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The search methods used in systematic reviews provide the foundation for establishing the body of literature from which conclusions are drawn and recommendations made. Searches should aim to be comprehensive and reporting of search methods should be transparent and reproducible. Campbell Collaboration systematic reviews strive to adhere to the best methodological guidance available for this type of searching. The current work aims to provide an assessment of the conduct and reporting of searches in Campbell Collaboration systematic reviews. Our objectives were to examine how searches are currently conducted in Campbell systematic reviews, how search strategies, search methods and search reporting adhere to the Methodological Expectations of Campbell Collaboration Intervention Reviews (MECCIR) and PRISMA standards, and identify emerging or novel methods used in searching in Campbell systematic reviews. We also investigated the role of information specialists in Campbell systematic reviews. We handsearched the Campbell Systematic Reviews journal tables of contents from January 2017 to March 2024. We included all systematic reviews published since 2017. We excluded other types of evidence synthesis (e.g., evidence and gap maps), updates to systematic reviews when search methods were not changed from the original pre-2017 review, and systematic reviews that did not conduct their own original searches. We developed a data extraction form in part based on the conduct and reporting items in MECCIR and PRISMA. In addition, we extracted information about the general quality of searches based on the use of Boolean operators, keywords, database syntax and subject headings. Data extraction included information about reporting of sources searched, some aspects of search quality, the use and reporting of supplementary search methods, reporting of the search strategy, the involvement of information specialists, date of the most recent search, and citation of the Campbell search methods guidance. Items were rated as fully, partially or not conducted or reported. We cross-walked our data extraction items to the 2019 MECCIR standards and 2020 PRISMA guidelines and provide descriptive analyses of the conduct and reporting of searches in Campbell systematic reviews, indicating level of adherence to standards where applicable. We included 111 Campbell systematic reviews across all coordinating groups published since 2017 up to the search date. Almost all (98%) included reviews searched at least two relevant databases and all reported the databases searched. All reviews searched grey literature and most (82%) provided a full list of grey literature sources. Detailed information about databases such as platform and date range coverage was lacking in 16% and 77% of the reviews, respectively. In terms of search strategies, most used Boolean operators, search syntax and phrase searching correctly, but subject headings in databases with controlled vocabulary were used in only about half of the reviews. Most reviews reported at least one full database search strategy (90%), with 63% providing full search strategies for all databases. Most reviews conducted some supplementary searching, most commonly searching the references of included studies, whereas handsearching of journals and forward citation searching were less commonly reported (51% and 62%, respectively). Twenty-nine percent of reviews involved an information specialist co-author and about 45% did not mention the involvement of any information specialist. When information specialists were co-authors, there was a concomitant increase in adherence to many reporting and conduct standards and guidelines, including reporting website URLs, reporting methods for forward citation searching, using database syntax correctly and using subject headings. No longitudinal trends in adherence to conducting and reporting standards were found and the Campbell search methods guidance published in 2017 was cited in only twelve reviews. We also found a median time lag of 20 months between the most recent search and the publication date. In general, the included Campbell systematic reviews searched a wide range of bibliographic databases and grey literature, and conducted at least some supplementary searching such as searching references of included studies or contacting experts. Reporting of mandatory standards was variable with some frequently unreported (e.g., website URLs and database date ranges) and others well reported in most reviews. For example, database search strategies were reported in detail in most reviews. For grey literature, source names were well reported but search strategies were less so. The findings will be used to identify opportunities for advancing current practices in Campbell reviews through updated guidance, peer review processes and author training and support.
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Public health restrictions to protect physical health during the COVID-19 pandemic had unintended effects on mental health, which may have disproportionately affected some potentially vulnerable groups. This scoping review of qualitative research provides a narrative synthesis of new mothers' perspectives on their mental health during COVID-19 pandemic restrictions through pregnancy to the postpartum period. Database searches in PubMed, CINAHL, and PsycINFO sought primary research studies published until February 2023, which focused on new mothers' self-perceived mental health during the pandemic (N = 55). Our synthesis found that new mothers' mental health was impacted by general public health restrictions resulting in isolation from family and friends, a lack of community support, and impacts on the immediate family. However, public health restrictions specific to maternal and infant healthcare were most often found to negatively impact maternal mental health, namely, hospital policies prohibiting the presence of birthing partners and in-person care for their infants. This review of qualitative research adds depth to previous reviews that have solely examined the quantitative associations between COVID-19 public health restrictions and new mothers' mental health. Here, our review demonstrates the array of adverse impacts of COVID-19 public health restrictions on new mothers' mental health throughout pregnancy into the postpartum period, as reported by new mothers. These findings may be beneficial for policy makers in future public health emergency planning when evaluating the impacts and unintended consequences of public health restrictions on new mothers.
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Thin plate smoothing spline models, covering Canada and the continental United States, were developed using ANUSPLIN for 30-year (1991-2020) monthly mean maximum and minimum temperature and precipitation. These models employed monthly weather station values from the North American dataset published by National Oceanic and Atmospheric Administration's (NOAA's) National Centers for Environmental Information (NCEI). Maximum temperature mean absolute errors (MAEs) ranged between 0.54 °C and 0.64 °C (approaching measurement error), while minimum temperature MAEs were slightly higher, varying from 0.87 °C to 1.0 °C. On average, thirty-year precipitation estimates were accurate to within approximately 10 % of total precipitation levels, ranging from 9.0 % in the summer to 12.2 % in the winter. Error rates were higher in Canada compared to estimates in the United States, consistent with a less dense station network in Canada relative to the United States. Precipitation estimates in Canada exhibited MAEs representing 14.7 % of mean total precipitation compared to 9.7 % in the United States. The datasets exhibited minimal bias overall; 0.004 °C for maximum temperature, 0.01 °C for minimum temperature, and 0.5 % for precipitation. Winter months showed a greater dry bias (0.8 % of total winter precipitation) compared to other seasons (-0.4 % of precipitation). These 30-year gridded datasets are available at â¼2 km resolution.
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Importance: There are insufficient data comparing 16α-18F-fluoro-17ß-estradiol (FES) positron emission tomography (PET) computed tomography (CT) with standard-of-care imaging (SOC) for staging locally advanced breast cancer (LABC) or evaluating suspected recurrence. Objective: To determine the detection rate of FES PET/CT and SOC for distant metastases in patients with estrogen receptor (ER)-positive LABC and recurrences in patients with ER-positive BC and suspected recurrence. Design, Setting, and Participants: This diagnostic study was conducted as a single-center phase 2 trial, from January 2021 to September 2023. The study design provided 80% power to find a 20% detection rate difference. Participants included patients with ER-positive LABC (cohort 1) or suspected recurrence (cohort 2). Data were analyzed from September 2023 to February 2024. Exposure: Participants underwent both SOC imaging and experimental FES PET/CT. When there were suspicious lesions on imaging, 1 was biopsied for histopathological reference standard to confirm presence (true positive) or absence (false positive) of malignant neoplasm. Main Outcomes and Measures: The outcome of interest was the detection rate of FES PET CT vs SOC for distant metastases and recurrences. Results: A total of 124 patients were accrued, with 62 in cohort 1 (median [IQR] age, 52 [32-84] years) and 62 in cohort 2 (median [IQR] age, 66 [30-93] years). In cohort 1, of 14 true-positive findings, SOC imaging detected 12 and FES detected 11 (P > .99). In cohort 2, of 23 true-positive findings, SOC detected 16 and FES detected 18 (P = .77). In 30 patients with lobular histology, of 11 true-positive findings, SOC detected 5 and FES detected 9 (P = .29). There were 6 false-positive findings on SOC and 1 false-positive finding on FES PET/CT (P = .13). Conclusions and Relevance: In this diagnostic study with pathological findings as the reference standard, no difference was found between FES PET/CT and current SOC imaging for detecting distant metastases in patients with ER-positive LABC or recurrences in patients with ER-positive tumors and suspected recurrence. FES PET/CT could be considered for both clinical indications, which are not part of current Appropriate Use Criteria for FES PET. The findings regarding FES PET/CT in patients with lobular tumors, and for lower false positives than current SOC imaging, warrant further investigation.
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Neoplasias da Mama , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Idoso , Adulto , Receptores de Estrogênio/metabolismo , Receptores de Estrogênio/análise , Estradiol/análogos & derivadosRESUMO
Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.
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Exercício Físico , Promoção da Saúde , Serviços de Saúde Escolar , Humanos , Serviços de Saúde Escolar/organização & administração , Promoção da Saúde/métodos , Criança , Educação Física e Treinamento/métodos , Instituições Acadêmicas , Adolescente , Avaliação de Programas e Projetos de Saúde , Meios de Transporte/métodosRESUMO
BACKGROUND: Various studies have demonstrated gender disparities in workplace settings and the need for further intervention. This study identifies and examines evidence from randomized controlled trials (RCTs) on interventions examining gender equity in workplace or volunteer settings. An additional aim was to determine whether interventions considered intersection of gender and other variables, including PROGRESS-Plus equity variables (e.g., race/ethnicity). METHODS: Scoping review conducted using the JBI guide. Literature was searched in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, ERIC, Index to Legal Periodicals and Books, PAIS Index, Policy Index File, and the Canadian Business & Current Affairs Database from inception to May 9, 2022, with an updated search on October 17, 2022. Results were reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension to scoping reviews (PRISMA-ScR), Sex and Gender Equity in Research (SAGER) guidance, Strengthening the Integration of Intersectionality Theory in Health Inequality Analysis (SIITHIA) checklist, and Guidance for Reporting Involvement of Patients and the Public (GRIPP) version 2 checklist. All employment or volunteer sectors settings were included. Included interventions were designed to promote workplace gender equity that targeted: (a) individuals, (b) organizations, or (c) systems. Any comparator was eligible. Outcomes measures included any gender equity related outcome, whether it was measuring intervention effectiveness (as defined by included studies) or implementation. Data analyses were descriptive in nature. As recommended in the JBI guide to scoping reviews, only high-level content analysis was conducted to categorize the interventions, which were reported using a previously published framework. RESULTS: We screened 8855 citations, 803 grey literature sources, and 663 full-text articles, resulting in 24 unique RCTs and one companion report that met inclusion criteria. Most studies (91.7%) failed to report how they established sex or gender. Twenty-three of 24 (95.8%) studies reported at least one PROGRESS-Plus variable: typically sex or gender or occupation. Two RCTs (8.3%) identified a non-binary gender identity. None of the RCTs reported on relationships between gender and other characteristics (e.g., disability, age, etc.). We identified 24 gender equity promoting interventions in the workplace that were evaluated and categorized into one or more of the following themes: (i) quantifying gender impacts; (ii) behavioural or systemic changes; (iii) career flexibility; (iv) increased visibility, recognition, and representation; (v) creating opportunities for development, mentorship, and sponsorship; and (vi) financial support. Of these interventions, 20/24 (83.3%) had positive conclusion statements for their primary outcomes (e.g., improved academic productivity, increased self-esteem) across heterogeneous outcomes. CONCLUSIONS: There is a paucity of literature on interventions to promote workplace gender equity. While some interventions elicited positive conclusions across a variety of outcomes, standardized outcome measures considering specific contexts and cultures are required. Few PROGRESS-Plus items were reported. Non-binary gender identities and issues related to intersectionality were not adequately considered. Future research should provide consistent and contemporary definitions of gender and sex. TRIAL REGISTRATION: Open Science Framework https://osf.io/x8yae .
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Equidade de Gênero , Local de Trabalho , Humanos , Feminino , Masculino , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Information literacy skills are an important part of research skills for undergraduate science students. This case study presents a novel approach to developing these types of research skills. By deconstructing the research process into separate steps, explicitly defining, and practicing the skills involved, students can progressively develop these skills and apply them. In this course, systematic reviews are used as exemplars for the research process. We align the Research Skills Development Framework with the steps of a systematic review and present specific skills and accompanying activities for each step. This workshop-based course emphasizes skill development and can help overcome assessments that rely solely on a final paper, with no record or evidence of the student research process, that could be created by a generative artificial intelligence tool.NEW & NOTEWORTHY This study presents a novel approach to teaching undergraduate science students rigorous research skills with scaffolded systematic review practice.
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Estudantes , Humanos , Currículo , Universidades , Pesquisa/educação , Ciência/educação , Revisões Sistemáticas como AssuntoRESUMO
Sedentary behavior (SB) or sitting is associated with multiple unfavorable health outcomes. Bone tissue responds to imposed gravitational and muscular strain with there being some evidence suggesting a causal link between SB and poor bone health. However, there are no population-based data on the longitudinal relationship between SB, bone change, and incidence of fragility fractures. This study aimed to examine the associations of sitting/SB (defined as daily sitting time), areal BMD (by DXA), and incident low trauma (fragility) osteoporotic fractures (excluding hands, feet, face, and head). We measured baseline (1995-7) and 10-yr self-reported SB, femoral neck (FN), total hip (TH), and lumbar spine (L1-L4) BMD in 5708 women and 2564 men aged 25 to 80+ yr from the population-based, nationwide, 9-center Canadian Multicentre Osteoporosis Study. Incident 10-yr fragility fracture data were obtained from 4624 participants; >80% of fractures were objectively confirmed by medical records or radiology reports. Vertebral fractures were confirmed by qualitative morphological methods. All analyses were stratified by sex. Multivariable regression models assessed SB-BMD relationships; Cox proportional models were fit for fracture risk. Models were adjusted for age, height, BMI, physical activity, and sex-specific covariates. Women in third/fourth quartiles had lower adjusted FN BMD versus women with the least SB (first quartile); women in the SB third quartile had lower adjusted TH BMD. Men in the SB third quartile had lower adjusted FN BMD than those in SB first quartile. Neither baseline nor stable 10-yr SB was related to BMD change nor to incident fragility fractures. Increased sitting (SB) in this large, population-based cohort was associated with lower baseline FN BMD. Stable SB was not associated with 10-yr BMD loss nor increased fragility fracture. In conclusion, habitual adult SB was not associated with subsequent loss of BMD nor increased risk of fracture.
The number of hours of sitting in a day (often called "sedentary behavior") is currently understood to be "bad for bone health" both because of increased bone loss and a higher risk for fractures. Very few studies in randomly sampled men and women from a whole population have consistently asked about hours of sitting and examined baseline bone density. Fewer still have compared hours of sitting and its changes over 10 yr with changes in bone density and the number of new fractures that occurred. The Canadian Multicentre Osteoporosis Study obtained sitting hours from 5708 women and 2564 men aged 25 to 80+ yr and compared it with the spine, total hip (TH), and femoral neck (FN) bone density values. The average sitting at 7.4 h in men was associated with slightly lower adjusted femoral neck bone density; in women, sitting 6.7 h/d was associated with slightly lower adjusted FN and TH bone density. Ten-year follow-up data (now in about 5000 people) showed no relationship between the slightly longer sitting (an increase of 18% in men and 22% in women) and bone loss or new bone fractures. In this large country-wide population-based study, hours of sitting each day were not associated with 10-yr BMD loss in women or men nor did sitting more associate with new bone fractures. These data are reassuring; women and men who walk regularly and have some moderate-vigorous physical activity each day, despite more sitting, do not seem to be at greater risk for osteoporosis.
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Osteoporose , Fraturas por Osteoporose , Adulto , Feminino , Humanos , Masculino , Densidade Óssea , Canadá/epidemiologia , Colo do Fêmur/diagnóstico por imagem , Vértebras Lombares , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Comportamento Sedentário , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou maisRESUMO
Evidence is sparse on how community-based health-promoting programs can be culturally adapted for racially minoritized, immigrant older adult populations. Choose to Move (CTM) is an evidence-based health-promoting program that enhances physical activity and mobility and diminished social isolation and loneliness in older adults in British Columbia, Canada. However, racially minoritized older adults were not reached in initial offerings. We purposively sampled CTM delivery staff (n = 8) from three not-for-profit organizations, in Metro Vancouver, British Columbia, that serve Chinese older adults. We used semistructured interviews, ethnographic observations, and meeting minutes to understand delivery staff's perspectives on factors that influence CTM adaptations for Chinese older adults. Deductive framework analysis guided by an adaptation framework, Framework for Reporting Adaptations and Modifications-Enhanced, found three dominant cultural- and immigration-related factors influenced CTM adaptations for Chinese older adults: (a) prioritizations, (b) familiarity, and (c) literacy. Findings may influence future program development and delivery to meet the needs of racially minoritized older adult populations.
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Solidão , Isolamento Social , Humanos , Idoso , Canadá , Colúmbia Britânica , Exercício Físico , ChinaRESUMO
This is the protocol for a Campbell systematic review. The review will address the following research questions: (1) What are the effects of economic development interventions on the economic outcomes of people in humanitarian settings? What factors explain any observed variations in effect such as setting, programme design features or duration? (2) What are the effects of economic development interventions on the food security, nutrition, the psychosocial and mental health, and the physical health outcomes of populations in humanitarian settings? (3) What are the success factors and barriers that affect the implementation and effectiveness of economic development interventions on populations affected by humanitarian crisis?
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Forest transition theory, as introduced by Alexander Mather, depicts forest recovery patterns often occurring in the wake of agricultural intensification and farmland abandonment. Since the forest transition theory was introduced, multiple pathways have been described in the scholarly literature to explain forest transition phases via varied socio-economic forces. This analysis of a set of 78 country-specific case studies published from 2019 to 2022 confirms social inequity in documented forest transitions; forest transition case studies from 2019 to 2022 were concentrated in highly developed countries. This review also substantiates the impact of agricultural land use changes in recent forest transitions. Four out of five case studies assessing pathways identified an economic development pathway for forest transitions. The effect of state interventions such as introducing incentives for reforestation in forest transitions reviewed was mixed; while almost one-third of forest transitions were attributed to state policies or laws, negative biodiversity impacts from forest plantations were documented. With respect to social justice, nearly a third of case studies included interviews with villagers or similar methodologies to capture social perceptions of forest transitions. Based on this review, governance and social equity forest transition benefits are critical issues for forest transition research.
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Ionising radiation is a human carcinogen, but the evidence is less clear that exposure to low-dose ionising radiation (LDIR) increases the risk of adverse cardiovascular outcomes. We synthesised the literature of chronic occupational exposure to LDIR and cardiovascular disease, particularly for ischaemic heart disease (IHD).The literature search was conducted using three databases including studies published between 1990 and 2022. A quality assessment of the studies was completed using the Office of Health and Assessment and Translation Risk of Bias Rating Tool. We conducted meta-analyses for IHD mortality using random effects models using measures of excess relative risk per sievert (ERR/Sv) obtained from internal cohort comparisons, as well as with standardised mortality ratios (SMRs) from external cohort comparisons.We identified 2189 articles, and of these, 26 provided data on IHD and were retained. Most studies were classified as having a 'moderate' level of risk of bias. Fourteen and 10 studies reporting external radiation doses were included in meta-analyses using SMR and ERR/Sv, respectively. The meta-summary SMR was 0.81 (95% CI 0.74 to 0.89) with evidence of reduced risk but high heterogeneity across studies. For internal cohort measures, the summary ERR/Sv for a lagged exposure of 10 years was 0.10 (95% CI 0.01 to 0.20) with low heterogeneity. The subgroup analysis by lagged exposure time showed the strongest association were for the 15 and 20 years lag.Our findings suggest that occupational exposure to LDIR increases the risk IHD mortality and highlight the relevance of internal cohort comparisons.
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Doenças Cardiovasculares , Isquemia Miocárdica , Doenças Profissionais , Exposição Ocupacional , Exposição à Radiação , Humanos , Isquemia Miocárdica/etiologia , Exposição Ocupacional/efeitos adversos , Radiação Ionizante , Risco , Doenças Profissionais/etiologia , Exposição à Radiação/efeitos adversosRESUMO
Heating degree days (HDD) represent a concise measure of heating energy requirements used to inform decision making about the impact of climate change on heating energy demand. This data paper presents spatial datasets of heating degree days (HDD) for Canada for two thirty-year periods, 1951-1980 and 1981-2010, using daily temperature gauge observations over these time periods. Stations with fewer than nine missing days in a year and greater than nine years of data over each thirty-year period were included, resulting in 1339 and 1679 stations for the 1951-1980 and 1981-2010 periods respectively. Mean absolute error (MAE) of the spatial models ranged from 124.2 Celsius degree days (C-days) for the 1951-1980 model (2.4% of the surface mean) to 137.6 C-days for the 1981-2010 model (2.7%). This note presents maps illustrating cross validation errors at a set of representative stations. The grids are available at â¼2 km resolutions.
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Women living with HIV (WLWH) may be at higher risk for osteoporosis and fragility fractures. However, limited prospective data describe long-term trajectories of bone mineral density (BMD) in WLWH versus women without HIV. Thus, in this prospective study, we aimed to compare 10-year change in areal BMD (aBMD) between WLWH (n = 49; 36.8 ± 8.8 years; 96% pre/perimenopausal) and HIV-negative women (population-based controls; n = 49; 41.9 ± 9.2 years; 80% pre/perimenopausal). In an exploratory analysis, we compared fracture history between WLWH and controls. Outcomes were lumbar spine (L1 to L4), total hip, and femoral neck aBMD at baseline and follow-up, which occurred at 13 and 10 years in WLWH and controls, respectively. We fit multivariable regression models to compare baseline and 10-year change in aBMD between groups, adjusting for osteoporosis risk factors. Within WLWH, we examined associations between aBMD and HIV-related factors, including combination antiretroviral therapy (cART) duration. WLWH were diagnosed 6.5 ± 3.7 years before baseline, 80% were on cART for 241 ± 142 weeks, and 49% had HIV plasma viral load <40 copies/mL. Before and after adjusting for osteoporosis risk factors, baseline and 10-year change in aBMD did not differ between WLWH and controls at any site. At baseline, more WLWH than controls reported a history of low-trauma fracture (30% versus 10%, p < 0.05) and major osteoporotic fracture (17% versus 4%, p < 0.05). During follow-up, the number of WLWH and controls with incident fragility fracture was not significantly different. Lifetime cART duration and tenofovir use were not associated with aBMD 10-year percent change. Higher CD4 count at baseline was positively associated with femoral neck aBMD 10-year percent change. Long-term aBMD change in this small WLWH cohort paralleled normal aging, with no evidence of influence from cART use; however, these results should be interpreted with caution given the small sample size. Larger cohort studies are needed to confirm these findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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BACKGROUND: Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults. METHODS: Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT. ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care). INFORMATION SOURCES: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020. OUTCOME MEASURES: Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. DATA SYNTHESIS: We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data. RESULTS: We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%). CONCLUSIONS: KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018084810.
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Pessoal de Saúde , Ciência Translacional Biomédica , Humanos , Idoso , Doença Crônica , Conhecimento , Gerenciamento ClínicoRESUMO
This is the protocol for a Campbell systematic review. The main objective of the review is to answer the following questions: What is the impact of mechanisation on agriculture? What is the impact of mechanisation on women's economic empowerment? The study will review the impact of mechanisation on labour demand and supply, land and labour productivity, farmers' incomes, health and women's empowerment. All literature will be considered, including nonintervention studies and studies not reporting gender-disaggregated results.
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BACKGROUND: Choose to Move (CTM), an effective health-promoting intervention for older adults, was scaled-up across British Columbia, Canada. Adaptations that enable implementation at scale may lead to 'voltage drop'-diminished positive effects of the intervention. For CTM Phase 3 we assessed: i. implementation; ii. impact on physical activity, mobility, social isolation, loneliness and health-related quality of life (impact outcomes); iii. whether intervention effects were maintained; iv) voltage drop, compared with previous CTM phases. METHODS: We conducted a type 2 hybrid effectiveness-implementation pre-post study of CTM; older adult participants (n = 1012; mean age 72.9, SD = 6.3 years; 80.6% female) were recruited by community delivery partners. We assessed CTM implementation indicators and impact outcomes via survey at 0 (baseline), 3 (mid-intervention), 6 (end-intervention) and 18 (12-month follow-up) months. We fitted mixed-effects models to describe change in impact outcomes in younger (60-74 years) and older (≥ 75 years) participants. We quantified voltage drop as percent of effect size (change from baseline to 3- and 6-months) retained in Phase 3 compared with Phases 1-2. RESULTS: Adaptation did not compromise fidelity of CTM Phase 3 as program components were delivered as intended. PA increased during the first 3 months in younger (+1 days/week) and older (+0.9 days/week) participants (p<0.001), and was maintained at 6- and 18-months. In all participants, social isolation and loneliness decreased during the intervention, but increased during follow-up. Mobility improved during the intervention in younger participants only. Health-related quality of life according to EQ-5D-5L score did not change significantly in younger or older participants. However, EQ-5D-5L visual analog scale score increased during the intervention in younger participants (p<0.001), and this increase was maintained during follow-up. Across all outcomes, the median difference in effect size, or voltage drop, between Phase 3 and Phases 1-2 was 52.6%. However, declines in social isolation were almost two times greater in Phase 3, compared with Phases 1-2. CONCLUSION: Benefits of health-promoting interventions-like CTM-can be retained when implemented at broad scale. Diminished social isolation in Phase 3 reflects how CTM was adapted to enhance opportunities for older adults to socially connect. Thus, although intervention effects may be reduced at scale-up, voltage drop is not inevitable.
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Qualidade de Vida , Isolamento Social , Humanos , Feminino , Idoso , Masculino , Solidão , Promoção da Saúde , Colúmbia BritânicaRESUMO
Replacement of fossil fuels with bioenergy, often in concert with carbon capture and storage, plays an important role in published low-emission pathways from the Intergovernmental Panel on Climate Change (IPCC) and other agencies. National and regional net-zero greenhouse gas emission commitments have caused a dramatic increase in forest biomass consumption globally, and the rise has been accompanied by debates in the scholarly literature and in society at large about the ecological and climate change impacts of forest biomass. This paper presents a quantitative analysis of media headlines about forest bioenergy published in 75 Canadian newspapers from 2010 to 2020. Using a lexicon and rules-based sentiment analysis tool, we explore negative and positive media headlines about forest biomass. Despite our finding that Canadian headlines about forest bioenergy were twice as likely to be positive as negative, media items document reversals away from forest biomass-generated domestic electricity. Our analysis found that increases in electricity costs following the introduction of forest biomass as a fuel type for Canadian electricity generation was a primary cause of these reversals. Headlines also critiqued the expanded production of wood pellets, citing forest ecological impacts and the debate about the net carbon impacts of forest biomass-generated energy. Safety issues, including stories about workplace injuries, and pellet plant fires, and economic issues, such as fiber supply and mill closures, were also featured. This research contributes a social science lens to understand perceptions over time about forest biomass for heat and power.
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OBJECTIVES: To chart the global literature on gender equity in academic health research. DESIGN: Scoping review. PARTICIPANTS: Quantitative studies were eligible if they examined gender equity within academic institutions including health researchers. PRIMARY AND SECONDARY OUTCOME MEASURES: Outcomes related to equity across gender and other social identities in academia: (1) faculty workforce: representation of all genders in university/faculty departments, academic rank or position and salary; (2) service: teaching obligations and administrative/non-teaching activities; (3) recruitment and hiring data: number of applicants by gender, interviews and new hires for various rank; (4) promotion: opportunities for promotion and time to progress through academic ranks; (5) academic leadership: type of leadership positions, opportunities for leadership promotion or training, opportunities to supervise/mentor and support for leadership bids; (6) scholarly output or productivity: number/type of publications and presentations, position of authorship, number/value of grants or awards and intellectual property ownership; (7) contextual factors of universities; (8) infrastructure; (9) knowledge and technology translation activities; (10) availability of maternity/paternity/parental/family leave; (11) collaboration activities/opportunities for collaboration; (12) qualitative considerations: perceptions around promotion, finances and support. RESULTS: Literature search yielded 94 798 citations; 4753 full-text articles were screened, and 562 studies were included. Most studies originated from North America (462/562, 82.2%). Few studies (27/562, 4.8%) reported race and fewer reported sex/gender (which were used interchangeably in most studies) other than male/female (11/562, 2.0%). Only one study provided data on religion. No other PROGRESS-PLUS variables were reported. A total of 2996 outcomes were reported, with most studies examining academic output (371/562, 66.0%). CONCLUSIONS: Reviewed literature suggest a lack in analytic approaches that consider genders beyond the binary categories of man and woman, additional social identities (race, religion, social capital and disability) and an intersectionality lens examining the interconnection of multiple social identities in understanding discrimination and disadvantage. All of these are necessary to tailor strategies that promote gender equity. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/8wk7e/.
Assuntos
Docentes , Equidade de Gênero , Gravidez , Humanos , Masculino , Feminino , Liderança , Salários e Benefícios , Recursos Humanos , Docentes de MedicinaRESUMO
Background: Palpable ductal carcinoma in-situ (pDCIS) is a subset of DCIS presenting with a clinical mass. We hypothesized pDCIS would have more aggressive clinical and pathological features, and higher rates of recurrence and upgrade to invasive disease compared to screen-detected DCIS. Materials and methods: We performed a retrospective analysis of female patients (age 28-76) with DCIS on core-needle biopsy. pDCIS patients had a physician documented palpable mass prior to initial biopsy. Descriptive statistics were performed to compare groups. Results: This study included 83 patients, 26 had pDCIS and 57 had screen-detected DCIS. Mean duration of follow-up was 49.4 months. pDCIS patients had significantly larger lesions (p = 0.03) which were more frequently biopsied via ultrasound (p = 0.002). In multivariate analysis, pDCIS was associated with ultrasound guided core needle biopsy, size of DCIS >2 cm, and comedo pattern (p = 0.001, p = 0.007 and p = 0.022, respectively). 7.7 % of pDCIS cases versus 3.5 % of screen-detected cases were upgraded to invasive cancer (p = 0.59). There was no difference in local recurrence (p = 0.55) between groups. Neither group experienced regional or distant recurrence. Conclusions: pDCIS was associated with some aggressive pathologic and clinical features and was more frequently diagnosed by ultrasound guided core-needle biopsy than screen-detected DCIS. However, there was no significant difference in rate of recurrence or upgrade to invasive disease between groups. Key message: Although pDCIS was associated with some aggressive pathologic and clinical features, there was no significant difference in rate of recurrence or upgrade to invasive disease compared to screen-detected DCIS.