SummaryBackgroundChildren with persistent hearing loss due to otitis media with effusion are commonly managed by surgical intervention. A safe, cheap, and effective medical treatment would enhance treatment options. Underpowered, poor-quality trials have found short-term benefit from oral steroids. We aimed to investigate whether a short course of oral steroids would achieve acceptable hearing in children with persistent otitis media with effusion and hearing loss.MethodsIn this individually randomised, parallel, double-blinded, placebo-controlled trial we recruited children aged 2–8 years with symptoms attributable to otitis media with effusion for at least 3 months and with confirmed bilateral hearing loss. Participants were recruited from 20 ear, nose, and throat (ENT), paediatric audiology, and audiovestibular medicine outpatient departments in England and Wales. Participants were randomly allocated (1:1) to sequentially numbered identical prednisolone (oral steroid) or placebo packs by use of computer-generated random permuted block sizes stratified by site and child's age. The primary outcome was audiometry-confirmed acceptable hearing at 5 weeks. All analyses were by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN49798431.FindingsBetween March 20, 2014, and April 5, 2016, 1018 children were screened, of whom 389 were randomised. 200 were assigned to receive oral steroids and 189 to receive placebo. Hearing at 5 weeks was assessed in 183 children in the oral steroid group and in 180 in the placebo group. Acceptable hearing was observed in 73 (40%) children in the oral steroid group and in 59 (33%) in the placebo group (absolute difference 7% [95% CI −3 to 17], number needed to treat 14; adjusted odds ratio 1·36 [95% CI 0·88–2·11]; p=0·16). There was no evidence of any significant differences in adverse events or quality-of-life measures between the groups.InterpretationOtitis media with effusion in children with documented hearing loss and attributable symptoms for at least 3 months has a high rate of spontaneous resolution. A short course of oral prednisolone is not an effective treatment for most children aged 2–8 years with persistent otitis media with effusion, but is well tolerated. One in 14 children might achieve improved hearing but not quality of life. Discussions about watchful waiting and other interventions will be supported by this evidence.FundingNational Institute for Health Research (NIHR) Health Technology Assessment programme.
Recent research concerning the potential presence of a national trend in regionally disaggregated US crime data is extended. In light of the varying levels of criminal activity noted in differing regions of the US, the present analysis considers whether a trend is emerging rather than currently present. Using alternative methods, potential convergence in criminal activity across the states of the US is examined. The results presented provide clear evidence of a previously undetected finding of convergence over the period 1960-2009 for all classifications of criminal activity considered. The importance and implications of these findings, along with their support in previous research on, inter alia, socioeconomic conditions, sentencing policies and alternative theories, are discussed.
This is an update (literature search up to 15 March 2022) of a rapid review examining whether vaccination against SARS-CoV-2 (COVID-19) affects transmission of SARS-CoV-2. Streamlined systematic methodologies were used to accelerate the review process. The update identified 17 additional studies: 6 studies reported on transmission and 11 studies reported viral load. There was high heterogeneity across studies, which varied in design, participant characteristics and SARS-CoV-2 variants reported. Evidence from this update supports previous findings that that transmission of Omicron and Delta variants is lowest in booster-vaccinated people, followed by fully vaccinated people, with the highest rate of transmission in unvaccinated people. Additionally, some studies compared transmission between different variants or sub-variants; risk of transmission appears to be higher with Omicron than Delta, regardless of vaccination status.
Testing for COVID-19 has been deployed globally as a tool to interrupt transmission through isolating positive contacts from the broader population. Financial support systems have been deployed to increase the isolation compliance, there is uncertainty as to the effectiveness of these measures. Three reviews were identified, as well as four primary studies that were published after the review search dates. Six studies showed that financial support for isolation was associated with a higher compliance to isolate. Two epidemiological modelling studies found that increased levels of social isolation were associated with a reduction in COVID-19 transmission. The findings from a DCE demonstrated a positive relationship with longer isolation duration and higher financial requirements. An economic model showed that support programmes have the potential to be a cost-effective intervention. A retrospective observational study offered evidence supporting the viability of delivering medically assisted isolation hotels for people unable to isolate at home. Further to the COVID-19 literature, two household surveys found that financial support and improved social restriction information was associated with compliance with H1N1 isolation Policy and practice implications: There is limited evidence to suggest that financial support for isolation can increase compliance, lower social engagement, and reduce infection levels. There is insufficient evidence to inform the optimal scale of financial support required There was no evidence related to effectiveness of financial support for disadvantaged populations who are required to isolate or any insight to the impact of financial support on equality The overall certainty in the evidence is relatively low. Most studies relied on participant reported data on preference or behaviour, and where observational data were used there were issues with data quality and unobserved cofounders.
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