Cochrane Db Syst Rev
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Cochrane Db Syst Rev · Jan 2013
Review Meta AnalysisVaccines for preventing enterotoxigenic Escherichia coli (ETEC) diarrhoea.
Infection with enterotoxigenic Escherichia coli (ETEC) bacteria is a common cause of diarrhoea in adults and children in developing countries and is a major cause of 'travellers' diarrhoea' in people visiting or returning from endemic regions. A killed whole cell vaccine (Dukoral®), primarily designed and licensed to prevent cholera, has been recommended by some groups to prevent travellers' diarrhoea in people visiting endemic regions. This vaccine contains a recombinant B subunit of the cholera toxin that is antigenically similar to the heat labile toxin of ETEC. This review aims to evaluate the clinical efficacy of this vaccine and other vaccines designed specifically to protect people against diarrhoea caused by ETEC infection. ⋯ There is currently insufficient evidence from RCTs to support the use of the oral cholera vaccine Dukoral® for protecting travellers against ETEC diarrhoea. Further research is needed to develop safe and effective vaccines to provide both short and long-term protection against ETEC diarrhoea.
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Cochrane Db Syst Rev · Jan 2013
Review Meta Analysis Comparative StudyMidwife-led continuity models versus other models of care for childbearing women.
Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. ⋯ Most women should be offered midwife-led continuity models of care and women should be encouraged to ask for this option although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.
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Cochrane Db Syst Rev · Jan 2013
Review Meta AnalysisDifferent types of dietary advice for women with gestational diabetes mellitus.
Gestational diabetes mellitus (GDM) affects a significant number of women each year and is associated with a wide range of adverse outcomes for women and their babies. Dietary counselling is the main strategy in managing GDM, but it remains unclear which dietary therapy is best. ⋯ Data for most comparisons were only available from single studies and they are too small for reliable conclusions about which types of dietary advice are the most suitable for women with GDM. Based on the current available evidence, we did not find any significant benefits of the diets investigated.Further larger trials with sufficient power to assess the effects of different diets for women with GDM on maternal and infant health outcomes are needed. Outcomes such as longer-term health outcomes for women and their babies, women's quality of life and health service cost should be included.
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Sweet potato (Ipomoea batatas) is among the most nutritious subtropical and tropical vegetables. It is also used in traditional medicine practices for type 2 diabetes mellitus. Research in animal and human models suggests a possible role of sweet potato in glycaemic control. ⋯ There is insufficient evidence about the use of sweet potato for type 2 diabetes mellitus. In addition to improvement in trial methodology, issues of standardization and quality control of preparations - including other varieties of sweet potato - need to be addressed. Further observational trials and RCTs evaluating the effects of sweet potato are needed to guide any recommendations in clinical practice.
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Cochrane Db Syst Rev · Jan 2013
Review Meta AnalysisContinuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.
Cardiotocography (known also as electronic fetal monitoring), records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic), so additional assessments of fetal well-being may be used, or the baby delivered by caesarean section or instrumental vaginal birth. ⋯ Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The challenge is how best to convey these results to women to enable them to make an informed choice without compromising the normality of labour.