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Journal of Bone and Mineral Research :... Oct 2014A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years.... (Meta-Analysis)
Meta-Analysis Review
A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic-database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight-bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross-sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies.
Topics: Adolescent; Biomechanical Phenomena; Bone and Bones; Child; Female; Humans; Male; Motor Activity; Observational Studies as Topic; Organ Size; Randomized Controlled Trials as Topic; Sports
PubMed: 24737388
DOI: 10.1002/jbmr.2254 -
BMC Public Health Nov 2012Influenza illness in children causes significant clinical and economic burden. Although some European countries have adopted influenza immunisation policies for healthy... (Review)
Review
BACKGROUND
Influenza illness in children causes significant clinical and economic burden. Although some European countries have adopted influenza immunisation policies for healthy children, the debate about paediatric influenza vaccination in most countries of the European Union is ongoing. Our aim was to summarise influenza burden (in terms of health outcomes and economic burden) in children in Western Europe via a systematic literature review.
METHODS
We conducted a systematic literature search of PubMed, EMBASE, and the Cochrane Library (1970-April 2011) and extracted data on influenza burden in children (defined as aged ≤ 18 years) from 50 publications (13 reporting laboratory-confirmed influenza; 37 reporting influenza-like illness).
RESULTS
Children with laboratory-confirmed influenza experienced hospitalisations (0.3%-20%), medical visits (1.7-2.8 visits per case), antibiotic prescriptions (7%-55%), and antipyretic or other medications for symptomatic relief (76%-99%); young children and those with severe illness had the highest rates of health care use. Influenza in children also led to absenteeism from day care, school, or work for the children, their siblings, and their parents. Average (mean or median) length of absence from school or day care associated with confirmed influenza ranged from 2.8 to 12.0 days for the children, from 1.3 to 6.0 days for their siblings, and from 1.3 to 6.3 days for their parents. Influenza negatively affected health-related quality of life in children with asthma, including symptoms and activities; this negative effect was smaller in vaccinated children than in non-vaccinated children.
CONCLUSIONS
Influenza burden in children is substantial and has a significant direct impact on the ill children and an indirect impact on their siblings and parents. The identified evidence regarding the burden of influenza may help inform both influenza antiviral use in children and paediatric immunisation policies in European countries.
Topics: Adolescent; Child; Child, Preschool; Cost of Illness; Europe; Humans; Infant; Influenza, Human; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 23146107
DOI: 10.1186/1471-2458-12-968 -
Journal of Educational Evaluation For... 2016The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted... (Review)
Review
PURPOSE
The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide.
METHODS
The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM).
RESULTS
Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill.
CONCLUSION
Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students' EBP competence.
Topics: Clinical Competence; Curriculum; Education, Medical, Undergraduate; Evidence-Based Practice; Health Occupations; Humans; Learning; Students, Health Occupations; Teaching
PubMed: 27649902
DOI: 10.3352/jeehp.2016.13.34 -
BMJ (Clinical Research Ed.) Jun 2003To review the clinical effectiveness of oseltamivir and zanamivir for the treatment and prevention of influenza A and B. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review the clinical effectiveness of oseltamivir and zanamivir for the treatment and prevention of influenza A and B.
DESIGN
Systematic review and meta-analyses of randomised controlled trials.
DATA SOURCES
Published studies were retrieved from electronic bibliographic databases; supplementary data were obtained from the manufacturers.
SELECTION OF STUDIES
Randomised controlled, double blind trials that were published in English, had data available before 31 December 2001, evaluated treatment or prevention of naturally occurring influenza with zanamivir or oseltamivir (if given using the formulation and dosage licensed for clinical use), and reported at least one end point of relevance.
REVIEW METHODS
The main outcome measures were the median time to the alleviation of symptoms (for treatment trials) and number of flu episodes avoided (for prevention trials). Three population groups were defined: children aged 12 years and under; otherwise healthy individuals aged 12 to 65 years; and "high risk" individuals (those with certain chronic medical conditions or aged 65 years and older).
RESULTS
Seventeen treatment trials and seven prevention trials identified met the inclusion criteria. All trials included compared one of the drugs against placebo or standard care. Treatment of children, otherwise healthy individuals, and high risk populations with zanamivir reduced the median duration of symptoms in days respectively by 1.0 (95% confidence interval 0.5 to 1.5), 0.8 (0.3 to 1.3), and 0.9 (-0.1 to 1.9) for the intention to treat population. The corresponding results, in days, for oseltamivir were 0.9 (0.3 to 1.5), 0.9 (0.3 to 1.4), and 0.4 (-0.7 to 1.4). The effect of giving zanamivir and oseltamivir prophylactically resulted in a relative reduction of 70-90% in the odds of developing flu, depending on the strategy adopted and the population studied.
CONCLUSIONS
Evidence from randomised controlled trials consistently supports the view that both oseltamivir and zanamivir are clinically effective for treating and preventing flu. However, evidence is limited for the treatment of certain populations and for all prevention strategies.
Topics: Acetamides; Adolescent; Adult; Aged; Antiviral Agents; Child; Child, Preschool; Enzyme Inhibitors; Guanidines; Humans; Infant; Infant, Newborn; Influenza A virus; Influenza B virus; Influenza, Human; Middle Aged; Neuraminidase; Oseltamivir; Pyrans; Randomized Controlled Trials as Topic; Sialic Acids; Zanamivir
PubMed: 12791735
DOI: 10.1136/bmj.326.7401.1235 -
Journal of Research in Medical Sciences... 2020This study aimed to evaluate the epidemiological studies on the relationship between organophosphate (OP) pesticide exposure during pregnancy and neonatal anthropometric... (Review)
Review
BACKGROUND
This study aimed to evaluate the epidemiological studies on the relationship between organophosphate (OP) pesticide exposure during pregnancy and neonatal anthropometric measures.
MATERIALS AND METHODS
In this systematic review and meta analyses, a comprehensive search of the literature for the association of maternal exposure to OP pesticides and birth outcome including birth weight, birth length, and head circumference was conducted from scientific databases of MEDLINE, Scopus, Web of Science, and Cochrane library until the end of April 2019. We used the following keyword to identify the relevant studies: "birth weight," "birth length," "pregnancy outcome,""birth outcome," "organophosphate pesticides," and "organophosphate metabolites." Only English language studies investigating the relationship between pregnant mothers' exposure to OP metabolites and birth outcomes were examined.
RESULTS
Of the 10 articles reviewed, eight studies used to assess the association with birth weight, as well as five, and six studies were used in meta analysis to determine the association between OP exposure and birth length and head circumference. Pooled estimates were performed using a fixed effects model or random effects model. No significant association was observed between maternal exposure to OPs and birth weight (β = 1.520;95% confidence interval [CI] [-10.781, 13.820]), birth length (β = -0.011; [-0.132, 0.109]), and head circumference (β =0.022; 95%CI [-0.06, 0.103]).
CONCLUSION
Although the effect of maternal exposure to OP on the birth outcome is not completely clear, strategies should be adopted to control the use of these substances.
PubMed: 33088316
DOI: 10.4103/jrms.JRMS_919_19 -
The Cochrane Database of Systematic... Jul 2011Acute diarrhoea is one of the principal causes of morbidity and mortality among children in low-income countries. The cornerstone of treatment is oral rehydration... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acute diarrhoea is one of the principal causes of morbidity and mortality among children in low-income countries. The cornerstone of treatment is oral rehydration therapy and dietary management. However, there is a lack of data and studies on both the timing and type of feeding that should be adopted during the course of the illness.
OBJECTIVES
To compare the efficacy and safety of early and late reintroduction of feeding in children with acute diarrhoea.
SEARCH STRATEGY
In May 2011, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE, EMBASE, LILACS, and mRCT. We also contacted researchers and organizations, and searched reference lists.
SELECTION CRITERIA
Randomized controlled trials of early versus late refeeding among children less than 10 years old with acute diarrhoea. Early refeeding was defined as within 12 hours of start of rehydration and late refeeding was defined as more than 12 hours after start of rehydration.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed the search results and the risk of bias, and extracted data. We present risk ratios for dichotomous outcomes and mean differences for continuous outcomes. We combined the results of the trials using meta-analysis when heterogeneity was not substantial.
MAIN RESULTS
Twelve trials involving 1283 participants wereincluded; 1226 participants were used in the analysis (724 in the early refeeding group and 502 in the late refeeding group). Nine trials described their allocation sequence, but only two used concealed allocation. One trial reported single-blinding but did not clearly identify the person who was blinded. Early refeeding meant intake during or immediately after start of rehydration, while late refeeding meant intake only 20 hours to 48 hours after start of rehydration. Significant heterogeneity was noted in the data for the duration of diarrhoea. There was no significant difference between the two refeeding groups in the number of participants who needed unscheduled intravenous fluids (six trials with 813 participants), who experienced episodes of vomiting (five trials with 466 participants), and who developed persistent diarrhoea (four trials with 522 participants). The mean length of hospital stay was also similar (two trials with 246 participants).
AUTHORS' CONCLUSIONS
There was no evidence that early refeeding increases the risk of unscheduled intravenous fluid use, episodes of vomiting, and development of persistent diarrhoea. No conclusion could be made regarding the duration of diarrhoea.
Topics: Acute Disease; Child; Child, Preschool; Developing Countries; Diarrhea; Eating; Fluid Therapy; Humans; Infant; Randomized Controlled Trials as Topic; Time Factors
PubMed: 21735409
DOI: 10.1002/14651858.CD007296.pub2 -
Nursing Open Sep 2022This study determined the factors associated with pregnancy uptake decision among seropositive HIV people receiving antiretroviral therapy in sub-Saharan Africa. (Review)
Review
AIM
This study determined the factors associated with pregnancy uptake decision among seropositive HIV people receiving antiretroviral therapy in sub-Saharan Africa.
DESIGN
Systematic review.
METHODS
The population, intervention, comparison and outcomes framework was adopted to search for literature after a scoping review using the preferred reporting items for systematic reviews and meta-analyses guidelines adopted in searching, and screening articles from four databases (PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Google scholar) to find 12 articles suitable for this study.
RESULTS
Motivators of pregnancy uptake among HIV-positive women include desire to have children, knowledge about PMTCT, cultural duty for married women to have children, and household income. Demotivating factors included the modern method of contraception and burden associated with pregnancy.
CONCLUSION
There is a need to improve on services that reduce conception-related risks especially for women who choose to conceive and to incorporate fertility-related counselling into HIV treatment services.
Topics: Africa South of the Sahara; Child; Contraception; Female; HIV Infections; Health Services Accessibility; Humans; Mass Screening; Pregnancy
PubMed: 35643950
DOI: 10.1002/nop2.1251 -
Eye (London, England) Mar 2021Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor... (Review)
Review
BACKGROUND
Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor photoscreening appears an attractive option. This review considers photoscreening used in community services, focusing on costs, cost-effectiveness and scope of use, compared with EUSCREEN project Country Reports describing how photo- and automated screening is used internationally.
METHODS
A systematic narrative review was carried out of all English language photoscreening literature to September 10th 2018, using publicly available search terms. Where costs were considered, a CASP economic evaluation checklist was used to assess data quality.
RESULTS
Of 370 abstracts reviewed, 55 reported large-scale community photoscreening projects. Five addressed cost-effectiveness specifically, without original data. Photoscreening was a stand-alone, single, test event in 71% of projects. In contrast, 25 of 45 EUSCREEN Country Reports showed that if adopted, photoscreening often supplements other tests in established programmes and is rarely used as a stand-alone test. Reported costs varied widely and evidence of cost-effectiveness was sparse in the literature, or in international practice. Only eight (13%) papers compared the diagnostic accuracy or cost-effectiveness of photoscreening and VA testing, and when they did, cost-effectiveness of photoscreening compared unfavourably.
DISCUSSION
Evidence that photoscreening reduces amblyopia or strabismus prevalence or improves overall outcomes is weak, as is evidence of cost-effectiveness, compared to later VA screening. Currently, the most cost-effective option seems to be a later, expert VA screening with the opportunity for a re-test before referral.
Topics: Amblyopia; Child; Cost-Benefit Analysis; Humans; Strabismus; Vision Disorders; Vision Screening
PubMed: 33257800
DOI: 10.1038/s41433-020-01261-8 -
PharmacoEconomics Jul 2022Valuing children's health states for use in economic evaluations is globally relevant and is of particular relevance in jurisdictions where a cost-utility analysis is...
BACKGROUND AND OBJECTIVES
Valuing children's health states for use in economic evaluations is globally relevant and is of particular relevance in jurisdictions where a cost-utility analysis is the preferred form of analysis for decision making. Despite this, the challenges with valuing child health mean that there are many remaining questions for debate about the approach to elicitation of values. The aim of this paper was to identify and describe the methods used to value children's health states and the specific issues that arise in the use of these methods.
METHODS
We conducted a systematic search of electronic databases to identify studies published in English since 1990 that used preference elicitation methods to value child and adolescent (under 18 years of age) health states. Eligibility criteria comprised valuation studies concerning both child-specific patient-reported outcome measures and child health states defined in other ways, and methodological studies of valuation approaches that may or may not have yielded a value set algorithm.
RESULTS
A total of 77 eligible studies were identified from which data on country setting, aims, condition (general population or clinically specific), sample size, age of respondents, the perspective that participants were asked to adopt, source of values (respondents who completed the preference elicitation tasks) and methods questions asked were extracted. Extracted data were classified and evaluated using narrative synthesis methods. The studies were classified into three groups: (1) studies comparing elicitation methods (n = 30); (2) studies comparing perspectives (n = 23); and (3) studies where no comparisons were presented (n = 26); selected studies could fall into more than one group. Overall, the studies varied considerably both in methods used and in reporting. The preference elicitation tasks included time trade-off, standard gamble, visual analogue scaling, rating/ranking, discrete choice experiments, best-worst scaling and willingness to pay elicited through a contingent valuation. Perspectives included adults' considering the health states from their own perspective, adults taking the perspective of a child (own, other, hypothetical) and a child/adolescent taking their own or the perspective of another child. There was some evidence that children gave lower values for comparable health states than did adults that adopted their own perspective or adult/parents that adopted the perspective of children.
CONCLUSIONS
Differences in reporting limited the conclusions that can be formed about which methods are most suitable for eliciting preferences for children's health and the influence of differing perspectives and values. Difficulties encountered in drawing conclusions from the data (such as lack of consensus and poor reporting making it difficult for users to choose and interpret available values) suggest that reporting guidelines are required to improve the consistency and quality of reporting of studies that value children's health using preference-based techniques.
Topics: Adolescent; Adult; Child; Child Health; Cost-Benefit Analysis; Humans; Parents; Quality of Life; Research Design
PubMed: 35619044
DOI: 10.1007/s40273-022-01149-3 -
Acta Otorhinolaryngologica Italica :... Oct 2011The aim of the study consists in a systematic review concerning the economic evaluation of cochlear implant (CI) in children by searching the main international clinical... (Review)
Review
The aim of the study consists in a systematic review concerning the economic evaluation of cochlear implant (CI) in children by searching the main international clinical and economic electronic databases. All primary studies published in English from January 2000 to May 2010 were included. The types of studies selected concerned partial economic evaluation, including direct and indirect costs of cochlear implantation; complete economic evaluation, including minimization of costs, cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) performed through observational and experimental studies. A total of 68 articles were obtained from the database research. Of these, 54 did not meet the inclusion criteria and were eliminated. After reading the abstracts of the 14 articles selected, 11 were considered eligible. The articles were then read in full text. Furthermore, 5 articles identified by bibliography research were added manually. After reading 16 of the selected articles, 9 were included in the review. With regard to the studies included, countries examined, objectives, study design, methodology, prospect of analysis adopted, temporal horizon, the cost categories analyzed strongly differ from one study to another. Cost analysis, cost-effectiveness analysis and an analysis of educational costs associated with cochlear implants were performed. Regarding the cost analysis, only two articles reported both direct cost and indirect costs. The direct cost ranged between € 39,507 and € 68,235 (2011 values). The studies related to cost-effectiveness analysis were not easily comparable: one study reported a cost per QALY ranging between $ 5197 and $ 9209; another referred a cost of $ 2154 for QALY if benefits were not discounted, and $ 16,546 if discounted. Educational costs are significant, and increase with the level of hearing loss and type of school attended. This systematic review shows that the healthcare costs are high, but savings in terms of indirect and quality of life costs are also significant. Cochlear implantation in a paediatric age is cost-effective. The exiguity and heterogeneity of studies did not allow detailed comparative analysis of the studies included in the review.
Topics: Child; Cochlear Implants; Costs and Cost Analysis; Humans
PubMed: 22287822
DOI: No ID Found