Proportion of contextual effects in the treatment of fibromyalgia - a meta-analysis of randomised controlled trials

Objectives: To examine the proportion of the total treatment effect that is attributable to contextual effects in randomised controlled trials (RCTs) of treatments for fibromyalgia. Methods: A systematic literature search was undertaken in Medline, Web of Science, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Allied and Complementary Medicine in September 2015. The proportion of contextualeffect (PCE) was calculated by dividing the improvement in the placebo arm by the improvement in the treatment arm. The measure was log-transformed for each trial and the random effects model was used to pool data. The primary outcome was pain. Secondary outcomes were fibromyalgia impact questionnaire (FIQ) total and fatigue. Heterogeneity was quantified using I2. Publication bias was assessed using a funnel plot and Egger's test. Subgroup analysis was undertaken to explore heterogeneity and potential determinants of the PCE. Results: 51 eligible trials (9599 participants) were identified. The PCE was 0.60 (95% CI0·56 to 0·64) for pain, 0·57 (95% CI 0·53 to 0·61) for FIQ total, and 0·63 (95% CI 0·59 to 0·68) for fatigue. The I2 was 99.4% for pain, 99.2% for FIQ total, and 97.6% for fatigue. Conclusion: More than half of the treatment effect in fibromyalgia RCTs results from non-specific contextual factors. Reporting the total treatment effect and the proportion of contextual effect in trials may help to better translate research evidence into clinical practice

The Preliminary Study on a Legal Framework Acceptance Relate to Halal Tourism in Lake Toba

Halal tourism is one form of tourism development and promotion that is anticipated to boost local economic growth and state revenue. Halal tourism aims to instill trust in Muslim visitors so that they are not hesitant to visit tourist destinations like Lake Toba where the majority of the population is non-Muslim and is one of the most popular tourist destinations. This is done to convince the tourists that these destinations welcome Muslim visitors even if Lake Toba’s population is primarily comprised of non-Muslims. The government must enact rules if halal tourism is to be practiced properly and lawfully. This study used normative and empirical research methods. Examining the rules and laws governing halal goods and tourism is done as normative research. Following surveys and interviews with villagers and business owners in the Lake Toba region, empirical research was conducted. The findings demonstrate that halal tourism is a concept that ensures the provision of the services and infrastructure required by Muslim travelers during their journey, including halal food, prayer spaces, and so forth. However, halal tourism currently has legal loopholes. Halal tourism in Lake Toba thus has advantages and disadvantages. In reality, local residents and business owners in the Lake Toba region are sympathetic to the notion, as long as it does not obliterate traditions and local culture, and does not act as a campaign to Islamize them. As a tourism marketing tactic, Indonesia can model its halal tourism policies after those of Malaysia. Keywords: preliminary study, legal frameworks, halal touris

The educational use of social networking sites among medical and health sciences students : a cross campus interventional study

Acknowledgements The authors are grateful to all students who actively participated in both phases of the study and provided valuable data for this research. Funding None.Peer reviewedPublisher PD

Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: meta-analysis of randomised controlled trials

Objective: To examine the overall treatment effect and the proportion attributable to contextual effect (PCE) in randomised controlled trials (RCTs) of diverse treatments for osteoarthritis (OA). Methods: We searched MEDLINE, EMBASE, CENTRAL, Science Citation Index, AMED, CINAHL through October 2014, supplemented with manual search of reference lists, published meta-analyses and systematic reviews. Included were RCTs in OA comparing placebo with representative complementary, pharmacological, non-pharmacological and surgical treatments. The primary outcome was pain. Secondary outcomes were function and stiffness. The overall treatment effect was defined as the improvement from baseline in the treatment group. The contextual effect was defined as that of the placebo group. The PCE was calculated by dividing the contextual effect over the overall treatment effect. The effect size (ES) of overall treatment effect and the PCE were pooled using random-effects model. Subgroup analysis and meta-regression were conducted to examine determinants of the PCE. Results: In total, 215 trials (41,392 participants) were included. The overall treatment effect for pain-reduction ranged from the smallest with lavage (ES=0.46, 95%CI: 0.24, 0.68) to the largest with topical NSAIDs (ES=1.37, 95%CI 1.19, 1.55). On average, 75% (PCE=0.75, 95%CI 0.72, 0.79) of pain reduction was attributable to contextual effect. It varied by treatment from 47% (PCE=0.47, 95%CI: 0.32, 0.70) for intra-articular corticosteroid to 91% (PCE=0.91, 95%CI: 0.60, 1.37) for joint lavage. Similar results were observed for function and stiffness. Treatment delivered by needle/injection and other means but oral medication, longer duration of treatment, larger sample size (≥100 per arm) and public funding source were associated with increased PCE for pain-reduction. Conclusions: The majority (75%) of the overall treatment effect in OA RCTs is attributable to contextual effects, rather than the specific effect of treatments. Reporting overall treatment effect and PCE, in addition to traditional ES over placebo, permits a more balanced, clinically meaningful interpretation of RCT results. This would help dispel the frequent discordance between conclusions from RCT evidence and clinical experience - the “efficacy paradox”

Occurrence Of Antibiotic Resistance In Gram Negative Bacteria Isolated From Patients At The Primary Healthcare Center In Surabaya

The objective of this study was to evaluate the occurrence of antibiotic resistance in gram negative bacteria in the Primary Healthcare Center in Surabaya. This study was a preliminary study, conducted in four Primary Healthcare Center in Surabaya during April until June 2017. Thirteen pathogens of gram negative bacteria were isolated from 49 specimens during the research period. Those isolates were 6 Klebsiella pneumoniae, 2 Klebsiella ozaenae, 2 Pseudomonas sp., 1 Salmonella paratyphi A, 1 Acinetobacter sp. and 1 Escherichia coli. The susceptibility test showed that all isolates were resistant to ampicillin, meanwhile all of Klebsiella pneumonia and Klebsiella ozaenae isolates still sensitive towards amoxicillin-clavulanat, trimethoprim-sulfamethoxazol, ciprofloxacin, and tetracycline. Furthermore, The Pseudomonas sp. and Acinetobacter sp. isolates not only resistant towards ampicillin, they also resistant to amoxicillin-clavulanat and trimethoprim-sulfamethoxazol, the Escherichia coli isolate also resistant to trimethoprim-sulfamethoxazol and tetracycline, and the Salmonella paratyphi A isolate also resistant towards ampicillin and ciprofloxacin. Based on this study, it can be concluded that all of gram negative bacteria isolated during the research period were resistant to ampicillin and there were some incidence of amoxicillin-clavulanat, trimetophrim-sulfomethoxazol, tetracycline, and ciprofloxacin resistance in gram negative bacteria isolated from patients at the four primary healthcare center in Surabaya

Health promotion activity in Kampung Biau,Bongawan

We from group 7 consist of 10 medical students and 5 nursing student had been sent to Kampung Biau, Bongawan to organize our Health Promotion event started from 24th of August until 2nd of September 2016. Coming along with us to observe our progress activity as a supervisor was Dr. Che Ismail Bin Che Noh, and our group is leads by Mr.Ephraim Koruthu Varugheese. Each member had their specific role in this group to maintain our activity progress smoothly throughout the program. Starting from the first day we arrived, the first activity that we have done is the opening ceremony for this Health Promotion that was held on the evening of the first day after we arrived. During our stay in the village, we also done several survey to get general overview about the region and health problems and then we can find some ways and took actions regarding these problems and to promote the health of the villagers. The various ways that we have done is such as: I. Rapid rural Appraisal (RRA) which includes the house-house visit, direct or field observation, key informant interview, individual interview, group meeting interview and discussion, health screening and also the social mapping. 2. Health education and health awareness by means of the exhibitions, talk, indoor and outdoor activities such as mini sports and tele match that have been participated by all the villagers from various age groups. 3. Visited to school in the area of Bongawan. This visit we aim to give a proper healthy lifestyle and talk to the student which will become the future generation to the country. For example, during our visit to the secondary school, we give a brief about the dangerous of smoking a conservative cigarette or e-cigarette. 4. Medical check-up. We held our medical check-up and health talk with the help from the local clinic in Bongawan. For example exhibition and talk for diabetes and breast cancer, the ways to prevent it. 5. Gotong-royong. We called all the villagers to joined cleaning Kg.Biau from garbage and avoid any breeding places for mosquito

The placebo effect and its determinants in fibromyalgia: meta-analysis of randomized controlled trials

The aims of this study were to determine whether placebo treatment in randomised controlled trials (RCTs) is effective for fibromyalgia and to identify possible determinants of the magnitude of any such placebo effect. A systematic literature search was undertaken for RCTs in people with fibromyalgia that included a placebo and/or a no-treatment (observation only or waiting list) control group. Placebo effect size (ES) for pain and other outcomes was measured as the improvement of each outcome from baseline divided by the standard deviation of the change from baseline. This effect was compared with changes in the no-treatment control groups. Meta-analysis was undertaken to combine data from different studies. Subgroup analysis was conducted to identify possible determinants of the placebo ES. A total of 3912 studies were identified from the literature search. After scrutiny, 229 trials met the inclusion criteria. Participants who received placebo in the RCTs experienced significantly better improvements in pain, fatigue, sleep quality, physical function, and other main outcomes than those receiving no treatment. The ES of placebo for pain relief was clinically moderate (0.53, 95%CI 0.48 to 0.57). The ES increased with increasing strength of the active treatment, increasing participant age and higher baseline pain severity, but decreased in RCTS with more women and with longer duration of fibromyalgia. In addition, placebo treatment in RCTs is effective in fibromyalgia. A number of factors (expected strength of treatment, age, gender, disease duration) appear to influence the magnitude of the placebo effect in this condition

Hubungan Kepercayaan Diri dengan Komunikasi Interpersonal pada Siswa SMPN X Cikarang Barat

Penelitian ini bertujuan untuk mengetahui hubungan antara kepercayaan diri dengan komunikasi interpersonal pada siswa SMPN X Cikarang Barat. Kepercayaan diri dan komunikasi interpersonal merupakan aspek penting dalam perkembangan sosial serta emosional remaja. Dalam konteks pendidikan, memahami hubungan antara kepercayaan diri dan komunikasi interpersonal pada siswa SMP dapat memberikan wawasan yang berharga bagi pendidikan dalam mengupaya meningkatkan kualitas interaksi sosial siswa. Metode yang digunakan dalam penelitian ini yaitu kuantitatif, dengan teknik pengambilan sambil menggunakan cluster random sampling sebanyak 168 responden yang terdiri dari tingkatan kelas VII dan VIII. Penelitian ini menggunakan dua alat ukur yaitu skala komunikasi interpersonal dari Devito dan skala kepercayaan diri dari Lauster. Data yang terkumpul dianalisis dengan korelasi pearson product moment. Hasil penelitian menunjukkan bahwa terdapat hubungan positif antara kepercayaan diri dengankomunikasi interpersonal pada siswa SMPN X Cikarang Barat. Semakin tinggi tingkat kepercayaan diri siswa, semakin baik kemampuan mereka dalam berkomunikasi. Hasil ini mengindikasikan bahwa kepercayaan diri memainkan peran penting dalam membentuk keterampilan komunikasi interpersonal siswa SMP, dengan begitu menyatakan bahwa hipotesis alternatif diterima. Saran untuk melanjutkan penelitian dan evaluasi lebih lanjut yang melibatkan sampel yang lebih banyak dan variasi sekolah yang lebih luas serta dapat menambah varibel-varibel lain

Pulpal and periapical disease in crowned vital teeth: a prospective matched cohort study

This study aimed to determine the incidence and contributing factors to pulpal and periapical disease in crowned vital teeth. Seventy-three pairs of healthy teeth were included and divided into two groups; ‘crowned’ and ‘untreated’ groups. The crowned group was prepared for full coverage crown and no treatment was carried out on the untreated group. Both groups were subjected to clinical and radiographic examination to detect endodontic signs and symptoms pre-operatively and one-week after crown cementation. Electric pulp test was also subjected to both groups, pre-operatively, after tooth preparation and before crown cementation. The incidence of pulpal and periapical disease was 6.8% and 1.4%, respectively, after tooth preparation. Factors associated with pulpal and periapical disease were exposed pulp during tooth preparation and pre-operative bone level <35%. Despite the low incidence, the occurrence of pulpal and periapical disease within a short period is noteworthy