Lack of transparency in reporting narrative synthesis of quantitative data: a methodological assessment of systematic reviews.

OBJECTIVE: To assess the adequacy of reporting and conduct of narrative synthesis of quantitative data (NS) in reviews evaluating the effectiveness of public health interventions. STUDY DESIGN AND SETTING: A retrospective comparison of a 20% (n = 474/2,372) random sample of public health systematic reviews from the McMaster Health Evidence database (January 2010-October 2015) to establish the proportion of reviews using NS. From those reviews using NS, 30% (n = 75/251) were randomly selected and data were extracted for detailed assessment of: reporting NS methods, management and investigation of heterogeneity, transparency of data presentation, and assessment of robustness of the synthesis. RESULTS: Most reviews used NS (56%, n = 251/446); meta-analysis was the primary method of synthesis for 44%. In the detailed assessment of NS, 95% (n = 71/75) did not describe NS methods; 43% (n = 32) did not provide transparent links between the synthesis data and the synthesis reported in the text; of 14 reviews that identified heterogeneity in direction of effect, only one investigated the heterogeneity; and 36% (n = 27) did not reflect on limitations of the synthesis. CONCLUSION: NS methods are rarely reported in systematic reviews of public health interventions and many NS reviews lack transparency in how the data are presented and the conclusions are reached. This threatens the validity of much of the evidence synthesis used to support public health. Improved guidance on reporting and conduct of NS will contribute to improved utility of NS systematic reviews.

Place of the "Public health" in the Tunisian medical research on the cardiovascular diseases: a bibliometric study (Medline: 1988-2017).

BACKGROUND:   The management of the cardiovascular diseases, main public health problem in Tunisia, is generating many difficulties that a socially responsible research should reflect them. The aim of this study is to assess dimensions of public health of Tunisian research on the cardiovascular diseases during thirty last years. METHODS: we conducted a bibliometric study relating to the public health information of the Tunisian cardiovascular papers indexed in the Medline database between January 1st 1988 and December 31st 2017. The following qualifiers were selected to define the public health dimension of paper: "epidemiology", "mortality", "statistics and numerical data", "economy", and "prevention and control". RESULTS: During thirty years (1988-2017), 176 references were identified and only 136 Tunisian publications were retained following the application of the inclusion criteria (first author affiliated in a Tunisian structure of health or research). The two medical specialties of "cardiology" and "Preventive medicine and Community" produced 47% of these articles. The selected publications were mainly original articles, monocentric studies, analytical, and written in French language for the national journal "La Tunisie Medicale". Among the 136 selected articles, 34 (25%) explored the ischemic heart diseases. "Epidemiology" and the "Prevention/Control" were two dimensions of the "Public health" the most studied in the Tunisian publications on the cardiovascular diseases, respectively in 84% and 44% of the cases. CONCLUSION: The Tunisian publications in the cardiovascular field accompanied the epidemiologic transition along the three last decades. While they were focusing on the epidemiology and the prevention of the ischemic heart diseases. Other dimensions of public health must be treated on the set of the cardiovascular diseases, such as the economics and etiologics studies.

HIV/AIDS: key lessons for a successful response and for future challenges

Movida por la rápida expansión de la epidemia de VIH/ SIDA y su impacto mundial, la Asamblea General de las Naciones Unidas convocará una reunión especial en Nueva York en junio de 2001 para examinar la situación de la enfermedad. Como parte de los preparativos para la reunión, el Secretario General de las Naciones Unidas, Kofi Annan, emitió en febrero de 2001 un documento titulado Reunión Especial de la Asamblea General para tratar el tema del VIH y el SIDA: informe del Secretario General. En el documento se examinan la propagación de la epidemia de VIH/SIDA y su impacto en términos demográficos, sociales y económicos. También se detallan las lecciones esenciales que se han aprendido sobre las características de una respuesta eficaz contra la epidemia, y sobre las dificultades de intensificar esa respuesta. He aquí algunas de las lecciones presentadas en el documento: las respuestas eficaces muestran un respeto por los derechos humanos; se puede prevenir la expansión de la epidemia; las iniciativas nacionales requieren dirección y la participación de una variedad de actores; las medidas de prevención son eficaces; la atención y el tratamiento deben ser integrales; las buenas respuestas se arraigan en el seno de la comunidad; es esencial empoderar a la juventud; las personas que viven con el VIH y el SIDA desempeñan un papel central en las medidas de respuesta, que deben tener en cuenta simultáneamente los factores de riesgo, la vulnerabilidad del paciente y el impacto de la enfermedad. Para poder incrementar el alcance y la profundidad de las respuestas que actualmente están surtiendo buenos resultados, habrá que superar una serie de dificultades, entre ellas las de proporcionar liderazgo y coordinación, mitigar el impacto social y económico de la epidemia, lanzar iniciativas internacionales, afrontar el costo de los medicamentos y destinar los recursos necesarios.