A basic introduction to fixed-effect and random-effects models for meta-analysis

Poststroke cognitive impairment among stroke survivors in Sub-Saharan Africa: a systematic review and meta-analysis

INTRODUCTION

Stroke is the leading cause of death and disability among adults and elderly individuals worldwide. Although several primary studies have been conducted to determine the prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa, these studies have presented inconsistent findings. Therefore, this study aimed to determine the pooled prevalence of poststroke cognitive impairment and identify its associated factors among stroke survivors in sub-Saharan Africa.

METHODS

The studies were retrieved from the Google Scholar, Scopus, PubMed, and Web of Science databases. A manual search of the reference lists of the included studies was performed. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa.

RESULTS

A total of 10 primary studies with a sample size of 1,709 stroke survivors were included in the final meta-analysis. The pooled prevalence of PSCI was obtained from the 9 included studies with a sample size of 1,566. In contrast, the data regarding the associated factors were obtained from all the 10 included studies with a sample size of 1,709. The pooled prevalence of poststroke cognitive impairment among stroke survivors was 59.61% (95% CI: 46.87, 72.35); I2 = 96.47%; P < 0.001). Increased age (≥ 45 years) [AOR = 1.23, 95% CI: 1.09, 1.40], lower educational level [AOR = 4.35, 95% CI: 2.87, 6.61], poor functional recovery [AOR = 1.75, 95% CI: 1.42, 2.15], and left hemisphere stroke [AOR = 4.88, 95% CI: 2.98, 7.99] were significantly associated with poststroke cognitive impairment.

CONCLUSIONS

The pooled prevalence of poststroke cognitive impairment was considerably high among stroke survivors in sub-Saharan Africa. Increased age, lower educational level, poor functional recovery, and left hemisphere stroke were the pooled independent predictors of poststroke cognitive impairment in sub-Saharan Africa. Stakeholders should focus on empowering education and lifestyle modifications, keeping their minds engaged, staying connected with social activities and introducing rehabilitative services for stroke survivors with these identified factors to reduce the risk of developing poststroke cognitive impairment.

Heterogeneity in effect size estimates

A typical empirical study involves choosing a sample, a research design, and an analysis path. Variation in such choices across studies leads to heterogeneity in results that introduce an additional layer of uncertainty, limiting the generalizability of published scientific findings. We provide a framework for studying heterogeneity in the social sciences and divide heterogeneity into population, design, and analytical heterogeneity. Our framework suggests that after accounting for heterogeneity, the probability that the tested hypothesis is true for the average population, design, and analysis path can be much lower than implied by nominal error rates of statistically significant individual studies. We estimate each type's heterogeneity from 70 multilab replication studies, 11 prospective meta-analyses of studies employing different experimental designs, and 5 multianalyst studies. In our data, population heterogeneity tends to be relatively small, whereas design and analytical heterogeneity are large. Our results should, however, be interpreted cautiously due to the limited number of studies and the large uncertainty in the heterogeneity estimates. We discuss several ways to parse and account for heterogeneity in the context of different methodologies.

Characteristics of rehabilitation protocols following operative treatment of terrible triad elbow injuries and the influence of early motion: A systematic review and meta-analysis

Background

As no consensus exists on the optimal postoperative rehabilitation protocol in terrible triad injuries, we sought to characterize the reported protocols and relate them to postoperative range of motion (ROM) measures and Mayo Elbow Performance Score (MEPS).

Methods

A systematic review was performed by searching PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases to identify articles on the operative treatment of terrible triad injuries reporting postoperative rehabilitation protocols were included. Included studies were descriptively summarized. Methodologic quality was assessed using the Methodological Index for Non-randomized Studies criteria. Meta-analysis compared postoperative ROM measures and the MEPS between patients initiating passive ROM exercises at ≤7 days vs. >7 days.

Results

Our review included 36 articles with 1123 elbows (66% male, mean age: 43 years, follow-up: 27 months). Of the studies reporting physical therapy protocols, it was most commonly initiated at 7 days postoperatively (6/36, 17%), passive ROM exercises at 7 days (3/25, 12%), and active ROM at 21 days (4/26, 15%). On meta-analysis, early passive ROM initiation was not associated with improved elbow ROM or MEPS.

Discussion

While rehabilitation protocols commonly advised passive ROM at one week post-operatively, meta-analysis did not support functional benefits of early passive ROM.

Study design

Systematic Review; Level of evidence, 4.

crossnma: An R package to synthesize cross-design evidence and cross-format data using network meta-analysis and network meta-regression

BACKGROUND

Although aggregate data (AD) from randomised clinical trials (RCTs) are used in the majority of network meta-analyses (NMAs), other study designs (e.g., cohort studies and other non-randomised studies, NRS) can be informative about relative treatment effects. The individual participant data (IPD) of the study, when available, are preferred to AD for adjusting for important participant characteristics and to better handle heterogeneity and inconsistency in the network.

RESULTS

We developed the R package crossnma to perform cross-format (IPD and AD) and cross-design (RCT and NRS) NMA and network meta-regression (NMR). The models are implemented as Bayesian three-level hierarchical models using Just Another Gibbs Sampler (JAGS) software within the R environment. The R package crossnma includes functions to automatically create the JAGS model, reformat the data (based on user input), assess convergence and summarize the results. We demonstrate the workflow within crossnma by using a network of six trials comparing four treatments.

CONCLUSIONS

The R package crossnma enables the user to perform NMA and NMR with different data types in a Bayesian framework and facilitates the inclusion of all types of evidence recognising differences in risk of bias.

Cardiac magnetic resonance imaging for discrimination of hypertensive heart disease and hypertrophic cardiomyopathy: a systematic review and meta-analysis

Introduction

Differentiating hypertensive heart disease (HHD) from hypertrophic cardiomyopathy (HCM) is crucial yet challenging due to overlapping clinical and morphological features. Recent studies have explored the use of various cardiac magnetic resonance (CMR) parameters to distinguish between these conditions, but findings have remained inconclusive. This study aims to identify which CMR parameters effectively discriminate between HHD and HCM and to investigate their underlying pathophysiological mechanisms through a meta-analysis.

Methods

The researchers conducted a systematic and comprehensive search for all studies that used CMR to discriminate between HHD and HCM and calculated the Hedges'g effect size for each of the included studies, which were then pooled using a random-effects model and tested for the effects of potential influencing variables through subgroup and regression analyses.

Results

In this review, 26 studies encompassing 1,349 HHD and 1,581 HCM cases were included for meta-analysis. Analysis revealed that HHD showed a significant lower in T1 mapping (g = -0.469, P < 0.001), extracellular volume (g = -0.417, P = 0.024), left ventricular mass index (g = -0.437, P < 0.001), and maximal left ventricular wall thickness (g = -2.076, P < 0.001), alongside a significant higher in end-systolic volume index (g = 0.993, P < 0.001) and end-diastolic volume index (g = 0.553, P < 0.001), compared to HCM.

Conclusion

This study clearly demonstrates that CMR parameters can effectively differentiate between HHD and HCM. HHD is characterized by significantly lower diffuse interstitial fibrosis and myocardial hypertrophy, along with better-preserved diastolic function but lower systolic function, compared to HCM. The findings highlight the need for standardized CMR protocols, considering the significant influence of MRI machine vendors, post-processing software, and study regions on diagnostic parameters. These insights are crucial for improving diagnostic accuracy and optimizing treatment strategies for patients with HHD and HCM.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023470557, PROSPERO (CRD42023470557).

The prevalence of spontaneous resolution among pediatric trigger thumb: a systematic review and meta-analysis

BACKGROUND

Trigger thumb is a prevalent hand condition observed in children, and its management remains a topic of considerable debate, ranging from mere observation to surgical intervention. In recent times, there has been a growing interest in exploring nonoperative treatments as alternatives to surgical procedures for managing pediatric trigger thumb. Gaining insight into the prevalence of spontaneous resolution in pediatric trigger thumb is of paramount importance. However, the literature presents a wide variation in estimates regarding the prevalence of this spontaneous resolution, highlighting the need for further investigation and consensus. The aim of this review was to estimate the overall prevalence of spontaneous resolution among pediatric trigger thumb.

METHODS

This study meticulously followed the PRISMA guidelines and registered in the PROSPERO. The PubMed, Embase, and Cochrane Library databases were searched for all relevant studies up to May 2024.Inclusion criteria were studies reported only observation spontaneous resolution pediatric trigger thumb, aged up to 14 years, reported at least 10 thumbs and followed up time at least 3 months. Confounded intervention treatment measure studies were excluded. To synthesize the prevalence rates from individual studies, we employed a random-effects meta-analysis. In order to uncover the sources of heterogeneity and to compare prevalence estimates across different groups, we performed sensitivity and subgroup analyses. To meticulously evaluate the quality of the included studies, the Joanna Briggs Institute's quality assessment checklist was employed. Furthermore, to assess the heterogeneity among the studies, both Cochran's Q test and the I² statistic were utilized.

RESULTS

A total of eleven studies were included for the final analysis, with 599 pediatric trigger thumbs. Our final meta-analysis showed that more than one-third of these pediatric trigger thumb cases resolved spontaneously, with a resolution rate of 43.5% (95% CI 29.6-58.6). Subgroup analyses showed that in terms of age at the first visit, the prevalence of spontaneous resolution in the less than 24 months group and in the 24 months or older group was 38.7%(95% CI 18.1-64.4)and 45.8%(95% CI 27.4-65.4), respectively. There was no significant difference between the two groups(P = 0.690). When analyzing follow up time, the prevalence of spontaneous resolution in the 24 months or longer group and in the less than 24 months group was 58.9%(95% CI 41.6-74.2)and 26.8%(95% CI 14.7-43.8), respectively.There was significant statistical differences between the two groups(P = 0.009). Based on the initial severity of interphalangeal (IP) joint flexion contracture, the prevalence of spontaneous resolution in the 30 degrees or less group and in the other measurements group was 54.1%(95% CI 31.5-75.1)and 37.1%(95% CI 21.9-55.4), respectively.There was no significant difference between the two groups(P = 0.259).

CONCLUSION

Our study demonstrates that a significant proportion of pediatric trigger thumbs resolve spontaneously. This finding highlights the benefits of early observation in managing this condition. By prioritizing non-operative observation, both parents and surgeons are better equipped to make informed decisions regarding the treatment of pediatric trigger thumb, potentially reducing the need for surgical intervention.

A systematic review with meta-analyses of the association between stigma and chronic pain outcomes

ABSTRACT

Stigma is common in people experiencing chronic pain and there are indications that it may adversely affect pain outcomes. However, to date, there is no systematic review exploring the impact of stigma on chronic pain-related outcomes. This systematic review and meta-analysis aimed to examine the association between stigma and key chronic pain outcomes and differences in stigma between pain conditions. Seven databases were searched for studies reporting a measure of association between stigma and at least one pain outcome in adults with chronic pain. Studies were screened by 2 independent researchers. Nineteen studies met eligibility criteria and data were extracted, quality-assessed, and narratively synthesised and meta-analysed where possible. Meta-analyses of bivariate cross-sectional correlations demonstrated significant positive correlations between stigma and pain intensity, disability, and depression, with small to moderate effects. Data from 2 prospective studies and those only reporting multivariate analyses that were not included in meta-analyses further supported these findings. There was some evidence that individuals who experience pain conditions with less clear pathophysiology may report greater stigma, although more research is needed. The review highlights that there is a growing number of studies on stigma in the pain field showing an adverse association between stigma and chronic pain outcomes.

Efficacy and safety of treatment modalities for cesarean scar pregnancy: a systematic review and network meta-analysis

OBJECTIVE

Cesarean scar pregnancy may lead to varying degrees of complications. There are many treatment methods for it, but there are no unified or recognized treatment strategies. This systematic review and network meta-analysis aimed to observe the efficacy and safety of treatment modalities for patients with cesarean scar pregnancy.

DATA SOURCES

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to January 31, 2024. In addition, relevant reviews and meta-analyses were manually searched for additional references.

STUDY ELIGIBILITY CRITERIA

Our study incorporated head-to-head trials involving a minimum of 10 women diagnosed with cesarean scar pregnancy through ultrasound imaging or magnetic resonance imaging, encompassing a detailed depiction of primary interventions and any supplementary measures. Trials with a Newcastle-Ottawa scale score <4 were excluded because of their low quality.

METHODS

We conducted a random-effects network meta-analysis and review for cesarean scar pregnancy. Group-level data on treatment efficacy and safety, reproductive outcomes, study design, and demographic characteristics were extracted following a predefined protocol. The quality of studies was assessed using the Cochrane risk-of-bias tools for randomized controlled trials and the Newcastle‒Ottawa scale for cohort studies and case series. The main outcomes were efficacy (initial treatment success) and safety (complications), of which summary odds ratios and the surface under the cumulative ranking curve using pairwise and network meta-analysis with random effects.

RESULTS

Seventy-three trials (7 randomized controlled trials) assessing a total of 8369 women and 17 treatment modalities were included. Network meta-analyses were rooted in data from 73 trials that reported success rates and 55 trials that reported complications. The findings indicate that laparoscopy, transvaginal resection, hysteroscopic curettage, and high-intensity focused ultrasound combined with suction curettage demonstrated the highest cure rates, as evidenced by surface under the cumulative ranking curve rankings of 91.2, 88.2, 86.9, and 75.3, respectively. When compared with suction curettage, the odds ratios (95% confidence intervals) for efficacy were as follows: 6.76 (1.99-23.01) for laparoscopy, 5.92 (1.47-23.78) for transvaginal resection, 5.00 (1.99-23.78) for hysteroscopic curettage, and 3.27 (1.08-9.89) for high-intensity focused ultrasound combined with suction curettage. Complications were more likely to occur after receiving uterine artery chemoembolization, suction curettage, methotrexate+hysteroscopic curettage, and systemic methotrexate; hysteroscopic curettage, high-intensity focused ultrasound combined with suction curettage, and Lap were safer than the other options derived from finite evidence; and the confidence intervals of all the data were wide.

CONCLUSION

Our findings indicate that laparoscopy, transvaginal resection, hysteroscopic curettage, and high-intensity focused ultrasound combined with suction curettage procedures exhibit superior efficacy with reduced complications. The utilization of methotrexate (both locally guided injection and systemic administration) as a standalone medical treatment is not recommended.

Three-Dimensional Printing in Surgical Education: An Updated Systematic Review of the Literature

INTRODUCTION

Three-dimensional printing (3DP) is being integrated into surgical practice at a significant pace, from preprocedural planning to procedure simulation. 3DP is especially useful in surgical education, where printed models are highly accurate and customizable. The aim of this study was to evaluate how 3DP is being integrated most recently into surgical residency training.

METHODS

We performed a structured literature search of the OVID/MEDLINE, EMBASE, and PUBMED databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles published from 2016 to 2023 that met predefined inclusion and exclusion criteria were included. Data extracted included surgical subspecialty using 3DP, application of 3DP, and any reported satisfaction measures of trainees. A thorough analysis of pooled data was performed to evaluate satisfaction rates among studies.

RESULTS

A total of 85 studies were included. The median number of participants was 18 (interquartile range 10-27). Fourteen surgical disciplines were represented, with ear, nose, and throat/otolaryngology having the highest recorded utilization of 3DP models among residents and medical students (22.0%), followed by neurosurgery (14.0%) and urology (12.0%). 3DP models were created most frequently to model soft tissue (35.3%), bone (24.7%), vessel (14.1%), mixed (16.4%), or whole organs (6.66%) (Fig.1). Feedback from trainees was overwhelmingly positive regarding the fidelity of the models and their support for integration into their training programs. Among trainees, the combined satisfaction rate with their use in the curriculum was 95% (95% confidence interval, 0.92-0.97), and the satisfaction rate with the model fidelity was 90% (95% confidence interval, 0.86-0.94).

CONCLUSIONS

There is wide variation in the surgical specialties utilizing 3DP models in training. These models are effective in increasing trainee comfort with both common and rare scenarios and are associated with a high degree of resident support and satisfaction. Plastic surgery programs may benefit from the integration of this technology, potentially strengthening future surgical curricula. Objective evaluations of their pedagogic effects on residents are areas of future research.

Quantifying the Impact of Alternative Definitions of Sepsis-Associated Acute Kidney Injury on its Incidence and Outcomes: A Systematic Review and Meta-Analysis

OBJECTIVES

To derive a pooled estimate of the incidence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients and to explore the impact of differing definitions of SA-AKI on these estimates.

DATA SOURCES

Medline, Medline Epub, EMBASE, and Cochrane CENTRAL between 1990 and 2023.

STUDY SELECTION

Randomized clinical trials and prospective cohort studies of adults admitted to the ICU with either sepsis and/or SA-AKI.

DATA EXTRACTION

Data were extracted in duplicate. Risk of bias was assessed using adapted standard tools. Data were pooled using a random-effects model. Heterogeneity was assessed by using a single covariate logistic regression model. The primary outcome was the proportion of participants in ICU with sepsis who developed AKI.

DATA SYNTHESIS

A total of 189 studies met inclusion criteria. One hundred fifty-four reported an incidence of SA-AKI, including 150,978 participants. The pooled proportion of patients who developed SA-AKI across all definitions was 0.40 (95% CI, 0.37-0.42) and 0.52 (95% CI, 0.48-0.56) when only the Risk Injury Failure Loss End-Stage, Acute Kidney Injury Network, and Improving Global Outcomes definitions were used to define SA-AKI. There was significant variation in the incidence of SA-AKI depending on the definition of AKI used and whether AKI defined by urine output criteria was included; the incidence was lowest when receipt of renal replacement therapy was used to define AKI (0.26; 95% CI, 0.24-0.28), and highest when the Acute Kidney Injury Network score was used (0.57; 95% CI, 0.45-0.69; p < 0.01). Sixty-seven studies including 29,455 participants reported at least one SA-AKI outcome. At final follow-up, the proportion of patients with SA-AKI who had died was 0.48 (95% CI, 0.43-0.53), and the proportion of surviving patients who remained on dialysis was 0.10 (95% CI, 0.04-0.17).

CONCLUSIONS

SA-AKI is common in ICU patients with sepsis and carries a high risk of death and persisting kidney impairment. The incidence and outcomes of SA-AKI vary significantly depending on the definition of AKI used.

Attention Deficit/Hyperactivity Disorder in Individuals with Non-Syndromic Craniosynostosis: A Systematic Review and Meta-Analysis

It is not yet understood whether, and to what extent, craniosynostosis impacts the development of Attention Deficit/Hyperactivity Disorder (ADHD). This PRISMA compliant and PROSPERO pre-registered (ID: CRD42023458640) systematic review and meta-analysis examines the association of single-suture, non-syndromic craniosynostosis with ADHD and inattention/hyperactivity symptoms. Data from 17 independent studies (Nparticipants = 2,389; Mage = 7.3 years) were analyzed, taking into consideration suture location, surgical status, age, and measures administered, where feasible. Few differences were found between cases and controls, but some studies reported high symptom levels. Additional research is required utilizing larger sample sizes and more comprehensive assessment of ADHD.

The effect of nurse-led remote telephone triage on symptom management of patients with cancer: A systematic review and meta-analysis

BACKGROUND

Cancer patients experience many symptoms. Nurse-led remote telephone triage can improve their quality of life by contributing to the management of these symptoms.

AIMS

This study aimed to investigate the effects of nurse-led remote telephone triage on symptom management of patients with cancer.

METHODS

The searches were conducted in 10 databases and gray literature from May 2023 to July 2023 without any year limitations. A fixed-effects model was used in the meta-analysis. Cochran's Q chi-squared test and I2 statistics were used for heterogeneity. The PRISMA checklist was used. Data obtained from the included studies were analyzed using CMA 3 software.

RESULTS

Six relevant studies (1671 patients) were included. Nurse-led remote telephone triage was found to have a positive and moderate effect on parameters such as pain (Hedge's g = 0.21, p < .001), fatigue (Hedge's g = 0.28, p < .001), and depression (Hedge's g = 0.24, p < .001) in patients with cancer. Also, the remote telephone triage had a positive and low effect on outcomes such as anxiety (Hedge's g = 0.17, p = .001), nausea (Hedge's g = 0.17, p = .004), and vomiting (Hedge's g = 0.16, p = .007) but did not affect diarrhea results.

LINKING EVIDENCE TO ACTION

This study showed that nurse-led remote telephone triage considerably improved the symptoms of patients with cancer. This study will increase oncology nurses' awareness that nurse-led remote telephone triage of patients with cancer can improve their symptoms. Remote symptom triage developed using evidence-based guidelines and protocols can significantly contribute to the regular follow-up of patients' symptoms, providing quality care, and establishing appropriate symptom management programs and systems with high levels of evidence.

Comparison of craniotomy and decompressive craniectomy for acute subdural hematoma: a meta-analysis of comparative study

BACKGROUND

Acute subdural hematoma (ASDH) necessitates urgent surgical intervention. Craniotomy (CO) and decompressive craniectomy (DC) are the two main surgical procedures for ASDH evacuation. This meta-analysis is to compare the clinical outcomes between the CO and DC procedures.

MATERIALS AND METHODS

The authors performed a meta-analysis according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA, Supplemental Digital Content 1, http://links.lww.com/JS9/C513 , Supplemental Digital Content 2, http://links.lww.com/JS9/C514 ) Statement protocol and assessing the methodological quality of systematic reviews (AMSTAR) (Supplemental Digital Content 3, http://links.lww.com/JS9/C515 ) guideline. The PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched. Comparative studies reporting the outcomes of the CO and DC procedures in patients with ASDH were included.

RESULTS

A total of 15 articles with 4853 patients [2531 (52.2%) receiving CO and 2322 (47.8%) receiving DC] were included in this meta-analysis. DC was associated with higher mortality [31.5 vs. 40.6%, odds ratio (OR)=0.58, 95% CI: 0.43-0.77] and rate of patients with poorer neurological outcomes (54.3 vs. 72.7%; OR=0.43, 95% CI: 0.28-0.67) compared to CO. The meta-regression model identified the comparability of preoperative severity as the only potential source of heterogeneity. When the preoperative severity was comparable between the two procedures, the mortality (CO 35.5 vs. DC 38.1%, OR=0.80, 95% CI: 0.62-1.02) and the proportion of patients with poorer neurological outcomes (CO 64.8 vs. DC 66.0%; OR=0.82, 95% CI: 0.57-1.16) were both similar. Reoperation rates were similar between the two procedures (CO 16.1 vs. DC 16.0%; OR=0.95, 95% CI: 0.61-1.48).

CONCLUSION

Our meta-analysis reveals that DC is associated with higher mortality and poorer neurological outcomes in ASDH compared to CO. Notably, this difference in outcomes might be driven by baseline patient severity, as the significance of surgical choice diminishes after adjusting for this factor. Our findings challenge previous opinions regarding the superiority of CO over DC and underscore the importance of considering patient-specific characteristics when making surgical decisions. This insight offers guidance for surgeons in making decisions tailored to the specific conditions of their patients.

Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis

BACKGROUND

Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design.

OBJECTIVE

This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included.

METHODS

A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes.

RESULTS

Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: χ21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results.

CONCLUSIONS

There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions.

TRIAL REGISTRATION

PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060.

Impact of water, sanitation, and hygiene (WASH) interventions on gender-specific school attendance and learning outcomes: A systematic review and meta-analysis protocol

The Water, Sanitation, and Hygiene (WASH) interventions have been acknowledged for their role in the public health and educational outcomes. While there are strong evidences that reveal that WASH facilities do reduce the prevalence of infectious diseases and improve the learning environment, data remain thin and equivocal on the differential impacts of WASH facilities on education by gender. The literature reviewed does not, in most cases; go to the extent of investigating if indeed both men and women students have unique needs especially in underprivileged areas. This is the point from which the present systematic review and meta-analysis intend to fill this gap by assessing the global evidence on the effect of WASH interventions on educational outcomes with due consideration given to gender. This systematic review will include international databases used for the search, such as PubMed, Google Scholar, Web of Science, Europe PubMed Central, and Scopus. Study eligibility will include cross-sectional studies published in English on the impact of WASH interventions on school attendance and academic performance, stratifying gender-specific outcomes. Data extracted will be analyzed using the STATA software version 17. The percentage of heterogeneity will be quantified through the I2 statistics to show the variability between the included studies. Based on the observed results, diversity will be checked among the outcomes of the study and based on that random-effect model will be used to estimate the pooled effect size. I will, therefore, make use of the Egger and Begg tests for checking statistical asymmetry. Publication bias will be assessed with funnel plots. These will ensure the methodologies used provide comprehensive and rigorous data analysis, which will give strong insights into the impacts of the WASH intervention on educational outcomes. Prospero registration number: Systematic review and Meta-analysis registration number: PROSPERO CRD42024536477.

Nonpharmacological Therapies for the Management of the Cognitive Dysfunctions in Poststroke Patients: A Systematic Review and Network Meta-analysis

OBJECTIVE

The aim of the study is to investigate the comparative effects of nonpharmacological therapies for managing global, attention, memory, and execution cognitive functions in stroke patients.

DESIGN

We searched PubMed, Embase, CINAHL, Cochrane Library, Web of Science, PEDro, and Google Scholar for randomized controlled trials that evaluated the effects of nonpharmacological therapies for treating stroke cognitive dysfunctions. We performed a network meta-analysis to estimate the mean treatment effect of 95% credible interval.

RESULTS

Seventy-three randomized controlled trials were included in the network meta-analysis for evidence syntheses. All therapies had significant effects than control on global cognition in stroke patients. Combined therapy was superior to other therapies for global cognition of all patients (vs. cognitive task therapy: 0.71, 95% credible interval = 0.14 to 1.29; vs. exercise: 0.88, 95% credible interval = 0.31 to 1.45, vs. physical modality therapy: 0.77, 95% credible interval = 0.16 to 1.40). Different therapies have effects on specific cognitive domains in stroke patients.

CONCLUSIONS

Our findings suggest that nonpharmacological therapies are effective in improving global cognitive function in stroke patients, with cognitive task therapy, exercise therapy, physical modality therapy, and combined therapy being viable options (most optimal approach: combined therapy). Precise selection of therapies based on the time since stroke onset and specific cognitive domains can further enhance treatment outcomes.

Genetic and environmental effects on morphological traits of social phenotypes in wasps

Many species exhibit distinct phenotypic classes, such as sexes in dioecious species or castes in social species. The evolution of these classes is affected by the genetic architecture governing traits shared between phenotypes. However, estimates of the genetic and environmental factors contributing to phenotypic variation in distinct classes have rarely been examined. We studied the genetic architecture underlying morphological traits in phenotypic classes in the social wasp Vespula maculifrons. Our data revealed patriline effects on a few traits, indicating weak genetic influences on caste phenotypic variation. Interestingly, traits exhibited higher heritability in queens than workers. This result suggests that genetic variation has a stronger influence on trait variation in the queen caste than the worker caste, which is unexpected because queens typically experience direct selection. Moreover, estimates of heritability for traits were correlated between the castes, indicating that variability in trait size was governed by similar genetic architecture in the two castes. However, we failed to find evidence for a significant relationship between caste dimorphism and caste correlation, as would be expected if trait evolution was constrained by intralocus genetic conflict. Our analyses also uncovered variation in the allometric relationships for traits. These analyses suggested that worker traits were proportionally smaller than queen traits for most traits examined. Overall, our data provide evidence for a strong environmental and moderate genetic basis of trait variation among castes. Moreover, our results suggest that selection previously operated on caste phenotype in this species, and phenotypic variation is now governed primarily by environmental differences.

Prevalence and factors associated with intestinal parasitic infections among preschool-aged children in Ethiopia: A systematic review and meta-analysis

Intestinal parasitic infections (IPIs) pose a serious public health threat across the globe, particularly in children residing in poor and most deprived communities like Ethiopia. Many published articles were available separately, and a detailed nationwide review was essential to combine all the results to draw a conclusion and avoid any informational conflicts, ambiguities, or misunderstandings. Therefore, this systematic review and meta-analysis aimed to provide pooled estimates for the individually available data on IPIs and its determinant factors among preschool-aged children (PSAC) in Ethiopia. Published and unpublished articles from various electronic databases were accessed using MeSH terms and keywords. I 2 and sensitivity analysis tests were used to assess potential sources of heterogeneity across studies. Funnel plot, Begg's, and Egger's regression tests were used to check publication bias. A random-effects model with a 95% confidence interval (CI) was used to calculate the pooled estimate of IPI. In this meta-analysis, a total of 14,994 PSAC were included in the 32 eligible studies. The pooled national prevalence of IPIs among PSAC was 32.52% (95% CI: 26.24, 38.80). Of these, single and mixed infections contribute 31.08% and 1.44%, respectively. According to the subgroup analysis, the highest prevalence was observed in simple random studies (39.61%; 95% CI: 29.19, 50.03), the Tigray region (58.00%; 95% CI: 54.10, 61.90), studies conducted in >384 (39.47%; 95% CI: 27.73, 51.20) sample sizes, cross-sectional studies (32.76%), community-based studies (42.33%; 95% CI: 31.93, 52.74), and from 2005 to 2016 (34.53%; 95% CI: 20.13, 48.92) study periods. Intestinal parasites were significantly associated with eating raw fruits and vegetables (aOR = 3.21; 95%CI: 1.11-5.31). The high prevalence of STHs observed in this systematic review and meta-analysis underscores the need for appropriate control and prevention strategies suitable for PSAC in Ethiopia.

Willingness to use PrEP among PrEP naïve men who have sex with men: a meta-analysis

This study aimed to measure the pooled estimate of willingness to use HIV pre-exposure prophylaxis (PrEP) (WTUP) among PrEP-naïve United States (U.S.)-based men who have sex with men (MSM). PubMed, Embase, Web of Science, CINAHL, and PsycINFO were searched. The search strategy contained the keyword willingness and interest and the MeSH terms for HIV and PrEP. Articles were included if they were published between January 2005 and May 2022, reported quantitative data on WTUP among PrEP-naïve US-based MSM, and were available as full text in English. Meta-analysis was conducted to assess the pooled effect size of WTUP prevalence using a random-effects model, heterogeneity in the pooled estimate was assessed, and subgroup analyzes were conducted. Fifteen studies were included based on the inclusion and exclusion criteria. Meta-analysis revealed a pooled prevalence proportion for WTUP of 0.58 (95% CI 0.54-0.61) (or 58 out of 100) among PrEP-naïve MSM. High inter-study heterogeneity (Q = 548.10, df = 19, p < 0.01, I2 = 96.53, τ2 = 0.09) was observed. Age of the study sample and region where the data were collected significantly moderated the pooled WTUP estimate. Age-appropriate PrEP related messaging and a focus on HIV priority areas of the U.S. would be important strategies to improve WTUP among MSM in the U.S. moving forward.

Extended Swedish Adoption Study of Adverse Stress Responses and Posttraumatic Stress Disorder

Importance

Twin studies have found that posttraumatic stress disorder (PTSD) is influenced by both genetic and environmental factors within a generation. No study has used an adoption design, which can address questions about the degree and sources of cross-generational transmission of adverse stress responses (ASRs) and PTSD.

Objectives

To examine whether ASRs or PTSD are transmitted from parents to offspring, and to clarify the relative importance of genes and rearing.

Design, Setting, and Participants

This cohort study used nationwide Swedish registry data from parents and offspring (n = 2 194 171, born 1960-1992) of 6 types of families (intact; had not lived with biological father; had not lived with biological mother; lived with stepfather; lived with stepmother; and adoptive). Follow-up occurred on December 31, 2018, and data were analyzed from March 3, 2023, to January 16, 2024.

Exposures

Three sources of parent-offspring resemblance: genes plus rearing, genes only, and rearing only.

Main Outcomes and Measures

Diagnoses of ASRs or PTSD were obtained from national inpatient, outpatient, and primary care medical registries. Parent-child resemblance was assessed by tetrachoric correlation. Sensitivity analyses were conducted to control for possible shared traumatic events.

Results

The study population included 2 194 171 individuals of 6 family types (1 146 703 [52.3%] male; median [range] age, 42 [20-63] years). The weighted tetrachoric correlations across family types were 0.15 (95% CI, 0.15-0.16) for genes plus rearing, 0.08 (95% CI, 0.06-0.11) for genes only, and 0.10 (95% CI, 0.07-0.12) for rearing only. Controlling for potential shared traumatic events, sensitivity analyses found that the correlation for rearing decreased, with the most conservative control (exclusion of parent-offspring dyads with onset of ASRs or PTSD within 1 year) suggesting equal correlations with genes and rearing.

Conclusions and Relevance

Diagnosis of ASRs or PTSD demonstrated cross-generational transmission, including both genetic and rearing correlations. Sensitivity analyses suggested that shared traumatic events partially accounted for the observed rearing correlations.

Effects of inpatient, residential, and day-patient treatment on obsessive-compulsive symptoms in persons with obsessive-compulsive disorder: A systematic review and meta-analysis

INTRODUCTION

Patients with severe or treatment-refractory obsessive-compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive-compulsive symptoms in patients with OCD.

METHODS

PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients.

RESULTS

We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and-if available-at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive-compulsive symptoms decreased from admission to discharge with large effect sizes (g = -1.59, 95%CI [-1.76; -1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [-0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures.

CONCLUSIONS

Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are-on average-maintained after discharge.

Does working memory training improve emotion regulation and reduce internalizing symptoms? A pair of three-level meta-analyses

BACKGROUND

Emotional dysfunction is a core feature of many mental disorders. Working memory training (WM-T) is promising to improve emotion regulation and reduce internalizing symptoms (anxiety and depressive symptoms), but the results are mixed. Therefore, we conducted meta-analyses to clarify these mixed results.

METHODS

We searched Web of Science, PubMed, ScienceDirect, and EBSCO to identify relevant studies and screened the references. The effect size was calculated using Hedges' g. Three-level, random-effects models were run using metafor in R.

RESULTS

The current study included 44 articles, of which 29 were involved with emotion regulation, and 30 were involved with internalizing symptoms. The results showed that WM-T could yield emotional benefits, but the benefits were confined to enhancing explicit emotional regulation capacity and reducing anxiety symptoms. For the meta-analysis regarding the effect of WM-T on emotion regulation, there was no significant moderator. For the meta-analysis regarding the effect of WM-T on internalizing symptoms, the emotional valence of the material and control group were statistically significant moderators.

CONCLUSION

WM-T could yield certain emotional effects, but only to improve explicit emotion regulation capacity and reduce anxiety symptoms. In addition, some measures could enhance the effect, such as targeting specific populations, increasing the number of training sessions (≥15) or duration (>450 minutes), using negative material, and using n-back training tasks.

Is there evidence for the asymmetrical transfer of strength to an untrained limb?

PURPOSE

The literature predominantly addresses cross-education of strength in the dominant limb rather than the non-dominant limb, guided by the hypothesis of an asymmetrical transfer of strength from unilateral training protocols. The purpose of the study was to review the literature and determine how much evidence was available to support this claim. A meta-analysis was performed to estimate the magnitude of this hypothesized asymmetrical transfer of strength.

METHODS

A literature search of all possible records was implemented using Cochrane Library, PubMed, and Scopus from February 2022 to May 2022. Comparison of randomized controlled trials was computed. The change scores and standard deviations of those change scores were extracted for each group. Only three studies met the criteria, from which a total of five effect sizes were extracted and further analyzed.

RESULTS

The overall effect of resistance training of the dominant limb on strength transfer to the non-dominant limb relative to the effects of resistance training the non-dominant limb on strength transfer to the dominant (non-training) limb was 0.46 (SE 0.42). The analysis from this study resulted in minimal support for the asymmetry hypothesis. Given the small number of studies available, we provide the effect but note that the estimate is unlikely to be stable.

CONCLUSION

Although it is repeatedly stated that there is an asymmetrical transfer of strength, our results find little support for that claim. This is not to say that it does not exist, but additional research implementing a control group and a direct comparison between limbs is needed to better understand this question.

Body mass index and multimorbidity risk: A systematic review and dose-response meta-analysis

OBJECTIVE

To verify the dose-response relationship between body mass index (BMI) and multimorbidity risk.

METHODS

PubMed, CINAHL, and Embase were systematically studied until January 25, 2023. Original articles on BMI and multimorbidity risk were included. Random effects model and dose-response meta-analysis were used to estimate the pooled odds ratio (OR) with 95 % confidence interval (CI). Subgroup analysis was performed to explore potential heterogeneity.

RESULTS

A total of 43 studies involving 969,130 patients (94,978 with multimorbidity) were involved in the meta-analysis. In the longitudinal studies, the pooled results showed that, compared to being a normal BMI, being overweight was much similar with 1.32 times possibility of getting multimorbidity; in persons with obesity the risk was 1.93 times higher; and the risk decreased 0.80 times among underweight persons. Additionally, obesity was 1.75 times as likely to be multimorbidity than those non-obese persons. In the cross-sectional studies, the pooled results demonstrated that persons with overweight and obesity had a 1.38-fold and 2.38-fold risk for multimorbidity, respectively; and the risk decreased 0.90 times among underweight persons compared to those with normal BMI. Besides, obese people are 1.89 times more likely to have multimorbidity than non-obese people. Dose response analysis found the linear connection between BMI and multimorbidity risk (Pnon-linearity=0.762), that for each 1 kg/m2 and 5 kg/m2 increase in BMI, the multimorbidity risk increased by 6 % and 35 %, respectively.

CONCLUSIONS

Multimorbidity increased linearly with an increase in BMI. Clinicians should pay attention to persons with abnormal weight, to help them achieve normal BMI.

Primary closure versus vertical rectus abdominis myocutaneous (VRAM) flap closure of perineal wound following abdominoperineal resection-a systematic review and meta-analysis

PURPOSE/AIM

Perianal wound healing and/or complications are common following abdominoperineal resection (APR). Although primary closure is commonly undertaken, myocutaneous flap closure such as vertical rectus abdominis myocutaneous flap (VRAM) is thought to improve wound healing process and outcome. A comprehensive meta-analysis was performed to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR.

METHODS

PubMed, MEDLINE, EMBASE, and Cochrane Central Registry of Controlled Trials were comprehensively searched until the 8th of August 2023. Included studies underwent meta-analysis to compare outcomes of primary closure versus VRAM flap closure of perineal wound following APR. The primary outcome of interest was perineal wound complications, and the secondary outcomes were abdominal wound complications, dehiscence, wound healing time, length of hospital stay, and mortality.

RESULTS

Ten studies with 1141 patients were included. Overall, 853 patients underwent primary closure (74.8%) and 288 patients underwent VRAM (25.2%). Eight studies reported on perineal wound complications after APR: 38.2% (n = 263/688) in the primary closure group versus 32.8% (n = 80/244) in the VRAM group. Perineal complication rates were statistically significantly lower in the VRAM group versus primary closure ((M-H OR, 1.61; 95% CI 1.04-2.49; 

CONCLUSION

We highlight the advantage of VRAM flap closure over primary closure for perineal wounds following APR. However, tailoring operative strategy based on patient and disease factors remains important in optimising outcomes.

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Key Words

• Abdominoperineal resection
• Perineal complications
• Surgical oncology
• Vertical rectus abdominis myocutaneous flap

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MESH Headings

• Humans
• Perineum/surgery
• Myocutaneous Flap
• Rectus Abdominis
• Wound Healing
• Proctectomy/methods
• Proctectomy/adverse effects
• Postoperative Complications
• Length of Stay/statistics & numerical data

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Grants

• The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Supported by Joly Cancer Leadership Programme, Trinity St James Cancer Institute
• University of Dublin, Trinity College

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Affiliation(s)

Hugo C Temperley Department of Surgery, St. James's Hospital, Dublin, Ireland. Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland.
Poorya Shokuhi Department of Surgery, St. James's Hospital, Dublin, Ireland
Niall J O'Sullivan Department of Surgery, St. James's Hospital, Dublin, Ireland
Benjamin Mac Curtain Department of Surgery, St John of God Subiaco Hospital, Perth, Australia
Caitlin Waters Department of Surgery, Fiona Stanley Hospital, Perth, Australia
Alannah Murray Department of Surgery, St. James's Hospital, Dublin, Ireland
Christina E Buckley Department of Plastics, St. James's Hospital, Dublin, Ireland
Maeve O'Neill Department of Surgery, St. James's Hospital, Dublin, Ireland
Brian Mehigan Department of Surgery, St. James's Hospital, Dublin, Ireland
Paul H McCormick Department of Surgery, St. James's Hospital, Dublin, Ireland
Michael E Kelly Department of Surgery, St. James's Hospital, Dublin, Ireland Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
John O Larkin Department of Surgery, St. James's Hospital, Dublin, Ireland

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Inflammatory Markers in Thyroid Eye Disease: A Meta-Analysis

Thyroid Eye Disease (TED) is an inflammatory autoimmune condition affecting the eyes, often associated with Graves' disease. Inflammation is important in TED, involving immune cells and orbital tissues. While inflammatory markers have been studied in other diseases, their role in TED is unclear. We included 734 participants from 5 eligible studies investigated associations between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) and TED. Initial analysis found no significant differences in these markers between TED and control groups. However, sensitivity analysis excluding an outlier study revealed significant differences in NLR, PLR, and MLR between groups, suggesting the potential association between these inflammatory markers and TED. More research is needed, but these findings indicate complex TED pathogenesis and that inflammation may offer insights for TED diagnosis and management.

Using ultrasound elastography to assess non-invasive, non-pharmacological interventions for musculoskeletal stiffness: a systematic review and meta-analysis

PURPOSE

To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness.

METHODS

A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed.

RESULTS

Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders (g = 1.488, 95% CI = 0.320-2.655, p = 0.013). Analyses for other intervention types and patient groups were underpowered.

CONCLUSION

Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.

Beta-blocker use and breast cancer outcomes: a meta-analysis

PURPOSE

Beta blockers (BBs) are commonly used cardiovascular medications, and their association with breast cancer outcomes has been examined in several previous observational studies and meta-analyses. In this study, an updated meta-analysis was undertaken to ascertain the association between BBs and both breast cancer death (BCD) and breast cancer recurrence (BCR).

METHODS

Articles were sourced from various databases up until the 14th of August 2023. Effect estimates were pooled using the random effects model, and the Higgins I2 statistic was computed to ascertain heterogeneity. Subgroup analyses were conducted by the potential for immortal time bias (ITB), the exposure period (prediagnosis vs postdiagnosis), and type of BB (selective vs non-selective). Publication bias was assessed using funnel plots and Egger's regression tests.

RESULTS

Twenty-four studies were included. Pooled results showed that there was no statistically significant association between BB use and both BCD (19 studies, hazard ratio = 0.90, 95% CI 0.78-1.04) and BCR (16 studies, HR = 0.87, 95% CI 0.71-1.08). After removing studies with ITB, the associations were attenuated towards the null. There was no effect modification for either outcome when stratifying by the exposure period or type of BB. There was clear evidence of publication bias for both outcomes.

CONCLUSION

In this meta-analysis, we found no evidence of an association between BB use and both BCD and BCR. Removing studies with ITB attenuated the associations towards the null, but there was no effect modification by the exposure period or type of BB.

Digital cognitive behavioural therapy for patients with insomnia and depression: A systematic review and meta-analysis

WHAT IS KNOWN ON THE SUBJECT

Sleep problems are common among those with depression, and there is increasing evidence that sleep problems should be addressed during treatment simultaneously rather than treating depression alone. The first-line treatment for insomnia is cognitive behavioural therapy for insomnia (CBT-I), due to a lack of well-trained therapists and patient time constraints (travelling, work), CBT-I has not been popularized. The development of digital cognitive behavioural therapy for insomnia (dCBT-I) is making the treatment more accessible.

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE

Interventions for dCBT-I were significantly better than other control conditions in both reducing insomnia and improving depression in patients with depression and insomnia comorbidities. The effect was found to be related to the duration of the intervention and the severity of insomnia before the intervention and therapist-involved dCBT-I has less shedding than self-help.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

It's important for mental health practitioners to realize that insomnia in depressed people needs to be treated. Future trials may explore the effectiveness of therapist-guided dCBT-I in depressed populations and analyse the cost-effectiveness of this treatment.

ABSTRACT

Aim The aim of the study was to systematically identify and synthesize the evidence for the effectiveness of digital cognitive behavioural therapy in insomnia with comorbid depression. Design Systematic review and metaanalysis. Methods A search was conducted on five English and four non-English databases from the inception of the databases to November 2023. This review adhered to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement 2020 and the included studies were evaluated using version 2 of the Cochrane risk of bias tool. This review examined sleep-related outcomes, including insomnia severity and sleep diaries, along with psychological outcomes, such as depression. We conducted a meta-analysis of each outcome using a random effects model. Heterogeneity was assessed by the I2 statistic. Results A total of seven articles with 1864 participants were included in this review. The results showed that the digital cognitive behavioural therapy group demonstrated a statistically significant amelioration in the severity of insomnia symptoms, as well as a reduction in depressive symptomatology compared with the control groups. The post-intervention effect was found to be related to the duration of the intervention and the severity of insomnia before the intervention. Conclusions Digital cognitive behavioural therapy for insomnia application in patients with depression and insomnia was demonstrated to be effective, less time-consuming and more accessible. Relevance to Clinical Practice We may consider incorporating nurses into treatment plans and conducting nurse-led interventions in specific programs. In the future, nurses may be able to provide exclusive digital behavioural therapy for insomnia to patients with depression to achieve greater effectiveness.

Effect of vasopressin injection technique on ovarian reserve during laparoscopic cystectomy of ovarian endometriomas: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

To evaluate the effect of injecting vasopressin during laparoscopic excision of ovarian endometriomas on ovarian reserve.

EVIDENCE ACQUISITION

Four different databases (PubMed, Cochrane Library, Scopus, and ISI Web of Science) were searched to identify relevant studies in March 2023. We selected randomized controlled trials (RCTs) that compared vasopressin injection in the intervention group versus no injection of vasopressin in the control group among women undergoing laparoscopic cystectomy of ovarian endometriomas. The main outcomes were the amount of bleeding, number of coagulation events, and levels of serum anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH). The available data were extracted and analyzed in a meta-analysis model using RevMan software.

EVIDENCE SYNTHESIS

Seven RCTs, involving a total number of 478 patients, were included in our study. The vasopressin group had significantly reduced blood loss amount and number of coagulation events compared to the control group (P=0.004 and P=0.005). There was a significant improvement in the AMH levels within 6 months after surgery in the vasopressin group (MD=0.52, 95% CI: 0.11, 0.93, P=0.01). In addition, the FSH levels within 6 months after laparoscopic cystectomy were significantly reduced with vasopressin injection.

CONCLUSIONS

Vasopressin injection during laparoscopic cystectomy of ovarian endometriomas is effective in reducing blood loss amount and frequency of coagulation, as well as protecting the ovarian reserve. More trials are encouraged to confirm our findings.

Prognostic value of liver stiffness in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis

BACKGROUND AND AIMS

liver stiffness measurement, assessed by vibration-controlled transient elastography, has been recognized as a powerful tool for liver fibrosis assessment. The potential of liver stiffness measurement to predict clinically relevant outcomes in fatty liver disease has received considerable attention. This study aimed to investigate the prediction of liver-related events in metabolic dysfunction-associated steatotic liver disease patients by liver stiffness measurement value on transient elastography.

METHODS

the electronic databases including PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov until 6 September 2023 were systematically searched. The hazard ratios adjusted for confounders were extracted and pooled by random-effects model analysis.

RESULTS

a total of 20,587 individuals from seven studies were included. The pooled hazard ratios (HRs) were 18.65 (95 % CI: 9.95-34.95, p < 0.01, I2 = 0 %) in the stratification analysis of the highest versus lowest liver stiffness measurement categories. In 1-kPa analysis, the risk of liver-related events was increased with 1 kPa increment (HR 1.05, 95 % CI: 1.03-1.07, p < 0.01, I2 = 74.47 %).

CONCLUSIONS

metabolic dysfunction-associated steatotic liver disease patients with high liver stiffness measurement values were at an increased risk of liver-related events. Liver stiffness measurement can be used as a prognostic tool to achieve risk stratification in fatty liver patients.

The efficacy, safety and effectiveness of hyperoncotic albumin solutions in patients with sepsis: A systematic review and meta-analysis

Background

Intravenous fluid therapy is a ubiquitous intervention for the management of patients with sepsis, however excessive cumulative fluid balance has been shown to result in worse outcomes. Hyperoncotic albumin is presented in low volumes, is an effective resuscitation fluid and may have effects beyond plasma volume expansion alone. This systematic review aimed to assess the efficacy, safety and effectiveness of hyperoncotic albumin solutions in the management of sepsis.

Methods

We searched four databases and two trial registries for controlled clinical trials of hyperoncotic albumin for management of sepsis. Review outcomes were mortality, need for renal replacement therapy, cumulative-fluid balance, and need for organ support. We used methods guided by the Cochrane Handbook for reviews of clinical interventions. Studies were assessed using Cochrane's Risk of Bias 2 tool. We performed pairwise meta-analysis where possible. Certainty of evidence was assessed using GRADE.

Results

We included six trials; four (2772 patients) were meta-analysed. Most studies had moderate or high risk of bias. There was no significant difference in 28-day mortality for septic patients receiving hyperoncotic albumin compared to other intravenous fluids (OR 0.95, [95% CI: 0.8-1.12]); in patients with septic shock (2013 patients) there was a significant reduction (OR 0.82 [95% CI: 0.68-0.98]). There was no significant difference in safety outcomes. Hyperoncotic albumin was associated with variable reduction in early cumulative fluid balance and faster resolution of shock.

Conclusions

There is no good-quality evidence to support the use of hyperoncotic albumin in patients with sepsis, but it may reduce short-term mortality in the sub-groups with septic shock. It appears safe in terms of need for renal replacement therapy and is associated with reduced early cumulative fluid balance and faster resolution of shock. Larger, better quality randomised controlled trials in patients with septic shock may enhance the certainty of these findings.

Review registration

PROSPERO ref: CRD42021150674.

Non-invasive neurostimulation to improve sleep quality and depressive symptoms in patients with major depressive disorder: A meta-analysis of randomized controlled trials

BACKGROUND

Non-invasive neurostimulation, including bright light therapy (BLT), repetitive transcranial magnetic (rTMS) and transcranial direct current stimulation (tDCS), has been shown to alleviate depressive symptoms in major depressive disorder (MDD). However, the efficacy of these interventions in addressing sleep disturbances in MDD patients remains a subject of debate.

OBJECTIVE

We aimed to conduct a meta-analysis of available randomized controlled trials (RCTs) to assess the effectiveness of non-invasive neurostimulation in improving sleep disturbances and depressive symptoms in MDD patients.

METHODS

Systematic searches for relevant RCTs were conducted in the databases PubMed, Cochrane Library, Web of Science, EMBASE, Wanfang and China National Knowledge Infrastructure up to January 2024. Data on outcomes comparable across the studies were meta-analyzed using Review Manager 5.3 and Stata 14. The pooled results were reported as standardized mean differences (SMD) with their respective 95% confidence intervals (CI).

RESULTS

Our analysis encompassed 15 RCTs involving 1348 patients. Compared to sham or no stimulation, non-invasive neurostimulation significantly improved sleep quality (SMD -0.74, 95%CI -1.15 to -0.33, p = 0.0004) and sleep efficiency (SMD 0.35, 95%CI 0.10 to 0.60, p = 0.006). It also significantly reduced severity of depressive symptoms (SMD -0.62, 95%CI -0.90 to -0.35, p < 0.00001). Subgroup analysis further demonstrated that patients experiencing sleep improvements due to neurostimulation showed a marked decrease in depressive symptoms compared to the control group (SMD = -0.90, 95% CI [-1.26, -0.54], p < 0.0001).

CONCLUSION

Current evidence from RCTs suggests that neurostimulation can enhance sleep quality and efficiency in individuals with MDD, which in turn may be associated with mitigation of depressive symptoms.

PROSPERO REGISTRATION

CRD42023423844.

Risk factors of suicide-related events in patients with epilepsy: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis examined the risk factors for suicide-related events (SRE) in patients with epilepsy (PWE).

METHODS

The PubMed, Embase, Cochrane Online Library, and ClinicalTrials.gov databases were searched for relevant articles published from 1946 to August 30, 2022. The quality of the extracted articles was assessed using the Newcastle-Ottawa scale. Subsequently, a meta-analysis of PWE was performed to calculate the random-effects pooled odds ratios (ORs) for studies investigating the association between suicide and its associated risk factors. All statistical analyses were performed using R version 4.1.0.

RESULTS

A total of 2,803 studies were screened, of which 23 articles comprising 6,723 PWE were included in our meta-analysis. Female sex (odds ratio [OR]=1.24, 95 % confidence interval [CI]: 1.08-1.43), low quality of life (QOL) scores (standardized mean difference [SMD]= -0.89, CI: -1.17 - -0.61), poor social support (OR=3.44, CI: 1.83-6.46), unemployment (OR=1.82, CI: 1.40-2.38), unmarried status (OR=1.48, CI: 1.12-1.97), low income (OR=1.37, CI: 1.07-1.76), low education (OR=1.33, CI: 1.04-1.68), use of antidepressant drugs (OR=7.77, CI: 3.17-19.03), uncontrolled seizures (OR=2.28, CI: 1.63-3.18), use of multiple antiepileptic drugs (OR=1.70, CI: 1.33-2.18), early age at onset of epilepsy (SMD= -0.15, CI: -0.30 - -0.0002), depression (OR=6.85, CI: 4.88-9.62), and anxiety (OR=3.76, CI: 2.92-4.84) were identified as significant risk factors of SRE.

SIGNIFICANCE

There are many risk factors for SRE in PWE, as outlined above. Interventions targeting these risk factors may help reduce the risk of SRE in PWE.

Short- and intermediate-term outcomes of transcatheter aortic valve replacement in low-risk patients: A meta-analysis and systematic review

Background

Transcatheter aortic valve replacement (TAVR) being currently employed in low surgical risk patients with severe symptomatic aortic stenosis (AS). The durability and extended outcomes of TAVR as compared to surgical aortic valve replacement (SAVR) in low-risk patients remains uncertain.

Methods

We selected randomized controlled trials (RCT) comparing outcomes of TAVR vs. SAVR in low surgical risk patients having severe AS using online databases. The primary outcome was all-cause death. The secondary outcomes were composite of all-cause death & disabling stroke, cardiovascular (CV) death, stroke, myocardial infarction (MI), permanent pacemaker (PPM) placement, new onset atrial fibrillation (AF), valve re-intervention and valve thrombosis. The outcomes were stratified at short- (1-year) and intermediate-term (≤5 years) follow-up. We used a random effect model to report outcomes as relative risk (RR) with a 95 % confidence interval (CI).

Results

The analysis consisted of six RCTs comprising 5,122 subjects with a mean age of 75.4 years. At short-term follow up, there was a significant reduction in all-cause death (RR: 0.62, 0.46-0.82, p = 0.001) and composite of all-cause death and disabling stroke (RR: 0.62, 0.45-0.83, p = 0.002) in patients undergoing TAVR. At intermediate-term follow-up, there was no significant difference in survival (RR:0.95, 0.73-1.24, p = 0.71) and composite outcome (RR: 0.95, 0.74-1.22, p = 0.71). TAVR patients had lower incidence of new onset AF, however, higher PPM placement.

Conclusion

In patients with severe AS having low-surgical risk, patients undergoing TAVR had improved short-term survival as compared to SAVR. This survival advantage was absent at intermediate-term follow-up. The long-term outcomes remain uncertain.

Psychometric Evidence That Paraphilia Is a Natural Kind

Is the category paraphilia a natural kind? That is, do different paraphilias share anything scientifically interesting or are they classified together because they are unusual and sometimes problematic? We investigated this question systematically in 11 samples of paraphilic males (N = 4,617) and 11 samples of control males (N = 1,494). Primary data consisted of responses to the 11-item Paraphilic Interests Scale. Contrary to our initial hypothesis, the scale mean was similar for paraphilic and control samples. Using logistic regression and the same items, we derived three highly correlated measures that robustly discriminated paraphilic and control samples (ds ranging from 0.86 to 0.92). These successful measures capitalized on the unanticipated fact that some items (especially those assessing transvestism and masochistic humiliation) were positively associated with membership in paraphilic samples, while others (especially those assessing voyeurism) were negatively associated with such membership. Subsequent analyses focused on one of the measures, the Paraphilic Interests Scale Contrast (PISC). Consistent with prior findings distinguishing paraphilias and homosexual orientation, PISC was not elevated among homosexual males compared with heterosexual males among the control groups. Within four paraphilic samples, PISC was positively associated with additional paraphilic phenomena. Results provide tentative support for both the proposition that paraphilia is a natural kind and the usefulness of PISC as a measure of paraphilia.

Outcomes of detrusorectomy in neurogenic bladders: A systematic review and meta-analysis

INTRODUCTION

This systematic review and meta-analysis aims to assess the outcomes of detrusorectomy in children with neurogenic bladder (NB).

MATERIALS AND METHODS

A search was performed in PUBMED, EMBASE and the Cochrane Library database in August 2023. The following search terms were used: "detrusorectomy", "detrusorotomy", "auto-augmentation". The two main primary outcomes were improvement in bladder capacity and bladder compliance after intervention. Outcomes were dichotomized into favorable and unfavorable. The secondary outcomes were the effect of postoperative bladder cycling on bladder compliance and bladder capacity and complications.

RESULTS

258 references were screened for inclusion, of these 242 were excluded. 8 of the remaining 16 studies were included for the qualitative and quantitative analysis. All studies were retrospective case series studies (165 patients). Median follow-up time varied between studies (1.75-11.1 years), while two studies reported a mean follow-up time of 8.1 years. Using a random effects meta-analysis, the overall rate for unchanged or improved bladder capacity was 95% (Proportion[CI]: 0.95 [0.61; 1.00]). The overall rate for improved bladder compliance after detrusorectomy was 67% (Proportion[CI]: 0.67 [0.26; 0.92)) (Summary Fig). In the bladder cycling group improved compliance was found in 89% of patients (Proportion[CI]: 0.89 [0.41; 0.99]), whereas it was 21% in the non-cycling group (Proportion[CI]: 0.21 [0.04; 0.61]) (p = 0.0552). Bladder cycling did not affect bladder capacity as the overall rate for unchanged or improved bladder capacity was 98% (Proportion[CI]: 0.98 [0.35; 0.92]) in the cycling and 73% (Proportion[CI]: 0.73 [0.46; 0.90]) in the non-cycling group (p > 0.05). Overall complications were encountered in 16 (9.7%) patients, with major complications (stones, bladder perforations) detected only in 5(3%) patients.

DISCUSSION

Detrusorectomy leads to an improved bladder compliance in 67% of children. As such, detrusorectomy proves to be a viable procedure to enhance bladder compliance or to cure overactivity. Importantly, the beneficial effect of detrusorectomy on bladder compliance seems to be long-lasting. Bladder capacity remained unchanged or improved in almost all patients undergoing detrusorectomy. Postoperative bladder cycling was effective in improving bladder compliance outcome compared to the non-cycling group. Proper patient selection is the key to good postoperative outcomes.

CONCLUSIONS

Detrusorectomy enhances bladder compliance in pediatric neurogenic bladders. Postoperative bladder cycling improves bladder compliance and the overall complication rate of the procedure is low. Therefore, detrusorectomy should be considered a valuable therapeutic option in the comprehensive management of neurogenic bladders in children.

The Effect of Prewarming on Perioperative Hypothermia: A Systematic Review and Meta-analysis of Randomized Controlled Studies

PURPOSE

One of the methods for maintaining perioperative normothermia is prewarming. This study was conducted to investigate the effect of a preoperative prewarming intervention on perioperative body temperature.

DESIGN

Systematic review and meta-analysis.

METHODS

A literature review was conducted using PubMed, CINAHL, Cochrane Central, Science Direct, Springer Link, Scopus, Web of Science, and Ovid databases. Randomized controlled trials that investigate the effect of prewarming on body temperature in the prevention of perioperative hypothermia were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Methodological quality was assessed using the Cochrane Collaboration "risk of bias" tool. Meta-analysis was performed with Comprehensive Meta-Analysis, version 2. Moderator analysis and publication bias assessment were performed. Funnel plots were analyzed using Orwin's fail-safe N, Trim, and Fill test method to investigate the source of heterogeneity.

FINDINGS

A total of 907 studies were found. The systematic review included 27 studies. Of these, 23 were included in the intraoperative meta-analysis, and 16 were included in the postoperative meta-analysis. According to the meta-analysis results, the prewarming intervention was effective in maintaining normothermia in the intraoperative (Hedge's g = 0.972, 95% confidence intervaI = 0.674 to 1.270) and postoperative (Hedge's g = 0.818, 95% confidence intervaI = 0.520 to 1.114) periods.

CONCLUSIONS

The findings of this systematic review and meta-analysis showed that preoperative prewarming played a significant role in providing and maintaining perioperative normothermia.

Does behavioural parent training reduce internalising symptoms (or not) among children with externalising problems? Systematic review and meta-analysis

Behaviour parent training (BPT) is known to effectively reduce child externalising problems. However, evidence for BPT to have secondary benefits for reducing internalising symptoms remains unclear. To address this, electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, and SCOPUS) were systematically searched for studies examining internalising outcomes from BPT among children aged 2-12 years with clinically elevated externalizing problems. Outcomes for internalising problems following BPT were analysed by meta-analysis. Of 9105 studies identified, 24 studies met the eligibility criteria. Results from meta-analysis demonstrated a significant small treatment effect size (g = - 0.41) for reducing internalising symptoms immediately after treatment. Studies showed moderate heterogeneity (I2 = 44%). Moderation analyses indicated that the overall treatment effect was robust against variations in treatment and study design characteristics. However, a review of individual study methods indicate that these results are limited by significant heterogeneity and limitations in clinical assessment. Overall, the results suggest that BPT programmes for reducing externalising problems have the potential to improve internalising outcomes, but that there is limited information to determine the reliability of these effects, highlighting the need for further investigation.

Dorsal Preservation versus Component Dorsal Hump Reduction Rhinoplasty: An Assessment of Patient-reported Outcomes

Background

The literature on patient-reported outcomes (PROs) discussing dorsal preservation rhinoplasty (DPR) and component dorsal hump reduction (CDHR) is scarce. This study aims to fill the gap in PROs between these techniques.

Methods

A systematic review was conducted to investigate PROs of DPR and CDHR. A proportion meta-analysis was conducted using Stata statistical software.

Results

A total of 25 studies met our inclusion criteria, pooling 1706 participants, with 13 studies on CDHP and 12 studies on DPR. Overall satisfaction rates were high, varying from 84% to 100% across studies. A subgroup analysis revealed that both techniques exhibited equally high satisfaction with no statistical differences (P = 0.18). A random-effects model revealed that about two of 100 treated patients underwent revisions across our cohort (95% interquartile range: 0-4). Notably, the CDHR technique was associated with a significant 53.7-point reduction in the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS)-cosmetic domain [95% confidence interval (CI): -62.7 to -44.8, P < 0.001], along with a meaningful improvement in SCHNOS-obstructive scores by -27.3 points (95% CI: -50.5 to -4.04, P = 0.02). Conversely, the DPR was linked to a 55.3-point reduction in the SCHNOS-cosmetic domain (95% CI: -60.7 to -49.9, P < 0.001), and a -19.5 point change in the SCHNOS-obstructive domain (95% CI: -27.9 to -11.1, P < 0.001).

Conclusion

Although PROs are comparable, the literature suggests that CDHR outcomes may be better than DPR in alleviating obstructive symptoms, potentially offering an evidence-based choice for addressing functional concerns in rhinoplasty.

Chinese herbal medicine and acupuncture for insomnia in stroke patients: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND

Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke.

METHODS

Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.

RESULTS

A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.

CONCLUSIONS

Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.

REGISTRATION

PROSPERO No. CRD42020194029 and No. CRD42020194030.

Efficacy of hyperbaric oxygen therapy as an adjunct therapy in the treatment of sleep disorders among patients with Parkinson's disease: a meta-analysis

Objective

To systematically evaluate the efficacy of hyperbaric oxygen therapy (HBOT) as an adjunct therapy for treating sleep disorders in patients with Parkinson's disease (PD).

Methods

We conducted comprehensive searches in eight databases from inception through September 2023, including PubMed, Cochrane Library, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database. The objective was to identify randomized controlled trials (RCTs) evaluating HBOT's effectiveness in alleviating sleep disorder symptoms in PD patients as an adjunct therapy. Literature screening and data extraction were independently executed by the authors. Meta-analyses were performed using Review Manager 5.3 software, and publication bias and sensitivity analyses were assessed using Stata 17.0 software.

Results

Seven RCTs involving 461 participants were included. The findings revealed that the addition of HBOT significantly enhanced sleep efficiency (MD = 15.26, 95% CI [10.89, 19.63], p < 0.00001), increased time in bed (MD = 69.65, 95% CI [43.01, 96.30], p < 0.00001), total sleep time (MD = 75.87, 95% CI [25.42, 126.31], p = 0.003), slow-wave sleep (SWS) time (MD = 6.14, 95% CI [3.95, 8.34], p < 0.00001), and rapid eye movement sleep (REM) time (MD = 4.07, 95% CI [2.05, 6.08], p < 0.0001), and reduced awakening frequency (MD = -11.55, 95% CI [-15.42, -7.68], p < 0.00001) and sleep latency (MD = -6.60, 95% CI [-9.43, -3.89], p < 0.00001). Additionally, significant improvements were observed in the Pittsburgh Sleep Quality Index (PSQI) (MD = -2.52, 95% CI [-2.85, -2.18], p < 0.00001), Epworth Sleepiness Scale (ESS) (MD = -2.90, 95% CI [-3.34, -2.47], p < 0.00001), Unified Parkinson's Disease Rating Scale Part III (UPDRS III) (MD = -1.32, 95% CI [-2.16, -0.47], p = 0.002), and Hoehn and Yahr grading (H-Y grading) (MD = -0.15, 95% CI [-0.28, -0.01], p = 0.03).

Conclusion

The current meta-analysis supports the efficacy of HBOT as an adjunct therapy in managing sleep disorders in PD patients. It is recommended for PD patients experiencing sleep disturbances.Systematic review registration:https://www.crd.york.ac.uk/, identifier: CRD42023462201.

Extended analysis on peripheral blood cytokines correlated with hepatitis B virus viral load in chronically infected patients - a systematic review and meta-analysis

Background

Hepatitis B Virus (HBV) can affect life quality. Monitoring and understanding the fluctuations of the HBV level of viremia related to the intricate immune activity of the host helps in the development of new treatment strategies and evaluation patterns. This meta-analysis presents the correlations between cytokines and the level of viremia in chronic HBV patients for a better comprehension of the immune mechanisms behind this infection.

Methods

We used PRISMA guidelines for this meta-analysis. The databases assessed were PUBMED, WEB OF SCIENCE, SCOPUS, and Cochrane Library. ZOTERO and PlotDigitizer helped the systematic research process. We extracted information related to the correlations between cytokines and the HBV-DNA level. Effect measures included comparisons between standardized mean differences and correlation coefficients. We evaluated retrieved articles with the Newcastle-Ottawa Quality Assessment Scale (NOS). The R 4.2.2 software displayed the statistical calculation and graphical representations.

Results

From 58,169 records, we extracted 16 articles with 32 different cytokine determinations. The main interleukins included in detection panels were IL-10 and IL-21. The meta-correlation analysis comprised 1,199 chronic HBV patients. The standardized mean difference between cytokine levels in HBV patients and healthy controls was 0.82 (95% CI = [-0.19, 1.84], p = 0.11). We observed a significant, fair, pooled correlation coefficient between IL-10, IL-9, and the viral load (r = 0.52, 95% CI = [0.19, 0.85]).

Conclusion

This meta-analysis brings novelty because it gives a first rigorous systematic look at multiple studies with many cytokines. Our research approaches a debatable issue and gives a possible solution for settling controversies. Future studies can arise towards understanding the immune disruption in HBV and the development of new, improved assays for prognosis.

Assessing the Effectiveness of Simulation-Based Education in Emerging Infectious Disease Management: A Systematic Review and Meta-analysis

SUMMARY STATEMENT

This systematic review and meta-analysis aimed to thoroughly examine the effectiveness of simulation-based education in the management of emerging infectious diseases, focusing on educational content and methods. Studies published between 2000 and 2022 were identified, and a meta-analysis was conducted using a random-effects model. The findings revealed that simulation-based education significantly enhances various competencies related to managing emerging infectious diseases, encompassing cognitive, negative-affective, positive-affective, and psychomotor outcomes. Subgroup analysis indicated that methods effective in improving competencies include the use of equipment with limited or full patient interaction, simulated or in situ settings, and scenarios involving some interruptions by educators or independent participation of trainees. This review underscores the importance of appropriate methodological considerations in simulation-based education, including equipment, settings, and scenario designs, to optimize educational outcomes in the management of emerging infectious diseases.

Burden of early neonatal mortality in Sub-Saharan Africa. A systematic review and meta-analysis

BACKGROUND

Globally, with a neonatal mortality rate of 27/1000 live births, Sub-Saharan Africa has the highest rate in the world and is responsible for 43% of all infant fatalities. In the first week of life, almost three-fourths of neonatal deaths occur and about one million babies died on their first day of life. Previous studies lack conclusive evidence regarding the overall estimate of early neonatal mortality in Sub-Saharan Africa. Therefore, this review aimed to pool findings reported in the literature on magnitude of early neonatal mortality in Sub-Saharan Africa.

METHODS

This review's output is the aggregate of magnitude of early neonatal mortality in sub-Saharan Africa. Up until June 8, 2023, we performed a comprehensive search of the databases PubMed/Medline, PubMed Central, Hinary, Google, Cochrane Library, African Journals Online, Web of Science, and Google Scholar. The studies were evaluated using the JBI appraisal check list. STATA 17 was employed for the analysis. Measures of study heterogeneity and publication bias were conducted using the I2 test and the Eggers and Beggs tests, respectively. The Der Simonian and Laird random-effect model was used to calculate the combined magnitude of early neonatal mortality. Besides, subgroup analysis, sensitivity analysis, and meta regression were carried out to identify the source of heterogeneity.

RESULTS

Fourteen studies were included from a total of 311 articles identified by the search with a total of 278,173 participants. The pooled magnitude of early neonatal mortality in sub-Saharan Africa was 80.3 (95% CI 66 to 94.6) per 1000 livebirths. Ethiopia had the highest pooled estimate of early neonatal mortality rate, at 20.1%, and Cameroon had the lowest rate, at 0.5%. Among the included studies, both the Cochrane Q test statistic (χ2 = 6432.46, P <0.001) and I2 test statistic (I2 = 99.80%, p <0.001) revealed statistically significant heterogeneity. Egger's weighted regression (p <0.001) and funnel plot show evidence of publication bias in this meta-analysis.

CONCLUSION

This review demonstrated that the pooled magnitude of early neonatal mortality in sub-Saharan Africa is substantial. Therefore, governmental and nongovernmental agencies, international organizations, healthcare providers and institutions and academic and research institutions should give a due attention and design strategies to reduce early neonatal mortality in Sub-Saharan Africa.

A Molecular Hypothesis on Malignant Transformation of Oral Lichen Planus: A Systematic Review and Meta-Analysis of Cancer Hallmarks Expression in This Oral Potentially Malignant Disorder

We aimed to qualitatively and quantitatively analyze, through a systematic review and meta-analysis, the current evidence on the differential expression of the hallmarks of cancer in oral lichen planus (OLP) samples, in order to know the earliest molecular mechanisms that could be involved in the malignant transformation of this oral potentially malignant disorder. We searched MEDLINE/PubMed, Embase, Web of Science, and Scopus for studies published before November 2023. We evaluated the methodological quality of studies and carried out meta-analyses to fulfill our objectives. Inclusion criteria were met by 110 primary-level studies, with 7065 OLP samples, in which the expression of 104 biomarkers were analyzed through immunohistochemistry. Most OLP samples showed sustained cell proliferation signaling (65.48%, 95%CI = 51.87-78.02), anti-apoptotic pathways (55.93%, 95%CI = 35.99-75.0), genome instability (48.44%, 95%CI = 13.54-84.19), and tumor-promoting inflammation events (83.10%, 95%CI = 73.93-90.74). Concurrently, OLP samples also harbored tumor growth suppressor mechanisms (64.00%, 95%CI = 53.27-74.12). In conclusion, current evidence indicates that molecular mechanisms promoting hyperproliferative signaling, an antiapoptotic state with genomic instability, and an escape of epithelial cells from immune destruction, are developed in LP-affected oral mucosa. It is plausible that these events are due to the actions exerted by the chronic inflammatory infiltrate. Malignant transformation appears to be prevented by tumor suppressor genes, which showed consistent upregulation in OLP samples.

The Effect of Walking on Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis

Background

Previous literature lacks summative information on the mental health benefits achieved from different forms of walking.

Objective

The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety.

Methods

This was a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.

Results

This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD -0.591, 95% CI -0.778 to -0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD -0.446, 95% CI -0.628 to -0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD -1.863, 95% CI -2.764 to -0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD -0.442, 95% CI -0.604 to -0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD -0.126, 95% CI -0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD -0.053, 95% CI -0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).

Conclusions

Various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.

Comprehensive evaluation of drought stress on medicinal plants: a meta-analysis

Drought stress significantly affects plants by altering their physiological and biochemical processes, which can severely limit their growth and development. Similarly, drought has severe negative effects on medicinal plants, which are essential for healthcare. The effects are particularly significant in areas that rely mostly on traditional medicine, which might potentially jeopardize both global health and local economies. Understanding effects of droughts on medicinal plants is essential for developing strategies to enhance plant adaptability to drought stress, which is vital for sustaining agricultural productivity under changing climatic conditions. In this study, a meta-analysis was conducted on 27 studies examining various parameters such as plant yield, chlorophyll content, relative water content, essential oil content, essential oil yield, non-enzymatic antioxidants, enzymatic antioxidants, phenols, flavonoids, and proline content. The analysis explored the effects of drought across different stress conditions (control, moderate, and severe) to gain deeper insights into the drought's impact. The categorization of these stress conditions was based on field or soil capacity: control (100-80%), moderate (80-50%), and severe (below 50%). This classification was guided by the authors' descriptions in their studies. According to meta-analysis results, enzymatic antioxidants emerge as the most responsive parameters to stress. Other parameters such as relative water content (RWC) and yield also exhibit considerable negative mean effect sizes under all three stress conditions. Therefore, when evaluating the impacts of drought stress on medicinal plants, it is beneficial to include these three parameters (enzymatic antioxidants, RWC, and yield) in an evaluation of drought stress. The chlorophyll content has been determined not to be a reliable indicator for measuring impact of drought stress. Also, measuring antioxidants such as flavonoids and phenols could be a better option than using radical scavenging methods like DPPH (2, 2-difenil-1-pikrilhidrazil), FRAP (ferric reducing antioxidant power), and ABTS (2, 2'-Azino-bis (3-ethylbenzothiazoline-6-sulfonic acid)).