scholarly journals Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e043054
Author(s):  
Clare Goodman ◽  
Georgia Keating ◽  
Ekavi Georgousopoulou ◽  
Charlotte Hespe ◽  
Kate Levett
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Adult Population ◽  
Significant Risk ◽  
High Dose ◽  
Specific Response ◽  
Clinical Scenarios ◽  
Subgroup Analyses ◽  
Antibiotic Associated Diarrhoea

ObjectiveTo evaluate existing evidence for the use of probiotics in preventing antibiotic-associated diarrhoea (AAD) in adults.DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).Data sourcesWe performed a literature search of the electronic databases CINAHL Plus, EMBASE, MEDLINE (Ovid) and Web of Science from database inception to May 2021 as well as hand searching of trial registries and reference lists of related reviews.Study selectionTwo reviewers identified whether RCTs met the following inclusion criteria: adult population to whom antibiotics were administered; a probiotic intervention; a placebo, alternative dose, alternative probiotic strain or no treatment control; and incidence of AAD as the outcome.Data extraction and synthesisTwo reviewers independently collected data and assessed risk of bias using preconstructed data extraction forms. We used a random effects model for all analyses. Subgroup analyses were performed to evaluate species-specific and dose-specific response.ResultsForty-two studies (11,305 participants) were included in this review. The pooled analysis suggests that co-administration of probiotics with antibiotics reduces the risk of AAD in adults by 37% (risk ratio (RR)=0.63 (95% CI 0.54 to 0.73), p<0.00001). The overall quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria was found to be moderate. In subgroup analyses, high dose compared with low dose of the same probiotic demonstrated a positive protective effect (RR 0.54 (95% CI 0.38 to 0.76), p<0.01), and only certain species, mainly of the lactobacillus and bifidobacteria genera, were found to be effective. Studies with a low baseline AAD risk did not show any difference in risk but studies with moderate or high baseline AAD risk demonstrated a significant risk reduction.ConclusionsProbiotics are effective for preventing AAD. Secondary analyses of higher dosages and certain species have shown increased effectiveness. Our results may not be applicable in clinical scenarios of lower baseline AAD risk.

scholarly journals Association Between Glucocorticoids Treatment and Viral Clearance Delay in Patients with COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Jianbo Li ◽  
Xuelian Liao ◽  
Yue Zhou ◽  
Luping Wang ◽  
Hang Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Viral Clearance ◽  
Cochrane Library ◽  
High Dose ◽  
Hazard Ratios ◽  
Subgroup Analyses ◽  
High Doses ◽  
Critical Ill

Abstract BackgroundEvidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. MethodsIn this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2002 to December 2, 2020. We mainly pooled the adjusted hazard ratios (HRs), mean difference (MD) or risk ratios (RRs) of viral clearance delay and did subgroup analyses by doses and the severity of illness.ResultsOne trial and 38 observational studies, with a total of 7119 patients, were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 (Adjusted HR 1.71, 95% CI 1.51 to 1.94, I2=22%, PI 1.45 to 2.01), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significantly higher among COVID-19 patients being mild or moderate ill (adjusted HR 1.94, 95% CI 1.39 to 2.70, I2=52%; MD 2.59, 95% CI 1.21 to 3.97, I2=24%), but not in those of being severe or critical ill (adjusted HR 1.85, 95% CI 1.05 to 3.26; MD 0.22, 95% CI -1.85 to 2.29, I2=56%); taking high doses (adjusted HR 1.49, 95% CI 1.03 to 2.15; unadjusted RR 1.47, 95% CI 1.12 to 1.94) rather taking low doses (adjusted HR 1.39, 95% CI 0.93 to 2.08; unadjusted RR 1.33, 95% CI 1.00 to 1.77) or pulse (unadjusted RR 1.85, 95% CI 0.66 to 5.19).ConclusionsGlucocorticoids treatment delayed viral clearance in COVID-19 patients of being mild or moderate ill or taking a high dose, rather in those of being severe or critical ill or taking low dose or pulse.

scholarly journals Association Between Glucocorticoids Treatment and Viral Clearance Delay in Patients with COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Jianbo Li ◽  
Xuelian Liao ◽  
Yue Zhou ◽  
Luping Wang ◽  
Hang Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Severity Of Illness ◽  
Viral Clearance ◽  
Cochrane Library ◽  
High Dose ◽  
Hazard Ratios ◽  
Subgroup Analyses ◽  
High Doses ◽  
Critical Ill

Abstract Background Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. Methods In this systematic review and meta-analysis, we searched studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2002 to December 2, 2020. We mainly pooled the adjusted hazard ratios (HRs), mean difference (MD) or risk ratios (RRs) of viral clearance delay and did subgroup analyses by doses and the severity of illness.Results One trial and 38 observational studies, with a total of 7119 patients, were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 (Adjusted HR 1.71, 95% CI 1.51 to 1.94, I2=22%, PI 1.45 to 2.01), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significantly higher among COVID-19 patients being mild or moderate ill (adjusted HR 1.94, 95% CI 1.39 to 2.70, I2=52%; MD 2.59, 95% CI 1.21 to 3.97, I2=24%), but not in those of being severe or critical ill (adjusted HR 1.85, 95% CI 1.05 to 3.26; MD 0.22, 95% CI -1.85 to 2.29, I2=56%); taking high doses (adjusted HR 1.49, 95% CI 1.03 to 2.15; unadjusted RR 1.47, 95% CI 1.12 to 1.94) rather taking low doses (adjusted HR 1.39, 95% CI 0.93 to 2.08; unadjusted RR 1.33, 95% CI 1.00 to 1.77) or pulse (unadjusted RR 1.85, 95% CI 0.66 to 5.19).Conclusions Glucocorticoids treatment delayed viral clearance in COVID-19 patients of being mild or moderate ill or taking a high dose, rather in those of being severe or critical ill or taking low dose or pulse.

scholarly journals A systematic review and meta-analysis of non-workplace interventions to reduce time spent sedentary in adults

2021 ◽  
Author(s):  
Jessica Faye Hall ◽  
Rekesh Corepal ◽  
Thomas Frederick Crocker ◽  
Natalie Lam ◽  
Louisa-Jane Burton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sedentary Behaviour ◽  
Data Extraction ◽  
Meta Analysis ◽  
Adult Population ◽  
Mean Difference ◽  
Sitting Time ◽  
Research Network ◽  
Inclusion Criteria ◽  
Post Intervention

Background: Sedentary behaviour has been the focus of considerable clinical, policy and research interest due to its detrimental effects on health and wellbeing. This systematic review aims to (1) develop a more precise description of different categories of interventions that aim to reduce sedentary time in adults by identifying specific components that form an intervention; (2) explore the effect of different categories of interventions in reducing time spent sedentary in adults. Methods: Ten electronic databases, websites of relevant organisations (e.g. the Sedentary Behaviour Research Network), and relevant reviews were searched. Inclusion criteria: Randomised controlled trials (RCTs), including cluster and randomised cross-over trials, in the adult population (clinical and non-clinical). Any study including a measure of sedentary behaviour was included even if reducing sedentary behaviour was not the primary aim. Exclusion criteria: Interventions delivered in schools, colleges, or workplaces; studies investigating the immediate effects of breaking up sitting time as part of a supervised (usually laboratory-based) intervention. Two review authors conducted data extraction and quality assessment (GRADE approach). Results: Searches identified 39,223 records, of which 85 studies met the inclusion criteria and were included in the review. Interventions shown to significantly reduce time spent sedentary were those which incorporated the provision of information, education, or support (advice/recommendations), in conjunction with either counselling (mean difference: -52.24 minutes/day; 95% CI: -85.37 to -19.10) or a form of structured/prescribed physical activity (standardised mean difference: -0.15; 95% CI: -0.23 to -0.07). However, this positive effect was not maintained at follow-up. No interventions were shown to break up prolonged sitting. Conclusions: This review presents a novel way of categorising interventions according to the types of components they comprised. There is evidence that interventions might be effective in reducing time spent sedentary immediately post-intervention. There were limited studies measuring sustained behaviour change.

scholarly journals Defining Optimal Dosing of Nimodipine in Aneurysmal Subarachnoid Hemorrhage: Study Protocol for a Systematic Review

2020 ◽  
Author(s):  
judith bellapart ◽  
Kevin B Laupland ◽  
Eva Malacova ◽  
Jeffrey Lipman ◽  
Jason A Roberts ◽  
...  
Keyword(s):  
Systematic Review ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Data Extraction ◽  
Meta Analysis ◽  
Future Research ◽  
Level Of Evidence ◽  
Optimal Dosing ◽  
Clinical Scenarios

Abstract Background: Nimodipine has been first line prophylaxis of cerebral vasospasm after subarachnoid hemorrhage for more than three decades, but its level of evidence has become controversial and essential questions regarding its pharmacological properties and its precise mechanism of action remain unclear. The level of evidence for Nimodipine was established in times when subarachnoid hemorrhage patients had their aneurysm secured in a delayed phase and when intravascular coiling was not established, these two clinical scenarios differ from current practice questioning the applicability of its therapeutic regimen. This review aims to investigate the strength of nimodipine as a prophylaxis for cerebral vasospasm within a contemporary context and to propose pathways for future research in nimodipine. Methods: We will search electronic databases including Medline, Embase, Cochrane, Web of Science and PubMed using a defined search strategy. Two authors will independently rate the quality of the searched evidence using the Chalmers scale for the scoring of studies ‘quality. Discrepancies will be assessed by a third independent author. All studies will be described in a table of studies’ characteristics and data extraction completed. Meta-analysis will be performed if there are two or greater homogeneous outcomes that suffices for reporting on measures of variability. Discussion: The results rising from this systematic review may guide further clinical trials focused on nimodipine dosing with the view of optimizing therapy for better neurological outcomes.Systematic review registration: PROSPERO ID = CRD42020188319

scholarly journals Estimated prevalence of dental fear in adults: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Ethieli R. Silveira ◽  
Mariana G. Cademartori ◽  
Helena S. Schuch ◽  
Jason M. Armfield ◽  
Flavio F. Demarco
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Random Effect ◽  
Population Based ◽  
Dental Fear ◽  
Study Selection ◽  
Pooled Prevalence ◽  
Subgroup Analyses ◽  
Fear And Anxiety

ABSTRACTObjectivesTo systematically review the literature on the prevalence of dental fear in adults to estimate a worldwide pooled prevalence and to investigate factors related to the heterogeneity of estimates.MethodsInclusion criteria were population-based studies reporting the prevalence or data that allowed the calculation of prevalence of dental fear in adults and/or elders. Five electronic databases (Embase, PubMed, Scopus, Virtual Health Library (BVS) and Web of Science) were searched. Two researchers independently performed the study selection, data extraction and quality assessment of the included studies. The prevalence pooled estimates of dental fear were calculated using fixed- and random-effect models. Subgroup analyses were performed to investigate variability between studies.ResultsThe search strategy identified 4,486 studies. After removal of duplicates (1,722), title and abstract screening (2,764) and full-text reading (108), 31 publications were deemed eligible for this systematic review. A total of 72,577 individuals 18 years of age or older composed the sample of this systematic review. The global estimated prevalence of dental fear and anxiety (DFA), high DFA and severe DFA in adults were 13.8%, 11.2% and 2.6%, respectively. Subgroup analyses showed a higher prevalence of DFA, high DFA and severe DFA among women and younger adults. The instrument used to measure dental fear also affected the prevalence of the outcome.ConclusionsDental fear and high dental fear are prevalent in adults worldwide, being more prevalent among women.

Vegetarianism and veganism compared with mental health and cognitive outcomes: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Isabel Iguacel ◽  
Inge Huybrechts ◽  
Luis A Moreno ◽  
Nathalie Michels
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Data Extraction ◽  
Meta Analysis ◽  
Well Being ◽  
Nutritional Deficiencies ◽  
Increased Risk ◽  
Subgroup Analyses ◽  
Vegetarian Diets

Abstract Context Vegetarian and vegan diets are increasing in popularity. Although they provide beneficial health effects, they may also lead to nutritional deficiencies. Cognitive impairment and mental health disorders have a high economic burden. Objective A meta-analysis was conducted to examine the relationship between vegan or vegetarian diets and cognitive and mental health. Data Sources PubMed, Scopus, ScienceDirect, and Proquest databases were examined from inception to July 2018. Study Selection Original observational or interventional human studies of vegan/vegetarian diets were selected independently by 2 authors. Data Extraction Raw means and standard deviations were used as continuous outcomes, while numbers of events were used as categorical outcomes. Results Of 1249 publications identified, 13 were included, with 17 809 individuals in total. No significant association was found between diet and the continuous depression score, stress, well-being, or cognitive impairment. Vegans/vegetarians were at increased risk for depression (odds ratio = 2.142; 95%CI, 1.105–4.148) and had lower anxiety scores (mean difference = −0.847; 95%CI, −1.677 to −0.018). Heterogeneity was large, and thus subgroup analyses showed numerous differences. Conclusions Vegan or vegetarian diets were related to a higher risk of depression and lower anxiety scores, but no differences for other outcomes were found. Subgroup analyses of anxiety showed a higher risk of anxiety, mainly in participants under 26 years of age and in studies with a higher quality. More studies with better overall quality are needed to make clear positive or negative associations. Systematic Review Registration PROSPERO registration no. CRD42018097204

scholarly journals Estimating the burden of hypertension and its significant risk factors among male commercial drivers in sub-Saharan Africa: A systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053825
Author(s):  
Martin Ackah ◽  
Louise Ameyaw ◽  
Mohammed Gazali Salifu ◽  
Cynthia Osei Yeboah
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Alcohol Consumption ◽  
Data Extraction ◽  
Meta Analysis ◽  
Significant Risk ◽  
Sub Saharan Africa ◽  
Male Adult ◽  
Commercial Drivers ◽  
Sub Saharan

ObjectiveThe study was designed to assess the burden and significant risk factors among male commercial drivers in sub-Saharan Africa (SSA).DesignSystematic review and meta-analysis.Data sourcesMedline via PubMed, Google Scholar, Cochrane databases and Africa Journal Online were searched from January 2010 to December 2020.Eligibility criteria for selecting studiesThe authors included observational studies reporting on the burden and/or risk factors for hypertension among commercial drivers in SSA. Male adult population ≥18 years working as a commercial driver in SSA as well articles published in English.Data extraction and synthesisTwo independent coauthors used a prepared data extraction form to extract data from the eligible published papers and assessed the risk of bias. DerSimonian and Laird random effects model was used to pool the burden of hypertension and significant risk factors among male commercial drivers in SSA. The presence of heterogeneity among studies was quantified by estimating variance using both Cochrane’s Q statistics and the I2 statistics. A subgroup and sensitivity analyses were performed.ResultsOverall, 14 articles met the inclusion criteria involving a total of 4285 male commercial drivers in SSA. The estimated pooled burden of hypertension among the male commercial drivers in SSA was 32% (95% CI 24% to 39%). The risk factors identified were age OR=1.10 (95% CI 1.06 to 1.15), overweight/obese OR=3.38 (95% CI 2.46 to 4.29), alcohol consumption OR=3.00 (95% CI 2.05 to 3.95) and duration of driving (≥5 years) OR=1.83 (95% CI 1.03 to 2.63). Funnel plot inspection and Egger’s regression test of small effect (0.5838) showed no evidence of publication bias.ConclusionsOur review showed that nearly one-third of male commercial drivers in SSA have hypertension. Reduction of modifiable risk factors such as overweight/obesity, alcohol consumption and long-term driving through multifaceted implementation strategies are recommended for prevention and control of hypertension among male commercial drivers in SSA.Trial registration numberCRD42021250910.

scholarly journals Prevalence of perinatal asphyxia and its associated factors in Ethiopia; A systematic review and meta-Analysis

2019 ◽  
Author(s):  
Moges Agazhe Assemie ◽  
Getaye Tizazu ◽  
Busha Gamachu Labata ◽  
Alemu Simegn
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Perinatal Asphyxia ◽  
Data Extraction ◽  
Meta Analysis ◽  
Significant Risk ◽  
Neonatal Resuscitation ◽  
Mortality And Morbidity ◽  
Prolonged Labour

Abstract Background: Perinatal asphyxia(PNA) is a severe health problem and main cause of neonatal mortality and morbidity worldwide. In Ethiopia, there are many studies conducted on PNA characterized by replete of inconsistent; unavailability of nation wide study to determines the prevalence of PNA and its determinants is an important gap. The aim of this study is to develop national consensus on pooled prevalence and associated factor key reports to enhance the quality and consistency of the evidence on perinatal asphyxia. Method: Systematic review and meta-analysis using computerized databases; searches were performed to locate all articles on the prevalence of perinatal asphyxia. Databases included were Pub Med, Cochran library, Google Scholar, Scopus and Science Direct systematically between 2014 and April 2019. All identified studies reporting the prevalence of PNA in Ethiopia were pooled. Two independent authors extracted the data using a standardized data extraction tool. The Cochrane Q test statistics and I2 tests were used to assess the heterogeneity of the studies. Random-effects model was used to calculate pooled estimates and determinant factor of PNA in Stata/se version-14. Result: The prevalence of PNA reported from fifteen studies was in the range of 3.1 to 47.5%. The pooled occurrence of PNA in Ethiopia based on 15 articles with a sample size of 17,091 was 21.1% (95% CI: 14, 28). There was high heterogeneity observed (I2 = 99.4%, p <0.001). Thus, Subgroup analysis in the study area was computed .Thus, the highest prevalence (40.4%) was observed from Oromia region and the lowest 8% noted from Dire Dawa city administration. Pooled odd ratio estimates from included studies revealed prolonged labour (OR=3.7, 95% CI 2.4, 5.7), low birth weight (OR=6.5, 95% CI 4.0, 10.3), and Meconium stained liquor (OR=6.6, 95% CI: 4.4, 10.1) are significant risk factors of perinatal asphyxia. Conclusion: In this review, prolonged labour, meconium stained liquor and low birth weight are significantly associated with perinatal asphyxia. Therefore, improve facility-based intra partum care and quality neonatal resuscitation service through capacity building for health professionals is needed.

scholarly journals Do smartphone applications and activity trackers increase physical activity in adults? Systematic review, meta-analysis and metaregression

2020 ◽  
pp. bjsports-2020-102892
Author(s):  
Liliana Laranjo ◽  
Ding Ding ◽  
Bruno Heleno ◽  
Baki Kocaballi ◽  
Juan C Quiroz ◽  
...  
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Text Messaging ◽  
Data Extraction ◽  
Meta Analysis ◽  
Vigorous Physical Activity ◽  
Mobile App ◽  
Metabolic Equivalents ◽  
Subgroup Analyses ◽  
The Impact

ObjectiveTo determine the effectiveness of physical activity interventions involving mobile applications (apps) or trackers with automated and continuous self-monitoring and feedback.DesignSystematic review and meta-analysis.Data sourcesPubMed and seven additional databases, from 2007 to 2020.Study selectionRandomised controlled trials in adults (18–65 years old) without chronic illness, testing a mobile app or an activity tracker, with any comparison, where the main outcome was a physical activity measure. Independent screening was conducted.Data extraction and synthesisWe conducted random effects meta-analysis and all effect sizes were transformed into standardised difference in means (SDM). We conducted exploratory metaregression with continuous and discrete moderators identified as statistically significant in subgroup analyses.Main outcome measuresPhysical activity: daily step counts, min/week of moderate-to-vigorous physical activity, weekly days exercised, min/week of total physical activity, metabolic equivalents.ResultsThirty-five studies met inclusion criteria and 28 were included in the meta-analysis (n=7454 participants, 28% women). The meta-analysis showed a small-to-moderate positive effect on physical activity measures (SDM 0.350, 95% CI 0.236 to 0.465, I2=69%, T2=0.051) corresponding to 1850 steps per day (95% CI 1247 to 2457). Interventions including text-messaging and personalisation features were significantly more effective in subgroup analyses and metaregression.ConclusionInterventions using apps or trackers seem to be effective in promoting physical activity. Longer studies are needed to assess the impact of different intervention components on long-term engagement and effectiveness.

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