Key Study Characteristics Research Articles

The health impacts of ambient air pollution in Australia: a systematic literature review

Ambient (outdoor) air pollution is a key risk factor for health for which effective policy plays an important preventative role. Australian federal and related state air quality standards have historically relied on international evidence for guidance, which may not accurately reflect the Australian context. However, there has been a large increase in Australian epidemiological studies over recent years. The aim of this study is to provide an updated systematic literature review of peer-reviewed epidemiological studies that examined the health impacts of outdoor air pollution in Australia, including short- and long-term exposure. Following PRISMA guidelines, we conducted a systematic literature review. Broad search terms were applied to two databases (PubMed and Web of Science) and Google Scholar. Quality assessment and risk of bias were assessed using standard metrics. Included studies were summarised by tabulating key study characteristics, grouped by health outcomes. In total, 72 studies were included in the review. Sixty-four (89%) studies used daily or hourly pollutant concentrations to examine short-term exposure impacts, of which 59 (92%) revealed significant associations with one or more health outcomes, including cardio-respiratory, all-cause mortality or morbidity and birth outcomes. Eight (11%) studies used annual average pollutant concentrations to investigate the long-term exposure finding significant associations with asthma, reduced lung function, atopy and cardio-respiratory mortality across five studies. The remaining three studies found no significant association with asthma, mortality and a range of self-reported diseases, respectively. Ambient air pollution has substantial health impacts in Australia. The body of domestic evidence has increased markedly since national air quality standards were first set in the 1990s, which could be drawn on by policy-makers when revising the existing standards, or considering new standards.

Shift work and health outcomes: an umbrella review of systematic reviews and meta-analyses of epidemiological studies.

Shift work is commonly increasing, and some physiological changes occur as workers sleep less and their circadian rhythms are disrupted. This umbrella review not only summarizes the evidence but also evaluates the validity of the associations of shift work with different health outcomes. We searched the MEDLINE, Web of Science, and Embase databases from their inception to April 25, 2020. For each systematic review and/or meta-analysis, we estimated the summary effect size, the 95% confidence interval, the 95% prediction interval, the between-study heterogeneity, evidence of small-study effects, and evidence of excess-significance bias. Eight eligible systematic reviews and meta-analyses were identified, providing data on 16 associations. We observed highly suggestive evidence for associations between shift work and myocardial infarction (having ever vs having never done shift work) and diabetes mellitus incidence (per 5-year increment in shift work). Furthermore, we observed suggestive evidence for an association between shift work and diabetes mellitus incidence (having ever vs having never done shift work). Two health outcomes, including prostate cancer incidence (having ever vs having never done shift work and rotating night shift work vs daytime work) and colorectal cancer incidence (longest vs shortest shift work time), were only supported by weak evidence. This umbrella review found that shift work was associated with several health outcomes with different levels of evidence. Associations for myocardial infarction and diabetes mellitus incidence were supported by highly suggestive evidence. Registry: PROSPERO; Identifier: CRD42020188537. Wu Q-J, Sun H, Wen Z-Y, etal. Shift work and health outcomes: an umbrella review of systematic reviews and meta-analyses of epidemiological studies. J Clin Sleep Med. 2022;18(2):653-662.

Communication research at the National Cancer Institute, 2013-2019: a grant portfolio analysis.

To analyze communication-focused grants funded by the National Cancer Institute (NCI) between fiscal years 2013 and 2019 to provide insight into the characteristics of funded projects and identify promising areas for future research. iSearch, a portfolio analysis tool, was queried to identify communication-related grants funded by NCI. Abstracts and specific aims were coded for key study characteristics. 344 unique competing grants with a substantial communication component were included in the final analysis. SAS version 9.4 was used to calculate code frequencies. Most communication grants focused on cancer prevention (n = 197), with fewer targeting diagnosis, treatment, survivorship, or end-of-life. Tobacco product use was the most frequently addressed topic (n = 128). Most grants targeted or measured outcomes at the individual (n = 332) or interpersonal level (n = 127). Cancer patients/survivors (n = 101) and healthcare providers (n = 63) were often the population of focus, while caregivers or those at increased risk for cancer received less attention. Studies were often based in healthcare settings (n = 125); few studies were based in schools or worksites. Many grants employed randomized controlled trials (n = 168), but more novel methods, like optimization trials, were uncommon. NCI's support of health communication research covers a diverse array of topics, populations, and methods. However, the current analysis also points to several promising opportunities for future research, including efforts focused on communication at later stages of the cancer control continuum and at multiple levels of influence, as well as studies that take advantage of a greater diversity of settings and leverage novel methodological approaches.

Community nurses' attitudes, knowledge and educational needs in relation to urinary continence, continence assessment and management: A systematic review.

To identify, appraise and summarise the available evidence relating to community nurses' attitudes, knowledge and educational needs in relation to urinary continence. Community nurses play a pivotal role in identifying and supporting individuals who experience urinary continence issues. Gaps in nurses' continence-related education and knowledge may contribute to sub-optimal assessment and management across the continuum of care. A systematic review. MEDLINE, CINAHL Complete and EMBASE were searched from inception to November 2020;keywords used included community nurses, urinary continence, incontinence, knowledge, attitude and education needs. Given the degree of heterogeneity between included studies, a meta-analysis was not feasible. Included studies were critically evaluated; key study characteristics and findings pertinent to the review purpose were summarised. The review adhered to the PRISMA 2020 checklist. Four studies reported in six papers were included. Community nurses lacked knowledge in certain areas of urinary continence and incontinence. Nurses reported they were adequately prepared but without sufficient knowledge to effectively care for those with urinary incontinence. Community nurses' attitudes to urinary incontinence were generally positive, but they demonstrated misconceptions that urinary incontinence was inevitable and less distressing for older people. There is limited research exploring community nurses' knowledge, attitudes and education needs in relation to urinary continence and incontinence care. Community nurses may have knowledge gaps and less favourable attitudes to some aspects of urinary continence care.

Role of systems science in preventing and controlling emerging infectious diseases: protocol for a scoping review

IntroductionIn recent history, many new infectious diseases have affected humans for the first time or have appeared in previously unaffected areas of the world; these diseases are known as emerging...

A scoping review of research on policies to address child undernutrition in the Millennium Development Goals era.

The breadth of research on the impact of nutrition-specific policies to address child undernutrition is not well documented. This review maps the evidence base and identifies gaps on such policies. We systematically searched Medline, Embase, PAIS Index for public policy, Scopus and Web of Science databases to identify eligible studies. Key study characteristics, including research design, type of policy, time span of policy before impact assessment, child age at outcome assessment and types of outcomes assessed, were abstracted in duplicate. Low-, middle- and high-income countries. Studies were eligible for inclusion if they aimed to assess the impact of population-level nutrition-specific policies on undernutrition among children under 10 years of age. Of the 5646 abstracts screened, eighty-three studies were included. A range of policies to address child undernutrition were evaluated; the majority were related to micronutrient fortification. Most studies were observational, reported on mandatory regional or sub-national polices, were conducted in high-income countries and evaluated policies within 1 year of implementation. A narrow set of health outcomes were evaluated, most commonly iodine deficiency disorders and neural tube defects. Nutrition policies were commonly associated with improved child nutritional status and health. However, this evidence is primarily based on limited settings and on a limited number of outcomes. Further research is needed to assess the longer-term impact of a broader range of nutrition policies on child health, particularly in low- and middle-income countries.

Assessment of Concordance and Discordance Among Clinical Studies Posted as Preprints and Subsequently Published in High-Impact Journals

This cross-sectional study examines the concordance between clinical studies posted as preprints and subsequently published in high-impact journals, including key study characteristics, reported results, and study interpretations.

Post-Neoadjuvant Surveillance and Surgery as Needed Compared with Post-Neoadjuvant Surgery on Principle in Multimodal Treatment for Esophageal Cancer: A Scoping Review.

Simple SummaryA substantial fraction of patients with esophageal cancer show post-neoadjuvant pathological complete response (pCR). Principal esophagectomy after neoadjuvant treatment is the standard of care for all patients, including those with pCR. Surveillance and surgery as needed may be a treatment alternative for these patients. We performed a scoping review and described all relevant clinical studies addressing these two treatment approaches. We identified three completed randomized controlled trials (RCTs) including 468 participants, three planned/ongoing RCTs with a planned sample size of 752 participants, one non-randomized controlled study with 53 participants, ten retrospective cohort studies (2228 participants) and one survey on patients’ preferences (100 participants). The current scoping review reveals that although surveillance and surgery as needed has been investigated within different study designs, the available study pool show methodological limitations and clinical results are heterogeneous. A thoroughly planned RCT considering these limitations will be of great importance to provide these patients with the best treatment.Background: A substantial fraction of patients with esophageal cancer show post-neoadjuvant pathological complete response (pCR). Principal esophagectomy after neoadjuvant treatment is the standard of care for all patients, although surveillance and surgery as needed in case of local recurrence may be a treatment alternative for patients with complete response (CR). Methods: We performed a scoping review to describe key characteristics of relevant clinical studies including adults with non-metastatic esophageal cancer receiving multimodal treatment. Until September 2020, relevant studies were identified through systematic searches in the bibliographic databases Medline, Web of Science, Cochrane Library, Science Direct, ClinicalTrials, the German study register, and the WHO registry platform. Results: In total, three completed randomized controlled trials (RCTs, with 468 participants), three planned/ongoing RCTs (with a planned sample size of 752 participants), one non-randomized controlled study (NRS, with 53 participants), ten retrospective cohort studies (with 2228 participants), and one survey on patients’ preferences (with 100 participants) were identified. All studies applied neoadjuvant chemoradiation protocols. None of the studies examined neoadjuvant chemotherapeutic protocols. Studies investigated patient populations with esophageal squamous cell carcinoma, adenocarcinoma, and mixed cohorts. Important outcomes reported were overall, disease-free and local recurrence-free survival. Limitations of the currently available study pool include heterogeneous chemoradiation protocols, a lack of modern neoadjuvant treatment protocols in RCTs, short follow-up times, the use of heterogeneous diagnostic methods, and different definitions of clinical CR. Conclusion: Although post-neoadjuvant surveillance and surgery as needed compared with post-neoadjuvant surgery on principle has been investigated within different study designs, the currently available results are based on a wide variation of diagnostic tools to identify patients with pCR, short follow-up times, small sample sizes, and variations in therapeutic procedures. A thoroughly planned RCT considering the limitations in the currently available literature will be of great importance to provide patients with CR with the best and less harmful treatment.

PROTOCOL: The effects of cannabis liberalization laws on health, safety, and socioeconomic outcomes: An evidence and gap map.

PROTOCOL: The effects of cannabis liberalization laws on health, safety, and socioeconomic outcomes: An evidence and gap map.

1719. Respiratory Syncytial Virus-Associated Hospitalization Rates among US Infants: A Systematic Review and Meta-Analysis

BackgroundUnderstanding the true magnitude of infant respiratory syncytial virus (RSV) burden is critical for determining the potential public-health benefit of RSV prevention strategies. Although global reviews of infant RSV burden exist, none have summarized data from the United States or evaluated how RSV burden estimates are influenced by variations in study design.MethodsWe performed a systematic literature review and meta-analysis of studies describing RSV-associated hospitalization rates among US infants. We also examined the impact of key study characteristics on these estimates.ResultsAfter review of 3058 articles through January 2020, we identified 25 studies with 31 unique estimates of RSV-associated hospitalization rates. Among US infants < 1 year of age, annual rates ranged from 8.4 to 40.8 per 1000 with a pooled rate= 19.4 (95%CI= 17.9–20.9). Study type was associated with RSV hospitalization rates (P =.003), with active surveillance studies having pooled rates per 1000 (11.1; 95%CI: 9.8–12.3) that were half that of studies based on administrative claims (21.4; 95%CI: 19.5–23.3) or modeling approaches (23.2; 95%CI: 20.2–26.2).ConclusionApplying the pooled rates identified in our review to the 2020 US birth cohort suggests that 73,680 to 86,020 RSV-associated infant hospitalizations occur each year. To date, public-health officials have used conservative estimates from active surveillance as the basis for defining US infant RSV burden. The full range of RSV-associated hospitalization rates identified in our review better characterizes the true RSV burden in infants and can better inform future evaluations of RSV prevention strategies.Disclosures John M. McLaughlin, PhD, Pfizer (Employee, Shareholder) Farid L. Khan, MPH, Pfizer (Employee, Shareholder) Heinz-Josef Schmitt, MD, Pfizer (Employee, Shareholder) Yasmeen Agosti, MD, Pfizer (Employee, Shareholder) Luis Jodar, PhD, Pfizer (Employee, Shareholder) Eric Simões, MD, Pfizer (Consultant, Research Grant or Support) David L. Swerdlow, MD, Pfizer (Employee, Shareholder)

Respiratory Syncytial Virus-Associated Hospitalization Rates among US Infants: A Systematic Review and Meta-Analysis.

BackgroundAlthough global reviews of infant respiratory syncytial virus (RSV) burden exist, none have summarized data from the United States or evaluated how RSV burden estimates are influenced by variations in study design.MethodsWe performed a systematic literature review and meta-analysis of studies describing RSV-associated hospitalization rates among US infants and examined the impact of key study characteristics on these estimates.ResultsWe reviewed 3328 articles through 14 August 2020 and identified 25 studies with 31 unique estimates of RSV-associated hospitalization rates. Among US infants <1 year of age, annual rates ranged from 8.4 to 40.8 per 1000 with a pooled rate of 19.4 (95% confidence interval [CI], 17.9–20.9). Study type influenced RSV-associated hospitalization rates (P = .003), with active surveillance studies having pooled rates (11.0; 95% CI, 9.8–12.2) that were half that of studies based on administrative claims (21.4; 19.5–23.3) or modeling approaches (23.2; 20.2–26.2).ConclusionsApplying our pooled rates to the 2020 US birth cohort suggests that 79 850 (95% CI, 73 680–86 020) RSV-associated infant hospitalizations occur each year. The full range of RSV-associated hospitalization rates identified in our review can better inform future evaluations of RSV prevention strategies. More research is needed to better understand differences in estimated RSV burden across study design.

Exploring the use of rapport in professional information‐gathering contexts by systematically mapping the evidence base

SummaryA growing body of research illustrates consensus between researchers and practitioners that developing rapport facilitates cooperation and disclosure in a range of professional information gathering contexts. In such contexts, rapport behaviors are often intentionally used in an attempt to facilitate a positive interaction with another adult, which may or may not result in genuine mutual rapport. To examine how rapport has been manipulated and measured in professional contexts we systematically mapped the relevant evidence‐base in this field. For each of the 35 studies that met our inclusion criteria, behaviors associated with building rapport were coded in relation to whether they were verbal, non‐verbal, or para‐verbal. Methods to measure rapport were also coded and recorded, as were different types of disclosure. A Searchable Systematic Map was produced to catalogue key study characteristics. Discussion focuses on the underlying intention of the rapport behaviors that featured most frequently across studies.

Perspective: Towards Automated Tracking of Content and Evidence Appraisal of Nutrition Research

Robust recommendations for healthy diets and nutrition require careful synthesis of available evidence. Given the increasing volume of research articles generated, the retrieval and synthesis of evidence are increasingly becoming laborious and time-consuming. Information technology could help to reduce workload for humans. To guide supervised learning however, human identification of key study characteristics is necessary. Reporting guidelines recommend that authors include essential content in articles and could generate manually labeled training data for automated evidence retrieval and synthesis. Here, we present a semiautomated approach to annotate, link, and track the content of nutrition research manuscripts. We used the STROBE extension for nutritional epidemiology (STROBE-nut) reporting guidelines to manually annotate a sample of 15 articles and converted the semantic information into linked data in a Neo4j graph database through an automated process. Six summary statistics were computed to estimate the reporting completeness of the articles. The content structure, presence of essential study characteristics as well as the reporting completeness of the articles are visualized automatically from the graph database. The archived linked data are interoperable through their annotations and relations. A graph database with linked data on essential study characteristics can enable Natural Language Processing in nutrition.

Treatment of sarcopenia in nursing home residents: a scoping review protocol

IntroductionSarcopenia has been recognised as a disease that is consistently associated with a range of geriatric syndromes and negative health consequences. The prevalence of sarcopenia is high among nursing home...

P0811CONFUSION BETWEEN ETIOLOGY AND PREDICTION IN CLINICAL OBSERVATIONAL STUDIES; HOW OFTEN DOES IT ARISE AND HOW CAN WE AVOID IT? A SCOPING REVIEW

Abstract Background and Aims In etiological research the aim is to uncover the causal effect of a specific exposure on an outcome. The aim in prediction research is to predict an outcome with the best accuracy, irrespective of possible causality. Although in observational research both types of studies use similar statistical methods (generally multivariable modelling), the interpretation differs. For example, when researching the causal effect of BMI on kidney failure, it is important to correct for confounders such as age (i.e. factors that causally affect both BMI and kidney failure). Judgement of confounders must be made on pre-existing knowledge. If we select confounders based on the data, we might also correct for hypertension and atherosclerosis (as they are associated with BMI and kidney failure). As this correction is in the causal pathway we would erroneously conclude that BMI does not affect the risk of kidney failure. Vice versa, a mortality prediction model for dialysis patients may include antihypertensive medication use as a predictor. It would be wrong to conclude that patients should discontinue this medication to improve prognosis; the medication use is a marker for a certain health status and we cannot interpret it in a causal manner. Similar to these examples, we’ve found that characteristics from etiology and prediction are often confused, leaving us with studies that may be misinterpreted. The aim of the current study is to quantify the amount of confusion between etiology and prediction in clinical observational studies and identify common mistakes that lead to this confusion. Method Studies published in January 2018 in the top journals of four distinct medical fields: General &amp; Internal medicine, Surgery, Cardiology and Nephrology were screened for inclusion. Original research studies on observational cohorts of humans were included. A list of key study characteristics of etiological and prediction research was developed by CLR and MvD in an iterative fashion. From these characteristics signaling questions for confusion were developed to score included studies. Results The developed key study characteristics of etiology and prediction are shown in the table. In total, 286 studies were screened of which 123 were included. Overall, 27% (n=33) of included articles contained some form of confusion between etiology and prediction. In the figure the journal impact factor is mapped against proportion of confusion per included journal. We can see a trend that as impact factors increase the amount of confusion decreases. In etiological studies, the most frequent (n=15) form of confusion was adjustment for variables based on predictive performance in the data, instead of known causal structure. The majority selected ‘confounders’ purely based on p-values and therefore potentially adjusted for intermediate variables, resulting in incorrect effect estimates. Another mistake in etiological studies (n=5) was the reporting of predictive performance measures such as the C-statistic for an etiological model. In prediction studies the most confusion occurred in the discussion (n=14). Seven studies interpreted predictors causally, for example by concluding that these predictors should be modified in order to improve patient outcomes. As the effect estimates of these studies do not account for confounding, this interpretation is invalid. Lastly, seven studies mention residual confounding as a limitation, which is only a problem in etiological research. Conclusion Confusion between etiology and prediction is a wide-spread methodological flaw in medical observational studies, particularly those published in lower impact clinical journals. As confusion may lead to erroneous conclusions, the distinction between causal and predictive research deserves more attention in medical research and scientific education.

Melanoma Risk in Patients Treated With Biologic Therapy for Common Inflammatory Diseases

Biologic therapies are widely prescribed immunomodulatory agents. There are concerns that compared with treatment with conventional systemic therapy, long-term biologic treatment for common immune-mediated inflammatory diseases, namely inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis, may be associated with increased risk of melanoma. To examine whether biologic treatment of IBD, RA, or psoriasis is associated with an increased risk of melanoma compared with conventional systemic therapy. Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles published from January 1, 1995, to February 7, 2019, for eligible studies. Randomized clinical trials, cohort studies, and nested case-control studies quantifying the risk of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with patients treated with conventional systemic therapy were included. Two reviewers independently extracted key study characteristics and outcomes. Study-specific risk estimates were pooled, and random- and fixed-effects model meta-analyses were conducted. Heterogeneity was assessed using the I2 statistic. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. The pooled relative risk (pRR) of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with biologic-naive patients treated with conventional systemic therapy. Seven cohort studies comprising 34 029 biologic-treated patients and 135 370 biologic-naive patients treated with conventional systemic therapy were eligible for inclusion. Biologic treatment was positively associated with melanoma in patients with IBD (pRR, 1.20; 95% CI, 0.60-2.40), RA (pRR, 1.20; 95% CI, 0.83-1.74), or psoriasis (hazard ratio, 1.57; 95% CI, 0.61-4.09) compared with those who received conventional systemic therapy, but the differences were not statistically significant. Adjustment for other risk factors was absent from most studies. The findings suggest that clinically important increases in melanoma risk in patients treated with biologic therapy for common inflammatory diseases cannot be ruled out based on current evidence. However, further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.

Costs and economic evaluations of Quality Improvement Collaboratives in healthcare: a systematic review

BackgroundIn increasingly constrained healthcare budgets worldwide, efforts to improve quality and reduce costs are vital. Quality Improvement Collaboratives (QICs) are often used in healthcare settings to implement proven clinical interventions within local and national programs. The cost of this method of implementation, however, is cited as a barrier to use. This systematic review aims to identify and describe studies reporting on costs and cost-effectiveness of QICs when used to implement clinical guidelines in healthcare.MethodsMultiple databases (CINAHL, MEDLINE, PsycINFO, EMBASE, EconLit and ProQuest) were searched for economic evaluations or cost studies of QICs in healthcare. Studies were included if they reported on economic evaluations or costs of QICs. Two authors independently reviewed citations and full text papers. Key characteristics of eligible studies were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Evers CHEC-List was used for full economic evaluations. Cost-effectiveness findings were interpreted through the Johanna Briggs Institute ‘three by three dominance matrix tool’ to guide conclusions. Currencies were converted to United States dollars for 2018 using OECD and World Bank databases.ResultsFew studies reported on costs or economic evaluations of QICs despite their use in healthcare. Eight studies across multiple healthcare settings in acute and long-term care, community addiction treatment and chronic disease management were included. Five were considered good quality and favoured the establishment of QICs as cost-effective implementation methods. The cost savings to the healthcare setting identified in these studies outweighed the cost of the collaborative itself.ConclusionsPotential cost savings to the health care system in both acute and chronic conditions may be possible by applying QICs at scale. However, variations in effectiveness, costs and elements of the method within studies, indicated that caution is needed. Consistent identification of costs and description of the elements applied in QICs would better inform decisions for their use and may reduce perceived barriers. Lack of studies with negative findings may have been due to publication bias. Future research should include economic evaluations with societal perspectives of costs and savings and the cost-effectiveness of elements of QICs.Trial registrationPROSPERO registration number: CRD42018107417.

Understanding and Quantifying the Scale-Up Penalty: a Systematic Review of Early Developmental Preventive Interventions with Criminological Outcomes

This article reviews the process of scaling up early developmental preventive interventions with criminological outcomes over the life-course, with a focus on quantifying the scale-up penalty. The scale-up penalty is an empirically based quantification of the amount of attenuation in the effects of interventions as they move from research and demonstration projects to large-scale delivery systems attempting to achieve population-level impacts. A systematic review was conducted, which included rigorous criteria for inclusion of studies, comprehensive search strategies to identify eligible studies, and a detailed protocol for coding key study characteristics and factors related to the scale-up penalty. A total of six studies met the inclusion criteria, originating in two countries (USA and Norway) and covering a 20-year period (1998 to 2017). Studies showed large variability in the scale-up penalty assigned, ranging from 0 to 50%, with one study reporting scale-up penalties from negative to 71%. A wide range of factors were considered in quantifying the scale-up penalty, including implementation context, heterogeneity in target populations, heterogeneity of service providers, and fidelity to the model. The most recent studies were more comprehensive in their consideration of factors influencing the scale-up penalty. It is important for program developers and policymakers to recognize and account for implementation challenges when scaling up early developmental preventive interventions. Further research in this area is needed to help mitigate attenuation of program effects and aid public investments in early developmental preventive interventions.

Patterns of incident genital human papillomavirus infection in women: A literature review and meta-analysis.

Human papillomavirus (HPV) infection acquisition is a necessary step in the development of cervical cancer. No study has systematically quantified the rate of newly acquired HPV infections from the published literature and determined its relationship with age. We performed a systematic review and meta-analysis to describe incident HPV infections in women. Medline® and Thomson Reuters Web of Science via PubMed® databases were searched. A total of 46 of 5136 studies met inclusion criteria and contributed results. We conducted a meta-regression analysis of 13 studies, which reported incidence rate estimates on over 13 high-risk HPV types, to provide pooled stratum-specific incidence rates and rate ratios for key population and study characteristics among 8488 women. Studies with mean age &lt; 30 years had relatively higher HPV incidence rates compared to studies with mean age ≥30 years: relative risk = 3.12; 95% CI: 1.41–6.93. HPV-16 was most frequently detected, followed by HPV-18: relative risk = 0.47; 95% CI: 0.33–0.67, and by HPV-58: relative risk = 0.45; 95% CI: 0.27–0.74. Younger age is a key predictor of genital HPV incidence in women. These data on the relative distribution of incident HPV infections will provide a baseline comparison for monitoring of changes in HPV incidence following the implementation of population-level HPV vaccination.

Obesity Prevention Worksite Wellness Interventions for Health Care Workers: A Narrative Review.

Background: Health care workers face elevated risk of obesity due to their unique work requirements. The purpose of this systematic review was to present a narrative summary of the characteristics and effectiveness of worksite wellness programs focusing on preventing obesity among health care workers. Method: The databases Medline, CINAHL, Embase, PsycINFO, and PubMed were searched. Experimental and quasi-experimental studies published in English (between 2000 and 2018) that (a) were worksite interventions, (b) had intervention directed toward health care employees, and (c) reported weight-related outcomes were included. We excluded commercial weight loss studies. Two coders extracted data on the following: purpose, key study characteristics, design, type and dosage of intervention, outcome measure(s), attrition rate, and risk of bias. Results: Of the 51 studies included in this review, the majority (75%, n = 38) targeted diet and physical activity behaviors. The majority reported improved weight outcomes in favor of the intervention. Overall, moderate- to high-intensity behavioral strategies, using any mode of intervention delivery (phone, face-to-face, or Internet), delivered by a trained professional were effective in improving weight-related outcomes. Environmental strategies were effective in improving healthier habits. Self-directed strategies worked better for motivated employees. Discussion: Multicomponent interventions offered in health care settings may be successful in improving employee weight. Across study designs, several gaps in the reporting of intervention design, dosage, fidelity, and system-level outcomes were found. Conclusion/Applying research to practice: Occupational health professionals should continue to be creative in developing multicomponent interventions (combining behavioral/educational, environmental, and organizational support) and use evidence guidance frameworks/tools to design an intervention and report dosage outcomes.