, emergency department or urgent care visits, and outpatient encounters by omicron sublineage (ie, likely BA.4/5-related vs likely XBB-related), time since bivalent booster receipt, age group, number of wild-type doses received, and immunocompromised status. This study is registered with ClinicalTrials.gov (NCT04848584). Analyses were conducted for 123 419 encounters (24 246 COVID-19 cases and 99 173 test-negative controls), including 4131 episode of critical illness (a subset of hospital admissions), 14 529 hospital admissions, 63 566 emergency department or urgent care visits, and 45 324 outpatient visits. 20 555 infections were BA.4/5 related and 3691 were XBB related. In adjusted analyses, relative vaccine effectiveness for those who received the BNT162b2 BA.4/5 bivalent booster compared with those who received at least two doses of a wild-type mRNA vaccine alone was an additional 50% (95% CI 23-68) against critical illness, an additional 39% (28-49) against hospital admission, an additional 35% (30-40) against emergency department or urgent care visits, and an additional 28% (22-33) against outpatient encounters. Waning of the bivalent booster from 0-3 months to 4-7 months after vaccination was evident for outpatient outcomes but was not detected for critical illness, hospital admission, and emergency department or urgent care outcomes. The relative effectiveness of the BNT162b2 BA.4/5 bivalent booster for XBB-related infections compared with BA.4/5-related infections was 56% (95% CI 12-78) versus 40% (27-50) for hospital admission; 34% (21-45) versus 36% (30-41) against emergency department or urgent care visits; and 29% (19-38) versus 27% (20-33) for outpatient encounters. By mid-April, 2023, individuals previously vaccinated only with wild-type vaccines had little protection against COVID-19-including hospital admission. A BNT162b2 BA.4/5 bivalent booster restored protection against a range of COVID-19 outcomes, including against XBB-related sublineages, with the most substantial protection observed against hospital admission and critical illness. Pfizer.

COMPARISON OF OUTCOME OF ARTESUNATE WITH QUININE IN CEREBRAL MALARIA; EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN PESHAWAR

Malaria remains a tremendous health burden in tropical regions, causing up to 24.3 billion episodes of clinical illness and 0.86 million deaths in 2009, with annual death rates of up to 93% in severe malaria. This study aims to compare the outcome of artesunate with quinine in cerebral malaria. This Randomized Controlled Trial was conducted in the Department of Medicine, Lady Reading Hospital, Peshawar, from December 2021 to January 2023. This study was conducted on 102 patients with cerebral malaria aged 12 to 60 years of age of either gender. Patients were divided into two groups: group A received artesunate, while Group B received quinine for cerebral malaria. Outcome in terms of in-hospital mortality and mortality at follow-up was assessed between both groups. According to the in hospital treatment outcome, the mortality rate in group A (Artesunate) was 3 (5.9%) while 10 (19.6%) in group B (Quinine), the in hospital treatment outcome (mortality) was significantly lower in group A as compared to group B (P = 0.03). According to the outcome at follow-up, the mortality rate in group A was 4 (7.8%) while 12 (23.5%) in group B, the outcome (mortality) at follow-up was significantly lower in group A as compared to group B (P = 0.02). From our study, we conclude that the outcome in terms of in-hospital mortality was significantly lower in artesunate group as compared to quinine group (P = 0.03), and mortality at follow-up was also significantly lower in artesunate group as compared to quinine group (P = 0.02) in cerebral malaria.

Database derived from an electronic medical record-based surveillance network of US emergency department patients with acute respiratory illness

BackgroundFor surveillance of episodic illness, the emergency department (ED) represents one of the largest interfaces for generalizable data about segments of the US public experiencing a need for unscheduled care. This protocol manuscript describes the development and operation of a national network linking symptom, clinical, laboratory and disposition data that provides a public database dedicated to the surveillance of acute respiratory infections (ARIs) in EDs.MethodsThe Respiratory Virus Laboratory Emergency Department Network Surveillance (RESP-LENS) network includes 26 academic investigators, from 24 sites, with 91 hospitals, and the Centers for Disease Control and Prevention (CDC) to survey viral infections. All data originate from electronic medical records (EMRs) accessed by structured query language (SQL) coding. Each Tuesday, data are imported into the standard data form for ARI visits that occurred the prior week (termed the index file); outcomes at 30 days and ED volume are also recorded. Up to 325 data fields can be populated for each case. Data are transferred from sites into an encrypted Google Cloud Platform, then programmatically checked for compliance, parsed, and aggregated into a central database housed on a second cloud platform prior to transfer to CDC.ResultsAs of August, 2023, the network has reported data on over 870,000 ARI cases selected from approximately 5.2 million ED encounters. Post-contracting challenges to network execution have included local shifts in testing policies and platforms, delays in ICD-10 coding to detect ARI cases, and site-level personnel turnover. The network is addressing these challenges and is poised to begin streaming weekly data for dissemination.ConclusionsThe RESP-LENS network provides a weekly updated database that is a public health resource to survey the epidemiology, viral causes, and outcomes of ED patients with acute respiratory infections.

C-reactive protein point-of-care testing and complementary strategies to improve antibiotic stewardship in children with acute respiratory infections in primary care.

This paper provides the perspective of an international group of experts on the role of C-reactive protein (CRP) point-of-care testing (POCT) and complementary strategies such as enhanced communication skills training and delayed prescribing to improve antibiotic stewardship in the primary care of children presenting with an acute illness episode due to an acute respiratory tract infection (ARTI). To improve antibiotics prescribing decisions, CRP POCT should be considered to complement the clinical assessment of children (6 months to 14 years) presenting with an ARTI in a primary care setting. CRP POCT can help decide whether a serious infection can be ruled out, before deciding on further treatments or management, when clinical assessment is unconclusive. Based on the evidence currently available, a CRP value can be a valuable support for clinical reasoning and facilitate communication with patients and parents, but the clinical assessment should prevail when making a therapy or referral decision. Nearly half of children tested in the primary care setting can be expected to have a CRP value below 20 mg/l, in which case it is strongly suggested to avoid prescribing antibiotics when the clinical assessment supports ruling out a severe infection. For children with CRP values greater than or equal to 20 mg/l, additional measures such as additional diagnostic tests, observation time, re-assessment by a senior decision-maker, and specialty referrals, should be considered.

Exploring the influence of Marxist ideology on episodes of bi-directional affective illness among undergraduates

BackgroundThis study aims to address the issue of bi-directional affective disorders among college students, fostering their holistic development in terms of moral, intellectual, physical, and aesthetic aspects. By integrating Marxist theory with contemporary national education contexts, the research seeks to incorporate these principles into Civic Education within universities and reform existing teaching methodologies.Subjects and MethodsTwenty students exhibiting bi-directional affective disorders were randomly selected from ten different Chinese colleges and institutions. With 100 students in each group, a total of 200 participants were evenly divided into an experimental group and a control group. The control group received standard collegiate Civic Education, while the experimental group was exposed to a Civic Teaching Mode enriched with Marxist insights. The 6-month trial was followed by data collection and analysis employing a customized emotional disorder scale and SPSS 23.0 software.ResultsFollowing 6 months of instruction, students in the experimental group displayed a decrease in affective disorder scale scores from 9.56 ± 0.58 to 1.24 ± 0.37. Conversely, students in the control group exhibited scores dropping from 9.74 ± 0.62 to 7.89 ± 0.52.ConclusionsIn comparison to traditional Civic Education, the integration of Marxist principles and the contextual specifics of Chinese education effectively address the limitations of conventional instruction, so as to comprehensively improve the two-way emotional barriers of students.

Cost of acute respiratory illness episode and its determinants among community-dwelling older adults: a four-site cohort study from India

IntroductionAdvocacy for the provision of public health resources, including vaccine for the prevention of acute respiratory illnesses (ARIs) among older adults in India, needs evidence on costs and benefits. Using...

Risk factors of recurrent respiratory infections in early school-age children

Acute respiratory infections (ARIs) annually rank first in the structure of infectious diseases both in Ukraine and worldwide. ARIs are the leading cause of disability and death in preschool children, and with recurrent episodes, they can impact the physical and psychological aspects of children's health, imposing a significant medical burden on families, healthcare systems, and society as a whole. Preventing recurrent respiratory infections (RRIs) can only be achieved through timely intervention in risk factors.Aim: to determine the influence of risk factors on the development of recurrent episodes of acute respiratory infections in children aged 5 to 7 years and to develop preventive measures for their control in primary healthcare settings.Materials and Methods. The authors retrospectively analyzed medical records of 342 children aged 5 to 7 years. The main group included children with RRIs (264), and the control group consisted of children with sporadic illness episodes (78). Results: the incidence of RRIs in children has two peaks at ages 3 and 6, which is likely associated with the commencement of attendance in childcare settings (kindergarten and school). Key prenatal and postnatal, clinical-anamnestic, and social risk factors that increase the likelihood of recurrent respiratory infections in younger school-age children were identified.Conclusions. factors significantly increasing the likelihood of developing RRIs in a child include: ARI episode within the first 6 months of life (OR = 22, 95% CI 11.6 - 41.7), previous pneumonia (OR = 12, 95% CI 3.7 - 40), and the presence of chronic infection foci in the form of tonsillitis (OR = 8.2, 95% CI 4.3 - 15.6), p=0.0001. Primary healthcare practitioners should follow strategies to modify these risk factors and not wait for further depletion of the child's adaptive potential (sanitation of chronic infection foci, promotion of breastfeeding, and tobacco cessation).

Mental health considerations for athlete removal from play and return to play planning

Abstract: Introduction: Athletes experience the same mental health disorders as the general population. When mental health symptoms or disorders are experienced more acutely, there may be occasions when the treating team needs to decide if it is in the best interest of the athlete to be removed from the sport environment for treatment and recovery. If an athlete has been away from the sport environment due to mental health symptoms or disorders, the treating team should be deliberate and collaborative in guiding their return. Removal-from-play (RFP) and return-to-play (RTP) decisions involving an athlete who has experienced mental health challenges can be complex. Methods: The literature around athlete mental health was reviewed to explore contributing and mitigating factors to mental health challenges in this population. General psychiatric recovery trajectories for selected mental illnesses were reviewed to inform RTP planning through and beyond illness episodes. The literature related to RFP and RTP for athletes in terms of specific physical factors (concussion and musculoskeletal injury) and mental health factors (specifically, depression, anxiety, and eating disorders) was also reviewed. Results: A scoping overview of athlete- and sport-specific factors yielded a framework that can be used to guide athlete support, RFP and RTP planning through and beyond mental health-related sport interruption. Conclusion: When mental health symptoms and disorders are present, decisions guiding RFP and RTP should be guided by clinical assessment of safety, stability and function. Due to the complex nature of mental disorders and the interaction of sport elements, it is recommended that sports psychiatrists are involved in the assessment and management process.

"Ordinary days would be extraordinary": The lived experiences of severe and enduring anorexia nervosa.

Approximately 25% of individuals with anorexia nervosa (AN) experience a chronic form of the disorder, referred to as severe and enduring anorexia nervosa (SE-AN). Although the classification of SE-AN remains preliminary, there have been increasing calls for a harm reduction-based, collaborative treatment model for these patients. To provide such care for patients with SE-AN, it is critical to listen to and learn from their lived experiences. Patients (N = 17) admitted to an inpatient eating disorders program who met initial criteria for SE-AN completed semi-structured interviews about the course of their illness and prior treatment episodes. Interviews were audio recorded and transcribed. Data were analyzed using an inductive, reflexive approach to thematic analysis that examined common themes within and across interviews. Three themes were identified focused on (1) the all-encompassing nature of SE-AN, (2) treatment experiences, and (3) living with chronic illness. Within these themes, there were subthemes. Overall, individuals noted clear insight about their condition, both negative and positive experiences with previous treatment, and hope for better quality of life despite their illness. Individuals with SE-AN describe their illness as a chronic condition and hope for a harm reduction-based treatment. Future work, including the lived experiences of individuals with SE-AN, is important to build our understanding of the classification and clinical characteristics of SE-AN and to develop treatment approaches that may best serve these individuals. Many people with anorexia nervosa do not achieve a full recovery despite repeated treatment episodes throughout their lifespan. Understanding the lived experiences of individuals with SE-AN may help to inform future treatment development efforts that could improve eating disorder and quality of life outcomes for these patients.

320 AKI-ng for better adherence: a quality improvement initiative on the medication ‘sick day rule’ in patients over 65 with acute kidney injury (AKI)

Abstract Background The successful mitigation of Acute Kidney Injury (AKI) among older patients is contingent on meticulous medication management, specifically adherence to the medication ‘sick day rule’. These rules, recommended by the National Institute for Health and Care Excellence (NICE) in their guidelines ‘Acute kidney injury: prevention, detection and management’, involves the temporary cessation of certain medications during episodes of acute illness. However, suboptimal adherence to this rule presents a considerable challenge in clinical practice. This quality improvement project aimed to address this issue, seeking to enhance adherence to the sick day rule among patients over the age of 65 admitted with AKI. Methods Initially we performed a medication reconciliation on all patients admitted to the medical take over a five-day period. Our intervention involved the distribution of information cards that clearly detailed the NICE guidelines. The cards were displayed prominently in key medical admission areas and could attach to doctors’ identification badges. We also provided education to Non-Consultant Hospital Doctors at Grand Rounds. Results Data collected revealed that of the 92 patients over 65 admitted, 27 met the AKI criteria. 23 of these 27 AKI patients were on medications that could exacerbate their AKI, while only 6 had all appropriate medications held. This trend extended to specific medication categories: only 8/19 patients on ACE inhibitors/ARBs, 1/5 on SGLT2 inhibitors, and 4/9 on metformin had their medication held. However, both patients on NSAIDs had their medication held, indicating a better adherence rate. Conclusion The goal of this quality improvement initiative is to bolster adherence to the medication sick day rule, thereby potentially reducing the incidence and severity of AKI in our older patient population. We plan to reaudit in the coming weeks to assess the impact of our intervention, affirming our ongoing commitment to improving patient outcomes through evidence-based quality improvement strategies.

Diurnal temperature variation and the implications for diagnosis and infectious disease screening: a population-based study.

Fevers have been used as a marker of disease for hundreds of years and are frequently used for disease screening. However, body temperature varies over the course of a day and across individual characteristics; such variation may limit the detection of febrile episodes complicating the diagnostic process. Our objective was to describe individual variation in diurnal temperature patterns during episodes of febrile activity using millions of recorded temperatures and evaluate the probability of recording a fever by sex and for different age groups. We use timestamped deidentified temperature readings from thermometers across the US to construct illness episodes where continuous periods of activity in a single user included a febrile reading. We model the mean temperature recorded and probability of registering a fever across the course of a day using sinusoidal regression models while accounting for user age and sex. We then estimate the probability of recording a fever by time of day for children, working-age adults, and older adults. We find wide variation in body temperatures over the course of a day and across individual characteristics. Thediurnal temperature pattern differed between men and women, and average temperatures declined forolder age groups. The likelihood of detecting a fever varied widely by the time of day and by an individual's age or sex. Time of day and demographics should be considered when using body temperatures for diagnostic or screening purposes. Our results demonstrate the importance of follow-up thermometry readings if infectious diseases are suspected.

Prophylactic Management of Women With Bipolar Disorder During Pregnancy and the Perinatal Period: Clinical Scenario-Based Practical Recommendations From A Group of Perinatal Psychiatry Authors.

Many women with bipolar disorder experience episodes of illness or relapses over the perinatal period, especially in the immediate postpartum period. Risks associated with treated/untreated psychopathologies and fetal exposure to bipolar medications make the management of bipolar disorder during these periods challenging for clinicians and patients. In light of the available effectiveness and reproductive safety data, the current clinical update based on the opinions of a group of international perinatal psychiatry authors recommends general considerations and specific management strategies for each possible clinical scenario, including mixed features, predominant polarity, diagnosis of subtypes of bipolar disorder, severity of previous episodes, and risk of recurrence of mood episodes.

Lithium treatment versus hospitalization in bipolar disorder and major depression patients

BackgroundPreventing hospitalization of major affective disorder patients is a fundamental clinical challenge for which lithium is expected to be helpful. MethodsWe compared hospitalization rates and morbidity of 260 patients with DSM-5 bipolar or major depressive disorder in the 12 months before starting lithium versus 12 months of its use. We evaluated duration of untreated illness, previous treatments, substance abuse, suicidal status, lithium dose, and use of other medicines for association with new episodes of illness or of symptomatic worsening as well as hospitalization, using bivariate and multivariate analyses. ResultsWithin 12 months before lithium, 40.4 % of patients were hospitalized versus 11.2 % during lithium treatment; other measures of morbidity also improved. Benefits were similar with bipolar and major depressive disorders. Independently associated with hospitalization during lithium treatment were: receiving an antipsychotic with lithium, suicide attempt during lithium treatment, lifetime substance abuse, and psychiatric hospitalization in the year before starting lithium, but not diagnosis. LimitationsParticipants and observation times were limited. The study was retrospective regarding clinical history, lacked strict control of treatments and was not blinded. ConclusionsThis naturalistic study adds support to the effectiveness of lithium treatment in preventing hospitalization in patients with episodic major mood disorders.

Parental health-seeking behavior on self-medication, antibiotic use, and antimicrobial resistance in children

Aim and ObjectivesThe study sought to identify parental trends in children's self-medication, health-seeking behavior, knowledge of self-medication, antibiotic use, and antimicrobial resistance in Asir, Saudi Arabia. MethodsA web-based cross-sectional study was carried out by a survey questionnaire. Snow Ball sampling technique was used to select the Eight hundred and sixteen parents with children in the Asir region by WhatsApp and email, and 650 participants who met the inclusion criteria consented to participate in the study. ResultsThere were 1809 episodes of childhood illnesses reported during the study period. The mean scores are on knowledge at 8.11 ± 2.43, favorable attitude at 17.60 ± 1.17, and practice was 7.72 ± 1.72, and a significant correlation was found between knowledge, attitude, and practice (KAP) at p = 0.01. Out of 624, the majority of parents showed strong knowledge and proficiency in antibiotics. However, the attitude scores of over 50% towards the usage of antibiotics were subpar. Around 54% of parents were self-medicating their children and 43% were unaware that skipping doses contributes to anti-microbial resistance (AMR). The facilitators for self-medication were male gender (aOR: 2.13; 95% CI: 1.26–3.98,p < 0.05), having more children (aOR: 2.78; 95% CI: 1.27–4.12p < 0.01), professional qualification (aOR:3.07; 95% CI 1.57– 4.68; p < 0.01), residing in urban area (aOR: 3.17; 95% CI: 2.13–5.61,p < 0.05), working in health care (aOR: 5.99; 95% CI: 1.78–18.2,p < 0.01) and high income (aOR: 3.57; 95% CI: 2.08–6.34,p < 0.05). ConclusionsThe findings indicated that the majority of parents had unfavorable views and improper practices of antibiotic usage. Strategic education programs to the targeted population, especially to the parents about side effects of antibiotics, dangerous consequences of self-medication, and crucial AMR concerns must be addressed immediately.

A contemporary ontology of continuity in general practice: Capturing its multiple essences in a digital age

Continuity is a long-established and fiercely-defended value in primary care. Traditional continuity, based on a one-to-one doctor-patient relationship, has declined in recent years. Contemporary general practice is organisationally and technically complex, with multiple staff roles and technologies supporting patient access (e.g. electronic and telephone triage) and clinical encounters (e.g. telephone, video and electronic consultations). Re-evaluation of continuity's relational, organisational, socio-technical and professional characteristics is therefore timely. We developed theory in parallel with collecting and analysing data from case studies of 11 UK general practices followed from 2021 to 2023 as they introduced (or chose not to introduce) remote and digital services. We used strategic, immersive ethnography, interviews, and material analysis of technologies (e.g. digital walk-throughs).Continuity was almost universally valued but differently defined across practices. It was invariably situated and effortful, influenced by the locality, organisation, technical infrastructure, wider system and the values and ways of working of participating actors, and often requiring articulation and ‘tinkering’ by staff. Remote and digital modalities provided opportunities for extending continuity across time and space and for achieving—to a greater or lesser extent—continuity of digital records and shared understandings of a patient and illness episode across the clinical team. Delivering continuity for the most vulnerable patients was sometimes labour-intensive and required one-off adaptations.Building on earlier work by Haggerty et al. we propose a novel ontology of four analytically distinct but empirically overlapping kinds of continuity—of the therapeutic relationship (based on psychodynamic and narrative paradigms), of the illness episode (biomedical-interpretive paradigm), of distributed work (sociotechnical paradigm), and of the practice's commitment to a community (political economy and ethics of care paradigm). This ontology allowed us to theorise and critique successes (continuity achieved) and failures (breaches of continuity and fragmentation of care) in our dataset.

Beyond the “Comforts” of work from home: Child health and the female wage penalty

Using data on American women and the health status of their children, this paper provides estimates of the effect of remote work on female wages. A temporary child health shock, which does not affect a woman's labor market outcomes beyond inducing her to work at home, is used as an instrument. Instrumental variable estimates indicate a substantial wage penalty that is more likely attributed to women's choices or assignments of less promotable job tasks when working from home. The findings are valuable in assessing the costs associated with remote flexibility, especially when children are required to stay at home during episodes of illness.

The family doctor: health, kin testing and primary care in Patna, India

Private primary care providers are usually the first site where afflictions come under institutional view. In the context of poverty, the relationship between illness and care is more complex than a simple division of responsibilities between various actors—with care given by kin, and diagnosis and treatment being the purview of providers. Since patients would often visit the provider with family members, providers are attuned to the patients’ web of kinship. Providers would take patients’ kinship arrangements into account when prescribing diagnostic tests and treatments. This paper terms this aspect of the clinical encounter as ‘kin testing’ to refer to situations/clinical encounters when providers take into consideration that care provided by kin was conditional. ‘Kin testing’ allowed providers to manage the episode of illness that had brought the patient to the clinic by relying on clinical judgment rather than confirmed laboratory tests. Furthermore, since complaints of poor health also were an idiom to communicate kin neglect, providers had to also discern how to negotiate diagnoses and treatments. Kinship determined whether the afflicted bodies brought to the clinics were diagnosed, whether medicines reached the body, and adherence maintained. The providers’ actions make visible the difference that kinship made in how health is imagined in the clinic and in standardized protocols. Focusing on primary care clinics in Patna, India, we contribute to research that shows that kinship determines care and management of illnesses at home by showing that relatedness of patients gets folded in the clinic by providers as well.

Novel Connections of Common Childhood Illnesses Based on More Than 5 Million Diary Registrations From Birth Until Age 3 Years.

All children experience numerous episodes of illness during the first 3 years of life. Most episodes are mild and handled without medical attention but nevertheless burden the families and society. There is a large, and still unexplained, variation in the burden of illness between children. To describe and provide a better understanding of the disease burden of common childhood diseases through a data-driven approach investigating the communalities between symptom patterns and predefined variables on predispositions, pregnancy, birth, environment, and child development. The study is based on the prospectively followed clinical mother-child cohort COpenhagen Prospective Studies on Asthma in Childhood, which includes 700 children with daily symptom registration in the first 3 years of life, including symptoms of cough, breathlessness, wheeze, cold, pneumonia, sore throat, ear infections, gastrointestinal infections, fever, and eczema. First, we described the number of episodes of symptoms. Next, factor analysis models were used to describe the variation in symptom load in the second year of life (both based on n= 556, with >90% complete diary). Then we characterized patterns of similarity between symptoms using a graphical network model (based on n= 403, with a 3-year monthly compliance of >50%). Finally, predispositions and pregnancy, birth, environmental, and developmental factors were added to the network model. The children experienced a median of 17 (interquartile range, 12-23) episodes of symptoms during the first 3 years of life, of which most were respiratory tract infections (median, 13; interquartile range, 9-18). The frequency of symptoms was the highest during the second year of life. Eczema symptoms were unrelated to the other symptoms. The strongest association to respiratory symptoms was found for maternal asthma, maternal smoking during the third trimester, prematurity, and CDHR3 genotype. This was in contrast to the lack of associations for the well-established asthma locus at 17q21. Healthy young children are burdened by multiple episodes of symptoms during the first 3 years of life. Prematurity, maternal asthma, and CDHR3 genotype were among the strongest drivers of symptom burden.

Effect of Probiotics on Common Cold, Influenza, and Influenza-Like Illness

The possible effect of probiotics consumption on the symptoms and courses of the common cold, influenza, and influenza-like illness was evaluated via a meta-analysis. Probiotic consumption reduced the incidence of the common cold (odds ratio [OR] = 0.50, 95% confidence interval [CI]: 0.38-0.64, P &lt; .001) and influenza-like illness episodes (OR = 0.24, 95% CI: 0.14-0.40, P &lt; .001) but had no significant effect on decreasing the influenza episodes (OR = 0.91, 95% CI: 0.62-1.35, P = .831). Probiotic supplementation showed a promising beneficial role in the reduction of the episodes and symptoms of the common cold and influenza-like illness.