Risk Factors for Musculoskeletal Complaints in Female Musicians: A Systematic Review and Exploration for Future Studies

BACKGROUND: Female musicians are prone to the development of musculoskeletal complaints (MSC). The etiology of this increased risk is poorly understood. As the number of professional female musicians increases, so does the importance of understanding female-specific risk factors for MSC in musicians. OBJECTIVE: To provide an overview of current literature of proven and possible risk factors/etiology of MSC in female musicians, and to identify topics for future studies. METHODS: Systematic review performed according to international guidelines. A database search was performed in MEDLINE (PubMed), Embase, CINAHL, Cochrane, PsycINFO, clinicaltrials.gov, and gray literature. Studies were independently selected and rated by two reviewers. QUIPS and STROBE guidelines were used for assessing quality and risk of bias. Risk factors were categorized by means of the theoretical framework of the International Classification of Functioning (ICF) and evaluated using the Bradford Hill criteria for causality. RESULTS: Out of 1,924 records, 10 eligible studies were included. A low to moderate level of methodological quality was present in the studies. Fifteen risk factors could be identified from the included studies, which were positioned in the ICF model. The two most frequently mentioned female-specific risk factors were hand size and joint laxity. None of the risk factors fulfilled Bradford Hill’s criteria for causality. Many other risk factors were suggested, while a number of expected causes were not encountered. CONCLUSION: At this moment, no evidence-based deductions can be made about female-specific risk factors for MSC in musicians. There is a lack of high-quality studies in this field and a need for studies with a different focus and a prospective study design.

Effectiveness of Take-Home Naloxone Programs in Athletic Training: An Evidence-to-Practice Review

The number of opioid overdoses (ODs) has risen in recent years and has become more complex due to the co-involvement of both prescription and illicit opioid drug use. Provisional programs for take-home naloxone (a medication designed to rapidly reverse opiate OD symptoms) kits have been distributed to combat this potentially fatal epidemic. Although there is strong evidence to support the efficacy of naloxone in the reversal of opiate OD, there is limited evidence to support the efficacy of take-home naloxone (THN) kits. The purpose of this evidence-to-practice review was to summarize a systematic review on the efficacy of THN programs. The authors aimed to include studies of THN programs that both trained opioid users in OD prevention and reported on OD outcomes. The Bradford Hill criteria (strength of association, temporality, consistency, specificity, dose-response relationship, biological plausibility, coherence, experimental evidence, and analogy) and five additional criteria (measure cost-effectiveness, absence of negative consequences, feasibility of implementation/expansion/ coverage, unanticipated benefits, and special populations) was used as dependent variables to determine the impact of public health intervention where randomized control trials (RCTs) are not ethically feasible or operationally practical. All 22 studies included provided empirical support using the Bradford Hill Criteria for community based THN programs. Despite being unable to deduce whether death would have occurred without the administration of THN, the studies combined accounted for an estimated 2316 successful opioid OD reversals. Thus, there is a strong association between THN administration and overdose survival. Additionally, there was a low rate of adverse events: withdrawal symptoms (2.8%), vomiting (2.2%), agitation (2.1%), seizures (0.1%). Consequently, we recommend that athletic trainers include opioid crisis management equipment and procedures in a site-specific policies manual. Clinical relevance is highly dependent on patient population and geographic location, considering 90% of reversed ODs were heroin induced. Application to individuals in organized sport is minimal, but nonetheless, individuals who are prescribed opioids for pain management should be candidates for THN programs. Athletic trainers and guardians of minors prescribed opioid medications should be educated on dispensing medication, best practices for opioid crisis management, and distribution of naloxone/THN.

Risicofactoren van psychotische symptomen en hun causaliteit: een overzicht

Risk factors of psychotic symptoms and their causality: an overview. Psychotic symptoms exist on a continuum in both clinical and non-clinical populations. The purpose of this review article is to provide a concise overview of the most studied risk factors ensuring a person moves along the continuum and exhibits more psychotic symptoms. A possible causal relationship is evaluated for every risk factor using the Bradford Hill criteria for causation. This literature study could show a strong association, dose-response relationship and temporal relationship between cannabis use and psychotic symptoms on the one hand and amphetamine use and psychotic symptoms on the other. Furthermore, a few biologically plausible mechanisms could be withheld, whereby a causal relationship seems likely in both cases. Regarding sleep problems, childhood victimization, urbanicity and demographic factors, there was sufficient scientific evidence in the literary study for this article to withhold an association with psychotic symptoms.

Construction of Mode of Action for Cadmium-Induced Renal Tubular Dysfunction Based on a Toxicity Pathway-Oriented Approach

Although it is recognized that cadmium (Cd) causes renal tubular dysfunction, the mechanism of Cd-induced nephrotoxicity is not yet fully understood. Mode of action (MOA) is a developing tool for chemical risk assessment. To establish the mechanistic MOA of Cd-induced renal tubular dysfunction, the Comparative Toxicogenomics Database (CTD) was used to obtain genomics data of Cd-induced nephrotoxicity, and Ingenuity® Pathway Analysis (IPA) software was applied for bioinformatics analysis. Based on the perturbed toxicity pathways during the process of Cd-induced nephrotoxicity, we established the MOA of Cd-induced renal tubular dysfunction and assessed its confidence with the tailored Bradford Hill criteria. Bioinformatics analysis showed that oxidative stress, DNA damage, cell cycle arrest, and cell death were the probable key events (KEs). Assessment of the overall MOA of Cd-induced renal tubular dysfunction indicated a moderate confidence, and there are still some evidence gaps to be filled by rational experimental designs.

Dorsal expansion-related manual disability in verrucae vulgaris patients treated with cryotherapy: A longitudinal study via big data

Background: Common warts frequently occur over the hands and may overlie critical structures, including the extensor expansion of the digits, for which cryotherapy can lead to manual disability. Aims and Objectives: We aim to implement big data to infer knowledge on the interest of web users regarding the dorsal expansion-related manual disability in verrucae vulgaris patients managed with cryotherapy. Materials and Methods: We mapped the interest of users of the surface web in connection with five topics: cryosurgery, extensor digitorum muscle, human papillomavirus, manual disability, and verruca vulgaris. We retrieved longitudinal data [2004-2019] concerning the spatio-temporal variations of interest in these topics, using Google Trends. We are also reporting a case of interest while analyzing it using the Bradford Hill criteria. Results: Sixty-four nations contributed to the spatial (geographic) map, including ten countries from the Middle East and the north of Africa (15.63%). There was high temporal variability concerning cryosurgery 29.61 (+/- 0.94), extensor digitorum muscle 64.43 (+/- 0.86), human papillomavirus 0.01 (+/- 0.01), manual disability 2.89 (+/- 0.13), and verruca vulgaris 9.39 (+/- 0.20). Conjoint inference, via Post-Hoc testing and neural networks [machine learning], assigned the highest synaptic weight [effect size] to “cryosurgery” and “extensor digitorum muscle”, thus indicating that these topics are of prime interest for web users, including anatomists and dermatologists. Conclusions: We are conveying two messages: 1) Dermatologists are encouraged to collaborate with data scientists to realize the importance of big data for evidence-based dermatology. 2) Physicians should exercise extra caution in managing patients with verrucae vulgaris using cryotherapy.

Onchocerca volvulus and epilepsy: A comprehensive review using the Bradford Hill criteria for causation

Background The possibility that onchocerciasis may cause epilepsy has been suggested for a long time, but thus far, an etiological link has not been universally accepted. The objective of this review is to critically appraise the relationship between Onchocerca volvulus and epilepsy and subsequently apply the Bradford Hill criteria to further evaluate the likelihood of a causal association. Methods PubMed and gray literature published until September 15, 2020, were searched and findings from original research were synthesized. Adherence to the 9 Bradford Hill criteria in the context of onchocerciasis and epilepsy was determined to assess whether the criteria are met to strengthen the evidence base for a causal link between infection with O. volvulus and epilepsy, including the nodding syndrome. Results Onchocerciasis as a risk factor for epilepsy meets the following Bradford Hill criteria for causality: strength of the association, consistency, temporality, and biological gradient. There is weaker evidence supporting causality based on the specificity, plausibility, coherence, and analogy criteria. There is little experimental evidence. Considering the Bradford Hill criteria, available data suggest that under certain conditions (high microfilarial load, timing of infection, and perhaps genetic predisposition), onchocerciasis is likely to cause epilepsy including nodding and Nakalanga syndromes. Conclusion Applying the Bradford Hill criteria suggests consistent epidemiological evidence that O. volvulus infection is a trigger of epilepsy. However, the pathophysiological mechanisms responsible for seizure induction still need to be elucidated.

Ibuprofen and risk of hypoglycemia in diabetic and non-diabetic consumers: analysis of international pharmacovigilance data

Introduction: Ibuprofen was associated with hypoglycemia in a single published case report in a diabetic patient. Ibuprofen, however, has never been associated so far with hypoglycemia in previously healthy non-diabetic individuals and thus, it is not listed as adverse effect in its summary of product characteristics approved by major regulatory authorities. Objective: This study was conducted to assess the causal relationship between ibuprofen and hypoglycemia in diabetic and non-diabetic individuals. Materials and Methods: Analysis of the literature and the WHO global database of individual case safety reports, VigiBase, was made to explore evidence on the association of ibuprofen and hypoglycemia. The unpublished data and the currently availablepublished toxicological, biological, clinical and epidemiological evidence, if any, was systematically organized using Austin Bradford Hill criteria, causality assessment framework, to assess the causal link between ibuprofen and hypoglycemia. Results: In VigiBase, there were 125 cases of hypoglycemia associated with ibuprofen, reported from 19 countries. About 50% had history of diabetes. Ibuprofen was reported as sole suspect in 36.8% of the cases and the only drug administered in18.4%. Hypoglycemia resolved following discontinuation of ibuprofen in 21.6% and recurred in three patients with rechallenge. Outcome was fatal in 10.5%. Where ibuprofen was solely administered, median time-to-onset of hypoglycemia was one-day following administration of the drug. In an experimental study, a significant decrease in blood glucose level was observed at a higher dose of ibuprofen compared to a low-dose. Conclusion: Currently available totality of evidence reflects a possible causal association between ibuprofen and hypoglycemia that need to be substantiated with further studies.