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Scientific Reports Jan 2023To promote health equity within the United States (US), randomized clinical trials should strive for unbiased representation. Thus, there is impetus to identify... (Meta-Analysis)
Meta-Analysis
To promote health equity within the United States (US), randomized clinical trials should strive for unbiased representation. Thus, there is impetus to identify demographic disparities overall and by disease category in US clinical trial recruitment, by trial phase, level of masking, and multi-center status, relative to national demographics. A systematic review and meta-analysis were conducted using MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov, between 01/01/2008 to 12/30/2019. Clinical trials (N = 5,388) were identified based on the following inclusion criteria: study type, location, phase, and participant age. Each clinical trial was independently screened by two researchers. Data was pooled using a random-effects model. Median proportions for gender, race, and ethnicity of each trial were compared to the 2010 US Census proportions, matched by age. A second analysis was performed comparing gender, race, and ethnicity proportions by trial phase, multi-institutional status, quality, masking, and study start year. 2977 trials met inclusion criteria (participants, n = 607,181) for data extraction. 36% of trials reported ethnicity and 53% reported race. Three trials (0.10%) included transgender participants (n = 5). Compared with 2010 US Census data, females (48.3%, 95% CI 47.2-49.3, p < 0.0001), Hispanics (11.6%, 95% CI 10.8-12.4, p < 0.0001), American Indians and Alaskan Natives (AIAN, 0.19%, 95% CI 0.15-0.23, p < 0.0001), Asians (1.27%, 95% CI 1.13-1.42, p < 0.0001), Whites (77.6%, 95% CI 76.4-78.8, p < 0.0001), and multiracial participants (0.25%, 95% CI 0.21-0.31, p < 0.0001) were under-represented, while Native Hawaiians and Pacific Islanders (0.76%, 95% CI 0.71-0.82, p < 0.0001) and Blacks (17.0%, 95% CI 15.9-18.1, p < 0.0001) were over-represented. Inequitable representation was mirrored in analysis by phase, institutional status, quality assessment, and level of masking. Between 2008 to 2019 representation improved for only females and Hispanics. Analysis stratified by 44 disease categories (i.e., psychiatric, obstetric, neurological, etc.) exhibited significant yet varied disparities, with Asians, AIAN, and multiracial individuals the most under-represented. These results demonstrate disparities in US randomized clinical trial recruitment between 2008 to 2019, with the reporting of demographic data and representation of most minorities not having improved over time.
Topics: Female; Humans; United States; Adult; Health Promotion; Randomized Controlled Trials as Topic; Ethnicity; White People; Hawaii
PubMed: 36593228
DOI: 10.1038/s41598-022-23664-1 -
Frontiers in Public Health 2022Since the emergence of COVID-19, mandatory facemask wearing has been implemented around the world to prevent viral transmission, however, the impact of wearing facemasks... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Since the emergence of COVID-19, mandatory facemask wearing has been implemented around the world to prevent viral transmission, however, the impact of wearing facemasks on patients with COPD was unclear.
METHODS
The current study undertakes a systematic review and meta-analysis of a comprehensive literature retrieval from six databases, based on the pre-determined eligibility criteria, irrespective of language. The risk of bias was assessed using an established instrument. We primarily focused on analyzing ETCO, SpO, and heart and respiratory rates, and also considered the impacts on physiological and exercise performance. A descriptive summary of the data and possible meta-analysis was performed. Forest plots were generated to pool estimates based on each of the study outcomes.
RESULTS
Of the 3,751 publications considered, six publications were selected for a systematic review and two publications were included for meta-analysis, however, the quality of these six studies was relatively low overall. In the case of inactivity, the facemask wearing COPD cohort had higher respiratory rates than that of the non-facemask wearing cohort (MD = 1.00 and 95% CI 0.47-1.53, < 0.05). There was no significant difference in ETCO (MD = 0.10 and 95% CI -1.57-1.78, > 0.05) and heart rate (MD = 0.40 and 95% CI -3.59-4.39, > 0.05) nor SpO (MD = -0.40 and 95% CI -0.84-0.04, > 0.05) between the COPD patients with and without facemasks. Furthermore, it was observed that the only significant differences between the COPD patients with and without facemasks undertaking different activities were FEV1 (%) (MD = 3.84 and 95% CI 0.14-7.54, < 0.05), FEV1/FVC (%) (MD = 3.25 and 95% CI 0.71-5.79, < 0.05), and blood lactate (MD = -0.90 and 95% CI -1.73 to -0.07, < 0.05).
CONCLUSION
Wearing facemasks decreased the exercise performance of patients with COPD, however, it had minimal impact on physiological indexes. Further investigations will be performed on the high-quality data from randomized control studies.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=326265, identifier: CRD42022326265.
Topics: Humans; COVID-19; Masks; Personal Protective Equipment; Sedentary Behavior; Pulmonary Disease, Chronic Obstructive
PubMed: 36466486
DOI: 10.3389/fpubh.2022.1027521 -
PloS One 2022To examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To examine the use of face mask intervention in mitigating the risk of spreading respiratory infections and whether the effect of face mask intervention differs in different exposure settings and age groups.
DESIGN
Systematic review and meta-analysis. We evaluated the risk of bias using the Cochrane Risk of Bias 2 tool (ROB2).
DATA SOURCES
We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials investigating the effect of face masks on respiratory infections published between 1981 and February 9, 2022. We followed the PRISMA 2020 guidelines.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
We included randomized controlled trials investigating the use of face mask intervention in mitigating the risk of spreading respiratory infections across different exposure settings.
RESULTS
We identified 2,400 articles for screening. 18 articles passed the inclusion criteria for both evidence synthesis and meta-analysis. There were N = 189,145 individuals in the face mask intervention arm and N = 173,536 in the control arm, and the follow-up times ranged from 4 days to 19 months. Our results showed between-study heterogeneity (p < 0.0001). While there was no statistically significant association over all studies when the covariate unadjusted intervention effect estimates were used (RR = 0.977 [0.858-1.113], p = 0.728), our subgroup analyses revealed that a face mask intervention reduced respiratory infections in the adult subgroup (RR = 0.8795 [0.7861-0.9839], p = 0.0249) and in a community setting (RR = 0.890 [0.812-0.975], p = 0.0125). Furthermore, our leave-one-out analysis found that one study biased the results towards a null effect. Consequently, when using covariate adjusted odds ratio estimates to have a more precise effect estimates of the intervention effect to account for differences at the baseline, the results showed that a face mask intervention did reduce respiratory infections when the biasing study was excluded from the analysis (OR = 0.8892 [0.8061-0.9810], p = 0.0192).
CONCLUSION
Our findings support the use of face masks particularly in a community setting and for adults. We also observed substantial between-study heterogeneity and varying adherence to protocol. Notably, many studies were subject to contamination bias thus affecting the efficacy of the intervention, that is when also some controls used masks or when the intervention group did not comply with mask use leading to a downward biased effect of treatment receipt and efficacy.
TRIAL REGISTRATION
PROSPERO registration number CRD42020205523.
Topics: Adult; Humans; Masks; Randomized Controlled Trials as Topic; Extraoral Traction Appliances; Respiratory Tract Infections; PubMed
PubMed: 36454947
DOI: 10.1371/journal.pone.0271517 -
Frontiers in Physiology 2022Face masks are widely used during the COVID-19 pandemic as one of the protective measures against the viral infection risk. Some evidence suggests that face mask...
Face masks are widely used during the COVID-19 pandemic as one of the protective measures against the viral infection risk. Some evidence suggests that face mask prolonged use can be uncomfortable, and discomfort can be exacerbated during exercise. However, the acute responses of mask-wearing during exercise on affective/psychological and exercise performance responses is still a topic of debate. To perform a systematic review with meta-analysis of the acute effects of mask-wearing during exercise on affective/psychological and exercise performance responses in healthy adults of different/diverse training status. This review (CRD42021249569) was performed according to Cochrane's recommendations, with searches performed in electronic (PubMed, Web of Science, Embase, SportDiscus, and PsychInfo) and pre-print databases (MedRxiv, SportRxiv, PsyArXiv, and Preprint.Org). Syntheses of included studies' data were performed, and the RoB-2 tool was used to assess the studies' methodological quality. Assessed outcomes were affective/psychological (discomfort, stress and affective responses, fatigue, anxiety, dyspnea, and perceived exertion) and exercise performance time-to-exhaustion (TTE), maximal power output (PO), and muscle force production] parameters. Available data were pooled through meta-analyses. Initially 4,587 studies were identified, 36 clinical trials (all crossover designs) were included. A total of 749 (39% women) healthy adults were evaluated across all studies. The face mask types found were clothing (CM), surgical (SM), FFP2/N95, and exhalation valved FFP2/N95, while the most common exercises were treadmill and cycle ergometer incremental tests, beyond outdoor running, resistance exercises and functional tests. Mask-wearing during exercise lead to increased overall discomfort (SMD: 0.87; 95% CI 0.25-1.5; = 0.01; I = 0%), dyspnea (SMD: 0.40; 95% CI 0.09-0.71; = 0.01; I = 68%), and perceived exertion (SMD: 0.38; 95% CI 0.18-0.58; < 0.001; I = 46%); decreases on the TTE (SMD: -0.29; 95% CI -0.10 to -0.48; < 0.001; I = 0%); without effects on PO and walking/running distance traveled ( > 0.05). Face mask wearing during exercise increases discomfort (large effect), dyspnea (moderate effect), and perceived exertion (small effect), and reduces the TTE (small effect), without effects on cycle ergometer PO and distance traveled in walking and running functional tests. However, some aspects may be dependent on the face mask type, such as dyspnea and perceived exertion. : [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249569], identifier [CRD42021249569].
PubMed: 36406998
DOI: 10.3389/fphys.2022.994454 -
Chemosphere Feb 2023Information on biodegradation kinetics of biodiesel fuels is a key aspect in risk and impact assessment practice and in selection of appropriate remediation strategies.... (Review)
Review
Information on biodegradation kinetics of biodiesel fuels is a key aspect in risk and impact assessment practice and in selection of appropriate remediation strategies. Unfortunately, this information is scattered, while factors influencing variability in biodegradation rates are still not fully understood. Therefore, we systematically reviewed 32 scientific literature sources providing 142 biodegradation and 56 mineralization half-lives of diesel and biodiesel fuels in various experimental systems. The analysis focused on the variability in half-lives across fuels and experimental conditions, reporting sets of averaged half-life values and their statistical uncertainty. Across all data points, biodegradation half-lives ranged from 9 to 62 days, and were 2-5.5 times shorter than mineralization half-lives. Across all fuels, biodegradation and mineralization half-lives were 2.5-8.5 times longer in terrestrial systems when compared to aquatic systems. The half-lives were generally shorter for blends with increasing biodiesel content, although differences in number of data points from various experiments masked differences in half-lives between different fuels. This in most cases resulted in lack of statistically significant effects of the type of blends and experimental system on biodegradation half-lives. Our data can be used for improved characterization of risks and impacts of biodiesel fuels in aerobic aquatic and terrestrial environments, while more experiments are required to quantify biodegradation kinetics in anaerobic conditions. Relatively high biodegradability of biodiesel may suggest that passive approaches to degrade and dissipate contaminants in situ, like monitored natural attenuation, may be appropriate remediation strategies for biodiesel fuels.
Topics: Half-Life; Biofuels; Kinetics; Biodegradation, Environmental; Gasoline
PubMed: 36403813
DOI: 10.1016/j.chemosphere.2022.137236 -
The Cochrane Database of Systematic... Nov 2022Nasal masks and nasal prongs are used as interfaces for providing continuous positive airway pressure (CPAP) for preterm infants with or at risk of respiratory distress,... (Review)
Review
BACKGROUND
Nasal masks and nasal prongs are used as interfaces for providing continuous positive airway pressure (CPAP) for preterm infants with or at risk of respiratory distress, either as primary support after birth or as ongoing support after endotracheal extubation from mechanical ventilation. It is unclear which type of interface is associated with lower rates of CPAP treatment failure, nasal trauma, or mortality and other morbidity.
OBJECTIVES
To assess the benefits and harms of nasal masks versus nasal prongs for reducing CPAP treatment failure, nasal trauma, or mortality and other morbidity in newborn preterm infants with or at risk of respiratory distress.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was October 2021.
SELECTION CRITERIA
We included randomised controlled trials comparing masks versus prongs as interfaces for delivery of nasal CPAP in newborn preterm infants (less than 37 weeks' gestation) with or at risk of respiratory distress.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were 1. treatment failure, 2. all-cause mortality, and 3. neurodevelopmental impairment. Our secondary outcomes were 4. pneumothorax, 5. moderate-severe nasal trauma, 6. bronchopulmonary dysplasia, 7. duration of CPAP use, 8. duration of oxygen supplementation, 9. duration of hospitalisation, 10. patent ductus arteriosus receiving medical or surgical treatment, 11. necrotising enterocolitis, 12. severe intraventricular haemorrhage, and 13. severe retinopathy of prematurity. We used the GRADE approach to assess the certainty of the evidence.
MAIN RESULTS
We included 12 trials with 1604 infants. All trials were small (median number of participants 118). The trials occurred after 2001 in care facilities internationally, predominantly in India (eight trials). Most participants were preterm infants of 26 to 34 weeks' gestation who received nasal CPAP as the primary form of respiratory support after birth. The studied interfaces included commonly used commercially available masks and prongs. Lack of measures to blind caregivers or investigators was a potential source of performance and detection bias in all the trials. Meta-analyses suggested that use of masks compared with prongs may reduce CPAP treatment failure (risk ratio (RR) 0.72, 95% confidence interval (CI) 0.58 to 0.90; 8 trials, 919 infants; low certainty). The type of interface may not affect mortality prior to hospital discharge (RR 0.83, 95% CI 0.56 to 1.22; 7 trials, 814 infants; low certainty). There are no data on neurodevelopmental impairment. Meta-analyses suggest that the choice of interface may result in little or no difference in the risk of pneumothorax (RR 0.93, 95% CI 0.45 to 1.93; 5 trials, 625 infants; low certainty). Use of masks rather than prongs may reduce the risk of moderate-severe nasal injury (RR 0.55, 95% CI 0.44 to 0.71; 10 trials, 1058 infants; low certainty). The evidence is very uncertain about the effect on bronchopulmonary dysplasia (RR 0.69, 95% CI 0.46 to 1.03; 7 trials, 843 infants; very low certainty).
AUTHORS' CONCLUSIONS
The available trial data provide low-certainty evidence that use of masks compared with prongs as the nasal CPAP interface may reduce treatment failure and nasal injury, and may have little or no effect on mortality or the risk of pneumothorax in newborn preterm infants with or at risk of respiratory distress. The effect on bronchopulmonary dysplasia is very uncertain. Large, high-quality trials would be needed to provide evidence of sufficient validity and applicability to inform policy and practice.
Topics: Humans; Infant, Newborn; Continuous Positive Airway Pressure; Infant, Premature; Bronchopulmonary Dysplasia; Masks; Pneumothorax; Respiratory Distress Syndrome
PubMed: 36374241
DOI: 10.1002/14651858.CD015129 -
Iranian Journal of Public Health Dec 2021The facemasks use has been discussed to prevent respiratory disease due airborne contamination. The aim of this study was to perform a systematic review about the face... (Review)
Review
BACKGROUND
The facemasks use has been discussed to prevent respiratory disease due airborne contamination. The aim of this study was to perform a systematic review about the face masks use to avoid airborne contamination during COVID-19 pandemic and related conditions, registered (PROSPERO-CRD42020198347) and performed according PRISMA.
METHODS
PubMed, Embase and Scopus databases were used to collect data. Observational studies, published in 2020, and English language, were included. Two reviewers independently identified records through database search and reference screening and disagreements were resolved by a third reviewer. Six studies were included.
RESULTS
The works investigated about the use of masks (different types) to prevent droplets dissemination with virus or bacterial suspension and decrease COVID-19 transmission routes, comfort, or temperature. The studies have moderate to critical risk of bias and the level of evidence is III-2.
CONCLUSION
It is recommended facemask use to prevent droplets from escaping airborne and infecting other people, although there are different percentages of protection and can be possible a discomfort related the use. Further clinical trials to the effectiveness of face mask to avoid airborne contamination during the COVID-19 pandemic and the factors interfering with their effectiveness should be conducted.
PubMed: 36317023
DOI: 10.18502/ijph.v50i12.7920 -
Frontiers in Public Health 2022Health Care Workers (HCWs) use Personal Protective Equipment (PPE) during the COVID-19 pandemic to protect themselves and prevent the transmission of the disease. The... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Health Care Workers (HCWs) use Personal Protective Equipment (PPE) during the COVID-19 pandemic to protect themselves and prevent the transmission of the disease. The use of PPE, especially respiratory masks, has adverse consequences, including headaches, which have been secondary and unusual. The aim of the present systematic review and meta-analysis study was to investigate the prevalence of PPE-associated headaches in HCWs during COVID-19 pandemic.
METHODS
The present review study was performed based on the PRISMA guideline. The protocol of the present study was registered in PROSPERO with the code CRD42022304437. Valid data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, Embase were used to identify and extract relevant studies. The searches were conducted between the beginning of 2020 and the end of January 2022. A random effects model was used for meta-analysis and index was used to investigate between-study heterogeneity. Data were analyzed using STATA ver. 14.
RESULTS
A total of 539 articles were first identified through initial search and finally 26 final studies were selected to undergo the meta-analysis phase. According to the results of meta-analysis, the prevalence of headache after and before the use of PPE was 48.27% (95% CI: 40.20-56.34, = 99.3%, = 0 < 001) and 30.47% (95% CI: 20.47-40.47, = 97.3%, = 0 < 001), respectively.
CONCLUSION
The results of the present study showed that the prevalence of PPE-associated headache in HCWs was relatively high, so, the use of PPE during COVID-19 pandemic can be considered as one of the causes of headache. Therefore, management strategies such as regular screening of HCWs for headaches and regular rest periods without the use of PPE can be effective in reducing the prevalence of headaches.
Topics: Humans; Personal Protective Equipment; COVID-19; Pandemics; SARS-CoV-2; Health Personnel; Headache
PubMed: 36311638
DOI: 10.3389/fpubh.2022.942046 -
Children (Basel, Switzerland) Sep 2022Cannulas with long and narrow tubing (CLNT) are increasingly being used as an interface for noninvasive respiratory support (NRS) in preterm neonates; however, their... (Review)
Review
BACKGROUND
Cannulas with long and narrow tubing (CLNT) are increasingly being used as an interface for noninvasive respiratory support (NRS) in preterm neonates; however, their efficacy compared to commonly used nasal interfaces such as short binasal prongs (SBP) and nasal masks (NM) has not been widely studied.
MATERIAL AND METHODS
Medline, Embase, CENTRAL, Health Technology Assessment Database, and Web of Science were searched for randomized clinical trials (RCTs) and observational studies investigating the efficacy of CLNT compared to SBP or NM in preterm neonates requiring NRS for primary respiratory and post-extubation support. A random-effects meta-analysis was used for data synthesis.
RESULTS
Three RCTs and three observational studies were included. Clinical benefit or harm could not be ruled out for the outcome of need for invasive mechanical ventilation (IMV) for CLNT versus SBP or NM [relative risk (RR) 1.37, 95% confidence interval (CI) 0.61-3.04, certainty of evidence (CoE) low]. The results were also inconclusive for the outcome of treatment failure [RR 1.20, 95% CI 0.48-3.01, CoE very low]. Oropharyngeal pressure transmission was possibly lower with CLNT compared to other interfaces [MD -1.84 cm H20, 95% CI -3.12 to -0.56, CoE very low]. Clinical benefit or harm could not be excluded with CLNT compared to SBP or NM for the outcomes of duration of IMV, nasal trauma, receipt of surfactant, air leak, and NRS duration.
CONCLUSION
Very low to low CoE and statistically nonsignificant results for the clinical outcomes precluded us from making any reasonable conclusions; however, the use of CLNT as an NRS interface, compared to SBP or NM, possibly transmits lower oropharyngeal pressures. We suggest adequately powered multicentric RCTs to evaluate the efficacy of CLNT when compared to other interfaces.
PubMed: 36291395
DOI: 10.3390/children9101461 -
Orphanet Journal of Rare Diseases Oct 2022The objective of this systematic review was to determine the orthodontic and dentofacial orthopedic treatments carried out in patients with ectodermal dysplasia to... (Review)
Review
OBJECTIVE
The objective of this systematic review was to determine the orthodontic and dentofacial orthopedic treatments carried out in patients with ectodermal dysplasia to facilitate functional and aesthetic rehabilitation.
METHODS
The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. We systematically searched PubMed, Web of Science, Scopus, Scielo, LILACS, EBSCOhost and Embase databases up to 6 January 2022. We included articles describing patients with any type of ectodermal dysplasia who received orthodontic or dentofacial orthopedic treatment to facilitate functional and aesthetic oral rehabilitation. The search was not restricted by language or year of publication. The quality of the studies was assessed using the Joanna Briggs Institute Quality Assessment Scale of the University of Adelaide for case series and case reports. The review was registered at the University of York Centre for reviews (CRD42021288030).
RESULTS
Of the initial 403 studies found, 29 met the inclusion criteria. After applying the quality scale, 23 were left for review-21 case reports and 2 case series. The initial age of patients ranged from 34 months to 24 years. Thirteen studies were on hypohidrotic and/or anhidrotic ectodermal dysplasia, of which two were X-chromosome linked. In one study, the patient had Wiktop syndrome, and in nine the type of ectodermal dysplasia was not specified. The duration of treatment was 7 weeks to 10 years. The treatments described were: fixed orthodontic appliances or simple acrylic plates designed for tooth movement, including leveling and aligning, closing of diastemata, retraction of impacted teeth in the dental arch; clear aligners; fixed and/or removable appliances for the correction of skeletal and/or dentoalveolar relationships; palatal expanders in combination with face masks for orthopedic traction of the maxilla; and orthognathic surgery. Only three studies provided cephalometric data.
CONCLUSION
The level of evidence of the articles reviewed was low and most orthopedic and dentofacial orthodontic treatments described were focused on correcting dental malpositioning and jaw asymmetries and not on stimulating growth from an early age. Studies with greater scientific evidence are needed to determine the best treatment for these patients.
Topics: Child, Preschool; Ectodermal Dysplasia; Ectodermal Dysplasia 1, Anhidrotic; Humans; Tooth Movement Techniques
PubMed: 36253866
DOI: 10.1186/s13023-022-02533-0