Cochrane News

Subscribe to Cochrane News feed
Updated: 9 hours 21 min ago

Provide feedback to help plan the Cochrane Convenes programme

Mon, 07/19/2021 - 15:20

Have your say on the Cochrane Convenes programme by filling in a short questionnaire

Cochrane Convenes is an online event hosted by Cochrane and co-organized with the World Health Organization and the COVID-19 Evidence Network to support Decision making (COVID-END) in October 2021. 

Drawing on experiences of the COVID-19 pandemic, the inaugural Cochrane Convenes will bring together leaders across the world to explore and then recommend the changes needed in evidence synthesis to prepare for and respond to future global health emergencies. It will also engage a larger global community of evidence producers and users in conversation via social media and other parallel activities.

In order to help us plan the programme, we want to learn from your experiences over the past 18 months. Please can we ask you to respond to this short questionnaire by 9 August. It will take about 10 minutes. You will remain anonymous. 

We will share responses and more information on how you can get involved in this opportunity in due course.  

Monday, July 19, 2021

Get up, stand up: new review looks at reducing sedentary behaviour in older adults

Thu, 07/08/2021 - 18:23

The ABC’s recent documentary series Old people’s home for 4 year olds surprised many by becoming a runaway ratings success. It attracted more viewers than Masterchef and took out an international Emmy Award to boot. It’s the first time the lives of lonely older Australians struggling with isolation, health and mental health issues have been the subject of so much public interest and attention. For Cochrane author Dr Paul Gardiner, this represents a welcome development.

‘One of the great public health successes of the twentieth century was increasing people’s lifespan,’ Paul says, ‘Now we really need a greater focus on the health and quality of life of older people throughout those additional years. To date, in many ways, they’ve been a largely forgotten population.’

Paul has long been interested in the well-being of older people, and believes understanding and addressing the impact of sedentary behaviour is one of the keys to delivering better health outcomes. As part of his broader research program, he recently co-authored a new Cochrane review on interventions for reducing sedentary behaviour in community‐dwelling older adults

‘This is the first review of interventions specifically targeting older people living in the community,’ he explains. ‘This is especially important because while we often hear concerns about children’s screen time or office workers sitting for too long at their desks, older adults are actually the most sedentary segment of society—they spend over 80 percent of their waking day sitting. At the same time, increasing evidence is telling us that sedentary behaviour is detrimental to their physical and mental health. Among other things, it’s linked with depression, chronic diseases, frailty, social isolation and premature death.’ 

It’s worth noting that sedentary behaviour is often confused with inactivity but is actually distinctly different. The former involves sitting or reclining while awake—think watching TV for long periods—while inactivity is regarded as too little exercise/not meeting physical activity guidelines. So for example, you might meet physical activity guidelines by doing an hour of moderate intensity activity each day, but you could still be sitting for very long periods as well. 

Key findings reflect lack of research, data and diversity 

‘Having weighed up the latest evidence for this review, our main finding was disappointing but not unexpected,’ Paul says. ‘In a nutshell, our conclusion was that we simply don’t have enough research in this area, and need more and better studies to build our evidence base.’ 

‘Overall I think this reflects that research in this area has often focused on younger populations, and that older people have largely been a neglected part of the population until recently, and that’s compounded by the fact the data we have on sitting time has only been gathered from as recently as 2000 onwards. So when we think about some of those big population cohort studies that have data from across 50 or 60 years, none of them ask about sitting time or sedentary behaviours across lifetimes and we don’t know if there are critical periods when it matters more how sedentary we are or if the impacts on health are accumulated. We’ll have to wait another few decades to get the kind of cumulative data we really need.’ 

‘For this latest review, we identified only seven relevant studies with 397 adults aged over 60—predominantly white, female and all from high-income countries. We really need to see future studies recruiting much larger and more varied global samples in terms of age, gender, ethnicity, and socioeconomic background. And within high-income countries, we need to recruit people from different cultural groups.’ 

Intervention-wise, the majority of studies looked at ways to help change sedentary behaviour through a combination of behaviour change techniques and strategies that included information, education, counselling and goal setting. Some used wearable technology and apps that record behaviour, others included prompts, text messages and phone calls. None of the studies looked at changes to the natural, built, home or social environment, or making changes at policy level.

‘Given the various limitations in terms of the size and quality of the studies, we can’t draw any definitive conclusions about whether these interventions are effective in changing sedentary behaviour at this stage,’ Paul says. ‘The evidence suggests they may reduce sedentary time slightly, but it’s unclear whether they have an impact on physical and mental health.’

 

So what’s next?

‘The need for higher-quality randomised controlled trials assessing the impact of interventions is clear,’ Paul says. ‘We recommend that future studies use more device-based measures, with devices that recognise posture and can distinguish between sitting, standing or lying down. There needs to be greater consistency and accuracy around what’s measured, recorded and assessed. We also need accurate assessments of individual behaviours like TV viewing time as there is some evidence that not all behaviours have the same impacts on health.’

‘Throughout Covid lockdowns we’ve seen older people embracing FaceTime, Zoom and other apps to communicate with family and friends, and research suggests that older people will embrace technology if they're trained and understand how to use it. If we can encourage this and address access and equity considerations, hopefully technology will provide new avenues for effective interventions, research and data collection.’

‘With these developments on the horizon and more relevant studies currently underway, hopefully we'll be in a much better position to make more conclusive recommendations when it’s time to update this latest Cochrane review. In the meantime, here’s hoping the next series of Old people’s home for 4 year olds will provide top tips and information on the importance of reducing sitting time—for all the young and old alike.'

Approaches sedentary behaviour interventions take to decreasing or breaking-up prolonged sitting time include:

  • Providing information: interventions could be used to educate people on the benefits of decreasing their overall sedentary time and breaking up prolonged sedentary periods, by using consultations/interviews, reviewing their own behaviour (self-monitoring by diary), or using a monitor to detect sedentary behaviour that provides feedback to identify times when prolonged sitting could be reduced.
  • Prompting: real-time behaviour prompts using wearable sensor and mobile technology that detects prolonged sedentary periods and prompts the individual to rise and move. Less frequent reminders by email and phone messages may act as a less regular prompt system.
  • Environmental restructuring: interventions may alter indoor or outdoor spaces to attempt to decrease individuals’ sedentary time. More specifically, home or care setting layout changes might be considered in order to encourage individuals to sit less. Standing tables and perching stools rather than comfortable seats are some other potential examples of this.
  • Challenge to cultural and social norms: it’s culturally and socially acceptable in many places to expect older adults to sit. It’s considered important to offer seats to older adults, such as on public transport. Friends and family often start doing household jobs and tasks for older people rather than them being encouraged to be active and continue doing these activities. There is also a tendency for a risk-averse culture around older adults, with a perception that sitting is safe and that standing might lead to a fall. Some interventions might challenge these cultural norms by educating older adults, family members or carers, or changing the perception of the place of older adults and active ageing in society.

Images: Old People's Home for 4 Year Olds courtesy of the ABC (home page feature photo), Paul Gardiner (pictured above)

Words: Shauna Hurley (Originally posted on Cochrane Australia) 

Additional Resources: 

Monday, July 12, 2021

Launch of Cochrane Cameroon celebrated

Wed, 07/07/2021 - 13:57

The launch of Cochrane Cameroon was officially celebrated on 30 June from its base at the Hôpital Central de Yaoundé.

At the launch Cochrane Cameroon highlighted its commitment to promoting evidence-based healthcare policy and practice; translation of research to policy and practice; advocating for evidence to promote access and equity to healthcare; effective collaboration, and, strengthening capacity for conducting and using systematic reviews.

"Cochrane Cameroon will play an important role in developing a critical mass of those who understand the role of evidence in improving healthcare," said Co-Director Pierre Ongolo-Zogo.

Cochrane activities in Cameroon have been underway for a number of years with collaborations working to produce high-quality, Africa-relevant reviews (particularly in HIV/AIDS, Tuberculosis and Malaria) and to support their use in policy and practice through stakeholder engagement and capacity building. 

“There have been Cochrane activities in Cameroon for a long time especially in author training and development,” said Lawrence Mbuagbaw Co-Director of Cochrane Cameroon. "Reviews by Cameroonian authors especially on HIV/AIDS have informed national and international guidelines, and impacted on the lives of people living with HIV. This launch is a huge step forward in our commitment to developing the evidence ecosystem in Cameroon."

Cochrane Cameroon has also been part of Cochrane Africa since its inception. This was initially an informal network established in 2007, created to build on the strong track record and to enhance and expand activities.  Cochrane Africa was officially launched at the Global Evidence Summit in Cape Town in 2017 with a vision to increase the use of best evidence to inform healthcare decision making in sub-Saharan Africa.

Cochrane Africa consists of regional centres including a Southern and Eastern Africa Hub, West Africa Hub and Francophone Africa Hub, and co-ordinating centre at Cochrane South Africa. Cochrane Cameroon focuses on Francophone African countries.

The launch of Cochrane Cameroon follows on the launch of Cochrane Kenya on 8 June. The increased presence of Cochrane in sub-Saharan Africa means the increased conduct of relevant reviews based on priority setting, identification of research gaps, and regional needs with the overall aim of improving health outcomes in Africa.

"Cochrane Cameroon will build on an important Cochrane goal of ensuring far more representation in Africa," said Charles Shey Wiysonge, Cochrane South Africa Director.

Monday, July 12, 2021

Cochrane’s Editor in Chief, Karla Soares-Weiser, introduces Cochrane Convenes

Tue, 07/06/2021 - 19:39

Preparing for and responding to global health emergencies: what have we learnt from COVID-19?

In this interview, Dr Karla Soares-Weiser introduces Cochrane Convenes, a virtual event that Cochrane is organizing from 5-8 October 2021. Cochrane Convenes will bring together key thought leaders from around the world to discuss the COVID-19 evidence response and develop recommendations to help prepare for and respond to future global health emergencies. 

Tell us about Cochrane Convenes.

Cochrane is co-organizing this event with the World Health Organization (WHO) and the COVID-19 Evidence Network to support Decision making (COVID-End). Our objective is to bring together leaders from a diversity of disciplines and perspectives from across the world to explore and recommend the changes needed in evidence synthesis to prepare for and respond to future global health emergencies.

One of the outputs will be an Action Plan with recommendations to be presented to policy makers at the next World Health Assembly. Cochrane will also use the Action Plan to inform our own strategy and response to global health priorities and to advocate for change within the wider evidence synthesis community. 

Why now?

“If not now, when?” The last 18 months have shown us the importance of collaboration, but we have also seen an increase in the amount of published research and how this may have contributed to misinformation and the politicization of health decision making as part of the infodemic. Evidence synthesis is more important than ever, but we need to understand the challenges to identify opportunities to respond better in the future. We know that the next pandemic is not a hundred years away. There are also longer-term crises to address, which have major impacts on people’s health, including climate change and inequity. The COVID-19 pandemic has highlighted the importance of challenging global inequality. 

Why Cochrane?

The response to COVID-19 has emphasized the need for evidence to support decisions in health and social care. Cochrane has a wealth of expertise in preparing and maintaining evidence syntheses and our global community was central in our ability to respond to this crisis. Our unique perspective places us well to host these discussions. As a global community of evidence producers, we know we need to support WHO and its member states with the best possible evidence and guidance, to ultimately ensure that local decision-makers and frontline healthcare professionals have the information they need. Our collective challenge is to find the best way to do this.

What themes will Cochrane Convenes  address?

It will be an opportunity to reflect on how the evidence community responded to the pandemic, and how evidence was shared and used in decision making. Perhaps most importantly, we will also discuss what worked and did not work - relating to both primary and secondary research - and what we should keep or change to make sure the world is better prepared to respond to future health emergencies.

Who is Cochrane Convenes for? 

The inaugural event will be organized into a series of invitation-only thematic roundtables, where recommendations will be discussed and developed, with some plenary sessions and personal experiences and stories from senior health professionals working on the frontline during the pandemic. We aim to include researchers; policy makers; and funders of research, primarily – because we hope the learnings and reflections bought about by this event will influence their decisions and ways of working in the future. We will also involve civil society and the public as the ultimate beneficiaries of good research and policy making – they will also help shape the agenda of this event and, in time, help hold the professionals to account.

What do you hope to achieve?

We want to create an environment for collaboration and the sharing of ideas on how we can be better prepared and aligned for future health emergencies. This support and advocacy will help build on strategic priorities but also identify ways that we can practically prepare – for example, identifying evidence gaps to inform future research as well as maintaining a database of evidence syntheses that can be available when needed . Awareness, advocacy and availability of high-quality and timely evidence will support a better response worldwide to inform improved health outcomes for all people. From Cochrane’s perspective, we will embed what we learn in our future organizational strategy.

Monday, July 12, 2021

Communicating to the public about vaccines and using digital strategies to promote vaccine uptake: information for planners and implementers

Thu, 07/01/2021 - 15:41

Based on evidence from systematic reviews, Cochrane Effective Practice and Organisation of Care (EPOC) has prepared three information leaflets for health systems planners and implementers involved in developing vaccine communication strategies. The leaflets are underpinned by systematic reviews from Cochrane and other sources and include this qualitative evidence synthesis: Healthcare worker's perceptions and experiences of communicating with people over 50 years of age about vaccination, which published today in the Cochrane Library.

The reviews underlying these leaflets include studies carried out prior to the COVID-19 pandemic. However, they include important information that has relevance for implementers rolling out vaccines for COVID-19. With countries at different stages of the COVID-19 vaccine rollout, the leaflets provide timely guidance for decision making.

The first leaflet provides prompts and questions for planners implementing strategies to improve vaccination communication between healthcare workers and older adults. The leaflet is based on the findings of a review of qualitative research published today by Cochrane EPOC, and produced within the VITAL (Vaccines, Infectious Diseases in the Ageing Population) consortium. “The review suggests a number of issues that implementers should consider, including the potential tension between the public health goal of increasing vaccine uptake and the goal of supporting informing vaccination choices by individuals,” says Claire Glenton, review author and EPOC editor at the Norwegian Institute of Public Health.

EPOC staff have also prepared two additional leaflets for the OECD’s COVID-19 Global Evaluation Coalition. One of these leaflets presents prompts and questions for planners implementing communication strategies for all target groups, including parents, older adults and healthcare workers and is based on four systematic reviews of qualitative research. The leaflet encourages planners to consider a range of factors, including people’s concerns and misconceptions about the disease and the vaccine; and the extent to which the information they are providing is transparent, timely and understandable, and accessible to hard-to-reach groups.



The third leaflet presents what we know about the effectiveness of digital strategies to promote vaccine uptake and summarises evidence from four systematic reviews on this topic. This leaflet illustrates that despite these strategies being used widely, the evidence is fragmented and shows mixed results.

Governments worldwide are currently undertaking or planning the rollout of COVID-19 vaccines, and some are starting to review their progress and refine their communication efforts to promote vaccine uptake.

Communication to the public is an important part of these and other vaccination strategies. Simon Lewin, review author and Joint Coordinating Editor of EPOC at the Norwegian Institute of Public Health and the South African Medical Research Council noted that, “Cochrane has been systematically assessing evidence about vaccine communication for a number of years. This remains a topic area that does not receive the attention it deserves from implementers or researchers. We hope that these leaflets will help implementers to better plan vaccination communication strategies in their setting”.

Funding sources
One of the contributing reviews was undertaken within the Vaccines, Infectious Diseases in the Ageing Population (VITAL) consortium. For more information, see https://vital-imi.eu/
Two of the briefs were commissioned and funded by the Evaluation Department of the Norwegian Agency for Development Cooperation (Norad).

Tuesday, July 20, 2021

2020 Journal Impact Factor for Cochrane Database of Systematic Reviews is 9.266

Wed, 06/30/2021 - 14:12

The 2020 Journal Citation Report (JCR) has just been released by Clarivate Analytics, and we are delighted to announce that Cochrane Database of Systematic Reviews (CDSR) Journal Impact Factor is now 9.266. This is an increase on the 2019Journal Impact Factor, which was 7.890.

The CDSR Journal Impact Factor is calculated by taking the total number of citations in a given year to all Cochrane Reviews published in the past 2 years and dividing that number by the total number of Reviews published in the past 2 years. It is a useful metric for measuring the strength of a journal by how often its publications are cited in scholarly articles.

Some highlights of the CDSR 2020 Journal Impact Factor include:

  • The CDSR is ranked 11th of the 169 journals in the Medicine, General & Internal category
  • The CDSR received 81,212 cites in the 2020 Journal Impact Factor period, compared with 67,763 in 2019
  • The 5-Year Journal Impact Factor is 9.871 compared with 7.974 in 2019

Cochrane Library’s Editor in Chief, Karla Soares-Weiser, commented: “I am delighted to see a rise in Impact Factor for the Cochrane Database of Systematic Reviews. We are pleased to see a rise in total citations and the five year impact factor is consistently strong. All of these data demonstrate the usage and impact of Cochrane reviews, and reflect enormous credit on our many thousands of contributors and groups.” 

The main Journal Impact Factor report and the Cochrane Review Group reports will be delivered in August 2021.

 

Wednesday, June 30, 2021

Cochrane Rehabilitation talks to Science in the Break

Tue, 06/29/2021 - 17:38

Science in the Break is a communication platform to make research more accessible to everyone and give more visibility to young researchers, which will potentially enhance their network and future collaborations. They focuses on health sciences and rehabilitation, touching on methods like musculoskeletal imaging, movement analysis, brain imaging, and brain stimulation techniques. Led by Tea Lulic-Kuryllo, Cristina Simon-Martinez, and Francesco Cenni, guests chat about their work, explain methods, and share academic and funding experiences. 

In their most recent episode they provide overview about Cochrane Rehabilitation (Carlotte Kiekens),  practical information on how to learn/contribute (Chiara Arienti), and a young researcher's perspective on their experience (Vanessa Young). 

 

Learn more about Science in the Break: 

Learn more about Cochrane Rehabilitation:

 

Wednesday, July 7, 2021

Featured review: Low-dose misoprostol given by mouth for induction of labour

Mon, 06/28/2021 - 14:53

First author of this new Cochrane Review, 'Low‐dose oral misoprostol for induction of labour', Robert Kerr explains, “Our review found that Misoprostol given orally outperforms the ‘gold-standard’ drug which is much more expensive, and used in preference in many countries. This review has the potential to impact millions of women and babies who have inductions of labour through its comparison of oral misoprostol with other commonly used induction techniques."
 
Labour inductions are common around the world. Induction rates vary worldwide, but for example in the UK, 1 in 3 women will have labour induced. Induction of labour may be a life-saving intervention and identifying effective and safe methods will help achieve greater positive birth experiences for mothers and their babies.

In this recently published Cochrane review, authors explored the evidence from randomised controlled trials to see if low-dose misoprostol given by mouth is effective in starting labour in women in their third trimester with a live baby. They compared misoprostol with other commonly used methods of inducing labour.

What is the issue?
Artificially starting labour, or induction, is common in pregnancy. Reasons include the mother having high blood pressure in pregnancy or the baby being past the due date. Misoprostol is a type of prostaglandin that can be taken in low doses by mouth to induce labour. Prostaglandins are hormone-like compounds that are made by the body for various functions (including the natural onset of labour). Unlike other prostaglandins such as vaginal dinoprostone, misoprostol does not need to be stored in the refrigerator. Taking a tablet is convenient to mothers and the low-dose tablet sizes are now available (25 µg).

Why is this important?
A good induction method achieves a safe birth for mother and baby. It is effective, results in a relatively low number of caesarean sections, has few side effects, and is highly acceptable to mothers. Some methods of inducing labour may cause more caesarean sections by being ineffective at bringing on labour, other methods may lead to more caesareans as they cause too many contractions (hyperstimulation) that result in the baby becoming distressed (foetal heart rate changes).

What evidence did we find?
We searched for evidence on 14 February 2021 and identified 61 trials involving 20,026 women for inclusion in this review. Not all trials were high quality.

Starting with oral misoprostol immediately may have a similar effect on rates of caesarean section (4 trials, 594 women; low-certainty evidence) to giving no treatment for 12 to 24 hours then starting oxytocin, while the effects of misoprostol on uterine hyperstimulation with foetal heart rate changes are unclear (3 trials, 495 women; very low-quality evidence). All women in theses trials had ruptured membranes.

Oral misoprostol was compared to vaginal dinoprostone in 13 trials (9676 women). Misoprostol use probably decreased the risk of caesarean section (moderate-certainty evidence). When studies were divided by their initial dose of misoprostol, there was evidence that use of 10 µg to 25 µg may be effective in reducing the risk of a caesarean section (9 trials, 8652 women), while the higher 50 µg dose might not reduce the risk (4 trials, 1024 women). There may be very small or no differences between misoprostol and dinoprostone in rates of vaginal births within 24 hours (10 trials, 8983 women; low-certainty evidence) but may be fewer cases of hyperstimulation with foetal heart rate changes with oral misoprostol (11 trials, 9084 women; low-certainty evidence).

Oral misoprostol was compared with vaginal misoprostol in 33 trials (6110 women). Oral use may have resulted in fewer vaginal births within 24 hours (16 trials, 3451 women; low-certainty evidence). Oral use may have caused less hyperstimulation with foetal heart rate changes (25 trials, 4857 women; low-certainty evidence), especially with a dose of 10 µg to 25 µg. There was no clear difference in the number of caesarean sections overall (32 trials, 5914 women; low-certainty evidence) but oral use likely resulted in fewer caesareans being performed because of concerns of the baby being in distress (24 trials, 4775 women).

When oral misoprostol was compared to oxytocin for induction, misoprostol use probably resulted in fewer caesarean sections (6 trials, 737 women). We found no clear difference in vaginal birth within 24 hours (3 trials, 466 women; moderate-certainty evidence) or hyperstimulation with foetal heart rate changes (3 trials, 331 women; very low-certainty evidence).

Oral misoprostol was compared to a balloon catheter inserted in the cervix to mechanically induce labour. The number of vaginal births within 24 hours may have increased with misoprostol (4 trials, 1044 women; low-certainty evidence). Misoprostol probably reduced the risk of caesarean section (6 trials, 2993 women; moderate-certainty evidence) with no difference in risk of hyperstimulation with foetal heart rate changes (4 trials, 1044 women; low-certainty evidence).

Different doses and timings of giving oral misoprostol were explored in three small trials. The certainty of the findings from these trials was either low or very low so we cannot draw any meaningful conclusions from this data.


What does this mean?
Using low-dose (50 µg or less) oral misoprostol to induce labour likely leads to fewer caesarean sections and so more vaginal births than vaginal dinoprostone, oxytocin, and a transcervical Foley catheter. Rates of hyperstimulation with foetal heart rate changes were comparable with these methods. Misoprostol taken by mouth causes less hyperstimulation with foetal heart changes compared to when taken vaginally.

More trials are needed to establish the most effective misoprostol regimen for labour induction, but for now the findings of this review support oral rather than vaginal use, and suggest that commencing oral misoprostol at a dose of 25 µg or less may be safe and effective.

Authors' conclusions:
Low-dose oral misoprostol is probably associated with fewer caesarean sections (and therefore more vaginal births) than vaginal dinoprostone, and lower rates of hyperstimulation with foetal heart rate changes. However, time to birth may be increased, as seen by a reduced number of vaginal births within 24 hours.

Compared to transcervical Foley catheter, low-dose oral misoprostol is associated with fewer caesarean sections, but equivalent rates of hyperstimulation.

Low-dose misoprostol given orally rather than vaginally is probably associated with similar rates of vaginal birth, although rates may be lower within the first 24 hours. However, there is likely less hyperstimulation with foetal heart changes, and fewer caesarean sections performed due to foetal distress.

The best available evidence suggests that low-dose oral misoprostol probably has many benefits over other methods for labour induction. This review supports the use of low-dose oral misoprostol for induction of labour, and demonstrates the lower risks of hyperstimulation than when misoprostol is given vaginally. More trials are needed to establish the optimum oral misoprostol regimen, but these findings suggest that a starting dose of 25 µg may offer a good balance of efficacy and safety.

Monday, June 28, 2021

Pages