The USPSTF concludes...

...that the evidence is insufficient to recommend for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children up to 5 years of age.
Rating: I Recommendation.
Release Date: February 2006

Rationale: Speech and language delay affects 5 to 8 percent of preschool children, often persists into the school years, and may be associated with lowered school performance and psychosocial problems. The USPSTF found insufficient evidence that brief, formal screening instruments that are suitable for use in primary care for assessing speech and language development can accurately identify children who would benefit from further evaluation and intervention. Fair evidence suggests that interventions can improve the results of short-term assessments of speech and language skills; however, no studies have assessed long-term outcomes. Furthermore, no studies have assessed any additional benefits that may be gained by treating children identified through brief, formal screening who would not be identified by addressing clinical or parental concerns. No studies have addressed the potential harms of screening or interventions for speech and language delays, such as labeling, parental anxiety, or unnecessary evaluation and intervention. Thus, the USPSTF could not determine the balance of benefits and harms of using brief, formal screening instruments to screen for speech and language delay in the primary care setting.

Effectiveness of home visitation by public-health nurses in prevention of the recurrence of child physical abuse and neglect: a randomised controlled

MacMillan HL, Thomas BH, Jamieson E, Walsh CA, Boyle MH, Shannon HS, Gafni A.
Effectiveness of home visitation by public-health nurses in prevention of the recurrence of child physical abuse and neglect: a randomised controlled trial.
Lancet. 2005 May 21-27;365(9473):1786-93.
BACKGROUND: Recurrence of child maltreatment is a major problem, yet little is known about approaches to reduce this risk in families referred to child protection agencies. Since home visitation by nurses for disadvantaged first-time mothers has proven effective in prevention of child abuse and neglect, we aimed to investigate whether this approach might reduce recidivism. METHODS: We enrolled in a randomised controlled trial 163 families with a history of one index child being exposed to physical abuse or neglect to compare standard treatment with a programme of home visitation by nurses in addition to standard treatment. The main outcome was recurrence of child physical abuse and neglect based on a standardised review of child protection records. Analysis was by intention to treat. FINDINGS: At 3-years' follow-up, records were available for 160 of 163 (98%) families randomised. 139 (85%) completed follow-up. Recurrence of child physical abuse (31 [43%] in the control group vs 29 [33%] in the intervention group) and neglect (37 [51%] vs 41 [47%]) did not differ between groups. However, hospital records showed significantly higher recurrence of either physical abuse or neglect in the intervention group than in the control group (21 [24%] vs 8 [11%]). There were no differences between groups for the other secondary outcome measures. INTERPRETATION: Despite the positive results of home visitation by nurses as an early prevention strategy, this visit-based strategy does not seem to be effective in prevention of recidivism of physical abuse and neglect in families associated with the child protection system. Much more effort needs to be directed towards prevention before a pattern of abuse or neglect is established in a family.

Breastfeeding and mean body mass index throughout life.

Owen CG, Martin RM, Whincup PH, Davey-Smith G, Gillman MW, Cook DG.

The effect of breastfeeding on mean body mass index throughout life: aquantitative review of published and unpublished observational evidence.

Am J Clin Nutr. 2005 Dec;82(6):1298-307.

BACKGROUND: Evidence from observational studies has suggested that breastfeeding may reduce the prevalence of obesity in later life. OBJECTIVE: The objective was to examine whether initial breastfeeding is related to lower mean body mass index (BMI; in kg/m(2)) throughout life.

DESIGN: The study was a systematic review of published studies investigating the association between infant feedingand a measure of obesity or adiposity in later life, which was supplemented with data from unpublished sources. Analyses were based on the mean differences in BMI between those subjects who were initially breastfed and those who were formula-fed (expressed as breastfed minus bottle-fed), which were pooled byusing fixed-effects models throughout.

RESULTS: From 70 eligible studies, 36 mean differences in BMI (from 355 301 subjects) between those breastfed and those formula-fed (reported as exclusive feeding in 20 studies) were obtained.Breastfeeding was associated with a slightly lower mean BMI than was formula feeding (-0.04; 95% CI: -0.05, -0.02). The mean difference in BMIs appeared larger in 15 small studies of <1000>or=1000 subjects (-0.03; 95% CI: -0.05, -0.02). An Egger test was statistically significant (P = 0.002). Adjustment for socioeconomic status, maternal smoking in pregnancy, and maternal BMI in 11 studies abolished the effect (-0.10; 95% CI: -0.14, -0.06 before adjustment;-0.01; 95% CI: -0.05, 0.03 after adjustment).

CONCLUSIONS: Mean BMI is lower among breastfed subjects. However, the difference is small and is likely to be strongly influenced by publication bias and confounding factors. Promotion of breastfeeding, although important for other reasons, is not likely to reduce mean BMI.

SMSL y colecho

Lancet. 2006 Jan 28;367(9507):314-9.

Major epidemiological changes in sudden infant death syndrome: a 20-yearpopulation-based study in the UK.

Blair PS, Sidebotham P, Berry PJ, Evans M, Fleming PJ.Institute of Child Life and Health, Department of Clinical Science, Universityof Bristol, UK.

BACKGROUND: Results of case-control studies in the past 5 years suggest that theepidemiology of sudden infant death syndrome (SIDS) has changed since the 1991UK Back to Sleep campaign. The campaign's advice that parents put babies ontheir back to sleep led to a fall in death rates. We used a longitudinal datasetto assess these potential changes.

METHODS: Population-based data from homevisits have been collected for 369 consecutive unexpected infant deaths (300SIDS and 69 explained deaths) in Avon over 20 years (1984-2003). Data obtainedbetween 1993 and 1996 from 1300 controls with a chosen "reference" sleep beforeinterview have been used for comparison.

FINDINGS: Over the past 20 years, theproportion of children who died from SIDS while co-sleeping with their parents,has risen from 12% to 50% (p<0.0001), p="0.01)." p="0.003)," p="0.0004)," p="0.0001).">

INTERPRETATION: Factors thatcontribute to SIDS have changed in their importance over the past 20 years.Although the reasons for the rise in deaths when a parent sleeps with theirinfant on a sofa are still unclear, we strongly recommend that parents avoidthis sleeping environment. Most SIDS deaths now occur in deprived families. Tobetter understand contributory factors and plan preventive measures we needcontrol data from similarly deprived families, and particularly, infant sleepenvironments.

Refers to: Prevention of sudden unexpected infant death, The Lancet, Volume 367, Issue 9507, 28 January 2006-3 February 2006, Pages 277-278 Jacobus P van Wouwe, and Remy A HiraSinga,