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Diabetes Care Mar 2023Combined low-risk lifestyle behaviors (LRLBs) have been associated with a reduction in type 2 diabetes risk. This relationship has not been systematically quantified. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Combined low-risk lifestyle behaviors (LRLBs) have been associated with a reduction in type 2 diabetes risk. This relationship has not been systematically quantified.
RESEARCH DESIGN AND METHODS
A systematic review and meta-analysis was conducted to assess the association of combined LRLBs with type 2 diabetes. Databases were searched up to September 2022. Prospective cohort studies reporting the association between a minimum of three combined LRLBs (including healthy diet) with incident type 2 diabetes were included. Independent reviewers extracted data and assessed study quality. Risk estimates of extreme comparisons were pooled using a random-effects model. Global dose-response meta-analysis (DRM) for maximum adherence was estimated using a one-stage linear mixed model. The certainty of the evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).
RESULTS
Thirty cohort comparisons (n = 1,693,753) involving 75,669 incident type 2 diabetes cases were included. LRLBs, with author-defined ranges, were healthy body weight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption. LRLBs were associated with 80% lower risk of type 2 diabetes (relative risk [RR] 0.20; 95% CI 0.17-0.23), comparing the highest with lowest adherence. Global DRM for maximum adherence to all five LRLBs reached 85% protection (RR 0.15; 95% CI 0.12-0.18). The overall certainty of the evidence was graded as high.
CONCLUSIONS
There is a very good indication that a combination of LRLBs that includes maintaining a healthy bodyweight, healthy diet, regular exercise, smoking abstinence or cessation, and light alcohol consumption is associated with a lower risk of incident type 2 diabetes.
Topics: Humans; Diabetes Mellitus, Type 2; Risk; Prospective Studies; Life Style; Exercise
PubMed: 36812419
DOI: 10.2337/dc22-1024 -
Microbial Genomics Feb 2023Whole-genome sequencing (WGS) has unparalleled ability to distinguish between bacteria, with many public health applications. The generation and analysis of WGS data...
Whole-genome sequencing (WGS) has unparalleled ability to distinguish between bacteria, with many public health applications. The generation and analysis of WGS data require significant financial investment. We describe a systematic review summarizing economic analyses of genomic surveillance of bacterial pathogens, reviewing the evidence for economic viability. The protocol was registered on PROSPERO (CRD42021289030). Six databases were searched on 8 November 2021 using terms related to 'WGS', 'population surveillance' and 'economic analysis'. Quality was assessed with the Drummond-Jefferson checklist. Following data extraction, a narrative synthesis approach was taken. Six hundred and eighty-one articles were identified, of which 49 proceeded to full-text screening, with 9 selected for inclusion. All had been published since 2019. Heterogeneity was high. Five studies assessed WGS for hospital surveillance and four analysed foodborne pathogens. Four were cost-benefit analyses, one was a cost-utility analysis, one was a cost-effectiveness analysis, one was a combined cost-effectiveness and cost-utility analysis, one combined cost-effectiveness and cost-benefit analyses and one was a partial analysis. All studies supported the use of WGS as a surveillance tool on economic grounds. The available evidence supports the use of WGS for pathogen surveillance but is limited by marked heterogeneity. Further work should include analysis relevant to low- and middle-income countries and should use real-world effectiveness data.
Topics: Cost-Benefit Analysis; Whole Genome Sequencing; Cost-Effectiveness Analysis; Bacteria; Genomics
PubMed: 36790430
DOI: 10.1099/mgen.0.000947 -
The Journal of Sexual Medicine Mar 2023Sexual functions are negatively affected during pregnancy with the emergence of physical, hormonal, mental, emotional, and behavioral changes; however, there is no... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sexual functions are negatively affected during pregnancy with the emergence of physical, hormonal, mental, emotional, and behavioral changes; however, there is no cumulative knowledge about the global prevalence of sexual dysfunction (SD) in pregnant women and the correlated factors in SD.
AIM
The study aimed to determine the prevalence of SD among pregnant women and the factors correlated with their SD scores.
METHODS
A systematic review and meta-analysis of studies focusing on SD in pregnant women were conducted in the PubMed, EBSCOhost, Web of Science, Turkish Medline, Scopus, Google Scholar, and Ovid databases by using the following combination of keywords: "pregnant" OR "pregnancy" AND "sexual dysfunction."
OUTCOMES
Nearly 70% of pregnant women were at risk for SD. The age of the pregnant woman, the spouse's age, and the duration of marriage were negatively correlated with the SD score, while the education level was positively correlated with it.
RESULTS
Initially, 5644 studies were identified: 693 studies were evaluated for eligibility and 668 were removed following the exclusion criteria. A total of 25 studies involving 6871 pregnant women were included in the meta-analysis. The pooled SD prevalence in pregnant women was 69.7% (95% CI, 59.9%-77.9%).
CLINICAL IMPLICATIONS
The results of this study can be used in the organization of prenatal care, especially for pregnant women at high risk for SD.
STRENGTHS AND LIMITATIONS
This meta-analysis is the first to reveal the global prevalence of SD and the factors correlated with SD scores in pregnant women. The most important limitation of this study is that it analyzes documents showing pregnant women at risk for SD according to an unconfirmed measurement tool for pregnant women.
CONCLUSION
Most pregnant women experience SD symptoms. More research is needed, specifically on validated tools that assess pregnancy-specific SD symptoms.
Topics: Pregnancy; Female; Humans; Pregnant Women; Prevalence; Sexual Dysfunction, Physiological
PubMed: 36764823
DOI: 10.1093/jsxmed/qdad002 -
Urogynecology (Philadelphia, Pa.) Feb 2023Studies have sought to evaluate factors that have perpetuated disparities in health care, including urogynecologic care. However, there remains a lack of understanding...
IMPORTANCE
Studies have sought to evaluate factors that have perpetuated disparities in health care, including urogynecologic care. However, there remains a lack of understanding of barriers to care specific to racial/ethnic minority populations.
OBJECTIVES
We aimed to report identified barriers to urogynecologic care (eg, care for symptoms/diagnoses of urinary incontinence [UI], accidental bowel leakage [ABL], and pelvic organ prolapse [POP]) for underrepresented racial and ethnic minority (URM) women in the United States.
STUDY DESIGN
We conducted a systematic search for studies through 5 electronic bibliographic databases. Inclusion criteria for eligible studies included the following: (1) studies reporting barriers to care for those with urogynecologic symptoms/diagnoses, (2) publication date year 2000 or later. Exclusion criteria included study cohorts with children, exclusively non-U.S. populations, cohorts without URM participants, and studies without qualitative research methodology. Study methodology, characteristics, as well as barriers and facilitators to urogynecologic care were captured using a thematic synthesis approach.
RESULTS
There were 360 studies identified. Twelve studies met criteria: 6 had study populations with UI, 3 with POP, 2 on UI and/or POP, and 1 on ABL. There were 7 focus group studies (total 44 groups, n = 330), 4 interview studies (total 160 interviews, n = 160), and 1 had both (10 interviews, 6 groups, n = 39). Most studies reported on patient-associated barriers (n = 10/12) and physician/provider-associated barriers (n = 10/12), whereas only half reported system-associated barriers (n = 6/12).
CONCLUSION
Identified barriers to urogynecologic care for URM populations were examined. Findings likely do not fully reflect barriers to urogynecologic care for URM populations. Comprehensive evaluation of social determinants of health and systemic racism within studies is needed to understand the unique barriers present for racially/ethnically diverse populations.
Topics: Child; Humans; United States; Female; Ethnicity; Ethnic and Racial Minorities; Minority Groups; Racial Groups; Delivery of Health Care; Urinary Incontinence
PubMed: 36735420
DOI: 10.1097/SPV.0000000000001302 -
Journal of Integrative and... Aug 2023Ginseng has been widely used in fatigue management. However, its efficacy on fatigue remains unclear. This study aimed to assess the efficacy and safety of ginseng and... (Meta-Analysis)
Meta-Analysis Review
Ginseng has been widely used in fatigue management. However, its efficacy on fatigue remains unclear. This study aimed to assess the efficacy and safety of ginseng and ginseng herbal formulas for fatigue in randomized clinical trials (RCTs). The authors searched PubMed, Embase, Cochrane, Web of Science, and Allied and Complementary Medicine Database (AMED) databases from inception to July 6, 2022. Outcomes included fatigue severity, quality of life (QoL), and adverse events (AEs). Quality of evidence was assessed using the Cochrane Risk of Bias Tool. They pooled all included data and performed subgroup analysis by fatigue type, assessment instrument, and ginseng type. The authors included 19 RCTs. Pooled analyses found no significant reduction in fatigue severity with ginseng versus controls (standardized mean difference [SMD]: -0.36, 95% confidence interval [CI]: -0.82 to 0.11, = 0.13). In subgroup analysis, there was significant fatigue reduction with the ginseng herbal formula (SMD: -0.39, 95% CI: -0.66 to -0.13, = 0.004) and chronic fatigue (CF) (SMD: -0.30, 95% CI: -0.56 to -0.03, = 0.03) compared to controls. Ginseng produced significant reductions in general (i.e., non-disease-specific) fatigue compared to controls (SMD: -0.48, 95% CI: -0.71 to -0.25, < 0.0001). Ginseng was associated with a trend toward QoL improvement ( = 0.05) and did not increase AEs compared with controls. Effect sizes were small. Ginseng herbal formulas improved fatigue severity compared to controls, especially among patients with CF, but with a small effect size. Rigorous RCTs as well as guidelines for standard ginseng usage are needed to further evaluate the effects of ginseng for fatigue and ensure proper use.
Topics: Humans; Panax; Quality of Life; Complementary Therapies; Randomized Controlled Trials as Topic
PubMed: 36730693
DOI: 10.1089/jicm.2022.0532 -
International Journal of Language &... 2023Previous research has demonstrated that many caregivers of care recipients with communication and swallowing impairments suffer from caregiver burden. Existing research... (Review)
Review
BACKGROUND
Previous research has demonstrated that many caregivers of care recipients with communication and swallowing impairments suffer from caregiver burden. Existing research sheds light on the presence of burden and various predicting factors, but little information on interventions to reduce caregiver burden.
AIMS
To determine how speech-language pathologists (SLPs) address caregiver burden in clinical practice.
METHODS
A systematic review was conducted according to PRISMA guidelines and 1898 unique articles were assessed for eligibility from nine electronic databases. Only 11 studies carried out a caregiver burden intervention involving an SLP. Details of the interventions were extracted per the Rehabilitation Treatment Specification System (RTSS) guidelines.
MAIN CONTRIBUTION
Results of the review revealed that SLP-led caregiver burden interventions can be effective in reducing burden. Multiple aspects of the intervention approaches, such as multidisciplinary care and targeting emotional burden, are discussed. Demographic factors, such as gender and socio-economic status (SES), are also taken into consideration.
CONCLUSIONS & IMPLICATIONS
This review suggests that SLPs can be effective at reducing caregiver burden through interventions involving caregivers across the lifespan and continuum of care.
WHAT THIS PAPER ADDS
What is already known on this subject Previous research has demonstrated that many caregivers of care recipients with communication and swallowing impairments suffer from caregiver burden. These caregivers range from parents of young children to spouses of individuals with dementia. However, it is unclear if and how SLPs address caregiver burden in clinical practice. What this paper adds to existing knowledge Using the RTSS, details of various caregiver burden interventions involving SLPs were identified. This review revealed that SLP-led caregiver burden interventions can be effective in reducing emotional and financial burden, as well as play a part in improving care-recipient outcomes. What are the potential or actual clinical implications of this work? This systematic review demonstrates that efforts to reduce caregiver burden within SLP practice may yield benefits for both caregivers and care recipients. It provides clinicians with a preliminary resource to help consider caregiver burden interventions that best suit the needs of the caregivers and their care recipients.
Topics: Child; Child, Preschool; Humans; Caregiver Burden; Caregivers; Communication; Communication Disorders; Speech; Speech-Language Pathology
PubMed: 36722020
DOI: 10.1111/1460-6984.12856 -
Current Oncology (Toronto, Ont.) Jan 2023A cancer diagnosis can impact patients' and caregivers' lives, posing different challenging situations. In particular, breast cancer and prostate cancer are two types of... (Review)
Review
BACKGROUND
A cancer diagnosis can impact patients' and caregivers' lives, posing different challenging situations. In particular, breast cancer and prostate cancer are two types of cancer involving families and especially spouses in challenges linked with the diagnosis and treatment process. Caregivers are usually involved in the treatment decision-making (TDM) process concerning patients' clinical pathway, cancer treatment, and ongoing therapies. To date, no contributions provide an exhaustive overview of the role of caregivers in cancer care and their involvement in the TDM process related to the therapies.
METHODS
We performed a systematic review of caregiver and patients experiences and perceptions of caregiver involvement in cancer TDM. Articles were searched on Public/Publisher MEDLINE (PubMed), Excerpta Medica Database (Embase), Medical Literature Analysis and Retrieval System Online (Medline), and American Psychological Association APA PsycINFO.
RESULTS
17 studies were included, 10 on prostate cancer and 7 on breast cancer. According to the reviewed studies, patients and caregivers experienced the cancer diagnosis with a sense of unity. Most patients preferred to have an active or collaborative role with caregivers in TDM, feeling it was important to consult or share the decision made with their caregivers. Caregivers preferred to collaborate with patients or let patients decide by themselves after considering their opinions. Caregiver involvement could have a positive influence on the patient's medical decisions, even if cancer diagnosis and treatments overwhelmed patients and caregivers.
CONCLUSIONS
These findings highlight the importance of using a perspective that focuses on the relationship between a patient and caregivers when they receive a cancer diagnosis and have to make a treatment decision. Targeting caregiver-patient dyads, rather than individuals, is important since a supported relationship could have a protective effect on psychological distress, quality of life (QOL), and relationship satisfaction. Moreover, dyads may benefit from interventions that focus on the needs of both the patient and caregiver.
Topics: Male; Humans; Quality of Life; Decision Making, Shared; Prostatic Neoplasms; Breast Neoplasms
PubMed: 36661710
DOI: 10.3390/curroncol30010061 -
Heart & Lung : the Journal of Critical... 2023Families of patients admitted to ICUs often experience post-intensive care syndrome-family, and previous studies have reported several possible risk factors. However, to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Families of patients admitted to ICUs often experience post-intensive care syndrome-family, and previous studies have reported several possible risk factors. However, to date, no meta-analyses have been conducted on the numerous risk factors associated with the development of post-intensive care syndrome-family and how strongly these factors are in association with post-intensive care syndrome-family.
OBJECTIVES
To identify risk factors for post-intensive care syndrome-family and determine the effect size of individual risk factors.
METHODS
This systematic review used MEDLINE, CINAHL, PsycINFO, and EMBASE databases to search all studies through December 1, 2021, that reported risk factors for anxiety, depression, PTSD, and prolonged grief disorder in the families of adult patients in ICUs. A meta-analysis was conducted to calculate an overall estimate for key risk factors, and odds ratio and 95% confidence intervals were used as summary statistics using the random-effects model.
RESULTS
Of 2964 identified studies, 17 were included. Nine factors for anxiety, eight for depression, and three for PTSD were assessed using results from 13 studies. The risk factor with the largest effect size was "history of mental illness," which, along with "female sex," was a significant risk factor common to anxiety, depression, and PTSD. "Poor communication with ICU staff," "severely ill patient," and "patients' spouse" were common risk factors for anxiety and depression.
CONCLUSIONS
We identified several risk factors related to patient and family demographic characteristics. Further research is required to identify and validate modifiable risk factors for the psychosocial experiences of families of ICU patients.
Topics: Adult; Humans; Female; Stress Disorders, Post-Traumatic; Anxiety; Intensive Care Units; Risk Factors; Depression
PubMed: 36642001
DOI: 10.1016/j.hrtlng.2023.01.005 -
International Journal of Bipolar... Jan 2023Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness... (Review)
Review
A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention.
BACKGROUND
Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II.
METHODS
We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the 'early course' of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach.
RESULTS
From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course.
CONCLUSIONS AND RECOMMENDATIONS
While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.
PubMed: 36595095
DOI: 10.1186/s40345-022-00275-3 -
Journal of the American Medical... Mar 2023Social isolation is a global health issue that affects older adults throughout their lives. This study aimed to identify the factors associated with social isolation in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Social isolation is a global health issue that affects older adults throughout their lives. This study aimed to identify the factors associated with social isolation in older adults.
DESIGN
Systematic review and meta-analysis.
SETTING AND PARTICIPANTS
Adults aged 60 years and older.
METHODS
We searched for observational studies without language restrictions in 11 databases from inception to August 2022. Pooled odds ratio (OR) and 95% CI were calculated using the R software (version 4.2.1). The modified Newcastle-Ottawa Scale was used to evaluate the risk of bias.
RESULTS
Eighteen factors were grouped into 5 themes. The following 13 factors were statistically significant: (1) demographics theme: aged 80 years and older (OR: 2.41; 95% CI: 1.20-4.85), less than or equal to a high school degree (OR: 1.68; 95% CI: 1.44-1.97), smoking (OR: 1.43; 95% CI: 1.18-1.73), and male (OR: 1.38; 95% CI: 1.01-1.89); (2) environment theme: low social support (OR: 7.77; 95% CI: 3.45-17.50) and no homeownership (OR: 1.38; 95% CI: 1.25-1.51); (3) role theme: no social participation (OR: 3.18; 95% CI: 1.30-7.80) and no spouse (OR: 2.61; 95% CI: 1.37-4.99); (4) physical health: hearing loss (OR: 2.78; 95% CI: 1.54-5.01), activities of daily living impairment (OR: 2.38; 95% CI: 1.57-3.61), and poor health status (OR: 1.52; 95% CI: 1.32-1.74); and (5) mental health: cognitive decline (OR: 1.85; 95% CI: 1.40-2.45) and depression (OR: 1.72; 95% CI: 1.21-2.44).
CONCLUSIONS AND IMPLICATIONS
Social isolation in older adults is associated with various factors. Hence, focused intervention should be adopted for older adults. In addition, further longitudinal studies are required to confirm a direct link between multiple factors and social isolation.
Topics: Humans; Male; Middle Aged; Aged; Activities of Daily Living; Social Isolation; Health Status; Social Participation; Longitudinal Studies
PubMed: 36549651
DOI: 10.1016/j.jamda.2022.11.008