Evaluation of potentially achievable vaccination coverage with simultaneous administration of vaccines among children in the United States

BackgroundRoutine administration of all age-appropriate doses of vaccines during the same visit is recommended for children by the National Vaccine Advisory Committee (NVAC) and the Advisory Committee on Immunization Practices (ACIP).MethodsEvaluate the potentially achievable vaccination coverage for ≥4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine (4+DTaP), ≥4 doses of pneumococcal conjugate vaccine (4+PCV), and the full series of Haemophilus influenzae type b vaccine (Hib-FS) with simultaneous administration of all recommended childhood vaccines. Compare the potentially achievable vaccination coverage to the reported vaccination coverage for calendar years 2001 through 2013; by state in the United States and by selected socio-demographic factors in 2013. The potentially achievable vaccination coverage was defined as the coverage possible for the recommended 4+DTaP, 4+PCV, and Hib-FS if missed opportunities for simultaneous administration of all age-appropriate doses of vaccines for children had been eliminated.ResultsCompared to the reported vaccination coverage, the potentially achievable vaccination coverage for 4+DTaP, 4+PCV, and Hib-FS could have increased significantly (P < 0.001), the vaccination coverage would have achieved the 90% target of Healthy People 2020 for the three vaccines beginning in 2005, 2008, and 2011 respectively. In 2013, the potentially achievable vaccination coverage increased significantly across all selected socio-demographic factors, potentially achievable vaccination coverage would have reached the 90% target for more than 51% of the states in the United States.ConclusionsThe findings in this study suggest that fully utilization of all opportunities for simultaneous administration of all age-eligible childhood doses of vaccines during the same vaccination visit is a critical strategy for achieving the vaccination coverage target of Healthy People 2020. Encouraging providers to deliver all recommended vaccines that are due at each visit by implementing client reminder and recall systems might decrease missed opportunities for simultaneous administration of childhood vaccines.     

Unique safety issues associated with virus-vectored vaccines: Potential for and theoretical consequences of recombination with wild type virus strains

In 2003 and 2013, the World Health Organization convened informal consultations on characterization and quality aspects of vaccines based on live virus vectors. In the resulting reports, one of several issues raised for future study was the potential for recombination of virus-vectored vaccines with wild type pathogenic virus strains. This paper presents an assessment of this issue formulated by the Brighton Collaboration.To provide an appropriate context for understanding the potential for recombination of virus-vectored vaccines, we review briefly the current status of virus-vectored vaccines, mechanisms of recombination between viruses, experience with recombination involving live attenuated vaccines in the field, and concerns raised previously in the literature regarding recombination of virus-vectored vaccines with wild type virus strains. We then present a discussion of the major variables that could influence recombination between a virus-vectored vaccine and circulating wild type virus and the consequences of such recombination, including intrinsic recombination properties of the parent virus used as a vector; sequence relatedness of vector and wild virus; virus host range, pathogenesis and transmission; replication competency of vector in target host; mechanism of vector attenuation; additional factors potentially affecting virulence; and circulation of multiple recombinant vectors in the same target population. Finally, we present some guiding principles for vector design and testing intended to anticipate and mitigate the potential for and consequences of recombination of virus-vectored vaccines with wild type pathogenic virus strains.     

Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability

BackgroundChildren with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors.Objective/Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone.MethodsParent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform.ResultsFifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions.ConclusionsE-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.     

贵州省1995－2018年HIV/AIDS生存时间及其影响因素分析

目的 了解1995-2018年贵州省HIV/AIDS生存时间及影响因素。方法 采用回顾性队列研究的方法,从"艾滋病防治基本信息系统"中下载1995-2018年贵州省报告的所有现住址为贵州省的HIV/AIDS报告卡。进行统计分析,运用寿命表法计算生存率、Kaplan-Meier法计算生存时间、Cox比例风险模型分析HIV/AIDS生存时间的影响因素。结果 纳入研究对象HIV/AIDS 53 232例,死亡率为8.53/100人年(14 210/166 679.18);生存时间中位数为10.20(95%CI:9.91~10.48)年,第1、5、10、20年的累积生存概率分别为0.85、0.68、0.51、0.36、0.19;多因素Cox比例风险模型分析结果显示,男性(与女性相比,aHR=0.757,95%CI:0.727~0.788)、未接受过抗病毒治疗(与接受过抗病毒治疗相比,aHR=0.173,95%CI:0.165~0.181)、首次CD₄⁺T淋巴细胞(CD₄)<200个/μl(与首次CD₄ ≥ 200个/μl者相比,aHR=0.410,95%CI:0.387~0.435)、≥ 45岁 (与<45岁者相比,aHR=1.506,95%CI:1.193~1.901)、文盲(与高中及以上学历者相比,aHR=0.904,95%CI:0.832~0.982)、未婚(与离异或丧偶者相比, aHR=0.896,95%CI:0.848~0.946)、异性性传播(与同性性传播者相比,aHR=0.555,95%CI:0.487~0.632)、苗族等少数民族(与汉族相比,aHR=1.185,95%CI:1.114~1.262)、农民/民工(与家政/待业者相比, aHR=0.874,95%CI:0.834~0.916)均是影响病例生存时间的因素。结论 贵州省HIV/AIDS死亡率较高,近年来并未出现明显的下降趋势,男性、≥ 45岁、文化程度较低、少数民族、首次CD₄检测<200个/μl等是影响HIV/AIDS生存时间的因素。应该针对具有这些特征的病例加强治疗和随访管理,以提高其生存质量。     

Technology and social media use by adult patients with intellectual and/or developmental disabilities

BackgroundTechnology and social media offer individuals with intellectual and/or developmental disabilities (I/DD) unique and innovative ways to facilitate active participation in their own healthcare process. What remains unclear is the extent to which devices are currently used by this growing patient population.ObjectiveTo explore the prevalence of technology and social media use, as well as the possible barriers, among adult patients with I/DD.MethodsA cross-sectional study utilizing an anonymous, accessible survey was used to obtain data from all adult patients (18 + years of age) with I/DD presenting for primary care services at a healthcare facility in New York between September and December of 2016.ResultsA total of 370 individuals completed the survey (529 approached, 69.9% response rate). Less than half (44.6%) of respondents used devices such as a tablet, smartphone or desktop; most (86.8%) did not use social media. Only 21.6% of respondents indicated that they use some type of assistive technology. While some respondents (46.0%) were identified by their caregivers as having a disability that would prevent them from learning/using technology, other respondents reported having no challenges (18.0%), needing training and/or ongoing support (7.4%), or being uncertain as to whether they would experience any challenges (15.5%).ConclusionsMany adult patients with I/DD do not use technology and social media that could promote self-determination and participation in their healthcare. Continued efforts must be made to promote technology use among adults with I/DD and to ensure that appropriate training is available for both the individual and his/her caregivers to achieve adoption and utilization.     

Disability advocacy messaging and conceptual links to underlying disability identity development among college students with learning disabilities and attention disorders

BackgroundLearning disabilities and attention disorders (LD/AD) are highly prevalent neurodevelopmental conditions that influence developmental trajectories and whose impacts exist throughout the life course. Self-advocacy skills are critical for college students with LD/AD, which are underpinned by understanding of self and one's disability.ObjectiveThis study examined disability advocacy messaging included in projects created by college students with LD/AD, compared patterns in disability messaging to existing disability identity models, and explored changes in disability messaging during receipt of holistic campus-based LD/AD supports.MethodsParticipants were 52 undergraduates with LD/AD enrolled in a larger study. This one-group analysis involved qualitative exploration of the projects’ topical content, use of grounded theory procedures for conceptualizing the data, and quantitative analysis to explore changes over time in disability advocacy messaging.ResultsParticipants messaged a broad range of disability-related topics. A five-level theoretical model of disability messaging was created from the textual data. The model evinces parallels to existing disability identity development models. A significant (p < .01) positive shift in disability messaging was observed in a comparison of messages from participants’ first and last projects submitted over the four-semester period of study involvement.ConclusionStudy findings support conceptual linkages among disability messaging and disability identity development. The resultant continuum model suggests a potential extension of existing disability identity development paradigms. Shifts in disability messaging provide preliminary evidence for potential personal and institutional benefits of engaging college students with LD/AD in disability-focused project creation.     

Spousal support and self-determined physical activity in individuals with multiple sclerosis: A theory-informed qualitative exploration

BackgroundIndividuals with multiple sclerosis (MS) tend to exhibit high levels of sedentary behavior which contributes to increased disability and comorbidity. Understanding what factors underlie the motivation to be physically active in this group is therefore important.ObjectiveThis theory-informed qualitative study explored spousal support and behavior in fostering self-determined physical activity engagement of adults with MS.MethodsEight couples were interviewed using a semi-structured interview guide derived from Self-Determination Theory.ResultsAnalysis of transcribed audio recordings revealed that supportive and empathetic spousal communication, encouragement and expectations regarding physical activity, and bonding through co-participation increased feelings of relatedness. In addition, co-planning and problem-solving around physical activity and serving as a behavioral model facilitated perceptions of competency, while spouses who valued their partners’ independence and offered choice enhanced autonomous motivation for physical activity.ConclusionsInsight into the marital context that supports self-determined physical activity decisions of individuals with MS may better inform family-oriented health promotion approaches in this group.     

Gritty,hardy, resilient,and socially supported: A replication study

BackgroundThe present study adds to the knowledge base in positive psychology and disability sport psychology by replicating and extending the research of Martin, Byrd, Watts, and Dent (2015).ObjectivesIn the current study we replicated previous findings by predicting life quality and sport engagement using measures of grit, hardiness, and resilience. We also extended the work of Martin et al. (2015) by examining athlete social support.MethodsEighty-seven adult (80 men, 7 women) wheelchair rugby athletes with various disabilities (e.g., amputee) participated in the current study. They completed questionnaires at rugby tournaments or on-line assessing grit, hardiness, resilience, social support and life satisfaction and sport engagement.ResultsOverall, the regression equation predicting life satisfaction was significant, F (4, 81) = 9.67, p < .00, accounting for thirty-two percent of the variance. One variable, resilience, contributed unique meaningful variance as indicated by its significant beta weight (β = 0.46, p < .001). The regression analyses predicting sport engagement was also significant, F (4, 81) = 12.08, p < .001, and predicted 37% of the variance. Grit (β = 0.21, p < .05), social support (β = 0.25, p < .01), resilience (β = 0.23, p < .05), and hardiness (β = 0.27, p < .05) were all significant predictors.ConclusionAthletes reporting high levels of resilience reported the highest quality of life. Athletes reporting high levels of grit, resilience, hardiness, and social support were the most engaged in their sport. We also partially replicated the work of Martin et al. (2015).