In Other Journals

Child care improves behaviour

Postnatal depression is known to have adverse consequences for children’s development, but less is known about the effects of maternal depression during toddlerhood. New Australian research used data from a longitudinal cohort study to follow 438 mothers and their children from birth to age 5. The researchers found that recurrent maternal depression when children were aged 2 and 3 was associated with child behaviour problems at age 5. However, as little as half a day of formal child care at the age of 2 quashed the effects of the maternal depression. Informal child care did not produce the same benefits. The researchers suggest that child care may be one way of buffering the effects of recurrent maternal depression. “A modest amount of formal child care for toddlers of depressed mothers is a simple strategy that may have benefits for affected mothers and their children”, the researchers conclude.

Pediatrics 2011; 128: e78-e84

Randomised controlled back-pedalling

It’s not just politicians who change their mind, according to an analysis of 1 year’s worth of research papers which were published in the New England Journal of Medicine (NEJM). The researchers examined the frequency of “medical reversals”, which they defined as a phenomenon where a new trial — superior to predecessors because of better design, increased power, or more appropriate controls — contradicts current clinical practice. Out of the 212 original articles published in the NEJM in 2009, 124 (58%) made some claim about a clinical practice. Of these, 16 articles (13%) were classified as medical reversals. Medical reversals applied to medical therapies, invasive procedures and screening tests. The authors argue that further study of medical reversals is “necessary and of profound importance”.

Arch Intern Med 2011; 11 July (online)

NO benefit from Invasive cystic fibrosis test

In kids with cystic fibrosis (CF), early pulmonary infection, particularly with Pseudomonas aeruginosa, leads to increased morbidity and mortality. However, it is difficult to detect infection in non-expectorating patients. Oropharyngeal cultures are used widely, despite concerns over their diagnostic accuracy. An alternative test is the bronchoalveolar lavage (BAL), which involves inserting fluid into the lungs under general anaesthetic, and then re-collecting the fluid for examination. Australian researchers randomly allocated 170 infants with CF to either BAL-directed or standard therapy, and followed each child for 5 years. Children in the BAL-directed group underwent BAL before age 6 months when well, when hospitalised for pulmonary exacerbations and if P. aeruginosa was detected. Treatment was prescribed according to the BAL or culture results. At 5 years, infants who underwent the invasive BAL test did not have a lower prevalence of infection with P. aeruginosa or structural lung injury. The test was also linked with mild adverse events, such as worsening of cough. “This study highlights the importance of examining diagnostic and management interventions using appropriately designed randomized controlled trials in a clinical practice setting”, the researchers wrote.

JAMA 2011; 306: 163-171

Children inherit battle scars

The mental health problems linked to military deployment don’t stop with the military personnel themselves. Previous research has shown that spouses are also affected, and a new study finds that parental deployment takes a mental health toll on children. The US study of more than 300 000 children of military personnel found that those whose parents were deployed to Iraq or Afghanistan were more likely to be diagnosed with a mental illness. The most common diagnoses were for acute stress reaction and adjustment disorders, depressive disorders and behavioural disorders. The researchers also identified a dose-response pattern, such that longer deployment was linked to worse mental health outcomes among children. The analysis determined that an extra 6579 mental health diagnoses among the children were attributable to parental deployment.

Arch Pediatr Adolesc Med 2011; 4 July (online)

For better or for worse

New research adds to our understanding of why marriage seems to decrease the risk of dying from cardiovascular disease. The Canadian study of 4400 patients found that men who were experiencing chest pain due to acute myocardial infarction presented to an emergency department or hospital earlier if they were married or in a de facto relationship than if they were single. The benefit of marriage was not observed for women. The researchers hypothesised that spouses may encourage earlier pursuit of medical care, either directly or indirectly, and that wives may be more likely to assume this caregiver role.

CMAJ 2011; 18 July (online)