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Biomedicines Jul 2023A better understanding of interindividual differences and the development of targeted therapies is one of the major challenges of modern medicine. The sex of a person... (Review)
Review
A better understanding of interindividual differences and the development of targeted therapies is one of the major challenges of modern medicine. The sex of a person plays a crucial role in this regard. This systematic review aimed to summarise and analyse available evidence on the mutual interactions between non-invasive brain stimulation and sex/polypeptide hormones. The PubMed database was searched from its inception to 31 March 2023, for (i) studies that investigated the impact of sex and/or polypeptide hormones on the effects induced by non-invasive brain stimulation, or (ii) studies that investigated non-invasive brain stimulation in the modulation of sex and/or polypeptide hormones. Eighteen studies (319 healthy and 96 disabled participants) were included. Most studies focused on female sex hormone levels during the menstrual cycle. The later follicular phase is associated with a weak between hemispheric and intracortical inhibition, strong intracortical facilitation, and high stimulation-induced neural and behavioural changes. The opposite effects are observed during the luteal phase. In addition, the participant's sex, presence and/or absence of real ovulation and increase in oestradiol level by chorionic gonadotropin injection influence the stimulation-induced neurophysiological and behavioural effects. In Parkinson's disease and consciousness disorders, the repetitive application of non-invasive brain stimulation increases oestradiol and dehydroepiandrosterone levels and reduces disability. To date, male hormones have not been sufficiently included in these studies. Here, we show that the sex and/or polypeptide hormones and non-invasive brain stimulation methods are in reciprocal interactions. This may be used to create a more effective and individualised approach for healthy individuals and individuals with disabilities.
PubMed: 37509620
DOI: 10.3390/biomedicines11071981 -
Journal of Deaf Studies and Deaf... Mar 2024There is great variability in the ways in which the speech intelligibility of d/Deaf and hard-of-hearing (DHH) children who use spoken language as part, or all, of their...
There is great variability in the ways in which the speech intelligibility of d/Deaf and hard-of-hearing (DHH) children who use spoken language as part, or all, of their communication system is measured. This systematic review examined the measures and methods that have been used when examining the speech intelligibility of children who are DHH and the characteristics of these measures and methods. A systematic database search was conducted of CENTRAL; CINAHL; Cochrane; ERIC; Joanna Briggs; Linguistics, Language and Behavior Abstracts; Medline; Scopus; and Web of Science databases, as well as supplemental searches. A total of 204 included studies reported the use of many different measures/methods which measured segmental aspects of speech, with the most common being Allen et al.'s (2001, The reliability of a rating scale for measuring speech intelligibility following pediatric cochlear implantation. Otology and Neurotology, 22(5), 631-633. https://doi.org/10.1097/00129492-200109000-00012) Speech Intelligibility Rating scale. Many studies included insufficient details to determine the measure that was used. Future research should utilize methods/measures with known psychometric validity, provide clear descriptions of the methods/measures used, and consider using more than one measure to account for limitations inherent in different methods of measuring the speech intelligibility of children who are DHH, and consider and discuss the rationale for the measure/method chosen.
Topics: Child; Humans; Speech Intelligibility; Deafness; Persons With Hearing Impairments; Reproducibility of Results; Cochlear Implantation; Speech Perception; Cochlear Implants
PubMed: 38079579
DOI: 10.1093/deafed/enad054 -
The Lancet. Public Health May 2024Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities.
METHODS
We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374.
FINDINGS
Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ=0·28, I=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types.
INTERPRETATION
Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health.
FUNDING
National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.
Topics: Humans; Disabled Persons; Life Expectancy; Mortality
PubMed: 38702095
DOI: 10.1016/S2468-2667(24)00054-9 -
Chiropractic & Manual Therapies Jun 2024To assess the concurrent validity and inter-rater agreement of the diagnosis of musculoskeletal (MSK) conditions using synchronous telehealth compared to standard... (Review)
Review
OBJECTIVES
To assess the concurrent validity and inter-rater agreement of the diagnosis of musculoskeletal (MSK) conditions using synchronous telehealth compared to standard in-person clinical diagnosis.
METHODS
We searched five electronic databases for cross-sectional studies published in English in peer-reviewed journals from inception to 28 September 2023. We included studies of participants presenting to a healthcare provider with an undiagnosed MSK complaint. Eligible studies were critically appraised using the QUADAS-2 and QAREL criteria. Studies rated as overall low risk of bias were synthesized descriptively following best-evidence synthesis principles.
RESULTS
We retrieved 6835 records and 16 full-text articles. Nine studies and 321 patients were included. Participants had MSK conditions involving the shoulder, elbow, low back, knee, lower limb, ankle, and multiple conditions. Comparing telehealth versus in-person clinical assessments, inter-rater agreement ranged from 40.7% agreement for people with shoulder pain to 100% agreement for people with lower limb MSK disorders. Concurrent validity ranged from 36% agreement for people with elbow pain to 95.1% agreement for people with lower limb MSK conditions.
DISCUSSION
In cases when access to in-person care is constrained, our study implies that telehealth might be a feasible approach for the diagnosis of MSK conditions. These conclusions are based on small cross-sectional studies carried out by similar research teams with similar participant demographics. Additional research is required to improve the diagnostic precision of telehealth evaluations across a larger range of patient groups, MSK conditions, and diagnostic accuracy statistics.
Topics: Humans; Musculoskeletal Diseases; Telemedicine; Reproducibility of Results; Cross-Sectional Studies
PubMed: 38872176
DOI: 10.1186/s12998-024-00542-3 -
Chinese Journal of Traumatology =... Sep 2023To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding... (Review)
Review
PURPOSE
To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding permanent impairment following road traffic crashes.
METHODS
We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement. An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020. Two teams include 2 reviewers each, screened independently the titles/abstracts, and after that, reviewed the full text of the included studies. The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. A third reviewer was assessed any discrepancy and all data of included studies were extracted. Finally, the data were systematically analyzed, and the related data were interpreted.
RESULTS
Five out of 16 studies were evaluated as high-quality according to the STROBE checklist. Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005. Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2% to 23% for car occupants and 2.8% to 46% for cyclists. Seven studies reported the risk of permanent medical impairment of the different body regions. Eleven studies stated the most common body region to develop permanent impairment, of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.
CONCLUSION
The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world. This would facilitate decision-making about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.
Topics: Humans; Accidents, Traffic; Disabled Persons; Abbreviated Injury Scale; Databases, Factual; Wounds and Injuries
PubMed: 36577609
DOI: 10.1016/j.cjtee.2022.11.002 -
Multiple Sclerosis (Houndmills,... Dec 2023Persons with multiple sclerosis (pwMS) might be particularly well suited to benefit from digital health applications because they are, on average, younger and less... (Review)
Review
BACKGROUND
Persons with multiple sclerosis (pwMS) might be particularly well suited to benefit from digital health applications because they are, on average, younger and less severely disabled than patients with many other chronic diseases. Many digital health applications for pwMS have been developed.
OBJECTIVES
Analysis of the evidence of digital health applications to improve health outcomes from a patient perspective.
METHODS
A systematic review was performed on all randomized controlled trials (RCTs) that have studied mobile health interventions for pwMS, that is, which can be applied with a smartphone, tablet, or laptop to improve patient-reported outcomes.
RESULTS
Of the 1127 articles identified in the literature search, 13 RCTs fit the inclusion criteria. Two trials studied messaging systems, two depression interventions, one addressed MS fatigue, five cognition, and three mobility issues, of which two focused on spasticity management. One trial aimed to enhance physical activity. Most were pilot studies that cannot yield definitive conclusions regarding efficacy. One depression intervention and one fatigue intervention showed significant results across several outcomes.
CONCLUSION
Several mobile self-guided digital health applications for pwMS have been tested in RCTs, and two interventions targeting depression and fatigue have demonstrated significant effects. Challenges remain regarding implementation into routine care.
Topics: Humans; Smartphone; Chronic Disease; Multiple Sclerosis; Telemedicine; Fatigue
PubMed: 37897326
DOI: 10.1177/13524585231201089 -
The Lancet. Infectious Diseases May 2024Chikungunya is an arboviral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes with a growing global burden linked to climate change and globalisation.... (Meta-Analysis)
Meta-Analysis
Chikungunya seroprevalence, force of infection, and prevalence of chronic disability after infection in endemic and epidemic settings: a systematic review, meta-analysis, and modelling study.
BACKGROUND
Chikungunya is an arboviral disease transmitted by Aedes aegypti and Aedes albopictus mosquitoes with a growing global burden linked to climate change and globalisation. We aimed to estimate chikungunya seroprevalence, force of infection (FOI), and prevalence of related chronic disability and hospital admissions in endemic and epidemic settings.
METHODS
In this systematic review, meta-analysis, and modelling study, we searched PubMed, Ovid, and Web of Science for articles published from database inception until Sept 26, 2022, for prospective and retrospective cross-sectional studies that addressed serological chikungunya virus infection in any geographical region, age group, and population subgroup and for longitudinal prospective and retrospective cohort studies with data on chronic chikungunya or hospital admissions in people with chikungunya. We did a systematic review of studies on chikungunya seroprevalence and fitted catalytic models to each survey to estimate location-specific FOI (ie, the rate at which susceptible individuals acquire chikungunya infection). We performed a meta-analysis to estimate the proportion of symptomatic patients with laboratory-confirmed chikungunya who had chronic chikungunya or were admitted to hospital following infection. We used a random-effects model to assess the relationship between chronic sequelae and follow-up length using linear regression. The systematic review protocol is registered online on PROSPERO, CRD42022363102.
FINDINGS
We identified 60 studies with data on seroprevalence and chronic chikungunya symptoms done across 76 locations in 38 countries, and classified 17 (22%) of 76 locations as endemic settings and 59 (78%) as epidemic settings. The global long-term median annual FOI was 0·007 (95% uncertainty interval [UI] 0·003-0·010) and varied from 0·0001 (0·00004-0·0002) to 0·113 (0·07-0·20). The highest estimated median seroprevalence at age 10 years was in south Asia (8·0% [95% UI 6·5-9·6]), followed by Latin America and the Caribbean (7·8% [4·9-14·6]), whereas median seroprevalence was lowest in the Middle East (1·0% [0·5-1·9]). We estimated that 51% (95% CI 45-58) of people with laboratory-confirmed symptomatic chikungunya had chronic disability after infection and 4% (3-5) were admitted to hospital following infection.
INTERPRETATION
We inferred subnational heterogeneity in long-term average annual FOI and transmission dynamics and identified both endemic and epidemic settings across different countries. Brazil, Ethiopia, Malaysia, and India included both endemic and epidemic settings. Long-term average annual FOI was higher in epidemic settings than endemic settings. However, long-term cumulative incidence of chikungunya can be similar between large outbreaks in epidemic settings with a high FOI and endemic settings with a relatively low FOI.
FUNDING
International Vaccine Institute.
Topics: Chikungunya Fever; Humans; Seroepidemiologic Studies; Chikungunya virus; Prevalence; Epidemics; Endemic Diseases; Adult; Disabled Persons; Male; Female
PubMed: 38342105
DOI: 10.1016/S1473-3099(23)00810-1 -
PloS One 2023Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not...
BACKGROUND
Over 1.3 billion people, or 16% of the world's population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic.
METHODS
A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding.
RESULTS
Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care.
DISCUSSION
Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.
Topics: Adult; Humans; Delivery of Health Care; Hospitalization; Pain; Disabled Persons; Neoplasms; Observational Studies as Topic
PubMed: 38091337
DOI: 10.1371/journal.pone.0285146 -
Journal of Neurology Sep 2023Upper limb function is one of the most affected domains in people with multiple sclerosis (PwMS), as self-reported by 50% of patients. Heterogeneous results have been... (Meta-Analysis)
Meta-Analysis Review
Upper limb function is one of the most affected domains in people with multiple sclerosis (PwMS), as self-reported by 50% of patients. Heterogeneous results have been found about the correlation between objective and subjective upper limb function. The aim of the present study is to perform a systematic review and meta-analysis of studies presenting data on the strength of association between the gold standard for 9-Hole Peg Test scores and Patient-Reported Outcome Measures (PROMs) of manual ability. Primary research studies including assessments of 9-Hole Peg Test scores and Patient-Reported Outcome Measures were searched in Scopus, Web of Science, and PubMed. Meta analytical calculations were performed using a random-effects model. We retrieved n = 27 studies including n = 75 distinct effect sizes (N of subjects = 3263). The central tendency analysis showed a strong correlation between 9-HPT scores and PROMs (r = 0.51, 95% CI [0.44, 0.58]). Moderator analysis showed the effect size to be significantly larger in studies with a mean or median EDSS level indicating severe disability. The publication bias hypothesis was not supported; instead, we noted that studies based on larger samples also tend to report stronger effect sizes. Results of the study indicate that the correlation between 9-HPT and PROMs is strong, although the constructs measured by these instrument does not fully overlap. The correlation between 9-HPT and PROMs was stronger in larger studies and when samples include a sizeable subgroup of PwMS with severe disability, pointing out the importance of sample diversity.
Topics: Humans; Multiple Sclerosis; Disability Evaluation; Upper Extremity; Disabled Persons; Patient Reported Outcome Measures
PubMed: 37294322
DOI: 10.1007/s00415-023-11801-3 -
The Journal of Prevention of... 2024Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide, and an updated quantification of its impact on morbidity, disability, and mortality is...
BACKGROUND
Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide, and an updated quantification of its impact on morbidity, disability, and mortality is warranted. We conducted a systematic literature review, focusing on the past decade, to characterize AD and assess its impact on affected individuals.
METHODS
Searches of Embase, MEDLINE, and the Cochrane Library were conducted on August 7, 2020 and updated on November 10, 2021. Observational studies from any country reporting incidence, prevalence, comorbidities, and/or outcomes related to disability and mortality/life expectancy, in people with mild cognitive impairment (MCI) due to AD, or mild, moderate, or severe AD dementia, were considered relevant.
RESULTS
Data were extracted from 88 studies (46 incidence/prevalence; 44 comorbidities; 25 mortality-/disability-related outcomes), mostly from Europe, the USA, and Asia. AD dementia diagnosis was confirmed using biomarkers in only 6 studies. Estimated 5-year mortality in AD was 35%, and comorbidity prevalence estimates varied widely (hypertension: 30.2-73.9%; diabetes: 6.0-24.3%; stroke: 2.7-13.7%). Overall, people with AD dementia were more likely to have cardiovascular disease or diabetes than controls, and 5-year mortality in people with AD dementia was double that in the age- and year-matched general population (115.0 vs 60.6 per 1,000 person-years).
CONCLUSIONS
AD is associated with excess morbidity and mortality. Future longitudinal studies of population aging, incorporating biomarker assessment to confirm AD diagnoses, are needed to better characterize the course of MCI due to AD and AD dementia.
Topics: Humans; Alzheimer Disease; Neurodegenerative Diseases; Dementia; Comorbidity; Diabetes Mellitus; Cost of Illness
PubMed: 38230722
DOI: 10.14283/jpad.2023.61