29.6.13

Timing of the introduction of complementary feeding and risk of childhood obesity: a systematic review.


 2013 May 27. PMID: 23736360


Abstract
The World Health Organisation recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age or beyond. Appropriate complementary foods should be introduced in a timely fashion, beginning when the infant is 6 months old. In developing countries, early or inappropriate complementary feeding may lead to malnutrition and poor growth, but in countries such as the United Kingdom and United States of America, where obesity is a greater public health concern than malnutrition, the relationship to growth is unclear. 
We conducted a systematic review of the literature that investigated the relationship between the timing of the introduction of complementary feeding and overweight or obesity duringchildhoodElectronic databases were searched from inception until 30 September 2012 using specified keywords. 
Following the application of strict inclusion/exclusion criteria, 23 studies were identified and reviewed by two independent reviewers. Data were extracted and aspects of quality were assessed using an adapted Newcastle-Ottawa scale. 
Twenty-one of the studies considered the relationship between the time at which complementary foods were introduced and childhood body mass index (BMI), of which five found that introducing complementary foods at <3 20="" 4="" a="" associated="" bmi="" class="highlight" higher="" in="" months="" nbsp="" one="" or="" span="" studies="" study="" two="" was="" weeks="" with="">childhood
. Seven of the studies considered the association between complementary feeding and body composition but only one study reported an increase in the percentage of body fat among children given complementary foods before 15 weeks of age. 
We conclude that there is no clear association between the timing of the introduction of complementary foods and childhood overweight or obesity, but some evidence suggests that very early introduction (at or before 4 months), rather than at 4-6 months or >6 months, may increase the risk of childhoodoverweight.
International Journal of Obesity advance online publication, 18 June 2013; doi:10.1038/ijo.2013.99.

28.6.13

School-based obesity prevention programs: A meta-analysis of randomized controlled trials.

Obesity (Silver Spring). 2013 Jun 22. doi: 10.1002/oby.20515. [Epub ahead of print].  PMID: 23794226

Objective: 
Attempts have been made to reduce childhood obesity through school-based programs. Systematic reviews of studies until 2006 reported a lack of consistency about effectiveness of such programs. Presented is an updated systematic review and meta-analysis. 
Design and Methods: 
Replication of methodology used in previous comprehensive systematic review and meta-analysis of randomized controlled trials of school based obesity prevention programs covering studies until 2006 to review studies thru January 2012. 
Results: Based on 32 studies (n=52,109), programs were mildly effective in reducing BMI relative to controls not receiving intervention. Studies of children had significant intervention effects, those of teenagers did not, though the difference between the two groups was not statistically significant. Meta-regression showed a significant linear hierarchy of studies with the largest effects for comprehensive programs more than 1 year-long that aimed to provide information on nutrition and physical activity, change attitudes, monitor behavior, modify environment, involve parents, increase physical activity and improve diet, particularly among children. 
Conclusions: Unlike earlier studies, more recent studies showed convincing evidence that school-based prevention interventions are at least mildly effective in reducing BMI in children, possibly because these newer studies tended to be longer, more comprehensive and included parental support.

27.6.13

Systematic Review of Community-Based Childhood Obesity Prevention Studies.

 2013 Jun 10. [Epub ahead of print] 
PMID:
 
23753099

Source

OBJECTIVE:
This study systematically reviewed community-based childhood obesity prevention programs in the United States and high-income countries.
METHODS:
We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library for relevant English-language studies. Studies were eligible if the intervention was primarily implemented in the community setting; had at least 1 year of follow-up after baseline; and compared results from an intervention to a comparison group. Two independent reviewers conducted title scans and abstract reviews and reviewed the full articles to assess eligibility. Each article received a double review for data abstraction. The second reviewer confirmed the first reviewer's data abstraction for completeness and accuracy.
RESULTS:
Nine community-based studies were included; 5 randomized controlled trials and 4 non-randomized controlled trials. One study was conducted only in the community setting, 3 were conducted in the community and school setting, and 5 were conducted in the community setting in combination with at least 1 other setting such as the home. Desirable changes in BMI or BMI z-score were found in 4 of the 9 studies. Two studies reported significant improvements in behavioral outcomes (1 in physical activity and 1 in vegetable intake).
CONCLUSIONS:
The strength of evidence is moderate that a combined diet and physical activity intervention conducted in the community with a school component is more effective at preventing obesity or overweight. More research and consistent methods are needed to understand the comparative effectiveness of childhood obesity prevention programs in the community setting.


A Systematic Review of Home-Based Childhood Obesity Prevention Studies.


Showell NN, Fawole O, Segal J, et al. Pediatrics. 2013 Jun 10. (Review) PMID: 23753095

BACKGROUND AND OBJECTIVES:
Childhood obesity is a global epidemic. Despite emerging research about the role of the family and home on obesity risk behaviors, the evidence base for the effectiveness of home-based interventions on obesity prevention remains uncertain. The objective was to systematically review the effectiveness of home-based interventions on weight, intermediate (eg, diet and physical activity [PA]), and clinical outcomes.

METHODS:
We searched Medline, Embase, PsychInfo, CINAHL, clinicaltrials.gov, and the Cochrane Library from inception through August 11, 2012. We included experimental and natural experimental studies with >/=1-year follow-up reporting weight-related outcomes and targeting children at home. Two independent reviewers screened studies and extracted data. We graded the strength of the evidence supporting interventions targeting diet, PA, or both for obesity prevention.
RESULTS:
We identified 6 studies; 3 tested combined interventions (diet and PA), 1 used diet intervention, 1 combined intervention with primary care and consumer health informatics components, and 1 combined intervention with school and community components. Select combined interventions had beneficial effects on fruit/vegetable intake and sedentary behaviors. However, none of the 6 studies reported a significant effect on weight outcomes. Overall, the strength of evidence is low that combined home-based interventions effectively prevent obesity. The evidence is insufficient for conclusions about home-based diet interventions or interventions implemented at home in association with other settings.
CONCLUSIONS:
The strength of evidence is low to support the effectiveness of home-based child obesity prevention programs. Additional research is needed to test interventions in the home setting, particularly those incorporating parenting strategies and addressing environmental influences.

21.6.13

Screening for Elevated Blood Pressure in Children and Adolescents. A Critical Appraisal

Arnaud Chiolero, MD, PhD; Pascal Bovet, MD, MPH; Gilles Paradis, MD, MSc


Although screening for elevated blood pressure (BP) in adults is beneficial, evidence of its beneficial effects in children is not clear. Elevated BP in children is associated with atherosclerosis early in life and tracks across the life course. However, because of the high variability in BP, tracking is weak, and having an elevated BP in childhood has a low predictive value for having elevated BP later in life. The absolute risk of cardiovascular diseases associated with a given level of BP in childhood and the long-term effect of treatment beginning in childhood are not known. No study has experimentally evaluated the benefits and harm of BP screening in children. One modeling study indicates that BP screen-and-treat strategies in adolescents are moderately cost-effective but less cost-effective than population-wide interventions to decrease BP for the reduction of coronary heart diseases. The US National Heart, Lung, and Blood Institute and the European Society of Hypertension recommend that children 3 years of age and older have their BP measured during every health care visit. According to the US Preventive Services Task Force, there is no sufficient evidence to recommend for or against screening, but their recommendations have to be updated. Whether the benefits of universal BP screening in children outweigh the harm has to be determined. Studies are needed to assess the absolute risk of cardiovascular diseases associated with elevated BP in childhood, to evaluate how to simplify the identification of elevated BP, to evaluate the long-term benefits and harm of treatment beginning in childhood, and to compare universal and targeted screening strategies.
Hypertension is a major risk factor for cardiovascular diseases (CVDs). Worldwide, 7.1 million deaths (13% of the global total) are due to elevated blood pressure (BP) in adults every year.1
Until recently, hypertension was rarely searched for or diagnosed in children and adolescents. However, the approach toward elevated BP in childhood is changing because of the growing evidence that elevated BP in youth has detrimental lifelong cardiovascular effects.2
The BP level in childhood tracks to the BP level in adulthood, and children with elevated BP have a higher probability of developing hypertension as adults than do children with low BP.3 This BP tracking is a major argument for being concerned with elevated BP early in life; since BP tracks, prevention and treatment of elevated BP early in life can result in a lifelong reduction of BP and of its associated conditions.
Furthermore, elevated BP in childhood is associated with cardiac left ventricular hypertrophy4 and a thickening of the carotid intima-media, a surrogate marker for atherosclerosis and a strong predictor of CVD.5 Raised fibrous plaques of atherosclerosis have been observed in the aorta of children as young as 8 years of age, and the plaque extent has been shown to be associated with BP levels.6
Another reason for the interest in elevated BP in childhood is the increase in the prevalence of obesity. Because obesity is associated with elevated BP at all ages including childhood,79 it is often assumed that the prevalence of hypertension has increased in youth in the last decades,1011although such trends have not been observed in all populations.1215 Finally, although the clinical approach to the prevention of CVD relies on the identification and treatment of risk factors starting in mid-adulthood, a life-course approach to prevent the development of risk factors starting in childhood offers new avenues for the prevention of hypertension and CVD.1617
In view of this evidence, universal BP screening beginning in childhood is advocated.1820Undiagnosed elevated BP has become a matter of concern in children.2122 Screening for elevated BP may help identify children at increased risk of hypertension and CVD later in life and for whom early treatment could be beneficial.23 Nevertheless, although there is strong evidence that screening for hypertension is beneficial for adults,2425 it is unclear whether screening is beneficial for children. Our aim is to critically appraise the evidence and recommendations regarding the screening for elevated BP in children and adolescents.

20.6.13

Asymptomatic Sexually Active Adolescents and Young Adults Should Not Be Screened for Herpes Simplex Virus

Hayley D. Mark, PhD, MPH, RN


Herpes simplex virus (HSV) types 1 and 2 are highly prevalent in the general population of the United States. The seroprevalence of HSV-2 and HSV-1 were 17% and 58%, respectively, in a cohort aged 14 to 49 years who participated in the National Health and Nutrition Examination Survey from 1999 to 2004.1 Seroprevalence is substantially less among adolescents and young adults. Approximately 80% of infected individuals are unaware of their infection and the majority of infections are transmitted by these individuals.2
Type-specific serological assays for HSV became commercially available in 1999, making possible wide-scale screening for HSV-1 and HSV-2. However, the value of HSV screening is controversial. Proponents argue that on detection, asymptomatic carriers can be counseled to use prevention methods and, thus, reduce the possibility of transmission to uninfected partners. Opponents point out the possibility that large numbers of asymptomatic individuals may receive a diagnosis of a stigmatized, chronic infection, with substantial transmission potential, but there are no substantial data to support the effectiveness of HSV screening in changing sexual behaviors or preventing transmission.
The important questions that a clinician must consider in determining the value of HSV screening among asymptomatic sexually active adolescents and young adults are derived from the Wilson and Jungner classic public health report3 on criteria for use of a screening test and include the following: (1) Is the disease an important public health problem? (2) Is an accurate screening test available and is it acceptable to the population? (3) Does screening improve health outcomes and symptoms or reduce transmission of disease? (4) Are the costs and risks of screening less than the benefits?

19.6.13

Electronic Media–Based Health Interventions Promoting Behavior Change in Youth A Systematic Review.

Kimberly Hieftje, PhD; E. Jennifer Edelman, MD, MHS; Deepa R. Camenga, MD, MHS; Lynn E. Fiellin, MD

Importance  Little research has been done on the efficacy of electronic media–based interventions, especially on their effect on health or safety behavior. The current review systematically identified and evaluated electronic media–based interventions that focused on promoting health and safety behavior change in youth.
Objective  To assess the type and quality of the studies evaluating the effects of electronic media–based interventions on health and safety behavior change.
Evidence Review  Studies were identified from searches in MEDLINE (1950 through September 2010) and PsycINFO (1967 through September 2010). The review included published studies of interventions that used electronic media and focused on changes in behavior related to health or safety in children aged 18 years or younger.
Findings  Nineteen studies met the criteria and focused on at least 1 behavior change outcome. The focus was interventions related to physical activity and/or nutrition in 7 studies, on asthma in 6, safety behaviors in 3, sexual risk behaviors in 2, and diabetes mellitus in 1. Seventeen studies reported at least 1 statistically significant effect on behavior change outcomes, including an increase in fruit, juice, or vegetable consumption; an increase in physical activity; improved asthma self-management; acquisition of street and fire safety skills; and sexual abstinence. Only 5 of the 19 studies were rated as excellent.
Conclusions and Relevance  Our systematic review suggests that interventions using electronic media can improve health and safety behaviors in young persons, but there is a need for higher-quality, rigorous interventions that promote behavior change.
More established forms of electronic media, such as television and radio, have been shown to encourage behavior change. Previous studies have demonstrated that their use can increase physical activity1 and reduce disruptive behavioral problems.2 However, other types of media, such as computer or video games, may be more effective in producing behavior change because they encourage active engagement and processing of information from the child. On any given day, 60% of young persons play video games, including 47% who play on a handheld player or a cell phone and 39% who play on a console player. Moreover, 99% of teenage boys and 94% of teenage girls play video games.3 Given their widespread use and interactive capabilities, computer and video games are an increasingly popular type of electronic media used in health interventions and have been a successful tool for health promotion and management of chronic medical conditions in children and adolescents.45 Although they did not meet the strict criteria for the present review, 2 articles67 describe how video game interventions target smoking cessation and asthma in adolescents.
Electronic media–based interventions lend themselves to experiential learning and, when created according to established health promotion and instructional design principles, offer distinct advantages over conventional methods of health education.4 Because of their repetitive nature, these interventions can better expose individuals to educational content and reinforce learning. Furthermore, electronic media–based interventions can be personalized through the creation of avatars and virtual identities. Finally, these interventions have interactive capability that can provide immediate feedback and increase player engagement. Accordingly, they may be an ideal platform for improving health outcomes for adolescents. However, little research has been done on the efficacy of electronic media–based interventions, especially on their effect on health or safety behavior.
The aim of this study is to systematically review the literature to identify and evaluate electronic media–based interventions focused on promoting health and safety behavior change in youth. Although several recent systematic reviews810 have been conducted to evaluate the effectiveness of electronic media–based interventions on health outcomes, these reviews were limited to video games as the only form of intervention1112 or to only a single specific health outcome. In addition, many reviews did not include safety behavior outcomes,810,1213 or youth populations.8 The present review expands on previous reviews by including studies that specifically focus on youth, use electronic media–based interventions as part of the study, and examine both health and safety behavior outcomes.

18.6.13

Emotional, Behavioral, and Developmental Features Indicative of Neglect or Emotional Abuse in Preschool Children A Systematic Review

Aideen Mary Naughton, MB, BCh, BAO, DCH, FRCPCH; Sabine Ann Maguire, MRCPCh, FRCPI; Mala Kanthi Mann, MIInfSc, MCLIP; Rebecca Caroline Lumb, BA; Vanessa Tempest, BScEcon, MA, GDL/CPE, PgDChild; Shirley Gracias, MBChB, DCH, MRCPsych; Alison Mary Kemp, MRCP, FRCPCH


Importance  Early intervention for neglect or emotional abuse in preschoolers may mitigate lifelong consequences, yet practitioners lack confidence in recognizing these children.
Objective  To define the emotional, behavioral, and developmental features of neglect or emotional abuse in preschoolers.
Evidence Review  A literature search of 18 databases, 6 websites, and supplementary searching performed from January 1, 1960, to February 1, 2011, identified 22 669 abstracts. Standardized critical appraisal of 164 articles was conducted by 2 independent, trained reviewers. Inclusion criteria were children aged 0 to 6 years with confirmed neglect or emotional abuse who had emotional, behavioral, and developmental features recorded or for whom the carer-child interaction was documented.
Findings  Twenty-eight case-control (matched for socioeconomic, educational level, and ethnicity), 1 cross-sectional, and 13 cohort studies were included. Key features in the child included the following: aggression (11 studies) exhibited as angry, disruptive behavior, conduct problems, oppositional behavior, and low ego control; withdrawal or passivity (12 studies), including negative self-esteem, anxious or avoidant behavior, poor emotional knowledge, and difficulties in interpreting emotional expressions in others; developmental delay (17 studies), particularly delayed language, cognitive function, and overall development quotient; poor peer interaction (5 studies), showing poor social interactions, unlikely to act to relieve distress in others; and transition (6 studies) from ambivalent to avoidant insecure attachment pattern and from passive to increasingly aggressive behavior and negative self-representation. Emotional knowledge, cognitive function, and language deteriorate without intervention. Poor sensitivity, hostility, criticism, or disinterest characterize maternal-child interactions.
Conclusions and Relevance  Preschool children who have been neglected or emotionally abused exhibit a range of serious emotional and behavioral difficulties and adverse mother-child interactions that indicate that these children require prompt evaluation and interventions.
Neglect is the most common form of maltreatment,12 with devastating lifelong consequences. The neurobiology of the infant brain can be altered in response to early emotional neglect,3 and brain imaging technology has confirmed the structural effect of neglect on the developing brain.4 The link between infant neglect and later aggression56 is highlighted by Kotch et al,7 who identified neglect in the first 2 years of life as a predictor of later aggression. Neglect means many things to many people,8 contributing to various working definitions and numerous tools to aid assessment and recognition. Social and health care professionals have a crucial role in recognizing and responding to signs of neglect, but when faced with subjective and value-based thresholds describing parental omission of good enough care, they may lack confidence in diagnosing neglect, unless there are clear physical signs (eg, faltering growth). The severe long-term consequences of emotional neglect and emotional abuse in the first 2 years of life910 have been identified, alongside the difficulty in recognition at such a young age.1112 Underrecognition has implications for physical, mental health,13 and mortality.14 Emotional neglect and emotional abuse are variously defined within child abuse categories. In the United Kingdom and the World Health Organization definition,emotional neglect is included within the category of neglect with a separate category of emotional abuse, whereas the 2 aspects are encompassed in the broader term psychological maltreatment by the American Professional Society on the Abuse of Children (eAppendix 1), which describes patterns of damaging interactions between the parent-carer and child through acts of omission or commission, acknowledging that emotional neglect and abuse have equally damaging effects on the child. Elements of psychological maltreatment are present in most categories of abuse, but when psychological maltreatment occurs discretely, there is often delay in both recognition and intervention.15 To optimize outcomes, early recognition is paramount. This systematic review aims to identify the scientific evidence behind the emotional, behavioral, and developmental features of the child and characteristics of primary carer-child interactions associated with neglect and/or emotional abuse of preschool children.

Primary Care Interventions to Prevent Child Maltreatment: U.S. Preventive Services Task Force Recommendation Statement

Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*
Description: Update of the child abuse and neglect portion of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for family and intimate partner violence.
Methods: The USPSTF commissioned a systematic review on interventions to prevent child maltreatment for children at risk, focusing on new studies and evidence gaps that were unresolved at the time of the 2004 recommendation. Beneficial outcomes considered include reduced exposure to maltreatment and reduced harms to physical or mental health or mortality.
Population: This recommendation applies to children in the general U.S. population from newborn to age 18 years who do not have signs or symptoms of maltreatment.
Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. (I statement)
The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.
It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.