A co-designed evaluation study to identify Breastfeeding Knowledge of General Practitioners' and Practice Nurses'.

The World Health Organization and American Academy of Paediatrics recommend exclusive breastfeeding until 6 months of age, with continued breastfeeding along with complementary solid foods for up to 2 years and beyond. Despite the well-established importance of breastfeeding, Irish rates remain the lowest in Europe. Healthcare professionals' breastfeeding knowledge and skills have a positive impact on increasing breastfeeding rates. There is limited evidence of the knowledge, attitudes or practices of general practitioners (GPs) and general practice nurses (GPNs), which is essential to breastfeeding in Ireland. The aim of this study was to evaluate the breastfeeding knowledge, attitudes and practices of GPs and GPNs in one community healthcare organisation (CHO) in Ireland. A co-designed evaluation study was used following low-risk ethical exemption (LS-LR-22-161). A modified version of a validated breastfeeding questionnaire was developed. A Project Steering Committee was established that included patient, and public involvement stakeholders. The anonymised survey was distributed via online Qualtrics platform (November 2022-February 2023). STROBE Guidelines were utilised. The overall response rate was 25.9% (n = 121) and valid responses were reported in the article. The total population size was n = 468 (GPs n = 290 and GPNs n = 178). Our pilot study identified that 42.7% (n = 47/110) of respondents never attended a breastfeeding education programme, and 53.9% (n = 55/102) identified that their knowledge could be improved. The majority of respondents, 92.9% (n = 92/99) wish to complete further education in breastfeeding. The results of this pilot study in one CHO in Ireland indicate a gap in knowledge and a need for specific breastfeeding and lactation theoretical and skills training for GPs and GPNs working in primary care to support, promote and protect breastfeeding.

Decline in Child Vaccination Coverage During the COVID-19 Pandemic - Michigan Care Improvement Registry, May 2016-May 2020.

On March 13, 2020, the United States declared a national state of emergency to control the pandemic spread of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1). Public health response measures to mitigate the pandemic have centered on social distancing and quarantine policies, including shelter-in-place and stay-at-home orders. Michigan implemented a stay-at-home order on March 23, 2020, to facilitate social distancing (2). Such strategies might result in decreased accessibility to routine immunization services, leaving children at risk for vaccine-preventable diseases and their complications (3). To evaluate whether vaccination coverage has changed during the pandemic, data from the Michigan Care Improvement Registry (the state's immunization information system) (MCIR) were analyzed. Changes in vaccine doses administered to children and the effects of those changes on up-to-date status were examined for vaccinations recommended at milestone ages corresponding to the end of an Advisory Committee on Immunization Practices (ACIP) recommendation period for one or more vaccines (4).

Factors associated with human immunodeficiency virus screening of women during pregnancy, labor and delivery, United States, 2005-2006.

The purpose of this study was to estimate prenatal human immunodeficiency virus (HIV) screening rates prior to and on admission to labor and delivery (L&D) and to examine factors associated with HIV screening, including hospital policies, with a comparison of HIV and hepatitis B prenatal screening practices and hospital policies. In March 2006, a survey of hospitals (n = 190) and review of paired maternal and infant medical records (n = 4,762) were conducted in 50 US states, DC, and Puerto Rico. Data from the survey and medical record review were analyzed using SAS software v9.2 (SAS Institute, Cary, NC). HIV testing before delivery occurred among 3,438 women (73.9%); African American and Hispanic women were more likely to be tested than white women [aOR 2.22, 95% CI (1.6-3.1) and aOR 1.55, 95% CI (1.1-2.2), respectively]. Among women without previous HIV testing, 138 (16.6%) were tested after admission to labor and delivery. Policies to test women with undocumented HIV status in at delivery were present in 65 (36.3%) hospitals. HIV testing after admission to L&D was more likely in hospitals with policies to test women with undocumented HIV status [aOR 5.91, 95% CI (2.0-17.8)]. Overall, policies and screening practices for HIV were consistently less prevalent than those for hepatitis B. Many women are not being routinely screened for HIV before or at delivery. Women with unknown HIV status were more likely to be tested in L&D in hospitals with testing policies.

Pulmonary Cryptococcosis: A Diagnostic and Management Challenge Case Report.

Cryptococcosis is a fungal infection that may arise in immunocompromised or immunocompetent individuals. This case report seeks to demonstrate the difficulty in diagnosing and treating cryptococcosis based on clinical presentation and radiographic features as together, they mimic other pathological conditions. A 56-year-old female with cirrhosis presented with persistent abdominal pain, dyspnea, vomiting, and diarrhea and was diagnosed with pulmonary cryptococcosis after an initial diagnosis of bacterial pneumonia. With no improvement following antibiotic therapy for suspected bacterial pneumonia, additional imaging was performed with a confirmatory lung biopsy for pulmonary cryptococcosis. The patient initiated antifungal therapy with the anticipation of completing approximately 12 months with follow-up imaging to evaluate improvement. After the patient experienced adverse effects of antifungal therapy and did not achieve significant improvement or recovery in her condition, it was apparent that cryptococcal pneumonia presents both diagnostic and management challenges that must be further explored.

An Evaluation of Knowledge and Comfort in Discussing the Human Papillomavirus (HPV) Vaccine Among a Sample of Physicians Practicing in South Carolina.

Objective To determine knowledge and comfort in discussing the human papillomavirus (HPV) vaccine among a sample of physicians practicing in South Carolina. Methods This descriptive cross-sectional study utilized a 33-question survey assessing knowledge of HPV, the HPV vaccine, and comfort in discussing associated topics with patients among a sample of physicians across the state of South Carolina. Descriptive and correlational analyses were performed. Results Of the total 66 participants, most self-reported having sufficient knowledge about HPV, yet responses to fact-based questions yielded an average score of only 7.03/13. Most felt comfortable discussing HPV, while some reported discomfort discussing sex-related topics (3.6%). A positive significant correlation was determined between having sufficient knowledge of HPV and comfort levels discussing both HPV and sex-related topics ((p-value < 0.001), (p = .0028)), comfort levels discussing HPV and comfort levels discussing sex (p = .0030), and comfort level discussing sex and previous communication training (Mantel-Haenszel chi-square = 0.0447). Conclusions The results of this study support the role of future interventions aimed at increasing the HPV knowledge base and training in discussions of sex for providers to help increase HPV vaccination rates in South Carolina.

The role of National Immunization Technical Advisory Groups in advising COVID-19 immunization policy during the pandemic: lessons from the Federation of Bosnia and Herzegovina.

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of experts that provides evidence-based recommendations on immunizations to policy-makers to assist them in making immunization policy and program decisions. NITAGs faced challenges in making evidence-based recommendations for COVID-19 vaccines during the COVID-19 pandemic due to the new vaccine products available in a short time period and limited available data on vaccine effectiveness and vaccine safety. The authors reviewed the process used by the NITAG in the Federation of Bosnia and Herzegovina, called the expert body, to develop COVID-19 vaccine recommendations. The article reviews the evidence that was considered by the expert body when developing 23 recommendations on COVID-19 vaccination and describes the challenges and successes faced by the body. The expert body recommendations led to the successful roll-out of COVID-19 vaccines and provided guidance for COVID-19 vaccination during the pandemic. The expert body plans to improve its work and procedures for developing routine immunization recommendations with the support of the WHO Regional Office for Europe.

The Effectiveness of a Mobile Health Clinic Delivering Mandatory and Elective Middle School Immunizations: A Descriptive Analysis.

INTRODUCTION: Mobile health clinics serve a unique role in which they can offer affordable and adaptable care to the population they serve. The Edward Via College of Osteopathic Medicine (VCOM) mobile clinics began in 2020 as a partnership with the South Carolina Department of Health and Environmental Control (SCDHEC) to address the low vaccination rates that resulted from the COVID-19 pandemic. METHODS:  This study is a descriptive analysis that examines the number of vaccinations of tetanus, diphtheria, and pertussis (Tdap) and human papillomavirus (HPV) at different locations of administration including pediatrician offices, the novel VCOM mobile vaccination clinic, and the Spartanburg Health Department. The variables of interest and the study endpoints focused on Tdap and HPV vaccinations among students aged 11-12 years old in Spartanburg County according to the type of healthcare delivery location. RESULTS: From April to May of 2021, the VCOM mobile clinic was able to administer 279 Tdap vaccines and 189 HPV vaccines to students at local middle schools, which surpasses the number of vaccines administered at other sites from August 2020 to May 2021 when compared individually for both Tdap and HPV vaccinations. CONCLUSIONS: By assessing the total volume of vaccines administered by each group, the VCOM mobile clinic was established as an effective method of delivery and played a crucial role in the vaccination efforts of the Spartanburg community. Mobile medical units should be considered for similar efforts in providing care to resource-limited communities and those with limited access to care.

Developing COVID-19 vaccine recommendations during the pandemic: The experience of Serbia's Expert Committee on Immunization.

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of national experts that provide evidence-based recommendations to policy-makers to assist them in making informed immunization policy and programme decisions. During the COVID-19 pandemic, NITAGs faced many challenges in making evidence-based recommendations for COVID-19 vaccines due to the rapidly evolving situation with new vaccine products available in a short time period and limited data on vaccine effectiveness. The authors reviewed the process used by Serbia's NITAG, which is called the Serbian Expert Committee on Immunization, to develop COVID-19 vaccine recommendations during the pandemic. The article examines the challenges and successes faced by the committee. Serbia's expert committee used the best available evidence to develop over forty recommendations on all aspects of COVID-19 vaccination. These expert committee recommendations facilitated the early procurement and successful roll-out of COVID-19 vaccines, guidance for vaccination of individuals at the highest risk, and high COVID-19 vaccination coverage in the country. The availability of five COVID-19 vaccines in Serbia was an advantage for the successful roll-out but posed challenges for the expert committee. Serbia's expert committee plans to use the experience and best practices developed during the pandemic to improve and expand its work moving forward.

Supporting National Immunization Technical Advisory Groups in the WHO European Region in developing national COVID-19 vaccination recommendations through online communication platform.

National Immunization Technical Advisory Groups are groups of multi-disciplinary experts that provide scientific advice to policy makers to enable them to make informed immunization policy and programme decisions. NITAGs faced challengesusing their routine approach to develop recommendations for COVID-19 vaccines during the pandemic. In response, the WHORegional Office for Europe (Regional Office), with the support of theRobert Koch Institute, developedan innovative approach of a series of webinars, provision of materials, and remote technical assistance to address these challenges. Polls conducted during webinars were used to tailor future webinars and evaluate the effectiveness of these interventions. According to poll results, 76% of participants found the webinars and resources shared very useful in their work on COVID-19 vaccination.The Regional Office plans to build further upon the scope of online communication and establish a regional online platform for NITAGs to further support NITAGs and build capacity.

Building immunization decision-making capacity within the World Health Organization European Region.

A National Immunization Technical Advisory Group (NITAG) is a multi-disciplinary body of national experts that provides evidence-based recommendations to policy-makers, assisting them in making sound immunization policy and programme decisions. The World Health Organization (WHO) Regional Office for Europe is working to strengthen the capacity of newly-established NITAGs and has targeted efforts on low- and middle-income countries. The Regional Office, in collaboration with WHO Headquarters and USA Centers for Disease Control and Prevention (CDC), developed a new training strategy and held training workshops to improve NITAGs' functioning and ability to make evidence-based recommendations. Feedback from countries that participated in trainings indicated that the updated training materials and interactive approach with follow-up technical support enabled them to align their NITAG charters and processes with WHO recommendations. To ensure continued progress, global and regional partners such as WHO and CDC should continue providing technical support to recently established NITAGs.

We Are Caregivers: Social Identity Is Associated with Lower Perceived Stress among Rural Informal Caregivers.

ABSTRACTInformal caregivers often experience high stress levels with little support, especially in rural settings. With a mixed-methods approach, this research explored experiences of rural informal caregivers, including how social identification as a caregiver, social interactions, and formal and informal coping support related to perceived stress. Major focus group themes (n = 8) included lacking available services, balancing challenges, unmet practical needs, and strong community identity. Survey data (n = 22) revealed that perceived coping support (e.g., having someone to turn to), social interactions, and caregiver identity (e.g., perceiving the role as important to one's self-concept) were associated with lower life upset stress, but only caregiver identity was associated with managing the personal distress and negative feelings associated with caregiving stress. Results suggest that, although available rural services may fall short, other options might alleviate caregiver stress, including facilitating access to coping support, encouraging social interactions, and enhancing caregiver social identity.

Spatial and temporal aspects of alcohol-related crime in a college town.

OBJECTIVE: The authors aimed to clarify crime "movement" through the city of Madison to focus efforts to address consequences of student drinking. The authors examined all crime reported by police during the 2003 year. METHODS: Using geographical information system (GIS) mapping and 2003 crime data from the University of Wisconsin-Madison and the city of Madison, the authors investigated the relationships among high-density alcohol outlets and various city neighborhoods. RESULTS: Different categories of crime showed different temporal and spatial patterns: Serious crimes peaked between 2 and 3AM, coinciding with bar closing time. Less serious crimes peaked between 11PM and midnight. Reports of vandalism peaked in the morning and afternoon. "Hotspots" for different crimes moved throughout the downtown. Results were consistent with problems associated with high-risk student drinking in college communities. CONCLUSION: These results and maps generated by GIS led directly to changes made by city and university officials to address high-risk drinking.

LASER-tissue interactions.

As new laser devices continue to emerge, it becomes increasingly important for the clinical dermatologist to understand the basic principles behind their operation. A fundamental understanding of how lasers interact with tissue will enable the physician to choose the most appropriate laser for a given clinical situation. Although the physical laws guiding laser design are vastly complex, the fundamental principles of laser-tissue interaction can be summarized as they are applicable to the clinician.

Factors Associated With Excessive Gestational Weight Gain: Review of Current Literature.

BACKGROUND: Excessive gestational weight gain (EGWG) places women at increased risk for complications during pregnancy and also increases the likelihood that they will remain overweight after pregnancy. The Institute of Medicine (IOM) has recommended weight gain guidelines based on pre-pregnancy body mass index (BMI), but evidence-based strategies to achieve these goals are limited. OBJECTIVE: This review discusses factors associated with EGWG with the goal of identifying targets for future intervention. METHODS: A search was performed using the PubMed database to identify all English-language papers published between 1995 and 2014 related to excessive weight gain in pregnancy. Papers were grouped by theme: preconception BMI, sociodemographics, diet and exercise, psychosocial characteristics, and type of prenatal care. RESULTS: Studies found that women who were overweight or obese at the time of conception were at higher risk of EGWG and that increased physical activity protected against EGWG. Studies on diet and sociodemographic characteristics were inconclusive. Psychological factors, specifically accurate perceptions of BMI, also appear to play a role in EGWG. Limited studies on methods of prenatal care delivery did not show improvement of weight parameters with group compared to one-on-one visits. CONCLUSION: Pre-pregnancy BMI is most strongly associated with EGWG, indicating that healthy weight habits throughout adult life may be especially important in periods of expected weight change, such as pregnancy. To decrease EGWG, providers should focus on improving pre-conception BMI through appropriate counseling on healthy eating and increased physical activity as well as encouraging pregnant women to continue moderate exercise during pregnancy when appropriate.

Doxycycline-induced photo-onycholysis.

An uncommon manifestation of phototoxicity, photo-onycholysis results in the separation of the distal nail from the nail bed. Photo-onycholysis may follow the use of various medications or may occasionally be idiopathic. We present a case of photo-onycholysis in a patient treated with doxycycline for acne vulgaris.

The effect of silicone gel on basic fibroblast growth factor levels in fibroblast cell culture.

BACKGROUND: Topical silicone gel has shown promise in the treatment of hypertrophic and keloid scars. However, its mechanism of action remains undetermined. OBJECTIVE: To investigate whether the presence of silicone alters the secretion of basic fibroblast growth factor (bFGF), a key cytokine involved in the scar formation process. DESIGN: Serum-free fibroblast cell cultures were established from normal, keloid, and fetal skin, which heals without scarring, and exposed to silicone gel. Serial cell counts were performed, and supernatants were collected for bFGF quantification by enzyme-linked immunosorbent assay at 4, 24, 72, and 120 hours. RESULTS: Growth curves were similar and no statistically significant differences in population doubling times were observed between treated and untreated specimens. Statistically significant differences in bFGF levels between treated and untreated normal fibroblasts were observed at 24, 72, and 120 hours after cell culture initiation. Differences in bFGF levels between treated and untreated fetal fibroblasts that approached statistical significance were observed at 72 and 120 hours. CONCLUSIONS: These results suggest that silicone gel is responsible for increased bFGF levels in normal and fetal dermal fibroblasts. We postulate that silicone gel treats and prevents hypertrophic scar tissue, which contains histologically normal fibroblasts, by modulating expression of growth factors such as bFGF. Our data support the hypothesis that substances that favorably influence wound healing do so by correcting a deficiency or overabundance of the growth factors that orchestrate the tissue repair process.

Clinical skills for nurses in medical assessment units.

AIM: To identify the skills possessed by nurses working in medical assessment units (MAUs) and those that are needed to enable them to undertake a detailed, holistic assessment of the patient. METHOD: A qualitative study was undertaken using mixed methods to obtain data. A postal survey using Delphi methodology was sent to a group of advanced nurse practitioners educated at master's degree level. Four focus groups were conducted with 38 qualified nurses working in a MAU. FINDINGS: The first round of the Delphi survey identified 27 skills deemed pertinent to nurses working in this setting. A second round resulted in 11 skills and a further five skills for the most senior nurses were identified by the postal survey participants. Focus groups also identified skills that nurses working in MAUs should possess. There was widespread agreement between participants that the degree of expertise pertaining to each skill would be dependent on their experience in the clinical area and would reflect their seniority. CONCLUSION: There is broad agreement between a body of expert opinion and staff working in a MAU that there are core skills nurses working in MAUs should possess. The author plans to use the results of the study to develop future training in the MAU.

The national Perinatal Hepatitis B Prevention Program, 1994-2008.

OBJECTIVE: To determine the trends and outcomes of the national Perinatal Hepatitis B Prevention Program (PHBPP) for infants born from 1994 to 2008. METHODS: PHBPPs in state and city public health jurisdictions annually submitted program outcome reports to the Centers for Disease Control and Prevention. The annual number of births to hepatitis B surface antigen (HBsAg)-positive women was estimated and used to evaluate the percentage of PHBPP-identified HBsAg-positive pregnant women. PHBPP reports were used to assess program objectives achieved, and infant outcomes by 12 to 24 months of age. RESULTS: From 1994 to 2008, the estimated number of annual births to HBsAg-positive women increased from 19 208 to 25 600 (P < .001). The annual number of PHBPP-managed infants increased (P < .001), comprising 40.8% to 50.5% of the estimated number. On average, 94.4% of PHBPP-managed infants received hepatitis B immunoglobulin and hepatitis B vaccine within 1 day of birth. The percentage of infants who completed the vaccine series by age 12 months decreased from 86.0% to 77.7% (P = .004), but the percentage who received postvaccination testing increased from 25.1% to 56.0% (P < .001). Incidence of chronic hepatitis B virus infection among tested infants decreased from 2.1% in 1999 to 0.8% in 2008 (P = .001). CONCLUSIONS: The PHBPP achieved substantial progress in preventing perinatal hepatitis B virus infection in the United States, despite an increasing number of at-risk infants. Significant gaps remain in identifying HBsAg-positive pregnant women, and completing management and assessment of their infants to ensure prevention of perinatal hepatitis B virus transmission.