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The Cochrane Database of Systematic... May 2015Cocaine misuse is a disorder for which no pharmacological treatment of proven efficacy exists. Advances in neurobiology could guide future medication development. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cocaine misuse is a disorder for which no pharmacological treatment of proven efficacy exists. Advances in neurobiology could guide future medication development.
OBJECTIVES
To investigate the efficacy and acceptability of dopamine agonists alone or in combination with any psychosocial intervention for the treatment of of people who misuse cocaine.
SEARCH METHODS
We run the search on 12 January 2015. We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE, CINAHL, PsycINFO, ICTRP, clinicaltrials.gov and screened reference lists.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) comparing dopamine agonists alone or associated with psychosocial intervention with placebo, no treatment or other pharmacological interventions.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methodological procedures.
MAIN RESULTS
Twenty four studies, including 2147 participants, met the inclusion criteria. Comparing any dopamine agonist versus placebo, we found no differences for any of the outcomes considered: dropout (moderate quality of evidence), abstinence (low quality of evidence), severity of dependence (low quality of evidence), adverse events (moderate quality of evidence). This was also observed when single dopamine agonists were compared against placebo. Comparing amantadine versus antidepressants, we found low quality of evidence that antidepressants performed better for abstinence (RR 0.25, 95% CI 0.12 to 0.53) based on two studies with 44 participants. No differences were found for dropout or adverse events, for both moderate quality of evidence.The major flaws of the included studies concerned selection bias because most studies did not report information about sequence generation (80%) and allocation concealment methods (86%): half of the included studies were judged at unclear risk of performance bias and 62.5% at unclear risk of detection bias for what concerns subjective outcomes.
AUTHORS' CONCLUSIONS
Current evidence from RCTs does not support the use of dopamine agonists for treating cocaine misuse. This absence of evidence may leave to clinicians the alternative of balancing the possible benefits against the potential adverse effects of the treatment. Even the potential benefit of combining a dopamine agonist with a more potent psychosocial intervention, which was suggested by the previous Cochrane Review (Soares 2003), is not supported by the results of this Cochrane Review update.
Topics: Amantadine; Antidepressive Agents; Bromocriptine; Cocaine-Related Disorders; Depression; Dopamine Agonists; Humans; Levodopa; Randomized Controlled Trials as Topic; Selection Bias
PubMed: 26014366
DOI: 10.1002/14651858.CD003352.pub4 -
Primary Care Diabetes Dec 2016The influenza virus is an important cause of morbidity and mortality for diabetics. The seasonal influenza vaccine's immunologic effectiveness is proven within the type... (Review)
Review
BACKGROUND
The influenza virus is an important cause of morbidity and mortality for diabetics. The seasonal influenza vaccine's immunologic effectiveness is proven within the type 1 and type 2 diabetic populations, but the level of evidence is low. This article presents a systematic review for the bias in the measure of the effectiveness of seasonal influenza vaccination among diabetics.
METHODS
Using systematic review methods, we searched three electronic databases for published literature (MEDLINE, EMBASE and the Cochrane Library) and two grey literature (SIGLE and NHS EED) databases, to identify studies published between 1997 and 2013, examining the effect of seasonal influenza vaccination, among diabetics, on any measure for influenza morbidity or mortality.
RESULTS
725 records were identified from the three databases and screening, short-listing was undertaken independently by two reviewers. After de-duplication, all records were screened by title and then abstract, and 34 short-listed records were reviewed in full, with 7 studies included: 4 cohort studies and 3 case-control studies, conducted in 7 countries. The most common outcome of interest in studies (n=4) was all-cause mortality among elderly diabetics (>65 years), with individual studies reporting reductions in risk of between 33% [95%CI: 4%-54%] and 68% [95%CI: 58%-75%]. We found only two studies for working-age adult diabetics: one reporting that vaccination prevented hospitalizations due to pneumonia or influenza (vaccine effectiveness [VE] 43%, [95%CI: 28%-54%]) and all-cause hospitalizations (VE: 28% [95%CI: 24%-32%]); and, another reporting no significant decrease in all-cause mortality for working-age adult diabetics. We have identified three major biases: the use of indirect health outcomes, a risk of selection bias (health-seeking bias), and no adjustment for participant pneumococcal vaccination status. The most recent included article finds that morbimortality is still lower during off-season influenza in both vaccinated and non-vaccinated diabetics, indicating important residual confounding.
CONCLUSION
To date, the strength of evidence supporting the routine use of seasonal influenza vaccination is low for diabetics older than 65, and very low for working-age diabetics.
Topics: Adolescent; Adult; Aged; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Humans; Influenza Vaccines; Influenza, Human; Male; Middle Aged; Risk Factors; Seasons; Selection Bias; Treatment Outcome; Vaccination; Young Adult
PubMed: 27290610
DOI: 10.1016/j.pcd.2016.05.005 -
American Journal of Preventive Medicine Sep 2013Although findings from recently published clinical trials and a review from the U.S. Preventive Services Task Force suggest that there is limited to no prostate cancer... (Review)
Review
CONTEXT
Although findings from recently published clinical trials and a review from the U.S. Preventive Services Task Force suggest that there is limited to no prostate cancer mortality benefit associated with prostate-specific antigen (PSA) screening, confusion remains as to whether the use of PSA as a screening tool for prostate cancer is warranted.
EVIDENCE ACQUISITION
A systematic literature review was done in 2012 to identify case-control studies from the past 20 years that focused on evaluating the association between screening for prostate cancer and prostate cancer mortality. Emphasis was put on synthesizing the results of these studies, evaluating their limitations, and identifying remaining questions and issues that should be addressed in future studies.
EVIDENCE SYNTHESIS
A total of seven studies were identified in this time period, with the majority suggesting that a reduction in prostate cancer mortality is associated with PSA screening. However, the findings may be limited by various biases inherent to case-control studies of screening tests, such as selection biases resulting from both case and control subject selection, exposure measurement issues, lead and length biases, and issues specific to prostate cancer screening such as the influence of digital rectal examinations.
CONCLUSIONS
Findings from existing case-control studies of PSA and prostate cancer mortality suggest that there is a mortality benefit from PSA screening. However, these studies may be limited by bias and must therefore be interpreted with caution. As uncertainty regarding PSA screening remains, future studies to evaluate the association between PSA and prostate cancer mortality should address these potential biases directly.
Topics: Case-Control Studies; Clinical Trials as Topic; Humans; Male; Mass Screening; Prostate-Specific Antigen; Prostatic Neoplasms; Selection Bias
PubMed: 23953359
DOI: 10.1016/j.amepre.2013.04.015 -
International Journal of Environmental... Oct 2023Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from... (Review)
Review
UNLABELLED
Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from epidemiology and other studies showing a sharp decline in cigarette use in parallel with the spread of e-cigarette use. This systematic review explores the reasons for this discrepancy.
METHODS
Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts.
RESULTS
A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors' conclusions that e-cigarettes have a significant effect on the initiation of cigarettes () at the population level. This sub-cohort design prohibits highlighting any , which is the most likely mechanism accounting for the competition between these two products.
CONCLUSIONS
While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.
Topics: Humans; Adolescent; Longitudinal Studies; Electronic Nicotine Delivery Systems; Smokers; Prospective Studies; Tobacco Products; Vaping
PubMed: 37887674
DOI: 10.3390/ijerph20206936 -
The Journal of Allergy and Clinical... Mar 2001Studies of exposure to pets and risk of asthma have yielded conflicting results. (Review)
Review
BACKGROUND
Studies of exposure to pets and risk of asthma have yielded conflicting results.
OBJECTIVES
We performed a systematic review to synthesize the evidence of the effect of exposure to pets in the home on the risk of asthma and asthma-related symptoms. We also assessed differences between the studies as sources of heterogeneity of the results.
METHODS
We conducted a MEDLINE search (until the end of 1999) using the following boolean search command: (asthma[all] OR wheez*[all]) AND (domestic animal*[all] OR pets[all]). The outcome was limited to either diagnosis of asthma or the symptom of wheezing. The exposure of interest was domestic animals in the home. Appropriate temporal relationship was defined as present in studies with either pet keeping within the first 2 years of life, in the past, or exposure to pets preceding the outcome.
RESULTS
Thirty-two of the 217 retrieved articles fulfilled the eligibility criteria. Inappropriate time sequence of the exposure and outcome information was an important source of heterogeneity and an indication of potential selection bias. Therefore we analyzed studies focusing on early exposure or ensuring appropriate temporal sequence. The pooled risk estimates for both asthma (fixed-effects odds ratio, 1.11; 95% CI, 0.98-1.25; heterogeneity, P =.04; random-effects odds ratio, 1.09; 95% CI, 0.89-1.34) and wheezing (fixed-effects odds ratio, 1.19; 95% CI, 1.05-1.35; heterogeneity, P =.03; random-effects odds ratio, 1.17; 95% CI, 0.95-1.44) indicated a small effect, which was limited to studies with a median study population age of over 6 years (fixed-effects odds ratio, 1.19; 95% CI, 1.02-1.40; heterogeneity, P =.04; random-effects odds ratio, 1.15; 95% CI, 0.86-1.56; fixed-effects odds ratio, 1.29; 95% CI, 1.12-1.48; heterogeneity, P =.31). In younger children the harmful effect disappeared for wheezing (odds ratio, 0.80; 95% CI, 0.59-1.08; P =.38).
CONCLUSION
Exposure to pets appears to increase the risk of asthma and wheezing in older children. The observed lower risk among exposed than among unexposed young children is consistent with a protective effect in this age group but could also be explained by selection bias.
Topics: Animals; Animals, Domestic; Asthma; Humans; Risk Factors
PubMed: 11240945
DOI: 10.1067/mai.2001.113240 -
Scandinavian Journal of Rheumatology Oct 2016The effects of inflammatory and degenerative arthritis on carpal tunnel syndrome (CTS) are not well known. This systematic review and meta-analysis aimed to assess... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The effects of inflammatory and degenerative arthritis on carpal tunnel syndrome (CTS) are not well known. This systematic review and meta-analysis aimed to assess whether rheumatoid arthritis (RA) and osteoarthritis (OA) increase the risk of CTS.
METHOD
Literature searches were conducted in PubMed, Embase, Web of Science, Scopus, Google Scholar, and ResearchGate until January 2015. Twenty-three (five cohort, 10 case control, and eight cross sectional) studies qualified for the meta-analyses. A random-effects meta-analysis was used and heterogeneity and publication bias were assessed.
RESULTS
Both RA and OA were associated with CTS. Pooled unadjusted odds ratios (ORs) were 1.91 [95% confidence interval (CI) 1.33-2.75, I(2) = 55.2%, nine studies, n = 10 688] for arthritis (either inflammatory or degenerative), 2.91 (95% CI 2.33-3.62, I(2) = 22.3%, 11 studies, n = 74 730) for RA, and 2.13 (95% CI 1.65-2.76, I(2) = 39.2%, five studies, n = 20 574) for OA of any joint. Pooled confounder-adjusted ORs were 1.96 (95% CI 1.21-3.18, I(2) = 73.1%, six studies, n = 11 542) for arthritis, 1.96 (95% CI 1.57-2.44, I(2) = 32.2%, eight studies, n = 72 212) for RA, and 1.87 (95% CI 1.64-2.13, I(2) = 0%, two studies, n = 19 480) for OA. There was no evidence of publication bias, and excluding cross-sectional studies or studies appraised as having a high risk of selection bias did not change the magnitude of the associations.
CONCLUSIONS
The findings of this systematic review and meta-analysis suggest that both RA and OA increase the risk of CTS. Further prospective studies on the effect of wrist OA on CTS are needed.
Topics: Arthritis, Rheumatoid; Carpal Tunnel Syndrome; Humans; Odds Ratio; Osteoarthritis; Risk Factors
PubMed: 27022991
DOI: 10.3109/03009742.2015.1114141 -
Addiction (Abingdon, England) Aug 2015A systematic review and meta-analysis were conducted to synthesize results from cohort studies on initiation into drug injection among vulnerable populations, to... (Meta-Analysis)
Meta-Analysis Review
AIMS
A systematic review and meta-analysis were conducted to synthesize results from cohort studies on initiation into drug injection among vulnerable populations, to quantify heterogeneity in the estimated incidence rates of drug injection and to identify potential sources of heterogeneity and bias.
METHODS
MEDLINE, EMBASE, PsycINFO and LILACS were searched for relevant studies published between 1980 and 2012. Investigators independently reviewed studies for inclusion, retrieved information on baseline population characteristics and follow-up features and assessed study quality. Study-specific incidence rates of drug injection were calculated as the number of new injectors divided by the person-years at risk. The I(2) statistic was used to quantify heterogeneity in incidence rates across studies, and random-effects meta-regression models were used to identify determinants of heterogeneity and bias.
RESULTS
Nine cohorts totalling 1843 participants met the inclusion criteria, with individual sample sizes of 70-415 participants and follow-up lengths of 6 months-3.4 years. The incidence of drug injection varied widely, from 2.1 to 24.2 cases per 100 person-years. The strong between-study heterogeneity (I(2) = 90%, P<0.001) was reduced significantly after accounting for the different follow-up lengths (I(2) = 17%, P = 0.30), with a 57% (95% confidence interval 46-66%) decrease in the pooled incidence of drug injection per 1-year increase in average follow-up.
CONCLUSIONS
The incidence of drug injection decreases sharply with increasing follow-up length in cohort studies on drug injection initiation. Low retention rates and potential for downward selection bias in cohort studies on drug injection initiation are caused primarily by greater loss to follow-up among individuals at higher risk of starting injection, compared with other participants.
Topics: Adult; Age of Onset; Cohort Studies; Female; Humans; Incidence; Male; Selection Bias; Substance Abuse, Intravenous; Vulnerable Populations; Young Adult
PubMed: 25845977
DOI: 10.1111/add.12940 -
Psychosomatic Medicine May 2016Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Psychological distress has been associated with poor outcomes in patients with chronic heart failure (HF), which is assumed to be partly due to poor HF self-care behavior. This systematic review and meta-analysis describes the current evidence concerning psychological determinants of self-care in patients with chronic HF.
METHODS
Eligible studies were systematically identified by searching electronic databases PubMed, PsycINFO, and the Conference Proceedings Citation Index (Web of Science) for relevant literature (1980-October 17, 2014). Study quality was assessed according to the level of risk of bias. Quantitative data were pooled using random-effects models.
RESULTS
Sixty-five studies were identified for inclusion that varied considerably with respect to sample and study characteristics. Risk of bias was high in the reviewed studies and most problematic with regard to selection bias (67%). Depression (r = -0.19, p < .001), self-efficacy (r = 0.37, p < .001), and mental well-being (r = 0.14, p = .030) were significantly associated with self-reported self-care. Anxiety was not significantly associated with either self-reported (r = -0.18, p = .24) or objective self-care (r = -0.04, p = .79), neither was depression associated with objectively measured medication adherence (r = -0.05, p = .44).
CONCLUSIONS
Psychological factors (depression, self-efficacy, and mental well-being) were associated with specific self-care facets in patients with chronic HF. These associations were predominantly observed with self-reported indices of self-care and not objective indices. Methodological heterogeneity and limitations preclude definite conclusions about the association between psychological factors and self-care and should be addressed in future research.
Topics: Depression; Heart Failure; Humans; Personal Satisfaction; Self Care; Self Efficacy
PubMed: 27082055
DOI: 10.1097/PSY.0000000000000270 -
Public Health Sep 2020Smoking has negative consequences on occupational health. The current meta-analysis was conducted with the aim to pool the studies about smoking and increased disability... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Smoking has negative consequences on occupational health. The current meta-analysis was conducted with the aim to pool the studies about smoking and increased disability pension.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
Articles were found in the scientific literature using keywords, and searching was limited to prospective cohort studies that had been published before August 2018. Based on the inclusion and exclusion criteria, 23 prospective cohort studies were selected. The analyses were carried out on the basis of the random-effects method. Subgroup analysis was also carried out. Finally, the bias of publication was examined using Begg's test, the Egger test, the trim-and-fill method, and the funnel plot.
RESULTS
Twenty-three studies were included. The results showed a positive association between smoking and disability pension, with a risk ratio (RR) of 1.41 and 95% confidence interval (95% CI) of 1.30-1.53 (P < 0.001). In men, the RR was equal to 1.48 and 95% CI was equal to 1.30-1.68 (P < 0.001). In women, the RR was equal to 1.23 and 95% CI was equal to 1.09-1.37 (P = 0.001). In current smokers, the RR was equal to 1.41 and 95% CI was equal to 1.26-1.57 (P < 0.001). In former smokers, the RR was equal to 1.16 and 95% CI was equal to 1.05-1.29 (P = 0.003). Qualitative evaluation showed that the studies had a low level of selection bias, data collection bias, and withdrawal and dropout bias.
CONCLUSIONS
Smoking is a risk factor for increasing disability pension, and men are at higher risk of disability pension. In addition, both current and former smokers are in high risk of disability pension. Overall, it can be concluded that smoking is a risk factor for occupational health.
Topics: Disabled Persons; Humans; Pensions; Prospective Studies; Risk Factors; Smoking
PubMed: 32882482
DOI: 10.1016/j.puhe.2020.04.013 -
International Journal of Environmental... Feb 2021Technostress is a widespread model used to study negative effects of using information communication technologies at work. The aim of this review is to assess the role... (Review)
Review
Technostress is a widespread model used to study negative effects of using information communication technologies at work. The aim of this review is to assess the role of socioeconomic position (SEP) in research on work-related technostress. We conducted systematic searches in multidisciplinary databases (PubMed, PubMed Central, Web of Science, Scopus, PsycInfo, PsycArticles) in June 2020 and independently screened 321 articles against eligibility criteria (working population, technostress exposure, health or work outcome, quantitative design). Of the 21 studies included in the narrative synthesis, three studies did not collect data on SEP, while 18 studies operationalised SEP as education (eight), job position (five), SEP itself (two) or both education as well as job position (three). Findings regarding differences by SEP are inconclusive, with evidence of high SEP reporting more frequent exposure to overall technostress. In a subsample of 11 studies reporting data on educational attainment, we compared the percentage of university graduates to World Bank national statistics and found that workers with high SEP are overrepresented in nine of 11 studies. The resulting socioeconomic sampling bias limits the scope of the technostress model to high SEP occupations. The lack of findings regarding differences by SEP in technostress can partly be attributed to limitations in study designs. Studies should aim to reduce the heterogeneity of technostress and SEP measures to improve external validity and generalisability across socioeconomic groups. Future research on technostress would benefit from developing context-sensitive SEP measures and quality appraisal tools that identify socioeconomic sampling biases by comparing data to national statistics.
Topics: Delivery of Health Care; Humans; Occupational Exposure; Occupations; Selection Bias
PubMed: 33672604
DOI: 10.3390/ijerph18042071