Primary Prevention In Children Research Articles

Appropriate therapy for implantable cardioverter defibrillators used as primary versus secondary prophylaxis

Abstract Funding Acknowledgements Type of funding sources: None. Background Implantable cardioverter defibrillators (ICD) are used for primary prevention in children highly suspicious of life-threatening arrhythmias due to family history and malignant syncope. This practice might potentially result in a lower incidence of appropriate therapy compared with ICDs implanted for secondary prevention following documented ventricular arrhythmias. Purpose We aimed to compare the rate of appropriate therapy after ICD implantation for primary versus secondary prevention in young children. Method Using national ICD registry, this retrospective nationawide cohort study included children aged ≤15 years who received their first ICD between 1988 and 2020. Patient characteristics, medical history including mortality, device indication, therapy and complications were retrieved from electronic medical files. The primary endpoint was time to appropriate therapy, defined as shock or anti-tachycardia pacing for ventricular tachycardia or fibrillation. Results During the study period, a total of 81 ICDs (39 ICDs pr. million live births) were implanted. Among these, 79 were included in the outcome analysis due to retrievable follow-up data. At baseline, the majority had channelopathies (44%) or structural heart diseases (42%), whereas 25 (32%) and 54 (68%) devices were implanted as primary and secondary prophylaxis, respectively. The median age at primary implantation was 13.9 and 11.6 years (p<0.05), respectively. During a median follow-up of 9.0 (IQR: 4.8–13.9) years, 44 patients experienced appropriate device therapy and 6 died, with no difference for primary and secondary prevention recipients (p=0.34 and p=0.83). The 10-year cumulative incidence of appropriate therapy was 56% for primary prevention recipients and 68% for secondary prevention recipients, whereas 10-year survival probability was 90% (95% CI: 76-100%) and 81 % (95% CI: 63%-99%), respectively. All deaths were of cardiovascular cause. Bleeding occurred in 0 versus 2, infection in 5 versus 4, and inappropriate shock therapy in 2 versus 11 patients, with an overall combined trend towards more events for ICDs implanted as secondary prophylaxis (p=0.08). Conclusions ICD implantation in young children was relatively rare. The rate of appropriate therapy was similar among primary and secondary ICD recipients, indicating too restrictive primary prophylaxis implantation, which should be investigated in future studies. The incidence of complications was highest among secondary ICD recipients.

“Dental Health” preventive program as a stage of rehabilitating children with cognitive developmental disabilities

Relevance. One of the paramount directions of preventive dentistry is the development of the author's methods of organization and implementation of dental diseases prevention programs in children with cognitive developmental disabilities, allowing for prevention customization, taking into account the features of child development with disabilities, as well as the combination of many objective factors. The study aimed to increase the efficiency of mentally-retarded children's rehabilitation by improving the dental disease prevention program.Materials and methods. The study involved 140 children diagnosed with moderate mental retardation and comparatively analyzed two methods over three years. Group 1 included 71 subjects aged 8-11 years trained according to "Dental Health", the author's dental and hygiene education program, developed and adjusted to the psychophysical needs of the child development. Group 2 consisted of 69 subjects, trained according to the dental and hygiene education program provided only by the teachers during classes on household chores. We evaluated the effectiveness of the "Dental Health" prevention program introduced into the specialized educational process by the following indices DMFT, simplified oral hygiene index (OHI-S); PMA index modified by Parma assessed the condition of the gums. Statistical data were processed using the IBM SPSS Statistics 18.0 application sof tware package.Results. The effectiveness analysis of the author's program for children with moderate mental retardation revealed that the level of oral hygiene in the children increased from "poor" to "good" (2.1 ± 0.3 points to good 0.2 ± 0.1 points); gingival inflammation decreased from 24.6 ± 0.5% to 14.4 ± 0.2%. Classes on dental education and hygiene training helped children with cognitive developmental disabilities to orient better in self, time and place; helped to improve memory, increase vocabulary, form new knowledge and skills, and gradually form effective communication based on the child's intellectual deficiency severity.Conclusions. The developed educational program "Dental Health" for dental diseases primary prevention in children with cognitive developmental disabilities allowed the formation of stable oral care skills, proved by a good score of oral hygiene indices.

MHealth Interventions to Reduce Physical Inactivity and Sedentary Behavior in Children and Adolescents: Systematic Review and Meta-analysis of Randomized Controlled Trials.

BackgroundChildren and adolescents increasingly do not meet physical activity (PA) recommendations. Hence, insufficient PA (IPA) and sedentary behavior (SB) among children and adolescents are relevant behavior change domains for using individualized mobile health (mHealth) interventions.ObjectiveThis review and meta-analysis investigated the effectiveness of mHealth interventions on IPA and SB, with a special focus on the age and level of individualization.MethodsPubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library were searched for randomized controlled trials published between January 2000 and March 2021. mHealth interventions for primary prevention in children and adolescents addressing behavior change related to IPA and SB were included. Included studies were compared for content characteristics and methodological quality and summarized narratively. In addition, a meta-analysis with a subsequent exploratory meta-regression examining the moderating effects of age and individualization on overall effectiveness was performed.ResultsOn the basis of the inclusion criteria, 1.3% (11/828) of the preliminary identified studies were included in the qualitative synthesis, and 1.2% (10/828) were included in the meta-analysis. Trials included a total of 1515 participants (mean age (11.69, SD 0.788 years; 65% male and 35% female) self-reported (3/11, 27%) or device-measured (8/11, 73%) health data on the duration of SB and IPA for an average of 9.3 (SD 5.6) weeks. Studies with high levels of individualization significantly decreased insufficient PA levels (Cohen d=0.33; 95% CI 0.08-0.58; Z=2.55; P=.01), whereas those with low levels of individualization (Cohen d=−0.06; 95% CI −0.32 to 0.20; Z=0.48; P=.63) or targeting SB (Cohen d=−0.11; 95% CI −0.01 to 0.23; Z=1.73; P=.08) indicated no overall significant effect. The heterogeneity of the studies was moderate to low, and significant subgroup differences were found between trials with high and low levels of individualization (χ21=4.0; P=.04; I2=75.2%). Age as a moderator variable showed a small effect; however, the results were not significant, which might have been because of being underpowered.ConclusionsEvidence suggests that mHealth interventions for children and adolescents can foster moderate reductions in IPA but not SB. Moreover, individualized mHealth interventions to reduce IPA seem to be more effective for adolescents than for children. Although, to date, only a few mHealth studies have addressed inactive and sedentary young people, and their quality of evidence is moderate, these findings indicate the relevance of individualization on the one hand and the difficulties in reducing SB using mHealth interventions on the other.Trial RegistrationPROSPERO CRD42020209417; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209417

The Role of Ethnicity in School-Based Obesity Intervention for School-Aged Children: A Pilot Evaluation.

Rates of obesity have risen disproportionately for ethnic minority youth in the United States. School-based programs may be the most comprehensive and cost-effective way to implement primary prevention in children. In this study we evaluated the effect of a school-based obesity prevention on the outcome of body mass index percentile (BMI%), with baseline weight class and ethnicity examined as moderators. Participants (N = 125), ages 7-11 (56% female) from 4 urban, low-income, ethnic minority (58% black, 42% Latino) schools were recruited. Two schools received the Urban Initiatives Work to Play health intervention, and 2 demographically matched schools served as wait-list controls. Hierarchical multiple regression was used to analyze the independent and interactive effects of key variables on BMI%. An interaction between intervention status and ethnicity revealed Latino youth in the intervention had lower BMI% than those in the control group. Participation did not cause BMI% outcomes to decrease for black participants. The study demonstrates the intervention is effective, but that the effectiveness varies across ethnicity. Interventions can be made more efficient and cost-effective by targeting youth of a common ethnicity that has shown empirical responsiveness to certain program elements.

Pratique médicale dans la prise en charge de l’hypertension artérielle comme facteur de risque rénal en pratique médicale générale, et en prévention primaire, chez l’enfant en milieu scolaire et la femme enceinte dans la région d’Annaba (Algérie)

ObjectiveTo study medical practice in the management of hypertension as a factor in renal risk in general medical practice and primary prevention in children at school, and pregnant women under prenatal monitoring. MethodThe longitudinal study, observational over a year, focused on medical practice in schools, maternal health and medical practice among 100 physicians (general practitioner and specialist practitioner) in Annaba (Algeria). ResultsIn children in schools, measurement of blood pressure is never done on the grounds because this gesture is considered unnecessary in 100% of cases. In pregnant women, the measurement of blood pressure is not performed in more than 26% of pregnant women because it is deemed unnecessary by the midwife in 89% of pregnant women and default material in 11% of they. In current medical practice, 69% of doctors routinely take blood pressure. For the rest, represented mainly by specialists, it is the patient who does not justify. Sixty-two percent of physicians, that is hypertension, above 140/90mmHg, and 15% of physicians that is hypertension, above 145/95mmHg. Among the physicians, 58.7% did not use urinary strip, either, because they think that this review should be done in a laboratory (64.8%), or because the urinary strip are not available at even consulting (35.2%). ConclusionInadequacies in the coverage (care) of the HTA are real. Their effects on the progress of prevalence of the renal insufficiency chronic terminal treated are possibly important.

Primary Prevention of Mental Disorders in Children of Mentally Ill Parents. The Kanu Programme "Canoe--Moving Jointly Forward"

Children of parents who suffer from mental health disorders are more likely to develop mental disorders than children of parents not suffering from mental disorders. For children at risk, preventive strategies are hardly available and, if available, rarely supported by a scientific evaluation. "Kanu - Gemeinsam weiterkommen (canoe - moving jointly forward)" is a preventive strategy that was developed within a research project focusing on primary prevention in children who live in families with parents affected by mental disorders. The intervention is characterised by a multi-modular concept and was tested in the adult psychiatric setting. Preliminary results indicate a preventive impact of the intervention programme.

Noninvasive imaging in children with hypertension

Clearly not all children with a high blood pressure (BP) reading need imaging investigation, so some form of selection must be applied. First, the significance of the BP should be established. Measurements made in a clinic may overestimate (or less commonly underestimate) a child’s hypertensive status. To avoid this problem 24-h ambulatory blood pressure monitoring (ABPM) is often used to provide a more comprehensive assessment. ABPM avoids the problem of overestimating hypertension caused by a “white coat effect.” It also allows assessment of BP during sleep, which may be important because absence of nocturnal dipping appears to be a strong indicator of clinically significant hypertension [10]. Nevertheless, hypertension in children is defined as a BP greater than the 95th centile for age, gender and height on three different occasions [5, 11]. (By definition, then, exactly 5% of children should be hypertensive. Why, then, are only 3–4% of children hypertensive? The reason is likely to be regression to the mean, i.e. measuring BP on three separate clinic visits decreases the probability that all will exceed the 95th centile. Another way of looking at this is that the normative values are too high. An alternative explanation is that we are getting systematically lower BP readings because of the replacement of mercury sphygmomanometers.) Prehypertension is defined as BP between the 90th and 95th centiles (or more than 120/80 mmHg, even if this is below the 90th centile). Prehypertension is not normally treated with drugs unless the child has comorbidities such as diabetes mellitus, chronic kidney disease or left ventricular hypertrophy. All children with BP >90th centile should be given advice about lifestyle changes, including weight loss for those who are overweight or obese (body mass index >30 kg m−2), instituting a healthy, low-sodium diet and getting regular physical activity. Adolescents should be advised to avoid tobacco and alcohol [12, 13, 14, 15]. Although this seems a sensible attempt at primary prevention in children, there is actually very little evidence that it is effective in reducing BP. The threshold for commencing drug treatment in children is stage 2 hypertension, which is defined as BP >99th centile plus 5 mmHg. There is a good case that stage 2 patients should be referred to centers with special expertise in the diagnosis and treatment of pediatric hypertension [11, 16, 17]. Children with stage 1 hypertension are only treated if they have comorbidities or symptoms or fail to respond to lifestyle changes [16].

Primary prevention for children of mentally ill parents: the Kanu-program

Aim The objective of the study is to develop, implement and evaluate a program of primary prevention for children of mentally ill parents. The main aim of the program is to reduce the burden on children and to improve their skills.

Frequency of Cardiac Death in Children With Idiopathic Dilated Cardiomyopathy

The prognosis in children with idiopathic dilated cardiomyopathy (IDC) is guarded, with the 5-year mortality rate ranging from 14% to 50%, owing to sudden cardiac death (SCD) or pump failure. The risk factors for SCD in adults with IDC include asymptomatic nonsustained ventricular tachycardia and poor left ventricular function. It is unclear whether these findings can be extrapolated to the pediatric population. A retrospective review of all patients with the diagnosis of IDC seen at a single institution from 1990 to 2004 was performed. A total of 85 patients (46 males), with a median age of 3.8 years (0 days to 17.3 years) were studied. The mean left ventricular ejection fraction was 25 +/- 12% (median 23%, range 45% to 45%) at presentation. The following arrhythmias occurred at presentation or during the initial hospitalization: nonsustained ventricular tachycardia in 6, sustained ventricular tachycardia or fibrillation in 1, supraventricular arrhythmias in 6, and both atrial and ventricular arrhythmias in 1. During a subsequent hospitalization or outpatient follow-up, 7 patients had the following arrhythmias: supraventricular arrhythmias in 2, nonsustained ventricular tachycardia in 4, and both atrial and ventricular arrhythmias in 1. The cumulative survival rate was 40% at a mean follow-up of 6.2 years (95% confidence interval 4.4 to 8.1). One single episode of SCD occurred in 1 patient without a history of sustained arrhythmias. In conclusion, in children with IDC, despite the low left ventricular ejection fraction and presence of ventricular arrhythmias, only one episode of SCD occurred in this group of patients. Given the 1% incidence of SCD in this cohort, the use of implantable cardioverter-defibrillators as primary prevention in children with IDC might not be indicated.

Are We Really Addressing the Core of Children’s Environmental Health?

More than 3 million children 10 million child deaths annually throughout the world [World Health Organization (WHO) 2005]. Some factors of susceptibility, including race, ethnicity, and socioeconomic status, are generally not well understood in the context of risk assessment. For children’s environmental health the focus is almost exclusively on age-related differences and exposure hazards, without much discussion of the myriad additional factors including nutritional status, preexisting health status, multiple exposures, and gender differences that can affect the life course of a child.

Overweight prevention in adolescents and children (behavioural and environmental prevention).

Health political backgroundIn 2006, the prevalence of overweight and adiposity among children and adolescents aged three to 17 years is 15%, 6.3% (800,000) of these are obese.Scientific backgroundObese children and adolescents have an increased body fat ratio. The reasons for overweight are – among others – sociocultural factors, and a low social status as determined by income and educational level of the parents. The consequences of adiposity during childhood are a higher risk of metabolic and cardiovascular diseases and increased mortality in adulthood. Possible approaches to primary prevention in children and adolescents are measures taken in schools and kindergarten, as well as education and involvement of parents. Furthermore, preventive measures geared towards changing environmental and living conditions are of particular importance.Research questionsWhat is the effectiveness and efficiency of different measures and programs (geared towards changing behaviour and environmental and living conditions) for primary prevention of adiposity in children and adolescents, with particular consideration of social aspects?MethodsThe systematic literature search yielded 1,649 abstracts. Following a two-part selection process with predefined criteria 31 publications were included in the assessment.ResultsThe majority of interventions evaluated in primary studies take place in schools. As the measures are mostly multi-disciplinary and the interventions are often not described in detail, no criteria of success for the various interventions can be extrapolated from the reviews assessed. An economic model calculation for Australia, which compares the efficiency of different interventions (although on the basis of low evidence) comes to the conclusion that the intervention with the greatest impact on society is the reduction of TV-ads geared towards children for foods and drinks rich in fat and sugar. There is a significant correlation between adiposity and socioeconomic deprivation. The lack of interventions (especially preventive measures geared towards changing environmental and living conditions) and studies focusing on this population group is noticeable.DiscussionThere are only a few primary studies of high quality on adiposity prevention in children and adolescents. Especially studies which compare different measures are lacking. This holds also true for the economic analysis, which seems logical insofar, as the basis for economic analyses are usually primary studies (preferably randomized controlled trials (RCT)) due to their evidence level). Studies on interventions geared towards changing environmental and living conditions and towards specific population groups (i. e. the socially disadvantaged) are hardly available.ConclusionsThere are hardly any primary studies of high quality on adiposity prevention in children and adolescents, especially studies which compare different measures are lacking. Interventions geared towards specific population groups (particularly for the socioeconomically disadvantaged) are specifically underrepresented. Establishing such studies is an essential requirement of adiposity prevention. Recommended are a combination of measures geared towards changing environmental and living conditions and towards specific population groups. Furthermore, it is recommended to systematically register future programs (preferably online) in order to be able to draft criteria of success.

Pencegahan primer pada anak yang berisiko karies tinggi (Primary prevention in children with high caries risk)

Oral and dental health has got improvement tremendously over the last century but the prevalence of dental caries in children has remained a significant clinical problem. Caries risk varies between individuals according to each subject’s balance between factors exposing to and protecting from caries attack. It is important to assess the risk of caries for all patients on a routine basis. Caries risk is divided into three levels: high, moderate, and low. Thereby, the dental professional is better to make a specific prevention and treatment recommendations to reduce a child risk and improve overall oral health. The goal of caries-risk assessment and preventive treatment is to eliminate caries or at least to reduce the high-caries occurrence down to the level of the remaining part of the age group. Preventive treatment is divided into three parts: primary, secondary, and tertiary prevention. This paper describes the primary prevention in children with high caries risk by behavior modification and tooth protection. Behavior modification is about dental health education, oral hygiene, diet and sugar consumption, sugar-free chewing gum and sugar-free medicines. Tooth protection is about sealant, usage of flouride and chlorhexidine.

What can we do in secondary prevention of cigarette smoking?

Cigarette smoking kills about six million smokers per year worldwide, and the cigarette has become a symbol of threat to mankind, particularly in industrialized countries. Tobacco smoking causes signs of addiction due to nicotine, but it is the inhaled and exhaled smoke that causes damage to health if cigarette smoking is continued for one or more decades. It is very difficult to attain a high efficacy of stopping smoking using methods of primary prevention in children and young adults. Secondary and tertiary prevention methods use medical and psychological support to the smoker (behavioural and aversion therapy) as well as medical advice in combination with drugs such as nicotine replacement or bupropion. Using a combination of these methods can increase effectiveness up to 45%. Use of nicotine replacement therapy (NRT) in combination with medical advice is the method of smoking cessation recommended by the World Health Organization. Bupropion causes several severe side effects which are not observed with NRT. This article reviews various NRT formulations, including chewing gum, patch, nasal spray, tablet and inhaler, and our experience of using NRT in medical practice, such as adverse events, withdrawal symptoms and the efficacy of NRT in patients with coronary heart disease (angina pectoris, cardiac arrhythmias, etc.), are briefly mentioned. Overall, we need greater efforts in practising primary and secondary prevention among current and future physicians to solve the health problems associated with tobacco use in many nations.

Fostering Prevention in the Pediatric Population

Although cardiovascular disease is seldom manifested clinically before the fourth or fifth decade of life, atherosclerotic cardiovascular disease processes begin in early childhood. Fatty streaks and atherosclerotic lesions have been found post-mortem in the aorta and coronary vessels of children as young as 6 years of age. The modifiable risk factors for heart and vascular disease that are found in adults, such as hypertension, dyslipidemia, smoking, obesity, and physical inactivity, are also present in children. Available evidence emphasizes the need for both population-based and individual approaches to primary prevention of CVD beginning in childhood. This article summarizes this evidence and outlines strategies for promoting primary prevention in children and adolescents.

Mite allergen exposure is a risk for the incidence of specific sensitization

Background: Mite allergen exposure is essential for the process of specific allergic sensitization. However, it is not clear whether incidence of specific sensitization at school age depends on the level of mite antigen exposure. Therefore the relationship between mite allergen exposure and incidence of specific sensitization was investigated. Methods: Eighteen hundred twelve primary school children were enrolled in a population-based 2-year follow-up study. In three consecutive skin prick tests (SPTs), each 12 months apart, sensitization to Dermatophagoides pteronyssinus (Dpt) and six non-Dpt allergens was ascertained. To assess exposure to Der p I between the first and second SPTs (period I) and the second and third SPTs (period II), the amount of antigen per gram of dust (taken from the children's mattresses was measured. By using the SPT reactions to Dpt as a basis, conversions after “no wheal” were classified as doubtful incidence (average yearly incidence = 6.7%) or definite incidence (average yearly incidence = 3.2%). Then, with the use of multiple logistic regression, the risk of exposure to Der p I (medians: 1.4 μg/gm in period I, 1.6 μg/gm in period II) was analyzed with adjustment being made for gender, low gestational age, parental atopy, and initial sensitization to non-Dpt allergens. Results: Regarding doubtful incidence, the analysis failed to identify a reliable cutoff point of exposure. For definite incidence, the Der p I exposure represents a significant risk in the total population, starting from a concentration of 9 μg/gm. This effect is modified by an initial sensitization to non-Dpt allergens: for these children exposure to concentrations above 2 μg/gm poses a significant risk, whereas for the population without other initial sensitizations, only an extremely high cutoff limit (>80 μg/gm) gains significance. Conclusion: Our data suggest that a concentration limit of 2 μg Der p I antigen per gram of dust should be regarded as minimal avoidance level for primary prevention in children with sensitization to other inhalant allergens. (J ALLERGY CLIN IMMUNOL 1994;94:44-52.)

BOOK REVIEWS

Books reviewed in this article: Sexually Abused Children and Their Families. Edited by P. B. Mracek and C. H. Kempe. Acquiring Language in a Conversational Context. Christine Howe. Behavioural Pediatrics and Child Development: a Clinical Handbook (2nd Edn). T. J. Kenny and R. L. Clemmens. Handbook of Behavioural Pediatrics. R. W. Block and F. C. Rash. The Evaluation and Care of Severely Disturbed Children and Their Families. Edited by Leon Hoffman. Hysteria. Edited by A. Roy. Child and Adolescent Psychopathology. Irving Welner. Incest: a Family Pattern. Jean Renvoize. The Process of Reading. D. C. Mitchell. The Troubled and Troubling Child. Nicholas Hobbs. The Deepening Shade: Psychological Aspects of Life‐threatening Illness. B. Sourkes. First Child, Second Child…. B. Wilson and G. Edington. Consequences of Child Abuse. M. A. Lynch and J. Roberts. Inventing Motherhood. The Consequences of an Ideal. Ann Dally. Special Education and Social Control. Invisible Disasters. J. Ford, D. Mongon and M. Whelan. Siblings. Judy Dunn and Carol Kendrick. The Child in his Family: Children in Turmoil: Tomorrow's Parents. Edited by E. J. Anthony and C. Chiland. Temperamental Differences in Infants and Young Children. Edited by Ruth Porter and Geralyn M. Collins. Psychology and Medicine. Edited by David Griffiths. Partnership with Parents. P. Mittler and H. Mittler. Healthier Children–Thinking Prevention. Primary Prevention for Children and Families. Schools and Disruptive Pupils. D. Galloway, T. Ball, D. Bloomfield and R. Seyd. The Star Profile: Social Training Achievement Record. Instruction manual and record sheet set. C. Williams. Psychoanalytic Psychology of Normal Development. Anna Freud. Pedestrian Accidents. Edited by Antony T. Chapman, Frances M. Wade and Hugh C. Foot. Institutional Abuse of Children and Youth. Edited by Ranae Hanson.

Dutile, F. N., Foust, C. H., & Webster, D. R. (Eds.). Early childhood intervention and juvenile delinquenry. Lexington, MA: Lexington Books, D. C. Heath & Co., 1982, 193 pp., $23.95. Frank, M. (Ed.) Primary prevention for children and families. New York: Haworth Press, 119 pp., $20.00

Dutile, F. N., Foust, C. H., & Webster, D. R. (Eds.). Early childhood intervention and juvenile delinquenry. Lexington, MA: Lexington Books, D. C. Heath & Co., 1982, 193 pp., $23.95. Frank, M. (Ed.) Primary prevention for children and families. New York: Haworth Press, 119 pp., $20.00

Primary prevention for children: a framework for the assessment of need.

This paper discusses the role of needs assessment procedures in the development of effective primary prevention strategies for children and youth. A number of techniques which may be employed in the assessment of need for such services are presented and their strengths and limitations for such application are discussed. Particular problems for needs assessment planning and implementation stemming from differences in the goals and objectives of preventive, as opposed to more traditional mental health services for children, are elaborated and possible strategies for their resolution suggested.