Paracetamol versus ibuprofen in treating episodic tension-type headache: a systematic review and network meta-analysis.

Tension-type headache (TTH) is the most common type of headache worldwide. It is defined and classified according to the International Classification of Headache Disorders. TTH is treated with over-the-counter medications, mostly paracetamol or ibuprofen. The purpose was to assess the effectiveness of paracetamol versus ibuprofen in treating episodic tension-type headache (ETTH) through direct and indirect comparisons of randomized controlled trials (RCTs). We included RCTs comparing paracetamol with a placebo, ibuprofen with a placebo, or paracetamol with ibuprofen for acute ETTH treatment that were published between 1988 and 2022. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and the Web of Science. The Cochrane Collaboration risk of bias tool was used to assess the risk of bias. We identified 14 studies including 6521 people with ETTH. None of the studies had a low risk of bias for all domains; this was most likely due to inadequate reporting and a small sample size. Ibuprofen (odds ratio (OR): 1.73, 95% confidence interval (CI): 1.17-2.56) showed better efficacy than paracetamol (OR: 1.62, 95% CI 1.24-2.13) for pain-free status at 2 h, while paracetamol (OR: 1.42, 95% CI 0.87-2.30) showed better efficacy than ibuprofen (OR: 1.20, 95% CI 0.58-2.48) for pain-free status at 1 h. Paracetamol was associated with the lowest likelihood of rescue medication use (OR: 0.49, 95% CI 0.37-0.65). Ibuprofen was associated with a lower likelihood of the occurrence of any events and gastrointestinal adverse events compared with placebo and paracetamol (OR: 0.95, 95% CI 0.64-1.41 and OR: 0.81, 95% CI 0.44-1.50, respectively). Paracetamol and ibuprofen showed better efficacy than placebo in treating ETTH; there was no statistically significant difference in efficacy between the two drugs. For individuals at a higher risk (like renal insufficiency or risk of GI bleeding), paracetamol may be considered as a preferred option instead of Ibuprofen. Further meta-analyses of head-to-head trials are needed for direct comparisons in the future.PROSPERO registration number: CRD42022340936.

The leadership styles of primary healthcare center managers and center performance outcomes in Riyadh, Saudi Arabia: A correlational study.

BACKGROUND: Leadership is a wide concept that is rapidly developing. Diverse theories suggest different styles of leadership, with strong relationships between the different styles and their outcomes. The transformational style emphasizes motivating employees and encouraging them to find new ways of dealing with issues. The transactional (TL) style promotes ideas of rewards and punishments. The Laissez-faire style is characterized by relaxation and the tendency to leave things to happen with minimal interference. MATERIALS AND METHODS: This is a descriptive cross-sectional study design conducted in Primary Healthcare Centers in Riyadh, Saudi Arabia. The leadership styles were assessed using a Multi-Factor Leadership Questionnaire, which identifies the different styles of leadership. SPSS v 26.0 was used for data analysis. t-test employed to compare leadership style between raters and managers. Logistics regression model used to determine the influence of leadership styles of managers. Pearson correlation coefficient determined the linear relationship between leadership styles and its domains. RESULTS: A total of 130 respondents (65 managers vs. 65 raters) took part. "Raters" refer to any persons other than the manager, such as a secretary, nurse, doctor. The "manager" is when the person rates himself. The global transformation mean score was 3.55, for TL it was 3.42 and for passive avoidant, the mean score was 0.93. The passive avoidant (t = 2.005; P = 0.047) and management by exception (passive) (MBEP) mean scores of raters were statistically significantly higher than managers. In the binary regression model, MBEP was the independent significant predictor of manager. CONCLUSION: The perceived leadership style of Primary Healthcare Center managers was transformational but with TL. Transformational leadership was positively correlated with TL leadership but negatively correlated with passive avoidant (The Laissez-faire style). The outcome of this study demonstrated that intellectual stimulation, idealized attributes, and inspirational motivation are perhaps better than contingent reward, active management.