Wednesday, July 1, 2015

A Hot July for AAP Grand Rounds and Me

Greetings and a premature Happy 4th of July! This month's issue of AAP Grand Rounds has a number of interesting commentaries on articles I just couldn't fit into the blog this month: osteoarthritis in ex-premature infants, heath effects of prenatal exposure to air pollutants, herd immunity with rotavirus immunization, and a review of population-based cohort studies, among others.

In Evidence eMended this month, I'll be covering the long-term effects of term infant birth weight on lung spirometry in later life, trends in all-terrain vehicle riding and safety, fetal hepatic steatosis associated with maternal diabetes mellitus, and, my favorite this month, dueling dyslipidemia guidelines for adolescents and young adults.

I hope you can join me online.

Tuesday, June 30, 2015

Debunking Sunscreen Myths

June is one of those fortuitous (for me) months with 5 Tuesdays, meaning I allow myself one free rant on the final Tuesday, not necessarily tied to AAP Grand Rounds reviews. This fifth Tuesday's rhapsody, however, has a tie to my review a few weeks ago regarding sunscreen use. Shortly after I wrote the review, an article appeared in the Washington Post debunking 5 "myths" about sunscreen. It was well written and seemingly well researched; I even learned to pay more attention to expiration dates on the sunscreen containers.

However, the article had no references, and, as loyal readers would perhaps predict of me, I felt compelled to find the quality of evidence behind the 5 myths.* First, I went to the online version of the article, and that turned out to be a treasure trove of background information. In all I found 21 hyperlinks to various sources. I went through them all to see how solid the "evidence" was and whether the myths truly were discredited.
Be familiar with 2011 FDA sunscreen labeling rules.
From Bluerasberry via Wikimedia

Of the 21 links, only 4 directly linked to original articles published in the scientific literature. Two were purely basic-science oriented and not applicable directly to human medicine, though I was intrigued to know that the red "sweat" of the hippopotamus has sunscreen properties. Of the other 2 original articles, 1 was a review, more or less equivalent to a book chapter, and the other I might generously call a systematic review of sun care advertising in popular US magazines. The remaining 17 were online commentaries of varying degrees of quality (sort of like this blog?). Some originated from medical or scientific web sites: Skin Cancer Foundation, American Academy of Dermatology, WebMD, and Chemical & Engineering News; further investigation from these sites usually led to high-quality original sources but took a lot of time, Most links in the Post article, however, were from non-scientific media: 3 from the Washington Post itself, 1 from National Public Radio, 1 from the National Weather Service (well, maybe that's a bit scientific), 1 from US News and World Report, and 1 from Dr. Oz (if you're thinking I should put Dr. Oz in the medical or scientific web site category, read my appraisal of the Dr. Oz show, which was actually much too kind to him).

Ultimately I think the Post article was pretty much on target, but it took a lot of work to get to the origins of some of the evidence. I was thinking it would have been nice to provide links more directly useful to all types of consumers.

And, next time you're out of sunscreen, try rubbing up against a friendly hippo.

*The 5 myths mentioned in the Post article, which in my opinion were effectively debunked and therefore are false, are
1. You need sunscreen only on sunny days.
2. The SPF is what matters.
3. Darker-skinned people have less need for sunscreen.
4. That old bottle is just fine.
5. Sunscreen is toxic.

Tuesday, June 23, 2015

In Search of the Magic Mountain - New Tuberculosis Treatments

No, I'm not referring to the amusement park, but rather to Thomas Mann's difficult (for me) novel set in a Swiss tuberculosis sanatorium. Thankfully we've come a long way from those days, but much remains unsettled about TB management. The current article extends advancements in treatment of latent tuberculosis to the pediatric population.

Source: Villarino ME, Scott NA, Weis SE, et al. Treatment for preventing tuberculosis in children and adolescents. A randomized clinical trial of a 3-month, 12-dose regimen of a combination of rifapentine and isoniazid. JAMA Pediatr. 2015;169(3):247-255; doi:10.1001/jamapediatrics.2014.3158. See AAP Grand Rounds commentary by Dr. Javier Santisteban-Ponce (subscription required). 

PICO Question: Among children with latent tuberculosis infection, is combination therapy with rifapentine and isoniazid for 3 months as safe and effective as daily isoniazid monotherapy for 9 months?
Question type: Intervention
Study design: Randomized open-label controlled

Tuesday, June 16, 2015

Knee Injuries in Youth Sports: The Long-Term Picture

June is a big month for sports championships. We've got our annual season championships in men's college baseball, women's college softball, and men's professional hockey and professional basketball. A bonus this year is the women's World Cup soccer championships. These elite athletes aside, lots of evidence points to long-term disability and other risks for those experiencing knee injury in childhood. This study is the first report from a long-term follow up study.

Source: Whittaker JL, Woodhouse LJ, Nettel-Aguirre A, et al. Outcomes associated with early post-traumatic osteoarthritis and other negative health consequences 3-10 years following knee joint injury in youth sport [publishedonline ahead of print February 26, 2015]. Osteoarthritis Cartilage. doi:10.1016/j.joca.2015.02.021. See AAP Grand Rounds commentary by Dr. Cynthia LaBella (subscription required). 

PICO Question: Among adolescents and young adults with sports-related knee injuries, are early osteoarthritis symptoms and associated adverse health outcomes present 3-10 years post-injury compared to age- and sport-matched uninjured controls?
Question type: Prognosis
Study design: Retrospective cohort

Tuesday, June 9, 2015

It's Summertime - Did You Remember Sunscreen?

I was thinking about this article while applying my sunscreen prior to a strawberry-picking endeavor. Would I have been more careful if I had family history or personal prior history of melanoma? I'd like to think so, but this study and others suggest we can improve on sun protection practices in high risk groups.

Source: Glenn BA, Lin T, Chang, LC, et al. Sun protection practices and sun exposure among children with a parental history of melanoma. Can Epi Bio Prev. 2015;24(1):169-177; doi:10.1158/1055-9965.EPI-14-0650. See AAP Grand Rounds commentary by Dr. Mary-Jane Staba Hogan (subscription required).

PICO Question: Among children of melanoma survivors, what is their sun exposure history and use of sun protection practices?
Question type: Descriptive
Study design: Cross-sectional survey

Tuesday, June 2, 2015

Teen Dating Violence - An Epidemic?

Sometimes we have information that suggests we take action by changing our clinical practice, but we don't know how. This survey study provides some alarming information which, if the true figures are even half of what was reported, suggest primary care providers need to make some changes in preventive care approaches.

Source: Vagi KJ, Olsen EO, Basile KC, et al. Teen dating violence (physical and sexual) among US high school students: findings from the 2013 National Youth Risk Behavior Survey. JAMA Pediatrics. 2015;169(5):474-482. doi:10.1001/jamapediatrics.2014.3577. See AAP Grand Rounds commentary by Dr. Charlene Wong (subscription required).

PICO Question: Among US high school students who date, what is the prevalence of physical and sexual teen dating violence and what are the associated health-risk behaviors?
Question type: Descriptive
Study design: Survey

Monday, June 1, 2015

Happy June!

Well, summer is here, and time for some fun for everyone I hope. Of course, clinicians never get a very long vacation from continuing education, and June's AAP Grand Rounds can make for some nice beach/mountains/Star Trek convention reading. This month's topics include a breakthrough in peanut allergy management, help for teen mothers, mortality causes in premies, and many others. I'll be blogging weekly about a new regimen for treating latent TB (only 12 doses!), outcomes from knee injuries in young children, teen dating violence, and sun protection in children with parental history of melanoma.

Also, a special "treat" this month is my Fifth Tuesday wildcard post - stay tuned for that on June 30, and have a great summer!

Tuesday, May 26, 2015

What's In a Name? Neurobehavioral Disorder with Prenatal Alcohol Exposure (ND-PAE)

This is the second of the 2 articles on fetal alcohol syndrome (aka ND-PAE) in the June AAP Grand Rounds. Maybe I'm testy and in need of a vacation, but I found this article to be unnecessarily difficult to unravel and find a real take-home message.

Source: Chasnoff IJ, Wells AM, King L. Misdiagnosis and missed diagnosis in foster and adopted children with prenatal alcohol exposure. Pediatrics. 2015;135(2):264-270; doi:10.1542/peds.2014-2171. See AAP Grand Rounds commentary by Dr. Emily Todd (subscription required).

PICO Question: Among foster or adopted children referred for mental health evaluation, what is the frequency of missed diagnosis and misdiagnosis of fetal alcohol spectrum disorders?
Question type: Diagnosis
Study design: Retrospective chart review

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