Diagnosis and testing practices for adolescent pertussis among a national sample of primary care physicians
Child Health Evaluation and Research Unit, University of Michigan, 300 North Ingalls, Ann Arbor, MI 48109-5456, USA. Preventive Medicine
(Impact Factor: 3.09).
04/2009; 48(5):500-4. DOI: 10.1016/j.ypmed.2009.02.020
Adolescents are a primary reservoir for propagating pertussis infection. This study aimed to describe diagnosis and testing practices for adolescent pertussis among a national sample of primary care physicians.
From January to March, 2007 we administered a written survey to a United States sample of American Medical Association physicians that included 725 family practitioners (FPs) and 725 general pediatricians (PDs).
Response rate was 60% (n=702). Overall, 16% of respondents indicated that they did not test adolescents for pertussis as part of their clinical practice. A similar proportion did not recognize the clinical manifestations of pertussis in a standardized adolescent case patient. FPs were less likely than PDs to test for pertussis in general and to diagnose the case patient with pertussis. Barriers to testing adolescents for pertussis included delay in obtaining test results (52%), inconvenience of sample collection (29%), lack of testing supplies (29%), lack of familiarity with testing protocols (28%) and cost (22%).
Our results suggest that a substantial number of primary care physicians do not utilize pertussis testing and may not be able to recognize the clinical symptoms of this infection in adolescents. Interventions to improve physician knowledge about this important public health issue may be warranted.
Available from: Diana gomez-barroso
- "This could be achieved by implementing a sentinel network of paediatricians and primary-care physicians that could act on the underreporting issue. It is estimated that between 47% and 80% among adults with whooping cough are misdiagnosed due to presenting with only mild clinical symptoms making it necessary to establish a proper differential diagnosis with other upper respiratory tract diseases and other sometimes forgotten, clinically similar infections (Moretti et al., 2000; Guinto-Ocampo et al., 2008; Dempsey et al., 2009). Serology would contribute to a correct diagnosis . "
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ABSTRACT: A retrospective, space-time study of whooping cough cases reported to the Public Health Agency of Barcelona, Spain between the years 2000 and 2011 is presented. It is based on 633 individual whooping cough cases and the 2006 population census from the Spanish National Statistics Institute, stratified by age and sex at the census tract level. Cluster identification was attempted using space-time scan statistic assuming a Poisson distribution and restricting temporal extent to 7 days and spatial distance to 500 m. Statistical calculations were performed with Stata 11 and SatScan and mapping was performed with ArcGis 10.0. Only clusters showing statistical significance (P <0.05) were mapped. The most likely cluster identified included five census tracts located in three neighbourhoods in central Barcelona during the week from 17 to 23 August 2011. This cluster included five cases compared with the expected level of 0.0021 (relative risk = 2436, P <0.001). In addition, 11 secondary significant space-time clusters were detected with secondary clusters occurring at different times and localizations. Spatial statistics is felt to be useful by complementing epidemiological surveillance systems through visualizing excess in the number of cases in space and time and thus increase the possibility of identifying outbreaks not reported by the surveillance system.
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ABSTRACT: This study investigates the predictive validity of the In-Training Examination (ITE). Although studies have confirmed the predictive validity of ITEs in other medical specialties, no study has been done for general pediatrics.
Each year, residents in accredited pediatric training programs take the ITE as a self-assessment instrument. The ITE is similar to the American Board of Pediatrics General Pediatrics Certifying Examination. First-time takers of the certifying examination over a 5-year period who took at least 1 ITE examination were included in the sample. Regression models analyzed the predictive value of the ITE.
The predictive power of the ITE in the first training year is minimal. However, the predictive power of the ITE increases each year, providing the greatest power in the third year of training.
Even though ITE scores provide information regarding the likelihood of passing the certification examination, the data should be used with caution, particularly in the first training year. Other factors also must be considered when predicting performance on the certification examination. This study continues to support the ITE as an assessment tool for program directors, as well as a means of providing residents with feedback regarding their acquisition of pediatric knowledge.
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