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Pediatric Academic Societies (PAS): Annual Meeting
Unhealthy body shape concerns linked to adverse outcomes
WASHINGTON – High levels of concern with muscularity, or with both muscularity and thinness, were relatively common – and were associated with a risk of adverse outcomes – among adolescent boys participating in the ongoing Growing Up Today Study.
Male adolescents may not be recognized as having body shape concerns or weight-related disorders because of their gender and what likely are gender-specific presentations. This analysis of the GUTS cohort, however, should put such concerns and disorders on the radar screen for pediatricians and other clinicians, Alison E. Field, Sc.D., reported at the annual meeting of the Pediatric Academic Societies.
The Growing Up Today Study – a National Institutes of Health–funded prospective cohort study established in 1996 to assess factors that influence weight change – has involved approximately 16,800 children (approximately 9,000 girls and 7,800 boys) who are offspring of women participating in the separate Nurses Health Study 2.
Questionnaires sent every 12-24 months to the boys participating in GUTS have assessed concerns with thinness, concerns with muscularity, use of products to enhance physique, bulimic behaviors, weight and height, depressive symptoms, drug use, and binge eating and drinking. To assess concerns about muscularity, for instance, boys were asked, "How frequently do you think about wanting to tone or define muscle?"
The analysis presented at the PAS meeting involved 5,527 male adolescents who had returned at least two questionnaires between 1999 and 2010. The boys ranged in age from 12 to 18 years in 1999.
Thinness itself was the least common concern. It was a significant concern of about 2% of boys aged 13-15 years, and the prevalence of the concern decreased in older age groups.
The prevalence of concerns and behaviors that included muscularity, on the other hand, was much higher, reported Dr. Field of the department of pediatrics at Harvard Medical School, Boston.
"Particularly troubling," Dr. Field said, was the prevalence of muscularity concerns coupled with the reported use of "potentially" unhealthy products (creatine supplements) and "definitely" unhealthy products (growth hormone or steroids). The prevalence grew from approximately 2% among 13- to 15-year-old boys, to about 7% among 16- to 18-year-old boys, to almost 9% among young men aged 19-22.
"A lot of these young men who are using unhealthy products to bulk up won’t be huge – not yet," said Dr. Field. "These are hard issues to assess, but it will be important for clinicians to probe."
Adolescent boys commonly want more muscularity, she said, but "we’re talking here about defining yourself around your physique and being willing to take on whatever it takes to achieve that."
Dr. Field and her coinvestigators used lagged analysis techniques to determine whether these concerns and behaviors led to certain adverse outcomes and risky behaviors.
Boys with thinness concerns, they found, were 2.5 times more likely than their peers without weight concerns to develop a high level of depressive symptoms (the top quartile of the Center for Epidemiologic Studies Depression Scale [CES-D] self-report scale) in the next 1-2 years.
Those with high concerns about both muscularity and thinness were more likely than their peers to start binge drinking frequently (odds ratio, 1.6) and using drugs (OR, 2.5) within the next 1-2 years, as were boys with high muscularity concerns who used supplements and other products to enhance physique (OR, 2.4 and 2, respectively).
The analysis also offers a window into the issue of eating disorders in males. Bulimia nervosa was rare across age groups, as was purging disorder until young adulthood, when the prevalence grew to just under 1% among males aged 23 years and older. The prevalence of meeting partial or full criteria for binge eating disorder (which for this analysis meant binge eating at least monthly), however, was much higher and grew with age, from almost 0.5% among boys aged 9-12, to more than 2% in the 19- to 22-year-old age group.
Research on disordered eating among males is tricky because most scales and other research tools have been validated for females only.
In terms of diagnosis, "the DSM-5 criteria [for eating disorders] have been improved for females, but we may not be capturing the problem for males," Dr. Field said. More discussion is needed, she said, on the possibility of gender differences.
Dr. Field reported no relevant financial disclosures.
WASHINGTON – High levels of concern with muscularity, or with both muscularity and thinness, were relatively common – and were associated with a risk of adverse outcomes – among adolescent boys participating in the ongoing Growing Up Today Study.
Male adolescents may not be recognized as having body shape concerns or weight-related disorders because of their gender and what likely are gender-specific presentations. This analysis of the GUTS cohort, however, should put such concerns and disorders on the radar screen for pediatricians and other clinicians, Alison E. Field, Sc.D., reported at the annual meeting of the Pediatric Academic Societies.
The Growing Up Today Study – a National Institutes of Health–funded prospective cohort study established in 1996 to assess factors that influence weight change – has involved approximately 16,800 children (approximately 9,000 girls and 7,800 boys) who are offspring of women participating in the separate Nurses Health Study 2.
Questionnaires sent every 12-24 months to the boys participating in GUTS have assessed concerns with thinness, concerns with muscularity, use of products to enhance physique, bulimic behaviors, weight and height, depressive symptoms, drug use, and binge eating and drinking. To assess concerns about muscularity, for instance, boys were asked, "How frequently do you think about wanting to tone or define muscle?"
The analysis presented at the PAS meeting involved 5,527 male adolescents who had returned at least two questionnaires between 1999 and 2010. The boys ranged in age from 12 to 18 years in 1999.
Thinness itself was the least common concern. It was a significant concern of about 2% of boys aged 13-15 years, and the prevalence of the concern decreased in older age groups.
The prevalence of concerns and behaviors that included muscularity, on the other hand, was much higher, reported Dr. Field of the department of pediatrics at Harvard Medical School, Boston.
"Particularly troubling," Dr. Field said, was the prevalence of muscularity concerns coupled with the reported use of "potentially" unhealthy products (creatine supplements) and "definitely" unhealthy products (growth hormone or steroids). The prevalence grew from approximately 2% among 13- to 15-year-old boys, to about 7% among 16- to 18-year-old boys, to almost 9% among young men aged 19-22.
"A lot of these young men who are using unhealthy products to bulk up won’t be huge – not yet," said Dr. Field. "These are hard issues to assess, but it will be important for clinicians to probe."
Adolescent boys commonly want more muscularity, she said, but "we’re talking here about defining yourself around your physique and being willing to take on whatever it takes to achieve that."
Dr. Field and her coinvestigators used lagged analysis techniques to determine whether these concerns and behaviors led to certain adverse outcomes and risky behaviors.
Boys with thinness concerns, they found, were 2.5 times more likely than their peers without weight concerns to develop a high level of depressive symptoms (the top quartile of the Center for Epidemiologic Studies Depression Scale [CES-D] self-report scale) in the next 1-2 years.
Those with high concerns about both muscularity and thinness were more likely than their peers to start binge drinking frequently (odds ratio, 1.6) and using drugs (OR, 2.5) within the next 1-2 years, as were boys with high muscularity concerns who used supplements and other products to enhance physique (OR, 2.4 and 2, respectively).
The analysis also offers a window into the issue of eating disorders in males. Bulimia nervosa was rare across age groups, as was purging disorder until young adulthood, when the prevalence grew to just under 1% among males aged 23 years and older. The prevalence of meeting partial or full criteria for binge eating disorder (which for this analysis meant binge eating at least monthly), however, was much higher and grew with age, from almost 0.5% among boys aged 9-12, to more than 2% in the 19- to 22-year-old age group.
Research on disordered eating among males is tricky because most scales and other research tools have been validated for females only.
In terms of diagnosis, "the DSM-5 criteria [for eating disorders] have been improved for females, but we may not be capturing the problem for males," Dr. Field said. More discussion is needed, she said, on the possibility of gender differences.
Dr. Field reported no relevant financial disclosures.
WASHINGTON – High levels of concern with muscularity, or with both muscularity and thinness, were relatively common – and were associated with a risk of adverse outcomes – among adolescent boys participating in the ongoing Growing Up Today Study.
Male adolescents may not be recognized as having body shape concerns or weight-related disorders because of their gender and what likely are gender-specific presentations. This analysis of the GUTS cohort, however, should put such concerns and disorders on the radar screen for pediatricians and other clinicians, Alison E. Field, Sc.D., reported at the annual meeting of the Pediatric Academic Societies.
The Growing Up Today Study – a National Institutes of Health–funded prospective cohort study established in 1996 to assess factors that influence weight change – has involved approximately 16,800 children (approximately 9,000 girls and 7,800 boys) who are offspring of women participating in the separate Nurses Health Study 2.
Questionnaires sent every 12-24 months to the boys participating in GUTS have assessed concerns with thinness, concerns with muscularity, use of products to enhance physique, bulimic behaviors, weight and height, depressive symptoms, drug use, and binge eating and drinking. To assess concerns about muscularity, for instance, boys were asked, "How frequently do you think about wanting to tone or define muscle?"
The analysis presented at the PAS meeting involved 5,527 male adolescents who had returned at least two questionnaires between 1999 and 2010. The boys ranged in age from 12 to 18 years in 1999.
Thinness itself was the least common concern. It was a significant concern of about 2% of boys aged 13-15 years, and the prevalence of the concern decreased in older age groups.
The prevalence of concerns and behaviors that included muscularity, on the other hand, was much higher, reported Dr. Field of the department of pediatrics at Harvard Medical School, Boston.
"Particularly troubling," Dr. Field said, was the prevalence of muscularity concerns coupled with the reported use of "potentially" unhealthy products (creatine supplements) and "definitely" unhealthy products (growth hormone or steroids). The prevalence grew from approximately 2% among 13- to 15-year-old boys, to about 7% among 16- to 18-year-old boys, to almost 9% among young men aged 19-22.
"A lot of these young men who are using unhealthy products to bulk up won’t be huge – not yet," said Dr. Field. "These are hard issues to assess, but it will be important for clinicians to probe."
Adolescent boys commonly want more muscularity, she said, but "we’re talking here about defining yourself around your physique and being willing to take on whatever it takes to achieve that."
Dr. Field and her coinvestigators used lagged analysis techniques to determine whether these concerns and behaviors led to certain adverse outcomes and risky behaviors.
Boys with thinness concerns, they found, were 2.5 times more likely than their peers without weight concerns to develop a high level of depressive symptoms (the top quartile of the Center for Epidemiologic Studies Depression Scale [CES-D] self-report scale) in the next 1-2 years.
Those with high concerns about both muscularity and thinness were more likely than their peers to start binge drinking frequently (odds ratio, 1.6) and using drugs (OR, 2.5) within the next 1-2 years, as were boys with high muscularity concerns who used supplements and other products to enhance physique (OR, 2.4 and 2, respectively).
The analysis also offers a window into the issue of eating disorders in males. Bulimia nervosa was rare across age groups, as was purging disorder until young adulthood, when the prevalence grew to just under 1% among males aged 23 years and older. The prevalence of meeting partial or full criteria for binge eating disorder (which for this analysis meant binge eating at least monthly), however, was much higher and grew with age, from almost 0.5% among boys aged 9-12, to more than 2% in the 19- to 22-year-old age group.
Research on disordered eating among males is tricky because most scales and other research tools have been validated for females only.
In terms of diagnosis, "the DSM-5 criteria [for eating disorders] have been improved for females, but we may not be capturing the problem for males," Dr. Field said. More discussion is needed, she said, on the possibility of gender differences.
Dr. Field reported no relevant financial disclosures.
AT THE PAS ANNUAL MEETING
Major Finding: Significant concerns with muscularity and the reported use of unhealthy products to achieve muscularity were relatively common, with a prevalence ranging from approximately 2% among 13- to 15-year-old boys to almost 9% among young adult males. These boys were 2.4 times more likely to start binge drinking frequently and twice as likely to use drugs as were their peers without high levels of concern about body shape.
Data Source: A cohort of 5,527 boys followed in the Growing Up Today Study.
Disclosures: Dr. Field reported no financial disclosures.
STD screening strategies: Urine not enough in MSM
WASHINGTON – Screening for chlamydia and gonorrhea infections using urine testing alone would have missed more than three-fourths of infections in a population of gay youth, a study has found.
"Urine screening alone is not a reliable proxy for all sites for gonorrhea and chlamydia infections in a youth men-who-have-sex-with-men population," reported Dr. Katie Plax at the annual meeting of the Pediatric Academic Societies (PAS).
Instead, it appears that triple screening – with pharyngeal and rectal testing done along with genital screening through urine tests – can enhance the detection of chlamydia and gonorrhea, especially in this high-risk population.
Dr. Plax and her coinvestigators screened 135 young men who have sex with men (MSM), aged 14-24 years, during 189 visits to a drop-in youth center in St. Louis that provides health and social services. Each of the youth had triple screening with nucleic acid simplification testing of urine, rectum, and pharyngeal specimens.
Of all the positive test results over the 12-month study, only 17% were from urine specimens, whereas 82% were in rectal or throat specimens. (There were 29 positive chlamydia tests in 26 of the 135 men, and 72 positive gonorrhea tests in 51 of the men. Twelve of the young men were positive for both infections.)
Urine screening alone would have missed 85% of chlamydia infections and 72% of gonorrhea infections, their analysis shows, while throat screening alone would have missed 88% of chlamydia infections and 43% of gonorrhea infections. Rectal screening had the highest yield, with the estimated rates of missed infections being 15% and 41%, respectively.
"More attention should be focused on the role that extragenital infections play," said Dr. Plax, director of the Adolescent Center at St. Louis Children’s Hospital and associate professor of pediatrics at Washington University in St. Louis. "For HIV-uninfected patients, this is a public health emergency, because we know that an STD [sexually transmitted disease] diagnosis is both a marker for potentially high-risk activity and also a potential cofactor for HIV acquisition."
Gonorrhea infections in particular "have been identified as one of the strongest and most consistent risk factors associated with HIV seroprevalence and HIV seroconversion," she said.
Almost half of the estimated 19 million new cases of sexually transmitted infections each year occur in youth aged 15-24 years, she noted. Moreover, the vast majority of gonorrhea and chlamydia infections – 85% – are asymptomatic.
The Centers for Disease Control and Prevention recommends routine laboratory screening for common STDs for all sexually active MSM, with screening tests selected based on types of reported intercourse. This is tricky to implement, Dr. Plax said, given that basic sexual history-taking still is challenging for many providers.
"We need to take better sexual histories. We can’t ask people, especially youth, are you gay, straight, or bisexual? They don’t identify that way," she noted. "You have to ask, do you have sex with men, women, or both?"
In another study reported at the PAS meeting, researchers found that physicians are documenting sexual histories and performing tests for sexually transmitted infections (STIs) infrequently in adolescent patients, including those who report sexual activity.
In this retrospective cross-sectional study of 1,000 randomly selected routine visits by patients aged 13-19 years, fewer than one-quarter of the patients had a documented sexual history. Of those who reported being sexually active, 38% underwent STI testing and 22% had ever undergone HIV testing specifically. Overall, only 2.6% of the patients had been tested for STIs in the year preceding their visit, and only 1.1% had been tested for HIV.
The patients were among 40,000 adolescents seeking care at 29 primary care practices affiliated with the Children’s Hospital of Philadelphia and the Children’s National Medical Center in Washington. The findings were reported by Rachel Witt, a medical student at the University of Pennsylvania, Philadelphia.
Dr. Plax reported that she and her coinvestigators had no disclosures. Ms. Witt had no disclosures.
WASHINGTON – Screening for chlamydia and gonorrhea infections using urine testing alone would have missed more than three-fourths of infections in a population of gay youth, a study has found.
"Urine screening alone is not a reliable proxy for all sites for gonorrhea and chlamydia infections in a youth men-who-have-sex-with-men population," reported Dr. Katie Plax at the annual meeting of the Pediatric Academic Societies (PAS).
Instead, it appears that triple screening – with pharyngeal and rectal testing done along with genital screening through urine tests – can enhance the detection of chlamydia and gonorrhea, especially in this high-risk population.
Dr. Plax and her coinvestigators screened 135 young men who have sex with men (MSM), aged 14-24 years, during 189 visits to a drop-in youth center in St. Louis that provides health and social services. Each of the youth had triple screening with nucleic acid simplification testing of urine, rectum, and pharyngeal specimens.
Of all the positive test results over the 12-month study, only 17% were from urine specimens, whereas 82% were in rectal or throat specimens. (There were 29 positive chlamydia tests in 26 of the 135 men, and 72 positive gonorrhea tests in 51 of the men. Twelve of the young men were positive for both infections.)
Urine screening alone would have missed 85% of chlamydia infections and 72% of gonorrhea infections, their analysis shows, while throat screening alone would have missed 88% of chlamydia infections and 43% of gonorrhea infections. Rectal screening had the highest yield, with the estimated rates of missed infections being 15% and 41%, respectively.
"More attention should be focused on the role that extragenital infections play," said Dr. Plax, director of the Adolescent Center at St. Louis Children’s Hospital and associate professor of pediatrics at Washington University in St. Louis. "For HIV-uninfected patients, this is a public health emergency, because we know that an STD [sexually transmitted disease] diagnosis is both a marker for potentially high-risk activity and also a potential cofactor for HIV acquisition."
Gonorrhea infections in particular "have been identified as one of the strongest and most consistent risk factors associated with HIV seroprevalence and HIV seroconversion," she said.
Almost half of the estimated 19 million new cases of sexually transmitted infections each year occur in youth aged 15-24 years, she noted. Moreover, the vast majority of gonorrhea and chlamydia infections – 85% – are asymptomatic.
The Centers for Disease Control and Prevention recommends routine laboratory screening for common STDs for all sexually active MSM, with screening tests selected based on types of reported intercourse. This is tricky to implement, Dr. Plax said, given that basic sexual history-taking still is challenging for many providers.
"We need to take better sexual histories. We can’t ask people, especially youth, are you gay, straight, or bisexual? They don’t identify that way," she noted. "You have to ask, do you have sex with men, women, or both?"
In another study reported at the PAS meeting, researchers found that physicians are documenting sexual histories and performing tests for sexually transmitted infections (STIs) infrequently in adolescent patients, including those who report sexual activity.
In this retrospective cross-sectional study of 1,000 randomly selected routine visits by patients aged 13-19 years, fewer than one-quarter of the patients had a documented sexual history. Of those who reported being sexually active, 38% underwent STI testing and 22% had ever undergone HIV testing specifically. Overall, only 2.6% of the patients had been tested for STIs in the year preceding their visit, and only 1.1% had been tested for HIV.
The patients were among 40,000 adolescents seeking care at 29 primary care practices affiliated with the Children’s Hospital of Philadelphia and the Children’s National Medical Center in Washington. The findings were reported by Rachel Witt, a medical student at the University of Pennsylvania, Philadelphia.
Dr. Plax reported that she and her coinvestigators had no disclosures. Ms. Witt had no disclosures.
WASHINGTON – Screening for chlamydia and gonorrhea infections using urine testing alone would have missed more than three-fourths of infections in a population of gay youth, a study has found.
"Urine screening alone is not a reliable proxy for all sites for gonorrhea and chlamydia infections in a youth men-who-have-sex-with-men population," reported Dr. Katie Plax at the annual meeting of the Pediatric Academic Societies (PAS).
Instead, it appears that triple screening – with pharyngeal and rectal testing done along with genital screening through urine tests – can enhance the detection of chlamydia and gonorrhea, especially in this high-risk population.
Dr. Plax and her coinvestigators screened 135 young men who have sex with men (MSM), aged 14-24 years, during 189 visits to a drop-in youth center in St. Louis that provides health and social services. Each of the youth had triple screening with nucleic acid simplification testing of urine, rectum, and pharyngeal specimens.
Of all the positive test results over the 12-month study, only 17% were from urine specimens, whereas 82% were in rectal or throat specimens. (There were 29 positive chlamydia tests in 26 of the 135 men, and 72 positive gonorrhea tests in 51 of the men. Twelve of the young men were positive for both infections.)
Urine screening alone would have missed 85% of chlamydia infections and 72% of gonorrhea infections, their analysis shows, while throat screening alone would have missed 88% of chlamydia infections and 43% of gonorrhea infections. Rectal screening had the highest yield, with the estimated rates of missed infections being 15% and 41%, respectively.
"More attention should be focused on the role that extragenital infections play," said Dr. Plax, director of the Adolescent Center at St. Louis Children’s Hospital and associate professor of pediatrics at Washington University in St. Louis. "For HIV-uninfected patients, this is a public health emergency, because we know that an STD [sexually transmitted disease] diagnosis is both a marker for potentially high-risk activity and also a potential cofactor for HIV acquisition."
Gonorrhea infections in particular "have been identified as one of the strongest and most consistent risk factors associated with HIV seroprevalence and HIV seroconversion," she said.
Almost half of the estimated 19 million new cases of sexually transmitted infections each year occur in youth aged 15-24 years, she noted. Moreover, the vast majority of gonorrhea and chlamydia infections – 85% – are asymptomatic.
The Centers for Disease Control and Prevention recommends routine laboratory screening for common STDs for all sexually active MSM, with screening tests selected based on types of reported intercourse. This is tricky to implement, Dr. Plax said, given that basic sexual history-taking still is challenging for many providers.
"We need to take better sexual histories. We can’t ask people, especially youth, are you gay, straight, or bisexual? They don’t identify that way," she noted. "You have to ask, do you have sex with men, women, or both?"
In another study reported at the PAS meeting, researchers found that physicians are documenting sexual histories and performing tests for sexually transmitted infections (STIs) infrequently in adolescent patients, including those who report sexual activity.
In this retrospective cross-sectional study of 1,000 randomly selected routine visits by patients aged 13-19 years, fewer than one-quarter of the patients had a documented sexual history. Of those who reported being sexually active, 38% underwent STI testing and 22% had ever undergone HIV testing specifically. Overall, only 2.6% of the patients had been tested for STIs in the year preceding their visit, and only 1.1% had been tested for HIV.
The patients were among 40,000 adolescents seeking care at 29 primary care practices affiliated with the Children’s Hospital of Philadelphia and the Children’s National Medical Center in Washington. The findings were reported by Rachel Witt, a medical student at the University of Pennsylvania, Philadelphia.
Dr. Plax reported that she and her coinvestigators had no disclosures. Ms. Witt had no disclosures.
AT THE PAS ANNUAL MEETING
Major finding: Screening practices in young men who have sex with men need to account for a significant number of nongenital chlamydia and gonorrhea infections; urine testing alone would have missed 85% of infections.
Data source: Analysis of screening testing performed on 135 young MSM who were seen at a youth center in St. Louis.
Disclosures: Dr. Plax reported that she and her coinvestigators had no disclosures. Ms. Witt had no disclosures.
Primary care project successful in promoting parent-child interactions
WASHINGTON – Poverty-related disparities in school readiness are a "major public health crisis," in the opinion of Dr. Alan L. Mendelsohn and his colleagues at Bellevue Hospital Center in New York, and they have long been thinking about how to best take advantage of pediatric well-child care visits to promote parent-child interactions that can reduce these disparities.
One of the parenting interventions they are studying – a program called the Video Interaction Project (VIP) – already has been shown to enhance parent-child interactions at the 6-month mark.
Now, it seems that the parenting program can have a long-term impact as well – and that continuing the interventions into the 3- to 5-year age group can have further, independent effects on parent-child interactions.
"Our new findings provide support for interventions based in pediatric primary care to enhance parenting in both the infant and toddler years and the preschool periods," Dr. Mendelsohn, a pediatric developmental behavioral health specialist, reported at the annual meeting of the Pediatric Academic Societies.
Enhancing parent-child interactions, he believes, should improve language and cognitive social-emotional development and ultimately promote school readiness and school performance. Poor children are exposed to 75% fewer words, he noted.
In the VIP program, a child development specialist videotapes the parent and child interacting together with a book or a toy either before or after routine primary care visits. The parent and specialist then watch the video together, with the specialist reinforcing positive interactions, offering suggestions for further interaction, and promoting parent self-reflection. VIP families also receive parenting pamphlets and learning materials at each visit.
The project has been developed in two phases, with VIP 0-3 covering children from birth through 3 years of age, and VIP 3-5 covering the preschool years and entailing increasingly rich play and literacy activities. All told, from birth through 5 years, about 15 VIP sessions take place for each participating family.
The research is part of the Bellevue Project for Early Language, Literacy, and Educational Success (BELLE Project). New mothers were enrolled during the postpartum period at Bellevue Hospital Center and randomized to VIP 0-3 or control; then at age 3 years, the VIP and control families were re-randomized to receive either additional VIP during ages 3-5 years or to control during that period. At 54 months, investigators performed single-blind assessments of parenting and child development.
Bellevue Hospital Center is a public hospital serving families of low socioeconomic status throughout New York City. The 450 mothers enrolled in BELLE are primarily first-generation Hispanic/Latino immigrants. All had singleton, full-term uncomplicated births and spoke English or Spanish as their primary language.
A prior published analysis of the cohort showed enhanced infant-parent interactions as reflected by significantly higher StimQ scores in the VIP 0-3 group at 6 months of age (Arch. Pediatr. Adolesc. Med. 2011;165:33-41). Another analysis at 33 months showed lower levels of parenting stress and a greater likelihood of normal cognitive development in VIP children (J. Dev. Behav. Pediatr. 2007;28:206-12).
The StimQ is an office-based survey developed by Dr. Mendelsohn and others at New York University (NYU) for measuring cognitive stimulation in the homes of young children. It is validated for use in low-socioeconomic populations whose primary language is English or Spanish.
The new 54-month analysis used adaptations of three StimQ-Preschool subscales: Parent Verbal Responsivity, Reading Activities, and Parent Involvement in Developmental Advance, the last of which measures the number of different interactional activities occurring between the caregiver and child that promote cognitive development.
At 54 months, VIP 0-3 was associated with significant increases in scores for parent verbal responsivity (8.98 vs. 7.95) and reading (24.91 vs. 23.75), but only a minimal increase in the score for teaching activities. VIP 3-5 was independently associated with significant increases in verbal responsivity (9.14 vs. 7.99) and teaching (13.18 vs. 12.04), with a trend toward enhancements in reading, Dr. Mendelsohn reported.
"Importantly, the effects were independent, suggesting additive impacts for those receiving interventions during both periods," he said.
Among the next steps in their research are comprehensive assessments in the first grade.
"We also need to work on replication and on understanding whether this is equally effective in other low-income groups," Dr. Mendelsohn said. "We need to build on this burgeoning science ... but we don’t want to just dilute and spread."
Dr. Alan L. Mendelsohn reported no disclosures. VIP has been funded by the National Institute of Child Health and Human Development, the Marks Family Foundation, the Tiger Foundation, Children of Bellevue, and KiDS of NYU.
WASHINGTON – Poverty-related disparities in school readiness are a "major public health crisis," in the opinion of Dr. Alan L. Mendelsohn and his colleagues at Bellevue Hospital Center in New York, and they have long been thinking about how to best take advantage of pediatric well-child care visits to promote parent-child interactions that can reduce these disparities.
One of the parenting interventions they are studying – a program called the Video Interaction Project (VIP) – already has been shown to enhance parent-child interactions at the 6-month mark.
Now, it seems that the parenting program can have a long-term impact as well – and that continuing the interventions into the 3- to 5-year age group can have further, independent effects on parent-child interactions.
"Our new findings provide support for interventions based in pediatric primary care to enhance parenting in both the infant and toddler years and the preschool periods," Dr. Mendelsohn, a pediatric developmental behavioral health specialist, reported at the annual meeting of the Pediatric Academic Societies.
Enhancing parent-child interactions, he believes, should improve language and cognitive social-emotional development and ultimately promote school readiness and school performance. Poor children are exposed to 75% fewer words, he noted.
In the VIP program, a child development specialist videotapes the parent and child interacting together with a book or a toy either before or after routine primary care visits. The parent and specialist then watch the video together, with the specialist reinforcing positive interactions, offering suggestions for further interaction, and promoting parent self-reflection. VIP families also receive parenting pamphlets and learning materials at each visit.
The project has been developed in two phases, with VIP 0-3 covering children from birth through 3 years of age, and VIP 3-5 covering the preschool years and entailing increasingly rich play and literacy activities. All told, from birth through 5 years, about 15 VIP sessions take place for each participating family.
The research is part of the Bellevue Project for Early Language, Literacy, and Educational Success (BELLE Project). New mothers were enrolled during the postpartum period at Bellevue Hospital Center and randomized to VIP 0-3 or control; then at age 3 years, the VIP and control families were re-randomized to receive either additional VIP during ages 3-5 years or to control during that period. At 54 months, investigators performed single-blind assessments of parenting and child development.
Bellevue Hospital Center is a public hospital serving families of low socioeconomic status throughout New York City. The 450 mothers enrolled in BELLE are primarily first-generation Hispanic/Latino immigrants. All had singleton, full-term uncomplicated births and spoke English or Spanish as their primary language.
A prior published analysis of the cohort showed enhanced infant-parent interactions as reflected by significantly higher StimQ scores in the VIP 0-3 group at 6 months of age (Arch. Pediatr. Adolesc. Med. 2011;165:33-41). Another analysis at 33 months showed lower levels of parenting stress and a greater likelihood of normal cognitive development in VIP children (J. Dev. Behav. Pediatr. 2007;28:206-12).
The StimQ is an office-based survey developed by Dr. Mendelsohn and others at New York University (NYU) for measuring cognitive stimulation in the homes of young children. It is validated for use in low-socioeconomic populations whose primary language is English or Spanish.
The new 54-month analysis used adaptations of three StimQ-Preschool subscales: Parent Verbal Responsivity, Reading Activities, and Parent Involvement in Developmental Advance, the last of which measures the number of different interactional activities occurring between the caregiver and child that promote cognitive development.
At 54 months, VIP 0-3 was associated with significant increases in scores for parent verbal responsivity (8.98 vs. 7.95) and reading (24.91 vs. 23.75), but only a minimal increase in the score for teaching activities. VIP 3-5 was independently associated with significant increases in verbal responsivity (9.14 vs. 7.99) and teaching (13.18 vs. 12.04), with a trend toward enhancements in reading, Dr. Mendelsohn reported.
"Importantly, the effects were independent, suggesting additive impacts for those receiving interventions during both periods," he said.
Among the next steps in their research are comprehensive assessments in the first grade.
"We also need to work on replication and on understanding whether this is equally effective in other low-income groups," Dr. Mendelsohn said. "We need to build on this burgeoning science ... but we don’t want to just dilute and spread."
Dr. Alan L. Mendelsohn reported no disclosures. VIP has been funded by the National Institute of Child Health and Human Development, the Marks Family Foundation, the Tiger Foundation, Children of Bellevue, and KiDS of NYU.
WASHINGTON – Poverty-related disparities in school readiness are a "major public health crisis," in the opinion of Dr. Alan L. Mendelsohn and his colleagues at Bellevue Hospital Center in New York, and they have long been thinking about how to best take advantage of pediatric well-child care visits to promote parent-child interactions that can reduce these disparities.
One of the parenting interventions they are studying – a program called the Video Interaction Project (VIP) – already has been shown to enhance parent-child interactions at the 6-month mark.
Now, it seems that the parenting program can have a long-term impact as well – and that continuing the interventions into the 3- to 5-year age group can have further, independent effects on parent-child interactions.
"Our new findings provide support for interventions based in pediatric primary care to enhance parenting in both the infant and toddler years and the preschool periods," Dr. Mendelsohn, a pediatric developmental behavioral health specialist, reported at the annual meeting of the Pediatric Academic Societies.
Enhancing parent-child interactions, he believes, should improve language and cognitive social-emotional development and ultimately promote school readiness and school performance. Poor children are exposed to 75% fewer words, he noted.
In the VIP program, a child development specialist videotapes the parent and child interacting together with a book or a toy either before or after routine primary care visits. The parent and specialist then watch the video together, with the specialist reinforcing positive interactions, offering suggestions for further interaction, and promoting parent self-reflection. VIP families also receive parenting pamphlets and learning materials at each visit.
The project has been developed in two phases, with VIP 0-3 covering children from birth through 3 years of age, and VIP 3-5 covering the preschool years and entailing increasingly rich play and literacy activities. All told, from birth through 5 years, about 15 VIP sessions take place for each participating family.
The research is part of the Bellevue Project for Early Language, Literacy, and Educational Success (BELLE Project). New mothers were enrolled during the postpartum period at Bellevue Hospital Center and randomized to VIP 0-3 or control; then at age 3 years, the VIP and control families were re-randomized to receive either additional VIP during ages 3-5 years or to control during that period. At 54 months, investigators performed single-blind assessments of parenting and child development.
Bellevue Hospital Center is a public hospital serving families of low socioeconomic status throughout New York City. The 450 mothers enrolled in BELLE are primarily first-generation Hispanic/Latino immigrants. All had singleton, full-term uncomplicated births and spoke English or Spanish as their primary language.
A prior published analysis of the cohort showed enhanced infant-parent interactions as reflected by significantly higher StimQ scores in the VIP 0-3 group at 6 months of age (Arch. Pediatr. Adolesc. Med. 2011;165:33-41). Another analysis at 33 months showed lower levels of parenting stress and a greater likelihood of normal cognitive development in VIP children (J. Dev. Behav. Pediatr. 2007;28:206-12).
The StimQ is an office-based survey developed by Dr. Mendelsohn and others at New York University (NYU) for measuring cognitive stimulation in the homes of young children. It is validated for use in low-socioeconomic populations whose primary language is English or Spanish.
The new 54-month analysis used adaptations of three StimQ-Preschool subscales: Parent Verbal Responsivity, Reading Activities, and Parent Involvement in Developmental Advance, the last of which measures the number of different interactional activities occurring between the caregiver and child that promote cognitive development.
At 54 months, VIP 0-3 was associated with significant increases in scores for parent verbal responsivity (8.98 vs. 7.95) and reading (24.91 vs. 23.75), but only a minimal increase in the score for teaching activities. VIP 3-5 was independently associated with significant increases in verbal responsivity (9.14 vs. 7.99) and teaching (13.18 vs. 12.04), with a trend toward enhancements in reading, Dr. Mendelsohn reported.
"Importantly, the effects were independent, suggesting additive impacts for those receiving interventions during both periods," he said.
Among the next steps in their research are comprehensive assessments in the first grade.
"We also need to work on replication and on understanding whether this is equally effective in other low-income groups," Dr. Mendelsohn said. "We need to build on this burgeoning science ... but we don’t want to just dilute and spread."
Dr. Alan L. Mendelsohn reported no disclosures. VIP has been funded by the National Institute of Child Health and Human Development, the Marks Family Foundation, the Tiger Foundation, Children of Bellevue, and KiDS of NYU.
AT THE PAS ANNUAL MEETING
Major Finding: A Video Interaction Project aimed at enhancing parent-child interactions during routine pediatric visits was associated with improved reading and parent verbal responsivity at 54 months for families who participated in VIP sessions starting at birth, and with improved parent teaching and verbal responsivity at 54 months for families who began participating in VIP sessions when children were 3 years old.
Data Source: The Bellevue Project, which randomized 450 consecutive low-income, at-risk mother-newborn dyads to primary care–based intervention or control arms.
Disclosures: Dr. Alan L. Mendelsohn reported no disclosures. VIP has been funded by the National Institute of Child Health and Human Development, the Marks Family Foundation, the Tiger Foundation, Children of Bellevue, and KiDS of NYU.
More than half of eligible girls don't get first HPV vaccine
WASHINGTON – Only about 40% of girls old enough to receive the HPV vaccine got the first dose during a year in which they were seen at least once in an urban community clinic, a study has shown.
The large cohort study also found that 53% of girls underwent a sexual health screening before initiating the HPV series, suggesting that many are already sexually active but unprotected, Dr. Annnika Hofstetter said at the annual meeting of the Pediatric Academic Societies.
The finding points out the importance of early education about HPV and sexual safety for both girls and parents, said Dr. Hofstetter of New York–Presbyterian Hospital.
"Even in settings with high HPV vaccine initiation rates, the series is often delayed," she said. "Promotion of early HPV vaccination consistent with [federal] guidelines is crucial."
Dr. Hofstetter examined the timing of the initial HPV vaccination in relation to age and sexual activity in 23,900 females aged 11-26 years. All had been seen at least once in any of 16 large urban health care clinics (family planning, ob.gyn., school-based health, pediatric, and family medicine). She divided the cohort into two subgroups: an age analysis of 10,489 who were 11-26 years old, and a sexual health screening analysis of 15,049 who were aged 11-19 years. The two subgroups add up to more that the total because there was overlap between them. The sexual health screening cohort included only girls who were getting the Pap smear and chlamydia test because they were considered to be sexually active.
Most of the cohort (78%) was Hispanic; 18% were black, and the rest were non-Hispanic whites. Most (72%) were also publicly insured; 23% had private insurance, and 5% had no health care coverage at all. Because all were at least 11 years old, all were eligible to receive the vaccine. If the vaccine wasn’t given during a visit, it was considered a "missed opportunity."
The first analysis included girls aged 11-26 years. It examined the age of first HPV vaccination in each year from 2007 to 2011. The percentage of girls who had at least the initial vaccination rose significantly over the study period, from about 35% in 2007 to 69% in 2011.
Vaccination rates were highest in the girls aged 11-12 and 13-17 years, but only about 40% of each group were vaccinated in each of the study years – leaving the other 60% unvaccinated.
When she compared the number of clinic visits with each girl’s immunization status, Dr. Hofstetter found a median of two to three missed vaccination opportunities for every year. About half of those who did get vaccinated had at least one missed opportunity before they got the first dose.
The second analysis examined sexual health screening – chlamydia testing and Pap smear – in relationship to vaccination timing. The tests were considered a proxy for sexual activity. Girls in this group were aged 11-19 years and had not yet been vaccinated.
More than half of this group (54%) had either a Pap smear (17%) or chlamydia test (37%). Of the chlamydia screens, 30% were negative and 7% were positive. Of the Pap smears, 11% were normal and 7% were abnormal.
During the discussion, a physician from Sweden said that some preschoolers in the country have been offered the series. "Giving it that early removes this entire question of prevaccination sexual activity," he said.
The study was partially funded by Merck. Dr. Hofstetter said she had no relevant financial disclosures.
WASHINGTON – Only about 40% of girls old enough to receive the HPV vaccine got the first dose during a year in which they were seen at least once in an urban community clinic, a study has shown.
The large cohort study also found that 53% of girls underwent a sexual health screening before initiating the HPV series, suggesting that many are already sexually active but unprotected, Dr. Annnika Hofstetter said at the annual meeting of the Pediatric Academic Societies.
The finding points out the importance of early education about HPV and sexual safety for both girls and parents, said Dr. Hofstetter of New York–Presbyterian Hospital.
"Even in settings with high HPV vaccine initiation rates, the series is often delayed," she said. "Promotion of early HPV vaccination consistent with [federal] guidelines is crucial."
Dr. Hofstetter examined the timing of the initial HPV vaccination in relation to age and sexual activity in 23,900 females aged 11-26 years. All had been seen at least once in any of 16 large urban health care clinics (family planning, ob.gyn., school-based health, pediatric, and family medicine). She divided the cohort into two subgroups: an age analysis of 10,489 who were 11-26 years old, and a sexual health screening analysis of 15,049 who were aged 11-19 years. The two subgroups add up to more that the total because there was overlap between them. The sexual health screening cohort included only girls who were getting the Pap smear and chlamydia test because they were considered to be sexually active.
Most of the cohort (78%) was Hispanic; 18% were black, and the rest were non-Hispanic whites. Most (72%) were also publicly insured; 23% had private insurance, and 5% had no health care coverage at all. Because all were at least 11 years old, all were eligible to receive the vaccine. If the vaccine wasn’t given during a visit, it was considered a "missed opportunity."
The first analysis included girls aged 11-26 years. It examined the age of first HPV vaccination in each year from 2007 to 2011. The percentage of girls who had at least the initial vaccination rose significantly over the study period, from about 35% in 2007 to 69% in 2011.
Vaccination rates were highest in the girls aged 11-12 and 13-17 years, but only about 40% of each group were vaccinated in each of the study years – leaving the other 60% unvaccinated.
When she compared the number of clinic visits with each girl’s immunization status, Dr. Hofstetter found a median of two to three missed vaccination opportunities for every year. About half of those who did get vaccinated had at least one missed opportunity before they got the first dose.
The second analysis examined sexual health screening – chlamydia testing and Pap smear – in relationship to vaccination timing. The tests were considered a proxy for sexual activity. Girls in this group were aged 11-19 years and had not yet been vaccinated.
More than half of this group (54%) had either a Pap smear (17%) or chlamydia test (37%). Of the chlamydia screens, 30% were negative and 7% were positive. Of the Pap smears, 11% were normal and 7% were abnormal.
During the discussion, a physician from Sweden said that some preschoolers in the country have been offered the series. "Giving it that early removes this entire question of prevaccination sexual activity," he said.
The study was partially funded by Merck. Dr. Hofstetter said she had no relevant financial disclosures.
WASHINGTON – Only about 40% of girls old enough to receive the HPV vaccine got the first dose during a year in which they were seen at least once in an urban community clinic, a study has shown.
The large cohort study also found that 53% of girls underwent a sexual health screening before initiating the HPV series, suggesting that many are already sexually active but unprotected, Dr. Annnika Hofstetter said at the annual meeting of the Pediatric Academic Societies.
The finding points out the importance of early education about HPV and sexual safety for both girls and parents, said Dr. Hofstetter of New York–Presbyterian Hospital.
"Even in settings with high HPV vaccine initiation rates, the series is often delayed," she said. "Promotion of early HPV vaccination consistent with [federal] guidelines is crucial."
Dr. Hofstetter examined the timing of the initial HPV vaccination in relation to age and sexual activity in 23,900 females aged 11-26 years. All had been seen at least once in any of 16 large urban health care clinics (family planning, ob.gyn., school-based health, pediatric, and family medicine). She divided the cohort into two subgroups: an age analysis of 10,489 who were 11-26 years old, and a sexual health screening analysis of 15,049 who were aged 11-19 years. The two subgroups add up to more that the total because there was overlap between them. The sexual health screening cohort included only girls who were getting the Pap smear and chlamydia test because they were considered to be sexually active.
Most of the cohort (78%) was Hispanic; 18% were black, and the rest were non-Hispanic whites. Most (72%) were also publicly insured; 23% had private insurance, and 5% had no health care coverage at all. Because all were at least 11 years old, all were eligible to receive the vaccine. If the vaccine wasn’t given during a visit, it was considered a "missed opportunity."
The first analysis included girls aged 11-26 years. It examined the age of first HPV vaccination in each year from 2007 to 2011. The percentage of girls who had at least the initial vaccination rose significantly over the study period, from about 35% in 2007 to 69% in 2011.
Vaccination rates were highest in the girls aged 11-12 and 13-17 years, but only about 40% of each group were vaccinated in each of the study years – leaving the other 60% unvaccinated.
When she compared the number of clinic visits with each girl’s immunization status, Dr. Hofstetter found a median of two to three missed vaccination opportunities for every year. About half of those who did get vaccinated had at least one missed opportunity before they got the first dose.
The second analysis examined sexual health screening – chlamydia testing and Pap smear – in relationship to vaccination timing. The tests were considered a proxy for sexual activity. Girls in this group were aged 11-19 years and had not yet been vaccinated.
More than half of this group (54%) had either a Pap smear (17%) or chlamydia test (37%). Of the chlamydia screens, 30% were negative and 7% were positive. Of the Pap smears, 11% were normal and 7% were abnormal.
During the discussion, a physician from Sweden said that some preschoolers in the country have been offered the series. "Giving it that early removes this entire question of prevaccination sexual activity," he said.
The study was partially funded by Merck. Dr. Hofstetter said she had no relevant financial disclosures.
AT THE PAS ANNUAL MEETING
Major finding: A comparison of the number of clinic visits with each girl’s HPV immunization status found a median of two to three missed vaccination opportunities for every year.
Data source: Two cohorts totaling 23,900 girls and women aged 11-26 years.
Disclosures: The study was partially funded by Merck. Dr. Hofstetter said she had no relevant financial disclosures.
Monotherapy as good as combo for kids with pneumonia
WASHINGTON – Beta-lactam monotherapy is likely to be just as effective as a combination of beta-lactam and macrolide therapy for the majority of children hospitalized with pneumonia, a study has shown.
A subanalysis of a large national study found no difference in the length of hospital stay for children with pneumonia, whether they had received ceftriaxone alone or in combination with azithromycin, Dr. Derek J. Williams said at the annual meeting of the Pediatric Academic Societies.
"This is an important finding, because we know that limiting antimicrobial use to the narrowest-spectrum agent for the shortest duration is imperative to slow the epidemic of antimicrobial resistance," said Dr. Williams, a pediatrician in the division of hospital medicine at Vanderbilt University, Nashville, Tenn.
His large retrospective study used data collected in the Etiology of Pneumonia in the Community (EPIC) study. Sponsored by the Centers for Disease Control and Prevention, EPIC now contains information on 1,496 children.
Dr. Williams’ study involved 941 children who were admitted to hospitals with presumed community-acquired pneumonia. Most of these (678) were treated with ceftriaxone alone; 263 received combination therapy with ceftriaxone and azithromycin.
There were some important baseline differences between the groups, Dr. Williams noted. Children in the combination group were significantly older than those in the monotherapy* group (median, 64 months vs. 19 months). They were also significantly more likely to have asthma (44% vs. 35%) or other high-risk comorbidities including cardiopulmonary, oncologic, or immunosuppressive conditions; hepatic or renal problems; metabolic or genetic issues; and neurodevelopmental disorders.
The median length of hospital stay was 64 hours in both groups. Neither an unadjusted nor adjusted analysis found any significant relationship between therapy type and length of stay.
A propensity score matching looked at the outcome in 190 children in each exposure group. It too found no significant relationships.
The results are in line with a national pediatric pneumonia treatment guideline, published in 2011 in Clinical Infectious Diseases (53:617-30),Dr. Williams said.
During discussion, however, he noted that the conclusions may be somewhat marred by the nature of the EPIC cohort. "Although more than 80% of EPIC children received antibiotics, a bacterial pathogen was identified in only 15%."
This prompted some comment from pediatric hospitalist Mark W. Shen of the Dell Children’s Medical Center of Central Texas, Austin.
"The EPIC study is probably one of our most robust studies looking at the etiology of community-acquired pneumonia in hospitalized kids," he said. "But it seems now that you could argue that potentially more than 85% of these could have a viral etiology for their disease. So that would make it exceedingly difficult to find any inherent differences in antibiotic treatment. Is there any gold standard for figuring out how we can assess the comparative effectiveness, if most of these cases could be viral?
"This is the big issue that we struggle with," said Dr. Williams. "How do we define bacterial pneumonia? Our methods for detecting viruses are far superior to those we use to detect bacteria. I think this is coming with biomarkers, but we are not there yet. I think we’re underestimating bacterial disease and coinfections, but I also think that retrospective data are just not as good as prospective. Until we are able to really define this, that’s going to be a difficult question to answer."
Dr. Shen was also an author on a poster at the meeting. His study found that the hospitalist changed or stopped antibiotics in 93% of children with pneumonia who were started on one during the emergency department visit. "Sixty percent of the time, we found that there was no difference in their outcomes," he said.
The EPIC study is funded by the Centers for Disease Control and Prevention. Dr. Williams said he had no relevant financial disclosures. Dr. Shen was listed in the program as having no financial disclosures.
*Correction, 6/26/13: An earlier version of this story misstated the type of therapy group in the description of the study.
WASHINGTON – Beta-lactam monotherapy is likely to be just as effective as a combination of beta-lactam and macrolide therapy for the majority of children hospitalized with pneumonia, a study has shown.
A subanalysis of a large national study found no difference in the length of hospital stay for children with pneumonia, whether they had received ceftriaxone alone or in combination with azithromycin, Dr. Derek J. Williams said at the annual meeting of the Pediatric Academic Societies.
"This is an important finding, because we know that limiting antimicrobial use to the narrowest-spectrum agent for the shortest duration is imperative to slow the epidemic of antimicrobial resistance," said Dr. Williams, a pediatrician in the division of hospital medicine at Vanderbilt University, Nashville, Tenn.
His large retrospective study used data collected in the Etiology of Pneumonia in the Community (EPIC) study. Sponsored by the Centers for Disease Control and Prevention, EPIC now contains information on 1,496 children.
Dr. Williams’ study involved 941 children who were admitted to hospitals with presumed community-acquired pneumonia. Most of these (678) were treated with ceftriaxone alone; 263 received combination therapy with ceftriaxone and azithromycin.
There were some important baseline differences between the groups, Dr. Williams noted. Children in the combination group were significantly older than those in the monotherapy* group (median, 64 months vs. 19 months). They were also significantly more likely to have asthma (44% vs. 35%) or other high-risk comorbidities including cardiopulmonary, oncologic, or immunosuppressive conditions; hepatic or renal problems; metabolic or genetic issues; and neurodevelopmental disorders.
The median length of hospital stay was 64 hours in both groups. Neither an unadjusted nor adjusted analysis found any significant relationship between therapy type and length of stay.
A propensity score matching looked at the outcome in 190 children in each exposure group. It too found no significant relationships.
The results are in line with a national pediatric pneumonia treatment guideline, published in 2011 in Clinical Infectious Diseases (53:617-30),Dr. Williams said.
During discussion, however, he noted that the conclusions may be somewhat marred by the nature of the EPIC cohort. "Although more than 80% of EPIC children received antibiotics, a bacterial pathogen was identified in only 15%."
This prompted some comment from pediatric hospitalist Mark W. Shen of the Dell Children’s Medical Center of Central Texas, Austin.
"The EPIC study is probably one of our most robust studies looking at the etiology of community-acquired pneumonia in hospitalized kids," he said. "But it seems now that you could argue that potentially more than 85% of these could have a viral etiology for their disease. So that would make it exceedingly difficult to find any inherent differences in antibiotic treatment. Is there any gold standard for figuring out how we can assess the comparative effectiveness, if most of these cases could be viral?
"This is the big issue that we struggle with," said Dr. Williams. "How do we define bacterial pneumonia? Our methods for detecting viruses are far superior to those we use to detect bacteria. I think this is coming with biomarkers, but we are not there yet. I think we’re underestimating bacterial disease and coinfections, but I also think that retrospective data are just not as good as prospective. Until we are able to really define this, that’s going to be a difficult question to answer."
Dr. Shen was also an author on a poster at the meeting. His study found that the hospitalist changed or stopped antibiotics in 93% of children with pneumonia who were started on one during the emergency department visit. "Sixty percent of the time, we found that there was no difference in their outcomes," he said.
The EPIC study is funded by the Centers for Disease Control and Prevention. Dr. Williams said he had no relevant financial disclosures. Dr. Shen was listed in the program as having no financial disclosures.
*Correction, 6/26/13: An earlier version of this story misstated the type of therapy group in the description of the study.
WASHINGTON – Beta-lactam monotherapy is likely to be just as effective as a combination of beta-lactam and macrolide therapy for the majority of children hospitalized with pneumonia, a study has shown.
A subanalysis of a large national study found no difference in the length of hospital stay for children with pneumonia, whether they had received ceftriaxone alone or in combination with azithromycin, Dr. Derek J. Williams said at the annual meeting of the Pediatric Academic Societies.
"This is an important finding, because we know that limiting antimicrobial use to the narrowest-spectrum agent for the shortest duration is imperative to slow the epidemic of antimicrobial resistance," said Dr. Williams, a pediatrician in the division of hospital medicine at Vanderbilt University, Nashville, Tenn.
His large retrospective study used data collected in the Etiology of Pneumonia in the Community (EPIC) study. Sponsored by the Centers for Disease Control and Prevention, EPIC now contains information on 1,496 children.
Dr. Williams’ study involved 941 children who were admitted to hospitals with presumed community-acquired pneumonia. Most of these (678) were treated with ceftriaxone alone; 263 received combination therapy with ceftriaxone and azithromycin.
There were some important baseline differences between the groups, Dr. Williams noted. Children in the combination group were significantly older than those in the monotherapy* group (median, 64 months vs. 19 months). They were also significantly more likely to have asthma (44% vs. 35%) or other high-risk comorbidities including cardiopulmonary, oncologic, or immunosuppressive conditions; hepatic or renal problems; metabolic or genetic issues; and neurodevelopmental disorders.
The median length of hospital stay was 64 hours in both groups. Neither an unadjusted nor adjusted analysis found any significant relationship between therapy type and length of stay.
A propensity score matching looked at the outcome in 190 children in each exposure group. It too found no significant relationships.
The results are in line with a national pediatric pneumonia treatment guideline, published in 2011 in Clinical Infectious Diseases (53:617-30),Dr. Williams said.
During discussion, however, he noted that the conclusions may be somewhat marred by the nature of the EPIC cohort. "Although more than 80% of EPIC children received antibiotics, a bacterial pathogen was identified in only 15%."
This prompted some comment from pediatric hospitalist Mark W. Shen of the Dell Children’s Medical Center of Central Texas, Austin.
"The EPIC study is probably one of our most robust studies looking at the etiology of community-acquired pneumonia in hospitalized kids," he said. "But it seems now that you could argue that potentially more than 85% of these could have a viral etiology for their disease. So that would make it exceedingly difficult to find any inherent differences in antibiotic treatment. Is there any gold standard for figuring out how we can assess the comparative effectiveness, if most of these cases could be viral?
"This is the big issue that we struggle with," said Dr. Williams. "How do we define bacterial pneumonia? Our methods for detecting viruses are far superior to those we use to detect bacteria. I think this is coming with biomarkers, but we are not there yet. I think we’re underestimating bacterial disease and coinfections, but I also think that retrospective data are just not as good as prospective. Until we are able to really define this, that’s going to be a difficult question to answer."
Dr. Shen was also an author on a poster at the meeting. His study found that the hospitalist changed or stopped antibiotics in 93% of children with pneumonia who were started on one during the emergency department visit. "Sixty percent of the time, we found that there was no difference in their outcomes," he said.
The EPIC study is funded by the Centers for Disease Control and Prevention. Dr. Williams said he had no relevant financial disclosures. Dr. Shen was listed in the program as having no financial disclosures.
*Correction, 6/26/13: An earlier version of this story misstated the type of therapy group in the description of the study.
AT THE PAS ANNUAL MEETING
Major finding: Whether treated with ceftriaxone alone or with a combination of ceftriaxone and azithromycin, children with community-acquired pneumonia stayed in the hospital a median of 64 hours.
Data source: A subanalysis involving 941 children in the EPIC study.
Disclosures: The EPIC study is funded by the Centers for Disease Control and Prevention. Dr. Williams said he had no relevant financial disclosures. Dr. Shen was listed in the program as having no financial disclosures.
Parents -not just teens-are distracted while driving
WASHINGTON – Teens and young adults are not the only ones who are distracted while driving. A survey of parents and caregivers shows they also are driving distracted – and putting their children at risk.
More than 600 parents and caregivers were surveyed while their children, aged 1-12 years, were being treated for any reason at one of two Michigan emergency rooms. They were asked how often they had engaged in any of 10 distracting behaviors – including talking on the phone, texting/surfing the Internet, using a navigation system, or reaching for the child or a toy – while driving with their child over the past month. Parents also were asked whether they had been in a motor vehicle collision.
Almost 90% of drivers reported engaging in at least one technology-related distraction while driving their child in the past month. Phone calls were most commonly reported; texts were least common. The median number of distractions checked off in the survey was four, reported Dr. Michelle L. Macy at the annual meeting of the Pediatric Academic Societies.
Drivers who reported engaging in distracting behaviors were more likely to report having ever been in a crash, said Dr. Macy, clinical lecturer in the departments of emergency medicine and pediatrics at the University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor.
Parents who disclosed using the phone – hand held or hands free – while driving were 2.6 times as likely to have reportedly been involved in a motor vehicle crash.
Dr. Macy reported that she had no disclosures. The research was funded by a grant from the Michigan Center for Advancing Safe Transportation throughout the Lifespan (M-CASTL). Dr. Macy also received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
WASHINGTON – Teens and young adults are not the only ones who are distracted while driving. A survey of parents and caregivers shows they also are driving distracted – and putting their children at risk.
More than 600 parents and caregivers were surveyed while their children, aged 1-12 years, were being treated for any reason at one of two Michigan emergency rooms. They were asked how often they had engaged in any of 10 distracting behaviors – including talking on the phone, texting/surfing the Internet, using a navigation system, or reaching for the child or a toy – while driving with their child over the past month. Parents also were asked whether they had been in a motor vehicle collision.
Almost 90% of drivers reported engaging in at least one technology-related distraction while driving their child in the past month. Phone calls were most commonly reported; texts were least common. The median number of distractions checked off in the survey was four, reported Dr. Michelle L. Macy at the annual meeting of the Pediatric Academic Societies.
Drivers who reported engaging in distracting behaviors were more likely to report having ever been in a crash, said Dr. Macy, clinical lecturer in the departments of emergency medicine and pediatrics at the University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor.
Parents who disclosed using the phone – hand held or hands free – while driving were 2.6 times as likely to have reportedly been involved in a motor vehicle crash.
Dr. Macy reported that she had no disclosures. The research was funded by a grant from the Michigan Center for Advancing Safe Transportation throughout the Lifespan (M-CASTL). Dr. Macy also received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
WASHINGTON – Teens and young adults are not the only ones who are distracted while driving. A survey of parents and caregivers shows they also are driving distracted – and putting their children at risk.
More than 600 parents and caregivers were surveyed while their children, aged 1-12 years, were being treated for any reason at one of two Michigan emergency rooms. They were asked how often they had engaged in any of 10 distracting behaviors – including talking on the phone, texting/surfing the Internet, using a navigation system, or reaching for the child or a toy – while driving with their child over the past month. Parents also were asked whether they had been in a motor vehicle collision.
Almost 90% of drivers reported engaging in at least one technology-related distraction while driving their child in the past month. Phone calls were most commonly reported; texts were least common. The median number of distractions checked off in the survey was four, reported Dr. Michelle L. Macy at the annual meeting of the Pediatric Academic Societies.
Drivers who reported engaging in distracting behaviors were more likely to report having ever been in a crash, said Dr. Macy, clinical lecturer in the departments of emergency medicine and pediatrics at the University of Michigan and C.S. Mott Children’s Hospital, Ann Arbor.
Parents who disclosed using the phone – hand held or hands free – while driving were 2.6 times as likely to have reportedly been involved in a motor vehicle crash.
Dr. Macy reported that she had no disclosures. The research was funded by a grant from the Michigan Center for Advancing Safe Transportation throughout the Lifespan (M-CASTL). Dr. Macy also received support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
AT THE PAS ANNUAL MEETING
Major finding: Almost 90% of parents who were surveyed engaged in at least one technology-related distraction while driving their child in the past month.
Data source: A survey of more than 600 parents and caregivers of children aged 1-12 years.
Disclosures: Dr. Macy reported that she had no disclosures. The research was funded by a grant from the Michigan Center for Advancing Safe Transportation Across the Lifespan. Dr. Macy also received support from the Eunice Kennedy Shriver National Institute for Child Health and Human Development.
Education not enough: Student attitudes on concussion are poor
WASHINGTON – Despite having knowledge of the symptoms and dangers of concussions, high school athletes are largely unwilling to report symptoms and abstain from play, according to a study of Cincinnati-area high school football players.
The vast majority of the athletes (91%) who responded to one of two surveys used in the study agreed with the statement, for instance, that it is "always or sometimes okay to play in a game with a concussion," reported Dr. Brit L. Anderson, a pediatric emergency fellow at Cincinnati Children’s Hospital Medical Center.
"High school football players are being successfully educated about concussions, from many important sources in their lives," Dr. Anderson reported at the annual meeting of the Pediatric Academic Societies. "Unfortunately, student knowledge does not translate into [safe] attitudes."
Of the 120 high school football players who participated in the study, 25% said they had suffered a concussion, and 70% said they had been taught about concussions. Most could identify the common signs and symptoms: Headache was identified by 93%, dizziness by 89%, difficulty remembering and sensitivity to light and sound by 78%, and difficulty concentrating by 76%. Only 53% correctly identified "feeling in a fog" as a symptom.
Almost all the athletes agreed that loss of consciousness is not a requirement for diagnosis of concussion (93%), and that one is at risk of serious injury or death if a second concussion occurs before the first is healed (92%). Many of the students (77%) also knew that an athlete who has had one concussion is more likely to sustain another.
Despite this knowledge, only 54% said they would always or sometimes report concussion symptoms to their coach, 53% said they would continue to play with a headache sustained in play, and 22% responded that "an athlete with a concussion has a responsibility to play in an important game," Dr. Anderson reported.
Dr. Anderson and her colleagues administered one of two similar validated surveys to the athletes to measure their knowledge and their attitudes about reporting symptoms and returning to play; most of the responses were pooled. The surveys were conducted on the first day of a football camp that drew athletes – largely upper-classmen – from local competitive high school football programs.
A mean knowledge and attitude score for each survey was calculated, and athletes with scores above and below the means were compared. There was no significant association between the mean knowledge score and the mean attitude score, nor between the mean attitude score and a history of previous concussion or recent concussion education.
There was a significant association, however, between the mean knowledge score and grade level, with the 9th graders (who comprised just 9% of the survey participants) having significantly lower scores than did the 10th, 11th, and 12th-graders, Dr. Anderson noted.
Notably, in response to one of the surveys, 91% indicated they would play a game with a concussion and 75% said they would "play through any injury in order for their team to win," she said.
Students were asked in the study to list who taught them about concussions; responses were equally divided between families, teachers, coaches, high school athletic trainers, and physicians, she noted.
Dr. Anderson reported that she had no relevant disclosures.
The findings raise the question of how effectively we are educating teenagers about the dangers of concussions. It is apparent that much more research needs to be done.
As physicians we must continue to educate all children and adolescents when they come in for sports physicals and check-ups about the symptoms and dangers of concussions. We need to utilize a multimodal approach – not only talking with our patients and their parents, but also giving them written information and even watching short video clips in which teens talk about the consequences of unreported, untreated concussions. In our practice, we share with many adolescents a Centers for Disease Control and Prevention–produced video called "Keeping Quiet Can Keep You Out of the Game."
It is estimated that only 40% of high schools in the United States have an athletic trainer, and in these communities, pediatricians play an especially important role. But even in areas where high school trainers are educating their student-athletes about concussions, physicians still need to play an active role in educating these teens as well as other children and teens in their practices and their communities. Young athletes and their parents must appreciate that a concussion is not just a ding to the head, or a bump, or a bruise. It is a serious injury that needs to be recognized, diagnosed, and treated properly. Too many concussions go unrecognized and untreated.
The most important element of treatment is cognitive and physical rest immediately afterward with careful monitoring when activities are resumed. In this light, the American Academy of Pediatrics will soon be releasing a "Return to Learn" paper on helping young athletes ease back into school properly after suffering concussions.
Dr. Joel Brenner chairs the American Academy of Pediatrics Council on Sports Medicine and Fitness and is the medical director of the sports medicine program at Children’s Hospital of the King’s Daughters in Norfolk, Va.
The findings raise the question of how effectively we are educating teenagers about the dangers of concussions. It is apparent that much more research needs to be done.
As physicians we must continue to educate all children and adolescents when they come in for sports physicals and check-ups about the symptoms and dangers of concussions. We need to utilize a multimodal approach – not only talking with our patients and their parents, but also giving them written information and even watching short video clips in which teens talk about the consequences of unreported, untreated concussions. In our practice, we share with many adolescents a Centers for Disease Control and Prevention–produced video called "Keeping Quiet Can Keep You Out of the Game."
It is estimated that only 40% of high schools in the United States have an athletic trainer, and in these communities, pediatricians play an especially important role. But even in areas where high school trainers are educating their student-athletes about concussions, physicians still need to play an active role in educating these teens as well as other children and teens in their practices and their communities. Young athletes and their parents must appreciate that a concussion is not just a ding to the head, or a bump, or a bruise. It is a serious injury that needs to be recognized, diagnosed, and treated properly. Too many concussions go unrecognized and untreated.
The most important element of treatment is cognitive and physical rest immediately afterward with careful monitoring when activities are resumed. In this light, the American Academy of Pediatrics will soon be releasing a "Return to Learn" paper on helping young athletes ease back into school properly after suffering concussions.
Dr. Joel Brenner chairs the American Academy of Pediatrics Council on Sports Medicine and Fitness and is the medical director of the sports medicine program at Children’s Hospital of the King’s Daughters in Norfolk, Va.
The findings raise the question of how effectively we are educating teenagers about the dangers of concussions. It is apparent that much more research needs to be done.
As physicians we must continue to educate all children and adolescents when they come in for sports physicals and check-ups about the symptoms and dangers of concussions. We need to utilize a multimodal approach – not only talking with our patients and their parents, but also giving them written information and even watching short video clips in which teens talk about the consequences of unreported, untreated concussions. In our practice, we share with many adolescents a Centers for Disease Control and Prevention–produced video called "Keeping Quiet Can Keep You Out of the Game."
It is estimated that only 40% of high schools in the United States have an athletic trainer, and in these communities, pediatricians play an especially important role. But even in areas where high school trainers are educating their student-athletes about concussions, physicians still need to play an active role in educating these teens as well as other children and teens in their practices and their communities. Young athletes and their parents must appreciate that a concussion is not just a ding to the head, or a bump, or a bruise. It is a serious injury that needs to be recognized, diagnosed, and treated properly. Too many concussions go unrecognized and untreated.
The most important element of treatment is cognitive and physical rest immediately afterward with careful monitoring when activities are resumed. In this light, the American Academy of Pediatrics will soon be releasing a "Return to Learn" paper on helping young athletes ease back into school properly after suffering concussions.
Dr. Joel Brenner chairs the American Academy of Pediatrics Council on Sports Medicine and Fitness and is the medical director of the sports medicine program at Children’s Hospital of the King’s Daughters in Norfolk, Va.
WASHINGTON – Despite having knowledge of the symptoms and dangers of concussions, high school athletes are largely unwilling to report symptoms and abstain from play, according to a study of Cincinnati-area high school football players.
The vast majority of the athletes (91%) who responded to one of two surveys used in the study agreed with the statement, for instance, that it is "always or sometimes okay to play in a game with a concussion," reported Dr. Brit L. Anderson, a pediatric emergency fellow at Cincinnati Children’s Hospital Medical Center.
"High school football players are being successfully educated about concussions, from many important sources in their lives," Dr. Anderson reported at the annual meeting of the Pediatric Academic Societies. "Unfortunately, student knowledge does not translate into [safe] attitudes."
Of the 120 high school football players who participated in the study, 25% said they had suffered a concussion, and 70% said they had been taught about concussions. Most could identify the common signs and symptoms: Headache was identified by 93%, dizziness by 89%, difficulty remembering and sensitivity to light and sound by 78%, and difficulty concentrating by 76%. Only 53% correctly identified "feeling in a fog" as a symptom.
Almost all the athletes agreed that loss of consciousness is not a requirement for diagnosis of concussion (93%), and that one is at risk of serious injury or death if a second concussion occurs before the first is healed (92%). Many of the students (77%) also knew that an athlete who has had one concussion is more likely to sustain another.
Despite this knowledge, only 54% said they would always or sometimes report concussion symptoms to their coach, 53% said they would continue to play with a headache sustained in play, and 22% responded that "an athlete with a concussion has a responsibility to play in an important game," Dr. Anderson reported.
Dr. Anderson and her colleagues administered one of two similar validated surveys to the athletes to measure their knowledge and their attitudes about reporting symptoms and returning to play; most of the responses were pooled. The surveys were conducted on the first day of a football camp that drew athletes – largely upper-classmen – from local competitive high school football programs.
A mean knowledge and attitude score for each survey was calculated, and athletes with scores above and below the means were compared. There was no significant association between the mean knowledge score and the mean attitude score, nor between the mean attitude score and a history of previous concussion or recent concussion education.
There was a significant association, however, between the mean knowledge score and grade level, with the 9th graders (who comprised just 9% of the survey participants) having significantly lower scores than did the 10th, 11th, and 12th-graders, Dr. Anderson noted.
Notably, in response to one of the surveys, 91% indicated they would play a game with a concussion and 75% said they would "play through any injury in order for their team to win," she said.
Students were asked in the study to list who taught them about concussions; responses were equally divided between families, teachers, coaches, high school athletic trainers, and physicians, she noted.
Dr. Anderson reported that she had no relevant disclosures.
WASHINGTON – Despite having knowledge of the symptoms and dangers of concussions, high school athletes are largely unwilling to report symptoms and abstain from play, according to a study of Cincinnati-area high school football players.
The vast majority of the athletes (91%) who responded to one of two surveys used in the study agreed with the statement, for instance, that it is "always or sometimes okay to play in a game with a concussion," reported Dr. Brit L. Anderson, a pediatric emergency fellow at Cincinnati Children’s Hospital Medical Center.
"High school football players are being successfully educated about concussions, from many important sources in their lives," Dr. Anderson reported at the annual meeting of the Pediatric Academic Societies. "Unfortunately, student knowledge does not translate into [safe] attitudes."
Of the 120 high school football players who participated in the study, 25% said they had suffered a concussion, and 70% said they had been taught about concussions. Most could identify the common signs and symptoms: Headache was identified by 93%, dizziness by 89%, difficulty remembering and sensitivity to light and sound by 78%, and difficulty concentrating by 76%. Only 53% correctly identified "feeling in a fog" as a symptom.
Almost all the athletes agreed that loss of consciousness is not a requirement for diagnosis of concussion (93%), and that one is at risk of serious injury or death if a second concussion occurs before the first is healed (92%). Many of the students (77%) also knew that an athlete who has had one concussion is more likely to sustain another.
Despite this knowledge, only 54% said they would always or sometimes report concussion symptoms to their coach, 53% said they would continue to play with a headache sustained in play, and 22% responded that "an athlete with a concussion has a responsibility to play in an important game," Dr. Anderson reported.
Dr. Anderson and her colleagues administered one of two similar validated surveys to the athletes to measure their knowledge and their attitudes about reporting symptoms and returning to play; most of the responses were pooled. The surveys were conducted on the first day of a football camp that drew athletes – largely upper-classmen – from local competitive high school football programs.
A mean knowledge and attitude score for each survey was calculated, and athletes with scores above and below the means were compared. There was no significant association between the mean knowledge score and the mean attitude score, nor between the mean attitude score and a history of previous concussion or recent concussion education.
There was a significant association, however, between the mean knowledge score and grade level, with the 9th graders (who comprised just 9% of the survey participants) having significantly lower scores than did the 10th, 11th, and 12th-graders, Dr. Anderson noted.
Notably, in response to one of the surveys, 91% indicated they would play a game with a concussion and 75% said they would "play through any injury in order for their team to win," she said.
Students were asked in the study to list who taught them about concussions; responses were equally divided between families, teachers, coaches, high school athletic trainers, and physicians, she noted.
Dr. Anderson reported that she had no relevant disclosures.
AT THE PAS ANNUAL MEETING
Major finding: Many of the 120 high school football players who participated in a survey-based study (70%) were knowledgeable about concussions, and most could identify common signs and symptoms, but only about half said that they would report symptoms to their coach, and 91% of respondents to one survey indicated they would play a game with a concussion.
Data source: Two validated surveys used to assess athletes’ knowledge and attitudes about concussion
Disclosures: Dr. Anderson reported that she had no relevant disclosures.
Video alleviates parents' vaccine concerns
WASHINGTON – A little bit of education can go a long way toward helping new parents understand the value of vaccines, according to Dr. Sarah E. Williams.
Parents who described themselves as worried about vaccine safety reported significantly greater confidence after they watched an 8-minute video about vaccine safety, she said at the annual meeting of the Pediatric Academic Societies.
Source: Vanderbilt University School of Medicine
"This is important because the study shows that it is possible to modify perceptions of vaccine-hesitant parents, which is likely the first step in the behavior change process," Dr. Williams said in an interview. "A larger sample size will be needed to see the actual change in vaccination rates."
Dr. Williams, a pediatrician who specializes in vaccinology and vaccine-preventable diseases at Vanderbilt University, Nashville, Tenn., conducted a randomized controlled trial of a vaccine education program in two pediatric offices. The study included parents of 2-week-old infants who were coming in for their first well-child check.
More than 450 parents completed the 15-item Parent Attitudes about Childhood Vaccines (PACV) survey, which examines parent behavior toward vaccines, their concerns about safety and efficacy, and other general questions about vaccines. Parents who scored 25 or higher were considered vaccine hesitant and invited to participate in the study; 369 agreed.
The control group received routine care and counseling. The intervention group received two short printed handouts and watched the video, which was narrated by Dr. Kathryn Edwards, professor of pediatrics at Vanderbilt. In it, Dr. Edwards touches on the safety of each of the infant vaccines; each discussion also includes a parent discussing his or her firsthand experience with an unvaccinated child falling seriously ill –or even dying.
The primary outcome was the change in PACV scores immediately after the video and at the 2-month well-child check. The secondary outcome was vaccine uptake.
Most of the parents (80%) were mothers; their mean age was 32 years. The majority were white (79%), and half reported an annual income of at least $75,000. The mean baseline PACV score was 28.
At the 2-month visit, the intervention group had a significant decrease in PACV score compared with the control group (median difference of 6.7). This finding remained significant after adjustment for baseline PACV score, race/ethnicity, and income.
There was not a significant between-group difference in on-time receipt of vaccines (control group, 82%; intervention group, 83%). However, Dr. Williams noted, the PACV scores in the intervention group remained stable from right after the video and reading until the 2-month visit. "This shows that brief education can improve vaccine attitudes in vaccine-hesitant parents and that these changes appear to be stable for at least 2 months."
She added that she is now developing a Web-based, interactive intervention that will allow parents to re-evaluate their feelings and ask their own questions. The project will continue to evolve along with public opinion about vaccines, she said.
"There’s a shifting hypothesis among these parents. As soon as we knock down one theory with research, another [one] crops up, so we need to have the opportunities to address these as they develop."
Dr. Williams said she had no relevant financial disclosures.
WASHINGTON – A little bit of education can go a long way toward helping new parents understand the value of vaccines, according to Dr. Sarah E. Williams.
Parents who described themselves as worried about vaccine safety reported significantly greater confidence after they watched an 8-minute video about vaccine safety, she said at the annual meeting of the Pediatric Academic Societies.
Source: Vanderbilt University School of Medicine
"This is important because the study shows that it is possible to modify perceptions of vaccine-hesitant parents, which is likely the first step in the behavior change process," Dr. Williams said in an interview. "A larger sample size will be needed to see the actual change in vaccination rates."
Dr. Williams, a pediatrician who specializes in vaccinology and vaccine-preventable diseases at Vanderbilt University, Nashville, Tenn., conducted a randomized controlled trial of a vaccine education program in two pediatric offices. The study included parents of 2-week-old infants who were coming in for their first well-child check.
More than 450 parents completed the 15-item Parent Attitudes about Childhood Vaccines (PACV) survey, which examines parent behavior toward vaccines, their concerns about safety and efficacy, and other general questions about vaccines. Parents who scored 25 or higher were considered vaccine hesitant and invited to participate in the study; 369 agreed.
The control group received routine care and counseling. The intervention group received two short printed handouts and watched the video, which was narrated by Dr. Kathryn Edwards, professor of pediatrics at Vanderbilt. In it, Dr. Edwards touches on the safety of each of the infant vaccines; each discussion also includes a parent discussing his or her firsthand experience with an unvaccinated child falling seriously ill –or even dying.
The primary outcome was the change in PACV scores immediately after the video and at the 2-month well-child check. The secondary outcome was vaccine uptake.
Most of the parents (80%) were mothers; their mean age was 32 years. The majority were white (79%), and half reported an annual income of at least $75,000. The mean baseline PACV score was 28.
At the 2-month visit, the intervention group had a significant decrease in PACV score compared with the control group (median difference of 6.7). This finding remained significant after adjustment for baseline PACV score, race/ethnicity, and income.
There was not a significant between-group difference in on-time receipt of vaccines (control group, 82%; intervention group, 83%). However, Dr. Williams noted, the PACV scores in the intervention group remained stable from right after the video and reading until the 2-month visit. "This shows that brief education can improve vaccine attitudes in vaccine-hesitant parents and that these changes appear to be stable for at least 2 months."
She added that she is now developing a Web-based, interactive intervention that will allow parents to re-evaluate their feelings and ask their own questions. The project will continue to evolve along with public opinion about vaccines, she said.
"There’s a shifting hypothesis among these parents. As soon as we knock down one theory with research, another [one] crops up, so we need to have the opportunities to address these as they develop."
Dr. Williams said she had no relevant financial disclosures.
WASHINGTON – A little bit of education can go a long way toward helping new parents understand the value of vaccines, according to Dr. Sarah E. Williams.
Parents who described themselves as worried about vaccine safety reported significantly greater confidence after they watched an 8-minute video about vaccine safety, she said at the annual meeting of the Pediatric Academic Societies.
Source: Vanderbilt University School of Medicine
"This is important because the study shows that it is possible to modify perceptions of vaccine-hesitant parents, which is likely the first step in the behavior change process," Dr. Williams said in an interview. "A larger sample size will be needed to see the actual change in vaccination rates."
Dr. Williams, a pediatrician who specializes in vaccinology and vaccine-preventable diseases at Vanderbilt University, Nashville, Tenn., conducted a randomized controlled trial of a vaccine education program in two pediatric offices. The study included parents of 2-week-old infants who were coming in for their first well-child check.
More than 450 parents completed the 15-item Parent Attitudes about Childhood Vaccines (PACV) survey, which examines parent behavior toward vaccines, their concerns about safety and efficacy, and other general questions about vaccines. Parents who scored 25 or higher were considered vaccine hesitant and invited to participate in the study; 369 agreed.
The control group received routine care and counseling. The intervention group received two short printed handouts and watched the video, which was narrated by Dr. Kathryn Edwards, professor of pediatrics at Vanderbilt. In it, Dr. Edwards touches on the safety of each of the infant vaccines; each discussion also includes a parent discussing his or her firsthand experience with an unvaccinated child falling seriously ill –or even dying.
The primary outcome was the change in PACV scores immediately after the video and at the 2-month well-child check. The secondary outcome was vaccine uptake.
Most of the parents (80%) were mothers; their mean age was 32 years. The majority were white (79%), and half reported an annual income of at least $75,000. The mean baseline PACV score was 28.
At the 2-month visit, the intervention group had a significant decrease in PACV score compared with the control group (median difference of 6.7). This finding remained significant after adjustment for baseline PACV score, race/ethnicity, and income.
There was not a significant between-group difference in on-time receipt of vaccines (control group, 82%; intervention group, 83%). However, Dr. Williams noted, the PACV scores in the intervention group remained stable from right after the video and reading until the 2-month visit. "This shows that brief education can improve vaccine attitudes in vaccine-hesitant parents and that these changes appear to be stable for at least 2 months."
She added that she is now developing a Web-based, interactive intervention that will allow parents to re-evaluate their feelings and ask their own questions. The project will continue to evolve along with public opinion about vaccines, she said.
"There’s a shifting hypothesis among these parents. As soon as we knock down one theory with research, another [one] crops up, so we need to have the opportunities to address these as they develop."
Dr. Williams said she had no relevant financial disclosures.
AT THE PAS ANNUAL MEETING
Major finding: A short educational video increased parent confidence in the safety and value of vaccines by nearly 7 points – a significant improvement.
Data source: A randomized controlled trial that included 369 parents of newborns.
Disclosures: Dr. Williams said she had no relevant financial disclosures.
Computer prompt boosts flu vaccine rates
WASHINGTON – A pop-up on children’s electronic medical records was enough of a reminder to significantly increase influenza vaccine coverage in four large urban clinics, according to Dr. Melissa S. Stockwell.
"FluAlert" was built into the electronic medical record system and synchronized with the New York City vaccine registry. When it was activated during the winter flu season, children were 9% more likely to be fully vaccinated for influenza than when the reminder system wasn’t engaged, she said at the annual meeting of the Pediatric Academic Societies.
In addition to prompting physicians to vaccinate, the program allowed them to document reasons that the vaccine wasn’t given – a particularly valuable feature, said Dr. Stockwell, a pediatrician who is medical director of the New York–Presbyterian Hospital immunization registry.
"In this world of core measures, documentation of why a child is not vaccinated is becoming increasingly important," she said.
FluAlert was designed based on provider and parent focus groups, and implemented at four urban, community clinics that serve a primarily low-income Hispanic population. When the child’s electronic medical record opens, a FluAlert box appears at the upper-right-hand corner of the screen. The program searches both the provider registry and the larger vaccination registry and displays the vaccination status as having received no vaccine, having received one vaccine, or up to date. It asks, "Do you want to order the flu vaccine today?"
"Our providers wanted the alert to show up early in the visit, when the child’s record is opened, in order to integrate it into conversation with the parent," Dr. Stockwell said. "Doctors can ignore the message, order the vaccine, or document any reason why it wasn’t given. It’s not a forced action."
The alert also offers a look at the child’s overall immunization status, with the opportunity to order those vaccines. A "more info" button offers talking points that can be incorporated into a discussion about the importance of vaccinations.
The program was tested in a randomized study, with each clinic having an on and off period in two flu season phases (October through December and January through February).
When FluAlert was on, it fired for 8,630 visits, identifying the 62% of children who were not up to date on the vaccine. Most of those alerts (77%) came up during well-child and adolescent visits; 16% were acute care visits, 7% were visits specifically for vaccination, and the remaining visits were for Women, Infants, and Children program assessments. Providers acted on the alert 82% of the time: 53% ordered the vaccine. When they did not order the vaccine, providers noted the reason 98% of the time.
Overall, non–up-to-date children who were seen when FluAlert was on were 9% more likely to receive vaccine than children seen during an "off" period.
The program was also associated with significantly more documentation about why a child who needed the flu shot didn’t get it. In total, 625 children left the visit unvaccinated. When FluAlert was on, the reason for not vaccinating was noted for 68%; when it was off, documentation was present for only 41%.
The alert’s relative unobtrusiveness is probably one reason it was embraced as well as it was, Dr. Stockwell added. "What really annoys people is if something pops up and you can’t do anything else until you go through the entire process. So having it sit there as a gentle reminder is more appealing than something that’s always flashing and telling providers what to do."
Dr. Stockwell said she had no relevant financial disclosures
WASHINGTON – A pop-up on children’s electronic medical records was enough of a reminder to significantly increase influenza vaccine coverage in four large urban clinics, according to Dr. Melissa S. Stockwell.
"FluAlert" was built into the electronic medical record system and synchronized with the New York City vaccine registry. When it was activated during the winter flu season, children were 9% more likely to be fully vaccinated for influenza than when the reminder system wasn’t engaged, she said at the annual meeting of the Pediatric Academic Societies.
In addition to prompting physicians to vaccinate, the program allowed them to document reasons that the vaccine wasn’t given – a particularly valuable feature, said Dr. Stockwell, a pediatrician who is medical director of the New York–Presbyterian Hospital immunization registry.
"In this world of core measures, documentation of why a child is not vaccinated is becoming increasingly important," she said.
FluAlert was designed based on provider and parent focus groups, and implemented at four urban, community clinics that serve a primarily low-income Hispanic population. When the child’s electronic medical record opens, a FluAlert box appears at the upper-right-hand corner of the screen. The program searches both the provider registry and the larger vaccination registry and displays the vaccination status as having received no vaccine, having received one vaccine, or up to date. It asks, "Do you want to order the flu vaccine today?"
"Our providers wanted the alert to show up early in the visit, when the child’s record is opened, in order to integrate it into conversation with the parent," Dr. Stockwell said. "Doctors can ignore the message, order the vaccine, or document any reason why it wasn’t given. It’s not a forced action."
The alert also offers a look at the child’s overall immunization status, with the opportunity to order those vaccines. A "more info" button offers talking points that can be incorporated into a discussion about the importance of vaccinations.
The program was tested in a randomized study, with each clinic having an on and off period in two flu season phases (October through December and January through February).
When FluAlert was on, it fired for 8,630 visits, identifying the 62% of children who were not up to date on the vaccine. Most of those alerts (77%) came up during well-child and adolescent visits; 16% were acute care visits, 7% were visits specifically for vaccination, and the remaining visits were for Women, Infants, and Children program assessments. Providers acted on the alert 82% of the time: 53% ordered the vaccine. When they did not order the vaccine, providers noted the reason 98% of the time.
Overall, non–up-to-date children who were seen when FluAlert was on were 9% more likely to receive vaccine than children seen during an "off" period.
The program was also associated with significantly more documentation about why a child who needed the flu shot didn’t get it. In total, 625 children left the visit unvaccinated. When FluAlert was on, the reason for not vaccinating was noted for 68%; when it was off, documentation was present for only 41%.
The alert’s relative unobtrusiveness is probably one reason it was embraced as well as it was, Dr. Stockwell added. "What really annoys people is if something pops up and you can’t do anything else until you go through the entire process. So having it sit there as a gentle reminder is more appealing than something that’s always flashing and telling providers what to do."
Dr. Stockwell said she had no relevant financial disclosures
WASHINGTON – A pop-up on children’s electronic medical records was enough of a reminder to significantly increase influenza vaccine coverage in four large urban clinics, according to Dr. Melissa S. Stockwell.
"FluAlert" was built into the electronic medical record system and synchronized with the New York City vaccine registry. When it was activated during the winter flu season, children were 9% more likely to be fully vaccinated for influenza than when the reminder system wasn’t engaged, she said at the annual meeting of the Pediatric Academic Societies.
In addition to prompting physicians to vaccinate, the program allowed them to document reasons that the vaccine wasn’t given – a particularly valuable feature, said Dr. Stockwell, a pediatrician who is medical director of the New York–Presbyterian Hospital immunization registry.
"In this world of core measures, documentation of why a child is not vaccinated is becoming increasingly important," she said.
FluAlert was designed based on provider and parent focus groups, and implemented at four urban, community clinics that serve a primarily low-income Hispanic population. When the child’s electronic medical record opens, a FluAlert box appears at the upper-right-hand corner of the screen. The program searches both the provider registry and the larger vaccination registry and displays the vaccination status as having received no vaccine, having received one vaccine, or up to date. It asks, "Do you want to order the flu vaccine today?"
"Our providers wanted the alert to show up early in the visit, when the child’s record is opened, in order to integrate it into conversation with the parent," Dr. Stockwell said. "Doctors can ignore the message, order the vaccine, or document any reason why it wasn’t given. It’s not a forced action."
The alert also offers a look at the child’s overall immunization status, with the opportunity to order those vaccines. A "more info" button offers talking points that can be incorporated into a discussion about the importance of vaccinations.
The program was tested in a randomized study, with each clinic having an on and off period in two flu season phases (October through December and January through February).
When FluAlert was on, it fired for 8,630 visits, identifying the 62% of children who were not up to date on the vaccine. Most of those alerts (77%) came up during well-child and adolescent visits; 16% were acute care visits, 7% were visits specifically for vaccination, and the remaining visits were for Women, Infants, and Children program assessments. Providers acted on the alert 82% of the time: 53% ordered the vaccine. When they did not order the vaccine, providers noted the reason 98% of the time.
Overall, non–up-to-date children who were seen when FluAlert was on were 9% more likely to receive vaccine than children seen during an "off" period.
The program was also associated with significantly more documentation about why a child who needed the flu shot didn’t get it. In total, 625 children left the visit unvaccinated. When FluAlert was on, the reason for not vaccinating was noted for 68%; when it was off, documentation was present for only 41%.
The alert’s relative unobtrusiveness is probably one reason it was embraced as well as it was, Dr. Stockwell added. "What really annoys people is if something pops up and you can’t do anything else until you go through the entire process. So having it sit there as a gentle reminder is more appealing than something that’s always flashing and telling providers what to do."
Dr. Stockwell said she had no relevant financial disclosures
AT THE PAS ANNUAL MEETING
Major finding: A pop-up computer reminder resulted in children being 9% more likely to receive flu vaccine than those whose electronic medical record didn’t have the system.
Data source: FluAlert reminder system, piloted in four large urban community clinics.
Disclosures: Dr. Stockwell said he had no relevant financial disclosures.
Driving after marijuana use common among older teens
WASHINGTON – Driving after marijuana use was common among college students at two large public universities who were randomly selected for phone interviews.
"Driving after marijuana use was significantly more common than driving under the influence of alcohol in college-age students, and males were much more likely ... which is consistent with a lot of the data on injury risk," reported Jennifer Whitehill, Ph.D., a postdoctoral fellow at the Harborview Injury Prevention and Research Center at the University of Washington, Seattle.
Among current marijuana users – defined as those who had used marijuana in the past 28 days – 31% said they drove after using it and 45% rode with a driver who had used it. The prevalence rates were 44% and 51%, respectively, among males and 9% and 35% among females, she reported at the annual meeting of the Pediatric Academic Societies.
The findings are especially important given new legislation that is likely to increase marijuana availability and further influence teens’ perception of risk.
The University of Washington, one of the two universities where the study took place, resides in one of two states that legalized the recreational use of marijuana in 2012. The study was conducted prior to passage of the law; continued research will provide "a good, natural longitudinal look" at attitudes and practices in light of the legislation, Dr. Whitehill said.
The literature thus far suggests a two- to threefold increase in crash risk for driving under the influence of marijuana, Dr. Whitehill said after the meeting.
One recent meta-analysis of information from nine prior studies showed that the risk of a crash was almost 2.7 times higher among marijuana users than nonusers (Epidemiol. Rev. 2012;34:65-72). Another review found an overall twofold increased risk, with risk estimates higher in studies of fatal collisions (BMJ 2012;344:e536).
However, the contribution of marijuana to the risk of crashes "can be a tricky thing to study and to isolate," she said, and research is attempting to determine the degree to which marijuana intoxication deteriorates driving performance.
Of 315 students who had just completed their freshman year, alcohol use was much more prevalent than marijuana use, as was expected – 65% said they had used alcohol in the past 28 days, compared with 21% who reported having used marijuana. Alcohol users were less likely to drive under the influence, however: 12% of males and 3% of females said they drove after drinking. More of the students – 21% of males and 12% of females – reported riding with a driver who had just consumed alcohol.
Researchers attempted to identify possible predictors and risk factors for impaired driving. They found that students who drove after marijuana use were 5.2 times as likely to have also been a passenger of a marijuana-using driver, and 2.5 times as likely to have also driven after alcohol use, as students who did not drive after using marijuana.
A younger age at the first use of marijuana was associated with a lower risk of driving under the influence of marijuana.
Students also were asked about their nonmedical use of stimulants and other prescription drugs. Four percent –a "relatively rare" prevalence – reported recent nonmedical prescription drug use, of which 11% said they drove after use, Dr. Whitehill reported.
The study did not measure the time between substance use and driving, she noted.
Dr. Whitehill reported that she had no relevant financial disclosures.
WASHINGTON – Driving after marijuana use was common among college students at two large public universities who were randomly selected for phone interviews.
"Driving after marijuana use was significantly more common than driving under the influence of alcohol in college-age students, and males were much more likely ... which is consistent with a lot of the data on injury risk," reported Jennifer Whitehill, Ph.D., a postdoctoral fellow at the Harborview Injury Prevention and Research Center at the University of Washington, Seattle.
Among current marijuana users – defined as those who had used marijuana in the past 28 days – 31% said they drove after using it and 45% rode with a driver who had used it. The prevalence rates were 44% and 51%, respectively, among males and 9% and 35% among females, she reported at the annual meeting of the Pediatric Academic Societies.
The findings are especially important given new legislation that is likely to increase marijuana availability and further influence teens’ perception of risk.
The University of Washington, one of the two universities where the study took place, resides in one of two states that legalized the recreational use of marijuana in 2012. The study was conducted prior to passage of the law; continued research will provide "a good, natural longitudinal look" at attitudes and practices in light of the legislation, Dr. Whitehill said.
The literature thus far suggests a two- to threefold increase in crash risk for driving under the influence of marijuana, Dr. Whitehill said after the meeting.
One recent meta-analysis of information from nine prior studies showed that the risk of a crash was almost 2.7 times higher among marijuana users than nonusers (Epidemiol. Rev. 2012;34:65-72). Another review found an overall twofold increased risk, with risk estimates higher in studies of fatal collisions (BMJ 2012;344:e536).
However, the contribution of marijuana to the risk of crashes "can be a tricky thing to study and to isolate," she said, and research is attempting to determine the degree to which marijuana intoxication deteriorates driving performance.
Of 315 students who had just completed their freshman year, alcohol use was much more prevalent than marijuana use, as was expected – 65% said they had used alcohol in the past 28 days, compared with 21% who reported having used marijuana. Alcohol users were less likely to drive under the influence, however: 12% of males and 3% of females said they drove after drinking. More of the students – 21% of males and 12% of females – reported riding with a driver who had just consumed alcohol.
Researchers attempted to identify possible predictors and risk factors for impaired driving. They found that students who drove after marijuana use were 5.2 times as likely to have also been a passenger of a marijuana-using driver, and 2.5 times as likely to have also driven after alcohol use, as students who did not drive after using marijuana.
A younger age at the first use of marijuana was associated with a lower risk of driving under the influence of marijuana.
Students also were asked about their nonmedical use of stimulants and other prescription drugs. Four percent –a "relatively rare" prevalence – reported recent nonmedical prescription drug use, of which 11% said they drove after use, Dr. Whitehill reported.
The study did not measure the time between substance use and driving, she noted.
Dr. Whitehill reported that she had no relevant financial disclosures.
WASHINGTON – Driving after marijuana use was common among college students at two large public universities who were randomly selected for phone interviews.
"Driving after marijuana use was significantly more common than driving under the influence of alcohol in college-age students, and males were much more likely ... which is consistent with a lot of the data on injury risk," reported Jennifer Whitehill, Ph.D., a postdoctoral fellow at the Harborview Injury Prevention and Research Center at the University of Washington, Seattle.
Among current marijuana users – defined as those who had used marijuana in the past 28 days – 31% said they drove after using it and 45% rode with a driver who had used it. The prevalence rates were 44% and 51%, respectively, among males and 9% and 35% among females, she reported at the annual meeting of the Pediatric Academic Societies.
The findings are especially important given new legislation that is likely to increase marijuana availability and further influence teens’ perception of risk.
The University of Washington, one of the two universities where the study took place, resides in one of two states that legalized the recreational use of marijuana in 2012. The study was conducted prior to passage of the law; continued research will provide "a good, natural longitudinal look" at attitudes and practices in light of the legislation, Dr. Whitehill said.
The literature thus far suggests a two- to threefold increase in crash risk for driving under the influence of marijuana, Dr. Whitehill said after the meeting.
One recent meta-analysis of information from nine prior studies showed that the risk of a crash was almost 2.7 times higher among marijuana users than nonusers (Epidemiol. Rev. 2012;34:65-72). Another review found an overall twofold increased risk, with risk estimates higher in studies of fatal collisions (BMJ 2012;344:e536).
However, the contribution of marijuana to the risk of crashes "can be a tricky thing to study and to isolate," she said, and research is attempting to determine the degree to which marijuana intoxication deteriorates driving performance.
Of 315 students who had just completed their freshman year, alcohol use was much more prevalent than marijuana use, as was expected – 65% said they had used alcohol in the past 28 days, compared with 21% who reported having used marijuana. Alcohol users were less likely to drive under the influence, however: 12% of males and 3% of females said they drove after drinking. More of the students – 21% of males and 12% of females – reported riding with a driver who had just consumed alcohol.
Researchers attempted to identify possible predictors and risk factors for impaired driving. They found that students who drove after marijuana use were 5.2 times as likely to have also been a passenger of a marijuana-using driver, and 2.5 times as likely to have also driven after alcohol use, as students who did not drive after using marijuana.
A younger age at the first use of marijuana was associated with a lower risk of driving under the influence of marijuana.
Students also were asked about their nonmedical use of stimulants and other prescription drugs. Four percent –a "relatively rare" prevalence – reported recent nonmedical prescription drug use, of which 11% said they drove after use, Dr. Whitehill reported.
The study did not measure the time between substance use and driving, she noted.
Dr. Whitehill reported that she had no relevant financial disclosures.
AT THE PAS ANNUAL MEETING
Major finding: Thirty-one percent of marijuana users drove after using the drug.
Data source: A survey study of 315 participants at two large universities.
Disclosures: Dr. Whitehill reported that she had no relevant financial disclosures.