Immunogenicity and safety of aerosolized measles vaccine: systematic review and meta-analysis.

Aerosols are the most promising non-injectable method of measles vaccination studied so far and their efficacy is thought to be comparable to injected vaccine. We conducted a systematic review up to May 2006 to examine the immunogenicity and safety of aerosolized measles vaccine (Edmonston-Zagreb or Schwarz strains) 1 month or more after vaccination. Where possible we estimated pooled serological response rates and odds ratios (with 95% confidence intervals, CI) comparing aerosolized and subcutaneous vaccines in children in three age groups and adults. We included seven randomized trials, four non-randomized trials and six uncontrolled studies providing serological outcome data on 2887 individuals. In children below 10 months, the studies were heterogeneous. In four comparative studies, seroconversion rates were lower with aerosolized than with subcutaneous vaccine and in two of these the difference was unlikely to be due to chance. In children 10-36 months, the pooled seroconversion rate with aerosolized vaccine was 93.5% (89.4-97.7%) and 97.1% (92.4-100%) with subcutaneous vaccine (odds ratio 0.27, 0.04-1.62). In 5-15-year olds the studies were heterogeneous. In all comparative studies aerosolized vaccine was more immunogenic than subcutaneous. Reported side effects were mild. Aerosolized measles vaccine appears to be equally or more immunogenic than subcutaneous vaccine in children aged 10 months and older. Large randomized trials are needed to establish the efficacy and safety of aerosolized measles vaccine as primary and booster doses.

Psychoeducation: a basic psychotherapeutic intervention for patients with schizophrenia and their families.

Psychoeducation was originally conceived as a composite of numerous therapeutic elements within a complex family therapy intervention. Patients and their relatives were, by means of preliminary briefing concerning the illness, supposed to develop a fundamental understanding of the therapy and further be convinced to commit to more long-term involvement. Since the mid 1980s, psychoeducation in German-speaking countries has evolved into an independent therapeutic program with a focus on the didactically skillful communication of key information within the framework of a cognitive-behavioral approach. Through this, patients and their relatives should be empowered to understand and accept the illness and cope with it in a successful manner. Achievement of this basic-level competency is considered to constitute an "obligatory-exercise" program upon which additional "voluntary-exercise" programs such as individual behavioral therapy, self-assertiveness training, problem-solving training, communication training, and further family therapy interventions can be built. Psychoeducation looks to combine the factor of empowerment of the affected with scientifically founded treatment expertise in as efficient a manner as possible. A randomized multicenter study based in Munich showed that within a 2-year period such a program was related to a significant reduction in rehospitalization rates from 58% to 41% and also a shortening of intermittent days spent in hospital from 78 to 39 days. Psychoeducation, in the form of an obligatory-exercise program, should be made available to all patients suffering from a schizophrenic disorder and their families.