Externally validated prediction models for pre‐eclampsia:systematic review and meta‐analysis

Objective: This systematic review and meta‐analysis aimed to evaluate the performance of existing externally validated prediction models for pre‐eclampsia (PE) (specifically, any‐onset, early‐onset, late‐onset and preterm PE). Methods: A systematic search was conducted in five databases (MEDLINE, EMBASE, Emcare, CINAHL and Maternity & Infant Care Database) and using Google Scholar/reference search to identify studies based on the Population, Index prediction model, Comparator, Outcome, Timing and Setting (PICOTS) approach until 20 May 2023. We extracted data using the CHARMS checklist and appraised the risk of bias using the PROBAST tool. A meta‐analysis of discrimination and calibration performance was conducted when appropriate. Results: Twenty‐three studies reported 52 externally validated prediction models for PE (one preterm, 20 any‐onset, 17 early‐onset and 14 late‐onset PE models). No model had the same set of predictors. Fifteen any‐onset PE models were validated externally once, two were validated twice and three were validated three times, while the Fetal Medicine Foundation (FMF) competing‐risks model for preterm PE prediction was validated widely in 16 different settings. The most common predictors were maternal characteristics (prepregnancy body mass index, prior PE, family history of PE, chronic medical conditions and ethnicity) and biomarkers (uterine artery pulsatility index and pregnancy‐associated plasma protein‐A). The FMF model for preterm PE (triple test plus maternal factors) had the best performance, with a pooled area under the receiver‐operating‐characteristics curve (AUC) of 0.90 (95% prediction interval (PI), 0.76–0.96), and was well calibrated. The other models generally had poor‐to‐good discrimination performance (median AUC, 0.66 (range, 0.53–0.77)) and were overfitted on external validation. Apart from the FMF model, only two models that were validated multiple times for any‐onset PE prediction, which were based on maternal characteristics only, produced reasonable pooled AUCs of 0.71 (95% PI, 0.66–0.76) and 0.73 (95% PI, 0.55–0.86). Conclusions: Existing externally validated prediction models for any‐, early‐ and late‐onset PE have limited discrimination and calibration performance, and include inconsistent input variables. The triple‐test FMF model had outstanding discrimination performance in predicting preterm PE in numerous settings, but the inclusion of specialized biomarkers may limit feasibility and implementation outside of high‐resource settings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology

Undernutrition among Ethiopian adults living with HIV: a meta-analysis.

BackgroundMalnutrition and human immunodeficiency virus (HIV) are interlaced in a vicious cycle and worsened in low and middle-income countries. In Ethiopia, even though individuals are dually affected by both malnutrition and HIV, there is no a nationwide study showing the proportion of malnutrition among HIV-positive adults. Consequently, this review addressed the pooled burden of undernutrition among HIV-positive adults in Ethiopia.MethodsWe searched for potentially relevant studies through manual and electronic searches. An electronic search was carried out using the database of PubMed, Google Scholar, and Google for gray literature and reference lists of previous studies. A standardized data extraction checklist was used to extract the data from each original study. STATA Version 13 statistical software was used for our analysis. Descriptive summaries were presented in tables, and the quantitative result was presented in a forest plot. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I 2 test. Finally, a random-effects meta-analysis model was computed to estimate the pooled proportion of undernutrition among HIV-positive adults.ResultsAfter reviewing 418 studies, 15 studies met the inclusion criteria and were included in the meta-analysis. Findings from 15 studies revealed that the pooled percentage of undernutrition among HIV-positive adults in Ethiopia was 26% (95% CI: 22, 30%). The highest percentage of undernutrition (46.8%) was reported from Jimma University specialized hospital, whereas the lowest proportion of undernutrition (12.3%) was reported from Dilla Hospital. The subgroup analyses of this study also indicated that the percentage of undernourishment among HIV-positive adults is slightly higher in the Northern and Central parts of Ethiopia (27.5%) as compared to the Southern parts of Ethiopia (25%).ConclusionThis study noted that undernutrition among HIV-positive adults in Ethiopia was quite common. This study also revealed that undernutrition is more common among HIV-positive adults with advanced disease stage, anemia, diarrhea, CD4 count less than 200 cells/mm3, and living in rural areas. Based on our findings, we suggested that all HIV-positive adults should be assessed for nutritional status at the time of ART commencement

Intestinal parasitosis and shigellosis among diarrheal patients in Gondar teaching hospital, northwest Ethiopia

<p>Abstract</p> <p>Background</p> <p>Diarrheal diseases are the major causes of morbidity and mortality in developing world. Understanding the etiologic agents of diarrheal diseases and their association with socio-demographic characteristics of patients would help to design better preventive measures. Thus, this study was aimed to determine the prevalence of intestinal parasites and enteropathogenic bacteria in diarrheic patients.</p> <p>Methods</p> <p>A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures.</p> <p><b><it>Results</it></b></p> <p>Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was <it>Entamoeba histolytica/dispar </it>(7.3%) followed by <it>Giardia lamblia </it>(5.0%), C<it>ryptosporidium parvum </it>(1.8%) and <it>Isospora belli </it>(1.3%). The dominant helminthic parasite identified was <it>Ascaris lumbricoides </it>(5.5%) followed by <it>Strongyloides stercoralis </it>and <it>Schistosoma mansoni </it>(3.1% each), hookworm infection (1.8%), and <it>Hymenolepis </it>species (1.3%). Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria <it>Shigella </it>and <it>Salmonella </it>species were isolated from 15.6% and 1.6%, respectively, of the patients. <it>Escherichia coli O57:H7 </it>was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the <it>Shigella </it>and <it>Salmonella </it>isolates were resistant to one or more commonly used antibiotics, respectively.</p> <p>Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (<it>P </it>< 0.05). Statistically significant associations were also observed between Shigella infections and patients who were using well and spring water for household consumption, and patients who had dysentery and mucoid stool (<it>P </it>< 0.05).</p> <p>Conclusions</p> <p>The high prevalence of intestinal parasites and <it>Shigella </it>species in diarrheic patients calls for institution of appropriate public health intervention measures to reduce morbidity and mortality associated with these diseases. The rational use of antibiotics should also be practiced.</p

Police-initiated diversion for youth to prevent future delinquent behavior: a systematic review

BackgroundOverly punitive responses to youth misconduct may have the unintended consequence ofincreasing the likelihood of future delinquency; yet, overly lenient responses may fail to serveas a corrective for the misbehavior. Police diversion schemes are a collection of strategiespolice can apply as an alternative to court processing of youth. Police-initiated diversionschemes aim to reduce reoffending by steering youth away from deeper penetration into thecriminal justice system and by providing an alternative intervention that can help youthaddress psychosocial development or other needs that contribute to their problem behavior.ObjectivesThe objective of this review was to synthesize the evidence on the effectiveness of pre-courtinterventions involving police warning or counseling and release, and cautioning schemes inreducing delinquent behavior.Search methodsA combination of 26 databases and websites were searched. References of relevant reviewswere also scanned to identify studies. We also consulted with experts in the field. Searcheswere executed by two reviewers and conducted between August 2016 and January 2017.Selection criteriaOnly experimental and quasi-experimental designs were eligible for this review. All quasiexperimentaldesigns must have had a comparison group similar to the police diversionintervention group with respect to demographic characteristics and prior involvement indelinquent behavior (i.e., at similar risk for future delinquent behavior). Additionally, studiesmust have included youth participants between 12 and 17 years of age who either underwenttraditional system processing or were diverted from court processing through a police-leddiversion program. Studies were also eligible if delinquency-related outcomes, includingofficial and non-official (self-report or third-party reporting) measures of delinquency werereported.Data collection and analysisThis study used meta-analysis to synthesize results across studies. This method involvedsystematic coding of study features and conversion of study findings into effect sizesreflecting the direction and magnitude of any police-led diversion effect. There were 19independent evaluations across the 14 primary documents coded for this review. From this,we coded 67 effect sizes of delinquent behavior post diversion across 31 diversion-traditionalprocessing comparisons. We analyzed these comparisons using two approaches. The firstapproach selected a single effect size per comparison based on a decision rule and the secondused all 67 effect sizes, nesting these within comparison condition and evaluation design.ResultsThe general pattern of evidence is positive, suggesting that police-led diversion modestlyreduces future delinquent behavior of low-risk youth relative to traditional processing.Authors’ conclusionsThe findings from this systematic review support the use of police-led diversion for low-riskyouth with limited or no prior involvement with the juvenile justice system. Thus, policedepartments and policy-makers should consider diversionary programs as part of the mix ofsolutions for addressing youth crime

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill & Melinda Gates Foundation

Examining the Effects of Supervised Laboratory Instruction on Students’ Motivation and Their Understanding of Chemistry

This paper examines the impact of supervised laboratory instruction (SLI) on grade 12 students’ understanding of acid–base and solution chemistry topics in the context of Ethiopian secondary schools. A mixed-methods research design was employed, with a purposive sampling of 160 secondary students from six schools in Northwest Ethiopia. The students were divided into two groups: an experimental group (n = 76) and a control group (n = 84). The experimental group attended sessions that were designed based on self-regulated learning (SRL) strategies with SLI, and the control group attended regular instruction designed by the course teacher. Both quantitative and qualitative data were collected to explore the impacts of the experimental and control lessons on improving students’ conceptual understanding and motivation. Descriptive and inferential statistics (for the quantitative data)and reflexive thematic analysis(for the qualitative data)were employed to analyse the data. The findings showed that the SLI-SRL teaching approach for the experimental group resulted in a significantly higher conceptual understanding of the selected chemistry topics than the regular instruction for the control group. In addition, participants from the experimental group indicated that the SLI approach enhanced their motivation towards chemistry. These findings suggest that improving high-school students’ motivation and their conceptual understanding of chemistry requires paying attention to the lesson design