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The Cochrane Database of Systematic... Jan 2017Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the... (Review)
Review
BACKGROUND
Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the risk of vertebral fragility fractures. Good practice in the care of those with DMD requires prevention of these adverse effects. Treatments to increase bone mineral density include bisphosphonates and vitamin D and calcium supplements, and in adolescents with pubertal delay, testosterone. Bone health management is an important part of lifelong care for patients with DMD.
OBJECTIVES
To assess the effects of interventions to prevent or treat osteoporosis in children and adults with DMD taking long-term corticosteroids; to assess the effects of these interventions on the frequency of vertebral fragility fractures and long-bone fractures, and on quality of life; and to assess adverse events.
SEARCH METHODS
On 12 September 2016, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL Plus to identify potentially eligible trials. We also searched the Web of Science ISI Proceedings (2001 to September 2016) and three clinical trials registries to identify unpublished studies and ongoing trials. We contacted correspondence authors of the included studies in the review to obtain information on unpublished studies or work in progress.
SELECTION CRITERIA
We considered for inclusion in the review randomised controlled trials (RCTs) and quasi-RCTs involving any bone health intervention for corticosteroid-induced osteoporosis and fragility fractures in children, adolescents, and adults with a confirmed diagnosis of DMD. The interventions might have included oral and intravenous bisphosphonates, vitamin D supplements, calcium supplements, dietary calcium, testosterone, and weight-bearing activity.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed reports and selected potential studies for inclusion, following standard Cochrane methodology. We contacted study authors to obtain further information for clarification on published work, unpublished studies, and work in progress.
MAIN RESULTS
We identified 18 potential studies, of which two, currently reported only as abstracts, met the inclusion criteria for this review. Too little information was available for us to present full results or adequately assess risk of bias. The participants were children aged five to 15 years with DMD, ambulant and non-ambulant. The interventions were risedronate versus no treatment in one trial (13 participants) and whole-body vibration versus a placebo device in the second (21 participants). Both studies reported improved bone mineral density with the active treatments, with no improvement in the control groups, but the abstracts did not compare treatment and control conditions. All children tolerated whole-body vibration treatment. No study provided information on adverse events. Two studies are ongoing: one investigating whole-body vibration, the other investigating zoledronic acid.
AUTHORS' CONCLUSIONS
We know of no high-quality evidence from RCTs to guide use of treatments to prevent or treat corticosteroid-induced osteoporosis and reduce the risk of fragility fractures in children and adults with DMD; only limited results from two trials reported in abstracts were available. We await formal trial reports. Findings from two ongoing relevant studies and two trials, for which only abstracts are available, will be important in future updates of this review.
Topics: Adolescent; Adrenal Cortex Hormones; Bone Density; Bone Density Conservation Agents; Calcium; Child; Child, Preschool; Diphosphonates; Humans; Imidazoles; Male; Muscular Dystrophy, Duchenne; Osteoporosis; Osteoporotic Fractures; Randomized Controlled Trials as Topic; Risedronic Acid; Spinal Fractures; Vibration; Vitamin D; Weight-Bearing; Zoledronic Acid
PubMed: 28117876
DOI: 10.1002/14651858.CD010899.pub2 -
Palliative Medicine Jan 2022Close relatives provide much of the care to people with cancer. As resilience can shield family caregivers from mental health problems, there has been a burgeoning...
BACKGROUND
Close relatives provide much of the care to people with cancer. As resilience can shield family caregivers from mental health problems, there has been a burgeoning interest in resilience-promoting interventions. However, the evidence necessary for the development of these interventions is scant and unsynthesized.
AIM
To create an overall picture of evidence on resilience in cancer caregiving by a theory-driven meta-synthesis.
DESIGN
In this systematically constructed review a thematic synthesis approach has been applied. The original findings were coded and structured deductively according to the theoretical framework. Consequently, the codes were organized inductively into themes and subthemes.
DATA SOURCES
Through September 2019, five electronic databases were searched for qualitative studies on resilience in cancer caregiving. The search was extended by a supplementary hand search. Seventeen studies met the eligibility criteria.
RESULTS
The elements of resilience, as described in the pre-defined theoretical framework of Bonanno, are reflected in the lived experiences of family caregivers. The resilience process starts with the diagnosis of advanced cancer and may result in mental wellbeing, benefit finding, and personal growth. The process is influenced by context elements such as individual history, sociocultural background, caregiver characteristics, and the behavior of the supportive network. A repertoire of coping strategies that caregivers use throughout the caregiving process moderates the resilience process.
CONCLUSION
This review and theoretical synthesis reveal key elements of resilience in the process of cancer caregiving, including influencing factors and outcomes. Implications and avenues for further research are discussed.
Topics: Adaptation, Psychological; Caregivers; Humans; Neoplasms; Qualitative Research
PubMed: 34986698
DOI: 10.1177/02692163211057749 -
Reports of Practical Oncology and... 2022The extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) is the most common orbital and adnexal lymphomas. Radiotherapy is one of the... (Review)
Review
BACKGROUND
The extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT) is the most common orbital and adnexal lymphomas. Radiotherapy is one of the most preferred treatment options for orbital lymphomas since they are localized and radiation sensitive. The objective of this study is to evaluate how radiation therapy affected the outcome of orbital MALT lymphoma.
MATERIALS AND METHODS
PRISMA guideline was used to conduct this systematic review of electronic databases (PubMed, EMBASE and Cochrane Library), then we assessed the quality of evidence of each paper.
RESULTS
Twenty-five studies were finally included. 94% studies were intended for definitive therapy and almost all of the studies used external radiation sources. The total doses given to the tumor bed ranged from 4 Gy to 55 Gy and were divided into three groups: ultra-low dose (4-6 Gy), standard-dose (24-30.6 Gy), and high-dose (> 30.6 Gy). 75-90% patients showed CR and local relapse was only reported at 3.5-5%. Higher 5-year PFS was reported in the patients group with lens shielding (90.1% 82.1%) and an increase in Meiboscore after RT courses. Toxicities, including dry eye and cataract, were reported in several patients. Acute toxicities subsided gradually over a few months with artificial tears. The risk of early cataract formation increases in patients who received > 30 Gy and lower in the IMRT group.
CONCLUSION
RT is a successful primary definitive therapy for low-grade orbital MALT lymphoma, with a high survival rate, low recurrence rate, and typically acceptable toxicity.
PubMed: 36196408
DOI: 10.5603/RPOR.a2022.0065 -
ACS Omega Aug 2022Due to problems such as the stress-shielding effect, strength-ductility trade-off dilemma, and use of rare-earth, expensive elements with high melting points in Ti... (Review)
Review
Due to problems such as the stress-shielding effect, strength-ductility trade-off dilemma, and use of rare-earth, expensive elements with high melting points in Ti alloys, the need for the design of new Ti alloys for biomedical applications has emerged. This article reports the effect of various alloying elements on the compressive mechanical performance of Ti alloys for biomedical applications for the first time as a systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on this subject. The search strategy in this systematic review used Scopus, Web of Science, and PubMed databases and searched the articles using (Beta-type OR β) AND Titanium AND (Mechanical property OR Microstructure) AND Alloying element keywords. Original articles from 2016 to 2022 published in English have been selected for this study as per the inclusion criteria. The results have shown that Nb can be used as the primary alloying element with Ti as it is a strong β-stabilizer element which also reduces the elastic modulus of Ti alloys. The β-eutectic elements (Fe, Cr, and Mn) have also emerged as cost-effective alloying elements that could improve the mechanical performance of Ti alloys. Ti-Nb-Zr-Ta alloyed with Si has shown potential to withstand the strength-ductility trade-off dilemma. The combination of a Ti-Nb binary alloy has emerged as an attractive material for designing low elastic modulus Ti alloys. The mechanical performance of the Ti-Nb alloy can be further improved using the β-eutectic (Fe, Cr, and Mn) and neutral (Zr, Sn) elements to be alloyed with a Ti-Nb binary alloy. The strength-ductility trade-off issue can be overcome using Si as an alloying element in Ti-Nb-Zr-Ta alloys.
PubMed: 36061649
DOI: 10.1021/acsomega.2c02096 -
BMJ Open Gastroenterology Oct 2021COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly... (Meta-Analysis)
Meta-Analysis
BACKGROUND
COVID-19 continues to pose a significant healthcare challenge throughout the world. Comorbidities including diabetes and hypertension are associated with a significantly higher mortality risk. However, the effect of cirrhosis on COVID-19 outcomes has yet to be systematically assessed.
OBJECTIVES
To assess the reported clinical outcomes of patients with cirrhosis who develop COVID-19 infection.
DESIGN/METHOD
PubMed and EMBASE databases were searched for studies included up to 3 February 2021. All English language primary research articles that reported clinical outcomes in patients with cirrhosis and COVID-19 were included. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias was assessed using the Quality In Prognostic Score (QUIPS) risk-of-bias assessment instrument for prognostic factor studies template. Meta-analysis was performed using Cochrane RevMan V.5.4 software using a random effects model.
RESULTS
63 studies were identified reporting clinical outcomes in patients with cirrhosis and concomitant COVID-19. Meta-analysis of cohort studies which report a non-cirrhotic comparator yielded a pooled mortality OR of 2.48 (95% CI: 2.02 to 3.04). Analysis of a subgroup of studies reporting OR for mortality in hospitalised patients adjusted for significant confounders found a pooled adjusted OR 1.81 (CI: 1.36 to 2.42).
CONCLUSION
Cirrhosis is associated with an increased risk of all-cause mortality in COVID-19 infection compared to non-cirrhotic patients. Patients with cirrhosis should be considered for targeted public health interventions to prevent COVID-19 infection, such as shielding and prioritisation of vaccination.
Topics: Bias; COVID-19; Humans; Hypertension; Liver Cirrhosis; SARS-CoV-2
PubMed: 34675033
DOI: 10.1136/bmjgast-2021-000739 -
Frontiers in Public Health 2023The Jewish Ultra-Orthodox (UO) population is an under-vaccinated minority group that has been disproportionally affected by outbreaks of vaccine-preventable diseases...
BACKGROUND
The Jewish Ultra-Orthodox (UO) population is an under-vaccinated minority group that has been disproportionally affected by outbreaks of vaccine-preventable diseases (VPD) such as measles and polio. Underlying reasons remain poorly characterized. We aimed to identify vaccination barriers and enablers in this population.
METHODS
We systematically reviewed the literature (PROSPERO: CRD42021273001), searching Pub-med, Web of science, Medline, PsychNet and Scopus from 1995 to 2021 for quantitative and qualitative primary research in English. Studies published outside the date range, not including barriers or enablers, or that were non-primary research were excluded. We assessed included publications for quality and extracted relevant data based on the 5As taxonomy: access, awareness, affordability, acceptance and activation.
RESULTS
We included nine qualitative and seven quantitative studies from the 125 studies identified. Access barriers included scheduling difficulties, inconvenient opening hours, and logistical difficulties related to having multiple young children. Acceptance barriers included safety concerns. Insufficient knowledge about the importance of vaccine and timely vaccination and the perception of being shielded from infections because of seclusion from wider society were key awareness barriers. Competing priorities, such as work and housework, were the main affordability barriers. Mainstream religious leadership's support for vaccination was an enabler, although recent studies suggest their influence on vaccination behavior is decreasing and influence of anti-vaccination messages is growing.
DISCUSSION
Barriers to vaccination among the UO were mainly logistical, with little religious framing. Safety and efficacy concerns were similar to those reported in the wider community. Decreasing influence of the traditionally pro-vaccine mainstream religious leadership and growing influence of anti-vaccination movements targeting the UO community are new phenomena that require close monitoring. Tailored interventions are required to protect the community and wider society against future VPD outbreaks.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO: CRD42021273001.
Topics: Child; Humans; Child, Preschool; Jews; Vaccination; Vaccines; Qualitative Research; Minority Groups
PubMed: 37900036
DOI: 10.3389/fpubh.2023.1244368 -
The American Journal of Clinical... Aug 2014Food insecurity is adversely associated with the physical and mental health of adults and children, and the mechanism that underlies this association has been assumed to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Food insecurity is adversely associated with the physical and mental health of adults and children, and the mechanism that underlies this association has been assumed to be dietary intake of lower quality in food insecure than food secure individuals. A thorough understanding of observed associations between food insecurity and dietary quality is needed to test this assumption and may highlight pathways through which to improve the health of food-insecure adults and children.
OBJECTIVE
We systematically reviewed all evidence of associations between food insecurity and dietary quality and contrasted associations observed in adults and those for children.
DESIGN
Evidence came from studies that appeared in indexed, peer-reviewed journals and 1) sampled US residents, 2) separately sampled children and adults, 3) contained a measure of food insecurity or food insufficiency, and 4) included at least one measure of dietary quality.
RESULTS
In adults, 170 associations between food insecurity and dietary quality were tested, and 50 associations (29%) suggested an adverse association. Food-insecure adults consumed fewer vegetables, fruit, and dairy products than did food secure adults and had lower intake of vitamins A and B-6, calcium, magnesium, and zinc. In children, 130 associations were tested, and 21 associations (16%) showed an adverse association. There was substantial evidence of only lower fruit consumption in food-insecure compared with food-secure children. Reporting and publication biases may have contributed to an overestimation of the association between food insecurity and dietary quality.
CONCLUSIONS
Food insecurity is adversely associated with dietary quality in adults, particularly intakes of nutrient-rich vegetables, fruit, and dairy that promote good health. However, food insecurity was less-consistently associated with lower dietary quality in children. The idea that parents effectively shield their children from compromised dietary quality because of food shortages is supported by the evidence.
Topics: Adult; Child; Child Nutritional Physiological Phenomena; Dairy Products; Diet; Family Characteristics; Female; Food Supply; Fruit; Health Promotion; Humans; Male; Nutrition Policy; Nutritive Value; Patient Compliance; Socioeconomic Factors; Vegetables
PubMed: 24944059
DOI: 10.3945/ajcn.114.084525 -
ELife Nov 2021Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transmission of respiratory pathogens such as SARS-CoV-2 depends on patterns of contact and mixing across populations. Understanding this is crucial to predict pathogen spread and the effectiveness of control efforts. Most analyses of contact patterns to date have focused on high-income settings.
METHODS
Here, we conduct a systematic review and individual-participant meta-analysis of surveys carried out in low- and middle-income countries and compare patterns of contact in these settings to surveys previously carried out in high-income countries. Using individual-level data from 28,503 participants and 413,069 contacts across 27 surveys, we explored how contact characteristics (number, location, duration, and whether physical) vary across income settings.
RESULTS
Contact rates declined with age in high- and upper-middle-income settings, but not in low-income settings, where adults aged 65+ made similar numbers of contacts as younger individuals and mixed with all age groups. Across all settings, increasing household size was a key determinant of contact frequency and characteristics, with low-income settings characterised by the largest, most intergenerational households. A higher proportion of contacts were made at home in low-income settings, and work/school contacts were more frequent in high-income strata. We also observed contrasting effects of gender across income strata on the frequency, duration, and type of contacts individuals made.
CONCLUSIONS
These differences in contact patterns between settings have material consequences for both spread of respiratory pathogens and the effectiveness of different non-pharmaceutical interventions.
FUNDING
This work is primarily being funded by joint Centre funding from the UK Medical Research Council and DFID (MR/R015600/1).
Topics: Adolescent; Adult; Aged; COVID-19; Disease Transmission, Infectious; Female; Humans; Male; Middle Aged; SARS-CoV-2; Young Adult
PubMed: 34821551
DOI: 10.7554/eLife.70294 -
Bulletin of the World Health... May 2015To refine estimates of the burden of alcohol-related oesophageal cancer in Japan. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To refine estimates of the burden of alcohol-related oesophageal cancer in Japan.
METHODS
We searched PubMed for published reviews and original studies on alcohol intake, aldehyde dehydrogenase polymorphisms, and risk for oesophageal cancer in Japan, published before 2014. We conducted random-effects meta-analyses, including subgroup analyses by aldehyde dehydrogenase variants. We estimated deaths and loss of disability-adjusted life years (DALYs) from oesophageal cancer using exposure distributions for alcohol based on age, sex and relative risks per unit of exposure.
FINDINGS
We identified 14 relevant studies. Three cohort studies and four case-control studies had dose-response data. Evidence from cohort studies showed that people who consumed the equivalent of 100 g/day of pure alcohol had an 11.71 fold, (95% confidence interval, CI: 2.67-51.32) risk of oesophageal cancer compared to those who never consumed alcohol. Evidence from case-control studies showed that the increase in risk was 33.11 fold (95% CI: 8.15-134.43) in the population at large. The difference by study design is explained by the 159 fold (95% CI: 27.2-938.2) risk among those with an inactive aldehyde dehydrogenase enzyme variant. Applying these dose-response estimates to the national profile of alcohol intake yielded 5279 oesophageal cancer deaths and 102,988 DALYs lost - almost double the estimates produced by the most recent global burden of disease exercise.
CONCLUSION
Use of global dose-response data results in an underestimate of the burden of disease from oesophageal cancer in Japan. Where possible, national burden of disease studies should use results from the population concerned.
Topics: Alcohol Dehydrogenase; Alcohol Drinking; Esophageal Neoplasms; Ethanol; Humans; Japan; Quality-Adjusted Life Years; Risk Factors
PubMed: 26229204
DOI: 10.2471/BLT.14.142141 -
La Medicina Del Lavoro Apr 2018With climate change, mean annual air temperatures are getting hotter and extreme weather events will become more and more common in most parts of the world. (Review)
Review
BACKGROUND
With climate change, mean annual air temperatures are getting hotter and extreme weather events will become more and more common in most parts of the world.
OBJECTIVES
As part of the EU funded project HEAT-SHIELD we conducted a systematic review to summarize the epidemiological evidence of the effects of global warming-related heat exposure on workers' health and productivity.
METHODS
Three separate searches, focused, respectively, on: i) heat-related illness (HRI), cardiovascular, respiratory and kidney diseases; ii) traumatic injuries; and iii) vector-borne diseases or vectors distribution, were conducted in PubMed. EMBASE was also consulted to retrieve relevant studies focused on the health effects of climate change. A fourth search strategy to assess the effects on work productivity was conducted both in PubMed and in the SCOPUS database.
RESULTS
A significant proportion of studies reported findings regarding the Mesoamerican nephropathy issue. This is a disease occurring especially among young and middle-aged male sugarcane workers, without conventional risk factors for chronic kidney disease. For injuries, there is a reversed U-shaped exposure-response relationship between Tmax and overall daily injury claims. Outdoor workers are at increased risk of vector-borne infectious diseases, as a positive correlation between higher air temperatures and current or future expansion of the habitat of vectors is being observed. As for productivity, agriculture and construction are the most studied sectors; a day with temperatures exceeding 32°C can reduce daily labour supply in exposed sectors by up to 14%.
CONCLUSIONS
The present findings should inform development of further research and related health policies in the EU and beyond with regard to protecting working people from the effects of workplace heat during climate change.
Topics: Agriculture; Climate Change; Construction Industry; Efficiency; European Union; Global Warming; Health Policy; Hot Temperature; Humans; Italy; Occupational Diseases; Occupational Exposure; Occupational Health; Public Health; Risk Factors; Workplace
PubMed: 29943748
DOI: 10.23749/mdl.v109i3.6851