<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3300"
                     title="Adult Smoking Hits Plateau"
                     score="0.015"
                     href="http://www.medpagetoday.com/PrimaryCare/Smoking/tb/22068?impressionId=1284025870491"
                     
      &lt;p&gt;One in five U.S. adults continues to smoke cigarettes  --  a percentage that hasn&apos;t budged since 2005  --  suggesting that more aggressive efforts are needed to reduce smoking-related diseases and deaths, the CDC said.&lt;/p&gt;
&lt;p&gt;Data from the 2009 National Health Interview Survey and the Behavioral Risk Factor Surveillance System (BRFSS) indicated that 20.6% of Americans 18 and older reported being current smokers, according to an early-release report in the CDC&apos;s &lt;em&gt;Morbidity and Mortality Weekly Report&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;In 2005, smoking prevalence stood at 20.9%  --  not significantly different from the 2009 figure or the rate for any year in between, according to the &lt;em&gt;MMWR&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;There has been no progress in reducing that number in five years,&quot; said Thomas Frieden, MD, director of CDC, in a conference call with reporters.&lt;/p&gt;
&lt;p&gt;Frieden said shrewd marketing by tobacco companies and stagnation in anti-smoking efforts have combined to stall a 40-year decline in smoking prevalence that began in 1964.&lt;/p&gt;
&lt;p&gt;He said full implementation of his agency&apos;s recommendations for state-level programs to reduce smoking would help resume progress toward elimination of smoking, but these have been underfunded  --  not necessarily because of the recession.&lt;/p&gt;
&lt;p&gt;&quot;Comprehensive evidence-based state programs are not being widely implemented,&quot; Frieden complained. &quot;Last year, states took in about $25 billion from tobacco taxes and the master settlement agreement [related to tobacco litigation], but spent only $700 million, about three cents of every dollar,&quot; on anti-smoking programs.&lt;/p&gt;
&lt;p&gt;He said spending 15 cents of each dollar in tobacco-related revenue could reduce the number of people who smoke by 5 million  --  shaving more than two percentage points off the national prevalence figure.&lt;/p&gt;
&lt;p&gt;Also, a separate &lt;em&gt;MMWR&lt;/em&gt; report based on National Health and Nutrition Examination Survey (NHANES) data found that some 88 million nonsmokers are exposed to secondhand smoke, as evidenced by serum levels of the nicotine metabolite cotinine.&lt;/p&gt;
&lt;p&gt;The prevalence of secondhand smoke exposure  --  at around four in 10 nonsmokers  --  has declined from 1999 to 2008, the study indicated, but it too appears to have hit a plateau.&lt;/p&gt;
&lt;p&gt;The NHANES data from 2007 to 2008 showed cotinine (at least 0.05 ng/mL) in 40.1% of nonsmokers, not significantly different from the 39.1% seen in the previous biennium or the 41.7% found in 2001 to 2002. In 1999 to 2000 the prevalence of cotinine in nonsmokers was 52.5%.&lt;/p&gt;
&lt;p&gt;Both studies also found that certain populations are more likely to inhale tobacco smoke  --  either by choice or through secondhand exposure.&lt;/p&gt;
&lt;p&gt;Current smokers  --  defined as those who reported having smoked at least 100 cigarettes in their lifetimes and were smoking regularly at the time they were interviewed  --  are more likely to be male, poor, non-Hispanic white or black, lacking a high school diploma, and living in the South or Midwest, the CDC reported.&lt;/p&gt;
&lt;p&gt;Secondhand smoke exposure was greatest in children and teens, males, and non-Hispanic blacks.&lt;/p&gt;
&lt;p&gt;Hispanic and Asian women, people with higher levels of education, and older adults continued to meet the Healthy People 2010 target of &amp;#8804;12% prevalence of smoking.&lt;/p&gt;
&lt;p&gt;While the CDC noted that smoking prevalence was lowest among Asian and Hispanic women, the current findings could not assess specific Asian and Hispanic subgroups.&lt;/p&gt;
&lt;p&gt;Frieden lambasted tobacco companies for &quot;sidestepping&quot; policies aimed at discouraging tobacco use, especially among young people.&lt;/p&gt;
&lt;p&gt;&quot;They insure that every cigarette they sell delivers nicotine quickly and efficiently to keep people addicted,&quot; he thundered. &quot;The industry uses targeted price discounts ... to get kids to start smoking,&quot; said Frieden.&lt;/p&gt;
&lt;p&gt;He also accused companies of targeting the youth market with flavored nicotine-laced lozenges &quot;to get around the ban on flavored cigarettes,&quot; as well as employing &quot;subtle and not-so-subtle ways&quot; to suggest some tobacco products are less harmful than others.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3302"
                     title="Cigarette Smoke May Affect Fertility (CME/CE)"
                     score="0.015"
                     href="http://www.medpagetoday.com/PrimaryCare/Smoking/tb/22069?impressionId=1284025870491"
                     
      &lt;p&gt;Smoking may provide an explanation for reduced fertility, results of two studies suggested.&lt;/p&gt;
&lt;p&gt;The first, by Claus Yding Andersen, MD, of the University of Copenhagen, and colleagues, found significant reductions in germ and somatic cells in the testes of male embryos from mothers who smoked during pregnancy, possibly related to the polycyclic aromatic hydrocarbons found in cigarette smoke.&lt;/p&gt;
&lt;p&gt;&quot;This effect may have long-term consequences on the future fertility of exposed offspring,&quot; the authors wrote online in &lt;em&gt;Human Reproduction&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The second study, by Mohamed Hammadeh, DVM, of Saarland University in Saarbr&amp;#252;cken, Germany, and colleagues, found that adult males who smoked had reduced levels of one of the proteins important in sperm formation. The findings were also published in &lt;em&gt;Human Reproduction&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Smoking male partners of couples facing infertility should be counseled to stop smoking,&quot; Hammadeh and his colleagues wrote.&lt;/p&gt;
&lt;p&gt;Andersen&apos;s group assessed the numbers of germ and somatic cells in the testes of 24 male embryos obtained following abortion during the first trimester (mean ages 37 to 68 days post-conception).&lt;/p&gt;
&lt;p&gt;According to self-report and confirmed by cotinine testing, fifteen of the mothers smoked during pregnancy. Median intake was 11 to 15 cigarettes a day.&lt;/p&gt;
&lt;p&gt;The smoking and nonsmoking mothers were similar in age, height, and body mass index.&lt;/p&gt;
&lt;p&gt;Compared with embryos from nonsmoking mothers, those from smoking mothers had significant reductions in germ cells (by 55%) and somatic cells (by 37%; &lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for both). The relationship was dose-dependent, with greater reductions associated with heavier smoking.&lt;/p&gt;
&lt;p&gt;The researchers combined the data from the current study with data on 28 female embryos from a previous study.&lt;/p&gt;
&lt;p&gt;Regardless of gender, there were still reductions in germ cells (by 41%) and somatic cells (by 29%) in embryonic gonads exposed to smoking in utero (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for both).&lt;/p&gt;
&lt;p&gt;The findings remained consistent after controlling for alcohol use and coffee consumption.&lt;/p&gt;
&lt;p&gt;The authors noted that the study could not determine whether the declines were permanent or a reflection of a growth delay that would be compensated for later in life.&lt;/p&gt;
&lt;p&gt;The study by Hammadeh and his colleagues evaluated the relationship between smoking and the formation of sperm  --  specifically the protamination process  --  among 53 heavy smokers (more than 20 cigarettes a day) and 63 nonsmokers. All were partners of a couple seeking treatment for infertility.&lt;/p&gt;
&lt;p&gt;Although smoking was not associated with semen volume or sperm concentration, smokers had significantly lower sperm vitality, motility, membrane integrity, and morphology (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 for all).&lt;/p&gt;
&lt;p&gt;The researchers also looked at levels of protamines 1 and 2, which are integral in sperm formation.&lt;/p&gt;
&lt;p&gt;Concentrations of protamine 2  --  but not protamine 1  --  were significantly lower in smokers (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05). Consequently, the P1/P2 ratio was greater in smokers (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;Cotinine levels and three oxidative stress biomarkers  --  reactive oxygen species, malondialdehyde, 8-hydroxyguanosine  --  were higher in smokers and correlated with P1/P2 ratios (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01 for all).&lt;/p&gt;
&lt;p&gt;The findings suggest that oxidative stress  --  which has been shown to be a major cause of male infertility  --  is greater in smokers, according to the researchers.&lt;/p&gt;
&lt;p&gt;The study provided support for the link between oxidative stress and infertility by showing that the oxidative stress biomarkers were significantly related to the percentages of sperm that had noncondensed chromatin and DNA fragmentation.&lt;/p&gt;
&lt;p&gt;&quot;Taken together, the results of the present study suggest a negative biological effect of smoking on spermatozoa DNA integrity and protamine distribution,&quot; the authors wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study by Andersen and colleagues was funded by the Danish Medical Research Council. The authors reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;Hammadeh and his colleagues did not report any funding sources or conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3314"
                     title="Sickle Cell Screening May Cause Harm (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/Genetics/GeneticTesting/tb/22082?impressionId=1284025870491"
                     
      A decision by the National Collegiate Athletic Association (NCAA) to require screening for sickle cell carrier status among Division I athletes ultimately may do more harm than good, researchers predict.&lt;br&gt;
&lt;br&gt;The screening program, which goes into effect in the current academic year, resulted from a lawsuit against the NCAA and Rice University following the death from acute exertional rhabdomyolysis of a 19-year-old boy after football practice, according to Vence L. Bonham, JD, of the National Human Genome Research Institute in Bethesda, Md., and colleagues.&lt;br&gt;
&lt;br&gt;Exertional rhabdomyolysis has been linked to carrying the sickle cell trait  --  having one S allele of beta-globin and one normal allele  --  the authors wrote in the Sept. 9 &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Other serious conditions that have been reported in carriers of the sickle cell trait include renal medullary carcinoma and splenic infarction  --  but these conditions are rare, Bonham and colleagues pointed out. Most sickle cell carriers are asymptomatic and have a normal life expectancy, they added.&lt;/p&gt;
&lt;p&gt;In background information provided by the authors, more than two million people in the U.S. were estimated to be carriers of the sickle cell trait  --  including roughly 8% of blacks, 0.5% of Hispanics, and 0.2% of whites.&lt;/p&gt;
&lt;p&gt;&quot;Thus, nearly all NCAA colleges and universities fielding multiple Division I teams will have students who test positive, and the screening program could identify 400 to 500 carriers each year,&quot; Bonham and co-authors wrote.&lt;/p&gt;
&lt;p&gt;Exercise-related sudden death is estimated to be 10 to 30 times higher among carriers, however, and in the 1970s large voluntary screening programs were organized.&lt;/p&gt;
&lt;p&gt;Unfortunately, no provisions were made for education and counseling, and the screening programs resulted in widespread confusion about important concerns such as the difference between sickle cell disease and carriage of the sickle cell trait. Most of those programs were later abandoned or altered, the authors noted.&lt;/p&gt;
&lt;p&gt;&quot;Although the NCAA program differs in scope and purpose from earlier programs, it shares the potential for unintended consequences,&quot; warned Bonham and colleagues.&lt;/p&gt;
&lt;p&gt;They expressed some specific concerns, including the following: &lt;ul&gt; &lt;li&gt;Assistance for athletes and families in decision-making and understanding the implications of test results&lt;/li&gt; &lt;li&gt;The need for follow-up testing to eliminate false positives&lt;/li&gt; &lt;li&gt;Privacy for students who test positive&lt;/li&gt; &lt;li&gt;Special concerns for minors&lt;/li&gt; &lt;li&gt;Implications of testing for students with athletic scholarships&lt;/li&gt; &lt;li&gt;Stigmatization of carriers&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;An earlier military program of testing for the sickle cell trait can be instructive, according to the authors.&lt;/p&gt;
&lt;p&gt;The screening program initially resulted in discrimination against carriers and soldiers who tested positive being prohibited from certain tasks, until research showed that some training modifications and attention to hydration could minimize the risks.&lt;/p&gt;
&lt;p&gt;Screening college athletes for the sickle cell trait also raises questions as to whether there will be additional testing in the future for other risky conditions  --  for example, inherited arrhythmia syndromes and cardiomyopathies  --  if better tests become available, Bonham and colleagues noted.&lt;/p&gt;
&lt;p&gt;&quot;Although the NCAA program may be an enlightened first step toward ensuring the health and well-being of student athletes, it could easily become subject to some of the perils that troubled earlier programs,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;An additional caution is that the screening program might be considered primarily a defensive legal move  --  because students can avoid testing if they can document previous screening or sign a waiver exempting the association and the university from liability.&lt;/p&gt;
&lt;p&gt;Perhaps, suggested the authors, the program should be considered an experiment that has implications for other screening programs and for sickle cell carriers worldwide.&lt;/p&gt;
&lt;p&gt;&quot;If it is indeed an experiment, the related data should be collected and analyzed rigorously, objectively, and transparently so that the costs and benefits of testing can be evaluated,&quot; they concluded.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;All authors declared no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3313"
                     title="ER First Choice for Many Seeking Care"
                     score="0.014"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/tb/22085?impressionId=1284025870491"
                     
      &lt;p&gt;WASHINGTON  --  Of the 354 million acute care visits patients made to healthcare providers over a three-year period, more than one-quarter took place in emergency rooms, representing a shift from the old days when general practitioners were the main providers of acute care.&lt;/p&gt;
&lt;p&gt;The study, which was published in the policy journal &lt;em&gt;Health Affairs&lt;/em&gt;, found that, in part because of office-based practitioners&apos; busy schedules, patients are increasingly going to the hospital for treatment for illnesses such as fever and stomach pain  --  ailments which used to be treated in a doctor&apos;s office.&lt;/p&gt;
&lt;p&gt;And fewer than half of all acute care visits involve the patient&apos;s personal physician, wrote the study authors, who were led by Stephen Pitts, MD, associate professor of emergency medicine at Emory University in Atlanta.&lt;/p&gt;
&lt;p&gt;Because most acute care visits took place in a non-primary care setting, only 42% of all visits involved a patient&apos;s personal physician.&lt;/p&gt;
&lt;p&gt;&quot;Americans&apos; access to primary care is in decline,&quot; the authors concluded.&lt;/p&gt;
&lt;p&gt;For the study, the researchers combined data from three large federal surveys of outpatient encounters to determine &quot;where, when, and why Americans seek treatment for acute health problems.&quot; The researchers determined whether the major reason for each visit was &quot;acute&quot; or not.&lt;/p&gt;
&lt;p&gt;They found that between 2001 and 2004, Americans made an average of more than a billion outpatient visits per year to doctors  --  which translates to a rate of 321 visits per 1,000 people per month.&lt;/p&gt;
&lt;p&gt;To compare, a 1961 study found that Americans made 250 &quot;illness visits&quot; per 1,000 adults each month.&lt;/p&gt;
&lt;p&gt;Acute care made up about one-third of all visits in the current study. Most of the visits were for nonacute care, including prenatal checks, physical exams, and managment of chronic diseases.&lt;/p&gt;
&lt;p&gt;Stomach and abdominal pain, chest pain, and fever topped the list for most common reasons for visiting the emergency department, while cough, sore throat, skin rash, and earache were the most common reasons for visiting a family physician&apos;s office.&lt;/p&gt;
&lt;p&gt;The study also broke down which types of doctors treated acute care patients and found: &lt;ul&gt; &lt;li&gt;28% of acute care visits were managed by hospital emergency departments&lt;/li&gt; &lt;li&gt;22% were managed family physicians&lt;/li&gt; &lt;li&gt;20% were managed by non-primary care office-based subspecialists&lt;/li&gt; &lt;li&gt;13% were managed by general pediatricians&lt;/li&gt; &lt;li&gt;10% were managed by general internists&lt;/li&gt; &lt;li&gt;7% were managed by hospital outpatient departments&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;&quot;Apparently, primary care physicians provide much less acute care than in the past,&quot; the authors concluded, adding that using emergency rooms for problems a primary care provider could treat is &quot;not desirable from a societal perspective.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Too often, emergency care is disconnected from patients&apos; ongoing healthcare needs,&quot; the authors wrote. &quot;Lack of shared health information promotes duplicative testing, hinders follow-up, and increases the risk of medical errors.&quot;&lt;/p&gt;
&lt;p&gt;The authors laid out a number of possible reasons for the shift to the emergency room, including office-based primary care doctors not having enough time or space to keep up with patient demand, and fear of litigation driving primary care physicians to refer patients to a hospital.&lt;/p&gt;
&lt;p&gt;The healthcare reform law  --  the Affordable Care Act (ACA)  --  contains a number of provisions that may help move patients back to primary care providers, the authors noted.&lt;/p&gt;
&lt;p&gt;For one, the ACA funds grants to test patient-centered medical home models. The authors said that although the medical home provisions should promote a substantial &quot;scaling-up&quot; of the model, it&apos;s unlikely America will soon become like Germany or the Netherlands, where most patients receive acute care in a doctor&apos;s office.&lt;/p&gt;
&lt;p&gt;In addition, the ACA provides increased reimbursement for primary care doctors.&lt;/p&gt;
&lt;p&gt;&quot;Enhanced rates of reimbursement ... may also spur some practitioners to expand access and may attract more medical students to primary care,&quot; the authors wrote. &quot;But the pipeline will take years, if not decades, to catch up.&quot;&lt;/p&gt;
&lt;p&gt;Also, if Medicare reimbursements are too low, primary care doctors may decide it&apos;s not financially worth it to treat Medicare patients and refer them to a hospital instead, the authors wrote.&lt;/p&gt;
&lt;p&gt;However, it the law does succeed in creating more primary care physicians, then emergency room visits for &quot;primary care treatable&quot; illnesses should decline, they said.&lt;/p&gt;
&lt;p&gt;The authors wrote that some have looked to retail clinics as a way to manage common medical ailments, but that retail clinics and urgent care centers are not &quot;a panacea for access,&quot; because they are poorly suited to manage chronic and acute conditions.&lt;/p&gt;
&lt;p&gt;&quot;Unless they are electronically linked to local hospitals and primary care practices, retail clinics and urgent care centers are likely to further fragment the delivery of health care,&quot; the authors said.&lt;/p&gt;
&lt;p&gt;The study also found some other emergency room trends, including: &lt;ul&gt; &lt;li&gt;While nearly all visits to doctor&apos;s offices and hospital outpatient departments occurred during the weekday, two-thirds of emergency room visits took place on weekends or after office hours. &lt;/li&gt; &lt;li&gt;General practitioners or family physicians saw the highest proportion of privately insured patients, while emergency departments were the most likely to treat Medicare patients, and hospital outpatient and emergency departments were most likely to treat uninsured patients. &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors pointed out a number of limitations to their study, including that visits to retail clinics, urgent care centers, military facilities, and institutional or industrial clinics were beyond the scope of the study. Also, the method used tended to oversample patients who were frequent users of healthcare services.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;One of the study authors, Emily Carrier, a health researcher at the Center for Studying Health System Change and a practicing emergency physician in Washington, reported receiving a training grant from the Centers for Disease Control and Prevention.&lt;/p&gt;&lt;p&gt;The authors listed no financial conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3312"
                     title="Flu Vaccine a Must for All Healthcare Workers, AAP Says (CME/CE)"
                     score="0.014"
                     href="http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb/22081?impressionId=1284025870491"
                     
      &lt;p&gt;All healthcare personnel should be required to get vaccinated against influenza, according to a new policy statement from the American Academy of Pediatrics.&lt;/p&gt;
&lt;p&gt;The authors, from the AAP&apos;s Committee on Infectious Diseases, said that influenza vaccination is needed to protect patients, and that healthcare personnel have an ethical and professional obligation to be immunized.&lt;/p&gt;
&lt;p&gt;&quot;Mandatory influenza immunization for all healthcare personnel is ethically justified, necessary, and long overdue to ensure patient safety,&quot; the authors wrote online ahead of the October print issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The Advisory Committee on Immunization Practices (ACIP), which provides the CDC with guidance, has been recommending influenza vaccination for healthcare personnel since the early 1980s, and earlier this year &lt;a href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/18701&quot; mce_href=&quot;http://www.medpagetoday.com/InfectiousDisease/URItheFlu/18701&quot; target=&quot;_blank&quot;&gt;recommended universal immunization&lt;/a&gt; of everybody older than 6 months.&lt;/p&gt;
&lt;p&gt;&quot;Healthcare personnel fail to lead by example if they recommend universal immunization, including influenza, to their patients but do not require it of themselves,&quot; the authors of the new AAP statement wrote. &quot;It is surprising that many healthcare personnel and the organizations that employ them have been inexcusably silent in addressing this patient safety issue.&quot;&lt;/p&gt;
&lt;p&gt;According to the Joint Commission, a vaccination rate of 80% or higher is needed to maintain the herd immunity necessary to substantially dampen the transmission of influenza in healthcare settings. The actual rate, however, has hovered around 40% in recent years.&lt;/p&gt;
&lt;p&gt;There was a slight bump last year during the H1N1 pandemic to 61.9% for trivalent seasonal vaccine, but only 37.1% of healthcare professionals received the pandemic vaccine and 34.7% received both the seasonal and pandemic vaccine.&lt;/p&gt;
&lt;p&gt;Reasons cited in the literature for refusal to receive influenza vaccine among healthcare workers include fears of developing flu-like illness or adverse effects, a perception that the risk of becoming ill with influenza is low, and concerns about exposure to thimerosal, which is found in some influenza vaccines.&lt;/p&gt;
&lt;p&gt;Voluntary programs aimed at increasing immunization rates through free and easily accessible vaccines, educational efforts, and incentives for getting vaccinated have resulted in little improvement in coverage rates, failing to overcome misconceptions about the risks and benefits of the vaccines.&lt;/p&gt;
&lt;p&gt;&quot;These findings highlight the importance of educating healthcare personnel of the risks, benefits, and basic principles of influenza vaccination,&quot; the statement authors wrote.&lt;/p&gt;
&lt;p&gt;They said mandatory vaccination seems to be the only option for achieving coverage rates greater than 80% and cited several examples of health systems that maintained rates of 88% or higher through mandatory programs.&lt;/p&gt;
&lt;p&gt;The authors pointed out that mandatory vaccination is not a new idea, since every state has laws requiring certain vaccines for school entry or attendance.&lt;/p&gt;
&lt;p&gt;Immunization requirements also have been upheld by the Supreme Court if they are a public health necessity, if the vaccines have been proven effective, if the immunization process is not onerous or unfair, and if vaccination does not put the health of the individual at risk.&lt;/p&gt;
&lt;p&gt;&quot;Despite this reality, implementation of mandatory influenza immunization programs for healthcare personnel continues to be controversial to some who argue that a mandatory program violates civil liberties,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The AAP has developed guidance to aid implementation of mandatory vaccination programs, which includes information on supply, payment, coding, and liability issues. It can be found at &lt;a href=&quot;http://aapredbook.aappublications.org/implementation/&quot; mce_href=&quot;http://aapredbook.aappublications.org/implementation/&quot; target=&quot;_blank&quot;&gt;www.aapredbook.org/implementation&lt;/a&gt;.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>