Background: Spoon dosing has been identified as a major cause
of dosing errors and pediatric poisonings (1). Although the U.S.
Food and Drug Administration recommends against using kitchen
utensils to dose liquid medicine (2), most persons still use spoons
when pouring medicine for themselves and their families (3). Although
dosing errors remain modest when using kitchen teaspoons,
they may increase when using various sizes of larger spoons (4). If the
size of a spoon leads a teaspoonful of liquid medicine to seem like
markedly more or less than 5 mL (5), a person may compensate by
under- or overdosing (Figure).
Objective: To examine whether the dose of liquid medicine varies
depending on the size of the spoon onto which it is poured.
Methods: During the cold and flu season, we asked 195 university
students (109 men; mean age, 20.1 years [SD, 1.7]) who were
recent patients at a university health clinic to dose 5 mL of cold
medicine into a teaspoon (5 mL, 2.7 x 4 cm), a medium-sized tablespoon
(15 mL, 4 x 6 cm), and a larger spoon (45 mL, 6 x 9 cm).
We told them that they were participating in a study about cold
medicine and asked them to suppose they were at home with a cold,
taking liquid medicine with a recommended dose of 1 teaspoon. So
participants would better understand the volume of a teaspoon, we
first gave them a full bottle of cold medicine and a teaspoon and
asked them to pour exactly 1 teaspoon (5 mL). Next, we asked
participants to pour the same 5-mL dose into each of the remaining
2 spoons in a randomized order. After each of these 2 pours, we
asked participants to indicate how confident they felt that they had
poured 5 mL (1 = not very confident; 9 = very confident) and how
effictive they believed their poured dose would be (1 = not very
effective; 9 = very effective). After they left the room, we measured
the volume of cold medicine they had poured into each of the 2
spoons. We performed all analyses by using SPSS statistical software,
version 15.0 (SPSS, Chicago, Illinois). We considered a P value less
than 0.050 to be statistically significant.
Results: The amount of cold medicine that participants poured
varied directly with the size of the spoon (4.58 vs. 5.58 mL; t =
4.63; P < 0.001). Participants underdosed when using the mediumsized
spoon (4.58 vs. 5 mL; t = <2.30; P = 0.022) and overdosed
when using the larger spoon (5.58 vs. 5 mL; t = 2.39; P = 0.017).
Although the capacity of the spoons was never a constraint,
participants dosed 8.4% less than prescribed into the medium-sized
spoon and 11.6% more into the larger spoon. Notwithstanding this
aggregate bias of 20%, participants had above-average confidence
that their pouring was accurate and believed that the doses they
poured into both spoons would be equally effective.
Discussion: The amount of liquid medicine a person doses may
vary with the size of the spoon used. Participants underdosed by
8.4% when using medium-sized spoons and overdosed by 11.6%
when using larger spoons. Although these educated participants had
poured in a well-lit room after a practice pour, they were unaware of
these biases and were confident that they had poured the correct
doses in both spoons. Whereas the clinical implications of an 8% to
12% dosing error in a 1-tsp serving of medicine may be minimal, the
dosing error is likely to accumulate among fatigued patients who are
medicating themselves every 4 to 8 hours for several days.
Although one would expect more experienced pourers, such as
nurses or practiced parents, to be less biased, this may not be so.
Even confident veteran bartenders poured 28% more liquor
into short, wide glasses than into tall, slender glasses of the same
volume (6). If a medicine’s efficacy is tied to its dose, it is more
effective to strongly encourage a patient to use a measuring cap,
dosing spoon, measuring dropper, or dosing syringe than to assume
that they can rely on their pouring experience and estimation abilities
with kitchen spoons.
Brian Wansink, PhD
Koert van Ittersum, PhD
Cornell University
Ithaca, NY 14853
Potential Conflicts of Interest: None disclosed.
References
1. Litovitz T. Implication of dispensing cups in dosing errors and pediatric poisonings:
a report from the American Association of Poison Control Centers. Ann Pharmacother.
1992;26:917-8. [PMID: 1504399]
2. U.S. Food and Drug Administration. Nonprescription cough and cold medicine
use in children—full version. Accessed at www.fda.gov/Drugs/DrugSafety
/DrugSafetyPodcasts/ucm078927.htm on 28 June 2009.
3. Madlon-Kay DJ, Mosch FS. Liquid medication dosing errors. J Fam Pract. 2000;
49:741-4. [PMID: 10947142]
4. Aziz AH, Khaleel AJ. How accurate are household spoons in drug administration?
Med Princ Pract. 1990/1991;2:106-9.
5. Delboeuf FJ. [Note on certain optical illusions: essay on a psychophysical
theory concerning the way in which the eye evaluates distances and angles.]
Bulletins de l’Acade´mie Royale des Sciences, Lettres et Beaux-arts de Belgique.
1865;19:195-216.
6. Wansink B, van Ittersum K. Shape of glass and amount of alcohol poured: comparative
study of effect of practice and concentration. BMJ. 2005;331:1512-4. [PMID:
16373735]
15.3.10
Identification and management of familial hypercholesterolaemia
Identification and management of familial hypercholesterolaemia.
Excelente guía de la prestigiosa NICE, editada en 2008. recomendable para pediatras y médicos de familia:
1 Guidance..................................................................................................6
1.1 Diagnosis...........................................................................................6
1.2 Identifying people with FH using cascade testing..............................9
1.3 Management....................................................................................10
1.4 Information needs and support........................................................20
1.5 Ongoing assessment and monitoring..............................................22
Y más y más
Excelente guía de la prestigiosa NICE, editada en 2008. recomendable para pediatras y médicos de familia:
1 Guidance..................................................................................................6
1.1 Diagnosis...........................................................................................6
1.2 Identifying people with FH using cascade testing..............................9
1.3 Management....................................................................................10
1.4 Information needs and support........................................................20
1.5 Ongoing assessment and monitoring..............................................22
Y más y más
12.3.10
Joan Carles March Cerdá a, Astrid Suess a, Alina Danet a, María Ángeles Prieto Rodríguez a, Manuel Romero VallecillosTabaco y publicidad. Revisión de los estudios publicados entre 2000 y 2008.Atención Primaria.martes, 09 mar 2010
Objetivo
Evaluar la influencia de la publicidad de tabaco en los hábitos de consumo.
Diseño
Revisión sistemática.
Fuente de datos
PubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma e Isooc (CSIC)
(enero 2000-septiembre 2008).
Métodos
Se han incluido 44 artículos de ámbito nacional o internacional que
relacionan el consumo de tabaco con alguna práctica publicitaria o de
promoción. Se han eliminado los artículos que no se centran en el
impacto de la publicidad y la promoción del tabaco sobre la conducta
de consumo y las investigaciones referidas a prevención, a
intervención o a prohibición a través de campañas, medidas, planes y
leyes antitabaco. El análisis de los artículos se ha centrado en los
actores identificados, la metodología empleada y la temática.
Resultados
La publicidad influye en el consumo de tabaco. Los mensajes
publicitarios llevan a iniciar el hábito (5 artículos) y a mantener el
hábito (3 artículos), construyen el concepto y la imagen de la persona
fumadora (5 artículos) y usan diferentes estrategias publicitarias (22
artículos).
11.3.10
Soft drink and juice consumption and risk of pancreatic cancer: the Singapore Chinese Health Study.
Mueller NT, Odegaard A, Anderson K, Yuan JM, Gross M, Koh WP, Pereira MA.
Cancer Control Program, Georgetown University Medical Center, Washington, District of Columbia, USA.
Cancer Epidemiol Biomarkers Prev. 2010 Feb;19(2):447-55.
BACKGROUND: Sugar-sweetened carbonated beverages (called soft drinks) and juices, which have a high glycemic load relative to other foods and beverages, have been hypothesized as pancreatic cancer risk factors. However, data thus far are scarce, especially from non-European descent populations. We investigated whether higher consumption of soft drinks and juice increases the risk of pancreatic cancer in Chinese men and women. METHODS: A prospective cohort analysis was done to examine the association between soft drink and juice consumption and the risk of pancreatic cancer in 60,524 participants of the Singapore Chinese Health Study with up to 14 years of follow-up. Information on consumption of soft drinks, juice, and other dietary items, as well as lifestyle and environmental exposures, was collected through in-person interviews at recruitment. Pancreatic cancer cases and deaths were ascertained by record linkage of the cohort database with records of population-based Singapore Cancer Registry and the Singapore Registry of Births and Deaths. RESULTS: The first 14 years for the cohort resulted in cumulative 648,387 person-years and 140 incident pancreatic cancer cases. Individuals consuming > or = 2 soft drinks/wk experienced a statistically significant increased risk of pancreatic cancer (hazard ratio, 1.87; 95% confidence interval, 1.10-3.15) compared with individuals who did not consume soft drinks after adjustment for potential confounders. There was no statistically significant association between juice consumption and risk of pancreatic cancer. CONCLUSION: Regular consumption of soft drinks may play an independent role in the development of pancreatic cancer.
7.3.10
Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.
Walsh T, Worthington HV, Glenny AM, et al. Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007868. (Review) PMID: 20091655
BACKGROUND: Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). The use of fluoride toothpaste is the primary intervention for the prevention of caries.
OBJECTIVES: To determine the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents, and to examine the potentially modifying effects of baseline caries level and supervised toothbrushing.
SEARCH STRATEGY: A search was undertaken on Cochrane Oral Health Group`s Trials Register, CENTRAL, MEDLINE and several other databases. Reference lists of articles were also searched. Date of the most recent searches: 8 June 2009.
SELECTION CRITERIA: Randomised controlled trials and cluster-randomised controlled trials comparing fluoride toothpaste with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with a follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or deciduous dentition as measured by the change in decayed, (missing), filled tooth surfaces (D(M)FS/d(m)fs) from baseline.
DATA COLLECTION AND ANALYSIS: Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were resolved by discussion and consensus or by a third party. The primary effect measure was the prevented fraction (PF), the caries increment of the control group minus the caries increment of the treatment group, expressed as a proportion of the caries increment in the control group. Where it was appropriate to pool data, network meta-analysis, network meta-regression or meta-analysis models were used. Potential sources of heterogeneity were specified a priori and examined through random-effects meta-regression analysis where appropriate.
MAIN RESULTS: 75 studies were included, of which 71 studies comprising 79 trials contributed data to the network meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that contributed to the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations (D(M)FS PF compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of 440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There is some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal.
AUTHORS`CONCLUSIONS: This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis.
20.2.10
Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement
Screening for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement
US Preventive Services Task Force.
Pediatrics published online Jan 18, 2010;DOI: 10.1542/peds.2009-2037
DESCRIPTION: Update of the 2005 US Preventive Services Task Force
(USPSTF) statement about screening for overweight in children and
adolescents.
METHODS: The USPSTF examined the evidence for the effectiveness of
interventions that are primary care feasible or referable. It also examined
the evidence for the magnitude of potential harms of treatment in
children and adolescents.
RECOMMENDATION. The USPSTF recommends that clinicians screen
children aged 6 years and older for obesity and offer them or refer
them to intensive counseling and behavioral interventions to promote
improvements in weight status (grade B recommendation).
US Preventive Services Task Force.
Pediatrics published online Jan 18, 2010;DOI: 10.1542/peds.2009-2037
DESCRIPTION: Update of the 2005 US Preventive Services Task Force
(USPSTF) statement about screening for overweight in children and
adolescents.
METHODS: The USPSTF examined the evidence for the effectiveness of
interventions that are primary care feasible or referable. It also examined
the evidence for the magnitude of potential harms of treatment in
children and adolescents.
RECOMMENDATION. The USPSTF recommends that clinicians screen
children aged 6 years and older for obesity and offer them or refer
them to intensive counseling and behavioral interventions to promote
improvements in weight status (grade B recommendation).
26.1.10
Donnelly JE, Greene JL, Gibson CA, et al. Physical Activity Across the Curriculum (PAAC): a randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Prev Med. 2009 Oct;49(4):336-41. E
BACKGROUND: Physical Activity Across the Curriculum (PAAC) was a three-year cluster randomized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children.
METHODS: Twenty-four elementary schools were cluster randomized to the Physical Activity Across the Curriculum intervention or served as control. All children in grades two and three were followed to grades four and five. Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers. Body Mass Index was the primary outcome, daily Physical activity and academic achievement were secondary outcomes.
RESULTS: The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9, respectively (NS). However, change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum. Schools with > or =75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had <75 min of Physical Activity Across the Curriculum (1.8+/-1.8 vs. 2.4+/-2.0, p=0.02). Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores.
CONCLUSIONS: The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children. Additionally, 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index.
METHODS: Twenty-four elementary schools were cluster randomized to the Physical Activity Across the Curriculum intervention or served as control. All children in grades two and three were followed to grades four and five. Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers. Body Mass Index was the primary outcome, daily Physical activity and academic achievement were secondary outcomes.
RESULTS: The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9, respectively (NS). However, change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum. Schools with > or =75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had <75 min of Physical Activity Across the Curriculum (1.8+/-1.8 vs. 2.4+/-2.0, p=0.02). Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores.
CONCLUSIONS: The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children. Additionally, 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index.
17.1.10
The Long-Term Effects of Breastfeeding on Child and Adolescent Mental Health: A Pregnancy Cohort Study Followed for 14 Years
Prolongar la lactancia beneficiaría la salud mental de un hijo hasta la adolescencia. Así lo señala el equipo de Wendy H. Oddy, del Instituto de Investigación en Salud Infantil Telethon, en West Perth, tras realizar una investigación en la que han participado 2.366 hijos de colaboradores en el estudio Raine (Western Australia Pregnancy Cohort Study), que evaluó la salud mental de cada niño a los 2, 5, 8, 10 y 14 años.
Y es que la lactancia ayudaría a los bebés a superar mejor el estrés y hasta reforzaría el apego entre la madre y el hijo, dos beneficios de largo plazo.
De la muestra analizada el 11% nunca había recibido leche materna, el 38% la había tomado por menos de seis meses y la mitad, durante seis meses o más.
Las madres que optaron por la lactancia por menos de seis meses eran más jóvenes, tenían menos educación formal, eran más pobres, estaban más estresadas y fumaban más que aquellas que optaron por el amamantamiento prolongado. Además, esas mujeres eran más propensas a sufrir depresión posparto y sus bebés solían tener problemas de desarrollo.
Las diferencias se observaron en la conducta que se internaliza, que es aquella en la que se interioriza la negatividad, como la depresión, y en la conducta que se exterioriza, como la agresión. La conducta mejoraba por cada mes adicional de lactancia prolongada.
La lactancia por seis meses o más se mantuvo asociada positivamente con la salud mental y el bienestar de los niños y los adolescentes tras controlar la influencia de los factores sociales, económicos y psicológicos, además de las experiencias en los primeros años de vida.
El equipo concluyó que "las intervenciones orientadas a aumentar la duración de la lactancia beneficiarían la salud mental y adolescente en el largo plazo".
Y es que la lactancia ayudaría a los bebés a superar mejor el estrés y hasta reforzaría el apego entre la madre y el hijo, dos beneficios de largo plazo.
De la muestra analizada el 11% nunca había recibido leche materna, el 38% la había tomado por menos de seis meses y la mitad, durante seis meses o más.
Las madres que optaron por la lactancia por menos de seis meses eran más jóvenes, tenían menos educación formal, eran más pobres, estaban más estresadas y fumaban más que aquellas que optaron por el amamantamiento prolongado. Además, esas mujeres eran más propensas a sufrir depresión posparto y sus bebés solían tener problemas de desarrollo.
Las diferencias se observaron en la conducta que se internaliza, que es aquella en la que se interioriza la negatividad, como la depresión, y en la conducta que se exterioriza, como la agresión. La conducta mejoraba por cada mes adicional de lactancia prolongada.
La lactancia por seis meses o más se mantuvo asociada positivamente con la salud mental y el bienestar de los niños y los adolescentes tras controlar la influencia de los factores sociales, económicos y psicológicos, además de las experiencias en los primeros años de vida.
El equipo concluyó que "las intervenciones orientadas a aumentar la duración de la lactancia beneficiarían la salud mental y adolescente en el largo plazo".
5.1.10
Geraldine Dawson, PhDa,b,c, Sally Rogers, PhDd, Jeffrey Munson, PhDe,f, Milani Smith, PhDe, Jamie Winter, PhDe, Jessica Greenson, PhDe, Amy Donaldson, PhDg and Jennifer Varley, MSeRandomized, Controlled Trial of an Intervention for Toddlers With Auti
OBJECTIVE: To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD).
METHODS: Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community.
RESULTS: Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group.
CONCLUSIONS: This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.
1.12.09
A. G., Falcao, L. F. M., de Souza Silva, E. H. L., de Cassia Xavier Balda, R., Guinsburg, R. Skin-to-Skin Contact and/or Oral 25% Dextrose for Procedural Pain Relief for Term Newborn Infants vía PEDIATRICS current issue de Chermont, el 30/11/09
OBJECTIVE: The goal was to compare the efficacy of oral 25% dextrose treatment and/or skin-to-skin contact for analgesia in term newborns during intramuscular injection of a hepatitis B vaccine.
METHODS: A prospective, randomized, partially blinded, clinical trial was performed with 640 healthy term newborns. Infants at 12 to 72 hours of life were assigned randomly to receive an intramuscular injection of hepatitis B vaccine in the right thigh according to 4 analgesia groups, that is, no analgesia (routine); oral 25% dextrose treatment, given 2 minutes before the injection; skin-to-skin contact, initiated 2 minutes before the injection and persisting throughout the procedure; and a combination of the oral dextrose treatment and skin-to-skin contact strategies. For all groups, Neonatal Facial Coding System and Neonatal Infant Pain Scale scores were evaluated before the procedure, during thigh cleansing, during the injection, and 2 minutes after the injection. Premature Infant Pain Profile scores also were assessed for all infants. Pain scores were compared among the 4 groups.
RESULTS: The use of oral 25% dextrose treatment reduced the duration of procedural pain in the studied population. Skin-to-skin contact decreased injection pain and duration. The combination of the 2 analgesic measures was more effective than either measure separately for term newborns.
CONCLUSIONS: Nonpharmacologic analgesic measures were effective for the treatment of procedural pain in term infants. The combination of oral 25% dextrose treatment and skin-to-skin contact acted synergistically to decrease acute pain in healthy neonates.
27.11.09
Wake M, Baur LA, Gerner B, et al. Outcomes and costs of primary care surveillance and intervention for overweight or obese children: the LEAP 2 randomised controlled trial. BMJ. 2009 Sep 3;339:b3308. doi: 10.1136/bmj.b3308. (Original) PMID: 19729418
OBJECTIVE: To determine whether ascertainment of childhood obesity by surveillance followed by structured secondary prevention in primary care improved outcomes in overweight or mildly obese children. DESIGN: Randomised controlled trial nested within a baseline cross sectional survey of body mass index (BMI). Randomisation and outcomes measurement, but not participants, were blinded to group assignment. SETTING: 45 family practices (66 general practitioners) in Melbourne, Australia. PARTICIPANTS: 3958 children visiting their general practitioner in May 2005-July 2006 were surveyed for BMI. Of these, 258 children aged 5 years 0 months up to their 10th birthday who were overweight or obese by International Obesity Taskforce criteria were randomised to intervention (n=139) or control (n=119) groups. Children who were very obese (UK BMI z score >or=3.0) were excluded. INTERVENTION: Four standard consultations over 12 weeks targeting change in nutrition, physical activity, and sedentary behaviour, supported by purpose designed family materials. Main outcomes measures Primary measure was BMI at 6 and 12 months after randomisation. Secondary measures were mean activity count/min by 7-day accelerometry, nutrition score from 4-day abbreviated food frequency diary, and child health related quality of life. Differences were adjusted for socioeconomic status, age, sex, and baseline BMI.
RESULTS: Of 781 eligible children, 258 (33%) entered the trial; attrition was 3.1% at 6 months and 6.2% at 12 months. Adjusted mean differences (intervention - control) at 6 and 12 months were, for BMI, -0.12 (95% CI -0.40 to 0.15, P=0.4) and -0.11 (-0.45 to 0.22, P=0.5); for physical activity in counts/min, 24 (-4 to 52, P=0.09) and 11 (-26 to 49, P=0.6); and, for nutrition score, 0.2 (-0.03 to 0.4, P=0.1) and 0.1 (-0.1 to 0.4, P=0.2). There was no evidence of harm to the child. Costs to the healthcare system were significantly higher in the intervention arm.
CONCLUSIONS: Primary care screening followed by brief counselling did not improve BMI, physical activity, or nutrition in overweight or mildly obese 5-10 year olds, and it would be very costly if universally implemented. These findings are at odds with national policies in countries including the US, UK, and Australia. TRIAL REGISTRATION: ISRCTN 52511065 (www.isrctn.org).
28.10.09
Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of Pain Control Methods.
Weissman, A., Aranovitch, M., Blazer, S., Zimmer, E. Z.
PEDIATRICS. Vol. 124 No. 5 November 2009, pp. e921-e926 doi:10.1542/peds.2009-0598
OBJECTIVE: Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants. The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing.
METHODS: A prospective study was conducted of 180 term newborn infants who were undergoing heel-lancing for routine neonatal screening of phenylketonuria and hypothyroidism. Newborns were assigned to 6 groups: (1) control (no pain relief intervention); (2) nonnutritive sucking; (3) holding by mother; (4) oral glucose solution; (5) oral formula feeding; or (6) breastfeeding. Outcome measures included the Neonatal Facial Coding System score; cry duration; and autonomic variables obtained from spectral analysis of heart rate variability before, during, and after heel-lancing.
RESULTS: Infants with no pain control showed the highest pain manifestation compared with newborns to whom pain control was provided. Infants who breastfed or received an oral formula showed the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36; P < .01), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest decrease in parasympathetic tone (–2 and –2.4, respectively, vs 1.2; P < .02) compared with the other groups.
CONCLUSIONS: Any method of pain control is better than none. Feeding and breastfeeding during heel-lancing were found to be the most effective methods of pain relief.
10.10.09
A school-based program to prevent adolescent dating violence: a cluster randomized trial
A school-based program to prevent adolescent dating violence: a cluster randomized trial.Wolfe DA, Crooks C, Jaffe P, et al. Arch Pediatr Adolesc Med. 2009 Aug;163(8):692-9.
OBJECTIVE: To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV). DESIGN: Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex. SETTING: Grade 9 health classes. PARTICIPANTS: A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials. MAIN OUTCOME MEASURES: The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.
RESULTS: The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.
CONCLUSION: The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.
OBJECTIVE: To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV). DESIGN: Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex. SETTING: Grade 9 health classes. PARTICIPANTS: A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials. MAIN OUTCOME MEASURES: The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.
RESULTS: The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.
CONCLUSION: The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.
4.10.09
Efficacy of Interventions to Improve Motor Development in Young Children: A Systematic Review. Riethmuller AM, Jones RA, Okely AD.Pediatrics. 2009 Sep 7. (Review) PMID: 19736263.
Objective: The objective of this study was to systematically review evidence from controlled trials on the efficacy of motor development interventions in young children.
Methods: A literature search of interventions was conducted of 14 electronic databases. Three reviewers independently evaluated studies to determine whether they met the inclusion criteria. Studies were compared on 5 components: design, methodologic quality, intervention components, efficacy, and alignment with the Consolidated Standard of Reporting Trials (CONSORT) and Transparent Reporting of Evaluation with Nonrandomized Designs (TREND) statements.
Results: Seventeen studies met the inclusion criteria. More than half (65%) were controlled trials and delivered at child care settings or schools (65%). Three studies had high methodologic quality. Studies were approximately 12 weeks in duration and delivered by teachers, researchers, and students. Parents were involved in only 3 studies. Nearly 60% of the studies reported statistically significant improvements at follow-up. Three studies aligned with the CONSORT and TREND statements.
Conclusions: This review highlights the limited quantity and quality of interventions to improve motor development in young children. The following recommendations are made: (1) both teachers and researchers should be involved in the implementation of an intervention; (2) parental involvement is critical to ensuring transfer of knowledge from the intervention setting to the home environment; and (3) interventions should be methodologically sound and follow guidelines detailed in the CONSORT or TREND statement.
Methods: A literature search of interventions was conducted of 14 electronic databases. Three reviewers independently evaluated studies to determine whether they met the inclusion criteria. Studies were compared on 5 components: design, methodologic quality, intervention components, efficacy, and alignment with the Consolidated Standard of Reporting Trials (CONSORT) and Transparent Reporting of Evaluation with Nonrandomized Designs (TREND) statements.
Results: Seventeen studies met the inclusion criteria. More than half (65%) were controlled trials and delivered at child care settings or schools (65%). Three studies had high methodologic quality. Studies were approximately 12 weeks in duration and delivered by teachers, researchers, and students. Parents were involved in only 3 studies. Nearly 60% of the studies reported statistically significant improvements at follow-up. Three studies aligned with the CONSORT and TREND statements.
Conclusions: This review highlights the limited quantity and quality of interventions to improve motor development in young children. The following recommendations are made: (1) both teachers and researchers should be involved in the implementation of an intervention; (2) parental involvement is critical to ensuring transfer of knowledge from the intervention setting to the home environment; and (3) interventions should be methodologically sound and follow guidelines detailed in the CONSORT or TREND statement.
2.9.09
Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: HHANES 2001-2004.
vía PEDIATRICS current issue de Kumar, J., Muntner, P., Kaskel, F. J., Hailpern, S. M., Melamed, M. L. el 31/08/09
OBJECTIVES: To determine the prevalence of 25-hydroxyvitamin D (25[OH]D) deficiency and associations between 25(OH)D deficiency and cardiovascular risk factors in children and adolescents.
METHODS: With a nationally representative sample of children aged 1 to 21 years in the National Health and Nutrition Examination Survey 2001–2004 (n = 6275), we measured serum 25(OH)D deficiency and insufficiency (25[OH]D <15 ng/mL and 15–29 ng/mL, respectively) and cardiovascular risk factors.
RESULTS: Overall, 9% of the pediatric population, representing 7.6 million US children and adolescents, were 25(OH)D deficient and 61%, representing 50.8 million US children and adolescents, were 25(OH)D insufficient. Only 4% had taken 400 IU of vitamin D per day for the past 30 days. After multivariable adjustment, those who were older (odds ratio [OR]: 1.16 [95% confidence interval (CI): 1.12 to 1.20] per year of age), girls (OR: 1.9 [1.6 to 2.4]), non-Hispanic black (OR: 21.9 [13.4 to 35.7]) or Mexican-American (OR: 3.5 [1.9 to 6.4]) compared with non-Hispanic white, obese (OR: 1.9 [1.5 to 2.5]), and those who drank milk less than once a week (OR: 2.9 [2.1 to 3.9]) or used >4 hours of television, video, or computers per day (OR: 1.6 [1.1 to 2.3]) were more likely to be 25(OH)D deficient. Those who used vitamin D supplementation were less likely (OR: 0.4 [0.2 to 0.8]) to be 25(OH)D deficient. Also, after multivariable adjustment, 25(OH)D deficiency was associated with elevated parathyroid hormone levels (OR: 3.6; [1.8 to 7.1]), higher systolic blood pressure (OR: 2.24 mmHg [0.98 to 3.50 mmHg]), and lower serum calcium (OR: –0.10 mg/dL [–0.15 to –0.04 mg/dL]) and high-density lipoprotein cholesterol (OR: –3.03 mg/dL [–5.02 to –1.04]) levels compared with those with 25(OH)D levels ≥30 ng/mL.
CONCLUSIONS: 25(OH)D deficiency is common in the general US pediatric population and is associated with adverse cardiovascular risks.
Vitamin D Status and Cardiometabolic Risk Factors in the United States Adolescents Poulation. ...
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vía PEDIATRICS current issue de Reis, J. P., von Muhlen, D., Miller, E. R., Michos, E. D., Appel, L. J. el 31/08/09
OBJECTIVE: Evidence on the association of vitamin D with cardiovascular risk factors in youth is very limited. We examined whether low serum vitamin D levels (25-hydroxyvitamin D [25(OH)D]) are associated with cardiovascular risk factors in US adolescents aged 12 to 19 years.
METHODS: We conducted a cross-sectional analysis of 3577 fasting, nonpregnant adolescents without diagnosed diabetes who participated in the 2001–2004 National Health and Nutrition Examination Survey. Cardiovascular risk factors were measured using standard methods and defined according to age-modified Adult Treatment Panel III definitions.
RESULTS: Mean 25(OH)D was 24.8 ng/mL; it was lowest in black (15.5 ng/mL), intermediate in Mexican American (21.5 ng/mL), and highest in white (28.0 ng/mL) adolescents (P < .001 for each pairwise comparison). Low 25(OH)D levels were strongly associated with overweight status and abdominal obesity (P for trend < .001 for both). After adjustment for age, gender, race/ethnicity, BMI, socioeconomic status, and physical activity, 25(OH)D levels were inversely associated with systolic blood pressure (P = .02) and plasma glucose concentrations (P = .01). The adjusted odds ratio (95% confidence interval) for those in the lowest (<15 ng/mL) compared with the highest quartile (>26 ng/mL) of 25(OH)D for hypertension was 2.36 (1.33–4.19); for fasting hyperglycemia it was 2.54 (1.01–6.40); for low high-density lipoprotein cholesterol it was 1.54 (0.99–2.39); for hypertriglyceridemia it was 1.00 (0.49–2.04); and for metabolic syndrome it was 3.88 (1.57–9.58).
CONCLUSIONS: Low serum vitamin D in US adolescents is strongly associated with hypertension, hyperglycemia, and metabolic syndrome, independent of adiposity.
10.8.09
Guideline on fluoride therapy.
Guideline on fluoride therapy.
American Academy of Pediatric Dentistry Liaison with Other Groups Committee, American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on fluoride therapy. Pediatr Dent 2008-2009;30(7 Suppl):121-4.
MAJOR RECOMMENDATIONS
If an individual's caries risk level is uncertain, treating this person as high risk is prudent until further experience allows a more accurate assessment.
Systemically Administered Fluoride Supplements
Fluoride supplements should be considered for all children drinking fluoride-deficient (<0.6 parts per million [ppm]) water. After determining the fluoride level of the water supply or supplies (either through contacting public health officials or water analysis), evaluating other dietary sources of fluoride, and assessing the child's caries risk, the daily fluoride supplement dosage can be determined using the Dietary Fluoride Supplementation Schedule (see the table below). To optimize the topical benefits of systemic fluoride supplements, the child should be encouraged to chew or suck fluoride tablets.
Professionally-Applied Topical Fluoride Treatment
Professional topical fluoride treatments should be based on caries-risk assessment. A pumice prophylaxis is not an essential prerequisite to this treatment. Appropriate precautionary measures should be taken to prevent swallowing of any professionally-applied topical fluoride. Children at moderate caries risk should receive a professional fluoride treatment at least every 6 months; those with high caries risk should receive greater frequency of professional fluoride applications (i.e., every 3-6 months). Ideally, this would occur as part of a comprehensive preventive program in a dental home. When a dental home cannot be established for individuals with increased caries risk as determined by caries risk assessment, periodic applications of fluoride varnish by trained non-dental healthcare professionals may be effective in reducing the incidence of early childhood caries.
Fluoride-Containing Products for Home Use
Therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Fluoridated toothpaste should be used twice daily as a primary preventive procedure. Twice daily use has benefits greater than once daily brushing. Parents should be counseled on their child's caries risk, dispensing an appropriate volume of toothpaste onto a soft, age-appropriate sized toothbrush, frequency of brushing, and performing/assisting brushing of young children. A 'smear' of fluoridated toothpaste for children less than 2 years of age may decrease risk of fluorosis. A 'pea-size' amount of toothpaste is appropriate for children aged 2 through 5 years. To maximize the beneficial effect of fluoride in the toothpaste, rinsing after brushing should be kept to a minimum or eliminated altogether.
Additional at-home topical fluoride regimens utilizing increased concentrations of fluoride should be considered for children at high risk for caries. These may include over-the counter or prescription strength formulations. Fluoride mouth rinses or brush-on gels may be incorporated into a caries-prevention program for a school-aged child at high risk.
American Academy of Pediatric Dentistry Liaison with Other Groups Committee, American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on fluoride therapy. Pediatr Dent 2008-2009;30(7 Suppl):121-4.
MAJOR RECOMMENDATIONS
If an individual's caries risk level is uncertain, treating this person as high risk is prudent until further experience allows a more accurate assessment.
Systemically Administered Fluoride Supplements
Fluoride supplements should be considered for all children drinking fluoride-deficient (<0.6 parts per million [ppm]) water. After determining the fluoride level of the water supply or supplies (either through contacting public health officials or water analysis), evaluating other dietary sources of fluoride, and assessing the child's caries risk, the daily fluoride supplement dosage can be determined using the Dietary Fluoride Supplementation Schedule (see the table below). To optimize the topical benefits of systemic fluoride supplements, the child should be encouraged to chew or suck fluoride tablets.
| Age | <0.3> | 0.3-0.6 ppm F | >0.6 ppm F |
| Birth-6 months | 0 | 0 | 0 |
| 6 months-3 years | 0.25 mg | 0 | 0 |
| 3-6 years | 0.50 mg | 0.25 mg | 0 |
| 6 years up to at least 16 years | 1.00 mg | 0.50 mg | 0 |
Professionally-Applied Topical Fluoride Treatment
Professional topical fluoride treatments should be based on caries-risk assessment. A pumice prophylaxis is not an essential prerequisite to this treatment. Appropriate precautionary measures should be taken to prevent swallowing of any professionally-applied topical fluoride. Children at moderate caries risk should receive a professional fluoride treatment at least every 6 months; those with high caries risk should receive greater frequency of professional fluoride applications (i.e., every 3-6 months). Ideally, this would occur as part of a comprehensive preventive program in a dental home. When a dental home cannot be established for individuals with increased caries risk as determined by caries risk assessment, periodic applications of fluoride varnish by trained non-dental healthcare professionals may be effective in reducing the incidence of early childhood caries.
Fluoride-Containing Products for Home Use
Therapeutic use of fluoride for children should focus on regimens that maximize topical contact, preferably in lower-dose, higher-frequency approaches. Fluoridated toothpaste should be used twice daily as a primary preventive procedure. Twice daily use has benefits greater than once daily brushing. Parents should be counseled on their child's caries risk, dispensing an appropriate volume of toothpaste onto a soft, age-appropriate sized toothbrush, frequency of brushing, and performing/assisting brushing of young children. A 'smear' of fluoridated toothpaste for children less than 2 years of age may decrease risk of fluorosis. A 'pea-size' amount of toothpaste is appropriate for children aged 2 through 5 years. To maximize the beneficial effect of fluoride in the toothpaste, rinsing after brushing should be kept to a minimum or eliminated altogether.
Additional at-home topical fluoride regimens utilizing increased concentrations of fluoride should be considered for children at high risk for caries. These may include over-the counter or prescription strength formulations. Fluoride mouth rinses or brush-on gels may be incorporated into a caries-prevention program for a school-aged child at high risk.
12.7.09
Birth weight, early weight gain, and subsequent risk of type 1 diabetes: systematic review and meta-analysis.
Harder T, Roepke K, Diller N, et al. Am J Epidemiol. 2009 Jun 15;169(12):1428-36. Epub 2009 Apr 10.(Review) PMID: 19363100.
Revisión sistemática y meta-análisis sobre la asociación entre el peso al nacimiento y el aumento de peso durante el primer año de vida y la posterior aparación de diabetes tipo 1.
El peso al nacimiento > 4,000 g se asoció con mayor riesgo de diabetes tipo 1 y en todos los estudios los pacientes con diabetes tipo 1 mostraron una mayor ganancia de peso durante el primer año de vida, en comparación con los controles.
Revisión sistemática y meta-análisis sobre la asociación entre el peso al nacimiento y el aumento de peso durante el primer año de vida y la posterior aparación de diabetes tipo 1.
El peso al nacimiento > 4,000 g se asoció con mayor riesgo de diabetes tipo 1 y en todos los estudios los pacientes con diabetes tipo 1 mostraron una mayor ganancia de peso durante el primer año de vida, en comparación con los controles.
2.6.09
AMERICAN ACADEMY OF PEDIATRICS:Medical Conditions Affecting Sports Participation
Committee on Sports Medicine and Fitness.PEDIATRICS Vol. 107 No. 5 May 2001, pp. 1205-1209 ( ACCESO A TEXTO COMPLETO)
Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete and parents on the risks of injury as they relate to the child's condition. This statement updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.
Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete and parents on the risks of injury as they relate to the child's condition. This statement updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.
20.4.09
Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children
National Collaborating Centre for Primary Care. Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. London (UK): National Institute for Health and Clinical Excellence; 2006 Dec. 2590 p.
La NICE con su excelencia caracteristica nos relata las alternativas de prevención en niños:
Children
The care of children and young people should be coordinated around their individual and family needs and should comply with national core standards as defined in the Children's national service frameworks (NSFs) for England and Wales.
The overall aim should be to create a supportive environment that helps overweight or obese children and their families make lifestyle changes.
Decisions on the approach to management of a child's overweight or obesity (including assessment and agreement of goals and actions) should be made in partnership with the child and family, and be tailored to the needs and preferences of the child and the family.
Interventions for childhood overweight and obesity should address lifestyle within the family and in social settings.
Parents (or carers) should be encouraged to take the main responsibility for lifestyle changes for overweight or obese children, especially if they are younger than 12 years. However, the age and maturity of the child and the preferences of the child and the parents should be taken into account.
La NICE con su excelencia caracteristica nos relata las alternativas de prevención en niños:
Children
The care of children and young people should be coordinated around their individual and family needs and should comply with national core standards as defined in the Children's national service frameworks (NSFs) for England and Wales.
The overall aim should be to create a supportive environment that helps overweight or obese children and their families make lifestyle changes.
Decisions on the approach to management of a child's overweight or obesity (including assessment and agreement of goals and actions) should be made in partnership with the child and family, and be tailored to the needs and preferences of the child and the family.
Interventions for childhood overweight and obesity should address lifestyle within the family and in social settings.
Parents (or carers) should be encouraged to take the main responsibility for lifestyle changes for overweight or obese children, especially if they are younger than 12 years. However, the age and maturity of the child and the preferences of the child and the parents should be taken into account.
The impact of quadrivalent human papillomavirus (HPV; types 6, 11, 16, and 18) L1 virus-like particle vaccine on infection and disease due to oncogeni
The impact of quadrivalent human papillomavirus (HPV; types 6, 11, 16, and 18) L1 virus-like particle vaccine on infection and disease due to oncogenic nonvaccine HPV types in sexually active women aged 16-26 years.
J Infect Dis. 2009 Apr 1;199(7):919-22.
Wheeler CM, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Perez G, Brown DR, Koutsky LA, Tay EH, García P, Ault KA, Garland SM, Leodolter S, Olsson SE, Tang GW, Ferris DG, Paavonen J, Steben M, Bosch FX, Dillner J, Joura EA, Kurman RJ, Majewski S, Muñoz N, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan J, Lupinacci LC, Giacoletti KE, James M, Vuocolo S, Hesley TM, Barr E.
University of New Mexico, Department of Molecular Genetics and Microbiology, Albuquerque, NM 87131, USA. cwheeler@salud.unm.edu
BACKGROUND: We evaluated the impact of a quadrivalent human papillomavirus (HPV) vaccine on infection and cervical disease related to 10 nonvaccine HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) associated with >20% of cervical cancers. The population evaluated included HPV-naive women and women with preexisting HPV infection and/or HPV-related disease at enrollment. METHODS: Phase 3 efficacy studies enrolled 17,622 women aged 16-26 years. Subjects underwent cervicovaginal sampling and Pap testing on day 1 and then at 6-12-month intervals for up to 4 years. HPV typing was performed on samples from enrollment and follow-up visits, including samples obtained for diagnosis or treatment of HPV-related disease. All subjects who received 1 dose and returned for follow-up were included. RESULTS: Vaccination reduced the rate of HPV-31/33/45/52/58 infection by 17.7% (95% confidence interval [CI], 5.1% to 28.7%) and of cervical intraepithelial neoplasia (CIN) 1-3 or adenocarcinoma in situ (AIS) by 18.8% (95% CI, 7.4% to 28.9%). Vaccination also reduced the rate of HPV-31/58/59-related CIN1-3/AIS by 26.0% (95% CI, 6.7% to 41.4%), 28.1% (95% CI, 5.3% to 45.6%), and 37.6% (95% CI, 6.0% to 59.1%), respectively. Although a modest reduction in HPV-31/33/45/52/58-related CIN2 or worse was observed, the estimated reduction was not statistically significant. CONCLUSIONS: These cross-protection results complement the vaccine's prophylactic efficacy against disease associated with HPV-6, -11, -16, and -18. Long-term monitoring of vaccinated populations are needed to fully ascertain the population-based impact and public health significance of these findings.
J Infect Dis. 2009 Apr 1;199(7):919-22.
Wheeler CM, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Perez G, Brown DR, Koutsky LA, Tay EH, García P, Ault KA, Garland SM, Leodolter S, Olsson SE, Tang GW, Ferris DG, Paavonen J, Steben M, Bosch FX, Dillner J, Joura EA, Kurman RJ, Majewski S, Muñoz N, Myers ER, Villa LL, Taddeo FJ, Roberts C, Tadesse A, Bryan J, Lupinacci LC, Giacoletti KE, James M, Vuocolo S, Hesley TM, Barr E.
University of New Mexico, Department of Molecular Genetics and Microbiology, Albuquerque, NM 87131, USA. cwheeler@salud.unm.edu
BACKGROUND: We evaluated the impact of a quadrivalent human papillomavirus (HPV) vaccine on infection and cervical disease related to 10 nonvaccine HPV types (31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) associated with >20% of cervical cancers. The population evaluated included HPV-naive women and women with preexisting HPV infection and/or HPV-related disease at enrollment. METHODS: Phase 3 efficacy studies enrolled 17,622 women aged 16-26 years. Subjects underwent cervicovaginal sampling and Pap testing on day 1 and then at 6-12-month intervals for up to 4 years. HPV typing was performed on samples from enrollment and follow-up visits, including samples obtained for diagnosis or treatment of HPV-related disease. All subjects who received 1 dose and returned for follow-up were included. RESULTS: Vaccination reduced the rate of HPV-31/33/45/52/58 infection by 17.7% (95% confidence interval [CI], 5.1% to 28.7%) and of cervical intraepithelial neoplasia (CIN) 1-3 or adenocarcinoma in situ (AIS) by 18.8% (95% CI, 7.4% to 28.9%). Vaccination also reduced the rate of HPV-31/58/59-related CIN1-3/AIS by 26.0% (95% CI, 6.7% to 41.4%), 28.1% (95% CI, 5.3% to 45.6%), and 37.6% (95% CI, 6.0% to 59.1%), respectively. Although a modest reduction in HPV-31/33/45/52/58-related CIN2 or worse was observed, the estimated reduction was not statistically significant. CONCLUSIONS: These cross-protection results complement the vaccine's prophylactic efficacy against disease associated with HPV-6, -11, -16, and -18. Long-term monitoring of vaccinated populations are needed to fully ascertain the population-based impact and public health significance of these findings.
16.4.09
Effect of school-based physical activity interventions on body mass index in children: a meta-analysis.
Harris KC, Kuramoto LK, Schulzer M, et al. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ. 2009 Mar 31;180(7):719-26
BACKGROUND: The prevalence of childhood obesity is increasing at an alarming rate. Many local governments have enacted policies to increase physical activity in schools as a way to combat childhood obesity. We conducted a systematic review and meta-analysis to determine the effect of school-based physical activity interventions on body mass index (BMI) in children.
METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials up to September 2008. We also hand-searched relevant journals and article reference lists. We included randomized controlled trials and controlled clinical trials that had objective data for BMI from before and after the intervention, that involved school-based physical activity interventions and that lasted for a minimum of 6 months.
RESULTS: Of 398 potentially relevant articles that we identified, 18 studies involving 18 141 children met the inclusion criteria. The participants were primarily elementary school children. The study duration ranged from 6 months to 3 years. In 15 of these 18 studies, there was some type of co-intervention. Meta-analysis showed that BMI did not improve with physical activity interventions (weighted mean difference -0.05 kg/m(2), 95% confidence interval -0.19 to 0.10). We found no consistent changes in other measures of body composition.
INTERPRETATION: School-based physical activity interventions did not improve BMI, although they had other beneficial health effects. Current population-based policies that mandate increased physical activity in schools are unlikely to have a significant effect on the increasing prevalence of childhood obesity.
BACKGROUND: The prevalence of childhood obesity is increasing at an alarming rate. Many local governments have enacted policies to increase physical activity in schools as a way to combat childhood obesity. We conducted a systematic review and meta-analysis to determine the effect of school-based physical activity interventions on body mass index (BMI) in children.
METHODS: We searched MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials up to September 2008. We also hand-searched relevant journals and article reference lists. We included randomized controlled trials and controlled clinical trials that had objective data for BMI from before and after the intervention, that involved school-based physical activity interventions and that lasted for a minimum of 6 months.
RESULTS: Of 398 potentially relevant articles that we identified, 18 studies involving 18 141 children met the inclusion criteria. The participants were primarily elementary school children. The study duration ranged from 6 months to 3 years. In 15 of these 18 studies, there was some type of co-intervention. Meta-analysis showed that BMI did not improve with physical activity interventions (weighted mean difference -0.05 kg/m(2), 95% confidence interval -0.19 to 0.10). We found no consistent changes in other measures of body composition.
INTERPRETATION: School-based physical activity interventions did not improve BMI, although they had other beneficial health effects. Current population-based policies that mandate increased physical activity in schools are unlikely to have a significant effect on the increasing prevalence of childhood obesity.
9.4.09
Natural History of Genital Warts: Analysis of the Placebo Arm of 2 Randomized Phase III Trials of a Quadrivalent Human Papillomavirus (Types 6, 11, 16
Garland SM, Steben M, Sings HL, et al. Natural History of Genital Warts: Analysis of the Placebo Arm of 2 Randomized Phase III Trials of a Quadrivalent Human Papillomavirus (Types 6, 11, 16, and 18) Vaccine. J Infect Dis. 2009 Jan 2
Background. The placebo arm of human papillomavirus (HPV) vaccine trials helps define the natural history of genital warts (GW). Methods. Women enrolled in the placebo arm ([Formula: see text]) of 2 randomized trials of a quadrivalent vaccine were examined for the presence of GW for up to 9 visits over approximately 4 years. A comprehensive examination of the perianal area, vulva, and vagina prompted biopsy. Biopsy samples were analyzed by a blinded panel of up to 4 histopathologists and tested for 14 HPV genotypes (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) by use of a polymerase chain reaction-based assay. Risk factors for the development of GW were assessed. Results. Women were followed up for an average of 3.6 years (range, 0-4.9 years). Overall, 298 (3.4%) of 8800 participants developed GW related to HPV-6 or HPV-11 (incidence rate, 0.87 cases per 100 person-years-at-risk). In total, 520 distinct lesions were diagnosed as GW. HPV DNA was detected in 472 (90.8%) lesions, with HPV-6 and HPV-11 detected in 447 (86.0%) of these lesions (94.7% of 472 HPV DNA-positive lesions). We found high-risk HPV types in 161 (31.0%) of 520 lesions. Risk factors for HPV-6- and HPV-11-related GW included infection at baseline, acquisition of new sex partners, a higher number of sex partners, and DNA positivity at baseline for a high-risk HPV type. Conclusions. We confirm the major role played by HPV-6 and HPV-11 in GW, as well as associated risk factors. A vaccine that includes these types of HPV could substantially reduce the overall burden of HPV disease.
Background. The placebo arm of human papillomavirus (HPV) vaccine trials helps define the natural history of genital warts (GW). Methods. Women enrolled in the placebo arm ([Formula: see text]) of 2 randomized trials of a quadrivalent vaccine were examined for the presence of GW for up to 9 visits over approximately 4 years. A comprehensive examination of the perianal area, vulva, and vagina prompted biopsy. Biopsy samples were analyzed by a blinded panel of up to 4 histopathologists and tested for 14 HPV genotypes (6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59) by use of a polymerase chain reaction-based assay. Risk factors for the development of GW were assessed. Results. Women were followed up for an average of 3.6 years (range, 0-4.9 years). Overall, 298 (3.4%) of 8800 participants developed GW related to HPV-6 or HPV-11 (incidence rate, 0.87 cases per 100 person-years-at-risk). In total, 520 distinct lesions were diagnosed as GW. HPV DNA was detected in 472 (90.8%) lesions, with HPV-6 and HPV-11 detected in 447 (86.0%) of these lesions (94.7% of 472 HPV DNA-positive lesions). We found high-risk HPV types in 161 (31.0%) of 520 lesions. Risk factors for HPV-6- and HPV-11-related GW included infection at baseline, acquisition of new sex partners, a higher number of sex partners, and DNA positivity at baseline for a high-risk HPV type. Conclusions. We confirm the major role played by HPV-6 and HPV-11 in GW, as well as associated risk factors. A vaccine that includes these types of HPV could substantially reduce the overall burden of HPV disease.
8.3.09
Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study
Does Breastfeeding Protect Against Substantiated Child Abuse and Neglect? A 15-Year Cohort Study
Lane Strathearn, MBBS, , Abdullah A. Mamun,, Jake M. Najman, and Michael J. O'Callaghan, MBBS,
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 483-49
OBJECTIVES. We explored whether breastfeeding was protective against maternally perpetrated child maltreatment.
METHODS. A total of 7223 Australian mother-infant pairs were monitored prospectively over 15 years. In 6621 (91.7%) cases, the duration of breastfeeding was analyzed with respect to child maltreatment (including neglect, physical abuse, and emotional abuse), on the basis of substantiated child protection agency reports. Multinomial logistic regression was used to compare no maltreatment with nonmaternal and maternally perpetrated maltreatment and to adjust for confounding in 5890 cases with complete data (81.5%). Potential confounders included sociodemographic factors, pregnancy wantedness, substance abuse during pregnancy, postpartum employment, attitudes regarding infant caregiving, and symptoms of anxiety or depression.
RESULTS. Of 512 children with substantiated maltreatment reports, >60% experienced 
1 episode of maternally perpetrated abuse or neglect (4.3% of the cohort). The odds ratio for maternal maltreatment increased as breastfeeding duration decreased, with the odds of maternal maltreatment for nonbreastfed children being 4.8 times the odds for children breastfed for 4 months. After adjustment for confounding, the odds for nonbreastfed infants remained 2.6 times higher, with no association seen between breastfeeding and nonmaternal maltreatment. Maternal neglect was the only maltreatment subtype associated independently with breastfeeding duration.
CONCLUSION. Among other factors, breastfeeding may help to protect against maternally perpetrated child maltreatment, particularly child neglect
7.3.09
Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
M.M. Vennemann, MD, MPH, PDa , T. Bajanowski, MD, PDb , B. Brinkmann, MD, PDa , G. Jorch, MD, PDc , K. Yücesan, MDa , C. Sauerland, MScd , E.A. Mitchell, FRACP, DSce and the GeSID Study Group
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410
BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of
sudden infant death syndrome were very successful. In some countries the advice to
breastfeed is included in the campaigns’ messages, but in other countries it is not.
OBJECTIVE. To examine the association between type of infant feeding and sudden
infant death syndrome.
METHODS. The German Study of Sudden Infant Death is a case-control study of 333
infants who died of sudden infant death syndrome and 998 age-matched controls.
RESULTS.A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of
age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding
at the age of 1 month also reduced the risk of sudden infant death syndrome, but
after adjustment this risk was not significant. Being exclusively breastfed in the last
month of life/before the interview reduced the risk, as did being partially breastfed.
Breastfeeding survival curves showed that both partial breastfeeding and exclusive
breastfeeding were associated with a reduced risk of sudden infant death syndrome.
CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant
death syndrome by 50% at all ages throughout infancy. We recommend including
the advice to breastfeed through 6 months of age in sudden infant death syndrome
risk-reduction messages
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410
BACKGROUND. In the last 20 years, the prevention campaigns to reduce the risk of
sudden infant death syndrome were very successful. In some countries the advice to
breastfeed is included in the campaigns’ messages, but in other countries it is not.
OBJECTIVE. To examine the association between type of infant feeding and sudden
infant death syndrome.
METHODS. The German Study of Sudden Infant Death is a case-control study of 333
infants who died of sudden infant death syndrome and 998 age-matched controls.
RESULTS.A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of
age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding
at the age of 1 month also reduced the risk of sudden infant death syndrome, but
after adjustment this risk was not significant. Being exclusively breastfed in the last
month of life/before the interview reduced the risk, as did being partially breastfed.
Breastfeeding survival curves showed that both partial breastfeeding and exclusive
breastfeeding were associated with a reduced risk of sudden infant death syndrome.
CONCLUSIONS. This study shows that breastfeeding reduced the risk of sudden infant
death syndrome by 50% at all ages throughout infancy. We recommend including
the advice to breastfeed through 6 months of age in sudden infant death syndrome
risk-reduction messages
3.3.09
Pediatric Primary Care to Help Prevent Child Maltreatment: The Safe Environment for Every Kid (SEEK) Model
Howard Dubowitz, MD, MS, Susan Feigelman, MD, Wendy Lane, MD and Jeongeun Kim, PhD.
CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care–based programs have been developed, and most have not been well evaluated.
OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment.
METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0–5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale.
RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis.
CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.
CONTEXT. Effective strategies for preventing child maltreatment are needed. Few primary care–based programs have been developed, and most have not been well evaluated.
OBJECTIVE. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment.
METHODS. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0–5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale.
RESULTS. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis.
CONCLUSIONS. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment. Replication and additional evaluation of the model are recommended.
3.2.09
Validity of Pure-Tone Hearing Screening at Well-Child Visits.
Donna R. Halloran, MD, MSPH; J. Michael Hardin, PhD; Terry C. Wall, MD, MPH
Arch Pediatr Adolesc Med. 2009;163(2):158-163.
Objective: to estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting.
Design: prospective cohort study.
Setting: eight academic and private pediatric practices.
Participants: a subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry.
Intervention: formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children).
Main Exposure: pure-tone audiometry screening.
Main Outcome: measures Audiologic evaluations.
Results: a total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively.
Conclusion: in light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.
Arch Pediatr Adolesc Med. 2009;163(2):158-163.
Objective: to estimate the sensitivity and specificity of pure-tone audiometry hearing screening in the primary care setting.
Design: prospective cohort study.
Setting: eight academic and private pediatric practices.
Participants: a subset of children from a convenience sample of 1061 children between 3 and 19 years of age were screened for hearing loss using pure-tone audiometry.
Intervention: formal audiologic evaluations (gold standard) for those children referred by their primary care physician (28 children) and for a random sample of children not referred (102 children).
Main Exposure: pure-tone audiometry screening.
Main Outcome: measures Audiologic evaluations.
Results: a total of 28 children were referred to an audiologist for formal hearing testing after pure-tone audiometry screening during a well-child visit, at which 25 children did not pass the initial screening and 3 could not complete the screening. Of the 25 children, only 7 were evaluated by an audiologist, for a follow-up rate of 25%. One child was diagnosed as having hearing loss. Formal audiologic assessment was also performed on a random sample of 102 children who were not referred to the audiologist. For the random sample, hearing loss was identified in 2 of 76 (3%) children who passed and 1 of 16 (6%) children who did not pass pure tone audiometry screening. The sensitivity and specificity of pure-tone audiometry were 50% and 78%, respectively.
Conclusion: in light of the increasing burden on physicians to provide preventive care, this study calls into question the value of hearing screening using pure-tone audiometry during well-child visits given the lack of follow-up after referral and the poor sensitivity.
27.1.09
Interventions to prevent child maltreatment and associated impairment.
Lancet. 2009 Jan 17;373(9659):250-66. Epub 2008 Dec 4.
Macmillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM, Taussig HN.
Summary: Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes—the Nurse—Family Partnership (best evidence) and Early Start—have been shown to prevent child maltreatment and associated outcomes such as injuries. One population-level parenting programme has shown benefits, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective in preventing recurrence of neglect. A few interventions for neglected children and mother—child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures.
9.11.08
Risk of contralateral testicular cancer among men with unilaterally undescended testis: A meta analysis
Akre O., Pettersson A., Richiardi L.
Int J Cancer. 2008 Oct 30. [Epub ahead of print]
The association between undescended testis (cryptorchidism) and testicular cancer is established, but it is not known whether the risk of testicular cancer among men with unilateral maldescent is increased in both testes, or only on the undescended side. This is a meta-analysis of 11 case-control studies and 1 cohort study that all assessed the risk of testicular cancer separately for the undescended and descended testis. We used fixed-effects meta-analysis to calculate pooled estimates and 95% confidence intervals (CIs) for the relative risk. Of 199 tumors in men with unilateral cryptorchidism, 158 (79%) were on the ipsilateral side and 41 (21%) on the contralateral side. The pooled relative risks for testicular cancer in the ipsilateral and contralateral testis were 6.33 (95% CI, 4.30 to 9.31) and 1.74 (95% CI, 1.01 to 2.98), respectively. We conclude that in 1-sided undescended testis, the risk of testicular cancer may be increased in both testes, although to a much greater extent on the ipsilateral side.
Int J Cancer. 2008 Oct 30. [Epub ahead of print]
The association between undescended testis (cryptorchidism) and testicular cancer is established, but it is not known whether the risk of testicular cancer among men with unilateral maldescent is increased in both testes, or only on the undescended side. This is a meta-analysis of 11 case-control studies and 1 cohort study that all assessed the risk of testicular cancer separately for the undescended and descended testis. We used fixed-effects meta-analysis to calculate pooled estimates and 95% confidence intervals (CIs) for the relative risk. Of 199 tumors in men with unilateral cryptorchidism, 158 (79%) were on the ipsilateral side and 41 (21%) on the contralateral side. The pooled relative risks for testicular cancer in the ipsilateral and contralateral testis were 6.33 (95% CI, 4.30 to 9.31) and 1.74 (95% CI, 1.01 to 2.98), respectively. We conclude that in 1-sided undescended testis, the risk of testicular cancer may be increased in both testes, although to a much greater extent on the ipsilateral side.
26.10.08
Counseling to Promote Breastfeeding
Esta es una actualización de las recomendaciones del año 2003 para promover la lactancia materna.
La U.S. Preventive Services Task Force recomienda las intervenciones de atención primaria, durante el embarazo y tras el nacimiento, para fomentar y apoyar la lactancia materna. Grado: recomendacion B .
Después de evaluar más de 25 ensayos aleatorios de intervenciones sobre la lactancia materna, el grupo de la Task Force llegó a la conclusión de que las intervenciones coordinadas durante el embarazo, nacimiento e infancia pueden aumentar el inicio, la duración y la exclusividad de la lactancia materna. Las intervenciones que incluyen componentes de atención prenatal y postnatal son las más eficaces en la prolongación del amamantamiento.
La lactancia materna tiene importantes beneficios para la salud de los bebés y sus madres: los bebés que son amamantados tienen menos infecciones y erupciones cutáneas alérgicas y tienen menos probabilidades de tener síndrome de muerte súbita infantil. Una vez finalizada la lactancia, tienen también menos probabilidades de desarrollar asma, diabetes, obesidad y leucemia infantil. Las mujeres que amamantan tienen menos riesgo de diabetes tipo 2, cáncer de mama, y cáncer de ovario que las mujeres que nunca amamantaron. Las recomendaciones han sido publicadas en el número de octubre de "Annals of Internal Medicine" y, junto a algunos materiales para uso clínico, están disponibles en el sitio Web de AHRQ en http://www.ahrq.gov/clinic/prevenix.htm
Después de evaluar más de 25 ensayos aleatorios de intervenciones sobre la lactancia materna, el grupo de la Task Force llegó a la conclusión de que las intervenciones coordinadas durante el embarazo, nacimiento e infancia pueden aumentar el inicio, la duración y la exclusividad de la lactancia materna. Las intervenciones que incluyen componentes de atención prenatal y postnatal son las más eficaces en la prolongación del amamantamiento.
La lactancia materna tiene importantes beneficios para la salud de los bebés y sus madres: los bebés que son amamantados tienen menos infecciones y erupciones cutáneas alérgicas y tienen menos probabilidades de tener síndrome de muerte súbita infantil. Una vez finalizada la lactancia, tienen también menos probabilidades de desarrollar asma, diabetes, obesidad y leucemia infantil. Las mujeres que amamantan tienen menos riesgo de diabetes tipo 2, cáncer de mama, y cáncer de ovario que las mujeres que nunca amamantaron. Las recomendaciones han sido publicadas en el número de octubre de "Annals of Internal Medicine" y, junto a algunos materiales para uso clínico, están disponibles en el sitio Web de AHRQ en http://www.ahrq.gov/clinic/prevenix.htm
14.10.08
Behavioral counseling to prevent sexually transmitted infections: U.S. PreventiveServices Task Force recommendation statement.
U.S. Preventive Services Task Force.
Collaborators: Calonge N, Petitti DB, DeWitt TG, Dietrich AJ, Gordis L, GregoryKD, Harris R, Isham G, Leipzig R, LeFevre ML, Loveland-Cherry C, Marion LN, MoyerVA, Ockene JK, Sawaya GF, Yawn BP.
Collaborators: Calonge N, Petitti DB, DeWitt TG, Dietrich AJ, Gordis L, GregoryKD, Harris R, Isham G, Leipzig R, LeFevre ML, Loveland-Cherry C, Marion LN, MoyerVA, Ockene JK, Sawaya GF, Yawn BP.
Ann Intern Med. 2008 Oct 7;149(7):491-6, W95.
DESCRIPTION: New U.S. Preventive Services Task Force (USPSTF) recommendations about behavioral counseling of adolescents and adults to prevent sexuallytransmitted infections (STIs).
METHODS: The USPSTF reviewed the evidence on the benefits and harms of counseling. The review included studies evaluating behavioral counseling interventions conducted in primary settings, those judged feasible in primary care, and those to which patients might be referred from primary care.
RECOMMENDATIONS: The USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation) Current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs. (I statement).
METHODS: The USPSTF reviewed the evidence on the benefits and harms of counseling. The review included studies evaluating behavioral counseling interventions conducted in primary settings, those judged feasible in primary care, and those to which patients might be referred from primary care.
RECOMMENDATIONS: The USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. (B recommendation) Current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs. (I statement).
13.9.08
Using decision analysis to better evaluate pediatric clinical guidelines.
Health Aff (Millwood). 2008 Sep-Oct;27(5):1467-75.
Cohen JT, Neumann PJ.Tufts
Although systematic and explicit, existing evidentiary criteria for clinicalguidelines tend to use study design as a surrogate for evidence quality.Moreover, they do not independently characterize evidence quality and netbenefits and do not systematically evaluate research needs. Decision analysis,which quantifies the range of potential net benefits based on whatever evidenceis available, can augment traditional frameworks. It is particularly useful forpediatric research, where randomized controlled trials are often unavailable and infeasible. Policymakers should incorporate decision analysis into comparativeeffectiveness research and clinical guidelines.
El artículo aún no es accesible a texto completo on-line (es un precoz PubMed - in process), pero el resumen promete.
11.9.08
Physical activity at the government-recommended level and obesity-related health outcomes: a longitudinal study (Early Bird 37)
Arch. Dis. Child. 2008;93;772-777
B S Metcalf, L D Voss, J Hosking, A N Jeffery, T J Wilkin
ABSTRACT
Background: In the UK and USA, government guidelines for childhood physical activity have been set (>60 min/ day at >3 metabolic equivalents of thermogenesis (METs)), and body mass index (BMI) chosen as the outcome measure.
Aim: To determine the extent to which physical activity at the government-recommended intensity is associated with change in body mass/fat and metabolic health in prepubertal
children.
Methods: Non-intervention longitudinal study of 113 boys and 99 girls (born 95/96) recruited from 54 schools. Physical activity (Actigraph accelerometers),changes in body mass (raw and age/gender-standardised BMI), fatness (skin-fold thickness and waist circumference)
and metabolic status (insulin resistance, triglycerides, cholesterol/HDL ratio and blood pressure separately and as a composite metabolic z score) were measured on four annual occasions (5, 6, 7 and 8 years).
Results: Mean physical activity did not change over time in either sex. Averaging the 7-day recordings from four time points rather than one increased the reliability of characterising a child’s activity from 71% to 90%. Some 42% of boys and 11% of girls met the guideline. There
were no associations between physical activity and changes in any measurement of body mass or fatness over time in either sex (eg, BMI standard deviation scores: r=20.02, p=0.76). However, there was a small to moderate inverse association between physical activity and change in composite metabolic score (r=20.19, p,0.01). Mixed effects modelling showed
that the improvement in metabolic score among the more active compared to the less active children was linear with time (20.08 z scores/year, p=0.001).
Conclusions: In children, physical activity above the government-recommended intensity of 3 METs is associated with a progressive improvement in metabolic health but not with a change in BMI or fatness. Girls habitually undertake less physical activity than boys, questioning whether girls in particular should be encouraged to do more, or the recommendations adjusted for girls.
B S Metcalf, L D Voss, J Hosking, A N Jeffery, T J Wilkin
ABSTRACT
Background: In the UK and USA, government guidelines for childhood physical activity have been set (>60 min/ day at >3 metabolic equivalents of thermogenesis (METs)), and body mass index (BMI) chosen as the outcome measure.
Aim: To determine the extent to which physical activity at the government-recommended intensity is associated with change in body mass/fat and metabolic health in prepubertal
children.
Methods: Non-intervention longitudinal study of 113 boys and 99 girls (born 95/96) recruited from 54 schools. Physical activity (Actigraph accelerometers),changes in body mass (raw and age/gender-standardised BMI), fatness (skin-fold thickness and waist circumference)
and metabolic status (insulin resistance, triglycerides, cholesterol/HDL ratio and blood pressure separately and as a composite metabolic z score) were measured on four annual occasions (5, 6, 7 and 8 years).
Results: Mean physical activity did not change over time in either sex. Averaging the 7-day recordings from four time points rather than one increased the reliability of characterising a child’s activity from 71% to 90%. Some 42% of boys and 11% of girls met the guideline. There
were no associations between physical activity and changes in any measurement of body mass or fatness over time in either sex (eg, BMI standard deviation scores: r=20.02, p=0.76). However, there was a small to moderate inverse association between physical activity and change in composite metabolic score (r=20.19, p,0.01). Mixed effects modelling showed
that the improvement in metabolic score among the more active compared to the less active children was linear with time (20.08 z scores/year, p=0.001).
Conclusions: In children, physical activity above the government-recommended intensity of 3 METs is associated with a progressive improvement in metabolic health but not with a change in BMI or fatness. Girls habitually undertake less physical activity than boys, questioning whether girls in particular should be encouraged to do more, or the recommendations adjusted for girls.
10.9.08
International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action
International Trends in Sudden Infant Death
Syndrome: Stabilization of Rates Requires Further
Action
PEDIATRICS 2008;122( 3): 660-666
Fern R. Hauck, Kawai O. Tanabe.
Syndrome: Stabilization of Rates Requires Further
Action
PEDIATRICS 2008;122( 3): 660-666
Fern R. Hauck, Kawai O. Tanabe.
CONCLUSIONS AND RECOMMENDATIONS
There have been impressive reductions in SIDS deaths around the world. These declines seem to be real and attributable, in large measure, to risk-reduction activities, especially placing infants supine to sleep. However, rates have stabilized in the majority of countries, and in some countries they remain unacceptably high, which highlights the need for risk-reduction activities to be continued, especially in communities with the greatest burden of SIDS. In the United States in 2004, the National Infant Sleep Position Survey revealed that 12.9% of infants were placed prone for sleep. Using the pooled odds ratios from 7 case-control studies conducted in the post–Back to Sleep period for prone sleeping position (6.02), we estimate that 47% of the annual
SIDS deaths in the United States could be attributed to prone sleeping (Appendix).Using a more conservative estimate of an odds ratio of 2.5 (based on 2 studies in the United States), an estimated 27% of SIDS deaths could be attributed to placing infants prone to sleep (Appendix). Thus, working toward eliminating the use of this position has the potential to reduce the number of SIDS deaths in the United States significantly.
Differences in rates and trends are also influenced by diagnostic shifts that have occurred. Consequently, several classifications for SIDS and SUID have been proposed as a way to achieve greater accuracy and consistency in diagnosis within and across countries.
The Nordic countries have been successful in adopting standard criteria to diminish previously identified discrepancies in SIDS rates. It is essential that more widespread consensus on the definition and classification of sudden unexpected death in infancy be achieved so that national and international comparisons are more meaningful. Several initiatives in the United States are
underway to develop a standardized approach, including development by the Centers for Disease Control and Prevention of a national surveillance system for SUIDs that would collect data on modifiable risk factors for SIDS and SUID and on the conduct and quality of the death-scene investigation and autopsy; a standardized classification scheme for cause of death will also be developed In addition, legislation is being considered that would fund this and other related activities, including training for those who investigate infant deaths and certify cause of death.
.../...
There have been impressive reductions in SIDS deaths around the world. These declines seem to be real and attributable, in large measure, to risk-reduction activities, especially placing infants supine to sleep. However, rates have stabilized in the majority of countries, and in some countries they remain unacceptably high, which highlights the need for risk-reduction activities to be continued, especially in communities with the greatest burden of SIDS. In the United States in 2004, the National Infant Sleep Position Survey revealed that 12.9% of infants were placed prone for sleep. Using the pooled odds ratios from 7 case-control studies conducted in the post–Back to Sleep period for prone sleeping position (6.02), we estimate that 47% of the annual
SIDS deaths in the United States could be attributed to prone sleeping (Appendix).Using a more conservative estimate of an odds ratio of 2.5 (based on 2 studies in the United States), an estimated 27% of SIDS deaths could be attributed to placing infants prone to sleep (Appendix). Thus, working toward eliminating the use of this position has the potential to reduce the number of SIDS deaths in the United States significantly.
Differences in rates and trends are also influenced by diagnostic shifts that have occurred. Consequently, several classifications for SIDS and SUID have been proposed as a way to achieve greater accuracy and consistency in diagnosis within and across countries.
The Nordic countries have been successful in adopting standard criteria to diminish previously identified discrepancies in SIDS rates. It is essential that more widespread consensus on the definition and classification of sudden unexpected death in infancy be achieved so that national and international comparisons are more meaningful. Several initiatives in the United States are
underway to develop a standardized approach, including development by the Centers for Disease Control and Prevention of a national surveillance system for SUIDs that would collect data on modifiable risk factors for SIDS and SUID and on the conduct and quality of the death-scene investigation and autopsy; a standardized classification scheme for cause of death will also be developed In addition, legislation is being considered that would fund this and other related activities, including training for those who investigate infant deaths and certify cause of death.
.../...
29.8.08
Routine measurement of head circumference as a tool for detecting intracranial expansion in infants: what is the gain? A nationwide survey.
Zahl SM, Wester K. Pediatrics.2008; 121 (3).
OBJECTIVE. The aim of the present study was to investigate the importance of routine head circumference measurements in the detection of intracranial expansive conditions, because only fragmented evidence exists in favor of this routine.
METHODS. The study was a nationwide study based on the medical records of all Norwegian departments of pediatrics and neurosurgery. The study included all Norwegian children <5 years of age who were hospitalized because of intracranial expansion during a 4-year period (1999–2002). Information about diagnostic codes, symptoms, and ages at symptom onset and at admission was collected from the medical records.
RESULTS. The study included 298 patients. For 173 (58%), hydrocephalus was the primary diagnosis; 57 (19%) had intracranial tumors and 68 (23%) had other primary diagnoses. For 46% of the children, increased head circumference was the first and main symptom leading to diagnosis. Increased head circumference was much more common as the symptom that led to diagnosis for patients with hydrocephalus (72%), compared with patients with cysts (31%) or tumors (5%). Increasing head circumference seems important mainly in detecting hydrocephalus and cysts, especially during the first 10 months of life.
CONCLUSIONS. Routine measurements of head circumference during the first year of life mainly detect infants with hydrocephalus or cysts; other expansive conditions yield other symptoms. Most children with increased head circumference as a symptom of intracranial expansion are identified during the first 10 months of life.
LETTERS TO THE EDITOR
What We Gain by Measuring Head Circumference
Robin K. Wilson and Michael A. Williams
Pediatrics 2008; 122: 219-220.
What We Gain by Measuring Head Circumference: In Reply
Sverre Morten Zahl and Knut Wester
Pediatrics 2008; 122: 220-221.
OBJECTIVE. The aim of the present study was to investigate the importance of routine head circumference measurements in the detection of intracranial expansive conditions, because only fragmented evidence exists in favor of this routine.
METHODS. The study was a nationwide study based on the medical records of all Norwegian departments of pediatrics and neurosurgery. The study included all Norwegian children <5 years of age who were hospitalized because of intracranial expansion during a 4-year period (1999–2002). Information about diagnostic codes, symptoms, and ages at symptom onset and at admission was collected from the medical records.
RESULTS. The study included 298 patients. For 173 (58%), hydrocephalus was the primary diagnosis; 57 (19%) had intracranial tumors and 68 (23%) had other primary diagnoses. For 46% of the children, increased head circumference was the first and main symptom leading to diagnosis. Increased head circumference was much more common as the symptom that led to diagnosis for patients with hydrocephalus (72%), compared with patients with cysts (31%) or tumors (5%). Increasing head circumference seems important mainly in detecting hydrocephalus and cysts, especially during the first 10 months of life.
CONCLUSIONS. Routine measurements of head circumference during the first year of life mainly detect infants with hydrocephalus or cysts; other expansive conditions yield other symptoms. Most children with increased head circumference as a symptom of intracranial expansion are identified during the first 10 months of life.
LETTERS TO THE EDITOR
What We Gain by Measuring Head Circumference
Robin K. Wilson and Michael A. Williams
Pediatrics 2008; 122: 219-220.
What We Gain by Measuring Head Circumference: In Reply
Sverre Morten Zahl and Knut Wester
Pediatrics 2008; 122: 220-221.
Pediatricians and the US Preventive Services Task Force: A Natural Partnership to Enhance the Health of Children
Virginia A. Moyer and David Nelson
Pediatrics 2008; 122: 174-176.
Comentario para informar a los lectores acerca de USPSTF: qué es, quien está involucrado, cómo funciona y qué pueden esperar los lectores de estas publicaciones.
Resulta interesante conocer la metodología de trabajo de uno de los grupos que más está marcando en la actualidad el rumbo de las actividades preventivas en la infancia.
Pediatrics 2008; 122: 174-176.
Comentario para informar a los lectores acerca de USPSTF: qué es, quien está involucrado, cómo funciona y qué pueden esperar los lectores de estas publicaciones.
Resulta interesante conocer la metodología de trabajo de uno de los grupos que más está marcando en la actualidad el rumbo de las actividades preventivas en la infancia.
A Critique of Criteria for Evaluating Vaccines for Inclusion in Mandatory School Immunization Programs
Douglas J. Opel, MDa,b, Douglas S. Diekema, MD, MPHa,b and Edgar K. Marcuse, MD, MPHb,c
Pediatrics. 2008 Aug;122(2):e504-10
Several new vaccines for children and young adults have been introduced recently and now appear on the Advisory Committee on Immunization Practices’ recommended childhood and adolescent immunization schedule (meningococcal, rotavirus, human papillomavirus). As new vaccines are introduced, states face complex decisions regarding which vaccines to fund and which vaccines to require for school or child care entry. This complexity is evidenced by the current debate surrounding the human papillomavirus vaccine. We present a critique to the approach and criteria for evaluating vaccines for inclusion in mandatory school immunization programs that have been adopted by the Washington State Board of Health by illustrating how these criteria might be applied to the human papillomavirus vaccine. We conclude that these 9 criteria can help ensure a deliberate and informed approach to important public policy decisions, but we argue that several clarifications of the review process are needed along with the addition of a 10th criterion that ensures that a new vaccine mandate relates in some manner to increasing safety in the school environment.
9.8.08
Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents
Bjorge T, et al. Body mass index in adolescence in relation to cause-specific mortality: a follow-up of 230,000 Norwegian adolescents. Am J Epidemiol. 2008 Jul 1;168(1):30-7
Abstract
The prevalence of obesity in childhood and adolescence has increased worldwide. Long-term effects of adolescent obesity on cause-specific mortality are not well specified. The authors studied 227,000 adolescents (aged 14-19 years) measured (height and weight) in Norwegian health surveys in 1963-1975. During follow-up (8 million person-years), 9,650 deaths were observed. Cox proportional hazards regression was used to compare cause-specific mortality among individuals whose baseline body mass index (BMI) was below the 25th percentile, between the 75th and 84th percentiles, and above the 85th percentile in a US reference population with that of individuals whose BMI was between the 25th and 75th percentiles. Risk of death from endocrine, nutritional, and metabolic diseases and from circulatory system diseases was increased in the two highest BMI categories for both sexes. Relative risks of ischemic heart disease death were 2.9 (95% confidence interval (CI): 2.3, 3.6) for males and 3.7 (95% CI: 2.3, 5.7) for females in the highest BMI category compared with the reference. There was also an increased risk of death from colon cancer (males: 2.1, 95% CI: 1.1, 4.1; females: 2.0, 95% CI: 1.2, 3.5), respiratory system diseases (males: 2.7, 95% CI: 1.4, 5.2; females: 2.5, 95% CI: 1.4, 4.8), and sudden death (males: 2.2, 95% CI: 1.2, 4.3; females: 2.7, 95% CI: 1.1, 6.6). Adolescent obesity was related to increased mortality in middle age from several important causes.
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Pues eso, que los gorditos adolescentes mueren más en los años medios de la vida adulta... si son noruegos ;-)
26.7.08
Neonatal hip instability and risk of total hip replacement in young adulthood: follow-up of 2,218,596 newborns - Medical Birth Registry of Norway
Engesaeter IØ, Lie SA, Lehmann TG, Furnes O, Vollset SE, Engesaeter LB.
The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Unifob, Bergen. ingvild.engesater@student.uib.no
BACKGROUND AND PURPOSE: Dysplasia is probably the most common underlying condition in osteoarthritis of the hip, leading to total hip replacement (THR) in young adulthood. We investigated whether hip instability at birth predisposes to THR in young adulthood.
METHODS: Since 1967, all newborns in Norway have been screened for neonatal hip instability (NHI) and the results have been reported to the Medical Birth Registry of Norway (MBRN). In the period 1967-2004, 2,218,596 newborns were registered. From 1987 to 2004, 442 of these individuals had been reported to the Norwegian Arthroplasty Register (NAR) after undergoing total hip replacement (mean age 25 (12-36) years).
RESULTS: Neonatal hip instability was reported in 19,432 newborns (0.88%) in the MBRN; according to the NAR, they had a 2.6 (CI 1.4-4.8) times increased risk of THR in young adulthood compared to those without NHI. The absolute risk was low, however; only 57 (95% CI: 30-105) in 10(5) for patients with NHI compared to 20 (95% CI: 18-22) in 10(5) for those without registered hip pathology. Of the 442 patients with THR, 95 were operated because of osteoarthritis of the hip secondary to dysplasia, according to the surgeon's report. However, only 8 of these 95 patients had been reported to have hip instability at birth.
INTERPRETATION: Neonatal hip instability increases the risk of THR in young adulthood. Unexpectedly, only 8% of those who underwent THR due to dysplasia were reported to have unstable hips at birth. Our results indicate that clinical testing for NHI is insufficient as a screening method for dysplastic hips that require THR in young adulthood.
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No parece que el cribado neonatal de la displasia evolutiva de cadera sea muy sensible :-(
O quizás es que lo de displasia evolutiva de cadera (DEC) sea muy cierto y muchas de ellas se desarrollen después del nacimiento. O quizás que los casos detectados por nosotros no llegan a THR precisamente por el cribado correcto al nacimiento y durante el primer año y el consiguiente tratamiento precoz. (Me quedo con esta última, que es la más favorable ;-)
The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Unifob, Bergen. ingvild.engesater@student.uib.no
BACKGROUND AND PURPOSE: Dysplasia is probably the most common underlying condition in osteoarthritis of the hip, leading to total hip replacement (THR) in young adulthood. We investigated whether hip instability at birth predisposes to THR in young adulthood.
METHODS: Since 1967, all newborns in Norway have been screened for neonatal hip instability (NHI) and the results have been reported to the Medical Birth Registry of Norway (MBRN). In the period 1967-2004, 2,218,596 newborns were registered. From 1987 to 2004, 442 of these individuals had been reported to the Norwegian Arthroplasty Register (NAR) after undergoing total hip replacement (mean age 25 (12-36) years).
RESULTS: Neonatal hip instability was reported in 19,432 newborns (0.88%) in the MBRN; according to the NAR, they had a 2.6 (CI 1.4-4.8) times increased risk of THR in young adulthood compared to those without NHI. The absolute risk was low, however; only 57 (95% CI: 30-105) in 10(5) for patients with NHI compared to 20 (95% CI: 18-22) in 10(5) for those without registered hip pathology. Of the 442 patients with THR, 95 were operated because of osteoarthritis of the hip secondary to dysplasia, according to the surgeon's report. However, only 8 of these 95 patients had been reported to have hip instability at birth.
INTERPRETATION: Neonatal hip instability increases the risk of THR in young adulthood. Unexpectedly, only 8% of those who underwent THR due to dysplasia were reported to have unstable hips at birth. Our results indicate that clinical testing for NHI is insufficient as a screening method for dysplastic hips that require THR in young adulthood.
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No parece que el cribado neonatal de la displasia evolutiva de cadera sea muy sensible :-(
O quizás es que lo de displasia evolutiva de cadera (DEC) sea muy cierto y muchas de ellas se desarrollen después del nacimiento. O quizás que los casos detectados por nosotros no llegan a THR precisamente por el cribado correcto al nacimiento y durante el primer año y el consiguiente tratamiento precoz. (Me quedo con esta última, que es la más favorable ;-)
5.7.08
La USPSTF recomienda el cribado de hipoacusia de todos los recién nacidos
Importance
Children with hearing loss have increased difficulties with verbal and nonverbal communication skills, increased behavioral problems, decreased psychosocial well-being, and lower educational attainment compared with children with normal hearing.
Detection
Because half of the children with hearing loss have no identifiable risk factors, universal screening (instead of targeted screening) has been proposed to detect children with permanent congenital hearing loss (PCHL). There is good evidence that newborn hearing screening testing is highly accurate and leads to earlier identification and treatment of infants with hearing loss.
Benefits of Detection and Early Treatment
Good-quality evidence shows that early detection improves language outcomes.
Harms of Detection and Early Treatment
There is limited evidence about the harms of screening, with conflicting research findings regarding anxiety associated with false-positive test results. There is limited information about the harms of treatment. Complications of cochlear implant surgery include increased risk of meningitis; however, the overall risks of complications of screening and treatment are estimated to be small.
USPSTF Assessment
The USPSTF concludes that there is moderate certainty that the net benefit of screening all newborn infants for hearing loss is moderate.
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(Teníamos razón ;-)
20.5.08
Prevención en salud bucodental en la infancia
En esta semana de mayo se ha incorporado a la Web de NGC la guía “Clinical guideline on periodicity of examination, preventive dental services, anticipatory guidance, and oral treatment for infants, children, and adolescents" cuya fuente es:
29.4.08
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schünemann HJ; GRADE Working Group.
BMJ. 2008 Apr 26;336(7650):924-6.
Summary points
Failure to consider the quality of evidence can lead to misguided recommendations; hormone replacement therapy for post-menopausal women provides an instructive example. High quality evidence that an intervention’s desirable effects are clearly greater than its undesirable effects, or are clearly not, warrants a strong recommendation.
Failure to consider the quality of evidence can lead to misguided recommendations; hormone replacement therapy for post-menopausal women provides an instructive example. High quality evidence that an intervention’s desirable effects are clearly greater than its undesirable effects, or are clearly not, warrants a strong recommendation.
Uncertainty about the trade-offs (because of low quality evidence or because the desirable and undesirable effects are closely balanced) warrants a weak recommendation.
Guidelines should inform clinicians what the quality of the underlying evidence is and whether recommendations are strong or weak.
The Grading of Recommendations Assessment, Development and Evaluation (GRADE ) approach provides a system for rating quality of evidence and strength of recommendations that is explicit, comprehensive, transparent, and pragmatic and is increasingly being adopted by organisations worldwide
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