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Complementary Therapies in Clinical... Aug 2022This systematic review aimed to update the evidence of ginseng on menopausal women's health care. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review aimed to update the evidence of ginseng on menopausal women's health care.
METHODS
We searched six databases (PubMed, AMED, EMBASE, the Cochrane Library, RISS, and KoreaMed) from their inception to April 2022 and included all placebo-controlled RCTs comparing any type of ginseng in menopausal women. The methodological quality of all studies was assessed using the Cochrane Risk of Bias Tool 2.0.
RESULTS
We included 15 RCTs with our inclusion criteria. The majority of studies considered bias a concern. Ginseng reduced menopausal symptoms in three studies (n = 515; standardized mean difference (SMD): -0.40, 95% confidence interval (CI): -0.73 to -0.07, P = 0.02) and lowed hot flashes (n = 515; SMD: -0.34, 95% CI: -0.66 to -0.01, P = 0.04). The meta-analysis of three other studies failed to show that ginseng was beneficial for sexual function (n = 491; SMD: 0.31, 95% CI: -0.30 to 0.92, P = 0.32). Three RCTs showed positive effects of ginseng on the quality of life score (n = 515, SMD: -0.31, 95% CI: -0.61 to -0.01, P = 0.05). In two studies, ginseng failed to produce significant effects on the vaginal maturation index and vaginal pH. Another three RCTs failed to demonstrate a beneficial effect of Korean red ginseng (KRG) on endometrial thickness.
CONCLUSION
This study demonstrated that ginseng can significantly reduce hot flashes, menopausal symptoms, and quality of life in menopausal women. In contrast, neither KRG nor ginseng appeared to have any direct effect on sexual dysfunction, hormones or biomarkers, or endometrial thickness. More rigorous RCTs are needed to overcome the current limitations.
Topics: Female; Hot Flashes; Humans; Menopause; Panax; Quality of Life; Randomized Controlled Trials as Topic; Women's Health
PubMed: 35691259
DOI: 10.1016/j.ctcp.2022.101615 -
Early Human Development May 2021Many women report low milk supply as the reason for premature breastfeeding cessation. Altered mammary gland development may impact a woman's lactation ability. (Review)
Review
BACKGROUND
Many women report low milk supply as the reason for premature breastfeeding cessation. Altered mammary gland development may impact a woman's lactation ability.
OBJECTIVE
This review identifies modern exogenous exposures which alter mammary gland development during embryonic life, puberty and pregnancy.
METHODS
A systematic review was undertaken whereby Medline, CINAHL and Embase articles published from January 1, 2005 to November 20, 2020 were searched using the keywords puberty or embry* or fetal or foetal or foetus or fetus or pregnan* or gestation* AND "mammary gland development" or "breast development" or "mammary development" or "mammary gland function" or "mammary function" or "insufficient glandular tissue" or "mammary hypoplasia" or "breast hypoplasia" or "mammary gland hypoplasia" or "tubular breast*" or "tuberous breast*" or "glandular tissue" or "breast composition" or "mammary composition" or "mammary gland composition". After initial screening of 1207 records, 60 full texts were assessed for eligibility; 6 were excluded due to lack of information about exposure or outcome, leaving 54 studies.
RESULTS
The review included results from 52 animal (rats and mice, monkeys, rabbits, sheep, goats pigs and cows) and 2 human studies. Various endocrine disrupting chemicals and an obesogenic diet were found to be associated with altered mammary gland morphology during key development stages.
CONCLUSIONS
To improve lactation outcomes, future studies need to focus on lactation as the endpoint and be conducted in a standardised manner to allow for a more significant contribution to the literature that allows for better comparison across studies.
Topics: Animals; Cattle; Endocrine Disruptors; Female; Lactation; Mammary Glands, Animal; Mice; Milk; Pregnancy; Rabbits; Rats; Sexual Maturation; Sheep; Swine
PubMed: 33711581
DOI: 10.1016/j.earlhumdev.2021.105342 -
Gynecological Endocrinology : the... Aug 2021It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this...
INTRODUCTION
It is estimated that 50% of women will suffer a severe form of vulvovaginal atrophy (VVA) related to menopause. Equally, young women may temporarily present this clinical problem while receiving various pharmacological or endocrine treatments or radiotherapy.
AIM
To determine clinical and diagnostic exams required to confirm the presence of VVA (also referred to as atrophic vaginitis, urogenital atrophy, or genitourinary syndrome of menopause) and rule out other genital or pelvic clinical conditions.
MATERIALS AND METHODS
Literature review searches were carried out on the main scientific article search engines (PubMed, SciELO, Cochrane) using different clinical terms, treatments or interventions and comorbidity related to VVA.
RESULTS
The development and severity of VVA depend mainly on the duration of hypoestrogenism. Hypoestrogenism causes changes in the urogenital tissue, generating signs and symptoms, such as dryness, burning, soreness, itching, and irritation of the genital skin. The diagnosis can be made through anamnesis (patient history), questionnaires, physical exam, and, sometimes, complementary exams. Objective vaginal assessment is essential and can be completed with the Vaginal Health Index, the Vaginal Maturation Index, or vaginal pH in the absence of infection or semen. The exclusion of other vulvovaginal organic pathology is essential to reach an accurate diagnosis and provide adequate treatment.
CONCLUSIONS
The specialist should be able to identify VVA, rule out other pathologies that make a differential diagnosis and conduct proper management.
Topics: Atrophic Vaginitis; Atrophy; Diagnosis, Differential; Dyspareunia; Estrogens; Female; Female Urogenital Diseases; Humans; Postmenopause; Surveys and Questionnaires; Syndrome; Urogenital Diseases; Vagina; Vaginal Diseases; Vulva; Vulvar Diseases
PubMed: 34036849
DOI: 10.1080/09513590.2021.1931100 -
Environment International Nov 2023Personal care products (PCPs) contain many different compounds and are a source of exposure to endocrine disrupting chemicals (EDCs), including phthalates and phenols....
BACKGROUND
Personal care products (PCPs) contain many different compounds and are a source of exposure to endocrine disrupting chemicals (EDCs), including phthalates and phenols. Early-life exposure to EDCs commonly found in PCPs has been linked to earlier onset of puberty.
OBJECTIVE
To characterize the human and animal evidence on the association between puberty-related outcomes and exposure to PCPs and their chemical constituents and, if there is sufficient evidence, identify groups of chemicals and outcomes to support a systematic review for a class-based hazard or risk assessment.
METHODS
We followed the OHAT systematic review framework to characterize the human and animal evidence on the association between puberty-related health outcomes and exposure to PCPs and their chemical constituents.
RESULTS
Ninety-eight human and 299 animal studies that evaluated a total of 96 different chemicals were identified and mapped by key concepts including chemical class, data stream, and puberty-related health outcome. Among these studies, phthalates and phenols were the most well-studied chemical classes. Most of the phthalate and phenol studies examined secondary sex characteristics and changes in estradiol and testosterone levels. Studies evaluating PCP use and other chemical classes (e.g., parabens) had less data.
CONCLUSIONS
This systematic evidence map identified and mapped the published research evaluating the association between exposure to PCPs and their chemical constituents and puberty-related health outcomes. The resulting interactive visualization allows researchers to make evidence-based decisions on the available research by enabling them to search, sort, and filter the literature base of puberty-related studies by key concepts. This map can be used by researchers and regulators to prioritize and target future research and funding to reduce uncertainties and address data gaps. It also provides information to inform a class-based hazard or risk assessment on the association between phthalate and phenol exposures and puberty-related health outcomes.
Topics: Animals; Humans; Endocrine Disruptors; Environmental Exposure; Phenol; Phenols; Phthalic Acids; Sexual Maturation
PubMed: 37948866
DOI: 10.1016/j.envint.2023.108307 -
EClinicalMedicine Jul 2022Preterm birth is a leading cause of neonatal mortality and morbidity, and imposes high health and societal costs. Antenatal corticosteroids (ACS) to accelerate fetal...
BACKGROUND
Preterm birth is a leading cause of neonatal mortality and morbidity, and imposes high health and societal costs. Antenatal corticosteroids (ACS) to accelerate fetal lung maturation are commonly used in conjunction with tocolytics for arresting preterm labour in women at risk of imminent preterm birth.
METHODS
We conducted a systematic review on the cost-effectiveness of ACS and/or tocolytics as part of preterm birth management. We systematically searched MEDLINE and Embase (December 2021), as well as a maternal health economic evidence repository collated from NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo, with no date cutoff. Eligible studies were economic evaluations of ACS and/or tocolytics for preterm birth. Two reviewers independently screened citations, extracted data on cost-effectiveness and assessed study quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.
FINDINGS
35 studies were included: 11 studies on ACS, eight on tocolytics to facilitate ACS administration, 12 on acute and maintenance tocolysis, and four studies on a combination of ACS and tocolytics. ACS was cost-effective prior to 34 weeks' gestation, but economic evidence on ACS use at 34-<37 weeks was conflicting. No single tocolytic was identified as the most cost-effective. Studies disagreed on whether ACS and tocolytic in combination were cost-saving when compared to no intervention.
INTERPRETATION
ACS use prior to 34 weeks' gestation appears cost-effective. Further studies are required to identify what (if any) tocolytic option is most cost-effective for facilitating ACS administration, and the economic consequences of ACS use in the late preterm period.
FUNDING
UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by WHO.
PubMed: 35747187
DOI: 10.1016/j.eclinm.2022.101496 -
JAMA Network Open Sep 2022Vaginal estrogen for genitourinary syndrome of menopause (GSM) should be used with caution in women with contraindications, highlighting the need for effective treatment... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Vaginal estrogen for genitourinary syndrome of menopause (GSM) should be used with caution in women with contraindications, highlighting the need for effective treatment alternatives.
OBJECTIVE
To compare the severity of GSM after vaginal laser vs estrogen therapy.
DATA SOURCES
The PubMed, Embase, and Cochrane Library databases were searched for articles published from database inception to April 8, 2022, with no language restrictions. Reference lists were also searched.
STUDY SELECTION
Randomized clinical trials (RCTs) that compared the use of lasers with vaginal estrogen in adults were selected.
DATA EXTRACTION AND SYNTHESIS
Two investigators independently extracted data from included studies. The Cochrane risk of bias tool for RCTs was used to assess risk of bias of each study. A random-effects model was used to pool mean differences (MDs) with 95% CIs.
MAIN OUTCOMES AND MEASURES
Primary outcomes were Vaginal Analog Scale (VAS; higher scores indicate severer symptoms), Vaginal Health Index (VHI; higher scores indicate better vaginal health), Vaginal Maturation Index (VMI; higher scores indicate higher estrogen effect on the vaginal epithelium), Female Sexual Function Index (FSFI; higher scores indicate better female sexual function), and Sexual Quotient-Female (SQ-F; higher scores indicate better female sexual function) questionnaire scores. Urinary symptoms were assessed as an additional outcome. Data analyses were performed from April 9 to 12, 2022.
RESULTS
A total of 6 RCTs with 270 women with GSM were included (135 were randomized to laser therapy and 135 to estrogen therapy; mean age ranged from 54.6 to 61.0 years). No significant differences were found between carbon dioxide laser and vaginal estrogen from baseline to the end of follow-up in overall VAS scores (MD, -0.16; 95% CI, -0.67 to 0.36; I2, 33.31%), VHI (MD, 0.20; 95% CI, -0.56 to 0.97; I2, 83.25%), VMI (MD, -0.56; 95% CI, -1.14 to 0.02; I2, 35.07%), FSFI (MD, -0.04; 95% CI, -0.45 to 0.36; I2, 41.60%), and SQ-F (P = .37 based on 1 study). Other questionnaire-based outcome measures demonstrated no difference between groups from baseline to the end of follow-up for changes in urinary symptoms.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis of RCTs found that vaginal laser treatment is associated with similar improvement in genitourinary symptoms as vaginal estrogen therapy. Further research is needed to test whether vaginal laser therapy could be a potential treatment option for women with contraindications to vaginal estrogen.
Topics: Estrogens; Female; Genital Diseases, Female; Humans; Lasers, Gas; Menopause; Middle Aged; Randomized Controlled Trials as Topic; Syndrome
PubMed: 36129710
DOI: 10.1001/jamanetworkopen.2022.32563 -
Eating and Weight Disorders : EWD Oct 2022Assessing the body composition of children and adolescents is important to monitor their health status. Anthropometric measurements are feasible and less-expensive than... (Review)
Review
PURPOSE
Assessing the body composition of children and adolescents is important to monitor their health status. Anthropometric measurements are feasible and less-expensive than other techniques for body composition assessment. This study aimed to systematically map anthropometric equations to predict adipose tissue, body fat, or density in children and adolescents, and to analyze methodological aspects of the development of anthropometric equations using skinfolds.
METHODS
A scoping review was carried out following the PRISMA-ScR criteria. The search was carried out in eight databases. The methodological structure protocol of this scoping review was retrospectively registered in the Open Science Framework ( https://osf.io/35uhc/ ).
RESULTS
We included 78 reports and 593 anthropometric equations. The samples consisted of healthy individuals, people with different diseases or disabilities, and athletes from different sports. Dual-energy X-ray absorptiometry (DXA) was the reference method most commonly used in developing equations. Triceps and subscapular skinfolds were the anthropometric measurements most frequently used as predictors in the equations. Age, stage of sexual maturation, and peak height velocity were used as complementary variables in the equations.
CONCLUSION
Our scoping review identified equations proposed for children and adolescents with a great diversity of characteristics. In many of the reports, important methodological aspects were not addressed, a factor that may be associated with equation bias.
LEVEL IV
Evidence obtained from multiple time series analysis such as case studies. (NB: dramatic results in uncontrolled trials might also be regarded as this type of evidence).
Topics: Absorptiometry, Photon; Adipose Tissue; Adolescent; Anthropometry; Body Composition; Child; Humans; Skinfold Thickness
PubMed: 35699918
DOI: 10.1007/s40519-022-01405-7 -
Menopause (New York, N.Y.) Jun 2018Intravaginal testosterone has emerged as a potential treatment for vulvovaginal atrophy (VVA) in women, in general, and women taking an aromatase inhibitor (AI). A...
OBJECTIVES
Intravaginal testosterone has emerged as a potential treatment for vulvovaginal atrophy (VVA) in women, in general, and women taking an aromatase inhibitor (AI). A systematic review of the literature was undertaken to determine whether available clinical trial data support efficacy and safety of intravaginal testosterone for the treatment of VVA.
METHODS
Scopus, MEDLINE, EMBASE, and the Cochrane Library databases were systematically searched on July 26, 2017, for human studies published in English of clinical trials of intravaginal testosterone.
RESULTS
Six separate clinical trials were identified that ranged in size from 10 to 80 participants, with either single dose, or durations of 4 to 12 weeks. Only one study incorporated a double-blind design. Three studies were of women taking an AI.Taken together, the studies suggest that intravaginal testosterone may lower vaginal pH, increase the proportion of vaginal lactobacilli, and possibly improve the vaginal maturation index. The lack of a placebo treatment in four studies, and failure to adjust for baseline differences, resulted in uncertainty of the effect on sexual function. Safety remains uncertain because of the small number of women exposed, short study durations, and inconsistent and incomplete outcome reporting for sex steroid levels.
CONCLUSION
Adequately powered double-blind, placebo-controlled clinical trials of intravaginal testosterone therapy are needed to establish both efficacy and safety.
Topics: Administration, Intravaginal; Atrophy; Female; Humans; Testosterone; Vagina; Vaginal Diseases; Vulva
PubMed: 29286987
DOI: 10.1097/GME.0000000000001052 -
Andes Pediatrica : Revista Chilena de... Jun 2021The last two decades have seen an exponential growth in the distribution and availability of child pornographic material on the Internet and social networks. The medical...
INTRODUCTION
The last two decades have seen an exponential growth in the distribution and availability of child pornographic material on the Internet and social networks. The medical community is involved in assisting the investigating authorities in relation to estimating the age and sexual maturity of the alleged victims.
OBJECTIVE
To determine the efficacy of using Tanner stages as a method for esti mating chronological age in alleged child pornography cases based on published evidence.
MATERIAL AND METHOD
Systematic review study in PubMed and Scopus databases following PRISMA guideli nes. Articles describing the outcome of using Tanner stages to estimate chronological age in alleged child pornography cases were identified. For screening, those written in English or Spanish published from January 1, 2000, to April 30, 2020, were considered. The following data were extracted from the articles included: type of study; material and methods used; Tanner items examined; evaluators' characteristics; results; estimated chronological age versus real age; observer-dependent variations (bias); and conclusions.
RESULTS
Seven studies were included. Three were literature reviews and four were case studies with expert testimony and observer bias. This method is ineffective when the alleged victim, in both sexes, shows sexual maturation in Tanner stages 3-5. In stages 1-2, it may be useful to state that the victim is under 18 years old, but not to determine their chronological age.
CONCLUSION
Scientific evidence discourages the use of Tanner stages to estimate the chronological age of the vic tim from images in alleged child pornography cases. Pediatricians, and other medical professionals, should avoid making a testimony that is not scientifically based.
Topics: Adolescent; Age Factors; Asia; Child; Child Abuse, Sexual; Child, Preschool; Erotica; Ethnicity; Europe; Expert Testimony; Female; Humans; Male; Observer Variation; Sexual Development; United States
PubMed: 34479256
DOI: 10.32641/andespediatr.v92i3.3374 -
Reproduction (Cambridge, England) Apr 2019Fetal alcohol exposure results in well-characterised neurobehavioural deficits in offspring, which form the basis for diagnosing fetal alcohol spectrum disorder....
Fetal alcohol exposure results in well-characterised neurobehavioural deficits in offspring, which form the basis for diagnosing fetal alcohol spectrum disorder. However, there is increasing interest in the full range of health complications that can arise in children and adults with this disorder. We used a systematic review approach to locate all clinical and preclinical studies across a broad range of health outcomes in offspring exposed to prenatal alcohol. Our search encompassed four databases (PubMed, CINAHL, EMBASE and Web of Science) and titles/abstracts from retrieved studies were screened against strict inclusion/exclusion criteria. This review specifically evaluated studies reporting on reproductive outcomes in both males and females. A total of 23 studies were included, 5 clinical and 18 preclinical. Although there was a wide range in the quality of reporting across both clinical and preclinical studies, and variable results, trends emerged amongst the reproductive measures that were investigated. In females, most studies focussed on age at first menarche/puberty onset, with evidence for a significant delay in alcohol-exposed offspring. In males, offspring exposed to prenatal alcohol had altered testosterone levels, reduced testes and accessory gland weights and reduced sperm concentration and semen volume. However, further studies are required due to the paucity of clinical studies, the narrow scope of female reproductive outcomes examined and inconsistencies in outcomes across preclinical studies. We recommend that adolescents and individuals of reproductive age diagnosed with f-etal alcohol spectrum disorder be assessed for reproductive dysfunction to allow appropriate management of their reproductive health and fertility.
Topics: Ethanol; Female; Fetal Alcohol Spectrum Disorders; Humans; Pregnancy; Prenatal Exposure Delayed Effects; Sexual Maturation
PubMed: 30653461
DOI: 10.1530/REP-18-0607