Risks of new-onset allergic sensitization and airway inflammation after early age swimming in chlorinated pools

Rationale

Irritant chlorination products in swimming pools can cause respiratory problems in swimmers but their possible implication in allergies development is still unclear.

Objectives

To assess prospectively whether early-life attendance at chlorinated pools increases the risks of IgE sensitization and of airways inflammation later during childhood.

Methods

We conducted a two-year prospective study among 196 kindergarten children (mean age of 5.7 years, 54% of boys). We measured exhaled nitric oxide (eNO) and aeroallergen-specific IgE in nasal mucosa. Parents completed a questionnaire about the child's health, chlorinated pool attendance and potential confounders.

Main Results

Ever swimming at indoor or outdoor chlorinated pools before the age of three years was associated with higher odds for new-onset IgE sensitization to house dust mite (adjusted odds ratio [aOR] 2.93, 95% confidence interval [CI] 1.14–7.55) and for new-onset increased eNO (>15 ppb; aOR, 4.54, 95% CI 1.48–13.9). For both outcomes, aORs increased dose-dependently with time spent in chlorinated pools with values reaching, respectively, 3.60 (95% CI 1.21–10.7) and 5.92 (95% CI 1.72–20.5) when the cumulative pool attendance exceeded 60 h These risks appeared independently of each other, of parental history of allergies and of pre-existing diseases, including eczema, which at baseline was more prevalent in early swimmers (aOR, 2.91; 95% CI 1.23–6.89). Such associations were not seen with IgE sensitization to pollen or cat allergens.

Conclusion

Attendance at chlorinated swimming pools in early life is associated with higher risks of new-onset airways inflammation and IgE sensitization to house dust mite, independently of other risk factors.     

Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test

Objective

The objective was to determine if simplified follow-up after early medical abortion, consisting of a telephone call 2 weeks after the procedure plus a self-performed low-sensitivity urine pregnancy (LSUP) test, was successful for screening for ongoing pregnancies in the year following its introduction as standard service.

Study design

A retrospective computerized database review of 1084 women at a hospital abortion service in Edinburgh, UK, who had a medical abortion (≤ 9 weeks) and went home to expel the pregnancy was performed. Women who screened ‘positive’ at telephone follow-up on the basis of ongoing pregnancy symptoms, scant bleeding or LSUP test result were scheduled for an ultrasound. The main outcome measures were the proportion of women scheduled for telephone follow-up successfully contacted and the proportion of ongoing pregnancies detected.

Results

A total of 943 women were scheduled for telephone follow-up. Ten women presented to the hospital before the time of the follow-up call. Of the remaining 933 women, 656 [70%, 95% confidence interval (CI) 67.7-73.2] were successfully contacted. Five hundred seventy-three (87%, 95% CI 84.5–89.7) of those contacted screened ‘negative’; no false negatives occurred. Eighty-three (13%, 95% CI 10.2–15.5) screened ‘positive,’ and of those, three had ongoing pregnancies. Of the 277 (30%, 95% CI 26.7–32.7) who were not contacted, two ongoing pregnancies occurred. The sensitivity of telephone follow-up with LSUP to detect ongoing pregnancy was 100% (95% CI 30.9%–100%), and specificity was 88% (95% CI 84.9%–90.1%). The negative predictive value was 100% (95% CI 99.1%–100%), and positive predictive value was 3.6% (95% CI 0.9%–10.9%).

Conclusion

A telephone call and LSUP test at 2 weeks are suitable as a standard method of follow-up for screening for ongoing pregnancy after early medical abortion.

Implications statement

For most women, a routine clinic follow-up after early medical abortion (to exclude ongoing pregnancy) can be replaced with a telephone call and a self-performed LSUP test at 2 weeks postprocedure.     

Clinical features of adults with seven-valent-conjugated-vaccine-serotype pneumococcal pneumonia

Background

Despite the reduction in adult invasive pneumococcal disease through ‘herd protection’ consequent to the introduction of childhood pneumococcal conjugate vaccination (PCV), a significant proportion of adults continue to develop pneumococcal pneumonia caused by one of the seven serotypes included in the seven-valent conjugated pneumococcal vaccine (PCV7). The clinical features and outcomes of these adults have not been previously reported.

Methods

Adults recruited over a three year period to a large prospective cohort study of community acquired pneumonia (CAP) were investigated for pneumococcal serotypes using a validated multiplex immunoassay (Bio-plex). The baseline characteristics and outcomes of adults with PCV7-serotype CAP in comparison to those with non-PCV7-serotype CAP were established.

Results

Pneumococcal aetiology was identified in 415 of 1166 (35.6%) individuals, and a serotype determined in 287 (69.2%). Following exclusion of three individuals with both a PCV7 and non-PCV7 serotype, 77 of the remaining 284 (27.1%) adults had CAP due to PCV7 serotypes. Adults with PCV7-serotype CAP were older (median years (inter-quartile range) 73.3 (60.8–84.4) versus 65.0 (46.1–78.0); p = 0.001) and were more likely to have a World Health Organisation performance status ≥1 (odds ratio (OR) 2.05, 95% confidence interval (CI) 1.21–3.50).The presence of stroke (adjusted OR 2.84, 95% CI 1.36–5.95) and dementia (adjusted OR 3.55, 95% CI 1.26–9.94) as underlying co-morbid illnesses were independently associated with PCV7-serotype CAP; 30-day mortality was significantly greater in adults with PCV7-serotype CAP (adjusted OR 4.38, 95% CI 1.85–10.34).

Conclusion

A significant proportion of adults continue to develop PCV7-serotype CAP in the era of childhood pneumococcal conjugate vaccination. These adults are more likely to have stroke and dementia as underlying co-morbid illnesses, and have a higher 30-day mortality. A combination of pneumococcal transmission factors, host factors and pneumococcal serotype specific characteristics are likely to explain these findings.     

Association between documented family history of cancer and screening for breast and colorectal cancer

Background

Previous research on ascertainment of cancer family history and cancer screening has been conducted in urban settings.

Purpose

To examine whether documented family history of breast or colorectal cancer is associated with breast or colorectal cancer screening.

Methods

Medical record reviews were conducted on 3433 patients aged 55 and older from four primary care practices in two rural Oregon communities. Data collected included patient demographic and risk information, including any documentation of family history of breast or colorectal cancer, and receipt of screening for these cancers.

Results

A positive breast cancer family history was associated with an increased likelihood of being up-to-date for mammography screening (OR 2.09, 95% CI 1.45–3.00 relative to a recorded negative history). A positive family history for colorectal cancer was associated with an increased likelihood of being up-to-date with colorectal cancer screening according to U.S. Preventive Services Task Force low risk guidelines for males (OR 2.89, 95% CI 1.15–7.29) and females (OR 2.47, 95% CI 1.32–4.64) relative to a recorded negative family history. The absence of any recorded family cancer history was associated with a decreased likelihood of being up-to-date for mammography screening (OR 0.70, 95% CI 0.56–0.88 relative to recorded negative history) or for colorectal cancer screening (OR 0.75, 95% CI 0.60–0.96 in females, OR 0.68, 95% CI 0.53–0.88 in males relative to recorded negative history).

Conclusion

Further research is needed to determine if establishing routines to document family history of cancer would improve appropriate use of cancer screening.     

Relationship between peri-operative outcomes and hospital surgical volume of total hip arthroplasty in Japan

Background

This study aimed to evaluate the relationship between peri-operative complication of total hip arthroplasty (THA) and hospital surgical volume.

Methods

We reviewed discharge administrative data from 8321 patients who underwent primary THA between July and December 2008. Relationships between complications and surgical volume were analyzed with multivariate logistic regression models including age, sex, and Charlson comorbidity index. Hospitals were categorized into four groups according to the 6-month volume of THA procedures.

Results

The most frequent complication was dislocation (1.41%). Next was infection (1.24%). Fracture and pulmonary embolism occurred in less than 1% of procedures. Patients who underwent THA in hospitals with the highest surgical volume had lower risk of dislocation and infection than those treated in the hospitals with the lowest surgical volume (odds ratio [OR] 0.321, 95% confidence interval [CI] 0.167–0.572 and OR 0.123, 95% CI 0.020–0.421). Patients aged 65 years and older were associated with increased risk of dislocation (OR 2.342, CI 1.555–3.624) and fracture (OR 2.799, CI 1.372–6.301). Females demonstrated lower risk of dislocation (OR 0.558, CI 0.352–0.869) and infection (OR 0.560, CI 0.365–0.882).

Conclusion

These results indicated that the increase in the risk of peri-operative dislocation of primary THA may be associated with low hospital surgical volume as well as age and male sex.     

Postpartum contraceptive choices among ethnically diverse women in New Mexico

Objective

The objective of the study was to determine if postpartum contraceptive choices by primiparous women differ by ethnicity.

Study design

Retrospective nested cohort study analyzing women’s characteristics and contraceptive choice.

Results

Of 652 participants, 312 (47.8%) were Hispanic, 287 (44.0%) were non-Hispanic white, and 53 (8.1%) were American Indian (AI). In multivariate analysis, depot medroxyprogesterone acetate (DMPA) and intrauterine device (IUD)/implant choice was related to AI [DMPA: odds ratio (OR) 15.28, confidence interval (CI) 4.49–52.04; IUD/implant: OR 0.46, CI 0.22–0.92] and Hispanic (DMPA: OR 3.44, CI 1.12–10.58) ethnicity.

Conclusion

DMPA use was higher among Hispanic and AI women and IUD/implant use lower in AI women compared to non-Hispanic white women.     

Safety of inactivated monovalent pandemic (H1N1) 2009 vaccination during pregnancy: A population-based study in Taiwan

Background

Pregnant women were prioritized for H1N1 vaccination during the 2009–2010 pandemic. Safety concerns exist with vaccinating pregnant women, particularly in their first trimesters.

Methods

We linked computerized data on H1N1 vaccination, National Health Insurance, and Taiwan Birth Registry and identified events of spontaneous abortions (SABs) and all singleton births that occurred/delivered during November 1, 2009–September 30, 2010. The observation period for each case of SAB (6–19 weeks gestation) was divided into period at risk (1–28 days after vaccination) and control periods (the remaining person-days until SAB). The self-controlled case series method for truncated observational periods assessed the incidence rate ratio (IRR) of SAB during the 1–28 days compared with those in the control period. The case-control design matched each case of adverse fetal outcomes to up to 10 controls on fetal sex and year/month of pregnancy onset, and calculated matched odds ratio (OR) on H1N1 vaccination at <14 or ≥14 weeks gestation.

Results

Sixty-five women with SAB had received H1N1 vaccination at 6–19 weeks gestation. The IRR of SAB for the risk period 1–28 days was 1.03 (95% confidence interval [CI] 0.55–1.93). Among the 147,294 live births and 1354 stillbirths, maternal H1N1 vaccine receipt at <14 weeks gestation was associated with significantly reduced likelihood of small for gestational age (SGA) birth (OR 0.72, 95% CI 0.61–0.84) and birth defect (OR 0.46, 95% CI 0.22–1.00), whereas receipt at ≥14 weeks gestation was associated with significantly reduced likelihood of stillbirth (OR 0.63, 95% CI 0.46–0.86), prematurity (OR 0.90, 95% CI 0.83–0.97), low birth weight (OR 0.81, 95% CI 0.74–0.88), and SGA birth (OR 0.90, 95% CI 0.84–0.97).

Conclusions

H1N1 vaccination during pregnancy did not increase risk of SAB or adverse fetal outcomes.     

Acceptability of a hypothetical group B strep vaccine among pregnant and recently delivered women

Objective

Group B Streptococcus (GBS) causes significant infant morbidity and mortality. Promising GBS vaccines are currently in clinical trials. Because GBS vaccines would be the first to specifically target pregnant women, we sought to assess acceptability of a hypothetical GBS vaccine.

Study design

We performed an internet survey among currently pregnant or recently delivered women receiving care at one of 9 Ob/Gyn practices in Colorado. Vaccine acceptability was assessed using questions based on constructs from the Health Belief Model. Multivariable analyses assessed the characteristics associated with GBS vaccine acceptability during the current/recent pregnancy.

Results

The response rate was 50% (n = 231). While 78% agreed that a GBS vaccine would be a good way to protect newborns, 90% and 83% agreed, respectively, that they worried generally about the safety and effectiveness of new vaccines. Moreover, 39% believed it is generally dangerous for pregnant women to get vaccines. Seventy nine percent ‘definitely’ or ‘probably’ would have gotten a GBS vaccine in their most recent pregnancy if available. The most influential factors associated with this outcome were a strong belief in the vaccine's benefits (adjusted odds ratio [AOR] 6.37, 95% confidence interval [CI] 2.01–20.16), and low perceived barriers to vaccination (AOR 0.11, 95% CI (0.03–0.37)).

Conclusion

A GBS vaccine may be acceptable to pregnant women but would benefit from strong provider support and education about the risks and consequences of GBS infection and the benefits to vaccination.     

Muscle strength and physical activity are associated with self-rated health in an adult Danish population

Objective

To describe associations of muscle strength, physical activity and self-rated health.

Method

Isometric muscle strength by maximal handgrip strength (HGS) or muscle strength by 30 s repeated chair stand test (30 s-CS) was combined with leisure time physical activity. Using logistic regression odds ratio was calculated for good self-rated health according to the combined associations among 16,539 participants (59.7% women), mean age 51.9 (SD: 13.8) years, from a cross-sectional study in Denmark 2007–2008.

Results

Good self-rated health was positively associated with higher levels of physical activity and greater muscle strength. Regarding HGS the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high HGS (OR = 6.84, 95% CI: 4.85–9.65 and OR = 7.34, 95% CI: 5.42–9.96 for men and women, respectively). Similarly the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high scores in the 30 s-CS test (6.06, 95% CI: 4.32–8.50 and 13.38, 95% CI: 9.59–18.67 for men and women, respectively). The reference groups were sedentary participants with low strength (HGS or 30 s-CS).

Conclusion

The combined score for physical activity level with either HGS or 30 s-CS was strongly positively associated with self-related health.     

Public awareness of colorectal cancer and screening in a Spanish population

Objectives

To investigate screening intentions and previous uptake of colorectal cancer (CRC) screening tests in a general population in Spain; and to determine knowledge about CRC, risk perceptions, major barriers to screening and perceived benefits of screening.

Study design

Cross-sectional study.

Methods

Six hundred consecutive Spanish individuals over 50 years of age completed a questionnaire to determine their screening intentions, previous CRC diagnostic procedures, and knowledge about screening procedures, risk factors for CRC, 5-year prognosis, warning signs and symptoms, incidence, age-related risk and perceived barriers to screening.

Results

Although 78.8% of subjects reported that they were willing to participate in CRC screening, only 12% had ever undergone a screening test, and none with screening intention. Awareness of a breast cancer screening test [odds ratio (OR) 1.67, 95% confidence interval (CI) 1.04–2.70; P = 0.035], visiting a general practitioner in the preceding year (OR 3.08, 95% CI 1.86–5.08; P < 0.0001), awareness of risk factors (OR 2.32, 95% CI 1.49–3.61; P < 0.001), awareness of CRC signs or symptoms (OR 1.65, 95% CI 1.03–2.64; P = 0.04) and belief in the efficacy of CRC screening (OR 8.85, 95% CI 1.53–51.3; P = 0.01) were independent predictors for intention to participate in CRC screening. The most common reasons given for refusing screening were ‘CRC tests might be dangerous’ (28.2%), ‘CRC tests might be painful’ (17.9%) and ‘feeling healthy’ (16.2%).

Conclusion

Although reported willingness to undergo CRC screening was high, CRC knowledge and actual uptake of CRC screening were low. An educational intervention to reduce barriers and increase awareness could improve uptake of CRC screening.     

Young women’s consistency of contraceptive use — does depression or stress matter?

Background

We prospectively examined the influence of young women’s depression and stress symptoms on their weekly consistency of contraceptive method use.

Study Design

Women ages 18-20 years (n= 689) participating in a longitudinal cohort study completed weekly journals assessing reproductive, relationship and health characteristics. We used data through 12 months of follow-up (n= 8877 journals) to examine relationships between baseline depression (CES-D) and stress (PSS-10) symptoms and consistency of contraceptive methods use with sexual activity each week. We analyzed data with random effects multivarible logistic regression.

Results

Consistent contraceptive use (72% of weeks) was 10–15 percentage points lower among women with moderate/severe baseline depression and stress symptoms than those without symptoms (p<.001). Controlling for covariates, women with depression and stress symptoms had 47% and 69% reduced odds of contraceptive consistency each week than those without symptoms, respectively (OR 0.53, CI 0.31–0.91 and OR 0.31, CI 0.18–0.52). Stress predicted inconsistent use of oral contraceptives (OR 0.27, CI 0.12–0.58), condoms (OR 0.40, CI 0.23–0.69) and withdrawal (OR 0.12, CI 0.03–0.50).

Conclusion

Women with depression and stress symptoms appear to be at increased risk for user-related contraceptive failures, especially for the most commonly used methods.

Implications

Our study has shown that young women with elevated depression and stress symptoms appear to be at risk for inconsistent contraceptive use patterns, especially for the most common methods that require greater user effort and diligence. Based upon these findings, clinicians should consider women’s psychological and emotional status when helping patients with contraceptive decision-making and management. User-dependent contraceptive method efficacy is important to address in education and counseling sessions, and women with stress or depression may be ideal candidates for long-acting reversible methods, which offer highly effective options with less user-related burden. Ongoing research will provide a greater understanding of how young women’s dynamic mental health symptoms impact family planning behaviors and outcomes over time.     

A multicentre randomized trial of combined individual and telephone counselling for smoking cessation

Objective

The present study assessed the effectiveness of smoking cessation programs combining individual and telephone counselling, compared to individual or telephone counselling alone.

Method

A randomized, multicentre, open-label trial was performed between January 2009 and July 2011 at six smoking cessation clinics in Spain. Of 772 smokers assessed for eligibility, 600 (77%) met inclusion criteria and were randomized. Smokers were randomized to receive individual counselling, combined telephone and individual counselling, or telephone counselling. The primary outcome was biochemically validated continuous abstinence at 52 weeks.

Results

The 52-week abstinence rate was significantly lower in the telephone group compared to the combined group (20.1% vs. 29.0%; OR, 1.32; 95% CI, 1.1–2.7) and to the individual counselling group (20.1% vs. 27.9%; OR, 1.37; 95% CI, 1.0–2.8). The 52-week abstinence rates were not significantly higher in the combined group than the individual group (OR, 0.97; 95% CI, 0.7–1.4).

Conclusion

Individual counselling and combined individual and telephone counselling were associated with higher 52-week abstinence rates than telephone counselling alone. A combined approach may be highly useful in the clinical treatment of smokers, as it involves less clinic visits than individual counselling alone, thus reducing the program cost, and it increases patient compliance compared to telephone counselling alone.     

Comparison of prospective daily diaries and retrospective recall to measure oral contraceptive adherence

Background

The purpose of this study was to determine if retrospective recall of oral contraceptive (OC) adherence provides data that are similar to data collected via daily diaries over the same time period. Factors associated with inconsistent agreement between prospective and retrospective measurements of adherence also were explored.

Study Design

A total of 185 women participated in a longitudinal, prospective cohort of OC users, and 113 of these women provided complete information on OC adherence during follow-ups. Concordance beyond chance was assessed using weighted kappa statistics, and logistic regression was used to identify factors associated with inconsistent reporting of adherence.

Results

There was substantial agreement between prospective and retrospective adherence information (weighted kappa=0.64; 95% CI: 0.52–0.77). Participants with a high school education or less and those who had problems with feeling sad while using OCs had increased odds of inconsistent reporting of adherence (OR=4.38, 95% CI: 1.41–13.61 and OR=3.52, 95% CI: 1.25–9.94, respectively).

Conclusion

While prospective data collection via diaries may improve accuracy, the added expense and burden on study participants may not be necessary. However, the use of retrospective recall may not be appropriate for all study populations.     

RU OK? The acceptability and feasibility of remote technologies for follow-up after early medical abortion

Objectives

We tested the effectiveness and feasibility of remote communication technologies to increase follow-up after early medical abortion.

Study design

Women (n= 999) were randomized to ‘remote’ follow-up incorporating a low-sensitivity pregnancy test and standardized symptom questionnaire administered online, by text message or telephone by a non-clinical call center operator 2 weeks after treatment, or to ‘clinic-based’ follow-up with ultrasound at 1 week. Women in the clinic-based group who could not return performed a high-sensitivity pregnancy test at 3 weeks and had a telephone call with clinic staff. The primary outcome was completion of follow-up. Rates of complications, acceptability and preferences were compared.

Results

The overall follow-up rate did not differ by group {clinic-based, 73% vs. remote, 69%; risk ratio (RR) 1.0 [95% confidence interval (CI) 0.9–1.2]}. In the clinic-based group, 83% did not return for an ultrasound scan and were followed up by phone. In the remote group, follow-up by phone or text was more successful than online (text: 75.4%; phone: 73.7%; online: 46.5%, p<.001). The proportion of women receiving additional care was 9% in the clinic-based group and was 4% in the remote group [RR 1.8 (95% CI 1.1–3.1)]. Most women found their follow-up method acceptable but would prefer follow-up by phone or text message if needed in future.

Conclusions

Follow-up after medical abortion using remote communication is feasible and, for most women, preferable to a clinic visit.

Implications

Medical abortion protocols typically use follow-up visits to ensure early identification of complications. This study demonstrates that follow-up can be achieved using remote communication technologies. This model may reduce the burden of multiple clinic visits on patients and providers.     

Steps/day and metabolic syndrome in African American adults: The Jackson Heart Study

Objective

To examine the relationship between pedometer-measured step count data and the Metabolic Syndrome (MetS) in African American adults.

Method

379 African American adults (mean age 60.1 years; 60% female) enrolled in the Jackson Heart Study (Jackson, MS) from 2000 to 2004 provided sufficient pedometer data for inclusion in this analysis. MetS was classified according to the International Diabetes Federation Task Force on Epidemiology and Prevention.

Results

Using steps/day categorized as tertiles (< 3717 (referent), 3717–6238, > 6238), participants taking 3717–6238 (Odds Ratio (OR)(95% Confidence Interval (CI)) = 0.34 (0.19, 0.61)) and > 6238 steps/day (OR(95% CI) = 0.43 (0.23, 0.78)) had lower odds of having MetS compared to participants in the lowest tertile. Using previously suggested steps/day cut-points (< 2500 (referent), 2500–4999, 5000–7499, ≥ 7500), the odds of having MetS were lower for participants taking 2500–4999 (OR(95% CI) = 0.32 (0.14, 0.72)), 5000–7499 (OR(95% CI) = 0.22 (0.09, 0.53)), and > 7500 (OR(95% CI) = 0.26 (0.11, 0.65)) steps/day compared to those taking < 2500 steps/day.

Conclusion

Compared to lower levels, higher levels of steps/day are associated with a lower prevalence of MetS in this older African American population.     

Factors associated with the immune response to hepatitis A vaccination in HIV-infected patients in the era of highly active antiretroviral therapy

Introduction

HIV seropositivity is considered a risk factor for complications in hepatitis A virus (HAV) infection. HAV vaccination schedules are widely implemented in HIV-infected patients, but the immune response remains impaired.

Methods

We analysed the response to vaccination (antiHAV titres ≥20 IU/l) in 282 HIV-infected patients included in a standard (1440 Elisa Units (EU) at 0, 6 months) or rapidly accelerated schedule (720 EU at 0, 7, 21 days and 6 months) between 1997 and 2009. Factors associated with the response to vaccination were analysed using logistic regression.

Results

The overall response rate was 73.4%. Male sex (OR: 0.16, 95% CI 0.05–0.51) and hepatitis C virus co-infection (OR: 0.30, 95% CI 0.14–0.74) were associated with a lower probability of response. Protective antibody response was associated with a higher CD4/CD8 ratio (OR: 3.69, 95% CI 1.3–10.5) and having received two doses of standard schedule (compared with patients receiving only one dose of the same schedule) (OR: 2.51, 95% CI 1.22–5.15). Three doses of the rapidly accelerated schedule were not more effective than a single dose of 1440 EU (OR: 1.32, 95% CI 0.48–3.63).

Conclusion

The low responses observed in patients receiving a single dose suggest the need to emphasize adhesion to vaccination protocols to avoid failure. The CD4/CD8 ratio may be considered as an immune status marker which could help to better choose the moment of vaccination. Our findings underscore the importance of identifying strategies that optimize the timing and effectiveness of hepatitis A vaccination in HIV-infected patients and of the need for further studies on individual factors such as sex and hepatitis C co-infection that may affect the response to vaccination. Likewise, the sub-optimal effectiveness of three doses of 720 EU in the rapidly accelerated schedule, if confirmed in future studies, might lead to a revision of the current schedule recommended for HIV-infected travellers.     

Delayed pregnancy testing and second-trimester abortion: can public health interventions assist with earlier detection of unintended pregnancy?

Background

Delayed pregnancy testing has been associated with presentation for abortion in the second trimester. Little is known about acceptability of potential interventions to hasten pregnancy recognition.

Study design

A total of 592 women presenting for abortion at six clinics in the United States completed surveys on contraceptive use, risk behavior, timing of first pregnancy test and interest in interventions to speed pregnancy recognition and testing.

Results

Forty-eight percent of women presenting for second-trimester abortion delayed testing until at least 8 weeks. In multivariate analysis, women who often spotted between periods had higher odds of delaying pregnancy testing [odds ratio (OR) 2.7, 95% confidence interval (CI) 1.04–6.94]. Women who often missed periods had higher odds of second-trimester abortion (OR 2.1, 95% CI 1.34–3.13). The majority (64%) of women were not aware of a fertile time in the menstrual cycle; these women had higher odds of second-trimester abortion (OR 2.0, 95% CI 1.21–3.37). Ninety-four percent of women expressed interest in at least one potential intervention to help recognize pregnancy earlier.

Conclusions

While there was near-universal interest in earlier pregnancy recognition, no single proposed intervention or scenario was endorsed by the majority. Improving sexual health awareness is an important consideration in future efforts to expedite pregnancy testing.

Implications

We found near-universal interest in earlier pregnancy recognition, though no single proposed intervention or scenario garnered majority support. Based on our findings, the concept of improving sexual health awareness through education should be incorporated in the development of future strategies to hasten recognition of unintended pregnancy.     

HPV vaccination in Hong Kong: Uptake and reasons for non-vaccination amongst Chinese adolescent girls

Objectives

The study aims to determine HPV vaccine uptake (≥1 dose) amongst adolescent girls in Hong Kong and to explore the reasons for non-acceptance of the vaccine.

Study design

A total of 1832 secondary school girls (15.5 ± 2.0 years) were randomly surveyed. Their HPV vaccine uptake was estimated, and their reasons for non-vaccination summarised.

Results

A total of 131 (7.2%, 95% CI: 6.0–8.4%) adolescent girls had received the HPV vaccine (≥1 dose). Vaccine uptake was positively associated with a higher maternal education level and locally born status. Amongst the non-vaccinated girls, 20.6% had never heard of or knew little about the vaccine, 20.2% ‘did not know where to receive’, and 17.8% were concerned about the cost.

Conclusions

The HPV vaccine uptake amongst adolescent girls in Hong Kong is very low. A school-based education and service programme is needed to improve uptake and prevent disparities in the Chinese population.