Exploring Factors Influencing Childhood Immunization Rates

Background: Coverage for childhood vaccinations has fallen below Healthy People 2020 targets. Known barriers to childhood immunizations include vaccination opposition, low parental education, low income, health systems’ policies, and misinformation. Known facilitators include high parental income and education levels; clinician reminders; more convenient immunization schedule; and vaccine information provided by healthcare providers. Purpose: The purpose of this program evaluation was to explore the barriers and facilitators for completion of childhood immunizations among students in a rural middle school. Methods: Data was collected from an immunization record audit at a School-Based Health Center (SBHC), key informant interviews, and a tool that determined readability of vaccination information. Findings: A record audit of 52 students revealed an immunization coverage of 92.3%. More White students had incomplete immunization coverage than minority students. The readability of required government vaccination information was at the 11th grade reading level. Conclusions: The SBHC model is effective for ensuring immunization coverage of required immunizations. Specific facilitators include clinician reminders and convenience of appointments, both provided by the SBHC. An immunization infographic might offer easy understandability to supplement the required vaccination information sheets

Altered carbohydrate and protein content in sports beverages: Influence on recovery from heavy endurance exercise

Purpose: The purpose of this study was to compare the efficacy of different carbohydrate-protein recovery beverages following heavy endurance exercise. Methods: Twelve well-trained male cyclists completed a glycogen-depleting trial followed by a 4 hour recovery period before completing a simulated 20-km time trial. During the recovery period, subjects consumed one of three isocaloric beverages [high-carbohydrate/low-protein (HCLP); low-carbohydrate/high-protein (LCHP); carbohydrate (CHO)] at 0h and 2h, as well as immediately following the 20-km time trial. Creatine kinase (CK), muscle soreness, isometric peak torque (MVC), and mental/physical fatigue/energy ratings were measured pre- and post trial. Glucose and lactate were measured during the glycogen depleting phase and subsequent exercise. Results: Subsequent exercise performance was not significantly different between treatments (LCHP 50.3±2.7 min; CHO 48.5±1.5 min; HCLP 48.8±2.1 min). No significant treatment*time interactions were observed for isometric peak torque (MVC), muscle soreness, or mental/physical energy/fatigue ratings. Creatine kinase levels pre- (LCHP 153.5±68.1; CHO 132.6±39.9; HCLP 137.0±41.1) and post exercise (LCHP 172.4±53.1; CHO 150.8±47.4; HCLP 146.6±27.4) were not significantly different between treatments. Conclusion: Recovery beverages containing equal caloric content and differing proportions of carbohydrate/protein provided similar effects on muscle recovery and subsequent exercise performance in well-trained cyclists

Routine Childhood Immunization in Appalachia: A 5-year review of the prevalence, pattern, and predictors of vaccine exemptions in Northeast Region Tennessee

Background The use of vaccines is among the most cost-effective tools for preventing infectious diseases and their complications. However, poor uptake and increasing exemption to routine childhood vaccination have been linked with outbreaks of infectious diseases such as measles, pertussis, and more recently poliomyelitis in the US. The objective of the study is to determine the prevalence, pattern, and predisposing factors of vaccine exemptions to childhood immunization amongst parents of children in the Northeast Region from 2017 to 2021. Methods The routine immunization data of children between 1-24 months in the Northeast region, Tennessee from 2017- 2021 was extracted. Based on the population of children within the birth cohort, a random sample of children was selected from birth certificates of children born in the first three months of 2 years prior in Tennessee’s eight counties in the Northeast region. Descriptive statistics with trends, Chi-square, and logistic regression were conducted to delineate factors associated with vaccine exemption in the region. Result The prevalence of vaccine exemption was 2% on average, but the vaccine exemption rate increased significantly from 1.5% in 2019 (pre-COVID pandemic) to 2.5% in 2020 (peri-COVID period). However, the mother’s level of education (aOR=2.37; CI=0.55-10.17), mother’s age (aOR=0.59; CI=0.14-2.51), TennCare attendance (aOR=0.57; CI=0.15-2.21) do not show statistically significant association with exemption to childhood vaccination in Northeast region in Tennessee. Conclusion There appears to be an increasing trend in the vaccine exemption to routine childhood immunizations in the Northeast region of Tennessee over the years. However, the impact of other factors associated with exemptions to childhood vaccinations needs further research

Technology adoption and extension strategies in Mediterranean Agriculture: the case of family farms in Chile

Extension services play a crucial role by improving skills and access to information thatresult in greater farm level innovations, especially on family farms which are the predominant formof agriculture in the world. This study analyzed the connection between strategies implemented byextension services and technology adoption on family farms. Using the case of the Servicio de AsesoríaTécnica (SAT) Program, we developed a bottom-up adoption index (AI) for vegetable and berryfarmers in three regions of Central ChileThis research was funded by FONDECYT, grant number 1171122.This research was funded by FONDECYT, grant number 1171122.Postprint (published version

Acute Spontaneous Subdural Hematoma of Arterial Origin

Acute spontaneous subdural hematoma (SDH) of arterial origin is very rare. We report a case of acute spontaneous SDH that showed contrast media extravasation from cortical artery on angiograms. A 58-year-old male patient developed sudden onset headache and right hemiparesis. Brain CT scan demonstrated acute SDH at left convexity. The patient was drowsy mentality on admission. He had no history of head trauma. Cerebral angiography was performed and revealed a localized extravasation of the contrast media from distal cortical MCA branch. After angiography, the patient deteriorated to comatose mentality. Decompressive craniectomy for removal of SDH was performed. We verified the arterial origin of the bleeding and coagulated the bleeding focus. The histological diagnosis was aneurysmal artery. He recovered after surgery with mild disability. In a case of acute spontaneous SDH, the possibility of a cortical artery origin should be considered

Outcomes of Children With Low-Grade Gliomas in Low- and Middle-Income Countries: A Systematic Review

Purpose: Pediatric CNS tumors are increasingly a priority, particularly with the WHO designation of low-grade glioma (LGG) as one of six index childhood cancers. There are currently limited data on outcomes of pediatric patients with LGGs in low- and middle-income countries (LMICs). Methods: To better understand the outcomes of LGGs in LMICs, this systematic review interrogated nine literature databases. Results: The search identified 14,977 publications. Sixteen studies from 19 countries met the selection criteria and were included for data abstraction and analysis. Eleven studies (69%) were retrospective reviews from single institutions, and one (6%) captured institutional data prospectively. The studies captured a total of 957 patients with a median of 49 patients per study. Seven (44%) of the studies described the treatment modalities used. Of 373 patients for whom there was information, 173 (46%) had a gross total or near total resection, 109 (29%) had a subtotal resection, and 91 (24%) had only a biopsy performed. Seven studies, with a total of 476 patients, described the frequency of use of radiotherapy and/or chemotherapy in the cohorts: 83 of these patients received radiotherapy and 76 received chemotherapy. The 5-year overall survival ranged from 69.2% to 93.5%, although lower survival rates were reported at earlier time points. We identified limitations in the published studies with respect to the cohort sizes and methodologies. Conclusion: The included studies reported survival rates frequently exceeding 80%, although the ultimate number of studies was limited, pointing to the paucity of studies describing the outcomes of children with LGGs in LMICs. This study underscores the need for more robust data on outcomes in pediatric LGG

Intensive care unit course of infants and children after cranial vault reconstruction for craniosynostosis

<p>Abstract</p> <p>Background</p> <p>Craniosynostosis (CSS) results from the premature closure of one or more cranial sutures, leading to deformed calvaria at birth. It is a common finding in children with an incidence of one in 2000 births. Surgery is required in order to release the synostotic constraint and promote normal calvaria growth. Cranial vault remodeling is the surgical approach to CSS repair at our institution and it involves excision of the frontal, parietal, and occipital bones. The purpose of this article is to describe the post-operative course of infants and children admitted to our PICU after undergoing cranial vault remodeling for primary CSS.</p> <p>Findings</p> <p>Complete data was available for analyses in only 82 patients, 44 males (M) and 38 females (F); M: F ratio was 1:1.2. Patients (pts) age in months (mo) ranged from 2 mo to 132 mo, mean 18.2 ±-24.9 mo and weights (wt) ranged from 4.7 kg to 31.4 kg, mean 10.24 ± 5.5 Kg.. Duration of surgery (DOS) ranged from 70 minutes to 573 minutes mean 331.6 ± 89.0 minutes. No significant correlation exist between duration of surgery, suture category, patient's age or use of blood products (P > 0.05). IOP blood loss was higher in older pts (P < 0.05) and it correlates with body temperature in the PICU (P < .0001). Post-op use of FFP correlated with intra-operative PRBC transfusion (P < 0.0001). More PRBC was transfused within 12 hrs-24 hrs in PICU compared to other time periods (P < 0.05). LOS in PICU was < 3 days in 68% and > 3 days in 32%. Pts with fever had prolonged LOS (P < 0. 05); re-intubation rate was 2.4% and MVD were 1.83 days. Repeat operation for poor cosmetic results occurred in 9.7% of pts.</p> <p>Conclusions</p> <p>Post-op morbidities from increased use of blood products can be minimized if cranial vault remodeling is done at a younger age in patients with primary CSS. PICU length of stay is determined in part by post-op pyrexia and it can be reduced if extensive evaluations of post-op fever are avoided.</p

Apolipoprotein epsilon 3 alleles are associated with indicators of neuronal resilience

<p>Abstract</p> <p>Background</p> <p>Epilepsy is associated with precocious development of Alzheimer-type neuropathological changes, including appearance of senile plaques, neuronal loss and glial activation. As inheritance of <it>APOE ε4 </it>allele(s) is reported to favor this outcome, we sought to investigate neuronal and glial responses that differ according to <it>APOE </it>genotype. With an eye toward defining ways in which <it>APOE ε3 </it>alleles may foster neuronal well-being in epilepsy and/or <it>APOE ε4 </it>alleles exacerbate neuronal decline, neuronal and glial characteristics were studied in temporal lobectomy specimens from epilepsy patients of either <it>APOE ε4,4 </it>or <it>APOE ε3,3 </it>genotype.</p> <p>Methods</p> <p>Tissue and/or cellular expressions of interleukin-1 alpha (IL-1α), apolipoprotein E (ApoE), amyloid β (Aβ) precursor protein (βAPP), synaptophysin, phosphorylated tau, and Aβ were determined in frozen and paraffin-embedded tissues from 52 <it>APOE ε3,3 </it>and 7 <it>APOE ε4,4 </it>(0.25 to 71 years) epilepsy patients, and 5 neurologically normal patients using Western blot, RT-PCR, and fluorescence immunohistochemistry.</p> <p>Results</p> <p>Tissue levels of IL-1α were elevated in patients of both <it>APOE ε3,3 </it>and <it>APOE ε4,4 </it>genotypes, and this elevation was apparent as an increase in the number of activated microglia per neuron (<it>APOE </it>ε<it>3,3 </it>vs <it>APOE ε4,4 </it>= 3.7 ± 1.2 vs 1.5 ± 0.4; <it>P </it>< 0.05). This, together with increases in βAPP and ApoE, was associated with apparent neuronal sparing in that <it>APOE ε4,4 </it>genotype was associated with smaller neuron size (<it>APOE ε4,4 </it>vs <it>APOE ε3,3 </it>= 173 ± 27 vs 356 ± 45; <it>P </it>≤ 0.01) and greater DNA damage (<it>APOE ε4,4 </it>vs <it>APOE ε3,3 </it>= 67 ± 10 vs 39 ± 2; <it>P </it>= 0.01). 3) Aβ plaques were noted at early ages in our epilepsy patients, regardless of <it>APOE </it>genotype (<it>APOE ε4,4 </it>age 10; <it>APOE ε3,3 </it>age 17).</p> <p>Conclusions</p> <p>Our findings of neuronal and glial events, which correlate with lesser neuronal DNA damage and larger, more robust neurons in epilepsy patients of <it>APOE ε3,3 </it>genotype compared to <it>APOE ε4,4 </it>genotype carriers, are consistent with the idea that the <it>APOE </it>ε<it>3,3 </it>genotype better protects neurons subjected to the hyperexcitability of epilepsy and thus confers less risk of AD (Alzheimer's disease).</p> <p>Please see related article: <url>http://www.biomedcentral.com/1741-7015/10/36</url></p

Clinical outcomes and patient-matched molecular composition of relapsed medulloblastoma

© 2021 by American Society of Clinical Oncology. Creative Commons Attribution Non-Commercial No Derivatives 4.0 License: https://creativecommons.org/licenses/by-nc-nd/4.0/Purpose: We sought to investigate clinical outcomes of relapsed medulloblastoma and to compare molecular features between patient-matched diagnostic and relapsed tumors. Methods: Children and infants enrolled on either SJMB03 (NCT00085202) or SJYC07 (NCT00602667) trials who experienced medulloblastoma relapse were analyzed for clinical outcomes, including anatomic and temporal patterns of relapse and postrelapse survival. A largely independent, paired molecular cohort was analyzed by DNA methylation array and next-generation sequencing. Results: A total of 72 of 329 (22%) SJMB03 and 52 of 79 (66%) SJYC07 patients experienced relapse with significant representation of Group 3 and wingless tumors. Although most patients exhibited some distal disease (79%), 38% of patients with sonic hedgehog tumors experienced isolated local relapse. Time to relapse and postrelapse survival varied by molecular subgroup with longer latencies for patients with Group 4 tumors. Postrelapse radiation therapy among previously nonirradiated SJYC07 patients was associated with long-term survival. Reirradiation was only temporizing for SJMB03 patients. Among 127 patients with patient-matched tumor pairs, 9 (7%) experienced subsequent nonmedulloblastoma CNS malignancies. Subgroup (96%) and subtype (80%) stabilities were largely maintained among the remainder. Rare subgroup divergence was observed from Group 4 to Group 3 tumors, which is coincident with genetic alterations involving MYC, MYCN, and FBXW7. Subgroup-specific patterns of alteration were identified for driver genes and chromosome arms. Conclusion: Clinical behavior of relapsed medulloblastoma must be contextualized in terms of up-front therapies and molecular classifications. Group 4 tumors exhibit slower biological progression. Utility of radiation at relapse is dependent on patient age and prior treatments. Degree and patterns of molecular conservation at relapse vary by subgroup. Relapse tissue enables verification of molecular targets and identification of occult secondary malignancies.info:eu-repo/semantics/publishedVersio