Top hot reads July 2009

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

 1. Childhood injuries and violence is the theme of the whole issue of Bulletin of the World Health Organisation Volume 87, Number 5, May 2009, which includes a systematic review of reviews on prevention of child abuse, an editorial on rehabilitation of the injured child by Shanthi Amerataunga, and a contemporary commentary on Haddon’s classic 1973 article about injury and countermeasures. The round table section reminds us very clearly how political and ideological revolution is needed to prevent childhood injuries. As Ian Roberts says: “It seems to me now that some deaths are more accept­able than others and that the distinction is an ideological one. In other words, I agree with Dr Pless: injury is a political issue. Governments blame the victims in road traffic injury and take no real preventive action because it serves the economic interests of the world’s most powerful companies to have it that way.” Social health outcomes following thermal injuries: A retrospective matched cohort study Arch Dis Child. 2009. doi:10.1136/adc.2008.143727 Could burn injury be a marker for risk of abuse or neglect? A group of 145 children aged under three years admitted to hospital with burns were more likely than age, sex and enumeration district matched controls to be referred to Social Services by their sixth birthday. Almost 10% of the children who experienced burns were subsequently abused or neglected, compared with 1.4% of controls. The epidemiological analysis in the abstract is limited to reporting of simple proportions. Nevertheless this paper raises interesting questions.

2. Safety watchdog warns of high dosage errors among children and young people BMJ 2009;338:b2500 doi:10.1136/bmj.b2500. Sobering statistics from the UK National Patient Safety Agency (NPSA) showing that between October 2007 and September 2008 60 000 of the reported 910 089 patient safety incidents involved children, with those aged under four years at particular risk.

3. Varying gender pattern of childhood injury mortality over time in Scotland Archives of Disease in Childhood 2009;94:524-530. Descriptive analysis of injury mortality data for children in Scotland aged 0-14 years, from 1982-2006 inclusive. A significant male excess was observed in all age groups over one year, and for all forms of injury except fire. Interestingly the authors found that the male excess “declined markedly over time … to the point where the previous male excess has almost disappeared in some age and cause categories.” This observation is largely unexplained.

4. Screening for asymptomatic chlamydia infections among sexually active adolescent girls during pediatric urgent care Arch Pediatr Adolesc Med.2009;163(6):559-564. Recognising the lack of preventive care for many adolescent girls, the research team randomly assigned ten pediatric clinics in Northern California to an intervention (monthly meetings to redesign their system to improve Chlamydia trachomatis (CT) screening during urgent care) or control (informational lecture about CT screening). The main outcome measure was the proportion of sexually active adolescent women screened for CT, which increased 15.93% in the intervention group compared with a 2.13% decline in the control clinics. The authors note that, despite this success, substantial barriers to such screening remain and require innovative strategic solutions.

5. Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases New England Journal of Medicine 2009 Volume 360:1981-1988. An interesting descriptive analysis of patterns of vaccine refusal in the USA using the proportion of children exempted from school immunisation requirements for nonmedical reasons as the primary measure of vaccine refusal. Findings included quantification of the increased risk of measles and pertussis in children who are unvaccinated for non-medical reasons compared with vaccinated children, and estimation of the population effects of allowing exemptions for non-medical reasons. Such risks are, of course, particularly important for children who are too young to be vaccinated, or who cannot be vaccinated for medical reasons. Geographic clustering was also observed, with county non-medical exemption rates ranging from 1.2% to 26.9%. The authors reiterate the advice of the American Academy of Pediatrics Committee on Bioethics against discontinuing a provider relationship with patients who refuse vaccines, and recommend respectfully listening to parental concerns and discussing the risks of nonvaccination. Reporting of MMR evidence in professional publications (1988-2007) .Arch Dis Child. 2009. doi:10.1136/adc.2008.154310. A very nice paper from the UK reporting content analysis of ‘comment’ articles in six major journals, following publication of the controversial MMR vaccine article by Wakefield et al in 1998. 264 articles referred to evidence endorsing the safety of MMR. Articles were classified as negative (10.9%), neutral (11.3%) or mixed (22.7%) in relation to MMR safety. The authors comment that the prolonged period of neutrality may “represent a missed opportunity to promote evidence-based practice.”

6. For a relevant visual treat follow this link to the cover picture of the May issue of Archives of Pediatrics and Adolescent Medicine which shows Dr. Schreiber of San Augustine giving a typhoid inoculation at a rural school, San Augustine County, Texas, April 1943.

7. Tackling health inequalities: 10 years on 2009. UK Department of Health. It was 10 years last November since the publication of the Acheson Report and this new publication reports on progress in the UK in reducing health inequalities, including the prioritisation of action to support mothers families and children, and the determined efforts to reduce child poverty. It is so encouraging to read a report where children feature in every chapter, and where there are some very positive outcomes as a result of political action. The appointment of a Minister for Children is cited as a “significant policy response to the importance of early life, with implications for health inequalities.” Can we in the antipodes follow suit?

8. Household ownership and use of insecticide treated nets among target groups after implementation of a national voucher programme in the United Republic of Tanzania: plausibility study using three annual cross sectional household surveys BMJ 2009;339: doi:10.1136/bmj.b2434. The 2008 World Malaria Report indicated that the disease was responsible for a million deaths in 2006, mostly of children aged under five years. A series of cross-sectional surveys involving over 6000 households, investigated the population impact of the Tanzania National Voucher Scheme in which every pregnant woman who attended antenatal services was given a voucher to be used as part payment for the purchase of a net from a local shop. The scheme was phased in from October 2004 until all of Tanzania was covered in May 2006. The results were encouraging: Household ownership of at least one net, and ownership of at least one insecticide treated net increased between 2005 and 2007. Use of any net and of insecticide treated nets by infants under 1 year of age also increased. However gaps in coverage remained, with the poorest children and households significantly less likely than the least disadvantaged to own or use protection. Nevertheless a good start.