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Biomedical subjects

A R Hinman

Publications and source records attributed to A R Hinman.

At least 19 recordsLinked to original sources
PubMed1992

Structuring HIV prevention service delivery systems on the basis of social science theory.

In order to identify the optimal configuration of HIV prevention programs, it is necessary to examine different theoretical models of behavior change. Cognitive/decision-making theories of human behavior change are compared to social learning theories vis-a-vis their influence on the structure of service delivery systems. Cognitive/decision-making theories ascribe behavior change to the provision of new information and favor the development of homogeneous interventions providing clients with information about risk behaviors. These interventions are easily standardized across delivery sites and various target populations. Social learning theories view behavior change as a series of stages and recognize the influence of sociocultural variables. They favor multiple heterogeneous interventions in a variety of settings, with the provision of skills training as well as information. Ongoing HIV prevention research indicates that social learning theories provide a more accurate paradigm of human behavior change for the complex behaviors related to HIV risk. Public health agencies must therefore continue to strengthen organizational and referral relationships with community-based organizations that can provide the specialized prevention interventions called for by social learning theory. This will require ongoing collaboration and technical assistance.

Adolescent↗
PubMed1992

When, where, and how do immunizations fail?

There are two main reasons for failure of immunizations: (1) failure of the vaccine delivery system to provide potent vaccines properly to persons in need; and (2) failure of the immune response, whether due to inadequacies of the vaccine or factors inherent in the host. The first category is by far the most important worldwide. The major factor contributing to failure of the delivery system is failure to vaccinate; in the developing world this is commonly a result of inadequacy of the vaccine supply. Other important factors include barriers to immunizations, improper use of vaccines, vaccine ineffectiveness at the time of use, and factors relating to client attitudes and knowledge. Failure of the immune response may be either primary or secondary (loss of protection after initial effectiveness). The shortcomings of existing vaccines must not deter us from taking maximal advantage of their benefits.

Humans↗
PubMed1992

Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease.

Poliomyelitis caused by wild poliovirus has been virtually nonexistent in the United States since 1980, and vaccine-associated paralytic poliomyelitis (VAPP) has emerged as the predominant form of the disease. We reviewed national surveillance data on poliomyelitis for 1960-1989 to assess the changing risks of wild-virus, vaccine-associated, and imported paralytic disease; we also sought to characterize the epidemiology of poliomyelitis for the period 1980-1989. The risk of VAPP has remained exceedingly low but stable since the mid-1960s, with approximately 1 case occurring per 2.5 million doses of oral poliovirus vaccine (OPV) distributed during 1980-1989. Since 1980 no indigenous cases of wild-virus disease, 80 cases of VAPP, and five cases of imported disease have been reported in the United States. Three distinct groups are at risk of vaccine-associated disease: recipients of OPV (usually infants receiving their first dose), persons in contact with OPV recipients (mostly unvaccinated or inadequately vaccinated adults), and immunologically abnormal individuals. Overall, 93% of cases in OPV recipients and 76% of vaccine-associated cases have been related to administration of the first or second dose of OPV. Our findings suggest that adoption of a sequential vaccination schedule (inactivated poliovirus vaccine followed by OPV) would be effective in decreasing the risk of VAPP while retaining the proven public health benefits of OPV.

Humans↗
PubMed1992

The laboratory's role in prevention and control of infectious diseases.

The laboratory is essential for optimal prevention and control of infectious diseases. Its major functions are identification and characterization of infectious agents and development of serological tests. Isolation of the agent and characterization of the immune response can lead to development of some of the most effective prevention tools--vaccines. After prevention/control programs are under way, confirmation of diagnosis remains important. As programs near the state of disease elimination or eradication, the laboratory role is critical in ensuring accurate diagnosis of suspicious illness. In the current global effort to eradicate poliomyelitis, the laboratory has a leading role in identifying poliovirus isolates as being wild or vaccine-like and in determining the relationships among cases of polio. Techniques are being developed that will enable the identification of wild poliovirus in the presence of large quantities of polio vaccine viruses, which will be necessary to document the eradication of polio.

History, 20th Century↗
PubMed1991

What will it take to fully protect all American children with vaccines?

Although 95% of children have had a full course of vaccines by the time they enter school, immunization levels among poor inner-city preschoolers may be substantially lower. Among the factors responsible for the disparity are the lack of a uniform data system to identify children who need vaccine; missed opportunities to offer immunizations; overinterpretation of contraindications; and administrative barriers to immunization. Remedies lie in a multifaceted approach: a tracking system that will prompt a reminder and then sound an alarm when an immunization is overdue; means of informing parents, probably best accomplished by an outreach worker of the same racial or ethnic background as the parent; removal of administrative barriers and increased access to services; incentives, either positive or negative, to raise the priority of immunizations; and more education for health care providers to ensure that they understand contraindications and do not miss opportunities to offer vaccines. Other possibilities are "express lane" services to immunize all children who come to a health care provider and the delivery of immunizations in child care settings and in programs such as Women, Infants, and Children, and Aid to Families With Dependent Children.

Child Health Services↗