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Ellis and Essex have published data that suggests that girls brought up in a family with higher quality "investment" from their parents and lower reported parental conflict have later onset puberty. |
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NeLM - News (Paediatrics)
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Headline news from the National electronic Library for Medicines, providing a daily news service for the NHS
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Seasonal dips in antibiotic use may lead to falls in incidence of resistant organisms
A study using antibiotic prescription data found indications that seasonal variations in antibiotic use led to changes in the incidence of antibiotic-resistant pneumococci.
There is evidence that reducing use of particular antibiotics can reduce the incidence of organisms resistant to those compounds, however not all studies support this. The authors of the current paper suggest that if resistance in an organism was associated with significant fitness cost, a reduction in antibiotic use would be followed by a rapid decrease in resistance. Evidence suggests that for Streptococcus pneumoniae, antibiotic resistance has a substantial cost, particularly high-level resistance: the aim of this study was to determine whether existing data on antibiotic prescribing volumes could be used to demonstrate this. The authors used data on antibiotic prescribing in children aged under 5 from a specific area of Israel, the Negev, which includes two ethnically distinct populations: Jewish and Bedouin. They determined seasonal trends in antibiotic prescribing over a five-year period for this group and assessed whether any association could be shown with resistance in pneumococci isolated from middle ear fluid in acute otitis media (AOM). Data came from 7 paediatric primary care clinics covering about 20% of the total population of children of this age group within the area.
Over the time course of the study, data were available on 236,466 antibiotic prescriptions and 3609 pneumococcal isolates. During the warm months, prescription rates decreased substantially in the Jewish children (36%) and less so (15%) in the Bedouin children. The most commonly used antibiotics were amoxicillin followed by amoxicillin-clavulanate. There were 11,022 AOM episodes recorded, of which 3,609 were documented as due to Strep. pneumoniae (2,984 other documented pathogen, 4,429 culture negative). Amongst the Jewish children, rates of antibiotic resistance in pneumococci were significantly higher during the colder months, a difference that remained after adjustment for potential confounding factors. Among the Bedouin children, where there was less seasonal difference in antibiotic prescribing, alterations in resistance patterns was not seen.
The authors conclude that their analysis shows rapid seasonal changes in resistance in pneumococci associated with marked changes in antibiotic prescribing. They suggest that this indicates a fitness cost to drug resistance in this organism.
An accompanying Comment discusses the paper and its potential implications.
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NICE consults on the evidence to inform the development of its guidance on promoting physical activity for children
NICE has been asked by the Department of Health to develop guidance on physical activity, play and sport for pre-school and school-age children in family, pre-school, school and community settings. All registered stakeholders are now invited to comment on the evidence that has been assembled to inform the development of this guidance; the consultation will run from 12 May to 9 June 2008. Please see the link above for further details.
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FDA approves aripiprazole (Abilify®) for maintenance treatment of paediatric patients with Bipolar I disorder or schizophrenia
According to BioSpace, aripiprazole (Abilify®) has been approved by the FDA for expanded indications in bipolar I disorder and schizophrenia. It is now indicated for the maintenance treatment of manic and mixed episodes associated with bipolar I disorder with or without psychotic features in paediatric patients (aged 10-17) and for the maintenance treatment of schizophrenia in adolescents (aged 13-17). In addition, aripiprazole was granted an indication for adjunctive therapy to either lithium or valproate for the acute treatment of manic and mixed episodes associated with bipolar I disorder with or without psychotic features in paediatric patients (aged 10-17).
Aripirazole was recently approved in the US for use in the acute treatment of the patient populations detailed above. It is not currently licensed in the UK for the treatment of paediatrics in any indication.
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Informal school-based peer-led intervention for smoking prevention in adolescence
The findings of a RCT of a peer-led intervention aimed at smoking prevention in secondary schools have been published in the Lancet. The study included 10,730 pupils aged 12?13 years in 59 schools in England and Wales: 29 schools (n=5372) were randomised to the control group to continue their usual smoking education and 30 (n=5358) to the intervention group. The intervention (ASSIST [A Stop Smoking In Schools Trial] programme) consisted of training influential students to act as peer supporters during informal interactions outside the classroom to encourage their peers not to smoke. Follow-up was immediately after the intervention and at 1 and 2 years. The primary outcomes were smoking in the past week in both the school year group and in a group at high risk of regular smoking uptake.
According to the intention to treat analysis, the odds ratio of being a smoker in intervention compared with control schools was:
? 0.75 (95% CI 0.55?1.01) immediately after the intervention (n=9349)
? 0.77 (0.59?0.99) at 1-year follow-up (n=9147)
? 0.85 (0.72?1.01) at 2-year follow-up (n=8756)
The corresponding odds ratios for the high-risk group were 0.79 (0.55?1.13 [n=3561]), 0.75 (0.56?0.99 [n=3483]), and 0.85 (0.70?1.02 [n=3294]), respectively. The odds of being a smoker in intervention compared with control schools using data from all three follow-ups was 0.78 (0.64?0.96). The researchers suggest ?if implemented on a population basis, the ASSIST intervention could lead to a reduction in adolescent smoking prevalence of public-health importance.? They acknowledge however that the sample size of 59 schools resulted in estimates of effect size that were of borderline significance and confidence in the study findings would have increased if the planned sample size of 66 schools had been maintained.
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HPA response to death of a child in London with diphtheria
The Health Protection Agency (HPA) is recommending that people ensure that they are up to date with their routine immunisations, following a report of the death of a child in London, most likely due to an infection with diphtheria. The agency states that diphtheria is extremely rare in the UK due to vaccinations children receive as part of the childhood immunisation programme. The few isolated cases that are seen are usually in unvaccinated people who have travelled to countries where the disease is still common. This particular child had not been immunised.
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Epidemiologic features of antipsychotic prescribing to children and adolescents in primary care in the United Kingdom
This study investigated the trends in antipsychotic prescribing for children and adolescents in UK general practice. The researchers evaluated data from the General Practice Research Database (GPRD). Overall, 384 participating general practices from the United Kingdom General Practice Research Database were used to identify patients 0 to 18 years of age who were prescribed >/= 1 antipsychotic medication between January 1, 1992, and December 31, 2005. The data were used to calculate annual age-specific prevalences and incidences of antipsychotic prescribing. The results found (direct from source):
? The overall prevalence of use of all antipsychotics increased from 1992 (0.39 users per 1000 patient-years) to 2005 (0.77 users per 1000 patient-years).
? The prescribing prevalence for patients 7 to 12 years of age almost tripled between 1992 (0.23 users per 1000 patient-years) and 2005 (0.61 users per 1000 patient-years).
? Atypical antipsychotic prescribing increased 60-fold from 1994 (0.01 users per 1000 patient-years) to 2005 (0.61 users per 1000 patient-years).
? However, typical antipsychotic prescribing decreased significantly from 2000 (0.44 users per 1000 patient-years) to 2005 (0.18 users per 1000 patient-years).
? The incidences for typical and atypical antipsychotics showed trends similar to those of the respective prevalences.
? However, the overall incidence (number of new starters) for all antipsychotics was relatively stable between 1992 and 2005, which suggests that patients remain on treatment longer.
The researchers note that their study has some limitations, for example, the study focused on prescribing in primary care and did not look at prescribing by secondary or tertiary care centres or prison services. Additionally, not all general practitioners had recorded the diagnosis in the medical records which they note limits the analysis of diagnostic indications.
The researchers conclude, ?We have identified 3 major trends in the prescribing of antipsychotic medications for children and adolescents in the UK. First, the prevalence of antipsychotic prescribing in general practice almost doubled between 1992 and 2005. Second, the greatest increase is affecting children 7 to 12 years of age. Third, there is a strong trend for the replacement of typical antipsychotics with atypical antipsychotics. This increase in prescribing is predominantly for off-label and unlicensed indications.? They also note that the increasing trends in the UK are not to the same extent as in the United States, where there has been a bigger increase in prescribing in this population. They add, ?Additional studies are required to investigate durations of treatment, long-term outcomes and adverse effects of treatments, factors influencing discontinuation, and the information available to children and families regarding safe prescribing.?
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Corticosteroids don't affect mortality in children with meningitis
A large retrospective cohort study of children with meningitis, predominantly not due to Haemophilus influenzae type b (Hib), did not identify any effect on mortality with corticosteroid treatment.
Evidence indicates that adjuvant treatment with corticosteroids reduces the incidence of hearing loss in children with meningitis due to Hib, however with the widespread use of Hib vaccine the causative organisms now involved have changed. Additionally, the effects of this therapy on mortality in childhood meningitis is uncertain. This study was intended to determine whether corticosteroid treatment affected mortality and length of hospital treatment in children with bacterial meningitis in an area where Hib vaccination was widespread. The study cohort was derived from an administrative database of resource utilisation data provided by about 20% of US tertiary care children's hospitals; it included all children younger than 18 discharged from any of the participating hospitals with a diagnosis of bacterial meningitis, excluding those with pre-existing ventricular shunts. Study period was 2001 to 2006 inclusive, the exposure of interest was administration of corticosteroid during the first 24 hours after admission, and the main outcome measures were time to death and time to hospital discharge.
There were 2,780 patients discharged from the participating hospitals with a diagnosis of bacterial meningitis over the study period. Mean age was 3.4 years, however the median was 9 months. Hib infections accounted for less than 5% of infections overall, and the most commonly identified causative organism was Streptococcus pneumoniae (18.1% overall). Adjuvant corticosteroids were given to 248 children (8.9%), with the percentage changing over time from 5.8% in 2001 to 12.2% in 2006. Overall mortality rate was 4.2%, with 23% of deaths occurring on the day of admission and half within the first week.
Adjuvant corticosteroid treatment did not affect mortality. There was no significant mortality difference associated with corticosteroid treatment whether by age group, or by infecting organism. Similarly, corticosteroid use did not significantly alter duration of hospital stay either overall or by subgroup. The authors conclude, therefore, that their study did not show any effect of adjuvant corticosteroid therapy on mortality or duration of hospital stay in children with bacterial meningitis. They note some limitations to the study, including the relatively low overall mortality that may have made it underpowered to detect a significant difference. As the use of this therapy appears to be increasing, they call for a suitably powered controlled trial to clarify whether or not it has any beneficial effects.
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Introduction of Human Papillomavirus Vaccine (HPV) into the national immunisation programme
This letter from the Chief Medical Officer, the Chief Nursing Officer and the Chief Pharmaceutical Officer provides information about the introduction of the human papillomavirus (HPV) vaccine into the national immunisation programme.
Following advice received from the Joint Committee on Vaccination and Immunisation (JCVI), HPV immunisation will be offered routinely to all 12- to 13-year-old girls (school year 8) to protect them against their future risk of cervical cancer. The new programme will start from the beginning of the 2008/09 school year. A new chapter on HPV vaccine for ?Immunisation against Infectious Disease 2006? (the ?Green Book?) is now available and provides clinical advice (see link below).
A two-year catch-up campaign will start from the beginning of the 2009/10 school year for all girls aged up to 18 years at 31 August 2009; further information on this will follow in due course.
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