Adherence to antiretroviral therapy among HIV-infected prisoners : a systematic review and meta-analysis

Data on antiretroviral therapy (ART) adherence among prison inmates are limited and not previously synthesized in a systematic manner. The objective of this study was to provide accurate and up-to-date ART adherence estimates among prison inmates. We searched electronic databases for all studies reporting adherence as a primary or secondary outcome among prison inmates. A random-effects model was used to pool adherence rates; sensitivity, heterogeneity and publication bias were assessed. Eleven studies involving 2895 HIV-infected prison inmates were included. The studies were carried out between 1992 and 2011 and reported between 1998 and 2013. A pooled analysis of all studies indicated a pooled estimate of 54.6% (95% confidence interval 48.1–60.9%) of prison inmates had adequate (≥95%) ART adherence. The adherence estimates were significantly higher among cross-studies and studies that used self-reported measures. In summary, our findings indicate that optimal adherence remains a challenge among prison inmates. It is crucial to monitor ART adherence and develop appropriate interventions to improve adherence among these population

Antiretroviral therapy and increased blood pressure in people living with HIV in a sub-Saharan African setting: investigating a plausible causal link using observational data

Whether the epidemiological association between antiretroviral therapy and increased blood pressure is of a causal nature remains largely unknown. The transition from association to causation could represent a fundamental step for taking preventive measures against hypertension and its untoward effects. Such preventive measures are especially crucial for people living with HIV in sub-Saharan African countries, where HIV is most widespread, trends in cardiovascular disease risk factors are rising persistently, and antiretroviral treatment coverage rates are rapidly increasing. Aims and objectives • To review the evidence for the epidemiological associations of antiretroviral therapy with increased blood pressure and other cardiovascular disease risk factors, and to obtain comprehensive estimates of the strengths of these associations in people living with HIV worldwide (Evidence synthesis). • To examine the epidemiological association between antiretroviral therapy and increased blood pressure using Hill’s criteria of causation (mini-review). • To investigate a plausible causal link between antiretroviral therapy and increased blood pressure among HIV-infected patients in a sub-Saharan setting using appropriate statistical methods (primary data analysis). Methods Evidence synthesis: A series of systematic reviews with meta-analyses were conducted to examine the associations of antiretroviral therapy with cardiovascular disease risk factors. Studies were sought from electronic databases and cross-references of relevant articles. Studies in which blood pressure and other cardio-metabolic outcomes were compared between HIV-infected adults naïve and exposed to antiretroviral therapy were eligible for the meta-analyses. The data from these studies were combined using random-effects meta-analyses to obtain pooled estimates of the associations between antiretroviral therapy and each cardio-metabolic outcome. Mini-review: Each of Hill’s criteria of causation was examined separately with regards to the association between antiretroviral therapy and increased blood pressure. Primary data analysis: Four hundred and six HIV-infected adults―306 antiretroviral-exposed and 100 antiretroviral-naïve―were recruited from a tertiary HIV clinic in semi-urban Nigeria between August and November 2014 as part of a cross-sectional study. To assess if antiretroviral therapy improves the prediction of hypertension, candidate logistic regression models for predicting hypertension were compared using Nagelkerke’s R2 and parameter estimates. Structural equation models were fitted to determine the indirect effects of antiretroviral therapy on blood pressure through body mass index, waist circumference, blood glucose level, and sleep quality, while controlling for socio-demographic and clinical characteristics. A propensity score matching model was fitted to examine the average treatment effects on the treated (ATT) of antiretroviral therapy on systolic and diastolic blood pressure. Results Evidence synthesis: Ninety-one observational studies comprising data for 83,669 HIV-infected patients were included in the meta-analyses. Cardio-metabolic measures were significantly higher among antiretroviral-exposed patients, compared to their naïve counterparts as shown in the forest plots below: Summary estimates of the pooled associations between antiretroviral therapy and cardio-metabolic outcomes (continuous) ART, antiretroviral therapy; CI, confidence interval; N, number of studies included in the meta-analyses. Summary plot shows ART is significantly associated with increases in all cardio-metabolic outcome measures. Summary estimates of the pooled associations between antiretroviral therapy and cardio-metabolic outcomes (categorical) CI, confidence interval; N, number of studies included in the meta-analyses. With the exception of combined overweight/obesity, ART is significantly associated with increased risk of cardio-metabolic disorders. Mini-review: The association between antiretroviral therapy and increased blood pressure fulfilled all of Hill’s criteria of causation, with the exception of ‘specificity’. Nonetheless, one would not expect the exposure to be specific in the context of a multifactorial condition, such as high blood pressure. Primary data analysis: Of 400 HIV-infected patients with reported hypertension status, 60 (15%) were diagnosed as hypertensive. Other important findings of primary data analysis include the following: • Without considering antiretroviral treatment status, the best parsimonious model for predicting hypertension comprised age, body mass index, family history of hypertension, and sleep quality (R2 = 0.265). The extent to which these variables fit within the predictive model was improved slightly when antiretroviral treatment status was included (R2 = 0.274). • The indirect effects of antiretroviral therapy on systolic (coefficient = 0.94, 95% CI = 0.73 to 2.43) and diastolic blood pressure (coefficient = 0.64, 95% CI = 0.16 to 2.09) through waist circumference remained statistically significant after adjusting for age, sex, lifestyle factors, CD4 cell count, and HIV infection duration. • After propensity score-matching, 25% of the initial population sample were dropped, so that 229 patients on antiretroviral therapy were matched to 74 antiretroviral-naïve patients. In this propensity score-matched sample, the estimated ATT of the effects of antiretroviral therapy on systolic (7.85 mmHg, 95% CI = 3.72 to 15.68) and diastolic blood pressure (7.45 mmHg, 95% CI = 4.99 to 13.61) remained statistically significant after achieving a balanced distribution of baseline covariates between antiretroviral-naïve and exposed patients. Conclusion Overall, antiretroviral therapy is potentially the single most consistent correlate of high blood pressure (and other cardiovascular disease risk factors) in people living with HIV. These findings also suggest a high probability that the epidemiological association between antiretroviral therapy and increased blood pressure may be causal. People living with HIV in sub-Saharan African countries may benefit from regular hypertension screening and other cardiovascular risk assessments after the commencement of antiretroviral therapy. Future studies should identify what phenotypes on the HIV clinical spectrum are most susceptible to the effects of antiretroviral therapy on blood pressure and other cardio-metabolic parameters, as well as the efficacies of targeted iinterventions on these phenotypes

Prevalence of Hypertension in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

We aimed to obtain overall and regional estimates of hypertension prevalence, and to examine the pattern of this disease condition across different socio-demographic characteristics in low-and middle-income countries. We searched electronic databases from inception to August 2015. We included population-based studies that reported hypertension prevalence using the current definition of blood pressure ≥140/90 mm Hg or self-reported use of antihypertensive medication. We used random-effects meta-analyses to pool prevalence estimates of hypertension, overall, by World Bank region and country income group. Meta-regression analyses were performed to explore sources of heterogeneity across the included studies. A total of 242 studies, comprising data on 1,494,609 adults from 45 countries, met our inclusion criteria. The overall prevalence of hypertension was 32.3% (95% confidence interval [CI] 29.4-35.3), with the Latin America and Caribbean region reporting the highest estimates (39.1%, 95% CI 33.1-45.2). Pooled prevalence estimate was also highest across upper middle income countries (37.8%, 95% CI 35.0-40.6) and lowest across low-income countries (23.1%, 95% CI 20.1-26.2). Prevalence estimates were significantly higher in the elderly (≥65 years) compared with younger adults (\u3c65 \u3eyears) overall and across the geographical regions; however, there was no significant sex-difference in hypertension prevalence (31.9% vs 30.8%, P = 0.6). Persons without formal education (49.0% vs 24.9%, P \u3c 0.00001), overweight/obese (46.4% vs 26.3%, P \u3c 0.00001), and urban settlers (32.7% vs 25.2%, P = 0.0005) were also more likely to be hypertensive, compared with those who were educated, normal weight, and rural settlers respectively. This study provides contemporary and up-to-date estimates that reflect the significant burden of hypertension in low- and middle-income countries, as well as evidence that hypertension remains a major public health issue across the various socio-demographic subgroups. On average, about 1 in 3 adults in the developing world is hypertensive. The findings of this study will be useful for the design of hypertension screening and treatment programmes in low- and middle-income countries

Household air pollution and high blood pressure : a secondary analysis of the 2016 Albania Demographic Health and Survey dataset

Background: Hypertension is a significant public health problem in low- and middle-income countries (LMICs). This study aimed to examine the association between household air pollution (HAP) and blood pressure using data from the 2016 Albania Demographic Health and Survey (DHS). Methods: We computed the odds ratio (OR) for the prevalence of hypertension between respondents exposed to clean fuels (e.g., electricity, liquid petroleum gas, natural gas, and biogas) and respondents exposed to polluting fuel (e.g., kerosene, coal/lignite, charcoal, wood, straw/shrubs/grass, and animal dung). Result: The results show that participants exposed to household polluting fuels in Albania were 17% more likely to develop hypertension than those not exposed to household air pollution (OR = 1.17, 95% CI 1.10 to 1.24). Subgroup analysis revealed that the odds of hypertension were more significant among women (OR = 1.22, 95% CI 1.13 to 1.31), rural residents (OR = 1.12, 95% CI 1.04 to 1.22), and participants aged >24 years (OR = 1.35, 95% CI 1.12 to 1.62) who were exposed to household polluting fuels compared to their counterparts who were not exposed. In summary, the results of the study show significant associations between household air pollution and hypertension risk overall, especially among women, rural dwellers, and people aged >24 years in Albania. Conclusion: In this study, an association between household air pollution and the risk of hypertension was found, particularly among low-income households, those with no education, women, and those who live in rural areas

Determining optimal strategies for primary prevention of cardiovascular disease : systematic review, cost-effectiveness review and network meta-analysis protocol

Background: Despite recent improvements in the burden of cardiovascular disease (CVD) in the UK, deaths from CVD are relatively high compared with other high-income countries. An estimated 7 million people in the UK are living with CVD, and the healthcare cost is approximately £11 billion annually. In more than 90% of cases, the risk of a first heart attack is thought to be related to modifiable risk factors including smoking, poor diet, lipidemia, high blood pressure, inactivity, obesity and excess alcohol consumption. The aim of the study is to synthesise evidence for the comparative effectiveness and cost-effectiveness of different interventions for the primary prevention of CVD. Methods: We will systematically search databases (for example, MEDLINE (Ovid), Embase (Ovid), Cochrane Library) and the reference lists of previous systematic reviews for randomised controlled trials that assess the effectiveness and cost-effectiveness of any form of intervention aimed at adult populations for the primary prevention of CVD, including but not limited to lipid lowering medications, blood pressure lowering medications, antiplatelet agents, nutritional supplements, dietary interventions, health promotion programmes, physical activity interventions or structural and policy interventions. Interventions may or may not be targeted at high-risk groups. Publications from any year will be considered for inclusion. The primary outcome will be all cause mortality. Secondary outcomes will be cardiovascular diseases related mortality, major cardiovascular events, coronary heart disease, incremental costs per quality-adjusted life years gained. If data permits, we will use network meta-analysis to compare and rank effectiveness of different interventions, and test effect modification of intervention effectiveness using subgroup analyses and meta-regression analyses. Discussion: The results will be important for policymakers when making decisions between multiple possible alternative strategies to prevent CVD. Compared to results from existing multiple separate pairwise meta-analyses, this overarching synthesis of all relevant work will enhance decision-making. The findings will be crucial to inform evidence-based priorities and guidelines for policies and planning prevention strategies of CVD

Rapid antigen detection and molecular tests for group A streptococcal infections for acute sore throat : systematic reviews and economic evaluation

Background Sore throat is a common condition caused by an infection of the airway. Most cases are of a viral nature; however, a number of these infections may be caused by the group A Streptococcus bacterium. Most viral and bacterial sore throat infections resolve spontaneously within a few weeks. Point-of-care testing in primary care has been recognised as an emerging technology for aiding targeted antibiotic prescribing for sore throat in cases that do not spontaneously resolve. Objective Systematically review the evidence for 21 point-of-care tests for detecting group A Streptococcus bacteria and develop a de novo economic model to compare the cost-effectiveness of point-of-care tests alongside clinical scoring tools with the cost-effectiveness of clinical scoring tools alone for patients managed in primary care and hospital settings. Data sources Multiple electronic databases were searched from inception to March 2019. The following databases were searched in November and December 2018 and searches were updated in March 2019: MEDLINE [via OvidSP (Health First, Rockledge, FL, USA)], MEDLINE In-Process & Other Non-Indexed Citations (via OvidSP), MEDLINE Epub Ahead of Print (via OvidSP), MEDLINE Daily Update (via OvidSP), EMBASE (via OvidSP), Cochrane Database of Systematic Reviews [via Wiley Online Library (John Wiley & Sons, Inc., Hoboken, NJ, USA)], Cochrane Central Register of Controlled Trials (CENTRAL) (via Wiley Online Library), Database of Abstracts of Reviews of Effects (DARE) (via Centre for Reviews and Dissemination), Health Technology Assessment database (via the Centre for Reviews and Dissemination), Science Citation Index and Conference Proceedings [via the Web of Science™ (Clarivate Analytics, Philadelphia, PA, USA)] and the PROSPERO International Prospective Register of Systematic Reviews (via the Centre for Reviews and Dissemination). Review methods Eligible studies included those of people aged ≥ 5 years presenting with sore throat symptoms, studies comparing point-of-care testing with antibiotic-prescribing decisions, studies of test accuracy and studies of cost-effectiveness. Quality assessment of eligible studies was undertaken. Meta-analysis of sensitivity and specificity was carried out for tests with sufficient data. A decision tree model estimated costs and quality-adjusted life-years from an NHS and Personal Social Services perspective. Results The searches identified 38 studies of clinical effectiveness and three studies of cost-effectiveness. Twenty-six full-text articles and abstracts reported on the test accuracy of point-of-care tests and/or clinical scores with biological culture as a reference standard. In the population of interest (patients with Centor/McIsaac scores of ≥ 3 points or FeverPAIN scores of ≥ 4 points), point estimates were 0.829 to 0.946 for sensitivity and 0.849 to 0.991 for specificity. There was considerable heterogeneity, even for studies using the same point-of-care test, suggesting that is unlikely that any single study will have accurately captured a test’s true performance. There is some randomised controlled trial evidence to suggest that the use of rapid antigen detection tests may help to reduce antibiotic-prescribing rates. Sensitivity and specificity estimates for each test in each age group and care setting combination were obtained using meta-analyses where appropriate. Any apparent differences in test accuracy may not be attributable to the tests, and may have been caused by known differences in the studies, latent characteristics or chance. Fourteen of the 21 tests reviewed were included in the economic modelling, and these tests were not cost-effective within the current National Institute for Health and Care Excellence’s cost-effectiveness thresholds. Uncertainties in the cost-effectiveness estimates included model parameter inputs and assumptions that increase the cost of testing, and the penalty for antibiotic overprescriptions. Limitations No information was identified for the elderly population or pharmacy setting. It was not possible to identify which test is the most accurate owing to the paucity of evidence. Conclusions The systematic review and the cost-effectiveness models identified uncertainties around the adoption of point-of-care tests in primary and secondary care settings. Although sensitivity and specificity estimates are promising, we have little information to establish the most accurate point-of-care test. Further research is needed to understand the test accuracy of point-of-care tests in the proposed NHS pathway and in comparable settings and patient groups

A Review of Energy Consumption in Foundry Industry

Energy is a multiplying factor which allows man to translate various raw material and resources into useful items to meet the daily demands and necessities of human beings. Foundry technology involved casting from molten metal transferred into a mould and permitted to harden under varying conditions depending on the purpose. This paper reviews the foundry industry as an energy exhaustive industry, in the sense that it requires energy in various forms such as electrical, heat and mechanical to carry out various engineering processes to deliver the appropriate casting required. It also reviews the different methods are currently being employed to make the manufacturing process more efficient and each of them have led to an increase in energy demand. It is affirmed that the new methods involved in foundry and their energy management policy can led to more efficient energy consumption for casted product

One hundred years of hypertension research : a topic modelling study

Background: Due to scientific and technical advancements in the field, published hypertension research has developed substantially during the last decade. Given the amount of scientific material published in this field, identifying the relevant information is difficult. We used topic modeling, which is a strong approach for extracting useful information from enormous amounts of unstructured text. Objective: This study aims to use a machine learning algorithm to uncover hidden topics and subtopics from 100 years of peer-reviewed hypertension publications and identify temporal trends. Methods: The titles and abstracts of hypertension papers indexed in PubMed were examined. We used the latent Dirichlet allocation model to select 20 primary subjects and then ran a trend analysis to see how popular they were over time. Results: We gathered 581,750 hypertension-related research articles from 1900 to 2018 and divided them into 20 topics. These topics were broadly categorized as preclinical, epidemiology, complications, and therapy studies. Topic 2 (evidence review) and topic 19 (major cardiovascular events) are the key (hot topics). Most of the cardiopulmonary disease subtopics show little variation over time, and only make a small contribution in terms of proportions. The majority of the articles (414,206/581,750; 71.2%) had a negative valency, followed by positive (119, 841/581,750; 20.6%) and neutral valency (47,704/581,750; 8.2%). Between 1980 and 2000, negative sentiment articles fell somewhat, while positive and neutral sentiment articles climbed substantially. Conclusions: The number of publications has been increasing exponentially over the period. Most of the uncovered topics can be grouped into four categories (ie, preclinical, epidemiology, complications, and treatment-related studies)

Static charged perfect fluid spheres in general relativity

Interior perfect fluid solutions for the Reissner-Nordstrom metric are studied on the basis of a new classification scheme. General formulas are found in many cases. Explicit new global solutions are given as illustrations. Known solutions are briefly reviewed.Comment: 23 pages, Revtex (galley), journal version, to appear in Phys.Rev.

Factors associated with attendance at screening for breast cancer : a systematic review and meta-analysis

Objective: Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance. Design: CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987–June 2019, and reporting attendance in relation to at least one patient-level factor. Data synthesis: Independent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible. Results: Of 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence. Conclusions: Attendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated. Trial registration number: CRD42016051597