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Industrial Psychiatry Journal 2024Anxiety symptoms when coexisting with tuberculosis (TB), can have deleterious effects on treatment continuation that could contribute to the development of treatment... (Review)
Review
Anxiety symptoms when coexisting with tuberculosis (TB), can have deleterious effects on treatment continuation that could contribute to the development of treatment resistance in TB. It is essential to understand the prevalence of anxiety in TB to develop clinical recommendations for its management. The primary objective of our review was to estimate the pooled prevalence of anxiety in TB patients along with the estimation of stress and quality of life in such patients. The relevant literature search on observational studies published in the English language till the year 2020 was carried out. A total of 8086 participants from 29 studies were included, of which 24 were cross-sectional studies and the remaining were case-control, and cohort studies. The estimated pooled prevalence of anxiety, comorbid depression, stress, and poor quality of life in TB patients was 32.54% [24.95, 41.18], 32.87% [25.79, 40.82], 52.68% [48.60, 56.72], and 79.51% [45.67, 94.72] respectively. When comparing the prevalence of anxiety across World Health Organization (WHO) regions, there was a statistically significant difference, with the African Region (AFR) having the highest prevalence i.e. 37.87% [29.59, 46.92], and the Western Pacific Region (WPR) having the lowest prevalence i.e. 15.83 % [12.72, 19.53]. The higher prevalence of anxiety in TB in the AFR and South-East Asian Region (SEAR) suggests a strong correlation with the developing status of these regions which calls for efforts to identify and treat the risk factors common to both anxiety and TB.
PubMed: 38853803
DOI: 10.4103/ipj.ipj_58_23 -
Public Health Jun 2024The objective of this study was to estimate prevalence of hepatitis C virus (HCV) exposure and infection among Indigenous and tribal populations globally. (Review)
Review
OBJECTIVES
The objective of this study was to estimate prevalence of hepatitis C virus (HCV) exposure and infection among Indigenous and tribal populations globally.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
We systematically searched bibliographic databases and grey literature (1/01/2000-16/06/2022). Prevalence estimates were synthesised overall, by World Health Organization region and HCV-risk group. For studies with comparator populations, prevalence ratios were estimated and pooled.
RESULTS
Ninety-two studies were included. Globally, among general Indigenous and tribal populations, the median prevalence of HCV antibody (HCV Ab) was 1.3% (interquartile range [IQR]: 0.3-3.8%, I = 98.5%) and HCV RNA was 0.4% (IQR: 0-1.3%, I = 96.1%). The Western Pacific Region had the highest prevalence (HCV Ab: median: 3.0% [IQR: 0.4-11.9%], HCV RNA: median 5.6% [IQR: 2.0-8.8%]). Prevalence was highest in people who injected drugs (HCV Ab: median: 59.5%, IQR: 51.5-67.6%, I = 96.6%; and HCV RNA: median: 29.4%, IQR: 21.8-35.2%, I = 97.2%). There was no association between HCV Ab prevalence and Indigenous/tribal status for general populations (prevalence ratio = 0.91; 95% CI: 0.56, 1.49) or key risk groups.
CONCLUSIONS
Indigenous and tribal peoples from the Western Pacific Region and recognised at-risk sub-populations had higher HCV prevalence. HCV prevalence showed no association with Indigenous/tribal status. However, this review was limited by heterogeneity and poor quality of constituent studies, varying definitions of Indigenous/tribal status, regional data gaps, and limited studies on chronic infection (HCV RNA). Comprehensive quality evidence on HCV epidemiology in Indigenous and tribal peoples is needed to tailor preventive and treatment interventions so these populations are not left behind in elimination efforts.
PubMed: 38850603
DOI: 10.1016/j.puhe.2024.04.035 -
Systematic Reviews Jun 2024Despite growing interest in workplace mental health interventions, evidence of their effectiveness is mixed. Implementation science offers a valuable lens to investigate... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite growing interest in workplace mental health interventions, evidence of their effectiveness is mixed. Implementation science offers a valuable lens to investigate the factors influencing successful implementation. However, evidence synthesis is lacking, especially for small-to-medium-sized enterprises (SMEs) and for specific work sectors. The objectives of this review are to establish the scope of research with explicit analysis of implementation aspects of workplace mental health interventions and to identify barriers and facilitators to implementation in general and within SMEs and selected sectors.
METHODS
A systematic scoping review and meta-synthesis of mixed methods process evaluation research from 11 databases, with the evaluation of methodological quality (MMAT) and confidence in findings (CERQual), was conducted. We selected information-rich studies and synthesised them using domains within the Nielsen and Randall implementation framework: context, intervention activities, implementation; and mental models.
RESULTS
We included 43 studies published between 2009 and 2022, of which 22 were rated as information-rich to be analysed for barriers and facilitators. Most studies were conducted in healthcare. Facilitators reflecting 'high confidence' included: relevant and tailored content, continuous and pro-active leadership buy-in and support, internal or external change agents/champions, assistance from managers and peers, resources, and senior-level experience and awareness of mental health issues. Healthcare sector-specific facilitators included: easy accessibility with time provided, fostering relationships, clear communication, and perceptions of the intervention. Stigma and confidentiality issues were reported as barriers overall. Due to the small number of studies within SMEs reported findings did not reach 'high confidence'. A lack of studies in construction and Information and Communication Technology meant separate analyses were not possible.
CONCLUSIONS
There is dependable evidence of key factors for the implementation of workplace mental health interventions which should be used to improve implementation. However, there is a lack of studies in SMEs and in a larger variety of sectors.
SYSTEMATIC REVIEW REGISTRATION
Research Registry ( reviewregistry897 ).
Topics: Humans; Workplace; Mental Health; Health Promotion; Qualitative Research; Leadership; Occupational Health
PubMed: 38849924
DOI: 10.1186/s13643-024-02569-2 -
The Science of the Total Environment Sep 2024Air quality (AQ) significantly impacts human health, influenced by both natural phenomena and human activities. In 2021, heightened awareness of AQ's health impacts...
Air quality (AQ) significantly impacts human health, influenced by both natural phenomena and human activities. In 2021, heightened awareness of AQ's health impacts prompted the revision of the World Health Organization (WHO) guidelines, advocating for stricter pollution standards. However, research on AQ has predominantly focused on high-income countries and densely populated cities, neglecting low- and middle-income countries, particularly Pacific Island Countries, Territories, and States (PICTS). This systematic review compiles existing peer-reviewed literature on AQ research in PICTS to assess the current state of knowledge and emphasize the need for further investigation. A systematic literature search yielded 40 papers from databases including Web of Science, Scopus, and Embase. Among the 26 PICTS, only 6 (Hawai'i, Fiji, Papua New Guinea, New Caledonia, Republic of Marshall Islands, and Pacific) have been subject to AQ-related research, with 4 considering the World Health Organization (WHO) parameters and 26 addressing non-WHO parameters. Analysis reveals AQ parameters often exceed 2021 WHO guidelines for PM, PM, SO, and CO, raising concerns among regional governments. Studies primarily focused on urban, agricultural, rural, and open ocean areas, with 15 based on primary data and 14 on both primary and secondary sources. Research interests and funding sources dictated the methods used, with a predominant focus on environmental risks over social, economic, and technological impacts. Although some papers addressed health implications, further efforts are needed in this area. This review underscores the urgent need for ongoing AQ monitoring efforts in PICTS to generate spatially and temporally comparable data. By presenting the current state of AQ knowledge, this work lays the foundation for coordinated regional monitoring and informs national policy development.
Topics: Humans; Air Pollutants; Air Pollution; Environmental Exposure; Environmental Health; Environmental Monitoring; Pacific Islands; World Health Organization
PubMed: 38848924
DOI: 10.1016/j.scitotenv.2024.173628 -
AIDS Research and Therapy Jun 2024Despite the widespread use of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) transmission, scant information on HIV drug resistance... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Despite the widespread use of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) transmission, scant information on HIV drug resistance mutations (DRMs) has been gathered over the past decade. This review aimed to estimate the pooled prevalence of pre-exposure prophylaxis and its two-way impact on DRM.
METHODS
We systematically reviewed studies on DRM in pre-exposure prophylaxis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. PubMed, Cochrane, and SAGE databases were searched for English-language primary studies published between January 2001 and December 2023. The initial search was conducted on 9 August 2021 and was updated through 31 December 2023 to ensure the inclusion of the most recent findings. The registration number for this protocol review was CRD42022356061.
RESULTS
A total of 26,367 participants and 562 seroconversion cases across 12 studies were included in this review. The pooled prevalence estimate for all mutations was 6.47% (95% Confidence Interval-CI 3.65-9.93), while Tenofovir Disoproxil Fumarate/Emtricitabine-associated drug resistance mutation prevalence was 1.52% (95% CI 0.23-3.60) in the pre-exposure prophylaxis arm after enrolment. A subgroup analysis, based on the study population, showed the prevalence in the heterosexual and men who have sex with men (MSM) groups was 5.53% (95% CI 2.55-9.40) and 7.47% (95% CI 3.80-12.11), respectively. Notably, there was no significant difference in the incidence of DRM between the pre-exposure prophylaxis and placebo groups (log-OR = 0.99, 95% CI -0.20 to 2.18, I2 = 0%; p = 0.10).
DISCUSSION
Given the constrained prevalence of DRM, the World Health Organization (WHO) advocates the extensive adoption of pre-exposure prophylaxis. Our study demonstrated no increased risk of DRM with pre-exposure prophylaxis (p > 0.05), which is consistent with these settings. These findings align with the previous meta-analysis, which reported a 3.14-fold higher risk in the pre-exposure prophylaxis group than the placebo group, although the observed difference did not reach statistical significance (p = 0.21).
CONCLUSIONS
Despite the low prevalence of DRM, pre-exposure prophylaxis did not significantly increase the risk of DRM compared to placebo. However, long-term observation is required to determine further disadvantages of extensive pre-exposure prophylaxis use. PROSPERO Number: CRD42022356061.
Topics: Humans; Pre-Exposure Prophylaxis; HIV Infections; Drug Resistance, Viral; Mutation; Anti-HIV Agents; HIV-1; Male; Administration, Oral; Female; Tenofovir; Prevalence
PubMed: 38844950
DOI: 10.1186/s12981-024-00627-2 -
Frontiers in Public Health 2024According to the World Health Organization (WHO), burnout is a syndrome conceptualized as resulting from chronic occupational stress that has not been successfully...
UNLABELLED
According to the World Health Organization (WHO), burnout is a syndrome conceptualized as resulting from chronic occupational stress that has not been successfully managed. It is characterized by emotional exhaustion, cynicism toward work, and a lack of personal accomplishment at work. Recent WHO guidelines on mental health suggest that mindfulness could have beneficial effects in a professional environment, but to the best of our knowledge, there is currently no study that has made a large inventory of research focused specifically on the effects of standardized programs on burnout. Which professional populations have already been studied? What are the characteristics of the programs? Have studies shown a significant effect and on what indicator?
OBJECTIVE
To assess the effects of standardized programs of mindfulness on burnout, we carried out a systematic review using an exhaustive inventory of the international literature based on randomized controlled trials (RCTs).
METHODS
The articles were selected according to PRISMA recommendations. The Embase, PubMed/MEDLINE, EBSCOhost, HAL databases were searched with the keywords "mindfulness," "burnout," and "randomized" in the title and abstract of each article. The data were all collected in an Excel spreadsheet and analyzed in pivot tables, which were then presented in graphs and maps.
RESULTS
A total of 49 RCTs were thus selected, the majority of which were of good methodological quality, of American origin (43% of studies), concerned professionals in the health sector (64% of participants included), and mostly women (76%). The RCTs assessed the effects of 31 different mindfulness programs, mostly with the Maslach Burnout Inventory (78% of RCTs). More than two-thirds of RCTs (67%) showed a significant beneficial effect on burnout measurement indicators, with emotional exhaustion being the most impacted component.
CONCLUSION
This systematic review shows that mindfulness-based interventions could be approaches of choice to prevent emotional distress of burnout. Further studies are still needed to determine which type of program is best suited to impact the two other components of burnout.
Topics: Mindfulness; Humans; Burnout, Professional; Randomized Controlled Trials as Topic; Female; Male
PubMed: 38841654
DOI: 10.3389/fpubh.2024.1381373 -
JAMA Network Open Jun 2024Treatment of locally advanced rectal cancer (LARC) involves neoadjuvant chemoradiotherapy plus total mesorectal excision and adjuvant chemotherapy. However, total... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Treatment of locally advanced rectal cancer (LARC) involves neoadjuvant chemoradiotherapy plus total mesorectal excision and adjuvant chemotherapy. However, total neoadjuvant therapy (TNT) protocols (ie, preoperative chemotherapy in addition to radiotherapy) may allow better adherence and early treatment of distant micrometastases and may increase pathological complete response (pCR) rates.
OBJECTIVE
To assess the efficacy and tolerability of TNT protocols for LARC.
DATA SOURCES
MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection electronic databases and ClinicalTrials.gov for unpublished studies were searched from inception to March 2, 2024.
STUDY SELECTION
Randomized clinical trials including adults with LARC who underwent rectal resection as a final treatment were included. Studies including nonoperative treatment (watch-and-wait strategy), treatments other than rectal resection, immunotherapy, or antiangiogenic agents were excluded. Among the initially identified studies, 2.9% met the selection criteria.
DATA EXTRACTION AND SYNTHESIS
Two authors independently screened the records and extracted data. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant pairwise and network meta-analyses with a random-effects model were performed in a frequentist framework, and the certainty of evidence was assessed according to the confidence in network meta-analysis approach.
MAIN OUTCOMES AND MEASURES
The primary outcome was pCR, defined as the absence of residual tumor at pathological assessment after surgery. Secondary outcomes included tolerability, toxic effects, perioperative outcomes, and long-term survival.
RESULTS
Of 925 records identified, 27 randomized clinical trials, including 13 413 adults aged 18 years or older (median age, 60.0 years [range, 42.0-63.5 years]; 67.2% male) contributed to the primary network meta-analysis. With regard to pCR, long-course chemoradiotherapy (L-CRT) plus consolidation chemotherapy (relative risk [RR], 1.96; 95% CI, 1.25-3.06), short-course radiotherapy (S-RT) plus consolidation chemotherapy (RR, 1.76; 95% CI, 1.34-2.30), and induction chemotherapy plus L-CRT (RR, 1.57; 95% CI, 1.09-2.25) outperformed standard L-CRT with single-agent fluoropyrimidine-based chemotherapy. Considering 3-year disease-free survival, S-RT plus consolidation chemotherapy (RR, 1.08; 95% CI, 1.01-1.14) and induction chemotherapy plus L-CRT (RR, 1.12; 95% CI, 1.01-1.24) outperformed L-CRT, in spite of an increased 5-year locoregional recurrence rate of S-RT plus consolidation chemotherapy (RR, 1.65; 95% CI, 1.03-2.63).
CONCLUSIONS AND RELEVANCE
In this systematic review and network meta-analysis, 3 TNT protocols were identified to outperform the current standard of care in terms of pCR rates, with good tolerability and optimal postoperative outcomes, suggesting they should be recognized as first-line treatments.
Topics: Rectal Neoplasms; Humans; Neoadjuvant Therapy; Network Meta-Analysis; Female; Middle Aged; Male; Randomized Controlled Trials as Topic; Adult
PubMed: 38833249
DOI: 10.1001/jamanetworkopen.2024.14702 -
Cureus May 2024The World Health Organization (WHO) declared COVID-19 a pandemic. The Centers for Disease Control and Prevention (CDC), WHO, and American College of Obstetricians and... (Review)
Review
The World Health Organization (WHO) declared COVID-19 a pandemic. The Centers for Disease Control and Prevention (CDC), WHO, and American College of Obstetricians and Gynecologists (ACOG) recommend vaccination of pregnant and lactating women, aiming to protect both mothers and their infants through transplacental and human milk antibody transmission. This study aims to assess the quantity of antibodies in human milk and determine the effect of time, vaccine type, and dose on antibody level. Single-arm prospective observational studies reporting the COVID-19-specific antibody level in human milk after COVID-19 vaccination during pregnancy or lactation were included. PubMed, Scopus, Cochrane, EBSCO, and Web of Science were searched from December 2019 to November 22, 2022. Data were extracted in a uniform Google sheet. A total of 2657 studies were identified. After the removal of duplicates and screening, 24 studies were included in the systematic review and meta-regression. Human milk COVID-19-specific antibody levels increased with subsequent vaccine doses, as reflected by a positive relationship for the second (coefficient=0.91, P-value 0.043 for IgA and coefficient=1.77, P-value 0.009 for IgG) and third (coefficient=1.23, P-value 0.0029 for IgA and coefficient=3.73, P-value 0.0068 for IgG) doses. The antibody level exhibited a weak positive relationship with the follow-up time (coefficient=0.13, P-value 0.0029 for IgA and coefficient=0.18, P-value 0.016 for IgG). Only one of the 38 infants showed detectable COVID-19 IgM and IgA antibody levels in their blood. There was an increase in the neutralizing activity of COVID-19 antibodies in human milk following the COVID-19 vaccination. From the analysis of published data, we found high positive levels of antibodies in human milk that increased with subsequent doses. Additionally, the human milk antibodies exhibit a positive neutralizing effect. Only one infant had detectable COVID-19 IgM+IgA antibodies in the blood. Further research is needed to discuss infant protection through a mother's vaccination.
PubMed: 38826925
DOI: 10.7759/cureus.59500 -
Environment International Jun 2024We aimed to assess evidence of long-term effects of exposure to radiofrequency (RF) electromagnetic fields (EMF) on indicators of cognition, including domains of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
We aimed to assess evidence of long-term effects of exposure to radiofrequency (RF) electromagnetic fields (EMF) on indicators of cognition, including domains of learning and memory, executive function, complex attention, language, perceptual motor ability and social cognition, and of an exposure-response relationship between RF-EMF and cognition.
METHODS
We searched PubMed, Embase, PsycInfo and the EMF-Portal on September 30, 2022 without limiting by date or language of publication. We included cohort or case-control studies that evaluated the effects of RF exposure on cognitive function in one or more of the cognitive domains. Studies were rated for risk of bias using the OHAT tool and synthesised using fixed effects meta-analysis. We assessed the certainty of the evidence using the GRADE approach and considered modification by OHAT for assessing evidence of exposures.
RESULTS
We included 5 studies that reported analyses of data from 4 cohorts with 4639 participants consisting of 2808 adults and 1831 children across three countries (Australia, Singapore and Switzerland) conducted between 2006 and 2017. The main source of RF-EMF exposure was mobile (cell) phone use measured as calls per week or minutes per day. For mobile phone use in children, two studies (615 participants) that compared an increase in mobile phone use to a decrease or no change were included in meta-analyses. Learning and memory. There was little effect on accuracy (mean difference, MD -0.03; 95% CI -0.07 to 0.02) or response time (MD -0.01; 95% CI -0.04 to 0.02) on the one-back memory task; and accuracy (MD -0.02; 95%CI -0.04 to 0.00) or response time (MD -0.01; 95%CI -0.04 to 0.03) on the one card learning task (low certainty evidence for all outcomes). Executive function. There was little to no effect on the Stroop test for the time ratio ((B-A)/A) response (MD 0.02; 95% CI -0.01 to 0.04, very low certainty) or the time ratio ((D-C)/C) response (MD 0.00; 95% CI -0.06 to 0.05, very low certainty), with both tests measuring susceptibility to interference effects. Complex attention. There was little to no effect on detection task accuracy (MD 0.02; 95% CI -0.04 to 0.08), or response time (MD 0.02;95% CI 0.01 to 0.03), and little to no effect on identification task accuracy (MD 0.00; 95% CI -0.04 to 0.05) or response time (MD 0.00;95% CI -0.01 to 0.02) (low certainty evidence for all outcomes). No other cognitive domains were investigated in children. A single study among elderly people provided very low certainty evidence that more frequent mobile phone use may have little to no effect on the odds of a decline in global cognitive function (odds ratio, OR 0.81; 95% CI 0.42 to 1.58, 649 participants) or a decline in executive function (OR 1.07; 95% CI 0.37 to 3.05, 146 participants), and may lead to a small, probably unimportant, reduction in the odds of a decline in complex attention (OR 0.67;95%CI 0.27 to 1.68, 159 participants) and a decline in learning and memory (OR 0.75; 95% CI 0.29 to 1.99, 159 participants). An exposure-response relationship was not identified for any of the cognitive outcomes.
DISCUSSION
This systematic review and meta-analysis found only a few studies that provided very low to low certainty evidence of little to no association between RF-EMF exposure and learning and memory, executive function and complex attention. None of the studies among children reported on global cognitive function or other domains of cognition. Only one study reported a lack of an effect for all domains in elderly persons but this was of very low certainty evidence. Further studies are needed to address all types of populations, exposures and cognitive outcomes, particularly studies investigating environmental and occupational exposure in adults. Future studies also need to address uncertainties in the assessment of exposure and standardise testing of specific domains of cognitive function to enable synthesis across studies and increase the certainty of the evidence.
OTHER
This review was partially funded by the WHO radioprotection programme and prospectively registered on PROSPERO CRD42021257548.
Topics: Humans; Cognition; Radio Waves; Electromagnetic Fields; Observational Studies as Topic; Child; Cell Phone; Environmental Exposure; Adult; Memory
PubMed: 38821015
DOI: 10.1016/j.envint.2024.108779 -
Clinics (Sao Paulo, Brazil) 2024Intravenous Thrombolysis (IVT) prior to Mechanical Thrombectomy (MT) for Acute Ischaemic Stroke (AIS) due to Large-Vessel Occlusion (LVO) remains controversial.... (Meta-Analysis)
Meta-Analysis Comparative Study Review
BACKGROUND AND PURPOSE
Intravenous Thrombolysis (IVT) prior to Mechanical Thrombectomy (MT) for Acute Ischaemic Stroke (AIS) due to Large-Vessel Occlusion (LVO) remains controversial. Therefore, the authors performed a meta-analysis of the available real-world evidence focusing on the efficacy and safety of Bridging Therapy (BT) compared with direct MT in patients with AIS due to LVO.
METHODS
Four databases were searched until 01 February 2023. Retrospective and prospective studies from nationwide or health organization registry databases that compared the clinical outcomes of BT and direct MT were included. Odds Ratios (ORs) and 95 % Confidence Intervals (CIs) for efficacy and safety outcomes were pooled using a random-effects model.
RESULTS
Of the 12 studies, 86,695 patients were included. In patients with AIS due to LVO, BT group was associated with higher odds of achieving excellent functional outcome (modified Rankin Scale score 0-1) at 90 days (OR = 1.48, 95 % CI 1.25-1.75), favorable discharge disposition (to the home with or without services) (OR = 1.33, 95 % CI 1.29-1.38), and decreased mortality at 90 days (OR = 0.62, 95 % CI 0.56-0.70), as compared with the direct MT group. In addition, the risk of symptomatic intracranial hemorrhage did not increase significantly in the BT group.
CONCLUSION
The present meta-analysis indicates that BT was associated with favorable outcomes in patients with AIS due to LVO. These findings support the current practice in a real-world setting and strengthen their validity. For patients eligible for both IVT and MT, BT remains the standard treatment until more data are available.
Topics: Humans; Ischemic Stroke; Thrombectomy; Treatment Outcome; Thrombolytic Therapy; Fibrinolytic Agents; Mechanical Thrombolysis
PubMed: 38820696
DOI: 10.1016/j.clinsp.2024.100394