Holbrookbirk4900

6% (n = 199) with bacteremia, and 0.3% (n = 11) with bacterial meningitis. There were 7 patients (0.2%) with neonatal HSV and 9 (0.3%) with pneumonia; 0.2% (n = 6) died. The presence of a complex chronic condition was associated with the presence of serious bacterial infection (P less then .001) and was present in 3 of 6 patients who died. In a sensitivity analysis including patients with any diagnosis code of hypothermia (n = 8122), 14.9% had serious bacterial infection, 0.6% had HSV, and 3.3% had pneumonia; 2.0% died. Conclusions Of infants with hypothermia ≤90 days of age, 8.3% had serious bacterial infections or HSV. Compared with literature from febrile infants, hypothermia is associated with a high mortality rate. Complex chronic conditions were particularly associated with poor outcomes. see more Additional research is required to risk stratify young infants with hypothermia.Objective To evaluate the effect of different modalities of centralized reminder/recall (autodialer, text, mailed reminders) on increasing childhood influenza vaccination. Study design Two simultaneous randomized clinical trials conducted from October 2017 to April 1, 2018, in New York State and Colorado. There were 61 931 children in New York (136 practices) and 23 845 children in Colorado (42 practices) who were randomized to different centralized reminder/recall modalities-4 arms in New York (autodialer, text, mailed, and no reminder control) and 3 arms in Colorado (autodialer, mailed, and no reminder control). The message content was similar across modalities. Up to 3 reminders were sent for intervention arms. The main outcome measure was receipt of ≥1 influenza vaccine. Results In New York, compared with the control arm (26.6%), postintervention influenza vaccination rates in the autodialer arm (28.0%) were 1.4 percentage points higher (adjusted risk ratio, 1.06; 95% CI, 1.02-1.10), but the rates for text (27.6%) and mail (26.8%) arms were not different from controls. In Colorado, compared with the control arm (29.9%), postintervention influenza vaccination rates for the autodialer (32.9%) and mail (31.5%) arms were 3.0 percentage points (adjusted risk ratio, 1.08; 95% CI, 1.03-1.12) and 1.6 percentage points (adjusted risk ratio, 1.06; 95% CI, 1.02-1.10) higher, respectively. Compared with the control arm, the incremental cost per additional vaccine delivered was $20 (New York) and $16 (Colorado) for autodialer messages. Conclusions Centralized reminder/recall for childhood influenza vaccine was most effective via autodialer, less effective via mail, and not effective via text messages. The impact of each modality was modest. Compared with no reminders, the incremental cost per additional vaccine delivered was also modest for autodialer messages. Trial registration ClinicalTrials.gov NCT03294473 and NCT03246100.Objective To assess the prevalence of functional gastrointestinal disorders (FGIDs) in young children in a cross-sectional, multicenter study in Belgium, Italy, and The Netherlands. Study design Children were enrolled if they were age 0-48 months, attending a general pediatrician (Belgium, Italy) or a well-baby clinic (The Netherlands) for routine follow-up. Separate questionnaires were developed for infants age 0-12 months and for toddlers age 13-48 months. Questionnaires evaluated the clinical history, symptoms, sociodemographic information on the family, and exposure to stressful life events. FGIDs were defined according to Rome IV criteria. Results In total 2751 children were included 1698 infants age 0-12 months and 1053 children age 13-48 months. The prevalence of any FGID in infants age 0-12 months and 13-48 months was 24.7% and 11.3%, respectively. The most common disorders were infant regurgitation (13.8%) in infants and functional constipation (9.6%) in toddlers. Multivariable regression analyses demonstrated that younger age (P = .030) and formula feeding (P = .045) were associated with the prevalence of any FGID among infants. Country (Italy) (P = .033) and parents subjected to domestic violence (P = .035) were associated with the prevalence of any FGID in toddlers age 13-48 months. Conclusions FGIDs are common in a community sample of Western European infants and toddlers. Regurgitation is most prevalent in infants and functional constipation is most common in toddlers. Younger age, formula feeding, and domestic violence to parents are associated with the prevalence of FGIDs.Nitrogen pollution is a serious environmental issue in the Danjiangkou Reservoir region (DRR), the water source of the South-to-North Water Diversion Project of China. In this research, seasonal surveys and a bi-weekly time series survey were conducted in the Qihe River Basin, one of the most densely populated agricultural basins in the DRR. Hydrochemical compositions (NO3- and Cl-), dual isotopes (δD-H2O, δ18O-H2O, δ15N-NO3-, and δ18O-NO3-), and a Markov Chain Monte Carlo isotope mixing model were jointly applied to unravel the sources, migrations, and transformations of the nitrate (NO3-) in the basin. It was revealed that the mixing between different sources was the main process controlling the isotopic compositions of the riverine NO3- in the upper-middle reaches. In contrast, denitrification occurred in the lower reaches. For the first time, the sources of NO3- were quantified at a basin scale in the DRR. Overall, the river transported 484.2 tons/year of NO3-N to the reservoir, of which 32.6%, 36.4%, 28.0%, and 3.0% was from soil organic nitrogen, chemical fertilizer, residential sewage and atmospheric precipitation, respectively. The NO3-N fluxes of the different sources were regulated by the monsoon climate and anthropogenic activities. For example, high precipitation and intense fertilization resulted in severe nonpoint source pollution. Denitrification thrived in soils and reservoirs in wet seasons. Temperature could regulate the migration, nitrification and denitrification processes. Based on the results, we suggest that the management strategies dealing with nitrogen pollution issue in the DRR should follow the specific spatiotemporal characteristics of NO3- sources, migration and transformation mechanisms.