1.4.14


Informe SESPAS
Este artículo revisa la evolución de los estilos de vida e identifica algunas prioridades y líneas de mejora en prevención y promoción de la salud en el momento actual de crisis económica. Se utilizan diversas fuentes, incluida una encuesta a 30 expertos/as en salud pública y atención primaria. Entre 2006 y 2012 no se detectan grandes cambios en estilos de vida, salvo un descenso en el consumo habitual de alcohol. Desciende ligeramente el consumo de drogas ilegales, pero aumenta el de psicofármacos. La mayoría de los/las expertos/as considera que debe mejorarse la toma de decisiones sobre cribados poblacionales y vacunas, incluyendo el análisis del coste de oportunidad, y mayor transparencia e independencia de los/las profesionales implicados/as. La prevención está contribuyendo a la medicalización de la vida, pero hay opiniones divididas sobre la necesidad de algunas actividades preventivas. Las prioridades en prevención están en el ámbito de la salud mental y de la infección por el virus de la inmunodeficiencia humana en grupos vulnerables. La mayoría de los/las expertos/as considera que las intervenciones de promoción de la salud tienen potencial para mitigar los efectos de la crisis, y que son grupos prioritarios la infancia, las personas desempleadas y otros grupos vulnerables. Son intervenciones prioritarias las actividades comunitarias en colaboración con ayuntamientos y otros sectores, la abogacía y la promoción de la salud mental. Se considera deseable un mayor uso de la legislación y de los medios de comunicación como herramientas de promoción. Es importante clarificar el rol del sector sanitario en las actividades intersectoriales, y reconocer las limitaciones, puesto que los determinantes sociales de salud dependen de otros sectores. Se advierte asimismo del riesgo derivado de los recortes y de las políticas que inciden negativamente en las condiciones de vida.

29.3.14

Ideal timing of orchiopexy: a systematic review.


Chan E, Wayne C, Nasr A; FRCSC for Canadian Association of Pediatric Surgeon Evidence-Based Resource.
The ideal management of cryptorchidism is a highly debated topic within the field of pediatric surgery. The optimal timing of orchiopexy is particularly unclear, as existing literature reports mixed recommendations. The aim of this study was to determine, based on a systematic review, the most favorable age at which orchiopexy should be performed. We conducted a systematic search of MEDLINE, Embase, CINAHL, and the Cochrane Library to find relevant articles. Two researchers quality assessed each study using the following tools: AMSTAR (systematic reviews), Jadad (RCTs), and MINORS (non-RCTs). We developed a conclusion based on the highest quality studies. We found one relevant systematic review, one RCT, and 30 non-RCTs. Fertility potential was greatest when orchiopexy was performed before 1 year of age. Additionally, orchiopexy before 10–11 years may protect against the increased risk of testicular cancer associated with cryptorchidism. Orchiopexy should not be performed before 6 months of age, as testes may descend spontaneously during the first few months of life. The highest quality evidence recommends orchiopexy between 6 and 12 months  of age. Surgery during this timeframe may optimize fertility potential and protect against testicular malignancy in children with cryptorchidism.

Approaches to enhancing the early detection of autism spectrum disorders: a systematic review of the literature.

Daniels AM(1), Halladay AK(2), Shih A(3), Elder LM(4), Dawson G(5).

Comment in
[Are We There Yet? The State of Early Prediction and Intervention in Autism Spectrum Disorder] 

BACKGROUND: A reliable diagnosis of autism can be made as early as 24 months, yet in many children diagnoses are made much later. A delay in diagnosis translates into a missed opportunity to provide early intervention services and to improve outcomes. The aim of the current study was to review the literature on early detection approaches in primary care and other community settings in the United States.
METHODS: A search was conducted of the peer-reviewed and gray literature to identify studies published from January 1990 through January 2013 testing approaches to enhance the early detection of autism in community settings in the United States.
RESULTS: The search identified 40 studies describing 35 approaches, which were grouped into the following categories: awareness (n = 4), routine screening (n = 21), and practice improvement to enhance screening (n = 10). Awareness approaches were associated with positive changes in knowledge of autism-related topics. Routine screening yielded high or increased rates of screening and referrals; however, few studies assessed the effect of screening on age at diagnosis or services enrollment. Practice improvement approaches resulted in increased screening and referral rates and highlighted the importance of adopting a multipronged approach to enhance early detection.

CONCLUSIONS: Although studies that tested screening approaches in community settings found positive results, the effectiveness of such efforts on reducing time to diagnosis and services enrollment remains largely untested. The fact that few studies reported outcomes beyond rates of referral indicates the need for enhanced methodological rigor, particularly with respect to length of follow-up and quality of measures used.

Clinical guidelines for postpartum women and infants in primary care: a systematic review.

Haran C, van Driel M, Mitchell BL, Brodribb WE(1).

BACKGROUND: While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care.
METHODS: PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument.
RESULTS: Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest.

CONCLUSIONS: Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.

A Systematic Review of Effective Interventions for Reducing Multiple Health Risk Behaviors in Adolescence.

Am J Public Health. 2014 Mar 13. [Epub ahead of print]
Hale DR(1), Fitzgerald-Yau N, Viner RM.

We systematically searched 9 biomedical and social science databases (1980-2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up.

Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies. (Am J Public Health. Published online ahead of print March 13, 2014: e1-e23. doi:10.2105/AJPH.2014.301874).

Dairy consumption and pre-school, school-age and adolescent obesity in developed countries: a systematic review and meta-analysis.

Dror DK.

Childhood obesity, the primary health problem affecting children in developed countries, has been attributed in part to changes in dietary patterns. Secular trends suggest a decrease in childhood dairy consumption coinciding with the rise in obesity prevalence.
The objective of the present systematic review and meta-analysis was to consider evidence of associations between dairy intake and adiposity in pre-schoolers, school-age children and adolescents in developed countries.
Of 36 studies included in the systematic review, sufficient data for effect size estimation and inclusion in the meta-analysis were obtained from 22 studies. No significant association was found between dairy intake and adiposity  in the aggregated data, although statistical heterogeneity was high (I(2)  = 0.72). Among adolescents, however, dairy intake was inversely associated with  adiposity (effect size -0.26, [-0.38, -0.14], P < 0.0001). Effect size was not predicted by exposure variable (milk vs. dairy), study design, statistical methods, outcome variables or sex. Interpretation of results was complicated by variability in study methods and insufficient adjustment for relevant confounders, particularly dietary reporting accuracy, sweetened beverage intake and pubertal development.

Despite limitations, available data suggest a neutral effect of dairy intake on adiposity during early and middle childhood and a modestly protective effect in adolescence.

Performance of Tuberculin Skin Test Measured against Interferon Gamma Release Assay as Reference Standard in Children.

Eisenhut M(1), Fidler K(2).
Objectives. International guidelines differ in the threshold of tuberculin skin test (TST) induration regarded as indicating Mycobacterium (M.) tuberculosis infection. Interferon gamma release assay (IGRA) results were used as reference to assess performance of TST induration thresholds for detection of M. tuberculosis infection in children.
Design. Systematic review which included studies containing data on TST, IGRA, and Bacillus Calmette-Guérin (BCG) status in children. Data bases searched were PubMed, EMBASE, and the Cochrane library. Specificities and sensitivities were calculated for TST thresholds 5, 10, and 15 mm and correlated with age and geographical latitude.
Results. Eleven studies with 2796 children were included. For BCG immunised children diameters of 5, 10, and 15 mm had median sensitivities of 87, 70, and 75% and specificities of 67, 93, and 90%, respectively. In non-BCG immunised children median sensitivities were 94, 95, and 83% and specificities 91, 95, and 97%. At the 10 mm threshold age correlated negatively with sensitivity of TST (r = -0.65, P = 0.04) and latitude correlated positively (r = 0.71, P = 0.02).

Conclusions. For the 10 mm threshold the sensitivity of the TST is lower in BCG immunised children. Younger  age and higher geographical latitude were associated with higher sensitivity of the TST.

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure.

Rosen LJ(1), Myers V, Hovell M, Zucker D, Ben Noach M. 

BACKGROUND AND OBJECTIVE: Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE. 
METHODS: Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed. 
RESULTS: Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20). 
CONCLUSIONS: Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.

Beyond the clinic: improving child health through evidence-based community development.

Komro KA(1), Tobler AL, Delisle AL, O'Mara RJ, Wagenaar AC.

BACKGROUND: Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities.
METHODS: To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990-2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.
RESULTS: Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies  conducted in the United States, but the vast majority of them were U.S.-based,
and the results therefore are most applicable to the U.S. context.

CONCLUSIONS: Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set  of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta-analytic review.

Liao Y, Liao J, Durand CP, Dunton GF.
Sedentary behaviour is emerging as an independent risk factor for paediatric obesity. Some evidence suggests that limiting sedentary behaviour alone could be effective in reducing body mass index (BMI) in children. However, whether adding physical activity and diet-focused components to sedentary behaviour reduction interventions could lead to an additive effect is unclear. This meta-analysis aims to assess the overall effect size of sedentary behaviour interventions on BMI reduction and to compare whether interventions that have multiple components (sedentary behaviour, physical activity and diet) have a higher mean effect size than interventions with single (sedentary behaviour) component. Included studies (n=25) were randomized controlled trials of children (<18 years) with intervention components aimed to reduce sedentary behaviour and measured BMI at pre- and post-intervention. Effect size was calculated as the mean difference in  BMI change between children in an intervention group and a control group. Results indicated that sedentary behaviour interventions had a significant effect on BMI reduction. The pooled effect sizes of multi-component interventions (g=-0.060-0.089) did not differ from the single-component interventions (g=-0.154), and neither of them had a significant effect size on its own.
Future paediatric obesity interventions may consider focusing on developing strategies to decrease multiple screen-related sedentary behaviours.

Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review.


Original bibliographic details:
Antwi FA, Fazylova N, Garcon MC, Lopez L, Rubiano R, Slyer JT. Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review. JBI Database of Systematic Reviews and Implementation Reports 2013; 11(6): 1-44. DOI 10.11124/jbisrir-2013-459
[In: DARE http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=12013057780#.UzaP8_l5Oup]

CRD summary
The authors concluded that a web-based programme, as part of a multi-component intervention, could reduce besity and being overweight, in school-aged children. The authors' conclusions may be overstated given the mixed results in the individual trials, the variation between the interventions, and the limited synthesis.

Authors' objectives
To assess the effectiveness of web-based programmes to reduce childhood obesity in school-aged children.

Searching
A broad range of 15 databases, including CINAHL, PubMed, EMBASE, PsycINFO and ERIC, was searched for articles from 1991 to August 2012; search strategies for each database were reported. Reference lists of included studies were checked. Studies had to be in English.

Study selection
Randomised controlled trials (RCTs) or pseudo-randomised trials of web-based programmes, alone or with other components, aimed at reducing obesity in four- to 18-year-olds, were eligible for inclusion. The outcomes of interest were measures of weight including body mass index (BMI), body weight and waist circumference.
The included trials were all conducted in the USA, except one that was conducted in the Netherlands. The trials included normal-weight, at-risk or overweight children. Most trials were of adolescent boys and girls. The interventions were typically weekly sessions of web-based programmes targeting weight loss, body image improvement, or behaviour modification for weight control. In all trials, the web-based intervention was delivered with other interventions, such as counselling sessions, parental involvement, or phone or email prompts. The interventions lasted between five and 52 weeks.
The authors did not state how many reviewers selected studies.

Assessment of study quality
Two reviewers independently assessed trial quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for randomised controlled or pseudo-randomised trials. Trials had to meet a minimum of six out of the 10 checklist criteria to be included in the review. Disagreements were resolved through discussion or by a third reviewer.

Data extraction
The mean and standard deviation of the body mass index (BMI), BMI z-score, waist-hip ratio, waist circumference, and body fat at the start and after intervention were extracted.
Two reviewers independently extracted the data; disagreements were resolved by discussion or by a third reviewer.

Methods of synthesis
A narrative synthesis was presented, due to significant clinical and methodological variation.

Results of the review
Twelve reports of eight RCTs were included (1,717 school-aged children; range 30 to 883). Follow-up ranged from three to 24 months. All RCTs were judged to be of adequate quality.
Four RCTs showed that web-based programmes reduced either BMI, BMI z-score, waist-hip ratio, or body fat. Reductions were not observed beyond nine months after the intervention. One RCT showed no difference in BMI, one showed no difference in BMI z-score, and two showed an increase in BMI at follow-up.
Parents were involved as part of the intervention in all the trials that showed an improvement or no change from the start. Telephone or email reminders were part of the intervention in four of these six trials.

Authors' conclusions
A reduction in obesity and being overweight, for school-aged children, was possible with web-based weight-reduction interventions that had other components.

CRD commentary
The review question and inclusion criteria were clear. The restriction to trials in English may have excluded some relevant data. Data extraction and quality assessment were undertaken by two reviewers independently, which reduced the potential for error, but it was unclear whether the same process was used for study selection. While all the included trials were considered to be of adequate quality, some were at risk of bias.
A narrative synthesis was appropriate given the differences in the included interventions and populations, but the synthesis was very limited. The synthesis was also limited by the small size and relatively short follow-up in the included trials. As all the interventions included other components it was difficult to determine whether any benefits were due to the web-based programme or to the other components.
The authors' conclusions may be overstated given the mixed results in the individual trials, the variation between the interventions, and the limited synthesis.

Implications of the review for practice and research
Practice: The authors stated that using web-based technology as part of a multi-component intervention for weight reduction in school-aged children was promising.
Research: The authors stated that future studies should evaluate the effects of web-based technology as a single intervention, on a large sample, over a long period of time.

27.3.14

Fluoride toothpaste use for young children

  1. American Dental Association Council on Scientific Affairs
  1. Address correspondence to the American Dental Association Council on Scientific Affairs, 211 E. Chicago Ave., Chicago, Ill. 60611.
The ADA currently advises caregivers to brush with water, and to consult with a dentist or physician before using fluoride toothpaste, for children younger than 2 years. Use of a pea-sized amount of fluoride toothpaste is recommended for children from 2 to 6 years of age.1 Other recommendations propose use of a “smear” of fluoride toothpaste (approximately 0.1 gram of toothpaste or 0.1 milligram of fluoride) for children younger than 2 years and a pea-sized amount (approximately 0.25 g toothpaste or 0.25 mg fluoride) for children from 2 to 6 years of age.2
The optimal dose of fluoride is 0.05 mg per kilogram per day.3 Using a pea-sized amount of toothpaste versus a smear more than doubles the amount of fluoride potentially consumed by a child. For example, an average 2-year-old child who weighs 15 kg, brushes his or her teeth twice a day with a smear of toothpaste and swallows all of the toothpaste would ingest 0.2 mg of fluoride, resulting in a dose of 0.013 mg/kg. If this same child were to brush twice per day with a pea-sized amount of toothpaste and swallow all of the toothpaste, he or she would ingest 0.5 mg fluoride, resulting in a dose of 0.033 mg/kg.4Children are exposed to fluoride through consumption of food and beverages. Considering these additional potential sources of fluoride and the risk of developing fluorosis at the time of tooth formation, the Council recommends use of a smear of toothpaste from eruption of the first tooth to age 3 years followed by use of a pea-sized amount for children aged 3 to 6 years. This regimen is intended to maximize the caries-preventive benefits of fluoride while further reducing the risk of developing fluorosis when compared with previous recommendations for use of a pea-sized amount of fluoride toothpaste starting when a child is 2 years of age.
Although the risk of developing fluorosis in the permanent dentition is associated with fluoride exposure beginning at 1 year of age, the risk to the permanent central incisors is greatest at approximately 2 years of age.5 The toothpaste regimen described previously is consistent with the schedule and dosage used for prescription fluoride supplements recommended for children who have a high risk of developing caries and who live in areas without fluoridated water. The supplement dosage increase goes into effect at age 3 years; previously, an increase in fluoride supplement dosage was recommended at 2 years of age.6 The recommendation was modifiedto 3 years of age to reduce the risk of developing dental fluorosis. For children at high risk of developing caries whose primary water supply contains less than 0.3 parts per million fluoride, the recommended systemic dietary fluoride supplementation is 0.25 mg (for children aged 6 months to 3 years) and 0.5 mg (for children aged 3 to 6 years).7
Recommending fluoride therapy in children—whether it be fluoride supplements, toothpaste or professional topical applications—typically is tied to caries risk assessment, with fluoride therapies recommended for children who are at high risk of developing caries. All children should undergo a caries risk assessment before their dentists make recommendations associated with preventing or controlling dental caries. This is a critical step in developing a personalized prevention plan. It also is critical that the dentist assess a child’s total fluoride exposure from all sources (beverages, food, toothpaste, supplements, topical applications and so forth) when developing a preventive treatment plan that is directed at optimizing caries control and safety. To address the risks and benefits associated with fluoride toothpaste use in young children adequately, the dentist should aim in conversations with caregivers to assess a child’s total fluoride exposure on the basis of all potential sources. There are no validated caries risk assessment tools with known sensitivity and specificity for children. This makes it challenging to base therapeutic recommendations on the risk of future disease development.8 Evaluation of caries risk assessment tools in adults that are validated has shown that the tools are not highly accurate in predicting future disease development.9,10 The best predictor of a person’s developing dental caries in the future is the presence of dental caries. Because most 1-year-old children do not have dental caries, and considering the rate of caries progression, it is difficult to predict which of these children will become the approximately 40 percent of children who experience dental caries in their primary teeth.1116 Therefore, considering the best available evidence and the continued high caries rate in children, the Council recommends the following:
  • ▬ For children younger than 3 years, caregivers should begin brushing children’s teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than a smear or the size of a grain of rice (Figure). Brush teeth thoroughly twice per day (morning and night) or as directed by a dentist or physician. Supervise children’s brushing to ensure that they use the appropriate amount of toothpaste.
  • ▬ For children 3 to 6 years of age, caregivers should dispense no more than a pea-sized amount (Figure) of fluoride toothpaste. Brush teeth thoroughly twice per day (morning and night) or as directed by a dentist or physician. Supervise children’s brushing to minimize swallowing of toothpaste.
  • ▬ It is especially critical that dentists provide counseling to caregivers that involves the use of oral description, visual aids and actual demonstration to help ensure that the appropriate amount of toothpaste is used.
     
     

26.3.14

Primary Care Behavioral Interventions to Prevent or Reduce Illicit Drug Use and Nonmedical Pharmaceutical Use in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force.

http://www.uspreventiveservicestaskforce.org/uspstf13/drugmisuse/drugmisusefinalrs.htm

Background: Drug use among youths is associated with negative health and social consequences. Even infrequent use increases the risk for serious adverse events by increasing risk-taking behaviors in intoxicated or impaired persons.
Purpose: To systematically review the benefits and harms of primary care–relevant interventions designed to prevent or reduce illicit drug use or the nonmedical use of prescription drugs among youths.
Data Sources: PubMed, PsycINFO, and the Cochrane Central Register of Controlled Trials through 4 June 2013; MEDLINE through 31 August 2013; and manual searches of reference lists and gray literature.
Study Selection: Two investigators independently reviewed 2253 abstracts and 144 full-text articles. English-language trials of primary care–relevant behavioral interventions that reported drug use, health outcomes, or harms were included.
Data Extraction: One investigator abstracted data from good- and fair-quality trials into prespecified evidence tables, and a second investigator checked these data.
Data Synthesis: Six trials were included, 4 of which examined the effect of the intervention on a health or social outcome. One trial found no effect of the intervention on marijuana-related consequences or driving under the influence of marijuana; 3 trials generally found no reduction in depressed mood at 12 or 24 months. Four of the 5 trials assessing self-reported marijuana use found statistically significant differences favoring the intervention group participants (such as a between-group difference of 0.10 to 0.17 use occasions in the past month). Three trials also reported positive outcomes in nonmedical prescription drug use occasions.
Limitations: The body of evidence was small, and there were heterogeneous measures of outcomes of limited clinical applicability. Trials primarily included adolescents with little or no substance use.
Conclusion: Evidence is inadequate on the benefits of primary care–relevant behavioral interventions in reducing self-reported illicit and pharmaceutical drug use among adolescents.
Primary Funding Source: Agency for Healthcare Research and Quality.

19.3.14

Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement.

U.S. Preventive Services Task Force (USPSTF). Screening for primary hypertension in children and adolescents: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013 Nov 5;159(9):613-9. [12 references] PubMed External Web Site Policy


Description: Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for high blood pressure in children and adolescents.
Methods: The USPSTF reviewed the evidence on screening and diagnostic accuracy of screening tests for blood pressure in children and adolescents, the effectiveness and harms of treatment of screen-detected primary childhood hypertension, and the association of hypertension with markers of cardiovascular disease in childhood and adulthood.
Population: This recommendation applies to children and adolescents who do not have symptoms of hypertension.
Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood.

13.3.14

Preventive services for children and adolescents

Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, McKeon K, Milteer L, Owens J, Rothe P, Snellman L, Solberg L, Vincent P. Preventive services for children and adolescents. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Sep. 96 p. [229 references]

Describe por niveles de evidencia todas las actividades preventivas.
Actualizado en septiembre 2013.


5.3.14

Trial of Daily Vitamin D Supplementation in Preterm Infants


  1. Vishnubhatla Sreenivas, PhDe
    1.  2014 Mar;133(3):e628-34. doi: 10.1542/peds.2012-3395. Epub 2014 Feb 10.

      OBJECTIVE: To compare the effect of 800 vs 400 IU of daily oral vitamin D3on the prevalence of vitamin D deficiency (VDD) at 40 weeks’ postmenstrual age (PMA) in preterm infants of 28 to 34 weeks’ gestation.
      METHODS: In this randomized double-blind trial, we allocated eligible infants to receive either 800 or 400 IU of vitamin D3 per day (n = 48 in both groups). 
      RESULTS: Prevalence of VDD in the 800-IU group was significantly lower than in the 400-IU group at 40 weeks (38.1% vs 66.7%; relative risk: 0.57; 95% confidence interval: 0.37–0.88) and at 3 months’ CA (12.5% vs 35%; relative risk: 0.36; 95% confidence interval: 0.14–0.90). One infant (2.4%) in the 800-IU group had vitamin D excess (100–150 ng/mL). Bone mineral content (mean ± SD: 79.6 ± 16.8 vs 84.7 ± 20.7 g; P = .27) and bone mineral density (0.152 ± 0.019 vs 0.158 ± 0.021 g/cm2P = .26) were not different between the 2 groups.
      CONCLUSIONS: Daily supplementation with 800 IU of vitamin D reduces the prevalence of VDD at 40 weeks’ PMA and at 3 months’ CA in preterm infants without showing any improvement in bone mineralization. However, there is a possibility that this dose may occasionally result in vitamin D excess