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International Journal of Molecular... Jul 2021Medical staff represent the largest group of workers occupationally exposed to ionizing radiation (IR). Chronic exposure to low-dose IR may result in DNA damage and... (Meta-Analysis)
Meta-Analysis
Medical staff represent the largest group of workers occupationally exposed to ionizing radiation (IR). Chronic exposure to low-dose IR may result in DNA damage and genotoxicity associated with increased risk of cancer. This review aims to identify the genotoxicity biomarkers that are the most elevated in IR-exposed vs. unexposed health workers. A systematic review of the literature was performed to retrieve relevant studies with various biomarkers of genotoxicity. Subsequent meta-analyses produced a pooled effect size for several endpoints. The search procedure yielded 65 studies. Chromosome aberrations (CA) and micronuclei (MN) frequencies were significantly different between IR-exposed and unexposed workers (θ = 3.19, 95% CI 1.46-4.93; and θ = 1.41, 95% CI 0.97-1.86, for total aberrant cells and MN frequencies, respectively), which was not the case for ring chromosomes and nucleoplasmic bridges. Although less frequently used, stable translocations, sister chromatid exchanges (SCE) and comet assay endpoints were also statistically different between IR-exposed and unexposed workers. This review confirms the relevance of CA and MN as genotoxicity biomarkers that are consistently elevated in IR-exposed vs. unexposed workers. Other endpoints are strong candidates but require further studies to validate their usefulness. The integration of the identified biomarkers in future prospective epidemiological studies is encouraged.
Topics: Biomarkers; Chromosome Aberrations; DNA Damage; Dose-Response Relationship, Radiation; Health Personnel; Humans; Occupational Exposure; Radiation, Ionizing
PubMed: 34299125
DOI: 10.3390/ijms22147504 -
Dento Maxillo Facial Radiology 2016Current guidelines highlight the need to optimize exposure parameters on CBCT equipment to levels that are as low as diagnostically acceptable. This systematic review... (Review)
Review
OBJECTIVES
Current guidelines highlight the need to optimize exposure parameters on CBCT equipment to levels that are as low as diagnostically acceptable. This systematic review aimed to answer the question "Can altering operating potential (kV) and tube current exposure time product (mAs) on CBCT machines reduce radiation dose to patients undergoing dental and/or maxillofacial scans without a detrimental impact on image quality/diagnostic accuracy?"
METHODS
Studies were selected and results reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. For each individual study, two authors (RG and JD or KH) independently extracted data using a specifically designed collection form, and an overall quality value was assigned using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Any disagreements in the overall quality value of a study were resolved by discussion between the current authors.
RESULTS
Nearly 75% of studies were considered to be of low or very low methodological quality using the GRADE system, and more studies stated that their results applied only in the specific situations they had investigated. However, most studies demonstrated that patient dose reduction is possible without a clinically relevant reduction in image quality.
CONCLUSIONS
For many CBCT machines, it should be possible to optimize one, or more, of the investigated exposure parameters and therefore reduce patient radiation dose, while maintaining diagnostic image quality for some diagnostic tasks. However, more rigorous research is still required.
Topics: Cone-Beam Computed Tomography; Humans; Radiation Dosage; Radiation Exposure; Radiographic Image Enhancement; Radiography, Dental; Time Factors
PubMed: 26732433
DOI: 10.1259/dmfr.20150254 -
Frontiers in Immunology 2020Transplant-associated thrombotic microangiopathy (TA-TMA) is a dangerous and life-threatening complication in patients undergoing hematopoietic stem cell transplantation... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Transplant-associated thrombotic microangiopathy (TA-TMA) is a dangerous and life-threatening complication in patients undergoing hematopoietic stem cell transplantation (HSCT). Eculizumab has been used in the treatment of TA-TMA, and several studies have confirmed the benefit of Eculizumab in patients with TA-TMA. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of Eculizumab for TA-TMA.
MATERIALS AND METHODS
We searched PubMed and Embase for studies on the efficacy and safety of Eculizumab in TA-TMA patients. Efficacy outcomes consisted of overall response rate (ORR), complete response rate (CRR), and survival rate at the last follow-up (SR). Safety outcomes were adverse events (AEs), including infection, sepsis, impaired liver function, infusion reactions, and death.
RESULTS
A total of 116 patients from six studies were subjected to meta-analysis. The pooled estimates of ORR, CRR, and SR for TA-TMA patients were 71% (95% CI: 58-82%), 32% (95% CI: 11-56%), and 52% (95% CI: 40-65%), respectively. Only one patient presented with a severe rash, and infection was the most common AEs. The main causes of death were infection and GvHD.
CONCLUSION
Current evidence suggests that Eculizumab improves SR and ORR in patients with TA-TMA and that Eculizumab is well tolerated. However, the number of studies is limited, and the findings are based mainly on data from observational studies. Higher quality randomized controlled trials and more extensive prospective cohort studies are needed.
Topics: Adolescent; Adult; Aged; Antibodies, Monoclonal, Humanized; Child; Child, Preschool; Complement Inactivating Agents; Female; Hematopoietic Stem Cell Transplantation; Humans; Infant; Male; Middle Aged; Observational Studies as Topic; Survival Rate; Thrombotic Microangiopathies; Treatment Outcome; Young Adult
PubMed: 33552043
DOI: 10.3389/fimmu.2020.564647 -
The Cochrane Database of Systematic... Jul 2016'Keratinocyte cancer' is now the preferred term for the most commonly identified skin cancers basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC),... (Review)
Review
BACKGROUND
'Keratinocyte cancer' is now the preferred term for the most commonly identified skin cancers basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), which were previously commonly categorised as non-melanoma skin cancers (NMSC). Keratinocyte cancer (KC) represents about 95% of malignant skin tumours. Lifestyle changes have led to increased exposure to the sun, which has, in turn, led to a significant increase of new cases of KC, with a worldwide annual incidence of between 3% and 8%. The successful use of preventive measures could mean a significant reduction in the resources used by health systems, compared with the high cost of the treatment of these conditions. At present, there is no information about the quality of the evidence for the use of these sun protection strategies with an assessment of their benefits and risks.
OBJECTIVES
To assess the effects of sun protection strategies (i.e. sunscreen and barrier methods) for preventing keratinocyte cancer (that is, basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) of the skin) in the general population.
SEARCH METHODS
We searched the following databases up to May 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trial registries and the bibliographies of included studies for further references to relevant trials.
SELECTION CRITERIA
We included randomised controlled clinical trials (RCTs) of preventive strategies for keratinocyte cancer, such as physical barriers and sunscreens, in the general population (children and adults), which may provide information about benefits and adverse events related to the use of solar protection measures. We did not include trials focused on educational strategies to prevent KC or preventive strategies in high-risk groups. Our prespecified primary outcomes were BCC or cSCC confirmed clinically or by histopathology at any follow-up and adverse events.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies for eligibility using Early Review Organizing Software (EROS). Similarly, two review authors independently used predesigned data collection forms to extract information from the original study reports about the participants, methods of randomisation, blinding, comparisons of interest, number of participants originally randomised by arm, follow-up losses, and outcomes, and they assessed the risk of bias. We resolved any disagreement by consulting a third author and contacted trial investigators of identified trials to obtain additional information. We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included one RCT (factorial design) that randomised 1621 participants.This study compared the daily application of sunscreen compared with discretionary use of sunscreen, with or without beta-carotene administration, in the general population. The study was undertaken in Australia; 55.2% of participants had fair skin, and they were monitored for 4.5 years for new cases of BCC or cSCC assessed by histopathology. We found this study to be at low risk of bias for domains such as allocation, blinding, and incomplete outcome data. However, we found multiple unclear risks related to other biases, including an unclear assessment of possible interactions between the effects of the different interventions evaluated (that is, sunscreen and beta-carotene). We found no difference in terms of the number of participants developing BCC (n = 1621; risk ratio (RR) 1.03, 95% confidence interval (CI) 0.74 to 1.43) or cSCC (n = 1621; RR 0.88, 95% CI 0.50 to 1.54) when comparing daily application of sunscreen with discretionary use, even when analyses were restricted to groups without beta-carotene supplementation. This evidence was of low quality, which means that there is some certainty that future studies may alter our confidence in this evidence.We reported adverse events in a narrative way and included skin irritation or contact allergy.We identified no studies that evaluated other sun protection measures, such as the use of sun-protective clothing, sunglasses, or hats, or seeking the shade when outdoors.
AUTHORS' CONCLUSIONS
In this review, we assessed the effect of solar protection in preventing the occurrence of new cases of keratinocyte cancer. We only found one study that was suitable for inclusion. This was a study of sunscreens, so we were unable to assess any other forms of sun protection. The study addressed our prespecified primary outcomes, but not most of our secondary outcomes. We were unable to demonstrate from the available evidence whether sunscreen was effective for the prevention of basal cell carcinoma (BCC) or cutaneous squamous cell carcinoma (cSCC).Our certainty in the evidence was low because there was a lack of histopathological confirmation of BCC or cSCC in a significant percentage of cases. Amongst other sources of bias, it was not clear whether the study authors had assessed any interaction effects between the sunscreen and beta-carotene interventions. We think that further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Topics: Adult; Australia; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Child; Humans; Neoplasms, Radiation-Induced; Randomized Controlled Trials as Topic; Skin Neoplasms; Sunlight; Sunscreening Agents; Ultraviolet Rays; Vitamins; beta Carotene
PubMed: 27455163
DOI: 10.1002/14651858.CD011161.pub2 -
Environmental Pollution (Barking, Essex... Jan 2023Evidence of the health impacts from environmental noise has largely been drawn from studies in high-income countries, which has then been used to inform development of... (Review)
Review
Evidence of the health impacts from environmental noise has largely been drawn from studies in high-income countries, which has then been used to inform development of noise guidelines. It is unclear whether findings in high-income countries can be readily translated into policy contexts in low-middle-income-countries (LMICs). We conducted this systematic review to summarise noise epidemiological studies in LMICs. We conducted a literature search of studies in Medline and Web of Science published during 2009-2021, supplemented with specialist journal hand searches. Screening, data extraction, assessment of risk of bias as well as overall quality and strength of evidence were conducted following established guidelines (e.g. Navigation Guide). 58 studies were identified, 53% of which were from India, China and Bulgaria. Most (92%) were cross-sectional studies. 53% of studies assessed noise exposure based on fixed-site measurements using sound level meters and 17% from propagation-based noise models. Mean noise exposure among all studies ranged from 48 to 120 dB (L), with over half of the studies (52%) reporting the mean between 60 and 80 dB. The most studied health outcome was noise annoyance (43% of studies), followed by cardiovascular (17%) and mental health outcomes (17%). Studies generally reported a positive (i.e. adverse) relationship between noise exposure and annoyance. Some limited evidence based on only two studies showing that long-term noise exposure may be associated with higher prevalence of cardiovascular outcomes in adults. Findings on mental health outcomes were inconsistent across the studies. Overall, 4 studies (6%) had "probably low", 18 (31%) had "probably high" and 36 (62%) had "high" risk of bias. Quality of evidence was rated as 'low' for mental health outcomes and 'very low' for all other outcomes. Strength of evidence for each outcome was assessed as 'inadequate', highlighting high-quality epidemiological studies are urgently needed in LMICs to strengthen the evidence base.
Topics: Poverty; Noise; Income; India; China; Developing Countries
PubMed: 36347406
DOI: 10.1016/j.envpol.2022.120605 -
Frontiers in Public Health 2022Over the decades, many assessment methods have been developed around the world and used for occupational health risk assessment (OHRA). This scoping review integrated...
BACKGROUND
Over the decades, many assessment methods have been developed around the world and used for occupational health risk assessment (OHRA). This scoping review integrated the literature on methodological studies of OHRA in China and aimed to identifies the research hot-spots and methodological research perspectives on OHRA in China.
METHODS
A scoping review of literature was undertaken to explore the research progress on OHRA methods in China. Focusing on OHRA methods, the authors systematically searched Chinese and English databases and relevant guideline websites from the date of establishment to June 30, 2022. Databases included Web of Science, PubMed, Scopus, the China National Knowledge Internet, WanFang Database. Some other websites were also searched to obtain gray literature. The extracted information included the author, year, region of first author, the target industry, risk assessment model, study type, the main results and conclusions.
RESULTS
Finally, 145 of 9,081 studies were included in this review. There were 108 applied studies, 30 comparative studies and 7 optimization studies on OHRA in China. The OHRA methods studied included: (1) qualitative methods such as Romanian model, Australian model, International Council on Mining and Metals model, and Control of Substances Hazardous to Health Essentials; (2) quantitative methods such as the U. S. Environmental Protection Agency inhalation risk assessment model, Physiologically Based Pharmacokinetic, and Monte Carlo simulation; (3) semi-quantitative methods such as Singapore model, Fuzzy mathematical risk assessment model, Likelihood Exposure Consequence method and Occupational Hazard Risk Index assessment method; (4) comprehensive method (Chinese OHRA standard GBZ/T 298-2017). Each of the OHRA methods had its own strengths and limitations. In order to improve the applicability of OHRA methods, some of them have been optimized by researchers.
CONCLUSIONS
There is a wide range of OHRA methods studied in China, including applied, comparative, and optimization studies. Their applicability needs to be further tested through further application in different industries. Furthermore, quantitative comparative studies, optimization studies, and modeling studies are also needed.
Topics: United States; Australia; Risk Assessment; Probability; Databases, Factual; China
PubMed: 36466494
DOI: 10.3389/fpubh.2022.1035996 -
PloS One 2016Poor adherence to tuberculosis (TB) treatment can lead to prolonged infectivity and poor treatment outcomes. Directly observed treatment (DOT) seeks to improve adherence... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Poor adherence to tuberculosis (TB) treatment can lead to prolonged infectivity and poor treatment outcomes. Directly observed treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medication. Although community-based DOT (CB-DOT) programs have been widely studied and promoted, their effectiveness has been inconsistent. The aim of this study was to critical appraise and summarize evidence of the effects of CB-DOT on TB treatment outcomes.
METHODS
Studies published up to the end of February 2015 were identified from three major international literature databases: Medline/PubMed, EBSCO, and EMBASE. Unpublished data from the grey literature were identified through Google and Google Scholar searches.
RESULTS
Seventeen studies involving 12,839 pulmonary TB patients (PTB) in eight randomized controlled trials (RCTs) and nine cohort studies from 12 countries met the criteria for inclusion in this review and 14 studies were included in meta-analysis. Compared with clinic-based DOT, pooled results of RCTs for all PTB cases (including smear-negative or -positive, new or retreated TB cases) and smear-positive PTB cases indicated that CB-DOT promoted successful treatment [pooled RRs (95%CIs): 1.11 (1.02-1.19) for all PTB cases and 1.11 (1.02-1.19) for smear-positive PTB cases], and completed treatment [pooled RRs (95%CIs): 1.74(1.05, 2.90) for all PTB cases and 2.22(1.16, 4.23) for smear-positive PTB cases], reduced death [pooled RRs (95%CIs): 0.44 (0.26-0.72) for all PTB cases and 0.39 (0.23-0.66) for smear-positive PTB cases], and transfer out [pooled RRs (95%CIs): 0.37 (0.23-0.61) for all PTB cases and 0.42 (0.25-0.70) for smear-positive PTB cases]. Pooled results of all studies (RCTs and cohort studies) with all PTB cases demonstrated that CB-DOT promoted successful treatment [pooled RR (95%CI): 1.13 (1.03-1.24)] and curative treatment [pooled RR (95%CI): 1.24 (1.04-1.48)] compared with self-administered treatment.
CONCLUSIONS
CB-DOT did improved TB treatment outcomes according to the pooled results of included studies in this review. Studies on strategies for implementation of patient-centered and community-centered CB-DOT deserve further attention.
Topics: Antitubercular Agents; Directly Observed Therapy; Humans; Treatment Outcome; Tuberculosis; Tuberculosis, Pulmonary
PubMed: 26849656
DOI: 10.1371/journal.pone.0147744 -
Journal of Skin Cancer 2021The aim of this systematic review is to summarise the evidence of the effectiveness of interventions targeted to adolescents (13 to 18 years inclusive) and delivered in... (Review)
Review
AIM
The aim of this systematic review is to summarise the evidence of the effectiveness of interventions targeted to adolescents (13 to 18 years inclusive) and delivered in a secondary school setting with the purpose of improving sun protection behaviour, reducing ultraviolet radiation (UVR) exposure, and/or improving physiological outcomes related to UVR exposure (such as erythema or naevi development).
METHODS
Peer-reviewed journal articles were identified from seven database searches (Cochrane, Embase, CINAHL, Scopus, Medline, PsycInfo, and Web of Science) to January 2020, forward citation searches of relevant articles, and monitoring of WHO INTERSUN UVR list server for recent publications. Relevant articles were collected and critically analysed using the Effective Public Health Practice framework. Two reviewers independently reviewed, and when deemed eligible, extracted data and performed quality appraisals for each study.
RESULTS
Thirteen studies met the criteria for inclusion in the review. There were no studies that met a "strong" quality rating, five received a "moderate" quality rating, and eight studies a "weak" quality rating. Three of those with a moderate rating found evidence for effectiveness. The most promising interventions overall (including the pilot/uncontrolled studies) were those that moved beyond a pure health education approach and used innovative approaches such as the provision of shade, or use of technology (e.g., appearance-based apps or real-time ultraviolet index (UVI) monitors).
CONCLUSIONS
There is a lack of high-quality published studies investigating the interventions delivered in a secondary school setting to protect students from UVR. The evidence could be strengthened if researchers used consistent, standardised outcome measures for sun protection exposure and behaviour. Other factors limiting the strength of evidence were short follow-up times (largely less than 6 months) and/or nonrobust study design.
PubMed: 33747567
DOI: 10.1155/2021/6625761 -
Noise & Health 2022Exposure to noise can increase biological stress reactions and that could increase the risk of stress-related prenatal effects, including adverse obstetric outcomes;... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Exposure to noise can increase biological stress reactions and that could increase the risk of stress-related prenatal effects, including adverse obstetric outcomes; however, the association between exposure to noise and adverse obstetric outcomes has not been extensively explored. The objective of this review was to evaluate the evidence between noise exposures and adverse obstetric outcomes, specifically preeclampsia, gestational diabetes, and gestational hypertension.
MATERIALS AND METHODS
A systematic review of English language, comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases between January 1, 1980 and December 29, 2021 was performed. Risk of bias for individual studies was assessed using the Risk of Bias Instrument for Nonrandomized Studies of Exposures, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the body of evidence for each outcome.
RESULTS
Six studies reporting on preeclampsia, gestational diabetes, and gestational hypertension were identified. Although some studies suggested there may be signals of increased responses to increased noise exposure for preeclampsia and gestational hypertension, the certainty in the evidence of an effect of increased noise on all the outcomes was very low due to concerns with risk of bias, inconsistency across studies, and imprecision in the effect estimates.
CONCLUSIONS
While the certainty of the evidence for noise exposure and adverse obstetric outcomes was very low, the findings from this review may be useful for directing further research in this area, as there is currently limited evidence available. These findings may also be useful for informing guidelines and policies involving noise exposure situations or environments.
Topics: Bias; Diabetes, Gestational; Female; Humans; Hypertension, Pregnancy-Induced; Noise; Pre-Eclampsia; Pregnancy
PubMed: 36124522
DOI: 10.4103/nah.nah_22_22 -
Medical Journal of the Islamic Republic... 2020Positron Emission Mammography (PEM) is an imaging technique which is increasing focuses on imaging the chest instead of imaging the whole body. The aim of this study... (Review)
Review
Positron Emission Mammography (PEM) is an imaging technique which is increasing focuses on imaging the chest instead of imaging the whole body. The aim of this study was to conduct a systematic review of the clinical efficacy and coste-ffectiveness of PEM technology, as compared with PET, as a diagnostic method used for breast cancer patients. The present study was a Health Technology Assessment (HTA), which was conducted via a systematic review of clinical efficacy and cost-effectiveness of the methods based on domestic evidence. To evaluate the efficacy of the PEM diagnostic method, as compared with PET, we used efficacy indices, including Sensitivity, Specificity, Accuracy, PPV, and NPV. The required data were collected through a meta-analysis of studies published in electronic databases from 1990 to 2016. In addition, direct costs in both methods were estimated and finally, a cost-effectiveness analysis was performed using the results of the study. Also, a one-way sensitivity analysis was performed to examine the effects of parameters' uncertainty in the model. In this study, we used STATA software to integrate the results of studies with similar parameters. A total of 722 cases (N) were obtained from the five final studies. The results of the meta-analysis performed on the collected data showed that the two methods were identical in terms of the Specificity and PPV parameters. However, as to Sensitivity, NPV, and Accuracy parameters, the PEM method was superior to the PET for diagnosis of primary breast cancer. The total cost of using PEM and PET was $1737385.7 and $1940903.5, respectively, and the cost of a one-time scan (cost per unit) using PEM and PET devices was $86.82 and $157.63, respectively. As compared with the PET method, the use of the PEM diagnostic method for diagnosis of breast cancer was cost-effective in terms of all the five studied parameters (it was definitely cost-effective for four parameters and was also considered as cost-effective for another index, since ICER was below the threshold). The results showed that the use of PEM technology for the diagnosis of primary breast cancer is more cost-effective than PET technology; thus, due to the wide range of PET technology in different fields, it is recommended that this method should be used in other areas of priority.
PubMed: 33315994
DOI: 10.34171/mjiri.34.100