Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Improved iodine status is associated with improved mental performance of schoolchildren in Benin. Mild iodine deficiency is associated with elevated hearing thresholds in children in Benin Effects of iodine supplementation during pregnancy on child growth and development at school age. Effects of Yoga on Mental and Physical Health: A Short Summary of Reviews A new risk of bias checklist applicable to randomized trials, observational studies, and systematic reviews was developed and validated to be used for systematic reviews focusing on drug adverse events. A systematic review of effectiveness and cost-effectiveness of school-based identification of children and young people at risk of, or currently experiencing mental health difficulties. Urinary iodine excretion as a predictor of the iodine content of breast milk. Psychological and psychosocial interventions offered to forensic mental health inpatients: a systematic review Avoidable waste of research related to outcome planning and reporting in clinical trials Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach Financial Conflicts of Interest and Conclusions About Neuraminidase Inhibitors for Influenza Systematic review of effectiveness of universal self-regulation-based interventions and their effects on distal health and social outcomes in children and adolescents: review protocol
Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : BACKGROUND An adequate iodine supply in utero and shortly after birth is known to be crucial to an individual 's physical and mental development . The question of whether iodine supplementation later in life can exert a favorable influence on the mental performance of iodine-deficient population s was addressed in various studies , but with contradictory results . OBJECTIVE The aim of this study was to examine the effect of an improvement in iodine status on mental and psychomotor performance of schoolchildren ( 7 - 11 y ) who were moderately to severely iodine deficient . DESIGN The study , which was originally planned as a double-blind , r and omized , placebo-controlled intervention , was carried out in an iodine-deficient population of schoolchildren ( n = 196 ) in northern Benin . As the population began to have access to iodized salt during the 1-y intervention period , the study population was split post hoc-on the basis of urinary iodine concentrations-into a group with improved iodine status and a group with unchanged iodine status . Changes in mental and psychomotor performance over the intervention period were compared . RESULTS Children with increased urinary iodine concentrations had a significantly greater increase in performance on the combination of mental tests than did the group with no change in urinary iodine concentrations . CONCLUSIONS An improvement in iodine status , rather than iodine status itself , determined mental performance in this population , which was initially iodine deficient . These findings suggest a " catch-up " effect in terms of mental performance Objective : Elevated hearing thresholds have been demonstrated in population s afflicted by endemic cretinism as a result of severe iodine deficiency . However , data on the effects of less severe iodine deficiency on hearing thresholds in apparently normal children are scant . This study addresses the question whether there is a relationship among iodine variables , hearing and mental performance in a mildly iodine-deficient population . Design : A r and omized , placebo-controlled intervention trial with an observation period of 11 months . Setting : An iodine-deficient area in northern Benin . Subjects : A total of 197 school children , aged 7–11 y. Interventions : A total of 97 children received an oral dose of iodized oil , containing 540 mg I , while 100 children received a placebo . About 3–4 months after supplementation , the whole population began to have access to iodized salt .  Non-verbal mental tests were administered and biochemical indicators ( thyrotropin , free thyroxine , thyroglobulin and urinary iodine ) were measured at the beginning and the end of the study . Hearing was measured at the end of the study in both ears by pure-tone audiometry at seven frequencies . Results : In this mildly iodine-deficient child population children with higher serum thyroglobulin concentrations had significantly higher hearing thresholds in the higher frequency range ( ≥2000 Hz ) than children with lower serum thyroglobulin concentration . Moreover children with lower hearing thresholds performed significantly better on the mental tests used . Conclusions : Even when iodine deficiency is ‘ mild ’ , promotion of adequate iodine intake through salt iodization programs and other means remains crucial . Sponsorship : Nestlé Foundation , Lausanne , Switzerl and ; Wageningen University , Wageningen , The Netherl and s . European Journal of Clinical Nutrition ( 2001 ) 55 , Growth and development of 207 children ( 49 % males ; mean age 5.4 years [ SD 0.2 ] , range 4 to 7.3 years whose mothers received iodine during pregnancy , and children who received iodine first in their 2nd year , were examined in 1996 ; 192 children ( 49 % males ; mean age 6.5 years [ SD 0.2 ] , range 5.8 to 6.9 years ) whose mothers received iodine while pregnant were seen in 1998 . Children were from the southern part of China 's Xinjiang Province which has the lowest levels of iodine in water and soil ever recorded .  Head circumference but not height was improved for those who received iodine during pregnancy ( compared with those receiving iodine at age 2 ) and for those supplemented before the end of the 2nd trimester ( relative to those supplemented during the 3rd trimester ) . Iodine before the 3rd trimester predicted higher psychomotor test scores for children relative to those provided iodine later in pregnancy or at 2 years . Results from the test for cognitive development result ed in trend only differences between those children supplemented during pregnancy versus later . The results address the question of when maternal iodine supplements should begin in public health programs world wide . Findings may be relevant to the treatment of maternal and newborn thyroid deficiency in industrialized countries , particularly for those infants delivered before the end of the second trimester This report summarizes the current evidence on the effects of  yoga interventions on various components of mental and physical health , by focussing on the evidence described in review articles . Collectively , these review s suggest a number of areas where yoga may well be beneficial , but more research is required for virtually all of them to firmly establish such benefits . The heterogeneity among interventions and conditions studied has hampered the use of meta- analysis as an appropriate tool for summarizing the current literature . Nevertheless , there are some meta-analyses which indicate beneficial effects of yoga interventions , and there are several r and omized clinical trials ( RCT 's ) of relatively high quality indicating beneficial effects of yoga for pain-associated disability and mental health .  Yoga may well be effective as a supportive adjunct to mitigate some medical conditions , but not yet a proven st and -alone , curative treatment . Larger-scale and more rigorous research with higher method ological quality and adequate control interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct treatment that is relatively cost-effective , may be practice d at least in part as a self-care behavioral treatment , provides a life-long behavioural skill , enhances self-efficacy and self-confidence and is often associated with additional positive side effects OBJECTIVES The objective of the study was to develop and vali date an adequate tool to evaluate the risk of bias of r and omized controlled trials , observational studies , and systematic review s assessing drug adverse events . STUDY DESIGN AND SETTING We developed a structured risk of bias checklist applicable to r and omized trials , cohort , case-control and nested case-control studies , and systematic review s focusing on drug safety . Face and content validity was judged by three experienced review ers . Interrater and intrarater reliability were determined using 20 r and omly selected studies , assessed by three other independent review ers including one performing a 3-week retest . RESULTS The developed checklist examines eight domains : study design and objectives , selection bias , attrition , adverse events information bias , other information bias , statistical methods to control confounding , other statistical methods , and conflicts of interest . The total number of questions varied from 10 to 32 depending on the study design . Interrater and intrarater agreements were fair with Kendall 's W of 0.70 and 0.74 , respectively . Median time to complete the checklist was 8.5 minutes . CONCLUSION The developed checklist showed face and content validity and acceptable reliability to assess the risk of bias for studies analyzing drug adverse events . Hence , it might be considered as a novel useful tool for systematic review s and meta-analyses focusing on drug safety BACKGROUND Although school-based programmes for the identification of children and young people ( CYP ) with mental health difficulties ( MHD ) have the potential to improve short- and long-term outcomes across a range of mental disorders , the evidence -base on the effectiveness of these programmes is underdeveloped . In this systematic review , we sought to identify and synthesis e evidence on the effectiveness and cost-effectiveness of school-based methods to identify students experiencing MHD , as measured by accurate identification , referral rates , and service uptake . METHOD Electronic bibliographic data bases : MEDLINE , Embase , PsycINFO , ERIC , British Education Index and ASSIA were search ed . Comparative studies were included if they assessed the effectiveness or cost-effectiveness of strategies to identify students in formal education aged 3 - 18 years with MHD , presenting symptoms of mental ill health , or exposed to psychosocial risks that increase the likelihood of developing a MHD . RESULTS We identified 27 studies describing 44 unique identification programmes . Only one study was a r and omised controlled trial . Most studies evaluated the utility of universal screening programmes ; where comparison of identification rates was made , the comparator test varied across studies . The heterogeneity of studies , the absence of r and omised studies and poor outcome reporting make for a weak evidence -base that only generate tentative conclusions about the effectiveness of school-based identification programmes . CONCLUSIONS Well- design ed pragmatic trials that include the evaluation of cost-effectiveness and detailed process evaluations are necessary to establish the accuracy of different identification models , as well as their effectiveness in connecting students to appropriate support in real-world setting Endemic goitre has re-emerged in Thail and . This is particularly dangerous for children since iodine deficiency disorders ( IDDs ) might negatively influence their intellectual and mental development . In order to assess the situation , the iodine content of breast milk was determined and a method is proposed on how to monitor IDDs in lactating mothers later on . Seventy-five lactating women aged from 15 to 45 years , from 12 villages of 3 districts , namely Chumpae . Srichompu and Pupaman within the mountainous areas of Khon Kaen province , Northeast of Thail and were investigated . The breast milk from 46.7 per cent of mothers was found to be below recommended st and ards . In addition , 52.0 per cent of the women investigated had low urinary iodine excretion . The risk of women with low iodine excretion was 15 fold higher in comparison to women with sufficient iodine excretion to provide breast milk for their babies with insufficient iodine content . It is concluded that urinary iodine excretion can be used to monitor the IDDs in lactating mothers Objective To examine the evidence for the use of psychological and psychosocial interventions offered to forensic mental health in patients . Design CINAHL , MEDLINE , PsycINFO , ScienceDirect and Web of Science data bases were search ed for research published in English between 1 January 1990 and 31 May 2018 . Outcome measures Disturbance , mental well-being , quality of life , recovery , violence/risk , satisfaction , seclusion , symptoms , therapeutic relationship and ward environment . There were no limits on the length of follow-up . Eligibility criteria We included r and omised controlled trial ( RCT ) studies of any psychological or psychosocial intervention in an inpatient forensic setting . Pilot or feasibility studies were included if an RCT design was used . We restricted our search criteria to in patients in low , medium and high secure units aged over 18 . We focused on interventions considered applicable to most patients residing in forensic mental health setting s. Data extraction and synthesis Two independent review ers extracted data and assessed risk of bias . Results 17 232 citations were identified with 195 full manuscripts examined in detail . Nine papers were included in the review . The heterogeneity of the identified studies meant that meta- analysis was inappropriate . The results were presented in table form together with a narrative synthesis . Only 7 out of 91 comparisons revealed statistically significant results with no consistent significant findings . The most frequently reported outcomes were violence/risk and symptoms . 61 % of the violence/risk comparisons and 79 % of the symptom comparisons reported improvements in the intervention groups compared with the control groups . Conclusions Current practice is based on limited evidence with no consistent significant findings . This review suggests psychoeducational and psychosocial interventions did not reduce violence/risk , but there is tentative support they may improve symptoms . More RCTs are required with : larger sample sizes , representative population s , st and ardised outcomes and control group interventions similar in treatment intensity to the intervention . PROSPERO registration number CRD42017067099 Background Inadequate planning , selective reporting , and incomplete reporting of outcomes in r and omized controlled trials ( RCTs ) contribute to the problem of waste of research . We aim ed to describe such a waste and to examine to what extent this waste could be avoided . Methods This research -on- research study was based on RCTs included in Cochrane review s with a summary of findings ( SoF ) table . We considered the outcomes reported in the SoF tables as surrogates for important outcomes for patients and other decision makers . We used a three-step approach . ( 1 ) First , in each review , we identified , for each important outcome , RCTs that were excluded from the corresponding meta- analysis . ( 2 ) Then , for these RCTs , we systematic ally search ed for registration s and protocol s to distinguish between inadequate planning ( an important outcome was not reported in registries or protocol s ) , selective reporting ( an important outcome was reported in registries or protocol s but not in publications ) , and incomplete reporting ( an important outcome was incompletely reported in publications ) . ( 3 ) Finally , we assessed , with the consensus of five experts , the feasibility and cost of measuring the important outcomes that were not planned . We considered inadequately planned or selectively or incompletely reported important outcomes as avoidable waste if the outcome could have been easily measured at no additional cost based on expert evaluation . Results Of the 2711 RCTs included in the main comparison of 290 review s , 2115 ( 78 % ) were excluded from at least one meta- analysis of important outcomes . Every trial contributed to 55 % , on average , of the meta-analyses of important outcomes . Of the 310 RCTs published in 2010 or later , 156 were registered . Inadequate planning affected 79 % of these RCTs , whereas incomplete and selective reporting affected 41 % and 15 % , respectively . For 63 % of RCTs , we found at least one missing important outcome for which the waste was avoidable and for 30 % , the waste was avoidable for all important outcomes . Conclusions Most of the RCTs included in our sample did not contribute to all the important outcomes in meta-analyses , mostly because of inadequate planning or incomplete reporting . A large part of this waste of research seemed to be avoidable At the end of a long week in the office , you sink back into your chair , reflecting on some of the more memorable patients you cared for and counseled . Through gentle history taking , you discovered that urinary incontinence is the underlying cause of an elderly patient 's increasing social isolation . During a careful physical examination , you detected bruising on the torso of a woman with chronic headaches and began to explore the longst and ing abusive relationship between the woman and her alcoholic partner . You discontinued procainamide therapy in a 72-year-old man who had asymptomatic premature ventricular contractions after myocardial infa rct ion . To prevent bleeding from esophageal varices , you started -blocker therapy in a woman with long-st and ing cryptogenic cirrhosis and portal hypertension . In couples ' therapy , discussing the future quality of life of a middle-aged gay man with human immunodeficiency virus infection , you journeyed through emotionally intense dialogue about advance directives . You presented the risk factors for major and minor bleeding to a 39-year-old woman who was considering warfarin therapy because of recently diagnosed atrial fibrillation and valvular heart disease . You listened to , made diagnoses for , treated , advised , and comforted many patients . Yet there were some hiccoughs in your practice along the way . You stumbled while debating the pros and cons of breast cancer screening with a healthy 48-year-old woman who has been staying current with information on the Internet . You question ed the merits of a personalized walking program suggested to you by a motivated 66-year-old man with severe claudication . Explaining that you wanted to review the best current evidence on these issues , you resolved to address your uncertainties before these patients made their next office visits , in a week 's time . Sighing deeply , you acknowledge that you have little time to read . You subscribe to three journals , which you browse months after they arrive-either when your journal stack becomes precariously high or when your guilt is sufficiently motivational . You sometimes find the conclusions of individual articles conflicting or confusing . You know that some of the decisions and suggestions you made this week , specifically your decisions about stopping procainamide therapy and starting -blocker therapy and your advice about bleeding risks from anticoagulant therapy , were based on the best current research evidence [ 1 - 3 ] . On the other h and , your patients ' inquiries about breast cancer screening and exercise treatment for claudication highlight your need for a concise , current , rigorous synthesis of the best available evidence on each of these topics : in brief , a systematic review [ 4 , 5 ] . Incorporating Research Evidence into Clinical Decision Making The foregoing scenario is familiar to practitioners . In a typical week , we encounter patients with diverse problems ; exercise numerous clinical , interpersonal , and technical skills ; and make many decisions . The factors that affect these decisions and their outcomes are complex . For instance , each patient has unique sociodemographic characteristics , cultural circumstances , and personal preferences . Each physician has unique knowledge , experiences , and values . Moreover , practitioners and their patients make decisions within the context of a rapidly changing health care system that influences the availability , accessibility , and cost of diagnostic tests and therapies [ 6 ] . Timely , useful evidence from the biomedical literature should be an integral component of clinical decision making . If one treatment has been shown to be better than another , we need to know , so that we can recommend the treatment to the appropriate patients . The worldwide effort to develop new tests and treatments , and to determine their usefulness , has never been stronger , and our patients and their families expect us to be fonts of the knowledge that results from this effort [ 7 ] . Unfortunately , it is easy for current best research evidence to pass us by [ 8 ] . We may lack the time , motivation , and basic skills needed to find , critically appraise , and synthesize information , all of which we must do if we are to integrate the results of original studies into our practice . Fortunately , several potent methods are emerging that can greatly enhance our ability to interpret and apply research evidence ; foremost among them is the systematic review . This article begins a series in Annals that will examine systematic review s in detail and explore their many applications . Systematic review s represent the best chance that most practitioners will have to underst and and accurately apply the key signals arising from the robust and increasingly productive search for solutions to medical problems . A properly conducted systematic review faithfully summarizes the evidence from all relevant studies on the topic of interest , and it does so concisely and transparently . What Is a Systematic Review ? Systematic review s are scientific investigations in themselves , with pre-planned methods and an assembly of original studies as their subjects . They synthesize the results of multiple primary investigations by using strategies that limit bias and r and om error [ 9 , 10 ] . These strategies include a comprehensive search of all potentially relevant articles and the use of explicit , reproducible criteria in the selection of articles for review . Primary research design s and study characteristics are appraised , data are synthesized , and results are interpreted . When the results of primary studies are summarized but not statistically combined , the review may be called a qualitative systematic review . A quantitative systematic review , or meta- analysis , is a systematic review that uses statistical methods to combine the results of two or more studies . The term overview is sometimes used to denote a systematic review , whether quantitative or qualitative . Summaries of research that lack explicit descriptions of systematic methods are often called narrative review s. Review articles are one type of integrative publication ; practice guidelines , economic evaluations , and clinical decision analyses are others . These other types of integrative articles often incorporate the results of systematic review s. For example , practice guidelines are systematic ally developed statements intended to assist practitioners and patients with decisions about appropriate health care for specific clinical circumstances [ 11 ] . Evidence -based practice guidelines are based on systematic review s of the literature , appropriately adapted to local circumstances and values . Economic evaluations compare both the costs and the consequences of different courses of action ; the knowledge of consequences that are considered in these evaluations is often generated by systematic review s of primary studies . Decision analyses quantify both the likelihood and the valuation of the expected outcomes associated with competing alternatives . Differences between Systematic and Narrative Review s All review s , narrative and systematic alike , are retrospective , observational research studies and are therefore subject to systematic and r and om error . Accordingly , the quality of a review - and thus its worth-depends on the extent to which scientific review methods have been used to minimize error and bias . This is the key feature that distinguishes traditional narrative review s from systematic review s ( Table 1 ) . If a review is prepared according to the steps outlined in the right column of Table 1 , it is more likely to be systematic and to provide unbiased conclusions . If review methods approximate those found in the middle column of Table 1 , the article is more likely to be a narrative review , and the conclusions are less likely to be based on an unbiased summary of all relevant evidence . Table 1 . Differences between Narrative Review s and Systematic Review s Systematic review s are generated to answer specific , often narrow , clinical questions in depth . These questions can be formulated explicitly according to four variables : a specific population and setting ( such as elderly out patients ) , the condition of interest ( for example , hypertension ) , an exposure to a test or treatment ( such as pharmacologic management ) , and one or more specific outcomes ( such as cardiovascular and cerebrovascular events and mortality ) [ 12 ] . Thus , an example of a well-formulated , clinical ly relevant question is , Does pharmacologic treatment of hypertension in the elderly prevent strokes and myocardial infa rct ions or delay death ? If the question that is driving the review is not clear from the title , abstract , or introduction , or if no methods section is included , the paper is more likely to be a narrative review than a systematic review [ 13 ] . Most narrative review articles deal with a broad range of issues related to a given topic rather than addressing a particular issue in depth [ 9 ] . For example , a narrative review on diabetes ( such as that which might be found in a textbook chapter ) might include sections on the physiology and pathophysiology of carbohydrate , lipid , and protein metabolism ; the epidemiology of and prognosis associated with diabetes ; diagnostic and screening approaches ; and preventive , therapeutic , rehabilitative , and palliative interventions . Thus , narrative review s may be most useful for obtaining a broad perspective on a topic ; they are less often useful in furnishing quantitative answers to specific clinical questions . Narrative review s are appropriate for describing the history or development of a problem and its management . Narrative review s may better describe cutting-edge developments if research is scant or preliminary or if studies are very limited by flawed design or execution [ 13 ] . They may be particularly useful for discussing data in light of underlying theory and context . Narrative review s can draw analogies and can conceptually integrate two independent fields of research , such as Aims : With the increase in the number of systematic review s available , a logical next step to provide decision makers in healthcare with the evidence they require has been the conduct of review s of existing systematic review s. Syntheses of existing systematic review s are referred to by many different names , one of which is an umbrella review . An umbrella review allows the findings of review s relevant to a review question to be compared and contrasted . An umbrella review 's most characteristic feature is that this type of evidence synthesis only considers for inclusion the highest level of evidence , namely other systematic review s and meta-analyses . A methodology working group was formed by the Joanna Briggs Institute to develop method ological guidance for the conduct of an umbrella review , including diverse types of evidence , both quantitative and qualitative . The aim of this study is to describe the development and guidance for the conduct of an umbrella review . Methods : Discussion and testing of the elements of methods for the conduct of an umbrella review were held over a 6-month period by members of a methodology working group . The working group comprised six participants who corresponded via teleconference , e-mail and face-to-face meeting during this development period . In October 2013 , the methodology was presented in a workshop at the Joanna Briggs Institute Convention . Workshop participants , review authors and method ologists provided further testing , critique and feedback on the proposed methodology . Results : This study describes the methodology and methods developed for the conduct of an umbrella review that includes published systematic review s and meta-analyses as the analytical unit of the review . Details are provided regarding the essential elements of an umbrella review , including presentation of the review question in a Population , Intervention , Comparator , Outcome format , nuances of the inclusion criteria and search strategy . A critical appraisal tool with 10 questions to help assess risk of bias in systematic review s and meta-analyses was also developed and tested . Relevant details to extract from included review s and how to best present the findings of both quantitative and qualitative systematic review s in a reader friendly format are provided . Conclusions : Umbrella review s provide a ready means for decision makers in healthcare to gain a clear underst and ing of a broad topic area . The umbrella review methodology described here is the first to consider review s that report other than quantitative evidence derived from r and omized controlled trials . The methodology includes an easy to use and informative summary of evidence table to readily provide decision makers with the available , highest level of evidence relevant to the question posed Industry funding and author financial conflicts of interest may influence the production and synthesis of scientific evidence ( 1 ) . Associations with the pharmaceutical company developing and marketing a drug have been found to influence the design of trials ( 2 ) , the conduct of trials ( 3 ) , and the reporting of trial results ( 47 ) . Furthermore , financial ties and industry funding seem to result in greater rates of favorable conclusions in clinical trials examining new drugs ( 812 ) . Fewer studies have considered the potential influence of financial conflicts of interest on the synthesis of clinical evidence in systematic review s ( 13 , 14 ) . Neuraminidase inhibitors , which are used in the prophylaxis and treatment of seasonal and p and emic influenza , have been the subject of ongoing uncertainty about their specific clinical benefits ( 15 , 16 ) . This is the result of not only the continuing emergence of strains with unknown drug responses but also the increasing awareness in the medical community that , until recently , its knowledge of the safety and efficacy of these drugs has been incomplete ( 17 ) . Despite the abundance of clinical trials and publications on neuraminidase inhibitors , the details of many key trials had not been disclosed ( 18 , 19 ) . As a result , systematic review ers analyzing and synthesizing evidence on the effectiveness of these agents have faced incomplete information , unresolved discrepancies in the data , and a high risk of publication and reporting biases among the primary clinical trials ( 20 , 21 ) . This prompted extensive efforts to access complete records of all published and unpublished clinical trials from manufacturers , culminating in the publication of several review s on the basis of comprehensive clinical study reports and potentially changing the way systematic review s will be undertaken in the future ( 2227 ) . Review s of neuraminidase inhibitors exhibit wide variation in their conclusions , ranging from strong endorsements of the use of these agents in the prophylaxis and treatment of influenza ( 28 , 29 ) to more conservative assessment s question ing the evidence on the drugs ' safety and efficacy ( 15 , 30 ) . The reasons for this discordance in review conclusions are likely multifactorial and may be related in part to the manner in which evidence is accessed , synthesized , and presented ( 23 , 27 ) , both in terms of the numerical results and the authors ' emphasis and interpretation ( 31 , 32 ) . Our aim was to determine whether there is an association between financial conflicts of interest and the favorable presentation of evidence in systematic review s on the use of neuraminidase inhibitors for the prophylaxis and treatment of influenza . Methods Data Sources Systematic review s were identified in PubMed , PubMed In Process , EMBASE , and the Cochrane Data base of Systematic Review s. Search es were done using the keywords influenza , neuraminidase inhibitors , oseltamivir , zanamivir , peramivir , and laninamivir . Articles were retrieved if the search terms appeared in the title or abstract or were included as data base-specific keywords . In PubMed and EMBASE , search es were also constrained to review publication types . We limited our search to English- language articles published since 1 January 2005 . These articles were manually review ed to identify those that focused on the use of neuraminidase inhibitors for influenza prophylaxis or treatment ( such as excluded articles primarily about drug development or other manufacturing processes ) . We selected all review s that used a systematic search protocol , which we defined as the inclusion and reporting of an explicit search strategy , including reasons for subsequent exclusion of articles . The final search es were done on 26 May 2014 . Cochrane review s are periodically up date d to incorporate new evidence , and the results and conclusions are resynthesized as indicated . The authors of these review s are typically different , and there may be differences in the methods as well as the results and language of the review . These up date d review s were included separately . Other Cochrane review s are occasionally rewritten by a subset of the authors for publication in medical journals as abridged versions to increase dissemination . These reports have separate peer review s and are prepared on the basis of a selection of the complete results . We considered these review s separately as well but also did a sensitivity analysis in which they were combined with the original Cochrane review s. Data Extraction Financial conflicts of interest were identified for all authors of the review s and included affiliations with or funding from the pharmaceutical company manufacturing any of the neuraminidase inhibitors under review . We defined financial conflicts of interest as employment , the funding of grants paid to an author or an author 's research group , and the funding of medical writers for the systematic review . These financial conflicts of interest were identified using information about affiliations or funding listed in the systematic review s , as well as in any other articles published by one of the authors during the 3 years before the publication of the index systematic review . In addition , we search ed authors ' personal and institutional Web sites ; lists of disclosures from GlaxoSmithKline ( Research Triangle Park , North Carolina ) and Roche Pharmaceuticals ( Basel , Switzerl and ) ; and performed Web search es combining the names of the authors , drugs , and pharmaceutical companies to identify any additional information about financial relationships . Details of the specific financial conflicts of interest identified for each author are listed in Appendix Table 1 . Appendix Table 1 . Financial Conflicts of Interest Among Authors of the Systematic Review s For each systematic review , we recorded whether prophylaxis or treatment was assessed , the forms of evidence to be included ( such as r and omized , controlled trials and observational studies ) , the specific clinical outcomes assessed , the population s examined , and whether meta-analyses were done . We also examined whether the review s included information about the validity or quality of the primary literature . In particular , we recorded whether there were statements addressing nonpublication of primary studies or publication bias , including tests done by the review ers to assess for bias in meta-analyses ( such as the Egger or Begg test [ 33 , 34 ] ) , difficulty in accessing comprehensive study data , and the prevalence or role of industry in conducting and funding the primary studies . Data Analysis Two investigators were provided with redacted copies of each review that did not include the review s ' authors , their affiliations , or information on financial conflicts of interest . These versions also did not contain the journal name , journal formatting , or the article 's acknowledgments or references . The investigators independently evaluated the review s and classified the prophylaxis and treatment assessment s as favorable or not favorable toward the use of neuraminidase inhibitors . They were instructed to do this grading on the basis of the entirety of the review text without restriction to conclusions or recommendations made in any specific section of the review , thus allowing them to take into account the emphasis and interpretation of the authors throughout the review . The agreement between the investigators was strong at 86 % ( Cohen , 0.72 ; P < 0.001 ) . Disagreements were resolved by a third investigator using the same redacted copies . Descriptive analyses were done to examine the associations between financial conflicts of interest and the grading of the systematic review s. A sensitivity analysis excluding the summary review s was done to further examine this association . We also assessed the association between financial conflicts of interest and the inclusion of statements addressing the validity or quality of the primary evidence . Role of the Funding Source This study was funded by the Australian National Health and Medical Research Council . The funding source had no role in the design and conduct of the study , analysis of the results , or the decision to su bmi t the manuscript for publication . Results We identified 827 published articles across the 4 data bases using the specified search criteria , with 26 systematic review s included in the final cohort ( Figure ) . Thirteen review s examined prophylaxis and 24 examined treatment of influenza , accounting for 37 distinct assessment s ( Appendix Table 2 ) . In terms of review methods , 7 were Cochrane systematic review s and 19 conducted and reported a meta- analysis ( 73 % ) . The evidence inclusion criteria were limited to r and omized , controlled trials for 14 of the systematic review s ( 54 % ) , and 5 included evidence from clinical study reports or patient-level data . The main population s examined were healthy adults ( 18 of 26 systematic review s ) , children ( 13 of 26 ) , and hospitalized patients ( 6 of 24 ) . The outcome measures for prophylaxis assessment s included influenza-like illness and laboratory-confirmed influenza . For the treatment assessment s , the outcomes were illness duration , influenza-related complications , hospitalization , and mortality , mostly in combination . Five review s were up date s of previous Cochrane review s , and 3 were summary review s based on Cochrane review s. Figure . Summary of evidence search and selection . Eligible systematic review s included those with outcomes related to the prophylaxis or treatment of influenza . Appendix Table 2 . Characteristics of Systematic Review s Examining Prophylaxis and Treatment Outcomes for Neuraminidase Inhibitors Association Between Financial Conflicts of Interest and Favorable Assessment s Seven of the 26 systematic review s ( 27 % ) , corresponding to 8 of the 37 assessment s ( 22 % ) , were associated with a financial conflict of interest ( Appendix Table 1 ) . We identified financial conflicts of interest in publications other than the index systematic review in 2 cases , and no additional Background Growing evidence suggests that childhood and adolescence self-regulation contributes to multiple health , educational and social outcomes . Considering the potential impact of self-regulation skills on improved life chances in conjunction with evidence suggesting that self-regulation can be modified by interventions , there is a need to identify interventions which are most effective in improving childhood and adolescence self-regulation . The present systematic review was design ed to determine the effectiveness of universal interventions focused on enhancing the  self-regulation of children and adolescents . As secondary outcomes , we will also examine the effectiveness of such interventions on distal health and social outcomes . Methods Eligible studies include r and omised controlled trials ( including cluster r and omised trials ) reporting on universal interventions design ed to improve self-regulation in childhood and adolescence ( age 0–19 years ) . The following data bases will be search ed for peer- review ed publications using an iterative search strategy : Medline , PsycINFO , EMBASE , ERIC , CINAHL Plus , British Education Index , Child Development & Adolescent Studies and CENTRAL without applying language or date filters . Additionally , reference lists and citations of included studies will be search ed for eligible studies . A 10 % proportion of the total titles and abstract s will be r and omly selected and screened independently by two review ers ( AP and DH ) . Results will be compared to ensure less than 5 % discrepancy , followed by screening of all results by one review er ( AP ) . Full-text review and data collection will be independently performed by two review ers . Any discrepancies will be solved by mutual discussion , and if unresolved , a third review er ( RV ) will be consulted . Meta- analysis will be conducted to quantify trial effects , if the data is sufficiently homogenous to allow quantitative synthesis . Otherwise , results will be described narratively . Discussion The evidence derived from the systematic review will strengthen the evidence base to inform planning of effective interventions targeting self-regulation skills in childhood and adolescence . This will benefit policy makers , academicians , research ers , health professionals , and also , young people who will benefit from policy and interventions informed by this review . Systematic review registration CRD42016047661
Thus , regardless of study design , iodine deficiency had a substantial impact on mental development .
Several review s and meta-analyses have examined the effects of iodine on mental development .
None focused on young children , so they were incomplete in summarizing the effects on this important age group .
The current systematic review therefore examined the relationship between iodine and mental development of children 5 years old and under .