Prevención de la obesidad en la primera infancia (1-5 años): una revisión sistemática de intervenciones conductuales multicomponentes basadas en la familia.

Johnson LG, Cho H, Lawrence SM, et al. Early childhood (1-5 years) obesity prevention: A systematic review of family-based multicomponent behavioral interventions. Prev Med. 2024 Apr;181:107918. DOI: 10.1016/j.ypmed.2024.107918.

INTRODUCCIÓN : En todo el mundo, 38,9 millones de niños menores de 5 años tienen sobrepeso u obesidad, lo que provoca diabetes tipo 2, complicaciones cardiovasculares, depresión y malos resultados educativos. La obesidad es difícil de revertir y los estilos de vida (saludables o no saludables) pueden persistir desde el año y medio de edad. Dirigirse a los cuidadores para ayudar a abordar conductas modificables puede ofrecer una solución viable.

OBJETIVO : Evaluar el impacto de las intervenciones familiares de componentes múltiples sobre los resultados basados ​​en el peso en la primera infancia y explorar los resultados de comportamiento secundarios relacionados.

MÉTODOS : Se realizaron búsquedas en cuatro bases de datos (1/2017-6/2022) de ensayos controlados aleatorios (ECA) de intervenciones de prevención de la obesidad en niños (1-5 años). Los estudios elegibles incluyeron un resultado basado en el peso medido objetivamente, intervenciones familiares dirigidas al cuidador o la familia e intervenciones que incluyeron al menos dos componentes conductuales de nutrición, actividad física o sueño.

RESULTADOS : Se identificaron once intervenciones que constan de cuatro modos de ejecución: autoguiada (n = 3), instrucción grupal cara a cara (n = 3), visitas domiciliarias cara a cara (n = 2) y niveles múltiples. de influencia (n = 3). Los estudios revisados ​​casi no informaron efectos significativos sobre los resultados basados ​​en el peso de los niños. Sólo dos estudios (uno fue un estudio piloto con poco poder estadístico) dieron como resultado resultados positivos significativos en el control del peso infantil. Siete de las intervenciones mejoraron significativamente la ingesta dietética de los niños.

CONCLUSIÓN : Excepto uno, los estudios revisados ​​informaron que las intervenciones familiares no tuvieron efectos significativos sobre los resultados basados ​​en el peso del niño. Los estudios futuros de este tipo deberían incluir mediciones del índice de masa corporal (IMC) basado en la edad y el sexo y las trayectorias, y también examinar otros beneficios importantes para los niños y las familias.

Primary Care Interventions to Prevent Child Maltreatment: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Viswanathan M, Rains C, Hart LC, et al. Primary Care Interventions to Prevent Child Maltreatment: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2024;331(11):959–971. doi:10.1001/jama.2024.0276

Importancia: El maltrato infantil se asocia con graves consecuencias físicas, psicológicas y conductuales negativas.

Objetivo: Revisar la evidencia sobre intervenciones factibles o referibles en atención primaria para prevenir el maltrato infantil para informar al Grupo de Trabajo de Servicios Preventivos de EE. UU.

Fuentes de datos: PubMed, Biblioteca Cochrane y registros de ensayos hasta el 2 de febrero de 2023; Referencias, expertos y vigilancia hasta el 6 de diciembre de 2023.

Selección de estudios: ensayos clínicos aleatorios en inglés de jóvenes hasta los 18 años (o sus cuidadores) sin exposición conocida ni signos o síntomas de maltrato actual o pasado.

Extracción y síntesis de datos: dos revisores evaluaron los títulos/resúmenes, los artículos de texto completo y la calidad de los estudios, y extrajeron los datos; cuando al menos 3 estudios similares estuvieron disponibles, se realizaron metanálisis.

Principales resultados y medidas: Informes medidos directamente de abuso o negligencia infantil (informes a los Servicios de Protección Infantil o retirada del niño del hogar); medidas indirectas de abuso o negligencia (lesiones, visitas al departamento de emergencias, hospitalización); salud y bienestar conductual, de desarrollo, emocional, mental o físico; mortalidad; daños.

Resultados: Se incluyeron veinticinco ensayos (N = 14 355 participantes); 23 incluyeron visitas domiciliarias. La evidencia de 11 estudios (5311 participantes) no indicó diferencias en la probabilidad de informes a los Servicios de Protección Infantil dentro del año posterior a la finalización de la intervención (odds ratio combinado, 1,03 [IC del 95 %, 0,84-1,27]). Cinco estudios (3336 participantes) no encontraron diferencias en el retiro del niño del hogar dentro de uno a tres años de seguimiento (cociente de riesgos agrupado, 1,06 [IC del 95%, 0,37 a 2,99]). La evidencia no sugirió ningún beneficio para las visitas al departamento de emergencias a corto plazo (<2 años) y las hospitalizaciones. La evidencia no fue concluyente para todos los demás resultados debido al número limitado de ensayos sobre cada resultado y a los resultados imprecisos. Entre dos ensayos que informaron daños, ninguno informó diferencias estadísticamente significativas. La evidencia contextual indicó (1) prácticas muy variables al evaluar, identificar y denunciar el maltrato infantil a los Servicios de Protección Infantil, incluidas variaciones por raza o etnia; (2) precisión muy variable de los instrumentos de detección; y (3) evidencia de que las intervenciones contra el maltrato infantil pueden estar asociadas con mejoras en algunos determinantes sociales de la salud.

Conclusiones y relevancia: La base de evidencia sobre intervenciones factibles o referibles desde entornos de atención primaria para prevenir el maltrato infantil no sugirió ningún beneficio o evidencia insuficiente para medidas directas o indirectas del maltrato infantil. Había poca información disponible sobre posibles daños. La evidencia contextual señaló el potencial de sesgo o inexactitud en la detección, identificación y notificación del maltrato infantil, pero también destacó la importancia de abordar los determinantes sociales al intervenir para prevenir el maltrato infantil.

Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan.

Honda K, Akune Y, Goto R. Cost-Effectiveness of School Urinary Screening for Early Detection of IgA Nephropathy in Japan. JAMA Netw Open. 2024;7(2):e2356412. doi:10.1001/jamanetworkopen.2023.56412

Key Points

Question  Is the nationwide urinary screening program for students in Japan cost-effective regarding early detection and intervention of IgA nephropathy?

Findings  In this economic evaluation of a hypothetical 1 000 000 children aged 6 years, the school urinary screening strategy cost was ¥4 186 642 (US $39 127) per quality-adjusted life-year gained compared with the no screening strategy, and the number of patients with end-stage kidney failure due to IgA nephropathy was reduced from 60.3 to 31.7 students/1 000 000 individuals.

Meaning  This study found that the school urinary screening program in Japan was cost-effective but cost-effectiveness depended on screening costs, annual probability of incident detection outside screening, and IgA nephropathy incidence.

Abstract

Importance  The evidence for and against screening for chronic kidney disease in youths who are asymptomatic is inconsistent worldwide. Japan has been conducting urinary screening in students for 50 years, allowing for a full economic evaluation that includes the clinical benefits of early detection and intervention for chronic kidney disease.

Objectives  To evaluate the clinical effectiveness and cost-effectiveness of school urinary screening in Japan, with a focus on the benefits of the early detection and intervention for IgA nephropathy, and to explore key points in the model that are associated with the cost-effectiveness of the school urinary screening program.

Design, Setting, and Participants  This economic evaluation with a cost-effectiveness analysis used a computer-simulated Markov model from the health care payer’s perspective among a hypothetical cohort of 1 000 000 youths aged 6 years in first grade in Japanese elementary schools, followed up through junior and high school. The time horizon was lifetime. Costs and clinical outcomes were discounted at a rate of 2% per year. Costs were calculated in Japanese yen and 2020 US dollars (¥107 = US $1).

Interventions  School urinary screening for IgA nephropathy was compared with no screening.

Main Outcomes and Measures  Outcomes were costs and quality-adjusted life-years (QALYs). Cost-effectiveness was determined by evaluating whether the incremental cost-effectiveness ratio (ICER) per QALY gained remained less than ¥7 500 000 (US $70 093).

Results  In the base case analysis, the ICER was ¥4 186 642 (US $39 127)/QALY, which was less than the threshold. There were 60.3 patients/1 000 000 patients in the no-screening strategy and 31.7 patients/1 000 000 patients in the screening strategy with an end-stage kidney disease. Cost-effectiveness improved as the number of screenings decreased (screening frequency <3 times: incremental cost, −¥75 [US $0.7]; incremental QALY, 0.00025; ICER, dominant), but the number of patients with end-stage kidney disease due to IgA nephropathy increased (40.9 patients/1 000 000 patients). Assuming the disutility due to false positives had a significant impact on the analysis; assuming a disutility of 0.01 or more, the population with no IgA nephropathy had an ICER greater than the threshold (¥8 304 093 [US $77 608]/QALY).

Conclusions and Relevance  This study found that Japanese school urinary screening was cost-effective, suggesting that it may be worthy of resource allocation. Key factors associated with cost-effectiveness were screening cost, the probability of incident detection outside of screening, and IgA nephropathy incidence, which may provide clues to decision-makers in other countries when evaluating the program in their own context.

Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: A Systematic Review for the US Preventive Services Task Force.

Chou R, Bougatsos C, Griffin J, Selph SS, Ahmed A, Fu R, Nix C, Schwarz E. Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: A Systematic Review for the US Preventive Services Task Force. JAMA. 2023 Nov 7;330(17):1674-1686. doi: 10.1001/jama.2023.20435. PMID: 37934216.

Importance: Dental caries is common in children and adolescents aged 5 to 17 years and potentially amenable to primary care screening and prevention.

Objective: To systematically review the evidence on primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force.

Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.

Study selection: Diagnostic accuracy of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions and systematic reviews of such studies; cohort studies on primary care oral health screening and preventive intervention harms.

Data extraction and synthesis: One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Random-effects meta-analysis was performed for fluoride supplements and xylitol; for other preventive interventions, pooled estimates were used from good-quality systematic reviews.

Main outcomes and measures: Dental caries, morbidity, functional status, quality of life, harms; diagnostic test accuracy.

Results: Three systematic reviews (total 20 684 participants) and 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study (total 15 026 participants) were included. No study compared screening vs no screening. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) (mean difference, -0.73 [95% CI, -1.30 to -0.19]) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 (95% CI, 0.09-0.27) at outcomes closest to 3 years (4 trials; n = 1525), fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 (95% CI, 0.11-0.76) at 1 to 4.5 years (5 trials; n = 3902), and resin-based sealants were associated with decreased risk of carious first molars (odds ratio, 0.21 [95% CI, 0.16-0.28]) at 48 to 54 months (4 trials; n = 440). No trial evaluated primary care counseling or dental referral. Evidence on screening accuracy, silver diamine fluoride, xylitol, and harms was very limited, although serious harms were not reported.

Conclusions and relevance: Administration of fluoride supplements, fluoride gels, varnish, and sealants in dental or school settings improved caries outcomes. Research is needed on the effectiveness of oral health preventive interventions in primary care settings and to determine the benefits and harms of screening.

Screening for Lipid Disorders in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Guirguis-Blake JM, Evans CV, Coppola EL, et al. Screening for Lipid Disorders in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023 Jul 18;330(3):261-274. doi: 10.1001/jama.2023.8867. (Systematic review).

ABSTRACT

IMPORTANCE: Lipid screening in childhood and adolescence can lead to early dyslipidemia diagnosis. The long-term benefits of lipid screening and subsequent treatment in this population are uncertain.

OBJECTIVE: To review benefits and harms of screening and treatment of pediatric dyslipidemia due to familial hypercholesterolemia (FH) and multifactorial dyslipidemia.

DATA SOURCES: MEDLINE and the Cochrane Central Register of Controlled Trials through May 16, 2022; literature surveillance through March 24, 2023.

STUDY SELECTION: English-language randomized clinical trials (RCTs) of lipid screening; recent, large US cohort studies reporting diagnostic yield or screen positivity; and RCTs of lipid-lowering interventions.

DATA EXTRACTION AND SYNTHESIS: Single extraction, verified by a second reviewer. Quantitative synthesis using random-effects meta-analysis.

MAIN OUTCOMES AND MEASURES: Health outcomes, diagnostic yield, intermediate outcomes, behavioral outcomes, and harms.

RESULTS: Forty-three studies were included (n = 491?516). No RCTs directly addressed screening effectiveness and harms. Three US studies (n = 395?465) reported prevalence of phenotypically defined FH of 0.2% to 0.4% (1:250 to 1:500). Five studies (n = 142?257) reported multifactorial dyslipidemia prevalence; the prevalence of elevated total cholesterol level (=200 mg/dL) was 7.1% to 9.4% and of any lipid abnormality was 19.2%. Ten RCTs in children and adolescents with FH (n = 1230) demonstrated that statins were associated with an 81- to 82-mg/dL greater mean reduction in levels of total cholesterol and LDL-C compared with placebo at up to 2 years. Nonstatin-drug trials showed statistically significant lowering of lipid levels in FH populations, but few studies were available for any single drug. Observational studies suggest that statin treatment for FH starting in childhood or adolescence reduces long-term cardiovascular disease risk. Two multifactorial dyslipidemia behavioral counseling trials (n = 934) demonstrated 3- to 6-mg/dL greater reductions in total cholesterol levels compared with the control group, but findings did not persist at longest follow-up. Harms reported in the short-term drug trials were similar in the intervention and control groups.

CONCLUSIONS AND RELEVANCE: No direct evidence on the benefits or harms of pediatric lipid screening was identified. While multifactorial dyslipidemia is common, no evidence was found that treatment is effective for this condition. In contrast, FH is relatively rare; evidence shows that statins reduce lipid levels in children with FH, and observational studies suggest that such treatment has long-term benefit for this condition.

Diez intervenciones preventivas de la consulta de Pediatría de Atención Primaria apoyadas por la OMS (I)

Esparza Olcina MJ, Grupo PrevInfad . Diez intervenciones preventivas de la consulta de Pediatría de Atención Primaria apoyadas por la OMS (I). Form Act Pediatr Aten Prim. 2023;16;88-91.

PUNTOS CLAVE

• En las consultas de Atención Primaria se implementan intervenciones basadas en pruebas, pero también prácticas comunes basadas en la tradición, no siempre inocuas ni exentas de costes.
• La OMS Europa ha elaborado un manual sobre la Atención Primaria para niños y adolescentes que incluye los estándares basados en pruebas de los cuidados sanitarios en la región europea de la OMS.
• Se resumen los diez artículos publicados, uno por cada actividad preventiva estudiada para menores de cinco años.
• Las actividades preventivas para menores de cinco años se han dividido en intervenciones farmacológicas únicas, intervenciones múltiples y cribados.

Child and adolescent mental well-being intervention programme: A systematic review of randomised controlled trials.

Lam LT, & Lam MK. (2023). Child and adolescent mental well-being intervention programme: A systematic review of randomised controlled trials. Frontiers in Psychiatry, 14, 1106816. DOI: 10.3389/fpsyt.2023.1106816

BACKGROUND: There has been an increasing awareness and recognition of mental well-being as one of the main outcome measures in national mental health policy and service provision in recent years. Many systemic reviews on intervention programmes for mental health or general well-being in young people have been conducted; however, these reviews were not mental well-being specific.

OBJECTIVE: This study aims to examine the effectiveness of child and adolescent mental well-being intervention programmes and to identify the approach of effective intervention by reviewing the available Randomised Controlled Trials.

METHODS: This systematic review study followed the PRISMA guidelines for systematic reviews ensuring a methodical and structured approach for the literature search and the subsequent review processes. The systematic literature search utilised major medical and health databases. Covidence, an online application for conducting systematic reviews, was used to assemble the titles, abstracts and full articles retrieved from the initial literature search. To examine the quality of the included trials for determining the strength of the evidence provided, the JBI Critical Appraisal Tool for Randomised Controlled Trial was used.

RESULTS: There were 34 studies identified after an extensive search of the literature following the PRISMA guidelines. Seven (7) fulfilled all selection criteria and provided information on the effect of an intervention programme on mental well-being in adolescence. Data were extracted and analysed systematically with key information summarised. The results suggested that two (2) programmes demonstrated significant intervention effects, but with a small effect size. The quality of these trials was also assessed using the JBI Critical Appraisal Tool for Randomised Controlled Trials and identified some methodological issues.

CONCLUSION: In conclusion, activity-based and psychoeducation are shown to be potentially effective approaches for future programme development. More research on a well-designed programme is urgently needed, particularly in developing countries, to provide good evidence in supporting the mental health policy through the enhancement of mental well-being in young people.