RESUMEN
BACKGROUND: The measles-mumps-rubella vaccine has been associated with immune thrombocytopenia purpura in 2 small studies. METHODS: By using the Vaccine Safety Datalink, we identified measles-mumps-rubella-vaccinated children aged 1 to 18. A case of immune thrombocytopenia purpura was defined as a patient with a platelet count of < or = 50,000/microL with clinical bleeding and normal red and white blood cell indices. The immune thrombocytopenia purpura incidence rates during exposed (42 days after vaccination) and unexposed time periods were determined. A retrospective cohort of vaccinated children was used to determine incident rate ratios for children aged 1 to 18 years, 12 to 23 months, and 12 to 15 months. RESULTS: A total of 1,036,689 children received 1,107,814 measles-mumps-rubella vaccinations; there were 259 confirmed patients with immune thrombocytopenia purpura. Because only 5 exposed cases occurred after age 2, analyses were limited to children aged 12 to 23 months. Exposed patients aged 12 to 23 months had lower median platelet counts than those who were unexposed and had similar median duration of illness (11 vs 10 days). The incident rate ratio was highest for children aged 12 to 15 months at 7.10. The incident rate ratio for boys aged 12 to 15 months was 14.59, and the incident rate ratio for girls in the same age group was 3.22. Seventy-six percent of immune thrombocytopenia purpura cases in children aged 12 to 23 months were attributable to measles-mumps-rubella vaccination. This vaccine causes 1 case of immune thrombocytopenia purpura per every 40,000 doses. CONCLUSION: Measles-mumps-rubella vaccine that is given in the second year of life is associated with an increased risk of immune thrombocytopenia purpura.
Asunto(s)
Vacuna contra el Sarampión-Parotiditis-Rubéola/efectos adversos , Púrpura Trombocitopénica/epidemiología , Púrpura Trombocitopénica/inmunología , Adolescente , Distribución por Edad , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Esquemas de Inmunización , Incidencia , Masculino , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Distribución de Poisson , Púrpura Trombocitopénica/etiología , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Estados UnidosRESUMEN
The Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, is working with state health agency staff and other stakeholders to develop a comprehensive and integrated approach to cancer control. To help stakeholders visualize the approach, a graphic model was developed based on stakeholder input and a literature review of existing models. Phases of the model include setting optimal objectives (data driven), determining optimal strategies (science driven), establishing feasible priorities (capacity driven), and implementing effective strategies (outcome driven). The model currently is being validated through case studies of state-level cancer planning in six states.
Asunto(s)
Participación de la Comunidad , Planificación en Salud/organización & administración , Neoplasias/prevención & control , Servicios Preventivos de Salud/organización & administración , Centers for Disease Control and Prevention, U.S. , Implementación de Plan de Salud , Humanos , Modelos Organizacionales , Estados UnidosRESUMEN
Site-specific and risk factor-specific cancer programs can point to impressive accomplishments, but coordination among them often is lacking. The Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, is working with state health agency staff and other stakeholders to develop a comprehensive, integrated, nationwide approach to cancer control. The participatory innovation diffusion model may help this complex public health innovation be adopted. The participants in the process identified problematic aspects of the innovation and steps that the division can take to ameliorate these problems before the innovation is implemented.
Asunto(s)
Difusión de Innovaciones , Planificación en Salud/organización & administración , Neoplasias/prevención & control , Servicios Preventivos de Salud/organización & administración , Centers for Disease Control and Prevention, U.S. , Humanos , Relaciones Interprofesionales , Modelos Organizacionales , Estados UnidosRESUMEN
With passage of the Breast and Cervical Cancer Mortality Prevention Act of 1990, significant activity has emerged in the development, implementation, and evaluation of breast and cervical cancer screening programs targeting underserved populations. This activity has prompted health educators and program planners to identify barriers to breast and cervical cancer screening specific to low-income and minority women, those traditionally underserved by cancer control programs, and to develop strategies that address these barriers. The authors reviewed current knowledge regarding barriers to breast and cervical cancer screening and public education interventions that address them. The results and implications for program planning activities are presented.