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Sunita Vohra

Publications and source records attributed to Sunita Vohra.

14 recordsLinked to original sources
PubMed2006

Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta-analysis.

OBJECTIVE: To conduct a systematic review of the efficacy and safety of exogenous melatonin in managing secondary sleep disorders and sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder. DATA SOURCES: 13 electronic databases and reference lists of relevant reviews and included studies; Associated Professional Sleep Society abstracts (1999 to 2003). STUDY SELECTION: The efficacy review included randomised controlled trials; the safety review included randomised and non-randomised controlled trials. QUALITY ASSESSMENT: Randomised controlled trials were assessed by using the Jadad Scale and criteria by Schulz et al, and non-randomised controlled trials by the Downs and Black checklist. DATA EXTRACTION AND SYNTHESIS: One reviewer extracted data and another reviewer verified the data extracted. The inverse variance method was used to weight studies and the random effects model was used to analyse data. MAIN RESULTS: Six randomised controlled trials with 97 participants showed no evidence that melatonin had an effect on sleep onset latency in people with secondary sleep disorders (weighted mean difference -13.2 (95% confidence interval -27.3 to 0.9) min). Nine randomised controlled trials with 427 participants showed no evidence that melatonin had an effect on sleep onset latency in people who had sleep disorders accompanying sleep restriction (-1.0 (-2.3 to 0.3) min). 17 randomised controlled trials with 651 participants showed no evidence of adverse effects of melatonin with short term use (three months or less). CONCLUSIONS: There is no evidence that melatonin is effective in treating secondary sleep disorders or sleep disorders accompanying sleep restriction, such as jet lag and shiftwork disorder. There is evidence that melatonin is safe with short term use.

Adolescent↗
PubMed2006

Probiotics.

Explore the source record for details and available documents.

Adult↗
PubMed2005

Integrating complementary and alternative medicine into academic medical centers: experience and perceptions of nine leading centers in North America.

BACKGROUND: Patients across North America are using complementary and alternative medicine (CAM) with increasing frequency as part of their management of many different health conditions. The objective of this study was to develop a guide for academic health sciences centers that may wish to consider starting an integrative medicine program. METHODS: We queried North American leaders in the field of integrative medicine to identify initial sites. Key stakeholders at each of the initial sites visited were then asked to identify additional potential study sites (snowball sampling), until no new sites were identified. We conducted structured interviews to identify critical factors associated with success and failure in each of four domains: research, education, clinical care, and administration. During the interviews, field notes were recorded independently by at least two investigators. Team meetings were held after each visit to reach consensus on the information recorded and to ensure that it was as complete as possible. Content analysis techniques were used to identify key themes that emerged from the field notes. RESULTS: We identified ten leading North American integrative medical centers, and visited nine during 2002-2003. The centers visited suggested that the initiation of an integrative medicine program requires a significant initial outlay of funding and a motivated "champion". The centers had important information to share regarding credentialing, medico-legal issues and billing for clinical programs; identifying researchers and research projects for a successful research program; and strategies for implementing flexible educational initiatives and establishing a functional administrative structure. CONCLUSION: Important lessons can be learned from academic integrative programs already in existence. Such initiatives are timely and feasible in a variety of different ways and in a variety of settings.

Academic Medical Centers↗
PubMed2005

Heat loss prevention in the delivery room for preterm infants: a national survey of newborn intensive care units.

BACKGROUND: Hypothermia incurred during delivery room resuscitation continues to cause morbidity in infants <29 weeks gestation. Three recent trials have shown that wrapping such infants instead of drying prevents heat loss, resulting in higher infant temperatures at Newborn Intensive Care Unit (NICU) admission. OBJECTIVE: To describe current NICU practices with respect to wrapping preterm infants to prevent heat loss in the delivery room. STUDY DESIGN: E-mail survey of neonatologists from national registry using a web-based survey tool. RESULTS: Of 411 e-mails successfully delivered, 125 (30%) responded. Most (87%) represented level III NICUs. Almost one-fifth of respondents (20%) use occlusive material instead of drying preterms in the delivery room. Considerable variation exists regarding choice of wrap and duration of use. Few adverse events were reported. CONCLUSION: "In all" was added -This implies 20% of all NICU's changed practice, 20% of level III NICUs responding have changed delivery room resuscitation practices rapidly in response to new evidence. No "gold" standard exists nationally and there is considerable variation in practice. Neonatal resuscitation guidelines for premature infants should include recommendations regarding choice occlusive wrap and application techniques.

Delivery Rooms↗
PubMed2005

Heat loss prevention: a systematic review of occlusive skin wrap for premature neonates.

OBJECTIVE: To systematically identify and synthesize investigations of the effectiveness of occlusive skin wrap for reducing heat loss in premature infants born at less than 36 weeks gestations. STUDY DESIGN: Systematic review. RESULTS: Three randomized controlled trials (RCT) and five historical controlled trials (HCT) were included. Meta-analysis shows wrapped infants had significantly higher admission temperatures than unwrapped infants (RCTs WMD 0.63 degrees C, 95% confidence interval (CI) 0.38, 0.87; HCTs WMD 0.96 degrees C, 95% CI 0.66, 1.27). A statistically significant difference in mortality was not found between wrapped and unwrapped infants in the RCTs (RR 0.72, 95% CI 0.36, 1.45) or the HCTs (RR 0.76, 95% CI 0.51, 1.13). CONCLUSIONS: The findings suggest that occlusive skin wrap prevents heat loss in premature infants. The meta-analysis lacked the power to provide definitive results regarding the effect of wrap on mortality.

Body Temperature Regulation↗
PubMed2005

The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis.

BACKGROUND: Exogenous melatonin has been increasingly used in the management of sleep disorders. PURPOSE: To conduct a systematic review of the efficacy and safety of exogenous melatonin in the management of primary sleep disorders. DATA SOURCES: A number of electronic databases were searched. We reviewed the bibliographies of included studies and relevant reviews and conducted hand-searching. STUDY SELECTION: Randomized controlled trials (RCTs) were eligible for the efficacy review, and controlled trials were eligible for the safety review. DATA EXTRACTION: One reviewer extracted data, while the other verified data extracted. The Random Effects Model was used to analyze data. DATA SYNTHESIS: Melatonin decreased sleep onset latency (weighted mean difference [WMD]: -11.7 minutes; 95% confidence interval [CI]: -18.2, -5.2)); it was decreased to a greater extent in people with delayed sleep phase syndrome (WMD: -38.8 minutes; 95% CI: -50.3, -27.3; n=2) compared with people with insomnia (WMD: -7.2 minutes; 95% CI: -12.0, -2.4; n=12). The former result appears to be clinically important. There was no evidence of adverse effects of melatonin. CONCLUSIONS: There is evidence to suggest that melatonin is not effective in treating most primary sleep disorders with short-term use (4 weeks or less); however, additional large-scale RCTs are needed before firm conclusions can be drawn. There is some evidence to suggest that melatonin is effective in treating delayed sleep phase syndrome with short-term use. There is evidence to suggest that melatonin is safe with short-term use (3 months or less).

Humans↗
PubMed2005

Characteristics of pediatric and adolescent patients attending a naturopathic college clinic in Canada.

OBJECTIVES: The use of complementary and alternative medicine (CAM) has grown substantially in North America and has drawn the attention of conventional-medicine practitioners. Conventional-medicine practitioners have expressed concern about the potential for unregulated CAM therapies to cause harm, the sometimes-uncertain cost-benefit ratios associated with these therapies, and the possibility that some CAM providers might advise against established conventional therapies, such as vaccination. These concerns are heightened with respect to the pediatric use of CAM products. To address this issue, we conducted a systematic audit of pediatric and adolescent case files at a large, college-based, Canadian naturopathic teaching clinic. We specifically sought to describe the demographic characteristics, reasons for presentation, use of CAM products, and vaccinations status of children presenting for naturopathic assessment. We also determined factors associated with the use of CAM products and vaccination status. METHODS: We identified all charts for children (<18 years of age) who presented to the Robert Schad Naturopathic Clinic, the teaching clinic of the Canadian College of Naturopathic Medicine, between February 1 and May 31, 2002. Data were abstracted directly from the standardized patient intake forms and from clinical notes recorded during the patient's initial visit to the clinic. The following data were obtained: age, gender, chief presenting complaints reported by parents, CAM product use at presentation, vaccination status, and reactions to vaccination. We conducted logistic regression analyses to identify factors associated with both CAM product use and vaccination status. RESULTS: A total of 482 charts were identified. The mean age of patients was 6.5 years (95% confidence interval [CI]: 1.6-11.4 years). The ratio of female subjects to male subjects was 1.09:1 (248:227). The most common reasons for presentation were skin disorders (23%), gastrointestinal complaints (17%), and psychiatric/behavioral disorders (15%). Thirty-five percent of children were using CAM products at presentation (21.2% when both vitamins and minerals were excluded). Vitamins were the most commonly used products (34.6%), followed by herbal remedies (14.9%), oil blends/fats (7.2%), minerals (5.6%), probiotics (4.5%), and homeopathic remedies (3.7%). Of charts with vaccination information, 8.9% indicated that children had not been vaccinated; possible vaccine-associated adverse events were reported for 27% of those who had been vaccinated. Partial or unvaccinated status was associated with younger age, attending the Canadian College of Naturopathic Medicine for advice regarding vaccination, and greater use of CAM products. CAM product use was associated with unvaccinated or partially vaccinated status (odds ratio [OR]: 2.86; 95% CI: 1.46-5.63), presenting with poor energy or fatigue (OR: 3.36; 95% CI: 1.00-11.26), or presenting with throat or sinus infections (OR: 4.06; 95% CI: 1.23-13.04). CONCLUSIONS: Children present for naturopathic assessment for diverse reasons, are high-level consumers of CAM products, and have lower rates of vaccination than population averages. The conventional-medicine community should work with naturopaths to address public health concerns in this population.

Abdominal Pain↗
PubMed2004

The use of herbal remedies by adolescents with eating disorders.

OBJECTIVE: To determine the frequency and type of herbal remedies and the reasons for herbal remedy use by adolescents with eating disorders. METHODS: Forty-six female adolescent females (age range, 10-17 years; mean age, 15 +/- 1.3 years) in a tertiary-care pediatric eating disorder treatment center from May 1998 to July 2000 volunteered for this cross-sectional study. They met the criteria for anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. Participants completed a 92-item self-administered questionnaire. We summarized information on demographics, use of herbal remedies, knowledge of safety issues of herbal remedies, and trust in the health care system. RESULTS: Of these 46 subjects, 17 (37%) used herbal remedies. Of these 17 subjects, 35% (6 of 17) used herbal remedies to decrease their appetites and to induce vomiting, 41% (7 of 17) knew nothing about herbal remedies, despite their use of these products, and 24% (4 of 17) reported that their physicians asked whether they used herbal remedies. The participants did not use herbal remedies because of their dissatisfaction with allopathic medicine. DISCUSSION: Adolescents with eating disorders frequently used herbal remedies for both weight control and non-weight control purposes. They did not regularly inform their physicians about their use of herbal remedies and physicians did not regularly inform their patients about this use. The generally high prevalence of herbal remedy use in this population suggests that health care providers need to be knowledgeable and should enquire about patients' use of these products. The perceived benefits, adverse effects, and herb-drug interactions of self-prescribed herbal remedies consumed by adolescents with eating disorders are unknown and further research is needed.

Adolescent↗
PubMed2004

Heat Loss Prevention (HeLP) in the delivery room: A randomized controlled trial of polyethylene occlusive skin wrapping in very preterm infants.

OBJECTIVES: To determine if polyethylene occlusive skin wrapping of very preterm infants prevents heat loss after delivery better than conventional drying and to evaluate if any benefit is sustained after wrap removal. STUDY DESIGN: This was a randomized controlled trial of infants <28 weeks' gestation. The experimental group was wrapped from the neck down. Only the head was dried. Control infants were dried completely. Rectal temperatures were compared on admission to the neonatal intensive care unit immediately after wrap removal and 1 hour later. RESULTS: Of 55 infants randomly assigned (28 wrap, 27 control), 2 died in the delivery room and 53 completed the study. Wrapped infants had a higher mean rectal admission temperature, 36.5 degrees C (SD, 0.8 degrees C), compared with 35.6 degrees C (SD, 1.3 degrees C) in control infants ( P = .002). One hour later, mean rectal temperatures were similar in both groups (36.6 degrees C, SD, 0.7 degrees C vs 36.4 degrees C, SD, 0.9 degrees C, P = .4). Size at birth was an important determinant of heat loss: Mean rectal admission temperature increased by 0.21 degrees C (95% CI, 0.04 to 0.4) with each 100-g increase in birth weight. CONCLUSIONS: Polyethylene occlusive skin wrapping prevents rather than delays heat loss at delivery in very preterm infants.

Apgar Score↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 2. A conceptual approach to causation-part 1.

One of the most common questions that arise in clinical practice is whether a causal relationship exists between two factors. In order to answer this question three steps need to be taken: First an association needs to be demonstrated between treatment/exposure and effect. Next, the possibility of this association being the result of error needs to be determined. Finally additional evidence to support a cause-and-effect relationship needs to be identified. Part 1 of this two-part paper describes how a complementary and alternative medicine provider goes through the first two steps when confronted with the question of whether silicone breast implants cause arthritis to develop. Also covered are the need for a control group when attempting to establish whether an association exists, the potential for systematic error (bias) or unsystematic error (chance) to distort an association, and the susceptibility of different study designs to systematic error.

Arthritis↗
PubMed2002

Teaching evidence-based complementary and alternative medicine: 2. A conceptual approach to causation-part 2.

As noted in Part 1, of this two-part paper, one of the most common questions that arise in clinical practice is whether a causal relationship exists between two factors. In order to answer this question we noted in Part 1 that three steps need to be taken: First an association needs to be demonstrated between treatment/exposure and effect. Next, the possibility of this association being the result of error needs to be determined. Finally, additional evidence to support a cause-and-effect relationship needs to be identified. Part 1 covered the first two steps and now Part 2 describes how a complementary and alternative medicine provider goes through the last step of this process when confronted with the question of whether silicone breast implants cause the development of arthritis. Part 3 examines the importance of answering the following questions: Did the cause precede the effect? How strong was the association observed? Is increasing exposure more likely to lead to disease? Is there evidence from several different studies showing the same association? Does withdrawal of the cause result in loss of the effect? Is there a biologic model that can explain the causal relationship?

Arthritis↗
PubMedDate not supplied

Paternal alcohol exposure and Turner syndrome.

AIMS: Turner syndrome (TS) is a sex chromosome aneuploidy that occurs as a result of a non-disjunctional error in meiosis I or anaphase lag; however, the aetiology of this disorder remains unknown. Anecdotal evidence suggests that paternal alcoholism may play an unidentified role in the aetiology of TS. Accordingly, the primary objective of this study was to determine the potential association between paternal alcohol exposure and TS. METHODS: The questionnaire was designed to solicit information about the parents' health and lifestyle habits occurring 1 year prior to and throughout the pregnancy of their daughter with TS. Alcohol dependence was assessed by the Brief Michigan Alcohol Screening Test (BMAST). The study population was solicited from the Turner's Syndrome Society of Canada and included any parent(s) having a child with TS who was of any age. Two hundred and twelve families completed and returned the survey. RESULTS: This provided a response rate of 86.5%. Six of the fathers (3.6%; n = 166) and six of the mothers (3.6%; n = 165) had scores of 5 or more on the BMAST (scores of 5+ are considered to be in the 'alcoholic range'). This is considerably lower than the population norm of 9.5%. CONCLUSIONS: Our study has suggested there is no association between paternal or maternal alcohol consumption and TS.

Adolescent↗
PubMedDate not supplied

Addressing the emergence of pediatric vaccination concerns: recommendations from a Canadian policy analysis.

Ever since the advent of pediatric vaccination, individuals have expressed concerns about both its risks and benefits. These concerns have once again resurfaced among some segments of the population and could potentially undermine national vaccination programs. The views of the public, however, must be considered and respected in the formulation of vaccination policy. We have conducted an analysis of the pediatric vaccination "debate" in the Canadian context. We believe that there is common ground between those who support pediatric vaccination and those who are concerned about these programs. Based on our findings, we believe that the goal of public health authorities should be to maintain trust in vaccines by continuing to meet certain reciprocal responsibilities. To do so, we recommend the following: 1) increased investment in adverse event reporting systems; 2) request for proposals for consideration of a no-fault compensation program; 3) developing pre-emptive strategies to deal with potential vaccine risks; 4) further examination of mechanisms to improve communication between physicians and parents concerned about vaccination. All of these approaches would require additional investment in pediatric vaccination. However, such an investment is easy to justify given the benefits offered by pediatric vaccination and the ramifications of failing to maintain confidence in vaccination programs or missing a vaccine-related adverse event.

Adverse Drug Reaction Reporting Systems↗