Preventing accidents in children under five

PHE have produced a new guide with the Child Accident Prevention Trust (CAPT) that equips all staff who work with children under five to help reduce the number of deaths and injuries | PHE

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Whether you work for a health service, early years education, play schemes, nurseries or are a childminder, this guide will help you help parents and carers keep their children safe from injuries. A serious accident has the potential to cause life-changing disability and disfigurement. A toddler who gets a severe bath water scald will require years of painful skin grafts. A fall at home can result in permanent brain damage. As well as the immediate physical impact, the injuries can have longer term effects on school readiness, education, employment, emotional wellbeing and family relationships.

This guidance, produced in association with the Child Accident Prevention Trust (CAPT), is for all staff working with children under 5 years and covers the 5 injury priorities:

  • choking, suffocation and strangulation
  • falls
  • burns and scalds
  • poisoning
  • drowning

The guidance also covers fire and roads. Each injury priority includes data for England, actions for health professionals and safety messages for parents and carers.

Read  the full overview here

Read the full guidance here

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First do no harm – The impact of financial incentives on dental x-rays

The Centre for Health Economics in York has published ‘First do no harm – The impact of financial incentives on dental x-rays’.

This paper assesses the impact of dentist remuneration on the incidence of potentially harmful dental x-rays. Unique panel data was used which provided details of 1.3 million treatment claims by Scottish NHS dentists made between 1998 and 2007. Controlling for unobserved heterogeneity of both patients and dentists the researchers estimated a series of fixed-effects models that are informed by a theoretical model of x-ray delivery and identify the effects on dental x-raying of dentists moving from a fixed salary to fee-for-service and patients moving from co-payment to exemption.

The study established that there are significant increases in x-rays when dentists receive fee for service rather than salary payments and patients are made exempt from payment. There are further increases in x-rays when a patient switches to a fee for service dentist relative to them switching to a salaried one.

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Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries

The Cochrane Database of Systematic Reviews has published ‘Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries’.

Vitamin A deficiency is a major public health problem in low and middle income countries. Vitamin A supplementation in children six months of age and older has been found to be beneficial, but no effect of supplementation has been noted for children between one and five months of age. Supplementation during the neonatal period has been suggested to have an impact by increasing body stores in early infancy.

Given the high burden of death among children younger than five years of age in low and middle income countries, and the fact that mortality in infancy is a major contributory cause, it is critical to obtain sound scientific evidence of the effect of vitamin A supplementation during the neonatal period on infant mortality and morbidity. Evidence provided in this review does not indicate a potential beneficial effect of vitamin A supplementation among neonates at birth in reducing mortality during the first six months or 12 months of life.

This finding shows an absence of a clear indication of the biological mechanism through which vitamin A could affect mortality. Along with substantial conflicting findings from individual studies conducted in settings with potentially varying levels of maternal vitamin A deficiency and infant mortality, absence of follow-up studies assessing any long-term impact of a bulging fontanelle after supplementation and the finding of a potentially harmful effect among female infants, additional research is warranted before a decision can be reached regarding policy recommendations for this intervention.

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The young adult follow-up of the longitudinal English and Romanian Adoptees study

Sonuga-Barke E, Kennedy M, et al, The Lancet Online First, 22nd February 2017

Research Published in the Lancet looked at  ‘Child-to-adult neurodevelopmental and mental health trajectories after early life deprivation: the young adult follow-up of the longitudinal English and Romanian Adoptees study’.

Time-limited, early-life exposures to institutional deprivation are associated with disorders in childhood, but it is unknown whether effects persist into adulthood.

To the knowledge of the researchers, this is the first large-scale study to follow a cohort of children who suffered profound but circumscribed periods of institutional deprivation through to adult life, allowing direct comparison of their post-institutional developmental trajectories across multiple neurodevelopmental and mental health domains.

The finding that early institutional deprivation is associated with a pervasive pattern of long-term impairment and burden is relevant to the health and wellbeing of the very large numbers of children worldwide still exposed to depriving and neglectful conditions. Even when the deprivation experienced is less severe than in the Romanian institutions, studies suggest that the cluster of neurodevelopmental problems seen in the English and Romanian Adoptees study sample are common in other samples of institutionalised but well cared for children and adolescents.

Questions about the extent to which such problems will persist to adulthood in these groups, and whether the findings can be generalised to children who experience other forms of abuse or trauma, remain to be investigated fully. The findings highlight the importance of documenting early-life adversity during clinical assessments. Records of adversary can aid in the planning of services to address the especially persistent and complex nature of the problems such individuals have. The results suggest that taking account of such histories is likely to be important in planning adult transitional services so that affected individuals have continued access to the specialist services they need.

Read the full text here

 

Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble

Kontis V,  Bennett JE et Al; The Lancet Online First,  21 February 2017

An article has been published in the Lancet ‘ Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble’.

Life expectancy is projected to increase in all 35 countries with a probability of at least 65% for women and 85% for men.

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Image caption: http://thelancet.com

The researchers conclude that the health-care needs of these people go beyond simply increasing the number of facilities and personnel, itself a challenge in the current era of austerity, and should involve considerations about how and where care is delivered including more integrated care in the community setting or even at home. At the same time, healthy ageing through the life course can prevent or delay the chronic conditions that affect older people; assistive technologies that compensate for loss of sensory and motor abilities, and appropriate changes to the built environment and transportation services can support independent living and mobility.

Social security and pensions will face additional payouts with extended longevity, which will further stress them unless work and retirement practices change, for example through gradual transition to retirement or later retirement age. Although rising life expectancy necessitates policies that can support healthy ageing, reframing of education–work–retirement practices, and investment in health and social care, our projections show the continued success of extending longevity.

Read the full text of the article here

Older people miss out on psychological therapies

Depression in older people is common, under-diagnosed, under-treated and attracts “therapeutic nihilism”, according to Professor Alistair Burns, NHS England’s National Clinical Director for Dementia | OnMedica

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Prof Burns say while one in five older people have clinical depression, “contrary to some popular and professional opinion, it is eminently treatable”. He wants clinicians to offer a wider range of treatments and therapies to target depression and anxiety which are both associated with increased risk of more serious physical and mental health problems.

“Treatments for depression in older people are largely the same as in younger people and there is high quality and convincing evidence that older people respond very well to interventions,”

While exercise is a “very effective” treatment for depression, Prof Burns cites the Health Survey for England which showed that only 18% of men and 19% of women aged 55-64 undertake the recommended amount of regular exercise, a figure falling to 10% and 2% for people aged 75-85.

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Screening for Chlamydia trachomatis Infections in Women

Wiesenfeld, , H.C. (2017) New England Journal of Medicine. 376:765-773

Chlamydial infection may result in pelvic inflammatory disease, infertility, and ectopic pregnancy. Chlamydia screening is recommended in sexually active women younger than 25 years of age and other women at increased risk and can be performed on vaginal swabs or urine samples.

Read the full abstract here