Socioeconomic inequalities in skilled attendance at birth and caesarean section rates in Myanmar 2015-2016: a cross-sectional study

OBJECTIVES

This study aims to assess inequalities in skilled birth attendance and utilisation of caesarean section (CS) in Myanmar.

STUDY DESIGN

Cross-sectional study design.

SETTING AND POPULATION

We used secondary data from the Myanmar Demographic and Health Survey (2015-2016). Our outcome measures of skilled birth attendance and utilisation of CS were taken from the most recent birth of interviewed women. Absolute and relative inequalities across several sociodemographic characteristics were assessed and evaluated by calculating rate differences, rate ratio and concentration indexes.

RESULTS

More than one-third (36%, 95% CI 32.5% to 39.4%) of women gave birth without a skilled birth attendant present at their most recent birth. 40.7% (95% CI 37.8% to 43.7%) gave birth in healthcare facilities, and the CS rate was 19.7% (95% CI 17.9% to 21.8%) for their most recent birth. The highest proportion of birth without a skilled provider was found in the hilly regions and rural residents, poorest and less educated women, and those with less than four antenatal care visits. Inequalities in birth without a skilled provider were observed across regions, place of residence, wealth quintile, education level and number of antenatal care taken. The highest rate of CS was found among plain regions and urban residents, richest women, more than secondary education, those with more than four antenatal care visits and in private health facilities. Inequalities in CS utilisation were observed across place of residence, wealth quintiles, education level, number of antenatal care taken and type of health facilities.

CONCLUSION

This study provides evidence regarding inequalities in maternal health service utilisation in Myanmar. Increasing maternal health service availability and accessibility, promoting quality of care and health education campaigns to increase maternal health services utilisation are recommended.

School-based comprehensive sexuality education for prevention of adolescent pregnancy: a scoping review

BACKGROUND

Adolescent pregnancy is a global public health problem. Numerous approaches for Comprehensive Sexuality Education (CSE) delivery in schools have been implemented around the world. Previous reviews on CSE did not follow the International Technical Guidance on Sexuality Education (ITGSE) because CSE is very diverse in terms of population, interventions, settings and outcomes. We conducted this scoping review to identify and map the evidence of school-based CSE for prevention of adolescent pregnancy with emphasis on adolescents' contraceptive use, unintended pregnancy and abortion.

METHODS

We searched PubMed, CENTRAL, Scopus, ISI Web of Science, CINAHL, and WHO ICTRP to identify potential eligible studies from their inception to 4th Nov 2023.We included randomized controlled trials (RCTs) and non-RCTs of CSE implemented in public or private schools for adolescents. CSE was defined as a multi-session intervention in school that covered topics including contraception, pregnancy, abortion, and HIV/STI. School-based interventions were the main intervention that may be either stand-alone or multicomponent. There was no limitation on study's geographical area, but only English-language studies were considered. Two reviewers selected and extracted data independently, discussed for consensus or consulted the third reviewer if there were discrepancies for final conclusion. Data were presented using figures, map and table.

RESULTS

Out of 5897 records, 79 studies (101 reports) were included in this review. Most studies were conducted in the United States and other high-income countries in secondary or high schools with cluster RCTs. All studies included participatory methods. Almost all studies included Sexual and Reproductive Health which is the eighth concept of CSE. Very few studies reported the prespecified primary outcomes of contraceptive use during last sex, unintended pregnancy and abortion and hence this highlighted the gaps of available evidence for these outcomes. The number of concepts, components, duration and providers of CSE varied across the included studies. However, none of the interventions identified in this scoping review adhered to the ITGSE recommended approach.

CONCLUSIONS

Our scoping review shows gaps in school-based CSE implementation in terms of completeness of concepts, components, providers, duration and outcomes recommended by ITGSE.

Incidence and prevalence of systemic sclerosis in Thailand in year 2017-2020: a database from the Ministry of Public Health

BACKGROUND

A better understanding of the epidemiological profile of systemic sclerosis (SSc) in Thais could improve care, human resource deployment, and public health budgeting.

OBJECTIVES

We aimed to determine the incidence and prevalence of SSc in Thailand between 2017 and 2020.

METHODS

A descriptive epidemiological study was performed using the Information and Communication Technology Center, Ministry of Public Health database, comprising all types of healthcare providers during the study period. Demographic data of patients having a primary diagnosis of M34 systemic sclerosis and over 18 years of age between 2017 and 2020 were reviewed. The incidence and prevalence of SSc were calculated as well as their respective 95% confidence intervals (CIs).

RESULTS

The number of SSc cases in 2017 was 15,920 from a total Thai population of 65,204,797. The prevalence of SSc in 2017 was 24.4 per 100,000 populations (95% CI 24.0-24.8). The prevalence of SSc among women was 2 times greater than among men (32.7 vs. 15.8 per 100,000). The incidence of SSc was stable from 2018 to 2019 but dropped slightly in 2020 (7.2, 7.6, and 6.8 per 100,000 person-years, respectively). Most SSc cases were in northeastern Thailand (11.6, 12.1, and 11.1 per 100,000 person-years from 2018 to 2020, respectively) and the peak was between 60 and 69 years of age (24.6, 23.8, and 20.9 per 100,000 person-years from 2018 to 2020, respectively).

CONCLUSION

SSc is a rare disease among Thais. The disease was commonly revealed in late middle-aged women with a peak at age 60-69 years, mainly from the northeast regions. The incidence remained stable during the study period, albeit during the emergence of the coronavirus pandemic a slight decline was recorded. Key Points • The incidence and prevalence of systemic sclerosis (SSc) vary across ethnic populations. • There is a lack of epidemiology research of SSc since the 2013 ACR/EULAR Classification Criteria for Scleroderma was adopted among Thais included Asia-Pacific population as the population has some different clinical features than those reported among Caucasians. • SSc is a rare connective disease among Thais and commonly presents in late middle-aged group of both genders, mainly in Thailand's northern and northeastern regions. • When compare to the epidemiology of SSc in Asia-Pacific, the prevalence of SSc in Thais was higher than among East Asians and the Indian population and the incidence of SSc among Thais was greater than the other Asia-Pacific population including Australian.

Implementing the individualized postpartum care with telemedicine during the COVID-19 pandemic at tertiary hospital in Thailand

Objective

This study sought to identify the impact of implementing the new postpartum care (individualized rescheduling postpartum visit) with telemedicine on postpartum services during the COVID-19 pandemic.

Study design

This is a retrospective cohort study conducted at Srinagarind Hospital, a tertiary hospital in northeast Thailand, to compare patient data before and after implementation. Delivery and postpartum data from May 2019 to December 2020 were retrieved from the hospital database. Intervention was implemented in March 2020. Data were analyzed to evaluate postpartum contact, contraceptive use, and breastfeeding using Wilcoxon rank sum and Chi-squared tests.

Results

There was a significant increase in postpartum contact from 48.0% (95% CI. 45.8 to 50.3) before the implementation of telemedicine to 64.6% (95% CI. 61.9 25 to 67.2) after (adjusted OR 1.5, 95% CI. 1.2 to 1.8). In the post-intervention group, contraception use also increased significantly (84.7% vs 49.7%; p < 0.001), and a higher proportion of women relied on long-acting reversible contraception (16.6% vs 5.7%; p < 0.001). However, patients in the post-intervention group were less likely to practice exclusive breastfeeding (46.6% vs 75.1%; p < 0.001).

Conclusion

Rescheduling the timing of a comprehensive visit accompanied by telemedicine support improved postpartum contact and contraceptive utilization, especially during the coronavirus pandemic. However, the observed decrease in exclusive breastfeeding highlights the need for better telehealth support.ImplicationOur findings support that individualized postpartum care with telemedicine is a feasible and useful approach to sustain services during a pandemic.

Interventions to increase the uptake of cervical cancer screening in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

To identify effective interventions to increase the uptake of cervical cancer screening (CCS) for low-and middle-income countries (LMICs).

METHODS

We searched PubMed, CENTRAL, ISI Web of Sciences, Scopus, OVID (Medline), CINAHL, LILACS, CNKI and OpenGrey for randomized controlled trials (RCTs) and cluster RCTs conducted in LMICs from January 2000 to September 2021. Two reviewers independently screened studies, extracted data, assessed risk of bias and certainty of evidence. Meta-analyses with random-effects models were conducted for data synthesis.

RESULTS

We included 38 reports of 24 studies involving 318,423 participants from 15 RCTs and nine cluster RCTs. Single interventions may increase uptake of CCS when compared with control (RR 1.47, 95% CI 1.19 to 1.82). Self-sampling of Human Papillomavirus (HPV) testing may increase uptake of CCS relative to routine Visual Inspection with Acetic Acid (RR 1.93, 95% CI 1.66 to 2.25). Reminding with phone call may increase uptake of CCS than letter (RR 1.72, 95% CI 1.27 to 2.32) and SMS (RR 1.59, 95% CI 1.19 to 2.13). Sending 15 health messages may increase uptake of CCS relative to one SMS (RR 2.75, 95% CI 1.46 to 5.19). Free subsidized cost may increase uptake of CCS slightly than $0.66 subsidized cost (RR 1.60, 95% CI 1.10 to 2.33). Community based HPV test may increase uptake of CCS slightly in compared to hospital collected HPV (RR 1.67, 95% CI 1.53 to 1.82). The evidence is very uncertain about the effect of combined interventions on CCS uptake relative to single intervention (RR 2.20, 95% CI 1.54 to 3.14).

CONCLUSIONS

Single interventions including reminding with phone call, SMS, community self-sampling of HPV test, and free subsidized services may enhance CCS uptake. Combined interventions, including health education interventions and SMS plus e-voucher, may be better than single intervention. Due to low-certainty evidences, these findings should be applied cautiously.

Transmission sources and severe rat lung worm diseases in travelers: a scoping review

BACKGROUND

Rat lung worm disease (RLWD) has several clinical forms including eosinophilic meningitis (EOM) and two severe forms, eosinophilic meningoencephalitis (EOME) and eosinophilic radiculomyelitis (EORM). It remains unclear whether transmission sources are associated with severe forms of RLWD. This study aimed to evaluate if transmission factors are related to the severity of RLWD among travelers by using a scoping review of case reports.

METHODS

This was a review using five databases to retrieve case reports and case series of travelers with RLWD. Clinical data and transmission sources of reported cases diagnosed as RLWD were retrieved. The outcome of the study was occurrence of severe forms of RLWD defined as EOME, EORM, and combined EOME/EORM.

RESULTS

We retrieved 1,326 articles from five databases and 31 articles were included in the analysis. There were 84 cases eligible from 15 countries. Four cases were excluded. Seventy cases were in EOM group and 10 cases had EOME or EORM. Compared with the EOM group, the EOME, EORM, and combination EOME/EORM group had similar age, sex, and risk factors of consumptions of apple snails, shrimp and prawn, and salad/vegetables. The EOME group had higher proportion of consumption of African snails than the EOM group (60% vs 13.8%). However, only one study reported the consumption of African snails and the heterogeneity between studies and the small sample size impeded direct comparisons between groups.

CONCLUSIONS

RLWD in travelers can be found in most continents and mostly get infected from endemic countries of RLWD. Further studies are required to evaluate the association between transmission vectors and severity of RLWD.

Adherence to Continuous Positive Airway Pressure Therapy in Pediatric Patients with Obstructive Sleep Apnea: A Meta-Analysis

Introduction

Obstructive sleep apnea (OSA) is a public health problem that affects children. Although continuous positive airway pressure (CPAP) therapy is effective, the CPAP adherence rate in children is varied. This study aimed to evaluate the CPAP adherence rate and factors associated with CPAP adherence in children with OSA using a systematic review.

Methods

The inclusion criteria were observational studies conducted in children with OSA and assessed adherence of CPAP using objective evaluation. The literature search was performed in four databases. Meta-analysis using fixed-effect model was conducted to combine results among included studies.

Results

In all, 34 studies that evaluated adherence rate and predictors of CPAP adherence in children with OSA were included, representing 21,737 patients with an average adherence rate of 46.56%. There were 11 calculations of factors predictive of CPAP adherence: age, sex, ethnicity, body mass index, obesity, income, sleep efficiency, the apnea-hypopnea index (AHI), severity of OSA, residual AHI, and lowest oxygen saturation level. Three different factors were linked to children with adherence and non-adherence to CPAP: age, body mass index, and AHI.

Conclusion

The CPAP adherence rate in children with OSA was 46.56%. Young age, low body mass index, and high AHI were associated with acceptable CPAP adherence in children with OSA.

Feasibility and readiness to implement Robson classification to monitor caesarean sections in public hospitals in Myanmar: Formative research

Recent years have demonstrated an increase in caesarean section (CS) in most countries worldwide with considerable concern for the potential consequences. In 2015, WHO proposed the use of Robson classification as a global standard for assessing, monitoring and comparing CS rates. Currently, there is no standardized method to assess CS in Myanmar. The aim of this study was to explore health provider's perceptions about the feasibility, acceptability and readiness to implement the Robson classification in public hospitals across Myanmar. Ten maternities were purposively chosen, including all five teaching hospitals (tertiary referral hospital-level) affiliated to each medical university in Myanmar, which provide maternal and newborn care services, and district/township hospitals. Face-to-face in-depth interviews (IDI) with healthcare providers and facility administrators were conducted using semi-structured discussion guides. Facility and medical records systems were also assessed. We used the thematic analysis approach and Atlas.ti qualitative analysis software. A total of 67 IDIs were conducted. Most participants had willingness to implement Robson classification if there were sufficient human resources and training. Limited human resources, heavy workloads, and infrastructure resources were the major challenges described that may hinder implementation. The focal person for data entry, analysis, or reporting could be differed according to the level of facility, availability of human resources, and ability to understand medical terms and statistics. The respondents mentioned the important role of policy enforcement for the sustainability of data collection, interpretation and feedback. The optimal review interval period could therefore differ according to the availability of responsible persons, and the number of births. However, setting a fixed schedule according to the specific hospital for continuous monitoring of CS rate is required. In Myanmar, implementation of Robson classification is feasible while key barriers mainly related to human resource and training must be addressed to sustain.

Fentanyl for labour pain management: a scoping review

BACKGROUND

Labour pain has been identified as an important reason for women to prefer caesarean section (CS). Fentanyl is one of the short acting opioids recommended by World Health Organization for pain relief during labour. This study aimed to identify and describe the available evidence on the use of fentanyl (monotherapy) for labour pain management by any routes of administration or regime.

METHODS

We included the records published until 31 December 2021 which reported administration of fentanyl to women with normal labour for labour pain relief. Data were extracted by one reviewer and checked by another reviewer using a standardised agreement form. We mapped and presented data descriptively in figure and tabular format.

RESULTS

We included 51 records from 49 studies in our scoping review. The studies were conducted in 12 countries, mostly high-income countries. The study designs of the 51 included records were varied as follows: 38 (74.5%) experimental studies (35 randomised controlled trials and three quasi-experimental studies), and 12 (23.5%) observational studies (five retrospective cohort studies, four prospective cohort studies, two retrospective descriptive studies, and one descriptive study) and one qualitative study. Of the included records, six used intranasal fentanyl, five used subcutaneous fentanyl, 18 (35.3%) used intravenous fentanyl, 18 (35.3%) used intrathecal fentanyl, and nine used epidural fentanyl. Many records compared fentanyl with another analgesic agent while five records (9.8%) had no comparison group and seven records (13.7%) compared with no analgesia group. The doses of fentanyl varied by routes, study and the requirement depended on the women. Pain assessment was the most frequent outcome measure presented in the records (78.4%). Only nine records (17.6%) investigated women's satisfaction about labour pain relief using fentanyl and seven records (13.7%) reported the effect of fentanyl on breastfeeding. The most common reported neonatal outcomes were foetal heart rate (33 records, 64.7%) and Apgar score (32 records, 62.7%).

CONCLUSION

There is limited primary evidence especially randomised controlled trials to evaluate the effectiveness and harms of different routes of fentanyl in low- or middle-income countries. There is a need for high-quality research to establish the most effective route of fentanyl and associated effects for evidence-based international guidelines.

A national surveillance of eosinophilic meningitis in Thailand

Introduction

Eosinophilic meningitis (EOM) is an emerging infectious disease worldwide. The most common cause of EOM is infection with Angiostrongylus cantonensis One possible method of monitoring and control of this infection is surveillance and prediction. There are limited data on national surveillance and predictive models on EOM. This study aimed to develop an online surveillance with a predictive model for EOM by using the national database.

Methods

We retrospectively retrieved reported cases of EOM from all provinces in Thailand and quantified them by month and year. Data were retrieved from Ministry of Public Health database. We developed a website application to explore the EOM cases in Thailand including regions and provinces using box plots. The website also provided the Autoregressive Integrated Moving Average (ARIMA) models and Seasonal ARIMA (SARIMA) models for predicting the disease cases from nation, region, and province levels. The suitable models were considered by minimum Akaike Information Criterion (AIC). The appropriate SARIMA model was used to predict the number of EOM cases.

Results

From 2003 to 2021, 3330 EOM cases were diagnosed and registered in the national database, with a peak in 2003 (median of 22 cases). We determined SARIMA(1,1,2)(2,0,0)[12] to be the most appropriate model, as it yielded the fitted values that were closest to the actual data. A predictive surveillance website was published on http://202.28.75.8/sample-apps/NationalEOM/.

Conclusions

We determined that web application can be used for monitoring and exploring the trend of EOM patients in Thailand. The predictive values matched the actual monthly numbers of EOM cases indicating a good fit of the predictive model.

A meta‑analysis to identify factors associated with CPAP machine purchasing in patients with obstructive sleep apnea

Obstructive sleep apnea (OSA) is a common disease and related to several cardiovascular diseases. Treatment with a continuous positive airway pressure (CPAP) machine is effective. However, not all patients with OSA purchase a CPAP machine for personal use. Previous studies showed different predictors of CPAP machine purchasing in patients with OSA. The present study aimed to summarize and identify predictors of CPAP purchasing using meta-analysis. The study was conducted using factors associated with CPAP purchasing in patients with OSA. The types of studies conducted in adult patients with OSA included: Randomized controlled trials, observational studies or descriptive studies comparing factors between those who purchased CPAP and those who did not. A total of five databases, including PubMed, Central database, Scopus, CINAHL Plus and Web of Science, were searched, and the final search was performed on February 8, 2021. Predictors for CPAP purchasing were determined. There were 598 articles from five databases, which met the inclusion criteria. After duplicated article removal, 390 articles were included in the screening process. There were 12 eligible articles for full text evaluation, and of those, eight studies met the study criteria with 1,605 patients from four countries. There were 11 variables that were available for a comparison between those who purchased the CPAP machine and those who did not, and six factors were different between the two groups: Age, years of education, income, smoking, Epworth Sleepiness Scale (ESS) score and apnea hypopnea index/respiratory disturbance index (AHI/RDI). The AHI/RDI was significantly different between the two groups, with the highest mean difference of 10.40 events/h (95% CI, 4.95-15.86). Patients who purchased CPAP were older (1.11 years), had more years of education (0.93 years), smoked more (1.15 pack/year), and had both higher ESS (0.61) and AHI/RDI (10.40) than those who did not purchase CPAP. Additionally, those who purchased CPAP had a 1.47 times higher income than those who did not. In conclusion, specific personal customer and clinical factors were related to the decision of CPAP purchase in patients with OSA.

Roselle for hypertension in adults

BACKGROUND

Hypertension is considered to be a serious health problem worldwide. Controlling and lowering blood pressure are of significant benefit to people with hypertension because hypertension is a risk factor for stroke, heart disease, and cardiovascular disease. Roselle, the tropical plant Hibiscus sabdariffa, also commonly called sour tea or red tea, has been used as both a thirst-quenching drink and for medicinal purposes.

OBJECTIVES

To assess the effect of Roselle on blood pressure in people with primary hypertension.

SEARCH METHODS

For this update, the Cochrane Hypertension Information Specialist searched the following databases and trials registers for randomised controlled trials (RCTs): the Cochrane Hypertension Specialised Register (to 6 August 2021), Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 7), MEDLINE Ovid (1946 to 5 August 2021), Embase Ovid (1974 to 5 August 2021), ProQuest Dissertations & Theses (to 6 August 2021), Web of Science Clarivate (to 7 August 2021), Food Science and Technology Abstracts Clarivate (to 7 August 2021), the WHO International Clinical Trials Registry Platform (to 6 August 2021), and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (to 6 August 2021). We searched Google Scholar and OpenSIGLE. We also handsearched local and regional Chinese databases: CBM, CMCC, TCMLARS, CNKI, CMAC, and the Index to Chinese Periodical Literature (to 14 September 2020), as well as Thai databases (ThaiJO, CUIR, TDC, CMU e-Theses, TCTR) (to 3 October 2020). There were no language or publication date restrictions.

SELECTION CRITERIA

We sought RCTs evaluating the use of any forms of Roselle with placebo or no treatment in adults with hypertension. Our primary outcome was change in trough and/or peak systolic and diastolic blood pressure (SBP, DBP). Secondary outcomes were withdrawals due to adverse effects, change in pulse pressure, and change in heart rate.

DATA COLLECTION AND ANALYSIS

All search results were managed using Covidence and re-checked for the number of records, inclusion and exclusion of studies with Mendeley reference management software. We used standard methodological procedures expected by Cochrane. Two review authors worked independently in parallel for screening (titles and abstracts, and full reports), data extraction, risk of bias assessment, and assessment of the certainty of the evidence using the GRADE approach. Any disagreements were resolved by discussion or by consultation with the third review author if necessary. We presented mean difference (MD) of change in SBP and DBP with their corresponding 95% confidence interval (CI).

MAIN RESULTS

For this update, only one RCT with a parallel-group design involving 60 participants with type 2 diabetes mellitus fulfilled the inclusion criteria. This study investigated the effect of Roselle extract capsules (total dose of 5600 mg) compared with placebo (lactose) at eight weeks. The study was at low risk of selection bias, performance bias, and detection bias. Conversely, it was at high risk of attrition bias, reporting bias, and other bias (baseline imbalance). We have very little confidence in the effect estimate of Roselle on change-from-baseline in both SBP and DBP between the two groups. The MD of change in SBP was 1.65, 95% CI -7.89 to 11.19 mmHg, 52 participants, very low-certainty evidence. The MD of change in DBP was 4.60, 95% CI -1.38 to 10.58 mmHg, 52 participants, very low-certainty evidence. Our secondary outcomes of withdrawals due to adverse effects, change in pulse pressure, and change in heart rate were not reported. Due to the limited available data, no secondary analyses were performed (subgroup and sensitivity analysis).

AUTHORS' CONCLUSIONS

The evidence is currently insufficient to determine the effectiveness of Roselle compared to placebo for controlling or lowering blood pressure in people with hypertension. The certainty of evidence was very low due to methodological limitations, imprecision, and indirectness. There is a need for rigorous RCTs that address the review question.

Any Effective Intervention to Improve CPAP Adherence in Children with Obstructive Sleep Apnea: A Systematic Review

Obstructive sleep apnea (OSA) in children is leading to several consequences as reported in adults. A continuous positive airway pressure (CPAP) machine is one of the effective treatments in pediatric OSA. However, the CPAP adherence rate is approximately 50%. This study aimed to evaluate if any interventions that improve CPAP adherence in pediatric patients with OSA using a systematic review. We included intervention studies on CPAP adherence in pediatric patients with OSA regardless of machine types. Five databases were used for article searching. Search terms included OSA, adherence, compliance, and CPAP. The outcomes of this study were adherence rate and usage hours/minutes. The outcomes were compared between the intervention and comparator groups with descriptive statistics. There were 2931 articles from 5-database searching. There were 41 articles related with children. There were 7 articles conducted with any intervention on CPAP compliance. Of those, 4 studies included in the analysis. There were 3 significant differences between both groups in 2 studies. Those with caregiver support had significantly longer CPAP use/night by 86.60 minutes (95% CI 10.90, 162.30) and percentage of CPAP usage more than 4 hours/night by 18.10% (95% CI 3.87, 32.33) than those without caregiver support. Those who received BPAP therapy had higher chance of good PAP adherence than those who received CPAP by 18.17 times (95% CI 5.19, 63.70). Caregiver support and BPAP therapy significantly improved CPAP adherence in children with OSA. Further studies are required to add additional comparisons and also other interventions.

Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer

BACKGROUND

Bladder dysfunction is a common complication following radical hysterectomy, caused by the damage to pelvic autonomic nerves that innervate the muscles of the bladder, urethral sphincter, and pelvic floor fasciae. Bladder dysfunction increases the rates of urinary tract infection, hospital visits or admission, and patient dissatisfaction. In addition, bladder dysfunction can also negatively impact patient quality of life (QoL). Several postoperative interventions have been proposed to prevent bladder dysfunction following radical hysterectomy. To our knowledge, there has been no systematic review evaluating the effectiveness and safety of these interventions for preventing bladder dysfunction following radical hysterectomy in women with cervical cancer.

OBJECTIVES

To evaluate the effectiveness and safety of postoperative interventions for preventing bladder dysfunction following radical hysterectomy in women with early-stage cervical cancer (stage IA2 to IIA2).

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to April week 2, 2020), and Embase via Ovid (1980 to 2020, week 16). We also checked registers of clinical trials, grey literature, conference reports, and citation lists of included studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of any type of postoperative interventions for preventing bladder dysfunction following a radical hysterectomy in women with stage IA2 to IIA2 cervical cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, compared results, and made judgments on the quality and certainty of the evidence. We resolved any disagreements through discussion or consultation with a third review author. Outcomes of interest consisted of spontaneous voiding recovery one week after the operation, quality of life (QoL), adverse events, post-void residual urine volume one month after the operation, urinary tract infection over the one month following the operation, and subjective urinary symptoms.

MAIN RESULTS

We identified 1464 records as a result of the search (excluding duplicates). Of the 20 records that potentially met the review criteria, we included five reports of four studies. Most of the studies had unclear risks of selection and reporting biases. Of the four studies, one compared bethanechol versus placebo and three studies compared suprapubic catheterisation with intermittent self-catheterisation. We identified two ongoing studies. Bethanechol versus placebo The study reported no information on the rate of spontaneous voiding recovery at one week following the operation, QoL, adverse events, urinary tract infection in the first month after surgery, and subjective urinary symptoms for this comparison. The volume of post-void residual urine, assessed at one month after surgery, among women receiving bethanechol was lower than those in the placebo group (mean difference (MD) -37.4 mL, 95% confidence interval (CI) -60.35 to -14.45; one study, 39 participants; very-low certainty evidence). Suprapubic catheterisation versus intermittent self-catheterisation The studies reported no information on the rate of spontaneous voiding recovery at one week and post-void residual urine volume at one month following the operation for this comparison. There was no difference in risks of acute complication (risk ratio (RR) 0.77, 95% CI 0.24 to 2.49; one study, 71 participants; very low certainty evidence) and urinary tract infections during the first month after surgery (RR 0.77, 95% CI 0.53 to 1.13; two studies, 95 participants; very- low certainty evidence) between participants who underwent suprapubic catheterisation and those who underwent intermittent self-catheterisation. Available data were insufficient to calculate the relative measures of the effect of interventions on QoL and subjective urinary symptoms.

AUTHORS' CONCLUSIONS

None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post-void residual volume of urine of 50 mL or less, or post-void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may minimise the risk of bladder dysfunction after radical hysterectomy by lowering post-void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self-catheterisation) remain unproven.

Are full-face helmets the most effective in preventing head and neck injury in motorcycle accidents? A meta-analysis

Motorcycles are the most common type of vehicle involved in traffic deaths in developing countries. Although helmets can provide protection against injury, there is limited evidence available regarding which type of helmet best protects against head and neck injuries in this setting. This review was conducted based on articles in the PubMed, Scopus, and Web of Science databases. We compared full-face helmets with other types of helmet with regard to head and neck injury prevention in road accidents involving motorcyclists. Of 702 studies, six were eligible with a total of 6,529 participants. When compared with partial and open helmets, the odds ratio of full-face helmets was 0.356 (95% CI of 0.280, 0.453) and 0.636 (95% CI of 0.453, 0.894), respectively, for reduction of head and neck injuries. In conclusion, full-face helmets reduced head and neck injuries in motorcycle accidents to a greater extent than other types of helmet. Policy makers should recommend that motorcyclists use full-face helmets.

An ecological study of eosinophilic meningitis caused by the nematode, Angiostrongylus cantonensis (Chen, 1935) (Nematoda: Metastrongylidae)

Climate change and other weather factors are associated with several infectious diseases, but are rarely reported as being associated with nematode infection. Eosinophilic meningitis (EOM) is an emerging disease worldwide caused by the nematode, Angiostrongylus cantonensis. It is transmitted through various agents such as snails and slugs. Temperature and rainfall are associated with snail population. There have been no previous studies on the relationship between weather and EOM. This was an ecological study. Numbers of EOM patients and weather data in Thailand's Loei province from 2006 to 2017 were obtained using a national database. A Spearman correlation was used to explore the relationship between EOM and weather variables. We developed a Poisson time series model combined with a distributed lag model (DLM) for estimating the effects of weather on EOM. We also created an autoregressive integrated moving average with exogeneous variable (ARIMAX) model for predicting future EOM cases over the following 12 months. There were 1126 EOM patients in the study. Among several weather factors, wind was significantly negatively correlated with the number of EOM patients (r_s: -0.204, 95% CI: -0.361 to -0.058; p value: 0.014). The ARIMAX(3, 0, 0) model with wind speed as a variable was appropriate for predicting the number of EOM patients. The predicted and actual numbers of EOM patients in 2018 were highly concordant. In conclusion, wind speed is significantly negatively correlated with the number of EOM patients.

Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa)

BACKGROUND

Radical hysterectomy is one of the standard treatments for stage Ia2 to IIa cervical cancer. Bladder dysfunction caused by disruption of the pelvic autonomic nerves is a common complication following standard radical hysterectomy and can affect quality of life significantly. Nerve-sparing radical hysterectomy is a modified radical hysterectomy, developed to permit resection of oncologically relevant tissues surrounding the cervical lesion, while preserving the pelvic autonomic nerves.

OBJECTIVES

To evaluate the benefits and harms of nerve-sparing radical hysterectomy in women with stage Ia2 to IIa cervical cancer.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid (1946 to May week 2, 2018), and Embase via Ovid (1980 to 2018, week 21). We also checked registers of clinical trials, grey literature, reports of conferences, citation lists of included studies, and key textbooks for potentially relevant studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) evaluating the efficacy and safety of nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa).

DATA COLLECTION AND ANALYSIS

We applied standard Cochrane methodology for data collection and analysis. Two review authors independently selected potentially relevant RCTs, extracted data, evaluated risk of bias of the included studies, compared results and resolved disagreements by discussion or consultation with a third review author, and assessed the certainty of evidence.

MAIN RESULTS

We identified 1332 records as a result of the search (excluding duplicates). Of the 26 studies that potentially met the review criteria, we included four studies involving 205 women; most of the trials had unclear risks of bias. We identified one ongoing trial.The analysis of overall survival was not feasible, as there were no deaths reported among women allocated to standard radical hysterectomy. However, there were two deaths in among women allocated to the nerve-sparing technique. None of the included studies reported rates of intermittent self-catheterisation over one month following surgery. We could not analyse the relative effect of the two surgical techniques on quality of life due to inconsistent data reported. Nerve-sparing radical hysterectomy reduced postoperative bladder dysfunctions in terms of a shorter time to postvoid residual volume of urine ≤ 50 mL (mean difference (MD) -13.21 days; 95% confidence interval (CI) -24.02 to -2.41; 111 women; 2 studies; low-certainty evidence) and lower volume of postvoid residual urine measured one month following operation (MD -9.59 days; 95% CI -16.28 to -2.90; 58 women; 2 study; low-certainty evidence). There were no clear differences in terms of perioperative complications (RR 0.55; 95% CI 0.24 to 1.26; 180 women; 3 studies; low-certainty evidence) and disease-free survival (HR 0.63; 95% CI 0.00 to 106.95; 86 women; one study; very low-certainty evidence) between the comparison groups.

AUTHORS' CONCLUSIONS

Nerve-sparing radical hysterectomy may lessen the risk of postoperative bladder dysfunction compared to the standard technique, but the certainty of this evidence is low. The very low-certainty evidence for disease-free survival and lack of information for overall survival indicate that the oncological safety of nerve-sparing radical hysterectomy for women with early stage cervical cancer remains unclear. Further large, high-quality RCTs are required to determine, if clinically meaningful differences of survival exist between these two surgical treatments.

Effect of postoperative coffee consumption on gastrointestinal function after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials

Coffee is believed to prevent postoperative ileus. This systematic review and meta-analysis was undertaken to determine the effectiveness of coffee consumption in stimulating gastrointestinal function after abdominal surgery. A number of databases for randomized controlled trials comparing coffee consumption following abdominal surgery versus water drinking or no intervention were searched. Cochrane’s Risk of Bias tool was used to assess risk of bias in included studies. Six trials involving 601 participants were included. All studies had high risk of performance bias. Three studies had an unclear risk of selection bias. Postoperative coffee consumption reduced time to first defecation (mean difference (MD), −9.98 hours; 95% CI, −16.97 to −2.99), time to first flatus (MD, −7.14 hours; 95% CI, −10.96 to −3.33), time to first bowel sound (MD, −4.17 hours; 95% CI, −7.88 to −0.47), time to tolerance of solid food (MD, −15.55 hours; 95% CI, −22.83 to −8.27), and length of hospital stay (MD, −0.74 days; 95% CI, −1.14 to −0.33). Benefits increased with increasing complexity of the procedure. None of the included studies reported adverse events associated with coffee consumption. Postoperative coffee consumption is effective and safe for enhancing the recovery of gastrointestinal function after abdominal surgery.

ENHANCEMENT OF LEARNING ON SAMPLE SIZE CALCULATION WITH A SMARTPHONE APPLICATION: A CLUSTER-RANDOMIZED CONTROLLED TRIAL

Sample size determination usually is taught based on theory and is difficult to understand. Using a smartphone application to teach sample size calculation ought to be more attractive to students than using lectures only. This study compared levels of understanding of sample size calculations for research studies between participants attending a lecture only versus lecture combined with using a smartphone application to calculate sample sizes, to explore factors affecting level of post-test score after training sample size calculation, and to investigate participants’ attitude toward a sample size application. A cluster-randomized controlled trial involving a number of health institutes in Thailand was carried out from October 2014 to March 2015. A total of 673 professional participants were enrolled and randomly allocated to one of two groups, namely, 341 participants in 10 workshops to control group and 332 participants in 9 workshops to intervention group. Lectures on sample size calculation were given in the control group, while lectures using a smartphone application were supplied to the test group. Participants in the intervention group had better learning of sample size calculation (2.7 points out of maximnum 10 points, 95% CI: 24 - 2.9) than the participants in the control group (1.6 points, 95% CI: 1.4 - 1.8). Participants doing research projects had a higher post-test score than those who did not have a plan to conduct research projects (0.9 point, 95% CI: 0.5 - 1.4). The majority of the participants had a positive attitude towards the use of smartphone application for learning sample size calculation.

Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes

BACKGROUND

Maternal nutrition during pregnancy is known to have an effect on fetal growth and development. It is recommended that women increase their calcium intake during pregnancy and lactation, although the recommended dosage varies among professionals. Currently, there is no consensus on the role of routine calcium supplementation for pregnant women other than for preventing or treating hypertension.

OBJECTIVES

To determine the effect of calcium supplementation on maternal, fetal and neonatal outcomes (other than for preventing or treating hypertension) as well as any possible side effects.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30th September 2014).

SELECTION CRITERIA

We considered all published, unpublished and ongoing randomised controlled trials (RCTs) comparing maternal, fetal and neonatal outcomes in pregnant women who received calcium supplementation versus placebo or no treatment. Cluster-RCTs were eligible for inclusion but none were identified. Quasi-RCTs and cross-over studies were not eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

MAIN RESULTS

Twenty-five studies met the inclusion criteria, but only 23 studies contributed data to the review. These 23 trials recruited 18,587 women, with 17,842 women included in final analyses. There were no statistically significant differences between women who received calcium supplementation and those who did not in terms of reducing preterm births less than 37 weeks' gestation (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.70 to 1.05; 13 studies, 16,139 women; random-effects model) or less than 34 weeks' gestation (RR 1.04, 95% CI 0.80 to 1.36; four trials, 5669). Most studies were of low risk of bias. We conducted sensitivity analysis for the outcome of preterm birth less than 37 weeks by removing two trials with unclear risk of bias for allocation concealment; the results then favoured treatment with calcium supplementation (RR 0.80, 95% CI 0.65 to 0.99; 11 trials, 15,379 women). There was no significant difference in infant low birthweight between the two treatment groups (RR 0.93, 95% CI 0.81 to 1.07; six trials, 14,162 infants; random-effects model). However, when compared to the control group, women in the calcium supplementation group gave birth to slightly heavier birthweight infants (mean difference 56.40, 95% CI 13.55 to 99.25; 21 trials, 9202 women; random-effects model).Three outcomes were chosen for assessment with the GRADE software: preterm birth less than 37 weeks; preterm birth less than 34 weeks; and low birthweight less than 2500 g. Evidence for these outcomes was assessed as of moderate quality.

AUTHORS' CONCLUSIONS

This review indicates that there are no clear additional benefits to calcium supplementation in prevention of preterm birth or low infant birthweight. While there was a statistically significant difference of 56 g identified in mean infant birthweight, there was significant heterogeneity identified, and the clinical significance of this difference is uncertain.

Corticosteroids for parasitic eosinophilic meningitis

BACKGROUND

Angiostrongylus cantonensis (A. cantonensis) is the major cause of infectious eosinophilic meningitis. Dead larvae of this parasite cause inflammation and exacerbate symptoms of meningitis. Corticosteroids are drugs used to reduce the inflammation caused by this parasite.

OBJECTIVES

To assess the efficacy and safety of corticosteroids for the treatment of eosinophilic meningitis.

SEARCH METHODS

We searched CENTRAL (2014, Issue 11), MEDLINE (1950 to November Week 3, 2014), EMBASE (1974 to December 2014), Scopus (1960 to December 2014), Web of Science (1955 to December 2014), LILACS (1982 to December 2014) and CINAHL (1981 to December 2014).

SELECTION CRITERIA

Randomised controlled trials (RCTs) of corticosteroids versus placebo for eosinophilic meningitis.

DATA COLLECTION AND ANALYSIS

Two review authors (SiT, SaT) independently collected and extracted study data. We graded the methodological quality of the RCTs. We identified and analysed outcomes and adverse effects.

MAIN RESULTS

We did not identifiy any new trials for inclusion or exclusion in this 2014 update. One study involving 110 participants (55 participants in each group) met our inclusion criteria. The corticosteroid (prednisolone) showed a benefit in shortening the median time to resolution of headaches (five days in the treatment group versus 13 days in the control group, P value < 0.0001). Corticosteroids were also associated with smaller numbers of participants who still had headaches after a two-week course of treatment (9.1% versus 45.5%, P value < 0.0001). The number of patients who needed repeat lumbar puncture was also smaller in the treatment group (12.7% versus 40%, P value = 0.002). There was a reduction in the median time of analgesic use in participants receiving corticosteroids (10.5 versus 25.0, P value = 0.038). There were no reported adverse effects from prednisolone in the treatment group.

AUTHORS' CONCLUSIONS

Corticosteroids significantly help relieve headache in patients with eosinophilic meningitis, who have a pain score of four or more on a visual analogue scale. However, there is only one RCT supporting this benefit and this trial did not clearly mention allocation concealment and stratification. Therefore, we agreed to grade our included study as a moderate quality trial. Future well-designed RCTs are necessary.

A comparison of statistical methods for identifying out-of-date systematic reviews

BACKGROUND

Systematic reviews (SRs) can provide accurate and reliable evidence, typically about the effectiveness of health interventions. Evidence is dynamic, and if SRs are out-of-date this information may not be useful; it may even be harmful. This study aimed to compare five statistical methods to identify out-of-date SRs.

METHODS

A retrospective cohort of SRs registered in the Cochrane Pregnancy and Childbirth Group (CPCG), published between 2008 and 2010, were considered for inclusion. For each eligible CPCG review, data were extracted and "3-years previous" meta-analyses were assessed for the need to update, given the data from the most recent 3 years. Each of the five statistical methods was used, with random effects analyses throughout the study.

RESULTS

Eighty reviews were included in this study; most were in the area of induction of labour. The numbers of reviews identified as being out-of-date using the Ottawa, recursive cumulative meta-analysis (CMA), and Barrowman methods were 34, 7, and 7 respectively. No reviews were identified as being out-of-date using the simulation-based power method, or the CMA for sufficiency and stability method. The overall agreement among the three discriminating statistical methods was slight (Kappa = 0.14; 95% CI 0.05 to 0.23). The recursive cumulative meta-analysis, Ottawa, and Barrowman methods were practical according to the study criteria.

CONCLUSION

Our study shows that three practical statistical methods could be applied to examine the need to update SRs.

Corticosteroids for parasitic eosinophilic meningitis

BACKGROUND

Angiostrongylus cantonensis (A. cantonensis) is the major cause of infectious eosinophilic meningitis. Dead larvae of this parasite cause inflammation and exacerbate symptoms of meningitis. Corticosteroids are drugs used to reduce inflammation caused by this parasite.

OBJECTIVES

To examine the effects and adverse events of corticosteroids in patients with eosinophilic meningitis.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to July Week 4, 2012), EMBASE (1974 to July 2012), Scopus (1960 to July 2012), Web of Science (1955 to July 2012), LILACS (1982 to July 2012), and CINAHL (1981 to July 2012).

SELECTION CRITERIA

Randomised controlled trials (RCTs) of corticosteroids versus placebo for eosinophilic meningitis.

DATA COLLECTION AND ANALYSIS

Two review authors (SiT, SaT) independently collected and extracted study data. We graded the methodological quality of the RCTs. We identified and analyzed outcomes and adverse effects.

MAIN RESULTS

One study involving 110 participants (55 participants in each group) met our inclusion criteria. The corticosteroid (prednisolone) showed a benefit in shortening the median time to resolution of headaches (five days in the treatment group versus 13 days in the control group, P < 0.0001). Corticosteroids were also associated with smaller numbers of participants who still had headaches after a two-week course of treatment (9.1% versus 45.5%, P < 0.0001). There was a reduction in median time of analgesics use in participants receiving corticosteroids (10.5 versus 25.0, P = 0.038). There were no reported adverse effects from prednisolone in the treatment group.

AUTHORS' CONCLUSIONS

Corticosteroids significantly help relieve headache in patients with eosinophilic meningitis. However, there is only one RCT supporting this benefit and this trial did not clearly mention allocation concealment and stratification. Future well-designed RCTs may be necessary.

Interventions for preventing excessive weight gain during pregnancy

BACKGROUND

Excessive weight gain during pregnancy is associated with multiple maternal and neonatal complications. However, interventions to prevent excessive weight gain during pregnancy have not been adequately evaluated.

OBJECTIVES

To evaluate the effectiveness of interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (20 October 2011) and MEDLINE (1966 to 20 October 2011).

SELECTION CRITERIA

All randomised controlled trials and quasi-randomised trials of interventions for preventing excessive weight gain during pregnancy.

DATA COLLECTION AND ANALYSIS

We assessed for inclusion all potential studies we identified as a result of the search strategy. At least two review authors independently assessed trial quality and extracted data. We resolved discrepancies through discussion. We have presented results using risk ratio (RR) for categorical data and mean difference for continuous data. We analysed data using a fixed-effect model.

MAIN RESULTS

We included 28 studies involving 3976 women; 27 of these studies with 3964 women contributed data to the analyses. Interventions focused on a broad range of interventions. However, for most outcomes we could not combine data in a meta-analysis, and where we did pool data, no more than two or three studies could be combined for a particular intervention and outcome. Overall, results from this review were mainly not statistically significant, and where there did appear to be differences between intervention and control groups, results were not consistent. For women in general clinic populations one (behavioural counselling versus standard care) of three interventions examined was associated with a reduction in the rate of excessive weight gain (RR 0.72, 95% confidence interval 0.54 to 0.95); for women in high-risk groups no intervention appeared to reduce excess weight gain. There were inconsistent results for mean weight gain (reported in all but one of the included studies). We found a statistically significant effect on mean weight gain for five interventions in the general population and for two interventions in high-risk groups.Most studies did not show statistically significant effects on maternal complications, and none reported significant effects on adverse neonatal outcomes.

AUTHORS' CONCLUSIONS

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes

BACKGROUND

Maternal nutrition during pregnancy is known to have an effect on fetal growth and development. It is recommended that women increase their calcium intake during pregnancy and lactation, although the recommended dosage varies among professionals. Currently, there is no consensus on the role of routine calcium supplementation for pregnant women other than for preventing or treating hypertension.

OBJECTIVES

To determine the effect of calcium supplementation on maternal, fetal and neonatal outcomes (other than for preventing or treating hypertension) as well as any possible side effects.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 March 2011).

SELECTION CRITERIA

We considered all published, unpublished and ongoing randomised controlled trials (RCTs) comparing maternal, fetal and neonatal outcomes in pregnant women who received calcium supplementation versus placebo or no treatment. We excluded quasi- and pseudo-RCTs.

DATA COLLECTION AND ANALYSIS

Two review authors identified studies for inclusion and extracted the data. Two review authors performed data analysis.

MAIN RESULTS

This review includes data from 21 studies (involving 16,602 women). There were no statistically significant differences between women who received calcium supplementation and those who did not in terms of reducing preterm births (less than 37 weeks' gestation) (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.73 to 1.11; 12 studies, 15615 women; random-effects model) and also in less than 34 weeks' gestation (RR 1.11; 95% CI 0.84 to 1.46; three trials, 5145 women). There was no significant difference in infant low birth weight between the two groups (RR 0.91; 95% CI 0.72 to 1.16; four trials, 13449 infants; random-effects). However, compared to the control group, women in the calcium supplementation group gave birth to slightly heavier birth weight infants (mean difference (MD) 64.66 g; 95% CI 15.75 to 113.58; 19 trials, 8287 women; random-effects).

AUTHORS' CONCLUSIONS

Calcium supplementation is associated with a significant protective benefit in the prevention of pre-eclampsia, and should be used for this indication according to a previous review. This review indicates that there are no additional benefits for calcium supplementation in prevention of preterm birth or low infant birth weight. While there was a statistically significant difference of 80 g identified in mean infant birth weight, there was significant heterogeneity identified, and the clinical significance of this difference is uncertain.

Meditation therapies for attention-deficit/hyperactivity disorder (ADHD)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders experienced in childhood and can persist into adulthood. The disorder has early onset and is characterized by a combination of overactive, poorly modulated behavior with marked inattention. In the long term it can impair academic performance, vocational success and social-emotional development. Meditation is increasingly used for psychological conditions and could be used as a tool for attentional training in the ADHD population.

OBJECTIVES

To assess the effectiveness of meditation therapies as a treatment for ADHD.

SEARCH STRATEGY

Our extensive search included: CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, C2-SPECTR, dissertation abstracts, LILACS, Virtual Health Library (VHL) in BIREME, Complementary and Alternative Medicine specific databases, HSTAT, Informit, JST, Thai Psychiatric databases and ISI Proceedings, plus grey literature and trial registries from inception to January 2010.

SELECTION CRITERIA

Randomized controlled trials that investigated the efficacy of meditation therapy in children or adults diagnosed with ADHD.

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently using a pre-designed data extraction form. We contacted study authors for additional information required. We analyzed data using mean difference (MD) to calculate the treatment effect. The results are presented in tables, figures and narrative form.

MAIN RESULTS

Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test (MD -8.34, 95% CI -107.05 to 90.37, 17 patients).

AUTHORS' CONCLUSIONS

As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported. More trials are needed.

Role of chest radiography in the diagnosis and follow-up of pulmonary metastasis in differentiated thyroid cancer

BACKGROUND

Post-treatment I-131 whole body scan (WBS) is known to be a very sensitive test in detecting metastasis in differentiated thyroid cancer (DTC). Therefore, in the presence of this sensitive method, the role of chest radiography (CXR) in the diagnosis of pulmonary metastasis has been questioned.

OBJECTIVE

The present study aimed to find the prevalence of pulmonary metastasis found on CXR in DTC patients who had negative post-treatment WBS.

MATERIAL AND METHOD

Retrospective comparison was undertaken of CXR and post-treatment WBS routinely performed in 300 DTC patients during the time of I-131 treatment from January 2003 to December 2006 in the Department of Radiology. Radiographic patterns of pulmonary metastasis classified as single nodule, multiple nodules, lymphangitic metastasis and pleural metastasis were also recorded.

RESULTS

Of the 300 DTC patients, 36 pulmonary metastases (12.0%) were diagnosed based on CXR and post-treatment I-131 WBS. Of these 36 cases, 11 (30.6%) were detected by both CXR and WBS, whereas 16 (44.4%) were detected by WBS alone and 9 (25.0%) by CXR alone. Seven of these 9 cases (77.8%) had lymphangitic pattern of pulmonary metastasis.

CONCLUSION

Although routine CXR has a limited role in the diagnosis of pulmonary metastasis in DTC patients being treated with I-131, it is helpful in detecting pulmonary metastasis in patients with negative post-treatment WBS.

Roselle for hypertension in adults

BACKGROUND

Hypertension is considered a serious health problem worldwide. Controlling and lowering blood pressure have a significant benefit to the hypertensive patients because hypertension is a risk factor for stroke, heart disease and cardiovascular disease. A tropical plant called Roselle, or Red Sorrel in English-speaking countries, has been used both as a thirst-quenching drink and for medical purposes.

OBJECTIVES

To explore the effect of Roselle on blood pressure in hypertensive adult patients.

SEARCH STRATEGY

The following databases were searched (Date of most recent search was September 2009): - Cochrane Database of Systematic Reviews (2nd Quarter 2009) - DARE (2nd Quarter 2009) - Ovid MEDLINE (1950 to Present with Daily Update) - EMBASE (1980 to 2009 Week 22) - AMED (1985 to May 2009) - EBSCO CINAHL - BIOSIS (1969 to 2008) - AGRICOLA (1970 to May 2009) - Food Science and Technology Abstract (1969 to 2009 June Week 1) - International Pharmaceutical Abstracts - International Bibliographic Information on Dietary Supplements - Clinical Trials.gov and Current Controlled Trials - OpenSIGLE - Hand searching of journals - ISI Web of Knowledge

SELECTION CRITERIA

We sought randomised control trials (RCTs) evaluating use of any forms of Roselle with placebo or no treatment in hypertensive patients. Change in trough and/or peak systolic and diastolic blood pressure were primary outcomes. Secondary outcomes were withdrawals due to adverse effects, change of pulse pressure and change of heart rate.

DATA COLLECTION AND ANALYSIS

Two review authors (C Ngamjarus, CN and P Pattanittum, PP) independently scanned titles and abstracts, as well as independently screened the full reports of the potentially relevant studies. At each stage, the results were compared and disagreements were solved by discussion.

MAIN RESULTS

No studies were identified that met the inclusion criteria. However, one abstract of an ongoing study is likely to meet the inclusion criteria, when completed.

AUTHORS' CONCLUSIONS

There is insufficient evidence to support the benefit of Roselle for either controlling or lowering blood pressure in patients with hypertension. Based on the information of this review, there is a clear need to develop well-designed studies to assess the efficacy of Roselle on hypertensive patients.