Impact of clinic interventions on the rate of influenza vaccination in pregnant women

OBJECTIVE: To assess the impact of interventions in a prenatal clinic on the influenza vaccination rate in pregnant women. STUDY DESIGN: This retrospective study of women receiving care in a university prenatal clinic examined the impact of several interventions to increase immunization rates implemented over 2 years. Influenza vaccination rates were assessed before and after the interventions, which included provider and staff education, stocking of the vaccine in the clinic and implementation of standing orders. RESULTS: Influenza vaccination rates in pregnant women increased from <1% to 37%. Standing orders were the most important intervention for increasing immunization rates. Patients who received care in the certified nurse midwife clinic were more likely to be vaccinated, while those who received care in a high-risk obstetric clinic were less likely. CONCLUSION: Interventions to improve influenza vaccination rates among pregnant women, particularly standing orders, are effective. These interventions should be implemented nationally in all prenatal care clinics.     

Impact of duty hour limitations on resident and student education in obstetrics and gynecology

OBJECTIVE: To identify educators' attitudes about the impact of duty hour limitations on resident and student education in obstetrics and gynecology (OB-GYN). STUDY DESIGN: One hundred OB-GYN educators attending a session at the 2005 annual meeting of the Council on Residency Education/Association of Professors of Obstetrics and Gynecology were administered an anonymous survey that contained 16 items related to attitudes about the impact of resident duty hour limitations. All questions were answered by at least 77 respondents. RESULTS: OB-GYN educators perceive that work hours have a negative impact on resident education: 63% reported that overall resident education is worse and that resident surgical volume has diminished. The majority of educators perceive that limited work hours created no change in resident interest in teaching, but 62% perceive that residents have less time available to teach. Thirty-nine percent perceive that medical students have a better attitude about the OB-GYN rotation. CONCLUSION: Educators should accommodate duty hour limitations in the context of excellence in student and resident education.     

Who really manages our patients’ medications? A study of inner city adults over 40 years of age

Objectives

Primarily to determine how many of our adult patients receive significant assistance from another individual with medication management. Secondarily, to determine if the number of prescribed medications can be predictors of whether the patient receives significant assistance with medication management.

Diesel engine exhaust exposure in underground mines: Comparison between different surrogates of particulate exposure

Exposure to diesel particulate matter (DPM) is frequently assessed by measuring indicators of carbon speciation, but these measurements may be affected by organic carbon (OC) interference. Furthermore, there are still questions regarding the reliability of direct-reading instruments (DRI) for measuring DPM, since these instruments are not specific and may be interfered by other aerosol sources. This study aimed to assess DPM exposure in 2 underground mines by filter-based methods and DRI and to assess the relationship between the measures of elemental carbon (EC) and the DRI to verify the association of these instruments to DPM. Filter-based methods of respirable combustible dust (RCD), EC, and total carbon (TC) were used to measure levels of personal and ambient DPM. For ambient measurements, DRI were used to monitor particle number concentration (PNC; PTrak), particle mass concentration (DustTrak DRX and DustTrak 8520), and the submicron fraction of EC (EC_1;Airtec). The association between ambient EC and the DRI was assessed by Spearman correlation. Geometric mean concentrations of RCD, respirable TC (TC_R) and respirable elemental EC (EC_R) were 170 µg/m³, 148 µg/m³, and 83 µg/m³ for personal samples, and 197 µg/m³, 151 µg/m³, and 100 µg/m³ for ambient samples. Personal measurements had higher TC_R:EC_R ratios compared to ambient samples (1.8 vs. 1.50) and weaker association between EC_R and TC_R. Among the DRI, the measures of EC₁ by the Airtec (ρ = 0.86; P < 0.001) and the respirable particles by the DustTrak 8520 (ρ = 0.74; P < 0.001) showed the strongest association with EC, while PNC showed a weak and non-significant association with EC. In conclusion, this study provided important information about the concentrations of DPM in underground mines by measuring several indicators using filter-based methods and DRI. Among the DRI, the Airtec proved to be a good tool for estimating EC concentrations and, although the DustTrak showed good association with EC, interferences from other aerosol sources should be considered when using this instrument to assess DPM.     

Occupational therapy students' attitudes towards inclusion education in Australia,United Kingdom,United States and Taiwan

This international, cross‐cultural study investigated the attitudes of occupational therapy students from Australia, United Kingdom, United States and Taiwan towards inclusive education for students with disabilities. The possible impact of professional education on students' attitudes was also explored. A total of 485 students from 11 entry‐level occupational therapy education programmes from Australia, the United Kingdom, the United Sates and Taiwan participated in the study. Among them, 264 were freshmen (first‐year students) and 221 were seniors (final‐year students). Data collected from a custom‐designed questionnaire were analysed both quantitatively and qualitatively. In general, the occupational therapy students reported having positive attitudes towards inclusion. Considerable differences, however, existed among the student groups from the four countries. Professional education appeared to have a significant impact on students' attitudes towards inclusion from first year to senior year. Although students were in favour of inclusion, they also cautioned that their support for inclusive practices depended on various factors such as adequate preparation, support and assistance to students with disabilities. Limitations of the study included the small, convenience sample and different degree structures of the participating programmes. Future research studies need to compare occupational therapy students' attitudes with students from other health care professions. A longitudinal study on the impact of the professional education programme on students' attitudes towards inclusive education is warranted. Copyright © 2009 John Wiley & Sons, Ltd.     

Preventing Youth Suicide: Potential “Crossover Effects” of Existing School-Based Programs

Notable increases in youth mental health problems combined with strains on the already stretched mental health workforce raise concerns that there will be an ensuing increase in youth suicide thoughts, behaviors, and even deaths. Schools are recognized as crucial settings for youth mental health support and suicide prevention activities, yet schools also face staff shortages and ever-increasing responsibilities for student well-being. Evidence is emerging that prevention programs originally designed to improve problem-solving skills and social-emotional functioning in youth have demonstrated downstream, “crossover effects,” that is, unanticipated benefits, on youth suicidal behavior. Relatively little research on crossover effects has been conducted within school settings, despite the strong potential for commonly administered programs to have an impact on later suicide risk. We review key suicide risk factors and their proposed mechanisms of action; we also discuss factors that may protect against suicide risk. We then identify upstream prevention programs targeting the same factors and mechanisms; these programs may hold promise for downstream, crossover effects on youth suicide risk. This paper is intended to provide a framework to help researchers, practitioners, and policymakers as they consider how to prevent youth suicide using existing school-based resources. Rigorous investigation of upstream prevention programs is urgently needed to determine ideal approaches schools and communities can deploy to prevent youth suicide.

     

Beyond guidelines: promoting clinical change in the real world

There is widespread recognition that simply publishing research findings is not enough to ensure that they are carried into clinical practice. One response to this has been the burgeoning "guidelines movement" of recent years, which has now reached the stage of generating guidelines for the production of guidelines. Argues that guidelines, and other forms of intervention to change clinical practice in an evidence-based direction, will succeed only to the extent that they engage actively with the real world of clinical decision making. This world is more complex than guidelines writers acknowledge, and includes economic, administrative, professional and personal incentives as well as those provided by research evidence. Engaging with this real world may be difficult, but it opens up new possibilities for understanding how clinicians act and how evidence may be used to inform clinical practice. Such possibilities include social influences, educational outreach, providing information to patients, negotiating local coalitions on specific issues and changing the administrative environment.     

Effects of SiC nanoparticles orally administered in a rat model: Biodistribution, toxicity and elemental composition changes in feces and organs

Background

Silicon carbide (SiC) presents noteworthy properties as a material such as high hardness, thermal stability, and photoluminescent properties as a nanocrystal. However, there are very few studies in regard to the toxicological potential of SiC NPs.

Objectives

To study the toxicity and biodistribution of silicon carbide (SiC) nanoparticles in an in vivo rat model after acute (24 h) and subacute (28 days) oral administrations. The acute doses were 0.5, 5, 50, 300 and 600 mg·kg^− 1, while the subacute doses were 0.5 and 50 mg·kg^− 1.

Results

SiC biodistribution and elemental composition of feces and organs (liver, kidneys, and spleen) have been studied by Particle-Induced X-ray Emission (PIXE). SiC and other elements in feces excretion increased by the end of the subacute assessment. SiC did not accumulate in organs but some elemental composition modifications were observed after the acute assessment. Histopathological sections from organs (stomach, intestines, liver, and kidneys) indicate the absence of damage at all applied doses, in both assessments. A decrease in the concentration of urea in blood was found in the 50 mg·kg^− 1 group from the subacute assessment. No alterations in the urine parameters (sodium, potassium, osmolarity) were found.

Conclusion

This is the first study that assesses the toxicity, biodistribution, and composition changes in feces and organs of SiC nanoparticles in an in vivo rat model. SiC was excreted mostly in feces and low traces were retrieved in urine, indicating that SiC can cross the intestinal barrier. No sign of toxicity was however found after oral administration.     

Mapping vaccine hesitancy—Country-specific characteristics of a global phenomenon

The term vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite the availability of vaccination services. Different factors influence vaccine hesitancy and these are context-specific, varying across time and place and with different vaccines. Factors such as complacency, convenience and confidence are involved. Acceptance of vaccines may be decreasing and several explanations for this trend have been proposed. The WHO Strategic Advisory Group of Experts (SAGE) on Immunization has recognized the global importance of vaccine hesitancy and recommended an interview study with immunization managers (IMs) to better understand the range of vaccine hesitancy determinants that are encountered in different settings. Interviews with IMs in 13 selected countries were conducted between September and December 2013 and various factors that discourage vaccine acceptance were identified. Vaccine hesitancy was not defined consistently by the IMs and most interpreted the term as meaning vaccine refusal. Although vaccine hesitancy existed in all 13 countries, some IMs considered its impact on immunization programmes to be a minor problem. The causes of vaccine hesitancy varied in the different countries and were context-specific, indicating a need to strengthen the capacity of national programmes to identify the locally relevant causal factors and to develop adapted strategies to address them.