Educational intervention regarding hypothermia: a teaching strategy for education in the Surgery Department

This is a quasi-experimental study performed using a short-term educational intervention involving nursing aides working in a Surgery Department, with the objective to identify the social and professional characteristics of the nursing aides, identify the differences in their knowledge regarding hypothermia following the educational intervention, and relate the nursing actions to the studied variables. It was found that the educational intervention was effective, considering that the difference in the mean nursing actions was 5.35 following the intervention. However, no significant difference was found regarding the nursing actions related to the studied variables. Further studies should be performed to investigate the education of nursing professionals considering their significant learning requirements in different units.

Effects of a combined aerobic and strength training program in youth patients with acute lymphoblastic leukemia

Cure rates of youth with Acute Lymphoblastic Leukemia (ALL) have increased in the past decades, but survivor's quality of life and physical fitness has become a growing concern. Although previous reports showed that resistance training is feasible and effective, we hypothesized that a more intense exercise program would also be feasible, but more beneficial than low- to moderate-intensity training programs. We aimed to examine the effects of an exercise program combining high-intensity resistance exercises and moderate-intensity aerobic exercises in young patients undergoing treatment for ALL. A quasi-experimental study was conducted. The patients (n = 6; 5-16 years of age) underwent a 12-week intra-hospital training program involving high-intensity strength exercises and aerobic exercise at 70% of the peak oxygen consumption. At baseline and after 12 weeks, we assessed sub-maximal strength (10 repetition-maximum), quality of life and possible adverse effects. A significant improvement was observed in the sub maximal strength for bench press (71%), lat pull down (50%), leg press (73%) and leg extension (64%) as a result of the training (p < 0.01). The parents' evaluations of their children's quality of life revealed an improvement in fatigue and general quality of life, but the children's self-reported quality of life was not changed. No adverse effects occurred. A 12-week in-hospital training program including high-intensity resistance exercises promotes marked strength improvements in patients during the maintenance phase of the treatment for Acute Lymphoblastic Leukemia without side-effects. Parents' evaluations of their children revealed an improvement in the quality of life.

Health and fitness benefits of a resistance training intervention performed in the workplace

Zavanela, PM, Crewther, BT, Lodo, L, Florindo, AA, Miyabara, EH, and Aoki, MS. Health and fitness benefits of a resistance training intervention performed in the workplace. J Strength Cond Res 26(3): 811-817, 2012-This study examined the effects of a workplace-based resistance training intervention on different health-, fitness-, and work-related measures in untrained men (bus drivers). The subjects were recruited from a bus company and divided into a training (n = 48) and control (n = 48) groups after initial prescreening. The training group performed a 24-week resistance training program, whereas the control group maintained their normal daily activities. Each group was assessed for body composition, blood pressure (BP), pain incidence, muscular endurance, and flexibility before and after the 24-week period. Work absenteeism was also recorded during this period and after a 12-week follow-up phase. In general, no body composition changes were identified in either group. In the training group, a significant reduction in BP and pain incidence, along with improvements in muscle endurance and flexibility were seen after 24 weeks (p < 0.05). There were no changes in these parameters in the control group, and the between-group differences were all significant (p < 0.05). A reduction in worker absenteeism rate was also noted in the training (vs. control) group during both the interventional and follow-up periods (p < 0.05). In conclusion, it was found that a periodized resistance training intervention performed within the workplace improved different aspects of health and fitness in untrained men, thereby potentially providing other work-related benefits. Thus, both employers and employees may benefit from the setup, promotion, and support of a work-based physical activity program involving resistance training.

Effects of a combined strengthening, stretching and functional training program versus usual-care on gait biomechanics and foot function for diabetic neuropathy: a randomized controlled trial

Background: Polyneuropathy is a complication of diabetes mellitus that has been very challenging for clinicians. It results in high public health costs and has a huge impact on patients' quality of life. Preventive interventions are still the most important approach to avoid plantar ulceration and amputation, which is the most devastating endpoint of the disease. Some therapeutic interventions improve gait quality, confidence, and quality of life; however, there is no evidence yet of an effective physical therapy treatment for recovering musculoskeletal function and foot rollover during gait that could potentially redistribute plantar pressure and reduce the risk of ulcer formation. Methods/Design: A randomised, controlled trial, with blind assessment, was designed to study the effect of a physiotherapy intervention on foot rollover during gait, range of motion, muscle strength and function of the foot and ankle, and balance confidence. The main outcome is plantar pressure during foot rollover, and the secondary outcomes are kinetic and kinematic parameters of gait, neuropathy signs and symptoms, foot and ankle range of motion and function, muscle strength, and balance confidence. The intervention is carried out for 12 weeks, twice a week, for 40-60 min each session. The follow-up period is 24 weeks from the baseline condition. Discussion: Herein, we present a more comprehensive and specific physiotherapy approach for foot and ankle function, by choosing simple tasks, focusing on recovering range of motion, strength, and functionality of the joints most impaired by diabetic polyneuropathy. In addition, this intervention aims to transfer these peripheral gains to the functional and more complex task of foot rollover during gait, in order to reduce risk of ulceration. If it shows any benefit, this protocol can be used in clinical practice and can be indicated as complementary treatment for this disease.

Diaphragmatic Breathing Training Program Improves Abdominal Motion During Natural Breathing in Patients With Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

Yamaguti WP, Claudino RC, Neto AP, Chammas MC, Gomes AC, Salge TM, Moriya HT, Cukier A, Carvalho CR. Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial. Arch Phys Med Rehabil 2012;93:571-7. Objective: To investigate the effects of a diaphragmatic breathing training program (DBTP) on thoracoabdominal motion and functional capacity in patients with chronic obstructive pulmonary disease. Design: A prospective, randomized controlled trial. Setting: Academic medical center. Participants: Subjects (N=30; forced expiratory volume in Is, 4270 +/- 13% predicted) were randomly allocated to either a training group (TG) or a control group (CG). Interventions: Subjects in the TG completed a 4-week supervised DBTP (3 individualized weekly sessions), while those in the CG received their usual care. Main Outcome Measures: Effectiveness was assessed by amplitude of the rib cage to abdominal motion ratio (RC/ABD ratio) (primary outcome) and diaphragmatic mobility (secondary outcome). The RC/ABD ratio was measured using respiratory inductive plethysmography during voluntary diaphragmatic breathing and natural breathing. Diaphragmatic mobility was measured by ultrasonography. A 6-minute walk test and health-related quality of life were also evaluated. Results: Immediately after the 4-week DBTP, the TG showed a greater abdominal motion during natural breathing quantified by a reduction in the RC/ABD ratio when compared with the CG (F=8.66; P<.001). Abdominal motion during voluntary diaphragmatic breathing after the intervention was also greater in the TG than in the CG (F=4.11; P<.05). The TG showed greater diaphragmatic mobility after the 4-week DBTP than did the CG (F=15.08; P<.001). An improvement in the 6-minute walk test and in health-related quality of life was also observed in the TG. Conclusions: DBTP for patients with chronic obstructive pulmonary disease induced increased diaphragm participation during natural breathing, resulting in an improvement in functional capacity.

Health education intervention in early and late postmenopausal Brazilian women

Aim To identify aspects of health in postmenopausal Brazilian women using a health-related educational program provided by a multidisciplinary team as part of the primary care approach for early and late postmenopausal symptoms. Design A prospective cohort was formed with 69 postmenopausal women; they were divided into groups corresponding to early (n = 32) and late postmenopause (n = 37) through gynecological and clinical evaluations. We administered the Kuppermann-Blatt Menopausal Index and the Women's Health Questionnaire before and after health education instructions. Results The average age for the onset of menopause was 47.9 years (n = 69). Fifty women (72.5%) in this study had completed their primary education, 78.3% (n = 54) performed manual labor, and 60.9% (n = 42) showed concomitant chronic illnesses. After attending a series of health-related presentations, the mean weight of the women was reduced by 3.54% in early postmenopausal women (p < 0.001) and by 2.06% in the late postmenopausal group (p < 0.001). The mean abdominal circumference was reduced by 1.75% (p < 0.001) in the early postmenopausal group. In addition, the total score in the Kuppermann-Blatt Menopausal Index decreased by 34.38% in the early and by 33.33% in the late postmenopausal groups. According to the Women's Health Questionnaire, there was a decrease in the domain Depressive mood by 0.839 to 0.700 (p < 0.001) in the early and by 0.814 to 0.648 (p < 0.001) in the late postmenopausal groups. Conclusion Regardless of improving menopausal symptoms and anthropometric parameters, the effects of the multidisciplinary team activities in early postmenopausal women may be similar to those in late postmenopausal women.

Cardiometabolic risk reduction through lifestyle intervention programs in the Brazilian public health system

Public health strategies to reduce cardiovascular morbidity and mortality should focus on global cardiometabolic risk reduction. The efficacy of lifestyle changes to prevent type 2 diabetes have been demonstrated, but low-cost interventions to reduce cardiometabolic risk in Latin-America have been rarely reported. Our group developed 2 programs to promote health of high-risk individuals attending a primary care center in Brazil. This study compared the effects of two 9-month lifestyle interventions, one based on medical consultations (traditional) and another with 13 multi-professional group sessions in addition to the medical consultations (intensive) on cardiometabolic parameters. Adults were eligible if they had pre-diabetes (according to the American Diabetes Association) and/or metabolic syndrome (International Diabetes Federation criteria for Latin-America). Data were expressed as means and standard deviations or percentages and compared between groups or testing visits. A p-value < 0.05 was considered significant. Results: 180 individuals agreed to participate (35.0% men, mean age 54.7 ± 12.3 years, 86.1% overweight or obese). 83 were allocated to the traditional and 97 to the intensive program. Both interventions reduced body mass index, waist circumference and tumor necrosis factor-α. Only intensive program reduced 2-hour plasma glucose and blood pressure and increased adiponectin values, but HDL-cholesterol increased only in the traditional. Also, responses to programs were better in intensive compared to traditional program in terms of blood pressure and adiponectin improvements. No new case of diabetes in intensive but 3 cases and one myocardial infarction in traditional program were detected. Both programs induced metabolic improvement in the short-term, but if better results in the intensive are due to higher awareness about risk and self-motivation deserves further investigation. In conclusion, these low-cost interventions are able to minimize cardiometabolic risk factors involved in the progression to type 2 diabetes and/or cardiovascular disease.

Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil)

Background Falling in older age is a major public health concern due to its costly and disabling consequences. However very few randomised controlled trials (RCTs) have been conducted in developing countries, in which population ageing is expected to be particularly substantial in coming years. This article describes the design of an RCT to evaluate the effectiveness of a multifactorial falls prevention program in reducing the rate of falls in community-dwelling older people. Methods/design Multicentre parallel-group RCT involving 612 community-dwelling men and women aged 60 years and over, who have fallen at least once in the previous year. Participants will be recruited in multiple settings in Sao Paulo, Brazil and will be randomly allocated to a control group or an intervention group. The usual care control group will undergo a fall risk factor assessment and be referred to their clinicians with the risk assessment report so that individual modifiable risk factors can be managed without any specific guidance. The intervention group will receive a 12-week Multifactorial Falls Prevention Program consisting of: an individualised medical management of modifiable risk factors, a group-based, supervised balance training exercise program plus an unsupervised home-based exercise program, an educational/behavioral intervention. Both groups will receive a leaflet containing general information about fall prevention strategies. Primary outcome measures will be the rate of falls and the proportion of fallers recorded by monthly falls diaries and telephone calls over a 12 month period. Secondary outcomes measures will include risk of falling, fall-related self-efficacy score, measures of balance, mobility and strength, fall-related health services use and independence with daily tasks. Data will be analysed using the intention-to-treat principle.The incidence of falls in the intervention and control groups will be calculated and compared using negative binomial regression analysis. Discussion This study is the first trial to be conducted in Brazil to evaluate the effectiveness of an intervention to prevent falls. If proven to reduce falls this study has the potential to benefit older adults and assist health care practitioners and policy makers to implement and promote effective falls prevention interventions. Trial registration ClinicalTrials.gov (NCT01698580)

Oral cleft prevention program (OCPP)

Background Oral clefts are one of the most common birth defects with significant medical, psychosocial, and economic ramifications. Oral clefts have a complex etiology with genetic and environmental risk factors. There are suggestive results for decreased risks of cleft occurrence and recurrence with folic acid supplements taken at preconception and during pregnancy with a stronger evidence for higher than lower doses in preventing recurrence. Yet previous studies have suffered from considerable design limitations particularly non-randomization into treatment. There is also well-documented effectiveness for folic acid in preventing neural tube defect occurrence at 0.4 mg and recurrence with 4 mg. Given the substantial burden of clefting on the individual and the family and the supportive data for the effectiveness of folic acid supplementation as well as its low cost, a randomized clinical trial of the effectiveness of high versus low dose folic acid for prevention of cleft recurrence is warranted. Methods/design This study will assess the effect of 4 mg and 0.4 mg doses of folic acid, taken on a daily basis during preconception and up to 3 months of pregnancy by women who are at risk of having a child with nonsyndromic cleft lip with/without palate (NSCL/P), on the recurrence of NSCL/P. The total sample will include about 6,000 women (that either have NSCL/P or that have at least one child with NSCL/P) randomly assigned to the 4 mg and the 0.4 mg folic acid study groups. The study will also compare the recurrence rates of NSCL/P in the total sample of subjects, as well as the two study groups (4mg, 0.4 mg) to that of a historical control group. The study has been approved by IRBs (ethics committees) of all involved sites. Results will be disseminated through publications and presentations at scientific meetings. Discussion The costs related to oral clefts are high, including long term psychological and socio-economic effects. This study provides an opportunity for huge savings in not only money but the overall quality of life. This may help establish more specific clinical guidelines for oral cleft prevention so that the intervention can be better tailored for at-risk women. ClinicalTrials.gov Identifier NCT00397917

Development of an integrative cessation program for co-smokers of cigarettes and cannabis: demand analysis, program description, and acceptability

Abstract Background Tobacco and cannabis use are strongly interrelated, but current national and international cessation programs typically focus on one substance, and address the other substance either only marginally or not at all. This study aimed to identify the demand for, and describe the development and content of, the first integrative group cessation program for co-smokers of cigarettes and cannabis. Methods First, a preliminary study using expert interviews, user focus groups with (ex-)smokers, and an online survey was conducted to investigate the demand for, and potential content of, an integrative smoking cessation program (ISCP) for tobacco and cannabis co-smokers. This study revealed that both experts and co-smokers considered an ISCP to be useful but expected only modest levels of readiness for participation.Based on the findings of the preliminary study, an interdisciplinary expert team developed a course concept and a recruitment strategy. The developed group cessation program is based on current treatment techniques (such as motivational interviewing, cognitive behavioural therapy, and self-control training) and structured into six course sessions.The program was evaluated regarding its acceptability among participants and course instructors. Results Both the participants and course instructors evaluated the course positively. Participants and instructors especially appreciated the group discussions and the modules that were aimed at developing personal strategies that could be applied during simultaneous cessation of tobacco and cannabis, such as dealing with craving, withdrawal, and high-risk situations. Conclusions There is a clear demand for a double cessation program for co-users of cigarettes and cannabis, and the first group cessation program tailored for these users has been developed and evaluated for acceptability. In the near future, the feasibility of the program will be evaluated. Trial registration Current Controlled Trials ISRCTN15248397

Nursing intervention in insulin administration: telephone follow-up

OBJECTIVE: To analyze the competency of people with diabetes mellitus to perform the insulin administration process, before and after telephone monitoring. METHODS: A quantitative, observational, longitudinal, comparative study. Participants were 26 people enrolled in the at-home capillary glycemia self-monitoring program. Data collection occurred in three phases, in January and February of 2010, for a period of 30 days for each person, by means of interview guided by a data collection instrument and an intervention manual. RESULTS: Of the 38 (100%) questions referring to the insulin administration process, telephone monitoring was demonstrated to be efficient in 30 (78.9%), but in 19 (50%) the intervention was statistically significant (p<0.05), in 11 (28.9%) there were no errors in responses to the final competency evaluation, and seven (18.4%) were not amenable to intervention. CONCLUSION: Telephone mornitoring was effective, as a nursing intervention strategy for the insulin administration process in the home.

Einfluss einer pharmazeutischen Betreuung auf den klinischen Verlauf und die Behandlungsergebnisse von Diabetikern mit Diabetischem Fußsyndrom (DFS)

Einfluss einer Pharmazeutischen Betreuung auf den klinischen Verlauf und die Behandlungsergebnisse von Diabetikern mit Diabetischem Fußsyndrom (DFS) Hintergrund/Rationale: In Deutschland gibt es etwa 6 Millionen Diabetiker und die Tendenz ist steigend. Das Diabetische Fußsyndrom (DFS) stellt eine häufige und besonders gravierende Folgeerkrankung des Diabetes mellitus dar. Jährlich werden in Deutschland ca. 45.000 Amputationen aufgrund des DFS bei Diabetikern durchgeführt. Es verursacht bei den Patienten physische und psychische Beeinträchtigungen und produziert hohe Krankheitskosten. Der Prävention, der Behandlung und der Rezidivprophylaxe des DFS kommt daher ein hoher Stellenwert zu. Ziel dieser Arbeit war es, ein klinisch-pharmazeutisches Betreuungsprogramm für Patienten mit DFS zu erarbeiten und den Einfluss der Pharmazeutischen Betreuung, speziell einer intensivierten Patientenschulung, auf klinische und soziale Behandlungsergebnisse hin zu untersuchen. Es sollte geklärt werden, ob eine zusätzliche pharmazeutische Betreuung Einfluss auf den Wundheilungsverlauf und die Abheilungsrate der Fußläsionen von Diabetikern mit DFS nehmen kann. Methoden: 52 Patienten mit DFS wurden in eine randomisierte, kontrollierte Studie eingeschlossen und im Verhältnis 1:1 einer Interventions- oder Kontrollgruppe zugeteilt. Die Interventionsgruppe wurde kontinuierlich durch einen Apotheker zusätzlich individuell betreut (Anleitung zum sachgerechten Umgang mit Arzneimitteln, Medizinprodukten und Therapiemaßnahmen), die Kontrollgruppe erhielt die übliche medizinische Betreuung. Die Auswirkungen der Intervention auf den klinischen Verlauf der beobachteten Fußläsionen, die Rezidivfreiheit und Rehospitalisierungsrate, aber auch auf die Patientenzufriedenheit, das Patientenwissen und die Lebensqualität wurden untersucht. Jeder Patient wurde über einen Zeitraum von 12 Monaten beobachtet. Ergebnisse: Die Studienergebnisse belegen einen positiven Einfluss der Pharmazeutischen Betreuung auf die klinischen Endpunkte der Diabetiker mit DFS. Die Wundheilung der Läsionen in der Interventionsgruppe, bezogen auf Abheilungsdauer und -rate, konnte klinisch positiv beeinflusst werden. Des weiteren konnte in der Interventionsgruppe die Anzahl an neu aufgetretenen Läsionen, sowie weiterer Krankenhausaufenthalte um jeweils fast 50% verringert werden. Durch die Pharmazeutische Betreuung konnte die Patientenzufriedenheit mit der Behandlung deutlich gesteigert werden. Entsprechendes fand sich für das Patientenwissen und die Lebensqualität.

Molekulare Ursachen und therapeutische Intervention bei der Alzheimer-Demenz

Ein charakteristisches, neuropathologisches Merkmal der Alzheimer-Demenz (AD), der am häufigsten vorkommenden Demenz-Form des Menschen, ist das Auftreten von senilen Plaques im Gehirn der Patienten. Hierbei stellt das neurotoxische A-beta Peptid den Hauptbestandteil dieser Ablagerungen dar. Einen Beitrag zu der pathologisch erhöhten A-beta Generierung liefert das verschobene Expressionsgleichgewicht der um APP-konkurrierenden Proteasen BACE-1 und ADAM10 zu Gunsten der beta-Sekretase BACE-1. In der vorliegenden Dissertation sollten molekulare Mechanismen identifiziert werden, die zu einem pathologisch veränderten Gleichgewicht der APP-Spaltung und somit zum Entstehen und Fortschritt der AD beitragen. Des Weiteren sollten Substanzen identifiziert werden, die durch Beeinflussung der Genexpression einer der beiden Proteasen das physiologische Gleichgewicht der APP-Prozessierung wiederherstellen können und somit therapeutisch einsetzbar sind.rnAnhand eines „Screenings“ von 704 Transkriptionsfaktoren wurden 23 Faktoren erhalten die das Verhältnis ADAM10- pro BACE-1-Promotor Aktivität beeinflussten. Exemplarisch wurden zwei der molekularen Faktoren auf ihren Wirkmechanismus untersucht: Der TF „X box binding protein-1“ (XBP-1), der die so genannte „unfolded protein response“ (UPR) reguliert, erhöhte die Expression von ADAM10 in Zellkultur-Experimenten. Die Menge dieses Faktors war in AD-Patienten im Vergleich zu gesunden, Alters-korrelierten Kontrollen signifikant erniedrigt. Im Gegensatz dazu verminderte der Seneszenz-assoziierte TF „T box 2“ (Tbx2) die Menge an ADAM10 in SH-SY5Y Zellen. Die Expression des Faktors selbst war in post-mortem Kortexgewebe von AD-Patienten erhöht. Zusätzlich zu den TFs konnten in einer Kooperation mit dem Helmholtz Zentrum München drei microRNAs (miRNA 103, 107, 1306) bioinformatisch prädiziert und experimentell validiert werden, die die Expression des humanen ADAM10 reduzierten.rnIm Rahmen dieser Arbeit konnten damit körpereigene Faktoren identifiziert werden, die die Menge an ADAM10 regulieren und folglich potenziell an der Entstehung der gestörten Homöostase der APP-Prozessierung beteiligt sind. Somit ist die AD auch im Hinblick auf eine A-beta-vermittelte Pathologie als multifaktorielle Krankheit zu verstehen, in der verschiedene Regulatoren zur gestörten APP-Prozessierung und somit zur pathologisch gesteigerten A-beta Generierung beitragen können. rnEine pharmakologische Erhöhung der ADAM10 Genexpression würde zu der Freisetzung von neuroprotektivem APPs-alpha und gleichzeitig zu einer reduzierten A-beta Generierung führen. Deshalb war ein weiteres Ziel dieser Arbeit die Evaluierung von Substanzen mit therapeutischem Potenzial im Hinblick auf eine erhöhte ADAM10 Expression. Von 640 FDA-zugelassenen Medikamenten einer Substanz-Bibliothek wurden 23 Substanzen identifiziert, die die Menge an ADAM10 signifikant steigerten während die Expression von BACE-1 und APP unbeeinflusst blieb. In Zusammenarbeit mit dem Institut für Pathologie (Johannes Gutenberg Universität Mainz) wurde ein Zellkultur-basiertes Modell etabliert, um die Permeationsfähigkeit der potenziellen Kandidaten-Substanzen über die Blut-Hirn Schranke (BHS) zu untersuchen. Von den 23 Medikamenten konnten neun im Rahmen des etablierten Modells als BHS-gängig charakterisiert werden. Somit erfüllen diese verbleibenden Medikamente die grundlegenden Anforderungen an ein AD-Therapeutikum. rnADAM10 spaltet neben APP eine Vielzahl anderer Substrate mit unterschiedlichen Funktionen in der Zelle. Zum Beispiel reguliert das Zelladhäsionsmolekül Neuroligin-1 (NL-1), das von ADAM10 prozessiert wird, die synaptische Funktion exzitatorischer Neurone. Aus diesem Grund ist die Abschätzung potenzieller, Therapie-bedingter Nebenwirkungen sehr wichtig. Im Rahmen eines Forschungsaufenthalts an der Universität von Tokio konnte in primären, kortikalen Neuronen der Ratte bei einer Retinoid-induzierten Erhöhung von ADAM10 neben einer vermehrten alpha-sekretorischen APP-Prozessierung auch eine gesteigerte Spaltung von NL-1 beobachtet werden. Dies lässt vermuten, dass bei einer Behandlung mit dem Retinoid Acitretin neben einer vermehrten APP-Spaltung durch ADAM10 auch die Regulation glutamaterger Neurone durch die Spaltung von NL-1 betroffen ist. Anhand eines geeigneten Alzheimer-Tiermodells sollten diese Befunde weiter analysiert werden, um so auf einen sicheren therapeutischen Ansatz bezüglich einer vermehrten ADAM10 Genexpression schließen zu können.rn

Impact of a nurse vaccination program on hepatitis B immunity in a Swiss HIV clinic

We evaluated the impact of a nurse program for hepatitis B virus vaccination in a center from the Swiss HIV Cohort Study. Immunity (anti-HBs >10 IU/mL) increased from 32% to 76% in the intervention center (n = 238) where vaccine management was endorsed by nurses, but only from 33% to 39% in control centers (n = 2712, P < 0.001) where management remained in charge of physicians. Immunity against HBV in the HIV population is insufficient in Switzerland. Specific nurse vaccination program may efficiently improve health care.