How to get started with a systematic review in epidemiology: an introductory guide for early career researchers

Background: systematic review is a powerful research tool which aims to identify and synthesize all evidence relevant to a research question. The approach taken is much like that used in a scientific experiment, with high priority given to the transparency and reproducibility of the methods used and to handling all evidence in a consistent manner.Early career researchers may find themselves in a position where they decide to undertake a systematic review, for example it may form part or all of a PhD thesis. Those with no prior experience of systematic review may need considerable support and direction getting started with such a project. Here we set out in simple terms how to get started with a systematic review.Discussion: advice is given on matters such as developing a review protocol, searching using databases and other methods, data extraction, risk of bias assessment and data synthesis including meta-analysis. Signposts to further information and useful resources are also given.Conclusion: a well-conducted systematic review benefits the scientific field by providing a summary of existing evidence and highlighting unanswered questions. For the individual, undertaking a systematic review is also a great opportunity to improve skills in critical appraisal and in synthesising evidence

Cigarette Smoking, Birthweight and Osteoporosis in Adulthood: Results from the Hertfordshire Cohort Study

We looked for interaction between early environment and adult lifestyle in determination of bone mineral content (BMC) and bone mineral density (BMD) among 498 men and 468 women for whom birth records were available. Participants completed a health questionnaire, and bone densitometry (DXA) of the lumbar spine and femoral neck performed

Deforestation: Correlations, Possible Causes and Some Implications

Changes in national forest areas during 1990-2000 are contrasted with other variables to illustrate correlations and provoke discussion about possible causes. Twenty-five statistically-significant correlations (including rural population, life expectancy, GDP, literacy, commerce, agriculture, poverty and inflation) are illustrated and a statistical model suggests that good governance, alternative employment opportunities, and payments for environmental services may be effective in combating deforestation. The data suggest that a global forest convention may need to be supported by substantial and carefully-targeted development assistance to foster good governance

Long-term outcome of patients with newly diagnosed chronic myeloid leukemia: a randomized comparison of stem cell transplantation with drug treatment.

Tyrosine kinase inhibitors represent today's treatment of choice in chronic myeloid leukemia (CML). Allogeneic hematopoietic stem cell transplantation (HSCT) is regarded as salvage therapy. This prospective randomized CML-study IIIA recruited 669 patients with newly diagnosed CML between July 1997 and January 2004 from 143 centers. Of these, 427 patients were considered eligible for HSCT and were randomized by availability of a matched family donor between primary HSCT (group A; N=166 patients) and best available drug treatment (group B; N=261). Primary end point was long-term survival. Survival probabilities were not different between groups A and B (10-year survival: 0.76 (95% confidence interval (CI): 0.69-0.82) vs 0.69 (95% CI: 0.61-0.76)), but influenced by disease and transplant risk. Patients with a low transplant risk showed superior survival compared with patients with high- (P<0.001) and non-high-risk disease (P=0.047) in group B; after entering blast crisis, survival was not different with or without HSCT. Significantly more patients in group A were in molecular remission (56% vs 39%; P=0.005) and free of drug treatment (56% vs 6%; P<0.001). Differences in symptoms and Karnofsky score were not significant. In the era of tyrosine kinase inhibitors, HSCT remains a valid option when both disease and transplant risk are considered

Looking forward through the past: identification of 50 priority research questions in palaeoecology

1. Priority question exercises are becoming an increasingly common tool to frame future agendas in conservation and ecological science. They are an effective way to identify research foci that advance the field and that also have high policy and conservation relevance. 2. To date, there has been no coherent synthesis of key questions and priority research areas for palaeoecology, which combines biological, geochemical and molecular techniques in order to reconstruct past ecological and environmental systems on time-scales from decades to millions of years. 3. We adapted a well-established methodology to identify 50 priority research questions in palaeoecology. Using a set of criteria designed to identify realistic and achievable research goals, we selected questions from a pool submitted by the international palaeoecology research community and relevant policy practitioners. 4. The integration of online participation, both before and during the workshop, increased international engagement in question selection. 5. The questions selected are structured around six themes: human–environment interactions in the Anthropocene; biodiversity, conservation and novel ecosystems; biodiversity over long time-scales; ecosystem processes and biogeochemical cycling; comparing, combining and synthesizing information from multiple records; and new developments in palaeoecology. 6. Future opportunities in palaeoecology are related to improved incorporation of uncertainty into reconstructions, an enhanced understanding of ecological and evolutionary dynamics and processes and the continued application of long-term data for better-informed landscape management

Can the use of volunteers improve mealtime care of adult patients or residents? A comprehensive literature review

Scope: malnutrition among older people in care settings is common and associated withadverse outcomes. Poor standards of mealtime care are reported, with one in fivepatients not receiving help with eating when required. We assessed the evidencefor volunteers improving mealtime care.Search Methods: the literature was searched in August 2008 using databases; MEDLINE®, CINHAL®, BNI and EMBASE. This identified 21 potentially relevant studies. Studieswere selected if they described the use of volunteers to assist adults at mealtimes in institutions and the effect this had on outcomes including nutritional intake andsatisfaction.Appraisal: seven studies fulfilled the criteria for inclusion. The methodology of 5 of the 7 studies was unclear due to the brevity of the report bringing into question the validity.Results: generally the review suggested the use of volunteers in mealtime care increasedsatisfaction of patients, relatives, volunteers, and staff concerning meal-time assistance (assessed using methods such as questionnaires and focus groups). One study found that the mean meal intake of 34 patients assisted to eat by a volunteer was increased by 26% in comparison to a matched group assisted by nursing staff.Conclusions: there is some evidence that volunteers can improve mealtime care of patients, however few well designed studies are reported. A detailed evaluation of the use of volunteers to improve the mealtime care in institutions, and any impact on patient health is required

Non-invasive assessment of lower limb geometry and strength using hip structural analysis and peripheral quantitative computed tomography: a population-based comparison

Hip fracture is the most significant complication of osteoporosis in terms of mortality, long-term disability and decreased quality of life. In the recent years, different techniques have been developed to assess lower limb strength and ultimately fracture risk. Here we examine relationships between two measures of lower limb bone geometry and strength; proximal femoral geometry and tibial peripheral quantitative computed tomography. We studied a sample of 431 women and 488 men aged in the range 59–71 years. The hip structural analysis (HSA) programme was employed to measure the structural geometry of the left hip for each DXA scan obtained using a Hologic QDR 4500 instrument while pQCT measurements of the tibia were obtained using a Stratec 2000 instrument in the same population. We observed strong sex differences in proximal femoral geometry at the narrow neck, intertrochanteric and femoral shaft regions. There were significant (p < 0.001) associations between pQCT-derived measures of bone geometry (tibial width; endocortical diameter and cortical thickness) and bone strength (strength strain index) with each corresponding HSA variable (all p < 0.001) in both men and women. These results demonstrate strong correlations between two different methods of assessment of lower limb bone strength: HSA and pQCT. Validation in prospective cohorts to study associations of each with incident fracture is now indicated

Physical performance and physical activity in older people: are developmental influences important?

Background: reduced physical performance and physical activity have serious health consequences, but adult determinants do not fully explain variation in older people. Objective: our objective was to investigate the relationship between early growth, physical performance and physical activity in older people. Methods: we studied 349 men and 280 women born 1931-1939 with known birth weight and weight at 1 year who were taking part in the Hertfordshire Cohort Study, UK. Physical performance was measured (3-m walk, chair rises and standing balance) and physical activity was assessed by questionnaire and converted to estimated energy expenditure. Results: poor balance was associated with lower birth weight (odds ratio [OR] for poor balance per standard deviation [SD] increase in birth weight = 0.68, p = 0.01) and weight at 1 year (OR for poor balance per SD increase in weight at 1 year = 0.67, p = 0.03) after adjustment for age and current size in men, but not in women. There were no significant positive relationships between early size and growth and the other measures of physical performance or physical activity in men or women. Conclusion: current lifestyle factors, particularly those affecting adult weight, may be more important than developmental influences on most measures of physical performance and physical activity in older peopl