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Parasites & Vectors Mar 2024In the Greater Mekong Subregion (GMS), new vector-control tools are needed to target mosquitoes that bite outside during the daytime and night-time to advance malaria...
Optimizing malaria vector control in the Greater Mekong Subregion: a systematic review and mathematical modelling study to identify desirable intervention characteristics.
BACKGROUND
In the Greater Mekong Subregion (GMS), new vector-control tools are needed to target mosquitoes that bite outside during the daytime and night-time to advance malaria elimination.
METHODS
We conducted systematic literature searches to generate a bionomic dataset of the main malaria vectors in the GMS, including human blood index (HBI), parity proportion, sac proportion (proportion with uncontracted ovary sacs, indicating the amount of time until they returned to host seeking after oviposition) and the resting period duration. We then performed global sensitivity analyses to assess the influence of bionomics and intervention characteristics on vectorial capacity.
RESULTS
Our review showed that Anopheles minimus, An. sinensis, An. maculatus and An. sundaicus display opportunistic blood-feeding behaviour, while An. dirus is more anthropophilic. Multivariate regression analysis indicated that environmental, climatic and sampling factors influence the proportion of parous mosquitoes, and resting duration varies seasonally. Sensitivity analysis highlighted HBI and parity proportion as the most influential bionomic parameters, followed by resting duration. Killing before feeding is always a desirable characteristic across all settings in the GMS. Disarming is also a desirable characteristic in settings with a low HBI. Repelling is only an effective strategy in settings with a low HBI and low parity proportion. Killing after feeding is only a desirable characteristic if the HBI and parity proportions in the setting are high.
CONCLUSIONS
Although in general adopting tools that kill before feeding would have the largest community-level effect on reducing outdoor transmission, other modes of action can be effective. Current tools in development which target outdoor biting mosquitoes should be implemented in different settings dependent on their characteristics.
Topics: Animals; Female; Humans; Malaria; Anopheles; Mosquito Vectors; Ecology; Feeding Behavior
PubMed: 38553759
DOI: 10.1186/s13071-024-06234-4 -
International Journal of Gynaecology... May 2024Evidence regarding the type and rate of intravenous (IV) fluid administration during labor is still inconclusive and the studies assessing the impact of IV fluids had... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Evidence regarding the type and rate of intravenous (IV) fluid administration during labor is still inconclusive and the studies assessing the impact of IV fluids had mixed results.
OBJECTIVES
To evaluate the effects of IV fluids at an infusion rate of 250 mL/h as compared with 125 mL/h on labor outcomes in nulliparous women.
SEARCH STRATEGY
We searched six databases for relevant studies through a search strategy containing the relevant keywords "IV hydration", "IV fluids", and "labor" from the inception of these databases to May 1, 2023, without any applied restrictions.
SELECTION CRITERIA
Search results were imported to Covidence for screening of eligible articles for this review. Randomized controlled trials (RCTs) assessing the impact of IV fluids at 250 mL/h on the outcomes of labor in nulliparous women at term (>37 weeks) as compared with 125 mL/h were included only.
DATA COLLECTION AND ANALYSIS
Data regarding the characteristics of included studies, participant's baseline characteristics, and concerned outcomes were collected in an Excel spreadsheet and all the concerned outcomes were pooled as risk ratios (RR) or mean difference (MD) with 95% confidence interval (CI) in the meta-analysis models using RevMan 5.4.
MAIN RESULTS
Pooled data from 11 RCTs with 1815 patients showed that 250 mL/h infusion rate had a significant reduction in cesarean section rate (RR 0.70, 95% CI 0.56-0.88, P = 0.002), the first stage of labor duration (MD -46.97, 95% CI -81.79 to -12.14, P = 0.008), the second stage of labor duration (MD -2.69, 95% CI -4.34 to -1.05, P = 0.001), prolonged labor incidence (RR 0.72, 95% CI 0.58-0.89, P = 0.003), as compared with 125 mL/h. Also, the vaginal delivery rate (RR 1.07, 95% CI 1.02-1.12, P = 0.009) was higher with a 250 mL/h infusion rate.
CONCLUSION
IV fluids at an infusion rate of 250 mL/h during labor in nulliparous women decreased the cesarean delivery rate, increased the vaginal delivery rate, shortened the first and second-stage labor duration, decreased the incidence of prolonged labor as compared with 125 mL/h. These findings suggest enhanced labor progression and a lower risk of labor complications with higher infusion rates. However, future research involving a more diverse population and exploring the potential benefits of combining IV infusion rates with other interventions, such as adding dextrose or less restrictive oral intake during labor, is needed.
Topics: Pregnancy; Female; Humans; Randomized Controlled Trials as Topic; Labor, Obstetric; Delivery, Obstetric; Cesarean Section; Parity
PubMed: 37855398
DOI: 10.1002/ijgo.15198 -
JAMA Ophthalmology Feb 2024Sex-based research in medicine has revealed inequities against females on almost every metric at almost every career stage; ophthalmology is no exception.
IMPORTANCE
Sex-based research in medicine has revealed inequities against females on almost every metric at almost every career stage; ophthalmology is no exception.
OBJECTIVE
To systematically review the experiences of females in ophthalmology (FiO) from training through practice in high-income countries (HICs).
EVIDENCE REVIEW
A systematic review of English-language studies, published between January 1990 and May 2022, relating to FiO in HICs was performed. PubMed, MEDLINE, and Embase electronic databases were searched, as well as the Journal of Academic Ophthalmology as it was not indexed in the searched databases. Studies were organized by theme at each career stage, starting in medical school when an interest in ophthalmology is expressed, and extending up to retirement.
FINDINGS
A total of 91 studies, 87 cross-sectional and 4 cohort, were included. In medical school, mentorship and recruitment of female students into ophthalmology was influenced by sex bias, with fewer females identifying with ophthalmologist mentors and gender stereotypes perpetuated in reference letters written by both male and female referees. In residency, females had unequal learning opportunities, with lower surgical case volumes than male trainees and fewer females pursued fellowships in lucrative subspecialties. In practice, female ophthalmologists had lower incomes, less academic success, and poorer representation in leadership roles. Female ophthalmologists had a greater scholarly impact factor than their male counterparts, but this was only after approximately 30 years of publication experience. Pervasive throughout all stages of training and practice was the experience of greater sexual harassment among females from both patients and colleagues. Despite these disparities, some studies found that females reported equal overall career satisfaction rating with males in ophthalmology, whereas others suggested higher burnout rates.
CONCLUSIONS AND RELEVANCE
Ophthalmology is approaching sex parity, however, the increase in the proportion of females in ophthalmology had not translated to an increase in female representation in leadership positions. Sex disparities persisted across many domains including recruitment, training, practice patterns, academic productivity, and income. Interventions may improve sex equity in the field.
Topics: Humans; Male; Female; Ophthalmology; Cross-Sectional Studies; Internship and Residency; Income; Ophthalmologists
PubMed: 38236584
DOI: 10.1001/jamaophthalmol.2023.6118 -
Neurosurgical Review Apr 2024Ruptured anterior communicating artery (ACoA) aneurysms are frequently associated with neuropsychological deficits. This review aims to compare neuropsychological... (Meta-Analysis)
Meta-Analysis Review
Ruptured anterior communicating artery (ACoA) aneurysms are frequently associated with neuropsychological deficits. This review aims to compare neuropsychological outcomes between surgical and endovascular approaches to ACoA. We systematically searched PubMed, Embase, and Web of Science for studies comparing the endovascular and surgical approaches to ruptured ACoA aneurysms. Outcomes of interest were the cognitive function, covered by memory, attention, intelligence, executive, and language domains, as well as motor and visual functions. Nine studies, comprising 524 patients were included. Endovascularly-treated patients showed better memory than those treated surgically (Standardized Mean Difference (SMD) = -2; 95% CI: -3.40 to -0.61; p < 0.01). Surgically clipped patients had poorer motor ability than those with coiling embolization (p = 0.01). Executive function (SMD = -0.20; 95% CI: -0.47 to 0.88; p = 0.55), language (SMD = -0.33; 95% CI: -0.95 to 0.30; p = 0.30), visuospatial function (SMD = -1.12; 95% CI: -2.79 to 0.56; p = 0.19), attention (SMD = -0.94; 95% CI: -2.79to 0.91; p = 0.32), intelligence (SMD = -0.25; 95% CI: -0.73 to 0.22; p = 0.30), and self-reported cognitive status (SMD = -0.51; 95% CI: -1.38 to 0.35; p = 0.25) revealed parity between groups. Patients with ACoA treated endovascularly had superior memory and motor abilities. Other cognitive domains, including executive function, language, visuospatial function, attention, intelligence and self-reported cognitive status revealed no statistically significant differences between the two approaches. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42023461283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461283.
Topics: Humans; Intracranial Aneurysm; Aneurysm, Ruptured; Endovascular Procedures; Treatment Outcome; Embolization, Therapeutic; Neurosurgical Procedures; Neuropsychological Tests
PubMed: 38676753
DOI: 10.1007/s10143-024-02418-9 -
Trauma Surgery & Acute Care Open 2024Evidence-based medicine has become the foundation for surgeons around the world to provide the most effective surgical care. However, the article processing charges...
BACKGROUND
Evidence-based medicine has become the foundation for surgeons around the world to provide the most effective surgical care. However, the article processing charges (APCs) and subscription fees for surgical journals may be a barrier, particularly for those in low-income and middle-income countries (LMICs).
OBJECTIVES
The objective of this study was to define the current options for producers and consumers of surgical literature, inclusive of trauma, across resource settings.
DATA SOURCES
The Web of Science Core Collection database.
STUDY APPRAISAL AND SYNTHESIS METHODS
A complete list of journals publishing surgical content between 2019 and 2020 was compiled. The most frequently indexed journals were reviewed using the individual journal websites to extract the type of access (ie, open, closed, hybrid), impact factors, publication languages, APCs, subscription pricing, and any discounts listed.
RESULTS
The literature search revealed 4759 unique journals. The 500 most frequently indexed were reviewed. The mean APC for a fully open access surgical journal was US$1574 and for a hybrid surgical journal was US$3338. The average costs for a 1-year subscription in a hybrid surgical journal were US$434 and US$1878 for an individual and institution, respectively. When considering purchasing power parity, APCs and subscription costs ranged from 2 to 15 times more expensive in LMICs when compared with those in the USA.
LIMITATIONS
Primary search term was in English only, and only peer-reviewed journal articles were reviewed.
CONCLUSIONS OR IMPLICATIONS OF KEY FINDINGS
Although initiatives exist to support peer-reviewed journals in LMICs, there is an exorbitant cost for authors in these countries, as well as those in high-income countries that are not affiliated with a large institution, to either publish in, or access, a majority of surgical journals. Efforts to lower the overall cost of publishing must be made to provide greater access to medical literature.
PROSPERO REGISTRATION NUMBER
CRD4202140227.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38274028
DOI: 10.1136/tsaco-2023-001238 -
The Journal of Asthma : Official... Sep 2023This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using biologic therapies as an add-on treatment to standard therapy in... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This meta-analysis was conducted to quantitatively pool the incremental net benefit (INB) of using biologic therapies as an add-on treatment to standard therapy in patients with moderate to severe asthma.
METHODS
We performed a comprehensive search in several databases published until April 2022. Studies were included if they were cost-effectiveness analyses reporting cost per quality-adjusted life-year or life-year on any biologic therapies as an add-on treatment for moderate to severe asthma in patients of all ages. Various monetary units were converted to purchasing power parity, adjusted to 2021 US dollars. The INBs were pooled across studies using a random-effects model, stratified by country income level (high-income countries (HICs) and low- and middle-income countries (LMICs)) and perspectives (health care or payer perspective (HCPP) and societal perspective (SP)) and age group (>12 years and 6-11 years). Heterogeneity was assessed using the I statistic.
RESULTS
A total of 32 comparisons from 25 studies were included. Pooled INB indicated that the use of omalizumab as an add-on treatment to standard therapy in those aged >12 years was not cost-effective in HICs from the HCPP ( = 8, INB, -6,341 (95% CI, -$25,000 to $12,210), I=86.18%) and SP ( = 5, -$14,000 (-$170,000 to $140,000), I=75.64%). A similar finding was observed in those aged 6-11 years from the HCPP in LMICs ( = 2, -$45,000 (-$73,000 to $17,000), I=00.00%). Subgroup analyses provided no explanations of the potential sources of heterogeneity.
CONCLUSION
The use of biologic therapies in moderate to severe asthma is not cost-effective compared to standard treatment alone.
Topics: Humans; Asthma; Cost-Benefit Analysis; Omalizumab; Biological Therapy
PubMed: 36825403
DOI: 10.1080/02770903.2023.2183407 -
Brazilian Oral Research 2024The aim of this systematic review was to answer the following question: "Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket...
The aim of this systematic review was to answer the following question: "Does alendronate, a nitrogen-containing bisphosphonate, improve or impair alveolar socket healing after tooth extraction in animal models"? To this end, a systematic review of the literature was carried out in PubMed, Scopus, LILACS, Web of Science, as well as in the gray literature up to May 2023. Preclinical studies that evaluated alveolar healing after tooth extraction and the intake of sodium alendronate compared with placebo were included. Two investigators were responsible for screening the articles independently, extracting the data, and assessing their quality through the SYRCLE's RoB tool for randomized trials in animal studies. The study selection process, study characteristics, risk of bias in studies, impact of alendronate on bone healing, and certainty of evidence were described in text and table formats. Methodological differences among the studies were restricted to the synthesis methods. The synthesis of qualitative results followed the Synthesis Without Meta-analysis (SWiM) reporting guideline. From the 19 included studies, five were considered to have low risk, three were of unclear risk, and eleven presented a high risk of bias. The studies were considered heterogeneous regarding alendronate posology, including its dosage and route of administration. Furthermore, a variety of animal species, different age ranges, diverse teeth extracted, and exposure or not to ovariectomy contributed to the lack of parity of the selected studies. Our results indicated that alendronate monotherapy negatively affects the early phase of wound healing after tooth extraction in preclinical studies, suggesting that the bone resorption process after tooth extraction in animals treated with alendronate might impair the bone healing process of the extraction socket. In conclusion, alendronate administration restrains bone resorption, thereby delaying alveolar socket healing . Future studies should be conducted to validate these findings and to better understand the effects of alendronate therapy on oral tissues.
Topics: Alendronate; Tooth Extraction; Animals; Wound Healing; Tooth Socket; Bone Density Conservation Agents
PubMed: 38747825
DOI: 10.1590/1807-3107bor-2024.vol38.0038