Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis.

J Subst Abuse Treat. 2015 Apr;51:1-18. doi: 10.1016/j.jsat.2014.09.001. Epub 2014

Sep 16.

Tanner-Smith EE, Lipsey MW.

This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11-18) and young adults (age 19-30). We identified 185 eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents (g = 0.27 and g = 0.19) and young adults (g = 0.17 and g = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.

Integrating Bodies of Evidence: Existing Systematic Reviews and Primary Studies. Methods Guide for Comparative Effectiveness Reviews.

Robinson KA, Chou R, Berkman ND, Newberry SJ, Fu R, Hartling L, Dryden D, Butler M, Foisy M, Anderson J, Motu’apuaka ML, Relevo R, Guise JM, Chang S. Integrating Bodies of Evidence: Existing Systematic Reviews and Primary Studies. Methods Guide for Comparative Effectiveness Reviews (Prepared by the Scientific Resource Center under Contract No. 290-2012-00004-C). AHRQ Publication No. 15-EHC007-EF. Rockville, MD: Agency for Healthcare Research and Quality. February 2015. 

http://www.effectivehealthcare.ahrq.gov/ehc/products/597/2049/integrating-evidence-report-150226.pdf 

The increasing number of systematic reviews, along with the time and money required to undertake a review, has motivated a desire to incorporate existing systematic reviews in a new review. In considering the integration of existing systematic reviews into new reviews, there is a tradeoff between accepting the results of the prior review and needing to either complete again the selected elements of the review or the review in its entirety. The key is to find the right balance in terms of an efficient and unbiased approach to conducting and reporting the integration of existing systematic reviews into the new review. In this working document, we have provided preliminary guidance to help find that balance.

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.

Ideal timing of orchiopexy: a systematic review.

Pediatr Surg Int. 2014 Jan;30(1):87-97.

Chan E, Wayne C, Nasr A; FRCSC for Canadian Association of Pediatric Surgeon Evidence-Based Resource.

The ideal management of cryptorchidism is a highly debated topic within the field of pediatric surgery. The optimal timing of orchiopexy is particularly unclear, as existing literature reports mixed recommendations. The aim of this study was to determine, based on a systematic review, the most favorable age at which orchiopexy should be performed. We conducted a systematic search of MEDLINE, Embase, CINAHL, and the Cochrane Library to find relevant articles. Two researchers quality assessed each study using the following tools: AMSTAR (systematic reviews), Jadad (RCTs), and MINORS (non-RCTs). We developed a conclusion based on the highest quality studies. We found one relevant systematic review, one RCT, and 30 non-RCTs. Fertility potential was greatest when orchiopexy was performed before 1 year of age. Additionally, orchiopexy before 10–11 years may protect against the increased risk of testicular cancer associated with cryptorchidism. Orchiopexy should not be performed before 6 months of age, as testes may descend spontaneously during the first few months of life. The highest quality evidence recommends orchiopexy between 6 and 12 months  of age. Surgery during this timeframe may optimize fertility potential and protect against testicular malignancy in children with cryptorchidism.

Clinical guidelines for postpartum women and infants in primary care: a systematic review.

BMC Pregnancy Childbirth. 2014 Jan 29;14:51.doi: 10.1186/1471-2393-14-51.

Haran C, van Driel M, Mitchell BL, Brodribb WE(1).

BACKGROUND: While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care.

METHODS: PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument.

RESULTS: Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest.

CONCLUSIONS: Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.

A Systematic Review of Effective Interventions for Reducing Multiple Health Risk Behaviors in Adolescence.

Am J Public Health. 2014 Mar 13. [Epub ahead of print]

Hale DR(1), Fitzgerald-Yau N, Viner RM.

We systematically searched 9 biomedical and social science databases (1980-2012) for primary and secondary interventions that prevented or reduced 2 or more adolescent health risk behaviors (tobacco use, alcohol use, illicit drug use, risky sexual behavior, aggressive acts). We identified 44 randomized controlled trials of universal or selective interventions and were effective for multiple health risk behaviors. Most were school based, conducted in the United States, and effective for multiple forms of substance use. Effects were small, in line with findings for other universal prevention programs. In some studies, effects for more than 1 health risk behavior only emerged at long-term follow-up.

Integrated prevention programs are feasible and effective and may be more efficient than discrete prevention strategies. (Am J Public Health. Published online ahead of print March 13, 2014: e1-e23. doi:10.2105/AJPH.2014.301874).

Performance of Tuberculin Skin Test Measured against Interferon Gamma Release Assay as Reference Standard in Children.

Tuberc Res Treat. 2014;2014:413459. doi:10.1155/2014/413459. Epub 2014 Feb 10.

Eisenhut M(1), Fidler K(2).

Objectives. International guidelines differ in the threshold of tuberculin skin test (TST) induration regarded as indicating Mycobacterium (M.) tuberculosis infection. Interferon gamma release assay (IGRA) results were used as reference to assess performance of TST induration thresholds for detection of M. tuberculosis infection in children.

Design. Systematic review which included studies containing data on TST, IGRA, and Bacillus Calmette-Guérin (BCG) status in children. Data bases searched were PubMed, EMBASE, and the Cochrane library. Specificities and sensitivities were calculated for TST thresholds 5, 10, and 15 mm and correlated with age and geographical latitude.

Results. Eleven studies with 2796 children were included. For BCG immunised children diameters of 5, 10, and 15 mm had median sensitivities of 87, 70, and 75% and specificities of 67, 93, and 90%, respectively. In non-BCG immunised children median sensitivities were 94, 95, and 83% and specificities 91, 95, and 97%. At the 10 mm threshold age correlated negatively with sensitivity of TST (r = -0.65, P = 0.04) and latitude correlated positively (r = 0.71, P = 0.02).

Conclusions. For the 10 mm threshold the sensitivity of the TST is lower in BCG immunised children. Younger  age and higher geographical latitude were associated with higher sensitivity of the TST.

Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review.

Original bibliographic details:

Antwi FA, Fazylova N, Garcon MC, Lopez L, Rubiano R, Slyer JT. Effectiveness of web-based programs on the reduction of childhood obesity in school-aged children: a systematic review. JBI Database of Systematic Reviews and Implementation Reports 2013; 11(6): 1-44. DOI 10.11124/jbisrir-2013-459

[In: DARE http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?ID=12013057780#.UzaP8_l5Oup]

CRD summary

The authors concluded that a web-based programme, as part of a multi-component intervention, could reduce besity and being overweight, in school-aged children. The authors' conclusions may be overstated given the mixed results in the individual trials, the variation between the interventions, and the limited synthesis.

Authors' objectives

To assess the effectiveness of web-based programmes to reduce childhood obesity in school-aged children.

Searching

A broad range of 15 databases, including CINAHL, PubMed, EMBASE, PsycINFO and ERIC, was searched for articles from 1991 to August 2012; search strategies for each database were reported. Reference lists of included studies were checked. Studies had to be in English.

Study selection

Randomised controlled trials (RCTs) or pseudo-randomised trials of web-based programmes, alone or with other components, aimed at reducing obesity in four- to 18-year-olds, were eligible for inclusion. The outcomes of interest were measures of weight including body mass index (BMI), body weight and waist circumference.

The included trials were all conducted in the USA, except one that was conducted in the Netherlands. The trials included normal-weight, at-risk or overweight children. Most trials were of adolescent boys and girls. The interventions were typically weekly sessions of web-based programmes targeting weight loss, body image improvement, or behaviour modification for weight control. In all trials, the web-based intervention was delivered with other interventions, such as counselling sessions, parental involvement, or phone or email prompts. The interventions lasted between five and 52 weeks.

The authors did not state how many reviewers selected studies.

Assessment of study quality

Two reviewers independently assessed trial quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for randomised controlled or pseudo-randomised trials. Trials had to meet a minimum of six out of the 10 checklist criteria to be included in the review. Disagreements were resolved through discussion or by a third reviewer.

Data extraction

The mean and standard deviation of the body mass index (BMI), BMI z-score, waist-hip ratio, waist circumference, and body fat at the start and after intervention were extracted.

Two reviewers independently extracted the data; disagreements were resolved by discussion or by a third reviewer.

Methods of synthesis

A narrative synthesis was presented, due to significant clinical and methodological variation.

Results of the review

Twelve reports of eight RCTs were included (1,717 school-aged children; range 30 to 883). Follow-up ranged from three to 24 months. All RCTs were judged to be of adequate quality.

Four RCTs showed that web-based programmes reduced either BMI, BMI z-score, waist-hip ratio, or body fat. Reductions were not observed beyond nine months after the intervention. One RCT showed no difference in BMI, one showed no difference in BMI z-score, and two showed an increase in BMI at follow-up.

Parents were involved as part of the intervention in all the trials that showed an improvement or no change from the start. Telephone or email reminders were part of the intervention in four of these six trials.

Authors' conclusions

A reduction in obesity and being overweight, for school-aged children, was possible with web-based weight-reduction interventions that had other components.

CRD commentary

The review question and inclusion criteria were clear. The restriction to trials in English may have excluded some relevant data. Data extraction and quality assessment were undertaken by two reviewers independently, which reduced the potential for error, but it was unclear whether the same process was used for study selection. While all the included trials were considered to be of adequate quality, some were at risk of bias.

A narrative synthesis was appropriate given the differences in the included interventions and populations, but the synthesis was very limited. The synthesis was also limited by the small size and relatively short follow-up in the included trials. As all the interventions included other components it was difficult to determine whether any benefits were due to the web-based programme or to the other components.

The authors' conclusions may be overstated given the mixed results in the individual trials, the variation between the interventions, and the limited synthesis.

Implications of the review for practice and research

Practice: The authors stated that using web-based technology as part of a multi-component intervention for weight reduction in school-aged children was promising.

Research: The authors stated that future studies should evaluate the effects of web-based technology as a single intervention, on a large sample, over a long period of time.

Effects of daily iron supplementation in primary-school-aged children: systematic review and meta-analysis of randomized controlled trials.

Low M, Farrell A, Biggs BA, et al. 
CMAJ. 2013 Nov 19;185(17):E791-802. doi: 10.1503/cmaj.130628. Epub 2013 Oct 15. (Review) PMID: 24130243

BACKGROUND: Anemia is an important public health and clinical problem. Observational studies have linked iron deficiency and anemia in children with many poor outcomes, including impaired cognitive development; however, iron supplementation, a widely used preventive and therapeutic strategy, is associated with adverse effects. Primary-school-aged children are at a critical stage in intellectual development, and optimization of their cognitive performance could have long-lasting individual and population benefits. In this study, we summarize the evidence for the benefits and safety of daily iron supplementation in primary-school-aged children.
METHODS: We searched electronic databases (including MEDLINE and Embase) and other sources (July 2013) for randomized and quasi-randomized controlled trials involving daily iron supplementation in children aged 5-12 years. We combined the data using random effects meta-analysis.
RESULTS: We identified 16 501 studies; of these, we evaluated 76 full-text papers and included 32 studies including 7089 children. Of the included studies, 31 were conducted in low- or middle-income settings. Iron supplementation improved global cognitive scores (standardized mean difference 0.50, 95% confidence interval [CI] 0.11 to 0.90, p = 0.01), intelligence quotient among anemic children (mean difference 4.55, 95% CI 0.16 to 8.94, p = 0.04) and measures of attention and concentration. Iron supplementation also improved age-adjusted height among all children and age-adjusted weight among anemic children. Iron supplementation reduced the risk of anemia by 50% and the risk of iron deficiency by 79%. Adherence in the trial settings was generally high. Safety data were limited.
INTERPRETATION: Our analysis suggests that iron supplementation safely improves hematologic and nonhematologic outcomes among primary-school-aged children in low- or middle-income settings and is well-tolerated.

Comment in

• Iron supplementation for children: Safety in all settings is not clear. [CMAJ. 2013]

Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis.

BMJ. 2013 Jun 21;346:f3443. doi: 10.1136/bmj.f3443.
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW; Nutrition Impact
Model Study Group (anaemia).

Comment in
    BMJ. 2013;347:f4399.

OBJECTIVES: To summarise evidence on the associations of maternal anaemia and
prenatal iron use with maternal haematological and adverse pregnancy outcomes;
and to evaluate potential exposure-response relations of dose of iron, duration
of use, and haemoglobin concentration in prenatal period with pregnancy outcomes.
DESIGN: Systematic review and meta-analysis
DATA SOURCES: Searches of PubMed and Embase for studies published up to May 2012 
and references of review articles.
STUDY SELECTION CRITERIA: Randomised trials of prenatal iron use and prospective 
cohort studies of prenatal anaemia; cross sectional and case-control studies were
excluded.
RESULTS: 48 randomised trials (17 793 women) and 44 cohort studies (1 851 682
women) were included. Iron use increased maternal mean haemoglobin concentration 
by 4.59 (95% confidence interval 3.72 to 5.46) g/L compared with controls and
significantly reduced the risk of anaemia (relative risk 0.50, 0.42 to 0.59),
iron deficiency (0.59, 0.46 to 0.79), iron deficiency anaemia (0.40, 0.26 to
0.60), and low birth weight (0.81, 0.71 to 0.93). The effect of iron on preterm
birth was not significant (relative risk 0.84, 0.68 to 1.03). Analysis of cohort 
studies showed a significantly higher risk of low birth weight (adjusted odds
ratio 1.29, 1.09 to 1.53) and preterm birth (1.21, 1.13 to 1.30) with anaemia in 
the first or second trimester. Exposure-response analysis indicated that for
every 10 mg increase in iron dose/day, up to 66 mg/day, the relative risk of
maternal anaemia was 0.88 (0.84 to 0.92) (P for linear trend<0.001). Birth weight
increased by 15.1 (6.0 to 24.2) g (P for linear trend=0.005) and risk of low
birth weight decreased by 3% (relative risk 0.97, 0.95 to 0.98) for every 10 mg
increase in dose/day (P for linear trend<0.001). Duration of use was not
significantly associated with the outcomes after adjustment for dose.
Furthermore, for each 1 g/L increase in mean haemoglobin, birth weight increased 
by 14.0 (6.8 to 21.8) g (P for linear trend=0.002); however, mean haemoglobin was
not associated with the risk of low birth weight and preterm birth. No evidence
of a significant effect on duration of gestation, small for gestational age
births, and birth length was noted.
CONCLUSIONS: Daily prenatal use of iron substantially improved birth weight in a 
linear dose-response fashion, probably leading to a reduction in risk of low
birth weight. An improvement in prenatal mean haemoglobin concentration linearly 
increased birth weight.

PMCID: PMC3689887
PMID: 23794316  [PubMed - indexed for MEDLINE]

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.

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

Pearce J, Taylor MA, Langley-Evans SC.

Int J Obes (Lond). 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 duringchildhood. Electronic 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.

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

Sobol-Goldberg S, Rabinowitz J, Gross R

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.

Systematic Review of Community-Based Childhood Obesity Prevention Studies.

Bleich SN, Segal J, Wu Y, Wilson R, Wang Y.

Pediatrics. 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.

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

JAMA Pediatr. 2013;167(6):574-580. doi:10.1001/jamapediatrics.2013.1095.

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.4- 5 Although they did not meet the strict criteria for the present review, 2 articles6- 7 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 reviews8- 10 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 intervention11- 12 or to only a single specific health outcome. In addition, many reviews did not include safety behavior outcomes,8- 10,12- 13 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.

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

JAMA Pediatr. 2013;():1-7. doi:10.1001/jamapediatrics.2013.192.

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,1- 2 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 aggression5- 6 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 life9- 10 have been identified, alongside the difficulty in recognition at such a young age.11- 12 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.