Antibiotics for sore throat

Background: Sore throat is a common reason for people to present for medical care. Although it remits spontaneously, primary care doctors commonly prescribe antibiotics for it. Objectives: To assess the benefits of antibiotics for sore throat for patients in primary care settings. Search methods: We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to July week 1, 2013) and EMBASE (January 1990 to July 2013). Selection criteria: Randomised controlled trials (RCTs) or quasi‐RCTs of antibiotics versus control assessing typical sore throat symptoms or complications. Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. We contacted trial authors from three studies for additional information. Main results: We included 27 trials with 12,835 cases of sore throat. We did not identify any new trials in this 2013 update. 1. Symptoms - Throat soreness and fever were reduced by about half by using antibiotics. The greatest difference was seen at day three. The number needed to treat to benefit (NNTB) to prevent one sore throat at day three was less than six; at week one it was 21. 2. Non‐suppurative complications - The trend was antibiotics protecting against acute glomerulonephritis but there were too few cases to be sure. Several studies found antibiotics reduced acute rheumatic fever by more than two‐thirds within one month (risk ratio (RR) 0.27; 95% confidence interval (CI) 0.12 to 0.60). 3. Suppurative complications - Antibiotics reduced the incidence of acute otitis media within 14 days (RR 0.30; 95% CI 0.15 to 0.58); acute sinusitis within 14 days (RR 0.48; 95% CI 0.08 to 2.76); and quinsy within two months (RR 0.15; 95% CI 0.05 to 0.47) compared to those taking placebo. 4. Subgroup analyses of symptom reduction - Antibiotics were more effective against symptoms at day three (RR 0.58; 95% CI 0.48 to 0.71) if throat swabs were positive for Streptococcus, compared to RR 0.78; 95% CI 0.63 to 0.97 if negative. Similarly at week one the RR was 0.29 (95% CI 0.12 to 0.70) for positive and 0.73 (95% CI 0.50 to 1.07) for negative Streptococcus swabs. Authors' conclusions: Antibiotics confer relative benefits in the treatment of sore throat. However, the absolute benefits are modest. Protecting sore throat sufferers against suppurative and non‐suppurative complications in high‐income countries requires treating many with antibiotics for one to benefit. This NNTB may be lower in low‐income countries. Antibiotics shorten the duration of symptoms by about 16 hours overall.Griffith Health, School of MedicineFull Tex

Recurrent episodes of injury in children : an Australian cohort study

Objective The aim of the present study was to compare sociodemographic characteristics of children with single versus recurrent episodes of injury and provide contemporary evidence for Australian injury prevention policy development. Methods Participants were identified from the Environments for Healthy Living: Griffith Birth Cohort Study 2006-11 (n≤2692). Demographic data were linked to the child's hospital emergency and admissions data from birth to December 2013. Data were dichotomised in two ways: (1) injured or non-injured; and (2) single or recurrent episodes of injury. Multivariate logistic regression was used for analysis. Results The adjusted model identified two factors significantly associated with recurrent episodes of injury in children aged 0.1). Conclusion National priorities should include targeted programs addressing the higher odds of recurrent episodes of injury experienced by children aged <3 years with younger mothers or those injured in the first 18 months of life. What is known about the topic? Children who experience recurrent episodes of injury are at greater risk of serious or irrecoverable harm, particularly when repeat trauma occurs in the early years of life. What does the paper add? The present study identifies key factors associated with recurrent episodes of injury in young Australian children. This is imperative to inform evidence-based national injury prevention policy development in line with the recent expiry of the National Injury Prevention and Safety Promotion Plan: 2004-2014. What are the implications for practitioners? Injury prevention efforts need to target the increased injury risk experienced by families from lower socioeconomic backgrounds and, as a priority, children under 3 years of age with younger mothers and children who are injured in the first 18 months of life. These families require access to education programs, resources, equipment and support, particularly in the child's early years. These programs could be provided as part of the routine paediatric and child health visits available to families after their child's birth or incorporated into hospital and general practitioner injury treatment plans

Impact of participant attrition on child injury outcome estimates : a longitudinal birth cohort study in Australia

Background Longitudinal research is subject to participant attrition. Systemic differences between retained participants and those lost to attrition potentially bias prevalence of outcomes, as well as exposure-outcome associations. This study examines the impact of attrition on the prevalence of child injury outcomes and the association between sociodemographic factors and child injury. Methods Participants were recruited as part of the Environments for Healthy Living (EFHL) birth cohort study. Baseline data were drawn from maternal surveys. Child injury outcome data were extracted from hospital records, 2006-2013. Participant attrition status was assessed up to 2014. Rates of injury-related episodes of care were calculated, taking into account exposure time and Poisson regression was performed to estimate exposure-outcome associations. Results Of the 2222 participating families, 799 families (36.0%) had complete follow-up data. Those with incomplete data included 137 (6.2%) who withdrew, 308 (13.8%) were lost to follow-up and 978 families (44.0%) who were partial/non-responders. Families of lower socioeconomic status were less likely to have complete follow-up data (p<0.05). Systematic differences in attrition did not result in differential child injury outcomes or significant differences between the attrition and non-attrition groups in risk factor effect estimates. Participants who withdrew were the only group to demonstrate differences in child injury outcomes. Conclusion This research suggests that even with considerable attrition, if the proportion of participants who withdraw is minimal, overall attrition is unlikely to affect the population prevalence estimate of child injury or measures of association between sociodemographic factors and child injury

Population-based interventions for preventing falls and fall-related injuries in older people.

Around one-third of older adults aged 65 years or older who live in the community fall each year. Interventions to prevent falls can be designed to target the whole community, rather than selected individuals. These population-level interventions may be facilitated by different healthcare, social care, and community-level agencies. They aim to tackle the determinants that lead to risk of falling in older people, and include components such as community-wide polices for vitamin D supplementation for older adults, reducing fall hazards in the community or people's homes, or providing public health information or implementation of public health programmes that reduce fall risk (e.g. low-cost or free gym membership for older adults to encourage increased physical activity). To review and synthesise the current evidence on the effects of population-based interventions for preventing falls and fall-related injuries in older people. We defined population-based interventions as community-wide initiatives to change the underlying societal, cultural, or environmental conditions increasing the risk of falling. We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers in December 2020, and conducted a top-up search of CENTRAL, MEDLINE, and Embase in January 2023. We included randomised controlled trials (RCTs), cluster RCTs, trials with stepped-wedge designs, and controlled non-randomised studies evaluating population-level interventions for preventing falls and fall-related injuries in adults ≥ 60 years of age. Population-based interventions target entire communities. We excluded studies only targeting people at high risk of falling or with specific comorbidities, or residents living in institutionalised settings. We used standard methodological procedures expected by Cochrane, and used GRADE to assess the certainty of the evidence. We prioritised seven outcomes: rate of falls, number of fallers, number of people experiencing one or more fall-related injuries, number of people experiencing one or more fall-related fracture, number of people requiring hospital admission for one or more falls, adverse events, and economic analysis of interventions. Other outcomes of interest were: number of people experiencing one or more falls requiring medical attention, health-related quality of life, fall-related mortality, and concerns about falling. We included nine studies: two cluster RCTs and seven non-randomised trials (of which five were controlled before-and-after studies (CBAs), and two were controlled interrupted time series (CITS)). The numbers of older adults in intervention and control regions ranged from 1200 to 137,000 older residents in seven studies. The other two studies reported only total population size rather than numbers of older adults (67,300 and 172,500 residents). Most studies used hospital record systems to collect outcome data, but three only used questionnaire data in a random sample of residents; one study used both methods of data collection. The studies lasted between 14 months and eight years. We used Prevention of Falls Network Europe (ProFaNE) taxonomy to classify the types of interventions. All studies evaluated multicomponent falls prevention interventions. One study (n = 4542) also included a medication and nutrition intervention. We did not pool data owing to lack of consistency in study designs. Medication or nutrition Older people in the intervention area were offered free-of-charge daily supplements of calcium carbonate and vitamin D . Although female residents exposed to this falls prevention programme had fewer fall-related hospital admissions (with no evidence of a difference for male residents) compared to a control area, we were unsure of this finding because the certainty of evidence was very low. This cluster RCT included high and unclear risks of bias in several domains, and we could not determine levels of imprecision in the effect estimate reported by study authors. Because this evidence is of very low certainty, we have not included quantitative results here. This study reported none of our other review outcomes. Multicomponent interventions Types of interventions included components of exercise, environment modification (home; community; public spaces), staff training, and knowledge and education. Studies included some or all of these components in their programme design. The effectiveness of multicomponent falls prevention interventions for all reported outcomes is uncertain. The two cluster RCTs included high or unclear risk of bias, and we had no reasons to upgrade the certainty of evidence from the non-randomised trial designs (which started as low-certainty evidence). We also noted possible imprecision in some effect estimates and inconsistent findings between studies. Given the very low-certainty evidence for all outcomes, we have not reported quantitative findings here. One cluster RCT reported lower rates of falls in the intervention area than the control area, with fewer people in the intervention area having one or more falls and fall-related injuries, but with little or no difference in the number of people having one or more fall-related fractures. In another cluster RCT (a multi-arm study), study authors reported no evidence of a difference in the number of female or male residents with falls leading to hospital admission after either a multicomponent intervention ("environmental and health programme") or a combination of this programme and the calcium and vitamin D programme (above). One CBA reported no difference in rate of falls between intervention and control group areas, and another CBA reported no difference in rate of falls inside or outside the home. Two CBAs found no evidence of a difference in the number of fallers, and another CBA found no evidence of a difference in fall-related injuries. One CITS found no evidence of a difference in the number of people having one or more fall-related fractures. No studies reported adverse events. Given the very low-certainty evidence, we are unsure whether population-based multicomponent or nutrition and medication interventions are effective at reducing falls and fall-related injuries in older adults. Methodologically robust cluster RCTs with sufficiently large communities and numbers of clusters are needed. Establishing a rate of sampling for population-based studies would help in determining the size of communities to include. Interventions should be described in detail to allow investigation of effectiveness of individual components of multicomponent interventions; using the ProFaNE taxonomy for this would improve consistency between studies. [Abstract copyright: Copyright © 2024 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.

THE BENEFITS AND INJURY RELATED HARMS OF PHYSICAL ACTIVITY IN CHILDREN AGED 5-12 YEARS

Background: The prevalence of overweight status amongst Australian children has increased substantially and now approximates one quarter of the paediatric population. Proponents of physical activity have argued that this increase in partly due to decreasing activity levels, coinciding with an increase in sedentary behaviour. Consequently, a public health agenda to increase physical activity participation has emerged and Australian guidelines were published in 2004, recommending that children aged 5-12 years participate in a minimum of 60 minutes of physical activity daily and spend no more than two hours a day using electronic media for entertainment. However, an unintended consequence of physical activity is exposure to the risk of injury. To date, these risks have not been quantified in primary school aged children despite injury being a leading cause for hospitalisation and death in this population. Furthermore, the protective effect of sufficient physical activity against obesity remains uncertain, with a lack of consensus of an independent relationship between activity and weight status. A clearer understanding of the relationship between physical activity and the positive and negative outcomes is therefore warranted to inform public health policy and ensure that the potential benefits of increased activity participation amongst the paediatric population will not be outweighed by the risks and costs of injury. Aims: There were five main aims of the thesis: 1. To describe the distribution of BMI in children 5-12 years by age, sex and SES 2. To quantify the association between physical activity and obesity in children 5-12 years 3. to describe the distribution of physical activity participation in children 5- 12 years by age, sex and SES. 4. To describe the physical activity specific incidence of injury in children 5- 12 years, by age, sex and SES 5. To quantify the association between categories of physical activity and injury type sustained. Method: The Childhood Injury Prevention Study (CHIPS) was a prospective cohort study that collected data from a randomly selected sample of Brisbane primary and pre-school children aged 5 to 12 years. Data for each participating child were available for the following variables: age, gender, body mass index (BMI), socioeconomic status (SES) indicators (household income, maternal education, school area SES), family size, home play equipment availability, transport method to school, estimated time per week in various types of physical activity and sedentary leisure activities, and incidence of injury recorded prospectively over 12 months. Analytic strategies Logistic regression analysis was performed to 1) determine the protective effect of compliance with the Australian guidelines against obesity. 2) identify variables that were associated with insufficient (&lt; 60 minutes) daily activity. The age and gender distribution of injury rates per hourly exposure were calculated for all activity and for organized, non-organised and common specific activities occurring outside school hours. Additionally, child-based injury rates were calculated for physical activity related injuries both in and out of the school setting. Results: Compliance with physical activity guidelines and protection against overweight status Approximately 20% of the cohort was considered overweight according to international age standardised BMI charts. Non-compliance with activity guidelines was 15% for out of school physical activity participation, and 31% for excessive electronic media entertainment use. Non-compliance with the minimal physical activity guideline increased the odds of being overweight by 28%, however this difference was not statistically significant. There was, however a significant 63% increase in the odds of overweight status amongst children who overused electronic media for entertainment. Children failing the minimum activity participation recommendation were less likely to walk or cycle to school (adjusted odds ratio (OR) 0.43; 95% CI = 0.24 0.77) or participate in organised sports or activity (OR 0.42; 95% CI = 0.28 0.64) and were more likely to spend in excess of 2 hours a day watching television of using a computer for entertainment (OR 2.10 (1.16 3.78). Harms of physical activity: exposure to injury risk A high number of injuries (89%) sustained by the cohort were directly related to physical activity and 34% of physical activity related injuries required professional medical treatment. Analysis of injuries occurring outside of school revealed an overall injury rate of 5.7 injuries per 10 000 hours of exposure to physical activity and a medically treated injury rate of 1.7 per 10 000 hours. The highest injury risks per exposure time occurred for tackle-style football, wheeled activities and tennis. Conclusion: One in seven children from the Greater Brisbane area are at risk for being insufficiently active according to Australian national guidelines whilst a third overuse electronic media. Given that overuse of electronic entertainment was positively associated with childhood obesity, these children should be the target of public health campaigns to promote alternative leisure time activities. Injury rates per hours of exposure to physical activity were low with less than 2 injuries requiring medical treatment occurring for every 10 000 hours of activity participation outside of school

Scopolamine (hyoscine) for preventing and treating motion sickness

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 3, 2004 and previously updated in 2007 and 2009.Motion sickness, the discomfort experienced when perceived motion disturbs the organs of balance, may include symptoms such as nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches. The control and prevention of these symptoms has included pharmacological, behavioural and complementary therapies. Although scopolamine (hyoscine) has been used in the treatment and prevention of motion sickness for decades, there have been no systematic reviews of its effectiveness. To assess the effectiveness of scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination for motion sickness in persons (both adults and children) without known vestibular, visual or central nervous system pathology. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 14 April 2011. All parallel-arm, randomised controlled trials (RCTs) focusing on scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination. We considered outcomes relating to the prevention of onset or treatment of clinically-defined motion sickness, task ability and psychological tests, changes in physiological parameters and adverse effects. Two authors independently extracted data from the studies using standardised forms. We assessed study quality. We expressed dichotomous data as odds ratio (OR) and calculated a pooled OR using the random-effects model. Of 35 studies considered potentially relevant, 14 studies enrolling 1025 subjects met the entry criteria. Scopolamine was administered via transdermal patches, tablets or capsules, oral solutions or intravenously. Scopolamine was compared against placebo, calcium channel antagonists, antihistamine, methscopolamine or a combination of scopolamine and ephedrine. Studies were generally small in size and of varying quality.Scopolamine was more effective than placebo in the prevention of symptoms. Comparisons between scopolamine and other agents were few and suggested that scopolamine was superior (versus methscopolamine) or equivalent (versus antihistamines) as a preventative agent. Evidence comparing scopolamine to cinnarizine or combinations of scopolamine and ephedrine is equivocal or minimal.Although sample sizes were small, scopolamine was no more likely to induce drowsiness, blurring of vision or dizziness compared to other agents. Dry mouth was more likely with scopolamine than with methscopolamine or cinnarizine.No studies were available relating to the therapeutic effectiveness of scopolamine in the management of established symptoms of motion sickness. The use of scopolamine versus placebo in preventing motion sickness has been shown to be effective. No conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. In addition, we identified no randomised controlled trials that examined the effectiveness of scopolamine in the treatment of established symptoms of motion sickness

A decision model for targeting social welfare services: a case study of intensive customer support

This article describes a decision model designed to help the Centrelink branch of the Australian Government Department of Human Services target investments in case coordination for high-need customers. The model uses a technique called multiple criteria analysis to score the investment priority of more than 1,000 geographic regions across Australia

Quantifying the risk of sports injury: a systematic review of activity‐specific rates for children under 16 years of age

Injuries caused by sports and other forms of physical activity in young children constitute a significant public health burden. It is important to quantify this risk to ensure that the benefits of sport participation are not outweighed by the potential harms. This review summarises the literature reporting exposure‐based injury rates for various forms of physical activity in children aged 15 years and younger. Forty eight studies were found, of which 27 reported injury rates per hourly based exposure measured and 21 reported injury rates according to some other measure. Fourteen different sports and activities were covered, mostly team ball sports, with soccer being the most widely studied. Injury definition and the method of ascertaining and measuring injuries differed between studies, which created a large variation in reported injury rates that did not necessarily represent actual differences in injury risk between activities. The highest hourly based injury rates were reported for ice hockey, and the lowest were for soccer, although the range of injury rates for both of these activities was wide. Very few studies have investigated sports‐related injuries in children younger than 8 years or in unorganised sports situations

The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature

The aim of this systematic review was to determine the supporting evidence for the clinical use of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting. Two authors searched three databases (Ovid Medline, Ovid Embase and The Cochrane Library) for relevant English language articles published through September 2014. Reference lists, conference proceedings and non-indexed academic journals were manually searched. A separate search was conducted using the Internet search engine Google to source additional studies from burns advisory agencies, first aid bodies, military institutions, manufacturer and paramedic websites. Two authors independently assessed study eligibility and relevance of non-traditional data forms for inclusion. Studies were independently assessed and included if Hydrogel-based burn dressings (HBD) were examined in first aid practices in the pre-hospital setting. A total of 129 studies were considered for inclusion, of which no pre-hospital studies were identified. The review highlights that current use of HBD in the pre-hospital setting appears to be driven by sources of information that do not reflect the paramedic environment. We recommend researchers in the pre-hospital settings undertake clinical trials in this field. More so, the review supports the need for expert consensus to identify key demographic, clinical and injury outcomes for clinicians and researchers undertaking further research into the use of dressings as a first aid measure