5.5.15

School-based education programmes for the prevention of child sexual abuse.

Walsh K, Zwi K, Woolfenden S, Shlonsky A.
Cochrane Database Syst Rev. 2015 Apr 16;4:CD004380. [Epub ahead of print]


BACKGROUND: Child sexual abuse is a significant global problem in both magnitude
and sequelae. The most widely used primary prevention strategy has been the
provision of school-based education programmes. Although programmes have been
taught in schools since the 1980s, their effectiveness requires ongoing scrutiny.
OBJECTIVES: To systematically assess evidence of the effectiveness of
school-based education programmes for the prevention of child sexual abuse.
Specifically, to assess whether: programmes are effective in improving students'
protective behaviours and knowledge about sexual abuse prevention; behaviours and
skills are retained over time; and participation results in disclosures of sexual
abuse, produces harms, or both.
SEARCH METHODS: In September 2014, we searched CENTRAL, Ovid MEDLINE, EMBASE
 and 11 other databases. We also searched two trials registers and screened the
reference lists of previous reviews for additional trials.
SELECTION CRITERIA: We selected randomised controlled trials (RCTs),
cluster-RCTs, and quasi-RCTs of school-based education interventions for the
prevention of child sexual abuse compared with another intervention or no
intervention.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the
eligibility of trials for inclusion, extracted data, and assessed risk of bias.
We summarised data for six outcomes: protective behaviours; knowledge of sexual
abuse or sexual abuse prevention concepts; retention of protective behaviours
over time; retention of knowledge over time; harm; and disclosures of sexual
abuse.
MAIN RESULTS: This is an update of a Cochrane Review that included 15 trials (up
to August 2006). We identified 10 additional trials for the period to September
2014. We excluded one trial from the original review. Therefore, this update
includes a total of 24 trials (5802 participants). We conducted several
meta-analyses. More than half of the trials in each meta-analysis contained unit
of analysis errors.1. Meta-analysis of two trials (n = 102) evaluating protective
behaviours favoured intervention (odds ratio (OR) 5.71, 95% confidence interval
(CI) 1.98 to 16.51), with borderline low to moderate heterogeneity (Chi² = 1.37,
df = 1, P value = 0.24, I² = 27%, Tau² = 0.16). The results did not change when
we made adjustments using intraclass correlation coefficients (ICCs) to correct
errors made in studies where data were analysed without accounting for the
clustering of students in classes or schools.2. Meta-analysis of 18 trials (n =
4657) evaluating questionnaire-based knowledge favoured intervention
(standardised mean difference (SMD) 0.61, 95% CI 0.45 to 0.78), but there was
substantial heterogeneity (Chi² = 104.76, df = 17, P value < 0.00001, I² = 84%,
Tau² = 0.10). The results did not change when adjusted for clustering (ICC: 0.1
SMD 0.66, 95% CI 0.51 to 0.81; ICC: 0.2 SMD 0.63, 95% CI 0.50 to 0.77).3.
Meta-analysis of 11 trials (n =1688) evaluating vignette-based knowledge favoured
intervention (SMD 0.45, 95% CI 0.24 to 0.65), but there was substantial
heterogeneity (Chi² = 34.25, df = 10, P value < 0.0002, I² = 71%, Tau² = 0.08).
The results did not change when adjusted for clustering (ICC: 0.1 SMD 0.53, 95%
CI 0.32 to 0.74; ICC: 0.2 SMD 0.60, 95% CI 0.31 to 0.89).4. We included four
trials in the meta-analysis for retention of knowledge over time. The effect of
intervention seemed to persist beyond the immediate assessment (SMD 0.78, 95% CI
0.38 to 1.17; I² = 84%, Tau² = 0.13, P value = 0.0003; n = 956) to six months
(SMD 0.69, 95% CI 0.51 to 0.87; I² = 25%; Tau² = 0.01, P value = 0.26; n = 929).
The results did not change when adjustments were made using ICCs.5. We included
three studies in the meta-analysis for adverse effects (harm) manifesting as
child anxiety or fear. The results showed no increase or decrease in anxiety or
fear in intervention participants (SMD -0.08, 95% CI -0.22 to 0.07; n = 795) and
there was no heterogeneity (I² = 0%, P value = 0.79; n=795). The results did not
change when adjustments were made using ICCs.6. We included three studies (n =
1788) in the meta-analysis for disclosure of previous or current sexual abuse.
The results favoured intervention (OR 3.56, 95% CI 1.13 to 11.24), with no
heterogeneity (I² = 0%, P value = 0.84). However, adjusting for the effect of
clustering had the effect of widening the confidence intervals around the OR
(ICC: 0.1 OR 3.04, 95% CI 0.75 to 12.33; ICC: 0.2 OR 2.95, 95% CI 0.69 to
12.61).Insufficient information was provided in the included studies to conduct
planned subgroup analyses and there were insufficient studies to conduct
meaningful analyses.The quality of evidence for all outcomes included in the
meta-analyses was moderate owing to unclear risk of selection bias across most
studies, high or unclear risk of detection bias across over half of included
studies, and high or unclear risk of attrition bias across most studies. The
results should be interpreted cautiously.
AUTHORS' CONCLUSIONS: The studies included in this review show evidence of
improvements in protective behaviours and knowledge among children exposed to
school-based programmes, regardless of the type of programme. The results might
have differed had the true ICCs or cluster-adjusted results been available. There
is evidence that children's knowledge does not deteriorate over time, although
this requires further research with longer-term follow-up. Programme
participation does not generate increased or decreased child anxiety or fear,
however there is a need for ongoing monitoring of both positive and negative
short- and long-term effects. The results show that programme participation may
increase the odds of disclosure, however there is a need for more programme
evaluations to routinely collect such data. Further investigation of the
moderators of programme effects is required along with longitudinal or data
linkage studies that can assess actual prevention of child sexual abuse.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004380.pub3/full

23.4.15

Comparison of tuberculin skin test and QuantiFERON®-TB gold in-tube for the diagnosis of childhood tuberculosis infection

Comparison of tuberculin skin test and QuantiFERON®-TB gold in-tube for the diagnosis of childhood tuberculosis infection

Selda Hancerli Torun, Ozan Uzunhan, Ayper Somer, Nuran Salman and Kaya Köksalan
Accepted manuscript online: 22 APR 2015 09:02AM EST | DOI: 10.1111/ped.12659

Pediatrics International

Aim

Tuberculosis (TB) is an important worldwide ongoing health issue. To be able to control tuberculosis, one should not only cure active tuberculosis cases but also detect childhood tuberculosis infection patients who have the possibility of developing active disease in the future. Our aim in this study is to compare a century-old tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube (QFT-GIT) test which was developed as an alternative to TST and claimed to be superior to TST in several ways for diagnosis of TB in childhood.

Materials and Methods

Fifty three children with TB disease between 5 months and 17.5 years of age and 92 healthy children from the same age group with no risk factors for tuberculosis infection were recruited into the study. All children were performed TST and QFT-GIT test and their demographic, clinic and laboratory data were recorded. Data was analyzed by using SPSS 14.

Results

53 patients were diagnosed TB. The mean of age distribution of the patients was 8.5±4.3 years (ranged from 5 months-17.5 years). 41.7 % of the patients were females. 16 of 53 patients were confirmed by culture. QFT-GIT test was positive in 16 and TST was positive in 15 among 16 culture-confirmed TB disease children. The sensitivity of TST and QFT-GIT could be estimated 93.8% and 100.0%, and the specificity of TST and QFT-GIT could be estimated 100.0% and 97.8%, respectively. When the results of QFT-GIT and TST were compared among 53 TB disease children including cases without bacteriologically confirmation, QFT-GIT was positive in 33 children, and TST was positive in 44 children. The sensitivity of TST and QFT-GIT could be estimated 83.0% and 62.3%, and the specificity of TST and QFT-GIT could be estimated 100.0% and 97.8%, respectively.

Conclusion

Although positive QFT-GIT test result is very significant for TB, negative results will not exclude TB infection. TST and QFT-GIT are used together may provide more efficient results. This article is protected by copyright. All rights reserved.

20.4.15

Interventions for the cessation of non-nutritive sucking habits in children.

Cochrane Database Syst Rev. 2015 Mar 31;3:CD008694. doi: 10.1002/14651858.CD008694.pub2.

Borrie FR, Bearn DR, Innes NP, Iheozor-Ejiofor Z.

BACKGROUND:

Comforting behaviours, such as the use of pacifiers (dummies, soothers), blankets and finger or thumb sucking, are common in babies and young children. These comforting habits, which can be referred to collectively as 'non-nutritive sucking habits' (NNSHs), tend to stop as children get older, under their own impetus or with support from parents and carers. However, if the habit continues whilst the permanent dentition is becoming established, it can contribute to, or cause, development of a malocclusion (abnormal bite). A diverse variety of approaches has been used to help children with stopping a NNSH. These include advice, removal of the comforting object, fitting an orthodontic appliance to interfere with the habit, application of an aversive taste to the digit or behaviour modification techniques. Some of these interventions are easier to apply than others and less disturbing for the child and their parent; some are more applicable to a particular type of habit.

OBJECTIVES:

The primary objective of the review was to evaluate the effects of different interventions for cessation of NNSHs in children. The secondary objectives were to determine which interventions work most quickly and are the most effective in terms of child and parent- or carer-centred outcomes of least discomfort and psychological distress from the intervention, as well as the dental measures of malocclusion (reduction in anterior open bite, overjet and correction of posterior crossbite) and cost-effectiveness.

SEARCH METHODS:

We searched the following electronic databases: the Cochrane Oral Health Group Trials Register (to 8 October 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 9), MEDLINE via OVID (1946 to 8 October 2014), EMBASE via OVID (1980 to 8 October 2014), PsycINFO via OVID (1980 to 8 October 2014) and CINAHL via EBSCO (1937 to 8 October 2014), the US National Institutes of Health Trials Register (Clinical Trials.gov) (to 8 October 2014) and the WHO International Clinical Trials Registry Platform (to 8 October 2014). There were no restrictions regarding language or date of publication in the searches of the electronic databases. We screened reference lists from relevant articles and contacted authors of eligible studies for further information where necessary.

SELECTION CRITERIA:

Randomised or quasi-randomised controlled trials in children with a non-nutritive sucking habit that compared one intervention with another intervention or a no-intervention control group. The primary outcome of interest was cessation of the habit.

DATA COLLECTION AND ANALYSIS:

We used standard methodological procedures expected by The Cochrane Collaboration. Three review authors were involved in screening the records identified; two undertook data extraction, two assessed risk of bias and two assessed overall quality of the evidence base. Most of the data could not be combined and only one meta-analysis could be carried out.

MAIN RESULTS:

We included six trials, which recruited 252 children (aged two and a half to 18 years), but presented follow-up data on only 246 children. Digit sucking was the only NNSH assessed in the studies. Five studies compared single or multiple interventions with a no-intervention or waiting list control group and one study made a head-to-head comparison. All the studies were at high risk of bias due to major limitations in methodology and reporting. There were small numbers of participants in the studies (20 to 38 participants per study) and follow-up times ranged from one to 36 months. Short-term outcomes were observed under one year post intervention and long-term outcomes were observed at one year or more post intervention. Orthodontics appliance (with or without psychological intervention) versus no treatmentTwo trials that assessed this comparison evaluated our primary outcome of cessation of habit. One of the trials evaluated palatal crib and one used a mix of palatal cribs and arches. Both trials were at high risk of bias. The orthodontic appliance was more likely to stop digit sucking than no treatment, whether it was used over the short term (risk ratio (RR) 6.53, 95% confidence interval (CI) 1.67 to 25.53; two trials, 70 participants) or long term (RR 5.81, 95% CI 1.49 to 22.66; one trial, 37 participants) or used in combination with a psychological intervention (RR 6.36, 95% CI 0.97 to 41.96; one trial, 32 participants). Psychological intervention versus no treatmentTwo trials (78 participants) at high risk of bias evaluated positive reinforcement (alone or in combination with gaining the child's co-operation) or negative reinforcement compared with no treatment. Pooling of data showed a statistically significant difference in favour of the psychological interventions in the short term (RR 6.16, 95% CI 1.18 to 32.10; I(2) = 0%). One study, with data from 57 participants, reported on the long-term effect of positive and negative reinforcement on sucking cessation and found a statistically significant difference in favour of the psychological interventions (RR 6.25, 95% CI 1.65 to 23.65). Head-to-head comparisonsOnly one trial demonstrated a clear difference in effectiveness between different active interventions. This trial, which had only 22 participants, found a higher likelihood of cessation of habit with palatal crib than palatal arch (RR 0.13, 95% CI 0.03 to 0.59).

AUTHORS' CONCLUSIONS:

This review found low quality evidence that orthodontic appliances (palatal arch and palatal crib) and psychological interventions (including positive and negative reinforcement) are effective at improving sucking cessation in children. There is very low quality evidence that palatal crib is more effective than palatal arch. This review has highlighted the need for high quality trials evaluating interventions to stop non-nutritive sucking habits to be conducted and the need for a consolidated, standardised approach to reporting outcomes in these trials.

16.4.15

Updated Swedish advice on reducing the risk of sudden infant death syndrome

Updated Swedish advice on reducing the risk of sudden infant
death syndrome
http://onlinelibrary.wiley.com/doi/10.1111/apa.12966/epdf

Acta Paediatrica


Volume 104, Issue 5 Pages 433 - 537, e187 - e234, May 2015

Göran Wennergren, Kerstin Nordstrand, Bernt Alm, Per Möllborg, Anna Öhman, Anita Berlin, Miriam Katz-Salamon and Hugo Lagercrantz
Article first published online: 13 MAR 2015 | DOI: 10.1111/apa.12966

ABSTRACT
This article reviews updated advice and factual material from the Swedish National Board of
Health and Welfare on reducing the risk of sudden infant death syndrome. Issues covered
by the guidance for parents and healthcare professionals include sleeping positions,
smoking, breastfeeding, bed sharing and using pacifiers.
Conclusion: The guidelines conclude that infants under three months of age are safest

sleeping in their own cot and that a pacifier can be used when they are going to sleep.http://onlinelibrary.wiley.com/doi/10.1111/apa.12966/epdf

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.