Michael R. Spence

Outcomes of a home visitation trial for pregnant and postpartum women at-risk for child placement☆

Abstract This study is a randomized clinical trial designed to test the psychosocial efficacy of a pre- and postpartum home visitation model for women at-risk for out-of-home placement of their newborns. Two hundred twenty-five pregnant women with high risk pregnancies for psychosocial reasons were recruited into the study and randomly assigned to an experimental ( n = 125 ) or control condition ( n = 100 ) when they presented for prenatal care at a large urban clinic. After an average of 16 months of exposure to the intervention, women in the experimental group reported significantly greater access to services and there was a trend for the experimental group to show a decrease in psychological distress. At 10 months, there was a trend for experimental group women to experience an increase in social support, but this was not sustained at 16 months. Although the difference was not statistically significant, a higher percentage of women in the experimental group had children in out-of-home living arrangements. There was also a trend among those with children in placement, for children of experimental group women to be placed in extended family care rather than foster care more frequently than controls. The implications of the findings for interventions with at-risk families are discussed.

Pelvic inflammatory disease in the adolescent

We studied 171 women, 106 young adults, and 65 adolescents, with a clinical diagnosis of pelvic inflammatory disease (PID) to determine whether differences existed in the presentation in these two groups. The study population was an age-stratified, random sample obtained from 1162 women with this condition. Demographic characteristics, sexual history, physical findings, severity of illness, and laboratory findings were compared between the two groups. The most significant findings were that the adolescents sought health care later in the course of the illness (7.8 vs. 5.6 days; p less than 0.02) and were more commonly infected with the gonococcus (42% vs. 28%; p less than 0.05). No statistically significant differences were found in the other parameters evaluated. Implications of these findings regarding the health care for sexually transmitted diseases (STDs) and the education of adolescents are discussed.

Hepatitis B: perceptions, knowledge and vaccine acceptance among registered nurses in high-risk occupations in a university hospital.

We employed a questionnaire to survey 334 registered nurses regarding their knowledge, perceptions and vaccine acceptance for Hepatitis B virus (HBV) infections. The study population was those persons working in areas considered at high-risk for contracting HBV. The nurses were asked to provide information regarding blood and body fluid exposures and the reporting of these exposures. The questionnaire was completed by 169 nurses (50.6%). Less than half of the respondents (42%) had been vaccinated. We found that 13 of 14 black nurses, compared to 85 of 154 nonblack nurses, had not been vaccinated (p less than .01). No other demographic differences between recipients and nonrecipients were noted. Partially or totally incorrect answers regarding transmittal knowledge were given by 108 of 160 (68%) respondents. Reasons for failure to be vaccinated were varied. Fear of side effects of the vaccine, contracting AIDS or hepatitis from the vaccine, or doubt of efficacy of the vaccine were cited by 50 of 88 (58%) respondents as reasons for not being vaccinated. Inability to schedule an appointment or unawareness of the vaccines availability were expressed by 23% and 17% of the individuals, respectively. Our data allow us to conclude that to improve vaccination compliance, the vaccine must be made more readily available, possibly through workplace on-site administration. Additionally, a concerted effort to educate our staff regarding HBV with particular emphasis on minorities is needed.

Measles immunization in HCWs.

Prior to the licensure of measles vaccine in 1963, there were over 500.000 cases of measles reported annually in the United States. After 1963, the number of cases declined to a low of slightly less than 3,000 cases per year between 1981 and 1988. In Philadelphia, a measles epidemic occurred in 1981, with 582 reported cases. Between 1982 and 1990, an average of only 11 cases occurred yearly in this city. This trend was abruptly halted in 1990, when 293 cases were reported and Philadelphia was declared a highincidence measles area. In accordance with recommendations of the Philadelphia Department of Health, a measles immunization program for healthcare personnel was instituted at Hahnemann Hospital. Mass immunization of medical personnel may be an effective strategy in assuring employee protection against disease and prevention of nosocomial infection. However, as cost-containment continues to be one of the major factors in the development and delivery of healthcare programs, medical insti tutions must evaluate this approach to the control of vaccinepreventable diseases. Antibody screening and selective vaccination is an alternative method for decreasing the number of susceptible individuals. We conducted a study to evaluate the costeffectiveness of mass versus selective measles vaccination of healthcare workers in an urban hospital setting. The study population consisted of 117 healthcare providers 21 to 60 years of age. Participation in this study was voluntary. Informed consent was obtained, and each subject completed a questionnaire pertaining to demographics, allergies, and history of previous measles infection or immunization. Pregnant women were excluded from the study. A prevaccine serum specimen was collected and stored at -70°C until testing. A 0.5-cc dose of live attenuated measles vaccine (Attenuvax, Merck, Sharp & Dohme, West Point, PA) was then administered subcutaneously. A second (postvaccine) serum sample was obtained four to six weeks later. Serum IgG antibodies in the paired prevactine and postvaccine sera were measured by enzyme immunoassay (Measlestat, BioWhittaker Inc, Walkersville, MD) following the directions in the package insert. Most subjects (108/117; 92.3%) possessed detectable antibody prior to vaccination. No antibody was detected in five subjects; another four had equivocal levels and were considered antibody negative. None of these nine individuals had a documented history of previous measles infection or measles immunization. All nine seroconverted following measles immunization. Our low susceptibility rate (9/ 117; 7.6%) is in agreement with previously reported rates among U.S. hospital employees of less than 1% to 8%. If we had vaccinated only the nine employees shown to be antibody negative, our cost would have been

Clinical Experience With Penicillin Skin Testing in a Large Inner-City STD Clinic

490.50 (

Cross-Allergenicity and Immunogenicity of Aztreonam

409.50 for screening and

Social and psychological correlates of substance abuse among pregnant women

81.00 for nine doses of measles vaccine). The total cost for vaccinating all subjects in our study population was

Psychosocial Characteristics of Pregnant Women with and without a History of Substance Abuse

1,053.00 (117 persons at

Invasive fetal monitoring and human immunodeficiency virus transmission

9.00/person). The cost for screening serum samples for antibody was

The interrelationship between trichomoniasis and contraceptive method in adolescent family planing patients

409.50 (117 sera at