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Environment International Jun 2024The World Health Organization (WHO) is bringing together evidence on radiofrequency electromagnetic field (RF-EMF) exposure in relation to health outcomes, previously...
BACKGROUND
The World Health Organization (WHO) is bringing together evidence on radiofrequency electromagnetic field (RF-EMF) exposure in relation to health outcomes, previously identified as priorities for research and evaluation by experts in the field, to inform exposure guidelines. A suite of systematic reviews have been undertaken by a network of topic experts and methodologists to collect, assess and synthesise data relevant to these guidelines. Following the WHO handbook for guideline development and the COSTER conduct guidelines, we systematically reviewed the evidence on the potential effects of RF-EMF exposure on male fertility in human observational studies.
METHODS
We conducted a broad and sensitive search for potentially relevant records within the following bibliographic databases: MEDLINE; Embase; Web of Science and EMF Portal. We also conducted searches of grey literature through relevant databases including OpenGrey, and organisational websites and consulted RF-EMF experts. We hand searched reference lists of included study records and for citations of these studies. We included quantitative human observational studies on the effect of RF-EMF exposure in adult male participants on infertility: sperm concentration; sperm morphology; sperm total motility; sperm progressive motility; total sperm count; and time to pregnancy. Titles and abstracts followed by full texts were screened in blinded duplicate against pre-set eligibility criteria with consensus input from a third reviewer as required. Data extraction from included studies was completed by two reviewers, as was risk of bias assessment using the Office of Health Assessment and Translation (OHAT) tool. We conducted a dose-response meta-analysis as possible and appropriate. Certainty of the evidence was assessed by two reviewers using the OHAT GRADE tool with input from a third reviewer as required.
RESULTS
We identified nine studies in this review; seven were general public studies (with the general public as the population of interest) and two were occupational studies (with specific workers/workforces as the population of interest). General public studies. Duration of phone use: The evidence is very uncertain surrounding the effects of RF-EMF on sperm concentration (10/6 mL) (MD (mean difference) per hour of daily phone use 1.6 10/mL, 95 % CI -1.7 to 4.9; 3 studies), sperm morphology (MD 0.15 percentage points of deviation of normal forms per hour, 95 % CI -0.21 to 0.51; 3 studies), sperm progressive motility (MD -0.46 percentage points per hour, 95 % CI -1.04 to 0.13; 2 studies) and total sperm count (MD per hour -0.44 10/ejaculate, 95 % CI -2.59 to 1.7; 2 studies) due to very low-certainty evidence. Four additional studies reported on the effect of mobile phone use on sperm motility but were unsuitable for pooling; only one of these studies identified a statistically significant effect. All four studies were at risk of exposure characterisation and selection bias; two of confounding, selective reporting and attrition bias; three of outcome assessment bias and one used an inappropriate statistical method. Position of phone: There may be no or little effect of carrying a mobile phone in the front pocket on sperm concentration, total count, morphology, progressive motility or on time to pregnancy. Of three studies reporting on the effect of mobile phone location on sperm total motility and, or, total motile count, one showed a statistically significant effect. All three studies were at risk of exposure characterisation and selection bias; two of confounding, selective reporting and attrition bias; three of outcome assessment bias and one used inappropriate statistical method. RF-EMF Source: One study indicates there may be little or no effect of computer or other electric device use on sperm concentration, total motility or total count. This study is at probably high risk of exposure characterisation bias and outcome assessment bias. Occupational studies. With only two studies of occupational exposure to RF-EMF and heterogeneity in the population and exposure source (technicians exposed to microwaves or seamen exposed to radar equipment), it was not plausible to statistically pool findings. One study was at probably or definitely high risk of bias across all domains, the other across domains for exposure characterisation bias, outcome assessment bias and confounding.
DISCUSSION
The majority of evidence identified was assessing localised RF-EMF exposure from mobile phone use on male fertility with few studies assessing the impact of phone position. Overall, the evidence identified is very uncertain about the effect of RF-EMF exposure from mobile phones on sperm outcomes. One study assessed the impact of other RF-EMF sources on male fertility amongst the general public and two studies assessed the impact of RF-EMF exposure in occupational cohorts from different sources (radar or microwave) on male fertility. Further prospective studies conducted with greater rigour (in particular, improved accuracy of exposure measurement and appropriate statistical method use) would build the existing evidence base and are required to have greater certainty in any potential effects of RF-EMF on male reproductive outcomes. Prospero Registration: CRD42021265401 (SR3A).
PubMed: 38880061
DOI: 10.1016/j.envint.2024.108817 -
International Journal of Infectious... Jun 2024To determine the efficacy and safety of respiratory syncytial virus (RSV) vaccines in infants and older adults.
OBJECTIVES
To determine the efficacy and safety of respiratory syncytial virus (RSV) vaccines in infants and older adults.
METHODS
We performed a systematic review and meta-analysis of randomized control trials that evaluated the efficacy of maternal RSV immunization against infections in infants, as well as the efficacy of RSV vaccines in older adults. The primary outcome was the vaccine efficacy against RSV-related lower respiratory tract disease (LRTD). GRADE criteria was used to evaluate the level of evidence.
RESULTS
Ten trials were included in the review. For maternal vaccination, the RSV vaccine showed favourable efficacy against RSV-related LRTD (vaccine efficacy 57.3%, 95% CI 31.3 to 73.5; low certainty) and RSV-related severe LRTD (vaccine efficacy 81.9%, 95% CI 56.8 to 92.4; moderate certainty) in infants within 90 days after birth. For older adults, Meta-analysis showed that RSV vaccines could also reduce the risk of RSV-related LRTD (vaccine efficacy 78.3%, 95% CI 65.6 to 86.3; moderate certainty) and RSV-related severe LRTD (vaccine efficacy 86.5%, 95% CI 68.3 to 94.3; moderate certainty). There was no significant difference in serious adverse events between RSV vaccines and placebo.
CONCLUSION
RSV vaccines have the potential to offer protection against RSV disease in both infants and older adults, without apparent safety concerns.
PubMed: 38878994
DOI: 10.1016/j.ijid.2024.107118 -
Frontiers in Public Health 2024Strikes in the health sector have been of growing concern, given their disruptive nature, negatively impacting the provision of health care and jeopardizing the...
INTRODUCTION
Strikes in the health sector have been of growing concern, given their disruptive nature, negatively impacting the provision of health care and jeopardizing the well-being of patients. This study aims to identify the main actors, the reasons behind industrial actions protests, strikes and lockouts (IAPSL) in sub-Saharan African countries and their impact on health care workers (specifically doctors) and health services, as well as to identify the main strategies adopted to reduce their impact on healthcare services.
METHODS
Studies published between January 2000 and December 2021 and archived in MEDLINE, Google Scholar, Scopus, ProQuest, and Science Direct were included. Quantitative, observational (i.e., cohort, case-control, cross-sectional, and ecological) and experimental studies, as well as mixed methods, quasi-experimental, and qualitative studies were eligible.
RESULTS
A total of 5521 studies were identified and after eliminating duplicates, applying the inclusion criteria, and assessing the risk of bias, a total of 11 studies were included in the review. Nurses and doctors are the actors most commonly involved in strikes. The main causes of strikes were salary claims and poor working conditions. The main strategies adopted to mitigate the strike consequences were to restrict services and prioritize emergency and chronic care, greater cooperation with the private sector and rearrange tasks of the available staff. The strikes led to a reduction in hospitalizations and in the number of women giving birth in health units, an increase in maternal and child morbidities and delays in the immunization process. Increased mortality was only reported in faith-based hospitals.
DISCUSSION
This evidence can assist decision-makers in developing strategies and interventions to address IAPSL by health care workers, contributing to strengthen the health system. Strikes in the health sector disrupt healthcare services provision and compromise the well-being of patients, especially the most disadvantaged, with consequences that may be difficult to overcome ever. The potential health impacts of strikes highlights the importance of their prevention or timely resolution through regulation and negotiations to balance the rights of health care workers and the rights of patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334173, identifier CRD42022334173.
Topics: Humans; Africa South of the Sahara; Health Personnel; Strikes, Employee; Physicians
PubMed: 38873309
DOI: 10.3389/fpubh.2024.1209201 -
Frontiers in Medicine 2024To investigate the effects of digital health interventions for improving adherence to oral iron supplementation in pregnant women.
OBJECTIVE
To investigate the effects of digital health interventions for improving adherence to oral iron supplementation in pregnant women.
LITERATURE SEARCH
Five databases were searched from their inception to October 2023 with no date restrictions.
STUDY SELECTION
Randomized controlled trials (RCTs) that assessed the effects of digital health interventions on adherence to oral iron supplementation (e.g., tablets and capsules) compared to non-digital health interventions for pregnant women were eligible.
DATA SYNTHESIS
We calculated standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs) for continuous variables using the inverse variance method. We calculated odds ratios (OR) with 95%CI for categorical variables using the Mantel-Haenszel model. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The risk of bias of the included RCTs was assessed using the Cochrane risk of bias tool 2.0.
RESULTS
Ten trials with 1,633 participants were included. Based on 7 trials, digital health interventions can improve objective adherence rate comparing with non-digital health interventions (1,289 participants, OR = 4.07 [2.19, 7.57], < 0.001, I = 69%) in pregnant women. Digital health interventions can improve subjective adherence behavior comparing with non-digital health interventions (3 trials, 434 participants, SMD = 0.82 [0.62, 1.01], < 0.001, I = 0%) in pregnant women. Based on 3 trials, digital health interventions can improve tablets consumption comparing with non-digital health interventions (333 participants, SMD = 1.00 [0.57, 1.42], < 0.001, I = 66%) in pregnant women. Digital health interventions can improve hemoglobin level comparing with non-digital health interventions (7 trials, 1,216 participants, MD = 0.59 [0.31, 0.88], < 0.001, I = 93%) in pregnant women.
CONCLUSION
Digital health interventions were effective at improving adherence to oral iron supplementation and hemoglobin levels in pregnant women.
PubMed: 38873205
DOI: 10.3389/fmed.2024.1375622 -
Frontiers in Global Women's Health 2024Work-life integration has been extensively researched in various contexts. Women dominate the nursing profession, but work-life integration is essential for men and...
BACKGROUND
Work-life integration has been extensively researched in various contexts. Women dominate the nursing profession, but work-life integration is essential for men and women since both are expected to focus equally on their families and careers. The nursing faculty perceives nurse educators' work environment as undervalued, lacking support, and limited time to grow and carry the heavy workload.
METHOD
A qualitative meta-synthesis of studies between 2013 and 2023 was conducted using ScienceDirect, EBSCO Host, Sage and Sabinet databases. Seven articles related to the research phenomenon were retrieved.
CONCLUSION
The resulting themes revolved around two central aspects: nurse educators' work and life integration. Nurse educators face various challenges with work-life integration and often view their failure as a personal rather than a societal issue. However, as much as achieving work-life integration is personal, there is a call for employers in academic environments to improve workplace policies, like better-paid maternity leave, affordable quality childcare, and social support. Furthermore, nurse educators' line managers should display warmth and encouragement about personal challenges affecting nurse educators.
PubMed: 38873168
DOI: 10.3389/fgwh.2024.1287484 -
BMC Public Health Jun 2024Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous...
BACKGROUND
Although exclusive breastfeeding is recommended for the first six months of life, research suggests that breastfeeding initiation rates and duration among Indigenous communities differ from this recommendation. Qualitative studies point to a variety of factors influencing infant feeding decisions; however, there has been no collective review of this literature published to date. Therefore, the objective of this scoping review was to identify and summarize the qualitative literature regarding Indigenous infant feeding experiences within Canada, the United States, Australia, and Aotearoa.
METHODS
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses- Scoping Reviews and the Joanna Briggs Institute Guidelines, in October 2020, Medline, Embase, CINAHL, PsycINFO, and Scopus were searched for relevant papers focusing on Indigenous infant feeding experiences. Screening and full-text review was completed by two independent reviewers. A grey literature search was also conducted using country-specific Google searches and targeted website searching. The protocol is registered with the Open Science Framework and published in BMJ Open.
RESULTS
Forty-six papers from the five databases and grey literature searches were included in the final review and extraction. There were 18 papers from Canada, 11 papers in the US, 9 studies in Australia and 8 studies conducted in Aotearoa. We identified the following themes describing infant feeding experiences through qualitative analysis: colonization, culture and traditionality, social perceptions, family, professional influences, environment, cultural safety, survivance, establishing breastfeeding, autonomy, infant feeding knowledge, and milk substitutes, with family and culture having the most influence on infant feeding experiences based on frequency of themes.
CONCLUSIONS
This review highlights key influencers of Indigenous caregivers' infant feeding experiences, which are often situated within complex social and environmental contexts with the role of family and culture as essential in supporting caregivers. There is a need for long-term follow-up studies that partner with communities to support sustainable policy and program changes that support infant and maternal health.
Topics: Female; Humans; Infant; Infant, Newborn; Australia; Breast Feeding; Canada; Qualitative Research; United States
PubMed: 38872131
DOI: 10.1186/s12889-024-19060-1 -
BMC Pregnancy and Childbirth Jun 2024Neonatal hypoglycaemia is the most common metabolic disorder in infants, and may be influenced by maternal glycaemic control. This systematic review evaluated the effect... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Neonatal hypoglycaemia is the most common metabolic disorder in infants, and may be influenced by maternal glycaemic control. This systematic review evaluated the effect of intrapartum maternal glycaemic control on neonatal hypoglycaemia.
METHODS
We included randomised controlled trials (RCTs), quasi-RCTs, non-randomised studies of interventions, and cohort or case-control studies that examined interventions affecting intrapartum maternal glycaemic control compared to no or less stringent control. We searched four databases and three trial registries to November 2023. Quality assessments used Cochrane Risk of Bias 1 or the Effective Public Health Practice Project Quality Assessment Tool. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analysis was performed using random-effects models analysed separately for women with or without diabetes. The review was registered prospectively on PROSPERO (CRD42022364876).
RESULTS
We included 46 studies of women with diabetes and five studies of women without diabetes: one RCT, 32 cohort and 18 case-control studies (11,273 participants). For women with diabetes, the RCT showed little to no difference in the incidence of neonatal hypoglycaemia between tight versus less tight intrapartum glycaemic control groups (76 infants, RR 1.00 (0.45, 2.24), p = 1.00, low certainty evidence). However, 11 cohort studies showed tight intrapartum glycaemic control may reduce neonatal hypoglycaemia (6,152 infants, OR 0.44 (0.31, 0.63), p < 0.00001, I = 58%, very low certainty evidence). For women without diabetes, there was insufficient evidence to determine the effect of tight intrapartum glycaemic control on neonatal hypoglycaemia.
CONCLUSIONS
Very uncertain evidence suggests that tight intrapartum glycaemic control may reduce neonatal hypoglycaemia in infants of women with diabetes. High-quality RCTs are required.
Topics: Humans; Hypoglycemia; Pregnancy; Female; Infant, Newborn; Glycemic Control; Pregnancy in Diabetics; Blood Glucose; Diabetes, Gestational; Infant, Newborn, Diseases
PubMed: 38872105
DOI: 10.1186/s12884-024-06615-8 -
PloS One 2024Poor attachment, suckling, and positioning contribute to ineffective breastfeeding techniques. Poor weight gain, stunting, and decreased immunity are caused by... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Poor attachment, suckling, and positioning contribute to ineffective breastfeeding techniques. Poor weight gain, stunting, and decreased immunity are caused by insufficient breast milk intake owing to ineffective breastfeeding techniques. Numerous primary studies conducted in Ethiopia have revealed negative effects of ineffective breastfeeding techniques. However, inconsistencies have been observed among these studies, and no review has been conducted to report the amalgamated magnitude and associated factors. Therefore, this review aimed to estimate the national prevalence and factors associated with ineffective breastfeeding techniques in Ethiopia.
METHODS
Using PRISMA standards, we systematically reviewed and meta-analyzed articles from PubMed, Cochrane Library, and Google Scholar to investigate the prevalence and associated factors of ineffective breastfeeding techniques. Q and I2 tests were used to assess heterogeneity across studies. To evaluate the national prevalence and effect size of the linked covariates, a weighted inverse variance random-effects model was used. Subgroup analysis was performed based on the region, sample size, and year of publication. Funnel plots and Egger's regression tests were used to examine publication bias. A sensitivity analysis was also performed to determine the impact of the studies.
RESULTS
The analysis included a total of eleven studies with 4,470 participants used in the analysis. The pooled prevalence of ineffective breastfeeding techniques in Ethiopia was 53.13% (45.49, 60.78) no formal education (AOR = 3.42; 95% CI:1.67-5.18; I2 = 72.2%; P = 0.0132), primipara (AOR = 2.72;95% CI:1.81-3.64; I2 = 46.7%; P = 0.131), postnatal care (PNC) (AOR = 1.84; 95% CI:1.35-2.32; I2 = 0%; P = 0.53), breastfeeding counseling (AOR = 1.93; 95% CI:1.23-2.63; I2 = 0%;P = 0.35), home delivery and having breast problem (AOR = 3.11; 95% CI:1.09-5.16; I2 = 0%;P = 0.877) and (AOR = 2.22; 95% CI:1.28-3.16; I2 = 0%;P = 0.80) respectively were significantly associated with ineffective breastfeeding techniques.
CONCLUSION
The prevalence of ineffective breastfeeding techniques in Ethiopia remains high. Policymakers and program officials should focus on empowering women, increasing institutional delivery, and providing counseling on breastfeeding throughout the maternal continuum of care. These measures will improve breastfeeding techniques and lead to better health of both infants and women.
Topics: Breast Feeding; Ethiopia; Humans; Female; Prevalence; Mothers
PubMed: 38870174
DOI: 10.1371/journal.pone.0303749 -
PloS One 2024Hypertension is a major global public health problem. It currently affects more than 1.4 billion people worldwide, projected to increase to 1.6 billion by 2025. Despite... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Hypertension is a major global public health problem. It currently affects more than 1.4 billion people worldwide, projected to increase to 1.6 billion by 2025. Despite numerous primary studies have been conducted to determine the prevalence of uncontrolled hypertension and identify its associated factors among hypertensive patients in Sub-Saharan Africa, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of uncontrolled hypertension and identify its associated factors.
METHODS
We have searched PubMed, Google Scholar, and Web of Science databases extensively for all relevant studies. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to compute the overall pooled prevalence of uncontrolled hypertension and the effect size of its associated factors. Variations across the included studies were checked using forest plot, funnel plot, I2 statistics, and Egger's test.
RESULTS
A total of twenty-six primary studies with a sample size of 11,600 participants were included in the final meta-analysis. The pooled prevalence of uncontrolled hypertension was 50.29% (95% CI: 41.88, 58.69; I2 = 98.98%; P<0.001). Age of the patient [AOR = 1.57: 95% CI: 1.004, 2.44], duration of diagnosis [AOR = 2.57: 95% CI: 1.18, 5.57], non-adherence to physical activity [AOR = 2.13: 95% CI: 1.15, 3.95], khat chewing [AOR = 3.83: 95% CI: 1.59, 9.24] and habitual coffee consumption [AOR = 10.79: 95% CI: 1.84, 63.24] were significantly associated with uncontrolled hypertension among hypertensive patients.
CONCLUSIONS
The pooled prevalence of uncontrolled hypertension was considerably high. Older age, duration of diagnosis, non-adherence to physical activity, khat chewing and habitual coffee consumption were independent predictors of uncontrolled hypertension. Therefore, health professionals and other responsible stakeholders should encourage hypertensive patients to adhere to regular physical activity, and abstain from khat chewing and habitual coffee consumption. Early identification of hypertension and management of comorbidities is crucial, and it should be emphasized to control hypertension easily.
Topics: Hypertension; Humans; Africa South of the Sahara; Prevalence; Risk Factors
PubMed: 38870163
DOI: 10.1371/journal.pone.0301547 -
Frontiers in Cellular and Infection... 2024Gestational diabetes mellitus (GDM) is a form of gestational diabetes mellitus characterized by insulin resistance and abnormal function of pancreatic beta cells. In...
INTRODUCTION
Gestational diabetes mellitus (GDM) is a form of gestational diabetes mellitus characterized by insulin resistance and abnormal function of pancreatic beta cells. In recent years, genomic association studies have revealed risk and susceptibility genes associated with genetic susceptibility to GDM. However, genetic predisposition cannot explain the rising global incidence of GDM, which may be related to the increased influence of environmental factors, especially the gut microbiome. Studies have shown that gut microbiota is closely related to the occurrence and development of GDM. This paper reviews the relationship between gut microbiota and the pathological mechanism of GDM, in order to better understand the role of gut microbiota in GDM, and to provide a theoretical basis for clinical application of gut microbiota in the treatment of related diseases.
METHODS
The current research results on the interaction between GDM and gut microbiota were collected and analyzed through literature review. Keywords such as "GDM", "gut microbiota" and "insulin resistance" were used for literature search, and the methodology, findings and potential impact on the pathophysiology of GDM were systematically evaluated.
RESULTS
It was found that the composition and diversity of gut microbiota were significantly associated with the occurrence and development of GDM. Specifically, the abundance of certain gut bacteria is associated with an increased risk of GDM, while other changes in the microbiome may be associated with improved insulin sensitivity. In addition, alterations in the gut microbiota may affect blood glucose control through a variety of mechanisms, including the production of short-chain fatty acids, activation of inflammatory pathways, and metabolism of the B vitamin group.
DISCUSSION
The results of this paper highlight the importance of gut microbiota in the pathogenesis of GDM. The regulation of the gut microbiota may provide new directions for the treatment of GDM, including improving insulin sensitivity and blood sugar control through the use of probiotics and prebiotics. However, more research is needed to confirm the generality and exact mechanisms of these findings and to explore potential clinical applications of the gut microbiota in the management of gestational diabetes. In addition, future studies should consider the interaction between environmental and genetic factors and how together they affect the risk of GDM.
Topics: Diabetes, Gestational; Gastrointestinal Microbiome; Humans; Pregnancy; Female; Insulin Resistance; Probiotics; Bacteria
PubMed: 38868299
DOI: 10.3389/fcimb.2024.1364545