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Objective: The objective of this systematic review and meta-analysis is to assess the association between tattooing and the risk of transmission of hepatitis B virus. Methods: A systematic search of MEDLINE, EMBASE, PubMed, Database of Abstracts of Reviews of Effects, ACP Journal Club and BIOSIS Previews was performed up to March 2011. Results: Forty-two observational studies were included in this systematic review, of which 31 were included in the meta-analysis. Pooled odds ratios (95% confidence intervals) of the association of tattooing and hepatitis B infection was 1.48 (1.30-1.68) when all studies were included in the analysis. Subgroup analysis shows the strongest association between tattooing and risk of hepatitis B among populations involved in high-risk behaviours (OR=1.64, 95% CI: 1.32-2.03). Conclusion: Findings of the current systematic review and meta-analysis indicate that tattooing is associated with hepatitis B transmission in all subgroups. A population health approach that emphasizes universal hepatitis B immunization, education of young adults who are more likely to get tattoos, and education of prison inmates (who have the highest background rate of hepatitis B infection), along with enforcement of guidelines and safer tattooing practices in prison, are fundamental in prevention of transmission of hepatitis B. Key words: Tattooing; hepatitis B; hepatitis; infections La traduction du resume se trouve a la fin de l'article. Objectif : Nous avons procede a un examen systematique et a une meta-analyse afin d'evaluer l'association entre le tatouage et le risque de transmission du virus de l'hepatite B. Methode : Recherche systematique dans les bases de donnees MEDLINE, EMBASE, PubMed, DARE (Database of Abstracts of Reviews of Effects), ACP Journal Club et BIOSIS Previews jusqu'en mars 2011. Resultats : Quarante-deux etudes observationnelles etaient comprises dans l'examen systematique, dont 31 ont ete incluses dans la metaanalyse. Le rapport de cotes combine (intervalles de confiance de 95 %) de l'association entre le tatouage et l'infection a VHB etait de 1,48 (1,30-1,68) lorsque toutes les etudes etaient comprises dans l'analyse. L'analyse par sous-groupe montre la plus forte association entre le tatouage et le risque d'hepatite B dans les populations s'adonnant a des comportements a risque (RC=1,64, IC de 95 % : 1,32-2,03). Conclusion : Les resultats de l'examen systematique et de la metaanalyse montrent que le tatouage est associe a la transmission de l'hepatite B dans tous les sous-groupes. Une approche axee sur la sante des populations, qui met l'accent sur la vaccination universelle contre l'hepatite B, la sensibilisation des jeunes adultes, plus susceptibles de se faire tatouer, et la sensibilisation des detenus (qui presentent le plus haut taux naturel d'infection a VHB), ainsi que l'application des lignes directrices et des pratiques de tatouage a moindre risque en prison, sont fondamentales pour prevenir la transmission de l'hepatite B. Mots cles : tatouage; hepatite B; hepatite; infections, Tattooing and body arts have become more prevalent in recent years, their popularity increasing among young adults. A population-based study revealed that one third of people younger than 30 years [...]

In 2005, the WHO Western Pacific Region adopted the hepatitis B control goal of reducing the hepatitis B surface antigen seroprevalence in children at least 5 years of age to less than 2% by 2012. Universal infant immunization with three doses of hepatitis B vaccine, including a timely birth dose, is the key recommended strategy. Measuring seroprevalence in children at least 5 years of age takes into account the period when the risk of acquiring a chronic infection is highest and provides an indicator that can be monitored in the short term, within 5 years of vaccine introduction, and which correlates strongly with the long-term consequences of hepatitis B. A time-bound supranational hepatitis B control goal was chosen to create a sense of political urgency for strengthening routine immunization services and improving access to delivery care as well as providing resources for hepatitis B vaccination. Consequently, the programme strategies selected are not stand-alone but also contribute to strengthening health systems. Independent certification of achievement of the control goal, hitherto used mainly for eradication goals, is planned for all countries. Early assessment showed that adopting the regional goal led to greater political commitment, with reduced inequalities in hepatitis B vaccination between and within countries. Previous declining trends in routine immunization coverage also show signs of reversal and there is major progress in providing timely birth doses. A similar approach may be relevant to countries in Africa and South Asia, that have a high hepatitis B disease burden faltering routine immunization and poor access to skilled delivery care. En 2005, la Region OMS du Pacifique occidental a adopte, concernant l'hepatite B, l'objectif de reduire a moins de 2% d'ici 2012 la prevalence de l'antigene de surface du VHB chez les enfants de moins de 5 ans. La principale strategie recommandee est la vaccination universelle des nourrissons avec trois doses de vaccin contre l'hepatite B, y compris une dose dans les delais a la naissance. La mesure de la seroprevalence chez les moins de 5 ans prend en compte la periode ou le risque de contracter une infection chronique est maximal et fournit un indicateur pouvant etre suivi a court terme sur les 5 ans ecoules depuis l'introduction du vaccin et fortement correle avec les consequences a long terme de l'llepatite B. Un objectif de lutte contre l'hepatite B supranational et lie au temps a ete choisi pour faire prendre conscience de l'urgence sur le plan strategique du renforcement des services de vaccination systematique et de l'amelioration de l'acces aux soins a l'accouchement, comme de la fourniture de moyens pour la vaccination contre l'hepatite B. Par consequent, les strategies programmatiques choisies ne sont pas independantes, mais contribuent egalement au renforcement des systemes de sante. Une certification independante de la realisation de l'objectif en termes de lutte contre la maladie, operation jusqu'ici principalement reservee a t'objectif d'eradication, est prevue pour l'ensemble des pays. Une premiere evaluation a montre que l'adoption de l'objectif regional avait conduit a un plus grand engagement politique, avec une reduction des inegalites en termes de vaccination contre l'hepatite B d'un pays a l'autre ou au sein d'un meme pays. Les tendances a la baisse precedemment relevees pour la couverture par la vaccination systematique presentent egalement des signes d'inversion et on constate un progres important dans l'administration dans les delais de la dose a la naissance. Une demarche similaire pourrait etre applicable aux pays d'Afrique et d'Asie du Sud-Est, dans lesquels la charge de morbidite due a l'hepatite B est elevee, la vaccination systematique regresse et l'acces aux soins a l'accouchement est insuffisant. En 2005, la Region dei Pacifico O ccidental de la OMS adopto la meta de control de la hepatitis B consistente en reducir la seroprevalencia dei antigeno de superficie dei VHB en los niRos de 5 o mas aros a menos dei 2% para 2012. La inmunizacion infantil universal con tres dosis de la vacuna anti-hepatitis B, incluida una dosis de nacimiento administrada puntualmente, es la estrategia clave recomendada. La decision de medir la seroprevalencia en los ninos de ai menos 5 aros responde ai hecho de que el riesgo de contraer una infeccion cronica es maximo en ese periodo, y de ese modo se obtiene un indicador que puede monitorearse a corto plazo, a los cinco anos de introducir la vacuna, y que esta fuertemente corretacionado con las consecuencias a largo plazo de la hepatitis B. Se eligio una meta supranacional de control de la hepatitis B sujeta a un plazo para transmitir la impresion de que el fortalecimiento de los servicios de inmunizacion sistematica y la mejora dei acceso a la atencion obstetrica, asi como la provision de recursos para la vacunacion contra la hepatitis B, constituyen una urgencia politica. Por consiguiente, las estrategias programaticas elegidas no se agotan en si mismas, pues contribuyen a fortalecer los sistemas de salud. Se ba previsto para todos los paises un proceso independiente de certificacion dei logro de la meta de control, aplicado hasta ahora principalmente a metas de erradicacion. Una evaluacion preliminar mosbo que la adopcion de la meta regional propicio un mayor compromiso politico, reduciendose las desigualdades en materia de vacunacion anti-hepatitis B tanto entre los paises como dentro de ellos. Las tendencias previas de disminucion de la cobertura de inmunizacion sistematica tambien muestran signos de inversion, y se observan avances importantes en la administracion puntual de las dosis de nacimiento. Enfoques similares a este pueden revestir interes para los paises de Africa y Asia meridional, que presentan una alta carga de morbilidad por hepatitis B, perturbaciones de la inmunizacion sistematica y acceso limitado a la atencion obstetrica especializada., Introduction Opinion is divided on the value of international bodies setting time-bound supranational disease-specific goals in an increasingly diversified world with growing inequalities in health and health-care priorities. (1,2) By [...]

The prevalence of vaccination against hepatitis B virus (HBV), factors associated with vaccination, and missed opportunities for vaccination were assessed among 949 street-recruited young injecting heroin users (IHUs) and noninjecting HUs (NIHUs). A cross-sectional study was carried out in Madrid, Barcelona, and Seville. Face-to-face interviews were held using a structured questionnaire with computer-assisted personal interviewing. Dried blood spot samples were tested for anti-HBV core antigen and HBV surface antigen. Bivariate and logistic regression analyses were performed. The prevalence of HBV vaccination was 21.7%, with significant differences among the cities (13.3% in Madrid, 18.4% in Seville, and 33.2% in Barcelona) and between IHUs (23.8%) and NIHUs (17.9%). In the logistic regression analysis, living in Barcelona and being aged 25 years or younger were associated with HBV vaccination in IHUs and NIHUs; in IHUs, vaccination was also associated with living in the street or in institutions for most of the last 12 months. Practically all those susceptible to HBV infection had missed at least one opportunity for vaccination, and most of them had missed such an opportunity in the last year. The proportion of vaccinated HUs remains very low despite efforts to set up harm reduction programs. New and more active strategies must be incorporated in these programs. Keywords: Hepatitis B; Vaccination; Substance-related disorders; Spain; Health policy

This study was designed to develop reliable and valid quantitative measures of the beliefs and attitudes toward hepatitis B virus (HBV) vaccination among gay men, using a community-based participatory research approach. A convenience sample of 358 gay men was recruited in two gay bars. Exploratory factor analysis performed on the first split-half sample was used to assess the factor structure from five scales measuring beliefs about HBV vaccination. The scales were based on constructs from the health belief model and the social cognitive theory. Confirmatory factor analysis was performed on the remaining half-sample using structural equation modeling. Multivariable analysis further validated the scales. These findings propose standardized measures that may be useful in assessing the beliefs and attitudes of gay men toward HBV vaccination to guide intervention design and evaluation. KEYWORDS. Gay men, vaccination, structural equation modeling, factor analysis, health belief model, social cognitive theory, community-based participatory research

Objective. In 1995, the Advisory Committee on Immunization Practices (ACIP) recommended routine hepatitis B (HB) vaccination of all unvaccinated 11- to 12-year-old adolescents. Little is known about the implementation of these recommendations in a managed care setting. The objective of this study was to determine the impact of ACIP recommendations on HB vaccination among adolescents in 3 managed care settings. Methods. We assessed HB vaccination coverage among adolescents who were enrolled in 3 large health maintenance organizations (HMOs) and who turned 13 years old after the 1995 ACIP recommendations. Children who were 8 to 10 years of age during May 1993 and were continuously enrolled through December 1998 were eligible. We used the HMOs' computerized immunization tracking system to collect HB vaccination dates. The percentage of adolescents who received 3 doses of HB vaccine was determined. Results. In HMOs A, B, and C, coverage levels for 3 doses of HB vaccine were 43.4%, 65.5%, and 25.7%, respectively, among 13-year-olds in 1998 compared with 26.1%, 50.4%, and 5.5% among 13-year-olds in 1996. Between the ages of 11 and 13 years, coverage rates among adolescents aged 13 in 1998 rose more than the coverage among adolescents aged 13 in 1996. The proportion of 13-year-olds in 1998 who received the first dose of HB vaccine by December 1998 was much higher at 89.6%, 65.2%, and 56.6% in HMOs A, B, and C, respectively, compared with the proportion who completed the 3-dose series (43.4%, 65.5%, and 25.7%, respectively). Conclusions. After the 1995 ACIP recommendations, HB vaccination coverage levels among 13-year-olds increased in each of the HMOs, suggesting adherence with national recommendations. Differences among the 3 HMOs may reflect differences in internal policies. More effective strategies may be needed to achieve the Healthy People 2010 goal of 90% vaccination coverage rates among adolescents. Pediatrics 2002;110:929-934; hepatitis B vaccine, adolescence, health maintenance organizations, managed care, vaccination, immunization., Prevention of hepatitis B virus (HBV) infection through vaccination of adolescents before they enter adulthood is crucial because young adults have the highest incidence of HBV infection in the United [...]

The opportunities and problems for hepatitis B vaccination programmes in prison settings are discussed. In particular, the advantages of modelling are stressed and an active case-finding approach is advocated. Measures for maintaining good case-holding are also discussed, and a 0, 1, 2 months vaccination regimen with 20 [micro]g doses of vaccine is advocated for prison settings. A higher reference level for inferring adequate immunization is also recommended, with booster injections for inmates who do not meet the higher reference after a primary course of vaccination. Keywords Hepatitis B vaccines/utilization/administration and dosage; Prisons; Immunization programs/organization and administration; Immunization schedule; Seroepidemiologic studies; Models, Theoretical; Hepatitis B/prevention and control; Program evaluation; Australia (source: MESH, NLM). Mots cles Vaccin anti-hepatite B/utilisation/administration et posologie; Prison; Programmes de vaccination/organisation et administration; Calendrier vaccination; Etude sero-epidemiologique; Modele theorique; Hepatite B/prevention et controle; Evaluation programme; Australie (source: MESH, INSERM). Palabras clave Vacunas contra hepatitis B/utilizacion/administracion y dosificacion; Prisiones; Programas de inmunizacion/ organizacion y administracion; Esquema de inmunizacion; Estudios seroepidemiologicos; Modelos teoricos; Hepatitis B/prevencion y control; Evaluacion de programas; Australia (fuente: DeCs, BIREME). Bulletin of the World Health Organization 2002;80:569-574., Voir page 573 le resume en francais. En la pagina 573 figura un resumen en espanol. Introduction Infection with hepatitis B virus is common among prison inmates (1, 2), mainly [...]

INTRODUCTION There are about two million individuals currently incarcerated in the United States, a number that has more than tripled since 1980. (1) In 1999, approximately 0.6% of the entire […]

Objective. To determine the impact of the American Academy of Pediatrics/US Public Health Service (AAP/USPHS) joint statement on thimerosal in vaccines on hospital infant hepatitis B vaccination policies in Wisconsin. Methods. The nurse managers of hospital newborn nurseries (n = 110) were surveyed by mail. Nonresponders were resurveyed. Twelve hospitals no longer provided obstetric services. Of the remaining 98 hospitals, 84 (86%) responded to the initial mailing and 14 (14%) responded to the second mailing. The number of hospitals that offered hepatitis B vaccine to infants before July 1999 was compared with that in March 2000. The number of hospitals that had policies in place to vaccinate infants whose mothers' hepatitis B surface antigen status (HBsAg) was positive or unknown during the thimerosal alert (July 1999 through November 1999) was compared with that in March 2000. Results. Before July 1999, 81% of the hospitals representing 84% of reported Wisconsin births routinely offered hepatitis B vaccine to all infants. By March 2000, 50% of hospitals, representing 43% of births, had resumed routine infant hepatitis B vaccination. Physician decision to use a combination Haemophilus influenzae type b hepatitis B vaccine was the most frequently given reason for not reinstituting infant hepatitis B vaccination. During the thimerosal alert, 23% of hospitals did not have policies to vaccinate infants whose mothers were HBsAg-positive and 51% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown. By March 2000, 6% of hospitals still did not have policies to vaccinate infants whose mothers were HBsAg-positive and 24% did not have policies to vaccinate infants whose mothers' HBsAg status was unknown. Conclusion. The AAP/USPHS joint statement on thimerosal in vaccines has resulted in a 38% decrease in the number of hospitals routinely offering infants hepatitis B vaccine. Although thimerosal-free hepatitis B vaccine is now available, some hospitals still do not have appropriate policies in place for vaccinating infants whose mothers' HBsAg status is positive or unknown. In the future, policymakers should include anticipated consequences that may result from changes in immunization policy in their recommendations. Pediatrics 2001; 107:755-758; hepatitis B vaccine, infant, thimerosal, hospital., ABBREVIATIONS. ACIP, Advisory Committee on Immunization Practices; AAP, American Academy of Pediatrics; AAFP, American Academy of Family Physicians; USPHS, US Public Health Service; HBsAg, hepatitis B surface antigen. Nearly a [...]

Byline: S. Chlabicz (1), A. Grzeszczuk (1) Keywords: Key words Hepatitis C virus (HCV); Hepatitis B virus (HBV); HBV vaccine; Immunogenicity Abstract: Hepatitis C is a disease with varying rates of progression. The role of hepatitis B virus (HBV) as a cofactor in the development of hepatitis C virus (HCV)-related cirrhosis and hepatocellular carcinoma (HCC) has been suggested and the use of HBV vaccine in all HCV-infected patients has been advocated. This review presents the implications of HBV and HCV coinfection and addresses the issues of HBV vaccine immunogenicity and safety in patients with chronic HCV infection. Author Affiliation: (1) Dept. of Infectious Diseases, Medical Academy of Bialystok, Zurawia 14, P-15-540 Bialystok, Poland, Phone: (+48/85) 7416-921, Fax: -921, e-mail: doctors@friko.onet.pl, PL Article note: Received: December, 1999 * Revision accepted: July 1, 2000

OBJECTIVES: This study aimed to evaluate a specifically designed hepatitis B education/promotion curriculum package as part of a successful hepatitis B vaccination delivery system to adolescents. METHODS: A randomised-controlled trial was used to evaluate the effect of the curriculum package (or intervention) on uptake of vaccine. Schools were randomly selected from the metropolitan region of Melbourne to intervention (66 schools or 7,588 students) or control groups (69 schools or 9,823 students). Class teachers administered the intervention to students over 4 class periods before the vaccination course. RESULTS: The difference in mean school uptake between intervention and control was small at 1-2% per dose. 95% confidence intervals around the differences were -5% to 2% per dose and not significant. Intervention schools taught an average of 7 items out of 12 from the curriculum package, immunisation rates increased by 4-10% per dose between low and high implementation schools, but this trend was not significant. Impact evaluation demonstrated significantly greater knowledge of hepatitis B and vaccination among students in the intervention than the control group. CONCLUSION: Hepatitis B vaccination of preadolescents was not increased by the implementation of a curriculum package that successfully increased knowledge and awareness of hepatitis B in a school-based vaccination program. Additional strategies directed at the education of parents, the cooperative role of schools and pro-active providers might also be required to maximise vaccine uptake in this age group. Page 305 A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients OBJECTIVE: To test the cost effectiveness of Hospital in the Home compared to hospital admission for acute medical conditions. METHOD: Randomised controlled trial at the Prince of Wales Hospital, Sydney, from October 1995 to February, 1997; 100 patients with acute medical conditions admitted through the Emergency Department. RESULTS: The Hospital in the Home (HITH) group costs per separation ($1,764, CI95% $1,416 - $2,111, n:50) were significantly lower (p < 0.0001, Mann-Whitney U - Wilcoxon Rank Sum) than the control group hospital separation ($3,614, CI 95% $2,881.37 - $4,347.27, n=47) with no significant difference in clinical outcomes, and comparable or better user satisfaction. CONCLUSION: Given the favourable clinical outcomes the HITH model produces at a lower cost, the cost-effectiveness of the care mode is high, and the allocative efficiency favourable. IMPLICATIONS: As a care model and critical pathway, HITH offers hospitals real bed day savings that can either be used to rationalise resource usage for a given level of activity, or increase throughput. Page 312 Dissemination of responsible service of alcohol initiatives to rugby league clubs OBJECTIVES: To determine the acceptability of intervention strategies that increase the responsible service of alcohol by nonmetropolitan rugby league clubs. METHOD: Rugby league clubs were provided an information kit and advice by local public health workers, police and a lead agency regarding their responsible service of alcohol practices. Rugby League clubs and public health workers completed an acceptability survey at the conclusion of the study. RESULTS: Data were collected from 160 contactable clubs (100% consent) and 12 of 14 participating public health workers. Almost all clubs reported of contact with the lead agency, public health workers and police to be acceptable. Fifty-nine percent of clubs reported contact with public health workers to be useful. One-third of the public health workers considered that they were not the most suitable professional group to be involved in delivering the intervention. CONCLUSIONS: In spite of a suggested culture of harmful alcohol consumption among rugby league participants and spectators, non-metropolitan rugby league clubs appear receptive to public health strategies that increase their responsible service of alcohol. IMPLICATIONS: The ability of the public health sector to meet this opportunity appears limited, and may require additional strategies to increase the capacity of public health workers to develop/deliver inter-sectoral interventions in this setting. Page 316 Trends in birth rates for teenagers in Queensland, 1988 to 1997: an analysis by economic disadvantage and geographic remoteness OBJECTIVE: To investigate trends in the birth rate for teenagers in Queensland, stratified by geographic remoteness and economic disadvantage. METHOD: This was an analysis of routine data for the period 1988 to 1997. The number of births were obtained from the Queensland Perinatal Data Collection. Population data (the denominators for the rates) were obtained from the Australian Bureau of Statistics. Economic disadvantage was based on place of usual residence of the mother. Because of differences in physical, social and psychological development, the data were analysed in three age groups: 13 to 14 years, 15 to 17 years and 18 to 19 years. RESULTS: Birth rates to teenagers who live in disadvantaged areas were 2 to 4 times higher than the rates for all of Queensland and 10 to 20 times higher than the rates in affluent areas. The trend analysis showed that the rates are decreasing in urban-affluent areas (about 2.5% per year), while they have remained stable, but extremely high in disadvantaged-remote areas, and are increasing (about 5% per year)in disadvantaged-urban areas. CONCLUSIONS: The relatively low and stable rates for all of Queensland have hidden marked variations in the trends for areas defined according to economic disadvantage and remoteness. The rates were especially high and showed no improvement over time in remote disadvantaged areas, which have a large Indigenous population. IMPLICATIONS: In some areas of Queensland births to teenagers is a pressing problem, especially because it can perpetuate a cycle of limited educational opportunities, social isolation and reliance on welfare. Page 320 Prevalence and acceptability of public health initiatives in licensed premises OBJECTIVES: To determine the prevalence and acceptability of public health initiatives in licensed premises. METHODS: Licensees/managers of all 333 licensed premises in the Hunter Region of NSW were interviewed to assess the practice of, and interest in undertaking public health initiatives relating to: responsible service of alcohol; environmental tobacco smoke; healthy-food choices; skin, breast and cervical cancer prevention; and the prevention of HIV/AIDS. RESULTS: Ninety eight percent of contacted premises participated in the study. Approximately two-thirds of premises reported having a responsible service of alcohol policy and training their staff in responsible service. One third of premises reported the provision of healthy food choices and smoke-free areas. Initiatives concerned with the prevention of cancer and HIV/AIDS were practised by less than 25% of premises. Between 41% and 85% of premises expressed an interest in undertaking all but two initiatives. Almost all interested premises accepted the offer of resources to facilitate adoption of public health initiatives. CONCLUSIONS: The study suggests that licensed premises are already involved in a number of public health initiatives, and that they appear willing to consider the introduction of a wide range of such initiatives. IMPLICATIONS: The prevalence of public health initiatives in licensed premises, and the extent of interest expressed by licensees/managers in undertaking such initiatives suggests that both a need and an opportunity exist for public health and other agencies to be more actively involved in disseminating appropriate services in this setting. Page 323 Alcohol consumption in a community sample of older people OBJECTIVE: To examine the prevalence and pattern of alcohol use among community-living elderly Australians. METHODS: A survey was conducted of randomly selected non-institutionalised people aged 75 years and older living in the inner western suburbs of Sydney. Personal interviews by trained interviewers covered background demographic information and self-reported alcohol use. RESULTS: 72% of men and 54% of women drank alcohol. The median usual daily volume of ethanol consumed by drinkers was 10 grams for men and 1.3 grams for women. However 11% of male drinkers and 6% of female drinkers consumed at defined hazardous or harmful levels. CONCLUSIONS AND IMPLICATIONS: Although a sizeable majority of these older people were either non-drinkers or very light drinkers, a small but important proportion drank in the hazardous to harmful range. Despite increasing evidence of the health benefits of alcohol consumption it remains important to be alert for potentially harmful alcohol use among older people. Page 327 An analysis of resources for Indigenous women in NSW about cervical screening OBJECTIVE: To examine resources about cervical screening made available to Indigenous women in NSW. METHOD: An Aboriginal woman, on behalf of another Aboriginal woman, telephoned 47 NSW based organisations in May 1998 for information about cervical screening. Received materials were analysed for format, content and readability and then submitted to a panel of Indigenous women for their feedback. RESULTS: Of those 34 organisations agreeing to send resources, only 20 (59%) did so. After removing duplicates, 12 cervical screening resources were available for review of which six were designed and printed in NSW and the other six originated outside NSW. Of the six resources developed in NSW, two (33%) were for Aboriginal women. Of the six resources originating from outside of NSW, another two (33%) also were for Aboriginal women. The Flesch readability scores for resources ranged from 58.6 to 87.27. Those developed in NSW had a significantly lower readability score than those from outside of NSW (p = 0.025). Despite lower education levels among the target group, there was no difference in the readability scores of resources designed for Indigenous women (p=l). CONCLUSIONS: Most resources obtained by us were not tailored for Indigenous women. IMPLICATIONS: This study has set a base line for resources available for Indigenous women. Our method could be replicated in the future to evaluate and monitor improvement. Page 331 Too fat to exercise? Obesity as a barrier to physical activity OBJECTIVE: To describe perceptions of being 'too fat' as a barrier to physical activity by gender and body mass index, and to examine the associations between feeling fat and other weight-related barriers to physical activity. METHODS: Analyses of cross-sectional self-report data from a representative population survey of 2,298 Australian adults. RESULTS: Overall, 4.4% of respondents reported being too fat as a barrier to physical activity; this being more common among women (6.2%), and among the obese (22.6%). Associations were found between being too fat as a barrier, and being too shy or embarrassed to exercise; being too lazy or not motivated; having an injury or disability (males only); and being not the sporty type (females only). There was no association between feeling too fat and poor health. CONCLUSIONS: Feeling too fat to exercise is a common barrier among the overweight, particularly for women. Results suggest gender differences in weight-related barriers to physical activity. IMPLICATIONS: A better understanding of the nature of weight-related physical activity barriers can help inform public health strategies designed to increase physical activity among those who are obese.

This report concerning the immunization of adolescents (ie, persons 11-21 years of age, as defined by the American Medical Association [AMA] and the American Academy of Pediatrics [AAP]) is a supplement to previous publications (ie, MMWR 1994;43 [No. RR-1] 1-38; the AAP 1994 Red Book: Report of the Committee on Infectious Diseases; Summary of Policy Recommendations for Periodic Health Examination, August 1996 from the American Academy of Family Physicians [AAFP]; and AMA Guidelines for Adolescent Preventive Services [GAPS]: Recommendations and Rationale). This report presents a new strategy to improve the delivery of vaccination services to adolescents and to integrate recommendations for vaccination with other preventive services provided to adolescents. This new strategy emphasizes vaccination of adolescents 11-12 years of age by establishing a routine visit to their health-care providers. Specifically, the purposes of this visit are to a) vaccinate adolescents who have not been previously vaccinated with varicella virus vaccine, hepatitis B vaccine, or the second dose of the measles, mumps, and rubella (MMR) vaccine; b) provide a booster dose of tetanus and diphtheria toxoids; c) administer other vaccines that may be recommended for certain adolescents; and d) provide other recommended preventive services. The recommendations for vaccination of adolescents are based on new or current information for each vaccine. The most recent recommendations from ACIP, AAP, AAFP, and AMA concerning specific vaccines and delivery of preventive services should be consulted for details., In the United States, vaccination programs that focus on infants and children have decreased the occurrence of many childhood, vaccine-preventable diseases.[1] However, many adolescents (ie, persons 11-21 years of age [...]

Hepatitis B prophylaxis in the form of immunization has become an increasingly effective protective measure across the United States. Various cohorts have been targeted and methodologies used by public health officials to attain optimal coverage of the population. New Mexico is in its third year of school-based hepatitis B immunization programs. New Mexico's approach to this issue is characterized by significant rates of participation (66% in middle schools and 56% in high schools), high vaccination series completion (88% in middle schools and 89% in high schools), and minimal financial investment (cost of vaccine). The 'Roll Up Your Sleeves' campaign was piloted, modified and adapted to New Mexico's multi-lingual and multi-cultural environment, resulting in these successes. (J Sch Health. 1997;67(7):273-276), Hepatitis B prophylaxis through immunization has become an increasingly effective protective measure across the United States.[1] Various cohorts have been targeted and methodologies used by public health officials in order [...]

Universal childhood vaccination against hepatitis B in Taiwan appears to have reduced the incidence of hepatocellular carcinoma. This is a type of liver cancer caused by chronic hepatitis B infection. An analysis of nationwide statistics on cancer reveal that the average annual incidence of hepatocellular carcinoma in children 6 to 14 years old was reduced by half between 1981-1986 and 1990-1994. Mortality rates from this disease also dropped during this period. In contrast, the rates of another type of childhood cancer, brain tumors, did not decrease.

The use of hepatitis B virus (HBV) vaccines in newborns appears to be steadily increasing particularly in hospitals where public health officials have encouraged its use. Researchers presented HBV vaccination rates from a national survey, from 63 nationally funded immunization projects, and from two regional immunization projects. National surveys show that the HBV vaccination rate increased from 56% to 73% among 21,677 children born between 1989 and 1993. Only 51% of the 63 nationally funded immunization projects routinely advised the use of the HBV vaccine at birth. The vaccination rates for the two regional immunization projects where the Departments of Public Health have encouraged or paid for HBV vaccine use in newborns were 82.3% and 69.1%. Healthier infants, infants born to mothers covered with Medical insurance, and those born at hospitals that encourage HBV vaccine use were more likely to receive an HBV vaccine., Objective. We assessed progress toward universal infant immunization against hepatitis B, which was first recommended in November 1991. Methods. Multiple data sources were used to describe vaccination policies and trends in infant hepatitis B vaccine coverage. Results. As of June 1993, 51% of the 63 local, state, and territorial immunization programs recommended hepatitis B vaccination of all newborns shortly after birth. The number of first dosages of hepatitis B vaccine administered to infants in public sector clinics increased rapidly from late 1992 to 1993, and at the end of 1993 was approximately two thirds the number of first dosages of other infant antigens. In a nationwide survey of hospital nurseries 47% offered hepatitis B vaccine to all newborns. Of 3982 sampled newborns in these hospitals, 36.2% had been vaccinated before discharge. In San Francisco and Connecticut, where public health officials encouraged hospitals to offer hepatitis B vaccination, first-dose coverage at discharge was 82.3% in 1994 and 69.1% in 1993, respectively. Coverage was higher in healthier infants and lower in infants of older or better-educated mothers. Results from the National Health Interview Survey demonstrate that three-dose completion at 12 months of age increased from less than 1% of children born in 1989 to 40% of children born in the fourth quarter of 1992. Vaccination at birth increased from less than 1% of infants born in 1989 to 32% of infants born in the second half of 1993. Conclusions. Infant hepatitis B vaccination has expanded rapidly since national recommendations were made; however, universal coverage has not been achieved. Pediatrics 1996;97:798-803; hepatitis B vaccines, infant, immunization programs, nurseries, hospital, health surveys., ABBREVIATIONS. HBV, hepatitis B virus; ACIP, Advisory Committee on Immunization Practices; AAP, American Academy of Pediatrics Committee on Infectious Diseases. Approximately 200,000 persons are infected with hepatitis B virus (HBV) [...]

Recommendations for universal immunization of infants against hepatitis B have been unsuccessful. Pediatricians (778) and family physicians (300) were surveyed after the Advisory Committee on Immunization Practice (ACIP) recommended the vaccine, and before and after the American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) made their recommendations. Pediatricians were almost twice as likely to agree with the need for the hepatitis B immunization than were family physicians. Even though many of the physicians agreed with the need for the vaccine, fewer of them actually implemented the vaccine in their practices. Some reasons for the lack of implementation were cost, especially among family physicians and doctors not affiliated with a health maintenance organization, and physicians' awareness that parents did not like their infants to receive several shots in one well-baby visit. The study suggests that the professional organizations coordinate announcements of new immunization policies to reduce confusion and resistance in their physician members., Objective. In November 1991 the Advisory Committee on Immunization Practice (ACIP) recommended universal hepatitis B immunization of infants. In February 1992 the American Academy of Pediatrics (AAP) and in August 1992 the American Academy of Family Physicians (AAFP) issued similar recommendations. The purpose of this study was to assess over time the effectiveness and impact of the dissemination efforts of the ACIP, AAP, and AAFP regarding this new recommendation and to determine the factors affecting its adoption. Design. Cohort survey over time. Setting. North Carolina. Participants. All 778 pediatricians and a random sample of 300 family physicians in North Carolina were surveyed by mail 3 months after publication of the ACIP recommendation (January/February 1992), but before the AAP and AAFP recommendations. Response rate was 78%. Of these, 83% responded to a follow-up survey 8 months later (October 1992). Main outcome measures. Rates of agreement and adoption of the recommendation for universal infant immunization with hepatitis B vaccine; factors affecting agreement and adoption of the recommendation. Results. In the first survey (3 months after the ACIP recommendation) more pediatricians than family physicians were aware of the new recommendation (82% vs 48%), yet only 37% of pediatricians and 23% of family physicians agreed that immunization of all newborns in their practice was warranted. Eight months later, after the AAP and AAFP recommendation, 66% of pediatricians and 32% of family physicians agreed universal immunization was warranted, but still only 53% of pediatricians and 23% of family physicians had adopted it into practice. Factors associated with these low rates of adoption include physician and practice characteristics, cost, perceived need for the vaccine, and aversion to multiple injections. Conclusions. Federal, AAP, and AAFP efforts have not been effective thus far in fostering widespread agreement and adoption of this recommendation. If this and future vaccine programs are to succeed, research is needed to determine influences on implementation of new recommendations and to address the economic and noneconomic concerns of physicians and parents. Pediatrics 1994;93:747-751; Immunization, vaccine, hepatitis B, dissemination.

Some pediatricians may be reluctant to follow the Centers for Disease Control's (CDC) recommendation for vaccinating all infants against hepatitis B. Hepatitis B is an infection that can be transmitted from mother to child. The CDC announced its recommendation in Nov 1991, and the American Academy of Pediatrics (AAP) made a similar recommendation in Feb 1992. Researchers surveyed the attitudes of 542 pediatricians towards the CDC's recommendation. Eighty-two percent of the physicians knew about the CDC's recommendation, but only 32% thought vaccination was necessary for the newborn infants in their practice. Seventy-seven percent relied on the AAP for information regarding the new recommendation, and 17% relied on the CDC., Despite immunization programs targeting high-risk groups, the incidence of hepatitis B has risen 37% over the last decade with 300000 new infections and 5000 related deaths now occurring annually in the United States. As a new strategy to control the spread of hepatitis B, the Advisory Committee on Immunization Practices of the Centers for Disease Control (CDC) recommended in November 1991 universal hepatitis B immunization of infants. Details were published in an addendum to Morbidity and Mortality Weekly Report. There was no other federal effort to disseminate this recommendation. On February 14, 1992, the American Academy of Pediatrics (AAP) issued a similar recommendation. The time between the CDC and AAP recommendations presented the opportunity to determine the singular effect on clinical practice of the CDC&apos;s dissemination effort. The purpose of this study was to assess (1) the effectiveness of the CDC in disseminating a new immunization recommendation, (2) the effect of the new recommendation on clinical practice, and (3) the degree to which noneconomic barriers may affect adoption of universal hepatitis B immunization. All 778 pediatricians in North Carolina were surveyed by mail 2 to 3 months after publication of the new CDC recommendation. Descriptive statistics, ? analysis, and logistic regression were used to assess the relationship of variables hypothesized to predict physician awareness of and/or agreement with the new recommendation. The response rate was 78%. Although 82% of pediatricians who administer immunizations were aware of the new recommendation, only 32% believed it was warranted in their practices. Twenty-six percent of respondents -expect more than half of parents to refuse three injections at a single well-child visit, a possible result of adding this vaccine to the primary immunization series. Additionally, 29% expect nurses to resist giving three injections at one visit. It is concluded that current CDC efforts are insufficient to effect change in clinical practice. Practical concerns of physicians and their patients regarding multiple injections and other issues must be considered when formulating new immunization recommendations if their implementation is to be successful. Pediatrics 1993;91:699-702; immunization, vaccine, hepatitis B.

In Oceania, an estimated 2 to 20 percent of the population carry the hepatitus B virus (HBV). About 40 to 90 percent of infections acquired in infancy and childhood lead […]

From July 1987 to June 1988, 1030 pregnant women with hepatitis B were reported to a New York City surveillance program. Among 832 infants under follow-up, the coverage rates for combined hepatitis B immune globulin and vaccine doses 1, 2, and 3 were 84%, 77%, and 59%, respectively. Infants covered by Medicaid and uninsured Black and Hispanic infants were significantly less likely to be completely vaccinated. An estimated 160 cases of chronic hepatitis B infection were prevented among infants enrolled in the program. Strategies are needed to improve vaccine coverage among hard-to-reach groups.

HEPATITIS B is a well-documented occupational hazard for health care workers, including both laboratory and nursing pesonnel [1]. The risk for acquiring hepatitis B virus infection is related to both […]

ABBREVIATIONS. ACIP, Advisory Committee on Immunization Practices; IOM, Institute of Medicine; AAP, American Academy of Pediatrics; USPHS, US Public Health Service., The Advisory Committee on Immunization Practices (ACIP) has established the hepatitis B vaccine birth dose as the preferred time for administering the first dose of hepatitis B vaccine in infants [...]