21.12.15

Parental Monitoring and Its Associations With Adolescent Sexual Risk Behavior: A Meta-analysis.

Dittus PJ, Michael SL, Becasen JS, Gloppen KM, McCarthy K, Guilamo-Ramos V.Pediatrics. 2015 Dec;136(6):e1587-99. doi: 10.1542/peds.2015-0305.
CONTEXT: Increasingly, health care providers are using approaches targetingparents in an effort to improve adolescent sexual and reproductive health.Research is needed to elucidate areas in which providers can target adolescentsand parents effectively. Parental monitoring offers one such opportunity, givenconsistent protective associations with adolescent sexual risk behavior. However,less is known about which components of monitoring are most effective and mostsuitable for provider-initiated family-based interventions.OBJECTIVE: We performed a meta-analysis to assess the magnitude of associationbetween parental monitoring and adolescent sexual intercourse, condom use, andcontraceptive use.DATA SOURCES: We conducted searches of Medline, the Cumulative Index to Nursingand Allied Health Literature, PsycInfo, Cochrane, the Education ResourcesInformation Center, Social Services Abstracts, Sociological Abstracts, Proquest,
and Google Scholar.STUDY SELECTION: We selected studies published from 1984 to 2014 that werewritten in English, included adolescents, and examined relationships betweenparental monitoring and sexual behavior.DATA EXTRACTION: We extracted effect size data to calculate pooled odds ratios(ORs) by using a mixed-effects model.RESULTS: Higher overall monitoring (pooled OR, 0.74; 95% confidence interval[CI], 0.69-0.80), monitoring knowledge (pooled OR, 0.81; 95% CI, 0.73-0.90), and
rule enforcement (pooled OR, 0.67; 95% CI, 0.59-0.75) were associated withdelayed sexual intercourse. Higher overall monitoring (pooled OR, 1.12; 95% CI,1.01-1.24) and monitoring knowledge (pooled OR, 1.14; 95% CI, 1.01-1.31) wereassociated with greater condom use. Finally, higher overall monitoring wasassociated with increased contraceptive use (pooled OR, 1.42; 95% CI, 1.09-1.86),as was monitoring knowledge (pooled OR, 2.27; 95% CI, 1.42-3.63).LIMITATIONS: Effect sizes were not uniform across studies, and most studies were
cross-sectional.CONCLUSIONS: Provider-initiated family-based interventions focused on parentalmonitoring represent a novel mechanism for enhancing adolescent sexual andreproductive health.

1.12.15

Gluten Introduction to Infant Feeding and Risk of Celiac Disease: Systematic Review and Meta-Analysis.




OBJECTIVE: 
To assess the evidence regarding the effect of time of gluten introduction and breastfeeding on the risk of developing celiac disease (CD).
STUDY DESIGN: 
We included randomized controlled trials and observational studies evaluating the proper timing for introducing gluten to the infant diet, the appropriate quantity of gluten consumption at weaning, and the effect of breastfeeding on CD risk. Studies were located through the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), EMBASE (Ovid), and System for Information on Grey Literature in Europe (SIGLE). Two independent authors collected the data.
RESULTS: 
A total of 1982 studies were identified, 15 of which were eligible for data extraction. A meta-analysis was performed on 2 randomized controlled trials, 10 cohort studies, and 1 case-control study. There was a 25% increase in CD risk with late (>6 months) vs recommended (4-6 months) gluten introduction (risk ratio [RR], 1.25; 95% CI, 1.08-1.45). There was no significant effect of breastfeeding vs no breastfeeding on CD risk (OR, 0.55; 95% CI, 0.28-1.10), with substantial heterogeneity (I2 = 92%) among studies.

CONCLUSION: 
There is currently no evidence to support that early introduction of gluten to the infant diet increases the risk of CD; however, late introduction of gluten may be associated with increased risk of CD. More studies are needed that control for potential confounders and that evaluate environmental factors in low-risk families.

2.10.15

Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial


Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial


Bruce W. Hollis, Carol L. Wagner, Cynthia R. Howard, Myla Ebeling, Judy R. Shary, Pamela G. Smith, Sarah N. Taylor, Kristen Morella, Ruth A. Lawrence, Thomas C. Hulsey.
PEDIATRICS Volume 136, number 4, October 2015

OBJECTIVE:


Compare effectiveness of maternal vitamin D3 supplementation with 6400 IU per day alone to maternal and infant supplementation with 400 IU per day.

METHODS:


Exclusively lactating women living in Charleston, SC, or Rochester, NY, at 4 to 6 weeks postpartum were randomized to either 400, 2400, or 6400 IU vitamin D3/day for 6 months.
Breastfeeding infants in 400 IU group received oral 400 IU vitamin D3/day; infants in 2400 and 6400 IU groups received 0 IU/day (placebo). Vitamin D de ficiency was defined as 25-hydroxy-vitamin D (25(OH)D) < 50 nmol/L.  2400 IU group ended in 2009 as greater infant deficiency occurred. Maternal serum vitamin D, 25(OH)D, calcium, and phosphorus concentrations and urinary calcium/creatinine ratios were measured at baseline then monthly, and infant blood parameters were measured at baseline and months 4 and 7.

RESULTS:


Of the 334 mother-infant pairs in 400 IU and 6400 IU groups at enrollment, 216 (64.7%) were still breastfeeding at visit 1; 148 (44.3%) continued full breastfeeding to 4 months and 95 (28.4%) to 7 months. Vitamin D deficiency in breastfeeding infants was greatly affected by race. Compared with 400 IU vitamin D3 per day, 6400 IU/day safely and significantly increased maternal vitamin D and 25(OH)D from baseline (P < 0.0001). Compared with breastfeeding infant 25(OH)D in the 400 IU group receiving supplement, infants in the 6400 IU group whose mothers only received supplement did not differ.

CONCLUSIONS:


Maternal vitamin D supplementation with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy her nursing infant’s requirement and offers an alternate strategy to direct infant supplementation.

 

17.8.15

Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources




El 5 de junio de 2015, el CDC (Centro para el control de enfermedades, por sus siglas en inglés) publicó una revisión de las guías para el tratamiento de enfermedades de transmisión sexual (ETS).

El documento muestra las recomendaciones diagnósticas y las estrategias de prevención más adecuadas. Con esta publicación, se actualiza la última guía publicada en el año 2010. 
Resumen de recomendaciones ( Guía rápida de recomendaciones)

22.7.15

Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents.


Ruotsalainen H1Kyngäs H2,3Tammelin T4Kääriäinen M2.
 J Adv Nurs. 2015 May 29. doi: 10.1111/jan.12696. (Review) PMID: 26031309

Abstract

AIMS:

To examine the effects of physical activity and exercise interventions on body mass index, subsequent physical activity and psychological symptoms for overweight and obese adolescents (12-18 years).

BACKGROUND:

Overweight and obesity have increased among adolescents globally and physical activity has decreased. Healthcare systems face challenges promoting physical activity and in treating obesity. Promotion of physical activity must be effective and school nurses should be equipped with the information and resources required to implement counselling for overweight and obese adolescents.

DESIGN:

A systematic review of randomized controlled trials was conducted according to procedures by the Centre for Reviews and Dissemination and the Joanna Briggs Institute.

DATA SOURCES:

Research studies published between 1950-2013 were identified from the following databases. CINAHL, MEDLINE (Ovid) and PsycINFO.

REVIEW METHODS:

Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. A narrative synthesis was used to report results, while a fixed-effect meta-analysis was used to analyse the interventions effects on physical activity and body mass index.

RESULTS:

Fourteen published studies were included to this review. Supervised exercise interventions most affected adolescents' body mass index. The interventions effect on adolescents' physical activity was small and heterogeneous. Two interventions positively affected psychological symptoms.

CONCLUSION:

Interventions were complex, with more than one component and the aspect that effectively promotes physical activity in obese adolescents was not clear. However, it seems that exercise interventions affect the body mass index of overweight or obese adolescents. Interventions that include a component for promoting physical activity with or without supervised exercise can affect subsequent physical activity and body mass index.

16.7.15

Speech and Language Delay and Disorders in Children Age 5 and Younger: Screening.

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children aged 5 years or younger.
To view the recommendation and the evidence on which it is based, please go to 
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/speech-and-language-delay-and-disorders-in-children-age-5-and-younger-screening.


PopulationAsymptomatic children aged ≤5 years whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development
RecommendationNo recommendation.
Grade: I statement (insufficient evidence)
Risk AssessmentRisk factors that have been reported to be associated with speech and language delay and disorders include male sex, family history of speech and language impairment, low parental education level, and perinatal risk factors (e.g., prematurity, low birth weight, and birth difficulties).
Screening TestsThe USPSTF found inadequate evidence on specific screening tests for use in primary care settings. Widely used screening tests in the United States include the Ages and Stages Questionnaire, the Language Development Survey, and the MacArthur-Bates Communicative Development Inventory.
Treatment and InterventionsInterventions for childhood speech and language disorders vary widely and can include speech-language therapy sessions and assistive technology (if indicated). Interventions are commonly individualized to each child's specific pattern of symptoms, needs, interests, personality, and learning style.
Balance of Benefits and HarmsThe current evidence is insufficient to assess the balance of benefits and harms of screening and interventions for speech and language delay and disorders in young children in primary care settings.
Other Relevant USPSTF RecommendationsThe USPSTF recommends screening for hearing loss in all newborn infants, and is developing a recommendation on screening for autism spectrum disorder in young children (available at www.uspreventiveservicestaskforce.org).

1.7.15

Primary prevention of childhood obesity, second edition.

Primary prevention of childhood obesity, second edition.

Registered Nurses' Association of Ontario (RNAO). Primary prevention of childhood obesity, second edition. Toronto (ON): Registered Nurses' Association of Ontario (RNAO); 2014 May. 140 p. [265 references]

Major Recommendations
The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field.
Practice Recommendations
Assessment
Recommendation 1.1
Routinely assess children's nutrition, physical activity, sedentary behaviour, and growth according to established guidelines, beginning as early as possible in a child's lifespan.
(Level of Evidence = IV)
Recommendation 1.2
Assess the family environment for factors (e.g., parenting/primary caregiver influences and socio-cultural factors) that may increase children's risk of obesity.
(Level of Evidence = IV)
Recommendation 1.3
Collaborate with school leaders to assess elementary-school environments for risk and protective conditions that influence childhood obesity, including:
  • Student demographics
  • School policies
  • Food and physical activity environments
(Level of Evidence = IV)
Recommendation 1.4
Assess neighbourhoods for community-level risk and protective conditions that influence childhood obesity.
(Level of Evidence = IV)
Planning
Recommendation 2.1
Engage community stakeholders when planning primary-prevention interventions for childhood obesity.
(Level of Evidence = IIb)
Recommendation 2.2
Develop interventions that are:
  • Universally applied, as early as possible (Level of Evidence = IV)
  • Targeted toward multiple behaviours (Level of Evidence = IV)
  • Implemented using multiple approaches (Level of Evidence = IIa)
  • Inclusive of parents/primary caregivers and the family (Level of Evidence = IIa), and
  • Implemented simultaneously in multiple settings (Level of Evidence = IIa)
Implementation
Recommendation 3.1
Support exclusive breastfeeding for the first six months of life followed by breastfeeding and complementary feeding up to two years of age or beyond.
(Level of Evidence = III)
Recommendation 3.2
Provide education and social support to help parents/primary caregivers to promote healthy eating and physical activity in infants and toddlers.
(Level of Evidence = Ib)
Recommendation 3.3
Collaborate with parents/primary caregivers, educators and support staff (e.g., teachers, child care providers, school leaders) to promote healthy eating and physical activity in all settings where preschool children gather.
(Level of Evidence = Ib)
Recommendation 3.4
Collaborate with school communities to promote regular physical activity among elementary-school children.
(Level of Evidence = IIb)
Recommendation 3.5
Facilitate and support the integration of health and nutrition education into elementary-school programs and support the improvement of the school food environment.
(Level of Evidence = IIa–III)
Evaluation
Recommendation 4.1
Monitor and evaluate the effectiveness of the family's approach to healthy eating and physical activity.
(Level of Evidence = IV)
Recommendation 4.2
Evaluate the effectiveness and sustainability of school- and community-based primary-prevention initiatives.
(Level of Evidence = IV)
Recommendation 4.3
Advocate and support the evaluation of an organization's compliance with healthy public policies, and the impact of such policies on childhood eating behaviours and physical activity.
(Level of Evidence = III)
Education Recommendations
Recommendation 5.1
Incorporate foundational primary-prevention curricula based on this Guideline into the undergraduate education of nurses and other health-care providers.
(Level of Evidence = IV)
Recommendation 5.2
Health-care professionals should participate in continuing education to enhance their ability to support the positive behavioural and environmental changes for children, families, and communities recommended in this Guideline.
(Level of Evidence = IV)
.../...