Child psychiatric skills in primary healthcare--self-evaluation of Finnish health centre doctors.

OBJECTIVE: To study Finnish general practitioners' (GP's) perceptions of their child psychiatric skills. METHODS: The study sample consisted of physicians (n=755) working in health centres situated in the special response area of the Tampere University Hospital, Finland. They were requested to assess their competence in 16 areas on a four-step Likert scale. The response rate was 66.1% (n=499). RESULTS: Physicians evaluated their child psychiatric skills as inadequate on many issues. The ability to identify depression was poorer the younger the child in question. Only a minority (14%) felt they were well able to identify a depressed infant. Many physicians considered themselves poorly skilled in assessing the relationship between infant and parents (39.8%), in assessing a child's need for psychiatric treatment (42.7%) and in identifying a child with attention-deficit disorder (40.7%). A majority (75.9%) rated their skills poor in co-operating with daycare personnel or school staff in matters concerning a child with conduct disturbance. Only 26.8% could assess the necessity of taking a child into custody. Women gave higher ratings of their skills in identifying depressed infants and in assessing the infant-parent relationship than men, whereas men assessed their skills as better in cases in which there were problems in co-operation with parents. CONCLUSIONS: In order to provide good psychiatric services for children, attention should be paid to the GPs' child psychiatric skills.

Clinical trial of a new trivalent measles-mumps-rubella vaccine in young children.

Trivalent measles-mumps-rubella virus vaccines, containing either Schwarz (two dosage levels), Urabe Am 9, and RA 27/3 strains or Moraten, Jeryl Lynn, and RA 27/3 strains, were evaluated in 174 children aged 14 to 24 months. Each of the three vaccines induced a nearly 100% seroconversion for measles and mumps and a full 100% seroconversion for rubella. Close home monitoring disclosed a high incidence and a relatively constant pattern of vaccine-associated reactions, similar for all three vaccines. Febrile reactions of greater than or equal to 39 degrees C between days 5 and 12 after vaccination were more frequent among the recipients of "high"-dose Schwarz strain vaccine (35%) than among the recipients of corresponding "low"-dose vaccine (13%). The Schwarz-Urabe Am 9-RA 27/3 was equally immunogenic and, with a low dose of measles virus, no more reactogenic than the Moraten-Jeryl Lynn-RA 27/3 trivalent vaccine.

Evaluation in young children of the Urabe Am 9 strain of live attenuated mumps vaccine in comparison with the Jeryl Lynn strain.

Urabe Am 9, a new strain of mumps vaccine, originally developed in Japan, was evaluated in children 14 to 20 months of age in a comparative trial with the Jeryl Lynn strain. Both vaccines performed well. The antibody responses were measured using a neutralization test and a haemolysis-in-gel test. The seroconversion rates at six weeks, as detected with either one or both tests, were 55/58 (94.8%) after the Urabe Am 9 and 58/60 (96.7%) after the Jeryl Lynn vaccine. Only mild infrequent adverse reactions were observed. It is concluded that both strains of live attenuated mumps vaccine are immunogenic and well-tolerated in this age group.

Comparison of the Urabe Am 9-Schwarz and Jeryl Lynn-Moraten combinations of mumps-measles vaccines in young children.

Two mumps-measles vaccine combinations were evaluated for their reactogenicity and immunogenicity in children aged 14 to 20 months. The Urabe Am 9-Schwarz combination vaccine was given to 108 double seronegative children. The seroconversion rate at six weeks after vaccination was 99.1% for measles (haemagglutination-inhibition test) and 92.6% for mumps (neutralization and haemolysis-in-gel tests). The Jeryl Lynn-Moraten vaccine was administered to 85 double seronegative children; the seroconversion rates were 95.3% for measles and 83.5% for mumps. The reported post-vaccination signs and symptoms resembled those seen after monovalent measles vaccine but were more accentuated. Fever over 37.5 C degrees was reported in 66.7% and unusual restlessness and irritability in 68.5% of the Urabe Am 9-Schwarz double seronegative vaccines compared to 55.3% (p less than 0.05) and 54.1% (p less than 0.05), respectively, in the recipients of the Jeryl Lynn-Moraten vaccine. These relatively high reaction rates probably reflect the close observation of the children by their parents during the study. Nevertheless, the tendency towards increased reaction rate and, possibly, reduced immunogenicity of bivalent mumps-measles vaccines as compared to the corresponding single vaccines should be taken into account in the planning of large scale vaccination of young children.