The effect direction plot revisited: application of the 2019 Cochrane Handbook guidance on alternative synthesis methods

Effect direction (evidence to indicate improvement, deterioration, or no change in an outcome) can be used as a standardized metric which enables the synthesis of diverse effect measures in systematic reviews. The effect direction (ED) plot was developed to support the synthesis and visualization of effect direction data. Methods for the ED plot require updating in light of new Cochrane guidance on alternative synthesis methods. To update the ED plot, statistical significance was removed from the algorithm for within‐study synthesis and use of a sign test was considered to examine whether patterns of ED across studies could be due to chance alone. The revised methods were applied to an existing Cochrane review of the health impacts of housing improvements. The revised ED plot provides a method of data visualization in synthesis without meta‐analysis that incorporates information about study characteristics and study quality, using ED as a common metric, without relying on statistical significance to combine outcomes of single studies. The results of sign tests, when appropriate, suggest caution in over‐interpreting apparent patterns in effect direction, especially when the number of included studies is small. The revised ED plot meets the need for alternative methods of synthesis and data visualization when meta‐analysis is not possible, enabling a transparent link between the data and conclusions of a systematic review. ED plots may be particularly useful in reviews that incorporate nonrandomized studies, complex systems approaches, and diverse sources of evidence, due to the variety of study designs and outcomes in such reviews

Award for Best Oral Presentation by a First Timer - Hunting zebra: retrieving rare disease guidelines

The EAHIL 2014 conference provided the opportunity to present a piece of work carried out by a team of informationprofessionals for RARE-Bestpractices (RBP), an international project to promote exchange of information andknowledge in rare disease. The authors work for Healthcare Improvement Scotland (HIS), a publicly fundedorganisation which uses evidence, scrutiny and improvement science to facilitate the delivery of safe, effective andpatient-centred healthcare. HIS is one of fifteen European partners contributing to RBP with our team providing thecore information professional support for the project. Work to develop a rare disease guideline search protocol waspresented in order to raise awareness of RARE-Bestpractices, and to demonstrate the engagement of informationprofessionals in multidisciplinary research projects

The contribution of natural experiments to the public health evidence base: four case studies in evidence synthesis

Background: Natural experiments and related study designs such as regression discontinuity (RD) are of increasing interest to researchers and decision makers because of their potential to address confounding and selection effects better than other observational study designs, with potentially greater applicability than controlled experiments. Research methods in health have been relatively slow to incorporate natural experiments compared to other fields such as economics and political science, but interest in these methods is growing rapidly. Objectives: This thesis aimed to (1) investigate the contribution of natural experimental designs to public health research, specifically the evaluation of public health interventions and environmental causes of disease and (2) explore how systematic review methods might be applied to make better use of natural experiments to inform public health and policy. Methods: The thesis comprises four case studies, including a systematic review of RD studies of health outcomes, a systematic review of RD studies of minimum legal drinking age (MLDA) legislation, development of a critical appraisal tool for RD studies, and a meta-review of endocrine-disrupting chemicals (EDCs) and breast cancer risk. Review protocols were registered in the PROSPERO database. Results: The first systematic review identified 181 RD studies of health outcomes which spanned a wide range of public health and policy questions, showing that this natural experimental design has been more widely applied than previously appreciated. Thematic analysis of the forcing variables and threshold rules used in these studies will aid in future applications of the design. The MLDA review of 17 econometric analyses identified challenges in the synthesis of natural experimental studies. The review identified evidence that MLDA has a causal effect on mortality and on alcohol-related hospital admissions. A ten-item checklist specific to the methodological requirements of RD designs was developed based on standards for RD produced by the What Works Clearinghouse; only 5% of the 181 studies met all ten criteria. The meta-review included 15 systematic reviews of EDCs and breast cancer risk; no primary studies in the review were identified as natural experiments. Conclusions: Natural experiments have the potential to support stronger causal inference through designs that address selection effects and confounding. For these designs to be translated into better evidence to inform decision-making, systematic reviews need to be able to identify and represent in detail the differences among non-randomised study designs. To do this requires further development of systematic review methods in order to synthesise results from econometric models and assess the quality of natural experimental studies

Improving the retrieval and dissemination of rare disease guidelines and research recommendations: a RARE-Bestpractices initiative

No abstract available

Report of an international workshop to explore the utility of the AGREE II instrument for appraisal of rare disease guidelines

No abstract available

The effect of school summer holidays on inequalities in children and young people’s mental health and cognitive ability in the UK using data from the millennium cohort study

BACKGROUND: Summer learning loss has been the subject of longstanding concern among researchers, the public and policy makers. The aim of the current research was to investigate inequality changes in children’s mental health and cognitive ability across the summer holidays. METHODS: We conducted linear and logistic regression analysis of mental health (borderline-abnormal total difficulty and prosocial scores on the strengths and difficulties questionnaire (SDQ)) and verbal cognitive ability (reading, verbal reasoning or vocabulary) at ages 7, 11 and 14, comparing UK Millennium Cohort Study members who were interviewed before and after the school summer holidays. Inequalities were assessed by including interaction terms in the outcome models between a discrete binary variable with values representing time periods and maternal academic qualifications. Coefficients of the interaction terms were interpreted as changes from the pre- to post-holiday period in the extent of inequality in the outcome between participants whose mothers had high or low educational qualifications. Separate models were fitted for each age group and outcome. We used inverse probability weights to allow for differences in the characteristics of cohort members assessed before and after the summer holidays. RESULTS: Mental health (borderline/abnormal SDQ total and prosocial scores) at ages 7 and 14 worsened and verbal cognitive ability scores at age 7 were lower among those surveyed after the summer holidays. Mental health inequalities were larger after the holidays at age 7 ([OR = 1.4; 95%CI (0.6, 3.2) and 14: [OR = 1.5; 95%CI (0.7, 3.2)], but changed little at age 11 (OR = 0.9; 95%CI (0.4, 2.6)]. There were differences in pro-social behaviours among those surveyed before/after the school holidays at age 14 [OR = 1.2; 95%CI (0.5, 3.5)] but not at age 7 or 11. There was little change in inequalities in verbal cognitive ability scores over the school holidays [Age 7: b = 1.3; 95%CI (− 3.3, 6.0); Age 11: b = − 0.7; 95%CI (− 4.3, 2.8); Age 14: b = − 0.3; 95%CI (− 1.0, 0.4)]. CONCLUSION: We found inequalities in mental health and cognitive ability according to maternal education, and some evidence or worsening mental health and mental health inequalities across school summer holidays. We found little evidence of widening inequalities in verbal cognitive ability. Widespread school closures during the COVID-19 restrictions have prompted concerns that prolonged closures may widen health and educational inequalities. Management of school closures should focus on preventing or mitigating inequalities that may arise from differences in the support for mental health and learning provided during closures by schools serving more or less disadvantaged children. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-022-12540-2

The long-term health effects of attending a selective school: a natural experiment

Background: Education is widely associated with better physical and mental health, but isolating its causal effect is difficult because education is linked with many socioeconomic advantages. One way to isolate education’s effect is to consider environments where similar students are assigned to different educational experiences based on objective criteria. Here we measure the health effects of assignment to selective schooling based on test score, a widely debated educational policy. Methods: In 1960s Britain, children were assigned to secondary schools via a test taken at age 11. We used regression discontinuity analysis to measure health differences in 5039 people who were separated into selective and non-selective schools this way. We measured selective schooling’s effect on six outcomes: mid-life self-reports of health, mental health, and life limitation due to health, as well as chronic disease burden derived from hospital records in mid-life and later life, and the likelihood of dying prematurely. The analysis plan was accepted as a registered report while we were blind to the health outcome data. Results: Effect estimates for selective schooling were as follows: self-reported health, 0.1 worse on a 4-point scale (95%CI − 0.2 to 0); mental health, 0.2 worse on a 16-point scale (− 0.5 to 0.1); likelihood of life limitation due to health, 5 percentage points higher (− 1 to 10); mid-life chronic disease diagnoses, 3 fewer/100 people (− 9 to + 4); late-life chronic disease diagnoses, 9 more/100 people (− 3 to + 20); and risk of dying before age 60, no difference (− 2 to 3 percentage points). Extensive sensitivity analyses gave estimates consistent with these results. In summary, effects ranged from 0.10–0.15 standard deviations worse for self-reported health, and from 0.02 standard deviations better to 0.07 worse for records-derived health. However, they were too imprecise to allow the conclusion that selective schooling was detrimental. Conclusions: We found that people who attended selective secondary school had more advantaged economic backgrounds, higher IQs, higher likelihood of getting a university degree, and better health. However, we did not find that selective schooling itself improved health. This lack of a positive influence of selective secondary schooling on health was consistent despite varying a wide range of model assumptions

Transmission of SARS-CoV-2 in educational settings in 2020: a review

Objectives: School closures have been used as a core non pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic.Methods: This literature review assessed studies published between December 2019 and April 1, 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The study Population was restricted to people 1-17 years old (excluding neonatal transmission), the Concept was to assess child-to-child and child-to-adult transmission, while the Context was to assess specifically educational setting transmission.Results: Fifteen studies met inclusion criteria, ranging from daycare centers to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020-2021 school year. In principle although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low -when NPI measures are implemented in parallel. Moreover, although the evidence was limited there was an indication that younger children may have a lower SAR than adolescents. Conclusions: Transmission in educational settings in 2020 was minimal -when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children