31.3.10

Childhood obesity and adult cardiovascular disease risk: a systematic review

Lloyd LJ, Langley-Evans SC, McMullen S. Childhood obesity and adult cardiovascular disease risk: a systematic review. Int J Obes (Lond). 2010 Jan;34(1):18-28. Epub 2009 May 12. (Review) PMID: 19434067
ABSTRACT
BACKGROUND: Although the relationship between adult obesity and cardiovascular disease (CVD) has been shown, the relationship with childhood obesity remains unclear. Given the evidence of tracking of body mass index (BMI) from childhood to adulthood, this systematic review investigated the independent relationship between childhood BMI and adult CVD risk.
OBJECTIVE: To investigate the association between childhood BMI and adult CVD risk, and whether the associations observed are independent of adult BMI. DESIGN: Electronic databases were searched from inception until July 2008 for studies investigating the association between childhood BMI and adult CVD risk. Two investigators independently reviewed studies for eligibility according to inclusion/exclusion criteria, extracted the data and assessed study quality using the Newcastle-Ottawa Scale.
RESULTS: Positive associations between childhood BMI and adult blood pressure or carotid intima-media thickness were generally attenuated once adjusted for adult BMI. Associations between childhood BMI and CVD morbidity/mortality had not been adjusted and do not provide evidence of an independent relationship. Negative associations between childhood BMI and blood pressure were observed in several adjusted data sets.
CONCLUSIONS: Little evidence was found to suggest that childhood obesity is an independent risk factor for CVD risk. Instead, the data suggest that relationships observed are dependent on the tracking of BMI from childhood to adulthood. Importantly, evidence suggests that risk of raised blood pressure is highest in those who are at the lower end of the BMI scale in childhood and overweight in adulthood. The findings challenge the widely accepted view that the presence of childhood obesity is an independent risk factor for CVD and that this period should be a priority for public health intervention. Although interventions during childhood may be important in prevention of adult obesity, it is important to avoid the potential for negative consequences when the timing coincides with critical stages of neurological, behavioural and physical development.

24.3.10

Spoons Systematically Bias Dosing of Liquid Medicine

Background: Spoon dosing has been identified as a major cause
of dosing errors and pediatric poisonings (1). Although the U.S.
Food and Drug Administration recommends against using kitchen
utensils to dose liquid medicine (2), most persons still use spoons
when pouring medicine for themselves and their families (3). Although
dosing errors remain modest when using kitchen teaspoons,
they may increase when using various sizes of larger spoons (4). If the
size of a spoon leads a teaspoonful of liquid medicine to seem like
markedly more or less than 5 mL (5), a person may compensate by
under- or overdosing (Figure).

Objective: To examine whether the dose of liquid medicine varies
depending on the size of the spoon onto which it is poured.

Methods: During the cold and flu season, we asked 195 university
students (109 men; mean age, 20.1 years [SD, 1.7]) who were
recent patients at a university health clinic to dose 5 mL of cold
medicine into a teaspoon (5 mL, 2.7 x 4 cm), a medium-sized tablespoon
(15 mL, 4 x 6 cm), and a larger spoon (45 mL, 6 x 9 cm).
We told them that they were participating in a study about cold
medicine and asked them to suppose they were at home with a cold,
taking liquid medicine with a recommended dose of 1 teaspoon. So
participants would better understand the volume of a teaspoon, we
first gave them a full bottle of cold medicine and a teaspoon and
asked them to pour exactly 1 teaspoon (5 mL). Next, we asked
participants to pour the same 5-mL dose into each of the remaining
2 spoons in a randomized order. After each of these 2 pours, we
asked participants to indicate how confident they felt that they had
poured 5 mL (1 = not very confident; 9 = very confident) and how
effictive they believed their poured dose would be (1 = not very
effective; 9 = very effective). After they left the room, we measured
the volume of cold medicine they had poured into each of the 2
spoons. We performed all analyses by using SPSS statistical software,
version 15.0 (SPSS, Chicago, Illinois). We considered a P value less
than 0.050 to be statistically significant.


Results: The amount of cold medicine that participants poured
varied directly with the size of the spoon (4.58 vs. 5.58 mL; t =
4.63; P < 0.001). Participants underdosed when using the mediumsized
spoon (4.58 vs. 5 mL; t = <2.30; P = 0.022) and overdosed
when using the larger spoon (5.58 vs. 5 mL; t = 2.39; P = 0.017).
Although the capacity of the spoons was never a constraint,
participants dosed 8.4% less than prescribed into the medium-sized
spoon and 11.6% more into the larger spoon. Notwithstanding this
aggregate bias of 20%, participants had above-average confidence
that their pouring was accurate and believed that the doses they
poured into both spoons would be equally effective.

Discussion: The amount of liquid medicine a person doses may
vary with the size of the spoon used. Participants underdosed by
8.4% when using medium-sized spoons and overdosed by 11.6%
when using larger spoons. Although these educated participants had
poured in a well-lit room after a practice pour, they were unaware of
these biases and were confident that they had poured the correct
doses in both spoons. Whereas the clinical implications of an 8% to
12% dosing error in a 1-tsp serving of medicine may be minimal, the
dosing error is likely to accumulate among fatigued patients who are
medicating themselves every 4 to 8 hours for several days.
Although one would expect more experienced pourers, such as
nurses or practiced parents, to be less biased, this may not be so.
Even confident veteran bartenders poured 28% more liquor
into short, wide glasses than into tall, slender glasses of the same
volume (6). If a medicine’s efficacy is tied to its dose, it is more
effective to strongly encourage a patient to use a measuring cap,
dosing spoon, measuring dropper, or dosing syringe than to assume
that they can rely on their pouring experience and estimation abilities
with kitchen spoons.

Brian Wansink, PhD
Koert van Ittersum, PhD
Cornell University
Ithaca, NY 14853

Potential Conflicts of Interest: None disclosed.

References
1. Litovitz T. Implication of dispensing cups in dosing errors and pediatric poisonings:
a report from the American Association of Poison Control Centers. Ann Pharmacother.
1992;26:917-8. [PMID: 1504399]
2. U.S. Food and Drug Administration. Nonprescription cough and cold medicine
use in children—full version. Accessed at www.fda.gov/Drugs/DrugSafety
/DrugSafetyPodcasts/ucm078927.htm on 28 June 2009.
3. Madlon-Kay DJ, Mosch FS. Liquid medication dosing errors. J Fam Pract. 2000;
49:741-4. [PMID: 10947142]
4. Aziz AH, Khaleel AJ. How accurate are household spoons in drug administration?
Med Princ Pract. 1990/1991;2:106-9.
5. Delboeuf FJ. [Note on certain optical illusions: essay on a psychophysical
theory concerning the way in which the eye evaluates distances and angles.]
Bulletins de l’Acade´mie Royale des Sciences, Lettres et Beaux-arts de Belgique.
1865;19:195-216.
6. Wansink B, van Ittersum K. Shape of glass and amount of alcohol poured: comparative
study of effect of practice and concentration. BMJ. 2005;331:1512-4. [PMID:
16373735]

15.3.10

Identification and management of familial hypercholesterolaemia

Identification and management of familial hypercholesterolaemia.

Excelente guía de la prestigiosa NICE, editada en 2008. recomendable para pediatras y médicos de familia:

1 Guidance..................................................................................................6
1.1 Diagnosis...........................................................................................6
1.2 Identifying people with FH using cascade testing..............................9
1.3 Management....................................................................................10
1.4 Information needs and support........................................................20
1.5 Ongoing assessment and monitoring..............................................22

Y más y más

12.3.10

Joan Carles March Cerdá a, Astrid Suess a, Alina Danet a, María Ángeles Prieto Rodríguez a, Manuel Romero VallecillosTabaco y publicidad. Revisión de los estudios publicados entre 2000 y 2008.Atención Primaria.martes, 09 mar 2010

Objetivo

Evaluar la influencia de la publicidad de tabaco en los hábitos de consumo.

Diseño

Revisión sistemática.

Fuente de datos

PubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma e Isooc (CSIC)
(enero 2000-septiembre 2008).

Métodos

Se han incluido 44 artículos de ámbito nacional o internacional que
relacionan el consumo de tabaco con alguna práctica publicitaria o de
promoción. Se han eliminado los artículos que no se centran en el
impacto de la publicidad y la promoción del tabaco sobre la conducta
de consumo y las investigaciones referidas a prevención, a
intervención o a prohibición a través de campañas, medidas, planes y
leyes antitabaco. El análisis de los artículos se ha centrado en los
actores identificados, la metodología empleada y la temática.

Resultados

La publicidad influye en el consumo de tabaco. Los mensajes
publicitarios llevan a iniciar el hábito (5 artículos) y a mantener el
hábito (3 artículos), construyen el concepto y la imagen de la persona
fumadora (5 artículos) y usan diferentes estrategias publicitarias (22
artículos).

11.3.10

Soft drink and juice consumption and risk of pancreatic cancer: the Singapore Chinese Health Study.

Mueller NT, Odegaard A, Anderson K, Yuan JM, Gross M, Koh WP, Pereira MA.

Cancer Control Program, Georgetown University Medical Center, Washington, District of Columbia, USA.

Cancer Epidemiol Biomarkers Prev. 2010 Feb;19(2):447-55.

BACKGROUND: Sugar-sweetened carbonated beverages (called soft drinks) and juices, which have a high glycemic load relative to other foods and beverages, have been hypothesized as pancreatic cancer risk factors. However, data thus far are scarce, especially from non-European descent populations. We investigated whether higher consumption of soft drinks and juice increases the risk of pancreatic cancer in Chinese men and women. METHODS: A prospective cohort analysis was done to examine the association between soft drink and juice consumption and the risk of pancreatic cancer in 60,524 participants of the Singapore Chinese Health Study with up to 14 years of follow-up. Information on consumption of soft drinks, juice, and other dietary items, as well as lifestyle and environmental exposures, was collected through in-person interviews at recruitment. Pancreatic cancer cases and deaths were ascertained by record linkage of the cohort database with records of population-based Singapore Cancer Registry and the Singapore Registry of Births and Deaths. RESULTS: The first 14 years for the cohort resulted in cumulative 648,387 person-years and 140 incident pancreatic cancer cases. Individuals consuming > or = 2 soft drinks/wk experienced a statistically significant increased risk of pancreatic cancer (hazard ratio, 1.87; 95% confidence interval, 1.10-3.15) compared with individuals who did not consume soft drinks after adjustment for potential confounders. There was no statistically significant association between juice consumption and risk of pancreatic cancer. CONCLUSION: Regular consumption of soft drinks may play an independent role in the development of pancreatic cancer.

7.3.10

Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.

Walsh T, Worthington HV, Glenny AM, et al. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007868. (Review) PMID: 20091655

BACKGROUND: Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). The use of fluoride toothpaste is the primary intervention for the prevention of caries.

OBJECTIVES: To determine the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents, and to examine the potentially modifying effects of baseline caries level and supervised toothbrushing.

SEARCH STRATEGY: A search was undertaken on Cochrane Oral Health Group`s Trials Register, CENTRAL, MEDLINE and several other databases. Reference lists of articles were also searched. Date of the most recent searches: 8 June 2009.

SELECTION CRITERIA: Randomised controlled trials and cluster-randomised controlled trials comparing fluoride toothpaste with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with a follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or deciduous dentition as measured by the change in decayed, (missing), filled tooth surfaces (D(M)FS/d(m)fs) from baseline.

DATA COLLECTION AND ANALYSIS: Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were resolved by discussion and consensus or by a third party. The primary effect measure was the prevented fraction (PF), the caries increment of the control group minus the caries increment of the treatment group, expressed as a proportion of the caries increment in the control group. Where it was appropriate to pool data, network meta-analysis, network meta-regression or meta-analysis models were used. Potential sources of heterogeneity were specified a priori and examined through random-effects meta-regression analysis where appropriate.

MAIN RESULTS: 75 studies were included, of which 71 studies comprising 79 trials contributed data to the network meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that contributed to the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations (D(M)FS PF compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of 440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There is some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal.

AUTHORS`CONCLUSIONS: This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis.