ResearchPad - observational-studies https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Retention of patients in opioid substitution treatment: A systematic review]]> https://www.researchpad.co/article/elastic_article_14597 Retention in opioid substitution (OST) treatment is associated with substantial reductions in all cause and overdose mortality. This systematic review aims to identify both protective factors supporting retention in OST, and risk factors for treatment dropout.MethodsA systematic search was performed using MEDLINE, Embase, PsycInfo, CINAHL and Web of Science (January 2001 to October 2019). Randomised controlled trials (RCTs) and observational cohort studies reporting on retention rates and factors associated with retention in OST were included. Factors associated with treatment retention and dropout were explored according to the Maudsley Addiction Profile. A narrative synthesis is provided.Results67 studies were included in this review (4 RCTs and 63 observational cohort studies; N = 294,592), all assessing factors associated with retention in OST or treatment dropout. The median retention rate across observational studies was approximately 57% at 12 months, which fell to 38.4% at three years. Studies included were heterogeneous in nature with respect to treatment setting, type of OST, risk factor assessment, ascertainment of outcome and duration of follow-up. While the presence of such methodological heterogeneity makes it difficult to synthesise results, there is limited evidence to support the influence of a number of factors on retention, including age, substance use, OST drug dose, legal issues, and attitudes to OST.ConclusionsYounger age, substance use particularly cocaine and heroin use, lower doses of methadone, criminal activity/incarceration, and negative attitudes to MMT appear to be associated with reduced retention in OST. A consensus definition of retention is required to allow for comparability across future studies. ]]> <![CDATA[‘In search of lost time’: Identifying the causative role of cumulative competition load and competition time-loss in professional tennis using a structural nested mean model]]> https://www.researchpad.co/article/N4f3da08e-598e-44d5-a4f3-a2c64fcebd1f

Injury prevention is critical to the achievement of peak performance in elite sport. For professional tennis players, the topic of injury prevention has gained even greater importance in recent years as multiple of the best male players have been sidelined owing to injury. Identifying potential causative factors of injury is essential for the development of effective prevention strategies, yet such research is hampered by incomplete data, the complexity of injury etiology, and observational study biases. The present study attempts to address these challenges by focusing on competition load and time-loss to competition—a completely observable risk factor and outcome—and using a structural nested mean model (SNMM) to identify the potential causal role of cumulative competition load on the risk of time-loss. Using inverse probability of treatment weights to balance exposure histories with respect to player ability, past injury, and consecutive competition weeks at each time point; the SNMM analysis of 389 professional male players and 55,773 weeks of competition found that total load significantly increases the risk of time-loss (HR = 1.05 per 1,000 games of additional load 95% CI 1.01-1.10) and this effect becomes magnified with age. Standard regression showed a protective effect of load, highlighting the value of more robust causal methods in the study of dynamic exposures and injury in sport and the need for further applications of these methods for understanding how time-loss and injuries of elite athletes might be prevented in the future.

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<![CDATA[Regional variations in geographic access to inpatient hospices and Place of death: A Population-based study in England, UK]]> https://www.researchpad.co/article/N0789e4f1-219e-494f-9677-036e019c10b6

Background

There is much variation in hospice use with respect to geographic factors such as area-based deprivation, location of patient’s residence and proximity to services location. However, little is known about how the association between geographic access to inpatient hospice and hospice deaths varies by patients’ region of settlement.

Study aim

To examine regional differences in the association between geographic access to inpatient hospice and hospice deaths.

Methods

A regional population-based observational study in England, UK. Records of patients aged ≥ 25 years (n = 123088) who died from non-accidental causes in 2014, were extracted from the Office for National Statistics (ONS) death registry. Our cohort comprised of patients who died at home and in inpatient hospice. Decedents were allocated to each of the nine government office regions of England (London, East Midlands, West Midlands, East, Yorkshire and The Humber, South West, South East, North West and North East) through record linkage with their postcode of usual residence. We defined geographic access as a measure of drive times from patients’ residential location to the nearest inpatient hospice. A modified Poisson regression estimated the association between geographic access to hospice, comparing hospice deaths (1) versus home deaths (0). We developed nine regional specific models and adjusted for regional differences in patient’s clinical & socio-demographic characteristics. The strength of the association was estimated with adjusted Proportional Ratios (aPRs).

Findings

The percentage of deaths varied across regions (home: 86.7% in the North East to 73.0% in the South East; hospice: 13.3% in the North East to 27.0% in the South East). We found wide differences in geographic access to inpatient hospices across regions. Median drive times to hospice varied from 4.6 minutes in London to 25.9 minutes in the North East. We found a dose-response association in the East: (aPRs: 0.22–0.78); East Midlands: (aPRs: 0.33–0.63); North East (aPRs: 0.19–0.87); North West (aPRs: 0.69–0.88); South West (aPRs: 0.56–0.89) and West Midlands (aPRs: 0.28–0.92) indicating that decedents who lived further away from hospices locations (≥ 10 minutes) were less likely to die in a hospice.

Conclusion

The clear dose-response associations in six regions underscore the importance of regional specific initiatives to improve and optimise access to hospices. Commissioners and policymakers need to do more to ensure that home death is not due to limited geographic access to inpatient hospice care.

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<![CDATA[Garlic intake and the risk of colorectal cancer]]> https://www.researchpad.co/article/Nfdb1fd97-0c58-4333-a97b-3a6a620fa4dd

Abstract

This was a meta-analysis of epidemiological articles that aimed to estimate the association of garlic intake with the risk of colorectal cancer (CRC).

Electronic databases, including the Cochrane Database of Systematic Reviews, PubMed, and EMBASE, were systemically searched from inception to May 2019 to identify related articles. In addition, a random model was used to pool the included evidence based on heterogeneity. Additionally, subgroup analyses were carried out to examine the differences between different groups. The stability of our findings was tested through sensitivity analyses. Publication bias was also assessed by Egger and Begg tests. Moreover, all enrolled studies were ordered according to the publication year for a cumulative meta-analysis.

A total of 11 studies (involving 12,558 cases) were included in the current meta-analysis. Our integrated relative risk (RR) of CRC was 0.80 (95% confidence interval [CI], 0.69–0.91) for the highest versus the lowest garlic consumption categories (RR: 0.71 [95% CI, 0.60–0.84] for controls and RR: 0.99 [95% CI, 0.80–1.23] for cohorts). There was significant heterogeneity across all enrolled studies (I2 = 68.3%, P< .01). The sensitivity analysis revealed no notable alterations of the integrated results. According to the funnel plot regarding garlic intake and the risk of CRC, together with the Egger test (P = .1) and Begg test (P = .064) results, there was no notable evidence of publication bias. The cumulative meta-analysis suggested that the 95% CIs became narrower with the increase in sample size.

Based on the existing evidence, garlic intake could reduce the risk of CRC.

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<![CDATA[Association of hospital and surgeon volume with mortality following major surgical procedures]]> https://www.researchpad.co/article/N0d87f8f0-e583-4a8d-906a-408631128127

Supplemental Digital Content is available in the text

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<![CDATA[The timing of urinary catheter removal after gynecologic surgery]]> https://www.researchpad.co/article/N877bf245-39fd-47d6-a2bf-cd976db458b2

Abstract

The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.

Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.

Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10–5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48–0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74–14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.

Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.

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<![CDATA[The relationship between magnesium and osteoarthritis of knee]]> https://www.researchpad.co/article/N10b611a7-e8a9-45d2-ab1b-3cb1db451bbf

Abstract

The impact of magnesium on risk of knee osteoarthritis (KOE) is still under investigation. This meta-analysis evaluated the relationship between magnesium and risk of KOE.

A comprehensive search was performed to identify retrospective cohort study or cross-sectional study of the association between magnesium and KOE from the Cochrane library, PubMed, and Embase. The search time limit was from the establishment of the database to December 2018. Two evaluators selected the literature, extracted the data, and evaluated the quality of the literature according to the inclusion and exclusion criteria, independently. Meta-analysis was performed using RevMan 5.3 software and publication bias was assessed using Begg and Egger test and funnel plot.

Finally, 6 studies were included with a total of 15,715 participants. Although higher daily intake of magnesium was associated with a significantly reduced risk of fracture in patients with KOE (OR = 0.66, 95%CI: 0.56, 0.78; P < .00001), it was not significant for lowering the risk of KOE (OR = 0.80; 95% CI: 0.61, 1.04; P = .1). Meta-analysis also showed that population with higher serum magnesium levels had significantly lower risk of KOE (odds ratio (OR) = 0.84; 95% confidence interval (CI): 0.72, 0.98; P = .03). Further subgroup analysis showed that the relationship between serum magnesium level and KOE risk was significantly affected by serum magnesium level (P = .006 for quartiles 4 vs 1).

Higher level of magnesium intake was not associated with lower risk of KOE. However, higher daily intake of magnesium may be inversely associated with risk of fracture in KOE patients.

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<![CDATA[Prognostic significance of neutrophil–lymphocyte ratio (NLR) in patients with ovarian cancer]]> https://www.researchpad.co/article/N1fbd123c-e29b-4053-ae87-d6b20edf0365

Abstract

The prognostic role of neutrophil to lymphocyte ratio (NLR) in patients with ovarian cancer remains inconsistent. This meta-analysis was conducted to evaluate the predictive value of this biomarker for prognoses in ovarian cancer patients.

We systematically searched PubMed, Web of Science, and Embase for eligible studies embracing multivariate results. The Newcastle-Ottawa Scale were used to assess the study quality. Pooled hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated.

Ten studies involving 2919 patients were included in this meta-analysis. In multivariate analysis, the group with higher NLR had worse overall survival (OS) (HR = 1.34, 95% CI = 1.16–1.54) and shorter PFS (HR = 1.36, 95% CI = 1.17–1.57) than the control group. Furthermore, PLR values higher than the cut-off were associated with not only poorer OS (HR = 1.97, 95% CI = 1.61–2.40) but also more unfavorable PFS (HR = 1.79, 95% CI = 1.46–2.20). Univariate analysis also indicated the same results. Additionally, subgroup analysis showed that when the cut-off values for NLR and PLR were higher, their predictive effects became stronger.

This comprehensive meta-analysis suggested that the values of inflammatory marker of NLR was associated with ovarian cancer survival. Therefore, inflammatory markers can potentially serve as prognostic biomarkers.

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<![CDATA[Arterial carboxyhaemoglobin levels in children admitted to PICU: A retrospective observational study]]> https://www.researchpad.co/article/5c8accf2d5eed0c4849903c7

While carbon monoxide (CO) is considered toxic, low levels of endogenously produced CO are protective against cellular injury induced by oxidative stress. Carboxyhaemoglobin (COHb) levels have been associated with outcomes in critically ill adults. We aimed to describe the distribution of carboxyhaemoglobin in critically ill children and the relationship of these levels with clinical outcomes. This retrospective observational study was conducted at a large tertiary paediatric intensive care unit (PICU). We included all children admitted to the PICU over a two-year period who underwent arterial blood gas analysis. We measured the following: (i) Population and age-related differences in COHb distribution; (ii) Change in COHb over the first week of admission using a multi-level linear regression analysis; (iii) Uni- and multivariable relationships between COHb and length of ventilation and PICU survival. Arterial COHb levels were available for 559/2029 admissions. The median COHb level was 1.20% (IQR 1.00–1.60%). Younger children had significantly higher COHb levels (p-value <2 x 10−16). Maximum Carboxyhaemoglobin was associated with survival 1.67 (95% CI: 1.01–2.57; p-value = 0.02) and length of ventilation (OR 5.20, 95% CI: 3.07–7.30; p-value = 1.8 x 10−6) following multi-variable analysis. First measured and minimum COHb values were weakly associated with length of ventilation, but not survival. In conclusion, children have increased COHb levels in critical illness, which are greater in younger children. Higher COHb levels are associated with longer length of ventilation and death in PICU. This may reflect increased oxidative stress in these children.

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<![CDATA[The association between body lead levels and childhood rickets]]> https://www.researchpad.co/article/5c973c91d5eed0c484968ac3

Supplemental Digital Content is available in the text

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<![CDATA[Strong association between the interleukin-8-251A/T polymorphism and coronary artery disease risk]]> https://www.researchpad.co/article/5c97400fd5eed0c48496de63

Abstract

Several reports have suggested a possible association between the interleukin (IL)-8-251A/T single-nucleotide polymorphism (SNP) and the susceptibility to coronary artery disease (CAD). Due to inconclusive results of the studies so far, we conducted a meta-analysis to systematically summarize the studies on the association between this SNP and CAD risk. A systematic literature search identified 9 case-control studies (3752 cases and 4219 controls) on the IL-8-251A/T polymorphism. We observed a significant association between different genetic forms of −251A/T SNP and CAD risk, like the allele model (A vs T: odds ratio [OR] 1.14, 95% confidence interval [CI] 1.02–1.27, P = .02), dominant model (AA + AT vs TT: OR 1.20, 95% CI 1.01–1.43, P = .042), recessive model (AA vs AT + TT: OR 1.15, 95% CI 1.03–1.27, P = .01), and homozygous model (AA vs TT: OR 1.26, 95% CI 1.01–1.56, P = .037), whereas the heterozygote model did not show any significant association (AT vs TT: OR 1.16, 95% CI 0.98–1.38, P = .091). Furthermore, significant heterogeneity was observed among studies in terms of all genetic models, except the recessive model. Analysis of the ethnic subgroups revealed a significantly higher risk of CAD in the East Asian population carrying this SNP, and the heterogeneity among the studies regarding the East Asian population was decreased after subgroup analysis. The results of this meta-analysis suggest that the IL-8-251A/T SNP may increase the risk of CAD, especially in people of East Asian ethnicity. Further large-scale, multicenter epidemiological studies are warranted to validate this finding.

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<![CDATA[Association of rs2910164 polymorphism in MiR-146a gene with psoriasis susceptibility]]> https://www.researchpad.co/article/5c929866d5eed0c48437f235

Abstract

The rs2910164 single nucleotide polymorphism (SNP) in miR-146a has been implicated in the etiology of psoriasis in different relevant studies with contradictory conclusions and limited sample size. Therefore, the aim of this study was to undertake a systematic review and meta-analysis to estimate the association between rs2910164 SNP and psoriasis. We searched the databases of PubMed, EMBASE, Web of Science, WanFang, and Chinese National Knowledge Infrastructure (CNKI) to identify relevant literatures published before July 15, 2018. Four case–control studies including 2212 cases and 2274 healthy controls from 4 different countries met the predetermined criteria. The effect size was pooled by odds ratios (ORs) and 95% confidence intervals (95%CIs). Recessive model (CC vs CG+GG) was confirmed to be the optimal model. The results indicated that rs2910164 SNP was significantly associated with psoriasis (OR = 0.74, 95%CI 0.60–0.91, P = .004), and individuals with CC-genotype were predisposed to have decreased risk of psoriasis.

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<![CDATA[The validity of diagnostic cut-offs for commercial and in-house scrub typhus IgM and IgG ELISAs: A review of the evidence]]> https://www.researchpad.co/article/5c61e90bd5eed0c48496f6fa

Background

Scrub typhus is a neglected tropical disease that causes acute febrile illness. Diagnosis is made based upon serology, or detection of the causative agent–Orientia tsutsugamushi–using PCR or in vitro isolation. The enzyme-linked immunosorbent assay (ELISA) is an objective and reproducible means of detecting IgM or IgG antibodies. However, lack of standardization in ELISA methodology, as well as in the choice of reference test with which the ELISA is compared, calls into question the validity of cut-offs used in diagnostic accuracy studies and observational studies.

Methodology/Principal findings

A PubMed search and manual screening of reference lists identified 46 studies that used ELISA antibody cut-offs to diagnose scrub typhus patients, 22 of which were diagnostic accuracy studies. Overall, 22 studies (47.8%) provided little to no explanation as to how the ELISA cut-off was derived, and 7 studies (15.2%) did not even state the cut-off used. Variation was seen locally in reference standards used, in terms of both the diagnostic test and cut-off titer. Furthermore, with the exception of studies using ELISAs manufactured by InBios, there was no standardization of the selection of antigenic strains. As a result, no consensus was found for determining a cut-off, ELISA methodology, or for a single value diagnostic cut-off.

Conclusions/Significance

We have concluded that there is a lack of consensus in the determination of a cut-off. We recommend interpreting the results from these studies with caution. Further studies will need to be performed at each geographic location to determine region-specific cut-offs, taking into consideration background antibody levels to discriminate true disease from healthy individuals.

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<![CDATA[Associations between use of macrolide antibiotics during pregnancy and adverse child outcomes: A systematic review and meta-analysis]]> https://www.researchpad.co/article/5c75abfad5eed0c484d07f62

Background

Evidence on adverse effects of maternal macrolide use during pregnancy is inconsistent. We conducted a systematic review and meta-analysis to investigate the association between macrolide use during pregnancy and adverse fetal and child outcomes.

Methods and findings

We included observational studies and randomised controlled trials (RCTs) that recorded macrolide use during pregnancy and child outcomes. We prioritized comparisons of macrolides with alternative antibiotics (mainly penicillins or cephalosporins) for comparability of indication and effect. Random effects meta-analysis was used to derive pooled odds ratios (OR) for each outcome. Subgroup analyses were performed according to specific types (generic forms) of macrolide.

Of 11,186 citations identified, 19 (10 observational, 9 RCTs) studies were included (21 articles including 228,556 participants). Macrolide prescribing during pregnancy was associated with an increased risk of miscarriage (pooled ORobs 1·82, 95% CI 1·57–2·11, three studies, I2 = 0%), cerebral palsy and/or epilepsy (ORobs 1·78, 1·18–2·69; one study), epilepsy alone (ORobs 2·02, 1·30–3·14, one study; ORRCT 1.03, 0.79–1.35, two studies), and gastrointestinal malformations (ORobs 1·56, 1·05–2·32, two studies) compared with alternative antibiotics. We found no evidence of an adverse effect on 12 other malformations, stillbirth, or neonatal death. Results were robust to excluding studies with high risk of bias.

Conclusions

Consistent evidence of an increased risk of miscarriage in observational studies and uncertain risks of cerebral palsy and epilepsy warrant cautious use of macrolide in pregnancy with warnings in drug safety leaflets and use of alternative antibiotics where appropriate. As macrolides are the third most commonly used class of antibiotics, it is important to confirm these results with high quality studies.

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<![CDATA[Influence of thermal ablation of hepatic metastases from gastric adenocarcinoma on long-term survival]]> https://www.researchpad.co/article/5c466f7ed5eed0c484551610

Supplemental Digital Content is available in the text

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<![CDATA[Supportive interventions to improve retention on ART in people with HIV in low- and middle-income countries: A systematic review]]> https://www.researchpad.co/article/5c1d5bc7d5eed0c4846ec944

Objectives

To determine whether supportive interventions can increase retention in care for patients on antiretroviral therapy (ART) in low- and middle-income countries (LMIC).

Design

Systematic review and meta-analysis.

Methods

We used Cochrane Collaboration methods. We included randomised controlled trials (RCT) and observational studies with comparators conducted in LMIC. Our principal outcomes were retention, mortality and the combined outcome of lost-to-follow-up (LTFU) or death.

Results

We identified seven studies (published in nine articles); six of the studies were from Sub-Saharan Africa. We found four types of interventions: 1) directly observed therapy plus extra support (“DOT-plus”), 2) community-based adherence support, 3) adherence clubs and 4) extra care for patients with low CD4 count. One RCT of a community-based intervention showed significantly improved retention at 12 months (RR 1.14, 95% CI 1.02 to 1.27), and three observational studies found significantly improved retention for paediatric patients followed for 12 to 36 months (RR 1.07, 95 CI 1.03 to 1.11), and for adult patients at 12 (RR 1.38, 95% CI 1.13 to 1.70) and 60 months (RR 1.07, 95% CI 1.07 to 1.08). One observational study of adherence clubs showed significantly reduced LTFU or mortality (RR 0.20, 95% CI 0.12 to 0.33). A cluster RCT of an extra-care intervention for high-risk patients also showed a significant increase in retention (RR 1.06, 95% CI 1.01 to 1.10), and an observational study of extra nursing care found a significant decrease in LTFU or mortality (RR 0.76, 95% CI 0.66 to 0.87).

Conclusions

Supportive interventions are associated with increased ART programme retention, but evidence quality is generally low to moderate. The data from this review suggest that programmes addressing psychosocial needs can significantly help retain patients in care.

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<![CDATA[School environmental contamination of methicillin-sensitive Staphylococcus aureus as an independent risk factor for nasal colonization in schoolchildren: An observational, cross-sectional study]]> https://www.researchpad.co/article/5c0ae44cd5eed0c48458954a

Objective

We aim to assess the similarities of proportional, phenotypic, and molecular characteristics between the school environment and schoolchildren on methicillin-sensitive S. aureus (MSSA) isolates.

Methods

A cross-sectional study was conducted between March 2016 and August 2016 in eight elementary schools in Guangzhou, China. Nasal swabs from students and environmental swabs from school environments were collected. Univariate and multivariate logistic regression analyses under a multistage stratified cluster cross-sectional survey design were performed to access the prevalence relationship and influencing factors, respectively. Phenotypic and molecular characterizations of MSSA isolates were conducted using the Kirby-Bauer disk diffusion method and polymerase chain reaction assays, respectively.

Results

In total, 1705 schoolchildren and 1240 environmental samples from 40 classes in eight elementary schools obtained between March and August 2016 were include in this study. The rates of MSSA prevalence among schoolchildren and the environment were 11.44% (195/1705) and 4.60% (57/1240), respectively. The odds ratios and 95% confidence intervals (CIs) on the prevalence of MSSA isolates were 1.11 (95% CI, 1.05–1.29; P = 0.010) and 1.04 (95% CI, 1.01–1.07; P = 0.003) for the school or class environment and students, respectively. Similar phenotypic and molecular characteristics were identified between schoolchildren and the environment. A cause and effect relationship could not be established because the study design was cross-sectional.

Conclusions

Because of the cross-sectional design, we can reveal the association between school environment and schoolchildren on MSSA, but it is not a cause and effect relationship.

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<![CDATA[High protein diet is of benefit for patients with type 2 diabetes]]> https://www.researchpad.co/article/5c217f97d5eed0c4844cede1

Supplemental Digital Content is available in the text

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<![CDATA[XRCC1 polymorphism and overall survival in ovarian cancer patients treated with platinum-based chemotherapy]]> https://www.researchpad.co/article/5c1845bfd5eed0c4847fbfac

Supplemental Digital Content is available in the text

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<![CDATA[Flavonoids intake and risk of type 2 diabetes mellitus]]> https://www.researchpad.co/article/5b59e880463d7e7cb05cf954

Abstract

Epidemiological studies exploring the role of flavonoids intake in preventing type 2 diabetes mellitus (T2DM) showed inconsistent results. Therefore, we performed a meta-analysis of relevant studies to examine the relationship between flavonoids intake and risk of T2DM. We hypothesized that flavonoids intake may decrease the risk of developing T2DM.

A systematical search in PubMed and Embase until September 2017 was performed to identify eligible prospective cohort studies. The summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effect models. Dose-response pattern between total flavonoids intake and T2DM risk was also estimated.

Eight prospective studies were included with 312,015 participants, of whom 19,953 developed T2DM during the follow-up periods of 4 to 28 years. Compared with lower consumption, high intake of total flavonoids was associated with a decreased risk of T2DM (RR: 0.89, 95% CI: 0.82–0.96). Among flavonoid subclasses, inverse correlations with T2DM were achieved for intakes of anthocyanidins, flavan-3-ols, flavonols, and isoflavones. Dose-response meta-analysis indicated a curvilinear relationship between total flavonoids intake and incident T2DM (P for nonlinearity = .042), with a significant risk reduction at an intake of ≥550 mg/day. When assuming a linear pattern, the risk of T2DM was decreased by 5% for each 300-mg/day increment in total flavonoids intake (RR: 0.95, 95% CI: 0.93–0.97).

Our study suggests that higher intakes of total flavonoids and subclasses (anthocyanidins, flavan-3-ols, flavonols, and isoflavones) are associated with lower risk of T2DM.

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