Vol. 130
No. 2
August 1, 2012
pp. e399
-e407
(doi:
10.1542/peds.2011-2087)
The development and use of evidence-based recommendations for preventive
care by primary care providers caring for children
is an ongoing challenge.
This issue is further
complicated by the fact that a higher proportion of recommendations by
the
US Preventive Services Task Force (USPSTF) for
pediatric preventive services in comparison with adult services have
insufficient
evidence to recommend for or against the service.
One important root cause for this problem is the relative lack of high
quality
screening and counseling studies in pediatric
primary care settings. The paucity of studies limits the development of
additional
evidence-based guidelines to enhance best practices
for pediatric and adolescent conditions. In this article, we describe
the following: (1) evidence-based primary care
preventive services as a strategy for addressing important pediatric
morbidities,
(2) the process of making evidence-based screening
recommendations by the USPSTF, (3) the current library of USPSTF
recommendations
for children and adolescents, and (4) factors
influencing the use of USPSTF recommendations and other evidence-based
guidelines
by clinicians. Strategies to accelerate the
implementation of evidence-based services and areas of need for future
research
to fill key gaps in evidence-based recommendations
and guidelines are highlighted.
Pediatrics
21.9.12
Behavioural interventions for the prevention of sexually transmitted infectionsin young people aged 13-19 years: a systematic review.
Health Educ Res. 2012 Jun;27(3):495-512. Epub 2012 Feb 20.
Picot J, Shepherd J, Kavanagh J, Cooper K, Harden A, Barnett-Page E, Jones J,
Clegg A, Hartwell D, Frampton GK.
Southampton Health Technology Assessments Centre, University of Southampton,
First Floor, Epsilon House, Enterprise Road, University of Southampton Science
Park, Southampton, SO16 7NS, UK. j.picot@soton.ac.uk
We systematically reviewed school-based skills building behavioural interventions
for the prevention of sexually transmitted infections. References were sought
from 15 electronic resources, bibliographies of systematic reviews/included
studies and experts. Two authors independently extracted data and
quality-assessed studies. Fifteen randomized controlled trials (RCTs), conducted
in the United States, Africa or Europe, met the inclusion criteria. They were
heterogeneous in terms of intervention length, content, intensity and providers.
Data from 12 RCTs passed quality assessment criteria and provided evidence of
positive changes in non-behavioural outcomes (e.g. knowledge and self-efficacy).
Intervention effects on behavioural outcomes, such as condom use, were generally
limited and did not demonstrate a negative impact (e.g. earlier sexual
initiation). Beneficial effect on at least one, but never all behavioural
outcomes assessed was reported by about half the studies, but this was sometimes
limited to a participant subgroup. Sexual health education for young people is
important as it increases knowledge upon which to make decisions about sexual
behaviour. However, a number of factors may limit intervention impact on
behavioural outcomes. Further research could draw on one of the more effective
studies reviewed and could explore the effectiveness of 'booster' sessions as
young people move from adolescence to young adulthood.
20.9.12
Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding
Jaafar SH, Jahanfar S, Angolkar M, Ho JJ. The Cochrane Library 2012, Issue 7
Abstract
Background
Objectives
Search methods
Selection criteria
Data collection and analysis
Main results
Authors' conclusions
Plain language summary
Effect of pacifier use on duration of breastfeeding in full-term infants
Our review concluded that for mothers who are motivated to breastfeed their infants, pacifier use before or after breastfeeding was established did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. The review provided moderate evidence from three randomised controlled trials (involving 1915 babies) comparing unrestricted with restricted pacifier use by healthy, full-term breastfeeding infants; two of the trials (1302 babies) were included in the analysis. However, there is a widespread belief that pacifiers may interfere with breast milk production and lead to discontinuation of breastfeeding.
18.9.12
The variability of reported salt levels in fast foods across six countries: opportunities for salt reduction.
CMAJ. 2012 Jun 12;184(9):1023-8. Epub 2012 Apr 16.
Dunford E, Webster J, Woodward M, Czernichow S, Yuan WL, Jenner K, Ni Mhurchu C, Jacobson M, Campbell N, Neal B.
Dunford E, Webster J, Woodward M, Czernichow S, Yuan WL, Jenner K, Ni Mhurchu C, Jacobson M, Campbell N, Neal B.
Abstract
BACKGROUND:
Several fast food companies have made commitments to reduce the levels of salt in the foods they serve, but technical issues are often cited as a barrier to achieving substantial reductions. Our objective was to examine the reported salt levels for products offered by leading multinational fast food chains.
METHODS:
Data on salt content for products served by six fast food chains operating in Australia, Canada, France, New Zealand, the United Kingdom and the United States were collected by survey in April 2010. Mean salt contents (and their ranges) were calculated and compared within and between countries and companies.
RESULTS:
We saw substantial variation in the mean salt content for different categories of products. For example, the salads we included in our survey contained 0.5 g of salt per 100 g, whereas the chicken products we included contained 1.6 g. We also saw variability between countries: chicken products from the UK contained 1.1 g of salt per 100 g, whereas chicken products from the US contained 1.8 g. Furthermore, the mean salt content of food categories varied between companies and between the same products in different countries (e.g., McDonald's Chicken McNuggets contain 0.6 g of salt per 100 g in the UK, but 1.6 g of salt per 100 g in the US).
INTERPRETATION:
The salt content of fast foods varies substantially, not only by type of food, but by company and country in which the food is produced. Although the reasons for this variation are not clear, the marked differences in salt content of very similar products suggest that technical reasons are not a primary explanation. In the right regulatory environment, it is likely that fast food companies could substantially reduce the salt in their products, translating to large gains for population health.
- PMID:
- 22508978
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC3381762
14.9.12
Association between different growth curve definitions of overweight and obesity and cardiometabolic risk in children
CMAJ. 2012 Jul 10;184(10):E539-50. Epub 2012 Apr 30.
Kakinami L, Henderson M, Delvin EE, Levy E, O'Loughlin J, Lambert M, Paradis G.
Kakinami L, Henderson M, Delvin EE, Levy E, O'Loughlin J, Lambert M, Paradis G.
Abstract
BACKGROUND:
Overweight and obesity in young people are assessed by comparing body mass index (BMI) with a reference population. However, two widely used reference standards, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) growth curves, have different definitions of overweight and obesity, thus affecting estimates of prevalence. We compared the associations between overweight and obesity as defined by each of these curves and the presence of cardiometabolic risk factors.
METHODS:
We obtained data from a population-representative study involving 2466 boys and girls aged 9, 13 and 16 years in Quebec, Canada. We calculated BMI percentiles using the CDC and WHO growth curves and compared their abilities to detect unfavourable levels of fasting lipids, glucose and insulin, and systolic and diastolic blood pressure using receiver operating characteristic curves, sensitivity, specificity and kappa coefficients.
RESULTS:
The z scores for BMI using the WHO growth curves were higher than those using the CDC growth curves (0.35-0.43 v. 0.12-0.28, p < 0.001 for all comparisons). The WHO and CDC growth curves generated virtually identical receiver operating characteristic curves for individual or combined cardiometabolic risk factors. The definitions of overweight and obesity had low sensitivities but adequate specificities for cardiometabolic risk. Obesity as defined by the WHO or CDC growth curves discriminated cardiometabolic risk similarly, but overweight as defined by the WHO curves had marginally higher sensitivities (by 0.6%-8.6%) and lower specificities (by 2.6%-4.2%) than the CDC curves.
INTERPRETATION:
The WHO growth curves show no significant discriminatory advantage over the CDC growth curves in detecting cardiometabolic abnormalities in children aged 9-16 years.
- PMID:
- 22546882
- [PubMed - in process]
- PMCID:
- PMC3394848
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