Vaccine confidence among parents: Large scale study in eighteen European countries.

BACKGROUND: Despite the fact that vaccines save 2-3 million lives worldwide every year, a percentage of children are not getting appropriately vaccinated, thus leading to disease outbreaks. One of the major reasons of low vaccine uptake in Europe is vaccine hesitancy, contributing to the recent measles outbreaks. Monitoring of vaccine hesitancy is valuable in early identification of vaccine concerns. METHODS: We performed an eighteen country European survey on parents' attitudes and behaviors regarding their children's immunization. Parents having at least one child 1-4 years old were mostly recruited by primary care paediatricians to reply to a web-based questionnaire. The questionnaire was developed by the European Academy of Paediatrics Research in Ambulatory Setting Network steering committee, based on similar surveys. An individual level hesitancy score was constructed using the answers to 21 questions, and correlations of the score with socio-demographic characteristics and types of providers were explored. To assess inter country differences, a country level self -reported confidence was defined. RESULTS: Fifty six percent and 24% of 5736 respondents defined themselves as "not at all hesitant", and "somewhat hesitant", respectively. Parents who consulted general practitioners were more hesitant than parents who consulted pediatricians (p < 0.05). Consultation with homeopathists was associated with the highest reported hesitancy (p < 0.05). Vaccine confidence was highest in Portugal and Cyprus, and lowest in Bulgaria and Poland. CONCLUSION: The majority of parents in Europe believe in the importance of childhood vaccination. However, significant lack of confidence was found in certain European countries, highlighting the need for continuous monitoring, awareness and response plans. The possible influence of different types of healthcare providers on parental decisions demonstrated for the first time in our survey, calls for further research. Monitoring and continuous medical education efforts aimed mostly at those professionals who might not be likely to recommend vaccination are suggested.

[Guideline 'Incontinence urine and feces' of the Dutch Preventive Youth Health Care]. / Jeugdgezondheidszorgrichtlijn 'Zindelijkheid urine en feces'.

Continence problems can occur during childhood. This guideline is for the Dutch Youth Health Care (JGZ) and gives recommendations for the prevention, early detection and treatment of these problems. As a preventative measure advices for potty training should be started in children aged 18-24 months. If incontinence is present, it is important to take a history and carry out physical examination. In children over the age of 5 who are incontinent of urine the following are recommended: taking child out of bed, calendar with reward system, bedwetting alarm or voiding diary; children over the age of 8 can follow dry bed training. Faecal incontinence is often associated with constipation. Incontinent children with constipation are given advice about normal eating and exercise patterns. If this is not successful then laxatives are prescribed. The JGZ should refer further if there are indications of an underlying condition; if children over the age of 5 are wet during the day; if children are incontinent of faeces at night; if children are incontinent of faeces but not constipated; if children persistently wet the bed; if there is faecal incontinence despite counselling, and if medication needs to be prescribed.