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Keeping the Passion Alive: Making the Right Turn Geraldine Padilla, PhD Professor and Associate Dean UCSF School of Nurs

Keeping the Passion Alive: Making the Right Turn Geraldine Padilla, PhD Professor and Associate Dean UCSF School of Nursing. Signs of Need for Change. Decrease in research interest, creativity, energy Interest in finding something new Hopping around from one scientific area to another

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Keeping the Passion Alive: Making the Right Turn Geraldine Padilla, PhD Professor and Associate Dean UCSF School of Nurs

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  1. Keeping the Passion Alive: Making the Right Turn Geraldine Padilla, PhD Professor and Associate Dean UCSF School of Nursing

  2. Signs of Need for Change • Decrease in research interest, creativity, energy • Interest in finding something new • Hopping around from one scientific area to another • Feeling a knowledge deficit

  3. Value of Change • Renewed energy and sense of discovery • New challenges • New collaborators • Study in foreign land, culture, language • New funding sources, regulations

  4. NIH Support for Change NRSA for Senior Fellows (F33): NIH awards F33s to experienced scientists who wish to make major changes in the direction of their research careers or who wish to broaden their scientific background by acquiring new research capabilities. (Supported by NINR and many other Institutes)

  5. NIH Support for Change Career Enhancement Award (K18): Provides full/part-time support for experienced scientists who wish to broaden their scientific capabilities or to make changes in their research careers by acquiring new research skills or knowledge. Award usually no more than 1-2 years. (Not supported by NINR and others. Stem cell research supported by some Institutes)

  6. Other Support for Change Fulbright (Full Grant): These grants provide some funding for research, books, supplies, in country travel, living allowance. • Good and feasible study plan • Strong host country support for the project

  7. Institutional Support for Change • Sabbatical, Mentor, Training • Research Intensive Universities: OK if fundable and publishable • Education intensive Universities: OK if content/clinical expertise and teaching continue in assigned areas

  8. Personal Plan • Used sabbatical • Obtained in country support from the Philippine Cancer Society • Collaborated with the Calif Div and Nat’l American Cancer Societies • Obtained Fulbright Award for 4 months

  9. Hepatitis B and Filipino Infants PROBLEM: HBV Prevalence in Filipinos • 1986 estimates: 12% of Filipinos (about 5 million) infected with HBV (Lingao et al. Am J Epi 1986;123:473-480) • 2004 estimates: 8 – 10% of Filipinos (about 8 million) infected with HBV (Philippine Cancer Society, 2004) • 2008 estimates to be published by PCS

  10. Prevalence of Chronic Hepatitis B High: 8% & above Intermediate: 2-8% Low: Below 2%

  11. Hepatitis B and Filipino Infants Purposes: • Describe status of Philippine policy implementation on HBV inoculation of newborns • Explore strategies to guide policy implementation • Work with the Philippine Cancer Society on plans to promote implementation

  12. HEPATITIS B DISEASE • Inflammatory liver condition caused by hepatitis B virus (HBV) infection • Persons with HBV may recover and develop lifelong immunity from the virus or they may become chronically infected

  13. HEPATITIS B DISEASE Acute Hepatitis B • duration: several weeks • symptoms: poor appetite, weakness, nausea, vomiting, abdominal or joint pain, jaundice, dark urine, skin rashes Chronic Hepatitis B • duration: lifetime • symptoms: 30% no signs of illness • mortality: 15-25% die early of HBV-related diseases, e.g. liver cancer, cirrhosis WHO 2001, So 2005, WHO 2003

  14. Hepatitis B and Filipino Infants HBV: Chronic infection • Mother to infant transmission accounts for 1/3 of HBsAg positive infants at 1 year (Lingao et al., 1989) • 15-25% of chronically infected die of HBV-related diseases (WHO, 2003)

  15. Philippine DOH (Central) Manila City/Municipal Health Office ORGANIZATIONAL CHART District Health Office DOH CHD- Region V (6 Provinces) Barangay Health Center Provincial Health Office District / Provincial Hospitals

  16. US COMPREHENSIVE IMMUNIZATION STRATEGY ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP)

  17. Hepatitis B and Filipino Infants HB Vaccination Schedule for Newborns: Philippine DoH Policy (2006) • First dose at birth* • Second dose at 6 weeks** • Third dose at 14 weeks** *If mother HBsAg or HBeAg positive, 1st dose given ASAP after birth + HB immune globulin if available and/or affordable **2nd, 3rd doses timed with other immunizations to promote adherence to follow-ups

  18. Hepatitis B and Filipino Infants HB Vaccine as part of Expanded Program on Immunization: Philippine DoH Policy (2006) • PDoH supplies free HB vaccine for children 0-11 mo. through public health facilities nationwide • 2007 75% of HB vaccine needs • 2008 100% of HB vaccine needs

  19. Hepatitis B and Filipino Infants METHODOLOGY: Design & Subjects • Pilot, descriptive study • Face-to-face recorded interviews • 32 stakeholders, but N=30 health care providers • > 21 years, Speak English/Tagalog • Involved in implementing the HBV infant vaccination program

  20. Hepatitis B and Filipino Infants HBV Immunization Study: Interview Content • Knowledge of HBV infant vaccination policy • Role in policy implementation • Perceived barriers, facilitators, strategies related to policy implementation

  21. Hepatitis B and Filipino Infants Procedures with participants • Signed a consent form • Participated in a 30 min - one hr interview • Interviews audio recorded, transcribed, all names erased, recordings destroyed after transcription • Interviewed in work place or a convenient location • Received P500 (pesos)

  22. Hepatitis B and Filipino Infants Health Care Providers • 30 interviewed from 1/18-4/15/07, 1/09 • 21 females, 9 males • 29 gov’t, 1 NGO • 12 MDs, 15 RNs, 1 Midwife, 2 Barangay Health Workers • 14 Admin/EPI Coordin, 1 Med Train, 12 Clinicians, 2 BHWs, 1 NGO volunteer l

  23. Hepatitis B and Filipino Infants HBV Immunization Study: 23 locations • 15 urban, 4 semi-urban, 4 rural • 13 metro Manila, 1 Marikina • Provinces: 6 Sorsogon, 1 Ilocos Sur, 1 Masbate, 1 Batangas

  24. Hepatitis B and Filipino Infants HBV Immunization Study: Results Impact of PDoH decentralization • PDoH supplies the vaccine • Local governments budget support of public health clinics which implement HBV immunization policy • Financial support uneven across 23 locations

  25. Hepatitis B and Filipino InfantsHBV Immunization Study: Results, 23 locations

  26. Hepatitis B and Filipino Infants HBV Immunization Study: Results, 23 locations Cold storage charts/records on hand • 5 out of 7 clinics • 2 out of 5 hospitals • 5 out of 7 city/provincial health offices • 1 Health office, 1 clinic, 1 NGO, 1 Business - not applicable

  27. Hepatitis B and Filipino Infants HBV Immunization Study: Results, 23 locations Vaccination charts/records available • 5 out of 8 clinics • 1 out of 5 hospitals • 3 out of 7 health offices • 1 Health office, 1 NGO, 1 Business - not applicable

  28. Hepatitis B & Filipino Infants: Results 21 applicable locations Factors facilitating policy implementation - but not consistently • Monovalent HB vaccine 10-dose vials available • Training programs for health care providers available • HB immunization patient handouts and brochures available at clinics and hospitals • Health care locations promoted 2nd, 3rd dose follow-ups with tracking through immunization cards & designated personnel

  29. Hepatitis B & Filipino Infants: Results 21 applicable locations Barriers to policy implementation • Problems with vaccine and syringe distribution • Inadequate clinic budgets for appropriate personnel • Lack of money and distances to clinic for follow-up doses • Issues with refrigeration capacity and cold storage maintenance in emergency situations or for transport in rural areas

  30. Hepatitis B & Filipino Infants: Results 30 Health Care Providers • Knowledge about vaccine integrity: All 30 • Knowledge about Hep B infant inoculation policy: Knowledge deficit among some health professionals

  31. Hepatitis B & Filipino Infants: Results 30 Health Care Providers Type of inoculation schedule implemented • 22 followed new schedule (birth, 6, 14 weeks) • 4 followed old/other schedule (6, 10, 14 weeks, or other) • 4 followed both

  32. Hepatitis B & Filipino Infants: Results 30 Health Care Providers Personal knowledge of vaccine availability policy • 27 knowledgeable • 3 ignorant

  33. Hepatitis B & Filipino Infants: Results 30 Health Care Providers Knowledge & attitudes concerning vaccine policy • 29 reported no negative cultural biases among mothers toward infant immunizations • but moderate to poor client knowledge of the inoculation schedule or appreciation of its importance

  34. Hepatitis B and Filipino Infants HBV Transmission Modes Transmission occurs when infected blood enters the body of a person not infected • Infected mother to child at birth • Wound to wound contact • Sharing toothbrushes, razors • Reusing needles (medical or nonmedical) • Unprotected sex with infected person

  35. Hepatitis B & Filipino Infants: Results HBV Transmission Myths shared by Filipinos • Sharing food or water • Sharing eating utensils, drinking water • Casual contact • Hugging or kissing • Breast feeding

  36. Hepatitis B & Filipino Infants: Preliminary Conclusions • Some progress made to reach 100% HBV inoculation of newborns • Exact information on number of newborns receiving 1st, 2nd and 3rd doses unknown • Insufficient data to determine rural versus urban differences in policy knowledge or implementation

  37. Hepatitis B & Filipino Infants:Research Needed • Identify gaps in knowledge and implementation of HBV vaccination policy & procedures country-wide • Identify strategies/technologies to promote efficient distribution & storage of supplies • Describe gap between births recorded and inoculations received across Barangays, in rural versus urban areas

  38. Hepatitis B & Filipino Infants:Research Needed Improve knowledge of & adherence to HBV infant inoculation policy among health care providers Identify strategies to assist mothers to adhere to inoculation schedule

  39. Hepatitis B & Filipino Infants:Research Needed Evaluate impact of Train-the-Trainer strategy implemented by the Philippine Cancer Society at Provincial or District Health level on: • Knowledge of Barangay Health Workers • Knowledge of mothers • Inoculation of infants

  40. Hepatitis B and Filipino Infants:Did I Make the Right Turn? • Pilot data presented at research conference • Pilot data needs to lead to future funded study at R01 level, but first need further baseline data on number of infants inoculated to determine need • Have maintained great interest in the area • Feel hopeful about impact of research • Funding interest in Infectious Dis. Is Africa

  41. Acknowledgements US Fulbright Scholar Program PAEF Philippine & American Cancer Societies Myrah Lelis All Project Participants

  42. Magka-isa Laban sa HBV. Ang Jade Ribbon ay tiniklop na parang Chinese karakter para sa lahat “人” na simbolo sa pagkakaisang tinig ng mamamayan laban sa Hepatitis B at kanser sa atay sa buong mundo. • Para sa karagdagan na impormasiyon, bisitahin ang http://liver.stanford.edu Asian Liver Center

  43. Hepatitis B and Filipino Infants Thank You

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