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
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)
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)
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)
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)


Screening and routine supplementation for iron deficiency anemia: a systematic review.

Pediatrics. 2015 Apr;135(4):723-33.
McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C.


Supplementation and screening for iron-deficiency anemia (IDA) in young children may improve growth and development outcomes. The goal of this study was to review the evidence regarding the benefits and harms of screening and routine supplementation for IDA for the US Preventive Services Task Force.


We searched Medline and Cochrane databases (1996-August 2014), as well as reference lists of relevant systematic reviews. We included trials and controlled observational studies regarding the effectiveness and harms of routine iron supplementation and screening in children ages 6 to 24 months conducted in developed countries. One author extracted data, which were checked for accuracy by a second author. Dual quality assessment was performed.


No studies of iron supplementation in young children reported on the diagnosis of neurodevelopmental delay. Five of 6 trials sparsely reporting various growth outcomes found no clear benefit of supplementation. After 3 to 12 months, Bayley Scales of Infant Development scores were not significantly different in 2 trials. Ten trials assessing iron supplementation in children reported inconsistent findings for hematologic measures. Evidence regarding the harms of supplementation was limited but did not indicate significant differences. No studies assessed the benefits or harms of screening or the association between improvement in impaired iron status and clinical outcomes. Studies may have been underpowered, and control factors varied and could have confounded results.


Although some evidence on supplementation for IDA in young children indicates improvements in hematologic values, evidence on clinical outcomes is lacking. No randomized controlled screening studies are available.


The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse

PEDIATRICS Volume 135, number 5, May 2015

The American Academy of Pediatrics (AAP) has updated its child physical abuse guideline to include new information on the lasting effects of abuse and on how pediatricians can protect children. The guideline highlights risk factors for abuse and abusive injuries that are frequently overlooked.
Child physical abuse is an important cause of pediatric morbidity and abstract mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children


Systematic screening for active tuberculosis: principles and recommendations.

Systematic screening for active tuberculosis: principles and recommendations.

World Health Organization (WHO). Systematic screening for active tuberculosis: principles and recommendations. Geneva (Switzerland): World Health Organization (WHO); 2013. 133 p. [103 references]

Major Recommendations
The rating schemes for the quality of the evidence (high, moderate, low, very low) and the strength of the recommendations (strong, conditional) are defined at the end of the "Major Recommendations" field.
Key Principles for Screening for Active Tuberculosis (TB)
The following key principles should be considered when planning a TB screening initiative.
  1. Before screening is initiated, high-quality TB diagnosis, treatment, care, management and support for patients should be in place, and there should be the capacity to scale these up further to match the anticipated rise in case detection that may occur as a result of screening. In addition, a baseline analysis should be completed in order to demonstrate that the potential benefits of screening clearly outweigh the risks of doing harm, and that the required investments in screening are reasonable in relation to the expected benefits.
  2. Indiscriminate mass screening should be avoided. The prioritization of risk groups for screening should be based on assessments made for each risk group of the potential benefits and harms, the feasibility of the initiative, the acceptability of the approach, the number needed to screen, and the cost effectiveness of screening.
  3. The choice of algorithm for screening and diagnosis should be based on an assessment of the accuracy of the algorithm for each risk group considered, as well as the availability, feasibility and cost of the tests.
  4. TB screening should follow established ethical principles for screening for infectious diseases, observe human rights, and be designed to minimize the risk of discomfort, pain, stigma and discrimination.
  5. The TB screening approach should be developed and implemented in a way that optimizes synergies with the delivery of other health services and social services.
  6. A screening strategy should be monitored and reassessed continually to inform re-prioritization of risk groups, re-adaptation of screening approaches when necessary and discontinuation of screening at an appropriate time.
See section 7 in the original guideline document for details on the key principles.
Recommendations on Risk Groups to Be Screened for Active TB ....


Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis.

J Subst Abuse Treat. 2015 Apr;51:1-18. doi: 10.1016/j.jsat.2014.09.001. Epub 2014
Sep 16.
Tanner-Smith EE, Lipsey MW.
This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11-18) and young adults (age 19-30). We identified 185 eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents (g = 0.27 and g = 0.19) and young adults (g = 0.17 and g = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.


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
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
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.



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


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.


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.


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.