Vaccination and risk of type 1 diabetes mellitus in active component U.S. Military, 2002-2008

Aims/hypothesis

To evaluate whether vaccination increases the risk of type 1 diabetes mellitus in active component U.S. military personnel.

Methods

We conducted a retrospective cohort study among active component U.S. military personnel age 17-35 years. Individuals with first time diagnoses of type 1 diabetes between January 1, 2002 and December 31, 2008 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. We used Poisson regression to estimate risk ratios between individual vaccine exposures and type 1 diabetes. Secondary analyses were performed controlling for receipt of multiple vaccines and available demographic variables.

Results

Our study population consisted of 2,385,102 individuals followed for approximately 7,644,098 person-years of service. This included 1074 incident type 1 diabetes cases. We observed no significant increased risk of type 1 diabetes after vaccination with anthrax vaccine adsorbed (AVA) [RR = 1.00; 95% CI (0.85, 1.17)], smallpox vaccine [RR = 0.84; 95% (CI 0.70, 1.01)], typhoid vaccine [RR = 1.03; 95% CI (0.87, 1.22)], hepatitis B vaccine [RR = 0.83; 95% CI (0.72, 0.95)], measles mumps rubella vaccine (MMR) [RR = 0.71, 95% CI (0.61, 0.83)], or yellow fever vaccine [RR = 0.70; 95% CI (0.59, 0.82)].

Conclusions

We did not find an increased risk of diagnosed type 1 diabetes and any of the study vaccines. We recommend that follow-up studies using medical record review to confirm case status should be considered to corroborate these findings.     

Children's perceptions of physical activity environments captured through ecological momentary assessment: a validation study

Objective

This study used ecological momentary assessment (EMA) to investigate whether children's perceptions of physical activity (PA) settings correspond with (1) parents' perceptions of neighborhood characteristics (convergent construct validity) and (2) children's level of PA in those settings (concurrent criterion validity).

Methods

Low-to-middle income, ethnically-diverse children (N = 108) (ages 9-13) living in Southern California participated in 8 days of EMA during non-school time. EMA measured current activity type (e.g., sports/exercise, TV watching) and perceptions of the current setting (i.e., vegetation, traffic, safety). The Neighborhood Environment Walkability Survey (NEWS) assessed parents' perceptions of neighborhood characteristics. EMA responses were time-matched to moderate-to-vigorous physical activity (MVPA) (measured by accelerometer) in the 30 min before and after each EMA survey. Data were collected in 2009-2010.

Results

Children's perceptions of vegetation and traffic in PA settings corresponded with parents' perceptions of the aesthetics (OR = 2.21, 95% CI = 1.04-4.73) and traffic (OR = 2.64, 95% CI = 1.31-5.30) in neighborhood environment, respectively. MVPA minutes were higher in settings perceived by children to have less traffic (β = 3.47, p < .05).

Conclusions

This work provides initial support for the construct and criterion validity of EMA-based measures of children's perceptions of their PA environments.     

Risk factors associated with parents claiming personal-belief exemptions to school immunization requirements: community and other influences on more skeptical parents in Oregon, 2006

Background and objectives

With vaccine-preventable diseases at record lows, few studies investigate rising parent-claimed exemptions to school immunization requirements. After finding exemption clusters in Oregon, we hypothesized that exemption risk factors may vary among communities. We surveyed parents to identify risk factors for exemptions and evaluated risk factor differences among communities with differing exemption rates.

Design

Retrospective cohort study, multi-staged, population-proportionate sampling.

Setting and participants

Parents of 2004-05 Oregon elementary school children (N = 2900).

Main outcome measure

Parent-reported exemption status.

Results

The response rate was 55%. Compared to vaccinators, exemptors were significantly more likely to have: strong vaccine concerns (weighted adjusted odds ratio (aOR) = 15.3, 95% CI 6.4-36.7); “vaccine-hesitant” concerns (aOR = 2.3; 95% CI 1.0-5.0); >1 childbirth(s) at a non-hospital, alternative setting (aOR = 3.6; 95% CI 1.6-8.0); distrust of local doctors (aOR = 2.7; 95% CI 1.0-7.5); reported chiropractic healthcare for their youngest school-age child (aOR = 3.9; 95% CI 1.8-8.5); and reported knowledge of someone with a vaccine-hurt child (aOR = 1.8; 95% CI 0.9-3.4). Exemptors were less likely to have “pro-vaccine” beliefs (aOR = 0.2; 95% CI 0.0-0.6) and less likely to report relying on print materials (aOR = 0.4; 95% CI 0.2-0.8).The strengths of association differed significantly for those with strong vaccine concerns and those reporting knowledge of someone with a vaccine-hurt child, depending on residence in exemption-rate areas, e.g., exemptors in medium-rate areas were more likely to have strong vaccine concerns (aOR = 13.5; 95% CI 5.4-34.0) than those in high-rate areas (aOR = 9.7; 95% CI 3.7-25.4).

Conclusions

Vaccine beliefs were important risk factors. That differing community-level exemption use modified the effects of several individual-level factors suggests that communities also influence parent decisions. Therefore, understanding community contexts and norms may be important when designing interventions.     

Associations of physical activity with neighborhood environments and transportation modes in older Japanese adults

Objective

We investigated associations of walking and other leisure-time physical activity (LTPA) with environmental characteristics and transportation modes in older Japanese adults.

Methods

This cross-sectional study in 2010-2011 used data from 421 community-dwelling older adults aged 65-85 years living in Kasama City, rural Japan. We used the Physical Activity Scale for the Elderly to assess walking and other LTPAs, and the International Physical Activity Questionnaire Environment Module for neighborhood environments.

Results

After adjusting for confounders, we found that good traffic safety and aesthetics were positively associated with high levels of walking (ORs = 1.64-2.12); whereas, good access to public transportation was negatively associated with walking (OR = 0.64, 95% CI = 0.42-0.98). Good access to recreational facilities, presence of sidewalks, absence of hills, seeing people exercise, and aesthetically pleasing surroundings were positively associated with high levels of LTPA except walking (ORs = 1.61-2.13). Individuals who rode bicycles more than once per week were more likely to engage in a LTPA except walking (1-3 days: OR = 1.72, 95% CI = 1.03-2.87; ≥ 4 days: OR = 2.90, 95% CI = 1.71-4.93).

Conclusion

This study adds information on correlates of physical activity among older Japanese adults; the positive association between LTPA except walking and the frequency of bicycle travel is an especially new and intriguing finding.     

Viral interference induced by live attenuated virus vaccine (OPV) can prevent otitis media

Background

The goal of this study was to evaluate whether a live attenuated poliovirus vaccine (OPV) has clinically relevant interfering effect with non-polio infections causing otitis media in young children.

Methods

Open trial in which the intervention group (64 children) received OPV at the age of 2, 3, 6 and 12 months. The control group (250 children) received IPV (inactivated polio vaccine) at the age of 6 and 12 months. Clinical symptoms were recorded by a questionnaire at the age of 3, 6, 12, 18 and 24 months.

Results

Otitis media episodes were less frequent in the OPV than in the control group. A significant difference was seen at the age of 6-18 months (IRR = 0.76 [95% CI 0.59-0.94], P = 0.011) and was particularly clear among children, who attended daycare (IRR 0.37 [95% CI 0.19-0.71], P = 0.003).

Conclusions

OPV provides some protection against otitis media. This effect may be mediated by viral interference with non-polio viruses.     

Knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a low-income, public health clinic population

Objective

The Public Health Center Vaccine Survey (PHCVS) examines the knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a largely low-income, urban, public health clinic population in Los Angeles County, USA.

Design

A cross-sectional survey of vulnerable individuals at risk for severe influenza infection was conducted in one of the nation's largest local public health jurisdictions.

Subjects

A total of 1541 clinic patients were recruited in the waiting rooms of five large public health centers in Los Angeles County from June to August, 2010.

Results

Among prospective respondents who met eligibility criteria, 92% completed the survey. The majority was black or Latino and most were between the ages of 18 and 44 years. More than half were unemployed; two-thirds had no health insurance; and nearly one-half reported having a high school education or less. About one-fifth reported they had received the H1N1 vaccine during the previous flu season. In comparative analyses, negative beliefs about vaccine safety and efficacy were highly predictive of H1N1 vaccination. Blacks were less likely than non-black respondents to report receiving the H1N1 vaccine (OR = 0.7, 95% CI = 0.6-1.0). Blacks were also less likely than other respondents to agree that vaccines can prevent disease (OR = 0.4, 95% CI = 0.3-0.5), that vaccines are safe (OR = 0.5, 95% CI = 0.4-0.6), and that they trust doctors/clinicians who recommend vaccines (OR = 0.5, 95% CI = 0.4-0.7).

Conclusions

Study findings provide a useful risk profile of vulnerable groups in Los Angeles County, which may be generalizable to other urban jurisdictions in the United States. They also describe real world situations that can be used to forecast potential challenges that vaccine beliefs may pose to national as well as local influenza pandemic planning and response, especially for communities with limited access to these preventive services.     

Brote de gastroenteritis por el consumo de agua de suministro público causado por Shigella sonnei

Objective

To investigate a waterborne outbreak in the population of València d’Àneu (Lleida, Spain).

Methods

A cohort study of consumption of mains water, bottled water and spring water was carried out. The sample was obtained by telephone contact with all private numbers in the municipality. We surveyed 58.3% of the population census (105/180) for water consumption, number of glasses drunk daily and symptoms. The water supply in the municipal system was sampled, and the presence of Enterobacteriaceae in the stool samples of 10 patients was determined. The association of each type of water was studied with estimation of relative risks (RR) and 95% confidence intervals (95% CI).

Results

The overall attack rate was 64.8% (68/105). The epidemic curve was consistent with an exposure of 6 days. Consumption of public supply water was associated with gastroenteritis (RR = 4.2, 95% CI: 1.5-11.9). In addition, a dose-response relationship was found (χ² = 34.1; p <0.001). There was a higher risk of illness in consumers of 2-3 glasses per day (RR = 4.3; CI 95%: 1.9-9.9) and in those drinking more than three glasses per day (RR = 4.9; 95% CI: 2.2 -10.9). The chlorinator of mains water froze and stopped working. Six stool cultures were positive for Shigella sonnei.

Conclusions

A waterborne outbreak of S. sonnei was caused by contamination of the public water supply. Investigation of illegal dumping of wastewater was recommended. Municipalities should ensure proper disinfection systems and prevent spillage near deposits.     

Associations of physical activity and screen-time on health related quality of life in adults

Background

Associations between the combined effect of physical activity and screen based activities on health related quality of life remain largely undetermined.

Methods

During 2008-2010, cross-sectional data for self-reported health related quality of life, physical activity, and screen-time were collected for 3796 Australian adults. Logistic regression was conducted to examine associations for six combinations of physical activity (none, insufficient, and sufficient), and screen-time (low and high) on health related quality of life.

Results

In comparison to the reference category (sufficient physical activity and low screen-time) men and women who reported no physical activity and either high (OR = 4.52, 95% CI 2.82-7.25) or low (OR = 2.29, 95% CI 1.37-3.80) screen-time, were significantly more likely to report over 14 unhealthy days. Men reporting either; no physical activity and high (OR = 3.15, 95% CI 1.92-5.15), or low (OR = 2.17, 95% CI 1.30-3.63) screen-time; insufficient physical activity and high (OR = 1.68, 95% CI 1.08-2.60), or low (OR = 1.79, 95% CI 1.14-2.82) screen-time were more likely to rate their health as poor or fair. In women this was significant for those who reported no physical activity and high screen-time (OR = 1.98, 95% CI, 1.19-3.31).

Conclusions

Results suggest that the combination of no physical activity and high screen-time demonstrated the greatest negative impact on health related quality of life.     

The built environment and recreational physical activity among adults in Curitiba, Brazil

Objective

To examine the relationship between objective measures of the built environment (BE) and recreational physical activity (PA) in adults from Curitiba, Brazil.

Method

A phone survey was carried among a random sample of 1206 people. Walking during leisure time (WLT) and moderate and vigorous recreational PA (MVPA) was measured using IPAQ. Characteristics of the BE were determined in an area of 500 m surrounding respondent's homes. Multivariate logistic regression analysis was used to estimate the associations between recreational PA and BE.

Results

After adjusting for confounders, WLT was associated with area income level US$971.45-3341.64 vs. US$167.05-461.06 (25.7% vs. 11.1% POR = 2.5; 95% CI = 1.5-4.4), having ≥ 2 gyms vs. none (26.1% vs. 12.7%, POR = 1.9; 95% CI = 1.2-3.0) and distance to recreation centers, 1769.1-2835.5 km vs. 2835.6-10,212.3 km (22.1% vs. 11.0%, POR = 2.3; 95% CI = (1.0-2.5). MVPA was associated with neighborhood income US$971.45-3341.64 vs. US$167.05-461.06 (47.6% vs. 22.0% POR = 3.0; 95% CI = 1.5-5.9) and having ≥ 2 gyms vs. none (41.7% vs. 26.0%, POR = 1.5; 95% CI = 1.11-2.1).

Conclusion

The presence of some recreational facilities for PA was associated with recommended levels of PA during leisure time in Curitiba, Brazil.     

Weather factor impacts on commuting to work by bicycle

Objective

Quantify the impact of weather conditions on individual decisions to commute to work by bicycle among a diverse panel of adults who commute ≥ 2 miles each way.

Method

Working adults (n = 163) in a northern U.S. state reported transportation mode for four seven-day periods in 2009-2010 that maximized seasonal weather variations. Personal characteristics, trip to work distances, and commuting mode data were linked to location- and time-specific weather data and daylight hours. Analyses focused on effect of weather conditions on reports of commuting by bicycle.

Results

Participants were diverse in age, gender and bicycle use, but were relatively well-educated; they traveled to work by bicycle on 34.5% of the logged commuting days. Modeling indicated that the likelihood of bicycle commuting increased in the absence of rain (odds ratio = 1.91; 95% confidence interval 1.42, 2.57) and with higher temperatures (1.03; 1.02, 1.04), and decreased with snow (0.90; 0.84, 0.98) and wind (0.95; 0.92, 0.97). Independent effects also were found for bicycle commuting distance, gender, and age, but not for daylight hours.

Conclusion

Precipitation, temperature, wind and snow conditions had significant and substantial independent effects on the odds of travel to work by bicycle among a diverse panel of adult bicycle commuters.     

Do social inequalities in cervical cancer screening persist among patients who use primary care? The Paris Prevention in General Practice survey

Objective

Social inequalities in cervical cancer screening may be related to either lack of access to care or inadequate delivery of preventive care by providers. We sought to characterize social inequalities among women consulting general practitioners with a wide range of social position indicators.

Methods

In 2005-06, 59 randomly recruited general practitioners from the Paris metropolitan area enrolled every woman aged 50-69 years seen during a two-week period. Cervical cancer screening status (overdue if the last cervical cancer screening had been more than 3 years earlier) was analyzed for 858 women in a logistic mixed model that considered: occupational class (in 5 levels, based on last occupation), education, income, characteristics related to family, housing, neighborhood, household wealth (social allocations, perceived financial difficulties in 4 levels, income tax), employment status, supplementary health insurance, and social network (4 levels).

Results

The rate of overdue patients did not vary between general practitioners (21%). social position indicators associated with overdue status (odds ratio between 2 adjacent decreasing social levels) were occupational class (1.20, 95% CI: 1.03-1.41), social network (1.52, 95% CI: 1.18-1.94), financial difficulties (1.42, 95% CI: 1.07-1.88), neighborhood safety (2.15, 95% CI: 1.10-4.20), and allocations (3.34, 95% CI: 1.12-9.96).

Conclusions

Even among women visiting general practitioners we observed marked social inequalities that persist above and beyond occupational class.     

Attitudinal and demographic predictors of measles, mumps and rubella (MMR) vaccine acceptance: development and validation of an evidence-based measurement instrument

Background and objective

Parents’ attitudes toward MMR vaccine and measles, mumps and rubella infections relate to their child's MMR status, therefore improving these attitudes is central to improving current suboptimal MMR uptake. However, no study has yet combined evidence-based, comprehensive and psychometrically validated assessment of these attitudes with reliable objective MMR status data, in order to identify through multivariate analyses the strongest attitudinal predictors of MMR uptake for interventions to target. The present study fills this lacuna by developing and testing a robust evidence-based MMR attitudes measurement instrument.

Design

Cross-sectional self-administered postal/telephone questionnaire with objective behavioural outcome.

Setting and participants

535 parents of children aged 5-18 in London and north-west England, UK (response rate 18.1%). Recruitment via Primary Care Trust records, age-stratified purposive sample with suboptimally immunised cases oversampled.

Main outcome measures

Parents’ responses to evidence-based measurement instrument comprising 20 attitude/previous behaviour items (collapsing to 5 scales) and 7 demographic items, and their children's PCT-recorded 5th birthday status for MMR dose 1 (on-time, late or none) and MMR dose 2 (on-time or none).

Results

The attitudes measurement instrument was psychometrically robust: content valid, and demonstrating good or acceptable internal consistency (Cronbach's alpha = 0.55-0.75 for all scales), test-retest reliability (Pearson's correlation >0.60-0.80, p < 0.01 to <0.001 for all scales and 11 individual items), concurrent/construct validity (t-tests for difference between MMR status groups p < 0.05 for four scales and thirteen individual items), and predictive/criterion validity (OR = 0.66, 95% confidence interval = 0.48-0.92 to OR = 1.97, 95% CI = 1.18-3.31 for three scales and five individual items). Black and minority ethnicity (OR = 1.94, 95% CI = 1.15-3.30 to OR = 4.15, 95% CI = 2.40-7.19), positive MMR attitudes (OR = 1.63, 95% CI = 1.00-2.66 to OR = 1.97, 95% CI = 1.18-1.31), and positive social attitudes (OR = 1.64, 95% CI = 1.23-2.40 to OR = 1.72, 95% CI = 1.13-2.38) independently predicted uptake for both MMR doses. MMR status groups differed most strongly on preference for single measles, mumps and rubella vaccines (6-9% variance in status explained), previous MMR acceptance/rejection (5-9%), and wishing to protect others through vaccinating one's own child (6-8%).

Conclusions

The measurement instrument is robust on multiple validity and reliability dimensions, and is appropriate for use in research and practice as a tool for designing and evaluating interventions. Parents appear to act in line with their attitudes toward MMR vaccine, though attitudes toward measles infection bore little relation to MMR uptake. This study indicates populations and attitudes to be prioritised in MMR uptake improvement interventions.     

Temporal trends and correlates of passive commuting to and from school in children from 9 provinces in China

Objective

To examine trends and correlates of passive (inactive) commuting to school among Chinese children aged 6-18 years in nine provinces.

Methods

The trends analysis used school commuting data from the China Health and Nutrition Surveys in 1997 (n = 2454), 2000 (n = 1978), 2004 (n = 1549) and 2006 (n = 1236). Generalized estimating equations examined trends after adjusting for age, sex and region, and also explored the correlates of passive commuting to school in urban and rural areas (n = 6935).

Results

An increase in passive commuting to school was noted (3.6% in 1997, 14.1% in 2006, P < 0.0001). Children attending schools not located in their local community were more likely to passively commute. In urban areas, maternal education was associated with increased passive commuting (AOR = 1.41, 95% CI: 1.03-1.92). In rural areas, family income (AOR_high/low = 2.12, 95% CI: 1.52-2.96), paternal education (AOR_high/low = 1.56, 95%CI: 1.17-2.07), and motorcycle ownership (AOR = 1.57, 95%CI: 1.19-2.07) were associated with passive commuting.

Conclusion

Passive commuting to school increased in China over a decade and was associated with family socioeconomic status, school location, and in rural children, with access to motorized vehicles.     

Validación de los componentes del síndrome metabólico autodeclarados en un estudio de cohortes

Objectives

To assess the accuracy of self-reported data needed to constitute the metabolic syndrome in the University of Navarra Follow-Up [Seguimiento Universidad de Navarra (SUN)] cohort.

Methods

The SUN project is a multi-purpose prospective cohort, formed by more than 20,000 university graduates, followed-up using surface mail questionnaires every 2 years. In a sample of 287 cohort participants, self-reported data on the criteria needed to define the metabolic syndrome (waist circumference, blood pressure, triglycerides, high-density lipoprotein-cholesterol and glucose) were compared with the same biometric data obtained by blood tests or measured by trained medical staff. Intra-class correlation coefficients with 95% confidence intervals (95% CI), relative mean error and agreement limits according to the method proposed by Bland and Altman were calculated for each variable studied.

Results

High intraclass correlations were found for the values of waist circumference (r = 0.86, 95% CI: 0.80-0.90) and triglycerides (r = 0.71, 95%CI: 0.61-0.79). Moderate intraclass correlations were found (between 0.46 and 0.63) for the other factors. Relative mean errors were always < 2.5%, and >91% of values were within the limits of agreement for all variables.

Conclusions

The results suggest that self-declared data on the criteria of metabolic syndrome obtained in the SUN cohort, though with some caution, are sufficiently accurate to be used in epidemiological studies.     

Predictors of acceptance of H1N1 influenza vaccination by FDNY firefighters and EMS workers

Background

There is a widely recognized need for vaccination of health care workers (HCWs). We undertook this study to assess the 2009-2010 H1N1 vaccination rates in ∼14,000 firefighters and emergency medical service (EMS) workers at the Fire Department of New York (FDNY) and to determine predictors of H1N1 vaccine acceptance.

Methods

After 9/11/01, FDNY developed a bio-preparedness drill where units are dispatched to FDNY-BIOPOD (biologic points of distributions) for rapid distribution of medications/vaccines in the event of a biological disaster. Since 2005, FDNY offers free, voluntary seasonal influenza vaccination during routine medical monitoring/treatment examinations and at FDNY-BIOPOD. In 2009, FDNY-BIOPOD instead offered the H1N1 vaccine. We report on FDNY H1N1 vaccination rates and on predictors of acceptance using bivariate and multivariable techniques.

Results

Overall, 10,612 (77%) FDNY workers were offered H1N1 vaccination, of whom 5831 (55%) accepted. Acceptance was 57.2% during FDNY-BIOPOD compared with 34.4% during medical monitoring/treatment exams (p = 0.0001). Workers who accepted prior seasonal influenza vaccinations were 4 times more likely to accept H1N1 vaccination (AOR = 4.4, CI₉₅ = 4.0-4.8).

Conclusion

FDNY offered H1N1 vaccination to 77% of its workforce during the 2009-2010 season. Prior seasonal vaccine acceptance and vaccination in a group setting such as FDNY-BIOPOD dramatically increased acceptance of the H1N1 vaccine. However, within a voluntary program, additional strategies are needed to further increase vaccine acceptance in first responders and other HCWs.     

Decisions to update comparative drug effectiveness reviews vary based on type of new evidence

Objective

To determine the time to and key factors associated with decision to update comparative effectiveness of reviews of drugs based on periodic scans of new evidence.

Study Design and Setting

Based on periodic scans of new evidence, we analyzed 69 decisions on whether to update for 41 comparative effectiveness reviews conducted for the Drug Effectiveness Review Project. We used the Kaplan-Meier product limit method to estimate mean time to update and generalized estimating equation logistic regression to estimate associations between updating decisions and review topic or characteristics of new evidence.

Results

Mean time to update was 24.9 months. Significant predictors of a decision to update were identification of a new drug (odds ratio [OR]: 5.71; 95% confidence interval [CI]: 1.68-19.44) and the number of new relevant trials (OR: 1.06; 95% CI: 1.03-1.10). Compared with nonpsychiatric topics, psychiatric topics were most rapidly developing (mean new relevant citations: 38.4 vs. 8.2; P = 0.0127) and were updated at a faster pace (mean survival time: 10.2 vs. 27.5 months; P < 0.0001).

Conclusion

Using periodic scans of new evidence, updating should be considered yearly for rapidly developing topics and biannually for other topics.     

Electronic reminders for cancer prevention: factors associated with preference for automated voice reminders or text messages

Objective

Prompting may promote engagement with behavior change interventions. Prompts can be delivered inexpensively via automated voice response (AVR) reminders or short message service (SMS) text messages. We examined the association between participants' characteristics and preferred reminder modality.

Methods

Healthy Directions 2 is a cluster randomized controlled trial implemented in Boston, Massachusetts to promote change in multiple behavioral cancer risk factors. At baseline (2009), participants completed a survey assessing socio-demographics, health status, height/weight, and factors associated with technology. One-third of participants randomized to receive the intervention (n = 598) were randomized to receive automated reminders, with participants selecting modality.

Results

28% (167/598) of participants selected SMS reminders. Controlling for clustering by primary care provider, younger participants (OR = 0.97, 95% CI = (0.95, 0.99), p < 0.01), those most comfortable with computers (very uncomfortable OR = 0.54, 95% CI = (0.29, 1.01), p ≤ 0.05: referent group = very comfortable), and those who frequently sent/received text messages (never OR = 0.09 CI = (0.04, 0.16) p < 0.01; 1-3 times/month OR = 0.38, 95% CI = (0.15, 0.93) p = 0.04: referent group = 1-5 times/week) were more likely to choose SMS.

Conclusions

Interventions should make both modalities available to ensure that more participants can benefit from prompting. Studies examining the effect of automated reminders may have reduced effectiveness or generalizability if they employ only one modality.     

A community-based randomized trial of a faith-placed intervention to reduce cervical cancer burden in Appalachia

Objective

Faith Moves Mountains assessed the effectiveness of a faith-placed lay health advisor (LHA) intervention to increase Papanicolaou (Pap) test use among middle-aged and older women in a region disproportionately affected by cervical cancer and low screening rates (regionally, only 68% screened in prior 3 years).

Method

This community-based RCT was conducted in four Appalachian Kentucky counties (December 2005-June 2008). Women aged 40-64 and overdue for screening were recruited from churches and individually randomized to treatment (n = 176) or wait-list control (n = 169). The intervention provided LHA home visits and newsletters addressing barriers to screening. Self-reported Pap test receipt was the primary outcome.

Results

Intention-to-treat analyses revealed that treatment group participants (17.6% screened) had over twice the odds of wait-list controls (11.2% screened) of reporting Pap test receipt post-intervention, OR = 2.56, 95% CI: 1.03-6.38, p = 0.04. Independent of group, recently screened participants (last Pap > 1 but < 5 years ago) had significantly higher odds of obtaining screening during the study than rarely or never screened participants (last Pap ≥ 5 years ago), OR = 2.50, 95% CI: 1.48-4.25, p = 0.001.

Conclusions

The intervention was associated with increased cervical cancer screening. The faith-placed LHA addressing barriers comprises a novel approach to reducing cervical cancer disparities among Appalachian women.     

Nursing workload predictors in Catalonia (Spain): a home care cohort study

Objective

To identify the characteristics of chronic patients and their environment in order to predict the nursing workload required 1 year after their inclusion in a home care program.

Methods

A longitudinal study was carried out in 72 primary health care teams in Catalonia (Spain) with a 1-year follow-up of 1,068 home care patients over 64 years old. The variables collected from each patient included data on health and social status (Charlson and Barthel indexes and the Pfeiffer, Braden and Gijon scales), carer overburden (Zarit scale), hospital admissions, use of emergency services, self-perceived health (SF-12) and the number of health worker visits.

Results

Patients received 7.2 (SD 10.4) visits per year from their nurse-in-charge, out of a total of 8.7 (SD 13.1) nursing visits per year. Risk factors for receiving more nursing visits at home were male gender (IRR = 1.42, 95%CI: 1.20-1.67), dependency for daily activities (IRR = 1.65, 95%CI: 1.29-2.13), decubitus ulcers (IRR = 4.03, 95%CI: 2.27-7.14) and receiving emergency medical care at home (IRR = 1.65, 95%CI: 1.31-2.07). In contrast, patients with major cognitive impairment (IRR = 0.78, 95%CI: 0.63-0.98) had a lower probability of receiving nursing visits at home.

Conclusions

Workload can be predicted by patients’ clinical characteristics. The positive correlation of workload with variables related to disease severity and the negative correlation with variables related to cognitive impairment show that home care nursing in Catalonia is basically demand-oriented.