Comparative analysis of machine learning approaches for predicting frequent emergency department visits.

BACKGROUND: Emergency Department (ED) overcrowding is an emerging risk to patient safety. This study aims to assess and compare the predictive ability of machine learning (ML) models for predicting frequent ED users. METHOD: Korean Health Panel data from 2008 to 2015 were used for this study. Individuals with four or more visits per year were considered frequent ED users. Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM) as well as two ensemble models, namely Bagging and Voting, were trained and tested to examine their predictive performance. RESULTS: The ML classification algorithms identified frequent ED users with high precision (90%-98%) and sensitivity (87%-91%), whereas LR showed fair precision (65%) and sensitivity (67%). The ML algorithms showed a high area under the curve (AUC) values from 89% for SVM to 96% for Random Forest, while LR showed the lowest AUC (65%). The classification error varied among algorithms; LR had the highest classification error (24.07%) while RF had the least (3.8%). CONCLUSIONS: Results show that ML classification algorithms are robust techniques to predict frequent ED users, and the variables in administrative health panels are reliable indicators for this purpose.

Socio-demographic and environmental risk factors associated with multiple under-five child loss among mothers in Bangladesh.

BACKGROUND: Despite the substantial decline in child mortality globally over the last decade, reducing neonatal and under-five mortality in Bangladesh remains a challenge. Mothers who experienced multiple child losses could have substantial adverse personal and public health consequences. Hence, prevention of child loss would be extremely desirable during women's reproductive years. The main objective of this study was to determine the risk factors associated with multiple under-five child loss from the same mother in Bangladesh. METHODS: In this study, a total of 15,877 eligible women who had given birth at least once were identified from the 2014 Bangladesh Demographic and Health Survey. A variety of count regression models were considered for identifying socio-demographic and environmental factors associated with multiple child loss measured as the number of lifetime under-five child mortality (U5M) experienced per woman. RESULTS: Of the total sample, approximately one-fifth (18.9%, n = 3003) of mothers experienced at least one child's death during their reproductive period. The regression analysis results revealed that women in non-Muslim families, with smaller household sizes, with lower education, who were more advanced in their childbearing years, and from an unhygienic environment were at significantly higher risk of experiencing offspring mortality. This study also identified the J-shaped effect of age at first birth on the risk of U5M. CONCLUSIONS: This study documented that low education, poor socio-economic status, extremely young or old age at first birth, and an unhygienic environment significantly contributed to U5M per mother. Therefore, improving women's educational attainment and socio-economic status, prompting appropriate timing of pregnancy during reproductive life span, and increasing access to healthy sanitation are recommended as possible interventions for reducing under-five child mortality from a mother. Our findings point to the need for health policy decision-makers to target interventions for socio-economically vulnerable women in Bangladesh.

Latent class growth modeling of depression and anxiety in older adults: an 8-year follow-up of a population-based study.

BACKGROUND: Depression and anxiety are common mental health conditions in the older adult population. Understanding the trajectories of these will help implement treatments and interventions. AIMS: This study aims to identify depression and anxiety trajectories in older adults, evaluate the interrelationship of these conditions, and recognize trajectory-predicting characteristics. METHODS: Group-based dual trajectory modeling (GBDTM) was applied to the data of 3983 individuals, aged 65 years or older who participated in the Korean Health Panel Study between 2008 and 2015. Logistic regression was used to identify the association between characteristics and trajectory groups. RESULTS: Four trajectory groups from GBDTM were identified within both depression and anxiety outcomes. Depression outcome fell into "low-flat (87.0%)", "low-to-middle (8.8%)", "low-to-high (1.3%)" and "high-stable (2.8%)" trajectory groups. Anxiety outcome fell into "low-flat (92.5%)", "low-to-middle (4.7%)", "high-to-low (2.2%)" and "high-curve (0.6%)" trajectory groups. Interrelationships between depression and anxiety were identified. Members of the high-stable depression group were more likely to have "high-to-low" or "high-curved" anxiety trajectories. Female sex, the presence of more than three chronic diseases, and being engaged in income-generating activity were significant predictors for depression and anxiety. CONCLUSIONS: Dual trajectory analysis of depression and anxiety in older adults shows that when one condition is present, the probability of the other is increased. Sex, having more than three chronic diseases, and not being involved in income-generating activity might increase risks for both depression and anxiety. Health policy decision-makers may use our findings to develop strategies for preventing both depression and anxiety in older adults.

Quantitative EEG (QEEG) Analysis of Emotional Interaction between Abusers and Victims in Intimate Partner Violence: A Pilot Study.

BACKGROUND: The perpetrators of intimate partner violence (IPV) and their victims have different emotional states. Abusers typically have problems associated with low self-esteem, low self-awareness, violence, anger, and communication, whereas victims experience mental distress and physical pain. The emotions surrounding IPV for both abuser and victim are key influences on their behavior and their relationship. METHODS: The objective of this pilot study was to examine emotional and psychological interactions between IPV abusers and victims using quantified electroencephalogram (QEEG). Two abuser-victim case couples and one non-abusive control couple were recruited from the Mental Image Recovery Program for domestic violence victims in Seoul, South Korea, from 7-30 June 2017. Data collection and analysis were conducted using BrainMaster and NeuroGuide. The emotional pattern characteristics between abuser and victim were examined and compared to those of the non-abusive couple. RESULTS: Emotional states and reaction patterns were different for the non-abusive and IPV couples. Strong delta, theta, and beta waves in the right frontal and left prefrontal lobes were observed in IPV case subjects. This indicated emotional conflict, anger, and a communication block or impaired communication between abuser and victim. CONCLUSIONS: Our study findings suggest brainwave control training via neurofeedback could be a possible therapy in managing emotional and communication problems related to IPV.

Oral Health Status and Patterns of Dental Service Utilization of Adolescents in Lesotho, Southern Africa.

This study aimed to characterize the best predictors for unmet dental treatment needs and patterns of dental service utilization by adolescents in the Kingdom of Lesotho, Southern Africa. A self-reported 40-item oral health survey was administered, and clinical oral examinations were conducted in public schools in Maseru from August 10 to August 25, 2016. Associations between psychosocial factors with oral health status and dental service utilization were evaluated using simple, bivariate, and multivariate regressions. Five hundred and twenty-six survey responses and examinations were gathered. The mean age of student participants was 16.4 years of age, with a range between 12 and 19 years of age. More than two thirds (68%; n = 355) of participants were female. The majority reported their quality of life (84%) and general health to be good/excellent (81%). While 95% reported that oral health was very important, only 11% reported their personal dental health as excellent. Three percent reported having a regular family dentist, with the majority (85%) receiving dental care in a hospital or medical clinic setting; only 14% had seen a dental professional within the previous two years. The majority of participants did not have dental insurance (78%). Clinical examination revealed tooth decay on 30% of mandibular and maxillary molars; 65% had some form of gingivitis. In multivariate analysis, not having dental education and access to a regular dentist were the strongest predictors of not visiting a dentist within the last year. Our results suggest that access to oral health care is limited in Lesotho. Further patient oral health education and regular dental care may make an impact on this population.

Trajectories of Depression and Their Predictors in a Population-Based Study of Korean Older Adults.

The aim of this study was to determine trajectories of depression in older adults and to identify predictors of membership in the different trajectory groups. A total of 3983 individuals aged 65 or older were included. Latent class growth models were used to identify trajectory groups. Of 3983 individuals, 2269 (57%) were females, with a mean baseline age of 72.4 years (SD = 6 years). Four depression trajectories were identified across 8 years of follow-up: "low-flat" (n = 3636; 86.6%), "low-to-middle" (n = 214; 9.2%), "low-to-high" (n = 31; 1.3%), and "high-stable" (n = 102; 2.9%). Compared to the low-flat depression group, high-stable depression group members were more likely to be female, have three or more chronic diseases, and were more likely not to own a home. Our findings will assist health policy decision-makers in planning intervention programs targeting those most likely to experience persistent depression in order to improve psychological well-being in the elderly.

Longitudinal change in arterial stiffness after delivery in women with preeclampsia and normotension: a prospective cohort study.

BACKGROUND: Preeclampsia is associated with increased arterial stiffness during pregnancy. However, data on the longitudinal change in arterial stiffness after delivery in women with preeclampsia are lacking. In this pilot study, we aimed to examine the longitudinal change in arterial stiffness using the cardio-ankle vascular index after delivery in women with preeclamptic and normotensive pregnancies. METHODS: We enrolled pregnant women with preeclampsia (n = 37) and normotension (n = 36) who gave birth at Seoul National University Bundang Hospital between March 2013 and May 2016, and followed-up at day 1, 6 months, and 12 months after delivery. The longitudinal change in the cardio-ankle vascular index and other variables (blood pressure, lipid profiles, serum creatinine, and liver enzymes) were compared between the two groups using the mixed-effects model, and interactions among the main predictors were examined. RESULTS: The longitudinal change in the cardio-ankle vascular index did not significantly differ between the two groups (ß = 0.11, 95% CI: - 0.31-0.54, p = 0.60). Predictors of the longitudinal change in the cardio-ankle vascular index included age, time since delivery, body mass index, and diabetes mellitus. Women with preeclampsia showed significantly elevated blood pressure, lipid profiles, serum creatinine, and liver enzymes compared to women with normotension over the course of 1 year of follow-up. CONCLUSIONS: Preeclampsia is associated with unfavorable blood pressure and metabolic indices after delivery. However, we found no difference in the longitudinal change in arterial stiffness between women with preeclampsia and normotension over the course of 1 year after delivery. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov on October 29, 2019 ( NCT04142268 ).

Aromatherapy for Managing Pain in Primary Dysmenorrhea: A Systematic Review of Randomized Placebo-Controlled Trials.

Aromatherapy, the therapeutic use of essential oils, is often used to reduce pain in primary dysmenorrhea. Eleven databases, including four English (PubMed, AMED, EMBASE, and the Cochrane Library) and seven Korean medical databases, were searched from inception through August 2018 without restrictions on publication language. Randomized controlled trials (RCTs) testing aromatherapy for pain reduction in primary dysmenorrhea were considered. Data extraction and risk-of-bias assessments were performed by two independent reviewers. All of the trials reported superior effects of aromatherapy for pain reduction compared to placebo (n = 1787, standard mean difference (SMD): -0.91, 95% CI: -1.17 to -0.64, p < 0.00001) with high heterogeneity (I² = 88%). A sub-analysis for inhalational aromatherapy for the alleviation of pain also showed superior effects compared to placebo (n = 704, SMD: -1.02, 95% CI: -1.59 to -0.44, p = 0.0001, I² = 95%). With regard to aromatherapy massage, the pooled results of 11 studies showed favorable effects of aromatherapy massage on pain reduction compared to placebo aromatherapy massage (n = 793, SMD: -0.87, 95% CI: -1.14 to -0.60, p < 0.00001, I² = 70%). Oral aromatherapy had superior effects compared to placebo (n = 290, SMD: -0.61, 95% CI: -0.91 to -0.30, p < 0.0001, I² = 0%). In conclusion, our systemic review provides a moderate level of evidence on the superiority of aromatherapy (inhalational, massage, or oral use) for pain reduction over placebo in primary dysmenorrhea.

Overview of model validation for survival regression model with competing risks using melanoma study data.

The article introduces how to validate regression models in the analysis of competing risks. The prediction accuracy of competing risks regression models can be assessed by discrimination and calibration. The area under receiver operating characteristic curve (AUC) or Concordance-index, and calibration plots have been widely used as measures of discrimination and calibration, respectively. One-time splitting method can be used for randomly splitting original data into training and test datasets. However, this method reduces sample sizes of both training and testing datasets, and the results can be different by different splitting processes. Thus, the cross-validation method is more appealing. For time-to-event data, model validation is performed at each analysis time point. In this article, we review how to perform model validation using the riskRegression package in R, along with plotting a nomogram for competing risks regression models using the regplot() package.

Fennel (Foeniculum vulgare) on management of menopausal symptoms: A protocol for systematic review of randomized controlled trials.

BACKGROUND: Fennel (Foeniculum vulgare) is often used in women's health care to treat dysmenorrhea, increase the milk supply, and address symptoms of menopause. The object of this review is to evaluate the current evidence on the efficacy of fennel for the management menopausal symptoms. METHODS AND ANALYSES: Thirteen databases will be searched from their inception to the present. These include PubMed, AMED, EMBASE, the Cochrane Library, six Korean medical databases (Korean Studies Information Service System, DBPIA, the Korean Institute of Science and Technology Information, the Research Information Service System, KoreaMed, and the Korean National Assembly Library), and 3 Chinese databases (the China National Knowledge Infrastructure Database [CNKI], the Chongqing VIP Chinese Science and Technology Periodical Database [VIP], and Wanfang Database). Study selection, data extraction, and assessments will be performed independently by 2 researchers. The risk of bias will be assessed using the Cochrane risk of bias tool. ETHICS AND DISSEMINATION: Ethical approval is not required, given that this protocol is for a systematic review only. The review will be published in a peer-reviewed journal and disseminated both electronically and in print. The review will be updated to inform and guide healthcare practice and policy. TRIAL REGISTRATION NUMBER: PROSPERO 2018 CRD42018085698.

Aromatherapy for managing menopausal symptoms: A protocol for systematic review and meta-analysis.

BACKGROUND: Aromatherapy is often used as a complementary therapy for women's health. This systematic review aims to evaluate the therapeutic effects of aromatherapy as a management for menopausal symptoms. METHODS: Eleven electronic databases will be searched from inception to February 2018. Randomized controlled trials that evaluated any type of aromatherapy against any type of control in individuals with menopausal symptoms will be eligible. The methodological quality will be assessed using the Cochrane risk of bias tool. Two authors will independently assess each study for eligibility and risk of bias and to extract data. RESULTS: This study will provide a high quality synthesis of current evidence of aromatherapy for menopausal symptoms measured with Menopause Rating Scale, the Kupperman Index, the Greene Climacteric Scale, or other validated questionnaires. CONCLUSIONS: The conclusion of our systematic review will provide evidence to judge whether aromatherapy is an effective intervention for patient with menopausal women. ETHICS AND DISSEMINATION: Ethical approval will not be required, given that this protocol is for a systematic review. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017079191.

Ginseng for Treating Hypertension: A Systematic Review and Meta-Analysis of Double Blind, Randomized, Placebo-Controlled Trials.

BACKGROUND: Evidence of ginseng for reducing blood pressure (BP) in hypertensive patients is controversial. This systematic review updated the previous reviews and evidence for it. METHODS: Ten databases were searched from their inception through October 2016, without language restriction. Randomized clinical trials (RCTs) were included if any types of ginseng were tested as the sole treatment or as an adjunct to other treatments for pre-hypertension or hypertension. The risk of bias (ROB) was assessed with Cochrane ROB tools by two independent reviewers. RESULTS: We found 528 potentially relevant articles, of which 9 RCTs met our inclusion criteria. Two studies reported positive effects of Korean red ginseng (KRG) on acute reduction of systolic BP (SBP: n=54, mean differences (MD), -6.52; P=0.0002; I2=0%) and diastolic BP DBP: MD, -5.21; P=0.0001; I2=0%), while two other trials failed to do so with north American ginseng (NAG) in both SBP and DBP. Five RCTs assessed the long-term effects of ginseng (KRG or NAG) on SBP and DBP. Two studies showed positive effects of KRG on reducing SBP and DBP compared with placebo (SBP: n = 183, MD, -2.92, P=0.04; I2 = 0%; DBP: MD, -3.19, P=0.008; I2 = 0%). CONCLUSION: This systematic review provides positive evidence for the efficacy of KRG on reducing blood pressure in patients with pre-hypertension and hypertension in acute and long-term. Future RCTs appear to be warranted.

Trajectories of Life Satisfaction and their Predictors among Korean Older Adults.

BACKGROUND: Among older adults, life satisfaction (LS) correlates with health, mortality, and successful ageing. As various potential threats to LS tend to increase with advancing years, patterns of age-related changes in LS among older adults remain inconsistent. This study aimed to identify LS trajectories in older adults and the characteristics of individuals who experience them. METHODS: Large-scale, nationally representative, longitudinal data collected from 2005 to 2013 were analyzed for this study. The outcome measure was a summary of multidimensional domains influencing LS: health, finance, housing, neighbor relationships, and family relationships. Latent class growth models and logistic regression models were used to identify trajectory groups and their predictors, respectively. RESULTS: Within 3517 individuals aged 65 or older, five trajectories were identified across eight follow-up years: "low-stable" (TG1; n = 282; 8%), "middle-stable" (TG2; n = 1146; 32.6%), "improving" (TG3; n = 75; 2.1%), "upper middle-stable" (TG4; n = 1653; 47%), and "high" (TG5; n = 361; 10.3%). High trajectory individuals more frequently had higher education, financial security, good physical health, and good mental health than those in the stable, but less satisfied, groups. Similarly, compared to the largest group (upper middle-stable trajectory), individuals in the low-stable or middle-stable trajectory group not only had poorer physical and mental health but were more likely to be living alone, financially stressed, and residing in urban locations. Individuals with improving trajectory were younger and in poorer mental health at baseline compared to the upper middle-stable trajectory group. CONCLUSION: Life satisfaction in the older follows distinct trajectories. For older adults, trajectories are stable over time and predictable, in part, from individual characteristics. Knowledge of these patterns is important for effective policy and program development.

Mesenchymal stromal cells inhibit CD25 expression via the mTOR pathway to potentiate T-cell suppression.

Mesenchymal stromal cells (MSCs) are known to suppress T-cell activation and proliferation. Several studies have reported that MSCs suppress CD25 expression in T cells. However, the molecular mechanism underlying MSC-mediated suppression of CD25 expression has not been fully examined. Here, we investigated the mTOR pathway, which is involved in CD25 expression in T cells. We showed that MSCs inhibited CD25 expression, which was restored in the presence of an inducible nitric oxide synthase (iNOS) inhibitor. Since CD25 mRNA expression was not inhibited, we focused on determining whether MSCs modulated components of the mTOR pathway in T cells. MSCs increased the phosphorylation of liver kinase B1 (LKB1) and AMP-activated protein kinase (AMPK) and decreased the phosphorylation of ribosomal protein S6 kinase 1 (S6K1) and eukaryotic translation initiation factor 4E-binding protein 1 (4E-BP1). In addition, the expression of 4E-BP1 increased dramatically in the presence of MSCs. An m7GTP pull-down assay showed increased binding of 4E-BP1 to the 5' cap-binding eukaryotic translation initiation factor 4E (eIF4E) complex in the presence of MSCs, which resulted in inhibition of mRNA translation. Treatment with 4EGI-1, a synthetic inhibitor of mRNA translation, also reduced CD25 expression in T cells. Polysome analysis confirmed decreased CD25 mRNA in the polysome-rich fraction in the presence of MSCs. Taken together, our results showed that nitric oxide, produced by MSCs, inhibits CD25 translation through regulation of the LKB1-AMPK-mTOR pathway to suppress T cells.

Acupuncture for Managing Cancer-Related Insomnia: A Systematic Review of Randomized Clinical Trials.

BACKGROUND: Insomnia is a prominent complaint of cancer patients that can significantly affect their quality of life and symptoms related to sleep quality. Conventional drug approaches have a low rate of success in alleviating those suffering insomnia. The aim of this systematic review was to assess the efficacy of acupuncture in the management of cancer-related insomnia. METHODS: A total of 12 databases were searched from their inception through January 2016 without language restriction. Randomized controlled trials (RCTs) and quasi-RCTs were included if acupuncture was used as the sole intervention or as an adjunct to another standard treatment for any cancer-related insomnia. The data extraction and the risk of bias assessments were performed by 2 independent reviewers. RESULTS: Of the 90 studies screened, 6 RCTs were included. The risk of bias was generally unclear or low. Three RCTs showed equivalent effects on the Pittsburgh Sleep Quality Index and 2 RCTs showed the similar effects on response rate to those of conventional drugs at the end of treatment. The other RCT showed acupuncture was better than hormone therapy in the numbers of hours slept each night and number of times woken up each night. The 3 weeks of follow-up in 2 RCTs showed superior effects of acupuncture compared with conventional drugs, and a meta-analysis showed significant effects of acupuncture. Two RCTs tested the effects of acupuncture on cancer-related insomnia compared with sham acupuncture. One RCT showed favourable effects, while the other trial failed to do so. CONCLUSION: There is a low level of evidence that acupuncture may be superior to sham acupuncture, drugs or hormones therapy. However, the number of studies and effect size are small for clinical significance. Further clinical trials are warranted.

Multidimensional construct of life satisfaction in older adults in Korea: a six-year follow-up study.

BACKGROUND: Aging raises wide-ranging issues within social, economic, welfare, and health care systems. Life satisfaction (LS) is regarded as an indicator of quality of life which, in turn, is associated with mortality and morbidity in older adults. The objective of this study was to identify the relevant predictors of life satisfaction and to investigate changes in a multidimensional construct of LS over time. METHODS: This analysis utilized data from the large-scale, nationally representative Korean Retirement and Income Study (KReIS), a longitudinal survey conducted biennially from 2005 to 2011. Outcome measures were degree of satisfaction with health, economic status, housing, neighbor relationships, and family relationships. GEE models were used to investigate changes in satisfaction within each of the five domains. RESULTS: Of a total 3531 individuals aged 65 or older, 2083 (59%) were women, and the mean age was 72 (s.d = ±6) years. The majority had a spouse (60.8%) and lived in a rural area (58%). Analysis showed that physical and mental health were consistently and significantly associated with satisfaction in each of the domains after adjusting for potential confounders. Living in a rural area and living with a spouse were related to satisfaction with economic, housing, family relationships, and neighbor relationships compared to living in urban areas and living without a spouse; the only outcome that did not show relationship to these predictors was health satisfaction. Female and rural residents reported greater economic satisfaction compared to male and urban residents. Living in an apartment was associated with 1.32 times greater odds of economic satisfaction compared to living in a detached house (95% CI: 1.14-1.53; p < 0.0001). Economic satisfaction was also 1.62 times more likely among individuals living with a spouse compared to single households (95% CI: 1.35-1.96; p < 0.0001). Financial stress index value was found to be a significant predictor of satisfaction with family relationships. CONCLUSIONS: Our study indicates that a single domain of LS or overall LS will miss many important aspects of LS as age-related LS is multi-faceted and complicated. While most studies focus on overall life satisfaction, considering life satisfaction as multidimensional is essential to gaining a complete picture.

Knowing the Enemy: Health Care Provider Knowledge of Computed Tomography Radiation Dose and Associated Risks.

BACKGROUND: There is ionizing radiation and associated risk from many medical imaging examinations, especially computed tomography (CT). Unfortunately, health care providers often have limited knowledge regarding radiation dose levels and potential risk. RESEARCH OBJECTIVES: To assess knowledge of dose levels and risk among referring physicians, imaging technologists, and radiologists in Saskatoon, Saskatchewan, and to identify potential differences between and within those groups. MATERIALS AND METHODS: A survey was designed and administered to health care professionals. RESULTS: A total of 308 of 328 surveys were completed (91% response rate). Overall 73% of physicians, 97% of radiologists, and 76% of technologists correctly believed that there is a risk for cancer from an abdomen-pelvic CT scan. Although only 18% of physicians, 28% of radiologists, and 22% of technologists selected the most appropriate estimate of abdominal-pelvic CT dose in terms of chest x-ray equivalents, this is similar to other reported studies. Physicians and technologists who use CT were more likely to select the correct dose than those who do not. Most respondents (91% of physicians, 100% of radiologists, and 100% of technologists) felt that pregnant patients should always be informed about radiation dose as a risk. Although frequency of discussing risk decreased with increasing patient age, technologists were more likely to discuss risk at any age. A total of 93% of respondents expressed interest in receiving dose feedback from medical imaging procedures. CONCLUSIONS: Radiologists and technologists generally showed better knowledge than referring physicians. Among physicians and technologists, knowledge was better in those who use CT than those who do not.

Acupuncture for treating alopecia areata: a protocol of systematic review of randomised clinical trials.

INTRODUCTION: Acupuncture is frequently used in dermatology for treating a number of skin disorders. There is no critically appraised evidence of the potential benefits and harm of acupuncture for alopecia areata (AA). This review aims to systematically evaluate the efficacy of acupuncture for the management of AA in randomised clinical trials (RCTs). METHODS AND ANALYSIS: 13 databases will be searched from their inception. These include PubMed, AMED, EMBASE, the Cochrane Library, 6 Korean medical databases (Koreanstudies Information Service System, DBPIA, The Town Society of Science Technology, Research Information Sharing Service, KoreaMed and the Korean National Assembly Library), 3 Chinese Databases (China National Knowledge Infrastructure Database (CNKI), the Chongqing VIP Chinese Science and Technology Periodical Database (VIP) and the Wanfang Database). Only randomised clinical trials (RCTs) using any type of acupuncture for AA will be considered. The selection of the studies, data abstraction and validation will be performed independently by two researchers. Methodological quality will be assessed with Cochrane risk of bias. DISSEMINATION: The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically and in print. Updates of the review will be conducted to inform and guide the healthcare practice and policy. TRIAL REGISTRATION NUMBER: PROSPERO 2015: CRD42015020397.

A systematic review and meta-analysis of tai chi for treating type 2 diabetes.

The aim of this review was to update and critically evaluate the evidence from randomised clinical trials (RCTs) of tai chi for patients with type 2 diabetes mellitus (T2DM). Twelve databases were searched by August 2014. Fifteen RCTs met all of the inclusion criteria. One RCT compared the effects of tai chi with sham exercise and failed to show the effectiveness of tai chi on fasting blood glucose (FBG), or HbA1c. The other four RCTs tested the effects of tai chi compared with various types of exercise and the meta-analysis failed to show an FBG-lowering effect. Five RCTs compared the effects of tai chi with an anti-diabetic medication and the meta-analysis showed favourable effects of tai chi on FBG. One RCT showed the positive effects of tai chi plus standard care on HbA1c and FBG compared with standard care alone. Four RCTs compared the effects of tai chi to no treatment and the meta-analysis failed to show the positive effects of tai chi on HbA1c. Three RCTs reported superior effects of tai chi on quality of life. In conclusion, the existing trial evidence is not convincing enough to suggest that tai chi is effective for managing patients with T2DM.

Herbal medicine (Gan Mai Da Zao decoction) for depression: a systematic review protocol.

INTRODUCTION: The aim of this systematic review is to analyse trial data on the effectiveness of a herbal medicine (Gan Mai Da Zao (GMDZ) decoction) in treating depression. METHODS AND ANALYSIS: 12 databases will be searched from their inception: PubMed, EMBASE, AMED, the Cochrane Library, five Korean medical databases (KoreaMed, DBpia, OASIS, the Research Information Service System (RISS) and the Korean Studies Information Service System (KISS)) and three Chinese medical databases (China National Knowledge Infrastructure (CNKI), the Wanfang Database and the Chinese Scientific Journals Database (VIP)). Randomised clinical trials (RCTs) or quasi-RCTs using a GMDZ decoction for any type of depression will be considered. The selection of the studies, data abstraction and validations will be performed independently by two researchers. DISSEMINATION: The findings will be disseminated to appropriate audiences via peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER: PROSPERO 2013:CRD42013005100.