Childhood fever:Parental paracetamol administration after consulting out-of-hours general practice

Background: Current guidelines emphasise prudent use of paracetamol in febrile children without pain. Little evidence is available on paracetamol administration by parents in general and post-GP-consultations. Objectives: To investigate if and how often parents of febrile children administer paracetamol to their child after consulting a GP during out-of-hours care. To explore if condition (painful or not), socio-economic status and age influenced this behaviour. Methods: This was a pre-planned secondary study, attached to an RCT (n?=?25,355) that studied the effect of an illness-focused interactive booklet on antibiotic prescriptions in febrile children between three months and 12?years, at 20 GP out-of-hours centres across the Netherlands. Baseline data and ICPC codes were retrieved from the GP out-of-hours centre database. During a telephone survey two weeks after consulting a GP out-of-hours centre, a random sample of parents was asked if and how often they had given their child paracetamol. Results: Parents of 548 children participated. Most parents administrated paracetamol for two weeks after consulting (83.8%). Children received 11 doses on average during follow-up (maximum 72 doses). Paracetamol administration increased with age. Age three to six months received paracetamol in 68% (17/25) of the cases versus 89.6% (121/135) in children aged five to twelve years. Frequency of paracetamol administration was similar for most common infections, regardless of being painful or painless. Conclusion: Most children who consulted out-of-hours general practice for fever and common infections received paracetamol at home during their illness episode, regardless of a painful condition being present. Paracetamol administration increased with age

Homeostatic model assessment of beta cell function predicting abnormal oral glucose tolerance testing in pregnancy:a systematic review and meta-analysis

Background: Gestational diabetes mellitus (GDM) complicates 1-14% of pregnancies and relates to increased risk of adverse obstetric outcomes. Currently GDM is diagnosed using an oral glucose tolerance test (OGTT), which is burdensome and time intensive.Objective: To compare current literature on whether the homeostatic model assessment beta cell function (HOMA-) is an accurate predictor of an abnormal OGTT in pregnant women.Methods: Pubmed, Cochrane and Embase were searched. Included studies evaluated pregnant women at risk for GDM using the homeostatic model assessment of beta cell function (HOMA-) for the assessment of beta cell function and the OGTT. Studies with animals, non-pregnant women, women with type 2 diabetes and post-partum diabetes were excluded. The QUADAS-2 criteria were used to assess the methodological quality of studies.Results: A total of 12 studies were included, reporting on 7292 women. Seven studies showed a difference in beta cell function between women with impaired glucose tolerance compared to healthy pregnant women. HOMA- is significantly lower in impaired glucose tolerance (