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American Journal of Medical Genetics.... Jul 2024Debates about the prospective clinical use of polygenic risk scores (PRS) have grown considerably in the last years. The potential benefits of PRS to improve patient... (Review)
Review
Debates about the prospective clinical use of polygenic risk scores (PRS) have grown considerably in the last years. The potential benefits of PRS to improve patient care at individual and population levels have been extensively underlined. Nonetheless, the use of PRS in clinical contexts presents a number of unresolved ethical challenges and consequent normative gaps that hinder their optimal implementation. Here, we conducted a systematic review of reasons of the normative literature discussing ethical issues and moral arguments related to the use of PRS for the prevention and treatment of common complex diseases. In total, we have included and analyzed 34 records, spanning from 2013 to 2023. The findings have been organized in three major themes: in the first theme, we consider the potential harms of PRS to individuals and their kin. In the theme "Threats to health equity," we consider ethical concerns of social relevance, with a focus on justice issues. Finally, the theme "Towards best practices" collects a series of research priorities and provisional recommendations to be considered for an optimal clinical translation of PRS. We conclude that the use of PRS in clinical care reinvigorates old debates in matters of health justice; however, open questions, regarding best practices in clinical counseling, suggest that the ethical considerations applicable in monogenic settings will not be sufficient to face PRS emerging challenges.
Topics: Humans; Multifactorial Inheritance; Genetic Predisposition to Disease; Morals; Genetic Testing; Risk Assessment; Genetic Counseling; Risk Factors; Genetic Risk Score
PubMed: 38450933
DOI: 10.1002/ajmg.a.63584 -
BMC Medical Ethics Mar 2024Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease...
BACKGROUND
Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture.
METHODS
To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher's Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers.
RESULTS
After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals.
CONCLUSIONS
The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.
Topics: Humans; Reproducibility of Results; Ethical Analysis; Beneficence; Early Diagnosis; Health Policy
PubMed: 38443930
DOI: 10.1186/s12910-024-01012-4 -
Frontiers in Public Health 2024Vitamin D deficiency (VDD) is a worldwide disease. VDD is also associated with an increased risk of HIV-related comorbidities and mortality, and patients have a tendency... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vitamin D deficiency (VDD) is a worldwide disease. VDD is also associated with an increased risk of HIV-related comorbidities and mortality, and patients have a tendency to develop active tuberculosis compared to those with latent tuberculosis infection. Vitamin D supplementation may modulate HIV replication, improve TB inflammation and reduce progression of HIV-TB co-infection.
METHODS
We meta-analyzed individual participant data from cohort studies, cross-sectional study, and RCTs of vitamin D in HIV group, TB group, and HIV-TB group. The primary outcomes were differences in vitamin D level and VDD prevalence between three groups, the secondary outcomes were CD4 count, HIV viral load, time to sputum smear conversion, time to culture conversion, relapse, morality, and TB score.
RESULTS
For vitamin D levels, the overall mean difference (MD) between HIV group and TB group was -0.21 (95% CI, -20.80-20.38; = 0.9, = 84%), HIV group and HIV-TB group was 0.87 (95% CI, -11.45-13.20; = 0.89, = 87%), and TB group and HIV-TB group was 1.17 (95% CI, -5.21-7.55; = 0.72, = 85%). For vitamin D deficiency prevalence, the overall odds ratio (OR) for HIV group versus TB group was 1.23 (95% CI, 0.46-3.31; = 0.68; = 70%), HIV group versus HIV-TB group was 1.53 (95% CI, 1.03-2.29; = 0.04; = 0%), and TB group versus HIV-TB group was 0.85 (95% CI, 0.61-1.20; = 0.36; = 22%). In HIV-TB group, the overall OR for vitamin D group versus placebo group was 0.78 (95% CI, 0.34-1.67; = 0.52; = 60%).
CONCLUSION
Our findings indicated that there were no variations in vitamin D levels between three groups. The prevalence of vitamin D deficiency was higher in the HIV-TB group than in the HIV group. Additionally, the administration of vitamin D supplements did not have obvious impact on CD4 count and viral load. Likewise, vitamin D had no effect on time to sputum smear conversion, time to culture conversion, relapse, 12-month morality, and TB score.
Topics: Humans; Vitamin D; Coinfection; Cross-Sectional Studies; HIV Infections; Vitamins; Vitamin D Deficiency; Recurrence
PubMed: 38439754
DOI: 10.3389/fpubh.2024.1344024 -
Current Sports Medicine Reports Mar 2024The prevalence of sexual abuse in competitive sports is increasing worldwide and requires a united call to action. The underreporting of such abuses gained media...
The prevalence of sexual abuse in competitive sports is increasing worldwide and requires a united call to action. The underreporting of such abuses gained media attention resulting from recent high-profile cases. In this article, we report the results of a systematic literature review, identifying root causes of underreporting sexual abuse in competitive sports. We identify that biases and conflicts of interest work against effective reporting of abuse by athletes at the individual, organizational, and cultural levels. We offer conflict of interest and bias mitigation approaches from the social science, law, business, research, and diagnostic error literature that may apply. Competitive sports organizations may use this analysis to identify barriers and improve the effective reporting of sexual abuse.
Topics: Humans; Athletes; Bias; Conflict of Interest; Sports; Sex Offenses
PubMed: 38437495
DOI: 10.1249/JSR.0000000000001146 -
Langenbeck's Archives of Surgery Mar 2024Surgery offers exciting opportunities but comes with demanding challenges that require attention from both surgical program administrators and aspiring surgeons. The...
PURPOSE
Surgery offers exciting opportunities but comes with demanding challenges that require attention from both surgical program administrators and aspiring surgeons. The hashtag #NoTrainingTodayNoSurgeonsTomorrow on 𝕏 (previously Twitter) underscores the importance of ongoing training. Our scoping review identifies educational challenges and opportunities for the next generation of surgeons, analyzing existing studies and filling gaps in the literature.
METHODS
Following the PRISMA guidelines, MEDLINE/PubMed was searched in February 2022, using the MeSH terms "surgeons/education," for articles in English or German on general, abdominal, thoracic, vascular, and hand surgery and traumatology targeting medical students, surgical residents, future surgeons, and fellows.
RESULTS
The initial search yielded 1448 results. After a step-by-step evaluation process, 32 publications remained for complete review. Three main topics emerged: surgical innovations and training (n = 7), surgical culture and environment (n = 19), and mentoring (n = 6). The articles focusing on surgical innovations and training mainly described the incorporation of structured surgical training methods and program initiatives. Articles on surgical culture examined residents' burnout, well-being, and gender issues. Challenges faced by women, including implicit bias and sexual harassment, were highlighted. Regarding mentoring, mentees' needs, training challenges, and the qualities expected of both mentors and mentees were addressed.
CONCLUSION
At a time of COVID-19-driven surgical innovations, the educational and working environment of the new generation of surgeons is changing. Robotic technology and other innovations require future surgeons to acquire additional technological and digital expertise. With regard to the cultural aspects of training, surgery needs to adapt curricula to meet the demands of the new generation of surgeons, but even more it has to transform its culture.
Topics: Humans; Curriculum; Data Accuracy; Social Responsibility; Surgeons
PubMed: 38433154
DOI: 10.1007/s00423-024-03270-7 -
Journal of Clinical Epidemiology May 2024This study aims to assess the quality, risk of bias, and conflicts of interest (COIs) of clinical trials conducted on the effects of fortified infant formula. (Review)
Review
OBJECTIVES
This study aims to assess the quality, risk of bias, and conflicts of interest (COIs) of clinical trials conducted on the effects of fortified infant formula.
STUDY DESIGN AND SETTTING
Systematic review including all randomized clinical trials targeting healthy children and using three arms: fortified infant formula; standard formula; and breastfeeding. We performed a descriptive analysis of the studies reviewed, assessed their quality using the "Risk of Bias 2- RoB 2" tool, and identified COIs.
RESULTS
A total of 40 studies were included. All showed a high overall risk of bias, with this being especially noteworthy in the "deviations from intention to treat" and "missing outcome data" domains. Of the total included studies, 29 reported conclusions in favor of the fortified formula; 15 studies reported multiple conclusions that were either contradictory or not in line with the results. COIs with industry were identified in 33 studies, and in 17 studies, these conflicts were not declared in the appropriate section.
CONCLUSION
From a methodological perspective, studies on fortified infant formula display low quality, made evident by the high risk of bias. Additionally, there are frequent COIs. These aspects must be considered by health professionals and the population when drawing up recommendations for the use of this product.
Topics: Infant Formula; Humans; Conflict of Interest; Infant; Randomized Controlled Trials as Topic; Bias; Infant, Newborn; Breast Feeding
PubMed: 38432526
DOI: 10.1016/j.jclinepi.2024.111313 -
Clinical Oral Investigations Mar 2024To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods. (Review)
Review
OBJECTIVES
To investigate the oral manifestations in women of reproductive age using hormonal contraceptive methods.
MATERIALS AND METHODS
This review is based on the PRISMA statement. A literature search incorporated observational studies from the last 21 years. An investigative question was formulated using the PICO model, studies were selected, and a quality analysis was performed using the modified STROBE guidelines. A bibliometric analysis was performed, and the data were examined.
RESULTS
Thirteen articles were included, with the majority evaluating periodontal status. Others analyzed factors such as the presence of alveolar osteitis, oral candidiasis, and salivary microbiome dysbiosis. Ten articles were deemed to have a low risk of bias.
CONCLUSIONS
Hormonal contraceptives may increase the risk of alveolar osteitis following tooth extraction and increase the presence of the Candida species in the oral cavity. They also affect the periodontium, such as the frequent development of gingivitis, but do not lead to changes in the salivary microbiome.
CLINICAL RELEVANCE
The increasing number of women using hormonal contraceptives and the knowledge that these contraceptives can produce oral cavity alterations underscore the need to evaluate the oral manifestations found in these women.
Topics: Female; Humans; Dry Socket; Contraceptives, Oral, Hormonal; Periodontium; Gingivitis; Contraception
PubMed: 38427087
DOI: 10.1007/s00784-024-05573-x -
Shoulder & Elbow Mar 2024This systematic review aims to provide normative values for internal and external glenohumeral rotation strength in rugby players. From the inception to March 2021, the... (Review)
Review
This systematic review aims to provide normative values for internal and external glenohumeral rotation strength in rugby players. From the inception to March 2021, the search strategy was (strength OR torque) AND shoulder AND rugby using PubMed, Scopus, Web of Science, and SPORTDiscus databases, with no language restrictions. This systematic review includes 15 articles involving 573 rugby players and presenting internal or external glenohumeral rotation strength values. Two main methods are used to assess glenohumeral rotation strength in rugby players: isokinetic and isometric methods; in the isometric method, the upper arm is abducted at either 0° or 90°. Owing to differences in isokinetic procedures and a lack of studies assessing isometric strength when the upper arm is in a neutral position, normative internal or external glenohumeral rotation strength values are only provided for isometric contractions when the upper arm is abducted at 90° based on 311 shoulders of 163 male rugby union players, with 2.04 ± 0.15 N.kg and 2.11 ± 0.13 N.kg for internal and external glenohumeral rotation strength, respectively. These findings may help strength and conditioning coaches and physical therapists, provide objective evidence when deciding whether or not rugby union players should return to sport.
PubMed: 38425741
DOI: 10.1177/17585732221098738 -
The Journal of School Health May 2024Suicide is a leading cause of death for adolescents, and school connectedness is a potential, modifiable protective factor for suicide. We sought to examine if school... (Review)
Review
BACKGROUND
Suicide is a leading cause of death for adolescents, and school connectedness is a potential, modifiable protective factor for suicide. We sought to examine if school connectedness protected against suicide among high school students and if potential moderators affected the relationship between school connectedness and suicide.
METHODS
We searched online databases (PubMed, EMBASE, CINAHL, and PsycINFO) on December 12, 2021, for studies that examined the effects of school connectedness on suicide among high school students.
RESULTS
This systematic review identified 34 studies that examined the effects of school connectedness on adolescent suicidality. Results indicated mixed findings of school connectedness on suicidality. Among studies that assessed a suicide ideation outcome, 73.3% found that school connectedness protected against suicide. Among studies that assessed a suicide attempts outcome, 50% found that school connectedness protected against suicide. Most included studies did not control for notable variables in their final models, such as sleep, impulsivity, substance use, or depression. No studies examined moderators of school connectedness and suicide.
CONCLUSIONS
School connectedness is somewhat protective of suicidality, and more protective of suicidal ideation than suicide attempts. Researchers should examine the construct of school connectedness among modern youth to better understand school connectedness and suicide.
Topics: Humans; Adolescent; Suicide, Attempted; Suicidal Ideation; Schools; Protective Factors; Adolescent Behavior
PubMed: 38383772
DOI: 10.1111/josh.13445 -
BMJ Open Feb 2024Occupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Occupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation.
DESIGN
A systematic review and meta-analysis.
DATA SOURCES
Google Scholar, PubMed, APA PsycINFO, Web of Science Core Collection, Scopus, ScienceDirect and Sage Journals Online were searched in June 2020 and updated in November 2022.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Observational studies that measured prevalence or average scores of moral injury, or PTED in any occupational group and any geographical location.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers screened and coded eligible studies. Study design, participant demographics, sampling method, location, measurement tool and prevalence or average scores were extracted. Risk of bias was assessed using the Quality Assessment Checklist for Prevalence Studies tool. Meta-analysis was conducted using random effects models. Results that could not be combined were summarised qualitatively in a narrative synthesis using the Guidance for Systematic Reviews.
RESULTS
In total, 88 studies across armed forces and veterans, healthcare, first responders, educators, journalists, child protection service employees, the unemployed, public-sector employees and mixed occupations were included. Studies included in each separate meta-analysis based on the measure used ranged from 2 to 30. The pooled prevalence of clinically relevant moral injury in healthcare professionals was 45%, and exposure to any potentially morally injurious event (PMIE) across occupations was 67%. Exposure to transgressions by others and betrayal was significantly lower in the armed forces than civilian occupations. Pooled prevalence of PTED across occupations was 26%.
CONCLUSION
Exposure to PMIEs, moral injury symptoms and PTED are prevalent at work and exposure to transgressions by others and betrayal are more likely in civilian occupations than the armed forces.
PROSPERO REGISTRATION NUMBER
CRD42020191766.
Topics: Child; Humans; Stress Disorders, Post-Traumatic; Occupational Diseases; Prevalence; Occupational Exposure; Cost of Illness; World Health Organization; Occupational Injuries
PubMed: 38382965
DOI: 10.1136/bmjopen-2023-071776