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Seidler AL, Aberoumand M, Hunter KE, Barba A, Libesman S, Williams JG, Shrestha N, Aagerup J, Sotiropoulos JX, Montgomery AA, Gyte GML, Duley L, Askie LM. Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis. Lancet 2023; 402:2209-2222. [PMID: 37977169 DOI: 10.1016/s0140-6736(23)02468-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Umbilical cord clamping strategies at preterm birth have the potential to affect important health outcomes. The aim of this study was to compare the effectiveness of deferred cord clamping, umbilical cord milking, and immediate cord clamping in reducing neonatal mortality and morbidity at preterm birth. METHODS We conducted a systematic review and individual participant data meta-analysis. We searched medical databases and trial registries (from database inception until Feb 24, 2022; updated June 6, 2023) for randomised controlled trials comparing deferred (also known as delayed) cord clamping, cord milking, and immediate cord clamping for preterm births (<37 weeks' gestation). Quasi-randomised or cluster-randomised trials were excluded. Authors of eligible studies were invited to join the iCOMP collaboration and share individual participant data. All data were checked, harmonised, re-coded, and assessed for risk of bias following prespecified criteria. The primary outcome was death before hospital discharge. We performed intention-to-treat one-stage individual participant data meta-analyses accounting for heterogeneity to examine treatment effects overall and in prespecified subgroup analyses. Certainty of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. This study is registered with PROSPERO, CRD42019136640. FINDINGS We identified 2369 records, of which 48 randomised trials provided individual participant data and were eligible for our primary analysis. We included individual participant data on 6367 infants (3303 [55%] male, 2667 [45%] female, two intersex, and 395 missing data). Deferred cord clamping, compared with immediate cord clamping, reduced death before discharge (odds ratio [OR] 0·68 [95% CI 0·51-0·91], high-certainty evidence, 20 studies, n=3260, 232 deaths). For umbilical cord milking compared with immediate cord clamping, no clear evidence was found of a difference in death before discharge (OR 0·73 [0·44-1·20], low certainty, 18 studies, n=1561, 74 deaths). Similarly, for umbilical cord milking compared with deferred cord clamping, no clear evidence was found of a difference in death before discharge (0·95 [0·59-1·53], low certainty, 12 studies, n=1303, 93 deaths). We found no evidence of subgroup differences for the primary outcome, including by gestational age, type of delivery, multiple birth, study year, and perinatal mortality. INTERPRETATION This study provides high-certainty evidence that deferred cord clamping, compared with immediate cord clamping, reduces death before discharge in preterm infants. This effect appears to be consistent across several participant-level and trial-level subgroups. These results will inform international treatment recommendations. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Anna Lene Seidler
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia.
| | - Mason Aberoumand
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Kylie E Hunter
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Angie Barba
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Sol Libesman
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | | | - Nipun Shrestha
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Jannik Aagerup
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | | | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lisa M Askie
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia
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Seidler AL, Libesman S, Hunter KE, Barba A, Aberoumand M, Williams JG, Shrestha N, Aagerup J, Sotiropoulos JX, Montgomery AA, Gyte GML, Duley L, Askie LM. Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data. Lancet 2023; 402:2223-2234. [PMID: 37977170 DOI: 10.1016/s0140-6736(23)02469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Deferred (also known as delayed) cord clamping can improve survival of infants born preterm (before 37 weeks of gestation), but the optimal duration of deferral remains unclear. We conducted a systematic review and individual participant data network meta-analysis with the aim of comparing the effectiveness of umbilical cord clamping strategies with different timings of clamping or with cord milking for preterm infants. METHODS We searched medical databases and trial registries from inception until Feb 24, 2022 (updated June 6, 2023) for randomised controlled trials comparing cord clamping strategies for preterm infants. Individual participant data were harmonised and assessed for risk of bias and quality. Interventions were grouped into immediate clamping, short deferral (≥15 s to <45 s), medium deferral (≥45 s to <120 s), long deferral (≥120 s), and intact cord milking. The primary outcome was death before hospital discharge. We calculated one-stage, intention-to-treat Bayesian random-effects individual participant data network meta-analysis. This study was registered with PROSPERO, CRD42019136640. FINDINGS We included individual participant data from 47 trials with 6094 participants. Of all interventions, long deferral reduced death before discharge the most (compared with immediate clamping; odds ratio 0·31 [95% credibility interval] 0·11-0·80; moderate certainty). The risk of bias was low for 10 (33%) of 30 trials, 14 (47%) had some concerns, and 6 (20%) were rated as having a high risk of bias. Heterogeneity was low, with no indication of inconsistency. INTERPRETATION This study found that long deferral of clamping leads to reduced odds of death before discharge in preterm infants. In infants assessed as requiring immediate resuscitation, this finding might only be generalisable if there are provisions for such care with the cord intact. These results are based on thoroughly cleaned and checked individual participant data and can inform future guidelines and practice. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Anna Lene Seidler
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia.
| | - Sol Libesman
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - Kylie E Hunter
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - Angie Barba
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - Mason Aberoumand
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - Jonathan G Williams
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - Nipun Shrestha
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - Jannik Aagerup
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - James X Sotiropoulos
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Lisa M Askie
- University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia
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Seidler AL, Willson ML, Aberoumand M, Williams JG, Hunter KE, Barba A, Simes RJ, Webster A. The changing landscape of clinical trials in Australia. Med J Aust 2023; 219:192-196. [PMID: 37573518 PMCID: PMC10952960 DOI: 10.5694/mja2.52059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/22/2023] [Accepted: 05/24/2023] [Indexed: 08/15/2023]
Affiliation(s)
| | | | | | | | - Kylie E Hunter
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - Angie Barba
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - R John Simes
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - Angela Webster
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
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Seidler AL, Hunter KE, Barba A, Aberoumand M, Libesman S, Williams JG, Shrestha N, Aagerup J, Gyte G, Montgomery A, Duley L, Askie L. Optimizing cord management for each preterm baby - Challenges of collating individual participant data and recommendations for future collaborative research. Semin Perinatol 2023:151740. [PMID: 37019711 DOI: 10.1016/j.semperi.2023.151740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
The optimal cord management strategy at birth for each preterm baby is still unknown, despite more than 100 randomized controlled trials (RCTs) undertaken on this question. To address this, we brought together all RCTs examining cord management strategies at preterm birth in the iCOMP (individual participant data on COrd Management at Preterm birth) Collaboration, to perform an individual participant data network meta-analysis. In this paper, we describe the trials and tribulations around obtaining individual participant data to resolve controversies around cord clamping, and we derive key recommendations for future collaborative research in perinatology. To reliably answer outstanding questions, future cord management research needs to be collaborative and coordinated, by aligning core protocol elements, ensuring quality and reporting standards are met, and carefully considering and reporting on vulnerable sub-populations. The iCOMP Collaboration is an example of the power of collaboration to address priority research questions, and ultimately improve neonatal outcomes worldwide.
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Affiliation(s)
- Anna Lene Seidler
- Senior Research Fellow, NHMRC Clinical Trials Centre, University of Sydney, Australia.
| | - Kylie E Hunter
- Human Mvt, Senior Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Angie Barba
- Senior Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Mason Aberoumand
- Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Sol Libesman
- Post Doctoral Research Associate, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Jonathan G Williams
- BMedBiotech, Evidence Analyst, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Nipun Shrestha
- Post Doctoral Research Associate, NHMRC Clinical Trials Center, University of Sydney, Australia
| | - Jannik Aagerup
- Research Administration Officer, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Gill Gyte
- Consumer Editor, Cochrane Pregnancy and Childbirth, University of Liverpool, UK
| | - Alan Montgomery
- Professor of Medical Statistics and Clinical Trials, Nottingham Clinical Trials Unit, University of Nottingham, UK
| | | | - Lisa Askie
- MPH FAHMS FHEA, University of Sydney, Australia
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5
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Hunter KE, Webster AC, Clarke M, Page MJ, Libesman S, Godolphin PJ, Aberoumand M, Rydzewska LHM, Wang R, Tan AC, Li W, Mol BW, Willson M, Brown V, Palacios T, Seidler AL. Development of a checklist of standard items for processing individual participant data from randomised trials for meta-analyses: Protocol for a modified e-Delphi study. PLoS One 2022; 17:e0275893. [PMID: 36219622 PMCID: PMC9553056 DOI: 10.1371/journal.pone.0275893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
Individual participant data meta-analyses enable detailed checking of data quality and more complex analyses than standard study-level synthesis of summary data based on publications. However, there is limited existing guidance on the specific systematic checks that should be undertaken to confirm and enhance data quality for individual participant data meta-analyses and how to conduct these checks. We aim to address this gap by developing a checklist of items for data quality checking and cleaning to be applied to individual participant data meta-analyses of randomised trials. This study will comprise three phases: 1) a scoping review to identify potential checklist items; 2) two e-Delphi survey rounds among an invited panel of experts followed by a consensus meeting; and 3) pilot testing and refinement of the checklist, including development of an accompanying R-markdown program to facilitate its uptake.
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Affiliation(s)
- Kylie E. Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
- * E-mail:
| | - Angela C. Webster
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Mike Clarke
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Matthew J. Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sol Libesman
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Peter J. Godolphin
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Mason Aberoumand
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Aidan C. Tan
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Wentao Li
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Melina Willson
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Talia Palacios
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Hunter KE, Johnson BJ, Askie L, Golley RK, Baur LA, Marschner IC, Taylor RW, Wolfenden L, Wood CT, Mihrshahi S, Hayes AJ, Rissel C, Robledo KP, O'Connor DA, Espinoza D, Staub LP, Chadwick P, Taki S, Barba A, Libesman S, Aberoumand M, Smith WA, Sue-See M, Hesketh KD, Thomson JL, Bryant M, Paul IM, Verbestel V, Stough CO, Wen LM, Larsen JK, O'Reilly SL, Wasser HM, Savage JS, Ong KK, Salvy SJ, Messito MJ, Gross RS, Karssen LT, Rasmussen FE, Campbell K, Linares AM, Øverby NC, Palacios C, Joshipura KJ, González Acero C, Lakshman R, Thompson AL, Maffeis C, Oken E, Ghaderi A, Campos Rivera M, Pérez-Expósito AB, Banna JC, de la Haye K, Goran M, Røed M, Anzman-Frasca S, Taylor BJ, Seidler AL. Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration: protocol for a systematic review with individual participant data meta-analysis of behavioural interventions for the prevention of early childhood obesity. BMJ Open 2022; 12:e048166. [PMID: 35058256 PMCID: PMC8783820 DOI: 10.1136/bmjopen-2020-048166] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/18/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. METHODS AND ANALYSIS Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD; if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified individual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. ETHICS AND DISSEMINATION Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. PROSPERO REGISTRATION NUMBER CRD42020177408.
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Affiliation(s)
- Kylie E Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Brittany J Johnson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Louise A Baur
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Ian C Marschner
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Charles T Wood
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alison J Hayes
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Denise A O'Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lukas P Staub
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul Chadwick
- Centre For Behaviour Change, University College London, London, UK
| | - Sarah Taki
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Angie Barba
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sol Libesman
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mason Aberoumand
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Wendy A Smith
- Canterbury Community Health Centre, Sydney Local Health District, Campsie, New South Wales, Australia
- Consumer Representative, Sydney, New South Wales, Australia
| | | | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | | | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, UK
| | - Ian M Paul
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Vera Verbestel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | | | - Li Ming Wen
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, The Netherlands
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Heather M Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer S Savage
- Department of Nutritional Sciences & Center for Childhood Obesity Research, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Ken K Ong
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Mary Jo Messito
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Rachel S Gross
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Levie T Karssen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, The Netherlands
| | - Finn E Rasmussen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Ana Maria Linares
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Nina Cecilie Øverby
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Vest-Agder, Norway
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida, USA
| | - Kaumudi J Joshipura
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Carolina González Acero
- Social Protection and Health Division, Inter-American Development Bank, Santo Domingo, Distrito Nacional, Dominican Republic
| | | | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - Ana B Pérez-Expósito
- Social Protection and Health Division, Inter-American Development Bank, Washington, District of Columbia, USA
| | - Jinan C Banna
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii, Honolulu, Hawaii, USA
| | - Kayla de la Haye
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael Goran
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Margrethe Røed
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Vest-Agder, Norway
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Barry J Taylor
- Better Start National Science Challenge, University of Otago, Dunedin, New Zealand
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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Johnson BJ, Hunter KE, Golley RK, Chadwick P, Barba A, Aberoumand M, Libesman S, Askie L, Taylor RW, Robledo KP, Mihrshahi S, O'Connor DA, Hayes AJ, Wolfenden L, Wood CT, Baur LA, Rissel C, Staub LP, Taki S, Smith W, Sue-See M, Marschner IC, Espinoza D, Thomson JL, Larsen JK, Verbestel V, Odar Stough C, Salvy SJ, O'Reilly SL, Karssen LT, Rasmussen FE, Messito MJ, Gross RS, Bryant M, Paul IM, Wen LM, Hesketh KD, González Acero C, Campbell K, Øverby NC, Linares AM, Wasser HM, Joshipura KJ, Palacios C, Maffeis C, Thompson AL, Ghaderi A, Lakshman R, Banna JC, Oken E, Campos Rivera M, Pérez-Expósito AB, Taylor BJ, Savage JS, Røed M, Goran M, de la Haye K, Anzman-Frasca S, Seidler AL. Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol. BMJ Open 2022; 12:e048165. [PMID: 35058255 PMCID: PMC8783827 DOI: 10.1136/bmjopen-2020-048165] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity. METHODS AND ANALYSIS Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. ETHICS AND DISSEMINATION The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study's findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders. PROSPERO REGISTRATION NUMBER CRD42020177408.
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Affiliation(s)
- Brittany J Johnson
- Caring Fututures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kylie E Hunter
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca K Golley
- Caring Fututures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Angie Barba
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mason Aberoumand
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sol Libesman
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kristy P Robledo
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Seema Mihrshahi
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Denise A O'Connor
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
| | - Alison J Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Charles T Wood
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Louise A Baur
- The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lukas P Staub
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Taki
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Wendy Smith
- Canterbury Community Health Centre, Campsie, New South Wales, Australia
- Consumer Representative, Sydney, New South Wales, Australia
| | | | - Ian C Marschner
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - David Espinoza
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Junilla K Larsen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Vera Verbestel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Cathleen Odar Stough
- Department of Psychology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Sarah-Jeanne Salvy
- Research Center for Health Equity, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Levie T Karssen
- Behavioural Science Institute, Radboud Universiteit, Nijmegen, Gelderland, The Netherlands
| | - Finn E Rasmussen
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Mary Jo Messito
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Rachel S Gross
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, UK
| | - Ian M Paul
- College of Medicine, Penn State, Hershey, Pennsylvania, USA
| | - Li Ming Wen
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Population Health Research and Evaluation Hub, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Carolina González Acero
- Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Santo Domingo, Dominican Republic
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nina Cecilie Øverby
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Ana M Linares
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Heather M Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kaumudi J Joshipura
- Center for Clinical Research and Health Promotion, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Universita degli Studi di Verona, Verona, Italy
| | - Amanda L Thompson
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, UK
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rajalakshmi Lakshman
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jinan C Banna
- Human Nutrition, Food and Animal Sciences, University of Hawaii System, Honolulu, Hawaii, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA
| | | | - Ana B Pérez-Expósito
- Office of Strategic Planning and Development Effectiveness, Inter- American Development Bank, Washington DC, District of Columbia, USA
| | - Barry J Taylor
- Better Start National Science Challenge, University of Otago, Dunedin, New Zealand
| | - Jennifer S Savage
- Department of Nutritional Sciences and Center for Childhood Obesity Research, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Margrethe Røed
- Faculty of Health and Sport Sciences, Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Michael Goran
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Kayla de la Haye
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Anna Lene Seidler
- National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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8
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Aberoumand M, Seidler AL, Williams J, Webster A, Tan A. 1477The landscape of COVID-19 trials in Australia. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The coronavirus disease 2019 (COVID-19) pandemic has seen a large number of clinical trials launched at unprecedented speed. We aimed to explore the landscape of COVID-19 trials in Australia, and to what extent Australian researchers have responded to global need for coordination and collaboration.
Methods
We systematically searched the Australian New Zealand Clinical Trials Registry (ANZCTR) and ClinicalTrials.gov from 1st January to 16th November 2020. We included all interventional studies addressing prevention, diagnosis or treatment of COVID-19, recruiting in Australia. We analysed the number and size of trials, additional recruitment countries, funding, trial purpose, study design, data sharing plans, and collection of COVID-19 core outcomes.
Results
We identified 56 COVID-19 trials, targeting 33,757 participants. They evaluated drugs (n = 34, 61%), vaccines (n = 10, 18%) or other interventions (n = 12, 21%), e.g. ventilators, digital health. Median target sample size was 150 (Q1-Q3=33-395). Only two trials utilised adaptive methods (Bayesian designs), and of the 34 COVID-19 treatment trials, only one included all core outcomes. Most (80%) indicated they were not planning to share data.
Conclusions
There has been impressive research scale-up and innovation in drug development and digital health, but fast-track procedures may have impacted scientific rigor and research prioritisation. Trials often lacked innovative study designs, were underpowered for clinical outcomes, collected limited core outcomes and did not intend to share data, precluding future evidence synthesis.
Key messages
The research response in Australia has been rapid, but better coordination is required. Infrastructure for innovation would support coordination of research efforts, and reduce research waste.
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Affiliation(s)
- Mason Aberoumand
- NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, country Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, country Australia
| | - Jonathan Williams
- NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, country Australia
| | - Angela Webster
- NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, country Australia
| | - Aidan Tan
- NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, country Australia
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Seidler AL, Aberoumand M, Williams JG, Tan A, Hunter KE, Webster A. The landscape of COVID-19 trials in Australia. Med J Aust 2021; 215:58-61.e1. [PMID: 34275134 PMCID: PMC8447014 DOI: 10.5694/mja2.51148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 12/29/2022]
Affiliation(s)
| | | | | | - Aidan Tan
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - Kylie E Hunter
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
| | - Angela Webster
- NHMRC Clinical Trials CentreUniversity of SydneySydneyNSW
- Westmead HospitalSydneyNSW
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