Acupuncture for the Prevention of Tension-Type Headache (2016)

Linde K, Allais G, Brinkhaus B, et al. Acupuncture for the prevention of tension-type headache.Cochrane Database Syst Rev2016, Issue 48. Art No.: CD007587. DOI: 10.1002/14651858.CD007587.pub2.

BACKGROUND

Acupuncture is often used for prevention of tension-type headache but its effectiveness is still controversial. This is an update of our Cochrane review originally published in Issue 1, 2009 of The Cochrane Library.

OBJECTIVES

To investigate whether acupuncture is (a) more effective than no prophylactic treatment/routine care only; (b) more effective than "sham" (placebo) acupuncture; and (c) as effective as other interventions in reducing headache frequency in adults with episodic or chronic tension-type headache.

SEARCH METHODS

We searched CENTRAL, MEDLINE, EMBASE, and AMED to 19 January 2016. We searched the World Health Organization (WHO) International Clinical Trials Registry Platform to 10 February 2016 for ongoing and unpublished trials.

SELECTION CRITERIA

We included randomized trials with a post-randomization observation period of at least eight weeks, which compared the clinical effects of an acupuncture intervention with a control (treatment of acute headaches only or routine care), a sham acupuncture intervention or another prophylactic intervention in adults with episodic or chronic tension-type headache.

DATA COLLECTION AND ANALYSIS

Two review authors checked eligibility; extracted information on participants, interventions, methods and results; and assessed study risk of bias and the quality of the acupuncture intervention. The main efficacy outcome measure was response (at least 50% reduction of headache frequency) after completion of treatment (three to four months after randomization). To assess safety/acceptability we extracted the number of participants dropping out due to adverse effects and the number of participants reporting adverse effects. We assessed the quality of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

MAIN RESULTS

Twelve trials (11 included in the previous version and one newly identified) with 2349 participants (median = 56, range: 10-1265) met the inclusion criteria. Acupuncture was compared with routine care or treatment of acute headaches only in two large trials (1265 and 207 participants), but they had quite different baseline headache frequency and management in the control groups. Neither trial was blinded but trial quality was otherwise high (low risk of bias). While effect size estimates of the two trials differed considerably, the proportion of participants experiencing at least 50% reduction of headache frequency was much higher in groups receiving acupuncture than in control groups (moderate quality evidence; trial 1: 302/629 (48%) versus 121/636 (19%); risk ratio (RR) = 2.5; 95% confidence interval (CI): 2.1-3.0; trial 2: 60/132 (45%) versus 3/75 (4%); RR = 11; 95% CI: 3.7-35). Long-term effects (beyond four months) were not investigated. Acupuncture was compared with sham acupuncture in seven trials of moderate- to high-quality (low risk of bias); five large studies provided data for one or more meta-analyses. Among participants receiving acupuncture, 205 of 391 (51%) had at least 50% reduction of headache frequency compared to 133 of 312 (43%) in the sham group after treatment (RR = 1.3; 95% CI: 1.09-1.5; four trials; moderate quality evidence). Results six months after randomization were similar. Withdrawals were low: 1 of 420 participants receiving acupuncture dropped out due to adverse effects and 0 of 343 receiving sham (six trials; low quality evidence). Three trials reported the number of participants reporting adverse effects: 29 of 174 (17%) with acupuncture versus 12 of 103 with sham (12%; odds ratio (OR) = 1.3; 95% CI: 0.60-2.7; low quality evidence). Acupuncture was compared with physiotherapy, massage, or exercise in four trials of low to moderate quality (high risk of bias); study findings were inadequately reported. No trial found a significant superiority of acupuncture and for some outcomes the results slightly favored the comparison therapy. None of these trials reported the number of participants dropping out due to adverse effects or the number of participants reporting adverse effects. Overall, the quality of the evidence assessed using GRADE was moderate or low, downgraded mainly due to a lack of blinding and variable effect sizes. AUTHORS׳ CONCLUSIONS: The available results suggest that acupuncture is effective for treating frequent episodic or chronic tension-type headaches, but further trials-particularly comparing acupuncture with other treatment options-are needed.

Parental concerns about complementary feeding: differences according to interviews with mothers with children of 7 and 13 months of age

BACKGROUND/OBJECTIVES

To investigate and analyze differences in parental concerns during earlier and later phases of complementary feeding.

SUBJECT/METHODS

Eight focus group interviews were conducted with 45 mothers of children aged 7 or 13 months. Deductive and inductive coding procedures were applied in the analysis.

RESULTS

There were marked differences in mothers' health concerns in early and in later phases of complementary feeding. In the early phase, feeding a child healthy food was an unquestioned and self-evident practice. The child's food was a specific category, separated from the rest of the family's food, and the mother's focus was on the immediate well-being and safety of the child. In the later phase, health concerns shifted towards a longer-term perspective, and the aim of integrating the child into the family's social world became as important as concerns about well-being and safety. Contested and partly contradictory practices resulted, including conscious acceptance of some intake of sugar and unhealthy fats. Perceived relevance of nutritional guidelines on complementary feeding was high in the early phase but declined later.

CONCLUSION

Mothers' concerns and practices in the feeding of a young child vary considerably across the early and later phases of complementary feeding. This should be explored further and taken into consideration in the targeting and timing of dietary guideline communications.

Multiple-type human papillomavirus infection in younger uncircumcised men

A cohort of 388 young men enrolled for military service in the Danish army was established and the participants underwent a clinical examination with human papillomavirus (HPV) testing. In addition, a questionnaire containing questions regarding sociodemographic variables, sexual habits and lifestyle factors was completed. The prevalence of HPV was 33.4% in this cohort of uncircumcised men aged 18-29 years. Multiple HPV types were prevalent with one-third of the HPV-positive men being positive for more than one HPV type. Number of recent sexual partners and infrequent condom use were strong risk factors, particularly in men having multiple HPV types. Our findings re-emphasize the importance of sexual transmission and also point to a role of factors that may be related to individual susceptibility as genital warts, alcohol intake and, to a lesser extent, smoking were strongly associated with having multiple HPV types.

Use of watershed factors to predict consumer surfactant risk, water quality, and habitat quality in the upper Trinity River, Texas

Surfactants are high production volume chemicals that are used in a wide assortment of "down-the-drain" consumer products. Wastewater treatment plants (WWTPs) generally remove 85 to more than 99% of all surfactants from influents, but residual concentrations are discharged into receiving waters via wastewater treatment plant effluents. The Trinity River that flows through the Dallas-Fort Worth metropolitan area, Texas, is an ideal study site for surfactants due to the high ratio of wastewater treatment plant effluent to river flow (>95%) during late summer months, providing an interesting scenario for surfactant loading into the environment. The objective of this project was to determine whether surfactant concentrations, expressed as toxic units, in-stream water quality, and aquatic habitat in the upper Trinity River could be predicted based on easily accessible watershed characteristics. Surface water and pore water samples were collected in late summer 2005 at 11 sites on the Trinity River in and around the Dallas-Fort Worth metropolitan area. Effluents of 4 major waste water treatment plants that discharge effluents into the Trinity River were also sampled. General chemistries and individual surfactant concentrations were determined, and total surfactant toxic units were calculated. GIS models of geospatial, anthropogenic factors (e.g., population density) and natural factors (e.g., soil organic matter) were collected and analyzed according to subwatersheds. Multiple regression analyses using the stepwise maximum R(2) improvement method were performed to develop prediction models of surfactant risk, water quality, and aquatic habitat (dependent variables) using the geospatial parameters (independent variables) that characterized the upper Trinity River watershed. We show that GIS modeling has the potential to be a reliable and inexpensive method of predicting water and habitat quality in the upper Trinity River watershed and perhaps other highly urbanized watersheds in semi-arid regions.

Cyclical changes in endogenous overnight creatinine clearance during the third trimester of pregnancy

To investigate the pattern of change in endogenous overnight creatinine clearance during the third trimester, 12 healthy women with uncomplicated pregnancies were examined three times a week. Urine was collected overnight from 22.00 to 08.00 hours and analysed for creatinine. Serum was sampled in the morning and analysed for creatinine, beta 2-microglobulin, progesterone and estradiol. The general trend of creatinine clearance was parabolic with a declining level during the last month before term. A sinusoid pattern with minimum values around the time when the women would have had menstruation had they not become pregnant was superimposed on the parabolic trend. A mathematical model (parabolas overlaid with a cosine curve) was constructed and fitted to the data. The cyclical pattern was significant. Serum creatinine showed a pattern with increasing values during the last 4-6 weeks before term and cyclical changes which were also significant. In the individual case the monthly and preterm clearance decrement sometimes was over 50%. Monthly and preterm decreases in creatinine clearance may be quite normal and serial measurements of creatinine clearance are therefore necessary to determine if declining values indicate pathological falls in the glomerular filtration rate.