17.3.06

Lost in translation? pediatric preventive care and language barriers.

J Pediatr. 2006 Feb;148(2):254-258.
Primary language of parent is associated with disparities in pediatric preventive care.Cohen AL, Christakis DA.
Department of Pediatrics, Child Health Institute, and Children's Hospital andRegional Medical Center, University of Washington, Seattle, Washington.

OBJECTIVES: To determine whether infants of parents whose primary language is not English are less likely to receive recommended preventive care than infant sof parents whose primary language is English.
STUDY DESIGN: We conducted a retrospective cohort study of all 38,793 1-year-old Medicaid-enrolled infants born in Washington state between January 1, 1999 and September 30, 2000. The main exposure was self-reported primary language of parents. Using multivariate regression, we estimated the relative risk of receiving appropriate and timely receipt of preventive care visits in the first year as recommended by theAmerican Academy of Pediatrics and Washington state Medicaid.
RESULTS: Fewerthan 1 in 6 (15.4%) infants received all 6 recommended preventive care visits in their first year of life. Infants of parents whose primary language was not English were half as likely to receive all recommended preventive care visits compared with infants of parents whose primary language was English (adjusted relative risk = 0.53; 95% confidence interval = 0.49 to 0.58). This disparity was seen in white, Hispanic, and African-American infants, but not in Asian-American infants.
CONCLUSIONS: Disparities based on primary language existin receipt of recommended pediatric preventive care in white, Hispanic, and African-American infants enrolled in Medicaid.

Evidence for identifying children at risk for being overweight, cardiovascular disease, and type 2 diabetes in primary care.

Bindler RM, Bruya MA.
INTRODUCTION: Practitioners have noted the escalating risk for children being overweight and having cardiovascular disease and type 2 diabetes. The purpose of this study was to apply current recommendations in examining children and to test an expanded model of assessment to predict risk.
METHOD: A nonexperimental descriptive design was applied at an academic nurse-managed clinic. Children who consented to participate (n = 118) were examined for height/weight (and calculated body mass index), blood pressure, family history, smoking exposure, acanthosis nigricans, and point-of-care nonfasting blood analysis of glucose, hemoglobin A(1C), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. Children with a body mass index greater than the 85th percentile were invited to return for fasting venipuncture, testing glucose, insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides (n = 23).
RESULTS: High rates of being overweight and additional risk factors were identified. Point-of-care machines had limited usefulness beyond usual measurements in identifying childhood risk.
DISCUSSION: Recommendations are made for nurses to take careful family histories and complete analysis of physical measurement to identify children needing further intervention to prevent and treat being overweight and disease risks.

Getting children to eat more fruit and vegetables: A systematic review.

Preventive Medicine, Volume 42, Issue 2, February 2006, Pages 85-95
Cécile Knai, Joceline Pomerleau, Karen Lock and Martin McKee.

Background: There is growing recognition of the need to increase consumption of currently suboptimal levels of fruit and vegetables by children, given their known beneficial effects for health. There is, however, a need for a synthesis of the evidence on interventions that might achieve this policy goal.
Methods: A systematic review of published and unpublished studies was carried out by searching 14 publication databases and contacting experts in the fields. All papers in eight languages were considered if they described individual- and population-based interventions and promotion programmes that encouraged the consumption of a diet relatively higher in fruit and/or vegetables in free-living, not acutely ill children of both genders, with follow-up periods of at least 3 months, measurement of change in intake and a control group.
Results: Fifteen studies focusing on children met the criteria for inclusion in the systematic review. None of the studies reviewed had a detrimental effect on fruit and vegetable consumption. Ten studies had a significant effect, ranging from +0.3 to +0.99 servings/day.
Conclusions: More research is needed to examine in more depth, for longer follow-up periods, the effectiveness of interventions promoting fruit and vegetable consumption. The evidence is strongest in favor of multi-component interventions to increase fruit and vegetable consumption in children.

8.3.06

Testicular growth from birth to two years of age, and the effect of orchidopexy at age nine months: A randomized, controlled study.

Acta Paediatr. 2006 Mar;95(3):318-24.
Aim: To study whether surgical treatment at age 9 mo in boys with congenital unilaterally palpable undescended testes (cryptorchidism) is followed by improved growth of the previously retained testes compared to non-treatment. Methods: At the age of 6 mo, 70 boys were randomized to surgical treatment at 9 mo and 79 boys to treatment at 3 y of age. The boys were then followed at 12 and 24 mo. Ultrasonography was used to determine testicular volume. Results: After orchidopexy, the previously retained testes resumed growth and were significantly larger than the non-operated testes at 2 y (0.49 ml vs 0.36 ml, p<0.001). Testicular growth after orchidopexy was also demonstrated by a higher mean ratio between the previously retained and the scrotal testes of the individual boys at 2 y: 0.84 for the surgically treated group, compared to 0.63 for the untreated group (p<0.001).Conclusion: Surgery at 9 mo has a beneficial effect on the growth of previously undescended testes.

7.3.06

Effects of brief exposure to water, breast-milk substitutes, or other liquids ont he success and duration of breastfeeding: a systematic review.

Szajewska H, Horvath A, Koletzko B, Kalisz M.
Acta Paediatr. 2006 Feb;95(2):145-52.
AIM: To systematically evaluate the effect of supplemental fluids or feedings during the first days of life on the overall breastfeeding duration and rate of exclusive breastfeeding among healthy infants.
METHODS: Medical subject headings and free-language terms were used to search the following electronic databases for studies relevant to breastfeeding: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), the Cochrane Library, and La Leche League. Only randomized, controlled trials (RCT) were considered for study inclusion.
RESULTS: Of 56 potentially relevant clinical trials identified, only one RCT (170 infants) met the inclusion criteria for this systematic review. In this study, formula feeding was significantly more frequent at 4 wk in the experimental group in which breastfeeding had been supplemented with 5% glucose ad libitum during the first 3 d of life (n = 83) than in the exclusively breastfed control group (n = 87) (p <>

6.3.06

Screening for developmental dysplasia of the hip: recommendation statement

United States Preventive Services Task Force (USPSTF). Screening for developmental dysplasia of the hip: recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality; 2006. 10 p. [48 references]
MAJOR RECOMMENDATIONS
The USPSTF concludes that evidence is insufficient to recommend routine screening for developmental dysplasia of the hip in infants as a means to prevent adverse outcomes.
I Recommendation.*
The pathophysiology and natural history of developmental dysplasia of the hip (DDH) are poorly understood. There is evidence that screening leads to earlier identification; however, 60% to 80% of the hips of newborns identified as abnormal or as suspicious for DDH by physical examination and >90% of those identified by ultrasound in the newborn period resolve spontaneously, requiring no intervention. There is poor evidence (poor quality studies) of the effectiveness of both surgical and non-surgical interventions; avascular necrosis of the hip (AVN) is reported in 0% to 60% of children who are treated for DDH. Thus, the USPSTF was unable to assess the balance of benefits and harms of screening for DDH but was concerned about the potential harms associated with treatment of infants identified by routine screening.
*Note: Standard language associated with the grade I recommendation is "The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing {the service}." For this specific recommendation, the USPSTF modified the language to indicate the lack of evidence that screening for a condition with a poorly defined natural history would improve health outcomes while there is evidence that interventions cause known harms.
Clinical Considerations
This USPSTF screening recommendation applies only to infants who do not have obvious hip dislocations or other abnormalities evident without screening. DDH represents a spectrum of anatomic abnormalities in which the femoral head and the acetabulum are aligned improperly or grow abnormally. DDH can lead to premature degenerative joint disease, impaired walking, and pain. Risk factors for DDH include female gender, family history of DDH, breech positioning, and in utero postural deformities. However, the majority of cases of DDH have no identifiable risk factors.
Screening tests for DDH have limited accuracy. The most common methods of screening are serial physical examinations of the hip and lower extremities, using the Barlow and Ortolani procedures, and ultrasonography. The Barlow examination is performed by adducting a flexed hip with gentle posterior force to identify a dislocatable hip. The Ortolani examination is performed by abducting a flexed hip with gentle anterior force to relocate a dislocated hip. Data assessing the relative value of limited hip abduction as a screening tool are sparse and suggest the test is of little value in early infancy and is of somewhat greater value as infants age.
Treatments for DDH include both nonsurgical and surgical options. Nonsurgical treatment with abduction devices is used in early treatment and includes the commonly prescribed Pavlik method. Surgical intervention is used when DDH is severe or diagnosed late or after an unsuccessful trial of non-surgical treatments. Evidence of the effectiveness of interventions is inconclusive because of a high rate of spontaneous resolution, absence of comparative studies of intervention versus nonintervention groups, and variations in surgical indications and protocols. Avascular necrosis of the hip is the most common and most severe potential harm of both surgical and nonsurgical interventions and can result in growth arrest of the hip and eventual joint destruction with significant disability.