Good Quality Systematic Reviews Research Articles

ADVANCES IN NON-SURGICAL MANAGEMENT OF GONARTHROSIS: A SYSTEMATIC REVIEW

Objectives: Knee osteoarthritis (KOA) is typically the result of wear and tear andprogressive loss of articular cartilage and may eventually lead to disability. Treatment forKOA begins with conservative methods and progresses to surgical treatmentoptions when conservative treatment fails. This systematic review aims to highlight the latestadvancements in non-surgical interventions to improve the management of this commonmusculoskeletal disorder. Methods: A comprehensive search of sources available in both English and Frenchencompassing various databases such as PubMed, Google Scholar, and relevant medicaljournals in addition to recommendations provided by prominent organizations(EULAR, ACR, SFR, SOFMER, OARSI, ESCEO, NICE, PANLAR, AAOS). Inclusion criteria were good quality systematic reviews, meta-analyses, practice guidelinesexcludingsurgicalKOA treatment. Results:We thoroughly examined a large set of 545 articles and meticulously selected 117 for detailed analysis. This carefully selected set comprised randomized controlled trials, consensus statements, international guidelines, systematic reviews, meta-analyses, cohort studies, and reviews. Qualitative synthesis revealed widely approved nonpharmacological therapies such as information/education programs, weight loss, and physicalactivity. Most agreed on pharmacological therapies were oral and local NSAIDs, Paracetamol, and intra articular corticosteroid injection. Other treatment options were subject to controversy. Conclusion:Various options are available for the treatment of KOA. However, KOA remains a commonglobal health challenge, affecting millions and compromising the quality of life through pain, functional limitations, and associated morbidities. A comprehensive and personalized approach seems crucial in order to reduce pain, improve knee function over the long term.

Top 5 Research Studies of the month for Italian Primary Care Physicians: October 2023.

This monthly article provides a selection of summaries of the most relevant studies identified as POEMs (patient-oriented evidence that matters) for Italian primary care physicians. Amoxicillin is no more likely to cause a rash than any other antibiotic in children with infectious mononucleosis. According to a good quality systematic review and network meta-analysis, only a small number of randomized controlled trials, disappointing in overall quality, suggest that for managing neuropsychiatric symptoms in adults with dementia, risperidone has the best balance of effectiveness and adverse effects. In a rigorously conducted double-blind randomized controlled trial, adults with acute low back or neck pain treated with opioids had no benefit in pain relief as those treated with placebo. In a large study of more than 21,000 participants aged 60 to 84 years, taking 60,000 IU vitamin D each month slightly reduced their likelihood of experiencing a major cardiovascular event (number needed to treat = 172 over 5 years). A single screening colonoscopy had higher rates of participation than 5 years of fecal occult blood testing in a high-quality study in which patients were offered free screening with these two methods (84% vs 73%; p<0.001).

Tratamiento farmacológico en tiempos de incertidumbre: uso de la hidroxicloroquina/cloroquina en el tratamiento de COVID-19

Background and objectives: In this moments, of extreme gravity in which we find ourselves, and in the uncertainty face about the most effective treatment against COVID-19 disease and with the aim of find the evidence that support the chloroquine/hydroxychloroquine use recommendation to treat COVID-19 disease, a systematic review of published studies and RCT studies publishes until April 28, 2020 was carried out. Material and methodsA systematic search was carried out in PubMed with the keywords COVID-19 and their synonyms and hydroxychloroquine/chloroquine. The data selection and extraction was elaborated by two researchers, independently. The results were discussed with a Primary Care physicians clinical group and the results were synthesized using GRADE methodology. ResultsA good quality systematic review was found that includes articles with a high risk of bias. And 8 EC launched that will produce results beyond May 2020. ConclusionsAlthough the conclusions of the systematic review generate a low confidence in the results, and the clinical variables that show benefit are intermediate variables, the side effects are acceptable and could be minimized with the use of QT lengthening risk tools, so it is could make a weak recommendation in favor of the use of chloroquine/hydroxychloroquine in patients with mild-moderate stage COVID-19.

Therapeutic Facet Joint Interventions in the Lumbar Spine: An Economic Value Perspective.

In this narrative review, the current literature on therapeutic interventions for low back pain of facet joint etiology is assessed from an economic value perspective. The efficacy and economics of facet joint interventions in the treatment of lumbar back pain is a controversial topic. Trends show that facet joint interventions are becoming increasingly used, perhaps as physicians become more averse to treating chronic low back pain with opioids. With the emphasis on value-based spine care and changing reimbursement models, the perspective of rigorously evaluating the outcomes these interventions provide and the costs they incur is particularly relevant. Although the evidence is noted to be limited, most systematic reviews fail to demonstrate the therapeutic utility of intra-articular facet joint injections in low back pain because of high study heterogeneity. A few good quality studies and systematic reviews describe moderate evidence for the utilization of therapeutic medial branch blocks and radiofrequency neurotomies in alleviating facet joint pain. Consequently, there is a need for high-quality cost-effectiveness studies for facet joint interventions so that evidence-based and economically viable solutions can be used to optimize patient care at a societally affordable price.

Efficacy of Biofeedback for Medical Conditions: an Evidence Map.

Biofeedback is increasingly used to treat clinical conditions in a wide range of settings; however, evidence supporting its use remains unclear. The purpose of this evidence map is to illustrate the conditions supported by controlled trials, those that are not, and those in need of more research. We searched multiple data sources (MEDLINE, PsycINFO, CINAHL, Epistemonikos, and EBM Reviews through September 2018) for good-quality systematic reviews examining biofeedback for clinical conditions. We included the highest quality, most recent review representing each condition and included only controlled trials from those reviews. We relied on quality ratings reported in included reviews. Outcomes of interest were condition-specific, secondary, and global health outcomes, and harms. For each review, we computed confidence ratings and categorized reported findings as no effect, unclear, or insufficient; evidence of a potential positive effect; or evidence of a positive effect. We present our findings in the form of evidence maps. We included 16 good-quality systematic reviews examining biofeedback alone or as an adjunctive intervention. We found clear, consistent evidence across a large number of trials that biofeedback can reduce headache pain and can provide benefit as adjunctive therapy to men experiencing urinary incontinence after a prostatectomy. Consistent evidence across fewer trials suggests biofeedback may improve fecal incontinence and stroke recovery. There is insufficient evidence to draw conclusions about effects for most conditions including bruxism, labor pain, and Raynaud's. Biofeedback was not beneficial for urinary incontinence in women, nor for hypertension management, but these conclusions are limited by small sample sizes and methodologic limitations of these studies. Available evidence suggests that biofeedback is effective for improving urinary incontinence after prostatectomy and headache, and may provide benefit for fecal incontinence and balance and stroke recovery. Further controlled trials across a wide range of conditions are indicated.

Factors Associated With Risk of Neurologic Complications After Peripheral Nerve Blocks: A Systematic Review.

The onset of neurologic complications after regional anesthesia is a complex process and may result from an interaction of host, agent, and environmental risk factors. The purpose of this systematic review was examine the qualitative evidence relating to various risk factors implicated in neurologic dysfunction after peripheral nerve block (PNB). The MEDLINE, OVID, and EMBASE databases were primary sources for literature. Cochrane, LILACS, DARE, IndMed, ERIC, NHS, and HTA via Centre for Reviews and Dissemination (CRD; York University) databases were searched for additional unique results. Randomized controlled studies, case-control studies, cohort studies, retrospective reviews, and case reports/case series reporting neurologic outcomes after PNB were included. Relevant, good-quality systematic reviews were also eligible. Human and animal studies evaluating factors important for neurologic outcomes were assessed separately. Information on study design, outcomes, and quality was extracted and reviewed independently by the 2 review authors. An overall rating of the quality of evidence was assigned using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Relevant full-text articles were separated based on type (prospective, retrospective, and nonhuman studies). Strengths of association were defined as high, moderate, inconclusive, or inadequate based on study quality and direction of association. The evidence from 77 human studies was reviewed to assess various host, agent, and environmental factors that have been implicated as possible risks. Most of the available evidence regarding the injurious effects of the 3 cardinal agents of mechanical insult, pressure, and neurotoxicity was extracted from animal studies (42 studies). Among the risk factors investigated in humans, block type had a strong association with neurologic outcome. Intraneural injection, which seems to occur commonly with PNBs, showed an inconsistent direction of association. Measures meant to increase precision and ostensibly reduce the occurrence of complications such as currently available guidance techniques showed little effect on the incidence of neurologic complications. Recovery from neurologic injury appears to be worse in patients with pre-existing risk factors. Categorization and definition of neurologic complication varied among studies, making synthesis of evidence difficult. Also, a significant portion of the evidence surrounding neurologic injury associated with PNB comes from animal or laboratory studies, the results of which are difficult to translate to clinical scenarios. Of the human studies, few had an a priori design to test associations between a specific risk factor exposure and resultant neurologic sequelae. A few risk factor associations were identified in human studies, but overall quality of evidence was low. Much of the evidence for risk factors comes from animal models and case reports. The final neurologic outcome seems to represent the complex interaction of the host, agent, and the environment.

Nonpharmacologic, nonherbal management of menopause-associated vasomotor symptoms: an umbrella systematic review (protocol).

BackgroundVasomotor symptoms such as hot flashes and night sweats are a common concern of perimenopausal and postmenopausal women and are associated with a decreased quality of life. These symptoms can be effectively managed with hormone therapy, but safety concerns limit its use. Thus, understanding the effectiveness of nonpharmacologic therapies such as acupuncture or yoga is critical to managing these common symptoms in older women. Our review seeks to address the following question: In women with menopause-associated vasomotor symptoms, what are the effects on health-related quality of life, vasomotor symptoms, and adverse events of the following nonpharmacologic, nonherbal interventions as compared with any inactive control or active comparator: (a) acupuncture, (b) yoga, tai chi, and qigong, (c) structured exercise, and (d) meditation, mindfulness-based practices, and relaxation?MethodsWe describe a protocol for an umbrella review approach, supplemented by evaluating randomized controlled trials (RCTs) published after the most recent good-quality systematic review for each of the eligible interventions. Specific interventions were chosen based on current literature and with input from a technical expert panel and organizational stakeholders. We will conduct a thorough literature search and perform a quality assessment of potentially included systematic reviews and RCTs.DiscussionOur umbrella review, supplemented by an additional search for eligible RCTs, aims to synthesize existing evidence on the use of nonpharmacologic, nonherbal interventions to manage bothersome vasomotor symptoms in perimenopausal and postmenopausal women.Systematic review registrationPROSPERO CRD42016029335Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0232-6) contains supplementary material, which is available to authorized users.

Commentary: "Estrogenic and Anti-Androgenic Endocrine Disrupting Chemicals and Their Impact on the Male Reproductive System".

Commentary: "Estrogenic and Anti-Androgenic Endocrine Disrupting Chemicals and Their Impact on the Male Reproductive System".

Systematic Review and Meta-analysis of Psychotropics Versus Placebo or Other Psychotropics Used as Rapid Tranquilization for Aggression in Children and Adolescents with Mental Disorders

Introduction Aggression is common in children and adolescents on psychiatric units. Rates ofaggression are 27% to 78% on forensic adolescent units, and similar onnon-forensic units. Sometimes rapid tranquilization is needed for managing thisproblem – but no good quality systematic reviews exist for this population. Objectives Weplanned to do a systematic review of psychotropics compared to placebo or otherpsychotropics by any route used as rapid tranquilization in aggression in childrenand adolescents with any mental disorder. Aims The aimis to provide evidence based and generalisable knowledge. Methods The‘PICO’ is as follows: Populationis children and adolescents up to the age18 with aggression and a mentaldisorder; Interventionsare psychotropics by any route; Comparisonsare placebo or other psychotropics by any route; and Outcomes are efficacyand safety. Only RCTs are eligible. A comprehensive search is carried outof Medline, Embase, Psychinfo and other databases. Articles selection anddata extraction is carried out by two reviewers independently for reliability. Articles are assessed for quality. Meta-analysis is preferred if warranted byheterogeneity assessment; otherwise narrative synthesis will be done usingGRADE evaluation. Results Thereview is underway. The effect sizes would be as follows: for dichotomousoutcomes relative risk, absolute risk change and numbers needed; and forcontinuous outcomes mean difference or standardized mean difference. Thesewould be sensitivity analyzed. If meta-analysis were not warranted, thennarrative synthesis will be presented. Conclusions Conclusions will be drawn for relative efficacy and safety of thepsychotropics.

An Introduction of the Systematic Review and Meta-Analysis

Systematic reviews and meta-analysis represent a specific type of medical research in which an original article is a unit of analysis. These methods of research are essential tools in integrating scientific information, increasing the internal and external validity of the conclusions of original articles, and suggesting areas for future research. Meta-analysis is becoming popular because it can combine results from similar studies to calculate an overall estimate of a treatment effect. They are also necessary for the practice of evidence-based medicine and the medical decision making. However, conducting good quality systematic reviews is not easy and difficult to interpret. Since analysis of a data with meta-analysis is a relatively new field of research, many clinicians have not had the opportunity to learn about systematic review and meta-analysis systematically. An introduction of the rationale for carrying out meta-analysis will be helpful to the clinician in interpreting the results of metaanalysis.

Overview of evidence in prevention and aetiology of food allergy: a review of systematic reviews.

The worldwide prevalence of food allergy appears to be increasing. Early life environmental factors are implicated in the aetiology of this global epidemic. The largest burden of disease is in early childhood, where research efforts aimed at prevention have been focused. Evidence synthesis from good quality systematic reviews is needed. We performed an overview of systematic reviews concerning the prevention and aetiology of food allergy, retrieving 14 systematic reviews, which covered three broad topics: formula (hydrolysed or soy) for the prevention of food allergy or food sensitization; maternal and infant diet and dietary supplements for the prevention of food allergy or food sensitization and hygiene hypothesis-related interventions. Using the AMSTAR criteria for assessment of methodological quality, we found five reviews to be of high quality, seven of medium quality and two of low quality. Overall we found no compelling evidence that any of the interventions that had been systematically reviewed were related to the risk of food allergy. Updating of existing reviews, and production of new systematic reviews, are needed in areas where evidence is emerging for interventions and environmental associations. Furthermore, additional primary studies, with greater numbers of participants and objective food allergy definitions are urgently required.

Comparative Effectiveness of New Oral Anticoagulants and Standard Thromboprophylaxis in Patients Having Total Hip or Knee Replacement

Pharmacologic thromboprophylaxis reduces the risk for venous thromboembolism after total hip replacement (THR) or total knee replacement (TKR). New oral anticoagulants (NOACs), including direct thrombin inhibitors and factor Xa inhibitors, are emerging options for thromboprophylaxis after these procedures. To compare the benefits and risks of NOACs versus standard thromboprophylaxis for adults having THR or TKR. MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from January 2009 through March 2013. English-language systematic reviews. Two independent reviewers abstracted data and rated study quality and strength of evidence. Six good-quality systematic reviews compared NOACs with low-molecular-weight heparin (LMWH) for thromboprophylaxis after THR or TKR. Risk for symptomatic deep venous thrombosis, but not risk for death or nonfatal pulmonary embolism, was reduced with factor Xa inhibitors compared with LMWH (4 fewer events per 1000 patients). Conversely, the risk for major bleeding increased (2 more events per 1000 patients). Outcomes of dabigatran did not significantly differ from those of LMWH. Indirect evaluation of NOACs by common comparison with LMWH showed nonsignificantly reduced risks for venous thromboembolism with rivaroxaban compared with dabigatran (risk ratio [RR], 0.68 [95% CI, 0.21 to 2.23]) and apixaban (RR, 0.59 [CI, 0.26 to 1.33]) but increased major bleeding. New oral anticoagulants have not been compared with warfarin, aspirin, or unfractionated heparin. Head-to-head comparisons among NOACs were not available. Efficacy is uncertain in routine clinical practice. New oral anticoagulants are effective for thromboprophylaxis after THR and TKR. Their clinical benefits over LMWH are marginal and offset by increased risk for major bleeding. U.S. Department of Veterans Affairs.

Tutorial Lecture

A systematic review is a useful research method to answer research questions related to public health, making use of all relevant evidence. This evidence can for example include findings of observational studies, intervention studies, economic evaluations or qualitative studies. Important steps in a systematic review include collecting appropriate evidence to answer the question, appraising the quality of the evidence, and synthesizing the evidence. The results of good quality systematic reviews are useful for researchers, practitioners and policy makers. This tutorial will address why systematic reviews are important, how to do a systematic review and what kinds of systematic reviews are needed to inform decision and policy making.

Public health interventions in midwifery: a systematic review of systematic reviews.

BackgroundMaternity care providers, particularly midwives, have a window of opportunity to influence pregnant women about positive health choices. This aim of this paper is to identify evidence of effective public health interventions from good quality systematic reviews that could be conducted by midwives.MethodsRelevant databases including MEDLINE, Pubmed, EBSCO, CRD, MIDIRS, Web of Science, The Cochrane Library and Econlit were searched to identify systematic reviews in October 2010. Quality assessment of all reviews was conducted.ResultsThirty-six good quality systematic reviews were identified which reported on effective interventions. The reviews were conducted on a diverse range of interventions across the reproductive continuum and were categorised under: screening; supplementation; support; education; mental health; birthing environment; clinical care in labour and breast feeding. The scope and strength of the review findings are discussed in relation to current practice. A logic model was developed to provide an overarching framework of midwifery public health roles to inform research policy and practice.ConclusionsThis review provides a broad scope of high quality systematic review evidence and definitively highlights the challenge of knowledge transfer from research into practice. The review also identified gaps in knowledge around the impact of core midwifery practice on public health outcomes and the value of this contribution. This review provides evidence for researchers and funders as to the gaps in current knowledge and should be used to inform the strategic direction of the role of midwifery in public health in policy and practice.

Anestesia neuroaxial comparada à anestesia geral para procedimentos na metade inferior do corpo: revisão sistemática de revisões sistemáticas

JUSTIFICATIVA E OBJETIVOS: As revisoes sistematicas organizam dados da literatura, combinando os resultados dos estudos publicados com o objetivo de resolver conflitos na area do conhecimento medico descrevendo as intervencoes. O relato inadequado das revisoes sistematicas pode prejudicar sua credibilidade e interferir na qualidade de seus resultados. O objetivo deste estudo foi determinar a frequencia de revisoes sistematicas de boa qualidade que comparam a anestesia neuroaxial com a anestesia geral para procedimentos na metade inferior do corpo. METODO: Revisao sistematica de revisoes sistematicas, com variavel primaria sendo a frequencia de revisoes sistematicas de boa qualidade. As informacoes foram analisadas a partir dos seguintes bancos de dados: LILACS (janeiro de 1982 a dezembro de 2010), PubMed (janeiro de 1950 a dezembro de 2010), Cochrane Database of Systematic Review e Database of Abstracts of Reviews of Effects (volume 10, 2010), e SciELO (em dezembro de 2010). A qualidade das revisoes sistematicas foi determinada pelo Overview Quality Assessment Questionnaire. O calculo do tamanho da amostra demonstrou ser necessaria a analise de 8 revisoes sistematicas, considerando que a frequencia de revisoes sistematicas de boa qualidade foi de 5%, a precisao absoluta de 15% e o nivel de significância de 5%. RESULTADOS: Foram identificados 1.995 artigos. O processo de selecao eliminou 1.968 artigos. Foram lidos 27 artigos de revisoes sistematicas na integra, foram excluidos 9 devido a incompatibilidade com os criterios de inclusao, e 8 eram publicacoes duplicadas. Dez revisoes sistematicas foram analisadas quanto a sua qualidade. A frequencia de revisoes sistematicas de boa qualidade foi de 40% (4/10; IC 95% 9,6 a 70,4%). CONCLUSAO: A frequencia de revisoes sistematicas de boa qualidade foi de 40%.

Neuraxial Anesthesia Compared to General Anesthesia for Procedures on the Lower Half of the Body: Systematic Review of Systematic Reviews

Systematic reviews organize literature data by combining results from published studies in order to resolve conflicts in the area of medical knowledge describing the interventions. The inadequate reporting of systematic reviews can damage the credibility and interfere in the results' quality. The objective of this study was to determine the frequency of good quality systematic reviews comparing neuraxial anesthesia with general anesthesia for procedures on the lower half of the body. Systematic review of systematic reviews. Primary variable: The frequency of good quality systematic reviews. The information was analyzed from the following databases: LILACS (January 1982 to December 2010); PubMed (January 1950 to December 2010); The Cochrane Database of Systematic Review and Database of Abstracts of Reviews of Effects (volume 10, 2010); and SciELO (December 2010). The quality of systematic reviews was determined by the Overview Quality Assessment Questionnaire. The sample size calculation showed that it was necessary to analyze eight systematic reviews, taking into account that the frequency of good quality systematic reviews was 5%, an absolute precision of 15%, and a significance level of 5%. Were identified 1,995 articles. The selection process eliminated 1,968 articles. Twenty-seven articles of systematic reviews were read in full, 9 were excluded due to incompatibility with the inclusion criteria, and 8 were duplicate publications. Ten systematic reviews were assessed for their quality. The frequency of good quality systematic reviews was 40% (4/10; 95% CI 9.6 to 70.4%). The frequency of good quality systematic reviews was 40%.

The Transplant Library of Randomized Controlled Trials and Systematic Reviews

The Transplant Library of Randomized Controlled Trials and Systematic Reviews

Primary Care–Relevant Interventions to Prevent Falling in Older Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force

Falls among older adults are both prevalent and preventable. To describe the benefits and harms of interventions that could be used by primary care practitioners to prevent falling among community-dwelling older adults. The reviewers evaluated trials from a good-quality systematic review published in 2003 and searched MEDLINE, the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL from the end of that review's search date to February 2010 to identify additional English-language trials. Two reviewers independently screened 3423 abstracts and 638 articles to identify randomized, controlled trials (RCTs) of primary care-relevant interventions among community-dwelling older adults that reported falls or fallers as an outcome. Trials were independently critically appraised to include only good- or fair-quality trials; discrepancies were resolved by a third reviewer. One reviewer abstracted data from 61 articles into standardized evidence tables that were verified by a second reviewer. Overall, the included evidence was of fair quality. In 16 RCTs evaluating exercise or physical therapy, interventions reduced falling (risk ratio, 0.87 [95% CI, 0.81 to 0.94]). In 9 RCTs of vitamin D supplementation, interventions reduced falling (risk ratio, 0.83 [CI, 0.77 to 0.89]). In 19 trials involving multifactorial assessment and management, interventions with comprehensive management seemed to reduce falling, although overall pooled estimates were not statistically significant (risk ratio, 0.94 [CI, 0.87 to 1.02]). Limited evidence suggested that serious clinical harms were no more common for older adults in intervention groups than for those in control groups. Interventions and methods of fall ascertainment were heterogeneous. Data on potential harms of interventions were scant and often not reported. Primary care-relevant interventions exist that can reduce falling among community-dwelling older adults. Agency for Healthcare Research and Quality.

Systematic Review: Factors Associated With Risk for and Possible Prevention of Cognitive Decline in Later Life

Many biological, behavioral, social, and environmental factors may contribute to the delay or prevention of cognitive decline. To summarize evidence about putative risk and protective factors for cognitive decline in older adults and the effects of interventions for preserving cognition. English-language publications in MEDLINE, HuGEpedia, AlzGene, and the Cochrane Database of Systematic Reviews from 1984 through 27 October 2009. Observational studies with 300 or more participants and randomized, controlled trials (RCTs) with 50 or more adult participants who were 50 years or older, drawn from general populations, and followed for at least 1 year were included. Relevant, good-quality systematic reviews were also eligible. Information on study design, outcomes, and quality were extracted by one researcher and verified by another. An overall rating of the quality of evidence was assigned by using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. 127 observational studies, 22 RCTs, and 16 systematic reviews were reviewed in the areas of nutritional factors; medical factors and medications; social, economic, or behavioral factors; toxic environmental exposures; and genetics. Few of the factors had sufficient evidence to support an association with cognitive decline. On the basis of observational studies, evidence that supported the benefits of selected nutritional factors or cognitive, physical, or other leisure activities was limited. Current tobacco use, the apolipoprotein E epsilon4 genotype, and certain medical conditions were associated with increased risk. One RCT found a small, sustained benefit from cognitive training (high quality of evidence) and a small RCT reported that physical exercise helps to maintain cognitive function. The categorization and definition of exposures were heterogeneous. Few studies were designed a priori to assess associations between specific exposures and cognitive decline. The review included only English-language studies, prioritized categorical outcomes, and excluded small studies. Few potentially beneficial factors were identified from the evidence on risk or protective factors associated with cognitive decline, but the overall quality of the evidence was low. Agency for Healthcare Research and Quality and the National Institute on Aging, through the Office of Medical Applications of Research, National Institutes of Health.

Identifying Evidence-Based Work on Mental Health Promotion in Schools in Europe: An Interim Report on the DataPrev Project

This paper is an interim report on the schools element of the DataPrev project, one element of a wider project funded by the European Union which aims to increase the understanding and knowledge across Europe of evidence-based mental health promotion policy and practice by creating a database of mental health promotion and mental disorder prevention programmes, and producing policy and practice guidelines. The schools’ element of the project involves a search for both universal and targeted school based programmes in Europe which can be shown by robust criteria to have the likelihood of promoting mental health in schools, and attempts to identify the principles that support effective programmes. It includes a systematic search for existing reviews, using over 80 search terms to reflect the range of terminology used in the field across disciplinary and geographical boundaries. To date (about half way through the process) over 40 recent good quality systematic reviews have been identified, from which 16 successful evidence-based school mental health interventions have been identified. Most of these originate in the United States (US), some come from Australia and some from Europe itself. The key features of effective programmes so far identified include operating on several fronts at once (‘whole school’), developing skills in students and staff, involving learners, balancing universal and targeted approaches, and consistent implementation over a long period of time.