The impacts associated with having ADHD: an umbrella review.

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) affects up to 5% of the population and is characterised by symptoms of impulsivity, hyperactivity and inattention. These symptoms are significantly impairing and carry additional risks for children and adults with ADHD, including negative mental health (e.g. depression), physical health (e.g. obesity) and societal outcomes (e.g. imprisonment, divorce). Very few studies have attempted to synthesise these risks in one publication due to the breadth of evidence published on the adverse outcomes of ADHD. Methods: An umbrella review was performed to identify reviews (systematic, meta-analysis and narrative) that investigate the risks arising from having ADHD. We conducted a narrative synthesis of the findings and conducted a quality review of the included publications. Results: Upon searching five databases, 16,675 records were identified. Of these, 125 reviews met the criteria for inclusion. A narrative synthesis of these findings highlighted three key domains of risks associated with ADHD: mental health, physical health, social and lifestyle. Most reviews were of good and moderate quality. Discussion: This review highlights the many risks associated with having ADHD, beyond its three key symptom domains and the impact of the condition on daily functioning. Registration: International Prospective Register of Systematic Reviews (PROSPERO CRD42023404073).

A qualitative study of barriers and motivators to prevent second-hand smoke exposure among pregnant women and children in Egypt: Identifying appropriate approaches for change.

BACKGROUND: The prevalence of daily second-hand smoke (SHS) exposure among pregnant non-smoking women and children in Egypt is estimated to be about 50% and 55%, respectively. This study aimed to explore barriers to preventing SHS exposure among pregnant women/children and smoking in the home in Egypt. METHODS: Six focus group discussions with pregnant women/mothers of children residing in urban/rural areas (n=61) were conducted. Data were managed and analyzed using the Framework Method. RESULTS: Sixty one participants aged 18-49 were recruited. They reported being never smokers and SHS exposure for themselves and their children was mainly at home. Pregnant women/mothers had some general knowledge of the dangers of SHS, but their knowledge appeared incomplete. The most commonly reported barriers to preventing SHS exposure/adopting a smoke-free home or workplace were social acceptance of smoking and SHS exposure, masculinity and gender norms of accepting smoking among men as a normative behavior, fear among women of damaging a relationship with family or even divorce, women resigning themselves to SHS exposure, and doctors not being supportive of smoking cessation. The majority of interviewees' families were reported to allow smoking anywhere in the home. Others implemented some measures to prevent SHS; however, these tended to be inconsistently implemented. CONCLUSION: Changing the norm of accepting smoking among men as a normative behavior within Egyptian society and better enforcement of smoke-free policies, will help to protect pregnant women and children from SHS. IMPLICATIONS: This study suggests promising approaches to support the promotion of smoke-free homes (SFH) and prevention of SHS exposure among pregnant women and children in public places in Egypt. Better enforcement of smoke-free policies is needed. Health care professionals (HCPs) should support smoking cessation services in primary health centers (PHCs). SHS policy, practice and research should focus on husbands/fathers as they are the main source of SHS. There is a need for denormalization of SHS exposure in Egyptian society.

Delivering yoga to people with hypertension in the UK: A qualitative study to explore yoga providers' knowledge, experiences, and attitudes.

Background and Aims: Yoga has become increasingly popular in the world and the UK for improving health and well-being. A growing body of research suggests that yoga could be used to improve the management of hypertension in addition to current management strategies. Previous cross-sectional studies have also reported that hypertension is one of the most commonly disclosed health conditions in yoga sessions in the United Kingdom. Therefore, semi-structured qualitative interviews were conducted with yoga providers in the United Kingdom (n = 19) to explore their knowledge, experiences, and attitudes toward delivering yoga to people with hypertension. Methods: Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Results: Eight themes were identified. Yoga providers were generally aware of the health conditions of their attendees, and they had a reasonable knowledge of the causes, signs and symptoms, and management of hypertension. While most had received some information about hypertension as part of their initial yoga teaching training, this was generally felt to be limited. They mentioned the biopsychosocial benefits of yoga on hypertension but also expressed their concerns about the lack of regulation, the wide disparity in what is being delivered under the label of yoga, and the competency of some yoga providers. Conclusion: The findings suggest that yoga provision in the United Kingdom should be regulated with a better link with health service providers. A manual and training for yoga providers in the United Kingdom for managing hypertension using yoga would be helpful to address the training needs of yoga providers. However, there is a need for more robust studies before recommending the implementation of yoga in the management of hypertension in the United Kingdom.

Experiences and views of parents on the prevention of second-hand smoke exposure in Middle Eastern countries: a qualitative systematic review.

OBJECTIVE: The objective of this review was to identify, appraise, and synthesize the evidence related to experiences and views of parents, children, and professionals on the prevention of second-hand smoke exposure to women and children in Middle Eastern countries. INTRODUCTION: Second-hand smoke exposure is a major health concern. It is problematic during pregnancy because of potential adverse reproductive effects and poor fetal outcomes. Childhood second-hand smoke exposure is linked to increased morbidity and mortality. Smoking prevalence is high among men in Middle Eastern countries and, as a result, large numbers of non-smoking men, women, and children are exposed to second-hand smoke daily. INCLUSION CRITERIA: Studies were considered for inclusion if they explored experiences and views on the prevention of second-hand smoke exposure among women and children in homes, workplaces, schools, personal vehicles, and public places in 17 Middle Eastern countries. This review included studies that focused on qualitative data, including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative descriptive, and feminist research. METHODS: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Scopus databases were searched to identify published studies from inception to January 2021. The search for unpublished studies included EThOS, OpenGrey, and ProQuest Dissertations and Theses. No language restrictions were applied. The JBI guidelines for qualitative systematic reviews were followed in conducting the review. The JBI process of meta-aggregation was used to identify categories and synthesize findings. RESULTS: Of 5229 records identified, two qualitative studies (in three publications) met the eligibility criteria and were included in the review. One study was conducted in Turkey and the other study (reported in two papers) was conducted in Israel. The methodological quality of the studies was high. The participants in the included studies were parents (n = 118 participants) aged between 18 and 42 years. The methods used for data collection were interviews analyzed using thematic content analysis. A total of 50 findings were extracted and aggregated into eight categories, based on the similarity of meaning. Three synthesized finding were generated (all with moderate confidence): i) Parents were aware of second-hand smoke and that exposure to second-hand smoke is harmful, although the health dangers of second-hand smoke exposure were not commonly discussed with parents during pregnancy;ii) Smoking is a socially and culturally accepted norm, with parents reporting cultural beliefs about traditional values as a barrier to reducing second-hand smoke exposure in the home and personal psychological factors to quitting smoking; iii) Parents implemented different physical restrictions on smoking, such as having rules about where smoking can take place, with psychological motivators reported as drivers to decrease second-hand smoke exposure among children in the home, but tended to lack certainty or confidence regarding whether such protective measures were needed or would be effective. CONCLUSIONS: The findings of this study offer an insight into parents' views on second-hand smoke exposure and its prevention in Middle Eastern countries. Parents have conflicting views on second-hand smoke exposure and techniques to minimize it. Interventions are needed to increase parents' knowledge about the harms of second-hand smoke to reduce women's and children's exposure to second-hand smoke. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019137006.

Effectiveness and Safety of Ayurvedic Medicines in Type 2 Diabetes Mellitus Management: A Systematic Review and Meta-Analysis.

Introduction: Many Ayurvedic medicines have the potential for managing type 2 diabetes mellitus (T2DM), with previous systematic reviews demonstrating effectiveness and safety for specific Ayurvedic medicines. However, many of the reviews need updating and none provide a comprehensive summary of all the Ayurvedic medicines evaluated for managing T2DM. Objective: The objective of this systematic review was to evaluate and synthesize evidence on the effectiveness and safety of Ayurvedic medicines for managing T2DM. Inclusion criteria: Published and unpublished RCTs assessing the effectiveness and safety of Ayurvedic medicines for managing T2DM in adults. Methods: The JBI systematic review methodology was followed. A comprehensive search of sources (including 18 electronic databases) from inception to 16 January 2021 was made. No language restrictions were applied. Data synthesis was conducted using narrative synthesis and random effects meta-analyses, where appropriate. Pooled results are reported as mean differences (MD) with 95% confidence intervals (CI). Results: Out of 32,519 records identified from the searches, 219 articles were included in the systematic review representing 199 RCTs (21,191 participants) of 98 Ayurvedic medicines. Overall, in the studies reviewed the methodology was not adequately reported, resulting in poorer methodological quality scoring. Glycated hemoglobin (HbA1c) was reduced using Aegle marmelos (L.) Corrêa (MD -1.6%; 95% CI -3 to -0.3), Boswellia serrata Roxb. (-0.5; -0.7 to -0.4), Gynostemma pentaphyllum (Thunb.) Makino (-1; -1.5 to -0.6), Momordica charantia L. (-0.3; -0.4 to -0.1), Nigella sativa L. (-0.4; -0.6 to -0.1), Plantago ovata Forssk. (-0.9; -1.4 to -0.3), Tinospora cordifolia (Willd.) Hook.f. and Thomson (-0.5; -0.6 to -0.5), Trigonella foenum-graecum L. (-0.6; -0.9 to -0.4), and Urtica dioica L. (-1.3; -2.4 to -0.2) compared to control. Similarly, fasting blood glucose (FBG) was reduced by 4-56 mg/dl for a range of Ayurvedic medicines. Very few studies assessed health-related quality of life (HRQoL). Adverse events were not reported in many studies, and if reported, these were mostly none to mild and predominately related to the gastrointestinal tract. Conclusion: The current evidence suggests the benefit of a range of Ayurvedic medicines in improving glycemic control in T2DM patients. Given the limitations of the available evidence and to strengthen the evidence base, high-quality RCTs should be conducted and reported.

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objectives: This systematic review aimed to synthesize the content, structure, and delivery characteristics of effective yoga interventions used for managing hypertension and to compare these characteristics with ineffective interventions. Design and Method: The JBI and the PRISMA guidelines were followed in this systematic review. RCTs conducted among hypertensive adults were included. RCTs reporting at least one of the major components of yoga (i.e., asana, pranayama, and dhyana and relaxation practices) and comparing them with no intervention or any intervention were eligible. Sixteen databases were searched for published and unpublished studies without any date and language restrictions till March 15, 2021. Results: The literature search yielded 13,130 records. 34 RCTs (evaluating 38 yoga interventions) met the inclusion criteria. Overall, included studies had low methodological quality mostly due to inadequate reporting. Yoga reduced SBP and DBP compared to a control intervention (MD -6.49 and -2.78; 95CI% -8.94- -4.04 and -4.11- -1.45, respectively). Eighteen, 14 and 20 interventions were effective in improving SBP, DBP, or either, respectively. 13 out of 20 effective interventions incorporated all the 3 major components of yoga and allocated similar durations to each component whereas ineffective interventions were more focused on the asana and duration of asana practice was longer. The most common duration and frequency of effective interventions were 45 min/session (in 5 interventions), 7 days/week (in 5 interventions), and 12 weeks (in 11 interventions) whereas the most common session frequency was 2 days a week (in 7 interventions) in ineffective interventions. Effective interventions were mostly center-based (in 15 interventions) and supervised (in 16 interventions) and this was similar with ineffective interventions. Conclusion: Despite the low quality and heterogeneity of included studies, our findings suggest yoga interventions may effectively manage hypertension. The differences between the effective and ineffective interventions suggest that effective yoga interventions mostly incorporated asana, pranayama, and dhyana and relaxation practices and they had a balance between these three components and included regular practice. They were mostly delivered in a center and under supervision. Future studies should consider developing and evaluating an intervention for managing hypertension using the synthesized findings of the effective interventions in this review. Systematic Review Registration: [PROSPERO], identifier [CRD42019139404].

Characteristics of Yoga Providers and Their Sessions and Attendees in the UK: A Cross-Sectional Survey.

Yoga is an ancient Indian philosophy and way of life that is being used as a method of improving health and wellbeing. Evidence shows that yoga has several health benefits, such as managing many noncommunicable diseases, such as hypertension, and improving mental health. The popularity of yoga is growing in the UK, but it is mostly unregulated with little information available about yoga providers and their sessions and attendees. This study aimed to explore who is providing yoga; what sessions are available, where, and at what cost; and who attends these sessions in the UK and whether yoga providers were aware of health conditions in their sessions. A cross-sectional survey was undertaken among yoga providers in the UK. They were approached through four major UK yoga associations. In total, 407 yoga providers participated. Most providers were aged 45-64 years (69%), female (93%), and white (93%). The median number of group sessions and one-to-one sessions delivered per week was four and two, respectively. The most common styles were Hatha (28%), Iyengar (26%), and Vinyasa (15%). Sessions had a varying emphasis on different yogic practices, but 59% of providers allocated most time to yogic poses (asana), 18% to breathing practices (pranayama), and 12% to meditation (dhyana) and relaxation practices. Most (73%) reported that their attendees disclosed their health conditions to them, most commonly mental health issues (41%), hypertension (25%), and heart diseases (9%). This study showed that yoga sessions are widely available in the UK, often provided and practiced by women, and concentrate on yogic poses. Sessions concentrate on the asana and tend not to include many of the more holistic aspects of yoga that are practiced in South Asian countries. Yoga providers are often aware of health conditions but may benefit from training to deliver sessions suitable for specific health conditions.

Content, Structure, and Delivery Characteristics of Yoga Interventions for Managing Hypertension: A Systematic Review Protocol.

AIMS: This systematic review aims to summarize the content, structure, and delivery characteristics of yoga interventions used for managing hypertension. INTRODUCTION: Globally, hypertension-related morbidity and mortality are high. Yoga might be a potential solution for managing hypertension. Several systematic reviews have evaluated the effectiveness of yoga interventions for managing hypertension. There is a need to summarize the content, structure, and delivery characteristics of yoga interventions used for managing hypertension. INCLUSION CRITERIA: Randomized controlled trials assessing the effectiveness of yoga interventions for managing hypertension in adults and reporting either the content, structure, or delivery characteristics will be included in this systematic review. METHODS: The Joanna Briggs Institute systematic review methodology will be followed to conduct the review. We aim to search for a wide range of sources to find both published and unpublished studies. The following databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Allied and Complementary Medicine (AMED), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Turning Research Into Practice (TRIP), AYUSH Research Portal, A Bibliography of Indian Medicine (ABIM), Digital Helpline for Ayurveda Research Articles (DHARA), CAM-QUEST, and Directory of Open Access Journals (DOAJ). The search for unpublished studies will include OpenGrey, EThOS, and ProQuest Dissertations and Theses. Databases will be searched from their inception dates, and no language restrictions will be applied. A narrative description of the findings will be written, structured around the aims of this systematic review. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42019139404.