BACKGROUND AND OBJECTIVES: Despite numerous studies reporting an elevated risk of infant mortality among women who are obese, the magnitude of the association is unclear. A systematic review and metaanalysis was undertaken to assess the association between maternal overweight or obesity and infant mortality.METHODS: Four health care databases and gray literature sources were searched and screened against the protocol eligibility criteria. Observational studies reporting on the relationship between maternal overweight and obesity and infant mortality were included. Data extraction and risk of bias assessments were performed.RESULTS: Twenty-four records were included from 783 screened. Obese mothers (BMI $30) had greater odds of having an infant death (odds ratio 1.42; 95% confidence interval, 1.24-1.63; P , .001; 11 studies); these odds were greatest for the most obese (BMI .35) (odds ratio 2.03; 95% confidence interval, 1.61-2.56; P , .001; 3 studies). CONCLUSIONS:Our results suggest that the odds of having an infant death are greater for obese mothers and that this risk may increase with greater maternal BMI or weight; however, residual confounding may explain these findings. Given the rising prevalence of maternal obesity, additional high-quality epidemiologic studies to elucidate the actual influence of elevated maternal mass or weight on infant mortality are needed. If a causal link is determined and the biological basis explained, public health strategies to address the issue of maternal obesity will be needed. Mr Meehan developed the protocol, executed the search strategy, screened all records, assessed risk of bias, extracted data, carried out the data analysis, interpreted results, and prepared the manuscript draft; Dr Beck advised on study methods and analysis, extracted data, assessed methodological quality, and reviewed and revised the manuscript; Mr Mair-Jenkins extracted data, assessed methodological quality, and reviewed and revised the manuscript; Dr Leonardi-Bee advised on study methods and analysis, provided arbitration, critically appraised the analysis, and reviewed and revised the manuscript; Dr Puleston supervised the study, screened all records for eligibility, extracted data and prepared, and reviewed and revised the manuscript; and all authors approved the manuscript for submission.The protocol is registered at the National Institute for Health Research international prospective register of systematic reviews (identifier CRD42012002171). Overweight and obesity are increasing in women of childbearing age and during pregnancy. 2 The prevalence of maternal obesity ranges from 1.8% to 25.3% across different countries. 3 A recent study from the United States showed an increase in the prevalence of obesity during pregnancy from 13.0% in 1993 to 22.0% in 2003. 4 Obese pregnant women are likely to be older, have higher parity, and live in areas of higher deprivation than nonobese women. 3 Although global infant mortality rates have declined from 61 to 40 deaths per 1000 live births betw...

BackgroundImmunocompromised 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.Methodology/Principal FindingsElectronic databases and grey literature were searched and records were screened against eligibility criteria. Data extraction and risk of bias assessments were performed in duplicate. Results were synthesised narratively and meta-analyses were conducted where feasible. Heterogeneity was assessed using I2 and publication bias was assessed using Begg's funnel plot and Egger's regression test. Many of the 209 eligible studies included an unclear or high risk of bias. Meta-analyses showed a significant effect of preventing influenza-like illness (odds ratio [OR] = 0.23; 95% confidence interval [CI] = 0.16–0.34; p<0.001) and laboratory confirmed influenza infection (OR = 0.15; 95% CI = 0.03–0.63; p = 0.01) through vaccinating immunocompromised patie nts compared to placebo or unvaccinated controls. We found no difference in the odds of influenza-like illness compared to vaccinated immunocompetent controls. The pooled odds of seroconversion were lower in vaccinated patients compared to immunocompetent controls for seasonal influenza A(H1N1), A(H3N2) and B. A similar trend was identified for seroprotection. Meta-analyses of seroconversion showed higher odds in vaccinated patients compared to placebo or unvaccinated controls, although this reached significance for influenza B only. Publication bias was not detected and narrative synthesis supported our findings. No consistent evidence of safety concerns was identified.Conclusions/SignificanceInfection prevention and control strategies should recommend vaccinating immunocompromised patients. Potential for bias and confounding and the presence of heterogeneity mean the evidence reviewed is generally weak, although the directions of effects are consistent. Areas for further research are identified.

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The clinical, public health and economic implications of antimicrobial resistance present a major threat to future healthcare. Antimicrobial use is a major driver of resistance, and antimicrobial stewardship programmes are increasingly being advocated as a means of improving the quality of prescribing. However, to increase their impact and assess their success, a better understanding of antimicrobial usage, both in primary and secondary care, and linkage with antimicrobial resistance data are required. In England, national summaries of primary care dispensing data are issued annually by the Health and Social Care Information Centre. However, there is currently no routine public reporting of antimicrobial usage in hospitals. In response to the threat posed by antimicrobial resistance, as highlighted in the Report of the Chief Medical Officer and on the request of the Department of Health, Public Health England has developed a new national programme, the English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). The programme will bring together the elements of antimicrobial utilization and resistance surveillance in both primary and secondary care settings, alongside the development of quality measures and methods to monitor unintended outcomes of antimicrobial stewardship and both public and professional behaviour interventions. This article reports on the background to the programme development, the current oversight group membership and the public reporting structure.