Pub Date : 2020-03-01DOI: 10.1097/XEB.0000000000000214
Rodrigo Feteira-Santos, João Fernandes, Ana Virgolino, Violeta Alarcão, Catarina Sena, Carlota P Vieira, Maria João Gregório, Paulo Nogueira, Andreia Costa, Pedro Graça, Osvaldo Santos
Aims: Interpretive front-of-package nutrition labelling can contribute to healthier food habits. This systematic review aimed to examine the effectiveness of interpretive front-of-package nutrition labelling schemes on consumers' food choices, namely at the moment of food purchase, and to analyse if this potential front-of-package nutrition labelling's effect varies according to different socioeconomic groups.
Methods: Electronic databases (Cochrane Library, PubMed, Scopus, and Web of Science) search was performed to identify peer-reviewed articles describing longitudinal studies evaluating the effect of front-of-package nutrition labelling schemes on consumers' food choices, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity 2012 Extension guidelines. No publication-period or language restrictions were applied. PROGRESS-Plus framework was used to report if and how socioeconomic factors were considered in analyses of front-of-package nutrition labelling-related interventions' effect.
Results: Nine studies were selected for narrative synthesis (seven randomized controlled trials and two cross-over trials). When compared with no-interpretive-label conditions, front-of-package nutrition labelling showed a positive impact for nutritional content understanding, healthiness perception of products, selection of products with better nutritional quality, and purchase intention. However, there is no robust evidence of superiority of a specific front-of-package nutrition labelling scheme's effect, neither on consumers' understanding of nutritional content nor on food choices. An evaluation of the studies following the PROGRESS-Plus framework revealed that socioecononomic status and education were the most frequently used dimensions, when assessing the effect of interpretative front-of-pack nutrition labels. More evidence is necessary to determine the role of front-of-pack nutrition labels in decreasing inequalities between different population subgroups, namely among the most vulnerable subgroups, on the promotion of healthy food choices.
Conclusion: Well controlled longitudinal studies, following a real-world evidence approach, are needed to clarify front-of-package nutrition labelling's impact on consumers' food choices, namely at purchase points, taking into account the most vulnerable population subgroups, such as those with lower literacy and/or financial resources.
目的:解释性包装正面营养标签可以促进健康的饮食习惯。本系统综述旨在检验包装正面营养标签解释方案对消费者食品选择的有效性，即在购买食品的那一刻，并分析这种包装正面营养标签的潜在影响是否因不同的社会经济群体而异。方法:电子数据库(Cochrane Library, PubMed, Scopus和Web of Science)进行检索，根据系统评价和荟萃分析(PRISMA)-Equity 2012扩展指南的首选报告项目，确定描述纵向研究评估包装前营养标签方案对消费者食品选择影响的同行评议文章。没有对出版期限或语言加以限制。PROGRESS-Plus框架用于报告在分析包装前营养标签相关干预措施的影响时是否以及如何考虑社会经济因素。结果:选择9项研究进行叙事综合(7项随机对照试验和2项交叉试验)。与无解释标签的情况相比，包装正面营养标签对营养成分的理解、产品的健康感知、选择营养质量更好的产品和购买意愿有积极的影响。然而，无论是对消费者对营养成分的理解还是对食物的选择，都没有强有力的证据表明特定的包装正面营养标签方案的优势。对PROGRESS-Plus框架下的研究进行的评估显示，在评估包装正面解释性营养标签的影响时，社会经济地位和教育是最常用的维度。需要更多的证据来确定包装正面营养标签在减少不同人口亚群体之间，即最脆弱的亚群体之间在促进健康食品选择方面的不平等方面的作用。结论:需要进行对照良好的纵向研究，遵循真实世界的证据方法，以澄清包装正面营养标签对消费者食品选择的影响，即在购买点，考虑到最脆弱的人群亚群体，如文化水平较低和/或经济资源较低的人群。
{"title":"Effectiveness of interpretive front-of-pack nutritional labelling schemes on the promotion of healthier food choices: a systematic review.","authors":"Rodrigo Feteira-Santos, João Fernandes, Ana Virgolino, Violeta Alarcão, Catarina Sena, Carlota P Vieira, Maria João Gregório, Paulo Nogueira, Andreia Costa, Pedro Graça, Osvaldo Santos","doi":"10.1097/XEB.0000000000000214","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000214","url":null,"abstract":"<p><strong>Aims: </strong>Interpretive front-of-package nutrition labelling can contribute to healthier food habits. This systematic review aimed to examine the effectiveness of interpretive front-of-package nutrition labelling schemes on consumers' food choices, namely at the moment of food purchase, and to analyse if this potential front-of-package nutrition labelling's effect varies according to different socioeconomic groups.</p><p><strong>Methods: </strong>Electronic databases (Cochrane Library, PubMed, Scopus, and Web of Science) search was performed to identify peer-reviewed articles describing longitudinal studies evaluating the effect of front-of-package nutrition labelling schemes on consumers' food choices, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity 2012 Extension guidelines. No publication-period or language restrictions were applied. PROGRESS-Plus framework was used to report if and how socioeconomic factors were considered in analyses of front-of-package nutrition labelling-related interventions' effect.</p><p><strong>Results: </strong>Nine studies were selected for narrative synthesis (seven randomized controlled trials and two cross-over trials). When compared with no-interpretive-label conditions, front-of-package nutrition labelling showed a positive impact for nutritional content understanding, healthiness perception of products, selection of products with better nutritional quality, and purchase intention. However, there is no robust evidence of superiority of a specific front-of-package nutrition labelling scheme's effect, neither on consumers' understanding of nutritional content nor on food choices. An evaluation of the studies following the PROGRESS-Plus framework revealed that socioecononomic status and education were the most frequently used dimensions, when assessing the effect of interpretative front-of-pack nutrition labels. More evidence is necessary to determine the role of front-of-pack nutrition labels in decreasing inequalities between different population subgroups, namely among the most vulnerable subgroups, on the promotion of healthy food choices.</p><p><strong>Conclusion: </strong>Well controlled longitudinal studies, following a real-world evidence approach, are needed to clarify front-of-package nutrition labelling's impact on consumers' food choices, namely at purchase points, taking into account the most vulnerable population subgroups, such as those with lower literacy and/or financial resources.</p>","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/XEB.0000000000000214","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37507604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/XEB.0000000000000203
Chase Meyer, Aaron Bowers, Daniel Tritz, Kaleb Fuller, C. Wayant, Courtney Cook, Trevor Torgerson, M. Som, M. Vassar
AIM The fragility index is calculated by changing one outcome event to a nonevent within a trial until the associated P value exceeds 0.05. In this study, we assessed the robustness, risk of bias (RoB), and power of randomized controlled trials that underlie recommendations set forth by the American College of Gastroenterology (ACG) on managing dyspepsia and Helicobacter pylori infections. METHODS All citations referenced in the guidelines were screened for inclusion criteria. The fragility indexes for eligible trials were then calculated. The likelihood and sources of bias in the included trials were evaluated by the Cochrane 'RoB' Tool 2.0. RESULTS The median fragility index for the 52 trials was three events. Five studies (9.6%) resulted in a fragility index of 0 when statistical analysis was applied. For the 52 trials, 12 (23.1%) were at a low RoB, 15 (28.8%) had some concerns, and 25 (48.1%) were at a high RoB. High RoB was most commonly due to bias of selection in the reported result (15.5%). CONCLUSION A median of three events was needed to nullify statistical significance in 52 trials that underpin guideline recommendations on the management of dyspepsia and H. pylori infections. In addition, concerns for RoB were found for these trials.
{"title":"The fragility of randomized trial outcomes underlying management of dyspepsia and Helicobacter pylori infections.","authors":"Chase Meyer, Aaron Bowers, Daniel Tritz, Kaleb Fuller, C. Wayant, Courtney Cook, Trevor Torgerson, M. Som, M. Vassar","doi":"10.1097/XEB.0000000000000203","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000203","url":null,"abstract":"AIM\u0000The fragility index is calculated by changing one outcome event to a nonevent within a trial until the associated P value exceeds 0.05. In this study, we assessed the robustness, risk of bias (RoB), and power of randomized controlled trials that underlie recommendations set forth by the American College of Gastroenterology (ACG) on managing dyspepsia and Helicobacter pylori infections.\u0000\u0000\u0000METHODS\u0000All citations referenced in the guidelines were screened for inclusion criteria. The fragility indexes for eligible trials were then calculated. The likelihood and sources of bias in the included trials were evaluated by the Cochrane 'RoB' Tool 2.0.\u0000\u0000\u0000RESULTS\u0000The median fragility index for the 52 trials was three events. Five studies (9.6%) resulted in a fragility index of 0 when statistical analysis was applied. For the 52 trials, 12 (23.1%) were at a low RoB, 15 (28.8%) had some concerns, and 25 (48.1%) were at a high RoB. High RoB was most commonly due to bias of selection in the reported result (15.5%).\u0000\u0000\u0000CONCLUSION\u0000A median of three events was needed to nullify statistical significance in 52 trials that underpin guideline recommendations on the management of dyspepsia and H. pylori infections. In addition, concerns for RoB were found for these trials.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90542627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-20DOI: 10.17267/2675-021xevidence.v1i2.2541
Denise Silva Matias, Luis Cláudio Lemos Correia, Daniel Oliveira Medina da Silva, Larrie Rabelo Laporte, Camila Verônica Souza Freire, Gabriel De Araújo Grisi, Thiago Masashi Taniguchi, Mariana Correia Moreira Cruz
Scientific paradigm violations are common in the medical literature. This article aims to describe the principles that should guide scientific thinking, such as the philosophy of skepticism, the consideration of multiple hypothesis, epidemiological criteria to demonstrate association, concern about random errors and the need to quantify the strength of association. We use the hypothesis of causality between Zika and microcephaly to illustrate these principles and cognitive mechanisms that predispose to its violation. This is an example of dissociation between certainty and level of evidence, since the association between these two entities was confirmed at a time when there was no evidence of quality that supported this association.
{"title":"The value of uncertainty: the Zika and Microcefalia link","authors":"Denise Silva Matias, Luis Cláudio Lemos Correia, Daniel Oliveira Medina da Silva, Larrie Rabelo Laporte, Camila Verônica Souza Freire, Gabriel De Araújo Grisi, Thiago Masashi Taniguchi, Mariana Correia Moreira Cruz","doi":"10.17267/2675-021xevidence.v1i2.2541","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.v1i2.2541","url":null,"abstract":"Scientific paradigm violations are common in the medical literature. This article aims to describe the principles that should guide scientific thinking, such as the philosophy of skepticism, the consideration of multiple hypothesis, epidemiological criteria to demonstrate association, concern about random errors and the need to quantify the strength of association. We use the hypothesis of causality between Zika and microcephaly to illustrate these principles and cognitive mechanisms that predispose to its violation. This is an example of dissociation between certainty and level of evidence, since the association between these two entities was confirmed at a time when there was no evidence of quality that supported this association.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74658315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.1097/XEB.0000000000000207
S. Doi, L. Furuya-Kanamori
Studies included in meta-analysis can produce results that depart from the true population parameter of interest due to systematic and/or random errors. Synthesis of these results in meta-analysis aims to generate an estimate closer to the true population parameter by minimizing these errors across studies. The inverse variance heterogeneity (IVhet), quality effects and random effects models of meta-analysis all attempt to do this, but there remains controversy around the estimator that best achieves this goal of reducing error. In an attempt to answer this question, a simulation study was conducted to compare estimator performance. Five thousand iterations at 10 different levels of heterogeneity were run, with each iteration generating one meta-analysis. The results demonstrate that the IVhet and quality effects estimators, though biased, have the lowest mean squared error. These estimators also achieved a coverage probability at or above the nominal level (95%), whereas the coverage probability under the random effects estimator significantly declined (<80%) as heterogeneity increased despite a similar confidence interval width. Based on our findings, we would recommend the use of the IVhet and quality effects models and a discontinuation of traditional random effects models currently in use for meta-analysis.
{"title":"Selecting the best meta-analytic estimator for evidence-based practice: a simulation study.","authors":"S. Doi, L. Furuya-Kanamori","doi":"10.1097/XEB.0000000000000207","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000207","url":null,"abstract":"Studies included in meta-analysis can produce results that depart from the true population parameter of interest due to systematic and/or random errors. Synthesis of these results in meta-analysis aims to generate an estimate closer to the true population parameter by minimizing these errors across studies. The inverse variance heterogeneity (IVhet), quality effects and random effects models of meta-analysis all attempt to do this, but there remains controversy around the estimator that best achieves this goal of reducing error. In an attempt to answer this question, a simulation study was conducted to compare estimator performance. Five thousand iterations at 10 different levels of heterogeneity were run, with each iteration generating one meta-analysis. The results demonstrate that the IVhet and quality effects estimators, though biased, have the lowest mean squared error. These estimators also achieved a coverage probability at or above the nominal level (95%), whereas the coverage probability under the random effects estimator significantly declined (<80%) as heterogeneity increased despite a similar confidence interval width. Based on our findings, we would recommend the use of the IVhet and quality effects models and a discontinuation of traditional random effects models currently in use for meta-analysis.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86884358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-09DOI: 10.1097/XEB.0000000000000210
M. Bahadori, M. Yaghoubi, Elaheh Haghgoshyie, Matina Ghasemi, E. Hasanpoor
AIM Medical consultation is not only one of the most important steps in disease diagnosis and patient treatment, but also every patient's right. The purpose of this review was to explore patients' and physicians' perspectives and experiences of the quality of medical consultations. METHODS A qualitative interview study was carried out in outpatient clinics. A combination of face-to-face and telephone interviews was used due to the geographical spread of the respondents. Interviews were recorded and transcribed verbatim. Thematic descriptive analysis was used to interpret the data. Eligible physicians (n = 21) and patients (n = 27) were invited to take part in a semistructured interview to explore the views, perceptions, and experiences of patients on various factors affecting the quality of medical consultations. RESULTS The consultation quality was categorized into three topics: structure quality, process quality, and outcome quality. Data synthesis identified the following major themes for structure quality of consultations: administrative-organizational quality (with eight subthemes), physical environment quality (with six subthemes), and educational quality (with three subthemes). In addition, process quality was categorized into two major themes: examination quality (with nine subthemes) and interpersonal quality (with 13 subthemes). Outcome quality consisted of three major themes: patient satisfaction (with four subthemes), clinical outcomes (with two subthemes), and organizational outcomes (with three subthemes). CONCLUSION Medical consultation plays a central role in the quality and effectiveness of the received health care. Using the indicators of consultation quality improvement can develop physicians' clinical competence and skills. Furthermore, decision-makers can use them to monitor and evaluate physicians' performance.
{"title":"Patients' and physicians' perspectives and experiences on the quality of medical consultations: a qualitative evidence.","authors":"M. Bahadori, M. Yaghoubi, Elaheh Haghgoshyie, Matina Ghasemi, E. Hasanpoor","doi":"10.1097/XEB.0000000000000210","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000210","url":null,"abstract":"AIM\u0000Medical consultation is not only one of the most important steps in disease diagnosis and patient treatment, but also every patient's right. The purpose of this review was to explore patients' and physicians' perspectives and experiences of the quality of medical consultations.\u0000\u0000\u0000METHODS\u0000A qualitative interview study was carried out in outpatient clinics. A combination of face-to-face and telephone interviews was used due to the geographical spread of the respondents. Interviews were recorded and transcribed verbatim. Thematic descriptive analysis was used to interpret the data. Eligible physicians (n = 21) and patients (n = 27) were invited to take part in a semistructured interview to explore the views, perceptions, and experiences of patients on various factors affecting the quality of medical consultations.\u0000\u0000\u0000RESULTS\u0000The consultation quality was categorized into three topics: structure quality, process quality, and outcome quality. Data synthesis identified the following major themes for structure quality of consultations: administrative-organizational quality (with eight subthemes), physical environment quality (with six subthemes), and educational quality (with three subthemes). In addition, process quality was categorized into two major themes: examination quality (with nine subthemes) and interpersonal quality (with 13 subthemes). Outcome quality consisted of three major themes: patient satisfaction (with four subthemes), clinical outcomes (with two subthemes), and organizational outcomes (with three subthemes).\u0000\u0000\u0000CONCLUSION\u0000Medical consultation plays a central role in the quality and effectiveness of the received health care. Using the indicators of consultation quality improvement can develop physicians' clinical competence and skills. Furthermore, decision-makers can use them to monitor and evaluate physicians' performance.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88931427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-09DOI: 10.1097/XEB.0000000000000211
Z. Jordan
The focus of most individuals and organizations working in the field of evidence-based healthcare (EBHC) is to operationalize evidence. Few would argue that the primary driver and ultimate objective of EBHC is to see it utilized to inform policy and practice that results in improved outcomes for patients. However, it is hard not to think of the infinity pool as a metaphor for the potentially limitless endeavour of methodological reflection, refinement and reconceptualization that many of us as evidence-based researchers seek to achieve. Diving into ‘methodological infinity pools’ (or down rabbit holes – you can choose whichever symbolism or imagery works best for you) can result in fresh, unexpected salience. There is no doubt that some benefit can come from considering tangential ways of thinking about some of the problems we seek to solve. Nevertheless, these tangents are not always necessarily productive or pragmatic and need to be tempered accordingly. The value proposition of systematic reviews in this context has been their ability to provide rigorously reviewed and synthesized trustworthy evidence. It is therefore critical that we deliver on that promise and invest in ensuring the highest quality result for key stakeholders. To that end, methodological advances in the science and timely delivery and update of evidence syntheses continue at a rapid rate. A considerable number of new methodological approaches are now appearing for different types of evidence, and there are also an increasing number of tools available to assist in improving reporting and methodological quality in the conduct of systematic reviews (QUOROM, PRISMA, AMSTAR, COSMIN, MOOSE, OQAQ, ROBIS). However, despite the existence of such tools common errors persist, including use of incomplete guidance, incorrect use of reporting tools and checklists or use of tolls in isolation without reference to methodological guidance for the conduct of reviews. Significant criticism has also been levelled at the science that currently underpins the conduct of systematic reviews and, in particular, meta-analyses. Prominent, experienced synthesis science scholars like John Ionnidis and Jos Kleijnen (among others) have been frequently cited for their observations regarding issues related to
{"title":"Focus is the new intelligence quotient for evidence-based practice.","authors":"Z. Jordan","doi":"10.1097/XEB.0000000000000211","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000211","url":null,"abstract":"The focus of most individuals and organizations working in the field of evidence-based healthcare (EBHC) is to operationalize evidence. Few would argue that the primary driver and ultimate objective of EBHC is to see it utilized to inform policy and practice that results in improved outcomes for patients. However, it is hard not to think of the infinity pool as a metaphor for the potentially limitless endeavour of methodological reflection, refinement and reconceptualization that many of us as evidence-based researchers seek to achieve. Diving into ‘methodological infinity pools’ (or down rabbit holes – you can choose whichever symbolism or imagery works best for you) can result in fresh, unexpected salience. There is no doubt that some benefit can come from considering tangential ways of thinking about some of the problems we seek to solve. Nevertheless, these tangents are not always necessarily productive or pragmatic and need to be tempered accordingly. The value proposition of systematic reviews in this context has been their ability to provide rigorously reviewed and synthesized trustworthy evidence. It is therefore critical that we deliver on that promise and invest in ensuring the highest quality result for key stakeholders. To that end, methodological advances in the science and timely delivery and update of evidence syntheses continue at a rapid rate. A considerable number of new methodological approaches are now appearing for different types of evidence, and there are also an increasing number of tools available to assist in improving reporting and methodological quality in the conduct of systematic reviews (QUOROM, PRISMA, AMSTAR, COSMIN, MOOSE, OQAQ, ROBIS). However, despite the existence of such tools common errors persist, including use of incomplete guidance, incorrect use of reporting tools and checklists or use of tolls in isolation without reference to methodological guidance for the conduct of reviews. Significant criticism has also been levelled at the science that currently underpins the conduct of systematic reviews and, in particular, meta-analyses. Prominent, experienced synthesis science scholars like John Ionnidis and Jos Kleijnen (among others) have been frequently cited for their observations regarding issues related to","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84457889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-04DOI: 10.1097/XEB.0000000000000206
S. Lai, Cheng-Li Lin, K. Liao
BACKGROUND/OBJECTIVE No systematic research focuses on the association between splenectomy and herpes zoster. This study aimed to investigate the association between splenectomy and herpes zoster in Taiwan. METHODS A population-based cohort study was conducted using the database of Taiwan National Health Insurance Program. There were 640 individuals aged 20-84 years who were newly diagnosed with splenectomy in 2000-2012 as the splenectomy group and 2546 sex-matched and age-matched individuals without splenectomy as the nonsplenectomy group. The incidence of herpes zoster at the end of 2013 was estimated. The multivariable Cox proportional hazards regression model was used to estimate the hazard ratio and 95% confidence interval (CI) for herpes zoster associated with splenectomy. RESULTS The overall incidence of herpes zoster was 1.41-fold higher in the splenectomy group than in the nonsplenectomy group (11.3 vs. 8.05 per 1000 person-years, 95% CI 1.11-1.78). After multivariable adjustments, the adjusted hazard ratio of herpes zoster was 1.57 for individuals with splenectomy (95% CI 1.08-2.29), compared with individuals without splenectomy. CONCLUSION Individuals with splenectomy are associated with 1.57-fold increased risk for developing herpes zoster in Taiwan. Vaccination against herpes zoster may be considered among these high-risk individuals.
背景/目的目前还没有系统的研究关注脾切除术与带状疱疹的关系。摘要本研究旨在探讨台湾地区脾切除术与带状疱疹的关系。方法采用台湾全民健保数据库进行人群队列研究。2000-2012年新诊断的20-84岁脾切除术患者640例作为脾切除术组，性别匹配和年龄匹配的未脾切除术患者2546例作为非脾切除术组。估计2013年底带状疱疹的发病率。采用多变量Cox比例风险回归模型估计带状疱疹伴脾切除术的风险比和95%置信区间(CI)。结果脾切除术组带状疱疹的总发病率是未脾切除术组的1.41倍(11.3 vs. 8.05 / 1000人年，95% CI 1.11-1.78)。经多变量校正后，与未行脾切除术的患者相比，行脾切除术的患者患带状疱疹的校正危险比为1.57 (95% CI 1.08-2.29)。结论台湾地区行脾切除术者发生带状疱疹的风险增加1.57倍。这些高危人群可考虑接种带状疱疹疫苗。
{"title":"Splenectomy associated with increased risk of herpes zoster in a population-based cohort study.","authors":"S. Lai, Cheng-Li Lin, K. Liao","doi":"10.1097/XEB.0000000000000206","DOIUrl":"https://doi.org/10.1097/XEB.0000000000000206","url":null,"abstract":"BACKGROUND/OBJECTIVE\u0000No systematic research focuses on the association between splenectomy and herpes zoster. This study aimed to investigate the association between splenectomy and herpes zoster in Taiwan.\u0000\u0000\u0000METHODS\u0000A population-based cohort study was conducted using the database of Taiwan National Health Insurance Program. There were 640 individuals aged 20-84 years who were newly diagnosed with splenectomy in 2000-2012 as the splenectomy group and 2546 sex-matched and age-matched individuals without splenectomy as the nonsplenectomy group. The incidence of herpes zoster at the end of 2013 was estimated. The multivariable Cox proportional hazards regression model was used to estimate the hazard ratio and 95% confidence interval (CI) for herpes zoster associated with splenectomy.\u0000\u0000\u0000RESULTS\u0000The overall incidence of herpes zoster was 1.41-fold higher in the splenectomy group than in the nonsplenectomy group (11.3 vs. 8.05 per 1000 person-years, 95% CI 1.11-1.78). After multivariable adjustments, the adjusted hazard ratio of herpes zoster was 1.57 for individuals with splenectomy (95% CI 1.08-2.29), compared with individuals without splenectomy.\u0000\u0000\u0000CONCLUSION\u0000Individuals with splenectomy are associated with 1.57-fold increased risk for developing herpes zoster in Taiwan. Vaccination against herpes zoster may be considered among these high-risk individuals.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83883078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-21DOI: 10.17267/2675-021xevidence.v1i2.2485
T. Lapa, Marcelo Nunes Dourado Rocha, N. A. Almeida Filho, André Luis Mattedi Dias
{"title":"A brief history of evidence-based medicine","authors":"T. Lapa, Marcelo Nunes Dourado Rocha, N. A. Almeida Filho, André Luis Mattedi Dias","doi":"10.17267/2675-021xevidence.v1i2.2485","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.v1i2.2485","url":null,"abstract":"<jats:p />","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72755960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-21DOI: 10.17267/2675-021xevidence.v1i2.2510
J. Li, Jessica Stetz
The evidence presented in this Cochrane meta-analysis shows the HPV vaccination confers significant benefit in preventing cervical pre-cancer. NNT of 60 for preventing one cervical pre-cancer (women 15 to 25 years old with or without HPV infection). The effect is higher for lesions associated with HPV16/18. The data also demonstrates an absence of serious adverse events. Therefore, we have assigned a color recommendation of Green (Benefit > Harm) to this vaccine.
{"title":"HPV vaccines for prevention of cervical pre-cancer in adolescent girls and women","authors":"J. Li, Jessica Stetz","doi":"10.17267/2675-021xevidence.v1i2.2510","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.v1i2.2510","url":null,"abstract":"The evidence presented in this Cochrane meta-analysis shows the HPV vaccination confers significant benefit in preventing cervical pre-cancer. NNT of 60 for preventing one cervical pre-cancer (women 15 to 25 years old with or without HPV infection). The effect is higher for lesions associated with HPV16/18. The data also demonstrates an absence of serious adverse events. Therefore, we have assigned a color recommendation of Green (Benefit > Harm) to this vaccine.","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75655766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-10-17DOI: 10.17267/2675-021xevidence.v1i2.2506
R. Sarkis-Onofre, T. Pereira-Cenci, Rafaela Bassani, M. Page, A. Tricco, D. Moher, M. Cenci, G. K. Pereira
OBJECTIVE: This study aimed to analyze the reporting and conduct characteristics of systematic reviews (SRs) published in dentistry by Brazilian corresponding authors and compare reporting characteristics of Brazilian SRs with the rest of the world. METHODS: A search in PubMed was performed to identify SRs published in dentistry in 2017 assessing different aspects of oral heath irrespective of the design of included studies. From this dataset, a subgroup analysis was performed considering only SRs published by Brazilian corresponding authors. Study screening was performed by two researchers independently, while for data extraction, one of three reviewers extracted details related to reporting and conduct of SRs. The completeness of reporting of 24 characteristics, included in the PRISMA Statement of the SRs classified as treatment/therapeutic, was evaluated comparing Brazilian SR to SRs from all other countries. RESULTS: We included 117 SRs with Brazilian corresponding authors. The majority focused on dental treatments (39.3%), with oral surgery (n=19, 16.2%) as the most commonly published. Included SRs presented varying reporting/conduct characteristics. Items such as use of reporting guidelines and screening method used were well reported. However, most SRs did not assess the risk of publication bias and did not use the GRADE assessment. Four (of 24) reporting characteristics of Brazilian SRs compared to SRs from the rest of world were reported statistically significantly more frequently: mention of a SR protocol, trial registry searched, screening method reported, and assessment of risk of bias/quality of studies. CONCLUSION: Reporting and conduct characteristics of Brazilian SRs are highly variable.
{"title":"Characteristics of systematic reviews published in dentistry by Brazilian corresponding authors","authors":"R. Sarkis-Onofre, T. Pereira-Cenci, Rafaela Bassani, M. Page, A. Tricco, D. Moher, M. Cenci, G. K. Pereira","doi":"10.17267/2675-021xevidence.v1i2.2506","DOIUrl":"https://doi.org/10.17267/2675-021xevidence.v1i2.2506","url":null,"abstract":"OBJECTIVE: This study aimed to analyze the reporting and conduct characteristics of systematic reviews (SRs) published in dentistry by Brazilian corresponding authors and compare reporting characteristics of Brazilian SRs with the rest of the world. METHODS: A search in PubMed was performed to identify SRs published in dentistry in 2017 assessing different aspects of oral heath irrespective of the design of included studies. From this dataset, a subgroup analysis was performed considering only SRs published by Brazilian corresponding authors. Study screening was performed by two researchers independently, while for data extraction, one of three reviewers extracted details related to reporting and conduct of SRs. The completeness of reporting of 24 characteristics, included in the PRISMA Statement of the SRs classified as treatment/therapeutic, was evaluated comparing Brazilian SR to SRs from all other countries. RESULTS: We included 117 SRs with Brazilian corresponding authors. The majority focused on dental treatments (39.3%), with oral surgery (n=19, 16.2%) as the most commonly published. Included SRs presented varying reporting/conduct characteristics. Items such as use of reporting guidelines and screening method used were well reported. However, most SRs did not assess the risk of publication bias and did not use the GRADE assessment. Four (of 24) reporting characteristics of Brazilian SRs compared to SRs from the rest of world were reported statistically significantly more frequently: mention of a SR protocol, trial registry searched, screening method reported, and assessment of risk of bias/quality of studies. CONCLUSION: Reporting and conduct characteristics of Brazilian SRs are highly variable. ","PeriodicalId":55996,"journal":{"name":"International Journal of Evidence-Based Healthcare","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85076307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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