World Asthma Day on 2 May is an annual event on organized by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world.
Cochrane Airways works with authors (typically clinicians and researchers) to produce systematic reviews on chronic obstructive pulmonary disease (COPD), bronchiectasis and other lung diseases, and asthma. Below are a variety of Cochrane resources related to World Asthma Day.
- Yoga may have health benefits for people with asthma (also in Russian, Polish, and Traditional Chinese).
- Yoga helps my asthma: Julie’s story and new Cochrane evidence on Evidently Cochrane.
- ‘The Workout That Actually Helps Your Asthma’ in Women's Health.
- 'Yoga may help asthmatics breathe freely’ in Big News Network.
- Remote versus face-to-face check-ups for asthma.
- Triggering the trigger: assessing the evidence for sublingual immunotherapy for asthma.
- Featured Review: Chronic disease management programmes for adults with asthma.
- Intravenous magnesium sulfate for treating children with acute asthma in the emergency department.
In this blog, GP Dr Robin Carr discusses the latest Cochrane evidence on whether asthma education for teachers and other school staff could improve the care of children with asthma in schools and reduce asthma deaths. Reposted with permission from Evidently Cochrane blog.
“ You can’t be serious, kids still die of asthma in your country?” my shocked friend said. “Actually, they still die in yours too”, I replied.
I remember as a GP when I first arrived in Somerset that they were still talking about the 12 year old child who had died from an asthma attack some years earlier. At that stage, the number of asthma deaths was about 2000 per year and had been coming down.Preventing asthma deaths
The overall deaths from asthma have come down in the last 30 years but it still remains a common cause of death worldwide. So it was with alarm that we all read The National Review of Asthma Deaths (NRAD) report on asthma deaths, which had concluded many are avoidable. There are added risks in low-income, minority and ethnic groups for increased asthma mortality.
The most shocking of all were the numbers of children who had died from asthma: 80% of under tens had a preventable intervention that could have helped, could have prevented their deaths. Most of them had not received any medical care.
There were a number of simple contributions that could have been made by the individuals themselves, through parents, schools, primary care and secondary care. The simplest of these was a Personalised Asthma Action Plan (PAAP). NRAD concluded that for school-aged children, parents and schools had a significant part to play in this great responsibility and an opportunity to stop this needless suffering.
Having witnessed many asthma attacks in adults and children, I can promise you it is a frightening thing. I was always taught not to show anxiety as this would inevitably be spotted by the parents or child and make the situation worse. But even for someone who had been trained, and knew exactly what to do and had the kit to do it, it was still alarming. I can only imagine the fear it must create for someone who is placed in loco parentis, as a teacher of an asthmatic child, when faced with a possible life-threatening asthma attack. I suspect that many will have made efforts to avoid this position and may even have considered their role as a teacher, if they were now expected to respond in this way?Finding out if teaching staff about asthma in schools could help
So what more could be done in schools that had been shown to work; teachers and schools are hard pressed enough without being expected to do something extra without robust proof of success?
Our Cochrane systematic review wanted to explore the question of educational contributions made in schools and what effect these then had on the children with asthma. Five cluster randomized controlled trials were looked at after an extensive search of the published literature. These covered 111 schools. They were all educational interventions although they differed in length and content. Because of this variation making quantitative or qualitative conclusions is hard, but there were a number of strong signals that came out.
- In the schools where staff had been given asthma education, the schools were more likely to have a written asthma policy.
- The staff were better prepared and they stuck more rigidly to the school policies for asthma.
- The intervention schools showed improvement in the measures taken to either prevent asthma or manage exercise-induced asthma attacks.
- Crucially, more staff in the intervention schools were more confident in knowing how to use salbutamol and a spacer.
- The educated staff had higher levels of knowledge about asthma.
But the quality of the studies was low and so drawing quantitative conclusions from these studies would be a mistake. Sadly, no outcomes such as admissions to hospital were measured.
So, one is left hoping that an improvement in staff knowledge will lead to a more appropriate response and improved outcomes. But we will have to await the results of such a study, where these outcomes are measured, if and when it is done. But it is fair to say that the first step in changing practice is to recognise an educational learning need and to address that.The way forward
Our study has shown that there is a lack of good, robust evidence to support our teaching colleagues with this task and onerous responsibility but that education does improve knowledge and will improve confidence and schools having policies and protocols to address asthma in the school place.
Education of staff along with Personalised Asthma Action Plans, access to immediately necessary treatment, in line with what is in the PAAP, and confidence with recognising an asthma attack and administering appropriate treatment, must be the way forward. We need to do everything we can to help our teaching community to help our children with this wholly preventable condition.Links:
Kew KM, Carr R, Donovan T, Gordon M. Asthma education for school staff. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD012255. DOI: 10.1002/14651858.CD012255.pub2.
Royal College of Physicians. Why asthma still kills: The National Review of Asthma Deaths (NRAD) Confidential Enquiry report. London: Royal College of Physicians; 2014. Available from: https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills
I have received honoraria from GSK, BI, Astrazenica, Chiesi, Pfitzer and Trudell for educational events that I have either organised or contributed to over the last three years. I have organised educational events for Oxfordshire which have involved payments from pharmaceutical companies to cover the cost of venues and educational materials for study days and small group work. I have received travel re-imbursement from Cochrane. I have been employed by Oxfordshire CCG as the respiratory lead and was the medical director for Avanaula Systems Ltd which ran the Somerset COPD service from 2007-2014.
I do not believe that any or all of these sources have either influenced or could be perceived to influence this piece of work or any of my work for Cochrane.Tuesday, May 2, 2017
We are pleased to announce that Cochrane Taiwan has appointed Chiehfeng (Cliff) Chen as its new Director, effective February 2017.
Cochrane Taiwan’s work in supporting and promoting evidence-based health care goes back to 2003, and Cliff has been involved with the team’s activities for 11 years. Under the leadership of Founding Director Ken Kuo, the Cochrane Taiwan team has been instrumental in establishing the Center for Evidence-Based Medicine at Taipei Medical University with government support for initiatives including funding for Cochrane Library access for all Ministry of Health and Welfare affiliated hospitals.
Cochrane Taiwan’s many other accomplishments include their key role in establishing an informal alliance of countries in East Asia in 2007 that meets annually and provides opportunities for training in systematic reviews. Taiwanese people are frequent users of the Library, often in the top ten of countries for full-text downloads, at the top of the list of non-English speaking countries for many years. Taiwan has made around 3,800 Cochrane Review abstracts available in Traditional Chinese; these have been translated by an active network of 500 clinicians.
Ken will be stepping down from managing day-to-day operations but will continue to provide advisory support and contributions to the team’s work.
Cochrane CEO Mark Wilson said, ‘I congratulate and warmly welcome Cliff to his new role. This opens a new chapter for the Cochrane Taiwan team following the outstanding leadership of Ken Kuo in supporting and promoting evidence-based health care over more than a decade. I look forward immensely to working with Cliff in his new role and the great team at Cochrane Taiwan.’
Please join us in congratulating Ken, Cliff, and Cochrane Taiwan as they begin this new era, and wishing them every success for the future.
Got a burning passion for health? Ready to make a difference? We’ve got you covered.
Together we will create health evidence and transform biomedical discovery. And we’d love you to be with us.Why a MedLit Blitz?
Cochrane Crowd has run a number of successful citation screening challenges and we’re upping the ante by running a bigger event, the MedLit Blitz, with our wonderful partner, Mark2Cure. And it just so happens to coincide with the anniversary of both platforms and with Citizen Science Day 2017. Get ready to celebrate!What exactly is happening for the MedLit Blitz?
We’re running 2 x 24-hour online screening challenges.When?
The Mark2Cure challenge begins on Thursday 11th May at 7pm GMT + 1 (UK time zone) and finishes at 7pm on Friday 12th May.How much time do I have to commit?
Of course, we’d love you to do both challenges in their entirety! Just kidding. Any contribution is welcomed, whether it be a few five-minute grabs or a more focused effort. You can choose to contribute to one challenge or to both.Sounds good so far. But I’m new to Cochrane Crowd. What is it all about?
Your best bet is to watch our 2-minute video introduction here.If I join in, what will I be doing?
Your mission in Cochrane Crowd is to identify studies that provide the best possible evidence of the effectiveness of a health treatment. Once identified by the Crowd the studies go into a central register where health researchers and practitioners can access them. The more studies identified by the Crowd, the more high-quality evidence is available to help health practitioners treat their clients.
Your mission in Mark2Cure is to identify how genes, diseases, and drugs are conceptually related, based on biomedical text. Mark2Cure works by teaching citizen scientists to precisely identify concepts and concept relationships in biomedical text. Once these tasks are completed, statistical algorithms take the data provided by the volunteers and use it to provide scientists with new tools for finding the information that they require.
Don’t be spooked by the science speak! You don’t need any prior knowledge to contribute to Cochrane Crowd or Mark2Cure.Will there be prizes?
We’re glad you asked! Prizes will go to the top three MedLit Blitz contributors. The winners will need to have taken part in both challenges. What are the prizes, you ask? You’ll have to wait and see!
As for the details: your contribution will be scored according to the number of citations screened in Cochrane Crowd plus the number of relationship annotations submitted in Mark2Cure.I’d like to know more about Cochrane Crowd, Mark2Cure and the MedLit Blitz.
Brilliant! We’re running a webinar on Monday 8th May to talk more about all of the above. Everyone is welcome, whether you’re already contributing to one or both platforms, or are a complete newcomer.
The process is very simple. You just have to sign up to the platform(s) you’ll be contributing to. Once you are signed up, we will email you with a reminder or two about the Blitz.
Sounds fun, can I tell all my friends about it and get them to join in?
Yes please! We want as many as possible to join us. You could share this page (share buttons below), retweet our tweets, or include information about the MedLit Blitz in your organisation’s newsletter or website.How can I find out more?
Cochrane Heart is seeking a Research Associate/Systematic Review Specialist. This post is based at the Group's editorial base at University College London's Institute of Health Informatics and will play an essential role in the conduction and editorial process of new systematic reviews on interventions for cardiovascular disorders. For more information, please see the full job description on the UCL website.
Closing date: 10 May 2017Friday, April 28, 2017 Category: Jobs
New Cochrane Review finds standardized tobacco packaging may lead to a reduction in smoking prevalence and reduces the appeal of tobacco.
According to the World Health Organization (WHO), tobacco use kills more people worldwide than any other preventable cause of death. Global health experts believe the best way to reduce tobacco use is by stopping people starting to use tobacco, and encouraging and helping existing users to stop.
The introduction of standardized (or ‘plain’) packaging was recommended by the WHO Framework Convention on Tobacco Control (WHO FCTC) guidelines. This recommendation was based on evidence around tobacco promotion in general and studies which examined the impact of changes in packaging on knowledge, attitudes, beliefs and behaviour. Standardized tobacco packaging places restrictions on the appearance of tobacco packs so that there is a uniform colour (and in some cases shape), with no logos or branding apart from health warnings and other government-mandated information; the brand name appears in a prescribed uniform font, colour, and size.
A number of countries have implemented, or are in the process of implementing, standardized tobacco packaging. Australia was the first country in the world to implement standardized packaging of tobacco products. The laws, which took full effect there in December 2012, also required enlarged pictorial health warnings.
A team of Cochrane researchers from the UK and Canada have summarized results from studies that examine the impact of standardized packaging on tobacco attitudes and behaviour. They have published their findings in the Cochrane Library.
The author team found 51 studies that looked at standardized packaging. The studies differed in the way they were done and also what they measured. Only one country had implemented standardized packaging at the time of this review, so evidence that tobacco use prevalence may have decreased following standardized packaging comes from one large observational study. A reduction in smoking behaviour is supported by routinely collected data from the Australian government. There are data from a range of other studies to indicate that appeal is lower with standardized packaging and this may help to explain the observed decline in prevalence. Researchers did not find any evidence suggesting that standardized packaging may increase tobacco use. No studies directly measured whether standardized packs influence uptake, cessation, or whether they prevent former smokers from taking up smoking again.
The amount of evidence for standardized packaging has increased markedly since the publication of the WHO guidelines in 2008. However, given its recency, there are no data on long-term impact. The amount of evidence will continue to expand as more countries implement standardized packaging and as studies assessing the longer-term effects of the Australian policy become available.
Cochrane lead author and Deputy Director of the UK Centre for Tobacco and Alcohol Studies, Professor Ann McNeill from King’s College London, said, “Evaluating the impact of standardized packaging on smoking behaviour is difficult to do; but the evidence available to us, whilst limited at this time, indicates that standardized packaging may reduce smoking prevalence. These findings are supported by evidence from a variety of other studies that have shown that standardized packaging reduces the promotional appeal of tobacco packs, in line with the regulatory objectives set. It would appear that the impact of standardized packaging may be affected by the detail of the regulations such as whether they ban descriptors, such as ‘smooth’ or ‘gold’, and control the shape of the tobacco pack.”
Co-author Jamie Hartmann-Boyce, from the Cochrane Tobacco Addiction Group, Oxford, UK, added: “Our evidence suggests that standardized packaging can change attitudes and beliefs about smoking, and the evidence we have so far suggests that standardized packaging may reduce smoking prevalence and increase quit attempts. We didn’t find any studies on whether changing tobacco packaging affects the number of young people starting to smoke, and we look forward to further research on this topic.”
Full citation: McNeill A, Gravely S, Hitchman SC, Bauld L, Hammond D, Hartmann-Boyce J. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No: CD011244. DOI:10.1002/14651858.CD011244.
For further information, please contact,
Ann McNeill, Lead Author
Professor of Tobacco Addiction
UK Centre for Tobacco and Alcohol Studies
National Addiction Centre
Institute of Psychiatry
King's College London
Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.
Cochrane produces reviews which study the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.
Cochrane is a not-for-profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.
Find out more at cochrane.org
Follow us on twitter @cochranecollab
If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: firstname.lastname@example.orgThursday, April 27, 2017
Specifications: Full Time, Permanent
Salary: Dependant on Experience
Application Closing Date: 26th May 2017
Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We do this by identifying, appraising and synthesizing individual research findings to produce the best available evidence on what can work, what might harm and where more research is needed. The primary results of this work are Cochrane Systematic Reviews, recognised by healthcare professionals, policy makers and patients as the benchmark for high-quality information about the effectiveness of treatment interventions.
This role is an exciting opportunity for someone to lead the development and management of the systematic review team for Cochrane Response. You will have overall responsibility for managing commissioned reviews and related work; taking on project management, customer relationship management, Cochrane engagement and systematic review production tasks. This is a commercial role where you will manage the day-to-day provision and delivery of tailored evidence synthesis services, responding to commissioners’ needs on a project by project basis.
The Ideal Candidate will have:
- First degree in a related field e.g. medical sciences, biology, statistics and a higher degree relevant to the research area or equivalent qualifications.
- 5+ years of relevant experience in systematic reviews.
- Authorship on at least one Cochrane Review.
- Must have demonstrated expertise in relevant evidence synthesis project management activities.
- Ability to exercise independent judgment within generally defined practices and policies that lead to methods or processes for obtaining results.
- Good organization and planning skills.
- Strong interpersonal skills and communication skills (both written and oral).
- Excellent presentation skills.
- Ability to problem solve and delegate appropriate tasks to subordinates.
- Strong leadership skills, self-motivated, adaptable to a dynamic environment.
- Able to collaborate effectively with the project team, and external partners.
- Adaptable and flexible to changing business and customer needs.
- Proficient IT skills, including Word, Excel and PowerPoint.
- Able to travel internationally.
For further information, please download the full job description.
If you would like to apply for this position, please send a CV along with a supporting statement and your salary expectations to email@example.com with “Cochrane Response Systematic Review Manager” in the subject line. The supporting statement should indicate why you are applying for the post, and how far you meet the requirements for the post outlined in the job description using specific examples. List your experience, achievements, knowledge, personal qualities, and skills which you feel are relevant to the post.
Deadline for applications: 26th May 2017
Wednesday, April 26, 2017 Category: Jobs
The March for Science took place on Saturday, 22 April 2017 - also known as Earth Day, a commemoration of environmental advocacy and science in the public interest established in the United States nearly 50 years ago. The March took place in more than 600 cities around the world, to champion the science that upholds the common good.
Cochrane contributors participated in marches worldwide and took part in Cochrane Crowd’s March for Science Sprint Screen. For more updates, please see the round-up on our Community site.
Classified Title: Sr. Research Data Analyst
Salary: $49,957 - $68,721
Contract: Minimum 2-year commitment, with funding for up to 5 years. John Hopkins University will arrange for work visas for qualified candidates.
Status: Full Time, Monday - Friday 37.5 hrs.
Location: Baltimore, USA
Closing Date: 26 May, 2017
This position is with the Cochrane Eyes and Vision (CEV) US Project. Primary duties include providing methodological support for the production of systematic reviews of interventions to prevent and treat eye disease and visual impairment and coordinating the activities of CEV systematic reviews conducted by US-based ophthalmologists, optometrists, and other vision researchers.
As a methodologist, the candidate will assist with key tasks in the systematic review process such as refining research questions, identifying and assessing relevant research studies for eligibility, critically appraising primary studies for bias, developing data collection forms, extracting/entering data, performing qualitative and quantitative synthesis (meta-analyses) of primary studies, and preparing manuscripts for publication in The Cochrane Library.
This position will serve as a technical expert and provide regular consultation to more than 50 US-based eye care clinicians and vision researchers conducting reviews and will perform any or all of the key tasks mentioned above to provide assistance as necessary. The candidate also will work closely with the Project Director, Principal Investigator, and additional CEV staff in the United Kingdom to resolve methodological and statistical issues and to ensure that reviews conducted by US-based researchers are of the highest quality.
Will assist with the development and preparation of training materials and actively participate in workshops on evidence-based healthcare and systematic review preparation. Other duties include participating in methodological research conducted by CEV faculty, providing support to staff by identifying unpublished clinical trials, assisting with reports to the funding agency, participating in journal clubs, organizing conference calls and staff meetings, and performing other tasks as assigned.
Master's degree in Epidemiology or other health related field with one year of experience related to the preparation and interpretation of systematic reviews, data management, and quality control procedures is required. Require highly specialized advanced knowledge, education and/or training in a specialized field of study to conduct research. Excellent oral, written, and interpersonal communication skills are required. A writing sample should be submitted with the application. Ability to produce and deliver effective presentations to a diverse audience is a must. Demonstrated ability on significant graduate project or additional doctoral education may substitute for experience to the extent permitted by the JHU equivalency formula. Must possess knowledge of Medical Science and Epidemiology. Experience in eyes and vision research a plus. Computer-related skills and familiarity with a variety of software applications including word processing, graphing, statistical, presentation and reference management software an absolute requirement. Keen attention to detail and excellent time and project management skills to handle multiple priorities and concurrent projects is required for this position. Must possess the ability to work independently and exercise initiative and independent judgment.
For more information and to apply, please see the full job posting.
Thursday, April 20, 2017 Category: Jobs
Applications are invited for the post of Information Specialist / Systematic Review Methodologist, to work as part of Cochrane Vascular based in Edinburgh, UK. Cochrane Vascular facilitates the development, publication, and maintenance of Cochrane systematic reviews addressing the diagnosis and treatment of peripheral vascular disease.
The post holder is expected to generate and manage their own workload to meet the overall objectives of Cochrane Vascular. This includes responsibility for all activities related to planning, organising and carrying out trials searching activities, working closely with and advising review authors in the development of their systematic reviews relating to trial searching and review methodology, and maintaining the Cochrane Vascular Trials Register.
The post holder must be educated to degree level with a qualification in a scientific/medical discipline, or information science, or librarianship; have significant relevant experience in a research environment; advanced literature searching expertise and experience of designing complex electronic search strategies; experience of conducting high-quality quantitative systematic reviews including critical appraisal, meta-analysis and writing up research for publication; and excellent inter-personal, writing, and communications skills.
For more information
Post: Information Specialist/Systematic Review Methodologist
Vacancy ref: 039430
Please register online at https://www.vacancies.ed.ac.uk/pls/corehrrecruit/erq_jobspec_version_4.display_form
Closing date: 21 April 2017
Wednesday, April 12, 2017 Category: Jobs
Cochrane is delighted to announce today the development of Cochrane Global Mental Health: a partnership that brings together the five Cochrane Review Groups that cover mental health conditions and the WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Section of Psychiatry and Clinical Psychology.
Cochrane Global Mental Health is located in the city of Verona, Italy, and is affiliated with the University of Verona, where the WHO Collaborating Centre is based. Cochrane Global Mental Health will promote evidence-based decision making in mental health care in low- and middle-income countries by supporting and training new authors of Cochrane Reviews, as well as working with clinicians, professional associations, policy-makers, patients, and the media to encourage the dissemination and use of Cochrane evidence globally.
Cochrane Global Mental Health is part of Cochrane, a global independent network of researchers, professionals, patients, carers, and people interested in health. Cochrane works with collaborators from more than 130 countries to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.
Activities of Cochrane Global Mental Health will be co-ordinated and led by Corrado Barbui, Director of the WHO Collaborating Centre for Research and Training in Mental Health and Service Organization, University of Verona, and Marianna Purgato, Post-Doctoral Researcher affiliated with the WHO Collaborating Centre.
Activities are planned, developed, and conducted in partnership with the five Cochrane Review Groups that cover mental health research: Cochrane Common Mental Disorders, Cochrane Dementia and Cognitive Improvement, Cochrane Developmental, Psychosocial and Learning Problems, Cochrane Drugs and Alcohol, and Cochrane Schizophrenia.
The Coordinator of Cochrane Global Mental Health, Corrado Barbui, says this is a hugely exciting opportunity: “The launch of Cochrane Global Mental Health is very important. We aim at developing a mutual learning approach and exchange attitude between mental health workers in different parts of the world. Producing and increasing the dissemination of the best available information on mental health care is critical for clinicians and patients everywhere in the world.”
The Cochrane Library's Editor in Chief, Dr David Tovey, warmly welcomed today’s news, “I am delighted we are announcing the Cochrane Global Mental Health which, by working closely together, will deepen and expand the scope, reach, and impact of Cochrane activities on health and healthcare decision making in low- and middle-income countries. Cochrane Global Mental Health will promote recognition and dissemination of studies conducted and published in low- and middle-income countries and this will not only simply increase the access of evidence, but also promote sharing of clinical experiences across countries.”
“We are keen to have a strong contribution in the work of Cochrane Global Mental Health from low- and middle-income countries, with the option of increasing involvement as capacity allows. Our chance to support mental health professionals in improving their decision making based on the best available evidence will support patient care” Marianna Purgato said. “This is an innovation for low- and middle-income countries and we intend to collaborate in the dissemination of Cochrane Reviews and to continue supporting Cochrane to reach its 2020 strategic objectives.”
For further information, please contact
Senior Media and Communications Manager, Cochrane
M +44(0) 7582 726 634 E firstname.lastname@example.org or email@example.com
For more information on the work of Cochrane Global Mental Health, please visit the website: http://globalmentalhealth.cochrane.org/.
Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.
Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.
Cochrane is a not-for-profit organization with collaborators from more than 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognised as representing an international gold standard for high quality, trusted information.
Find out more at cochrane.org
Follow us on twitter @cochranecollab
If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: firstname.lastname@example.orgFriday, April 21, 2017
Published recently, the sixth update of the Cochrane Review on Psychosocial interventions for supporting women to stop smoking in pregnancy weighs up the evidence on a critical health and social equity issue. Smoking remains one of the few preventable factors associated with complications in pregnancy, and has serious long-term implications for women and babies. While the number of women smoking in pregnancy is decreasing in high-income countries, where it’s associated with poverty, it’s increasing in low- to middle-income countries.
‘This is now one of the largest reviews in the Cochrane Library,’ explains review author Dr Catherine Chamberlain, who has worked on each update of the review since 2003. ‘It includes 102 randomised controlled trials involving almost 30,000 women. Three of these were conducted among Indigenous communities (in Australia, Canada and New Zealand), and nine were conducted in Australia. Smoking during pregnancy is three times more prevalent among Aboriginal and Torres Strait Islander women than among non-Aboriginal women, so we need to look closely at what kinds of interventions can support Indigenous women.’
In this latest update, Catherine and colleagues set out to identify and compare the effectiveness of a range of psychosocial interventions that aim to support pregnant women to stop smoking, including counselling, health education, feedback, social support, incentives and exercise. They found counselling, feedback and financial incentives appear to reduce the number of women smoking in late pregnancy. The effect of health education and social support was less clear.
‘Overall we found that psychosocial interventions increased the proportion of women who had stopped smoking in late pregnancy by 35% and also increased mean infant birthweight by 56 grams. The number of babies born with low birthweight was reduced by 17% and the number admitted to neonatal intensive care immediately after birth by 22%. However, as we note in the review, most of the studies were carried out in high-income countries, making it difficult to assess if the findings are applicable to many other contexts.’
Importantly, the review finds that the interventions don’t appear to have any overall negative physical or psychological effects, are positively received by most women, and may improve psychological well-being. But as the review highlights, the findings need to be considered carefully and in the context of many complex psychological, socio-economic and environmental factors and risks.
‘Interventions should incorporate strategies to reduce the risks we identified in this review, including stigmatisation and depicting mothers who smoke as 'harming' their babies. We know that some anti-smoking campaigns aim to shock or shame people into quitting and don’t necessarily take into account low self-esteem, low self-efficacy, poverty, stress and increased caring responsibilities that are common among women who continue to smoke during pregnancy. It’s important that psychosocial interventions don’t undermine women’s self-confidence or leave them with a sense of failure.’
To add to this complexity, some psychosocial interventions such as incentives are seen as contentious. Incentive-based interventions see women receive a financial incentive in the form of shopping vouchers (and in one study lottery tickets) contingent on their stopping smoking. Incentives are offered in conjunction with feedback interventions, where information is provided to the mother about the measurement of by-products of smoking (such as carbon monoxide or urine cotinine measurements.
‘Some of the evidence we are seeing suggests incentives can be effective, but there are a whole lot of issues around what’s seen as ‘paying people not to smoke’’, says Catherine. ‘There’s been a mixed response to the concept of incentives both here in Australia and in the UK, but I think they are really interesting in terms of using positive reinforcement rather than more punitive approaches. People in low income groups often have low self-confidence and low self-efficacy so you need to balance risk messages with positive support. We’ve had a lot of contact with the people who run incentives trials and they do seem to have been highly effective when delivered intensively, even for high risk pregnant women attending drug dependency units. Incentives have the potential to reduce inequalities and support women in practical ways and that’s encouraging. So despite the controversy, we do need to do some careful thinking and analysis around this, and look clearly at the evidence for what works for different women. Nicotine replacement therapy appears to have a small effect and most people would support subsidies for these. Yet there seems to be barriers for paying similar amounts for incentives which seem to be much more effective. There are also the added benefits of funding going directly to predominantly poor pregnant women, and the pilot evidence shows these funds are spent on useful household goods such as a washing machine or fridge. Ultimately we really need to look at and understand which psychosocial interventions work for different women and why.’
Catherine heads to the UK next month to further the aims and understanding of this review through an Endeavour Award funded by the Australian Government, the NHMRC and the Judith Lumley Centre at La Trobe University. Based with Professor James Thomas at the Evidence for Policy and Practice Centre at University College London, Catherine will meet with colleagues from the Cochrane Pregnancy and Childbirth Group, the UK Tobacco Control Centre and Dundee and Stirling Universities to discuss and analyse both the quantitative and qualitative aspects of this important research.
Cochrane evidence is now being translated into 14 languages following the launch of the Thai translation project.
Cochrane Thailand will contribute to Cochrane’s Translation Strategy by participating in Thai language, translation, and dissemination activities. The translation team will make Abstracts and Plain Language Summaries and podcasts accessible in Thai, with a focus on the translation of newly published and updated Cochrane Reviews. The team will disseminate Thai language content via the Cochrane Thailand Facebook page
Professor Pisake Lumbiganon, Professor Malinee Laopaiboon, and Nampet Jampathong are coordinating the Thai project. They said the translations will help to provide trusted health evidence to Thai people without language barriers.
Cochrane and Oregon Health & Science University (OHSU) are delighted to announce the support of the Robert Wood Johnson Foundation for Cochrane and OHSU's ongoing work to build, pilot, and scale a next generation evidence system to transform the translation of health research into practice. This system is a major component of Cochrane's wider technology development program designed to address the challenge of making sense of an ever-increasing amount of health research and builds on Cochrane’s investment in projects including Linked Data, Project Transform, and review production tools.
The next generation evidence system is developing new approaches including machine learning, crowd engagement and ‘living’ systematic reviews to change the ways health data are used to discover new insights for global health.
“Cochrane is helping to create new ways of synthesising the results of health research and this project will be an important step of that journey.” said Julian Elliott, Co-PI of the project. “These systems will be more efficient and collaborative and enable research to impact on health care in near real time.”
This project has three components that together make a significant contribution to these novel systems:
- Building an active online citizen science community who will build skills and contribute to a wide range of 'micro-tasks' required to generate systematic reviews through the Cochrane Crowd platform.
- Developing, implementing, and validating natural language processing and machine learning systems that semi-automate the extraction of tabular data from research publications.
- Utilizing the above systems to deliver two exemplar 'living' systematic reviews.
The Foundation will provide a grant to support the work of Cochrane and OHSU teams and partners in the USA, UK, and Australia.
“Systematic reviews that bring the best science to bear on clinical decisions are a cornerstone of patient-centered care,” said Mark Helfand, Co-PI of the project. “ Living systematic reviews offer the best option for a future in which the public contributes to timely reviews that can move the best evidence into practice.”Thursday, March 23, 2017
We are looking for Cochrane Groups to host the 2020 and 2021 Cochrane Colloquia and the 2019, 2020, and 2021 Cochrane Governance Meetings.
Cochrane Colloquia are the flagship scientific meetings of the organization and have been held annually since 1993 in different locations across the world. They bring opportunities for people to discuss, develop, and promote scientific developments relevant to the work of Cochrane, provide training, and help shape Cochrane’s future direction. They are a chance for the community to get together to discuss the latest topics in evidence-based health care and learn about Cochrane methods through workshops and presentations.
The Colloquium is currently organized and hosted by a Cochrane Centre, Associate Centre, or Affiliate each year. The host is responsible for the local organizing of the Colloquium with support from the Central Executive Team.
The 2018 Colloquium will be held in Edinburgh and hosted by Cochrane UK; the 2019 Colloquium will be held in Santiago, Chile and hosted by Cochrane South America. We are looking for other Cochrane Groups to host the 2020 and 2021 Colloquia.
Cochrane Governance Meetings
Cochrane Governance Meetings are Cochrane’s annual business meetings. 'Cochrane Governance Meetings' is the new name for the Cochrane Mid-Year Meeting, and will be renamed for the 2018 meetings onwards.
The Governance Meetings are an opportunity for the Cochrane’s Governing Board, Councils, and Executives to meet and discuss the organization’s Strategy to 2020 and related targets, and how these are being developed and implemented.
Cochrane Portugal will be hosting the 2018 Cochrane Governance Meetings in Lisbon. We are looking for new Cochrane Groups to host our 2019, 2020, and 2021 events.
It is important to note that Governance Meetings must be held in Europe or an easily accessible transport hub. At a minimum, the location should be within two hours’ travelling time of an international airport.
Colloquium and Governance Meeting hosts are offered support from the Cochrane Executive Team throughout the organization and hosting of the event.
The deadline for submissions is 28 July 2017.Monday, March 20, 2017
Cochrane’s logo illustrates the summary results from an iconic systematic review: Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.
Each horizontal line represents the results of one study, while the diamond represents the combined result - our best estimate of whether the treatment is effective or harmful. The diamond sits clearly to the left of the vertical line representing “no difference”; therefore the evidence indicates that the treatment is beneficial. We call this representation a “forest plot”. This forest plot within our logo illustrates an example of the potential for systematic reviews to improve health care. It shows that corticosteroids given to women who are about to give birth prematurely can save the life of the newborn child.
Despite several trials showing the benefit of corticosteroids, adoption of the treatment among obstetricians was slow. The systematic review (originally published by Crowley et al. and with a new update published 21 March) was influential in increasing use of this treatment. This simple intervention has probably saved thousands of premature babies.
Lead author Devender Roberts discusses the latest update to this important Cochrane Review in a podcast interview, and highlights the key messages that can be taken from this update:
What does this latest update tell us? What do we know that's new?
This update clarifies some methodologies and the answers to some questions, such as gestational age at first dose, or relationships between interval of first doese to delivery and outcomes - all things that can really only be determined by [looking at] individual patient data.
Is there a need for further research around different results in different settings of care?
There are many possible factors affecting outcomes in different settings of care, but no real explanation of how an intervention that is so effective over so many decades in higher-resource settings doesn't have the same effect in lower-resource settings. And in fact the WHO is sponsoring a trial to try to generate more evidence to help answer that question.
- Listen to the podcast interview
- Read the Cochrane Review
- Read a personal impact story: “Wearing Cochrane evidence”
- Watch “What is a Systematic Review?”
- Read about the history and meaning of the Cochrane logo
- Read BMJ Opinion Blogpost: “Iain Chalmers: Should the Cochrane logo be accompanied by a health warning?”
- Read “Prenatal Corticosteroids for Reducing Morbidity and Mortality after Preterm Birth” on the history of Modern Biomedicine.
World Kidney Day, held on March 14, is a global campaign aimed at raising awareness of the importance of our kidneys.
Cochrane Kidney and Transplant is concerned with the evaluation of care relevant to patients with kidney disease and the means of managing problems associated with interventions (chronic care, prevention, treatment, rehabilitation, and side effects of medication).
Cochrane Kidney and Transplant, one of 53 Cochrane review groups that produce and disseminate systematic reviews of research on healthcare interventions, is helping provide reliable evidence to improve health outcomes.
For more information about Cochrane reviews and the work of Cochrane Kidney Transplant, please visit the Cochrane Kidney and Transplant website. To learn how you can contribute to the work of Cochrane as a citizen scientist, you can visit the Join Cochrane section of our website.
World Kidney Day, held on March 9, is a global campaign aimed at raising awareness of the importance of our kidneys. To advance the 2017 theme, “Kidney Disease & Obesity: Healthy Lifestyle for Healthy Kidneys”, World Kidney Day aims to promote education about the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviours an affordable option.
Cochrane Kidney and Transplant (CKT) is concerned with the evaluation of care relevant to patients with kidney disease and the means of managing problems associated with interventions (chronic care, prevention, treatment, rehabilitation, and side effects of medication).
A healthy lifestyle is important not only in reducing the risk of developing kidney disease, but also in improving the lives of people with the disease. In a World Kidney Day feature article, Cochrane Kidney and Transplant editor Suetonia Palmer highlights the recent Cochrane Kidney and Transplant reviews that have informed lifestyle care for people with kidney disease .
For more information about these reviews and the work of Cochrane Kidney Transplant, please visit the Cochrane Kidney and Transplant website. To learn how you can contribute to the work of Cochrane as a citizen scientist, you can visit the Cochrane website about how to get involved.
This year, Cochrane, is joining with four other leading organizations – Guidelines International Network, Campbell Collaboration, International Society for Evidence-based Health Care, and Joanna Briggs Institute - to hold the first ‘Global Evidence Summit’ in Cape Town, South Africa from 13-16 September 2017.
The theme of the Summit, ‘Using Evidence. Improving Lives.’, will highlight and promote evidence-informed approaches to health and social research, policy and development.
The Summit will focus on the opportunities and challenges facing low- and middle-income countries - a key reason why the Summit will be hosted in Cape Town, South Africa. The event is expected to attract up to 1500 delegates and will bring together many parts of the evidence community to promote evidence-informed decision-making worldwide.
Find out more at globalevidencesummit.org/registration-fees
Stipend applications open until 28 April 2017The Global Evidence Summit have also launched a number of stipend and bursaries to help consumers, students, and other attendees based in developing countries to attend.
A number of stipends and bursaries to help cover registration, travel costs, accommodation, and other expenses associated with attending the Global Evidence Summit are available for eligible applicants.
Cochrane are providing the annual consumer and developing country stipends. But the organisers have also received further funding to support delegates from a LMIC setting including policy makers and researchers as well as African-based students. Follow the link to find out whether you are eligible and how to apply. The deadline for Cochrane and Global Evidence Summit stipends is the 28 April 2017.
Find out more at globalevidencesummit.org/stipends-and-bursaries
Find out more at globalevidencesummit.org
- The Guidelines International Network
- The Campbell Collaboration
- The International Society for Evidence-based Health Care
- The Joanna Briggs Institute
Cochrane South Africa
Senior Media and Communications Manager, Cochrane
To celebrate International Women’s Day (8 March), we wanted to highlight the Anne Anderson Award, which recognizes a female member of Cochrane who has made a significant contribution to the enhancement and visibility of women's participation within Cochrane. The Anne Anderson Award is one of severally prizes awarded annually.
Who was Anne Anderson?
Anne Anderson was a contributor to the stream of thinking and effort that gave birth to evidence-based health care. A clinically qualified reproductive physiologist, Anne had an active interest in women’s health, co-editing the first edition of Women’s Problems in General Practice with Ann McPherson and contributed to Effectiveness and Satisfaction in Antenatal Care (1982), edited by Murray Enkin and Iain Chalmers. She was discussing with Marc Keirse and Iain Chalmers the possibility of co-editing a companion volume on elective birth, however her premature death from breast cancer in 1983 ended her involvement. Anne Anderson was 46 years old when she died. Iain Chalmers, Murray Enkin and Marc Keirse went on to publish Effective Care in Pregnancy and Childbirth (ECPC) in 1989, dedicating the book in part to Anne. ECPC, through its systematic approach to assessing the research literature, is widely acknowledged to have led to development of Cochrane (more about Anne Anderson: Wikipedia).
What’s the goal of the Anne Anderson Award?
The goal of the Anne Anderson Award is to recognize and stimulate individuals contributing to the enhancement of women’s visibility and participation in Cochrane’s leadership. In the footsteps of Anne Anderson, many outstanding women continue to contribute and inspire other women to improve health knowledge for the good of their communities.
Who are some of the past recipients?
2017: Sally Green
2016: Nicky Cullum
2015: Lisa Bero
2014: Elizabeth Waters
2013: Cindy Farquhar
2011: Caroline Crowther
What are the prize recipients awarded?
The 2019 Award recipient will be announced at Cochrane Colloquium Santiago and receives a plaque from Cochrane honouring her contributions. The award recipient designates the cash award of $3000 USD to assist a woman from a low-resource setting with Cochrane activities; this will include how funds have been used to inform decision-making in a specific healthcare setting.