Kaiser Permanente

Adverse childhood experiences (ACEs) are associated with poor health and educational outcomes on a population level. School-based health centers (SBHCs) may be uniquely positioned to support youth with ACEs, but little is known about ACEs screening and response in that setting. In this qualitative study, we characterized barriers and facilitators to addressing ACEs in SBHCs from the perspectives of SBHC clinicians. We conducted semistructured interviews with clinicians affiliated with a large public school district in Southern California that had implemented ACEs screening in its SBHCs. Interviews explored attitudes toward and experiences with ACEs screening in SBHCs, as well as differences between screening in SBHCs and other settings. We used a thematic analysis approach, continuing until thematic saturation was reached. The sample included 10 SBHC clinicians. Six major themes emerged. Three themes were considered opportunities: 1) SBHCs serve as a bridge to care and resources for youth with ACEs, 2) SBHC clinicians are versatile in their approach to addressing ACEs, and 3) structural elements of SBHCs facilitate ACEs screening and response. The remaining 3 were considered challenges: 1) SBHCs have limited capacity for follow-up for youth with ACEs, 2) providers experience challenges with obtaining accurate ACEs screening results, and 3) responding to ACEs screening is complex. SBHCs have the potential to support identification and response among youth with ACEs, though challenges remain. Policy and practice recommendations may consider how SBHCs can be leveraged as a unique context to support vulnerable populations at risk of toxic stress.

Digital surveys and electronic health records (EHR) can be combined to provide comprehensive assessments of vaccine safety. Limited post-marketing safety data exists for two new RSV vaccines among older adults (Pfizer RSVPreF and GSK RSVPreF3+ASO1). We used digital survey data from adults ≥60years receiving RSV vaccines through Kaiser Permanente Southern California from November 8, 2023, to February 29, 2024. Enrolled participants received 14-day post-vaccination surveys soliciting local and systemic reactions. Survey results were combined with EHR data. Medical chart reviews were conducted among participants self-reporting receiving medical care for vaccine-related symptoms within 21days of vaccination. We recruited 14,482 participants aged ≥60years following RSV vaccination (GSK: 7873 [59%]; Pfizer: 5555 [41%]), including 1054 participants receiving COVID-19 vaccinations on the same day (GSK:618; Pfizer:436). Local and systemic reactions were reported more frequently following GSK vaccinations than Pfizer. The most frequently reported reactions were pain at injection site (56.5% and 14.4%, respectively), fatigue (35.5% and 21.8%), myalgia (26.2% and 13.0%), headache (21.5% and 12.8%) and fever (7.8% and 3.3%). Participants rarely reported seeking medical care (GSK: 158/7873;2.0%; Pfizer: 104/5555;1.9%). Of these, 229 had ≥1 EHR-documented medical encounter 0-21days post-vaccination, of which 102 (0.8%) were considered possibly related to vaccination (GSK:69; Pfizer:33; RSV+COVID-19:0). Via chart review, the most common diagnoses identified as possibly related to vaccination included respiratory symptoms, such ascough (n=20 and n=9, respectively) and congestion (n=13 and n=6). No severe events were deemed related to vaccination. Reported reactogenicity symptoms were higher among participants receiving COVID-19 vaccines on the same day compared to participants receiving RSV vaccines alone. The most common reactions after RSV vaccines were local pain, fatigue, myalgia, and headache. GSK vaccine recipients containing the AS01E adjuvant reported reactions more frequently than Pfizer vaccine recipients. Consistent with pre-licensure safety data, most symptoms were transient and did not require medical care.

IntroductionThis study evaluated the real-world effectiveness and safety of biosimilar trastuzumab-anns to the reference trastuzumab in a United States (U.S.) population.MethodsThis observational, multicenter, non-inferiority cohort study used electronic medical records from an integrated U.S. healthcare system. Eligible patients were HER2 + breast cancer patients treated with trastuzumab-anns (August 2019-December 2020) or trastuzumab (March 2017-July 2018). Patients were stratified by treatment setting (curative or palliative) and followed for up to 12 months, death, or end of membership, whichever occurred first. The effectiveness outcome was treatment failure, a composite of all-cause mortality or treatment change. The NI margin was set with an upper limit of 5% and multivariate Cox proportional hazards models were used. The safety was assessed by the incidence of cardiomyopathy and neutropenia. Sensitivity analysis was conducted using stabilized inverse probability of treatment weighting.ResultsOf the 4,111 patients eligible, 1,784 met the inclusion criteria with 893 patients in the trastuzumab-anns group and 891 in the reference trastuzumab group. For the composite of treatment failure, trastuzumab-anns was non-inferior to trastuzumab at 7.7% and 5.6%, respectively (90% CI: 0.0% to 4.0%; p < 0.01). A two-way analysis with Cox proportional hazard models showed no significant difference in the risk of treatment failure (adjusted hazards ratio 0.88, 95% CI: 0.6 to 1.3; p = 0.52). Rates of cardiomyopathy and neutropenia were comparable between groups.ConclusionIn this real-world U.S. population, trastuzumab-anns was non-inferior to reference trastuzumab in the treatment of HER2 + breast cancer.