Promoting pneumococcal immunizations among rural Medicare beneficiaries using multiple strategies.

CONTEXT: Vaccine-preventable diseases among adults are major contributing causes of morbidity and mortality in the United States. However, adult immunizations continue to be underutilized in both urban and rural areas. PURPOSE: To evaluate the effectiveness of a community-wide education campaign and mailed reminders promoting pneumococcal immunizations to rural Medicare beneficiaries. METHODS: We implemented a community-wide education campaign, and mailed reminders were sent to Medicare beneficiaries in 1 media market in Montana to increase pneumococcal immunizations. In a second distinct media market, mailed reminders only were sent to beneficiaries. FINDINGS: The proportion of respondents aged 65 years and older aware of pneumococcal immunizations increased significantly from baseline to follow-up among respondents both in the education-plus-reminder (63% to 78%, P = 0.04) and the reminder-only (64% to 74%, P = 0.05) markets. Overall from 1998 to 1999, there was a 3.7-percentage-point increase in pneumococcal immunization claims for Medicare beneficiaries in the education-plus-reminder market and a 1.5-percentage-point increase in the reminder-only market. Medicare beneficiaries sent reminders in the education-plus-reminder market compared to those in the reminder-only market were more likely to have a claim for pneumococcal immunization in 1999 (odds ratio 1.18, 95% confidence interval 1.08 to 1.28). The results suggest that these quality improvement strategies (community education plus reminders and reminders alone) modestly increased pneumococcal immunization awareness and pneumococcal immunization among rural adults. Mailed reminder exposure was associated with an increased prevalence of pneumococcal immunizations between 1998 and 1999 and was augmented somewhat by the education campaign.

Skin breakdown in children and high-frequency oscillatory ventilation.

OBJECTIVE: To investigate the relationship of high-frequency oscillatory ventilation (HFOV) to skin breakdown on the scalp and ears in mechanically ventilated children. STUDY DESIGN: Retrospective cohort study of 32 patients supported with HFOV paired with 32 patients supported with conventional mechanical ventilation (CV) in a pediatric intensive care unit (PICU). RESULTS: By univariate analysis, more HFOV patients had skin breakdown than did the CV patients (53% vs 12.5%, p=.001); HFOV patients also had greater severity of illness (Pediatric Risk of Mortality scores), higher mortality, and longer durations of neuromuscular blockade, low systolic blood pressure, and time exposed to risk. Life table analysis demonstrated no difference in the rate of skin breakdown between HFOV and CV patients. Multifactorial analysis showed that only PICU time at risk was a risk factor for skin breakdown. CONCLUSIONS: HFOV was not an independent risk factor for the development of skin breakdown. PICU time at risk was the sole risk factor for the development of skin breakdown in all mechanically ventilated patients in the PICU.

[Fertility and induced abortion in poor Chilean women from the perspective of medical anthropology]. / Fecundidad y aborto provocado en mujeres chilenas de sectores populares desde la perspectiva de la antropologia medica.

PIP: Sociocultural and psychological investigations were conducted to determine why lower class Chilean women undergo abortions despite strong social, religious, and legal sanctions. According to various estimates, there are 2 undetected illegal abortions in Chile for each abortion leading to hospitalization of the woman. Some 120,000-150,000 abortions are estimated to occur each year, compared to perhaps 300,000 live births. Illegal abortion is the principal cause of maternal mortality in Chile, carrying 4 times greater risk of death than term pregnancy. Because of the extreme difficulty of obtaining systematic information on abortion in the society at large, the studies were conducted in hospital wards treating women for septic abortions. Qualitative studies were 1st conducted using intensive methods such as life histories and a test of body image to assess knowledge of reproductive anatomy and physiology. A more extensive study was then done 2 of the 6 health services in metropolitan Santiago and a health service in Valparaiso. The sample of 357 women represented almost all of the women treated for abortion in the services during the time of the study. The women were lower class, primarily of urban origin, and 16-34 years old for the most part. 60% were single and 10% were separated or widowed. 75% had some secondary education but only 20% had finished secondary school. 1/2 of the sample had no gainful employment and 60% of the rest lacked any type of social insurance. 1/2 of the abortions were in single women abandoned by their partners or who lived with their parents and feared their reactions. 15% were single women who feared loss of employment. 30% were married with children and gave economic reasons for seeking abortion. The women were found to have erroneous ideas about the reproductive cycle, believing pregnancy to be possible only around the time of menstruation. Their beliefs were part of a coherent system passed down by oral tradition and not challenged by any scientific teaching imparted in the educational process. Very few used modern contraception. They relied instead on periodic abstinence during the days they erroneously believed to be fertile. They were not strongly motivated to seek modern contraception and many believed they lacked access or did not meet qualifications for family planning programs. The products of conception were not viewed as a truly living thing until after the 1st months of gestation. They believed that once the lesser abortifacient actions such as drinking concoctions were undertaken the child would inevitably be deformed. They were thus motivated for the 2nd stage, traumatic introduction of foreign objects into the uterus to provoke abortion usually at the hands of unskilled person under septic conditions. Most of the women knew of safer means of abortion but were unable to pay for them.^ieng