22.3.15

Missed Opportunities for Tuberculosis Screening in Primary Care.

J Pediatr. 2015 Feb 23. pii: S0022-3476(15)00084-0. doi:10.1016/j.jpeds.2015.01.037. [Epub ahead of print]
van der Heijden YF, Heerman WJ, McFadden S, Zhu Y, Patterson BL.

OBJECTIVE: 
To assess how frequently pediatric practitioners perform latent tuberculosis infection (LTBI) screening according to guidelines. We hypothesized that screening occurs less frequently among children whose parents do not speak English as the primary language.
STUDY DESIGN: 
We conducted a retrospective cohort study of patients attending well-child visits in an urban academic pediatric primary care clinic between April 1, 2012, and March 31, 2013. We assessed documentation of 3 LTBI screening identified as at high risk for LTBI. Of these, 514 (62%) did not have documented tuberculin skin test (TST) placement and documentation of results.
RESULTS: 
During the study period, 387 of 9143 children (4%) had no documentation of screening question responses. Among the other 8756 children, 831 (10%) were documentation of results, but non-Hispanic Black children were more likely to not TST placement in the appropriate time frame. Thirty-nine of 213 children (18%) who had a TST placed did not have documented results. Multivariable regression showed that parent language was not associated with TST placement or have a documented test result (aOR, 2.12; 95% CI, 1.07-4.19; P = .03) when results among high-risk children, the latter of which was associated with adjusting for age, sex, parent primary language, insurance status, day of the week, and study year of TST placement.
CONCLUSION: 
Parent primary language was not associated with LTBI testing. However, we found substantial gaps in TST placement and documentation of TST race/ethnicity. Targeted quality improvement efforts should focus on developing processes to ensure complete screening in high-risk children.

10.3.15

Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement

Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement FREE

Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force*
 Ann Intern Med. 2014;161:902-910. doi:10.7326/M14-1981
The USPSTF recommends screening for chlamydia in sexually active females aged 24 years or younger and in older women who are at increased risk for infection. (B recommendation)The USPSTF recommends screening for gonorrhea in sexually active females aged 24 years or younger and in older women who are at increased risk for infection. (B recommendation)The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for chlamydia and gonorrhea in men. (I statement)

The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.
It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement

Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement FREE

Michael L. LeFevre, MD, MSPH, on behalf of the U.S. Preventive Services Task Force*
Ann Intern Med. 2014;161:894-901. doi:10.7326/M14-1965
In 2008, the USPSTF recommended high-intensity behavioral counseling to prevent STIs for all sexually active adolescents and for adults who were at increased risk for STIs (B recommendation). At that time, the USPSTF also found that the evidence was insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non–sexually active adolescents and in adults who were not at increased risk for STIs (I statement). This updated recommendation reaffirms that the evidence is adequate to recommend high-intensity behavioral counseling for persons who are at increased risk (including all sexually active adolescents) and recognizes that some interventions of lesser intensity are also effective

6.3.15

Screening programmes for developmental dysplasia of the hip in newborn infants (Review)

Shorter D, Hong T, Osborn DA

The Cochrane Collaboration and published in The Cochrane Library
2011, Issue 9. http://www.thecochranelibrary.com

Background
Uncorrected developmental dysplasia of the hip (DDH) is associated with long term morbidity such as gait abnormalities, chronic pain and degenerative arthritis.
Objectives
To determine the effect of different screening programmes for DDH on the incidence of late presentation of congenital hip dislocation.
Search methods
Searches were performed in CENTRAL (The Cochrane Library), MEDLINE and EMBASE (January 2011) supplemented by searches of clinical trial registries, conference proceedings, cross references and contacting expert informants.
Selection criteria
Randomised, quasi-randomised or cluster trials comparing the effectiveness of screening programmes for DDH.
Data collection and analysis
Three independent review authors assessed study eligibility and quality, and extracted data.
Main results
No study examined the effect of screening (clinical and/or ultrasound) and early treatment versus not screening and later treatment.
One study reported universal ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery but was associated with a significant increase in treatment.
One study reported targeted ultrasound compared to clinical examination alone did not result in a significant reduction in late diagnosed DDH or surgery, with no significant difference in rate of treatment.
Meta-analysis of two studies found universal ultrasound compared to targeted ultrasound did not result in a significant reduction in late diagnosed DDH or surgery. There was heterogeneity between studies reporting the effect on treatment rate.
Meta-analysis of two studies found delayed ultrasound and targeted splinting compared to immediate splinting of infants with unstable (but not dislocated) hips resulted in no significant difference in the rate of late diagnosed DDH. Both studies reported a significant reduction in treatment with use of delayed ultrasound and targeted splinting.
One study reported delayed ultrasound and targeted splinting compared to immediate splinting of infants with mild hip dysplasia on ultrasound resulted in no significant difference in late diagnosed DDH but a significant reduction in treatment. No infants in either group received surgery.
Authors’ conclusions
There is insufficient evidence to give clear recommendations for practice. There is inconsistent evidence that universal ultrasound results in a significant increase in treatment compared to the use of targeted ultrasound or clinical examination alone. Neither of the ultrasound strategies have been demonstrated to improve clinical outcomes including late diagnosed DDH and surgery. The studies are substantially underpowered to detect significant differences in the uncommon event of late detected DDH or surgery. For infants with unstable hips or mildly dysplastic hips, use of delayed ultrasound and targeted splinting reduces treatment without significantly increasing the rate of late diagnosed DDH or surgery.



4.3.15

Integrating Bodies of Evidence: Existing Systematic Reviews and Primary Studies. Methods Guide for Comparative Effectiveness Reviews.


Robinson KA, Chou R, Berkman ND, Newberry SJ, Fu R, Hartling L, Dryden D, Butler M, Foisy M, Anderson J, Motu’apuaka ML, Relevo R, Guise JM, Chang S. Integrating Bodies of Evidence: Existing Systematic Reviews and Primary Studies. Methods Guide for Comparative Effectiveness Reviews (Prepared by the Scientific Resource Center under Contract No. 290-2012-00004-C). AHRQ Publication No. 15-EHC007-EF. Rockville, MD: Agency for Healthcare Research and Quality. February 2015. 


The increasing number of systematic reviews, along with the time and money required to undertake a review, has motivated a desire to incorporate existing systematic reviews in a new review. In considering the integration of existing systematic reviews into new reviews, there is a tradeoff between accepting the results of the prior review and needing to either complete again the selected elements of the review or the review in its entirety. The key is to find the right balance in terms of an efficient and unbiased approach to conducting and reporting the integration of existing systematic reviews into the new review. In this working document, we have provided preliminary guidance to help find that balance.

7.1.15

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review.


Driessen CE(1), Cameron AJ, Thornton LE, Lai SK, Barnett LM.

Author information: 
(1)School of Health and Social Development, Deakin University, Burwood,
Australia.

Previous school obesity-prevention reviews have included multi-component
interventions. Here, we aimed to review the evidence for the effect of isolated
food environment interventions on both eating behaviours (including food
purchasing) and/or body weight. Five electronic databases were searched (last
updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on 
school food environment changes, based on a review of titles and abstracts.
Thirty-seven further papers were excluded, for not meeting the inclusion
criteria. The final selection consisted of 18 papers (14 United States, 4 United 
Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing
or eating behaviours and two studies assessed both weight and behaviour.
Seventeen of 18 papers reported a positive outcome on either BMI (or change in
BMI) or the healthfulness of food sold or consumed. Two studies were rated as
strong quality and 11 as weak. Only three studies included a control group. A
school environment supportive of healthy eating is essential to combat heavy
marketing of unhealthy food. Modification of the school food environment
(including high-level policy changes at state or national level) can have a
positive impact on eating behaviours. A need exists, however, for further
high-quality studies.


PMID:
 
25266705
 
[PubMed - in process]

8.12.14

Pediatric exposure to laundry detergent pods.

(Las cápsulas de detergente son un producto doméstico peligroso)

Valdez ALCasavant MJSpiller HAChounthirath TXiang HSmith GA.

 2014 Dec;134(6):1127-35. doi: 10.1542/peds.2014-0057. Epub 2014 Nov 10.

OBJECTIVE:

Laundry detergent pods are a new product in the US marketplace. This study investigates the epidemiologic characteristics and outcomes of laundry detergent pod exposures among young children in the United States.

METHODS:

Using data from the National Poison Data System, exposures to laundry detergent pods among children younger than 6 years of age during 2012-2013 were investigated.

RESULTS:

There were 17 230 children younger than 6 years exposed to laundry detergent pods in 2012-2013. From March 2012 to April 2013, the monthly number of exposures increased by 645.3%, followed by a 25.1% decrease from April to December 2013. Children younger than 3 years accounted for 73.5% of cases. The major route of exposure was ingestion, accounting for 79.7% of cases. Among exposed children, 4.4% were hospitalized and 7.5% experienced a moderate or major medical outcome. A spectrum of clinical effects from minor to serious was seen with ingestion and ocular exposures. There were 102 patients (0.6%) exposed to a detergent pod via ingestion, aspiration, or a combination of routes, including ingestion, who required tracheal intubation. There was 1 confirmed death.

CONCLUSIONS:

Laundry detergent pods pose a serious poisoning risk to young children. This nationwide study underscores the need for increased efforts to prevent exposure of young children to these products, which may include improvements in product packaging and labeling, development of a voluntary product safety standard, and public education. Product constituent reformulation is another potential strategy to mitigate the severity of clinical effects of laundry detergent pod exposure.

5.12.14

 Risk and Protective Factors for Falls From Furniture in Young Children: Multicenter Case-Control Study.

Kendrick D y cols. JAMA pediatr. 2014 Dec 1. doi: 10.1001/jamapediatrics.2014.2374. [Epub ahead of print]

Importance:

Falls from furniture are common in young children but there is little evidence on protective factors for these falls.

Objective:

To estimate associations for risk and protective factors for falls from furniture in children aged 0 to 4 years.

Design, Setting, and Participants:

Multicenter case-control study at hospitals, minor injury units, and general practices in and around 4 UK study centers. Recruitment commenced June 14, 2010, and ended April 27, 2012. Participants included 672 children with falls from furniture and 2648 control participants matched on age, sex, calendar time, and study center. Thirty-five percent of cases and 33% of control individuals agreed to participate. The mean age was 1.74 years for cases and 1.91 years for control participants. Fifty-four percent of cases and 56% of control participants were male. Exposures included safety practices, safety equipment use, and home hazards.

Main Outcomes and Measures:

Falls from furniture occurring at the child's home resulting in attendance at an emergency department, minor injury unit, or hospital admission.

Results:

Compared with parents of control participants, parents of cases were significantly more likely not to use safety gates in the home (adjusted odds ratio [AOR], 1.65; 95% CI, 1.29-2.12) and not to have taught their children rules about climbing on kitchen objects (AOR, 1.58; 95% CI, 1.16-2.15). Cases aged 0 to 12 months were significantly more likely to have been left on raised surfaces (AOR, 5.62; 95% CI, 3.62-8.72), had their diapers changed on raised surfaces (AOR, 1.89; 95% CI, 1.24-2.88), and been put in car/bouncing seats on raised surfaces (AOR, 2.05; 95% CI, 1.29-3.27). Cases 3 years and older were significantly more likely to have played or climbed on furniture (AOR, 9.25; 95% CI, 1.22-70.07). Cases were significantly less likely to have played or climbed on garden furniture (AOR, 0.74; 95% CI, 0.56-0.97).

Conclusions and Relevance:

If estimated associations are causal, some falls from furniture may be prevented by incorporating advice into child health contacts, personal child health records, and home safety assessments about use of safety gates; not leaving children, changing diapers, or putting children in car/bouncing seats on raised surfaces; allowing children to play or climb on furniture; and teaching children safety rules about climbing on objects.