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JAMA Mar 2024Child maltreatment is associated with serious negative physical, psychological, and behavioral consequences. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Child maltreatment is associated with serious negative physical, psychological, and behavioral consequences.
OBJECTIVE
To review the evidence on primary care-feasible or referable interventions to prevent child maltreatment to inform the US Preventive Services Task Force.
DATA SOURCES
PubMed, Cochrane Library, and trial registries through February 2, 2023; references, experts, and surveillance through December 6, 2023.
STUDY SELECTION
English-language, randomized clinical trials of youth through age 18 years (or their caregivers) with no known exposure or signs or symptoms of current or past maltreatment.
DATA EXTRACTION AND SYNTHESIS
Two reviewers assessed titles/abstracts, full-text articles, and study quality, and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.
MAIN OUTCOMES AND MEASURES
Directly measured reports of child abuse or neglect (reports to Child Protective Services or removal of the child from the home); proxy measures of abuse or neglect (injury, visits to the emergency department, hospitalization); behavioral, developmental, emotional, mental, or physical health and well-being; mortality; harms.
RESULTS
Twenty-five trials (N = 14 355 participants) were included; 23 included home visits. Evidence from 11 studies (5311 participants) indicated no differences in likelihood of reports to Child Protective Services within 1 year of intervention completion (pooled odds ratio, 1.03 [95% CI, 0.84-1.27]). Five studies (3336 participants) found no differences in removal of the child from the home within 1 to 3 years of follow-up (pooled risk ratio, 1.06 [95% CI, 0.37-2.99]). The evidence suggested no benefit for emergency department visits in the short term (<2 years) and hospitalizations. The evidence was inconclusive for all other outcomes because of the limited number of trials on each outcome and imprecise results. Among 2 trials reporting harms, neither reported statistically significant differences. Contextual evidence indicated (1) widely varying practices when screening, identifying, and reporting child maltreatment to Child Protective Services, including variations by race or ethnicity; (2) widely varying accuracy of screening instruments; and (3) evidence that child maltreatment interventions may be associated with improvements in some social determinants of health.
CONCLUSION AND RELEVANCE
The evidence base on interventions feasible in or referable from primary care settings to prevent child maltreatment suggested no benefit or insufficient evidence for direct or proxy measures of child maltreatment. Little information was available about possible harms. Contextual evidence pointed to the potential for bias or inaccuracy in screening, identification, and reporting of child maltreatment but also highlighted the importance of addressing social determinants when intervening to prevent child maltreatment.
Topics: Adolescent; Child; Humans; Advance Directives; Advisory Committees; Child Abuse; Emergency Service, Hospital; Primary Health Care; United States; Social Determinants of Health; Child Protective Services
PubMed: 38502070
DOI: 10.1001/jama.2024.0276 -
Health Promotion and Chronic Disease... Mar 2024The COVID-19 pandemic exacerbated health inequities worldwide. Research conducted in Canada shows that Black populations were disproportionately exposed to COVID-19 and... (Review)
Review
INTRODUCTION
The COVID-19 pandemic exacerbated health inequities worldwide. Research conducted in Canada shows that Black populations were disproportionately exposed to COVID-19 and more likely than other ethnoracial groups to be infected and hospitalized. This scoping review sought to map out the nature and extent of current research on COVID-19 among Black people in Canada.
METHODS
Following a five-stage methodological framework for conducting scoping reviews, studies exploring the effects of the COVID-19 pandemic on Black people in Canada, published up to May 2023, were retrieved through a systematic search of seven databases. Of 457 identified records, 124 duplicates and 279 additional records were excluded after title and abstract screening. Of the remaining 54 articles, 39 were excluded after full-text screening; 2 articles were manually picked from the reference lists of the included articles. In total, 17 articles were included in this review.
RESULTS
Our review found higher rates of COVID-19 infections and lower rates of COVID-19 screening and vaccine uptake among Black Canadians due to pre-COVID-19 experiences of institutional and structural racism, health inequities and a mistrust of health care professionals that further impeded access to health care. Misinformation about COVID-19 exacerbated mental health issues among Black Canadians.
CONCLUSIONS
Our findings suggest the need to address social inequities experienced by Black Canadians, particularly those related to unequal access to employment and health care. Collecting race-based data on COVID-19 could inform policy formulation to address racial discrimination in access to health care, quality housing and employment, resolve inequities and improve the health and well-being of Black people in Canada.
Topics: Humans; Black People; Canada; COVID-19; North American People; Pandemics
PubMed: 38501682
DOI: 10.24095/hpcdp.44.3.05 -
Journal of Plastic, Reconstructive &... Apr 2024In 1993, the National Institutes of Health Revitalization Act mandated increasing minority and women enrollment in clinical trials (CTs). This study aimed to investigate... (Meta-Analysis)
Meta-Analysis
UNLABELLED
In 1993, the National Institutes of Health Revitalization Act mandated increasing minority and women enrollment in clinical trials (CTs). This study aimed to investigate trends in race and ethnicity enrollment and reporting in US plastic and reconstructive surgery (PRS) CT.
METHODS
A comprehensive systematic review was performed. All CTs in PRS from 2012 to 2022 were included. To assess racial and ethnic representation within CTs, a random-effects meta-analysis of proportion was conducted to pool the prevalence of the binomial data.
RESULTS
A total of 3609 studies were initially identified in the search strategy, with 154 later classified as CTs in PRS. Only 36 met the eligibility criteria for reporting race and ethnicity and were included in the analysis. A total of 7281 participants were included: 446 (6.1%) males and 6835 (93.9%) females. From CTs that correctly reported race, the pooled prevalence of races were as follows: Whites 78% (95% confidence interval [CI] 73-82%), Black or African Americans 8% (95% CI 5-11%), Asians 1% (95% CI <1-2%), American Indians <1% (95% CI <1-<1%), and Pacific Islanders <1% (95% CI <1-<1%). From the studies that reported ethnicity correctly, the pooled prevalence of Hispanics was 7% (95% CI 5-9%), and Non-Hispanics was 12% (<1-38%).
CONCLUSIONS
Disparities in minority representation were present among PRS CTs. This suggests clear limitations in generalizing PRS CT results to the population. Efforts to decrease the gap in minority enrollment and accurately report race and ethnicity are needed in all fields, including plastic surgery.
Topics: Female; Humans; Male; Black or African American; Ethnicity; Hispanic or Latino; Surgery, Plastic; United States; White; Clinical Trials as Topic; Asian; American Indian or Alaska Native; Native Hawaiian or Other Pacific Islander
PubMed: 38484437
DOI: 10.1016/j.bjps.2024.02.062 -
Academic Medicine : Journal of the... Mar 2024Letters of recommendations (LORs) are key components of academic medicine applications. Given that bias against students and trainees underrepresented in medicine (UIM)...
PURPOSE
Letters of recommendations (LORs) are key components of academic medicine applications. Given that bias against students and trainees underrepresented in medicine (UIM) has been demonstrated across assessment, achievement, and advancement domains, the authors reviewed studies on LORs to assess racial, ethnic, and UIM differences in LORs. Standardized LORs (SLORs), an increasingly common form of LORs, were also assessed for racial and ethnic differences.
METHOD
A systematic review was conducted for English-language studies that assessed racial or ethnic differences in LORs in academic medicine published from database inception to July 16, 2023. Studies evaluating SLORs underwent data abstraction to evaluate their impact on the given race or ethnicity comparison and outcome variables.
RESULTS
Twenty-three studies describing 19,012 applicants and 41,925 LORs were included. Nineteen studies (82.6%) assessed LORs for residency, 4 (17.4%) assessed LORs for fellowship, and none evaluated employment or promotion. Fifteen of 17 studies (88.2%) assessing linguistic differences reported a significant difference in a particular race or ethnicity comparison. Of the 7 studies assessing agentic language (e.g., "strong," "confident"), 1 study found fewer agentic terms used for Black and Latinx applicants, and 1 study reported higher agency scores for Asian applicants and applicants of races other than White. There were mixed results for the use of communal and grindstone language in UIM and non-UIM comparisons. Among 6 studies, 4 (66.7%) reported that standout language (e.g., "exceptional," "outstanding") was less likely to be ascribed to UIM applicants. Doubt-raising language was more frequently used for UIM trainees. When SLORs and unstructured LORs were compared, fewer linguistic differences were found in SLORs.
CONCLUSIONS
There is a moderate bias against UIM candidates in the domains of linguistic differences, doubt-raising language, and topics discussed in LORs, which has implications for perceptions of competence and ability in the high-stakes residency and fellowship application process.
PubMed: 38466619
DOI: 10.1097/ACM.0000000000005688 -
BMJ Open Mar 2024The term "problem drinking" includes a spectrum of alcohol problems ranging from excessive or heavy drinking to alcohol use disorder. Problem drinking is a leading risk...
BACKGROUND
The term "problem drinking" includes a spectrum of alcohol problems ranging from excessive or heavy drinking to alcohol use disorder. Problem drinking is a leading risk factor for death and disability globally. It has been measured and conceptualised in different ways, which has made it difficult to identify common risk factors for problem alcohol use. This scoping review aims to synthesise what is known about the assessment of problem drinking, its magnitude and associated factors.
METHODS
Four databases (PubMed, Embase, PsycINFO, Global Index Medicus) and Google Scholar were searched from inception to 25 November 2023. Studies were eligible if they focused on people aged 15 and above, were population-based studies reporting problem alcohol use and published in the English language. This review was reported based on guidelines from the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist'. Critical appraisal was done using the Newcastle-Ottawa Scale.
RESULTS
From the 14 296 records identified, 10 749 underwent title/abstract screening, of which 352 full-text articles were assessed, and 81 articles were included for data extraction. Included studies assessed alcohol use with self-report quantity/frequency questionnaires, criteria to determine risky single occasion drinking, validated screening tools, or structured clinical and diagnostic interviews. The most widely used screening tool was the Alcohol Use Disorder Identification Test. Studies defined problem drinking in various ways, including excessive/heavy drinking, binge drinking, alcohol use disorder, alcohol abuse and alcohol dependence. Across studies, the prevalence of heavy drinking ranged from <1.0% to 53.0%, binge drinking from 2.7% to 48.2%, alcohol abuse from 4.0% to 19.0%, alcohol dependence from 0.1% to 39.0% and alcohol use disorder from 2.0% to 66.6%. Factors associated with problem drinking varied across studies. These included sociodemographic and economic factors (age, sex, relationship status, education, employment, income level, religion, race, location and alcohol outlet density) and clinical factors (like medical problems, mental disorders, other substance use and quality of life).
CONCLUSIONS
Due to differences in measurement, study designs and assessed risk factors, the prevalence of and factors associated with problem drinking varied widely across studies and settings. The alcohol field would benefit from harmonised measurements of alcohol use and problem drinking as this would allow for comparisons to be made across countries and for meta-analyses to be conducted.
TRIAL REGISTRATION NUMBER
Open Science Framework ID: https://osf.io/2anj3.
Topics: Humans; Alcohol Drinking; Alcohol-Related Disorders; Alcoholism; Quality of Life
PubMed: 38458797
DOI: 10.1136/bmjopen-2023-080657 -
JAMA Network Open Mar 2024There is increasing concern that continued use of a glomerular filtration rate (GFR) estimating equation adjusted for a single racial group could exacerbate chronic... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
There is increasing concern that continued use of a glomerular filtration rate (GFR) estimating equation adjusted for a single racial group could exacerbate chronic kidney disease-related disparities and inequalities.
OBJECTIVE
To assess the performance of GFR estimating equations across varied patient populations.
DATA SOURCES
PubMed, Embase, Web of Science, ClinicalTrials.gov, and Scopus databases were systematically searched from January 2012 to February 2023.
STUDY SELECTION
Inclusion criteria were studies that compared measured GFR with estimated GFR in adults using established reference standards and methods. A total of 6663 studies were initially identified for screening and review.
DATA EXTRACTION AND SYNTHESIS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 2 authors independently extracted data on studies that examined the bias and accuracy of GFR estimating equations. For each outcome, a random-effects model was used to calculate pooled estimates. Data analysis was conducted from March to December 2023.
MAIN OUTCOMES AND MEASURES
The primary outcomes were bias and accuracy of estimated GFRs in Black vs non-Black patients, as well as in individuals with chronic conditions. Bias was defined as the median difference between the measured GFR and the estimated GFR. Accuracy was assessed with P30 (the proportion of persons in a data set whose estimated GFR values were within 30% of measured GFR values) and measures of heterogeneity.
RESULTS
A total of 12 studies with a combined 44 721 patients were included. Significant heterogeneity was found in the bias of various GFR estimation equations. Race-corrected equations and creatinine-based equations tended to overestimate GFR in Black populations and showed mixed results in non-Black populations. For creatinine-based equations, the mean bias in subgroup analysis was 2.1 mL/min/1.73 m2 (95% CI, -0.2 mL/min/1.73 m2 to 4.4 mL/min/1.73 m2) in Black persons and 1.3 mL/min/1.73 m2 (95% CI, 0.0 mL/min/1.73 m2 to 2.5 mL/min/1.73 m2) in non-Black persons. Equations using only cystatin C had small biases. Regarding accuracy, heterogeneity was high in both groups. The overall P30 was 84.5% in Black persons and 87.8% in non-Black persons. Creatinine-based equations were more accurate in non-Black persons than in Black persons. For creatinine-cystatin C equations, the P30 was higher in non-Black persons. There was no significant P30 difference in cystatin C-only equations between the 2 groups. In patients with chronic conditions, P30 values were generally less than 85%, and the biases varied widely.
CONCLUSIONS AND RELEVANCE
This systematic review and meta-analysis of GFR estimating equations suggests that there is bias in race-based GFR estimating equations, which exacerbates kidney disease disparities. Development of a GFR equation independent of race is a crucial starting point, but not the sole solution. Addressing the disproportionate burden of kidney failure on Black individuals in the US requires an enduring, multifaceted approach that should include improving diagnostics, tackling social determinants of health, confronting systemic racism, and using effective disease prevention and management strategies.
Topics: Adult; Humans; Creatinine; Cystatin C; Glomerular Filtration Rate; Bias; Renal Insufficiency, Chronic
PubMed: 38441895
DOI: 10.1001/jamanetworkopen.2024.1127 -
Gastrointestinal Endoscopy Jul 2024Substantial differences exist in pancreatic cancer outcomes across ethnoracial stratifications. We sought to assess racial, ethnic, sex, and age reporting and inclusion... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
Substantial differences exist in pancreatic cancer outcomes across ethnoracial stratifications. We sought to assess racial, ethnic, sex, and age reporting and inclusion of participants in pancreatic cancer screening studies.
METHODS
A systematic search of Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science Core Collection from inception to 2022 was conducted. Original studies on pancreatic cancer screening were identified and assessed for reporting and inclusion on race, ethnicity, sex, and age. The pooled proportions of study participants for these characteristics were calculated and compared with population-based benchmarks.
RESULTS
Among 27 eligible pancreatic cancer screening studies, 26 reported data on either sex, race, or ethnicity, with a total of 5273 participants. Information on participant sex was reported by 26, race by 12, and ethnicity by 8 studies. Participants in these studies were almost all white (pooled proportion, 93.1%; 95% confidence interval [CI], 89.7-96.4) and non-Latino (pooled proportion, 97.4%; 95% CI, 94.0-100), and these groups were over-represented when compared with the general population. Female participants were well represented, with a pooled proportion of 63.2% (95% CI, 59.9-66.6). When reported, mean or median participant age was <60 years. Meta-regression revealed higher proportions of female participants in studies from the United States (P = .002). No association between increasing participation of racial or ethnic under-represented populations and study quality, ascending year of publication, or source of study funding was noted.
CONCLUSIONS
Substantial disparities in race, ethnicity, sex, and age reporting and inclusion in pancreatic cancer studies were noted, even among high-quality and publicly funded studies.
Topics: Humans; Pancreatic Neoplasms; Early Detection of Cancer; Age Factors; Sex Factors; Ethnicity; Racial Groups; Healthcare Disparities; Female; Patient Selection; Male
PubMed: 38432492
DOI: 10.1016/j.gie.2024.02.014 -
Journal of Medical Internet Research Feb 2024Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions.
OBJECTIVE
This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health.
METHODS
We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health.
RESULTS
Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults.
CONCLUSIONS
For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.
Topics: Humans; Aged; Health Literacy; Mental Health; Ethnicity; Minority Groups; Africa
PubMed: 38421687
DOI: 10.2196/51268 -
Expert Review of Respiratory Medicine 2024Underrepresentation of minority groups in clinical trials may hinder the potential benefits of pulmonary rehabilitation (PR) programs for individuals with chronic...
BACKGROUND
Underrepresentation of minority groups in clinical trials may hinder the potential benefits of pulmonary rehabilitation (PR) programs for individuals with chronic obstructive pulmonary disease (COPD). The aim of this work was to determine whether participants in PR randomized control trials (RCTs) conducted in the U.S.A., Canada, the UK, and Australia are representative of ethnicity, sex, gender, and sociodemographic characteristics.
RESEARCH DESIGN
A systematic search was performed for relevant literature from inception to December 2022. Titles and abstracts were screened before undergoing a full article review. Relevant data on reporting of age, sex, gender, ethnicity, and sociodemographic characteristics of participants was extracted.
RESULTS
Thirty-six RCTs met the inclusion criteria. Only 6% of publications reported on ethnicity, with ≥90% of participants reported as 'White.' All 36 papers reported on age, with the mean between 60 and 69 years old. Thirty-five studies reported on sex (97%), with the majority (67%) reporting more male than female participants. There was no mention of different genders in any paper. Other sociodemographic factors were reported in 7 (19%) papers.
CONCLUSIONS
Inclusivity and representation in clinical trials are essential to ensure that research findings are generalizable. Clinical trialists need to consider the demographics of today's society during recruitment.
Topics: Aged; Female; Humans; Male; Middle Aged; Randomized Controlled Trials as Topic; Pulmonary Disease, Chronic Obstructive; Sociodemographic Factors
PubMed: 38410864
DOI: 10.1080/17476348.2024.2324086 -
Journal of Epidemiology and Global... Jun 2024Latina women experience disproportionately higher rates of HPV infection, persistence, and progression to cervical dysplasia and cancer compared to other racial-ethnic...
BACKGROUND
Latina women experience disproportionately higher rates of HPV infection, persistence, and progression to cervical dysplasia and cancer compared to other racial-ethnic groups. This systematic review explores the relationship between the cervicovaginal microbiome and human papillomavirus infection, cervical dysplasia, and cervical cancer in Latinas.
METHODS
The review abides by the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, EMBASE, and Scopus databases were searched from January 2000 through November 11, 2022. The review included observational studies reporting on the cervicovaginal microbiota in premenopausal Latina women with human papillomavirus infection, cervical dysplasia, and cervical cancer.
RESULTS
Twenty-five articles were eligible for final inclusion (N = 131,183). Forty-two unique bacteria were reported in the cervicovaginal microbiome of Latinas. Seven bacteria: Lactobacillus crispatus, Lactobacillus iners, Chlamydia trachomatis, Prevotella spp., Prevotella amnii, Fusobacterium spp. and Sneathia spp. were enriched across multiple stages of cervical carcinogenesis in Latinas. Therefore, the total number of reported bacteria includes four bacteria associated with the healthy state, 16 bacteria enriched in human papillomavirus outcomes, 24 unique bacteria associated with abnormal cytology/dysplasia, and five bacteria associated with cervical cancer. Furthermore, three studies reported significantly higher alpha and beta diversity in Latinas with cervical dysplasia and cancer compared to controls. Lactobacillus depletion and an increased abundance of L. iners in Latinas compared to non-Latinas, regardless of human papillomavirus status or lesions, were observed.
CONCLUSIONS
The identification of 42 unique bacteria and their enrichment in cervical carcinogenesis can guide future cervicovaginal microbiome research to better inform cervical cancer prevention strategies in Latinas.
Topics: Humans; Female; Papillomavirus Infections; Uterine Cervical Neoplasms; Hispanic or Latino; Vagina; Microbiota; Uterine Cervical Dysplasia; Carcinogenesis
PubMed: 38407720
DOI: 10.1007/s44197-024-00201-z