Nonnutritive sucking and necrotizing enterocolitis. The effects of water and non‐nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial The effects of water and non-nutritive sweetened beverages on weight loss during a 12-week weight loss treatment program. Effects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake Nonnutritive Sucking during Heelstick Procedures Decreases Behavioral Distress in the Newborn Infant Promotion of preterm infant nipple feeding with nonnutritive sucking. Effect of Nonnutritive Sucking On Behavioral State In Preterm Infants Before Feeding Alcohol screening in primary care Nonnutritive sucking and oral sucrose relieve neonatal pain during intramuscular injection of hepatitis vaccine. Soothing Pain-Elicited Distress in Chinese Neonates Developmental care decreases physiologic and behavioral pain expression in preterm neonates. Hormonal responses to non-nutritive sweeteners in water and diet soda Strength indices of the proximal femur and shaft in prepubertal female gymnasts. Short-term consumption of sucralose, a nonnutritive sweetener, is similar to water with regard to select markers of hunger signaling and short-term glucose homeostasis in women. Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials The external validity of published randomized controlled trials in primary care A simple method to correct for the design effect in systematic reviews of trials using paired dichotomous data. Bone mass and structure are enhanced following a 2-year randomized controlled trial of exercise in prepubertal boys. Comparative Effectiveness of Dipeptidylpeptidase-4 Inhibitors in Type 2 Diabetes: A Systematic Review and Mixed Treatment Comparison THE INFLUENCE OF GESTATIONAL AGE ON THE EFFICACY AND SHORT‐TERM SAFETY OF SUCROSE FOR PROCEDURAL PAIN RELIEF Sympathetic Neural Mechanisms in Normal and Hypertensive Pregnancy in Humans Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review Randomized Trial of Treadmill Walking With Body Weight Support to Establish Walking in Subacute Stroke: The MOBILISE Trial
The purpose of this study was to explore the possible protective effect of nonnutritive sucking ( NNS ) against the development of necrotizing enterocolitis ( NEC ) . A retrospective chart review was conducted to examine the histories of 12 preterm infants who were enrolled in a longitudinal study of the effects of NNS on energy expenditure , weight gain , and feeding readiness . Six infants were enrolled in the control group ;  they did not receive NNS but did develop NEC .  Six infants were in the experimental group and did not develop NEC . The groups were compared on the basis of clinical correlates associated with NEC . These included race , gender , birth weight , five-minute Apgar , maternal bleeding , maternal age , and length of ruptured membranes . For infants who developed NEC , the number of clinical correlates ranged from one to four . For infants who received NNS , the range of clinical correlates was from one to five . It is not possible to conclude from this study that NNS protects preterm infants from NEC . Prospect i ve studies of larger sample sizes that involve examination of the effect of NNS on gastric motility and enzyme and hormone secretion are needed Objective To evaluate the effects of water versus beverages sweetened with non‐nutritive sweeteners ( NNS ) on body weight in subjects enrolled in a year‐long behavioral weight loss treatment program . Methods The study used a r and omized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight‐stable people with overweight and obesity . All participants participated in a weight loss program plus assignment to consume 24 ounces ( 710 ml ) of water or NNS beverages daily for 1 year . Results NNS and water treatments were non‐equivalent , with NNS treatment  showing greater weight loss at the end of 1 year . At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg ( P < 0.001 for difference ) . Conclusions Water and NNS beverages were not equivalent for weight loss and maintenance during a 1‐year behavioral treatment program . NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users  of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program . These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program OBJECTIVE To compare the efficacy of non-nutritive sweetened beverages ( NNS ) or water for weight loss during a 12-week behavioral weight loss treatment program . METHODS An equivalence trial design with water or NNS beverages as the main factor in a prospect i ve r and omized trial among 303 men and women was employed . All participants participated in a behavioral weight loss treatment program . The results of the weight loss phase ( 12 weeks ) of an ongoing trial ( 1 year ) that is also evaluating the effects of these two treatments on weight loss maintenance were reported . RESULTS The two treatments were not equivalent with the NNS beverage treatment group losing significantly more weight compared to the water group ( 5.95 kg versus 4.09 kg ; P < 0.0001 ) after 12 weeks . Participants in the NNS beverage group reported significantly greater reductions in subjective feelings of hunger than those in the water group during 12 weeks . CONCLUSION These results show that water is not superior to NNS beverages for weight loss during a comprehensive behavioral weight loss program Background : Substituting sweeteners with non-nutritive sweeteners ( NNS ) may aid in glycaemic control and body weight management . Limited studies have investigated energy compensation , glycaemic and insulinaemic responses to artificial and natural NNS . Objectives : This study compared the effects of consuming NNS ( artificial versus natural ) and sucrose ( 65 g ) on energy intake , blood glucose and insulin responses . Methods : Thirty healthy male subjects took part in this r and omised , crossover study with four treatments : aspartame- , monk fruit- , stevia- and sucrose-sweetened beverages . On each test day , participants were asked to consume a st and ardised breakfast in the morning , and they were provided with test beverage as a preload in mid-morning and ad libitum lunch was provided an hour after test beverage consumption . Blood glucose and insulin concentrations were measured every 15 min within the first hour of preload consumption and every 30 min for the subsequent 2 h. Participants left the study site 3 h after preload consumption and completed a food diary for the rest of the day . Results : Ad libitum lunch intake was significantly higher for the NNS treatments compared with sucrose ( P=0.010 ) . The energy ' saved ' from replacing sucrose with NNS was fully compensated for at subsequent meals ; hence , no difference in total daily energy intake was found between the treatments ( P=0.831 ) . The sucrose-sweetened beverage led to large spikes in blood glucose and insulin responses within the first hour , whereas these responses were higher for all three NNS beverages following the test lunch . Thus , there were no differences in total area under the curve ( AUC ) for glucose ( P=0.960 ) and insulin ( P=0.216 ) over 3 h between the four test beverages . Conclusions : The consumption of calorie-free beverages sweetened with artificial and natural NNS have minimal influences on total daily energy intake , postpr and ial glucose and insulin compared with a sucrose-sweetened beverage We investigated if nonnutritive sucking ( NNS ) during heelstick procedures alleviates behavioral distress in neonates . In our NICU , 26 neonates without severe complications ( mean Minde score 0.8 , range 0–3 ) , undergoing heelstick procedures at least twice a day , in the first 2 weeks of life , were enrolled in the trial ( mean gestational age 33.9 weeks , range 26–39 weeks , mean birth weight 1,988.5 g , range 1,200–4,010 g , mean Apgar score at the first minute 6.7 , range 4–10 , at the fifth minute 8.5 , range 6–10 ) . Two heelpricks were performed in each neonate with NNS r and omly assigned . Behavioral states , transcutaneous oxygen tension ( TcPO2 ) , heart rate , and respiratory rate were monitored before , during and after the heelstick procedures . Heelstick procedures lasted for a mean of 109 s ( range 50–230 s ) with NNS , and a mean of 128.8 s ( range 20–420 s ) without NNS . Compared with baseline , heart rate and behavioral distress increased and respiratory rate decreased during heelstick and after heelstick . Oxygen tension did not change . Nonnutritive sucking had no effect on respiratory rate or transcutaneous oxygen tension , but reduced the time of crying and the heart rate increase during the procedure . In conclusion , NNS can be recommended to reduce distress in newborns undergoing invasive routine procedures . Further studies are needed to evaluate the effects of NNS on respiratory rate and blood gas levels Transition of preterm infants from enteral to nipple feeding is a necessary milestone for hospital discharge . This study tested the efficacy of one potential intervention to facilitate the transition process . Ten minutes of nonnutritive sucking ( NNS ) and a control condition were administered r and omly before first nipple feedings . The sample consisted of 20 preterm infants ( gestational ages 27 - 33 weeks , M = 31.6 , SD = 1.7 ; birth weights 931 - 2 , 140 g , M = 1,649 , SD = 373 ) who served as their own controls . NNS result ed in fewer behavioral state changes during feedings and produced quiet , awake states more frequently during feedings . Heart rates did not differ between feedings following NNS compared with those in the control condition To describe the effect of nonnutritive sucking ( NNS ) on behavioral state ( BSt ) in preterm infants before feedings 24 preterm infants were r and omly assigned and studied before each of their first 16 bottle feedings . Twelve received NNS by pacifier for 5 minutes ; 12 did not receive a pacifier .  BSt was measured with a 12-category scale for 30 seconds before the 5-minute period ( BSt1 ) and for 30 seconds after ( BSt2 ) . Sleep states decreased for both groups . BSts considered more optimal for feeding increased more during NNS ( 86 vs. 46 ) . Restless states were three times less frequent after NNS ( 23 vs. 68 ) . Differences between groups were nonsignificant at BSt1 , but were significant at BSt2 , p < .001 . In the absence of self-regulatory feeding policies based on early hunger cues , NNS for 5 minutes prefeeding is simple , brief , and suitable for implementation in busy neonatal intensive care units . Nonnutritive sucking was an effective modulator of behavioral state for this sample Behind the numbers What should primary care doctors do about screening for alcohol problems ? Beich and colleagues ( p 590 ) seem to have provided the answer : Nothing . Some will consider their results authoritative and conclude these activities are ineffective in general practice . But as with all systematic review s and meta-analyses , there can be devils in the details . Beich et al have addressed a clinical ly important question : “ How effective is screening in general practice for identifying drinkers who can and do benefit from brief intervention ? ” The most trustworthy answer would come from a r and omized controlled trial of screening and brief intervention compared with no systematic screening or intervention , but no such studies exist.1 The results of such a trial would provide a direct measurement of the number needed to screen ( NNS ) to benefit one patient.2 In the absence of studies evaluating such direct evidence , review ers are forced to examine and link separate bodies of evidence ( Is the screening test accurate ? How effective is the intervention ? ) . With the CONTEXT Newborns are subject to pain during routine invasive procedures . Pain caused by immunization injections is preventable , but remains untreated in neonates . OBJECTIVES The purpose of the study was to compare the effectiveness of three nonpharmacological pain relief strategies on  newborns ' pain , physiological parameters , and cry duration before , during , and after hepatitis B  intramuscular ( IM ) injection . METHODS In this prospect i ve , r and omized clinical trial , we enrolled 165 newborns ( gestational age , ≥36 weeks ) . The infants received IM injections and were r and omized to three treatment groups : nonnutritive sucking ( NNS ) , 20 % oral sucrose , or routine care . Pain was measured by the Neonatal Facial Coding System , physiological signals by electrocardiogram monitors , and cry duration using a stopwatch . RESULTS Pain was significantly lower among infants in the NNS ( B=-11.27 , P<0.001 ) and sucrose ( B=-11.75 , P<0.001 ) groups than that in controls after adjusting for time effects , infant sleep/wake state , number of prior painful experiences , and baseline pain scores . Infants in the NNS and sucrose groups also had significantly lower mean heart and respiratory rates than the controls . Cry duration of infants receiving sucrose was significantly shorter than those in the NNS ( Z=-3.36 , P<0.001 ) and control groups ( Z=-7.80 , P<0.001 ) . CONCLUSION NNS and oral sucrose can provide analgesic effects and need to be given before painful procedures as brief as a one-minute IM injection . Sucrose orally administered two minutes before injection more effectively reduced newborns ' pain during injection than NNS . Both nonpharmacological methods more effectively relieved newborns ' pain , stabilized physiological parameters , and shortened cry duration  during IM hepatitis injection than routine care Objective . To test the effect of nonnutritive sucking ( NNS ) , music therapy ( MT ) , and combined NNS and MT ( NNS + MT ) , versus no intervention , on heart rate , transcutaneous oxygen ( TcPao 2 ) levels , and pain behavior of neonates in intensive care units having blood taken by a heel-stick procedure . Methodology . A within-subjects , counter-balancing , repeated- measures design conducted in a government-funded hospital in Hong Kong , comparing TcPao 2 levels , heart rate , and pain behavior outcomes in 27 neonates . Results . Repeated- measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions ( Wilk 's λ = .142 ; F[3,27 ] = 31.82 ; η2 = .47 ) . One-way analysis of variance revealed that the 3 comfort interventions significantly reduced neonates ' heart rate ( Wilk 's λ = .647 ; F[2,27 ] = 18.93 ; η2 = .35 ) , improved their TcPao 2 levels ( Wilk 's λ = .481;F [ 2,27 ] = 37.42 ; η2 = .51 ) , and reduced their pain behavior ( Wilk 's λ = .312 ; F [ 2,27 ] = 76.42 ; η2 = .68 ) . Posthoc scheffe tests revealed that NNS + MT had the strongest effect on neonates ' TcPao 2 levels and pain behavior ; MT alone had the strongest effect on neonates ' heart rate . Conclusions . Health professionals using NNS + MT when doing heel-sticks can improve the TcPao 2 levels of neonates and reduce their pain . Using MT alone can improve the heart rate of neonates Pain expression in the neonate ( NN ) is affected by intrinsic and extrinsic factors ( gestational and postconceptional age , states , and painful experiences ) . The impact of developmental care is discussed in relation to defined pain expression . The aim of this r and omized crossover study was to determine the impact of developmental care on pain expression during a nursing intervention in preterm NNs . Nineteen preterm NNs ( gestational age , 29 + /- 1.8 weeks body weight , 1212 + /- 255 g ) were included . Each NN experienced 2 r and omly ordered diaper changes ( with and without developmental support ) . Physiologic responses ( heart rate , oxygen saturation , hypoxic events with SaO(2 ) less than 80 % , bradycardia less than 80 beats/min ) were studied during 3 periods : baseline , diaper change ( time 0 ) , and recovery period . Pain expression was evaluated with 2 pain scales : chronic pain with Echelle Douleur et Inconfort ( [ EDIN ] or Pain and discomfort scale for newborns ) at time B60 minutes , 0 , + 30 minutes , and + 60 minutes and procedural pain with the Preterm Infant Pain Profile ( PIPP ) at time 0 . Statistical analysis was conducted with a Wilcoxon nonparametric test . PIPP , EDIN 0 , EDIN + 30 minutes , and EDIN + 60 minutes scores were significantly decreased with developmental care versus without developmental care : 8.7 + /- 1.9 v 11.1 + /- 2.36 ( P < .01 ) 0.6 + /- 0.5 v 3.2 + /- 2.9 ( P < .01);0.33 + /- 0.5 v 3.9 + /- 2.5 ( P < .001);0.3 + /- 3.4 v 3.4 + /- 3 ( P < .001 ) , respectively . Hypoxic events rate was decreased with developmental care during the baseline and diaper change periods . The lowest oxygen saturation observed during the PIPP measure was significantly higher with developmental care ( 88.8 % + /- 3 % v 81.8 % + /- 4 % P < .01 ) . Developmental care significantly decreased the PIPP and EDIN pain scores and hypoxic events during a routine nursing intervention Background Non-nutritive sweeteners ( NNS ) , especially in form of diet soda , have been linked to metabolic derangements ( e.g. obesity and diabetes ) in epidemiologic studies . We aim ed to test acute metabolic effects of NNS in isolation ( water or seltzer ) and in diet sodas . Methods We conducted a four-period , cross-over study at the National Institutes of Health Clinical Center ( Bethesda , Maryl and ) . Thirty healthy adults consumed 355 mL water with 0 mg , 68 mg , 170 mg , and 250 mg sucralose , and 31 individuals consumed 355 mL caffeine-free Diet Rite Cola ™ , Diet Mountain Dew ™ ( 18 mg sucralose , 18 mg acesulfame-potassium , 57 mg aspartame ) , and seltzer water with NNS ( 68 mg sucralose and 41 mg acesulfame-potassium , equivalent to Diet Rite Cola ™ ) in r and omized order , prior to oral glucose tolerance tests . Blood sample s were collected serially for 130 min . Measures included GLP-1 , GIP , glucose , insulin , C-peptide , glucose absorption , gastric emptying , and subjective hunger and satiety ratings . Results Diet sodas  augmented active GLP-1 ( Diet Rite Cola ™ vs. seltzer water , AUC , p = 0.039 ; Diet Mountain Dew ™ vs. seltzer water , AUC , p = 0.07 ) , but gastric emptying and satiety were unaffected . Insulin concentrations were nominally higher following all NNS conditions without altering glycemia . Sucralose alone ( at any concentration ) did not affect metabolic outcomes . Conclusions Diet sodas but not NNS in water augmented GLP-1 responses to oral glucose . Whether the trends toward higher insulin concentrations after NNS are of clinical importance remains to be determined . Our findings emphasize the need to test metabolic effects of NNS after chronic consumption . Trial registration The data for this manuscript were gathered from clinical trial # NCT01200940 INTRODUCTION / PURPOSE The role of impact loading activity on bone mass is well established ; however , there are little data on the effects of exercise on bone geometry and indices of bone strength . The primary purpose of this study was to compare indices of bone strength at the proximal femur ( PF ) between elite premenarcheal gymnasts ( N= 30 ) and age-matched controls ( N= 30 ) . METHODS Structural properties of the proximal femur were derived from the hip analyses program and included measurement of subperiosteal width , endosteal diameter , cross-sectional area , bone mineral density , cross-section moment of inertia ( CSMI ) , and section modulus ( Z ) . These parameters were measured for two regions of the PF : the narrow neck ( NN ) , and the shaft ( S ) . In addition , a strength index ( S-SI ) was calculated at the shaft by dividing the Z at the shaft by the femur length . A secondary purpose was to compare bone mineral content ( BMC ) values at the total body , lumbar spine , and three sites at the PF ( neck , trochanter , and total ) between the groups . All dependent values were compared adjusting for height and weight using an ANCOVA procedure and for relative lean body mass . RESULTS The gymnasts had significantly greater size-adjusted strength indices ( CSMI , Z , and SI ) at the NN and S. Gymnasts also had significantly greater size-adjusted BMC at all sites investigated . However , these differences disappeared when adjusted for relative lean body mass . CONCLUSION When adjusted for body size , gymnasts had significantly greater indices of both axial strength and bending strength at the NN region of the PF and S , as well as a greater bone SI at the femoral shaft . These differences may be related to greater relative lean body mass attained in gymnastics training Nonnutritive sweeteners have been used to lower the energy density of foods with the intention of affecting weight loss or weight maintenance . However , some epidemiological and animal evidence indicates an association between weight gain or insulin resistance and artificial sweetener consumption . In the present study , we hypothesized that the nonnutritive sweetener sucralose , a trichlorinated sucrose molecule , would elicit responses similar to water but different from sucrose and sucrose combined with sucralose on subjective and hormonal indications of hunger and short-term glucose homeostasis . Eight female volunteers ( body mass index , 22.16 ± 1.71 kg/m(2 ) ; age , 21.75 ± 2.25 years )  consumed sucrose and /or sucralose in water in a factorial design . Blood sample s were taken at fasting and 30 and 60 minutes after treatment followed by a st and ardized breakfast across treatments , and blood sample s were taken 30 , 60 , 90 , and 120 minutes after breakfast . Plasma was analyzed for glucose , insulin , glucagon , triacylglycerols ( TAG ) , and acylated ghrelin . Perceptions of hunger and other subjective measurements were assessed before each blood sample . No differences were detected in subjective responses , circulating triacylglycerol , or glucagon concentrations among treatments over time . Significant differences were observed in insulin , glucose , and acylated ghrelin concentrations over time only between sucrose-containing treatments and non-sucrose-containing treatments regardless of sucralose consumption . Therefore , sucralose may be a relatively inert nonnutritive sweetener with regard to hunger signaling and short-term glucose homeostasis Background The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace . We conducted a systematic review to ( i ) examine the effectiveness of workplace-based diet and /or physical activity interventions aim ed at healthcare professionals and to ( ii ) identify and describe key components of effective interventions . Seven electronic data bases were systematic ally search ed . Results Thirteen r and omised controlled trials met the inclusion criteria , of which seven had data available for meta- analysis . Where meta- analysis was possible , studies were grouped according to length of follow-up ( < 12 months and ≥12 months ) and behavioural target ( diet only , physical activity only or diet and physical activity ) , with outcome data pooled using a weighted r and om effects model . Nine studies reported statistically significant ( between-group ) differences . Four studies reported being informed by a behaviour change theory . Meta- analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight ( −3.95 Kg , [ 95 % CI −4.96 to- 2.95 Kg ] ) than controls up to 12 months follow up . Conclusions Workplace diet and /or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous . To improve the evidence base , we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content Background A criticism of R and omized Controlled Trials ( RCTs ) in primary care is that they lack external validity , participants being unrepresentative of the wider population . Our aim was to determine whether published primary care-based RCTs report information about how the study sample is assembled , and whether this is associated with RCT characteristics . Methods We review ed  RCTs published in four primary care journals in the years 2001–2004 . Main outcomes were : ( 1 ) eligibility fraction ( proportion eligible of those screened ) , ( 2 ) enrolment fraction ( proportion r and omised of those eligible ) , ( 3 ) recruitment fraction ( proportion of potential participants actually r and omised ) , and ( 4 ) number of patients needed to be screened ( NNS ) in order to r and omize one participant . Results A total of 148 RCTs were review ed . One hundred and three trials ( 70 % ) reported the number of individuals assessed by investigators for eligibility , 119 ( 80 % ) reported the number eligible for participation , and all reported the actual number recruited . The median eligibility fraction was 83 % ( IQR 40 % to 100 % ) , and the median enrolment fraction was 74 % ( IQR 49 % to 92 % ) . The median NNS was 2.43 , with some trials reportedly recruiting every patient or practice screened for eligibility , and one trial screening 484 for each patient recruited . We found no association between NNS and journal , trial size , multi- or single-centre , funding source or type of intervention . There may be associations between provision of sufficient recruitment data for the calculation of NNS and funding source and type of intervention . Conclusion RCTs reporting recruitment data in primary care suggest that once screened for eligibility and found to match inclusion criteria patients are likely to be r and omized . This finding needs to be treated with caution as it may represent inadequate identification or reporting of the eligible population . A substantial minority of RCTs did not provide sufficient information about the patient recruitment process BACKGROUND AND OBJECTIVES In systematic review s of interventions of studies where r and omization was done by individual but data are paired ( such as eyes , ears ) , it is necessary to account for the natural clustering present . The Cochrane H and book suggests treating these as examples of cluster r and omized trials . An incorrect analysis ( without adjustment ) would usually overestimate the precision of the estimate . We discuss a simple method of adjustment that deals with this problem . METHODS From a cross-tabulation of the event being present on the " left " and " right " body part , we estimate the design effect which is a measure of the inflation on the variance due to clustering . This estimate is then used to obtain an adjusted effect size per trial by reducing the number of events and the sample size in each intervention group . RESULTS In a systematic review on Auto-inflation for Glue Ear , data on improvement were obtained for pairs of ears . The design effect obtained from these data was 1.25 . In a meta- analysis , the weights given to the trials changed after adjustment from 33 % to 11 % in one case . CONCLUSION In a systematic review , when dealing with paired data , it is possible to give adequate weighting to each trial using a simple adjusting method Exercise during growth has a positive influence on bone mineral accrual , yet little is known about how bone geometry and strength adapt to loading during growth . Our primary objective was to compare changes in proximal femur bone geometry and strength between 31 prepubertal ( Tanner Stage 1 ) boys who participated in a school-based , high-impact circuit intervention ( 12 min , three times a week ) for 20 months and 33 maturity-matched controls . Our secondary objective was to compare changes in total body ( TB ) , proximal femur ( PF ) , and lumbar spine ( LS ) bone mineral content ( BMC ) and bone area ( BA ) in these groups . We assessed geometric variables and bone strength at the narrow neck ( NN ) , intertrochanteric ( TR ) region , and femoral shaft regions by applying the Hip Structure Analysis program to proximal femur dual energy X-ray absorptiometry scans ( DXA , Hologic QDR 4500 ) . Further , we assessed total body , lumbar spine , and proximal femur BMC and BA by DXA and derived total body lean mass and fat mass from total body scans . Intervention ( 10.2 + /- 0.5 years ) and control boys ( 10.1 + /- 0.5 years ) had similar baseline height ( 140.8 vs. 141.3 cm ) and weight ( 36.9 vs. 35.4 kg ) , and average 20-month physical activity scores ( Physical Activity Question naire for Children , PAQ-C ) and calcium intakes ( 861 vs. 852 mg/day , food frequency question naire ) . Twenty-month height and weight changes were not significantly different between groups ; lean mass changed more ( P < 0.05 ) in intervention boys ( 22.8 % ) than control boys ( 18.6 % ) . At the NN region , intervention boys had greater bone expansion on both the periosteal ( + 2.6 % , P = 0.1 ) and endosteal ( + 2.7 % , P = 0.2 ) surfaces , result ing in significantly greater changes in section modulus ( bone bending strength ) ( + 7.5 % , P = 0.02 , ANCOVA , adjusting for height change , final Tanner Stage , and baseline bone values ) . Changes at the intertrochanteric and femoral shaft regions were not significantly different between groups . Femoral neck ( FN ) BMC changes were significantly greater in intervention boys ( + 4.3 % , P < 0.01 ) ; changes in BA and BMC for other regions were not significantly different between groups . In summary , a school-based , high-impact exercise intervention implemented three times a week for 12 min is an effective strategy for site-specific gains in bone strength at the narrow neck region of the proximal femur Objective To compare the safety and efficacy of the dipeptidylpeptidase-4 ( DPP-4 ) inhibitors in patients with type 2 diabetes and inadequate glycemic control . Design Systematic review of r and omized controlled trials ( RCTs ) , health economic evaluation studies , systematic review s , and meta-analyses , followed by primary Bayesian mixed treatment comparison meta-analyses ( MTCs ) , and secondary frequentist direct-comparison meta-analyses using a r and om-effects model . Outcomes were reported as weighted mean change from baseline , or odds ratio ( OR ) with 95 % credible interval . Data sources MEDLINE , MEDLINE In-Process , EMBASE , and BIOSIS via Dialog ProQuest ; Cochrane Central Register of Controlled Trials and Cochrane Data base of Systematic Review s via EBSCO ; four diabetes and two technical congress abstract s ; and health technology assessment organization websites . Eligibility criteria Patients with type 2 diabetes and inadequate glycemic control receiving any pharmacological anti-diabetic treatment . Data extraction and analysis Title/ abstract s were review ed for eligibility , followed by full-text review of publications remaining after first pass . A three-person team filtered articles and an independent review er checked a r and om selection ( 10 % ) of filtered articles . Data extraction and quality assessment of studies were also independently review ed . Five DPP-4 inhibitors ( alogliptin , linagliptin , saxagliptin , sitagliptin , and vildagliptin ) were compared via meta- analysis ( where data were available ) as monotherapy , dual therapy ( plus metformin , sulfonylurea , pioglitazone , or insulin ) , and triple therapy ( plus metformin/sulfonylurea ) . Results The review identified 6,601 articles ; 163 met inclusion criteria and 85 publications from 83 RCTs contained sufficient or appropriate data for analysis . MTCs demonstrated no differences between DPP-4 inhibitors in mean change from baseline in glycosylated hemoglobin ( HbA1c ) or body weight , or the proportions of patients achieving HbA1c < 7 % or experiencing a hypoglycemic event , apart from in patients on alogliptin plus metformin , who achieved HbA1c < 7 % more frequently than those treated with saxagliptin plus metformin [ OR 6.41 ( 95 % CI 3.15–11.98 ) versus 2.17 ( 95 % CI 1.56–2.95 ) ] . Conclusions This systematic review and MTC showed similar efficacy and safety for DPP-4 inhibitors as treatment for type 2 diabetes , either as monotherapy or combination therapy BACKGROUND Physiologic and behavioral responses to procedural pain are influenced by gestational age ( GA ) . Compared with term neonates , hospitalized preterm neonates are subjected to more painful procedures aim ed at improving their clinical outcome . Although several trials to determine the efficacy of sucrose for managing procedural pain have been conducted , none have examined the influence of GA . OBJECTIVES To examine the influence of GA on the efficacy and short-term safety of oral sucrose for relieving procedural pain associated with heel lances . To explore GA differences in behavioral and physiologic indicators of pain . METHODS As part of a larger r and omized controlled trial ( RCT ) to examine the efficacy and safety of sucrose during heel lance , 190 neonates were stratified by GA : ( a ) 27 to 31 6/7 weeks ( group 1 ; n = 63 ) , ( b ) 32 to 35 6/7 weeks ( group 2 ; n = 63 ) , and ( c ) > 36 weeks ( group 3 ; n = 64 ) . They were then r and omized to receive ( a ) oral sucrose and non-nutritive sucking ( NNS ) , ( b ) sucrose alone , or ( c ) sterile water and NNS ( control ) for a heel lance . The influence of GA was determined by examining the short-term safety , as defined by the number of associated adverse events ( choking , coughing or vomiting , sustained tachycardia , sustained tachypnea or dyspnea , or sustained oxygen desaturation ) . The efficacy was measured by changes in a vali date d pain measure , scored during each phase of the intervention and analyzed according to GA groups . RESULTS Significant differences in pain response existed in each GA group , with the lowest mean pain scores in the sucrose and NNS group . Significant GA differences in behavioral and physiologic responses were found , with the most mature neonates demonstrating the greatest magnitude of pain response . The greatest number of short-term adverse effects to treatment occurred in the lowest GA group . CONCLUSIONS In a secondary analysis of a larger RCT , sucrose and NNS was the most efficacious intervention for single heel lances in each of 3 GA groups . However , infants of lower GA experienced more adverse events . Research on the efficacy and safety of repeated doses of oral sucrose , tested in infants from a wide range of GA , is required Background —Direct recordings from peripheral sympathetic nerves have shown an increased sympathetic drive in pregnancy-induced hypertension ( PIH ) and preeclampsia ( PE ) . It is unknown whether sympathetic drive is altered in normal pregnancy , when arterial blood pressure can be normal or relatively low . The aim of this study was to measure and compare peripheral sympathetic discharge , its vasoconstrictor effect and its baroreceptor control , during pregnancy and postpartum in women with normal pregnancy ( NP ) and PIH and in normotensive nonpregnant ( NN ) women . Methods and Results —Twenty-one women with NP , 18 women with PIH , and 21 NN women had  muscle sympathetic nerve activity  assessed from multiunit discharges ( MSNA ) and from single units with defined vasoconstrictor properties ( s-MSNA ) . The s-MSNA in NP ( 38±6.6 impulses/100 beats ) was greater ( P < 0.05 ) than in NN women ( 19±1.8 impulses/100 beats ) despite similar age and body weight but less than in PIH women ( P < 0.001 ) ( 146±23.5 impulses/100 beats ) . MSNA followed a similar trend . Cardiac baroreceptor reflex sensitivity ( BRS ) was impaired in NP and PIH women relative to NN . After delivery , sympathetic activity decreased to values similar to those obtained in NN , and there was an increase in BRS . In women with NP , the decrease in sympathetic output occurred despite an insignificant change in blood pressure . Conclusions — Central sympathetic output was increased in women with normal pregnancy and was even greater in the hypertensive pregnant group . The findings suggest that the moderate sympathetic hyperactivity during the latter months of normal pregnancy may help to return the arterial pressure to nonpregnant levels , although when the increase in activity is excessive , hypertension may ensue Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community ( non‐institutional care ) . Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team ‐ for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta‐analyses , systematic review s , r and omised control trials , quasi‐experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Search strategy The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . Assessment of quality Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . Data collection and analysis St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta‐ analysis . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . Results A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty‐five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta‐ analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta‐ analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well‐being , self‐efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta‐ analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . Effectiveness of intervention type Four categories of intervention were included in the review ‐ psycho‐educational , support , multi‐component and other . Psycho‐educational Thirteen studies used  psycho‐educational interventions , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta‐ analysis . No significant impact of psycho‐educational interventions was found for the outcome categories of subjective well‐being , self‐efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta‐ analysis and demonstrated a small but significant improvement on caregiver burden . Multi‐component Twelve of the studies report multi‐component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self‐efficacy , depression , subjective well‐being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta‐ analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits .  Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . Effectiveness of interventions using specific outcome categories In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on  caregiver depression was available for meta‐ analysis from eight studies . This indicated that multi‐component and psycho‐educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta‐ analysis and findings indicated that there were no significant effects of any of interventions . No meta‐ analysis was possible for the outcome categories of health , self‐efficacy or subjective well‐being . Implication s for practice From this review there is evidence to support the use of well‐ design ed psycho‐educational or multi‐component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved Encourage active participation in educational interventions for caregivers Offer individualised programs rather than group sessions Provide information on an ongoing basis , with specific information about services and coaching regarding their new role Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which : Simply refer caregivers to support groups Only provide self help material s Only offer peer Background and Purpose — The main objective of this r and omized trial was to determine whether treadmill walking with body weight support was effective at establishing independent walking more often and earlier than current physiotherapy intervention for nonambulatory stroke patients . Methods — A r and omized trial with concealed allocation , blinded assessment , and intention-to-treat analysis was conducted . One hundred twenty-six stroke patients who were unable to walk were recruited and r and omly allocated to an experimental or a control group within 4 weeks of stroke . The experimental group undertook up to 30 minutes per day of treadmill walking with body weight support via an overhead harness whereas the control group undertook up to 30 minutes of overground walking . The primary outcome was the proportion of participants achieving independent walking within 6 months . Results — Kaplan – Meier estimates of the proportion of experimental participants who achieved independent walking were 37 % compared with 26 % of the control group at 1 month , 66 % compared with 55 % at 2 months , and 71 % compared with 60 % at 6 months ( P=0.13 ) . The experimental group walked 2 weeks earlier , with a median time to independent walking of 5 weeks compared to 7 weeks for the control group . In addition , 14 % ( 95 % CI , −1–28 ) more of the experimental group were discharged home . Conclusions — Treadmill walking with body weight support is feasible , safe , and tends to result in more people walking independently and earlier after stroke . Trial Registration — NN Clinical Trial.gov ( NCT00167531 )
When comparing NNS vs sucrose , significant weight/ BMI differences appeared favouring NNS .
Consumption of NNS led to significantly negative weight/ BMI differences in unrestricted energy diets , but not in weight-reduction diets .
Participants with overweight/obesity and adults showed significant favourable weight/ BMI differences with NNS .
Data suggest that replacing sugar with NNS leads to weight reduction , particularly in participants with overweight/obesity under an unrestricted diet , information that could be utilized for evidence -based public policy decisions
There is an ongoing debate about the possible influences of nonnutritive sweeteners ( NNS ) on body weight .
We conducted a systematic review and meta- analysis of r and omized controlled trials ( RCTs ) with NNS to assess their impact on body weight .