Objective: The aim was to formulate practice guidelines for the diagnosis and treatment of polycystic ovary syndrome (PCOS). Participants: An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer developed the guideline. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence. Conclusions: We suggest using the Rotterdam criteria for diagnosing PCOS (presence of two of the following criteria: androgen excess, ovulatory dysfunction, or polycystic ovaries). Establishing a diagno...

Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.

In May 2019, the International Scientific Association for Probiotics and Prebiotics (ISAPP) convened a panel of nutritionists, physiologists and microbiologists to review the definition and scope of synbiotics. The panel updated the definition of a synbiotic to “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host”. The panel concluded that defining synbiotics as simply a mixture of probiotics and prebiotics could suppress the innovation of synbiotics that are designed to function cooperatively. Requiring that each component must meet the evidence and dose requirements for probiotics and prebiotics individually could also present an obstacle. Rather, the panel clarified that a complementary synbiotic, which has not been designed so that its component parts function cooperatively, must be composed of a probiotic plus a prebiotic, whereas a synergistic synbiotic does not need to be so. A synergistic synbiotic is a synbiotic for which the substrate is designed to be selectively utilized by the co-administered microorganisms. This Consensus Statement further explores the levels of evidence (existing and required), safety, effects upon targets and implications for stakeholders of the synbiotic concept. Gut microbiota can be manipulated to benefit host health, including the use of probiotics, prebiotics and synbiotics. This Consensus Statement outlines the definition and scope of the term ‘synbiotics’ as determined by an expert panel convened by the International Scientific Association for Probiotics and Prebiotics in May 2019.

/pdf/the-international-scientific-association-for-probiotics-and-3ghshfpw97.pdf

The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics

This paper reviews a theory of causal inference based on the Structural Causal Model (SCM) described in (Pearl, 2000a). The theory unifies the graphical, potential-outcome (Neyman-Rubin), decision analytical, and structural equation approaches to causation, and provides both a mathematical foundation and a friendly calculus for the analysis of causes and counterfactuals. In particular, the paper establishes a methodology for inferring (from a combination of data and assumptions) the answers to three types of causal queries: (1) queries about the effect of potential interventions, (2) queries about counterfactuals, and (3) queries about the direct (or indirect) effect of one event on another.

What is Causal Inference

Background Mass vaccination campaigns to prevent coronavirus disease 2019 (Covid-19) are occurring in many countries; estimates of vaccine effectiveness are urgently needed to support deci...

https://www.nejm.org/doi/pdf/10.1056/NEJMoa2107715?articleTools=true

Effectiveness of an Inactivated SARS-CoV-2 Vaccine in Chile.

Behavioral Risk Factor Surveillance System

Importance Atopic dermatitis (AD) is a highly prevalent condition that may be associated with an altered gastrointestinal microbiota that promotes an immune environment more susceptible to allergic disease. Synbiotics, a mixture of prebiotics and probiotics, have been used for the prevention and treatment of AD. Objective To investigate the efficacy of synbiotics for primary prevention and treatment of AD. Data Sources PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the CAB Abstracts Archive searchable database were searched from the inception of all databases to October 15, 2015, with no language restrictions. Study Selection We included all published randomized clinical trials of synbiotics for prevention and/or treatment of AD. To be included, a publication needed to clearly define the intervention as oral administration of synbiotics (combination of probiotics and prebiotics) and must have included an assessment of AD disease severity, such as the Severity Scoring of Atopic Dermatitis (SCORAD) index, or the incidence of AD as an outcome measure. Only 8 of 257 initially identified studies (3%) met selection criteria. Data Extraction and Synthesis Data extraction was independently done by multiple observers and cross-checked to avoid errors. The quality of the selected studies was critically examined following the Cochrane guidelines. Data were pooled using a random-effects model. Main Outcomes and Measures The primary outcomes were the SCORAD index (treatment studies) and the relative risk of AD (prevention studies). The hypothesis was formulated before data collection. Results A total of 257 abstracts were screened to identify 6 treatment studies (369 children enrolled; aged 0 months to 14 years) and 2 prevention studies (1320 children enrolled; up to age 6 months in one study and term neonates aged P  = .008). Heterogeneity was significant ( I 2  = 77.1%; P  = .001). Subgroup analysis showed that the beneficial effect was significant only when using mixed strains of bacteria (weighted mean difference, −7.32; 95% CI, −13.98 to −0.66; P  = .03) and when used in children aged 1 year or older (weighted mean difference, −7.37; 95% CI, −14.66 to −0.07; P  = .048). From the 2 prevention studies included, the pooled relative risk ratio of AD in those treated with synbiotics compared with placebo was 0.44 (95% CI, 0.11 to 1.83; P  = .26). Conclusions and Relevance This meta-analysis shows evidence that supports the use of synbiotics for the treatment of AD, particularly synbiotics with mixed strains of bacteria and for children aged 1 year or older. Further studies are needed to evaluate the effectiveness of synbiotics for primary prevention of AD.

/pdf/synbiotics-for-prevention-and-treatment-of-atopic-dermatitis-4p09z5vtzq.pdf

Synbiotics for Prevention and Treatment of Atopic Dermatitis: A Meta-analysis of Randomized Clinical Trials

Although randomized placebo-controlled trials (RCT) are critical to establish efficacy of vaccines at the time of licensure, important remaining questions about vaccine effectiveness (VE)-used here to include individual-level measures and population-wide impact of vaccine programmes-can only be answered once the vaccine is in use, from observational studies. However, such studies are inherently at risk for bias. Using a causal framework and illustrating with examples, we review newer approaches to detecting and avoiding confounding and selection bias in three major classes of observational study design: cohort, case-control and ecological studies. Studies of influenza VE, especially in seniors, are an excellent demonstration of the challenges of detecting and reducing such bias, and so we use influenza VE as a running example. We take a fresh look at the time-trend studies often dismissed as 'ecological'. Such designs are the only observational study design that can measure the overall effect of a vaccination programme [indirect (herd) as well as direct effects], and are in fact already an important part of the evidence base for several vaccines currently in use. Despite the great strides towards more robust observational study designs, challenges lie ahead for evaluating best practices for achieving robust unbiased results from observational studies. This is critical for evaluation of national and global vaccine programme effectiveness.

Observational studies and the difficult quest for causality: lessons from vaccine effectiveness and impact studies.

Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome

Prevalence and risk of depressive disorders in women with polycystic ovary syndrome (PCOS).

The use of social media as a powerful health communication tool is an area of current research interest. Our objective was to describe use of Facebook by State Health Departments (SHDs) in US, and their relationship with CDC's Behavioral Risk Factor Surveillance System (BRFSS) data. Facebook pages of 34 SHDs were studied over a 200 day period, coding 2597 posts into 19 broad health communication categories. Mean number of Facebook posts per SHD was 76.4 (range 34-133); most frequent topic areas included healthy living (12%), communicable diseases (9%), vaccines and immunization (7%), emergency preparedness and response (7%), infant and child health (5%), smoking and tobacco use (5%), and miscellaneous (32%). Through web-based interactive graphics (Google motion charts), we contrasted Facebook posts with CDC's BRFSS data on adult nutrition and physical activity, vaccination, smoking, adolescent health and road traffic accidents. Our research finds an apparent disconnect between content provided on Facebook by SHDs and the health conditions that affect their populations. Acknowledging the severe limitations in funding and human resources faced by the SHDs, our research attempts to present the factual situation in embracing a vastly popular social media platform for health communication. We believe there is a need for research exploring methods to balance the demands and resources.

Ayan Jha

Papers

Synbiotics for Prevention and Treatment of Atopic Dermatitis: A Meta-analysis of Randomized Clinical Trials

Observational studies and the difficult quest for causality: lessons from vaccine effectiveness and impact studies.

Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome

Prevalence and risk of depressive disorders in women with polycystic ovary syndrome (PCOS).

The Use of Social Media by State Health Departments in the US: Analyzing Health Communication Through Facebook.