Prevention and Control of Pneumococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbidity and Mortality Weekly Report 46 (April 4, 1997): Entire issue.
ACIP recommends administration of the pneumoccocal polysaccharide vaccine to all persons in groups at increased risk for pneumococcal disease, including adults aged >65 years and all persons aged >2 years with certain underlying medical conditions, such as HIV infection, liver disease, and sickle cell disease.
Each year in the United States, pneumococcal disease accounts for 3,000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and 7 million cases of otitis media. Annually, pneumococcal infection causes an estimated 40,000 deaths in the United States, more deaths than any other vaccine-preventable bacterial disease. Approximately half of these deaths could be prevented through the use of vaccine.
The report updates ACIP recommendations from 1989 and contains
information and findings on risk factors, antimicrobial resistance among pneumococci,
vaccine effectiveness and cost-effectiveness, indications for vaccination, guidelines for
revaccination, strategies for improving delivery of vaccine, and development of
penumococcal conjugate vaccine.
Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbidity and Mortality Weekly Report 46 (April 25,1997): Entire issue.
Vaccinating persons at high risk before the influenza season each year is the most effective measure for reducing the impact of influenza and its complications, especially among persons aged >65 years. For the 1997-98 influenza season, ACIP has changed recommendations for pregnant and breastfeeding women and updated information about effects and adverse reactions.
Because of their increased risk for influenza-related complications,
women who will be in the second or third trimester of pregnancy during the influenza
season are among the ACIP's target groups for special vaccination programs. Other target
groups include residents of nursing homes and other chronic-care facilities that house
persons of any age who have chronic medical conditions, and adults and children who have
chronic disorders of the pulmonary or cardiovascular systems. ACIP also recommends the
vaccine for people who can transmit influenza to persons at high risk, including their
household members and health care providers. For the general population, ACIP advises that
physicians should administer influenza vaccine to any person who wishes to reduce the
likelihood of becoming ill with influenza.
American Journal of Preventive Medicine, 13 (March/April 1997). Theme Articles: Childhood Immunizations: American College of Preventive Medicine Practice Policy. R. Patel and L. Kinsinger. 74-77. The Ad Hoc Working Group for the Development of Standards for Pediatric Immunization Practice has developed 18 standards that constitute essential vaccine policies for improving childhood immunization coverage, including providers implementing tracking systems and following only true contraindications. The group has suggested these enhancements for compliance, especially for preschool children: vaccination registries, followup and reminder systems, incentives, and performance measures.
Development and Multicenter Evaluation of Multistation Clinical Teaching Scenarios on Immunization: The ATPM-CDC Teaching Immunization for Medical Education (TIME) Project. R.K Zimmerman et al. 78-83. Developed by a multidisciplinary team at the University of Pittsburgh, case-based immunization education materials substantially increased knowledge among medical students and primary care residents. Furthermore, both learners and facilitators gave favorable ratings to these extensively tested materials.
Immunization Rates Among Young Children in the Public and Private Health Care Sectors. D.M. Simpson, L. Suarez, and D.R. Smith. 84-88. Both public and private sectors need to improve immunization rates, which are well below the national objective of 90 percent coverage in 2-year-olds. This study showed that implementing local standards or care or community initiatives will have an effect on all children regardless of source of care.
Barriers to Measles and Pertussis Immunization: The Knowledge and Attitudes of Pennsylvania Primary Care Physicians. R.K. Zimmerman et al. 89-97. Free vaccine supplies and increased provider education are needed to achieve national immunization objectives. In a survey of 268 family physicians, pediatricians, and general practitioners younger than 65 years of age, many respondents lacked knowledge about vaccine contraindications even though most felt that the vaccines are safe and efficacious. Physicians who did not receive free vaccine were more likely to refer uninsured children to public vaccine clinics.
Incidence of Infectious Disease and the Licensure of Immunobiologics
in the United States. D. Campos-Outcalt and M. Aickin. 98-103. According to historical
data, effective mass immunization is associated with the rapid decline of measles,
pertussis, and polio after vaccines were introduced. Lack of national data prevents
analysis of similar trends for rubella and mumps, although local data, where available,
support the same conclusion about the substantial benefits of mass immunization policies.
Are physicians less likely to recommend preventive services to low-SES patients? L.I. Solberg, M.L. Brekke, and T.E. Kottke. Preventive Medicine 26 (May/June 1997): 350-57.
Health care professionals should increase their efforts to recommend and provide needed preventive services to all patients.
Randomly identified clients of 22 private primary care clinics in the greater metropolitan Minneapolis-St. Paul area were surveyed within 2 weeks of a visit to measure their self-reported need for the eight preventive services targeted in the study and the clinic activities related to those services during the visit. The questions for both men and women focused primarily on when the subject had last received each of the preventive services and whether at the visit the service was recommended or provided. The number of usable responses was 4,245, with 1,684 in the low-SES group. In that group, 34.7 percent had medical assistance, 38.5 percent had no insurance, 9.9 percent were on Medicare, 16.8 percent had other insurance. In the non-low-SES group of 2,561, 1.53 percent were on Medicare, and the balance had other insurance.
The findings were robust. While low-SES patients were just as likely to
receive recommendations for needed preventive services, in both groups, the rates of
recommendation and receipt of preventive services needed improvement. Except for blood
pressure checks and tobacco advice, only 7 to 30 percent of patients needing a service
were recommended to receive it during the opportunity of a clinic visit. The only
differences were for tobacco identification and advice to quit, with low-SES patients
reporting more frequent service. Differentiating the two groups most significantly was the
magnitude of the need for preventive services, not physicians' advice, income, or
insurance status. For example, low-SES patients were 20 to 30 percent less up to date on
such target preventive services as mammograms and cholesterol screenings.
Training physicians to conduct physical activity counseling. B.H. Marus et al. Preventive Medicine 26 (March/April 1997): 382-88.
Physician-delivered physical activity counseling, customized to the motivational level and lifestyles of sedentary individuals aged 50 and older, produces improvements in patients' accumulation of moderate activity throughout the day.
In this study, physician intervention was designed to increase activity in adults through physician training in counseling, algorithms to facilitate customized counseling, patient manuals, and followup visits. Forty-four subjects completed the study--19 who received counseling (experimental) and 25 in the control group who did not receive counseling. A 6-week followup revealed differences in the increase in activity between the experimental and control groups. The increase in physical activity was greatest for patients receiving a higher level of specific activity counseling.
The U.S. Preventive Services Task Force recommends that clinicians
counsel all patients to engage in a program of regular physical activity, tailored to
their health status and personal lifestyle. This study suggests that brief exercise
counseling (3 to 5 minutes) by physicians is both acceptable and feasible.
Fruit-vegetable consumption self-efficacy in youth. K.R. Heatey and D. L. Thombs. American Journal of Health Behavior 21 (May/June 1997): 172-77.
Youth are more likely to eat fruits and vegetables if they develop self-efficacy skills for selecting foods in varied social and institutional settings.
A convenience sample of 393 New York adolescents, with a mean age just above 13, answered questions to assess perceptions of their ability to make healthy food choices in social settings and their 24-hour food intake.
Findings indicate that nutrition education programs should enhance
skills in two areas: resisting negative environmental influence, or being confident in
one's ability to eat fruit and vegetables despite inhibiting social conditions, and
persuading others to eat fruits and vegetables when selecting foods together.
New evidence on antioxidant nutrients: guidelines for health education. L.W. Turner et al. American Journal of Health Behavior 21 (May/June 1997): 216-21.
Until clinical studies can clarify and confirm the benefit from taking antioxidant supplements, health professionals would be irresponsible in recommending them.
Diets high in fruits, vegetables, and grains have been associated with reduced risk for life-threatening diseases, such as cancer, diabetes, and heart disease. This benefit is attributed to the ability of antioxidants to neutralize damage-causing free radicals. Under extensive study are the antioxidant roles of several nutrients found in plant foods, including beta-carotene and vitamins A, C, and E. However, foods deliver thousands of chemicals, and researchers must be careful in giving credit for a particular benefit to any one nutrient. Antioxidant nutrients behave differently at various levels of intake. At physiological levels typical of a healthy diet, they may act as antioxidants, but at pharmacological doses typical of supplements, they may act as pro-oxidants, stimulating the production of free radicals, especially when metal ions such as iron (also often found in supplements) are present. Vitamin toxicity is a risk. The long-term consequences of taking large amounts of antioxidants are not known.
The Food and Drug Administration and the National Academy of Sciences have stated that they do not recommend increases in vitamins C and E and beta-carotene and believe more complete antioxidant research is needed.
The best way to supplement antioxidant nutrients is to eat five generous
servings of fruits and vegetables daily, especially citrus fruits and green and yellow
vegetables.
Prevention of pediatric drowning and near-drowning: a survey of members of the American Academy of Pediatrics. J.E. O'Flaherty and P.L. Pirie. Pediatrics 99 (February 1997): 169-74.
By providing their patients and parents with information and guidance about prevention of drowning, pediatricians could save children's lives.
Drowning is the second leading cause of death by unintentional injury in the pediatric population (aged 0 to 19 years), accounting for more than 2,000 deaths each year. Although pediatricians have been effective child advocates in a number of injury prevention areas, drowning has not been widely addressed in their practices or formal training.
Of the 560 pediatricians questioned about their knowledge, beliefs, and practices concerning drowning prevention, only 4.1 percent were personally involved in community education or legislative efforts to prevent childhood drowning. Yet, 85 percent of the respondents believed pediatricians have a responsibility to do so. Three-fourths of all respondents agreed that education on prevention of childhood drowning and near-drowning would be useful.
The Consumer Product Safety Commission estimated that at the time of drowning, 69 percent of young children were being supervised by one or both parents and that a lapse of supervision occurred for only a few minutes. Pediatricians are in an ideal position to make these facts known to parents and should advise them to fence all pools, learn CPR, and teach children over 3 years old to swim.
Approximately the same number of children drown in residential swimming
pools each year as the number who died in the year before the Poison Prevention Packaging
Act, which pediatricians were instrumental in passing in 1970. Clinicians can combat
childhood drowning by making prevention a practice priority.
Summer sun exposure: knowledge, attitudes, and behaviors of midwest adolescents. J.K. Robinson, A.W. Rademaker et al. Preventive Medicine 26 (May/June 1997): 364-72.
Teenagers can prevent skin cancer and sunburn by using adequate quantities of sunscreen prior to sun exposure, by wearing protective clothing, and by ceasing deliberate tanning. Parents and physicians should encourage and ensure teen sun-prevention behavior, and parents should serve as role models.
Experts hypothesize that 90 percent of the cases of nonmelanoma skin cancer and two-thirds of the cases of melanoma may be attributed to excessive sunlight exposure. Since the average American obtains most of his lifetime sun exposure prior to age 21, adequate sun protection by teens will reduce their lifetime risk of developing skin cancer.
Six hundred and fifty-eight Illinois youth between ages 11 and 19 participated in a telephone survey of their knowledge and attitudes about sun exposure and protection, sources of information, current sun exposure, and types of protection used. Respondents reported extensive summer outdoor exposure and sunburning.
Eighty-five percent of respondents reported that too much sun is
harmful, causing skin cancer and sunburn. Sunburn was mentioned more often by respondents
with skin types that burn easily and tan poorly, girls, and those with higher
socioeconomic status. A majority of respondents associated improved appearance, feeling
better, and socialization with outdoor summer activities. Only 26 percent of subjects
reported using sunscreen daily, whereas 49 percent used it a few times a year. The
frequency of tanning parlor use by girls at high risk to develop skin cancer was alarming.
Determining effective follow-up of e-mail surveys. M.J. Kittelson. American Journal of Health Behavior 21 (May/June 1997): 193-96.
Followup memos improve the response rate for e-mail surveys, which offer potential for quick and easy data collection by health professionals.
In this quasi-experimental study, the 276 individuals listed in the International E-Mail Directory for Health Educators were divided into four groups and sent questionnaires. Three of the four groups received reminders by memos and a copy of the original survey, with one, two, or three memos sent depending on the group assignment. The overall survey response was 47.5 percent; the response rate doubled when subjects received followup memos.
Back to
ODPHP.