The Impact of Vitamin D Levels on Clinical Manifestations of Multisystem Inflammatory Syndrome in Children: A Cross-Sectional Study.

BACKGROUND: Hyperinflammatory response that resembles Kawasaki disease may develop in children after COVID-19 disease, and it is called multisystem inflammatory syndrome in children. The cause of MIS-C is dysregulated innate immune response and a subsequent cytokine storm that results in endothelial damage. It has been determined that low levels of serum 25(OH)D increase the risk of developing immune-related diseases and disorders. METHODS: To determine the incidence of hypovitaminosis D, and a possible correlation between 25(OH)D levels and the clinical severity of MIS-C, 21 patients hospitalized in the University Hospital of Split due to MIS-C were evaluated. RESULTS: Hypovitaminosis D was detected in 95% of MIS-C patients. We found a significant relationship between the severity of MIS-C and 25(OH)D levels, as patients with more severe MIS-C had lower 25(OH)D. MIS-C patients with lower vitamin D levels had worse systolic and diastolic function of the left ventricle according to echocardiograms. There was no relationship between 25(OH)D levels and the tested laboratory inflammatory and cardiac markers. CONCLUSION: Hypovitaminosis D is very common in children with MIS-C and influences the severity of the disease. VD could be a new potential biomarker in MIS-C, and VD replacement therapy should be considered early on in the treatment of MIS-C.

Changes following the Onset of the COVID-19 Pandemic in the Burden of Hospitalization for Respiratory Syncytial Virus Acute Lower Respiratory Infection in Children under Two Years: A Retrospective Study from Croatia.

To understand the changes in RSV hospitalization burden in children younger than two years following the onset of the COVID-19 pandemic, we reviewed hospital records of children with acute lower respiratory infection (ALRI) between January 2018 and June 2022 in Split-Dalmatia County, Croatia. We compared RSV activity, age-specific annualized hospitalization rate, and disease severity between pre-COVID-19 and COVID-19 periods. A total of 942 ALRI hospital admissions were included. RSV activity remained low for the typical RSV epidemic during 2020-2021 winter. An out-of-season RSV resurgence was observed in late spring and summer of 2021. Before the COVID-19 pandemic, the annualized hospitalization rate for RSV-associated ALRI was 13.84/1000 (95% CI: 12.11-15.76) and highest among infants under six months. After the resurgence of RSV in the second half of 2021, the annualized hospitalization rate for RSV-associated ALRI in children younger than two years returned to the pre-pandemic levels with similar age distribution but a statistically higher proportion of severe cases. RSV immunization programs targeting protection of infants under six months of age are expected to remain impactful, although the optimal timing of administration would depend on RSV seasonality that has not yet been established in the study setting since the onset of the COVID-19 pandemic.

The role of birth month in the burden of hospitalisations for acute lower respiratory infections due to respiratory syncytial virus in young children in Croatia.

BACKGROUND: Birth month was an important risk factor for respiratory syncytial virus (RSV) hospitalisation in infants. However, little is known about the role of birth month in RSV hospitalisation in finer age bands during infancy, which is relevant to strategies for RSV passive immunisations for infants. We aimed to understand the role of birth month in the burden of RSV-associated acute lower respiratory infection (ALRI) hospitalisation in finer age bands of the first year of life. METHODS: In this retrospective study, we analysed the hospitalisation records during 2014-19 at the University Hospital of Split, Split-Dalmatia County, Croatia. We estimated all-cause and RSV associated ALRI hospitalisation rates among children under five years, with a focus on infants by finer age band and birth month. RESULTS: We included 1897 ALRI hospitalisations during the study period. Overall in children under five years, annual hospitalisation rate was 14.66/1000 (95% CI: 14.01-15.34) for all-cause ALRI, and was 7.56/1000 (95% CI: 6.83-8.34) for RSV-ALRI. RSV-ALRI hospitalisation rate was highest in infants aged 28 days-<3 months (61.15/1000, 95% CI: 52.91-70.31). Infants born in November, December and January (2-3 months before RSV peak) had the highest hospitalisation rates during infancy. Depending on the birth month of infants, the risk of RSV-ALRI hospitalisation peaked at different months of age; infants who were born in September had the highest RSV-ALRI hospitalisation rate at the age of 3-<6 months. CONCLUSIONS: Our study underlines the importance of birth month in planning RSV immunisation strategies for infants, and provides useful baseline data for effectiveness analysis of novel RSV prophylactic products.

Framing the numerical findings of Cochrane plain language summaries: two randomized controlled trials.

BACKGROUND: Cochrane systematic review Plain language Summaries (CSR PLSs should serve as a tool for the evidence translation to non-medical population. However, the evidence of optimal type of numerical presentation in CSR PLSs is still scarce. The aim of this study was to investigate readers' comprehension and preferences for different presentation of findings, including framing and numerical data, in Cochrane systematic review Plain Language Summaries (CSR PLSs). METHODS: We conducted a parallel randomized trial and a crossover randomized trial at the School of Medicine and family practice offices in Split, Croatia. The participants were students and consumers. We assessed possible differences in comprehension, measured by four questions on PLS content, of CSR PLSs depending on the positive or negative framing of results (n = 91) (Trial 1) or using percentages or frequencies for the presentation of results (n = 245) (Trial 2). The outcome measures were comprehension of PLS content, perceived effectiveness of the treatment and readiness to use the treatment (all on 1-10 scales). RESULTS: In Trial 1 we found no difference in readers' perception of the effectiveness of the described treatment, desire that the treatment be offered by their family doctor, readiness to use the treatment, or comprehension when CSR PLS results were presented positively or negatively. In Trial 2 we found no difference in CSR PLS comprehension when results were presented as natural frequencies or percentages (BF10 = 0.62, Bayesian t-test for independent samples). CONCLUSIONS: Numerical presentation and framing direction of results appear to have no significant impact on understanding of messages in CSR PLSs. TRIAL REGISTRATION: The trials were registered in ClinicalTrials.gov. Protocol registration numbers: Trial 1: NCT03442387; Trial 2: NCT03554252.

Comparison of blogshots with plain language summaries of Cochrane systematic reviews: a qualitative study and randomized trial.

BACKGROUND: Cochrane, an organization dedicated to the production and dissemination of high-quality evidence on health, endeavors to reach consumers by developing appropriate summary formats of its systematic reviews. However, the optimal type of presentation of evidence to consumers is still unknown. OBJECTIVE: The aim of this study was to investigate consumer preferences for different summary formats of Cochrane systematic reviews (CSRs), using both qualitative and quantitative approaches. METHODS: Initially, we conducted three focus groups with medical students (n = 7), doctors (n = 4), and patients (n = 9) in 2017 to explore their health information search habits and preferences for CSR summary formats. Based on those findings, we conducted a randomized trial with medical students at the University of Split School of Medicine, Croatia, and with patients from three Dalmatian family practices to determine whether they prefer CSR blogshots (n = 115) or CSR plain language summaries (PLSs; n = 123). RESULTS: Participants in the focus groups favored brief and explicit CSR summary formats with fewer numbers. Although we found no difference in participants' preferences for a specific summary format in the overall sample, subgroup analysis showed that patients preferred blogshots over PLSs in comparison to medical students (P = 0.003, eta squared effect size η2 = 0.04). CONCLUSION: CSR summaries should be produced in a format that meets the expectations and needs of consumers. Use of blogshots as a summary format could enhance the dissemination of CSRs among patients. TRIAL REGISTRATION: The trial was registered in ClinicalTrials.gov, NCT03542201. Registered on May 31st 2018.