22.7.15

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


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

Abstract

AIMS:

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

BACKGROUND:

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

DESIGN:

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

DATA SOURCES:

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

REVIEW METHODS:

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

RESULTS:

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

CONCLUSION:

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

16.7.15

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

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


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

1.7.15

Primary prevention of childhood obesity, second edition.

Primary prevention of childhood obesity, second edition.

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

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

9.6.15

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.

BACKGROUND AND OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

4.6.15

The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse
Cindy W. Christian, MD, FAAP, COMMITTEE ON CHILD ABUSE AND NEGLECT

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

2.6.15

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 ....

9.5.15

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.