New combination vaccines: DTaP-IPV (Kinrix) and DTaP-IPV/Hib (Pentacel).

OBJECTIVE: To evaluate the clinical utility of diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine ([DTaP-IPV]; Kinrix) and diphtheria and tetanus toxoids and acellular pertussis adsorbed,inactivated poliovirus and Haemophilus b conjugate (tetanus toxoid conjugate)vaccine ([DTaP-IPV/Hib]; Pentacel) in the schedule for pediatric immunizations. DATA SOURCES: PubMed was searched (1966-April 2009) using the key words Kinrix and Pentacel. Subject headings included vaccines, combined; diphtheria-tetanus-pertussis vaccine; diphtheria-tetanus-acellular pertussis vaccines; poliovirus vaccine, inactivated; and Haemophilus influenzae type b polysaccharide vaccine tetanus toxin conjugate. The search was limited to English-language publications involving humans. Product labeling was obtained from GlaxoSmithKline and Sanofi Pasteur. The Centers for Disease Control and Prevention (CDC) Web site was searched for relevant recommendations published June 2008-October 2009. STUDY SELECTION AND DATA EXTRACTION: Phase 2 and 3 clinical trials evaluating immunogenicity and safety of DTaP-IPV and DTaP-IPV/Hib were reviewed. Published trials were supplemented with abstracts, review articles, manufacturer product labeling, and CDC recommendations. DATA SYNTHESIS: DTaP-IPV is immunogenic compared to its component vaccines,with no effect of concomitantly administered measles, mumps, and rubella vaccine.Although injection site pain has occurred more with the combination vaccine, its use would reduce by 1 the number of injections given when a child is 4-6 years old.DTaP-IPV/Hib is immunogenic and safe compared to separate vaccines.Immunogenicity to 7-valent pneumococcal conjugate vaccine and hepatitis B(HepB) vaccine is not affected by concomitant administration. DTaP-IPV/Hib decreases injections by up to 7 when given at 2, 4, 6, and 15-18 months of age. It fits into the schedule more easily than DTaP-HepB-IPV (Pediarix), the other DTaP containing combination vaccine indicated for the primary infant series. CONCLUSIONS: DTaP-IPV and DTaP-IPV/Hib combination vaccines are immunogenic and safe when given to infants and children. They reduce the number of required injections. Combination vaccines are encouraged to promote timely vaccination and complete immunization schedules.

IMPACT survey: IMpaired fecundity in Physicians and Association with Clinical Time.

OBJECTIVE: Studies suggest female physicians experience higher rates of infertility than the general population. The overall objective of this study was to determine the rate of impaired fecundity in a sample of female emergency physicians and compare it to the Centers for Disease Control and Prevention (CDC) National Survey of Family Growth (NSFG) data. Impaired fecundity is defined as physical difficulty in getting pregnant or carrying a pregnancy to live birth. METHODS: We performed a cross-sectional survey of female emergency physicians to determine the rate of impaired fecundity. Survey questions were adapted from the NSFG to allow comparison to the general population. Statistical comparisons were made using contingency tables (with chi-square and tau-c assessments), 1-sample t tests, and independent samples t tests, as appropriate. RESULTS: A total of 2072 women completed the survey with a mean (SD) current age of 38.9 (7.2) years. Data were analyzed for women of childbearing years (15-44 years old as defined by the CDC; n = 1705 [82% total responses]). The rate of impaired fecundity in emergency physicians was 24.9% as compared to the NSFG cohort (12.1%; P < 0.001). Female emergency physicians with impaired fecundity reported working 9.8 overall more clinical hours (95% CI 2.5-17) and 4.5 more night hours (95% CI 0.8-8.2) than those with normal fecundity. CONCLUSION: Female emergency physicians have increased rates of impaired fecundity when compared with a general population cohort. Clinical workload and night shifts are greater in female emergency physicians with impaired fecundity. Research is needed to elucidate work-related impaired fecundity risk factors.

Smoking Cessation Counseling in Family Medicine: Changing Patient Perceptions.

BACKGROUND: Tobacco use causes significant morbidity and mortality. Although studies show that people who smoke cigarettes are more likely to quit when health care providers recommend cessation, many patients may not perceive that advice was given. PURPOSE: Using a survey, to determine if a provider visual cue improves patient perception that smoking cessation counseling occurred. Another objective is to evaluate effects on frequency of specific counseling elements. METHODS: This was a quasi-experimental intervention study with a pre-post test design. The intervention was a quitline reference card attached to the billing form as a prompt for providers to address smoking cessation. The patient survey included 6 elements, each assigned 1 point. The outcomes were the mean survey summary score preintervention compared to postintervention and the distribution of individual elements. RESULTS: Preintervention, 40 patients who smoke cigarettes completed the survey; 46 patients were enrolled postintervention. The groups were similar, with no significant differences in age, gender, or race/ethnicity. Mean survey summary scores pre- and postintervention were 4.1 and 5.1, respectively (P < .05). Compared with preintervention, more patients perceived the recommendation for a smoking cessation course postintervention (40% vs 83%, P < .05). No significant differences in perceptions of other counseling elements were found. CONCLUSIONS: Providing a visual cue such as a quitline card is an effective and inexpensive means of prompting a provider to discuss smoking cessation and can be easily integrated into practice. Our results indicate that this strategy improves patient perceptions of counseling with potential to improve community health through education.

Predictors of tetanus-diphtheria- acellular pertussis vaccination among adults receiving tetanus vaccine in the United States: data from the 2008 national health interview survey.

BACKGROUND . The incidence of pertussis in the United States has been increasing. Adult vaccination is important to reduce disease burden and prevent transmission to infants at high risk of complications. The tetanus-diphtheria-acellular pertussis (Tdap) vaccine has been available in the United States since 2005 and is indicated as a one-time replacement for the routine tetanus-diphtheria (Td) booster. However, among adults receiving tetanus vaccination, only about half receive Tdap. PURPOSE . To identify predictors of adult Tdap vaccination among individuals who receive tetanus vaccine. METHODS . National Health Interview Survey data from 2008 were analyzed in 2011. Respondents were 18 to 64 years old, received tetanus vaccination during 2005-2008, and were aware if it contained pertussis. Predictors of Tdap vaccination were identified with multivariate logistic regression using procedures for complex survey methods. RESULTS . Overall, 51.1% of respondents received Tdap. Vaccination was less likely for those 50 to 64 years old compared with those 18 to 24 years old (odds ratio [OR] = 0.61, 95% confidence interval [CI] = 0.38-0.96). Some college education was associated with higher odds of vaccination compared with lower education levels (OR = 1.55, 95% CI = 1.16-2.07). Having 2 to 3 office visits (OR = 2.01, 95% CI = 1.32-3.06) or 4 to 9 office visits (OR = 1.60, 95% CI = 1.06-2.42) in the previous year increased the odds of vaccination compared with no visits. Individuals with functional limitation due to illness had lower odds compared with no limitation (OR = 0.70, 95% CI = 0.54-0.91). CONCLUSIONS . In 2008, 51.1% of adult Td vaccinations included pertussis, suggesting continued efforts to remove barriers are needed. Interventions should target older, functionally impaired, and educationally disadvantaged populations.

Smoking cessation in family medicine: effects of an area health education center training program.

BACKGROUND AND OBJECTIVES: Many clinicians have not received adequate training in smoking cessation. We examined the effects of a tobacco training program on clinician behavior, attitudes, knowledge, and comfort related to smoking cessation. METHODS: In a prospective cohort study, family medicine residents and faculty completed a pretest, followed by an educational intervention that encompassed presentations on smoking cessation resources, motivational interviewing, and the neurobiology of addiction and pharmacotherapy. After 3 months, participants completed a postintervention survey. Results were analyzed using chi-square tests to examine the effects of training. RESULTS: Thirty-three residents and faculty completed the pretraining survey and 25 completed the posttraining survey. Following training, participants were more familiar and comfortable with Public Health Service Clinical Practice Guidelines (P < .0001). No significant differences were found in performance of the 5 As (Ask, Advise, Assess, Assist, and Arrange) or other behaviors, including providing assistance with counseling, cessation plans, resources, or pharmacotherapy. There were no improvements in knowledge of specific intervention plans or attitudes related to identifying and counseling smokers. CONCLUSION: A multidisciplinary tobacco training program increases clinician familiarity and comfort with practice guidelines, and may contribute to improving care activities that promote a healthy lifestyle. Future research should explore other interventions that have the potential of changing practice patterns on a larger scale. Future studies should also assess the effect of training programs on patient-oriented outcomes.