HEADS UP

Abstract

A number of studies have explored factors determining whether to admit a child with bronchiolitis to hospital, but few are clinically useful. A retrospective UK study used logistic regression to analyse presenting clinical parameters as predictors of hospital admission.1 Of 449 infants <12 months old presenting to one hospital with a clinical diagnosis of bronchiolitis, 163 (36%) were admitted. The authors found a number of clinical factors that predicted hospitalisation, but selected the five ‘best’ predictors [age, duration of symptoms, respiratory rate, heart rate and oxygen saturation] to generate a scoring system (see Table). A score of 3 or greater demonstrated acceptable diagnostic accuracy. The authors do not propose use of the scoring system in an absolute way to rule in or rule out admission, but suggest that it might be useful to guide inexperienced clinicians in when to seek senior review. Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au A recent study from Cincinnati Children's Hospital used an electronic monitoring system to accurately assess adherence in 124 children (age 2–12 years) with newly diagnosed epilepsy.1 All children were prescribed twice daily medication, with either carbamazapine or valproic acid. Despite parents being aware that the cap on the bottle was electronically recording the dates and times when medication was given, only 42% had ‘near perfect’ adherence over the first 6 months. A number of patterns or trajectories of non-adherence were observed (see Figure), but of particular concern were the 13% who had ‘severe, early’ non-adherence, and a further 7% with ‘delayed, but severe’ non-adherence. The reminder had either ‘moderate’ non-adherence (13%), or ‘mild’ non-adherence (26%). The specific pattern of adherence was usually established within the first month of therapy. Socioeconomic status (SES) was the only independent predictor of adherence trajectory, being worse in the lower SES groups. However, given the small sample size and large age range, the study has limited power to detect significant predictors. Six-month adherence Trajectories of Children with New-Onset Epilepsy. Reviewer: Craig Mellis, craig.mellis@sydney.edu.au Australia was the first country to introduce an extensive national vaccination programme with human papillomavirus (HPV) vaccine starting in April 2007. Australia instituted sustained school-based immunisation of all 12–13-year-old girls and, in addition, a catch-up programme for 13–17-year-olds through schools and 18–26-year-olds through general practice. Three-dose vaccine coverage in Victoria is estimated at 79% of first year high school students and 71% of final year students. The Victorian Cytology Service has documented a 38% decrease (95% Confidence Intervals 16–61%) in ‘high-grade’ cervical abnormalities in girls younger than 18 years in the 3 years since HPV vaccine introduction.1 These lesions are purported to be precursors of cervical cancer, although the definition used included some early changes not so convincingly associated with cancer. A similar decrease has not yet occurred in older women, suggesting the decline in younger girls is truly a result of the immunisation programme. These promising data should help us persuade vacillating girls and their parents of the considerable benefits of HPV vaccination. Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au Children are sleeping less as they grow more obese, but is there a link? A longitudinal study from New Zealand called the FLAME study (Family, Lifestyle, Activity, Movement and Eating) used some novel approaches to address this question.1 To measure activity, children aged 3–5 years wore an accelerometer, which is like a sophisticated pedometer, but at night as well as during the day, thus obtaining a measure of sleep duration. Body composition was measured using bioelectrical impedance and, from 5–7 years, dual energy X-ray absorptiometry (DXA). Children aged 3–5 years slept an average of 11 hours a night. Body Mass Index (BMI) at age 3–5 was strongly correlated with sleep: after adjusting for confounders each extra hour of sleep was associated with a 0.48 reduction in BMI (95% confidence interval 0.01–0.96) and a 39% reduction in the risk of being overweight (>85th centile for BMI). The differences in BMI were mainly due to increased fat deposition. These data strongly support a causal link between reduced sleep in pre-schoolchildren and obesity. The authors conclude that young children who do not get enough sleep are at increased risk of becoming overweight. Link: http://www.bmj.com/content/342/bmj.d2712.full.pdf Reviewers: Louise Baur, LouiseB3@chw.edu.au; David Isaacs, david.isaacs@health.nsw.gov.au