Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents

BACKGROUND Rheumatic heart disease accounts for up to 250 000 premature deaths every year worldwide and can be regarded as a physical manifestation of poverty and social inequality. We aimed to estimate the prevalence of rheumatic heart disease in endemic countries as assessed by different screening modalities and as a function of age. METHODS We searched Medline, Embase, the Latin American and Caribbean System on Health Sciences Information, African Journals Online, and the Cochrane Database of Systematic Reviews for population-based studies published between Jan 1, 1993, and June 30, 2014, that reported on prevalence of rheumatic heart disease among children and adolescents (≥5 years to <18 years). We assessed prevalence of clinically silent and clinically manifest rheumatic heart disease in random effects meta-analyses according to screening modality and geographical region. We assessed the association between social inequality and rheumatic heart disease with the Gini coefficient. We used Poisson regression to analyse the effect of age on prevalence of rheumatic heart disease and estimated the incidence of rheumatic heart disease from prevalence data. FINDINGS We included 37 populations in the systematic review and meta-analysis. The pooled prevalence of rheumatic heart disease detected by cardiac auscultation was 2·9 per 1000 people (95% CI 1·7-5·0) and by echocardiography it was 12·9 per 1000 people (8·9-18·6), with substantial heterogeneity between individual reports for both screening modalities (I(2)=99·0% and 94·9%, respectively). We noted an association between social inequality expressed by the Gini coefficient and prevalence of rheumatic heart disease (p=0·0002). The prevalence of clinically silent rheumatic heart disease (21·1 per 1000 people, 95% CI 14·1-31·4) was about seven to eight times higher than that of clinically manifest disease (2·7 per 1000 people, 1·6-4·4). Prevalence progressively increased with advancing age, from 4·7 per 1000 people (95% CI 0·0-11·2) at age 5 years to 21·0 per 1000 people (6·8-35·1) at 16 years. The estimated incidence was 1·6 per 1000 people (0·8-2·3) and remained constant across age categories (range 2·5, 95% CI 1·3-3·7 in 5-year-old children to 1·7, 0·0-5·1 in 15-year-old adolescents). We noted no sex-related differences in prevalence (p=0·829). INTERPRETATION We found a high prevalence of rheumatic heart disease in endemic countries. Although a reduction in social inequalities represents the cornerstone of community-based prevention, the importance of early detection of silent rheumatic heart disease remains to be further assessed. FUNDING UBS Optimus Foundation.

PEDro or Cochrane to Assess the Quality of Clinical Trials? A Meta-Epidemiological Study.

OBJECTIVE There is debate on how the methodological quality of clinical trials should be assessed. We compared trials of physical therapy (PT) judged to be of adequate quality based on summary scores from the Physiotherapy Evidence Database (PEDro) scale with trials judged to be of adequate quality by Cochrane Risk of Bias criteria. DESIGN Meta-epidemiological study within Cochrane Database of Systematic Reviews. METHODS Meta-analyses of PT trials were identified in the Cochrane Database of Systematic Reviews. For each trial PeDro and Cochrane assessments were extracted from the PeDro and Cochrane databases. Adequate quality was defined as adequate generation of random sequence, concealment of allocation, and blinding of outcome assessors (Cochrane criteria) or as trials with a PEDro summary score ≥5 or ≥6 points. We combined trials of adequate quality using random-effects meta-analysis. RESULTS Forty-one Cochrane reviews and 353 PT trials were included. All meta-analyses included trials with PEDro scores ≥5, 37 (90.2%) included trials with PEDro scores ≥6 and only 22 (53.7%) meta-analyses included trials of adequate quality according to the Cochrane criteria. Agreement between PeDro and Cochrane was poor for PeDro scores of ≥5 points (kappa = 0.12; 95% CI 0.07 to 0.16) and slight for ≥6 points (kappa 0.24; 95% CI 0.16-0.32). When combining effect sizes of trials deemed to be of adequate quality according to PEDro or Cochrane criteria, we found that a substantial difference in the combined effect size (≥0.15) was evident in 9 (22%) out of the 41 meta-analyses for PEDro cutoff ≥5 and 10 (24%) for cutoff ≥6. CONCLUSIONS The PeDro and Cochrane approaches lead to different sets of trials of adequate quality, and different combined treatment estimates from meta-analyses of these trials. A consistent approach to assessing RoB in trials of physical therapy should be adopted.

Reporting and handling missing outcome data in mental health: a systematic review of Cochrane systematic reviews and meta-analyses

OBJECTIVES The purpose of the study was to provide empirical evidence about the reporting of methodology to address missing outcome data and the acknowledgement of their impact in Cochrane systematic reviews in the mental health field. METHODS Systematic reviews published in the Cochrane Database of Systematic Reviews after January 1, 2009 by three Cochrane Review Groups relating to mental health were included. RESULTS One hundred ninety systematic reviews were considered. Missing outcome data were present in at least one included study in 175 systematic reviews. Of these 175 systematic reviews, 147 (84%) accounted for missing outcome data by considering a relevant primary or secondary outcome (e.g., dropout). Missing outcome data implications were reported only in 61 (35%) systematic reviews and primarily in the discussion section by commenting on the amount of the missing outcome data. One hundred forty eligible meta-analyses with missing data were scrutinized. Seventy-nine (56%) of them had studies with total dropout rate between 10 and 30%. One hundred nine (78%) meta-analyses reported to have performed intention-to-treat analysis by including trials with imputed outcome data. Sensitivity analysis for incomplete outcome data was implemented in less than 20% of the meta-analyses. CONCLUSIONS Reporting of the techniques for handling missing outcome data and their implications in the findings of the systematic reviews are suboptimal.

The Character of Christian-Muslim Encounter: Essays in Honour of David Thomas

The Character of Christian-Muslim Encounter is a Festschrift in honour of David Thomas, Professor of Christianity and Islam, and Nadir Dinshaw Professor of Inter Religious Relations, at the University of Birmingham, UK. The Editors have put together a collection of over 30 contributions from colleagues of Professor Thomas that commences with a biographical sketch and representative tribute provided by a former doctoral student, and comprises a series of wide-ranging academic papers arranged to broadly reflect three dimensions of David Thomas’ academic and professional work – studies in and of Islam; Christian-Muslim relations; the Church and interreligious engagement. These are set in the context of a focussed theme – the character of Christian-Muslim encounters – and cast within a broad chronological framework.

The Holy Bible, containing the Old and New Testaments, with copious marginal references : also, the introductions to all the books and chapters in the Bible : with the general preface, as affixed to the commentary of Thomas Scott.

New Testament has special t.p.: The New Testament of our Lord and Saviour Jesus Christ : with copious marginal references by Thomas Scott.

Sketches and business directory of Boston and its vicinity : for 1860 and 1861.

University of Illinois Library bookplate “Purchased from Mr. H.A. Rattermann of Cincinnati in 1915”.

Christopher Columbus and the New world of his discovery; a narrative

Mode of access: Internet.

The literature of the nineteenth of April, 1775-1875.

Mode of access: Internet.

The feudal history of the county of Derby : (chiefly during the 11th, 12th, and 13th centuries) /

No more published.

Canadian nights; being sketches and reminiscences of life and sport in the Rockies, the prairies, and the Canadian woods,

Mode of access: Internet.

Romantic biography of the age of Elizabeth; or, Sketches of life from the bye-ways of history.

v. 1. Introduction. Margaret of Valois, Queen of Henry IV. Robert Dudley, Earl of Leicester. Castelnau, Ambassador from France. La Mothe Fenelon. La Mothe Fenelon and Castelnau. Thomas Howard, fourth duke of Norfolk. Hugh, Earl of Tyrone, and notices of Walter, 1st Earl of Essex. Dr. Dee.--v. 2. Calvin and the church of Geneva. William Whittingham and the Puritans. Archbishop Whitgift and Dr. Cartwright. John Darrel, the exorcist. Loyola and the order of the Jesuits. Robert Parsons, Edmund Campian, and the Jesuits in England. Pope Sixtus V. Charles de Valois, Duc d'Angoulême. Henry de la Tour d'Auvergne, Viscount Turenne and Duke de Bouillon.

State university of Iowa : plan of organization and course of studies adopted by the Board of Trustees, June 28th, 1860.

Mode of access: Internet.

The house of Cecil,

Mode of access: Internet.

Procès des trois Anglais, Robert-Thomas Wilson, John-Ely Hutchinson, Michel Bruce, et autres, accusés d'avoir facilité l'évation de Lavalette.

Mode of access: Internet.

Athenian letters: or, The epistolary correspondence of an agent of the king of Persia, residing at Athens during the Peloponnesian war. A new edition; to which is prefixed a geographical index. In two volumes. Illustrated with engravings, and a map of ancient Greece ...

The work of a group of English writers each letter being signed by an initial indicating the author, as follows. P.-Philip Yorke; C.-Charles Yorke; R.-G.H. Rooke; G.-John Green; W.-Daniel Wray; H.-Henry Heaton; E.-Wm. Heberden; O.-Henry Coventry; L.-John Lawry; T.-Catherine Talbot; B.-Thomas Birch; S.-Samuel Salter. The work was edited by Thomas Birch, the brothers Yorke having the largest share in the composition of the letters.