Abstract
Mindfulness-Based Interventions for Substance Use Disorders
Substance abuse disorders are common and relapse after treatment is frequent. This Cochrane review looked at the effects of mindfulness-based interventions on abstinence and cravings in people being treated for substance abuse. The authors found 40 studies of which 35 trials with 2825 participants provided data for analysis. Compared with other treatments (e.g., medication), mindfulness-based interventions may slightly increase the percentage of days without substance use after treatment and at up to 10 months after treatment. However, the evidence about the effects of mindfulness-based interventions compared with no treatment is uncertain due to unblinded outcome assessment, small sample sizes, and variation between trials. Mindfulness-based interventions did not increase attrition from treatment and there was no indication that they were associated with adverse events.
Humour-Based Interventions for People with Schizophrenia
This Cochrane review looked for evidence on humor-based interventions for people with schizophrenia. Humor-based interventions were defined as “any intervention that promotes health and wellness by stimulating a playful discovery, expression, or appreciation of the absurdity or incongruity of life's situations.” The authors found three studies and two studies (96 participants) provided data for analysis. One study with 30 participants compared a humor-based intervention with a recreational therapy program and reported on general mental state and negative symptoms. The second study compared a humor-based intervention with standard care, and this study did not report on mental state or symptoms. Overall, the limited data made it impossible to form conclusions on any outcomes, and the authors stated that additional trials are necessary.
Music Interventions for Improving Psychological and Physical Outcomes in People with Cancer
Cancer is commonly accompanied by physical and emotional distress and decreases in quality of life. This updated Cochrane review looked at the effects of music therapy (music offered by a trained music therapist) and music medicine (defined as prerecorded music provided by medical personnel) on well-being in people with cancer. The authors found a total of 81 trials with 5576 participants comparing music interventions with standard care. The authors stated that music may reduce anxiety, depression, and pain, and increase hope, although the certainty of the evidence was low. Music therapy may also slightly reduce fatigue and improve quality of life. The overall quality of the trials was poor and children further research may be useful in clarifying the effects of music interventions for adults and children with cancer.
Cannabinoids for the Treatment of Dementia
Dementia is a difficult-to-treat condition that primarily affects older adults and leads to progressive loss of cognitive abilities and independent functioning. This Cochrane review looked at cannabinoids as a potential treatment for the cognitive, psychological, and behavioral symptoms of dementia. The authors found a total of 4 studies with 126 participants. The studies tested natural delta-9-tetrahydrocannabinol (THC) and synthetic THC analogues against placebo in people with different types of dementia. The authors did not observe any clinically important effects of cannabinoids in the trials, but because of the small number, size, and duration of the studies, the authors were unable to make any conclusions about the benefits or harms of cannabinoids. Larger trials with longer follow-up are needed.
Non-Pharmacological Interventions for Stuttering in Children Six Years and Younger
This Cochrane review looked for evidence on the effects of nonpharmacological interventions, compared with no intervention or usual care, to treat stuttering in young children. The authors found 4 studies with 151 children in which a nonpharmacological program was compared with a waiting list. All the studies tested the Lidcombe program, a 1- to 2-year behavioral program in which parents of young children are trained by speech therapists to treat their children at home. The studies showed a decrease in stuttering with the Lidcombe program at 3–9 months. One study found that the program probably increases speech efficiency (the number of nonstuttered syllables per second). The findings on decreased stuttering are uncertain due to problems with the conduct of the studies, the small total number of participants, and differences between studies. Additional good-quality long-term studies are needed.
Ketamine and Other Glutamate Receptor Modulators for Depression in Adults with Unipolar Major Depressive Disorder
Major depression is usually treated with medication, but not all people respond to the currently available drugs. Glutamate receptor modulators, such as the glutamate receptor antagonist ketamine, are a newer class of drug with potential for treating depression. This updated Cochrane review found a total of 64 studies (5299 participants) on glutamate receptor modulators for depression, including ketamine (31 trials), esketamine (9 trials), and 14 other drugs. Ketamine and esketamine were both more effective than placebo in treating symptoms of depression. However, both drugs had more side effects than placebo and the reduction in symptoms lasted only 1 week after treatment for ketamine and up to 4 weeks after treatment for esketamine. Further trials that compare these drugs with other medications and compare the benefits and harms over the longer term are needed.
Vitamin D Supplementation for Chronic Liver Diseases in Adults
People with chronic liver disease often have low levels of vitamin D. This Cochrane review summarized the evidence on the benefits and harms of supplemental vitamin D for adults with chronic liver disease. The authors found 27 studies with 1979 participants comparing vitamin D with placebo or no intervention. The trials were at high risk of bias and there were few participants with data on important outcomes. Information from the studies was inadequate to show whether vitamin D supplementation increases, decreases, or has no effect upon all-cause mortality, liver-related mortality, or adverse events in people with chronic liver disease. There was no information on liver-related morbidity and health-related quality of life. Better quality studies with information on clinically important outcomes are needed.
Calcium Supplementation for Prevention of Primary Hypertension
Hypertension is a common condition that is a risk factor for mortality from heart disease and stroke. A previous Cochrane review found that calcium could help manage existing hypertension, so this Cochrane review looked at the evidence for calcium supplementation as a way to prevent hypertension. The authors found 20 placebo-controlled studies with 3512 participants, and 18 trials with 3140 participants provided data for meta-analysis. Calcium supplementation led to a mean reduction of −1.37 mm Hg in systolic blood pressure and a reduction of -1.45 mm Hg in diastolic blood pressure. Higher doses led to greater decreases in blood pressure. More information is needed on the best dose, the type of calcium, and outcomes at longer term to inform clinical practice.
Ivermectin for Preventing and Treating COVID-19
Ivermectin is an antiparasitic drug that has been proposed as a treatment for COVID-19. This Cochrane review looked for evidence from randomized controlled trials comparing ivermectin with no treatment, placebo, standard care, or another proven treatment for COVID-19. The authors found 14 studies with 1678 participants comparing ivermectin with no treatment, placebo, or standard care. Nine trials were conducted in inpatients with COVID-19, four trials were conducted in outpatients with mild COVID-19, and one trial tested ivermectin for prevention of Severe Acute Respiratory Syndrome Coronavirus-2 infection. The authors found that there were problems with the conduct of the trials and few participants and few events overall for important outcomes such as mortality, and concluded that the evidence on ivermectin for COVID-19 is uncertain. There are 31 trials in progress and the review will be updated when more evidence is available.