scholarly journals Respiratory and Cardiovascular Health Effects of E-Cigarette Substitution: Protocol for Two Living Systematic Reviews

2021 ◽  
Author(s):  
Renee O'Leary ◽  
Maria Qureshi ◽  
Guisy Rita Maria La Rosa ◽  
Robin W. M. Vernooij ◽  
Damian Chukwu Odimegwu ◽  
...  
Keyword(s):  
Health Effects ◽  
Systematic Reviews ◽  
Cardiovascular Health ◽  
Cardiovascular Effects ◽  
White Paper ◽  
Assessment Tools ◽  
Peer Review Journal ◽  
Potential Benefits ◽  
Based Medicine ◽  
Country Specific

Background: Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, respiratory and cardiovascular effects in particular, have come to differing conclusions. Objective: The purpose of our two systematic reviews is to critically assess and synthesize the available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal is to promote the health literacy of ENDS users with facts on the health effects of ENDS. A secondary goal is to develop policy briefs to provide governmental bodies with a preliminary assessment of the potential public health impacts of ENDS. Methods: These two reviews will be living systematic reviews. The systematic reviews will be initiated with a baseline review. Studies will be evaluated with the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned due to the heterogeneity of data. A search for recently published studies will be conducted every three months, and an updated review published every six months for the duration of the project or possibly longer. Results: The baseline and updated reviews will be published in a peer review journal. The review findings will be reported in a white paper for clinicians, a fact sheet for people who use ENDS, and country-specific policy briefs. Conclusions: The substitution of ENDS for cigarettes is one of the ways to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research.

scholarly journals Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews

10.2196/29084 ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. e29084
Author(s):  
Renee O'Leary ◽  
Maria Ahmed Qureshi ◽  
Giusy Rita Maria La Rosa ◽  
Robin W M Vernooij ◽  
Damian Chukwu Odimegwu ◽  
...  
Keyword(s):  
Health Effects ◽  
Systematic Reviews ◽  
Cardiovascular Health ◽  
Cardiovascular Effects ◽  
White Paper ◽  
Assessment Tools ◽  
Evidence Based ◽  
Narrative Synthesis ◽  
Potential Benefits ◽  
Based Medicine

Background Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. Objective We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. Methods These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. Results The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. Conclusions The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. Trial Registration PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 International Registered Report Identifier (IRRID) DERR1-10.2196/29084

scholarly journals Respiratory and Cardiovascular Health Effects of e-Cigarette Substitution: Protocol for Two Living Systematic Reviews (Preprint)

2021 ◽  
Author(s):  
Renee O'Leary ◽  
Maria Ahmed Qureshi ◽  
Giusy Rita Maria La Rosa ◽  
Robin W M Vernooij ◽  
Damian Chukwu Odimegwu ◽  
...  
Keyword(s):  
Health Effects ◽  
Systematic Reviews ◽  
Cardiovascular Health ◽  
Cardiovascular Effects ◽  
White Paper ◽  
Assessment Tools ◽  
Evidence Based ◽  
Narrative Synthesis ◽  
Potential Benefits ◽  
Based Medicine

BACKGROUND Despite the clear risks of tobacco use, millions of people continue to smoke. Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been proposed as a substitute for those who are unwilling or unable to quit. Current systematic and narrative reviews on the health effects of ENDS use, particularly respiratory and cardiovascular effects, have come to differing conclusions. OBJECTIVE We conducted two systematic reviews to critically assess and synthesize available human studies on the respiratory and cardiovascular health effects of ENDS substitution for people who smoke. The primary goal is to provide clinicians with evidence on the health effects of ENDS substitution to inform their treatment recommendations and plans. The twin goal of the reviews is to promote health literacy in ENDS users with facts on the health effects of ENDS. METHODS These two reviews will be living systematic reviews. The systematic reviews will be initiated through a baseline review. Studies will be evaluated using the JBI quality assessment tools and a checklist of biases drawn from the Centre for Evidence Based Medicine Catalogue of Bias. A narrative synthesis is planned because of the heterogeneity of data. A search for recently published studies will be conducted every 3 months, and an updated review will be published every 6 months for the duration of the project or possibly longer. RESULTS The baseline and updated reviews will be published in a peer-reviewed journal. The findings of the reviews will be reported in a white paper for clinicians and a fact sheet for people who use ENDS. CONCLUSIONS The substitution of ENDS for cigarettes is one way to potentially reduce the risks of smoking. Clinicians and their patients need to understand the potential benefits and possible risks of substituting ENDS for cigarettes. Our living systematic reviews seek to highlight the best and most up-to-date evidence in this highly contentious and fast-moving field of research. CLINICALTRIAL PROSPERO CRD42021239094; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239094 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29084

Cardiovascular effects of air pollution

2008 ◽  
Vol 115 (6) ◽  
pp. 175-187 ◽  
Author(s):  
Robert D. Brook
Keyword(s):  
Air Pollution ◽  
Cardiovascular Diseases ◽  
Health Effects ◽  
Cardiovascular Health ◽  
Cardiovascular Effects ◽  
Systemic Circulation ◽  
Pollution Source ◽  
Global Public Health ◽  
Particle Exposure

Air pollution is a heterogeneous mixture of gases, liquids and PM (particulate matter). In the modern urban world, PM is principally derived from fossil fuel combustion with individual constituents varying in size from a few nanometres to 10 μm in diameter. In addition to the ambient concentration, the pollution source and chemical composition may play roles in determining the biological toxicity and subsequent health effects. Nevertheless, studies from across the world have consistently shown that both short- and long-term exposures to PM are associated with a host of cardiovascular diseases, including myocardial ischaemia and infarctions, heart failure, arrhythmias, strokes and increased cardiovascular mortality. Evidence from cellular/toxicological experiments, controlled animal and human exposures and human panel studies have demonstrated several mechanisms by which particle exposure may both trigger acute events as well as prompt the chronic development of cardiovascular diseases. PM inhaled into the pulmonary tree may instigate remote cardiovascular health effects via three general pathways: instigation of systemic inflammation and/or oxidative stress, alterations in autonomic balance, and potentially by direct actions upon the vasculature of particle constituents capable of reaching the systemic circulation. In turn, these responses have been shown to trigger acute arterial vasoconstriction, endothelial dysfunction, arrhythmias and pro-coagulant/thrombotic actions. Finally, long-term exposure has been shown to enhance the chronic genesis of atherosclerosis. Although the risk to one individual at any single time point is small, given the prodigious number of people continuously exposed, PM air pollution imparts a tremendous burden to the global public health, ranking it as the 13th leading cause of morality (approx. 800000 annual deaths).

scholarly journals Cardiovascular health impacts of wildfire smoke exposure

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Hao Chen ◽  
James M. Samet ◽  
Philip A. Bromberg ◽  
Haiyan Tong
Keyword(s):  
Health Effects ◽  
Cardiovascular Health ◽  
Cardiovascular Effects ◽  
Ambient Air ◽  
Smoke Exposure ◽  
Health Impacts ◽  
Economic Losses ◽  
Knowledge Gaps ◽  
Wildfire Smoke ◽  
Toxicological Studies

AbstractIn recent years, wildland fires have occurred more frequently and with increased intensity in many fire-prone areas. In addition to the direct life and economic losses attributable to wildfires, the emitted smoke is a major contributor to ambient air pollution, leading to significant public health impacts. Wildfire smoke is a complex mixture of particulate matter (PM), gases such as carbon monoxide, nitrogen oxide, and volatile and semi-volatile organic compounds. PM from wildfire smoke has a high content of elemental carbon and organic carbon, with lesser amounts of metal compounds. Epidemiological studies have consistently found an association between exposure to wildfire smoke (typically monitored as the PM concentration) and increased respiratory morbidity and mortality. However, previous reviews of the health effects of wildfire smoke exposure have not established a conclusive link between wildfire smoke exposure and adverse cardiovascular effects. In this review, we systematically evaluate published epidemiological observations, controlled clinical exposure studies, and toxicological studies focusing on evidence of wildfire smoke exposure and cardiovascular effects, and identify knowledge gaps. Improving exposure assessment and identifying sensitive cardiovascular endpoints will serve to better understand the association between exposure to wildfire smoke and cardiovascular effects and the mechanisms involved. Similarly, filling the knowledge gaps identified in this review will better define adverse cardiovascular health effects of exposure to wildfire smoke, thus informing risk assessments and potentially leading to the development of targeted interventional strategies to mitigate the health impacts of wildfire smoke.

scholarly journals Assessing the indirect effects of COVID-19 on healthcare delivery, utilization and health outcomes: a scoping review

2021 ◽  
Author(s):  
Charlotte M Roy ◽  
E Brennan Bollman ◽  
Laura M Carson ◽  
Alexander J Northrop ◽  
Elizabeth F Jackson ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Health Effects ◽  
Scoping Review ◽  
Cardiovascular Health ◽  
Healthcare Delivery ◽  
Final Analysis ◽  
High Income ◽  
Future Research ◽  
Published Data ◽  
Local Health

Abstract Background The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects. Methods A scoping review of peer-reviewed literature using three search engines was performed. Results One hundred and seventy studies were included in the final analysis. Nearly half (46.5%) of included studies focused on cardiovascular health outcomes. The main methodologies used were observational analytic and surveys. Data were drawn from individual health facilities, multicentre networks, regional registries, and national health information systems. Most studies were conducted in high-income countries with only 35.4% of studies representing low- and middle-income countries (LMICs). Conclusion Healthcare utilization for non-COVID-19 conditions has decreased almost universally, across both high- and lower-income countries. The pandemic’s impact on non-COVID-19 health outcomes, particularly for chronic diseases, may take years to fully manifest and should be a topic of ongoing study. Future research should be tied to system improvement and the promotion of health equity, with researchers identifying potentially actionable findings for national, regional and local health leadership. Public health professionals must also seek to address the disparity in published data from LMICs as compared with high-income countries.

scholarly journals Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Jennifer Pillay ◽  
Aireen Wingert ◽  
Tara MacGregor ◽  
Michelle Gates ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Health Care ◽  
Ectopic Pregnancy ◽  
Clinical Outcomes ◽  
Pelvic Pain ◽  
Systematic Reviews ◽  
Patient Preferences ◽  
Chronic Pelvic Pain ◽  
Task Force ◽  
Ct Screening ◽  
Potential Benefits

Abstract Background We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients’ place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. Methods We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. Results Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female’s risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. Discussion Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. Systematic review registration International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.

EU merger review of the acquisition of non-controlling minority shareholdings: where to now?

2015 ◽  
Vol 13 (2) ◽  
pp. 69-92
Author(s):  
Frank Montag ◽  
Mary Wilks
Keyword(s):  
White Paper ◽  
Merger Control ◽  
Eu Merger Control ◽  
Potential Benefits ◽  
One Year ◽  
Minority Shareholdings ◽  
Minority Interests ◽  
Policy Proposals ◽  
Benefits And Costs ◽  
The Eu

AbstractOn 9 July 2014, the European Commission (the Commission) published its White Paper “Towards more effective EU merger control”, which reviewed the operation of the EU Merger Regulation (EUMR) ten years after the introduction of the substantive test of “significant impediment to substantial competition” (SIEC) and proposed certain specific improvements, including the review of non-controlling minority interests under the EUMR. The 2014 White Paper followed approximately one year of consultation with Member States and interested parties, and was accompanied by a Staff Working Document, which analyses in more detail the considerations underlying the policy proposals in the 2014 White Paper, and an Impact Assessment, which analyses the potential benefits and costs of the various policy options considered.Less than six months after the consultation on the 2014 White Paper closed, Competition Commissioner Margrethe Vestager indicated that the Commission is reconsidering its proposals to allow it to review the acquisition of non-controlling minority shareholdings under the EUMR. This decision has been welcomed by many in the business and legal community as the “targeted transparency system” proposed by the Commission had raised a number of concerns regarding proportionality, legal certainty, cost and administrative burden.Whilst we await the Commission’s next move, this article considers whether non-controlling minority shareholdings should be subject to EU merger control and the extent to which the Commission’s originally envisaged system adequately dealt with the issues it sought to address. This article also proposes a number of principles that the authors suggest should be taken into account when designing a balanced system of merger review for acquisitions of non-controlling minority shareholdings in which the burden of the additional review is proportionate to the goals pursued.

scholarly journals INVESTIGATION AND MODELING OF TRANSPORT NOISE DEPENDENCE ON TRAFFIC SPEED AND IMPACT ON POPULATION ANNOYANCE

2022 ◽  
Vol 30 (1) ◽  
pp. 22-29
Author(s):  
Tomas Vilniškis ◽  
Andrej Naimušin ◽  
Tomas Januševičius
Keyword(s):  
Sleep Disorders ◽  
Health Effects ◽  
Noise Level ◽  
Negative Impact ◽  
Traffic Noise ◽  
Cardiovascular Effects ◽  
Vehicle Speed ◽  
Traffic Speed

Transport noise is a serious problem in cities and has a negative impact on both health and economics. In addition to the aforementioned unnoticed health effects, traffic noise has also been identified as one of the leading causes of sleep disorders, annoyance and negative cardiovascular effects. This research consists of three parts: part one involves onsite measurements of traffic noise in Trakai town; part two simulates traffic noise at different average vehicle speeds; part three assesses the number of people affected by traffic noise. The carried-out simulation has demonstrated that the noise level changes very slightly at different average vehicle speeds. It should be noticed that more noise is generated at average vehicle speed of 30 km/h rather than at 50 km/h. The assessment of the annoyance level has disclosed that an average vehicle speed of 30 km/h should cause the highest level of annoyance (highest – 26.8%).

scholarly journals Systematic review protocol exploring the impact of the COVID-19 pandemic on the wellbeing of general practitioners

2021 ◽  
Author(s):  
Laura Jefferson ◽  
Su Golder ◽  
Veronica Dale ◽  
Holly Essex ◽  
Elizabeth McHugh ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Quality Assessment ◽  
General Practitioners ◽  
Systematic Reviews ◽  
Assessment Tools ◽  
Systematic Review Protocol ◽  
Health And Wellbeing ◽  
Review Protocol ◽  
The Impact

Background Over recent years chronic stress and burnout have been reported by doctors working in general practice in the UK NHS and internationally. The COVID-19 pandemic has changed general practitioners working lives; adding potential pressures from avoiding infection and addressing pent-up demand for care, but also changing processes such as rapidly taking up remote consultations. To date, there has been a focus on exploring the impact of the pandemic on the wellbeing of hospital clinicians. No registered systematic reviews currently focus on exploring the impact of the pandemic on the mental health and wellbeing of general practitioners. Aims and objectives To synthesise the current international evidence base exploring the impact of COVID-19 on the mental health and wellbeing of general practitioners, and which factors are associated with their reported mental health and wellbeing during the pandemic. Methods In this paper we report a systematic review protocol, following PRISMA guidance. In our search strategy we will identify primary research studies or systematic reviews exploring the mental health and wellbeing of general practitioners during the COVID-19 pandemic in four databases (MEDLINE, Embase, PsychInfo and Medrxiv) and Google Scholar. We will hand-search reference lists and grey literature. Two reviewers will undertake all stages including study selection, data extraction and quality assessment, with arbitration by a third reviewer where necessary. We will use standardised quality assessment tools to ensure transparency and reduce bias in quality assessment. Depending on the quality of included studies, we may undertake a sensitivity analysis by excluding studies from narrative synthesis that are rated as low quality using the checklists. We will describe the findings across studies using narrative thematic data synthesis, and if sufficiently homogenous data are identified, we will pool quantitative findings through meta-analysis.

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