Cooking improves digestibility, palatability, and microbiological profile of meats, but can produce compounds with carcinogenic potential, such as heterocyclic amines (HAs) and polycyclic aromatic hydrocarbons (PAHs). It has been shown that the formation of these compounds in meats can be inhibited by spiced marinades, but there is a complexity to check and compare the results of isolated studies with so many variables involved. Thus, this work aimed to review studies that evaluated the effects of spices on the formation of HAs and PAHs in meats according to cooking techniques and spice type. A meta-analysis with a random effect model was conducted using response ratios (R) to identify and summarize previous results and answer the research question. The use of spices before frying (R* = 0.52), grilling (R* = 0.63), or roasting (R* = 0.74) meat, and spicing with garlic and onion (R* = 0.57), pepper (R* = 0.63), and other spices with phenolic compounds (R* = 0.63), decrease the formation of HAs and PAHs, due to the antioxidant and electron transfer capacity. In this article, we discuss how the improvement of culinary techniques with the dissemination of knowledge about meat preparation conditions is an effective strategy for reducing the formation and ingestion of HAs and PAHs; this is important due to the growing evidence about the association between meat consumption and chronic diseases. This is the first systematic review with meta-analysis about this topic and can guide industry, food services, and population to improve the safety associated with meat consumption.

Effects of seasoning on the formation of heterocyclic amines and polycyclic aromatic hydrocarbons in meats: A meta-analysis.

To systematically review the problem of appetite loss after major abdominal surgery.
Appetite loss is a common problem after major abdominal surgery. Understanding of etiology and treatment options is limited.
We searched Medline, Cochrane Central Register of Controlled Trials, and Web of Science for studies describing postoperative appetite loss. Data were extracted to clarify definition, etiology, measurement, surgical influence, pharmacological, and nonpharmacological treatment. PROSPERO registration ID: CRD42021224489.
Out of 6144 articles, we included 165 studies, 121 of which were also analyzed quantitatively. A total of 19.8% were randomized, controlled trials (n = 24) and 80.2% were nonrandomized studies (n = 97). The studies included 20,506 patients undergoing the following surgeries: esophageal (n = 33 studies), gastric (n = 48), small bowel (n = 6), colon (n = 27), rectal (n = 20), hepatobiliary (n = 6), and pancreatic (n = 13). Appetite was mostly measured with the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ C30, n = 54). In a meta-analysis of 4 randomized controlled trials gum chewing reduced time to first hunger by 21.2 hours among patients who had bowel surgery. Other reported treatment options with positive effects on appetite but lower levels of evidence include, among others, intravenous ghrelin administration, the oral Japanese herbal medicine Rikkunshito, oral mosapride citrate, multidisciplin-ary-counseling, and watching cooking shows. No studies investigated the effect of well-known appetite stimulants such as cannabinoids, steroids, or megestrol acetate on surgical patients.
Appetite loss after major abdominal surgery is common and associated with increased morbidity and reduced quality of life. Recent studies demonstrate the influence of reduced gastric volume and ghrelin secretion, and increased satiety hormone secretion. There are various treatment options available including level IA evidence for postoperative gum chewing. In the future, surgical trials should include the assessment of appetite loss as a relevant outcome measure.

The Problem of Appetite Loss After Major Abdominal Surgery: A Systematic Review.

Chronic Obstructive Pulmonary Disease is a common, preventable, and treatable disease. Here, we conducted a systematic review of Chronic Obstructive Pulmonary Disease and its risk factors in Nepal for the last two decades.
We systematically searched databases to find all relevant Chronic Obstructive Pulmonary Disease research papers from 2000 to 2020. Two reviewers screened the literature using Covidence based on the study protocol. Data extraction was done using Microsoft Excel from selected studies. Final data analysis was done using CMA v.3. Our review protocol is available in PROSPERO (CRD42020215486) on 20 November 2020.
The database search revealed 1416 studies of which 13 were included in quantitative analysis. The prevalence of Chronic Obstructive Pulmonary Disease in the adult population was 22·7% (CI, 12·5-37·7) of whom 54·9% were female (CI, 51·9-57·9). Nearly three-fourth of the participants (73·1%) of Chronic Obstructive Pulmonary Disease patients had informal education (CI, 58·6-84·0). The commonest primary occupation was agriculture and farming in 39·4% (CI, 31·3-48·2), followed by homemaker (36·8%). It was observed that 28·5% of the Chronic Obstructive Pulmonary Disease patients were former smokers, 25·8% non-smokers, and 59·4% were current smokers. More than two-third (76·2%) of Chronic Obstructive Pulmonary Disease patients relied upon traditional firewood cooking, whereas only 14.6% was adopted fireless cooking.
The pooled prevalence of Chronic Obstructive Pulmonary Disease in Nepal was significantly high with more cases in females compared to males. Smoking and traditional firewood cooking were major risk factors among Chronic Obstructive Pulmonary Disease cases in Nepal.

Prevalence and Risk Factors of COPD in Nepal: A Systematic Review and Meta-Analysis.

Epidemiological studies have shown that eating fish significantly reduces cardiovascular disease (CVD) incidence and mortality. However, more focused meta-analyses based on the most recent results from prospective cohort studies are needed. This systematic review and meta-analysis aims to update the association between fish intake and cardiovascular disease (CVD) risk using recent prospective studies. A systematic review and meta-analysis following the PRISMA guideline was conducted based on a random effects synthesis of multivariable-adjusted relative risks (RRs) of high vs. low categories of fish intake in relation to CVD incidence and mortality. Non-linear meta-regression was applied to investigate the shape of the association between fish intake and CVD risk. Sensitivity analysis and stratifications by type of CVD outcome, type of fish intake and type of cooking were performed. Based on 18 papers reporting 17 independent estimates of CVD risk (1,442,407 participants and 78,805 fatal and non-fatal CVD events), high vs. low intake of fish corresponded to about 8% reduced CVD risk (RR = 0.93 [0.88-0.98]). According to a non-linear dose-response meta-regression, 50 g of fish intake per day corresponded to a statistically significant 9% reduced fatal and non-fatal CVD risk (RR = 0.92 [0.90-0.95]). Similarly, fish intake in the range of a weekly intake of two to three portions of fish with a size of 150 g resulted in 8% fatal and non-fatal CVD risk reduction (RR = 0.93 [0.91-0.96]). The recommended two portions of fish a week reduces the risk of CVD outcomes by approximately 10%. A full portion of fish a day reduces CVD risk by up to 30%.

Fish Intake in Relation to Fatal and Non-Fatal Cardiovascular Risk: A Systematic Review and Meta-Analysis of Cohort Studies.

Salmonella and Campylobacter are common bacterial hazards causing foodborne illnesses worldwide. A large proportion of Salmonella and Campylobacter illnesses are attributed to contaminated poultry products that are mishandled or under cooked. Processing interventions such as chilling and post-chill dip are critical to reducing microbial contamination of poultry. A comprehensive search of the literature published between 2000 and 2021 was conducted in the databases Web of Science, Academic Search Complete, and Academic OneFile. Studies were included if they were in English and investigated the effects of interventions against Salmonella and/or Campylobacter on whole carcasses and/or parts during the chilling or post-chill stages of poultry processing. Random-effects meta-analyses were performed using the "meta" package in the R programming language. Subgroup analyses were assessed according to outcome measure reported, microorganism tested, processing stage assessed, and chemical treatment used. The results included 41 eligible studies. Eighteen studies reported results of 28 separate interventions against Salmonella and 31 reported results of 50 separate interventions against Campylobacter. No significant difference (P> 0.05) was observed when comparing the combined mean difference of all interventions targeting Salmonella to the combined mean difference of all interventions targeting Campylobacter or when comparing chilling times within each pathogen subgroup. For analyses examining antimicrobial additives, peroxyacetic acid (PAA) had the largest reduction against Salmonella population regardless of chilling time (P< 0.05). PAA also had the largest reduction against Campylobacter population and prevalence during primary chilling (P< 0.01). Air chilling showed a lower reduction for Campylobacter than any immersion chilling intervention (P< 0.05). Chilling time and antimicrobial used during poultry processing had varying effects depending on the pathogen and outcome measure investigated (concentration or prevalence). High heterogeneity and low sample numbers in most analyses suggest that more high-quality research that is well-designed and has transparent reporting of methodology and results is needed to corroborate the results.

Interventions to reduce Salmonella and Campylobacter during chilling and post-chilling stages of poultry processing: a systematic review and meta-analysis.

Greater understanding of patient-reported barriers and facilitators to seeking and accessing sexual health services will help formulate strategies to assist gynecologic and breast cancer patients to overcome obstacles to accessing sexual health support because they typically do not seek sexual education and/or treatment when confronted with sexual concerns.
The objectives of this systematic review were to (i) explore the patient-reported barriers to seeking and accessing support for sexual problems in gynecologic and breast cancer survivors, and (ii) identify strategies used to successfully overcome the barriers to accessing sexual health information and/or treatment.
The main outcome measures included factors that prevent and/or facilitate gynecologic and breast cancer patients with sexual concerns seeking and accessing sexual health-related services.
Systematic searches of major electronic databases (Ovid MEDLINE, PsycINFO, CINAHL, ProQuest, and Chinese database CNKI) from January 2009 to July 2019 were used to identify the barriers and facilitators to seeking sexual education/treatment from the perspective of gynecologic and breast cancer survivors. A narrative synthesis was conducted.
20 studies met the inclusion criteria including 12 qualitative, 6 quantitative, and 2 mixed methods studies. 4 interconnected themes were derived from 13 subthemes relating to the barriers/facilitators to seeking and accessing sexual health support. The most common barriers were embarrassment/discomfort in discussing sexual concerns, perceived discomfort of healthcare providers in discussing sexual issues, limitations of the healthcare system to address sexual problems, and the multidimensional nature of sexuality. Help-seeking for sexual health concerns was facilitated by: (i) oncology health professionals initiating and conducting open, honest discussions around sexual concerns with patients; (ii) the availability of information in multiple forms; and (iii) appropriate timing of information provision according to women's preferences.
Oncology health professionals need to develop an open, honest, accepting communication style and be accessible to women with cancer and their partners within healthcare systems.
The systematic review was conducted in accordance with guidelines. Variability in the primary aims and outcomes of the included studies precluded a meta-analysis.
Training programs for providers of oncology care should enhance their knowledge of sexual issues in gynecologic and/or breast cancer, enhance their communication skills with patients, and improve their ability to consult or refer patients to psycho-oncologists or other mental health professionals. Dai Y, Cook OY, Yeganeh L, et al. Patient-Reported Barriers and Facilitators to Seeking and Accessing Support in Gynecologic and Breast Cancer Survivors With Sexual Problems: A Systematic Review of Qualitative and Quantitative Studies. J Sex Med 2020;17:1326-1358.

Patient-Reported Barriers and Facilitators to Seeking and Accessing Support in Gynecologic and Breast Cancer Survivors With Sexual Problems: A Systematic Review of Qualitative and Quantitative Studies.

Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing.
To assess the effects of hand-washing promotion interventions on diarrhoeal episodes in children and adults.
We searched CENTRAL, MEDLINE, Embase, nine other databases, the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), and metaRegister of Controlled Trials (mRCT) on 8 January 2020, together with reference checking, citation searching and contact with study authors to identify additional studies.
Individually-randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand-washing interventions on diarrhoea episodes in children and adults with no intervention.
Three review authors independently assessed trial eligibility, extracted data, and assessed risks of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, we pooled incidence rate ratios (IRRs) using the generic inverse variance method and a random-effects model with a 95% confidence interval (CI). We used the GRADE approach to assess the certainty of the evidence.
We included 29 RCTs: 13 trials from child day-care centres or schools in mainly high-income countries (54,471 participants), 15 community-based trials in LMICs (29,347 participants), and one hospital-based trial among people with AIDS in a high-income country (148 participants). All the trials and follow-up assessments were of short-term duration. Hand-washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevent around one-third of diarrhoea episodes in high-income countries (incidence rate ratio (IRR) 0.70, 95% CI 0.58 to 0.85; 9 trials, 4664 participants, high-certainty evidence) and may prevent a similar proportion in LMICs, but only two trials from urban Egypt and Kenya have evaluated this (IRR 0.66, 95% CI 0.43 to 0.99; 2 trials, 45,380 participants; low-certainty evidence). Only four trials reported measures of behaviour change, and the methods of data collection were susceptible to bias. In one trial from the USA hand-washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; 3 trials, 1845 participants; low-certainty evidence). Hand-washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (IRR 0.71, 95% CI 0.62 to 0.81; 9 trials, 15,950 participants; moderate-certainty evidence). However, six of these nine trials were from Asian settings, with only one trial from South America and two trials from sub-Saharan Africa. In seven trials, soap was provided free alongside hand-washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: RR 0.66, 95% CI 0.58 to 0.75; 7 trials, 12,646 participants; education only: RR 0.84, 95% CI 0.67 to 1.05; 2 trials, 3304 participants). There was increased hand washing at major prompts (before eating or cooking, after visiting the toilet, or cleaning the baby's bottom) and increased compliance with hand-hygiene procedure (behavioural outcome) in the intervention groups compared with the control in community trials (data not pooled: 4 trials, 3591 participants; high-certainty evidence). Hand-washing promotion for the one trial conducted in a hospital among a high-risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (mean difference -1.68, 95% CI -1.93 to -1.43; 1 trial, 148 participants; moderate-certainty evidence). Hand-washing frequency increased to seven times a day in the intervention group versus three times a day in the control arm in this hospital trial (1 trial, 148 participants; moderate-certainty evidence). We found no trials evaluating the effects of hand-washing promotions on diarrhoea-related deaths or cost effectiveness.
Hand-washing promotion probably reduces diarrhoea episodes in both child day-care centres in high-income countries and among communities living in LMICs by about 30%. The included trials do not provide evidence about the long-term impact of the interventions.
La diarrea es responsable de 1 800 000 muertes de niños en los países de ingresos bajos y medios (PIBM). Una de las estrategias identificadas para prevenir la diarrea es el lavado de manos.
Evaluar los efectos de las intervenciones de promoción del lavado de manos sobre los episodios de diarrea en niños y adultos. MÉTODOS DE BÚSQUEDA: El 8 de enero de 2020 se realizaron búsquedas en CENTRAL, MEDLINE, Embase, en otras nueve bases de datos, la Plataforma de registros internacionales de ensayos clínicos (ICTRP) de la Organización Mundial de la Salud (OMS) y el metaRegister of Controlled Trials (mRCT), además de comprobación de referencias, búsqueda de citas y contacto con los autores de los estudios para identificar estudios adicionales. CRITERIOS DE SELECCIÓN: Ensayos controlados aleatorizados (ECA) individuales y por conglomerados que compararon los efectos de las intervenciones de lavado de manos sobre los episodios de diarrea en niños y adultos, con ninguna intervención. OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión, de forma independiente, evaluaron la elegibilidad de los ensayos, extrajeron los datos y evaluaron los riesgos de sesgo. Los análisis se estratificaron por guarderías infantiles o escuelas, comunidad y contextos hospitalarios. Cuando fue conveniente, se agruparon los cocientes de la tasa de incidencia (CTI) según el método de la varianza inversa genérica y un modelo de efectos aleatorios con un intervalo de confianza (IC) del 95%. Se utilizaron los criterios GRADE para evaluar la certeza de la evidencia.
Se incluyeron 29 ECA: 13 ensayos de guarderías infantiles o escuelas en países principalmente de ingresos altos (54 471 participantes), 15 ensayos comunitarios en PIMB (29 347 participantes) y un ensayo hospitalario en pacientes con sida en países de ingresos altos (148 participantes). Todos los ensayos y evaluaciones de seguimiento fueron a corto plazo. La promoción del lavado de manos (actividades educativas, a veces con la provisión de jabón) en las guarderías infantiles o las escuelas previene alrededor de un tercio de los episodios de diarrea en los países de ingresos altos (cociente de tasa de incidencia [CTI] 0,70; IC del 95%: 0,58 a 0,85; nueve ensayos, 4664 participantes, evidencia de certeza alta), y podría prevenir una proporción similar en los PIMB, pero solo dos ensayos en zonas urbanas de Egipto y Kenya lo han evaluado (CTI 0,66; IC del 95%: 0,43 a 0,99; dos ensayos, 45 380 participantes, evidencia de certeza baja). Solo cuatro ensayos informaron sobre medidas de cambio en el comportamiento y los métodos de recopilación de datos fueron susceptibles de sesgo. En un ensayo de los EE.UU. se informó de que el comportamiento de lavado de manos mejoró; y en el ensayo de Kenya que proporcionó jabón gratuito, el lavado de manos no aumentó, pero sí el uso de jabón (datos no agrupados; tres ensayos, 1845 participantes, evidencia de certeza baja). La promoción del lavado de manos entre las comunidades en los PIMB probablemente previene alrededor de una cuarta parte de los episodios de diarrea (CTI 0,71; IC del 95%: 0,62 a 0,81; nueve ensayos, 15 950 participantes, evidencia de calidad moderada). Sin embargo, seis de estos nueve ensayos procedían de entornos asiáticos, y solo hubo un ensayo en América del Sur y dos en el África subsahariana. En siete ensayos, el jabón se suministró gratuitamente junto con la educación para el lavado de manos, y el tamaño del efecto medio general fue mayor que en los dos ensayos que no suministraron jabón (jabón suministrado: RR 0,66; IC del 95%: 0,58 a 0,75; siete ensayos, 12 646 participantes; solo educación: RR 0,84; IC del 95%: 0,67 a 1,05; dos ensayos, 3304 participantes). Hubo un aumento del lavado de manos en los momentos más importantes (antes de comer o cocinar, después de ir al baño o de limpiar el trasero del niño), y un aumento en el cumplimiento del procedimiento de higiene de las manos (resultado conductual) en los grupos de intervención, en comparación el control, en los ensayos comunitarios (datos no agrupados: cuatro ensayos, 3591 participantes; evidencia de certeza alta). La promoción del lavado de manos en el único ensayo realizado en un hospital en una población de alto riesgo mostró una reducción significativa de los episodios medios de diarrea (1,68 menos) en el grupo de intervención (diferencia de medias ‐1,68; IC del 95%: ‐1,93 a ‐1,43; un ensayo, 148 participantes, evidencia de certeza moderada). En este ensayo hospitalario la frecuencia del lavado de manos aumentó hasta siete veces al día en el grupo de intervención versus tres veces al día en el grupo control (un ensayo, 148 participantes, evidencia de certeza moderada). No se encontraron ensayos que evaluaran los efectos de la promoción del lavado de manos sobre las muertes relacionadas con la diarrea ni el coste‐efectividad.
La promoción del lavado de manos probablemente reduce los episodios de diarrea en las guarderías infantiles de los países de altos ingresos y en las comunidades que viven en los PIMB, en aproximadamente el 30%. Los ensayos incluidos no aportan evidencia sobre el efecto a largo plazo de esta intervención.

Papers