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Research methods in the social sciences

Importance The use of palliative care programs and the number of trials assessing their effectiveness have increased. Objective To determine the association of palliative care with quality of life (QOL), symptom burden, survival, and other outcomes for people with life-limiting illness and for their caregivers. Data Sources MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL to July 2016. Study Selection Randomized clinical trials of palliative care interventions in adults with life-limiting illness. Data Extraction and Synthesis Two reviewers independently extracted data. Narrative synthesis was conducted for all trials. Quality of life, symptom burden, and survival were analyzed using random-effects meta-analysis, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy–palliative care scale (FACIT-Pal) instrument (range, 0-184 [worst-best]; minimal clinically important difference [MCID], 9 points); and symptom burden translated to the Edmonton Symptom Assessment Scale (ESAS) (range, 0-90 [best-worst]; MCID, 5.7 points). Main Outcomes and Measures Quality of life, symptom burden, survival, mood, advance care planning, site of death, health care satisfaction, resource utilization, and health care expenditures. Results Forty-three RCTs provided data on 12 731 patients (mean age, 67 years) and 2479 caregivers. Thirty-five trials used usual care as the control, and 14 took place in the ambulatory setting. In the meta-analysis, palliative care was associated with statistically and clinically significant improvements in patient QOL at the 1- to 3-month follow-up (standardized mean difference, 0.46; 95% CI, 0.08 to 0.83; FACIT-Pal mean difference, 11.36] and symptom burden at the 1- to 3-month follow-up (standardized mean difference, −0.66; 95% CI, −1.25 to −0.07; ESAS mean difference, −10.30). When analyses were limited to trials at low risk of bias (n = 5), the association between palliative care and QOL was attenuated but remained statistically significant (standardized mean difference, 0.20; 95% CI, 0.06 to 0.34; FACIT-Pal mean difference, 4.94), whereas the association with symptom burden was not statistically significant (standardized mean difference, −0.21; 95% CI, −0.42 to 0.00; ESAS mean difference, −3.28). There was no association between palliative care and survival (hazard ratio, 0.90; 95% CI, 0.69 to 1.17). Palliative care was associated consistently with improvements in advance care planning, patient and caregiver satisfaction, and lower health care utilization. Evidence of associations with other outcomes was mixed. Conclusions and Relevance In this meta-analysis, palliative care interventions were associated with improvements in patient QOL and symptom burden. Findings for caregiver outcomes were inconsistent. However, many associations were no longer significant when limited to trials at low risk of bias, and there was no significant association between palliative care and survival.

Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis.

The systematic review was commissioned by the Australian National Health and Medical Research Council (NHMRC) to evaluate the scientific literature relating to the health effects of fluoride and fluoridation. The systematic review's research questions relate to the caries-reducing benefits and associated potential health risks of providing fluoride systemically (via addition to water, milk and salt) and the use of topical fluoride agents, such as toothpaste, gel, varnish and mouthrinse. Although the review summarises the recent evidence, it does not constitute health policy or clinical practice recommendations. A literature search was undertaken using the Medline and Embase databases (via www.embase.com
 ). In addition, the Cochrane Systematic Review and Clinical Trial databases were searched to help identify additional systematic reviews and original studies. Because of the availability of recent systematic reviews, searches were limited to publications from 1996 onwards . The search was conducted in December 2006 and limited to English-language publications. Based on types of intervention (individual or population) and the outcomes assessed (efficacy or safety), the hierarchy of study types considered most relevant for answering each of the clinical questions defined in this review was chosen (Table 1). The levels of evidence used by NHMRC for intervention and aetiological studies are summarised in Table 2.
 Screening of eligible studies was conducted by three reviewers. Data were extracted for all of the included systematic reviews and individual studies using standardised data-extraction forms. This included information about the study design, NHMRC level of evidence, population, intervention, comparator, outcome definitions and results. Information relating to potential biases and study quality were also extracted. Where appropriate, study results were pooled using standard meta-analysis techniques. In total, 5418 nonduplicate citations were identified. After applying the inclusion and exclusion criteria, 408 citations were considered potentially eligible for inclusion in the review. After the review of the full papers of potentially eligible articles, 77 citations were included in the review. The summary of findings was presented in the context of the research questions (Table 3).
 Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride. It is recommended (see also www.nhmrc.gov.au/news/media/rel07/_files/fluoride_flyer.pdf
 ) that water be fluoridated in the target range of 0.6–1.1 mg/l, depending on the climate, to balance reduction of dental caries and occurrence of dental fluorosis.n particular with reference to care in hospital for those following stroke.

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A systematic review of the efficacy and safety of fluoridation

Millions of people are potentially exposed to volcanic gases worldwide, and exposures may differ from those in anthropogenic air pollution. A systematic literature review found few primary studies relating to health hazards of volcanic gases. SO2 and acid aerosols from eruptions and degassing events were associated with respiratory morbidity and mortality but not childhood asthma prevalence or lung function decrements. Accumulations of H2S and CO2 from volcanic and geothermal sources have caused fatalities from asphyxiation. Chronic exposure to H2S in geothermal areas was associated with increases in nervous system and respiratory diseases. Some impacts were on a large scale, affecting several countries (e.g., Laki fissure eruption in Iceland in 1783-4). No studies on health effects of volcanic releases of halogen gases or metal vapors were located. More high quality collaborative studies involving volcanologists and epidemiologists are recommended.

Health Hazards from Volcanic Gases: A Systematic Literature Review

The geographic distribution of fluoride in surface and groundwater in Ethiopia with an emphasis on the Rift Valley.

https://www.thelancet.com/pdfs/journals/lanhiv/PIIS2352-3018(15)00111-3.pdf

Nurse-led palliative care for HIV-positive patients taking antiretroviral therapy in Kenya: a randomised controlled trial

During a project to determine the fluoride levels of milk in Lake Elementaita region, the authors were astonished by the high levels of fluorosis in children living in the area. With special reference to children, a study was designed to establish and describe the levels of dental fluorosis and also to determine other sources of fluoride to the community. The levels of dental fluorosis were recorded using Thylstrup and Fejerskov classification method (TF) for children aged between 2-14 years. Biodata information, feeding habits and details of fluoride history were collected using a questionnaire form filled out with the help of teachers and/or parents. Results pertain to both continuous and non-continuous residents for both primary and permanent dentition. The high fluorosis level of 95.8% was associated with the fluoride concentration in the community water supply and food. Food samples analysed for fluoride include cows milk (the major source of nutrients for the children in the area), vegetables and water. Fluoride levels in drinking water from different boreholes were high, varying from 2.0-20.9 pg/mL-1. Milk fluoride levels in samples from seven localities ranged from 0.05-0.22 pg/mL-1 (mean) and an individual animal range of 0.02-0.34 pg/g-1 . Vegetables had fluoride levels between 7.9-59.3 pg/g1 with an exception of one with 296.6 pg/g-1 . The soils in which the vegetables are grown had over 1000 ppm. This being a landscape formed by the process of faulting and volcanic activity, the dust from Lake Elementaita also had high fluoride concentration of 2300 pg/g-1.

Fluorosis in children and sources of fluoride around Lake Elementaita

Introduction: Pain is a common symptom for patients receiving palliative care, but can be relieved by effective pain management. Nurses play a critical part in implementing pain management effectively and must therefore have a solid foundation of knowledge and a positive attitude toward it. Aim: The purpose of this study was to implement and evaluate an educational pain management programme (PMP) for nurses in Kenya. Methods: The effects of the PMP were measured using a quasi-experimental pre-post test design. Twenty seven nurses from two units in a single health institution in Kenya participated in a baseline assessment using the Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP). Nine randomly selected nurses then received 7 hours of focused education. This group completed the assessment again both immediately after and 2 weeks after the PMP. Results: A deficit in knowledge and attitudes related to pain management was prominent at baseline. The nurses who received the PMP scored significantl...

http://www.magonlinelibrary.com/doi/pdf/10.12968/ijpn.2013.19.7.341

Impact of an educational pain management programme on nurses' pain knowledge and attitudes in Kenya

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Fluorosis in children and sources of fluoride around lake elementaita region of kenya

Solanum incanum is used in Africa and other parts of world as a folklore remedy for various ailments that include; sore throat, angina, stomach ache, ear inflammation, snake bites, wounds, liver disorders, skin ailments (ringworm), warts, inflammatory conditions, painful periods and fever. Phytochemical studies of this herb indicate that it contains substances such as steroidal alkaloids, glyco-alkaloids, antioxidants (flavonoids and chlorogenics), saponins and even carcinogenic substances. The herbal extract posses’ antinociceptive, antipyretic, antispasmolytic, orexic, anorexic, hypoglycemic, antimicrobial, anti-schistosomal, anti-fungal, and anti-cancer activity. The herb is therefore likely to be a major source of novel, affordable and effective therapeutic substances against myriad ailments afflicting people in the world. This review explores the phyto-pharmacological effects of the S. incanum and compiles vital information that may assist researchers on what is known about this herb and gaps for further investigation.

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Hellen Kariuki

Papers

Nurse-led palliative care for HIV-positive patients taking antiretroviral therapy in Kenya: a randomised controlled trial

Fluorosis in children and sources of fluoride around Lake Elementaita

Impact of an educational pain management programme on nurses' pain knowledge and attitudes in Kenya

Fluorosis in children and sources of fluoride around lake elementaita region of kenya

Ethno medicinal, phytochemical and pharmacological aspects of solanum incanum (lin.)