More vaccines for children? Parents' views

AIM: To investigate parents' views regarding potential new vaccines. We examined attitudes towards severity of specific infections, acceptability of potential vaccines and preferences for the number of injections they would want their child to receive on any one occasion. DESIGN: Cross sectional survey. METHODS: Parents of children aged 18-24 months in three Primary Care Trusts in England were asked to complete a questionnaire. RESULTS: Of the 859 parents who responded (38%), over 90% believed that the vaccines currently on offer prevent disease always or almost always. Of those who rated meningitis as serious or very serious, 84% would accept a vaccine against meningococcal group B infection and 69% against pneumococcal infection. Only 34% of those who said their child would make a full recovery from chicken pox would accept a vaccine. Over half the respondents preferred new vaccines to be given separately. Fifty seven percent of parents would not want their child to have more than two injections per clinic visit. CONCLUSIONS: Parents' views on the severity of illness influence their acceptance of a new vaccine. Their preference for as few injections as possible at a single clinic visit needs to be reconciled with their concerns over the use of combination vaccines.     

How stable is medicaid coverage for children?

We examined Medicaid coverage patterns in five states for children who were covered as of December 2003. Looking back three years, we found that Medicaid was a source of continuous coverage for sizable proportions of children (43-66 percent were covered for two or more years) but a revolving door for others (16-41 percent had gaps). In all states, gaps were short, from two to four months. Continuity implies that states can demand more of the health care system to improve the quality of care; short gaps imply that policies and procedures should be revisited to reduce gaps for eligible children.     

Nutrition education for children—results and perspectives

Aim Recent scientific literature reveals a tremendous change in the health status of children and adolescents caused by malnutrition and changes in general lifestyle. Thus, the crucial value of a sustainable nutrition education has long been recognised as a major component of public health nutrition strategies. This paper describes a study that took several requirements for nutrition education programmes into account by developing and evaluating a new age-adapted version of an existing nutrition education programme.Methods The objective of the evaluation was to draw conclusions about the effects of the interventions success. A quasi-experimental field study design was utilised, arranging subjects into intervention, comparison and control groups. For each group, a pre- and post-test was assessed. Between the pre-test and post-test, a period of 4 months elapsed. In total, data from 616 children, 474 parents and 47 teachers were included in the evaluation.Results In general, all children in the intervention group (IG) across all ages showed a statistically significant improvement of general nutrition-related knowledge between the pre-test and post-test, which was measured in one section of the questionnaire. The comparison between intervention group (IG) and control group (CG) revealed significantly stronger improvement for the intervention group (IG). In comparison with the control group, the intervention group did not show any meaningful improvement in any of the five age groups. Parents, kindergarten-teachers and school teachers of all intervention groups reported serious changes for the health-conscious attitudes in children.Conclusion In summarising, the presented age-adapted nutrition education programme and its evaluation could show a clear improvement of nutrition-related knowledge and less clear improvements in nutrition-related attitudes and behavioural intentions. A sustainable prolongation of the programme could lead to even higher improvement.     

Dental group prophylaxis - for children only?

In Germany, caries in 12-year olds have declined by 70 % in the last decade. This was the result of a variety of preventive measures such as salt fluoridation, group related prevention in schools and kindergartens, and individualized preventive measures offered in dental offices. On a national scale, salt fluoridation seems to be the measure with the highest efficacy and efficiency. Firstly, it has the potential to reach the entire population, and secondly it is highly cost-effective. The cost-benefit ratio for salt fluoridation ranges from 25 to 80, e. g. for one Euro spent on prevention, 25 to 80 Euro can be saved in therapy. However, salt fluoridation alone cannot stop caries, and it is not at all effective in preventing gingivitis and periodontitis. Therefore, additional measures have to be taken. The cost-benefit ratio for group-related prevention ranges from 2.4 to 19.5 and for individualized prevention from 0.7 to 2.1. Besides the better cost-effectiveness, group-related prevention has the advantage of advanced target group attainment. For example, it is easy to reach children in schools whereas it is difficult to review them in a dental office. Therefore, group related-prevention should have priority. This should not be restricted to children and adolescents, seniors can also be attended in groups. In Germany, about 950,000 people live in old people's homes, and additionally about 570,000 people in nursing homes. This population often suffers from severe oral health problems such as caries, periodontitis, and diseases involving the mucosa. Taking into account that the number of elderly institutionalized people is increasing in Germany, the establishment of group-related prevention for this part of the population seems to be an important goal in health policy.     

Is Bacillus Calmette-Guerin revaccination necessary for Japanese children?

BACKGROUND: Bacillus Calmette-Guerin (BCG) revaccination has been implemented in Japan among tuberculin-negative first grade primary and first grade junior high school students for decades. Controversies regarding the effectiveness of BCG revaccination and low incidence of tuberculosis (TB) among Japanese children prompted this study. METHODS: Cost-effectiveness and cost-benefit analyses were conducted for a cohort of schoolchildren who underwent revaccination during 1996. The study population was a hypothetical cohort comprising 1.35 million first grade primary school and 1.51 million first grade junior high school students enrolled in 1996 at locations throughout Japan. Assuming 50% vaccine efficacy for revaccination, a 10-year duration of protection, and 5% annual discount rate, we calculated the total hypothetical number of TB cases averted, the cost and number of immunizations per TB case averted, and the benefit-cost ratio for the program. RESULTS: The revaccination program for 1996 schoolchildren cohort would prevent 296 TB cases over a 10-year period at a cost of US$ 108,378 per case averted. About 4,963 immunizations would be required to prevent one child from developing TB. The benefit-cost ratio remained at 0.13 with baseline assumptions and ranged from 0.05 to 0.29 and from 0.02 to 0.74 for one-way and two-way sensitivity analyses, respectively. CONCLUSION: BCG revaccination among schoolchildren is not supported by available scientific and economic data. Based on the results of this study, current BCG revaccination policies in Japan and other countries should be reexamined.     

Are trends in diabetes incidence changing for minority children?

PURPOSE: To contrast incidence rates and time trends of typical type 1 diabetes with non-autoimmune insulin-resistant type 2 diabetes in minority children (Early 2).METHODS: A population based registry of all insulin treated African-American and Hispanic children residing in Chicago, aged 0-17 years at onset, diagnosed between 1985-1994 provided data. Medical records were reviewed and abstracted (N = 739), and a subset of patients were interviewed (n = 195). Based on these data sources, cases were assigned to the early type 2 category if one or more of the following variables were present: notation of "atypical" or "possible type 2" diabetes in the medical record; obesity (defined as BMI >/= 27 (kg/m(2))) or acanthosis nigricans noted at diagnosis; a report by the patient of going off insulin six months after initial diagnosis without developing diabetic ketoacidosis; or reporting the use of oral hypoglycemic agents with or without insulin. The Chi-square test for homogeneity was used to determine differences between proportions of groups. Time trend analysis of incidence was done using regression models with the Poisson distribution.RESULTS: The 10-year average annual incidence rate was 10.3 per 100,000 population for typical type 1 diabetes (n = 565) and 3.2 per 100,000 for those with characteristics of early 2 diabetes (n = 174). Over the ten year interval the incidence rate remained static for typical type 1 diabetes. In the early 2 group there was a 9.0% average annual percent increase over the ten year interval (p < 0.01).CONCLUSIONS: The trends in incidence rates vary between typical type and early 2 diabetes. We hypothesize that this is associated with the increasing rate of obesity and a lack of physical activity in young people.     

Is day case tonsillectomy suitable for children in Cumbria?

Day case tonsillectomy has been advocated as a means of reducing health-care costs associated with in-patient care. The authors studied 74 consecutive children undergoing conventional overnight stay tonsillectomy using a parental questionnaire and a retrospective case note review. Medical exclusion criteria for day surgery were present in 21 per cent, and social exclusion criteria in 82 per cent. Overall, only 16 per cent of children satisfied all the criteria for suitability. On the day of surgery, 29 per cent of children were reported as having poorly controlled pain and 31 per cent as having nausea and vomiting, such that unplanned admission would have been likely had they been done as day cases. In total 63 per cent of parents were unhappy or very unhappy with the possibility of same day discharge. The authors do not plan to introduce day case tonsillectomy in Cumbria.     

Pandemic influenza planning for children and youth: Who's looking out for our kids ?

Recent worldwide attention on influenza pandemics has mainly focused on planning and preparation. Some published plans appear to have missed some unique considerations relevant to children and youth, leaving a serious and potentially devastating gap in our pandemic response. This paper highlights those unique considerations and encourages health administrators and policy-makers to rise to the challenge and demonstrate leadership by ensuring that all institutions consider children and youth in their pandemic planning.     

Food ads on TV: a health hazard for children?

OBJECTIVE: To examine the nutritional quality of food in television food advertisements that are targeted at children. METHOD: We videotaped 42 hours of children's programs and analysed the food advertisements' content and nutrient composition using the New Zealand Food Composition Database. RESULTS: Of 269 food advertisements, 63% were for foods 'high in fat and/or sugar'. Children who ate only the advertised foods would eat a diet too high in fat, saturated fat, protein, free sugars and sodium. Furthermore, their diets would have suboptimal levels of fibre and suboptimal intakes of a number of important micronutrients (depending on age), including magnesium, selenium and vitamin E. The food products advertised on this channel rarely included nutritious low-cost foods that are necessary for food security in low-income groups. There were also no food advertisements that included any of the healthy foods consumed by Maori and Pacific peoples. CONCLUSIONS: Food advertisements targeted at children generally reflect the dietary pattern associated with an increased risk of obesity and dental caries in childhood; and cardiovascular disease, diabetes and cancers in adulthood.     

Clinical inquiries. When should we screen children for hyperlipidemia?

Children should be screened for hyperlipidemia when there is a history of familial hypercholesterolemia (strength of recommendation [SOR]: C). No clear evidence supports screening all children or just those with family history of cardiovascular disease (CVD) or hyperlipidemia (SOR: C).