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Honey, I shrunk the kids (but it was probably worth it)

Steve McDonald and Tari Turner
Med J Aust 2014; 201 (7): 372. || doi: 10.5694/mja14.01226
Published online: 6 October 2014

Anxious parents can take some comfort from two recent reviews that explore the impact of inhaled corticosteroids on the growth of children with mild to moderate persistent asthma. The first, which included 25 trials with more than 8400 children, concluded that steroids reduce growth during the first year of treatment (by about half a centimetre). The reduction is less pronounced in subsequent years, and seems minor compared with the known benefits of these drugs for controlling asthma. The second review, which included data on 3400 children from 22 trials, found that lower doses of corticosteroids have less impact on growth, supporting the “minimal effective dose” approach (doi: 10.1002/14651858.CD009471.pub2; 10.1002/14651858.CD009878.pub2).

Of course, when it comes to obesity, shrinking is desirable. The recently updated review of surgery for weight loss in adults, which now includes 22 trials with 1800 participants, found that compared with no surgery, body mass index was six units lower 1 to 2 years after surgery. This finding extended to improvements in health-related quality of life and aspects of diabetes. The review highlights potentially important differences in surgical procedures; for example, three studies found that gastric bypass achieved greater weight loss than adjustable gastric bands. Given that most trials followed participants for only 1 or 2 years, the long-term effects of surgery remain unclear (doi: 10.1002/14651858.CD003641.pub4).

There's no doubting the effects of topical antifungal treatments for tinea cruris and tinea corporis. A new review, which includes 129 trials involving over 18 000 participants, contains that all-too-rare phrase, “All of the treatments examined appeared to be effective”. Terbinafine and naftifine were found to be effective, with only mild and infrequent side effects. Similarly, other topical antifungal treatments, particularly azoles, were also effective, but the high or unclear risk of bias of many studies made it difficult to pick a clear winner (doi: 10.1002/14651858.CD009992.pub2).

With shiftwork and non-standard working hours becoming an increasingly common feature of modern life (to say nothing of parenting), what can we do to counteract sleepiness and sleep disturbances? A new review of pharmacological interventions included 15 small trials involving 700 shiftworkers. It found that melatonin increases sleep length (by about 25 minutes) compared with placebo but not sleep quality, and that both modafinil and armodafinil increased alertness and reduced sleepiness but were associated with adverse events, meaning that neither drug is approved for shiftworkers in Europe. And what of the familiar staple, caffeine? In one trial, caffeine reduced sleepiness during night shifts, when workers also napped before shifts. Nothing about whether the analysis was barista-adjusted (doi: 10.1002/14651858.CD009776.pub2).

For more on these and other reviews, check out the ever-growing Cochrane Library at www.thecochranelibrary.com.

  • Steve McDonald
  • Tari Turner

  • Australasian Cochrane Centre

Correspondence: steve.mcdonald@monash.edu

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