Top hot reads April 2009

Ten top hot reads provided monthly by our australian colleague Dr Mavis Duncanson  

1. The World Health Organisation fact sheet on a human rights-based approach to neglected tropical diseases notes that “children and women are disproportionately affected by some neglected tropical diseases and may face additional barriers to seeking and receiving treatment”. This very readable four-page document highlights the global impact of diseases which have a high associated burden, particularly for children, but which are too often ignored.

2. The previous item is also relevant in the context of the potential public health ‘disaster’ of an Influenza A H1N1 epidemic. This front page article from The Age (30 April 2009) highlights the disproportionate attention given to a potential threat to “us and people like us” compared with the daily threats already experienced by millions internationally.

3. Prevalence of Antihypertensive, Antidiabetic, and Dyslipidemic Prescription Medication Use Among Children and Adolescents It is a little difficult to know how to interpret the findings of this serial, cross-sectional study of 5-6 million commercially insured US children and adolescents aged 6 to 18 years, which showed increasing use of oral antidiabetic and antihypertensive drugs from November 2004 to June 2007. The overall use of all agents increased from 3.3 per 1000 youths in November 2004 to 3.8 per 1000 youths. The 16- to 18-year-olds had the highest prevalence , however the greatest rate of increase was found among 6- to 11-year-olds among whom angiotensin-converting enzyme inhibitor use increased 27.7% among girls and 25.2% among boys. Dyslipidemia therapy, which was dominated by statin use, declined 22.9% for the total sample over the same time frame. Whether this increasing use indicates increased awareness of treatment needs, increased incidence of cardiovascular risk factors, or overmedicalisation it maybe highlights the costs of pursuing individual interventions, and an apparent lack of effective population level intervention.

4. Hearing Screening in Newborns. Systematic Review of Accuracy, Effectiveness, and Effects of Interventions after Screening This systematic review identified 17 non-randomised controlled studies (two of screening versus no screening; six of therapeutic effect of early versus later treatment; and nine that assessed the accuracy of screening tests).

There is a lack of high-quality evidence regarding all elements of newborn hearing screening. The studies comparing screening versus no screening showed an improvement of speech development of children in the screening group compared to the group without screening. Early treatment of hearing impairment was associated with better language development in comparison to children with later treatment. Diagnostic studies found sensitivities between 50% and 100%, and specificities between 49.1% and 97.2%. One study evaluated these tests in a two-stage screening procedure and reported a sensitivity of 91.7% (95% CI, 74.2% to 97.7%) and a specificity of 98.5% (95% CI, 98.3% to 98.7%).

5. Managing evidence-based knowledge: the need for reliable, relevant and readable resources CMAJ 2009;180: 942-945. A classic evidence-based paper that includes a useful scale for rating the relevance and newsworthiness of individual studies.

6. Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial BMJ 2009;338:b974 A randomised controlled trial from a peri-urban settlement in South Africa, of an intervention designed to improve the mother-infant relationship and security of infant attachment. The intervention consisted of home visiting by previously untrained lay community workers who visited in the later months of pregnancy and until the child was six months of age. The outcome measures were quality of mother-infant interactions at six and 12 months postpartum; infant attachment security at 18 months and, as a secondary outcome, maternal depression at six and 12 months. The intervention was associated with significant benefit to the mother-infant relationship, with mothers in the intervention group more sensitive and less intrusive in their interactions with their infants at six and 12 months. This seems a promising intervention for use in the developing world.

7. Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study BMJ 2009;338:b1458. This survey was undertaken by trained interviewers who visited parents of 743 children aged 8-12 years with cerebral palsy in eight European regions. The Life-H questionnaire was used to assess participation. Pain, and severely impaired walking, fine motor skills, communication, and intellectual abilities were associated with lower participation across most domains. Substantial variation between regions was also observed, with children in east Denmark showing consistently higher participation than children in other regions. I found it somewhat surprising that a study about participation interviewed parents rather than the children themselves. However this study is very relevant to child population health, as noted in the editorial in the same issue of BMJ: Two findings of this study are particularly compelling. The first is the observation that children’s participation varied substantially across nine European regions. … This emphasises how much the environment contributes to people’s possibilities in life engagement [and] … points to the powerful role that social, legislative, and other external influences can have on the day to day lives of people with disabilities and their families. For example, some policies in Denmark, such as financial help to poor families and transportation services for children to access recreational programmes, which are also important for children who are not disabled, seem to facilitate integration of children and young people with disabilities. …forward thinking community planners and policy makers can develop programmes that benefit everyone and particularly improve the lives of less advantaged citizens. The study presents a challenge to health professionals to recognise opportunities to improve the wellbeing of young disabled people through advocacy in the sociopolitical arena. The second compelling finding is that … pain is strongly associated with lower levels of participation in children with cerebral palsy. Although this observation is not surprising, it shows how important it is to assess children’s pain status and manage it effectively…