Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children

ObjectiveTo describe vaccine attitudes among pediatric healthcare providers attending immunization conferences.Study designAttendees of 5 American Academy of Pediatrics (AAP)-sponsored vaccine conferences held between June and November 2013 anonymously completed a questionnaire assessing vaccine attitudes and practices prior to the opening of educational sessions. Pearson's chi-square tests and Fisher's exact tests were used to analyze associations between vaccine attitudes, vaccine practices and provider characteristics.Results680 providers attending AAP-sponsored vaccine conferences were included. 661/666 (99%) enrolled providers state they routinely recommend standard pediatric vaccines, yet, 30 (5%) state that they do not routinely recommend influenza and/or human papillomavirus (HPV) vaccines. These providers expressed vaccine safety (87/680 (13%)) and efficacy (21/680 (31%)) concerns and stated belief in vaccine misperceptions: vaccine causes autism (34/668, 5%), multiple vaccines at a single visit reduces vaccine efficacy (43/680, 6%) or overwhelms the immune system (63/680, 9%), and administering HPV vaccine will increase the likelihood of unprotected adolescent sexual activity (29/680, 4%). Six percent of providers who do not routinely recommend all pediatric vaccines correctly identified themselves as vaccine hesitant.ConclusionVaccine hesitancy is under-recognized among pediatric providers attending AAP-sponsored immunization conferences. Educational interventions tailored to address provider vaccine concerns are needed to improve provider vaccine confidence.     

Food Allergy: A Comprehensive Population-Based Cohort Study

Objective

To determine the incidence and temporal trends of food allergies.

Role of clinical suspicion in pediatric blunt trauma patients with severe mechanisms of injury

Objectives

In adult patients with blunt trauma, severe mechanism of injury leads to routine pan-computed tomography (CT). Due to concerns about the risk of radiation, we sought to determine whether clinical suspicion could identify children requiring radiographic imaging.

Chest pain as a manifestation of hypokalemia in a pediatric patient

Patients presenting to the emergency department with chest pain are common and a cause of significant concern to patients and families and physicians alike. The causes of chest pain are myriad. These causes span diverse categories including cardiovascular, respiratory, abdominal and gastrointestinal, musculoskeletal, psychiatric, hematologic and oncologic, and neurologic Thull-Freedman (2010) [1]. These diverse etiologies present a diagnostic and management challenge to the ER physician who is tasked to minimize unnecessary diagnostics while not missing any significant disease. Multiple reviews have discussed the various etiologies of chest pain in the pediatric patient presenting to the ER but none of these recent reviews has included hypokalemia as a cause of chest pain Talner and Carboni (2000), Cava and Sayger (2004), Ringstrom and Freedman (2006), Foy and Filippone (2015), Yeh and Yeh (2015) [2], [3], [4], [5], [6]. Additionally, no reviews of hypokalemia describe this condition presenting with chest pain (Mandal, 1997; Gennari, 2002; Medford-Davis and Rafique, 2014 [7], [8], [9]).This case report describes a pediatric patient who presents with chest pain that was attributed to hypokalemia. This report attempts to make practitioners aware that hypokalemia may present with chest pain and to encourage ER providers to include this in the differential diagnosis.     

分析我院儿科门诊用药现状促进临床合理用药

目的：分析我院儿科门诊用药现状,为促进临床合理用药提供建议。方法：从我院儿科门诊2014年1～3月开具的处方中随机抽取1250张进行研究,对儿科疾病构成比、处方用药分布及抗菌药使用情况进行归纳统计,明确儿科门诊中不合理用药情况。结果：我院儿科门诊疾病以上、下呼吸道感染为主,占61.0%（762/1250）;抗菌药物使用率为64.0%（800/1250）,其中三代头孢药物使用率占18.75%（150/800）;800张抗菌处方中,76%为口服中成药,使用率最高,12%为注射剂,均为单联用药。不合理用药以无指征滥用抗菌药物几率最高,达到31.0%,其次为选药不合理及重复用药。结论：我院儿科门诊用药做到中西药并重,抗菌药物使用率高,但给药途径相对合理,三代头孢抗菌药物选择占18.75%,用药起点偏高,易导致耐药菌,需引起注意。