The association between childhood neighborhood relationship and mental health in middle and later life: Evidence from the China Health and Retirement Longitudinal Study.

BACKGROUND: It is unclear that whether childhood neighborhood relationship is associated with mental health among middle-aged and older adults. To overcome this research gap, this study aimed to investigate the association between childhood neighborhood relationship and mental health among the middle-aged and older adults in China. METHODS: The data of this study was sourced from the 2014 and 2015 waves of China Health and Retirement Longitudinal Study. We used ordinary least squares and logit regression models to explore the association between childhood neighborhood relationship and mental health among the middle-aged and older adults in China. RESULTS: The regression results indicate that the middle-aged and older adults who lived in place where neighbors had close-knit relationships at childhood was significantly associated with decreased odds of suffering from depressive symptoms (OR = 0.4259, p < 0.001). Furthermore, compared to the middle-aged and older adults who lived in place where neighbors were not close-knit at childhood, those who lived in place where neighbors were close-knit at childhood had a reduced CES-D score (coefficient = - 2.7822, p < 0.001). CONCLUSION: This study demonstrates the importance of living in place where neighbors had close-knit relationships at childhood. The integrated interventions, including maintaining close-knit neighborhood relationships and strengthening the construction of community, may be useful to improve mental health.

Does Hearing Impairment Affect Mental Health Among Chinese Older Adults? Evidence from the Chinese Longitudinal Healthy Longevity Survey.

BACKGROUND AND AIM: Hearing impairment is a commonly reported chronic condition among older adults. Hearing impairment is significantly associated with reduced quality of life and diminished function status. This study aimed to investigate the association between hearing impairment and mental health among Chinese older adults, with a focus on exploring the moderating effects of social participation and exercise on this association. METHODS: The data of this study were obtained from the 2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). We employed ordinary least squares regression models to analyze the effect of hearing impairment on mental health. Propensity score matching (PSM) and doubly robust estimation were employed to conduct robustness checks. RESULTS: Hearing impairment produced an adverse effect on Mini-Mental State Examination (MMSE) score (coefficient = -1.4073, p < 0.001), while it had a positive effect on depression score (coefficient = 0.8682, p < 0.001). Further analyses using PSM and doubly robust estimation reported similar results. Moreover, social participation (coefficient = 0.9424, p < 0.001) and exercise (coefficient = 0.7001, p < 0.01) moderated the association between hearing impairment and MMSE score. Social participation (coefficient = -0.5991, p > 0.05) and exercise (coefficient = 0.7806, p > 0.05) did not moderate the association between hearing impairment and depression score. CONCLUSION: We provide robust evidence indicating that hearing impairment had significantly negative effects on the cognitive function and depression status of older adults. Furthermore, we find that social participation and exercise relieved the negative effect of hearing impairment on cognitive function.

Losigamone add-on therapy for focal epilepsy.

BACKGROUND: Epilepsy is a common neurologic disorder, affecting approximately 50 million people worldwide; nearly a third of these people have epilepsy that is not well controlled by a single antiepileptic drug (AED) and they usually require treatment with a combination of two or more AEDs. In recent years, many newer AEDs have been investigated as add-on therapy for focal epilepsy; losigamone is one of these drugs and is the focus of this systematic review. This is an update of a Cochrane Review first published in 2012 and updated in 2018. OBJECTIVES: To investigate the efficacy and tolerability of losigamone when used as an add-on therapy for focal epilepsy. SEARCH METHODS: For the latest update on 20 August 2019, we searched the Cochrane Register of Studies (CRS Web) and MEDLINE. CRS Web includes randomized or quasi-randomized, controlled studies from the Specialized Registers of Cochrane Review Groups including Cochrane Epilepsy, CENTRAL, PubMed, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (ICTRP). Previously we searched trials registers and contacted the manufacturer of losigamone and authors of included studies for additional information. We did not impose any language restrictions. SELECTION CRITERIA: Randomized controlled, add-on studies comparing losigamone with placebo for focal epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study quality and extracted data. The primary outcomes were 50% or greater reduction in seizure frequency and seizure freedom; the secondary outcomes were treatment withdrawal and adverse events. Results are presented as risk ratios (RRs) with 95% confidence intervals (CIs) or 99% CIs (for the individual listed adverse events to make an allowance for multiple testing). MAIN RESULTS: Two studies involving a total of 467 participants, aged over 18 years, were eligible for inclusion. Both studies assessed losigamone 1200 mg/day or 1500 mg/day as an add-on therapy for focal epilepsy. We assessed one study as being of good methodological quality while the other was of uncertain quality. For the efficacy outcomes, results showed that participants taking losigamone were significantly more likely to achieve a 50% or greater reduction in seizure frequency (RR 1.76, 95% CI 1.14 to 2.72; 2 studies, 467 participants; moderate-quality evidence), but associated with a significant increase of treatment withdrawal when compared with those taking placebo (RR 2.16, 95% CI 1.28 to 3.67; 2 studies, 467 participants; moderate-quality evidence). For the tolerability outcomes, results indicated that the proportion of participants who experienced adverse events in the losigamone group was higher than in the placebo group (RR 1.34, 95% CI 1.00 to 1.80; 2 studies, 467 participants; moderate-quality evidence). Dizziness was the only adverse event significantly reported in relation to losigamone (RR 3.82, 99% CI 1.69 to 8.64; 2 studies; 467 participants; moderate-quality evidence). Neither study reported the proportion of participants achieving seizure freedom. A subgroup analysis according to different doses of losigamone showed that a higher dose of losigamone (1500 mg/day) was associated with a greater reduction in seizure frequency than lower doses, but was also associated with more dropouts due to adverse events. AUTHORS' CONCLUSIONS: The results of this review showed that losigamone did reduce seizure frequency but was associated with more treatment withdrawals when used as an add-on therapy for people with focal epilepsy. However, the included studies were of short-term duration and uncertain quality. Future well-designed randomized, double-blind, placebo-controlled studies with a longer-term duration are needed. We did not find any new studies since the last version of this review. We judged the overall quality of the evidence for the outcomes assessed as moderate.

Utilization of psychiatric rehabilitation services and influencing factors among people with psychotic disorders in rural communities of Guangxi, China.

OBJECTIVES: To identify the rate and predictors of utilization of rehabilitation services among people with psychotic disorders in rural communities of Guangxi. STUDY DESIGN: A cross-sectional survey was conducted among individuals with schizophrenia or other psychoses (severe mental disorder, ICD10: F20-F29), aged over 15 years, and their care-givers in Guangxi, China. Trained village doctors located individuals known to them and suspected as having schizophrenia or other psychoses within the target areas and recruited them into the study. Data on demographic characteristics, clinical symptoms and functions, treatment history, and reasons, if any, for non-utilization of mental health service were collected. Logistic regression was used to determine associated factors for utilization of mental health services. RESULTS: A total of 424 individuals experiencing psychosis (mean age 41.4 ± 13.0 years, 60.6% male) and 319 caregivers (mean age 55.3 ± 14.2 years) were interviewed. The median duration of disease was 13.4 years. 83.0% of patients had never used rehabilitation services. Greater use of rehabilitation was associated with having a non-organic disorder (OR = 11.6, 95% CI = 1.6-86.0) and living with a caregivers (OR = 3.2, 95% CI = 1.2-8.3). The top three reasons for not using rehabilitation services were lack of awareness (57.1%), lack of money (14.2%) and lack of belief in the service (12.8%). CONCLUSIONS: These findings indicate a high unmet need for psychiatric rehabilitation services among people with psychotic disorders in rural areas of Guangxi. Strategies such as outreach programme and collaborative and partnership network with the local community are needed to encourage people with psychotic disorders in rural communities to increase their utilization of rehabilitation services.

Losigamone add-on therapy for focal epilepsy.

BACKGROUND: Epilepsy is a common neurologic disorder, affecting approximately 50 million people worldwide; nearly a third of these people have epilepsy that is not well controlled by a single antiepileptic drug (AED) and they usually require treatment with a combination of two or more AEDs. In recent years, many newer AEDs have been investigated as add-on therapy for focal epilepsy; losigamone is one of these drugs and is the focus of this systematic review. This is an update of a Cochrane review first published in 2012 (Cochrane Database of Systematic Reviews 2012, Issue 6) and updated in 2015. OBJECTIVES: To investigate the efficacy and safety of losigamone when used as an add-on therapy for focal epilepsy. SEARCH METHODS: For the latest update on 9 February 2017, we searched the Cochrane Epilepsy Specialized Register, CENTRAL and MEDLINE . We searched trials registers and contacted the manufacturer of losigamone and authors of included studies for additional information. We did not impose any language restrictions. SELECTION CRITERIA: Randomized controlled, add-on trials comparing losigamone with placebo for focal epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. The primary outcomes were 50% or greater reduction in seizure frequency and seizure freedom; the secondary outcomes were treatment withdrawal and adverse events. Results are presented as risk ratios (RRs) with 95% confidence intervals (CIs) or 99% CIs (for the individual listed adverse events to make an allowance for multiple testing). MAIN RESULTS: Two trials involving a total of 467 participants, aged over 18 years, were eligible for inclusion. Both trials assessed losigamone 1200 mg/day or 1500 mg/day as an add-on therapy for focal epilepsy. We assessed one trial as being of good methodological quality while the other was of uncertain quality. For the efficacy outcomes, results did show that participants taking losigamone were significantly more likely to achieve a 50% or greater reduction in seizure frequency (RR 1.76, 95% CI 1.14 to 2.72), but associated with a significant increase of treatment withdrawal when compared with those taking placebo (RR 2.16, 95% CI 1.28 to 3.67). For the safety outcomes, results indicated that the proportion of participants who experienced adverse events in the losigamone group was higher than in the placebo group (RR 1.34, 95% CI 1.00 to 1.80), dizziness was the only adverse event significantly reported in relation to losigamone (RR 3.82, 99% CI 1.69 to 8.64). The proportion of participants achieving seizure freedom was not reported in either trial report. A subgroup analysis according to different doses of losigamone showed that a higher dose of losigamone (1500 mg/day) was associated with a greater reduction in seizure frequency than lower doses, but was also associated with more dropouts due to adverse events. AUTHORS' CONCLUSIONS: The results of this review showed that losigamone did reduce seizure frequency but was associated with more treatment withdrawals when used as an add-on therapy for people with focal epilepsy. However, the included trials were of short-term duration and uncertain quality. Future well-designed randomized, double-blind, placebo-controlled trials with a longer-term duration are needed. No new studies have been found since the last version of this review. We judged the overall quality of the evidence for the outcomes assessed as moderate.

Equity in health financing of Guangxi after China's universal health coverage: evidence based on health expenditure comparison in rural Guangxi Zhuang autonomous region from 2009 to 2013.

BACKGROUND: Healthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China's medical sector reform. METHODS: Socio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions. RESULTS: The overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay. CONCLUSION: Our study demonstrates an inequitable distribution of government healthcare subsidies in China from 2009 to 2013, and the inequity was reduced, especially in rural areas. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

Evaluation on equality and efficiency of health resources allocation and health services utilization in China.

BACKGROUND: China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. METHODS: Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012-2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012-2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. RESULTS: From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from -0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. CONCLUSIONS: There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource investments for different provinces.

Assessing equity in the distribution of high-technology medical equipment in Guangxi: evidence from an ethnic minority region in Southern China.

BACKGROUND: High-technology medical equipment (HTME) are important health resources. However, there is unequal distribution of these equipment in favor of metropolis and well equipped health facilities. This study sought to examine the equity gaps in the distribution of HTME in Guangxi. The results of this study could shed light on the future HTME allocation in Guangxi Zhuang Autonomous Region. METHODS: Data related to HTME was sourced from a general investigation of all the hospitals of Guangxi. Concentration index was used to assess the equity status of HTME in Guangxi. RESULTS: Over all, the total amount of HTME in Guangxi had been increasing from 2011 to 2015, and the per million population HTME of five kinds were all increased at the same time. Meanwhile, the concentration indices ranged between 0.1020 and 0.4617. The five medical equipment were all concentrated among the rich. CONCLUSIONS: The possession of SPECT per million population in Guangxi is lower than the national average level while it is superior to the national average level for CT, MRI, DSA and LA. The equity status in the distribution of the five medical equipment has deteriorated since 2011. In 2015, the equity status of CT was the best, while the equity status of MRI was the worst. Meanwhile, 45.1% of HTME were concentrated in Nanning, Guilin, and Liuzhou.

The impact of predisposing, enabling, and need factors in utilization of health services among rural residents in Guangxi, China.

BACKGROUND: Healthcare in China has significantly improved, meanwhile many  socio-economic risk factors and health conditions factors affect accessibility and utilization of health services in rural areas. Inequity of health service in China needs to  be estimated and reduced. Andersen behavioral model is useful to assess the association of health service utilization with predisposing, enabling, and need factors. METHODS: A survey was conducted among 4634 residents of 897 households in 2012. Logistic regression analysis was performed to explore the association of predisposing (age, gender, marital status, ethnicity and family size), enabling (education level, travel time to the nearest health facility, medical expense per capita, and health insurance coverage), and need factors (chronic disease) with the utilization of health services (i.e. physician visit and hospitalization). RESULTS: We observed a significant association between need factor (chronic diseases) and health service unitization, after adjusting for all predisposing and enabling factors (physician visits: odds ratio (OR) = 5.87, 95 % confidence interval (CI) = 4.71-7.32; hospitalization: OR = 4.04, 95 % CI = 2.90-5.61, respectively). In addition, age, gender, marital status, family size and education level were significant predictors of health service utilization. The travel time to the nearest health facility was associated with the utilization of physician visits, and expenditure on healthcare was a hindering factor of hospitalization. CONCLUSIONS: The predisposing and enabling factors had a minor impact on health service utilization, while the need factor was a dominant predictor of health service utilization among rural residents in China.

Evaluation of performance and impacts of maternal and child health hospital services using Data Envelopment Analysis in Guangxi Zhuang Autonomous Region, China: a comparison study among poverty and non-poverty county level hospitals.

BACKGROUND: As the core of the county-level Maternal and Child Health Hospitals (MCHH) in rural areas of China, the service efficiency affects the fairness and availability of healthcare services. This study aims to identify the determinants of hospital efficiency and explore how to improve the performance of MCHH in terms of productivity and efficiency. METHODS: Data was collected from a sample of 32 county-level MCHHs of Guangxi in 2014. Firstly, we specified and measured the indicators of the inputs and outputs which represent hospital resources expended and its profiles respectively. Then we estimated the efficiency scores using Data Envelopment Analysis (DEA) for each hospital. Efficiency scores were decomposed into technical, scale and congestion components, and the potential output increases and/or input reductions were also estimated in this model, which would make relatively inefficient hospitals more efficient. In the second stage, the estimated efficiency scores are regressed against hospital external and internal environment factors using a Tobit model. We used DEAP (V2.1) and R for data analysis. RESULTS: The average scores of technical efficiency, net technical efficiency (managerial efficiency) and scale efficiency of the hospitals were 0.875, 0.922 and 0.945, respectively. Half of the hospitals were efficient, and 9.4 % and 40.6 % were weakly efficient and inefficient, respectively. Among the low-productiveness hospitals, 61.1 % came from poor counties (Poor counties in this article are in the list of key poverty-stricken counties at the national level, published by The State Council Leading Group Office of Poverty Alleviation and Development, 2012). The total input indicated that redundant medical resources in poverty areas were significantly higher than those in non-poverty areas. The Tobit regression model showed that the technical efficiency was proportional to the total annual incomes, the number of discharge patients, and the number of outpatient and emergency visits, while it was inversely proportional to total expenditure and the actual number of open beds. Technical efficiency was not associated with number of health care workers. CONCLUSION: The overall operational efficiency of the county-level MCHHs in Guangxi was low and needs to be improved. Regional economic differences affect the performances of hospitals. Health administrations should adjust and optimize the resource investments for the different areas. For the hospitals in poverty areas, policy-makers should not only consider the hardware facilities investment, but also the introduction of advanced techniques and high-level medical personnel to improve their technical efficiency.

Losigamone add-on therapy for partial epilepsy.

BACKGROUND: Epilepsy is a common neurologic disorder, affecting approximately 50 million people worldwide; nearly a third of these people are not well controlled by a single antiepileptic drug (AED) and usually require treatment with a combination of two or more AEDs. In recent years, many newer AEDs have been investigated as add-on therapy for partial epilepsy; losigamone is one of these drugs and is the focus of this systematic review. This is an update of a Cochrane review first published in 2012 (Cochrane Database of Systematic Reviews 2012, Issue 6). OBJECTIVES: To investigate the efficacy and safety of losigamone when used as an add-on therapy for partial epilepsy. SEARCH METHODS: We searched the Cochrane Epilepsy Group Specialized Register (16 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 16 February 2015) and MEDLINE (Ovid, 1946 to 16 February 2015). We searched trials registers and contacted the manufacturer of losigamone and authors of included studies for additional information. We did not impose any language restrictions. SELECTION CRITERIA: Randomized controlled, add-on trials comparing losigamone with placebo for partial epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. The primary outcomes were 50% or greater reduction in seizure frequency and seizure freedom; the secondary outcomes were treatment withdrawal and adverse events. Results are presented as risk ratios (RRs) with 95% confidence intervals (CIs) or 99% CIs (for the individual listed adverse events to make an allowance for multiple testing). MAIN RESULTS: Two trials involving a total of 467 patients, aged over 18 years, were eligible for inclusion. Both trials assessed losigamone 1200 mg/day or 1500 mg/day as an add-on therapy for partial epilepsy. One trial was assessed as being of good methodological quality while the other was of uncertain quality. For the efficacy outcomes, results did show patients taking losigamone were significantly more likely to achieve a 50% or greater reduction in seizure frequency (RR 1.76; 95% CI 1.14 to 2.72), but associated with a significant increase of treatment withdrawal when compared with those taking placebo (RR 2.16; 95% CI 1.28 to 3.67). For the safety outcomes, results indicated the proportion of patients who experienced adverse events in the losigamone group was higher than the placebo group (RR 1.34; 95% CI 1.00 to 1.80), dizziness was the only adverse event significantly reported in relation to losigamone (RR 3.82; 99% CI 1.69 to 8.64). The proportion of patients achieving seizure freedom was not reported in either trial report. A subgroup analysis according to different doses of losigamone showed that a higher dose of losigamone (1500 mg/day) was associated with a greater reduction in seizure frequency than lower doses, but was also associated with more dropouts due to adverse events. AUTHORS' CONCLUSIONS: The results of this review showed losigamone did reduce seizure frequency but was associated with more treatment withdrawals when used as an add-on therapy for people with partial epilepsy. However, trials included were of short-term duration and uncertain quality. Future well-designed randomized, double-blind, placebo-controlled trials with a longer-term duration are needed. No new studies have been found since the last version of this review.

Vigabatrin versus carbamazepine monotherapy for epilepsy.

BACKGROUND: This is an update of a Cochrane review first published in 2012 (Cochrane Database of Systematic Reviews 2012, Issue 1).The efficacy and safety of vigabatrin (VGB) as an add-on therapy for refractory epilepsy have been well established. However, this information needs to be weighed against the risk of development of visual field defects. Whether VGB monotherapy is an effective and safe treatment compared with the standard antiepileptic drug carbamazepine (CBZ) as monotherapy for epilepsy has not been systematically reviewed. OBJECTIVES: To investigate the efficacy and safety of VGB versus CBZ monotherapy for epilepsy in children and adults. SEARCH METHODS: For the latest update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3 of 4), MEDLINE (1948 to July 2015), EMBASE (1974 to July 2015) and the Chinese Biomedical Database (CBM) (1979 to July 2015). We searched trial registers and contacted the manufacturer of VGB and authors of included studies for additional information. We applied no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing VGB versus CBZ monotherapy for epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. The primary outcome was time to treatment withdrawal. Secondary outcomes were time to achieve six-month and 12-month remission after randomisation, time to first seizure after randomisation and adverse events. We presented results as hazard ratios (HRs) with 95% confidence intervals (CIs) (time to event data) or as risk ratios (RRs) with 95% CIs (adverse events). MAIN RESULTS: Five studies involving a total of 734 participants were eligible for inclusion. We assessed only one study as good quality and the other four as poor quality. However, it was difficult to perform a meta-analysis by extracting aggregate data to synthesise the results as originally planned, mainly because not all studies reported the same outcomes as those chosen for this review. No significant differences favoured VGB or CBZ in terms of time to treatment withdrawal and time to achieve six-month remission after dose stabilisation from randomisation, but results did show a disadvantage for VGB on time to first seizure after randomisation. Compared with CBZ, VGB was associated with more occurrences of weight gain and fewer occurrences of skin rash and drowsiness. No differences in visual field defects and visual disturbances were noted. AUTHORS' CONCLUSIONS: Data are currently insufficient to address the risk-benefit balance of VGB versus CBZ monotherapy for epilepsy. Given the high prevalence of visual field defects reported in an existing systematic review of observational studies (Maguire 2010), VGB monotherapy should be prescribed with caution for epilepsy and should not be considered a first-line choice. If necessary, the visual field should be frequently assessed. Future research should focus on investigating the reasons for visual field defects and exploring potential prevention strategies. Moreover, future monotherapy studies of epilepsy should report results according to the recommendations of the International League Against Epilepsy (ILAE) Commission, and methodological quality should be improved.

Motivational interviewing for improving recovery after stroke.

BACKGROUND: Psychological problems are common complications following stroke that can cause stroke survivors to lack the motivation to take part in activities of daily living. Motivational interviewing provides a specific way for enhancing intrinsic motivation, which may help to improve activities of daily living for stroke survivors. OBJECTIVES: To investigate the effect of motivational interviewing for improving activities of daily living after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group's Trials Register (November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 1), MEDLINE (1948 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), PsycINFO (1806 to March 2015), PsycBITE (March 2015) and four Chinese databases. In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers and conference proceedings, checked reference lists, and contacted authors of relevant studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing motivational interviewing with no intervention, sham motivational interviewing or other psychological therapy for people with stroke were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted eligible data and assessed risk of bias. Outcome measures included activities of daily living, mood and death. MAIN RESULTS: One study involving a total of 411 participants, which compared motivational interviewing with usual care, met our inclusion criteria. The results of this review did not show significant differences between groups receiving motivational interviewing or usual stroke care for participants who were not dependent on others for activities of daily living, nor on the death rate after three-month and 12-month follow-up, but participants receiving motivational interviewing were more likely to have a normal mood than those who received usual care at three-months and 12-months follow-up. AUTHORS' CONCLUSIONS: There is insufficient evidence to support the use of motivational interviewing for improving activities of daily living after stroke. Further well designed RCTs are needed.

Creatine for Parkinson's disease.

BACKGROUND: Parkinson's disease is one of the most common neurodegenerative disorders and mitochondrial dysfunction plays an important role in its pathogenesis. Creatine is effective in improving mitochondrial function. It may therefore be useful for slowing the progression of Parkinson's disease. OBJECTIVES: To assess the efficacy and safety of creatine used alone or as an adjuvant treatment for Parkinson's disease. SEARCH METHODS: We searched the Cochrane Movement Disorders Group Trials Register, CENTRAL (The Cochrane Library 2013, November Issue 4), MEDLINE (January 1966 to 10 November 2013), EMBASE (1974 to 10 November 2013) and two Chinese databases. We searched ongoing trials registers and conference proceedings, checked reference lists and contacted authors of included trials. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing creatine versus placebo for Parkinson's disease. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials for inclusion, assessed trial quality and extracted data. MAIN RESULTS: We included two RCTs with a total of 194 patients. Both trials compared creatine with placebo for Parkinson's disease and both had methodological limitations. There was no clear evidence of an effect on motor function (MD -0.26; 95% confidence interval (CI) -4.39 to 3.88, low quality evidence), activities of daily living (MD 0.37; 95% CI -1.28 to 2.02, low quality evidence) or quality of life after one or two years of treatment. One trial reported serious adverse events that were not attributed to creatine. Also, one trial observed higher rates of gastrointestinal effects at two years follow-up. AUTHORS' CONCLUSIONS: The evidence base on the effects of creatine in Parkinson's disease is limited by risk of bias, small sample sizes and short duration of the eligible trials. It does not provide a reliable basis on which treatment decisions can be made. Future well-designed RCTs with larger sample size and long-term follow-up are needed to assess creatine for Parkinson's disease.

Mycophenolate mofetil for relapsing-remitting multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system and a leading cause of disability in young and middle-aged adults. Mycophenolate mofetil (MMF) is an immunosuppressive agent that has been used for the prevention of allograft rejection after renal, cardiac, or liver transplant and in patients with autoimmune diseases such as active relapsing-remitting (RRMS) and progressive MS. OBJECTIVES: To assess the efficacy and safety of MMF for preventing disease activity in patients with RRMS. SEARCH METHODS: We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register (January 14, 2013). We searched three Chinese databases (January 2013) and checked reference lists of identified trials. We contacted authors and pharmaceutical companies to ask for additional information. We applied no language restrictions. SELECTION CRITERIA: We included randomized controlled trials with a follow-up of at least 12 months that compared MMF as monotherapy or in combination with other treatments versus placebo, another drug, or the same cointervention as the treated group. DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials for inclusion, assessed trial quality, and extracted data. MAIN RESULTS: One included study involving 26 participants with new-onset RRMS investigated the efficacy and safety of MMF (13 participants) versus placebo in interferon ß-1a-treated participants. It was assessed to be at high risk of bias, and had a small numbers of participants receiving treatment with short-term duration. There was inadequate information provided by the study to determine the effect of MMF in reducing relapses, preventing disability progression, or developing new T2- or new gadolinium (Gd)-enhanced lesions on magnetic resonance imaging (MRI) after a 12-month follow-up period. No data were available at 24 months. No serious adverse effects were reported. All participants in the MMF-treated group suffered from gastrointestinal upset, but none of them discontinued therapy as a result. AUTHORS' CONCLUSIONS: The evidence we found from one small study was insufficient to determine the effects of MMF as an add-on therapy for interferon ß-1a in new-onset RRMS participants.

Tobacco use and smoking cessation practices among physicians in developing countries: a literature review (1987-2010).

Physicians have a key role to play in combating tobacco use and reducing the tobacco induced harm to health. However, there is a paucity of information about tobacco-use and cessation among physicians in developing countries. To assess the need for and nature of smoking cessation services among physicians in developing countries, a detailed literature review of studies published in English, between 1987 and 2010 was carried out. The electronic databases Medline and Pub Med were searched for published studies. The findings show that there are regional variations in the current smoking prevalence, quitting intentions, and cessation services among physicians. Smoking prevalence (median) was highest in Central/Eastern Europe (37%), followed by Africa (29%), Central and South America (25%) and Asia (17.5%). There were significant gender differences in smoking prevalence across studies, with higher prevalence among males than females. Smoking at work or in front of patients was commonly practiced by physicians in some countries. Asking about smoking status or advising patients to quit smoking was not common practice among the physicians, especially among smoker physicians. Organized smoking cessation programs for physicians did not exist in all of these regions. This review suggests that while smoking of physicians varies across different developing regions; prevalence rates tend to be higher than among physicians in developed countries. Quitting rates were low among the physicians, and the delivery of advice on quitting smoking was not common across the studies. To promote tobacco control and increase cessation in populations, there is a need to build physicians' capacity so that they can engage in tobacco use prevention and cessation activities.

Hyperbaric oxygen therapy for vascular dementia.

BACKGROUND: Hyperbaric oxygen therapy (HBOT) has been used to treat a variety of conditions and has shown possible efficacy for treating vascular dementia (VaD) in experimental and preliminary clinical studies. OBJECTIVES: To assess the efficacy and safety of HBOT for VaD, used alone or as an adjuvant treatment. SEARCH METHODS: We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group Specialised Register on 20 December 2011 using the terms: hyperbaric OR oxygen OR HBO OR HBOT. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases, numerous trial registries and grey literature sources. We also searched the Chinese Biomedical Database (CBM), the Chinese National Knowledge Infrastructure (CNKI) and the VIP Chinese Science and Technique Journals Database on 10 November 2011 using the terms 'gaoyayang', 'xueguanxingchidai' and 'chidai'. In addition, we contacted authors of included studies for additional information. SELECTION CRITERIA: Trials were eligible for inclusion if they were randomised controlled trials comparing HBOT to no intervention or to sham HBOT, or comparing HBOT plus another treatment to the same other treatment in patients with VaD. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. MAIN RESULTS: One study involving 64 patients was included. It compared HBOT as an adjuvant to donepezil with donepezil alone. This one included study was judged to be of poor methodological quality. Patients receiving HBOT plus donepezil had significantly better cognitive function than the donepezil only group after 12 weeks of treatment, measured by the Mini-Mental State Examination (MMSE) (WMD 3.50; 95% CI 0.91 to 6.09) or by Hasegawa's Dementia Rating Scale (HDS) (WMD 3.10; 95% CI 1.16 to 5.04). There were no deaths or withdrawals, and the study did not mention safety assessment at all. Global function, behavioral disturbance and activities of daily living were not investigated in the study. AUTHORS' CONCLUSIONS: There is insufficient evidence to support HBOT as an effective treatment for patients with VaD. Future trials should be randomised, double-blind comparisons of HBOT to sham HBOT.

Losigamone add-on therapy for partial epilepsy.

BACKGROUND: Epilepsy is a common neurologic disorder, affecting approximately 50 million people worldwide; nearly a third of these people are not well controlled by a single antiepileptic drug and usually require treatment with a combination of two or more antiepileptic drugs. In recent years, many newer antiepileptic drugs have been investigated as add-on therapy for partial epilepsy; losigamone is one of these drugs and is the focus of this systematic review. OBJECTIVES: To investigate the efficacy and safety of losigamone when used as an add-on therapy for partial epilepsy. SEARCH METHODS: We searched the Cochrane Epilepsy Group Specialized Register (1 May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL Issue 4 of 12, The Cochrane Library, 2012) and MEDLINE (1 May 2012). We searched trials registers and contacted the manufacturer of losigamone and authors of included studies for additional information. There were no language restrictions. SELECTION CRITERIA: Randomized controlled add-on trials comparing losigamone with placebo for partial epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. The primary outcomes were 50% or greater reduction in seizure frequency and seizure freedom; the secondary outcomes were treatment withdrawal and adverse events. Results are presented as risk ratios (RR) with 95% confidence intervals (CIs) or 99% CIs (for the individual listed adverse events to make an allowance for multiple testing). MAIN RESULTS: Two trials involving a total of 467 patients were eligible for inclusion. Both trials assessed losigamone 1200 or 1500 mg/d as an add-on therapy for partial epilepsy. One trial was assessed as being of good methodologic quality while the other was of uncertain quality. For the efficacy outcomes, results did show patients taking losigamone were significantly more likely to achieve a 50% or greater reduction in seizure frequency (RR 1.75; 95% CI 1.14 to 2.72), but associated with a significant increase of treatment withdrawal when compared with those taking placebo (RR 2.16; 95% CI 1.28 to 3.67). For the safety outcomes, results indicated the proportion of patients who experienced adverse events in the losigamone group was higher than the placebo group (RR 1.34; 95% CI 1.00 to 1.80), dizziness was the only adverse event significantly in relation to losigamone (RR 3.82; 99% CI 1.69 to 8.64). The proportion of patients achieving seizure freedom was not reported in either trial report. A subgroup analysis according to different doses of losigamone showed that a higher dose of losigamone (1500 mg/d) is associated with a greater reduction in seizure frequency than lower doses, but is also associated with more dropouts due to adverse events. AUTHORS' CONCLUSIONS: The results of this review showed losigamone can reduce seizure frequency but was associated with more treatment withdrawals when used as an add-on therapy for people with partial epilepsy. However, trials included were of short-term duration and uncertain quality. Future well-designed randomized, double-blind, placebo-controlled trials with a longer-term duration are needed.

Inspiratory muscle training for the recovery of function after stroke.

BACKGROUND: Inspiratory muscle weakness has been observed in patients with stroke. Inspiratory muscle training is an intervention that has shown possible effects for functional recovery of patients with stroke. OBJECTIVES: To investigate the effect and safety of inspiratory muscle training for improving activities of daily living, respiratory muscle function, quality of life and cardiorespiratory fitness after stroke. SEARCH METHODS: We searched the Cochrane Stroke Group's Trials Register (August 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, October Issue 4), MEDLINE (1948 to October 2011), EMBASE (1974 to October 2011), CINAHL (1982 to October 2011), AMED (1985 to October 2011), PEDro (October 2011) and four Chinese databases. In an effort to identify further published, unpublished and ongoing trials, we searched ongoing trials registers and conference proceedings, checked reference lists, and contacted authors of relevant studies and training devices manufactures. There were no language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing inspiratory muscle training with no intervention, sham inspiratory muscle training or other cardiorespiratory training for patients with stroke were eligible. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. The primary outcomes were activities of daily living and respiratory muscle strength; the secondary outcomes were quality of life, cardiorespiratory fitness and adverse effects. MAIN RESULTS: We included two trials involving a total of 66 patients in this review. Pooling analyses of data was not possible due to considerable heterogeneity between the trials and a lack of data in both trials. One study found a significant increase in respiratory muscle strength favouring inspiratory muscle training over sham inspiratory muscle training, but there was no significant difference between groups on quality of life. The other study showed that patients receiving inspiratory muscle training were more likely to improve their activities of daily living, quality of life and cardiorespiratory fitness than those patients who received no intervention. However, the main results were not compared directly with breathing retraining. Furthermore, neither of the trials assessed the safety and tolerance of inspiratory muscle training. AUTHORS' CONCLUSIONS: There is insufficient evidence to support inspiratory muscle training as an effective treatment to improve function after stroke, and no evidence relating to the safety of inspiratory muscle training. Further well-designed RCTs are required.

Sildenafil citrate for erectile dysfunction in patients with multiple sclerosis.

BACKGROUND: Erectile dysfunction (ED) is a common sexual disease in male patients with multiple sclerosis (MS). Sildenafil citrate is considered as an effective drug in the treatment of male ED in the general population, but it has not been systematically reviewed in patients with MS. OBJECTIVES: To assess the efficacy and safety of sildenafil citrate for ED in patients with MS. SEARCH METHODS: We searched the Cochrane (November 2011), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4 of 4, 2011), MEDLINE (PubMed) (January 1966 to November 2011), EMBASE (January 1974 to November 2011) and the China Biological Medicine Database (CBM) (1979 to November 2011). We searched trials registers and conference proceedings and contacted pharmaceutical company and authors of included studies for additional data. There were no language restrictions. SELECTION CRITERIA: Randomised controlled trials comparing sildenafil citrate with placebo or no treatment for ED in patients with MS. DATA COLLECTION AND ANALYSIS: Two review authors independently selected articles for inclusion, extracted data and assessed trial quality. Disagreements were resolved by discussion between review authors. Authors of included studies were contacted for additional information. Results were presented as relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI). MAIN RESULTS: Two randomised controlled trials involving a total of 420 patients were identified. Both trials investigated the short-term efficacy and safety of sildenafil citrate for ED in patients with MS. Patients taking sildenafil citrate were more likely to improve their ability to achieve and maintain an erection measured by International Index of Erectile Function and achieve vaginal penetration ( (RR 1.28, 95%CI 0.92 to 1.78) and complete intercourse measured by Sexual Encounter Profile diary (RR RR 1.38, 95%CI 1.00 to 1.90). and receive A global well respond measured by Global Assessment Question (RR 2.72, 95%CI 1.40 to 5.28) was reported. One trial showed sildenafil citrate is effective in quality of life improvement, while the other trial did not find any significant difference between both groups. Both included trials were judged as high risk of attrition bias. Adverse events were also reported: the most common were headache, flushing, rhinitis, visual disturbances and dyspepsia. Two patients suffered serious adverse events: one with coronary artery disease requiring triple bypass surgery and one with a cerebrovascular accident. AUTHORS' CONCLUSIONS: There is limited evidence to support sildenafil citrate as an effective treatment for ED in patients with MS. Future well designed randomised, double blinded, placebo-controlled trials with long-term duration are needed.