Systematic Review Of Cohort Studies Research Articles

Robotic and Sensor Technologies for Mobility in Older People.

Maintaining independent mobility is fundamental to independent living and to the quality of life of older people. Robotic and sensor technologies may offer a lot of potential and can make a significant difference in the lives of older people and to their primary caregivers. The aim of this study was to provide a presentation of the methods that are used up till now for analysis and evaluation of human mobility utilizing sensor technologies and to give the state of the art in robotic platforms for supporting older people with mobility limitations. The literature was reviewed and systematic reviews of cohort studies and other authoritative reports were identified. The selection criteria included (1) patients with age ≥60 years; (2) patients with unstable gait, with or without recurrent falls; (3) patients with slow movements, short strides, and little trunk movement; (4) sensor technologies that are currently used for mobility evaluation; and (5) robotic technologies that can serve as a supporting companion for older people with mobility limitations. One hundred eighty-one studies published up until February 2017 were identified, of which 36 were included. Two categories of research were identified from the review regarding the robot and sensor technologies: (1) sensor technologies for mobility analysis and (2) robots for supporting older people with mobility limitations. Potential for robotic and sensor technologies can be taken advantage of for evaluation and support at home for elder persons with mobility limitations in an automated way without the need of the physical presence of any medical personnel, reducing the stress of caregivers.

Zinc status and risk of cardiovascular diseases and Type 2 diabetes mellitus - A systematic review of cohort studies

Zinc status and risk of cardiovascular diseases and Type 2 diabetes mellitus - A systematic review of cohort studies

Relationship between Periodontal Disease and Chronic Kidney Disease: A Systematic Review of Cohort Studies

Relationship between Periodontal Disease and Chronic Kidney Disease: A Systematic Review of Cohort Studies

Impact Factors of Quality of Life among HIV/AIDS Patients after Antiretroviral Therapy: A Cohort Study Systematic Review

The aim of this paper is to descript the impact factors of HIV/AIDS patients’ quality of life (QOL) after antiretroviral therapy by reviewing cohort studies. We searched PubMed and EmBase databases from inception to September 2015 for primary cohort studies about HIV/AIDS patients’ QOL. Thirty cohort studies were enrolled in this review. Among the predictors, job stability and social support were mentioned as associating positively with QOL. IDU, symptoms, depressions, and higher viral loads associated negatively with QOL. The studies did not all achieve the same results, but none of the studies directly contradicted each other. To improve HAART benefits for HIV/AIDS patients, it is important to improve QOL predictors and weaken factors associated with decreased QOL, especially for female and older HIV/AIDS patients.

Information and Communication Technologies for the Activities of Daily Living in Older Patients with Dementia: A Systematic Review.

Significant innovations have been introduced in recent years in the application of information and communication technologies (ICTs) to support healthcare for patients with dementia. In the present systematic review, our goal is to keep track of ICT concepts and approaches to support the range of activities of daily living for people with dementia and to provide a snapshot of the effect that technology is having on patients' self-reliance. We reviewed the literature and identified systematic reviews of cohort studies and other authoritative reports. Our selection criteria included: (1) activities of daily living, (2) ICT, and (3) dementia. We identified 56 studies published between 2000 and 2015, of which 26 met inclusion criteria. The present systematic review revealed many ICT systems that could purportedly support the range of activities of daily living for patients with dementia. The results showed five research bodies: 1) technologies used by patients with dementia, 2) technologies used by caregivers, 3) monitoring systems, 4) ambient assistive living with ICTs, and 5) tracking and wayfinding. There is a potential for ICTs to support dementia care at home and to improve quality of life for caregivers, reducing healthcare costs and premature institutional care for these patients.

Suboptimal Implementation of Evidence-based Therapy for Acute Variceal Hemorrhage: A Systematic Review of Observational Studies.

Gastroenterologists should strive to improve the outcomes associated with acute variceal hemorrhage (AVH) by optimizing care delivery and clinician preparedness through training. Unfortunately, data regarding contemporary outcomes and management of AVH are limited. We performed a systematic review of cohort studies examining outcomes and management of AVH from January 1990 to September 2016. We pooled data on mortality and utilization of medical therapy, endoscopic interventions, balloon tamponade (BT), and salvage procedures (portal decompressive surgery or transjugular portosystemic shunt). The pooled 6-week mortality rate after AVH was 17.7% (95% confidence interval [CI], 14.4%-21.7%). Sclerotherapy was used in 18.7% of cases (95% CI, 9.2%-34.3%), and no endoscopic intervention was provided in 14.3% of patients (95% CI, 9.7%-20.6%). The overall rate of BT use was 10.8% (95% CI, 8.2%-14.1%). Salvage procedures were used in 5.7% (95% CI, 3.7%-8.6%), falling to 1.7% (95% CI, 0.7%-3.8%) among patients treated after 2000. Although pooled rates of timely endoscopy and vasoactive medication use were high (85.8% and 83.0%, respectively), only half of patients received prophylactic antibiotics (52.8%; 95% CI, 40.0%-66.2%). In studies that enrolled patients exclusively after 2000, 13.8% of patients (95% CI, 7.0%-25.4%) received sclerotherapy, salvage transjugular portosystemic shunt fell to 1.7% (95% CI, 0.7%-3.8%), BT use fell slightly to 8.7% (95% CI, 6.4%-11.6%), and vasoactive medication and prophylactic antibiotic use rose to 91.4% (95% CI, 86.0%-94.9%) and 62.7% (95% CI, 48.9%-74.9%), respectively. AVH is associated with high mortality rates and suboptimal implementation of evidence-based therapies including prophylactic antibiotics and endoscopic interventions, suggesting a need for quality improvement. In addition, the frequent need for BT and sclerotherapy suggests that specific attention to these procedures in gastroenterology training curricula may be warranted.

Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis

Background: Lumbar disc herniation (LDH), a common disease, is often treated conservatively, frequently resulting in spontaneous resorption of the herniated disc. The incidence of this phenomenon, however, remains unknown. Objective: To analyze the incidence of spontaneous resorption after conservative treatment of LDH using computed tomography and magnetic resonance imaging. Study Design: Meta-analysis and systematic review of cohort studies. Setting: The work was performed at The Suzhou Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine. Methods: We initiated a search for the period from January 1990 to December 2015 using PubMed, Embase, and the Cochrane Library. Two independent reviewers examined the relevant reports. The references from these reports were also searched for additional trials using the criteria established in the PRISMA statement. Results: Our results represent the pooled results from 11 cohort studies. The overall incidence of spontaneous resorption after LDH was 66.66% (95% CI 51% – 69%). The incidence in the United Kingdom was 82.94% (95% CI 63.77% – 102.11%). The incidence in Japan was 62.58% (95% CI 55.71% – 69.46%). Limitations: Our study was limited because there were few sources from which to extract data, either in abstracts or published studies. There were no randomized, controlled trials that met our criteria. Conclusions: The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH. More large-scale, double-blinded, randomized, controlled trials are necessary to study the phenomenon of spontaneous resorption of LDH. Key words: Lumbar, disc herniation, spontaneous resorption, conservative treatment, incidence, country, meta-analysis, systematic review, observational studies, study designs

In pregnant women with depression, is SSRI exposure during pregnancy associated with significant congenital abnormalities in the newborn?

EVIDENCE-BASED ANSWER Although persistent pulmonary hypertension of the newborn (PPHN) is a relatively rare event, SSRI medication exposure during the last 90 days of pregnancy is associated with an increased risk (SOR: B, cohort study). Exposure to sertraline or citalopram in the first 16 weeks of gestation is associated with an increased risk of congenital septal heart defects (SOR: B, cohort study). Exposure to paroxetine and fluoxetine in the first 3 months of gestation is associated with increased risk for several major congenital malformations (SOR: B, systematic review of cohort studies). Overall, these risks need to be weighed against the risk of untreated depression in pregnancy.

Wide Variation in Reported Rates of Stroke Across Cohorts of Patients With Atrial Fibrillation.

Oral anticoagulants decrease ischemic stroke rates in patients with atrial fibrillation (AF) but increase the risk of bleeding. For the average patient with AF, the threshold of annual ischemic stroke rate where the benefit of anticoagulation outweighs the bleeding risk (net clinical benefit) has been shown to be ≈1% to 2%. Guideline recommendations for oral anticoagulants in AF are based on the CHA2DS2-VASc stroke risk point scores, assuming that those scores translate to fixed stroke rates. However, the relationship between stroke point scores and annual stroke rates may vary substantially across populations. We sought to comprehensively assess the reported rates of stroke in patients with AF and the relationship of stroke rates to stroke risk point scores. A systematic review of cohort studies and randomized controlled trials enrolled patients with nonvalvular AF not treated with oral anticoagulants. Of the 3552 studies screened, we identified 34 studies eligible for analysis. Overall stroke rates in cohort studies were highly heterogeneous (Q=5706.54, P<0.001; I2 = 99.6%) and ranged from 0.45% to 9.28% per year, despite being of similar objective study quality. The mean North American stroke rate was less than one-third that of the mean European stroke rate (P<0.0001). However, a random effects regression indicated that between-study variability was not significantly accounted for by cohort region, prospective versus retrospective design, calendar year of study, or outcome event cluster. At a CHA2DS2-VASc score of 1, 76% of cohorts reported ischemic stroke rates <1% per year and only 18% of cohorts reported a stroke rate >2% per year. At a CHA2DS2-VASc score of 2, 27% of cohorts reported stroke rates below 1% per year, 40% reported stroke rates between 1 and 2% per year, and 33% reported stroke rates >2% per year. Substantial variation exists across cohorts in overall stroke rates and rates corresponding to CHA2DS2-VASc point scores. These variations can affect the point score threshold for recommending oral anticoagulants in AF. The majority of cohorts did not observe stroke rates that would indicate a clear expected net clinical benefit for anticoagulating AF patients with CHA2DS2-VASc scores of 1 or 2.

Potential fluid biomarkers for pathological brain changes in Alzheimer's disease: Implication for the screening of cognitive frailty.

Cognitive frailty (CF) overlaps with early neuropathological alterations associated with aging-related major neurocognitive disorders, including Alzheimer's disease (AD). Fluid biomarkers for these pathological brain alterations allow for early diagnosis in the preclinical stages of AD, and for objective prognostic assessments in clinical intervention trials. These biomarkers may also be helpful in the screening of CF. The present study reviewed the literature and identified systematic reviews of cohort studies and other authoritative reports. The selection criteria for potentially suitable fluid biomarkers included: i) Frequent use in studies of fluid-derived markers and ii) evidence of novel measurement techniques for fluid-derived markers. The present study focused on studies that assessed these biomarkers in AD, mild cognitive impairment and non-AD demented subjects. At present, widely used fluid biomarkers include cerebrospinal fluid (CSF), total tau, phosphorylated tau and amyloid-β levels. With the development of novel measurement techniques and improvements in understanding regarding the mechanisms underlying aging-related major neurocognitive disorders, numerous novel biomarkers associated with various aspects of AD neuropathology are being explored. These include specific measurements of Aβ oligomer or monomer forms, tau proteins in the peripheral plasma and CSF, and novel markers of synaptic dysfunction, neuronal damage and apoptosis, neuronal activity alteration, neuroinflammation, blood brain barrier dysfunction, oxidative stress, metabolites, mitochondrial function and aberrant lipid metabolism. The proposed panels of fluid biomarkers may be useful in the early diagnosis of AD, prediction of the progression of AD from preclinical stages to the dementia stage, and the differentiation of AD from non-AD dementia. In combination with physical frailty, the present study surmised that these biomarkers may also be used as biomarkers for CF, thus contribute to discovering causes and informing interventions for cognitive impairment in individuals with CF.

Is there an association between prenatal acetaminophen use and development of asthma?

Evidence-Based Answer There does appear to be an association between maternal prenatal acetaminophen use and the risk of developing childhood wheezing and asthma (SOR: B, systematic review of cohort studies and individual cohort studies).

Are IUDs an effective and safe form of birth control for teen patients?

Evidence-based answer Yes. Contraceptive failure rates are similar among those who use intrauterine devices (IUDs), implants, or depot medroxyprogesterone acetate (DMPA) injections, while pill, patch, or ring (PPR) methods have higher failure rates (SOR: B, cohort study). When compared with oral contraceptives, IUDs in adolescents have similar or better continuation rates (SOR: B, systematic review of cohort studies). Adolescents receiving IUDs have similar risk of infection but higher expulsion rates than women receiving IUDs who are 18 to 21 years old (SOR: B, retrospective cohort study).

Prognostic factors for disability and sick leave in patients with subacute non-malignant pain: a systematic review of cohort studies

ObjectiveThis systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients.SettingGeneral practice and other primary care facilities.ParticipantsAdults (>18 years) with a subacute (≤3-month)...

Effects of thyroid autoimmunity on pregnancy outcomes in euthyroid women receiving in vitro fertilization: a meta-analysis

To investigate the association of thyroid autoimmunity (TAI) with pregnancy outcomes in euthyroid women undergoing in vitro fertilization (IVF). The meta-analysis was a systematic review of cohort studies published before May 10th, 2014. Data were retrieved from Medline, Embase and Cochrane library, and the keywords were "thyroid autoimmunity" and "pregnancy outcome", with restriction to artificial reproductive technique. RevMan 5.2 software was used for data analysis. In all, 11 cohort studies met the inclusion criteria and were included in the meta-analysis. The results showed that TAI was not associated with clinical pregnancy rate (RR=0.99, 95%CI: 0.89-1.11, P=0.92), but significantly associated with miscarriage risk (RR=1.54, 95%CI: 1.24-1.92, P<0.001). Live birth/ongoing pregnancy rate decreased in the TAI group compared with the control group, but there was no statistically significant difference (RR=0.89, 95%CI: 0.79-1.00, P=0.06). As for euthyroid women who are receiving IVF, TAI contributes to increased risk of miscarriage. Therefore, we recommend universal screening for thyroid disease among women undergoing IVF.

Red Blood Cell Transfusion in Patients With Traumatic Brain Injury: A Systematic Review and Meta-Analysis.

Our objectives were to evaluate the frequency of red blood cell (RBC) transfusion in patients with traumatic brain injury (TBI) as well as potential determinants and outcomes associated with RBC transfusion in this population. We conducted a systematic review of cohort studies and randomized trials of patients with TBI. We searched Medline, Embase, the Cochrane Library, and BIOSIS databases from their inception up to April 2015. We selected studies of adult patients with acute TBI reporting data on RBC transfusions. Cumulative incidences of transfusion were pooled using random-effect models with a DerSimonian approach. To evaluate the association between RBC transfusion and potential determinants or clinical outcomes, we pooled risk ratios or mean differences with random-effect models and the Mantel-Haenszel method. We identified 24 eligible studies (17414 patients). After pooling data from 23 studies (7524 patients), approximately 36% (95% confidence interval [CI], 28-44; I(2) = 98%) of patients received RBC transfusion at some point during their hospital stay. Hemoglobin thresholds for transfusion were rarely available (reported in 9 studies) and varied from 6 to 10 g/dL. Glasgow Coma Scale scores at admission were lower in patients who were transfused than those who were not (3 cohort studies; 1371 patients; mean difference of 1.38 points [95% CI, 0.86-1.89]; I(2) = 12%). Mortality was not significantly different among transfused and nontransfused patients in univariate and multivariate meta-analyses. Hospital length of stay was longer among patients receiving RBC transfusion compared to those who did not (3 studies; n = 455; mean difference, 9.58 days [95% CI, 3.94-15.22]; I(2) = 74%). Results should be considered cautiously due to the high heterogeneity and high risk of confounding from the observational nature of included studies. Red blood cell transfusion is frequent in patients with TBI, and transfusion practices varied widely between studies. Current published data highlight the lack of clinical evidence guiding transfusion strategies in TBI.

Do beta-blockers worsen respiratory status in patients with COPD?

Evidence-Based Answer Use of beta-blockers in patients with mild to moderate chronic obstructive pulmonary disease (COPD) does not adversely affect forced expiratory volume in 1 second (FEV1), symptoms, or beta-agonist response (SOR: A, meta-analysis). The effect on mortality is mixed. In COPD populations with high prevalence of heart failure and vascular disease, beta-blockers (predominantly noncardioselective beta-blockers) are associated with decreased mortality (SOR: B, systematic review of cohort studies and single cohort study). In patients with more severe, oxygen-dependent COPD, beta-blockers may be associated with increased mortality (SOR: C, cohort study).

Breastfeeding, bottle feeding practices and malocclusion in the primary dentition: a systematic review of cohort studies.

The World Health Organization recommends exclusive breast feeding for at least six months. However, there is no scientific evidence of the benefits of breast feeding for oral health in children under primary dentition. This study aimed to search for scientific evidence regarding the following question: is bottle feeding associated with malocclusion in the primary dentition compared to children that are breastfed? An electronic search was performed in seven databases. The systematic review included 10 cohort studies. It was not possible to conduct meta-analysis; therefore a qualitative analysis was assessed. The majority of studies evaluated feeding habits by means of questionnaires and conducted a single examination. Three studies observed that bottle feeding was significantly associated with overjet and posterior crossbite. Studies reported several cut-off times for breastfeeding (varying from 1 month up to 3 years of age) and several types of malocclusion. Controlling for non-nutritive sucking habits was reported for only half of the studies and this may have led to biased results. The scientific evidence could not confirm a specific type of malocclusion associated with the feeding habits or an adequate time of breastfeeding to benefit the children against malocclusion. Further cohort studies are needed to confirm this evidence.

Diet Quality and Weight Change in Adults Over Time: A Systematic Review of Cohort Studies

This systematic review examines the relationship between diet quality and weight gain in adults over time and is an update of our previous review of the same topic. The goal was to synthesise the best available current evidence on diet quality and weight change within longitudinal analyses. The inclusion criteria were case-control or cohort studies, and adults aged ≥18 years. The dependent variable was diet quality indexes and the independent variable was any measurement of body weight. The current systematic review identified 16 studies published between 1970 and 2014. Of these, eight were published since our last review. The findings of these recent studies confirm the results of our previous review, that higher diet quality is associated with relatively lower prospective weight gain, as well as a lower risk of becoming overweight or obese, compared with poor diet quality. Across the 16 studies, it appears that the diet quality indexes based on foods alone, or food and nutrient components, are more predictive of weight change. However, further research is needed to confirm this. Additionally, high-quality analyses that assess change in diet quality over time are needed.

Prevalence of Human Papillomavirus Infection in the Female Genital Tract of Kidney Transplant Recipients: A Systematic Review

Estimation of the prevalence of high-risk human papillomavirus (HR-HPV) genotypes and cervical intraepithelial neoplasia (CIN) in female renal transplant recipients (RTRs) is important for formulating strategies for the prevention and screening of cervical cancer in this susceptible group. A systematic review of cohort studies was conducted to evaluate the prevalence of HR-HPV cervical infection and CIN in female kidney graft recipients in comparison to healthy controls. This study adhered to the meta-analysis of observational studies in epidemiology guidelines. Studies had to meet the following criteria: (1) Cohort studies of female RTRs that assessed results of cervical cytology and/or HPV prevalence, (2) studies including adult and nonpregnant subjects, (3) the description of the study's methodological and statistical methods is provided, and (4) the prevalence of HPV was clearly stated. The prevalence of HPV infection and CIN reported in the assessed studies ranged, respectively, from 4% to 45% and 0% to more than 48% in female RTR groups, while in the control groups the prevalence ranged from 17.5% to 38% and 0% to 13%. There are relatively few publications dealing with the prevalence of CIN and HPV infection in the population of transplant recipients, and the current available studies show important methodological differences. Therefore, new observational studies with larger numbers of transplanted women, proper design and control of these biases are needed to see if, among this population, the prevalence of HR-HPV infection and CIN is greater.

Are paediatric operations evidence based? A prospective analysis of general surgery practice in a teaching paediatric hospital.

Paediatric surgical practice should be based upon solid scientific evidence. A study in 1998 (Baraldini et al., Pediatr Surg Int) indicated that only a quarter of paediatric operations were supported by the then gold standard of evidence based medicine (EBM) which was defined by randomized controlled trials (RCTs). The aim of the current study was to re-evaluate paediatric surgical practice 16 years after the previous study in a larger cohort of patients. A prospective observational study was performed in a tertiary level teaching hospital for children. The study was approved by the local research ethics board. All diagnostic and therapeutic procedures requiring a general anaesthetic carried out over a 4-week period (24 Feb 2014-22 Mar 2014) under the general surgery service or involving a general paediatric surgeon were included in the study. Pubmed and EMBASE were used to search in the literature for the highest level of evidence supporting the recorded procedures. Evidence was classified according to the Oxford Centre for Evidence Based Medicine (OCEBM) 2009 system as well as according to the classification used by Baraldini et al. Results was compared using Χ (2) test. P < 0.05 was considered statistically significant. During the study period, 126 operations (36 different types) were performed on 118 patients. According to the OCEBM classification, 62 procedures (49 %) were supported by systematic reviews of multiple homogeneous RCTs (level 1a), 13 (10 %) by individual RCTs (level 1b), 5 (4 %) by systematic reviews of cohort studies (level 2a), 11 (9 %) by individual cohort studies, 1 (1 %) by systematic review of case-control studies (level 3a), 14 (11 %) by case-control studies (level 3b), 9 (7 %) by case series (type 4) and 11 procedures (9 %) were based on expert opinion or deemed self-evident interventions (type 5). High level of evidence (OCEBM level 1a or 1b or level I according to Baraldini et al. PSI 1998) supported 75 (60 %) operations in the current study compared to 18 (26 %) in the study of 1998 (P < 0.0001). The present study shows that nowadays a remarkable number of paediatric surgical procedures are supported by high level of evidence. Despite this improvement in evidence-based paediatric surgical practice, more than a third of the procedures still lack sufficient evidence-based literature support. More RCTs are warranted to support and direct paediatric surgery practice according to the principals of EBM.