The Internal Consistency and Validity of the Vaccination Attitudes Examination Scale: A Replication Study.

Background: Vaccinations are important preventative health behaviors. The recently developed Vaccination Attitudes Examination (VAX) Scale aims to measure the reasons behind refusal/hesitancy regarding vaccinations. Purpose: The aim of this replication study is to conduct an independent test of the newly developed VAX Scale in the UK. We tested (a) internal consistency (Cronbach's α); (b) convergent validity by assessing its relationships with beliefs about medication, medical mistrust, and perceived sensitivity to medicines; and (c) construct validity by testing how well the VAX Scale discriminated between vaccinators and nonvaccinators. Methods: A sample of 243 UK adults completed the VAX Scale, the Beliefs About Medicines Questionnaire, the Perceived Sensitivity to Medicines Scale, and the Medical Mistrust Index, in addition to demographics of age, gender, education levels, and social deprivation. Participants were asked (a) whether they received an influenza vaccination in the past year and (b) if they had a young child, whether they had vaccinated the young child against influenza in the past year. Results: The VAX (a) demonstrated high internal consistency (α = .92); (b) was positively correlated with medical mistrust and beliefs about medicines, and less strongly correlated with perceived sensitivity to medicines; and (c) successfully differentiated parental influenza vaccinators from nonvaccinators. Conclusion: The VAX demonstrated good internal consistency, convergent validity, and construct validity in an independent UK sample. It appears to be a useful measure to help us understand the health beliefs that promote or deter vaccination behavior.

Rehabilitating patients after critical care.

Many people survive critical illness but experience problems such as post-traumatic stress disorder, after discharge from the critical care unit. This article aims to help intensive care and ward-based nurses, as well as the wider multidisciplinary team, understand the importance of promoting rehabilitation for patients after critical illness. It outlines how critical illness and admission to intensive care affects patients and families, and details rehabilitation strategies that have been adopted and proved beneficial.

Predictors of three-dimensional breast kinematics during bare-breasted running.

PURPOSE: This study aimed to analyze differences in breast kinematics between breast cup sizes during running and the ability of breast and body size measurements to explain these differences. METHODS: Forty-eight women (A to G cup; mean ± SD: age = 26.0 ± 6.0 yr, stature = 1.667 ± 0.064 m, mass = 62.78 ± 8.24 kg) with chest sizes of 32 to 38 inches participated. Chest and breast girths, a restricted anthropometric profile, suprasternal notch to nipple distances, and body mass index were measured, and breast mass was estimated. Multiplanar relative breast displacement, velocity, and acceleration during treadmill running were then recorded. Differences in breast kinematics were compared between cup sizes before and after allometric/polynomial scaling using significant breast and body size measures. RESULTS: All kinematic variables significantly increased with breast cup size (P < 0.05). Mean anterior-posterior (a/p), medial-lateral (m/l), and vertical bare-breasted displacements ranged from 0.030 to 0.059 m, from 0.018 to 0.062 m, and from 0.042 to 0.099 m, respectively, across A to G cups. Breast velocities ranged from 0.428 to 1.244 m·s(-1) (a/p), 0.411 to 1.708 m·s(-1)(m/l), and 0.819 to 2.174 m·s(-1) (vertical), respectively. Increases in breast acceleration varied from 11.664 to 48.438 m·s(-1) (a/p), 15.572 to 51.987 m·s(-1) (m/l), and 23.301 to 66.447 m·s(-1) (vertical), respectively. Scaling models found that breast mass was the only anthropometric measure to consistently explain differences in breast kinematics between cup sizes. CONCLUSIONS: Bare-breasted kinematics significantly increased with cup size during running. Differences in breast displacement, velocity, and acceleration between cup sizes could be predicted using estimates of breast mass based on conventional brassiere sizing. These data inform the design and evaluation of effective bra support.

A protocol for monitoring soft tissue motion under compression garments during drop landings.

This study used a single-subject design to establish a valid and reliable protocol for monitoring soft tissue motion under compression garments during drop landings. One male participant performed six 40 cm drop landings onto a force platform, in three compression conditions (none, medium high). Five reflective markers placed on the thigh under the compression garment and five over the garment were filmed using two cameras (1000 Hz). Following manual digitisation, marker coordinates were reconstructed and their resultant displacements and maximum change in separation distance between skin and garment markers were calculated. To determine reliability of marker application, 35 markers were attached to the thigh over the high compression garment and filmed. Markers were then removed and re-applied on three occasions; marker separation and distance to thigh centre of gravity were calculated. Results showed similar ground reaction forces during landing trials. Significant reductions in the maximum change in separation distance between markers from no compression to high compression landings were reported. Typical errors in marker movement under and over the garment were 0.1mm in medium and high compression landings. Re-application of markers showed mean typical errors of 1mm in marker separation and <3mm relative to thigh centre of gravity. This paper presents a novel protocol that demonstrates sufficient sensitivity to detect reductions in soft tissue motion during landings in high compression garments compared to no compression. Additionally, markers placed under or over the garment demonstrate low variance in movement, and the protocol reports good reliability in marker re-application.

Kawasaki disease: diagnosis, management and cardiac sequelae.

Kawasaki disease (KD) is an acute self-limiting systemic vasculitis of unknown etiology and the most common cause of acquired coronary disease in children aged 6 months to 5 years. The inflammatory process results in coronary arteritis, aneurysmal lesions, arterial thrombotic occlusion or even sudden death. The diagnostic tests are unknown but treatment with immunoglobulin and aspirin is effective at reducing cardiac complications from 25 to 4.7% in the UK. Myocardial, endocardial or pericardial inflammation may occur acutely or many years later and abnormalities of myocardial blood flow may require ongoing medication, interventional catheterization or even cardiac surgery. There are several new drugs that may have important roles to play in managing KD in children and young adults.

Elbow Flexor Strength, Muscle Size, and Moment Arms in Prepubertal Boys and Girls.

The aim of this study was to examine elbow flexion torque, muscle cross-sectional area (CSA), and leverage in boys and girls. Thirty-eight prepubertal children (9.6 ± 0.3 years) volunteered to participate. All performed isometric flexion actions at 10°, 50°, and 90° of elbow flexion. Magnetic resonance imaging was used to assess elbow flexor (EF) muscle CSA and brachialis moment arm lengths. No significant gender differences were observed for any of the variables studied. EF CSA was directly proportional to isometric torque at 50° and 90°. CSA explained between 47% and 57% of torque variance. Moment arm estimates explained 19% of the variance in isometric torque at 90°. These baseline data contribute to our understanding of factors influencing strength variation during childhood.

Behaviour sequelae following acute Kawasaki disease.

BACKGROUND: Kawasaki disease is a systemic vasculitis and may affect cerebral function acutely. The aim of the present study was to measure a number of behaviour and social parameters within a cohort of Kawasaki disease patients. METHODS: Parents of children with past diagnosis of Kawasaki disease were recruited to complete several behaviour screening questionnaires. Sixty five sets of questionnaires relating to the patient cohort received were eligible for inclusion. Two control groups were used, a hospital (HC) control and a sibling control (SC) group. RESULTS: 40% of the Kawasaki disease group showed elevated internalising scores in the clinical or borderline-clinical range. This compared with 18% of hospital controls and 13% of sibling controls. Additionally, the Kawasaki disease (KD) group were shown to be experiencing greater overall total difficulties when compared with the controls (KD 13.7, HC 8.6, SC 8.9). The KD group attained higher behavioural scores within the internalising sub-categories of somatic problems (KD 61, HC 57, SC 54) and withdrawn traits (KD 56, HC 53, SC 51). The KD group were also shown to be suffering more thought problems (KD 57, HC 53, SC 50) compared with the controls. Further difficulties relating to conduct (KD 3.3, HC 1.4) and social interactions (KD 6.7, HC 8.3) are also highlighted for the KD group compared with hospital controls. Positron emission tomograms were performed on nine patients to investigate severe behavioural problems. Three showed minor changes, possibly a resolving cerebral vasculopathy. CONCLUSION: Kawasaki disease can be associated with significant behavioural sequelae. This is an important consideration in the long-term follow up and referral to a clinical psychologist may be necessary in selected patients.

Elbow flexion and extension strength relative to body or muscle size in children.

PURPOSE: The purpose of this study was to examine gender- and age-related differences in elbow flexion and extension strength in children, when linear size measurements and actual measurements of muscle size were used as explanatory variables in a multilevel model. METHODS: Thirty-seven children participated in a 3-yr longitudinal study (18 boys and 19 girls). The average age +/- SD at the first test occasion was 13.0 +/- 0.3 yr. Stature, arm length, isokinetic concentric and isometric elbow extension and flexion torques, and MRI-determined elbow flexor and extensor muscle cross-sectional areas (CSAs) were assessed annually. Multilevel modeling was used to describe the relationship between the measured torques and body/muscle size variables, incorporating age, age by gender, and gender as additional explanatory variables. RESULTS: When muscle CSA was included in the static and dynamic torque multilevel models, gender differences in strength were nonsignificant. In contrast, use of stature or arm length alone, suggested gender differences in strength that could not be explained by differences in body size. All torque measures were best explained by inclusion of muscle CSA and a linear dimension in the models. Age also explained additional variance in torque, but the influence of age was action and muscle specific. CONCLUSION: Use of only linear dimensions rather than muscle CSA to account for differences in size may have clouded our understanding of strength development in children.

The general practice research database: role in pharmacovigilance.

The General Practice Research Database (GPRD) is the world's largest computerised database of anonymised longitudinal clinical records from primary care. The database already has an international reputation in the field of drug safety signal evaluation where the results of GPRD-based pharmacoepidemiological studies have been used to inform regulatory pharmacovigilance decision making. The characteristics and richness of the data are such that the GPRD is likely to prove a key data resource for the proactive pharmacovigilance anticipated in risk management and pharmacovigilance plans. An update of recent developments to the database and new data available from it -- including spontaneously recorded suspected adverse drug reactions -- is presented in the article, with a description of how the data can be used to support a variety of pharmacovigilance applications. The possibility of using the GPRD in signal detection and assessment of the impact of pharmacovigilance activities in the future is also discussed.