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The Cochrane Database of Systematic... Oct 2015It has been reported that ozone therapy might be helpful in treating foot ulcers in people with diabetes mellitus (DM). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
It has been reported that ozone therapy might be helpful in treating foot ulcers in people with diabetes mellitus (DM).
OBJECTIVES
To assess the effects of ozone therapy on the healing of foot ulcers in people with DM.
SEARCH METHODS
In March 2015 we searched: The Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid EMBASE, EBSCO CINAHL, Science Citation Index, Chinese Biomedical Literature Database and The Chinese Clinical Registry. There were no restrictions based on language, date or study setting.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that compared ozone therapy with sham ozone therapy or any other interventions for foot ulcers in people with DM, irrespective of publication date or language.
DATA COLLECTION AND ANALYSIS
Two reviewers independently screened all retrieved citations, selected relevant citations and extracted data. Disagreements were resolved by discussion with a third reviewer. The methodological quality of included studies and the evidence level of outcomes were assessed using the Cochrane risk of bias tool and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach respectively. Data were expressed using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with their 95% confidence interval (95% CI). Review Manager (RevMan) software was used to analyse the data.
MAIN RESULTS
Three studies (212 participants) were included in this review. The overall risk of bias was high for two trials and unclear for one.One trial (101 participants) compared ozone treatment with antibiotics for foot ulcers in people with DM. The study had a follow-up period of 20 days. This study showed that ozone treatment was associated with a greater reduction in ulcer area from baseline to the end of the study than treatment with antibiotics (MD -20.54 cm(2), 95% CI -20.61 to -20.47), and a shorter duration of hospitalisation (MD -8.00 days, 95% CI -14.17 to -1.83), but did not appear to affect the number of ulcers healed over 20 days (RR 1.10, 95% CI 0.87 to 1.40). No side effects were observed in either group.The other two trials (111 participants) compared ozone treatment plus usual care with usual care for foot ulcers in people with DM. The meta-analysis results did not show evidence of a difference between groups for the outcomes of reduction of ulcer area (MD -2.11 cm(2), 95% CI -5.29 to 1.07), the number of ulcers healed (RR 1.69, 95% CI 0.90 to 3.17), adverse events (RR 2.27, 95% CI 0.48 to 10.79), or amputation rate (RR 2.73, 95%CI 0.12, 64.42).
AUTHORS' CONCLUSIONS
The available evidence was three small RCTs with unclear methodology, so we are unable to draw any firm conclusions regarding the effectiveness of ozone therapy for foot ulcers in people with DM.
Topics: Adult; Anti-Bacterial Agents; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; Humans; Ozone; Randomized Controlled Trials as Topic
PubMed: 26505864
DOI: 10.1002/14651858.CD008474.pub2 -
International Heart Journal Mar 2021Atrial fibrillation (AF) is the most common cardiac arrhythmia; it has been known to increase the risk of stroke and heart failure. The association between air... (Meta-Analysis)
Meta-Analysis
Atrial fibrillation (AF) is the most common cardiac arrhythmia; it has been known to increase the risk of stroke and heart failure. The association between air pollutants and AF has remained to be controversial. Thus, in this study, we sought to undertake a systematic review and meta-analysis in order to assess the short- and long-term effects of ambient air pollution on AF.We searched PubMed, Web of Science, Embase, and Ovid for all related studies up to October 2019. We used the random-effects model to estimate the excess risk percentage (ER%) and confidence intervals (CI) for particulate matter with diameter ≤ 2.5 (PM) and ≤ 10 μm (PM), sulfur dioxide (SO), nitrogen dioxide (NO), ozone (O), and carbon monoxide (CO). Results were further analyzed by subgroups according to location, age, outcome, and gender.In total, 18 studies were included in our meta-analysis: 5 evaluated for long-term effects, 12 for short-term effects, and 1 for both long- and short-term effects. For the short term, ER per 10 μg/m increase of pollutants was 1.8% (0%-3.7%) for PM and 1.1% (-0.2%-2.4%) for PM; per 10 parts per billion (ppb) increment of gaseous pollutions was 3.2% (0.6%-5.8%) for NO, 2.9% (0.3%-5.7%) for SO, 0.5% (-3.4%-4.7%) for O, and 2.0% (-1.3%-5.4%) for CO per 1000 ppb change. The subgroup analysis showed the short-term effect was significantly different by region, gender, outcome, and age. Meanwhile, in the long term, except for O, a statistically significant association was noted between AF incidence and all pollutants.Our meta-analysis suggests that short-term exposure to part of pollutants (PM, SO, and NO) increases AF attack. Further, long-term exposure to air pollution can significantly contribute to the incidence of AF in a healthy population.
Topics: Air Pollutants; Air Pollution; Atrial Fibrillation; Global Health; Humans; Incidence
PubMed: 33678796
DOI: 10.1536/ihj.20-523 -
Environmental Research Dec 2022Air pollution is speculated to increase the risks of COVID-19 spread, severity, and mortality. (Review)
Review
BACKGROUND
Air pollution is speculated to increase the risks of COVID-19 spread, severity, and mortality.
OBJECTIVES
We systematically reviewed studies investigating the relationship between air pollution and COVID-19 cases, non-fatal severity, and mortality in North America and Europe.
METHODS
We searched PubMed, Web of Science, and Scopus for studies investigating the effects of harmful pollutants, including particulate matter with diameter ≤2.5 or 10 μm (PM or PM), ozone (O), nitrogen dioxide (NO), sulfur dioxide (SO) and carbon monoxide (CO), on COVID-19 cases, severity, and deaths in Europe and North America through to June 19, 2021. Articles were included if they quantitatively measured the relationship between exposure to air pollution and COVID-19 health outcomes.
RESULTS
From 2,482 articles screened, we included 116 studies reporting 355 separate pollutant-COVID-19 estimates. Approximately half of all evaluations on incidence were positive and significant associations (52.7%); for mortality the corresponding figure was similar (48.1%), while for non-fatal severity this figure was lower (41.2%). Longer-term exposure to pollutants appeared more likely to be positively associated with COVID-19 incidence (63.8%). PM, PM, O, NO, and CO were most strongly positively associated with COVID-19 incidence, while PM and NO with COVID-19 deaths. All studies were observational and most exhibited high risk of confounding and outcome measurement bias.
DISCUSSION
Air pollution may be associated with worse COVID-19 outcomes. Future research is needed to better test the air pollution-COVID-19 hypothesis, particularly using more robust study designs and COVID-19 measures that are less prone to measurement error and by considering co-pollutant interactions.
Topics: Air Pollutants; Air Pollution; COVID-19; Carbon Monoxide; Environmental Exposure; Humans; Incidence; Nitrogen Dioxide; Ozone; Particulate Matter; Sulfur Dioxide
PubMed: 36030916
DOI: 10.1016/j.envres.2022.114155 -
BMC Oral Health Apr 2015Untreated dentin caries in primary teeth is commonly found in preschool children worldwide. Recently, the use of simple non-surgical approaches to manage the situation... (Review)
Review
BACKGROUND
Untreated dentin caries in primary teeth is commonly found in preschool children worldwide. Recently, the use of simple non-surgical approaches to manage the situation has been advocated. The aim of the study was to systematically review and evaluate the literature on effectiveness of non-surgical methods in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children.
METHODS
A systematic search of the main electronic databases (Pubmed, Cochrane Collaboration, EMBASE) was conducted to identify peer reviewed papers published in English in the years 1947-2014. Keywords and MeSH terms used in the search were "dental caries", "primary dentition" and various non-surgical treatments (fluoride, sealant, resin infiltration, xylitol, chlorhexidine, CPP-ACP, ozone, etc.). The inclusion criteria were clinical studies conducted in children under 6 years old, and reported findings on caries arrest or caries progression in primary teeth. Retrieved papers were read by two reviewers independently to assess suitability for inclusion, and the final decision was made by consensus. Quality of the included studies was assessed and data were extracted for analysis.
RESULTS
The search identified 323 papers for screening. Among these, 290 papers did not satisfy the study inclusion criteria. Consequently, 33 full papers were retrieved and reviewed. Finally, 4 studies were included. Three studies reported that topical applications of silver diammine fluoride (SDF) solution could arrest dentin caries in preschool children. One study supported that having a daily toothbrushing exercise in kindergarten using toothpaste with 1000 ppm fluoride could stabilize the caries situation in young children.
CONCLUSIONS
There is limited evidence to support the effectiveness of SDF applications or daily toothbrushing with fluoride toothpaste in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. More well-designed randomized controlled trials are required to confirm these findings.
Topics: Anti-Infective Agents, Local; Cariostatic Agents; Child, Preschool; Dental Caries; Dentin; Humans; Pit and Fissure Sealants; Tooth Remineralization; Tooth, Deciduous
PubMed: 25888484
DOI: 10.1186/s12903-015-0033-7 -
International Journal of Environmental... Sep 2022At present, ambient air pollution poses a significant threat to patients with cardiovascular disease (CVD). The heart rate variability (HRV) is a marker of the cardiac... (Meta-Analysis)
Meta-Analysis
At present, ambient air pollution poses a significant threat to patients with cardiovascular disease (CVD). The heart rate variability (HRV) is a marker of the cardiac autonomic nervous system, and it is related to air pollution and cardiovascular disease. There is, however, considerable disagreement in the literature regarding the association between ozone (O) and HRV. To further investigate the effects of short-term exposure to O on HRV, we conducted the first meta-analysis of relevant studies. The percentage change of HRV indicator(s) is the effect estimate extracted for the quantitative analysis in this study. In our meta-analysis, per 10 ppb increase in O was significantly associated with decreases in the time-domain measurements, for standard deviation of the normal-to-normal (NN) interval (SDNN) -1.11% (95%CI: -1.35%, -0.87%) and for root mean square of successive differences (RMSSD) -3.26% (95%CI: -5.42%, -1.09%); in the frequency-domain measurements, for high frequency (HF) -3.01% (95%CI: -4.66%, -1.35%) and for low frequency (LF) -2.14% (95%CI: -3.83%, -0.45%). This study showed short-term exposure to O was associated with reduced HRV indicators in adults, which suggested that the cardiac autonomic nervous system might be affected after O exposure, contributing to the association between O exposure and CVD risk.
Topics: Adult; Air Pollutants; Air Pollution; Cardiovascular Diseases; Heart Rate; Humans; Ozone
PubMed: 36141453
DOI: 10.3390/ijerph191811186 -
Environmental Research Jan 2023Volatile organic compound (VOC) emissions have attracted wide attention due to their impacts on atmospheric quality and public health. However, most studies reviewed... (Review)
Review
Volatile organic compound (VOC) emissions have attracted wide attention due to their impacts on atmospheric quality and public health. However, most studies reviewed certain aspects of natural VOCs (NVOCs) or anthropogenic VOCs (AVOCs) rather than comprehensively quantifying the hotspots and evolution trends of AVOCs and NVOCs. We combined the bibliometric method with the evolution tree and Markov chain to identify research focus and uncover the trends in VOC emission sources. This study found that research mainly focused on VOC emission characteristics, effects on air quality and health, and VOC emissions under climate change. More studies concerned on AVOCs than on NVOCs, and AVOC emissions have shifted with a decreasing proportion of transport emissions and an increasing share of solvent utilization in countries with high emissions and publications (China and the USA). Research on AVOCs is imperative to develop efficient and economical abatement techniques specific to solvent sources or BTEX species to mitigate the detrimental effects. Research on NVOCs originating from human sources risen due to their application in medicine, while studies on sources sensitive to climate change grew slowly, including plants, biomass burning, microbes, soil and oceans. Research on the long-term responses of NVOCs derived from various sources to climate warming is warranted to explore the evolution of emissions and the feedback on global climate. It is worthwhile to establish an emission inventory with all kinds of sources, accurate estimation, high spatial and temporal resolution to capture the emission trends in the synergy of industrialization and climate change as well as to simulate the effects on air quality. We review VOC emissions from both anthropogenic and natural sources under climate change and their effects on atmospheric quality and health to point out the research directions for the comprehensive control of global VOCs and mitigation of O pollution.
Topics: Humans; Volatile Organic Compounds; Air Pollutants; Ozone; Air Pollution; Solvents; China; Environmental Monitoring
PubMed: 36162470
DOI: 10.1016/j.envres.2022.114386 -
International Journal of Molecular... Oct 2021In the last sixty years, publications in reputed journals have shown the preclinical positive effect of ozone gas in cancer cells. However, the translation of these...
In the last sixty years, publications in reputed journals have shown the preclinical positive effect of ozone gas in cancer cells. However, the translation of these results into clinical practice is far away from success. A comprehensive approach is necessary for this, and oncologists and researchers need guidance from medical specialists with in-depth knowledge of ozone in medicine. In this article, we review the evidence around this question and suggest different potential research lines to those interested in this exciting field.
Topics: Humans; Ozone
PubMed: 34769225
DOI: 10.3390/ijms222111796 -
Environment International Nov 2020WHO has published several volumes of Global Air Quality Guidelines to provide guidance on the health risks associated with exposure to outdoor air pollution. As new... (Meta-Analysis)
Meta-Analysis
BACKGROUND
WHO has published several volumes of Global Air Quality Guidelines to provide guidance on the health risks associated with exposure to outdoor air pollution. As new scientific evidence is generated, air quality guidelines need to be periodically revised and, where necessary, updated.
OBJECTIVES
The aims of the study were 1) to summarise the available evidence on the effect of long-term exposure to ozone (O) and nitrogen dioxide (NO) on mortality; 2) and to assess concentration response functions (CRF), their shape and the minimum level of exposures measured in studies to support WHO's update of the global air quality guidelines.
DATA SOURCES
We conducted a systematic literature search of the Medline, Embase and Web of Science databases following a protocol proposed by WHO and applied Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines for reporting our results.
STUDY ELIGIBILITY CRITERIA
Cohort studies in human populations (including sub-groups at risk) exposed to long-term concentrations of NO and O. Outcomes assessed were all-cause, respiratory, Chronic Obstructive Pulmonary Disease (COPD) and Acute Lower Respiratory Infection (ALRI) mortality.
STUDY APPRAISAL AND SYNTHESIS METHODS
Studies included in the meta-analyses were assessed using a new Risk of Bias instrument developed by a group of experts convened by WHO. Study results are presented in forest plots and quantitative meta-analyses were conducted using random effects models. The certainty of evidence was assessed using a newly developed adaptation of GRADE.
RESULTS
The review identified 2068 studies of which 95 were subject to full-text review with 45 meeting the inclusion criteria. An update in September 2018 identified 159 studies with 1 meeting the inclusion criteria. Of the 46 included studies, 41 reported results for NO and 20 for O. The majority of studies were from the USA and Europe with the remainder from Canada, China and Japan. Forty-two studies reported results for all-cause mortality and 22 for respiratory mortality. Associations for NO and mortality were positive; random-effects summary relative risks (RR) were 1.02 (95% CI: 1.01, 1.04), 1.03 (1.00, 1.05), 1.03 (1.01, 1.04) and 1.06 (1.02, 1.10) per 10 μg/m for all-cause (24 cohorts), respiratory (15 cohorts), COPD (9 cohorts) and ALRI (5 cohorts) mortality respectively. The review identified high levels of heterogeneity for all causes of death except COPD. A small number of studies investigated the shape of the concentration-response relationship and generally found little evidence to reject the assumption of linearity across the concentration range. Studies of O using annual metrics showed the associations with all-cause and respiratory mortality were 0.97 (0.93, 1.02) and 0.99 (0.89, 1.11) per 10 μg/m respectively. For studies using peak O metrics, the association with all-cause mortality was 1.01 (1.00, 1.02) and for respiratory mortality 1.02 (0.99, 1.05), each per 10 μg/m. The review identified high levels of heterogeneity. Few studies investigated the shape of the concentration-response relationship. Certainty in the associations (adapted GRADE) with mortality was rated low to moderate for each exposure-outcome pair, except for NO and COPD mortality which was rated high.
LIMITATIONS
The substantial heterogeneity for most outcomes in the review requires explanation. The evidence base is limited in terms of the geographical spread of the study populations and, for some outcomes, the small number of independent cohorts for meta-analysis precludes meaningful meta-regression to explore causes of heterogeneity. Relatively few studies assessed specifically the shape of the CRF or multi-pollutant models.
CONCLUSIONS
The short-comings in the existing literature base makes determining the precise nature (magnitude and linearity) of the associations challenging. Certainty of evidence assessments were moderate or low for both NO and O for all causes of mortality except for NO and COPD mortality where the certainty of the evidence was judged as high.
Topics: Air Pollutants; Air Pollution; Canada; China; Europe; Humans; Japan; Nitrogen Dioxide
PubMed: 33032072
DOI: 10.1016/j.envint.2020.105998 -
Environmental Pollution (Barking, Essex... Jan 2020The number of children diagnosed with autism spectrum disorder (ASD) has been increasing. Previous studies suggested potential association between pregnancy air... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The number of children diagnosed with autism spectrum disorder (ASD) has been increasing. Previous studies suggested potential association between pregnancy air pollution exposure and ASD. This systematic review and meta-analysis is intended to summarize the association between maternal exposure to outdoor air pollution and ASD in children by trimester based on recent studies.
METHODS
A systematic literature search in 3 databases (Medline, Embase, and Web of Science) was performed using subject headings related to ASD and air pollution since 2007. Eligible studies were screened and evaluated based on predetermined criteria. For meta-analyses, the studies were grouped by air pollutant and exposure time (prenatal period and trimesters). Within-group studies were standardized by log odds ratio (OR) and then combined by three meta-analysis methods: frequentist fixed and random effects models, and Bayesian random effects model.
RESULTS
Initial search identified 1564 papers, of which 25 studies remained for final analysis after duplicates and ineligible studies were removed. Of the 25 studies, 13, 14, 12, and 7 studies investigated ASD in children associated with PM, PM, NO, and ozone, respectively. The frequentist and Bayesian random effects models resulted in different statistical significance. For prenatal period, frequentist meta-analysis returned significant pooled ORs with 95% confidence intervals, 1.06(1.01,1.11) for PM and 1.02(1.01,1.04) for NO, whereas Bayesian meta-analysis showed similar ORs with wider 95% posterior intervals, 1.06(1.00,1.13) for PM and 1.02(1.00,1.05) for NO. Third trimester appeared to have higher pooled ORs for PM, PM, and ozone, but patterns in the time-varying associations over the trimester were inconsistent.
CONCLUSIONS
For positive association between maternal exposure to ambient air pollution and ASD in children, there is some evidence for PM, weak evidence for NO and little evidence for PM and ozone. However, patterns in associations over trimesters were inconsistent among studies and among air pollutants.
Topics: Air Pollutants; Air Pollution; Autism Spectrum Disorder; Bayes Theorem; Child; Female; Humans; Maternal Exposure; Odds Ratio; Ozone; Particulate Matter; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 31733973
DOI: 10.1016/j.envpol.2019.113307 -
International Journal of Environmental... Oct 2022There are several techniques for the removal of pharmaceuticals (drugs) from wastewater; however, strengths and weaknesses have been observed in their elimination... (Review)
Review
There are several techniques for the removal of pharmaceuticals (drugs) from wastewater; however, strengths and weaknesses have been observed in their elimination processes that limit their applicability. Therefore, we aimed to evaluate the best techniques for the removal of pharmaceuticals from municipal and hospital wastewater. For this, a non-experimental, descriptive, qualitative-quantitative design was used, corresponding to a systematic review without meta-analysis. Based on established inclusion and exclusion criteria, 31 open-access articles were selected from the Scopus, ProQuest, EBSCOhost, and ScienceDirect databases. The results showed that high concentrations of analgesics such as naproxen (1.37 mg/L) and antibiotics such as norfloxacin (0.561 mg/L) are frequently found in wastewater and that techniques such as reverse osmosis, ozonation, and activated sludge have the best removal efficiency, achieving values of 99%. It was concluded that reverse osmosis is one of the most efficient techniques for eliminating ofloxacin, sulfamethoxazole, carbamazepine, and diclofenac from municipal wastewater, with removal rates ranging from 96 to 99.9%, while for hospital wastewater the activated sludge technique proved to be efficient, eliminating analgesics and antibiotics in the range of 41-99%.
Topics: Wastewater; Sewage; Diclofenac; Naproxen; Norfloxacin; Water Pollutants, Chemical; Carbamazepine; Hospitals; Ozone; Sulfamethoxazole; Anti-Bacterial Agents; Ofloxacin; Pharmaceutical Preparations; Waste Disposal, Fluid
PubMed: 36293682
DOI: 10.3390/ijerph192013105