KELLY COLLEEN MCDONALD, MAJ, MC.Am Fam Physician 2007;75:221-8
Child abuse is a common diagnosis in the United States and should be considered any time neglect or emotional, physical, or sexual abuse is a possibility. Although home visitation programs have been effective in preventing child maltreatment, much of the approach to and management of child abuse is directed by expert opinion or legal mandate. Any suspicion of abuse must be reported to Child Protective Services. A multidisciplinary approach is recommended to adequately evaluate and treat child abuse victims; however, the responsibility often lies with the family physician to recognize and treat these cases at first presentation to prevent significant morbidity and mortality. (Am Fam Physician 2007;75:221-8. Copyright © 2007 American Academy of Family Physicians.)
20.5.07
Benefits and harms associated with the practice of bed sharing: a systematic review.
Horsley T, Clifford T, Barrowman N, Bennett S, Yazdi F, Sampson M, Moher D,
Dingwall O, Schachter H, Cote A.
Arch Pediatr Adolesc Med. 2007 Mar;161(3):237-45.
(Comment in: Arch Pediatr Adolesc Med. 2007 Mar;161(3):305-6.)
OBJECTIVE: To examine evidence of benefits and harms to children associated with bed sharing, factors (eg, smoking) altering bed sharing risk, and effective strategies for reducing harms associated with bed sharing.
DATA SOURCES: MEDLINE, CINAHL, Healthstar, PsycINFO, the Cochrane Library, Turning Research Into Practice, and Allied and Alternative Medicine databases between January 1993 and January 2005. STUDY SELECTION: Published, English-language records investigating the practice of bed sharing (defined as a child sharing a sleep surface with another individual) and associated benefits and harms in children 0 to 2 years of age.
DATA EXTRACTION: Any reported benefits or harms (risk
factors) associated with the practice of bed sharing.
DATA SYNTHESIS: Forty observational studies met our inclusion criteria. Evidence consistently suggests that there may be an association between bed sharing and sudden infant death syndrome (SIDS) among smokers (however defined), but the evidence is not as consistent among nonsmokers. This does not mean that no association between bed sharing and SIDS exists among nonsmokers, but that existing data do not convincingly establish such an association. Data also suggest that bed sharing may be more strongly associated with SIDS in younger infants. A positive
association between bed sharing and breastfeeding was identified. Current data
could not establish causality. It is possible that women who are most likely to
practice prolonged breastfeeding also prefer to bed share.
CONCLUSION: Well-designed, hypothesis-driven prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the relationship between bed sharing, its benefits, and its harms.
Dingwall O, Schachter H, Cote A.
Arch Pediatr Adolesc Med. 2007 Mar;161(3):237-45.
(Comment in: Arch Pediatr Adolesc Med. 2007 Mar;161(3):305-6.)
OBJECTIVE: To examine evidence of benefits and harms to children associated with bed sharing, factors (eg, smoking) altering bed sharing risk, and effective strategies for reducing harms associated with bed sharing.
DATA SOURCES: MEDLINE, CINAHL, Healthstar, PsycINFO, the Cochrane Library, Turning Research Into Practice, and Allied and Alternative Medicine databases between January 1993 and January 2005. STUDY SELECTION: Published, English-language records investigating the practice of bed sharing (defined as a child sharing a sleep surface with another individual) and associated benefits and harms in children 0 to 2 years of age.
DATA EXTRACTION: Any reported benefits or harms (risk
factors) associated with the practice of bed sharing.
DATA SYNTHESIS: Forty observational studies met our inclusion criteria. Evidence consistently suggests that there may be an association between bed sharing and sudden infant death syndrome (SIDS) among smokers (however defined), but the evidence is not as consistent among nonsmokers. This does not mean that no association between bed sharing and SIDS exists among nonsmokers, but that existing data do not convincingly establish such an association. Data also suggest that bed sharing may be more strongly associated with SIDS in younger infants. A positive
association between bed sharing and breastfeeding was identified. Current data
could not establish causality. It is possible that women who are most likely to
practice prolonged breastfeeding also prefer to bed share.
CONCLUSION: Well-designed, hypothesis-driven prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the relationship between bed sharing, its benefits, and its harms.
11.5.07
Infant sleep position, head shape concerns, and sleep positioning devices
Lynne Hutchison, Alistair Stewart, Edwin Mitchell (2007)
Journal of Paediatrics and Child Health 43 (4), 243–248.
Aim: The Back To Sleep campaign has successfully promoted the use of the supine sleep position for infants, with a corresponding decrease in sudden infant death syndrome death rates around the world. The aim of this study was to survey current infant sleep position practices, concerns about plagiocephaly, and the use of sleep positioning devices.
Methods: A postal survey of 400 mothers of infants aged 6 weeks to 4 months was carried out in Auckland, New Zealand.
Results: Of the 278 (69.5%) respondents, the supine position was usually used in 64.8%, the prone position in 2.9%, with 32.3% using the side position or a combination of side and back positions. Approximately one-third had a concern about their infant’s head shape, and 80% described practices to help prevent head deformation. Thirty per cent reported they had changed their infant’s sleep position because of head shape concerns. A third of the mothers used some sort of positioning system to maintain the infant’s sleep position.
Conclusions: Anxieties about plagiocephaly, aspiration of vomit, and poor quality sleep are the main concerns that parents have about sleeping their infants on their backs. Further education is needed to inform mothers about these issues and to alleviate their fears.
Methods: A postal survey of 400 mothers of infants aged 6 weeks to 4 months was carried out in Auckland, New Zealand.
Results: Of the 278 (69.5%) respondents, the supine position was usually used in 64.8%, the prone position in 2.9%, with 32.3% using the side position or a combination of side and back positions. Approximately one-third had a concern about their infant’s head shape, and 80% described practices to help prevent head deformation. Thirty per cent reported they had changed their infant’s sleep position because of head shape concerns. A third of the mothers used some sort of positioning system to maintain the infant’s sleep position.
Conclusions: Anxieties about plagiocephaly, aspiration of vomit, and poor quality sleep are the main concerns that parents have about sleeping their infants on their backs. Further education is needed to inform mothers about these issues and to alleviate their fears.
10.5.07
Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary].
CMAJ. 2007 Apr 10;176(8):S1-13.2006
Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E;
Obesity CanadaClinical Practice Guidelines Expert Panel. Department of Medicine, Julia McFarlane Diabetes Research Centre, Diabetes andEndocrine Research Group, University of Calgary, Calgary, Alta.dcwlau@ucalgary.ca
We have attempted to use a rigorous, evidence-based approach to the development of the practice recommendations, while also acknowledging the breadth of topics to be assessed and the inherent limitations of the obesity literature on these topics.
In addition to making recommendations for treatment interventions, the most common application of clinical practice guidelines, we have also provided recommendations on interventions related to screening and prevention at the individual and population levels.
The recommendations are based on a prespecified process that was overseen by the Steering Committee. Specific chapters of the guidelines were delegated to a group of content experts within the Expert Panel, who performed a systematic literature review and were responsible for drafting the recommendations for each chapter. Recommendations were appraised by an independent Evidence-based Review Committee, members of which assessed whether the assigned level of evidence reflected the strength of the existing literature. The interactive process by which the recommendations were developed, reviewed and revised included 4 joint meetings of the Steering Committee and Expert Panel. The final draft of the guidelines was reviewed by the Steering Committee and by external stakeholders and experts, who included representatives from academia, industry and government and non government officials.
In addition to making recommendations for treatment interventions, the most common application of clinical practice guidelines, we have also provided recommendations on interventions related to screening and prevention at the individual and population levels.
The recommendations are based on a prespecified process that was overseen by the Steering Committee. Specific chapters of the guidelines were delegated to a group of content experts within the Expert Panel, who performed a systematic literature review and were responsible for drafting the recommendations for each chapter. Recommendations were appraised by an independent Evidence-based Review Committee, members of which assessed whether the assigned level of evidence reflected the strength of the existing literature. The interactive process by which the recommendations were developed, reviewed and revised included 4 joint meetings of the Steering Committee and Expert Panel. The final draft of the guidelines was reviewed by the Steering Committee and by external stakeholders and experts, who included representatives from academia, industry and government and non government officials.
Childhood obesity: should primary school children be routinely screened? A systematic review and discussion of the evidence
Arch Dis Child. 2007 May;92(5):416-22..
Westwood M, Fayter D, Hartley S, Rithalia A, Butler G, Glasziou P, Bland M,Nixon J, Stirk L, Rudolf M.
BACKGROUND: Population monitoring has been introduced in UK primary schools inan effort to track the growing obesity epidemic. It has been argued that parents should be informed of their child's results, but is there evidence that moving from monitoring to screening would be effective? We describe what is known about the effectiveness of monitoring and screening for overweight and obesity in primary school children and highlight areas where evidence is lacking and research should be prioritised.
DESIGN: Systematic review with discussion of evidence gaps and future research.
DATA SOURCES: Published and unpublished studies (any language) from electronic databases (inception to July 2005),clinical experts, Primary Care Trusts and Strategic Health Authorities, and reference lists of retrieved studies.
REVIEW METHODS: We included any study that evaluated measures of overweight and obesity as part of a population-level assessment and excluded studies whose primary outcome measure was prevalence.
RESULTS: There were no trials assessing the effectiveness of monitoring or screening for overweight and obesity. Studies focussed on the diagnostic accuracy of measurements. Information on the attitudes of children, parents and health professionals to monitoring was extremely sparse.
CONCLUSIONS: Our review found a lack of data on the potential impact of population monitoring or screening for obesity and more research is indicated. Identification of effective weight reduction strategies for children and clarification of the role of preventative measures are priorities. It is difficult to see how screening to identify individual children can be justified without effective interventions.
Surgery for Undescended Testes and Risk for Testicular Cancer: Age Matters
Orchiopexy in the first few years of life means less risk for testicular cancer.
At 1 year of age, about 1% of boys have undescended testes (cryptorchidism). Most experts recommend that orchiopexy should be performed before the age of 2 years because some research has suggested a link between testicular cancer and older age at surgery.
Swedish investigators identified 16,983 men in a national registry who had received a diagnosis of cryptorchidism from 1964 through 1999 and who had undergone orchiopexy before age 20 (mean age at surgery, 8.6 years). During a mean follow-up of 12.4 years, 56 men developed testicular cancer. Compared with risk in the general population, the risk for testicular cancer among those who underwent surgery before age 13 was increased (relative risk, 2.2); this twofold increased risk was noted for patients treated at all ages before 13. Among those who underwent surgery after age 13, the risk increased significantly (RR, 5.4).
Comment: These data clearly support the current recommendation that orchiopexy for undescended testis should be performed during the first few years of life.
— Howard Bauchner, MD
Published in Journal Watch Pediatrics and Adolescent Medicine May 9, 2007
Citation(s):
Pettersson A et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 2007 May 3; 356:1835-41.
At 1 year of age, about 1% of boys have undescended testes (cryptorchidism). Most experts recommend that orchiopexy should be performed before the age of 2 years because some research has suggested a link between testicular cancer and older age at surgery.
Swedish investigators identified 16,983 men in a national registry who had received a diagnosis of cryptorchidism from 1964 through 1999 and who had undergone orchiopexy before age 20 (mean age at surgery, 8.6 years). During a mean follow-up of 12.4 years, 56 men developed testicular cancer. Compared with risk in the general population, the risk for testicular cancer among those who underwent surgery before age 13 was increased (relative risk, 2.2); this twofold increased risk was noted for patients treated at all ages before 13. Among those who underwent surgery after age 13, the risk increased significantly (RR, 5.4).
Comment: These data clearly support the current recommendation that orchiopexy for undescended testis should be performed during the first few years of life.
— Howard Bauchner, MD
Published in Journal Watch Pediatrics and Adolescent Medicine May 9, 2007
Citation(s):
Pettersson A et al. Age at surgery for undescended testis and risk of testicular cancer. N Engl J Med 2007 May 3; 356:1835-41.
Suscribirse a:
Entradas (Atom)