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Age and Ageing Jul 2023community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as... (Meta-Analysis)
Meta-Analysis
BACKGROUND
community-based complex interventions for older adults have a variety of names, including Comprehensive Geriatric Assessment, but often share core components such as holistic needs assessment and care planning.
OBJECTIVE
to summarise evidence for the components and effectiveness of community-based complex interventions for improving older adults' independent living and quality of life (QoL).
METHODS
we searched nine databases and trial registries to February 2022 for randomised controlled trials comparing complex interventions to usual care. Primary outcomes included living at home and QoL. Secondary outcomes included mortality, hospitalisation, institutionalisation, cognitive function and functional status. We pooled data using risk ratios (RRs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs).
RESULTS
we included 50 trials of mostly moderate quality. Most reported using holistic assessment (94%) and care planning (90%). Twenty-seven (54%) involved multidisciplinary care, with 29.6% delivered mainly by primary care teams without geriatricians. Nurses were the most frequent care coordinators. Complex interventions increased the likelihood of living at home (RR 1.05; 95% CI 1.00-1.10; moderate-quality evidence) but did not affect QoL. Supported by high-quality evidence, they reduced mortality (RR 0.86; 95% CI 0.77-0.96), enhanced cognitive function (SMD 0.12; 95% CI 0.02-0.22) and improved instrumental activities of daily living (ADLs) (SMD 0.11; 95% CI 0.01-0.21) and combined basic/instrumental ADLs (SMD 0.08; 95% CI 0.03-0.13).
CONCLUSIONS
complex interventions involving holistic assessment and care planning increased the chance of living at home, reduced mortality and improved cognitive function and some ADLs.
Topics: Humans; Aged; Independent Living; Quality of Life; Activities of Daily Living; Hospitalization; Geriatric Assessment
PubMed: 37505991
DOI: 10.1093/ageing/afad132 -
Heliyon May 2023The prediabetes population is large and easily overlooked because of the lack of obvious symptoms, which can progress to diabetes. Early screening and targeted... (Review)
Review
BACKGROUNDS
The prediabetes population is large and easily overlooked because of the lack of obvious symptoms, which can progress to diabetes. Early screening and targeted interventions can substantially reduce the rate of conversion of prediabetes to diabetes. Therefore, this study systematically reviewed prediabetes risk prediction models, performed a summary and quality evaluation, and aimed to recommend the optimal model.
METHODS
We systematically searched five databases (Cochrane, PubMed, Embase, Web Of Science, and CNKI) for published literature related to prediabetes risk prediction models and excluded preprints, duplicate publications, reviews, editorials, and other studies, with a search time frame of March 01, 2023. Data were categorized and summarized using a standardized data extraction form that extracted data including author; publication date; study design; country; demographic characteristics; assessment tool name; sample size; study type; and model-related indicators. The PROBAST tool was used to assess the risk of bias profile of included studies.
FINDINGS
14 studies with a total of 15 models were eventually included in the systematic review. We found that the most common predictors of models were age, family history of diabetes, gender, history of hypertension, and BMI. Most of the studies (83.3%) had a high risk of bias, mainly related to under-reporting of outcome information and poor methodological design during the development and validation of models. Due to the low quality of included studies, the evidence for predictive validity of the available models is unclear.
INTERPRETATION
We should pay attention to the early screening of prediabetes patients and give timely pharmacological and lifestyle interventions. The predictive performance of the existing model is not satisfactory, and the model building process can be standardized and external validation can be added to improve the accuracy of the model in the future.
PubMed: 37215820
DOI: 10.1016/j.heliyon.2023.e15529 -
Journal of Geriatric Oncology Jun 2023The number of older patients with cancer is expected to continue to increase owing to the aging population. Recently, the usefulness of geriatric assessment (GA)... (Review)
Review
Significance of the comprehensive geriatric assessment in the administration of chemotherapy to older adults with cancer: Recommendations by the Japanese Geriatric Oncology Guideline Committee.
INTRODUCTION
The number of older patients with cancer is expected to continue to increase owing to the aging population. Recently, the usefulness of geriatric assessment (GA) conducted by multiple staff members from different medical backgrounds has been reported; however, a consensus on the effectiveness of GA has not yet been achieved.
MATERIALS AND METHODS
We, as the Japanese Geriatric Oncology Guideline Committee for elderly patients with cancer, conducted a literature search of randomized controlled trials published before August 2021 that used GA or comprehensive GA (CGA) as an intervention for patients with cancer undergoing chemotherapy. As the key outcomes for answering the clinical question, we focused on survival benefit, adverse events, and quality of life (QOL). After a systematic review of these studies, the expert panel member developed recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.
RESULTS
For older patients with cancer, GA or CGA is suggested during or before chemotherapy (weakly recommended). Chemotherapy-induced adverse events were significantly reduced by GA/CGA interventions without any adverse effects on survival. Health-related QOL tended to improve with the GA/CGA interventions.
DISCUSSION
Although, in our opinion, GA/CGA does require time and resources, it poses no harm patients. Therefore, we suggest expanding the human resources and educating skills of medical providers for clinical implementation of GA/CGA.
Topics: Aged; Humans; Aging; East Asian People; Geriatric Assessment; Neoplasms; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 37062639
DOI: 10.1016/j.jgo.2023.101485 -
Acta Neurochirurgica Jan 2024The pterional or frontosphenotemporal craniotomy has stood the test of time and continues to be a commonly used method of managing a variety of neurosurgical pathology.... (Review)
Review
BACKGROUND
The pterional or frontosphenotemporal craniotomy has stood the test of time and continues to be a commonly used method of managing a variety of neurosurgical pathology. Already described in the beginning of the twentieth century and perfected by Yasargil in the 1970s, it has seen many modifications. These modifications have been a normal evolution for most neurosurgeons, tailoring the craniotomy to the patients' specific anatomy and pathology. Nonetheless, an abundance of variations have appeared in the literature.
METHODS
A search strategy was devised according to the 2020 Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) statement. To identify articles investigating the variations in the pterional approach, the following search terms were applied: (pterional OR minipterional OR supraorbital) AND (approach OR craniotomy OR technique).
RESULTS
In total, 3552 articles were screened with 74 articles being read in full with 47 articles being included for review. Each article was examined according the name of the technique, temporalis dissection technique, craniotomy technique and approach.
CONCLUSION
This systematic review gives an overview of the different techniques and modifications to the pterional craniotomy since it was initially described. We advocate for the use of a more standardised nomenclature that focuses on the target zone to simplify the management approach to supratentorial aneurysms.
Topics: Humans; Aneurysm; Craniotomy; Neurosurgeons; Temporal Muscle
PubMed: 38227061
DOI: 10.1007/s00701-024-05888-4 -
Reviews in Medical Virology May 2022This study aimed to systematically assess COVID-19 patient background characteristics and pre-existing comorbidities associated with hospitalisation status. The... (Meta-Analysis)
Meta-Analysis Review
This study aimed to systematically assess COVID-19 patient background characteristics and pre-existing comorbidities associated with hospitalisation status. The meta-analysis included cross-sectional, cohort, and case-series studies with information on hospitalisation versus outpatient status for COVID-19 patients, with background characteristics and pre-existing comorbidities. A total of 1,002,006 patients from 40 studies were identified. Significantly higher odds of hospitalisation were observed in Black individuals (OR = 1.33, 95% CI: 1.04-1.70), males (OR = 1.59, 95% CI: 1.43-1.76), and persons with current/past smoking (OR = 1.59, 95% CI: 1.34-1.88). Additionally, individuals with pre-existing comorbidities were more likely to be hospitalised [asthma (OR = 1.22, 95% CI: 1.02-1.45), COPD (OR = 3.68, 95% CI: 2.97-4.55), congestive heart failure (OR = 6.80, 95% CI: 4.97-9.31), coronary heart disease (OR = 4.40, 95% CI: 3.15-6.16), diabetes (OR = 3.90, 95% CI: 3.29-4.63), hypertension (OR = 3.89, 95% CI: 3.34-4.54), obesity (OR = 1.98, 95% CI: 1.59-2.46) and renal chronic disease (OR = 5.84, 95% CI: 4.51-7.56)]. High heterogeneity and low publication bias among all factors were found. Age was not included due to the large variability in the estimates reported. In this systematic review/meta-analysis for patients with COVID-19, Black patients, males, persons who smoke, and those with pre-existing comorbidities were more likely to be hospitalised than their counterparts. Findings provide evidence of populations with higher odds of hospitalisation for COVID-19.
Topics: COVID-19; Comorbidity; Cross-Sectional Studies; Humans; Hypertension; Male; Outpatients
PubMed: 34674338
DOI: 10.1002/rmv.2306 -
American Journal of Public Health Mar 2023Schools are sites of dating and relationship violence (DRV) and of gender-based violence (GBV) victimization and perpetration. School-based interventions can reach a... (Meta-Analysis)
Meta-Analysis
Schools are sites of dating and relationship violence (DRV) and of gender-based violence (GBV) victimization and perpetration. School-based interventions can reach a broad range of students, targeting both individual and group processes that may underpin DRV and GBV. Considering DRV and GBV jointly is important because of their shared etiologies. Comparing the effectiveness of interventions using network meta-analysis (NMA) can support decision-making on optimal resource use. To evaluate the comparative effectiveness of school-based interventions for children aged 5 to 18 years on DRV and GBV victimization, perpetration, and related mediators. We searched 21 databases in July 2020 and June 2021, alongside extensive supplementary search methods, including gray literature searches, forward and backward citation chasing, and searches on first and last author names. We included randomized-controlled trials of interventions for children of compulsory school age implemented within the school setting, and either partially or wholly aimed at changing DRV or GBV outcomes. Pairwise meta-analyses using random-effects robust variance estimation considered intervention effectiveness on DRV and GBV victimization and perpetration using odds ratios, and on mediators (e.g., knowledge and attitudes) using standardized mean differences. Effects were divided into short-term (< 12 months postbaseline) and long-term (≥ 12 months postbaseline). NMAs on victimization and perpetration outcomes compared interventions categorized by breadth of mechanism and complexity of delivery and implementation. Meta-regression tested sensitivity to percentage of girls in the trial sample and country context. Our analysis included 68 trials. Evidence was stronger overall for effects on DRV than for GBV, with significant long-term impacts on DRV victimization (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.68, 0.99) and DRV perpetration (OR = 0.78; 95% CI = 0.64, 0.94). Knowledge and attitudinal effects were predominantly short-term (e.g., for DRV-related violence acceptance, = 0.16; 95% CI = 0.08, 0.24). NMAs did not suggest the superiority of any intervention type; however, most analyses for GBV outcomes were inconsistent. A higher proportion of girls in the sample was associated with increased effectiveness on long-term victimization outcomes. Evidence is stronger for DRV than for GBV, despite considerable heterogeneity. Certainty of findings was low or very low overall. Violence reductions may require more than 1 school year to become apparent. More extensive interventions may not be more effective. A possible reason for stronger effectiveness for DRV is that whereas GBV is ingrained in school cultures and practices, DRV is potentially more open to change via addressing individual knowledge and attitudes. (. 2023;113(3):320-330. https://doi.org/10.2105/10.2105/AJPH.2022.307153).
Topics: Child; Female; Humans; Gender-Based Violence; Network Meta-Analysis; Violence; Crime Victims; Attitude
PubMed: 36791352
DOI: 10.2105/AJPH.2022.307153 -
Heliyon Mar 2024Self-harm (any self-injury or -poisoning regardless of intent) is highly prevalent in transgender and gender diverse (TGD) populations. It is strongly associated with... (Review)
Review
BACKGROUND
Self-harm (any self-injury or -poisoning regardless of intent) is highly prevalent in transgender and gender diverse (TGD) populations. It is strongly associated with various adverse health and wellbeing outcomes, including suicide. Despite increased risk, TGD individuals' unique self-harm pathways are not well understood. Following PRISMA guidelines we conducted the first systematic review of risk and protective factors for self-harm in TGD people to identify targets for prevention and intervention.
METHODS
We searched five electronic databases (PubMed, PsychInfo, Scopus, MEDLINE, and Web of Science) published from database inception to November 2023 for primary and secondary studies of risk and/or protective factors for self-harm thoughts and behaviours in TGD people. Data was extracted and study quality assessed using Newcastle-Ottawa Scales.
FINDINGS
Overall, 78 studies published between 2007 and 2023 from 16 countries (N = 322,144) were eligible for inclusion. Narrative analysis identified six key risk factors for self-harm in TGD people (aged 7-98years) were identified. These are younger age, being assigned female at birth, illicit drug and alcohol use, sexual and physical assault, gender minority stressors (especially discrimination and victimisation), and depression or depressive symptomology. Three important protective factors were identified: social support, connectedness, and school safety. Other possible unique TGD protective factors against self-harm included: chosen name use, gender-identity concordant documentation, and protective state policies. Some evidence of publication bias regarding sample size, non-responders, and confounding variables was identified.
INTERPRETATION
This systematic review indicates TGD people may experience a unique self-harm pathway. Importantly, the risk and protective factors we identified provide meaningful targets for intervention. TGD youth and those assigned female at birth are at increased risk. Encouraging TGD people to utilise and foster existing support networks, family/parent and peer support groups, and creating safe, supportive school environments may be critical for self-harm and suicide prevention strategies. Efforts to reduce drug and alcohol use and experiences of gender-based victimisation and discrimination are recommended to reduce self-harm in this high-risk group. Addressing depressive symptoms may reduce gender dysphoria and self-harm. The new evidence presented in this systematic review also indicates TGD people may experience unique pathways to self-harm related to the lack of social acceptance of their gender identity. However, robust longitudinal research which examines gender-specific factors is now necessary to establish this pathway.
PubMed: 38468947
DOI: 10.1016/j.heliyon.2024.e26074 -
PloS One 2023Undernutrition (Body Mass Index < 18.5 kg/m2) is a common problem and a major cause of hospital admission for patients living with HIV. Though sub-Saharan Africa is the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Undernutrition (Body Mass Index < 18.5 kg/m2) is a common problem and a major cause of hospital admission for patients living with HIV. Though sub-Saharan Africa is the most commonly affected region with HIV and malnutrition, a meta-analysis study that estimates the prevalence and correlates of undernutrition among adults living with HIV has not yet been conducted. The objective of this study was to determine the pooled prevalence of undernutrition and associated factors among adults living with HIV/AIDS in sub-Saharan Africa.
METHODS
Studies published in English were searched systematically from databases such as PubMed, Google Scholar, and gray literature, as well as manually from references in published articles. Observational studies published from 2009 to November 2021 were included. The data extraction checklist was prepared using Microsoft Excel and includes author names, study area, publication year, sample size, prevalence/odds ratio, and confidence intervals. The results were presented and summarized in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standard. Heterogeneity was investigated using the Q test, I2, τ2, τ and predictive interval. STATA version 17 was used to analyze the data. A meta-analysis using a random-effects model was used to determine the overall prevalence and adjusted odds ratio. The study has been registered in PROSPERO with a protocol number of CRD42021268603.
RESULTS
In this study, a total of 44 studies and 22,316 participants were included. The pooled prevalence of undernutrition among adult people living with HIV (PLWHIV) was 23.72% (95% CI: 20.69-26.85). The factors associated with undernutrition were participants' age (AOR = 0.5, 95% CI: 0.29-0.88), gender (AOR = 2.08, 95% CI: 0.22-20.00), World Health Organization (WHO) clinical stage (AOR = 3.25, 95% CI: 2.57-3.93), Cluster of Differentiation 4 (CD4 count) (AOR = 1.94, 95% CI: 1.53-2.28), and duration of ART (AOR = 2.32, 95% CI: 1.6-3.02).
CONCLUSION
The pooled prevalence of undernutrition among adult PLWHIV in sub-Saharan Africa remained high. WHO clinical stage, CD4 count, duration of ART treatment, age, and sex were found to be the factors associated with undernutrition. Reinforcing nutrition counseling, care, and support for adults living with HIV is recommended. Priority nutritional screening and interventions should be provided for patients with advanced WHO clinical stages, low CD4 counts, the male gender, younger age groups, and ART beginners.
Topics: Humans; Adult; Male; Nutrition Assessment; Prevalence; Nutritional Status; HIV Infections; Malnutrition; Africa South of the Sahara
PubMed: 36961844
DOI: 10.1371/journal.pone.0283502 -
Environmental Pollution (Barking, Essex... Dec 2022Per-and polyfluoroalkyl substances (PFAS) is a collective name for approximately 4700 synthetic chemicals ubiquitous in the aquatic environment worldwide. They are used... (Meta-Analysis)
Meta-Analysis Review
Per-and polyfluoroalkyl substances (PFAS) is a collective name for approximately 4700 synthetic chemicals ubiquitous in the aquatic environment worldwide. They are used in a wide array of products and are found in living organisms around the world. Some PFAS have been associated with cancer, developmental toxicity, endocrine disruption, and other health effects. Only a fraction of PFAS are currently monitored and regulated and the presence and effects on aquatic organisms of many PFAS are largely unknown. The aim of this study is to investigate the health effects of environmentally relevant concentrations of PFAS on aquatic organisms at different consumer trophic levels through a systematic review and meta-analysis. The main result shows that PFAS in concentrations up to 13.5 μg/L have adverse effects on body size variables for secondary consumers. However, no significant effects on liver or gonad somatic indices and neither on fecundity were found. In addition, the results show that there are large research gaps for PFAS effects on different organisms in aquatic environments at environmentally relevant concentrations. Most studies have been performed on secondary consumers and there is a substantial lack of studies on other consumers in aquatic ecosystems.
Topics: Fluorocarbons; Aquatic Organisms; Ecosystem
PubMed: 36244496
DOI: 10.1016/j.envpol.2022.120422 -
BMC Neurology Sep 2023Menopause is a physiologic phase in women's lives. Findings regarding multiple sclerosis (MS) course through menopause are diverse. So, we designed this systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Menopause is a physiologic phase in women's lives. Findings regarding multiple sclerosis (MS) course through menopause are diverse. So, we designed this systematic review and meta-analysis to estimate the impact of menopause on relapse rate, and disability status in women with MS.
METHODS
PubMed, Scopus, EMBASE, Web of Science, and google scholar were systematically searched by two independent researchers on January 1st, 2023. They also evaluated conference abstracts, and references of the included studies. In addition, data regarding the total number of participants, name of the first author of the publication, publication year, country of origin, disease duration, disease type, annual relapse rate, and Expanded Disability Status Scale (EDSS) before and after menopause were recorded.
RESULTS
A literature search revealed 1024 records. Twenty-one full texts were evaluated, and finally, four studies were included for meta-analysis. Mean ARR before menopause ranged between 0.21 and 0.37, and after menopause ranged between 0.13 and 0.08. The SMD of mean ARR ranged between - 1.04, and - 0.29, while the pooled SMD was estimated as -0.52(95% CI: -0.88, -0.15) (I = 73.6%, P = 0.02). The mean EDSS before menopause ranged between 1.5 and 2, and after menopause ranged between 2 and 3.1. The SMD of EDSS ranged between 0.46, and 0.71. The pooled SMD of EDSS change (after menopause-before menopause) estimated as 0.56(95% CI: 0.38, 0.73)(I = 0, P = 0.4).
CONCLUSION
The result of this systematic review and meta-analysis show that menopause can be associated with relapse rate reduction, unlike increase in disease-related disability in women with MS.
Topics: Humans; Female; Multiple Sclerosis; Menopause; Patients; Chronic Disease
PubMed: 37667181
DOI: 10.1186/s12883-023-03332-1