Does parental involvement make a difference in school-based nutrition and physical activity interventions? A systematic review of randomized controlled trials

Objectives

Parental involvement is often advocated as important for school-based interventions, however, to date, only inconsistent evidence is available. Therefore, this study aimed at determining the impact of parental involvement in school-based obesity prevention interventions in children and adolescents.

Methods

A systematic review of obesity prevention studies published from 1990 to 2010 including a comparison between school-based interventions with and without parental component was conducted. Only studies reporting effects on health behaviour-related outcomes were included.

Results

Some positive effects of parental involvement were found on children’s behaviours and behavioural determinants. Parental modules including different strategies and addressing several home-related determinants and parenting practices concerning eating and physical activity behaviours were more likely to be effective. However, no conclusive evidence could be provided concerning the added value of parent involvement, because of the paucity of studies to test this hypothesis. The few studies that are available provide inconsistent evidence.

Conclusions

There is a need for more studies comparing school-based interventions with and without a parental component, and dose, strategies and content of parental components of school-based interventions should be better reported in articles.     

Are there gender differences in core symptoms,temperament, and short‐term prospective outcome in anorexia nervosa?

OBJECTIVE: The objective of this study was to compare symptoms, premorbid personality phenotypes, and short-term outcome between males and females with anorexia nervosa. METHOD: Symptom and personality ratings were obtained at the time of hospital admission, and outcome was assessed at discharge and again 1 year later. RESULTS: Gender effects were negligible at admission, with the exception of greater weight concern among females. Lifetime anxiety disorders and personality traits implicated in liability for anorexia nervosa were common among patients of both genders. Females had greater persistence of symptom morbidity over the 1-year follow-up. CONCLUSION: Although gender has little effect on the clinical features of anorexia nervosa, the illness runs a more protracted early course in females. Possible mechanisms underlying greater persistence of morbidity in females include sexual dimorphisms in brain neurotransmission, gender differences in attitudes regarding ideal body weight, and anxiety-related personality phenotypes associated with anorexia nervosa.     

Are eating disorders associated with borderline personality disorder? a critical review

Seven studies using structured diagnostic interviews have assessed the prevalence of borderline personality disorder among patients with eating disorders, yielding rates from 0% to 42% in different samples. However, many patients with eating disorders suffer from depression, and there is substantial overlap between the symptoms of depression and those of borderline personality disorder. Thus, structured interviews for borderline personality disorder–most of which are of untested or uncertain specificity–may perhaps frequently produce false-positive diagnoses of borderline personality disorder in patients with eating disorders and hence yield exaggerated estimates of the true prevalence of borderline personality disorder in this population. Considering the grave implications of the borderline diagnosis, one must remain critical of studies in this area until further data, using instruments of documented specificity, blind ratings, and suitable control groups, become available.     

Strategic memory in adults with anorexia nervosa: Are there similarities to obsessive compulsive spectrum disorders?

OBJECTIVE: There is growing interest in the relationship between anorexia nervosa (AN) and obsessive-compulsive (OC) spectrum disorders (e.g., OCD, body dysmorphic disorder [BDD]). Previous neuropsychological investigations of OC spectrum disorders have identified problems with the efficient use of strategy on complex measures of learning and memory. This study evaluated nonverbal strategic memory in AN outpatients using an approach previously applied to OC spectrum disorders. METHOD: Eighteen patients with AN and 19 healthy control participants completed the Rey-Osterrieth Complex Figure Test (RCFT), a widely used measure of nonverbal strategic planning, learning, and memory. RESULTS: Individuals with AN differed significantly from healthy controls in the organizational strategies used to copy the RCFT figure, and they recalled significantly less information on both immediate and delayed testing. Multiple regression analyses indicated that group differences in learning were mediated by copy organizational strategies. CONCLUSION: These results are identical to study findings in OCD and BDD, indicating important shared neuropsychological features among AN and these OC spectrum disorders. As in OCD and BDD, the essential cognitive deficit in AN was impaired use of organizational strategies, which may inform our understanding of the pathophysiology of AN and potentially offer treatment implications.     

How can adherence to lipid-lowering medication be improved? A systematic review of randomized controlled trials

OBJECTIVE: Poor patient adherence to lipid-lowering medication is a major contributory factor in the lack of success in treating hyperlipidaemia. The objective of this review was to assess the effect of adherence-enhancing interventions for lipid-lowering medication. DESIGN: Systematic review of randomized controlled trials (RCTs). Data sources: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycInfo and CINAHL for all-language publications in November 2005. Direct contact with authors of included RCTs. METHODS: Two reviewers extracted data independently and assessed studies according to criteria outlined by the Cochrane Reviewers' Handbook. RESULTS: Nine RCTs were included in the review. Substantial between-study heterogeneity made pooling of data inappropriate. Four out of nine RCTs reported significantly improved adherence rates. The interventions associated with improved adherence were simplification of drug regimen (absolute increase 11%), patient information and education (13%) and intensified patient care (8.6% and 24%). Duration of follow-up was short, ranging from 2 to 24 months. No clear pattern emerged with regard to different classes of lipid-lowering drugs and adherence levels. CONCLUSIONS: Intensified patient care appears to be the most promising intervention in terms of improved adherence to lipid-lowering drugs. Numbers of trials are low and evidence is sparse. Important aspects to be addressed in future studies are long-term follow-up, effect of improved adherence on serum lipid levels and concurrent, economic evaluation of adherence-enhancing strategies.     

Are coffee and tea consumption associated with urinary tract cancer risk? A systematic review and meta-analysis

BACKGROUND: Narrative reviews have concluded that there is a small association between coffee consumption and an increased risk of urinary tract cancer, possibly due to confounding by smoking. No association for tea consumption has been indicated. This systematic review attempts to summarize and quantify these associations both unadjusted and adjusted for age, smoking and sex. METHOD: Thirty-four case-control and three follow-up studies were included in this systematic review. Summary odds ratios (OR) were calculated by meta-regression analyses. RESULTS: The unadjusted summary OR indicated a small increased risk of urinary tract cancer for current coffee consumers versus non-drinkers. The adjusted summary OR were: 1.26 (95% CI : 1.09-1.46) for studies with only men, 1.08 (95% CI : 0.79-1.46) for studies with only women and 1.18 (95% CI : 1.01-1.38) for studies with men and women combined. Neither unadjusted nor adjusted summary OR provided evidence for a positive association between tea consumption and urinary tract cancer. Even though studies differed in methodology, the results were rather consistent. We did not perform dose-response analyses for coffee and tea consumption due to sparse data. CONCLUSIONS: In accordance with earlier reviews, we found that coffee consumption increases the risk of urinary tract cancer by approximately 20%. The consumption of tea seems not to be related to an increased risk of urinary tract cancer.     

Is there evidence for recommending needleless closed catheter access systems in guidelines? A systematic review of randomized controlled trials

A systematic review was conducted to determine whether certain vascular access policies are better than others in terms of prevention of catheter-related infections. Publications were retrieved by a search of Medline, the Cochrane Library and Embase up to May 2005. All randomized trials and systematic reviews/meta-analyses of randomized trials evaluating the effect of vascular access policies (i.e. needleless closed systems, conventional closed systems or conventional open systems) on catheter-related infection in hospitalized patients with intravascular catheters in situ were selected. Two reviewers independently assessed trial quality and extracted data. Data from the original publications were used to calculate the relative risk or the incidence-density relative rate of catheter-related infection. Data for similar outcomes were combined in the analysis where appropriate using a random-effects model. Of the six studies reviewed, one was excluded. Five randomized controlled trials were included in the review. The quality of the trials and the way they were reported were generally unsatisfactory. Four trials compared needleless closed systems with conventional open systems. There was a trend for an advantage of the needleless closed devices in terms of less catheter-associated bloodstream infection, less catheter tip colonization and less hub inlet colonization. There were no possibilities for combining data because of clinical heterogeneity. One trial compared needleless closed systems with conventional closed systems and the evidence was inconclusive. From the point of view of infection prevention, there are no objections to use these new systems. However, there is insufficient evidence at this stage to recommend the needleless closed vascular devices.     

Are immunosuppressive medications associated with decreased responses to routine immunizations? A systematic review

Background

Long-term immunosuppressive medications are being used more commonly for a variety of medical conditions, including immune-mediated diseases and organ transplantation. While these medications are often necessary, they are associated with an increased risk of serious infections. Vaccination may be a way to prevent a variety of infections but vaccine responses among patients receiving immunosuppressive therapies have been variable.

Purpose

To systematically review the literature describing immune responses among patients on immunosuppressive therapies to vaccinations including influenza, pneumococcal, meningococcal, hepatitis A and B, tetanus toxoid, pertussis, varicella, and zoster.

Data sources

English language citations in the MEDLINE and EMBASE databases from 1985 to 2010.

Study selection

Two reviewers independently screened titles and abstracts to identify prospective, controlled studies reporting pre- and post-vaccination titers of recommended vaccines in patients receiving long-term immunosuppressive therapies for full-text review.

Data extraction

Three reviewers independently assessed study characteristics including treatment regimens and pre- and post-vaccination titers.

Data synthesis

Of the 972 identified titles, fifteen met inclusion criteria. Ten studies assessed the effects of immunosuppressive medications on responses to influenza vaccine, four studies investigated responses following pneumococcal vaccination, and one study assessed both influenza and pneumococcal vaccination. Five of the studies that evaluated influenza vaccination showed partially diminished responses among individuals receiving immunosuppressive therapies, while one of the pneumococcal vaccine studies showed significantly decreased responses following vaccination. Patients treated with more than one immunosuppressive medication were the least likely to respond to vaccination.

Limitations

The heterogeneity of reported outcomes limits generalizeability.

Conclusions

Immunosuppressive therapy, particularly combination regimens, may blunt response to influenza and pneumococcal vaccinations. To ensure the best chance of response, immunizations should be administered prior to initiation of immunosuppressive medications whenever possible.     

What is remission in adolescent anorexia nervosa? A review of various conceptualizations and quantitative analysis

OBJECTIVE: The current article evaluated models of remission in anorexia nervosa (AN). METHOD: A dataset from 86 adolescents with AN was used to model definitions of remission by using (a) Morgan-Russell categories, (b) criteria proposed by Pike, (c) criteria proposed by Kordy, et al. (d) DSM-IV-text revision criteria, (e) other weight thresholds, (f) psychological symptoms (Eating Disorder Examination [EDE] scores), and (g) combinations of these. RESULTS: The mean age was 15.2 +/- 1.6 years. Remission rates varied from 3% to 96% depending on the method used. Combining percent ideal body weight and EDE scores appeared to reduce the variability in rates, capture the most meaningful aspects of remission, and avoid the pitfalls of other methods. CONCLUSION: These methods of defining remission produce a wide range of outcomes, demonstrating the importance of defining remission consistently. Weight and psychological variables combined appear most important in defining remission.