Physician beliefs and practices regarding the use of hepatitis A vaccine.

BACKGROUND: In 1999, the Centers for Disease Control and Prevention recommended routine vaccination of children against hepatitis A in states, counties, and communities with rates twice the national average or greater. Milwaukee is such a community. OBJECTIVES: To assess physician knowledge, beliefs, and practices regarding hepatitis A disease and hepatitis A vaccine recommendations in Milwaukee. METHODS: A cross-sectional study of 291 Milwaukee pediatricians and family physicians using a self-administered questionnaire. RESULTS: The response rate was 46%. Of physicians responding, 88% were aware that hepatitis A vaccine was recommended for all children in Milwaukee >2 years of age; 61% believed hepatitis A was a significant health problem, with a significant difference between pediatricians and family physicians (74% versus 43%); and 65% stated they offered the vaccine "almost always" or "most of the time" to children between the ages of 2 and 19 years. CONCLUSIONS: More physician education is needed regarding the public health impact of hepatitis A and the value of the vaccine.

Comparison of caregiver otitis media risk factor knowledge in suburban and urban primary care environments.

OBJECTIVE: There are many risk factors for otitis media. Some of these, such as passive tobacco smoke exposure and childcare arrangements; have the potential to be modified. The purpose of this study is to assess caregiver knowledge deficits about risk factors associated with otitis media and their willingness to modify behaviors associated with those risks. RESEARCH DESIGN AND METHODS: This study is a prospective survey study investigating knowledge deficits of parents or guardians of children ages 6-36 months about the risk factors of otitis media. The patients were consecutively drawn from a suburban and an urban pediatric practice. Any difference in survey results between these two groups was also assessed. Participants completed a survey of 21 questions with content including demographic and OM risk factor data. RESULTS: A total of 401 caregivers completed surveys, with 213 from an urban pediatric practice and 188 from a suburban practice. There was a significant difference in the ethnic distributions of the two populations. The suburban population had a significantly greater family history of ear infections, number of ear infections in the past 12 months, and number of previous ventilation tubes placed. The urban population had a significantly greater number of smokers in the household and decreased knowledge about day care as a risk for OM. The urban population's question responses suggested a greater willingness to change day care arrangements to reduce the risk of otitis media. CONCLUSIONS: Both populations demonstrated knowledge deficits regarding risk factors associated with OM and both populations exhibited willingness to modify behaviors to reduce risk. These findings demonstrate that there are opportunities for improving education regarding OM risk factors and that this education could potentially reduce risk for OM and in turn reduce the incidence of OM in children.

Anomalies, abnormalities, and care of the umbilicus.

This article discusses various anomalies and abnormalities of the umbilical cord and issues related to cord care. The issue of screening newborns with an isolated single umbilical artery for renal abnormalities is addressed. The clinical presentation of infants with omphalomesenteric and urachal duct remants along with the more common umbilical granuloma is reviewed. All three of these abnormalities can present with a wet or draining cord. The need for umbilical cord treatment with antimicrobial/antiseptic agents versus dry cord care is discussed, as are serious infections that involve the cord.

Misdiagnoses of ovarian masses in children and adolescents.

OBJECTIVE: The purpose of this study is to describe the presenting signs and symptoms and the presumptive diagnoses of children who were admitted to our children's hospital with ovarian masses. DESIGN METHODS: A retrospective chart review was performed on all patients hospitalized between November 1985 and May 1994, with a discharge diagnosis of an ovarian mass. Age, presenting symptom(s), duration of symptoms, physical exam findings, and radiologic imaging results were obtained. The preliminary and final diagnoses were recorded. For comparison purposes, the number of females with a discharge diagnosis of appendicitis for the same period was obtained. RESULTS: Fifty-one patients were identified. Functional cysts accounted for 43% and tumors for 57%. During the same period, 246 females were diagnosed with appendicitis, making ovarian masses about one fifth as common. The most common presenting complaint was abdominal pain (73%). On physical examination, 69% of girls had abdominal tenderness, and 29% had a palpable mass. Thirty-eight percent of patients seen in the emergency room had a preliminary diagnosis of appendicitis. In all patients but 5, the diagnosis was confirmed by radiologic evaluation. These 5 remaining patients underwent surgery for suspected appendicitis with 3 ultimately revealing functional ovarian cysts. CONCLUSION: Ovarian masses often present with abdominal complaints that can mimic other diseases, in particular, appendicitis. Although considered relatively uncommon, in our hospital, they comprised one fifth as many admissions as did appendicitis in females during the study period. In females that present with a clinical picture consistent with appendicitis, ovarian masses should be considered in the differential and a computed tomography scan or ultrasound should be obtained.

The effect of education, feedback, and provider prompts on the rate of missed vaccine opportunities in a community health center.

The purpose of this study was to determine whether education, feedback, and provider prompts decrease the rate of missed vaccine opportunities; and the reasons for missed opportunities in the post-intervention group. A nonrandomized, before and after study to evaluate the effect of education, feedback, and provider prompts on missed opportunities was conducted in an inner-city community health center with a predominantly hispanic population. Vaccine opportunities were defined as visits of children 36 months or younger who were vaccination-eligible by ACIP guidelines. Consecutive sampling was used to identify two groups of children with vaccine opportunities: pre- and post-intervention. Feedback was given to vaccine providers on the frequency of missed opportunities in the pre-intervention group. The ACIP recommended vaccine schedule and true vaccine contraindications were reviewed. Nursing personnel were taught to identify and tag charts of children with vaccine opportunities. Physicians were asked to record vaccination status and the reason any vaccination was deferred. Missed opportunities decreased significantly, from 49% (173/352) to 13% (45/344), after the interventions (p < 0.001). The reasons for the 45 missed opportunities in the post-intervention sample were parent refusal (15.6%), moderate or severe illness (15.6%), and incorrect documentation as "up-to-date" (13.3%). In 28.9% there was a missed opportunity for simultaneous immunization. No reasons were documented for the remaining missed opportunity visits (26.6%). The interventions, which emphasized improving provider knowledge of vaccinations and screening vaccine status at each visit, effectively decreased missed opportunities.

Tinea capitis: epidemiology, diagnosis and management strategies.

Tinea capitis is a common superficial fungal infection of the scalp in children, particularly in those of African descent. Trichophyton tonsuran, an anthropophilic dermatophyte, is responsible for the majority of cases in North America. The clinical presentations are variable and include: (i) a "seborrheic" form that is scaling, often without noticeable hair loss; (ii) a pustular, crusted pattern, either localized or more diffuse; (iii) a "black dot" variety characterized by small black dots within areas of alopecia; (iv) a kerion, which is an inflammatory mass; and (v) a scaly, annular patch. Most experts still consider griseofulvin to be the drug of choice, but recommend a higher dosage of 20-25 mg/kg/day for 8 weeks because of the increase in treatment failures. Despite a history of having an excellent tolerability profile, the long treatment course and higher doses required for griseofulvin have led to consideration of new antifungal agents for this infection. Terbinafine, itraconazole, and fluconazole compartmentalize in skin, hair, and nails, thereby allowing shorter treatment courses of < or =4 weeks. All have generally been shown to be effective in the treatment of tinea capitis and appear relatively well tolerated, with gastrointestinal symptoms being the most common adverse effect. Monitoring for liver enzyme elevations is generally unnecessary if therapy is limited to