Methodological limitations in studies assessing the effects of environmental and socioeconomic variables on the spread of COVID-19: a systematic review

Abstract Background While numerous studies have assessed the effects of environmental (meteorological variables and air pollutants) and socioeconomic variables on the spread of the COVID-19 pandemic, many of them, however, have significant methodological limitations and errors that could call their results into question. Our main objective in this paper is to assess the methodological limitations in studies that evaluated the effects of environmental and socioeconomic variables on the spread of COVID-19. Main body We carried out a systematic review by conducting searches in the online databases PubMed, Web of Science and Scopus up to December 31, 2020. We first excluded those studies that did not deal with SAR-CoV-2 or COVID-19, preprints, comments, opinion or purely narrative papers, reviews and systematic literature reviews. Among the eligible full-text articles, we then excluded articles that were purely descriptive and those that did not include any type of regression model. We evaluated the risk of bias in six domains: confounding bias, control for population, control of spatial and/or temporal dependence, control of non-linearities, measurement errors and statistical model. Of the 5631 abstracts initially identified, we were left with 132 studies on which to carry out the qualitative synthesis. Of the 132 eligible studies, we evaluated 63.64% of the studies as high risk of bias, 19.70% as moderate risk of bias and 16.67% as low risk of bias. Conclusions All the studies we have reviewed, to a greater or lesser extent, have methodological limitations. These limitations prevent conclusions being drawn concerning the effects environmental (meteorological and air pollutants) and socioeconomic variables have had on COVID-19 outcomes. However, we dare to argue that the effects of these variables, if they exist, would be indirect, based on their relationship with social contact.

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PP39 What is the risk of major trauma following a fall down stairs? – A systematic review

Emergency Medicine Journal ◽

10.1136/emermed-2021-999.39 ◽

2021 ◽

Vol 38 (9) ◽

pp. A16.2-A16

Author(s):

Christopher Holt ◽

Samuel Keating ◽

Michael Tonkins ◽

Daniel Bradbury ◽

Gordon Fuller

Keyword(s):

Systematic Review ◽

Major Trauma ◽

Alcohol Intoxication ◽

Grey Literature ◽

Developed Countries ◽

Risk Of Bias ◽

Qualitative Synthesis ◽

Increased Risk ◽

Study Heterogeneity ◽

Serious Injury

BackgroundSpecific mechanisms of injury are stated in pre-hospital triage tools to identify suspected cases of major trauma. Falls down stairs are common presentations in UK emergency departments, yet are frequently overlooked as a causative mechanism of major trauma. No prior systematic review has examined this association.MethodsSeven internationally recognised literature databases and seven grey literature databases were screened utilising a common search strategy from inception until 31 December 2019. Abstracts were screened for relevance by a single reviewer. Full texts were screened and subsequently extracted by 3 separate reviewers against strict inclusion/exclusion criteria. A risk of bias assessment based on GRADE recommendations was performed. In the absence of study heterogeneity, a narrative synthesis was planned. The reporting of this systematic review followed PRISMA 2009 statement guidelines.Results5240 articles were identified from database searching, 89 articles had their full texts assessed for eligibility and 6 articles were included for qualitative synthesis. All studies were retrospective in nature and originated from more economically developed countries. 7431 patients who fell down stairs were analysed, of which, 707 (9.5%) met major trauma definitions. Falls down stairs resulted in a significantly increased risk of serious injury compared to other fall mechanisms (OR: 1.621, 95% CI: 1.381 – 1.902, p<0.0005). Analysis of confounding factors demonstrated age (OR: 2.59, 95% CI: 1.57 – 4.28, p<0.001) and alcohol intoxication (OR: 2.6, 95% CI: 1.4 – 4.7, p=0.001) to be significantly associated with major trauma. Risk of bias was moderate to high across all 6 studies.ConclusionThis systematic review highlighted the paucity of literature surrounding the incidence of major trauma following falls down stairs.A retrospective cohort study is currently being undertaken to analyse the risk of major trauma following falls down stairs. On completion, the results will be incorporated with the results of this systematic review.

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Effect of Cystic Fibrosis Transmembrane Receptor Modulators on Anthropometric and Growth Parameters in Individuals with Cystic Fibrosis: A Systematic Review (OR36-08-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz035.or36-08-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Jessica Alvarez ◽

Julianna Bailey ◽

Ellen Bowser ◽

Kristen Farnham ◽

Mark Mangus, Sr. ◽

...

Keyword(s):

Systematic Review ◽

Cystic Fibrosis ◽

Growth Parameters ◽

Class Ii ◽

Risk Of Bias ◽

New Drugs ◽

Class Iii ◽

Qualitative Synthesis ◽

Anthropometric Parameters ◽

Poor Growth

Abstract Objectives Individuals with cystic fibrosis (CF) are at high risk for malnutrition and poor growth. New drugs that modulate CF transmembrane receptor (CFTR) function are available, although their effects on anthropometric parameters are not clear. This systematic review aimed to determine if various CFTR modulator therapies affect weight and growth parameters in individuals with CF. Methods A literature search was conducted using MEDLINE, CINAHL and Embase databases for peer-reviewed, randomized controlled trials (RCT) published from January 2002 to May 2018 that examined the effect of CFTR modulation therapy on weight and growth parameters in children and adults with CF. Articles were screened for relevance, data was extracted and summarized, and risk of bias was assessed to determine the quality of evidence. Results A total of 612 original articles were identified, and 13 articles representing 10 RCTs were included in qualitative synthesis and three were included in quantitative synthesis. All but one RCT demonstrated low risk of bias. The targeted class of CFTR mutation varied by RCT. Studies indicated that, in children and adults with CF with class III mutations, ivacaftor treatment alone increased weight and BMI (4 RCTs), but it did not influence growth in individuals with class II (1 RCT) or class IV mutations (1 RCT). Treatment with ivacaftor + lumacaftor in adults homozygous for the F508del CFTR mutation (class II) increased BMI following 24 weeks of treatment (2 RCTs), but there was no effect in adults heterozygous for the mutation treated for 8 weeks (1 RCT). Treatment with lumacaftor + tezacaftor in individuals ages 12–20 years with class II mutations did not change growth parameters (1 RCT). Conclusions Effects of CFTR modulators on increasing weight and growth in individuals with CF are likely dependent on the therapy formulation (single vs combination therapy) and the targeted CFTR mutation. Whereas ivacaftor alone increases weight and growth parameters in individuals with class III mutations, ivacaftor + lumacaftor is more effective at increasing BMI in adults homozygous for the class II F508del CFTR mutation. Additional studies are needed to determine effects of other CFTR modulator drugs on growth parameters in individuals with varying CFTR mutations. Funding Sources Academy of Nutrition and Dietetics/Medical Nutrition DPG, National Institutes of Health.

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The effects of pharmacological interventions on quality of life and fatigue in sarcoidosis: a systematic review

European Respiratory Review ◽

10.1183/16000617.0057-2019 ◽

2020 ◽

Vol 29 (155) ◽

pp. 190057 ◽

Cited By ~ 2

Author(s):

Roeland Vis ◽

Ewoudt M.W. van de Garde ◽

Jan C. Grutters ◽

Ingrid H.E. Korenromp

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Minimal Important Difference ◽

Risk Of Bias ◽

Controlled Trials ◽

Qualitative Synthesis ◽

Pharmacological Interventions ◽

Open Label ◽

Double Blind

AimsMany sarcoidosis patients experience a reduction in health-related quality of life (HRQoL) and a majority of patients report fatigue. Historically, drug trials in sarcoidosis have focused on changes in chest radiographs, lung function parameters and biomarkers, while HRQoL and fatigue have not been the main outcomes examined. We performed a systematic review of the literature to evaluate the existing evidence on the effects of pharmacological interventions on HRQoL and fatigue outcomes.MethodsThe systematic search was performed in Medline and Embase and yielded 15 records covering seven randomised controlled trials and seven single-arm open label studies, which were included in a qualitative synthesis (the results of one study were included in two publications). 12 studies evaluated immunosuppressive and/or immunomodulatory therapies and two studies evaluated stimulants.ResultsNine out of the 14 studies observed positive treatment effects from the interventions on HRQoL and/or fatigue, exceeding the minimal important difference. The risk of bias was generally high with only three studies rated as having a low risk of bias. The results suggest a potential for improvement in HRQoL and/or fatigue in patients with active disease who are either untreated or treated but not yet fully stabilised or therapy refractory.ConclusionMore randomised, double-blind and placebo-controlled trials are needed to expand the evidence base on these important outcome parameters.

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Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses

Materials ◽

10.3390/ma13112513 ◽

2020 ◽

Vol 13 (11) ◽

pp. 2513 ◽

Cited By ~ 3

Author(s):

Anna Iliadi ◽

Despina Koletsi ◽

Theodore Eliades ◽

George Eliades

Keyword(s):

Systematic Review ◽

Risk Of Bias ◽

P Value ◽

Dental Practice ◽

Qualitative Synthesis ◽

Eligibility Criteria ◽

Manual Search ◽

Dust Generation ◽

Dental Procedures ◽

Meta Analyses

Composite dust generation is most likely a continuous and daily procedure in dental practice settings. The aim of this systematic review was to identify, compile and evaluate existing evidence on interventions and composite material properties related to the production of aerosolized dust during routine dental procedures. Seven electronic databases were searched, with no limits, supplemented by a manual search, on 27 April 2020 for published and unpublished research. Eligibility criteria comprised of studies of any design, describing composite dust production related to the implementation of any procedure in dental practice. Study selection, data extraction and risk of bias (RoB) assessment was undertaken independently either in duplicate, or confirmed by a second reviewer. Random effects meta-analyses of standardized mean differences (SMD) with associated 95% confidence intervals (CIs) were employed where applicable. A total of 375 articles were initially identified, resulting in 13 articles being included in the qualitative synthesis, of which 5 contributed to meta-analyses overall. Risk of bias recordings ranged between low and high, pertaining to unclear/raising some concerns, in most cases. All types of composites, irrespective of the filler particles, released significant amounts of nano-sized particles after being ground, with potentially disruptive respiratory effects. Evidence supported increased % distribution of particles < 100 nm for nanocomposite Filtek Supreme XTE compared to both conventional hybrid Z100MP (SMD: 1.96, 95% CI: 0.85, 3.07; p-value; 0.001) and nano- hybrid Tetric EvoCeram (SMD: 1.62, 95% CI: 0.56, 2.68; p-value: 0.003). For cytotoxicity considerations of generated aerosolized particles, both nanocomposites Filtek Supreme XTE and nanohybrid GradiO revealed negative effects on bronchial epithelial cell viability, as represented by % formazan reduction at 330–400 μg/mL for 24 hours, with no recorded differences between them (SMD: 0.19; 95% CI: −0.17, 0.55; p-value: 0.30). Effective and more rigorous management of dental procedures potentially liable to the generation of considerable amounts of aerosolized composite dust should be prioritized in contemporary dental practice. In essence, protective measures for the clinician and the practices’ personnel should also be systematically promoted and additional interventions may be considered in view of the existing evidence.

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Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis

Journal of Dental Research ◽

10.1177/0022034516682017 ◽

2017 ◽

Vol 96 (3) ◽

pp. 261-269 ◽

Cited By ~ 42

Author(s):

D.C. Penoni ◽

T.K.S. Fidalgo ◽

S.R. Torres ◽

V.M. Varela ◽

D. Masterson ◽

...

Keyword(s):

Systematic Review ◽

Postmenopausal Women ◽

Meta Analysis ◽

Risk Of Bias ◽

Qualitative Synthesis ◽

Mineral Density ◽

Clinical Attachment Loss ◽

Attachment Loss ◽

Meta Analyses ◽

Periodontal Attachment

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20–0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01–0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23–4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36–3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74–7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.

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Effectiveness of chemotherapy in advanced differentiated thyroid cancer: a systematic review

Endocrine Related Cancer ◽

10.1530/erc-15-0194 ◽

2016 ◽

Vol 23 (2) ◽

pp. R71-R84 ◽

Cited By ~ 21

Author(s):

Ana Albero ◽

Juliana Ester Lopéz ◽

Alberto Torres ◽

Luis de la Cruz ◽

Tomas Martín

Keyword(s):

Systematic Review ◽

Differentiated Thyroid Carcinoma ◽

Risk Of Bias ◽

Phase Iii ◽

Response To Treatment ◽

Systematic Research ◽

Survival Times ◽

Qualitative Synthesis ◽

Phase Ii Studies ◽

Well Differentiated

In differentiated thyroid carcinoma refractory to radioactive iodine (CDT-RTI), chemotherapy has been considered for decades to be the only systemic therapy with palliative purpose. Phase II studies assessing the efficacy of different chemotherapy outlines have been published. Nevertheless, phase III studies in these tumours have not been performed. Our objective is to evaluate the effectiveness of chemotherapy in patients with CDT-RTI by a systematic review of published studies. Systematic research of the literature in Medline and Embase databases (among others) was carried out. The full texts of selected references were analysed by two independent reviewers and then assessed for risk of bias in each study. We also extracted data using specifically designed questionnaires. Later, a qualitative synthesis of results was performed and pooled data were calculated. We found that 16 studies with 473 patients published in the last 40 years were included out of 509 identified references in databases. Thirteen studies (176 patients) included data on response to treatment and histology. Four studies included 70 patients only with well-differentiated non-medullary tumours. Response rate (RR) was 22.1% (0–57%) for 13 studies, 25% for the 176 patients and 27.1% for the 70 patients, with 2.5, 3.4 and 2.8% complete responses respectively. Survival times could not be assessed or pooled due to the lack of data and heterogeneity of the studies, and was determined to have a high risk of bias. Although it has not been possible to find solid evidence about the efficacy of chemotherapy, the results shown indicate that it may have some effectiveness, although this should be proven with well-designed studies using modern drugs.

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Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research

Materials ◽

10.3390/ma13081843 ◽

2020 ◽

Vol 13 (8) ◽

pp. 1843 ◽

Cited By ~ 4

Author(s):

Anna Iliadi ◽

Despina Koletsi ◽

Spyridon N. Papageorgiou ◽

Theodore Eliades

Keyword(s):

Systematic Review ◽

Controlled Trial ◽

Current Data ◽

Risk Of Bias ◽

P Value ◽

Laboratory Studies ◽

Qualitative Synthesis ◽

Safety Considerations

Use of thermoplastic material in orthodontics, either as aligner or as retainer appliances, is common practice and is likely to increase in the years to come. However, no systematic assessment on safety considerations of these adjuncts has been implemented up to date. The aim of this systematic review was to collectively appraise the existing evidence from both clinical and laboratory studies, on whether these appliances are associated with any estrogenic/cytotoxic effects or bisphenol-A (BPA) and monomer leaching. Eight electronic databases were searched with no limits in December 22, 2019, for published and unpublished research. Eligibility criteria comprised of studies of any design, describing use of any type of thermoplastic aligner. Study selection, data extraction and risk of bias (RoB) assessment was done independently, either in duplicate or confirmed by a second reviewer. Random effects meta-analyses of weighted mean differences (WMD) with associated 95% Confidence Intervals (CIs) were planned. Quality of the evidence was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 58 articles were initially identified, while 5 were included in qualitative synthesis and 2 of those contributed to the quantitative syntheses. Four studies were in-vitro, while one was a randomized controlled trial; all assessed some type of orthodontic aligner or retainer, either as-received or retrieved. Risk of bias recordings ranged between unclear and high for all studies. Proliferation induction capacity of thermoplastic appliances’ eluents on MCF-7 cells failed to be confirmed compared to beta-estradiol (2 studies: 5% v/v, WMD: −182.08; 95% CI: −198.83, −165.33; p-value < 0.001; and 20% v/v, WMD: −184.53; 95% CI: −206.17, −162.88; p-value < 0.001). No cytotoxic activity was detected as well. In addition, although evidence from in-vitro studies was indicative of no traceable detection of BPA or other monomers, the findings from a single clinical trial were allied to increased levels of BPA in whole stimulated saliva, after up to 30 days of thermoplastic retainer usage, compared to standard Hawley retainer. The quality of the evidence overall was low to medium. Current data from in-vitro research are indicative of an absence of an estrogenic or cytotoxic effect of thermoplastic aligners or retainers. Regarding BPA or monomer release, evidence from clinical and laboratory studies appear inconsistent.

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Diabetes, Care Homes, and the Influence of Technology on Practice and Care Delivery in Care Homes: Systematic Review and Qualitative Synthesis (Preprint)

10.2196/preprints.11526 ◽

2018 ◽

Author(s):

Rebecca Mathews ◽

Chris O'Malley ◽

Jenny M Hall ◽

Leah Macaden ◽

Sandra MacRury

Keyword(s):

Systematic Review ◽

Diabetes Management ◽

Care Home ◽

Risk Of Bias ◽

Care Homes ◽

Cochrane Library ◽

Qualitative Synthesis ◽

Home Setting ◽

Use Of Technology ◽

Home Community

BACKGROUND Diabetes is increasing in prevalence and complexity in the care home setting, affecting up to a quarter of care home residents. Health outcomes for these residents are impacted by management of the disease, health care professionals (HCPs)’ decision-making skills within the care home setting, and access to specialist services. The use of technology has the potential to recognize opportunities for early intervention that enables efficient responsive care, taking a fundamental role in linking the care home community to wider multidisciplinary teams for support. OBJECTIVE The aim of this paper was to identify evidence that explores factors relevant to the use of technology in and around the care home setting to aid in the management of diabetes. METHODS Databases searched using a structured prespecified approach included: PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), OVID Nursing database, Scopus, MEDLINE, the Cochrane Library, and the King’s Fund from 2012 to 2017: handsearching was undertaken additionally for any gray literature. Preferred Reporting Items for Systematic review and Meta-Analysis Protocol was used as protocol with Risk of Bias in Systematic reviews a tool to assess the risk of bias across studies. Studies had to include interventions that combined technology to or from the care home setting to support residents living with diabetes. RESULTS The combined search strategy identified a total of 493 electronic records. Of these, 171 papers were screened for eligibility, 66 full papers were accessed, and 13 have been included in this study. Qualitative synthesis has identified different strands of research evidence in what and how technology is currently being used in and around care homes to enhance diabetes management. New initiatives and implementations of technology and emerging models of care that included the use of technology have also been included. CONCLUSIONS By triangulating the perspectives of HCPs, practitioners, specialists, and members of the care home community, the authors anticipate that this review will represent an up-to-date, evidence-based overview of the potential for using technology within the care home setting for diabetes management as well as stimulate research in this area.

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Enhanced Medical and Community Face Masks with Antimicrobial Properties: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10184066 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4066

Author(s):

Katy Stokes ◽

Roberto Peltrini ◽

Umberto Bracale ◽

Marcella Trombetta ◽

Leandro Pecchia ◽

...

Keyword(s):

Systematic Review ◽

Infectious Diseases ◽

Disease Transmission ◽

Antimicrobial Properties ◽

Antimicrobial Treatment ◽

Risk Of Bias ◽

Qualitative Synthesis ◽

Antimicrobial Treatments

Face masks help to limit transmission of infectious diseases entering through the nose and mouth. Beyond reprocessing and decontamination, antimicrobial treatments could extend the lifetime of face masks whilst also further reducing the chance of disease transmission. Here, we review the efficacy of treatments pertaining antimicrobial properties to medical face masks, filtering facepiece respirators and non-medical face masks. Searching databases identified 2113 studies after de-duplication. A total of 17 relevant studies were included in the qualitative synthesis. Risk of bias was found to be moderate or low in all cases. Sixteen articles demonstrated success in avoiding proliferation (if not elimination) of viruses and/or bacteria. In terms of methodology, no two articles employed identical approaches to efficacy testing. Our findings highlight that antimicrobial treatment is a promising route to extending the life and improving the safety of face masks. In order to reach significant achievements, shared and precise methodology and reporting is needed.

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The association between ambient air pollution and pulmonary tuberculosis: a systematic review protocol

Environmental Evidence ◽

10.1186/s13750-020-00213-9 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Christian Akem Dimala ◽

Benjamin Momo Kadia ◽

Anna Hansell

Keyword(s):

Systematic Review ◽

Air Pollution ◽

Pulmonary Tuberculosis ◽

Hospital Admission ◽

Air Pollutants ◽

Hospital Admissions ◽

Ambient Air ◽

Risk Of Bias ◽

Ambient Air Pollution ◽

Cochrane Library

Abstract Background There is inconclusive evidence on the association between ambient air pollution and pulmonary tuberculosis-related hospital admission and mortality. This review aims to assess if and to what extent, selected air pollutants are associated to pulmonary tuberculosis (PTB) incidence, hospital admissions and mortality. Methods This will be a systematic review and meta-analysis of studies published in English between January 1st, 1946 and October 31st, 2020, quantitatively assessing the association between air pollutants and PTB incidence, hospital admissions and mortality. A comprehensive search strategy will be used to search the databases: Medline, Embase, Scopus and The Cochrane Library. Retrieved studies will be screened based on the set eligibility criteria and data will be extracted from eligible studies. Extracted data will be analysed on STATA version 14.0 software. Studies included will be assessed for their quality using the respective Study Quality Assessment Tools of the National Health Institute. The quality of the evidence on the study outcomes will be graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The risk of bias will be assessed using Cochrane’s Risk of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Study characteristics, socio-demographic and clinical characteristics across eligible studies will be summarised and presented. Pooled estimates of the measures of association between air pollutants and PTB incidence, hospital admission and mortality will be obtained through random-effect meta-analyses models and the respective I2 test statistics will be reported. Meta-regression analyses will be done in case of significant between-study heterogeneity.

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