Quantitative Observational Studies Research Articles

Resilience and mental health among perinatal women: a systematic review.

This review aimed to assess the current evidence on the relationship between resilience and mental health employed in response to the impacts of mental health. This review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA). The protocol of this review was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023470966). Three authors searched peer-reviewed articles using several electronic databases, including Scopus, PubMed/MEDLINE, Psych Info, EMBASE, and Web of Science, from September to October 2023 and included all the studies from any time until November 1, 2023. The review included all eligible quantitative observational and qualitative studies, irrespective of geographical boundaries. Depression, anxiety, and post-traumatic stress disorders were found to be the most common, but not the only, mental health disorders during the perinatal period, and higher maternal resilience during perinatal periods was found to reduce mental health disorders. It was also found that pregnant women were more resilient to mental health disorders than postpartum women. Tolerance of uncertainty and a positive cognitive appraisal, women's self-behavior and family functioning, and protective psychosocial resources such as dispositional optimism, parental sense of mastery, self-esteem, gratitude, and forgiveness were found to be the most common mechanisms of resilience among perinatal women. Older age, having an adolescent partner, family income, and distress were found to affect resilience. Noting that women's resilience is an important tool to prevent perinatal mental health disorders, maternal healthcare providers need to counsel perinatal women on resilience-boosting mechanisms, such as applying self-behavior and having social support or close family relationships. It is recommended to counsel or provide psychosocial interventions for the woman's companion or partner to give strong support for the woman in each of the perinatal periods. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=470966, identifier CRD42023470966.

Empowering Vulnerable Populations through Technology: Innovations and Challenges in Social Work

Purpose: This study aims to explore the efficacy of integrating digital solutions and technological aids in social work practices, specifically for assisting vulnerable populations. It investigates the historical and current relevance of technology in social work, with a focus on overcoming the digital divide that restricts access for these groups. Methodology: Utilizing a mixed-methods approach, this research combines qualitative and quantitative methodologies, including surveys, interviews, and observational studies, to examine the advantages and limitations of digital interventions like telehealth platforms compared to traditional face-to-face services. Additionally, it delves into the potential of Artificial Intelligence (AI) and related technologies to foster independence among vulnerable populations. Findings: The study reveals that while digital solutions offer significant benefits, including increased accessibility and potential for personalization through AI, they also present challenges, notably the digital divide due to economic, cognitive, and socio-cultural barriers. It suggests that hybrid models incorporating both digital and traditional methods could enhance social work practices. The research underscores the importance of addressing ethical considerations in the deployment of AI technologies. Originality: This research contributes original insights into the integration of technology within social work, highlighting the complexities of the digital divide and proposing a strategic framework for incorporating technological aids. It offers a foundational understanding of how digital tools can complement traditional social work practices, ensuring ethical considerations are prioritized. Furthermore, it opens avenues for future research on the dynamic interplay between technology and social work, aiming for a more inclusive and effective approach to supporting vulnerable populations.

Return to work after ischaemic stroke in young adults: a scoping review.

The aim of the study was to synthesize the body of knowledge on the factors that are important to the process of returning to work after ischaemic stroke in young adults under 55 years of age. Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA checklist for scoping reviews were used. A total of 2,249 studies were identified through a bibliographic search in six databases. A total of ten studies were finally selected to respond to the research questions. Eight studies were quantitative observational studies, and two studies had a case study design. The rate of returning to work varied between the studies. The frequency of returning to work in young stroke patients, independent of the time of assessment, ranged from 42.4% to 86%. Returning to work after ischaemic stroke in young adults is a complex process and multidimensional problem which is affected by clinical variables (level of neurological deficits, cognitive ability, independency in activities of daily living, fatigue and depression, cardiovascular factors), as well as the socioeconomic and occupational status. There is insufficient evidence concerning interventions promoting return to work. Future studies should focus on examining effective interventions to help young stroke survivors return to work.

Incidence, contributing factors and outcomes of birth injury among newborns in Africa: a systematic review of quantitative evidence protocol

IntroductionBirth injury is a significant public health problem in Africa, with a high incidence and associated mortality and morbidity. Systematic reviews that indicate the incidence, contributing factors and outcomes of...

Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has taken the lives of millions and disrupted countless more worldwide. Simply living through the pandemic has had drastic effects on the health of citizens. Diet, an important aspect of health, has been uniquely affected by the pandemic, although these changes have not been sufficiently studied among youth. ObjectivesThe objective of this systematic review was to investigate dietary changes of youth during COVID-19. MethodsA prespecified literature review was conducted using MEDLINE, EMBASE, Scopus, and CINAHL to identify studies from January 2020 to May 2023 that assessed dietary changes among youth aged ≤20 y compared with before the pandemic. Only quantitative observational studies that were published in English were included. Two authors completed all screening/study selection independently, with disagreements being resolved via discussion. Data extraction was completed by 1 author. Dietary changes were categorized into food groups and habits for analysis purposes. ResultsIn total, 67 studies met inclusion criteria. Most studies used recall to assess changes (48/67; 71.6%). Most studies found an increase in fruits and vegetables (24/46; 52.2%), grain products (6/11; 54.5%), meat, poultry, and eggs (4/8, 50.0%), diet quality indices and/or overall dietary assessments (7/13, 53.8%), and the frequency of snacking (9/12; 75.0%), whereas generally finding a decrease in ultraprocessed foods (32/53; 60.4%), compared with before the COVID-19 pandemic. Mixed findings or primarily no changes were found for fish and aquatic products, legumes, beans, seeds and nuts, milk and milk products, breakfast consumption, and nutrient intake. ConclusionsMostly favorable dietary changes appear to have occurred among youth during COVID-19, although there were several mixed findings and unclear takeaways among the foods and habits under study. The heterogeneity of defining food groups was a noted limitation in the current review.

A systematic review of risk factors associated with road traffic crashes and injuries among commercial motorcycle drivers

To effectively reduce road traffic crashes (RTCs) and injuries interventions should be based on firm evidence regarding risk factors of RTCs and injuries in that specific population. Therefore, we undertook a systematic review to determine risk factors of RTCs and injuries among commercial motorcycle drivers. Searches were performed from inception to May 2022 in Medline, Embase, Cochrane Library, Web of Science Core Collection, PsycINFO and Cinahl, along with registers and reference lists. Inclusion criteria were commercial motorcycle drivers, quantitative observational studies, and RTCs and injuries. The search resulted in 1546 articles, of which 20 met the relevance and quality criteria. Of the 20 articles, 17 were cross-sectional, 2 were case-control studies, and one was a cohort study. Close to half of all articles (9) came from sub-Saharan Africa. Risk factors with consistent association with RTCs and injuries were young age, low education level, alcohol consumption, speeding, mobile phone use, non-helmet use, risky driving behaviours and long working hours. There was inconclusive evidence for driver’s training, work schedules, motorcycle ownership, experience, dependents number, and marital status. More robust designs such as case-control or longitudinal studies are required to gain a comprehensive understanding of the antecedents of RTCs among commercial motorcycle drivers.

The aetiology of maxillofacial trauma in Australia: A scoping review.

The oral and maxillofacial complex is subject to a range of traumas. Injuries to the region are devastating and have a great impact on social health outcomes. This review intends to investigate the aetiologies of maxillofacial trauma across Australia. This review was written in accordance with the PRISMA-ScR. Comprehensive searches of CINAHL, MEDLINE, Ovid, Scopus, and Web of Science databases were conducted to identify potentially relevant literature. Quantitative observational epidemiological studies were sought and were required to include at least one aetiology to the maxillofacial region in their data set. A total of 31 eligible studies were included. The greatest recorded causes of maxillofacial injuries included inter-personal violence (34.98%) falls (20.87%), sports (15.62%), and motor-vehicle accidents (14.31%). These four aetiologies cumulatively accounted for more than 85% of maxillofacial injuries. From all sustained injuries (n = 7661), the orbit was the most prevalent site of fracture (31.85%), followed by the zygoma (22.01%), mandible (21%), nasal bone (12.45%), maxilla (10.04%), dentoalveolus (1.84%), antrum (<1%), and frontal bone (<1%). Violence was an unprecedented cause of trauma-additional research is recommended to further characterize the correlation between the two variables. Research is also recommended specifically in regional/rural communities, where data was particularly limited. © 2024 Australian Dental Association.

The Moderating Effects of Smart Phone Addiction on the Relationship between Life Satisfaction, Sleep Quality and Academic Achievement among College Students: A Systematic Review

This systematic review investigated the intricate dynamics between smartphone addiction and the well-being of college students, specifically examining its moderating effects on the relationships between life satisfaction, sleep quality, and academic achievement. This review further strengthens the evidence presented in previous studies that emphasize the negative influence of excessive smartphone usage on sleep quality and academic performance. The study employed quantitative observational studies that were obtained from five databases. During the selection process, PRISMA guidelines were followed, and the study incorporated studies from various countries globally, all of which were in English. The studies enrolled 31678 people, with females ranging from 33.1% to 75.5%; studies quality ranged from low to moderate. The results show that life satisfaction is positively associated with perceived academic achievement and also sleep quality is positively associated with the initial level of pre-sleep cognitive arousal, which hence leads to good academic performance. In contrast, Smartphone addiction was positively associated with daytime sleepiness and school disengagement while also negatively associated with Grade Point Average (GPA). Therefore, this study shows excessive use of smartphones among the youth, which in correlation affects the relationship between their life satisfaction, sleep quality and academic achievement. An extensive amount of studies needs to be done on smartphone addiction so that better plans can be made for preventive measures.

Dentists' attitudes and practices toward evidence-based dentistry: a systematic review.

Considering that attitudes toward evidence-based dentistry (EBD) may predict implementation behaviors, the objective of this systematic review was to synthesize and evaluate the existing evidence related to dentists' attitudes and practices toward EBD. We included primary studies that collected information from interviews, questionnaires, or conversation sessions with dentists. The following sources were searched: Cochrane Central Register of Controlled Trials, Embase, PubMed, Scopus, and Web of Science, in addition to gray literature. The included studies were appraised according to the assessment tools recommended by the Joanna Briggs Institute for qualitative and quantitative observational studies. Descriptive data were collected in standardized tables and descriptively synthesized. The selection process resulted in 36 included studies. Dentists share positive opinions about EBD and predominantly report willingness to learn or adopt these practices. Despite high methodological risks and significant heterogeneity, the results collected in this review indicated that scientific journals, clinical practice guidelines, and trusted colleagues are generally perceived as influential and useful by dentists, who highly consulted these information sources. Despite supportive reported attitudes toward EBD, very low certainty exists about actual EBD-related practices.

Impacts for health and care workers of Covid-19 and other public health emergencies of international concern: living systematic review, meta-analysis and policy recommendations

BackgroundHealth and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR).MethodsWe reviewed literature retrieved from MEDLINE—PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes.ResultsThe 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted.DiscussionPHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

Digital Competence among Healthcare Leaders: A Mixed‐Methods Systematic Review

Background. New evidence on the digital competencies of healthcare leaders can provide essential knowledge for building training for the leaders to ensure high‐quality patient care. Objective. The aim of this mixed‐methods systematic review was to identify the current best evidence from qualitative, quantitative, and mixed‐methods studies on healthcare leaders’ digital competence experiences and perceptions and factors associated with it. Methods. A mixed‐methods systematic review was conducted following the Joanna Briggs Institute guidelines for mixed‐methods systematic reviews by including original qualitative and quantitative observational studies and mixed‐methods studies published in English or Finnish between January 2012 and January 2024. The studies were retrieved from four databases (CINAHL, PubMed, Scopus, and Medic). In total, 4470 articles were screened, 122 were eligible for full‐text screening, and 19 articles were included in the review according to the established inclusion and exclusion criteria. Data Extraction and Synthesis. Data tabulation and narrative synthesis for quantitative studies and content analysis for qualitative studies. Results. The synthesis of qualitative data identified five main categories that describe healthcare leaders’ experiences with digital competencies: (1) the need for developing leader’s own, professionals’, and patients’ competence in the digitalisation of healthcare, (2) the need for expertise in the health IT implementation process, (3) positive perceptions towards technology, (4) negative perceptions towards technology, and (5) ability to act as an advocate to implement technology into practice. Data from the selected quantitative studies presents that factors associated with the digital competence of healthcare leaders include individual characteristics, career characteristics, training, and other factors. Conclusion. This review suggests that developing and supporting healthcare leaders’ digital competencies should be considered in healthcare organizations, research, and education to make their digital competencies meet the demands of increasingly digitalising healthcare development work.

Self-care behaviors and associated factors among individuals with type 2 diabetes in Ghana: a systematic review

BackgroundSelf-care remains an effective model for diabetes management and care in low-and-middle-income countries due to the limited resources available for the clinical management of the disease and its complications This study examined adherence to self-care behaviors and associated factors among people with type 2 diabetes in Ghana.MethodsPubMed, PsycINFO, Scopus, Web of Science, Embase and Google scholar were used to identify quantitative observational studies published between 1990 and September 30, 2023. Studies exclusive to persons with type 2 diabetes ≥ 18 years of age in a Ghanaian setting were included in this review. Findings of primary studies were analyzed using narrative synthesis.ResultsTwelve studies, presenting data on a total of 2,671 persons with type 2 diabetes, were included. All the studies were published in the last decade (2015–2022) and a majority of them were from the Greater Accra Region. The mean number of days (per week) participants adhered to a self-care behavior were in the ranges of 3.9–4.4 for diet, 4.2–4.8 for physical activity, 0.5–2.2 for self-monitoring of blood glucose (SMBG), and 2.9–5.0 for foot care. Adherence rates for medication were in the range of 33.5–84.5%. Patient-related factors, sociodemographic/economic-related factors, condition-related factors, and healthcare system-related factors were associated with various self-care behaviors.ConclusionAdherence to self-care behaviors among persons with type 2 diabetes in Ghana remains an ongoing challenge with significant variations in adherence among patients with different characteristics.

Eight characteristics of rigorous multilevel implementation research: a step-by-step guide

BackgroundAlthough healthcare is delivered in inherently multilevel contexts, implementation science has no widely endorsed methodological standards defining the characteristics of rigorous, multilevel implementation research. We identify and describe eight characteristics of high-quality, multilevel implementation research to encourage discussion, spur debate, and guide decision-making around study design and methodological issues.RecommendationsImplementation researchers who conduct rigorous multilevel implementation research demonstrate the following eight characteristics. First, they map and operationalize the specific multilevel context for defined populations and settings. Second, they define and state the level of each construct under study. Third, they describe how constructs relate to each other within and across levels. Fourth, they specify the temporal scope of each phenomenon at each relevant level. Fifth, they align measurement choices and construction of analytic variables with the levels of theories selected (and hypotheses generated, if applicable). Sixth, they use a sampling strategy consistent with the selected theories or research objectives and sufficiently large and variable to examine relationships at requisite levels. Seventh, they align analytic approaches with the chosen theories (and hypotheses, if applicable), ensuring that they account for measurement dependencies and nested data structures. Eighth, they ensure inferences are made at the appropriate level. To guide implementation researchers and encourage debate, we present the rationale for each characteristic, actionable recommendations for operationalizing the characteristics in implementation research, a range of examples, and references to make the characteristics more usable. Our recommendations apply to all types of multilevel implementation study designs and approaches, including randomized trials, quantitative and qualitative observational studies, and mixed methods.ConclusionThese eight characteristics provide benchmarks for evaluating the quality and replicability of multilevel implementation research and promote a common language and reference points. This, in turn, facilitates knowledge generation across diverse multilevel settings and ensures that implementation research is consistent with (and appropriately leverages) what has already been learned in allied multilevel sciences. When a shared and integrated description of what constitutes rigor is defined and broadly communicated, implementation science is better positioned to innovate both methodologically and theoretically.

Prevalence and Determinants of Diabetic Retinopathy Among Type 2 Diabetic Patients in Saudi Arabia: A Systematic Review.

Diabetic retinopathy (DR) is a preventable complication of diabetes; however, it is a serious one if not early recognized and properly managed as it can lead to visual impairment. This review aimed to summarize the prevalence and determinants of DR among type 2 diabetic patients in Saudi Arabia. Eligible articles for this systematic review were quantitative observational studies that were English-published between 2015 and 2021, peer-reviewed, and conducted on patients with type 2 diabetes mellitus (DM). The studies were obtained by searching PubMed/Medline, ScienceDirect, Cochrane Library Database, and Google Scholar. The risk of bias was assessed using the National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies. Out of 16 preliminary studies, 12 were eligible for inclusion in this systematic review. One study was a chart review, one was a prospective study, and the remaining were cross-sectional studies. Regarding the study tool, retinopathy was diagnosed by an ophthalmologist using fundus photography and/or slit-lamp examination in most of the studies (n=7). However, some studies reported obtaining data from patient interviews and medical files (n=4). Concerning the outcome, an overall high prevalence of DR (ranging between 6.25% and 88.1%) and some significant associated risk factors were determined, including longer duration of diabetes, older age, poor blood pressure control, poor glycemic control, and physical inactivity. Most studies showed moderate overall quality. In conclusion, DR is a common complication of type 2 diabetes in Saudi Arabia. Some avoidable risk factors are identified, through which the doctors can identify patients at high risk of DR through early screening and can, thus, initiate prompt treatment to reduce the risk of vision deterioration.

Women's needs in their journey towards motherhood via oocyte donation: A mixed methods systematic review.

Given the significant changes in family formation through donation procedures, providing an optimal level of care that is responsive to the needs of mothers who get pregnant via oocyte donation is pivotal to improve their maternal role. Therefore, it is necessary to recognize the needs of oocyte donation mothers to address their specific needs. This study aimed to review the needs of women in their journey towards motherhood via oocyte donation. In this systematic review, which followed the updated Joanna Briggs Institute's methodological guidance for conducting a mixed methods systematic review, the quantitative observational and qualitative studies were searched through databases including PubMed, Web of Science, PsycINFO, the Cochran Library, and Google Scholar search engine. Letters to the editor, commentaries, magazine articles, articles without full text and abstracts presented in congresses were excluded. All English-language articles related to the needs of oocyte donation mothers, without time limitation, were reviewed. The eligible studies were critically appraised independently by 2 researchers. 4649 records were identified from those 18 articles were finally included in the review. The needs of oocyte donation mothers comprised 8 categories: The need for special services in fertility clinics, the need to improve the quality of care, the need for emotional support and psychological consultation, information needs, the need for financial support, the need for disclosure counseling, educational needs, and the need for sociocultural and religious support. This review suggests various needs of oocyte donation mothers. The results can be used in carefully planning supportive programs for this vulnerable population.

Does adherence to antiretroviral therapy differ by place of residence in Nigeria? A systematic review and meta-analysis protocol

IntroductionRetention in care is still a significant challenge in the HIV treatment cascade and varies extensively across regions, leading to poor adherence to antiretroviral therapy (ART). Several factors across different...

Determinants of antibiotic self-medication: A systematic review and meta-analysis.

Decreasing the prevalence of antibiotic self-medication among the public requires proper understanding of the risk factors involved. However, the determinants of antibiotic self-medication are not well defined. To identify patient and health system-related determinants of antibiotic self-medication among the public. A systematic review of quantitative observational studies and qualitative studies was undertaken. PubMed, Embase, and Web of Science were searched to identify studies on determinants of antibiotic self-medication. The data were analyzed using meta-analysis, descriptive analysis, and thematic analysis. Sixty-eight studies were included in the review. From meta-analyses, male sex (pooled odds ratio [POR]: 1.52, 95% confidence interval [CI]: 1.19-1.75), lack of satisfaction with healthcare services/physicians (POR: 3.53, 95% CI: 2.26-4.75) were associated with antibiotic self-medication. In subgroup analysis, lower age was directly associated with self-medication in high-income countries (POR: 1.61, 95% CI: 1.10-2.36). In low- and middle-income countries, people with greater knowledge of antibiotics were less likely to self-medicate (POR: 0.2, 95% CI: 0.08-0.47). Patient-related determinants identified from descriptive and qualitative studies included previous experience with antibiotics and similar symptoms, perceived low severity of disease, intention to save time and get better quickly, cultural beliefs about curative power of antibiotics, advice from family/friends, and having home stock of antibiotics. Health system-related determinants included high cost of consulting physicians and low cost of self-medication, lack of access to physician/medical care, lack of trust/confidence in physicians, greater trust in pharmacists, long distance of physicians/healthcare facilities, long waiting time at healthcare facilities, easy access to antibiotics from pharmacies, and convenience associated with self-medication. Patient and health system-related determinants are associated with antibiotic self-medication. Interventions to decrease antibiotic self-medication should incorporate community programs along with appropriate policies and healthcare reforms targeting these determinants with specific attention to population at high risk of self-medication.

Farmers' adoption of ecological practices: A systematic literature map

AbstractUnderstanding the factors associated with adoption of ecological farming practices is a well‐established topic of interest to agricultural economists. As the transition to more sustainable agriculture has become a policy priority for the European Union, broad and balanced reviews of this literature are important. We develop a systematic map of quantitative observational studies which describes the ecological practice(s) adopted, the frequency of inclusion and significance of a range of independent variables, and how the dependent variable is measured. We also conduct a quality assessment. We find that while socio‐demographic variables and farm structural variables are frequently included, they were insignificant more often than they were significant. For behavioural factors we find stronger evidence for the importance of cognitive or attitudinal variables compared to dispositional attitudinal variables. We also find a growing interest in social factors which will be valuable for researchers to explore further and reflect on the policy implications of our findings.

Education and training for infection prevention and control provided by long-term care homes to family caregivers: a scoping review protocol.

The objective of this review is to map the infection prevention and control education and training that long-term care homes use with families during a pandemic or infectious outbreak. During the COVID-19 pandemic, restrictions were imposed on visits to long-term care homes to decrease the risk of virus transmission. These restrictions had negative consequences for both residents and families. A scoping review of infection prevention and control education and training used with families will inform family visitation practices and policies during future infectious outbreaks. This review will examine literature describing infection prevention and control education and training provided to families in long-term care homes. Research and narrative papers, including experimental, quasi-experimental, descriptive observational quantitative and qualitative studies, reviews, text, policy, and opinion papers, will be considered for inclusion. A 3-step approach will be followed, in line with the JBI methodology for scoping reviews. Published literature will be searched for in databases including CINAHL, Embase, ERIC, MEDLINE, and AgeLine. Published and unpublished papers will be considered from 1990 to the present, in English or in French. The World Health Organization, Centers for Disease Control, and the Public Health Agency of Canada websites will be searched for unpublished and gray literature. Two authors will independently review and assess studies for inclusion and extract the data. The findings will be charted in a narrative summary and tables.

Meta-analysis of factors associated with antidiabetic drug prescribing for type 2 diabetes mellitus.

There is a lack of consensus on prescribing alternatives to initial metformin therapy and intensification therapy for type 2 diabetes mellitus (T2DM) management. This review aimed to identify/quantify factors associated with prescribing of specific antidiabetic drug classes for T2DM. Five databases (Medline/PubMed, Embase, Scopus, Web of Science) were searched using the synonyms of each concept (patients with T2DM, antidiabetic drugs and factors influencing prescribing) in both free text and Medical Subject Heading (MeSH) forms. Quantitative observational studies evaluating factors associated with antidiabetic prescribing of metformin, sulfonylurea, thiazolidinedione, Dipeptidyl-peptidase 4 inhibitors (DPP4-I), sodium glucose transporter 2 inhibitors (SGLT2-I), Glucagon-Like peptide receptor agonist (GLP1-RA) and insulin in outpatient settings and published from January 2009 to January 2021 were included. Quality assessment was performed using a Newcastle-Ottawa scale. The validation was done for 20% of identified studies. The pooled estimate was measured using a three-level random-effect meta-analysis model based on odds ratio [95% confidence interval]. Age, sex, body mass index (BMI), glycaemic control (HbA1c) and kidney-related problems were quantified. Of 2331 identified studies, 40 met the selection criteria. Of which, 36 and 31 studies included sex and age, respectively, while 20 studies examined baseline BMI, HbA1c and kidney-related problems. The majority of studies (77.5%, 31/40) were rated as good and despite that the overall heterogeneity for each studied factor was more than 75%, it is mostly related to within-study variance. Older age was significantly associated with higher sulfonylurea prescription (1.51 [1.29-1.76]), yet lower prescribing of metformin (0.70 [0.60-0.82]), SGLT2-I (0.57 [0.42-0.79]) and GLP1-RA (0.52 [0.40-0.69]); while higher baseline BMI showed opposite significant results (sulfonylurea: 0.76 [0.62-0.93], metformin: 1.22 [1.08-1.37], SGLT2-I: 1.88 [1.33-2.68], and GLP1-RA: 2.35 [1.54-3.59]). Both higher baseline HbA1c and having kidney-related problems were significantly associated with lower metformin prescription (0.74 [0.57-0.97], 0.39 [0.25-0.61]), but more insulin prescriptions (2.41 [1.87-3.10], 1.52 [1.10-2.10]). Also, DPP4-I prescriptions were higher for patients with kidney-related problems (1.37 [1.06-1.79]) yet lower among patients with higher HbA1c (0.82 [0.68-0.99]). Sex was significantly associated with GLP1-RA and thiazolidinedione prescribing (F:M; 1.38 [1.19-1.60] and 0.91 [0.84-0.98]). Several factors were identified as potential determinants of antidiabetic drug prescribing. The magnitude and significance of each factor differed by antidiabetic class. Patient's age and baseline BMI had the most significant association with the choice of four out of the seven studied antidiabetic drugs followed by the baseline HbA1c and kidney-related problems which had an impact on three studied antidiabetic drugs, whereas sex had the least impact on prescribing decision as it was associated with GLP1-RA and thiazolidinedione only.