Epidemiological Meta-analyses Research Articles

Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses

ObjectiveTo evaluate the existing meta-analytic evidence of associations between exposure to ultra-processed foods, as defined by the Nova food classification system, and adverse health outcomes.DesignSystematic umbrella review of existing meta-analyses.Data...

Distributions of alcohol use and alcohol-caused death and disability in Canada: Defining alcohol harm density functions and new perspectives on the prevention paradox.

The aims of this study were to examine the distribution of alcohol use and to define 'harm density functions' representing distributions of alcohol-caused health harm in Canada, by sex, towards better understanding which groups of drinkers experience the highest aggregate harms. This was an epidemiological modeling study using survey and administrative data on alcohol exposure, death and disability and risk relationships from epidemiological meta-analyses. This work took place in Canada, 2019. Canadians aged 15 years or older participated. Measures included modeled life-time mean daily alcohol use in grams of pure alcohol (ethanol) per day, alcohol-caused deaths and alcohol-caused disability-adjusted life-years. As a life-time average, more than half of Canadians aged 15+ (62.8% females, 46.9% males) use fewer than 10g of pure alcohol per day (g/day). By volume, the top 10% of the population consume 45.9% of the total ethanol among males and 47.1% of the total ethanol among females. The remaining 90% of the population experience a slim majority of alcohol-caused deaths (males 55.3%, females 46.9%). Alcohol harm density functions compose the size of the using population and the risk experienced at each volume level to show that the population-level harm experienced is highest for males at 25 g/day and females at 13 g/day. Almost 50% of alcohol use in Canada is concentrated among the highest 10% of drinkers, but more than half of the alcohol-caused deaths in Canada in 2019 were experienced by the bottom 90% of the population by average volume, providing evidence for the prevention paradox. New alcohol harm density functions provide insight into the aggregate health harm experienced across the mean alcohol use spectrum and may therefore be used to help determine where alcohol policies should be targeted for highest efficacy.

Real-world effectiveness of the inactivated COVID-19 vaccines against variant of concerns: meta-analysis

BackgroundCOVID-19 has killed over 6 million people worldwide, making it the worst global health disaster since the 1918 influenza pandemic. Experts have worked to establish the source, track and analyse the disease, and produce treatment and preventative guidelines. Inactivated vaccines have little evidence of efficacy compared to mRNA and adenoviral vector vaccines; however, three doses of both mRNA and inactivated vaccines appear to provide significant and lasting protection against severe disease and mortality. This study examines inactivated vaccine effectiveness data by disease status, age, gender, primary immunisation, booster doses, and SARS-CoV2 virus types. MethodsWe conducted a quantitative epidemiological meta-analysis study to assess the vaccine effectiveness of inactivated COVID-19 vaccines. Data extraction was performed on the selected studies, and data analysis was conducted using a random-effects model to determine consolidated assessments of vaccine effectiveness. Subgroup analyses were conducted for gender, age, disease level, and vaccine status, and sensitivity analyses were conducted to assess the robustness of the results. ResultsThe overall effect size of inactivated COVID-19 vaccinations was statistically significant (p-value<0.05), suggesting that complete vaccination should be the primary method of vaccination. Partial vaccination was associated with lower levels of vaccine effectiveness (70.18 95% CI 57.33–83.02) than complete vaccination (79.52 95% CI 67.88–91.71)) and booster vaccination (84.22 95% CI 74.34–94.10), suggesting that it is essential to finish the recommended vaccine series and receive booster doses.Fig.–3: Partially vaccinated individuals showed a vaccine effect size of 70.18 (95% CI 57.33–83.02), indicating that the vaccine was moderately effective in preventing COVID-19 among this group. Fully vaccinated individuals showed a vaccine effect size of 79.52 (95% CI 67.88–91.71), indicating a higher level of vaccine effectiveness. Finally, booster-vaccinated individuals showed a vaccine effect size of 84.22 (95% CI 74.34–94.10), indicating the highest level of vaccine effectiveness. ConclusionInactivated COVID-19 vaccines are highly effective in preventing COVID-19, and complete vaccination and booster vaccination are associated with higher levels of vaccine effectiveness compared to partial vaccination. These findings highlight the importance of completing the recommended vaccine series and receiving booster doses to provide greater protection against COVID-19.

PATHMAP (Pathogen And Tree fruit Health MAP): A Smartphone App and Interactive Dashboard to Record and Map Tree Fruit Diseases, Disorders, and Insect Pests

PATHMAP (Pathogen And Tree fruit Health MAP) is a smartphone application (app) and interactive dashboard developed specifically for support specialists, extension personnel, and university scientists supporting the tree fruit industry. The PATHMAP app collects detailed information about observed diseases, insect pests, and disorders and provides the option to attach photos. The data are then visualized using a graphical interface dashboard displaying an interactive color-coded map. Prior to the development of PATHMAP, abundant tree fruit disorder data were collected each year, but a central interactive repository for archiving data and facilitating communication of field observations did not exist. PATHMAP has been beta tested by university extension personnel, private consultants, and university scientists to ensure usability and functionality. PATHMAP will be used within the tree fruit industry for monitoring known pest patterns, occurrences, and outbreaks of emerging pathogens. It will augment existing extension diagnosis listservs that have value in visual diagnosis but are cumbersome and have no archiving capabilities. Data obtained through the tool can be used in epidemiological meta-analyses and to develop new predictive models, and can serve as a platform to track emerging pathogens, insects, and disorders for a variety of cropping systems. [Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2022.

Nicotine products relative risk assessment: an updated systematic review and meta-analysis

Background: The nicotine products relative risk assessment estimates the relative risk of tobacco-related diseases due to use of 15 nicotine products. This update adds new data to the original analysis and creates separate categories for United States and rest of world varieties of smokeless tobacco, as well as bidi cigarettes. Methods: The PubMed®, MEDLINE and Clinicaltrials.gov databases were searched systematically. The study lists were exported, screened at the title, abstract and full-text level according to pre-defined inclusion/exclusion criteria. The study quality was assessed, and risk of bias was accounted for in the screening criteria. The extracted data was synthesized into a toxin emissions/content analysis for 12 Group 1 carcinogens, used to estimate lifetime cancer risk, and epidemiological meta-analysis of over 40 tobacco-related diseases. The two analyses were integrated into a combined risk score for each nicotine product, weighted by the risk of bias due to missing data, and incorporated into the relative risk spectrum. Results: In this update, 70 new studies were added to the synthesis, making a total of 123 studies included. All combustible tobacco products score between 40 and 100, with bidis and smokeless (rest of world) also in this range. All other products have a combined risk score of 10 or less, including U.S. chewing tobacco, U.S. dipping tobacco, snus, heat-not-burn tobacco, electronic cigarettes, non-tobacco pouches and nicotine replacement therapy. Discussion: Consistent with previous studies, we define a group of high-risk nicotine products, scoring between 40 and 100 on the spectrum, and reduced risk nicotine products, scoring less than 10. Limitations of this study include the potential for bias due to missing data, the heterogeneity of the data included in the relative risk hierarchy synthesis, and the assumed consumption levels.

The effects of cannabis and alcohol on driving performance and driver behaviour: a systematic review and meta-analysis.

Cannabis and alcohol are frequently detected in fatal and injury motor vehicle crashes. While epidemiological meta-analyses of cannabis and alcohol have found associations with an increase in crash risk, convergent evidence from driving performance measures is insufficiently quantitatively characterized. Our objectives were to quantify the magnitude of the effect of cannabis and alcohol-alone and in combination-on driving performance and behaviour. Systematic review and meta-analysis. We systematically searched Academic Search Complete, CINAHL, Embase, Scopus, Google Scholar, MEDLINE, PsycINFO, SPORTDiscus and TRID. Of the 616 studies that underwent full-text review, this meta-analysis represents 57 studies and 1725 participants. We extracted data for hazard response time, lateral position variability, lane deviations or excursions, time out of lane, driving speed, driving speed variability, speed violations, time speeding, headway, headway variability and crashes from experimental driving studies (i.e. driving simulator, closed-course, on-road) involving cannabis and/or alcohol administration. We reported meta-analyses of effect sizes using Hedges' g and r. Cannabis alone was associated with impaired lateral control [e.g. g = 0.331, 95% confidence interval (CI) = 0.212-0.451 for lateral position variability; g = 0.198, 95% CI = 0.001-0.395 for lane excursions) and decreased driving speed (g = -0.176, 95% CI = -0.298 to -0.053]. The combination of cannabis and alcohol was associated with greater driving performance decrements than either drug in isolation [e.g. g = 0.480, 95% CI = 0.096-0.865 for lateral position variability (combination versus alcohol); g = 0.525, 95% CI = 0.049-1.002 for time out of lane (versus alcohol); g = 0.336, 95% CI = 0.036-0.636 for lateral position variability (combination versus cannabis; g = 0.475, 95% CI = 0.002-0.949 for time out of lane (combination versus cannabis)]. Subgroup analyses indicated that the effects of cannabis on driving performance measures were similar to low blood alcohol concentrations. A scarcity of data and study heterogeneity limited the interpretation of some measures. This meta-analysis indicates that cannabis, like alcohol, impairs driving, and the combination of the two drugs is more detrimental to driving performance than either in isolation.

Risk of prevalence of latent tuberculosis infection in health care workers-an idiographic meta-analysis from a Chinese perspective.

BackgroundChina is one of the countries sharing the major burden of tuberculosis (TB) in the world. Health care workers (HCWs) are subject to a high risk of occupational latent tuberculosis infection (LTBI)—an asymptomatic state of TB disease. However, the heterogenic composition of healthcare professionals in terms of nature of their work leads to the inconsistency in predicting the prevalence of LTBI amongst them. Furthermore, the global statistics do not account for the analysis conducted within the Chinese population. Our study reflects a systemic and epidemiological meta-analysis to investigate the risk of contracting LTBI by the HCWs of China.MethodsA systematic review of the literature was performed to identify studies reporting LTBI prevalence or incidence among HCWs and a control groups in China. Risk of infection, as well as subgroup analysis was calculated by pooled effect estimates. Review Manager 5.0 was used to perform the meta-analyses.ResultsTwenty studies containing 9,654 HCWs met the inclusion criteria. The average prevalence of LTBI among HCWs was 51.5%, ranging from 27.9–88.8%. HCWs had a higher risk of prevalence of LTBI than the control groups [odds ratio (OR), 1.78, 95% confidence interval (CI), 1.46–2.16]. In the subgroup analysis, the prevalence of LTBI in HCWs with respect to the control groups was observed to be highest in Eastern China (OR, 2.05; 95% CI, 1.35–3.11). Furthermore, the pooled OR for LTBI was 1.90 and 1.65 separately from the results of the tuberculin skin test (TST) and the interferon-gamma release assay. Lastly, upon comparing the HCWs with the control groups from the community and the nosocomial source, it was observed that the pooled OR favored for the prevalence of LTBI, which was primarily community-sourced (3.12 and 1.54). HCWs had an increased risk of prevalence of LTBI than the control groups, both in general hospitals and TB specific hospitals (pooled OR 2.4 and 1.57).ConclusionsRisk of LTBI infection among HCWs is relatively high in China, especially in the eastern region, predisposed by the cumulative exposure to Mycobacterium tuberculosis from the community and the general hospitals. Overall, our data reflects an alarming risk posed to our HCWs, and calls for immediate reforms at the policy levels, so as to implement effective screening and treatment of affected HCWs in China.

Nature and Well-Being: Estimating the Effects of Exposure to Green Space on Health Disparities across Washington, DC

Background: Expanding green space can help mitigate climate change and improve public health in urban settings. Epidemiological meta-analyses have demonstrated that increased exposure to green space improves health outcomes by increasing physical activity, improving mental health, and decreasing all-cause mortality. Washington, DC, has a large degree of environmental and health inequality, with life expectancy by neighborhood ranging from 68.2 to 89.3 years, for example.The objective of this study is to assess current neighborhood-level disparities in exposure to green space, as well as the differences in associated health impacts, across Washington, DC.Methods: We utilize green space databases and communication with governmental agencies to estimate exposure to green space across DC neighborhoods. We estimate associated health impacts using exposure-response relationships from epidemiological meta-analyses, and life expectancy and physical activity, mapped by statistical-neighborhood in the 2018 DC Health Equity Report.Results: Preliminary results suggest that the effect of green space exposure on all-cause mortality in DC is consistent with meta-analysis studies’ exposure-response relationship: pooled hazard ratio of all-cause mortality is 0.96 (95% CI 0.94-0.97) for each increment of 0.1 NDVI in residential buffer zones. Quantitative estimates of the degree of population exposure to green space and associated health impacts across DC neighborhoods will be determined and presented in the following months.Conclusion: Understanding the health benefits of exposure to green space in cities will help policymakers understand the local improvements in public health and health inequality that can be achieved via urban sustainability planning. Results of our study will help integrate the health impacts of green space into urban climate action planning at the local scale through Sustainable DC and the DC Office of Health Equity, as well as through international agencies like C40 Cities.

Using satellite remote sensing to estimate intra-urban disparities in air pollution health impacts in Washington DC

Background: Ambient air pollution in cities is of growing concern as urbanization and economic development continue, yet many cities lack information on local exposure levels and health impacts, both of which are needed to make evidence-based mitigation decisions. Remote sensing and Earth system models, though widely used for assessing air pollution health impacts globally, could be of particular value for targeted assessment of air pollution exposures and health impacts in cities where there is high population density but sparse ground-based monitoring stations.Methods: We used high resolution data inputs to assess intra-urban heterogeneity in PM2.5-attributable health impacts between 2000 and 2015, using Washington DC as a case study. Data inputs included ~1km x 1km satellite-derived global population and PM2.5 estimates; neighborhood-scale, age-standardized baseline disease rates from the DC Department of Health (DOH) and the CDC 500 Cities project; and PM2.5 concentration-response functions for chronic obstructive pulmonary disease, lung cancer, stroke and asthma emergency department visits from epidemiological meta-analyses. We also compare the spatial distribution estimated using rates obtained from the DOH versus a modeling approach used by the CDC 500 Cities projectResults: Results suggest that although PM2.5 concentrations have been decreasing in DC over time, the associated health burden continues to be unevenly distributed across the city, affecting mostly the neighborhoods with high proportions of vulnerable populations. These results support the findings from the Health Equity Report for the District of Columbia 2018, which suggests that there is a high degree of environmental and health inequality within the city.Conclusions: Urban-scale health impact assessments could help inform city-specific air pollution mitigation strategies aimed at protecting the public and reducing health disparities within the city. This case study for Washington, DC, can provide a model for estimating intra-urban air pollution-attributable health risks in other cities in the U.S. and worldwide.

Severe fever with thrombocytopenia syndrome: a systematic review and meta-analysis of epidemiology, clinical signs, routine laboratory diagnosis, risk factors, and outcomes

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with the high case-fatality rate, and lack of vaccines. We aimed to systematically analysed the epidemiological characteristics, clinical signs, routine laboratory diagnosis, risk factors, and outcomes.MethodsDocuments on SFTS were collected by searching the Chinese National Knowledge Infrastructure, Wan Fang Data, PubMed, Embase, and Web of Science databases from 2011 to 2018. Meta-analysis was performed by using Review Manager and Stata software.ResultsTwenty-five articles involving 4143 cases were included. Diarrhea (odds ratio (OR) =1.60, 95% confidence interval (CI): 1.06 to 2.42, P = 0.02), and vomiting (OR = 1.56, 95% CI: 1.01 to 2.39, P = 0.04) on admission were associated with the fatal outcomes of SFTS. Compared to patients with mild symptoms, patients with severe symptoms had significantly elevated levels of lactic acid dehydrogenase (standard mean difference (SMD) =1.27, 95% CI: 0.59 to 1.94), alanine aminotransferase (SMD = 0.55, 95% CI: 0.24 to 0.85), aspirate aminotransferase (SMD = 1.01, 95% CI: 0.69 to 1.32), and creatine kinase (SMD = 1.04, 95% CI: 0.74 to 1.33) but had reduced platelet counts (SMD = -0.87, 95% CI: − 1.16 to − 0.58) and albumin levels (SMD = -1.00, 95% CI: − 1.32 to − 0.68). The risk factors for poor prognosis included age (mean difference (MD) =6.88, 95% CI: 5.41 to 8.35) and farming (OR = 2.01, 95% CI: 1.06 to 3.80). For the risk factors of contracting SFTS, the incidence of SFTS related to tick bites was 24% [95% CI: 0.18 to 0.31]. The pooled case-fatality rate of SFTS patients was 18% [95% CI: 0.16 to 0.21].ConclusionsChina is the country with the highest incidence of SFTS. May to July was the peak of the epidemic, and farmers were a high-risk group. The risk factor for SFTS included age (poor prognosis) and tick bites (contracting SFTS). Patients with severe diarrhea and vomiting symptoms on admission should be noted. Clinicians could use routine laboratory parameters and clinical symptoms as references for clinically suspected cases, classification of SFTS, and timely treatment, especially in basic hospitals.

Genome-wide association and epidemiological analyses reveal common genetic origins between uterine leiomyomata and endometriosis

Uterine leiomyomata (UL) are the most common neoplasms of the female reproductive tract and primary cause for hysterectomy, leading to considerable morbidity and high economic burden. Here we conduct a GWAS meta-analysis in 35,474 cases and 267,505 female controls of European ancestry, identifying eight novel genome-wide significant (P < 5 × 10−8) loci, in addition to confirming 21 previously reported loci, including multiple independent signals at 10 loci. Phenotypic stratification of UL by heavy menstrual bleeding in 3409 cases and 199,171 female controls reveals genome-wide significant associations at three of the 29 UL loci: 5p15.33 (TERT), 5q35.2 (FGFR4) and 11q22.3 (ATM). Four loci identified in the meta-analysis are also associated with endometriosis risk; an epidemiological meta-analysis across 402,868 women suggests at least a doubling of risk for UL diagnosis among those with a history of endometriosis. These findings increase our understanding of genetic contribution and biology underlying UL development, and suggest overlapping genetic origins with endometriosis.

"Side Effects" Observed Within ~1-90 Days After Cannabis Onset: Epidemiological Estimates for the United States, 2004-2014.

Among newly incident cannabis users, fewer than 4% develop cannabis dependence syndromes within 12 to 24 months, but earlier cannabis side effect (SE) incidence and early syndrome formation remains understudied. We estimate cannabis SE incidence within ~1 to 90 days after first use, and estimate odds ratios (OR) for SE pairs to quantify potential syndromic "running together." Each year, 2004 to 2014, the US populations under study consisted of noninstitutionalized civilian residents age 12-years-and-older, sampled for National Surveys on Drug Use and Health. Computerized self-interviews identified 3710 newly incident cannabis users and asked about SEs. Analysis-weighted year-specific SE and SE-SE pair incidence proportions were estimated. Analysis-weighted odds ratio (OR) estimates quantify SE-SE co-occurrences, judged as "greater than chance" when lower bounds (LB) of 95% confidence intervals (CIs) exceed 1.0. Meta-analysis is used to summarize and to check reproducibility. Illustrative of estimates on 17 SEs, roughly 1/2 of cannabis initiates experienced "wanting or trying to cut down or stop using," but 80% of these cut back, such that less than 7% had symptom-like inability to cut back or stop. An estimated 25% had "spent a lot of time getting or using cannabis." The SE-SE paired estimate is 2.8% for those who had spent a lot of time and also had wanted/tried to cut down (95% CI = 2.0, 4.0). OR estimation suggests no syndromic co-occurrence of this SE-SE pair (OR = 0.9; 95% CI = 0.5, 1.6). In contrast, "cannabis causing serious problems at home/work/school" and "continuing to use despite physical problems" were more rare, but had strong SE-SE co-occurrence (OR = 14.8, LB = 2.4). For 78 of 136 possible SE-SE pairs, meta-analysis LB estimates exceeded the 1.0 threshold. In these US community samples of cannabis initiates studied soon after first use, the vast majority were free of individual SE experiences counted toward Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition cannabis use disorder diagnoses. For a minority, SE-SE pairs might indicate syndrome formation. These epidemiological meta-analysis estimates might find use in refinement of clinical practice guidelines for fast effective syndrome screens when primary care patients are seen soon after cannabis onset, akin to clinical screening guides designed for newly incident drinkers (Am J Addict 2019;00:1-9).

A Systematic Review and Meta-Analysis of Epidemiology of Risky Sexual Behaviors in College and University Students in Ethiopia, 2018.

Background Risk of sexual ill-health occurs with the onset of unsafe sexual activity, mostly among the adolescents, and continues as long as the risky activities are engaged in. Globally, and in Africa, adolescent AIDS-related mortality among adolescents has been increasing. Therefore, a systematic review and meta-analysis of epidemiology of risky sexual behaviors in college and university students in Ethiopia is mandatory. Methods We conducted extensive search of articles as indicated in the guideline of reporting systematic review and meta-analysis (PRISMA). Databases such as PubMed, Global Health, Africa-wides, Google advance search, Scopus, and EMBASE were accessed for literature search. The pooled estimated effect of epidemiology of risky sexual behaviors and associated factors were analyzed by using the random effects model meta-analysis and 95% CI was also considered. PROSPERO registration number is CRD42018109277. Result A total of 18 studies with 10,218 participants were encompassed in this meta-analysis. The estimated pooled prevalence of risky sexual behaviors among college and university students was 41.62%. Being male [OR: 2.35, with 95% (CI; 1.20, 4.59)], alcohol use [OR: 2.68, with 95% CI; (1.67, 4.33)] and watching pornography [OR: 4.74, with 95% CI; (3.21, 7.00)] were positively associated with risky sexual behaviors. Conclusion and recommendation Risky sexual behavior among students was high. Educational institutions should give special attention for male sex, alcohol user, and students who watch pornography.

The reliability of an environmental epidemiology meta-analysis, a case study

Claims made in science papers are coming under increased scrutiny with many claims failing to replicate. Meta-analyses are questionable when based on data from observational studies which are often unreliable. We examine the reliability of the base studies used in an air quality/heart attack meta-analysis and the resulting meta-analysis. A meta-analysis study that includes 14 observational air quality/heart attack studies is examined for its statistical reliability. We use simple counting to evaluate the reliability of the base papers and a p-value plot of the p-values from the base studies to examine study heterogeneity. We find that the base papers have the potential for massive multiple testing and multiple modeling with no statistical adjustments. Statistics coming from the base papers are not guaranteed to be unbiased, a requirement for a valid meta-analysis. There is study heterogeneity for the base papers with strong evidence for so called p-hacking in some, possibly many, of the studies. We make two observations: there are many claims at issue in each of the 14 base studies so uncorrected multiple testing is a serious issue. We find that some of the base papers exhibit the characteristics of p-hacking and are therefore not reliable; the resulting meta-analysis is not reliable.

Estimates of the Global Burden of Ambient [Formula: see text], Ozone, and [Formula: see text] on Asthma Incidence and Emergency Room Visits.

Background:Asthma is the most prevalent chronic respiratory disease worldwide, affecting 358 million people in 2015. Ambient air pollution exacerbates asthma among populations around the world and may also contribute to new-onset asthma.Objectives:We aimed to estimate the number of asthma emergency room visits and new onset asthma cases globally attributable to fine particulate matter (), ozone, and nitrogen dioxide () concentrations.Methods:We used epidemiological health impact functions combined with data describing population, baseline asthma incidence and prevalence, and pollutant concentrations. We constructed a new dataset of national and regional emergency room visit rates among people with asthma using published survey data.Results:We estimated that 9–23 million and 5–10 million annual asthma emergency room visits globally in 2015 could be attributable to ozone and , respectively, representing 8–20% and 4–9% of the annual number of global visits, respectively. The range reflects the application of central risk estimates from different epidemiological meta-analyses. Anthropogenic emissions were responsible for and 73% of ozone and impacts, respectively. Remaining impacts were attributable to naturally occurring ozone precursor emissions (e.g., from vegetation, lightning) and (e.g., dust, sea salt), though several of these sources are also influenced by humans. The largest impacts were estimated in China and India.Conclusions:These findings estimate the magnitude of the global asthma burden that could be avoided by reducing ambient air pollution. We also identified key uncertainties and data limitations to be addressed to enable refined estimation. https://doi.org/10.1289/EHP3766

A systematic review and meta-analysis of epidemiology of depression in people living with HIV in east Africa

BackgroundDepression is the most prevalent psychiatric disorder among people living with HIV (PLWHIV) and is associated with poor quality of life, additional comorbidities, disability, unemployment, poorer therapeutic outcomes and risky behaviors. The present systematic review and meta-analysis aims to systematically summarize empirical evidence and to formulate recommendations for future research.MethodsWe searched PubMed, EMBASE, SCOPUS, and relevant literature for possible studies to include. A qualitative and quantitative analysis was undertaken for this systematic review. Subgroup and sensitivity analysis were performed. Cochran's Q- and the I2 test were used to assess heterogeneity. The presence of publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots.ResultsOf 283 titles initially identified, 81 abstracts were eligible for review. Of these, 46 articles qualified for full text review and 19 were retained. In our meta-analysis the pooled prevalence of depression in PLWHIV was 38% (95% CI 29.30-47.54). The pooled prevalence estimates of depression was 49.79% in Ethiopia and 30.88% in Uganda. In addition, the prevalence of depression was 12.40% and 46% as measured by diagnostic and screening instrument respectively. Our qualitative synthesis showed that factors such as having opportunistic infection, perceived stigma, negative life event, WHO clinical staging of disease, hospitalization in the past one month, stressful life events, food insecurity, self-efficacy, missed frequency of clinic visit, frequency of follow-up, older age, low income, urban residence and being government employee were strongly and significantly associated with depression in PLWHIV in east Africa.ConclusionThe pooled prevalence estimates of prevalence of depression in PLWHIV was 38%. The prevalence estimates of depression in PLWHIV in Ethiopia was significantly higher than Uganda. In addition the prevalence of depression was significantly higher in studies conducted by screening than diagnostic instrument. Routine screening and integrated management of depression into the existing HIV care services is warranted. Validation and use of standard instrument to assess depression in PLWHIV is needed. Moreover, longitudinal and community based studies focusing on incidence and determinates of depression in PLWHIV are recommended.

Gastrocutaneous fistulae in children - A systematic review and meta-analysis of epidemiology and treatment options.

Gastrostomy tubes are a common adjunct to the care of vulnerable pediatric patients. This study systematically evaluates the epidemiology and risk-factors for gastrocutaneous fistulae (GCF) after gastrostomy removal in children and reviews treatment options focusing on nonoperative management (NOM). After protocol registration (CRD-42017059565), multiple databases were searched. Studies describing epidemiology in children and GCF treatment at any age were included. Critical appraisal was performed (MINORS risk-of-bias assessment tool). One-sided meta-analysis was executed to estimate efficacy of therapeutic adjuncts using a random-effects model. Sixteen articles evaluating pediatric GCF were identified. 44% defined GCF as persistence >1month which occurred in 31±7% of cases. Risk factors for pediatric GCF include age at gastrostomy, timing of removal, open technique, and fundoplication. Mean MINORS score was 0.60±0.16. Seventeen additional studies were identified reporting 142 patients undergoing NOM (endoscopic, systemic, and local therapies), and one pediatric comparative study was identified. Overall aggregate proportion of GCF closure after any NOM is 77% (80% success rate in local/systemic therapies; 75% success rate in endoscopic approaches). No adverse events were reported. Persistent GCF complicates the management of gastrostomies in 1/3 of children with predictable risk factors. Several treatment options exist that obviate the need for general anesthesia. Their efficacy is unclear. Further prospective investigations are clearly warranted. III - Systematic Review and Meta-Analysis Based on Retrospective Case Control Studies.

A Systematic Review and Meta-Analysis of Epidemiology and Clinical Manifestations of Human Brucellosis in China.

Background. Brucellosis has a wide spectrum of clinical manifestations and it may last several days or even several years; however, it is often misdiagnosed and therefore may cause inadequate therapy and prolonged illness. Previous studies about meta-analysis of manifestations of brucellosis reported in English lacked the data published in Chinese, which did not provide details about the contact history, laboratory tests, and misdiagnosis. We undertake a meta-analysis of clinical manifestations of human brucellosis in China to identify those gaps in the literature. We have searched published articles in electronic databases up to December 2016 identified as relating to clinical features of human brucellosis in China. 68 studies were included in the analysis. The main clinical manifestations were fever, fatigue, arthralgia, and muscle pain (87%, 63%, 62%, and 56%, resp.). There are significant differences between adults and children. Rash, respiratory and cardiac complications, and orchitis/epididymitis were more prevalent in children patients. The common complications of brucellosis were hepatitis, followed by osteoarthritis, respiratory diseases, cardiovascular diseases, central nervous system dysfunction, hemophagocytic syndrome, and orchitis/epididymitis in male. In the nonpastoral areas, brucellosis has a high ratio of misdiagnosis. Our analysis provides further evidence for the accurate diagnosis, particularly in assessing severe, debilitating sequelae of this infection.

Conversion between noise exposure indicators Leq24h, LDay, LEvening, LNight, Ldn and Lden: Principles and practical guidance.

This article presents empirically derived conversion rules between the environmental noise exposure metrics Leq24h, LDay, LEvening, LNight, Ldn, and Lden for the noise sources road, rail and air traffic. It caters to researchers that need to estimate the value of one (unknown) noise metric from the value of another (known) metric, e.g. in the scope of epidemiological meta-analyses or systematic reviews, when results from different studies are pooled and need to be related to one common exposure metric. Conversion terms are derived using two empirical methods a) based on analyzing the diurnal variation of traffic, and b) by analyzing differences between calculated noise exposure metrics. For a) we collected and analyzed diurnal traffic share data from European and US airports as well as data on the diurnal variation of traffic from roads in several European countries and from railway lines in Switzerland which were derived from counting stations and official records. For b) we calculated differences between noise metrics in over 50'000 stratified randomly sampled dwellings in Switzerland. As a result of this exercise, conversion terms, including uncertainty estimates, are systematically tabulated for all variants of the target metrics. Guidance as to the practical applicability of the proposed conversions in different contexts is provided, and limitations of their use are discussed.

The Health Systems Barriers and Facilitators for RHD Prevalence: An Epidemiological Meta-Analysis From Uganda and Tanzania.

Rheumatic heart disease (RHD) is an important and preventable cause of cardiovascular disease. As part of a recent RHD initiative in Uganda and Tanzania, we systematically reviewed group A streptococcal disease (GAS), acute rheumatic fever (ARF), and RHD in these countries. Using a systematic review and meta-analysis/meta-synthesis, we searched PubMed, Embase, and grey literature for quantitative and qualitative studies conducted in Uganda and Tanzania that included individuals affected by GAS, ARF, and RHD. We pre-specified 3 sets of outcomes: 1) disease epidemiology; 2) barriers and facilitators to health care; and 3) stakeholder identification and engagement. Study descriptors, outcomes, and interest, and quality assessments were recorded. For the first objective, we conducted random-effects meta-analyses. For the second objective, we produced a narrative synthesis of themes. No studies contained data on the third objective. Of 293 records identified, 12 met our inclusion criteria (9 for objective 1 and 3 for objective 2). Most quantitative studies were at moderate or high risk of bias, and only 1 of 2 qualitative studies was high quality. We estimated the prevalence of RHD to be 17.9 (95% confidence interval [CI]: 4.0 to 41.2) per 1,000 individuals. The most frequent nonfatal sequelae were heart failure, pulmonary hypertension, and atrial fibrillation. Case-fatality rates in medical and surgical wards were 17% (95% CI: 13% to 21%) and 27% (95% CI: 18% to 36%), respectively. Barriers and facilitators to GAS and RHD care were identified in the domains of individual knowledge, family support, provider communication and knowledge, and system design. RHD remains endemic in Tanzania and Uganda, and symptomatic RHD is associated with high rates of morbidity and mortality. We have identified critical data gaps in the areas of GAS and ARF epidemiology as well as health care utilization patterns and their determinants.