August 28th, 2008 by Dr. Val Jones in Uncategorized
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There is no doubt that vaccines are life-saving, and their development is one of the most important contributions to medical science in the past century. There are about a dozen regularly recommended adult vaccines, and kids in the US receive about 16 shots before the age of 2. New vaccines are being developed all the time.
With this year’s flu season just around the corner, a recent poll suggests that only 44% of parents have their children vaccinated against influenza. I decided to interview two pediatricians about the influenza vaccine, to find out more about it.
Dr. Ben Spitalnick is Assistant Clinical Professor, Mercer University School of Medicine, Savannah, Georgia. Dr. Stacy Stryer is Revolution Health’s pediatric specialist in private practice in Virginia. She offers a post-script at the end of the interview.
Dr. Val: What is the AAP’s current recommendation regarding vaccinating children against influenza?
Dr. Spitalnik: This is the first year that the AAP (as well as the ACIP) has recommended flu vaccination for all children age 6 months to age 18 years, regardless of whether or not they fall into the “high risk” medical categories that have been used as screening parameters in recent years. In addition, they recommend vaccination of pregnant women and all health care providers. Finally, they recommend vaccination of household contacts and out-of-home providers of all children under 5 years of age, and similar contacts of children older than 5 with high risk health conditions.
Dr. Val: What percent of parents vaccinate their children against influenza?
Dr. Spitalnik: While over 80% of parents recognize that there is an influenza vaccine available, data show that only about 44% of parents have had their child vaccinated against influenza in the past. In addition, despite the AAP’s broader recommendations regarding flu vaccination, still less than half (about 48%) plan to vaccinate against the flu this coming year. While there are plenty of possible reasons why vaccination rates are so low, health providers owe it to their patients to continue to find ways to improve delivery of and education about the influenza vaccine.
Dr. Val: What did the National Parent-Child Survey uncover about parents’ attitudes towards flu vaccines?
Dr. Spitalnik: The National Parent-Child Survey certainly provided some eye-opening data. While experts recognize that getting an annual flu vaccine is the single best way to protect yourself or your child from catching influenza, the survey shows that parents rank the flu vaccine sixth in importance to prevent the flu. Specifically, parents in this survey believe that hand washing, adequate sleep, balanced diet, avoiding sick contacts, and taking vitamins are better ways to protect against the flu. This helps emphasize the point that the health care community must continue to find ways to educate the public about influenza, and more importantly, its prevention.
Dr. Val: If someone has the flu, how can they help to prevent their child from getting it?
Dr. Spitalnik: Chances are this year, as with most years, almost every child will be in close contact with someone that has the flu. While hand washing, avoiding sick contacts, and getting adequate rest and nutrition may help against the flu, the single most effective way to prevent a child from getting the flu is having the child vaccinated. While protection after vaccination is fairly quick, it is not instantaneous, so waiting until your child is exposed to the flu is not the best approach. Instead, follow the recommendations of your health care provider and get vaccinated at the right time, and don’t wait until it may be too late.
Dr. Val: How dangerous is the flu virus to children? Are there any subgroups of children at higher risk?
Dr. Spitalnik: The flu is a significant danger to children, though the public doesn’t seem to appreciate the risk, which could be why vaccination rates are so low. While many feel the flu is nothing more than a severe form of the “common cold”, in reality it can lead to very high fever, dehydration, pneumonia, and can even be fatal. In fact, Influenza is the single leading cause of vaccine-preventable disease in the U.S., with estimates between 15 million and 60 million cases in the US a year among all age groups. Influenza leads to 200,000 hospitalizations and about 36,000 deaths a year in the U.S., mostly in infants and the elderly.
There are certain subgroups of children that are at higher risk for complications from the flu. These include children with asthma or other chronic lung conditions, certain heart diseases, patients who have weakened immune systems including HIV, sickle cell anemia, kidney disease, diabetes, and others. These are groups that we offer flu vaccines to first, when the vaccine is in short supply. The list above is not comprehensive, and any patient with a specific question about their own child’s medical conditions should contact their physician.
Dr. Val: Does the recent resurgence of measles tell us anything about parents’ attitudes towards childhood vaccinations?
Dr. Spitalnik: Yes, it certainly does. Cases of measles in the U.S. are at their highest level in more than a decade, with half of these cases in patients from families that rejected the measles vaccine. Many of the other cases were from exposures to these unvaccinated patients, but in children who were not yet old enough to receive the measles vaccination. I know that some physicians are asking parents (who refuse to vaccinate their children) to find a new doctor. They’re worried that other families’ infants may be exposed in the waiting room to kids with measles.
While some parents are refusing vaccines for their kids, there is impressive data from Japan clearly demonstrating the life-saving value of vaccinating children against influenza. In the 1960’s, the death rate in Japan from pneumonia and Influenza (P&I) was approximately 10 per 100,000. Over the next decade flu vaccination in the schools was made optional and then mandatory, and by the 1980’s the death rate from P&I showed a steady decline, eventually down to 4 in 100,000 – a significant reduction. In 1987, however, parents were allowed to refuse vaccination, and in a decade death rates quickly rose back up to near their 1960’s levels.
There is clearly more we need to do to help educate our patients about vaccines, not just with influenza. Specifically, however, flu vaccine education has its own hurdles, and I hope this year we all do a better job protecting our patients from this dangerous disease.
Dr. Val: What’s the most important thing that parents should know about the flu vaccine?
Dr. Spitalnik: If I had to choose one it would be that the flu vaccine, in any form, is the single best way to protect your child from the flu, which can be a serious threat to their health, and is now recommended for ALL children age 6 months to 18 years.
In addition, parents need to know that the flu vaccine is better than ever this year: First of all, there does not appear to be any shortage of supply. Second, all 3 strains of the vaccine have been changed to help ensure stronger protection. And finally, there is more than one way to get the flu vaccination, both the traditional shot and an intranasal spray, both of which should be available from their health care provider early this flu season.
P.S. By Dr. Stacy Stryer: Dr. Spitalnick offers some very good information and advice regarding the flu vaccine. While certain high risk groups, such as infants (ages 6 months and up), children with asthma and other chronic diseases, and those who are immunosuppressed are all at a greater risk of developing severe complications if they contract the flu, it is also possible for healthy children to develop complications from the influenza virus. Dr. Spitalnick discussed the best way to prevent children from contracting the flu, which is by receiving the vaccine. There are two forms of influenza protection available, the nasal spray and the traditional injection. The nasal spray, FluMist, may only be given to children ages 2 and older, and is contraindicated for children with asthma, several chronic diseases, and severe egg allergies, yet is more protective than the injection. Good hygiene, such as frequent handwashing and keeping hands away from the face, can also help reduce the risk of contracting the flu.
*Dr. Spitalnik has been a speaker for Glaxo Smith Kline and MedImmune. Dr. Stryer has nothing to disclose.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 4th, 2008 by Dr. Val Jones in Uncategorized
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I’m not sure if you’ve heard the news from north of the border, but my parents recently called me to tell me about it. Apparently, a 22 year old man was attacked on a bus en route to Winnipeg. A Chinese male passenger with a hunting knife had some sort of psychotic break and began stabbing his seat mate. The bus driver pulled over and the terrified passengers exited the bus as the assailant decapitated, gutted, and partially ate his victim in front of the onlookers.
The Royal Canadian Mounted Police (RCMP) subdued the man and have taken him into their custody.
This is probably the most disgusting, heinous crime ever committed in Canada. We are all in shock.
I’m sure that more information about the murderer will become available as the investigation continues.
**
Addendum: a Twitter friend of mine pointed out that this beheading was actually the third in a series of bizarre and unrelated decapitation murders world-wide. There was also one in Greece and one in the UK. Tragic.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 13th, 2008 by Dr. Val Jones in True Stories
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My caller ID displayed an unfamiliar number and I answered the phone hesitantly. Background noise and static nearly drowned out the caller’s determined intent to introduce himself. “This is Dr…. [couldn’t quite make it out]. Is this Val Jones?”
“Dr. Who?” I asked, trying to recognize the voice.
“Dr. Anderson. Is this the Val Jones I know?”
My mind raced through its physician contact list, without finding a match.
“Doctor… Anderson?” I said, trying so hard not to betray my lack of name recognition.
“Yes, yes, that’s right. I was your pediatrician. Remember me?”
Suddenly it all came back to me – this dear gentleman did indeed take care of me when I was young. I remembered him as a tall, fit man with white hair and kind eyes. He had stitched my face after I was bitten by a dog, put my shoulder back in its socket, and diagnosed fractured ribs after I fell out of a tree house. I guess I went to see him pretty regularly growing up, though I hadn’t thought of him in decades.
“Wow! Of course! Dr. Anderson I… I’m so surprised to hear from you after all these years. My goodness. How did you find my cell phone number?”
“Well, it wasn’t easy. Your parents have moved off the farm, and your university didn’t have any recent records. I finally found someone you used to work with and they found you on the Internet and got me in touch with Revolution Health…”
“Gosh, I’m sorry you had to go through all that to find me. What was it that you needed to talk to me about?”
“Well, I’m 90 years old now, and I’ve been thinking about my former patients. I was going through my records and I found your file a few years ago. My wife and I have been praying for all the kids I used to treat, and we started praying for you a while back. You were such a bright little girl – I always knew you’d do great things in this world. I guess I was just curious how you’d turned out and what you were doing in life. This is kind of like a follow up visit I guess.”
I was stunned. I became misty-eyed as I imagined this 90 year old man and his 91 year old wife praying for his former patients, remembering them fondly and even going out of their way to contact them for follow up, for no other reason than to know how they were making out in life, and wishing them well.
I spent about half an hour telling my pediatrician about my life and catching up with his. His wife had undergone biltareral knee replacements after her 90th birthday and was walking around with the help of a cane. He had 5 grand children that were doctors, was actively involved in his church, and still traveled extensively.
“Gee, Dr. Anderson – I’m so glad you’re doing so well. It was so nice of you to call.”
“I’m so glad I got to hear your voice, Val. Nothing makes me happier than to know you’ve grown up to be a doctor. Now take good care of your patients, ok? Keep track of them, and make sure they’re doing alright.”
As I said goodbye I thought to myself, “Those are some pretty big shoes to fill. But it sure feels good to be a patient who was NOT ‘lost to follow up.'”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 11th, 2008 by Dr. Val Jones in News
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The Wall Street Journal recently described some interesting new research related to the early detection of autism. Some scientists suggest that babies at risk for developing autism have different facial-scanning eye movement patterns. In other words, babies tend to focus on the eyes and mouth of faces in their direct line of sight. Babies at risk for developing autism have difficulty recognizing faces and their eyes may tend to wander. Although this test is not a diagnostic tool, it could be used to predict risk as early as 9 months – which could allow parents to get their children into early intervention programs sooner than they do now.
Researchers at Canada’s McMaster University recently announced that they had developed a computerized test using eye-movement sensors that aims to predict the risk of autism in children as young as 9 months. The system, which administers five eye-tracking tests over 10 minutes, measures the direction and fixation of a child’s eyes when confronted with computerized images, including human faces.
“Children with autism in general have difficulty extracting affective information from faces, and also difficulty in recognizing faces,” says Katarzyna Chawarska, director of the Yale clinic. By tracking eye movements, “we can begin to understand what interests them, how they examine objects they select for processing, and what motivates them intrinsically,” she says.
But eye-tracking won’t pick out all children with autism. That’s because the disorder can manifest itself in a variety of ways at different ages, such as a child not responding when called or failing to exhibit normal body gestures. Some children also won’t cooperate with the eye-tracking equipment.
I think it’s too early to know how valuable this tool will be in the evaluation of children at risk for autism spectrum disorders, but it’s certainly an interesting idea.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 6th, 2008 by Dr. Val Jones in Book Reviews
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I met the author of Glori: A Different Story
(Nicole Lynn Hannans) here at Revolution Health a couple of months ago. She is a vibrant, beautiful young woman who had a child in her late teens. Nicole explained to me that the vast majority of America’s teen pregnancy resources are dedicated to prevention. Once a teen becomes pregnant, there is very little support for next steps. For this reason, young mothers have difficulty completing a college education and are often trapped in a lifelong cycle of poverty.
As a young African American woman, Nicole was determined not to become a statistic. Despite all the odds, being homeless and surrounded by her boyfriend’s drug dealing business, she managed to escape that life and attended The College of William and Mary as a single mom. She wrote Glori: A Different Story, to inspire other pregnant teens to go and do likewise – knowing that no matter what the odds, an unexpected pregnancy does not prevent women from achieving their potential in life.
The story begins with Nicole as a carefree teen, enjoying outings with friends and flirtations with guys. In preparation for her prom, she ponders her date options. She decides, against her better judgment, to go with a charismatic “bad boy” football player whom she suspects may be dealing drugs. But she finds his charm irresistible and he persuades her that her fears are unfounded.
Soon Nicole is dating this young man (RaKeim) and is deeply attached to him. Sadly, her life begins to spiral out of control as she realizes that all of her suspicions were correct – he is a crack dealer trying to live the life of a big time “gangster.” RaKeim is narcissistic, unfaithful, abusive, and obsessed with money. Nicole gets pregnant, moves out of her home to be with RaKeim and cannot seem to come to grips with who he is rather than whom she hopes he will be.
While reading the book, every fiber in your being wants to scream, “Get out, Nicole, he’s no good for you! Run!” But RaKeim knows just how to play with her emotions, and she is reeled back in time and again. A prophetic statement from a doting aunt punctuates the madness of homelessness and crack fiends: “It takes time to get a relationship out of your system.”
And it did take several years for the RaKeim poison to work its way out of Nicole’s life. The turning point came one night when he tried to steal their baby, and then broke down the apartment door and beat Nicole. After menacing calls, being threatened with a gun, and in-person harassment, Nicole came to realize that she would never be safe. The police were unwilling to issue her a restraining order without further proof of RaKeim’s potential for violence. She had to handle this one alone.
As luck would have it, RaKeim was in and out of jail, which gave Nicole some relief from his behavior. During that time she graduated with high honors from the College of William and Mary, enrolled in a Master’s Program, got a job working with sick children at NIH, and found love again.
Nicole’s straight forward account of her struggles makes a few things quite clear: 1) women are not adequately protected by current domestic violence protocols 2) psychopathic men have an uncanny ability to manipulate their victims 3) overcoming the odds is a matter of will, determination, and very hard work and 4) a mother’s love for her child can inspire her to achieve greatness.
If you’re interested in learning more about Nicole’s life, please check out her website at www.nicoleink.com Her book is aptly named: Glori: A Different Story, and I hope that it inspires many other young moms to reach for glory – and to triumph over adversity.
*** Join Nicole’s Group – Click here***
Further resources for teenage moms:
The Healthy Teen Network
Planned Parenthood
Girl Mom
National Family Planning & Reproductive Health AssociationThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
