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Gordon M, Khudr J, Sinopoulou V, Lakunina S, Rane A, Akobeng A. Quality of reporting inflammatory bowel disease randomised controlled trials: a systematic review. BMJ Open Gastroenterol 2024; 11:e001337. [PMID: 38631808 PMCID: PMC11033348 DOI: 10.1136/bmjgast-2023-001337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Our objective was to perform a systemic evaluation of the risk of bias in randomised controlled trial (RCT) reports published on inflammatory bowel disease (IBD). DESIGN We assessed the risk of bias using the Cochrane tool, as indicators of poor methodology or subsequently poor reporting. We systematically selected, with dual independent judgements, all studies published on IBD with no time limits and assessed the methodological quality of included studies again using independent dual ratings. RESULTS 563 full texts were included after selection and review. No abstract publications were free of any source of bias. Full-text publications still fared badly, as only 103 full-text papers exhibited a low risk of bias in all reporting domains when excluding blinding. RCTs published in journals with higher impact factor (IF) were associated with an overall reduced rate of being at high risk. However, only 6% of full RCT publications in journals with an IF greater than 10, published in the past 5 years, were free of bias.The trend over time is towards improved reporting in all areas. Trials published by larger author teams, in full-text form and by industry and public sponsorship were positively correlated with a lower risk of bias. Only allocation concealment showed a statistically significant improvement with time (p=0.037). CONCLUSION These findings are consistent with those of other specialties in the literature. While this unclear risk of bias may represent poor reporting of methods instead of poor methodological quality, it leaves readers and future secondary researchers with significant questions regarding such key issues.
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Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, UK
- Blackpool Families Division, Blackpool Victoria Hospital, Blackpool, UK
| | - Jamal Khudr
- School of Medicine, University of Central Lancashire, Preston, UK
- Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - Aditi Rane
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Anthony Akobeng
- Gastroenterology, Sidra Medicine, Doha, Ad Dawhah, Qatar
- School of Medicine, Weill Cornell Medical College-Qatar, Doha, Qatar
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Leone C, Xu X, Mishra A, Thippareddi H, Singh M. Interventions to reduce Salmonella and Campylobacter during chilling and post-chilling stages of poultry processing: a systematic review and meta-analysis. Poult Sci 2024; 103:103492. [PMID: 38335673 PMCID: PMC10864810 DOI: 10.1016/j.psj.2024.103492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Salmonella and Campylobacter are common bacterial hazards causing foodborne illnesses worldwide. A large proportion of Salmonella and Campylobacter illnesses are attributed to contaminated poultry products that are mishandled or under cooked. Processing interventions such as chilling and post-chill dip are critical to reducing microbial contamination of poultry. A comprehensive search of the literature published between 2000 and 2021 was conducted in the databases Web of Science, Academic Search Complete, and Academic OneFile. Studies were included if they were in English and investigated the effects of interventions against Salmonella and/or Campylobacter on whole carcasses and/or parts during the chilling or post-chill stages of poultry processing. Random-effects meta-analyses were performed using the "meta" package in the R programming language. Subgroup analyses were assessed according to outcome measure reported, microorganism tested, processing stage assessed, and chemical treatment used. The results included 41 eligible studies. Eighteen studies reported results of 28 separate interventions against Salmonella and 31 reported results of 50 separate interventions against Campylobacter. No significant difference (P> 0.05) was observed when comparing the combined mean difference of all interventions targeting Salmonella to the combined mean difference of all interventions targeting Campylobacter or when comparing chilling times within each pathogen subgroup. For analyses examining antimicrobial additives, peroxyacetic acid (PAA) had the largest reduction against Salmonella population regardless of chilling time (P< 0.05). PAA also had the largest reduction against Campylobacter population and prevalence during primary chilling (P< 0.01). Air chilling showed a lower reduction for Campylobacter than any immersion chilling intervention (P< 0.05). Chilling time and antimicrobial used during poultry processing had varying effects depending on the pathogen and outcome measure investigated (concentration or prevalence). High heterogeneity and low sample numbers in most analyses suggest that more high-quality research that is well-designed and has transparent reporting of methodology and results is needed to corroborate the results.
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Affiliation(s)
- Cortney Leone
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - Xinran Xu
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - Abhinav Mishra
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | | | - Manpreet Singh
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA.
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Smith KW, Freeman NLB, Bir A. Assessing risk of bias in the meta-analysis of round 1 of the Health Care Innovation Awards. Syst Rev 2024; 13:36. [PMID: 38254172 PMCID: PMC10802023 DOI: 10.1186/s13643-023-02409-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/04/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Systematic reviews of observational studies can be affected by biases that lead to under- or over-estimates of true intervention effects. Several tools have been reported in the literature that attempt to characterize potential bias. Our objective in this study was to determine the extent to which study-specific bias may have influenced intervention impacts on total costs of care (TCOC) in round 1 of the Health Care Innovation Awards. METHODS We reviewed 82 statistical evaluations of innovation impacts on Medicare TCOC. We developed five risk-of-bias measures and assessed their influence on TCOC impacts using meta-regression. RESULTS The majority of evaluations used propensity score matching to create their comparison groups. One third of the non-randomized interventions were judged to have some risk of biased effects due largely to the way they recruited their treatment groups, and 35% had some degree of covariate imbalance remaining after propensity score adjustments. However, in the multivariable analysis of TCOC effects, none of the bias threats we examined (comparison group construction method, risk of bias, or degree of covariate imbalance) had a major impact on the magnitude of HCIA1 innovation effects. Evaluations using propensity score weighting produced larger but imprecise savings effects compared to propensity score matching. DISCUSSION Our results suggest that it is unlikely that HCIA1 TCOC effect sizes were systematically affected by the types of bias we considered. Assessing the risk of bias based on specific study design features is likely to be more useful for identifying problematic characteristics than the subjective quality ratings used by existing risk tools.
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Affiliation(s)
- Kevin W Smith
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA, 02452-8413, USA.
| | - Nikki L B Freeman
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA, 02452-8413, USA
| | - Anupa Bir
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA, 02452-8413, USA
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Wang J, Vaddu S, Bhumanapalli S, Mishra A, Applegate T, Singh M, Thippareddi H. A systematic review and meta-analysis of the sources of Campylobacter in poultry production (preharvest) and their relative contributions to the microbial risk of poultry meat. Poult Sci 2023; 102:102905. [PMID: 37516002 PMCID: PMC10405099 DOI: 10.1016/j.psj.2023.102905] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/31/2023] Open
Abstract
A systematic review and meta-analysis were conducted to idetnify the relative contributions of the sources of Campylobacter in poultry live production to Campylobacter prevalence of broiler meat. The keywords of Campylobacter, prevalence, live production, and broiler were used in Google Scholar to address the research interest. A total of 16,800 citations were identified, and 63 relevant citations were included in the meta-analysis after applying predetermined inclusion and exclusion criteria. A generalized linear mixed model approach combined with logit transformation was used in the current meta-analysis to stabilize the variance. The analysis revealed that Campylobacter is ubiquitous in the poultry house exterior environment including surroundings, wildlife, domestic animals, and farm vehicle, with a predicted prevalence of 14%. The recovery of Campylobacter in the interior environment of the poultry house is far less abundant than in the exterior, with a prevalence of 2%, including litter, water, insects, mice, feed, and air. A lack of evidence was observed for vertical transmission due to the day-old chicks being free of Campylobacter from 4 studies identified. Live birds are the predominant carrier of Campylobacter, with a predicted prevalence of 41%. Transportation equipment used for live haul had an overall prevalence of 39%, with vehicles showing a predicted prevalence of 44% and crates with a predicted prevalence of 22%. The results of this meta-analysis highlight the need to implement effective biosecurity measures to minimize the risk of Campylobacter in poultry meat, as human activity appears to be the primary factor for Campylobacter introduction.
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Affiliation(s)
- J Wang
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Vaddu
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Bhumanapalli
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - A Mishra
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - T Applegate
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - M Singh
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - H Thippareddi
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA.
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Chacón-Moscoso S, Sanduvete-Chaves S, Lozano-Lozano JA, Holgado-Tello FP. The Methodological Quality Scale (MQS) for intervention programs: validity evidence. Front Psychol 2023; 14:1217661. [PMID: 37484087 PMCID: PMC10358327 DOI: 10.3389/fpsyg.2023.1217661] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction A wide variety of instruments are used when assessing the methodological quality (MQ) of intervention programs. Nevertheless, studies on their metric quality are often not available. In order to address this shortcoming, the methodological quality scale (MQS) is presented as a simple and useful tool with adequate reliability, validity evidence, and metric properties. Methods Two coders independently applied the MQS to a set of primary studies. The number of MQ facets was determined in parallel analyses before performing factor analyses. For each facet of validity obtained, mean and standard deviation are presented jointly with reliability and average discrimination. Additionally, the validity facet scores are interpreted based on Shadish, Cook, and Campbell's validity model. Results and discussion An empirical validation of the three facets of the MQ (external, internal, and construct validity) and the interpretation of the scores were obtained based on a theoretical framework. Unlike other existing scales, MQS is easy to apply and presents adequate metric properties. In addition, MQ profiles can be obtained in different areas of intervention using different methodologies and proves useful for both researchers doing meta-analysis and for evaluators and professionals designing a new intervention.
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Affiliation(s)
- Salvador Chacón-Moscoso
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, Spain
- Departamento de Psicología, Universidad Autónoma de Chile, Santiago, Chile
| | - Susana Sanduvete-Chaves
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, Sevilla, Spain
| | | | - Francisco Pablo Holgado-Tello
- Departamento de Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, Spain
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Türk S, Korfmacher AK, Gerger H, van der Oord S, Christiansen H. Interventions for ADHD in childhood and adolescence: A systematic umbrella review and meta-meta-analysis. Clin Psychol Rev 2023; 102:102271. [PMID: 37030086 DOI: 10.1016/j.cpr.2023.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/03/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
There are several meta-analyses of treatment effects for children and adolescents with attention deficit hyperactivity disorder (ADHD). The conclusions of these meta-analyses vary considerably. Our aim was to synthesize the latest evidence of the effectiveness of psychological, pharmacological treatment options and their combination in a systematic overview and meta-meta-analyses. A systematic literature search until July 2022 to identify meta-analyses investigating effects of treatments for children and adolescents with ADHD and ADHD symptom severity as primary outcome (parent and teacher rated) yielded 16 meta-analyses for quantitative analyses. Meta-meta-analyses of pre-post data showed significant effects for pharmacological treatment options for parent (SMD = 0.67, 95% CI 0.60 to 0.74) and teacher ADHD symptom ratings (SMD = 0.68, 95% CI 0.54 to 0.82) as well as for psychological interventions for parent (SMD = 0.42, 95% CI 0.33 to 0.51) and teacher rated symptoms (SMD = 0.25, 95% CI 0.12 to 0.38). We were unable to calculate effect sizes for combined treatments due to the lack of meta-analyses. Our analyses revealed that there is a lack of research on combined treatments and for therapy options for adolescents. Finally, future research efforts should adhere to scientific standards as this allows comparison of effects across meta-analyses.
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Affiliation(s)
- Selina Türk
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Ann-Kathrin Korfmacher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Heike Gerger
- Family Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229, ER, Maastricht, Netherlands
| | | | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Wang J, Vaddu S, Bhumanapalli S, Mishra A, Applegate T, Singh M, Thippareddi H. A systematic review and meta-analysis of the sources of Salmonella in poultry production (pre-harvest) and their relative contributions to the microbial risk of poultry meat. Poult Sci 2023; 102:102566. [PMID: 36996513 PMCID: PMC10074252 DOI: 10.1016/j.psj.2023.102566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Salmonella is a major foodborne pathogen associated with poultry and poultry products and a leading cause for human salmonellosis. Salmonella is known to transmit in poultry flocks both vertically and horizontally. However, there is a lack of knowledge on relative contribution of the factors on Salmonella prevalence in poultry live production system including hatchery, feed, water, environment-interior, and -exterior. Therefore, a systematic review and meta-analysis was conducted to quantify the potential sources of Salmonella during preharvest and their relative contributions to the microbial risk of poultry meat. A total of 16,800 studies identified from Google Scholar and 37 relevant studies were included in the meta-analysis for relative contributions to Salmonella positivity on broilers after applying exclusion criteria. A generalized linear mixed model approach combined with logit transformation was used in the current study to stabilize the variance. The analysis revealed that the hatchery is the most significant contributor of Salmonella with a prevalence of 48.5%. Litter, feces, and poultry house internal environment were the other 3 major contributing factors with a prevalence of 25.4, 16.3, and 7.9%, respectively. Moreover, poultry house external environment (4.7%), feed (4.8%), chicks (4.7%), and drinker water also contributed to the Salmonella positivity. Results from this meta-analysis informed the urgent need for controls in live production to further reduce Salmonella in fresh, processed poultry. The control strategies can include eliminating the sources of Salmonella and incorporating interventions in live production to reduce Salmonella concentrations in broilers.
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Affiliation(s)
- J Wang
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Vaddu
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - S Bhumanapalli
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - A Mishra
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - T Applegate
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
| | - M Singh
- Department of Food Science and Technology, University of Georgia, Athens, GA 30602, USA
| | - H Thippareddi
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA.
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Semkovska M, Knittle H, Leahy J, Rasmussen JR. Subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression: A systematic review and meta-analysis. Aust N Z J Psychiatry 2023; 57:21-33. [PMID: 35362328 DOI: 10.1177/00048674221089231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subjective cognitive complaints represent a leading reason for suboptimal prescription of electroconvulsive therapy, the most acutely effective treatment for depression. However, research findings regarding their presentation are conflicting. OBJECTIVE To describe, quantify and explain the variability in subjective cognitive complaints and subjective cognition following electroconvulsive therapy for depression. METHODS We searched systematically PubMed, Embase, PsycARTICLES, CINAHL and relevant reviews for research published from 1 January 1972 to 31 August 2020. We included all independent studies of patients whose subjective cognition was assessed following brief-pulse electroconvulsive therapy for depression. Three meta-analyses were conducted to quantify: (1) the prevalence of patients presenting with cognitive complaints following electroconvulsive therapy; (2) the pre-post electroconvulsive therapy change in subjective cognition and (3) the association between change in depressive symptoms and change in cognitive complaints. Effect sizes were calculated using random-effects models. Eight prespecified demographic and clinical moderators of between-study variability were assessed using sub-group analyses and meta-regressions. RESULTS Data from 72 studies including 5699 participants were meta-analysed. Weighted mean prevalence of patients with cognitive complaints was 48.1% (95% confidence interval = [42.3%, 53.9%]). The type of subjective measure used significantly impacted the pre-post electroconvulsive therapy change in subjective cognition, showing, respectively, large improvement (g = 0.81; 95% confidence interval = [0.59, 1.03]) after electroconvulsive therapy with the Squire Self-Rating Scale of Memory and small worsening (g = -0.48; 95% confidence interval = [-0.70, -0.26]) with 1-item memory scales. The strongest predictors of improved post-electroconvulsive therapy subjective cognition were increased age and larger post-electroconvulsive therapy decrease in depressive symptoms. The weighted mean correlation between pre-post electroconvulsive therapy decrease in depressive symptoms and pre-post electroconvulsive therapy decrease in cognitive complaints was 0.46 (95% confidence interval = [0.39, 0.53]). CONCLUSION Variability in subjective cognition following electroconvulsive therapy is mostly explained by the degree of post-treatment persisting depression and by the subjective assessment used. Scales measuring exclusively subjective worsening present limited clinical utility and instruments allowing the detection of both improvement and worsening in subjective cognition should be preferred.
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Affiliation(s)
- Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Hannah Knittle
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Janet Leahy
- Department of Psychology, University of Limerick, Limerick, Ireland
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Lee-Easton MJ, Magura S. Discrepancies in Ratings of Behavioral Healthcare Interventions Among Evidence-Based Program Resources Websites. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231186836. [PMID: 37462104 DOI: 10.1177/00469580231186836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Decision makers in the behavioral health disciplines could benefit from tools to assist them in identifying and implementing evidence-based interventions. One tool is an evidence-based program resources website (EBPR). Prior studies documented that when multiple EBPRs rate an intervention, they may disagree. Prior research concerning the reason for such conflicts is sparse. The present study examines how EBPRs rate interventions and the sources of disagreement between EBPRs when rating the same intervention. This study hypothesizes that EBPRs may disagree about intervention ratings because they either use different rating paradigms or they use different studies as evidence of intervention effectiveness (or both). This study identified 15 EBPRs for inclusion. One author (M.J.L.E.) coded the EBPRs for which "tiers of evidence" each EBPR used to classify behavioral health interventions and which criteria they used when rating interventions. The author then computed one Jaccard index of similarity for the criteria shared between each pair of EBPRs that co-rated interventions, and one for the studies used by EBPR rating pairs when rating the same program. The authors used a combination of chi-square, correlation, and binary logistic regression analyses to analyze the data. There was a statistically significant negative correlation between the number of Cochrane Risk of Bias criteria shared between 2 EBPRs and the likelihood of those 2 EBPRs agreeing on an intervention rating (r = -.12, P ≤ .01). There was no relationship between the number of studies evaluated by 2 EBPRs and the likelihood of those EBPRs agreeing on an intervention rating. The major reason for disagreements between EBPRs when rating the same intervention in this study was due to differences in the rating criteria used by the EBPRs. The studies used by the EBPRs to rate programs does not appear to have an impact.
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Lekagul A, Piancharoen P, Chattong A, Suradom C, Tangcharoensathien V. Living through the psychological consequences of COVID-19 pandemic: a systematic review of effective mitigating interventions. BMJ Open 2022; 12:e060804. [PMID: 35882462 PMCID: PMC9329730 DOI: 10.1136/bmjopen-2022-060804] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This review assesses interventions and their effectiveness in mitigating psychological consequences from pandemic. METHOD Published English literatures were searched from four databases (Medline, PubMed, Embase and PsycINFO) from January 2020 and September 2021. A total of 27 papers with 29 studies (one paper reported three studies) met inclusion criteria. Cochrane risk-of-bias tool is applied to assess the quality of all randomised controlled trials (RCT). RESULTS All studies were recently conducted in 2020. Publications were from high-income (13, 44.8%), upper middle-income (12, 41.4%) and lower middle-income countries (3, 10.3%) and global (1, 3.5%). Half of the studies conducted for general population (51.7%). One-third of studies (8, 27.6%) provided interventions to patients with COVID-19 and 20.7% to healthcare workers. Of the 29 studies, 14 (48.3%) were RCT. All RCTs were assessed for risk of biases; five studies (15, 35.7%) had low risk as measured against all six dimensions reflecting high-quality study.Of these 29 studies, 26 diagnostic or screening measures were applied; 8 (30.9%) for anxiety, 7 (26.9%) for depression, 5 (19.2%) for stress, 5 (19.2%) for insomnia and 1 (3.8%) for suicide. Measures used to assess the baseline and outcomes of interventions were standardised and widely applied by other studies with high level of reliability and validity. Of 11 RCT studies, 10 (90.9%) showed that anxiety interventions significantly lowered anxiety in intervention groups. Five of the six RCT studies (83.3%) had significantly reduced the level of depression. Most interventions for anxiety and stress were mindfulness and meditation based. CONCLUSIONS Results from RCT studies (11%, 78.6%) were effective in mitigating psychological consequences from COVID-19 pandemic when applied to healthcare workers, patients with COVID-19 and general population. These effective interventions can be applied and scaled up in other country settings through adaptation of modes of delivery suitable to country resources, pandemic and health system context.
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Affiliation(s)
- Angkana Lekagul
- International Health Policy Program, Amphur Muang, Nonthaburi, Thailand
| | | | - Anamika Chattong
- International Health Policy Program, Amphur Muang, Nonthaburi, Thailand
| | - Chawisa Suradom
- Psychiatry, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
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Wang H, Song J, Lin Y, Dai W, Gao Y, Qin L, Chen Y, Tam W, Wu IX, Chung VC. Trial-level characteristics associate with treatment effect estimates: a systematic review of meta-epidemiological studies. BMC Med Res Methodol 2022; 22:171. [PMID: 35705904 PMCID: PMC9202161 DOI: 10.1186/s12874-022-01650-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To summarize the up-to-date empirical evidence on trial-level characteristics of randomized controlled trials associated with treatment effect estimates. METHODS A systematic review searched three databases up to August 2020. Meta-epidemiological (ME) studies of randomized controlled trials on intervention effect were eligible. We assessed the methodological quality of ME studies using a self-developed criterion. Associations between treatment effect estimates and trial-level characteristics were presented using forest plots. RESULTS Eighty ME studies were included, with 25/80 (31%) being published after 2015. Less than one-third ME studies critically appraised the included studies (26/80, 33%), published a protocol (23/80, 29%), and provided a list of excluded studies with justifications (12/80, 15%). Trials with high or unclear (versus low) risk of bias on sequence generation (3/14 for binary outcome and 1/6 for continuous outcome), allocation concealment (11/18 and 1/6), double blinding (5/15 and 2/4) and smaller sample size (4/5 and 2/2) significantly associated with larger treatment effect estimates. Associations between high or unclear risk of bias on allocation concealment (5/6 for binary outcome and 1/3 for continuous outcome), double blinding (4/5 and 1/3) and larger treatment effect estimates were more frequently observed for subjective outcomes. The associations between treatment effect estimates and non-blinding of outcome assessors were removed in trials using multiple observers to reach consensus for both binary and continuous outcomes. Some trial characteristics in the Cochrane risk-of-bias (RoB2) tool have not been covered by the included ME studies, including using validated method for outcome measures and selection of the reported results from multiple outcome measures or multiple analysis based on results (e.g., significance of the results). CONCLUSIONS Consistently significant associations between larger treatment effect estimates and high or unclear risk of bias on sequence generation, allocation concealment, double blinding and smaller sample size were found. The impact of allocation concealment and double blinding were more consistent for subjective outcomes. The methodological and reporting quality of included ME studies were dissatisfactory. Future ME studies should follow the corresponding reporting guideline. Specific guidelines for conducting and critically appraising ME studies are needed.
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Affiliation(s)
- Huan Wang
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Jinlu Song
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Yali Lin
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Wenjie Dai
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Yinyan Gao
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Lang Qin
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Yancong Chen
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China
| | - Wilson Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Irene Xy Wu
- 5/F, Xiangya School of Public Health, No. 238, Shang-ma-yuan-ling Alley, Kaifu district, Changsha, China. .,Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan, China.
| | - Vincent Ch Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.,School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Carvajal B, White H, Brooks J, Thomson AM, Cooke A. Experiences of midwives and nurses when implementing abortion policies: A systematic integrative review. Midwifery 2022; 111:103363. [DOI: 10.1016/j.midw.2022.103363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/21/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
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13
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Eick SM, Goin DE, Lam J, Woodruff TJ, Chartres N. Authors' rebuttal to Integrated Risk Information System (IRIS) response to "Assessing risk of bias in human environmental epidemiology studies using three tools: different conclusions from different tools". Syst Rev 2022; 11:53. [PMID: 35321722 PMCID: PMC8944042 DOI: 10.1186/s13643-022-01894-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
This letter responds to the US Environmental Protection Agency's Integrated Risk Information System (IRIS) program letter by Radke et al. (2021) that was published in response to the application of the IRIS risk of bias tool in our recent study "Assessing risk of bias in human environmental epidemiology studies using three tools: different conclusions from different tools." Their letter stated that we misrepresented the IRIS approach. Here, we respond to their three points raised and how we did not misrepresent their tool and also identified areas for improvement: (1) why it should be expected that different reviewers could reach different conclusions with the IRIS tool, as ratings are subject to reviewer judgment; (2) why our interpretation that "low" or "uninformative" studies could be excluded from a body of evidence was reasonable; and (3) why we believe the use of a rating system that generates an overall rating based on an individual domain or a combination of identified deficiencies essentially acts as a score and assumes that we know empirically how much each risk of bias domain should contribute to the overall rating for that study. We have elaborated on these points in our letter.
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Affiliation(s)
- Stephanie M Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dana E Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Juleen Lam
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.,Department of Public Health, California State University, East Bay, Hayward, CA, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas Chartres
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
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14
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Corbett GA, Lee S, Woodruff TJ, Hanson M, Hod M, Charlesworth AM, Giudice L, Conry J, McAuliffe FM. Nutritional interventions to ameliorate the effect of endocrine disruptors on human reproductive health: A semi-structured review from FIGO. Int J Gynaecol Obstet 2022; 157:489-501. [PMID: 35122246 PMCID: PMC9305939 DOI: 10.1002/ijgo.14126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/02/2022] [Indexed: 11/09/2022]
Abstract
Background Endocrine disrupting chemicals have harmful effects on reproductive, perinatal, and obstetric outcomes. Objective To analyze the evidence on nutritional interventions to reduce the negative effects of endocrine disruptors on reproductive, perinatal, and obstetric outcomes. Search strategy A search of MEDLINE (PubMed), Allied Health Literature (CINAHL), EMBASE, Web of Science, and the Cochrane Database was conducted from inception to May 2021. Selection criteria Experimental studies on human populations. Data collection and analysis Data were collected from eligible studies. Risk of bias assessment was completed using the Cochrane risk of bias tool and the ROBINS‐I Tool. Results Database searches yielded 15 362 articles. Removing 11 181 duplicates, 4181 articles underwent abstract screening, 26 articles were eligible for full manuscript review, and 16 met full inclusion criteria. Several interventions were found to be effective in reducing exposure to endocrine disruptors: avoidance of plastic containers, bottles, and packaging; avoidance of canned food/beverages; consumption of fresh and organic food; avoidance of fast/processed foods; and supplementation with vitamin C, iodine, and folic acid. There were some interventional studies examining therapies to improve clinical outcomes related to endocrine disruptors. Conclusion Dietary alterations can reduce exposure to endocrine disruptors, with limited data on interventions to improve endocrine‐disruptor–related clinical outcomes. This review provides useful instruction to women, their families, healthcare providers, and regulatory bodies. Nutritional interventions shown to reduce exposure to endocrine disruptors include avoidance of canned/processed or plastic‐packaged foods. Consumption of fresh/organic foods and vitamin C, iodine, and folic acid also reduce exposure.
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Affiliation(s)
- Gillian A Corbett
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sadhbh Lee
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Tracey J Woodruff
- Program on Reproductive Health and Environment, Department of Obstetrics and Gynecology, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Mark Hanson
- International Federation of Gynaecology and Obstetrics (FIGO) Committee on Impact of Pregnancy on Long-term Health.,Institute of Developmental Sciences and NIHR Biomedical Research Centre, University of Southampton and NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Moshe Hod
- International Federation of Gynaecology and Obstetrics (FIGO) Committee on Impact of Pregnancy on Long-term Health.,Mor Comprehensive Women's Health Care Centre, Tel Aviv, Israel
| | - Anne Marie Charlesworth
- Program on Reproductive Health and Environment, Department of Obstetrics and Gynecology, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Linda Giudice
- International Federation of Gynecology and Obstetrics (FIGO) Committee on Climate Change and Toxic Environmental Exposures.,Centre for Reproductive Sciences, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Jeanne Conry
- Environmental Health and Leadership Foundation, United States
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, UCD School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,International Federation of Gynaecology and Obstetrics (FIGO) Committee on Impact of Pregnancy on Long-term Health
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15
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Maziarz M. Is meta-analysis of RCTs assessing the efficacy of interventions a reliable source of evidence for therapeutic decisions? STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2022; 91:159-167. [PMID: 34922183 DOI: 10.1016/j.shpsa.2021.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 06/14/2023]
Abstract
Literature-based meta-analysis is a standard technique applied to pool results of individual studies used in medicine and social sciences. It has been criticized for being too malleable to constrain results, averaging incomparable values, lacking a measure of evidence's strength, and problems with a systematic bias of individual studies. We argue against using literature-based meta-analysis of RCTs to assess treatment efficacy and show that therapeutic decisions based on meta-analytic average are not optimal given the full scope of existing evidence. The argument proceeds with discussing examples and analyzing the properties of some standard meta-analytic techniques. First, we demonstrate that meta-analysis can lead to reporting statistically significant results despite the treatment's limited efficacy. Second, we show that meta-analytic confidence intervals are too narrow compared to the variability of treatment outcomes reported by individual studies. Third, we argue that literature-based meta-analysis is not a reliable measurement instrument. Finally, we show that meta-analysis averages out the differences among studies and leads to a loss of information. Despite these problems, literature-based meta-analysis is useful for the assessment of harms. We support two alternative approaches to evidence amalgamation: meta-analysis of individual patient data (IPD) and qualitative review employing mechanistic evidence.
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Affiliation(s)
- Mariusz Maziarz
- Interdisciplinary Centre for Ethics, Jagiellonian University, Kraków, Poland; Institute of Philosophy, Jagiellonian University, Grodzka 52, Kraków, Poland.
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16
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O'Dea RE, Lagisz M, Jennions MD, Koricheva J, Noble DW, Parker TH, Gurevitch J, Page MJ, Stewart G, Moher D, Nakagawa S. Preferred reporting items for systematic reviews and meta-analyses in ecology and evolutionary biology: a PRISMA extension. Biol Rev Camb Philos Soc 2021; 96:1695-1722. [PMID: 33960637 PMCID: PMC8518748 DOI: 10.1111/brv.12721] [Citation(s) in RCA: 129] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/29/2022]
Abstract
Since the early 1990s, ecologists and evolutionary biologists have aggregated primary research using meta-analytic methods to understand ecological and evolutionary phenomena. Meta-analyses can resolve long-standing disputes, dispel spurious claims, and generate new research questions. At their worst, however, meta-analysis publications are wolves in sheep's clothing: subjective with biased conclusions, hidden under coats of objective authority. Conclusions can be rendered unreliable by inappropriate statistical methods, problems with the methods used to select primary research, or problems within the primary research itself. Because of these risks, meta-analyses are increasingly conducted as part of systematic reviews, which use structured, transparent, and reproducible methods to collate and summarise evidence. For readers to determine whether the conclusions from a systematic review or meta-analysis should be trusted - and to be able to build upon the review - authors need to report what they did, why they did it, and what they found. Complete, transparent, and reproducible reporting is measured by 'reporting quality'. To assess perceptions and standards of reporting quality of systematic reviews and meta-analyses published in ecology and evolutionary biology, we surveyed 208 researchers with relevant experience (as authors, reviewers, or editors), and conducted detailed evaluations of 102 systematic review and meta-analysis papers published between 2010 and 2019. Reporting quality was far below optimal and approximately normally distributed. Measured reporting quality was lower than what the community perceived, particularly for the systematic review methods required to measure trustworthiness. The minority of assessed papers that referenced a guideline (~16%) showed substantially higher reporting quality than average, and surveyed researchers showed interest in using a reporting guideline to improve reporting quality. The leading guideline for improving reporting quality of systematic reviews is the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Here we unveil an extension of PRISMA to serve the meta-analysis community in ecology and evolutionary biology: PRISMA-EcoEvo (version 1.0). PRISMA-EcoEvo is a checklist of 27 main items that, when applicable, should be reported in systematic review and meta-analysis publications summarising primary research in ecology and evolutionary biology. In this explanation and elaboration document, we provide guidance for authors, reviewers, and editors, with explanations for each item on the checklist, including supplementary examples from published papers. Authors can consult this PRISMA-EcoEvo guideline both in the planning and writing stages of a systematic review and meta-analysis, to increase reporting quality of submitted manuscripts. Reviewers and editors can use the checklist to assess reporting quality in the manuscripts they review. Overall, PRISMA-EcoEvo is a resource for the ecology and evolutionary biology community to facilitate transparent and comprehensively reported systematic reviews and meta-analyses.
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Affiliation(s)
- Rose E. O'Dea
- Evolution & Ecology Research Centre and School of Biological and Environmental SciencesUniversity of New South WalesSydneyNSW2052Australia
| | - Malgorzata Lagisz
- Evolution & Ecology Research Centre and School of Biological and Environmental SciencesUniversity of New South WalesSydneyNSW2052Australia
| | - Michael D. Jennions
- Research School of BiologyAustralian National University46 Sullivans Creek RoadCanberra2600Australia
| | - Julia Koricheva
- Department of Biological SciencesRoyal Holloway University of LondonEghamSurreyTW20 0EXU.K.
| | - Daniel W.A. Noble
- Evolution & Ecology Research Centre and School of Biological and Environmental SciencesUniversity of New South WalesSydneyNSW2052Australia
- Research School of BiologyAustralian National University46 Sullivans Creek RoadCanberra2600Australia
| | | | - Jessica Gurevitch
- Department of Ecology and EvolutionStony Brook UniversityStony BrookNY11794‐5245U.S.A.
| | - Matthew J. Page
- School of Public Health and Preventative MedicineMonash UniversityMelbourneVIC3004Australia
| | - Gavin Stewart
- School of Natural and Environmental SciencesNewcastle UniversityNewcastle upon TyneNE1 7RUU.K.
| | - David Moher
- Centre for Journalology, Clinical Epidemiology ProgramOttawa Hospital Research InstituteGeneral Campus, 501 Smyth Road, Room L1288OttawaONK1H 8L6Canada
| | - Shinichi Nakagawa
- Evolution & Ecology Research Centre and School of Biological and Environmental SciencesUniversity of New South WalesSydneyNSW2052Australia
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17
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Cook J, Hull L, Crane L, Mandy W. Camouflaging in autism: A systematic review. Clin Psychol Rev 2021; 89:102080. [PMID: 34563942 DOI: 10.1016/j.cpr.2021.102080] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/30/2021] [Accepted: 08/24/2021] [Indexed: 01/15/2023]
Abstract
Some autistic people employ strategies and behaviours to cope with the everyday social world, thereby 'camouflaging' their autistic differences and difficulties. This review aimed to systematically appraise and synthesise the current evidence base pertaining to autistic camouflaging. Following a systematic search of eight databases, 29 studies quantifying camouflaging in children and adults with autism diagnoses or high levels of autistic traits were reviewed. The multiple methods used to measure camouflaging broadly fell under two different approaches: internal-external discrepancy or self-report. These approaches appear to relate to two distinct but potentially connected elements of camouflaging: observable behavioural presentations and self-perceived camouflaging efforts. While significant variation was noted across individual study findings, much of the existing literature supported three preliminary findings about the nature of autistic camouflaging: (1) adults with more self-reported autistic traits report greater engagement in camouflaging; (2) sex and gender differences exist in camouflaging; and (3) higher self-reported camouflaging is associated with worse mental health outcomes. However, the research base was limited regarding participant characterisation and representativeness, which suggests that conclusions cannot be applied to the autistic community as a whole. We propose priorities for future research in refining the current understanding of camouflaging and improving measurement methods.
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Affiliation(s)
- Julia Cook
- Research Department of Clinical, Educational, & Health Psychology, University College London, UK.
| | - Laura Hull
- Research Department of Clinical, Educational, & Health Psychology, University College London, UK
| | - Laura Crane
- Centre for Research in Autism and Education (CRAE), UCL Institute of Education, University College London, UK
| | - William Mandy
- Research Department of Clinical, Educational, & Health Psychology, University College London, UK
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18
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Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes BW, Mohseni-Bandpei MA, Mansournia MA, Delavari S, Keshtkar A, Bahramian M. Dry Needling for the Treatment of Tension-Type, Cervicogenic, or Migraine Headaches: A Systematic Review and Meta-Analysis. Phys Ther 2021; 101:6145044. [PMID: 33609358 DOI: 10.1093/ptj/pzab068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/21/2020] [Accepted: 12/31/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review's main objective was to assess the effectiveness of dry needling on headache pain intensity and related disability in patients with TTH, CGH, or migraine. METHODS Medline/PubMed, Scopus, Embase, PEDro, Web of Science, Ovid, Allied and Complementary Medicine Database/EBSCO, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris dppc2) and their respective CIs. RESULTS Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only 4 trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity in the short term in patients with TTH (SMD -1.27, 95% CI = -3.56 to 1.03, n = 230), CGH (SMD -0.41, 95% CI = -4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI = -0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related disability in the short term in patients with TTH (SMD -2.28, 95% CI = -2.66 to -1.91, n = 160) and CGH (SMD -0.72, 95% CI = -1.09 to -0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH. CONCLUSIONS Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related disability in the short term. IMPACT Although further high-methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every 1 or 2 patients with TTH treated by dry needling, 1 patient will likely show decreased headache intensity (number needed to treat [NNT] = 2; large effect) and improved related disability (NNT = 1; very large effect). In CGH, for every 3 or 4 patients treated by dry needling, 1 patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related disability (NNT = 3; medium effect).
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Affiliation(s)
- Mohammadreza Pourahmadi
- Rehabilitation Research Center, Department of Physical Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jan Dommerholt
- Bethesda Physiocare, Bethesda, Maryland, USA.,Myopain Seminars, Bethesda, Maryland, USA.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Bart Willem Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.,Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Delavari
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abbasali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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19
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Arroyave WD, Mehta SS, Guha N, Schwingl P, Taylor KW, Glenn B, Radke EG, Vilahur N, Carreón T, Nachman RM, Lunn RM. Challenges and recommendations on the conduct of systematic reviews of observational epidemiologic studies in environmental and occupational health. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:21-30. [PMID: 32415298 PMCID: PMC7666644 DOI: 10.1038/s41370-020-0228-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 05/05/2023]
Abstract
Systematic reviews are powerful tools for drawing causal inference for evidence-based decision-making. Published systematic reviews and meta-analyses of environmental and occupational epidemiology studies have increased dramatically in recent years; however, the quality and utility of published reviews are variable. Most methodologies were adapted from clinical epidemiology and have not been adequately modified to evaluate and integrate evidence from observational epidemiology studies assessing environmental and occupational hazards, especially in evaluating the quality of exposure assessments. Although many reviews conduct a systematic and transparent assessment for the potential for bias, they are often deficient in subsequently integrating across a body of evidence. A cohesive review considers the impact of the direction and magnitude of potential biases on the results, systematically evaluates important scientific issues such as study sensitivity and effect modifiers, identifies how different studies complement each other, and assesses other potential sources of heterogeneity. Given these challenges of conducting informative systematic reviews of observational studies, we provide a series of specific recommendations based on practical examples for cohesive evidence integration to reach an overall conclusion on a body of evidence to better support policy making in public health.
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Affiliation(s)
| | - Suril S Mehta
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Neela Guha
- International Agency for Research on Cancer, World Health Organization, Lyon, France
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| | - Pam Schwingl
- Integrated Laboratory Systems, Morrisville, NC, USA
| | - Kyla W Taylor
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Barbara Glenn
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Elizabeth G Radke
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Nadia Vilahur
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Tania Carreón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Rebecca M Nachman
- Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Washington, DC, USA
| | - Ruth M Lunn
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
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20
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Abstract
Methodological flaws, limitations, and inadequate practices in research are well known and pose threats to the internal validity of any research study. However, there are ways of safeguarding research conduct to reduce the chance of research producing distorted results. Numerous tools now exist to assess the incorporation of such safeguards into primary research studies (also known as quality and/or risk-of-bias assessment). These tools typically include a variety of items that are then checked against those implemented in the study. Despite a lot of research in this area, no comprehensive generic classification of safeguards across study designs exist, although attempts have been made to clarify aspects of this. We review the developments in this area as well as use preliminary data from 100 methodological studies to illustrate our proposed approach. We conclude by proposing a new framework for identifying research studies at risk of being biased and the information in this article will promote a unification of the diverse approaches to facilitating bias assessment in clinical research.
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21
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Eick SM, Goin DE, Chartres N, Lam J, Woodruff TJ. Assessing risk of bias in human environmental epidemiology studies using three tools: different conclusions from different tools. Syst Rev 2020; 9:249. [PMID: 33121530 PMCID: PMC7596989 DOI: 10.1186/s13643-020-01490-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews are increasingly prevalent in environmental health due to their ability to synthesize evidence while reducing bias. Different systematic review methods have been developed by the US National Toxicology Program's Office of Health Assessment and Translation (OHAT), the US Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS), and by the US EPA under the Toxic Substances Control Act (TSCA), including the approach to assess risk of bias (ROB), one of the most vital steps which is used to evaluate internal validity of the studies. Our objective was to compare the performance of three tools (OHAT, IRIS, TSCA) in assessing ROB. METHODS We selected a systematic review on polybrominated diphenyl ethers and intelligence quotient and/or attention deficit hyperactivity disorder because it had been endorsed by the National Academy of Sciences. Two reviewers followed verbatim instructions from the tools and independently applied each tool to assess ROB in 15 studies previously identified. We documented the time to apply each tool and the impact the ROB ratings for each tool had on the final rating of the quality of the overall body of evidence. RESULTS The time to complete the ROB assessments varied widely (mean = 20, 32, and 40 min per study for the OHAT, IRIS, and TSCA tools, respectively). All studies were rated overall "low" or "uninformative" using IRIS, due to "deficient" or "critically deficient" ratings in one or two domains. Similarly, all studies were rated "unacceptable" using the TSCA tool because of one "unacceptable" rating in a metric related to statistical power. Approximately half of the studies had "low" or "probably low ROB" ratings across all domains with the OHAT and Navigation Guide tools. CONCLUSIONS Tools that use overall ROB or study quality ratings, such as IRIS and TSCA, may reduce the available evidence to assess the harms of environmental exposures by erroneously excluding studies, which leads to inaccurate conclusions about the quality of the body of evidence. We recommend using ROB tools that circumvents these issues, such as OHAT and Navigation Guide. SYSTEMATIC REVIEW REGISTRATION This review has not been registered as it is not a systematic review.
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Affiliation(s)
- Stephanie M Eick
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Dana E Goin
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Nicholas Chartres
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Juleen Lam
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.,Department of Health Sciences, California State University, East Bay, Hayward, CA, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
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22
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Nicholas JA, Edwards NC, Edwards RA, Dellarole A, Grosso M, Phillips AL. Real-world adherence to, and persistence with, once- and twice-daily oral disease-modifying drugs in patients with multiple sclerosis: a systematic review and meta-analysis. BMC Neurol 2020; 20:281. [PMID: 32664928 PMCID: PMC7371467 DOI: 10.1186/s12883-020-01830-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nonadherence to disease-modifying drugs (DMDs) for multiple sclerosis (MS) is associated with poorer clinical outcomes, including higher rates of relapse and disease progression, and higher medical resource use. A systematic review and quantification of adherence and persistence with oral DMDs would help clarify the extent of nonadherence and nonpersistence in patients with MS to help prescribers make informed treatment plans and optimize patient care. The objectives were to: 1) conduct a systematic literature review to assess the availability and variability of oral DMD adherence and/or persistence rates across 'real-world' data sources; and 2) conduct meta-analyses of the rates of adherence and persistence for once- and twice-daily oral DMDs in patients with MS using real-world data. METHODS A systematic review of studies published between January 2010 and April 2018 in the PubMed database was performed. Only studies assessing once- and twice-daily oral DMDs were available for inclusion in the analysis. Study quality was evaluated using a modified version of the Newcastle-Ottawa Scale, a tool for assessing quality of observational studies. The random effects model evaluated pooled summary estimates of nonadherence. RESULTS From 510 abstracts, 31 studies comprising 16,398 patients with MS treated with daily oral DMDs were included. Overall 1-year mean medication possession ratio (MPR; n = 4 studies) was 83.3% (95% confidence interval [CI] 74.5-92.1%) and proportion of days covered (PDC; n = 4 studies) was 76.5% (95% CI 72.0-81.1%). Pooled 1-year MPR ≥80% adherence (n = 6) was 78.5% (95% CI 63.5-88.5%) and PDC ≥80% (n = 5 studies) was 71.8% (95% CI 59.1-81.9%). Pooled 1-year discontinuation (n = 20) was 25.4% (95% CI 21.6-29.7%). CONCLUSIONS Approximately one in five patients with MS do not adhere to, and one in four discontinue, daily oral DMDs before 1 year. Opportunities to improve adherence and ultimately patient outcomes, such as patient education, medication support/reminders, simplified dosing regimens, and reducing administration or monitoring requirements, remain. Implementation of efforts to improve adherence are essential to improving care of patients with MS.
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Affiliation(s)
| | | | | | | | - Megan Grosso
- EMD Serono, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Rockland, MA, USA
| | - Amy L Phillips
- EMD Serono, Inc. (an affiliate of Merck KGaA, Darmstadt, Germany), Rockland, MA, USA
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Golden CE, Mishra A. Prevalence of Salmonella and Campylobacter spp. in Alternative and Conventionally Produced Chicken in the United States: A Systematic Review and Meta-Analysis. J Food Prot 2020; 83:1181-1197. [PMID: 32294168 DOI: 10.4315/jfp-19-538] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/26/2020] [Indexed: 02/07/2023]
Abstract
ABSTRACT The burden of foodborne illness linked to the consumption of contaminated broiler meat is high in the United States. With the increase in popularity of alternative poultry rearing and production systems, it is important to identify the differences in food safety risks presented by alternative systems compared with conventional methods. Although many studies have been conducted that surveyed foodborne pathogen prevalence along the broiler supply chain, a systematic overview of all of the results is lacking. In the current study, a systematic review and meta-analysis were conducted to quantify the differences in prevalence of Salmonella and Campylobacter spp. in farm environment, rehang, prechill, postchill, and retail samples between conventional and alternative production systems. A systematic search of Web of Science and PubMed databases was conducted to identify eligible studies. Studies were then evaluated by inclusion criteria, and the included studies were qualitatively and quantitatively analyzed. In total, 137 trials from 72 studies were used in the final meta-analysis. Meta-analysis models were individually constructed for subgroups that were determined by sample type, pathogen, and production type. All subgroups possessed high amounts of heterogeneity (I2 > 75%). For environmental sample subgroups, Campylobacter prevalence was estimated to be 15.8 and 52.8% for conventional and alternative samples, respectively. Similar prevalence estimates for both production types were observed for Salmonella environmental samples and all retail samples. For conventional samples, Campylobacter and Salmonella prevalence was highest in prechill samples followed by rehang and postchill samples, respectively. The results herein will be useful in future quantitative microbial risk assessments for characterizing the differences in foodborne illness risks presented by different broiler production systems. HIGHLIGHTS
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Affiliation(s)
- Chase E Golden
- Department of Food Science and Technology, University of Georgia, 100 Cedar Street, Athens, Georgia 30602, USA (ORCID: https://orcid.org/0000-0001-9214-0745 [A.M.])
| | - Abhinav Mishra
- Department of Food Science and Technology, University of Georgia, 100 Cedar Street, Athens, Georgia 30602, USA (ORCID: https://orcid.org/0000-0001-9214-0745 [A.M.])
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Arnesen EK, Christensen JJ, Andersen R, Eneroth H, Erkkola M, Høyer A, Lemming EW, Meltzer HM, Halldórsson ÞI, Þórsdóttir I, Schwab U, Trolle E, Blomhoff R. The Nordic Nutrition Recommendations 2022 - structure and rationale of qualified systematic reviews. Food Nutr Res 2020; 64:4403. [PMID: 32612488 PMCID: PMC7307429 DOI: 10.29219/fnr.v64.4403] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/18/2020] [Accepted: 04/18/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Qualified systematic reviews (SRs) will form the main basis for evaluating causal effects of nutrients or food groups on health outcomes in the sixth edition of Nordic Nutrition Recommendations to be published in 2022 (NNR2022). OBJECTIVE To describe rationale and structure of SRs used in NNR2022. DESIGN The SR methodologies of the previous edition of NNR were used as a starting point. Methodologies of recent SRs commissioned by leading national food and health authorities or international food and health organizations were examined and scrutinized. Methodologies for developing SRs were agreed by the NNR2022 Committee in a consensus-driven process. RESULTS Qualified SRs will be developed by a cross-disciplinary group of experts and reported according to the requirements of the EQUATOR network. A number of additional requirements must also be fulfilled, including 1) a clearly stated set of objectives and research questions with pre-defined eligibility criteria for the studies, 2) an explicit, reproducible methodology, 3) a systematic search that attempts to identify all studies that would meet the eligibility criteria, 4) an assessment of the validity of the findings of the included studies through an assessment of 'risk of bias' of the studies, 5) a systematic presentation and synthesis of the characteristics and findings of the included studies, and 6) a grading of the overall evidence. The complete definition and requirements of a qualified SR are described. DISCUSSION Most SRs published in scientific journals do not fulfill all criteria of the qualified SRs in the NNR2022 project. This article discusses the structure and rationale for requirements of qualified SRs in NNR2022. National food and health authorities have only recently begun to use qualified SRs as a basis for nutrition recommendations. CONCLUSION Qualified SRs will be used to inform dietary reference values (DRVs) and food-based dietary guidelines (FBDGs) in the NNR2022 project.
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Affiliation(s)
| | - Jacob Juel Christensen
- Department of Nutrition, University of Oslo, Oslo, Norway
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Oslo University Hospital, Oslo, Norway
| | - Rikke Andersen
- National Food Institute, Technical University of Denmark (DTU), Kgs. Lyngby, Denmark
| | | | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Anne Høyer
- The Norwegian Directorate of Health, Oslo, Norway
| | | | | | | | - Inga Þórsdóttir
- School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ursula Schwab
- Department of Medicine, Endocrinology and Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland, and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, Kuopio, Finland
| | - Ellen Trolle
- National Food Institute, Technical University of Denmark (DTU), Kgs. Lyngby, Denmark
| | - Rune Blomhoff
- Department of Nutrition, University of Oslo, Oslo, Norway
- The Norwegian Directorate of Health, Oslo, Norway
- Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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Roerecke M, Vafaei A, Hasan OSM, Chrystoja BR, Cruz M, Lee R, Neuman MG, Rehm J. Alcohol Consumption and Risk of Liver Cirrhosis: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2019; 114:1574-1586. [PMID: 31464740 PMCID: PMC6776700 DOI: 10.14309/ajg.0000000000000340] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To systematically summarize the risk relationship between different levels of alcohol consumption and incidence of liver cirrhosis. METHODS MEDLINE and Embase were searched up to March 6, 2019, to identify case-control and cohort studies with sex-specific results and more than 2 categories of drinking in relation to the incidence of liver cirrhosis. Study characteristics were extracted and random-effects meta-analyses and meta-regressions were conducted. RESULTS A total of 7 cohort studies and 2 case-control studies met the inclusion criteria, providing data from 2,629,272 participants with 5,505 cases of liver cirrhosis. There was no increased risk for occasional drinkers. Consumption of one drink per day in comparison to long-term abstainers showed an increased risk for liver cirrhosis in women, but not in men. The risk for women was consistently higher compared to men. Drinking ≥5 drinks per day was associated with a substantially increased risk in both women (relative risk [RR] = 12.44, 95% confidence interval [CI]: 6.65-23.27 for 5-6 drinks, and RR = 24.58, 95% CI: 14.77-40.90 for ≥7 drinks) and men (RR = 3.80, 95% CI: 0.85-17.02, and RR = 6.93, 95% CI: 1.07-44.99, respectively). Heterogeneity across studies indicated an additional impact of other risk factors. DISCUSSION Alcohol is a major risk factor for liver cirrhosis with risk increasing exponentially. Women may be at higher risk compared to men even with little alcohol consumption. More high-quality research is necessary to elucidate the role of other risk factors, such as genetic vulnerability, body weight, metabolic risk factors, and drinking patterns over the life course. High alcohol consumption should be avoided, and people drinking at high levels should receive interventions to reduce their intake.
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Affiliation(s)
- Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada
| | - Afshin Vafaei
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada
| | - Bethany R Chrystoja
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada
| | - Marcus Cruz
- In Vitro Drug Safety and Biotechnology, Toronto, Ontario, Canada
| | - Roy Lee
- In Vitro Drug Safety and Biotechnology, Toronto, Ontario, Canada
| | - Manuela G Neuman
- In Vitro Drug Safety and Biotechnology, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine and Global Health, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Toronto, Ontario, Canada
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Stone JC, Glass K, Munn Z, Tugwell P, Doi SAR. Comparison of bias adjustment methods in meta-analysis suggests that quality effects modeling may have less limitations than other approaches. J Clin Epidemiol 2019; 117:36-45. [PMID: 31541691 DOI: 10.1016/j.jclinepi.2019.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/24/2019] [Accepted: 09/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The quality of primary research is commonly assessed before inclusion in meta-analyses. Findings are discussed in the context of the quality appraisal by categorizing studies according to risk of bias. The impact of appraised risk of bias on study outcomes is typically judged by the reader; however, several methods have been developed to quantify this risk of bias assessment and incorporate it into the pooled results of meta-analysis, a process known as bias adjustment. The advantages, potential limitations, and applicability of these methods are not well defined. STUDY DESIGN AND SETTING Comparative evaluation of the applicability of the various methods and their limitations are discussed using two examples from the literature. These methods include weighting, stratification, regression, use of empirically based prior distributions, and elicitation by experts. RESULTS Use of the two examples from the literature suggest that all methods provide similar adjustment. Methods differed mainly in applicability and limitations. CONCLUSION Bias adjustment is a feasible process in meta-analysis with several strategies currently available. Quality effects modelling was found to be easily implementable with fewer limitations in comparison to other methods.
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Affiliation(s)
- Jennifer C Stone
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Canberra, ACT, Australia; SYRCLE, Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Zachary Munn
- The Joanna Briggs Institute, The University of Adelaide, Adelaide, Australia
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, Qatar University, Doha, Qatar.
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Radke EG, Glenn BS, Braun JM, Cooper GS. Phthalate exposure and female reproductive and developmental outcomes: a systematic review of the human epidemiological evidence. ENVIRONMENT INTERNATIONAL 2019; 130:104580. [PMID: 31351310 PMCID: PMC9400136 DOI: 10.1016/j.envint.2019.02.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/23/2018] [Accepted: 02/01/2019] [Indexed: 05/19/2023]
Abstract
OBJECTIVE We performed a systematic review of the epidemiology literature to identify the female reproductive and developmental effects associated with phthalate exposure. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA Six phthalates were included in the review: di(2-ethylhexyl) phthalate (DEHP), diisononyl phthalate (DINP), dibutyl phthalate (DBP), diisobutyl phthalate (DIBP), butyl benzyl phthalate (BBP), and diethyl phthalate (DEP). The initial literature search (of PubMed, Web of Science, and Toxline) included all studies of female reproductive and developmental effects in humans, and outcomes were selected for full systematic review based on data availability. STUDY EVALUATION AND SYNTHESIS METHODS For each outcome, studies were evaluated using criteria defined a priori for risk of bias and sensitivity by two reviewers using a domain-based approach. Evidence was synthesized by outcome and phthalate and strength of evidence was summarized using a structured framework. RESULTS The primary outcomes reviewed here are (number of included/excluded studies in parentheses): pubertal development (5/13), time to pregnancy (3/4), preterm birth (8/12), and spontaneous abortion (5/0). Among these outcomes, preterm birth had moderate evidence of a positive association with phthalate exposure (specifically DEHP, DBP, and DEP). Exposure levels for BBP, DIBP, and DINP were generally lower than for the phthalates with an observed effect, which may partially explain the difference due to lower sensitivity. Other phthalate/outcome combinations were considered to have slight or indeterminate evidence of an association. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Overall, these results support that some phthalates may be associated with higher odds of preterm birth in humans, though there is some remaining inconsistency. More evidence is needed on the mechanism and relevant exposure window for this association. The views expressed are those of the authors and do not necessarily represent the views or policies of the U.S. EPA.
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Affiliation(s)
- Elizabeth G Radke
- U.S. Environmental Protection Agency, National Center for Environmental Assessment, United States.
| | - Barbara S Glenn
- U.S. Environmental Protection Agency, National Center for Environmental Assessment, United States
| | - Joseph M Braun
- Brown University, School of Public Health, United States
| | - Glinda S Cooper
- U.S. Environmental Protection Agency, National Center for Environmental Assessment, United States; The Innocence Project, United States
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Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon MP, Griffiths F, Nicolau B, O’Cathain A, Rousseau MC, Vedel I. Improving the content validity of the mixed methods appraisal tool: a modified e-Delphi study. J Clin Epidemiol 2019; 111:49-59.e1. [DOI: 10.1016/j.jclinepi.2019.03.008] [Citation(s) in RCA: 223] [Impact Index Per Article: 44.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022]
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Hay-Smith EJ, Englas K, Dumoulin C, Ferreira CH, Frawley H, Weatherall M. The Consensus on Exercise Reporting Template (CERT) in a systematic review of exercise-based rehabilitation effectiveness: completeness of reporting, rater agreement, and utility. Eur J Phys Rehabil Med 2019; 55:342-352. [PMID: 30947493 DOI: 10.23736/s1973-9087.19.05791-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rehabilitation interventions are diverse - making decisions about pooling data in meta-analyses challenging. Intervention reporting templates such as the Consensus on Exercise Reporting Template (CERT) may help reviewers document intervention variability. AIM To assess inter-rater agreement and utility of CERT used to assess completeness of reporting of one rehabilitation exercise intervention: pelvic floor muscle training (PFMT). DESIGN A non-experimental agreement study. SETTING Update of the Cochrane systematic review comparing different approaches to PFMT for urinary incontinence in women. POPULATION Two PFMT arms from 21 newly identified trials. METHODS Five raters independently used CERT to assess sufficiency of reporting of each arm (experimental PFMT and control PFMT) of each trial. One rater, PFMT non-expert, rated all trials. Four raters, all PFMT experts, assessed a mutually exclusive subgroup of the trials. In addition to rating sufficiency - "Yes" compared to No" or "Uncertain" - raters also reported on CERT utility. Expert ratings were used to determine the proportion of CERT items rated as sufficiently reported. Rater agreement was estimated using coefficient kappa and McNemar's test. RESULTS The range of CERT items rated as sufficiently reported was 0 to 15 of 19 items, and the mean for both trial arms was 5.5. For agreement, 11 of 19 items had sufficient data to estimate coefficient kappa and only 3 of 11 had a kappa >0.4 (moderate agreement). From the 12 of 19 items for which McNemar's test could be performed, five had evidence that PFMT experts more often rated the reporting as sufficient than the non-expert. Raters reported the CERT template was comprehensive but not complete and needed contextualizing for PFMT. CONCLUSIONS Completeness of reporting was poor for this example of a rehabilitation exercise intervention, and equally poor in both trial arms. Inter-rater agreement of completeness of reporting was also poor. Using a data extraction tool with poor rater-agreement may add unnecessary burden in a review. However, using a data extraction tool that enables assessment of intervention homogeneity has benefits in making decisions about which data to pool or not. CLINICAL REHABILITATION IMPACT Researchers reporting clinical trials must pay more attention to completeness of rehabilitation exercise reporting.
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Affiliation(s)
- E Jean Hay-Smith
- Department of Medicine, University of Otago, Wellington, New Zealand -
| | - Kadri Englas
- Department of Medicine, University of Otago, Wellington, New Zealand
- Haapsalu Neurological Rehabilitation Center, Haapsalu, Estonia
| | - Chantale Dumoulin
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montréal, Canada
| | - Cristine H Ferreira
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Helena Frawley
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
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Dehghan-Nayeri N, Ghaffari F, Sadeghi T, Mozaffari N. Effects of Motivational Interviewing on Adherence to Treatment Regimens Among Patients With Type 1 Diabetes: A Systematic Review. Diabetes Spectr 2019; 32:112-117. [PMID: 31168281 PMCID: PMC6528390 DOI: 10.2337/ds18-0038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Motivational interviewing (MI) is a strategy for promoting adherence to treatment regimens among patients with diabetes. However, limited evidence exists regarding its effectiveness in reducing A1C. OBJECTIVE To identify and synthesize evidence about the effectiveness of patient, provider, and health system interventions to improve diabetes care among patients with type 1 diabetes. DESIGN This was a systematic review of randomized controlled trials. METHODS A search was conducted of the scientific databases MEDLINE, Elsevier, CINAHL, Google Scholar, ProQuest, Ovid, and PubMed without imposing any time limit. Only four documents met the inclusion criteria and were included in the final analysis. The methodological quality of these four articles was reviewed by three reviewers using the Jadad Scale. The main intervention and the primary outcome in this study were MI or motivational enhancement therapy and A1C, respectively. RESULTS The retrieved studies reported that MI promotes self-monitoring of blood glucose and reduces A1C. CONCLUSION MI is effective in enhancing patients' adherence to the treatment regimen and thereby decreasing A1C. Given the fact that the reviewed studies had not eliminated the effects of confounding factors, further studies are needed to assess the pure effects of MI on adherence to treatment regimens and A1C levels.
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Affiliation(s)
- Nahid Dehghan-Nayeri
- Tehran University of Medical Sciences School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Tahereh Sadeghi
- Evidence-Based Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Mozaffari
- Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
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Roerecke M, Kaczorowski J, Myers MG. Comparing Automated Office Blood Pressure Readings With Other Methods of Blood Pressure Measurement for Identifying Patients With Possible Hypertension: A Systematic Review and Meta-analysis. JAMA Intern Med 2019; 179:351-362. [PMID: 30715088 PMCID: PMC6439707 DOI: 10.1001/jamainternmed.2018.6551] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Automated office blood pressure (AOBP) measurement involves recording several blood pressure (BP) readings using a fully automated oscillometric sphygmomanometer with the patient resting alone in a quiet place. Although several studies have shown AOBP measurement to be more accurate than routine office BP measurement and not subject to a "white coat effect," the cumulative evidence has not yet been systematically reviewed. OBJECTIVE To perform a systematic review and meta-analysis to examine the association between AOBP and office BP readings measured in routine clinical practice and in research studies, and ambulatory BP recorded during awake hours, as the latter is a standard for predicting future cardiovascular events. DATA SOURCES The MEDLINE, Embase, and Cochrane Library were searched from 2003 to April 25, 2018. STUDY SELECTION Studies on systolic and diastolic BP measurement by AOBP in comparison with awake ambulatory BP, routine office BP, and research BP measurements were included if they contained 30 patients or more. DATA EXTRACTION AND SYNTHESIS Study characteristics were abstracted independently and random effects meta-analyses and meta-regressions were conducted. MAIN OUTCOMES AND MEASURES Pooled mean differences (95% CI) of systolic and diastolic BP between types of BP measurement. RESULTS Data were compiled from 31 articles comprising 9279 participants (4736 men and 4543 women). In samples with systolic AOBP of 130 mm Hg or more, routine office and research systolic BP readings were substantially higher than AOBP readings, with a pooled mean difference of 14.5 mm Hg (95% CI, 11.8-17.2 mm Hg; n = 9; I2 = 94.3%; P < .001) for routine office systolic BP readings and 7.0 mm Hg (95% CI, 4.9-9.1 mm Hg; n = 9; I2 = 85.7%; P < .001) for research systolic BP readings. Systolic awake ambulatory BP and AOBP readings were similar, with a pooled mean difference of 0.3 mm Hg (95% CI, -1.1 to 1.7 mm Hg; n = 19; I2 = 90%; P < .001). CONCLUSIONS AND RELEVANCE Automated office blood pressure readings, only when recorded properly with the patient sitting alone in a quiet place, are more accurate than office BP readings in routine clinical practice and are similar to awake ambulatory BP readings, with mean AOBP being devoid of any white coat effect. There has been some reluctance among physicians to adopt this technique because of uncertainty about its advantages compared with more traditional methods of recording BP during an office visit. Based on the evidence, AOBP should now be the preferred method for recording BP in routine clinical practice.
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Affiliation(s)
- Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Janusz Kaczorowski
- University of Montreal Hospital Research Centre, Department of Family and Emergency Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Martin G Myers
- Schulich Heart Program, Division of Cardiology, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Stone J, Gurunathan U, Glass K, Munn Z, Tugwell P, Doi SA. Stratification by quality induced selection bias in a meta-analysis of clinical trials. J Clin Epidemiol 2019; 107:51-59. [DOI: 10.1016/j.jclinepi.2018.11.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/26/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
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Hohn RE, Slaney KL, Tafreshi D. Primary Study Quality in Psychological Meta-Analyses: An Empirical Assessment of Recent Practice. Front Psychol 2019; 9:2667. [PMID: 30687152 PMCID: PMC6333691 DOI: 10.3389/fpsyg.2018.02667] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/11/2018] [Indexed: 01/08/2023] Open
Abstract
As meta-analytic research has come to occupy a sizeable contingent of published work in the psychological sciences, clarity in the reporting of such work is crucial to its interpretability and reproducibility. This is especially true regarding the assessment of primary study quality, as notions of study quality can vary across research domains. The present study examines the general state of reporting practices related to primary study quality in a sample of 382 published psychological meta-analyses, as well as the reporting decisions and motivations of the authors that published them. Our findings suggest adherence to reporting standards has remained poor for assessments of primary study quality and that the discipline remains inconsistent in its reporting practices generally. We discuss several potential reasons for the poor adherence to reporting standards in our sample, including whether quality assessments are being conducted in the first place, whether standards are well-known within the discipline, and the potential conflation of assessing primary study quality with other facets of conducting a meta-analysis. The implications of suboptimal reporting practices related to primary study quality are discussed.
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Affiliation(s)
- Richard E Hohn
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Kathleen L Slaney
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Donna Tafreshi
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
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Bero L, Chartres N, Diong J, Fabbri A, Ghersi D, Lam J, Lau A, McDonald S, Mintzes B, Sutton P, Turton JL, Woodruff TJ. The risk of bias in observational studies of exposures (ROBINS-E) tool: concerns arising from application to observational studies of exposures. Syst Rev 2018; 7:242. [PMID: 30577874 PMCID: PMC6302384 DOI: 10.1186/s13643-018-0915-2] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/09/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Systematic reviews, which assess the risk of bias in included studies, are increasingly used to develop environmental hazard assessments and public health guidelines. These research areas typically rely on evidence from human observational studies of exposures, yet there are currently no universally accepted standards for assessing risk of bias in such studies. The risk of bias in non-randomised studies of exposures (ROBINS-E) tool has been developed by building upon tools for risk of bias assessment of randomised trials, diagnostic test accuracy studies and observational studies of interventions. This paper reports our experience with the application of the ROBINS-E tool. METHODS We applied ROBINS-E to 74 exposure studies (60 cohort studies, 14 case-control studies) in 3 areas: environmental risk, dietary exposure and drug harm. All investigators provided written feedback, and we documented verbal discussion of the tool. We inductively and iteratively classified the feedback into 7 themes based on commonalities and differences until all the feedback was accounted for in the themes. We present a description of each theme. RESULTS We identified practical concerns with the premise that ROBINS-E is a structured comparison of the observational study being rated to the 'ideal' randomised controlled trial. ROBINS-E assesses 7 domains of bias, but relevant questions related to some critical sources of bias, such as exposure and funding source, are not assessed. ROBINS-E fails to discriminate between studies with a single risk of bias or multiple risks of bias. ROBINS-E is severely limited at determining whether confounders will bias study outcomes. The construct of co-exposures was difficult to distinguish from confounders. Applying ROBINS-E was time-consuming and confusing. CONCLUSIONS Our experience suggests that the ROBINS-E tool does not meet the need for an international standard for evaluating human observational studies for questions of harm relevant to public and environmental health. We propose that a simpler tool, based on empirical evidence of bias, would provide accurate measures of risk of bias and is more likely to meet the needs of the environmental and public health community.
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Affiliation(s)
- Lisa Bero
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales, 2006, Australia.
| | - Nicholas Chartres
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales, 2006, Australia
| | - Joanna Diong
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alice Fabbri
- Charles Perkins Centre and School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, 6th floor, Sydney, New South Wales, 2006, Australia
| | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australia
| | - Juleen Lam
- Department of Ob/Gyn & the Institute for Health Policy Studies, University of California, San Francisco, USA.,Department of Health Sciences, California State University, East Bay, San Francisco, USA
| | - Agnes Lau
- School of Pharmacy, University of California, San Francisco, USA
| | - Sally McDonald
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Barbara Mintzes
- School of Pharmacy, Faculty of Medicine and Health and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Patrice Sutton
- Department of Ob/Gyn & the Institute for Health Policy Studies, University of California, San Francisco, USA
| | | | - Tracey J Woodruff
- Department of Ob/Gyn & the Institute for Health Policy Studies, University of California, San Francisco, USA
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Hong QN, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon MP, Griffiths F, Nicolau B, O’Cathain A, Rousseau MC, Vedel I, Pluye P. The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. EDUCATION FOR INFORMATION 2018. [DOI: 10.3233/efi-180221] [Citation(s) in RCA: 615] [Impact Index Per Article: 102.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Quan Nha Hong
- Department of Family Medicine, McGill University, Montréal, QC, Canada
- Method Development Platform, Quebec SPOR SUPPORT Unit, Montréal, QC, Canada
| | - Sergi Fàbregues
- Department of Psychology and Education, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Felicity Boardman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Margaret Cargo
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Pierre Dagenais
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Frances Griffiths
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Belinda Nicolau
- Faculty of Dentistry, Division of Oral Health and Society Research, McGill University, Montréal, QC, Canada
| | - Alicia O’Cathain
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montréal, QC, Canada
- Method Development Platform, Quebec SPOR SUPPORT Unit, Montréal, QC, Canada
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Lowe J, Briggs A, Whittle S, Hoon E, Stephenson M. Effectiveness of probiotics in the management of inflammatory arthritis: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:2295-2303. [PMID: 30096059 DOI: 10.11124/jbisrir-2017-003692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
REVIEW QUESTIONS The questions of this systematic review are: i) What is the effectiveness of probiotics as a therapeutic intervention for individuals living with inflammatory arthritis? ii) What are the reported adverse effects of probiotics when used as a therapeutic intervention for individuals living with inflammatory arthritis?
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Affiliation(s)
- Judith Lowe
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Andrew Briggs
- School of Health Sciences, Curtin University, Perth, Australia
| | | | - Elizabeth Hoon
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Matthew Stephenson
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
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Transradial Versus Transfemoral Access for Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Stenosis: A Systematic Review and Meta-Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:790-798. [PMID: 30442537 DOI: 10.1016/j.carrev.2018.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/24/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION PCI of ULMS is frequently performed through TFA because of technical complexity and safety concern. Studies have shown comparable efficacy and safety of TRA versus TFA, however, these studies are few in number. We intended to compare the clinical outcomes between transradial access (TRA) and transfemoral access (TFA) in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery stenosis (ULMS) by performing a meta-analysis. METHOD A systematic search of database, including, PubMed, Web of Science, Google scholar and Cochrane Database were performed by two independent reviewers. Studies were included comparing "TRA" versus "TFA" in patients undergoing PCI in ULMS. The primary outcome was a procedural success rate. Secondary outcomes were major bleeding, access site complications, in-hospital and long term: major adverse cardiac events (MACE), myocardial infarction (MI) and cardiovascular mortality. RESULTS Eight studies were included in the analysis. The procedural success rate was 97.3% and there was no statistically significant difference between TRA and TFA groups (OR, 1.41 [CI 0.64, 3.12], I2 = 26%). The rates of access site complications (OR, 0.17 [CI 0.07, 0.41], I2 = 16%), major bleeding (OR, 0.39 [CI 0.17, 0.86], I2 = 0%) and all-cause mortality (OR, 0.28 [CI 0.12, 0.64], I2 = 0%) were lower in the TRA group. There were no significant differences in in-hospital and long term cardiovascular mortality, MI and MACE between the two groups. CONCLUSION In contrast to TFA, TRA is associated with reduced bleeding and access site complications, with similar procedural success rate in patients undergoing PCI of ULMS.
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Rayes HA, Tani C, Kwan A, Marzouk S, Colosimo K, Medina-Rosas J, Mustafa A, Su J, Lambiris P, Mosca M, Touma Z. What is the prevalence of cognitive impairment in lupus and which instruments are used to measure it? A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48:240-255. [DOI: 10.1016/j.semarthrit.2018.02.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 01/10/2018] [Accepted: 02/16/2018] [Indexed: 11/30/2022]
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Losilla JM, Oliveras I, Marin-Garcia JA, Vives J. Three risk of bias tools lead to opposite conclusions in observational research synthesis. J Clin Epidemiol 2018; 101:61-72. [DOI: 10.1016/j.jclinepi.2018.05.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/15/2018] [Accepted: 05/25/2018] [Indexed: 12/20/2022]
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A Systematic Review and Meta-Analysis on the Strength and Consistency of the Associations between Dupuytren Disease and Diabetes Mellitus, Liver Disease, and Epilepsy. Plast Reconstr Surg 2018; 141:367e-379e. [PMID: 29481401 PMCID: PMC5841852 DOI: 10.1097/prs.0000000000004120] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The role of diabetes mellitus, liver disease, and epilepsy as risk factors for Dupuytren disease remains unclear. In this systematic review and meta-analysis, the strength and consistency of these associations were examined. Methods: The MEDLINE, EMBASE, and Web of Science databases were searched for articles reporting an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy published before September 26, 2016. The frequencies of Dupuytren disease and diabetes mellitus, liver disease, and epilepsy were extracted, as was information on potential confounders. Generalized linear mixed models were applied to estimate pooled odds ratios, adjusted for confounders. Heterogeneity between studies was quantified using an intraclass correlation coefficient and was accounted for by a random effect for study. Results: One thousand two hundred sixty unique studies were identified, of which 32 were used in the meta-analyses. An association between Dupuytren disease and diabetes mellitus was observed (OR, 3.06; 95 percent CI, 2.69 to 3.48, adjusted for age), which was stronger for type 1 diabetes mellitus than for type 2 diabetes mellitus but was not statistically significant (p = 0.24). An association between Dupuytren disease and liver disease was observed (OR, 2.92; 95 percent CI, 2.08 to 4.12, adjusted for sex). Dupuytren disease and epilepsy were associated, yielding an OR of 2.80 (95 percent CI, 2.49 to 3.15). Heterogeneity between studies was moderate to low. Conclusions: These findings demonstrate an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy. Prospective, longitudinal studies are needed to elucidate the pathways causing these associations.
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Roerecke M, Tobe SW, Kaczorowski J, Bacon SL, Vafaei A, Hasan OSM, Krishnan RJ, Raifu AO, Rehm J. Sex-Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies. J Am Heart Assoc 2018; 7:e008202. [PMID: 29950485 PMCID: PMC6064910 DOI: 10.1161/jaha.117.008202] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although it is well established that heavy alcohol consumption increases the risk of hypertension, the risk associated with low levels of alcohol intake in men and women is unclear. METHODS AND RESULTS We searched Medline and Embase for original cohort studies on the association between average alcohol consumption and incidence of hypertension in people without hypertension. Random-effects meta-analyses and metaregressions were conducted. Data from 20 articles with 361 254 participants (125 907 men and 235 347 women) and 90 160 incident cases of hypertension (32 426 men and 57 734 women) were included. In people drinking 1 to 2 drinks/day (12 g of pure ethanol per drink), incidence of hypertension differed between men and women (relative riskwomen vs men=0.79; 95% confidence interval, 0.67-0.93). In men, the risk for hypertension in comparison with abstainers was relative risk=1.19 (1.07-1.31; I2=59%), 1.51 (1.30-1.76), and 1.74 (1.35-2.24) for consumption of 1 to 2, 3 to 4, and 5 or more standard drinks per day, respectively. In women, there was no increased risk for 1 to 2 drinks/day (relative risk=0.94; 0.88-1.01; I2=73%), and an increased risk for consumption beyond this level (relative risk=1.42; 1.22-1.66). CONCLUSIONS Any alcohol consumption was associated with an increase in the risk for hypertension in men. In women, there was no risk increase for consumption of 1 to 2 drinks/day and an increased risk for higher consumption levels. We did not find evidence for a protective effect of alcohol consumption in women, contrary to earlier meta-analyses.
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Affiliation(s)
- Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Ontario, Canada
- PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sheldon W Tobe
- Department of Medicine, University of Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal, Quebec, Canada
- CRCHUM (University of Montreal Hospital Research Centre), Montreal, Quebec, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
- Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Quebec, Canada
| | - Afshin Vafaei
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Omer S M Hasan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Ontario, Canada
| | - Rohin J Krishnan
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Amidu O Raifu
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Dalla Lana School of Public Health (DLSPH), University of Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Ontario, Canada
- PAHO/WHO Collaborating Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
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Mueller M, D'Addario M, Egger M, Cevallos M, Dekkers O, Mugglin C, Scott P. Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations. BMC Med Res Methodol 2018; 18:44. [PMID: 29783954 PMCID: PMC5963098 DOI: 10.1186/s12874-018-0495-9] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 04/24/2018] [Indexed: 12/16/2022] Open
Abstract
Background Systematic reviews and meta-analyses of observational studies are frequently performed, but no widely accepted guidance is available at present. We performed a systematic scoping review of published methodological recommendations on how to systematically review and meta-analyse observational studies. Methods We searched online databases and websites and contacted experts in the field to locate potentially eligible articles. We included articles that provided any type of recommendation on how to conduct systematic reviews and meta-analyses of observational studies. We extracted and summarised recommendations on pre-defined key items: protocol development, research question, search strategy, study eligibility, data extraction, dealing with different study designs, risk of bias assessment, publication bias, heterogeneity, statistical analysis. We summarised recommendations by key item, identifying areas of agreement and disagreement as well as areas where recommendations were missing or scarce. Results The searches identified 2461 articles of which 93 were eligible. Many recommendations for reviews and meta-analyses of observational studies were transferred from guidance developed for reviews and meta-analyses of RCTs. Although there was substantial agreement in some methodological areas there was also considerable disagreement on how evidence synthesis of observational studies should be conducted. Conflicting recommendations were seen on topics such as the inclusion of different study designs in systematic reviews and meta-analyses, the use of quality scales to assess the risk of bias, and the choice of model (e.g. fixed vs. random effects) for meta-analysis. Conclusion There is a need for sound methodological guidance on how to conduct systematic reviews and meta-analyses of observational studies, which critically considers areas in which there are conflicting recommendations. Electronic supplementary material The online version of this article (10.1186/s12874-018-0495-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monika Mueller
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Maddalena D'Addario
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myriam Cevallos
- CTU Bern, Clinical Trials Unit Bern, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Olaf Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Pippa Scott
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
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Savović J, Turner RM, Mawdsley D, Jones HE, Beynon R, Higgins JPT, Sterne JAC. Association Between Risk-of-Bias Assessments and Results of Randomized Trials in Cochrane Reviews: The ROBES Meta-Epidemiologic Study. Am J Epidemiol 2018; 187:1113-1122. [PMID: 29126260 PMCID: PMC5928453 DOI: 10.1093/aje/kwx344] [Citation(s) in RCA: 265] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/17/2017] [Indexed: 11/25/2022] Open
Abstract
Flaws in the design of randomized trials may bias intervention effect estimates and increase between-trial heterogeneity. Empirical evidence suggests that these problems are greatest for subjectively assessed outcomes. For the Risk of Bias in Evidence Synthesis (ROBES) Study, we extracted risk-of-bias judgements (for sequence generation, allocation concealment, blinding, and incomplete data) from a large collection of meta-analyses published in the Cochrane Library (issue 4; April 2011). We categorized outcome measures as mortality, other objective outcome, or subjective outcome, and we estimated associations of bias judgements with intervention effect estimates using Bayesian hierarchical models. Among 2,443 randomized trials in 228 meta-analyses, intervention effect estimates were, on average, exaggerated in trials with high or unclear (versus low) risk-of-bias judgements for sequence generation (ratio of odds ratios (ROR) = 0.91, 95% credible interval (CrI): 0.86, 0.98), allocation concealment (ROR = 0.92, 95% CrI: 0.86, 0.98), and blinding (ROR = 0.87, 95% CrI: 0.80, 0.93). In contrast to previous work, we did not observe consistently different bias for subjective outcomes compared with mortality. However, we found an increase in between-trial heterogeneity associated with lack of blinding in meta-analyses with subjective outcomes. Inconsistency in criteria for risk-of-bias judgements applied by individual reviewers is a likely limitation of routinely collected bias assessments. Inadequate randomization and lack of blinding may lead to exaggeration of intervention effect estimates in randomized trials.
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Affiliation(s)
- Jelena Savović
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research
| | - Rebecca M Turner
- Medical Research Council
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - David Mawdsley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Hayley E Jones
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rebecca Beynon
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research
| | - Jonathan A C Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research
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Patient Characteristics Associated With Quality of Colonoscopy Preparation: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2018; 16:357-369.e10. [PMID: 28826680 DOI: 10.1016/j.cgh.2017.08.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Some features of patients are associated with inadequate bowel preparation, which reduces the effectiveness of colonoscopy examination. We performed a systematic review and meta-analysis of the association between patients' sociodemographic characteristics, health conditions, and medications with inadequate bowel preparation. METHODS We searched the PubMed, Scopus, and Cochrane Review databases for randomized controlled trials cohort (prospective and retrospective), case-control, and cross-sectional studies published through March 2016. We collected information on study design, study population, and bowel preparation. For each factor, we obtained the odds ratio (OR) for inadequate bowel preparation. We conducted the meta-analyses using the random-effects approach and investigated any identified heterogeneity and publication bias via graphical methods, stratification, and meta-regression. RESULTS We performed a meta-analysis of 67 studies, comprising 75,818 patients. The estimated pooled OR for inadequate bowel preparation was small for sociodemographic characteristics: 1.14 for age, and 1.23 for male sex (excluding studies in Asia, which had substantial heterogeneity and publication bias), and 1.49 for low education. The effect of high body mass index differed significantly in studies with mostly female patients (OR, 1.05) vs those with mostly male patients (OR, 1.30) (P = .013 for the difference). ORs for constipation and cirrhosis were heterogeneous; adjusted ORs were larger than unadjusted ORs (1.97 vs 1.29 for constipation and 3.41 vs 1.36 for cirrhosis). Diabetes (OR, 1.79), hypertension (OR, 1.25), stroke or dementia (OR, 2.09), and opioid use (OR, 1.70) were associated with inadequate bowel preparation. History of abdominal surgery (OR, 0.99) did not associate with inadequate bowel preparation. Use of tricyclic antidepressants had a larger effect on risk of inadequate bowel preparation in studies of mostly female patients (OR, 2.62) than studies of mostly male patients (OR, 1.42) (P = .085 for the difference). CONCLUSIONS In a systematic review and meta-analysis, we found no single patient-related factor to be solely associated with inadequate bowel preparation. Health conditions and use of some medications appear to be stronger predictors than sociodemographic characteristics.
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Rietbergen C, Stefansdottir G, Leufkens HG, Knol MJ, De Bruin ML, Klugkist I. Evidence Synthesis in Harm Assessment of Medicines Using the Example of Rosiglitazone and Myocardial Infarction. Front Med (Lausanne) 2018. [PMID: 29520360 PMCID: PMC5827152 DOI: 10.3389/fmed.2017.00228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The current system of harm assessment of medicines has been criticized for relying on intuitive expert judgment. There is a call for more quantitative approaches and transparency in decision-making. Illustrated with the case of cardiovascular safety concerns for rosiglitazone, we aimed to explore a structured procedure for the collection, quality assessment, and statistical modeling of safety data from observational and randomized studies. We distinguished five stages in the synthesis process. In Stage I, the general research question, population and outcome, and general inclusion and exclusion criteria are defined and a systematic search is performed. Stage II focusses on the identification of sub-questions examined in the included studies and the classification of the studies into the different categories of sub-questions. In Stage III, the quality of the identified studies is assessed. Coding and data extraction are performed in Stage IV. Finally, meta-analyses on the study results per sub-question are performed in Stage V. A Pubmed search identified 30 randomized and 14 observational studies meeting our search criteria. From these studies, we identified 4 higher level sub-questions and 4 lower level sub-questions. We were able to categorize 29 individual treatment comparisons into one or more of the sub-question categories, and selected study duration as an important covariate. We extracted covariate, outcome, and sample size information at the treatment arm level of the studies. We extracted absolute numbers of myocardial infarctions from the randomized study, and adjusted risk estimates with 95% confidence intervals from the observational studies. Overall, few events were observed in the randomized studies that were frequently of relatively short duration. The large observational studies provided more information since these were often of longer duration. A Bayesian random effects meta-analysis on these data showed no significant increase in risk of rosiglitazone for any of the sub-questions. The proposed procedure can be of additional value for drug safety assessment because it provides a stepwise approach that guides the decision-making in increasing process transparency. The procedure allows for the inclusion of results from both randomized an observational studies, which is especially relevant for this type of research.
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Affiliation(s)
- Charlotte Rietbergen
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Hubert G Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands
| | - Mirjam J Knol
- National Institute for Public Health and the Environment, De Bilt, Netherlands
| | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, Netherlands.,Copenhagen Centre for Regulatory Science (CORS), University of Copenhagen, Copenhagen, Denmark
| | - Irene Klugkist
- Department of Methodology and Statistics, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, Netherlands.,Measurement and Data Analysis, Behavioural, Management and Social Sciences, Research Methodology, University of Twente, Enschede, Netherlands
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46
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Recommendations for assessing the risk of bias in systematic reviews of health-care interventions. J Clin Epidemiol 2017; 97:26-34. [PMID: 29248724 DOI: 10.1016/j.jclinepi.2017.12.004] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 11/29/2017] [Accepted: 12/08/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Risk-of-bias assessment is a central component of systematic reviews, but little conclusive empirical evidence exists on the validity of such assessments. In the context of such uncertainty, we present pragmatic recommendations that promote transparency and reproducibility in processes, address methodological advances in the risk-of-bias assessment, and can be applied consistently across review topics. STUDY DESIGN AND SETTING Epidemiological study design principles; available empirical evidence, risk-of-bias tools, and guidance; and workgroup consensus. RESULTS We developed recommendations for assessing the risk of bias of studies of health-care interventions specific to framing the focus and scope of risk-of-bias assessment; selecting the risk-of-bias categories; choosing assessment instruments; and conducting, analyzing, and presenting results of risk-of-bias assessments. Key recommendations include transparency and reproducibility of judgments, separating risk of bias from other constructs such as applicability and precision, and evaluating the risk of bias per outcome. We recommend against certain past practices, such as focusing on reporting quality, relying solely on study design or numerical quality scores, and automatically downgrading for industry sponsorship. CONCLUSION Risk-of-bias assessment remains a challenging but essential step in systematic reviews. We presented standards to promote transparency of judgments.
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Umer A, Kelley GA, Cottrell LE, Giacobbi P, Innes KE, Lilly CL. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health 2017; 17:683. [PMID: 28851330 PMCID: PMC5575877 DOI: 10.1186/s12889-017-4691-z] [Citation(s) in RCA: 315] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 08/22/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Overweight and obesity is a major public health concern that includes associations with the development of cardiovascular disease (CVD) risk factors during childhood and adolescence as well as premature mortality in adults. Despite the high prevalence of childhood and adolescent obesity as well as adult CVD, individual studies as well as previous systematic reviews examining the relationship between childhood obesity and adult CVD have yielded conflicting results. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. METHODS Studies were included if they met the following criteria: (1) longitudinal and cohort studies (including case-cohort), (2) childhood exposure and adult outcomes collected on the same individual over time, (3) childhood obesity, as defined by the original study authors, (4) English-language articles, (5) studies published up to June, 2015, (6) one or more of the following CVD risk factors [systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), and triglycerides (TG)], (7) outcome(s) not self-reported, and (8) exposure measurements (child's adiposity) assessed by health professionals, trained investigators, or self-reported. Studies were retrieved by searching three electronic databases as well as citation tracking. Fisher's r to z score was calculated for each study for each outcome. Pooled effect sizes were calculated using random-effects models while risk of bias was assessed using the STROBE instrument. In order to try and identify sources of heterogeneity, random-effects meta-regression was also performed. RESULTS Of the 4840 citations reviewed, a total of 23 studies were included in the systematic review and 21 in the meta-analysis. The findings suggested that childhood obesity is significantly and positively associated with adult SBP (Zr = 0.11; 95% CI: 0.07, 0.14), DBP (Zr = 0.11; 95% CI: 0.07, 0.14), and TG (Zr =0.08; 95% CI: 0.03, 0.13), and significantly and inversely associated with adult HDL (Zr = -0.06; 95% CI: -0.10, -0.02). For those studies that adjusted for adult body mass index (BMI), associations were reversed, suggesting that adult BMI may be a potential mediator. Nine studies had more than 33% of items that placed them at an increased risk for bias. CONCLUSIONS The results of this study suggest that childhood obesity may be a risk factor for selected adult CVD risk factors. However, a need exists for additional, higher-quality studies that include, but are not limited to, both unadjusted and adjusted measures such as BMI before any definitive conclusions can be reached. SYSTEMATIC REVIEW AND META-ANALYSIS PROSPERO 2015: CRD42015019763 .
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Affiliation(s)
- Amna Umer
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA.
| | - George A Kelley
- Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Lesley E Cottrell
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Peter Giacobbi
- Department of Epidemiology, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Kim E Innes
- Department of Epidemiology, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Christa L Lilly
- Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
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Umer A, Kelley GA, Cottrell LE, Giacobbi P, Innes KE, Lilly CL. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health 2017. [PMID: 28851330 DOI: 10.1186/s12889‐017‐4691‐z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Overweight and obesity is a major public health concern that includes associations with the development of cardiovascular disease (CVD) risk factors during childhood and adolescence as well as premature mortality in adults. Despite the high prevalence of childhood and adolescent obesity as well as adult CVD, individual studies as well as previous systematic reviews examining the relationship between childhood obesity and adult CVD have yielded conflicting results. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. METHODS Studies were included if they met the following criteria: (1) longitudinal and cohort studies (including case-cohort), (2) childhood exposure and adult outcomes collected on the same individual over time, (3) childhood obesity, as defined by the original study authors, (4) English-language articles, (5) studies published up to June, 2015, (6) one or more of the following CVD risk factors [systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), and triglycerides (TG)], (7) outcome(s) not self-reported, and (8) exposure measurements (child's adiposity) assessed by health professionals, trained investigators, or self-reported. Studies were retrieved by searching three electronic databases as well as citation tracking. Fisher's r to z score was calculated for each study for each outcome. Pooled effect sizes were calculated using random-effects models while risk of bias was assessed using the STROBE instrument. In order to try and identify sources of heterogeneity, random-effects meta-regression was also performed. RESULTS Of the 4840 citations reviewed, a total of 23 studies were included in the systematic review and 21 in the meta-analysis. The findings suggested that childhood obesity is significantly and positively associated with adult SBP (Zr = 0.11; 95% CI: 0.07, 0.14), DBP (Zr = 0.11; 95% CI: 0.07, 0.14), and TG (Zr =0.08; 95% CI: 0.03, 0.13), and significantly and inversely associated with adult HDL (Zr = -0.06; 95% CI: -0.10, -0.02). For those studies that adjusted for adult body mass index (BMI), associations were reversed, suggesting that adult BMI may be a potential mediator. Nine studies had more than 33% of items that placed them at an increased risk for bias. CONCLUSIONS The results of this study suggest that childhood obesity may be a risk factor for selected adult CVD risk factors. However, a need exists for additional, higher-quality studies that include, but are not limited to, both unadjusted and adjusted measures such as BMI before any definitive conclusions can be reached. SYSTEMATIC REVIEW AND META-ANALYSIS PROSPERO 2015: CRD42015019763 .
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Affiliation(s)
- Amna Umer
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA.
| | - George A Kelley
- Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Lesley E Cottrell
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Peter Giacobbi
- Department of Epidemiology, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Kim E Innes
- Department of Epidemiology, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
| | - Christa L Lilly
- Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia, USA
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Murphy B, Ibrahim JE, Bugeja L, Pilgrim J, Cicuttini F. The Use of Deceased Controls in Epidemiologic Research: A Systematic Review. Am J Epidemiol 2017; 186:367-384. [PMID: 28460057 DOI: 10.1093/aje/kwx052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/25/2016] [Indexed: 12/13/2022] Open
Abstract
Scholarly debate on the use of deceased controls in epidemiologic research continues. This systematic review examined published epidemiologic research using deceased persons as a control group. A systematic search of 5 major biomedical literature databases (MEDLINE, CINAHL, PsycINFO, Scopus, and EMBASE) was conducted, using variations of the search terms "deceased" and "controls" to identify relevant peer-reviewed journal articles. Information was sought on study design, rationale for using deceased controls, application of theoretical principles of control selection, and discussion of the use of deceased controls. The review identified 134 studies using deceased controls published in English between 1978 and 2015. Common health outcomes under investigation included cancer (n = 31; 23.1%), nervous system diseases (n = 26; 19.4%), and injury and other external causes (n = 22; 16.4%). The majority of studies used deceased controls for comparison with deceased cases (n = 95; 70.9%). Investigators rarely presented their rationale for control selection (n = 25/134; 18.7%); however, common reasons included comparability of information on exposures, lack of appropriate controls from other sources, and counteracting bias associated with living controls. Comparable accuracy was the most frequently observed principle of control selection (n = 92; 68.7%). This review highlights the breadth of research using deceased controls and indicates their appropriateness in studies using deceased cases.
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Oliveras I, Losilla JM, Vives J. Methodological quality is underrated in systematic reviews and meta-analyses in health psychology. J Clin Epidemiol 2017; 86:59-70. [DOI: 10.1016/j.jclinepi.2017.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/09/2016] [Accepted: 05/02/2017] [Indexed: 01/09/2023]
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