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Women and Birth : Journal of the... Feb 2024Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. (Review)
Review
PROBLEM
Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally.
BACKGROUND
There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously.
AIM
To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy.
METHODS
Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded.
FINDINGS
Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal.
DISCUSSION
Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research.
CONCLUSION
Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.
Topics: Female; Humans; Pregnancy; Delivery, Obstetric; Labor, Obstetric; Midwifery; Parity; Parturition
PubMed: 37704535
DOI: 10.1016/j.wombi.2023.08.009 -
European Journal of Obstetrics &... Sep 2023Incarcerated gravid uterus (IGU) is a serious complication of pregnancy that leads to adverse obstetric outcomes. The aim of this review was to describe this entity in... (Review)
Review
Incarcerated gravid uterus (IGU) is a serious complication of pregnancy that leads to adverse obstetric outcomes. The aim of this review was to describe this entity in detail. We also aimed to understand if pregnancies with predisposing risk factors that increase the risk of developing IGU had a difference in their clinical manifestations, treatment, and obstetric outcomes. The PubMed, MEDLINE, Embase, Scopus databases and clinicaltrials.gov were searched from inception to July 2023. Case reports and series that provided all the details of the pregnancy and IGU outcome were included. Study quality and risk of bias were assessed using a tool that is an adaptation from criteria listed by Pierson, Bradford Hills and Newcastle Ottawa scale modification. Patients with the condition of interest included in this review were grouped into those with documented, identified risk factors and no risk factors. The two groups were compared to understand the difference in obstetric outcome and presentation of IGU. Data were analyzed and summarized descriptively, categorical variables were assessed by chi-squared test or Fisher's exact test, and continuous variables by the Wilcoxon Mann Whitney test. Of 236 articles found, 62 articles with 80 cases were included in the final analysis. The median age was 32 [27-35] years. The median gestational age of diagnosis was 17 [14-26] weeks. The most common risk factor was fibroids (N = 22, 27.5 %). Most common presentation was urinary complaints and lower abdomen pain (N = 47, 58.6 %). Twenty-seven patients (33.6 %) needed more than one visit for the diagnosis to be made. Conservative management was the first step to treat IGU in most patients. Most common complication was fetal malpresentation (N = 13, 40.6 %). Patients with or without risk factors developing IGU had no statistical difference in- parity, median gestational age of diagnosis, delay in diagnosis, increased chance of misdiagnosis, management of IGU or in obstetric outcome (all p > 0.05). It is important to recognize this entity early to prevent obstetric complications especially when patients report urinary retention and abdomen pain. The presence of risk factors does not change the management course or obstetric outcome in patients with IGU. Hence it is reasonable to start with conservative management of IGU regardless of presence of risk factors or the gestational age of diagnosis, in clinical practice.
PubMed: 37664181
DOI: 10.1016/j.eurox.2023.100227 -
BMC Veterinary Research Aug 2023Subclinical mastitis (SCM) is one of the most economically important diseases affecting the dairy industry. The SCM does not cause visible changes in the udder or... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Subclinical mastitis (SCM) is one of the most economically important diseases affecting the dairy industry. The SCM does not cause visible changes in the udder or physical changes of the milk as compared to clinical mastitis, and a clear overview of the prevalence and risk factors in the different regions of Africa is still lacking. The objective of this study was to investigate the prevalence of SCM and assess the associated risk factors and dominant bacterial pathogens among cattle in Africa.
MATERIALS AND METHODS
We gathered and systematically reviewed literature concerning SCM, published in English from January 2010 through December 2020 in two databases (PubMed and Web of Science), and meta-analysis was conducted using the 'meta' and 'metafor' packages in the R statistical software.
RESULTS
A total of 258 studies were retrieved and at the end of the screening, 82 full-texts were eligible for inclusion in the meta-analysis. The prevalence of SCM was reported in 11 countries in five regions of Africa, and the random-effects model showed that the weighted pooled prevalence estimate (PPE) was 48.2% (95% CI: 43.6-52.8%). Heterogeneity was high and statistically significant as I (proportion of observed variation) was 98.1% (95% CI: 98.0-98.3%), τ (true between-study variance) was 0.0433 (95% CI: 0.0322-0.0611), and the Cochran Q statistic was 4362.8 (p < 0.0001). Subgroup and meta-regression analyses showed that East Africa had significantly (p = 0.0092) the highest PPE of SCM (67.7%, 95% CI: 55.7-78.7) followed by West Africa (50.5%, 95%CI: 31.4-69.5), and the lowest was in North Africa (40.3%, 95%: 32.2-48.6). Other significant moderators for SCM were age (p < 0.0001), breed (p = 0.0002), lactation stage (p = 0.019) and parity (p = 0.0008) of cattle. Staphylococcus species (prevalence 43.7%) were the most predominant pathogens, followed by Streptococcus (18.2%) and Escherichia species (9.5%).
CONCLUSION
The present study showed a high variation of SCM prevalence in various parts of Africa, although there is a need for more data in some regions. The reported prevalence is a clear sign of inappropriate management practices among cattle herds and an indicator of the threat that SCM poses to the dairy industry. The information about the predisposing factors may guide effective management and control strategies to reduce transmission of the disease.
Topics: Pregnancy; Animals; Cattle; Female; Staphylococcal Infections; Prevalence; Mastitis, Bovine; Lactation; Milk; Risk Factors; Africa; Dairying; Cattle Diseases
PubMed: 37573335
DOI: 10.1186/s12917-023-03673-6 -
Journal of Orthopaedic Surgery and... Aug 2023Osteoporosis affects more than 200 million women worldwide, with postmenopausal women being particularly susceptible to this condition and its severe sequelae... (Meta-Analysis)
Meta-Analysis
Osteoporosis affects more than 200 million women worldwide, with postmenopausal women being particularly susceptible to this condition and its severe sequelae disproportionately, such as osteoporotic fractures. To date, the current focus has been more on symptomatic treatment, rather than preventive measures. To address this, we performed a meta-analysis aiming to identify potential predictors of osteoporotic fractures in postmenopausal women, with the ultimate goal of identifying high-risk patients and exploring potential therapeutic approaches. We searched Embase, MEDLINE and Cochrane with search terms (postmenopausal AND fracture) AND ("risk factor" OR "predictive factor") in May 2022 for cohort and case-control studies on the predictors of osteoporotic fracture in postmenopausal women. Ten studies with 1,287,021 postmenopausal women were found eligible for analyses, in which the sample size ranged from 311 to 1,272,115. The surveyed date spanned from 1993 to 2021. Our results suggested that age, BMI, senior high school and above, parity ≥ 3, history of hypertension, history of diabetes mellitus, history of alcohol intake, age at menarche ≥ 15, age at menopause < 40, age at menopause > 50, estrogen use and vitamin D supplements were significantly associated with osteoporotic fracture in postmenopausal women. Our findings facilitate the early prediction of osteoporotic fracture in postmenopausal women and may contribute to potential therapeutic approaches. By focusing on preventive strategies and identifying high-risk individuals, we can work toward reducing the burden of osteoporosis-related fractures in this vulnerable population.
Topics: Humans; Female; Osteoporotic Fractures; Osteoporosis, Postmenopausal; Postmenopause; Osteoporosis; Risk Factors; Bone Density
PubMed: 37543616
DOI: 10.1186/s13018-023-04051-6 -
Costs and models used in the economic analysis of Total Knee Replacement (TKR): A systematic review.PloS One 2023The main objective of this review is to summarize the evidence on the core modelling specifications and methodology on the cost-effectiveness of TKR compared to...
OBJECTIVES
The main objective of this review is to summarize the evidence on the core modelling specifications and methodology on the cost-effectiveness of TKR compared to non-surgical management. Another objective of this study is to synthesize evidence of TKR cost and compare it across countries using purchasing power parity (PPP).
METHODOLOGY
The electronic databases used for this review were MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), HTAIn repository, Cost effectiveness Analysis (CEA) registry, and Google Scholar. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the validity of the methods and transparency in reporting the results. The Quality of Health Economic Studies (QHES) was used to check the quality of economic evaluation models of the studies included. The cost of TKR surgery from high income and low- or middle-income countries were extracted and converted to single USD ($) using purchasing power parities (PPP) method.
RESULT
Thirty-two studies were included in this review, out of which eight studies used Markov model, five used regression model, one each reported Marginal structure model, discrete simulation model, decision tree and Osteoarthritis Policy Model (OAPol) respectively to assess the cost-effectiveness of TKR. For PPP, twenty-six studies were included in the analysis of TKR cost. The average cost of TKR surgery was the lowest in developing country-India ($3457) and highest in USA ($19568).
CONCLUSION
The findings of this review showed that the Markov model was most widely used in the analysis of the cost effectiveness of TKR. Our review also concluded that the cost of TKR was higher in the developed countries as compared to the developing countries.
Topics: Humans; Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Cost-Effectiveness Analysis; Osteoarthritis; India; Models, Economic; Quality-Adjusted Life Years
PubMed: 37490490
DOI: 10.1371/journal.pone.0280371 -
BMC Cancer Jul 2023Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Associations between reproductive factors and breast cancer (BC) risk vary by molecular subtype (i.e., luminal A, luminal B, HER2, and triple negative/basal-like [TNBC]). In this systematic review and meta-analysis, we summarized the associations between reproductive factors and BC subtypes.
METHODS
Studies from 2000 to 2021 were included if BC subtype was examined in relation to one of 11 reproductive risk factors: age at menarche, age at menopause, age at first birth, menopausal status, parity, breastfeeding, oral contraceptive (OC) use, hormone replacement therapy (HRT), pregnancy, years since last birth and abortion. For each reproductive risk factor, BC subtype, and study design (case-control/cohort or case-case), random-effects models were used to estimate pooled relative risks and 95% confidence intervals.
RESULTS
A total of 75 studies met the inclusion criteria for systematic review. Among the case-control/cohort studies, later age at menarche and breastfeeding were consistently associated with decreased risk of BC across all subtypes, while later age at menopause, later age of first childbirth, and nulliparity/low parity were associated with increased risk of luminal A, luminal B, and HER2 subtypes. In the case-only analysis, compared to luminal A, postmenopausal status increased the risk of HER2 and TNBC. Associations were less consistent across subtypes for OC and HRT use.
CONCLUSION
Identifying common risk factors across BC subtypes can enhance the tailoring of prevention strategies, and risk stratification models can benefit from subtype specificity. Adding breastfeeding status to current BC risk prediction models can enhance predictive ability, given the consistency of the associations across subtypes.
Topics: Female; Pregnancy; Humans; Triple Negative Breast Neoplasms; Risk Factors; Reproductive History; Parity; Breast
PubMed: 37430191
DOI: 10.1186/s12885-023-11049-0 -
Journal of Affective Disorders Oct 2023Unintended pregnancies are linked to adverse parental mental health, yet little attention has been given to this relationship in fathers specifically. We aimed to... (Review)
Review
BACKGROUND
Unintended pregnancies are linked to adverse parental mental health, yet little attention has been given to this relationship in fathers specifically. We aimed to meta-analyse associations between unintended pregnancies and mental health problems in fathers with children aged ≤36 months.
METHODS
We conducted keyword searches of Medline, CINAHL, Academic Search Complete, PsycInfo and Embase to February 2, 2022, and hand searched included reference lists.
RESULTS
Of 2826 records identified, 23 studies (N = 8085 fathers), reporting 29 effects, were eligible for meta-analysis. Included studies assessed depression, anxiety, stress, parenting stress, post-traumatic stress disorder (PTSD), alcohol misuse and psychological distress. Pooled estimates, from random effects meta-analyses, for all mental health outcomes (k = 29; OR = 2.28) and depression only (k = 19; OR = 2.36), showed that the odds of reporting mental health difficulties were >2-fold higher in men reporting unintended births compared with those reporting intended births. However, there was no evidence of association with anxiety (k = 2) or stress (k = 2). Overall, mental health problems were greater in low-income countries. No differences were found across parity, timepoint of mental health assessment, or instruments used to measure mental health symptoms.
LIMITATIONS
Analyses were limited by the use of retrospective assessment of pregnancy intention, and heterogeneity of measures used. Further, assessment of fathers' mental health was restricted to the first year postpartum. This review was limited to English language studies.
CONCLUSIONS
Unintended pregnancies present an identifiable risk for postpartum mental health problems in fathers.
PubMed: 37393953
DOI: 10.1016/j.jad.2023.06.065 -
HPB : the Official Journal of the... Oct 2023Postoperative complications following distal pancreatectomy (DP) are common, especially postoperative pancreatic fistula (POPF). In order to design adequate prophylactic... (Review)
Review
BACKGROUND
Postoperative complications following distal pancreatectomy (DP) are common, especially postoperative pancreatic fistula (POPF). In order to design adequate prophylactic strategies, it is of relevance to determine the costs of these complications. An overview of the literature on the costs of complications following DP is lacking.
METHODS
A systematic literature search was performed in PubMed, Embase, and Cochrane Library (inception until 1 August 2022). The primary outcome was the costs (i.e. cost differential) of major morbidity, individual complications and prolonged hospital stay. Quality of non-RCTs were assessed using the Newcastle-Ottawa scale. Costs were compared with the use of Purchasing Power parity. This systematic review was registered with PROSPERO (CRD42021223019).
RESULTS
Overall, seven studies were included with 854 patients after DP. The rate POPF grade B/C varied between 13% and 27% (based on five studies) with a corresponding cost differential of EUR 18,389 (based on two studies). The rate of severe morbidity varied between 13% and 38% (based on five studies) with a corresponding cost differential of EUR 19,281 (based on five studies).
CONCLUSION
This systematic review reported considerable costs for POPF grade B/C and severe morbidity after DP. Prospective databases and studies should report on all complications in a uniform matter to better display the economic burden of complications of DP.
Topics: Humans; Pancreatectomy; Pancreas; Pancreatic Fistula; Postoperative Complications; Morbidity; Retrospective Studies
PubMed: 37391314
DOI: 10.1016/j.hpb.2023.03.007 -
Women's Health (London, England) 2023Female pelvic organ prolapse is a common condition associated with significant impact on women's lives from a biopsychosocial perspective. The aim of this systematic... (Review)
Review
Female pelvic organ prolapse is a common condition associated with significant impact on women's lives from a biopsychosocial perspective. The aim of this systematic review is to identify, appraise and summarize the biopsychosocial profile of women with pelvic organ prolapse. Searches were completed from inception to October 2022 from PubMed, Web of Science, EMBASE, CINAHL, Cochrane, PsycINFO and PEDro using a search string and in line with the Preferred Reporting Information for Systematic reviews and Meta-Analyses protocol. English language studies (randomized controlled trials, cohort studies, case-control studies, qualitative research) investigating female pelvic organ prolapse and using a validated patient-reported outcome measure and validated pelvic organ prolapse objective measurement were examined. Two reviewers independently screened titles, abstracts and full articles for eligibility. Data extraction included participant characteristics, pelvic organ prolapse grading and outcome measures. Risk of bias was assessed using the appropriate Joanna Briggs Institute Tool. Baseline mean score for each questionnaire or questionnaire domain in each category was presented in tertiles (low, moderate and high impact) to allow simple classification of impact. Of 8341 articles identified, 18 were included (n = 2075 women, age range = 22-85 years, parity range = 0-10). One objective outcome measure graded pelvic organ prolapse: Pelvic Organ Prolapse Quantification measurement. Eleven validated patient-reported outcome measures were utilized; two pelvic organ prolapse-specific (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, Pelvic Organ Prolapse Quality of Life Questionnaire), the remainder pelvic health (International Consultation on Incontinence Questionnaire-Vaginal Symptoms, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, Pelvic Floor Distress Inventory-20, Incontinence Impact Questionnaire-7, Female Sexual Function Index, Urinary Distress Inventory-6, Kings Health Questionnaire, Pelvic Floor Impact Questionnaire-7) or general health questionnaires (Short Form-36). Patient-reported outcome measures included in the review reported moderate levels of pain with sexual intercourse and low levels of bodily pain. Pelvic organ prolapse had a low to moderate impact in sleep/energy and quality of life and sexual function domains. Its impact on physical symptoms and general health perception domains was low. Patient-reported outcome measures results for physical functioning varied from low to high impact. More impact was demonstrated when using pelvic organ prolapse-specific patient-reported outcome measures. There are opportunities for improvement in the use of patient-reported outcome measures in clinical research which would facilitate increased understanding of the biopsychosocial profile of women with pelvic organ prolapse.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Pregnancy; Young Adult; Case-Control Studies; Pain; Pelvic Organ Prolapse; Quality of Life
PubMed: 37387355
DOI: 10.1177/17455057231181012 -
Frontiers in Veterinary Science 2023Bovine mastitis is one of the most common and prevalent diseases affecting dairy cattle worldwide. It adversely affects the quality and quantity of milk production and...
BACKGROUND
Bovine mastitis is one of the most common and prevalent diseases affecting dairy cattle worldwide. It adversely affects the quality and quantity of milk production and leads to a significant economic loss for the farmers.
METHODS
This article aimed to estimate the prevalence of clinical mastitis (CM) infection in mainland China using a systematic review and meta-analysis. The research reports published during 1983-2022 in English or Chinese from databases (PubMed, Google Scholar, Cochrane Library, Science Direct, Web of Science, VIP Database for Chinese Technical Periodicals (VIP), Chinese National Knowledge Infrastructure (CNKI), and Wan Fang database) were identified after reviewing the relevant scientific literature. Based on our inclusion criteria, this study analyzed the prevalence of CM in 47 published studies prevalence extracted the total number of cattle infected with CM from the available studies, allowing us to estimate the prevalence of CM infection among these in mainland China.
RESULTS
The pooled prevalence with the 95% CI for the clinical mastitis was 10% (95% CI: 9.00, 12.00). The majority of CM was associated with lactation, parity, and age, with higher prevalence observed in late lactation 15% (95% CI: 11.00, 18.00) and mid-lactation 10% (95% CI: 6.00, 13.00) in comparison to early lactation 8% (95% CI: 5.00, 10.00). The incidence of CM increased significantly with the increase of parity and age, and the highest incidence rates were 19% (95% CI: 15.00, 23.00) and 16% (95% CI: 12.00, 19.00) at parity and age ≥7, respectively. Among the seasons, the highest prevalence of CM infection was found in autumn 9% (95% CI: 2.00, 17.00). Interestingly, no significant effects were evident regarding the influence of quarter on the prevalence of CM.
CONCLUSION
Thus, estimating the prevalence of CM among cattle in mainland China. through meta-analysis can provide adequate measures to control CM, reduce economic losses, and prevent the spread and transmission of CM in Chinese herds.
PubMed: 37275611
DOI: 10.3389/fvets.2023.1185995