Chemsex refers to the use of psychoactive substances with sex. We carried out a systematic scoping review of methodological characteristics of chemsex research among men who have sex with men (MSM), published between 2010 and 2020. For inclusion, chemsex had to be the main focus, and studies had to specify GHB/GBL, stimulant (amphetamine, crystal meth, ecstasy/MDMA, cathinones, cocaine) and/or ketamine use with sex as a variable. From 7055 titles/abstracts, 108 studies were included, mostly cross-sectional, and from Western countries. About one-third of studies recruited exclusively from clinical settings. A majority of these recruited from sexually transmitted infection (STI) clinics. The included quantitative studies analyzed possible associations between chemsex and STI health (40%), mental health (15%), drug health (12%), sexological health (10%), and post-diagnostic HIV health (7%). Most studies included GHB/GBL and crystal meth in their operationalization of chemsex. Definitions and operationalizations of chemsex vary greatly in the literature, and researchers of chemsex among MSM should consider ways in which this variation impacts the validity of their results. More studies are needed among MSM in non-high income and non-Western countries, and examination of possible links between chemsex and post-diagnostic HIV health, sexological health, and mental health.
To identify and describe the content of templates for reporting prehospital major incident medical management.Systematic literature review according to PRISMA guidelines.PubMed/MEDLINE, EMBASE, CINAHL, Scopus and Web of Knowledge. Grey literature was also searched.Templates published after 1 January 1990 and up to 19 March 2012. Non-English language literature, except Scandinavian; literature without an available abstract; and literature reporting only psychological aspects were excluded.The main database search identified 8497 articles, among which 8389 were excluded based on title and abstract. An additional 96 were excluded based on the full-text. The remaining 12 articles were included in the analysis. A total of 107 articles were identified in the grey literature and excluded. The reference lists for the included articles identified five additional articles. A relevant article published after completing the search was also included. In the 18 articles included in the study, 10 different templates or sets of data are described: 2 methodologies for assessing major incident responses, 3 templates intended for reporting from exercises, 2 guidelines for reporting in medical journals, 2 analyses of previous disasters and 1 Utstein-style template.More than one template exists for generating reports. The limitations of the existing templates involve internal and external validity, and none of them have been tested for feasibility in real-life incidents.The review is registered in PROSPERO (registration number: CRD42012002051).
Abstract Introduction ST waveform analysis (STAN) was introduced as an adjunct to cardiotocography (CTG) to improve neonatal and maternal outcomes. The aim of the present study was to quantify the efficacy of STAN vs CTG and assess the quality of the evidence using GRADE. Material and methods We performed systematic literature searches to identify randomized controlled trials and assessed included studies for risk of bias. We performed meta‐analyses, calculating pooled risk ratio (RR) or Peto odds ratio (OR). We also performed post hoc trial sequential analyses for selected outcomes to assess the risk of false‐positive results and the need for additional studies. Results Nine randomized controlled trials including 28 729 women were included in the meta‐analysis. There were no differences between the groups in operative deliveries for fetal distress (10.9 vs 11.1%; RR 0.96; 95% confidence interval [CI] 0.82–1.11). STAN was associated with a significantly lower rate of metabolic acidosis (0.45% vs 0.68%; Peto OR 0.66; 95% CI 0.48–0.90). Accordingly, 441 women need to be monitored with STAN instead of CTG alone to prevent one case of metabolic acidosis. Women allocated to STAN had a reduced risk of fetal blood sampling compared with women allocated to conventional CTG monitoring (12.5% vs 19.6%; RR 0.62; 95% CI 0.49–0.80). The quality of the evidence was high to moderate. Conclusions Absolute effects of STAN were minor and the clinical significance of the observed reduction in metabolic acidosis is questioned. There is insufficient evidence to state that STAN as an adjunct to CTG leads to important clinical benefits compared with CTG alone.
This systematic review on radiographic hand osteoarthritis (HOA) covering publications in the databases Medline and Embase for the period 1947 to April 2021, with a final selection of 10 studies, revealed a high prevalence of hand osteoarthritis among both vibration-exposed men and non-exposed. The results show a non-significant, unadjusted risk-increase of about 50% for X-ray-diagnosed hand osteoarthritis for those who work with vibrating machinery compared to referents. The risk estimate does not provide reliable support that working with exposure from vibrating machines increases the risk of radiographic changes in the hands.
Not all patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) benefit from treatment with systemic corticosteroids and antibiotics. The aim of the study was to identify criteria recommended in current COPD guidelines for treating acute exacerbations with systemic corticosteroids and antibiotics and to assess the underlying evidence. Current COPD guidelines were identified by a systematic literature search. The most recent guidelines as per country/organisation containing recommendations about treating acute exacerbations of COPD were included. Guideline development and criteria for treating acute exacerbations with systemic corticosteroids and antibiotics were appraised. Randomised controlled trials directly referred to in context with the recommendations were evaluated in terms of study design, setting, and study population. A total of 19 COPD guidelines were included. Systemic corticosteroids were often universally recommended to all patients with acute exacerbations. Criteria for treatment with antibiotics were mainly an increase in respiratory symptoms. Objective diagnostic tests or clinical examination were only rarely recommended. Only few criteria were directly linked to underlying evidence, and the trial patients represented a highly specific group of COPD patients. Current COPD guidelines are of little help in primary care to identify patients with acute exacerbations probably benefitting from treatment with systemic corticosteroids and antibiotics in primary care, and might contribute to overuse or inappropriate use of either treatment.
Background Accidental hypothermia (AH) is an unintended decrease in body core temperature (BCT) to below 35°C. We present an update on physiological/pathophysiological changes associated with AH and rewarming from hypothermic cardiac arrest (HCA). Temperature Regulation and Metabolism Triggered by falling skin temperature, Thyrotropin-Releasing Hormone (TRH) from hypothalamus induces release of Thyroid-Stimulating Hormone (TSH) and Prolactin from pituitary gland anterior lobe that stimulate thyroid generation of triiodothyronine and thyroxine (T4). The latter act together with noradrenaline to induce heat production by binding to adrenergic β3-receptors in fat cells. Exposed to cold, noradrenaline prompts degradation of triglycerides from brown adipose tissue (BAT) into free fatty acids that uncouple metabolism to heat production, rather than generating adenosine triphosphate. If BAT is lacking, AH occurs more readily. Cardiac Output Assuming a 7% drop in metabolism per °C, a BCT decrease of 10°C can reduce metabolism by 70% paralleled by a corresponding decline in CO. Consequently, it is possible to maintain adequate oxygen delivery provided correctly performed cardiopulmonary resuscitation (CPR), which might result in approximately 30% of CO generated at normal BCT. Liver and Coagulation AH promotes coagulation disturbances following trauma and acidosis by reducing coagulation and platelet functions. Mean prothrombin and partial thromboplastin times might increase by 40–60% in moderate hypothermia. Rewarming might release tissue factor from damaged tissues, that triggers disseminated intravascular coagulation. Hypothermia might inhibit platelet aggregation and coagulation. Kidneys Renal blood flow decreases due to vasoconstriction of afferent arterioles, electrolyte and fluid disturbances and increasing blood viscosity. Severely deranged renal function occurs particularly in the presence of rhabdomyolysis induced by severe AH combined with trauma. Conclusion Metabolism drops 7% per °C fall in BCT, reducing CO correspondingly. Therefore, it is possible to maintain adequate oxygen delivery after 10°C drop in BCT provided correctly performed CPR. Hypothermia may facilitate rhabdomyolysis in traumatized patients. Victims suspected of HCA should be rewarmed before being pronounced dead. Rewarming avalanche victims of HCA with serum potassium > 12 mmol/L and a burial time >30 min with no air pocket, most probably be futile.
We appreciate the comments from Olofsson 1 and Kessler et al. 2. We investigated several outcomes in our review, and two (risk of metabolic acidosis and operative vaginal delivery) showed statistically significant differences in favor of STAN. 3. Two other high quality meta-analyses were published almost simultaneously 4, 5, and neither reported significant differences in rates of metabolic acidosis. Saccone et al. 4 and Neilson 5 used risk ratio (RR) and random effect models, whereas we used peto odds ratio (OR) and fixed effect model for outcomes with an incidence <1%. Both approaches have pros and cons and we hesitate to define either one as superior. Olofsson argues that we did the most correct meta-analysis 3. Positive feedback is always welcome, but it is tempting to ask whether this judgment is related to the fact that our meta-analysis shows positive results for metabolic acidosis, whereas the others do not. We once again emphasize the need to view all results in context, particularly when the only interesting effect manifests itself in a surrogate outcome with uncertain clinical validity. Surrogate outcomes are used to predict the risk of future serious events, thus shortening the size, duration and cost of trials. Unfortunately, this is associated with pitfalls and bias 6, 7. The uncertain validity of metabolic acidosis is demonstrated in an individual patient data review 4 investigating a composite endpoint (at least one of the following: intrapartum fetal death, neonatal death, Apgar score ≤3 at five minutes, neonatal seizures, metabolic acidosis, intubation for ventilation at delivery or neonatal encephalopathy) without finding a difference between STAN and CTG. Hence, we disagree with Kessler et al. and Olofsson, who seem to take the validity of metabolic acidosis for granted. Kessler et al. assume that 10.3% of all babies born with metabolic acidosis have severe adverse outcomes due to an intrapartum hypoxic event. Their calculation presupposes that the risk reductions for metabolic acidosis and for serious adverse events are linearly related. We find this inference speculative, and wonder why one should trust estimates based on assumption rather than direct data. Direct data suggest that that STAN might be associated with reduced survival 3-5. Kessler et al. estimated that STAN will prevent 493 operative vaginal deliveries in Norway each year. This estimate is based on the questionable assumption that all delivery units use STAN on all laboring women, and they ask whether we regard this reduction as unimportant. We welcome efforts to reduce operative deliveries without compromising neonatal outcomes, but this should involve other approaches rather than STAN. Olofsson further argues that our GRADE assessments are influenced by culture, norms and other preferences. This is of course true. The use of GRADE does not guarantee consensus, but we note that the Cochrane meta-analysis 5 arrived at very similar conclusions. Olofsson states that relying more on negative than positive evidence is a part of being human, suggesting that our conclusions are prone to bias. We believe that confirmation bias, conflicts of interest and uncritical embracement of new technology 8 are the most potent sources of bias in this field. We do not see any reasons why we could be more exposed to this type of bias than others. As an extension of the latter argument, it is tempting to refer to the criticism of the recently published US study 9. This study was funded with 3 million USD and supported by Neoventa AB 10. The STAN algorithm was different from that used in Europe, but the algorithm was the same as used by Neoventa for their FDA approval 10. In 2014, Olofsson, Kessler, Yli and others published a review 11 and concluded: “The results of the ongoing multicenter RCT in the United States are some months away. Certainly the contribution of the USA data will help to determine whether the addition of ST analysis to conventional CTG results in improved perinatal outcomes.” After the US study showed negative results, Kessler, Yli and others published a statement with severe objections to this study on the Neoventa homepage 12. It is tempting to speculate whether this criticism would have been raised if the US study had published positive results.
Feeding activity was recorded in captive Svalbard ptarmigan (Lagopus mutus hyperboreus) under natural photoperiodic conditions at 70°N and 79°N. At 79°N, activity was intermittent and non-circadian in summer, when the sun was permanently above the horizon, and in midwinter, when the sun was permanently lower than 6° below the horizon. The intermittent feeding pattern was evident in summer at 70°N, whereas feeding activity in winter appeared to be entrained. In spring and autumn all birds were diurnal, with morning and evening bouts of feeding activity. The phase relationship between the onset or end of activity and the photoperiod showed marked changes, especially at 79°N, but in general, activity onset was more precise relative to twilight than activity end. At 79°N there was a sigmoidal relationship between activity time and photoperiod and activity time was longer in autumn than in spring at equal photoperiods. Based on our results, the activity pattern of Svalbard ptarmigan may be described in terms of a two-oscillator model, although a one-oscillator model cannot be excluded. The possibility is discussed that rhythmic feeding or food availability may act as a zeitgeber in addition to the light-dark cycle.
