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Unpublished Studies (unpublished + studies)

Distribution by Scientific Domains

Medical Sciences	92%

Selected Abstracts

The social and economic consequences of childhood-onset Type 1 diabetes mellitus across the lifecourse: a systematic review

DIABETIC MEDICINE, Issue 8 2006
B. Milton
Abstract Background The incidence of childhood-onset (Type 1) diabetes is high, and increasing, particularly among the very young. The aim of this review was to determine the longer-term social consequences of having diabetes as a child and to determine whether adverse consequences are more severe for disadvantaged children. Methods Results from published and unpublished studies were synthesized narratively to examine the impact of diabetes on education, employment and income in adulthood. The question of whether the impact differed for different social groups was also examined. Results Case-control studies found that children with diabetes missed more school than healthy children. Most studies of attainment found no differences between children with diabetes and non-diabetic control subjects or the local population, although poor metabolic control, early-onset, longer illness duration and serious hypoglycaemic events were associated with underachievement. People with childhood-onset diabetes may experience disadvantage in employment, and have a lower income in adulthood, although diabetic complications appear to be the most important determinant of social consequences in later life. Conclusions Many children with diabetes,especially late-onset,perform equally well at school despite increased rates of absence, but it is not yet clear whether specific subgroups are at greater risk of educational underperformance. People with childhood-onset diabetes, however, do appear to experience some disadvantage in adult employment. Qualitative research and cohort studies are needed to fill key gaps in the existing evidence base. Future research must also examine the impact of diabetes-related risk factors on socio-economic consequences. [source]

The feasibility of smoking reduction: an update

ADDICTION, Issue 8 2005
John R. Hughes
ABSTRACT Aim To update conclusions of a previous review of smoking reduction on the extent to which (1) smokers spontaneously reduce their smoking, (2) smokers who try to quit and fail return to smoking less, (3) smokers can substantially reduce and maintain reductions via pharmacological and behavioral treatments and (4) smokers compensate when they reduce. Method Qualitative systematic review. Data sources Systematic computer searches and other methods. Study selection Published and unpublished studies of smokers not trying to stop smoking. We located 13,26 studies for each of the four aims. Data extraction The first author entered data with confirmation by second author. Data synthesis Due to the heterogeneity of methods and necessity of extensive recalculation, a meta-analysis was not feasible. Results Few daily smokers spontaneously reduce. Among those who try to stop smoking and relapse, some return to reduced smoking but whether they maintain this reduction is unclear. Nicotine replacement (and perhaps behavior therapies) can induce smokers not interested in quitting to make significant reductions in their smoking and maintain these over time. Some compensatory smoking occurs with reduction but significant declines in smoke exposure still occur. Conclusions These results indicate that reduction is feasible when aided by treatment. Whether reduction should be promoted will depend on the effect of reduction on health outcomes and future cessation. [source]

Do Premarital Education Programs Really Work?

FAMILY RELATIONS, Issue 3 2010
A Meta-analytic Study
Previous studies (J. S. Carroll & W. J. Doherty, 2003) have asserted that premarital education programs have a positive effect on program participants. Using meta-analytic methods of current best practices to look across the entire body of published and unpublished evaluation research on premarital education, we found a more complex pattern of results. We coded 47 studies and found that premarital education programs do not improve relationship quality/satisfaction when unpublished studies are included in the analysis, although studies that follow couples past the honeymoon stage to detect prevention effects are rare. In contrast, premarital education programs appear to be effective at improving couple communication, with studies that employed observational measures rather than self-report measures producing large effects. Still, given the mixed, modest results, there is ample room and a real need to improve the practice of premarital education. [source]

Cognitive leisure activities and their role in preventing dementia: a systematic review

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2010
Cindy Stern BHSc(Hons)
Abstract Background, Dementia inflicts a tremendous burden on the healthcare system. Identifying protective factors or effective prevention strategies may lead to considerable benefits. One possible strategy mentioned in the literature relates to participation in cognitive leisure activities. Aim, To determine the effectiveness of cognitive leisure activities in preventing Alzheimer's and other dementias among older adults. Inclusion criteria Types of participants.,Adults aged at least 60 years of age with or without a clinical diagnosis of dementia that resided in the community or care setting. Types of interventions.,Cognitive leisure activities, defined as activities that required a mental response from the individual taking part in the activity (e.g. reading). Types of outcomes.,The presence or absence of dementia was the outcome of interest. Types of studies.,Any randomised controlled trials, other experimental studies, as well as cohort, case,control and cross-sectional studies were considered for inclusion. Search strategy.,A search for published and unpublished studies in the English language was undertaken with no publication date restriction. Methodological quality, Each study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments. Data collection and analysis, Information was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. Because of the heterogeneity of populations and interventions, meta-analyses were not possible and results are presented in narrative form. Results, There were no randomised controlled trials located that met inclusion criteria. Thirteen observational studies were included in the review; the majority were cohort design. Because of the heterogeneity of interventions, the study design, the way in which they were grouped and the different stages of life they were measured at, statistical pooling was not appropriate. Studies were grouped by stage of adult life participation when interventions were undertaken, that is, early adulthood, middle adulthood and late life. Five out of six studies showed a positive association between participating in activities and a reduced risk of developing Alzheimer's disease and other dementias when interventions were undertaken in middle adulthood and six out of seven studies produced a positive association for late life participation. Results indicated that some activities might be more beneficial than others; however, results should be interpreted with caution because of the subjective nature of activity inclusion. Conclusion ,,Actively participating in cognitive leisure activities during mid- or late life may be beneficial in preventing the risk of Alzheimer's disease and other dementias in the elderly; however, the evidence is currently not strong enough to infer a direct causal relationship. ,,Participating in selected cognitive leisure activities may be more favourable than others but currently there is no strong evidence to recommend one over the other. [source]

Policy related to abdominoplasty in publicly funded elective surgery programs: a systematic review

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2009
Alan Pearson RN, DipNEd
Abstract Objectives, This systematic review set out to establish best practice in relation to policy for the inclusion/exclusion of abdominoplasty procedures within public health systems. Inclusion criteria, The review considered any studies relating to abdominoplasty that addressed issues of inclusion/exclusion from public funded health systems including criteria for clinical need, contraindications, fit/ready for surgery, policy compliance and issues in relation to surgical training. Search strategy, The search strategy sought to find published and unpublished studies and papers limited to English. An initial search of Medline and CINAHL was undertaken, followed by an analysis of keywords contained in the title, abstract and index terms. A second comprehensive search was then undertaken using Medline, CINAHL, EMBASE, AUSTROM, Health Business, and FullTEXT Elite and PsycINFO. The search was restricted to the period 1995,2005. Methodological quality, Each paper identified was assessed by two independent reviewers for methodological quality before inclusion in the review using an appropriate critical appraisal instrument from the Joanna Briggs Institute System for the Unified Management and Assessment Review Instrument package. Results, A total of 19 papers were included in the review. Owing to the diverse nature of the papers no meta-analysis or meta-synthesis was able to be used to pool studies. The results are therefore presented in a narrative form. The papers identified were mainly retrospective audits and discussion/opinion papers. The main issues addressed were criteria to establish clinical need, contraindications and policy compliance. Conclusion, There are clinical indicators, mainly in relation to physical symptoms/dysfunction, to support exemption of some cases of abdominoplasty. For abdominoplasty to be conducted clinical need must be assessed and formally documented. Where clinical need is primarily based on psychological distress/dysfunction a formal psychiatric assessment should be used to justify surgery. [source]

The effectiveness of Cognitive,Behavioural Therapy with hopeful elements to prevent the development of depression in young people: a systematic review

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2009
Anthony Venning B Hth Sci (Hons), B Soc
Abstract Background, The onset of depression during adolescence can adversely impact future functioning. Cognitive,Behavioural Therapy (CBT) has been suggested to prevent depression in adolescence by providing an individual with the ability to interpret and the tools to deal with the impact of negative life events. Objective, Examine the best available evidence to determine the effectiveness of CBT to prevent the onset of depression in young people, and assess whether the incorporation of hopeful elements makes CBT more effective. Search strategy, A comprehensive three-step search strategy was developed to find both published and unpublished studies in English from 1987 to March 2007. Papers selected for retrieval were then assessed for methodological validity by two independent reviewers. Selection criteria, Papers that used a randomised controlled design and investigated the efficacy of CBT to prevent the onset of depression in young people between the age of 10 years and 16 years were included. Papers were included if the CBT involved between four and 15 sessions, a follow-up period of between 3 and 24 months and included typical strategies, such as the identification of negative and irrational beliefs, the establishment of links between thoughts, feelings and behaviours, and provided tools so participants could self-monitor these. Data analysis, Data were extracted using the standard tool from the Joanna Briggs Institute, pooled in a meta-analysis, and then grouped and analysed according to the amount of hopeful elements the CBT was judged to contain. Results and conclusion, Limited evidence was found to indicate that CBT, regardless of its content (i.e. with or without hopeful elements), is effective at preventing the onset of clinical levels of depression in young people on a sustained basis. Nonetheless, given the devastating impact that depression can have on young people's future functioning, further research is needed to develop effective interventions to equip young people with the cognitive skills to buffer its onset on a more sustained basis and to enable them to reach and sustain mental health. [source]

The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2008
Marianne Lamb RN
Abstract Objectives, The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. Inclusion criteria, This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. Search strategy, The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Methodological quality, Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data collection, Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data synthesis, Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. Results, A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. Conclusion, The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self. [source]

Nursing and midwifery management of hypoglycaemia in healthy term neonates

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 7 2005
Vivien Hewitt BSc(Hons) GradDipLib
Executive summary Objectives The primary objective of this review was to determine the best available evidence for maintenance of euglycaemia, in healthy term neonates, and the management of asymptomatic hypoglycaemia in otherwise healthy term neonates. Inclusion criteria Types of studies The review included any relevant published or unpublished studies undertaken between 1995 and 2004. Studies that focus on the diagnostic accuracy of point-of-care devices for blood glucose screening and/or monitoring in the neonate were initially included as a subgroup of this review. However, the technical nature and complexity of the statistical information published in diagnostic studies retrieved during the literature search stage, as well as the considerable volume of published research in this area, suggested that it would be more feasible to analyse diagnostic studies in a separate systematic review. Types of participants The review focused on studies that included healthy term (37- to 42-week gestation) appropriate size for gestational age neonates in the first 72 h after birth. Exclusions ,,preterm or small for gestational age newborns; ,,term neonates with a diagnosed medical or surgical condition, congenital or otherwise; ,,babies of diabetic mothers; ,,neonates with symptomatic hypoglycaemia; ,,large for gestational age neonates (as significant proportion are of diabetic mothers). Types of intervention All interventions that fell within the scope of practice of a midwife/nurse were included: ,,type (breast or breast milk substitutes), amount and/or timing of feeds, for example, initiation of feeding, and frequency; ,,regulation of body temperature; ,,monitoring (including screening) of neonates, including blood or plasma glucose levels and signs and symptoms of hypoglycaemia. Interventions that required initiation by a medical practitioner were excluded from the review. Types of outcome measures Outcomes that were of interest included: ,,occurrence of hypoglycaemia; ,,re-establishment and maintenance of blood or plasma glucose levels at or above set threshold (as defined by the particular study); ,,successful breast-feeding; ,,developmental outcomes. Types of research designs The review initially focused on randomised controlled trials reported from 1995 to 2004. Insufficient randomised controlled trials were identified and the review was expanded to include additional cohort and cross-sectional studies for possible inclusion in a narrative summary. Search strategy The major electronic databases, including MEDLINE/PubMed, CINAHL, EMBASE, LILACS, Cochrane Library, etc., were searched using accepted search techniques to identify relevant published and unpublished studies undertaken between 1995 and 2004. Efforts were made to locate any relevant unpublished materials, such as conference papers, research reports and dissertations. Printed journals were hand-searched and reference lists checked for potentially useful research. The year 1995 was selected as the starting point in order to identify any research that had not been included in the World Health Organisation review, which covered literature published up to 1996. The search was not limited to English language studies. Assessment of quality Three primary reviewers conducted the review assisted by a review panel. The review panel was comprised of nine nurses with expertise in neonatal care drawn from senior staff in several metropolitan neonatal units and education programs. Authorship of journal articles was not concealed from the reviewers. Methodological quality of each study that met the inclusion criteria was assessed by two reviewers, using a quality assessment checklist developed for the review. Disagreements between reviewers were resolved through discussion or with the assistance of a third reviewer. Data extraction and analysis Two reviewers used a data extraction form to independently extract data relating to the study design, setting and participants; study focus and intervention(s); and measurements and outcomes. As only one relevant randomised controlled trial was found, a meta-analysis could not be conducted nor tables constructed to illustrate comparisons between studies. Instead, the findings were summarised by a narrative identifying any relevant findings that emerged from the data. Results Seven studies met the inclusion criteria for the objective of this systematic review. The review provided information on the effectiveness of three categories of intervention , type of feeds, timing of feeds and thermoregulation on two of the outcome measures identified in the review protocol , prevention of hypoglycaemia, and re-establishment and maintenance of blood or plasma glucose levels above the set threshold (as determined by the particular study). There was no evidence available on which to base conclusions for effectiveness of monitoring or developmental outcomes, and insufficient evidence for breast-feeding success. Given that only a narrative review was possible, the findings of this review should be interpreted with caution. The findings suggest that the incidence of hypoglycaemia in healthy, breast-fed term infants of appropriate size for gestational age is uncommon and routine screening of these infants is not indicated. The method and timing of early feeding has little or no influence on the neonatal blood glucose measurement at 1 h in normal term babies. In healthy, breast-fed term infants the initiation and timing of feeds in the first 6 h of life has no significant influence on plasma glucose levels. The colostrum of primiparous mothers provides sufficient nutrition for the infant in the first 24 h after birth, and supplemental feeds or extra water is unnecessary. Skin-to-skin contact appears to provide an optimal environment for fetal to neonatal adaptation after birth and can help to maintain body temperature and adequate blood glucose levels in healthy term newborn infants, as well as providing an ideal opportunity to establish early bonding behaviours. Implications for practice The seven studies analysed in this review confirm the World Health Organisation's first three recommendations for prevention and management of asymptomatic hypoglycaemia, namely: 1Early and exclusive breast-feeding is safe to meet the nutritional needs of healthy term newborns worldwide. 2Healthy term newborns that are breast-fed on demand need not have their blood glucose routinely checked and need no supplementary foods or fluids. 3Healthy term newborns do not develop ,symptomatic' hypoglycaemia as a result of simple underfeeding. If an infant develops signs suggesting hypoglycaemia, look for an underlying condition. Detection and treatment of the cause are as important as correction of the blood glucose level. If there are any concerns that the newborn infant might be hypoglycaemic it should be given another feed. Given the importance of thermoregulation, skin-to-skin contact should be promoted and ,kangaroo care' encouraged in the first 24 h after birth. While it is important to main the infant's body temperature care should be taken to ensure that the child does not become overheated. [source]

Direct versus Indirect Veneer Restorations for Intrinsic Dental Stains

JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 2 2006
Article first published online: 25 APR 200
abstract Objective:, The purpose of this study was to examine the effectiveness of indirect and direct veneer restorations, particularly with regard to longevity and patient satisfaction. Materials and Methods:, This study evaluated the literature on randomized clinical trials comparing direct and indirect veneers on anterior teeth. The search strategy involved Medline and other databases and was followed by contacting authors to determine whether any additional published or unpublished studies were available. Relevant studies were assessed for factors such as quality of randomization, outcome assessment, and completeness of recall evaluation. Data from the studies were extracted by three independent reviewers using special forms. Authors were contacted for clarification and missing data. Study details such as dates, demographics of the sample, and outcomes were recorded. Results:, The electronic searches identified 29 clinical trials and 1 systematic review. Six of those were screened as potentially relevant to the review, but following a more detailed screening, only one study (Meijering and colleagues, 1998) met all of the inclusion criteria. In the 2-year recall of that study, the overall survival rates were 94% for porcelain, 90% for indirect composite, and 74% for direct composite veneers. The survival rate was higher when the incisal edge was reduced. Patient satisfaction rates were 93% for porcelain, 82% for indirect composite, and 67% for direct composite. Conclusion:, Very little reliable evidence compares the effectiveness of indirect versus indirect veneers. For an individual patient, the choice between the two options should take into account patient preference and the clinician's experience. [source]

Collateral Reports in the College Setting: A Meta-Analytic Integration

ALCOHOLISM, Issue 5 2009
Brian Borsari
Background:, The majority of research examining college drinking utilizes self-report data, and collateral reports have been used to verify participants' self-reported alcohol use. Methods:, This meta-analytic integration examined the correspondence of over 970 collateral and participant dyads in the college setting. Results and Conclusions:, Results indicated that there is little bias (mean difference) between collateral estimates of participant drinking and participant's self-report. A cumulative meta-analysis revealed that this (null) effect was stable and unlikely to be altered by subsequent research or the existence of unpublished studies. Analysis of the agreement between collaterals and participant estimates (measured by intraclass correlation coefficients; ICCs) revealed moderate levels of agreement (mean ICC = 0.501). Examination of predictors of both bias and agreement in collateral and participant reports indicates a possible intentional and protective underreporting on the part of the collaterals. Ways to reduce this bias are discussed along with the value of using collaterals to verify participant self-report in the college setting. [source]

Zinc Deficiency in Pregnancy and Fetal Outcome

NUTRITION REVIEWS, Issue 1 2006
Dheeraj Shah MD
Maternal zinc deficiency during pregnancy has been related to adverse effects on progeny, and there are data showing that mild to moderate zinc deficiency (as assessed by available indicators) is quite common in the developing world. Observational data relating zinc deficiency to adverse fetal outcome have produced conflicting results, mainly because of the lack of a valid indicator of zinc deficiency in pregnancy. Studies of human pregnancy and zinc supplementation, including those from developing countries, have failed to document a consistent beneficial effect on fetal growth, duration of gestation, and early neonatal survival. Preliminary results from unpublished studies in developing countries have also proven to be discouraging. However, recent data and some preliminary findings indicate a beneficial effect of maternal zinc supplementation on neonatal immune status and infant morbidity from infectious diseases, and there is also preliminary evidence that zinc supplementation may prevent congenital malformations (cleft lip/palate). With respect to neurobehavioral development, the evidence is conflicting, with only one study reporting a positive outcome. More research is required to assess the benefits of the large-scale introduction of zinc supplementation during pregnancy on congenital malformations, immune functions, neurobehavior, and overall neonatal survival in countries where zinc deficiency is a problem. Currently available information does not support the routine use of zinc supplementation to improve pregnancy outcome. [source]

Iron and Colorectal Cancer Risk: Human Studies

NUTRITION REVIEWS, Issue 5 2001
F.A.C.S., Richard L. Nelson M.D
Some reports have associated iron with cancer risk, particularly of the colorectum. This review will focus on the human studies that have investigated this association. Comparative studies were sought in which people with and without colorectal neoplastic lesions, either cancers or adenomatous polyps, were assessed for iron exposure. Iron exposure variables included dietary iron intake, iron vitamin supplementation, body iron stores as measured by ferritin or transferrin saturation, and gene status for hereditary hemochromatosis. Medline was searched for published reports using the key words iron, cancer, colon, rectum, ferritin, transferrin, and hemochromatosis. In addition, the Cochrane Library was searched for relevant studies and several authors were contacted to investigate their awareness of unpublished studies. Studies were categorized by study design and ranked for quality of innovation in design, sample size, and thoroughness of iron status ascertainment. Thirty-three studies were reviewed in 26 publications. Of the larger studies, approximately three-quarters supported the association of iron, in all three strata of exposure, with colorectal neoplasia risk. Because iron is broadly supplemented in the American diet, the benefits of iron supplementation need to be measured against the long-term risks of increased iron exposure, one of which may be increased risk of colorectal cancer. [source]

Genotoxic potential of xenobiotic growth promoters and their metabolites,

APMIS, Issue 2 2001
Review article
This paper reviews data reported in the literature as well as recent and unpublished studies from our laboratory on the metabolism and genotoxicity of the xenobiotic growth promoters 17,-trenbolone, melengestrol acetate and zeranol. In our metabolic study, the oxidative in vitro metabolites generated by hepatic microsomes from rats, bovine and humans were analyzed by HPLC and GC/MS. 17,-Trenbolone gave rise to at least 13 monohydroxylated products, whereas 12 mono- and dihydroxylated metabolites were obtained with melengestrol acetate and at least 5 with zeranol. The genotoxic potential of the parent compounds was studied using the following endpoints: induction of HPRT mutations in cultured V79 cells and of lacI mutations in E. coli; induction of micronuclei in V79 cells; and formation of DNA adducts in cultured primary rat hepatocytes. Negative results were obtained in most of these assay systems. Only the micronucleus induction was marginally positive with 17,-trenbolone and zeranol at near-cytotoxic concentrations. Commercial melengestrol acetate was found to contain an impurity causing apoptosis in V79 cells. The genotoxic potential of the numerous oxidative metabolites of the xenobiotic growth promoters remains to be studied. [source]