USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

Published online July 2, 2012 Pediatrics 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.

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. 

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

To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear.

Objectives

To assess the effect of unrestricted versus restricted pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 March 2012).

Selection criteria

Randomised and quasi-randomised controlled trials comparing unrestricted versus restricted pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.

Data collection and analysis

Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data were checked for accuracy.

Main results

We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.93 to 1.05), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to 1.13), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).

Authors' conclusions

Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking. 

Plain language summary

Effect of pacifier use on duration of breastfeeding in full-term infants

Breast milk is superior to other baby foods in providing balanced nutrition and protection against allergy and infection to newborns. Breastfeeding is recommended by the World Health Organization, exclusively in the first six months and then as a dietary supplement. Breastmilk production and supply are maintained by frequent suckling of the breast and nipple stimulation. A pacifier is a non-nutritive sucking device used to calm an infant that has become a cultural norm in many parts of the world. However there is a widespread belief that pacifiers may interfere with breast milk production and lead to discontinuation of breastfeeding.
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.

 

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.

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

 

Free PMC Article

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.

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

 

Free PMC Article