-
Journal of Public Health Management and... 2013The Centers for Disease Control and Prevention encourages the use of risk factor questionnaires to screen children for lead poisoning. A majority of state health... (Review)
Review
CONTEXT
The Centers for Disease Control and Prevention encourages the use of risk factor questionnaires to screen children for lead poisoning. A majority of state health departments have formal lead screening guidelines that recommend health care providers use questionnaires.
OBJECTIVE
We conducted a systematic review to evaluate the ability of lead screening questionnaires to predict lead poisoning risk among children.
METHODS
Articles that reported the evaluation of a predesigned lead screening questionnaire were obtained by searching Medline/PubMed and by examining references of articles obtained through the online search. From each evaluation, we abstracted the number of children that were true positive, false positive, true negative, and false negative, according to the results of the screening questionnaire and the follow-up blood lead test. From these data, we calculated specificity and sensitivity of the questionnaire for each evaluation.
RESULTS
Twenty articles met the inclusion criteria: these included 28 separate questionnaire evaluations. Among 17 evaluations of the 1991 Centers for Disease Control and Prevention questionnaire, sensitivity ranged from 0.25 to 0.87, specificity from 0.31 to 0.80, and accuracy (sum of sensitivity and specificity) from 0.74 to 1.39. The pooled mean estimates for this questionnaire were sensitivity 0.61 (95% confidence interval: 0.53-0.68); specificity 0.52 (0.45-0.60); accuracy 1.12 (1.06-1.18). Among 11 evaluations of all other questionnaires, sensitivity ranged from 0.43 to 0.90, specificity from 0.17 to 0.66, and accuracy from 0.94 to 1.27. For these questionnaires, the pooled mean estimates were sensitivity 0.76 (0.68-0.85), specificity 0.41 (0.33-0.49), and accuracy 1.12 (1.06-1.18).
CONCLUSIONS
Lead screening questionnaires showed a wide range of sensitivity and specificity and performed little better than chance at predicting lead poisoning risk among children.
Topics: Centers for Disease Control and Prevention, U.S.; Child; Diagnostic Errors; Humans; Lead Poisoning; Mass Screening; Risk Assessment; Sensitivity and Specificity; Surveys and Questionnaires; United States
PubMed: 22668673
DOI: 10.1097/PHH.0b013e3182249523 -
Foodborne Pathogens and Disease Feb 2022Listeriosis is a rare bacterial infection associated with foodborne illness that can result in septicemia, a serious acute outcome. Sepsis is responsible for one in... (Meta-Analysis)
Meta-Analysis
Listeriosis is a rare bacterial infection associated with foodborne illness that can result in septicemia, a serious acute outcome. Sepsis is responsible for one in three deaths during hospitalization. The objective of this study was to conduct a systematic review and meta-analysis to estimate the proportion of infections resulting in septicemia. PubMed, Embase, Scopus, and Web of Science were searched from January 1, 2000, to April 1, 2018, for epidemiological studies that assessed studies focusing on infections with the outcome of septicemia. Articles in English, Spanish, and Portuguese using case-control, cohort, or outbreak studies reporting measures of association between and septicemia were included. Bias and heterogeneity were assessed using univariate meta-regression for region, sample size, study design, and report method. Nineteen articles were eligible for inclusion post-screening, the majority of which were conducted in Europe ( = 15); utilized a retrospective cohort design ( = 16); and collected data via routine or laboratory surveillance methods ( = 10). Prevalence of sepsis ranged from 4.2% to 100% among study populations of 6 to 1374 individuals. Overall, the proportion of listeriosis cases that developed sepsis was 46% (95% confidence interval [CI] 31.0-61.0%); for neonatal cases, 21.3% (95% CI 11.0-31.6%); and for maternal and neonatal cases, 18.8% (95% CI 10.7-26.8%). The heterogeneity was high for overall and group meta-analyses, but it could not be explained by the subanalyses for the overall proportion, whereas for neonatal, and neonatal and maternal cases combined, China had a significantly lower proportion than Europe and the United States. Septicemia following infection is a severe acute complication with 31-61% rate found overall; however, greater delineation of demographic data is needed to determine important risk factors. Future research should aim to address the gaps in knowledge in the long-term outcomes of sepsis from infection, and whether these outcomes differ from those due to other infections.
Topics: Foodborne Diseases; Humans; Infant, Newborn; Listeria monocytogenes; Listeriosis; Retrospective Studies; Sepsis
PubMed: 34883025
DOI: 10.1089/fpd.2021.0046 -
Reviews on Environmental Health Mar 2024Lead in the environment remains a matter of grave concern for public health. Lead has been associated with some traditional medicines and has been linked to cases of... (Review)
Review
Lead in the environment remains a matter of grave concern for public health. Lead has been associated with some traditional medicines and has been linked to cases of lead poisoning. A comprehensive compilation of these reports has not previously been conducted. The objective of this review is to explore how common is lead exposure after traditional medicine use, and which countries, systems and/or products are of most concern when it comes to lead contamination. A systematic search was conducted on PubMed, Ovid and EMBASE for studies published between 2005 and 2020. A grey literature search was conducted. Search terms related to lead and traditional medicine were developed for each database, and there were no limitations on language. Studies were included if they examined elevated lead in humans resulting from the use of traditional medicines reported in case reports, case-series, or observational studies. Of the papers discussing lead exposure, 85 case reports were identified and synthesized for the current review. Several themes were identified in the included studies. Traditional medicine has been used in the many parts of the world, however use is more common in South and Southeast Asian countries. The level of detectable lead in products varied widely by region and product types. Consumers of traditional medicines sought products for a wide variety of symptoms and ailments. The symptoms of lead poisoning from traditional medicine use reflected the typical symptom profile of lead poisoning, highlighting the need for awareness of traditional medicine products as a source of lead exposure. Traditional medicine usage remains an important part of health care in many regions, however there is a risk of lead exposure from several products. Health care practitioners in all regions of the world should be aware of the risk and explore the potential for traditional medicine use for patients presenting with elevated blood lead levels. Countries with a strong traditional medicine culture should explore policies for reducing lead exposure from traditional medicine products. JG, LO and MNBD are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of the World Health Organization.
Topics: Humans; Asia; Databases, Factual; Lead; Lead Poisoning; Medicine, Traditional
PubMed: 36322973
DOI: 10.1515/reveh-2022-0079 -
BMJ Clinical Evidence Jul 2008Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood... (Review)
Review
INTRODUCTION
Carbon monoxide is an odourless, colourless gas, and poisoning causes hypoxia, cell damage, and death. Exposure to carbon monoxide is measured either directly from blood samples and expressed as a percentage of carboxyhaemoglobin, or indirectly using the carbon monoxide in expired breath. Carboxyhaemoglobin percentage is the most frequently used biomarker of carbon monoxide exposure. Although the diagnosis of carbon monoxide poisoning can be confirmed by detecting elevated levels of carboxyhaemoglobin in the blood, the presence of clinical signs and symptoms after known exposure to carbon monoxide should not be ignored.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of oxygen treatments for acute carbon monoxide poisoning? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2007 (BMJ Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: 100% hyperbaric oxygen, oxygen 28%, and oxygen 100% by non-re-breather mask.
Topics: Carbon Monoxide; Carbon Monoxide Poisoning; Carboxyhemoglobin; Humans; Oxygen; Respiration
PubMed: 19445736
DOI: No ID Found -
Expert Review of Gastroenterology &... Apr 2018Traditional Chinese medicine (TCM) is becoming increasingly popular and related adverse events are often ignored or underestimated. (Meta-Analysis)
Meta-Analysis Review
BACKGROUNDS
Traditional Chinese medicine (TCM) is becoming increasingly popular and related adverse events are often ignored or underestimated.
AIMS
This systematic review aimed to evaluate the clinical characteristics and outcomes of TCM-induced liver injury (TCM-ILI) and to estimate the proportion of TCM-ILI in all drug-induced liver injuries (DILI).
METHODS
China National Knowledge Infrastructure, Wanfang, VIP, PubMed, and Embase databases were searched. Demographic, clinical, and survival data were extracted and pooled. Factors associated with worse outcomes were calculated. For the proportion meta-analyses, the data were pooled by using a random-effects model.
RESULTS
Overall, 21,027 articles were retrieved, of which 625 were finally included. There was a predominance of female and older patients. The proportion of liver transplantation was 2.18% (7/321). The mortality was 4.67% (15/321). Male, higher aspartate aminotransferase and direct bilirubin, and lower albumin were significantly associated with an increased risk of death/liver transplantation in TCM-ILI patients. The proportion of TCM-ILI in all DILI was 25.71%. The proportion was gradually increased with year.
CONCLUSIONS
Our work summarises current knowledge regarding clinical presentation, disease course, and prognosis of TCM-ILI. TCM can result in hepatotoxicity, even death or necessitate life-saving liver transplantation. Governmental regulation of TCM products should be strictly established.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Chemical and Drug Induced Liver Injury; Chi-Square Distribution; Child; Child, Preschool; Drugs, Chinese Herbal; Female; Humans; Infant; Liver Function Tests; Liver Transplantation; Male; Medicine, Chinese Traditional; Middle Aged; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 29323538
DOI: 10.1080/17474124.2018.1427581 -
Molecules (Basel, Switzerland) Jan 2021Trichothecene mycotoxins are sesquiterpenoid compounds primarily produced by fungi in taxonomical genera such as , , , and others, under specific climatic conditions on... (Review)
Review
Trichothecene mycotoxins are sesquiterpenoid compounds primarily produced by fungi in taxonomical genera such as , , , and others, under specific climatic conditions on a worldwide basis. mold is a major plant pathogen and produces a number of trichothecene mycotoxins including deoxynivalenol (or vomitoxin), nivalenol, diacetoxyscirpenol, and T-2 toxin, HT-2 toxin. Monogastrics are sensitive to vomitoxin, while poultry and ruminants appear to be less sensitive to some trichothecenes through microbial metabolism of trichothecenes in the gastrointestinal tract. Trichothecene mycotoxins occur worldwide however both total concentrations and the particular mix of toxins present vary with environmental conditions. Proper agricultural practices such as avoiding late harvests, removing overwintered stubble from fields, and avoiding a corn/wheat rotation that favors growth in residue can reduce trichothecene contamination of grains. Due to the vague nature of toxic effects attributed to low concentrations of trichothecenes, a solid link between low level exposure and a specific trichothecene is difficult to establish. Multiple factors, such as nutrition, management, and environmental conditions impact animal health and need to be evaluated with the knowledge of the mycotoxin and concentrations known to cause adverse health effects. Future research evaluating the impact of low-level exposure on livestock may clarify the potential impact on immunity. Trichothecenes are rapidly excreted from animals, and residues in edible tissues, milk, or eggs are likely negligible. In chronic exposures to trichothecenes, once the contaminated feed is removed and exposure stopped, animals generally have an excellent prognosis for recovery. This review shows the occurrence of trichothecenes in food and feed in 2011-2020 and their toxic effects and provides a summary of the discussions on the potential public health concerns specifically related to trichothecenes residues in foods associated with the exposure of farm animals to mycotoxin-contaminated feeds and impact to human health. Moreover, the article discusses the methods of their detection.
Topics: Animal Feed; Animals; Food Analysis; Food Contamination; Food Microbiology; Foodborne Diseases; Humans; Mitosporic Fungi; Trichothecenes
PubMed: 33467103
DOI: 10.3390/molecules26020454 -
PLoS Neglected Tropical Diseases Apr 2024Snakebite envenoming represents a significant and often neglected public health challenge, particularly in rural communities across tropical and subtropical regions. An... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Snakebite envenoming represents a significant and often neglected public health challenge, particularly in rural communities across tropical and subtropical regions. An estimated 1.2-5.5 million people are envenomed by snakebites annually. More than 125,000 of these bites are fatal, and 3-4 times as many results in disability/disfigurement. Despite its prevalence, collecting accurate epidemiological data on snakebite is challenging. This systematic review and meta-analysis collates global epidemiology data on snakebite morbidity and mortality.
METHODS
Medline, Embase, Cochrane and CINAHL Plus databases were searched for articles published between 2001-2022. Pooled incidence and mortality were obtained using random effects modelling, heterogeneity (I2) was tested, and sensitivity analyses performed. Newcastle-Ottawa Scale assessed study quality.
RESULTS
Out of the four databases, 5,312 articles were found. After removing duplicates, 3,953 articles were screened by title and abstract and 65 articles containing information on snakebite epidemiology, encompassing 663,460 snakebites, were selected for analysis. The people most at risk for snakebite were men (59%), engaged in agricultural labour (27.5%), and residing in rural areas (66.7%). More than half (57%) of the reported bites resulted in envenoming. Incidents occurred frequently in the summer season (38.5%), during daytime (56.7%), and bites were most often to the lower limb (56.4%). Envenoming severity was frequently mild (46.7%), treated in hospital (68.3%), and was treated with anti-venom (64.7%). The pooled global incidence and mortality was 69.4 /100,000 population (95%CI: 36.8 to 101.9) and 0.33/100,000 population (95%CI, 0.14 to 0.52) per year, respectively. Stratified by continents, Asia had the highest incidence of 130.7/100,000 population (95%CI: 48.3 to 213.1) while Europe has the lowest with 0.7/100,000 population (95%CI: -0.2 to 1.5). The highest mortality was reported in Asia at 0.96/100,000 population (95% CI: 0.22 to 1.70), and Africa 0.44/100,000 population (95%CI: -0.03 to 0.84). Incidence was highest among inhabitants of lower-middle-income countries 132.7/100,000 population (95%CI: 55.4 to 209.9) while mortality was highest in low-income countries at 0.85/100,000 population (95% CI: -0.06 to 2.31).
CONCLUSION
Incidence and mortality rates noted here highlight the global impact of snakebite and underscore the critical need to address the burden of snakebite envenoming. It also reveals that while reported snakebite incidence was higher in lower-middle-income countries, the burden of mortality was greatest among inhabitants of low-income countries, again emphasising the need for greater efforts to tackle this neglected tropical disease.
Topics: Male; Humans; Female; Snake Bites; Antivenins; Incidence; Asia; Prevalence
PubMed: 38574167
DOI: 10.1371/journal.pntd.0012080 -
Systematic Reviews Apr 2017Scorpion stings cause an estimated 3000 deaths per annum worldwide. We conducted a systematic review of all controlled clinical trials related to scorpion sting... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Scorpion stings cause an estimated 3000 deaths per annum worldwide. We conducted a systematic review of all controlled clinical trials related to scorpion sting management.
METHODS
We searched PubMed, EMBASE, Scopus, Web of Science and CINAHL and included controlled prospective clinical trials (randomized or non-randomized). The following interventions were assessed: adults and children with scorpion stings treated with (a) steroids vs. placebo, (b) different methods of pain relief, (c) antivenom vs. supportive treatment, (d) prazosin vs. supportive treatment, (e) antivenom vs. prazosin and (f) antivenom plus prazosin vs. prazosin alone. When trials had comparative outcomes, they were combined in a meta-analysis. Data was analysed with Review Manager 5. Dichotomous data were compared with relative risk (RR), and continuous data were compared with mean differences using a fixed effect model. There is no PROSPERO registration number for this study.
RESULTS
Antivenom against Centruroides sp. are effective in reversing the clinical syndrome faster than no antivenom treatment in children (RR, 0.02; 95% CI, 0.01 to 0.06; 322 participants; three trials). Antivenom (against Mesobuthus tamulus) and prazosin combination is better than prazosin alone for faster resolution of symptoms (mean difference, -12.59 h; 95% CI, -14.01 to -11.17; 173 participants; three trials).
CONCLUSIONS
The polyvalent antivenom against Centruroides sp. in USA/Mexico and the monovalent antivenom against M. tamulus in India are effective for rapid resolution of symptoms. Prazosin is useful as an add-on therapy for M. tamulus stings.
Topics: Adrenergic alpha-1 Receptor Antagonists; Animals; Antivenins; Controlled Clinical Trials as Topic; Drug Therapy, Combination; Humans; Pain; Prazosin; Scorpion Stings; Scorpion Venoms; Scorpions; Steroids
PubMed: 28390429
DOI: 10.1186/s13643-017-0469-8 -
BMJ Open Jul 2023Charcoal production and utilisation are linked to various health issues and occupational hazards. However, to our knowledge, no systematic review has primarily focused...
UNLABELLED
Charcoal production and utilisation are linked to various health issues and occupational hazards. However, to our knowledge, no systematic review has primarily focused on the health implications of charcoal production and its use while distinguishing charcoal from other solid fuels such as wood and coal.
OBJECTIVES
This systematic review presents a synthesis of the evidence on the health risks associated with producing and using charcoal across the world.
DESIGN
Systematic review using a systematic narrative synthesis approach.
DATA SOURCES
MEDLINE (through Ovid interface), CINAHL, Embase, Web of Science, PsycINFO, Cochrane Library and SCOPUS, from inception to 26 February 2021.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Peer-reviewed journal articles reporting empirical findings on the associations between charcoal usage/production and health parameters.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers extracted data and assessed the quality of primary studies.
RESULTS
Our findings showed that charcoal production and usage are linked with specific adverse health outcomes, including respiratory diseases (n=21), cardiorespiratory and neurological diseases (n=1), cancer (n=3), DNA damage (n=3), carbon monoxide (CO) poisoning (n=2), physical injury (n=2), sick house syndrome (n=1), unintentional weight loss and body mass index (BMI) reduction (n=2), increase in blood pressure (n=1) and CO death (n=1). Among the included articles that reported respiratory diseases (n=21), there was one case of asthma and tuberculosis and two cases of chronic obstructive pulmonary disease.
CONCLUSIONS
This review links charcoal production/usage and some associated human health risks. These include respiratory diseases and other non-respiratory illnesses such as sick-building syndrome, cardiovascular diseases, DNA damage, CO poisoning and death, unintentional weight loss and BMI reduction, and physical injuries.
Topics: Humans; Charcoal; Asthma; Blood Pressure; Carbon Monoxide; Carbon Monoxide Poisoning
PubMed: 37487686
DOI: 10.1136/bmjopen-2022-065914 -
The American Journal of Emergency... Sep 2019Organophosphate (OP) pesticides are still widely available in developing countries, leading to numerous accidental or suicidal poisonings every year. Lipid emulsion... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Organophosphate (OP) pesticides are still widely available in developing countries, leading to numerous accidental or suicidal poisonings every year. Lipid emulsion treatments are commonly used in resuscitating OP poisoning patients but few studies regarding their use have been reported. Our meta-analysis aimed to analyze the efficacy and outcomes of lipid resuscitation on OP poisoning patients.
METHODS
A systematic search for associated studies was conducted in Pubmed, EMBASE, MEDLINE, the Cochrane Library and the Chinese National Knowledge Infrastructure. Collected data was pooled using Revman v5.3. Outcomes included prognosis (cured vs. mortality rates), hepatic function (serum ALT, AST, Total Bilirubin (TBIL) level), serum acetylcholinesterase (AchE) level and respiratory function (rate of respiratory muscular paralysis).
RESULTS
Seven randomized controlled studies consisting of 630 patients meeting inclusion criteria were identified. Lipid emulsion helped to improve the cure rate [OR = 2.54, 95% CI (1.33, 4.86), p = 0.005] and lower the mortality rate [OR = 0.31, 95% CI (0.13, 0.74), p = 0.009]. Serum ALT, AST and TBIL in patients undergoing lipid resuscitation were lower than those in the control groups [ALT, SMD = -1.52, 95% CI (-2.64, 0.40), p = 0.008; AST, SMD = -1.66, 95% CI (-3.15, 0.16), p = 0.03; TBIL, SMD = -1.26, 95% CI (-2.32, 0.20), p = 0.02]. Serum AchE level were increased in patients treated with lipid emulsion [SMD = 2.15, 95% CI (1.60, 2.71), p < 0.00001]. Rate of respiratory muscular paralysis was lower in patients undergoing lipid resuscitation than those in the control groups [OR = 0.19, 95% CI (0.05, 0.71), p = 0.01].
CONCLUSION
Based on our meta-analysis of included RCT reports, lipid resuscitation seems likely to help improve prognosis and liver function of OP poisoning patients. However, larger multi-center RCTs are still recommended.
Topics: Acetylcholinesterase; Alanine Transaminase; Aspartate Aminotransferases; Bilirubin; Fat Emulsions, Intravenous; Humans; Mortality; Organophosphate Poisoning; Respiratory Paralysis; Resuscitation; Treatment Outcome
PubMed: 30527914
DOI: 10.1016/j.ajem.2018.11.022