A surge in food insecurity during the COVID-19 pandemic in a cohort in Mexico City.

BACKGROUND: The COVID-19 pandemic has not only caused tremendous loss of life and health but has also greatly disrupted the world economy. The impact of this disruption has been especially harsh in urban settings of developing countries. We estimated the impact of the pandemic on the occurrence of food insecurity in a cohort of women living in Mexico City, and the socioeconomic characteristics associated with food insecurity severity. METHODS: We analyzed data longitudinally from 685 women in the Mexico City-based ELEMENT cohort. Food insecurity at the household level was gathered using the Latin American and Caribbean Food Security Scale and measured in-person during 2015 to 2019 before the pandemic and by telephone during 2020-2021, in the midst of the pandemic. Fluctuations in the average of food insecurity as a function of calendar time were modeled using kernel-weighted local polynomial regression. Fixed and random-effects ordinal logistic regression models of food insecurity were fitted, with timing of data collection (pre-pandemic vs. during pandemic) as the main predictor. RESULTS: Food insecurity (at any level) increased from 41.6% during the pre-pandemic period to 53.8% in the pandemic stage. This increase was higher in the combined severe-moderate food insecurity levels: from 1.6% pre-pandemic to 16.8% during the pandemic. The odds of severe food insecurity were 3.4 times higher during the pandemic relative to pre-pandemic levels (p<0.01). Socioeconomic status quintile (Q) was significantly related to food insecurity (Q2 OR = 0.35 p<0.1, Q3 OR = 0.48 p = 0.014, Q4 OR = 0.24 p<0.01, and Q5 OR = 0.17 p<0.01), as well as lack of access to social security (OR = 1.69, p = 0.01), and schooling (OR = 0.37, p<0.01). CONCLUSIONS: Food insecurity increased in Mexico City households in the ELEMENT cohort as a result of the COVID-19 pandemic. These results contribute to the body of evidence suggesting that governments should implement well-designed, focalized programs in the context of economic crisis such as the one caused by COVID-19 to prevent families from the expected adverse health and well-being consequences associated to food insecurity, especially for the most vulnerable.

The Impact of the Double School Shift System on Lifestyle Behaviors Among Mexican Adolescents.

PURPOSE: Early school start times could adversely impact adolescent sleep duration. They could also impact other behaviors like diet and physical activity, either directly or indirectly through effects on sleep. We examined whether the double school shift system was associated with sleep, diet, and physical activity behaviors among Mexican adolescents. METHODS: The analytic sample included 305 Mexican adolescents from a cohort study (on average 14.53 ± 1.75 years old and 51% male). Sleep and physical activity were measured with wrist actigraphy, while diet and other lifestyle behaviors were assessed with questionnaires. Regression analyses were conducted to compare lifestyle behaviors between the morning and afternoon school shifts, adjusting for potential confounders. RESULTS: Adolescents attending the morning school shift (44%) had pronounced differences in sleep compared to those attending afternoon shift, including a 1.77-hour shorter sleep duration on weekdays (95% CI -1.55, -2.00), a 0.40-hour longer sleep duration on weekends (95% CI 0.10, 0.70), higher social jetlag (1.07 hours with a 95% CI of 0.87, 1.27), and an earlier chronotype. Morning shift students also had 0.85 hours longer sedentary time (95% CI 0.61, 1.10) and higher consumption of a meat and starchy food dietary pattern. Among boys only, morning shift was associated with a lower likelihood of smoking and higher consumption of a breakfast pattern. DISCUSSION: Overall, attending a morning school shift was associated with shorter sleep, more social jetlag, greater sedentary time, and higher consumption of a meat and starchy diet. However, among boys, a few healthier behaviors were observed for the morning versus afternoon shift.

From Castleman disease histopathological features to idiopathic multicentric Castleman disease: a multiparametric approach to exclude potential iMCD histopathological mimickers.

AIMS: International consensus diagnostic criteria for idiopathic multicentric Castleman disease (iMCD) includes lymph node Castleman disease (CD) histopathological features as major criteria. Our aim was to apply those criteria in a series of 42 cases with CD to find differences among unicentric CD, iMCD, HHV-8+multicentric CD (HHV-8+MCD) and POEMS/plasma cell neoplasia (PCN)-associated CD. METHODS: Available clinical and laboratory criteria were collected. Histopathological features (germinal centre hyperplasia/regression, plasmacytosis, hypervascularity and follicular dendritic cell (FDC) prominence) were graded and immunohistochemistry with antibodies against CD20, CD3, CD138, HHV-8, Ig isotype (IgG, IgG4, IgA, IgM, IgD), kappa, lambda was performed in all cases. RESULTS: Fourteen cases had hyaline-vascular type unicentric CD, 15 were HHV-8+MCD, 7 cases PCN/POEMS-associated CD and 5 cases were iMCD. One case was consistent with systemic lupus erythematosus (SLE) lymphadenopathy. Differences in grading of the CD-associated histopathological features showed that FDC proliferation was prominent in unicentric CD, hypervascularity was increased in HHV-8 positive MCD and germinal centre hyperplasia was restricted to iMCD cases and SLE. Monotypic plasma cells were readily identifiable in the lymph node biopsies in 43% of PCN/POEMS-associated CD. All three cases had lambda light chain restriction with IgA (two cases) and IgG (one case) isotypes. CONCLUSIONS: HHV-8+ MCD and PCN/POEMS-related CD are the major mimickers of iMCD in lymph node biopsies. Grading of the five histopathological features for CD might be useful to, in conjunction with complete ancillary testing, suggest for specific disease entities.

Methodological and users' surveys on the use of the LILACS database in Cochrane reviews identified desirable improvements to the database.

BACKGROUND: Latin American and Caribbean Health Sciences Literature (LILACS) is the main reference database in the region; however, the way in which this resource is used in Cochrane systematic reviews has not been studied. OBJECTIVES: To assess the search methods of Cochrane reviews that used LILACS as a source of information and explore the Cochrane community's perceptions about this resource. METHODS: We identified all Cochrane reviews of interventions published during 2019, which included LILACS as a source of information, and analysed their search methods and also ran a survey through the Cochrane Community. RESULTS: We found 133 Cochrane reviews that reported the full search strategies, identifying heterogeneity in search details. The respondents to our survey highlighted many areas for improvement in the use of LILACS, including the usability of the search platform for this purpose. DISCUSSION: The use and reporting of LILACS in Cochrane reviews demonstrate inconsistencies, as evidenced by the analysis of search reports from systematic reviews and surveys conducted among members of the Cochrane community. CONCLUSION: With better guidance on how LILACS database is structured, information specialists working on Cochrane reviews should be able to make more effective use of this unique resource.

The development of tone discrimination in infancy: Evidence from a cross-linguistic, multi-lab report.

We report the findings of a multi-language and multi-lab investigation of young infants' ability to discriminate lexical tones as a function of their native language, age and language experience, as well as of tone properties. Given the high prevalence of lexical tones across human languages, understanding lexical tone acquisition is fundamental for comprehensive theories of language learning. While there are some similarities between the developmental course of lexical tone perception and that of vowels and consonants, findings for lexical tones tend to vary greatly across different laboratories. To reconcile these differences and to assess the developmental trajectory of native and non-native perception of tone contrasts, this study employed a single experimental paradigm with the same two pairs of Cantonese tone contrasts (perceptually similar vs. distinct) across 13 laboratories in Asia-Pacific, Europe and North-America testing 5-, 10- and 17-month-old monolingual (tone, pitch-accent, non-tone) and bilingual (tone/non-tone, non-tone/non-tone) infants. Across the age range and language backgrounds, infants who were not exposed to Cantonese showed robust discrimination of the two non-native lexical tone contrasts. Contrary to this overall finding, the statistical model assessing native discrimination by Cantonese-learning infants failed to yield significant effects. These findings indicate that lexical tone sensitivity is maintained from 5 to 17 months in infants acquiring tone and non-tone languages, challenging the generalisability of the existing theoretical accounts of perceptual narrowing in the first months of life. RESEARCH HIGHLIGHTS: This is a multi-language and multi-lab investigation of young infants' ability to discriminate lexical tones. This study included data from 13 laboratories testing 5-, 10-, and 17-month-old monolingual (tone, pitch-accent, non-tone) and bilingual (tone/non-tone, non-tone/non-tone) infants. Overall, infants discriminated a perceptually similar and a distinct non-native tone contrast, although there was no evidence of a native tone-language advantage in discrimination. These results demonstrate maintenance of tone discrimination throughout development.

Preoperative education in patients undergoing foot and ankle surgery: a scoping review.

BACKGROUND: International guidelines promote preoperative education for patients undergoing orthopedic surgery. However, the evidence sustaining these recommendations comes mainly from studies for hip and knee replacement surgery. Little is known about patients undergoing foot and ankle surgery. We aimed to map and characterize all the available evidence on preoperative education for patients undergoing foot and ankle surgery. METHODS: This study complies with the PRISMA-ScR guidelines. We searched eight databases, including MEDLINE, Embase, and CENTRAL. We performed cross-citations and revised the references of included studies. We included studies addressing preoperative education in patients undergoing foot and ankle surgery. We did not exclude studies because of the way of delivering education, the agent that provided it, or the content of the preoperative education addressed in the study. Two independent authors screened the articles and extracted the data. The aggregated data are presented in descriptive tables. RESULTS: Of 1596 retrieved records, only 15 fulfilled the inclusion criteria. Four addressed preoperative education on patients undergoing foot and ankle surgery and the remaining 11 addressed a broader population, including patients undergoing foot and ankle surgery but did not provide separate data of them. Two studies reported that preoperative education decreases the length of stay of these patients, another reported that education increased the knowledge of the participants, and the other leaflets were well received by patients. CONCLUSION: This scoping review demonstrates that evidence on preoperative education in foot and ankle surgery is scarce. The available evidence supports the implementation of preoperative education in patients undergoing foot and ankle surgery for now. The best method of education and the real impact of this education remain to be determined.

A methodological review finds mismatch between overall and pairwise overlap analysis in a sample of overviews.

OBJECTIVES: Overlap of primary studies is a key methodological challenge for overviews. There are limited reports of methods used to address overlap, and there is no detailed assessment of the corrected covered area (CCA) of a representative sample of overviews. To describe the approaches used to address overlap, and to estimate the overall and pairwise CCA. METHODS: We searched PubMed for overviews published in 2018. Two authors conducted the screening process. We described the strategy used for assessing overlap, and calculated overall and pairwise CCA for each overview. RESULTS: We analyzed a random sample of 30 out of 89 eligible articles. Eleven did not address the overlap. Of the remainder, most frequent strategies were visual assessment and discussion of overlap as a limitation. Median overall CCA among the included overviews was 6.7%. The pairwise analysis showed that 52.8% of SR pairs had slight overlap, while 28.3% had very high overlap. CONCLUSION: Reported strategies for addressing overlap vary considerably among overview authors. The pairwise approach for assessing the CCA revealed highly overlapped pairs of SRs in overviews with overall slight overlap and vice versa. We encourage authors to complement the overall CCA assessment with a pairwise approach.

Prepandemic viral community-acquired pneumonia: Diagnostic sensitivity and specificity of nasopharyngeal swabs and performance of clinical severity scores.

The objectives of this work were to assess the diagnostic sensitivity and specificity of nasopharyngeal (NP) swabs for viral community-acquired pneumonia (CAP) and the performance of pneumonia severity index (PSI) and CURB-65 severity scores in the viral CAP in adults. A prospective observational cohort study of consecutive 341 hospitalized adults with CAP was performed between January 2018 and March 2020. Demographics, comorbidities, symptoms/signs, analytical data, severity scores, antimicrobials, and outcomes were recorded. Blood, NP swabs, sputum, and urine samples were collected at admission and assayed by multiplex real time-PCR, bacterial cultures, and Streptococcus pneumoniae and Legionella pneumophila antigens detection, to determine the etiologies and quantify the viral load. The etiology was identified in 174 (51.0%) patients, and in 85 (24.9%) it was viral, the most frequent rhinovirus and influenza virus. The sensitivity of viral detection in sputum (50.7%) was higher than in NP swabs (20.9%). Compared with sputum, the positive predictive value and specificity of NP swabs for viral diagnosis were 95.8% and 96.9%, respectively. Performance of PSI and CURB-65 scores in all CAP with etiologic diagnosis were as expected, with mortality associated with higher values, but they were not associated with mortality in patients with viral pneumonia. NP swabs have lower sensitivity but high specificity for the diagnosis of viral CAP in adults compared with sputum, reinforcing the use NP swabs for the diagnostic etiology work-up. The PSI and CURB-65 scores did not predict mortality in the viral CAP, suggesting that they need to be updated scores based on the identification of the etiological agent.

Intravitreal antivascular endothelial growth factor in diabetic macular oedema: scoping review of clinical practice guidelines recommendations.

BACKGROUND: Diabetic macular oedema (DME) is a worldwide major cause of low vision and blindness. Intravitreal antivascular endothelial growth factor (anti-VEGF) constitutes an effective treatment. Clinical practice guidelines (CPGs) are synthesis documents that seek to improve patient care. OBJECTIVES: To identify CPGs that make anti-VEGF recommendations for DME and to assess their reporting quality and their considerations when making recommendations. ELIGIBILITY CRITERIA: CPGs published between December 2009 and December 2019 that make explicit anti-VEGF recommendations in DME. SOURCES OF EVIDENCE: Sensitive search strategy in Embase, Google Scholar and hand-searching on 165 websites. METHODS: We extracted information from each CPG with a previously piloted sheet. Two independent authors applied theAppraisal of Guidelines, Research and Evaluation tool (AGREE-II) assessment for each CPG. RESULTS: The 21 included CPGs recommend anti-VEGF for DME, but there is a wide variation among the clinical aspects included, such as location of DME, visual acuity required, therapeutical alternatives or discontinuation. Most have a poor quality of reporting based on the AGREE-II tool assessment, especially those developed by ophthalmological societies, those that have an exclusive content about DME, and those where most of their authors disclose conflict of interest (COI) with pharmaceutical industry or where their authors did not report COIs. Pharmaceutical-sponsored CPGs did not use systematic reviews (SRs) to support their recommendations. Very few recommendations consider patient values and preferences, equity, acceptability and feasibility of the intervention. CONCLUSIONS: Most of the CPGs that made recommendations of anti-VEGF for DME have poor quality of reporting, do not use SRs and do not consider patients' values and preferences.

Duration, timing, and consistency of sleep in relation to inflammatory cytokines in Mexican adolescents.

OBJECTIVE: To evaluate whether sleep duration, timing, and variability were associated with inflammatory cytokines in a cohort of Mexico City adolescents. METHODS: The analytic sample comprised >500 adolescents who were part of an ongoing longitudinal study in Mexico City. At two time points during mid-to-late puberty (average age 14, n = 391) and late-to-post puberty (average age 16, n = 345), adolescents completed a follow-up visit that included 7-day wrist actigraphy and clinical assessment of plasma inflammatory cytokines (high-sensitivity C-reactive protein, Interleukin 1ß, Interleukin 6, and Tumor Necrosis Factor ɑ). Sleep characteristics included weekday and weekend sleep duration and midpoint (median of bed and wake time), as well as sleep variability (SD of sleep duration across 7 days) and social jetlag (midpoint difference from weekdays to weekends). At each time point, multivariable linear regression models were run with log inflammatory levels as the outcome and categories of sleep characteristics as predictors, while adjusting for potential confounders (specific to each model). Analyses were run unstratified and sex-stratified. RESULTS: In the mid-to-late pubertal visit, weekday sleep duration was inversely associated with natural log hs-CRP after adjustment (Q4 vs Q1: ß = -0.41, 95% Confidence Interval (CI) -0.81 to -0.01) and later sleep midpoint was positively associated with log hs-CRP (Q4 vs Q1: ß = 0.55, 95% CI 0.13 to 0.97). Sleep duration variability was associated with higher IL-1ß among boys, while in girls social jetlag was associated with higher IL-1ß and weekend sleep duration was inversely associated with IL-6. At the late-to-post pubertal visit, there were few associations except for a positive association between weekday sleep duration and hs-CRP among boys (ß = 0.60, 95% CI 0.04 to 1.16) and a non-linear positive association between social jetlag and hs-CRP among girls (ß = 0.80, 95% CI 0.22 to 1.37 comparing 2 to 3 h of social jetlag vs <1 h). CONCLUSION: Later timing, shorter duration, and inconsistency of sleep were related to higher levels of inflammatory biomarkers, but associations were more evident at the mid-to-late pubertal visit than the late-to-post pubertal visit.

Embolización de la arteria renal: serie de casos y revisión de la literatura / Renal artery embolization: case series and literature review

Resumen Introducción: La embolización de arteria renal (EAR) es un procedimiento percutáneo que ocluye la arteria renal, con la consecuente isquemia del territorio vascular. Sus indicaciones más comunes son la hematuria y el manejo paliativo en cáncer renal metastásico. A pesar del desarrollo técnico y de la experiencia progresiva, los estudios incluyen un número reducido de pacientes y en nuestro país se revisan casos aislados. Objetivo: Describir la experiencia en el Servicio de Salud Valparaíso San Antonio y revisar la literatura existente. Materiales y Método: Realizamos un estudio descriptivo de los pacientes sometidos a EAR por anemia severa secundaria a hematuria, durante los años 2012 a 2020. Posteriormente, realizamos una revisión de la literatura en PubMed, hasta abril de 2020. Resultados: Incluimos 9 pacientes, 6 (66,7%) hombres y 3 (33,3%) mujeres. La mediana de edad fue de 69 años (RIC = 18). La principal causa de la hematuria fue cáncer renal avanzado (7 pacientes). No hubo complicaciones, y se logró éxito clínico en todos los pacientes. Nuestra búsqueda de literatura arrojó 571 referencias y 24 cumplieron con nuestros criterios de elegibilidad. La edad de los pacientes y las causas subyacentes de hematuria fueron variadas. La menor tasa de éxito clínico fue de 65%, sin embargo, 15 estudios (62,5%) reportaron un éxito igual o mayor al 90%. Seis estudios reportaron más de un 10% de pacientes con alguna complicación. Conclusión: Nuestros resultados y la evidencia revisada muestran que la EAR parece ser segura y eficaz en el manejo de anemia severa secundaria a hematuria.

Introduction: Renal artery embolization (RAE) is a percutaneous procedure that occludes the renal artery, with consequent ischemia of the vascular territory. The most common indications include hematuria and palliation for metastatic renal cancer. Despite technical development and progressive experience, studies include a small number of patients and few cases have been published in our country. Aim: To share our experience at Valparaíso-San Antonio Health Service and to review the existing literature. Materials and Method: We performed a retrospective descriptive review of medical records of patients with severe anemia due to hematuria managed with RAE, between 2012 and 2020. Subsequently, we conducted a literature search in PubMed, from inception until April 2020. Results: We included 9 patients. There were 6 (66.7%) males and 3 (33.3%) females with a median age of 69 years (IQR = 18). Main cause of hematuria was advanced kidney cancer (7 patients). There were no complications and clinical success was achieved in all patients. Our literature search yielded 571 references, 24 met our eligibility criteria. The age of patients and the underlying causes of hematuria were varied. The lowest clinical success rate was 65%, however, 15 studies (62.5%) reported a success equal to or greater than 90%. Six studies reported more than 10% of patients with complications. Conclusión: Our results and the studies reviewed show that RAE appears to be safe and effective in the management of patients with severe anemia due to hematuria.

Key concepts for searching evidence: an introduction for healthcare professionals. / Conceptos clave para la búsqueda de evidencia: una introducción para profesionales de la salud.

The currently abundant bibliography on healthcare can make the search process an exhausting and frustrating experience. For this reason, it is essential to learn the basic concepts of research question formulation, information sources, and search strategies to make this process more efficient and user-friendly. The search strategy is an iterative process that allows the incorporation of tools and terms in the strategy design to optimize evidence retrieval. Each strategy varies according to the questions, the language used, the source of information accessed, and the available tools. This article is part of a methodological series of narrative reviews on biostatistics and clinical epidemiology. This narrative review describes the essential elements for developing a literature search strategy and identifying the relevant evidence concerning a clinical question through familiar and accessible sources (such as Google and Google Scholar), as well as search interfaces and technical-scientific databases focused on biomedical knowledge (PubMed and The Cochrane Library).

La abundante bibliografía disponible actualmente sobre una determinada temática puede hacer que el proceso de búsqueda se vuelva una experiencia extenuante y frustrante. Por esta razón, resulta necesario tener presente los conceptos básicos sobre formulación de preguntas, fuentes de información y estrategias de búsqueda a fin de hacer más eficaz y amigable a este proceso. La generación de una estrategia de búsqueda es un proceso iterativo que permite incorporar herramientas y términos en el diseño de esta para optimizar la recuperación de evidencia. Cada estrategia variará según la pregunta formulada, el lenguaje utilizado, la fuente de información a la cual se accede y las herramientas utilizadas que se encuentren disponibles en dichas fuentes. Este artículo es parte de una serie metodológica de revisiones narrativas sobre aspectos relacionados con bioestadística y epidemiología clínica. El objetivo de esta revisión es detallar y brindar múltiples herramientas para la búsqueda aplicada al ámbito clínico, analizando paso a paso su formulación y aplicación tanto en fuentes comunes y accesibles (como Google y Google Académico), como en interfaces de búsqueda y bases de datos centradas en conocimiento biomédico de carácter técnico-científico (PubMed y The Cochrane Library).

Sleep Difficulties among Mexican Adolescents: Subjective and Objective Assessments of Sleep.

OBJECTIVE/BACKGROUND: Self-reported sleep difficulties, such as insomnia symptoms, have been reported among adolescents. Yet, studies of their prevalence and correlates are scarce among Latin Americans. This study sought (1) to describe associations between sociodemographic and lifestyle factors with self-reported sleep difficulties and (2) to examine associations between self-reported sleep difficulties and actigraphy-based sleep. PARTICIPANTS: Participants included 477 Mexican adolescents from the ELEMENT cohort. METHODS: Over 7 days, self-reported sleep measures (hard time falling asleep, overall sleep difficulties, and specific types of sleep difficulties) were obtained from daily sleep diaries. Actigraphy-based sleep measures (duration, i.e. sleep onset to morning wake, midpoint, and fragmentation) were concurrently assessed using a wrist actigraph. RESULTS: Mean (SD) age was 15.9 (2.2) years, and 53.5% were females. Mean (SD) sleep duration was 8.5 (1.2) h/night. Half reported a hard time falling asleep at least 3 days, and 25% had sleep difficulties at least 3 days over 7 days. The 3 types of sleep difficulties commonly reported among the entire cohort were insomnia/restlessness (29%), environmental (27%), and mental/emotional difficulties (19%). Female sex, smoking behavior, and socioeconomic indicators were among the most consistent factors associated with sleep difficulties. Subjective sleep difficulties were associated with shorter sleep duration (ß = -20.8 [-35.3, -6.2] min), while subjective hard time falling asleep was associated with longer sleep duration (ß = 11.3 [4.6, 27.2] min). CONCLUSION: A high proportion of Mexican adolescents in the sample reported sleep difficulties. Findings demonstrate the importance of obtaining subjective and objective sleep measures for a more comprehensive assessment of adolescent sleep.

Introduction to network meta-analysis for evidence synthesis. / Introducción a los metanálisis en red para la síntesis de evidencia.

This article belongs to a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology. The goal is to present basics concepts concerning the systematics reviews of multiple treatments comparisons with network meta-analysis. For clinical ques-tions with several therapeutic alternatives to be compared, the central question is how to classify or rank their effectiveness (benefit and harm) to choose the best option. The network meta-analysis aims to answer questions related to the effectiveness and safety of comparing multiple treatments by the simultaneous analysis of results raised from direct and indirect comparisons. The network geometry is the general graphical representation of the network meta-analysis and allows to understand and assess the strength of comparisons. The network meta-analysis should check several assumptions to be valid, especially the transitivity assumption, which allows assuming that there are no systematic differences among the included comparisons, except their compared interventions. Thus, it is possible to know the relative therapeutic effectiveness of each pair of interventions included in the network meta-analysis and their ranking in terms of categorization. It has been proposed to use a modified Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach considering the distinctive features of network meta-analysis to assess the certainty of the evidence for each comparison and the ranking of interventions.

Este artículo forma parte de una serie metodológica colaborativa de revisiones narrativas sobre bioestadística y epidemiología clínica. El objetivo de este trabajo es presentar conceptos básicos respecto de las revisiones sistemáticas de intervenciones múltiples con metanálisis en red. Para las preguntas clínicas en las que hay muchas alternativas terapéuticas que compiten (o se comparan) entre sí. La pregunta central es cómo clasificar u ordenar jerárquicamente su efecto (beneficio y/o daño) para escoger la mejor opción. Los metanálisis en red buscan responder a preguntas relacionadas con la efectividad o seguridad de múltiples tratamientos comparados entre sí, mediante el análisis simultáneo de resultados surgidos tanto de comparaciones directas como de comparaciones indirectas. La geometría de la red (network geometry) es la representación gráfica general de los metanálisis en red y permite comprender e incluso evaluar la fuerza de las comparaciones. Para que un metanálisis de comparaciones múltiples sea válido debe cumplir una serie de supuestos, destacándose el supuesto de transitividad que permite asumir que no hay diferencias sistemáticas entre las comparaciones disponibles, a excepción de las intervenciones comparadas. Así, es posible conocer la efectividad terapéutica relativa entre cualquier par de intervenciones del metanálisis en red y el orden de las intervenciones en términos de su categorización. Se ha propuesto utilizar el modelo Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) modificado en cuanto a las particularidades de los metanálisis en red para valorar la certeza de la evidencia, tanto para cada comparación como para la jerarquización de intervenciones.

Introducción a los metanálisis en red para la síntesis de evidencia / Introduction to network meta-analysis for evidence synthesis

Este artículo forma parte de una serie metodológica colaborativa de revisiones narrativas sobre bioestadística y epidemiología clínica. El objetivo de este trabajo es presentar conceptos básicos respecto de las revisiones sistemáticas de intervenciones múltiples con metanálisis en red. Para las preguntas clínicas en las que hay muchas alternativas terapéuticas que compiten (o se comparan) entre sí. La pregunta central es cómo clasificar u ordenar jerárquicamente su efecto (beneficio y/o daño) para escoger la mejor opción. Los metanálisis en red buscan responder a preguntas relacionadas con la efectividad o seguridad de múltiples tratamientos comparados entre sí, mediante el análisis simultáneo de resultados surgidos tanto de comparaciones directas como de comparaciones indirectas. La geometría de la red (network geometry) es la representación gráfica general de los metanálisis en red y permite comprender e incluso evaluar la fuerza de las comparaciones. Para que un metanálisis de comparaciones múltiples sea válido debe cumplir una serie de supuestos, destacándose el supuesto de transitividad que permite asumir que no hay diferencias sistemáticas entre las comparaciones disponibles, a excepción de las intervenciones comparadas. Así, es posible conocer la efectividad terapéutica relativa entre cualquier par de intervenciones del metanálisis en red y el orden de las intervenciones en términos de su categorización. Se ha propuesto utilizar el modelo Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) modificado en cuanto a las particularidades de los metanálisis en red para valorar la certeza de la evidencia, tanto para cada comparación como para la jerarquización de intervenciones.

This article belongs to a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology. The goal is to present basics concepts concerning the systematics reviews of multiple treatments comparisons with network meta-analysis. For clinical ques-tions with several therapeutic alternatives to be compared, the central question is how to classify or rank their effectiveness (benefit and harm) to choose the best option. The network meta-analysis aims to answer questions related to the effectiveness and safety of comparing multiple treatments by the simultaneous analysis of results raised from direct and indirect comparisons. The network geometry is the general graphical representation of the network meta-analysis and allows to understand and assess the strength of comparisons. The network meta-analysis should check several assumptions to be valid, especially the transitivity assumption, which allows assuming that there are no systematic differences among the included comparisons, except their compared interventions. Thus, it is possible to know the relative therapeutic effectiveness of each pair of interventions included in the network meta-analysis and their ranking in terms of categorization. It has been proposed to use a modified Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach considering the distinctive features of network meta-analysis to assess the certainty of the evidence for each comparison and the ranking of interventions.

What you need to know about scoping reviews. / Lo que tienes que saber sobre las revisiones panorámicas.

The increasing amount of evidence has caused an increasing amount of literature reviews. There are different types of reviews systematic reviews are the best known, and every type of review has different purposes. The scoping review is a recent model that aims to answer broad questions and identify and expose the available evidence for a broader question, using a rigorous and reproducible method. In the last two decades, researchers have discussed the most appropriate method to carry out scoping reviews, and recently the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR) reporting guideline was published. This is the fifth article of a methodological collaborative series of narrative reviews about general topics on biostatistics and clinical epidemiology. This review aims to describe what scoping reviews are, identify their objectives, differentiate them from other types of reviews, and provide considerations on how to carry them out.

La cantidad creciente de evidencia ha provocado a su vez un aumento en el número de revisiones de la literatura. Existen distintos tipos de revisiones donde las más conocidas son las revisiones sistemáticas, y cada tipo de revisión posee objetivos distintos. La revisión panorámica (o scoping review) es un modelo reciente que busca dar respuestas a preguntas amplias, a la vez que intenta identificar y exponer la evidencia disponible para una pregunta en particular, a través de un método riguroso y reproducible. En las últimas dos décadas se ha discutido cuál es el método más apropiado para realizarlas, siendo la extensión de Preferred Reporting Items For Systematic Reviews and Meta-Analyses para Scoping reviews (PRISMA-ScR) la guía de reporte más recientemente incorporada. Este artículo es el quinto de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica. Esta revisión tiene como objetivo describir qué son las revisiones panorámicas, identificar sus objetivos, diferenciarlas de otros tipos de revisiones de literatura, y dar algunas consideraciones sobre cómo estas se pueden llevar a cabo.

Rapid reviews: definitions and uses. / Revisiones rápidas: definiciones y usos.

This article is the first in a collaborative methodological series of narrative reviews on biostatistics and clinical epidemiology. This review aims to present rapid reviews, compare them with systematic reviews, and mention how they can be used. Rapid reviews use a methodology like systematic reviews, but through shortcuts applied, they can attain answers in less than six months and with fewer resources. Decision-makers use them in both America and Europe. There is no consensus on which shortcuts have the least impact on the reliability of conclusions, so rapid reviews are heterogeneous. Users of rapid reviews should identify these shortcuts in the methodology and be cautious when interpreting the conclusions, although they generally reach answers concordant with those obtained through a formal systematic review. The principal value of rapid reviews is to respond to health decision-makers needs when the context demands answers in limited time frames.

Este artículo es el primero de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica. El objetivo de esta revisión es presentar las revisiones rápidas, compararlas con las revisiones sistemáticas y mencionar su uso actual. Las revisiones rápidas utilizan una metodología similar a las revisiones sistemáticas, pero mediante atajos utilizados en su desarrollo; permiten alcanzar respuestas en menos de seis meses y con menos recursos, por lo que son utilizadas por tomadores de decisiones tanto en América como Europa. No existe consenso sobre cuáles atajos tienen menor impacto en la confiabilidad de las conclusiones, por lo que las revisiones rápidas son heterogéneas entre sí. Los consumidores deben identificar estos atajos en la metodología y ser precavidos en la interpretación de las conclusiones, aunque generalmente alcanzan respuestas concordantes con las obtenidas mediante una revisión sistemática tradicional. Su principal atractivo es ajustarse a las necesidades de los tomadores de decisiones en salud, cuando el contexto exige respuestas en plazos de tiempo acotados.

Maternal and perinatal outcomes related to COVID-19 and pregnancy: An overview of systematic reviews.

INTRODUCTION: Evidence about coronavirus disease 2019 (COVID-19) and pregnancy has rapidly increased since December 2019, making it difficult to make rigorous evidence-based decisions. The objective of this overview of systematic reviews is to conduct a comprehensive analysis of the current evidence on prognosis of COVID-19 in pregnant women. MATERIAL AND METHODS: We used the Living OVerview of Evidence (L·OVE) platform for COVID-19, which continually retrieves studies from 46 data sources (including PubMed/MEDLINE, Embase, other electronic databases, clinical trials registries, and preprint repositories, among other sources relevant to COVID-19), mapping them into PICO (population, intervention, control, and outcomes) questions. The search covered the period from the inception date of each database to 13 September 2020. We included systematic reviews assessing outcomes of pregnant women with COVID-19 and/or their newborns. Two authors independently screened the titles and abstracts, assessed full texts to select the studies that met the inclusion criteria, extracted data, and appraised the risk of bias of each included systematic review. We measured the overlap of primary studies included among the selected systematic reviews by building a matrix of evidence, calculating the corrected covered area, and assessing the level of overlap for every pair of systematic reviews. RESULTS: Our search yielded 1132 references. 52 systematic reviews met inclusion criteria and were included in this overview. Only one review had a low risk of bias, three had an unclear risk of bias, and 48 had a high risk of bias. Most of the included reviews were highly overlapped among each other. In the included reviews, rates of maternal death varied from 0% to 11.1%, admission to intensive care from 2.1% to 28.5%, preterm deliveries before 37 weeks from 14.3% to 61.2%, and cesarean delivery from 48.3% to 100%. Regarding neonatal outcomes, neonatal death varied from 0% to 11.7% and the estimated infection status of the newborn varied between 0% and 11.5%. CONCLUSIONS: Only one of 52 systematic reviews had a low risk of bias. Results were heterogeneous and the overlap of primary studies was frequently very high between pairs of systematic reviews. High-quality evidence syntheses of comparative studies are needed to guide future clinical decisions.

Registered trials address questions already answered with high-certainty evidence: A sample of current redundant research.

OBJECTIVE: To identify clinical trials registered later than 2015, that study the effect of an intervention on a primary outcome whose "Certainty of Evidence" (CoE) has already been rated "high" in a Cochrane SR. STUDY DESIGN AND SETTING: We searched the Cochrane Library for all SRs from 2015. We analyzed SRs of interventions and excluded withdrawn reviews or those with no Summary of Findings (SoF) table. We retrieved the GRADE CoE ratings of each SR's primary outcomes in the SoF tables and identified those rated "high." We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials to identify records of clinical studies that tackled those outcomes and were registered after the date of publication of the respective 2015 SR. RESULTS: We selected 602 SRs. Eighty-one contained a "high" CoE rating on at least one primary outcome, totaling 152 primary outcomes rated "high." We found 39 clinical trials registered for primary outcomes with evidence already rated as "high" in a 2015 Cochrane SR. CONCLUSION: This study shows the existence of clinical trials registered to study primary outcomes whose CoE has already been rated "high" in a Cochrane SR.

Custody and child symptomatology in high conflict divorce: an analysis of latent profiles / Custodia y Sintomatología de los Hijos en Divorcios Altamente Conflictivos: Análisis de Perfiles Latentes

BACKGROUND: There is much controversy about the impact of joint physical custody on child symptomatology in the context of high interparental conflict. In this study we analyzed child symptomatology with person-centered methodology, identifying differential profiles, considering post-divorce custody, parental symptomatology, and coparenting variables. We examined the association between these profiles and child symptomatology, as well as the mediating role of parenting in that association. METHOD: The participants were 303 divorced or separated Spanish parents with high interparental conflict. We used the study of latent profiles and the INDIRECT procedure in Mplus. We also controlled for the variables age and number of children, new partners, frequency of the relationship with the ex-partner, time elapsed since the divorce, and gender of the parent. RESULTS: From the parents' perspective, the profile characterized by low parental symptomatology and high coparenting, regardless of the type of custody, was related to children exhibiting less somatic, anxious, and depressive symptomatology, and aggressive behavior. The mediating role of parenting was also identified. CONCLUSIONS: Parental symptomatology, coparenting, and parenting are essential for understanding post-divorce child symptomatology and the study highlights importance of person-centered multidimensional models

ANTECEDENTES: existe una gran controversia acerca del impacto de la custodia física compartida en la sintomatología infantil en contexto de alto conflicto interparental. El presente estudio analizó la sintomatología infantil a través de una metodología centrada en la persona, identificando perfiles diferenciales al considerar las variables custodia postdivorcio, sintomatología parental y coparentalidad. Se analizó la asociación entre estos perfiles y la sintomatología infantil, así como el papel mediador de la parentalidad. MÉTODO: participaron 303 progenitores españoles divorciados o separados con alto conflicto interparental. Se empleó el estudio de perfiles latentes y el procedimiento INDIRECT Mplus, controlando las variables edad, número de hijos/as, nuevas parejas estables, frecuencia de relación entre progenitores, tiempo transcurrido desde el divorcio y género del/a progenitor/a. RESULTADOS: desde la perspectiva de los progenitores, el perfil caracterizado por baja sintomatología parental y alta coparentalidad, independientemente del tipo de custodia, se relacionó con menor sintomatología somática y ansioso-depresiva de hijos/as, y con menor comportamiento agresivo. Se confirmó el papel mediador de la parentalidad. CONCLUSIONES: se identifica la sintomatología parental, la coparentalidad y la parentalidad como variables fundamentales para comprender la sintomatología infantil postdivorcio, así como la relevancia de emplear modelos multidimensionales centrados en la persona