From The Cochrane Library
Prepared by: Dr. Mona Nasser, Coordinator
The Cochrane Developing Countries Network, The Cochrane Collaboration
E-mail: [email protected]
The Cochrane Library is the best single source of high quality health care information. One of the databases in the Cochrane
library is the Cochrane Database of Systematic Reviews which includes Cochrane Systematic Reviews and Protocols. These
reviews are prepared by volunteers around the world in collaboration with the Cochrane Review Groups of the Cochrane
The following synopses highlight some of the key health care conclusions and their implications for practice as published in
The Cochrane Library, 2007, Issue 1. For more information on the Cochrane Collaboration or to obtain a full copy of the
reviews, go to the website www.thecochranelibrary.com.
Beta blockers are less effective than other drugs for first-line treatment of
high blood pressure
For patients with high blood pressure (BP), the initial therapy to lower BP is vital as it significantly reduces their risk of
cardiovascular disease and stroke. According to a Cochrane Review, lead by Review Author Charles Wiysonge from the
Ministry of Public Health, in Yaoundé, Cameroon, beta blockers were found to be less effective than other drugs such
as thiazides, calcium channel blockers, and rennin angiotensin system inhibitors in initial attempts to lower BP. The
reviewers found a weak effect of beta blocker on stroke compared to placebo or no treatment, but no effect was observed on
coronary heart diseases and total mortality. Other trials involving CCB (Calcium Channel Blockers) have shown that CCB
drugs reduce stroke more effectively than beta blockers. These results were based on the information obtained from 13
randomized controlled trials that involved 91,000 participants. Seventy-five percent of these participants received atenolol
as a beta blocker, therefore further research is needed to determine the effects of different types of beta blockers on reducing
stroke and the risk of cardiovascular diseases.
Wiysonge CS, Bradley H, Mayosi BM, Maroney R, Mbewu A, Opie LH et al. Beta-blockers for hypertension. Cochrane
Database of Systematic Reviews 2007, Issue 1. Art. No.: CD002003. DOI: 10.1002/14651858.CD002003.pub2.
Viagra-like drugs can treat erectile dysfunction in men with diabetes
Diabetes can influence the sexual life of men, and approximately 50% of them may suffer from absence of sufficient
erection for sexual intercourse during the course of their condition. The authors found 3 phosphodiesterase type 5 (PDE-
5) inhibitors, sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis) which can increase diabetic men’s satisfaction
with their sexual life compared to placebo. “If taken as prescribed and when no contra-indications exist, PDE-5 inhibitors
provide a useful option for men with diabetes who suffer from erectile dysfunction,” says Lead Review Author M Vardi.
Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetesmellitus. CochraneDatabase
of Systematic Reviews 2007, Issue 1. Art. No.: CD002187. DOI: 10.1002/14651858.CD002187.pub3.
School meals can improve the health of poor children
School meals can improve physical and mental health of disadvantaged children. Good nutrition is essential for healthy
child development. One way of boosting children’s intake is to give them food at school. Cochrane Reviewers looked to see
whether school feeding programmes could produce benefits in terms of the children’s physical, mental, and psychosocial
health. They considered the data from 18 studies, 9 of which had been carried out in low income countries and 9 in high
income countries. In low income countries, compared to controls, school-fed children’s attendance increased by 4 to 6 days
per year. Children who were fed at school also gained more than controls on maths achievement, and on some cognitive
tasks requiring attention, mental flexibility, and rapid processing of information. Children in low income countries who
were given meals gained weight faster than controls. In lower income countries, in trials that had been carefully regulated,
fed children gained an average of 0.39 kg more over 19 months than controls did. Gains of over 0.7 kg in 11.3 months
were reported in less regulated trials. In high income countries, children fed at school showed some increase in weight gain.
The data collected so far indicate that disadvantaged children gain in several ways if they are given food at school. It is
important to make sure that these meals contain sufficient energy, protein, and essential micronutrients says Lead Review
Kristjansson EA, Robinson V, Petticrew M, MacDonald B, Krasevec J, Janzen L et al. School feeding for improving the
physical and psychosocial health of disadvantaged elementary school children. Cochrane Database of Systematic Reviews
2007, Issue 1. Art. No.: CD004676. DOI: 10.1002/14651858.CD004676.pub2.
www.smj.org.sa Saudi Med J 2007; Vol. 28 (2) 309
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