Clinical Inquiries, 2017
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Item Which interventions are effective in managing parental vaccine refusal?(Family Physicians Inquiries Network, 2017) Brelsford, Dan; Knutzen, Elise; Neher, Jon O.; Safranek, SarahQ: Which interventions are effective in managing parental vaccine refusal? A: it's unclear whether educational initiatives alone alter vaccine refusal. Although about a third of parents cite herd immunity as motivation for vaccination, its efficacy in addressing vaccine hesitancy isn't clear (strength of recommendation [SOR]: B, systematic reviews not limited to randomized controlled trials [RCTs]). ultifaceted interventions (encompassing improved access to vaccines, immunization mandates, and patient education) may produce a ≥25% increase in vaccine uptake in groups with vaccine hesitancy and low utilization (SOR: B, extrapolated from a meta-analysis across di-verse cultures).Correcting false information about influenza vaccination improves perceptions about the vaccine, but may decrease intention to vaccinate in parents who already have strong concerns about safety (SOR: C, low-quality RCT). Discussions about vaccines that are more paternalistic (presumptive rather than participatory) are associated with higher vaccination rates, but lower visit satisfaction (SOR: C, observational study). Providers should thoroughly address patient concerns about safety and encourage vaccine use (SOR: C, expert opinion).Item What is the optimal frequency for dental checkups for children and adults?(Family Physicians Inquiries Network, 2017) Hahn, Thomas W.; Kraus, Connie; Hooper-Lane, ChristopherQ: What is the optimal frequency for dental checkups for children and adults? A: It is unclear, but studies suggest that it should be based largely on individual risk. The American Academy of Pediatric Dentistry recommends a 6-month interval for preventive dental visits (strength of recommendation [SOR]: C, expert opinion), but a 24-month interval does not result in an increased incidence of dental caries in healthy children and young adults or increased incidence of gingivitis in healthy adults (SOR: B, a single randomized controlled trial [RCT]). In adults with risk factors (eg, smoking or diabetes), visits at 6-month intervals are associated with a lower incidence of tooth loss (SOR: C, a retrospective cohort study). Children with risk factors (eg, caries) may benefit from a first dental visit by age 3 years (SOR: C, a retrospective cohort study).Item Are oral emergency contraceptives a safe & effective form of long-term birth control?(Family Physicians Inquiries Network, 2017) Kraus, Connie; Hooper-Lane, ChristopherQ: Are oral emergency contraceptives a safe & effective form of long-term birth control? A: Yes, but not as effective as some other methods. Annual pregnancy rates in women using pericoital levonor- gestrel 150 mcg to 1 mg range from 4.9% to 8.9%; menstrual irregularity is the most common adverse effect (strength of recommendation [SOR]: B, Cochrane review of lower-quality trials). In women younger than 35 years who have sexual intercourse 6 or fewer times per month, correct and consistent use of pericoital levonorgestrel 1.5 mg results in an annual pregnancy rate of 11% (SOR:B,one large prospective, open-label trial). Pericoital contraception is less effective than long-acting reversible contraceptives (annual pregnancy rates of 0.05%-0.8%) or perfect use of combined oral contraceptives (0.3% annual pregnancy rate), but similar to, or better than, typical use of combined oral contraception (9%) and condoms (18%).Item What is the most effective treatment for scabies?(Family Physicians Inquiries Network, 2017) Campbell, Jonathon J.; Paulson, Christopher P.; Nashelsky, Joan; Guthmann, RickQ: What is the most effective treatment for scabies? Evidence-based answer: Topical permethrin is the most effective treatment for classic scabies (strength of recommendation [SOR]: A, meta-analyses with consistent results). Topical lindane and crotamiton are inferior to permethrin but appear equivalent to each other and benzyl benzoate, sulfur, and natural synergized pyrethrins (SOR: B, limited randomized trials). Although not as effective as topical permethrin, oral ivermectin is an effective treatment compared with placebo (SOR: B,a single small randomized trial). Oral ivermectin may reduce the prevalence of scabies at one year in populations with endemic disease more than topical permethrin (SOR: B, a single randomized trial).Item What effects -- if any -- does marijuana use during pregnancy have on the fetus or child?(Family Physicians Inquiries Network, 2017) Zhang, Angela; Marshall, Robert; Kelsberg, Gary; Safranek, Sarah; Neher, JonQ: What effects -- if any -- does marijuana use during pregnancy have on the fetus or child? Evidence-based answer: The effects are unclear. Marijuana use during pregnancy is associated with clinically unimportant lower birth weights (growth differences of approximately 100 g), but no differences in preterm births or congenital anomalies (strength of recommendation [SOR]: B, prospective and retrospective cohort studies with methodologic flaws). Similarly, prenatal marijuana use isn't associated with differences in neurodevelopmental outcomes (behavior problems, intellect, visual perception, language, or sustained attention and memory tasks) at birth, in the neonatal period, or in childhood through age 3 years. However, it may be associated with minimally lower verbal/quantitative IQ scores (1%) at age 6 years and increased impulsivity and hyperactivity (1%) at 10 years. Prenatal use isn't linked to increased substance use at age 14 years (SOR: B, conflicting long-term prospective and retrospective cohort studies with methodologic flaws).