Physicians' human papillomavirus vaccine recommendations in the context of permissive guidelines for male patients: a national study

BACKGROUND: Little is known about physicians' human papillomavirus (HPV) vaccine recommendations for males while the Advisory Committee on Immunization Practices' (ACIP) permissive guidelines for male vaccination were in effect. The purpose of this study was to examine and explore factors associated with U.S. physicians' HPV vaccine recommendations to early (ages 11-12), middle (13-17), and late adolescent/young adult (18-26) males. METHODS: Nationally representative samples of family physicians and pediatricians were selected in 2011 (n = 1,219). Physicians reported the frequency with which they recommended HPV vaccine to male patients ["always" (>75% of the time) vs. other] for each age group. Statistically significant predictors of vaccine recommendation were identified using multivariable logistic regression. RESULTS: The prevalence of physicians reporting they "always" recommended HPV vaccination for males was 10.8% for ages 11 to 12, 12.9% for ages 13 to 17, and 13.2% for ages 18 to 26. Pediatrician specialty and self-reported early adoption of new vaccines were significantly associated with recommendation for all patient age groups. In addition, physician race and patient payment method were associated with physician recommendations to patients ages 11 to 12, and patient race was associated with recommendations to ages 13 to 17 and 18 to 26. CONCLUSIONS: Less than 15% of physicians surveyed reported "always" recommending HPV vaccine to male patients following national guidelines for permissive vaccination. Vaccine financing may have affected physicians' vaccine recommendations. IMPACT: If these recommendation practices continue following the ACIP's routine recommendation for males in October 2011, then interventions designed to increase recommendations should target family physicians and possibly use early adopters to encourage support of HPV vaccination guidelines

Missing the Target for Routine Human Papillomavirus Vaccination: Consistent and Strong Physician Recommendations Are Lacking for 11- to 12-Year-Old Males

Rates of routine human papillomavirus (HPV) vaccination of adolescent males in the U.S. are low. Leading health organizations advocate consistent and strong physician recommendations to improve HPV vaccine dissemination. This study describes the prevalence and correlates of consistent and strong physician recommendations for HPV vaccination of adolescent males

Florida physicians' reported use of AFIX-based strategies for human papillomavirus vaccination

HPV vaccination rates in Florida are low. To increase rates, the CDC recommends clinics adhere to components of their evidence-based quality improvement program, AFIX (Assessment, Feedback, Incentives, and eXchange of information). We explored factors associated with engaging in HPV-specific AFIX-related activities. In 2016, we conducted a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida and assessed vaccination practices, clinic characteristics, and HPV-related knowledge. Data were analyzed in 2017. The primary outcome was whether physicians' clinics engaged in ≥1 AFIX activity. We stratified by physician specialty and developed multivariable models using a backward selection approach. Of the participants in the analytic sample (n = 340), 52% were male, 60% were White of any ethnicity, and 55% were non-Hispanic. Pediatricians and family medicine physicians differed on: years practicing medicine (p < 0.001), HPV-related knowledge (p < 0.001), and VFC provider status (p < 0.001), among others. Only 39% of physicians reported engaging in ≥1 AFIX activity. In the stratified multivariable model for pediatricians, AFIX activity was significantly associated with HPV-related knowledge (aOR = 1.33;95%CI = 1.08–1.63) and provider use of vaccine reminder prompts (aOR = 3.61;95%CI = 1.02–12.77). For family medicine physicians, HPV-related knowledge was significant (aOR = 1.57;95%CI = 1.20–2.05) as was majority race of patient population (non-Hispanic White vs. Other: aOR = 3.02;95%CI = 1.08–8.43), daily patient load (<20 vs. 20–24: aOR = 9.05;95%CI = 2.72–30.10), and vaccine administration to male patients (aOR = 2.98;95%CI = 1.11–8.02). Fewer than half of Florida pediatric and family medicine physicians engaged in any AFIX activities. Future interventions to increase AFIX engagement should focus on implementing and evaluating AFIX activities in groups identified as having low engagement in AFIX activities

The diversity of population responses to environmental change

This is the final version. Available from Wiley via the DOI in this record.Data available from the Dryad Digital Repository: https:// doi.org/10.5061/dryad.d5f54s7The current extinction and climate change crises pressure us to predict population dynamics with ever-greater accuracy. Although predictions rest on the well-advanced theory of age-structured populations, two key issues remain poorly explored. Specifically, how the age-dependency in demographic rates and the year-to-year interactions between survival and fecundity affect stochastic population growth rates. We use inference, simulations and mathematical derivations to explore how environmental perturbations determine population growth rates for populations with different age-specific demographic rates and when ages are reduced to stages. We find that stage- vs. age-based models can produce markedly divergent stochastic population growth rates. The differences are most pronounced when there are survival-fecundity-trade-offs, which reduce the variance in the population growth rate. Finally, the expected value and variance of the stochastic growth rates of populations with different age-specific demographic rates can diverge to the extent that, while some populations may thrive, others will inevitably go extinct.Max Planck Society, Marie Curie FellowshipERCGerman Research FoundationSwiss National Science FoundationNational Science FoundationNational Institute of AgingRamon y Cajal Research GrantWenner-Gren FoundationLeakey FoundationNational Geographic SocietyZoological Society of San DiegoUniversity of PennsylvaniaArgentinean National Council of Researc

Cost-Effectiveness of Various Diagnostic Approaches for Occupational Asthma

BACKGROUND: Diagnosis of occupational asthma (OA) by specific inhalation challenge (SIC) can be costly and is not always available. The use of sputum testing to avoid this in some patients may be a more cost-effective alternative

Transport and deposition of radionuclides after the Fukushima nuclear accident: international model inter-comparison in the framework of a WMO Task Team

In the framework of a Task Team set up after the Fukushima accident sponsored by WMO, the atmospheric transport and deposition models (ATDMs) FLEXPART (Austria), HYSPLIT (U.S.), MLDP0 (Canada), NAME (UK) and RATM (Japan) were inter-compared. These models are well-known and widely used for emergency response activities. As alternative model input data, JMA made available a Meso-Analysis with 5 km/ 3 hour resolution, and a radar/rain gauge precipitation analysis with 1 km and 30 minutes resolution. To allow maximum flexibility regarding the release rates of key nuclides, the computations were based on the concept of source-receptor matrices, in this connection also called transfer coefficient matrices (TCM). The matrices are calculated every 3 hours after 11 March 2011 00 UTC, based on unit emissions, and thus can be overlaid with any present and future release scenario that becomes established. As computational species, the model considered tracers, depositing gases and depositing aerosols, allowing accounting for the range of substances emitted during a nuclear accident. The model comparison was based on observed deposition patterns of Cesium-137 in the Fukushima province as collected by MEXT/USDOE shortly after the accident, and a few available in situ stations measuring radioactive isotopes. To perform a statistical comparison, established parameters like correlation coefficient (r), fractional bias (FB) and figure of merit in space (FMS) were used. A further ensemble analysis was performed to determine what subset of model results out of all available would provide non-redundant information and thus is optimal to describe the transport and deposition during the accident. The investigation showed (i) that a TCM-based calculation approach has a lot of merits due to its flexibility, (ii) that models tended to perform better if they were run in improved resolution or directly with the Japanese Meso-analysis, (iii) that the model results depend on the selection of the source term with the term provided by JAAE ranking best in terms of reproducing local deposition patterns, and (iv) that the ensemble analysis is a very useful approach to select optimized subsets of models in case that measurement data are already available.JRC.H.2-Air and Climat

World Meteorological Organization’s model simulations of the radionuclide dispersion and deposition from the Fukushima Daiichi nuclear power plant accident

The World Meteorological Organization (WMO) organized a small Task Team (TT) to respond to a request from the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) to assist them with the meteorological aspects of a dose assessment from the radiological releases from the Fukushima Daiichi nuclear power plant accident. The TT’s primary mission was to examine how the use of meteorological analyses and the introduction of additional meteorological observational data, could improve atmospheric transport, dispersion and deposition calculations, a critical component to the dose computations. Although the TT would not be doing dose computations directly for the UNSCEAR assessment, the members agreed that the best way to evaluate the suitability of the various meteorological analyses for the assessment was to actually use the meteorological data in Atmospheric Transport Dispersion and Deposition Models (ATDM) and compare the model predictions against radiological monitoring data.JRC.H.2-Air and Climat