American journal of preventive medicine
-
Use of standing orders for adult influenza vaccination a national survey of primary care physicians.
Influenza vaccination of adults remains below recommended levels. Standing orders programs (SOPs) that allow nonphysician medical staff to assess eligibility and administer vaccines without an individualized physician's order are a proven method to increase vaccination rates. However, recent data on their use are not available. ⋯ Fewer than half of physicians report using SOPs for influenza vaccination, a number that is not much higher than it was about a decade ago. Approaches to increase use of SOPs are needed.
-
Numerous interventions have been shown to increase physical activity but have not been ranked by effectiveness or cost. ⋯ The cost effectiveness, effect size, and study quality should all be considered when choosing physical activity interventions.
-
Growing concern about the limited generalizability of trials of preventive interventions has led to several proposals concerning the design, reporting, and interpretation of such trials. This paper presents an epidemiologic framework that highlights three key determinants of population impact of many prevention programs: the proportion of the population at risk who would be candidates for a generic intervention in routine use, the proportion of those candidates who are actually intervened on through a specific program, and the reduction in incidence produced by that program among recipients. It then describes how the design of a prevention trial relates to estimating these quantities. Implications of the framework include the following: (1) reach is an attribute of a program, whereas external validity is an attribute of a trial, and the two should not be conflated; (2) specification of a defined target population at risk is essential in the long run and merits greater emphasis in the planning and interpretation of prevention trials; (3) with due attention to sampling frame and sampling method, the process of subject recruitment for a trial can yield key information about quantities that are important for assessing its potential population impact; and (4) exclusions during subject recruitment can be conceptually separated into intervention-driven, program-driven, and trial-design-driven exclusions, which have quite different implications for trial interpretation and for estimating population impact of the intervention studied.
-
More than half a million U.S. women and more than 100,000 men are treated for injuries from intimate partner violence (IPV) annually, making IPV perpetration a major public health problem. However, little is known about causes of perpetration across the life course. ⋯ Individuals with recent stressors and histories of childhood adversity are at particularly elevated risk of IPV perpetration; therefore, prevention efforts should target this population. Treatment programs for IPV perpetrators, which have not been effective in reducing risk of perpetrating, may benefit from further investigating the role of stress and stress reactivity in perpetration.
-
Shingles (herpes zoster [HZ]) is a localized, generally painful and debilitating disease that occurs most frequently among older adults. It is caused by reactivation of varicella-zoster virus. HZ causes substantial morbidity, especially among older adults. The vaccine to prevent HZ was approved by Food and Drug Administration and recommended by the Advisory Committee for Immunization Practices for people aged ≥60 years in 2006 (these recommendations were published in 2008). ⋯ By 2008, HZ vaccination coverage was 6.7%. The coverage level was low among all groups, but it was lowest among minority groups. Increased efforts are needed to remove barriers and to enable HZ vaccination among all adults aged ≥60 years.