Can routine offering of influenza vaccination in office-based settings reduce racial and ethnic disparities in adult influenza vaccination?

BACKGROUND: Influenza vaccination remains below the federally targeted levels outlined in Healthy People 2020. Compared to non-Hispanic whites, racial and ethnic minorities are less likely to be vaccinated for influenza, despite being at increased risk for influenza-related complications and death. Also, vaccinated minorities are more likely to receive influenza vaccinations in office-based settings and less likely to use non-medical vaccination locations compared to non-Hispanic white vaccine users. OBJECTIVE: To assess the number of "missed opportunities" for influenza vaccination in office-based settings by race and ethnicity and the magnitude of potential vaccine uptake and reductions in racial and ethnic disparities in influenza vaccination if these "missed opportunities" were eliminated. DESIGN: National cross-sectional Internet survey administered between March 4 and March 14, 2010 in the United States. PARTICIPANTS: Non-Hispanic black, Hispanic and non-Hispanic white adults living in the United States (N = 3,418). MAIN MEASURES: We collected data on influenza vaccination, frequency and timing of healthcare visits, and self-reported compliance with a potential provider recommendation for vaccination during the 2009-2010 influenza season. "Missed opportunities" for seasonal influenza vaccination in office-based settings were defined as the number of unvaccinated respondents who reported at least one healthcare visit in the Fall and Winter of 2009-2010 and indicated their willingness to get vaccinated if a healthcare provider strongly recommended it. "Potential vaccine uptake" was defined as the sum of actual vaccine uptake and "missed opportunities." KEY RESULTS: The frequency of "missed opportunities" for influenza vaccination in office-based settings was significantly higher among racial and ethnic minorities than non-Hispanic whites. Eliminating these "missed opportunities" could have cut racial and ethnic disparities in influenza vaccination by roughly one half. CONCLUSIONS: Improved office-based practices regarding influenza vaccination could significantly impact Healthy People 2020 goals by increasing influenza vaccine uptake and reducing corresponding racial and ethnic disparities.

Evolución: de la especie humana al cyborg

Resumen: Gracias a la evolución biológica y cultural el ser humano ha sido capaz de adaptarse al ambiente. Una opción para mejorar las prestaciones humanas podría ser la obtención de un cyborg o ser humano biónico en el cual la parte inorgánica fuese un chip computacional conectado directamente al cerebro. Esta y otras posibilidades se debaten en el presente artículo. Palabras clave: Evolución biológica, selección natural, evolución cultural, cyborg, biónico, inteligencia.

Reflexiones sobre los cyborgs y los robots: evolucion humana y aumentacion

The human being has changed in time due to both, biological and cultural evolution. In a first step, biological evolution was the cornerstone of the changes in our species. However, cultural evolution was also a key element producing adaptations that allowed the evolution of modern human being. These adaptations include aspects as different as clothing, tools, reading and writing, calculation and some forms of rudimentary prosthesis. Technoscience has enhanced these adaptations that conduce to the concept of broad-sense cyborg. Present human society includes a huge proportion of these latter individuals. In this article we discuss this reality and the future of our society based on the interconnections between humans, cyborgs and robots.

Literatura, indústria cultural e formação humana

Este trabalho aborda questões referentes à literatura e aos produtos da indústria cultural, especialmente aos chamados romances "cor-de-rosa", focalizando as potencialidades de diferentes discursos na formação da subjetividade. As protagonistas dos romances O Quinze e As Três Marias, de Rachel de Queiroz são utilizadas como referência. Nesta perspectiva, evidencia-se a impregnação das criações ficcionais, atuando, de forma subconsciente e inconsciente, nas camadas profundas da personalidade, que pode em alguns casos, ampliar o conhecimento e a experiência humanos, aguçar os meios de expressão, despertar o senso crítico, mas em outros, reforçar a alienação da realidade. Conclui que enquanto a literatura oferece a possibilidade de libertar, os produtos da indústria cultural, ou seja, a literatura de massas, constituem um convite à alienação, ao conformismo, uma vez que tendem a inculcar estereótipos e preconceitos.

Immunogenicity and safety of an intradermal boosting strategy for vaccination against influenza in lung transplant recipients.

The immunogenicity of influenza vaccine is suboptimal in lung transplant recipients. Use of a booster dose and vaccine delivery by the intradermal rather than intramuscular route may improve response. We prospectively evaluated the immunogenicity and safety of a 2-dose boosting strategy of influenza vaccine. Sixty lung transplant recipients received a standard intramuscular injection of the 2006-2007 inactivated influenza vaccine, followed 4 weeks later by an intradermal booster of the same vaccine. Immunogenicity was assessed by measurement of geometric mean titer of antibodies after both the intramuscular injection and the intradermal booster. Vaccine response was defined as 4-fold or higher increase of antibody titers to at least one vaccine antigen. Thirty-eight out of 60 patients (63%) had a response after intramuscular vaccination. Geometric mean titers increased for all three vaccine antigens following the first dose (p < 0.001). However, no significant increases in titer were observed after the booster dose for all three antigens. Among nonresponders, 3/22 (13.6%) additional patients responded after the intradermal booster (p = 0.14). The use of basiliximab was associated with a positive response (p = 0.024). After a single standard dose of influenza vaccine, a booster dose given by intradermal injection did not significantly improve vaccine immunogenicity in lung transplant recipients.

Monitoring mortality as an indicator of influenza in Catalonia, Spain.

This study aimed to investigate the behaviour of two indicators of influenza activity in the area of Barcelona and to evaluate the usefulness of modelling them to improve the detection of influenza epidemics. DESIGN: Descriptive time series study using the number of deaths due to all causes registered by funeral services and reported cases of influenza-like illness. The study concentrated on five influenza seasons, from week 45 of 1988 to week 44 of 1993. The weekly number of deaths and cases of influenza-like illness registered were processed using identification of a time series ARIMA model. SETTING: Six large towns in the Barcelona province which have more than 60,000 inhabitants and funeral services in all of them. MAIN RESULTS: For mortality, the proposed model was an autoregressive one of order 2 (ARIMA (2,0,0)) and for morbidity it was one of order 3 (ARIMA (3,0,0)). Finally, the two time series were analysed together to facilitate the detection of possible implications between them. The joint study of the two series shows that the mortality series can be modelled separately from the reported morbidity series, but the morbidity series is influenced as much by the number of previous cases of influenza reported as by the previous mortality registered. CONCLUSIONS: The model based on general mortality is useful for detecting epidemic activity of influenza. However, because there is not an absolute gold standard that allows definition of the beginning of the epidemic, the final decision of when it is considered an epidemic and control measures recommended should be taken after evaluating all the indicators included in the influenza surveillance programme.

Reproducción humana asistida: los problemas que suscita desde la bioética y el derecho

El artículo trata de los problemas éticos y jurídicos que surgen a raíz de la puesta en práctica de técnicas de reproducción asistida, al querer determinar la paternidad o poder elegir el sexo de un embrión viable, entre otros.

Filosofia, ciencia social y cognición humana

Tradicionalmente, las ciencias sociales se han fundado en categorías de sentido común para describir la realidad, de modo que aceptan tácitamente el principio de la folk psychology, según el cual las personas actúan para conseguir aquello que desean, dadas unas creencias. Sin embargo, aunque los deseos y las creencias puedan ser causas de la acción, no hay modo de definir de forma conceptualmente independiente cada uno de estos elementos con el fin de elaborar leyes de la acción que sean informativas y empíricamente corregibles o ajustables. Se hace necesario substituir este sistema explicativo por otro que «divida la naturaleza por sus articulaciones». Alejada del fallido programa de investigación conductista, la ciencia social puede explorar nuevas vías para convertirse en una disciplina rigurosa equipada con un conjunto de teorías que permitan reorganizar las valiosas observaciones disponibles y sugerir nuevas hipótesis interdisciplinariamente integradas. Sin embargo, esto no ocurrirá en la medida en que no haya forma de escapar a las limitaciones de la folk psychology. El presente artículo trata de mostrar cómo la psicología evolucionaria, centrada en los mecanismos evolucionados de procesamiento de información presentes en la mente humana, proporcionaría la conexión causal necesaria entre la biología evolucionaria y los complejos e irreductibles fenómenos sociales y culturales estudiados por sociólogos, economistas, antropólogos e historiadores.

"Blade Runner" o la pregunta por la dignidad humana

Al pensar en la relación entre el fundamento de la dignidad humana y la resolución de algunos problemas bioéticos, me vino a la cabeza Blade Runner, la película de Ridley Scott basada en un relato de Philip K. Dickque lleva el extravagante título de ¿Sueñan los androides con ovejas eléctricas? (extravagante si vemos la película pero no tanto si leemos el relato)...

Documento sobre congelación de ovocitos para la reproducción humana

Con este documento se pretende informar sobre la congelación de ovocitos para la reproducción humana y abordar el problema desde distintos punto de vista, con el fin de proporcionar argumentos y participar en el debate generado sobre el uso y aplicación de las técnicas de reproducción asistida y fomentar la necesaria actualización de una normativa que, si bien fue pionera en su momento, presenta hoy las carencias y contradicciones que el avance científico y el devenir social han ocasionado, y que requieren su puesta al día.

Pesquisa educacional e experiência humana na perspectiva hermenêutica

O ensaio aborda a fragilidade teórica da pesquisa educacional brasileira, desdobrando a argumentação em três seções. Na primeira, baseando-se em Bernardete Gatti, o texto alinhava alguns traços do diagnóstico sobre as dificuldades e os limites do atual estágio da pesquisa educacional no país. Na segunda, concentra-se em resumir o aspecto nuclear da ambiguidade da experiência ordinária, científica e filosófica. Pretende mostrar que, se tais formas foram acompanhadas por tendências dogmáticas, também apresentam concepções abertas e plurais. Na última parte, procura justificar a experiência hermenêutica gadameriana como perspectiva promissora para ampliar a noção de experiência humana, visando a descortinar um novo olhar sobre a natureza da pesquisa educacional.

"El Barranc de Gàfols" (Ginestar, Tarragona) y "Aldovesta" (Benifallet, Tarragona): estudio arqueozoológico como base de teorización sobre la dieta humana a principios de la Edad del Hierro y la complejidad económica en el curso bajo del Ebro.

En relación a trabajos recientes sobre los patrones de poblamiento protohistórico en el curso bajo del Ebro y la causalidad económica (Asensio el alii, 1996/ Mascort el alii, 1991), decidimos plantear un estudio que nutriera dichas hipótesis mediante el análisis arqueozoológico de dos yacimientos culturalmente contemporáneos y de cronologías sucesivas, ubicados a orillas de este río.

How critical is timing for the diagnosis of influenza in general practice?

QUESTIONS UNDER STUDY: The diagnostic significance of clinical symptoms/signs of influenza has mainly been assessed in the context of controlled studies with stringent inclusion criteria. There was a need to extend the evaluation of these predictors not only in the context of general practice but also according to the duration of symptoms and to the dynamics of the epidemic. PRINCIPLES: A prospective study conducted in the Medical Outpatient Clinic in the winter season 1999-2000. Patients with influenza-like syndrome were included, as long as the primary care physician envisaged the diagnosis of influenza. The physician administered a questionnaire, a throat swab was performed and a culture acquired to document the diagnosis of influenza. RESULTS: 201 patients were included in the study. 52% were culture positive for influenza. By univariate analysis, temperature >37.8 degrees C (OR 4.2; 95% CI 2.3-7.7), duration of symptoms <48 hours (OR 3.2; 1.8-5.7), cough (OR 3.2; 1-10.4) and myalgia (OR 2.8; 1.0-7.5) were associated with a diagnosis of influenza. In a multivariable logistic analysis, the best model predicting influenza was the association of a duration of symptom <48 hours, medical attendance at the beginning of the epidemic (weeks 49-50), fever >37.8 and cough, with a sensitivity of 79%, specificity of 69%, positive predictive value of 67%, negative predictive value of 73% and an area under the ROC curve of 0.74. CONCLUSIONS: Besides relevant symptoms and signs, the physician should also consider the duration of symptoms and the epidemiological context (start, peak or end of the epidemic) in his appraisal, since both parameters considerably modify the value of the clinical predictors when assessing the probability of a patient having influenza.

Ciência da informação e cognição humana: uma abordagem do processamento da informação

Apresenta as possibilidades de inter-relação entre a ciência da informação e os estudos relativos à cognição humana. Discute resultados de pesquisas sobre processamento da informação na psicologia cognitiva referentes ao desempenho dos indivíduos na leitura e na aquisição de conhecimento, assim como na transformação de informação em conhecimento. Focaliza estudos sobre a cognição e metacognição e a importância dessa abordagem para a recuperação de informação, assim como o processo de indexação em sistemas de informação.