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Sports Medicine - Open Apr 2024Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is...
BACKGROUND
Musculoskeletal conditions are a leading contributor to disability worldwide. The treatment of these conditions accounts for 7% of health care costs in Germany and is often provided by physiotherapists. Yet, an overview of the cost-effectiveness of treatments for musculoskeletal conditions offered by physiotherapists is missing. This review aims to provide an overview of full economic evaluations of interventions for musculoskeletal conditions offered by physiotherapists.
METHODS
We systematically searched for publications in Medline, EconLit, and NHS-EED. Title and abstracts, followed by full texts were screened independently by two authors. We included trial-based full economic evaluations of physiotherapeutic interventions for patients with musculoskeletal conditions and allowed any control group. We extracted participants' information, the setting, the intervention, and details on the economic analyses. We evaluated the quality of the included articles with the Consensus on Health Economic Criteria checklist.
RESULTS
We identified 5141 eligible publications and included 83 articles. The articles were based on 78 clinical trials. They addressed conditions of the spine (n = 39), the upper limb (n = 8), the lower limb (n = 30), and some other conditions (n = 6). The most investigated conditions were low back pain (n = 25) and knee and hip osteoarthritis (n = 16). The articles involved 69 comparisons between physiotherapeutic interventions (in which we defined primary interventions) and 81 comparisons in which only one intervention was offered by a physiotherapist. Physiotherapeutic interventions compared to those provided by other health professionals were cheaper and more effective in 43% (18/42) of the comparisons. Ten percent (4/42) of the interventions were dominated. The overall quality of the articles was high. However, the description of delivered interventions varied widely and often lacked details. This limited fair treatment comparisons.
CONCLUSIONS
High-quality evidence was found for physiotherapeutic interventions to be cost-effective, but the result depends on the patient group, intervention, and control arm. Treatments of knee and back conditions were primarily investigated, highlighting a need for physiotherapeutic cost-effectiveness analyses of less often investigated joints and conditions. The documentation of provided interventions needs improvement to enable clinicians and stakeholders to fairly compare interventions and ultimately adopt cost-effective treatments.
PubMed: 38613739
DOI: 10.1186/s40798-024-00713-9 -
Journal of Clinical Medicine Mar 2024: Children with CP show deficits in executive function compared to their typically developing peers, based on the majority of the available evidence. However, the... (Review)
Review
: Children with CP show deficits in executive function compared to their typically developing peers, based on the majority of the available evidence. However, the magnitude of these deficits, as well as the proportions of the shortfalls in the three main components, have not yet been examined. This is the first meta-analysis to synthesize evidence on the magnitude of differences between patients with cerebral palsy (CP) and typically developing populations in different components of executive function skills (working memory, inhibitory control and cognitive flexibility), and thus makes recommendations on which areas of executive functioning are in greatest need of intervention. : We conducted a systematic literature search of four databases for studies that measured executive functions in these two groups until 31 August 2023. We calculated the standardized mean difference (Hedges' g), an average effect size overall, and for the three components of executive function skills separately, we used several moderator analyses, including methodological differences between the primary studies. : Fifteen articles were included in the meta-analysis. The average mean difference in executive functioning overall was large (g+ = -0.82). Furthermore, large significant differences were found in working memory (g+ = -0.92) and inhibitory control (g+ = -0.82) and a moderate difference was identified in cognitive flexibility (g+ = -0.57). In addition, results of moderator analyses reveal the importance of a rigorous matching of control group participants and CP patients. : The results demonstrate a severe impairment in all executive functions among CP patients compared to typically developing peers, which do not decrease over time.
PubMed: 38610632
DOI: 10.3390/jcm13071867 -
Value in Health : the Journal of the... Apr 2024Health-related quality-of-life (HRQoL) instruments for cardiovascular diseases (CVD) have been commonly used to measure important patient-reported outcomes (PROs) in... (Review)
Review
A Systematic Review and Quality Assessment of Cardiovascular Disease-Specific Health-Related Quality-of-Life Instruments Part I: Instrument Development and Content Validity.
OBJECTIVES
Health-related quality-of-life (HRQoL) instruments for cardiovascular diseases (CVD) have been commonly used to measure important patient-reported outcomes (PROs) in clinical trials and practices. This study aimed at systematically identifying and assessing the content validity of CVD-specific HRQoL instruments in clinical studies.
METHODS
The research team searched Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed from inception to January 20, 2022. The research team included studies that reported the development and content validity for CVD-specific instruments. Two reviewers independently assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methods on evaluating content validity of PROs. Content analysis was used to categorize the items included in the instruments.
RESULTS
The research team found 69 studies reporting the content validity of 40 instruments specifically developed for CVD. Fourteen (35.0%) were rated "sufficient" with very low to moderate quality of evidence. For PRO development, all instruments were rated "doubtful" or "inadequate." Twenty-eight (70.0%) instruments cover the core concepts of HRQoL.
CONCLUSIONS
The quality of development and content validity vary among existing CVD-specific instruments. The evidence on the content validity should be considered when choosing a HRQoL instrument in CVD clinical studies and health economic evaluations.
PubMed: 38608875
DOI: 10.1016/j.jval.2024.04.001 -
Frontiers in Pediatrics 2024Limited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic...
BACKGROUND
Limited data are available on the clinical impact and economic burden of COVID-19 in the pediatric population in Argentina. We aimed to estimate the disease and economic burden of COVID-19 on children and adolescents.
METHODS
We analyzed official national databases and conducted a supplemental systematic review of the published literature with meta-analysis in children aged 0-18. The period of interest was from March 2020 to August 2021, before the introduction of vaccination in this age group as a national strategic plan. In addition, we used a cost of illness analysis to estimate the direct medical costs associated with COVID-19. All costs are reported in US dollars 2023.
RESULTS
A total of 450,503 confirmed COVID-19 cases and 180 multisystem inflammatory syndrome (MIS-C) were reported in Argentina in the study period. Fourteen observational clinical studies were identified. The meta-analyses of severity level from hospital patients showed that according to different studies 15%-28% of cases were asymptomatic, 68%-88% were mild or moderate, and 3%-10% were severe or critical. About 28% of children had an underlying disease. In addition, the estimated economic burden associated with COVID-19 was 80 million dollars and 4 million dollars corresponded to MISC.
CONCLUSION
Significant impact of COVID-19 on the healthcare system and substantial economic implications for the pediatric population in Argentina were identified. The findings should help policymakers to make informed decisions and allocate resources effectively.
PubMed: 38606369
DOI: 10.3389/fped.2024.1352260 -
Heliyon Apr 2024Tuberculosis (TB) is a significant public health disease and a major contributor to illness and death worldwide, including in Ethiopia. There are many information from...
BACKGROUND
Tuberculosis (TB) is a significant public health disease and a major contributor to illness and death worldwide, including in Ethiopia. There are many information from first source which had inconclusive result in Ethiopia. Therefore, this review aimed to produce pooled evidence on the TB treatment delay and factors associated with it.
METHODS
The absence of a similar study with a systematic review and meta-analysis was confirmed. Articles from online available and unpublished sources conducted within Ethiopia between 2002 and 2024, were thoroughly screened using electronic sources such as Medline, Embase, Hinari, PubMed, the Cochrane Library, the Web of Science, and Google Scholar. Data analysis was performed using STATA version 14. Heterogeneity was assessed using Inverse of Variance (I) and Cochrane Q tests. The funnel plot was employed to rule existence of publications subjectively while bias was checked using Egger's statistical method to quantify the bias.
RESULT
Prevalence of TB treatment delay in Ethiopia was 50.42% at 95% (43.21, 57.64). Factors such as knowledge about TB, distance to health facilities less than 10 km, initial contact at a government service providing center for TB, having some educations, having pulmonary Tuberculosis, urban residency, were prtotective towards treatment delay. Female in gender, no chest pain symptom, disease severity with no restriction on daily activity, alcohol drinkers, and unmarried respondents were at higher risk to miss on time tuberculosis treatment.
CONCLUSION AND RECOMMENDATION
The tuberculosis treatment delay in Ethiopia was considerably unexpected and basic personal variables and facility related variables were statistically associated with treatment. Therefore, Ethiopian TB control programs have to recognize and tackle the problem, obstacles, and vulnerability across the continuum patient care taking down and connecting to treatment post-diagnosis. This can be achieved by capacitating both government and non-governmental service provision centers and minimizing unfilled difference across professional awareness and skill, which will contribute further to minimizing delay.
PubMed: 38586418
DOI: 10.1016/j.heliyon.2024.e28699 -
BMC Medicine Apr 2024Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from... (Review)
Review
BACKGROUND
Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity).
METHODS
Scoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist. All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework.
RESULTS
We screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes.
CONCLUSIONS
There is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex.
TRIAL REGISTRATION
Open Science Framework https://osf.io/x8yae .
Topics: Male; Female; Humans; Gender Equity; Canada; Workplace; Randomized Controlled Trials as Topic
PubMed: 38581003
DOI: 10.1186/s12916-024-03346-7 -
Frontiers in Microbiology 2024One of the biggest obstacles in diagnosing Implant-Associated Infections is the lack of infection criteria and standardized diagnostic methods. These infections present...
INTRODUCTION
One of the biggest obstacles in diagnosing Implant-Associated Infections is the lack of infection criteria and standardized diagnostic methods. These infections present a wide range of symptoms, and their diagnosis can be hampered by the formation of microbial biofilms on the surface of implants. This study aimed to provide insight into the performance of sonication in the diagnosis of infections associated with Cardiac Implantable Electronic Devices, to help define a consensus on the algorithm for the microbial diagnosis of these infections.
METHODS
We carried out a systematic review with meta-analysis. The PRISMA methodology guidelines were followed, and an advanced search was carried out in PubMed and Web of Science, which enabled 8 articles to be included in the review, in which a meta-analysis was also carried out. QUADAS-2 was used to assess the risk of bias and effect measures were calculated to assess publication bias.
RESULTS
The overall sensitivity of the method was 0.823 (95% CI: 0.682-0.910) and the specificity was 0.632 (95% CI: 0.506-0.743).
DISCUSSION
These results suggest that sonication may offer advantages in diagnosing these infections. However, it is essential to approach these findings carefully and take into account the recommendations provided in the EHRA 2019 guidelines. This study highlights the importance of more effective diagnostic approaches for implantable medical device-associated infections to improve the quality of treatment and minimize the risks associated with these challenging medical conditions.
PubMed: 38559357
DOI: 10.3389/fmicb.2024.1361626 -
Journal of Dentistry May 2024Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Erosive tooth wear is a multifactorial condition. The aim of this systematic review and meta-analysis was to identify key risk factors for erosive tooth wear in permanent dentition.
STUDY SELECTION
Observational studies reporting anamnestic risk factors for erosive tooth wear. Methodological quality and risk of bias were assessed using the modified Newcastle-Ottawa scale for cross-sectional studies. Risk factors were visually presented in a heatmap, and where possible, random-effects meta-analyses were performed for the odds ratios (ORs) of risk factors.
SOURCES
Electronic databases (MEDLINE, Embase, Scopus, and Web of Science) and manual searches in February 2023. The protocol was registered in PROSPERO (CRD4202339776).
DATA
A total of 87 publications reporting on 71 studies were included in the systematic review. The studies examined a variety of anamnestic risk factors (n = 80) that were categorized into ten domains (socio-demographics, socio-economics, general health, oral diseases, medication, oral hygiene, food, beverages, dietary habits, and leisure-related risk factors). Meta-analyses revealed significant associations between erosive tooth wear and male gender (p<0.001; OR=1.30, 95 % CI: 1.16-1.44), regurgitation (p=0.033; OR=2.27, 95 % CI: 1.41-3.65), digestive disorders (p<0.001; OR=1.81, 95 % CI: 1.48-2.21), consumption of acidic foods (p=0.033; OR=2.40, 95 % CI: 1.44-4.00), seasoning sauces (p=0.003; OR=1.28, 95 % CI: 1.13-1.44), nutritional supplements (p=0.019; OR=1.73, 95 % CI: 1.28-2.35), and carbonated drinks (p=0.019; OR=1.43, 95 % CI: 1.17-1.75). Most included studies exhibited low bias risk.
CONCLUSIONS
Observational studies investigated a variety of anamnestic risk factors for erosive tooth wear. Future studies should employ validated questionnaires, particularly considering the most important risk factors.
CLINICAL SIGNIFICANCE
Erosive tooth wear is a prevalent condition. Clinicians should concentrate primarily on symptoms of gastroesophageal reflux disease and dietary factors when screening patients at risk for erosive tooth wear.
Topics: Humans; Risk Factors; Tooth Erosion; Tooth Wear; Feeding Behavior; Male; Female; Oral Hygiene; Sex Factors; Cross-Sectional Studies
PubMed: 38552999
DOI: 10.1016/j.jdent.2024.104962 -
BMC Pregnancy and Childbirth Mar 2024One of the most significant demographic challenges over the past three decades has been the substantial reduction in fertility rates, worldwidely. As a developing...
BACKGROUND
One of the most significant demographic challenges over the past three decades has been the substantial reduction in fertility rates, worldwidely. As a developing country, Iran has also experienced a rapid decline in fertility over the past decades. Understanding factors influencing fertility is essential for development programs. Moreover, it's crucial to study the parameters that affect the intention for childbearing in any society. Therefore, through a systematic scoping review, the present study investigates the factors influencing couples' decisions toward childbearing.
METHODS
This study was a systematic scoping review conducted in 2023. To design and conduct this scoping review, Joanna Briggs Institute's Protocol (Institute TJB, The Joanna Briggs Institute Reviewers ' manual 2015; methodology for JBI scoping reviews, 2015) was used and the framework presented by Levac et al. (2010) was also used as a guide for conducting this review. Studies were searched in three main databases including ISI Web of Sciences, PubMed, and Scopus, using a predefined search strategy. Google Scholar was also used for complementary search. The search period was from 2002 to 2022.
RESULTS
A total of 18,454 studies were identified across three primary databases. After evaluating articles in three distinct phases based on title, abstract, and full-text, 46 articles were deemed eligible for inclusion in the scoping review. The qualitative analysis of the collected data from the selected studies through the scoping review led to classifying factors influencing households' desire for childbearing into eight main themes and 101 sub-themes. The main themes associated with factors impacting households' intention for childbearing encompass individual determinants, demographic and familial influencing factors, cultural elements, social factors, health-related aspects, economic considerations, insurance-related variables, and government support/incentive policies.
CONCLUSIONS
Comprehensive and holistic attention from governments and officials toward the various factors affecting households' intention and behavior regarding childbearing appears beneficial and effective. Furthermore, given the relative ineffectiveness of some of the current government's supportive/incentive policies to increase couples' desire for childbearing, it seems necessary to review and amend these policies. This review should address the most significant challenges and factors contributing to couples' reluctance to childbearing or strengthen factors that can play a substantial role in fostering fertility and childbearing desires.
Topics: Child; Humans; Fertility; Family Characteristics; Motivation; Intention; Data Collection
PubMed: 38539104
DOI: 10.1186/s12884-024-06385-3 -
Phlebology Jun 2024The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage. (Review)
Review
The anterior saphenous vein. Part 3. Systematic review of the literature and payor coverage policies. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology.
OBJECTIVE
The objective of this study is to systemically review the literature on Anterior Saphenous Vein (ASV) reflux treatment and insurance impediments to treatment coverage.
METHODS
A literature search was performed using a PRISMA framework. In addition, a cross-sectional analysis of insurance policies for ASV treatment was evaluated.
RESULTS
Published evidence and treatment considerations in the literature for ASV treatment are discussed. In 155 of 226 (68.6%) insurance policies reviewed coverage of ASV ablation was allowed while 62/226 (27.4%) did not specify coverage and 9/226 (4.0%) specified ASV treatment was not covered. Of the 155 that provide ASV coverage, 98 (62.2%) provide coverage with criteria such as requiring prior treatment of the great saphenous vein.
CONCLUSIONS
Vein treatment experts should continue to advocate to insurance carriers to update their varicose vein treatment policies to reflect the substantial clinical evidence so that patients with ASV reflux can be appropriately treated.
Topics: Humans; Saphenous Vein; Varicose Veins; Insurance Coverage; Venous Insufficiency; Societies, Medical; United States
PubMed: 38526968
DOI: 10.1177/02683555231223281