Résumé :
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[BDSP. Notice produite par INIST z1tR0xbC. Diffusion soumise à autorisation]. Context. - Immunization rates in the inner city remain lower than in the general US population, but efforts to raise immunization levels in inner-city areas have been largely untested. Objective. - To assess the effectiveness of case management in raising immunization levels among infants of inner-city, African American families. Design. - Randomized controlled trial with follow-up through 1 year of life. Setting. - Low-income areas of inner-city Los Angeles, Calif. Patients. - A representative sample of 419 African American infants and their families. Interventions. In-depth assessment by case managers before infants were 6 weeks of age, with home visits 2 weeks prior to when immunizations were scheduled and additional follow-up visits as needed. Main Outcome Measures. - Percentage of children with up-to-date immunizations at age 1 year, characteristics associated with improved immunization rates, and cost-effectiveness of case management intervention. Results. - A total of 365 newborns were followed up to age 1 year. Overall, the immunization completion for the case management group was 13.2 percentage points higher than the control group (63.8% vs 50.6% ; P=01). In a logistic model, the case management effect was limited to the 25% of the sample who reported 3 or fewer well-child visits (odds ratio, 3.43 ; 95% confidence interval, 1.26-9.35) ; for them, immunization levels increased by 28 percentage points. (...)
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