Publications by authors named "Gilbert Ramirez"

28 Publications

  • Page 1 of 1

Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program.

Arch Gerontol Geriatr 2020 Aug 18;91:104235. Epub 2020 Aug 18.

Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA; Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA. Electronic address:

Background: Fear of falling restricts mobility and increases fall risk among older adults. Fall-related efficacy (i.e. the confidence to perform activities without falling), a construct related to fear of falling, has also been associated with active living and fall prevention. This study statistically synthesized the program effects of A Matter of Balance Volunteer Lay Leader (AMOB/VLL) model, designed to improve fall-related efficacy and promote daily activities among community-dwelling older adults.

Methods: Research articles and doctoral dissertations that examined the effect of the AMOB/VLL on fear of falling and fall-related efficacy were searched from multiple databases. A random effects model was used to compute mean weighted effect sizes, 95 % CIs, and heterogeneity (I). Bias was examined through a funnel plot and Egger's test. Factors associated with heterogeneity were also explored.

Results: Seventeen AMOB/VLL studies involving 3,860 participants were identified. The pooled effects of the 13 studies with sufficient information for effect size calculation, were -0.29 (95 % CI: -0.40, -0.19) for fear of falling and 0.51 (95 % CI: 0.42, 0.60) for fall-related efficacy. Effect sizes differed partially due to outcome measures of fall-related efficacy. Covariate adjustment and study quality were not associated with differences in effect sizes. No substantial evidence of asymmetry and publication bias was found.

Conclusion: This study provides evidence supporting AMOB/VLL as an effective intervention for reducing fear of falling and improving fall-related efficacy. A greater consistency in outcome measures is needed to optimally capture changes in fear of falling and fall-related efficacy among community-dwelling older adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.archger.2020.104235DOI Listing
August 2020

Building the Evidence Base for the Prevention of Raw Milk-Acquired Brucellosis: A Systematic Review.

Front Public Health 2020 13;8:76. Epub 2020 Mar 13.

Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, United States.

The scientific evidence of the health risks associated with the consumption of raw milk has been known for a long time. However, less clear is the impact of acquiring infectious diseases from raw milk consumption in the United States (US) due to incomplete reporting of cases and the complex factors associated with the sale and consumption of raw milk. Investigations of this current study focused on human brucellosis, one of the infectious diseases commonly acquired through the consumption of raw milk and milk products, and which continues to be a public health threat worldwide. A qualitative systematic review of the sources of opinions that contribute to the increased trend of raw milk sales and consumption in the US was conducted. Interestingly, opinions about the sale of raw milk and/or the benefits arising from its consumption varied by US region, with the proportion of messages supporting raw milk consumption being highest in the Northeast compared to other US regions. Several evidence gaps and factors that possibly contribute to the increased prevalence of raw milk-acquired brucellosis were identified including inadequate monitoring of the raw milk sales process and lack of approved diagnostic methods for validating the safety of raw milk for human consumption. The unavailability of data specifying brucellosis cases acquired from raw milk consumption have precluded the direct association between raw milk and increased brucellosis prevalence in the United States. Nevertheless, the evidence gaps identified in this study demonstrate the need for intensified surveillance of raw-milk acquired infectious diseases including human brucellosis; establishment of safety and quality control measures for the process of selling raw milk; and design of an effective strategy for the prevention of raw milk-acquired infectious diseases including brucellosis. Overall, for the first time, this study has not only shown the gaps in evidence that require future investigations, but also, variations in the perception of raw milk consumption that may impact disease acquisition in different US regions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2020.00076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082743PMC
March 2020

Opioid Use and the Risk of Falls, Fall Injuries and Fractures among Older Adults: A Systematic Review and Meta-Analysis.

J Gerontol A Biol Sci Med Sci 2020 09;75(10):1989-1995

Center for Population Health and Aging, Texas A&M University, College Station.

Background: There is increasing concern about opioid use as a pain treatment option among older adults. Existing literature implies an association between opioid use and fracture, increasing the risk of death and disabilities; yet, this relationship with other fall-related outcomes has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes of falls, fall injuries, and fractures among older adults.

Methods: A systematic literature search was conducted using nine databases: Medline, Embase, CINAHL, PsycInfo, Global Health, Northern Light Sciences Conference Abstracts, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We log-transformed effect sizes (relative risk [RR], odds ratio [OR], and hazard ratio [HR]) to compute pooled risk estimates comparable across the studies. The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Meta-regressions explored differences in risk estimates by analysis method, study design, setting, and study quality.

Results: Thirty studies, providing 34 relevant effect sizes, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with falls, fall injuries, and fractures, with effect sizes ranging from 0.15 to 0.71. In meta-regressions, no selected factors explained heterogeneity.

Conclusion: While heterogeneity is present, results suggest an increased risk of falls, fall injuries, and fractures among older adults who used opioids. Findings highlight the need for opioid education and nonopioid-related pain management interventions among older adults to decrease fall-related risk.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/gerona/glaa038DOI Listing
September 2020

A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis.

PLoS Negl Trop Dis 2019 01 18;13(1):e0007112. Epub 2019 Jan 18.

Department of Veterinary Pathobiology, Texas A&M University, College Station, Texas, United States of America.

Background: Infection of bones and joints remains one of the most commonly described complications of brucellosis in humans and is predominantly reported in all ages and sexes in high-risk regions, such as the Middle East, Asia, South and Central America, and Africa. We aimed to systematically review the literature and perform a meta-analysis to estimate the global prevalence of osteoarticular brucellosis (OAB).

Methodology: Major bibliographic databases were searched using keywords and suitable combinations. All studies reporting the incidence and clinical manifestations of osteoarticular brucellosis in humans, and demonstrated by two or more diagnostic methods (bacteriological, molecular, serological, and/or radiographic) were included. Random model was used, and statistical significance was set at 0.05.

Principal Findings: A total of 56 studies met the inclusion criteria and were included in the systematic review and meta-analysis. There was an evidence of geographical variation in the prevalence of osteoarticular disease with estimates ranging from 27% in low-risk regions to 36% in high-risk regions. However, the difference was not significant. Thus, brucellosis patients have at least a 27% chance of developing osteoarticular disease.

Conclusions: The prevalence of OAB is not dependent on the endemicity of brucellosis in a particular region. Hence, further research should investigate the potential mechanisms of OAB, as well as the influence of age, gender, and other socioeconomic factor variations in its global prevalence, as this may provide insight into associated exposure risks and management of the disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pntd.0007112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355028PMC
January 2019

Biobehavioral determinants of glycemic control in type 2 diabetes: A systematic review and meta-analysis.

Patient Educ Couns 2016 10 19;99(10):1558-67. Epub 2016 Mar 19.

The University of Texas at Austin, School of Nursing, Austin, TX, USA.

Objectives: To conduct a model-driven meta-analysis of correlational research on psychological and motivational predictors of diabetes outcomes, with adherence factors as mediators.

Methods: A comprehensive literature search of published and unpublished studies located a sample of 775 individual correlational or predictive studies reported across 739 research reports.

Results: Results varied according to the outcome variable included in the regression models. Depression had a larger negative effect on adherence to physical activity than on dietary adherence. Coping and self-efficacy were strongly related to dietary adherence, which was strongly related to improved glycemic control. Medication adherence was related to glycosylated hemoglobin, whereas medications and self-monitoring were related to fasting blood glucose. Adding appointment keeping to the models did not significantly alter the results.

Conclusion: Self-efficacy was the most consistent predictor of all adherence behaviors and dietary adherence was the most significant predictor of HbA1c. Physical activity was the most predictive factor of BMI and glucose self-monitoring the most predictive of FBG.

Practice Implications: Metabolic control is a primary goal in T2DM, so the best pathway to attaining that goal appears to be an emphasis on self-efficacy and dietary adherence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pec.2016.03.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028237PMC
October 2016

Reducing Recreational Sedentary Screen Time: A Community Guide Systematic Review.

Am J Prev Med 2016 Mar;50(3):402-415

Schools of Medicine and Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.

Context: Sedentary time spent with screen media is associated with obesity among children and adults. Obesity has potentially serious health consequences, such as heart disease and diabetes. This Community Guide systematic review examined the effectiveness and economic efficiency of behavioral interventions aimed at reducing recreational (i.e., neither school- nor work-related) sedentary screen time, as measured by screen time, physical activity, diet, and weight-related outcomes.

Evidence Acquisition: For this review, an earlier ("original") review (search period, 1966 through July 2007) was combined with updated evidence (search period, April 2007 through June 2013) to assess effectiveness of behavioral interventions aimed at reducing recreational sedentary screen time. Existing Community Guide systematic review methods were used. Analyses were conducted in 2013-2014.

Evidence Synthesis: The review included 49 studies. Two types of behavioral interventions were evaluated that either (1) focus on reducing recreational sedentary screen time only (12 studies); or (2) focus equally on reducing recreational sedentary screen time and improving physical activity or diet (37 studies). Most studies targeted children aged ≤13 years. Children's composite screen time (TV viewing plus other forms of recreational sedentary screen time) decreased 26.4 (interquartile interval= -74.4, -12.0) minutes/day and obesity prevalence decreased 2.3 (interquartile interval= -4.5, -1.2) percentage points versus a comparison group. Improvements in physical activity and diet were reported. Three study arms among adults found composite screen time decreased by 130.2 minutes/day.

Conclusions: Among children, these interventions demonstrated reduced screen time, increased physical activity, and improved diet- and weight-related outcomes. More research is needed among adolescents and adults.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2015.09.030DOI Listing
March 2016

Recommendation to Reduce Patients' Blood Pressure and Cholesterol Medication Costs.

Prev Chronic Dis 2015 Nov 25;12:E209. Epub 2015 Nov 25.

HealthPartners Institute for Education and Research, Minneapolis, Minnesota.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5888/pcd12.150253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674441PMC
November 2015

WITHDRAWN: Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.

Cochrane Database Syst Rev 2014 Nov 21(11):CD002285. Epub 2014 Nov 21.

Research Director, James P. Swyers Enterprises, 1905 West Rogers Ave, Baltimore, Maryland, USA, 21209.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/14651858.CD002285.pub3DOI Listing
November 2014

Model-driven meta-analyses for informing health care: a diabetes meta-analysis as an exemplar.

West J Nurs Res 2015 Apr 19;37(4):517-35. Epub 2014 Aug 19.

Texas A&M University, College Station, TX, USA.

A relatively novel type of meta-analysis, a model-driven meta-analysis, involves the quantitative synthesis of descriptive, correlational data and is useful for identifying key predictors of health outcomes and informing clinical guidelines. Few such meta-analyses have been conducted and thus, large bodies of research remain unsynthesized and uninterpreted for application in health care. We describe the unique challenges of conducting a model-driven meta-analysis, focusing primarily on issues related to locating a sample of published and unpublished primary studies, extracting and verifying descriptive and correlational data, and conducting analyses. A current meta-analysis of the research on predictors of key health outcomes in diabetes is used to illustrate our main points.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0193945914548229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4511466PMC
April 2015

Treatment with exenatide once weekly or twice daily for 30 weeks is associated with changes in several cardiovascular risk markers.

Vasc Health Risk Manag 2012 12;8:621-9. Epub 2012 Nov 12.

Amylin Pharmaceuticals, San Diego, CA, USA.

Background: Cyslipidemia and type 2 diabetes are two of the most significant risk factors for the development of cardiovascular disease. Measurement of lipoprotein subclasses provides important information about derangements in lipid metabolism and helps refine cardiovascular risk assessment. Exenatide, a glucagon-like peptide 1 receptor agonist, improved glycemic control, obesity, hypertension, and dyslipidemia in patients with type 2 diabetes in clinical trials.

Methods: In the DURATION-1 trial, patients with type 2 diabetes were treated with exenatide once weekly or twice daily for 30 weeks. This post hoc analysis evaluated the impact of exenatide on lipoprotein subclasses in 211 DURATION-1 patients using vertical auto profile methodology and the Statistical Package for the Social Sciences general linear model adjusted for glycosylated hemoglobin (HbA(1c)) and weight.

Results: Baseline lipids and high sensitivity C-reactive protein were normal overall based on the standard lipid panel. Once-weekly exenatide reduced apolipoprotein B and the apolipoprotein B to apolipoprotein A1 ratio (P < 0.05), independent of glycemic improvement and weight loss. A significant shift in lipoprotein pattern away from small, dense low-density lipoprotein-4 cholesterol was also observed (P < 0.05). Exenatide once weekly increased high-density lipoprotein-2 cholesterol, even after adjustment for changes in HbA(1c) and weight (P < 0.05). Triglycerides, very low-density lipoprotein cholesterol, and high sensitivity C-reactive protein were reduced with both the once-weekly and twice-daily exenatide regimens (P < 0.05).

Conclusion: In this post hoc analysis, exenatide significantly improved a number of cardiovascular risk markers. Continuous exenatide exposure with exenatide once weekly elicited a greater response than did immediate-release exenatide twice daily, generally independent of glycemic improvement and weight loss. Thus, in addition to improving glycemic control, exenatide induced favorable changes in lipid and lipoprotein metabolism and decreased systemic inflammation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/VHRM.S37969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500143PMC
May 2013

Socioeconomic Status and Survival of People with Human Immunodeficiency Virus Infection before and after the Introduction of Highly Active Antiretroviral Therapy: A Systematic Literature Review.

J AIDS Clin Res 2012 Jul;3(6)

Department of Epidemiology and Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Florida, USA.

Background: Human immunodeficiency virus/acquired immunodeficiency disease syndrome-associated mortality contributes considerably to overall mortality rates among adults in the United States. The purpose of this review is to systematically examine conceptual approaches that have been used to evaluate the association between socioeconomic status of people infected with human immunodeficiency virus and their survival and summarize existing evidence regarding the association between socioeconomic status and mortality due to human immunodeficiency virus/acquired immunodeficiency disease syndrome.

Methods: We systematically retrieved neighborhood and individual-level studies of acquired immunodeficiency disease syndrome-related or all-cause mortality among patients diagnosed with human immunodeficiency virus that reported original data and analyzed socioeconomic status as a predictor of mortality.

Results: We included 21 studies (19 cohort and 2 case-control studies). Heterogeneity in both the conceptual approaches to socioeconomic status measurements and selection of variables for the adjustment of the measure of association precluded meta-analysis of the results. Six studies observing populations before the introduction of highly active antiretroviral therapy found that socioeconomic status was not associated with human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality. In the post- highly active antiretroviral therapy period socioeconomic status was inconsistently associated with Human immunodeficiency virus/acquired immunodeficiency disease syndrome mortality risk in studies adjusting for highly active antiretroviral therapy use.

Conclusion: Further studies considering multilevel socioeconomic status measurements and controlling for treatment and clinical variables are needed to enhance understanding of the role of socioeconomic gradients on human immunodeficiency virus outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3933225PMC
http://dx.doi.org/10.4172/2155-6113.1000163DOI Listing
July 2012

Statin therapy in the prevention of recurrent cardiovascular events: a sex-based meta-analysis.

Arch Intern Med 2012 Jun;172(12):909-19

Department of Neurology, Neurological Institute, Columbia University, New York, New York 10032, USA.

Background: The effect of statins on the prevention of cardiovascular events is well demonstrated. Whether this protective effect is equal for women and men remains less well established. Our objective was to evaluate if statin therapy is equally effective in decreasing recurrent cardiovascular events in women and men.

Data Sources: Randomized clinical trials were searched in PubMed using as indexing terms (statins OR cholesterol lowering medications) AND (cardiovascular events OR stroke OR myocardial infarction OR cardiovascular death).

Study Selection: We included randomized, double-blinded, placebo-controlled trials evaluating statins for secondary prevention of cardiovascular events. Studies with an open-label design and observational studies were excluded.

Data Extraction: The earliest citation was used to determine the characteristic of the studied population and the methodology. All subsequent citations corresponding to the trial were evaluated for outcome rates by sex.

Data Synthesis: Eleven trials representing 43,193 patients were included in the analysis. Overall, statin therapy was associated with a reduced risk of cardiovascular events in all outcomes for women (relative risk [RR], 0.81 [95% CI, 0.74-0.89]) and men (RR, 0.82 [95% CI, 0.78-0.85]). However, they did not reduce all-cause mortality in women vs men (RR, 0.92 [95% CI, 0.76-1.13] vs RR, 0.79 [95% CI, 0.720.87]) or stroke (RR, 0.92 [95% CI, 0.76-1.10] vs RR, 0.81 [95% CI, 0.72-0.92]).

Conclusions: Statin therapy is an effective intervention in the secondary prevention of cardiovascular events in both sexes, but there is no benefit on stroke and all-cause mortality in women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archinternmed.2012.2145DOI Listing
June 2012

Endotoxin exposure and childhood wheeze and asthma: a meta-analysis of observational studies.

J Asthma 2011 Sep 6;48(7):685-93. Epub 2011 Jul 6.

Robert Stempel School of Public Health, Florida International University, Miami, FL 33199, USA.

Background: Exposure to endotoxin has been widely investigated as a potential factor for asthma and associated symptoms in children with different results. To clarify a potential relationship, we performed the present meta-analysis to integrate the results of studies examining the association of endotoxin exposure with wheeze and asthma in children.

Methods: A search for relevant studies and reviews was conducted in MEDLINE, Highwire, CINAHL, and The Cochrane Library databases. Adjusted odds ratio (OR) with corresponding 95% confidence interval (CI) for endotoxin exposure and wheeze or asthma were retrieved and pooled to generate summary effect estimates in STATA 11.1.

Results: Nineteen studies were included in the meta-analysis. The summary estimates suggested that endotoxin was positively associated with wheeze in infants and toddlers (meta-OR: 1.48, 95% CI: 1.10-1.98), but negatively related to asthma in school-aged children (meta-OR: 0.82, 95% CI: 0.69-0.97 for endotoxin concentration and 0.68, 95% CI: 0.50-0.93 for endotoxin load).

Conclusions: Based on the studies evaluated, endotoxin is a risk factor for wheeze in younger children, but a protective factor for asthma in older children. Thus, this study supports the "hygiene hypothesis."
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/02770903.2011.594140DOI Listing
September 2011

Rehabilitation interventions for improving physical and psychosocial functioning after hip fracture in older people.

Cochrane Database Syst Rev 2010 Jan 20(1):CD007624. Epub 2010 Jan 20.

Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia, Australia, 5041.

Background: Social and psychological factors such as fear of falling, self-efficacy and coping strategies are thought to be important in the recovery from hip fracture in older people.

Objectives: To evaluate the effects of interventions aimed at improving physical and psychosocial functioning after hip fracture.

Search Strategy: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE (to December 2008), other databases and reference lists of related articles.

Selection Criteria: Randomised and quasi-randomised trials of rehabilitation interventions applied in inpatient or ambulatory settings to improve physical or psychosocial functioning in older adults with hip fracture. Primary outcomes were physical and psychosocial function and 'poor outcome' (composite of mortality, failure to return to independent living and/or readmission).

Data Collection And Analysis: Two authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Disagreements were moderated by a third author.

Main Results: Nine small heterogeneous trials (involving 1400 participants) were included. The trials had differing interventions, including 'usual care' comparators, providers, settings and outcome assessment. Although most trials appeared well conducted, poor reporting hindered assessment of their risk of bias.Three trials testing interventions (reorientation measures, intensive occupational therapy, cognitive behavioural therapy) delivered in inpatient settings found no significant differences in outcomes. Two trials tested specialist-nurse led care, which was predominantly post-discharge but included discharge planning in one trial: this trial found some benefits at three months but the other trial found no differences at 12 months. Coaching (educational and motivational interventions) was examined in two very different trials: one trial found no effect on function at six months; and the other showed coaching improved self-efficacy expectations at six months, although not when combined with exercise. Two trials testing interventions (home rehabilitation; group learning program) started several weeks after hip fracture found no significant differences in outcomes at 12 months.

Authors' Conclusions: Some outcomes may be amenable to psychosocial treatments; however, there is insufficient evidence to recommend practice changes. Further research on interventions described in this review is required, including attention to timing, duration, setting and administering discipline(s), as well as treatment across care settings. To facilitate future evaluations, a core outcome set, including patient-reported outcomes such as quality of life and compliance, should be established for hip fracture trials.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/14651858.CD007624.pub3DOI Listing
January 2010

Improving the health of populations - evidence for policy and practice action.

Authors:
Gilbert Ramírez

J Evid Based Med 2009 Nov;2(4):216-9

Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.

The evidence-based movement has greatly improved how health scientists review literature. It has also resulted in improvements in the conduct and reporting of primary studies. Its impact in the practice of clinical medicine has been greater than in public health, both in terms of practice and policy decisions. In order to substantially improve population health, there needs to be a paradigm shift in academia - evidence should be guided by the needs of practitioners and policymakers in terms of relevance and timeliness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1756-5391.2009.01044.xDOI Listing
November 2009

The effectiveness of worksite nutrition and physical activity interventions for controlling employee overweight and obesity: a systematic review.

Am J Prev Med 2009 Oct;37(4):340-57

Community Guide Branch, Division of Health Communication and Marketing, National Center for Health Marketing, CDC, Atlanta, Georgia 30333, USA.

This report presents the results of a systematic review of the effectiveness of worksite nutrition and physical activity programs to promote healthy weight among employees. These results form the basis for the recommendation by the Task Force on Community Preventive Services on the use of these interventions. Weight-related outcomes, including weight in pounds or kilograms, BMI, and percentage body fat were used to assess effectiveness of these programs. This review found that worksite nutrition and physical activity programs achieve modest improvements in employee weight status at the 6-12-month follow-up. A pooled effect estimate of -2.8 pounds (95% CI=-4.6, -1.0) was found based on nine RCTs, and a decrease in BMI of -0.5 (95% CI=-0.8, -0.2) was found based on six RCTs. The findings appear to be applicable to both male and female employees, across a range of worksite settings. Most of the studies combined informational and behavioral strategies to influence diet and physical activity; fewer studies modified the work environment (e.g., cafeteria, exercise facilities) to promote healthy choices. Information about other effects, barriers to implementation, cost and cost effectiveness of interventions, and research gaps are also presented in this article. The findings of this systematic review can help inform decisions of employers, planners, researchers, and other public health decision makers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amepre.2009.07.003DOI Listing
October 2009

The promise and pitfalls of systematic reviews.

Annu Rev Public Health 2006 ;27:81-102

Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Texas 77030, USA.

The systematic review "movement" that has transformed medical journal reports of clinical trials and reviews of clinical trials has taken hold in public health, with the most recent milestone, the publication of the first edition of The Guide to Community Health Services in 2005. In this paper we define and distinguish current terms, point out important resources for systematic reviews, describe the impact of systematic review on the quality of primary studies and summaries of the evidence, and provide perspectives on the promise of systematic reviews for shaping the agenda for public health research. Several pitfalls are discussed, including a false sense of rigor implied by the terms "systematic review" and "meta-analysis" and substantial variation in the validity of claims that a particular intervention is "evidence based," and the difficulty of translating conclusions from systematic reviews into public health advocacy and practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1146/annurev.publhealth.27.021405.102239DOI Listing
June 2006

Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting.

J Clin Oncol 2005 Oct;23(28):7188-98

JPS Enterprises, Baltimore, MD 21209, USA.

Purpose: Assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients.

Materials And Methods: Randomized trials of acupuncture-point stimulation by needles, electrical stimulation, magnets, or acupressure were retrieved. Data were provided by investigators of the original trials and pooled using a fixed-effects model.

Results: Eleven trials (N = 1,247) were pooled. Overall, acupuncture-point stimulation reduced the proportion of acute vomiting (relative risks [RR] = 0.82; 95% CI, 0.69 to 0.99; P = .04), but not the mean number of acute emetic episodes or acute or delayed nausea severity compared with controls. By modality, stimulation with needles reduced the proportion of acute vomiting (RR = 0.74; 95% CI, 0.58 to 0.94; P = .01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI, 0.60 to 0.97; P = .02), but manual acupuncture did not; delayed symptoms were not reported. Acupressure reduced mean acute nausea severity (standardized mean difference = -0.19; 95% CI, -0.38 to -0.01; P = .03) and most severe acute nausea, but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics.

Conclusion: This review complements data on postoperative nausea and vomiting, suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies with state-of-the-art antiemetics as well as studies for refractory symptoms are needed to determine clinical relevance. Acupressure seems to reduce chemotherapy-induced acute nausea severity, though studies did not involve a placebo control. Noninvasive electrostimulation seems unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1200/JCO.2005.06.028DOI Listing
October 2005

A meta-analysis comparing the effect of thiazolidinediones on cardiovascular risk factors.

Arch Intern Med 2004 Oct;164(19):2097-104

University of Texas Health Science Center, San Antonio, TX 78229, USA.

Background: In patients with type 2 diabetes mellitus, all therapeutic options should be evaluated for their effect on cardiovascular risk factors, in addition to glycemic control. We conducted a meta-analysis of randomized controlled trials of pioglitazone hydrochloride and rosiglitazone maleate in patients with type 2 diabetes to evaluate their effect on glycemic control, lipids, blood pressure, and weight.

Methods: Randomized controlled trials of patients with type 2 diabetes that compared pioglitazone or rosiglitazone with placebo for 12 weeks were included. Primary analysis was to compare thiazolidinediones with placebo. Secondary analysis was to identify whether treatment with pioglitazone differed from rosiglitazone in any outcomes. We calculated weighted mean differences and 95% confidence intervals.

Results: Twenty-three randomized controlled trials were identified. Both thiazolidinediones demonstrated similar hemoglobin A(1c) level decreases of 1.0% to 1.5% and similar increases in body weight of approximately 3.0 kg. Pioglitazone significantly lowered triglyceride level (-40 mg/dL [-0.45 mmol/L]; 95% confidence interval [CI], -53 to -26 mg/dL [-0.60 to -0.29 mmol/L]), increased high-density lipoprotein cholesterol (HDL-C) level (+4.6 mg/dL [+0.12 mmol/L]; 95% CI, 3.6 to 5.5 mg/dL [0.09 to 0.14 mmol/L]), and showed neutral effect on low-density lipoprotein cholesterol (LDL-C) and total cholesterol levels. Rosiglitazone significantly increased HDL-C level (+2.7 mg/dL [+0.07 mmol/L]; 95% CI, 2.0 to 3.4 mg/dL [0.05 to 0.09 mmol/L]), but increased LDL-C level (+15 mg/dL [+0.39 mmol/L]; 95% CI, 13 to 17 mg/dL [0.34 to 0.44 mmol/L]), total cholesterol level (+21 mg/dL [+0.54 mmol/L]; 95% CI, 18 to 25 mg/dL [0.47 to 0.65 mmol/L]), and demonstrated neutral effect on triglyceride level (-1.1 mg/dL [-0.12 mmol/L]; 95% CI, -14 to 12 mg/dL [-0.16 to 0.14 mmol/L]). No data were available on pioglitazone and blood pressure. Rosiglitazone had a neutral effect on systolic (-0.7 mm Hg; 95% CI, -2.6 to 1.1 mm Hg) and diastolic (-0.8 mm Hg; 95% CI, -1.8 to 0.3) blood pressure.

Conclusions: Thiazolidinediones have similar effects on glycemic control and body weight. Pioglitazone produced a more favorable lipid profile. Head-to-head comparative trials as well as longer-term cardiovascular outcome studies are needed to determine whether there are differences in efficacy between the 2 thiazolidinediones.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archinte.164.19.2097DOI Listing
October 2004

Predicting risk for disciplinary action by a state medical board.

Tex Med 2004 Jan;100(1):84-90

Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr, Suite 600, Houston, TX 77005, USA.

Disciplinary actions taken against physicians in the United States have been increasing over the last decade, yet the factors that place physicians at risk have not been well identified. The objective of this study is to identify predictors of physician disciplinary action. This case-control study used data from the Texas State Board of Medical Examiners from January 1989 through December 1998. Characteristics of disciplined physicians and predictors of disciplinary action for all violations and by type of violation were the main outcome descriptors. Years in practice, black physicians, and osteopathic graduates were positive predictors for disciplinary action. In contrast, female physicians, international medical graduates, and Hispanic and Asian physicians were less likely to receive disciplinary action compared with male, US allopathic, and white physicians, respectively. Most specialists, except psychiatrists and obstetrician-gynecologists, were less likely to be disciplined than were family practitioners, whereas general practitioners were more likely to be disciplined. More studies are needed to corroborate these findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2004

Milk thistle for the treatment of liver disease: a systematic review and meta-analysis.

Am J Med 2002 Oct;113(6):506-15

Department of Medicine, University of California, San Francisco 94143, USA.

Purpose: Milk thistle, an herbal compound, is the dietary supplement taken most frequently by patients with chronic liver disease. We performed a systematic review of the literature to determine the efficacy and safety of this herb for the treatment of liver disease.

Methods: We searched English and non-English reports through July 1999 using thirteen databases and reference lists, and contacting manufacturers and technical experts. Reviewers independently screened all reports to identify randomized placebo-controlled trials that evaluated milk thistle for the treatment of liver disease. Outcomes of primary interest included mortality, histological findings on liver biopsy specimens, serum aminotransferase and albumin levels, and prothrombin times.

Results: Fourteen trials met inclusion criteria. Four trials reported outcomes for mortality among 433 participants. The overall summary odds ratio for mortality in the milk thistle group compared with placebo was 0.8 (95% confidence interval [CI]: 0.5 to 1.5; P = 0.6). Three trials assessed histology on liver biopsy; study quality was inversely associated with the likelihood of histological benefit for milk thistle compared with placebo. There were no differences in serum alanine aminotransferase, aspartate aminotransferase, or albumin levels, or prothrombin times, among participants assigned to milk thistle compared with those assigned to placebo. The only statistically significant difference was a greater reduction in alanine aminotransferase levels among patients with chronic liver disease assigned to milk thistle (-9 IU/L, 95% CI: -18 to -1 IU/L; P = 0.05), but this reduction was of negligible clinical importance and no longer statistically significant after limiting analyses to studies of longer duration or of higher quality. The frequency of adverse effects was low and, in clinical trials, indistinguishable from placebo.

Conclusion: Treatment with milk thistle appears to be safe and well tolerated. We found no reduction in mortality, in improvements in histology at liver biopsy, or in biochemical markers of liver function among patients with chronic liver disease. Data are too limited to exclude a substantial benefit or harm of milk thistle on mortality, and also to support recommending this herbal compound for the treatment of liver disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s0002-9343(02)01244-5DOI Listing
October 2002

HIV prevention research for men who have sex with men: a systematic review and meta-analysis.

J Acquir Immune Defic Syndr 2002 Jul;30 Suppl 1:S118-29

Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

A systematic review of HIV prevention reports published or distributed in the United States as of June 1998 yielded 9 rigorous controlled trials reporting intervention effects on unprotected sex for men who have sex with men. A summary measure of these effects was favorable (odds ratio,.69), statistically significant (95% confidence interval, 0.56-0.86), and very homogeneous. This summary value indicates a 26% reduction in the proportion of men engaging in unprotected anal intercourse. The most clearly favorable effects were observed among interventions that promoted interpersonal skills, were delivered in community-level formats, or focused on younger populations or those at higher behavioral risk. These studies demonstrate that interventions can promote risk reduction among men who have sex with men. Yet given the epidemiology of HIV in the United States, the small number of rigorous controlled intervention trials for this population is striking. Many more rigorous evaluations of HIV prevention efforts with men who have sex with men are needed to ascertain with confidence the effects of specific intervention components, population characteristics, and methodologic features.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2002

Meta-analysis of the effects of behavioral HIV prevention interventions on the sexual risk behavior of sexually experienced adolescents in controlled studies in the United States.

J Acquir Immune Defic Syndr 2002 Jul;30 Suppl 1:S94-S105

School of Public Health, University of Texas, Houston 77030, USA.

To estimate the effect of behavioral and social interventions on sexual risk of HIV among sexually experienced adolescents in the United States and to assess factors associated with variation in outcomes, we selected studies from the HIV/AIDS Prevention Research Synthesis project database. Twenty studies published or reported during the years 1988 through 1998 met criteria: 16 presented sufficient data; of these, 15 evaluated behavioral interventions and 1 a social intervention. Summary odds ratios (ORs) and 95% confidence intervals (CIs), weighted by study precision, indicated significantly less sex without condoms (number of studies, k, 13; OR, 0.66; CI, 0.55-0.79) and lower behavioral risk (k, 2; OR, 0.66; CI, 0.50-0.88), but no difference in number of partners (k, 8; OR, 0.89; CI, 0.76-1.05) or STDs (k, 2; OR, 1.18; CI, 0.48-2.86). A composite sexual risk behavior variable (k, 16; 1 outcome per study; preferred order, sex without condoms, number of partners, risk index) was used for heterogeneity and publication bias tests and stratified analyses. Overall, these interventions had a significant protective effect on sexually experienced adolescents (k, 16; OR, 0.65; CI, 0.50 - 0.85), although there was a suggestion of publication bias. Study design and intervention variables did not explain outcome variation. An exploratory finding may merit investigation: interventions tested with single ethnic groups out-of-class (k, 5) had larger effects than in-class interventions with mixed ethnic groups (k, 11), whether the mixed groups were in- (k, 6) or out-of class (k, 5).
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2002

A meta-analysis of the effect of HIV prevention interventions on the sex behaviors of drug users in the United States.

J Acquir Immune Defic Syndr 2002 Jul;30 Suppl 1:S73-93

Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

We examined the effectiveness of 33 U.S.-based HIV intervention studies in reducing the sexual risk behaviors of drug users by reducing unprotected sex or increasing the use of male condoms. The studies, identified as of June 1998, through the HIV/AIDS Prevention Research Synthesis project, were published in 1988 or later, measured behavioral or biologic outcomes, used experimental designs or certain quasi-experimental designs, and reported sufficient data for calculating an effect size for sexual risk reduction. Of the 33 studies, 94% recruited injection drug users; 21% recruited crack users. The mean age of participants was 36 years. Almost all studies were randomized (94%), provided another HIV intervention to the comparison groups (91%), and evaluated behavioral interventions (91%). On average, interventions were conducted in 5 sessions (total, 10 hours) during 4.5 months. Interventions compared with no interventions were strong and significant (k = 3; odds ratio [OR], 0.60; 95% confidence interval [CI], 0.43-0.85). Interventions compared with other HIV interventions showed a modest additional benefit (k = 30; OR, 0.91; 95% CI, 0.81-1.03). When we extrapolated our result (an OR of 0.60) to a population with a 72% prevalence of risk behavior, the proportion of drug users who reduced their risk behaviors was 12.6% greater in the intervention groups than in the comparison groups. Our meta-analysis shows that interventions can lead to sexual risk reduction among drug users and justifies providing interventions to drug users. Developing interventions with stronger effects to further reduce sexual risk behaviors among drug users must remain a high priority.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2002

A protocol for the analytical aspects of a systematic review of HIV prevention research.

J Acquir Immune Defic Syndr 2002 Jul;30 Suppl 1:S62-72

Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

Quantitative analysis can reveal the consistency of intervention effects across studies, as well as the variation of effects according to study-level characteristics. After consulting with project experts in methods and content, and reviewing the literatures on research synthesis and on HIV prevention, we developed a systematic protocol of analytical methods for synthesis of behavioral and biologic outcome data from HIV intervention studies. This protocol included procedures for identifying eligible studies; defining, characterizing, and prioritizing outcomes; abstracting and calculating estimates of effect; adjusting for baseline distributions and intraclass correlation; transforming estimates to a common metric; summarizing effects; examining differences in effectiveness among groups of studies; and translating these results into terms useful to HIV prevention practitioners and researchers. We applied these procedures to transform outcome data reported in many different statistical formats into odds ratios that could be combined and compared across studies. We analyzed data on behaviors related to sexual risk for HIV infection (unprotected sex, condom use, and number of partners) as well as data on biologic outcomes (incidence of HIV and other sexually transmitted infections). This framework may be useful for meta-analyses of prevention research in other fields, particularly when primary research features diverse outcome measures and methods of analysis.
View Article and Find Full Text PDF

Download full-text PDF

Source
July 2002

Identifying depression in primary care: a literature synthesis of case-finding instruments.

Gen Hosp Psychiatry 2002 Jul-Aug;24(4):225-37

The South Texas Veterans Health Care System, Audie Murphy Division-Veterans Evidence-based Research Dissemination and Implementation, San Antonio, TX, USA.

We evaluated the usefulness of case-finding instruments for identifying patients with major depression or dysthymia in primary care settings using English language literature from Medline, a specialized trials registry and bibliographies of selected papers. Studies were done in primary care settings with unselected patients and compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected. A total of 16 case-finding instruments were assessed in 38 studies. More than 32,000 patients received screening with a case-finding instrument; approximately 12,900 of these received criterion standard assessment. Case-finding instruments ranged in length from 1 to 30 questions. Average administration times ranged from less than 2 min to 6 min. Median sensitivity for major depression was 85% (range 50% to 97%); median specificity was 74% (range 51% to 98%). No significant differences between instruments were found. However for individual instruments, estimates of sensitivity and specificity varied significantly between studies. For the combined diagnoses of major depression or dysthymia, overall sensitivity was 79% (CI, 74% to 83%) and overall specificity 75% (CI, 70% to 81%). Stratified analyses showed no significant effects on overall instrument performance for study methodology, criterion standard choice, or patient characteristics. We found that multiple instruments with reasonable operating characteristics are available to help primary care clinicians identify patients with major depression. Because operating characteristics of these instruments are similar, selection of a particular instrument should depend on issues such as feasibility, administration and scoring times, and the instruments' ability to serve additional purposes, such as monitoring severity or response to therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s0163-8343(02)00195-0DOI Listing
September 2002

Is this patient clinically depressed?

JAMA 2002 Mar;287(9):1160-70

Department of Veterans Affairs Medical Center, 508 Fulton St, HSR&D, Bldg 6, Durham, NC 27705, USA.

Context: Depressive disorders are highly prevalent in the general population, but recognition and accurate diagnosis are made difficult by the lack of a simple confirmatory test.

Objective: To review the accuracy and precision of depression questionnaires and the clinical examination for diagnosing clinical depression.

Data Sources: We searched the English-language literature from 1970 through July 2000 using MEDLINE, a specialized registry of depression trials, and bibliographies of selected articles.

Study Selection: Case-finding studies were included if they used depression questionnaires with easy to average literacy requirements, evaluated at least 100 primary care patients, and compared questionnaire results with accepted diagnostic criteria for major depression. Eleven questionnaires, ranging in length from 1 to 30 questions, were assessed in 28 published studies. Reliability studies for the clinical examination required criterion-based diagnoses made by at least 2 clinicians who interviewed the patient or reviewed a taped examination. Fourteen studies evaluated interrater reliability.

Data Extraction: Pairs of authors independently reviewed articles. For case-finding studies, quality assessment addressed sample size and whether patients were selected consecutively or randomly, the criterion standard was administered and interpreted independently of and blind to the results of the case-finding instrument, and the proportion of persons receiving the criterion standard assessment was less than or more than 50% of those approached for criterion standard assessment. For reliability studies, quality assessment addressed whether key patient characteristics were described, the interviewers collected clinical history independently, and diagnoses were made blinded to other clinicians' evaluations.

Data Synthesis: In case-finding studies, average questionnaire administration times ranged from less than 1 minute to 5 minutes. The median likelihood ratio positive for major depression was 3.3 (range, 2.3-12.2) and the median likelihood ratio negative was 0.19 (range, 0.14-0.35). No significant differences between questionnaires were found. For mental health care professionals using a semistructured interview, agreement was substantial to almost perfect for major depression (kappa = 0.64-0.93). Nonstandardized interviews yielded somewhat lower agreement (kappa = 0.55-0.74). A single study showed that primary care clinicians using a semistructured interview have high agreement with mental health care professionals (kappa = 0.71).

Conclusions: Multiple, practical questionnaires with reasonable performance characteristics are available to help clinicians identify and diagnose patients with major depression. Diagnostic confirmation by mental health care professionals using a clinical interview or by primary care physicians using a semistructured interview can be made with high reliability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jama.287.9.1160DOI Listing
March 2002