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Objective: Over half of the world's refugee population are under the age of 18 years. This systematic review aims to summarize the current body of evidence for the prevalence of mental illness in child and adolescent refugee populations. Method(s): Eight electronic databases, gray literature, and Google Scholar were searched for articles from 1 January 2003 to 5 February 2018. Strict inclusion criteria regarding the diagnosis of mental illness were imposed. Study quality was assessed using a template according to study design, and study heterogeneity using the I2 statistic. Random effects meta-analyses results were presented given heterogeneity among studies. The protocol for this systematic review was registered with PROSPERO (CRD42016046349). Result(s): Eight studies were eligible, involving 779 child and adolescent refugees and asylum seekers, with studies conducted in 5 countries. The overall prevalence of posttraumatic stress disorder (PTSD) was 22.71% (95% CI 12.79-32.64), depression 13.81% (95% CI 5.96-21.67), and anxiety disorders 15.77% (95% CI 8.04-23.50). Attention-deficit/hyperactivity disorder (ADHD) was 8.6% (1.08-16.12) and oppositional defiant disorder (ODD) was 1.69% (95% CI -0.78 to 4.16). Because of the high heterogeneity, further subgroup analyses were conducted. Conclusion(s): Refugee and asylum seeker children have high rates of PTSD, depression, and anxiety. Without the serious commitment by health and resettlement services to provide early support to promote mental health, these findings suggest that a high proportion of refugee children are at risk for educational disadvantage and poor social integration in host communities, potentially affecting their life course.Copyright © 2019 American Academy of Child and Adolescent Psychiatry

Background: Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS. Method(s): International healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations. Result(s): This paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years post-menarche; > 90 days for any one cycle (> 1 year post-menarche), cycles< 21 or > 45 days (> 1 to < 3 years post-menarche); cycles < 21 or > 35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Mullerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an 'at risk' label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hy

Polycystic ovary syndrome (PCOS) affects 8-13% of women. The Rotterdam diagnostic criteria include polycystic ovarian morphology (PCOM) on ultrasound, but given recognized challenges, serum anti-Mullerian hormone (AMH) is proposed as an alternative. To inform international PCOS guidelines, a systematic review was completed. Key identified gaps include large international studies in well-defined populations across the lifespan, clustering of AMH with PCOS features, relationships to long-term health outcomes, and improved quality, assay standardization, and sample handling, all needed to determine cut offs. Here we identify research priorities to address these gaps and enhance AMH utility in PCOS. Once issues are addressed, AMH levels could replace more costly and less accessible ultrasound in PCOS diagnosis.Copyright © 2019

Background: Polycystic ovary syndrome (PCOS) presents with four phenotypes with varying severity. PCOS is associated with increased risk of pregnancy complications. It is unclear if PCOS phenotypes are variably associated with pregnancy complications. We aimed to conduct a meta-analysis of pregnancy complications in women with and without PCOS by PCOS phenotypes. Method(s): A comprehensive search was performed in several electronic databases for pregnancy outcomes in women with and without PCOS. Outcomes of interest included miscarriage, gestational diabetes (GDM), gestational hypertension (GH), preeclampsia (PE), induction of labour (IoL), Caesarean section (CS), intra-uterine growth restriction, preterm birth, birth weight, macrosomia and small for gestational age and large for gestational age (LGA). Twenty six of 4294 identified studies, compromising 1743 women with and 8294 women without PCOS were included. Result(s): The odds ratio (OR) for GDM [3.5; 95% confidence interval (CI) 2.0, 6.0], GH [3.9; 2.1, 7.2], PE [2.7; 1.5, 4.9], IoL [1.8; 1.1, 2.9], CS [1.5; 1.2, 2.0] and LGA [1.4; 1.1, 2.0] were higher in PCOS. Of these, the increased odds were maintained across PCOS phenotypes for GDM and GH however odds were significantly associated with hyperandrogenic phenotypes for PE, IoL, CS and LGA. Women with the hyperandrogenic phenotypes had significantly higher body mass index. Conclusion(s): In pregnancy, glucose profile and blood pressure should be equally screened across PCOS phenotypes with further consideration in women with the hyperandrogenic phenotypes.

Background: To develop and translate rigorous, comprehensive evidence-based diagnosis, assessment and treatment guidelines to improve the lives of women with polycystic ovary syndrome (PCOS) worldwide. Method(s): Extensive multidisciplinary health professional and patient engagement informed guideline priority areas. Best practice evidence-based guideline development involved extensive evidence synthesis. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework covered evidence quality, feasibility, acceptability, cost, implementation and recommendation strength. Governance included international advisory board (six continents), project board, five guideline development groups (GDG) with 63 members, consumer and translation committees. Thirty-seven organisations across 71 countries collaborated with 23 face-to-face international meetings over 15 months. Convened Committees from partner and collaborating organisations provided peer review and the guideline was approved by the NHMRC. This abstract focuses on the lifestyle management and models of care GDG. Result(s): Women with PCOS should be offered regular weight monitoring. Healthy lifestyle (diet, exercise and behavioural strategies) behaviours should be recommended in all women with PCOS to achieve and/or maintain healthy weight and to optimise hormonal outcomes, general health and quality of life across the life-course. 5-10% weight loss in those with excess weight yields significant clinical improvements and is considered successful weight reduction within six months Health professionals should advise standard population recommendation for diet composition, physical activity and sedentary behaviour. Lifestyle interventions could include behavioural strategies or health behavioural or cognitive behavioural interventions. Personal sensitivities, marginalisation and potential weight-related stigma and psychological factors such as anxiety and depressive symptoms, body image concerns an

Background: Polycystic ovary syndrome (PCOS) has a prevalence of 8–13%. Given the prevalence, diverse health impacts and variation in care, rigorous evidence‐based guidelines are needed in PCOS management. This systematic review with meta‐analyses aimed to investigate the effect of the combined oral contraceptive pill (COCP) and/or metformin in the management of hormonal and clinical features of PCOS, to inform international guidelines. Methods: Electronic databases were searched systematically from inception until 11 January 2017 to inform the guideline process. Eligible studies were randomized controlled trials which investigated the effect of COCPs and/or metformin alone or combined on hormonal and clinical features in women with PCOS. Outcomes were prioritized as critical for informing a decision about an intervention or important or not important, according to GRADE. Articles were assessed by one author against selection criteria, in consultation with a second author. Data were double extracted independently by four authors, and data quality appraisal was completed. Meta‐analyses were conducted, where appropriate. Results: Fifty‐six studies were eligible for inclusion. Outcomes prioritized by women and health professionals included the following: irregular cycles, insulin resistance, weight, BMI, thromboembolic events and gastrointestinal effects. In low‐quality evidence in adolescents, meta‐analyses demonstrated that metformin was better than COCP for BMI (mean difference [MD] −4.02 [−5.23, −2.81], P < 0.001); COCP was better than metformin for menstrual regulation (MD −0.19 [−0.25, −0.13], P < 0.00001). In low‐quality evidence in adults, meta‐analyses demonstrated that metformin was better than placebo for BMI (MD −0.48 [−0.94, −0.02], P = 0.04); metformin was better than COCP for fasting insulin (MD 4.00 [2.59, 5.41], P = 0.00001), whereas COCP was better than metformin for irregular cycles (MD 12.49 [1.34, 116.62], P = 0.03). Combined oral co

Introduction While a number of studies have reported increased risk of adverse pregnancy outcomes in polycystic ovary syndrome (PCOS), these have not been designed considering the impact of body mass index (BMI) as an important contributor to both PCOS severity and pregnancy outcomes. We therefore aimed to explore the impact of BMI on adverse pregnancy outcomes in PCOS. Methods A comprehensive search was conducted in Medline, Medline in-process and other non-indexed citations, EMBASE and all EBM reviews. Prospective studies reporting pregnancy outcomes including miscarriage, gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth, small and large for gestational age birth in women with and without PCOS, until 4th April 2017, were identified as eligible for inclusion. Data were expressed as odds ratio (OR) with 95% confidence interval (CI) and analyzed using the random effect model for meta-analysis. Results Out of a total of 4292 identified articles, 24 prospective studies were included in the meta-analysis. Women with PCOS showed higher risk for miscarriage (OR 2.85, 95% CI 1.74-4.65), gestational diabetes (OR 3.04, 95% CI 2.26-4.10), gestational hypertension (OR 2.24, 95% CI 1.71-2.95), pre-eclampsia (OR 1.90, 95% CI 1.32-2.74), preterm birth (OR 1.51, 95% CI 1.09- 2.08) but similar risk for small for gestational age birth (OR 1.56, 95% CI 0.76-3.21) and large for gestational age birth (OR 1.19, 95% CI 0.90-1.58), compared to women without PCOS. On subgroup analysis by BMI-matched studies, this higher risk was maintained for miscarriage (OR: 4.00, 95% CI 2.59-6.18) and gestational diabetes (OR: 4.94, 95% CI 1.06-23.08), but not for gestational hypertension (OR: 2.50, 95% CI 0.69-9.05), preeclampsia (OR: 2.61, 95% CI 0.55-12.34) and preterm birth (OR: 1.64, 95% CI 0.61-4.41). The risks became significant for small for gestational age birth (OR: 4.52, 95% CI 1.92-10.61) and large for gestational age birth (OR: 1.99, 95% CI 1.05-3.77) in BMI-matc

Study Question: What is the impact of preconception lifestyle interventions on live birth, birth weight and pregnancy rate? Summary Answer: Lifestyle interventions showed benefits for weight loss and increased natural pregnancy rate, but not for live birth or birth weight. What is Known Already: Evidence on the practice and content of preconception counseling and interventions is variable and limited. Study Design, Size, Duration: Systematic review and meta-analysis (MA). Main search terms were those related to preconception lifestyle. Database searched were Ovid MEDLINE(R), EBM Reviews, PsycINFO, EMBASE and CINAHL Plus. No language restriction was placed on the published articles. The final search was performed on 10 January 2017. Participants/Materials, Setting, Methods: Participants were non-pregnant women of childbearing age intent on conceiving or their male partners. Exclusion criteria include participants with BMI < 18 kg/m2, animal trials, hereditary disorder in one or both partners and trials focusing solely on alcohol or smoking cessation/reduction, micronutrient supplementation, or diabetes control. Anthropometric, fertility, obstetric and fetal outcomes were assessed. Bias and quality assessments were performed. Main Results and The Role of Chance: The search returned 1802 articles and eight studies were included for analysis. Populations targeted were primarily overweight or obese subfertile women seeking reproductive assistance, with few community-based studies and none including men. MA showed greater reduction in weight (n = 3, P < 0.00001, mean difference: -3.48 kg, 95% CI: -4.29, -2.67, I2 = 0%) and BMI (n = 2, P < 0.00001, mean difference: -1.40 kg/m2, 95% CI: -1.95, -0.84, I2 = 24%) with intervention. The only significant fertility outcome was an increased natural pregnancy rate (n = 2, P = 0.003, odds ratio: 1.87, CI: 1.24, 2.81, I2 = 0%). No differences were observed for ART adverse events, clinical pregnancy, pregnancy complications, delivery

Study question: What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary answer: International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. What is known already: Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. Study design, size, duration: International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Participants/materials, setting, methods: Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation

Introduction There is conflicting evidence regarding the efficacy of high dose salicylates in improving cardiometabolic risk in healthy and type 2 diabetes patients. We aimed to determine whether treatment with salicylates at an anti-inflammatory dose (>= 1 g daily) would improve cardiometabolic risk in healthy individuals and type 2 diabetes patients, compared to placebo. Methods Medline, Medline-in-process, Embase, and all EBM databases were searched for studies published up to December 2016. Twenty-eight articles from 24 studies comprising 1591 participants were included. Two reviewers independently assessed the risk of bias and extracted data from included studies. Meta-analyses using random-effects model were used to analyze the data. Results High dose salicylates (>= 3 g/d) decreased fasting glucose (MD -0.4 mmol/l, 95% CI - 0.54, - 0.27) and glucose area under the curve (MD -0.41 mmol/l, 95% CI - 0.81, - 0.01). Salicylates (>= 3 g/d) also increased fasting insulin (MD 2.4 muU/ml, 95% CI 0.3, 4.4), 2-h insulin (MD 25.4 muU/ml, 95% CI 8.2, 42.6), insulin secretion (MD 79.2, 95% CI 35, 123) but decreased fasting C-peptide (MD -0.11 nmol/l, 95% CI - 0.2, - 0.04), insulin clearance (MD -0.26 l/min, 95% CI - 0.36, - 0.16) and triglycerides (MD -0.36 mmol/l, 95% CI - 0.51, - 0.21) and increased total adiponectin (MD 1.97 mug/ml, 95% CI 0.99, 2.95). A lower salicylate dose (1-2.9 g) did not change any cardiometabolic parameters (p > 0.1). No significant difference was observed between those receiving salicylates and placebo following withdrawal due to adverse events. Conclusions High dose salicylates appear to improve cardiometabolic risk factors in healthy individuals and type 2 diabetes patients. PROSPERO registration number CRD42015029826.Copyright © 2017 Elsevier Inc.

IMPORTANCE: Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with the IOM guidelines and pregnancy outcomes is unclear. OBJECTIVE(S): To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI >=30]) and maternal and infant outcomes. DATA SOURCES AND STUDY SELECTION: Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain. DATA EXTRACTION AND SYNTHESIS: Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data. MAIN OUTCOMES AND MEASURES: Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus. RESULT(S): Of 5354 identified studies, 23 (n = 1309136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, -2% [-10% to -6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, -2% [-3% to -1%]); cesarean delivery s

STUDY QUESTION: What is the impact of preconception lifestyle interventions on live birth, birth weight and pregnancy rate? SUMMARY ANSWER: Lifestyle interventions showed benefits for weight loss and increased natural pregnancy rate, but not for live birth or birth weight. WHAT IS KNOWN ALREADY: Evidence on the practice and content of preconception counseling and interventions is variable and limited. STUDY DESIGN, SIZE, DURATION: Systematic review and meta-analysis (MA). Main search terms were those related to preconception lifestyle. Database searched were Ovid MEDLINE(R), EBM Reviews, PsycINFO, EMBASE and CINAHL Plus. No language restriction was placed on the published articles. The final search was performed on 10 January 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were non-pregnant women of childbearing age intent on conceiving or their male partners. Exclusion criteria include participants with BMI < 18 kg/m2, animal trials, hereditary disorder in one or both partners and trials focusing solely on alcohol or smoking cessation/reduction, micronutrient supplementation, or diabetes control. Anthropometric, fertility, obstetric and fetal outcomes were assessed. Bias and quality assessments were performed. MAIN RESULTS AND THE ROLE OF CHANCE: The search returned 1802 articles and eight studies were included for analysis. Populations targeted were primarily overweight or obese subfertile women seeking reproductive assistance, with few community-based studies and none including men. MA showed greater reduction in weight (n = 3, P < 0.00001, mean difference: -3.48 kg, 95% CI: -4.29, -2.67, I2 = 0%) and BMI (n = 2, P < 0.00001, mean difference: -1.40 kg/m2, 95% CI: -1.95, -0.84, I2 = 24%) with intervention. The only significant fertility outcome was an increased natural pregnancy rate (n = 2, P = 0.003, odds ratio: 1.87, CI: 1.24, 2.81, I2 = 0%). No differences were observed for ART adverse events, clinical pregnancy, pregnancy complications

Introduction: The extraskeletal role of Vitamin D is being increasingly recognised. This has important clinical implications, as Vitamin D deficiency has reached epidemic proportions worldwide. Vitamin D has proposed anti-inflammatory properties, yet the role of Vitamin D supplementation in reducing inflammation remains largely unknown. The purpose of this review is to investigate the impact of Vitamin D supplementation on inflammation, and to identify relevant knowledge gaps in the field. Methods and analysis: Medline, CINAHL, EMBASE and All EBM will be systematically searched for randomised controlled trials (RCTs) and systematic reviews of RCTs, comparing Vitamin D supplementation with placebo, usual care or other pharmacological or non-pharmacological interventions. One reviewer will assess articles for eligibility according to prespecified selection criteria, after which 2 independent reviewers will perform data extraction and quality appraisal. Meta-analyses will be conducted where appropriate. Ethics and dissemination: Formal ethical approval is not required as no primary data is collected. This systematic review will identify potential clinical implications of Vitamin D deficiency and supplementation, and will be disseminated through a peer-reviewed publication and at conference meetings, to inform future research on the efficacy of Vitamin D supplementation for inflammation and inflammatory diseases.

BACKGROUND: Here we describe the consensus guideline methodology, summarise the evidence-based recommendations we provided to the World Health Organisation (WHO) for their consideration in the development of global guidance and present a narrative review on the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS). OBJECTIVE AND RATIONALE: The aim of this paper was to present an evidence base for the management of anovulatory PCOS. SEARCH METHOD(S): The evidence to support providing recommendations involved a collaborative process for: (i) identification of priority questions and critical outcomes, (ii) retrieval of up-to-date evidence and exiting guidelines, (iii) assessment and synthesis of the evidence and (iv) the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation, the methodologist evaluated the quality of the supporting evidence that was then graded as very low, low, moderate or high for consideration during consensus. OUTCOME(S): Evidence was synthesized and we made recommendations across the definition of PCOS including hyperandrogenism, menstrual cycle regulation and ovarian assessment. Metabolic features and the impact of ethnicity were covered. Management includes lifestyle changes, bariatric surgery, pharmacotherapy (including clomiphene citrate (CC), aromatase inhibitors, metformin and gonadotropins), as well as laparoscopic surgery. In-vitro fertilization (IVF) was considered as were the risks of ovulation induction and of pregnancy in PCOS. Approximately 80% of women who suffer from anovulatory infertility have PCOS. Lifestyle intervention is recommended first in women who are obese largely on the basis of general health benefits. Bariatric surgery can be considered where the body mass index (BMI) is >= 35 kg/m2 and lifestyle therapy has failed. Carefully conducted and monitored pharmacological ovulation induction can achieve good

Background: Self-management models can be a very powerful resource in the health system provided they are well tailored to a particular disease and setting. Patient outcomes have been demonstrated to improve when self-management practices are embedded in the care of people with certain diseases. However, it remains unclear whether self-management models and specific components of these programmes can be implemented in order to effectively improve the care of people with diabetes and/or chronic kidney disease. Methods/Design: Medline (including Medline in-process), Excerpta medica database (EMBASE), Cumulative Index to Nursing and Allied Health (CINAHL) and all evidence-based medicine (EBM) will be systematically searched for randomised controlled studies comparing self-management models with usual care in patients with diabetes or chronic kidney disease. Two reviewers will independently assess articles for eligibility: extract data, evaluate risk of bias and complete quality assessment of included studies. The data will be tabulated and narratively synthesised. Meta-analyses will be performed if there is sufficient homogenous data. Discussion(s): This protocol utilises rigorous methodology as well as pre-specified eligibility criteria to comprehensively search for diabetes and kidney disease self-management models which have been compared with usual care in randomised controlled trials. The review is likely to provide insight into the effectiveness of current models for improving patient self-management, and this may address the key translational issue of how to integrate and tailor these self-management practices for patients with diabetes and chronic kidney disease. Systematic review registration: PROSPERO CRD42015017316.Copyright © 2015 Zimbudzi et al.

While lifestyle management is recommended as first-line treatment of polycystic ovary syndrome (PCOS), the optimal dietary composition is unclear. The aim of this study was to compare the effect of different diet compositions on anthropometric, reproductive, metabolic, and psychological outcomes in PCOS. A literature search was conducted (Australasian Medical Index, CINAHL, EMBASE, Medline, PsycInfo, and EBM reviews; most recent search was performed January 19, 2012). Inclusion criteria were women with PCOS not taking anti-obesity medications and all weight-loss or maintenance diets comparing different dietary compositions. Studies were assessed for risk of bias. A total of 4,154 articles were retrieved and six articles from five studies met the a priori selection criteria, with 137 women included. A meta-analysis was not performed due to clinical heterogeneity for factors including participants, dietary intervention composition, duration, and outcomes. There were subtle differences between diets, with greater weight loss for a monounsaturated fat-enriched diet; improved menstrual regularity for a low-glycemic index diet; increased free androgen index for a high-carbohydrate diet; greater reductions in insulin resistance, fibrinogen, total, and high-density lipoprotein cholesterol for a low-carbohydrate or low-glycemic index diet; improved quality of life for a low-glycemic index diet; and improved depression and self-esteem for a highprotein diet. Weight loss improved the presentation of PCOS regardless of dietary composition in the majority of studies. Weight loss should be targeted in all overweight women with PCOS through reducing caloric intake in the setting of adequate nutritional intake and healthy food choices irrespective of diet composition. © 2013 Academy of Nutrition and Dietetics.

Background: Evidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM. Methods. A mixed-methods study was conducted consisting of a controlled trial and focus groups with second year graduate medical students. Students received the EBM course delivered using either a didactic approach (DID) to learning EBM or a blended-learning approach (BL). Student competency in EBM was assessed using the Berlin tool and a criterion-based assessment task, with student perceptions on the interventions assessed qualitatively. Results: A total of 61 students (85.9%) participated in the study. Competency in EBM did not differ between the groups when assessed using the Berlin tool (p = 0.29). Students using the BL approach performed significantly better in one of the criterion-based assessment tasks (p = 0.01) and reported significantly higher self-perceived competence in critical appraisal skills. Qualitative analysis identified that students had a preference for the EBM course to be delivered using the BL approach. Conclusions: Implementing a blended-learning approach to EBM teaching promotes greater student appreciation of EBM principles within the clinical setting. Integrating a variety of teaching modalities and approaches can increase student self-confidence and assist in bridging the gap between the theory and practice of EBM. © 2013 Ilic et al.; licensee BioMed Central Ltd.

Estrogen (17beta-estradiol, E2)-deficient aromatase knockout (ArKO) mice develop Sertoli and Leydig cells at puberty. We hypothesized that estrogen, directly or indirectly, regulates genes responsible for somatic cell differentiation and steroidogenesis. ArKO ovaries expressed estrogen receptors alpha and beta, and LH receptor, indices of estrogen responsiveness in the ovary. Wild-type (Wt) and ArKO mice received either E2 or placebo for 3 wk, from 7-10 wk of age. E2 decreased serum FSH and LH and increased uterine weights of 10-wk-old ArKO mice. We measured mRNA expression of Sertoli cell, Sry-like HMG box protein 9 (Sox9); three upstream transcription factors, liver receptor homolog-1 (Lrh-1), steroidogenic factor 1, and dosage-sensitive sex reversal adrenal hypoplasia congenital critical region on the X chromosome gene 1; and one downstream factor, MUllerian-inhibiting substance. Placebo-treated ArKO ovaries have increased Sox9 (15-fold; P < 0.001), Mullerian-inhibiting substance (2.9-foLd), Lrh-1 (7.7-fold), and dosage-sensitive sex reversal adrenal hypoplasia congenital critical region on the X chromosome gene 1 (12-fold) expression compared with Wt at 10 wk. Steroidogenic factor 1 was similar to Wt. Consistent with increased serum T levels and Leydig cells in their ovaries, placebo-treated ArKO ovaries had increased 17alpha-hydroxylase, 17beta-hydroxysteroid dehydrogenase type-3, and 17beta-hydroxysteroid dehydrogenase type-1 expression compared with Wt at 10 wk. E2 treatment for 3 wk improved the ovarian phenotype, decreased development of Sertoli cells, decreased the expression of Sox9, Lrh-1, and the steroidogenic enzymes in ArKO ovaries, and induced ovulation in some cases. In conclusion, the expression of the genes regulating somatic cell differentiation is directly or indirectly responsive to estrogen.

The Problem Gambling Research and Treatment Centre (PGRTC) has developed the first evidence-based guideline to address problem gambling in Australia — Guideline for screening, assessment and treatment in problem gambling. The entire guideline and related appendices have been approved by the Chief Executive Officer of the National Health and Medical Research Council (NHMRC) under s. 14A of the National Health and Medical Research Council Act 1992. In approving the guideline, the NHMRC considered that it meets the NHMRC’s standard for clinical practice guidelines. The guideline will be available on the PGRTC websites (http://www.med.monash.edu.au/sphc/pgrtc and http://www.education.unimelb.edu.au/problemgambling). The full guideline addresses screening, assessment and treatment issues relating to problem gambling; in this abridged outline, we focus solely on treatment interventions for problem gamblers.