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JAMA Internal Medicine Jan 2023Since the onset of the COVID-19 pandemic, there have been calls for COVID-19 clinical trials to be fully representative of all demographic groups. However, limited... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Since the onset of the COVID-19 pandemic, there have been calls for COVID-19 clinical trials to be fully representative of all demographic groups. However, limited evidence is available about the sex, racial, and ethnic representation among COVID-19 prevention and treatment trials.
OBJECTIVE
To investigate whether female participants and racial and ethnic minority individuals are adequately represented in COVID-19 prevention and treatment trials in the US.
DATA SOURCES
Identified studies were registered on ClinicalTrials.gov or published in the PubMed database from October 2019 to February 2022.
STUDY SELECTION
Included studies must have provided the number of enrolled participants by sex, race, or ethnicity. Only interventional studies conducted in the US for the primary purpose of the diagnosis, prevention, or treatment of (or supportive care for) COVID-19 conditions were included.
DATA EXTRACTION AND SYNTHESIS
Data on counts of enrollments by demographic variables (sex, race, and ethnicity) and location (country and state) were abstracted. Studies were broadly categorized by primary purpose as prevention (including vaccine and diagnosis studies) vs treatment (including supportive care studies). A random effects model for single proportions was used. Trial estimates were compared with corresponding estimates of representation in the US population with COVID-19.
MAIN OUTCOMES AND MEASURES
Sex, racial, and ethnic representation in COVID-19 clinical trials compared with their representation in the US population with COVID-19.
RESULTS
Overall, 122 US-based COVID-19 clinical trials comprising 176 654 participants were analyzed. Studies were predominantly randomized trials (n = 95) for treatment of COVID-19 (n = 103). Sex, race, and ethnicity were reported in 109 (89.3%), 95 (77.9%), and 87 (71.3%) trials, respectively. Estimated representation in prevention and treatment trials vs the US population with COVID-19 was 48.9% and 44.6% vs 52.4% for female participants; 23.0% and 36.6% vs 17.7% for Hispanic or Latino participants; 7.2% and 16.5% vs 14.1% for Black participants; 3.8% and 4.6% vs 3.7% for Asian participants; 0.2% and 0.9% vs 0.2% for Native Hawaiian or Other Pacific Islander participants; and 1.3% and 1.4% vs 1.1% for American Indian or Alaska Native participants. Compared with expected rates in the COVID-19 reference population, female participants were underrepresented in treatment trials (85.1% of expected; P < .001), Black participants (53.7% of expected; P = .003) and Asian participants (64.4% of expected; P = .003) were underrepresented in prevention trials, and Hispanic or Latino participants were overrepresented in treatment trials (206.8% of expected; P < .001).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, aggregate differences in representation for several demographic groups in COVID-19 prevention and treatment trials in the US were found. Strategies to better ensure diverse representation in COVID-19 studies are needed, especially for prevention trials.
Topics: Humans; Female; United States; Ethnicity; COVID-19; Minority Groups; Pandemics; Hispanic or Latino
PubMed: 36469312
DOI: 10.1001/jamainternmed.2022.5600 -
International Journal of Environmental... Apr 2021Time-use of older adults can be different than in earlier life, especially during the transition from pre- to post-retirement or after experiencing major life events,... (Review)
Review
Time-use of older adults can be different than in earlier life, especially during the transition from pre- to post-retirement or after experiencing major life events, and the changes could affect their mental health. However, the extent and nature of such research in gerontology have not been examined to date. Therefore, this scoping review sought to map the literature on time-use and mental health in the older population to examine the extent and nature of those research activities. A scoping review was conducted using four databases-PubMed, Scopus, CINAHL, and EMBASE according to PRISMA guidelines. Data were extracted using a pretested tool to develop a descriptive analysis and thematic summary. A total of 11 articles met the eligibility criteria. Seven out of 11 studies involved cross-sectional design, while the remainder were longitudinal studies. The longitudinal studies mainly were secondary data analysis. Time-use data were mainly collected using daily diaries, and the most common mental health outcome included was depression. Only two studies did not evaluate the direct relationship between time-use and mental health. Our review has revealed studies evaluating time-use and mental health in older adults. Limitations of review and recommendations for future studies are discussed.
Topics: Aged; Cross-Sectional Studies; Humans; Mental Health; Population Groups
PubMed: 33922295
DOI: 10.3390/ijerph18094459 -
Medicine Mar 2023Many studies had shown that with global warming, heat waves may increase the mortality risk of Chinese populations. However, these findings are not consistent.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many studies had shown that with global warming, heat waves may increase the mortality risk of Chinese populations. However, these findings are not consistent. Therefore, we elucidated the associations by meta-analysis and quantified the magnitude of these risks, as well as the underlying factors.
METHODS
We searched the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, EMBASE, and Web of Science for literature screening up to Nov 10, 2022, to analyze the effect of heat waves on mortality in the Chinese population. Literature screening and data extraction were performed independently by two researchers and the data were merged by meta-analysis. In addition, we conducted subgroup analysis by sex, age, years of education, region, and number of events to explore the source of heterogeneity.
RESULTS
Fifteen related studies on the impact on heat waves of the death of Chinese people were included in this study. The results of the meta-analysis showed that heat waves were significantly associated with increased mortality from non-accidental deaths, cardiovascular diseases, stroke, respiratory diseases, and circulatory diseases in the Chinese population: non-accidental mortality (RR = 1.19, 95% CI: 1.13-1.27, P < .01), cardiovascular diseases (RR = 1.25, 95% CI: 1.14-1.38), stroke (RR = 1.11, 95% CI: 1.03-1.20), respiratory diseases (RR = 1.18, 95% CI: 1.09-1.28), and circulatory diseases (RR = 1.11, 95% CI: 1.06-1.17). Subgroup analyses showed that heat waves had a higher risk of non-accidental death for those with <6 years of education than for those with ≥6 years of education. Meta-regression analysis showed that the contribution of the study year to the inter studied heterogeneity was 50.57%. The sensitivity analysis showed that the exclusion of any single study did not materially alter the overall combined effect. The meta-analysis method indicated no obvious evidence of publication bias.
CONCLUSIONS
The results of the review indicated that heat waves were associated with increased mortality in the Chinese population, that attention should be paid to high-risk groups, and that public health policies and strategies should be implemented to more effectively respond to and adapt to climate change.
Topics: Humans; Cardiovascular Diseases; East Asian People; Respiratory Tract Diseases; Stroke; Extreme Heat
PubMed: 37000079
DOI: 10.1097/MD.0000000000033345 -
International Journal of Environmental... Jan 2022Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of... (Review)
Review
Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.
Topics: Adult; Black or African American; Cross-Sectional Studies; Depression; Ethnicity; Humans; Social Determinants of Health; United States
PubMed: 35162519
DOI: 10.3390/ijerph19031498 -
Journal of Racial and Ethnic Health... Apr 2023Disproportionate rates of psychiatric disorders, like substance use and posttraumatic stress disorders (SUD and PTSD), exist among American Indian and Alaska Native... (Review)
Review
INTRODUCTION
Disproportionate rates of psychiatric disorders, like substance use and posttraumatic stress disorders (SUD and PTSD), exist among American Indian and Alaska Native (AI/AN) individuals. This review examines substance use and trauma in existing AI/AN literature and utilizes an AI/AN-specific model to culturally inform the relationship between these factors and provide recommendations for future research.
METHODS
We searched three databases through April 2021 for peer-reviewed articles that examined substance use and trauma in AI/AN individuals.
RESULTS
The search identified 289 articles and of those, 42 were eligible for inclusion, including 36 quantitative and 6 qualitative studies. Rates of lifetime trauma exposure varied from 21 to 98% and were correlated with increased rates of SUDs. A dose response of traumatic events also increased the likelihood of an SUD among reservation-based AI populations. Factors from the Indigenist Stress Coping model included cultural buffers such as traditional healing and cultural identity, which aided in recovery from SUD and trauma, and social stressors like boarding school attendance, discrimination, and historical loss.
CONCLUSIONS
SUD and trauma are highly correlated among AI/AN individuals though rates of PTSD are lower than might be expected suggesting resilience. However, this pattern may not be consistent across all AI/AN groups and further research is needed to better explain the existing relationship of SUD and PTSD and relevant historical and cultural factors. Further research is needed to culturally tailor, implement, and validate PTSD and SUD assessments and treatments to ameliorate these health inequities.
Topics: Humans; American Indian or Alaska Native; Indians, North American; Substance-Related Disorders; Stress Disorders, Post-Traumatic
PubMed: 35089579
DOI: 10.1007/s40615-022-01250-5 -
Clinical Psychology Review Apr 2016For decades, the literature has reported persistent treatment disparities among depressed Latinos. Fortunately, treatment development and evaluation in this underserved... (Review)
Review
For decades, the literature has reported persistent treatment disparities among depressed Latinos. Fortunately, treatment development and evaluation in this underserved population has expanded in recent years. This review summarizes outcomes across 36 unique depression treatment studies that reported treatment outcomes for Latinos. Results indicated that there was significant variability in the quality of RCT and type/number of cultural adaptations. The review suggested that there might a relation between cultural adaptations with treatment outcomes; future studies are warranted to confirm this association. Cognitive Behavioral Therapy was the most evaluated treatment (CBT; n=18, 50% of all evaluations), followed by Problem Solving Therapy (PST; n=4), Interpersonal Therapy (IPT; n=4), and Behavioral Activation (BA; n=3). CBT seems to fare better when compared to usual care, but not when compared to a contact-time matched control condition or active treatment. There is growing support for PST and IPT as efficacious depression interventions among Latinos. IPT shows particularly positive results for perinatal depression. BA warrants additional examination in RCT. Although scarce, telephone and in-home counseling have shown efficacy in reducing depression and increasing retention. Promotora-assisted trials require formal assessment. Limitations and future directions of the depression psychotherapy research among Latinos are discussed.
Topics: Depressive Disorder, Major; Health Services Accessibility; Healthcare Disparities; Hispanic or Latino; Humans; Psychotherapy; Treatment Outcome
PubMed: 27113679
DOI: 10.1016/j.cpr.2016.04.001 -
Ciencia & Saude Coletiva Apr 2018Food security and the vulnerability among indigenous and peasant populations has become a topic of interest to public health all around the world, leading to the... (Review)
Review
Food security and the vulnerability among indigenous and peasant populations has become a topic of interest to public health all around the world, leading to the investigation about measurement, classification and factors that determine it. This systematic review aims to describe the situation of food security in indigenous and peasant communities, and the methods used for evaluation. The literature search was performed on the Pub Med (5), ScienceDirect (221) and Scopus (377) databases searching for publications between 2004 and 2015, a total of 603 items were located with the search engines. At the end of the screening process and after adding the items found in the gray literature, 25 papers were obtained to write the review. In the 11 years evaluated between 2004 and 2015, scientific activity around the theme was poor with just 4.54% of the publications on this subject, but for 2011 the percentage increased to 13 publications, 63%. Various factors that influence the development of food insecurity are climate change, the diversity of agriculture, globalization and market westernization.
Topics: Agriculture; Climate Change; Food Supply; Global Health; Humans; Internationality; Population Groups; Public Health
PubMed: 29694594
DOI: 10.1590/1413-81232018234.13882016 -
Canadian Journal of Public Health =... Jan 2014Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care can prevent disease progression in the individual and prevent onwards... (Review)
Review
OBJECTIVE
Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care can prevent disease progression in the individual and prevent onwards transmission within the community. This review describes HIV testing coverage in populations disproportionately affected by HIV and in the general population in Canada.
METHODS
A search of published and grey literature on HIV testing uptake in Canada was conducted. Studies reporting quantitative data on testing practices (ever tested, recent testing, and regular testing), published in either English or French from 2008-2012, were included. Studies that involved testing for immigration or prenatal purposes, and post-intervention studies, were excluded. Included studies were assessed using a modified version of the Public Health Agency of Canada's Descriptive Study Critical Appraisal Tool. Pooled prevalence for percent ever tested was calculated for subpopulations and heterogeneity was estimated using the I2 statistic.
SYNTHESIS
A total of 26 studies were included in the review. The highest rates of ever having been tested were among people who inject drugs (90.6%) and inmates (90.4%); followed by men who have sex with men (83.0%); Aboriginal peoples (55.5%); and the general population (32.8%). Limited information was available on regular and recent testing.
CONCLUSION
HIV testing can reduce the number of undiagnosed cases in Canada. Future research should focus on testing coverage in certain populations, and on the extent to which populations engage in regular testing.
Topics: Canada; HIV Infections; Humans; Mass Screening; Population Groups
PubMed: 24735698
DOI: 10.17269/cjph.105.4128 -
Journal of General Internal Medicine Aug 2012To systematically review the literature to determine which interventions improve the screening, diagnosis or treatment of cervical cancer for racial and/or ethnic... (Review)
Review
OBJECTIVES
To systematically review the literature to determine which interventions improve the screening, diagnosis or treatment of cervical cancer for racial and/or ethnic minorities.
DATA SOURCES
Medline on OVID, Cochrane Register of Controlled Trials, CINAHL, PsycINFO and Cochrane Systematic Reviews.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS
We searched the above databases for original articles published in English with at least one intervention designed to improve cervical cancer prevention, screening, diagnosis or treatment that linked participants to the healthcare system; that focused on US racial and/or ethnic minority populations; and that measured health outcomes. Articles were reviewed to determine the population, intervention(s), and outcomes. Articles published through August 2010 were included.
STUDY APPRAISAL AND SYNTHESIS METHODS
One author rated the methodological quality of each of the included articles. The strength of evidence was assessed using the criteria developed by the GRADE Working Group.
RESULTS
Thirty-one studies were included. The strength of evidence is moderate that telephone support with navigation increases the rate of screening for cervical cancer in Spanish- and English-speaking populations; low that education delivered by lay health educators with navigation increases the rate of screening for cervical cancer for Latinas, Chinese Americans and Vietnamese Americans; low that a single visit for screening for cervical cancer and follow up of an abnormal result improves the diagnosis and treatment of premalignant disease of the cervix for Latinas; and low that telephone counseling increases the diagnosis and treatment of premalignant lesions of the cervix for African Americans.
LIMITATIONS
Studies that did not focus on racial and/or ethnic minority populations may have been excluded. In addition, this review excluded interventions that did not link racial and ethnic minorities to the health care system. While inclusion of these studies may have altered our findings, they were outside the scope of our review.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
Patient navigation with telephone support or education may be effective at improving screening, diagnosis, and treatment among racial and ethnic minorities. Research is needed to determine the applicability of the findings beyond the populations studied.
Topics: Early Detection of Cancer; Ethnicity; Female; Humans; Minority Groups; Practice Guidelines as Topic; Racial Groups; Treatment Outcome; Uterine Cervical Neoplasms
PubMed: 22798213
DOI: 10.1007/s11606-012-2052-2 -
Brain Imaging and Behavior Dec 2022Diversity of participants in biomedical research with respect to race, ethnicity, and biological sex is crucial, particularly given differences in disease prevalence,... (Review)
Review
Diversity of participants in biomedical research with respect to race, ethnicity, and biological sex is crucial, particularly given differences in disease prevalence, recovery, and survival rates between demographic groups. The objective of this systematic review was to report on the demographics of neuroimaging studies using magnetic resonance imaging (MRI). The Web of Science database was used and data collection was performed between June 2021 to November 2021; all articles were reviewed independently by at least two researchers. Articles utilizing MR data acquired in the United States, with n ≥ 10 human subjects, and published between 2010-2020 were included. Non-primary research articles and those published in journals that did not meet a quality control check were excluded. Of the 408 studies meeting inclusion criteria, approximately 77% report sex, 10% report race, and 4% report ethnicity. Demographic reporting also varied as function of disease studied, participant age range, funding, and publisher. We anticipate quantitative data on the extent, or lack, of reporting will be necessary to ensure inclusion of diverse populations in biomedical research.
Topics: Humans; United States; Magnetic Resonance Imaging; Ethnicity
PubMed: 36114313
DOI: 10.1007/s11682-022-00724-8