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1.
Pediatrics ; 149(2)2022 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-35104357

RESUMEN

The purpose of this report is to educate providers about the risk of infectious diseases associated with emerging alternative peripartum and neonatal practices. This report will provide information pediatricians may use to counsel families before birth and to appropriately evaluate and treat neonates who have been exposed to these practices.


Asunto(s)
Terapias Complementarias/tendencias , Salud del Lactante/tendencias , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Enfermedades Transmisibles/diagnóstico , Enfermedades Transmisibles/epidemiología , Enfermedades Transmisibles/transmisión , Terapias Complementarias/efectos adversos , Femenino , Humanos , Recién Nacido , Embarazo , Factores de Riesgo
2.
Am J Prev Med ; 57(4): e125-e133, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31471001

RESUMEN

INTRODUCTION: Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women. STUDY DESIGN: RCT. SETTING/PARTICIPANTS: This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013-July 2016, with data analysis in 2017-2018. INTERVENTION: Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and "Ask a Question" portal. MAIN OUTCOME MEASURES: Tdap and influenza vaccination. These outcomes were analyzed separately. RESULTS: For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. CONCLUSIONS: Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01873040.


Asunto(s)
Intervención basada en la Internet , Aceptación de la Atención de Salud/estadística & datos numéricos , Medios de Comunicación Sociales , Vacunación/estadística & datos numéricos , Adulto , Colorado , Toma de Decisiones , Vacunas contra Difteria, Tétanos y Tos Ferina Acelular/administración & dosificación , Femenino , Humanos , Vacunas contra la Influenza/administración & dosificación , Modelos Logísticos , Embarazo
3.
Acad Pediatr ; 18(8): 882-888, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30107236

RESUMEN

OBJECTIVE: To evaluate the relative use, usefulness, and facilitators and barriers to use as perceived by providers of 5 different components in a human papillomavirus vaccine communication intervention-which was found to be effective at improving human papillomavirus vaccination rates. METHODS: Four serial surveys of 108 providers (doctor of medicine, nurse practitioner, or doctor of osteopathic medicine) from intervention clinics involved in the study assessed the use and usefulness of the 5 communication intervention components during a 12-month period. RESULTS: Survey response rates were 79% to 86%. The fact sheet (64%-77%) and motivational interviewing techniques (MI; 86%) were the most used components-use was sustained during the 12-month period. These components also were perceived as somewhat or very useful by most providers, and this perceived usefulness increased over time (very or somewhat useful at end of study, 97% fact sheet, 98% MI, respectively). Although fewer providers reported using the Web site (15%-42%), or disease images (6%-17%), when these were used, most providers (67%-87%) felt they were somewhat or very useful. The decision aid was not used frequently (17%-41% of providers), and 43% of providers felt it was not very or not at all useful. Facilitators and barriers were identified for each component. The fact sheet and MI were perceived as the easiest to integrate into the clinic workflow. CONCLUSIONS: The fact sheet and MI were the most used and most useful intervention components. Both were easy to integrate into clinic workflow, and their use was sustained over time. Dissemination of similar interventions in the future should focus on these 2 specific components.


Asunto(s)
Actitud del Personal de Salud , Comunicación , Entrevista Motivacional , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Educación del Paciente como Asunto , Técnicas de Apoyo para la Decisión , Femenino , Humanos , Ciencia de la Implementación , Internet , Masculino , Enfermeras Practicantes , Médicos , Relaciones Profesional-Paciente , Mejoramiento de la Calidad , Encuestas y Cuestionarios
4.
Vaccine ; 36(35): 5273-5281, 2018 08 23.
Artículo en Inglés | MEDLINE | ID: mdl-30061026

RESUMEN

BACKGROUND: Despite safe and effective childhood immunizations, decreased acceptance of vaccines has become an emerging global problem. The WHO SAGE Working Group on Vaccine Hesitancy developed a common diagnostic tool, the Vaccine Hesitancy Scale (VHS), to identify and compare hesitancy in different global settings. We field tested the VHS in rural and urban Guatemala. METHODS: We analyzed data from the enrollment visit of a study conducted at four public health clinics in Guatemala. Infants ages 6 weeks-6 months presenting for their first wellness visit were enrolled March-November 2016. Parents completed a demographic survey that included the 10 dichotomous and 10 Likert scale VHS questions. Chi-square or Fisher's exact for categorical and ANOVA test for continuous variables were used to assess significance levels in survey differences. We conducted a factor analysis to assess the Likert scale questions. RESULTS: Of 1088 families screened, 871 were eligible and 720 (82.7%) participated. No parent had ever refused a vaccination, and only eight parents (1.1%) had been reluctant or hesitated to get a vaccination for their children. However, only 40.8% (n = 294) of parents said that they think most parents like them have their children vaccinated with all the recommended vaccines. Factor analysis identified two underlying constructs that had eigenvalues of 1.0 or greater and a substantive lack of variability in response across the Likert scale. There were consistent differences between how study clinics responded to the ordinal scaling. CONCLUSION: Our results suggest problems with interpretation of the VHS, especially in the presence of vaccine shortages and using a Likert scale that does not resonate across diverse cultural settings. Our factor analysis suggests that the Likert scale items are more one-dimensional and do not represent the multiple constructs of vaccine hesitancy. We suggest more work is needed to refine this survey for improved reliability and validity. Clinical Trial Registry: NCT02567006.


Asunto(s)
Vacunas/uso terapéutico , Adolescente , Adulto , Análisis de Varianza , Femenino , Guatemala , Humanos , Masculino , Aceptación de la Atención de Salud , Negativa del Paciente al Tratamiento , Adulto Joven
5.
Am J Obstet Gynecol ; 214(5): 617.e1-7, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-26627727

RESUMEN

BACKGROUND: There is increasing attention on immunizations by obstetrician-gynecologists and a need to improve vaccination rates for all women. OBJECTIVE: To evaluate the effect of a multimodal intervention on rates of immunization with tetanus, diphtheria, and acellular pertussis (Tdap); human papillomavirus (HPV); and influenza in outpatient obstetrics and gynecology clinics. STUDY DESIGN: Immunization rates at 2 clinics were compared pre- and post-implementation of multiple interventions at a public integrated health-care system. Study interventions began on June 6, 2012 and concluded on May 31, 2014; the preimplementation time period used was June 6, 2010 to June 5, 2012. Interventions included stocking of immunizations in clinics, revision and expansion of standing orders, creation of a reminder/recall program, identification of an immunization champion to give direct provider feedback, expansion of a payment assistance program, and staff education. All women aged 15 and older who made a clinic visit during influenza season were included in the influenza cohort; women who delivered an infant during the study time period and had at least 1 prenatal visit within 9 months preceding delivery were included in the Tdap cohort; each clinic visit by a nonpregnant woman aged 15-26 years was assessed and included in the HPV analysis as an eligible visit if the patient was lacking any of the 3 HPV vaccines in the series. The primary outcome was receipt of influenza and Tdap vaccine per current American College of Obstetricians and Gynecologists guidelines and receipt of HPV vaccine during eligible visits. Influenza and Tdap were assessed with overall coverage rates at the institutional level, and HPV was assessed at the visit level by captured opportunities. All analyses included generalized estimating equations and the primary outcome was assessed with time as a covariate in all models. RESULTS: A total of 19,409 observations were included in the influenza cohort (10,231 pre- and 9178 post-intervention), 2741 in the Tdap cohort (1248 pre- and 1493 post-intervention), and 12,443 in the HPV cohort (7966 pre- and 4477 post-intervention). Our population was largely Hispanic, English-speaking, and publicly insured. The rate of influenza vaccination increased from 35.4% pre-intervention to 46.0% post-intervention (P < .001). The overall rate for Tdap vaccination increased from 87.6% pre-intervention to 94.5% post-intervention until the recommendation to vaccinate during each pregnancy was implemented (z = 4.58, P < .0001). The average Tdap up-to-date rate after that recommendation was 75.0% (z = -5.77, P < .0001). The overall rate of HPV vaccination with an eligible visit increased from 7.1% before to 23.7% after the intervention. CONCLUSION: Using evidence-based practices largely established in other settings, our intervention was associated with increased rates of influenza, Tdap, and HPV vaccination in outpatient underserved obstetrics and gynecology clinics. Integrating such evidence-based practices into routine obstetrics and gynecology care could positively impact preventive health for many women.


Asunto(s)
Promoción de la Salud/organización & administración , Vacunación/estadística & datos numéricos , Adulto , Instituciones de Atención Ambulatoria , Colorado , Toxoide Diftérico , Práctica Clínica Basada en la Evidencia , Femenino , Ginecología , Humanos , Vacunas contra la Influenza , Obstetricia , Vacunas contra Papillomavirus , Vacuna contra la Tos Ferina , Toxoide Tetánico , Adulto Joven
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