To provide a step-by-step, easy-to-understand, practical guide for systematic review and meta-analysis of observational studies.
A multidisciplinary team of researchers with extensive experience in ...observational studies and systematic review and meta-analysis was established. Previous guidelines in evidence synthesis were considered.
There is inherent variability in observational study design, population, and analysis, making evidence synthesis challenging. We provided a framework and discussed basic meta-analysis concepts to assist reviewers in making informed decisions. We also explained several statistical tools for dealing with heterogeneity, probing for bias, and interpreting findings. Finally, we briefly discussed issues and caveats for translating results into clinical and public health recommendations. Our guideline complements "A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research" and addresses peculiarities for observational studies previously unexplored.
We provided 7 steps to synthesize evidence from observational studies. We encourage medical and public health practitioners who answer important questions to systematically integrate evidence from observational studies and contribute evidence-based decision-making in health sciences.
The level of injury is linked with biochemical alterations and limitations in physical activity among individuals with spinal cord injury (SCI), which are crucial determinants of body composition. We ...searched five electronic databases from inception until 22 July 2021. The pooled effect estimates were computed using random-effects models, and heterogeneity was calculated using I2 statistics and the chi-squared test. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled 40 studies comprising 4872 individuals with SCI (3991 males, 825 females, and 56 sex-unknown) in addition to chronic SCI (median injury duration 12.3 y, IQR 8.03–14.8). Individuals with tetraplegia had a higher fat percentage (weighted mean difference (WMD) 1.9%, 95% CI 0.6, 3.1) and lower lean mass (WMD −3.0 kg, 95% CI −5.9, −0.2) compared to those with paraplegia. Those with tetraplegia also had higher indicators of central adiposity (WMD, visceral adipose tissue area 0.24 dm2 95% CI 0.05, 0.43 and volume 1.05 L 95% CI 0.14, 1.95), whereas body mass index was lower in individuals with tetraplegia than paraplegia (WMD −0.9 kg/mg2, 95% CI −1.4, −0.5). Sex, age, and injury characteristics were observed to be sources of heterogeneity. Thus, individuals with tetraplegia have higher fat composition compared to paraplegia. Anthropometric measures, such as body mass index, may be inaccurate in describing adiposity in SCI individuals.
Having a grandchild who survived childhood cancer might affect grandparents’ mental health. We aimed to A) describe the psychological distress of grandparents of childhood cancer survivors (CCS) and ...compare their distress to the Swiss general population, and B) explore the associations between the psychological distress of grandparents with person-, child-, and cancer-related characteristics.
This is a cross-sectional study conducted in Switzerland. Grandparents were identified from families of eligible CCS (cancer diagnosis before 18 years old; 3–10 years after diagnosis). A subsample of a representative sample for the Swiss general population was used for comparison similar in age, gender and language region. The Brief Symptom Inventory-18 (BSI-18) was administered to assess psychological distress on three domains: somatization, depression, anxiety; and a Global Severity Index GSI. We ran Chi-squared and t-tests to compare grandparents and comparisons, and univariable, multivariable and multilevel regressions to analyze associations.
In total, 122 grandparents (60.7% female, mean age=72.8; SD=6.8) and 354 comparisons participated (55.4% female; mean age=65.7; SD=5.5). Grandparents reported average distress levels and their scores did not differ significantly from the comparison sample (all p>.05). Grandparents with worse health perception described more psychological distress (somatization: β=6.86, p<.001; depression: β=4.17 p<.001; anxiety: β=5.87, p<.001; GSI: β=6.30, p<.001), while single grandparents experienced more depression than those in a partnership (β=-6.21, p=.013).
Our findings are encouraging, showing adequate psychological health among grandparents of CCS. However, grandparents who perceived their health as poorer encounter higher levels of distress and may benefit from access to support groups and tailored informational material.
•Grandparents’ psychological distress level did not differ from comparisons.•Grandparents with worse health perception and singles reported more distress.•Support groups are recommended for grandparents who are at risk for distress.
Palliative care (PC) is an integral part of cancer treatment. However, data on service availability is limited in childhood cancers.
To describe the availability of PC services in paediatric oncology ...centres across Europe, and to identify barriers and facilitators for implementing and providing paediatric palliative care (PPC).
Paediatric oncology centres across Europe were invited to complete an online questionnaire.
A total of 158 paediatric oncology centres from 27 European countries participated. More than half of the centres (n=102, 64.6%) reported offering specialised PPC (defined as 24/7 coverage services with specialized physician and a multidisciplinary team). Most centres included a multidisciplinary care team (n=123, 80.9%) and PC at home (n=105, 69.1%). In 38.7% centres, service capacity was reported to be lower than demand. In most centres, PC consultation was initiated for a refractory neoplasm (n=126, 81.2%). Few centres (n=11, 7.1%) offered PC consultation at the time of a new cancer diagnosis. Eighty-two centres (52.6%) reported having bereavement services. Negative parental perception (n=99, 64.7%) and late referrals (n=91, 59.5%) were major barriers to implementation perceived by health care providers.
Our results suggest that specialised PPC is available in more than half of paediatric oncology settings across Europe. Although half have had PPC available for >10 years, many cannot fulfil the demand for service. Barriers to implementation (i.e., parental education, staff training) should be addressed, with resources and services further expanded to cover the demand for PPC, including bereavement care.
Grandparents play a crucial role in providing their families with love, support, and wisdom, often also supporting them in practical and financial ways. The psychosocial effects experienced by ...grandparents when a grandchild is diagnosed with an illness can be significant, including increased stress, anxiety, grief, and disruptions in their own lives. Yet, the experience of grandparents is often overlooked in the literature. The GROKids Project aims to investigate how grandparents are affected by a grandchild's cancer diagnosis. It employs a mixed-methods approach and consists of three studies: a longitudinal cohort study (Study 1) and a qualitative study (Study 2) involving grandparents of children with a recent cancer diagnosis, and a cross-sectional study (Study 3) of grandparents of childhood cancer survivors. Study 1 covers four time points over two years after the cancer diagnosis, while Study 2 explores the lived experiences of a subsample of these grandparents. Study 3 collects data from grandparents of childhood cancer survivors diagnosed 3 to 10 years ago. Participants are recruited across eight pediatric oncology centers in Switzerland, and through patient advocacy and support groups. Eligibility criteria include having a grandchild diagnosed with cancer and being fluent in German, French, or Italian. This project addresses the gaps in understanding the psychosocial effects on grandparents having a grandchild diagnosed with cancer. It utilizes a comprehensive approach, including multiple methodologies and considering the broader family context. The project's strengths lie in its mixed-methods design, longitudinal approach, and inclusion of the perspectives of the sick children, siblings, and parents, besides grandparents. By gaining a more profound understanding of grandparents' experiences, researchers and healthcare professionals can develop targeted interventions and support services to address grandparents' unique needs.
Abstract
Aims
Optimal endovascular management of intermittent claudication (IC) remains disputed. This systematic review and meta-analysis compares efficacy and safety outcomes for balloon ...angioplasty (BA), bare-metal stents (BMS), drug-coated balloons (DCB), drug-eluting stents (DES), covered stents, and atherectomy.
Methods and results
Electronic databases were searched for randomized, controlled trials (RCT) from inception through November 2021. Efficacy outcomes were primary patency, target-lesion revascularization (TLR), and quality-of-life (QoL). Safety endpoints were all-cause mortality and major amputation. Outcomes were evaluated at short-term (<1 year), mid-term (1–2 years), and long-term (≥2 years) follow-up. The study was registered on PROSPERO (CRD42021292639). Fifty-one RCTs enrolling 8430 patients/lesions were included. In femoropopliteal disease of low-to-intermediate complexity, DCBs were associated with higher likelihood of primary patency short-term: odds ratio (OR) 3.21, 95% confidence interval (CI) 2.44–4.24; long-term: OR 2.47, 95% CI 1.93–3.16, lower TLR (short-term: OR 0.33, 95% CI 0.22–0.49; long-term: OR 0.42, 95% CI 0.29–0.60) and similar all-cause mortality risk, compared with BA. Primary stenting using BMS was associated with improved short-to-mid-term patency and TLR, but similar long-term efficacy compared with provisional stenting. Mid-term patency (OR 1.64, 95% CI 0.89–3.03) and TLR (OR 0.50, 95% CI 0.22–1.11) estimates were comparable for DES vs. BMS. Atherectomy, used independently or adjunctively, was not associated with efficacy benefits compared with drug-coated and uncoated angioplasty, or stenting approaches. Paucity and heterogeneity of data precluded pooled analysis for aortoiliac disease and QoL endpoints.
Conclusion
Certain devices may provide benefits in femoropopliteal disease, but comparative data in aortoiliac arteries is lacking. Gaps in evidence quantity and quality impede identification of the optimal endovascular approach to IC.
Structured Graphical Abstract
Structured Graphical Abstract
Major findings from a random-effects meta-analysis investigating the efficacy and safety of endovascular revascularization strategies in the treatment of intermittent claudication at short- (<1 year), mid- (1–2 years), and long-term (≥2 years) follow-up. The forest plots display pooled odds ratios with associated 95% confidence intervals for the outcomes target-lesion revascularization (left) and primary patency (right) comparing drug-coated vs. uncoated balloon angioplasty, primary vs. provisional bare-metal stenting and drug-eluting vs. bare-metal stenting in femoropopliteal artery disease. BA, balloon angioplasty; BMS, bare-metal stents; CI, confidence interval; DCB, drug-coated balloons; DES, drug-eluting stents; OR, odds ratio; RCT, randomized controlled trial.
We aimed to explore longitudinal changes in androgen levels in individuals with spinal cord injury (SCI) within initial inpatient rehabilitation stay and identify clinical/injury characteristics ...associated with hormone levels. Linear regression analysis was applied to explore the association between personal/injury characteristics and androgen hormones (total testosterone, free testosterone, sex hormone-binding globulin (SHBG), dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S)) at admission to rehabilitation. Longitudinal changes in androgen levels were studied using linear mixed models. Analyses were stratified by sex and by injury type. We included 70 men and 16 women with SCI. We observed a non-linear association between age, time since injury, and androgens at baseline. At admission to initial rehabilitation, mature serum SHBG (full-length, protein form which lacks the N-terminal signaling peptide) was higher, while DHEA and DHEA-S were lower among opioid users vs. non-users. Serum levels of total testosterone and DHEA-S increased over rehabilitation period β 3.96 (95%CI 1.37, 6.56), p = 0.003 and β 1.77 (95%CI 0.73, 2.81), p = 0.01, respectively. We observed no significant changes in other androgens. Restricting our analysis to men with traumatic injury did not materially change our findings. During first inpatient rehabilitation over a median follow up of 5.6 months, we observed an increase in total testosterone and DHEA-S in men with SCI. Future studies need to explore whether these hormonal changes influence neurological and functional recovery as well as metabolic parameters during initial rehabilitation stay.
Swiss chard (Beta vulgaris L. var. cicla or flavescens) is a green leafy vegetable whose bioactive compounds have been studied due to its effects on health. We systematically reviewed the nutritional ...profile and bioactive composition of Swiss chard and reported their concentrations. Four main databases were searched for studies analyzing the chemical composition of Swiss chard. Screening, selection of articles, and data extraction were carried out by two independent reviewers. Twenty-eight articles of 1102 records identified by bibliographic search met our inclusion criteria for final analysis. We found a total of 192 chemical compounds categorized into 23 groups. The cicla variety was the most studied, and nutrients and phytochemicals were reported mainly on leaves. Betalains with 20% of the reported data, fats (16%), flavonoids (11%), non-flavonoid phenolics (11%), terpenes and derivatives (8%), carbohydrates (7%), and minerals (6%) were among the most reported categories. Swiss chard leaves have the highest content of fiber, sodium, magnesium, flavonoids, and vitamin C, while stems are high in potassium. Swiss chard should be considered a source of nutrients and phytochemicals, and further research is needed on identifying and quantifying other bioactive compounds and understanding their impact on health.
Moringa oleifera as a Galactagogue Raguindin, Peter Francis N; Dans, Leonila F; King, Jacelie F
Breastfeeding medicine,
2014 Jul-Aug, Letnik:
9, Številka:
6
Journal Article
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