Changes in Influenza Vaccination Rates After Withdrawal of Live Vaccine.

BACKGROUND: Before the start of the 2016-2017 influenza season, the Advisory Committee on Immunization Practices withdrew its recommendation promoting the use of live attenuated influenza vaccines (LAIVs). There was concern that this might lessen the likelihood that those with a previous LAIV would return for an injectable influenza vaccine (IIV) and that child influenza immunization rates would decrease overall. METHODS: Using Oregon's statewide immunization registry, the ALERT Immunization Information System, child influenza immunization rates were compared across the 2012-2013 through 2016-2017 seasons. Additionally, matched cohorts of children were selected based on receipt of either an LAIV or an IIV during the 2015-2016 season. Differences between the IIV and LAIV cohorts in returning for the IIV in the 2016-2017 season were assessed. RESULTS: Overall, influenza immunization rates for children aged 2 to 17 years were unchanged between the 2015-2016 and 2016-2017 seasons. Children aged 3 to 10 with a previous IIV were 1.03 (95% confidence interval, 1.02 to 1.04) times more likely to return for an IIV in 2016-2017 than those with a previous LAIV, whereas children aged 11 to 17 years with a previous IIV were 1.08 (95% confidence interval, 1.05 to -1.09) times more likely to return. CONCLUSIONS: Withdrawal of the LAIV recommendation was not associated with an overall change in child influenza immunization rates across seasons. Children with a previous (2015-2016) IIV were slightly more likely to return during the 2016-2017 season for influenza immunization than those with a previous LAIV.

Cognitive deficits are associated with functional impairment in severely depressed patients.

Cognitive deficits have been associated with poorer function and quality of life (QOL) in schizophrenia, but no similar findings have been confirmed in persons with major depressive episode (MDE). We investigated whether cognitive deficits were associated with detrimental effects on the QOL of persons with primary MDE. Seventy-seven non-demented adults with MDE underwent evaluations of mood, cognition and QOL. Cognition was assessed with the Mini-Mental State Exam, and delayed recall on the Rey Auditory Verbal Learning Task and the Rey Figure. QOL assessments included instrumental activities of daily living (IADL), activities of daily living (ADL), and satisfaction in role functioning and relationships. Univariate correlation and regression models were used to find those mood and cognitive variables most closely related to each QOL dimension. ADL function and satisfaction with role functioning and relationships were most closely related to depression severity and age. IADL functioning, however, was most closely associated with global cognition. This study did not take into account the physical health of the participants, and all the participants were seriously ill with depression. Thus, the results may not apply to persons with less severe MDE. Antidepressant treatments that preserve or enhance global cognition in addition to relieving core depressive symptoms may lead to the best functional outcomes.

Stability over time of patients' attitudes toward ECT.

This study examined the stability of patients' attitudes toward electroconvulsive therapy (ECT). Surveys were administered to 64 study participants at 2 and 4 weeks post treatment. The survey responses were highly significantly correlated and not significantly different, which suggests that attitudes toward ECT are stable during this time.

Proxy validation of patient self-reports of ADL and IADL function before and after electroconvulsive therapy.

OBJECTIVE: To determine whether electroconvulsive therapy (ECT) patients' self-reported functional status is similar to that reported by a proxy. BACKGROUND: Increasing levels of depression are associated with deteriorating functional status as reflected in the Instrumental Activities of Daily Living (IADL) scale. Depressed patients referred for ECT have poorer IADL status compared with depressed patients receiving medications, suggesting that IADL status may shape physicians' decision to recommend ECT ( 1). Further, IADL status improves with treatment of depression, both in ECT-and medication-treated patients. Given the potential importance of IADL status for ECT patients, we examined whether IADL status as reported by patients prior to ECT was comparable to IADL status as described by a proxy. DESIGN/METHODS: Forty depressed patients (23 men and 17 women, mean age 58.1 +/- 17.5) were each interviewed alone with the 21-item Hamilton Depression Rating Scale (HDRS), Mini-Mental State Exam (MMSE), an Activities of Daily Living (ADL) scale, and an IADL scale. We then privately interviewed a first-degree relative who lived with each patient and recorded their impression of the patient's ADL and IADL function before ECT, and at 2 and 4 weeks after ECT. RESULTS: baseline scores for HDRS and MMSE were consistent with a severe level of depressive symptoms and intact global cognitive function. Patients' and proxies' IADL scores were highly correlated before ECT, 2 weeks after ECT, and 4 weeks after ECT. Significant, but slightly weaker correlations were seen for ADL scores. CONCLUSIONS: Ideally, ADL and IADL function would be measured by direct observation rather than either patient or proxy report. At this time it is unknown whether the patient or the proxy report should be considered the "gold standard." In this study, the patients' self-reported functional scores were highly correlated with the proxies' scores. We conclude that patients' reports of their function are roughly comparable to proxies' impressions before and after ECT.