Alcohol and the risk of sleep apnoea: a systematic review and meta-analysis

Objective: A systematic review and meta-analysis of the association between alcohol consumption and risk of sleep apnoea in adults. Methods: We searched Medline, EMBASE and Web of Science databases from 1985 to 2015 for comparative epidemiological studies assessing the relation between alcohol consumption and sleep apnoea. Two authors independently screened and extracted data. Random effects meta-analysis was used to estimate pooled effect sizes with 95% confidence intervals (CI). Heterogeneity was quantified using I[superscript]2 and explored using subgroup analyses based on study exposure and outcome measures, quality, design, adjustment for confounders and geographical location. Publication bias was assessed using a funnel plot and Egger’s test. Results: We identified 21 studies from which estimates of relative risk could be obtained. Meta-analysis of these estimates demonstrated that higher levels of alcohol consumption increased the risk of sleep apnoea by 25% (RR 1.25, 95%CI 1.13-1.38, I[superscript]2=82%, p<0.0001). This estimate’s differences were robust in alcohol consumption and sleep apnoea definitions, study design and quality but was greater in Low and Middle Income Country locations. We detected evidence of publication bias (p=0.001). A further eight included studies reported average alcohol consumption in people with and without sleep apnoea. Meta-analysis revealed that mean alcohol intake was two units/week higher in those with sleep apnoea, but this difference was not statistically significant (p=0.41). Conclusion: These findings suggest that alcohol consumption is associated with a higher risk of sleep apnoea, further supporting evidence that reducing alcohol intake is of potential therapeutic and preventive value in this condition

Alcohol consumption and the risk of tuberculosis: a systematic review and meta-analysis

OBJECTIVE: To perform a systematic review and meta-analysis of the association between alcohol consumption and tuberculosis risk.METHODS: Medline, EMBASE and Web of Science were searched for observational studies from 2005 to April 2018. Reference lists of included studies were screened.RESULTS: Forty nine studies were included. Compared to people with low or no alcohol intake, the risk of tuberculosis in people with high or any alcohol consumption was increased by a relative odds of 1.90 (95% CI: 1.-2.23). Substantial levels of heterogeneity were seen (I2=82%), but there was no evidence of publication bias (P=0.). Sensitivity analysis restricted to studies using no alcohol drinking as a reference group found a slightly lower but still increased risk (Odds Ratio= 1.59, 95%CI: 1.38-1.84). Subgroup analyses found no significant differences in relation to study design and quality, geographic location, publication year, and adjustment for confounders. A pooled analysis of a further four studies reporting hazard ratios, found nearly a tripling increase in risk of TB in relation to alcohol consumption during follow-up (HR=2.81, 95%CI: 2.12-3.74). An exposure-response analysis showed that for every 10-20 grams daily alcohol intake, there was 12% increase in TB risk.CONCLUSION: Alcohol consumption is an important risk factor for the development of TB

Incidence, prevalence, risk factors and health consequences of polypharmacy in adults in South Asia: a systematic review protocol

Objective: The objective of the systematic review is to summarize the incidence, prevalence, risk factors and health consequences of polypharmacy in adults in South Asia.Introduction: Several studies have been conducted in South Asia on the incidence, prevalence, risk factors and health consequences of polypharmacy in adults. Until now, no systematic review has been conducted on this topic.Inclusion criteria: Related epidemiological studies conducted on adults (aged 18 years and over) and residing in any country within South Asia (i.e. Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka) will be eligible for inclusion.Methods: MEDLINE, Embase, CINAHL, PsycINFO, BNI, Web of Science, Scopus and AMED databases will be searched to identify published studies. The search for unpublished studies will include EthOS, OpenGrey and ProQuest Dissertations and Theses. Databases will be searched from their inception dates and no language restrictions will be applied. The Joanna Briggs Institute systematic review methodology will be followed to conduct the review. Data synthesis will be conducted using narrative synthesis and meta-analyses, where appropriate

Barriers and facilitators to type 2 diabetes management in the Caribbean region: a systematic review protocol

The objective of this systematic review is to summarize the barriers and facilitators to type 2 diabetes management in the Caribbean region

Alcohol and tobacco content in UK video games and their association with alcohol and tobacco use among young people

Aims: To determine the extent to which video games include alcohol and tobacco content and assess the association between playing them and alcohol and smoking behaviours in adolescent players. Design: Assessment of substance in the 32 UK bestselling video games of 2012/2013; online survey of adolescent playing of 17 games with substance content; content analysis of the five most popular games. Setting: Great Britain Participants: 1,094 adolescents aged 11-17 years. Measurements: Reported presence of substance content in the 32 games; estimated numbers of adolescents who had played games; self-reported substance use; semi-quantitative measures of substance content by interval coding of video game cut scenes. Findings: Non-official sources reported substance content in 17 (44%) games but none were reported by the official Pan European Game Information (PEGI) system. Adolescents who had played at least one game were significantly more likely ever to have tried smoking (adjusted OR 2.70, 95% CI 1.75 to 4.17) or consumed alcohol (adjusted OR 2.35, 95% CI 1.70 to 3.23). In the five most popular game episodes of alcohol actual use, implied use and paraphernalia occurred in 31 (14%), 81 (37%) and 41 (19%) intervals, respectively. Tobacco actual use, implied use and paraphernalia occurred in 32 (15%), 27 (12 %) and 53 (24%) intervals, respectively. Conclusions: Alcohol and tobacco content is common in the most popular video games but not reported by the official PEGI system. Content analysis identified substantial substance content in a sample of those games. Adolescents who play these video games are more likely to have experimented with tobacco and alcohol

Exploring heterogeneity in meta-analyses using summary and individual patient data methodologies from stroke trials

Until recently, meta-analyses have usually been performed based on summary data methods. Individual patient data methods are becoming more popular, but the advantages of using these methods have not been fully investigated with regards to assessing and exploring heterogeneity. This thesis has assessed whether there are any clinically important differences in the results from analysing data from three meta-analyses of randomised controlled trials in the area of stroke medicine, using summary and individual patient data methodologies. Blood pressure ill Acute Stroke Collaboration (BASC) The management of blood pressure during the acute phase of stroke remains an enigma, therefore a systematic review and meta-analysis of existing randomised controlled trials was conducted to assess the effects of vasoactive drugs on outcome. Trends towards an increase in the risk of death, and death or dependency at the end of trial were found in patients randomised to a vasoactive drug as compared to those randomised to control. When baseline systolic blood pressure was taken into account in the analyses, patients randomised to a vasoactive drug had a significantly higher risk of death at the end of trial. Analyses also indicated that patients recruited early and within 48 hours has significant increases in the risk of death at the end of trial. However, no significant effects were seen for early change in systolic blood pressure. Community occupational therapy in stroke patients An evaluation of the efficacy of occupational therapy given in the community to stroke patients was performed using a systematic review and meta-analysis of randomised controlled trials. At the end of intervention, patient randomised to occupational therapy had significantly higher scores for extended and personal activities of daily living, and non-significantly higher scores for leisure participation. These effects appeared to be maintained over time. No effects were seen between the groups for death or minor psychiatric disorders as measured in patients or their carers. Subgroup analyses revealed that the benefits of occupational therapy were greatest when targeted interventions were used. Also, being male or independent at baseline was found to be important predictor of extended activities of daily living scores. Dipyridamole in Stroke Collaboration (DISC) Results from randomised controlled trials of dipyridamole, given with and without aspirin, for secondary prevention after stroke or transient ischaemic attack have given conflicting results; therefore, we performed a systematic review and meta-analysis. The risk of subsequent fatal or non-fatal stroke was reduced using the dual treatment of aspirin and dipyridamole as compared to either aspirin alone, dipyridamole alone, or control. Additionally, the dual treatment lowered the risk of non-fatal stroke, and subsequent vascular events defined by a composite outcome (non-fatal stroke, non fatal myocardial infarction, or vascular death). Analyses indicated that these results were independent of method of formulation of dipyridamole, dose of aspirin, type of qualifying event, and gender of the patients. However, increasing age was found to be an important predictor of subsequent stroke. These systematic reviews demonstrate that collaborations within the area of stroke medicine can be successful and much data can be shared. The findings from meta-analyses can be informative about the effectiveness of particular treatment and about which patients should be targeted for treatment; and may help steer the direction of future trials. Although summary data meta-analyses are practically easier to perform, it is important that assessments and explorations of heterogeneity should always be performed. Meta-analyses based on individual patient data may be needed to allow for more in depth investigations of heterogeneity, especially of patient characteristics. However, they themselves are not the panacea to all difficulties since they are subject to particular problems, mainly related to obtaining individual patient data to enable these in depth analyses to be performed

Promotion of breastfeeding by dental teams: A survey of early career dentists

Breastfeeding provides a range of positive health benefits for both mother and baby. Due to maternal exemption of dental charges, dentists have the access and opportunity to provide information to expectant and nursing mothers, and are in an optimal position to positively influence breastfeeding behaviour. A cross-sectional survey of early career dentists in the East Midlands was conducted. The survey questionnaire assessed levels of confidence, knowledge and practice regarding breastfeeding. Barriers identified in supporting and encouraging breastfeeding were lack of knowledge (81%; n=57), lack of confidence (63%; n=44) and lack of time (52%; n=36). Approximately two thirds reported they had never received training and a majority felt they would benefit from this (86%; n=60). Early career dentists in the East Midlands reported limited knowledge and a lack of confidence in the delivery of breastfeeding advice. Wider incorporation of training into undergraduate and postgraduate programmes could be considered, which may improve breastfeeding rates