Systematic Review Of Epidemiological Studies Research Articles

Exposure to silicon carbide and cancer risk: a systematic review.

To conduct a systematic review of epidemiologic studies on risk of cancer from exposure to silicon carbide (SiC). We followed established guidelines to search electronic databases for studies on populations exposed to SiC. We conducted meta-analyses when the data justified it. We identified two studies of SiC production workers and several studies of users. The studies of production workers indicated an increased risk of lung cancer. The increased risk was restricted to workers with elevated dust exposure and, in the most informative study from Norway, was linked to estimated cristobalite exposure, a form of crystalline silica. Increased risk was not linked to SiC particles, once cristobalite exposure was controlled for. Studies of SiC users in various industries did not reveal an increased risk of lung cancer. The increased risk of lung cancer detected in the SiC production industry appears to be associated with high exposure levels to total dust, including crystalline silica and cristobalite which occurred in this industry in the past decades. It may not persist under current exposure circumstances, characterized by lower levels and use of personal protection equipment. Commercial users of SiC-based products were not affected.

Confounding of the association between statins and Parkinson disease: systematic review and meta-analysis.

Both statins and higher serum cholesterol have been reported to reduce to risk of Parkinson Disease (PD). Given the importance of adjusting for cholesterol levels when evaluating the effect of statins, we assessed whether the protective effect of statins would remain when adjustment for cholesterol is performed. We conducted a systematic review of epidemiologic studies that reported quantitative estimates of the association between statins and incident PD and were published through February 2016. Random-effects meta-analysis was used to assess the effect of statins on PD separately among the studies that adjusted for either cholesterol or hyperlipidemia and studies that did not. Ten eligible studies that evaluated the use of statins and incident PD were identified. Among the six studies that did not adjust for cholesterol, a protective effect of statins was observed (relative risk 0.75; 95% confidence intervals (CI) 0.60 to 0.92). Excluding studies with possible bias because of reverse causation or stratifying on study design did not affect the results. No protective effect was observed among the four studies that adjusted for either cholesterol of hyperlipidemia (relative risk 0.91; 95%CI 0.68 to 1.22). The effect estimate for studies that adjusted for cholesterol was 1.04 (95%CI 0.68 to 1.59) when a study with immortal time bias was excluded. The apparent protective effect of statins on risk of PD is at least partially explained by confounding by statin indication. Immortal time bias and healthy user effects also could have contributed to biased results. Copyright © 2016 John Wiley & Sons, Ltd.

Habitual physical activity in adolescents and young adults with Cerebral Palsy and age-matched peers

To provide a summary of the existing published knowledge on the association between sedentary lifestyle and childhood asthma. Twelve years ago, the first longitudinal studies carried out in children showed a relationship between physical activity and asthma. Several epidemiological studies confirmed these findings, with sedentary lifestyle predicting the onset of asthma.A systematic review of epidemiological studies was conducted within the MEDLINE database. Epidemiological studies on children subjects, published in English were included in the review. A comprehensive literature search yielded 50 studies for further consideration. Following the application of the eligibility criteria, we identified 11 studies.A positive association and an excess risk of asthma during childhood were revealed to sedentary lifestyle. The findings proved the association between childhood asthma and sedentary lifestyle. The correlation between bronchial asthma and sedentary life during childhood and identifying whether preventable or treatable risk factors exist needs to be determined. Further research on the topic is essential for safer and standardised conclusions.Asthma can be controlled when managed properly. The role of the nurse as an educator should establish and maintain a relationship with patients in order to help them manage their disease. The steps towards asthma management will help paediatric patients to guide their approach to the condition.

Diet Quality and Cancer Outcomes in Adults: A Systematic Review of Epidemiological Studies.

Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk and mortality. The aims of this systematic review are to (1) describe diet quality scores used in cohort or cross-sectional research examining cancer outcomes; and (2) describe associations between diet quality scores and cancer risk and mortality. The protocol was registered in Prospero, and a systematic search using six electronic databases was conducted through to December 2014. Records were assessed for inclusion by two independent reviewers, and quality was evaluated using a validated tool. Sixty-four studies met inclusion criteria from which 55 different diet quality scores were identified. Of the 35 studies investigating diet quality and cancer risk, 60% (n = 21) found a positive relationship. Results suggest no relationship between diet quality scores and overall cancer risk. Inverse associations were found for diet quality scores and risk of postmenopausal breast, colorectal, head, and neck cancer. No consistent relationships between diet quality scores and cancer mortality were found. Diet quality appears to be related to site-specific adult cancer risk. The relationship with cancer mortality is less conclusive, suggesting additional factors impact overall cancer survival. Development of a cancer-specific diet quality score for application in prospective epidemiology and in public health is warranted.

Is phytoestrogen intake associated with decreased risk of prostate cancer? A systematic review of epidemiological studies based on 17,546 cases.

This study uses current epidemiological data to evaluate whether phytoestrogen intake is associated with a reduced risk of prostate cancer. We performed a random-effect meta-analysis of published data retrieved from PubMed, Web of Science, ProQuest, and CNKI, which was supplemented by a manual search of relevant references. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Subgroup analysis and meta-regression were performed to explore the source of heterogeneity. Sensitivity analysis was evaluated to assess the stability of the results. Egger's test and funnel plots were used to detect the existence of publication bias. We retrieved 507 papers, and 29 studies were ultimately confirmed as eligible. The meta-analysis showed that phytoestrogen intake was significantly associated with a reduced risk of prostate cancer, with an odds ratio (OR) of 0.77 (95% CI 0.66-0.88; I(2) =77.6%). The food/nutritional sources that were significantly associated with a reduced risk of prostate cancer included soy and soy products, tofu, legumes, daidzein, and genistein. Subgroup analysis indicated that the associations were significant among Asians and Caucasians, but not among Africans. Meta-regression revealed that the pooled OR increased with the number of cases in the studies. The results might be affected by publication bias based on the Eggers' test (p=0.011) and the asymmetry of the funnel plot. Phytoestrogen intake may reduce the risk of prostate cancer in Asians and Caucasians. Regular intake of food that is rich in phytoestrogens, such as soy/soy products or legumes, should be recommended.

Evidence for a causal link between sepsis and long-term mortality: a systematic review of epidemiologic studies.

BackgroundIn addition to acute hospital mortality, sepsis is associated with higher risk of death following hospital discharge. We assessed the strength of epidemiological evidence supporting a causal link between sepsis and mortality after hospital discharge by systematically evaluating the available literature for strength of association, bias, and techniques to address confounding.MethodsWe searched Medline and Embase using the following ‘mp’ terms, MESH headings and combinations thereof - sepsis, septic shock, septicemia, outcome. Studies published since 1992 where one-year post-acute mortality in adult survivors of acute sepsis could be calculated were included. Two authors independently selected studies and extracted data using predefined criteria and data extraction forms to assess risk of bias, confounding, and causality. The difference in proportion between cumulative one-year mortality and acute mortality was defined as post-acute mortality. Meta-analysis was done by sepsis definition categories with post-acute mortality as the primary outcome.ResultsThe literature search identified 11,156 records, of which 59 studies met our inclusion criteria and 43 studies reported post-acute mortality. In patients who survived an index sepsis admission, the post-acute mortality was 16.1 % (95 % CI 14.1, 18.1 %) with significant heterogeneity (p < 0.001), on random effects meta-analysis. In studies reporting non-sepsis control arm comparisons, sepsis was not consistently associated with a higher hazard ratio for post-acute mortality. The additional hazard associated with sepsis was greatest when compared to the general population. Older age, male sex, and presence of comorbidities were commonly reported independent predictors of post-acute mortality in sepsis survivors, challenging the causality relationship. Sensitivity analyses for post-acute mortality were consistent with primary analysis.ConclusionsEpidemiologic criteria for a causal relationship between sepsis and post-acute mortality were not consistently observed. Additional epidemiologic studies with recent patient level data that address the pre-illness trajectory, confounding, and varying control groups are needed to estimate sepsis-attributable additional risk and modifiable risk factors to design interventional trials.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1276-7) contains supplementary material, which is available to authorized users.

Poluição do ar como fator de risco para a saúde: uma revisão sistemática no estado de São Paulo

Além de prejudicar a fauna e a flora, a poluição atmosférica é capaz de afetar a saúde das pessoas. Este estudo teve como objetivo realizar uma revisão sistemática dos estudos epidemiológicos desenvolvidos no estado de São Paulo que avaliaram os efeitos da poluição do ar na saúde da população. Todas as pesquisas encontradas sugerem que existe associação da poluição atmosférica com problemas na saúde das populações estudadas. Dentre os principais trabalhos desenvolvidos, há uma diversidade de doenças estudadas, demonstrando que o efeito da poluição do ar não afeta apenas o sistema respiratório, mas pode ser causador de risco para outros problemas como o baixo peso ao nascer, incidência e mortalidade por câncer, partos prematuros e anemia falciforme.

Ovarian cancer risk and nonisoflavone flavonoids intake: A systematic review of epidemiological studies.

Background:Although several studies have investigated the association between ovarian cancer risk and nonisoflavone flavonoids intake, these findings are inconsistent. This systematic review of published epidemiological studies was conducted to summarize and clarify the evidence on the association between ovarian cancer incidence and nonisoflavone flavonoids intake.Materials and Methods:PubMed, Scopus, Google Scholar, and EMBASE databases were searched based on MeSH term (ovarian neoplasm in combination with flavonoids) to identify related English and non-English papers published up to June 2016. We summarized the results of the relevant studies in this review.Results:In total, seven studies (four with cohort and three with case–control design) included in this review. The results of conducted cohort studies show no relation between ovarian cancer risk and total nonisoflavone flavonoids intake, and only one study reported a significant reduction between ovarian cancer incidence and kaempferol and luteolin intake. Similar to those in the cohort studies, also in case–control studies, no association was found between total nonisoflavone flavonoids intake and ovarian cancer risk, just an inverse association between flavonols intake and ovarian cancer was reported.Conclusion:Several studies investigated the relation of nonisoflavone flavonoids intake and ovarian cancer risk; none of them reported any association for total nonisoflavone flavonoids intake, but some reported an inverse association between certain subclasses or individual flavonoids. These findings are limited, and there is a need for further and more accurate researches to be confirmed.

Environmental chemicals and DNA methylation in adults: a systematic review of the epidemiologic evidence.

Current evidence supports the notion that environmental exposures are associated with DNA-methylation and expression changes that can impact human health. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between environmental chemicals with DNA methylation levels in adults. After excluding arsenic, recently evaluated in a systematic review, we identified a total of 17 articles (6 on cadmium, 4 on lead, 2 on mercury, 1 on nickel, 1 on antimony, 1 on tungsten, 5 on persistent organic pollutants and perfluorinated compounds, 1 on bisphenol A, and 3 on polycyclic aromatic hydrocarbons). The selected articles reported quantitative methods to determine DNA methylation including immunocolorimetric assays for total content of genomic DNA methylation, and microarray technologies, methylation-specific quantitative PCR, Luminometric Methylation Assay (LUMA), and bisulfite pyrosequencing for DNA methylation content of genomic sites such as gene promoters, LINE-1, Alu elements, and others. Considering consistency, temporality, strength, dose-response relationship, and biological plausibility, we concluded that the current evidence is not sufficient to provide inference because differences across studies and limited samples sizes make it difficult to compare across studies and to evaluate sources of heterogeneity. Important questions for future research include the need for larger and longitudinal studies, the validation of findings, and the systematic evaluation of the dose-response relationships. Future studies should also consider the evaluation of epigenetic marks recently in the research spotlight such as DNA hydroxymethylation and the role of underlying genetic variants.Electronic supplementary materialThe online version of this article (doi:10.1186/s13148-015-0055-7) contains supplementary material, which is available to authorized users.

Factors associated with exclusive breastfeeding in the first six months of life in Brazil: a systematic review.

ABSTRACTOBJECTIVE To identify factors associated with exclusive breastfeeding in the first six months of life in Brazil.METHODS Systematic review of epidemiological studies conducted in Brazil with exclusive breastfeeding as outcome. Medline and LILACS databases were used. After the selection of articles, a hierarchical theoretical model was proposed according to the proximity of the variable to the outcome.RESULTS Of the 67 articles identified, we selected 20 cross-sectional studies and seven cohort studies, conducted between 1998 and 2010, comprising 77,866 children. We identified 36 factors associated with exclusive breastfeeding, being more often associated the distal factors: place of residence, maternal age and education, and the proximal factors: maternal labor, age of the child, use of a pacifier, and financing of primary health care.CONCLUSIONS The theoretical model developed may contribute to future research, and factors associated with exclusive breastfeeding may subsidize public policies on health and nutrition.

The effects of outdoor air pollution on the respiratory health of Canadian children: A systematic review of epidemiological studies.

Outdoor air pollution is a global problem with serious effects on human health, and children are considered to be highly susceptible to the effects of air pollution. To conduct a comprehensive and updated systematic review of the literature reporting the effects of outdoor air pollution on the respiratory health of children in Canada. Searches of four electronic databases between January 2004 and November 2014 were conducted to identify epidemiological studies evaluating the effect of exposure to outdoor air pollutants on respiratory symptoms, lung function measurements and the use of health services due to respiratory conditions in Canadian children. The selection process and quality assessment, using the Newcastle-Ottawa Scale, were conducted independently by two reviewers. Twenty-seven studies that were heterogeneous with regard to study design, population, respiratory outcome and air pollution exposure were identified. Overall, the included studies reported adverse effects of outdoor air pollution at concentrations that were below Canadian and United States standards. Heterogeneous effects of air pollutants were reported according to city, sex, socioeconomic status and seasonality. The present review also describes trends in research related to the effect of air pollution on Canadian children over the past 25 years. The present study reconfirms the adverse effects of outdoor air pollution on the respiratory health of children in Canada. It will help researchers, clinicians and environmental health authorities identify the available evidence of the adverse effect of outdoor air pollution, research gaps and the limitations for further research.

Declining rates of fatal and nonfatal intracerebral hemorrhage: epidemiological trends in Australia.

BackgroundA recent systematic review of epidemiological studies reported intracerebral hemorrhage (ICH) incidence and mortality as unchanged over time; however, comparisons between studies conducted in different health services obscure assessment of trends. We explored trends in ICH rates in a large, representative population in New South Wales, Australia's most populous state (≈7.3 million).Methods and ResultsAdult hospitalizations with a principal ICH diagnosis from 2001 to 2009 were linked to death registrations through to June 30, 2010. Trends for overall, fatal, and nonfatal ICH rates within 30 days and fatal rates for 30‐day survivors at 365 days were calculated. There were 11 332 ICH patient admissions meeting eligibility criteria, yielding a crude hospitalization rate of 25.2 per 100 000 (age‐standardized rate: 17.2). Age‐ and sex‐adjusted overall rates significantly declined by an average of 1.6% per year (P=0.03). Fatal ICH declined by an average of 2.6% per year (P=0.004). For 30‐day survivors, a nonsignificant decline of 2.3% per year in fatal ICH at 365 days was estimated (P=0.17). Male sex and birth in the Oceania region and Asia were associated with an increased ICH risk, although this depended on age. Approximately 12% of ICH admissions would be prevented if the socioeconomic circumstances of the population equated with those of the least disadvantaged.ConclusionsOverall and fatal ICH rates have fallen in this large Australian population. Improvements in cardiovascular prevention and acute care may explain declining rates. There was no evidence of an increase in devastated survivors because the longer term mortality of 30‐day survivors has not increased over time.

Viral infections and colorectal cancer: a systematic review of epidemiological studies.

Numerous studies have found the presence of viral DNA in colorectal tumor tissues. However, whether viral infections contribute to the risk of colorectal cancer (CRC) is still under debate. We aimed to provide an overview of published epidemiological studies on the association between viral infections and CRC. A systematic literature search was performed in PubMed to find relevant studies published until 8 May 2014. Information collected included study population, sample type, laboratory method and prevalence of viral infection in cancer or precancer patients and controls. We found 41 studies that fulfilled the selection criteria, all of which had cross-sectional or case-control designs, and most of which were of small to moderate size. Viral infections included human papillomaviruses (HPV), human polyomaviruses, human herpesviruses, human bocavirus and Inoue-Melnick virus. Inconsistent results were observed across studies. Many studies reported higher viral DNA prevalence in tumor tissues than in normal noncancerous tissues either in the same patients or in CRC-free controls. However, potential contamination or temporal sequence of the infection and cancer development were often unclear. Seroprevalence studies assessing antibody titers indicative of viral infections did not find statistically significant differences between CRC cases and healthy controls. Overall published evidence on the role of viral infections in CRC etiology remains limited. Given the potential importance of viral infections and their implication for prevention, there is a strong need for large, methodologically rigorous epidemiological studies.

Association between pancreatitis and subsequent risk of pancreatic cancer: a systematic review of epidemiological studies.

This study aimed to summarize published epidemiological evidence for the relationship between pancreatitis and subsequent risk of pancreatic cancer (PC). We searched Medline and Embase for epidemiological studies published by February 5th, 2014 examining the risk of PC in pancreatitis patients using highly inclusive algorithms. Information about first author, year of publication, country of study, recruitment period, type of pancreatitis, study design, sample size, source of controls and attained age of subjects were extracted by two researchers and Stata 11.0 was used to perform the statistical analyses and examine publication bias. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with the random effects model. A total of 17 articles documenting 3 cohort and 14 case-control studies containing 14,667 PC cases and 17,587 pancreatitis cases were included in this study. The pooled OR between pancreatitis and PC risk was 7.05 (95%CI: 6.42-7.75). However, the pooled ORs of case-control and cohort studies were 4.62 (95%CI: 4.08-5.22) and 16.3 (95%CI: 14.3-18.6) respectively. The risk of PC was the highest in patients with chronic pancreatitis (pooled OR=10.35; 95%CI: 9.13-11.75), followed by unspecified type of pancreatitis (pooled OR=6.41; 95%CI: 4.93-8.34), both acute and chronic pancreatitis (pooled OR=6.13; 95%CI: 5.00-7.52), and acute pancreatitis (pooled OR=2.12; 95%CI: 1.59-2.83). The pooled OR of PC in pancreatitis cases diagnosed within 1 year was the highest (pooled OR=23.3; 95%CI: 14.0-38.9); and the risk in subjects diagnosed with pancreatitis for no less than 2, 5 and 10 years were 3.03 (95%CI: 2.41-3.81), 2.82 (95%CI: 2.12-3.76) and 2.25 (95%CI: 1.59-3.19) respectively. Pancreatitis, especially chronic pancreatitis, was associated with a significantly increased risk of PC; and the risk decreased with increasing duration since diagnosis of pancreatitis.

Cadmium and Reproductive Health in Women: A Systematic Review of the Epidemiologic Evidence.

An evolving body of evidence supports that cadmium, a non-essential heavy metal, may be associated with multiple adverse women's reproductive health outcomes. Our objective was to conduct a systematic review of epidemiologic studies that evaluated cadmium exposure and the following reproductive health outcomes: puberty/menarche, fertility, time to pregnancy, pregnancy loss, preeclampsia, endometriosis, uterine leiomyoma, and menopause. Twenty-two studies were identified based upon our search criteria. Available evidence was inadequate to draw meaningful conclusions for most of the reproductive outcomes studied. The strongest evidence was for a possible association between cadmium and preeclampsia, which was limited to cross-sectional studies. Some evidence, although conflicting, was also observed for fertility related outcomes. This lack of evidence underscores the need for additional research on cadmium and women's reproductive health outcomes.

The atopic march: IgE is not the only road

Eczema, allergic rhinitis, and asthma are common diseases of childhood around the world, especially in high-income countries. 1 Deckers IA McLean S Linssen S Mommers M van Schayck CP Sheikh A Investigating international time trends in the incidence and prevalence of atopic eczema 1990–2010: a systematic review of epidemiological studies. PLoS One. 2012; 7: e39803 Crossref PubMed Scopus (332) Google Scholar , 2 Sly RM Changing prevalence of allergic rhinitis and asthma. Ann Allergy Asthma Immunol. 1999; 82: 233-248 Summary Full Text PDF PubMed Google Scholar These diseases usually occur in the same individual, which could be a result of a pathophysiological link. 3 Dharmage SC Lowe AJ Matheson MC Burgess JA Allen KJ Abramson MJ Atopic dermatitis and the atopic march revisited. Allergy. 2013; (published online Oct 14.)https://doi.org/10.1111/all.12268 Crossref Scopus (240) Google Scholar The interaction between these comorbidities is typically known as the atopic march, in which eczema or atopic dermatitis progresses to allergic rhinitis and asthma. 4 Zheng T Yu J Oh MH Zhu Z The atopic march: progression from atopic dermatitis to allergic rhinitis and asthma. Allergy Asthma Immunol Res. 2011; 3: 67-73 Crossref PubMed Scopus (277) Google Scholar Indeed, several cohort studies have shown that a diagnosis of eczema significantly increases the risk of developing either allergic rhinitis or asthma. This risk is greater among children who produce IgE antibodies in response to environmental triggers than in children who do not, which suggests that allergic sensitisation is an important factor. 3 Dharmage SC Lowe AJ Matheson MC Burgess JA Allen KJ Abramson MJ Atopic dermatitis and the atopic march revisited. Allergy. 2013; (published online Oct 14.)https://doi.org/10.1111/all.12268 Crossref Scopus (240) Google Scholar However, the risk of developing asthma among children with eczema is partly confounded by viral infections and this atopic march can also occur in the absence of underlying allergic sensitisation. 3 Dharmage SC Lowe AJ Matheson MC Burgess JA Allen KJ Abramson MJ Atopic dermatitis and the atopic march revisited. Allergy. 2013; (published online Oct 14.)https://doi.org/10.1111/all.12268 Crossref Scopus (240) Google Scholar , 5 Khan SH Park SS Sirajuddin IA Grayson MH Respiratory virus and asthma: the role of immunoglobulin E. Clin Ther. 2008; 30: 1017-1024 Summary Full Text PDF PubMed Scopus (11) Google Scholar Therefore, the atopic march is not just a simple temporal relationship explained by increased concentrations of IgE, but instead it is a complex process affected by different environmental and genetic factors. Understanding what proportion of these allergic comorbidities occur as a result of allergic sensitisation is important for prevention and to provide a better understanding of the pathophysiology of allergic comorbidities. Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort studyCoexistence of eczema, rhinitis, and asthma in the same child is more common than expected by chance alone—both in the presence and absence of IgE sensitisation—suggesting that these diseases share causal mechanisms. Although IgE sensitisation is independently associated with excess comorbidity of eczema, rhinitis, and asthma, its presence accounted only for 38% of comorbidity, suggesting that IgE sensitisation can no longer be considered the dominant causal mechanism of comorbidity for these diseases. Full-Text PDF

Biomarkers of heart failure with normal ejection fraction: a systematic review

Heart failure with normal ejection fraction (HFNEF) is a major and growing public health problem, currently representing half of the heart failure burden. Although many studies have investigated the diagnostic and prognostic value of new biomarkers in heart failure, limited data are available on biomarkers other than natriuretic peptides in HFNEF. We performed a systematic review of epidemiological studies on the associations of biomarkers with the occurrence of HFNEF and with the prognosis of HFNEF patients. Biomarkers examined most extensively in HFNEF include biomarkers of myocyte stress, inflammation, and extracellular matrix remodelling. Some biomarkers have been shown to be increased to a different extent in HFNEF compared with heart failure with reduced ejection fraction (HFREF). Several biomarkers, including biomarkers of myocyte stress, inflammation, extracellular matrix remodelling, growth differentiation factor 15 (GDF-15), cystatin C, resistin, and galectin-3, were associated with development of HFNEF and with clinical outcomes of HFNEF patients in terms of morbidity and mortality. Several biomarkers, including biomarkers of myocyte stress, inflammation, extracellular matrix remodelling, GDF-15, cystatin C, resistin, and galectin-3, appeared to be promising diagnostic and prognostic tools in patients with HFNEF. Investigation of the incremental diagnostic and prognostic value of these biomarkers, or a combination thereof, over established clinical covariates and imaging techniques in large, prospective studies is warranted.

Cadmium Exposure and Clinical Cardiovascular Disease: A Systematic Review

Mounting evidence supports that cadmium, a toxic metal found in tobacco, air and food, is a cardiovascular risk factor. Our objective was to conduct a systematic review of epidemiologic studies evaluating the association between cadmium exposure and cardiovascular disease. Twelve studies were identified. Overall, the pooled relative risks (95% confidence interval) for cardiovascular disease, coronary heart disease, stroke, and peripheral arterial disease were: 1.36 (95% CI: 1.11, 1.66), 1.30 (95% CI: 1.12, 1.52), 1.18 (95% CI: 0.86, 1.59), and 1.49 (95% CI: 1.15, 1.92), respectively. The pooled relative risks for cardiovascular disease in men, women and never smokers were 1.29 (1.12, 1.48), 1.20 (0.92, 1.56) and 1.27 (0.97, 1.67), respectively. Together with experimental evidence, our review supports the association between cadmium exposure and cardiovascular disease, especially for coronary heart disease. The number of studies with stroke, heart failure (HF) and peripheral arterial disease (PAD) endpoints was small. More studies, especially studies evaluating incident endpoints, are needed.

Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: a systematic review of epidemiological studies across 1987–2011

The goal of this paper was to systematically review evidence on (1) the potential magnitude of the psychopathological impacts of community-wide disasters on child and adolescent survivors, and (2) the long-term course or trajectory of disaster-induced psychopathology among children and adolescents. The PubMed/MEDLINE and PsycINFO databases were searched from their respective inception through December 2011. All of the resulting epidemiological studies of child and adolescent survivors following community-wide disasters were examined. Sixty cross-sectional studies and 25 longitudinal or long-term follow-up studies were identified. The estimated rates of posttraumatic stress disorder (PTSD) and depression among child and adolescent survivors varied greatly across the included studies, ranging from 1.0 to 95 % and 1.6 to 81 %, respectively, while the reported rates of diagnosable PTSD according to the DSM-IV criteria and diagnosable depression ranged from 1.0 to 60 % and 1.6 to 33 %, respectively. The long-term courses of psychopathology among youthful survivors were summarized. Methodological issues with those studies were discussed. The empirical findings summarized in this review highlight the importance of psychosocial intervention at early postdisaster stages for child and adolescent survivors. The methodological flaws revealed by this review indicate the need for continued attempts to better understand the epidemiology and trajectory of psychopathological problems among youthful survivors.

Associations between dietary variety and measures of body adiposity: a systematic review of epidemiological studies

Dietary variety is positively correlated with energy intake in most studies. However, the associations between dietary variety and measures of body adiposity are inconsistent in the literature, which limits the development of clear national nutrition recommendations regarding dietary variety. In the present systematic review, we critically evaluate the associations between dietary variety and measures of body adiposity among healthy adults within the existing literature. We conducted a systematic search of the MEDLINE and Web of Science databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to examine these associations. We identified twenty-six studies in total that investigated the associations between dietary variety and body adiposity measures. Total variety was non-significantly associated with body adiposity in most studies, while variety in recommended foods was either inversely associated (six out of ten studies) or non-significantly associated (three out of ten studies) with body adiposity. Conversely, variety in non-recommended foods (i.e. sources of added sugars and solid fats) increased the likelihood of excess adiposity in most studies (six out of nine studies). Definitions and measurement of dietary variety were inconsistent across studies and contributed to some of the discrepancies noted in the literature. In conclusion, among the studies that met the inclusion criteria for the present review, dietary variety was inconsistently associated with body adiposity in diverse populations. Using consistent and specific definitions of dietary variety may help provide further insight into the associations between dietary variety and excess adiposity before definitive public health messages are ma