Challenges for evidence-based environmental management: what is acceptable and sufficient evidence of causation?

2017 ◽  
Vol 36 (1) ◽  
pp. 240-249 ◽  
Author(s):  
Susan J. Nichols ◽  
Michael Peat ◽  
J. Angus Webb
10.2196/20158 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e20158
Author(s):  
Dylan Gilbey ◽  
Helen Morgan ◽  
Ashleigh Lin ◽  
Yael Perry

Background Young people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities. Objective This review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility. Methods A systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively. Results The search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health–related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking. Conclusions There is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender–attracted women, trans and gender-diverse people, and people with intersex variations. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164


2019 ◽  
Vol 6 (4) ◽  
pp. 209-214
Author(s):  
Yuliya S. Medkova ◽  
D. R Markar’yan ◽  
I. A Tulina ◽  
Yu. A Churina ◽  
L. S Aleksandrov ◽  
...  

Introduction. Nowadays there are no sufficient evidence based data for a scientifically approach to the treatment of hemorrhoids during pregnancy and after childbirth, as well as current data of the prevalence of hemorrhoidal thrombosis (HT) and possible risk factors. Material and methods. The study included pregnant women and puerperas who were actively diagnosed with chronic hemorrhoids (CH) and HT. The physical examination was performed four times: at the woman’s initial visit to the obstetrician-gynecologist, at 24 weeks of pregnancy, at 36 weeks of pregnancy, in the postpartum period (within 7 days after delivery). Patients suffering from HT were asked to answer a questionnaire to determine possible risk factors. Results. A study was conducted on a population of 668 women. 104 women was diagnosed with CH in the postpartum period, and 81 - during pregnancy. The median VAS score with HT was 7. Second delivery, age over 30 years old, lack of physical activity during pregnancy and vaginal delivery are possible risk factors for the development of HT. Conclusions. In the presence of a high risk of HT during pregnancy and in the postpartum period, preventive examinations by a coloproctologist are an important aspect of patient management.


2018 ◽  
Vol 46 (11) ◽  
pp. 2780-2788 ◽  
Author(s):  
Michaela O’Connor ◽  
Anas A. Minkara ◽  
Robert W. Westermann ◽  
James Rosneck ◽  
T. Sean Lynch

Background: The use of arthroscopic treatment for intra-articular hip pathology has demonstrated improved patient-reported outcomes (PROs) with a lower rate of complications, reoperation, and patient morbidity as compared with traditional methods. Although the use of this minimally invasive approach has increased in prevalence, no evidence-based return-to-play (RTP) criteria have been developed to ensure an athlete’s preparedness for sporting activities. Purpose: To determine if there exists sufficient evidence in the literature to support an RTP protocol and functional assessment after hip arthroscopy, as well as to assess the mean rate and duration of RTP. Study Design: Systematic review and meta-analysis. Methods: The search terms “hip arthroscopy,” “return to play,” and 10 related terms were searched in PubMed, Cochrane Library, Scopus, and Web of Science, yielding 263 articles. After screening, 22 articles were included. RTP timeline, rehabilitation protocols, and conditional criteria measures were assessed with previously established criteria. Pooled estimates were calculated for RTP rate and duration, and weighted mean scores were determined for PROs. Results: A total of 1296 patients with 1442 total hips were identified. Although 54.5% (12 of 22) of studies did not provide a guideline for RTP duration after hip arthroscopy, 36.4% (8 of 22) recommended a duration of 4 months, while 9.1% (2 of 22) recommended 3 months. The most frequently described postoperative rehabilitation protocols were weightbearing guidelines (15 studies) and passive motion exercises (9 studies). Only 2 studies satisfied the criteria for a sufficient RTP protocol, and 3 provided a specific replicable test for RTP. The mean RTP duration was 7.4 months (95% CI, 6.1-8.8 months), and the return rate was 84.6% (95% CI, 80.4%-88.8%; P = .008) at a mean ± SD follow-up of 25.8 ± 2.4 months. Mean modified Harris Hip Score (mHHS) improved from 63.1 to 84.1 postoperatively (+33.3%), while Non-arthritic Hip Score improved from 61.7 to 86.8 (+40.7%). A lower preoperative mHHS was significantly associated with a higher postoperative improvement ( r = −0.95, P = .0003). Conclusion: Significant variability exists in RTP protocols among institutions owing to a lack of standardization. Despite a high overall rate of RTP and improvement in PROs after hip arthroscopy, the majority of rehabilitation protocols are not evidence based and rely on expert opinion. No validated functional test currently exists to assess RTP.


Author(s):  
Gerard H. Poll ◽  
Caitlyn Maskalunas ◽  
Lauren Walls ◽  
Samantha Durbin ◽  
Haley Hunken ◽  
...  

Purpose An important role of social communication assessment is to support intervention planning as adolescents with disabilities transition to workplaces and other adult settings. Adoption of evidence-based assessment practices would align professionals with legal and ethical mandates for schools and other settings. There is, however, limited adoption of evidence-based assessment selection. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) provide a structured approach to identifying assessments with sufficient validity and reliability backed by strong evidence. The purpose of this review was to identify directly administered social communication assessments for adolescents and to apply the COSMIN framework to evaluate their measurement properties. Method A systematic search identified 13 assessments designed for 14- to 21-year-olds with developmental disabilities putting them at risk for social communication deficits. Measurement properties were extracted from included studies and rated for sufficiency. The quality of evidence supporting the findings was graded using COSMIN guidelines. Results Five social communication assessments were recommended as having sufficient evidence of content validity and internal consistency. Remaining assessments could be recommended as gaps in the evidence for their measurement properties are filled. Conclusions The application of the COSMIN standards has the potential to advance evidence-based assessment for social communication. There were important gaps in the independent replication of measurement properties and methodological shortcomings in the evaluation of reliability, measurement error, and structural validity.


Author(s):  
P. Moghetti ◽  
◽  
S. Balducci ◽  
L. Guidetti ◽  
P. Mazzuca ◽  
...  

Abstract Aims Regular exercise is considered a cornerstone in the management of type 2 diabetes mellitus (T2DM). It improves glucose control and cardiovascular risk factors, contributes to weight loss, and also improves general well-being, likely playing a role in the prevention of chronic complications of diabetes. However, compliance to exercise recommendations is generally inadequate in subjects with T2DM. Walking is the most ancestral form of physical activity in humans, easily applicable in daily life. It may represent, in many patients, a first simple step towards lifestyle changes. Nevertheless, while most diabetic patients do not engage in any weekly walking, exercise guidelines do not generally detail how to improve its use. The aims of this document are to conduct a systematic review of available literature on walking as a therapeutic tool for people with T2DM, and to provide practical, evidence-based clinical recommendations regarding its utilization in these subjects. Data synthesis Analysis of available RCTs proved that regular walking training, especially when supervised, improves glucose control in subjects with T2DM, with favorable effects also on cardiorespiratory fitness, body weight, and blood pressure. Moreover, some recent studies have shown that even short bouts of walking, used for breaking prolonged sitting, can ameliorate glucose profiles in diabetic patients with sedentary behavior. Conclusions There is sufficient evidence to recognize that walking is a useful therapeutic tool for people with T2DM. This document discusses theoretical and practical issues for improving its use.


Pain Medicine ◽  
2019 ◽  
Vol 20 (8) ◽  
pp. 1619-1632 ◽  
Author(s):  
Cindy Crawford ◽  
Courtney Boyd ◽  
Kevin Berry ◽  
Patricia Deuster ◽  

Abstract Objective Approximately 55–76% of Service members use dietary supplements for various reasons; although such use has become popular, decisions are often driven by information that is not evidence-based. This work evaluates whether current research on dietary ingredients for chronic musculoskeletal pain provides sufficient evidence to inform decisions for practice and self-care, specifically for Special Operations Forces personnel. Methods A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. Grading of Recommendations, Assessment, Development and Evaluation was used to determine confidence in the effect estimates. The committee used a decision table to make evidence-informed judgments across decision-making factors and recommendations for practice and self-care use. Results Nineteen dietary ingredients were assessed. No recommendations were given for boswellia, ginger, rose hip, or s-adenosyl-L-methionine (SAMe); specifically, although ginger can be obtained via food, no recommendation is provided for use as a supplement due to unclear research. Further, there were insufficient strong research on boswellia and SAMe and possible compliance issues (i.e., high number of capsules required daily) associated with rose hip. Conclusions No recommendations were made when the evidence was low quality or trade-offs were so closely balanced that any recommendation would be too speculative. Research recommendations are provided to enhance the quality and body of evidence for the most promising ingredients. Clinicians and those with chronic pain can rely on evidence-based recommendations to inform their decisions.


2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Steven J. Cooke ◽  
Jake C. Rice ◽  
Kent A. Prior ◽  
Robin Bloom ◽  
Olaf Jensen ◽  
...  

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Carrie Ann Adams ◽  
Esteban Fernández-Juricic ◽  
Erin Michael Bayne ◽  
Colleen Cassady St. Clair

Abstract Background Artificial light is ubiquitous in the built environment with many known or suspected impacts on birds. Birds flying at night are known to aggregate around artificial light and collide with illuminated objects, which may result from attraction and/or disorientation. In other contexts, birds are repelled by light-based deterrents, including lasers and spotlights. Artificial light can also change birds’ perceptions of habitat quality, resulting in selection or avoidance of illuminated areas. Studies documenting aggregation, deterrence, and habitat selection are typically considered separate literature bodies, but they actually study a common set of populations, interventions/exposures, and responses. Our systematic map provides a comprehensive, searchable database of evidence of the effects of artificial light on bird movement and distribution, increasing both the quantity and diversity of studies that are accessible for further comparison and synthesis. We identify and describe the evidence available for four secondary questions relevant to conservation or management: aggregation/mortality at structures with artificial lights, evidence that light attracts and/or disorients birds, light-based deterrent efficacy, and the influence of continuous illumination on habitat selection. Methods Using the principles of systematic reviews and methods published in an earlier protocol, we conducted an extensive and interdisciplinary literature search. We searched multidisciplinary citation indices as well as databases and websites specific to conservation, pest management, transportation, and energy. In our map, we included all studies reporting eligible populations (birds), interventions/exposures (artificial light), and outcomes (movement through space, behaviour preceding movement, or distribution). We evaluated the quantity of available evidence based on meta-data fields related to study context, population traits, light source characteristics, and outcome variables. We used these meta-data to identify relevant evidence for each secondary question and describe aspects of our secondary questions that may support reviews (evidence clusters) and others that require more research (knowledge gaps). Review findings We manually screened 26,208 articles and coded meta-data for 490 eligible studies in a searchable database, organizing the literature to facilitate future reviews and evidence-based management. Much of the evidence was concentrated in particular locations (Northern hemisphere), taxonomic orders (Passeriformes, Charadriiformes, and others), and light wavelengths (red and white). We identified 56 distinct response variables and organized them into 3 categories (behaviour, distribution, and avian community), showing the diversity in bird responses to light. Conclusions Our database can be used to answer the secondary questions we identified and other questions about the effects of artificial light on bird movement and resulting changes to distribution. There may be sufficient evidence for a review of the weather and lunar conditions associated with collisions, which could help identify nights when reduction of artificial light is most important. Further experiments should investigate whether specific types of light can reduce collisions by increasing the detectability of structures with artificial lights. The efficacy of lasers as deterrents could be evaluated through systematic review, though more studies are needed for UV/violet lasers. To reduce the impacts of outdoor lighting on birds, research should investigate how spectral composition of white light influences bird attraction, orientation, and habitat selection.


2021 ◽  
Vol 3 (3) ◽  
pp. 329-338
Author(s):  
Muhammad Sajjad Hussain ◽  
Muhammad Atif Nawaz ◽  
Tusawar Iftikhar Ahmad ◽  
Muhammad Azhar Bhatti

For the last two decades, environmental degradation has become the most serious concern at multiple levels and has gained special attention of literature and policymakers. Strict implementation of the evidence-based policy solutions could serve as a regulatory tool to gradually overcome this issue. The current study examines the role of environmental governance (environmental-related taxes) and green energy (renewable energy consumption and production) on the carbon dioxide (CO2) emission of the ten most CO2 emitting countries. The study has used economic growth as the control variable. Data has been extracted from the world development indicators (WDI) from 2012 to 2020. The study employed the robust standard error and fixed effect model (FEM) to examine the linkage among the variables under consideration. The results indicated that environmental governance and green energy have a significant role in reducing environmental degradation in the ten most CO2 emitting countries in the world. The findings of this empirical and evidence-based study suggest to the relevant environmental management authorities, administrative bodies, and policymakers to incorporate environmental governance and green energy in their environmental management strategies.


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