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Efficacy and safety of pharmacotherapy for smoking cessation among pregnant smokers: a meta-analysis

The review concluded there may be clinical evidence to support use of pharmacotherapy for smoking cessation among pregnant women smokers but further randomised controlled trials were needed. The authors' conclusion is cautious but the paucity of the evidence base and some limitations in the review process mean the reliability of the conclusions is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: a systematic evidence review for the US Preventive Services Task Force

The authors concluded that interventions in primary care might prevent smoking initiation, over 12 months, in children and adolescents, but further research was advised. These cautious conclusions reflect the evidence presented and appear to be broadly reliable, despite the exclusion of trials of low quality or not reported in English.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Smoking cessation in severe mental illness: what works?

The authors concluded treating tobacco dependence was effective in patients with severe mental illness. Treatments that worked in the general population worked for those with severe mental illness and appeared approximately equally effective. Treating tobacco dependence in patients with stable psychiatric conditions did not worsen mental state. The authors' conclusions reflect the evidence presented and are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Obesity Management Interventions Delivered in Primary Care for Patients with Hypertension or Cardiovascular Disease: A Review of Clinical Effectiveness [Internet]

The first-line strategy for the treatment of obesity and prevention of cardiometabolic disease is achieving weight loss. Lifestyle measures, which consist of reductions in caloric intake by between 500 to 1000 calories per day, together with increases in physical activity and changes in health behaviors, are the cornerstone of prevention and treatment of obesity. However, maintenance of behavioral changes associated with weight loss can be challenging and short-term improvements commonly fail to be translated into long-term behavioral maintenance. Therefore, adding anti-obesity drugs in obese patients who do not achieve sufficient weight loss or who find it difficult to maintain initial weight loss after lifestyle modifications may be a good strategy for patients who can safely use them.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: July 9, 2014
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Suicide Prevention Interventions and Referral/Follow-Up Services: A Systematic Review [Internet]

Suicide is the tenth leading cause of death in the United States (US), with nearly 100 suicides occurring each day and over 36,000 dying by suicide each year. Among Veterans and current military, suicide is a national public health concern. Recent estimates suggest current or former military represent 20 percent of all known suicides in the US and the rate of suicides among Veterans utilizing Veterans Health Administration (VHA) services is estimated to be higher than the general population. The enormity of the problem has led to several major public health initiatives and a growth in research funding for suicide prevention.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: March 2012
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What is the clinical effectiveness and cost-effectiveness of cytisine compared with varenicline for smoking cessation? A systematic review and economic evaluation

The study found that both varenicline and cytisine are effective interventions to aid in the cessation of smoking compared with placebo control. Cytisine was shown to have the greater expected efficacy and was estimated to be more cost-effective compared with varencline. The review was limited by inclusion of only two studies on cytisine and, therefore, a head-to-head trial of varenicline and cysitine is recommended.

Health Technology Assessment - NIHR Journals Library.

Version: May 2014
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Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Interventions to prevent smoking uptake or encourage cessation among children or adolescents may help slow or halt increased tobacco-related illness.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: December 2012
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Screening for Depression in Adults: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Depression is relatively common in primary care patients but is not always identified by primary care providers.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: January 2016
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Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders

This guideline has been developed to advise on the identification, treatment and management of the eating disorders anorexia nervosa, bulimia nervosa and related conditions. The guideline recommendations have been developed by a multidisciplinary group of health care professionals, patients and their representatives, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with eating disorders while also emphasising the importance of the experience of care for patients and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2004
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Screening for Child and Adolescent Depression In Primary Care Settings: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Depression among youth is a relatively common, disabling condition that is associated with serious long-term morbidities and risk of suicide. The majority of depressed youth, however, are undiagnosed and untreated, despite opportunities for identification in settings such as primary care.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: April 2009
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Systematic Review of Suicide Prevention in Veterans [Internet]

This systematic review updates evidence on the accuracy of methods to identify individuals at increased risk for suicide, and the efficacy/effectiveness and adverse effects of healthcare service interventions in reducing suicide and other suicidal self-directed violence. Important areas of ongoing research and current evidence gaps on suicide prevention are also addressed. This report includes studies relevant to healthcare services provided to Veterans and military personnel in the United States (US), and updates 3 previous Department of Veterans Affairs (VA) Evidence-based Synthesis Program (ESP) reviews on these topics.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: November 2015
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Medications to help people to stop smoking: an overview of reviews

Smoking is a main cause of early death throughout the world. There are a number of medications which can help people to quit smoking. Three of these, nicotine replacement therapy (NRT), bupropion and varenicline, are licensed for this purpose in the USA and Europe. Cytisine (similar to varenicline) is licensed for use in Russia and Eastern Europe. We reviewed studies of these and other treatments, including nortriptyline, to compare their benefits and risks.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Are there any effective interventions to help individuals with depression to quit smoking?

People with depression are very often heavy smokers. We wanted to know whether treatments to help people quit smoking are effective for people with current depression or with a history of depression. In this review, treatments were divided into those with or without specific attention to handling depression. We found that smoking cessation treatments with specific attention to handling depression helped smokers who suffered from depression to quit. Psychosocial 'mood management' interventions, where participants learn how to handle depressive symptoms with psychological techniques, were effective in those with current depression and with a history of it. Bupropion, an antidepressant medication to help quit smoking, has been shown to be effective for smoking cessation in healthy smokers. Our findings show that bupropion may benefit smokers with a history of depression as well. However, this was not found for those with current depression. There was a lack of evidence for the effectiveness of other antidepressants to help smokers with a history of depression to quit. There was also not enough evidence for the use of antidepressants in smokers with current depression. Although treatments without specific attention to handling depression, such as nicotine replacement therapy and standard psychosocial smoking cessation interventions, have been shown to help other groups of people to quit smoking, there was not enough evidence to show that they were helpful in people with a history of or with current depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Relapse prevention in UK Stop Smoking Services: current practice, systematic reviews of effectiveness and cost-effectiveness analysis

Smoking remains a major, international cause of death and disease, and killed approximately 80,000 people in England in 2007. Reducing smoking is a major priority for governments and health systems like the UK National Health Service (NHS). The UK has implemented a comprehensive tobacco control strategy over recent years, involving a combination of population tobacco control interventions (such as price rises, advertising ban, smoke-free legislation) combined with treatment for dependent smokers through a national network of NHS Stop Smoking Services (NHS SSS). The NHS SSS provide evidence-based smoking cessation treatment, which is highly cost-effective. In England, over 4 million people have set a quit date through the services since their inception in 2000, with over 4 million of these having stopped smoking 4 weeks after their quit date. However, it is estimated that approximately 75% of these '4-week quitters' will have subsequently relapsed back to smoking ('relapsers') 6 months after their quit date. This project aimed to investigate whether and how the NHS SSS could reduce this proportion of relapsers, by providing relapse prevention interventions (RPIs) or treatments in order to improve the effectiveness of services in helping smokers to stop.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2010

Interventions for preventing weight gain after smoking cessation

When giving up smoking, most people put on weight. Many smokers are concerned about this and say it may put them off making an attempt quit. Some studies show that weight gain also leads to people resuming smoking after an initially successful quit attempt. On the other hand, there are good reasons to believe that trying to limit weight gain may reduce the chance of stopping smoking. Several drug and behavioural programmes to limit post cessation weight gain have been tested. Of the drug treatments, naltrexone showed the most promise, but there were no data on its effects on weight once drug treatment stopped and there was not enough evidence to judge its effects on long term quitting. Weight management education alone did not limit weight gain and may undermine cessation. Weight management education with personalised support giving feedback on personal goals and a personal energy prescription limited weight gain and there was no evidence that it undermined cessation. Intermittent use of a VLCD improved cessation success and weight gain in the short term but not in the longer term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

[Antidepressants for prevention of winter depression]

Many people in northern latitudes suffer from winter blues, which occurs as a reaction to reduced sunlight. Three‐quarters of those affected are women. Lethargy, overeating, craving for carbohydrates and depressed mood are common symptoms. In some people, winter blues becomes depression, which seriously affects their daily lives. Up to two‐thirds experience depressive symptoms every winter.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Long‐term effects of weight‐reducing drugs in people with elevated blood pressure

Doctors often recommend that people who are overweight or obese with elevated blood pressure lose weight, which may include taking anti‐obesity drugs to assist in weight and blood pressure reduction. Two active ingredients (rimonabant and sibutramine) were withdrawn from the market in 2009 and 2010, respectively. Current guidelines for the pharmacological management of obesity quote five medications (orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion, and liraglutide) that have been approved for long‐term weight reduction by the US Food and Drug Administration. However, two of these drugs (phentermine/topiramate and lorcaserin) did not obtain approval in Europe.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Drug treatments for stopping smoking in pregnancy

Smoking during pregnancy harms women and infants. Women who continue to smoke during pregnancy generally are poorer and more poorly educated and are more likely to have no partner or have a partner who smokes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Strategies for managing sexual dysfunction caused by antidepressants

Antidepressants can have numerous effects on sexual function including altered sexual desire, erection difficulties and orgasm problems. This systematic review investigated different ways to manage such sexual dysfunction. We included 23 randomised studies, with a total of 1886 participants who had developed their sexual problems while taking antidepressant medication. Twenty‐two of these studies looked at the addition of further medication to the ongoing treatment for depression. For men with antidepressant‐induced erectile dysfunction, the addition of sildenafil (Viagra; three studies, 255 participants) or tadalafil (Cialis; one study, 54 participants) appeared to improve the situation. For women with antidepressant‐induced sexual dysfunction the addition of bupropion (Wellbutrin, Zyban; three studies, 482 participants) at higher doses appears to be the most promising approach studied so far, but further data from randomised trials are likely to be required before it can be recommended confidently. We did not find evidence that any intervention led to a worsening of psychiatric symptoms; however, we cannot be confident of this for many of the interventions studied, as only small numbers of participants have been studied so far.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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