Background Physician recommendation is a key predictor of human papillomavirus (HPV) vaccine uptake. Understanding factors associated with recommendation is important for efforts to increase current ...suboptimal vaccine uptake. Purpose This study aimed to examine physician recommendations to vaccinate female patients aged 11–26 years, in 2009 and 2011, at 3 and 5 years postvaccine licensure, respectively. A second aim was to identify trends in factors associated with vaccine recommendation for ages 11 and 12 years. Methods Nationally representative samples of physicians practicing family medicine, pediatrics, and obstetrics and gynecology were randomly selected from the American Medical Association Physician Masterfile ( n =1538 in 2009, n =1541 in 2011). A mailed survey asked physicians about patient and clinical practice characteristics; immunization support; and frequency of HPV vaccine recommendation (“always” ≥75% of the time vs other). Analyses were conducted in 2012. Results Completed surveys were received from 1013 eligible physicians (68% response rate) in 2009 and 928 (63%) in 2011. The proportion of physicians who reported always recommending HPV vaccine increased significantly from 2009 to 2011 for patients aged 11 or 12 years (35% vs 40%, respectively; p =0.03), but not for patients aged 13–17 years (53% vs 55%; p =0.28) or 18–26 years (50% vs 52%; p =0.52). Physician specialty, age, and perceived issues/barriers to vaccination were associated with vaccine recommendation for patients aged 11 or 12 in both years. Conclusions Results suggest a modest increase in recommendations for HPV vaccination of girls aged 11 or 12 years over a 2-year period; however, recommendations remain suboptimal for all age groups despite national recommendations for universal immunization.
Background Although incidence of vaccine-preventable diseases has decreased, states’ school immunization requirements are increasingly challenged. Subsequent to a federal court ruling affecting ...religious immunization exemptions to school requirements, new legislation made philosophical immunization exemptions available in Arkansas in 2003–2004. This retrospective study conducted in 2006 describes the impact of philosophical exemption legislation in Arkansas. Methods Arkansas Division of Health data on immunization exemptions granted were linked to Department of Education data for all school attendees (grades K through 12) during 2 school years before the legislation (2001–2002 and 2002–2003 Years 1 and 2, respectively) and 2 years after philosophical exemptions were available (2003–2004 and 2004–2005 Years 3 and 4, respectively). Changes in numbers, types, and geographic distribution of exemptions granted are described. Results The total number of exemptions granted increased by 23% (529 to 651) from Year 1 to 2; by 17% (total 764) from Year 2 to 3 after philosophical exemptions were allowed; and by another 50% from Year 3 to 4 (total 1145). Nonmedical exemptions accounted for 79% of exemptions granted in Years 1 and 2, 92% in Year 3, and 95% in Year 4. Importantly, nonmedical exemptions clustered geographically, suggesting concentrated risks for vaccine-preventable diseases in Arkansas communities. Conclusions Legislation allowing philosophical exemptions from school immunization requirements was linked to increased numbers of parents claiming nonmedical exemptions, potentially causing an increase in risk for vaccine-preventable diseases. Continued education and dialogue are needed to explore the balance between individual rights and the public’s health.
Prenatal Immunization Education Návar, Ann Marie, MHS; Halsey, Neal A., MD; Carter, Terrell C., MHS ...
American journal of preventive medicine,
2007, Letnik:
33, Številka:
3
Journal Article
Recenzirano
Background Vaccine safety concerns and lack of knowledge regarding vaccines contribute to delays in infant immunization. Prenatal vaccine education could improve risk communication and timely ...vaccination. This study sought to determine the proportion of obstetric practices and hospital-based prenatal education classes that provide pregnant women with infant immunization information, the willingness of obstetric practices to provide infant immunization information, and the proportion of first-time mothers who receive a pediatric prenatal visit. Methods A telephone survey was conducted of 100 pediatric practices and 100 obstetric practices randomly selected from the American Medical Association Physician Masterfile between January and March 2005, with analysis performed April 2005. Results Seventy-one of 100 (71%) selected obstetric practices and 85 of 100 (85%) selected pediatric practices participated. Sixteen obstetric practices (23%) reported providing pregnant women with information on routine childhood immunizations. Thirty-four of the 52 practices (65%) that did not provide such information reported willingness to do so. Ten of 51 hospitals (20%) did not provide information about routine childhood immunizations to prenatal class participants. Sixty-six of the 85 pediatric practices (78%) provided a pediatric prenatal visit. Among these, the median percentage of first-time mothers who received a visit was 30%. Conclusions Prenatal visits are a missed opportunity for providing education about infant immunizations. Incorporating immunization education into routine obstetric prenatal care may increase maternal knowledge of infant vaccines and reduce delayed immunization.
Summary Background The influenza A (H1N1) 2009 monovalent vaccination programme was the largest mass vaccination initiative in recent US history. Commensurate with the size and scope of the ...vaccination programme, a project to monitor vaccine adverse events was undertaken, the most comprehensive safety surveillance agenda in the USA to date. The adverse event monitoring project identified an increased risk of Guillain-Barré syndrome after vaccination; however, some individual variability in results was noted. Guillain-Barré syndrome is a rare but serious health disorder in which a person's own immune system damages their nerve cells, causing muscle weakness, sometimes paralysis, and infrequently death. We did a meta-analysis of data from the adverse event monitoring project to ascertain whether influenza A (H1N1) 2009 monovalent inactivated vaccines used in the USA increased the risk of Guillain-Barré syndrome. Methods Data were obtained from six adverse event monitoring systems. About 23 million vaccinated people were included in the analysis. The primary analysis entailed calculation of incidence rate ratios and attributable risks of excess cases of Guillain-Barré syndrome per million vaccinations. We used a self-controlled risk-interval design. Findings Influenza A (H1N1) 2009 monovalent inactivated vaccines were associated with a small increased risk of Guillain-Barré syndrome (incidence rate ratio 2·35, 95% CI 1·42–4·01, p=0·0003). This finding translated to about 1·6 excess cases of Guillain-Barré syndrome per million people vaccinated. Interpretation The modest risk of Guillain-Barré syndrome attributed to vaccination is consistent with previous estimates of the disorder after seasonal influenza vaccination. A risk of this small magnitude would be difficult to capture during routine seasonal influenza vaccine programmes, which have extensive, but comparatively less, safety monitoring. In view of the morbidity and mortality caused by 2009 H1N1 influenza and the effectiveness of the vaccine, clinicians, policy makers, and those eligible for vaccination should be assured that the benefits of inactivated pandemic vaccines greatly outweigh the risks. Funding US Federal Government.
Abstract We investigated whether dementia risk factors were associated with prodromal Alzheimer’s disease (AD) according to the International Working Group-2 and National Institute of ...Aging-Alzheimer’s Association criteria, and with cognitive decline. 1394 subjects from with Mild Cognitive Impairment (MCI) from 14 different studies were classified according to these research criteria, based on cognitive performance and biomarkers. We compared the frequency of ten risk factors between the subgroups and used Cox-regression to examine the effect of risk factors on cognitive decline. Depression, obesity and hypercholesterolemia occurred more often in individuals with low-AD-likelihood, compared to those with a high-AD-likelihood. Only alcohol use increased the risk of cognitive decline, regardless of AD pathology. These results suggest that traditional risk factors for AD are not associated with prodromal AD or with progression to dementia, among subjects with MCI. Future studies should validate these findings and determine whether risk factors might be of influence at an earlier stage (i.e. preclinical) of AD.
Background Aristolochic acids are nephrotoxins and predispose to upper-tract urothelial carcinoma. The risk of bladder urothelial carcinoma after kidney transplantation and its relationship to ...upper-tract urothelial carcinoma is not well defined. Study Design Case series. Setting & Participants Single-center cohort of 38 women given kidney transplants for end-stage aristolochic acid nephropathy. Outcomes & Measurements The prevalence of upper urinary tract urothelial carcinoma was determined by collecting pathological results of specimens obtained by means of bilateral ureteronephrectomy. We also established the cumulative incidence of bladder urothelial carcinoma in biopsies performed during prospective screening cystoscopies during a 15-year follow-up. Results Upper-tract urothelial carcinoma was found in 17 patients with aristolochic acid nephropathy (44.7%). During follow-up, bladder urothelial carcinoma was diagnosed in 15 patients 68 to 169 months after cessation of aristolochic acid exposure (39.5%): 8 urothelial carcinoma in situ, 4 noninvasive low-grade papillary urothelial carcinoma, and 3 infiltrating urothelial carcinoma. 12 of 17 patients (71%) with a history of upper-tract urothelial carcinoma developed bladder urothelial carcinoma during follow-up, whereas this occurred in only 3 of 21 patients (14%) without upper-tract urothelial carcinoma ( P < 0.01). Despite local and/or systemic chemotherapy, 3 patients died and 2 radical cystectomies were performed. Limitations Small sample size of this case series. Conclusions Upper-tract and bladder urothelial carcinoma are dramatic complications in kidney transplant recipients with aristolochic acid nephropathy, confirming the carcinogenic properties of aristolochic acids. We identified upper-tract urothelial carcinoma as a potent risk factor for the subsequent development of bladder urothelial carcinoma after kidney transplantation for aristolochic acid nephropathy. Because this complication may occur years after aristolochic acid discontinuation, we suggest regular cystoscopies in addition to the bilateral ureteronephrectomy in kidney transplant recipients with aristolochic acid nephropathy.
Summary Because of the advent of a new influenza A H1N1 strain, many countries have begun mass immunisation programmes. Awareness of the background rates of possible adverse events will be a crucial ...part of assessment of possible vaccine safety concerns and will help to separate legitimate safety concerns from events that are temporally associated with but not caused by vaccination. We identified background rates of selected medical events for several countries. Rates of disease events varied by age, sex, method of ascertainment, and geography. Highly visible health conditions, such as Guillain-Barré syndrome, spontaneous abortion, or even death, will occur in coincident temporal association with novel influenza vaccination. On the basis of the reviewed data, if a cohort of 10 million individuals was vaccinated in the UK, 21·5 cases of Guillain-Barré syndrome and 5·75 cases of sudden death would be expected to occur within 6 weeks of vaccination as coincident background cases. In female vaccinees in the USA, 86·3 cases of optic neuritis per 10 million population would be expected within 6 weeks of vaccination. 397 per 1 million vaccinated pregnant women would be predicted to have a spontaneous abortion within 1 day of vaccination.
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