Influenza vaccination as a primary or secondary prevention for cardiovascular diseases: A systematic review of the literature

Background: Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. CVD mainly comprise of coronary heart disease and stroke and were ranked first and fourth respectively amongst leading causes of death in the United States. Influenza (flu) causes annual outbreaks and pandemics and is increasingly recognized as an important trigger for acute coronary syndromes and stroke. Influenza vaccination is an inexpensive and effective strategy for prevention of influenza related complications in high risk individuals. Though it is recommended for all CVD patients, Influenza vaccine is still used at suboptimal levels in these patients owing to prevailing controversy related to its effectiveness in preventing CVD. This review was undertaken to critically assess the effectiveness of influenza vaccination as a primary or secondary prevention method for CVD. ^ Methods: A systematic review was conducted using electronic databases OVID MEDLINE, PUBMED (National Library of Medicine), EMBASE, GOOGLE SCHOLAR and TRIP (Turning Research into Practice). The study search was limited to peer-reviewed articles published in English language from January 1970 through May 2012. The case control studies, cohort studies and randomized controlled trials related to influenza vaccination and CVD, with data on at least one of the outcomes were identified. In the review, only population-based epidemiologic studies in all ethnic groups and of either sex and with age limitation of 30 yrs or above, with clinical CVD outcomes of interest were included. ^ Results: Of the 16 studies (8 case control studies, 6 cohort studies and 2 randomized controlled trials) that met the inclusion criteria, 14 studies reported that there was a significant benefit in u influenza vaccination as primary or secondary prevention method for preventing new cardiovascular events. In contrary to the above findings, two studies mentioned that there was no significant benefit of vaccination in CVD prevention. ^ Conclusion: The available body of evidence in the review elucidates that vaccination against influenza is associated with reduction in the risk of new CVD events, hospitalization for coronary heart disease and stroke and as well as the risk of death. The study findings disclose that the influenza vaccination is very effective in CVD prevention and should be encouraged for the high risk population. However, larger and more future studies like randomized control trials are needed to further evaluate and confirm these findings. ^

Sex Trafficking of Minors in the U.S.: Implications for Policy, Prevention and Research

Context: Information currently available on the trafficking of minors in the U.S. for commercial sexual exploitation includes approximations of the numbers involved, risk factors that increase the likelihood of victimization and methods of recruitment and control. However, specific characteristics about this vulnerable population remain largely unknown. Objective: This article has two distinct purposes. The first is to provide the reader with an overview of available information on minor sex trafficking in the U.S. The second is to present findings and discuss policy, research, and educational implications from secondary data analysis of 115 cases of minor sex trafficking in the U.S. Design: Minor sex trafficking cases were identified through two main venues - a review of U.S. Department of Justice press releases of human trafficking cases and an online search of media reports. Searches covered the time period from October 28, 2000, which coincided with the passage of the VTVPA through October 31, 2009. Cases were included in analysis if the incident involved at least one victim under the age of 18, occurred in the U.S., and at least one perpetrator had been arrested, indicted, or convicted. Results: A total of 115 separate incidents involving at least 153 victims were located. These occurrences involved 215 perpetrators, with the majority of them having been convicted (n = 117, 53.4%), The number of victims involved in a single incident ranged from 1 to 9. Over 90% of victims were female who ranged in age from 5 to 17 years. There were more U.S. minor victims than those from other countries. Victims had been in captivity from less than 6 months to 5 years. Minors most commonly fell into exploitation through some type of false promise indicated (16.3%, n = 25), followed by kidnapping (9.8%, n = 15). Over a fifth of the sample (22.2%, n = 34) were abused through two commercial sex practices, with almost all (94.1%, n = 144) used in prostitution. One of every five victims (24.8%, n = 38) had been advertised on an Internet website. Conclusions: Results of a review of known information about minor sex trafficking and findings from analysis of 115 incidents of the sex trafficking of youth in the U.S. indicate a need for stronger legislation to educate various professional groups, more comprehensive services for victims, stricter laws for pimps and traffickers, and preventive educational interventions beginning at a young age.

Skills training and social influences for violence prevention in middle schools: A curriculum evaluation

This pilot study evaluated the effect of skills training and of social influences on self-reported aggressive behavior in a sample of 239 sixth-grade students. The effect of two intervention groups and one control group were compared. In the first intervention group, a 15-session, violence-prevention curriculum was taught by the teacher. In the second intervention group, the same curriculum was taught by the teacher with the assistance of peer leaders trained to modify social norms about violence. The control group was evaluated but did not receive any training. The design included four schools. In two schools, three classes were assigned to one of the two interventions or to the control group. In the other two schools, two classes were assigned to either intervention (teacher only) or control. Students were evaluated before and after the implementation of the curriculum using a standardized questionnaire.^ The primary outcome was the effect of the curriculum and peer leaders on self-reported aggressive behaviors. The secondary outcome was their impact on intervening variables: knowledge about violence, conflict-resolution skills, self-efficacy, and attitudes.^ The intervention had a moderate effect on reducing self-reported aggressive behaviors among boys in two of the six classes that received the curriculum. Both classes with peer leaders reduced their aggressive behavior, but this reduction was significant in only one. A peer leader selection problem could probably explain this lack of effect.^ In three of the four schools, both interventions had an overall significant effect on increasing knowledge about violence and skills to reduce violence. Students also developed a more negative attitude toward violence after the intervention. As hypothesized, attitude change was stronger among students from the teacher plus peer leader group. No intervention effect was observed on self-efficacy nor on attitudes toward skills to reduce violence. Limitations of the study and implications for violence prevention in schools are discussed. ^

The effectiveness of a needleless intravenous system in prevention of percutaneous injury in two hospitals

This study assessed if hospital-wide implementation of a needleless intravenous connection system reduces the number of reported percutaneous injuries, overall and those specifically due to intravenous connection activities.^ Incidence rates were compared before and after hospital-wide implementation of a needleless intravenous system at two hospitals, a full service general hospital and a pediatric hospital. The years 1989-1991 were designated as pre-implementation and 1993 was designated as post-implementation. Data from 1992 were not included in the effectiveness evaluation to allow employees to become familiar with use of the new device. The two hospitals showed rate ratios of 1.37 (95% CI = 1.22-1.54, p $\le$.0001) and 1.63 (95% CI = 1.34-1.97, p $\le$.0001), or a 27.1% and a 38.6% reduction in overall injury rate, respectively. Rate ratios for intravenous connection injuries were 2.67 (95% CI = 1.89-3.78, p $\le$.0001) and 3.35 (95% CI = 1.87-6.02, p $\le$.0001), or a 62.5% and a 69.9% reduction in injury rate, respectively. Rate ratios for all non-intravenous connection injuries were calculated to control for factors other than device implementation that may have been operating to reduce the injury rate. These rate ratios were lower, 1.21 and 1.44, demonstrating the magnitude of injury reduction due to factors other than device implementation. It was concluded that the device was effective in reduction of numbers of reported percutaneous injuries.^ Use-effectiveness of the system was also assessed by a survey of randomly selected device users to determine satisfaction with the device, frequency of use and barriers to use. Four hundred seventy-eight surveys were returned for a response rate of 50.9%. Approximately 94% of respondents at both hospitals expressed satisfaction with the needleless system and recommended continued use. The survey also revealed that even though over 50% of respondents report using the device "always" or "most of the time" for intravenous medication administration, flushing lines, and connecting secondary intravenous lines, needles were still being used for these same activities. Compatibility, accessibility and other technical problems were reported as reasons for using needles for these activities. These problems must be addressed, by both manufacturers and users, before the needleless system will be effective in prevention of all intravenous connection injuries. ^

Physical activity and survival after a first myocardial infarction: The Corpus Christi Heart Project

Previous studies have demonstrated that habitual physical activity is associated with a reduced risk of incident coronary heart disease (CHD). However, the role of physical activity in lowering the risk of all-cause mortality, CHD mortality, reinfarction, or receipt of a revascularization procedure after a first myocardial infarction (MI) remains unresolved, particularly in minority populations. To investigate the associations between physical activity and risk of all-cause mortality, CHD mortality, reinfarction, and receipt of a revascularization procedure, this study was conducted among Mexican-American and non-Hispanic white women and men who survived a first MI. The Corpus Christi Heart Project, a population-based cardiovascular surveillance study, provide data which included vital status, survival time, medical history, CHD risk factor information, including level of physical activity among Mexican-American and non-Hispanic white adults who had experienced a first MI between May, 1988 and April, 1990. MI patients were interviewed at baseline and annually thereafter until their death or through May, 1995. A categorical variable was created to reflect change in level of physical activity following the first MI; categories included (1) sedentary with no change, (2) decreased activity, (3) increased activity, and (4) moderate activity with no change (the referent group). Proportional hazards regression analyses were used to assess the relationship of level of physical activity and risk of death, reinfarction, or receipt of a revascularization procedure adjusting for age, sex, ethnicity, severity of MI, and CHD risk factor status. Over a 7-year follow-up period, the relative risk (95% confidence intervals) of all-cause mortality was 4.67 (2.27, 9.60) for the sedentary-no change group, 2.33 (0.96, 5.67) for the decreased activity group, and 0.52 (0.11, 2.41) for the increased activity group. The relative risk of CHD mortality was 6.92 (2.05, 23.34) for the sedentary-no change group, 2.40 (0.55, 10.51) for the decreased activity group, and 1.58 (0.26, 9.65) for the increased activity group. The relative risk for reinfarction was 2.50 (1.52, 4.10) for the sedentary-no change group, 2.26 (1.24, 4.12) for the decreased activity group, and 0.52 (0.21, 1.32) for the increased activity group. Finally, the relative risk for receipt of a revascularization procedure was 0.65 (0.39, 1.07) for the sedentary-no change group, 0.45 (0.22, 0.92) for the decreased activity group, and 1.01 (0.51, 2.02) for the increased activity group. No interactions were observed for ethnicity or severity of first MI. These results are consistent with the hypothesis that moderate physical activity is independently associated with a lower risk of all-cause mortality, CHD mortality, and reinfarction, but not revascularization, among Mexican-American and non-Hispanic white, female and male, first MI patients. These results also support the current recommendation that physical activity plays an important role in the secondary prevention of CHD. ^

Development and formative evaluation of an obesity prevention intervention for the pediatric primary care setting: Helping HAND (Healthy Activity and Nutrition Directions)

As the obesity epidemic continues to increase, the pediatric primary care office setting remains a relatively unexplored arena to offer obesity prevention interventions for children. The increased risk for adult obesity among 10 to 14 year-old children who are overweight, suggests obesity prevention programs should be introduced just before this age or early in this age period. Research is also accumulating on the importance of targeting parents along with children, since parents are in charge of the home environment for children. Therefore, the aim of this project was to develop an obesity prevention program called Helping HAND (Healthy Activity and Nutrition Directions) based on Social Cognitive Theory and authoritative parenting techniques for the pediatric primary care setting and conduct one-on-one interviews with parents as the initial formative evaluation of the intervention material for the obesity prevention intervention. A secondary aim of the project was to determine the feasibility of identifying appropriate subjects for the intervention, and conducting qualitative evaluations of the materials through recruitment through pediatric primary care settings. ^

The role of social support in HIV prevention among young Latino men who have sex with men

The purpose of this formative study was to determine and prioritize the HIV-prevention needs of Latino young men who have sex with men (YMSM) in Chihuahua (Mexico), Texas, and California, based on YMSM and service provider perceptions of the factors affecting the assimilation and implementation of HIV-preventive behaviors. These factors included: perceived social support, identification of the modes of HIV transmission, perceived risk of HIV, perceived norms and attitudes of peers.^ The study, drawn from a secondary data set, was a convenience sample of providers (n=8) and clients (n=15). Participants completed face-to face interviews and a survey instrument. Interviews were analyzed to identify common themes and congruence among client groups, and among clients and providers. Providers’ understanding of theoretical constructs of interventions was also assessed. Survey data were analyzed to determine variable frequencies and their congruence to the qualitative analysis. ^ The results revealed several differences and many commonalities in the assimilation of protective messages. Client and provider perceptions were congruent across all domains. Providers demonstrated intuitive command of theoretical concepts but inconsistently verbalized their application. Both clients and providers recognized Latinos possessed high HIV-knowledge levels, despite inconsistent protective behaviors. Clients and providers consistently identified important reasons leading to inconsistent protective behaviors, such as: lack of access to targeted information and condoms, self-esteem, sexual identification, situational factors, decreased perceived HIV-risk, and concerns about homophobia, stigma, and rejection. Other factors included: poverty, failure to reach disenfranchised populations, and lack of role models/positive parental figures. The principal conclusion of the study was that there is a need for further study to understand the interrelationship between larger socioeconomic issues and consistent protective behaviors.^

A Su Salud Injury Prevention expansion: Analysis of injury prevention perceptions in a Hispanic community

Unintentional injury is the leading cause of death for American ages one to 44 and is ranked in the top ten causes of death for all age groups (CDC, 2006a). A Su Salud Injury Prevention was developed to address injury prevention awareness and education. The program is a mass media education campaign that uses role models, mass media, and community outreach to prevent injury. In 2009, University Health System (UHS) expanded the program. Baseline data were collected from 426 residents in targeted neighborhoods northwest of downtown San Antonio to support the expansion. The purpose of this study was to explore injury perceptions, knowledge, and behaviors of adults living in the expansion area, and define the predominant factors associated with these perceptions. A secondary aim was to assess community awareness and willingness to participate in the program.^ Survey results showed motor vehicle crashes (MVC), falls, drinking and driving, and guns and assaults were considered the most serious injures for adults. The most serious child injuries were MVC, abuse and neglect, falls, and head injuries. Residents were knowledgeable of state seatbelt policy, and over 90% responded as compliant for seatbelt and child car seat use. Most were knowledgeable about drinking and driving state policy and negative outcomes. However, 70% of those reporting driving under the influence of alcohol within the last year engaged in repeat high risk behavior. Men and residents under the age of 55 were more likely to engage in repeat drinking and driving (OR= 3.6, 7.0 respectively). Residents consider injury prevention an important issue, and have interest in a local injury prevention program. Younger women are the most likely to participate in a local program as potential role models and volunteers.^ Results from the study are summarized into an injury prevention and demographic profile of the community that will be used to develop tailored injury prevention messages to create a more effective program, and support program coordinators in effective community engagement. Results will also be used as a comparative basis for future evaluation of a behavioral injury prevention program focused on a predominantly Mexican-American community.^

Engaging stakeholders in community-level obesity prevention programming: Evaluation of the Fit Family Challenge

Introduction: Both a systems approach to change and a focus on multi-sector interventions ensures obesity prevention programming within the community is equitable, sustainable, and cost-effective. An authentic community engagement approach is required to implement interventions guided by best-evidence research and practice. Although there are examples illustrating the benefits of community engagement, there is no standardized method to implement it. The San Antonio Sports Foundation (SA Sports), a non-profit community-based organization, implements a variety of free events and programs promoting active life styles. One such program is the Fit Family Challenge which is a summer-long program implemented at the school level targeted at families. ^ Aims: This thesis was a culmination of the experience from the student collaborating with SA Sports as part of a practicum opportunity. Using secondary data collected by the Fit Family Challenge during the 2011 year, the goals of this thesis were: to assess individual changes; evaluate short-term impact; and describe the community engagement process. ^ Methods: SA Sports collected quantitative and qualitative data during the implementation and evaluation of the FFC program. SA Sports allowed the used of de-identified data to be analyzed to study the aims of this thesis. ^ Results: The program was able to provide families with the knowledge, information, and opportunity to exercise as a family and cook healthier meals. School district coordinators were generally satisfied and illustrated the benefits of a community partnership. An authentic community engagement was present highlighting the importance of communication, collaboration and the sustainability of such partnerships in the community. ^ Conclusion: The success of an obesity program should focus on triggers that initiate behavioral change rather than physiological changes. The evaluation was guided by a community engagement approach, which illustrated the development of new partnerships and the strengthening of other collaborations. Ultimately, the engagement approach empowered the community to identify their own problems and build collaboration, rather than tackling obesity prevention alone. ^

Planning for Emotional Labor and Secondary Traumatic Stress in Child Welfare Organizations

This analysis provides an emergent framework that emphasizes a neglected component of both direct practice with families and organizational development. Human emotions, both beneficial (positive emotional labor) and harmful (negative emotional labor), have received short shrift in leadership development, supervision, direct practice preparation and supports, and workforce stabilization, and professionalization. Significantly, a key indicator of negative emotional labor—secondary traumatic stress (STS)—often has been ignored and neglected, despite the fact that it may be endemic in the workforce. STS typically results from traumatic events in practice, but it also stems from workplace violence. Often undetected and untreated, STS is at least a hidden correlate and perhaps a probable cause of myriad problems such as questionable practice with families, life-work conflicts, undesirable workforce turnover, and a sub-optimal organizational climate. Special interventions are needed. At the same time, new organizational designs are needed to promote and reinforce positive emotional labor. Arguably, positive emotional labor and the positive organizational climates it facilitates are requisites for harmonious relations between jobs and personal lives, desirable workforce retention, and better outcomes for children and families. What’s more, specialized interventions for positive emotional labor constitute a key component in the prevention system for STS. A dual design for positive emotional labor and STS (and other negative emotional labor) prevention/intervention is provided herewith. Early detection and rapid response systems for STS, with social work leadership, receive special attention. Guidelines for new organizational designs for emotional labor in child welfare are offered in conclusion.