Improving influenza vaccination rates in children with asthma: a test of a computerized reminder system and an analysis of factors predicting vaccination compliance.

Fewer than 10% of children with moderate or severe asthma receive an annual influenza vaccination despite their heightened susceptibility to severe infections and recommendations by the American Academy of Pediatrics and the Immunization Practices Advisory Committee that all such children be vaccinated annually. Patient, provider, and system factors leading to this poor vaccination rate are not well understood. This study tested the effectiveness of a computerized reminder system in improving influenza vaccination rates in children with asthma and examined patient barriers to vaccination at one pediatric clinic in an urban teaching hospital. A computer database identified 124 children with moderate or severe asthma. Patients were randomly assigned either to study group (n = 63), who were sent a personalized letter reminder about the need for an influenza vaccination, or to a control group (n = 61), who received no reminder. Study group mothers were interviewed 2 months after the letter was sent to assess factors associated with receipt of vaccination, including demographic features, parental worry about asthma and vaccine side effects, the four dimensions of the Health Belief Model, and health locus of control beliefs. Nineteen study group patients (30%) received an influenza vaccination, compared with only 4 control patients (7%) (P < .01). Forty-three mothers of children in the study group were interviewed; 14 (33%) of these children had received the vaccination. Of the characteristics investigated, two significantly correlated with vaccination compliance: high levels of parental worry about asthma (positively correlated: odds ratio = 23.3, P < .01) and high levels of parental worry about vaccine side effects (negatively correlated: odds ratio = 0.087, P = .025).(ABSTRACT TRUNCATED AT 250 WORDS)

Developmental issues and the choice of feeding method of adolescent mothers.

Approximately one million teenagers become pregnant each year, resulting in over 600,000 live births. An exploratory study was conducted to look at attitudes of adolescent mothers toward breastfeeding. Striking differences were found in the responses between groups of breastfeeding and bottlefeeding mothers. The effect of developmental needs and levels on the choice of feeding method was explored.

Adolescent cognitive and contraceptive behaviors.

PIP: Sexually active teenage girls tend to wait at least a year before commencing contraceptive use, but half of all adolescent pregnancies occur within 6 months of the onset of sexual activity. To promote contraceptive use among adolescents and prevent unwanted pregnancy, an understanding of adolescent cognitive development is necessary. It has been suggested that many teenagers become pregnant not as a result of a lack of information, but because they lack the cognitive and behavioral skills needed to use the information. The major cognitive task in adolescence--formal operational thinking--involves the ability to analyze situations and hypothesize outcomes. According to Paiget, the capacity to imagine the future and act accordingly begins to emerge at about 11 years of age. However, many teenagers fail to develop this ability to think beyond the present and remain immersed in sexual fantasies when it comes to the area of sexuality. Since they are unable to conceptualize pregnancy and childbearing, they fail to use contraception. Moreover, adolescents commonly believe that they are not at risk of pregnancy the 1st few times they have sexual intercourse and are generally immune from the negative consequences of personal actions. Group discussions and role playing appear to be particularly effective tools to help adolescents speculate on the possible results of engaging in various sexual behaviors and stimulate cognitive development to advance from a concrete to a formal operational level.^ieng

Assessment and management of the developmentally delayed infant in primary care.

Developmental delay is common, and early identification is important. This article discusses the nurse practitioner's role in the assessment and management of the developmentally delayed infant. Assessment procedures and tools are described. Current controversies regarding early assessment and intervention are discussed. Research on early intervention programs for both the environmentally deprived and the biologically impaired infant is reviewed, and guidelines for the evaluation of these programs are given. Management issues and the nurse practitioner's role in the ongoing care of these infants are discussed.

Applying research in practice: parenting the premature infant.

As the survival rate for premature infants increases, studies examining the interaction of parents with their premature infants have begun to appear in the literature. This review of the research can guide nurses in a variety of settings in clinical intervention strategies with these families.

Parental thinking: assessment and applications in nursing.

Recent research indicates that knowledge of what a parent thinks may be more valuable information than observations of what a parent does. Therefore, maternal-child nurses should have a sound knowledge about not only specific behaviors that promote good parenting but also parental thinking, or the ideas parents hold about child rearing and child development. The authors present the importance of the nursing role in assessment of parental thinking, utilization of an appropriate framework for these assessments, and the considerations of nursing interventions that build on such assessments.

Evaluation of New York State's Child Health Plus: children who have asthma.

BACKGROUND: Little is known about the impact of providing health insurance to uninsured children who have asthma or other chronic diseases. OBJECTIVES: To evaluate the association between health insurance and the utilization of health care and the quality of care among children who have asthma. DESIGN: Before-and-during study of children for a 1-year period before and a 1-year period immediately after enrollment in a state-funded health insurance plan. INTERVENTION: In 1991 New York State implemented Child Health Plus (CHPlus), a health insurance program providing ambulatory and ED (ED), but not hospitalization coverage for children 0 to 12.99 years old whose family incomes were below 222% of the federal poverty level and who were not enrolled in Medicaid. SUBJECTS: A total of 187 children (2-12.99 years old) who had asthma and enrolled in CHPlus between November 1, 1991 and August 1, 1993. MAIN OUTCOME MEASURES: Rates of primary care visits (preventive, acute, asthma-specific), ED visits, hospitalizations, number of specialists seen, and quality of care measures (parent reports of the effect of CHPlus on quality of asthma care, and rates of recommended asthma therapies). The effect of CHPlus was assessed by comparing outcome measures for each child for the year before versus the year after CHPlus enrollment, controlling for age, insurance coverage before CHPlus, and asthma severity. DATA ASCERTAINMENT: Parent telephone interviews and medical chart reviews at primary care offices, EDs, and public health clinics. MAIN RESULTS: Visit rates to primary care providers were significantly higher during CHPlus compared with before CHPlus for chronic illness care (.995 visits before CHPlus vs 1.34 visits per year during CHPlus), follow-up visits (.86 visits vs 1.32 visits per year), total visits (5.69 visits vs 7.11 visits per year), and for acute asthma exacerbations (.61 visits vs 0.84 visits per year). There were no significant associations between CHPlus coverage and ED visits or hospitalizations, although specialty utilization increased (30% vs 40%; P =.02). According to parents, CHPlus reduced asthma severity for 55% of children (no change in severity for 44% and worsening severity for 1%). Similarly, CHPlus was reported to have improved overall health status for 45% of children (no change in 53% and worse in 1%), primarily attributable to coverage for office visits and asthma medications. CHPlus was associated with more asthma tune-up visits (48% before CHPlus vs 63% during CHPlus). There was no statistically significant effect of CHPlus on several other quality of care measures such as follow-up after acute exacerbations, receipt of influenza vaccination, or use of bronchodilators or antiinflammatory medications. CONCLUSIONS: Health insurance for uninsured children who have asthma helped overcome financial barriers that prevented children from receiving care for acute asthma exacerbations and for chronic asthma care. Health insurance was associated with increased utilization of primary care for asthma and improved parent perception of quality of care and asthma severity, but not with some quality indicators. Although more intensive interventions beyond health insurance are needed to optimize quality of asthma care, health insurance coverage substantially improves the health care for children who have asthma.