Top Hot Reads

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."

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).

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

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.

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.

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

• 1. Closing the gap in a generation: health equity through action on the social determinants of health The Lancet. 2008; 372, 1661 - 1669. A summary of the key findings and recommendations of the report in August from the Commission on Social Determinants of Health. You can register with the Lancet and read this full article free of charge. This whole issue of the Lancet has a focus on health equity. The article below particularly relevant for child population health.
• 2. Effects of fully-established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational study. The Lancet. 2008; 372, 1641 - 1647. A quasi-experimental observational study, comparing 5883 3-year-old children and their families from 93 disadvantaged Sure Start Local Programmes (SSLP) areas with 1879 3-year-old children and their families from 72 similarly deprived areas in England without SSLPs.

1. Improving the use of research evidence in guideline development: 1. Guidelines for guidelines.  Health Research Policy and Systems 2006, 4:13     

The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the first of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research.

2. Socio-economic position and adolescents' health in Italy: the role of the quality of social relations. Eur J Pub Health 2006 16(6):627-632