Brief Approaches to Developmental-Behavioral Promotion inPrimary Care: Updates on Methods and Technology.

Glascoe FP, Trimm F. Brief Approaches to Developmental-Behavioral Promotion inPrimary Care: Updates on Methods and Technology. Pediatrics. 2014 Apr 28. [Epubahead of print] PubMed PMID: 24777220.

Well-child visits are a critical opportunity to promote learning and development,

encourage positive parenting practices, help children acquire behavioral
self-control, enhance the development and well-being of children and their
families, identify problems not amenable to brief in-office counseling, and refer
for services when needed. This article outlines the communication skills,
instructional methods, and resource options that enable clinicians to best assist
families. Also covered is how to monitor progress and outcomes. A total of 239
articles and 52 Web sites on parent/patient education were reviewed for this
study. Providers require a veritable armamentarium of instructional methods.
Skills in nonverbal and verbal communication are needed to elicit the
parent/patient agenda, winnow topics to a manageable subset, and create the
"teachable moment." Verbal suggestions, with or without standardized spoken
instructions, are useful for conveying simple messages. However, for complex
issues, such as discipline, it is necessary to use a combination of verbal
advice, written information, and "teach-back," aided by role-playing/modeling or 
multimedia approaches. Selecting the approaches most likely to be effective
depends on the topic and family characteristics (eg, parental literacy and
language skills, family psychosocial risk and resilience factors, children's
developmental-behavioral status). When providers collaborate well (with parents, 
patients, and other service providers) and select appropriate educational
methods, families are better able to act on advice, leading to improvements in
children's well-being, health, and developmental-behavioral outcomes. Provided
are descriptions of methods, links to parenting resources such as cell phone
applications, Web sites (in multiple languages), interactive technology, and
parent training courses.

PMID: 24777220  [PubMed - as supplied by publisher]

Validityof Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use.

Kelly SM, Gryczynski J, Mitchell SG, Kirk A, O'Grady KE, Schwartz RP. Validityof Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use.Pediatrics. 2014 Apr 21. [Epub ahead of print] PubMed PMID: 24753528; PubMedCentral PMCID: PMC4006430.

BACKGROUND AND OBJECTIVE: The National Institute on Alcohol Abuse and Alcoholism 
developed an alcohol screening instrument for youth based on epidemiologic data. 
This study examines the concurrent validity of this instrument, expanded to
include tobacco and drugs, among pediatric patients, as well as the acceptability
of its self-administration on an iPad.
METHODS: Five hundred and twenty-five patients (54.5% female; 92.8% African
American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and
other Drugs (BSTAD) via interviewer-administration or self-administration using
an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders
(SUDs) were identified using a modified Composite International Diagnostic
Interview-2 Substance Abuse Module. Receiver operating characteristic curves,
sensitivities, and specificities were obtained to determine optimal cut points on
the BSTAD in relation to SUDs.
RESULTS: One hundred fifty-nine (30.3%) adolescents reported past-year use of ≥1 
substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and
50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items
on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95;
specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity =
0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93).
iPad self-administration was preferred over interviewer administration (z = 5.8; 
P < .001).
CONCLUSIONS: The BSTAD is a promising screening tool for identifying problematic 
tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of 
substance use among adolescents may indicate need for intervention.

Prenatal Vitamin D and Dental Caries in Infants.

Schroth RJ, Lavelle C, Tate R, Bruce S, Billings RJ, Moffatt ME. PrenatalVitamin D and Dental Caries in Infants. Pediatrics. 2014 Apr 21. [Epub ahead ofprint] PubMed PMID: 24753535.

OBJECTIVES: Inadequate maternal vitamin D (assessed by using 25-hydroxyvitamin D [25OHD]) levels during pregnancy may affect tooth calcification, predisposing enamel hypoplasia and early childhood caries (ECC). The purpose of this study was to determine the relationship between prenatal 25OHD concentrations and dental caries among offspring during the first year of life.

METHODS: This prospective cohort study recruited expectant mothers from an economically disadvantaged urban area. A prenatal questionnaire was completed and serum sample drawn for 25OHD. Dental examinations were completed at 1 year of age while the parent/caregiver completed a questionnaire. The examiner was blinded to mothers’ 25OHD levels. A P value ≤ .05 was considered significant.

RESULTS: Overall, 207 women were enrolled (mean age: 19 ± 5 years). The mean 25OHD level was 48 ± 24 nmol/L, and 33% had deficient levels. Enamel hypoplasia was identified in 22% of infants; 23% had cavitated ECC, and 36% had ECC when white spot lesions were included in the assessment. Mothers of children with ECC had significantly lower 25OHD levels than those whose children were caries-free (41 ± 20 vs 52 ± 27 nmol/L; P = .05). Univariate Poisson regression analysis for the amount of untreated decay revealed an inverse relationship with maternal 25OHD. Logistic regression revealed that enamel hypoplasia (P < .001), infant age (P = .002), and lower prenatal 25OHD levels (P = .02) were significantly associated with ECC.

CONCLUSIONS: This study found that maternal prenatal 25OHD levels may have an influence on the primary dentition and the development of ECC.

Meta-analysis of parental protection of children from tobacco smoke exposure.

Rosen LJ, Myers V, Hovell M, et al. Meta-analysis of parental protection of children from tobacco smoke exposure. Pediatrics. 2014 Apr;133(4):698-714. doi: 10.1542/peds.2013-0958. Epub 2014 Mar 24. (Review) PMID: 24664094

BACKGROUND AND OBJECTIVE: Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE.

METHODS: Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed.

RESULTS: Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20).

CONCLUSIONS: Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.

Screening for Suicide Risk in Adolescents, Adults, and Older Adults in Primary Care: U.S. Preventive Services Task Force Recommendation Statement

O'Connor E(1), Gaynes BN, Burda BU, Soh C, Whitlock EP.

Ann Intern Med. 2013 May 21;158(10):741-54. 

http://annals.org/article.aspx?articleid=1872851

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[Description: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for suicide risk.

Methods: The USPSTF reviewed the evidence on the accuracy and reliability of instruments used to screen for increased suicide risk, benefits and harms of screening for increased suicide risk, and benefits and harms of treatments to prevent suicide.

Population: This recommendation applies to adolescents, adults, and older adults in the general population who do not have an identified psychiatric disorder.

Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults in a primary care setting. (I statement)]


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BACKGROUND: In 2009, suicide accounted for 36 897 deaths in the United States.

PURPOSE: To review the accuracy of screening instruments and the efficacy and

safety of screening for and treatment of suicide risk in populations and settings
relevant to primary care.

DATA SOURCES: Citations from MEDLINE, PsycINFO, the Cochrane Central Register of 

Controlled Trials, and CINAHL (2002 to 17 July 2012); gray literature; and a

surveillance search of MEDLINE for additional screening trials (July to December 
2012).

STUDY SELECTION: Fair- or good-quality English-language studies that assessed the

accuracy of screening instruments in primary care or similar populations and
trials of suicide prevention interventions in primary or mental health care


settings.

DATA EXTRACTION: One investigator abstracted data; a second checked the
abstraction. Two investigators rated study quality.

DATA SYNTHESIS: Evidence was insufficient to determine the benefits of screening 

in primary care populations; very limited evidence identified no serious harms.
Minimal evidence suggested that screening tools can identify some adults at


increased risk for suicide in primary care, but accuracy was lower in studi


eMinimal evidence limited to high-risk populations suggested poor

performance of screening instruments in adolescents. Trial evidence showed that

psychotherapy reduced suicide attempts in high-risk adults but not adolescents.

Most trials were insufficiently powered to detect effects on deaths.

LIMITATION: Treatment evidence was derived from high-risk rather than

screening-detected populations. Evidence relevant to adolescents, older adults,
and racial or ethnic minorities was limited.

CONCLUSION: Primary care-feasible screening tools might help to identify some

adults at increased risk for suicide but have limited ability to detect suicide

risk in adolescents. Psychotherapy may reduce suicide attempts in some high-risk 

adults, but effective interventions for high-risk adolescents are not yet proven.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Eficacia de las políticas institucionales de prevencióndel consumo de alcohol en adolescentes: la opinión de expertos y adolescentesadolescentesCristian Suáreza. Gonzalo del Morala, Gonzalo Musitua,Juan Carlos Sánchez y Bev John Aten Primaria. 2014;xxx(xx):xxx---xxx

ResumenObjetivo: Conocer la opinión de un grupo de adolescentes y profesionales/expertos en adolescencia, familia, escuela, medios de comunicación y políticas locales acerca de la eficacia delas políticas institucionales en la prevención del consumo de alcohol en adolescentes.

Emplazamiento: Cuatro centros educativos de la provincia de Sevilla. Sede central de la Fun-dación Alcohol y Sociedad en Madrid.Diseño: Estudio cualitativo siguiendo el método propuesto por la Teoría fundamentada (Groun-ded theory) (Glaser y Strauss, 1967).

Método: Información obtenida a partir de 10 grupos de discusión guiados por entrevistas semi-estructuradas. Análisis de la información mediante Atlas ti 5.Participantes: Treinta y dos profesionales/expertos nacionales y 40 adolescentes de ambossexos entre 15-20 años residentes en la provincia de Sevilla, seleccionados por muestreo inten-cional teórico.

Resultados: Los expertos consideran eficaces la mayoría de las acciones o medidas preventivasevaluadas mientras que los adolescentes niegan el impacto preventivo de la mayor parte de ellas. Los adolescentes proponen medidas centradas en la reducción de la oferta de alcohol,mientras que los expertos proponen un modelo mixto, en el que se combinen políticas dereducción de la oferta y de la demanda, en función de objetivos específicos a corto y largoplazo.Conclusiones: Se ha obtenido una visión general sobre aquello que según adolescentes y exper-tos es eficaz o ineficaz en la prevención del consumo de alcohol, y acerca de las claves que sedeberían tener en cuenta para diseñar políticas eficaces.
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