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BMC Public Health Jul 2022Within the past two decades, Ethiopia has achieved one of the fastest reductions of open defecation worldwide. This change can be attributed to the implementation of a...
BACKGROUND
Within the past two decades, Ethiopia has achieved one of the fastest reductions of open defecation worldwide. This change can be attributed to the implementation of a national sanitation strategy that focused on facilitating community demand for latrine adoption and use of basic self-constructed latrines but less on other preconditions of hygienic sanitation. Recognition of sanitation by policymakers also catalyzed primary research in this area. As such, the synthesis of the available evidence is both warranted and possible. In this article, we thus decided to assess available primary evidence on the household-level sanitation in Ethiopia and its influencing factors.
METHODS
We searched primary studies that present findings on the role of factors influencing household-level sanitation outcomes in Ethiopia. We typologically classified sanitation outcomes analyzed in identified literature and computed pooled estimates for the most prevalent ones (measures of latrine availability and use). We characterized thematic types (themes and sub-themes) of influential sanitation drivers and used network analysis to examine the relational patterns between sanitation outcomes and their influencing factors.
FINDINGS
We identified 37 studies that met our inclusion criteria-all but one published after 2009. The general latrine coverage pooled across 23 studies was 70% (95% CI: 62-77%), the share of improved latrines pooled across 15 studies was 55% (95% CI: 41-68%), and latrine use pooled across 22 studies was 72% (95% CI: 64-79%). Between-study heterogeneity was high, and no time trends were identified. The identified sanitation outcomes were classified into eight types and factors reported to influence these outcomes were classified into 11 broader themes and 43 more specific sub-themes. Factors around the quality of latrines represented the most frequent sub-theme of consequential drivers. We found that the available research focused predominantly on outcomes concerning the initial adoption and use of basic latrines, emulating the main focus of national sanitation strategy. By contrast, research on drivers of the sustainability of sanitation change and, in particular, on the upgrading of latrines, has been rare despite its urgency. There is a high need to redirect the focus of sanitation research in Ethiopia towards understanding these factors on both the demand and supply side.
Topics: Ethiopia; Family Characteristics; Humans; Hygiene; Rural Population; Sanitation; Toilet Facilities
PubMed: 35906616
DOI: 10.1186/s12889-022-13822-5 -
Journal of Integrative and... Nov 2023Gastrointestinal immobility is experienced by many patients who undergo gastric surgery. This complication delays enteral nutrition, prolongs hospitalization, and... (Meta-Analysis)
Meta-Analysis Review
Gastrointestinal immobility is experienced by many patients who undergo gastric surgery. This complication delays enteral nutrition, prolongs hospitalization, and causes discomfort. Acupoint stimulation is a popular alternative nonpharmacological treatment for gastrointestinal immobility. This study aimed to explore the effects of acupoint stimulation on gastrointestinal immobility after gastrectomy. Systematic review and meta-analysis. Databases (PubMed, Cochrane, Joanna Briggs Institute EBP Database, Medline, CINAHL Complete, and Airiti library) were searched from their inception to April 2022 for relevant articles. Articles in Chinese and English were included, without limitations on year, region, or country. The inclusion criteria were studies with participants >18 years of age, postgastric surgery, and hospitalization. In addition, randomized controlled trials (RCTs) were included. Data were analyzed using random effects models, and data heterogeneity was investigated using subgroup analysis. Meta-analysis was performed using Review Manager 5.4 software. We included 785 participants from six studies. Invasive and noninvasive acupoint stimulation reduced the time of gastrointestinal mobility better than usual care. In the control group, the time of first flatus was 43.56 ± 9.57 h to 108 ± 19.2 h, and the time of first defecation was 77.27 ± 22.67 h to 139.2 ± 24 h. In the experimental group, the time of first flatus and defecation was 36.58 ± 10.75 h to 79.97 ± 37.31 h and 70.56 ± 15.36 h to 108.55 ± 10.75 h, respectively. Subgroup analysis showed that invasive acupoint stimulation with acupuncture reduced the time of first flatus and defecation to 15.03 h (95% confidence interval [CI] = -31.06 to 1.01) and 14.12 h (95% CI = -32.78 to 4.54), respectively. Noninvasive acupoint stimulation, including acupressure and transcutaneous electrical acupoint stimulation (TEAS), reduced the time of first flatus and defecation to 12.33 h and (95% CI = -20.59 to -4.06) and 12.20 h (95% CI = -24.92 to 0.52), respectively. Acupoint stimulation improved the gastrointestinal immobility of postgastrectomy. In the included RCT articles, invasive and noninvasive stimulations were effective. However, noninvasive acupoint stimulation, such as with TEAS and acupressure, was more efficient and convenient than invasive stimulation. Overall, health care professionals with adequate training or under the supervision of an acupuncturist can effectively perform acupoint stimulation to improve the quality of postgastrectomy care. They can select commonly used and effective acupoints to enhance gastrointestinal motility. Acupoint stimulation, such as acupressure, electrical acupoint stimulation, or acupuncture, can be included in postgastrectomy routine care to improve gastrointestinal motility and reduce abdominal discomfort.
Topics: Humans; Acupuncture Points; Flatulence; Gastrectomy; Acupuncture Therapy; Gastrointestinal Motility
PubMed: 37379490
DOI: 10.1089/jicm.2022.0752 -
Pediatric Surgery International Jan 2015The laparoscopically-assisted anorectal pull-through (LAARP) for recto-bladderneck and recto-prostatic anorectal malformations (RB/RP-ARMs) is believed to improve... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The laparoscopically-assisted anorectal pull-through (LAARP) for recto-bladderneck and recto-prostatic anorectal malformations (RB/RP-ARMs) is believed to improve patient outcomes. We performed a systematic review of the effect of LAARP on postoperative mucosal prolapse and defecation dysfunction.
METHODS
A comprehensive search of MEDLINE, EMBASE, CENTRAL, and grey literature was performed (2000-2014). Full-text screening, data abstraction and quality appraisal were conducted in duplicate. Included studies reported a primary diagnosis of RB/RP-ARM and compared LAARP versus open repair (OPEN).
RESULTS
From 3681 retrieved articles, 7 studies enrolling 187 patients were analyzed. One was a randomized control trial, 6 were retrospective observational studies, and all were single-centre. The majority were of poor-moderate quality (MINORS scores: mean 16.42 (SD 2.225) out of 24). Mucosal prolapse was not significantly different after LAARP versus OPEN (p = 0.18). Defecation outcomes were inconsistently reported but were no different between LAARP and OPEN for either children >3 years old (p = 0.84), or all ages combined (p = 0.11).
CONCLUSION
We found no significant difference in rates of mucosal prolapse or defecation scores for LAARP compared to OPEN for children with RB/RP-ARMs. However, studies are small and of poor-moderate quality and results are heterogeneous. Comprehensive, standardized, reliable reporting is necessary to guide practice and inform postoperative guidelines.
LEVEL OF EVIDENCE
1c.
Topics: Abnormalities, Multiple; Anal Canal; Anorectal Malformations; Anus, Imperforate; Digestive System Surgical Procedures; Female; Humans; Infant, Newborn; Laparoscopy; Male; Prostatic Diseases; Rectum; Urinary Bladder Fistula
PubMed: 25316437
DOI: 10.1007/s00383-014-3626-3 -
Journal of Pediatric Gastroenterology... Mar 2010Knowledge regarding prognosis and factors influencing the clinical course of functional constipation in children is important to enable general practitioners and... (Review)
Review
BACKGROUND AND AIM
Knowledge regarding prognosis and factors influencing the clinical course of functional constipation in children is important to enable general practitioners and paediatricians to give accurate patient information, to compare treatment strategies, and identify children with high risk for unfavourable outcome. The objective of the study was to investigate and summarize the quantity and quality of evidence on prognosis of childhood constipation with and without treatment and its predictive factors.
METHODS
An extensive literature search in MEDLINE and Embase was performed to identify prospective follow-up studies evaluating the prognosis or prognostic determinants of functional constipation. Methodological quality was assessed using a standardised list. Results on prognosis of constipation were statistically pooled, and the influence of prognostic factors was summarised in a best evidence synthesis.
RESULTS
The search strategy resulted in a total of 2882 abstracts. Only 14 publications met our inclusion criteria, of which 21% scored high methodological quality. Included studies showed large heterogeneity in study populations and outcome measures. Without regard to these differences, 49.3% +/- 11.8% of all of the children followed for 6 to 12 months were found to recover and taken off laxatives. The percentage of children who were free from complaints, regardless of laxative use, after 6 to 12 months was 60.6% +/- 19.2%. There is substantial evidence that defecation frequency and a positive family history are not associated with recovery from constipation.
CONCLUSIONS
The few studies published on prognosis of childhood functional constipation and predictive factors showed large heterogeneity and poor methodological quality. Overall, 60.6% of children are found to be free from symptoms after 6 to 12 months. Recovery rate showed no relation with defecation frequency or positive family history. Based on the present literature, we are unable to identify a group of children with high risk for poor prognosis.
Topics: Child; Colonic Diseases, Functional; Constipation; Family; Humans; Laxatives; Prognosis; Prospective Studies; Recovery of Function; Risk Factors
PubMed: 20118805
DOI: 10.1097/MPG.0b013e3181afcdc3 -
Journal of Gastrointestinal Surgery :... Nov 2021To systematically review literature and to assess the status of the ERAS protocol in pediatric populations undergoing gastrointestinal surgery. (Meta-Analysis)
Meta-Analysis Review
AIM
To systematically review literature and to assess the status of the ERAS protocol in pediatric populations undergoing gastrointestinal surgery.
METHODS
Literature research was carried out for papers comparing ERAS and traditional protocol in children undergoing gastrointestinal surgery. Data on complications, hospital readmission, length of hospital stay, intraoperative fluid volume, post-operative opioid usage, time to defecation, regular diet, intravenous fluid stop, and costs were collected and analyzed. Analyses were performed using OR and CI 95%. A p value <0.05 was considered significant.
RESULTS
A total of 8 papers met the inclusion criteria, with 943 included patients. There was no significant difference in complication occurrence and 30-day readmission. Differently, length of stay, intraoperative fluid volume, post-operative opioid use, time to first defecation, time to regular diet, time to intravenous fluid stop, and costs were significantly lower in the ERAS groups.
CONCLUSIONS
ERAS protocol is safe and feasible for children undergoing gastrointestinal surgery. Without any significant complications and hospital readmission, it decreases length of stay, ameliorates the recovery of gastrointestinal function, and reduces the needs of perioperative infusion, post-operative opioid administration, and costs.
Topics: Analgesics, Opioid; Child; Digestive System Surgical Procedures; Humans; Length of Stay; Patient Readmission; Postoperative Complications; Postoperative Period; Recovery of Function
PubMed: 34244952
DOI: 10.1007/s11605-021-05053-7 -
European Spine Journal : Official... Aug 2016To evaluate the efficacy of single-stage posterior vertebral column resection for old thoracolumbar fracture-dislocations with spinal cord injury. (Review)
Review
PURPOSE
To evaluate the efficacy of single-stage posterior vertebral column resection for old thoracolumbar fracture-dislocations with spinal cord injury.
METHODS
From January 2007 to June 2013, twelve male patients (average age, 32.6 years; range 19-57 years) with old fracture-dislocations of the thoracolumbar spine and spinal cord injury underwent single-stage posterior vertebral column resection and internal fixation. All patients were assessed for relief of the pain and restoration of neurologic function. Postoperative Cobb angle was measured and bone graft fusion was evaluated by X-ray. A systematic review of 25 studies evaluating surgical management of thoracolumbar fractures with spinal cord injuries was also performed.
RESULTS
From our case series, six of the nine patients with Frankel grade A had significant improvement in urination and defecation after surgery. The three patients with Frankel grades B and C had progression of 1-2 grades after surgery. Bony fusion was achieved and local back pain was relieved in all patients after surgery. From our systematic review of 25 studies, the majority of patients had improved back pain, the postoperative kyphotic angle was significantly reduced compared with pre-operative kyphotic angle.
CONCLUSION
Single-stage posterior vertebral column resection and internal fixation for old thoracolumbar fracture-dislocations is an ideal treatment allowing for thorough decompression, relief of pain, correction of deformities, and restoration of spinal stability.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Back Pain; Bone Transplantation; Decompression, Surgical; Female; Fracture Fixation, Internal; Humans; Joint Dislocations; Kyphosis; Lumbar Vertebrae; Male; Middle Aged; Postoperative Period; Plastic Surgery Procedures; Spinal Cord Injuries; Spinal Fractures; Thoracic Vertebrae; Thoracic Wall; Young Adult
PubMed: 25953526
DOI: 10.1007/s00586-015-3955-5 -
The American Journal of Gastroenterology Nov 2018Balloon expulsion testing (BET) is recommended to evaluate for dyssynergic defecation in patients with chronic constipation (CC). However, it remains poorly standardized... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Balloon expulsion testing (BET) is recommended to evaluate for dyssynergic defecation in patients with chronic constipation (CC). However, it remains poorly standardized and is limited to specialized centers. Our goal was to assess the clinical utility of balloon expulsion as an initial test for dyssynergic defecation and to determine appropriate testing parameters.
METHODS
We performed a literature search to identify cohort studies of unselected subjects with CC and case-control studies of subjects with/without dyssynergic defecation. We defined dyssynergic defecation by constipation symptoms and a positive reference test (anorectal manometry [ARM], defecography, or electromyography [EMG]). We performed a meta-analysis using a bivariate mixed-effects regression model to assess summary sensitivity, specificity, and area under the curve (AUC) with 95% confidence intervals (CI). We conducted a meta-regression to investigate individual test parameters and demographic variables.
RESULTS
We identified 15 eligible studies comprising 2090 individual assessments of BET. Among cohort studies, the AUC was 0.80 (95% CI: 0.61-0.91) with 70% sensitivity (95% CI: 52-83%) and 77% specificity (95% CI: 70-82%). In pooling cohort and case-control studies, the AUC was 0.84 (95% CI: 0.68-0.93) with 70% sensitivity (95% CI: 53-82%) and 81% specificity (95% CI: 75-86%). Subject positioning (seated vs. left lateral decubitus) did not significantly affect test performance in cohort (p = 0.82) or case-control (p = 0.43) analysis. Most studies evaluated 50-60 mL water insufflation. Test performance was not significantly affected by varying the maximum allowed expulsion time between 1 to 5 min. Age and gender likely accounted for significant study heterogeneity between studies. Choice of reference test, continent of study, and year of study did not significantly affect test performance.
DISCUSSION
We report an optimized BET protocol. The performance characteristics of BET could support its use as a point of service test to screen for dyssynergic defecation in chronically constipated subjects.
Topics: Anal Canal; Ataxia; Chronic Disease; Constipation; Defecation; Defecography; Diagnostic Techniques, Digestive System; Electromyography; Humans; Manometry; Mass Screening; Patient Positioning; Practice Guidelines as Topic; ROC Curve; Rectum; Time Factors
PubMed: 30171220
DOI: 10.1038/s41395-018-0230-5 -
International Journal of Clinical... Jun 2010It is unclear how polyethylene glycol (PEG) laxatives compare with other classes of laxative in terms of efficacy. To assess efficacy of PEG vs. placebo and active... (Meta-Analysis)
Meta-Analysis Review
It is unclear how polyethylene glycol (PEG) laxatives compare with other classes of laxative in terms of efficacy. To assess efficacy of PEG vs. placebo and active comparators in adults with non-organic constipation. Text Word searches were carried out on MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Clinical Trials and Google Scholar databases covering the period January 1970 to October 2009. Search terms were (constipation) AND (randomised OR randomized) AND (PEG OR polyethylene OR macrogol OR movicol OR idrolax OR miralax OR transipeg OR forlax OR colyte OR golytely OR isocolan OR nulytely) NOT colonoscopy. Only published randomised controlled trials, with a parallel-group or cross-over design, comparing oral PEG with placebo or a comparator laxative in adults with a history of non-organic constipation, were included. The frequency of defaecation in each arm, on completion of the protocol-defined treatment duration was extracted. All pooled analyses were based on random effect models. Of the 20 qualifying studies, 10 were vs. placebo, seven were vs. lactulose, and four were vs. other agents. One study compared PEG, placebo and lactulose. PEG treatment resulted in a highly significant increase in defaecations/week over placebo (all studies: additional 1.98 stools/week; p = 0.0003, high-quality studies: additional 2.34 stools/week; p = 0.0001) and over lactulose (all studies: additional 1 stool/week; p = 0.0017, high-quality studies: additional 1.65 stools/week; p = 0.021). This meta analysis is the only quantitative statistical analysis to have been published in the field. PEG was found to be a more effective laxative than lactulose in adult patients with constipation.
Topics: Adult; Constipation; Defecation; Electrolytes; Humans; Laxatives; Osmolar Concentration; Polyethylene Glycols; Treatment Outcome
PubMed: 20584228
DOI: 10.1111/j.1742-1241.2010.02397.x -
European Journal of Gastroenterology &... Aug 2022Hemorrhoids are common anorectal pathology, with high recurrence rates after surgical treatment. It is hypothesized that high straining forces during paradoxical... (Meta-Analysis)
Meta-Analysis
Hemorrhoids are common anorectal pathology, with high recurrence rates after surgical treatment. It is hypothesized that high straining forces during paradoxical contractions and inadequate relaxation are causally related to hemorrhoids. This review aimed to assess the coprevalence of functional constipation and dyssynergic defecation in a population with hemorrhoids. Moreover, the effects of rubber band ligation (RBL) were analyzed. Sources included Pubmed, Embase and CENTRAL . Randomized trials, cohort and case-control studies that investigated the prevalence of constipation in patients with hemorrhoids or the prevalence of hemorrhoids in patients with constipation compared to healthy subjects were included. Manometric studies were also eligible. Quality assessment was performed by using the Newcastle Ottawa Quality Assessment Scale. The primary outcome was the prevalence of functional constipation or dyssynergic defecation in patients with hemorrhoids. Nineteen studies were included. Prevalence of constipation was significantly higher in patients with hemorrhoids compared to controls [OR (odds ratio), 2.09; 95% CI (confidence interval), 1.27-3.44]. No significant difference in the prevalence of hemorrhoids between patients with constipation compared to controls was found (OR, 2.37; 95% CI, 0.67-8.44). Anal pressures in patients with hemorrhoids were significantly higher compared to healthy controls in all manometric studies. After RBL, these pressures remained significantly higher in patients with hemorrhoids ( P = 0.001). Functional constipation, dyssynergic defecation and higher basal anal pressures are more prevalent in patients with hemorrhoids compared to controls. Improvement of therapy for functional constipation, especially dyssynergic defecation patterns, might lead to better long-term outcomes and reduce recurrence.
Topics: Anal Canal; Case-Control Studies; Constipation; Defecation; Hemorrhoids; Humans; Manometry
PubMed: 35412490
DOI: 10.1097/MEG.0000000000002361 -
International Journal of Environmental... May 2022Fecal contamination of water sources and open defecation have been linked to cholera outbreaks in India. However, a systematic review on the drivers responsible for... (Review)
Review
Fecal contamination of water sources and open defecation have been linked to cholera outbreaks in India. However, a systematic review on the drivers responsible for these outbreaks has yet to be published. Here, we systematically review the published literature on cholera outbreaks in India between 2011 and 2020. We searched studies in English in three databases (MEDLINE, EMBASE, and Web of Science) and the Integrated Disease Surveillance Program that tracks cholera outbreaks throughout India. Two authors independently extracted data and assessed the quality of the included studies. Quantitative data on the modes of transmission reviewed in this study were assessed for any change over time between 2011-2015 and 2016-2020. Our search retrieved 10823 records initially, out of which 81 full-text studies were assessed for eligibility. Among these 81 studies, 20 were eligible for inclusion in this review. There were 565 reported outbreaks between 2011 and 2020 that led to 45,759 cases and 263 deaths. Outbreaks occurred throughout the year; however, they exploded with monsoons (June through September). In Tamil Nadu, a typical peak of cholera outbreaks was observed from December to January. Seventy-two percent (33,089/45,759) of outbreak-related cases were reported in five states, namely Maharashtra, West Bengal, Punjab, Karnataka, and Madhya Pradesh. Analysis of these outbreaks highlighted the main drivers of cholera including contaminated drinking water and food, inadequate sanitation and hygiene (including open defecation), and direct contact between households. The comparison between 2011-2015 and 2016-2020 showed a decreasing trend in the outbreaks that arose due to damaged water pipelines. Many Indians still struggle with open defecation, sanitation, and clean water access. These issues should be addressed critically. In addition, it is essential to interrupt cholera short-cycle transmission (mediated by households, stored drinking water and foodstuffs) during an outbreak. As cholera is associated with deprivation, socio-economic development is the only long-term solution.
Topics: Cholera; Disease Outbreaks; Drinking Water; Humans; India; Sanitation
PubMed: 35565133
DOI: 10.3390/ijerph19095738