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1.
Respiration ; 101(4):422-432, 2022.
Article in English | GIM | ID: covidwho-1840677

ABSTRACT

Background: Surgical lung biopsy (SLB) is performed in patients with acute respiratory distress syndrome (ARDS);however, its clinical utility remains unclear. Objectives: We categorized the pathological diagnoses and investigated the predictive value for short-term mortality. Method: Three electronic databases (MEDLINE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) were searched for the included studies. The QUADAS-2 was used to evaluate the risk of bias and its applicability. The types and populations of pathological diagnoses were investigated. The pooled sensitivity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were estimated at a fixed specificity. Hierarchical summary receiver operating characteristic curves were drawn.

2.
British Journal of Clinical Pharmacology ; 88(4):1567-1589, 2021.
Article in English | GIM | ID: covidwho-1840337

ABSTRACT

Aims: Growing evidence suggests an association between the use of sedative-hypnotic medications and risk of dementia. The aim of this study is to examine this association using a meta-analysis approach.

3.
Millat-Martinez, Pere, Gharbharan, Arvind, Alemany, Andrea, Casper, Rokx, Geurtsvankessel, Corine, Papageourgiou, Grigorios, Nan, van Geloven, Jordans, Carlijn, Groeneveld, Geert, Swaneveld, Francis, van der Schoot, Ellen, Corbacho-Monné, Marc, Ouchi, Dan, Piccolo Ferreira, Francini, Malchair, Pierre, Videla, Sebastian, García García, Vanesa, Ruiz-Comellas, Anna, Ramírez-Morros, Anna, Rodriguez Codina, Joana, Amado, Simon Rosa, Joan-Ramon, Grifols, Blanco, Julian, Blanco, Ignacio, Ara, Jordi, Bassat, Quique, Bonaventura, Clotet, Baro, Bàrbara, Troxel, Andrea, Zwaginga, Jaap Jan, Mitjà, Oriol, Rijnders Bart, J. A.; Rijnders, Bart, Katsikis, Peter, Müller, Yvonne, Koopmans, Marion, Bogers, Susanne, Miedema, Jelle, Russcher, Henk, Scherpenisse, Cees, van Engen, Rene, Karisli, Ayten, Götz, Hannelore, Struik, Jelle, Rokx-Niemantsverdriet, Lotte, Jan Zwaginga, Jaap, Zwaginga, Lisa, Oud, Josine, Meier, Romy, van Zwet, Erik, Mooijaart, Simon, Albersen, Arjan, Vrielink, Hans, van de Watering, Leo, Hogema, Boris, van Wijngaarden, Peter, van Etten, Ronald, van Gammeren, Adriaan, Maas, Nanda, van Ginneken, Betty, den Hollander, Jan, Verstijnen, Jose, van den Berg – Rahman, Juliette, Karim, Faiz, Siepke, Hiddema, van Elst, Kim, van Leeuwen-Segarceanu, Elena, Reitsma, Annette, Molenkamp, Karin, Soetekouw, Robert, Band, Caterina, de Droog, José, Lammers, Jolanda, Buitenhuis, Lonneke, Postma, Douwe, Koster, David, Lukens, Michaèl, Scholtens, Thea, van den Boomgaard, Maartje, Vonk, Machiel, Kampschreur, Linda, van Vonderen, Marit, Vrolijk, Loes, Reusken, Chantal, Reimerink, Johan, Harvala, Heli, Costes, Gèlia, Capdevila-Jáuregui, Mar, Torrano-Soler, Pamela, San José, Alba, Jiménez, Zahida, Ramírez-Viaplana, Ferran, Ferrer, Susana, Gallardo, Mireia, Ubals, Maria, González-Beiras, Camila, Vall-Mayans, Martí, Rodriguez-Arias, Miquel Angel, Suñer, Clara, Puig, Jordi, Nieto, Aroa, Galvan-Femenia, Ivan, Comas-Leon, Xavier, Millat-Martínez, Pere, Bonet Papell, Glòria, Delgado Capel, Maria, Díez Sánchez, Beatriz, Pons Barber, Maria, Gonzalez Ruiz, Cristian, Navarrete Gonzalez, Laura, González García, David, Vivero Larraza, Ainhoa, Carceles Peiró, Victor, Roquer López, Clàudia, Ferrer, Magí, Gudiol, Carlota, Otero, Aurema, Ruibal Suarez Jose, Carlos, Pellejero Alvaro, Zarauza, Llopis Roca, Ferran, Rodriguez Cortez, Orlando, Casares Gonzalez, Pablo, Arcos Vila, Gemma, Flores Aguilera, Begoña, Rodríguez-Sevilla, Graciela, Dastis Arias, Macarena, Roca Font, Judit, Carrasco Matos Katherine, M.; Glòria, Saüch Valmaña, Vidal Obradors, Carla, Rodríguez Codina, Joana, Tarres García, Silvia, Curriu, Sabatès Margarida, Nieto Rodríguez, Raquel, Joan-Ramon, Grífols, Millan, Anna, Contreras, Enric, Ancochea, Àgueda, Línio, Rosa, Fornos, Miriam, Casamitjana, Natàlia, Alonso, Eva, Martinez, Núria, Maglio, Laura Analía, Comellas Fernandez, Laura, Garcia, Nadia, Hernández, Luis, González, María Isabel, Bravo, Anna, García, Yolanda, Prat, Núria, Verdaguer, Joaquim, Vértiz Guidotti, Thatiana, Benavent, Sergio, Bianco, Andrea Sofia, Briones Zambrano Ney, Nicanor, Viozquez Meya, Maria, Forcada, Anna, Vidal-Alaball, Josep, Giménez, Montserrat, París, Alexa, Fernández, Rivas Gema, Casañ Lopez, Cristina, Hernández, Águeda, Bordoy, Antoni E.; González Soler, Victoria, Edwars, Pradenas, Marfil, Silvia, Trinité, Benjamin, Bonet, Mireia, Cantoni, Jordi, Marks, Michael.
Nature Communications ; 13(1), 2022.
Article in English | ProQuest Central | ID: covidwho-1839524

ABSTRACT

Data on convalescent plasma (CP) treatment in COVID-19 outpatients are scarce. We aimed to assess whether CP administered during the first week of symptoms reduced the disease progression or risk of hospitalization of outpatients. Two multicenter, double-blind randomized trials (NCT04621123, NCT04589949) were merged with data pooling starting when <20% of recruitment target was achieved. A Bayesian-adaptive individual patient data meta-analysis was implemented. Outpatients aged ≥50 years and symptomatic for ≤7days were included. The intervention consisted of 200–300mL of CP with a predefined minimum level of antibodies. Primary endpoints were a 5-point disease severity scale and a composite of hospitalization or death by 28 days. Amongst the 797 patients included, 390 received CP and 392 placebo;they had a median age of 58 years, 1 comorbidity, 5 days symptoms and 93% had negative IgG antibody-test. Seventy-four patients were hospitalized, 6 required mechanical ventilation and 3 died. The odds ratio (OR) of CP for improved disease severity scale was 0.936 (credible interval (CI) 0.667–1.311);OR for hospitalization or death was 0.919 (CI 0.592–1.416). CP effect on hospital admission or death was largest in patients with ≤5 days of symptoms (OR 0.658, 95%CI 0.394–1.085). CP did not decrease the time to full symptom resolution.Trial registration: Clinicaltrials.gov NCT04621123 and NCT04589949. Registration: NCT04621123 and NCT04589949 on https://www.clinicaltrials.govClinical studies have suggested that the therapeutic potential of polyclonal convalescent plasma is highest in the first days of symptoms. Here, the authors present results from a pooled analysis of two clinical trials in COVID-19 outpatients that did not provide conclusive evidence in favor of convalescent plasma.

4.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-335918

ABSTRACT

Introduction The infection-fatality rate (IFR) of COVID-19 has been carefully measured and analyzed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries. Methods We systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using population representative samples collected by early 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. We analyzed the serology data using a Bayesian model that incorporates conventional sampling uncertainty as well as uncertainties about assay sensitivity and specificity. We then calculated IFRs using individual case reports or aggregated public health updates, including age-specific estimates whenever feasible. Results Seroprevalence in many developing country locations was markedly higher than in high-income countries. In most locations, seroprevalence among older adults was similar to that of younger age cohorts, underscoring the limited capacity that these nations have to protect older age groups. Age-specific IFRs were roughly 2x higher than in high-income countries. The median value of the population IFR was about 0.5%, similar to that of high-income countries, because disparities in healthcare access were roughly offset by differences in population age structure. Conclusion The burden of COVID-19 is far higher in developing countries than in high-income countries, reflecting a combination of elevated transmission to middle-aged and older adults as well as limited access to adequate healthcare. These results underscore the critical need to accelerate the provision of vaccine doses to populations in developing countries.

5.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-335650

ABSTRACT

BACKGROUND Debate about the level of asymptomatic severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection continues. The amount of evidence is increasing and study designs have changed over time. We updated a living systematic review to address three questions: (1) Amongst people who become infected with SARS-CoV-2, what proportion does not experience symptoms at all during their infection? (2) What is the infectiousness of asymptomatic and presymptomatic, compared with symptomatic, SARS-CoV-2 infection? (3) What proportion of SARS-CoV-2 transmission in a population is accounted for by people who are asymptomatic or presymptomatic? METHODS AND FINDINGS The protocol was first published on 1 April 2020 and last updated on 18 June 2021. We searched PubMed, Embase, bioRxiv and medRxiv, aggregated in a database of SARS-CoV-2 literature, most recently on 6 July 2021. Studies of people with PCR-diagnosed SARS-CoV-2, which documented symptom status at the beginning and end of follow-up, or mathematical modelling studies were included. Studies restricted to people already diagnosed, of single individuals or families, or without sufficient follow-up were excluded. One reviewer extracted data and a second verified the extraction, with disagreement resolved by discussion or a third reviewer. Risk of bias in empirical studies was assessed with a bespoke checklist and modelling studies with a published checklist. All data syntheses were done using random effects models. Review question (1): We included 130 studies. Heterogeneity was high so we did not estimate a mean proportion of asymptomatic infections overall (interquartile range 14-50%, prediction interval 2-90%), or in 84 studies based on screening of defined populations (interquartile range 20-65%, prediction interval 4-94%). In 46 studies based on contact or outbreak investigations, the summary proportion asymptomatic was 19% (95% CI 15-25%, prediction interval 2-70%). (2) The secondary attack rate in contacts of people with asymptomatic infection compared with symptomatic infection was 0.32 (95% CI 0.16-0.64, prediction interval 0.11-0-95, 8 studies). (3) In 13 modelling studies fit to data, the proportion of all SARS-CoV-2 transmission from presymptomatic individuals was higher than from asymptomatic individuals. Limitations of the evidence include high heterogeneity and high risks of selection and information bias in studies that were not designed to measure persistently asymptomatic infection, and limited information about variants of concern or in people who have been vaccinated. CONCLUSIONS Based on studies published up to July 2021, most SARS-CoV-2 infections were not persistently asymptomatic and asymptomatic infections were less infectious than symptomatic infections. Summary estimates from meta-analysis may be misleading when variability between studies is extreme and prediction intervals should be presented. Future studies should determine the asymptomatic proportion of SARS-CoV-2 infections caused by variants of concern and in people with immunity following vaccination or previous infection. Without prospective longitudinal studies with methods that minimise selection and measurement biases, further updates with the study types included in this living systematic review are unlikely to be able to provide a reliable summary estimate of the proportion of asymptomatic infections caused by SARS-CoV-2.

6.
International Journal of Infectious Diseases ; 118:183-193, 2022.
Article in English | CAB Abstracts | ID: covidwho-1838865

ABSTRACT

Objectives: Molecular testing for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) is costly. Therefore, we appraised the evidence regarding pooling samples from multiple individuals to test for CT/NG.

7.
Am J Cardiol ; 172:159-161, 2022.
Article in English | ProQuest Central | ID: covidwho-1838525

ABSTRACT

[...]we still have some other concerns that were not analyzed in these systematic reviews: the risk difference between BNT162b2 and mRNA-1273 and the increased risk of acute myocarditis in the young population, especially after the second dose in male teenagers.1,2 However, several articles regarding this topic have been published since the database search of these systematic reviews. [...]we have increased the number of studies and added a subanalysis of the incidence of acute myocarditis by the types of vaccine administered and in young males who received the second dose of the mRNA vaccine. In this situation, elevated risk of myocarditis after mRNA vaccine should be known to recipients, but it should be also noted that the benefit-risk analysis performed by the Centers for Disease Control and Prevention has shown a positive balance of vaccination for all age groups of both genders. [...]studies that focus on evaluating risk factors and mechanisms of developing acute myocarditis are needed, especially among young male recipients, as mRNA vaccine will become more widely available in young children.Disclosures The authors have no conflicts of interest to declare.

8.
Cochrane Database of Systematic Reviews ; 1(109), 2022.
Article in English | CAB Abstracts | ID: covidwho-1838127

ABSTRACT

Background: Heated tobacco products (HTPs) are designed to heat tobacco to a high enough temperature to release aerosol, without burning it or producing smoke. They differ from e-cigarettes because they heat tobacco leaf/sheet rather than a liquid. Companies who make HTPs claim they produce fewer harmful chemicals than conventional cigarettes. Some people report stopping smoking cigarettes entirely by switching to using HTPs, so clinicians need to know whether they are effective for this purpose and relatively safe. Also, to regulate HTPs appropriately, policymakers should understand their impact on health and on cigarette smoking prevalence. Objectives: To evaluate the effectiveness and safety of HTPs for smoking cessation and the impact of HTPs on smoking prevalence. Search methods: We searched the Cochrane Tobacco Addiction Group's Specialised Register, CENTRAL, MEDLINE, and six other databases for relevant records to January 2021, together with reference-checking and contact with study authors and relevant groups. Selection criteria: We included randomised controlled trials (RCTs) in which people who smoked cigarettes were randomised to switch to exclusive HTP use or a control condition. Eligible outcomes were smoking cessation, adverse events, and selected biomarkers. RCTs conducted in clinic or in an ambulatory setting were deemed eligible when assessing safety, including those randomising participants to exclusively use HTPs, smoke cigarettes, or attempt abstinence from all tobacco. Time-series studies were also eligible for inclusion if they examined the population-level impact of heated tobacco on smoking prevalence or cigarette sales as an indirect measure. Data collection and analysis: We followed standard Cochrane methods for screening and data extraction. Our primary outcome measures were abstinence from smoking at the longest follow-up point available, adverse events, serious adverse events, and changes in smoking prevalence or cigarette sales. Other outcomes included biomarkers of harm and exposure to toxicants/carcinogens (e.g. NNAL and carboxyhaemoglobin (COHb)). We used a random-effects Mantel-Haenszel model to calculate risk ratios (RR) with 95% confidence intervals (CIs) for dichotomous outcomes. For continuous outcomes, we calculated mean differences on the log-transformed scale (LMD) with 95% CIs. We pooled data across studies using meta-analysis where possible. Main results: We included 13 completed studies, of which 11 were RCTs assessing safety (2666 participants) and two were time-series studies. We judged eight RCTs to be at unclear risk of bias and three at high risk. All RCTs were funded by tobacco companies. Median length of follow-up was 13 weeks. No studies reported smoking cessation outcomes. There was insufficient evidence for a difference in risk of adverse events between smokers randomised to switch to heated tobacco or continue smoking cigarettes, limited by imprecision and risk of bias (RR 1.03, 95% CI 0.92 to 1.15;I2 = 0%;6 studies, 1713 participants). There was insufficient evidence to determine whether risk of serious adverse events differed between groups due to very serious imprecision and risk of bias (RR 0.79, 95% CI 0.33 to 1.94;I2 = 0%;4 studies, 1472 participants). There was moderate-certainty evidence for lower NNAL and COHb at follow-up in heated tobacco than cigarette smoking groups, limited by risk of bias (NNAL: LMD -0.81, 95% CI -1.07 to -0.55;I2 = 92%;10 studies, 1959 participants;COHb: LMD -0.74, 95% CI -0.92 to -0.52;I2 = 96%;9 studies, 1807 participants). Evidence for additional biomarkers of exposure are reported in the main body of the review. There was insufficient evidence for a difference in risk of adverse events in smokers randomised to switch to heated tobacco or attempt abstinence from all tobacco, limited by risk of bias and imprecision (RR 1.12, 95% CI 0.86 to 1.46;I2 = 0%;2 studies, 237 participants). Five studies reported that no serious adverse events occurred in either group (53

9.
Cochrane Database of Systematic Reviews ; 1(351), 2022.
Article in English | CAB Abstracts | ID: covidwho-1838126

ABSTRACT

Background: Debates on effective and safe diets for managing obesity in adults are ongoing. Low-carbohydrate weight-reducing diets (also known as 'low-carb diets') continue to be widely promoted, marketed and commercialised as being more effective for weight loss, and healthier, than 'balanced'-carbohydrate weight-reducing diets. Objectives: To compare the effects of low-carbohydrate weight-reducing diets to weight-reducing diets with balanced ranges of carbohydrates, in relation to changes in weight and cardiovascular risk, in overweight and obese adults without and with type 2 diabetes mellitus (T2DM). Search methods: We searched MEDLINE (PubMed), Embase (Ovid), the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection (Clarivate Analytics), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) up to 25 June 2021, and screened reference lists of included trials and relevant systematic reviews. Language or publication restrictions were not applied. Selection criteria: We included randomised controlled trials (RCTs) in adults (18 years+) who were overweight or living with obesity, without or with T2DM, and without or with cardiovascular conditions or risk factors. Trials had to compare low-carbohydrate weight-reducing diets to balanced-carbohydrate (45% to 65% of total energy (TE)) weight-reducing diets, have a weight-reducing phase of 2 weeks or longer and be explicitly implemented for the primary purpose of reducing weight, with or without advice to restrict energy intake. Data collection and analysis: Two review authors independently screened titles and s and full-text articles to determine eligibility;and independently extracted data, assessed risk of bias using RoB 2 and assessed the certainty of the evidence using GRADE. We stratified analyses by participants without and with T2DM, and by diets with weight-reducing phases only and those with weight-reducing phases followed by weight-maintenance phases. Primary outcomes were change in body weight (kg) and the number of participants per group with weight loss of at least 5%, assessed at short- (three months to < 12 months) and long-term ( 12 months) follow-up. Main results: We included 61 parallel-arm RCTs that randomised 6925 participants to either low-carbohydrate or balanced-carbohydrate weight-reducing diets. All trials were conducted in high-income countries except for one in China. Most participants (n = 5118 randomised) did not have T2DM. Mean baseline weight across trials was 95 kg (range 66 to 132 kg). Participants with T2DM were older (mean 57 years, range 50 to 65) than those without T2DM (mean 45 years, range 22 to 62). Most trials included men and women (42/61;3/19 men only;16/19 women only), and people without baseline cardiovascular conditions, risk factors or events (36/61). Mean baseline diastolic blood pressure (DBP) and low-density lipoprotein (LDL) cholesterol across trials were within normal ranges. The longest weight-reducing phase of diets was two years in participants without and with T2DM. Evidence from studies with weight-reducing phases followed by weight-maintenance phases was limited. Most trials investigated low-carbohydrate diets (> 50 g to 150 g per day or < 45% of TE;n = 42), followed by very low ( 50 g per day or < 10% of TE;n = 14), and then incremental increases from very low to low (n = 5). The most common diets compared were low-carbohydrate, balanced-fat (20 to 35% of TE) and high-protein (> 20% of TE) treatment diets versus control diets balanced for the three macronutrients (24/61). In most trials (45/61) the energy prescription or approach used to restrict energy intake was similar in both groups. We assessed the overall risk of bias of outcomes across trials as predominantly high, mostly from bias due to missing outcome data. Using GRADE, we assessed the certainty of evidence as moderate to very low across outcomes. Participants without and with T2DM lost weight when following weight-reducing phases of both diets at the short (range: 12.2 to 0

10.
Cochrane Database of Systematic Reviews ; 1(211), 2022.
Article in English | CAB Abstracts | ID: covidwho-1838125

ABSTRACT

Background: High intake of added sugar have been suggested to impact the risk for cardiovascular disease (CVD). Knowledge on the subject can contribute to preventing CVD. Objectives: To assess the effects of a high versus low-added sugar consumption for primary prevention of CVD in the general population. Search methods: We searched Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase, Conference Proceedings Citation Index-Science (CPCI-S) on 2 July 2021. We also conducted a search of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) Search Portal for ongoing or unpublished trials. The search was performed together with reference checking, citation searching and contact with study authors to identify additional studies. We imposed no restriction on language of publication or publication status. Selection criteria: We included randomised controlled trials (RCTs), including cross-over trials, that compared different levels of added sugar intake. Exclusion criteria were: participants aged below 18 years;diabetes mellitus (type 1 and 2);and previous CVD. Primary outcomes were incident cardiovascular events (coronary, carotid, cerebral and peripheral arterial disease) and all-cause mortality. Secondary outcomes were changes in systolic and diastolic blood pressure, total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting plasma glucose and adverse events (gastrointestinal symptoms and impaired dental health). Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Main results: We included 21 RCTs (1110 participants completing the interventions) examining the effects of different levels of added sugar intake with a mean duration of 14 weeks. The study participants were generally described as healthy and the mean age ranged from 22 to 57 years. No studies reported on cardiovascular events or all-cause mortality. There was minimal effect of low intake of added sugar on total cholesterol levels (MD 0.11, 95% CI 0.01 to 0.21;I2 = 0%;16 studies;763 participants;low certainty of evidence) and triglycerides (MD 0.10, 95% CI 0.03 to 0.17;I2 = 3%;14 studies;725 participants) but no evidence of effect on LDL-cholesterol and HDL-cholesterol. There was minimal effect on diastolic blood pressure (MD 1.52, 95% CI 0.67 to 2.37;I2 = 0%;13 studies;873 participants) and on systolic blood pressure (MD 1.44, 95% 0.08 to 2.80;I2 = 27%, 14 studies;873 participants;low certainty of evidence), but no evidence of effect on fasting plasma glucose. Only one study reported on dental health, with no events. No other trials reported adverse events (impaired dental health or gastrointestinal symptoms). All results were judged as low-quality evidence according to GRADE. The risk of bias was generally unclear, five studies were classified at an overall low risk of bias (low risk in at least four domains, not including other bias). Authors' conclusions: No trials investigating the effect of added sugar on cardiovascular events or all-cause mortality were identified in our searches. Evidence is uncertain whether low intake of added sugar has an effect on risk factors for CVD;the effect was small and the clinical relevance is, therefore, uncertain. Practical ways to achieve reductions in dietary added sugar includes following current dietary recommendations. Future trials should have longer follow-up time and report on all-cause mortality and cardiovascular events in order to clarify the effect of added sugar on these outcomes. Future trials should also aim for more direct interventions and preferably be more independent of industry funding.

11.
Cochrane Database of Systematic Reviews ; 1(99), 2022.
Article in English | CAB Abstracts | ID: covidwho-1838124

ABSTRACT

Background: Bronchiectasis is a common but under-diagnosed chronic disorder characterised by permanent dilation of the airways arising from a cycle of recurrent infection and inflammation. Symptoms including chronic, persistent cough and productive phlegm are a significant burden for people with bronchiectasis, and the main aim of treatment is to reduce exacerbation frequency and improve quality of life. Prophylactic antibiotic therapy aims to break this infection cycle and is recommended by clinical guidelines for adults with three or more exacerbations a year, based on limited evidence. It is important to weigh the evidence for bacterial suppression against the prevention of antibiotic resistance and further evidence is required on the safety and efficacy of different regimens of intermittently administered antibiotic treatments for people with bronchiectasis. Objectives: To evaluate the safety and efficacy of intermittent prophylactic antibiotics in the treatment of adults and children with bronchiectasis. Search methods: We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted searches on 6 September 2021, with no restriction on language of publication. Selection criteria: We included randomised controlled trials (RCTs) of at least three months' duration comparing an intermittent regime of prophylactic antibiotics with placebo, usual care or an alternate intermittent regimen. Intermittent prophylactic administration was defined as repeated courses of antibiotics with on-treatment and off-treatment intervals of at least 14 days' duration. We included adults and children with a clinical diagnosis of bronchiectasis confirmed by high resolution computed tomography (HRCT), plain film chest radiograph, or bronchography and a documented history of recurrent chest infections. We excluded studies where participants received high dose antibiotics immediately prior to enrolment or those with a diagnosis of cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA), primary ciliary dyskinesia, hypogammaglobulinaemia, sarcoidosis, or a primary diagnosis of COPD. Our primary outcomes were exacerbation frequency and serious adverse events. We did not exclude studies on the basis of review outcomes. Data collection and analysis: We analysed dichotomous data as odds ratios (ORs) or relative risk (RRs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures expected by Cochrane. We conducted GRADE assessments for the following primary outcomes: exacerbation frequency;serious adverse events and secondary outcomes: antibiotic resistance;hospital admissions;health-related quality of life. Main results: We included eight RCTs, with interventions ranging from 16 to 48 weeks, involving 2180 adults. All evaluated one of three types of antibiotics over two to six cycles of 28 days on/off treatment: aminoglycosides, ss-lactams or fluoroquinolones. Two studies also included 12 cycles of 14 days on/off treatment with fluoroquinolones. Participants had a mean age of 63.6 years, 65% were women and approximately 85% Caucasian. Baseline FEV1 ranged from 55.5% to 62.6% predicted. None of the studies included children. Generally, there was a low risk of bias in the included studies. Antibiotic versus placebo: cycle of 14 days on/off. Ciprofloxacin reduced the frequency of exacerbations compared to placebo (RR 0.75, 95% CI 0.61 to 0.93;I2 = 65%;2 studies, 469 participants;moderate-certainty evidence), with eight people (95% CI 6 to 28) needed to treat for an additional beneficial outcome. The intervention increased the risk of antibiotic resistance more than twofold (OR 2.14, 95% CI 1.36 to 3.35;I2 = 0%;2 studies, 624 participants;high-certainty evidence). Serious adverse events, lung function (FEV1), health-related qual

12.
JAMA Internal Medicine ; 182(2):106-114, 2021.
Article in English | CAB Abstracts | ID: covidwho-1838104

ABSTRACT

Importance: Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG;yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear.

13.
International Journal of Environmental Research and Public Health ; 19(9):5233, 2022.
Article in English | ProQuest Central | ID: covidwho-1837296

ABSTRACT

Violence against children and adolescents is a global public health problem. In Brazil, there are challenging boundaries for professionals in the protection network in general and for health professionals in particular. Moreover, among other factors, there is the challenge of referral, due to weaknesses in decision making, given the nature of sexual violence and how it is managed by healthcare services. This study aims to propose a Meta-Analytic framework to support the referral of young victims of sexual violence, considering levels of severity, independent of factors such as how protection systems are structured and managed and the local laws in force. We propose a Meta-Analytic approach, developed using the fundamentals of Delphi and DPSIR (Drivers, Pressures, State, Impact, and Response Model of Intervention), from the perspective of Value-Focused Thinking. The Delphi method was structured in two stages: the first stage aimed to identify and classify typical cases of sexual violence;the second stage used the DPSIR model, with the aim of identifying the decision criteria for typical cases that occur in a given municipality. The main outcomes are: (i) the application of the modified Delphi participatory method within the context of local social policies;(ii) the construction of a value tree based on Value-Focused Thinking;and (iii) the identification and systematization of criteria that most interfere with the evaluation of cases of sexual violence, which can be used for multi-criteria decision making.

14.
Journal of Maternal and Child Health ; 7(1):22-33, 2022.
Article in English | CAB Abstracts | ID: covidwho-1836444

ABSTRACT

Background: Pregnancy is a state of great susceptibility to infectious diseases, and it is not surprising that viral infections can affect pregnancy outcomes. COVID-19 infection during pregnancy is considered a risk factor for adverse outcomes such as, preterm delivery. This study aimed to analyze the risk of preterm delivery in pregnant women with COVID-19. Subjects and Method: This study was conducted using a systematic review and meta-analysis. Article searches were conducted using electronic databases such as Google Scholar, PubMed, and Scopus. The articles used are articles published from 2020-2021. The keywords used to retrieve the articles were: [(COVID-19 OR 2019-nCoV OR "novel coronavirus" OR SARS-CoV-2 OR "coronavirus 2") AND ("preterm birth" OR preterm OR "preterm delivery")] . The inclusion criteria used were full paper with observational studies (retrospective or prospective cohorts), multivariate analysis with Adjusted Odd Ratios (aOR), study subjects were pregnant women who were confirmed to be infected with COVID-19, comparison were pregnant women who were negative for COVID-19, outcome study was preterm birth (<37 weeks). The article search results are listed in the PRISMA diagram and analyzed using the Review Manager 5.3 . application.

15.
Journal of Health Promotion and Behavior ; 6(4):298-306, 2021.
Article in English | CAB Abstracts | ID: covidwho-1836442

ABSTRACT

Background: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The magnitude of the global spread of COVID-19, and the declaration by the WHO as a public health emergency pandemic, has created an urgent need for rapid diagnosis, vaccines and therapies for COVID-19. This study aims to determine the relationship between perceptions of COVID-19 and vaccination with the Health Belief Model theory approach, one of which is perceived benefit, with the acceptance of COVID-19 vaccination. Subjects and Method: This study uses a systematic review and meta-analysis with PICO, population: people with an age range of 18-65 years. Intervention: health belief model. Comparison: not health belief model. Outcome: Receiving the COVID-19 Vaccine (Perceived Benefit). The articles used were obtained from several databases, namely Google Scholar, Pubmed, Science Direct, MDPI. The article search keywords were "Health Belief Model" AND "vaccination COVID-19" OR COVID-19 vaccine" AND "COVID-19" The inclusion criteria for research articles were full-text articles using a cross-sectional study design, community research subjects with a range of aged 18-65 years, with the result of the study being receiving the COVID-19 Vaccine (Perceived Benefit) after which a multivariate analysis was carried out with adjusted Odds Ratio (aOR). Data were analyzed using the Review Manager application (RevMan 5.4).

16.
Journal of Modern Rehabilitation ; 16(2):131-138, 2022.
Article in English | Scopus | ID: covidwho-1836164

ABSTRACT

Introduction: This study aimed to estimate the prevalence of dysphonia in patients with COVID-19. Materials and Methods: English and Persian studies that reported dysphonia in patients with COVID-19 were included. Review and case report studies were excluded. We searched Web of Science, PubMed, Google Scholar, and Scopus from January 1, 2020, to July 15, 2021. The prevalence of dysphonia was obtained by combining the results and weighing the sample sizes in the corresponding studies. Heterogeneity was evaluated using the Cochran Q test and I2 Results: Of the 1830 articles identified, 7 studies (n=1410 patients) were included in the meta-analysis. The pooled prevalence of dysphonia was 31% (%95CI: 13%-48%). The prevalence rates of dysphonia in men and women with COVID-19 were 28.2% (%95CI: 14%-46%) and 32.8% (%95CI: 22%-45%), respectively. Conclusion: Because of the design of the included studies, the reliability of the results is limited. There was notable heterogeneity in the data, not because of publication bias, but rather the small sample sizes or the heterogeneity of the COVID-19 disease. About one-third of patients with COVID-19 may have dysphonia as the only symptom. Therefore, one should even be careful in approaching those who have only dysphonia. © 2021 The Authors.

17.
PLoS Medicine ; 19(3), 2022.
Article in English | CAB Abstracts | ID: covidwho-1833506

ABSTRACT

Background: Optimizing services to facilitate engagement and retention in care of people living with HIV (PLWH) on antiretroviral therapies (ARTs) is critical to decrease HIV-related morbidity and mortality and HIV transmission. We systematically reviewed the literature for the effectiveness of implementation strategies to reestablish and subsequently retain clinical contact, improve viral load suppression, and reduce mortality among patients who had been lost to follow-up (LTFU) from HIV services. Methods and findings: We searched 7 databases (PubMed, Cochrane, ERIC, PsycINFO, EMBASE, Web of Science, and the WHO regional databases) and 3 conference archives (CROI, IAC, and IAS) to find randomized trials and observational studies published through 13 April 2020. Eligible studies included those involving children and adults who were diagnosed with HIV, had initiated ART, and were subsequently lost to care and that reported at least one review outcome (return to care, retention, viral suppression, or mortality). Data were extracted by 2 reviewers, with discrepancies resolved by a third. We characterized reengagement strategies according to how, where, and by whom tracing was conducted. We explored effects, first, among all categorized as LTFU from the HIV program (reengagement program effect) and second among those found to be alive and out of care (reengagement contact outcome). We used random-effect models for meta-analysis and conducted subgroup analyses to explore heterogeneity. Searches yielded 4,244 titles, resulting in 37 included studies (6 randomized trials and 31 observational studies). In low- and middle-income countries (LMICs) (N= 16), tracing most frequently involved identification of LTFU from the electronic medical record (EMR) and paper records followed by a combination of telephone calls and field tracing (including home visits), by a team of outreach workers within 3 months of becoming LTFU (N= 7), with few incorporating additional strategies to support reengagement beyond contact (N= 2). In high-income countries (HICs) (N = 21 studies), LTFU were similarly identified through EMR systems, at times matched with other public health records (N= 4), followed by telephone calls and letters sent by mail or email and conducted by outreach specialist teams. Home visits were less common (N= 7) than in LMICs, and additional reengagement support was similarly infrequent (N = 5). Overall, reengagement programs were able to return 39% (95% CI: 31% to 47%) of all patients who were characterized as LTFU (n= 29). Reengagement contact resulted in 58% (95% CI: 51% to 65%) return among those found to be alive and out of care (N= 17). In 9 studies that had a control condition, the return was higher among those in the reengagement intervention group than the standard of care group (RR: 1.20 (95% CI: 1.08 to 1.32, P < 0.001)). There were insufficient data to generate pooled estimates of retention, viral suppression, or mortality after the return. Conclusions: While the types of interventions are markedly heterogeneity, reengagement interventions increase return to care. HIV programs should consider investing in systems to better characterize LTFU to identify those who are alive and out of care, and further research on the optimum time to initiate reengagement efforts after missed visits and how to best support sustained reengagement could improve efficiency and effectiveness.

18.
Transfusion Medicine & Hemotherapy ; : 1-13, 2022.
Article in English | Academic Search Complete | ID: covidwho-1832795

ABSTRACT

Background: The outbreak of COVID-19 has resulted in more than 200 million infections and 4 million deaths. The blood derivative therapy represented by intravenous immunoglobulin (IVIG) and convalescent plasma (CP) therapy may be the promising therapeutics for COVID-19. Methods: A systematic article search was performed for eligible studies published up to August 3, 2021, through the PubMed, Embase, Cochrane Library. The included articles were screened by using rigorous inclusion and exclusion criteria. All analyses were conducted using Review Manager 5.4. Quality of studies and risk of bias were evaluated. Results: A total of 5 IVIG therapy and 13 CP therapy randomized controlled trials were included with a sample size of 13,696 subjects diagnosed with COVID-19. IVIG could reduce the mortality compared with the control group (RR 0.65, 95% CI: 0.46–0.93, p = 0.02). The use of CP did not effectively reduce the mortality (RR 0.97, 95% CI: 0.91–1.03, p = 0.38), the length of hospital stay (MD −0.47, 95% CI: −4.13 to 3.20, p = 0.80), and the mechanical ventilation use (RR = 0.98, 95% CI: 0.89–1.07, p = 0.62) of the patients with COVID-19. Treatment with IVIG or CP was not significantly associated with an increase in reported adverse events (RR 1.07, 95% CI: 0.94–1.22, p = 0.28). Conclusions: Treatment with IVIG could be effective and safe to improve survival for patients with COVID-19. But the benefit of CP in the treatment of COVID-19 is limited. The certainty of the evidence was moderate for all outcomes. [ FROM AUTHOR] Copyright of Transfusion Medicine & Hemotherapy is the property of Karger AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

19.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-335079

ABSTRACT

Background: As mortality from COVID-19 is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. Methods: We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to SARS-CoV-2, including death, hospitalisation, Intensive Care Unit (ICU) admission, and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11th June 2021 in Ovid Medline and Embase. Results are presented as Odds Ratios (ORs) with 95% confidence intervals (95%C.I.) and absolute risk differences (RD) in deaths per 1,000 COVID-19 patients. Findings: We included 88 cohort studies with age/gender adjusted data from 6,653,207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease, and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes, and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke, and liver disease. Interpretation: The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of non-pharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.

20.
Embase; 2022.
Preprint in English | EMBASE | ID: ppcovidwho-335002

ABSTRACT

Objective: Cancer is a comorbidity that leads to progressive worsening of Covid-19 with increased mortality. This is a systematic review and meta-analysis to yield evidence of adverse outcomes of Covid-19 in gynecologic cancer. Methods: Searches through PubMed, Google Scholar, ScienceDirect, and medRxiv to find articles on the outcome of gynecologic cancer with Covid-19 (24 July 2021-19 February 2022). Newcastle-Ottawa Scale tool is used to evaluate the quality of included studies. Pooled odds ratio (OR), 95% confidence interval (CI), random-effects model were presented. This study was registered to PROSPERO (CRD42021256557). Results: We accepted 51 studies (1991 gynecologic cancer with Covid-19). Covid-19 infection was lower in gynecologic cancer vs hematologic cancer (OR 0.71, CI 0.56-0.90, p 0.005). Severe Covid and death were lower in gynecologic cancer vs lung and hematologic cancer (OR 0.36, CI 0.16-0.80, p 0.01), (OR 0.52, CI 0.44-0.62, p <0.0001), (OR 0.26, CI 0.10-0.67 p 0.005), (OR 0.63, CI 0.47-0.83, p 0.001) respectively. Increased Covid death is seen in gynecologic cancer vs breast, non-covid cancer, and non-cancer covid (OR 1.50, CI 1.20-1.88, p 0.0004), (OR 11.83, CI 8.20-17.07, p <0.0001), (OR 2.98, CI 2.23-3.98, p <0.0001) respectively. Conclusion: Gynecologic cancer has higher Covid-19 adverse outcomes compared to non-cancer, breast cancer, non-metastatic, and Covid-19 negative population. Gynecologic cancer has fewer Covid-19 adverse outcomes compared to other cancer types, lung cancer, and hematologic cancer. These findings may aid health policies and services during the ongoing global pandemic.

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