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The Knowledge Centre in the Norwegian Institute of Public Health was asked by physiotherapist Irene Krystad at the department for physiotherapy at Tysvær municipality, to find research on the effects of stretching after treatment with botulinum toxin for adult patients with spasticity. After having searched for literature, they had found limited documentation and saw the need of mapping existing research on this subject in a systematic way. We conducted a systematic mapping review by searching for systematic reviews and randomised controlled trials om the effect of stretching after treatment with botulinum toxin versus treatment with botulinum toxin alone on adults with spasticity. The search for systematic reviews resulted in 1109 references. We included four of these systematic reviews. The reviews included five randomised controlled trials with a total of 119 patients that were relevant to our research question. The search for randomised controlled trials resulted in 2617 references. Of these we included five trials with a total of 138 patients. Four of these trials were included in the systematic review. We chose not to include the fifth trial that was included in the reviews, because we considered the intervention used not to achieve a mechanism of stretching. We identified gaps in the existing literature on research on the effect of stretching after treatment with botulinum toxin versus botulinum toxin alone.

Botulinum toxin --- Stretching exercises. --- Spasticity --- Therapeutic use. --- Patients --- Rehabilitation.

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Labor (Obstetrics) --- Circumcision. --- Complications.

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Female genital mutilation/cutting (FGM/C) has been performed in various forms for millennia and involves the partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. In this systematic review we addressed harm occurring during the cutting or alteration modification process and the short-term period. We included 56 observational studies that documented immediate complications. There were 14 studies in which two or more groups of girls and women with different types of FGM/C were compared with regards to the occurrence of one or more acute complications. There are three main findings:1. The most common immediate FGM/C complications were: pain, excessive bleeding, swelling, problems with wound healing, urine retention.2. The girls and women undergoing FGM/C often suffered more than one immediate complication.3. There were few differences in risk of immediate complications among different types of FGM/C, but there might be a greater risk of immediate complications for women with FGM/C type III (infibulation) compared to types I-II. There was evidence of under-reporting of complications. However, the findings show that the FGM/C procedure unequivocally causes immediate, and typically several, health complications during the FGM/C procedure and the short-term period. Each of the most common complications occurred in more than one of every ten girls and women who undergo FGM/C. The participants in these studies had FGM/C types I through IV, thus immediate complications such as bleeding and swelling occur in setting with all forms of FGM/C. Even FGM/C type I and type IV 'nick', the forms of FGM/C with least anatomical extent, presented immediate complications. The results document that multiple immediate and quite serious complications can result from FGM/C. These results should be viewed in light of long-term complications, such as obstetric and gynecological problems, and protection of human rights.

Female genital mutilation.

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The prevention of poor health habits among children and adolescents has the potential to create improved health throughout the life span. In order to be better able to initiate health promotion and preventive interventions, it is important to get an overview of the effectiveness of such initiatives. We included six systematic reviews of high methodological quality. We found no systematic reviews on the effectiveness of social health promotion intervention for children and adolescents that met our inclusion criteria. The reviews were broad (therefore, interventions were described in general terms only). Based on our synthesis of the results and assessment of the quality of the documentation for long-term effects of the health promotion and preventive interventions in the six included systematic reviews, we can draw the following conclusions:1. School-based initiatives to promote a healthy diet may possibly lead to higher intakes of fruits and vegetables in children and adolescents.2. The documentation was too limited to draw any conclusions about the effectiveness of school-based interventions to promote physical activity in children and adolescents.3. Preventive interventions that focus on physical activity and nutritional education to prevent obesity among 0-5 year-olds may possibly not lead to less obesity.4. The documentation was too limited to draw any conclusions about the effectiveness of preventive interventions that focus on increasing physical activity and healthy eating to prevent obesity in children and adolescents aged 6-18 years.5. Abstinence-only interventions may possibly not be effective in preventing sexually transmitted infections or pregnancy among children and adolescents.6. Abstinence-plus interventions may possibly not be effective in preventing sexually transmitted infections or pregnancy among children and adolescents.

Health promotion. --- Children --- Exercise --- Obesity --- Nutrition. --- Health aspects. --- Prevention.

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The prevention of poor health habits among children and adolescents has the potential to create improved health throughout the life span. In order to be better able to initiate health promotion and preventive interventions, it is important to get an overview of the effectiveness of such initiatives. We included six systematic reviews of high methodological quality. We found no systematic reviews on the effectiveness of social health promotion intervention for children and adolescents that met our inclusion criteria. The reviews were broad (therefore, interventions were described in general terms only). Based on our synthesis of the results and assessment of the quality of the documentation for long-term effects of the health promotion and preventive interventions in the six included systematic reviews, we can draw the following conclusions:1. School-based initiatives to promote a healthy diet may possibly lead to higher intakes of fruits and vegetables in children and adolescents.2. The documentation was too limited to draw any conclusions about the effectiveness of school-based interventions to promote physical activity in children and adolescents.3. Preventive interventions that focus on physical activity and nutritional education to prevent obesity among 0-5 year-olds may possibly not lead to less obesity.4. The documentation was too limited to draw any conclusions about the effectiveness of preventive interventions that focus on increasing physical activity and healthy eating to prevent obesity in children and adolescents aged 6-18 years.5. Abstinence-only interventions may possibly not be effective in preventing sexually transmitted infections or pregnancy among children and adolescents.6. Abstinence-plus interventions may possibly not be effective in preventing sexually transmitted infections or pregnancy among children and adolescents.

Health promotion. --- Children --- Exercise --- Obesity --- Nutrition. --- Health aspects. --- Prevention.