The effect of smoking cessation counselling in pregnant women: a meta-analysis of randomised controlled trials

ObjectiveSmoking in people with serious mental illness is a major public health problem and contributes to significant levels of morbidity and mortality. The aim of the review was to systematically examine the efficacy of methods used to aid smoking cessation in people with serious mental illness.MethodA systematic review and meta-analysis of randomised controlled trials to compare the effectiveness and safety of pharmacological and behavioural programmes for smoking cessation in people with serious mental illness. Electronic databases were searched for trials to July 2018. We used the Cochrane Collaboration’s tool for assessing the risk of bias.ResultsTwenty-eight randomised controlled trials were identified. Varenicline increased the likelihood of smoking cessation at both 3 months (risk ratio (RR) 3.56, 95% CI 1.82 to 6.96, p=0.0002) and at 6 months (RR 3.69, 95% CI 1.08 to 12.60, p=0.04). Bupropion was effective at 3 months (RR 3.96, 95% CI 1.86 to 8.40, p=0.0003), especially at a dose of 300 mg/day, but there was no evidence of effect at 6 months (RR 2.22, 95% CI 0.52 to 9.47, p=0.28). In one small study, nicotine therapy proved effective at increasing smoking cessation up to a period of 3 months. Bupropion used in conjunction with nicotine replacement therapy showed more effect than single use. Behavioural and bespoke interventions showed little overall benefit. Side effects were found to be low.ConclusionThe new information of this review was the effectiveness of varenicline for smoking cessation at both 3 and 6 months and the lack of evidence to support the use of both bupropion and nicotine products for sustained abstinence longer than 3 months. Overall, the review found relatively few studies in this population.

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Effect of probiotic supplementation in pregnant women: a meta-analysis of randomised controlled trials

British Journal Of Nutrition ◽

10.1017/s0007114519003374 ◽

2019 ◽

Vol 123 (8) ◽

pp. 870-880 ◽

Cited By ~ 4

Author(s):

Linghan Kuang ◽

Yongmei Jiang

Keyword(s):

Pregnant Women ◽

Atopic Eczema ◽

Gestational Age ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Probiotic Supplementation ◽

Randomised Controlled

AbstractProbiotics are being used increasingly in pregnant women, whereas the efficiency on pregnancy outcomes is yet lacking. PubMed, Embase and the Cochrane Library were searched. Relative risks (RR) or weighted mean differences (WMD) with 95 % CI were employed to calculate the summary outcomes. A total of eighteen randomised controlled trials (RCT) including 4356 pregnant women were eligible. The summary RR indicated that probiotic supplementation was associated with a significant decrease in the risk of atopic eczema (RR 0·68; 95 % CI 0·58, 0·81; P < 0·001) and eczema (RR 0·79; 95 % CI 0·68, 0·91; P = 0·002) without significant heterogeneity. Probiotic supplementation was associated with a prolonged gestational age (WMD 0·09; 95 % CI 0·04, 0·15; P = 0·001) with insignificant heterogeneity, whereas no significant effect was exerted on birth weight (P = 0·851). The risks of death (RR 0·34; 95 % CI 0·13, 0·91; P = 0·031) and necrotising enterocolitis (NEC) (RR 0·38; 95 % CI 0·18, 0·81; P = 0·012) were significantly reduced in pregnant women receiving probiotics without evidence of heterogeneity. These findings suggested that probiotics in pregnant women were beneficial for atopic eczema, eczema, gestational age, death and NEC.

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Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2013-004107 ◽

2014 ◽

Vol 4 (3) ◽

pp. e004107 ◽

Cited By ~ 29

Author(s):

Alexander Nagrebetsky ◽

Rachel Brettell ◽

Nia Roberts ◽

Andrew Farmer

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Randomised Controlled

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Smoking cessation in individuals who use vaping as compared with traditional nicotine replacement therapies: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-044222 ◽

2021 ◽

Vol 11 (2) ◽

pp. e044222

Author(s):

Catherine M Pound ◽

Jennifer Zhe Zhang ◽

Ama Tweneboa Kodua ◽

Margaret Sampson

Keyword(s):

Systematic Review ◽

Smoking Cessation ◽

Cigarette Smoking ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Smoking Reduction ◽

Registration Number ◽

Randomised Controlled

ObjectivesDespite the aggressive marketing of electronic nicotine device systems (ENDS) as smoking cessation tools, the evidence of their effectiveness is mixed. We conducted a systematic review of randomised controlled trials to determine the effect of ENDS on cigarette smoking cessation, as compared with other types of nicotine replacement therapies (NRT).DesignSystematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.Data sourcesMEDLINE, Embase, the CENTRAL Trials Registry of the Cochrane Collaboration using the Ovid interface, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform trials registries were searched through 17 June 2020.Eligibility criteria for studiesRandomised controlled trials in which any type of ENDS was compared with any type of NRT, in traditional cigarette users.Data extraction and synthesisThe primary outcome was smoking cessation, defined as abstinence from traditional cigarette smoking for any time period, as reported in each included study, regardless of whether abstinence is self-reported or biochemically validated. Secondary outcomes included smoking reduction, harms, withdrawal and acceptance of therapy. A random-effect model was used, and data were pooled in meta-analyses where appropriate.ResultsSix studies were retained from 270. Most outcomes were judged to be at high risk of bias. The overall quality of evidence was graded as ‘low’ or ‘very low’. Pooled results showed no difference in smoking cessation (rate ratio (RR) 1.42, 95% CI 0.97 to 2.09), proportion of participants reducing smoking consumption (RR 1.25, 95% CI 0.79 to 1.98), mean reduction in cigarettes smoked per day (mean difference 1.11, 95% CI −0.41 to 2.63), or harms (RR 0.96, 95% CI 0.76 to 1.20), between groups.ConclusionWe found no difference in smoking cessation, harms and smoking reduction between e-cigarette and NRT users. However, the quality of the evidence was low. Further research is needed before widespread recommendations are made with regard to the use of ENDS.PROSPERO registration numberSystematic review registration number: protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) on February 27th, 2020; CRD42020169416.

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Does Influenza Vaccination during Pregnancy Have Effects on Non-Influenza Infectious Morbidity? A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Vaccines ◽

10.3390/vaccines9121452 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1452

Author(s):

Katrine Pedersbæk Hansen ◽

Christine Stabell Benn ◽

Thomas Aamand ◽

Martin Buus ◽

Isaquel da Silva ◽

...

Keyword(s):

Adverse Events ◽

Pregnant Women ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Middle Income ◽

Live Vaccines ◽

All Cause Mortality ◽

Randomised Controlled ◽

Meta Analyses

The recommendation to provide inactivated influenza vaccine (IIV) to pregnant women is based on observed protection against influenza-related morbidity in mother and infant. Non-live vaccines may have non-specific effects (NSEs), increasing the risk of non-targeted infections in females. We reviewed the evidence from available randomised controlled trials (RCTs) of IIV to pregnant women, to assess whether IIV may have NSEs. Four RCTs, all conducted in low- and middle-income settings, were identified. We extracted information on all-cause and infectious mortality and adverse events in women and their infants. We conducted meta-analyses providing risk ratios (RR). The meta-analysis for maternal all-cause mortality provided a RR of 1.48 (95% CI = 0.52–4.16). The estimates for miscarriage/stillbirth and infant all-cause mortality up to 6 months of age were 1.06 (0.78–1.44) and 1.11 (0.87–1.41), respectively. IIV was associated with a higher risk of non-influenza infectious adverse events, with meta-estimates of 2.01 (1.15–3.50) in women and 1.36 (1.12–1.67) in infants up to 6 months of age. Thus, following a pattern seen for other non-live vaccines, IIV was associated with a higher risk of non-influenza infectious adverse events. To ensure that scarce resources are used well, and no harm is inflicted, further RCTs are warranted.

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Intensive Smoking Cessation Interventions in Denmark - Based on data from the Danish Smoking Cessation Database

Clinical Health Promotion - Research and Best Practice for patients staff and community ◽

10.29102/clinhp.18003s ◽

2018 ◽

Vol 8 (S3) ◽

pp. 1-43

Author(s):

Mette Rasmussen

Keyword(s):

Smoking Cessation ◽

Cohort Studies ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Real Life ◽

Successful Outcome ◽

Controlled Trials ◽

Set Up ◽

Randomised Controlled ◽

Study Designs

Background Tobacco smoking is by far the most deadly and preventable lifestyle factor for public health, both globally and nationally. Nevertheless, it is estimated that worldwide, more than 1.1 billion adults are smokers. Today, 16% (0.8 million) of the adult population in Denmark are daily smokers, while 23% (1.1 million) consider themselves smokers, and one in four deaths are smoking related. The most effective method of reducing smoking prevalence is by employing a two-tier strategy to 1) prevent adolescents from initiating smoking and 2) offer effective help to smokers to quit. The aim of this thesis was to evaluate the effect of intensive smoking cessation interventions (ISCI) on successful quitting through different study designs, synthesised from cohort studies and a review of randomised controlled trials. The aim was fulfilled through 4 scientific studies, each with their own objective. Studies A systematic review with meta-analysis (I) was set up to compare ISCI and shorter interventions in randomised controlled trials (RCT). Initially, 9,569 unique papers were identified, and, after screening for relevant studies, 18 RCTs were included, investigating a total of 10,131 smokers. The studies were primarily conducted in Western Europa and the USA. The body of evidence for three of four outcomes were graded moderate, and the last outcome was graded low. A random effect meta-analysis revealed that smokers randomised to ISCI were significantly more likely to be successful quitters compared to shorter interventions for all four outcomes. The primary outcome (continuous abstinence in the short and long term) increased the chance of success 3-fold. A methodological study (II) of the Danish National Smoking Cessation Database (SCDB) was undertaken. The development of the SCDB and the most commonly registered smoking cessation interventions (SCI) were described, as were the data collection and validity. Two cohort studies based on the data from the SCDB were conducted to evaluate the effectiveness of SCI in real life. One study investigated the effectiveness of five different SCIs (III) and found that the intensive Gold Standard Programme’ (GSP - Standard SCI in Denmark) was the only intervention that was effective for both men and women. The other cohort study was set up to investigate the effectiveness of the GSP in a vulnerable subgroup of smokers diagnosed with severe mental disorder (SMD) (IV). The study showed that smokers with SMD were significantly less likely to become successful quitters compared to smokers without mental disorders. However, one in every four smokers with SMD managed to stay continuously smoke-free for at least 6 months compared to one in three in the comparison group. The data were analysed using a mixed-effect logistic regression model. In both cohort studies, compliance was identified as the strongest predictor of a successful outcome. Conclusion This thesis adds to the evidence on intensive smoking cessation interventions (ISCI) through different study designs. The results from both study designs favoured ISCI, although the GSP was significantly less effective in smokers with SMD compared to smokers without mental illness. To develop effective SCI in the future, it is important to evaluate the effects in an RCT and to follow-up the post-implementation effects in real life (e.g., through a national SCDB).

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Effects of physical exercise during pregnancy on mothers’ and neonates’ health: a protocol for an umbrella review of systematic reviews and meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2019-030162 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030162

Author(s):

Gema Sanabria-Martínez ◽

Raquel Poyatos-León ◽

Blanca Notario-Pacheco ◽

Celia Álvarez-Bueno ◽

Iván Cavero-Redondo ◽

...

Keyword(s):

Pregnant Women ◽

Systematic Reviews ◽

Fixed Effects ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Evaluation Framework ◽

Controlled Trials ◽

Randomised Controlled ◽

Meta Analyses

IntroductionA growing interest has emerged on the effects of exercise during gestation. Several systematic reviews and meta-analyses have shown that prenatal exercise could reduce the mothers’ risk for some disorders. Despite this, evidence regarding the risk of caesarean section, birth weight or Apgar score at delivery is still controversial. Furthermore, practitioners are reluctant to recommend exercise to pregnant women suffering from some disorders, such as hypertension, pre-eclampsia or pregnant women with obesity. Moreover, the scarcity of studies addressing the risks and benefits of exercise at higher intensity prevent practitioners from recommending it at higher dosages. Umbrella reviews represent an appropriate design to elucidate the reasons behind the contradictory findings of previous systematic reviews.MethodsThis protocol was developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook. Medline, EMBASE, Web of Science, Cochrane database of systematic reviews, Epistemonikos, Prospero register and SPORTDiscuss databases will be searched to identify systematic reviews, meta-analyses and randomised controlled trials that examine the effect of exercise on pregnancy outcomes from inception to August 2019. Searches will be conducted from September to November 2019.Statistical analysisMethodological quality will be evaluated using the AMSTAR 2 tool. The certainty of evidence and strength of recommendations for meta-analyses will be assessed by the Grading of Recommendations Assessment, Development and Evaluation framework. The summary effect sizes will be calculated through the use of random-effects and fixed-effects models. Heterogeneity among studies will be assessed using the I2statistic, and evidence of excess significance bias and evidence of small study effects will also be evaluated.Ethics and disseminationEthical approval will not be needed for this review protocol. The results will be disseminated to academic audiences by peer-reviewed publications. Furthermore, results will be disseminated to clinical audiences through professionals’ associations and social networks, and may influence guidelines developers in order to improve outcomes in mothers and offspring.PROSPERO registration numberCRD42019123410.

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