27.4.10

Screening for child abuse at emergency departments: a systematic review

Screening for child abuse at emergency departments: a systematic review
Louwers E, Affourtit M, Moll H, Koning H, Korfage I.Arch Dis Child 2010;95:214-218.
Introduction Child abuse is a serious problem worldwide and can be difficult to detect. Although children who experience the consequences of abuse will probably be treated at an emergency department, detection rates of child abuse at emergency departments remain low. Objective To identify effective interventions applied at emergency departments that significantly increase the detection rate of confirmed cases of child abuse. Design This review was carried out according to the Cochrane Handbook. Two reviewers individually searched PubMed, the Cochrane Library, EMBASE, Web of Science and CINAHL for papers that met the inclusion criteria. Results Fifteen papers describing interventions were selected and reviewed; four of these were finally included and assessed for quality. In these studies the intervention consisted of a checklist of indicators of risk for child abuse. After implementation, the rate of detected cases of suspected child abuse increased by 180% (weighted mean in three studies). The number of confirmed cases of child abuse, reported in two out of four studies, showed no significant increase. Conclusions Interventions at emergency departments to increase the detection rate of cases of confirmed child abuse are scarce in the literature. Past study numbers and methodology have been inadequate to show conclusive evidence on effectiveness.

22.4.10

Riesgo de muerte por causas no naturales durante la primera infancia en hijos de padres con enferemdad mental

Chen YH, Chiou HY, Tang CH, et al. Risk of death by unnatural causes during early childhood in offspring of parents with mental illness. Am J Psychiatry. 2010 Feb;167(2):198-205. Epub 2009 Dec 1. (Original) PMID: 19952076

OBJECTIVE: Limited evidence reveals an elevated mortality risk in offspring of psychiatric patients after infancy. This nationwide population-based study in Taiwan aimed to investigate mortality risk in preschool children up to age 5 whose parents have severe mental illness. METHOD: Three nationwide population-based data sets were linked. A total of 3,166 children with one or both parents having schizophrenia or an affective disorder were identified, together with a comparison cohort of 25,328 children matched with the study group in terms of maternal age and year of delivery. Cox proportional hazard regressions were performed to compute hazard ratios, with adjustment for sociodemographic characteristics and maternal medical comorbidities.
RESULTS: During the preschool years, 54 (1.7%) deaths were documented among offspring of parents with severe mental illness and 155 (0.6%) in the comparison cohort. Parental mental illness was independently associated with a risk of death nearly 2.4 times higher (95% CI=1.72-3.28) than in the comparison cohort. The association was even more marked for unnatural causes of death, in which the mortality risk was 8.35 times greater (95% CI=4.04-17.24) in children of affected parents than in the comparison cohort. The proportional mortality rates were as high as 20.4% and 11.1% for accident and homicide, respectively, among offspring exposed to parental mental illness.
CONCLUSIONS: An elevated mortality risk, especially from unnatural causes of death, was identified for offspring of parents with severe mental illness during the preschool years in an Asian society. There is an urgent need for multidisciplinary team approaches and risk management strategies to support psychiatric patients who are having difficulty with the transition to parenthood.

17.4.10

Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.

Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.
Am J Clin Nutr. 2010 Mar 10. [Epub ahead of print]

Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.
Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H.

Division of Molecular Epidemiology Jikei University School of Medicine Minato-ku Tokyo Japan.

Abstract
BACKGROUND: To our knowledge, no rigorously designed clinical trials have evaluated the relation between vitamin D and physician-diagnosed seasonal influenza. OBJECTIVE: We investigated the effect of vitamin D supplements on the incidence of seasonal influenza A in schoolchildren. DESIGN: From December 2008 through March 2009, we conducted a randomized, double-blind, placebo-controlled trial comparing vitamin D(3) supplements (1200 IU/d) with placebo in schoolchildren. The primary outcome was the incidence of influenza A, diagnosed with influenza antigen testing with a nasopharyngeal swab specimen. RESULTS: Influenza A occurred in 18 of 167 (10.8%) children in the vitamin D(3) group compared with 31 of 167 (18.6%) children in the placebo group [relative risk (RR), 0.58; 95% CI: 0.34, 0.99; P = 0.04]. The reduction in influenza A was more prominent in children who had not been taking other vitamin D supplements (RR: 0.36; 95% CI: 0.17, 0.79; P = 0.006) and who started nursery school after age 3 y (RR: 0.36; 95% CI: 0.17, 0.78; P = 0.005). In children with a previous diagnosis of asthma, asthma attacks as a secondary outcome occurred in 2 children receiving vitamin D(3) compared with 12 children receiving placebo (RR: 0.17; 95% CI: 0.04, 0.73; P = 0.006). CONCLUSION: This study suggests that vitamin D(3) supplementation during the winter may reduce the incidence of influenza A, especially in specific subgroups of schoolchildren. This trial was registered at https://center.umin.ac.jp as UMIN000001373.

13.4.10

Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and a

Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents.

Since each child is unique, these recommendations are designed for the care of children who have no contributing medical conditions and are developing normally. These recommendations will need to be modified for children with special health care needs or if disease or trauma manifests variations from normal. The American Academy of Pediatric Dentistry (AAPD) emphasizes the importance of very early professional intervention and the continuity of care based on the individualized needs of the child. Refer to the text of the original guideline document for supporting information and references.

Incluye tabla de actividades por grupos de edad

Guideline on perinatal oral health care.

Guideline on perinatal oral health care.
Every expectant mother receives a comprehensive oral health evaluation from a dentist and, if not previously accomplished, establishes a dental home as early as possible during pregnancy. The first visit should consist of review of medical, dental, and dietary histories, risk assessment for caries and periodontal disease, diagnosis of disease and other conditions, oral health education, and anticipatory guidance. Radiographic assessment and treatment of oral conditions should be performed with attention to maternal and fetal safety and patient comfort.
All primary health care professionals who serve pregnant women provide education on the etiology and prevention of early childhood caries (ECC). Oral health counseling and referral for a comprehensive oral examination and treatment during pregnancy is especially important for the mother.
The curriculum of all medical, nursing, and allied health professional programs include education in perinatal oral health, including the infectious etiology of ECC, methods of oral health risk assessment, anticipatory guidance, and the need for early establishment of a dental home.
Parents/caregivers establish a dental home for infants by 12 months of age.
Legislators, policy makers and third party payors be educated about the benefits of perinatal intervention in order to support efforts that improve access to oral health care for pregnant women, including more frequent and comprehensive services.

Guideline on infant oral health care.

Guideline on infant oral health care.All primary health care professionals who serve mothers and infants provide parent/caregiver education on the etiology and prevention of early childhood caries (ECC). Oral health counseling and referral for a comprehensive oral examination and treatment during pregnancy is especially important for the mother.
The infectious and transmissible nature of bacteria that cause ECC and methods of oral health risk assessment, anticipatory guidance, and early intervention be included in the curriculum of all medical, nursing, and allied health professional programs.
Every infant receive an oral health risk assessment from his/her primary health care provider or qualified health care professional by 6 months of age. This initial visit should consist of the following:
Assessing the patient's risk of developing oral disease using a caries risk assessment
Providing education on infant oral health
Evaluating and optimizing fluoride exposure
Parents or caregivers establish a dental home for infants by 12 months of age. The following should be accomplished at that visit:
Recording thorough medical (infant) and dental (mother or primary caregiver and infant) histories
Completing a thorough oral examination
Assessing the infant's risk of developing caries and determining an appropriate prevention plan and interval for periodic reevaluation based upon that assessment
Providing anticipatory guidance regarding dental and oral development, fluoride status, non-nutritive sucking habits, teething, injury prevention, oral hygiene instruction, and the effects of diet on the dentition
Planning for comprehensive care in accordance with accepted guidelines and periodicity schedules for pediatric oral health
Referring patients to the appropriate health professional if intervention is necessary