Acute otitis media and its prevention by immunization: a survey of Canadian pediatricians' knowledge, attitudes and beliefs.

INTRODUCTION: Acute otitis media (AOM) is one of the most common bacterial infectious diseases among children and is a leading cause of child healthcare visits and antibiotic prescriptions. Few vaccines have the potential to prevent AOM. The newer pneumococcal conjugate vaccines (PCV) offer a larger spectrum of protection against AOM, as well as preventing severe diseases. The main aim of this study was to assess pediatricians' opinions regarding AOM and its prevention by immunization. RESULTS: Response rate was 50%. Around 60% of respondents estimated that more than 50% of their patients under the age of 3 years would suffer from at least one episode of AOM in the following year. Most respondents (79%) rated consequences of AOM as moderate. Almost all physicians (99%) considered the newer PCV as safe and effective. Most respondents considered their knowledge of the new vaccines was sufficient. More than 90% had a firm intention to recommend newer PCV to their patients. Perceived benefits of AOM prevention by immunization were: reduction of antibiotic administration and reduction of post-AOM complications. More than half of respondents (53%) considered the risk of adverse events as a barrier to AOM prevention by immunization. In multivariate analysis, the main determinant of pediatricians' intention to recommend newer PCV was perceived safety and efficacy of the vaccines (partial R2 = 0.40, p < 0.0001). DISCUSSION: Results of this survey show that AOM is perceived as an important health problem by paediatricians. Information about the increased protection against AOM offered by newer PCV should be disseminated to physicians. MATERIALS AND METHODS: A self-administered, anonymous, mail-based questionnaire based upon the Health Belief Model and the Analytical framework for immunization programs was sent to all 1,852 Canadian pediatricians.

Burden of acute otitis media on Canadian families.

OBJECTIVE: To estimate the burden of acute otitis media (AOM) on Canadian families. DESIGN: Telephone survey using random-digit dialing. SETTING: All Canadian provinces between May and June 2008. PARTICIPANTS: Caregivers of 1 or more children aged 6 months to 5 years. MAIN OUTCOME MEASURES: Caregivers' reports on the number of AOM episodes experienced by the child in the past 12 months, as well as disease characteristics, health services and medication use, time spent on medical consultations (including travel), and time taken off from work to care for the sick children. RESULTS: A total of 502 eligible caregivers were recruited, 161 (32%) of whom reported at least 1 AOM episode for their children and 42 (8%) of whom reported 3 or more episodes during the past 12 months. Most children (94%, 151 of 161) visited with health professionals during their most recent AOM episodes. The average time required for medical examination was 3.1 hours in an emergency department and 1.8 hours in an outpatient clinic. Overall, 93% of episodes resulted in antibiotics use. A substantial proportion of caregivers (38%) missed work during this time; the average time taken off work was 15.9 hours. CONCLUSION: In Canada, episodes of AOM are still associated with substantial use of health services and indirect costs to the caregivers.

Perception of the social support for adolescents who undergo corrective back surgery for scoliosis.

The objective of this study is to compare the perception of social support upon admission and 6 weeks postoperation of adolescents aged 13 to 19 years (M = 14.7 years), who underwent corrective back surgery for scoliosis. Twenty-two French-speaking participants were found from three different hospital centers located in two large cities in the Quebec province. Data were collected using the French version of Interpersonal Relationships Inventory (IPRI). No significant difference was observed between the results obtained on admission and those obtained 6 weeks later for the global measures of social support available. Nevertheless, analysis of data at the two time points showed a significant difference with regard to intimacy of adolescents. Adolescents reported feeling more invaded in the postoperative period (6 weeks after the surgery) than on admission at the hospital. These results serve to point out the nursing care involvement as well as the surgical techniques and ambulatory care that reduce hospitalization time. The results raise questions about the nurse's role in the adequate support for adolescents as well as the impact of reduced length of hospitalization.

Immunization services offered in Québec (Canada) pharmacies.

Canadian Pharmacists are easy to reach. Although Québec pharmacists are not allowed to administer vaccines, they can: (1) promote vaccination, (2) counsel patients on vaccination, (3) sell vaccines and (4) provide vaccine administration by a nurse. Our objectives were to describe immunization services given in Québec pharmacies and assess the potential relation between, on one hand, pharmacy characteristics and difficulties perceived by pharmacists and, on the other hand, vaccine administration. In 2008-09, an anonymous questionnaire was mailed to all Québec pharmacy owners (n = 1663). Among the 1102 (66%) respondents, 90% stated that vaccines were sold, 27% that a nurse administered vaccines in their pharmacy and 44% were planning to offer vaccine administration in the next five years. Three out of four stated they were doing vaccine promotion and 65%, vaccine counselling. Half of respondents said they would be willing to administer vaccines themselves if legislative modifications were made. Recommendations for cold chain maintenance were followed in 23% of pharmacies selling vaccines. Presence of another health professional in the pharmacy, higher number of opening hours, not being located in the same building than a medical clinic and having an agreement to collaborate with a public health unit or a medical clinic for immunization were positively associated with vaccine administration in multivariate analysis. Higher perceived difficulties with lack of demand from patients were negatively associated with vaccine administration. Most pharmacists are willing to increase their involvement in immunization. Collaboration between public health professionals and pharmacists should be reinforced.

New vaccines offering a larger spectrum of protection against acute otitis media: will parents be willing to have their children immunized?

OBJECTIVES: To examine parents' knowledge, attitudes and beliefs regarding acute otitis media (AOM) and parents' willingness to vaccinate their children with new vaccine offering larger spectrum of protection against AOM. METHODS: Telephone survey conducted in a stratified sample of household in 10 Canadian provinces using random-digit dialling methodology. Parents of children aged 6 months to 5 years were reached. RESULTS: 502 parents participated. Mean age of the child was 3 years and 32% have had at least one AOM episode during the last 12 months. The great majority of parents agreed that recommended vaccines are important (94%) and useful (94%) for children's health. Parents felt that their knowledge on AOM was very (27%) or somewhat (54%) sufficient. Most parents (73%) thought that antibiotics use was always useful to treat an AOM and 54% estimated that vaccination is an effective mean of preventing AOM. Sixty-four percent (64%) of the surveyed parents were willing to vaccinate their child with a new vaccine offering larger spectrum of protection against AOM. A higher proportion of parents whose child had experienced an AOM were willing to have their children vaccinated. The strongest predictor of parental willingness to vaccinate was subjective norm, or the perception that the other parent of the child and the doctor will approve/recommend the vaccination behaviour. CONCLUSIONS: When new vaccines are available, a key issue is the willingness of parents to adopt it. Health providers should be aware of their important role to inform parents and promote immunization.