牙齿缺失对急性缺血性卒中患者预后影响的临床研究

目的：探讨牙齿缺失对急性缺血性卒中患者预后的影响。方法选择2011年10月至2012年6月汕头大学医学院附属粤北人民医院神经内科住院的急性期缺血性卒中患者164例,采集患者的人口学资料、既往病史和牙齿缺失等情况,检测血脂、血糖、同型半胱氨酸、超敏C反应蛋白、白细胞、纤维蛋白原、肌酐等血清学指标,入院3天内完成美国国立卫生研究院卒中量表（NIHSS）评分,出院后每半年及研究截止时通过电话随访评定患者改良Rankin量表（mRS）评分。采用t检验或秩和检验比较各组变量指标,组间频率比较采用卡方检验,并行ROC曲线及Logistic回归分析。结果缺血性卒中预后不良相关因素Logistic单因素分析显示,年龄（OR＝1.04,95％CI：1.01～1.07, P＝0.02）、肌酐（OR＝1.01,95％CI：1.00～1.02, P＝0.04）、牙齿缺失数（OR＝1.05,95％CI：1.01～1.08, P＝0.01）及入院时NIHSS评分（OR＝1.22,95％CI：1.12～1.33, P＜0.001）是预后不良的危险因素。而经Logistic多因素分析,校正年龄及其他因素的影响后,仅NIHSS 评分（OR＝1.24,95％CI：1.11～1.40, P＜0.001）和牙齿缺失数（OR＝1.07,95％CI：1.02～1.12, P＝0.004）与缺血性卒中预后不良相关。结论牙齿缺失数可能是与NIHSS评分相同,均是影响缺血性卒中预后不良的危险因素。     

Acupuncture for the treatment of sudden sensorineural hearing loss: A systematic review and meta-analysis: Acupuncture for SSNHL

BackgroundAcupuncture as an alternative treatment method is widely used in the treatment of sudden sensorineural hearing loss(SSNHL) in China. We performed a systematic review and meta-analysis to assess the clinical efficacy of acupuncture for the management of SSNHL patients.Materials and MethodsThe PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure and WanFang databases were searched. Searches were performed on April 27, 2018 and without language and publication year restrictions. We collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of SSNHL patients to assess its efficacy and safety. The RevMan5.3 software was used for analysis. The fixed-effects model can be applied to calculate the risk ratio (RR) or weighted mean difference (WMD) if the chi-square test shows there was no significance of heterogeneity (p > 0.10, I²<50%). Otherwise, the random effects mode was used.ResultsTwenty randomized controlled trials met our inclusion criteria. The electroacupuncture(EA), manual acupuncture(MA) plus western medicine(WM) and EA plus WM groups lead to significantly better pure tone audiometry(PTA) than WM alone in cured rate (P = 0.01; P < 00,001; P < 0.006, respectively). However, no significant differences were observed between MA and WM (p = 0.27). In terms of total effective rate, all of them showed significant improvement compared to WM alone (MA: P = 0.03; EA: P = 0.01; MA + WM: P < 0.00001; EA + WM: P = 0.04). In addition, no significant difference was found between the MA plus WM and WM alone groups in the improvement of tinnitus (P = 0.37). No trials reported serious adverse events.ConclusionAcupuncture could be a valid treatment option for SSNHL, especially for patients who could not be cured by drugs alone. However, the outcome was limited temporarily due to the lack of high-quality research support. High-quality evidence is needed to clarify the future efficacy and safety of acupuncture for SSNHL.     

Pistachios and cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled clinical trials

BackgroundPrevious experimental studies have reported that pistachios can elicit positive effects on lipid profile, blood pressure, and inflammation; however, a meta-analysis of the available evidence has yet to be performed.Objectivethe aim of this study was to conduct systematic review and meta-analysis of the effect of pistachio enriched diets on cardiometabolic risk factors, such as weight, BMI, blood pressure, serum lipids, blood glucose, and inflammatory biomarkers.DesignA literature search was carried out for RCTs in medical databases, including PubMed/MEDLINE, Scopus, and Cochrane databases, with no time limitation up to August 2019, and conducted in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines.Results11 RCTs, with 506 participants, that reported the effect of pistachios consumption on cardiometabolic risk factors were included in this systematic review and meta-analysis. Our findings indicated that pistachios consumption significantly reduced FBS (WMD: -3.73, 95 % CI: -6.99, -0.46, I² = 99 %), TC/HDL (WMD: -0.46, 95 % CI: -0.76, -0.15, I² = 95 %), LDL/HDL (WMD: -0.24, 95 % CI: -0.38, -0.11, I² = 96 %), HbA1C (WMD: -0.14, 95 % CI: -0.26, -0.02, I² = 60 %), Insulin (WMD: -2.43, 95 % CI: -4.85, -0.001, I² = 58 %), SBP (WMD: -3.10, 95 % CI: -5.35, -0.85, I² = 63 %), and MDA (WMD: -0.36, 95 % CI: -0.49, -0.23, I² = 0%). Importantly, we did not observe adverse effects of pistachios consumption on BMI or blood pressure.ConclusionThis systematic review and meta-analysis demonstrates that pistachios consumption can elicit a beneficial effect on some cardiometabolic risk factors. All previous clinical studies are well designed but some points have still remained unclear including the effects of different pistachios dosages on cardio metabolic risk factors and efficacy of pistachios consumption in preventing endothelial dysfunction. Further examination is required to determine the effect of pistachios consumption on further endothelial function risk factors.     

Blueberry and cardiovascular disease risk factors: A systematic review and meta-analysis of randomized controlled trials

Background and aimsCardiovascular disease (CVD) remains an important cause of mortality and morbidity that can be prevented by the consumption of healthy foods. These include blueberry, a dark coloured berry containing extremely high amounts of functional ingredients. We therefore examined the extent to which supplementation with blueberry effects on CVD risk indices.MethodsWe searched the ISI Web of Science, Scopus, PubMed and Cochrane Library on March 2020 and checked reference lists from primary studies and review articles for any additional studies. No language restrictions were applied. All randomized and controlled clinical trials (RCTs) using blueberry supplements to modify CVD risk factors were included in our analysis.ResultsMean Difference (MD) was pooled using a random effects model and 11 studies were included in the final analysis. Pooled effect size showed that supplementation with blueberry had a small insignificant effect in reducing plasma triglycerides (MD = −0.27 mmol/l; 95 % CI: −0.57, 0.17, p = 0.06). Although current study found no differences between blueberry and control groups for any other outcomes, subgroup analysis suggested a favourable impact of blueberry on reducing body weight. Significant weight loss was indicated from studies longer with a follow up of more than 6 weeks or with blueberry powder or freeze-dried blueberry.ConclusionCurrent evidence is insufficient to show a benefit of blueberry supplements in modifying CVD risk factors across a variety of adult populations. Robust data and larger studies are required to assess potential effects.     

Statin use and risk of liver cancer: A meta-analysis of 7 studies involving more than 4.7 million patients

AIM: To pool data currently available to determine the association between statin use and the risk of liver cancer. METHODS: A computerized literature search was conducted to identify those relevant studies between January 1966 and March 2013. Stata 11.0 (Stata Corp, College Station, Texas) was used for statistical analyses. Pooled relative risk (RR) estimates with 95%CI were calculated for overall analysis and subgroup analyses, using the random- and fixed-effects models. Heterogeneities between studies were evaluated by Cochran’s Q test and I² statistic. The Begg’s funnel plot and Egger’s regression asymmetry test were used to detect the publication bias. RESULTS: Seven studies were included in our meta-analysis according to the selection criteria, including four cohort studies and three case-control studies. These studies involved 4725593 people and 9785 liver cancer cases. The overall analysis showed that statin use was statistically associated with a significantly reduced risk of liver cancer (random-effects model, RR = 0.61, 95%CI: 0.49-0.76, P < 0.001; fixed-effects model, RR = 0.64, 95%CI: 0.57-0.71, P < 0.001); however, significant heterogeneity was found between studies (Cochran’s Q statistic = 19.13, P = 0.004; I² = 68.6%). All subgroup analyses provided supporting evidence for the results of overall analysis. Begg’s (Z = 0.15, P = 0.881) and Egger’s test (t =-0.44, P = 0.681) showed no significant risk of having a publication bias. CONCLUSION: Statin use was associated with the reduced risk of liver cancer. To clearly clarify this relationship, more high quality studies are required.     

A meta-analysis of risk factors that predict psychopathology following accidental trauma.

PURPOSE: This meta-analysis aimed to explore the risk factors that place a child at risk of psychopathology following accidental trauma. DESIGN AND METHODS: The predictive power of 8 factors was examined via transforming and combining the effect sizes to yield a weighted average effect size for each factor. RESULTS: The results indicated that the majority of effect sizes, although significant, were inconsistent across the studies, yielding little conclusive evidence. However, pretrauma psychopathology and threat to life were strong and consistent predictors. PRACTICE IMPLICATIONS: Information gathered from such meta-analyses could be used in the identification of at-risk children and the development of screening tools. However, further widespread and comprehensive reviews of the potential risk factors and their relationships to psychopathology need to be investigated.     

The association between miR-146a gene rs2910164 polymorphism and gastric cancer risk: A meta-analysis

PurposeStudies have demonstrated that single nucleotide polymorphisms (SNPs) in miRNAs may lead to varying functional outcomes by altering miRNAs expression, even leading to the development of cancers. The association between a single nucleotide polymorphism (SNP) in miR-146a rs2910164 and susceptibility to gastric cancer has been studied during the recent years, but the results are still inconclusive and inconsistent. We performed a meta-analysis to evaluate the relationship between miR-146a rs2910164 polymorphism and the risk of gastric cancer.Materials and methodsThe databases of PubMed, MEDLINE and Web of Science were searched for suitable studies. A total of 8 published case–control studies on miR-146a rs2910164 polymorphism and gastric cancer risk including 4308 cases and 6370 controls were included.ResultsOverall, significant association was observed between rs2910164 and gastric cancer risk in allele model (OR = 1.11, 95% CI = 1.02–1.21); homozygote model (OR = 1.26, 95% CI = 1.10–1.43) and dominant model (OR = 1.21, 95% CI = 1.09–1.34). Stratified analysis by ethnicity showed significant association between rs2910164 polymorphism and gastric cancer susceptibility in Asians (OR = 1.10, 95% CI = 1.00–1.23 for G vs. C; OR = 1.25, 95% CI = 1.09–1.43 for GG vs. CC; OR = 1.19, 95% CI = 1.07–1.33 for GG vs. GC+CC, respectively). When stratified by genotyping methods and sample size, increased gastric cancer risk was only observed with the method by TaqMan and the sample size more than 1000.ConclusionIn summary, this meta-analysis indicated that miR-146a rs2910164 polymorphism was associated with the susceptibility to gastric cancer, especially in Asian population.     

Markers of cardiovascular risk in patients with antiphospholipid syndrome: A meta-analysis of literature studies

Abstract

Several studies reported on the association between antiphospholipid syndrome (APS) and venous thrombosis. In contrast, little is known about cardiovascular (CV) risk in APS. We performed a meta-analysis on the impact of APS on major markers of CV risk.

Studies on the relationship between APS and common carotid artery intima-media thickness (CCA-IMT), internal carotid artery IMT (ICA-IMT), carotid bifurcation IMT (BIF-IMT), prevalence of carotid plaques, flow-mediated dilation (FMD), nitrate-mediated dilation (NMD), and ankle-brachial index (ABI) were systematically searched in PubMed, Web of Science, Scopus, and EMBASE databases. Twenty case-control studies (668 cases, 678 controls) were included. Compared to controls, APS patients showed a higher CCA-IMT (mean difference [MD] 0.11 mm; 95% CI 0.07, 0.14), ICA-IMT (MD 0.08 mm; 95% CI 0.05, 0.11), BIF-IMT (MD 0.09 mm; 95% CI 0.06, 0.12) and a higher frequency of carotid plaques (OR 3.87; 95% CI 1.61, 9.31). Moreover, a lower FMD was found in APS subjects than in controls (MD –4.49%; 95% CI –6.20, –2.78), with no differences in NMD (MD –1.80%; 95% CI –4.01, 0.42). Finally, an increased prevalence of pathological ABI was found in APS patients compared to controls (OR 7.26; 95% CI 1.77, 29.71).

Despite heterogeneity among studies, APS appears significantly associated with markers of subclinical atherosclerosis and CV risk. These findings can be useful to plan adequate prevention strategies and therapeutic approaches.     

The relationship of actual height loss with health-seeking behaviors and risk factors in perimenopausal and menopausal women

PURPOSE: To explore whether there is a difference in the perceived height and actual height in the perimenopausal or menopausal woman and discover the difference's effect on osteoporosis health-seeking preventive behaviors and risk factor awareness. DATA SOURCES: Sixty-three perimenopausal and menopausal women, aged 45-70 years, who presented at three Midwestern clinics for their annual physical exam. Data were collected with The Osteoporosis Questionnaire, which included the Osteoporosis Risk Questionnaire, Health-O-Meter height measuring stick, tape measure with inch-rule for arm span measurements, and balance scale for weight. CONCLUSIONS: There were a significant relationship between actual height loss and osteoporosis risk factors (r = 0.41595, p = 0.0007) and a trend for a relationship between adjusted height loss and osteoporosis risk factors (r = 0.2407, p = 0.0574). IMPLICATIONS FOR PRACTICE: Due to the great expense of current testing for bone mass density loss, the results of this study may help clinicians more readily identify markers for increased risk of osteoporosis through simple height measurements and osteoporosis risk factor assessments during annual visits.     

高血压病主要危险因素的Meta分析

目的研究中国居民高血压病的主要影响因素,探讨预防对策。方法通过检索中国知网收集2000年至2011年4月发表的所有与高血压病危险因素相关的病例对照研究,并采用Meta分析方法对纳入研究的结果进行定量合并分析,计算其合并危险因素暴露的比值比(OR值)及95%可信区间(CI)。结果共纳入11篇文献,研究了饮酒、吸烟、体质指数(BMI)、高血压家族史、盐摄入量、文化程度、经济状况等危险因素与高血压病之间的联系。其中BMI、高血压家族史、盐摄入量、吸烟、饮酒、经济状况与高血压病相关,其OR(95%CI)分别为2.45(2.09,2.87)、2.01(1.92,2.11)、1.68(1.23,2.28)、1.58(1.50,1.66)、2.17(2.04,2.31)及2.57(1.89,3.48)。结论 BMI、高血压家族史、盐摄入量、吸烟、饮酒、经济状况与高血压病相关,是高血压病发生的主要危险因素。     

脂肪酸的摄入与子宫内膜癌相关性的荟萃分析

目的: 系统评价脂肪的摄入与子宫内膜癌发病风险间的相关性。方法: 采用计算机检索PubMed、Web of science、EMbase、CBM、维普数据库、万方数据库,查找有关脂肪酸摄入与子宫内膜癌发病风险间相关性的流行病研究,文献检索时限至2016年6月止。所有文献均由2位研究者严格地按照纳入和排除标准筛选和提取,采用Stata 11.0软件分别对总脂肪、饱和脂肪酸、多不饱和脂肪酸及单一不饱和脂肪酸进行荟萃分析。结果: 最终纳入16篇研究,共6 480个研究对象。结果显示,与低摄入量人群相比,高总脂肪[OR=1.22,95%CI为1.02~1.46）、高饱和脂肪酸（OR=1.21,95%CI为1.00~1.47）摄入均增加了子宫内膜癌的发病危险。在亚型分析中,病例对照组合并OR值后亦显示,高总脂肪（OR=1.39,95%CI为1.14~1.70）、高饱和脂肪酸（OR=1.34,95%CI为1.13~1.60）摄入增加了子宫内膜癌的发病危险;在队列研究中未发现总脂肪酸水平与子宫内膜癌发病间具有相关性。在美国（OR=1.39,95%CI为1.00~1.93）的高能量饮食摄入人群（OR=2.17,95%CI为1.57~2.99）和吸烟人群（OR=1.30,95%CI为1.04~1.62）中,饱和脂肪酸高摄入均增加了子宫内膜癌的发病风险。结论: 病例对照研究显示,高摄入总脂肪及饱和脂肪酸升高了子宫内膜癌的发病风险。美国的高能量饮食摄入人群及吸烟人群中,饱和脂肪酸高摄入增加子宫内膜癌的发病风险。但尚未发现不饱和脂肪酸与子宫内膜癌发生间存在相关性。仍需纳入更多的流行病学研究,以探讨脂肪摄入与子宫内膜癌间的相关性。     

Combined oral contraceptives and the risk of myocardial infarction

The studies on the combined oral contraceptive (COC) pill and myocardial infarction are reviewed. A reasonable conclusion is that the COC pill causes a two-fold increase in the risk of myocardial infarction. There is a marked interaction with smoking. The pill causes coagulation changes and affects lipoprotein and carbohydrate metabolism and these changes provide a plausible explanation for its effect. However, there are dangers in using these surrogate end-points to predict which pills carry the greatest risk. This must depend on an assessment of the epidemiology, and at present third generation pills have not convincingly been shown to be safer in this regard. The risk of causing myocardial infarction in non-smokers is small but we should be wary of prescribing the pill to smokers over 34 years old and especially to smokers over 39 years old.     

Efficacy of topical vs intravenous tranexamic acid in reducing blood loss and promoting wound healing in bone surgery: A systematic review and meta-analysis

BACKGROUNDTranexamic acid (TXA) has been used as an anti-fibrinolytic drug for over half a century and has received much attention in recent decades.AIMTo evaluate the efficacy of topical vs intravenous TXA in reducing blood loss and promoting wound healing in bone surgery.METHODSFrom the electronic resources, PubMed, Cochrane Library, Embase, ISI, and Scopus were used to perform a literature search over the last 10 years between 2010 and 2020. EndNote™ X8 was used for managing the electronic resource. Searches were performed with mesh terms. The data were retracted blindly by two independent reviewers. Random effects were used to deal with potential heterogeneity and I² showed heterogeneity. Chi-square (I²) tests were used to quantify the extent of heterogeneity (P < 0.01 was considered statistically significant). The efficacy of topical TXA in reducing blood loss and promoting wound healing in bone surgery was compared with intravenous TXA and placebo.RESULTSAccording to the research design, 1360 potentially important research abstracts and titles were discovered in our electronic searches, and 18 papers remained in agreement with our inclusion criteria. It was found that TXA reduced 277.51 mL of blood loss compared to placebo, and there was no significant difference between topical TXA and IV TXA in reducing blood loss in bone surgery. Our analyses also showed that TXA significantly reduced blood transfusion compared to placebo and there was no significant difference between topical TXA and IV TXA.CONCLUSIONThe use of both topical and intravenous TXA are equally effective in reducing blood loss in bone surgery, which might be beneficial for wound healing after surgery.     

Smoking patterns among Jordanian health professionals: A study about the impediments to tobacco control in Jordan

Background

Little is known about Arab health professionals' smoking practices.

Aim

This is the first study to examine smoking practices among Arab health professionals.

Methods

Background: Little is known about Arab nurses and physicians' smoking patterns.

Aim

This study aims to examine smoking patterns among Arab nurses and physicians.

Methods

A total of 918 nurses and physicians participated in this study. Data were collected using the Global Professional Health Survey.

Results

About 38.8% are current smokers. The smoking percentages for male nurses and male physicians were high (83.8%, 94.6% respectively) compared to female nurses and female physicians (16.2%, 5.4% respectively). Approximately 53.8% wanted to quit and 60.6% had made previous quit attempts that lasted for more than two days. About 64.1% believed that nurses and physicians who smoke were less likely to advise patients to stop smoking. The predictors of smoking were: age when tried first cigarettes OR = 6.36, 95% CI = 4.48, 9.04; father smokes OR = 1.95, 95% CI = 1.40, 2.72; mother smokes OR = 1.99, 95% CI = 1.18, 3.39; shift work OR = 1.45, 95% CI = 1.04, 2.03; and the interaction (gender and profession) OR = 1.82, 95% CI = 1.55, 2.14.

Discussion

Effective interventions often begin with and/or depend on nurses and physicians being committed to smoking cessation. Given the very high smoking rates among nurses and physicians a key priority must be to provide quit smoking programs and to enable them to become effective champions of smoking cessation nationwide.     

Betel quid chewing and oral potential malignant disorders and the impact of smoking and drinking: A meta-analysis

BACKGROUNDOral potential malignant disorders (OPMDs) are a precancerous condition of oral disease. Several studies have found that betel quid chewing, smoking and alcohol drinking might be the risk factors of OPMDs. But the relationships of them, especially their interaction are still inconclusive.AIMTo evaluate the relationship between betel quid chewing and OPMDs and to explore the interaction of smoking and alcohol drinking on the relationship.METHODSWe searched PubMed, Web of Science, Embase and the Cochrane Library databases with items complete until January 2021 for relevant studies. The research data were extracted according to the inclusion criteria. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to evaluate the effect size. Subgroup analysis was performed to assess interactions between exposures and OPMDs. Relative excess risk of interaction (RERI) was used to estimate the size of interaction. RESULTSNine articles were selected in the final meta-analysis. The results showed that betel quid chewing (pooled OR: 8.70, 95%CI: 5.18-14.61), alcohol consumption (pooled OR: 1.95, 95%CI: 1.5-2.55), and smoking (pooled OR:4.35, 95%CI: 3.06-6.2) could significantly increase the risk of OPMDs compared to individuals without these behaviors. Smoking and alcohol drinking synergistically increased the association between betel quid chewing and OPMDs (pooled OR_(BQ+SM):14.38, 95%CI: 7.14-28.95; pooled OR_(BQ+DK): 11.12, 95%CI: 8.00-15.45, respectively). The RERI_(BQ+SM) and RERI_(BQ+DK) were 2.33 and 1.47, respectively.CONCLUSIONThe synergistic effects between smoking/drinking and betel quid highlights the importance of focusing on individuals with multiple exposures. Further study should be conducted to confirm these interactions.     

The HLA-DQB1 gene polymorphisms associated with cervical cancer risk: A meta-analysis

Human leukocyte antigens (HLA) alleles may affect the development of cervical cancer through immunologic control of human papillomavirus (HPV). The association between HLA-DQB1 alleles and risk of cervical cancer has been extensively studied, but the results obtained remain inconsistent. To explore a more extensive role of HLA-DQB1 alleles on cervical cancer risk, we carried out a meta-analysis including 4862 cases and 8988 controls from 22 published studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the strength of the association. The overall results suggested that HLA-DQB1*02 (OR = 0.91, 95% CI = 0.82–0.99), *03 (OR = 0.85, 95% CI = 0.74–0.97) and *0603 (OR = 0.62, 95% CI = 0.53–0.72) had a significantly association with decreased cervical cancer risk. In contrast, DQB1*05 (OR = 1.18, 95% CI = 1.01–1.38), *0301 (OR = 1.14, 95% CI = 1.06–1.23) and *0402 (OR = 1.31, 95% CI = 1.04–1.64) conferred a significantly higher risk to cervical cancer. Moreover, a significantly association with increased or decreased cervical cancer risk was found among Europeans and Asians after stratification of the HLA-DQB1 alleles by ethnicity. These findings supported that the HLA-DQB1 alleles may contribute to genetic susceptibility of cervical cancer. Further studies with a greater number of cases are expected to confirm our results.     

Association between BRCA1 rs799917 polymorphism and breast cancer risk: A meta-analysis of 19,878 subjects

Studies investigating the association between the BRCA1 rs799917 polymorphism and breast cancer risk have reported controversial results. In order to derive a more precise estimation of the relationship, we performed a comprehensive meta-analysis. A total of 8 articles comprising 19,878 subjects were included in this meta-analysis. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by Stata 11 software. Heterogeneity tests were conducted by Q test with I² value, and publication bias assessment was performed by Begg's funnel plot and Egger's test. The pooled results did not show any sufficient evidence approving the association between the BRCA1 rs799917 polymorphism and breast cancer risk in total population (T vs C: OR = 1.01, 95% CI = 0.97–1.06; TT vs CC: OR = 1.03, 95% CI = 0.93–1.13; CT vs CC: OR = 1.04, 95% CI = 0.92–1.16; TT + CT vs CC: OR = 1.04, 95% CI = 0.94–1.15; TT vs CT + CC: OR = 1.03, 95% CI = 0.94–1.12). In the further subgroup analyses, no significant associations were found in any comparison models according to ethnicity and source of controls. No publication bias was observed in this meta-analysis. In summary, based on the overall results, this meta-analysis strongly suggests that the BRCA1 rs799917 polymorphism is not associated with breast cancer risk.     

Barriers and facilitators in providing oral care to nursing home residents,from the perspective of care aides: A systematic review and meta-analysis

BackgroundOral health of nursing home residents is generally poor, with severe consequences for residents’ general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents.MethodsWe systematically searched the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence.ResultsWe included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care = 45% (15%–77%); care providers’ lack of knowledge, education or training in providing oral care = 24% (7%–47%); general difficulties in providing oral care = 26% (19%–33%); lack of time = 31% (17%–47%); general dislike of oral care = 19% (8%–33%); and lack of staff = 22% (13%–31%).ConclusionsWe found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents’ responsive behaviors and to improve care aides’ oral care knowledge are especially needed.