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Future Studies Need (future + studies_need)
Selected AbstractsThe relation between different dimensions of alcohol consumption and burden of disease: an overviewADDICTION, Issue 5 2010Jürgen Rehm ABSTRACT Aims As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease. Methods Systematic literature reviews were used to identify alcohol-related diseases, birth complications and injuries using standard epidemiological criteria to determine causality. The extent of the risk relations was taken from meta-analyses. Results Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome. Dose,response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases. Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries. For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day). For several disease and injury categories, the effects were stronger on mortality compared to morbidity. There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden. Conclusions Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes. Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol,disease relationships. [source] Benefits and risks of interferon therapy for hepatitis B,HEPATOLOGY, Issue S5 2009Robert Perrillo Alpha interferon is the only licensed drug for hepatitis B with immunomodulatory as well as viral inhibitory properties. Potential advantages of interferon compared to nucleoside analogs include a lack of drug resistance, a finite and defined treatment course, and a higher likelihood for hepatitis B surface antigen (HBsAg) clearance. Approximately 30% of hepatitis B e antigen (HBeAg)-positive and 40% of HBeAg-negative cases have a sustained virological response (when defined as HBeAg seroconversion and/or hepatitis B virus (HBV) DNA levels below 20,000 copies/mL, respectively) 6 months after completion of a 48-week course of peginterferon alfa-2a These responses remain durable in 80% and 50% of cases, respectively, when evaluated several years later. Recent studies have shown that changes in HBsAg and HBeAg concentration during treatment predict sustained virological response and serial monitoring of HBsAg is helpful in predicting HBsAg clearance. HBeAg-positive patients with genotype A have higher rates of HBeAg and HBsAg clearance, whereas HBeAg-negative patients with genotype D have the lowest rate of response to interferon therapy. Long-term follow-up of virological responders to either standard alpha interferon or peginterferon has demonstrated a progressive increase in the rate of HBsAg clearance, particularly in patients who were initially HBeAg-positive. Future studies need to address if specific virological benchmarks during therapy can be used to tailor treatment duration. Conclusion: Peginterferon alfa has a place as first-line therapy of hepatitis B in patients who are carefully selected on the basis of pretreatment serum HBV DNA and aminotransferase levels, safety considerations, and viral genotype. (HEPATOLOGY 2009;49:S103,S111.) [source] Psychosocial interventions for non-professional carers of people with Parkinson's disease: a systematic scoping reviewJOURNAL OF ADVANCED NURSING, Issue 3 2008Susanne Hempel Abstract Title.,Psychosocial interventions for non-professional carers of people with Parkinson's disease: a systematic scoping review. Aim., This paper is a report of a scoping review to systematically identify and collate the evidence on psychosocial interventions for non-professional carers of people with Parkinson's disease. Background., Carers are critical to people with Parkinson's disease maintaining independent living and quality of life. Parkinson's disease imposes a challenging constellation of symptoms and no summary of effective interventions for carers and their unique support needs exists. Data sources., Thirty electronic databases were searched from their inception to July 2006, and bibliographies and specific internet sites were scanned. Methods., Eligible studies were categorized according to design, type of economic evaluation where applicable, number of participants, country of evaluation, intervention, orientation, provider, setting, method of delivery, carer population, patient population, carer outcomes, patient outcomes and authors' conclusions. Data were extracted by one reviewer and checked by another reviewer; discrepancies were resolved through discussion or arbitration by a third reviewer. Findings., Thirty studies met the inclusion criteria. Most investigated relatively unique interventions involving multiple elements; the majority were not aimed primarily at carers but were embedded in patient treatment programmes. Many were pilot studies, employing weak research designs and involving very small numbers of participants and most were not designed to assess the clinical or cost effectiveness of the intervention for the carers. Conclusion., Several interventions merit further investigation but there is currently little evidence to show which approaches are effective and cost effective in supporting carers. Future studies need to employ appropriate and rigorous research designs with adequate samples and outcome measures, and with more focus on the carer. [source] Anonymity and Self-Disclosure on WeblogsJOURNAL OF COMPUTER-MEDIATED COMMUNICATION, Issue 4 2007Hua Qian Bloggers are typically cautious about engaging in self-disclosure because of concerns that what they post may have negative consequences. This article examines the relationship between anonymity (both visual and discursive) and self-disclosure on weblogs through an online survey. The results suggest that increased visual anonymity is not associated with greater self-disclosure, and the findings about the role of discursive anonymity are mixed. Bloggers whose target audience does not include people they know offline report a higher degree of anonymity than those whose audience does. Future studies need to explore the reasons why bloggers visually and discursively identify themselves in particular ways. [source] Breast Binding , Is It All That It's Wrapped Up To Be?JOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2003IBCLC, Kathy Swift MSN Objective: To investigate the difference in breast symptoms between breast binding and support bra wearing in nonbreastfeeding postpartum mothers. Design: A systematic replication of an earlier study by Bristol using a pre-experimental posttest design. Setting: A private, for-profit hospital in a city in the south-central region of the United States. Participants: Sixty nonbreastfeeding postpartum women who gave birth to viable newborns of singleton gestations, had an uncomplicated postpartum, and did not receive hormonal lactation suppressants. Main Outcome Measures: Postpartum breast engorgement, leakage, tenderness, and use of pain relief measures as measured by the Bristol Record of Symptoms. Results: Analysis of the data revealed no significant difference relative to breast engorgement between the two groups during the first 10 postpartum days. However, the breast-binder group reported a greater degree of breast tenderness, breast leakage, and use of other pain relief measures. Conclusion: Breast binding should be discontinued as a method of lactation suppression and use of support bras encouraged. Future studies need to focus on comfort for nonbreastfeeding, postpartum mothers. [source] Monounsaturated Fat and Cardiovascular RiskNUTRITION REVIEWS, Issue 2006Jose López-Miranda MD On the basis of the information discussed in this review, we can conclude that the effects of a high intake of monounsaturated fatty acids (MUFA) from olive oil include a wide range of healthy benefits beyond improvement in cholesterol levels, suggesting that this type of diet has great potential in preventing cardiovascular disease. MUFA-enriched diets reduce insulin requirements and decrease plasma concentrations of glucose and insulin in type 2 diabetic patients, unlike high-saturated fatty acid and low-fat, high-carbohydrate diets. Moreover, some data show that this dietary model could have a hypotensive effect. There is also substantial evidence that oleic-enriched low-density lipoprotein (LDL) is more resistant to oxidative modifications and that dietary MUFA may influence various components and functions related to the endothelium. These include endothelium-dependent vasodilatation and a reduced capacity of oleicenriched LDL to promote the adhesion and chemotaxis of monocytes. On the other hand, a MUFA diet decreases the prothrombotic environment, modifying platelet adhesion, coagulation, and fibrinolysis. Its reducing effect on PAI-1 plasma levels is of particular relevance. This wide range of anti-atherogenic effects could explain the low rate of cardiovascular mortality found in Mediterranean countries, where there is a moderate to high supply of dietary MUFA. Future studies need to focus on uncovering the mechanisms by which the Mediterranean diet exerts its beneficial effects [source] Angiogenesis Therapy for the Treatment of Erectile DysfunctionTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2010Jeffrey J. Lysiak PhD ABSTRACT Introduction., Over the past 15 years, significant advances have been made in the treatment of erectile dysfunction (ED). The most significant of these advances has been pharmacological treatment of ED with phosphodiesterase type 5 (PDE5) inhibitors. This therapy greatly increased the awareness of ED and has helped stimulate research into the underlying causes of ED. While treatment with PDE5 inhibitors continues to be the current therapy of choice, approximately 40% of men treated with PDE5 inhibitors fail to have significant improvement in erectile function and PDE5 inhibitors do not reverse the vasculopathic processes associated with ED. With this in mind, new therapies must be developed. The treatment with angiogenic growth factors such as vascular endothelial cell growth factor (VEGF) may be one such therapy. Aim., This review will focus on defining key terms in the angiogenic process, angiogenic growth factors, and different delivery methods, and summarize results from angiogenic therapies for the treatment of ED. Methods., A review of the literature was performed on all angiogenic therapies for the treatment of ED. A brief review on the angiogenic factors was also performed Results., Angiogenic therapies for the treatment of ED are possible and promising; however, further investigation is needed to advance clinically. Conclusions., Although numerous studies have now employed angiogenic factors for the possible treatment of ED in several animal models, we are still not at the point to begin human investigations. Future studies need to examine proper dosage of the angiogenic agent, route of delivery, time course for delivery, and combination therapies. Lysiak JJ, Kavoussi PK, Ellati RT, Steers WD, and Annex BH. Angiogenesis therapy for the treatment of erectile dysfunction. J Sex Med 2010;7:2554,2563. [source] Predictors of parenting self-efficacy in mothers and fathers of toddlersCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2010P. R. Sevigny Abstract Background Researchers interested in child developmental outcomes have highlighted the role that parenting self-efficacy (PSE) plays in psychosocial child adjustment. PSE is a cognitive construct that can be broadly defined as an individual's appraisal of his or her competence in the parental role. PSE has emerged in the literature as an important variable when exploring variance in parenting skills. Despite this, much remains to be learned about PSE. Little is known about the predictors of PSE, with much of the existing research conducted in a piecemeal fashion that lacks a solid theoretical framework. In addition, PSE in fathers has been understudied and relatively little is known about PSE in families with toddler age children. Informed by Belsky's process model of parenting, this study explored similarities and differences in PSE and the predictors of PSE for mothers and fathers of toddlers. Methods A total of 62 cohabiting couples whose first-born child was 18,36 months old completed self-report measures of PSE, general self-efficacy, depression, marital satisfaction, parenting stress, child difficultness and family functioning. Results For fathers, parenting stress and their relational functioning (i.e. marital satisfaction and family functioning) with their spouse predicted PSE scores. For mothers, general self-efficacy and relational functioning were predictive of PSE. Conclusions and limitations The results of this study support the use of Belsky's process model of parenting to study the predictors of PSE. Important differences were found in the prediction models for mothers and fathers. Future studies need to clarify the nature of parental self-efficacy beliefs in fathers and continue to use comprehensive theoretical models to identify potentially relevant covariates of PSE. Limitations of the current investigation include reliance on self-report measures and the homogeneity of the sample. [source] Feeding and dementia: a systematic literature reviewJOURNAL OF ADVANCED NURSING, Issue 1 2006Roger Watson PhD RN FIBiol FRSA Aim., This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. Background., Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. Method., A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms ,feeding', ,eating' and ,dementia' combined as follows: ,(feeding or eating) and (dementia)'. A second search was carried out combining the search terms ,mealtimes' and ,dementia' as follows: ,mealtimes and dementia'. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. Results., Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. Conclusions., Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis. [source] Serotonin and Parkinson's disease: On movement, mood, and madness,MOVEMENT DISORDERS, Issue 9 2009Susan H. Fox MRCP Abstract An appreciation of the multiple roles that serotonin (5-HT) may play in Parkinson's disease (PD) has increased in recent years. Early pathological studies in PD demonstrated nonselective reductions of 5-HT in brain tissue but little correlation to comorbidities such as dyskinesia and mood disturbance. This, combined with treatment failures using serotonergic drugs in comparison to levodopa, meant the field was largely neglected until recently. The multitude of subtypes of 5-HT receptors in the brain and an increased understanding of the potential function 5-HT may play in modulating other neurotransmitter systems, including dopamine, GABA, and glutamate, have meant an expansion in efforts to develop potential serotonergic drugs for both motor and nonmotor symptoms in PD. However, several unanswered questions remain, and future studies need to focus on correlating changes in 5-HT neurotransmission in both pathological and in vivo imaging studies with a full clinical phenotype. © 2009 Movement Disorder Society [source] How do you initiate oestrogen therapy in a girl who has not undergone puberty?CLINICAL ENDOCRINOLOGY, Issue 1 2009Peter C. Hindmarsh Summary The physiology of puberty needs to be taken into consideration in the induction of puberty. Puberty is a relatively slow process and replacement therapy should mimic this. Long-term maintenance requires careful monitoring and long-term assessment of risk-benefit. This has not been appreciably defined in the adolescent population. Options for fertility need careful consideration and may depend on the adequacy of pubertal induction in terms of uterine development. A number of regimens are available for pubertal induction but the lack of comparisons makes it difficult to advocate for a particular regimen. There remain a number of areas of uncertainty, and future studies need to consider these issues and whether there are cardiovascular risk factor advantages to certain preparations. The long-term risks of breast and gynaecological malignancy remain uncertain. Long-term cohort studies are required to address these issues. [source] | |||||||||||||