Dietary exposures and allergy prevention in high-risk infants

Allergic conditions in children are a prevalent health concern in Canada. The burden of disease and the societal costs of proper diagnosis and management are considerable, making the primary prevention of allergic conditions a desirable health care objective. This position statement reviews current evidence on dietary exposures and allergy prevention in infants at high risk for developing allergic conditions. It revisits previous dietary recommendations for pregnancy, breastfeeding and formula feeding, and provides an approach for introducing solid foods to high-risk infants. While there is no evidence that delaying the introduction of any specific food beyond six months of age helps to prevent allergy, the protective effect of early introduction of potentially allergenic foods (at four to six months of age) remains under investigation. Recent research appears to suggest that regularly ingesting a new, potentially allergenic food may be as important as when that food is first introduced. © Canadian Paediatric Society 2013

From theoretical concepts to policies and applied programmes: the landscape of integration of oral health in primary care

Background: Despite its importance, the integration of oral health into primary care is still an emerging practice in the field of health care services. This scoping review aims to map the literature and provide a summary on the conceptual frameworks, policies and programs related to this concept. Methods: Using the Levac et al. six-stage framework, we performed a systematic search of electronic databases, organizational websites and grey literature from 1978 to April 2016. All relevant original publications with a focus on the integration of oral health into primary care were retrieved. Content analyses were performed to synthesize the results. Results: From a total of 1619 citations, 67 publications were included in the review. Two conceptual frameworks were identified. Policies regarding oral heath integration into primary care were mostly oriented toward common risk factors approach and care coordination processes. In general, oral health integrated care programs were designed in the public health sector and based on partnerships with various private and public health organizations, governmental bodies and academic institutions. These programmes used various strategies to empower oral health integrated care, including building interdisciplinary networks, training nondental care providers, oral health champion modelling, enabling care linkages and care coordinated process, as well as the use of e-health technologies. The majority of studies on the programs outcomes were descriptive in nature without reporting long-term outcomes. Conclusions: This scoping review provided a comprehensive overview on the concept of integration of oral health in primary care. The findings identified major gaps in reported programs outcomes mainly because of the lack of related research. However, the results could be considered as a first step in the development of health care policies that support collaborative practices and patient-centred care in the field of primary care sector

A Comparison of Journal Instructions Regarding Institutional Review Board Approval and Conflict-of-interest Disclosure between 1995 and 2005

OBJECTIVES: To compare 2005 and 1995 ethics guidelines from journal editors to authors regarding requirements for institutional review board (IRB) approval and conflict-of-interest (COI) disclosure. DESIGN: A descriptive study of the ethics guidelines published in 103 English-language biomedical journals listed in the Abridged Index Medicus in 1995 and 2005. Each journal was reviewed by the principal author and one of four independent reviewers. RESULTS: During the period, the proportion of journals requiring IRB approval increased from 42% (95% CI 32.2% to 51.2%, p\u3c0.001) to 76% (95% CI 66.4% to 83.1%, p\u3c0.001). In 2005, an additional 9% referred to the Declaration of Helsinki or the International Committee of Medical Journal Editors\u27 Uniform requirements for ethical guidelines; 15% (95% CI 8.5% to 22.5%, p\u3c0.01) provided ambiguous or no requirements. The proportion of journals requiring COI disclosure increased from 75% (95% CI 66.6% to 83.3%, p\u3c0.05) to 94% (95% CI 89.4% to 98.6%, p\u3c0.05); 41% had comprehensive requirements, while some addressed only funding source (6%), were vague (10%) or both (14%). Criteria for authorship rose from 40% (95% CI 30.5% to 49.5%, p\u3c0.05) to 72% (95% CI 63.3% to 80.7%, p\u3c0.05). Journals with higher impact factors were more likely to require IRB approval (p\u3c0.01). Journals in anaesthesia and radiology all required IRB approval; requirements in other disciplines varied. CONCLUSIONS: Instructions to authors regarding ethical standards have improved. Some remain incomplete, especially regarding the scope of disclosure of COI. The ethical guidelines presented to authors need further clarification and standardisation

Examining the educational value of a CanMEDS roles framework in pediatric morbidity and mortality rounds

Abstract Background In order to determine whether the CanMEDS roles could be helpful in solidifying knowledge during clinical training, we examined quality of care issues identified during morbidity and mortality (M&M) rounds. Methods During the M&M rounds, following the case presentation, there was a pause and attendees were asked to identify quality of care issues that were present in the case. The attendees were assigned to a CanMEDS prompted group or non-prompted group. Following the rounds, the issues were identified, coded according to CanMEDS role, and compared between groups. Results A total of 111 individuals identified a total of 350 issues; 57 individuals were in the CanMEDS-prompted group and 54 were in the unprompted group. The mean number of issues identified was significantly higher in the CanMEDS-prompted group compared to the unprompted group (3.7 versus 2.6, p = 0.039). There were significantly more issues raised in the prompted group for the roles of communicator, collaborator, scholar and professional. Conclusions Using CanMEDS roles as prompts, attendees at M&M rounds identify more quality of care issues than if not given a prompt. Use of the CanMEDS framework may assist learners to consolidate the linkage between expected training objectives and the complexities of clinical practice

Ankyloglossia and breastfeeding

Ankyloglossia (\u27tongue-tie\u27) is a relatively common congenital anomaly characterized by an abnormally short lingual frenulum, which may restrict tongue tip mobility. There is considerable controversy regarding its diagnosis, clinical significance and management, and there is wide variation in practice in this regard. Most infants with ankyloglossia are asymptomatic and do not exhibit feeding problems. Based on available evidence, frenotomy cannot be recommended for all infants with ankyloglossia. There may be an association between ankyloglossia and significant breastfeeding difficulties in some infants. This subset of infants may benefit from frenotomy (the surgical division of the lingual frenulum). When an association between significant tongue-tie and major breastfeeding problems is clearly identified and surgical intervention is deemed to be necessary, frenotomy should be performed by a clinician experienced with the procedure and using appropriate analgesia. More definitive recommendations regarding the management of tongue-tie in infants await clear diagnostic criteria and appropriately designed trials