Clinical: Journals Watch - Puberty, breastfeeding and faints

Too busy to read the journals? Let Dr Suzanne Hunter guide you through the latest findings.

Changing rooms for children - Arch Dis Child 2006; 91: 177

Traditionally boys and girls in primary schools would change for PE together. Given that puberty is happening earlier (75 per cent of year six girls have some breast development and 75 per cent of boys have some testicular enlargement), researchers in Sheffield questioned schools on their changing facilities.

The results showed that 39 per cent of schools had received specific requests for separate changing rooms from children and 21 per cent from parents. However, only 12 per cent of schools had separate changing rooms, so when a request came in, they suggested corridors, toilets, staff room or shielding by fellow pupils. None of this seems very satisfactory.

Sounds like some capital building investment is needed.

Breastfeeding protects against diarrhoea - Arch Dis Child 2006; 91: 245-50

One of the reasons for recommending breastfeeding is its protective effect against infectious disease. This study compared breastfeeding with incidence of diarrhoea and also compared it with social deprivation.

It found that breastfeeding gave definite protection for the duration of breastfeeding and for about two months after. The protective effect was even more striking for those in lower socioeconomic or crowded households - unfortunately those who are less likely to breastfeed.

The course of eczema - Br J Dermatol 2006; 154: 505-13

Although most patients with eczema are atopic, some are not. Researchers in Germany followed a group of children to examine the course of eczema in relation to the presence of atopy and also with respect to sex in children aged five to seven. On the day of the examination 9 per cent of girls and 6 per cent of boys had eczema.

In girls, if eczema started under two years old, it was four times as likely to be due to atopy, whereas later-onset eczema was not. Boys were more often atopic at a later stage than girls.

The excess in eczema in five- and seven-year-old girls over boys was due to non-atopic eczema. This seems to be due to skin physiology and more indoor play in girls.

Fits, faints and funny turns - Arch Dis Child 2006; 91: 214-8

Paroxysmal events in children can have a wide range of causes, and it is tempting to label them as of epileptic origin. This study reviewed all the diagnoses of children referred over eight years to a dedicated 'fits, faints and funny turns' clinic.

Only 23 per cent of children had a diagnosis of epilepsy. Syncope turned out to be the commonest cause with 42 per cent of cases, and another 36 per cent were due to identifiable, non-epileptic causes. This left 14 per cent of cases that were unclassified.

The good news was that these unclassified children, who were left untreated, had no adverse sequelae and so expectance treatment seems safe in these instances.

Use your ratio - Am J Cardiol 2006; 97: 372-5

When you have a patient with high total blood cholesterol, but a normal ratio, should you treat them or not? This study, which once again dipped into the good old Framingham Data, has strengthened the cause for using the ratio.

Over 20 years the risk of developing CHD was related to both the total/HDL or the LDL/HDL ratios, but was independent of the individual lipids that compose the ratio. This reassures that using the ratio alone is the correct way to assess the need for treatment of raised cholesterol.

- Dr Hunter is a GP in Bishops Waltham, Hampshire, and a member of our team who regularly review the journals

INFORMING PATIENTS

Separate changing rooms in schools are not provided for children at an early age.

Breastfeeding is protective against infectious disease.

Eczema and atopy affect girls earlier than boys.

Most fits and funny turns occurring in children are caused by syncope.

The risk of developing CHD is related to LDL/HDL ratio.

RESEARCH OF THE WEEK

Assessing liver fibrosis - Gut 2006; 55: 403-8

Progressive liver fibrosis is a common development of all chronic liver diseases and the gold standard for assessing the condition is a liver biopsy. There are plenty of procedures to which we subject our patients that I would not fancy going through; a liver biopsy is fairly high on this list.

This study compared liver biopsy with a non-invasive technique called transient elastography (FibroScan), which measures liver stiffness by way of an ultrasonic transducer.

The researchers found good correlation between the two methods, with an accuracy of 90 per cent. I do not know whether this is good enough for initial diagnosis, but it sounds great for follow-up evaluation.

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