Health care provider use of motivational interviewing to address vaccine hesitancy in college students

BACKGROUND

Vaccine-preventable diseases significantly influence the health and academic success of college students. Despite the known negative impact of these diseases, vaccination rates routinely fall short of national goals and recommendations. Although vaccination decisions are complex, a recommendation from a health care provider is one of the key motivators for individuals receiving a vaccine. Motivational interviewing (MI), a counseling approach primarily used to address substance abuse, can be applied to other health-related behaviors.

LOCAL PROBLEM

Despite previous quality improvement efforts aimed at increasing vaccine rates for influenza, human papillomavirus (HPV), and meningitis B (MenB), vaccinations at large university health centers have been well below benchmarks set by Healthy People 2020.

METHODS

This study was guided by the Theory of Planned Behavior and included MI training and regular reinforcement for health care providers to address vaccine hesitancy with college students.

RESULTS

Influenza vaccination rates improved, but HPV vaccine rates remained stable and MenB vaccine rates decreased compared with the previous year. Clinicians demonstrated a significant increase in knowledge of MI techniques after a targeted educational intervention. Repeat measures indicate the potential for sustained improvement when ongoing reinforcement is provided.

CONCLUSION

MI can be an effective part of a strategy to increase vaccination rates.

Rheumatoid Meningitis: Diagnostic and Therapeutic Observations

A 75-year-old female with untreated rheumatoid arthritis presented with two weeks of behavioral changes and cognitive decline. A neurologic examination showed severe encephalopathy, brisk reflexes, and bilateral Babinski sign. A contrast-enhanced brain MRI demonstrated right meningeal enhancement and periventricular white matter disease. A computed tomographic angiogram (CTA) of the head and neck was negative for vasculitis. The cerebrospinal fluid (CSF) demonstrated lymphocytic pleocytosis. The patient's serum rheumatoid factor levels were elevated. A biopsy of the leptomeninges and cortex showed lymphocytic vasculitis of the cortical tissue and patchy lymphoplasmacytic infiltrates of dural small vessels consistent with rheumatoid meningitis. The patient received pulse-dose steroids followed by cyclophosphamide infusions. At her three month follow-up appointment, the patient's mental status had improved mildly. A follow-up brain MRI showed resolution of enhancement, but progression of subcortical bihemispheric white matter disease. Subsequently, the patient developed a respiratory infection and passed away. In rheumatoid arthritis, symptoms of encephalopathy, headaches, seizures, or focal neurologic deficits should raise suspicion for CNS involvement. This potentially treatable disease warrants prompt diagnosis.

Every picture tells a story

Children can be psychologically, as well as physically, damaged by meningitis. Art therapy can help them to explore their fears.

Character changes from idiopathic cranial pachymeningoencephalitis

A 66-year-old man with idiopathic cranial pachymeningoencephalitis was described. He suffered from left orbital pain, and character changes. He became short tempered, and was very attached to trifles. Two years prior to these symptoms, he had developed transient left abducent nerve palsy. Head MRI showed a thickening and enhancement of the dura mater on gadolinium-enhanced T1-weighted images, and high signal intensity lesions at bilateral frontal lobes predominantly in the white matter on T2-weighted images. Biopsies revealed microglial proliferation in the cerebral parenchyma, and mild lymphocytic perivascular infiltration. No evidence of intracranial infection was detected. We therefore treated him with methylprednisolone pulse therapy followed by oral prednisolone. His character became gradually normalized, and bilateral frontal lobe lesions seen on MRI disappeared. This is the first case to describe recurrent pachymeningoencephalitis with character changes, and symptoms were probably due to frontal lobe dysfunction.

Dissociating Task-set Selection from Task-set Inhibition in the Prefrontal Cortex

Patients with focal lesions in the left (n = 7) and right (n = 4) prefrontal cortex were compared with controls (n = 16) in a task-switching experiment using four different, simple spatial tasks. Each of these tasks involved a left-right decision, either regarding an arrow, the word “left” or “right”, a circle position, or the direction of a moving line. We compared performance on trials that required rule switches versus rule repetitions (local switch costs) and we compared performance between blocks with bivalent stimuli (two dimensions present) and blocks with univalent stimuli (only one dimension present) to assess global switch costs. Patients with left prefrontal lesions, but not patients with right prefrontal lesions, exhibited increased costs on trials in which the relevant dimension switched (local switch costs), but also on no-switch trials with bivalent stimuli (global costs). We also assessed task-set inhibition in the form of the backward-inhibition effect [increased response times to recently abandoned tasks; Mayr, U., & Keele, S. Changing internal constraints on action: The role of backward inhibition. Journal of Experimental Psychology: General, 129, 4-26, 2000]. Although left frontal patients showed normal inhibition, right frontal patients showed no evidence for inhibition. These results suggest a neurocognitive dissociation between task-set selection and inhibition.

Clozapine reduces violent behavior in heterogeneous diagnostic groups

Violent behavior is a significant problem in the psychiatric hospital setting. Persistently violent patients often require seclusion and/or restraints and typically receive high doses of medication and polypharmacy. Clozapine has been found to be effective in reducing aggression in patients with psychosis. Thus, we examined the effects of clozapine in a heterogeneous group of persistently violent patients. A chart review of the effect of clozapine in persistently violent patients was performed. Changes in the number of violent episodes and the need for seclusion and restraint were assessed for a 3-month period before and after receiving clozapine. In this group of five, carefully selected, persistently violent patients, clozapine treatment resulted in marked decreases in violent episodes and the use of seclusion and restraint. These data suggest a role for clozapine in the treatment of persistently violent patients irrespective of DSM-IV diagnosis.

ICD-10 mild cognitive disorder following meningitis due to neurosarcoidosis

We report the case of a patient referred to our department with the diagnosis of conversion disorder, who ultimately proved to have neurosarcoidosis presenting with mild cognitive disorder. Despite the criticism of mild cognitive disorder as a diagnostic entity, our patient met the criteria for it. The reported case exemplifies the difficulties in classifying mild cognitive deficits in patients suffering from brain diseases without major morphological damage.

[Emotional disturbances in patients with infectious mononucleosis and serous meningitis]

30 patients with infectious mononucleosis (19 females and 11 males) and 30 ones with serous meningitis (16 females and 14 males) aged 16-35 years admitted to hospital on the disease day 2-14 were examined clinicopsychologically, clinicofunctionally and using laboratory tests. The examination has revealed emotional disturbances in 40% of patients with serous meningitis and 20% of those with infectious mononucleosis. Clinical manifestations were characterized by polymorphism, combination of somatovegetative and anxiodepressive disorders. Personality accentuations in the patients are described.

Evaluation of cochlear implantation in post-meningitic adults

Meningitis is an important cause of deafness and in some studies has been associated with poorer outcomes in adult patients following cochlear implantation. Of the first 100 adults implanted under the Midland Cochlear Implant Programme, 28 were deafened as a result of meningitis. We compare our experience with these patients with patients with a non-meningitic aetiology. A degree of cochlear ossification was a more common finding in the meningitic group. In six cases (four meningitis, two non-meningitis) ossification was encountered only during surgery, not being apparent on pre-operative radiology. The average scores achieved on auditory tests by the meningitic group were similar to those achieved by non-meningitic patients. At nine months, using only the implant, users were able to identify 54 per cent of common environmental sounds, achieved an average score of 30 words per minute on connected discourse tracking and identified an average of 42 per cent of words correctly in BKB sentences. Poorer outcomes were more commonly associated with cochlear ossification. In patients with cognitive and neurological sequelae, benefits with the implant were not always apparent in the early months, however, with intensive therapy these patients can obtain measurable sustained benefit from their implant.

Needs of parents of the child hospitalised with acquired brain damage

This paper describes the findings of a descriptive study into needs of parents of children with Acquired Brain Damage during hospitalisation. Thirty four parents of 28 children treated at a tertiary referral pediatric hospital were interviewed. Parents described their experiences during their child's hospitalisation and identified needs which, when met, enabled them to care for their children and cope with the sudden illness and disabilities. Three themes were identified: services that optimised the child's recovery, services which supported parents cope with child's illness and services assisting in maintenance of family functioning and stability. An emerging model of parental needs and nursing interventions to meet these are identified.

What worries parents when their preschool children are acutely ill, and why: a qualitative study

OBJECTIVE

To identify and explore parents' concerns when young children become acutely ill.

DESIGN

Qualitative study making use of semi-structured one to one and group interviews with parents of preschool children.

SETTING

Disadvantaged inner city community.

SUBJECTS

95 parents of preschool children.

RESULTS

Fever, cough, and the possibility of meningitis were parents' primary concerns when their children became acutely ill. Parents' concerns reflected lay beliefs, their interpretation of medical knowledge, and their fears that their child might die or be permanently harmed. Parents worried about failing to recognise a serious problem. Concerns were expressed within the context of keenly felt pressure, emphasising parents' responsibility to protect their child from harm. They were grounded in two linked factors: parents' sense of personal control when faced with illness in their child and the perceived threat posed by an illness.

CONCLUSIONS

Better understanding of parents' concerns may promote effective communication between health professionals and parents. Modification of parents' personal control and perceived threat using appropriate information and education that acknowledge and address their concerns may be a means of empowering parents.

[Follow-up of development following inflammatory CNS diseases in childhood]

In the acute phase of inflammatory diseases of the CNS diagnosis and outset of treatment should be effected with the least possible delay to that avoiding risks of partial recovery. The regained quality of life is of increasing importance for the evaluation of intensive and supportive therapy as mortality could be markedly decreased by anti-bacterial and antiviral treatment. Only a close follow-up will result in definite prognostic assertions. For the early detection of secondary damages the complete battery of up-to-date neurologic diagnostics has to be considered.

Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials

We enrolled 200 infants and older children with bacterial meningitis in two prospective double-blind, placebo-controlled trials to evaluate the efficacy of dexamethasone therapy in addition to either cefuroxime (Study 1) or ceftriaxone (Study 2). Altogether, 98 patients received placebo and 102 received dexamethasone (0.15 mg per kilogram of body weight every six hours for four days). At the beginning of therapy, the clinical and demographic characteristics of the patients in the treatment groups were comparable. The mean increase in the cerebrospinal fluid concentration of glucose and the decreases in lactate and protein levels after 24 hours of therapy were significantly greater in those who received dexamethasone than in those who received placebo (glucose, 2.0 vs. 0.4 mmol per liter [36.0 vs. 6.9 mg per deciliter], P less than 0.001; lactate, 4.0 vs. 2.1 mmol per liter [38.3 vs. 19.8 mg per deciliter], P less than 0.001; and protein, 0.64 vs. 0.25 g per liter [64.0 vs. 25.3 mg per deciliter], P less than 0.05). One patient in the placebo group in Study 1 died. As compared with those who received placebo, the patients who received dexamethasone became afebrile earlier (1.6 vs. 5.0 days; P less than 0.001) and were less likely to acquire moderate or more severe bilateral sensorineural hearing loss (15.5 vs. 3.3 percent; P less than 0.01). Twelve patients in the two placebo groups (14 percent) had severe or profound bilateral hearing loss requiring the use of a hearing aid, as compared with 1 (1 percent) in the two dexamethasone groups (P less than 0.001). We conclude that dexamethasone is beneficial in the treatment of infants and children with bacterial meningitis, particularly in preventing deafness.

Long-term outcome of group B streptococcal meningitis

Group B Streptococcus is a common cause of neonatal sepsis and meningitis. The purpose of this study was to evaluate the neurologic, psychologic, and academic status of children who had group B streptococcal meningitis and to compare these children with their siblings. Seventy-four children who acquired group B streptococcal meningitis between one day and 6 months of life formed the study population. Survivors were 3 to 18 years old at the time of their follow-up evaluations. Twenty children (27%) died, two were institutionalized, one severely affected child died at age 2 years, 15 were assessed by phone interview, and two were lost to follow-up. Thirty-four children and 21 siblings were comprehensively evaluated with physical and neurologic examinations, hearing tests, and tests of intellectual, perceptual-motor, and behavioral-adaptive functions. Of the total population, nine children (12%) had major neurologic sequelae (spastic quadraplegia, profound mental retardation, hemiparesis, deafness, or blindness). Six children had acute hydrocephalus; two were doing well after shunt placement. In general, those children surviving group B streptococcal meningitis without major sequelae appeared to be functioning normally or comparably to their sibling in intellectual, social, and academic matters.

The psychological impact of pediatric bacterial meningitis on the family

Twenty-eight families participated in a prospective study of family coping with childhood bacterial meningitis. Most of the parents were seen by physicians and nursing staff as exhibiting anxiety during the first week of treatment, and many mothers later reported their fear for the child's life. Depressive behavior was also commonly noted in mothers by physicians; however, both mothers and fathers were generally seen as cooperating with staff and communicating well with them. Most of the families were rated as coping well with the diagnosis and treatment by physicians, nurses and psychosocial staff. Nineteen families participated in a follow-up assessment 1 to 2 years after diagnosis. Coping was found to be relatively stable over time, and mothers' coping at the follow-up interview was significantly correlated with their coping at diagnosis. Most of them raised concerns about residual damage and fear of life-threatening illness. There were no significant differences between families who had received a psychological intervention and those who had not. Careful monitoring of parental knowledge and perceptions was recommended to prevent later problems.

The evolution of visual and auditory evoked potentials in infants with perinatal disorder

The evolutionary changes of evoked potentials (EPs) were studied from the neonatal period up to 1 year of age in 41 infants with various perinatal disorders. Abnormal EPs in the first week of life recovered quickly. In infants with normal outcome, abnormal EPs became normal within a month. In infants with cerebral palsy (CP) or mental retardation (MR), EPs recovered within 2-3 months of age. Infants with more severe neurological damage showed abnormal EPs even beyond 6 months of age. Abnormal EPs beyond 2 weeks of age indicated poor prognosis. As for the wave form of EPs, absent responses or abnormal wave form reflected more severe brain dysfunction. AEPs tended to show more profound abnormalities than VEP. However, some infants with absent AEP in the first week of life had a favorable prognosis. AEPs seemed to be more easily affected by brain dysfunction.

Escherichia coli meningitis in the newborn: follow-up study

Followup study of 22 cases of meningitis due to Escherichia coli (E. coli) in the newborn period showed a mortality rate of 7 out of 22 (31.88%), severe physical and mental sequelae occurred in one case and mild to moderate sequelae in two others. Most psychometric tests were within normal range in the survivors examined. There was a correlation between low birth weight and a high CSF protein with adverse prognosis.