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An evaluation of the BIOSELF 110 fertility indicator

Ismail M, Arshat H, Pulcrano J, Royston P, Spieler J

Contraception, 1989 Jan;39(1):53-71.
PMID: 2642781

The BIOSELF 110 is a hand-held, non-invasive electronic instrument that measures basal body temperature and cycle length, and automatically identifies the fertile and infertile phases of the menstrual cycle with flashing red light and green light signals, respectively. The device was evaluated in 77 cycles from 33 ovulatory women in Kuala Lumpur, Malaysia. Ultrasound monitoring of maximum follicular diameter (MFD) and urinary LH measurements with Ovustick were used as reference methods to estimate the time of ovulation and the fertile period. Based on the MFD day, the BIOSELF correctly identified the entire fertile period, and at least four fertile days, in 89% and 94% of the cycles studied, respectively. The mean duration of the fertile period as determined by the number of flashing red light days was 11.0 days (SD 2.9). The device correctly identified the onset of the postovulatory infertile phase in 94% of cycles, with a mean duration of about 10 (green light) days. The results were similar using the LH peak day as the reference method. The mean interval from the onset of the fertile period (first flashing red light day) to the MFD day was 6.9 days (SD 2.6), and from the MFD day to the end of the fertile period, 3.1 days (SD 2.2). The BIOSELF 110 showed itself to be a reliable device for identifying the fertile and infertile phases of the menstrual cycle and, thus, should be a useful aid for couples seeking pregnancy. Prospective clinical trials are underway to assess the contraceptive effectiveness of the device.

Matched MeSH terms: Time Factors
An evaluation of tocotrienol ethosomes for transdermal delivery using Strat-M® membrane and excised human skin

Nair RS, Billa N, Leong CO, Morris AP

Pharm Dev Technol, 2021 Feb;26(2):243-251.
PMID: 33274672 DOI: 10.1080/10837450.2020.1860087

Tocotrienol (TRF) ethosomes were developed and evaluated in vitro for potential transdermal delivery against melanoma. The optimised TRF ethosomal size ranged between 64.9 ± 2.2 nm to 79.6 ± 3.9 nm and zeta potential (ZP) between -53.3 mV to -62.0 ± 2.6 mV. Characterisation of the ethosomes by ATR-FTIR indicated the successful formation of TRF-ethosomes. Scanning electron microscopy (SEM) images demonstrated the spherical shape of ethosomes, and the entrapment efficiencies of all the formulations were above 66%. In vitro permeation studies using full-thickness human skin showed that the permeation of gamma-T3 from the TRF ethosomal formulations was significantly higher (p

Matched MeSH terms: Time Factors
An expectation-maximization algorithm based Kalman smoother approach for single-trial estimation of event-related potentials

Ting CM, Samdin SB, Salleh ShH, Omar MH, Kamarulafizam I

Annu Int Conf IEEE Eng Med Biol Soc, 2012;2012:6534-8.
PMID: 23367426 DOI: 10.1109/EMBC.2012.6347491

This paper applies an expectation-maximization (EM) based Kalman smoother (KS) approach for single-trial event-related potential (ERP) estimation. Existing studies assume a Markov diffusion process for the dynamics of ERP parameters which is recursively estimated by optimal filtering approaches such as Kalman filter (KF). However, these studies only consider estimation of ERP state parameters while the model parameters are pre-specified using manual tuning, which is time-consuming for practical usage besides giving suboptimal estimates. We extend the KF approach by adding EM based maximum likelihood estimation of the model parameters to obtain more accurate ERP estimates automatically. We also introduce different model variants by allowing flexibility in the covariance structure of model noises. Optimal model selection is performed based on Akaike Information Criterion (AIC). The method is applied to estimation of chirp-evoked auditory brainstem responses (ABRs) for detection of wave V critical for assessment of hearing loss. Results shows that use of more complex covariances are better estimating inter-trial variability.

Matched MeSH terms: Time Factors
An immunodiffusion analysis of strains of Mycobacterium ulcerans isolated in Australia, Malaya, Mexico, Uganda and Zaire

Stanford JL

J Med Microbiol, 1973 Aug;6(3):405-8.
PMID: 4199273
Matched MeSH terms: Time Factors
An improved light dark box test by using a real-time video tracking system

Narayanan SN, Kumar RS

Acta. Biol. Hung., 2018 Dec;69(4):371-384.
PMID: 30587025 DOI: 10.1556/018.69.2018.4.1

In the behavioral science field, many of the oldest tests have still most frequently been used almost in the same way for decades. The subjective influence of human observer and the large inter-observer and interlab differences are substantial among these tests. This necessitates the possibility of using technological innovations for behavioral science to obtain new parameters, results and insights as well. The light-dark box (LDB) test is a characteristic tool used to assess anxiety in rodents. A complete behavioral analysis (including both anxiety and locomotion parameters) is not possible by performing traditional LDB test protocol, as it lacks the usage of a real-time video recording of the test. In the current report, we describe an improved approach to conduct LDB test using a real-time video tracking system.

Matched MeSH terms: Time Factors
Fulltext An international survey of medical ethics curricula in Asia

Miyasaka M, Akabayashi A, Kai I, Ohi G

J Med Ethics, 1999 Dec;25(6):514-21.
PMID: 10635508

SETTING: Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries.
OBJECTIVE: To characterise the medical ethics curricula at Asian medical schools.
DESIGN: Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand.
PARTICIPANTS: A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country.
MAIN OUTCOME MEASURES: The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties.
RESULTS: A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics.
CONCLUSION: Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse.

Matched MeSH terms: Time Factors
An investigation of the effect of prolonged glove wearing on the hand skin health of dental healthcare workers

Boyle DK, Forsyth A, Bagg J, Stroubou K, Griffiths CE, Burke FJ

J Dent, 2002 Jul-Aug;30(5-6):233-41.
PMID: 12450714

Glove wearing during patient treatment has been central to dental surgery infection control for over 15 years. However, little is known about the cutaneous effects of glove wearing on the hands of dental healthcare workers (DHCWs). The objective of this project was to assess the hand skin health of DHCWs before and after wearing gloves of two types and to compare this with a control group of non-DHCWs.

Matched MeSH terms: Time Factors
Fulltext An observation on the decomposition process of gasoline-ingested monkey carcasses in a secondary forest in Malaysia

Rumiza AR, Khairul O, Zuha RM, Heo CC

Trop Biomed, 2010 Dec;27(3):373-83.
PMID: 21399577

This study was designed to mimic homicide or suicide cases using gasoline. Six adult long-tailed macaque (Macaca fascicularis), weighing between 2.5 to 4.0 kg, were equally divided into control and test groups. The control group was sacrificed by a lethal dose of phenobarbital intracardiac while test group was force fed with two doses of gasoline LD50 (37.7 ml/kg) after sedation with phenobarbital. All carcasses were then placed in a decomposition site to observe the decomposition and invasion process of cadaveric fauna on the carcasses. A total of five decomposition stages were recognized during this study. This study was performed during July 2007. Fresh stage of control and test carcasses occurred between 0 to 15 and 0 to 39 hours of exposure, respectively. The subsequent decomposition stages also exhibited the similar pattern whereby the decomposition process of control carcasses were faster than tested one. The first larvae were found on control carcasses after 9 hours of death while the test group carcasses had only their first blowfly eggs after 15 hours of exposure. Blow flies, Achoetandrus rufifacies and Chrysomya megacephala were the most dominant invader of both carcasses throughout the decaying process. Diptera collected from control carcasses comprised of scuttle fly, Megaselia scalaris and flesh fly, sarcophagid. We concluded that the presence of gasoline and its odor on the carcass had delayed the arrival of insect to the carcasses, thereby slowing down the decomposition process in the carcass by 6 hours.

Matched MeSH terms: Time Factors
Fulltext An occurrence of Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) from a human corpse in a high-rise building in Malaysia: a case report

Syamsa RA, Ahmad FM, Zuha RM, Khairul AZ, Marwi MA, Shahrom AW, et al.

Trop Biomed, 2012 Mar;29(1):107-12.
PMID: 22543610 MyJurnal

This is the first report of Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) on a human corpse discovered in a high-rise building in Malaysia. On 5 March 2008, a decomposing body of an adult female was found on the top floor of a thirteen-story building in Kuala Lumpur, Malaysia. Her body was colonized by S. nudiseta larvae, which were normally associated with corpses found indoors at ground level. The post-mortem interval (PMI) was estimated at approximately 5 to 9 days. This case is significant as it demonstrates that this species can locate a dead body even in a high-rise building. Further findings of fly distribution especially in high-rise buildings should be reported to assist entomologists in PMI analysis.

Matched MeSH terms: Time Factors
Fulltext An open label comparative study of glimepiride versus repaglinide in type 2 diabetes mellitus Muslim subjects during the month of Ramadan

Anwar A, Azmi KN, Hamidon BB, Khalid BA

Med J Malaysia, 2006 Mar;61(1):28-35.
PMID: 16708731 MyJurnal

This study was conducted to compare the treatment efficacy between a prandial glucose regulator, repaglinide and a new sulphonylurea, glimepiride in Muslim Type 2 diabetic patients who practice Ramadan fasting. Forty-one patients, previously treated with a sulphonylurea or metformin, were divided to receive either repaglinide (n=20, preprandially three-times daily) or glimepiride (n=21, preprandially once daily) 3 months before the month of Ramadan. During Ramadan, patients modified their eating pattern to two meals daily, and the triple doses of repaglinide were redistributed to two preprandial doses. Four point blood glucose monitoring were performed weekly during the month of Ramadan and the subsequent month. Measurements of the 4-point blood glucose were significantly lower in the glimepiride group compared to the repaglinide group both during and after Ramadan. The glycaemic excursion was better in the morning for the repaglinide group and better in the afternoon and evening for the glimepiride group during the Ramadan period. There was no statistically significant difference in the incidence of hypoglycaemia between the two groups during and after Ramadan. There was no difference in the glycaemic excursion post-Ramadan. The longer duration of action of glimepiride may offer an advantage over repaglinide during the 13.5 hours of fast in Ramadan for diabetic patients.

Matched MeSH terms: Time Factors
Fulltext An outbreak of rabies in dogs in the state of Terengganu 1995-1996

Loke YK, Murugesan E, Suryati A, Tan MH

Med J Malaysia, 1998 Mar;53(1):97-100.
PMID: 10968145

The presence of rabies in dogs has been well recognized in areas of Malaysia close to the Thai border but it has rarely ever been reported in Terengganu which is a state on the East Coast of Malaysia. From November 1995 to June 1996 six different rabid stray dogs were found to have been involved in dog bite attacks on 9 members of the public. We report these cases to highlight that rabid dog bites may occur even in areas where the disease is thought to be rate. Medical and veterinary staff must keep the possibility of the risk of rabies in mind when faced with patients who have been bitten by dogs.

Matched MeSH terms: Time Factors
Analysing the accuracy of machine learning techniques to develop an integrated influent time series model: case study of a sewage treatment plant, Malaysia

Ansari M, Othman F, Abunama T, El-Shafie A

Environ Sci Pollut Res Int, 2018 Apr;25(12):12139-12149.
PMID: 29455350 DOI: 10.1007/s11356-018-1438-z

The function of a sewage treatment plant is to treat the sewage to acceptable standards before being discharged into the receiving waters. To design and operate such plants, it is necessary to measure and predict the influent flow rate. In this research, the influent flow rate of a sewage treatment plant (STP) was modelled and predicted by autoregressive integrated moving average (ARIMA), nonlinear autoregressive network (NAR) and support vector machine (SVM) regression time series algorithms. To evaluate the models' accuracy, the root mean square error (RMSE) and coefficient of determination (R2) were calculated as initial assessment measures, while relative error (RE), peak flow criterion (PFC) and low flow criterion (LFC) were calculated as final evaluation measures to demonstrate the detailed accuracy of the selected models. An integrated model was developed based on the individual models' prediction ability for low, average and peak flow. An initial assessment of the results showed that the ARIMA model was the least accurate and the NAR model was the most accurate. The RE results also prove that the SVM model's frequency of errors above 10% or below - 10% was greater than the NAR model's. The influent was also forecasted up to 44 weeks ahead by both models. The graphical results indicate that the NAR model made better predictions than the SVM model. The final evaluation of NAR and SVM demonstrated that SVM made better predictions at peak flow and NAR fit well for low and average inflow ranges. The integrated model developed includes the NAR model for low and average influent and the SVM model for peak inflow.

Matched MeSH terms: Time Factors
Analysis of human infectious avian influenza virus: hemagglutinin genetic characteristics in Asia and Africa from 2004 to 2009

Zhang J, Lei F

Integr Zool, 2010 Sep;5(3):264-71.
PMID: 21392344 DOI: 10.1111/j.1749-4877.2010.00212.x

In the present study, we used nucleotide and protein sequences of avian influenza virus H5N1, which were obtained in Asia and Africa, analyzed HA proteins using ClustalX1.83 and MEGA4.0, and built a genetic evolutionary tree of HA nucleotides. The analysis revealed that the receptor specificity amino acid of A/HK/213/2003, A/Turkey/65596/2006 and etc mutated into QNG, which could bind with á-2, 3 galactose and á-2, 6 galactose. A mutation might thus take place and lead to an outbreak of human infections of avian influenza virus. The mutations of HA protein amino acids from 2004 to 2009 coincided with human infections provided by the World Health Organization, indicating a "low-high-highest-high-low" pattern. We also found out that virus strains in Asia are from different origins: strains from Southeast Asia and East Asia are of the same origin, whereas those from West Asia, South Asia and Africa descend from one ancestor. The composition of the phylogenetic tree and mutations of key site amino acids in HA proteins reflected the fact that the majority of strains are regional and long term, and virus diffusions exist between China, Laos, Malaysia, Indonesia, Azerbaijan, Turkey and Iraq. We would advise that pertinent vaccines be developed and due attention be paid to the spread of viruses between neighboring countries and the dangers of virus mutation and evolution.

Matched MeSH terms: Time Factors
Fulltext Analysis of motorcyclist riding behaviour on speed table

Yuen CW, Karim MR, Saifizul A

ScientificWorldJournal, 2014;2014:236396.
PMID: 24991638 DOI: 10.1155/2014/236396

This paper focuses on the study of the change of various types of riding behaviour, such as speed, brake force, and throttle force applied, when they ride across the speed table. An instrumented motorcycle equipped with various types of sensor, on-board camera, and data logger was used in acquiring the traffic data in the research. Riders were instructed to ride across two speed tables and the riding data were then analyzed to study the behaviour change from different riders. The results from statistical analysis showed that the riding characteristics such as speed, brake force, and throttle force applied are influenced by distance from hump, riding experience, and travel mileage of riders. Riders tend to apply higher brake intensity at distance point 50 m before the speed table and release the braking at point -10 m after the hump. In short, speed table has different rates of influence towards riding behaviour on different factors, such as distance from hump and different riders' attributes.

Matched MeSH terms: Time Factors
Anatomy and Physiology of Left Ventricular Suction Induced by Rotary Blood Pumps

Salamonsen RF, Lim E, Moloney J, Lovell NH, Rosenfeldt FL

Artif Organs, 2015 Aug;39(8):681-90.
PMID: 26146861 DOI: 10.1111/aor.12550

This study in five large greyhound dogs implanted with a VentrAssist left ventricular assist device focused on identification of the precise site and physiological changes induced by or underlying the complication of left ventricular suction. Pressure sensors were placed in left and right atria, proximal and distal left ventricle, and proximal aorta while dual perivascular and tubing ultrasonic flow meters measured blood flow in the aortic root and pump outlet cannula. When suction occurred, end-systolic pressure gradients between proximal and distal regions of the left ventricle on the order of 40-160 mm Hg indicated an occlusive process of variable intensity in the distal ventricle. A variable negative flow difference between end systole and end diastole (0.5-3.4 L/min) was observed. This was presumably mediated by variable apposition of the free and septal walls of the ventricle at the pump inlet cannula orifice which lasted approximately 100 ms. This apposition, by inducing an end-systolic flow deficit, terminated the suction process by relieving the imbalance between pump requirement and delivery from the right ventricle. Immediately preceding this event, however, unnaturally low end-systolic pressures occurred in the left atrium and proximal left ventricle which in four dogs lasted for 80-120 ms. In one dog, however, this collapse progressed to a new level and remained at approximately -5 mm Hg across four heart beats at which point suction was relieved by manual reduction in pump speed. Because these pressures were associated with a pulmonary capillary wedge pressure of -5 mm Hg as well, they indicate total collapse of the entire pulmonary venous system, left atrium, and left ventricle which persisted until pump flow requirement was relieved by reducing pump speed. We suggest that this collapse caused the whole vascular region from pulmonary capillaries to distal left ventricle to behave as a Starling resistance which further reduced right ventricular output thus contributing to a major reduction in pump flow. We contend that similar complications of manual speed control also occur in the human subject and remain a major unsolved problem in the clinical management of patients implanted with rotary blood pumps.

Matched MeSH terms: Time Factors
Ancient jades map 3,000 years of prehistoric exchange in Southeast Asia

Hung HC, Iizuka Y, Bellwood P, Nguyen KD, Bellina B, Silapanth P, et al.

Proc Natl Acad Sci U S A, 2007 Dec 11;104(50):19745-50.
PMID: 18048347

We have used electron probe microanalysis to examine Southeast Asian nephrite (jade) artifacts, many archeologically excavated, dating from 3000 B.C. through the first millennium A.D. The research has revealed the existence of one of the most extensive sea-based trade networks of a single geological material in the prehistoric world. Green nephrite from a source in eastern Taiwan was used to make two very specific forms of ear pendant that were distributed, between 500 B.C. and 500 A.D., through the Philippines, East Malaysia, southern Vietnam, and peninsular Thailand, forming a 3,000-km-diameter halo around the southern and eastern coastlines of the South China Sea. Other Taiwan nephrite artifacts, especially beads and bracelets, were distributed earlier during Neolithic times throughout Taiwan and from Taiwan into the Philippines.

Matched MeSH terms: Time Factors
Fulltext Annatto-derived tocotrienol stimulates osteogenic activity in preosteoblastic MC3T3-E1 cells: a temporal sequential study

Wan Hasan WN, Abd Ghafar N, Chin KY, Ima-Nirwana S

Drug Des Devel Ther, 2018;12:1715-1726.
PMID: 29942115 DOI: 10.2147/DDDT.S168935

PURPOSE: Annatto-derived tocotrienol (AnTT) has been shown to improve bone formation in animal models of osteoporosis. However, detailed studies of the effects of AnTT on preosteoblastic cells were limited. This study was conducted to investigate the osteogenic effect of AnTT on preosteoblast MC3T3-E1 cells in a time-dependent manner.
MATERIALS AND METHODS: Murine MC3T3-E1 preosteoblastic cells were cultured in the different concentrations of AnTT (0.001-1 µg/mL) up to 24 days. Expression of osteoblastic differentiation markers was measured by qPCR (osterix [OSX], collagen 1 alpha 1 [COL1α1], alkaline phosphatase [ALP], and osteocalcin [OCN]) and by fluorometric assay for ALP activity. Detection of collagen and mineralized nodules was done via Direct Red staining and Alizarin Red staining, respectively.
RESULTS: The results showed that osteoblastic differentiation-related genes, such as OSX, COL1α1, ALP, and OCN, were significantly increased in the AnTT-treated groups compared to the vehicle group in a time-dependent manner (P<0.05). Type 1 collagen level was increased from day 3 to day 15 in the AnTT-treated groups, while ALP activity was increased from day 9 to day 21 in the AnTT-treated groups (P<0.05). Enhanced mineralization was observed in the AnTT-treated groups via increasing Alizarin Red staining from day 3 to day 21 (P<0.05).
CONCLUSION: Our results suggest that AnTT enhances the osteogenic activity by promoting the bone formation-related genes and proteins in a temporal and sequential manner.

Matched MeSH terms: Time Factors
Fulltext Annual and geographical distribution of Shigella serotypes in Sabah, Malaysia from 1974 to 1978

Kan SKP, Chan MKC

Med J Malaysia, 1980 Sep;35(1):9-13.
PMID: 7254007

19,983 cases of diarrhoea throughout Sabah, Malaysia from January 1971 to December 1978 were bacteriologically examined for Shigella. A total of 241 Shigella isolates representing 9 serotypes were encountered. S. flexneri and S. sonnei accounted for 69.7% and 29.5% of the isolates respectively. S. flexneri type 2 was very common and comprised 47% of the flexneri strains. S. flexneri types 5.6 and Y were rarely found. Only two cases of S. boydii were isolated. S. dysenteriae was not encountered. Isolation rates ranged from 0.64% to 1.73% while the percentages or cases of diarrhoea bacteriologically examined in relation to the number notified range from 13.7 to 29.6. Kota Kinabalu. Tawau and Sandakan accounted for 50.6%. 21.2% and 8.2% of Shigella isolates respectively. However. no isolations were made from Lahad Datu, Semporna and Victoria [Labuan Island]. S. flexneri type 5 was only found in Sandakan while S. flexnert type Y was isolated from Kota Kinubulu. No S. Sonnel was found in Ranau and Tenom.

Matched MeSH terms: Time Factors
Fulltext Annular closure device for disc herniation: meta-analysis of clinical outcome and complications

Choy WJ, Phan K, Diwan AD, Ong CS, Mobbs RJ

BMC Musculoskelet Disord, 2018 Aug 16;19(1):290.
PMID: 30115053 DOI: 10.1186/s12891-018-2213-5

BACKGROUND: Lumbar intervertebral disc herniation is a common cause of lower back and leg pain, with surgical intervention (e.g. discectomy to remove the herniated disc) recommended after an appropriate period of conservative management, however the existing or increased breach of the annulus fibrosus persists with the potential of reherniation. Several prosthesis and techniques to reduce re-herniation have been proposed including implantation of an annular closure device (ACD) - Barricaid™ and an annular tissue repair system (AR) - Anulex-Xclose™. The aim of this meta-analysis is to assist surgeons determine a potential approach to reduce incidences of recurrent lumbar disc herniation and assess the current devices regarding their outcomes and complications.
METHODS: Four electronic full-text databases were systematically searched through September 2017. Data including outcomes of annular closure device/annular repair were extracted. All results were pooled utilising meta-analysis with weighted mean difference and odds ratio as summary statistics.
RESULTS: Four studies met inclusion criteria. Three studies reported the use of Barricaid (ACD) while one study reported the use of Anulex (AR). A total of 24 symptomatic reherniation were reported among 811 discectomies with ACD/AR as compared to 51 out of 645 in the control group (OR: 0.34; 95% CI: 0.20,0.56; I2 = 0%; P

Matched MeSH terms: Time Factors
Fulltext Antenatal breastfeeding education for increasing breastfeeding duration

Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M

Cochrane Database Syst Rev, 2016 Dec 06;12(12):CD006425.
PMID: 27922724 DOI: 10.1002/14651858.CD006425.pub4

BACKGROUND: Breast milk is well recognised as the best food source for infants. The impact of antenatal breastfeeding (BF) education on the duration of BF has not been evaluated.
OBJECTIVES: To assess the effectiveness of antenatal breastfeeding (BF) education for increasing BF initiation and duration.
SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register on 1 March 2016, CENTRAL (The Cochrane Library, 2016, Issue 3), MEDLINE (1966 to 1 March 2016) and Scopus (January 1985 to 1 March 2016). We contacted experts and searched reference lists of retrieved articles.
SELECTION CRITERIA: All identified published, unpublished and ongoing randomised controlled trials (RCTs) assessing the effect of formal antenatal BF education or comparing two different methods of formal antenatal BF education, on the duration of BF. We included RCTs that only included antenatal interventions and excluded those that combined antenatal and intrapartum or postpartum BF education components. Cluster-randomised trials were included in this review. Quasi-randomised trials were not eligible for inclusion.
DATA COLLECTION AND ANALYSIS: We assessed all potential studies identified as a result of the search strategy. Two review authors extracted data from each included study using the agreed form and assessed risk of bias. We resolved discrepancies through discussion. We assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS: This review update includes 24 studies (10,056 women). Twenty studies (9789 women) contribute data to analyses. Most studies took place in high-income countries such as the USA, UK, Canada and Australia. In the first five comparisons, we display the included trials according to type of intervention without pooling data. For the 'Summary of findings' we pooled data for a summary effect.Five included studies were cluster-randomised trials: all of these adjusted data and reported adjustments as odds ratios (OR). We have analysed the data using the generic inverse variance method and presented results as odds ratios, because we were unable to derive a cluster-adjusted risk ratio from the published cluster-trial. We acknowledge that the use of odds ratio prevents the pooling of these cluster trials in our main analyses. One method of BF education with standard (routine) careThere were no group differences for duration of any BF in days or weeks. There was no evidence that interventions improved the proportion of women with any BF or exclusive BF at three or six months. Single trials of different interventions were unable to show that education improved initiation of BF, apart from one small trial at high risk of attrition bias. Many trial results marginally favoured the intervention but had wide confidence intervals crossing the line of no effect. BF complications such as mastitis and other BF problems were similar in treatment arms in single trials reporting these outcomes. Multiple methods of BF education versus standard careFor all trials included in this comparison we have presented the cluster-adjusted odds ratios as reported in trial publications. One three-arm study found the intervention of BF booklet plus video plus Lactation Consultant versus standard care improved the proportion of women exclusively BF at three months (OR 2.60, 95% CI 1.25 to 5.40; women = 159) and marginally at six months (OR 2.40, 95% CI 1.00 to 5.76; women = 175). For the same trial, an intervention arm without a lactation consultant but with the BF booklet and video did not have the same effect on proportion of women exclusively BF at three months (OR 1.80, 95% CI 0.80 to 4.05; women = 159) or six months (OR 0.90, 95% CI 0.30 to 2.70; women = 184). One study compared monthly BF sessions and weekly cell phone message versus standard care and reported improvements in the proportion of women exclusively BF at both three and six months (three months OR 1.80, 95% CI 1.10 to 2.95; women = 390; six months OR 2.40, 95% CI 1.40 to 4.11; women = 390). One study found monthly BF sessions and weekly cell phone messages improved initiation of BF over standard care (OR 2.61, 95% CI 1.61 to 4.24; women = 380). BF education session versus standard care, pooled analyses for 'Summary of findings' (SoF)This comparison does not include cluster-randomised trials reporting adjusted odds ratios. We did not downgrade any evidence for trials' lack of blinding; no trial had adequate blinding of staff and participants. The SoF table presents risk ratios for all outcomes analysed. For proportion of women exclusively BF there is no evidence that antenatal BF education improved BF at three months (RR 1.06, 95% CI 0.90 to 1.25; women = 822; studies = 3; moderate quality evidence) or at six months (RR 1.07, 95% CI 0.87 to 1.30; women = 2161; studies = 4; moderate quality evidence). For proportion of women with any BF there were no group differences in BF at three (average RR 0.98, 95% CI 0.82 to 1.18; women = 654; studies = 2; I² = 60%; low-quality evidence) or six months (average RR 1.05, 95% CI 0.90 to 1.23; women = 1636; studies = 4; I² = 61%; high-quality evidence). There was no evidence that antenatal BF education could improve initiation of BF (average RR 1.01, 95% CI 0.94 to 1.09; women = 3505; studies = 8; I² = 69%; high-quality evidence). Where we downgraded evidence this was due to small sample size or wide confidence intervals crossing the line of no effect, or both.There was insufficient data for subgroup analysis of mother's occupation or education.
AUTHORS' CONCLUSIONS: There was no conclusive evidence supporting any antenatal BF education for improving initiation of BF, proportion of women giving any BF or exclusively BF at three or six months or the duration of BF. There is an urgent need to conduct a high-quality, randomised controlled study to evaluate the effectiveness and adverse effects of antenatal BF education, especially in low- and middle-income countries. Evidence in this review is primarily relevant to high-income settings.

Matched MeSH terms: Time Factors

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