From Google Scholar & other sources: Selected Journal Articles, Newsletters, Dissertations, Theses, Commentary
Clinical Journal of Pain
Post Acceptance: July 21, 2015
Taddio Special Topics Series: PDF Only
Psychological Interventions for Vaccine Injections in Young Children 0 to 3 Years: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials
Riddell, Rebecca Pillai PhD; Taddio, Anna BScPhm, MSc, PhD; McMurtry, C. Meghan PhD; Chambers, Christine T. PhD; Shah, Vibhuti MD, MSc; Noel, Melanie PhD; HELPinKIDS Team
Background: This systematic review evaluated the effectiveness of distraction for reducing infant distress during vaccinations in young children aged 0 to 3 years.
Design/Methods: Database searches identified relevant randomized and quasi-randomized controlled trials. Three separate clinical questions related to variants of the psychological strategy of distraction (directed video; directed toy; non-directed toy) were pursued. Distress was identified as the critical outcome to assess the benefits of distraction and extracted from relevant trials. Distress was analyzed by phase of procedure (distress pre-procedure; distress acute; distress recovery; idiosyncratic phases based on some or all of the three aforementioned phases).
Results: Ten studies were included in the review. Significant results are presented herein. For directed video distraction, moderate quality evidence suggested distress was lowered in the treatment group (SMD 0.68 lower [95% CI -1.04, -0.32]) for the acute+recovery phase as well as the pre-procedure phase (SMD 0.49 lower [95% CI -76, -0.22]). For directed toy distraction, the analysis of low quality evidence for a combined pre-procedure+acute+recovery phase of distress (analysis n=81), suggested distress was lowered in the treatment group (SMD 0.47 lower [95% CI -0.91, -0.02]). An effect for non-directed toy distraction was also seen, analyzing very low quality evidence, for the acute distress phase (n=290; SMD 0.93 lower, [95% CI -1.86, 0.00]).
Conclusions: Generally low to very low quality evidence suggests that there may be an effect of directed (toy and video) and non-directed toy distraction for children aged 0 to 3, for certain phases of the vaccination.
Process Interventions for Vaccine Injections: Systematic Review of Randomized Controlled Trials and Quasi-randomized Controlled Trials
Pillai Riddell, Rebecca PhD; Anna, Taddio BScPhm, MSc, PhD; McMurtry, C. Meghan PhD; Vibhuti, Shah MD, MSc; Melanie, Noel PhD; Chambers, Christine T. PhD; HELPinKIDS&Adults Team
Background: This systematic review evaluated the effectiveness of process interventions (education for clinicians, parent presence, education of parents [before and on day of vaccination], and education of patients on day of vaccination) on reducing vaccination pain, fear, and distress and increasing the use of interventions during vaccination.
Design/Methods: Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Critical outcomes were pain, fear, distress [when applicable], and use of pain management interventions. Data were extracted according to procedure phase (pre-procedure, acute, recovery, combinations of these) and pooled using established methods. Analyses were conducted using Standardized Mean Differences (SMD) and Risk Ratios (RR).
Results: Thirteen studies were included. Results were generally mixed. Based on low to very low quality evidence, the following specific critical outcomes showed significant effects suggesting: (1) Clinicians should be educated about vaccine injection pain management [Use of interventions: SMD 0.66 (95% Confidence Interval [CI] 0.47, 0.85)]; (2) Parents should be present [Distress Pre-procedure: SMD -0.85 (95% CI -1.35, -0.35]; (3) Parents should be educated prior to the vaccination day [Use of Intervention pre-procedure: SMD 0.83 (95% CI 0.25, 1.41) and RR 2.08 (95% CI 1.51, 2.86); Distress Acute: SMD -0.35 (95% CI -0.57, -0.13)]; (4) Parents should be educated on the vaccination day [Use of interventions: 1.02 SMD (95% CI 0.22, 1.83) and RR 2.42 (1.47, 3.99); Distress Pre-Procedure+Acute+Recovery: -0.48 (95% CI -0.82, -0.15)]; and (5) Individuals 3 years of age and older should be educated on the day of vaccination [Fear pre-procedure: -0.67 SMD (95% CI -1.28, -0.07)].
Conclusions: Educating individuals involved in the vaccination procedure (clinicians, parents of children being vaccinated; individuals older than 3 y of age) is beneficial to increase use of pain management strategies, reduce distress surrounding with vaccination, and to reduce fear.
Pharmacological and combined interventions to reduce vaccine injection pain in children and adults: systematic review and meta-analysis
Taddio Special Topics Series: PDF Only
Shah, Vibhuti FRCPC, MD, MSc; Taddio, Anna BScPhm, MSc, PhD; McMurtry, C. Meghan PhD, C Psych; Halperin, Scott A. MD; Noel, Melanie PhD; Riddell, Rebecca Pillai PhD, C Psych; Chambers, Christine T. PhD, C Psych; HELPinKIDS Team
Background: This systematic review assessed the effectiveness and safety of pharmacotherapy and combined interventions for reducing vaccine injection pain in individuals across the lifespan.
Design/Methods: Electronic databases were searched for relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear as well as observer-rated distress were critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI).
Results: Fifty-Five studies that examined breastfeeding (which combines sweet-tasting solution, holding and sucking), topical anesthetics, sweet-tasting solutions (sucrose, glucose), vapocoolants, oral analgesics, and combination of two versus one intervention were included. The following results report findings of analyses of critical outcomes with the largest number of participants. Compared to control, acute distress was lower for infants breastfed during vaccination (n=792): SMD -1.78 (CI: -2.35, -1.22) and before vaccination (n=100): SMD -1.43 (CI: -2.14, -0.72). Compared to control/placebo, topical anesthetics showed benefit on acute distress in children (n=1424): SMD -0.91, (CI: -1.36, -0.47) and self-reported pain in adults (n=60): SMD -0.85 (CI: -1.38, -0.32). Acute and recovery distress was lower for children who received sucrose (n=2071): SMD -0.76, (CI: -1.19, -0.34) or glucose (n=818): [SMD: -0.69, (CI: -1.03, -0.35)] compared to placebo/no treatment. Vapocoolants reduced acute pain in adults [(n=185) SMD -0.78, (CI: -1.08, -0.48)] but not children. Evidence from other needle procedures showed no benefit of acetaminophen or ibuprofen. The administration of topical anesthetics before and breastfeeding during vaccine injections showed mixed results when compared to topical anesthetics alone. There were no additive benefits of combining glucose and non-nutritive sucking (pacifier) compared to glucose or non-nutritive sucking (pacifier) alone or breastfeeding and sucrose compared to breastfeeding or sucrose alone.
Conclusions: Breastfeeding, topical anesthetics, sweet-tasting solutions and the combination of topical anesthetics and breastfeeding are effective in reducing vaccine injection pain in infants and children and its use should become the standard of care. In adults, limited data demonstrate some benefit of topical anesthetics and vapocoolants
Women’s Health Issues (WHI)
Published Online: July 23, 2015
Knowledge of HPV and HPV Vaccine among Women Ages 19 to 26
Zoe Unger, MPH, Abby Maitra, MPH, Julia Kohn, PhD, MPA, Sangita Devaskar, MPH, Lisa Stern, RN, MSN, Ashlesha Patel, MD, MPH
Publication stage: In Press Corrected Proof
To describe knowledge about human papillomavirus (HPV) and HPV vaccination among women ages 19 to 26 seeking a variety of services at reproductive health centers. A secondary objective was to identify common sources of HPV information.
Ten reproductive health centers enrolled 365 women ages 19 to 26 in a randomized, controlled trial to determine the effect of automated reminder messages on HPV vaccine completion. Using responses from a 61-item self-administered baseline questionnaire completed before initiating the HPV vaccine, this subanalysis assessed participants’ knowledge regarding HPV and the HPV vaccine.
Knowledge of HPV prevention, transmission, and disease outcomes among the study population was highly variable. The mean HPV knowledge score was 11.0 of a possible 19 (SD = 3.8). Most participants (77%) had heard of the HPV vaccine before completing the questionnaire and indicated that their primary sources of information about the vaccine were television ads (61%), health care providers (52%), and friends (45%).
Despite a relatively high awareness of the vaccine, specific knowledge regarding HPV and the HPV vaccine varied substantially and participant scores highlighted knowledge gaps among vaccine-eligible young women. Media, health care providers, and friends were identified by participants as sources of information and may influence their knowledge of HPV and the HPV vaccine.