Shirley Alexander

Ethical issues in preventing mother-to-child transmission of hepatitis B by immunisation

Without intervention, a pregnant woman who is a chronic hepatitis B carrier is at risk of transmitting hepatitis B and of her infant becoming a chronic carrier and having a significantly increased lifetime risk of developing liver cancer or cirrhosis. Hepatitis B vaccine and immunoglobulin reduce the risk of the baby becoming a carrier, but with only a short window period after birth to deliver this potentially life-saving intervention. We reviewed the evidence on the magnitude of the risk. If the carrier mother is e antigen positive (highly infective), the calculated risk to the infant without intervention is 75.2%, reduced to 6.0% by giving vaccine and immunoglobulin at birth. If the mother is surface antigen positive but e antigen negative, the risk to the infant without intervention is 10.3%, reduced to 1.0% by giving vaccine and immunoglobulin. If vaccine is accepted but immunoglobulin refused, as for example by some Jehovahs Witnesses, the risk to babies of e antigen positive mothers is reduced to 21.0% and to babies of e antigen negative mothers to 2.6%. These figures can be used to inform parents and as a possible basis for child protection proceedings if parents decline vaccine and/or immunoglobulin. We argue from the perspective of the best interests of the child that the severity of the condition justifies initiating child protection proceedings whenever a baby is born to a hepatitis B carrier mother and, despite concerted attempts to persuade them, the parents refuse vaccine and/or immunoglobulin.

Doctors' use of mobile devices in the clinical setting: a mixed methods study.

Mobile device use has become almost ubiquitous in daily life and therefore includes use by doctors in clinical settings. There has been little study as to the patterns of use and impact this has on doctors in the workplace and how negatively or positively it impacts at the point of care.

Tertiary-level management of overweight and obese children and adolescents: Does intensive dietetic intervention have a positive impact on weight control?

Aim Tertiary clinical management of paediatric obesity is complex and the best treatment model of care is unknown. We aimed to ascertain if a prescriptive nutritional intervention in a tertiary dietetic clinic resulted in a reduction in body mass index (BMI) z-score. Methods Data (age, gender, anthropometry, clinic visits (number, timing) ) were collected on all patients between June 2005–September 2009 and intention to treat analyses were carried out by using linear mixed models. Results For attendees, significant reductions in BMI z-scores occurred in boys after the third clinic appointment (P = 0.04) and in girls after the fifth appointment (P = 0.046). Final mean BMI z-score reduction was 0.28 ± 0.09 for boys and 0.24 ± 0.12 for girls. A significant reduction in waist to height ratio (WHER) for girls (from mean 0.62 ± 0.06 to 0.54 ± 0.04) was achieved by the fifth visit (P < 0.001). Conclusions Prescriptive nutritional intervention in a tertiary dietetic clinical setting resulted in a significant reduction in BMI z-scores in both boys and girls evident by the third and fifth clinical appointments (contacts), respectively. No correlation was found between intensity of appointments in terms of length of time between clinic visits, age or initial BMI of the patient and reduction in BMI z-score. These findings reinforce that multiple appointments are required to produce a beneficial effect.

Childhood obesity: who’s to blame and who should pay?

In the 1990s, the WHO used the term ‘globesity’ to warn of an escalating global epidemic, commenting that millions of people were at risk of developing serious chronic, noninfectious diseases and other related health problems [101]. The International Obesity Task Force has subsequently termed obesity the ‘Millennium Disease’, highlighting the major international impact of this condition [102]. In fact, obesity is now a pandemic, affecting both adults and children in developed and developing countries.