METHODS: This systematic review and meta-analysis followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using CoCoPop mnemonic approach. We searched JSTOR, Scopus, PubMed, Web of Science, and MEDLINE databases for studies on the prevalence of malnutrition in refugee children from 1984 to August 2024 with restricted English language. The screening of research articles was undertaken using COVIDENCE 2.0 software. The JBI checklist was used to assess the methodological quality of the included articles. The meta analysis was carried out using MedCalc 22.018 software. The gray literature was manually searched from the reputed organizations focusing on refugee children and was narratively analyzed for malnutrition statistics. Furthermore, the corroboration of primary research articles and gray literature was conducted for comprehensive understanding.
RESULTS: The review included 10 full-text research articles, all with cross-sectional study design and 11 gray literatures. The 10 studies covered a total of 4,274 participants with 3,536 urban and 738 rural refugee children aged between 0 and 19 years [refugee children (n = 8) and refugee adolescents (n = 2)]. The sample size of the included studies varied between 58 and 1,087 and mostly from Bangladesh. The prevalence of stunting ranged from 3.9-75.4% in the included studies [pooled prevalence: 31.8% (95% CI: 18.6-46.6%)]; wasting between 0.3-24.3% [pooled prevalence:10.1% (95% CI: 4.6-17.3)]; underweight between 4.4-65% [pooled prevalence: 19.1% (95% CI: 10.8-29.2%)]; and overweight between 3 and 24% [pooled prevalence: 6.5% (95% CI: 2.6-12.1%)]. Time trend analysis of the prevalence of malnutrition showed a decreasing trend in underweight, an increasing trend for stunting and wasting, and overweight including a rising prevalence of dual burden of under-and overnutrition.
DISCUSSION: The study indicates a high prevalence of undernutrition and a rising prevalence of overnutrition -the Asian paradox of the double burden of malnutrition in refugee children living in South Asia. The coexisting double burden of malnutrition among refugee children calls for comprehensive programs and policies for the prevention and management of the double burden of malnutrition.
METHODS: A systematic search of PubMed, EMBASE, and Web of Science was conducted up to June 7, 2024, following PRISMA guidelines to identify studies related to COVID-19 vaccines and POTS. Eligible studies included randomized controlled trials, cohort studies, cross-sectional studies, case-control studies, case series, and case reports. Screening, data extraction, and quality assessment were independently performed by two reviewers using the Joanna Briggs Institute Checklists and the Newcastle-Ottawa Scale.
RESULTS: Of the 1,531 articles identified, 10 met the inclusion criteria, encompassing a total of 284,678 participants. These studies included five case reports, two case series, one cross-sectional study, one prospective observational study, and one cohort study. The cohort study reported that the odds of new POTS diagnoses post-vaccination were 1.33 (95% CI: 1.25-1.41) compared to the 90 days prior. In contrast, the post-infection odds were 2.11 (95% CI: 1.70-2.63), and the risk of POTS was 5.35 times higher (95% CI: 5.05-5.68) post-infection compared to post-vaccination. Diagnostic findings across studies included elevated norepinephrine levels and reduced heart rate variability. Reported management strategies involved ivabradine, intravenous therapies, and lifestyle modifications.
CONCLUSION: The risk of POTS following COVID-19 vaccination is lower than that observed post-SARS-CoV-2 infection; however, existing studies are limited by small sample sizes and methodological variability. Further research is needed to clarify the incidence, mechanisms, and long-term outcomes of vaccine-related POTS to inform effective clinical management strategies.
METHODS: We systematically searched PubMed, EMBASE, and Web of Science up until April 01, 2024, to find studies reporting the prevalence and severity of neurological and musculoskeletal complications associated with Lyme disease. Screening and data extraction were conducted using Nested Knowledge software. Two independent reviewers performed the quality assessment using the Newcastle-Ottawa Scale. Meta-analyses were performed using R software v4.3, employing a random-effects model.
RESULTS: Out of 3576 records, 17 studies were included, involving 3932 participants. These studies revealed significant prevalence of musculoskeletal symptoms (21.1%) and neurological disabilities (18%) among Lyme disease patients. The analysis showed a notable increase in risk for both complications in individuals with Lyme disease, with pooled Risk Ratios (RR) of 1.82 for musculoskeletal symptoms and 1.64 for neurological disabilities, indicating a significantly higher risk compared to control groups. Although heterogeneity across the studies was high, sensitivity analysis confirmed the consistency of our findings. Additionally, there was evidence of publication bias.
CONCLUSION: The study reveals significant neurological and musculoskeletal complications in Lyme disease patients, emphasizing the importance of early diagnosis, comprehensive treatment, and supportive care. The noted heterogeneity and potential publication bias highlight the need for transparent research and further study on long-term outcomes.
METHOD: A systematic search of PubMed, Embase, and Web of Science was conducted in accordance with the PRISMA framework and registered with PROSPERO (ID: CRD42025644604) to enhance transparency. The search, conducted up to January 2024, included studies focusing on the association between migraine and PPI use. Data screening and extraction were performed using Nested Knowledge software. Meta-analyses were conducted in R software, with heterogeneity assessed through the I² statistic. Pooled adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Sensitivity analyses were also performed to assess the robustness of the results. Gender and migraine subtype were considered in subgroup analyses. Additionally, the GRADE approach was applied to assess the certainty of the evidence across the pooled outcomes.
RESULTS: Five studies involving over 1.5 million participants met the inclusion criteria. The overall pooled adjusted odds ratio (aOR) was 2.508 (95% CI, 0.790-7.969; I² = 91.2%). However, there was a significant association in males (aOR, 3.875; 95% CI, 2.413-6.222; I² = 0%) but not in females (aOR, 2.475; 95% CI, 0.563-10.890; I² = 91.1%). No significant differences were found between migraine types: with aura (aOR, 2.079; 95% CI, 0.945-4.576; I² = 25.4%) and without aura (aOR, 2.524; 95% CI, 0.807-7.896; I² = 96.5%). The GRADE assessment indicated a very low certainty of the evidence.
CONCLUSION: This review found no significant overall association between PPI use and migraine. However, a significant association was observed in males but not in females. Further research is needed to clarify this association and explore the underlying causality mechanisms, and migraine subtypes, particularly why the association appears more pronounced in males.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: A literature search was conducted across databases including PubMed, Embase, Web of Science, and Cochrane on October 20, 2023. The included studies reported the number of pregnant women and the count of those who were dual users. Quality assessment was undertaken using the JBI tool. The pooled prevalence of dual use was determined via a random-effects model. All statistical analyses were executed using R software, version 4.3.
PROSPERO: CRD42023486020.
RESULTS: Eighteen studies were analyzed, encompassing 5,983,363 pregnant women. The meta-analysis indicated an overall prevalence of 4.6% (95% CI: 2.0-10.3) for dual users with significant heterogeneity (I2 = 100%). Subgroup analysis based on the country showed a prevalence of 4.9% (95% CI: 2.0 to 11.6) for USA and 8.1% (95% CI: 0.00 to 1.00) for UK. Meta-regression revealed reduction of prevalence of dual use from 2019 to 2023. A potential publication bias was indicated by the LFK index and the Doi plot.
CONCLUSION: The dual consumption of e-cigarettes and traditional tobacco in pregnant women is a significant health concern, with a notable prevalence. Given the established risks of tobacco smoking during pregnancy and the uncertainties surrounding e-cigarettes, more comprehensive research and public health interventions are urgently needed to address this issue.
METHODS: This review was conducted following the PRISMA guidelines and included studies up to March 2024 from PubMed, Embase, and Web of Science. Eligible studies were longitudinal, including prospective cohorts, nested case-controls, and post-hoc analyses of RCTs that reported stroke outcomes in relation to PPI use. Data were synthesized using random-effects meta-analysis models in R software version 4.3.
RESULTS: Our search yielded 41 studies encompassing over 800,000 participants globally. Meta-analysis of 14 observational studies revealed a slight but non-significant increased stroke risk among patients with prior CVD (pooled HR = 1.222, 95% CI: 0.963 to 1.481, I² = 78%). In contrast, analysis of 15 studies without prior CVD showed a modestly increased risk (pooled HR = 1.15, 95% CI: 1.023 to 1.288, I² = 98%). Five RCTs involving patients with CVD reported a pooled RR of 1.158 (95% CI: 0.914 to 1.466), indicating no significant risk increase.
CONCLUSION: The association between PPI use and stroke risk appears modest and is influenced by the presence of cardiovascular conditions. Clinical decision-making should consider individual patient risk profiles, and further high-quality studies are needed to guide safer PPI prescribing practices.
OBJECTIVE: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India.
METHODS: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators.
RESULTS: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions.
CONCLUSIONS: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas.
METHODS: Adhering the PRISMA 2020 guidelines and registered in the PROSPERO database, we conducted a systematic review and meta-analysis using the PubMed, Embase, and Web of Science databases up to October 2024. Nested Knowledge was used for screening and data extraction. Studies reporting quantitative data on the prevalence or mortality of dengue and leptospirosis co-infections were included. Data extraction and quality assessment were performed independently by two reviewers using the Modified Newcastle-Ottawa Scale. Statistical analyses, including prevalence and mortality estimation, sensitivity analysis were conducted using R, with heterogeneity evaluated by the I² statistic.
RESULTS: Out of 3,982 records, 14 studies met the eligibility criteria, yielding a pooled prevalence of dengue and leptospirosis co-infection at 2.33% (95% CI: 1.41-3.46%) across 16,638 participants, with significant heterogeneity (I² = 90%). The prediction interval for co-infection ranged from 0.05 to 7.27%. The pooled mortality rate among co-infected patients was 9.96% (95% CI: 0-53.49%), with moderate heterogeneity (I² = 71%). The prediction interval for mortality ranged from 0.00 to 100%. Publication bias was indicated by an LFK index of 2.52.
CONCLUSION: This meta-analysis revealed a moderate prevalence and a notable mortality rate for dengue and leptospirosis co-infections, with significant variability observed across different studies. Further research into the immunopathology and the implementation of integrated surveillance systems could enhance the effectiveness of diagnosis and treatment strategies in regions where these diseases are endemic.
METHOD: We extracted asthma data from the Global Burden of Disease database for South Asia (1990-2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Total Percentage change (TPC) in age-standardized rates of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated.
RESULTS: Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males.
CONCLUSION: Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.
METHODS: A comprehensive search was conducted across PubMed, Embase, and Web of Science, covering studies published up to September 30, 2024. We included peer-reviewed observational studies evaluating the link between cannabis consumption and the risk of asthma diagnosis. Data synthesis employed a random-effects meta-analysis to account for heterogeneity. R statistical software (version 4.4) was used for statistical analyses.
RESULTS: The search yielded 8 relevant studies after screening 1,887 records. The pooled odds ratio (OR) for the association between cannabis consumption and the risk of asthma diagnosis was 1.31, 95% confidence interval (CI): 1.19-1.44, indicating greater odds of having asthma compared to non-users. Moderate heterogeneity was observed (I² = 46%), and sensitivity analysis confirmed the robustness of the findings.
CONCLUSION: This systematic review and meta-analysis identifies a significant association between cannabis use and greater odds of having asthma. These findings emphasize the importance of raising awareness about the potential respiratory risks associated with cannabis use. Future research should prioritize identifying moderating factors, such as the frequency and mode of cannabis consumption, to enhance understanding of this association and provide a stronger evidence base for potential public health interventions.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: This analysis utilized data from the GBD study to assess age-standardized prevalence (ASPR), incidence (ASIR), disability-adjusted life years (DALYs) (ASDR), and mortality rates (ASMR) for COPD across Indian states. Joinpoint regression was used to analyze temporal trends, while ARIMA models predicted future incidence rates.
RESULTS: In 2021, the highest ASIR was observed in Rajasthan at 306.28, and the highest ASMR was observed in Uttarakhand at 227.19. Projections suggest that the ASIR for COPD in India will decrease from 265.16 in 2022 to 258.19 by 2031. The heatmap analysis identified states like Uttarakhand and Rajasthan as having the highest DALYs attributable to COPD risk factors, including air pollution and tobacco use.
CONCLUSION: COPD remains a public health challenge in India, with regional variability. Targeted interventions addressing air pollution, smoking cessation, and improved healthcare access are essential to mitigate the disease's future burden, particularly in high-risk regions.
METHODS: We conducted a comprehensive search across PubMed, Embase, and Web of Science until November 10 2024, selecting studies based on pre-defined criteria that involve adults with AF and measurements of VEGF levels. The selected studies included observational and experimental designs, excluding non-English and methodologically insufficient publications. Narrative synthesis was used for summarising the results.
RESULTS: Eight studies met the inclusion criteria. The studies show a general trend of elevated VEGF levels in AF patients compared to controls, with significant heterogeneity in findings across studies. VEGF subtypes such as VEGF-A and VEGF-D demonstrated stronger associations with AF risk compared to VEGF-C. These variations point to the complex role of VEGF in AF, influencing factors like angiogenesis, endothelial function, and inflammatory responses.
CONCLUSION: VEGF is potentially a significant contributor to AF pathophysiology, with its levels reflecting disease activity. The variability observed across studies suggests a need for standardized measurement approaches and further investigation into VEGF subtypes. Future research should focus on longitudinal studies to better understand the causal relationships and the potential of VEGF as a therapeutic target and biomarker in AF management.
CLINICAL TRIAL NUMBER: Not applicable.
METHODS: A comprehensive literature search was conducted across PubMed, Embase, and Web of Science up to July 30, 2024. Studies that met the inclusion criteria randomized controlled trials, cohort studies, case-control studies, and observational studies assessing the incidence of prostate cancer in GLP-1 RA-treated patients were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias tool. Meta-analysis was performed using a random effects model.
RESULTS: A total of five studies were included, analyzing data from diverse international contexts. The included studies showed a reduced risk of prostate cancer with both adjusted and unadjusted effect estimates with GLP-1 RAs. The meta-analysis revealed an RR of 0.72 (95% CI: 0.610 to 0.832), indicating a statistically significant 28% reduction in prostate cancer risk associated with GLP-1 RA use compared to placebo or other antidiabetic drugs. Moderate heterogeneity was observed (I2 = 51%). Sensitivity analysis confirmed the results.
CONCLUSION: The findings suggest a significant protective association between GLP-1 RA use and reduced prostate cancer risk in men, particularly those with T2DM. This supports the potential of GLP-1 RAs not only in diabetes management but also as a strategy to mitigate cancer risk. Further research is required to confirm these findings and explore the underlying mechanisms, considering different dosages, durations of therapy, and patient subgroups based on demographic and metabolic characteristics.
METHODS: Data for this study were sourced from the Global burden of disease (GBD) 2021 study, which utilizes a Bayesian meta-regression model to estimate mortality, prevalence, and disability-adjusted life years (DALYs). Spatial maps depicting the age-standardized prevalence rate and age-standardized mortality rate for neonatal disorders in South Asia were generated using QGIS software. Mortality forecasts for the period 2022-2031, attributed to various neonatal disorders, were produced employing the Auto-Regressive Integrated Moving Average model in R software. Additionally, an analysis of overall neonatal mortality trends from 1980 to 2021 was conducted, supplemented by a heat map that compares DALYs attributable to various neonatal disorders across South Asian countries in 2021.
RESULTS: Between 1980 and 2021, South Asia experienced a substantial decline in neonatal mortality rates, with India and Bangladesh leading the progress. Mortality decreased by 40%, while DALYs fell by 35%, despite a 15% increase in the prevalence. The prevalence of neonatal encephalopathy due to birth asphyxia and trauma surged by 355%, yet its mortality dropped by 31%. Pakistan recorded the highest neonatal mortality and disease burden, particularly for hemolytic disease and other neonatal jaundice and neonatal encephalopathy due to birth asphyxia and trauma. In India and Bangladesh, neonatal preterm birth and neonatal sepsis and other neonatal infections contributed most to mortality. Neonatal encephalopathy due to birth asphyxia and trauma accounted for the highest DALYs. Forecasts predict continued reductions in neonatal mortality across South Asia, except in Pakistan, where persistently high rates are expected till 2031.
CONCLUSION: For South Asian countries to meet the SDG target for neonatal mortality by 2030, intensified and continuous efforts are required. These efforts should focus on identifying high-risk pregnancies and improving the quality of care during childbirth to address the root causes and reduce preventable neonatal deaths.
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: A search was conducted across multiple databases until February 15, 2024. Observational studies that assessed the prevalence of gaming disorder were included. Nested Knowledge software was used for screening and data extraction. The quality assessment was performed using the Joanna Briggs Institute tool. Meta-analysis using a random effect model was used to synthesize prevalence rates. Statistical analyses were performed in R software version 4.3.
RESULTS: The meta-analysis included 84 studies covering a diverse geographical scope totaling 641,763 individuals. The pooled prevalence of gaming disorder was 8.6 % (95 % CI: 6.9 %-10.8 %), (I2 = 100 %). Subgroup analysis revealed varying prevalence rates by country, with China reporting the highest rate at 11.7 % (95 % CI: 8.6 %-15.7 %). Meta-regression analysis highlighted an increasing trend in the prevalence of gaming disorder over the years, underscoring the growing impact of digital technologies.
CONCLUSION: A significant prevalence of gaming disorder among adolescents is observed. With an increasing trend, fostering healthy gaming habits, enhancing awareness, and implementing effective intervention programs are crucial. This emphasizes the importance of global efforts in combating the growing challenge of gaming disorder among adolescents.
METHODS: A comprehensive search was conducted across PubMed, Embase, and Web of Science for studies published up to September 20, 2024. Observational studies assessing the association between ENDS use and COPD risk were included. A random-effects meta-analysis was performed using R statistical software (version 4.4). Tobacco smoking, a key confounder in COPD research, was accounted for in many included studies, with adjustments varying across studies.
RESULTS: Fifteen studies met the inclusion criteria. The pooled odds ratio (OR) for current ENDS use and COPD risk was 1.488 (95 % CI: 1.363-1.623). Former ENDS users had an OR of 1.839 (95 % CI: 1.513-2.234), and ever-users had an OR of 1.787 (95 % CI: 1.421-2.247). Sensitivity analyses confirmed the robustness of findings, and no publication bias was detected.
CONCLUSION: This meta-analysis provides evidence of a significant association between ENDS use and increased COPD risk, even after adjusting for tobacco smoking. Future research should standardize smoking adjustments and investigate the independent impact of ENDS use on COPD.
OBJECTIVE: This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.
METHODS: We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.
RESULTS: Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.
CONCLUSIONS: This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.
TRIAL REGISTRATION: PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.