scholarly journals Rethinking research in breast-feeding: a critique of the evidence base identified in a systematic review of interventions to promote and support breast-feeding

2007 ◽  
Vol 10 (7) ◽  
pp. 726-732 ◽  
Author(s):  
MJ Renfrew ◽  
H Spiby ◽  
L D'Souza ◽  
LM Wallace ◽  
L Dyson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Breast Feeding ◽  
Professional Education ◽  
Evidence Base ◽  
Small Sample ◽  
Practice Change ◽  
Policy Goals ◽  
Breast Feed ◽  
Small Sample Sizes ◽  
The Uk

AbstractObjectiveTo appraise critically the relevance and value of the evidence base to promote and support the duration of breast-feeding, with a specific focus on disadvantaged groups.DesignA systematic review was conducted of intervention studies relevant to enhancing the duration of breast-feeding; topics included public health, public policy, clinical issues, and education, training and practice change. A systematic search was conducted. Eighty studies met the inclusion criteria. Data were systematically extracted and analysed. Full results and recommendations are reported elsewhere. Here a critique of the evidence base – topics, quality and gaps – is reported.ResultsMany studies were substantially methodologically flawed, with problems including small sample sizes, inconsistent definitions of breast-feeding and lack of appropriate outcomes. Few were based on relevant theory. Only a small number of included studies (10%) were conducted in the UK. Very few targeted disadvantaged subgroups of women. No studies of policy initiatives or of community interventions were identified. There were virtually no robust studies of interventions to prevent and treat common clinical problems, or of strategies related to women's health issues. Studies of health professional education and practice change were limited. Cost-effectiveness studies were rare.ConclusionsPolicy goals both in the UK and internationally support exclusive breast-feeding until 6 months of age. The evidence base to enable women to continue to breast-feed needs to be strengthened to include robust evaluations of policies and practices related to breast-feeding; a step change is needed in the quality and quantity of research funded.

scholarly journals A Systematic Review of the Clinical Use of Gabapentin and Pregabalin in Bipolar Disorder

2021 ◽  
Vol 14 (9) ◽  
pp. 834
Author(s):  
Qin Xiang Ng ◽  
Ming Xuan Han ◽  
Seth En Teoh ◽  
Clyve Yu Leon Yaow ◽  
Yu Liang Lim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Significant Proportion ◽  
Evidence Base ◽  
Small Sample ◽  
Long Term Outcomes ◽  
Open Label ◽  
Related Drug ◽  
Small Sample Sizes

Despite its prevalence and disease burden, several chasms still exist with regard to the pharmacotherapy of bipolar disorder (BD). Polypharmacy is commonly encountered as a significant proportion of patients remain symptomatic, and the management of the depressive phase of the illness is a particular challenge. Gabapentin and pregabalin have often been prescribed off-label in spite of a paucity of evidence and clinical practice guidelines to support its use. This systematic review aimed to synthesize the available human clinical trials and inform evidence-based pharmacological approaches to BD management. A total of six randomized, controlled trials (RCTs) and 13 open-label trials involving the use of gabapentin and pregabalin in BD patients were reviewed. Overall, the studies show that gabapentin and its related drug pregabalin do not have significant clinical efficacy as either monotherapy or adjunctive therapy for BD. Gabapentin and pregabalin are probably ineffective for acute mania based on the findings of RCT, with only small open-label trials to support its potential adjunctive role. However, its effects on the long-term outcomes of BD remain to be elucidated. The evidence base was significantly limited by the generally small sample sizes and the trials also had heterogeneous designs and generally high risk of bias.

Reunifying Successfully: A Systematic Review of Interventions to Reduce Child Welfare Recidivism

2020 ◽  
Vol 30 (8) ◽  
pp. 832-845
Author(s):  
Catherine A. LaBrenz ◽  
Lisa S. Panisch ◽  
Chun Liu ◽  
Rowena Fong ◽  
Cynthia Franklin
Keyword(s):  
Systematic Review ◽  
Child Welfare ◽  
Evidence Base ◽  
Small Sample ◽  
Effect Sizes ◽  
Inclusion Criteria ◽  
Welfare Systems ◽  
Prior Literature ◽  
Small Sample Sizes

As many as one third of children who reunify from child welfare systems reenter care because of continued child maltreatment. This can have long-term deleterious effects on mental health. Yet, few studies have examined interventions that have been effective in promoting successful reunification or reunification that does not result in recidivism. This study presents findings from a systematic review of interventions that target successful reunification. We searched five academic databases, governmental and educational websites to identify prior literature. Three researchers extracted data from N = 216 studies retrieved and screened in 10 that met all inclusion criteria. However, small sample sizes, lack of replication of studies, and small effect sizes limit the generalizability of findings. As such, the findings from this review highlight a need for more rigorous studies to build the evidence base of post-permanence interventions for families that reunify.

scholarly journals Viscoelastometric Testing to Assess Hemostasis of COVID-19: A Systematic Review

2021 ◽  
Vol 10 (8) ◽  
pp. 1740
Author(s):  
Marion Bareille ◽  
Michaël Hardy ◽  
Jonathan Douxfils ◽  
Stéphanie Roullet ◽  
Dominique Lasne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mechanical Strength ◽  
Small Sample ◽  
The Common ◽  
Small Sample Sizes ◽  
Definition Of ◽  
Reported Data ◽  
Prophylactic Anticoagulation ◽  
The Impact ◽  
Heparin Neutralization

Infection by SARS-CoV-2 is associated with a high risk of thrombosis. The laboratory documentation of hypercoagulability and impaired fibrinolysis remains a challenge. Our aim was to assess the potential usefulness of viscoelastometric testing (VET) to predict thrombotic events in COVID-19 patients according to the literature. We also (i) analyzed the impact of anticoagulation and the methods used to neutralize heparin, (ii) analyzed whether maximal clot mechanical strength brings more information than Clauss fibrinogen, and (iii) critically scrutinized the diagnosis of hypofibrinolysis. We performed a systematic search in PubMed and Scopus databases until December 31st, 2020. VET methods and parameters, and patients’ features and outcomes were extracted. VET was performed for 1063 patients (893 intensive care unit (ICU) and 170 non-ICU, 44 studies). There was extensive heterogeneity concerning study design, VET device used (ROTEM, TEG, Quantra and ClotPro) and reagents (with non-systematic use of heparin neutralization), timing of assay, and definition of hypercoagulable state. Notably, only 4 out of 25 studies using ROTEM reported data with heparinase (HEPTEM). The common findings were increased clot mechanical strength mainly due to excessive fibrinogen component and impaired to absent fibrinolysis, more conspicuous in the presence of an added plasminogen activator. Only 4 studies out of the 16 that addressed the point found an association of VETs with thrombotic events. So-called functional fibrinogen assessed by VETs showed a variable correlation with Clauss fibrinogen. Abnormal VET pattern, often evidenced despite standard prophylactic anticoagulation, tended to normalize after increased dosing. VET studies reported heterogeneity, and small sample sizes do not support an association between the poorly defined prothrombotic phenotype of COVID-19 and thrombotic events.

Nipple Confusion

PEDIATRICS ◽  
1993 ◽  
Vol 92 (2) ◽  
pp. 300-301
Author(s):  
DOREN FREDRICKSON
Keyword(s):  
Breast Feeding ◽  
Statistical Power ◽  
White Women ◽  
Small Sample Size ◽  
False Negative ◽  
Small Sample ◽  
Bottle Feeding ◽  
Feeding Duration ◽  
Breast Feed ◽  
The Impact

To the Editor.— I wish to comment on the study reported by Cronenwett et al,1 which was a fascinating prospective study among married white women who planned to breast-feed. Women were randomly selected to perform either exdusive breast-feeding or partial breast-feeding with bottled human milk supplements to determine the impact of infant temperament and limited bottle-feeding on breast-feeding duration. The authors admit that small sample size and lack of statistical power make a false-negative possible.

Systematic Review of Pre-Injury Migraine Disorder as a Risk Factor for Worse Outcome Following Sport-Related Concussion

2019 ◽  
Vol 34 (5) ◽  
pp. 754-754
Author(s):  
D P Terry ◽  
A J Gardner ◽  
G L Iverson
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Age Of Onset ◽  
Small Sample ◽  
Self Report ◽  
Cochrane Library ◽  
Clinical Recovery ◽  
Other Information ◽  
Sport Athlete ◽  
Small Sample Sizes

Abstract Purpose This systematic review examined clinical outcomes (i.e., prognosis) following a sport-related concussion in athletes who have a pre-injury history of migraines. Clinical recovery was defined functionally as recovery from symptoms or full return to activities following injury. Data Selection All studies published prior to February 2019 that addressed pre-injury migraines as a possible predictor of clinical recovery from concussion were included. Broadly, the search included (i) sport/athlete-related terms, (ii) concussion-related terms, and (iii) diverse predictor/modifier terms. The following databases were utilized: PubMed, PsycINFO®, MEDLINE®, CINAHL, Cochrane Library, EMBASE, SPORTDiscus, Scopus, and Web of Science. After removing duplicates from the 9,372 identified articles, 5,888 abstracts were screened, 358 full-text articles were reviewed, and 15 articles examining pre-injury migraines as a predictor of recovery were included. Data Synthesis Most articles examined pre-injury migraines as an exploratory/secondary predictor of concussion outcome. Migraine history was predominantly based on self-report. Studies included minimal other information about this condition (e.g., age of onset, migraine frequency/severity, past treatment). Methodological rigor varied greatly across studies. Most studies did not find pre-injury migraines to be associated with concussion outcome, but several of these studies had small or very small sample sizes. Larger, better-designed studies suggested pre-injury migraines may be a risk factor for worse concussion outcome. Effect sizes were rarely reported or able to be calculated. Conclusion There is some evidence to suggest pre-injury migraines may be a vulnerability factor for a prolonged recovery following concussion. Future studies should focus on improving methodological quality when assessing the relationship between pre-injury migraines and concussion outcome.

Nutritional intervention for ADHD

2018 ◽  
Author(s):  
Jan K. Buitelaar ◽  
Nanda Rommelse ◽  
Verena Ly ◽  
Julia J. Rucklidge
Keyword(s):  
Fatty Acids ◽  
Clinical Relevance ◽  
Randomized Clinical Trials ◽  
Nutritional Intervention ◽  
Evidence Base ◽  
Small Sample ◽  
Omega 3 ◽  
Dietary Interventions ◽  
Small Sample Sizes ◽  
Sampling Procedures

This chapter discusses four dietary interventions (exclusion of artificial colours and preservatives; restrictive elimination diets/oligoantigenic diets; supplementation with omega-3 fatty acids; and supplementation with micronutrients) and their clinical relevance for ADHD. The evidence base for exclusion of artificial colours and preservatives has many gaps. Effectiveness of the elimination phase of elimination diets has been demonstrated in several randomized clinical trials and about one-third of the children with ADHD show an excellent response. Data on maintenance of effect in the longer term, however, are lacking. Supplementation of free fatty acids was associated with a small but reliable reduction of ADHD symptoms, but the clinical relevance is unclear. The trials using a broad spectrum of micronutrients show promise but suffered from small sample sizes, lack of controls, varied sampling procedures and inclusion criteria, and multiple assessment methods, and need confirmation.

scholarly journals Psychosocial Benefits of Cooking Interventions: A Systematic Review

2017 ◽  
Vol 45 (2) ◽  
pp. 167-180 ◽  
Author(s):  
Nicole Farmer ◽  
Katherine Touchton-Leonard ◽  
Alyson Ross
Keyword(s):  
Systematic Review ◽  
Quantitative Research ◽  
Psychosocial Outcomes ◽  
Self Esteem ◽  
Small Sample ◽  
Inclusion Criteria ◽  
Self Confidence ◽  
Small Sample Sizes ◽  
Psychosocial Benefits

Objectives. Cooking interventions are used in therapeutic and rehabilitative settings; however, little is known about the influence of these interventions on psychosocial outcomes. This systematic review examines the research evidence regarding the influence of cooking interventions on psychosocial outcomes. Methods. A systematic review of the literature examined peer-reviewed research using Embase, PubMed, CINALH Plus, and PsychInfo with the following search terms: cooking, culinary, baking, food preparation, cookery, occupational therapy, mental health, mood, psychosocial, affect, confidence, self-confidence, self-esteem, socialization, and rehabilitation. Inclusion criteria were the following: adults, English, influence of cooking interventions on psychosocial outcomes. PRISMA guidelines were used. Results. The search yielded 377 articles; and 11 ultimately met inclusion criteria and were reviewed. Generally, the quality of the research was weak due to nonrandomization, unvalidated research tools, and small sample sizes. However, inpatient and community-based cooking interventions yielded positive influences on socialization, self-esteem, quality of life, and affect. Conclusions. Finding benefits to cooking that extend beyond nutritional may be helpful in increasing motivation and frequency of cooking. This review suggests that cooking interventions may positively influence psychosocial outcomes, although this evidence is preliminary and limited. Further qualitative and rigorous quantitative research are needed to identify mechanisms by which cooking interventions may improve psychosocial outcomes.

Prevalence of tuberculosis, brucellosis and trypanosomiasis in cattle in Tanzania: a systematic review and meta-analysis

2016 ◽  
Vol 17 (1) ◽  
pp. 16-27 ◽  
Author(s):  
Silvia Alonso ◽  
Ian Dohoo ◽  
Johanna Lindahl ◽  
Cristobal Verdugo ◽  
Isaiah Akuku ◽  
...  
Keyword(s):  
Systematic Review ◽  
Production Systems ◽  
Strong Predictor ◽  
Meta Analysis ◽  
Small Sample ◽  
Skin Tests ◽  
Prevalence Studies ◽  
Prevalence Estimates ◽  
Using Data ◽  
Small Sample Sizes

AbstractA meta-analysis was performed to derive prevalence estimates for Brucella spp., Mycobacterium spp. and Trypanosoma spp. in cattle in Tanzania using data derived from a systematic review of zoonotic hazards in cattle production systems. Articles published before 2012 reporting prevalence and considered at least moderate in quality were included in the analysis. Results showed high heterogeneity between studies, with wide ranges in the reported prevalence: Brucella (0.3–60.8%), Mycobacterium (0.1–13.2%) and Trypanosoma (0.82–33.3%). Overall meta-analytic mean prevalence estimates were 8.2% (95% CI 6.5–10.2), 1.28% (95% CI 0.35–4.58) and 10.3% (95% CI 6.20–16.70) respectively, for Brucella spp., Mycobacterium spp. and Trypanosoma spp. Time and region were predictors of variability of Brucella spp. prevalence, while diagnostic test was a strong predictor of Mycobacterium spp. prevalence, with higher prevalence estimates given by skin tests compared with post-mortem inspection. None of the studied factors were associated with prevalence of Trypanosoma spp. The small sample sizes, range of study locations, study designs and diagnostics used, contributed to high variability among prevalence estimates. Larger and more robust prevalence studies are needed to adequately support risk assessment and management of animal and public health threats.

scholarly journals MECHANISMS IN ENDOCRINOLOGY: Epigenetic modifications and gestational diabetes: a systematic review of published literature

2017 ◽  
Vol 176 (5) ◽  
pp. R247-R267 ◽  
Author(s):  
Gunn-Helen Moen ◽  
Christine Sommer ◽  
Rashmi B Prasad ◽  
Line Sletner ◽  
Leif Groop ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gestational Diabetes ◽  
Current Knowledge ◽  
Epigenetic Modifications ◽  
Research Literature ◽  
Small Sample ◽  
Epigenetic Alterations ◽  
Search Terms ◽  
Small Sample Sizes

ObjectiveTo summarize the current knowledge on epigenetic alterations in mother and offspring subjected to gestational diabetes (GDM) and indicate future topics for research.DesignSystematic review.MethodsWe performed extensive searches in PubMed, EMBASE and Google scholar, using a combination of the search terms: GDM, gestational diabetes, epigenetic(s), methylation, histone modification, histone methylation, histone acetylation, microRNA and miRNA. Studies that compared women diagnosed with GDM and healthy controls were included. Two authors independently scanned the abstracts, and all included papers were read by at least two authors. The searches were completed on October 31st, 2016.ResultsWe identified 236 articles, of which 43 were considered relevant for this systematic review. Studies published showed that epigenetic alterations could be found in both mothers with GDM and their offspring. However, differences in methodology, diagnostic criteria for GDM and populations studied, together with a limited number of published studies and small sample sizes, preclude clear conclusions about the role of epigenetic modifications in transmitting risk from GDM mothers to their offspring.ConclusionThe current research literature suggests that GDM may have impact on epigenetic modifications in the mother and offspring. However, larger studies that include multiple cohorts of GDM patients and their offspring are needed.

scholarly journals Looking for crumbs in the obesity forest: anti-obesity interventions in the Mexican population. History, and systematic review with Meta-Analysis

2021 ◽  
Author(s):  
Esperanza M. Garcia-Oropesa ◽  
Yoscelina E. Martinez-Lopez ◽  
Sonia Maria Ruiz-Cejudo ◽  
Jose Dario Martinez-Ezquerro ◽  
Alvaro Diaz-Badillo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Behavioral Interventions ◽  
Meta Analysis ◽  
Small Sample ◽  
Population History ◽  
Sample Sizes ◽  
Obesity And Diabetes ◽  
Small Sample Sizes

Mexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. Obesity has been treated for centuries focused-on weight loss while other treatments on associated conditions like gout, diabetes (T2D), and hypertriglyceridemia. To date, there is no systematic review that synthetize the origin of obesity clinics in Mexico and the efforts to investigate treatments for obesity tested by randomized clinical trials (RCT). We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve anti-obesity RCT through 2019 and without inferior temporal limit. The systematic review included RCT of anti-obesity treatments in the Mexican adult population, including alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions reporting biometric outcomes such as BMI, weight, waist circumference, triglycerides, glucose, among others. Studies with at least three months of treatment were included in the meta-analysis. We found 634 entries, after removal of duplicates and screening the studies based on eligibility criteria, we analyzed 43, and 2 multinational-collaborative studies. Most of the national studies have small sample sizes, and the studied strategies do not have replications in the population. The nutrition/behavioral interventions were difficult to blind, and most studies have medium to high risk of bias. Nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like plain water instead of sweet beverages decrease triglycerides and systolic blood pressure. Participants with obesity and hypertension can have benefic effects with antioxidants, and treatment with insulin increase weight in those with T2D. The study of obesity in Mexico has been on-going for more than four decades, but the interest on RCT just increased until this millennium, but with small sample sizes and lack of replication. The interventions affect different metabolic syndrome components, which should be analyzed in detail with the population living on the U.S.-Mexico border; therefore, bi-national collaboration is desirable to disentangle the cultural effects on this population's treatment response.

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