30.8.13

Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial.

Pediatrics. 2013 Aug 19. [Epub ahead of print]
Laborie LB, Engesæter IO, Lehmann TG, Eastwood DM, Engesæter LB, Rosendahl K.

OBJECTIVE:Screening for hip dysplasia is controversial. A previous randomized
controlled trial revealed that adding universal or selective ultrasound to
routine clinical examination gave a nonsignificant reduction in rates of late
presenting cases, but with higher treatment rates. This study assesses
differences in outcome at skeletal maturity for the 3 newborn screening
strategies in terms of radiographic markers of acetabular dysplasia and early
degenerative change and avascular necrosis (AVN) secondary to neonatal
treatment.
METHODS:From the initial trial including 11 925 newborns, a population-based sample of 3935 adolescents was invited for follow-up at age 18 to 20 years. A standardized weight-bearing anteroposterior view was obtained. The outcomes evaluated were the radiographic findings of dysplasia (center-edge angle, femoral head extrusion-index, acetabular depth-width ratio, Sharp's angle, subjective evaluation of dysplasia) and degenerative change (joint-space width). 
Signs of AVN were documented.
RESULTS: Of the 3935 subjects invited, 2038 (51.8%) attended the maturity review, of which 2011 (58.2% female patients) were included: 551, 665, and 795 subjects from the universal, selective, and clinical  groups, respectively. Rates per group of positive radiographic findings associated with dysplasia or degenerative change varied depending on radiographic marker used. No statistically significant differences were detected between
groups. No AVN was seen.
CONCLUSIONS:Although both selective and universal ultrasound screenings gave a nonsignificant reduction in rates of late cases when compared with expert clinical programs, we were unable to demonstrate any additional reduction in the rates of radiographic findings associated with acetabular dysplasia or degenerative change at maturity. Increased treatmet
rates were not associated with AVN.

29.8.13

Preventing Dental Caries in Children under 5 Years: Systematic Review Updating USPSTF Recommendation.

Pediatrics. 2013 Aug;132(2):332-50. doi: 10.1542/peds.2013-1469. Epub 2013 Jul15.Chou R, Cantor A, Zakher B, Mitchell JP, Pappas M.

BACKGROUND AND OBJECTIVE: Screening and preventive interventions by primary care 
providers could improve outcomes related to early childhood caries. The objective
of this study was to update the 2004 US Preventive Services Task Force systematic
review on prevention of caries in children younger than 5 years of age.
METHODS: Searching Medline and the Cochrane Library (through March 2013) and
reference lists, we included trials and controlled observational studies on the
effectiveness and harms of screening and treatments. One author extracted study
characteristics and results, which were checked for accuracy by a second author. 
Two authors independently assessed study quality.
RESULTS: No study evaluated effects of screening by primary care providers on
clinical outcomes. One good-quality cohort study found pediatrician examination
associated with a sensitivity of 0.76 for identifying a child with cavities. No
new trials evaluated oral fluoride supplementation. Three new randomized trials
were consistent with previous studies in finding fluoride varnish more effective 
than no varnish (reduction in caries increment 18% to 59%). Three trials of
xylitol were inconclusive regarding effects on caries. New observational studies 
were consistent with previous evidence showing an association between early
childhood fluoride use and enamel fluorosis. Evidence on the accuracy of risk
prediction instruments in primary care settings is not available.
CONCLUSIONS: There is no direct evidence that screening by primary care
clinicians reduces early childhood caries. Evidence previously reviewed by the US
Preventive Services Task Force found oral fluoride supplementation effective at
reducing caries incidence, and new evidence supports the effectiveness of
fluoride varnish in higher-risk children.

28.8.13

Estimating overweight risk in childhood from predictors during infancy.

Pediatrics. 2013 Aug;132(2):e414-21. doi: 10.1542/peds.2012-3858.Epub 2013Jul15.
Weng SF, Redsell SA, Nathan D, Swift JA, Yang M, Glazebrook C.

OBJECTIVE: The aim of this study was to develop and validate a risk score
algorithm for childhood overweight based on a prediction model in infants.
METHODS: Analysis was conducted by using the UK Millennium Cohort Study. The
cohort was divided randomly by using 80% of the sample for derivation of the risk
algorithm and 20% of the sample for validation. Stepwise logistic regression
determined a prediction model for childhood overweight at 3 years defined by the 
International Obesity Task Force criteria. Predictive metrics R(2), area under
the receiver operating curve (AUROC), sensitivity, specificity, positive
predictive value (PPV), and negative predictive value (NPV) were calculated.
RESULTS: Seven predictors were found to be significantly associated with
overweight at 3 years in a mutually adjusted predictor model: gender, birth
weight, weight gain, maternal prepregnancy BMI, paternal BMI, maternal smoking in
pregnancy, and breastfeeding status. Risk scores ranged from 0 to 59
corresponding to a predicted risk from 4.1% to 73.8%. The model revealed
moderately good predictive ability in both the derivation cohort (R(2) = 0.92,
AUROC = 0.721, sensitivity = 0.699, specificity = 0.679, PPV = 38%, NPV = 87%)
and validation cohort (R(2) = 0.84, AUROC = 0.755, sensitivity = 0.769,
specificity = 0.665, PPV = 37%, NPV = 89%).
CONCLUSIONS: Using a prediction algorithm to identify at-risk infants could
reduce levels of child overweight and obesity by enabling health professionals to
target prevention more effectively. Further research needs to evaluate the
clinical validity, feasibility, and acceptability of communicating this risk.

26.8.13

Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: a systematic evidence review for the U.S. Preventive Services Task Force.

Primary Care Interventions to Prevent Tobacco Use in Children and Adolescents, Topic Page. U.S. Preventive Services Task Force. http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm
The U.S. Preventive Services Task Force (USPSTF) recommendations on primary care interventions to prevent tobacco use in children and adolescents.
Current Recommendation

  • The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.


Release Date: August 2013
----------------------------------------------------------------------------------------------------------------------------------------------------------
This article was first published in:


Patnode CD, O'Connor E, Whitlock EP, Perdue LA, Soh C, Hollis J.

BACKGROUND: Interventions to prevent smoking uptake or encourage cessation among young persons might help prevent tobacco-related illness.
PURPOSE: To review the evidence for the efficacy and harms of primary care-relevant interventions that aim to reduce tobacco use among children and adolescents.
DATA SOURCES: Three systematic reviews that collectively covered the relevant literature; MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects through 14 September 2012; and manual searches of reference lists and gray literature.
STUDY SELECTION: Two investigators independently reviewed 2453 abstracts and 111 full-text articles. English-language trials of behavior-based or medication interventions that were relevant to primary care and reported tobacco use, health outcomes, or harms were included.
DATA EXTRACTION: One investigator abstracted data from good- and fair-quality trials into an evidence table, and a second checked these data.
DATA SYNTHESIS: 19 trials (4 good-quality and 15 fair-quality) that were designed to prevent tobacco use initiation or promote cessation (or both) and reported self-reported smoking status or harms were included. Pooled analyses from a random-effects meta-analysis suggested a 19% relative reduction (risk ratio, 0.81 [95% CI, 0.70 to 0.93]; absolute risk difference, -0.02 [CI, -0.03 to 0.00]) in smoking initiation among participants in behavior-based prevention interventions compared with control participants. Neither behavior-based nor bupropion cessation interventions improved cessation rates. Findings about the harms related to bupropion use were mixed.
LIMITATIONS: No studies reported health outcomes. Interventions and measures were heterogeneous. Most trials examined only cigarette smoking. The body of evidence was largely published 5 to 15 years ago.
CONCLUSION: Primary care-relevant interventions may prevent smoking initiation over 12 months in children and adolescents.
PMID: 23229625 [PubMed - indexed for MEDLINE]

19.8.13

Retrieving Clinical Evidence: A Comparison of PubMed and Google Scholar for Quick Clinical Searches

Salimah Z Shariff1,2, BMath, PhD; Shayna AD Bejaimal1, BMedSc; Jessica M Sontrop1,2, PhD; Arthur V Iansavichus1, MLIS; R Brian Haynes3,4, MD, PhD; Matthew A Weir1, MD; Amit X Garg1,2,3, MD, PhD

(J Med Internet Res 2013;15(8):e164)
doi:10.2196/jmir.2624

ABSTRACT

Background: Physicians frequently search PubMed for information to guide patient care. More recently, Google Scholar has gained popularity as another freely accessible bibliographic database.
Objective: To compare the performance of searches in PubMed and Google Scholar.
Methods: We surveyed nephrologists (kidney specialists) and provided each with a unique clinical question derived from 100 renal therapy systematic reviews. Each physician provided the search terms they would type into a bibliographic database to locate evidence to answer the clinical question. We executed each of these searches in PubMed and Google Scholar and compared results for the first 40 records retrieved (equivalent to 2 default search pages in PubMed). We evaluated the recall (proportion of relevant articles found) and precision (ratio of relevant to nonrelevant articles) of the searches performed in PubMed and Google Scholar. Primary studies included in the systematic reviews served as the reference standard for relevant articles. We further documented whether relevant articles were available as free full-texts.
Results: Compared with PubMed, the average search in Google Scholar retrieved twice as many relevant articles (PubMed: 11%; Google Scholar: 22%; P<.001). Precision was similar in both databases (PubMed: 6%; Google Scholar: 8%; P=.07). Google Scholar provided significantly greater access to free full-text publications (PubMed: 5%; Google Scholar: 14%;P<.001).
Conclusions: For quick clinical searches, Google Scholar returns twice as many relevant articles as PubMed and provides greater access to free full-text articles.

6.8.13

Schedules for home visits in the early postpartum period.

Yonemoto N, Dowswell T, Nagai S, et al. Schedules for home visits in the early postpartum period. Cochrane Database Syst Rev. 2013 Jul 23;7:CD009326. (Review) PMID: 23881661

BACKGROUND: Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families.

OBJECTIVES: To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH

METHODS: We searched the Cochrane Pregnancy and Childbirth Group`s Trials Register (28 January 2013) and reference lists of retrieved articles.

SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems).

DATA COLLECTION AND ANALYSIS: Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software.

MAIN RESULTS: We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no strong evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care.

AUTHORS' CONCLUSIONS: Overall, findings were inconsistent. Postnatal home visits may promote infant health and maternal satisfaction. However, the frequency, timing, duration and intensity of such postnatal care visits should be based upon local needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.