Pharmacological treatment of cocaine dependence: a systematic review

Aims Cocaine dependence is a common and serious condition, associated with severe medical, psychological and social problems, including the spread of infectious diseases. This systematic review assesses critically the efficacy of pharmacotherapy for treating cocaine dependence. Methods The literature search strategy included: electronic searches of Cochrane Library holdings, EMBASE, MEDLINE, PsycLIT, Biological Abstracts and LILACS; scans of reference lists of relevant articles, personal communications, conference abstracts, unpublished trials from the pharmaceutical industry and book chapters on the treatment of cocaine dependence. Randomized controlled trials (RCTs) focusing on the use of antidepressants (ADs), carbamazepine (CBZ), dopamine agonists (DAs) and other drugs used in the treatment of cocaine dependence were included. The reviewers extracted data independently, and relative risks (RR) with 95% confidence interval (CI) were estimated. Qualitative assessments were carried out using a Cochrane validated checklist. Where possible, analysis was carried out according to ‘intention‐to‐treat’ principles. Findings The search strategy generated 45 different trials. Most studied drugs were ADs (20 studies), DAs and CBZ. Data were very heterogeneous, with dropout rates within the studies between 0 and 84%. A non‐significant trend favoring CBZ was found in terms of dropouts (RR 0.88; 95% CI 0.75–1.03) and results from one trial suggest that fluoxetine patients are less likely to drop out. The main efficacy outcome reported in the studies was the presence of cocaine metabolites in the urine. No significant results were found, regardless the type of drug or dose used for all relevant outcomes assessed. Conclusions There is no current evidence supporting the clinical use of CBZ, antidepressants, dopamine agonists, disulfiram, mazindol, phenytoin, nimodipine, lithium and NeuRecover‐SA in the treatment of cocaine dependence. Larger randomized investigation must be considered, while taking into account that these time‐consuming efforts should be reserved for medications showing more relevant and promising evidence. Given the high dropout rate among the test population, clinicians may wish to consider adding psychotherapeutic supportive measures aimed at keeping patients in treatment programs.     

Thrombophilia in pregnancy: a systematic review

Growing evidence suggests that thrombophilia is associated with venous thromboembolism (VTE) and adverse pregnancy outcomes. However, methodological limitations have made it difficult to obtain a clear overview of the overall risks. We conducted a systematic review to determine the risk of VTE and adverse pregnancy outcomes associated with thrombophilia in pregnancy. The effectiveness of prophylactic interventions during pregnancy was also evaluated. Major electronic databases were searched, relevant data abstracted and study quality assessed by two independent reviewers. Odds ratios (ORs) stratified by thrombophilia type were calculated for each outcome. A total of 79 studies were included in our review. The risks for individual thrombophilic defects were determined for VTE (ORs, 0.74-34.40); early pregnancy loss (ORs, 1.40-6.25); late pregnancy loss (ORs, 1.31-20.09); pre-eclampsia (ORs, 1.37-3.49); placental abruption (ORs, 1.42-7.71) and intrauterine growth restriction (ORs, 1.24-2.92). Low-dose aspirin plus heparin was the most effective in preventing pregnancy loss in thrombophilic women (OR, 1.62). Our findings confirm that women with thrombophilia are at risk of developing VTE and complications in pregnancy. However, despite the increase in relative risk, the absolute risk of VTE and adverse outcomes remains low. There is also a lack of controlled trials of antithrombotic intervention to prevent pregnancy complications. Thus, at present, universal screening for thrombophilia in pregnancy cannot be justified clinically.     

Reporting of treatment fidelity in behavioural paediatric obesity intervention trials: a systematic review

Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double‐coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter‐coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p < 0.01) as was the number of articles published for a given study (p < 0.01). The frequency of reporting treatment fidelity components has not improved over time (p = 0.26). Specific recommendations are made to support paediatric obesity researchers in leading health behaviour disciplines towards more rigorous measurement and reporting of treatment fidelity.     

Measuring treatment outcomes in gambling disorders: a systematic review

Background and Aims

Considerable variation of outcome variables used to measure recovery in the gambling treatment literature has precluded effective cross‐study evaluations and hindered the development of best‐practice treatment methodologies. The aim of this systematic review was to describe current diffuse concepts of recovery in the gambling field by mapping the range of outcomes and measurement strategies used to evaluate treatments, and to identify more commonly accepted indices of recovery.

Methods

A systematic search of six academic databases for studies evaluating treatments (psychological and pharmacological) for gambling disorders with a minimum 6‐month follow‐up. Data from eligible studies were tabulated and analysis conducted using a narrative approach. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) were adhered to.

Results

Thirty‐four studies were reviewed systematically (RCTs = 17, comparative designs = 17). Sixty‐three different outcome measures were identified: 25 (39.7%) assessed gambling‐specific constructs, 36 (57.1%) assessed non‐gambling specific constructs, and two instruments were used across both categories (3.2%). Self‐report instruments ranged from psychometrically validated to ad‐hoc author‐designed questionnaires. Units of measurement were inconsistent, particularly in the assessment of gambling behaviour. All studies assessed indices of gambling behaviour and/or symptoms of gambling disorder. Almost all studies (n = 30; 88.2%) included secondary measures relating to psychiatric comorbidities, psychological processes linked to treatment approach, or global functioning and wellbeing.

Conclusions

In research on gambling disorders, the incorporation of broader outcome domains that extend beyond disorder‐specific symptoms and behaviours suggests a multi‐dimensional conceptualization of recovery. Development of a single comprehensive scale to measure all aspects of gambling recovery could help to facilitate uniform reporting practices across the field.     

Safety of contraceptive use among women with congenital heart disease: A systematic review

Objective: Women with congenital heart disease (CHD) are at increased risk of preg‐ nancy complications and need information on safe, effective contraceptive methods to avoid unintended pregnancy. This systematic review examines evidence regarding safety of contraceptive use among women with CHD.
Methods: The PubMed database was searched for any peer‐reviewed articles pub‐ lished through April 2018 that included safety outcomes associated with reversible contraceptive methods among women with CHD.
Results: Five articles met inclusion criteria: three studies comparing contraceptive users to nonusers and two noncomparative studies. Sample sizes ranged from 65 to 505 women with CHD. Two studies found a higher percent of thromboembolic com‐ plications among women with Fontan palliation or transposition of the great arteries using oral contraceptives. One study, among women with Fontan palliation, found no increased risk of thromboembolic complications between contraceptive users (not separated by type) and nonusers. Two studies found no endocarditis among intrau‐ terine device users.
Conclusions: There is a paucity of data regarding the safety of contraceptive meth‐ ods among women with CHD. Limited evidence suggests an increased incidence of thromboembolic complications with use of oral contraceptives. Further studies are needed to evaluate contraceptive safety and quantify risk in this growing population. There is also limited data regarding the safety of contraceptive methods among women with CHD. Further information is needed to assist practitioners counseling women with CHD on safety of contraceptive methods.     

Non-specialist psychosocial support interventions for women living with HIV: A systematic review

Many women living with HIV experience a range of physical, social, and psychological challenges linked to their HIV status. Psychosocial support interventions may help women cope with these challenges and may allow women to make better decisions around their sexual and reproductive health (SRH), yet no reviews have summarized the evidence for the impact of such interventions on well-being and SRH decision-making among women living with HIV. We systematically reviewed the evidence for non-specialist delivered psychosocial support interventions for women living with HIV, which are particularly relevant in low-resource settings. Outcomes of interest included mental, emotional, social well-being and/or quality of life, common mental health disorders, and SRH decision-making. Searching was conducted through four electronic databases and secondary reference screening. Systematic methods were used for screening and data abstraction. Nine articles met the inclusion criteria, showing positive or mixed results for well-being and depressive symptoms indicators. No studies reported on SRH decision-making outcomes. The available evidence suggests that psychosocial support interventions may improve self-esteem, coping and social support, and reduce depression, stress, and perceived stigma. However, evidence is mixed. Most studies placed greater emphasis on instrumental health outcomes to prevent HIV transmission than on the intrinsic well-being and SRH of women living with HIV. Many interventions included women living with HIV in their design and implementation. More research is required to understand the most effective interventions, and their effect on sexual and reproductive health and rights.     

Platelet-rich plasma for the treatment of alopecia: a systematic review and meta-analysis

BackgroundThe number of articles evaluating the efficacy of platelet-rich plasma (PRP) in androgenetic alopecia (AGA) and alopecia areata (AA) has increased exponentially during the last years. This systematic review and meta-analysis is aimed at evaluating the benefit of PRP in the treatment of alopecia.Material and methodsWe searched MEDLINE (through PUBMED), Embase, and CENTRAL for relevant data. Treatment effect was described by mean difference (MD) and risk difference with 95% confidence intervals (CI). The GRADE system was used to assess the certainty of the body of evidence.ResultsWe found 27 controlled trials (1,117 subjects) that met our inclusion criteria: 18 trials (713 subjects) in patients with AGA, and 9 (404 subjects) in patients with AA. Eleven studies had a split head design. There was heterogeneity in types of PRP (e.g., activated and non-activated) and administration schedules. PRP was compared to saline injections (18 studies), local steroid injections (4 studies) and other comparators (5 studies). Most commonly reported outcomes were hair density and hair regrowth. It was not possible to pool all outcome data because of heterogeneity in reporting, and because reporting was often limited to a single study. Compared to saline injections, PRP injections increased hair density over a medium-term follow-up (MD, 25.6 hairs/cm²; 95 % CI: 2.62–48.57), but the evidence was rated as low quality due to inconsistency and risk of bias. In individuals with AA, it is unclear whether PRP injection compared with triamcinolone injection increase the rate of subjects with hair regrowth (very-low quality of evidence due to inconsistency, imprecision, and risk of bias). There were no serious adverse events related to PRP injection or control treatments.ConclusionsThere is limited evidence showing benefit of PRP for treatment of alopecia, and most of this evidence is of low quality.     

Effectiveness of weight loss interventions – is there a difference between men and women: a systematic review

Effective strategies are required to reduce the prevalence of overweight and obesity; however, the effectiveness of current weight loss programmes is variable. One contributing factor may be the difference in weight loss success between men and women. A systematic review was conducted to determine whether the effectiveness of weight loss interventions differs between men and women. Randomized controlled trials published up until March 2014 were included. Effect sizes (Hedges' g) were used to examine the difference in weight outcomes between men and women. A total of 58 studies met the eligibility criteria with 49 studies of higher quality included in the final data synthesis. Eleven studies that directly compared weight loss in men and women reported a significant sex difference. Ten of these reported that men lost more weight than women; however, women also lost a significant amount of weight. Analysis of effect sizes found small differences in weight loss favouring men for both diet (g = 0.489) and diet plus exercise (g = 0.240) interventions. There is little evidence from this review to indicate that men and women should adopt different weight loss strategies. Current evidence supports moderate energy restriction in combination with exercise for weight loss in both men and women.     

Exenatide efficacy and safety: a systematic review

Objective To examine the efficacy, effectiveness and side effects of exenatide when compared with oral glucose‐lowering agents or insulin therapy. Research design and methods Relevant citations were identified from searches of multiple bibliographic databases supplemented with searches of the US Food and Drug Administration website and other sources. A qualitative synthesis was performed, with a random effects meta‐analysis when appropriate. Results We identified 17 studies. In placebo‐controlled trials of subjects with poorly controlled diabetes (with both groups receiving various oral glucose‐lowering agents), exenatide 10 μg twice daily improved glycated haemoglobin (HbA_1c) by approximately 1.0% over 30 weeks [pooled estimate ?0.97%, 95% confidence interval (CI), ?1.16 to ?0.79%, P < 0.0001] and exenatide treatment over 16–30 weeks was associated with weight loss of 1.0–2.5 kg. Exenatide appeared to confer a similar benefit to various insulin regimes for glycaemic control at follow‐up between 16 and 52 weeks (pooled estimate HbA_1c?0.04%, 95% CI, ?0.14 to 0.06%, P = 0.41), but was advantageous over insulin with respect to weight loss (3–6 kg loss at up to 52 weeks of follow‐up). Nausea was the most common adverse event in placebo‐ and active‐controlled trials. Rates of hypoglycaemia were similar in exenatide and insulin groups, but were higher with exenatide 10 μg twice daily compared with placebo and hypoglycaemia was most frequent when a sulphonylurea was administered. Conclusions In subjects with poorly controlled diabetes, exenatide was associated with a reduction in HbA_1c that was similar to introducing another oral agent or insulin. Weight loss may be an advantage with exenatide. Long‐term studies in diverse and unselected populations are needed to clarify the benefit vs. harm profile of this drug.     

Artemether-lumefantrine for uncomplicated malaria: a systematic review

BACKGROUND: The World Health Organization (WHO) is promoting artemether-lumefantrine for treating uncomplicated malaria. The objective of this review is to summarize available evidence of its effects compared with other antimalarial regimens. METHODS: We sought randomized and quasi-randomized studies comparing artemether-lumefantrine with any other antimalarial drug regimen. Databases searched were MEDLINE (to February 2003), EMBASE (to February 2003), and the Cochrane Controlled Trials Register (issue 1, 2003). Conference proceedings and reference article lists were searched and malaria researchers and the drug manufacturer were contacted. Two reviewers independently applied inclusion criteria and extracted data. RESULTS: Six trials (1698 participants) studied the four-dose regimen. Fever and parasite clearance tended to be shorter with artemether-lumefantrine, but parasitological failure on day 28 was more common with artemether-lumefantrine in comparison with mefloquine (one trial, n = 233), halofantrine (one trial, n = 86) and mefloquine-artesunate (one trial, n = 537); but less common with chloroquine (two trials, n = 378). For the six-dose regimen, two studies compared artemether-lumefantrine with mefloquine-artesunate, but there was insufficient data to demonstrate any meaningful comparative effects for day 28 parasitaemia, and no difference in parasite or fever clearance time was detected. There were 11 parasitological failures with artemether-lumefantrine and none with mefloquine-artesunate. CONCLUSION: There is no evidence to demonstrate the four-dose regimen of artemether-lumefantrine results in a higher cure rate than other antimalarial regimens against which it has been tested, apart from chloroquine in areas with high chloroquine resistance. Artemether-lumefantrine has potential advantages over non-artemisinin regimens because of the faster clearance time and gametocyte clearance. There is insufficient evidence about the six-dose regimen to know whether it is less or more effective than current antimalarial drug regimens.     

Acupuncture treatment for emotional problems in infertile women: A protocol for systematic review and meta-analysis

Background:Infertility causes emotional and psychological problems, including anxiety, depression, low self-efficacy, and chronic mental stress in women. These emotional problems can negatively affect fertility treatment. Numerous studies have reported the clinical therapeutic effects of acupuncture on emotional problems; however, the efficacy and safety of acupuncture treatment for emotional problems in infertile women remain unclear. This protocol aims to evaluate the efficacy and safety of acupuncture for treating emotional problems in infertile women.Methods:We will search the following databases from their inception to April 30, 2021: MEDLINE, EMBASE, Cochrane Library, Korean Medical Databases (KoreaMed, Korean studies Information Service System, Korean Traditional Knowledge Portal, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, and National Digital Science Library), and Chinese databases (CNKI and Wan Fang Database). We will include randomized controlled trials on acupuncture for emotional problems in infertile women. There will be no restrictions regarding language or publication date. The primary outcome will be assessed using an emotion-related assessment scale. The risk of bias of the included studies will be measured using the Cochrane risk of bias assessment tool. For meta-analysis, RevMan Version 5.4 software will be used to combine the relative risks for dichotomous outcomes, as well as the mean differences or standardized mean differences for continuous outcomes, with both having 95% confidence intervals.Results:Based on current evidence, this study will assess the effectiveness and safety of acupuncture for emotional problems in infertile women.Conclusion:This study will provide evidence for evaluating the acupuncture efficacy for infertile women with emotional problems.Registration number:INPLASY202150082.     

厄尔尼诺-南方涛动现象与流行性感冒联系的系统评价

目的调查分析既往及正在执行的厄尔尼诺-南方涛动现象(El Ni1o-Southern Oscillation,ENSO)与流行性感冒关联的相关研究,并评价ENSO对流行性感冒相关指标(如流感流行高峰的出现时间、流感样病例报告人数等)的影响,为进一步开展天气及气象因素影响流感病毒传播研究提供依据和建议。方法计算机检索MEDLINE,EMBASE,Science Direct,HEED、中国生物医学文献数据库(CBMdisc)、万方学位论文全文数据库,查找1988~2016年10月已发表的关于ENSO与流行性感冒联系的文献,并运用循证医学方法进行文献数据提取和分析。结果共检索到78篇文献,其中符合纳入标准的已发表文献10篇。二次文献研究显示,出现ENSO与流感大流行的发生,流感高峰的出现时间,流感样病例就诊数及重症死亡数都有较大关联,且El Ni1o和La Ni1a现象对流感相关指标的影响也不尽相同。结论从纳入研究的已发表文献分析结果来看,ENSO与流行性感冒相关指标之间有较强的相关性。     

Genetic variants and the metabolic syndrome: a systematic review

Several candidate gene studies on the metabolic syndrome (MetS) have been conducted. However, for most single nucleotide polymorphisms (SNPs) no systematic review on their association with MetS exists. A systematic electronic literature search was conducted until the 2nd of June 2010, using HuGE Navigator. English language articles were selected. Only genes of which at least one SNP–MetS association was studied in an accumulative total population ≥4000 subjects were included. Meta‐analyses were conducted on SNPs with three or more studies available in a generally healthy population. In total 88 studies on 25 genes were reviewed. Additionally, for nine SNPs in seven genes (GNB3, PPARG, TCF7L2, APOA5, APOC3, APOE, CETP) a meta‐analysis was conducted. The minor allele of rs9939609 (FTO), rs7903146 (TCF7L2), C56G (APOA5), T1131C (APOA5), C482T (APOC3), C455T (APOC3) and 174G>C (IL6) were more prevalent in subjects with MetS, whereas the minor allele of Taq‐1B (CETP) was less prevalent in subjects with the MetS. After having systematically reviewed the most studied SNP–MetS associations, we found evidence for an association with the MetS for eight SNPs, mostly located in genes involved in lipid metabolism.     

Treatments for spit tobacco use: a quantitative systematic review

Aims Spit tobacco use is prevalent in the United States and is associatedwith adverse health consequences. Health‐care providers have neitherevidence summaries nor evidence‐based guidelines to assist themin treating patients who use spit tobacco. Design We completed a systematic review of the literature to determinethe efficacy and safety of pharmacological and behavioral interventionsfor the treatment of spit tobacco use. Findings We found six randomized controlled trials testing pharmacological interventionsand eight testing behavioral interventions. Using random‐effects meta‐analyses,bupropion sustained‐release (SR) increased point prevalence tobaccoabstinence at 12 weeks [odds ratio (OR) 2.1; 95% confidenceinterval (CI), 1.0–4.2]. Nicotine replacementtherapy with patch or gum increased point prevalence tobacco abstinenceat 6 months (OR 1.3; 95% CI, 1.0–1.6).Behavioral interventions increased long‐term (6 month)point prevalence tobacco abstinence (OR 1.7; 95% CI, 1.1–2.9).Studies including an oral examination followed by feedback to thepatient had the highest treatment effect. Conclusions Behavioral interventions for ST users are effective for increasing STabstinence rates. Bupropion SR is probably effective and nicotinereplacement therapy may be effective. This evidence from randomizedcontrolled trials provides health‐care professionals with informationnecessary to effectively treat spit tobacco use.     

Global warming and obesity: a systematic review

Global warming and the obesity epidemic are two unprecedented challenges mankind faces today. A literature search was conducted in the PubMed, Web of Science, EBSCO and Scopus for articles published until July 2017 that reported findings on the relationship between global warming and the obesity epidemic. Fifty studies were identified. Topic‐wise, articles were classified into four relationships – global warming and the obesity epidemic are correlated because of common drivers (n = 21); global warming influences the obesity epidemic (n = 13); the obesity epidemic influences global warming (n = 13); and global warming and the obesity epidemic influence each other (n = 3). We constructed a conceptual model linking global warming and the obesity epidemic – the fossil fuel economy, population growth and industrialization impact land use and urbanization, motorized transportation and agricultural productivity and consequently influences global warming by excess greenhouse gas emission and the obesity epidemic by nutrition transition and physical inactivity; global warming also directly impacts obesity by food supply/price shock and adaptive thermogenesis, and the obesity epidemic impacts global warming by the elevated energy consumption. Policies that endorse deployment of clean and sustainable energy sources, and urban designs that promote active lifestyles, are likely to alleviate the societal burden of global warming and obesity.