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Kanayama A, Siraj I, Moeyaert M, Steiner K, Yu EC, Ereky‐Stevens K, Iwasa K, Ishikawa M, Kahlon M, Warnatsch R, Dascalu A, He R, Mehta PP, Robinson N, Shi Y. PROTOCOL: Key characteristics of effective preschool-based interventions to promote self-regulation: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1383. [PMID: 38566844 PMCID: PMC10985547 DOI: 10.1002/cl2.1383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/04/2023] [Indexed: 04/04/2024]
Abstract
This is the protocol for a Cochrane Review. The objectives are as follows: The aim of this systematic review is to advance our understanding of the key characteristics of effective preschool-based interventions designed to foster self-regulation. To accomplish this, the review addresses the following questions: 1. What types of preschool-based interventions have been developed to promote self-regulation? 2. What is the average effect of these preschool-based interventions on self-regulation, focusing on four key constructs: integrative effortful control, integrative executive function, self-regulation, and self-regulated learning? 3. What characteristics-such as Resource Allocation, Activity Type, and Instruction Method-could potentially contribute to the effects of preschool-based interventions in promoting self-regulation?
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Affiliation(s)
| | - Iram Siraj
- Department of EducationUniversity of OxfordOxfordUK
| | - Mariola Moeyaert
- Department of Educational and Counseling PsychologyThe State University of New YorkAlbanyNew YorkUSA
| | - Kat Steiner
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - Elie ChingYen Yu
- Division of Educational Psychology and MethodologyThe State University of New YorkAlbanyNew YorkUSA
| | | | | | - Moeko Ishikawa
- Graduate School of Human SciencesOsaka UniversityOsakaJapan
| | | | | | | | - Ruoying He
- Division of the Social SciencesUniversity of ChicagoChicagoIllinoisUSA
| | | | | | - Yining Shi
- Department of PsychologyUniversity of CambridgeCambridgeUK
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Lule H, Mugerwa M, Ssebuufu R, Kyamanywa P, Bärnighausen T, Posti JP, Wilson ML. Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident-Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55297. [PMID: 38713507 PMCID: PMC11109866 DOI: 10.2196/55297] [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: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. OBJECTIVE This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident-related injuries in an African low-resource setting. METHODS This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident-related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. RESULTS The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. CONCLUSIONS This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. TRIAL REGISTRATION Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55297.
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Affiliation(s)
- Herman Lule
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Micheal Mugerwa
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Patrick Kyamanywa
- Mother Kevin Postgraduate Medical School, Uganda Martyr's University, Nkozi, Uganda
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
| | - Jussi P Posti
- Neurocentre, Department of Neurosurgery and Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
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Döhmen A, Kock M, Fischer F, Rose M, Obbarius A, Klapproth CP. Are OMERACT recommendations followed in clinical trials on fibromyalgia? A systematic review of patient-reported outcomes and their measures. Qual Life Res 2023; 32:1521-1536. [PMID: 36181588 PMCID: PMC10172242 DOI: 10.1007/s11136-022-03261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 10/07/2022]
Abstract
PURPOSE Patient-Reported Outcomes (PROs) and its measures (PROMs) are key to outcome assessment in Fibromyalgia (FM) trials. The aim of this review was to investigate which domains and instruments were assessed in recent FM trials and to compare them to recommendations by the Outcome Measures in Rheumatology (OMERACT) initiative. In addition, we investigated the overlap with a generic health assessment approach, i.e. eight domains suggested by the Patient-Reported Outcome Measurement Information System® (PROMIS®). METHODS In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search in scientific databases including PubMed, PsycInfo, and Embase was conducted to identify studies that assessed at least two dimensions of health-related quality of life (HRQoL) from 2015 to June 2022. Non-randomized and randomized controlled trials were included in the analysis. We extracted PROs and PROMs used in each study. RESULTS From 1845 identified records, 107 records out of 105 studies met the inclusion criteria. Studies investigated 50 PROs using 126 different PROMs. Most frequently assessed domains were pain, depression, fatigue, and anxiety (> 95% of the studies). The disease-specific FIQ was the most frequently applied PROM (82%). Overall, only 9% of the studies covered all domains deemed mandatory by OMERACT. Very few studies covered all eight generic health domains suggested by PROMIS. CONCLUSION The majority of trials covered most OMERACT domains or generic PROMIS health domains. There was, however, great variability in the instruments used to assess the domains, which points at a limited degree of standardization in the field.
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Affiliation(s)
- Annika Döhmen
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Milan Kock
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department of Quantitative Health Sciences, Medical School, University of Massachusetts, Worcester, MA, USA
| | - Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, USA
| | - Christoph Paul Klapproth
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Mingay E, Hart M, Yoong S, Palazzi K, D’Arcy E, Pursey KM, Hure A. The Impact of Modifying Food Service Practices in Secondary Schools Providing a Routine Meal Service on Student's Food Behaviours, Health and Dining Experience: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:3640. [PMID: 36079897 PMCID: PMC9460342 DOI: 10.3390/nu14173640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents’ food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39; 1.12 to 1.23; p = 0.002), fruit serves selected (mean difference (MD): 0.09; 0.09 to 0.09; p < 0.001) and consumed (MD: 0.10; 0.04 to 0.15; p < 0.001), and vegetable serves consumed (MD: 0.06; 0.01 to 0.10; p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25; 41% to 77%; p = 0.002) and consumption (14 of 24; 39% to 76%; p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).
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Affiliation(s)
- Edwina Mingay
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Melissa Hart
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter New England Mental Health Service, Calvary Mater Hospital, Newcastle, NSW 2298, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW 2287, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Kerrin Palazzi
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
| | - Ellie D’Arcy
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Kirrilly M. Pursey
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Alexis Hure
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
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Le LM, Veettil SK, Donaldson D, Kategeaw W, Hutubessy R, Lambach P, Chaiyakunapruk N. The impact of pharmacist involvement on immunization uptake and other outcomes: An updated systematic review and meta-analysis. J Am Pharm Assoc (2003) 2022; 62:1499-1513.e16. [PMID: 35961937 PMCID: PMC9448680 DOI: 10.1016/j.japh.2022.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
Background The underutilization of immunization services remains a big public health concern. Pharmacists can address this concern by playing an active role in immunization administration. Objective We performed a systematic review and meta-analysis to assess the impact of pharmacist-involved interventions on immunization rates and other outcomes indirectly related to vaccine uptake. Methods A systematic literature search was conducted using MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases from inception to February 2022 to identify randomized controlled trials (RCTs) and observational studies in which pharmacists were involved in the immunization process. Studies were excluded if no comparator was reported. Two reviewers independently completed data extraction and bias assessments using standardized forms. Meta-analyses were performed using a random-effects model. Results A total of 14 RCTs and 79 observational studies were included. Several types of immunizations were provided, including influenza, pneumococcal, herpes zoster, Tdap, and others in a variety of settings (community pharmacy, hospital, clinic, others). Pooled analyses from RCTs indicated that a pharmacist as immunizer (risk ratio 1.14 [95% CI 1.12–1.15]), advocator (1.31 [1.17–1.48]), or both (1.14 [1.12–1.15]) significantly increased immunization rates compared with usual care or non–pharmacist-involved interventions. The quality of evidence was assessed as moderate or low for those meta-analyses. Evidence from observational studies was consistent with the results found in the analysis of the RCTs. Conclusion Pharmacist involvement as immunizer, advocator, or both roles has favorable effects on immunization uptake, especially with influenza vaccines in the United States and some high-income countries. As the practice of pharmacists in immunization has been expanded globally, further research on investigating the impact of pharmacist involvement in immunization in other countries, especially developing ones, is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Nathorn Chaiyakunapruk
- Correspondence: Nathorn Chaiyakunapruk, PharmD, PhD, Professor. Department of Pharmacotherapy, University of Utah College of Pharmacy, 30 S 2000 E, Salt Lake City, UT 84112.
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Barrigah-Benissan K, Ory J, Sotto A, Salipante F, Lavigne JP, Loubet P. Antiseptic Agents for Chronic Wounds: A Systematic Review. Antibiotics (Basel) 2022; 11:350. [PMID: 35326813 PMCID: PMC8944418 DOI: 10.3390/antibiotics11030350] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 01/01/2023] Open
Abstract
In many parts of the world, antiseptic agents remain non-indicated in chronic wound care. In the current context of bacterial resistance to antibiotics and the development of new-generation antiseptic agents, wound antisepsis represents an asset for the prevention of wound infection. We aimed to evaluate four common antiseptic agents in chronic wound care complete healing. The review protocol was based on the Cochrane Handbook for Systematic Reviews of Intervention and devised in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement guidelines. Five databases and three clinical trials registries were searched from inception to 30 June 2021 without language restrictions. We included randomised trials evaluating the efficacy of antiseptic agents in chronic wound care in adults. Interventions considered were those using antiseptics for cleansing or within a dressing. Risk of bias was assessed using the bias excel tool provided by the Bristol Academy. Evidence quality was assessed using Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Of 838 studies, 6 were finally included, with a total of 725 patients. The included studies assessed iodine (cadexomer or povidone iodine) (n = 3), polyhexanide (n = 2), and octenidine (n = 1). Limited evidence suggested a better wound healing completion with iodine compared to saline (two randomised controlled trials (RCT), 195 patients, pooled RR 1.85 (95%CI (1.27 to 2.69)), moderate-quality evidence). There was not enough evidence to suggest a difference in wound healing using octenidine or polyhexamide. None of the antiseptic agents influenced adverse event occurrence compared to saline.
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Affiliation(s)
- Koko Barrigah-Benissan
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France
| | - Jérôme Ory
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France
| | - Albert Sotto
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Infectious Diseases, University of Montpellier, CHU Nîmes, 30029 Nîmes, France
| | - Florian Salipante
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, University of Montpellier, CHU Nîmes, 30029 Nîmes, France
| | - Jean-Philippe Lavigne
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Microbiology and Hospital Hygiene, University of Montpellier, CHU Nîmes, 30029 Nîmes, France
| | - Paul Loubet
- Bacterial Virulence and Chronic Infections, INSERM U1047, Department of Infectious Diseases, University of Montpellier, CHU Nîmes, 30029 Nîmes, France
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Holcomb DA, Knee J, Capone D, Sumner T, Adriano Z, Nalá R, Cumming O, Brown J, Stewart JR. Impacts of an Urban Sanitation Intervention on Fecal Indicators and the Prevalence of Human Fecal Contamination in Mozambique. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:11667-11679. [PMID: 34382777 PMCID: PMC8429117 DOI: 10.1021/acs.est.1c01538] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Fecal source tracking (FST) may be useful to assess pathways of fecal contamination in domestic environments and to estimate the impacts of water, sanitation, and hygiene (WASH) interventions in low-income settings. We measured two nonspecific and two human-associated fecal indicators in water, soil, and surfaces before and after a shared latrine intervention from low-income households in Maputo, Mozambique, participating in the Maputo Sanitation (MapSan) trial. Up to a quarter of households were impacted by human fecal contamination, but trends were unaffected by improvements to shared sanitation facilities. The intervention reduced Escherichia coli gene concentrations in soil but did not impact culturable E. coli or the prevalence of human FST markers in a difference-in-differences analysis. Using a novel Bayesian hierarchical modeling approach to account for human marker diagnostic sensitivity and specificity, we revealed a high amount of uncertainty associated with human FST measurements and intervention effect estimates. The field of microbial source tracking would benefit from adding measures of diagnostic accuracy to better interpret findings, particularly when FST analyses convey insufficient information for robust inference. With improved measures, FST could help identify dominant pathways of human and animal fecal contamination in communities and guide the implementation of effective interventions to safeguard health.
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Affiliation(s)
- David A. Holcomb
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
| | - Jackie Knee
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Drew Capone
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
| | - Trent Sumner
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia 30332, United States of America
| | | | - Rassul Nalá
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
| | - Jill R. Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, United States of America
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Song CY, Lin PS, Hung PL. Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179374. [PMID: 34501963 PMCID: PMC8431322 DOI: 10.3390/ijerph18179374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 11/16/2022]
Abstract
Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical-cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.
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Affiliation(s)
- Chen-Yi Song
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
- Correspondence:
| | - Pay-Shin Lin
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Master Degree Program in Healthcare Industry, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Healthy Aging Research Center, Chang Gung University, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Pei-Lun Hung
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan;
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Dietrich N, Estradé A, Antonio Cruzado J. Efficacy of Meaning-Centered Psychotherapy in adult patients with advanced cancer: A systematic review and meta-analysis. PSICOONCOLOGIA 2021. [DOI: 10.5209/psic.77752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: We conducted a PRISMA-compliant systematic review of clinical trials, and a meta-analysis of randomised clinical trials (RCTs) of manualised Meaning-Centered Psychotherapy (MCP) interventions for adult advanced cancer patients. We searched seven databases for trials published in English and Spanish, until March 27, 2021. Results: Seven trials were included in the systematic review, and four in the meta-analysis. The systematic review favoured the effectiveness of MCP for the improvement of spiritual well-being, quality of life (QoL), sense of meaning and psychological distress, although inconsistencies between the trials were found. In pre-post meta-analytic estimates, MCP had a superior therapeutic effect than control conditions for spiritual well-being (d=0.52, p<0.001), QoL (d=0.60, p<0.001), anxiety symptoms (d=-0.47, p<0.001), depressive symptoms (d=-0.50, p<0.001) and desire for hastened death (d=-0.28, p<0.001). No differences were observed in between-group comparisons. MCP was not associated with an increased risk of abandonment at post-treatment (OR=0.86, p=0.57). Conclusion: Manualised MCP interventions are a promising treatment for the improvement of spiritual well-being and quality of life and the reduction of psychological distress in adult patients with advanced cancer. The evidence base is still in an emerging state and should be expanded by higher methodological quality studies.
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Huang WK, Hsu HC, Chang SH, Chou WC, Chang PH, Chiang SF, Chang JWC, Chen JS, Yang TS, See LC. Real-World Effectiveness of Adjuvant Oxaliplatin Chemotherapy in Stage III Colon Cancer: A Controlled Interrupted Time Series Analysis. Front Pharmacol 2021; 12:693009. [PMID: 34267662 PMCID: PMC8276019 DOI: 10.3389/fphar.2021.693009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/28/2021] [Indexed: 12/09/2022] Open
Abstract
Background: The real-world effectiveness of oxaliplatin in stage III colon cancer has not been determined in a large-scale population. We aimed to assess the real-world impact of adjuvant oxaliplatin treatment on the survival of these patients. Methods: Based on Taiwan cancer registry, we evaluated 17,801 patients with resected stage III colon cancer, including 14,168 patients receiving adjuvant chemotherapy and 3,633 not receiving adjuvant chemotherapy as the control group between 2004 and 2014. We used the controlled interrupted time-series analysis to assess the three-year disease-free survival and five-year overall survival rates before (2004–2008) and after (2009–2014) the addition of oxaliplatin. Results: The introduction of oxaliplatin was associated with no significant improvement in the slopes (per half-year) of the three-year disease-free survival rate (0.2%, 95% CI: −1.7∼2.2%) and five-year overall survival rate (0.6%, 95% CI: −1.8∼3%). The patients receiving oxaliplatin-based chemotherapy also showed no significant increase in the slopes (per half-year) of the three-year disease-free survival rate (0.6%, 95% CI: −1.4∼2.6%) and five-year overall survival rate (1%, 95% CI: −1.5∼3.5%). The nonsignificant results were consistent across subgroup analyses of age (<70 vs. ≥70 years), recurrence risk (T1-3 or N1 vs. T4 or N2), and cycle of oxaliplatin use (≤6 vs. >6). However, oxaliplatin-based chemotherapy significantly increased the slope (per half-year) of the five-year OS (2%, 95% CI: 0.2∼3.8%) for patients in the high-risk group (T4 or N2). The present results were robust in several sensitivity analyses. Conclusion: Among real-world patients with stage III colon cancer, the introduction of oxaliplatin does not yield a significant improvement in survival. Future work should identify the subpopulation(s) of patients who benefit significantly from the addition of oxaliplatin.
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Affiliation(s)
- Wen-Kuan Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hung-Chih Hsu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hao Chang
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Hung Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Sum-Fu Chiang
- Division of Colon and Rectal Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsai-Sheng Yang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan
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11
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Meduri A, Oliverio GW, Bergandi L, De Salvo G, Frisina R, Mazzotta C, Aragona P. Role of Cold Balanced Salt Solution (BSS) in the Prophylaxis of Cystoid Macular Edema After Cataract Surgery: A Prospective Randomized Study. Clin Ophthalmol 2021; 15:2519-2526. [PMID: 34168425 PMCID: PMC8216722 DOI: 10.2147/opth.s304146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose To evaluate the postoperative effect on central retinal macular thickness of a cooled irrigating eye solution used during cataract surgery. Patients and Methods In this prospective, single-center study, 100 eyes of 50 patients (26 males and 24 females) were evaluated with spectral domain optical coherence tomography (SD-OCT) before and after phacoemulsification for senile cataract. Eyes were randomly divided into two groups based on the irrigating solution used during surgery: Group 1, 50 eyes received intraoperative irrigating solution at room temperature (~20.0±0.1°C); and Group 2, 50 fellow eyes received cold intraoperative irrigating solution (2.7±0.1°C). Changes in central macular thickness (CMT) were evaluated in both groups by SD-OCT macular raster scan for the nine Early Treatment of Diabetic Retinopathy Study (ETDRS) subfields and total macular volume, performed pre-surgery, and 1 and 4 weeks post-surgery. Results Despite there being no significant differences in variables between the two groups preoperatively, significant increases in CMT were observed at 1 week after surgery in both groups (p=0.02 and p=0.03, respectively), as well as in total macular volume (p<0.0001 and p=0.02, respectively). Inter-subgroup analysis showed a significant reduction in CMT (p=0.03) and total macular volume (p=0.001) at 1 week post-surgery in Group 2 compared to Group 1, whereas no significant differences were observed at 4 weeks. Conclusion The use of a cooled irrigating eye solution during phacoemulsification may be beneficial in preventing the possible development of postoperative macular thickening. Further clinical studies may support this finding.
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Affiliation(s)
- Alessandro Meduri
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | - Giovanni William Oliverio
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | | | - Gabriella De Salvo
- Eye Unit, University Hospital Southampton Foundation Trust, Southampton, UK
| | - Rino Frisina
- Department of Neurosciences - Ophthalmology, University of Padova, Padua, Italy
| | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, Alta Val d'Elsa Hospital, Siena, Italy.,Siena Crosslinking Center, Siena, Italy
| | - Pasquale Aragona
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
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12
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Orkin AM, Venugopal J, Curran JD, Fortune MK, McArthur A, Mew E, Ritchie SD, Drennan IR, Exley A, Jamieson R, Johnson DE, MacPherson A, Martiniuk A, McDonald N, Osei-Ampofo M, Wegier P, Van de Velde S, VanderBurgh D. Emergency care with lay responders in underserved populations: a systematic review. Bull World Health Organ 2021; 99:514-528H. [PMID: 34248224 PMCID: PMC8243031 DOI: 10.2471/blt.20.270249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the individual and community health effects of task shifting for emergency care in low-resource settings and underserved populations worldwide. Methods We systematically searched 13 databases and additional grey literature for studies published between 1984 and 2019. Eligible studies involved emergency care training for laypeople in underserved or low-resource populations, and any quantitative assessment of effects on the health of individuals or communities. We conducted duplicate assessments of study eligibility, data abstraction and quality. We synthesized findings in narrative and tabular format. Findings Of 19 308 papers retrieved, 34 studies met the inclusion criteria from low- and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies). Targeted emergency conditions included trauma, burns, cardiac arrest, opioid poisoning, malaria, paediatric communicable diseases and malnutrition. Trainees included the general public, non-health-care professionals, volunteers and close contacts of at-risk populations, all trained through in-class, peer and multimodal education and public awareness campaigns. Important clinical and policy outcomes included improvements in community capacity to manage emergencies (14 studies), patient outcomes (13 studies) and community health (seven studies). While substantial effects were observed for programmes to address paediatric malaria, trauma and opioid poisoning, most studies reported modest effect sizes and two reported null results. Most studies were of weak (24 studies) or moderate quality (nine studies). Conclusion First aid education and task shifting to laypeople for emergency care may reduce patient morbidity and mortality and build community capacity to manage health emergencies for a variety of emergency conditions in underserved and low-resource settings.
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Affiliation(s)
- Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada
| | | | | | - Melanie K Fortune
- Division of Clinical Sciences, Northern Ontario School of Medicine, Timmins, Canada
| | | | - Emma Mew
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Ian R Drennan
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adam Exley
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
| | | | - David E Johnson
- Wilderness Medical Associates International, Portland, United States of America
| | - Andrew MacPherson
- Department of Emergency Medicine, University of British Columbia, Victoria, Canada
| | - Alexandra Martiniuk
- Faculty of Medicine School of Public Health, University of Sydney, Sydney, Australia
| | | | - Maxwell Osei-Ampofo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Stijn Van de Velde
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - David VanderBurgh
- Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
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13
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Schwartz DG, Ataiants J, Roth A, Marcu G, Yahav I, Cocchiaro B, Khalemsky M, Lankenau S. Layperson reversal of opioid overdose supported by smartphone alert: A prospective observational cohort study. EClinicalMedicine 2020; 25:100474. [PMID: 32954238 PMCID: PMC7486335 DOI: 10.1016/j.eclinm.2020.100474] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Rapid naloxone administration is crucial in reversing an opioid overdose. We investigated whether equipping community members, including people who use opioids (PWUO), with a smartphone application enabling them to signal and respond to suspected overdose would support naloxone administration in advance of Emrgency Medical Services (EMS). METHODS This observational cohort study of opioid overdose intervention used a dedicated smartphone app, UnityPhilly, activated by volunteers witnessing an overdose to signal other nearby volunteers in Philadelphia (March 2019 - February 2020). Alerted volunteers chose to respond, or declined to respond, or ignored/missed the alert. Witnessing volunteer was connected to 9-1-1 through a semi-automated telephone call. The primary outcome was layperson-initiated overdose reversal before EMS arrival, and a secondary outcome was hospital transfer. This study is registered with ClinicalTrials.gov, NCT03305497. FINDINGS 112 volunteers, including 57 PWUO and 55 community members, signaled 291 suspected opioid overdose alerts. 89 (30⸱6%) were false alarms. For 202 true alerts, the rate of layperson initiated naloxone use was 36⸱6% (74/202 cases). Most naloxone-use cases occurred in the street (58⸱11% (43/74)) and some in home settings (22⸱98% (17/74)). The first naloxone dose was provided by a nearby volunteer responding to the alert in 29⸱73% (22/74) of cases and by the signaling volunteer in 70⸱27% (52/74) of cases. Successful reversal was reported in 95⸱9% (71/74) of cases. Layperson intervention preceded EMS by 5 min or more in 59⸱5% of cases. Recovery without hospital transport was reported in 52⸱7% (39/74) of cases. INTERPRETATION Our findings support the benefits of equipping community members, potentially witnessing suspected opioid overdose, with naloxone and an emergency response community smartphone app, alerting EMS and nearby laypersons to provide additional naloxone. FUNDING Funding provided by NIH through NIDA, grant number: 5R34DA044758.
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Affiliation(s)
- David G. Schwartz
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
- Corresponding author.
| | - Janna Ataiants
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Alexis Roth
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Inbal Yahav
- Coller School of Management, Tel-Aviv University, Tel-Aviv, Israel
| | - Benjamin Cocchiaro
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Khalemsky
- Information Systems Division, Graduate School of Business, Bar-Ilan University, Ramat-Gan, Israel
| | - Stephen Lankenau
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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14
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Rositch AF, Loffredo C, Bourlon MT, Pearlman PC, Adebamowo C. Creative Approaches to Global Cancer Research and Control. JCO Glob Oncol 2020; 6:4-7. [PMID: 32716656 PMCID: PMC7846070 DOI: 10.1200/go.20.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Loffredo
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Maria T Bourlon
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paul C Pearlman
- National Cancer Institute Center for Global Health, Rockville, MD
| | - Clement Adebamowo
- Institute of Human Virology, Department of Epidemiology and Public Health, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD.,Institute of Human Virology, Abuja, Nigeria.,Center for Bioethics and Research, Ibadan, Nigeria
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15
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Niederkrotenthaler T, Braun M, Pirkis J, Till B, Stack S, Sinyor M, Tran US, Voracek M, Cheng Q, Arendt F, Scherr S, Yip PSF, Spittal MJ. Association between suicide reporting in the media and suicide: systematic review and meta-analysis. BMJ 2020; 368:m575. [PMID: 32188637 PMCID: PMC7190013 DOI: 10.1136/bmj.m575] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the association between reporting on suicides, especially deaths of celebrities by suicide, and subsequent suicides in the general population. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed/Medline, PsychInfo, Scopus, Web of Science, Embase, and Google Scholar, searched up to September 2019. REVIEW METHODS Studies were included if they compared at least one time point before and one time point after media reports on suicide; follow-up was two months or less; the outcome was death by suicide; and the media reports were about non-fictional suicides. Data from studies adopting an interrupted time series design, or single or multiple arm before and after comparisons, were reviewed. RESULTS 31 studies were identified and analysed, and 20 studies at moderate risk of bias were included in the main analyses. The risk of suicide increased by 13% in the period after the media reported a death of a celebrity by suicide (rate ratio 1.13, 95% confidence interval 1.08 to 1.18; 14 studies; median follow-up 28 days, range 7-60 days). When the suicide method used by the celebrity was reported, there was an associated 30% increase in deaths by the same method (rate ratio 1.30, 95% confidence interval 1.18 to 1.44; 11 studies; median follow-up 28 days, range 14-60 days). For general reporting of suicide, the rate ratio was 1.002 (0.997 to 1.008; five studies; median follow-up 1 day, range 1-8 days) for a one article increase in the number of reports on suicide. Heterogeneity was large and partially explained by celebrity and methodological factors. Enhanced funnel plots suggested some publication bias in the literature. CONCLUSIONS Reporting of deaths of celebrities by suicide appears to have made a meaningful impact on total suicides in the general population. The effect was larger for increases by the same method as used by the celebrity. General reporting of suicide did not appear to be associated with suicide although associations for certain types of reporting cannot be excluded. The best available intervention at the population level to deal with the harmful effects of media reports is guidelines for responsible reporting. These guidelines should be more widely implemented and promoted, especially when reporting on deaths of celebrities by suicide. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019086559.
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Affiliation(s)
- Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria
- Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - Marlies Braun
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria
- Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Benedikt Till
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria
- Wiener Werkstaette for Suicide Research, Vienna, Austria
| | - Steven Stack
- Department of Criminology and Department of Psychiatry, Wayne State University, Detroit, MI, USA
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ulrich S Tran
- Wiener Werkstaette for Suicide Research, Vienna, Austria
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Vienna, Austria
| | - Martin Voracek
- Wiener Werkstaette for Suicide Research, Vienna, Austria
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Vienna, Austria
| | - Qijin Cheng
- Department of Social Work, Chinese University of Hong Kong, Hong Kong, China
| | - Florian Arendt
- Wiener Werkstaette for Suicide Research, Vienna, Austria
- Department of Communication, University of Vienna, Vienna, Austria
| | - Sebastian Scherr
- School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Paul S F Yip
- Centre for Suicide Research and Prevention, and Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
| | - Matthew J Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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16
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Zou K, Li HY, Zhou D, Liao ZJ. The effects of diagnosis-related groups payment on hospital healthcare in China: a systematic review. BMC Health Serv Res 2020; 20:112. [PMID: 32050962 PMCID: PMC7017558 DOI: 10.1186/s12913-020-4957-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 02/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a growing interest in using diagnosis-related groups (DRGs) payment to reimburse inpatient care worldwide. But its effects on healthcare and health outcomes are controversial, and the evidence from low- and middle- income countries (LMICs) is especially scarce. The objective of this study is to evaluate the effects of DRGs payment on healthcare and health outcomes in China. METHOD A systematic review was conducted. We searched literature databases of PubMed, Cochrane Library, EMBASE, Web of Science, Chinese National Knowledge Infrastructure and SinoMed for empirical studies examining the effects of DRGs payment on healthcare in mainland China. We performed a narrative synthesis of outcomes regarding expenditure, efficiency, quality and equity of healthcare, and assessed the quality of evidence. RESULTS Twenty-three publications representing thirteen DRGs payment studies were included, including six controlled before after studies, two interrupted time series studies and five uncontrolled before-after studies. All studies compared DRGs payment to fee-for-service, with or without an overall budget, in settings of tertiary (7), secondary (7) and primary care (1). The involved participants varied from specific groups to all inpatients. DRGs payment mildly reduced the length of stay. Impairment of equity of healthcare was consistently reported, especially for patients exempted from DRGs payment, including: patient selection, cost-shifting and inferior quality of healthcare. However, findings on total expenditure, out of pocket payment (OOP) and quality of healthcare were inconsistent. The quality of the evidence was generally low or very low due to the study design and potential risk of bias of included studies. CONCLUSION DRGs payment may mildly improve the efficiency but impair the equity and quality of healthcare, especially for patients exempted from this payment scheme, and may cause up-coding of medical records. However, DRGs payment may or may not contain the total expenditure or OOP, depending on the components design of the payment. Policymakers should very carefully consider each component of DRGs payment design against policy goals. Well-designed randomised trials or comparative studies are warranted to consolidate the evidence of the effects of DRGs payment on healthcare and health outcomes in LMICs to inform policymaking.
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Affiliation(s)
- Kun Zou
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hong-Ying Li
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Die Zhou
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zai-Jun Liao
- Department of Medical Records and Statistics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology of China, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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