ORCID Profile
0000-0002-4337-9757
Current Organisation
Australian National University
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Publisher: Springer Singapore
Date: 2021
Publisher: SAGE Publications
Date: 20-07-2016
Abstract: Acute coronary syndromes (ACS) are the most common cardiovascular diseases and are associated with a significant risk of mortality and morbidity. The Global Registry of Acute Coronary Events (GRACE) risk score postdischarge is a widely used ACS prediction model for risk of mortality (low, intermediate, and high) however, it has not yet been validated in patients from the Arabian Gulf. This prospective multicenter study (second Gulf Registry of Acute Coronary Events) provides detailed information of the GRACE risk score postdischarge in patients from the Arabian Gulf. Its prognostic utility was validated at 1-year follow-up in over 5000 patients with ACS from 65 hospitals in 6 Arabian Gulf countries (Bahrain, Saudi Arabia, Qatar, Oman, United Arab Emirates, and Yemen). Overall, the goodness of fit (Hosmer and Lemeshow statistic P value = .826), calibration, and discrimination (area under the receiver operating characteristic curve = 0.695 95% confidence interval: 0.668-0.722) were good. The GRACE risk score postdischarge can be used to stratify 1 year mortality risk in the Arabian Gulf population it does not require further calibration and has a good discriminatory ability.
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 14-01-2020
Publisher: Elsevier BV
Date: 2016
Publisher: Wiley
Date: 16-12-2015
DOI: 10.1002/PDS.3736
Publisher: SAGE Publications
Date: 05-2016
Abstract: Ferguson’s (2015a) meta-analysis assessed a very important and controversial topic about children’s mental health and video games. In response to the concerns raised by researchers about the appropriateness of the meta-analytical methods used by Ferguson we decided to reanalyze the data and discuss two major misconceptions about meta-analysis. We argue that partial correlations can (and should) be meta-analyzed instead of zero-order bivariate correlations if the predictors included in the partial correlation represent a similar construct. We also discuss the fallacy by which the conventional meta-analytical model assumes that the studies’ effect sizes came into being according to the same random effect construct used by the analysis. Our replication results using partial correlations, standardized (valid and reliable) outcomes, and an improved meta-analytical model (that does not assume a random effect is the mechanism of data generation) confirmed the main results of Ferguson’s meta-analysis. There was a significant yet very small effect on aggressive behavior of exposure to both general, r p = 0.062, 95% CI [0.012, 0.112], and violent, r p = 0.055, 95% CI [0.019, 0.091], video games. A very small effect was seen on reduced prosocial behavior, but this was only in the general video game exposure category, r p = 0.072, 95% CI [0.045, 0.100].
Publisher: Wiley
Date: 23-12-2015
Abstract: Well-known risk factors for Clostridium difficile infection (CDI) are exposure to antibiotics and gastric acid suppressants. Recent studies have provided some evidence of an association between hypovitaminosis D and the risk of CDI. Therefore, this meta-analysis aimed to pool all the existing evidence to investigate the association between 25-hydroxyvitamin D (25[OH]D) and CDI. A systematic search was conducted in 3 databases (PubMed, Embase, and Web of Sciences) for epidemiological studies that examined the association between mean 25(OH)D concentrations and CDI as well as between 25(OH)D status and CDI severity or recurrence. 25(OH)D status was defined as "lower" or "higher" at a threshold concentration of <20 or ≥20 ng/mL, respectively. Pooled effect sizes were computed using the inverse variance heterogeneity model of meta-analysis. Eight publications (n = 4479 patients) were included in the meta-analysis. The mean concentration of 25(OH)D in patients with CDI was 3.54 ng/mL (95% confidence interval [CI], 0.39-6.89 ng/mL) lower than in patients without CDI. Patients with lower 25(OH)D status had a higher odds (odds ratio [OR], 1.61 95% CI, 1.02-2.53) of developing severe CDI compared with those with a higher 25(OH)D status. No significant association was found between 25(OH)D status and CDI recurrence. The results of this meta-analysis suggest that lower mean concentrations of 25(OH)D were associated with CDI. A lower 25(OH)D status increased the odds of severe CDI but not of CDI recurrence.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Elsevier BV
Date: 10-2017
Publisher: Wiley
Date: 31-10-2019
DOI: 10.1111/OBR.12964
Abstract: Previous randomized and observational studies on the efficacy of metformin in pregnancy to reduce incident gestational diabetes mellitus (GDM) in women at high risk (obesity, polycystic ovary syndrome [PCOS], or pregestational insulin resistance) have been conflicting and several groups are planning further randomized controlled trials (RCTs) to answer this question conclusively. This work assesses the efficacy of metformin in pregnancy to avert one outcome-incident GDM in women at high risk. We included RCTs comparing metformin with usual care or placebo controls in terms of incident GDM and recruiting women at high risk during early pregnancy. Eleven eligible trials enrolled 2370 adult women whose intervention arm consisted of metformin started at conception or before 20 weeks of gestation. Risk of GDM was similar in intervention compared with controls (risk ratio [RR] 1.03 95% confidence interval [CI], 0.85-1.24). The data were of sufficient quality meeting the criteria for consistency and directness. We conclude that metformin does not contribute to averting the GDM outcome in women at high risk when initiated in pregnancy. The evidence provided by this synthesis affirms that further broad clinical trials investigating this question are no longer needed.
Publisher: American Society for Microbiology
Date: 2017
DOI: 10.1128/JCM.01779-16
Abstract: Clostridium difficile infection (CDI) is becoming less exclusively a health care-associated CDI (HA-CDI). The incidence of community-associated CDI (CA-CDI) has increased over the past few decades. It has been postulated that asymptomatic toxigenic C. difficile (TCD)-colonized patients may play a role in the transfer of C. difficile between the hospital setting and the community. Thus, to investigate the relatedness of C. difficile across the hospital and community settings, we compared the characteristics of symptomatic and asymptomatic host patients and the pathogens from these patients in these two settings over a 3-year period. Two studies were simultaneously conducted the first study enrolled symptomatic CDI patients from two tertiary care hospitals and the community in two Australian states, while the second study enrolled asymptomatic TCD-colonized patients from the same tertiary care hospitals. A total of 324 patients (96 with HA-CDI, 152 with CA-CDI, and 76 colonized with TCD) were enrolled. The predominant C. difficile ribotypes isolated in the hospital setting corresponded with those isolated in the community, as it was found that for 79% of the C. difficile isolates from hospitals, an isolate with a matching ribotype was isolated in the community, suggesting that transmission between these two settings is occurring. The toxigenic C. difficile strains causing symptomatic infection were similar to those causing asymptomatic infection, and patients exposed to antimicrobials prior to admission were more likely to develop a symptomatic infection (odds ratio, 2.94 95% confidence interval, 1.20 to 7.14). Our findings suggest that the development of CDI symptoms in a setting without establishment of hospital epidemics with binary toxin-producing C. difficile strains may be driven mainly by host susceptibility and exposure to antimicrobials, rather than by C. difficile strain characteristics.
Publisher: Elsevier BV
Date: 04-2014
Publisher: IOP Publishing
Date: 02-07-2019
Publisher: SAGE Publications
Date: 10-02-2022
DOI: 10.1177/14407833211072566
Abstract: Anti-discrimination laws around the world have explicitly protected LGBTQ+ people from discrimination with various levels of exceptions for religion. Some conservative religious organisations in Australia are advocating to be allowed to discriminate against LGBTQ+ people in certain organisations they manage. The political debate in Australia has focused on religiously affiliated organisations that provide services in education, social welfare, health care, and aged care. We argue that religious exceptions allowing discrimination should be narrow because they cause considerable harm, reinforce, disadvantage and because LGBTQ+ people are deserving of respect and rights. We draw on a national representative survey to demonstrate that the views of some conservative religious lobby groups do not represent the views of the majority of religious people in Australia or the views of the majority of Christian people.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
Publisher: Oxford University Press (OUP)
Date: 10-04-2021
DOI: 10.1093/JTM/TAAB060
Publisher: Elsevier BV
Date: 09-2020
Publisher: Wiley
Date: 10-2018
Publisher: Elsevier BV
Date: 05-2021
DOI: 10.1016/J.PHRS.2021.105546
Abstract: The comparative efficacy of gestational diabetes (GDM) treatments lack conclusive evidence for choice of first-line treatment. The aim of this study was to compare the efficacy of metformin and glibenclamide to insulin using a core outcome set (COS) to unify outcomes across trials investigating the treatment of gestational diabetes mellitus. A network meta-analysis (NMA) was conducted. PubMed, Embase, and Cochrane Controlled Register of Trials were searched from inception to January 2020. RCTs that enrolled pregnant women who were diagnosed with GDM and that compared the efficacy of different pharmacological interventions for the treatment of GDM were included. A generalized pairwise modelling framework was employed. A total of 38 RCTs with 6046 participants were included in the network meta-analysis. Compared to insulin, the estimated effect of metformin indicated improvements for weight gain (WMD -2·39 kg 95% CI -3·31 to -1·46), maternal hypoglycemia (OR 0.34 95% CI 0.12 to 0·97) and LGA (OR 0.61 95% CI 0.38 to 0·98). There were also improvements in estimated effects for neonatal hypoglycemia (OR 0.48 95% CI 0.19 to 1·25), pregnancy induced hypertension (OR 0.63 95% CI 0.37 to 1·06), and preecl sia (OR 0.74 95% CI 0.538 to 1·04), though with limited evidence against our model hypothesis of equivalence with insulin for these outcomes. Metformin is, at least, comparable to insulin for the treatment of GDM. Glibenclamide appears less favorable, in comparison to insulin, than metformin.
Publisher: Springer Science and Business Media LLC
Date: 15-06-2021
DOI: 10.1186/S12916-021-02008-2
Abstract: Zero-events studies frequently occur in systematic reviews of adverse events, which consist of an important source of evidence. We aimed to examine how evidence of zero-events studies was utilized in the meta-analyses of systematic reviews of adverse events. We conducted a survey of systematic reviews published in two periods: January 1, 2015, to January 1, 2020, and January 1, 2008, to April 25, 2011. Databases were searched for systematic reviews that conducted at least one meta-analysis of any healthcare intervention and used adverse events as the exclusive outcome. An adverse event was defined as any untoward medical occurrence in a patient or subject in healthcare practice. We summarized the frequency of occurrence of zero-events studies in eligible systematic reviews and how these studies were dealt with in the meta-analyses of these systematic reviews. We included 640 eligible systematic reviews. There were 406 (63.45%) systematic reviews involving zero-events studies in their meta-analyses, among which 389 (95.11%) involved single-arm-zero-events studies and 223 (54.93%) involved double-arm-zero-events studies. The majority (98.71%) of these systematic reviews incorporated single-arm-zero-events studies into the meta-analyses. On the other hand, the majority (76.23%) of them excluded double-arm-zero-events studies from the meta-analyses, of which the majority (87.06%) did not discuss the potential impact of excluding such studies. Systematic reviews published at present (2015-2020) tended to incorporate zero-events studies in meta-analyses than those published in the past (2008-2011), but the difference was not significant (proportion difference=−0.09, 95% CI −0.21 to 0.03, p = 0.12). Systematic review authors routinely treated studies with zero-events in both arms as “non-informative” carriers and excluded them from their reviews. Whether studies with no events are “informative” or not largely depends on the methods and assumptions applied, thus sensitivity analyses using different methods should be considered in future meta-analyses.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.CMI.2016.08.030
Abstract: To investigate the prevalence and risk factors for asymptomatic toxigenic (TCD) and nontoxigenic Clostridium difficile (NTCD) colonization in a broad cross section of the general hospital population over a 3-year period. Patients without diarrhoea admitted to two Australian tertiary hospitals were randomly selected through six repeated cross-sectional surveys conducted between 2012 and 2014. Stool specimens were cultured under anaerobic conditions, and C. difficile isolates were tested for the presence of toxin genes and ribotyped. Patients were then grouped into noncolonized, TCD colonized or NTCD colonized for identifying risk factors using multinomial logistic regression models. A total of 1380 asymptomatic patients were enrolled 76 patients (5.5%) were TCD colonized and 28 (2.0%) were NTCD colonized. There was a decreasing annual trend in TCD colonization, and asymptomatic colonization was more prevalent during the summer than winter months. TCD colonization was associated with gastro-oesophageal reflux disease (relative risk ratio (RRR) = 2.20 95% confidence interval (CI) 1.17-4.14), higher number of admissions in the previous year (RRR = 1.24 95% CI 1.10-1.39) and antimicrobial exposure during the current admission (RRR = 2.78 95% CI 1.23-6.28). NTCD colonization was associated with chronic obstructive pulmonary disease (RRR = 3.88 95% CI 1.66-9.07) and chronic kidney failure (RRR = 5.78 95% CI 2.29-14.59). Forty-eight different ribotypes were identified, with 014/020 (n = 23), 018 (n = 10) and 056 (n = 6) being the most commonly isolated. Risk factors differ between patients with asymptomatic colonization by toxigenic and nontoxigenic strains. Given that morbidity is largely driven by toxigenic strains, this novel finding has important implications for disease control and prevention.
Publisher: Oxford University Press (OUP)
Date: 08-04-2021
DOI: 10.1093/JTM/TAAB057
Abstract: Chemoprophylaxis with weekly doses of tafenoquine (200 mg/day for 3 days before departure [loading dose], 200 mg/week during travel and 1-week post-travel [maintenance doses]) is effective in preventing malaria. Effectiveness of malaria chemoprophylaxis drugs in travellers is often compromised by poor compliance. Shorter schedules that can be completed before travel, allowing ‘drug-free holidays’, could increase compliance and thus reduce travel-related malaria. In this meta-analysis, we examined if a loading dose of tafenoquine alone is effective in preventing malaria in short-term travellers. Four databases were searched in November 2020 for randomized controlled trials (RCTs) that assessed efficacy and/or safety of tafenoquine for chemoprophylaxis. Network meta-analysis using the generalized pair-wise modelling framework was utilized to estimate the odds ratio (OR) of malaria infection in long-term (& days) and short-term (≤28 days) travellers, as well as adverse events (AEs) associated with receiving loading dose of tafenoquine alone, loading dose of tafenoquine followed by maintenance doses, loading dose of mefloquine followed by maintenance doses, or placebo. Nine RCTs (1714 participants) were included. In long-term travellers, compared to mefloquine, tafenoquine with maintenance doses (OR = 1.05 95% confidence interval [CI]: 0.44–2.46) was equally effective in preventing malaria, while there was an increased risk of infection with the loading dose of tafenoquine alone (OR = 2.89 95% CI: 0.78–10.68) and placebo (OR = 62.91 95% CI: 8.53–463.88). In short-term travellers, loading dose of tafenoquine alone (OR = 0.98 95% CI: 0.04–22.42) and tafenoquine with maintenance doses (OR = 1.00 95% CI: 0.06–16.10) were as effective as mefloquine. The risk of AEs with tafenoquine with maintenance doses (OR = 1.03 95% CI: 0.67–1.60) was similar to mefloquine, while loading dose of tafenoquine alone (OR = 0.58 95% CI: 0.20–1.66) was associated with lower risk of AEs, although the difference was not statistically significant. For short-term travellers, loading dose of tafenoquine alone was equally effective, had possibly lower rate of AEs, and likely better compliance than standard tafenoquine or mefloquine chemoprophylaxis schedules with maintenance doses. Studies are needed to confirm if short-term travellers remain free of infection after long-term follow-up. The meta-analysis was registered in PROSPERO (CRD42021223756). Tafenoquine is the latest approved drug for malaria chemoprophylaxis. A loading dose of tafenoquine (200 mg/day for 3 days before departure) is as effective in preventing malaria in short-term (≤28 days) travellers as chemoprophylaxis schedules of tafenoquine or mefloquine with maintenance doses, allowing travellers to have a ‘drug-free holiday’.
Publisher: Oxford University Press (OUP)
Date: 26-08-2020
DOI: 10.1136/POSTGRADMEDJ-2020-137868
Abstract: To investigate the effect of monetary incentive and the dose–response relationship of participants’ response rates in surveys. Three databases were searched for randomised controlled trials (RCTs) that investigated the effect of monetary incentives on participants’ first and final response rates. First response is defined as the responses after the participant was initially contacted and final response is defined as the responses after several reminders were sent. The potential dose–response relationship of the amount of monetary incentive on the relative response rate (RRR) was established by fitting a restricted cubic spline function based on the robust-error meta-regression model. 105 RCTs were identified. The first RRR increased by 49% (RRR=1.49 95% CI 1.29 to 1.72) when monetary incentives were provided. Dose–response analysis revealed that an amount between US$6.25 and US$8 had the maximum effect on increasing the first response rate. On average, the final RRR increased almost by 20% (RRR=1.18 95% CI 1.11 to 1.25) with monetary incentive compared to no-monetary incentive. An amount between US$10 and US$15 had the maximum effect on the final response rate, with an increase in the final RRR of 34% (RRR=1.34 95% CI 1.19 to 1.51). There was a significant increase in the response rate when two or more reminders were sent. Monetary incentives and reminders improve the response rates. Future studies need to consider providing monetary incentives and sending at least two reminders to increase the response rate and reduce the chances of non-response bias.
Publisher: Public Library of Science (PLoS)
Date: 25-10-2013
Publisher: Oxford University Press (OUP)
Date: 10-04-2021
DOI: 10.1093/JTM/TAAB059
Abstract: Current guidelines for rabies pre-exposure prophylaxis (PrEP) recommend multiple vaccine doses. Travellers sometimes present for pre-travel consultation with insufficient time to complete standard PrEP schedules. We investigated the efficacy of one-dose intramuscular (IM) vaccine in priming the immune system (as PrEP) by measuring antibody response to simulated post-exposure prophylaxis (PEP). A quasi-experimental pre–post intervention clinical trial was conducted at a specialist travel clinic in Australia. Adults (≥18 years) without a history of rabies vaccination were included. At Visit 1, seronegative status was confirmed and one dose of 0.5 ml IM rabies vaccine (Verorab®) administered. At Visit 2 (≥60 days after Visit 1), serology was repeated and a simulated PEP dose (0.5 ml IM) given on this day and again 3 days later (Visit 3). Serology was repeated at Visit 4 (7 days after Visit 2). A total of 94 antibody-negative participants were included (& years [n = 50] ≥50 years [n = 44]). At Visit 2, 38.0 and 31.8% of participants aged & and ≥50 years were antibody-positive (≥0.5 EU/ml). At Visit 4, all participants were antibody-positive 82.0 and 47.7% of participants aged & and ≥50 years had antibody levels & EU/ml, respectively. One-dose IM vaccine was effective as PrEP for priming the immune system in both age groups, resulting in rapid development of antibodies 7 days after commencing simulated PEP. If there is insufficient time to complete a standard PrEP schedule, one-dose IM could be considered as an alternative schedule for short trips, rather than not offering travellers any doses at all. Clinical trials registration: ACTRN12619000946112.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 07-2014
Publisher: Springer Science and Business Media LLC
Date: 20-08-2015
Publisher: Oxford University Press (OUP)
Date: 14-01-2021
DOI: 10.1093/JTM/TAAA006
Abstract: Intradermal (ID) rabies vaccination for pre-exposure prophylaxis (PrEP) has become increasingly popular however, there is limited evidence about the effectiveness of different ID PrEP schedules in travellers aged & 50 years or their response to ID boosters. This study aimed to compare across different ID vaccine schedules and age groups the proportion of travellers who were seropositive after (i) primary course of ID PrEP and (ii) a booster. Travellers who received ID PrEP at a travel medicine clinic in South Australia from 2000 to 2016 were included. Three schedules were examined: 1IDx3 (1 × 0.1 ml on days 0, 7, 21–28), 2IDx2 (2 × 0.1 ml on days 0, 7) and 4IDx1 (4x0.1 ml on day 0). The 4IDx1 is a non-standard schedule that has been previously explored in research settings, but not endorsed by WHO for PrEP. Antibody titres of ≥0.5 IU/ml were considered seropositive. The proportion seropositive after a primary course or post-booster was estimated for each schedule and age category. Predictors of seronegative status after a primary course were examined using multivariable logistic regression models. Overall, 835 travellers (median age 37.5 years 37.1% & 50 years) were included in the analyses of seropositivity after a primary course. Another group of 771 travellers (median age 45.9 years 43.5% & 50 years) was included in the analyses of seropositivity post-booster. The proportion seropositive after primary course was 92.5% (95%CI: 90.5–94.1%) and highest with the 1IDx3 schedule (93.4% 95%CI: 91.4–95.0%). After adjusting for age and timing of the serology, the odds of seronegative status were four times higher (OR 4.17 95%CI: 1.43–12.18) with the 4IDx1 schedule compared to 1IDx3. Overall, 98.7% (95%CI: 97.6–99.3%) were seropositive post-booster. Of 46 travellers who received a booster ≥3 years after PrEP, all were seropositive post-booster. In older travellers, the 1IDx3 schedule was the most effective, and a high proportion were seropositive post-booster even many years after a primary course.
Publisher: Wiley
Date: 16-07-2022
DOI: 10.1002/JRSM.1587
Abstract: In evidence‐based practice, new topics generally only have a few studies available for synthesis. As a result, the evidence of such meta‐analyses raised substantial concerns. We investigated the robustness of the evidence from these earliest studies. Real‐world data from the Cochrane Database of Systematic Reviews (CDSR) were collected. We emulated meta‐analyses with the earliest 1 to 10 studies through cumulative meta‐analysis from eligible meta‐analyses. The magnitude and the direction of meta‐analyses with the earliest few studies were compared to the full meta‐analyses. From the CDSR, we identified 20,227 meta‐analyses of binary outcomes and 7683 meta‐analyses of continuous outcomes. Under the tolerable difference of 20% on the magnitude of the effects, the convergence proportion ranged from 24.24% (earliest 1 study) to 77.45% (earliest 10 studies) for meta‐analyses of few earliest studies with binary outcomes. For meta‐analyses of continuous outcomes, the convergence proportion ranged from 13.86% to 56.52%. In terms of the direction of the effects, even when only three studies were available at the earliest stage, the majority had the same direction as full meta‐analyses Only 19% for binary outcomes and 12% for continuous outcomes changed the direction as further evidence accumulated. Synthesizing evidence from the earliest studies is feasible to support urgent decision‐making, and in most cases, the decisions would be reasonable. Considering the potential uncertainties, it is essential to evaluate the confidence of the evidence of these meta‐analyses and update the evidence when necessary.
Publisher: Springer Science and Business Media LLC
Date: 28-02-2019
Publisher: Centers for Disease Control and Prevention (CDC)
Date: 09-2016
Publisher: Wiley
Date: 23-07-2015
DOI: 10.1111/PACE.12681
Publisher: Bioscientifica
Date: 2018
DOI: 10.1530/ERC-17-0397
Abstract: The incidence of differentiated thyroid cancer (DTC) has rapidly increased worldwide over the last decades. It is unknown if the increase in diagnosis has been mirrored by an increase in thyroidectomy rates with the concomitant economic impact that this would have on the health care system. DTC and thyroidectomy incidence as well as DTC-specific mortality were modeled using Poisson regression in New South Wales (NSW), Australia per year and by sex. The incidence of 2002 was the point from which the increase in rates was assessed cumulatively over the subsequent decade. The economic burden of potentially avoidable thyroidectomies due to the increase in diagnosis was estimated as the product of the additional thyroidectomy procedures during a decade attributable to rates beyond those reported for 2002 and the national average hospital cost of an uncomplicated thyroidectomy in Australia. The following results were obtained. The incidence of both DTC and thyroidectomy doubled in NSW between 2003 and 2012, while the DTC-specific mortality rate remained unchanged over the same period. Based on the 2002 incidence, the projected increase over 10 years (2003–2012) in thyroidectomy procedures was 2196. This translates to an extra cost burden of over AUD$ 18,600,000 in surgery-related health care expenditure over one decade in NSW. Our findings suggest that, if this rise is solely attributable to overdetection, then the rising expenditure serves no additional purpose. Reducing unnecessary detection and a conservative approach to managing DTC are sensible and would lead to millions of dollars in savings and reduced harms to patients.
Publisher: Springer Science and Business Media LLC
Date: 14-11-2015
Publisher: Elsevier BV
Date: 02-2020
Publisher: Elsevier BV
Date: 02-2022
DOI: 10.1016/J.JCLINEPI.2020.08.019
Abstract: In clinical trials, the relative risk or risk ratio (RR) is a mainstay of reporting of the effect magnitude for an intervention. The RR is the ratio of the probability of an outcome in an intervention group to its probability in a control group. Thus, the RR provides a measure of change in the likelihood of an event linked to a given intervention. This measure has been widely used because it is today considered a measure with "portability" across varying outcome prevalence, especially when the outcome is rare. It turns out, however, that there is a much more important problem with this ratio, and this paper aims to demonstrate this problem. We used mathematical derivation to determine if the RR is a measure of effect magnitude alone (i.e., a larger absolute value always indicating a stronger effect) or not. We also used the same derivation to determine its relationship to the prevalence of an outcome. We confirm the derivation results with a follow-up analysis of 140,620 trials scraped from the Cochrane. We demonstrate that the RR varies for reasons other than the magnitude of the effect because it is a ratio of two posterior probabilities, both of which are dependent on baseline prevalence of an outcome. In addition, we demonstrate that the RR shifts toward its null value with increasing outcome prevalence. The shift toward the null happens regardless of the strength of the association between intervention and outcome. The odds ratio (OR), the other commonly used ratio, measures solely the effect magnitude and has no relationship to the prevalence of an outcome in a study nor does it overestimate the RR as is commonly thought. The results demonstrate the need to (1) end the primary use of the RR in clinical trials and meta-analyses as its direct interpretation is not meaningful, (2) replace the RR by the OR, and (3) only use the postintervention risk recalculated from the OR for any expected level of baseline risk in absolute terms for purposes of interpretation such as the number needed to treat. These results will have far-reaching implications such as reducing misleading results from clinical trials and meta-analyses and ushering in a new era in the reporting of such trials or meta-analyses in practice.
Publisher: Oxford University Press (OUP)
Date: 03-10-2019
DOI: 10.1093/CID/CIY854
Abstract: Poor compliance with chemoprophylaxis is a major contributing factor to the risk of malaria in travelers. Pre-travel chemoprophylaxis may improve compliance by enabling "drug-free holidays." The standard treatment dose of atovaquone roguanil (250 mg/100 mg, 4 tablets/day for 3 days) provides protection against malaria for at least 4 weeks, and could therefore potentially be used for pre-travel chemoprophylaxis. In this study, we assessed the compliance, tolerability, and acceptability of the 3-day atovaquone roguanil schedule for malarial chemoprophylaxis. Two hundred thirty-three participants were recruited from 4 specialized travel medicine clinics in Australia. Adults traveling to malaria-endemic areas with low/medium risk for ≤4 weeks were enrolled and prescribed the 3-day schedule of atovaquone roguanil, completed at least 1 day before departure. Questionnaires were used to collect data on demographics, travel destination, medication compliance, side effects, and reasons for choosing the 3-day schedule. Overall, 97.7% of participants complied with the 3-day schedule. Although side effects were reported in 43.3% of the participants, these were well tolerated, and mainly occurred during the first and second days. None of the participants developed malaria. The main reasons for choosing the 3-day schedule over standard chemoprophylaxis options were that it was easier to remember (72.1%), required taking fewer tablets (54.0%), and to help scientific research (54.0%). The 3-day atovaquone roguanil schedule had an impressively high compliance rate, and was well tolerated and accepted by travelers. Further studies are required to assess the effectiveness of this schedule for chemoprophylaxis in travelers. ACTRN12616000640404.
Publisher: Springer Science and Business Media LLC
Date: 28-07-2015
DOI: 10.1038/SREP12666
Abstract: Following rapid, global clonal dominance of hypervirulent ribotypes, Clostridium difficile now constitutes the primary infectious cause of nosocomial diarrhoea. Evidence indicates at least three possible mechanisms of hypervirulence that facilitates the successful invasion of these atypical strains: 1) increased infectiousness relative to endemic strains 2) increased symptomatic disease rate relative to endemic strains and 3) an ability to outcompete endemic strains in the host’s gut. Stochastic simulations of an infection transmission model demonstrate clear differences between the invasion potentials of C. difficile strains utilising the alternative hypervirulence mechanisms and provide new evidence that favours certain mechanisms (1 and 2) more than others (3). Additionally, simulations illustrate that direct competition between strains (inside the host’s gut) is not a prerequisite for the sudden switching that has been observed in prevailing ribotypes previously dominant C. difficile strains can be excluded by hypervirulent ribotypes through indirect (exploitative) competition.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.JINF.2014.06.014
Abstract: To identify the spatio-temporal patterns and environmental factors associated with Clostridium difficile infection (CDI) in Queensland, Australia. Data from patients tested for CDI were collected from 392 postcodes across Queensland between May 2003 and December 2012. A binomial logistic regression model, with CDI status as the outcome, was built in a Bayesian framework, incorporating fixed effects for sex, age, source of the s le (healthcare facility or community), elevation, rainfall, land surface temperature, seasons of the year, time in months and spatially unstructured random effects at the postcode level. C. difficile was identified in 13.1% of the s les, the proportion significantly increased over the study period from 5.9% in 2003 to 18.8% in 2012. CDI peaked in summer (14.6%) and was at its lowest in autumn (10.1%). Other factors significantly associated with CDI included female sex (OR: 1.08 95%CI: 1.01-1.14), community source s les (OR: 1.12 95%CI: 1.05-1.20), and higher rainfall (OR: 1.09 95%CI: 1.02-1.17). There was no significant spatial variation in CDI after accounting for the fixed effects in the model. There was an increasing annual trend in CDI in Queensland from 2003 to 2012. Peaks of CDI were found in summer (December-February), which is at odds with the current epidemiological pattern described for northern hemisphere countries. Epidemiologically plausible explanations for this disparity require further investigation.
Publisher: Oxford University Press (OUP)
Date: 06-11-2020
DOI: 10.1093/JTM/TAZ083
Abstract: Recent studies have shown that over 50% of people travelling to Southeast Asia return colonized with multidrug-resistant Enterobacterales (MRE) including carbapenemase-producing Enterobacterales. Importation of MRE by travellers and subsequent spread to family members, communities and healthcare facilities poses real risks that have not yet been adequately assessed. This systematic review and meta-analysis aims to quantify the risk factors and interventions for reducing the risk of MRE acquisition among international travellers. A systematic search was conducted in PubMed, Web of Science and Scopus for analytical epidemiological studies containing data post-2000 that assessed the risk factors to acquire and/or interventions to reduce the risk of MRE acquisition in travellers. Two researchers independently screened all the studies and extracted the information, and disagreements were resolved through consensus. The proportions of MRE acquisition by the region of destination and the odds ratio (OR) for the different risk factors and/or interventions were pooled using the inverse variance heterogeneity model. A total of 20 studies (5253 travellers from high-income countries) were included in the meta-analysis. South Asia [58.7% 95% confidence interval (CI), 44.5–72.5%] and Northern Africa (43.9% 95% CI 37.6–50.3%) were the travel destinations with the highest proportion of MRE acquisition. Inflammatory bowel disease (OR 2.1 95% CI 1.2–3.8), use of antibiotics (OR 2.4 95% CI 1.9–3.0), traveller’s diarrhoea (OR 1.7 95% CI 1.3–2.3) and contact with the healthcare system overseas (OR 1.5 95% CI 1.1–2.2) were associated with MRE colonization. Vegetarians (OR 1.4 95% CI 1.0–2.0) and backpackers (OR 1.5 95% CI 1.2–1.8) were also at increased odds of MRE colonization. Few studies (n = 6) investigated preventive measures and found that consuming only bottled water/beverages, meticulous hand hygiene and probiotics had no protective effect on MRE colonization. International travel is an important driver for MRE spread worldwide. Future research needs to identify effective interventions to reduce the risk of MRE acquisition as well as design strategies to reduce local transmission on return.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.JHIN.2019.03.001
Abstract: Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhoea with peak incidence in late winter or early autumn. Although CDI is commonly associated with hospitals, community transmission is important. To explore potential drivers of CDI seasonality and the effect of community-based interventions to reduce transmission. A mechanistic compartmental model of C. difficile transmission in a hospital and surrounding community was used to determine the effect of reducing transmission or antibiotic prescriptions in these settings. The model was extended to allow for seasonal antibiotic prescriptions and seasonal transmission. Modelling antibiotic seasonality reproduced the seasonality of CDI, including approximate magnitude (13.9-15.1% above annual mean) and timing of peaks (0.7-1.0 months after peak antibiotics). Halving seasonal excess prescriptions reduced the incidence of CDI by 6-18%. Seasonal transmission produced larger seasonal peaks in the prevalence of community colonization (14.8-22.1% above mean) than seasonal antibiotic prescriptions (0.2-1.7% above mean). Reducing transmission from symptomatic or hospitalized patients had little effect on community-acquired CDI, but reducing transmission in the community by ≥7% or transmission from infants by ≥30% eliminated the pathogen. Reducing antibiotic prescription rates led to approximately proportional reductions in infections, but limited reductions in the prevalence of colonization. Seasonal variation in antibiotic prescription rates can account for the observed magnitude and timing of C. difficile seasonality. Even complete prevention of transmission from hospitalized patients or symptomatic patients cannot eliminate the pathogen, but interventions to reduce transmission from community residents or infants could have a large impact on both hospital- and community-acquired infections.
Publisher: Cambridge University Press (CUP)
Date: 22-12-2014
DOI: 10.1017/ICE.2014.39
Abstract: Clostridium difficile infection (CDI) has been extensively described in healthcare settings however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI. A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted. Twelve publications (n=56,776 patients) met inclusion criteria. Antimicrobial (odds ratio, 6.18 95% CI, 3.80–10.04) and corticosteroid (1.81 1.15–2.84) exposure were associated with increased risk of CA-CDI. Among the comorbidities, inflammatory bowel disease (odds ratio, 3.72 95% CI, 1.52–9.12), renal failure (2.64 1.23–5.68), hematologic cancer (1.75 1.02–5.68), and diabetes mellitus (1.15 1.05–1.27) were associated with CA-CDI. By location, antimicrobial exposure was associated with a higher risk of CA-CDI in the United States, whereas proton-pump inhibitor exposure was associated with a higher risk in Europe. By life stages, the risk of CA-CDI associated with antimicrobial exposure greatly increased in adults older than 65 years. Antimicrobial exposure was the strongest risk factor associated with CA-CDI. Further studies are required to investigate the risk of CA-CDI associated with medications commonly prescribed in the community. Patients with diarrhea who have inflammatory bowel disease, renal failure, hematologic cancer, or diabetes are appropriate populations for interventional studies of screening. Infect Control Hosp Epidemiol 2014 (0):1–10
Publisher: Springer Science and Business Media LLC
Date: 03-03-2016
Publisher: Wiley
Date: 12-01-2021
Abstract: Findings about the effect of prophylactic antibiotics in preventing genital tract infection (GTI) associated with surgical procedures used for incomplete abortions are conflicting. Some reported a decrease in infection associated with the use of antibiotic prophylaxis, whereas others found no significant reduction in GTI. To synthesise systematically the evidence on the effect of prophylactic antibiotics compared with placebo in women undergoing surgical procedures for incomplete abortion. In February 2020, PubMed, Embase and Cochrane Central for Register of Controlled Trials were searched for relevant published randomised controlled trials. Randomised controlled trials reporting GTI following surgical procedures for incomplete abortion and comparing antibiotic prophylaxis with placebo. Meta‐analysis using inverse variance heterogeneity model included subgroup and sensitivity analyses determined a priori were conducted. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 16 178 women who participated in 24 eligible randomised controlled trials published between 1975 and 2019 were included. Pooled estimates showed the risk of GTI following surgical procedures after incomplete abortion was significantly lower among those who had prophylactic antibiotics (relative risk [RR] = 0.72 95% CI 0.58–0.90 I 2 = 49%). There was no significant effect of antibiotics in women in low‐ and middle‐income countries (three studies, 3579 participants, RR = 0.90 95% CI 0.50–1.62 I 2 = 63%), but it was clinically and statistically significant among women high‐income countries (21 studies, 12 599 participants, RR = 0.67 95% CI 0.53–0.84 I 2 = 44%), with a strong level of evidence as assessed by GRADE. This study provides evidence that antibiotic prophylaxis is beneficial in reducing post‐abortion GTI among women undergoing surgical procedures for incomplete abortion. More studies are needed from low‐ and middle‐income countries. Prophylactic antibiotics after incomplete abortion are effective in reducing GTI. More studies are needed from low‐ and middle‐income countries.
Publisher: Springer Science and Business Media LLC
Date: 27-03-2018
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JAMDA.2018.10.010
Abstract: Pressure injuries (PIs) are one of the most common types of complex wounds and impose a huge economic burden on the healthcare system and the patients. A plethora of topical treatments is widely available for PI treatment, yet there is a paucity of evidence with regard to the most effective treatment. The objective of this study was to compare the effect of various topical treatments and identify the best treatment choice(s) for PI healing. Systematic review and network meta-analysis. All published randomized controlled trials that compared the effectiveness of 2 or more of the following dressing groups: basic, foam, active, hydroactive, and other wound dressings. The outcome was the relative risk (RR) of complete healing following treatment and the generalized pairwise modeling framework was used to generate mixed treatment effects against hydroactive wound dressing, currently the standard of treatment for PIs. All treatments were then ranked by their point estimates. 40 studies (1757 participants) comparing 5 dressing groups were included in the analysis. All dressings groups ranked better than basic (ie, saline gauze or similar inert dressing). The foam [RR 1.18 95% confidence interval (CI) 0.95-1.48] and active wound dressing (RR 1.16 95% CI 0.92-1.47) ranked better than hydroactive wound dressing in terms of healing of PIs when the latter was used as the reference group. There was substantial uncertainty around the point estimates however, evidence from our analysis supports the use of hydroactive wound dressings to replace basic dressings. Foam and active wound dressing groups seem promising and therefore need further investigation. High-quality, rigorously conducted research about the clinical effectiveness of the topical treatments in these 2 groups developed in consultation with health professionals, patients, and their carers is needed to identify if indeed foam and active wound dressings provide advantages over hydroactive dressings.
Publisher: Cold Spring Harbor Laboratory
Date: 07-09-2021
DOI: 10.1101/2021.09.03.21263103
Abstract: This study aims to estimate the prevalence and longevity of detectable SARS-CoV-2 antibodies as well as memory cells T and B after recovery. In addition, the prevalence of COVID-19 reinfection, and the preventive efficacy of previous infection with SARS-CoV-2 were investigated. A synthesis of existing research was conducted. The Cochrane Library for COVID-19 resources, the China Academic Journals Full Text Database, PubMed, and Scopus as well as preprint servers were searched for studies conducted between 1 January 2020 to 1 April 2021. We included studies with the relevant outcomes of interest. All included studies were assessed for methodological quality and pooled estimates of relevant outcomes were obtained in a meta-analysis using a bias adjusted synthesis method. Proportions were synthesized with the Freeman-Tukey double arcsine transformation and binary outcomes using the odds ratio (OR). Heterogeneity between included studies was assessed using the I2 and Cochran’s Q statistics and publication bias was assessed using Doi plots. Fifty-four studies, from 18 countries, with around 12 000 000 in iduals, followed up to 8 months after recovery were included. At 6-8 months after recovery, the prevalence of SARS-CoV-2 specific immunological memory remained high IgG – 90.4% (95%CI 72.2-99.9, I 2 =89.0%, 5 studies), CD4+ - 91.7% (95%CI 78.2 – 97.1, one study), and memory B cells 80.6% (95%CI 65.0-90.2, one study) and the pooled prevalence of reinfection was 0.2% (95%CI 0.0 – 0.7, I 2 = 98.8, 9 studies). In iduals previously infected with SARS-CoV-2 had an 81% reduction in odds of a reinfection (OR 0.19, 95% CI 0.1 - 0.3, I 2 = 90.5%, 5 studies). Around 90% of people previously infected with SARS-CoV-2 had evidence of immunological memory to SARS-CoV-2, which was sustained for at least 6-8 months after recovery, and had a low risk of reinfection. PROSPERO: CRD42020201234 In iduals who recover from COVID-19 may have immunity against future infection but the proportion who develop immunity is uncertain. Further, there is uncertainty about the proportion of in iduals who get reinfected with COVID-19. Using data from 54 studies with follow up time up to 8 months after recovery, during the period February 2020-February 2021, we found that, post-COVID-19, up to 90% of in iduals had antibodies and memory T and B cells against SARS-CoV-2. We also found a pooled prevalence of reinfection of 0.2%, and that infection conferred an 81% decrease in odds of reinfection with SARS-CoV-2, compared to unimmunized in iduals without previous COVID-19. This review of 12 million in iduals presents evidence that most in iduals who recover from COVID-19 develop immunological memory to SARS-CoV-2, which was still detectable for up to 8 months. Further, reinfection after recovery from COVID-19 was rare during the first 8 months after recovery, with a prevalence below 1%, while prior infection confers protection with an odds ratio of 0.19 and a preventive efficacy of 80% at a baseline prevalence of 5% for COVID-19 in a community. In iduals with a history of COVID-19 infection have immunity against the disease for up to 8 months, although this period could be longer. These in iduals could be prioritized last for COVID-19 vaccinations or considered for single dose vaccinations. This comprehensive review addresses key questions on prevalent immunological memory and risk of reinfection in in iduals with prior confirmed COVID-19 using robust systematic review methods. Some of the included studies which examined prevalent immunological memory were small studies which were affected by loss to follow up. The review did not examine evidence for immunity against the new ergent variants, which may be more likely to have immune evasion behaviour and may present a higher risk of reinfection. Lastly, the review did not examine the effect of the severity of COVID-19 on both immunological memory and the risk of reinfection.
Publisher: Springer Science and Business Media LLC
Date: 21-04-2020
DOI: 10.1186/S12872-020-01466-5
Abstract: Angiotensin receptor blockers (ARBs) are commonly used as a treatment for many cardiovascular diseases, but their safety has been called into question. The VALUE trial found an increased risk of myocardial infarction in participants receiving ARBs compared to other antihypertensive. The aim of the meta-analysis was to synthetize the available evidence of randomised controlled trials (RCTs) and elucidate if ARBs increase the risk of cardiovascular events. A comprehensive search was conducted to identify RCTs that assessed the safety of ARBs. Titles and abstracts of all papers were independently screened by two authors. Data extraction and quality assessment were also performed independently. The relative risk (RR) of all-cause mortality, myocardial infarction, and stroke were pooled using the IVhet model. Multiple sensitivity analyses were conducted to assess the effect of ARBs by restricting the analysis to different participants’ characteristics. Forty-five RCTs comprising of 170,794 participants were included in the analysis. The pooled estimates revealed that ARBs do not increase the risk of all-cause mortality (RR 1.00 95%CI 0.97–1.04), myocardial infarction (RR 1.01 95%CI 0.96–1.06), and stroke (RR 0.92 95%CI 0.83–1.01). The sensitivity analysis did not yield a particular group of patients at increased risk of cardiovascular events with ARBs. Risk of all-cause mortality and stroke decreased with ARB when the proportion of smokers in a population was 25% (RR 0.91 95%CI 0.84–0.98) and in females (RR 0.76 95%CI 0.68–0.84), respectively. A RBs do not increase the risk of major cardiovascular events and are safe for use in patients.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Springer Science and Business Media LLC
Date: 23-03-2020
DOI: 10.1186/S12890-020-1102-5
Abstract: Paracetamol and ibuprofen are the most commonly used medications for fever and pain management in children. While the efficacy appears similar with both drugs, there are contradictory findings related to adverse events. In particular, incidence of wheezing and asthma among children taking paracetamol compared to ibuprofen, remain unsettled. We conducted a meta-analysis of randomized controlled trials (RCTs) that compared wheezing and asthma exacerbations in children taking paracetamol versus ibuprofen. A comprehensive search was conducted in five databases. RCTs reporting on cases of wheezing or asthma exacerbations in infants or children after the administration of paracetamol or ibuprofen were included. The pooled effect size was estimated using the Peto’s odds ratio. Five RCTs with 85,095 children were included in the analysis. The pooled estimate (OR 1.05 95%CI 0.76–1.46) revealed no difference in the odds of developing asthma or presenting an exacerbation of asthma in children who received paracetamol compared to ibuprofen. When the analysis was restricted to RCTs that examined the incidence of asthma exacerbation or wheezing, the pooled estimate remained similar (OR 1.01 95%CI 0.63–1.64). Additional bias adjusted quality effect sensitivity model yielded similar results (RR 1.03 95%CI 0.84–1.28). Although, Ibuprofen and paracetamol appear to have similar tolerance and safety profiles in terms of incidence of asthma exacerbations in children, we suggest high quality trials with clear definition of asthma outcomes after receiving ibuprofen or paracetamol at varying doses with longer follow-up are warranted for any conclusive finding.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.ACVD.2016.09.007
Abstract: Current guideline recommendations encourage culprit vessel only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, recent studies have shown a better clinical outcome in patients who receive multivessel PCI. To measure and compare clinical outcomes between partial revascularization (PR) versus complete revascularization (CR) in patients with STEMI and multivessel disease who underwent a cardiac rehabilitation programme. We retrospectively reviewed the medical records of 282 patients with STEMI and multivessel disease who received PR or CR and were subsequently enrolled in a cardiac rehabilitation programme between July 2006 and November 2013 at La Paz University Hospital. The incidences of cardiovascular events, new PCI, hospital admissions for cardiovascular reasons and mortality were compared between the PR and CR groups. Overall, 143 patients received PR and 139 received CR. Baseline characteristics were similar in both groups, except for mean age (59.3 vs. 56.7 years P=0.02), diabetes mellitus prevalence (34.3% vs. 20.1% P=0.01) and number of arteries with stenosis (2.6 vs. 2.3 P=0.001). During the mean follow-up of 48.0±25.9 months, a cardiovascular event occurred in 23 (16.1%) PR patients and 20 (14.4%) CR patients, with no statistically significant differences in the early (hazard ratio: 0.61, 95% confidence interval: 0.19-1.89) or late (hazard ratio: 1.40, 95% confidence interval: 0.62-3.14) follow-up periods. Cox regression, adjusted for age, sex, presence of diabetes mellitus and number of affected coronary vessels, showed no difference in new cardiovascular event risk. There were no statistical differences in clinical outcomes between PR and CR among patients who received cardiac rehabilitation.
Publisher: Oxford University Press (OUP)
Date: 12-12-2020
DOI: 10.1093/JTM/TAAA232
Publisher: Cold Spring Harbor Laboratory
Date: 23-04-2022
DOI: 10.1101/2022.04.20.22274108
Abstract: In Australia, Japanese Encephalitis virus circulated in tropical north Queensland between 1995 and 2005. In 2022, a dramatic range expansion across the southern states resulted in 24 confirmed human cases and three deaths. We discuss the outbreak drivers and estimate the potential size of the human population at risk.
Publisher: Wiley
Date: 26-08-2022
DOI: 10.1002/JRSM.1598
Abstract: Limiting the search date is a common approach utilised in therapeutic/interventional rapid reviews. Yet the accuracy of pooled estimates is unknown when applied to rapid reviews of diagnostic test accuracy studies. Data from all systematic reviews of diagnostic test accuracy studies published in the Cochrane Database of Systematic Reviews, until February 2022 were collected. Meta‐analyses with at least five studies were included to emulate rapid reviews by limiting the search to the recent 1, 2, 3, 4, 5, 10, 15, 20, 25, 30, 35 and 40 years. The magnitude of the pooled area under the curve (AUC), sensitivity and specificity for the full meta‐analysis and the rapid reviews were compared. A total of 846 diagnostic meta‐analyses were included. When the search date was limited to the recent 10 and 15 years, more than 75% and 80% of meta‐analyses presented less than 5% difference between the pooled AUC, sensitivity and specificity of the full meta‐analysis and the rapid review. There was little gain in the precision of the pooled estimates when the emulated rapid reviews included more than 15 years in the search. Rapid reviews restricted by search date are a valid and reliable approach for diagnostic test accuracy studies. Robust evidence can be achieved by restricting the search date to the recent 10–15 years. Future studies need to examine the reduction in workload and time to finish the rapid reviews under different search date limits.
Publisher: Wiley
Date: 03-02-2021
DOI: 10.1002/OSP4.480
Abstract: With the rising number of outcomes being reported following gestational diabetes (GDM), the outcomes in existing studies vary widely making it challenging to compare and contrast the effectiveness of different interventions for GDM. The purpose of this study was to develop a core outcome and measurement set (COS) for GDM treatment trials. A Delphi study with structured consultation with stakeholders and discussion within a specialist Gestational Metabolic Group (GEM) were combined with a comprehensive systematic search across different databases (PubMed, Cochrane Library, and Embase). Several Delphi rounds over 2 years were conducted culminating in this report. The process resulted in a targeted set of outcomes constituting a “GEM treatment set” aligned with expert opinion. The final COS also included a measurement set for the 11 important clinical outcomes from three major domains: maternal metabolic, fetal, and pregnancy related. Based on the results of this study, it is recommended that future clinical trials on GDM report outcomes uniformly keeping to the recommended COS outcomes.
Publisher: Elsevier BV
Date: 2021
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/SH14062
Abstract: Background Cardiovascular disease (CVD) is a major cause of death among HIV-positive in iduals receiving combination antiretroviral therapy (cART). The risk of CVD is estimated using a variety of risk calculations, however, currently there is no specific CVD risk calculator endorsed for Australians receiving cART. Methods: A retrospective study of 210 Queensland men older than 35 years with cART-treated HIV was conducted to estimate the prevalence of CVD and the risk of a cardiovascular event occurring within 5 years. The weighted Cohen’s kappa coefficient was used to estimate the agreement between the Australian Absolute CVD Risk Calculator and the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) 5-year Estimated CVD Risk Equation. Results: The prevalence of CVD was 31.9%. Hypertensive disease was the most prevalent CVD (25.2%). Queensland men with cART-treated HIV were at moderate risk (5%) of a cardiovascular event in the next 5 years. There was a substantial agreement (κ = 0.63) between the Australian Absolute CVD Risk Calculator and the D:A:D 5-year Estimated CVD Risk Equation. Conclusions: Queensland men with cART-treated HIV are experiencing high prevalence of CVD and are at moderate risk of a CVD event in the next 5 years. Primary care guidelines should emphasise CVD prevention as a keystone for the treatment of people living with HIV.
Publisher: Springer Science and Business Media LLC
Date: 23-03-2020
Publisher: The Royal Society
Date: 19-12-2012
Abstract: Half a century of research into the physiology and biochemistry of sun–shade acclimation in erse plants has provided reality checks for contemporary understanding of thylakoid membrane dynamics. This paper reviews recent insights into photosynthetic efficiency and photoprotection from studies of two xanthophyll cycles in old shade leaves from the inner canopy of the tropical trees Inga sapindoides and Persea americana (avocado). It then presents new physiological data from avocado on the time frames of the slow coordinated photosynthetic development of sink leaves in sunlight and on the slow renovation of photosynthetic properties in old leaves during sun to shade and shade to sun acclimation. In so doing, it grapples with issues in vivo that seem relevant to our increasingly sophisticated understanding of Δ pH-dependent, xanthophyll-pigment-stabilized non-photochemical quenching in the antenna of PSII in thylakoid membranes in vitro .
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.JAMDA.2019.05.001
Abstract: Previous studies have placed those with excessive sedentary behavior at increased risk of all-cause mortality. There is evidence of interdependency of sedentary behavior with physical activity, and its elucidation will have implications for guidelines and practice. This study investigated if sedentary behavior-related mortality risk can be offset by moderate- to vigorous-intensity physical activity (MVPA) considered in a time-use fashion. PubMed was searched (from its inception till May 2018) for studies or meta-analyses that used data harmonized for MVPA. Of the 17 data-custodians located, 7 provided data on sitting time or TV viewing time, or both. A dose-response meta-analysis modeling log relative risks of all-cause mortality against uncompensated sedentary behavior metabolic equivalent hours (USMh) was run using the robust error meta-regression method. (Registration: CRD42017062439) SETTING: In idual subject data held by data custodians on this topic. General adults. Sedentary time, MVPA. Five harmonized cohorts of sitting time (258,688 participants) and 4 of TV viewing time (156,593 participants) demonstrated that sedentary behavior was significantly associated with mortality, but this risk was attenuated with increasing energy expenditure through MVPA modeled in a time-use fashion. The average increment in mortality per USMh spent on sitting was 1% [relative risk (RR) 1.01, 95% confidence interval (CI) 1.00, 1.02 P = .01] and that per USMh spent on TV viewing was 7% (RR 1.07, 95% CI 1.04, 1.10 P < .001). The thresholds for risk started at 7 USMh for sitting and 3 USMh for TV viewing. Our findings suggest that overall daily sitting time energy expenditure of 7 MET-hours (or TV viewing of 3 MET-hours) in excess of that expended on MVPA is independently related to all-cause mortality. These findings support the view that sitting is strongly influenced by consideration of concurrent MVPA in its impact on adverse health consequences and that the USMh is a more practical metric of sedentary behavior.
Publisher: Elsevier BV
Date: 07-2021
Publisher: Oxford University Press (OUP)
Date: 27-07-2017
DOI: 10.1093/JTM/TAX052
Abstract: Gap year travellers can potentially be exposed to many infectious diseases and other travel-related health problems including injuries and psychological problems. Currently, there is little information on health and wellbeing of this particular group of travellers. Participants were recruited from an organization that specialized in organising international gap year placements. Gap year travellers were asked to complete a pre-departure survey on demographics, placement destination and duration, previous travel experience, hobbies, risk taking behaviour, anticipated problems during the placement, and pre-travel preparations. After the placement, participants were asked to complete a post-trip survey on their experiences, problems, health issues, and medical treatment required. The 88 and 34 gap year travellers aged 17-23 years completed pre- and post-placement surveys respectively. The duration of placements ranged from 3 to 12 months. Psychological stressors were frequently reported [ n = 26 (76.5%) felt home sick n = 18 (52.9%) experienced culture shock n = 17 (50.0%) had difficulty communicating with the locals]. The majority of participants (91.2%) tried to work out a solution for the stressor on their own. Twenty-eight (82.4%) participants reported medical problems during their placement the most common problems were sunburn ( n = 19 55.9%), respiratory infections ( n = 15 44.1%), weight change ( n = 14 41.2%), and diarrhoea/food poisoning ( n = 13 38.2%). Three participants (3.4%) were admitted to hospital for a muscle injury, head injury and skin infection after getting a tribal tattoo. Psychological stressors were common, but most did not seek help. Some medical problems encountered during their placement may have been preventable with improved pre-departure preparation. Gap year, pre-departure, preparation.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
Publisher: Elsevier BV
Date: 07-2021
Publisher: Oxford University Press (OUP)
Date: 10-10-2021
DOI: 10.1093/JTM/TAAA191
Abstract: In our re-analysis with adjusted assumptions, we found that a previous study substantially oversestimated the effectiveness of Australia’s complete travel ban against China in the introduction of SARS-CoV-2 into Australia.
Publisher: Wiley
Date: 03-2022
DOI: 10.1002/JRSM.1550
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2017
Publisher: Wiley
Date: 11-05-2023
DOI: 10.1111/ZPH.13048
Abstract: Periodic vaccination against rabies is essential for in iduals at continuing risk of rabies exposure. There is limited evidence on long‐term immunogenicity after a 3‐dose intramuscular (3IM) pre‐exposure prophylaxis (PrEP) and single IM booster dose, thus current guideline recommendations differ in the interval for serology tests following PrEP and boosters. This study investigated post‐PrEP and post‐booster persistence of antibodies in Australian bat carers. Bat carers who received 3IM PrEP/booster doses and had post‐PrEP/booster serology test results were included. The proportion of antibody‐negative ( .5 EU/mL) in iduals after PrEP/booster dose were examined. Three hundred and five participants (65.6% females, median age at PrEP 43.1 years) were included. The proportion who were antibody‐negative varied depending on the time between 3IM PrEP and the serology test: 8.0% year, 29.8% 1–2 years, 21.2% 2–3 years and 7.7% years. Ninety‐one participants receiving booster doses were further assessed. Only one participant was antibody‐negative at years after receiving one IM booster dose. Our findings support that a serology test should be performed 1 year after 3IM PrEP, followed by first booster if required. Rabies antibodies persist for many years after receiving the booster doses. The interval between subsequent serology tests and the first booster dose should be no longer than 3 years. Future studies are required to provide more insight into the most appropriate timing of subsequent boosters.
Publisher: Cold Spring Harbor Laboratory
Date: 30-08-2022
DOI: 10.1101/2022.08.27.22279301
Abstract: Data extraction is the foundation for research synthesis evidence, and it is often time- and labor-consuming, and prone to errors. Whilst data extraction errors frequently occur in the literature, an interesting phenomenon was observed that data extraction error tend to be more common in trials of pharmaceutical interventions compared to non-pharmaceutical ones. This phenomenon has not been verified by high-quality evidence, the elucidation of which would have implications for guidelines, practice, and policy. We propose a crossover, multicenter, investigator-blinded, trial to elucidate the potential variants on the data extraction error rates of meta-analyses with pharmaceutical against non-pharmaceutical interventions. Eligible 90 participants would be 2 nd year or above post-graduate students (e.g., masters, doctoral program). Participants will be randomized to one of the two groups to complete pre-defined data extraction tasks: 1) group A will contain 10 randomized controlled trials (RCTs) of pharmaceutical interventions 2) group B will contain 10 RCTs of non-pharmaceutical interventions. Participants would then be assigned to the alternative group for another round of data extraction, after a 30 mins washout period. Finally, those participants assigned to A or B group will be further 1:1 randomly matched based on a random-sequenced number, for the double-checking process on the extracted data. The primary outcome will be the data extract error rates of pharmaceutical intervention group and non-pharmaceutical group, before the double-checking process, in terms of the cell level, study level, and participant level. The secondary outcome will be the data error error rates of pharmaceutical intervention group and non-pharmaceutical group, after the double-checking process, again, in terms of the cell level, study level, and participant level. Generalized linear mixed effects model (based on the above three levels) will be used to estimate the potential differences in the error rates, with a log link function for binomial data. Subgroup analyses will account for the following factors i.e., the experience of in iduals on systematic reviews, and the time used for the data extraction. This study has been approved by the institutional review board of Anhui Medical University (No.83220405). Findings of the study will be presented at international scientific meetings, and publish in peer-reviewed academic journal. Chinese Clinical Trial Register Center (Identifier: ChiCTR2200062206). This will be the first trial to compare data extraction error rates in pharmaceutical intervention and non-pharmaceutical intervention studies for research synthesis. This will be the third randomized trial on the strategy of data extraction in the world and the first in the Asia-Pacific region. The use of a crossover design provides a valid way to reduce the potential impact of heterogeneous contexts of the studies and thus is expected to provide robust evidence to support better evidence synthesis practice. We will restrict the participants to 2 nd year post-graduate students or above to ensure the feasibility of the trial this restriction will no doubt impact the representativeness of the s les. A group of useful strategies (eg. use U disk and isolate signal etc.) should be taken to minimize the impact of the possible sharing of the completed extraction table among the participants.
Publisher: MDPI AG
Date: 25-03-2021
Abstract: Botswana has the third highest human immunodeficiency virus (HIV) prevalence globally, and the severity of the epidemic within the country varies considerably between the districts. This study aimed to identify clusters of HIV and associated factors among adults in Botswana. Data from the Botswana Acquired Immunodeficiency Syndrome (AIDS) Impact Survey IV (BIAS IV), a nationally representative household-based survey, were used for this study. Multivariable logistic regression and Kulldorf’s scan statistics were used to identify the risk factors and HIV clusters. Socio-demographic characteristics were compared within and outside the clusters. HIV prevalence among the study participants was 25.1% (95% CI 23.3–26.4). HIV infection was significantly higher among the female gender, those older than 24 years and those reporting the use of condoms, while tertiary education had a protective effect. Two significant HIV clusters were identified, one located between Selibe-Phikwe and Francistown and another in the Central Mahalapye district. Clusters had higher levels of unemployment, less people with tertiary education and more people residing in rural areas compared to regions outside the clusters. Our study identified high-risk populations and regions with a high burden of HIV infection in Botswana. This calls for focused innovative and cost-effective HIV interventions on these vulnerable populations and regions to curb the HIV epidemic in Botswana.
Publisher: BMJ
Date: 11-2019
DOI: 10.1136/BMJGH-2019-001776
Abstract: Background Long-lasting insecticidal nets and indoor residual sprays have significantly reduced the burden of malaria. However, several hurdles remain before elimination can be achieved: mosquito vectors have developed resistance to public health insecticides, including pyrethroids, and have altered their biting behaviour to avoid these indoor control tools. Systemic insecticides, drugs applied directly to blood hosts to kill mosquitoes that take a blood meal, offer a promising vector control option. To date, most studies focus on repurposing ivermectin, a drug used extensively to treat river blindness. There is concern that overdependence on a single drug will inevitably repeat past experiences with the rapid spread of pyrethroid resistance in malaria vectors. Diversifying the arsenal of systemic insecticides used for mass drug administration would improve this strategy’s sustainability. Methods Here, a review was conducted to identify systemic insecticide candidates and consolidate their pharmacokinetic harmacodynamic properties. The impact of alternative integrated vector control options and different dosing regimens on malaria transmission reduction are illustrated through mathematical model simulation. Results The review identified drugs from four classes commonly used in livestock and companion animals: avermectins, milbemycins, isoxazolines and spinosyns. Simulations predicted that isoxazolines and spinosyns are promising candidates for mass drug administration, as they were predicted to need less frequent application than avermectins and milbemycins to maintain mosquitocidal blood concentrations. Conclusions These findings will provide a guide for investigating and applying different systemic insecticides to achieve more effective and sustainable control of malaria transmission.
Publisher: Cambridge University Press (CUP)
Date: 2021
DOI: 10.1017/S0950268821001515
Abstract: There is a paucity of evidence about the prevalence and risk factors for symptomatic infection among children. This study aimed to describe the prevalence of symptomatic coronavirus disease 2019 (COVID-19) and its risk factors in children and adolescents aged 0–18 years in Qatar. We conducted a cross-sectional study of all children aged 0–18 years diagnosed with COVID-19 using polymerase chain reaction in Qatar during the period 1st March to 31st July 2020. A generalised linear model with a binomial family and identity link was used to assess the association between selected factors and the prevalence of symptomatic infection. A total of 11 445 children with a median age of 8 years (interquartile range (IQR) 3–13 years) were included in this study. The prevalence of symptomatic COVID-19 was 36.6% (95% confidence interval (CI) 35.7–37.5), and it was similar between children aged years (37.8%), 5–9 years (34.3%) and 10 + years (37.3%). The most frequently reported symptoms among the symptomatic group were fever (73.5%), cough (34.8%), headache (23.2%) and sore throat (23.2%). Fever (82.8%) was more common in symptomatic children aged years, while cough (38.7%) was more prevalent in those aged 10 years or older, compared to other age groups. Variables associated with an increased risk of symptomatic infection were contact with confirmed cases (RD 0.21 95% CI 0.20–0.23 P = 0.001), having visited a health care facility (RD 0.54 95% CI 0.45–0.62 P = 0.001), and children aged under 5 years (RD 0.05 95% CI 0.02–0.07 P = 0.001) or aged 10 years or older (RD 0.04 95% CI 0.02–0.06 P = 0.001). A third of the children with COVID-19 were symptomatic with a higher proportion of fever in very young children and a higher proportion of cough in those between 10 and 18 years of age.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
DOI: 10.1097/XEB.0000000000000207
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 ( %) 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.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
Publisher: Elsevier BV
Date: 02-2021
Publisher: Oxford University Press (OUP)
Date: 02-2017
Publisher: Mary Ann Liebert Inc
Date: 07-2018
Abstract: Salmonella is a leading cause of foodborne enterocolitis worldwide. Antimicrobial use in food animals is the driving force for antimicrobial resistance among Salmonella particularly in high-income countries. Nontyphoidal Salmonella (NTS) infections that are multidrug resistant (MDR) (nonsusceptible to ≥1 agent in ≥3 antimicrobial categories) may result in more severe health outcomes, although these effects have not been systematically examined. We conducted a systematic review and meta-analysis to examine impacts of MDR NTS on disease outcomes in high-income settings. We systematically reviewed the literature from scientific databases, including PubMed, Scopus, and grey literature sources, using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We included peer-reviewed publications of case-control and cohort studies, outbreak investigations, and published theses, imposing no language restriction. We included publications from January 1, 1990 through September 15, 2016 from high-income countries as classified by the World Bank, and extracted data on duration of illness, hospitalization, morbidity and mortality of MDR, and pan-susceptible NTS infections. After removing duplicates, the initial search revealed 4258 articles. After further screening, 16 eligible studies were identified for the systematic review, but, only 9 of these were included in the meta-analysis. NTS serotypes differed among the reported studies, but serotypes Typhimurium, Enteritidis, Newport, and Heidelberg were the most often reported MDR pathogens. Salmonella infections that were MDR were associated with excess bloodstream infections (odds ratio [OR] 1.73 95% confidence interval [CI] 1.32-2.27), more frequent hospitalizations (OR 2.51 95% CI 1.38-4.58), and higher mortality (OR 3.54 95% CI 1.10-11.40) when compared with pan-susceptible isolates. Our study suggests that MDR NTS infections have more serious health outcomes compared with pan-susceptible strains. With the emergence of MDR Salmonella strains in high-income countries, it is crucial to reduce the use of antimicrobials in animals and humans, and intervene to prevent foodborne infections.
Publisher: Cambridge University Press (CUP)
Date: 14-03-2023
DOI: 10.1017/S1755048322000414
Abstract: Political debates over religious freedom in Australia became prominent in the context of marriage equality, achieved in 2017. The Australian Christian Right (ACR) has driven these debates, but there is little research focusing on its discourse of religious freedom. This article examines a range of texts from ACR actors. Using discourse and theoretical analyses, we identify three key turns in the religious freedom rhetoric of the ACR: “ontological security,” “existential stress,” and “meaning vertigo.” We also explore how mimetic ACR discourse is compared to the United States' Christian Right (USCR). As with the USCR, this research demonstrates how the ACR—suffering meaning vertigo and aiming to re-secure its previously taken-for-granted worldview—has successfully reframed the discourse of religious freedom by positioning itself as a besieged minority.
Publisher: Oxford University Press (OUP)
Date: 25-04-2021
Abstract: Combined hepatitis A and typhoid vaccine is available in Australia, but licensed for use from age 16 years however it is used “off-label” in children. The combined vaccine is well tolerated in children aged 2–16 years and the risk of adverse events is similar to those receiving concurrent monovalent vaccines.
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: SAGE Publications
Date: 10-07-2016
Abstract: To develop and test a self-reported scale designed to measure the antecedents of depression. Participants of the Sustainable Mastery of Innovative Lifelong Exercise (SMILE) Tai Chi program were invited to complete the scale for antecedents of depressive symptoms. The scale included questions regarding events/factors the participants have experienced over the past three months and preceded their depressive symptoms. The reliability of the questions was assessed using the Cronbach’s alpha. Principal components analysis was used to examine if there were domains of interest across the scale questions. A total of 126 participants completed the scale. The scale had a good internal consistency (Cronbach’s α = 0.82). Principal components analysis identified three components (life events, psychosocial problems, and physical/health problems) in the scale and the components detected the root categories of depression in more than 56% of the cases. This simple self-administered scale has proven to provide a reliable measure for the antecedent factors of depression in the SMILE Tai Chi cohort further validation of the scale in different settings is encouraged.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-10-2016
Abstract: Differentiated thyroid cancer (DTC) incidence has been reported to have increased three- to 15-fold in the past few decades. It is unclear whether this represents overdiagnosis or a true increase in incidence. Therefore, the current study aimed to estimate the prevalence of incidental DTC in published autopsy series and determine whether this prevalence has been increasing over time. PubMed, Embase, and Web of Science were searched from inception to December 2015 for relevant studies. Two authors searched for all autopsy studies that had included patients with no known history of thyroid pathology and reported the prevalence of incidental DTC (iDTC). Two authors independently extracted the data, and discrepancies were resolved by another author. The pooled prevalence of iDTC was assessed using a fixed-effects meta-analysis model with robust error variance. The time effect was studied using an inverse-variance weighted logit-linear regression model with robust error variance and a time variable. Thirty-five studies, conducted between 1949 and 2007, met the inclusion criteria and contributed 42 data sets and 12,834 autopsies. The prevalence of iDTC among the partial and whole examination subgroups was 4.1% (95% CI, 3.0% to 5.4%) and 11.2% (95% CI, 6.7% to 16.1%), respectively. Once the intensiveness of thyroid examination was accounted for in the regression model, the prevalence odds ratio stabilized from 1970 onward, and no time effect was observed. The current study confirms that iDTC is common, but the observed increasing incidence is not mirrored by prevalence within autopsy studies and, therefore, is unlikely to reflect a true population-level increase in tumorigenesis. This strongly suggests that the current increasing incidence of iDTC most likely reflects diagnostic detection increasing over time.
Publisher: Oxford University Press (OUP)
Date: 29-09-2021
DOI: 10.1093/JTM/TAAA181
Abstract: Highlight Uptake of Japanese encephalitis (JE) vaccine remains low among travellers, with cost of vaccines likely being one of the main hurdles. We found that smaller doses of JE vaccine administered via intradermal (ID) had similar effect on seroconversion than standard doses administered via subcutaneous. ID is a cheaper yet effective route of JE vaccine administration, and could potentially increase vaccination uptake among travellers.
Publisher: Public Library of Science (PLoS)
Date: 16-03-2015
Publisher: Springer Science and Business Media LLC
Date: 25-03-2019
Publisher: Informa UK Limited
Date: 14-11-2020
No related grants have been discovered for Luis Furuya-Kanamori.