***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Indirect evidence is accumulating for an association between antibiotic use , especially in early childhood , and long-term immunologic health . The authors evaluated the association between  antibiotic use in childhood and subsequent development of type 1 diabetes .  A nationwide cohort study of all Danish singleton children born during 1995 - 2003 ( n = 606,420 ) was conducted .  Incidence rate ratios for type 1 diabetes comparing children according to antibiotic use were estimated . Antibiotic use was classified according to class , number of uses , and age at use . Use of any antibiotic was not associated with type 1 diabetes ( rate ratio = 1.16 , 95 % confidence interval : 0.91 , 1.50 ) . Evaluation of type 1 diabetes risk according to number of courses of any antibiotic yielded no association between antibiotic use and type 1 diabetes , with an increase in rate ratio per course of 1.02 ( 95 % confidence interval : 0.97 , 1.07 ) . No specific class of antibiotics was associated with type 1 diabetes , no specific age of use was associated with type 1 diabetes , and no specific age at onset of type 1 diabetes was associated with antibiotics . In a large nationwide prospect i ve study , no association between  antibiotic use and type 1 diabetes was found among Danish children OBJECTIVES To apply an institutional clinical data warehouse ( CDW ) to the assessment of  adverse drug reactions ( ADRs ) and demonstrate its utility through a specific example . METHODS We modeled the process for assessing ADRs through retrospective cohort design by using CDW at the Osaka University Hospital as follows : 1 ) We defined a drug X , an adverse drug reaction ( ADR ) Y , and a laboratory measurement Z to assess Y during a given study period ; 2 ) we excluded those whose Z value exceeded the defined criteria or were not available at the inception of the cohort ; 3 ) we divided the patients into two groups based on exposure or non-exposure to X ; 4 ) we matched the patient characteristics between the two groups through stratification and r and omization ; and 5 ) we compared the frequency of patients who presented Y during the study period between the two groups . Aminoglycoside and Cephalosporin associated nephrotoxicity in pediatric in patients was used as an example to demonstrate the usefulness of this approach . RESULTS Our evaluation indicates that there is an increased risk of nephrotoxicity for pediatric in patients who were prescribed cephalosporin either alone or in combination with aminoglycoside ; further , aminoglycoside tends to increase the cephalosporin-associated nephrotoxicity . CONCLUSIONS Our findings are consistent with those drawn from other studies , indicating that the method of applying an institutional CDW is useful for assessing ADRs BACKGROUND The Oka strain of live attenuated varicella virus was licensed for use in healthy children in the United States in March , 1995 . We report a postmarketing evaluation of the short term safety of this vaccine within Kaiser Permanente . METHODS After licensure varicella vaccination was introduced into the preventive care program of the Northern California Kaiser Permanente Medical Care Program . Potential adverse events after vaccination with varicella vaccine were identified from automated clinical data bases of hospitalizations , emergency room visits and clinic visits . Deaths were identified from automated clinical data bases at Kaiser as well as from the State death records for California . To evaluate safety , rates of diagnosis-specific events in the risk periods were compared with the rates of such diagnosis-specific events in two self control and one historical control period . RESULTS During the study period of April 1 , 1995 , to December 31 , 1996 , a total of 89753 adults and children received varicella vaccine .  A total of 3200 relative risks were calculated , and of these 5 hospital diagnostic categories , 9 emergency visit diagnostic categories and 30 outpatient diagnostic categories demonstrated at least 1 relative risk with a P value of < 0.05 in 1 or more age groups and in comparisons with 1 control period or more . The p value for these tests was not adjusted for multiple comparisons . Of these categories 14 demonstrated an increased risk either in more than 1 age group or against more than 1 comparison group . These categories included elective procedures , febrile seizure , febrile illness , well child , acute gastroenteritis , varicella , congenital anomaly , " rule out sepsis , " trauma , viral syndrome , apnea , back pain , congenital valvular heart disease and vision evaluation for glasses . Of these the outcomes of elective procedure , congenital anomaly , congenital valvular heart disease , well child and vision evaluation for glasses were judged not to have a biologically plausible association with vaccination . A second diagnostic grouping included febrile illness , viral illness , febrile seizure and " rule out sepsis . " In an analysis of these events which adjusted for the concomitant administration of M-M-R(II ) vaccine , none of the associations was statistically associated with receipt of varicella vaccine . The diagnostic category of " rule out sepsis " still had a relative risk of 1.95 with P = 0.02 . None of the children in the " rule out sepsis " category had positive bacteriologic cultures from any other normally sterile site . Because of the large number of gastroenteritis cases , we review ed a r and om sample of 100 exposed and 100 unexposed cases . From this review no consistent time association or clustering of any of these events was seen in the exposed follow-up time interval . Only gastroenteritis and negative evaluations for sepsis were thought to be possibly associated with receipt of varicella vaccine . Although there was a statistically significant increased risk over the entire 30 day-period , there was no clustering of these events within the 30-day window . CONCLUSION In this study population of 89753 children and adults , the varicella vaccine ( Oka strain , Merck ) appeared to have a favorable safety profile . In addition rates of varicella-like rash and of breakthrough cases were both low and consistent with the rates observed in prelicensure studies From the early 1990s infants started to receive acellular pertussis vaccine combined with diphtheria and tetanus toxoids ( DTaP ) before live vaccines such as measles , rubella , and mumps vaccines , which contained gelatin as a stabilizer . Then , an increasing number of cases of anaphylactic/allergic reactions to those live vaccines were reported . Almost all these cases had a previous history of receiving three or four doses of DTaP containing gelatin .  Anaphylactic/allergic reactions to live measles vaccine were analyzed using information obtained from the Reporting System , a retrospective study , as well as from the Monitoring System , a prospect i ve study . Dramatic decreases in anaphylactic/allergic reactions to live measles vaccines were observed immediately after each manufacturer marketed gelatin-free or gelatin (hypo-allergic)-containing live measles vaccine , and since the end of 1998 reports on anaphylactic/allergic reactions to live measles vaccine have almost ceased BACKGROUND The ongoing debate on the incidence and types of iatrogenic injuries in American hospitals has been informed primarily by the Harvard Medical Practice Study , which analyzed hospitalizations in New York in 1984 . The generalizability of these findings is unknown and has been question ed by other studies . OBJECTIVE We used methods similar to the Harvard Medical Practice Study to estimate the incidence and types of adverse events and negligent adverse events in Utah and Colorado in 1992 . DESIGN AND SUBJECTS We selected a representative sample of hospitals from Utah and Colorado and then r and omly sample d 15,000 nonpsychiatric 1992 discharges . Each record was screened by a trained nurse- review er for 1 of 18 criteria associated with adverse events . If > or = 1 criteria were present , the record was review ed by a trained physician to determine whether an adverse event or negligent adverse event occurred and to classify the type of adverse event . MEASURES The measures were adverse events and negligent adverse events . RESULTS Adverse events occurred in 2.9+/-0.2 % ( mean+/-SD ) of hospitalizations in each state . In Utah , 32.6+/-4 % of adverse events were due to negligence ; in Colorado , 27.4+/-2.4 % . Death occurred in 6.6+/-1.2 % of adverse events and 8.8+/-2.5 % of negligent adverse events . Operative adverse events comprised 44.9 % of all adverse events ; 16.9 % were negligent , and 16.6 % result ed in permanent disability . Adverse drug events were the leading cause of nonoperative adverse events ( 19.3 % of all adverse events ; 35.1 % were negligent , and 9.7 % caused permanent disability ) . Most adverse events were attributed to surgeons ( 46.1 % , 22.3 % negligent ) and internists ( 23.2 % , 44.9 % negligent ) . CONCLUSIONS The incidence and types of adverse events in Utah and Colorado in 1992 were similar to those in New York State in 1984 . Iatrogenic injury continues to be a significant public health problem . Improving systems of surgical care and drug delivery could substantially reduce the burden of iatrogenic injury OBJECTIVE Pediatric interventional radiologists are frequently challenged when faced with organ biopsies . Because of the need for patient immobility and the potential risk of morbidity with patient movement during biopsies , many radiologists prefer general anesthesia to sedation . We present our experience with radiologist-supervised ketamine sedation in pediatric patients undergoing renal and hepatic biopsies . MATERIAL S AND METHODS Quality assurance data were accessed from a computerized data base that prospect ively collects demographics , outcome parameters , and adverse events on all patients who receive ketamine sedation .  Patients received an IV ketamine bolus of 2 mg/kg followed by a continuous infusion of ketamine of up to 150 mcg/kg/min titrated to the responsiveness of the patient . RESULTS Sixty-five children received  ketamine for liver ( n = 35 ) and renal ( n = 30 ) biopsies . The mean age of the study group was 7.0 + /- 2.7 ( SD ) years . The cohort included patients with an American Society of Anesthesiologists ( ASA ) physical status classification of ASA 1 ( 3 % ) , ASA 2 ( 78 % ) , and ASA 3 ( 19 % ) . The duration of ketamine sedation  averaged 39 + /- 20 ( SD ) minutes , with an average procedure time of 32 + /- 19 ( SD ) minutes . All procedures were successfully completed , and there were no major adverse events . CONCLUSION Interventional radiologists performing solid organ biopsies in the pediatric population often use general anesthesia to ensure immobility , adequate analgesia , and safe conditions . Our experience suggests that interventional radiologists may supervise a nurse-administered ketamine protocol to provide safe , effective analgesia and sedation for liver and renal biopsies UNLABELLED Recent reports out of Japan have linked therapeutic use of the oral neuraminidase inhibitor oseltamivir with adverse neuropsychiatric outcomes in adolescents . OBJECTIVE To assess if protective measures should be taken to mitigate potential adverse outcomes among United States Department of Defense ( DoD ) pediatric beneficiaries who are prescribed oseltamivir therapeutically .  STUDY GROUP DoD healthcare beneficiaries , ages 1 through 21 years , who received a diagnosis of influenza from 1 October 2006 through 30 September 2007 . METHODS A retrospective cohort study using electronic healthcare service and pharmacy fill . Cross tabulations and propensity-adjusted logistic regression analyses were performed to compare the frequency of adverse neuropsychiatric outcomes among those treated therapeutically with oseltamivir with those that were not . RESULTS The prevalences of neuropsychiatric diagnoses following the influenza diagnosis overall and among the treated and untreated groups were 3.5 % , 3.0 % , and 3.8 % , respectively ( p < .05 ) . A statistically significant protective effect was associated with oseltamivir treatment ( prevalence odds ratio ( POR ) = 0.82 ( 95 % CI , 0.69 , 0.96 ) ) in a propensity-adjusted regression model . The model significantly associated increasing patient age with the likelihood of an adverse neuropsychiatric outcome , but the associations with patient gender and parental rank , a proxy used for socioeconomic status , were not statistically Significant . CONCLUSIONS Our retrospective study found no evidence that oseltamivir treatment for influenza increased the risk of adverse neuropsychiatric outcomes among the study population . An additional study focusing on prospect i ve medical surveillance of influenza patients is warranted A retrospective cohort design of Medicaid medical and pharmacy cl aims for 1996 through 2005 was employed for 14 171 children and adolescents prescribed an antidepressant medication and a r and om sample of 4500 children not treated with any class of psychotropic medication to compare the prevalence rates of cardiovascular and neurological adverse events . The treated cohort evinced a higher prevalence of cardiovascular events , orthostatic hypotension , seizures , insomnia , 
    Output:
    
Multi-system reactions were most commonly studied , followed by central nervous system and mental and behavioural disorders .
Vaccines were most frequently prescribed followed by corticosteroids , general anaesthetics and antidepressants .
CONCLUSIONS Routine electronic healthcare records were increasingly reported to be used for pharmacovigilance in children .