You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Publication bias and clinical trials.
Abstract 1:
A study was performed to evaluate the extent to which the medical literature may be misleading as a result of selective publication of r and omized clinical trials ( RCTs ) with results showing a statistically significant treatment effect . Three hundred eighteen authors of published trials were asked whether they had participated in any unpublished RCTs .  The 156 respondents reported 271 unpublished and 1041 published trials . Of the 178 completed unpublished RCTs with a trend specified , 26 ( 14 % ) favored the new therapy compared to 423 of 767 ( 55 % ) published reports ( p less than 0.001 ) . For trials that were completed but not published , the major reasons for nonpublication were " negative " results and lack of interest . From the data provided , it appears that nonpublication was primarily a result of failure to write up and su bmi t the trial results rather than rejection of su bmi tted manuscripts . The results of this study imply the existence of a publication bias of importance both to meta- analysis and the interpretation of statistically significant positive trials


Title 2:
Clinical effects of diaper types on the skin of normal infants and infants with atopic dermatitis.
Abstract 2:
Cloth diapers , cellulose core diapers ( conventional disposable diapers ) , and cellulose core diapers containing absorbent gelling material were examined for their effects on diaper rash and skin microbiology of normal infants and infants with atopic dermatitis in a 26-week double-blind clinical trial . Infants with atopic dermatitis wearing the diapers containing absorbent gelling material  had significantly lower diaper rash grade s than infants with atopic dermatitis wearing cloth diapers at five of eight grading visits . Infants with atopic dermatitis wearing conventional cellulose core diapers had statistically less rash at one of eight visits . There was no statistically significant difference between diaper types at three of the eight visits . At no time did the cloth group have less diaper rash than the conventional cellulose or absorbent gelling material disposable diaper group . A statistical correlation between the severity of general atopic dermatitis outside the diaper area and the diaper rash condition under the diaper occurred only in the atopic dermatitis group wearing cloth diapers . Isolation of microorganisms from the intact , uninvolved skin surface both inside and outside the diaper showed no biologically significant changes in the presence or numbers of selected skin organisms . Repeated isolation , at multiple grading visits of Staphylococcus aureus from uncompromised skin inside the diaper area was infrequent but correlated with the diagnosis of atopic dermatitis when observed


Title 3:
Clinical studies with disposable diapers containing absorbent gelling materials: evaluation of effects on infant skin condition.
Abstract 3:
Disposable  infant diapers  with absorbent gelling material ( cross-linked sodium polyacrylates ) incorporated into the core were clinical ly evaluated for their effect on infant skin condition .  Absorbent gelling material s tightly hold water and provide pH control by a buffering capacity as well as by helping to segregate urine apart from feces . Four clinical studies were conducted with each following a rigid protocol that controlled for variables of diet and age in addition to the diaper material that may influence the development of diaper dermatitis and helped to control for any inherent bias in the study . This allowed for the controlled assessment of skin condition with respect to diaper type . Absorbent gelling material -containing disposable , conventional ( 100 % cellulose core ) disposable , and home-laundered cloth diapers were test products . In these studies 1614 infants were initially enrolled with 522 of them assigned to absorbent gelling material disposable , 738 to conventional disposable , and 354 to home-laundered cloth diapers .  Objective measurements of skin wetness ( transepidermal water loss ) and skin pH , as well as double-blind grading of diaper dermatitis , were the measures of skin condition . Absorbent gelling material disposable diapers were associated with significantly reduced skin wetness , closer to normal skin pH , and lower degrees of diaper dermatitis when compared to conventional disposable or home-laundered cloth diapers . The results are consistent with the hypothesis that better control in the diaper area of skin wetness , skin pH , and the prevention of the mixing of urine and feces produces a better diaper environment


Title 4:
Effects of breathable disposable diapers: reduced prevalence of Candida and common diaper dermatitis.
Abstract 4:
Infants wearing breathable disposable diapers experienced significantly less  diaper dermatitis ( DD )  compared to infants wearing st and ard , nonbreathable disposable diapers in a series of double-blind clinical trials . Severe DD , including confirmed infection with C and ida albicans , was reduced by 38 - 50 % among infants wearing highly breathable ( HB ) diapers . The prevalence of DD was inversely related to the breathability of the garments . The inhibitory effect of breathable diapers on the survival of C and ida was further confirmed in controlled experiments with adult volunteers . A suspension of C. albicans cells was applied to delineated sites on the volar forearm . Each site was then covered by a full-thickness patch from either an HB or a st and ard diaper .  Survival of C and ida colonies was reduced by almost two-thirds in the breathable diaper-covered sites compared to the control sites


Title 5:
Comparison of disposable diapers with fluff absorbent and fluff plus absorbent polymers: effects on skin hydration, skin pH, and diaper dermatitis.
Abstract 5:
Diaper dermatitis results from the action of a number of physical and chemical factors on the skin . While its etiology is complex , there is agreement that prolonged contact between wet diapers and the skin leading to excessive hydration of the stratum corneum and reduced barrier function is a primary factor . Recent research also indicates that pH elevation result ing from ammonia production increases the probability of skin damage due to fecal enzyme activity . New diapers containing absorbent polymers blended with cellulose fluff in the absorbent core have been developed . The absorbent polymer binds fluids and controls pH in the diaper environment . To assess the effectiveness of these diapers , a clinical study was conducted with approximately 150 infants over 15 weeks , using fluff diapers and absorbent polymer diapers .  The results clearly showed that the diapers with absorbent polymer provide a better skin environment than those with fluff only with respect to lower skin wetness and pH control ( instrumental measurements ) . In addition , the clinicians ' grade s indicated a directional reduction in diaper rash severity


Title 6:
Effects of diaper types on diaper dermatitis associated with diarrhea and antibiotic use in children in day-care centers.
Abstract 6:
Infants and toddlers in day-care centers have a relatively high frequency of diarrhea and /or oral antibiotic use  , and may be at increased risk of developing diaper dermatitis when diapered . A six-month , prospect i ve , double-blind study was conducted in day-care centers in Houston , Texas , to determine the  frequency of diarrhea , antibiotic use , and diaper dermatitis in infants and toddlers wearing conventional ( cellulose-only core ) disposable diapers or disposable diapers with a core of absorbent gelling material ( AGM ) and cellulose .  A question naire was administered weekly to the day-care staff to gather health information , and weekly visual examinations were made of children for diaper dermatitis . The frequency of diarrhea was 1.9 episodes per child-year and that of antibiotic use was 3.3 courses per child-year . Infants diapered in disposable diapers with AGM had a significantly ( P 0.032 ) lower mean grade of diaper dermatitis during diarrhea episodes and a lower ( P 0.054 ) mean grade during antibiotic use , compared to those diapered in conventional disposable diapers . There was no significant difference between groups with regard to isolation of Staphylococcus aureus or C and ida albicans from superficial skin cultures of the diapered area . The results indicate that diarrhea and antibiotic use occur frequently in children in day-care centers , and that the severity of diaper dermatitis is less in children wearing AGM disposable diapers than those wearing conventional disposable diapers in that setting


Title 7:
The effect of diaper type and overclothing on fecal contamination in day-care centers.
Abstract 7:
Fecal coliform contamination of environmental surfaces and h and s in the day-care center is common . This study evaluated the effect of two diaper types on fecal contamination .  Ten rooms in four day-care centers containing 141 children were studied in a prospect i ve , r and omized , crossover study . A total of 2946 sample s were cultured during the 9-week study . Fecal coliforms were isolated from 307 inanimate objects ( 15 % ) , 73 toy balls ( 46 % ) , and 131 h and s ( 17 % ) . The number of contaminated inanimate objects was significantly less in rooms where paper diapers were worn when compared with that in rooms where double cloth diapers with plastic overpants were worn and in rooms where clothes were worn over diapers . Inanimate object cultures had more contamination in rooms in which diarrhea had occurred . Containment of feces by overclothes and diaper type may be important in decreasing transmission of enteric pathogens in day-care environments


Title 8:
Skin benefits from continuous topical administration of a zinc oxide/petrolatum formulation by a novel disposable diaper.
Abstract 8:
BACKGROUND Diaper dermatitis is a common childhood affliction . Aim ing to help reduce the prevalence of this problem , we have advanced in our development of a novel diaper that delivers dermatological formulations to help protect the skin from over-hydration and irritation . OBJECTIVE To determine the clinical benefits of a novel disposable diaper design ed to deliver a zinc oxide and petrolatum-based formulation continuously to the skin during use . METHODS All studies were independent , blinded , r and omized clinical trials . Study A was conducted to confirm transfer of the zinc oxide/petrolatum ( ZnO/Pet ) formulation from the diaper to the child 's skin during use . Children wore a single diaper for 3 h or multiple diapers for 24 h. After the use period , stratum corneum sample s were taken from each child and analysed for ZnO/Pet . Study B evaluated the prevention of skin irritation and barrier damage from a st and ard skin irritant ( SLS ) in an adult arm model . Study C evaluated skin erythema and diaper rash in 268 infants over a 4-week usage period . One half of the infants used the ZnO/Pet diaper , while the other half used a control diaper that was identical except for the absence of the ZnO/Pet formulation . RESULTS The ointment formulation and ZnO transferred effectively from the diaper to the child 's skin during product use . Transfer of ZnO increased from 4.2 microg/cm2 at 3 h to > 8 microg/cm2 at 24 h. Exposure to the formulations directly on adult skin prior to an irritant challenge was associated with up to a 3.5 reduction in skin barrier damage and skin erythema . Greatest reductions were seen for the ZnO containing formulations . Wearing of the formulation treated diaper was also associated with a significant reduction in skin erythema and diaper rash compared to the control product . CONCLUSIONS The results demonstrated the clinical benefits associated with continuous topical administration of a zinc oxide/petrolatum-based formulation by this novel diaper


Title 9:
Association of skin wetness and pH with diaper dermatitis.
Abstract 9:
The strength of the association between diaper dermatitis and measurements of skin wetness and skin pH was evaluated by statistical analysis of four  diaper trials involving 1601 infants . Although the strength of the association between skin wetness and diaper dermatitis was greater than that between skin pH and diaper dermatitis , increases in wetness and pH were both significantly associated with elevated mean grade s for diaper dermatitis . The skin environment least likely to be associated with diaper dermatitis is one in which increases in both skin wetness and skin pH are minimized


Title 10:
Continuous Topical Administration of a Petrolatum Formulation by a Novel Disposable Diaper
Abstract 10:
Background : Diaper dermatitis is a common childhood affliction . Aim ing to help reduce the prevalence of this problem , we have developed a novel diaper to deliver to the skin dermatological formulations intended to help protect the skin from overhydration and irritation . Objective : To determine the clinical benefits of a novel disposable diaper design ed to deliver a petrolatum-based formulation continuously to the skin during use . Methods : Two independent , blinded , r and omized clinical trials were conducted , involving an aggregate total of 391 children , 8–24 months of age . All comparisons were done versus a control diaper , identical to the test product except for the absence of the petrolatum formulation . The studies determined the effects of the novel diaper on skin erythema and diaper rash . Results : Use of the formulation-treated diaper was associated with significant reductions in severity of erythema and diaper rash compared to the control product . Conclusions : The results demonstrated the clinical benefits associated with continuous topical administration of a petrolatum-based formulation by this novel diaper . We anticipate that this advance in diaper design will contribute significantly to further reduce the prevalence and severity of irritant contact dermatitis in the diaper area


Title 11:
Incidence of diaper rash when using cloth and disposable diapers.
Abstract 11:
A FEW INVESTIGATORS have compared the incidence of diaper rash among users of disposable diapers and cloth diapers .  Grant et al 1 surveyed more than 1,200 mothers and found the highest incidence of diaper rash among users of home-laundered cloth diapers . The lowest incidence of rash was noted for users of disposable diapers and commercially laundered cloth diapers , with no significant difference between the two . Wiener , 2 in a nonblinded study , made single observations on 146 one-month-old infants and reported a higher incidence of rash among users of disposable diapers than for cloth diaper users . No information was gathered on the frequency of diaper changes or recent occurrence of diarrhea or other minor illnesses . The present study evaluated the incidence of diaper rash in a blind , prospect i ve study comparing cloth diapers to three types of disposable diapers
There is not enough evidence from good quality r and omised controlled trials to support or refute the use and type of disposable napkins for the prevention of napkin dermatitis in infants