There’s often a social and emotional element with teen acne and the symptoms can vary with age, heredity and habits. “In some cases, teenagers have unrealistic expectations for the treatment and as such, they sometimes don’t stick with the treatments long enough to see the results. This is an ongoing challenge for dermatologists to better educate their young patients and manage expectations for the best long-term results.

Understanding Acne

Although acne is not new and almost every teenager has it at one point in their lives, the exact cause of acne remains unknown. In broad strokes it is caused by a couple of related factors. They include the rise in male sex hormones occurring in all teens, which transmits the sebaceous (oil) glands into overdrive. Another factor is heredity: in most cases, pimply teens have at least one parent with their own history of acne. In addition, other influencers for acne typical for many adolescents include psychological stress, makeup/cosmetics (too much or unsuitable makeup and moisturizers with acne inducing ingredients), pressure or irritation from sports equipment, environmental exposures, and overly fervent cleaning and scrubbing. Lastly, diet and nutrition also likely play a role in causing acne, though additional research is needed in this area.

Treatment Alternatives for Teens

The typical first step of acne treatment for teens is topical medications. The most conventional nonprescription alternatives are benzoyl peroxide, mild acids like salicylic acid, and sulfur-based products. If results aren’t seen from topical nonprescription medications, dermatologists will recommend prescription-strength topical medications such as topical antibiotics, sulfur based products and retinoids (derivatives of Vitamin A) such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac). Each of these medications come in gels, lotions, creams, soaps, liquids, and pads, so the patient can choose what they prefer. The catch is that all of these treatments necessitate compliance, meaning that the teenage patient needs to be diligent and consistent in using them for positive results.

It is typical when treating teen acne that sometimes things get worse before they get better. The reason this happens is that the medications accelerate the life cycle of all the pimples, including tiny pimples that would have taken longer to come to a head without the medicine. Also, it’s easy to over-use topical acne medicines, particularly by teenagers who are hoping for a faster resolution of their acne. In most cases, acne medications need to be used in small amounts to avoid dryness, irritation, burning, or redness. When patients incorrectly use acne medication they can become discouraged and quit using the medications before they’ve had a chance to work. Lastly, some acne medications may interact with the sun. The dermatologist needs to educate patients about the best ways to minimize and manage the side effects.

When nonprescription and prescription topical medications aren’t providing the desired results, stronger options include prescription oral medications: antibiotics such as Doxycycline and oral retinoids, (isotretinoin (Sotret, Claravis, Amnesteem, formerly sold as Accutane), and hormonal therapy (birth control pills and spironolactone). As with any pill, these drugs must be taken as prescribed. Sometimes this is challenging for teenagers. However, some teens favor pills to creams since there is a perception that they are easier to use. “We find that sometimes the adolescent who won’t use topical medications will be particularly compliant with oral medicines.

Dermatologists have additional tools for treating teen acne. Sometimes in-office procedures such as laser or light therapy, acne surgery and corticosteroid injections for large or painful pimples can be helpful. These procedures don’t require compliance (with the exception of making it to the appointments), and as a result they are often a good choice for teen patients.

In some situations, adolescent acne is precipitated by psychological issues. Studies have shown that stress can exacerbate acne. Moreover, research has shown that having acne can create or worsen depression and social anxiety.” Regrettably being depressed or anxious can substantially affect a patient’s compliance with a treatment plan.

The good news for teenagers is that there are more options today for treating teen acne than ever before. With the help of a dermatologists and compliance with the treatment plan, improvement and minimization of acne can be achieved.

Loretta Pratt, MD, is board-certified in Internal Medicine and Dermatology. She is in practice with Advanced Dermatology PC in Chadds Ford, PA.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com

I

“Mucus and phlegm get sort of a bad reputation,” says Dr. Richard Boucher, a lung expert at the University of North Carolina, in the National Institutes of Health newsletter NIH News in Health. “People think about it as something you’re supposed to cough up and get out, that it’s a bad thing. But in truth, mucus really is the interface between you and the outside world.”

Mucus lines the moist surfaces of your body like the lungs, sinuses, mouth, stomach, and intestines. Even your eyes are coated with a thin layer of mucus. It serves as a lubricant to keep tissues from drying out.

Mucus is also very important for filtering out materials that you breathe in through your nose, such as dust and allergens and microorganisms,” says Dr. Andrew Lane, an ear, nose, and throat expert at Johns Hopkins University. “Anything that you breathe in gets stuck in the mucus.

In the next hour, you’re going to inhale thousands of bacteria. But you’ll never know it. Bacteria land on the mucus-lined surface of the lungs and get trapped. Then little hairs called cilia go to work. They push the mucus up and out of the lungs with all the trapped bacteria, viruses, and dust.

“It comes up at sort of a nice slow rate to the back of the throat,” Boucher says. “And if you’re normal and healthy, you never feel it.”

The mucus, together with the bacteria and other trapped substances, then goes to the stomach and eventually pass out of the body.

Our body makes a lot of mucus, although no one’s quite sure how much. Mucus is mostly water. But it also contains special proteins, sugars, and molecules that help the body control harmful germs.

You usually only notice mucus only when you’re making too much of it, or if it changes consistency.

An infection can make mucus thicker and stickier. Infections also lead to inflammation in the mucous membranes that line the nose and the rest of your airway. This can cause certain airway glands to make more mucus. That mucus can get thick with bacteria and cells that arrive to fight the infection. That can stimulate even more mucus production.

“When mucus is particularly excessive, it can be bothersome in terms of runny nose, clogged nose, and post-nasal drip,” says Dr. Bruce Bochner, an allergy expert at Northwestern University. Post-nasal drip is when excess mucus from the back of the nose gathers and drips down the back of the throat. It’s a common cause of a cough.

Allergies can also cause your body to make extra mucus. When you have an allergy, your immune system overreacts to a harmless substance, like pollen, dust, or animal dander. Cells in your airway then release substances, like histamine.

Histamine can make you sneeze. It also causes the mucous membranes in the nose to swell and the glands to make more mucus. Bochner’s team studies how certain proteins on immune cells control allergies and inflammation. They’re also looking at how certain components of mucus might help fight inflammation.

Your body usually makes thicker mucus when you have a cold (caused by viruses) or sinus infection (caused by bacteria).

Most mucus problems are temporary. But producing too much mucus contributes to some serious conditions. This includes cystic fibrosis, a genetic disorder that causes mucus in the lungs to become thick and glue-like.

Mucus can come in a range of colors. This won’t surprise you if you’ve ever looked closely at your tissues after blowing your nose. During a cold, you may find that it is cloudy or yellowish. Proteins released by the cells that cause inflammation can get stuck in the mucus and give it this color, Lane explains. He’s currently studying how cells in the nose and sinus are involved in long-term inflammation, called chronic sinusitis.

Brown or black mucus is more common in heavy smokers and some types of lung disease. Greenish, brownish, or bloody colors may signal a bacterial infection.

But that’s not always the case. It can be difficult to figure out what’s wrong simply by your mucus color. Since many things can cause your body to make too much mucus, doctors rely on other clues to diagnose and treat the problem.

Experts offer these tips for when you have too much mucus:

Use a humidifier or vaporizer. Keeping your nose and throat moist may reduce mucus and phlegm production.

Apply a warm, moist washcloth to your face.

Try a nasal saline spray or rinse. Clearing out mucus can help you breathe easier. Commercial products are available. If making your own, only use distilled, sterile, or previously boiled water.

Consider taking over-the-counter medications. Expectorants can thin mucus to help clear it from your chest. Decongestants shrink blood vessels, so you produce less mucus. (Be careful about overusing them, as they can make the problem worse.) Antihistamines can help if your mucus is caused by allergies.

Talk with your health care provider if your runny nose or congestion lasts more than three weeks or occurs with a fever.

Now, researchers say, it appears that the age of the father has an impact as well on both mother and infant.

In a study published in The BMJ, researchers from Stanford University looked at data on 40,529,905 births that took place in the U.S. between 2007 and 2016. They found that as the age of the father increased, so did the risk of the infant being born prematurely, having a low birth weight, and requiring post-natal support such as assisted ventilation, admission to neonatal intensive care, or antibiotics.

After adjusting for age of the mother, maternal smoking, race, education, and number of prenatal visits, the investigators made these observations:

• Children of fathers aged 45 years or more were born 0.12 weeks earlier and with a 14% higher odds of being premature (less than 37 weeks) compared to those whose fathers were aged 25 to 34 years.
• Children of fathers aged 45 years or more had a 14% greater risk of low birth weight (less than 5.5 lbs.) than infants born to younger fathers.
• Infants with fathers aged 45 years or more also had 14% higher odds of being admitted to a neonatal intensive care unit and 18% higher odds of having seizures, compared with infants with fathers aged 25 to 34 years.
• If the father was aged 55 years or older, newborns also tended to score less well on the Apgar test, a test used to quickly assess the health of a child at birth.
• The risk of gestational diabetes for pregnant women also increased in line with the age of the father, with women carrying the child of a man aged 55 years or older having 34% higher odds of gestational diabetes.

“A significant number of these negative outcomes might have been prevented if older fathers had elected to have children before 45.”

However, the researchers stressed that because the study is only observational, they can’t draw any firm conclusions about cause and effect. Additionally, they said that the overall risk of negative outcomes probably still remains low. Despite that, the researchers concluded, advanced paternal age is linked with negative effects on mothers and infants.

“A significant number of these negative birth outcomes might have been prevented if older fathers had elected to have children before the age of 45 years. The risks associated with advancing paternal age should be included in discussions regarding family planning and reproductive counseling,” they wrote.

In the U.S., the number of first births to women older than 35 years has risen by about two percent annually since the 1970s, and the percentage of all births in the US to fathers aged more than 40 has doubled to nine percent over the same period.

An estimated six million American children have attention deficit hyperactivity disorder (ADHD)—and about 60% of those cases will carry on into adulthood. But have you heard about Nature Deficit Disorder? It has the potential to affect as many if not more children than ADHD, and worse, a larger number of adults…could you have it?

Coined by author and nature lover Richard Louv in 2005, Nature Deficit Disorder is not really a medical condition. It’s more of an all-encompassing term used to describe the phenomenon of modern lifestyles leading people farther and farther from nature—and suffering the consequences.

One of the main causes of Nature Deficit Disorder is excessive technology use.

In other words, we’re spending far too much time lost in our phones, scrolling on our computers, and swiping away at our tablets. Today’s children, dubbed “iGen,” spend an average of six and a half hours per day in front of a screen…that’s up from only three hours a day in 1995.

If you’re thinking phew, I’m glad I’m not a kid anymore—don’t get too comfortable. Adults spend even more time looking at screens. CNN reports that American adults, on average, clock in more than ten hours of screen time each day, with nearly two hours of that time spent on digital media platforms.

By the end of their lives, most adults will have spent about five years on social media.

Technology use is so ubiquitous that many people don’t even realize how much time they actually spend wrapped up in their devices—and how little time they spend in the great outdoors. That time adds up, and both children and adults miss out on the physical and mental relief that nature has to offer.

According to Louv and other Nature Deficit Disorder subscribers, the resulting effect on health can be severe. Heart conditions, diabetes, obesity, near-sightedness, asthma, anxiety, and depression are among the many increasingly common disorders that can be linked to NDD. Even ADHD can be linked to NDD, as studies have found that screen time can increase a child’s risk of developing ADHD, while time spent in nature can decrease a child’s risk.

Other factors like increased urbanization, a lack of green spaces in cities, and limited public transportation to wilderness areas only compound these issues, making it difficult for people to access nature even if they try to.

Many organizations have made it their mission to close this gap with urban youth, offering programs that provide low-cost or free opportunities to engage with nature. The Fresh Air Fund provides low-income children form New York City the opportunity to attend free sleepaway camp in the woods of upstate New York. In Washington, D.C., low-income youth have the change to spend weekends, vacations, and summers in nature with CityKids, a program that provides wilderness enrichment in the form of bicycle rides, hiking trips, and even a summer-long stay at a ranch in Wyoming. But for adults, similar assistance—and time—can be hard to find.

One coping mechanism adapted by adults is a “digital diet.”

The idea behind these quick fixes is that even when you aren’t able to access nature directly, you can still take measures to offset some of the negative side effects of Nature Deficit Disorder by decreasing your technology use. Digital diets aren’t just a new-wave health craze…take it from the tech experts themselves.

Apple, Google, Intel, and Facebook are just a few of the many leading companies that have top-level executives taking regular digital diets, limiting their children’s screen time, and setting other boundaries for technology use.

So while it might hurt to admit that you are a technology “user,” digital diets remind us that taking preventative measures against Nature Deficit Disorder is as simple as stepping back, unplugging, and opening up your senses to the endless other offerings the natural world has to offer.

Previous studies have demonstrated that insufficient sleep among youth can result in learning difficulties, impaired judgment and risk of adverse health behaviors. This newest study, published in a JAMA Pediatrics research letter on October 1, found an association between sleep duration and personal safety risk-taking actions.

Adolescents require 8-10 hours of sleep at night for optimal health, according to sleep experts, yet more than 70 percent of high school students get less than that.

“We found the odds of unsafe behavior by high school students increased significantly with fewer hours of sleep,” said lead author Mathew Weaver, PhD, research fellow, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital. “Personal risk-taking behaviors are common precursors to accidents and suicides, which are the leading causes of death among teens and have important implications for the health and safety of high school students nationally.”

Compared to students who reported sleeping eight hours at night, high school students who slept fewer than six hours were twice as likely to self-report using alcohol, tobacco, marijuana or other drugs, and driving after drinking alcohol. They were also nearly twice as likely to report carrying a weapon or being in a fight.

The strongest associations, researchers found, were related to mood and self- harm. Those who slept less than six hours were more than three times as likely to consider or attempt suicide, and four times as likely to attempt suicide, resulting in treatment. Only 30 percent of the students in the study reported averaging more than eight hours of sleep on school nights.

The Youth Risk Behavior Surveys are administered biannually by the U.S. Centers for Disease Control and Prevention (CDC) at public and private schools across the country. Researchers used data from 67,615 high school students collected between 2007 and 2015. Personal safety risk-taking behaviors were examined individually and as composite categories. All analyses were weighted to account for the complex survey design and controlled for age, sex, race, and year of survey in mathematical models to test the association between sleep duration and each outcome of interest.

“Insufficient sleep in youth raises multiple public health concerns, including mental health, substance abuse, and motor vehicle crashes,” said senior author Elizabeth Klerman, MD, PhD, director of the Analytic Modeling Unit, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital. “More research is needed to determine the specific relationships between sleep and personal safety risk-taking behaviors. We should support efforts to promote healthy sleep habits and decrease barriers to sufficient sleep in this vulnerable population.”

The study, from investigators in the Center for Injury Research and Policy at Nationwide Children’s Hospitals, was published online in September 2018 in Pediatrics. The study examined characteristics of injuries related to infant walkers and evaluated the effect of the 2010 federal mandatory safety standard on these injuries.

The analysis found that more than 230,000 children younger than 15 months old were treated in hospital emergency departments in the US for infant walker-related injuries from 1990 through 2014. The number of infant walker-related injuries decreased dramatically during the study period, dropping from 20,650 in 1990 to 2,001 in 2014. The overall reduction in injuries was primarily due to a decline in falls down stairs, according to a news release from Nationwide Children’s Hospitals.

The decrease in stair falls was attributable in part to the implementation of safety standards that required changes to the way infant walkers are designed. In 1997, a voluntary safety standard was adopted that required infant walkers to be wider than a standard doorway or to have a mechanism that would cause it to stop if one or more of the wheels dropped over the edge of a step.

Then, in June 2010, the U.S. Consumer Product Safety Commission (CPSC) issued a mandatory safety standard that included more stringent requirements for infant walker design, standardized the evaluation method to prevent stair falls, and added a parking brake test. The mandatory safety standard also made it easier for the CPSC to stop non-complying infant walkers at entry points to the US before they entered the marketplace (all 10 kinds of infant walkers recalled between 2001 and 2010 were imported products).

While the greatest decrease in injuries occurred during the earlier years of the study, there was an additional 23% drop in injuries in the 4 years after the federal mandatory safety standard went into effect in 2010 compared with the prior 4 years. Researchers concluded that this reduction may, in part, be due to the standard as well as other factors such as decreased infant walker use and fewer older infant walkers in homes.

“The good news is that the number of infant walker-related injuries has continued to decrease substantially during the past 25 years,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “However, it is important for families to understand that these products are still causing serious injuries to young children and should not be used.”

Most of the injuries (91%) were to the head or neck, and about 30% of the injuries were concussions/closed head injuries or skull fractures, the news release said. The three leading causes of injuries were falls down stairs, falls out of the infant walker, and injuries that occurred because the infant walker gave the child access to something they wouldn’t normally be able to reach (mostly burns from hot objects).

“Infant walkers give quick mobility (up to 4 feet per second) to young children before they are developmentally ready. Despite the decrease in injuries over the years, there are still too many serious injuries occurring related to this product,” Smith said. “Because of this, we support the American Academy of Pediatrics’ call for a ban on the manufacture, sale, and importation of infant walkers in the U.S.”

The statistics for the study were obtained from the National Electronic Injury Surveillance System (NEISS) database, which is maintained by the CPSC. The NEISS database provides information about consumer product-related injuries treated in hospital emergency departments across the country.

Schools have a federally mandated 30 minutes of physical activity every day, but physical education offerings are dwindling, according to a news release from the University of Michigan.

A series of recent studies from the university found that two-minute bursts of in-class exercise breaks increased the amount of daily exercise for elementary children without hurting math performance. More importantly, when incorporated into classrooms across southeast Michigan, teachers found the breaks were doable and didn’t disrupt learning.

“What we’re showing is that we can give kids an additional 16 minutes of health-enhancing physical activity,” said Rebecca Hasson, principal investigator and one of the lead authors.

Hasson, U-M associate professor of kinesiology and nutritional sciences, is the director of the Childhood Disparities Research Laboratory, which collaborated on the five studies with the U-M schools of public health, education, and architecture and urban planning, and Project Healthy Schools, a statewide community-Michigan Medicine collaborative.

While 16 minutes doesn’t sound like much, it adds up, Hasson said. Kids are supposed to get an hour of exercise a day–30 minutes of that during school. Most don’t.

“Many kids don’t have PE every day but they might have recess, and if they get 10 more minutes of activity there, it would meet that school requirement,” Hasson said in the news release. “This doesn’t replace PE, it’s a supplement. We’re trying to create a culture of health throughout the entire school day, not just in the gym.”

The Active Class Space lab studies examined the effect of activity breaks on mood, cognition, appetite and overall physical activity of 39 children in Hasson’s lab. A study done in real classrooms tested the feasibility of implementing inPACT (Interrupting Prolonged sitting with ACTivity), the exercise program Hasson and her colleagues developed.

In the lab studies, kids ages 7-11 completed four experiments: eight hours of sitting, interrupted with two-minute low-, moderate- or high-intensity activity breaks, and eight hours of sitting interrupted with two minutes of sedentary screen time.

Findings show that when the sitting was interrupted with high-intensity activity breaks, children maintained their usual activity levels away from the laboratory, thereby burning an additional 150 calories a day without overeating. Unlike adults, children in the study didn’t compensate for the increased exercise by sitting around after school or by eating more, Hasson said.

While mood was higher immediately following the screen-time breaks compared to the activity breaks, children reported positive mood during both the sedentary and exercise conditions, and they subsequently rated the activity breaks as more fun.

And, after high-intensity activity, overweight and obese children enjoyed improved moods all day, Hasson said. This suggests children reflected upon the exercise and took more satisfaction in it.

All of the activity breaks elicited the same level of math performance, and when Hasson took the exercise breaks to real classrooms, teachers could do them.

“We got a lot of pushback at first. The fear was that teachers would be overloaded,” Hasson said. “Teachers get a lot of stuff thrown at them. Our experience was that teachers were all very positive about exercise. They know it’s good for the kids. They were open to the idea, but they needed more information on how to do it safely.”

U-M’s College of Architecture and Urban Planning and School of Education, along with Project Healthy Schools staff, helped design classrooms to accommodate exercise and to safely get kids exercising and then back to class work quickly.

“Teachers were worried it would make kids more rowdy, but 99 percent of kids were back on task within 30 seconds of doing activity breaks,” Hasson said. “We even had one teacher who did an activity break in the middle of a math exam–she realized the benefit of getting them up and moving.”

Hasson said there would be future studies with longer exercise breaks; researchers will gauge the impact of those breaks on students’ mood,

A release from the hospital quotes corresponding author Bruce Levy, MD, chief of the Division of Pulmonary and Critical Care Medicine, as saying, “Asthmatic patients are not identical. Asthma genetics and clinical characterization of patients have provided evidence for differences that have profoundly affected our approach to clinical care. But we still have an incomplete understanding of the origins of asthma, and only limited information is available on long-term asthma prognosis. No therapies are available to cure asthma, and there remains much work to be done.”

To model allergic lung inflammation in a dirty indoor environment, the team exposed a mouse model to a common environmental indoor allergen – house dust mite – as well as to endotoxin, a toxin released by bacterial cells. Exposure to both stimuli triggered complex lung inflammation, including a phenomenon known as lung NETosis.

In response to inflammatory triggers, white blood cells known as neutrophils form “neutrophil extracellular traps” (NETs). NETosis is the process by which NETs get activated and released. NETs can play a significant role in helping defend a host from invaders, but they can also cause organ injury and inflammation. Vital NETosis is a process in which neutrophils extrude their nuclear material, including DNA, to form NETs and then reseal their membranes to create cytoplasts – cells that lack a nucleus. Levy and colleagues found that in their model, NETosis and cytoplasts appeared to play a key role in triggering and amplifying an allergen-initiated neutrophilic immune response in lung inflammation.

In addition to studying animals, the team also examined samples of fluid from the lungs of human severe asthma patients, finding that a subset of patients had high neutrophil counts and detectable NETs and cytoplasts – important implications for how to design more precise clinical trials for severe asthma treatment.

Currently, clinical trials for new drugs to treat moderate and severe asthma do not stratify patients by neutrophil count or other important markers of inflammation. The team notes that markers of NETosis – including NETs and cytoplasts in sputum – may provide an opportunity to better tailor trials and treatments in subsets of asthma patients for future clinical research.

A release from the university quotes senior author Pejman Rohani, who has a joint appointment in the UGA College of Veterinary Medicine and the Odum School of Ecology, as saying, “This study is important in that it revealed that there has been no change to the epidemiology of pertussis that is causing the rise in the number of cases. Instead, it is a function of the way vaccines were administered over the decades. It is an effect that takes a long time to manifest.”

The release explains that pertussis is a respiratory infection caused by the bacterium Bordetella pertussis, which can cause serious infections in infants and young children. Routine vaccination for the disease began in the 1940s and led to a 100-fold decrease in the number of reported cases–to the point that the prospect of eliminating the disease seemed possible. But since the mid-1970s pertussis has made a comeback.

Rohani and his team examined long-term surveillance data from Massachusetts to try to understand why.

The most popular theory on the increase of pertussis cases is that the new generation of vaccines is somehow flawed, but Rohani and his colleagues saw no evidence to support that. Instead they found that today’s pertussis vaccines, like earlier ones, are largely very effective despite not providing 100 percent lifelong protection to those individuals who get vaccinated.

What they did discover was that high rates of vaccination when the vaccine was first introduced led to an overall decrease in transmission across the population. Even those who weren’t vaccinated were therefore less likely to contract the disease.

As vaccinated individuals age, however, the protection afforded by the vaccine begins to wear off in some cases. Furthermore, there are fewer and fewer people still alive who survived pertussis infections in the days before vaccination, and thus gained lifelong immunity.

This combination means that the number of people who are susceptible to contracting pertussis is slowly rising–setting the stage for an increase in the number of new cases, especially in older individuals. This is known as the “end of the honeymoon” period.

The results of this study will help to serve as a guide for future vaccination campaigns. The model identifies the core transmission group to be schoolchildren, so the researchers recommend that group should be the main focus of vaccination campaigns, rather than the current emphasis on vaccinating adults. Going forward researchers will further analyze the results of this study to assess the number and frequency of booster vaccines.

Besides Rohani, the paper’s co-authors are Matthieu Domenech de Cellès of the University of Michigan and the Institut Pasteur at the University of Versailles St-Quentin-en-Yvelines; Felicia Maria G. Magpantay of University of Michigan and University of Manitoba and Aaron A. King of the University of Michigan.

###

The research was supported by the National Institutes of Health (1R01AI101155) and by MIDAS, National Institute of General Medical Sciences U54-GM111274. The Massachusetts Department of Public Health provided data used in the study.

Reminders can be sent to patients, parents or guardians, or whole populations when vaccines are due, either because of age or other risk factors. Recalls are sent when vaccines are overdue. Reminders and recalls can be sent by letter, postcard, telephone call, computerized telephone call, or text message. They work by addressing the common reasons that immunizations may be missed, such as forgetting or missing appointments, not knowing immunization schedules, and having concerns about vaccinations. For reminders to be successful, vaccination records and contact information need to be accurate and up-to-date, the reminders need to be readable, and vaccination services need to be accessible.

A team of Cochrane researchers have updated a systematic review which summarizes the results of 75 studies from 10 countries including 55 studies involving 138, 625 children, adolescents and adults. Some studies contributed to more than one comparison in the review because they delivered interventions to more than one population of interest. There were 29 studies of reminders for routine immunizations in infants and children such as MMR and polio, 24 studies of influenza vaccination in adults, 12 studies of adolescent immunizations, 8 studies of routine immunizations in adults such as tetanus or hepatitis B, and 5 studies of influenza vaccination in children. Fifty-eight studies were performed in the US, the remainder were conducted in Australasia, Europe and Africa.

The studies looked at reminders sent by letter, telephone call, computerized telephone call, text message, or a combination of all these formats, and compared these with no reminders, media-based activities aimed at promoting immunizations, or simple general-practice-based immunization awareness campaigns.

The Cochrane researchers found that reminder and recall systems increase the number of children and adults receiving any kind of immunization. Reminding people that they have an upcoming vaccination probably increases the number of who receive vaccinations. Based on the results from combining studies in adults and children, about 8% more people received a vaccination following a reminder compared with no reminder. Similar results were found in children and adults when they were analysed separately. The researchers noted variation in the results of the studies and the difference in the effect of reminders could vary when used in different settings.

There is high quality evidence that postcards, text messages and computerized telephone calls are all effective methods for delivering reminders.

The release quotes lead Cochrane author, Julie Jacobson Vann from The University of North Carolina at Chapel Hill School of Nursing as saying, “The evidence shows that reminding people to have vaccinations increases the number of people who receive vaccinations. All types of patient reminder and recall are likely to be effective, and reminding people over the telephone was most effective. Even a small effect of patient reminders and recalls, when scaled to a whole population, could have a large beneficial effect on public health.

“We have the technology to incorporate patient reminders and recall into routine primary care. Reminder and recall systems need to be tailored to each health service setting to maximize their effectiveness, for example person-to-person telephone reminders are effective, but they may also be more costly than other methods.”

“As technologies develop we need to consider how they can enhance reminder and recall interventions. For example, we need to learn more about the characteristics of the most effective centralized and text message interventions.”