With millions of journal articles published yearly, it is impossible to keep up. Every month we ask some of our friends from PERUKI (Paediatric Emergency Research in the UK and Ireland) to point out something that has caught their eye. This time we have our primary care colleagues from Chesterfield and Derbyshire Dales have taken over, putting a primary care slant on the most recent wrap up…
Article 1: Can online educational videos broaden young women’s contraceptive choice?
Mazza D, Buckingham P, McCarthy E, Enticott J. Can an online educational video broaden young women’s contraceptive choice? Outcomes of the PREFER pre-post intervention study. BMJ Sex Reprod Health. 2022 Oct;48(4):267-274. doi: 10.1136/bmjsrh-2021-201301. Epub 2022 Feb 28. PMID: 35228303.
What’s it about?
The PREFER study looked at whether watching a bespoke online made educational affected decision-making around contraceptive choices.
The study, conducted in Australia, used a pre/post-intervention model. 322 participants, between 16 and 25, were recruited via Facebook. Participants took part in three surveys – one before the video was shown, one immediately after and then one six months later. They rated their knowledge of contraceptives using a Likert scale at each stage.
There was a 10-fold increase in participants feeling more knowledgeable about all contraceptive options after watching the video. Interestingly, contraception preferences also changed, with more participants choosing LARC (Long Acting Reversible Contraceptives) over COCP (Combined Oral Contraceptive Pill) or barrier methods. At six months, there was a modest increase (of 4.3%) in the use of LARCs.
Why does it matter?
According to Public Health England, 45% of UK pregnancies are unplanned. The UK school curriculum contains no structured teaching about contraception, and many young people are not aware of the options available.
Only 6% of participants in this study reported a reasonable level of knowledge about contraceptive methods before watching the video. After the short educational video, young people felt more informed about their options, and there was a higher use of LARCs. These are the preferable contraceptive choice, so this point appears to have been well communicated in the video.
This study also demonstrated the usefulness of social media as a research platform. Though Facebook was the only platform used in this study, it does suggest that there is scope for this methodology to become more widespread.
Clinically Relevant Bottom Line
A short educational video promoted via social media can increase the understanding and use of LARCs. This resource could easily be used by clinicians when counselling young people about contraception.
Reviewed by: Nikesh Bhatt and Lauren Peaker
Article 2: Did COVID-19 affect developmental milestones in 12 months olds?
Byrne, S. et al. (2023) Social Communication Skill Attainment in babies born during the COVID-19 pandemic: A birth cohort study, Archives of Disease in Childhood. Available at: https://adc.bmj.com/content/108/1/20 (Accessed: 16 May 2023).
What’s it about?
This study examined the developmental outcomes of 12 months olds from a “pandemic” cohort of babies (309 babies). Babies born between March-May 2020 were compared with a historic baseline” cohort of babies (1629 babies) born between 2008-2011. The assessment was via a parental-reported questionnaire close to the child’s first birthday.
Taking into account certain baseline characteristics, the data showed that: fewer infants in the pandemic cohort had one definite and meaningful word (76.6% vs 89.3%), could point (83.8% vs 92.8%) or wave bye-bye (87.7% vs 94.4%) at the 12-month assessment.
There were significant differences between the cohorts: one definite and meaningful word (RR 0.86), ability to point (RR 0.91) and ability to wave bye-bye (RR 0.94)] with a confidence interval of 95%.
Unfortunately, the developmental assessment was not standardized and given that it was completed by parents, it was open to recall bias. The researchers and parents were not blinded to the purpose of the study.
There were a number of key confounding factors to consider, including differences in maternal education and mental well-being, as well as single-parent status, nutrition, housing, and socioeconomic status.
Why does it matter?
We don’t know the impact of sustained lockdowns on the social development of children who will have missed out on opportunities to socialise outside the family unit. There has been a significant increase in the number of children being referred for an autism assessment leading to long waiting lists and tightening of referral criteria.
Clinically Relevant Bottom Line
Despite its limitations, this study showed that lockdown delayed children attaining key social communication by one year of age. We can use this information in our discussions with families. It might also provide some insight into the effects of lockdown on the social development of children.
Reviewed by: Kathryn Allen, Atif Ali, and Gireesha Verma
Article 3: What effect does the diagiosis of cancer in a parent have on their children?
Alexander ES, O’Connor M, Halkett GKB. The Psychosocial Effect of Parental Cancer: Qualitative Interviews with Patients’ Dependent Children. Children (Basel). 2023 Jan 15;10(1):171. doi: 10.3390/children10010171. PMID: 36670721; PMCID: PMC9857104.
What’s it about?
This study explored the impact a parent having cancer has on their dependent children. The researchers conducted semi-structured interviews with twelve children aged between 5-17 over one year. All were living with a parent who had a diagnosis of cancer. They identified four main themes identified – feeling worried and distressed, understanding their parent’s cancer diagnosis, feeling disconnected from support, and needing someone to talk to.
Why does it matter?
Previous research suggested that 24% of children aged (1-11) will experience a parent diagnosed with cancer. This can cause significant disruption to family life. Many of these children suffered heightened anxiety and distress that negatively impacted their quality of life. There is a disparity between the level of support offered to adults with cancer and their children. The young people in this study felt disconnected from their support networks (parents, friends or extended family) and felt that healthcare professionals were inaccessible. Children’s needs are often overlooked during their parents’ cancer journey.
Children whose parents have cancer are more likely to develop psychosocial or emotional disorders. Despite a push for patient and family-centred care, children are rarely consulted, and there are often discrepancies between what a child reports and what their parent reports is going on at home.
Clinically Relevant Bottom Line
Children who were interviewed for this study said that they felt worried and distressed when their parent was diagnosed. This can lead to a lasting impact on their well-being, even after their parent’s remission or passing. The study also identified barriers to communication and comprehension that may inform future practices to help children and adults communicate more effectively.
Children need help to understand their parent’s diagnosis and the complex emotions it brings up.
Reviewed by: Tawanda Oscar Antonio and Ben Cumberland.
Article 4: Are the antibiotics prescribed in primary care for LRTIs effective?
Paul Little et al. Antibiotic effectiveness for children with lower respiratory tract infections: prospective cohort and trial in primary care. British Journal of General Practice 2023; 73 (728): e156-e163.DOI 10.3399/BJGP.2022.0239
What’s it about?
Antibiotics are commonly prescribed for lower respiratory tract infections (LRTIs) in children, even though many of these infections are viral. Unnecessary antibiotic use contributes to the development of antibiotic resistance and risks other adverse effects, making it important to consider the appropriateness of prescribing.
This prospective cohort study tried to document the effectiveness of antibiotics prescribed for chest infections in children.
A total of 764 children aged between one and twelve took part (438 trial, 326 observation). Of those 326 in the pragmatic observational arm, 312 had antibiotic prescription data: 157 received no antibiotics, 141 took immediate antibiotics, and 14 had delayed antibiotics. There were 744 participants; in total – 368 received no antibiotic, and 376 were given or were prescribed an antibiotic.
Those in the trial group were randomised to receive amoxicillin 50 mg/kg for seven days or a placebo. The authors did not define the term uncomplicated. However, they defined an acute LRTI as a cough lasting <21 days with associated localising signs (SOB, sputum, pain), not requiring immediate referral to hospital, and no alternative cause for cough, e.g. hayfever. They looked at the duration of symptoms (days), .degree of symptoms, and illness progression requiring hospital assessment (secondary outcome).
Children randomised to the antibiotic arm had a one-day (non-significant) reduction in the duration of symptoms. Antibiotics had no impact on illness progression.
Why does it matter?
Antibiotics are commonly prescribed for children with chest infections but may fuel antibiotic resistance.
Clinically Relevant Bottom Line
In uncomplicated chest infections, antibiotics did not significantly reduce the duration of illness, and increased side effects children experienced. GPs should support parents to self-manage the majority of chest infections at home and communicate clearly when and how to seek medical help if they remain concerned.
Reviewed by: Dr Rasheed Odunusi and Dr Ellie Corso
Article 5: Can healthcare provider interventions in early childhood have a positive impact on development?
Hirve, R., Adams, C., Kelly, C.B., McAullay, D.R., Hurt, L., Edmond, K.M. and Strobel, N.A., 2023. Effect of early childhood development interventions delivered by healthcare providers to improve cognitive outcomes in children at 0-36 months: A systematic review and meta-analysis. Archives of Diseases in Childhood.
What’s it about?
This was a systematic review/meta-analysis of interventions delivered by healthcare providers to enhance cognitive outcomes in infants aged 0-36 months. They included 42 trials involving 15,557 infants from families facing adversity such as poverty, drug abuse, or preterm birth.
The primary outcome measure was cognitive development in children at 0–36 months. Secondary outcomes included:
(1) speech, language, fine motor, gross motor, social, emotional, behaviour, executive functioning and adaptive functioning; and
(2) maternal mental health.
The interventions focused on responsive caregiving, early learning support, and motor stimulation. The results suggested potential improvements in motor and cognitive outcomes, as well as home environment quality for disadvantaged children. However, no effects were noted with regard to speech, language, socio-emotional, behaviour, or maternal mental health outcomes.
The authors emphasized the low to moderate degree of evidence. However, they do provide valuable insights into healthcare providers’ role in enhancing neurodevelopmental outcomes for vulnerable infants within the first three years of life.
Why does it matter?
Primary healthcare services may impact the neurodevelopment of infants aged 0-36 months. Early interventions improve motor development and the home environment. Over 40% of disadvantaged children experience neurodevelopmental issues, putting economic pressure on the healthcare system. Primary healthcare providers, like midwives and child health nurses, make a real difference by supporting early neurodevelopment.
Clinically Relevant Bottom Line
Early neurodevelopment has a profound impact on transitioning into adulthood. Early childhood interventions by primary healthcare professionals can have a positive effect on cognitive and motor outcomes.
Reviewed by: Engy Abdelrahim and Lauren Wallis
If we have missed out on something useful or you think other articles are absolutely worth sharing, please add them in the comments!
That’s it for this month. Many thanks to all of our reviewers who have taken the time to scour the literature so you don’t have to.
