Influenza Vaccination, Self-reported Illness, and Obstacles for Vaccination Among the 2010 ROTC Warrior Forge Cadet Cohort.

INTRODUCTION: This study evaluates a large cohort of college students after the 2009-2010 pandemic H1N1 influenza season. The objective was to assess influenza vaccination status, influenzalike illnesses (ILIs), and other characteristics associated with attaining immunizations. METHODS: This study was conducted during the summer 2010 the Reserve Officer Training Corps Leadership Development and Assessment Course involving 6272 college students. A voluntary, anonymous questionnaire was administered to assess study objectives. RESULTS: Vaccination rates were 39.9% for pandemic H1N1, 40.6% for seasonal influenza, and 32.6% for receiving both vaccinations. Age less than 25 and having a Reserve Officer Training Corps scholarship were associated with lower odds of receiving vaccinations, whereas entering the nursing field and simultaneous membership in the Army reserve forces were associated with higher odds of vaccination. There are 11.2% of respondents reported having an ILI, including 4.3% with severe ILI. There were 4184 reasons indicated for not attaining influenza vaccinations, which are listed in categorical groupings. CONCLUSIONS: A historical anchor for vaccination rates and ILI is provided in a large cohort of college students following the 2009 H1N1 influenza pandemic. Influenza immunization locations were determined, as was self-reported obstacles to receiving vaccinations. These are important results for public health leaders seeking to increase vaccination rates during future influenza seasons.

Respiratory illnesses at the 2009 U.S. Army ROTC Advanced Camp.

Every summer the U.S. Army Reserve Officer Training Corps (ROTC) conducts the Leader Development Assessment Course (LDAC) for several thousand upcoming senior-year cadets. This study describes respiratory illnesses at 2009 ROTC LDAC after the emergence of the novel H1N1 influenza pandemic. This retrospective cohort study examines 5554 cadets and 1,616 cadres from 2009, and 5180 LDAC 2008 cadets. Respiratory clinic visits for 2009 cadets were higher than 2009 cadres and 2008 cadets, at 8.7, 2.0, and 4.2 visits per 1000 person-days available, respectively (p < 0.001). Further, respiratory illness hospitalizations and isolations were higher for 2009 cadets than cadres (p = 0.020). Although substantial efforts were made to prevent respiratory infections, there was considerable impact from respiratory illnesses, in the context of the novel H1N1 influenza pandemic, among 2009 ROTC LDAC participants. Our experience offers important lessons for future LDAC planning and for similar close quarters living circumstances.

Prenatal breastfeeding education and breastfeeding outcomes.

PURPOSE: To examine the impact of various breastfeeding outcomes of three cohorts receiving different methods of prenatal breastfeeding education. METHODS: Retrospective cohort design with patients attending a breastfeeding education class at an Army medical center. Controls were matched for sponsor rank, marital status, and smoking status. One hundred ninety-four mothers who expressed intent to breastfeed received breastfeeding education as follows: (a) a class that used video demonstration and group teaching by a lactation consultant, (b) a new mothers' support group with one-on-one teaching prenatally and weekly meetings postpartum, taught by a lactation consultant and a pediatrician, and (c) a control group educated at prenatal visits only. Descriptive statistics, chi-square, ANOVA, unpaired t test, and logistic regression were used to analyze the data. RESULTS: Women who attended prenatal breastfeeding classes had significantly increased breastfeeding at 6 months when compared to controls (p = .01). There was no significant difference in rates between types of classes offered (p = .45). CLINICAL IMPLICATIONS: Prenatal breastfeeding education can influence the amount of time women breastfeed. All providers of prenatal care should consider offering such classes in order to improve breastfeeding rates.

Reducing tobacco use in adolescents.

After steadily decreasing since the late 1990s, adolescent smoking rates have stabilized at levels well above national goals. Experts recommend screening for tobacco use and exposure at every patient visit, although evidence of improved outcomes in adolescents is lacking. Counseling should be provided using the 5-A method (ask, advise, assess, assist, and arrange). All smokers should be offered smoking cessation assistance, including counseling, nicotine replacement therapy, bupropion therapy, or combination therapy. Pharmacotherapy of any kind doubles the likelihood of successful smoking cessation in adults; however, nicotine replacement therapy is the only pharmacologic intervention that has been extensively studied in children. Community interventions such as smoking bans and educational programs have been effective at reducing smoking rates in children and adolescents. Antismoking advertising and tobacco sales taxes also help deter new smokers and motivate current smokers to attempt to quit.

Common questions in managing hyperlipidemia.

Hyperlipidemia is a serious disease that affects the health and well-being of many, and further complicates other chronic illnesses. When treating a patient who has a lipid disorder, it is wise to take a global approach to the problem by assessing the patient's history and risk factors, collaborating on developing a healthy lifestyle plan to which the patient can commit, and initiating appropriate therapy when indicated.