Posted On: June 28, 2013

HPV Vaccine Is a Clear Success

As we wrote a couple of years ago, adolescent vaccination rates for several diseases were up, and although the one for human papillomavirus (HPV) was among them, its rates lagged the others.

Being vaccinated against HPV before a person is sexually active protects girls from developing cervical cancer later in life and can protect boys from genital warts and penile and anal cancer. HPV is the most common sexually transmitted infection.

Despite the less than ideal vaccination numbers, there’s good news: The HPV vaccine is reducing the prevalence of the virus dramatically in teenage girls.

As reported by NPR, the Centers for Disease Control and Prevention (CDC) has released a study showing that in the first four years of immunization, infections from the four strains of the virus targeted by the vaccines fell by more than half among U.S. 14- to 19-year-olds.

The study, published in the Journal of Infectious Diseases, found no decrease in the HPV strains covered by the vaccine in other age groups, which supports the idea that the vaccine is responsible for the decrease among teenagers. Also supporting the association is the fact that researchers did not find that sexual activity among girls in the target population had decreased; still, the prevalence of HPV declined from nearly 12% to slightly more than 5%.

Despite the CDC’s vigorous promotion of getting kids vaccinated before they become sexually active, many parents resist, somehow thinking that being immunized is the same thing as giving permission to have sex. Others are wary in general of vaccines, an attitude we’ve addressed here, ( “More Proof that Vaccines Have Nothing to Do with Autism”) and here. (“Feds Say Childhood Vaccine Schedule Is Safe and Effective.”)

Federal health officials, according to NPR, were surprised at the significant decrease, considering that only about 1 in 3 girls in this age group has received the full three-dose course of the vaccine. About half have received a single dose.

The CDC recommends that girls get the HPV vaccine when they are 11 or 12, but females as old as 26 are urged to get the three-shot course if they have not received the vaccine earlier. The recommendation is the same for boys, except that the “catch-up” vaccination is recommended only until 21.

The cost, says NPR, runs $128 to $135 a dose, or around $400 for the full course, but it’s covered by many insurers, and Vaccines for Children, a federal program, provides it free for qualified patients.

The CDC’s goal is to get 80 percent of adolescents fully vaccinated. CDC Director Dr. Thomas Friedan told NPR, “Of girls alive today between the ages of zero and 13, there will be 50,000 more cases of cancer if we don't increase the rates to 80%. And for every single year we delay in getting to 80%, another 4,400 women are going to develop cervical cancer in their lifetimes — even with good screening programs."

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Posted On: June 21, 2013

Bicycle Helmets Save Lives and Brains

Riding a bicycle without a proper helmet is a no brainer—that is, you risk losing your brain if you fall off a bike with an unprotected head.

Now, a new study published in the Journal of Pediatrics confirms the common sense of always wearing a helmet. It says that bike helmet laws seem to prevent more head injuries and deaths than formerly believed, a conclusion that contradicts another study questioning the safety value of bicycle helmet legislation.

As interpreted on AboutLawsuits.com, the Pediatrics research analyzed data from the Fatality Analysis Reporting System (FARS) of bicyclists younger than 16 who died between 1999 and 2010. FARS is a nationwide census providing the National Highway Traffic Safety Administration (NHTSA), Congress and the public with yearly data about fatal injuries suffered in motor vehicle traffic crashes.

Those data indicated that states with mandatory bike helmet laws had a 20% lower fatality rate than those that didn’t.

But a study published in the British Medical Journal (BMJ) that analyzed Canadian laws between 1994 and 2003 found no effect of bike helmet laws on child fatalities. (It defined young people as those younger than 18.)

Although that study concluded that injury rates declined in provinces that had bike helmet requirements, researchers said the decrease wasn’t the result of helmet laws because injury rates had begun to decline when the legislation was enacted, and they didn’t continue to decline after the laws were in place.

The BMJ researchers attributed the lower injury numbers to improved public education about bike safety, safe-riding media campaigns and wider availability of subsidized helmets.

But let’s look at that conclusion with a critical eye: Doesn’t it logically follow that if you are a better informed cyclist you understand the necessity of wearing a helmet? Why would authorities subsidize helmets if they weren’t clearly protective, if there wasn’t a clear benefit?

More than 900 people die each year from bicycle collisions, according to AboutLawsuits, and about 3 in 4 of those fatalities were caused by a head injury.

Every bicyclist, young or old, should wear a helmet. Parents should set the right example by wearing a helmet when they ride, and they should require their kids to wear one from the first time they get on a trike.

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Posted On: June 14, 2013

Drowning Victims Don’t Look Like They’re in Trouble

It’s summer, and time for a reminder that drowning is the No. 2 cause of accidental death in children 15 and younger (No. 1 is vehicle accidents). Astonishingly, about half the children who will drown in a year, according to a story on Slate.com reprinted from a blog by Mario Vittone, will do so within 25 yards of a parent or other adult.

How is this possible? Isn’t it obvious when someone is in trouble in the water? Doesn’t he or she thrash, struggle and yell for help?

Actually, no; as the story says, “Drowning is almost always a deceptively quiet event. The waving, splashing and yelling that dramatic conditioning (television) prepares us to look for is rarely seen in real life.”

The reason is physiology. The instinctive drowning response, a term coined by Francesco A. Pia, Ph.D., is how people respond when they are suffocating in the water. As Pia describes in an article in On Scene: The Journal of the U.S. Coast Guard Search and Rescue, it looks like this:

1. Except in rare circumstances, drowning people are unable to yell for help. The respiratory system was designed for breathing, and if you can’t breathe, your body makes speech a secondary concern. You have to breathe before you can talk.

2. Drowning people’s mouths alternately sink below and reappear above the surface of the water. Your mouth is not above the surface of the water long enough for you to exhale, inhale and yell for help. You have time only to exhale and inhale before your mouth starts to sink below the surface of the water.

3. Drowning people can’t wave for help. Instinct forces you to extend your arms laterally and press down on the water’s surface to leverage your body so you can lift your mouth out of the water to breathe.

4. During the instinctive drowning response, you can’t voluntarily control your arm movements. If you’re struggling on the surface, you can’t wave for help, move toward a rescuer or reach out for a piece of rescue equipment.

5. From beginning to end of the instinctive drowning response your body remains upright in the water, with no evidence of a supporting leg kick. Unless rescued by a trained person, you can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

Children are particularly at risk, because they generally last only as long as 20 or 30 seconds in the instinctive drowning response.

Someone in the water who is yelling for help and thrashing probably is in real trouble, just not usually the end stages of it. They might be in aquatic distress, which doesn’t always precede the instinctive drowning response, and also doesn’t last long. Unlike true drowning, Vittone writes, these victims still can assist in their own rescue by grabbing grab lifelines, for example. But people nearby have to pay attention—there isn’t much time to help.

Other signs that people in the water are in danger of drowning:


  • head low in the water, mouth at water level

  • head tilted back with mouth open

  • eyes glassy and empty, unable to focus

  • eyes closed

  • hair over forehead or eyes

  • not using legs; vertical body position

  • hyperventilating or gasping

  • trying unsuccessfully to swim in a particular direction

  • trying to roll over on the back

  • appear to be climbing an invisible ladder

So vigilance is key—drowning people don’t usually look like they’re in trouble. They might just look like they are treading water. To find out, ask the person, “Are you all right?” If you get a vocal response, it’s probably OK. If you get a blank stare, you might have fewer than 30 seconds to get to them. Parents should remember that children playing in the water make noise. If they go quiet, get to them quickly.

For other pool safety tips, see our blog, “Surviving the Drowning Season.”

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Posted On: June 7, 2013

Well-Child Visits Help Keep Kids Out of the Hospital

We have been among the voices raised against the overuse and abuse of medical resources (here and here, for example), but sometimes medical attention is wholly appropriate even without symptoms or complaints.

When it comes to kids, according to a new study in the American Journal of Managed Care, regularly scheduled doctor visits even in the absence of a problem might well be wise. Young children who missed more than half of their recommended well-child visits, the study concludes, had as much as twice the risk of hospitalization compared with children who attended theirs.

Not surprising was the fact that kids with chronic conditions such as asthma and heart disease and who missed their recommended appointments had as much as three times the risk of being hospitalized as those with chronic conditions who were seen as recommended.

The study involved more than 20,000 children enrolled in Group Health Cooperative, a large health-care system in Seattle, from 1999 to 2006. The study followed the subjects from birth to age 3 1/2 or until their first hospital stay, whichever came first.

As quoted in a story on ScienceDaily.com, lead study author Dr. Jeffrey Tom, said, "Well-child visits are important because this is where children receive preventive immunizations and develop a relationship with their provider. These visits allow providers to identify health problems early and help to manage those problems so the children are less likely to end up in the hospital."

It goes without saying (although the study made it clear) that regular, preventive care for children with special needs and chronic conditions is even more important because of possible complications.

Most children in the study—3 in 4—attended at least 3 in 4 of their recommended visits. But this could be such a high percentage because Group Health coverage required no copayment for such visits. The authors acknowledge that the lack of a financial burden, even a small one, is an important incentive to maintaining a recommended medical visit schedule.

Four in 100 children in the study, and 9 in 100 of them with a chronic condition, were hospitalized. The two most common reasons for hospitalization in both groups, according to Science Daily, were pneumonia and asthma.

Children who missed more than half of their visits had as much as twice the risk of hospitalization compared with those who attended most of theirs. Children with chronic conditions who missed more than half of their visits had nearly twice to more than three times the risk of hospitalization compared with those who attended most of their visits.

During the study period, Group Health recommended nine well-child visits between birth and 3 1/2 years of age: the first at 3 to 5 days old, then at 1, 2, 4, 6, 10 and 15 months, and at 2 and 3 ½ years.

Although the study is very clear about the value of well-baby visits, a huge consideration is that the findings might not apply to all health systems. Group Health is an integrated health-care system, or one where care is well-coordinated as a person ages or a disorder progresses. Also, most of the study’s subjects attended most of their well-child visits and belong to affluent, well-educated families. Although some research studies can adjust for certain variables within the population they study, this one couldn’t adjust for income, education, race, or ethnicity.

And of course there is no absolute cause-and-effect conclusion that missing well-child visits increases the chances of hospitalization. But it’s pretty clear that there’s an important association. In addition to well-baby visits providing the opportunity for preventive care, Science Daily notes that parents who miss well-child visits are probably less likely to manage their kids' illnesses and follow treatment regimens, which could result in higher rates of hospitalization for the children.

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