Top hot reads January 2009

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

• 1. The Child Development Index: Holding governments to account for children’s wellbeing was launched by Save the Children just before Christmas, using a globally representative, multi-dimensional tool to monitor and compare the wellbeing of children in more than 140 developed and developing countries. The index is simple, using three easily available and commonly understood indicators that are clearly indicative of child wellbeing:

.under-five mortality rate

.percentage of under fives who are moderately or severely underweight

.percentage of primary school-age children who are not enrolled in school.

The data table is also available as an Excel sheet.  Our region is surprisingly absent – no Pacific/ Oceania region is described.  Australia is included in developed countries, and Fiji in East and South East Asia.  Apart from that exclusion, the report provides up-to-date comparative information for key parts of the world, and reminds us of the persisting inequities for so many children internationally, especially in parts of Africa and Asia.  There would be many Pacific children in similar circumstances if they were included.

• 2. Promotion of children’s rights and prevention of child maltreatment The Lancet, 2009 Volume 373, Pages 332-343. One of the articles in the Lancet Child Maltreatment series, this opinion piece shows how a child rights framework can contribute to both public-health and child protection responses to the persistent global issue of child maltreatment. Authors come from several countries, and conclude “The greatest strength of an approach based on the UNCRC is that it provides a legal instrument for implementing policy, accountability, and social justice, all of which enhance public-health responses.”

• 3. World report on child injury prevention from WHO and UNICEF was also released late last year. 232 pages of excellent information about the extent and urgency of injury to children internationally. An inspiring blend of addressing upstream determinants and reporting practical and effective community initiatives (e.g. cycle helmets). The focus is on unintentional injury – with reference to other recent international reports that deal with child abuse, youth violence and sexual violence. Not for quick reading, but an excellent resource on injury prevention with a global perspective.

• 4. Hypersensitivity reactions to human papillomavirus vaccine in Australian schoolgirls: retrospective cohort study BMJ 2008;337:a2642. This retrospective cohort study identified 35 schoolgirls aged 12 to 18.9 years with suspected hypersensitivity reactions to the quadrivalent human papillomavirus vaccine, after administration of more than 380 000 doses in schools. 25 girls agreed to further evaluation, and of these only three were found to have probable hypersensitivity to the quadrivalent vaccine.
• 5. Effects of Social Development Intervention in Childhood 15 Years Later Arch Pediatr Adolesc Med. 2008; 162:1133-1141. From Seattle, a follow-up when the participants were aged 24 and 27 years, of a universal intervention in 15 public elementary schools. The intervention consisted of teacher training in classroom instruction and management, child social and emotional skill development, and parent workshops. The outcome measures were self-reports of functioning in school, work, and community and of mental health, sexual behaviour, substance use and crime, and court records. Specific effects included significantly better educational and economic attainment, mental health, and sexual health by age 27 years, with no observed effect on substance use and crime at ages 24 or 27 years.
• 6. Alcohol Environments and Disparities in Exposure Associated with Adolescent Drinking in California Am J Public Health 2008, 10.2105/AJPH.2007.122077. Looks to be a nicely designed spatial epidemiology study that shows, not surprisingly, that alcohol outlets are concentrated in disadvantaged neighbourhoods, and that binge drinking and driving after drinking among adolescents aged 12 to 17 years were significantly associated with the presence of alcohol retailers within 0.5 miles of home. Simulation of changes in the alcohol environment showed that if alcohol sales were reduced from the mean number of alcohol outlets around the lowest-income quartile of households to that of the highest quartile, prevalence of binge drinking would fall from 6.4% to 5.6% and driving after drinking from 7.9% to 5.9%.
• 7. Detecting implausible social network effects in acne, height, and headaches: longitudinal analysis BMJ 2008;337:a2533. A very nice methodological paper from the UK warning of the dangers of leaping too quickly to social networking conclusions, and highlighting the importance of considering possible environmental confounders. Using statistical analysis common in network studies, to analyse subsamples of the National Longitudinal Study of Adolescent Health, significant network effects were observed in the acquisition of acne, headaches, and height. After adjustment for environmental confounders, however, the results become uniformly smaller and insignificant.
• 8. Association between school absence and physical function in paediatric CFS/ME Arch Dis Child. 2008. doi:10.1136/adc.2008.143537. A paper which is largely clinical but provides a reminder of the educational impact of chronic disease and the importance of physical activity and function for all children. A review of 211 children aged under 18 years with Chronic Fatigue Syndrome found that 62% attended 40% of school or less. Reduced school attendance was associated with reduced physical function rather than anxiety. Authors conclude that improving school attendance in children with CFS/ME should focus on evidence-based interventions to improve physical function, particularly concentrating on interventions that are likely to reduce pain and fatigue.
• 9. Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage The Lancet, 2008, 372: pp2031 – 2046. A study funded by the Bill and Melinda Gates Foundation estimated the coverage of three doses of diphtheria, tetanus, and pertussis vaccine (DTP3) based on surveys using all available data, and compared this with countries’ official reports. They found that crude coverage of DTP3 based on surveys had increased gradually from 59% in 1986 to 74% over 20 years from 1986-2006. There were substantial differences between officially reported and survey-based coverage during the Universal Childhood Immunisation campaign. The authors conclude that there is an urgent need for independent and contestable monitoring of health indicators in the current performance-based funding context, which provides an incentive to over report in countries receiving Global Alliance on Vaccines and Immunisations (GAVI) disbursements.