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Tan A, Blair A, Homer CS, Digby R, Vogel JP, Bucknall T. Pregnant and postpartum women's experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis. BMC Pregnancy Childbirth 2024; 24:262. [PMID: 38605319 PMCID: PMC11007880 DOI: 10.1186/s12884-024-06439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 03/24/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Pregnant and postpartum women's experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic. METHODS A qualitative evidence synthesis of studies relating to women's experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings. RESULTS Sixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment. CONCLUSIONS The findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.
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Affiliation(s)
- Annie Tan
- School of Nursing and Midwifery, Deakin University, Geelong, Australia.
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.
- Centre for Quality and Patient Safety Research, Institute of Health Transformation, Geelong, Australia.
| | - Amanda Blair
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Caroline Se Homer
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Robin Digby
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research, Institute of Health Transformation, Geelong, Australia
- Alfred Health, Melbourne, Australia
| | - Joshua P Vogel
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
- Centre for Quality and Patient Safety Research, Institute of Health Transformation, Geelong, Australia
- Alfred Health, Melbourne, Australia
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Rees EM, Lotto Batista M, Kama M, Kucharski AJ, Lau CL, Lowe R. Quantifying the relationship between climatic indicators and leptospirosis incidence in Fiji: A modelling study. PLOS Glob Public Health 2023; 3:e0002400. [PMID: 37819894 PMCID: PMC10566718 DOI: 10.1371/journal.pgph.0002400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/25/2023] [Indexed: 10/13/2023]
Abstract
Leptospirosis, a global zoonotic disease, is prevalent in tropical and subtropical regions, including Fiji where it's endemic with year-round cases and sporadic outbreaks coinciding with heavy rainfall. However, the relationship between climate and leptospirosis has not yet been well characterised in the South Pacific. In this study, we quantify the effects of different climatic indicators on leptospirosis incidence in Fiji, using a time series of weekly case data between 2006 and 2017. We used a Bayesian hierarchical mixed-model framework to explore the impact of different precipitation, temperature, and El Niño Southern Oscillation (ENSO) indicators on leptospirosis cases over a 12-year period. We found that total precipitation from the previous six weeks (lagged by one week) was the best precipitation indicator, with increased total precipitation leading to increased leptospirosis incidence (0.24 [95% CrI 0.15-0.33]). Negative values of the Niño 3.4 index (indicative of La Niña conditions) lagged by four weeks were associated with increased leptospirosis risk (-0.2 [95% CrI -0.29 --0.11]). Finally, minimum temperature (lagged by one week) when included with the other variables was positively associated with leptospirosis risk (0.15 [95% CrI 0.01-0.30]). We found that the final model was better able to capture the outbreak peaks compared with the baseline model (which included seasonal and inter-annual random effects), particularly in the Western and Northern division, with climate indicators improving predictions 58.1% of the time. This study identified key climatic factors influencing leptospirosis risk in Fiji. Combining these results with demographic and spatial factors can support a precision public health framework allowing for more effective public health preparedness and response which targets interventions to the right population, place, and time. This study further highlights the need for enhanced surveillance data and is a necessary first step towards the development of a climate-based early warning system.
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Affiliation(s)
- Eleanor M. Rees
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Martín Lotto Batista
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Epidemiology Department, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, The University of the South Pacific, Suva, Fiji
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Colleen L. Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
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Willis GA, Kearns T, Mayfield HJ, Sheridan S, Thomsen R, Naseri T, David MC, Engelman D, Steer AC, Graves PM, Lau CL. Scabies prevalence after ivermectin-based mass drug administration for lymphatic filariasis, Samoa 2018-2019. PLoS Negl Trop Dis 2023; 17:e0011549. [PMID: 37607196 PMCID: PMC10497159 DOI: 10.1371/journal.pntd.0011549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 09/12/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Scabies is a common skin infestation caused by the Sarcoptes scabei mite. Ivermectin, one of three drugs used in mass drug administration (MDA) for lymphatic filariasis, is also effective for treating scabies. Ivermectin-based MDA was first conducted in Samoa in August 2018, with ivermectin being offered to those aged ≥5 years. Here, we report scabies prevalence in Samoa after MDA. METHODS We conducted household surveys 1.5-3.5 months (Survey 1) and 6-8 months (Survey 2) after the 2018 MDA in 35 primary sampling units. We conducted clinical examination for scabies-like rash and used International Alliance for the Control of Scabies classification criteria. We estimated scabies prevalence by age, gender and region. Multivariable logistic regression was used to assess factors associated with prevalence. RESULTS We surveyed 2868 people (499 households) and 2796 people (544 households) aged 0-75 years in Surveys 1 and 2, respectively. Scabies prevalence increased from 2.4% (95% CI 2.1-2.7%) to 4.4% (95% CI 4.0-4.9%) between surveys. Scabies was associated with younger age (0-4 years: aOR 3.5 [2.9-4.2]; 5-15 years: aOR 1.6 [1.4-1.8] compared to ≥16 years), female gender (aOR 1.2 [95% CI 1.1-1.4]; region (aOR range from 1.4 [1.1-1.7] to 2.5 [2.1-3.1] between regions), large households (aOR 2.6 [2.0-3.4] households ≥13), and not taking MDA in 2018 (aOR 1.3 [95% CI 1.1-1.6]). CONCLUSIONS We found moderate prevalence of scabies in two population-representative surveys conducted within 8 months of the 2018 MDA for lymphatic filariasis. Prevalence appeared to increase between the surveys, and ongoing surveillance is recommended, particularly in young children.
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Affiliation(s)
- Gabriela A. Willis
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Helen J. Mayfield
- Research School of Population Health, Australian National University, Canberra, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sarah Sheridan
- National Centre for Immunisation Research and Surveillance, Sydney, Australia
| | | | | | - Michael C. David
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Daniel Engelman
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Andrew C. Steer
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Patricia M. Graves
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Colleen L. Lau
- Research School of Population Health, Australian National University, Canberra, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Xu C, Furuya-Kanamori L, Lin L, Zorzela L, Yu T, Vohra S. Measuring the impact of zero-cases studies in evidence synthesis practice using the harms index and benefits index (Hi-Bi). BMC Med Res Methodol 2023; 23:61. [PMID: 36907858 PMCID: PMC10010026 DOI: 10.1186/s12874-023-01884-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES In evidence synthesis practice, dealing with studies with no cases in both arms has been a tough problem, for which there is no consensus in the research community. In this study, we propose a method to measure the potential impact of studies with no cases for meta-analysis results which we define as harms index (Hi) and benefits index (Bi) as an alternative solution for deciding how to deal with such studies. METHODS Hi and Bi are defined by the minimal number of cases added to the treatment arm (Hi) or control arm (Bi) of studies with no cases in a meta-analysis that lead to a change of the direction of the estimates or its statistical significance. Both exact and approximating methods are available to calculate Hi and Bi. We developed the "hibi" module in Stata so that researchers can easily implement the method. A real-world investigation of meta-analyses from Cochrane reviews was employed to evaluate the proposed method. RESULTS Based on Hi and Bi, our results suggested that 21.53% (Hi) to 26.55% (Bi) of Cochrane meta-analyses may be potentially impacted by studies with no cases, for which studies with no cases could not be excluded from the synthesis. The approximating method shows excellent specificity (100%) for both Hi and Bi, moderate sensitivity (68.25%) for Bi, and high sensitivity (80.61%) for Hi compared to the exact method. CONCLUSIONS The proposed method is practical and useful for systematic reviewers to measure whether studies with no cases impact the results of meta-analyses and may act as an alternative solution for review authors to decide whether to include studies with no events for the synthesis or not.
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Affiliation(s)
- Chang Xu
- Key Laboratory for Population Health Across-Life Cycle (Anhui Medical University), Ministry of Education, Anhui, China.
- School of Public Health, Anhui Medical University, Anhui, China.
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Liliane Zorzela
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Tianqi Yu
- Research Center of Epidemiology and Statistics (CRESS-U1153), INSERM, Université Paris Cité, Paris, France
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Alinejad-Rokny H, Ghavami Modegh R, Rabiee HR, Ramezani Sarbandi E, Rezaie N, Tam KT, Forrest ARR. MaxHiC: A robust background correction model to identify biologically relevant chromatin interactions in Hi-C and capture Hi-C experiments. PLoS Comput Biol 2022; 18:e1010241. [PMID: 35749574 PMCID: PMC9262194 DOI: 10.1371/journal.pcbi.1010241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 07/07/2022] [Accepted: 05/23/2022] [Indexed: 12/13/2022] Open
Abstract
Hi-C is a genome-wide chromosome conformation capture technology that detects interactions between pairs of genomic regions and exploits higher order chromatin structures. Conceptually Hi-C data counts interaction frequencies between every position in the genome and every other position. Biologically functional interactions are expected to occur more frequently than transient background and artefactual interactions. To identify biologically relevant interactions, several background models that take biases such as distance, GC content and mappability into account have been proposed. Here we introduce MaxHiC, a background correction tool that deals with these complex biases and robustly identifies statistically significant interactions in both Hi-C and capture Hi-C experiments. MaxHiC uses a negative binomial distribution model and a maximum likelihood technique to correct biases in both Hi-C and capture Hi-C libraries. We systematically benchmark MaxHiC against major Hi-C background correction tools including Hi-C significant interaction callers (SIC) and Hi-C loop callers using published Hi-C, capture Hi-C, and Micro-C datasets. Our results demonstrate that 1) Interacting regions identified by MaxHiC have significantly greater levels of overlap with known regulatory features (e.g. active chromatin histone marks, CTCF binding sites, DNase sensitivity) and also disease-associated genome-wide association SNPs than those identified by currently existing models, 2) the pairs of interacting regions are more likely to be linked by eQTL pairs and 3) more likely to link known regulatory features including known functional enhancer-promoter pairs validated by CRISPRi than any of the existing methods. We also demonstrate that interactions between different genomic region types have distinct distance distributions only revealed by MaxHiC. MaxHiC is publicly available as a python package for the analysis of Hi-C, capture Hi-C and Micro-C data.
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Affiliation(s)
- Hamid Alinejad-Rokny
- Harry Perkins Institute of Medical Research, QEII Medical Centre and Centre for Medical Research, The University of Western Australia, Perth, Australia
- Bio Medical Machine Learning Lab (BML), The Graduate School of Biomedical Engineering, UNSW Sydney, Sydney, Australia
- Health Data Analytics Program, AI-enabled Processes (AIP) Research Centre, Macquarie University, Sydney, Australia
- * E-mail: (HAR); (ARRF)
| | - Rassa Ghavami Modegh
- Bioinformatics and Computational Biology Lab, Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Hamid R. Rabiee
- Bioinformatics and Computational Biology Lab, Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Ehsan Ramezani Sarbandi
- Bioinformatics and Computational Biology Lab, Department of Computer Engineering, Sharif University of Technology, Tehran, Iran
| | - Narges Rezaie
- Center for Complex Biological Systems, University of California Irvine, Irvine, California, United States of America
| | - Kin Tung Tam
- Harry Perkins Institute of Medical Research, QEII Medical Centre and Centre for Medical Research, The University of Western Australia, Perth, Australia
| | - Alistair R. R. Forrest
- Harry Perkins Institute of Medical Research, QEII Medical Centre and Centre for Medical Research, The University of Western Australia, Perth, Australia
- * E-mail: (HAR); (ARRF)
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Rees EM, Lau CL, Kama M, Reid S, Lowe R, Kucharski AJ. Estimating the duration of antibody positivity and likely time of Leptospira infection using data from a cross-sectional serological study in Fiji. PLoS Negl Trop Dis 2022; 16:e0010506. [PMID: 35696427 PMCID: PMC9232128 DOI: 10.1371/journal.pntd.0010506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/24/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Leptospirosis is a zoonotic disease prevalent throughout the world, but with particularly high burden in Oceania (including the Pacific Island Countries and Territories). Leptospirosis is endemic in Fiji, with outbreaks often occurring following heavy rainfall and flooding. As a result of non-specific clinical manifestation and diagnostic challenges, cases are often misdiagnosed or under-ascertained. Furthermore, little is known about the duration of persistence of antibodies to leptospirosis, which has important clinical and epidemiological implications. Methodology and principal findings Using the results from a serosurvey conducted in Fiji in 2013, we fitted serocatalytic models to estimate the duration of antibody positivity and the force of infection (FOI, the rate at which susceptible individuals acquire infection or seroconversion), whilst accounting for seroreversion. Additionally, we estimated the most likely timing of infection. Using the reverse catalytic model, we estimated the duration of antibody persistence to be 8.33 years (4.76–12.50; assuming constant FOI) and 7.25 years (3.36–11.36; assuming time-varying FOI), which is longer than previous estimates. Using population age-structured seroprevalence data alone, we were not able to distinguish between these two models. However, by bringing in additional longitudinal data on antibody kinetics we were able to estimate the most likely time of infection, lending support to the time-varying FOI model. We found that most individuals who were antibody-positive in the 2013 serosurvey were likely to have been infected within the previous two years, and this finding is consistent with surveillance data showing high numbers of cases reported in 2012 and 2013. Conclusions This is the first study to use serocatalytic models to estimate the FOI and seroreversion rate for Leptospira infection. As well as providing an estimate for the duration of antibody positivity, we also present a novel method to estimate the most likely time of infection from seroprevalence data. These approaches can allow for richer, longitudinal information to be inferred from cross-sectional studies, and could be applied to other endemic diseases where antibody waning occurs. Leptospirosis is a bacterial zoonotic disease that occurs in almost all regions of the world, with a particularly high burden of disease in Oceania. It is widely considered to be a Neglected Zoonotic Disease, and it is often mis-diagnosed and under-ascertained. Very little information exists about the persistence of antibodies to leptospirosis, which is important for understanding how long individuals may have partial protection against reinfection. In this study, we show how data collected from a large population survey of leptospirosis antibodies can be used to estimate the duration of antibody persistence. Knowledge of the duration of antibody persistence enables an estimation of the duration of immunity to re-infection, which is most likely antibody-mediated. We also estimate the rate at which susceptible individuals acquire infection (force of infection), whilst accounting for antibody waning. This provides more accurate estimates of population-wide disease burden. Finally, we show how the results from a cross-sectional population survey can be used to estimate when infections may have occurred. This is particularly useful in areas with limited surveillance. This approach could be applied to other neglected diseases for which data are limited and where antibody waning occurs.
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Affiliation(s)
- Eleanor M. Rees
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Colleen L. Lau
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Mike Kama
- Fiji Centre for Communicable Disease Control, Suva, Fiji
- The University of the South Pacific, Suva, Fiji
| | - Simon Reid
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Rachel Lowe
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Barcelona Supercomputing Center, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Adam J. Kucharski
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Xu C, Zhou X, Zorzela L, Ju K, Furuya-Kanamori L, Lin L, Lu C, Musa OAH, Vohra S. Utilization of the evidence from studies with no events in meta-analyses of adverse events: an empirical investigation. BMC Med 2021; 19:141. [PMID: 34126999 PMCID: PMC8204528 DOI: 10.1186/s12916-021-02008-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUNDS Zero-events studies frequently occur in systematic reviews of adverse events, which consist of an important source of evidence. We aimed to examine how evidence of zero-events studies was utilized in the meta-analyses of systematic reviews of adverse events. METHODS We conducted a survey of systematic reviews published in two periods: January 1, 2015, to January 1, 2020, and January 1, 2008, to April 25, 2011. Databases were searched for systematic reviews that conducted at least one meta-analysis of any healthcare intervention and used adverse events as the exclusive outcome. An adverse event was defined as any untoward medical occurrence in a patient or subject in healthcare practice. We summarized the frequency of occurrence of zero-events studies in eligible systematic reviews and how these studies were dealt with in the meta-analyses of these systematic reviews. RESULTS We included 640 eligible systematic reviews. There were 406 (63.45%) systematic reviews involving zero-events studies in their meta-analyses, among which 389 (95.11%) involved single-arm-zero-events studies and 223 (54.93%) involved double-arm-zero-events studies. The majority (98.71%) of these systematic reviews incorporated single-arm-zero-events studies into the meta-analyses. On the other hand, the majority (76.23%) of them excluded double-arm-zero-events studies from the meta-analyses, of which the majority (87.06%) did not discuss the potential impact of excluding such studies. Systematic reviews published at present (2015-2020) tended to incorporate zero-events studies in meta-analyses than those published in the past (2008-2011), but the difference was not significant (proportion difference=-0.09, 95% CI -0.21 to 0.03, p = 0.12). CONCLUSION Systematic review authors routinely treated studies with zero-events in both arms as "non-informative" carriers and excluded them from their reviews. Whether studies with no events are "informative" or not largely depends on the methods and assumptions applied, thus sensitivity analyses using different methods should be considered in future meta-analyses.
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Affiliation(s)
- Chang Xu
- Department of Population Medicine, College of Medicine, Qatar University, Al Jamiaa Street, P. O. Box, 2713, Doha, Qatar.
| | - Xiaoqin Zhou
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Liliane Zorzela
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ke Ju
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Lifeng Lin
- Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Cuncun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Omran A H Musa
- Department of Population Medicine, College of Medicine, Qatar University, Al Jamiaa Street, P. O. Box, 2713, Doha, Qatar
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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8
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Lau CL, Meder K, Mayfield HJ, Kearns T, McPherson B, Naseri T, Thomsen R, Hedtke SM, Sheridan S, Gass K, Graves PM. Lymphatic filariasis epidemiology in Samoa in 2018: Geographic clustering and higher antigen prevalence in older age groups. PLoS Negl Trop Dis 2020; 14:e0008927. [PMID: 33347456 PMCID: PMC7785238 DOI: 10.1371/journal.pntd.0008927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/05/2021] [Accepted: 10/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Samoa conducted eight nationwide rounds of mass drug administration (MDA) for lymphatic filariasis (LF) between 1999 and 2011, and two targeted rounds in 2015 and 2017 in North West Upolu (NWU), one of three evaluation units (EUs). Transmission Assessment Surveys (TAS) were conducted in 2013 (failed in NWU) and 2017 (all three EUs failed). In 2018, Samoa was the first in the world to distribute nationwide triple-drug MDA using ivermectin, diethylcarbamazine, and albendazole. Surveillance and Monitoring to Eliminate LF and Scabies from Samoa (SaMELFS Samoa) is an operational research program designed to evaluate the effectiveness of triple-drug MDA on LF transmission and scabies prevalence in Samoa, and to compare the usefulness of different indicators of LF transmission. This paper reports results from the 2018 baseline survey and aims to i) investigate antigen (Ag) prevalence and spatial epidemiology, including geographic clustering; ii) compare Ag prevalence between two different age groups (5-9 years versus ≥10 years) as indicators of areas of ongoing transmission; and iii) assess the prevalence of limb lymphedema in those aged ≥15 years. METHODS A community-based cluster survey was conducted in 30 randomly selected and five purposively selected clusters (primary sampling units, PSUs), each comprising one or two villages. Participants were recruited through household surveys (age ≥5 years) and convenience surveys (age 5-9 years). Alere Filariasis Test Strips (FTS) were used to detect Ag, and prevalence was adjusted for survey design and standardized for age and gender. Adjusted Ag prevalence was estimated for each age group (5-9, ≥10, and all ages ≥5 years) for random and purposive PSUs, and by region. Intraclass correlation (ICC) was used to quantify clustering at regions, PSUs, and households. RESULTS A total of 3940 persons were included (1942 children aged 5-9 years, 1998 persons aged ≥10 years). Adjusted Ag prevalence in all ages ≥5 years in randomly and purposively selected PSUs were 4.0% (95% CI 2.8-5.6%) and 10.0% (95% CI 7.4-13.4%), respectively. In random PSUs, Ag prevalence was lower in those aged 5-9 years (1.3%, 95% CI 0.8-2.1%) than ≥10 years (4.7%, 95% CI 3.1-7.0%), and poorly correlated at the PSU level (R-square = 0.1459). Adjusted Ag prevalence in PSUs ranged from 0% to 10.3% (95% CI 5.9-17.6%) in randomly selected and 3.8% (95% CI 1.3-10.8%) to 20.0% (95% CI 15.3-25.8%) in purposively selected PSUs. ICC for Ag-positive individuals was higher at households (0.46) compared to PSUs (0.18) and regions (0.01). CONCLUSIONS Our study confirmed ongoing transmission of LF in Samoa, in accordance with the 2017 TAS results. Ag prevalence varied significantly between PSUs, and there was poor correlation between prevalence in 5-9 year-olds and older ages, who had threefold higher prevalence. Sampling older age groups would provide more accurate estimates of overall prevalence, and be more sensitive for identifying residual hotspots. Higher prevalence in purposively selected PSUs shows local knowledge can help identify at least some hotspots.
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Affiliation(s)
- Colleen L. Lau
- Research School of Population Health, Australian National University, Canberra, Australia
- * E-mail:
| | - Kelley Meder
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Helen J. Mayfield
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Brisbane, Australia
| | - Brady McPherson
- Research School of Population Health, Australian National University, Canberra, Australia
| | | | | | - Shannon M. Hedtke
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Sarah Sheridan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Katherine Gass
- Neglected Tropical Diseases Support Center, The Task Force for Global Heath, Decatur, Georgia, United States of America
| | - Patricia M. Graves
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
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