-
Therapeutic Advances in Musculoskeletal... 2022Racial and ethnic disparities in osteoarthritis (OA) patients' disease experience may be related to marked differences in the utilization and prescription of... (Review)
Review
BACKGROUND
Racial and ethnic disparities in osteoarthritis (OA) patients' disease experience may be related to marked differences in the utilization and prescription of pharmacologic treatments.
OBJECTIVES
The main objective of this rapid systematic review was to evaluate studies that examined race/ethnic differences in the use of pharmacologic treatments for OA.
DATA SOURCES AND METHODS
A literature search (PubMed and Embase) was ran on 25 February 2022. Studies that evaluated race/ethnic differences in the use of OA pharmacologic treatments were included. Two reviewers independently screened titles and abstracts and abstracted data from full-text articles. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.
RESULTS
The search yielded 3880 titles, and 17 studies were included in this review. African Americans and Hispanics were more likely than non-Hispanic Whites to use prescription non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for OA. However, compared to non-Hispanic Whites with OA, African Americans and Hispanics with OA were less likely to receive a prescription for cyclooxygenase-2-selective NSAIDs and less likely to report the use of joint health supplements (i.e. glucosamine and chondroitin sulfate). There were minimal/no significant race/ethnic differences in the patient-reported use of the following OA therapies: acetaminophen, opioids, and other complementary/alternative medicines (vitamins, minerals, and herbs). There were also no significant race differences in the receipt of intra-articular therapies (i.e. glucocorticoid or hyaluronic acid). However, there is limited evidence to suggest that African Americans may be less likely than Whites to receive opioids and intra-articular therapies in some OA patient populations.
CONCLUSION
This systematic review provides an overview of the current pharmacologic options for OA, with a focus on race and ethnic differences in the use of such medical therapies.
PubMed: 35794906
DOI: 10.1177/1759720X221105011 -
Cureus Sep 2022In recent times, nonalcoholic fatty liver disease (NAFLD) has been considered one of the major causes of liver disease across the world. NAFLD is defined as the... (Review)
Review
In recent times, nonalcoholic fatty liver disease (NAFLD) has been considered one of the major causes of liver disease across the world. NAFLD is defined as the deposition of triglycerides in the liver and is associated with obesity and metabolic syndrome. Hyperinsulinemia, insulin resistance (IR), fatty liver, hepatocyte injury, unbalanced proinflammatory cytokines, mitochondrial dysfunction, oxidative stress, liver inflammation, and fibrosis are the main pathogenesis in NAFLD. Recent studies suggest that the action of intestinal microbiota through chronic inflammation, increased intestinal permeability, and energy uptake plays a vital role in NAFLD. Moreover, polycystic ovarian syndrome also causes NAFLD development through IR. Age, gender, race, ethnicity, sleep, diet, sedentary lifestyle, and genetic and epigenetic pathways are some contributing factors of NAFLD that can exacerbate the risk of liver cirrhosis and hepatocellular carcinoma (HCC) and eventually lead to death. NAFLD has various presentations, including fatigue, unexplained weight loss, bloating, upper abdominal pain, decreased appetite, headache, anxiety, poor sleep, increased thirst, palpitation, and a feeling of warmth. Some studies have shown that NAFLD with severe coronavirus disease 2019 (COVID-19) has poor outcomes. The gold standard for NAFLD diagnosis is liver biopsy. Other diagnostic tools are imaging tests, serum biomarkers, microbiota markers, and tests for extrahepatic complications. There are no specific treatments for NAFLD. Therefore, the main concern for NAFLD is treating the comorbid conditions such as anti-diabetic agents for type 2 diabetes mellitus, statins to reduce HCC progression, antioxidants to prevent hepatocellular damage, and bariatric surgery for patients with a BMI of >40 kg/m and >35 kg/m with comorbidities. Lifestyle and dietary changes are considered preventive strategies against NAFLD advancement. Inadequate treatment of NAFLD further leads to cardiac consequences, sleep apnea, chronic kidney disease, and inflammatory bowel disease. In this systematic review, we have briefly discussed the risk factors, pathogenesis, clinical features, and numerous consequences of NAFLD. We have also reviewed various guidelines for NAFLD diagnosis along with existing therapeutic strategies for the management and prevention of the disease.
PubMed: 36320966
DOI: 10.7759/cureus.29657 -
Caries Research 2023Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are... (Meta-Analysis)
Meta-Analysis
Racially minoritized children often bear a greater burden of dental caries, but the overall magnitude of racial gaps in oral health and their underlying factors are unknown. A systematic review and meta-analysis were conducted to fill these knowledge gaps. We compared racially minoritized (E) children aged 5-11 years (P) with same-age privileged groups (C) to determine the magnitude and correlates of racial inequities in dental caries (O) in observational studies (S). Using the PICOS selection criteria, a targeted search was performed from inception to December 1, 2021, in nine major electronic databases and an online web search for additional grey literature. The primary outcome measures were caries severity, as assessed by mean decayed, missing, and filled teeth (dmft) among children and untreated dental caries prevalence (d > 0%). The meta-analysis used the random-effects model to calculate standardized mean differences (SMD) and 95% confidence intervals (95% CI). Subgroup analysis, tests for heterogeneity (I2, Galbraith plot), leave-one-out sensitivity analysis, cumulative analysis, and publication bias (Egger's test and funnel plots) tests were carried out. The New Castle Ottawa scale was used to assess risk of bias. This review was registered with PROSPERO, CRD42021282771. A total of 75 publications were included in the descriptive analysis. The SMD of dmft score was higher by 2.30 (95% CI: 0.45, 4.15), and the prevalence of untreated dental caries was 23% (95% CI: 16, 31) higher among racially minoritized children, compared to privileged groups. Cumulative analysis showed worsening caries outcomes for racially marginalized children over time and larger inequities in dmft among high-income countries. Our study highlights the high caries burden among minoritized children globally by estimating overall trends and comparing against factors including time, country, and world income. The large magnitude of these inequities, combined with empirical evidence on the oral health impacts of racism and other forms of oppression, reinforce that oral health equity can only be achieved with social and political changes at a global level.
Topics: Child; Humans; Dental Caries; Prevalence; Oral Health; Bias; Income
PubMed: 37734332
DOI: 10.1159/000533565 -
Infection and Drug Resistance 2023Isavuconazole (ISA) is a second generation broad-spectrum triazole antifungal drug derived from voriconazole structure, and its oral capsules is currently the only oral... (Review)
Review
Isavuconazole (ISA) is a second generation broad-spectrum triazole antifungal drug derived from voriconazole structure, and its oral capsules is currently the only oral preparation approved for invasive mucormycosis. In recent years, population pharmacokinetic studies of ISA have been reported continuously. This paper aims to summarize the characteristics of population pharmacokinetic models of ISA in adults, and provide theoretical basis for individualized administration of ISA. We systematically searched PubMed, Embase, CNKI, Wanfang, VIP and other databases to collect population pharmacokinetic models published from the establishment of the database to March 2023. A total of 6 studies were included in this review, including healthy men and women, invasive fungal infections with malignant tumors or neutropenia, solid organ transplantation. The dose of ISA was 40-400mg for single-dose. The multiple-dose of ISA was 200mg every 8 hours for the first 48 hours and then 200mg once daily. All studies used a two-compartment model, first-order elimination. For oral formulations, except for one study that used first-order absorption, the others used Weibull absorption. Body mass index (BMI) was the most common covariable, followed by total body weight, lean body mass, race, sex, population type (healthy volunteers/patients), and creatinine clearance. These studies included several covariates, and the clearance rate (CL) was similar among populations. In the future, external validation and population pharmacokinetic studies in special populations such as patients with severe liver disease and ECMO support are needed.
PubMed: 38089964
DOI: 10.2147/IDR.S434622 -
International Journal of Gynecological... Sep 2023There is evidence that there are differences in survival outcomes among patients with endometrial cancer of different ethnic groups. We aimed to assess the quantity and...
OBJECTIVES
There is evidence that there are differences in survival outcomes among patients with endometrial cancer of different ethnic groups. We aimed to assess the quantity and quality of race/ethnicity reporting in the literature on endometrial cancer published from January 2020 to December 2020.
METHODS
In this systematic review, electronic searches of PubMed, MEDLINE, Web of Sciences, Scopus, and Cochrane Library databases were performed for all articles published in 2020. A total of 3330 articles were reviewed, of which 949 (35%) peer-reviewed human-based articles focusing on endometrial cancer were included. Non-research-focused articles, review articles, meta-analyses, case reports, and non-human studies were excluded. We analyzed the proportion of studies reporting race/ethnicity and assessed the quality of reporting with regard to the adherence to the International Committee of Medical Journal Editors (ICMJE) recommendations. We evaluated the influence of study characteristics on race/ethnicity reporting and compared articles published in journals which adhere to the ICMJE recommendations against those that did not explicitly state that they did.
RESULTS
Of the 949 (28.5%) included articles, 166 (17.5%) reported race/ethnicity of patients, with low quality of reporting. The reporting rate of race/ethnicity was similar when comparing articles from ICMJE and non-ICMJE journals (62 (20.4%) vs 104 (16.1%); p=0.11), prospective versus retrospective studies (53 (22.7%) vs 113 (15.8%); p=0.02), and national versus international studies (147 (17.5%) vs 19 (17.4%); p=0.99). Studies performed in the WHO region of Americas were significantly more consistent in reporting race compared with other regions (119 (44.7%) vs 23 (6.8%) European, 2 (7.4%) Eastern Mediterranean, 21 (7.1%) Western Pacific, 0 (0%) South-East Asia; p<0.001). Female corresponding authors were significantly more consistent in reporting race than male authors (94 (22.5%) vs 72 (13.6%); p<0.001).
CONCLUSIONS
Human-based articles focusing on endometrial cancer have a low frequency and quality of race/ethnicity reporting, even in journals claiming to follow ICMJE recommendations.
Topics: Humans; Female; Male; Ethnicity; Prospective Studies; Retrospective Studies; Endometrial Neoplasms; Databases, Factual
PubMed: 37479465
DOI: 10.1136/ijgc-2023-004552 -
BMC Medicine Apr 2024Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from... (Review)
Review
BACKGROUND
Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity).
METHODS
Scoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist. All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework.
RESULTS
We screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes.
CONCLUSIONS
There is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex.
TRIAL REGISTRATION
Open Science Framework https://osf.io/x8yae .
Topics: Male; Female; Humans; Gender Equity; Canada; Workplace; Randomized Controlled Trials as Topic
PubMed: 38581003
DOI: 10.1186/s12916-024-03346-7 -
Journal of the American Geriatrics... Sep 2023The timely detection of Alzheimer's disease and other related dementias (ADRD) is suboptimal. Digital data already stored in electronic health records (EHR) offer... (Review)
Review
BACKGROUND
The timely detection of Alzheimer's disease and other related dementias (ADRD) is suboptimal. Digital data already stored in electronic health records (EHR) offer opportunities for enhancing the timely detection of ADRD by facilitating the development of passive digital markers (PDMs). We conducted a systematic evidence review to identify studies that describe the development, performance, and validity of EHR-based PDMs for ADRD.
METHODS
We searched the literature published from January 2000 to August 2022 and reviewed cross-sectional, retrospective, or prospective observational studies with a patient population of 18 years or older, published in English that collected and interpreted original data, included EHR as a source of digital data, and had the primary purpose of supporting ADRD care. We extracted relevant data from the included studies with guidance from the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist and used the US Preventive Services Task Force criteria to appraise each study.
RESULTS
We included and appraised 19 studies. Four studies were considered to have a fair quality, and none was considered to have a good quality. The functionality of the PDMs varied from detecting mild cognitive impairment, Alzheimer's disease or ADRD, to forecasting stages of ADRD. Only seven studies used a valid reference diagnostic method. Nine PDMs used only structured EHR data, and five studies provided complete information on the race and ethnicity of its population. The number of features included in the PDMs ranges from 10 to 853, and the PMDs used a variety of statistical and machine learning algorithms with various time-at-risk windows. The area under the curve (AUC) for the PDMs varied from 0.67 to 0.97.
CONCLUSION
Although we noted heterogeneity in the PDMs development and performance, there is evidence that these PDMs have the potential to detect ADRD at earlier stages.
Topics: Humans; Alzheimer Disease; Cross-Sectional Studies; Dementia; Observational Studies as Topic; Retrospective Studies; Sensitivity and Specificity
PubMed: 37249252
DOI: 10.1111/jgs.18426 -
Journal of Neuro-oncology Jul 2023Social determinants of health broadly affect healthcare access and outcomes. Studies report that minorities and low socioeconomic status (SES) patients undergoing... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Social determinants of health broadly affect healthcare access and outcomes. Studies report that minorities and low socioeconomic status (SES) patients undergoing intracranial meningioma resection demonstrate worse outcomes and higher mortality rates. This systematic review and meta-analysis summarizes the available research reporting racial and SES disparities in intracranial meningioma resection outcomes.
METHODS
A systematic review was conducted using PRISMA guidelines and included peer-reviewed, English-language articles from the United States between 2000 and 2022 that reported racial and SES disparities in meningioma outcomes. Outcomes included overall survival (OS), extent of resection (EOR), hospitalization costs, length of stay (LOS), 30-day readmission, recurrence, and receipt of surgery and adjuvant radiotherapy. A quantitative meta-analysis was performed only on survival outcomes by race. All other variables were summarized as a systematic review.
RESULTS
633 articles were identified; 19 studies met inclusion criteria. Black or low SES patients were more likely to have increased hospitalization costs, rates of 30-day readmission, LOS, recurrence and less likely to undergo surgery, gross total resection, and adjuvant radiotherapy for their tumors. Six studies were used for the quantitative meta-analysis of race and OS. Compared to White patients, Black patients had significantly worse survival outcomes, and Asian patients had significantly better survival outcomes.
CONCLUSION
Disparities in outcomes exist for patients who undergo surgery for meningioma, such that Black and low SES patients have worse outcomes. The literature is quite sparse and contains confounding relationships not often accounted for appropriately. Further studies are needed to help understand these disparities to improve outcomes.
Topics: Humans; United States; Meningioma; Social Class; Hospitalization; Length of Stay; Meningeal Neoplasms; Healthcare Disparities
PubMed: 37440095
DOI: 10.1007/s11060-023-04393-5 -
International Journal of Environmental... Sep 2021There is increasing potential to improve the research and reporting on the health and wellbeing of Indigenous and Tribal peoples through the collection and (re)use of... (Review)
Review
There is increasing potential to improve the research and reporting on the health and wellbeing of Indigenous and Tribal peoples through the collection and (re)use of population-level data. As the data economy grows and the value of data increases, the optimization of data pertaining to Indigenous peoples requires governance that defines who makes decisions on behalf of whom and how these data can and should be used. An international a priori PROSPERO (#CRD42020170033) systematic review was undertaken to examine the health research literature to (1) identify, describe, and synthesize definitions and principles; (2) identify and describe data governance frameworks; and (3) identify, describe, and synthesize processes, policies and practices used in Indigenous Data Governance (ID-GOV). Sixty-eight articles were included in the review that found five components that require consideration in the governance of health research data pertaining to Indigenous people. This included (1) Indigenous governance; (2) institutional ethics; (3) socio-political dynamics; (4) data management and data stewardship; and (5) overarching influences. This review provides the first systematic international review of ID-GOV that could potentially be used in a range of governance strategies moving forward in health research.
Topics: Health Services, Indigenous; Humans; Native Hawaiian or Other Pacific Islander
PubMed: 34639617
DOI: 10.3390/ijerph181910318 -
Digital Health 2020To date the application of eHealth strategies among adults and adolescents undergoing metabolic and bariatric surgery (MBS) has not been systematically reviewed. This... (Review)
Review
OBJECTIVE
To date the application of eHealth strategies among adults and adolescents undergoing metabolic and bariatric surgery (MBS) has not been systematically reviewed. This study comprehensively examines eHealth intervention studies among MBS patients within the RE-AIM framework to assess reach, effectiveness, adoption, implementation and maintenance of these efforts.
METHODS
A search was conducted using PubMed, EMBASE, CINAHL, PsycNET and SCOPUS of original research relating to eHealth strategies for MBS patients published in peer-reviewed journals and revealed 38 published articles between 2011 and 2019.
RESULTS
Studies varied widely in terms of design (qualitative to randomized controlled trials) and eHealth delivery method (telemedicine to blog post content) with a balance of pre- or post-MBS use. No studies included adolescents and very few reported (1) a conceptual framework to support study design/outcomes; and (2) race/ethnicity composition.
CONCLUSIONS
Although some studies report that eHealth strategies/interventions are effective in producing post-MBS weight loss and other positive health outcomes, most are pilot studies or have study design limitations. There is an opportunity for development of (1) tailored eHealth interventions to support pre- and post-MBS sustained behavior change and improved outcomes; and (2) rigorous studies that employ robust conceptual frameworks so dissemination and implementation efforts can be mapped to construct-driven outcomes.
PubMed: 32030193
DOI: 10.1177/2055207619898987