Publications - Abstracts
Women's Health
"Improving the quality of patient care & health outcomes through research & education."
Women's Health
The following paper was presented at the National Immunization Conference in Atlanta, Georgia.
IMPROVING INFLUENZA VACCINE COVERAGE IN PREGNANT WOMEN
Melanie Mouzoon1, Flor Munoz2, Frances Smith3, Anthony Greisinger4, Oscar Wehmanen4, Brenda Brehm4 and W. Paul Glezen5
1Pediatrics, Kelsey-Seybold Clinic, 7900 Fannin Suite 2100, Houston, TX, USA,
2Pediatric Infectious Disease, Baylor College of Medicine,
3Obstetrics/Gynecology, Kelsey-Seybold Clinic,
4Kelsey Research Foundation,
5Molecular Virology and Microbiology, Baylor College of Medicine
Learning Objectives for this Presentation:
Recognize the need to develop strategies to improve influenza vaccination in pregnant women
Understand a model program to increase influenza vaccine coverage in pregnant women
Background:
ACIP recommends that pregnant women receive inactivated influenza vaccine. U.S. coverage is only 12.8% in this vulnerable population.
Setting:
Kelsey-Seybold Clinic (KSC) provides primary and specialized care in the Houston area. Influenza vaccine coverage of pregnant women at KSC averaged 3.5% per year during 1998-2002. We describe strategies adopted to improve influenza immunization coverage in pregnant women in a large health care organization.
Population:
Women receiving prenatal care at KSC obstetric-gynecology (OB-GYN).
Project Description:
A retrospective electronic database search of four consecutive influenza seasons (2003/04 to 2006/07) was performed to estimate influenza immunization rates in pregnant women after implementation of three main strategies: 1) adoption of standing orders for influenza vaccine administration in OB and general medicine practices, 2) annual employee influenza immunization campaign through broadcast emails and notices with information on immunization in pregnancy, and 3) assessment of immunization rates in pregnant women for individual OB providers, followed by encouragement and behavior modeling by the department Chair, with updates on influenza vaccine in pregnancy to staff during quarterly meetings.
Results/Lessons Learned:
Influenza vaccine coverage rates increased from 3.5% to 21.1%) in 2003/04, 30.6% in 2004/05, 32% in 2005/06, and 40.5% in 2006/07. The number of prenatal care visits was the most important predictor for receipt of influenza vaccine, while insurance plans that cover pregnancy as a bundled service were a potential barrier for vaccination. Concurrently, employee influenza vaccine coverage increased from 36% in 2003/04, to 51% in 2004/05, 56% in 2005/06, and 62% in 2006/07. Influenza vaccination rates in pregnant women can be improved substantially with standing orders for immunization and promotion through vaccine advocates and active educational activities focusing on encouraging influenza immunization in patients and health care providers.
Women's Health
The following paper was published in the August 2007, American Journal of Public Health.
The influence of subjective social status on vulnerability to postpartum smoking among young pregnant women.
Reitzel LR, Vidrine JI, Li Y, Mullen PD, Velasquez MM, Cinciripini PM, Cofta-Woerpel L, Greisinger A, Wetter DW.
Department of Health Disparities Research, M. D. Anderson Cancer Center, University of Texas, Houston, TX 77030-4009, USA. lrreitze@mdanderson.org
OBJECTIVES: Associations between subjective social status, a subjective measure of socioeconomic status, and predictors of risk for postpartum smoking were examined among 123 pregnant women (aged 18-24 years) who stopped smoking because of pregnancy. The goal was to identify how subjective social status might influence the risk for postpartum smoking and to elucidate targets for intervention.
METHODS: We used multiple regression equations to examine the predictive relations between subjective social status and tobacco dependence, self-rated likelihood of postpartum smoking, confidence, temptations, positive and negative affect, depression, stress, and social support. Adjusted analyses were also conducted with control for race/ethnicity, education, income, and whether participant had a partner or not (partner status).
RESULTS: In unadjusted and adjusted analyses, subjective social status predicted tobacco dependence, likelihood of postpartum smoking, confidence, temptations, positive affect, negative affect, and social support. Adjusted analyses predicting depression and stress approached significance.
Women's Health
The following paper was published in the December 2006, Patient Education Counseling.
Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors.
Basen-Engquist K, Taylor CL, Rosenblum C, Smith MA, Shinn EH, Greisinger A, Gregg X, Massey P, Valero V, Rivera E.
The University of Texas M.D. Anderson Cancer Center, USA. kbasenen@mdanderson.org
OBJECTIVE: This paper will report the results of a pilot test of a 6-month, 21-session intervention to increase breast cancer survivors' physical activity by teaching them to incorporate short periods of moderate activity into their daily routines (lifestyle intervention). The effect of the intervention on physical performance, quality of life, and physical activity are reported.
METHODS: Sixty breast cancer survivors were randomized to either a lifestyle intervention or a standard care control group. Physical performance, quality of life (Medical outcomes study short form-36 [SF-36]), and physical activity (7-day recall and motivation readiness), were assessed at baseline and 6 months.
RESULTS: The lifestyle group had significantly better performance in the 6-min walk task than the controls (p=0.005) at 6 months. The intervention had positive effects on the bodily pain (p=0.020) and general health (p=0.006) subscales from the SF-36. The lifestyle group had a greater motivational readiness for physical activity at 6-month than standard care, but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did > or =30 min of moderate or more intense activity.
CONCLUSIONS: Despite the small sample size, the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity, and should be tested in a larger randomized trial.
PRACTICE IMPLICATIONS: If the lifestyle approach is shown to be effective in a larger trial, it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment.
Women's Health
The following article was published in Obstetrics and Gynecology, 2006 Feb;107(2 Pt 1):310-3.
Single-Dose Fluconazole for Vulvovaginal Candidiasis - Impact on Prothrombin Time in Women Taking Warfarin
Mark A. Turrentine, MD
Kelsey-Seybold Clinic, Houston, Texas
Objective: To estimate the effect of a single oral 150mg dose of fluconazole on the prothrombin time of women on long-term warfarin therapy.
Methods: Women on warfarin therapy for 6 months or more with no change in dose within 4 weeks of the study, and a prothrombin time (PT) with an International Normalized Ratio (INR) between 2 and 3 were invited to participate. Two consecutive baseline PTs were obtained (days 1 and 0), and women were given 150mg of fluconazole. Prothrombin times were measured on days 2, 5, and 8 of the study. The change in PT was calculated from the difference between the baseline PT on day 0 and the PT during the study period. To detect a 10% difference in a PT (approximately 2.1 seconds) of a patient with an INR of 2.0, at P<.05 and a power of 90%, 5 subjects are required.
Results: Six women participated. The mean ( standard deviation) PT for day 0 was 27.7 4.1 seconds or INR 2.6 0.4. The PT increased 11% at day 2, 34% at day 5, and 2% at day 8; these differences were not statistically significant. However, on half of the women had either a clinically relevant increase of the INR greater than 4, or bleeding that required their dosage of warfarin to be decreased.
Conclusion: A single 150mg oral dose of fluconazole may increase the PT to a clinically relevant level in a woman on chronic warfarin therapy. Clinicians should monitor the PT carefully after a single dose of fluconazole.
Women's Health
The following article was published in Patient Education Counselors, 2006 July 13
Randomized pilot test of a lifestyle activity intervention for breast cancer survivors.
Karen Basen-Engquist1,
,
, Cindy L. Carmack Taylor1,
Carol Rosenblum1,
Murray A. Smith1,
Eileen H. Shinn1,
Anthony Greisinger2,
Xylina Gregg3,
Pamela Massey1,
Vicente Valero1
and Edgardo Rivera1
1The University of Texas M.D. Anderson Cancer Center
2Kelsey Research Foundation
3Kelsey-Seybold Clinic, USA
Objective: This paper will report the results of a pilot test of a 6-month, 21-session intervention to increase breast cancer survivors' physical activity by teaching them to incorporate short periods of moderate activity into their daily routines (lifestyle intervention). The effect of the intervention on physical performance, quality of life, and physical activity are reported.
Methods: Sixty breast cancer survivors were randomized to either a lifestyle intervention or a standard care control group. Physical performance, quality of life (Medical outcomes study short form-36 [SF-36]), and physical activity (7-day recall and motivation readiness), were assessed at baseline and 6 months.
Results: The lifestyle group had significantly better performance in the 6-min walk task than the controls (p=0.005) at 6 months. The intervention had positive effects on the bodily pain (p=0.020) and general health (p=0.006) subscales from the SF-36. The lifestyle group had a greater motivational readiness for physical activity at 6-month than standard care, but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did >/=30min of moderate or more intense activity.
Conclusions: Despite the small sample size, the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity, and should be tested in a larger randomized trial.
Practice Implications: If the lifestyle approach is shown to be effective in a larger trial, it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment.
Women's Health
The following article was published in Am J Obstet Gynecol, 2005 Apr; 192(4): 1098-106
Safety of influenza vaccination during pregnancy
Flor M.
Munoz MD1,
,
, Anthony J. Greisinger PhD2,
Oscar A. Wehmanen MS2,
Melanie E. Mouzoon MD3,
James C. Hoyle MD3,
Frances A. Smith MD3
and W. Paul Glezen MD1
1Baylor College of Medicine, Departments of Pediatrics and Molecular
Virology and Microbiology
2Kelsey Research Foundation
3Kelsey-Seybold Clinic
Objective: The purpose of this study was to evaluate the safety of influenza vaccine that is administered in the second or third trimester of gestation.
Study Design: A retrospective electronic database search of 5 influenza seasons (July 1, 1998, to June 30, 2003) was performed at a large multispecialty clinic in Houston, Texas. Immunization rates were calculated, and outcomes of pregnancy were compared between a cohort of healthy women who received influenza vaccine and a control group of healthy unvaccinated women who were matched by age, month of delivery, and type of medical insurance.
Results: Among 7183 eligible mother-infant pairs, only 252 pregnant women (3.5%) received the influenza vaccine. Women with medical insurance were more likely to be vaccinated, although the rates for women with chronic underlying conditions were similar to those of healthy women, regardless of insurance status. The mean gestational age at the time of influenza vaccination was 26.1 weeks (range, 14-39 weeks). No serious adverse events occurred within 42 days of vaccination, and there was no difference between the groups in the outcomes of pregnancy (including cesarean delivery and premature delivery) and infant medical conditions from birth to 6 months of age.
Conclusion: Influenza vaccine that was administered in the second or third trimester of gestation was safe in this study population.
