Review Of Contemporary Evidence Research Articles

Paternal preconception modifiable risk factors for adverse pregnancy and offspring outcomes: a review of contemporary evidence from observational studies

BackgroundThe preconception period represents transgenerational opportunities to optimize modifiable risk factors associated with both short and long-term adverse health outcomes for women, men, and children. As such, preconception care is recommended to couples during this time to enable them to optimise their health in preparation for pregnancy. Historically, preconception research predominately focuses on maternal modifiable risks and health behaviours associated with pregnancy and offspring outcomes; limited attention has been given to inform paternal preconception health risks and outcomes. This systematic review aims to advance paternal preconception research by synthesising the current evidence on modifiable paternal preconception health behaviours and risk factors to identify associations with pregnancy and/or offspring outcomes.MethodsMedline, Embase, Maternity and Infant care, CINAHL, PsycINFO, Scopus, and ISI Proceedings were searched on the 5th of January 2023, a date limit was set [2012–2023] in each database. A Google Scholar search was also conducted identifying all other relevant papers. Studies were included if they were observational, reporting associations of modifiable risk factors in the preconception period among males (e.g., identified as reproductive partners of pregnant women and/or fathers of offspring for which outcomes were reported) with adverse pregnancy and offspring outcomes. Study quality was assessed using the Newcastle–Ottawa Scale. Exposure and outcome heterogeneity precluded meta-analysis, and results were summarised in tables.ResultsThis review identified 56 cohort and nine case control studies. Studies reported on a range of risk factors and/or health behaviours including paternal body composition (n = 25), alcohol intake (n = 6), cannabis use (n = 5), physical activity (n = 2), smoking (n = 20), stress (n = 3) and nutrition (n = 13). Outcomes included fecundability, IVF/ISCI live birth, offspring weight, body composition/BMI, asthma, lung function, leukemia, preterm birth, and behavioural issues. Despite the limited number of studies and substantial heterogeneity in reporting, results of studies assessed as good quality showed that paternal smoking may increase the risk of birth defects and higher paternal BMI was associated with higher offspring birthweight.ConclusionThe current evidence demonstrates a role of paternal preconception health in influencing outcomes related to pregnancy success and offspring health. The evidence is however limited and heterogenous, and further high-quality research is needed to inform clinical preconception care guidelines to support men and couples to prepare for a health pregnancy and child.

MEASURING SOCIOECONOMIC STATUS IN OLDER POPULATIONS: A SCOPING REVIEW AND INTERNATIONAL PERSPECTIVE

Socioeconomic status (SES) is often measured using indicators that are less relevant to older populations. Building on earlier debates about these issues, an up-to-date, critical review of contemporary evidence and approaches is needed. A key question is how these challenges might vary between countries and different socio-cultural contexts. An international systematic scoping review was undertaken to a) identify which measures of SES have been used in studies of older adults’ health, healthcare utilization and social care utilization, and b) critically appraise the application and validity of these measures in older populations. Systematic searches were conducted in five databases (Medline, Scopus, EMBASE, PsychInfo, Web of Science and Health Management Information Consortium) in May 2018. Studies were eligible if they reported data about the relationship between a measure of SES and self-rated health, healthcare use or social care use for people aged 60+ years, and were published after 2000 in a high-income country (as defined by the Organisation for Economic Cooperation and Development). Sixty-two studies across seventeen countries were included. Measures used included: education (n=41), income (n=37), subjective SES (n=8), occupational or employment (n=10), area deprivation (n=10), combined wealth (n=7), home ownership (n=13), and housing conditions (n=2). A minority (n=7) used a range of proxy variables. The challenges of applying these measures to older populations will be considered. Attention is given to how these challenges may differ by country, whilst considering the added complexities of age, gender and socio-cultural context. Implications for future research on older adults’ health inequalities are discussed.

Economic evaluation of health promotion and primary prevention actions for older people—a systematic review

Healthy ageing and health promotion (HP) actions for older people have become an important health sector priority. At the same time, the application of economic evaluation methods in the field of health interventions in order to support allocative decision processes is of growing importance. The aims of the review were to analyze what the existing evidence is on cost-effectiveness of HP and/or primary prevention (PP) programmes for older people whilst providing deeper insight into methodological aspects of such studies, their overall quality and issues related to practical implementation of results. Systematic review of contemporary evidence (2000-15). Studies' eligibility criteria included target population 65 years old or older; interventions classified as HP or PP; a full economic evaluation conducted. The search strategy included five electronic databases and Internet websites of institutions or projects related to the topic. Quality assessment of the studies was based on the 'Drummond checklist'. After screening 6450 records, 29 papers were included, the vast majority of which (22) focus on fall prevention strategies. In this area, there are examples of good and moderate quality studies which confirm the cost-effectiveness of diverse physical activity interventions in fall prevention. The existing studies are characterized by huge differences in the methods applied as well as overall quality which limits the comparability and generalizability of the results. There is a need for development and implementation of economically driven studies, with methods adjusted to particular character of HP and/or PP strategies for older population.

CRITERIA FOR SELECTION OF PATIENTS WITH HIGH CHANCE OF COMPLETE OR OPTIMAL DEBULKING IN ADVANCED OVARIAN CANCER

The optimal approach to initial management of advanced ovarian cancer remains controversial. Current guidelines point out the high importance of surgical efforts to achieve complete or optimal cytoreduction and advisability of neoadjuvant chemotherapy as an option for patients with high risk of suboptimal debulking. However, there are no well-established criteria for patient selection for each approach. Here we provide a contemporary review of evidence for the utility of various methods for patient selection (eg, various clinical factors, serum levels of tumor markers, radiological models based on assessment of tumor dissemination pattern by computed tomography (CT), magnetic resonance imaging and positron-emission tomography/CT (PET/CT)). Capacity of these methods to predict surgical outcomes in patients with advanced ovarian cancer was evaluated. A detailed review of diagnostic laparoscopy as an emerging method for precise assessment of tumor resectability in these patients was made. We summarized the experience of dedicated cancer centers in patient selection for interval and primary debulking surgery as well as their experience in various diagnostic methods utilization in this setting.

“Men and Women o’the Time”: Allegory in Three 2015 Productions

This essay starts with a comment from a choric figure in Jonson’s The Staple of News (1626): that the Vice and other figures from the older moral drama now appear onstage “attired like men and women o'the time.” After a review of contemporary evidence, the focus is on three 2015 productions. First is a clearly allegorical script, Carol Ann Duffy’s adaptation of the best known moral play, Everyman , at the National Theatre where a relatively short early Tudor play, with its homily linked to the protagonist’s preparation for Death and a final reckoning, was transformed into a much longer polemic against today’s abuse of the environment. The other two items singled out are the RSC productions at the Swan of The Jew of Malta and Volpone , neither of which contains overt allegory yet both include sections that may have been understood then in near allegorical terms, whether to depict a sleeping Christianity in Marlowe’s Malta or an ejection of Conscience in Jonson’s Venice. The goal is to call attention to the possibility of new possibilities and meanings lurking behind a familiar episode or configuration so that theatre history, rather than being reductive, can display how the play of ideas in a scene or sequence could be both entertaining and meaningful in their theatrical terms and--perhaps--still translatable into ours.

Global evidence directing regional preventive strategies in Southeast Asia for fighting TB/HIV

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-epidemics form a huge burden of disease in the Southeast Asia region. Five out of eleven nations in this region are high TB/HIV burden countries: Myanmar, Thailand, India, Indonesia and Nepal. The trends of TB incidence in these countries have been rising in recent years, in contrast to a falling global trend. Experts in the field of TB control and health service providers have been perplexed by the association of TB and HIV infections which causes a mosaic clinical presentation, a unique course with poor treatment outcomes including death. We conducted a review of contemporary evidence relating to TB/HIV control with the aims of assisting integrated health system responses in Southeast Asia and demystifying current evidence to facilitate translating it into practice.