This month, Bubble Wrap has a primary care slant with a takeover from the GP trainee group in Chesterfield. The articles are relevant and interesting for those working in the acute care system.
With millions of journal articles published yearly, it is impossible to keep up. The Bubble wrap team scoured the literature, so you don’t have to. With a wide variety of topics, take a few minutes and look at what’s new in paediatrics.
Happy Reading 🙂
If you or your team want to submit a review, please contact Dr. Vicki Currie at @DrVickiCurrie1 or vickijanecurrie@gmail.com.
Article 1: How does being in nature affect the health and well-being of adolescents?
Lomax T, Butler J, Cipriani A, Singh I. Effect of nature on the mental health and well-being of children and adolescents: meta-review. Br J Psychiatry. 2024 Sep;225(3):401-409. doi: 10.1192/bjp.2024.109. PMID: 39101636; PMCID: PMC11536187.
What’s it about?
The authors conducted a meta-review of 16 systematic reviews, two scoping reviews, and 5 cohort studies exploring nature’s impact on the mental health of children and adolescents.Â
A standardised framework was used to describe nature, nature-based interventions and mental health and well-being outcomes, aiming to minimise bias.
The studies were primarily descriptive, so the findings were presented qualitatively rather than quantitatively.
Challenges arose in managing confounding variables such as air pollution in urban parks or the specific outdoor activities considered and suggesting quality, quantity, or dose required. Despite these limitations, most of the studies reported significant positive effects of nature exposure on mental health, however some positive trends lacked clear significance.
Another significant limitation of the study was the lack of data on the socioeconomic factors of those involved.
Why does it matter?
Rising global urbanisation and increasing rates of mental health issues highlight the urgency of addressing this topic. In the UK, the proportion of children aged 7 to 16 with a probable mental disorder jumped from 12% in 2017 to 18% in 2022. By 2050, an estimated 68% of the world’s population will live in urban areas, likely fuelling this growing trend.
For lots of excellent articles on adolescent health, check out this section of the website Adolescent Medicine Archives – Don’t Forget the Bubbles.
Clinically Relevant Bottom Line
Encouraging children to spend more time in green spaces and natural environments can significantly benefit their mental health. General practice can incorporate this into lifestyle management strategies. For example, nature-based activities and interventions, such as those promoted by the NHS Green Social Prescribing Programme, play a crucial role in improving mental health outcomes for young people.
Reviewed by Sarah Ghanem and Millie Varney (GPST3)
Article 2:Â How can GPs help young people avoid self-harm?
Faraz Mughal, Carolyn A Chew-Graham, Ellen Townsend, Christopher J Armitage, Martyn Lewis and Benjamin Saunders British Journal of General Practice 2024; 74 (749): e832-e838. DOI: https://doi.org/10.3399/BJGP.2024.0209
What’s it about?
This was a qualitative study exploring the challenges that GPs face in supporting young people who have self-harmed. The aim was to explore the capabilities and motivations of GPs and their perceived training needs to help them.
Fifteen NHS GPs from England were interviewed, and the results were analysed using the COM-B behaviour model. A patient and public advisory group was formed (PPI) using five young people with previous self-harm and three parents or carers of young people who had self-harmed.
The study highlighted that GPs were highly motivated and wanted to support their patients. However, they faced emotional fatigue and time constraints, further impacted by their workload. They identified the need for better consultation tools and felt there were unmet training needs around communication, knowledge, and optimising safety.
Why does it matter?
Self-harm is a growing concern in young people and is associated with co-morbid depression and anxiety. It can lead to poor educational outcomes, suicide and mortality. The risk of suicide is fifty times higher in the year following a self-harm attempt, and GPs are often the first healthcare professionals to come into contact with these patients.
For a deep dive into self-harm, check out Deliberate Self-Harm – Don’t Forget the Bubbles.
Clinically Relevant Bottom Line
There is a need for evidence-based interventions and continued research to enhance the capability and motivations of GPs further to help young people avoid engaging in self-harm.
Reviewed by Simra Siddiqui and Robert Telford (GPST1)
Article 3: Â What impact does smartphone use have on the well-being of adolescent girls?rls?
Kosola S, Mörö S, Holopainen E, Smartphone use and well-being of adolescent girls: a population-based study, Archives of Disease in Childhood 2024;109:576-581
What’s it about?
This cohort study explored the associations between smartphone and social media use and mental health among teenage girls.
1,164 students from the 21 participating Finnish schools submitted smartphone usage screenshots and completed various surveys. These surveys measured social media addiction (Bergen Social Media Addiction Scale/BSMAS), anxiety (Generalised Anxiety Disorder-7), and body image (Body Appreciation Scale-2).
The average daily smartphone use was 5.8 hours, with 3.9 hours spent on social media.
BSMAS outcomes showed social media addiction was common amongst the group (16.6%) and was associated with anxiety (37.2% potential anxiety disorder as per GAD-7) as well as poor body image, tiredness and loneliness.
Why does it matter?
This study provides objective evidence supporting the relationship between harmful social media use and damaging psychological effects. Building an evidence base of these dangers could help shape future legislation, precautionary measures, and public health guidance for a problem that will likely escalate over the coming years.
One of the harmful effects of smartphone use is detailed here: Technology-facilitated sexual assault in children and adolescents – Don’t Forget the Bubbles.
Clinically Relevant Bottom Line
Given the prevalence of adolescent mental health issues that present to general practice, we should routinely ask about social media and smartphone use as part of our clinical assessment. Addressing these factors and educating patients and parents could play a vital role in early intervention and improving psychological well-being.
Reviewed by Alex Scholes and Zoe Maskell (GP ST2)
Article 4: Can decision-making tools help GPs reduce antibiotic prescribing for children with cough?
Clare Clement, Jenny Ingram, Christie Cabral, Peter S Blair, Alastair D Hay, Penny Seume and Jeremy Horwood British Journal of General Practice 2024; 74 (743): e401-e407. DOI: https://doi.org/10.3399/BJGP.2023.0330
What’s it about?
This qualitative study explored the use of The CHIldren with COugh (CHICO) intervention and how clinicians embedded it in general practice.Â
It incorporates an algorithm to predict future hospitalisation risk, elicitation of carer concerns, and a carer-focused personalised leaflet recording treatment decisions and safety-netting information. Interviews explored the acceptability of the CHICO intervention.Â
The intervention included three components.
1. Identifying specific carer concerns
2. Using a clinician focussed STARWave algorithm for support in the decision not to prescribe antibiotics
3. Carer focussed personalised leaflet with decisions made at a consultation, addressing concerns and safety-netting information
The CHICO intervention emerged from the CHICO trial conducted between October 2018 and September 2021 in UK general practices. Clinicians from 56 of the 144 study practices were randomly selected and invited via email to participate in structured telephone interviews. In total, 20 GPs and six practice nurses from 24 practices across 13 CCGs were interviewed.
Clinicians found the CHICO intervention easy to use and quick. Clinicians found it particularly helpful to elicit any carer concerns. It was used as a supportive tool for decision-making rather than necessarily changing practice.
Why does it matter?
Unnecessary antibiotic use drives antimicrobial resistance. This intervention focused on improving antibiotic management and reducing overprescribing by identifying children at low risk of hospitalisation.
Clinician interviews highlighted that the CHICO intervention was easy to use and effectively supported decision-making and conversations with carers when antibiotics were not prescribed.
For a look at how to manage chronic cough, check out Managing Chronic Cough – Don’t Forget the Bubbles
Clinically Relevant Bottom Line
The CHICO intervention may be most useful for borderline cases at risk of hospitalisation. While it is a helpful supporting tool, it does not seem to alter overall prescribing behaviour significantly. To better fit into the time-constrained clinical practice environment, the intervention may require adaptation to align more closely with clinicians’ consultation workflows. Further research is needed to refine and evaluate its impact.
Reviewed by Madhavi Anem and Tamar Denton (GPST2)
Article 5: What are the long-term effects of childhood UTIs?
Hughes, K. et al (2024). Long-term consequences of urinary tract infection in childhood: an electronic population-based cohort study in Welsh primary and secondary care. British Journal of General Practice. 2024 June; 74(743): e371-e378. doi: https://doi.org/10.3399/BJGP.2023.0174
What’s it about?
This retrospective observational study examined whether experiencing a UTI before the age of 5 increases the risk of kidney scarring, hypertension, or chronic kidney disease (CKD). A total of 159,201 children were included, with 11,099 (7.0%) having microbiologically confirmed UTIs.
Kidney scarring was rare, occurring in only 0.16% of children. While a single UTI did not increase the risk, children with multiple UTIs were 7.1 times more likely to develop kidney scarring. Among those with both UTI and kidney scarring, 83% had vesico-ureteric reflux, a condition that increases UTI risk. Excluding children with congenital urinary anomalies, the risk of kidney scarring following UTI was only 2.2 times higher.
Children who had a UTI before the age of 5 were 1.44 times more likely to develop hypertension and 1.67 times more likely to develop CKD. However, with an average follow-up period of 9.53 years, the study could not determine the risk into adulthood when these conditions are more commonly diagnosed.
For a closer look at UTI’s UTI whizzdom – the next steps – Don’t Forget the Bubbles.
Why does it matter?
Existing evidence shows a variable relationship between childhood UTIs, kidney scarring, and long-term consequences. However, most studies have been conducted in secondary care settings, where children are often more severely ill or have conditions such as vesico-ureteric reflux (VUR).
Clarifying this link is crucial as it could influence urine collection practices in primary care. If children without congenital anomalies are not at increased risk of long-term complications, routine imaging and follow-up may be unnecessary.
Clinically Relevant Bottom Line
A single UTI in children rarely leads to long-term adverse effects. Recurrent UTIs may require investigation and referral, given the risk of subsequent health problems.
Reviewed by Ryan Cory and Sarah Ingram
If we missed something useful or you think other articles are worth sharing, please add them in the comments!
That’s it for this month—many thanks to our reviewers for scouring the literature so you don’t have to.
Vicki Currie, DFTB Bubble Wrap Lead, reviewed and edited all articles.
