Hepatitis A vaccination coverage among adolescents (13–17 years) in the United States, 2008–2016

BackgroundThe hepatitis A (HepA) vaccine was recommended by the Advisory Committee on Immunization Practices (ACIP) incrementally from 1996 to 1999. In 2006, HepA vaccine was recommended (1) universally for children aged 12–23 months, (2) for persons who are at increased risk for infection, or (3) for any person wishing to obtain immunity. Catch-up vaccination can be considered.ObjectiveTo assess HepA vaccine coverage among adolescents and factors independently associated with vaccination administration in the US.MethodsThe 2008–2016 National Immunization Survey–Teen was utilized to determine 1 and ≥2 dose HepA vaccination coverage among adolescents aged 13–17 years. Factors associated with HepA vaccine series initiation (1 dose) were determined by bivariate and multivariable analyses. Data were stratified by state groups based on ACIP recommendation: universal child vaccination recommended since 1999 (group 1); child vaccination considered since 1999 (group 2); universal child vaccination recommendation since 2006 (group 3).ResultsIn 2016, national vaccination coverage for 1 and ≥2 doses of HepA vaccine among adolescents was 73.9% and 64.4%, respectively. Nationally, a 40 percentage point increase in vaccination coverage occurred among adolescents born in 1995 compared to adolescents born in 2003. Nationally, the independent factors associated with increased vaccine initiation was race/ethnicity (Hispanic, American Indian/Alaskan Native, Asian), military payment source and provider recommendation for HepA vaccination (2008–2013). Living in a suburban or rural region, living in poverty (level <1.33–5.03), and absence of state daycare or school HepA requirement were common factors associated with decreased likelihood of vaccine initiation.ConclusionsEfforts to increase HepA vaccine coverage in adolescents in all regions of the country would strengthen population protection from hepatitis A virus (HAV).     

Healthy and Ready to Learn: Effects of a School‐Based Public Health Insurance Outreach Program for Kindergarten‐Aged Children

BACKGROUND

Rates of child insurance coverage have increased due to expansions in public programs, but many eligible children remain uninsured. Uninsured children are less likely to receive preventative care, which leads to poorer health and achievement in the long term. This study is an evaluation of a school‐based health insurance outreach initiative, “Healthy and Ready to Learn,” aiming to identify and enroll uninsured kindergarteners in areas of high economic need in 16 counties in North Carolina.

METHODS

Regression discontinuity design and difference‐in‐differences analyses were used to estimate the effect of the initiative on Medicaid and CHIP enrollment (primary outcome) and preventive care use (well‐child visits; secondary outcome). Focus groups and key‐informant interviews were conducted to assess best practices and identify barriers to outreach for child enrollment.

RESULTS

The initiative increased enrollment rates by 12.2% points and increased well‐child exam rates by 8.6% points in the RD models, but not differences‐in‐differences, and did not significantly increase well‐child visits.

CONCLUSIONS

Findings demonstrate the potential benefits of using schools as a point of intervention in enrolling young children in public health insurance and as a source of trusted information for low‐income parents.     

Étude prospective de la qualité de vie après une CHIP par oxaliplatine pour carcinose péritonéale

BackgroundCytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is now the reference technique for limited peritoneal carcinomatosis (PC). Operative mortality is actually at 3 or 4%, and decrease as morbidity. Together, they did not limit acceptation of HIPEC. However, one of the major limitation of this aggressive treatment is that patient can be afraid to impair overall quality of life (QoL). The aim of this article was to assess QoL in patients at least 12 months after HIPEC using Oxaliplatin.MethodPatients completed a questionnaire before and after surgery at 1, 3, 6 and 12 months. QoL was assessed with the EORTC QLQ-C30 questionnaire.ResultatsBetween September 2006 and October 2008, 32 of 35 patients who had undergone HIPEC were interviewed. PC originated in primary lesions of the colon/rectum (N = 17), ovary (N = 3), stomach (N = 3), appendix (N = 2), mesothelium (N = 2), pseudomyxoma peritonei (N = 3) and primary carcinoma of peritoneum (N = 2). The percentage of patients completing the questionnaire at each time point was: baseline = 87% (N = 28); 1 and 3 months = 46% (N = 15); 6 months = 62% (N = 20); and 12 months = 59% (N = 19). Morbidity and mortality were respectively 35 and 5%. Median hospital stay was 19 days. QoL score had decreased considerably in 60% of patients in the early postoperative assessment period after HIPEC (1 month), as compared with baseline score. Forty five per cent had reported significant pain and limitations on physical functioning. QoL score had returned to baseline at 3 months in 53,3% of patients: 20% reported lack of energy and fatigue. Fifty-five and 73% of patients had recovered their overall QoL at 6 and 12 months, respectively. Also, psychosocial problems, diarrhea and constipation, and peripheral neuropathy of oxaliplatin were reported in 20% of survivors over the course of the first year after HIPEC.ConclusionShort-term QoL with physical and functional well-being are impaired in the first few months after surgery plus HIPEC using oxaliplatin. Long-term QoL returns to baseline at 3 months; however 20% of patients still report psychosocial problems, gastrointestinal symptoms and oxaliplatin-induced neuropathy. It is useful and important for patients to see this HIPEC QoL data at the time of consultation before treatment.     

组织芯片的简便制作方法及在病理研究中的应用

【目的】探讨组织芯片的简便制作方法。【方法】选取130例乳腺癌、肠癌标本,40 g/L甲醛固定,石蜡包埋、常规切片,苏木素-伊红(HE)染色;手工制作空白蜡块,孔距0.2 cm,孔径0.2 cm,深2~4 mm;采用直径0.1 cm的皮带冲钻孔采集组织芯,安插于空白蜡块,制作组织片蜡块;蜡块的切片厚4μm;之后将蜡片裱于载玻片上,经处理后再行免疫组化染色。【结果】1张载玻片上可裱45个微组织,130例标本只需3张玻片即可完成1项指标的检测,且组织形态良好,免疫组化染色阳性定位清楚,背景干净。【结论】该组织芯片制作方法简便易行,便于普及,且所含信息量大,可减少试剂用量,便于比较分析。     

坏死性凋亡与肿瘤

坏死性凋亡是不依赖于caspase激活的一种细胞程序性死亡方式,其激活主要依赖于坏死性小体的形成。坏死性凋亡的调控受到多种因素响,RIPK1既可启动坏死性凋亡,也可抑制坏死性凋亡;caspase-8是坏死性凋亡的重要负反馈调节蛋白;CHIP是新发现的坏死性凋亡调控蛋白。坏死性凋亡的触发为对经典凋亡途径抵抗的肿瘤提供了新的治疗策略。     

Evaluating levels of dentist participation in Medicaid: A complicated endeavor

Background

The availability of dentists to care for Medicaid beneficiaries is a longstanding concern of many families and those who serve them in the dental profession as well as policy makers. Yet, little information beyond the number of enrolled dentists has been reliably determined. The American Dental Association (ADA) Health Policy Institute has called for more nuanced measures that better reflect dentistry’s contribution to the care of Medicaid beneficiaries.

The relationship between education debt and career choices in professional programs: The case of dentistry

Background

The authors examined the relationship between education debt and career choice, particularly dentists’ decisions to specialize, participate in public health insurance programs, and join dental management service organizations (DMSOs).