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Infants diagnosed with Pierre Robin sequence frequently have airway obstruction. In severe cases of obstruction, mandibular distraction osteogenesis (MDO) can alleviate the airway blockage through elongation of the mandible and subsequent anterior placement of the tongue. However, there are several complications associated with MDO in the very young child. Among those are injuries to teeth that develop in the area of the MDO osteotomies. Such injuries include distalization and/or morphologic anomalies of primary and permanent molars. We describe a case of an unusual macrodontia of the primary mandibular left second molar in a six-year-old male who underwent MDO as an infant. We believe that the mesial-distal elongation of the crown of the primary second molar occurred through distraction histogenesis of the tooth structures during the distraction of the mandible. We discuss the importance of preoperative planning to minimize such damages to the developing dentition.

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INTRODUCTION: Decreased vaccination rates in children have played a role in the deaths of several children in the United States over the last decade. Interventions to date have been ineffective at changing vaccination patterns. No studies have evaluated a conciliatory patient-centered approach where parent concerns were acknowledged and addressed in a group setting. METHODS: Vaccine-averse parents with incompletely vaccinated children were recruited from a family medicine practice. These parents attended three group visit sessions centered on vaccine safety and efficacy. Pre and post surveys were given at each session. The children's vaccination records were examined in the year prior and the year following the groups. One year after the group visits, parents were interviewed about their attitudes toward vaccination. RESULTS: There were no significant attitude changes in parents attending the group visits. In the year following the visits, the percentage of recommended vaccines that children had received did not increase. Interviews with parents revealed a broad range of concerns about vaccines and a widespread desire for a longer-term study designed to address these concerns. CONCLUSIONS: Surveys and vaccination records revealed no significant change in attitudes or behavior after three group visit sessions, consistent with other research on interventions with vaccine-averse parents. The phone interviews demonstrated a desire for further research into long-term effects of vaccines, with most parents stating that they would consider changing their beliefs if the research was free from commercial bias, addressed their concerns, and was extended out over a long period of time.

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BACKGROUND: In 2006, a new rotavirus vaccine (RotaTeq) was licensed in the US and recommended for routine immunization of all US infants. Because a previously licensed vaccine (Rotashield) was withdrawn from the US for safety concerns, identifying barriers to uptake of RotaTeq will help develop strategies to broaden vaccine coverage. METHODS: We explored beliefs and attitudes of parents (n = 57) and providers (n = 10) towards rotavirus disease and vaccines through a qualitative assessment using focus groups and in-depth interviews. RESULTS: All physicians were familiar with safety concerns about rotavirus vaccines, but felt reassured by RotaTeq's safety profile. When asked about likelihood of using RotaTeq on a scale of one to seven (1 = "absolutely not;" 7 = "absolutely yes") the mean score was 5 (range = 3-6). Physicians expressed a high likelihood of adopting RotaTeq, particularly if recommended by their professional organizations and expressed specific interest in post-marketing safety data. Similarly, consumers found the RotaTeq safety profile to be favorable and would rely on their physician's recommendation for vaccination. However, when asked to rank likelihood of having their child vaccinated against rotavirus (1 = "definitely not get;" 7 = "definitely get"), 29% ranked 1 or 2, 36% 3 or 4, and 35% 5 to 7. CONCLUSION: Our qualitative assessment provides complementary data to recent quantitative surveys and suggests that physicians and parents are likely to adopt the newly licensed rotavirus vaccine. Increasing parental awareness of the rotavirus disease burden and providing physicians with timely post-marketing surveillance data will be integral to a successful vaccination program.

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