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      Occupational outcomes of people with multiple sclerosis during the COVID-19 pandemic: a systematic review with meta-analysis

      systematic-review

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          Abstract

          Background

          People with Multiple Sclerosis (PwMS) are vulnerable to unfavorable occupational outcomes and the COVID-19 pandemic brought major consequences on people’s professional lives. In this view, we decided to investigate the occupational outcomes of PwMS during the COVID-19 pandemic.

          Methods

          We performed a systematic review with meta-analysis searching key terms in four databases. We initially included any peer-reviewed original article that enrolled adult patients with the diagnosis of MS and assessed any occupational variable during the COVID-19 pandemic. There were no time limits and no language restrictions. The primary outcomes were the prevalence of unemployment, retirement and employment status change among people with MS during the COVID-19 pandemic. Other outcomes included the modality and characteristics of work: type of work, full-time work, part-time work and remote work. We also searched for data from studies that addressed any change in the work status due to the COVID-19 outbreak.

          Results

          We identified 49 eligible articles comprising a total sample size of 17,364 individuals with MS. The pooled prevalence of unemployment and retirement was 0.47 (95% CI = 0.42–0.53). The pooled prevalence of PwMS who were unemployed or retired was positively associated with the progressive phenotype of the disease ( p = 0.017) and the use of glatiramer acetate ( p = 0.004), but negatively associated with hospitalization due to COVID-19 ( p = 0.008) and the use of immunosuppressants ( p = 0.032), siponimod ( p < 0.001), and cladribine ( p = 0.021). The pooled proportion of PwMS that reported any change of the employment status during the COVID-19 pandemic was 0.43 (95% CI = 0.36–0.50) while the pooled prevalence of PwMS who worked remotely during this period was 0.37 (95% CI = 0.15–0.58). The change in employment status was negatively associated with the duration of MS ( p = 0.03) but positively associated with the progressive phenotype of the disease ( p < 0.001).

          Conclusion

          Our seminal review may serve as an example of how patients with neurological diseases or disabilities in general may have their jobs impacted in a pandemic and foster the context of global socio-economic crisis.

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          Most cited references87

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          The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Bias in meta-analysis detected by a simple, graphical test

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              Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

              Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                27 November 2023
                2023
                : 11
                : 1217843
                Affiliations
                [1] 1Department of Health Sciences, University of Genoa , Genoa, Italy
                [2] 2Ospedale Policlinico San Martino di Genova IRCCS , Genoa, Italy
                Author notes

                Edited by: Manuela Altieri, University of Campania Luigi Vanvitelli, Italy

                Reviewed by: Lindsay Rechtman, McKing Consulting Corporation, United States; Mario Risi, University of Campania Luigi Vanvitelli, Italy

                *Correspondence: Bruno Kusznir Vitturi, z_azul@ 123456hotmail.com
                Article
                10.3389/fpubh.2023.1217843
                10711111
                38089033
                8db4b096-8714-4a22-98e1-eda31a75eed8
                Copyright © 2023 Vitturi, Rahmani, Montecucco, Dini and Durando.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 05 May 2023
                : 09 November 2023
                Page count
                Figures: 8, Tables: 1, Equations: 0, References: 88, Pages: 17, Words: 9482
                Categories
                Public Health
                Systematic Review
                Custom metadata
                Occupational Health and Safety

                multiple sclerosis,demyelinating diseases,immunomodulators,occupational health,unemployment,public health,covid-19,work

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