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31.
《Clinical nutrition (Edinburgh, Scotland)》2020,39(6):1742-1752
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The Institute of Medicine distinguishes between programs based on who is targeted: the entire population (universal), those
at risk (selective), or persons exhibiting the early stages of use or related problem behavior (indicated). Evaluations suggest
that although universal programs can be effective in reducing and preventing substance use, selective and indicated programs
are both more effective and have greater cost-benefit ratios. This paper tests these assumptions by comparing the impact of
these program types in reducing and preventing substance use at the individual level (i.e., those exposed to intervention
services) and in the population (i.e., those exposed and not exposed to intervention services). A meta-analysis was performed
on 43 studies of 25 programs to examine program comparability across IOM categories. When examining unadjusted effect sizes
at the individual level, universal programs were modestly more successful in reducing tobacco use, but selective and indicated
programs were modestly more successful in reducing alcohol and marijuana use. When adjusted to the population level, the average
effect sizes for selective and indicated programs were reduced by approximately half. At the population level, universal programs
were more successful in reducing tobacco and marijuana use and selective and indicated programs were more successful in reducing
alcohol use. Editors’ Strategic Implications: The authors’ focus on the public health value of a prevention strategy is compelling and provides a model for analyses of
other strategies and content areas. 相似文献
34.
C Langenbach 《International journal of gynaecology and obstetrics》2006,92(1):10-18
OBJECTIVE: To assess misoprostol's ability to prevent postpartum hemorrhage (PPH) where no alternatives exist. Comparison to oxytocics demonstrates how similarly misoprostol achieves a level of effectiveness-obtainable only in hospitals-in remote locations around the world. METHOD: Using the Mantel-Haenszel fixed-effects model and the DerSirmonian and Laird random-effects model, summary statistics indicated that misoprostol's excess risk of PPH was only 4% when compared to oxytocics. RESULT: This risk difference was well within the range of expected results for all uterotonic agents and does not warrant branding misoprostol as an inferior drug. CONCLUSION: Conventional uterotonic drugs should not be used to set the lowest-accepted level of effectiveness in settings where they are entirely unsuitable. Continuing to weigh the benefits of one effective drug against another only delays the distribution of misoprostol in countries where it is the only feasible choice and must be measured against no treatment at all. 相似文献
35.
36.
P C G?tzsche 《Journal of clinical epidemiology》1990,43(12):1313-1318
In a meta-analysis of placebo controlled NSAID trials, the sensitivity of the effect variables was calculated as the correlation coefficient and as the difference between drug and placebo, divided by the placebo group standard deviation. The patient's global evaluation was the most sensitive variable overall. Pain was more sensitive than Ritchie's index. Several variables may be omitted from clinical trials, especially if two active drugs are being compared. For example, the best maximum estimate for the difference in ESR between NSAADs and placebo was 1.0 mm/hr (95% confidence interval −1.5 to 3.4 mm/hr), and for joint size 0.44% (−1.0 to 1.9%), corresponding to a quarter of a millimeter for each of the 10 joints usually measured. It is suggested to record only the patient's global evaluation, pain, and morning stiffness. 相似文献
37.
背景 流行病学研究表明,绝经后女性的高血压患病率高于老年男性。近年来,有关绝经后高血压的临床表现、病理特征、发病机制、治疗方法等受到越来越多的关注,但由于受到研究设计、样本量、人群特征、资源不足等因素的影响,其危险因素的研究结果不一致且缺乏全面报道。目的 运用系统评价方式探讨女性绝经后高血压的危险因素,为更好地预防和管理绝经后高血压提供循证证据。方法 于2022年1—5月,计算机检索中国知网、万方数据知识服务平台、中国生物医学文献服务系统、PubMed、EmBase、the Cochrane Library、Web of Science电子数据库,获取与绝经后高血压危险因素相关的队列及病例对照研究。检索时限为建库起至2022-05-20。由2名研究者独立根据纳入和排除标准筛选文献、提取资料,采用纽卡斯尔-渥太华量表(NOS)对所提取的文献进行偏倚风险评估,将得分≥6分(高质量)的文献纳入研究,最后采用RevMan 5.3对其进行Meta分析。结果 共纳入10篇文献,5篇为队列研究,5篇为病例对照研究,共涉及16个危险因素,总样本量为34 864,且均为高质量文献。Meta分析结果显示,... 相似文献
38.
J. Tamarelle A.C.M. Thiébaut B. de Barbeyrac C. Bébéar J. Ravel E. Delarocque-Astagneau 《Clinical microbiology and infection》2019,25(1):35-47
Background
The vaginal microbiota may modulate susceptibility to human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections. Persistent infection with a carcinogenic HPV is a prerequisite for cervical cancer, and C. trachomatis, N. gonorrheae and M. genitalium genital infections are all associated with pelvic inflammatory disease and subsequent infertility issues.Objectives
To evaluate the association between these infections and the vaginal microbiota.Data sources
The search was conducted on Medline and the Web of Science for articles published between 2000 and 2016.Study eligibility criteria
Inclusion criteria included a measure of association for vaginal microbiota and one of the considered STIs, female population, cohort, cross-sectional and interventional designs, and the use of PCR methods for pathogen detection.Methods
The vaginal microbiota was dichotomized into high-Lactobacillus vaginal microbiota (HL-VMB) and low-Lactobacillus vaginal microbiota (LL-VMB), using either Nugent score, Amsel's criteria, presence of clue cells or gene sequencing. A random effects model assuming heterogeneity among the studies was used for each STI considered.Results
The search yielded 1054 articles, of which 39 met the inclusion criteria. Measures of association with LL-VMB ranged from 0.6 (95% CI 0.3–1.2) to 2.8 (95% CI 0.3–28.0), 0.7 (95% CI 0.4–1.2) to 5.2 (95% CI 1.9–14.8), 0.8 (95% CI 0.5–1.4) to 3.8 (95% CI 0.4–36.2) and 0.4 (95% CI 0.1–1.5) to 6.1 (95% CI 2.0–18.5) for HPV, C. trachomatis, N. gonorrhoeae and M. genitalium infections, respectively.Conclusions
Although no clear trend for N. gonorrhoeae and M. genitalium infections could be detected, our results support a protective role of HL-VMB for HPV and C. trachomatis. Overall, these findings advocate for the use of high-resolution characterization methods for the vaginal microbiota and the need for longitudinal studies to lay the foundation for its integration in prevention and treatment strategies. 相似文献39.
In genome scans of ankylosing spondylitis (AS), with the exception of the HLA loci, linkage has not been easy to replicate across studies. We applied the genome-search meta-analysis (GSMA) method to genome scans of AS and spondyloarthropathy (SpA) to assess evidence for linkage across studies. Three AS genome scans and one SpA scan including 430 families with 1,048 affected individuals were used. All four original genome scans mainly analyzed Caucasian families. Seven bins had both Psumrnk and Pord<0.05, suggesting these bins most likely contain AS-linked loci; bin 6.2, 6.1, 6.3, 16.3, 19.2, 17.1, and 16.4. The GSMA produced significant genome-wide evidence for linkage on chromosome 6p22.3–6p21.1 (Psumrnk=0.000003), including the HLA locus. In addition to the HLA-B27 locus, strong linkage evidence was found on chromosome 6p25.3–6p22.3 (Psumrnk=0.0013) and 6p21.1–6p15 (Psumrnk=0.043). In the GSMA of four genome scans including one SpA study, the bin 9.4 (9q21.32–9q33.1) was newly found for linkage (Psumrnk=0.043, Pord=0.013). This GSMA added the evidence of the HLA loci as the greatest susceptibility factor to AS and showed evidences of chromosome 6, 16q, 19, 17p, and 9q as non-HLA susceptibility loci. 相似文献
40.
Atkinson L Paglia A Coolbear J Niccols A Parker KC Guger S 《Clinical psychology review》2000,20(8):1019-1040
This meta-analysis addresses the association between attachment security and each of three maternal mental health correlates. The meta-analysis is based on 35 studies, 39 samples, and 2,064 mother-child pairs. Social-marital support (r = .14; based on 16 studies involving 17 samples and 902 dyads), stress (r = .19; 13 studies, 14 samples, and 768 dyads), and depression (r = .18; 15 studies, 19 samples, and 953 dyads) each proved significantly related to attachment security. All constructs showed substantial variance in effect size. Ecological factors and approach to measuring support may explain the heterogeneity of effect sizes within the social-marital support literature. Effect sizes for stress varied according to the time between assessment of stress and assessment of attachment security. Among studies of depression, clinical samples yielded significantly larger effect sizes than community samples. We discuss these results in terms of measurement issues (specifically, overreliance on self-report inventories) and in terms of the need to study the correlates of change in attachment security, rather than just the correlates of attachment security per se. 相似文献