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Tartour AI, Chivese T, Eltayeb S, Elamin FM, Fthenou E, Seed Ahmed M, Babu GR. Prenatal psychological distress and 11β-HSD2 gene expression in human placentas: Systematic review and meta-analysis. Psychoneuroendocrinology 2024; 166:107060. [PMID: 38677195 DOI: 10.1016/j.psyneuen.2024.107060] [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: 11/03/2023] [Revised: 03/10/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND The placenta acts as a buffer to regulate the degree of fetal exposure to maternal cortisol through the 11-Beta Hydroxysteroid Dehydrogenase isoenzyme type 2 (11-β HSD2) enzyme. We conducted a systematic review and meta-analysis to assess the effect of prenatal psychological distress (PPD) on placental 11-β HSD2 gene expression and explore the related mechanistic pathways involved in fetal neurodevelopment. METHODS We searched PubMed, Embase, Scopus, APA PsycInfo®, and ProQuest Dissertations for observational studies assessing the association between PPD and 11-β HSD2 expression in human placentas. Adjusted regression coefficients (β) and corresponding 95% confidence intervals (CIs) were pooled based on three contextual PPD exposure groups: prenatal depression, anxiety symptoms, and perceived stress. RESULTS Of 3159 retrieved records, sixteen longitudinal studies involving 1869 participants across seven countries were included. Overall, exposure to PPD disorders showed weak negative associations with the placental 11-β HSD2 gene expression as follows: prenatal depression (β -0.01, 95% CI 0.05-0.02, I2=0%), anxiety symptoms (β -0.02, 95% CI 0.06-0.01, I2=0%), and perceived stress (β -0.01 95% CI 0.06-0.04, I2=62.8%). Third-trimester PPD exposure was more frequently associated with lower placental 11-β HSD2 levels. PPD and placental 11-β HSD2 were associated with changes in cortisol reactivity and the development of adverse health outcomes in mothers and children. Female-offspring were more vulnerable to PPD exposures. CONCLUSION The study presents evidence of a modest role of prenatal psychological distress in regulating placental 11-β HSD2 gene expression. Future prospective cohorts utilizing larger sample sizes or advanced statistical methods to enhance the detection of small effect sizes should be planned. Additionally, controlling for key predictors such as the mother's ethnicity, trimester of PPD exposure, mode of delivery, and infant sex is crucial for valid exploration of PPD effects on fetal programming.
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Affiliation(s)
- Angham Ibrahim Tartour
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar.
| | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Safa Eltayeb
- Qatar Biobank for Medical Research, Qatar Foundation, Doha, Qatar
| | - Fatima M Elamin
- Office of Research Ethics and Integrity, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Eleni Fthenou
- Qatar Biobank for Medical Research, Qatar Foundation, Doha, Qatar
| | - Mohammed Seed Ahmed
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
| | - Giridhara Rathnaiah Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, P. O. Box:2713, Doha, Qatar
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Abdallah BM, Elshoeibi AM, ElTantawi N, Arif M, Hourani RF, Akomolafe AF, Hamwi MN, Mahmood FR, Saracoglu KT, Saracoglu A, Chivese T. Comparison of postoperative pain in children after maintenance anaesthesia with propofol or sevoflurane: a systematic review and meta-analysis. Br J Anaesth 2024; 133:93-102. [PMID: 38670899 PMCID: PMC11213989 DOI: 10.1016/j.bja.2024.03.022] [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: 12/27/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Propofol and sevoflurane are two of the most commonly used anaesthetics for paediatric surgery. Data from some clinical trials suggest that postoperative pain incidence is lower when propofol is used for maintenance of anaesthesia compared with sevoflurane, although this is not clear. METHODS This meta-analysis compared postoperative pain following maintenance of anaesthesia with propofol or sevoflurane in paediatric surgeries. PubMed Medline, Embase, Scopus, Web of Science and Cochrane Library were searched for randomised controlled trials (RCTs) that compared postoperative pain between sevoflurane and propofol anaesthesia in children. After quality assessment, a meta-analysis was carried out using bias-adjusted inverse heterogeneity methods, heterogeneity using I2 and publication bias using Doi plots. RESULTS In total, 13 RCTs with 1174 children were included. The overall synthesis suggested nearly two-fold higher odds of overall postoperative pain in the sevoflurane group compared with the propofol group (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.12-3.15, I2=58.2%). Further, children in the sevoflurane group had higher odds of having higher pain scores (OR 3.18, 95% CI 1.83-5.53, I2=20.9%), and a 60% increase in the odds of requiring postoperative rescue analgesia compared with propofol (OR 1.60, 95% CI 0.89-2.88, I2=58.2%). CONCLUSIONS Children maintained on inhalational sevoflurane had higher odds of postoperative pain compared with those maintained on propofol. The results also suggest that sevoflurane is associated with higher odds of needing postoperative rescue analgesia compared with propofol. REGISTRATION The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023445913.
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Affiliation(s)
| | | | | | - Mariah Arif
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Razan F Hourani
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Mahmoud N Hamwi
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Kemal T Saracoglu
- College of Medicine, QU Health, Qatar University, Doha, Qatar; Department of Anaesthesiology, ICU, and Perioperative Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayten Saracoglu
- College of Medicine, QU Health, Qatar University, Doha, Qatar; Department of Anaesthesiology, ICU, and Perioperative Medicine, Aisha Bint Hamad Al-Attiyah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Tawanda Chivese
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
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Barrington MJ, D'Souza RS, Mascha EJ, Narouze S, Kelley GA. Systematic reviews and meta-analyses in regional anesthesia and pain medicine (Part I): guidelines for preparing the review protocol. Reg Anesth Pain Med 2024; 49:391-402. [PMID: 37945065 DOI: 10.1136/rapm-2023-104801] [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: 06/26/2023] [Accepted: 06/26/2023] [Indexed: 11/12/2023]
Abstract
Comprehensive resources exist on how to plan a systematic review and meta-analysis. The objective of this article is to provide guidance to authors preparing their systematic review protocol in the fields of regional anesthesia and pain medicine. The focus is on systematic reviews of healthcare interventions, with or without an aggregate data meta-analysis. We describe and discuss elements of the systematic review methodology that review authors should prespecify, plan, and document in their protocol before commencing the review. Importantly, authors should explain their rationale for planning their systematic review and describe the PICO framework-participants (P), interventions (I),comparators (C), outcomes (O)-and related elements central to constructing their clinical question, framing an informative review title, determining the scope of the review, designing the search strategy, specifying the eligibility criteria, and identifying potential sources of heterogeneity. We highlight the importance of authors defining and prioritizing the primary outcome, defining eligibility criteria for selecting studies, and documenting sources of information and search strategies. The review protocol should also document methods used to evaluate risk of bias, quality (certainty) of the evidence, and heterogeneity of results. Furthermore, the authors should describe their plans for managing key data elements, the statistical construct used to estimate the intervention effect, methods of evidence synthesis and meta-analysis, and conditions when meta-analysis may not be possible, including the provision of practical solutions. Authors should provide enough detail in their protocol so that the readers could conduct the study themselves.
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Affiliation(s)
- Michael J Barrington
- Department of Anesthesia and Perioperative Pain Medicine, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, Minnesota
| | - Edward J Mascha
- Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - George A Kelley
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia, USA
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Ahmed AI, Kaleem MZ, Elshoeibi AM, Elsayed AM, Mahmoud E, Khamis YA, Furuya-Kanamori L, Stone JC, Doi SA. MASTER scale for methodological quality assessment: Reliability assessment and update. J Evid Based Med 2024; 17:263-266. [PMID: 38864529 DOI: 10.1111/jebm.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Affiliation(s)
- Ashraf I Ahmed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Muhammad Zain Kaleem
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Amgad Mohamed Elshoeibi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Abdalla Moustafa Elsayed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Elhassan Mahmoud
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Yaman A Khamis
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
| | - Jennifer C Stone
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Suhail A Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
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Saracoglu A, Fawzy I, Saracoglu KT, Abdallah BM, Arif M, Schmidt M. Point of care guided coagulation management in adult patients on ECMO: A systematic review and meta-analysis. J Crit Care 2024; 83:154830. [PMID: 38744017 DOI: 10.1016/j.jcrc.2024.154830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/02/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Despite the advancements in extracorporeal membrane oxygenation (ECMO) technology, balancing the prevention of thrombosis and the risk of bleeding in patients on ECMO is still a significant challenge for physicians. This systematic review and meta-analysis aimed to assess the efficacy and safety of viscoelastic point-of-care (POC)-guided coagulation management in adult patients on ECMO. METHODS PubMed Medline, Embase, Scopus, Web of Science, and Cochrane Library databases were searched. After quality assessment, meta-analysis was carried out using random effects model, heterogeneity using I2 and publication bias using Doi and Funnel plots. RESULTS A total of 1718 records were retrieved from the searches. Fifteen studies that enrolled a total of 583 participants met the inclusion criteria. Of those, 3 studies enrolling 181 subjects were eligible for meta-analysis. In patients managed with POC-guided algorithms, the odds were coherently lower for bleeding (OR 0.71, 95%CI 0.36-1.42), thrombosis (OR 0.91, 95%CI 0.32-2.60), and in-hospital mortality (OR 0.54, 95%CI 0.29-1.03), but not for circuit change or failure (OR 1.50, 95%CI 0.59-3.83). However, the differences were not statistically significant due to wide 95%CIs. CONCLUSION Viscoelastic POC monitoring demonstrates potential benefits for coagulation management in ECMO patients. Future research should focus on standardizing evidence to improve clinical decision-making. REGISTRATION The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023486294.
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Affiliation(s)
- Ayten Saracoglu
- Department of Anaesthesiology, ICU, and Perioperative Medicine, Aisha Bint Hamad Al-Attiyah Hospital, Hamad Medical Corporation, Doha, Qatar; College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Ibrahim Fawzy
- Department of Critical Care Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kemal Tolga Saracoglu
- College of Medicine, QU Health, Qatar University, Doha, Qatar; Department of Anaesthesiology, ICU, and Perioperative Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Mariah Arif
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Matthieu Schmidt
- Sorbonne Université, Institute of Cardiometabolism and Nutrition, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
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Fouche PF, Stein C, Nichols M, Meadley B, Bendall JC, Smith K, Anderson D, Doi SA. Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2024; 83:435-445. [PMID: 37999653 DOI: 10.1016/j.annemergmed.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/14/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023]
Abstract
STUDY OBJECTIVE Traumatic injury causes a significant number of deaths due to bleeding. Tranexamic acid (TXA), an antifibrinolytic agent, can reduce bleeding in traumatic injuries and potentially enhance outcomes. Previous reviews suggested potential TXA benefits but did not consider the latest trials. METHODS A systematic review and bias-adjusted meta-analysis were performed to assess TXA's effectiveness in emergency traumatic injury settings by pooling estimates from randomized controlled trials. Researchers searched Medline, Embase, and Cochrane Central for randomized controlled trials comparing TXA's effects to a placebo in emergency trauma cases. The primary endpoint was 1-month mortality. The methodological quality of the trials underwent assessment using the MASTER scale, and the meta-analysis applied the quality-effects method to adjust for methodological quality. RESULTS Seven randomized controlled trials met the set criteria. This meta-analysis indicated an 11% decrease in the death risk at 1 month after TXA use (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.84 to 0.95) with a number needed to treat of 61 to avoid 1 additional death. The meta-analysis also revealed reduced 24-hour mortality (OR 0.76, 95% CI 0.65 to 0.88) for TXA. No compelling evidence of increased vascular occlusive events emerged (OR 0.96, 95% CI 0.73 to 1.27). Subgroup analyses highlighted TXA's effectiveness in general trauma versus traumatic brain injury and survival advantages when administered out-of-hospital versus inhospital. CONCLUSIONS This synthesis demonstrates that TXA use for trauma in emergencies leads to a reduction in 1-month mortality, with no significant evidence of problematic vascular occlusive events. Administering TXA in the out-of-hospital setting is associated with reduced mortality compared to inhospital administration, and less mortality with TXA in systemic trauma is noted compared with traumatic brain injury specifically.
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Affiliation(s)
| | - Christopher Stein
- Department of Emergency Medical Care, University of Johannesburg, Johannesburg, Gauteng, South Africa
| | - Martin Nichols
- Clinical Systems, New South Wales Ambulance, Rozelle, NSW, Australia
| | - Benjamin Meadley
- Department of Paramedicine, Monash University, Mulgrave, Victoria, Australia
| | - Jason C Bendall
- Clinical Systems, New South Wales Ambulance, Rozelle, NSW, Australia
| | | | | | - Suhail A Doi
- College of Medicine, Qatar University, Doha, Qatar
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Stone JC, Leonardi-Bee J, Barker TH, Sears K, Klugar M, Munn Z, Aromataris E. Common tool structures and approaches to risk of bias assessment: implications for systematic reviewers. JBI Evid Synth 2024; 22:389-393. [PMID: 38385437 DOI: 10.11124/jbies-23-00463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
There are numerous tools available to assess the risk of bias in individual studies in a systematic review. These tools have different structures, including scales and checklists, which may or may not separate their items by domains. There are also various approaches and guides for the process, scoring, and interpretation of risk of bias assessments, such as value judgments, quality scores, and relative ranks. The objective of this commentary, which is part of the JBI Series on Risk of Bias, is to discuss some of the distinctions among different tool structures and approaches to risk of bias assessment and the implications of these approaches for systematic reviewers.
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Affiliation(s)
- Jennifer C Stone
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Timothy H Barker
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Health Evidence Synthesis, Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Kim Sears
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Queen's Collaboration for Health Care Quality, Queen's University, Kingston, ON, Canada
| | - Miloslav Klugar
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- The Czech Republic, A JBI Centre of Excellence, Prague, Czech Republic
- Center of Evidence-based Education & Arts Therapies: A JBI Affiliated Group, Faculty of Education, Palacký University Olomouc, Olomouc, Czech Republic
- Cochrane Czech Republic, Prague, Czech Republic
- Czech GRADE Centre, Prague, Czech Republic
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Health Evidence Synthesis, Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Barrington MJ, D'Souza RS, Mascha EJ, Narouze S, Kelley GA. Systematic Reviews and Meta-analyses in Regional Anesthesia and Pain Medicine (Part I): Guidelines for Preparing the Review Protocol. Anesth Analg 2024; 138:379-394. [PMID: 37942958 DOI: 10.1213/ane.0000000000006573] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Comprehensive resources exist on how to plan a systematic review and meta-analysis. The objective of this article is to provide guidance to authors preparing their systematic review protocol in the fields of regional anesthesia and pain medicine. The focus is on systematic reviews of health care interventions, with or without an aggregate data meta-analysis. We describe and discuss elements of the systematic review methodology that review authors should prespecify, plan, and document in their protocol before commencing the review. Importantly, authors should explain their rationale for planning their systematic review and describe the PICO framework-participants (P), interventions (I), comparators (C), outcomes (O)-and related elements central to constructing their clinical question, framing an informative review title, determining the scope of the review, designing the search strategy, specifying the eligibility criteria, and identifying potential sources of heterogeneity. We highlight the importance of authors defining and prioritizing the primary outcome, defining eligibility criteria for selecting studies, and documenting sources of information and search strategies. The review protocol should also document methods used to evaluate risk of bias, quality (certainty) of the evidence, and heterogeneity of results. Furthermore, the authors should describe their plans for managing key data elements, the statistical construct used to estimate the intervention effect, methods of evidence synthesis and meta-analysis, and conditions when meta-analysis may not be possible, including the provision of practical solutions. Authors should provide enough detail in their protocol so that the readers could conduct the study themselves.
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Affiliation(s)
- Michael J Barrington
- From the Department of Anesthesia and Perioperative Pain Medicine, Oregon Health & Sciences University, Portland, Oregon
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, Minnesota
| | - Edward J Mascha
- Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio
| | - George A Kelley
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, West Virginia
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Buchanan M, Walker G, Boden JM, Mansoor Z, Newton-Howes G. Protective factors for psychosocial outcomes following cumulative childhood adversity: systematic review. BJPsych Open 2023; 9:e197. [PMID: 37855106 PMCID: PMC10594245 DOI: 10.1192/bjo.2023.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/26/2023] [Accepted: 08/13/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The long-term cumulative impact of exposure to childhood adversity is well documented. There is an increasing body of literature examining protective factors following childhood adversity. However, no known reviews have summarised studies examining protective factors for broad psychosocial outcomes following childhood adversity. AIMS To summarise the current evidence from longitudinal studies of protective factors for adult psychosocial outcomes following cumulative exposure to childhood adversity. METHOD We conducted a formal systematic review of studies that were longitudinal; were published in a peer-reviewed journal; examined social, environmental or psychological factors that were measured following a cumulative measure of childhood adversity; and resulted in more positive adult psychosocial outcomes. RESULTS A total of 28 studies from 23 cohorts were included. Because of significant heterogeneity and conceptual differences in the final sample of articles, a meta-analysis was not conducted. The narrative review identified that social support is a protective factor specifically for mental health outcomes following childhood adversity. Findings also suggest that aspects of education are protective factors to adult socioeconomic, mental health and social outcomes following childhood adversity. Personality factors were protective for a variety of outcomes, particularly mental health. The personality factors were too various to summarise into meaningful combined effects. Overall GRADE quality assessments were low and very low, although these scores mostly reflect that all observational studies are low quality by default. CONCLUSIONS These findings support strategies that improve connection and access to education following childhood adversity exposure. Further research is needed for the roles of personality and dispositional factors, romantic relationship factors and the combined influences of multiple protective factors.
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Affiliation(s)
- Mary Buchanan
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Grace Walker
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Joseph M. Boden
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Zara Mansoor
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Campbell AC, Pearce LA, Willoughby M, Borschmann R, Young J, Bruun A, Sundbery J, Kinner SA. Adverse childhood experiences, morbidity, mortality and resilience in socially excluded populations: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e074314. [PMID: 37848305 PMCID: PMC10582898 DOI: 10.1136/bmjopen-2023-074314] [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: 04/03/2023] [Accepted: 09/17/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION Socially excluded populations, defined by homelessness, substance use disorder, sex work or criminal justice system contact, experience profound health inequity compared with the general population. Cumulative exposure to adverse childhood experiences (ACEs), including neglect, abuse and household dysfunction before age 18, has been found to be independently associated with both an increased risk of social exclusion and adverse health and mortality outcomes in adulthood.Despite this, the impact of ACEs on health and mortality within socially excluded populations is poorly understood. METHODS AND ANALYSIS We will search MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Educational Resources Information Center, PsycINFO, Applied Social Science Index and Abstracts and Criminal Justice Database for peer-reviewed studies measuring ACEs and their impact on health and mortality in socially excluded populations.Three review questions will guide our data extraction and analysis. First, what is the prevalence of ACEs among people experiencing social exclusion in included studies? Second, what is the relationship between ACEs and health and mortality outcomes among people experiencing social exclusion? Does resilience modify the strength of association between ACEs and health outcomes among people experiencing social exclusion?We will meta-analyse the relationship between ACE exposure and health outcomes classified into six a prior categories: (1) substance use disorders; (2) sexual and reproductive health; (3) communicable diseases; (4) mental illness; (5) non-communicable diseases and (6) violence victimisation, perpetration and injury. If there are insufficient studies for meta-analysis, we will conduct a narrative synthesis. Study quality will be assessed using the MethodologicAl STandards for Epidemiological Research scale. ETHICS AND DISSEMINATION Our findings will be disseminated in a peer-reviewed journal, in presentations at academic conferences and in a brief report for policy makers and service providers. We do not require ethics approval as this review will use data that have been previously published. PROSPERO REGISTRATION NUMBER CRD42022357565.
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Affiliation(s)
- Alexander Charles Campbell
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Lindsay A Pearce
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa Willoughby
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Rohan Borschmann
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Department of Psychiatry, Oxford University, Oxford, UK
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Andrew Bruun
- Youth Support and Advocacy Service, Melbourne, Victoria, Australia
| | - Jacqui Sundbery
- Youth Support and Advocacy Service, Melbourne, Victoria, Australia
| | - Stuart A Kinner
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
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Haregu T, Cho E, Spittal M, Armstrong G. The rate of transition to a suicide attempt among people with suicidal thoughts in the general population: A systematic review. J Affect Disord 2023; 331:57-63. [PMID: 36948464 DOI: 10.1016/j.jad.2023.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION While suicidal thoughts are relatively common in the general population, roughly affecting one in ten people during their lifetime, the transition from suicidal thoughts to a suicide attempt is rarer. There is limited consensus on the transition rate from suicidal ideation to suicide attempts. OBJECTIVE To review and summarize evidence on the rate of transition from suicidal ideation to a suicide attempt, and the factors associated with this transition, in the general population. METHODS A comprehensive search was conducted using MEDLINE, PsycINFO, and Embase for relevant articles published between January 1, 2000, and March 3, 2021. We identified 18 eligible studies that examined the transition from suicidal ideation to a suicide attempt in non-clinical populations. We assessed the quality of the included studies using the MASTER scale. The review has been registered with PROSPERO (CRD42021248325). RESULTS Rates of transitioning to a suicide attempt among people with suicidal ideation varied substantially across studies, from 2.6 % to 37 %. Follow-up periods also varied substantially, from 12 to 300 months, impeding reliable comparisons across studies or pooling data for further analyses. The most examined risk factors were mental health disorders such as major depressive and anxiety disorders, which were typically associated with higher odds of transition to a suicide attempt. LIMITATIONS High level of heterogeneity and limited quality of the studies. CONCLUSION The risk of transition from suicidal thoughts to a suicide attempt is moderate to high. Further longitudinal research is required to refine the rate and explore social determinants of transition from suicidal ideation to suicide attempts.
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Affiliation(s)
- Tilahun Haregu
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
| | | | - Matthew Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Gregory Armstrong
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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12
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Stone JC, Glass K, Ritskes-Hoitinga M, Munn Z, Tugwell P, Doi SAR. Methodological quality assessment should move beyond design specificity. JBI Evid Synth 2023; 21:507-519. [PMID: 36683451 DOI: 10.11124/jbies-22-00362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study aimed to assess the utility of a unified tool (MASTER) for bias assessment against design-specific tools in terms of content and coverage. METHODS Each of the safeguards in the design-specific tools was compared and matched to safeguards in the unified MASTER scale. The design-specific tools were the JBI, Scottish Intercollegiate Guidelines Network (SIGN), and the Newcastle-Ottawa Scale (NOS) tools for analytic study designs. Duplicates, safeguards that could not be mapped to the MASTER scale, and items not applicable as safeguards against bias were flagged and described. RESULTS Many safeguards across the JBI, SIGN, and NOS tools were common, with a minimum of 10 to a maximum of 23 unique safeguards across various tools. These 3 design-specific toolsets were missing 14 to 26 safeguards from the MASTER scale. The MASTER scale had complete coverage of safeguards within the 3 toolsets for analytic designs. CONCLUSIONS The MASTER scale provides a unified framework for bias assessment of analytic study designs, has good coverage, avoids duplication, has less redundancy, and is more convenient when used for methodological quality assessment in evidence synthesis. It also allows assessment across designs that cannot be done using a design-specific tool.
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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.,JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Kathryn Glass
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.,Department for Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, 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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13
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Munn Z, Stone JC, Aromataris E, Klugar M, Sears K, Leonardi-Bee J, Barker TH. Assessing the risk of bias of quantitative analytical studies: introducing the vision for critical appraisal within JBI systematic reviews. JBI Evid Synth 2023; 21:467-471. [PMID: 36476419 DOI: 10.11124/jbies-22-00224] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A key step in the systematic review process is the assessment of the methodological quality (or risk of bias) of the included studies. At JBI, we have developed several tools to assist with this evaluation. As evidence synthesis methods continue to evolve, it has been necessary to revise and reflect on JBI's current approach to critical appraisal and to plan a strategy for the future. In this first paper of a series focusing on risk of bias assessment, we introduce our vision for risk of bias assessment for JBI. In future papers in this series, the methodological approach taken for this revision process will be discussed, along with the revised tools and guidance for using these tools.
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Affiliation(s)
- Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jennifer C Stone
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech Republic [Middle European] Centre for Evidence-Based Healthcare: A JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Kim Sears
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | - Jo Leonardi-Bee
- The Nottingham Centre for Evidence Based Healthcare: A JBI Centre of Excellence, School of Medicine, University of Nottingham, Nottingham, UK
| | - Timothy Hugh Barker
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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14
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Heerde J, Borschmann R, Young J, Kinner SA, Sawyer SM, Patton GC. Mortality among people who have experienced homelessness: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e067182. [PMID: 36806070 PMCID: PMC9943969 DOI: 10.1136/bmjopen-2022-067182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Homelessness is a major contributor to health inequalities. People who experience homelessness are at markedly increased risk of multiple and complex health morbidities which likely increase their susceptibility to early, preventable death. Despite this, the mortality burden in this group remains poorly understood, limited in part by insufficient synthesis of data at a global level. This systematic review will synthesise international literature examining rates of risk and protective factors for mortality among people who have experienced homelessness. METHODS AND ANALYSIS We will search MEDLINE, PsycINFO, Embase and PubMed for peer-reviewed cohort studies examining mortality among people who have experienced homelessness. No study eligibility restrictions will be placed on the date, country of origin, or language of publications, or age of the sample. We will assess the quality of included studies using the Methodological Standards for Epidemiological Research scale. Our measures of mortality will include: (A) incidence-all cause and cause specific, expressed as a crude mortality rate (CMR) per 1000 person-years, with 95% CI and (B) all cause and cause specific, indirectly standardised mortality ratios (SMRs) with 95%CI. Associations between risk and protective factors and all-cause and cause-specific mortality will be reported using pooled relative risk ratios with 95% CI. Where there are sufficient data, the influence of subgroup and methodological factors on CMRs, SMRs and predictive factors will be examined using meta-regression. ETHICS AND DISSEMINATION This study does not require institutional ethics review or approval as it will synthesise findings from published studies that have previously been granted relevant ethics approvals. Study findings will be disseminated through a peer-reviewed journal article, conference and seminar presentations. A plain language summary will be distributed through the authors' academic and professional networks. PROSPERO REGISTRATION NUMBER CRD42021272937.
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Affiliation(s)
- Jessica Heerde
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- School of Social Work, The University of Melbourne, Parkville, Victoria, Australia
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jesse Young
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - George C Patton
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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15
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Elmakaty I, Elsayed B, Elmarasi M, Kujan O, Malki MI. Clinicopathological and prognostic value of chemokine receptor CCR7 expression in head and neck squamous cell carcinoma: a systematic review and meta-analysis. Expert Rev Anticancer Ther 2023; 23:443-453. [PMID: 36744447 DOI: 10.1080/14737140.2023.2177156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to identify the clinicopathological characteristics and prognostic value of CC chemokine receptor 7 (CCR7) expression in patients with head and neck squamous cell carcinoma (HNSSC). METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in this meta-analysis. Up to the 2nd of July 2022 a search was conducted using five databases: PubMed, Embase, Scopus, ProQuest, and Web of Science. The methodological standards for the epidemiological research scale were used to assess the quality of the included articles, and Stata software was used to synthesise the meta-analysis. RESULTS We considered 13 of the 615 studies which included 1005 HNSCC patients. High expression of CCR7 increased the pooled odds ratio (OR) of advanced stage, tumour size, metastasis and recurrence by 2.82 [95% confidence interval (CI) 1.84 to 4.33], 2.48 (95% CI 1.68, to 3.67), 3.57, 95% CI 2.25 to 5.05) and 3.93 (95% CI 2.03 to 7.64), respectively. High CCR7 reduced overall patient survival [hazard ratio 2.62 (95% CI 1.59 to 4.32)]. CONCLUSION This study showed that high expression of CCR7 in HNSCC tumours was significantly associated with worse clinicopathological and survival outcomes, suggesting that CCR7 and its pathway could be potential therapeutic strategies for HNSCC.
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Affiliation(s)
| | - Basel Elsayed
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Omar Kujan
- Oral Diagnostic and Surgical Sciences Division, UWA Dental School, the University of Western Australia, Perth, Australia
| | - Mohammed Imad Malki
- Pathology Unit, Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
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16
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Badran S, Doi SA, Iskeirjeh S, Aljassem G, Jafarian N, Clark J, Habib AM, Glass GE. Metabolic changes after nonsurgical fat removal: A dose response meta-analysis. J Plast Reconstr Aesthet Surg 2023; 77:68-77. [PMID: 36549125 DOI: 10.1016/j.bjps.2022.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Obesity-induced insulin resistance leads to the metabolic syndrome. Both bariatric surgery and surgical fat removal have been shown to improve metabolic health, but the metabolic benefits of nonsurgical fat removal remain uncertain. The aim of this paper is to establish whether nonsurgical fat removal exerts measurable, lasting metabolic benefits by way of changes to serum lipid profiles. METHODS PubMed, Cochrane CENTRAL, Embase, and clinical trials registers were searched using the Polyglot Search Translator to find studies examining quantitative changes in metabolic markers after nonsurgical body contouring procedures. The MethodologicAl STandard for Epidemiological Research (MASTER) scale was adopted for the quality assessment of the included studies. The robust-error meta-regression (REMR) model was employed. RESULTS Twenty-two studies and 676 participants were included. Peak body compositions measures manifest as a reduction of 2 units in body mass index (BMI), 1 kg of body weight (BW), 5 cm in waist circumference (WC) and 1.5 cm in abdominal fat thickness (FT), sustained up to 60 days postprocedure. Transient increases of 15 mg/dL in low-density lipoprotein (LDL), 10 mg/dl in triglycerides (TG), and 15 mg/dl in total cholesterol (TC) were observed at 2 weeks postprocedure. CONCLUSION While nonsurgical fat removal exerts sustained effects on body anthropometrics, changes to serum lipid profiles were transient. There is no compelling evidence at present to support the conclusion that nonsurgical fat removal is metabolically beneficial.
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Affiliation(s)
- Saif Badran
- Division of Plastic and Reconstructive Surgery, Washington University, St. Louis, MO, USA; College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Suhail A Doi
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sara Iskeirjeh
- College of Medicine and Public Heath, Flinders University, Adelaide, SA
| | - Ghanem Aljassem
- Department of Plastic Surgery, Hamad General Hospital, Doha, Qatar
| | - Nasrin Jafarian
- Department of Plastic Surgery, Hamad General Hospital, Doha, Qatar
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Queensland, SA, Australia
| | - Abdella M Habib
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Graeme E Glass
- Weill Cornell Medicine Qatar, Qatar Foundation, Doha, Qatar; Department of Surgery, Sidra Medicine, Doha, Qatar.
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17
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Metabolic changes after surgical fat removal: A dose-response meta-analysis. J Plast Reconstr Aesthet Surg 2023; 76:238-250. [PMID: 36527906 DOI: 10.1016/j.bjps.2022.10.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bariatric surgery averts obesity-induced insulin resistance and the metabolic syndrome. By contrast, surgical fat removal is considered merely an esthetic endeavor. The aim of this article was to establish whether surgical fat removal, similar to bariatric surgery, exerts measurable, lasting metabolic benefits. METHODS PubMed, Embase, and Scopus were searched using the Polyglot Search Translator to find studies examining quantitative expression of metabolic markers. Quality assessment was done using the MethodologicAl STandard for Epidemiological Research scale. The robust-error meta-regression model was employed for this synthesis. RESULTS Twenty-two studies with 493 participants were included. Insulin sensitivity improved gradually with a maximum reduction in fasting insulin and homeostatic model assessment for insulin resistance of 17 pmol/L and 1 point, respectively, at postoperative day 180. Peak metabolic benefits manifest as a reduction of 2 units in body mass index, 3 kg of fat mass, 5 cm of waist circumference, 15 µg/L of serum leptin, 0.75 pg/ml of tumor necrosis factor-alpha, 0.25 mmol/L of total cholesterol, and 3.5 mmHg of systolic and diastolic blood pressure that were observed at day 50 but were followed by a return to preoperative levels by day 180. Serum high-density lipoproteins peaked at 50 days post-surgery before falling below the baseline. No significant changes were observed in lean body mass, serum adiponectin, resistin, interleukin-6, C-reactive protein, triglyceride, low-density lipoproteins, free fatty acids, and fasting blood glucose. CONCLUSION Surgical fat removal exerts several metabolic benefits in the short term, but only improvements in insulin sensitivity last beyond 6 months.
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18
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Wang Y, Ghadimi M, Wang Q, Hou L, Zeraatkar D, Iqbal A, Ho C, Yao L, Hu M, Ye Z, Couban R, Armijo-Olivo S, Bassler D, Briel M, Gluud LL, Glasziou P, Jackson R, Keitz SA, Letelier LM, Ravaud P, Schulz KF, Siemieniuk RAC, Brignardello-Petersen R, Guyatt GH. Instruments assessing risk of bias of randomized trials frequently included items that are not addressing risk of bias issues. J Clin Epidemiol 2022; 152:218-225. [PMID: 36424692 DOI: 10.1016/j.jclinepi.2022.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 10/05/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To establish whether items included in instruments published in the last decade assessing risk of bias of randomized controlled trials (RCTs) are indeed addressing risk of bias. STUDY DESIGN AND SETTING We searched Medline, Embase, Web of Science, and Scopus from 2010 to October 2021 for instruments assessing risk of bias of RCTs. By extracting items and summarizing their essential content, we generated an item list. Items that two reviewers agreed clearly did not address risk of bias were excluded. We included the remaining items in a survey in which 13 experts judged the issue each item is addressing: risk of bias, applicability, random error, reporting quality, or none of the above. RESULTS Seventeen eligible instruments included 127 unique items. After excluding 61 items deemed as clearly not addressing risk of bias, the item classification survey included 66 items, of which the majority of respondents deemed 20 items (30.3%) as addressing risk of bias; the majority deemed 11 (16.7%) as not addressing risk of bias; and there proved substantial disagreement for 35 (53.0%) items. CONCLUSION Existing risk of bias instruments frequently include items that do not address risk of bias. For many items, experts disagree on whether or not they are addressing risk of bias.
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Affiliation(s)
- Ying Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Qi Wang
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liangying Hou
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Atiya Iqbal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cameron Ho
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Malini Hu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Zhikang Ye
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Susan Armijo-Olivo
- University of Applied Sciences, Faculty of Business and Social Sciences, Osnabrück, Germany; Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton Canada
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Briel
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Meta-Research Centre Basel, Department of Clinical Research, University Hospital Basel, Switzerland
| | - Lise Lotte Gluud
- Gastro Unit, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Rod Jackson
- Section of Epidemiology & Biostatistics at the School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Sheri A Keitz
- Department of Medicine, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Luz M Letelier
- Department of Internal Medicine, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Alameda 340, Santiago, Chile
| | - Philippe Ravaud
- Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), INSERM, Université Paris Descartes, Paris, France
| | - Kenneth F Schulz
- School of Medicine, University of North Carolina at Chapel Hill, USA
| | - Reed A C Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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19
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Chivese T, Matizanadzo JT, Musa OAH, Hindy G, Furuya-Kanamori L, Islam N, Al-Shebly R, Shalaby R, Habibullah M, Al-Marwani TA, Hourani RF, Nawaz AD, Haider MZ, Emara MM, Cyprian F, Doi SAR. The prevalence of adaptive immunity to COVID-19 and reinfection after recovery - a comprehensive systematic review and meta-analysis. Pathog Glob Health 2022; 116:269-281. [PMID: 35099367 PMCID: PMC9248963 DOI: 10.1080/20477724.2022.2029301] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
This study aims to estimate the prevalence and longevity of detectable SARS-CoV-2 antibodies and T and B memory cells after recovery. In addition, the prevalence of COVID-19 reinfection and the preventive efficacy of previous infection with SARS-CoV-2 were investigated. A synthesis of existing research was conducted. The Cochrane Library, the China Academic Journals Full Text Database, PubMed, and Scopus, and preprint servers were searched for studies conducted between 1 January 2020 to 1 April 2021. Included studies were assessed for methodological quality and pooled estimates of relevant outcomes were obtained in a meta-analysis using a bias adjusted synthesis method. Proportions were synthesized with the Freeman-Tukey double arcsine transformation and binary outcomes using the odds ratio (OR). Heterogeneity was assessed using the I2 and Cochran's Q statistics and publication bias was assessed using Doi plots. Fifty-four studies from 18 countries, with around 12,000,000 individuals, followed up to 8 months after recovery, were included. At 6-8 months after recovery, the prevalence of SARS-CoV-2 specific immunological memory remained high; IgG - 90.4% (95%CI 72.2-99.9, I2 = 89.0%), CD4+ - 91.7% (95%CI 78.2-97.1y), and memory B cells 80.6% (95%CI 65.0-90.2) and the pooled prevalence of reinfection was 0.2% (95%CI 0.0-0.7, I2 = 98.8). Individuals previously infected with SARS-CoV-2 had an 81% reduction in odds of a reinfection (OR 0.19, 95% CI 0.1-0.3, I2 = 90.5%). Around 90% of recovered individuals had evidence of immunological memory to SARS-CoV-2, at 6-8 months after recovery and had a low risk of reinfection.RegistrationPROSPERO: CRD42020201234.
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Affiliation(s)
- Tawanda Chivese
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar,CONTACT Tawanda Chivese ; Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Joshua T. Matizanadzo
- Department of Public Health and Primary Care, Brighton and Sussex Medical School, UK
| | - Omran A. H. Musa
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - George Hindy
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, Australia
| | - Nazmul Islam
- Department of Public Health, Qu Health, Qatar University, Doha, Qatar
| | - Rafal Al-Shebly
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Rana Shalaby
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Mohammad Habibullah
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Talal A. Al-Marwani
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Rizeq F. Hourani
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Ahmed D. Nawaz
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Mohammad Z. Haider
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Mohamed M. Emara
- Immunology Section, Basic Medical Sciences Department, College of Medicine, Qu Health, Qatar University, Doha, Qatar,Microbiology Section, Biomedical and Pharmaceutical Research Unit, Qu Health, Qatar University, Doha, Qatar
| | - Farhan Cyprian
- Immunology Section, Basic Medical Sciences Department, College of Medicine, Qu Health, Qatar University, Doha, Qatar
| | - Suhail A. R. Doi
- Department of Population Medicine, College of Medicine, Qu Health, Qatar University, Doha, Qatar
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20
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Othman MM, Khudadad H, Dughmosh R, Syed A, Clark J, Furuya-Kanamori L, Abou-Samra AB, Doi SAR. Towards a better understanding of self-management interventions in type 2 diabetes: A meta-regression analysis. Prim Care Diabetes 2021; 15:985-994. [PMID: 34217643 DOI: 10.1016/j.pcd.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/31/2021] [Accepted: 06/17/2021] [Indexed: 01/15/2023]
Abstract
AIMS Attributes that operationally conceptualize diabetes self-management education (DSME) interventions have never been studied previously to assess their impact on relevant outcomes of interest in people with type 2 diabetes (T2D). The aim of this study was to determine the impact of existing interventions classified by their delivery of skills or information related attributes on immediate (knowledge), intermediate (physical activity), post-intermediate (HbA1c), and long-term (quality of life) outcomes in people with T2D. METHODS PubMed, Embase, PsycINFO, and Cochrane Library/Cochrane CENTRAL as well as the grey literature were searched to identify interventional studies that examined the impact of DSME interventions on the four different outcomes. Eligible studies were selected and appraised independently by two reviewers. A meta-regression analysis was performed to determine the impact of delivery of the skills- and information-related attributes on the chosen outcomes. RESULTS 142 studies (n = 25,511 participants) provided data, of which 39 studies (n = 5278) reported on knowledge, 39 studies (n = 8323) on physical activity, 99 studies (n = 17,178) on HbA1c and 24 studies (n = 5147) on quality of life outcomes. Meta-regression analyses demonstrated that skills-related attributes had an estimated effect suggesting improvement in knowledge (SMD [standardized mean difference] increase of 0.80; P = 0.025) and that information-related attributes had an estimated effect suggesting improvement in quality of life (SMD increase of 0.96; P = 0.405). Skill- and information-related attributes did not have an estimated effect suggesting improvement in physical activity or in HbA1c. CONCLUSIONS The study findings demonstrate that the skills and information related attributes contribute to different outcomes for people with T2D. This study provides, for the first time, preliminary evidence for differential association of the individual DSME attributes with different levels of outcome.
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Affiliation(s)
- Manal M Othman
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Hanan Khudadad
- Department of Clinical Research, Primary Health Care Corporation, Doha, Qatar.
| | - Ragae Dughmosh
- Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Asma Syed
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Justin Clark
- The Centre for Research into Evidence Based Practice, Bond University, Gold Coast, Queensland, Australia.
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
| | - Abdul-Badi Abou-Samra
- Qatar Metabolic Institute and Medicine Department, Hamad Medical Corporation, Doha, Qatar.
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
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21
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Tsheten T, Clements ACA, Gray DJ, Adhikary RK, Furuya-Kanamori L, Wangdi K. Clinical predictors of severe dengue: a systematic review and meta-analysis. Infect Dis Poverty 2021; 10:123. [PMID: 34627388 PMCID: PMC8501593 DOI: 10.1186/s40249-021-00908-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022] Open
Abstract
Background Severe dengue is a life-threatening complication; rapid identification of these cases, followed by adequate management is crucial to improve the clinical prognosis. Therefore, this study aimed to identify risk factors and predictors of severe dengue.
Methods A literature search for studies reporting risk factors of severe dengue among individuals with dengue virus infection was conducted in PubMed, Scopus and Web of Science database from inception to December 31, 2020. Pooled odds ratios (ORs) for patients’ demographic characteristics, co-morbidities, and warning signs were estimated using an inverse variance heterogeneity model.
Results We included 143 articles in the meta-analysis from a total of 13 090 articles retrieved from the literature search. The risk factors of severe dengue were: being a child [OR = 1.96; 95% confidence interval (CI): 1.22–3.13], secondary infection (OR = 3.23; 95% CI: 2.28–4.57), and patients with pre-existing diabetes (OR = 2.88; 95% CI: 1.72–4.81) and renal disease (OR = 4.54; 95% CI: 1.55–13.31). Warning signs strongly associated with severe disease were increased haematocrit with a concurrent decrease in platelet count (OR = 5.13; 95% CI: 1.61–16.34), abdominal pain (OR = 2.00; 95% CI: 1.49–2.68), lethargy (OR = 2.73; 95% CI: 1.05–7.10), vomiting (OR = 1.80; 95% CI: 1.43–2.26), hepatomegaly (OR = 5.92; 95% CI: 3.29–10.66), ascites (OR = 6.30; 95% CI: 3.75–10.60), pleural effusion (OR = 5.72; 95% CI: 3.24–10.10) and melena (OR = 4.05; 95% CI: 1.64–10.00). Conclusions Our meta-analysis identified children, secondary infection, diabetes and renal disease(s) as important predictors of severe dengue. Our finding also supports the predictive ability of the WHO warning signs to identify severe dengue. These findings are useful for clinicians to identify severe dengue for management and timely interventions. ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00908-2.
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Affiliation(s)
- Tsheten Tsheten
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia. .,Royal Centre for Disease Control, Ministry of Health, Thimphu, Bhutan.
| | - Archie C A Clements
- Telethon Kids Institute, Nedlands, Australia.,Curtin University, Perth, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Ripon K Adhikary
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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22
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Chivese T, Musa OAH, Hindy G, Al-Wattary N, Badran S, Soliman N, Aboughalia ATM, Matizanadzo JT, Emara MM, Thalib L, Doi SAR. Efficacy of chloroquine and hydroxychloroquine in treating COVID-19 infection: A meta-review of systematic reviews and an updated meta-analysis. Travel Med Infect Dis 2021; 43:102135. [PMID: 34265436 PMCID: PMC8273040 DOI: 10.1016/j.tmaid.2021.102135] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022]
Abstract
Objective To synthesize findings from systematic reviews and meta-analyses on the efficacy and safety of chloroquine (CQ) and hydroxychloroquine (HCQ) with or without Azithromycin for treating COVID-19, and to update the evidence using a meta-analysis. Methods A comprehensive search was carried out in electronic databases for systematic reviews, meta-analyses and experimental studies which investigated the efficacy and safety of CQ, HCQ with or without Azithromycin to treat COVID-19. Findings from the reviews were synthesised using tables and forest plots and the quality effect model was used for the updated meta-analysis. The main outcomes were mortality, the need for intensive care services, disease exacerbation, viral clearance and occurrence of adverse events. Results Thirteen reviews with 40 primary studies were included. Two meta-analyses reported a high risk of mortality, with ORs of 2.2 and 3.0, and the two others found no association between HCQ and mortality. Findings from two meta-analyses showed that HCQ with Azithromycin increased the risk of mortality, with similar ORs of 2.5. The updated meta-analysis of experimental studies showed that the drugs were not effective in reducing mortality (RR 1.1, 95%CI 1.0–1.3, I2 = 0.0%), need for intensive care services (OR 1.1, 95%CI 0.9–1.4, I2 = 0.0%), virological cure (OR 1.5, 95%CI 0.5–4.4, I2 = 39.6%) or disease exacerbation (OR 1.2, 95%CI 0.3–5.9, I2 = 31.9%) but increased the odds of adverse events (OR 12,3, 95%CI 2.5–59.9, I2 = 76.6%). Conclusion There is conclusive evidence that CQ and HCQ, with or without Azithromycin are not effective in treating COVID-19 or its exacerbation. Registration PROSPERO: CRD42020191353.
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Affiliation(s)
- Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Omran A H Musa
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - George Hindy
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Noor Al-Wattary
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Saif Badran
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar; Hamad General Hospital, Doha, Qatar
| | - Nada Soliman
- College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | | | - Mohamed M Emara
- Basic Medical Sciences Department, College of Medicine, QU Health, Qatar University, Doha, Qatar; Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
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