Epidemiologic Reviews最新文献

Previous research has highlighted the role of social determinants of health on mental health outcomes, but their impact on suicide mortality is less understood. The aim of this umbrella review was to systematically examine the association between 10 social determinants of health, as defined by the World Health Organization, and suicide mortality. A keyword search of titles and abstracts was conducted in six digital databases for studies published to 24 August 2023. Inclusion criteria were peer-reviewed systematic reviews and meta-analyses in English examining the association between these determinants and suicide. Methodological quality was assessed using an adapted AMSTAR-2 tool. Due to significant heterogeneity in the included studies, a meta-analysis was not undertaken. A narrative synthesis, structured by social determinant, was conducted. 49 records (25 meta-analyses and 24 systematic reviews) were eligible for inclusion in this review. The social determinants with the most available evidence were housing, basic amenities and the environment (n=21), income and social protection (n=13), unemployment (n=8) and early childhood development (n=6). Limited evidence was identified for education (n=3), social inclusion and non-discrimination (n=3) and working life conditions (n=3). No reviews examined the relationship between affordable healthcare services, structural conflict or food insecurity and suicide mortality. There was evidence of a modest effect of social determinants on suicide mortality. Most evidence related to unemployment, job insecurity, income and social protection and childhood adversity. The methodological quality of the included reviews varied considerably. High-quality research fully exploring the relationship between social and environmental factors and suicide risk is needed.

While the economic impact of guaranteed income (recurring, unconditional, and unrestricted cash transfers intended to supplement the income of participants) is well-studied, much less is known about how guaranteed income may impact health, especially in the context of high-income countries like the U.S. and Canada. We searched five electronic databases for terms related to "guaranteed income" and "cash transfer" through April 23, 2022. Among 5,340 records originally identified, 25 met our inclusion criteria and represented 16 unique guaranteed income initiatives. Most included studies used a quantitative approach (n=22, 88%), were published between 2000-2022 (n=21, 84%), and were in the U.S. (n=15, 60%). Health outcomes included: maternal and child health (e.g., pre-term births, breastfeeding initiation), healthcare utilization (e.g., hospital admissions), mental health (e.g., depression), physical health (e.g., body mass index) and behavioral health (e.g., substance use). Maternal, infant, and child health were most highly represented health outcomes. Guaranteed income initiatives generally had significant positive impacts on health outcomes, with the largest impact seen among the most vulnerable recipients. There was a notable absence of data on neighborhood-level health outcomes, chronic and infectious diseases, potential unintended consequences, and long-term impacts of guaranteed income on health. While studies on the impact of guaranteed income and health studies are few, they suggest guaranteed income has the potential to positively impact many, but not all, health outcomes. Rigorous assessment of health outcomes is still needed, and additional health outcomes should be considered in the design and evaluation of guaranteed income initiatives.

Although COVID-19 vaccines are generally very safe, the risks of myocarditis and pericarditis after receiving an messenger RNA (mRNA) vaccine have been established, with the highest risk in young men. Most systematic reviews and meta-analyses of the risk of myocarditis or pericarditis have included passive surveillance data, which is subject to reporting errors. Accurate measures of age-, sex-, and vaccine dose- and type-specific risks are crucial for assessment of the benefits and risks of the vaccination. A systematic review and meta-analysis of the risks of myocarditis and pericarditis attributable COVID-19 vaccines were conducted, stratified by age groups, sex, vaccine type, and vaccine dose. Five electronic databases and gray literature sources were searched on November 21, 2023. Article about studies that compared a COVID-19-vaccinated group with an unvaccinated group or time period (eg, self-controlled) were included. Passive surveillance data were excluded. Meta-analyses were conducted using random-effects models. A total of 4030 records were identified; ultimately, 17 articles were included in this review. Compared with unvaccinated groups or unvaccinated time periods, the highest attributable risk of myocarditis or pericarditis was observed after the second dose in boys aged 12-17 years (10.18 per 100 000 doses [95% CI, 0.50-19.87]) of the BNT162b2 vaccine and in young men aged 18-24 years (attributable risk, 20.02 per 100 000 doses [95% CI, 10.47-29.57]) for the mRNA-1273 vaccine. The stratified results based on active surveillance data provide the most accurate available estimates of the risks of myocarditis and pericarditis attributable to specific COVID-19 vaccinations for specific populations. Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42023443343.

Racial and ethnic minorities have been disproportionally burdened by hospitalization and death due to COVID-19. Participation of individuals of diverse races and ethnicities in clinical trials, according to study-level characteristics of randomized controlled trials (RCTs) that test effectiveness of COVID-19 drugs, could be insightful for future researchers. Our objective for this scoping review was to describe the frequency of race and ethnicity reported as demographic variables and specific reporting of race and ethnicity according to COVID-19 RCT characteristics. We conducted comprehensive searches in PubMed, ProQuest, World Health Organization Database, and Cochrane Central Register of Controlled Trials, and gray literature via preprint servers from January 1, 2020, to May 4, 2022. We included RCTs on emergency- or conditionally approved COVID-19 drug interventions (remdesivir, baricitinib, and molnupiravir) with or without comparators. Self-reported race as American Indian/Pacific Islander, Asian, Black/African American, or White, ethnicity as Hispanic/Latinx, study design characteristics, and participant-relevant data were collected. In total, 17 RCTs with 17 935 participants were included. Most (n = 13; 76%) reported at least 1 race and ethnicity and were US-based, industry-funded RCTs. Asian, Black, Latinx, and White participants were mostly enrolled in RCTs that studied remdesivir. Native American and Hawaiian participants were mostly assessed for progression to high-flow oxygen/noninvasive ventilation. Time to recovery was assessed predominantly in Black and White participants, whereas hospitalization or death was mostly assessed in Asian, Latinx, and multirace participants. Trialists should be aware of RCT-level factors and characteristics that may be associated with low participation of racial and ethnic minorities, which could inform evidence-based interventions to increase minority participation.

Food insecurity disproportionately affects women during their reproductive years. Food insecurity is associated with many negative health outcomes in the general population, including hypertension, diabetes, depression, anxiety, and obesity, particularly in women, yet it remains unclear whether it has negative implications for perinatal outcomes. We conducted a systematic scoping review using PubMed, Embase, and Scopus to identify studies of food insecurity and perinatal outcomes, including preterm birth, birth weight, gestational diabetes, hypertensive disorders of pregnancy, gestational weight gain, and mental health outcomes during the perinatal and immediate postpartum periods, and breastfeeding initiation. Twenty-nine studies were included. There is consistent evidence that individuals experiencing food insecurity in the prenatal period are at greater risk for depression and anxiety during pregnancy and postpartum. The findings were inconclusive for preterm delivery, birth weight, and other pregnancy outcomes, including gestational diabetes, hypertensive disorders of pregnancy, and gestational weight gain. This review highlights important data gaps related to the assessment of food insecurity in pregnancy that must be addressed to draw conclusions about potential perinatal outcomes among those experiencing food insecurity. More research is needed to understand the impacts of food insecurity on pregnancy outcomes and assess whether efforts to alleviate food insecurity improve outcomes.

Comparisons between randomized trial analyses and observational analyses that attempt to address similar research questions have generated many controversies in epidemiology and the social sciences. There has been little consensus on when such comparisons are reasonable, what their implications are for the validity of observational analyses, or whether trial and observational analyses can be integrated to address effectiveness questions. Here, we consider methods for using observational analyses to complement trial analyses when assessing treatment effectiveness. First, we review the framework for designing observational analyses that emulate target trials and present an evidence map of its recent applications. We then review approaches for estimating the average treatment effect in the target population underlying the emulation, using observational analyses of the emulation data alone and using transportability analyses to extend inferences from a trial to the target population. We explain how comparing treatment effect estimates from the emulation against those from the trial can provide evidence on whether observational analyses can be trusted to deliver valid estimates of effectiveness-a process we refer to as benchmarking-and, in some cases, allow the joint analysis of the trial and observational data. We illustrate different approaches using a simplified example of a pragmatic trial and its emulation in registry data. We conclude that synthesizing trial and observational data-in transportability, benchmarking, or joint analyses-can leverage their complementary strengths to enhance learning about comparative effectiveness, through a process combining quantitative methods and epidemiologic judgments.

For lethal means safety counseling (LMSC) interventions to reduce population-level suicide rates, interventions must be deployed across many settings and populations. We conducted a systematic search in 6 databases to review the current state of LMSC interventions across study designs, settings, intervention providers, populations, and injury prevention levels (eg, universal). Eligibility criteria were as follows: any individual or group receiving an LMSC intervention involving a human-to-human component aiming to influence adult behaviors related to lethal suicide methods, and outcome assessment of storage behaviors and/or suicidal self-directed violence (SDV). Risk of bias was assessed using the Effective Public Health Practice Project quality assessment tool. A descriptive synthesis approach was used for analysis. Twenty-two studies were included that reported medication- and/or firearm-storage behaviors and/or SDV after LMSC. Of the 19 studies assessing behavioral change, 14 reported a significant improvement in safe storage behaviors, and all studies measuring acceptability reported that participants found the interventions favorable. The quality of evidence was limited. No studies were rated low risk of bias, and 77% were rated high risk of bias. There was substantial heterogeneity in the settings, populations, injury prevention levels, delivery methods, and intervention elements. Many included studies focused on caregivers of pediatric populations, and few studies assessed SDV outcomes. Higher-quality trials conducted across a variety of settings, particularly those focusing on adults at risk of suicide, are needed. This review was preregistered with the International Prospective Register of Systematic Reviews (no. CRD42021230668).

The widespread occurrence of knee injuries in athletes when playing basketball, in particular, damage to the cartilage system of the knee joint is reviewed. Basketball players may develop post-traumatic chondropathy with a subsequent change in the functional state of knee joints, which is inextricably linked with a decrease in the quality of life, the occurrence of pain syndrome, shortening of career duration, an increased risk of surgical interventions, and possible disability, from a long-term perspective. This review was conducted to explore modern ideas about the impact of post-traumatic chondropathy on the functional state of knee joints in athletes during basketball games. Literature databases were searched for relevant studies. Given the character of the basketball game, knee injuries, both acute and chronic, are widespread among athletes of this sport, including cartilaginous defects of the knee joint. The findings of this study are of practical value for sports medicine doctors, physiotherapists, and traumatologists because they present the main mechanisms of knee injuries in athletes when playing basketball and the possible consequences of these injuries in the long term.

Progress toward racial health equity cannot be made if we cannot measure its fundamental driver: structural racism. As in other epidemiologic studies, the first step is to measure the exposure. But how to measure structural racism is an ongoing debate. To characterize the approaches epidemiologists and other health researchers use to quantitatively measure structural racism, highlight methodological innovations, and identify gaps in the literature, we conducted a scoping review of the peer-reviewed and gray literature published during 2019-2021 to accompany the 2018 published work of Groos et al., in which they surveyed the scope of structural racism measurement up to 2017. We identified several themes from the recent literature: the current predominant focus on measuring anti-Black racism; using residential segregation as well as other segregation-driven measures as proxies of structural racism; measuring structural racism as spatial exposures; increasing calls by epidemiologists and other health researchers to measure structural racism as a multidimensional, multilevel determinant of health and related innovations; the development of policy databases; the utility of simulated counterfactual approaches in the understanding of how structural racism drives racial health inequities; and the lack of measures of antiracism and limited work on later life effects. Our findings sketch out several steps to improve the science related to structural racism measurements, which is key to advancing antiracism policies.