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Ask, Acknowledge, & Advise: Tips and advice you can use
   December 2012
In This Issue
Why Acknowledge?
Vaccines in the news
What we're reading
Answering your questions
Featured investigator
Featured website
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Greetings!

 

Welcome to the December 2012 newsletter.  We are happy to report that all 30 intervention trainings have now been completed, keeping this project on track to have all data capture, analysis, and write-ups completed by December 2013.   

 

As always, we appreciate your feedback, comments, or questions. In the meantime, happy reading, and again, thank you.

 

Best wishes,

David Grossman, MD, MPH

Group Health Research Institute

"Let's Talk Vaccines" study principal investigator

  
   
2012: the year in review  

At the beginning of 2012, the Vax Northwest team was busy putting the final touches on the intervention, refining our study metrics, designing collateral materials, and wondering if it was possible to recruit 50 clinics into this study.  56 clinics later, we are happy to report that the training stage of this intervention has concluded.  Some additional statistics that participants in this study have helped to actualize:
  • 408 mothers have been recruited into the study 
  • 30 clinics have been trained as part of the intervention arm and 26 were enrolled as control clinics (control clinics will receive study materials at a later date) 
  • 471 providers are enrolled in the studyBird4

We thank all of the team members and study participants who have helped make this study a success to date and look forward to sharing study results in late 2013.  Vax Northwest team members will be meeting in January 2013 to discuss where this intervention might go next and how best to continue approaching the topic of vaccine hesitancy through innovative, well-researched, and evaluated approaches.  

 

 

Vaccines in the news  

Bird drinking coffee  

The FDA has approved the first seasonal influenza vaccine manufactured using cell culture technology.  The vaccine, called Flucelvax, uses technology that has been used in the U.S. for decades for the manufacturing of other vaccines.  According to the CDC, "Advantages of cell culture technology include the ability to maintain an adequate supply of readily available, previously tested and characterized cells for use in vaccine production and the potential for a faster start-up of the vaccine manufacturing process in the event of a pandemic."

 

An article in a New York Times blog profiles the research of scientists at the Center for Infectious Disease Research and Policy at the University of Minnesota, which questions the efficacy of the flu vaccine, claiming in particular that the vaccine has little or no protection for elderly adults.  Chief of Epidemiology at the CDC, Dr. Joesph Bresee, responded by saying, "Does it work as well as the measles vaccine?  No, and it's not likely to.  But the vaccine works."  

 

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What we're reading

  

Here are some recent articles that are informing or work:

Blendell et al's "Discussing Vaccination With Concerned Patients: An Evidence-Based Resource for Healthcare Providers" from J Perinat Neonat Nurs (2012) offers a series of resources and talking points for healthcare providers to use in promoting vaccination amongst parents.  The article links to evidence-based resources, but does not offer an evidence-based protocol itself.  The resources contained in the piece are very useful, especially if you need a longer, more detailed explanation for the most common challenging questions presented by vaccine hesitant parents.
Bird2
Australian researcher Julie Leask, who was recently in Seattle learning about the efforts of Vax Northwest and educating our partner organizations, has a new article in BMC Pediatrics that describes why we need to think about how we have vaccination conversations and less about what we say during those conversations.  The article, entitled "Communicating with parents about vaccination: a framework for health professionals" (2012) advises a 'chunking and checking' approach to conversations about vaccines: "Chunking and checking refers to the provision of information in small chunks followed by checking the person's understanding" (3).


In a study that speaks to the very heart of the 'Let's Talk Vaccines' intervention, a new article entitled "How well do doctors know their patients? Factors affecting physician understanding of health belief models" (Street & Haidet, 2010) argues that doctors generally have a poor understanding of their patients' health beliefs.  Their understanding improved greatly, however, when patients were active contributors to health consultations.

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Answering your questions

  

Below is a response to a question submitted at a recent training.  We encourage participants in this study to submit their questions, whenever they arise, throughout the study.  We will share some answers here, but all will be available on our study website.

How do I know vaccines are safe when so much conflicting data comes out regularly?  

There is at least some conflicting evidence that exists for virtually everything in medicine. This is in part due to the very nature of science, specifically the fact that any study performed on consecutive groups of people will rarely yield the same result. For this reason, standards of care in medicine are generally based upon the aggregate information provided by multiple studies, which, when taken together, will tend to provide a more accurate assessment of the actual situation than the information that comes from any single study alone.

 

This is also, however, in part a result of the fact that the quality of published studies can vary widely with regard to issues such as study design, methods of data collection, control for confounding, appropriate statistical analysis, and interpretation of findings. Much of the "data" that is cited as suggesting that vaccines are associated with a high rate of serious complications falls into the inferior category. The truth is that where vaccine safety is concerned, there is very little "conflicting" data.

 

A good example of this is illustrated by the analysis on vaccines and autism that was performed several years ago by the Immunization Safety Review Committee (which was established by the Institute of Medicine to evaluate the evidence on possible causal associations between immunizations and certain adverse outcomes). A link to the full paper can be found here.  The review of literature was literally exhaustive--reviewing and thoroughly assessing virtually every paper published on the subject up to that time (as well as other data). The conclusion reached following this review was unequivocal: It was not only felt that the overall body of evidence did not demonstrate an association between vaccines and autism, but that the evidence actually favored "rejection" of such an association. That is, the well-done studies were fairly uniform in their findings that vaccines did not appear to be associated with the significant increase in autism rates.

 

The study cited above is paralleled time and again in other studies and reviews regarding purported adverse consequences of vaccines.  Research evidence is unequivocal about the overall safety of vaccines. 

 

 

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Featured investigator 

Nora Henrikson, PhD, MPH

Nora Henrikson is an investigator at the Group Health Research Institute and a co-investigator on the "Let's Talk Vaccines" research study.  Broadly, Nora's research agenda focuses on how people interface with health-related technologies, interventions, and policies that they encounter when seeking health care.  With a goal of ensuring that people never feel like health care 'happens' to them, Nora explores the transfer of knowledge to and from both providers and patients.  Nora enjoys how the "Let's Talk Vaccines" research project takes a multi-level approach to a complex social phenomenon and that the emphasis is on how communication can happen effectively around a sometimes contentious social topic.  As a mother of young children, Nora also experiences these conversations and decisions among her peers, giving this study another layer of meaning to her.

Nora believes that this project is a great example of a scientific response to how our society is becoming less 'vertical' as well as more digitally connected.  This
fundamentally alters the patient/provider relationship; we are watching the adolescence of this change, which is an exciting but challenging time.  We don't yet know what balance of information delivery and communication styles will translate into the best outcomes for patients, but projects like this begin to answer such questions.

The photo on right shows the many tracking tools Nora uses to keep pace with the key domains involved in this study: moms, hospitals, clinics, and providers (and she thanks Aaron Scrol and Janice Miyoshi for their amazing assistance in creating these tools).   Anyone involved in this study can convey how this process taxed our organizational skills to the max, but Nora was one of key players in making it all come together successfully. 

Featured web resource

 

Dr. Wendy Sue Swanson is the author of the blog Seattle Mama Doc, an informed, thoughtful, and compassionate blog designed to help parents navigate information and "facilitate decisions that let [them] rest easier at night."  Dr. Swanson writes in a comforting, approachable, and informative prose and grounds her work in the principles that prevention reigns and parents only want to do what is right.  Blogging a couple times each week, Dr. Swanson covers topics from immunization to voting with your children to circumcision.  The tone is simple and caring while the information is robust, making this an enormously appealing resource for parents.  Dr. Swanson was also awarded the CDC Childhood Immunization Champion award from the IACW and DOH last year!

 

 

New 'Why we vaccinate' videos   

 

Why We Vaccinate - Sarah's Story
Why We Vaccinate - Sarah's Story


 

 

 

Vax Northwest recently produced three new video segments of local parents sharing why they fully vaccinate their children.  All three videos are available on the public-facing pages of the Vax Northwest website and are intended as a peer-to-peer endorsement of childhood immunization.  

 

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