Prevención de la obesidad en la primera infancia (1-5 años): una revisión sistemática de intervenciones conductuales multicomponentes basadas en la familia.

Johnson LG, Cho H, Lawrence SM, et al. Early childhood (1-5 years) obesity prevention: A systematic review of family-based multicomponent behavioral interventions. Prev Med. 2024 Apr;181:107918. DOI: 10.1016/j.ypmed.2024.107918.

INTRODUCCIÓN : En todo el mundo, 38,9 millones de niños menores de 5 años tienen sobrepeso u obesidad, lo que provoca diabetes tipo 2, complicaciones cardiovasculares, depresión y malos resultados educativos. La obesidad es difícil de revertir y los estilos de vida (saludables o no saludables) pueden persistir desde el año y medio de edad. Dirigirse a los cuidadores para ayudar a abordar conductas modificables puede ofrecer una solución viable.

OBJETIVO : Evaluar el impacto de las intervenciones familiares de componentes múltiples sobre los resultados basados ​​en el peso en la primera infancia y explorar los resultados de comportamiento secundarios relacionados.

MÉTODOS : Se realizaron búsquedas en cuatro bases de datos (1/2017-6/2022) de ensayos controlados aleatorios (ECA) de intervenciones de prevención de la obesidad en niños (1-5 años). Los estudios elegibles incluyeron un resultado basado en el peso medido objetivamente, intervenciones familiares dirigidas al cuidador o la familia e intervenciones que incluyeron al menos dos componentes conductuales de nutrición, actividad física o sueño.

RESULTADOS : Se identificaron once intervenciones que constan de cuatro modos de ejecución: autoguiada (n = 3), instrucción grupal cara a cara (n = 3), visitas domiciliarias cara a cara (n = 2) y niveles múltiples. de influencia (n = 3). Los estudios revisados ​​casi no informaron efectos significativos sobre los resultados basados ​​en el peso de los niños. Sólo dos estudios (uno fue un estudio piloto con poco poder estadístico) dieron como resultado resultados positivos significativos en el control del peso infantil. Siete de las intervenciones mejoraron significativamente la ingesta dietética de los niños.

CONCLUSIÓN : Excepto uno, los estudios revisados ​​informaron que las intervenciones familiares no tuvieron efectos significativos sobre los resultados basados ​​en el peso del niño. Los estudios futuros de este tipo deberían incluir mediciones del índice de masa corporal (IMC) basado en la edad y el sexo y las trayectorias, y también examinar otros beneficios importantes para los niños y las familias.

Primary Care Interventions to Prevent Child Maltreatment: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Viswanathan M, Rains C, Hart LC, et al. Primary Care Interventions to Prevent Child Maltreatment: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2024;331(11):959–971. doi:10.1001/jama.2024.0276

Importancia: El maltrato infantil se asocia con graves consecuencias físicas, psicológicas y conductuales negativas.

Objetivo: Revisar la evidencia sobre intervenciones factibles o referibles en atención primaria para prevenir el maltrato infantil para informar al Grupo de Trabajo de Servicios Preventivos de EE. UU.

Fuentes de datos: PubMed, Biblioteca Cochrane y registros de ensayos hasta el 2 de febrero de 2023; Referencias, expertos y vigilancia hasta el 6 de diciembre de 2023.

Selección de estudios: ensayos clínicos aleatorios en inglés de jóvenes hasta los 18 años (o sus cuidadores) sin exposición conocida ni signos o síntomas de maltrato actual o pasado.

Extracción y síntesis de datos: dos revisores evaluaron los títulos/resúmenes, los artículos de texto completo y la calidad de los estudios, y extrajeron los datos; cuando al menos 3 estudios similares estuvieron disponibles, se realizaron metanálisis.

Principales resultados y medidas: Informes medidos directamente de abuso o negligencia infantil (informes a los Servicios de Protección Infantil o retirada del niño del hogar); medidas indirectas de abuso o negligencia (lesiones, visitas al departamento de emergencias, hospitalización); salud y bienestar conductual, de desarrollo, emocional, mental o físico; mortalidad; daños.

Resultados: Se incluyeron veinticinco ensayos (N = 14 355 participantes); 23 incluyeron visitas domiciliarias. La evidencia de 11 estudios (5311 participantes) no indicó diferencias en la probabilidad de informes a los Servicios de Protección Infantil dentro del año posterior a la finalización de la intervención (odds ratio combinado, 1,03 [IC del 95 %, 0,84-1,27]). Cinco estudios (3336 participantes) no encontraron diferencias en el retiro del niño del hogar dentro de uno a tres años de seguimiento (cociente de riesgos agrupado, 1,06 [IC del 95%, 0,37 a 2,99]). La evidencia no sugirió ningún beneficio para las visitas al departamento de emergencias a corto plazo (<2 años) y las hospitalizaciones. La evidencia no fue concluyente para todos los demás resultados debido al número limitado de ensayos sobre cada resultado y a los resultados imprecisos. Entre dos ensayos que informaron daños, ninguno informó diferencias estadísticamente significativas. La evidencia contextual indicó (1) prácticas muy variables al evaluar, identificar y denunciar el maltrato infantil a los Servicios de Protección Infantil, incluidas variaciones por raza o etnia; (2) precisión muy variable de los instrumentos de detección; y (3) evidencia de que las intervenciones contra el maltrato infantil pueden estar asociadas con mejoras en algunos determinantes sociales de la salud.

Conclusiones y relevancia: La base de evidencia sobre intervenciones factibles o referibles desde entornos de atención primaria para prevenir el maltrato infantil no sugirió ningún beneficio o evidencia insuficiente para medidas directas o indirectas del maltrato infantil. Había poca información disponible sobre posibles daños. La evidencia contextual señaló el potencial de sesgo o inexactitud en la detección, identificación y notificación del maltrato infantil, pero también destacó la importancia de abordar los determinantes sociales al intervenir para prevenir el maltrato infantil.

Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan.

Honda K, Akune Y, Goto R. Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan. JAMA Netw Open. 2024;7(2):e2356412. doi:10.1001/jamanetworkopen.2023.56412

Key Points

Question  Is the nationwide urinary screening program for students in Japan cost-effective regarding early detection and intervention of IgA nephropathy?

Findings  In this economic evaluation of a hypothetical 1 000 000 children aged 6 years, the school urinary screening strategy cost was ¥4 186 642 (US $39 127) per quality-adjusted life-year gained compared with the no screening strategy, and the number of patients with end-stage kidney failure due to IgA nephropathy was reduced from 60.3 to 31.7 students/1 000 000 individuals.

Meaning  This study found that the school urinary screening program in Japan was cost-effective but cost-effectiveness depended on screening costs, annual probability of incident detection outside screening, and IgA nephropathy incidence.

Abstract

Importance  The evidence for and against screening for chronic kidney disease in youths who are asymptomatic is inconsistent worldwide. Japan has been conducting urinary screening in students for 50 years, allowing for a full economic evaluation that includes the clinical benefits of early detection and intervention for chronic kidney disease.

Objectives  To evaluate the clinical effectiveness and cost-effectiveness of school urinary screening in Japan, with a focus on the benefits of the early detection and intervention for IgA nephropathy, and to explore key points in the model that are associated with the cost-effectiveness of the school urinary screening program.

Design, Setting, and Participants  This economic evaluation with a cost-effectiveness analysis used a computer-simulated Markov model from the health care payer’s perspective among a hypothetical cohort of 1 000 000 youths aged 6 years in first grade in Japanese elementary schools, followed up through junior and high school. The time horizon was lifetime. Costs and clinical outcomes were discounted at a rate of 2% per year. Costs were calculated in Japanese yen and 2020 US dollars (¥107 = US $1).

Interventions  School urinary screening for IgA nephropathy was compared with no screening.

Main Outcomes and Measures  Outcomes were costs and quality-adjusted life-years (QALYs). Cost-effectiveness was determined by evaluating whether the incremental cost-effectiveness ratio (ICER) per QALY gained remained less than ¥7 500 000 (US $70 093).

Results  In the base case analysis, the ICER was ¥4 186 642 (US $39 127)/QALY, which was less than the threshold. There were 60.3 patients/1 000 000 patients in the no-screening strategy and 31.7 patients/1 000 000 patients in the screening strategy with an end-stage kidney disease. Cost-effectiveness improved as the number of screenings decreased (screening frequency <3 times: incremental cost, −¥75 [US $0.7]; incremental QALY, 0.00025; ICER, dominant), but the number of patients with end-stage kidney disease due to IgA nephropathy increased (40.9 patients/1 000 000 patients). Assuming the disutility due to false positives had a significant impact on the analysis; assuming a disutility of 0.01 or more, the population with no IgA nephropathy had an ICER greater than the threshold (¥8 304 093 [US $77 608]/QALY).

Conclusions and Relevance  This study found that Japanese school urinary screening was cost-effective, suggesting that it may be worthy of resource allocation. Key factors associated with cost-effectiveness were screening cost, the probability of incident detection outside of screening, and IgA nephropathy incidence, which may provide clues to decision-makers in other countries when evaluating the program in their own context.

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: A Systematic Review for the US Preventive Services Task Force.

Chou R, Bougatsos C, Griffin J, Selph SS, Ahmed A, Fu R, Nix C, Schwarz E. Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: A Systematic Review for the US Preventive Services Task Force. JAMA. 2023 Nov 7;330(17):1674-1686. doi: 10.1001/jama.2023.20435. PMID: 37934216.

Importance: Dental caries is common in children and adolescents aged 5 to 17 years and potentially amenable to primary care screening and prevention.

Objective: To systematically review the evidence on primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force.

Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.

Study selection: Diagnostic accuracy of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions and systematic reviews of such studies; cohort studies on primary care oral health screening and preventive intervention harms.

Data extraction and synthesis: One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Random-effects meta-analysis was performed for fluoride supplements and xylitol; for other preventive interventions, pooled estimates were used from good-quality systematic reviews.

Main outcomes and measures: Dental caries, morbidity, functional status, quality of life, harms; diagnostic test accuracy.

Results: Three systematic reviews (total 20 684 participants) and 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study (total 15 026 participants) were included. No study compared screening vs no screening. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) (mean difference, -0.73 [95% CI, -1.30 to -0.19]) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 (95% CI, 0.09-0.27) at outcomes closest to 3 years (4 trials; n = 1525), fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 (95% CI, 0.11-0.76) at 1 to 4.5 years (5 trials; n = 3902), and resin-based sealants were associated with decreased risk of carious first molars (odds ratio, 0.21 [95% CI, 0.16-0.28]) at 48 to 54 months (4 trials; n = 440). No trial evaluated primary care counseling or dental referral. Evidence on screening accuracy, silver diamine fluoride, xylitol, and harms was very limited, although serious harms were not reported.

Conclusions and relevance: Administration of fluoride supplements, fluoride gels, varnish, and sealants in dental or school settings improved caries outcomes. Research is needed on the effectiveness of oral health preventive interventions in primary care settings and to determine the benefits and harms of screening.

Screening for Lipid Disorders in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Guirguis-Blake JM, Evans CV, Coppola EL, et al. Screening for Lipid Disorders in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023 Jul 18;330(3):261-274. doi: 10.1001/jama.2023.8867. (Systematic review).

ABSTRACT

IMPORTANCE: Lipid screening in childhood and adolescence can lead to early dyslipidemia diagnosis. The long-term benefits of lipid screening and subsequent treatment in this population are uncertain.

OBJECTIVE: To review benefits and harms of screening and treatment of pediatric dyslipidemia due to familial hypercholesterolemia (FH) and multifactorial dyslipidemia.

DATA SOURCES: MEDLINE and the Cochrane Central Register of Controlled Trials through May 16, 2022; literature surveillance through March 24, 2023.

STUDY SELECTION: English-language randomized clinical trials (RCTs) of lipid screening; recent, large US cohort studies reporting diagnostic yield or screen positivity; and RCTs of lipid-lowering interventions.

DATA EXTRACTION AND SYNTHESIS: Single extraction, verified by a second reviewer. Quantitative synthesis using random-effects meta-analysis.

MAIN OUTCOMES AND MEASURES: Health outcomes, diagnostic yield, intermediate outcomes, behavioral outcomes, and harms.

RESULTS: Forty-three studies were included (n = 491?516). No RCTs directly addressed screening effectiveness and harms. Three US studies (n = 395?465) reported prevalence of phenotypically defined FH of 0.2% to 0.4% (1:250 to 1:500). Five studies (n = 142?257) reported multifactorial dyslipidemia prevalence; the prevalence of elevated total cholesterol level (=200 mg/dL) was 7.1% to 9.4% and of any lipid abnormality was 19.2%. Ten RCTs in children and adolescents with FH (n = 1230) demonstrated that statins were associated with an 81- to 82-mg/dL greater mean reduction in levels of total cholesterol and LDL-C compared with placebo at up to 2 years. Nonstatin-drug trials showed statistically significant lowering of lipid levels in FH populations, but few studies were available for any single drug. Observational studies suggest that statin treatment for FH starting in childhood or adolescence reduces long-term cardiovascular disease risk. Two multifactorial dyslipidemia behavioral counseling trials (n = 934) demonstrated 3- to 6-mg/dL greater reductions in total cholesterol levels compared with the control group, but findings did not persist at longest follow-up. Harms reported in the short-term drug trials were similar in the intervention and control groups.

CONCLUSIONS AND RELEVANCE: No direct evidence on the benefits or harms of pediatric lipid screening was identified. While multifactorial dyslipidemia is common, no evidence was found that treatment is effective for this condition. In contrast, FH is relatively rare; evidence shows that statins reduce lipid levels in children with FH, and observational studies suggest that such treatment has long-term benefit for this condition.

Diez intervenciones preventivas de la consulta de Pediatría de Atención Primaria apoyadas por la OMS (I)

Esparza Olcina MJ, Grupo PrevInfad . Diez intervenciones preventivas de la consulta de Pediatría de Atención Primaria apoyadas por la OMS (I). Form Act Pediatr Aten Prim. 2023;16;88-91.

PUNTOS CLAVE

• En las consultas de Atención Primaria se implementan intervenciones basadas en pruebas, pero también prácticas comunes basadas en la tradición, no siempre inocuas ni exentas de costes.
• La OMS Europa ha elaborado un manual sobre la Atención Primaria para niños y adolescentes que incluye los estándares basados en pruebas de los cuidados sanitarios en la región europea de la OMS.
• Se resumen los diez artículos publicados, uno por cada actividad preventiva estudiada para menores de cinco años.
• Las actividades preventivas para menores de cinco años se han dividido en intervenciones farmacológicas únicas, intervenciones múltiples y cribados.

Child and adolescent mental well-being intervention programme: A systematic review of randomised controlled trials.

Lam LT, & Lam MK. (2023). Child and adolescent mental well-being intervention programme: A systematic review of randomised controlled trials. Frontiers in Psychiatry, 14, 1106816. DOI: 10.3389/fpsyt.2023.1106816

BACKGROUND: There has been an increasing awareness and recognition of mental well-being as one of the main outcome measures in national mental health policy and service provision in recent years. Many systemic reviews on intervention programmes for mental health or general well-being in young people have been conducted; however, these reviews were not mental well-being specific.

OBJECTIVE: This study aims to examine the effectiveness of child and adolescent mental well-being intervention programmes and to identify the approach of effective intervention by reviewing the available Randomised Controlled Trials.

METHODS: This systematic review study followed the PRISMA guidelines for systematic reviews ensuring a methodical and structured approach for the literature search and the subsequent review processes. The systematic literature search utilised major medical and health databases. Covidence, an online application for conducting systematic reviews, was used to assemble the titles, abstracts and full articles retrieved from the initial literature search. To examine the quality of the included trials for determining the strength of the evidence provided, the JBI Critical Appraisal Tool for Randomised Controlled Trial was used.

RESULTS: There were 34 studies identified after an extensive search of the literature following the PRISMA guidelines. Seven (7) fulfilled all selection criteria and provided information on the effect of an intervention programme on mental well-being in adolescence. Data were extracted and analysed systematically with key information summarised. The results suggested that two (2) programmes demonstrated significant intervention effects, but with a small effect size. The quality of these trials was also assessed using the JBI Critical Appraisal Tool for Randomised Controlled Trials and identified some methodological issues.

CONCLUSION: In conclusion, activity-based and psychoeducation are shown to be potentially effective approaches for future programme development. More research on a well-designed programme is urgently needed, particularly in developing countries, to provide good evidence in supporting the mental health policy through the enhancement of mental well-being in young people.

Psychometric Properties of Screening Instruments for Social Network Use Disorder in Children and Adolescents A Systematic Review.

Schlossarek S, Schmidt H, Bischof A, et al. Psychometric Properties of Screening Instruments for Social Network Use Disorder in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2023;177(4):419–426. doi:10.1001/jamapediatrics.2022.5741

Abstract

Importance  Children and adolescents spend considerable time on the internet, which makes them a highly vulnerable group for the development of problematic usage patterns. A variety of screening methods have already been developed and validated for social network use disorder (SNUD); however, a systematic review of SNUD in younger age groups has not been performed.

Objective  To review published reports on screening tools assessing SNUD in children and adolescents with a maximum mean age of 18.9 years.

Evidence Review  To identify instruments for the assessment of SNUD, a systematic literature search was conducted in the databases PsycINFO, PubMed, Web of Science, PsycArticles, and Scopus. The final search took place on May 2, 2022. Psychometric properties of available tools were examined and evaluated to derive recommendations for suitable instruments for individuals up to 18 years of age.

Findings  A total of 5746 publications were identified, of which 2155 were excluded as duplicates. Of the remaining 3591 nonredundant publications, 3411 studies were assessed as not relevant after title and abstract screening. A full-text analysis of 180 remaining studies classified as potentially eligible resulted in a final inclusion of 29 studies revealing validation evidence for a total of 19 tools. The study quality was mostly moderate. With regard to validation frequency, 3 tools exhibited the largest evidence base: Social Media Disorder Scale (SMDS), the short version of the Bergen Facebook Addiction Scale, and Bergen Social Media Addiction Scale–Short Form (BSMAS-SF). Among these, 1 study tested a parental version (SMDS-P) for its psychometric properties. Taking all criteria into account, the strongest recommendation was made for the SMDS and BSMAS-SF.

Conclusions and Relevance  Results suggest that the SMDS-SF and BSMAS-SF were appropriate screening measures for SNUD. Advantages of the SMDS are the availability of a short version and the possibility of an external parental rating.

Number Needed to Screen for Tuberculosis Disease Among Children: A Systematic Review.

Robsky KO, Chaisson LH, Naufal F, et al. Number Needed to Screen for Tuberculosis Disease Among Children: A Systematic Review. Pediatrics. 2023 Apr 1;151(4):e2022059189. doi: 10.1542/peds.2022-059189.

Context: Improving detection of pediatric tuberculosis (TB) is critical to reducing morbidity and mortality among children.

Objective: We conducted a systematic review to estimate the number of children needed to screen (NNS) to detect a single case of active TB using different active case finding (ACF) screening approaches and across different settings.

Data sources: We searched 4 databases (PubMed, Embase, Scopus, and the Cochrane Library) for articles published from November 2010 to February 2020.

Study selection: We included studies of TB ACF in children using symptom-based screening, clinical indicators, chest x-ray, and Xpert.

Data extraction: We indirectly estimated the weighted mean NNS for a given modality, location, and population using the inverse of the weighted prevalence. We assessed risk of bias using a modified AXIS tool.

Results: We screened 27 221 titles and abstracts, of which we included 31 studies of ACF in children < 15 years old. Symptom-based screening was the most common screening modality (weighted mean NNS: 257 [range, 5-undefined], 19 studies). The weighted mean NNS was lower in both inpatient (216 [18-241]) and outpatient (67 [5-undefined]) settings (107 [5-undefined]) compared with community (1117 [28-5146]) and school settings (464 [118-665]). Risk of bias was low.

Limitations: Heterogeneity in the screening modalities and populations make it difficult to draw conclusions.

Conclusions: We identified a potential opportunity to increase TB detection by screening children presenting in health care settings. Pediatric TB case finding interventions should incorporate evidence-based interventions and local contextual information in an effort to detect as many children with TB as possible.

La presencia de factores de riesgo cardiovascular en los niños aumenta el riesgo de enfermedades cardiovasculares en los adultos.

Blanco Rodríguez C, González Rodríguez MP. La presencia de factores de riesgo cardiovascular en los niños aumenta el riesgo de enfermedades cardiovasculares en los adultos. Evid Pediatr. 2023;19:8.

Valoración crítica del artículo: Jacobs DR, Woo JG, Sinaiko AR, Daniels SR, Ikonen J, Juonala M, et al. Childhood Cardiovascular Risk Factors and Adult Cardiovascular Events. N Engl J Med. 2022 May 19;386(20):1877-88.

Objetivo: establecer la relación causal entre la presencia de factores de riesgo cardiovascular (FRCV) en niños y el desarrollo de enfermedad cardiovascular (ECV) en el adulto.

Diseño: estudio de cohortes prospectivo con tiempo medio de seguimiento de 35 años.

Emplazamiento: participantes en i3C (consorcio de cohorte cardiovascular infantil) que incluye 7 cohortes registradas en Australia, Finlandia y Estados Unidos.

Población de estudio: se incluyeron 40 648 participantes del registro de i3C, realizado entre los años 1970-1990, con edades de 3 a 19 años.

Evaluación del factor de riesgo: se incluyeron el índice de masa corporal (IMC), la tensión arterial sistólica (TAS), los niveles de colesterol total, los niveles de triglicéridos y el hábito tabáquico. Se calcularon unas puntuaciones estandarizadas individuales, así como una puntuación combinada (calculada como la media no ponderada de la suma de las cinco individuales). Otras variables registradas fueron: edad, sexo, nivel educativo de las familias y de los participantes en edad adulta. Los calendarios de medición de estas variables fueron desiguales y no siempre completos en las siete cohortes. El consumo de tabaco se registró como sí o no.

Medición del resultado: las variables de resultado fueron ECV fatales (ECVF) y no fatales (ECVnF): infarto de miocardio, accidente cerebrovascular, angina, accidente isquémico transitorio, insuficiencia cardiaca isquémica, intervención carotidea, aneurisma de aorta abdominal o revascularización coronaria. La información se recogió entre 2015 y 2019 a través de encuestas a los participantes y, cuando no se localizaron, consultando los registros nacionales de mortalidad. Se codificaron según la Clasificación Internacional de Enfermedades 9 y 10. Los modelos se ajustaron por sexo, raza negra, cohorte, edad media de seguimiento, número de visitas en la infancia y educación parental. Los registros médicos fueron revisados por un comité médico que desconocía los datos de los participantes.

La imputación se basó en los 319 ECVF que ocurrieron en 38 589 participantes y 779 ECVF y ECVnF observados en 20 656 participantes. En un subgrupo de 13 401 participantes, de quienes se dispusieron los datos de factores de riesgo en la infancia y en la vida adulta (media de edad 31 años; desviación estándar [DE] 5,6 años), se incluyeron 115 ECVF y en 11 156 participantes 406 ECVF o ECVnF. Se estimaron los cocientes de riesgos instantáneos (hazard ratio [HR]) por cada unidad de aumento en las puntuaciones estandarizadas, excepto para el tabaco, que se estimó para fumar frente a no fumar.

Resultados principales: los ECV acontecieron a una edad media de 47 (DE 8) años, siendo más frecuentes en los pacientes de mayor edad, varones y con un nivel educativo inferior. Los resultados fueron similares en las siete cohortes estudiadas.

En el análisis de 38 589 participantes se produjo un ECVF en 319 (0,8%) (49,7% varones y 15% afroamericanos, edad media de visita en la infancia 11,8 años (DE 3,1). El HR para un ECVF fue 1,30 (intervalo de confianza del 95% [IC 95]: 1,14 a 1,47) por cada unidad de incremento en la puntuación del nivel de colesterol, 1,5 (IC 95: 1,33 a 1,7) para los triglicéridos, 1,44 (IC 95: 1,33 a 1,57) para el IMC, 1,34 (IC 95: 1,19 a 1,5) para la TAS y 1,61 (IC 95: 1,21 a 2,13) en consumo de tabaco. El HR para un ECVF en la puntuación combinada fue 2,71 (IC 95: 2,23 a 3,29).

En el análisis de 20 656 participantes, 779 tuvieron un ECVF o ECVnF (3,8%). El HR combinado para ECVF y ECVnF fue 2,75 (IC 95: 2,48 a 3,06).

En el grupo de 13 041 participantes con datos de factores de riesgo disponibles en la infancia y adultos, el HR combinado para ECVF fue 3,54 (IC 95: 2,57 a 4,87) y para ECVF y ECVnF 3,21 (IC 95: 2,69 a 3,85).

Los pacientes con puntuación estandarizada combinada ≥0 tuvieron un riesgo 2 a 9 veces más alto de ECV en la vida adulta que aquellos con puntuación <-0,5.

Conclusión: la presencia de factores de riesgo cardiovascular en la infancia y su progresión en la vida adulta se asocia a eventos cardiovasculares en el adulto de edad media.

Comentario Crítico (Evid Pediatr)

Justificación: la presencia de FRCV en la infancia se ha asociado con ECV en adultos. En general, los estudios realizados hasta ahora han encontrado una asociación con enfermedad subclínica1. Este estudio analiza la posible asociación con ECVF y ECVnF en la vida adulta. La prevención de la ECV es un problema de salud importante2, por lo que es prioritaria la identificación y el control de estos factores de riesgo desde la infancia.

Validez o rigor científico: se trata de un estudio de cohortes con una gran muestra poblacional y un amplio intervalo de edades durante la infancia, con largo seguimiento. Existe definición clara de la población, de la exposición y del efecto. La medición del resultado fue independiente. Existe una secuencia temporal entre la exposición y el efecto.

La mayoría de los participantes son de raza blanca (solo 15% raza negra), por lo que sus resultados no incluyen posibles diferencias raciales. A pesar de esta agrupación de datos de siete poblaciones distintas no existen diferencias entre las cohortes en la edad de inicio, de la patología cardiovascular (rara por debajo de la cuarta década de la vida) ni tampoco en los HR de los factores de riesgo cardiovasculares estudiados. Durante el seguimiento hay una pérdida del 46,5% de la población en la que no se pueden tener datos de posibles EVCnF, por lo que, aunque se realizan diferentes imputaciones estadísticas para evitar sesgos en los resultados, estos podrían existir y ser aún mayor la carga de enfermedad en pacientes con factores de riesgo presentes en la infancia y en la vida adulta.

Importancia clínica: los niveles elevados de triglicéridos o colesterol, un IMC elevado, cifras altas de TAS en la infancia o un hábito tabáquico desde edades tempranas se asocian con ECV en el adulto a partir de la cuarta década de la vida. Si el 0,8% de la población tiene una ECVF, la presencia de estos factores en la infancia eleva a más del doble la posibilidad de presentar un ECV en el adulto joven (2,7 más para ECVF y 2,75 más para ECVF o ECVnF).

Los niños con puntuaciones estandarizadas de riesgo altas (≥0) tienen entre un 2 y un 9% más de riesgo de sufrir ECV, siendo este riesgo directamente proporcional a dicha puntuación. Por tanto, el estudio de la presencia de FRCV y su prevención deben comenzar desde la infancia en todos los individuos1,2. La puesta en marcha de políticas poblacionales de educación para salud cardiovascular en la edad pediátrica es una medida prioritaria para cambiar el estilo de vida de niños y adolescentes y de esta forma reducir la morbimortalidad de esta patología y el impacto económico que la ECV supone para la sociedad. La OMS publica una guía de intervenciones para la prevención y control de ECV3. La eficiencia de estas políticas ya se ha puesto de manifiesto en algunos países como Finlandia, con campañas sobre dieta saludable, con un importante descenso en las tasas de mortalidad por ECV en este país5.

Aplicabilidad en la práctica clínica: los resultados son aplicables a nuestro entorno. Los FRCV en la infancia pueden producir ECV y muerte en adultos jóvenes. Se debería considerar una prioridad sanitaria potenciar programas de educación para la prevención primaria de estos factores en la infancia y adolescencia.

Conflicto de intereses de los autores del comentario: no existen.

Interactivity, Quality, and Content of Websites Promoting Health Behaviors During Infancy: 6-Year Update of the Systematic Assessment.

Jawad D, Cheng H, Wen L, Rissel C, Baur L, Mihrshahi S, Taki S

J Med Internet Res 2022;24(10):e38641   URL: https://www.jmir.org/2022/10/e38641

DOI: 10.2196/38641

Background:

As of 2021, 89% of the Australian population are active internet users. Although the internet is widely used, there are concerns about the quality, accuracy, and credibility of health-related websites. A 2015 systematic assessment of infant feeding websites and apps available in Australia found that 61% of websites were of poor quality and readability, with minimal coverage of infant feeding topics and lack of author credibility.

Objective:

We aimed to systematically assess the quality, interactivity, readability, and comprehensibility of information targeting infant health behaviors on websites globally and provide an update of the 2015 systematic assessment.

Methods:

Keywords related to infant milk feeding behaviors, solid feeding behaviors, active play, screen time, and sleep were used to identify websites targeting infant health behaviors on the Google search engine on Safari. The websites were assessed by a subset of the authors using predetermined criteria between July 2021 and February 2022 and assessed for information content based on the Australian Infant Feeding Guidelines and National Physical Activity Recommendations. The Suitability Assessment of Materials, Quality Component Scoring System, the Health-Related Website Evaluation Form, and the adherence to the Health on the Net code were used to evaluate the suitability and quality of information. Readability was assessed using 3 web-based readability tools.

Results:

Of the 450 websites screened, 66 were included based on the selection criteria and evaluated. Overall, the quality of websites was mostly adequate. Media-related sources, nongovernmental organizations, hospitals, and privately owned websites had the highest median quality scores, whereas university websites received the lowest median score (35%). The information covered within the websites was predominantly poor: 91% (60/66) of the websites received an overall score of ≤74% (mean 53%, SD 18%). The suitability of health information was mostly rated adequate for literacy demand, layout, and learning and motivation of readers. The median readability score for the websites was grade 8.5, which is higher than the government recommendations (<grade 8). Overall, 74% (49/66) of the websites obtained a poor rating for interactivity, measuring active control, 2-way communication, and synchronicity. The most common features found on websites were social media links (61/66, 92%), frequently asked questions (48/66, 73%), and videos (44/66, 67%). Only 14% (9/66) of websites presented culturally responsive information.

Conclusions:

Quality, content, readability, and interactivity of websites promoting health behaviors during infancy ranged between poor and adequate. Since the 2015 systematic assessment, there was a slight improvement in the quality of websites but no difference in the Suitability Assessment of Materials rating and readability of information. There is a need for researchers and health care providers to leverage innovative web-based platforms to provide culturally competent evidence-based information based on government guidelines that are accessible to those with limited English proficiency.

Screening for Eating Disorders in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement.

Davidson KW, Barry MJ, Mangione CM, et al.

JAMA. 2022 Mar 15;327(11):1061-1067. doi: 10.1001/jama.2022.1806.

Importance: Eating disorders (eg, binge eating disorder, bulimia nervosa, and anorexia nervosa) are a group of psychiatric conditions defined as a disturbance in eating or eating-related behaviors that impair physical or psychosocial functioning. According to large US cohort studies, estimated lifetime prevalences for anorexia nervosa, bulimia nervosa, and binge eating disorder in adult women are 1.42%, 0.46%, and 1.25%, respectively, and are lower in adult men (anorexia nervosa, 0.12%; bulimia nervosa, 0.08%; binge eating disorder, 0.42%). Eating disorder prevalence ranges from 0.3% to 2.3% in adolescent females and 0.3% to 1.3% in adolescent males. Eating disorders are associated with short-term and long-term adverse health outcomes, including physical, psychological, and social problems.

Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for eating disorders in adolescents and adults with a normal or high body mass index. Evidence limited to populations who are underweight or have other physical signs or symptoms of eating disorders was not considered. The USPSTF has not previously made a recommendation on this topic.

Population: Adolescents and adults (10 years or older) who have no signs or symptoms of eating disorders (eg, rapid weight loss, weight gain, or pronounced deviation from growth trajectory; pubertal delay; bradycardia; oligomenorrhea; and amenorrhea).

Evidence Assessment: The USPSTF concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. The evidence is limited and the balance of benefits and harms cannot be determined.

Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for eating disorders in adolescents and adults. (I statement).

Estimated effect of secondary screening for hip dislocation.

Wenger D, Tiderius CJ, Düppe H.

Archives of Disease in Childhood Published Online First: 03 July 2020. doi: 10.1136/archdischild-2020-319250

Abstract

Objectives 

To quantify the effect of secondary screening for hip dislocations.

Design

Retrospective analysis of hospital files from participants in a prospectively collected nationwide registry.

Setting

Child healthcare centres and orthopaedic departments in Sweden.

Participants

Of 126 children with hip dislocation diagnosed later than 14 days age in the 2000–2009 birth cohort, 101 had complete data and were included in the study.

Interventions

The entire birth cohort was subject to clinical screening for hip instability at 6–8 weeks, 6 months and 10–12 months age. Children diagnosed through this screening were compared with children presenting due to symptoms, which was used as a surrogate variable representing a situation without secondary screening.

Main outcome measures

Age at diagnosis and disease severity of late presenting hip dislocations.

Results

Children diagnosed through secondary screening were 11 months younger (median: 47 weeks) compared with those presenting with symptoms (p<0.001). Children diagnosed through secondary screening had 11% risk of having a high (severe) dislocation, compared with 38% for those diagnosed due to symptoms; absolute risk reduction 27% (95% CI: 9.7% to 45%), relative risk 0.28 (95% CI: 0.11 to 0.70). Children presenting due to symptoms had OR 5.1 (95% CI: 1.7 to 15) of having a high dislocation, and OR 11 (95% CI: 4.1 to 31) of presenting at age 1 year or older, compared with the secondary screening group. The secondary screening was able to identify half of the children (55%, 95% CI: 45% to 66%) not diagnosed through primary screening.

Conclusions

Secondary screening at child healthcare centres may have substantially lowered the age at diagnosis in half of all children with late presenting hip dislocation not diagnosed through primary screening, with the risk of having a high dislocation decreased almost to one-quarter in such cases.

View Full Text

http://dx.doi.org/10.1136/archdischild-2020-319250

Treatment of Depression in Children and Adolescents: A Systematic Review.

Viswanathan M, Kennedy SM, McKeeman J, Christian R, Coker-Schwimmer M, Cook Middleton J, Bann C, Lux L, Randolph C, Forman-Hoffman V. 

Comparative Effectiveness Review No. 224. (Prepared by the RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center under Contract No. 290-2015-00011-I.) AHRQ Publication No. 20-EHC005-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2020. 

Background. Depressive disorders can affect long-term mental and physical health functioning among children and adolescents, including increased risk of suicide. Despite access to several nonpharmacological, pharmacological, and combined treatment options for childhood depression, clinicians contend with sparse evidence and are concerned about harms associated with treatment.

Methods. We conducted a systematic review to evaluate the efficacy, comparative effectiveness, and moderators of benefits and harms of available nonpharmacological and pharmacological treatments for children and adolescents with a confirmed diagnosis of a depressive disorder (DD)—major depressive disorder (MDD), persistent depressive disorder (previously termed dysthymia) or DD not otherwise specified. We searched five databases and other sources for evidence available from inception to May 29, 2019, dually screened the results, and analyzed eligible studies.

Results. We included in our analyses data from 60 studies (94 articles) that met our review eligibility criteria. For adolescents (study participants’ ages range from 12 to 18 years) with MDD, cognitive behavioral therapy (CBT), fluoxetine, escitalopram, and combined fluoxetine and CBT may improve depressive symptoms (1 randomized controlled trial [RCT] each, n ranges from 212 to 311); whether the magnitude of improvement is clinically significant is unclear. Among adolescents or children with MDD, CBT plus medications (8–17 years) may be associated with lower rates of relapse (1 RCT [n = 121]). In the same population (6–17 years), selective serotonin reuptake inhibitors (SSRIs) may be associated with improved response (7 RCTs [n = 1,525]; risk difference [RD], 72/1,000 [95% confidence interval (CI), 2 to 24], I2 = 9%) and functional status (5 RCTs [n = 941]; standardized mean difference, 0.16 [95% CI, 0.03 to 0.29]; I2 = 0%). For adolescents or children with any DD (7–18 years), CBT or family therapy may be associated with improvements in symptoms, response, or functional status (1 RCT each, n ranges from 64 to 99). Among children with any DD (7–12 years), family-based interpersonal therapy may be associated with improved symptoms (1 RCT, n = 38). Psychotherapy trials did not report harms. SSRIs may be associated with a higher risk of serious adverse events among adolescents or children with MDD (7–18 years; 9 RCTs [n = 2,206]; RD, 20/1,000 [95% CI, 1 to 440]; I2, 4%) and with a higher risk of withdrawal due to adverse events among adolescents with MDD (12–18 years; 4 RCTs [n = 1,296], RD, 26/1,000 [95% CI, 6 to 45]; I2, 0%). Paroxetine (1 RCT [n = 180]) may be associated with a higher risk of suicidal ideation or behaviors among adolescents with MDD (12–18 years). Evidence was insufficient to judge the risk of suicidal ideation or behavior for other SSRIs for adolescents and children with MDD or other DD (7–18 years) (10 RCTs [n = 2,368]; relative risk, 1.14 [95% CI, 0.89 to 1.45]; I2, 8%). However, this report excluded data on inpatients and those without depressive disorders, whom the Food and Drug Administration included in finding an increased risk of suicidality for all antidepressants across all indications.

Conclusion. Efficacious treatments exist for adolescents with MDD. SSRIs may be associated with increased withdrawal and serious adverse events. No evidence on harms of psychotherapy were identified.

Global Prevalence of Hypertension in ChildrenA Systematic Review and Meta-analysis

Song P, Zhang Y, Yu J, Zha M, Zhu Y, Rahimi K, Rudan I.
JAMA Pediatr. 2019;173(12):1154-1163. doi:10.1001/jamapediatrics.2019.3310

Key Points
Question: What is the prevalence of hypertension in the general pediatric population
Findings:  In this systematic review and meta-analysis of 47 articles, the prevalence of childhood hypertension increased from 1994 to 2018 and the increase was associated with higher body mass index, with the pooled estimate being 4.00% among individuals 19 years and younger. In 2015, the prevalence of childhood hypertension ranged from 4.32% among children aged 6 years to 3.28% among those aged 19 years and peaked at 7.89% among those aged 14 years.
Meaning: The findings suggest that childhood hypertension is becoming more common in the general pediatric population, representing a considerable public health challenge worldwide.

Abstract
Importance: Reliable estimates of the prevalence of childhood hypertension serve as the basis for adequate prevention and treatment. However, the prevalence of childhood hypertension has rarely been synthesized at the global level.
Objective: To conduct a systematic review and meta-analysis to assess the prevalence of hypertension in the general pediatric population.
Data Sources: PubMed, MEDLINE, Embase, Global Health, and Global Health Library were searched from inception until June 2018, using search terms related to hypertension (hypertension OR high blood pressure OR elevated blood pressure), children (children OR adolescents), and prevalence (prevalence OR epidemiology).
Study Selection: Studies that were conducted in the general pediatric population and quantified the prevalence of childhood hypertension were eligible. Included studies had blood pressure measurements from at least 3 separate occasions.
Data Extraction and Synthesis: Two authors independently extracted data. Random-effects meta-analysis was used to derive the pooled prevalence. Variations in the prevalence estimates in different subgroups, including age group, sex, setting, device, investigation period, BMI group, World Health Organization region and World Bank region, were examined by subgroup meta-analysis. Meta-regression was used to establish the age-specific prevalence of childhood hypertension and to assess its secular trend.
Main Outcomes and Measures: Prevalence of childhood hypertension overall and by subgroup.
Results: A total of 47 articles were included in the meta-analysis. The pooled prevalence was 4.00% (95% CI, 3.29%-4.78%) for hypertension, 9.67% (95% CI, 7.26%-12.38%) for prehypertension, 4.00% (95% CI, 2.10%-6.48%) for stage 1 hypertension, and 0.95% (95% CI, 0.48%-1.57%) for stage 2 hypertension in children 19 years and younger. In subgroup meta-analyses, the prevalence of childhood hypertension was higher when measured by aneroid sphygmomanometer (7.23% vs 4.59% by mercury sphygmomanometer vs 2.94% by oscillometric sphygmomanometer) and among overweight and obese children (15.27% and 4.99% vs 1.90% among normal-weight children). A trend of increasing prevalence of childhood hypertension was observed during the past 2 decades, with a relative increasing rate of 75% to 79% from 2000 to 2015. In 2015, the prevalence of hypertension ranged from 4.32% (95% CI, 2.79%-6.63%) among children aged 6 years to 3.28% (95% CI, 2.25%-4.77%) among those aged 19 years and peaked at 7.89% (95% CI, 5.75%-10.75%) among those aged 14 years.
Conclusions and Relevance: This study provides a global estimation of childhood hypertension prevalence based on blood pressure measurements in at least 3 separate visits. More high-quality epidemiologic investigations on childhood hypertension are still needed.


Editorial
Understanding the Global Prevalence of Hypertension in Children and Adolescents

POSITION STATEMENT
Early detection for autism spectrum disorders in young children

Zwaigenbaum L, Brian JA, Ip A; Canadian Paediatric Society, Autism Spectrum Disorder Guidelines Task Force
Paediatr Child Health 2019 24(7):424–432.
Posted: Oct 24 2019

Abstract
Autism spectrum disorder (ASD) is a life-long neurodevelopmental disorder, characterized by impairments in social communication, repetitive, restricted patterns of behaviour, and unusual sensory sensitivities or interests. ASD significantly impacts the lives of children and their families. Currently, the estimated prevalence of ASD is 1 in 66 Canadians aged 5 to 17 years. General paediatricians, family physicians, and other health care professionals are, therefore, seeing more children with ASD in their practices. The timely diagnosis of ASD, and referral for intensive behavioural and educational interventions at the earliest age possible, may lead to better long-term outcomes by capitalizing on the brain’s neuroplasticity at younger ages. This statement provides clear, comprehensive, evidence-informed recommendations and tools to help community paediatricians and other primary care providers monitor for the earliest signs of ASD—an important step toward an accurate diagnosis and comprehensive needs assessment for intervention planning.

Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-analysis.

Skeen S, Laurenzi CA, Gordon SL, du Toit S, Tomlinson M, Dua T, Fleischmann A, Kohl K, Ross D, Servili C, Brand AS, Dowdall N, Lund C, van der Westhuizen C, Carvajal-Aguirre L, Eriksson de

Carvalho C, Melendez-Torres GJ.

Pediatrics. 2019 Aug;144(2). pii: e20183488. doi: 10.1542/peds.2018-3488. Epub 2019 Jul 1.

CONTEXT: Although adolescent mental health interventions are widely implemented, little consensus exists about elements comprising successful models.

OBJECTIVE: We aimed to identify effective program components of interventions to promote mental health and prevent mental disorders and risk behaviors during adolescence and to match these components across these key health outcomes to inform future multicomponent intervention development.

DATA SOURCES: A total of 14 600 records were identified, and 158 studies were

included.

STUDY SELECTION: Studies included universally delivered psychosocial interventions administered to adolescents ages 10 to 19. We included studies published between 2000 and 2018, using PubMed, Medline, PsycINFO, Scopus, Embase, and Applied Social Sciences Index Abstracts databases. We included randomized controlled, cluster randomized controlled, factorial, and crossover trials.

Outcomes included positive mental health, depressive and anxious symptomatology,  violence perpetration and bullying, and alcohol and other substance use.

DATA EXTRACTION: Data were extracted by 3 researchers who identified core components and relevant outcomes. Interventions were separated by modality; data  were analyzed by using a robust variance estimation meta-analysis model, and we estimated a series of single-predictor meta-regression models using random effects.

RESULTS: Universally delivered interventions can improve adolescent mental health and reduce risk behavior. Of 7 components with consistent signals of effectiveness, 3 had significant effects over multiple outcomes (interpersonal skills, emotional regulation, and alcohol and drug education).

LIMITATIONS: Most included studies were from high-income settings, limiting the applicability of these findings to low- and middle-income countries. Our sample included only trials.

CONCLUSIONS: Three program components emerged as consistently effective across different outcomes, providing a basis for developing future multioutcome intervention programs.

Defining certainty of net benefit: a GRADE concept paper.

Alper BS, Oettgen P, Kunnamo I on behalf of The GRADE Working Group, et al

BMJ Open 2019;9:e027445. doi: 10.1136/bmjopen-2018-027445 

Abstract

Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess and report certainty of evidence and strength of recommendations. This GRADE concept article is not GRADE guidance but introduces certainty of net benefit, defined as the certainty that the balance between desirable and undesirable health effects is favourable. Determining certainty of net benefit requires considering certainty of effect estimates, the expected importance of outcomes and variability in importance, and the interaction of these concepts. Certainty of net harm is the certainty that the net effect is unfavourable. Guideline panels using or testing this approach might limit strong recommendations to actions with a high certainty of net benefit or against actions with a moderate or high certainty of net harm. Recommendations may differ in direction or strength from that suggested by the certainty of net benefit or harm when influenced by cost, equity, acceptability or feasibility.

 

WHO guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age.

World Health Organization: Geneva; 2019. Licence: CC BY-NC-SA 3.0 IGO.

Disponible en: https://apps.who.int/iris/bitstream/handle/10665/311664/9789241550536-eng.pdf?sequence=1&isAllowed=y

La nueva guía de la OMS sobre recomendaciones en actividad física, sedentarismo y sueño para menores de 5 años completa la anteriormente publicada, dirigida a los grupos de edad de 5-17 años, 18-64 años y más de 65 años.

En la publicación se revisa la información disponible sobre el impacto del sueño inadecuado y los comportamientos sedentarios en los niños, así como el beneficio de una mayor actividad. 

Se desarrollan una serie de recomendaciones separadas para bebés, de 1 a 2 años y de 3 a 4 años que enfatizan la actividad física y el sueño de buena calidad. Además, subrayan la importancia de que los niños no pasen más de una hora al día restringidos en cochecitos y recomiendan que pasen el menor tiempo posible frente a una pantalla.

Estos consejos han generado críticas de algunos expertos que cuestionan la calidad de la evidencia utilizada para hacer las recomendaciones, así como la viabilidad y los beneficios de limitar el tiempo de pantallas.

Outcomes of a Brief Cognitive Skills-Based Intervention (COPE) for Adolescents in the Primary Care Setting.

Erlich, Kimberly J. et al. 

Journal of Pediatric Health Care , Volume 0 , Issue 0 , Articles in Press.

DOI: https://doi.org/10.1016/j.pedhc.2018.12.001

Introduction

Approximately 25% of adolescents have behavioral disorders, yet few receive treatment. Primary care (PC) screening for depression and anxiety is recommended; however treatments, such as cognitive behavioral therapy (CBT), are rarely available in PC settings. Our aim was to determine whether the use of a CBT-based intervention (COPE for Teens) is associated with improved outcomes on measures of depression and anxiety, and to understand the patient experience.

Methods

Health record data were examined, including questionnaires on depression (PHQ-A), anxiety (GAD-7), and experience with COPE. Differences between pre- and post-intervention scores were evaluated by paired t-tests. Questionnaire data were analyzed via thematic coding.

Results

Thirty-seven patients (73% female; ages 12-18) completed pre- and post-intervention measures. Comparison showed decrease in PHQ-A scores by 2.1 (p = 0.0067) and GAD-7 scores by 2.3 (p= 0.0081). Questionnaire data demonstrate satisfaction with COPE.

Discussion

Among these 37 adolescents, COPE provided effective PC-based behavioral treatment and a positive experience. Increased availability of COPE could improve care for adolescents.