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Diabetes Research and Clinical Practice Jan 2016Diabetes mellitus (DM) may be a risk factor for venous thromboembolism (VTE) but results are inconsistent. (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
Diabetes mellitus (DM) may be a risk factor for venous thromboembolism (VTE) but results are inconsistent.
AIM
We conducted a systematic review and meta-analysis of epidemiologic studies to quantify the association between DM and VTE.
METHODS AND RESULTS
We included studies identified in PubMed, Web of Science, and CINAHL through 07/31/2014. We identified 19 studies that met our selection criteria. We pooled RRs using a random-effects model: the pooled RR for the association of DM with VTE was 1.10 (95% CI: 0.94-1.29). Between-study heterogeneity was explored with a forest plot, funnel plot, meta-regression, and a stratified analysis. Between-study heterogeneity was observed and not explained by study design, method of DM assessment, or degree of adjustment for confounding. Sensitivity analyses omitted one study at a time to assess the influence of any single study on the pooled estimate. These analyses indicated that one large study was highly influential; when this study was excluded, the pooled estimate increased and just reached statistical significance: 1.16 (95% CI: 1.01-1.34).
CONCLUSIONS
This meta-analysis suggests either no association or a modest positive one between DM and VTE in the general population. DM is unlikely to play a major role in VTE development.
Topics: Diabetes Mellitus; Diabetic Angiopathies; Humans; Risk Factors; Venous Thromboembolism
PubMed: 26612139
DOI: 10.1016/j.diabres.2015.10.019 -
Vaccines Nov 2022Foodborne enteritis is a major disease burden globally. Two of the most common causative bacterial enteropathogens in humans are Campylobacter and Salmonella species... (Review)
Review
Foodborne enteritis is a major disease burden globally. Two of the most common causative bacterial enteropathogens in humans are Campylobacter and Salmonella species which are strongly associated with the consumption of raw or contaminated chicken. The poultry industry has approached this issue by use of a multi-hurdle method across the production chain to reduce or eliminate this risk. The use of poultry vaccines is one of these control methods. A systematic review and meta-analysis of vaccination effects against caecal Campylobacter and Salmonella were performed on primary research published between 2009 and 2022. Screening was conducted by three reviewers with one reviewer performing subsequent data extraction and one reviewer performing the risk of bias assessment. The confidence in cumulative evidence was evaluated based on the GRADE method. Meta-analyses were performed using standardised mean differences (SMDs) with additional analyses and random effects regression models on intervention effects grouped by the vaccine type. A total of 13 Campylobacter and 19 Salmonella studies satisfied the eligibility criteria for this review. Many studies included multi-arm interventions, resulting in a total of 25 Campylobacter and 34 Salmonella comparators which were synthesised. The analyses revealed a large reduction in pathogen levels; however, many effects required statistical adjustment due to unit of analysis errors. There was a moderate level of confidence in the reduction of Campylobacter by 0.93 SMD units (95% CI: −1.275 to −0.585; p value < 0.001) and a very low level of confidence in the reduction of Salmonella by 1.10 SMD units (95% CI: −1.419 to −0.776; p value < 0.001). The Chi2 test for heterogeneity (p value 0.001 and <0.001 for Campylobacter and Salmonella, respectively) and the I2 statistic (52.4% and 77.5% for Campylobacter and Salmonella, respectively) indicated high levels of heterogeneity in the SMDs across the comparators. The certainty of gathered evidence was also affected by a high risk of study bias mostly due to a lack of detailed reporting and, additionally for Salmonella, the presence of publication bias. Further research is recommended to source areas of heterogeneity, and a conscious effort to follow reporting guidelines and consider units of analysis can improve the strength of evidence gathered to provide recommendations to the industry.
PubMed: 36423031
DOI: 10.3390/vaccines10111936 -
BMC Geriatrics Jan 2017Sunlight exposure and high vitamin D status have been hypothesised to reduce the risk of developing dementia. The objective of our research was to determine whether lack... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sunlight exposure and high vitamin D status have been hypothesised to reduce the risk of developing dementia. The objective of our research was to determine whether lack of sunlight and hypovitaminosis D over time are associated with dementia.
METHODS
We systematically searched MEDLINE (via PubMed), Cochrane Library, EMBASE, SCOPUS, Web of Science, ICONDA, and reference lists of pertinent review articles from 1990 to October 2015. We conducted random effects meta-analyses of published and unpublished data to evaluate the influence of sunlight exposure or vitamin D as a surrogate marker on dementia risk.
RESULTS
We could not identify a single study investigating the association between sunlight exposure and dementia risk. Six cohort studies provided data on the effect of serum vitamin D concentration on dementia risk. A meta-analysis of five studies showed a higher risk for persons with serious vitamin D deficiency (<25 nmol/L or 7-28 nmol/L) compared to persons with sufficient vitamin D supply (≥50 nmol/L or 54-159 nmol/L) (point estimate 1.54; 95% CI 1.19-1.99, I = 20%). The strength of evidence that serious vitamin D deficiency increases the risk of developing dementia, however, is very low due to the observational nature of included studies and their lack of adjustment for residual or important confounders (e.g. ApoE ε4 genotype), as well as the indirect relationship between Vitamin D concentrations as a surrogate for sunlight exposure and dementia risk.
CONCLUSIONS
The results of this systematic review show that low vitamin D levels might contribute to the development of dementia. Further research examining the direct and indirect relationship between sunlight exposure and dementia risk is needed. Such research should involve large-scale cohort studies with homogeneous and repeated assessment of vitamin D concentrations or sunlight exposure and dementia outcomes.
Topics: Cohort Studies; Dementia; Female; Humans; Risk Factors; Sunlight; Vitamin D; Vitamin D Deficiency
PubMed: 28086755
DOI: 10.1186/s12877-016-0405-0 -
PloS One 2016In animal models, long-term moderate energy restriction (ER) is reported to decelerate carcinogenesis, whereas the effect of severe ER is inconsistent. The impact of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In animal models, long-term moderate energy restriction (ER) is reported to decelerate carcinogenesis, whereas the effect of severe ER is inconsistent. The impact of early-life ER on cancer risk has never been reviewed systematically and quantitatively based on observational studies in humans.
OBJECTIVE
We conducted a systematic review of observational studies and a meta-(regression) analysis on cohort studies to clarify the association between early-life ER and organ site-specific cancer risk.
METHODS
PubMed and EMBASE (1982 -August 2015) were searched for observational studies. Summary relative risks (RRs) were estimated using a random effects model when available ≥3 studies.
RESULTS
Twenty-four studies were included. Eleven publications, emanating from seven prospective cohort studies and some reporting on multiple cancer endpoints, met the inclusion criteria for quantitative analysis. Women exposed to early-life ER (ranging from 220-1660 kcal/day) had a higher breast cancer risk than those not exposed (RRRE all ages = 1.28, 95% CI: 1.05-1.56; RRRE for 10-20 years of age = 1.21, 95% CI: 1.09-1.34). Men exposed to early-life ER (ranging from 220-800kcal/day) had a higher prostate cancer risk than those not exposed (RRRE = 1.16, 95% CI: 1.03-1.30). Summary relative risks were not computed for colorectal cancer, because of heterogeneity, and for stomach-, pancreas-, ovarian-, and respiratory cancer because there were <3 available studies. Longer duration of exposure to ER, after adjustment for severity, was positively associated with overall cancer risk in women (p = 0.02). Ecological studies suggest that less severe ER is generally associated with a reduced risk of cancer.
CONCLUSIONS
Early-life transient severe ER seems to be associated with increased cancer risk in the breast (particularly ER exposure at adolescent age) and prostate. The duration, rather than severity of exposure to ER, seems to positively influence relative risk estimates. This result should be interpreted with caution due to the limited number of studies and difficulty in disentangling duration, severity, and geographical setting of exposure.
Topics: Breast Neoplasms; Caloric Restriction; Colorectal Neoplasms; Female; Humans; Male; Neoplasms; Prostatic Neoplasms; Regression Analysis; Risk
PubMed: 27643873
DOI: 10.1371/journal.pone.0158003 -
Academic Emergency Medicine : Official... Sep 2011The objectives were to conduct a comprehensive, systematic review of the literature for risk adjustment measures (RAMs) and outcome measures (OMs) for prehospital trauma... (Review)
Review
OBJECTIVES
The objectives were to conduct a comprehensive, systematic review of the literature for risk adjustment measures (RAMs) and outcome measures (OMs) for prehospital trauma research and to use a structured expert panel process to recommend measures for use in future emergency medical services (EMS) trauma outcomes research.
METHODS
A systematic literature search and review was performed identifying the published studies evaluating RAMs and OMs for prehospital injury research. An explicit structured review of all articles pertaining to each measure was conducted using the previously established methodology developed by the Canadian Physiotherapy Association ("Physical Rehabilitation Outcome Measures").
RESULTS
Among the 4,885 articles reviewed, 96 RAMs and/or OMs were identified from the existing literature (January 1958 to February 2010). Only one measure, the Glasgow Coma Scale (GCS), currently meets Level 1 quality of evidence status and a Category 1 (strong) recommendation for use in EMS trauma research. Twelve RAMs or OMs received Category 2 status (promising, but not sufficient current evidence to strongly recommend), including the motor component of GCS, simplified motor score (SMS), the simplified verbal score (SVS), the revised trauma score (RTS), the prehospital index (PHI), EMS provider judgment, the revised trauma index (RTI), the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the field trauma triage (FTT), the pediatric triage rule, and the out-of-hospital decision rule for pediatrics.
CONCLUSIONS
Using a previously published process, a structured literature review, and consensus expert panel opinion, only the GCS can currently be firmly recommended as a specific RAM or OM for prehospital trauma research (along with core measures that have already been established and published). This effort highlights the paucity of reliable, validated RAMs and OMs currently available for outcomes research in the prehospital setting and hopefully will encourage additional, methodologically sound evaluations of the promising, Category 2 RAMs and OMs, as well as the development of new measures.
Topics: Emergency Medical Services; Humans; Outcome Assessment, Health Care; Pilot Projects; Reproducibility of Results; Risk Adjustment; Trauma Severity Indices
PubMed: 21906205
DOI: 10.1111/j.1553-2712.2011.01148.x -
PloS One 2018Pregnancy-related critical illness leads to death for 3-14% of affected women. Although identifying patients at risk could facilitate preventive strategies, guide... (Meta-Analysis)
Meta-Analysis
PURPOSE
Pregnancy-related critical illness leads to death for 3-14% of affected women. Although identifying patients at risk could facilitate preventive strategies, guide therapy, and help in clinical research, no prior systematic review of this literature exploring the validity of risk prediction models for maternal mortality exists. Therefore, we have systematically reviewed and meta-analyzed risk prediction models for maternal mortality.
METHODS
Search strategy: MEDLINE, EMBASE and Scopus, from inception to May 2017. Selection criteria: Trials or observational studies evaluating risk prediction models for maternal mortality. Data collection and analysis: Two reviewers independently assessed studies for eligibility and methodological quality, and extracted data on prediction performance.
RESULTS
Thirty-eight studies that evaluated 12 different mortality prediction models were included. Mortality varied across the studies, with an average rate 10.4%, ranging from 0 to 41.7%. The Collaborative Integrated Pregnancy High-dependency Estimate of Risk (CIPHER) model and the Maternal Severity Index had the best performance, were developed and validated from studies of obstetric population with a low risk of bias. The CIPHER applies to critically ill obstetric patients (discrimination: area under the receiver operating characteristic curve (AUC) 0.823 (0.811-0.835), calibration: graphic plot [intercept-0.09, slope 0.92]). The Maternal Severity Index applies to hospitalized obstetric patients (discrimination: AUC 0.826 [0.802-0.851], calibration: standardized mortality ratio 1.02 [0.86-1.20]).
CONCLUSIONS
Despite the high heterogeneity of the study populations and the limited number of studies validating the finally eligible prediction models, the CIPHER and the Maternal Severity Index are recommended for use among critically ill and hospitalized pregnant and postpartum women for risk adjustment in clinical research and quality improvement studies. Neither index has sufficient discrimination to be applicable for clinical decision making at the individual patient level.
Topics: Area Under Curve; Critical Illness; Databases, Factual; Delivery, Obstetric; Female; Humans; Maternal Mortality; Pregnancy; ROC Curve; Risk
PubMed: 30513118
DOI: 10.1371/journal.pone.0208563 -
Annals of Intensive Care Dec 2022The literature is unresolved on whether female receive advanced cardiac life support less than do male and on whether female have a survival advantage over male after... (Review)
Review
BACKGROUND
The literature is unresolved on whether female receive advanced cardiac life support less than do male and on whether female have a survival advantage over male after cardiopulmonary resuscitation.
METHODS
We systematically searched PubMed, Embase and Web of Science databases (from inception to 23-April-2022) for papers reporting outcomes in adult male and female after out-of-hospital cardiac arrest. The main study outcome was the rate of adjusted survival to hospital discharge or 30 days. Secondary outcomes included unadjusted survival to hospital discharge and favourable neurological outcome.
RESULTS
A total of 28 studies were included, involving 1,931,123 patients. Female were older than male, their cardiac arrests were less likely to be witnessed and less likely to present with a shockable rhythm. Unadjusted analysis showed that females had a lower likelihood of survival than males (OR 0.68 [0.62-0.74], I = 97%). After adjustment, no significant difference was identified between male and female in survival at hospital discharge/30 days (OR 1.01 [0.93-1.11], I = 87%). Data showed that male had a significantly higher likelihood of favorable neurological outcome in unadjusted analysis but this trend disappeared after adjustment. Both the primary outcome (adjusted for several variables) and the secondary outcomes were associated with substantial heterogeneity. The variables examined using meta-regression, subgroup and sensitivity analyses (i.e., study type, location, years, population, quality of adjustment, risk of bias) did not reduce heterogeneity.
CONCLUSIONS
The adjusted rate of survival to hospital discharge/30 days was similar for male and female despite an initial seeming survival advantage for male. The validity of this finding is limited by substantial heterogeneity despite in-depth investigation of its causes, which raises concerns regarding latent inequalities in some reports nonetheless. Further study on this topic may require inclusion of factors not reported in the Utstein template and in-depth analysis of decision-making processes.
PubMed: 36534195
DOI: 10.1186/s13613-022-01091-9 -
Parental Age and the Risk for Alzheimer's Disease in Offspring: Systematic Review and Meta-Analysis.Dementia and Geriatric Cognitive... 2021Alzheimer's disease (AD) is the most common cause of dementia worldwide, accounting for 50-75% of all cases. While older maternal and paternal age at childbirth are...
BACKGROUND
Alzheimer's disease (AD) is the most common cause of dementia worldwide, accounting for 50-75% of all cases. While older maternal and paternal age at childbirth are established risk factors for Down syndrome which is associated with later AD, it is still not entirely clear whether parental age is a risk factor for AD. Previous studies have suggested contradictory findings.
OBJECTIVES
We conducted a systematic review and meta-analysis to examine whether parental (maternal and paternal) age at birth was associated with AD and whether individuals born to younger or older parents were at an increased risk for AD.
METHODS
Two reviewers searched the electronic database of PubMed for relevant studies. Eligibility for the meta-analysis was based on the following criteria: (1) studies involving patients with AD and an adequate control group, (2) case control or cohort studies, (3) studies investigating parental age. All statistical analyses were completed in STATA/IC version 16.
RESULTS
Eleven studies involving 4,371 participants were included in the systematic review and meta-analysis. Meta-analysis demonstrated no significant association between maternal (weighted mean difference [WMD] 0.49, 95% CI -0.52 to 1.49, = 0.34) and paternal age and AD (WMD 1.00, 95% CI -0.55 to 2.56, = 0.21). Similarly, individuals born to younger (<25 years) or older parents (>35 years) did not demonstrate a differential risk for AD.
CONCLUSIONS
Overall, this meta-analysis did not demonstrate an association between parental age and the risk of AD in offspring. These findings should be interpreted with caution given the limited power of the overall meta-analysis and the methodological limitations of the underlying studies as in many cases no adjustment for potential confounders was included.
PubMed: 34178019
DOI: 10.1159/000515523 -
Frontiers in Surgery 2014A possible etiological association between endometriosis and ovarian cancer has been repeatedly reported in the literature. (Review)
Review
BACKGROUND
A possible etiological association between endometriosis and ovarian cancer has been repeatedly reported in the literature.
OBJECTIVE
Our aim was to evaluate published epidemiological data on this issue.
REVIEW METHODS
We conducted an extensive search of the literature in MEDLINE, of articles ever published until February 2014, using the key-words "endometriosis" and "ovarian" and one of the following terms in the title: "cancer" or "malignancy" or "malignant" or "tumor" or "neoplasia" or "neoplasm" or "transformation." Retrieved papers were checked for further relevant publications.
RESULTS
Overall, our search yielded 1 prospective cohort study, 10 retrospective cohort, and 5 case-control studies. A meta-analysis of these studies was not considered to be appropriate, due to differences in data reporting, study design, and adjustment for confounding factors.
LIMITATIONS
The main limitation of studies found, with one exception, was the lack of operative confirmation of endometriosis.
CONCLUSION
An association of endometriosis with clear-cell and endometrioid ovarian cancer was a consistent finding in most studies. On the other hand, existing epidemiological evidence linking endometriosis with ovarian cancer is insufficient to change current clinical practice. Prospective cohort studies, with prior laparoscopic confirmation, localization, and staging of endometriosis are needed, in order to further clarify this issue.
PubMed: 25593938
DOI: 10.3389/fsurg.2014.00014 -
Scandinavian Journal of Work,... Jan 2020Objectives Evidence on the effect of smoking on sickness absence could guide workplace smoking cessation interventions and encourage employers to promote smoking... (Meta-Analysis)
Meta-Analysis
Objectives Evidence on the effect of smoking on sickness absence could guide workplace smoking cessation interventions and encourage employers to promote smoking cessation among their employees. This systematic review and meta-analysis aimed to summarize evidence on the association between smoking and sickness absence and determine whether there are differences in this association for study design, methodology, and sample characteristics. Methods We searched for studies that reported on smoking status and sickness absence, used empirical data, were published in a peer-reviewed journal in the last 25 years, and written in English. We conducted pooled analyses in which uni- and multivariate generalized linear regression models were applied. Results After screening 2551 unique records, 46 articles from 43 studies were included, of which 33 studies (with 1 240 723 participants) could be included in the pooled analyses. Smoking was associated with an 31% increase in risk of sickness absence compared to non-smoking (95% confidence interval (CI) 1.24-39). We did not find statistically significant different effect sizes for study location, gender, age, occupational class, study design, assessment of sickness absence, short- versus long-term sickness absence, and adjustment for relevant confounders. Furthermore, smoking was associated with 2.89 more sickness absence days per year compared to non-smoking (95% CI 2.08-3.70). Conclusions We found robust evidence showing that smoking increases both the risk and number of sickness absence days in working populations, regardless of study location, gender, age, and occupational class. Encouraging smoking cessation at the workplace could therefore be beneficial for employers and employees.
Topics: Absenteeism; Humans; Smoking; Workplace
PubMed: 31478055
DOI: 10.5271/sjweh.3848