AbstractImportance:The COVID-19 pandemic’s effect on the prevalence of anxiety symptoms among healthcare workers remains unclear. Hence, an investigation into their prevalence and the changes before and during the pandemic is needed.Objective:To provide a comprehensive summary of the prevalence of anxiety symptoms among healthcare workers internationally and to compare this before and during the COVID-19 pandemic.Data Sources:A literature search was conducted using Medline, PubMed databases, and Embase for observational studies from their establishment in January 1963, January 1963, and January 1989, respectively, to August 2022.Study Selection:A standardized search strategy was applied to the databases with keywords assembled into three categories, including “healthcare workers”, “anxiety symptoms”, and “miscellaneous”. The inclusion criteria were: (I) evaluation of the prevalence of anxiety symptoms among healthcare workers employed in hospitals; (II) measured through validation tools or questionnaires; (III) published in English. The exclusion criteria were: (I) no overall prevalence of anxiety provided; (II) case series, case reports, intervention research, and commentaries.Data Extraction and Synthesis:The protocol was developed based on the PRISMA guidelines. The pooled prevalence and 95% confidence interval (CI) were estimated using a random effects model.Main Outcome(s) and Measure(s):The articles were analyzed according to subgroups divided based on the time of the studies conducted, participant occupations, locations, screening instruments, and publication years.Results:A total of 358 cross-sectional articles with 373 estimates from 65 countries were included. The overall prevalence of anxiety symptoms among healthcare workers was 41.4% (95% CI, 39.3-43.4). The prevalence of anxiety symptoms before and during the COVID-19 pandemic were 40.7% (95% CI: 34.1-47.3) and 41.2% (95% CI: 39.1-43.3), respectively. Compared with studies before the pandemic, a higher prevalence of anxiety symptoms was identified among nurses, residents, and physicians during the pandemic.Conclusions and Relevance:A considerable proportion of healthcare workers have experienced anxiety symptoms, with their global prevalence increasing during the COVID-19 pandemic. Further research is needed to determine effective prevention and treatment strategies, particularly during the COVID-19 pandemic.Systematic review registration:CRD42022370819.
Background: An increasing number of studies have reported associations between single nucleotide polymorphisms (SNPs) and ovarian cancer (OC) risk. However, some of the findings were inconsistent. The objective of this umbrella review was to evaluate the associations comprehensively and quantitatively. Methods: The protocol of this review was registered in PROSPERO (No. CRD42022332222). We searched the PubMed, Web of Science, and Embase databases to identify related systematic reviews and meta-analyses from inception to 15 October 2021. In addition to estimating the summary effect size by using fixed and random effects models and calculating the 95% prediction interval, we evaluated the cumulative evidence for associations with nominally statistical significance based on the Venice criteria and false positive report probability (FPRP). Results: Forty articles were included in this umbrella review, which referred to a total of 54 SNPs. The median number of original studies per meta-analysis was four, while the median number of total subjects was 3455. All included articles had greater than moderate methodological quality. A total of 18 SNPs were nominally statistically associated with OC risk; 6 SNPs (8 genetic models), 5 SNPs (7 genetic models), and 16 SNPs (25 genetic models) were identified as strong, moderate, and weak cumulative evidence, respectively. Conclusion: This umbrella review revealed associations between SNPs and OC risk and suggested strong cumulative evidence of associations of six SNPs (eight genetic models) with OC risk.
Background: The colors of fruits and vegetables (FV) reflect the presence of pigmented bioactive compounds. The evidence of pre-diagnosis specific FV color group intake contributing to ovarian cancer (OC) survival is limited and inconsistent. Methods: A prospective cohort study was conducted between 2015 and 2020 with 700 newly diagnosed OC patients. Pre-diagnosis dietary information was assessed by a validated food frequency questionnaire. We classified FV into five groups based on the color of their edible parts (e.g., green, red/purple, orange/yellow, white, and uncategorized groups). Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association of specific color groups of FV before diagnosis with OC survival. Potential multiplicative and additive interactions were assessed. Results: 130 patients died during a median follow-up of 37.57 (interquartile: 24.77-50.20) months. We observed the improved survival with a higher pre-diagnosis intake of total FV (HRtertile 3 vs. tertile 1 = 0.63, 95%CI = 0.40-0.99), total vegetables (HRtertile 3 vs. tertile 1 = 0.57, 95%CI = 0.36-0.90), and red/purple FV (HRtertile 3 vs. tertile 1 = 0.52, 95%CI = 0.33-0.82). In addition, we observed significant dose-response relationships for per standard deviation increment between total vegetable intake (HR = 0.79, 95%CI = 0.65-0.96) and red/purple group intake (HR = 0.77, 95%CI = 0.60-0.99) before diagnosis with OC survival. Additionally, pre-diagnosis green FV intake was borderline associated with better OC survival (HRper standard deviation increment = 0.83; 95%CI = 0.69-1.00). In contrast, we did not observe significant associations between pre-diagnosis intake of total fruits, orange/yellow, white, and uncategorized groups and OC survival. Conclusion: Pre-diagnosis FV intake from various color groups, especially the green and red/purple ones, may improve OC survival. Further studies are needed to validate our findings.
BACKGROUND There is currently no consensus on the impact of a higher co-author scale (the number of authors) on paper citation. No studies have comprehensively explored the interaction effects of co-author scale and paper characteristics on paper citations. OBJECTIVE We aimed to determine the interaction effects between co-author scale and paper characteristics on paper citations in medical informatics. METHODS A total of 34,399 papers were included in this study. Highly-cited papers were identified among the top 10% of all published papers in the current year. Logistic regression analyses were conducted to estimate the associations between co-author scale and paper citation. RESULTS We found that higher co-author scale was significantly associated with highly-cited papers. Significant independent risk factors were identified using multivariate analysis. A subgroup analysis showed that higher co-author scale significantly increased the probability of a paper becoming highly-cited if it was published in the past 9-14 years (OR = 1.24; 95% CI: 1.03 –1.50), has 20-30 references (OR = 1.38; 95% CI: 1.13 –1.70), was a funded paper (OR = 1.30; 95% CI: 1.11 –1.52), was published in a European journal (OR = 1.22; 95% CI: 1.06 –1.40), or was published in multi-disciplinary (≥5) journals (OR = 1.70; 95% CI: 1.38 –2.08). CONCLUSIONS Our study demonstrated that there was a statistically significant interaction effect between co-author scale and paper characteristics on paper citation in medical informatics. These results provide further empirical evidence on the association between co-author scale, paper characteristics, and paper citation, and provide suggestions for researchers who are launching new projects.
Background: Atorvastatin decreases blood lipids but is associated with side effects. Zhibitai is a traditional Chinese medicine used to treat blood lipid disorders. The objective of this study is to evaluate the lipid-lowering effect, antiinflammatory effect, and adverse events of zhibitai combined to atorvastatin in patients with coronary heart diseases (CHDs). Methods: Patients with CHD (n = 150) were randomized to: zhibitai 480 mg + atorvastatin 10 mg (ZA10 group), atorvastatin 20 mg (A20 group), and atorvastatin 40 mg (A40 group). Lipid profile, cardiotrophin-1 (CT-1), and C-reactive protein (CRP) were measured after 4 and 8 weeks of treatment. Self-reported side effects, liver function, kidney function, and creatine kinase levels were monitored. Results: After 8 weeks, triglycerides, total cholesterol (TC), LDL-cholesterol (LDL-C), and apolipoprotein B100 (ApoB100) levels were decreased in the ZA10 group (−64%, −37%, −46%, and −54%, respectively, compared with baseline), and these changes were similar to those of the A40 group (P > 0.05). CT-1 and high sensitivity-C reactive protein (hs-CRP) levels were significantly decreased in the ZA10 group after 4 and 8 weeks (4 weeks: −73% and 96%; 8 weeks: −89% and −98%; all P < 0.01), without differences among the 3 groups (P > 0.05). After 8 weeks of treatment, adverse events (abdominal distention, nausea, vomiting, and hunger) were found in 4, 5, and 7 patients in the ZA10, A20, and A40 groups, respectively. Conclusion: ZA10 significantly reduced triglycerides, TC, LDL-C, ApoB, CT-1, and hs-CRP levels in patients with CHD, similar to the effects of A40 and A20, but ZA10 lead to fewer adverse events.
The relationship between the consumption of foods with added fructose and non-alcoholic fatty liver disease (NAFLD) was inconsistent in previous epidemiological studies, and no meta-analysis has been performed on the pooled results.
Previous experimental studies have indicated that exposure to beta blocker provides protective effects against ovarian cancer (OC). However, findings from epidemiologic studies have still been controversial. Therefore, we carried out a meta-analysis to update and quantify the correlation between post-diagnostic beta blocker usage and OC prognosis.The meta-analysis had been registered at PROSPEPO. The number of registration is CRD42020188806. A comprehensive search of available literatures in English prior to April 16, 2020, was conducted in PubMed, EMBASE, and the Web of Science databases. Random-effects models were used to calculate overall hazard ratios (HRs) and 95% confidence intervals (CIs). Publication bias assessments, and subgroup, sensitivity, and meta-regression analyses were also performed.Of the 637 initially identified articles, 11 retrospective cohort studies with 20,274 OC patients were included. The summary HRs did not reveal any statistically significant associations between post-diagnostic beta blocker use and OC prognosis characteristics, such as total mortality (HR = 1.08, 95% CI = 0.92-1.27, I2 = 76.5%, n = 9), cancer-specific mortality (HR = 1.22, 95% CI = 0.89-1.67, I2 = 88.1%, n=3), and progression-free survival (HR = 0.88, 95% CI = 0.75-1.05, I2 = 0, n = 4). No evidence of publication bias was observed in current analysis. In our subgroup analyses, the majority of results were consistent with the main findings. However, several positive correlations were detected in studies with ≥800 cases (HR = 1.20, 95% CI = 1.05-1.37), no immortal time bias (HR = 1.28, 95% CI = 1.10-1.49), and adjustment for comorbidity (HR = 1.20, 95% CI = 1.05-1.37). In the meta-regression analysis, no evidence of heterogeneity was detected in the subgroups according to study characteristics and confounding factors.Post-diagnostic beta blocker use has no statistical correlation with OC prognosis. More prospective cohort studies are necessary to further verify our results.Identifier (CRD42020188806).
Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is the most common liver injury. We performed this umbrella review of meta-analyses to summarize the evidence on the associations of nutritional, lifestyle, and metabolic factors with NAFLD. Methods: We searched the PubMed, Embase, and Web of Science databases from inception until July 2, 2020, to identify meta-analyses of observational studies which explored the associations of nutritional, lifestyle, and metabolic factors with NAFLD. Evidence levels were assessed using summary effect sizes, 95% prediction intervals, between-study heterogeneity, evidence of small-study effects, and evidence of excess significance bias for each meta-analysis. (No. of PROSPERO, CRD42020200124). Results: Twenty two risk or protective factors from 10 published meta-analyses were included and studied. Three risk factors (sugar-sweetened beverage consumption, serum fetuin-A, and waist circumference) with highly suggestive levels of evidence and three risk factors (soft drink consumption, former smoking, and body mass index) with suggestive levels of evidence were identified. Only two protective factors (physical activity and serum vitamin D level [among adults in Western countries]) with suggestive levels of evidence were identified. Furthermore, other six risk factors and two protective factors with weak levels of evidence were identified. Conclusions: We found varying levels of evidence of associations of nutritional, lifestyle, and metabolic factors and NAFLD. The results suggest that nutritional and lifestyle management should be considered as a major primary preventive strategy for NAFLD. Moreover, considering the low quality of included meta-analyses and limited area of research topics, future high-quality original studies and meta-analyses should be performed to study these associations.
Background: Sleep is closely related to various diseases. Several meta-analyses have provided evidence of sleep and cancer, and yet the credibility of this evidence has not been comprehensively quantified. Thus, we conducted an umbrella review to quantify the evidence for systematic reviews and meta-analyses of observational studies on sleep characteristics (sleep duration, sleep quality, napping, bedtime, and wake-up time) and cancer-related outcomes. Methods: PubMed, Web of Science (Core Collection), and Embase databases were searched from inception until 29 July 2022. Assessment of Multiple Systematic Reviews, version 1, was used to evaluate the methodological quality of each eligible systematic review or meta-analysis. For each association, the summary effect with a 95% confidence interval was evaluated by fixed and random effects models. The 95% prediction interval, heterogeneity, small-study effects, and excess significance bias were also evaluated. Evidence of the associations from systematic reviews and meta-analyses was ranked based on the established criteria of published literature as convincing, highly suggestive, suggestive, weak, or non-significant. Results: The umbrella review identified thirty meta-analyses on the aforementioned associations from six articles. The methodological quality of five articles was high or moderate. Suggestive evidence was found for associations between long sleep duration and a 21% increased risk of colorectal cancer, a 9% increased all-cancer mortality and a 65% increased mortality of lung cancer, and associations between short sleep duration and a 21% increased mortality of lung cancer. Additionally, the evidence of associations between short sleep duration and lung cancer mortality was upgraded to convincing, and between long sleep duration and lung cancer mortality was upgraded to highly suggestive, among the population reporting 24 h sleep duration. Conclusion: Abnormal sleep duration might be linked to several adverse cancer-related outcomes.
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