NIHR Signal: Group-based interventions may help teenagers stop smoking

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Published on 30 January 2018

There is no single clear intervention that helps young people quit smoking in the UK, but this review shows that group counselling is one that may be effective.

Interventions included in this review were diverse, for example, computer or text-based, group or individual counselling. Drug treatments such as nicotine patches were included too. Although the review was large, including 41 trials involving more than 13,000 young people, most interventions were not shown to be effective. In contrast, about a third more of those taking part in group counselling quit smoking compared with controls.

Given the high cost to the NHS attributed to smoking-related illness and the uptake of smoking in teenage years, finding effective interventions for this age group is imperative. This review suggests that using group counselling as one tactic might be effective.

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NIHR Signal: Inhaled anaesthesia with anti-sickness medication in children has the same risk of vomiting as intravenous anaesthesia

Published on 27 February 2018

Post-operative vomiting is common in children. One strategy is to use an intravenous anaesthetic, which is known to cause lower rates of sickness than inhaled anaesthetics. There are disadvantages to this though, such as the need for injections before a child is asleep, slowing of the heart and difficulty in monitoring depth of the anaesthetic.

This review of four trials included 558 children who had an operation to correct a squint. A third of children in each anaesthetic group had post-operative vomiting. There was no difference in time spent in the recovery room.

The results indicate that individual factors may be more important when deciding on which type of anaesthetic to use rather than risk of post-operative vomiting.

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Parental perspectives of the impact of epilepsy and seizures on siblings of children with epilepsy (Journal of Pediatric Health Care)

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This study aimed to assess parental perspectives of the impact of epilepsy and seizures on siblings of children in the Seizures and Outcomes Study. The study found that some siblings of children with epilepsy are at risk for psychosocial problems. Primary and specialty care providers are well positioned to identify and monitor these children through evaluations and referrals as necessary.

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Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study) (BMJ)

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The aim of this study was to assess the effectiveness of a school and family based healthy lifestyle programme (WAVES intervention) compared with usual practice, in preventing childhood obesity. The primary analyses suggest that this experiential focused intervention had no statistically significant effect on BMI z score or on preventing childhood obesity. Schools are unlikely to impact on the childhood obesity epidemic by incorporating such interventions without wider support across multiple sectors and environments. Included in a response to these findings from the Royal College of Paediatrics and Child Health (RCPCH), the Officer for Health Promotion said, ‘This study is disappointing but it only suggests this particular school-based intervention didn’t have the positive results we’d have hoped for. That doesn’t mean we should stop developing interventions in schools, nor does it mean that all schools interventions won’t be successful. Schools are a key place of action on childhood obesity. But it does confirm what we already know – that programmes in schools will not on their own combat childhood obesity.

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Comparison of an in-person vs. ehealth mindfulness meditation-based intervention for adolescents with chronic medical conditions: a mixed methods study (Journal of Adolescent Health)

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Purpose: Mindfulness-based interventions (MBIs) have been shown to have positive impacts on mental health and well-being for adolescents living with chronic health conditions. However, many teens with chronic illnesses experience barriers such as pain, reduced mobility and distance making it difficult to attend mindfulness programs in person and compromising accessibility. The aim of this study was to compare the acceptability and effectiveness of a MBI for adolescents with chronic illnesses delivered in person vs. electronically.

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Cochrane review: Interventions to prevent hypothermia at birth in preterm and/or low birth weight infants

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Background

Newborn admission temperature is a strong predictor of outcomes across all gestations. Hypothermia immediately after birth remains a worldwide issue and, if prolonged, is associated with harm. Keeping preterm infants warm is difficult even when recommended routine thermal care guidelines are followed in the delivery room.

Authors’ conclusions

Evidence of moderate quality shows that use of plastic wraps or bags compared with routine care led to higher temperatures on admission to NICUs with less hypothermia, particularly for extremely preterm infants. Thermal mattresses and SSC also reduced hypothermia risk when compared with routine care, but findings are based on two or fewer small studies. Caution must be taken to avoid iatrogenic hyperthermia, particularly when multiple interventions are used simultaneously. Limited evidence suggests benefit and no evidence of harm for most short-term morbidity outcomes known to be associated with hypothermia, including major brain injury, bronchopulmonary dysplasia, retinopathy of prematurity, necrotising enterocolitis, and nosocomial infection. Many observational studies have shown increased mortality among preterm hypothermic infants compared with those who maintain normothermia, yet evidence is insufficient to suggest that these interventions reduce risk of in-hospital mortality across all comparison groups. Hypothermia may be a marker for illness and poorer outcomes by association rather than by causality. Limitations of this review include small numbers of identified studies; small sample sizes; and variations in methods and definitions used for hypothermia, hyperthermia, normothermia, routine care, and morbidity, along with lack of power to detect effects on morbidity and mortality across most comparison groups. Future studies should: be adequately powered to detect rarer outcomes; apply standardised morbidity definitions; focus on longer-term outcomes, particularly neurodevelopmental outcomes.

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