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American Journal of Obstetrics and... Mar 2024This systematic review and meta-analysis aimed to conduct a thorough and contemporary assessment of maternal and neonatal outcomes associated with water birth in... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to conduct a thorough and contemporary assessment of maternal and neonatal outcomes associated with water birth in comparison with land-based birth.
DATA SOURCES
We conducted a comprehensive search of PubMed, EMBASE, CINAHL, and gray literature sources, from inception to February 28, 2023.
STUDY ELIGIBILITY CRITERIA
We included randomized and nonrandomized studies that assessed maternal and neonatal outcomes in patients who delivered either conventionally or while submerged in water.
METHODS
Pooled unadjusted odds ratios with 95% confidence intervals were calculated using a random-effects model (restricted maximum likelihood method). We assessed the 95% prediction intervals to estimate the likely range of future study results. To evaluate the robustness of the results, we calculated fragility indices. Maternal infection was designated as the primary outcome, whereas postpartum hemorrhage, perineal lacerations, obstetrical anal sphincter injury, umbilical cord avulsion, low Apgar scores, neonatal aspiration requiring resuscitation, neonatal infection, neonatal mortality within 30 days of birth, and neonatal intensive care unit admission were considered secondary outcomes.
RESULTS
Of the 20,642 articles identified, 52 were included in the meta-analyses. Based on data from observational studies, water birth was not associated with increased probability of maternal infection compared with land birth (10 articles, 113,395 pregnancies; odds ratio, 0.93; 95% confidence interval, 0.76-1.14). Patients undergoing water birth had decreased odds of postpartum hemorrhage (21 articles, 149,732 pregnancies; odds ratio, 0.80; 95% confidence interval, 0.68-0.94). Neonates delivered while submerged in water had increased odds of cord avulsion (10 articles, 91,504 pregnancies; odds ratio, 1.75; 95% confidence interval, 1.38-2.24) and decreased odds of low Apgar scores (21 articles, 165,917 pregnancies; odds ratio, 0.69; 95% confidence interval, 0.58-0.82), neonatal infection (15 articles, 53,635 pregnancies; odds ratio, 0.64; 95% confidence interval, 0.42-0.97), neonatal aspiration requiring resuscitation (19 articles, 181,001 pregnancies; odds ratio, 0.60; 95% confidence interval, 0.43-0.84), and neonatal intensive care unit admission (30 articles, 287,698 pregnancies; odds ratio, 0.56; 95% confidence interval, 0.45-0.70).
CONCLUSION
When compared with land birth, water birth does not appear to increase the risk of most maternal and neonatal complications. Like any other delivery method, water birth has its unique considerations and potential risks, which health care providers and expectant parents should evaluate thoroughly. However, with proper precautions in place, water birth can be a reasonable choice for mothers and newborns, in facilities equipped to conduct water births safely.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Delivery, Obstetric; Infant Mortality; Natural Childbirth; Postpartum Hemorrhage; Water
PubMed: 38462266
DOI: 10.1016/j.ajog.2023.08.034 -
Ageing Research Reviews Sep 2023In this study, we sought to summarize the associations between overall, plant-, and animal-based low carbohydrate diet (LCD) scores and the risk of all-cause,... (Meta-Analysis)
Meta-Analysis Review
Overall, plant-based, or animal-based low carbohydrate diets and all-cause and cause-specific mortality: A systematic review and dose-response meta-analysis of prospective cohort studies.
INTRODUCTION
In this study, we sought to summarize the associations between overall, plant-, and animal-based low carbohydrate diet (LCD) scores and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality from prospective cohort studies.
METHODS
We searched PubMed, Scopus, and Web of Science up to January 2022. We included prospective cohort studies that investigated the relationship between LCD-score and risk of overall, CVD, or cancer mortality. Two investigators assessed the studies for eligibility and extracted the data. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a random-effects model.
RESULTS
Ten studies, with 421022 participants, were included in the analysis. In the high-versus-low meta-analysis, overall (HR:1.05,95%CI:0.97, 1.13, I =72.0%) and animal-based LCD-scores (HR: 1.08, 95% CI: 0.97-1.21; I = 88.0%) were not associated with all-cause mortality, but plant-based LCD-score was associated with a risk reduction (HR:0.87, 95%CI:0.78,0.97; I = 88.4%). CVD mortality was not associated with overall, plant-, or animal-based LCD-scores. Overall (HR:1.14, 95%CI:1.05,1.24; I = 37.4%) and animal-based LCD scores (HR:1.16,95%CI:1.02,1.31; I = 73.7%) were associated with a higher risk of cancer mortality, while plant-based LCD-score was not. A U-shaped relationship was revealed between overall LCD-score and all-cause and CVD mortality. The shape of relationship between LCD and cancer mortality was a linear dose-response.
CONCLUSION
In conclusion, diets with a moderate carbohydrate content were associated with the lowest risk of all-cause and CVD mortality. If the sources of macronutrients that replaced carbohydrates were plant-based, the risk of all-cause mortality was reduced linearly with lower carbohydrate content. The risk of cancer mortality increased linearly with the increase in carbohydrate content. Considering the low certainty of evidence, more robust prospective cohort studies are suggested.
Topics: Animals; Humans; Cause of Death; Prospective Studies; Diet, Carbohydrate-Restricted; Cardiovascular Diseases; Carbohydrates; Neoplasms
PubMed: 37419282
DOI: 10.1016/j.arr.2023.101997 -
Intensive Care Medicine Apr 2024The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of this study is to provide a summary of the existing literature on the association between hypotension during intensive care unit (ICU) stay and mortality and morbidity, and to assess whether there is an exposure-severity relationship between hypotension exposure and patient outcomes.
METHODS
CENTRAL, Embase, and PubMed were searched up to October 2022 for articles that reported an association between hypotension during ICU stay and at least one of the 11 predefined outcomes. Two independent reviewers extracted the data and assessed the risk of bias. Results were gathered in a summary table and studies designed to investigate the hypotension-outcome relationship were included in the meta-analyses.
RESULTS
A total of 122 studies (176,329 patients) were included, with the number of studies varying per outcome between 0 and 82. The majority of articles reported associations in favor of 'no hypotension' for the outcomes mortality and acute kidney injury (AKI), and the strength of the association was related to the severity of hypotension in the majority of studies. Using meta-analysis, a significant association was found between hypotension and mortality (odds ratio: 1.45; 95% confidence interval (CI) 1.12-1.88; based on 13 studies and 34,829 patients), but not for AKI.
CONCLUSION
Exposure to hypotension during ICU stay was associated with increased mortality and AKI in the majority of included studies, and associations for both outcomes increased with increasing hypotension severity. The meta-analysis reinforced the descriptive findings regarding mortality but did not yield similar support for AKI.
Topics: Humans; Critical Care; Morbidity; Hospital Mortality; Hypotension; Acute Kidney Injury; Intensive Care Units
PubMed: 38252288
DOI: 10.1007/s00134-023-07304-4 -
The Lancet. Public Health Mar 2024The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The positive effect of education on reducing all-cause adult mortality is known; however, the relative magnitude of this effect has not been systematically quantified. The aim of our study was to estimate the reduction in all-cause adult mortality associated with each year of schooling at a global level.
METHODS
In this systematic review and meta-analysis, we assessed the effect of education on all-cause adult mortality. We searched PubMed, Web of Science, Scopus, Embase, Global Health (CAB), EconLit, and Sociology Source Ultimate databases from Jan 1, 1980, to May 31, 2023. Reviewers (LD, TM, HDV, CW, IG, AG, CD, DS, KB, KE, and AA) assessed each record for individual-level data on educational attainment and mortality. Data were extracted by a single reviewer into a standard template from the Global Burden of Diseases, Injuries, and Risk Factors Study. We excluded studies that relied on case-crossover or ecological study designs to reduce the risk of bias from unlinked data and studies that did not report key measures of interest (all-cause adult mortality). Mixed-effects meta-regression models were implemented to address heterogeneity in referent and exposure measures among studies and to adjust for study-level covariates. This study was registered with PROSPERO (CRD42020183923).
FINDINGS
17 094 unique records were identified, 603 of which were eligible for analysis and included data from 70 locations in 59 countries, producing a final dataset of 10 355 observations. Education showed a dose-response relationship with all-cause adult mortality, with an average reduction in mortality risk of 1·9% (95% uncertainty interval 1·8-2·0) per additional year of education. The effect was greater in younger age groups than in older age groups, with an average reduction in mortality risk of 2·9% (2·8-3·0) associated with each additional year of education for adults aged 18-49 years, compared with a 0·8% (0·6-1·0) reduction for adults older than 70 years. We found no differential effect of education on all-cause mortality by sex or Socio-demographic Index level. We identified publication bias (p<0·0001) and identified and reported estimates of between-study heterogeneity.
INTERPRETATION
To our knowledge, this is the first systematic review and meta-analysis to quantify the importance of years of schooling in reducing adult mortality, the benefits of which extend into older age and are substantial across sexes and economic contexts. This work provides compelling evidence of the importance of education in improving life expectancy and supports calls for increased investment in education as a crucial pathway for reducing global inequities in mortality.
FUNDING
Research Council of Norway and the Bill & Melinda Gates Foundation.
Topics: Adult; Humans; Databases, Factual; Educational Status; Life Expectancy; Norway; Mortality
PubMed: 38278172
DOI: 10.1016/S2468-2667(23)00306-7 -
The International Journal of Oral &... Oct 2023To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for... (Meta-Analysis)
Meta-Analysis
PURPOSE
To assess the survival rate (SR) and probability of postoperative complications at both the implant and patient level for each of the four surgical techniques for zygomatic implant (ZI) placement: Brånemark, sinus slot, extrasinus, and extramaxillary.
MATERIALS AND METHODS
A systematic literature review and meta-analysis of clinical studies that reported the survival rate and postoperative ZI complications for the rehabilitation of atrophic edentulous maxillae was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Two independent reviewers consulted four databases during the literature search: MEDLINE (PubMed), Google Scholar, Clinicaltrials.gov, and LILACS. Duplicate articles were eliminated.
RESULTS
A total of 35 studies were included in the meta-analysis. Subgroup analysis showed that study design (prospective vs retrospective) had no significant impact (P = .10) on the outcomes. The SR was highest for the Brånemark and extrasinus techniques (100%) and lowest for the sinus slot technique (94%; 95% CI = 86% to 102%). The extramaxillary (38%; 95% CI = 1% to 3%) and the Brånemark (29%; 95% CI = 15% to 44%) techniques resulted in the highest occurrence of patient-level complications. Moreover, the extramaxillary technique showed the highest percentage of prothesis-related complications (44%; 95% CI = 27% to 62%).
CONCLUSIONS
ZI placement was demonstrated to be a reliable technique for the rehabilitation of severely atrophic maxillae, irrespective of the surgical technique evaluated. Accurate case and surgical protocol selection is of paramount importance to reduce technique-related postoperative complications.
Topics: Humans; Dental Implants; Retrospective Studies; Prospective Studies; Survival Rate; Dental Implantation, Endosseous; Postoperative Complications; Zygoma; Maxilla; Dental Prosthesis, Implant-Supported; Jaw, Edentulous; Follow-Up Studies
PubMed: 37847828
DOI: 10.11607/jomi.10330 -
Health Psychology : Official Journal of... Apr 2024Various literature are suggestive of a relation between lifetime trauma and mortality risk in adulthood, however, findings seem unclear and inconsistent. In our...
OBJECTIVE
Various literature are suggestive of a relation between lifetime trauma and mortality risk in adulthood, however, findings seem unclear and inconsistent. In our preregistered review, we conducted a systematic review to examine the association between lifetime trauma and mortality risk in adulthood.
METHOD
Six databases (Scopus, Web of Science, CINAHL [EBSCO], PsycInfo [EBSCO], Embase, and Medline [PubMed]); were searched up to April 2023 for studies reporting adult mortality outcomes associated with traumatic events accumulated across the lifespan. Five studies were found, and a narrative review of the literature was conducted.
RESULTS
Five studies met the inclusion criteria, including 5,506 individuals. Two studies with men/male-only samples reported no relation between lifetime trauma and mortality risk; however, three studies with a mixed-sex sample found a positive relation between lifetime trauma and mortality risk, indicating that the more traumatic events a person has across their lifespan, the greater their mortality risk.
CONCLUSION
Lifetime trauma appears to be associated with mortality risk during adulthood. The strongest evidence stems from larger samples. However, research is sparse and inconclusive. A plethora of additional research is needed to address several limitations within the current literature, which includes utilizing standardized measures of lifetime trauma, replication of effects, and the examination of vulnerable and underrepresented populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Topics: Adult; Humans; Male; Longevity; Wounds and Injuries; Mortality; Female
PubMed: 38190201
DOI: 10.1037/hea0001343 -
The British Journal of Dermatology May 2024Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer that most commonly occurs in ultraviolet-exposed body sites. The epidemiology of MCC in different...
BACKGROUND
Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer that most commonly occurs in ultraviolet-exposed body sites. The epidemiology of MCC in different geographies and populations is not well characterized.
OBJECTIVES
The objective of this systematic review is to summarize evidence on the incidence, mortality and survival rates of MCC from population-based studies.
METHODS
We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from database inception to 6 June 2023. No geographic, age or date exclusions were applied. We included population-based studies of MCC that reported the incidence, survival or mortality rate, and also considered systematic reviews. A data-charting form was created and validated to identify variables to extract. Two reviewers then independently charted the data for each included study with patient characteristics, and estimates of incidence rate, mortality rate, and survival rate and assessed the quality of included studies using the Joanna Briggs Institute Checklist for Prevalence studies, Newcastle-Ottawa Scale and Assessment of Multiple Systematic Reviews. We abstracted age-, sex-, stage- and race-stratified outcomes, and synthesized comparisons between strata narratively and using vote counting. We assessed the certainty of evidence for those comparisons using the Grading of Recommendations, Assessments, Developments and Evaluations framework.
RESULTS
We identified 11 472 citations, of which 52 studies from 24 countries met our inclusion criteria. Stage I and the head and neck were the most frequently reported stage and location at diagnosis. The incidence of MCC is increasing over time (high certainty), with the highest reported incidences reported in southern hemisphere countries [Australia (2.5 per 100 000); New Zealand (0.96 per 100 000) (high certainty)]. Male patients generally had higher incidence rates compared with female patients (high certainty), although there were some variations over time periods. Survival rates varied, with lower survival and/or higher mortality associated with male sex (moderate certainty), higher stage at diagnosis (moderate-to-high certainty), older age (moderate certainty), and immunosuppression (low-to-moderate certainty).
CONCLUSIONS
MCC is increasing in incidence and may increase further given the ageing population of many countries. The prognosis of MCC is poor, particularly for male patients, those who are immunosuppressed, and patients diagnosed at higher stages or at an older age.
Topics: Carcinoma, Merkel Cell; Humans; Skin Neoplasms; Incidence; Survival Rate
PubMed: 37874770
DOI: 10.1093/bjd/ljad404 -
The Science of the Total Environment Nov 2023Infant mortality is a widely reported indicator of population health and a leading public health concern. In this systematic review and meta-analysis, we review the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM
Infant mortality is a widely reported indicator of population health and a leading public health concern. In this systematic review and meta-analysis, we review the available literature for epidemiologic evidence of the association between short-term air pollution exposure and infant mortality.
METHODS
Relevant publications were identified through PubMed and Web of Science databases using comprehensive search terms and screened using predefined inclusion/exclusion criteria. We extracted data from included studies and applied a systematic rubric for evaluating study quality across domains including participant selection, outcome, exposure, confounding, analysis, selective reporting, sensitivity, and overall quality. We performed meta-analyses, using both fixed and random-effect methods, and estimated pooled odds ratios (ORs) and 95 % confidence intervals (95%CI) for pollutants (nitrogen dioxide (NO), sulfur dioxide (SO), coarse particulate matter (PM), fine particulate matter (PM), ozone (O), carbon monoxide (CO)) and infant mortality, neonatal mortality, or postneonatal mortality.
RESULTS
Our search returned 549 studies. We excluded 490 studies in the abstract screening phase and an additional 37 studies in the full text screening phase, leaving 22 studies for inclusion. Among these 22 studies, 14 included effect estimates for PM, 13 for O, 11 for both NO and CO, 8 for SO, and 3 for PM. We did not calculate a pooled OR for PM due to the limited number of studies available and demonstrated heterogeneity in the effect estimates. The pooled ORs (95%CI) with the greatest magnitudes were for a 10-ppb increase in SO or NO concentration in the days before death (1.07 [95%CI: 1.02, 1.12], 1.04 [95%CI: 1.01, 1.08], respectively). The pooled OR for PM was 1.02 (95%CI: 1.00, 1.03), and the pooled ORs for CO and O were 1.01 (95%CI: 1.00, 1.02) and 0.99 (95%CI: 0.97, 1.01).
CONCLUSIONS
Increased exposure to SO, NO, PM, or CO is associated with infant mortality across studies.
Topics: Infant; Infant, Newborn; Humans; Air Pollutants; Nitrogen Dioxide; Environmental Exposure; Air Pollution; Particulate Matter; Ozone; Infant Mortality; Sulfur Dioxide
PubMed: 37459995
DOI: 10.1016/j.scitotenv.2023.165522 -
Acta Neurochirurgica Sep 2023To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades.
METHODS
We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries).
RESULTS
Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9-22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI-related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028).
CONCLUSION
A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.
Topics: Humans; Hospital Mortality; Cervical Cord; Prospective Studies; Retrospective Studies; Neck Injuries; Spinal Cord Injuries; Methylprednisolone
PubMed: 37480505
DOI: 10.1007/s00701-023-05720-5 -
Cannabis and Cannabinoid Research Apr 2024To determine whether prenatal cannabis use alone increases the likelihood of fetal and neonatal morbidity and mortality. We searched bibliographic databases, such as... (Meta-Analysis)
Meta-Analysis
To determine whether prenatal cannabis use alone increases the likelihood of fetal and neonatal morbidity and mortality. We searched bibliographic databases, such as PubMed, Embase, Scopus, Cochrane reviews, PsycInfo, MEDLINE, Clinicaltrials.gov, and Google Scholar from inception through February 14, 2022. Cohort or case-control studies with prespecified fetal or neonatal outcomes in pregnancies with prenatal cannabis use. Primary outcomes were preterm birth (PTB; <37 weeks of gestation), small-for-gestational-age (SGA), birthweight (grams), and perinatal mortality. Two independent reviewers screened studies. Studies were extracted by one reviewer and confirmed by a second using a predefined template. Risk of bias assessment of studies, using the Newcastle-Ottawa Quality Assessment Scale, and Grading of Recommendations Assessment, Development, and Evaluation for evaluating the certainty of evidence for select outcomes were performed by two independent reviewers with disagreements resolved by a third. Random effects meta-analyses were conducted, using adjusted and unadjusted effect estimates, to compare groups according to prenatal exposure to cannabis use status. Fifty-three studies were included. Except for birthweight, unadjusted and adjusted meta-analyses had similar results. We found very-low- to low-certainty evidence that cannabis use during pregnancy was significantly associated with greater odds of PTB (adjusted odds ratio [aOR], 1.42; 95% confidence interval [CI], 1.19 to 1.69; , 93%; =0.0001), SGA (aOR, 1.76; 95% CI, 1.52 to 2.05; , 86%; <0.0001), and perinatal mortality (aOR, 1.5; 95% CI, 1.39 to 1.62; , 0%; <0.0001), but not significantly different for birthweight (mean difference, -40.69 g; 95% CI, -124.22 to 42.83; , 85%; =0.29). Because of substantial heterogeneity, we also conducted a narrative synthesis and found comparable results to meta-analyses. Prenatal cannabis use was associated with greater odds of PTB, SGA, and perinatal mortality even after accounting for prenatal tobacco use. However, our confidence in these findings is limited. Limitations of most existing studies was the failure to not include timing or quantity of cannabis use. This review can help guide health care providers with counseling, management, and addressing the limited existing safety data. PROSPERO CRD42020172343.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Premature Birth; Cannabis; Birth Weight; Perinatal Mortality; Fetal Growth Retardation; Perinatal Death
PubMed: 36730710
DOI: 10.1089/can.2022.0262