Top hot reads February 2009

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

1.    Country-led M&E Systems: Better evidence, better policies, better development results.  A new publication from UNICEF with key points summarised in a powerpoint presentation here.  With a focus on developing countries, many of the lessons are equally applicable in New Zealand and Australia. Evidence based policy making is “an approach that helps people make well informed decisions about policies, programmes and projects by putting the best available evidence at the heart of policy development and implementation.”   Valuable background information for us all.

2.    Minimising medication errors in children Archives of Disease in Childhood 2009;94:161-164.  A review from the UK points out that most studies about medication errors are conducted in adults, and that this is also a significant problem in the paediatric population. The paper reviews the factors contributing to paediatric medication errors, including lack of appropriate paediatric formulations, communication issues between health professionals, dose calculation mistakes and inadequate clinical practice and discusses risk reduction strategies.

3.    Downward trends in the prevalence of childhood overweight in the setting of 12-year school- and community-based programmes Public Health Nutrition, 23 Dec 2008 doi:10.1017/S1368980008004278.  Thanks to Graham Vimpani for alerting me to the encouraging story of the French towns of Fleurbaix and Laventie.  The research reports a cross-sectional survey of 5- to 12-year-old children attending school in these towns, and two comparison towns, following a school-based nutrition information programme initiated in 1992, with a number of consequent community-based interventions. In the 2004 school year, the overweight prevalence was significantly lower in the intervention towns (8·8%) than in the comparison towns (17·8%). Blogger Yoni Freedhoff has an excellent summary of the project and comments that these are perhaps the only two towns in the world where childhood obesity rates are dramatically declining. Why? “What Fleurbaix and Laventie did was what has been missing from every other public health intervention I’ve ever come across. They treated this as a disease of the environment, rather than a disease of the individual.” Photograph is from the UK Telegraph article on the intervention.

4.    When does severe childhood obesity become a child protection issue? MJA 2009; 190 (3): 136-139.  Closer to home, the article that hit the headlines in relation to seeking guidelines for situations where childhood obesity may be an indicator of parental neglect.   This MJA issue includes five articles on aspects of childhood obesity that provide informed comment from different perspectives on this important issue.

5.    Trade and health: Time for the health sector to get involved. The Lancet, Volume 373, Pages 273 – 274.  On January 21 The Lancet launched a six-part series on trade and health that “provides timely analysis of the key challenges to achieving an appropriate balance between trade and health across a diverse range of issues.”  This series challenges those of us who perceive trade as complex or unrelated to our practice to take another look.

6.    What essential medicines for children are on the shelf? Bulletin of the World Health Organization  Volume 87, Number 3, March 2009, 161-244.  This study, with researchers from the University of Newcastle, NSW, surveyed 14 central African countries and found that only three countries where more than 50% of the drugs that are considered essential for children (as indicated by national lists and standard treatment guidelines) available from central medical stores. They conclude that “substantial progress towards Millennium Development Goals will not occur without a major effort to improve access to medicines for children.”

7.    Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns BMJ 2009;338:a3037. This large-scale study found that adding pulse oximetry to clinical examination improved the detection rate of duct dependent circulation from 63% to 82.8%, and reduced the false positive rate from 1.90% to 0.17%.  The authors note that 31/69 of the “false positive” cases with pulse oximetry had other pathology and that referral of all cases with positive oximetry results for echocardiography resulted in only 2.3 echocardiograms with normal cardiac findings for every true positive case of duct dependent circulation. The risk of leaving hospital with undiagnosed duct dependent circulation was 28/100 (28%) in other referring regions versus 5/60 (8%) in West Götaland. In the other referring regions 11/25 (44%) of babies with transposition of the great arteries left hospital undiagnosed versus 0/18 in West Götaland (P=0.0010), and severe acidosis at diagnosis was more common (33/100 (33%) v 7/60 (12%). No baby died from undiagnosed duct dependent circulation in West Götaland versus five babies from the other referring regions. 

8.    Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort BMJ 2009;338:a2981.  A longitudinal study from the UK followed 3652 members of the British 1946 birth cohort, who were assessed by their teachers for symptoms of externalising behaviour at age 13 and 15, through to ages 36-53. Adolescents with severe or mild externalising behaviour were more likely to leave school without any qualifications (65.2%; 52.2%) compared with those with no externalising behaviour (30.8%). On a composite measure of global adversity throughout adulthood that included mental health, family life and relationships, and educational and economic problems, those with severe externalising behaviour scored significantly higher (40.1% in top quarter), as did those with mild externalising behaviour (28.3%), compared with those with no externalising behaviour (17.0%).  Authors conclude that adolescents who exhibit externalising behaviour experience multiple social and health impairments that adversely affect them, their families, and society throughout adult life.  Just in case we need reminding of the importance of promoting wellbeing in the early years.