Pelvic floor: vaginal or caesarean delivery? A review of systematic reviews.

INTRODUCTION AND HYPOTHESIS: In recent years the number of caesarean sections has increased worldwide for different reasons. to review the scientific evidence relating to the impact of the type of delivery on pelvic floor disorders (PFDs) such as urinary and faecal incontinence and pelvic organ prolapse. METHODS: A review of systematic reviews and meta-analysis, drawn from the following databases: MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library and LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud/Latin American and Caribbean Health Sciences Literature) prior to January 2019. The directives of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in assessing article quality. RESULTS: Eleven systematic reviews were evaluated, 6 of which found a significantly decreased risk of urinary incontinence associated with caesarean section and 3 meta-analyses showed a significant reduction in POP for caesarean section, compared with vaginal delivery. Of 5 reviews that examined delivery type and faecal incontinence, only one indicated a lower incidence of faecal incontinence associated with caesarean delivery. However, most of the studies included in these reviews were not adjusted for important confounding factors and the risk of PFDs was not analysed by category of caesarean delivery (elective or urgent). CONCLUSION: When compared with vaginal delivery, caesarean is associated with a reduced risk of urinary incontinence and pelvic organ prolapse. These results should be interpreted with caution and do not help to address the question of whether elective caesareans are protective of the maternal pelvic floor.

Web 2.0 Tools in the Prevention of Curable Sexually Transmitted Diseases: Scoping Review.

BACKGROUND: The internet is now the primary source of information that young people use to get information on issues related to sex, contraception, and sexually transmitted infections. OBJECTIVE: The goal of the research was to review the scientific literature related to the use of Web 2.0 tools as opposed to other strategies in the prevention of curable sexually transmitted diseases (STDs). METHODS: A scoping review was performed on the documentation indexed in the bibliographic databases MEDLINE, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Literatura Latinoamericana y del Caribe en Ciencias de la Salud, PsycINFO, Educational Resources Information Center, the databases of Centro Superior de Investigaciones Científicas in Spain, and the Índice Bibliográfico Español de Ciencias de la Salud from the first available date according to the characteristics of each database until April 2017. The equation search was realized by means of the using of descriptors together with the consultation of the fields of title register and summary with free terms. Bibliographies of the selected papers were searched for additional articles. RESULTS: A total of 627 references were retrieved, of which 6 papers were selected after applying the inclusion and exclusion criteria. The STDs studied were chlamydia, gonorrhea, and syphilis. The Web 2.0 tools used were Facebook, Twitter, Instagram, and YouTube. The 6 papers used Web 2.0 in the promotion of STD detection. CONCLUSIONS: Web 2.0 tools have demonstrated a positive effect on the promotion of prevention strategies for STDs and can help attract and link youth to campaigns related to sexual health. These tools can be combined with other interventions. In any case, Web 2.0 and especially Facebook have all the potential to become essential instruments for public health.

A BPMN Based Notation for the Representation of Workflows in Hospital Protocols.

Flowcharts used for hospital protocols have a series of ambiguities and limitations in order to express some types of information. In this article, a notation proposal for flowcharts that partially avoids these problems is presented. This new notation is an adaptation of BPMNE2, an extension of the Business Process Model and Notation (BPMN), which allows direct modelling of procedures that follow the Hazard Analysis and Critical Control Points (HACCP) model. The new notation has been validated in the hospital context, specifically in the field of hazardous drugs (HDs). To measure usability from the perspective of the health staff and auditors, the System Usability Scale (SUS) was used. A total of 47 experts took part in the assessment, resulting in a SUS score of 71, that corresponds to an acceptable level of usability. The feedback provided by these participants allows us to discover benefits and drawbacks of the proposal. Also, it is noteworthy that 76.6% of professionals prefer to migrate to the new notation from the ISO 5807:1985 notation, the most commonly used model. In addition to the direct benefits of this notation from the human point of view, its machine-understandable nature provides the required support for its integration into software tools for intelligent monitoring and auditing.

QR Codes: Outlook for Food Science and Nutrition.

QR codes opens up the possibility to develop simple-to-use, cost-effective-cost, and functional systems based on the optical recognition of inexpensive tags attached to physical objects. These systems, combined with Web platforms, can provide us with advanced services that are already currently broadly used on many contexts of the common life. Due to its philosophy, based on the automatic recognition of messages embedded on simple graphics by means of common devices such as mobile phones, QR codes are very convenient for the average user. Regretfully, its potential has not yet been fully exploited in the domains of food science and nutrition. This paper points out some applications to make the most of this technology for these domains in a straightforward manner. For its characteristics, we are addressing systems with low barriers to entry and high scalability for its deployment. Therefore, its launching among professional and final users is quite simple. The paper also provides high-level indications for the evaluation of the technological frame required to implement the identified possibilities of use.

Beneficial effects of legumes on parameters of the metabolic syndrome: a systematic review of trials in animal models.

Legume consumption plays a pivotal role in the prevention and treatment of the metabolic syndrome (MetS). This systematic review aimed to highlight the beneficial effects of legume interventions for the prevention and/or improvement of parameters related to the MetS and the implicated metabolic pathways so far reported. The methodology involved a search in four electronic databases (Medline, Web of Science, Scopus, Cochrane Library) from January 2007 to December 2014, considering as descriptors 'Metabolic Syndrome' and 'Fabaceae' and adequately adjusting the equation in each one of them. In total, forty-one studies were finally included. The majority of the studies described a regulating effect on glucose and lipid metabolism due to legume administration, whereas effects on blood pressure and renal parameters are not fully described. Regarding the metabolic pathways involved, they include the up-regulation of genes related to ß-oxidation and acetyl-CoA degradation and the down-regulation of glycolytic and lipogenesis genes, as well as those associated with the acetyl-CoA synthesis. The ameliorating effects of legume consumption on the alterations associated with the MetS are clearly reported and coincide with changes in the expression of protein and genes involved in lipid and glucose metabolism. More research needs to be conducted including more legume species that are highly consumed as part of a healthy dietary pattern.

Disorders induced by direct occupational exposure to noise: Systematic review.

BACKGROUND: To review the available scientific literature about the effects on health by occupational exposure to noise. MATERIALS AND METHODS: A systematic review of the retrieved scientific literature from the databases MEDLINE (via PubMed), ISI-Web of Knowledge (Institute for Scientific Information), Cochrane Library Plus, SCOPUS, and SciELO (collection of scientific journals) was conducted. The following terms were used as descriptors and were searched in free text: "Noise, Occupational," "Occupational Exposure," and "Occupational Disease." The following limits were considered: "Humans," "Adult (more than 18 years)," and "Comparative Studies." RESULTS: A total of 281 references were retrieved, and after applying inclusion/exclusion criteria, 25 articles were selected. Of these selected articles, 19 studies provided information about hearing disturbance, four on cardiovascular disorders, one regarding respiratory alteration, and one on other disorders. CONCLUSIONS: It can be interpreted that the exposure to noise causes alterations in humans with different relevant outcomes, and therefore appropriate security measures in the work environment must be employed to minimize such an exposure and thereby to reduce the number of associated disorders.

[Bibliometric study of scientific output published by the Revista Panamericana de Salud Pública/Pan American Journal of Public Health from 1997-2012]. / Estudio bibliométrico de la producción científica publicada por la Revista Panamericana de Salud Pública/ Pan American Journal of Public Health en el período de 1997 a 2012.

OBJECTIVE: To characterize the scientific output of the Revista Panamericana de Salud Pública/Pan American Journal of Public Health (RPSP) as a scientific publication of reference in the public health sector in the Americas. METHODS: A descriptive cross-sectional study was conducted based on the articles published in the RPSP from 1997-2012. Bibliometric indicators of productivity (documents published, languages, authorship, and indices of productivity and collaboration); impact (impact factor according to the SciELO Network, Journal Citation Report and SCImago); key words; and bibliographic references, their structure (document type and main nucleus of Bradford) and degree of obsolescence (Burton and Kebler half-life, and Price index), were analyzed. RESULTS: A total of 2 815 articles with a median of 3 authors and 2 institutions per article were published. The percentage of original research articles increased in 2008-2012 compared to 2003-2007 and 1997-2002 (P < 0.001). The predominant language was Spanish, displaced by English in the last 5 years. A total of 88.76% of the key words referred to the Health Sciences Descriptors (DeCS) and had a public health and community orientation related to the Americas. The Burton and Kebler half-life of bibliographic references was 8 years, although it decreased to 5 years in 2012. The Price index was 20.47% and the nucleus of Bradford was made up of 20 mainstream journals. The percentage of self-citation was low (2.07%). CONCLUSIONS: The RPSP is an international publication with bibliometric indicators similar to those of the most representative Latin American health science journals, with improvements in the recent years studied that lead it to fully meet international publishing criteria.

Public interest in drug-related problems reflected in information search trends: an infodemiological study.

BACKGROUND: The analysis of how people search and "navigate" the internet to obtain health-related information and how they communicate and share this information can provide valuable knowledge about the disease patterns behaviour and health habits of populations. OBJECTIVE: To determine the population's interest in drug-related problems through information search trends. METHOD: A descriptive ecological correlational study, based on obtaining Google Trends data. VARIABLES STUDIED: relative search volume (RSV), evolution over time, milestones and seasonality. RESULTS: The most searched topic was drug overdose, with mean RSV of 56.25 ± 0.65. The highest increase occurred in the contraindication topic (R2 = 0.87, p < 0.001). The main milestone was observed in the drug overdose topic in July 2018 (RSV = 100). A very close relationship was found between adverse drug reaction and contraindication (R = 0.89, p < 0.001). Slight seasonality was noted in the adverse drug reaction (augmented Dickey-Fuller test [ADF] = -1.96), contraindication (ADF = -2.66) and drug interaction (ADF = -1.67) topics, but did not show an epidemiological trend. CONCLUSIONS: The greatest public interest was found in the drug overdose and contraindication topics, which showed a stronger upward trend, although the seasonality study did not show any very notable data or demonstrate epidemiological information search behaviour. The main milestone observed was due to media factors related to the consumption of narcotics. There was a clear difference in English-speaking countries in the use of the drug overdose topic. A correlation between the adverse drug reaction and contraindication topics was confirmed.

[Presence and adequacy of pharmaceutical preparations in the Spanish edition of Wikipedia]. / Presencia y adecuación de los principios activos farmacológicos en la edición española de la Wikipedia.

OBJECTIVE: To determine the presence, and to evaluate the adequacy of pharmaceutical preparations in the Spanish edition of Wikipedia. DESIGN: Descriptive cross-sectional study. SETTING: the terms studied were obtained from the Vademecum, UBM Medica Spain S.A, (http://vademécum.es). PARTICIPANTS: the sample was calculated by simple random sampling without replacement from the active ingredients present in the Vademecum, making the estimation of population parameters (expected value of approximately 0.5; 0.05 range accuracy and confidence level=0.95) in an infinite population. METHOD: The existence and adequacy of the terminology was observed by accessing the Spanish edition of Wikipedia. The term was considered adequate when the information contained the proper use, dosage and adverse effects. MAIN MEASUREMENTS: The qualitative binary variable yes/no (presence of the pharmaceutical drug, use, posology, adverse effects, adequacy) were described by frequency and percentage, quantitative (number of queries, update) using mean and standard deviation. The existences of an association between qualitative variables were analyzed using chi-square, and significance of the differences of means for independent samples, using the Student t test. RESULTS: Of the sample studied (n=386), 171 terms were found, with 15 being adequate. Significant differences were observed between adequacy and dose (P<.001) and adverse effects (P<.001), but not with use (P=.193). CONCLUSIONS: Pharmaceutical preparation entries in the Spanish edition of Wikipedia are still insufficient and the adequacy of the information remains inconsistent.

[Presence and characteristics of nursing terminology in Wikipedia]. / Terminología enfermera en Wikipedia: presencia y características.

OBJECTIVE: To determine the presence and consultations with nurse terminology in the Spanish edition of Wikipedia, and to analyze the differences with the English edition. METHOD: We confirmed the existence of terminology via the Internet by the access to the Spanish and English editions of Wikipedia. RESULTS: We calculated the study sample (n = 386) from the 1840 nursery terms. 337 were found in the Spanish edition and 350 in the English. We found significant differences between the two editions (p < 0.001). Also differences were winched on to the number of references in terms (p < 0.001). However, there were not differences in the update/obsolescence of information, neither in the number of queries. CONCLUSIONS: The entries (articles) on nursing terminology in the Spanish edition of Wikipedia, has not yet reached an optimum level. Differences between Spanish and English editions of Wikipedia are more related to term existence than adequacy of information.

Antibiotic Infographics Available on the Internet: Documentary Quality, Purpose, and Appropriateness as Educational Tools on Antimicrobial Resistance.

Antimicrobial resistance is a major threat to global health in the 21st century. In the age of the internet and social media, infographics may constitute an effective educational resource for transmitting complete messages about antibiotics and antimicrobial resistance and driving behavioural change. We aimed to evaluate the infographics on antibiotics available on the internet in terms of their documentary quality, purpose, and appropriateness as educational tools for explaining the strategic lines defined in the World Health Organization Global Action Plan on Antimicrobial Resistance (GAP-AMR) and for conveying the One Health concept. We obtained the infographics for this cross-sectional study on 4 March 2021 by searching the terms "infographic" and "antibiotic" in Google Images. We verified infographic documentary quality by analysing the image, authorship, title, structure, date, and licence. To evaluate the purpose, we determined whether it coincided with one of the strategic objectives set out in the GAP-AMR. The degree of appropriateness depended on the type of key awareness message on antibiotic use. After obtaining these results, we performed a cross-sectional evaluation to determine how successfully these infographics conveyed the One Heath concept. We selected 247 infographics from 518 references. Of the included infographics, 97 (39%) were produced by public institutions; 58 (23%) read from left to right; 142 (57%) had an educational purpose; 156 (63%) focused on humans; 140 (57%) were subject to copyright; and 97 (39%) had no licence of any type. Almost one quarter (n = 57; 23%) included no key message on proper use of antibiotics. Infographics that included an author/promoter had a significantly higher mean number of messages that those without disclosure of authorship (1.67 vs. 0.50; p < 0.001). The infographics on antibiotics available on the internet are of moderate general quality. Most are produced by public institutions and have a clear and readable layout, but very few have a Creative Commons license to enable their reuse as informative material. The most common purpose is to improve awareness and understanding of antimicrobial resistance; few infographics focus on the remaining four strategic objectives of the GAP-AMR. It would be useful for authors of educational infographics on antibiotics to promote key messages related to antimicrobial resistance and the One Health concept, in accordance with the first objective of the WHO GAP-AMR.

Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature.

Background: This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). Methods: The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." Results: A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Conclusion: Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.

Occupational Health Applied Infodemiological Studies of Nutritional Diseases and Disorders: Scoping Review with Meta-Analysis.

(1) Objective: to identify and review existing infodemiological studies on nutritional disorders applied to occupational health and to analyse the effect of the intervention on body mass index (BMI) or alternatively body weight (BW); (2) Methods: This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American, and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Nutrition Disorders, "Occupational Health" and "Infodemiology", applying the filters "Humans" and "Adult: 19+ years". The search was conducted on 29 May 2021; (3) Results: a total of 357 references were identified from the bibliographic database searches; after applying the inclusion and exclusion criteria, a total of 11 valid studies were obtained for the review. Interventions could be categorised into (1) interventions related to lifestyle, physical activity, and dietary changes through education programmes, (2) interventions associated with lifestyle, physical activity, and dietary changes through the use of telemonitoring systems or self-help applications, (3) interventions tied to lifestyle, physical activity, and dietary changes through control and/or social network support groups, and (4) interventions linked to changes in the work environment, including behavioural change training and work environment training tasks. The meta-analysis demonstrated that the heterogeneity present when analysing the results for BMI was 72% (p < 0.01), which decreased to 0% (p = 0.57) when analysing the outcomes for weight, in which case the null hypothesis of homogeneity could be accepted. In all instances, the final summary of the effect was on the decreasing side for both BMI and BW; (4) Conclusions: Despite the high heterogeneity of the results reported, the trend shown in all cases indicates that the intervention methodologies implemented by empowering individuals through Web 2.0 technologies are positive in terms of the problem of overweight. Further implementation of novel strategies to support individuals is needed to overcome obesity, and, at least in the early studies, these strategies seem to be making the necessary change.

Suitability of indexing terms in the MEDLINE bibliographic database on drug-related problems.

BACKGROUND: For years, there has been controversy about the meaning of medication-related problems (MRPs). This has led several authors to attempt to redefine and classify this term with the aim of using it correctly in the healthcare setting. So far without achieving the desired objective, resulting in erroneous results in the sources of information and thus in malpractice in the sector. OBJECTIVE: To describe and analyze the appropriateness of the existing indexing of scientific publications in the MEDLINE bibliographical database with respect to drug-related problems (DRPs) and to determine whether the descriptors used fulfilled the function of suitably representing this concept. METHODS: A descriptive study was conducted, using the following search terms: Medication Errors; Drug Interactions; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Contraindications, Drug. The sample size was calculated by estimating population parameters in an infinite population (expected value = 0.05; precision of interval = 0.05; level of confidence = 0.95) and the selection method was simple random sampling without replacement, taking the total number of bibliographical references in the database as the basis. The agreement of the indexing with DRPs was evaluated with the coefficient of determination (R2), and the Cohen kappa coefficient was used for the association between the definition of the descriptors and the objective of the article. RESULTS: The 1930 records analyzed showed a total of 2888 different major topics. These major topics were present, with at least one of the five descriptors studied, in 482 (25.0%; 95% CI 23.0-27.0) documentary files, with statistically significant differences between the two phases analyzed (χ2 = 183.8; degrees of freedom (df) = 1; p < 0.001): 1st phase, 295 (13.3%; 95% CI 13.7-16.9) and 2nd phase, 187 (9.7%; 95% CI 8.4-11.0). Overall scientific output with the five descriptors showed a coefficient of determination (R2) of 0.9 (p < 0.001) and the relationship between the objective of the study and the definitions of the five descriptors was 0.9 (p < 0.001). CONCLUSIONS: There was a very good direct exponential trend of the overall scientific output retrieved with the terms associated with DRPs, although the progression of the five descriptors separately did not show a growth model conforming to expectations. There was a moderate agreement between the objective of the study and the definition of each of the five descriptors used and a low relationship between the objective of the study and the concept of DRPs used for this investigation. It is essential to have a descriptor that unifies the terminological diffusion that has existed up till now, since process (causes) and effects (outcomes) have been mixed together under the various definitions and classifications of DRPs found in the studies.

Population Interest in Information on Obesity, Nutrition, and Occupational Health and Its Relationship with the Prevalence of Obesity: An Infodemiological Study.

OBJECTIVE: To identify and analyze population interest in obesity, nutrition, and occupational health and safety and its relationship with the worldwide prevalence of obesity through information search trends. METHOD: In this ecological study, data were obtained through online access to Google Trends using the topics "obesity", "nutrition", and "occupational health and safety". Obesity data were obtained from the World Health Organization (WHO) website for crude adult prevalence and estimates by region. The variables studied were relative search volume (RSV), temporal evolution, milestone, trend, and seasonality. The temporal evolution of the search trends was examined by regression analysis (R2). To assess the relationship between quantitative variables, the Spearman correlation coefficient (Rho) was used. Seasonality was verified using the augmented Dickey-Fuller (ADF) test. RESULTS: The RSV trends were as follows: obesity (R2 = 0.04, p = 0.004); nutrition (R2 = 0.42, p < 0.001); and occupational health and safety (R2 = 0.45, p < 0.001). The analysis of seasonality showed the absence of a temporal pattern (p < 0.05 for all terms). The associations between world obesity prevalence (WOP) and the different RSVs were as follows: WOP versus RSV obesity, Rho = -0.79, p = 0.003; WOP versus RSV nutrition, Rho = 0.57, p = 0.044; and WOP versus RSV occupational health and safety, Rho = -0.93, p = 0.001. CONCLUSIONS: Population interest in obesity continues to be a trend in countries with the highest prevalence, although there are clear signs popularity loss in favor of searches focused on possible solutions and treatments, with a notable increase in searches related to nutrition and diet. Despite the fact that most people spend a large part of their time in the workplace and that interventions including various strategies have been shown to be useful in combating overweight and obesity, there has been a decrease in the population's interest in information related to obesity in the workplace. This information can be used as a guide for public health approaches to obesity and its relationship to nutrition and a healthy diet, approaches that are of equal utility and applicability in occupational health.

Occupational Health of Health-Care Workers with Overnutrition: Scoping Review with Meta-Analysis.

(1) Objective: To review the scientific literature on the impact of interventions to enhance the occupational health of health-care workers with overnutrition. (2) Methods: Scoping review with meta-analysis. Data were obtained by consulting the following bibliographic databases: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS), and Medicina en Español (MEDES). The terms used as descriptors and as text in the title and abstract fields of the records were "health workers", "overnutrition", and "occupational health", using the filters "human", "adult": 19+ years", and "clinical trial". The search update date was January 2023. The documentary quality of the articles was evaluated using the CONSORT questionnaire and the presence of bias was assessed using the Rob 2.0 tool. (3) Results: From the 611 digitally retrieved references, 17 clinical trials were selected after applying the inclusion and exclusion criteria. CONSORT scores ranged from a minimum of 14.6% to a maximum of 91.7%, with a median of 68.8%. According to the SIGN criteria, this review provided "1" evidence with a grade B recommendation. Six different types of intervention were tested, grouped into strategies ranging from a single intervention to a combination of four interventions. The summary effect of the meta-analysis showed significant weight loss, but no association with reduced body mass index. (4) Conclusions: While workplace interventions have been shown to be potentially effective, and strategies using different types of interventions have been proven to be useful in tackling overnutrition, an effective and sustainable solution for changing the behavior of health professionals to tackle overweight and obesity has yet to be identified.

Systematic reviews in nutrition: standardized methodology.

The objective of this study is to establish a methodological proposal in order to carry out qualitative systematic reviews and apply these findings to a review of Omega-3 Fatty Acids with respect to health and illness. Based on a methodological proposal, a general protocol was developed to provide a sound basis for the preparation of the reviews in this journal supplement. A systematic technique was proposed in order to revise the existing scientific literature on Omega-3 Fatty Acids, with particular emphasis on aspects relating to health and illness. The aim of qualitative systematic reviews is to collate and summarise the results of the primary studies reviewed which will be carried out through a descriptive synthesis. It can be concluded that systematic reviews provide a summary of the existing primary documents on a specific scientific question. The detailed and explicit methods used lead to the identification, critical evaluation and synthesis of the scientific literature. Furthermore, both bias and random effects are reduced, resulting in more reliable data from which to draw conclusions and make recommendations to support decision-making.

[Cancer in the population under 19 years of age caused by chemical contamination in drinking water: a systematic review]. / Cáncer por contaminación química del agua de consumo humano en menores de 19 años: una revisión sistemática.

OBJECTIVE: To evaluate the association between exposure to the main chemical contaminants in drinking water and the rise in cancer cases among the population under age 19. METHODS: A systematic review was undertaken of the scientific literature compiled in the MEDLINE (via PubMed©), EMBASE©, Web of Knowledge, Cochrane Library Plus, Latin American and Caribbean Literature on Health Sciences (LILACS), SCOPUS, and SCIRUS databases. The descriptors used were "neoplasms" and "water pollution, chemical," limited to studies that included people under age 19. Articles selected were of any type in any language, from the inception of the indexing of the primary source until March of 2011. RESULTS: The search generated 266 articles, from which 20 were selected after applying the inclusion and exclusion criteria. Drinking water contaminants analyzed were arsenic, disinfection byproducts, nitrogen compounds, petroleum derivatives, agricultural pesticides, radionuclides, and others of industrial origin. The majority of the studies did not find a significant link between exposure to drinking water contaminants and the increase in cancer cases in the under-19 population segment. In some of the studied populations a significant dose-response relationship was observed. CONCLUSIONS: Taking into account that the articles located were insufficiently up-to-date, more studies are required in order to know the effect of drinking water contamination on cancer rates, in particular among children and youths, who are more susceptible.

[Interventions to reduce salt consumption through labeling]. / Intervenciones para reducir el consumo de sal a través del etiquetado.

OBJECTIVE: Determine the extent to which labeling of food products informs about salt consumption. METHODS: A critical and systematic analysis was conducted of 9 studies selected out of a total of 133 studies. The studies were collected by reviewing the scientific literature on interventions conducted in the human population aimed towards reducing salt consumption through label messaging. All of the information was obtained by direct consultation and by Internet from the scientific literature collected in several databases. RESULTS: Out of the 133 articles recovered, after the inclusion and exclusion criteria were applied, 9 studies were selected for review. All of them took into account the ability of the study population to interpret and understand salt content labeling in foods. CONCLUSIONS: Food consumers understand and value easily recognizable logos more than the information found on nutritional composition labels. Therefore, use of alternative logos that facilitate this information and are also standardized could be justified. This situation is reinforced because the inclusion of symbols that are easily understandable favors the most adequate choice by consumers.

Impact of Variation in Pill/Package Appearance of Drugs on Patients' Behavior: A Systematic Review.

OBJECTIVE: This systematic review aims to identify and critically evaluate the available evidence on the impact of switches in pill appearance/packaging on patient's behavior. METHODS: Studies from inception to March 2021 were searched across MEDLINE through PubMed, the Cochrane Library, Embase, and Scopus. Included studies carried out an original evaluation in English or Spanish language that evaluated the impact of switches in pill appearance/packaging on patient's behavior. Two authors independently extracted study data and evaluated studies for methodological quality according to the STROBE guidelines. RESULTS: Ten studies were included, and the mean (SD) number of STROBE criteria satisfied was 17.2 (3.9). Three of 5 studies found a significant association between change in pill appearance and persistence to treatment; the 3 studies that evaluated the impact of a change on adherence to treatment found a significant association; 1 of the 2 studies that evaluated the relationship between a change a clinical outcome found a significant association with the prevalence of uncontrolled blood pressure; and 1 study showed lower rates of switchbacks to the branded product compared with patients who switched to generic drug products, with different appearance. CONCLUSIONS: This systematic review showed an impact of the change in pill/package appearance on patients' behavior in 7 of the 10 studies included. Generic switching may lead to unintended consequences on patients' behavior, mainly regarding adherence to treatment.