ABSTRACT. Objective. Current American Academy of Pediatrics and United States Public Health ServiceImmunization Practices Advisory Committee recommendations for hepatitis B immunization in premature infants weighing <2 kg at birth born to hepatitis B surface antigen (HB S Ag)-negative mothers are to delay the initiation of vaccination until such infants reach 2 kg or until 2 months of age. This proposal to delay vaccination at birth in these low-risk infants was based on limited studies not conducted in the United States. We sought to reassess current recommendations to delay administration of hepatitis B vaccine in low-risk premature infants by determining the immunogenicity of early hepatitis B vaccination in a US population and identifying variables associated with poor immunogenicity.Methods. A total of 148 infants <37 weeks' gestation born to mothers negative for HB S Ag were recruited at birth and stratified to three birth weight groups: <1000 g, 1000 to 1500 g, and >1500 g. Recombinant hepatitis B vaccine was administered within the first week of life, at 1 to 2 months of age, and at 6 to 7 months of age. Serum obtained at birth and after the second and third doses of vaccine was tested for antibody to HB S Ag. Variables associated with poor response were sought prospectively by collecting demographic and clinical data.Results. A total of 118 subjects (83%) completed the study. Postsecond dose sera were available for 117 infants and postthird dose sera were available for 112 infants. The seroprotection rate (attaining >10 mIU/mL HB S antibody) after two doses was low (25%) regardless of birth weight; infants weighing <1000 g at birth had the poorest response (11%). The seroprotection response rate after three doses of vaccine increased with birth weight; infants weighing <1500 g at birth (groups 1 and 2) had lower rates of response (52% and 68%, respectively) than did infants weighing >1500 g at birth (group 3; 84% response rate). The seroprotection response rate of group 3 infants after three doses of vaccine, although low, could not be differentiated from the response rates reported for full-term infants using 95% confidence intervals. Of all infants who did not achieve protective levels of antibody after three doses of vaccine, 96% (26/ 27) weighed <1700 g at birth. The geometric mean HB S antibody levels in responders were 88 and 386 mIU/mL after two and three doses, respectively. Of 36 children with a birth weight >1500 g, 33 (91%) achieved levels of HB S antibody >100 mIU/mL after three doses of vaccine, compared with 25/35 (71%) of infants with birth weight <1500 g.Using logistic regression analysis, nonresponders were more likely than were responders to have been treated with steroids (26% vs 9%) and to have had a low birth weight (1037 g vs 1455 g). In addition, the seroresponse rate of black infants was more likely than that of white infants to be associated with poor weight gain (falling off 2 percentile ranks in weight) in the first 6 months of life: 22% of black and 60% of white children who ...
In an effort to make health manpower training programs and health services research and policy andysis activities more responsive to health care needs in Washington State, a Delphi process was used to obtain perceptions of critical health problems from knowledgeable persons in the health services field.The technique revealed a reasonable agreement among respondents that the following items, in order of priority, were the ten most important problems facing the citizens of Washington State.1. Health care is not accessible to all residents of the state due to financial and geographical barriers, maldistribution of health services and manpower, and related factors. 2. The cost of health services continues to increase rapidly without sufficient incentives for containment. 3. Current patterns of health care delivery are not directed toward preventive, ambulatory, and home care. 4.Reimbursement mechanisms perpetuate the current disorganized system for delivering health care. 5. Health care services are not provided in a comprehensive and coordinated manner. 6. There will be increased environmentally caused disease from pollution, chemicals, stress, and ailments associated with the workplace. 7. The public is not properly educated about health and ways to maintain it. 8. There is inadequate coordination and planning between health and other 9. There is a lack of responsiveness in the health care system to changing social services. patterns of disease. 10. There are inadequate measures of health outcomes. Published by Duke University Press Muscuvicc, et al. 0 The Delphi Technique and Health Priorities 389While these results are similar to those of other studies, this paper contributes two new pieces of important information. It provides rankings of the major health issues and it illustrates the differences in perceptions of the major health issues by the various respondent groups. Also, after reviewing some of the ways in which organizations and groups can have an effect on the major health problems identified, it is suggested that universities, health planners, third parties, regulators, consumers, and direct providers coordinate their efforts. The findings presented in this article offer a starting point for this endeavor.The time required to collect, analyze, interpret and report data usually presents a problem for policy makers. Therefore, health services researchers who have attempted to respond to policy makers' needs have experimented with various ways of obtaining data. One method that has proven useful is the Delphi technique, a group process using written responses to a series of questionnaires to poll individuals whom it is difficult to bring together physically. In the first questionnaire individuals respond to a broad question. Each subsequent questionnaire builds upon responses to preceding ones until a consensus has been approached or sufficient information exchange has been obtained. Delphi preserves anonymity and, unlike face-to-face meetings, prevents domination by a small group. The objectives of the De...
In this article we describe a clinical proficiency review required of 3rd-year graduate students, and we present data from a study of its psychometric properties and utility. Students' oral and written case presentations were evaluated on seven dimensions by a six-member panel composed of faculty and students. Moderately high interjudge reliabilities were achieved, although the level of agreement between rater pairs was related to the level of similarity of their theoretical orientation. Significant correlations were obtained between panel ratings and those of current field placement supervisors, hut not with supervisor's ratings from prior or subsequent placements. Performance on the clinical proficiency review was relatively independent of academic performance measures such as course grades and scores on a six-part comprehensive examination.The American Psychological Association (APA) mandates "an explicit, comprehensive system for evaluation" by faculty of accredited clinical programs (APA, 1979, p. 8). Although interest in the evaluation and prediction of clinical competence is not new (
The Waste Wise Schools Program was established by EcoRecycle Victoria to implement waste and litter education in Victorian schools. It is now operating in over 900 schools in Victoria and 300 schools in other Australian states / territories. This paper provides detailed case studies of two active schools in the Waste Wise Schools Program and considers for each school how the Program started, what it meant to the school, the environmental, educational, social and economic outcomes of the Program and the key success factors. It discusses evidence that the Program has changed the thinking and behaviour of many families at the schools, suggesting that the children may be acting as catalysts to influence their parent's waste wise behaviour, i.e. having an intergenerational influence. Guidelines for promoting this influence are proposed.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.