Risultati per: Review: cancro dell’endometrio

Focus su tumori ereditari e immunità nei contesti oncologici

Background
Sub-Saharan Africa mirrors global patterns with an expanding elderly demographic, frequently characterised by a high incidence of non-communicable diseases (NCDs), manifesting as multimorbidity. Physical activity (PA) is a validated intervention for managing the increasing prevalence of NCDs in this demographic.

Objective
This review aimed to elucidate the extent of PA interventions implemented in Sub-Saharan Africa for managing NCDs in older people (OP).

Eligibility criteria
This review synthesised randomised controlled trials published in English since 2010, focusing on PA interventions for managing NCDs or associated risk factors in OP in Sub-Saharan Africa.

Sources of evidence
The Joanna Briggs Institute methodology for scoping reviews was implemented with searches in the following databases: PubMed, EBSCOhost (Academic Search Premier AfricaWide Information, CINAHL, Health Sources Premier Academic/Nursing), Scopus and ProQuest.

Charting methods
Extraction and reporting adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews framework, ensuring rigorous and systematic synthesis.

Results
A total of 3754 studies were initially identified, with 67 studies ultimately included after applying the exclusion criteria. The synthesised trials tested primarily supervised structured PA interventions (n=30), education on PA and lifestyle (n=30) and combined structured PA with lifestyle education (n=7). A structured supervised PA regimen combining aerobic exercise at 60–80% of maximum heart rate (three 45–60 min sessions per week) and resistance training starting at 50% of one-repetition maximum (3 weekly sessions of three sets with 10–12 repetitions per muscle group), progressively increasing to 60%, was the most effective in reducing risk factors associated with NCDs in this cohort.

Conclusion
This analysis confirms that a structured PA regimen paired with lifestyle education significantly mitigates NCDs in Sub-Saharan Africa’s elderly population. Furthermore, it highlights the imperative for further investigation into non-pharmacological strategies, especially those targeting hypertension, diabetes and cognitive health disorders.

Objectives
Randomised trials for the management of drug-resistant infections are challenging to conduct as target patient populations often lack decision-making capacity, and enrolment windows are typically short. Improving informed consent and risk communication in these trials is especially crucial for protecting patient interests and maximising trial efficiency. This study aimed to understand challenges in risk communication and informed consent in antimicrobial clinical trials.

Design
Scoping review.

Data sources
Searches were conducted in Embase, Medline, CINAHL and Web of Science Core for peer-reviewed English articles that were published from January 2000 to April 2023.

Eligibility criteria
Included articles were empirical studies or expert opinions that sought experts’, patients’ or representatives’ opinions on informed consent in the context of clinical trials involving antibiotic/anti-infective agents.

Data extraction and synthesis
Abstract screening, full-text review, data extraction and evidence rating were performed by two independent reviewers. Extracted data were summarised and reported qualitatively based on common themes. A total of 2330 records were retrieved, and 29 articles were included in the review.

Results
Half of the articles involving medical experts and one-third involving patients and representatives reported that full comprehension by patients and representatives was challenging or not achievable. Healthcare providers and consent takers were crucial for the quality of informed consent. The level of trust consent givers placed on healthcare providers had a critical influence on the consent rate. Emotional distress was pervasive among patients/representatives.

Conclusion
The findings indicate that strengthening consent takers’ communication skills in providing emotional support to patients and their representatives may improve informed consent. More research is needed to understand informed consent in low-income and middle-income and non-English-speaking countries.

Introduction
Global Health Initiatives (GHIs) have significantly improved access to healthcare globally. However, high maternal mortality rates persist in low- and middle-income countries (LMICs) such as Uganda. Despite heavy investment from the GHIs, there is insufficient evidence on the effects of GHIs on the quality of care of maternal health services and yet this significantly impacts maternal outcomes. Available evidence has focused on outputs such as facility deliveries and utilisation of services. These outputs alone are not a reflection of the quality of care, which is crucial in improving maternal outcomes. Given the inadequate information available, we will conduct a scoping review to collate available evidence on the effects of GHIs on the quality of care of maternal health services. The protocol outlined here describes the scoping review aimed at examining the available evidence on the effects of GHIs on maternal health services quality in Sub-Saharan Africa. The information gathered will be used to inform subsequent studies on the effects of GHI on the quality of care of maternal health services in Uganda and later inform policymakers, programmers and health workers on how best to maximise investments from GHIs through improved quality of care. The findings from this study will mainly be used to inform policy on maternal health services in Uganda.

Methods and analysis
The study will use Arksey and O’Malley’s enhanced six-stage framework for conducting scoping reviews. The core research question for this review is ‘what is the available evidence on the effects of global health initiatives on the quality of healthcare provided for maternal health services in health facilities of Sub-Saharan Africa’. We will consider peer-reviewed and non-peer-reviewed articles, reports and policy documents discussing the effects of GHIs on maternal health services from 2010 to 2023 available in all languages. Relevant databases including Ovid Medline, Embase, Cochrane Library, Centre for Agriculture and Biosciences International Global Health (Ovid), Cumulated Index to Nursing and Allied Health Literature, Scopus and the Joanna Briggs Institute Evidence Synthesis will be used for the search. Grey literature from various sources will also be included. Data on the study design, results and methodology will be extracted using a Google Form. This review’s report will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We will employ specific inclusion and exclusion criteria for evidence during the literature screening and mapping process, including study types, focus, timeframe, language and location. The quality of included studies will be assessed using the Critical Appraisal Skills Programme tool and the Mixed Methods Appraisal Tool where applicable. Subsequently, the identified data will be subjected to descriptive analysis and visual representation.

Ethics and dissemination
Ethical approval is not required for this review as it only uses literature available in the public domain. The results will be shared via a peer-reviewed journal, conference presentations and stakeholder consultations.

Introduction
People with intellectual disability are at risk of poor physical and mental health. Risks to health are compounded by poor health literacy, that is, reduced capacity to access health services, respond quickly to changes in health status and navigate care pathways. Building health literacy skills is a strength-based way to increase health and optimise the use of healthcare services. The internet is a primary source of health information for many people, including people with intellectual disability and their families. This scoping review will aim to identify and collate online lay healthcare resources available to and developed for people with intellectual disability and their families and evaluate whether domains of health literacy are addressed.

Methods and analysis
This review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. The proposed search strategy has three components. Resources will be identified by (1) reviewing disability organisation websites, (2) searching key disability and health terms in the Google search engine and (3) snowball sampling to identify additional resources through links in identified websites and resources. Resources will be selected if they are freely available, presented in or translatable into English, provide health information and are directed to people with intellectual disability or their family members. Extracted data will include descriptors of the source, format, area of health and targeted age range. Content relevant to domains of health literacy will be documented and gaps in available health information will be identified. Study findings will be presented in narrative, tabular and visual forms.

Ethics and dissemination
Ethical approval will not be sought because primary data will not be collected. The results will be disseminated in peer-reviewed literature, as conference presentations, as a synthesised resource for people with intellectual disability and their families and in summary documents for health service managers and policymakers.

Objective
In this scoping review, we aim to consolidate the evidence on inequalities in service coverage in Africa using a comprehensive set of stratifiers. These stratifiers include place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status and social capital. Our approach provides a more holistic understanding of the different dimensions of inequality in the context of universal health coverage (UHC).

Design
We conducted a scoping review following the Joanna Briggs Institute Manual for Evidence Synthesis.

Data sources
We searched MEDLINE, Embase, Web of Science, CINAHL, PyscINFO, Cochrane Library, Google Scholar and Global Index Medicus for articles published between 1 January 2005 and 29 August 2022 examining inequalities in utilisation of health services for reproductive, maternal, newborn and child health (RMNCH), infectious or non-communicable diseases in Africa.

Eligibility criteria for selecting studies
We included any empirical research that assessed inequalities in relation to services for RMNCH (eg, family planning), infectious diseases (eg, tuberculosis treatment) and non-communicable diseases (eg, cervical cancer screening) in Africa.

Data extraction and synthesis
The data abstraction process followed a stepwise approach. A pilot-tested form capturing study setting, inequality assessment and service coverage indicators was developed and finalised. Data were extracted by one reviewer and cross-checked by another, with discrepancies resolved through consensus meetings. If a consensus was not reached, senior reviewers made the final decision. We used a narrative approach to describe the study characteristics and mapped findings against PROGRESS-Plus stratifiers and health service indicators. Quantitative findings were categorised as ‘proequity’, ‘antiequity’ or ‘equal’ based on service utilisation across social groups.

Results
We included 178 studies in our review, most studies published within the last 5 years (61.1%). Most studies assessed inequality using socioeconomic status (70.6%), followed by age (62.4%), education (60.7%) and place of residence (59.0%). Few studies focused on disability, social capital and ethnicity/race and intersectionality of stratifiers. Most studies were on RMNCH services (53.4%) and infectious disease services (43.3%). Few studies were qualitative or behavioural analyses. Results highlight significant inequalities across different equity stratifiers and services with inconsistent trends of inequalities over time after the implementation of strategies to increase demand of services and strengthen health systems.

Conclusion
There is a need to examine equity in service coverage for a variety of health conditions among various populations beyond the traditional classification of social groups. This also requires using diverse research methods identifying disparities in service use and various barriers to care. By addressing these knowledge gaps, future research and health system reforms can support countries in moving closer to achievement of UHC targets.

Migrants have unique risk factors for under-immunisation in the MENA region and have low vaccination coverage despite some level of entitlement to services. Data on vaccination coverage, drivers of uptake and policies for migrants in the MENA region is limited to small-scale studies among accessible groups, mostly focusing on COVID-19 compared to routine childhood and adult vaccination. There is an urgent need to strengthen data collection to better understand coverage across different migrant groups, ages, and MENA countries, especially on adult and catch-up vaccinations for routine immunisations, and develop innovative co-designed strategies to address specific drivers of vaccine uptake among this group.

High-certainty evidence indicates that GDHT reduces the risk of SSI when compared to conventional fluid therapy in adults undergoing surgery. New studies are unlikely to change this outcome. These findings justify a stronger recommendation for the use of GDHT.

Preconception antibiotics exposure in females increases the risk of infertility, miscarriage, and congenital anomalies. Macrolides, sulfonamides, and trimethoprim increase the risk of infertility, spontaneous miscarriage, and congenital malformation while beta-lactams and quinolones reduce the risk. Clinicians, pregnancy planners, and health care policymakers should be warranted for pregnancy needs and success. Further clinical and mechanistic studies are required to illustrate their specific functions and cause effects.

Introduction
Efforts to improve access to essential medicines globally include the implementation and assessment of national medicine policies. Although existing assessment tools may identify gaps, they do not link these to health system functions and policy priority areas in a way that facilitates decision-making. This systematic review aims to identify and map out existing indicators assessing essential medicines policies; assess their strengths and limitations and understand the parameters required to develop a new instrument for assessing access to medicines in a way that better supports decision makers in identifying and addressing the gaps in their national medicine policies.

Methods and analysis
This systematic review is guided by the updated Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. Eligible studies will be identified across scholarly databases (MEDLINE, Embase and Scopus) and grey literature using relevant subject headings and text words. Title, abstract screening and full-text screening will be conducted by two independent reviewers. Indicators or assessment tools focused on the performance of national medicine policies with respect to improving access to essential medicines will be eligible. Data will be extracted using a pretested data abstraction form. Findings will be reported in the form of a descriptive narrative. This study will provide insights into the relevance of existing indicators and tools for assessing access to essential medicines policies. This review will also discuss the opportunities for the development of a new instrument for the assessment of national medicines policies in a way that better supports decision makers to improve access to essential medicines.

Ethics and dissemination
This systematic review does not require ethics approval as it only aims to synthesise evidence from the literature. Findings will be disseminated to key health stakeholders including researchers and global and public health organisations and published in a peer-review journal. This protocol has been registered on PROSPERO (CRD42023493052).

Objectives
To quantify the association between Gestational Diabetes Mellitus (GDM) and adverse pregnancy outcomes and primarily compare the associations between diagnostic criteria following the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations and non-IADPSG criteria, which use higher blood glucose cut-offs.

Design
Systematic review and meta-analysis of observational studies using contemporary GDM diagnostic criteria.

Data sources
PubMed, Scopus, Google Scholar, Cochrane Database of Systematic Reviews and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for articles published between 2010 and 2023. The search was carried out on 15 May 2023.

Eligibility criteria
Studies were included if they were observational studies that reported adjusted effect sizes for GDM-related adverse outcomes and compared outcomes between women with and without GDM, used contemporary diagnostic criteria and were conducted after 2010.

Data extraction and synthesis
Two reviewers independently extracted data and assessed study quality using the MethodologicAl STandards for Epidemiological Research (MASTER) scale. Bias-adjusted inverse variance heterogeneity meta-analysis models were used to synthesise adjusted effect sizes. The same meta-analytic models were used to synthesise the overall OR and their 95% CIs for comparisons of the criteria which followed the IADPSG recommendations to other criteria, mostly with higher blood glucose cut-offs (non-IADPSG).

Results
We included 30 studies involving 642 355 participants. GDM was associated with higher odds of maternal outcomes, namely; caesarean section (adjusted OR (aOR) 1.24, 95% CI 1.01 to 1.51) and pregnancy-induced hypertension (aOR 1.55, 95% CI 1.03 to 2.34). GDM was associated with higher odds of neonatal outcomes, specifically; macrosomia (aOR 1.38, 95% CI 1.13 to 1.69), large for gestational age (aOR 1.42, 95% CI 1.23 to 1.63), preterm birth (aOR 1.41, 95% CI 1.21 to 1.64), neonatal intensive care unit admission (aOR 1.42, 95% CI 1.12 to 1.78), neonatal hypoglycaemia (aOR 3.08, 95% CI 1.80 to 5.26) and jaundice (aOR 1.47, 95% CI 1.12 to 1.91). Further analyses showed no major differences in adverse pregnancy outcomes between IADPSG and non-IADPSG criteria.

Conclusions
GDM is consistently associated with adverse pregnancy, maternal and foetal outcomes, regardless of the diagnostic criteria used. These findings suggest no significant difference in risk between lower and higher blood glucose cut-offs used in GDM diagnosis.

Introduction
Financial protection (FP) is a central function of health systems to enhance access to essential care and improve health equity. We aim to characterise evidence on the distribution of FP in high-income countries as well as how equity of FP is conceptualised and measured in these settings. Findings from this review can advance methodological and conceptual knowledge about equity in FP, guide the evaluation of health systems and inform policy on eliminating inequitable barriers to care to achieve universal health coverage.

Methods and analysis
We will undertake a scoping review following guidance from Colquhoun et al and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We will search four academic databases covering health sciences and economic literature as well as four grey literature sources for relevant publications. Screening for eligibility will be performed independently by two reviewers after calibration of screening criteria. Data will be charted using a standardised form and summarised by thematic analysis.

Ethics and dissemination
Institutional research ethics review was not required; however, research ethics will be considered iteratively throughout the research process. Research findings will be disseminated to scientific and policy meetings, summarised for lay audiences and submitted for publication in a peer-reviewed journal.

It is advisable to introduce Category-2 and -3 models in a clinical setting, especially for NCNSST prognostic for aiding risk-stratification. Although AI-supported predictions in paediatric oncology are at an early stage of development, it is imperative to further explore their potential. This requires structured data collection and ethical sharing from paediatric oncology patients in sufficient quantity and quality.

Objectives
Ramadan fasting is an Islamic religious practice involving abstinence from food and drink from dawn to sunset. Its consequences on kidney-relevant outcomes in patients with chronic kidney disease (CKD) and kidney transplant recipients remain unclear.

Design
Systematic review and meta-analysis.

Data sources
MEDLINE, Embase, Global Health, CINAHL (EBSCOhost), Scopus, Web of Science and Google Scholar were searched up to 18 September 2023.

Eligibility criteria
We included observational studies among non-dialysis CKD and kidney transplant recipients who fasted during Ramadan and examined changes in kidney function.

Data extraction and synthesis
Standardised methods were used by two independent reviewers to screen, select and extract data. Outcomes included changes in serum creatinine (SCr), estimated glomerular filtration rate (eGFR), proteinuria, blood pressure, electrolytes and adverse events—all pre- and post-Ramadan. Results were pooled using random effects modelling.

Results
We included 32 observational studies with a total of 2592 participants. 21 studies reported on participants with CKD and 11 studies reported on kidney transplant recipients (studies variably including non-fasting control arms). Meta-analysis of 25 studies revealed that Ramadan fasting was not associated with changes to SCr for the following groups according to study design: CKD with a non-fasting arm (mean difference (MD)=0.82 µmol/L; 95% CI –7.22, 8.86; I2=38%); transplant with a non-fasting arm (MD=–0.17 µmol/L; 95% CI –2.50, 2.15; I2=0%) and CKD without a non-fasting arm (post–pre MD=13.84 µmol/L; 95% CI –3.78, 31.47; I2=88%). For transplant studies without a non-fasting arm, lower SCr was associated with the post-Ramadan period (post–pre MD=–5.40 µmol/L; 95% CI –10.78, –0.02; I2=0%). In the 18 studies that reported on eGFR, fasting during Ramadan was not associated with an effect on eGFR for any of the groups.

Conclusion
We report inconsistent effects of Ramadan fasting on kidney function in CKD or kidney transplantation. Results should be interpreted with caution due to the significant limitations of the underlying studies.

Introduction
Coughing during extubation can lead to several postoperative complications, including surgical site bleeding, intracranial hypertension and high intraocular pressure. Currently, various pharmacological and non-pharmacological interventions are employed in clinical practice to reduce coughing during extubation. However, it is unclear which of these interventions has the best preventive effect and the fewest adverse events. Therefore, we plan to conduct a systematic review and network meta-analysis to compare the effects of all interventions.

Methods and analysis
We will search MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, CNKI and Wanfang databases, as well as reference lists from previously published papers, from the date of their inception to April 2024. We will only include randomised controlled trials, regardless of publication in any language. The primary outcome is the incidence of cough during extubation, using the modified Minogue scales. The secondary outcomes are as follows: (1) the incidence of severe coughing (grade 4); (2) the incidence of other types of postoperative airway complications, such as laryngospasm, apnoea, hypoxaemia and sore throat, which will be evaluated within 24 hours after surgery; (3) the side effects related to the interventions, such as bradycardia (heart rate less than 60 beats per minute), hypotension or allergic reactions, which will be evaluated within 24 hours from the start of the drug to the postoperative period and (4) the time from the end of the surgery to the extubation of the endotracheal tube. The articles meeting the criteria will be independently evaluated by two researchers based on the established screening criteria. The data will then be extracted. Bias will be assessed for all included studies using the Cochrane Risk of Bias Risk Assessment Tool Version 2. We will use the Netmeta package of the R software with a random-effects model to make direct and indirect comparisons through the frequency framework. We will assess the quality of evidence using Confidence in Network Meta-Analysis.

Ethics and dissemination
Ethical approval is not required for this protocol, as we will only pool published data. We plan to submit our manuscript for publication in a peer-reviewed academic journal.

PROSPERO registration number
CRD42023401609.