Parent's perception of respiratory syncytial virus and subsequent wheezing burden: A multi-country cross-sectional survey.

BACKGROUND: Respiratory Syncytial Virus (RSV) is the leading cause of hospitalization in infants. RSV bronchiolitis is associated with an increased risk of subsequent wheezing. We aimed to document the parents' perception of the link between RSV infection and subsequent wheezing, wheezing-related healthcare and family resources use, and its impact on family daily life. METHODS: This cross-sectional online survey enrolled 1200 parents with at least one child ≤6y living in the United States, United Kingdom, Spain, and Italy. Children diagnosed with RSV bronchiolitis before age of 2 years were included in the RSV group, and those never diagnosed with RSV bronchiolitis in the Reference group. RESULTS: The odds of wheezing were 4.5-fold (95%CI 3.5-5.9) higher in the RSV than in the Reference group. The odds increased to 7.7-fold (95%CI 5.4-11.1) among children who were hospitalized, and 9-fold (95%CI 5.1-16.6) among those admitted to pediatric intensive care with RSV bronchiolitis. Similar trends were observed across all countries. In total, 57% of parents reported their child's wheezing to have moderate to severe impact on their emotional well-being, and 53% on their daily life activities and/or social life. 64% of parents reported moderate-severe impact of wheezing on child's quality of sleep and 49% and 46% reported a moderate-severe impact on their children's emotional well-being and physical activities. CONCLUSIONS: This survey suggests an association between RSV infection and subsequent wheezing in children across different countries. Wheezing, especially in association with RSV infection, was associated with increased healthcare utilization and costs, and significantly impacted parents' and children daily life.

Social-Emotional Development of Toddlers: Randomized Controlled Trial of an Office-Based Intervention.

PURPOSE: During the toddler years, temper tantrums and impulsive behaviors are the norm. These behaviors can frustrate even the most experienced mothers. DESIGN AND METHODS: A prospective, double blind, randomized controlled trial using pre-test/post-test experimental design was used to examine the effectiveness of an office-based educational program to improve maternal confidence and the social-emotional development of toddlers. The Toddler Care Questionnaire (TCQ) was administered to all mothers as a pre and post intervention test. The treatment intervention was a videotaped (DVD) parenting skills intervention on the social-emotional development of toddlers and on maternal confidence in caring for toddlers. RESULTS: Sixty mothers and 60 toddlers entered the study with 29 mothertoddler dyads randomized to the treatment group and 31 to the control group. Twenty-six (26) mother-toddler dyads in the treatment and 25 mother-toddler dyads in the control group completed the study. Pairwise comparisons of adjusted means showed significant improvements for both toddler groups on the Brigance toddler screen, and no statistically significant difference in gains between the groups. The mixed model results for the TCQ showed an overall significant improvement from preto post-test, and a non-significant interaction between group and time indicting no significant difference in gains seen by treatment groups. CONCLUSIONS: Brief educational programs on DVD's are an efficient way to offer information to mothers while in the office waiting area. PRACTICE IMPLICATIONS: Pediatric nurses who encounter mothers who struggle with caring for their toddlers may find brief-office based interventions a valuable tool for educating parents.

Vaccine hesitancy: Not a new phenomenon, but a new threat.

Vaccines have been recognized as one of the top 10 public health achievements of the 20th century. In 1998, a study on the connection between measles, mumps, rubella vaccine and autism was published by the now discredited Andrew Wakefield. That study was retracted in 2010, but the damage was already done. The purpose of this article is to review the history of vaccine hesitancy and discuss a successful paradigm for speaking with vaccine-hesitant parents. Discussion of immunizations related to public health law and religious exemptions will also be reviewed.

Societal impact of combination vaccines: experiences of physicians, nurses, and parents.

Crowded immunization schedules can result in missed or delayed dosing. Combination vaccines help immunize children on time, limit the required number of injections, and allow new vaccines to be added to the schedule. In the United States, a pentavalent vaccine combining diphtheria, tetanus toxoids, and acellular pertussis (DTaP), recombinant hepatitis B (HepB), and inactivated poliovirus vaccine (IPV) is available. Here, we describe the findings of informal surveys among providers, nurse managers, business managers, and parents on their attitudes toward and experiences with the DTaP-HepB-IPV vaccine. Combination vaccine use is expected to increase as more become available and awareness of their benefits grows.

Hepatitis A: disease burden and current childhood vaccination strategies in the United States.

Hepatitis A can be a serious disease and represents a substantial health and economic burden. In recent years, a decline in the number of cases of hepatitis A has been observed, which has been attributed in part to the implementation of vaccination policies in states with high disease incidence. In May 2006, the Advisory Committee on Immunization Practices published updated recommendations to include routine hepatitis A vaccination for all children beginning at 12 to 23 months of age. In this review, information on hepatitis A disease burden is presented with a discussion on the new recommendations and implementation of hepatitis A vaccination.

Homecare issues in rotavirus gastroenteritis.

PURPOSE: This article will describe the burden of rotavirus gastroenteritis (RGE) and its management, highlighting educational issues that nurse practitioners can assist caregivers to enhance at-home management. DATA SOURCE: A Medline search of the medical literature was used to identify articles that describe the burden, clinical presentation, and management of RGE. CONCLUSIONS: RGE is a serious medical condition characterized by diarrhea and vomiting and is a major cause of morbidity and hospitalization among children aged 5 years or younger. Proper at-home treatment can be challenging; however, improved home care may limit emergency department visits and hospitalizations. IMPLICATIONS FOR PRACTICE: Mild to moderate RGE may be successfully managed at home if caregivers are adequately educated in deciding when a child needs to be evaluated in a physician's office and in managing dehydration at home.

Strengthening the supply of routinely recommended vaccines in the United States: recommendations from the National Vaccine Advisory Committee.

Between late 2000 and the spring of 2003, the United States experienced shortages of vaccines against 8 of 11 preventable diseases in children. In response, the Department of Health and Human Services requested that the National Vaccine Advisory Committee (NVAC) make recommendations on strengthening the supply of routinely recommended vaccines. The NVAC appointed a Working Group to identify potential causes of vaccine supply shortages, develop strategies to alleviate or prevent shortages, and enlist stakeholders to consider the applicability and feasibility of these strategies. The NVAC concluded that supply disruptions are likely to continue to occur. Strategies to be implemented in the immediate future include expansion of vaccine stockpiles, increased support for regulatory agencies, maintenance and strengthening of liability protections, improved communication among stakeholders, increased availability of public information, and a campaign to emphasize the benefits of vaccination. Strategies requiring further study include evaluation of appropriate financial incentives to manufacturers and streamlining the regulatory process without compromising safety or efficacy.

Communicating the benefits of combination vaccines to parents and health care providers.

Infants may receive as many as 5 separate injections at an office visit in order to comply with the 2002 childhood immunization schedule. Many parents and healthcare providers disagree with administering 4 or 5 injections at one visit, and therefore may delay some injections until another visit. This practice may lead to decreased compliance and can increase costs for the parent. New combination vaccines will help to simplify the immunization schedule, and health care providers will need to be able to address parental concerns regarding these vaccines. Nurses are often responsible for administering vaccines in the office setting, and therefore are also influential in deciding which vaccines should be ordered. The purpose of this article is to educate nurses on communicating the benefits of combination vaccines to parents and other healthcare providers.

Public health perspectives on the rising incidence of pertussis.

OBJECTIVES: Pertussis is one of the few vaccine-preventable diseases on the rise in the United States, particularly among adolescents. We analyzed the epidemiology of pertussis, focusing on disease burden in public health, and examined methods for controlling pertussis and reducing its incidence. DESIGN, SAMPLE, AND MEASUREMENTS: We evaluated current knowledge about pertussis, reported cases of pertussis in the United States, and the changing recognition, diagnosis, and management of the disease. The development of a pertussis vaccine, now licensed and recommended for use in adolescents and adults, was reviewed. RESULTS: Of reported cases in 2004, 38% occurred in adolescents. The increased incidence of pertussis may be the result of better diagnosis, better reporting, and increased awareness of the disease. The burden of adolescent and adult pertussis is significant and includes medical visits, laboratory tests, treatment for cases and contacts, time lost from school and work, disruption of schools experiencing outbreaks, and public health and media turmoil. At current disease rates, the financial cost of adolescent pertussis in this decade is projected at $3.2 billion. CONCLUSIONS: Efforts are needed to increase health care providers' knowledge of pertussis disease and vaccines, improve on-time infant immunization rates, promote immunization registries and public health surveillance, and ensure adequate compensation for vaccine purchase and administration. Universal recommendations for and widespread use of acellular pertussis vaccines in adolescents are the most effective measures in controlling the disease.