Limit Influenza Spread in Family

Influenza is transmitted predominantly from person to person through infectious respiratory droplets Although more than 70 years have passed since influenza A was discovered, debate continues over its mode of transmission; specifically, whether influenza is transmitted via airborne contact, respiratory droplets, or direct contact, or via a combination of these routes. Possible modes of respiratory virus transmission include the following (Brankston, 2007): Direct physical contact between an infected individual and a susceptible host, resulting in the transfer of microorganisms Indirect contact via an intermediate object that is touched by the infected individual and is not cleaned prior to coming in contact with a susceptible host Droplet transmission (drops ≥ 5 mcm in diameter) via sneezing, coughing, or speaking; these droplets are propelled < 1 m through the air and come in contact with the oral, nasal, or conjunctival mucosa of a susceptible host (ie, they do not remain suspended in the air) Airborne transmission via aerosolization (airborne particles ≤ 5 mcm in diameter); organisms are contained in droplets or in dust particles and remain suspended in the air for long periods of time

Some basic principles to help prevent the spread of influenza include:
1) avoid close contact with people who are sick;
2) stay home when you are sick;
3) cover mouth and nose when sneezing;
4) wash hands frequently;
5) avoid touching eyes, nose, or mouth while you are sick; and
6) get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

Influenza virus survives on the hands for < 5 minutes but regular hand washing is a commonsense action that should be widely followed (Inglesby, 2006).

The impact of influenza can vary from year to year and be influenced by the circulating strains and protective antibody levels in the population. However, the efficacy of influenza vaccine among children in preventing laboratory-confirmed influenza is estimated to be 80%

School-age children and young adults who are completely susceptible experience the highest incidence of infection and contribute most of the spread of infection during an epidemic.

source: Medscape's Medpulse CME
Limiting the Spread of Influenza in a Family Setting to Reduce Secondary Infections

meningococcal vaccine

Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP).

Bilukha OO, Rosenstein N; National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC).

Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC, 1600 Clifton Road NE, MS C-09, Atlanta, GA 30333, USA. OBB0@cdc.gov

In January 2005, a tetravalent meningococcal polysaccharide-protein conjugate vaccine ([MCV4] Menactra, manufactured by Sanofi Pasteur, Inc., Swiftwater, Pennsylvania) was licensed for use among persons aged 11-55 years. CDCns Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of young adolescents (defined in this report as persons aged 11-12 years) with MCV4 at the preadolescent health-care visit (at age 11-12 years). Introducing a recommendation for MCV4 vaccination among young adolescents might strengthen the role of the preadolescent visit and have a positive effect on vaccine coverage among adolescents. For those persons who have not previously received MCV4, ACIP recommends vaccination before high-school entry (at approximately age 15 years) as an effective strategy to reduce meningococcal disease incidence among adolescents and young adults. By 2008, the goal will be routine vaccination with MCV4 of all adolescents beginning at age 11 years. Routine vaccination with meningococcal vaccine also is recommended for college freshmen living in dormitories and for other populations at increased risk (i.e., military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, patients with anatomic or functional asplenia, and patients with terminal complement deficiency). Other adolescents, college students, and persons infected with human immunodeficiency virus who wish to decrease their risk for meningococcal disease may elect to receive vaccine. This report updates previous reports from ACIP concerning prevention and control of meningococcal disease. It also provides updated recommendations regarding use of the tetravalent meningococcal polysaccharide vaccine (MPSV4) and on antimicrobial chemoprophylaxis.

pneumococcal vaccine reduce pneumonia morbidity

Routine Pneumococcal Vaccination Linked to Fewer Medical Visits in Kids Under 2

Healthcare visits and expenditures due to pneumonia in children under age 2 have declined markedly since routine pneumococcal vaccination was implemented in that age group, reports Archives of Pediatric and Adolescent Medicine.

Researchers reviewed health records from a large database of self-insured employers across the U.S. Data on approximately 77,000 children younger than 2 years were available each year from 1997 through 2004. Among the findings:

• From the prevaccination period (1997–1999) to 2004, hospitalization of children for all-cause pneumonia and pneumococcal pneumonia dropped by 52% and 58%, respectively.
• Ambulatory visits for all-cause pneumonia fell by 41%, while visits for pneumococcal pneumonia decreased by 47%.
• Estimated national annual medical expenditures for all-cause pneumonia and pneumococcal pneumonia dropped by 45% and 27%, respectively.

The authors conclude: "The decline in disease ... highlights the further health and economic benefits of [the 7-valent pneumococcal conjugate vaccine] in young children in the United States."

Archives of Pediatrics and Adolescent Medicine article (Free)

ACIP recommendations on preventing pneumococcal disease in kids (2000) (Free)

Meningococal Vaccine for 2-10yrs

ACIP Recommends Meningococcal Vaccine in Children at Increased Risk

Children between the ages of 2 and 10 and at increased risk for invasive meningococcal disease should receive quadrivalent meningococcal conjugate vaccine (MCV4), the Advisory Committee on Immunization Practices recommends.

Previously, the MCV4 vaccine was only approved for people aged 11 to 55 years.

As detailed in MMWR, children may be considered to be at increased risk if they:

• travel to or live in nations with hyperendemic or epidemic meningococcal disease;
• have terminal complement component deficiencies;
• suffer anatomic or functional asplenia;
• are infected with HIV (MCV4's efficacy among these children is not known);
• received the MPSV4 (polysaccharide) vaccine at least 3 years ago and are still at increased risk.

The vaccine may also be used to control outbreaks of meningococcal disease in children.

Physician's First Watch for December 7, 2007
David G. Fairchild, MD, MPH, Editor-in-Chief

Reducing Pain from Injections

• Members of a university-based pediatric pain relief program hosted a consensus conference to review the existing literature and generate expert recommendations regarding best practices for reduction of injection pain.
• The pain associated with immunizations can create anxiety and distress for the children receiving the immunizations, their parents, and healthcare providers. Dread evoked by painful immunization procedures may create feelings of persistent tension in future clinical encounters, thereby interfering with optimal delivery of healthcare.
• The injection process can be divided into 2 periods: before the injection and during the injection.
• Before the injection, preparation of a child older than 2 years reduces anxiety and subsequent pain. Children younger than 4 years should be prepared shortly before the injection itself.
• Intramuscular immunizations should be administered in the vastus lateralis (anterolateral thigh) for infants and toddlers younger than 18 months and in the deltoid (upper arm) for children older than 36 months. The ventrogluteal area may be the most appropriate site for all age groups.
• Despite the common belief that the shortest needle with the thinnest gauge would produce the least trauma and pain, this does not seem to be the case. Several studies suggest that longer needles, which are more likely to penetrate muscle than shorter ones, cause less pain, fewer adverse effects, and less local reaction.
• During the injection, parental attitudes affect the child's pain behaviors. Excessive parental reassurance, criticism, or apology tends to increase distress, whereas humor and distraction may reduce distress.
• The child's age, temperament, and interests and parent's personal style will aid in selecting effective distraction techniques. These may include storytelling, reading to the child, deep breathing, and blowing.
• During injection to children younger than 6 months, sucrose solution should be routinely given directly into the mouth or on a pacifier. This decreases evidence of distress and is relatively inexpensive.
• Because of the high cost and time needed for administration, routine local anesthetic administration is not indicated, but selective use is recommended for children who are especially fearful, who have had previous negative experiences, or who will require multiple procedures in the future.
• Pressure at the immunization site decreases pain, whether applied with a device or finger, and this strategy is noninvasive, inexpensive, and without adverse effects. Properties of the injectate itself can exacerbate pain, but there has been little research in this area.
• Parents often prefer that multiple injections be given simultaneously, rather than sequentially, if there are sufficient personnel.

Pearls for Practice

• Before the injection, important aspects of the immunization process that may reduce pain include preparing the child and family, site selection for the injection, selection of needle length and gauge, and specific properties of the injectate.
• During the injection itself, key elements of the immunization process that may reduce pain include parental demeanor, use of sucrose, use of topical anesthetic agents, nonpharmacologic and physical strategies, and specific aspects of administration technique.

Source: Medscape Medical News May 07

Teen Weight Loss

Safe steps to a healthy weight

from http://www.mayoclinic.com/health/teen-weight-loss/WT00012

Healthy habits are the key to teen weight loss. Show your teen the way with this practical plan for success.

Teenage obesity is a dangerous — and growing — problem. There's no magic bullet for teen weight loss, but there's plenty you can do to help. Start by encouraging your teen to adopt healthy habits that can last a lifetime.

Have a heart-to-heart

If your teen is overweight, he or she is probably concerned about the excess weight, too. Aside from lifelong health risks such as high blood pressure and diabetes, the social and emotional fallout of being overweight can be devastating for a teenager. It can also be frustrating to attempt weight loss and have poor results. Offer support and gentle understanding — and a willingness to help your teen take control of the problem.

You might say, "I can't change your weight. That's up to you. But I can help you make the right decisions."

Dispute unrealistic images

Weight and body image can be delicate issues, especially for teenage girls. When it comes to teen weight loss, remind your teen that there's no single ideal and no perfect body. The right weight for one person might not be the right weight for another.

Rather than talking about "fat" and "thin," encourage your teen to focus on practicing the behaviors that promote a healthy weight. Your family doctor can help set realistic goals for body mass index and weight based on your teen's age, height and general health.

Resist quick fixes

Help your teen understand that losing weight — and keeping it off — is a lifetime commitment. Fad diets may rob your growing teen of iron, calcium and other essential nutrients. Weight-loss pills and other quick fixes don't address the root of the problem. And the effects are often short-lived. Without a permanent change in habits, any lost weight is likely to return — and then some.

Promote activity

Like adults, teens need about 60 minutes of physical activity a day. But that doesn't necessarily mean 60 solid minutes at a stretch. Shorter, repeated bursts of activity during the day can help burn calories, too. In fact, any physical activity counts.

Team sports through school or community programs are great ways to get active. If your teen isn't an athlete or is hesitant to participate in certain sports, that's OK. Encourage him or her to walk, bike or in-line skate to school, or to walk a few laps through the halls before class. Suggest trading one hour of after-school channel surfing for shooting baskets in the driveway, jumping rope or walking the dog. Even household chores such as vacuuming and washing the car have aerobic benefits.

MORE ON THIS TOPIC

• Fitness for kids: Getting your children off the couch
• Children and sports: Choices for all ages

Suggest breakfast

If your teen fights the alarm clock the way it is, getting up even earlier to eat breakfast may be a tough sell — but it's important. A nutritious breakfast will jump-start your teen's metabolism and give him or her energy to face the day ahead. Even better, it may keep your teen from eating too much during the rest of the day.

If your teen resists high-fiber cereal or whole-wheat toast, suggest last night's leftovers. Even a piece of string cheese or a small handful of nuts and a piece or two of fruit can do the job.

MORE ON THIS TOPIC

• Breakfast: Why is it so important?

Encourage smart snacking

It can be tough to make healthy choices when school halls are lined with vending machines, but it's possible. Encourage your teen to replace even one bag of chips a day with a healthier grab-and-go option from home:

• Frozen grapes
• Oranges, strawberries or other fresh fruit
• Sliced red, orange or yellow peppers
• Cherry tomatoes
• Baby carrots
• Low-fat yogurt or pudding
• Pretzels
• Graham crackers
• String cheese

MORE ON THIS TOPIC

• Snacks: How they fit into a healthy diet

Watch portion sizes

When it comes to portions, size matters. Encourage your teen to scale back and stop eating when he or she is full. It might take just one slice of pizza or half the pasta on the plate to feel full — and there's no shame in sharing a meal, ordering a smaller portion or taking home leftovers.

MORE ON THIS TOPIC

• Lose weight with proper portion control

Count liquid calories

The average 12-ounce can of soda has more than 100 calories and 10 teaspoons of sugar. The calories and sugar in fruit juice, specialty coffees and other drinks can add up quickly as well. Drinking water instead of soda and other sugary drinks may spare your teen hundreds of calories and a day's worth of sugar — or even more. For variety, suggest flavored water, seltzer water or unsalted club soda.

Allow occasional treats

Late-night pizza with friends or nachos at the mall don't need to derail your teen's healthy-eating plan. Suggest a breadstick and marinara sauce instead of garlic bread dripping in butter and cheese, or a shared snack rather than a full-size order. Let your teen know that he or she is in control — and an occasional indulgence is OK. A trend toward healthier habits is what really matters.

Make it a family affair

Rather than singling out your teen, adopt healthier habits as a family. After all, eating healthier foods and getting more exercise is good for everybody.

• Encourage the entire family to eat more fruits, veggies and whole grains, such as whole-wheat bread, brown rice and oatmeal. Be sure to set a good example yourself.
• Leave junk food at the grocery store. Healthy foods sometimes cost more, but it's an important investment.
• Try new recipes or healthier alternatives to family favorites.
• Banish food from the couch to curb mindless munching.
• Plan active family outings, such as evening walks or weekend visits to a local recreation center.

Be positive

Being overweight doesn't inevitably lead to a lifetime of low self-esteem, but your acceptance is critical. Listen to your teen's concerns. Comment on his or her efforts, skills and accomplishments. Make it clear that your love is unconditional — not dependent on weight loss. Help your teen learn healthy ways to express his or her feelings, such as writing in a journal.

If your teen is struggling with low self-esteem or isn't able to cope with his or her weight in a healthy manner, consider a support group, formal weight-control program or professional counseling. Additional support may give your teen the tools to counter social pressure, cultivate more positive self-esteem and take control of his or her weight. The benefits will last a lifetime.

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Anti-obesity Drugs Reduce Weight by less than 5kg

1) Taking anti-obesity drugs results in only 'modest’ weight loss
(Long term pharmacotherapy for obesity and overweight: updated meta-analysis)
BMJ Online First

(Editorial: Orlistat over the counter)
BMJ Online First

Children could have their cholesterol levels tested at about 15 months of age to prevent heart disease later in life, say doctors in a study published on bmj.com today.

Patients taking anti-obesity drugs will only see "modest" weight loss and many will remain significantly obese or overweight, according to a study published on bmj.com today.

The study, which looked at the long-term effectiveness of anti-obesity medications, found that three drugs recommended for long-term use - orlistat, sibutramine and rimonabant, reduced weight by less than 5kg (11 pounds). This equated to a loss of less than 5% of total body weight. Guidelines from the National Institute for Clinical Excellence recommend stopping the use of anti-obesity drugs if 5% of total body weight is not lost after three months.

While making changes to lifestyle and diet are recommended as the initial treatment for obesity, the use of anti-obesity drugs is common. It’s estimated that in 2005 global sales of anti-obesity drugs reached $1.2billion. Current UK guidelines recommend using drug therapy in addition to making lifestyle changes if a patient has a body mass index of greater than 30.

The Canadian researchers reviewed the evidence from thirty placebo-controlled trials where adults took anti-obesity drugs for a year or longer. The mean weight of the volunteers in all of the trials was 100kg (15.7 stone). The mean body mass index levels were 35 - 36.

Professor Raj Padwal and colleagues found orlistat reduced weight by 2.9kg, sibutramine by 4.2kg and rimonabant by 4.7kg. They also found that patients taking the weight loss pills were significantly more likely to achieve 5 - 10% weight loss, compared to those who took the placebo.

The health benefits associated with taking the drugs varied. For example, orlistat reduced the incidence of diabetes in one trial and all three drugs lowered patients’ levels of certain types of cholesterol. Adverse effects were recorded with all three drugs, in particular, rimonabant increased the risk of mood disorders such as depression or anxiety. The authors noted that no trials examined rates of death and disease as a result of taking anti-obesity pills. They recommend that trials looking at this should be carried out in the future.

The authors also noted that there were high drop-out levels in all the trials. On average 30 - 40% of patients failed to complete the trial. They say this suggests that a failure to properly adhere to the treatment could be a major factor limiting the effectiveness of anti-obesity drug therapy.

In an accompanying editorial, Professor Gareth Williams warns of the potential damage to society if anti-obesity drugs are licensed to be sold without prescription. This already happens in the United States, and as Glaxo Smith Kline (GSK) has applied to sell orlistat over the counter throughout Europe, it could happen here. He warns:

"Selling anti-obesity drugs over the counter will perpetuate the myth that obesity can be fixed simply by popping a pill and could further undermine the efforts to promote healthy living, which is the only long term escape from obesity."

Contact:
Assistant Professor, Raj Padwal, University of Alberta, Canada
Email: rpadwal@ualberta.ca
Editorial: Professor Gareth Williams, University of Bristol, UK
Email: gareth.williams@bristol.ac.uk