Cigarette smoking causes marked inhibition of substance P-induced tPA release in vivo in humans. This provides an important mechanism whereby endothelial dysfunction may increase the risk of atherothrombosis through a reduction in the acute fibrinolytic capacity.

ABSTRACT. Objective. To examine the attitudes, beliefs, and behaviors of parents whose children were underimmunized with respect to >2 vaccines that have recently received negative attention, compared with parents whose children were fully immunized with respect to the recommended vaccines.Design. Case-control study. Setting. A sample of households that participated in the National Immunization Survey were recontacted in 2001.Main Outcome Measure. Vaccination status was assessed. Case subjects were underimmunized with respect to >2 of 3 vaccines (diphtheria-tetanus-pertussis or diphtheria-tetanus-acellular pertussis, hepatitis B, or measlescontaining vaccines), and control subjects were fully immunized.Results. The response rate was 52.1% (2315 of 4440 subjects). Compared with control households, case households were more likely to make $0 to $30 000 (adjusted odds ratio [OR]: 2.7; 95% confidence interval [CI]: 1.5-4.6) than at least $75 000, to have >2 providers (OR: 2.0; 95% CI: 1.3-3.1) than 1, and to have >4 children (OR: 3.1; 95% CI: 1.5-6.3) than 1 child. With control for demographic and medical care factors, case subjects were more likely than control subjects to not want a new infant to receive all shots (OR: 3.8; 95% CI: 1.5-9.8), to score vaccines as unsafe or somewhat safe (OR: 2.0; 95% CI: 1.2-3.4), and to ask the doctor or nurse not to give the child a vaccine for reasons other than illness (OR: 2.7; 95% CI: 1.2-6.1). Among case subjects, 14.8% of underimmunization was attributable to parental attitudes, beliefs, and behaviors.Conclusions. Attitudes, beliefs, and behaviors indicative of vaccine safety concerns contribute substantially to underimmunization in the United States. Although concerns were significantly more common among parents of underimmunized children, many parents of fully immunized children demonstrated similar attitudes, beliefs, and behaviors, suggesting a risk to the currently high vaccination levels. Efforts to maintain and improve immunization coverage need to target those with attitudes/beliefs/behaviors indicative of vaccine safety concerns, as well as those with socioeconomic and health care access problems. Pediatrics 2004;114:e16 -e22. URL: http://www.pediatrics.org/cgi/content/full/114/1/e16; underimmunization, attitudes, beliefs, behaviors.ABBREVIATIONS. DTaP, diphtheria-tetanus-acellular pertussis; DTP, diphtheria-tetanus-pertussis; MCV, measles-containing vaccine; MMR, measles-mumps-rubella; NIS, National Immunization Survey; OR, odds ratio; CI, confidence interval. I mmunizations have reduced the incidence of vaccine-preventable disease by Ͼ95% for every pediatric vaccine recommended for routine use before 1990. 1 As the number of immunizations has increased, however, reports of postimmunization adverse events, both vaccine-related and coincidental, have increased. This increase, combined with the decrease in the incidence of vaccine-preventable diseases, has resulted in an increased focus on vaccine safety. 2 Some have linked vaccinations with acute and chronic illnes...

SummaryThe effects on blood flow and plasma fibrinolytic and coagulation parameters of intraarterial substance P, an endothelium dependent vasodilator, and sodium nitroprusside, a control endothelium independent vasodilator, were studied in the human forearm circulation. At subsystemic locally active doses, both substance P (2-8 pmol/min) and sodium nitroprusside (2-8 μg/min) caused dose-dependent vasodilatation (p <0.001 for both) without affecting plasma concentrations of PAI-1, von Willebrand factor antigen or factor VIII:C activity. Substance P caused local increases in t-PA antigen and activity (p <0.001) in the infused arm while sodium nitroprusside did not. At higher doses, substance P increased blood flow and t-PA concentrations in the noninfused arm. We conclude that brief, locally active and subsystemic infusions of intraarterial substance P cause a rapid and substantial local release of t-PA which appear to act via a flow and nitric oxide independent mechanism. This model should provide a useful and selective method of assessing the in vivo capacity of the forearm endothelium to release t-PA acutely.

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