Feasibility of video observed therapy to support controller inhaler use among children in West Baltimore.

OBJECTIVE: To assess feasibility of a novel video directly observed therapy (DOT)-based digital asthma program intended to support correct inhaled corticosteroid (ICS) use among children. METHODS: We conducted a 60-day pilot study among patients 2-18 years attending a primary care clinic with prescribed ICS and sub-optimally controlled asthma (recent hospitalization, ICS nonadherence, frequent rescue inhaler use, therapy escalation, or Asthma Control Test <20). Participants used a mobile application to receive reminders, submit videos of ICS doses (video DOT), and receive asynchronous feedback on adherence and inhaler technique. We assessed enrollment, engagement, program metrics, and user experience; adherence and inhaler errors were secondary outcomes. RESULTS: Of 26 eligible patients, 21 (81%) enrolled and submitted ≥1 video; median age was 11 years (8-15), 71% were male, 90% had Medicaid, and 62% experienced ≥1 exacerbation in the previous 6 months. Retention was 57% and 52% at week 5 and 8, respectively. Participants submitted 810 videos. Missed doses, inhaler errors (n = 247) and adherence issues (n = 107) prompted 543 communications; inadequate inspiration or holding breath were most common. Among 16 patients with engagement >7 days and >4 videos, median inhaler error rate (proportion of videos with ≥1 error) decreased from week 1 to week 2 (73% vs 8%, p ≤ 0.05) with median adherence >80%. Participants experienced the program as long, but easy to use; benefits included building routines, skill, and independence. CONCLUSIONS: This pilot study suggests high program acceptability among our cohort. High engagement with improved inhaler technique over the first 14 days suggests shorter implementation.Supplemental data for this article is available online at at.

Sexual abuse and corporal punishment during childhood: a pilot retrospective survey of university students in Costa Rica.

A sample of 497 students at the University of Costa Rica completed a survey on perceptions and experiences with various forms of punishment and experiences with sexual abuse during childhood. Spanking was shown to be the most widely accepted and most common form of discipline. The majority of the students considered most types of punishment forms of abuse. This study lacks a comparison group and cannot be generalized to the entire Costa Rican population. The section on sexual abuse demonstrated that 32% of the women and 13% of the men experienced some type of sexual abuse during childhood. The abuse mainly occurred between the ages of 5 and 10, and men were most often perpetrators.

Seroepidemiologic survey of varicella: Value of specific fluorescent antibody test.

The sensitive varicella-zoster fluorescent antibody to membrane antigen (V-Z FAMA) test was used in a seroepidemiologic survey of two outbreaks of varicella involving 30 children. The attack rate of varicella based on clinical observations alone was 60%. The attack rate based on clinical and serological observations lay between 78% and 82%, after excluding those children who had detectable antibody at the time of exposure. No subclinical varicella infection was observed in this small series of patients. No boost in antibody response was observed in immunes who were exposed to varicella. No patients with detectable V-Z antibody by FAMA at the time of exposure developed clinical varicella. The V-Z FAMA test provided helpful information about the immune status of persons exposed to varicella.

Recombinant yeast hepatitis B vaccine compared with plasma-derived vaccine: immunogenicity and effect of a booster dose.

The immunogenic effect of recombinant yeast and plasma-derived hepatitis B vaccines administered at 0, 1 and 6 months was evaluated in 334 seronegative health professionals. The seroconversion rates following 10 micrograms, 5 micrograms and 2.5 micrograms doses of recombinant vaccine were similar to those observed after 20 micrograms doses of plasma-derived vaccine. The geometric mean antibody titres (G.M.T.) induced by 10 micrograms and 5 micrograms doses of recombinant vaccine were similar to those observed after 20 micrograms doses of plasma-derived vaccine. The G.M.T. values were lowest after 2.5 micrograms doses of recombinant vaccine. However, the recipients of the 2.5 micrograms had a significant anti-HBs response after a fourth (booster) dose of recombinant vaccine was given at 12 months. A booster dose of recombinant hepatitis B vaccine was given to 31 health professionals who had been successfully immunised with plasma-derived vaccine 5-7 years previously. A significant anamnestic response was observed in 30 (97%) of these individuals in spite of the fact that 16 (52%) had low or undetectable levels of anti-HBs before the booster dose was given.

Post-exposure hepatitis B vaccination of sexual partners of acute viral hepatitis patients.

Sexual transmission of HBV was studied in a sample of 350 sporadic acute viral hepatitis type B adult patients hospitalised in the Infectious Diseases Hospital of Athens, Greece. Spouses with acute viral hepatitis type B (six in number) or asymptomatic HBsAg carriership (80 in number) were considered as the most likely sources of infection in 86 (24.6 per cent) of the 350 patients. Only 164 (46.8 per cent) spouses were susceptible to HBV and 149 agreed to participate in a double-blind, placebo-controlled, randomised trial of hepatitis B vaccine. The Merck Sharp and Dohme vaccine (20 micrograms per dose) or placebo were administered as soon as possible and repeated one and six months later. Vaccinees were interviewed, clinically examined and bled one, three, six and nine months after the first injection. HBV events (clinical hepatitis type B in seven or serological evidence of HBV infection in 15) were diagnosed in 22 vaccinees. We anticipate completing the required sample to establish the possible protective efficacy of the hepatitis B vaccine by the end of November 1982. Final results of the trial will be available early next year.

Viral hepatitis type B: prospects for active immunization.

Studies with heat-activated serum containing hepatitis B virus (MS2 strain) revealed 1) it was not infectious, 2) it was antigenic and 3) it was protectie. Acitve immunization with this preparation was associated with the detection of antibody to the hepatitis B surface antigen (anti-HBs) and no detectable core antibody (anti-HBc). In addition, various investigators have prepared a synthetic hepatitis B peptide vaccine, These findings indicate that it should be feasible to develop an inactivated hepatitis B vaccine by the use of purified hepatitis B surface antigen or one of its polypeptides.

Atypical measles syndrome: unusual hepatic, pulmonary, and immunologic aspects.

The atypical measles syndrome is a relatively new disease that was first recognized 15 years ago. Initially, it occurred in children who were exposed to wild measles virus several years after they were immunized with killed measles vaccine. It was characterized by a two- to three-day prodrome of high fever, cough, headache, and myalgia followed by a rash that resembled Rocky Mountain spotted fever, scarlet fever, or varicella and associated with roentgenographic evidence of pneumonia with or without pleural effusion. This report highlights three unusual manifestations of this syndrome: 1) transient hepatitis, 2) persistence of pulmonary lesions for several years, and 3) occurrence of excessively high measles hemagglutination-inhibition antibody titers. Today, this syndrome occurs predominantly in adolescents and young adults.

Hepatitis A and B: serologic survey of various population groups.

Seven population groups were tested by radioimmunoassay for the presence of hepatitis A antibody (anti-HAV), hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). Detection of anti-HAV was indicative of past hepatitis A infection and presence of HBsAg or anti-HBs indicated past hepatitis B infection. The results of tests of 680 serum specimens from the seven groups were as follows: (1) of 100 newly admitted children to Willowbrook where hepatitis A and B were hyperendemic, 32% had anti-HAV and 4% had anti-HAV and 4% had HBsAg (1%) plus anti-HBs (3%); (2) of 100 Willowbrook residents who lived in the institution about three or more years, 97% had anti-HAV and 90% had HBsAg (32%) plus anti-HBs (58%); (3) of 100 new Willowbrook employees, 50% had anti-HAV and 13% had anti-HBs; (4) of 100 Willowbrook employees who worked in the institution more than three years, 75% had anti-HAV and 30% had HBsAg (3%) plus anti-HBs (27%); (5) of 80 house staff physicians, 27.5% had anti-HAV and 10% had anti-HBs; (6) of 100 student 34% had anti-HAV and 6% had anti-HBs; and (7) of 100 suburban teenagers 4% had anti-HAV and 5% had anti-HBs. This study confirmed the variability of the prevalence of hepatitis A and B markers among different population groups and the effect of socioeconomic status and environmental factors on the incidence of past infection caused by hepatitis A and B viruses.

Postburn itching, pain, and psychological symptoms are reduced with massage therapy.

Twenty patients with burn injuries were randomly assigned to a massage therapy or a standard treatment control group during the remodeling phase of wound healing. The massage therapy group received a 30-minute massage with cocoa butter to a closed, moderate-sized scar tissue area twice a week for 5 weeks. The massage therapy group reported reduced itching, pain, and anxiety and improved mood immediately after the first and last therapy sessions, and their ratings on these measures improved from the first day to the last day of the study.

Burn injuries benefit from massage therapy.

Twenty-eight adult patients with burns were randomly assigned before debridement to either a massage therapy group or a standard treatment control group. State anxiety and cortisol levels decreased, and behavior ratings of state, activity, vocalizations, and anxiety improved after the massage therapy sessions on the first and last days of treatment. Longer-term effects were also significantly better for the massage therapy group including decreases in depression and anger, and decreased pain on the McGill Pain Questionnaire, Present Pain Intensity scale, and Visual Analogue Scale. Although the underlying mechanisms are not known, these data suggest that debridement sessions were less painful after the massage therapy sessions due to a reduction in anxiety, and that the clinical course was probably enhanced as the result of a reduction in pain, anger, and depression.

Mass vaccination against hepatitis B in preschool children: immunogenicity after three reduced doses.

The immunising effect of three reduced doses of Merck Sharp and Dohme (MSD) H-B Vax plasma derived vaccine delivered at monthly intervals was evaluated in 1225 four year old children. Eighteen children had evidence of previous or current infection with HBV. Of the remaining 1207 children, 1186 (98.3%) had antibody to hepatitis B surface antigen (anti-HBs) when tested by enzyme immunoassay (EIA). Levels of anti-HBs in 96 randomly selected sera were independently quantitated by radioimmunoassay (RIA) and all were positive for anti-HBs, with a geometric mean titre of 1013. There was no significant difference in seroconversion or anti-HBs levels between the groups of children nationwide. In 19 of the 39 centres, seroconversion was 100%. No centre had less than 92% seroconversion. This study confirms that three 2 microgram doses of MSD H-B Vax plasma derived vaccine given intramuscularly (IM) at monthly intervals are highly immunogenic in this paediatric population.

Low dose hepatitis B vaccination in children.

One hundred and sixty-nine children negative for hepatitis B surface antigen (HBsAg) and antibody (anti-HBs), were given three doses of hepatitis B vaccine at monthly intervals. Doses were two micrograms or four micrograms given intradermally (ID) or intramuscularly (IM). All children were tested for HBsAg, anti-HBs and antibody to hepatitis B core antigen (anti-HBc) one month after the second dose of vaccine. Overall, 74% of children on two micrograms doses and 71% of children on four micrograms doses responded to two doses of vaccine by the production of anti-HBs. At this point, mass immunisation of other susceptible children was commenced. Four of 92 (4%) three to five year old subjects and 20 of 77 (26%) nine to 12 year olds were found to be anti-HBc positive alone, indicating prior infection. All 77 older children were further tested two months after the third dose of vaccine. All 20 who were anti-HBc positive, sero-converted for anti-HBs. Of the remaining 57, 52 (91%) produced anti-HBs at acceptable geometric mean titres (GMT). Three doses of two micrograms of H-B-VAX, given at monthly intervals were chosen for mass vaccination of high risk susceptible children in this mobile community, providing over 90% sero-conversion at low cost with a minimum of side effects.

Antibody responses to recombinant, yeast-derived hepatitis B vaccine in teenage New Zealand children.

Three groups of healthy teenage New Zealand children were given 2.5 micrograms, 5 micrograms and 10 micrograms, which is the currently recommended dose, of Merck Sharp and Dohme recombinant yeast-derived hepatitis B vaccine at time 0, 1 and 6 months and tested for antibody responses to vaccine and for other hepatitis B virus markers. Seroconversion rates exceeded 98% in all three groups. Geometric mean titres (GMT) of the anti-HBs increased with higher doses. There was no significant differences in GMT between the sexes. Under the conditions of this study, 2.5 micrograms doses of this vaccine induced an excellent antibody response in children 12-14 years of age.

Hepatitis B vaccination in children: five year booster study.

AIM: to demonstrate that appropriate doses of hepatitis B vaccines would be protective for at least five years in children. This would be shown by administering booster doses and measuring the response. METHODS: 2 micrograms intramuscular (IM) doses of Merck Sharp and Dohme (MSD) recombinant DNA vaccine (rDNAV) were given to 318 children who had received age appropriate doses of MSD plasma derived vaccine (PDV) five years earlier. Sera were tested for hepatitis B virus (HBV) seromarkers pre- and postbooster. RESULTS: all children who had responsed to primary immunisation demonstrated an anamnestic response. The geometric mean titre (GMT) of antibody to hepatitis B surface antigen (antiHBs) rose from 89 to 4777 IU/L. AntiHBs was detected in 94% of vaccinees just prior to the five year booster, and 96.5% a mean of 10 days later. CONCLUSION: when initial vaccine seroconversion is satisfactory, protection of responders persists for at least five years, assuming that the response to vaccine boosters mimics the response to wild virus. Therefore, for population control of hepatitis B in children in endemic areas, booster doses are not required for at least five years.