The Effect of Overdose Education and Naloxone Distribution: An Umbrella Review of Systematic Reviews

2021 ◽  
pp. e1-e12
Author(s):  
Amir Razaghizad ◽  
Sarah B. Windle ◽  
Kristian B. Filion ◽  
Genevieve Gore ◽  
Irina Kudrina ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Reviews ◽  
Optimal Strategies ◽  
Risk Of Bias ◽  
Opioid Overdose ◽  
Umbrella Review ◽  
High Concentration ◽  
Exclusion Criteria ◽  
High Quality Research ◽  
Reported Data

Background. Opioids contribute tomore than 60 000 deaths annually in North America. While the expansion of overdose education and naloxone distribution (OEND) programs has been recommended in response to the opioid crisis, their effectiveness remains unclear. Objectives. To conduct an umbrella review of systematic reviews to provide a broad-based conceptual scheme of the effect and feasibility of OEND and to identify areas for possible optimization. Search Methods. We conducted the umbrella review of systematic reviews by searching PubMed, Embase, PsycINFO, Epistemonikos, the Cochrane Database of Systematic Reviews, and the reference lists of relevant articles. Briefly, an academic librarian used a 2-concept search, which included opioid subject headings and relevant keywords with a modified PubMed systematic review filter. Selection Criteria. Eligible systematic reviews described comprehensive search strategies and inclusion and exclusion criteria, evaluated the quality or risk of bias of included studies, were published in English or French, and reported data relevant to either the safety or effectiveness of OEND programs, or optimal strategies for the management of opioid overdose with naloxone in out-of-hospital settings. Data Collection and Analysis. Two reviewers independently extracted study characteristics and the quality of included reviews was assessed in duplicate with AMSTAR-2, a critical appraisal tool for systematic reviews. Review quality was rated critically low, low, moderate, or high based on 7 domains: protocol registration, literature search adequacy, exclusion criteria, risk of bias assessment, meta-analytical methods, result interpretation, and presence of publication bias. Summary tables were constructed, and confidence ratings were provided for each outcome by using a previously modified version of the Royal College of General Practitioners’ clinical guidelines. Main Results. Six systematic reviews containing 87 unique studies were included.We found that OEND programs produce long-term knowledge improvement regarding opioid overdose, improve participants’ attitudes toward naloxone, provide sufficient training for participants to safely and effectivelymanage overdoses, and effectively reduce opioid-relatedmortality. High-concentration intranasal naloxone (.2mg/mL) was as effective as intramuscular naloxone at the same dose, whereas lower-concentration intranasal naloxone was less effective. Evidence was limited for other naloxone formulations, as well as the need for hospital transport after overdose reversal. The preponderance of evidence pertained persons who use heroin. Author's Conclusions. Evidence suggests that OEND programs are effective for reducing opioid-related mortality; however, additional high-quality research is required to optimize program delivery. Public Health Implications. Community-based OEND programs should be implemented widely in high-risk populations. (Am J Public Health. Published online ahead of print July 2, 2021: e1–e12. https://doi.org/10.2105/AJPH.2021.306306 )

The Effect of Overdose Education and Naloxone Distribution: An Umbrella Review of Systematic Reviews

2021 ◽  
Vol 111 (8) ◽  
pp. 1516-1517
Author(s):  
Amir Razaghizad ◽  
Sarah B. Windle ◽  
Kristian B. Filion ◽  
Genevieve Gore ◽  
Irina Kudrina ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Optimal Strategies ◽  
Risk Of Bias ◽  
Opioid Overdose ◽  
Umbrella Review ◽  
High Concentration ◽  
Exclusion Criteria ◽  
High Quality Research ◽  
Reported Data ◽  
Related Mortality

Background. Opioids contribute to more than 60 000 deaths annually in North America. While the expansion of overdose education and naloxone distribution (OEND) programs has been recommended in response to the opioid crisis, their effectiveness remains unclear. Objectives. To conduct an umbrella review of systematic reviews to provide a broad-based conceptual scheme of the effect and feasibility of OEND and to identify areas for possible optimization. Search Methods. We conducted the umbrella review of systematic reviews by searching PubMed, Embase, PsycINFO, Epistemonikos, the Cochrane Database of Systematic Reviews, and the reference lists of relevant articles. Briefly, an academic librarian used a 2-concept search, which included opioid subject headings and relevant keywords with a modified PubMed systematic review filter. Selection Criteria. Eligible systematic reviews described comprehensive search strategies and inclusion and exclusion criteria, evaluated the quality or risk of bias of included studies, were published in English or French, and reported data relevant to either the safety or effectiveness of OEND programs, or optimal strategies for the management of opioid overdose with naloxone in out-of-hospital settings. Data Collection and Analysis. Two reviewers independently extracted study characteristics and the quality of included reviews was assessed in duplicate with AMSTAR-2, a critical appraisal tool for systematic reviews. Review quality was rated critically low, low, moderate, or high based on 7 domains: protocol registration, literature search adequacy, exclusion criteria, risk of bias assessment, meta-analytical methods, result interpretation, and presence of publication bias. Summary tables were constructed, and confidence ratings were provided for each outcome by using a previously modified version of the Royal College of General Practitioners’ clinical guidelines. Main Results. Six systematic reviews containing 87 unique studies were included. We found that OEND programs produce long-term knowledge improvement regarding opioid overdose, improve participants’ attitudes toward naloxone, provide sufficient training for participants to safely and effectively manage overdoses, and effectively reduce opioid-related mortality. High-concentration intranasal naloxone (> 2 mg/mL) was as effective as intramuscular naloxone at the same dose, whereas lower-concentration intranasal naloxone was less effective. Evidence was limited for other naloxone formulations, as well as the need for hospital transport after overdose reversal. The preponderance of evidence pertained persons who use heroin. Author’s Conclusions. Evidence suggests that OEND programs are effective for reducing opioid-related mortality; however, additional high-quality research is required to optimize program delivery. Public Health Implications. Community-based OEND programs should be implemented widely in high-risk populations.

scholarly journals The state of child nutrition in Ethiopia: an umbrella review of systematic review and meta-analysis reports

2020 ◽  
Author(s):  
Shimels Hussien Mohammed ◽  
Tesfa Dejenie Habtewold ◽  
Amanuel Godana Arero ◽  
Ahmad Esmaillzadeh
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Systematic Reviews ◽  
Complementary Feeding ◽  
Meta Analysis ◽  
Feeding Practices ◽  
The State ◽  
Umbrella Review ◽  
Child Feeding ◽  
Timely Initiation

Abstract Background Malnutrition remains to be a major public health problem in developing countries, particularly among children under-5 years of age children who are more vulnerable to both macro and micro-nutrient deficiencies. Various systematic review and meta-analysis (SRM) studies were done on nutritional statuses of children in Ethiopia, but no summary of the findings was done on the topic. Thus, this umbrella review was done to summarize the evidence from SRM studies on the magnitude and determinants of malnutrition and poor feeding practices among under-5 children in Ethiopia. Methods PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Google Scholar were searched for SRM studies on magnitude and risk factors of malnutrition and child feeding practice indicators in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and determinants of stunting, wasting, underweight, and poor child feeding practices were pooled and summarized with random-effects meta-analysis models. Result We included nine SRM studies, containing a total of 214,458 under-5 children from 255 observation studies. The summary estimates of prevalence of stunting, underweight, and wasting were 42% (95%CI=37-46%), 33% (95%CI=27-39%), and 15% (95%CI=12-19%), respectively. The proportion of children who met the recommendations for timely initiation of breastfeeding, exclusive breastfeeding during the first 6 months, and timely initiation of complementary feeding were 65%, 60%, and 62%, respectively. The proportion of children who met the recommendations for dietary diversity and meal frequency were 20%, and 56%, respectively. Only 10% of children fulfilled the minimum criteria of acceptable diet. There was a strong relationship between poor feeding practices and the state of malnutrition, and both conditions were related to various health, socio-economic, and environmental factors. Conclusion Child malnutrition and poor feeding practices are highly prevalent and of significant public health concern in Ethiopia. Only few children are getting proper complementary feeding. Multi-sectoral efforts are needed to improve children’s feeding practices and reduce the high burden of malnutrition in the country.

Are Wearable Devices Effective for Preventing and Detecting Falls: An Umbrella Review (A Review of Systematic Reviews)

2021 ◽  
Author(s):  
Daniel Joseph Warrington ◽  
Elizabeth Shortis ◽  
Paula Jane Whittaker
Keyword(s):  
Systematic Reviews ◽  
Low Cost ◽  
Meta Analysis ◽  
Wearable Devices ◽  
Umbrella Review ◽  
Comprehensive Overview ◽  
High Quality Research ◽  
Multiple Sensors ◽  
Specificity And Sensitivity ◽  
Cochrane Database

Abstract Background: Falls are a common and serious health issue facing the global population, causing an estimated 646,000 deaths per year globally. Wearable devices typically combine accelerometers, gyroscopes and even barometers; using the data collected and inputting this into an algorithm that decides whether a fall has occurred. The purpose of this umbrella review was to provide a comprehensive overview of the systematic reviews on the effectiveness of wearable electronic devices for falls detection in adults.Methods: MEDLINE, Embase, Cochrane Database of Systematic Reviews (CDSR), and CINAHL, were searched from their inceptions until April 2019 for systematic reviews that assessed the accuracy of wearable technology in the detection of falls.Results: Seven systematic reviews were included in this review. Due to heterogeneity between the included systematic reviews in their methods and their reporting of results, a meta-analysis could not be performed. Most devices tested used accelerometers, often in combination with gyroscopes. Three systematic reviews reported an average sensitivity of 93.1% or greater and an average specificity of 86.4% or greater for the detection of falls. Placing sensors on the trunk, foot or leg appears to provide the highest accuracy for falls detection, with multiple sensors increasing the accuracy, specificity, and sensitivity of these devices. Conclusions: This review demonstrated that wearable device technology offers a low-cost and accurate way to effectively detect falls and summon for help. There are significant differences in the effectiveness of these devices depending on the type of device and its placement. Further high-quality research is needed to confirm the accuracy of these devices in frail older people in real-world settings.

scholarly journals The effect of different COVID-19 public health restrictions on mobility: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260919
Author(s):  
Mark A. Tully ◽  
Laura McMaw ◽  
Deepti Adlakha ◽  
Neale Blair ◽  
Jonny McAneney ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Risk Of Bias ◽  
Narrative Synthesis ◽  
Evidence Database ◽  
The Individual ◽  
Reported Data ◽  
Individual Strategies ◽  
The Impact ◽  
At Home

Background In response to the COVID-19 pandemic, most countries have introduced non-pharmaceutical interventions, such as stay-at-home orders, to reduce person-to-person contact and break trains of transmission. The aim of this systematic review was to assess the effect of different public health restrictions on mobility across different countries and cultures. The University of Bern COVID-19 Living Evidence database of COVID-19 and SARS-COV-2 publications was searched for retrospective or prospective studies evaluating the impact of COVID-19 public health restrictions on Google Mobility. Titles and abstracts were independently screened by two authors. Information from included studies was extracted by one researcher and double checked by another. Risk of bias of included articles was assessed using the Newcastle Ottowa Scale. Given the heterogeneous nature of the designs used, a narrative synthesis was undertaken. From the search, 1672 references were identified, of which 14 were included in the narrative synthesis. All studies reported data from the first wave of the pandemic, with Google Mobility Scores included from January to August 2020, with most studies analysing data during the first two months of the pandemic. Seven studies were assessed as having a moderate risk of bias and seven as a low risk of bias. Countries that introduced more stringent public health restrictions experienced greater reductions in mobility, through increased time at home and reductions in visits to shops, workplaces and use of public transport. Stay-at-home orders were the most effective of the individual strategies, whereas mask mandates had little effect of mobility. Conclusions Public health restrictions, particularly stay-at-home orders have significantly impacted on transmission prevention behaviours. Further research is required to understand how to effectively address pandemic fatigue and to support the safe return back to normal day-to-day behaviours.

scholarly journals Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
V J McGowan ◽  
S. Buckner ◽  
R. Mead ◽  
E. McGill ◽  
S. Ronzi ◽  
...  
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Health Outcomes ◽  
Health Inequalities ◽  
Systematic Reviews ◽  
Future Research ◽  
Primary Study ◽  
Umbrella Review ◽  
The Impact ◽  
Health And Health Inequalities

Abstract Background Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. Methods Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). Results Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms – can all have positive impacts on health outcomes – particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. Conclusions Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. Trial registration PROSPERO CRD42019158309

What public health strategies work to reduce the tobacco demand among young people? An umbrella review of systematic reviews and meta-analyses

Health Policy ◽  
2019 ◽  
Vol 123 (5) ◽  
pp. 480-491 ◽  
Author(s):  
Alice Mannocci ◽  
Insa Backhaus ◽  
Valeria D’Egidio ◽  
Antonio Federici ◽  
Paolo Villari ◽  
...  
Keyword(s):  
Public Health ◽  
Young People ◽  
Systematic Reviews ◽  
Umbrella Review ◽  
Meta Analyses ◽  
Public Health Strategies

scholarly journals The state of child nutrition in Ethiopia: an umbrella review of systematic review and meta-analysis reports

2020 ◽  
Author(s):  
Shimels Hussien Mohammed ◽  
Tesfa Dejenie Habtewold ◽  
Amanuel Godana Arero ◽  
Ahmad Esmaillzadeh
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Systematic Reviews ◽  
Complementary Feeding ◽  
Meta Analysis ◽  
Feeding Practices ◽  
The State ◽  
Umbrella Review ◽  
Child Feeding ◽  
Timely Initiation

Abstract BackgroundMalnutrition remains to be a major public health problem in developing countries, particularly among children under-5 years of age children who are more vulnerable to both macro and micro-nutrient deficiencies. Various systematic review and meta-analysis (SRM) studies were done on nutritional statuses of children in Ethiopia, but no summary of the findings was done on the topic. Thus, this umbrella review was done to summarize the evidence from SRM studies on the magnitude and determinants of malnutrition and poor feeding practices among under-5 children in Ethiopia. Methods PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Google Scholar were searched for SRM studies on magnitude and risk factors of malnutrition and child feeding practice indicators in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and determinants of stunting, wasting, underweight, and poor child feeding practices were pooled and summarized with random-effects meta-analysis models. ResultWe included nine SRM studies, containing a total of 214,458 under-5 children from 255 observation studies. The summary estimates of prevalence of stunting, underweight, and wasting were 42% (95%CI=37-46%), 33% (95%CI=27-39%), and 15% (95%CI=12-19%), respectively. The proportion of children who met the recommendations for timely initiation of breastfeeding, exclusive breastfeeding during the first 6 months, and timely initiation of complementary feeding were 65%, 60%, and 62%, respectively. The proportion of children who met the recommendations for dietary diversity and meal frequency were 20%, and 56%, respectively. Only 10% of children fulfilled the minimum criteria of acceptable diet. There was a strong relationship between poor feeding practices and the state of malnutrition, and both conditions were related to various health, socio-economic, and environmental factors. ConclusionChild malnutrition and poor feeding practices are highly prevalent and of significant public health concern in Ethiopia. Only a few children are getting proper complementary feeding. Multi-sectoral efforts are needed to improve children’s feeding practices and reduce the high burden of malnutrition in the country.

scholarly journals Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low- and middle-income countries (LMICs): An umbrella review

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0251905
Author(s):  
Elodie Besnier ◽  
Katie Thomson ◽  
Donata Stonkute ◽  
Talal Mohammad ◽  
Nasima Akhter ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Diseases ◽  
Health Inequalities ◽  
Systematic Reviews ◽  
Health Interventions ◽  
Umbrella Review ◽  
Public Health Interventions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disadvantaged Groups

Despite significant progress in the last few decades, infectious diseases remain a major threat to child health in low- and middle-income countries (LMICs)—particularly amongst more disadvantaged groups. It is imperative to understand the best available evidence concerning which public health interventions reduce morbidity, mortality and health inequalities in children aged under five years. To address this gap, we carried out an umbrella review (a systematic reviews of reviews) to identify evidence on the effects of public health interventions (promotion, protection, prevention) on morbidity, mortality and/or health inequalities due to infectious diseases amongst children in LMICs. Ten databases were searched for records published between 2014–2021 alongside a manual search of gray literature. Articles were quality-assessed using the Assessment of Multiple Systematic Reviews tool (AMSTAR 2). A narrative synthesis was conducted. We identified 60 systematic reviews synthesizing 453 individual primary studies. A majority of the reviews reported on preventive interventions (n = 48), with a minority on promotion (n = 17) and almost no reviews covering health protection interventions (n = 2). Effective interventions for improving child health across the whole population, as well as the most disadvantaged included communication, education and social mobilization for specific preventive services or tools, such as immunization or bed nets. For all other interventions, the effects were either unclear, unknown or detrimental, either at the overall population level or regarding health inequalities. We found few reviews reporting health inequalities information and the quality of the evidence base was generally low. Our umbrella review identified some prevention interventions that might be useful in reducing under five mortality from infectious diseases in LMICs, particularly amongst the most disadvantaged groups.

scholarly journals Are wearable devices effective for preventing and detecting falls: an umbrella review (a review of systematic reviews)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Joseph Warrington ◽  
Elizabeth Jane Shortis ◽  
Paula Jane Whittaker
Keyword(s):  
Systematic Reviews ◽  
Low Cost ◽  
Meta Analysis ◽  
Wearable Devices ◽  
Umbrella Review ◽  
Comprehensive Overview ◽  
High Quality Research ◽  
Multiple Sensors ◽  
Specificity And Sensitivity ◽  
Cochrane Database

Abstract Background Falls are a common and serious health issue facing the global population, causing an estimated 646,000 deaths per year globally. Wearable devices typically combine accelerometers, gyroscopes and even barometers; using the data collected and inputting this into an algorithm that decides whether a fall has occurred. The purpose of this umbrella review was to provide a comprehensive overview of the systematic reviews on the effectiveness of wearable electronic devices for falls detection in adults. Methods MEDLINE, Embase, Cochrane Database of Systematic Reviews (CDSR), and CINAHL, were searched from their inceptions until April 2019 for systematic reviews that assessed the accuracy of wearable technology in the detection of falls. Results Seven systematic reviews were included in this review. Due to heterogeneity between the included systematic reviews in their methods and their reporting of results, a meta-analysis could not be performed. Most devices tested used accelerometers, often in combination with gyroscopes. Three systematic reviews reported an average sensitivity of 93.1% or greater and an average specificity of 86.4% or greater for the detection of falls. Placing sensors on the trunk, foot or leg appears to provide the highest accuracy for falls detection, with multiple sensors increasing the accuracy, specificity, and sensitivity of these devices. Conclusions This review demonstrated that wearable device technology offers a low-cost and accurate way to effectively detect falls and summon for help. There are significant differences in the effectiveness of these devices depending on the type of device and its placement. Further high-quality research is needed to confirm the accuracy of these devices in frail older people in real-world settings.

scholarly journals The prevalence of type 2 diabetes in people with psychiatric disorders: an umbrella review protocol

2020 ◽  
Author(s):  
Nanna Lindekilde ◽  
Stine Scheuer ◽  
Femke Rutters ◽  
Jan Erik Henriksen ◽  
Katrine Hass Rubin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Psychiatric Disorder ◽  
Systematic Reviews ◽  
Clinical Care ◽  
Risk Of Bias ◽  
Umbrella Review ◽  
Control Groups ◽  
Cross Sectional

Abstract Background: Many epidemiological studies have investigated the prevalence of type 2 diabetes in individuals with a psychiatric disorder. In an umbrella review, we aim to systematically summarize existing systematic reviews examining the prevalence of type 2 diabetes in people with a psychiatric disorder. When information is available in the identified systematic reviews, comparisons with control groups without a psychiatric disorder will be made. Furthermore, we aim to assess the quality of the included systematic reviews. Methods: The umbrella review will be based on a comprehensive systematic search of systematic reviews of observational (cross-sectional or longitudinal) studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. Four electronic databases (Embase, PsycINFO, PubMed and the Cochrane Database of Systematic Reviews) will be searched. Retrieved papers will be screened for eligibility by two independent reviewers. Furthermore, the reference lists of all included publications will be screened. Data will be extracted by using an a priori developed data extraction form and two independent reviewers will assess the risk of bias in the included systematic reviews using with the Risk of Bias in Systematic Reviews (ROBIS) tool. A narrative data-synthesis and a subsequent meta-analysis based on the primary studies will be made. Discussion: For each psychiatric disorder, the data regarding the prevalence of type 2 diabetes will be summarized and discussed. When possible, comparisons with control groups will be reported and discussed. Finally, future implications and recommendations for clinical care will be presented. Systematic review registration: (registration number) Keywords: Type 2 diabetes, Psychiatric disorder, Prevalence, Umbrella review, Systematic review

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