USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge. This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.     

Parental perspectives of early childhood caries

BACKGROUND. Parental perspectives of children with early childhood caries may help inform the development and improvement of caries prevention strategies. OBJECTIVES. This study aimed to explore parents' experiences, perceptions, and expectations regarding prevention and management of early childhood caries. Methods. The authors conducted semistructured interviews with 25 parents of children aged 2 to 5 years, with a known history of caries. All interviews were transcribed and coded, and iterative analyses were conducted to identify key emergent themes within the data. RESULTS. Parents had limited knowledge of behaviors contributing to early childhood caries and when to first seek regular dental care. Parents expected pediatricians to provide education on how to prevent childhood caries, conduct preliminary oral health assessments, and help establish early linkages between medical and dental care. CONCLUSION. The findings make a strong case for pediatricians to take responsibility for engaging and educating parents on fostering optimal oral health and helping to access early childhood dental care.     

An evaluation of the effectiveness of sterilization of infant formulas by thermal heating and an aseptic method

Ready mixed, or reconstituted infant formulas, were prepared using a “Terminal Heating” or an “Aseptic “technique. Bacterial counts were made on samples both before and after refrigeration for 53 and 96 days. A second batch of samples were subjected to alternating intervals of incubation and refrigeration. The formulas were tested for taste and palatability. Up to 56 days of refrigeration, the formulas were satisfactory from a microbiological point of view, but after 96 days, one sample reconstituted in a disposable feeding bottle was completely spoiled. Formula reconstituted and refrigerated in a pitcher also showed evidence of contamination. Spoilage of two other samples were attributed to the use of non‐sterile utensils or equipment and chemical changes of a non‐biological nature. Although Terminal Heating and the Aseptic Method were both effective when carried out by a trained microbiologist, contamination during use of the Aseptic Method is possible. Under field conditions strict control of sterility is unlikely, therefore Terminal Heating of infant formulas is recommended in preference to the Aseptic technique described.     

NITROGEN AND PROTEIN COMPONENTS OF HUMAN MILK

ABSTRACT. The true protein content of human milk is 0.9%, in well-nourished as well as malnourished mothers. Casein constitutes only about 20% of the protein nitrogen in human milk. The remaining 80 % is derived from the whey proteins, the three dominant components being α-lactalbumin, lactoferrin and secretory IgA. α-lactalbumin is a subunit of lactose synthetase. Lactoferrin is an iron-binding glycoprotein which plays a role in the defence against gastro-intestinal infections and is probably also involved in iron transport in the gut. Secretory IgA is comparatively stable at low pH; it is resistant to proteolytic enzymes and plays an essential role in the immunological defence against gastro-intestinal infections. Lysozyme is a minor component of the whey proteins and represents an active enzyme with a bactericidal effect. The nutritional and immunological significance of the marked differences with respect to the nitrogen and protein compositions of human milk and cow's milk should not be underestimated, but need further elucidation.