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Environmental Health Insights 2021Back pain, such as upper and low back pain are among the most common musculoskeletal conditions that can cause major public health and socioeconomic problems. Back pain... (Review)
Review
BACKGROUND
Back pain, such as upper and low back pain are among the most common musculoskeletal conditions that can cause major public health and socioeconomic problems. Back pain is one of the leading causes of disability that reduces worker performance and well-being and increases absence from work, which can cause an enormous economic burden. In developing countries, particularly in Ethiopia, there is no adequate evidence on the overall prevalence of occupational-related upper and low back pain, and they remain less prioritized and empirically unrepresented. Therefore, this study aimed to determine the prevalence of occupational-related upper and low back pain among the working population of Ethiopia.
METHODS
This systematic review and meta-analysis considered studies conducted in Ethiopia, written in English, and published from 2017 to 2020. Articles were searched from 9 electronic databases (Web of Science, SCOPUS, PubMed, Google Scholar, CINAHL, Cochrane Library, African Index Medicus, African Journals Online database, and Science Direct) using a combination of Boolean logic operators, Medical Subject Headings, and main keywords. The quality assessment of the articles was performed using the Joanna Briggs Institute Critical Appraisal tools to determine the relevance of the articles to the study. A random effects model was used to estimate the pooled prevalence, the 95% confidence interval, and the degree of heterogeneity among the included studies. Sensitivity analyses were performed to identify the influence of outliers and to identify sources of heterogeneity.
RESULTS
Of the 1114 studies identified from the included databases, 20 studies were included in the systematic review and meta-analysis. The pooled prevalence of occupational-related upper and low back pain in the previous year was (27.1% [95% CI: 18.4, 37.9]) and (54.2% [95% CI: 48.2, 60.0]), respectively. Based on a subgroup analysis by publication year, study population, and regions where the studies were conducted, the prevalence of upper back pain was (43.8% [95% CI: 39.3, 47.7]), (34.7% [95% CI: 33.1, 36.2]), and (36.2% [95% CI: 33.6, 39.0]), respectively, while the prevalence of low back pain was (61.8% [95% CI: 58.9, 64.6], (52.8% [95% CI: 51.3, 54.3]), and (55.2% [95% CI: 51.4, 59.0]), respectively.
CONCLUSIONS
This systematic review and meta-analysis found that 54.2% of the included study participants experienced low back pain in the previous year, while 27.1% experienced upper back pain. The highest prevalence was reported among pedestrian back-loading women.
PubMed: 35002252
DOI: 10.1177/11786302211067839 -
JAMA Network Open Feb 2024Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Considerable controversy exists regarding the best spontaneous breathing trial (SBT) technique to use.
OBJECTIVE
To summarize trials comparing alternative SBTs.
DATA SOURCES
Several databases (MEDLINE [from inception to February 2023], the Cochrane Central Register of Controlled Trials [in February 2023], and Embase [from inception to February 2023] and 5 conference proceedings (from January 1990 to April 2023) were searched in this systematic review and meta-analysis.
STUDY SELECTION
Randomized trials directly comparing SBT techniques in critically ill adults or children and reporting at least 1 clinical outcome were selected.
DATA EXTRACTION AND SYNTHESIS
Paired reviewers independently screened citations, abstracted data, and assessed quality for the systematic review and meta-analysis using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA guidelines). Data were pooled using random-effects models.
MAIN OUTCOMES AND MEASURES
Primary outcomes included SBT success, extubation success, and reintubation.
RESULTS
The systematic review and meta-analysis identified 40 trials that included 6716 patients. Low-quality evidence (14 trials [n = 4459]) suggested that patients were not more likely to pass a pressure support (PS) compared with a T-piece SBT (risk ratio [RR], 1.04; 95% CI, 0.97-1.11; P = .31; I2 = 73%), unless 1 outlier trial accounting for all heterogeneity was excluded (RR, 1.09; 95% CI, 1.06-1.12; P < .001; I2 = 0% [13 trials; n = 3939]; moderate-quality evidence), but were significantly more likely to be successfully extubated (RR, 1.07; 95% CI, 1.04-1.10; P < .001; I2 = 0%; 16 trials [n = 4462]; moderate-quality evidence). Limited data (5 trials [n = 502]) revealed that patients who underwent automatic tube compensation/continuous positive airway pressure compared with PS SBTs had a significantly higher successful extubation rate (RR, 1.10; 95% CI, 1.00-1.21; P = .04; I2 = 0% [low-quality evidence]). Compared with T-piece SBTs, high-flow oxygen SBTs (3 trials [n = 386]) had significantly higher successful extubation (RR, 1.06; 95% CI, 1.00-1.11; P = .04; I2 = 0%) and lower reintubation (RR, 0.37; 95% CI, 0.21-0.65; P = <.001; I2 = 0% [both low-quality evidence]) rates. Credible subgroup effects were not found.
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, the findings suggest that patients undergoing PS compared with T-piece SBTs were more likely to be extubated successfully and more likely to pass an SBT, after exclusion of an outlier trial. Pressure support SBTs were not associated with increased risk of reintubation. Future trials should compare SBT techniques that maximize differences in inspiratory support.
Topics: Adult; Child; Humans; Critical Illness; Ventilator Weaning; Oxygen; Continuous Positive Airway Pressure; Intubation, Intratracheal
PubMed: 38393729
DOI: 10.1001/jamanetworkopen.2023.56794 -
Frontiers in Oncology 2023The study's purpose was to evaluate the correlation between overall survival (OS) and its potential surrogate endpoints: pathologic complete response (pCR) and...
PURPOSE
The study's purpose was to evaluate the correlation between overall survival (OS) and its potential surrogate endpoints: pathologic complete response (pCR) and event-free survival (EFS)/disease-free survival (DFS) in neoadjuvant and/or adjuvant HR+/HER2- breast cancer.
METHODS
Systematic search was performed in MEDLINE, EMBASE, Cochrane Library databases and other relevant sources to identify literature that have reported outcomes of interest in the target setting. The strength of correlation of EFS/DFS with OS, pCR with OS, and pCR with EFS/DFS was measured using Pearson's correlation coefficient (r) based on weighted regression analysis. For Surrogate Endpoint-True Endpoint pairs where correlation was found to be moderate, surrogate threshold effect (STE) was estimated using a mixed-effects model. Sensitivity analyses were conducted on the scale and weights used and removing outlier data.
RESULTS
Moderate correlation was observed of relative measures [log(HR)] of EFS/DFS and OS (r = 0.91; 95% CI: 0.83, 0.96, < 0.0001). STE for HR was estimated to be 0.73. Association between EFS/DFS at 1, 2 and 3 years with OS at 4- and 5-year landmarks was moderate. Relative treatment effects of pCR and EFS/DFS were not strongly associated (r: 0.24; 95% CI: -0.63, 0.84, = 0.6028). Correlation between pCR and OS was either not evaluated due to inadequate sample size (relative outcomes) or weak (absolute outcomes). Results obtained in the sensitivity analyses were similar to base scenario.
CONCLUSION
EFS/DFS were moderately correlated with OS in this trial-level analysis. They may be considered as valid surrogates for OS in HR+/HER2- breast cancer.
PubMed: 37205193
DOI: 10.3389/fonc.2023.1119102 -
Heliyon Jan 2024This review aimed to harmoniously summarize and compare outlier rates for various cardiac troponin (cTn) assays, including high-sensitivity-cTn (hs-cTn) assays and... (Review)
Review
OBJECTIVES
This review aimed to harmoniously summarize and compare outlier rates for various cardiac troponin (cTn) assays, including high-sensitivity-cTn (hs-cTn) assays and contemporary cTn (generation of assays prior to hs-cTn ones) assays, from the published studies.
METHODS
The PRISMA guidelines were utilized to perform this systematic review. Five databases, including PubMed, Scopus, Embase, Cochrane Library, and Web of Science, were searched using specific keywords up to June 30th, 2023. Studies reporting specifically calculated outlier rates for cTn assays when conducting in-vitro diagnosis in human samples were included. Selected studies were then further assessed using the GRADE tool.
RESULTS
Thirteen studies were included. The data from the studies were summarized statistically in this review. The results showed substantial evidence of improved analytical robustness or reduced respective mean rates of outliers, critical outliers, and analytical outliers for hs-cTn assays (0.14 %, 0.18 %, and 0.18 %) compared to contemporary cTn assays (0.63 %, 0.71 %, and 0.50 %).
CONCLUSION
The findings offer promisingly provide a comprehensive reference for laboratory scientists and clinical staff in choosing the most suitable cTn assay for patient care regrading outlier rates. Besides, this review reveals the advancements of hs-cTn assays with lower outlier rates than contemporary cTn assays. The emerging challenges for continuously improving analytical robustness of cTn assays are also elaborated.
PubMed: 38205298
DOI: 10.1016/j.heliyon.2023.e23788 -
Frontiers in Psychiatry 2023People who have been infected by COVID-19 showing persistent symptoms after 4 weeks from recovery are thought to suffer from Long-COVID syndrome (LC). There is...
OBJECTIVE
People who have been infected by COVID-19 showing persistent symptoms after 4 weeks from recovery are thought to suffer from Long-COVID syndrome (LC). There is uncertainty on the clinical manifestations of LC. We undertook a systematic review to summarize the available evidence about the main psychiatric manifestations of LC.
METHOD
PubMed (Medline), Scopus, CINHAL, PsycINFO, and EMBASE were searched until May 2022. Studies reporting estimation of emerging psychiatric symptoms and/or psychiatric diagnoses among adult people with LC were included. Pooled prevalence for each psychiatric condition was calculated in absence of control groups to compare with.
RESULTS
Thirty-three reports were included in the final selection, corresponding to 282,711 participants with LC. After 4 weeks from COVID-19 infection recovery, participants reported the following psychiatric symptoms: depression, anxiety, post-traumatic symptoms (PTS), cognitive and sleeping disturbances (i.e., insomnia or hypersomnia). The most common psychiatric manifestation resulted to be sleep disturbances, followed by depression, PTS, anxiety, and cognitive impairment (i.e., attention and memory deficits). However, some estimates were affected by important outlier effect played by one study. If study weight was not considered, the most reported condition was anxiety.
CONCLUSIONS
LC may have non-specific psychiatric manifestations. More research is needed to better define LC and to differentiate it from other post-infectious or post-hospitalization syndromes.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (CRD42022299408).
PubMed: 37415689
DOI: 10.3389/fpsyt.2023.1138389 -
Annals of Internal Medicine Sep 2015Use of epidural corticosteroid injections is increasing. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Use of epidural corticosteroid injections is increasing.
PURPOSE
To review evidence on the benefits and harms of epidural corticosteroid injections in adults with radicular low back pain or spinal stenosis of any duration.
DATA SOURCES
Ovid MEDLINE (through May 2015), Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, prior systematic reviews, and reference lists.
STUDY SELECTION
Randomized trials of epidural corticosteroid injections versus placebo interventions, or that compared epidural injection techniques, corticosteroids, or doses.
DATA EXTRACTION
Dual extraction and quality assessment of individual studies, which were used to determine the overall strength of evidence (SOE).
DATA SYNTHESIS
30 placebo-controlled trials evaluated epidural corticosteroid injections for radiculopathy, and 8 trials were done for spinal stenosis. For radiculopathy, epidural corticosteroids were associated with greater immediate-term reduction in pain (weighted mean difference on a scale of 0 to 100, -7.55 [95% CI, -11.4 to -3.74]; SOE, moderate), function (standardized mean difference after exclusion of an outlier trial, -0.33 [CI, -0.56 to -0.09]; SOE, low), and short-term surgery risk (relative risk, 0.62 [CI, 0.41 to 0.92]; SOE, low). Effects were below predefined minimum clinically important difference thresholds, and there were no longer-term benefits. Limited evidence showed no clear effects of technical factors, patient characteristics, or comparator interventions on estimates. There were no clear effects of epidural corticosteroid injections for spinal stenosis (SOE, low to moderate). Serious harms were rare, but harms reporting was suboptimal (SOE, low).
LIMITATIONS
The review was restricted to English-language studies. Some meta-analyses were based on small numbers of trials (particularly for spinal stenosis), and most trials had methodological shortcomings.
CONCLUSION
Epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function. However, benefits were small and not sustained, and there was no effect on long-term surgery risk. Limited evidence suggested no effectiveness for spinal stenosis.
Topics: Adrenal Cortex Hormones; Humans; Injections, Epidural; Low Back Pain; Radiculopathy; Spinal Stenosis
PubMed: 26302454
DOI: 10.7326/M15-0934 -
The Journal of Sexual Medicine Apr 2016A systematic review and meta-analysis was conducted to evaluate how various definitions of transgender affect prevalence estimates. (Review)
Review
INTRODUCTION
A systematic review and meta-analysis was conducted to evaluate how various definitions of transgender affect prevalence estimates.
AIMS
To evaluate the epidemiology of transgender and examine how various definitions of transgender affect prevalence estimates and to compare findings across studies that used different methodologies, in different countries, and over different periods.
METHODS
PubMed, EMBASE, and Medline were searched to identify studies reporting prevalence estimates of transgender in a population. All studies were grouped based on the case definition applied to the numerator. Summary estimates were derived using a random-effects model for total prevalence of transgender and for male-to-female and female-to-male subgroups. Overall and stratum-specific meta-prevalence estimates (mPs) and 95% confidence intervals (CIs) were accompanied by tests for heterogeneity and meta-regressions to assess sources of heterogeneity.
MAIN OUTCOME MEASURES
The main outcome measure was population prevalence of transgender. Secondary outcomes included gender-specific prevalence estimates for male-to-female and female to male subgroups.
RESULTS
Thirty-two studies met the inclusion criteria for systematic review. Of those, 27 studies provided necessary data for a meta-analysis. Overall mP estimates per 100,000 population were 9.2 (95% CI = 4.9-13.6) for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6-9.1) for transgender-related diagnoses. Of studies assessing self-reported transgender identity, the mP was 871 (95% CI = 519-1,224); however, this result was influenced by a single outlier study. After removal of that study, the mP changed to 355 (95% CI = 144-566). Significant heterogeneity was observed in most analyses.
CONCLUSION
The empirical literature on the prevalence of transgender highlights the importance of adhering to specific case definitions because the results can range by orders of magnitude. Standardized and routine collection of data on transgender status and gender identity is recommended.
Topics: Adult; Concept Formation; Female; Humans; Male; Outcome Assessment, Health Care; Prevalence; Terminology as Topic; Transgender Persons; Transsexualism
PubMed: 27045261
DOI: 10.1016/j.jsxm.2016.02.001 -
Brain, Behavior, and Immunity Mar 2021Chronic inflammation contributes to multiple diseases including cardiovascular diseases, autoimmune disorders, metabolic disorders, and psychiatric conditions.... (Meta-Analysis)
Meta-Analysis
Chronic inflammation contributes to multiple diseases including cardiovascular diseases, autoimmune disorders, metabolic disorders, and psychiatric conditions. Melatonin, a hormone responsible for circadian rhythm, plays a complex role within the immune system, including having an anti-inflammatory effect. While there are numerous animal studies demonstrating this effect, few human clinical trials have been conducted. This systematic review of clinical trials examined whether exogenous melatonin reduces levels of inflammatory markers in humans. We searched PubMed, Embase, Cochrane Library, Scopus, and PsycINFO, and the references of the identified articles for randomized and non-randomized placebo-controlled trials. Data were extracted from the articles and meta-analyses were conducted using a random effects model to calculate standardized mean differences (SMDs, i.e., Cohen's d). From an initial search result of 4548 references, 31 studies met the inclusion criteria and were included involving 1517 participants. Melatonin had significant anti-inflammatory effects on interleukin (IL)-1 (SMD -1.64; 95% confidence interval [CI] -2.86, -0.43; p = 0.008), IL-6 (-3.84; -5.23, -2.46; p < 0.001), IL-8 (-21.06; -27.27, -14.85; p < 0.001), and tumor necrosis factor (TNF) (-1.54; -2.49, -0.58; p = 0.002), but not on C-reactive protein (CRP) (-0.18; -0.91, 0.55; p = 0.62). Trimming outlier studies with large effect sizes eliminated publication bias, and summary effect sizes were significant for IL-1 (SMD -1.11; 95% CI -1.90, -0.32; p = 0.006), IL-6 (-1.91; -2.98, -0.83; p = 0.001), and IL-8 (-13.46; -18.88, -8.04; p < 0.001), but not for TNF (-0.45; -1.13, 0.23; p = 0.19). Exogenous melatonin reduced levels of inflammatory markers and may be useful for prevention and adjuvant treatment of inflammatory disorders. Melatonin is safe with few side effects, which makes it an excellent agent for prevention of inflammatory disorders. Because chronic inflammation increases with aging and inflammation plays a role in the etiology of numerous diseases that affect older populations, melatonin has the potential to be widely used particularly in older adults.
Topics: Aged; Animals; Anti-Inflammatory Agents; C-Reactive Protein; Dietary Supplements; Humans; Inflammation; Melatonin
PubMed: 33581247
DOI: 10.1016/j.bbi.2021.01.034 -
Archives of Medical Science : AMS 2022Omega-6 polyunsaturated fatty acids (PUFAs) represent almost 15% of the total energy intake in Western countries. Their effects on the cardiovascular (CV) risk factors...
Omega-6 fatty acids and the risk of cardiovascular disease: insights from a systematic review and meta-analysis of randomized controlled trials and a Mendelian randomization study.
INTRODUCTION
Omega-6 polyunsaturated fatty acids (PUFAs) represent almost 15% of the total energy intake in Western countries. Their effects on the cardiovascular (CV) risk factors are still controversial. Thus, we performed a systematic review and meta-analysis of randomized control trials (RCTs) as well as a Mendelian randomization (MR) analysis to evaluate the links and possible causality between supplementation or serum levels of omega-6 PUFA, CV disease (CVD) and cardiometabolic risk factors.
MATERIAL AND METHODS
Selected databases were searched until September 2019 to identify prospective studies investigating the effects of omega-6 PUFA supplementation on CVD events/mortality. Random-effects model meta-analysis was performed for quantitative data synthesis. Trial sequential analysis (TSA) was used to evaluate the optimal sample size to detect a 20% reduction in outcomes after administration of omega-6 PUFAs. The inverse variance weighted (IVW) method, weighted median-based method, MR-Egger and MR-Pleiotropy RESidual Sum and Outlier (PRESSO) were applied for MR.
RESULTS
The pooled estimate risk ratio (RR) of omega-6 PUFA supplementation was 0.94 for any CVD event (95% CI: 0.77-1.15, = 66.2%), 1.06 for CVD death (95% CI: 0.73-1.55, = 66.2%), 0.84 for coronary heart disease (CHD) events (95% CI: 0.61-1.16, = 79.4%), 0.87 for myocardial infarction (MI) (95% CI: 0.74-1.01, = 2.3%) and 1.36 for stroke (95% CI: 0.45-4.07, = 55.3%). In contrast, MR showed that individuals with higher serum omega-6 acid - adrenic acid (AA) levels had a greater risk for CHD events (IVW β = 0.526), MI (IVW β = 0.606) and large artery stroke (IVW β = 1.694), as well as increased levels of fasting blood glucose (FBG) (IVW β = 0.417), low-density lipoprotein cholesterol (LDL-C) (IVW β = 0.806), high-density lipoprotein cholesterol (HDL-C) (IVW β = 0.820), and lower levels of triglycerides (TG) (IVW β = -1.064) and total cholesterol (TC) (IVW β = -1.064).
CONCLUSIONS
Omega-6 PUFA supplementation did not affect the risk for CVD morbidity and mortality. Additionally, based on MR analysis we found that higher AA levels might even significantly increase the risk of CHD, MI and large artery stroke, as well as the levels of FBG and LDL-C, whereas they were negatively associated with TC and TG. Since a considerable chance of heterogeneity was observed for some of the results, further research is needed to elucidate the effects of omega-6 PUFAs on cardiometabolic outcomes.
PubMed: 35316920
DOI: 10.5114/aoms/136070 -
Journal of the American Heart... Oct 2017The recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The recent finding that aortic pulse wave velocity (aPWV) is increased in patients with inflammatory bowel disease may explain why the cardiovascular risk is increased despite the low prevalence of traditional cardiovascular risk factors. We aimed to test whether inflammation is associated with aortic stiffening in this setting after adjustment for major confounders and to perform subgroup analyses.
METHODS AND RESULTS
A systematic literature search for aPWV in inflammatory bowel disease was performed using PubMed, Scopus, Web of Science, and Google Scholar databases (last accessed May 7, 2017). Inclusion criterion was peer-reviewed publications on clinical studies reporting original data. This study followed the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data 2015 guidelines. Data were provided for 4 cohorts in 3 countries (151 participants with ulcerative colitis, 159 with Crohn's disease, and 227 control patients). Using aPWV, cohort-specific scores were calculated after log-transform and combined in meta-analysis to form pooled effects using a random-effects model. Compared with controls, aPWV was increased in patients with Crohn's disease (mean difference 0.78 score; 95% confidence interval, 0.56-1.00 score [<0.001]) and ulcerative colitis (mean difference 0.75 score; 95% confidence interval, 0.52-0.97 score [<0.001]). In an outlier-robust multivariate linear regression model adjusted for prespecified confounders, aPWV was associated with disease duration (years, β=0.05 score; 95% confidence interval, 0.02-0.08 score [<0.001]) and white blood cell count (billion cells/L, β=0.07 score; 95% confidence interval, 0.02-0.11 score [=0.002]) but not with markers of acute inflammation (C-reactive protein and erythrocyte sedimentation rate), cardiovascular risk factors, and therapy.
CONCLUSIONS
The increased aPWV reported in patients with inflammatory bowel disease is associated with inflammation.
CLINICAL TRIAL REGISTRATION
URL: http://www.crd.york.ac.uk. Unique identifier: PROSPERO 2016: CRD42016053070.
Topics: Biomarkers; Blood Sedimentation; C-Reactive Protein; Cardiovascular Diseases; Colitis, Ulcerative; Crohn Disease; Humans; Inflammation; Inflammation Mediators; Leukocyte Count; Linear Models; Multivariate Analysis; Prognosis; Pulse Wave Analysis; Risk Factors; Vascular Stiffness
PubMed: 29018026
DOI: 10.1161/JAHA.117.007003