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

Prevalence of delayed antiretroviral therapy initiation among people living with HIV: A systematic review and meta-analysis

OBJECTIVE

HIV continues to be a global challenge. Key recommendations for HIV prevention and treatment are presented on rapid antiretroviral therapy (ART) initiation. However, several studies showed a high prevalence of delayed ART initiation. The aim of this systematic review and meta-analysis was to assess the prevalence of delayed ART initiation among HIV-infected patients globally.

METHODS

This review summarised eligible studies conducted between January 2015 and August 2022 on the prevalence of delayed ART initiation in HIV-infected adults (age ≥ 15). Relevant studies were systematic searched through PubMed/Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases. Random-effects models were used to calculate pooled prevalence estimates. The heterogeneity was evaluated using Cochran's Q test and I2 statistics. Moreover, potential sources of heterogeneity were explored using univariate subgroup analysis.

RESULTS

Data on the prevalence of delayed ART initiation was pooled across 29 studies involving 34,937 participants from 15 countries. The overall pooled prevalence of delayed ART initiation was 36.1% [95% confidence interval (CI), 29.7-42.5%]. In subgroup analysis, the estimated pooled prevalence decreased with age. By sex, the prevalence was higher among male patients (39.3%, 95% CI: 32.2-46.4%) than female (36.5%, 95% CI: 26.9-50.7%). Patients with high CD4 cell count were more likely to delay ART initiation than those with low CD4 cell count (>500cells/mm3: 40.3%; 201-500cells/mm3: 33.4%; and ≤200cells/mm3: 25.3%).

CONCLUSIONS

Our systematic review and meta-analysis identified a high prevalence of delayed ART initiation. The prolonged time interval between diagnosis and treatment is a prevalent and unaddressed problem that should spur initiatives from countries globally. Further research is urgently needed to identify effective strategies for promoting the early ART initiation.

Graft Failure After Coronary Artery Bypass Grafting and Its Association With Patient Characteristics and Clinical Events: A Pooled Individual Patient Data Analysis of Clinical Trials With Imaging Follow-Up

BACKGROUND

Graft patency is the postulated mechanism for the benefits of coronary artery bypass grafting (CABG). However, systematic graft imaging assessment after CABG is rare, and there is a lack of contemporary data on the factors associated with graft failure and on the association between graft failure and clinical events after CABG.

METHODS

We pooled individual patient data from randomized clinical trials with systematic CABG graft imaging to assess the incidence of graft failure and its association with clinical risk factors. The primary outcome was the composite of myocardial infarction or repeat revascularization occurring after CABG and before imaging. A 2-stage meta-analytic approach was used to evaluate the association between graft failure and the primary outcome. We also assessed the association between graft failure and myocardial infarction, repeat revascularization, or all-cause death occurring after imaging.

RESULTS

Seven trials were included comprising 4413 patients (mean age, 64.4±9.1 years; 777 [17.6%] women; 3636 [82.4%] men) and 13 163 grafts (8740 saphenous vein grafts and 4423 arterial grafts). The median time to imaging was 1.02 years (interquartile range [IQR], 1.00-1.03). Graft failure occurred in 1487 (33.7%) patients and in 2190 (16.6%) grafts. Age (adjusted odds ratio [aOR], 1.08 [per 10-year increment] [95% CI, 1.01-1.15]; P=0.03), female sex (aOR, 1.27 [95% CI, 1.08-1.50]; P=0.004), and smoking (aOR, 1.20 [95% CI, 1.04-1.38]; P=0.01) were independently associated with graft failure, whereas statins were associated with a protective effect (aOR, 0.74 [95% CI, 0.63-0.88]; P<0.001). Graft failure was associated with an increased risk of myocardial infarction or repeat revascularization occurring between CABG and imaging assessment (8.0% in patients with graft failure versus 1.7% in patients without graft failure; aOR, 3.98 [95% CI, 3.54-4.47]; P<0.001). Graft failure was also associated with an increased risk of myocardial infarction or repeat revascularization occurring after imaging (7.8% versus 2.0%; aOR, 2.59 [95% CI, 1.86-3.62]; P<0.001). All-cause death after imaging occurred more frequently in patients with graft failure compared with patients without graft failure (11.0% versus 2.1%; aOR, 2.79 [95% CI, 2.01-3.89]; P<0.001).

CONCLUSIONS

In contemporary practice, graft failure remains common among patients undergoing CABG and is strongly associated with adverse cardiac events.

The Potential of Ultrasound Radiomics in Carpal Tunnel Syndrome Diagnosis: A Systematic Review and Meta-Analysis

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy for which ultrasound imaging has recently emerged as a valuable diagnostic tool. This meta-analysis aims to investigate the role of ultrasound radiomics in the diagnosis of CTS and compare it with other diagnostic approaches. Methods: We conducted a comprehensive search of electronic databases from inception to September 2023. The included studies were assessed for quality using the Quality Assessment Tool for Diagnostic Accuracy Studies. The primary outcome was the diagnostic performance of ultrasound radiomics compared to radiologist evaluation for diagnosing CTS. Results: Our meta-analysis included five observational studies comprising 840 participants. In the context of radiologist evaluation, the combined statistics for sensitivity, specificity, and diagnostic odds ratio were 0.78 (95% confidence interval (CI), 0.71 to 0.83), 0.72 (95% CI, 0.59 to 0.81), and 9 (95% CI, 5 to 15), respectively. In contrast, the ultrasound radiomics training mode yielded a combined sensitivity of 0.88 (95% CI, 0.85 to 0.91), a specificity of 0.88 (95% CI, 0.84 to 0.92), and a diagnostic odds ratio of 58 (95% CI, 38 to 87). Similarly, the ultrasound radiomics testing mode demonstrated an aggregated sensitivity of 0.85 (95% CI, 0.78 to 0.89), a specificity of 0.80 (95% CI, 0.73 to 0.85), and a diagnostic odds ratio of 22 (95% CI, 12 to 41). Conclusions: In contrast to assessments by radiologists, ultrasound radiomics exhibited superior diagnostic performance in detecting CTS. Furthermore, there was minimal variability in the diagnostic accuracy between the training and testing sets of ultrasound radiomics, highlighting its potential as a robust diagnostic tool in CTS.

Effectiveness of behavioural economics-informed interventions to promote physical activity: A systematic review and meta-analysis

OBJECTIVE

For beneficial health outcomes sufficient and sustained physical activity levels are recommended but difficult to achieve. This systematic review evaluates the effectiveness of behavioural economics (BE)-informed interventions to increase individuals' physical activity level in the long-term.

METHODS

We conducted a systematic literature search using Medline (via PubMed), PsycInfo, and EconLit (both via EBSCOhost) including randomized controlled trials of at least 24 weeks duration that evaluated BE-informed interventions to promote physical activity in adults. Potential BE approaches were commitment devices, social incentives, motivational feedback, goal setting, gamification, and financial incentives. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for (cluster-) randomized trials. A random-effects meta-analysis was conducted to summarize the outcome measure daily step count.

RESULTS

Based on 13 studies with 4347 participants, the BE-informed interventions most often applied were commitment lotteries (n = 8) and social incentives (n = 7). Risk of bias assessment classified five studies as low, six as moderate, and two as high risk of bias. Significant results on study level towards BE-informed interventions were observed for commitment lotteries (n = 3) and gamification (n = 4). Including healthy and diseased individuals in the meta-analysis (n = 10), the increase in daily step count in experimental groups compared to control was statistically significant for the intervention period (standardized mean difference (SMD) = 0.13, 95%-CI: 0.00-0.25, I2 = 59%, p = 0.04) but not for the follow-up (SMD = 0.08, 95%-CI: -0.00-0.17, I2 = 17%, p = 0.06). Excluding high risk of bias studies (n = 2) resulted in statistically significant effects with reduced heterogeneity for both periods.

CONCLUSION

Our review reveals a potential effect of BE-informed interventions to promote physical activity. The small effect underlines the importance to evaluate the behavioural channels which may explain the heterogeneity in individuals' responses to BE strategies.

Effect of exercise interventions on brain-derived neurotrophic factor expression in people with overweight and obesity: protocol for a systematic review and meta-analysis

INTRODUCTION

Epidemic obesity ('globobesity') has led to a considerable rise in the prevalence and incidence of many disabling conditions, including cognitive dysfunction. Recent evidence has suggested that habitual exercise can alleviate the deleterious effects of obesity on cognitive functioning across the lifespan. Given that there is a potential link among obesity, exercise, cognitive health and brain-derived neurotrophic factor (BDNF), this systematic review aims to critically appraise interventional trials on exercise and BDNF and to estimate the pooled effect of exercise training on BDNF levels among healthy individuals with overweight and obesity.

METHODS AND ANALYSIS

Six electronic databases-PubMed, MEDLINE, EMBASE, Web of Science, Ovid Nursing Database and SPORTDiscus-will be searched from their inception through December 2022. Only interventional studies, including randomised controlled trials and quasi-experimental studies, with full text available and reported in English will be included. The primary outcomes will be changes in BDNF levels among healthy subjects with overweight and obesity following either acute or chronic bouts of exercise interventions. Two reviewers will independently conduct data extraction and risk of bias assessment for included trials using the Physiotherapy Evidence Database Scale. We will produce a narrative synthesis, with findings categorised by sex, age groups and types of exercise training. Data will be extracted and pooled for meta-analyses using random-effects models.

ETHICS AND DISSEMINATION

No formal ethical approval is required for this systematic review. The findings of this review will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023414868.

Meta-analysis of blood indices and production physiology of broiler chickens on dietary fermented cassava intervention

The effects of dietary fermented cassava on the blood constituents and production parameters of broiler chickens have been reported with variable outcomes. Therefore, this investigation aimed to explore the impacts of dietary fermented cassava on growth traits, blood constituents, visceral organ, and carcass characteristics of broiler chickens. Four databases were searched for studies that assessed responses of broiler chickens dietary fermented cassava. Eleven articles were used for the investigation, and data generated were analysed using OpenMEE software. A random effects model was used, and effect sizes were presented as standardised mean difference (SMD) at a 95 % confidence interval (CI). Sources of heterogeneity were evaluated using the following modifiers: broiler strain used, cassava form, feeding duration, type of microbes used for the fermentation, and inclusion level of cassava. Results indicate that fermented cassava-based diets increased feed intake (SMD = 0.38; 95 % CI: 0.11, 0.65; P = 0.006), feed conversion ratio (SMD = 1.26; 95 % CI: 0.91, 1.61; P < 0.001), white blood cells (SMD = 1.26; 95 % CI: 0.54, 1.98; P < 0.001), total serum protein (SMD = 1.23; 95 % CI: 0.41, 2.05; P = 0.003), serum cholesterol (SMD = 0.43; 95 % CI: 0.01, 0.85; P = 0.050), serum creatinine (SMD = 2.53; 95 % CI: 0.53, 4.53; P = 0.013), and serum uric acid (SMD = 4.33; 95 % CI: 6.25, 2.41; P < 0.001), but lowered average daily gain and carcass yield, taking heterogeneity into account. Results reveal that studied modifiers were responsible for the inconsistent results among authors. In conclusion, dietary fermented cassava negatively influenced carcass yield, growth performance, and aspects of blood indices of broiler chickens, but did not affect abdominal fat content, visceral organ weights, and cut-part weights. However, more innovative research is needed to improve the feeding quality of cassava using other biotechnological tools in order to maximise its potential as an energy source in broiler chickens.

Toothpaste ingestion-evaluating the problem and ensuring safety: systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the ingestion of toothpaste and its sequelae. The study adhered to the PRISMA guidelines and was registered in the PROSPERO database. A comprehensive search strategy was conducted across multiple databases, resulting in the inclusion of 18 relevant publications. Eligible studies encompassed various designs and included both children and adults as the study population. Data extraction was carried out systematically, and relevant information on study characteristics, interventions, and outcomes were collected. The assessment of bias was performed using the Joanna Briggs Institute's Critical Appraisal Tools showing variations of bias among the included studies. The overall risk of systemic toxicity was found to be low, and no severe or life-threatening events were reported in the included studies. Furthermore, some toothpaste formulations containing higher concentrations of fluoride were associated with an increased risk of dental fluorosis. These findings have several implications for practice and policy. Healthcare providers and dental professionals should emphasize the importance of promoting safe toothpaste use, especially in vulnerable populations such as young children who are more prone to accidental ingestion. Public health campaigns and educational initiatives should aim to raise awareness about appropriate toothpaste usage and the potential risks. In addition, toothpaste manufacturers and regulatory bodies should consider revising guidelines and regulations to ensure the safety of oral care products, including the appropriate concentration of active ingredients. Future research should focus on investigating the long-term effects of toothpaste ingestion, exploring potential interactions between different active ingredients, and evaluating the efficacy of current preventive measures.

Inhaled Corticosteroid Exposure and Risk of Cataract in Patients with Asthma and COPD: A Systematic Review and Meta-Analysis

Purpose

Both systemic and inhaled corticosteroids may increase the risk of cataract in patients with both chronic obstructive pulmonary disease (COPD) and asthma. Our aim was to assess the degree of association between cataract and corticosteroid exposure in patients with asthma and COPD.

Methods

A systematic literature review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The odds ratio estimates were extracted from each article. A random effects model was applied for estimate pooling in separate meta-analyses according to study design. Meta-regression was performed to assess the dose-response relationship between corticosteroid exposure and the risk of cataract development.

Results

A total of 19 studies met the criteria for inclusion in this review, of which 12 studies provided effect estimates for pooled analyses. All but one of the included observational studies reported a significant association between use of corticosteroids and cataract development in cohorts of asthma and/or COPD patients. Pooled analyses revealed on average a doubled risk of cataract in corticosteroid-exposed asthma and COPD patients. Studies have shown that daily high-dose inhaled corticosteroid (ICS) ≥ 1000 μg is associated with a significant risk of developing cataract and by that predispose to subsequent cataract surgery, although one study showed that systemic corticosteroids increase cataract risk more than ICS.

Conclusion

ICS treatment in asthma and COPD patients is a risk factor for cataract development. Our results emphasize a previously underestimated potential long-term risk of treatment with ICS and underline the importance of targeting ICS treatment, and not least dosing, to improve the risk-benefit ratio of maintenance treatment in both asthma and COPD.

Herbal medicine for the treatment of chronic cough: a systematic review and meta-analysis

Objectives: Chronic cough is a frequent condition worldwide that significantly impairs quality of life. Herbal medicine (HM) has been used to treat chronic cough due to the limited effectiveness of conventional medications. This study aimed to summarize and determine the effects of HM on patients with chronic cough. Methods: A comprehensive search of 11 databases was conducted to find randomized controlled clinical trials (RCTs) that reported the effects of HM for patients with chronic cough on 16 March 2023. The primary outcome was cough severity, and the secondary outcomes included cough-related quality of life, cough frequency, total effective rate (TER), and cough recurrence rate. The methodological quality of the included studies was assessed using the Cochrane risk of bias tool, and the certainty of the evidence for effect estimates was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations tool. Results: A total of 80 RCTs comprising 7,573 patients were included. When HM was used as an alternative therapy to conventional medication, there were inconsistent results in improving cough severity. However, HM significantly improved cough-related quality of life and TER and significantly lowered the cough recurrence rate compared with conventional medication. When used as an add-on therapy to conventional medication, HM significantly improved cough severity, cough-related quality of life, and TER and significantly lowered the recurrence rate. In addition, HM had a significantly lower incidence of adverse events when used as an add-on or alternative therapy to conventional medication. The subgroup analysis according to age and cause of cough also showed a statistically consistent correlation with the overall results. The certainty of the evidence for the effect of HM was generally moderate to low due to the risk of bias in the included studies. Conclusion: HM may improve cough severity and cough-related quality of life, and lower the cough recurrence rate and incidence of adverse events in patients with chronic cough. However, due to the high risk of bias and clinical heterogeneity of the included studies, further high-quality placebo-controlled clinical trials should be conducted using a validated and objective assessment tool. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023418736, CRD42023418736.

Repetitive transcranial magnetic stimulation improves cardiovascular autonomic nervous system control: A meta-analysis

BACKGROUND

Cardiovascular autonomic system (ANS) may be affected by altered neural activations in the brain. This systematic review and meta-analysis investigated potential effects of repetitive transcranial magnetic stimulation (rTMS) protocols on cardiovascular ANS control.

METHODS

Through 19 qualified studies, we acquired 70 comparisons for data synthesis. Individual effect sizes were estimated by comparing changes in following cardiovascular ANS control variables between active and sham stimulation conditions: (a) blood pressure (BP), (b) heart rate (HR), and (c) heart rate variability (HRV). Moreover, two moderator variable analyses determined whether changes in cardiovascular ANS control were different based on (a) rTMS protocols (excitatory rTMS versus inhibitory rTMS) and (b) specific targeted cortical regions, respectively.

RESULTS

The random-effects model meta-analysis revealed significant improvements in cardiovascular ANS control after the rTMS protocols. Specifically, applying excitatory and inhibitory rTMS protocols significantly decreased values of BP and HR variables. For HRV variables, excitatory rTMS protocols showed significant positive effects. These improvements in cardiovascular ANS control were observed while applying either excitatory rTMS protocols to the left dorsolateral prefrontal cortex or inhibitory rTMS protocols to the right dorsolateral prefrontal cortex.

LIMITATIONS

Relatively small number of studies for inhibitory rTMS on the right dorsolateral prefrontal cortex were included in this meta-analysis.

CONCLUSION

These findings suggest that applying excitatory and inhibitory rTMS protocols on prefrontal cortical regions may be effective to improve cardiovascular ANS control.

The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses

BACKGROUND

Emerging epidemiological data suggest that hundreds of primary studies have examined the prevalence of ADHD in children and adolescents and dozens of systematic view and meta-analyses studies have been conducted on the subject. The purpose of this umbrella review is to provide a robust synthesis of evidence from these systematic reviews and meta-analyses.

METHODS

We systematically searched PubMed, Web of Science, PsychINFO, and Scopus to find pertinent studies. The study was preregistered with PROSPERO (CRD42023389704). The quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews (AMSTAR). Prevalence estimates from the included studies were pooled using invariance variance weighted random-effect meta-analysis.

RESULTS

Thirteen meta-analytic systematic reviews (588 primary studies) with 3,277,590 participants were included in the final analysis. A random effect meta-analysis of these studies showed that the global prevalence of ADHD in children and adolescents was 8.0 % (95%CI 6.0-10 %). The prevalence estimate was twice higher in boys (10 %) compared to girls (5 %). Of the three subtypes of ADHD, the inattentive type of ADHD (ADHD-I) was found to be the most common type of ADHD followed by the hyperactive (ADHD-HI) and the combined types (ADHD-C).

CONCLUSION

Findings from our compressive umbrella review suggest that ADHD is highly prevalent in children and adolescents with boys twice more likely to experience the disorder than girls. Our results underpin that priority should be given to preventing, early identifying, and treating ADHD in children and adolescents.

Evaluating the potential of matrix metalloproteinase as a diagnostic biomarker in rheumatoid arthritis and periodontitis: A systematic review and meta-analysis

BACKGROUND

Matrix metalloproteinases (MMPs) play a crucial role in the pathogenesis of several chronic diseases including rheumatoid arthritis (RA) and periodontitis (PD). RA patients with periodontitis (RA-PD) are associated with elevated inflammatory burden due to increased production of proinflammatory cytokines. Controlling upregulated MMPs activity in these patients may have potential therapeutic effects. Therefore, aim of this study is to address the focused question: "Do RA subjects with concurrent PD have different levels of MMPs in comparison to RA alone, PD alone and HC subjects?"

METHODS

The systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search from 4 electronic databases (EMBASE, Medline, Web of Science, and Cochrane library) and manual search was performed from inception to July 2023. Quality assessment of each article was done using Newcastle-Ottawa Scale. Meta-analyses derived results were summarized as standardized mean difference (SMD) with 95% confidence intervals.

RESULTS

A total of 879 articles were extracted. Following screening and full text assessment, 9 studies were included. MMP-1, MMP-3, MMP-8, MMP-9, and MMP-13 were consistently elevated in RA-PD subjects. MMP-8 levels were found to be higher in RA-PD subjects compared with RA alone, PD alone, and HC in 3 studies reporting GCF levels (SMD = 1.2; Z = 2.07; P = .04) and 2 studies reporting serum levels (SMD = 0.87; Z = 4.53; P < .00001).

CONCLUSION

RA-PD group showed significantly higher MMP levels in their serum and GCF compared with HC, RA, and PD alone individuals. MMP-8 may serve as a reliable biomarker in the diagnosis and management of RA-PD subjects.

The relationship between hemoglobin and V ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x : A systematic review and meta-analysis

OBJECTIVE

There is widespread agreement about the key role of hemoglobin for oxygen transport. Both observational and interventional studies have examined the relationship between hemoglobin levels and maximal oxygen uptake (V ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x ) in humans. However, there exists considerable variability in the scientific literature regarding the potential relationship between hemoglobin andV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x . Thus, we aimed to provide a comprehensive analysis of the diverse literature and examine the relationship between hemoglobin levels (hemoglobin concentration and mass) andV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x (absolute and relativeV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x ) among both observational and interventional studies.

METHODS

A systematic search was performed on December 6th, 2021. The study procedures and reporting of findings followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Article selection and data abstraction were performed in duplicate by two independent reviewers. Primary outcomes were hemoglobin levels andV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x values (absolute and relative). For observational studies, meta-regression models were performed to examine the relationship between hemoglobin levels andV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x values. For interventional studies, meta-analysis models were performed to determine the change inV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x values (standard paired difference) associated with interventions designed to modify hemoglobin levels orV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x . Meta-regression models were then performed to determine the relationship between a change in hemoglobin levels and the change inV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x values.

RESULTS

Data from 384 studies (226 observational studies and 158 interventional studies) were examined. For observational data, there was a positive association between absoluteV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x and hemoglobin levels (hemoglobin concentration, hemoglobin mass, and hematocrit (P<0.001 for all)). Prespecified subgroup analyses demonstrated no apparent sex-related differences among these relationships. For interventional data, there was a positive association between the change of absoluteV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x (standard paired difference) and the change in hemoglobin levels (hemoglobin concentration (P<0.0001) and hemoglobin mass (P = 0.006)).

CONCLUSION

These findings suggest thatV ˙ ⁢ O 2 ⁢ m ⁢ a ⁢ x values are closely associated with hemoglobin levels among both observational and interventional studies. Although our findings suggest a lack of sex differences in these relationships, there were limited studies incorporating females or stratifying results by biological sex.

Cardiovascular Risk Associated with Alpha-1 Antitrypsin Deficiency (AATD) Genotypes: A Meta-Analysis with Meta-Regressions

BACKGROUND

Alpha-1 antitrypsin deficiency (AATD) can result in severe liver and respiratory disorders. The uninhibited elastase activity on the elastic tissue of arterial walls suggests that AATD may also impact vascular health. Thus, we performed a meta-analysis of the studies evaluating cardiovascular risk in individuals with AATD and non-AATD controls.

METHODS

A systematic literature search was conducted in the main scientific databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Differences between cases and controls were expressed as odds ratios (OR) with 95% confidence intervals (95%CI). The protocol was registered on PROSPERO under the identification number CRD42023429756.

RESULTS

The analysis of eight studies showed that, with a prevented fraction of disease of 15.0% and a corresponding OR of 0.779 (95%CI: 0.665-0.912; p = 0.002), a total of 24,428 individuals with AATD exhibited a significantly lower risk of ischemic heart disease compared to 534,654 non-AATD controls. Accordingly, given a prevented fraction of disease of 19.5%, a lower risk of acute myocardial infarction was documented when analyzing four studies on 21,741 cases and 513,733 controls (OR: 0.774; 95%CI: 0.599-0.999; p = 0.049). Sensitivity and subgroup analyses substantially confirmed results. Meta-regression models suggested that these findings were not influenced by AATD genotypes or prevalence of chronic obstructive pulmonary disease (COPD) among cases and controls, while higher differences in the prevalence of male sex (Z-score: 3.40; p < 0.001), hypertension (Z-score: 2.31; p = 0.021), and diabetes (Z-score: 4.25; p < 0.001) were associated with a lower effect size.

CONCLUSIONS

Individuals with AATD may exhibit a reduced risk of ischemic heart disease, even in the presence of mild deficiency of the serine protease inhibitor. Although caution is warranted due to the observational nature of the data, future pharmacological and rehabilitation strategies should also take this controversial relationship into account.

Relationship between comorbidity and health outcomes in patients with heart failure: a systematic review and meta-analysis

BACKGROUND

The prevalence of heart failure (HF) is expected to rise due to increased survivorship and life expectancy of patients with acute heart conditions. Patients with HF and other multiple comorbid conditions are likely to have poor health outcomes. This study aimed to assimilate the current body of knowledge and to provide the pooled effect of HF patients' comorbid conditions on health outcomes.

METHODS

A systematic search was performed using MEDLINE, EMBASE and CINAHL databases. Observational studies evaluating the relationship between comorbid conditions and the health outcomes of HF were included. The pooled effect sizes of comorbidity on the identified health outcomes were calculated using a random effects model, and the heterogeneity was evaluated using I2 statistics.

RESULTS

A total of 42 studies were included in this review, and a meta-analysis was performed using the results of 39 studies. In the pooled analysis, the presence of a comorbid condition showed a significant pooled effect size in relation to the prognostic health outcomes: all-cause mortality (HR 1.31; 95% CI 1.18, 1.45), all-cause readmission (HR 1.16; 95% CI 1.09, 1.23), HF-related readmission (HR 1.13; 95% CI 1.05, 1.23), and non-HF-related readmission (HR 1.17; 95% CI 1.07, 1.27). Also, comorbidity was significantly associated with health-related quality of life and self-care confidence. Furthermore, we identified a total of 32 comorbid conditions from included studies. From these, 16 individual conditions were included in the meta-analyses, and we identified 10 comorbid conditions to have negative effects on overall prognostic outcomes: DM (HR 1.16, 95% CI 1.11, 1.22), COPD (HR 1.31, 95% CI 1.23, 1.39), CKD (HR 1.18, 95% CI 1.14, 1.23, stroke (HR 1.25, 95% CI 1.17, 1.31), IHD (HR 1.17, 95% CI 1.11, 1.23), anemia (HR 1.42, 95% CI 1.14, 1.78), cancer (HR 1.17, 95% CI 1.04, 1.32), atrial fibrillation (HR 1.25, 95% CI 1.01, 1.54), dementia (HR 1.19, 95% CI 1.03, 1.36) and depression (HR 1.17, 95% CI 1.04, 1.31).

CONCLUSIONS

Comorbid conditions have significantly negative pooled effects on HF patient health outcomes, especially in regard to the prognostic health outcomes. Clinicians should carefully identify and manage these conditions when implementing HF interventions to improve prognostic outcomes.

Prevalence of suicidal ideation and suicide attempts in individuals with psychosis and bipolar disorder in South Asia: systematic review and meta-analysis

BACKGROUND

Suicidal ideation and attempts are growing public health concerns globally. Evidence from high-income countries suggests that individuals with psychosis and bipolar disorder are at increased risk of suicidal ideation and attempts, but there is a scarcity of evidence from South Asia.

AIMS

To estimate the prevalence of suicidal ideation and attempts in individuals with psychosis and bipolar disorder in South Asia.

METHOD

In this systematic review and meta-analysis, four databases (PsycINFO, Web of Science, EMBASE and Medline) were searched until December 2022. Pooled prevalence was estimated with random-effects models. Heterogeneity was quantified with the I2-statistic.

RESULTS

The pooled sample size across the 21 studies was 3745 participants, 1941 (51.8%) of which were male. The pooled prevalence of suicide attempts in South Asian people with either psychosis or bipolar disorder was 22% (95% CI 17-27; n = 15). The pooled prevalence of suicidal ideation with psychosis or bipolar disorder combined was 38% (95% CI 27-51; n = 10). Meta-regression, subgroup and sensitivity analysis showed that the pooled prevalence estimates for both suicide attempt and ideation remained unaffected by variations in critical appraisal ratings and study designs. Only one study reported data on suicide-related deaths.

CONCLUSIONS

One in four individuals diagnosed with psychosis or bipolar disorder have reported suicide attempts, whereas up to one in three have experienced suicidal ideation. These findings underscore the urgent need for clinicians to regularly assess and monitor suicidal ideation and attempts among individuals with these disorders in South Asia.

Diagnostic biomarkers and aortic dissection: a systematic review and meta-analysis

BACKGROUND

Aortic dissection (AD) is a serious and fatal vascular disease. The earlier the condition of AD patients can be assessed precisely, the more scientifically controlled the patient's condition will be. Therefore, timely and accurate diagnosis is significant for AD. Blood biomarker testing as a method of liquid biopsy can improve the diagnostic efficiency of AD. This study conducted a systematic review of the current blood diagnostic biomarkers of AD.

METHODS

The PubMed, Cochrane Library, Web of Science, and Embase electronic databases were systematically searched from inception to January 1, 2023, using the terms "aortic dissection", "serum", "plasma" and "diagnosis". Stata 12.0 software was used to perform Random effects meta-analysis was performed using Stata 12.0 software to determine the effect sizes and corresponding 95% confidence intervals. Then, a summary receiver operator characteristic (SROC) curve was drawn, and the area under the ROC curve (AUC) was calculated.

RESULTS

D-dimer had the best sensitivity and AUC for AD, with values of 0.96 (95% CI: 0.93-0.98) and 0.95 (95% CI: 0.93-0.97), respectively. The sensitivity and AUC values for D-dimer with a cut-off value of 500 ng/mL were 0.97 (95% CI: 0.95-0.99) and 0.94 (95% CI: 0.92-0.96), respectively. In contrast, microRNA had a better specificity value for AD, at 0.79 (95% CI: 0.73-0.83).

CONCLUSIONS

D-dimer and microRNA have good accuracy in the diagnosis of AD, but the specificity of D-dimer is worse, and studies of microRNA are insufficient. The combination of different biomarkers can improve the diagnostic accuracy. Other blood biomarkers are related to the pathological progression of AD and can be selected according to pathological progress.

National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis

BACKGROUND

Preterm birth is the leading cause of neonatal mortality and is associated with long-term physical, neurodevelopmental, and socioeconomic effects. This study updated national preterm birth rates and trends, plus novel estimates by gestational age subgroups, to inform progress towards global health goals and targets, and aimed to update country, regional, and global estimates of preterm birth for 2020 in addition to trends between 2010 and 2020.

METHODS

We systematically searched population-based, nationally representative data on preterm birth from Jan 1, 2010, to Dec 31, 2020 and study data (26 March-14 April, 2021) for countries and areas with no national-level data. The analysis included 679 data points (86% nationally representative administrative data [582 of 679 data points]) from 103 countries and areas (62% of countries and areas having nationally representative administrative data [64 of 103 data points]). A Bayesian hierarchical regression was used for estimating country-level preterm rates, which incoporated country-specific intercepts, low birthweight as a covariate, non-linear time trends, and bias adjustments based on a data quality categorisation, and other indicators such as method of gestational age estimation.

FINDINGS

An estimated 13·4 million (95% credible interval [CrI] 12·3-15·2 million) newborn babies were born preterm (<37 weeks) in 2020 (9·9% of all births [95% CrI 9·1-11·2]) compared with 13·8 million (12·7-15·5 million) in 2010 (9·8% of all births [9·0-11·0]) worldwide. The global annual rate of reduction was estimated at -0·14% from 2010 to 2020. In total, 55·6% of total livebirths are in southern Asia (26·8% [36 099 000 of 134 767 000]) and sub-Saharan Africa (28·7% [38 819 300 of 134 767 000]), yet these two regions accounted for approximately 65% (8 692 000 of 13 376 200) of all preterm births globally in 2020. Of the 33 countries and areas in the highest data quality category, none were in southern Asia or sub-Saharan Africa compared with 94% (30 of 32 countries) in high-income countries and areas. Worldwide from 2010 to 2020, approximately 15% of all preterm births occurred at less than 32 weeks of gestation, requiring more neonatal care (<28 weeks: 4·2%, 95% CI 3·1-5·0, 567 800 [410 200-663 200 newborn babies]); 28-32 weeks: 10·4% [9·5-10·6], 1 392 500 [1 274 800-1 422 600 newborn babies]).

INTERPRETATION

There has been no measurable change in preterm birth rates over the last decade at global level. Despite increasing facility birth rates and substantial focus on routine health data systems, there remain many missed opportunities to improve preterm birth data. Gaps in national routine data for preterm birth are most marked in regions of southern Asia and sub-Saharan Africa, which also have the highest estimated burden of preterm births. Countries need to prioritise programmatic investments to prevent preterm birth and to ensure evidence-based quality care when preterm birth occurs. Investments in improving data quality are crucial so that preterm birth data can be improved and used for action and accountability processes.

FUNDING

The Children's Investment Fund Foundation and the UNDP, United Nations Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction.

Effects of supplementation with milk protein on glycemic parameters: a GRADE-assessed systematic review and dose-response meta-analysis

BACKGROUND

It is suggested that supplementation with milk protein (MP) has the potential to ameliorate the glycemic profile; however, the exact impact and certainty of the findings have yet to be evaluated. This systematic review and dose-response meta-analysis of randomized controlled trials (RCTs) assessed the impact of MP supplementation on the glycemic parameters in adults.

METHODS

A systematic search was carried out among online databases to determine eligible RCTs published up to November 2022. A random-effects model was performed for the meta-analysis.

RESULTS

A total of 36 RCTs with 1851 participants were included in the pooled analysis. It was displayed that supplementation with MP effectively reduced levels of fasting blood glucose (FBG) (weighted mean difference (WMD): -1.83 mg/dL, 95% CI: -3.28, -0.38; P = 0.013), fasting insulin (WMD: -1.06 uU/mL, 95% CI: -1.76, -0.36; P = 0.003), and homeostasis model assessment of insulin resistance (HOMA-IR) (WMD: -0.27, 95% CI: -0.40, -0.14; P < 0.001) while making no remarkable changes in serum hemoglobin A1c (HbA1c) values (WMD: 0.01%, 95% CI: -0.14, 0.16; P = 0.891). However, there was a significant decline in serum levels of HbA1c among participants with normal baseline body mass index (BMI) based on sub-group analyses. In addition, HOMA-IR values were significantly lower in the MP supplement-treated group than their untreated counterparts in short- and long-term supplementation (≤ 8 and > 8 weeks) with high or moderate doses (≥ 60 or 30-60 g/d) of MP or whey protein (WP). Serum FBG levels were considerably reduced upon short-term administration of a low daily dose of WP (< 30 g). Furthermore, the levels of serum fasting insulin were remarkably decreased during long-term supplementation with high or moderate daily doses of WP.

CONCLUSION

The findings of this study suggest that supplementation with MP may improve glycemic control in adults by reducing the values of fasting insulin, FBG, and HOMA-IR. Additional trials with longer durations are required to confirm these findings.

Mortality risks associated with floods in 761 communities worldwide: time series study

OBJECTIVE

To evaluate lag-response associations and effect modifications of exposure to floods with risks of all cause, cardiovascular, and respiratory mortality on a global scale.

DESIGN

Time series study.

SETTING

761 communities in 35 countries or territories with at least one flood event during the study period.

PARTICIPANTS

Multi-Country Multi-City Collaborative Research Network database, Australian Cause of Death Unit Record File, New Zealand Integrated Data Infrastructure, and the International Network for the Demographic Evaluation of Populations and their Health Network database.

MAIN OUTCOME MEASURES

The main outcome was daily counts of deaths. An estimation for the lag-response association between flood and daily mortality risk was modelled, and the relative risks over the lag period were cumulated to calculate overall effects. Attributable fractions of mortality due to floods were further calculated. A quasi-Poisson model with a distributed lag non-linear function was used to examine how daily death risk was associated with flooded days in each community, and then the community specific associations were pooled using random effects multivariate meta-analyses. Flooded days were defined as days from the start date to the end date of flood events.

RESULTS

A total of 47.6 million all cause deaths, 11.1 million cardiovascular deaths, and 4.9 million respiratory deaths were analysed. Over the 761 communities, mortality risks increased and persisted for up to 60 days (50 days for cardiovascular mortality) after a flooded day. The cumulative relative risks for all cause, cardiovascular, and respiratory mortality were 1.021 (95% confidence interval 1.006 to 1.036), 1.026 (1.005 to 1.047), and 1.049 (1.008 to 1.092), respectively. The associations varied across countries or territories and regions. The flood-mortality associations appeared to be modified by climate type and were stronger in low income countries and in populations with a low human development index or high proportion of older people. In communities impacted by flood, up to 0.10% of all cause deaths, 0.18% of cardiovascular deaths, and 0.41% of respiratory deaths were attributed to floods.

CONCLUSIONS

This study found that the risks of all cause, cardiovascular, and respiratory mortality increased for up to 60 days after exposure to flood and the associations could vary by local climate type, socioeconomic status, and older age.

Use of Yeast Cell Wall Extract for Growing Pigs Consuming Feed Contaminated with Mycotoxins below or above Regulatory Guidelines: A Meta-Analysis with Meta-Regression

Using a random-effects meta-analysis, the performance of growing pigs under a mycotoxin challenge (MT) with or without supplementation of yeast cell wall extract (YCWE, Mycosorb®, Alltech Inc.) was evaluated. Both MT and YCWE were also compared to animal controls not receiving mycotoxins (CTRL). Meta-regression was used to further explore the impacts of MT at/below (category 1) or above (category 2) global regulatory guidelines. Following the screening, 23 suitable references (30 mycotoxin treatments) were used. Overall, MT lowered average daily gain (ADG, p < 0.001) and average daily feed intake (ADFI, p < 0.0001) from CTRL by -84 and -165 g, respectively. Inclusion of YCWE during mycotoxin challenges (YCWE+MT, average 2.1 kg/ton) tended to result in greater ADG (+17 g, p = 0.068) compared to MT treatments. The gain-to-feed ratio (G:F) was not impacted by MT or YCWE+MT. Further investigation by meta-regression revealed that pigs fed MT in category 1 had lower ADG (-78.5 g, p < 0.001) versus CTRL, while YCWE+MT had higher ADG (+48 g, p < 0.001) over MT and was similar to CTRL. The ADFI was not impacted, although YCWE+MT had ADFI values similar to the CTRL. In category 2, ADG and ADFI of pigs fed MT were lower than CTRL (-85.1 and -166 g, respectively, p < 0.0001), with a tendency for YCWE+MT to result in higher ADFI (+25.3 g, p = 0.062). In summary, the inclusion of YCWE provided benefits to performance during common mycotoxin challenge levels (at or below regulatory guidelines).

A meta-analysis of randomized controlled studies on the hepatoxicity induced by polybrominated diphenyl ethers (PBDEs) in rats and mice

Several toxicological studies were conducted to evaluate the hepatoxicity of PBDEs using different animal models, congeners, duration of exposure, and other parameters. These variations in different animal models and conditions might have an impact on extrapolating experimental results to humans. Hence, by the meta-analysis, we aimed to clarify and elucidate the species differences in hepatoxicity induced by PBDE exposure in rats and mice across different conditions and moderators. Fourteen in vivo studies that utilized rats and mice models were identified, and data such as author names, year of publication, type of PBDE congeners, rodent species, life stage of exposure, dosage, duration, and hepatoxicity indicators were extracted. The pooled standard mean difference (SMD) with a 95% confidence interval (95% CI) was used to evaluate the association between hepatoxicity and PBDE exposure across multiple approaches of measurement. Subgroup analysis, meta-regression, and interaction analysis were utilized to elucidate the species-related differences among the results of the involved studies. The pooled SMD of hepatoxicity of PBDE exposure in the involved in vivo studies was 1.82 (p = 0.016), indicating exposure to PBDE congeners and mixtures is associated with a significant increase in liver toxicity in rodents. Moreover, findings showed that rats were more sensitive to PBDEs than mice with the BDE-209 had the highest SMD value. Among the life stages of exposure, embryonic stage was found to be the most sensitive to hepatoxicity induced by PBDE congeners. Positive relationships were found between the incidence of hepatoxicity with dosage and duration of exposure to PBDE. Interaction analyses showed significant interactions between rodent species (rats or mice), dosage, length of exposure, and hepatotoxicity endpoints. Rats demonstrated an increased susceptibility to variations in organ weight, histopathological changes, mitochondrial dysfunction, and oxidative stress markers. Conversely, mice showed pronounced lipid accumulation and modifications in liver enzyme expression levels. However, significant differences were not found in terms of endoplasmic reticular stress as a mechanistic endpoint for hepatotoxicity. In conclusion, this meta-analysis showed that there might be some species-related differences in hepatoxicity induced by PBDE exposure in rats and mice depending on the parameters used. This study highlights the importance of cross-species extrapolation of results from animal models to accurately assess the potential risks to human health from exposure to PBDEs.

Predictors of extubation failure in newborns: a systematic review and meta-analysis

Extubation failure (EF) is a significant concern in mechanically ventilated newborns, and predicting its occurrence is an ongoing area of research. To investigate the predictors of EF in newborns undergoing planned extubation, we conducted a systematic review and meta-analysis. A systematic literature search was conducted in PubMed, Web of Science, Embase, and Cochrane Library for studies published in English from the inception of each database to March 2023. The PRISMA guidelines were followed in all phases of this systematic review. The Risk of Bias Assessment for Nonrandomized Studies tool was used to assess methodological quality. Thirty-four studies were included, 10 of which were overall low risk of bias, 15 of moderate risk of bias, and 9 of high risk of bias. The studies reported 43 possible predictors in six broad categories (intrinsic factors; maternal factors; diseases and adverse conditions of the newborn; treatment of the newborn; characteristics before and after extubation; and clinical scores and composite indicators). Through a qualitative synthesis of 43 predictors and a quantitative meta-analysis of 19 factors, we identified five definite factors, eight possible factors, and 22 unclear factors related to EF. Definite factors included gestational age, sepsis, pre-extubation pH, pre-extubation FiO2, and respiratory severity score. Possible factors included age at extubation, anemia, inotropic use, mean airway pressure, pre-extubation PCO2, mechanical ventilation duration, Apgar score, and spontaneous breathing trial. With only a few high-quality studies currently available, well-designed and more extensive prospective studies investigating the predictors affecting EF are still needed. In the future, it will be important to explore the possibility of combining multiple predictors or assessment tools to enhance the accuracy of predicting extubation outcomes in clinical practice.

Imagery rescripting as a short intervention for symptoms associated with mental images in clinical disorders: A systematic review and meta-analysis

There is an unmet need for effective short-term therapeutic techniques to reduce clinical symptoms associated with prospective-, as well as retrospective aversive mental images across mental disorders. We investigated the efficacy of imagery rescripting (IR) as a short-term intervention across clinical disorders, as the literature suggests that this technique could be a promising intervention to reduce psychopathology by altering intrusive mental images. A systematic literature review identified 23 trials including 805 adult patients, out of which 15 trials were designed as randomized controlled trials (RCT) including patients with the following diagnoses: Social anxiety disorder (SAD), Posttraumatic-Stress-Disorder (PTSD), Bulimia Nervosa, Borderline Personality Disorder, Obsessive-Compulsive Disorder, nightmare disorder, test anxiety, health anxiety, and Generalized Anxiety Disorder. Most studies (14) comprised of one treatment session. Effect size estimates indicate that IR is highly effective in reducing clinical symptoms associated with mental images from pre-, to post-treatment (g = 1.09, 95% CI = [0.64; 1.53]), as well as from pre-treatment to follow-up (g = 1.90, 95% CI = [1.02; 2.77]). Comparing the IR intervention to a passive control group showed large effect sizes at post-treatment (g = -0.99; 95% CI = [-1.79; -0.20]), however, comparing IR to an active control group resulted in a small effect (g = -0.05; 95% CI = [-0.43; 0.33]). Lastly, large effects of IR were found for the SAD and PTSD subgroups, for comorbid symptoms of depression. In summary, our results indicate that IR is a promising short-term therapeutic technique for clinical symptoms associated with aversive prospective-, and retrospective mental images.

Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with cardiac arrest: a comparative meta-analysis and trial sequential analysis

BACKGROUND

Although outcomes of patients after cardiac arrest remain poor, studies have suggested that extracorporeal cardiopulmonary resuscitation (ECPR) might improve survival and neurological outcomes. We aimed to investigate any potential benefits of using ECPR over conventional cardiopulmonary resuscitation (CCPR) in patients with out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA).

METHODS

In this systematic review and meta-analysis, we searched MEDLINE via PubMed, Embase, and Scopus from Jan 1, 2000, to April 1, 2023, for randomised controlled trials and propensity-score matched studies. We included studies comparing ECPR with CCPR in adults (aged ≥18 years) with OHCA and IHCA. We extracted data from published reports using a prespecified data extraction form. We did random-effects (Mantel-Haenszel) meta-analyses and rated the certainty of evidence using the Grading of Recommendations, Assessments, Developments, and Evaluations (GRADE) approach. We rated the risk of bias of randomised controlled trials using the Cochrane risk-of-bias 2.0 tool, and that of observational studies using the Newcastle-Ottawa Scale. The primary outcome was in-hospital mortality. Secondary outcomes included complications during extracorporeal membrane oxygenation, short-term (from hospital discharge to 30 days after cardiac arrest) and long-term (≥90 days after cardiac arrest) survival with favourable neurological outcomes (defined as cerebral performance category scores 1 or 2), and survival at 30 days, 3 months, 6 months, and 1 year after cardiac arrest. We also did trial sequential analyses to evaluate the required information sizes in the meta-analyses to detect clinically relevant reductions in mortality.

FINDINGS

We included 11 studies (4595 patients receiving ECPR and 4597 patients receiving CCPR) in the meta-analysis. ECPR was associated with a significant reduction in overall in-hospital mortality (OR 0·67, 95% CI 0·51-0·87; p=0·0034; high certainty), without evidence of publication bias (pegger=0·19); the trial sequential analysis was concordant with the meta-analysis. When considering IHCA only, in-hospital mortality was lower in patients receiving ECPR than in those receiving CCPR (0·42, 0·25-0·70; p=0·0009), whereas when considering OHCA only, no differences were found (0·76, 0·54-1·07; p=0·12). Centre volume (ie, the number of ECPR runs done per year in each centre) was associated with reductions in odds of mortality (regression coefficient per doubling of centre volume -0·17, 95% CI -0·32 to -0·017; p=0·030). ECPR was also associated with an increased rate of short-term (OR 1·65, 95% CI 1·02-2·68; p=0·042; moderate certainty) and long-term (2·04, 1·41-2·94; p=0·0001; high certainty) survival with favourable neurological outcomes. Additionally, patients receiving ECPR had increased survival at 30-day (OR 1·45, 95% CI 1·08-1·96; p=0·015), 3-month (3·98, 1·12-14·16; p=0·033), 6-month (1·87, 1·36-2·57; p=0·0001), and 1-year (1·72, 1·52-1·95; p<0·0001) follow-ups.

INTERPRETATION

Compared with CCPR, ECPR reduced in-hospital mortality and improved long-term neurological outcomes and post-arrest survival, particularly in patients with IHCA. These findings suggest that ECPR could be considered for eligible patients with IHCA, although further research into patients with OHCA is warranted.

FUNDING

None.

Stopping Disease-Modifying Treatments in Multiple Sclerosis: A Systematic Review and Meta-Analysis of Real-World Studies

BACKGROUND

The question of whether multiple sclerosis requires life-long disease-modifying treatments (DMTs) remains unanswered. Some studies suggest that older patients with stable disease may safely discontinue their DMTs, yet comprehensive evidence-based data are scarce and real-world studies have provided mixed results.

OBJECTIVE

The aim of this study was to assess the rate of disease reactivation and associated risk factors after discontinuation of DMTs in patients with multiple sclerosis.

METHODS

We searched scientific databases (PubMed/MEDLINE, Scopus and Google Scholar) to identify real-world studies published until 31 July, 2023 that reported the number of patients who experienced relapses and/or disability accrual (outcomes of interest) following a therapy discontinuation longer than 12 months. Magnetic resonance activity and treatment re-start after DMT discontinuation were also considered as additional outcomes. We excluded studies where therapy discontinuation was explicitly related to an unintended or planned pregnancy or preceded a treatment switch. We ran random-effects meta-analyses, subgroup analyses and meta-regression models to provide pooled estimates of post-discontinuation relapse and disability events, and to identify their potential moderators (predictors).

RESULTS

After an independent screening, 22 articles met the eligibility criteria, yielding a pooled sample size of 2942 patients followed for 1-7 years after discontinuation (11,689 patient-years). The pooled rates for relapse and disability events were 6.7 and 5.8 per 100 patient-years, respectively. However, available data did not allow us to disentangle isolated disability accrual from relapse-associated worsening. Studies including older patients (β = -0.65, p = 0.006), patients with a longer exposure to DMTs (β = -2.22, p = 0.001) and patients with a longer period of disease stability (β = -2.74, p = 0.002) showed a lower risk of relapse events. According to meta-regression equations, the risk of relapse events after DMT discontinuation became negligible (arbitrarily set at < 1% per year) at approximately 60 years of age, and after either 10 years of DMT exposure, or 8 years of disease stability. Additional analyses showed pooled rates for magnetic resonance imaging activity and re-start events of 16.7 and 17.5 per 100 patient-years, respectively.

CONCLUSIONS

Based on our quantitative synthesis of real-world data, in the absence of definitive answers from clinical trials, DMT discontinuation appears feasible with a high degree of certainty in selected patients. While our findings are robust regarding relapse events, future efforts are warranted to determine if DMT discontinuation is associated with isolated disability accrual.

Baseline benzodiazepine exposure is associated with greater risk of transition in clinical high-risk for psychosis (CHR-P): a meta-analysis

BACKGROUND

Emerging meta-analytical evidence indicates that baseline exposure to antipsychotics and to antidepressants in individuals at clinical high-risk for psychosis (CHR-P) have opposite prognostic effects as regards imminent transition to psychosis, with antipsychotics associated with higher risk and antidepressants associated with a lower risk in comparison to not-exposed individuals. Despite their common use, baseline exposure to benzodiazepines (BDZ) in CHR-P has surprisingly received poor attention as a potential risk modulator for transition to psychosis. The current systematic review and meta-analysis were performed to fix such a knowledge gap.

METHODS

Systematic scrutiny of Medline and Cochrane library, performed up to 31 December 2022, searching for English-language studies on CHR-P reporting numeric data about the sample, the transition outcome at a predefined follow-up time and raw data on BDZ baseline exposure in relation to such outcome.

RESULTS

Of 1893 identified records, five studies were included in the systematic review and meta-analysis. The proportion of participants with exposure to BDZ at baseline ranged from 5.5% (one study) to 46.2%, with an average of 16.8%. At the end of the period of observation, i.e., the follow-up as reported in the study, 28.4% [95% confidence interval (CI) 19.7-39.1%] participants developed psychosis among the BDZ-exposed against 9.3% (7.3 to 11.9%) among the controls. CHR-P participants who were already under BDZ treatment at baseline had more than double chance of transition to psychosis than CHR-P participants who were BDZ-naïve. The risk ratio (RR) was 2.42 (95% CI 1.38-4.23) in the common effects model (z = 3.09; p = 0.002), and 2.40 (1.53 to 3.77) in the random-effects model (z = 5.40; p = 0.006; tau-squared = 0.0). There was no relevant heterogeneity: Cochran's Q = 1.49; df = 4; p = 0.828; I2 = 0.0% (95% CI 0.0-79%). Quality was good in four studies.

CONCLUSIONS

Ongoing BDZ exposure at inception in CHR-P is associated with a higher risk of transition to psychosis at follow up. This meta-analytic association, which echoes a similar effect of baseline antipsychotic exposure, plausibly indicates that the clinicians' prescription of pharmacological intervention captures some form of prognostically-relevant information (e.g. an anxiety permeated mental state requiring BDZ prescription) that are not adequately encompassed by current CHR-P categorical criteria.

Rehabilitation of the severely resorbed maxilla by using quad zygomatic implant-supported prostheses: a systematic review and meta-analysis

STATEMENT OF PROBLEM

Quad zygomatic implants have been used as a treatment option for patients with a severely resorbed maxilla. However, data on the average rate of success of the prosthesis, survival of the zygomatic implants, and associated complications are sparse.

PURPOSE

The purpose of this systematic review and meta-analysis was to assess prosthetic and zygomatic implant success of treating severe maxillary resorption with prostheses supported by 4 zygomatic implants, with an additional review on potential complications.

MATERIAL AND METHODS

A comprehensive search of studies published in English between January 2001 and December 2020 was performed in the PubMed, OVID, EBSCO, and EMBASE databases according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42021219468). The population, intervention, comparison, and outcome (PICO) question was "What is the effectiveness of oral rehabilitations using only 4 zygomatic implants placed in severely resorbed maxillae?" The search results were subjected to a systematic review for articles reporting prosthetic success and zygomatic implant survival. Prosthetic success was analyzed by using a fixed-effects inverse-variance model. The random-effects model was adopted for meta-analysis as moderate heterogeneity was identified among studies that reported implant survival in quad zygoma treatments. The quality of publications was appraised by using the Critical Appraisal Skills Program (CASP) checklists.

RESULTS

Of the 82 titles, 7 studies that met the inclusion criteria without an overlap of patient cohorts were quantitatively analyzed for the average rate of prosthetic success and implant survival. All prostheses in the aggregated studies were immediately loaded with acrylic resin interim prostheses replaced by a definitive prosthesis, which consisted of overdentures retained by bar splinting (n=2), metal bar-reinforced prostheses (n=2), fixed screw-retained acrylic resin prostheses (n=34), and screw-retained titanium prostheses with ceramic or acrylic resin teeth (n=75). Technical complications of zygomatic implants included mobility associated with a machined surface and fracture of the abutment screw. The most common prosthetic complications reported were fracture of the definitive prosthesis and loss of the interim prosthesis subsequent to the failure of at least 1 zygomatic implant. The results showed that prostheses supported by quad zygoma implants displayed an overall success of 100% (CI=95%, I2=0.00%, P=.850), whereas zygomatic implants showed a survival rate of 98% (CI=95%, I2=60.48%, P=.040) with minimal implant failures and few complications.

CONCLUSIONS

Although the data analysis showed favorable results for rehabilitating severely resorbed maxillae by using quad zygoma with high prosthetic success and high implant survival rate, further long-term clinical studies are required to strengthen the evidence. However, potential implant and prosthetic complications should be considered while planning this treatment approach.

Association of Helicobacter pylori with migraine headaches and the effects of this infection and its eradication on the migraine characteristics in adults: A comprehensive systematic review and meta-analysis

BACKGROUND

Migraine is one of the most common neurological disorders that can severely overshadow people's quality of life, and Helicobacter pylori infection is a health problem in different societies. During the last two decades, many original studies have been conducted on the various aspects of the relationship between these two disorders; however, they have reported different and sometimes contradictory results.

METHODS

This study was conducted based on the PRISMA protocol. We performed a comprehensive literature search in the online databases up to May 2023, and 22 studies that contained original data on the relationship between H. pylori infection and migraine headaches in adults were included. For performing the meta-analysis, we calculated the odds ratios (OR) and 95% confidence intervals (CI), using a random-effects model, and to determine the possible causes of heterogeneity, we conducted a subgroup meta-analysis.

RESULTS

The overall OR for the association of H. pylori infection and migraine headaches through 493,794 evaluated individuals was 2.80 [95% CI = 1.75-4.48; I2  = 89.20, p < 0.01], which reveals a statistically significant association between these disorders. It was found that the studies that were conducted in Asian regions and the recently published ones have clearly shown a higher association between migraine and H. pylori infection. On the other hand, migraine patients who are infected with H. pylori have similar signs and symptoms as H. pylori-negative migraineurs; meanwhile, the clinical trials conducted in this field strongly emphasize the benefits of eradicating H. pylori infection in migraine patients and have estimated its effectiveness in improving migraine headaches equivalent to current common migraine treatments. Furthermore, it was reported that white matter lesions were 2.5-fold higher on brain MRI in patients with H. pylori-positive migraine compared with H. pylori-negative migraineurs; however, the evidence does not support the role of oxidative stress in patients suffering from H. pylori infection and migraine and refuses the role of Cag-A-positive strains of H. pylori in migraine headaches.

CONCLUSION

According to the currently available data, it seem reasonable that patients with a definite diagnosis of migraine who also suffer from gastrointestinal problems, undergo the H. pylori detection tests and if the evaluations are positive, H. pylori eradication treatment can be considered even before any migraine treatment.

A meta-analytic exploration of associations between religious service attendance and sexual risk taking in adolescence and emerging adulthood

Findings since 2000 about the association between the frequency of religious service attendance (formal religiosity) and sexual risk taking in adolescents and emerging adults were explored. A systematic literature search (April 2020) focused on articles with data on religiosity and age at sexual debut, number of sexual partners, condom use at most recent sexual intercourse, and consistent condom use. A total of 27 studies with 37,430 participants (Mage = 18.4, range: 12-25, 43.5% male) were included. In random-effects meta-analysis, the link between formal religiosity and sexual risk taking was significant only for age at sexual debut (r = 0.09, 95% CI = 0.05, 0.13) and the number of sexual partners (r = -0.14, 95% CI = -0.19, -0.09). Weak associations between the constructs of interest indicate that formal religiosity is not sufficient to protect young people's sexual health.

A meta-analysis of training effects on English phonological awareness and reading in native Chinese speakers

Enhancing English phonological awareness is critical in promoting native English speakers' reading development. However, less attention has been paid to the role of phonological awareness development for English language learners in a logographic context. This meta-analysis aims to evaluate the effectiveness of training native Chinese speakers' English phonological awareness and reading across age groups. Thirty-three articles, including 37 independent samples, were identified as training studies that reported English phonological awareness as an outcome measure, and 16 articles, including 17 independent samples, featured training studies that reported reading as an outcome measure. Results based on a random-effect model revealed the effect sizes for overall English phonological awareness (including English syllable awareness, phoneme awareness, and rhyme awareness) and overall reading (including word reading and pseudoword reading) were g = 0.651 (n = 3137) and g = 0.498 (n = 1506), respectively. Specifically, instructional training exerted a small impact on word reading (g = 0.297), moderate effects on syllable awareness (g = 0.468) and pseudoword reading (g = 0.586), a medium to large effect on phoneme awareness (g = 0.736), and a large impact on rhyme awareness (g = 0.948). The moderator analyses yielded several significant findings. Regarding the English phonological awareness outcome, programs integrating lexical semantic knowledge exhibited the largest trend in enhancing native Chinese speakers' skills. Among all age groups, upper elementary students benefited most from instructional training. Furthermore, more intensive training had a greater impact than less intensive training. In terms of the reading outcome, similar to English phonological awareness findings, upper elementary students realized the greatest improvements. Additionally, unpublished articles indicated a larger training effect on reading than published ones. These findings provide practitioners with guidelines for delivering effective instruction to promote phonological awareness and reading ability for English language learners in a logographic language context.

The association between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty: a systematic review and meta-analysis

BACKGROUND

The purpose of this study was to evaluate the relationship between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty (RSA) with stratification based on measurement method and implant design.

METHODS

This systematic review was performed using PRISMA-P guidelines. PubMed/Medline, Cochrane Trials, and Embase were queried for articles evaluating the relationship between humeral lengthening and clinical outcomes inclusive of range of motion (ROM), strength, outcome scores, and pertinent complications (acromial and scapular spine fractures, nerve injury) after RSA. The relationship between humeral lengthening and clinical outcomes was reported descriptively overall and stratified by measurement method and implant design (globally medialized vs. lateralized). A positive association was defined as increased humeral lengthening being associated with greater ROM, outcome scores, or a greater incidence of complications, whereas a negative association denoted that increased humeral lengthening was associated with poorer ROM, outcome scores, or a lower incidence of complications. Meta-analysis was performed to compare humeral lengthening between patients with and without fractures of the acromion or scapular spine.

RESULTS

Twenty-two studies were included. Humeral lengthening was assessed as the acromiohumeral distance (AHD), the distance from the acromion to the greater tuberosity (AGT), the acromion to the deltoid tuberosity (ADT), and the acromion to the distal humerus (ADH). Of 11 studies that assessed forward elevation, a positive association with humeral lengthening was found in 6, a negative association was found in 1, and 4 studies reported no association. Of studies assessing internal rotation (n = 9), external rotation (n = 7), and abduction (n = 4), all either identified a positive or lack of association with humeral lengthening. Studies assessing outcome scores (n = 11) found either a positive (n = 5) or no (n = 6) association with humeral lengthening. Of the studies that assessed fractures of the acromion and/or scapular spine (n = 6), 2 identified a positive association with humeral lengthening, 1 identified a negative association, and 3 identified no association. The single study that assessed the incidence of nerve injury identified a positive association with humeral lengthening. Meta-analysis was possible for AGT (n = 2) and AHD (n = 2); greater humeral lengthening was found in patients with fractures for studies using the AGT (mean difference 4.5 mm, 95% CI 0.7-8.3) but not the AHD. Limited study inclusion and heterogeneity prohibited identification of trends based on method of measuring humeral lengthening and implant design.

CONCLUSION

The relationship between humeral lengthening and clinical outcomes after RSA remains unclear and requires future investigation using a standardized assessment method.

Effects of Resistance Training with Blood Flow Restriction on Explosive Power of Lower Limbs: A Systematic Review and Meta-Analysis

The purpose of this systematic review and meta-analysis was to compare changes in explosive power between blood flow restriction training and traditional resistance training protocols. Searches of PubMed, Scopus, Web of Science, and OVID Medline were conducted for studies. Inclusion criteria were: (a) healthy people; (b) randomized controlled or controlled trials; (c) outcome measures of explosive performance (peak power, rate of force development, jump performance, sprint performance, etc.); (d) involving a comparison between blood flow restriction training and traditional resistance training. Quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) scale. A total of 12 studies (262 subjects) were finally included for analysis. The PEDro scale score had a median of 5 of 10 points (range: 3-6 points). Significant small to moderate improvements were observed in blood flow restriction training [jump: standard mean difference (SMD) of 0.36 (95% CI: 0.02; 0.69); sprint: SMD of 0.54 (95% CI: 0.00; 1.07); power: SMD of 0.72 (95% CI: 0.17; 1.27)] when compared to traditional resistance training. The findings indicate that blood flow restriction training is more effective in improving explosive power of lower limbs compared to traditional resistance training in healthy people. In addition, blood flow restriction with a wide cuff (≥ 10 cm) during training improved explosive power better than with a narrow cuff or during the rest interval. Blood flow restriction training is very suitable for athletes in short competitive seasons and those who are not able to tolerate high loads (i.e., rehabilitators and the elderly).

Global prevalence of sleep disturbances among breast cancer survivors: A systematic review with meta-analysis

Breast cancer is a common cancer in which patients are highly susceptible to different sleep disturbances. However, current evidence lacked consistency in methodologies in investigating the prevalence of sleep disturbances among breast cancer survivors. The review aims to (1) investigate the global prevalence of sleep disturbances among breast cancer survivors; and (2) investigate the factors influencing the prevalence estimates. A comprehensive search was conducted in 8 databases using a 3-step approach, up to January 2022. The Newcastle-Ottawa Scale and Cochrane risk of bias tool were used to evaluate the quality of individual studies. Meta-analysis, meta-regression, and subgroup analysis were performed using R software. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations criteria. A total of 51 studies were selected involving 28,036 breast cancer survivors across 17 countries. The global prevalence of poor sleep quality was 62%, different severities of insomnia were 3%-32%, and excessive daytime sleepiness was 24%. Subgroup analyses showed that a significantly higher prevalence of poor sleep quality was found in breast cancer survivors during treatment compared with pre- or post-treatment. No significant covariates were found in a series of meta-regression analyses. The majority (73.5%) of individual studies were high quality but the certainty of the evidence was low or very low according to Grading of Recommendations, Assessment, Development, and Evaluations criteria. More than half of breast cancer survivors have sleep disturbances, so developing a strategic intervention is warranted. Given the low or very low certainty of the evidence, a robust design for large-scale research is crucial in the future.

Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression

BACKGROUND

We sought to assess the safety and efficacy of endovenous thermal ablation (EVTA) in treating large great saphenous veins (GSV) > 12 mm in diameter.

METHODS

We performed a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 for comparative and noncomparative studies depicting EVTA in the treatment of GSV > 12 mm. Primary endpoints included GSV occlusion, technical success, deep vein thrombosis (DVT), and endovenous heat-induced thrombosis (EHIT). We conducted a comparative analysis between GSV > 12 mm and < 12 mm and a meta-regression analysis for two sets of studies, one including the whole dataset, containing treatment arms of comparative studies with GSV < 12 mm and one exclusively for GSV > 12 mm.

RESULTS

Seven studies, including 2564 GSV, depicting radiofrequency (RFA) and endovenous laser ablation (EVLA) were included. GSV > 12 mm occlusion, technical success, DVT, and EHIT estimates were 95.9% (95% CI: 93.6-97.8), 99.9% (95% CI: 98.9-100.0), 0.04% (95% CI: 0.0-3.4), and 1.6% (95% CI: 0.3-3.5). Meta-regression revealed a negative association between GSV diameter and occlusion for both the whole dataset (p < 0.01) and the > 12 mm groups (p = 0.04), GSV diameter and technical success for both groups (p < 0.01), (p = 0.016), and GSV diameter and EHIT only for the whole dataset (p = 0.02). The comparative analysis between GSV < 12 mm and GSV > 12 mm displayed an occlusion estimate of OR 1.79 (95% CI: 1.25-2.56) favoring small GSV.

CONCLUSION

Whereas we have displayed excellent occlusion and technical success results for the EVTA of GSV > 12 mm, our analysis has illustrated the unfavorable impact of GSV diameter on occlusion, technical success, and EHIT outcomes regardless of the 12 mm threshold. Potential parameter or device adjustments in a diameter-oriented fashion could further enhance outcomes.

Network Meta-analysis of Combined Strength and Power Training for Countermovement Jump Height

Combined strength and power training in a training program is considered to improve the vertical jump, which is frequently quantified using the countermovement jump height. It is not yet clear whether one of the different training set structures, such as complex training, contrast training, compound training and traditional training, is superior to another. The aim of this review is to describe and assess the comparative effects of the set structures on countermovement jump height in healthy subjects. A systematic review and network meta-analysis (NMA) was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analyses. Three databases were systematically searched. Risk of bias was assessed using the Risk of Bias 2 tool. NMAs were performed using a random-effects model. Twenty-four studies were included. All interventions were superior to control (no intervention) with mean differences ranging from 2.87 [95% confidence interval (CI): 1.99 to 3.74] for complex training to 3.43 (95% CI: 2.61 to 4.26) for traditional training. None of the training interventions were superior compared to each other in strength and/or power trained subjects, as well as in non-strength and/or power trained subjects. The findings support the combination of strength and power training to improve countermovement jump height.

Effect of Taichi Chuan on health-related physical fitness in adults: A systematic review with meta-analysis

PURPOSE

Taichi Chuan was previously shown to benefit physical health, but the results were inconsistent. The main reason is that the mechanism is not clear and may be interpreted differently. In this systematic review, we analyzed the data obtained from various randomized controlled trials to identify the effectiveness of Taichi Chuan and the mechanism by which it improves the physical health of adults.

METHODS

We systematically searched various databases, including PubMed, Web of Science, Scopus, Embase, EBSCO Host, Science Direct, CNKI, Wan-Fang, and VPCS, and obtained 1448 articles for review. The articles were selected following the PICO eligibility criteria. We performed a systematic review and meta-analysis to interpret the results of the different studies.

RESULTS

We included 16 studies in the systematic review. Six of them were of very high quality, ten were of acceptable quality. Overall, the results showed that Taichi Chuan is beneficial to physical fitness, but not all indices supported this statement. Specifically, the effects were significant on Balance (ES = - 0.33; P = 0.02), BMI (ES = - 0.83; P < 0.00001), body fat (ES = - 0.45; P < 0.00001), and vital capacity (ES = 23.39; P = 0.01). However, there were no significant effects on systolic blood pressure (ES = 0.07; P = 0.94) and diastolic blood pressure (ES = 0.03; P = 0.97).

CONCLUSION

We found sufficient high-quality evidence to suggest that Taichi Chuan affects balance, BMI, body fat, vital capacity, and flexibility (sit-reach) in adults. The mechanism can be explained by low posture (balance) and moderate intensity of Taichi Chuan. However, no study has explained how to maintain concentration while keeping a dynamic low posture, which made it difficult to validate the finding that Taichi Chuan can reduce sympathetic tension under stress. In this study, we assumed that relaxation methods, which work on the central nervous system that links the body and the mind, might be the key explanation. However, further studies based on scientific, replicable methods need to be performed to confirm our findings.

Risk Markers for Male Perpetration of Sexual Assault on College Campuses: A Meta-Analysis

Sexual assault (SA) on college campuses remains a prominent public health issue. This meta-analysis focuses on identifying all potential risk markers for college male SA perpetration. Using standard search procedures, a total of 25 studies yielding 89 unique effect sizes were included in the study. Significant risk markers were related to hegemonic masculinity (e.g., peer approval of SA, rape myth acceptance, sexist beliefs, hostility towards women), other forms of dating violence perpetration (e.g., physical and psychological dating violence perpetration), and the college party culture (e.g., binge drinking, alcohol and substance use, frequency of hook-ups). Psychological dating violence victimization, athletic team membership, race/ethnicity, relationship status, and religiosity were not significant risk markers for SA perpetration. Findings support potential benefits of SA prevention efforts prioritizing peer education/student leaders modeling SA disapproval, challenging hegemonic masculinity, healthy relationship and sexual education, as well as alcohol and substance use awareness.

Impact of fear of recurrence in patients with cancer on caregivers' psychological health: A meta-analysis

Objective

This study aims to quantitatively investigate the relationship between fear of cancer recurrence in patients with cancer and their caregivers' psychological health, examining the extent of the impact of this fear on caregivers.

Methods

We conducted a comprehensive search in PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO databases from inception until May 2023 for relevant English publications. Pearson correlation coefficients (r) were utilized as effect sizes to assess the overall relationship between fear of recurrence and psychological outcomes among caregivers of patients with cancer.

Results

A total of 19 eligible studies were included in the analysis. The findings revealed a moderate positive correlation between fear of recurrence in patients with cancer and caregivers' fear of recurrence and depression. A relatively weaker correlation was observed between patients' fear of recurrence and caregivers' anxiety. Due to considerable heterogeneity (I2 ​= ​91.99%, Q ​= ​212.23), the primary outcome of fear of recurrence in patients with cancer influencing caregivers' fear of recurrence was examined through subgroup analyses.

Conclusions

Our meta-analysis established a significant positive correlation between fear of recurrence in patients with cancer and negative psychological consequences among caregivers, including recurrence fear, depression, and anxiety. Future research should explore the evolution of adverse psychological outcomes in both patients with cancer and their caregivers over time and delve into the bivariate psychological impact within the patient-caregiver dyads.

Systematic review registration

PROSPERO, CRD42022383866.

Does deception involve more cognitive control than truth-telling? Meta-analyses of N2 and MFN ERP studies

A number of psychological theories propose that deception involves more cognitive control than truth-telling. Over the last decades, event-related potentials (ERPs) have been used to unravel this question, but the findings are mixed. To address this controversy, two meta-analyses were conducted to quantify the results of existing studies reporting N2 or medial frontal negativity (MFN) associated with deception. In total, 32 papers consisting of 1091 participants were included, which yielded 32 effect sizes for N2 and 7 effect sizes for MFN. We found that deception was associated with a more negative N2 and MFN than truth-telling with medium and large effect sizes (r = .25 and .51, respectively). We also found that the deception paradigm modulated the results (p = .043), but found no evidence for publication bias. Our findings indicate that deception involves more cognitive control than truth-telling. Our review also identifies gaps in this literature, including a need for more ERP studies using spontaneous deception.

The Effect of Coaching Programs on Physical Activity and Pain in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVES

Coaching programs are used to achieve continuity in physical activity and reduce pain severity in patients with rheumatoid arthritis. Our aim was to examine the effects of coaching programs on physical activity and pain in patients with rheumatoid arthritis through randomized controlled trials.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Scopus, PubMed, Web of Science, Cochrane Library, Science Direct, EBSCOhost/CINAHL Complete, Springer Link, ProQuest, and Ovid databases were searched without year limitations in English until May 2023.

REVIEW/ANALYSIS METHODS

PRISMA guideline was employed. Comprehensive Meta-Analysis 3 software was used to analyze the meta-analysis data. Two researchers independently assessed the quality of the included studies using the Cochrane Collaboration tool.

RESULTS

This study included six randomized controlled trials with a total of 983 participants. It was determined that the coaching programs were effective in improving physical activity levels (95% CI = 0.14-0.39, Hedge's g = 0.27, p < .001) and reducing pain (95% CI = 0.07-0.39, Hedge's g = 0.23, p = .006) in the intervention groups compared with the control groups. It was determined that the application of coaching programs in the form of face-to-face sessions and phone calls at 7-10 sessions per year in patients diagnosed with rheumatoid arthritis was beneficial in pain management and improving physical activity levels.

CONCLUSIONS

Face-to-face sessions and telephone interviews are recommended as part of a coaching program for the maintenance of physical activity and pain management in patients with rheumatoid arthritis. Coaching programs can improve patients' functional status. There is a need to determine effective strategies by increasing awareness of the coaching programs implemented by nurses.

Endoscopic Versus Conservative Therapy for Bleeding Peptic Ulcer with Adherent Clot: A Comprehensive Systematic Review and Meta-Analysis

INTRODUCTION

Peptic ulcers with adherent clots are associated with a high-risk of rebleeding and mortality. However, the optimal management of bleeding ulcers with adherent clots remains unclear. We conducted this systematic review and meta-analysis to compare endoscopic therapy and conservative therapy to manage bleeding ulcers with adherent clots.

METHODS

We systematically searched PubMed, Embase, and Web of Science databases through October 2022 to include all studies comparing the endoscopic and conservative therapeutic approaches for bleeding ulcers with adherent clots. Our primary outcome was rebleeding (overall and 30-day). The secondary outcomes were mortality (overall and 30-day), need for surgery, and length of hospital stay (LOS). The random-effects model was used to calculate the pooled odds ratios (OR) and mean differences (MD) with the corresponding confidence intervals (CI) for proportional and continuous variables, respectively.

RESULTS

Eleven studies (9 RCTs) with 833 patients (431 received endoscopic therapy vs. 402 received conservative therapy) were included. Overall, endoscopic therapy was associated with lower overall rebleeding (OR 0.41, 95% CI 0.22-0.79, P = 0.007), 30-day rebleeding (OR 0.43, 95% CI 0.21-0.89, P = 0.002), overall mortality (OR 0.47, 95% CI 0.23-0.95, P = 0.04), 30-day mortality (OR 0.43, 95% CI 0.21-0.89, P = 0.002), need for surgery (OR 0.44, 95% CI 0.21-0.95, P = 0.04), and LOS (MD - 3.17 days, 95% CI - 4.14, - 2.19, P < 0.00001). However, subgroup analysis of randomized controlled trials (RCTs) showed no significant difference in overall mortality (OR 0.78, 95% CI 0.24-2.52, P = 0.68) between the two strategies, with numerically lower but statistically non-significant rates of overall rebleeding (7.2% vs. 18.5%, respectively; OR 0.42, 95% CI 0.17-1.05, P = 0.06), statistically lower rate of need for surgery (OR 0.28, 95% CI 0.08-0.96, P = 0.04) with endoscopic therapy compared to conservative therapy.

CONCLUSIONS

Our meta-analysis demonstrates that endoscopic therapy was overall associated with lower rates of rebleeding (overall and 30-day), mortality (overall and 30-day), need for surgery, and LOS, compared to conservative therapy for the management of bleeding ulcers with adherent clots. However, subgroup analysis of RCTs showed that endoscopic therapy was associated with numerically lower but statistically non-significant rates of overall rebleeding and a statistically lower rate of need for surgery compared to conservative therapy with similar overall mortality rates. Combined treatment with thermal therapy and injection therapy was the most effective treatment modality in reducing rebleeding risk. Further large-scale RCTs are needed to validate our findings.

Incisional hernias post cytoreductive surgery/peritonectomy and hyperthermic intraperitoneal chemotherapy: a systematic review and meta-analysis

PURPOSE

Cytoreductive surgery (CRS) is often combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for the treatment of peritoneal tumour deposits. Considering CRS, the evidence relating the large incisions, local chemotherapy and abdominal wall trauma to incisional hernias (IH) has not been synthesized. This systematic review and meta-analysis was conducted to examine the proportion of IH present in patients post CRS and the effect HIPEC had on these rates.

METHODS

PubMed, EMBASE, and Cochrane Central Registry of Trials were searched up to June 2023 to examine studies relating IH and CRS plus or minus HIPEC. The most up to date PRISMA guidelines were followed. Pertinent clinical information was synthesized in tabular form. A meta-analysis reporting the pooled proportions of IH post CRS plus or minus HIPEC, the odds of IH in HIPEC versus non-HIPEC CRS and the difference in follow-up time between groups was conducted.

RESULTS

Nine studies comprising 1416 patients were included. The pooled proportion of IH post CRS was 12% (95% confidence interval (CI) 8-16%) in HIPEC and 7% (95% CI 4-10%) in non-HIPEC patients and 11% (95% CI 7-14%) overall. Previously reported rates of IH in midline laparotomy range from 10 to 30%. The odds of IH in the HIPEC was 1.9 times higher compared to non-HIPEC cohorts however this was not statistically significant (odds ratio (OR) 1.9, 95% 0.7-5.2; p = 0.21). There was no significant difference in average follow-up times between HIPEC and non-HIPEC cohorts.

CONCLUSIONS

IH post CRS plus or minus HIPEC were in the expected range for midline laparotomies. IH in patients receiving HIPEC may occur at a greater proportion than in non-HIPEC patients, however, there were too few studies in our meta-analysis to determine this with statistical significance.

Global Prevalence and Factors Related to Intimate Partner Violence Amongst People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome: A Systematic Review, Meta-Analysis, and Meta-Regression

Reviews of intimate partner violence (IPV) have primarily focused on women and same-sex relationships, but little is known about the global epidemiology of IPV among people living with HIV/AIDS (PLWHA). This review employed meta-analytic approaches to determine the worldwide prevalence and factors related to different forms of IPV among PLWHA. Databases including PubMed, Cochrane review, EMBASE, Scopus, PsycINFO, CINAHL, ProQuest, and registers, were systematically reviewed until November 5, 2021. The meta-analysis was conducted using the metafor package in R software. The Newcastle Ottawa Scale and Cochrane Risk of Bias Tool version 1 were used to assess the study quality and risk of bias, respectively. A total of 49 published articles and 42,280 participants, were included in the meta-analysis. Over their lifetime, four in ten PLWHA have experienced some type of IPV. Over a quarter have experienced physical, emotional, or psychological IPV. One in five PLWHA experienced at least one form of IPV during the recall period of last year, with emotional IPV being the most prevalent. Rates of physical and any types of IPV differed substantially between IPV measurements. IPV rates also varied significantly by the study design, with physical (29%) and sexual (18%) IPV rates being more prevalent in cross-sectional studies. Public health measures are critical for preventing and combating IPV among PLWHA. Additional cross-national research using robust sampling methods is required to obtain more representative samples and thus a more reliable prevalence estimate of IPV prevalence.

Effects of Structural Allograft versus Polyetheretherketone Cage in Patients Undergoing Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

BACKGROUND

Inter body spacers have been widely used in patients undergoing spinal fusion surgery; however, it is not clear whether one implant shows superior clinical outcomes compared with the other. This systematic review and meta-analysis comprehensively evaluated the radiologic outcomes and patient-reported outcomes of structural allograft versus polyetheretherketone (PEEK) implants in patients undergoing spinal fusion surgery.

METHODS

Extensive literature searches were conducted on online databases, including MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Library, until January 2023. The present study adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and the Newcastle-Ottawa Scale and Cochrane Collaboration Risk of Bias tool were used to assess the quality of the included studies.

RESULTS

Fifteen studies, encompassing 8020 patients, met the eligibility criteria. The results indicate that structural allografts show a higher fusion rate compared with PEEK implants (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.05-3.37; P ＝0.03; I2 = 71%). In addition, the structural allograft group also had a lower pseudarthrosis rate (OR, 0.40; 95% CI, 0.20-0.80; P = 0.009; I2 = 75%) and reoperation rate (OR, 0.46; 95% CI, 0.26-0.81; P = 0.007; I2 = 38%).

CONCLUSIONS

Our systematic review and meta-analysis show that structural allograft has a higher fusion rate compared with PEEK implants in patients undergoing spinal fusion surgery. In addition, structural allograft has a lower pseudarthrosis rate and reoperation rate.

The association between callous-unemotional traits and substance use in childhood and adolescence: A systematic review and meta-analysis

Callous-unemotional (CU) traits are characterized by a lack of guilt and empathy, restricted affect, and low concern about performance, and are increasingly recognized as co-occurring with substance use in youth. However, there is mixed evidence concerning whether they make a unique contribution to substance use. This systematic review and meta-analysis sought to quantify the association between CU traits and substance use in childhood, accounting for potential moderators including sample characteristics (age, gender, community versus clinical/forensic samples), CU traits measure and informant, and study design (cross-sectional or longitudinal). Separate meta-analyses were conducted for alcohol, cannabis, and a substance use composite. Small, significant associations were found between CU traits and alcohol (θ = 0.17), cannabis (θ = 0.17) and the substance use composite (θ = 0.15), which were present in both community and clinical/forensic samples. Findings suggest that CU traits co-occur with a range of substance use problems, and that CU traits should be considered in assessments of youth presenting with substance use problems regardless of the nature of the setting.

Prevalence of attention deficit hyperactivity disorder in adults: Umbrella review of evidence generated across the globe

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) is a class of neurodevelopmental disorders which is commonly diagnosed in school-age children, but it can occur in any age group. To provide a robust synthesis of published evidence on the prevalence of ADHD in adults, we conducted an umbrella review of systematic reviews and meta-analyses.

METHODS

The review was guided by preferred reporting items for systematic review and meta-analysis (PRISMA). We searched PsychINFO, Web of Science, PubMed, and Scopus to retrieve pertinent studies. The review protocol was registered with PROSPERO (CRD42023389704). A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used to assess the quality of the included studies. A random-effects model was used to perform a meta-analysis.

RESULTS

Five systematic reviews and meta-analyses (57 unique primary studies) with data on 21,142,129 adult participants were eligible for inclusion in this umbrella review. Inverse variance weighted random effect meta-analysis of these studies indicated that the pooled prevalence of ADHD in adults was 3.10% (95%CI 2.60-3.60%). ADHD-I (the inattentive type of ADHD) remained the commonest type of ADHD, followed by ADHD-HI (the hyperactive type) and ADHD-C (the combined type).

CONCLUSION

The results indicate that ADHD is relatively high in adults, with ADHD-I remaining the most common subtype. Attention should be given to preventing, reducing, identifying, and managing ADHD in adults.

Atypical hemispheric lateralization of brain function and structure in autism: a comprehensive meta-analysis study

BACKGROUND

Characteristic changes in the asymmetric nature of the human brain are associated with neurodevelopmental differences related to autism. In people with autism, these differences are thought to affect brain structure and function, although the structural and functional bases of these defects are yet to be fully characterized.

METHODS

We applied a comprehensive meta-analysis to resting-state functional and structural magnetic resonance imaging datasets from 370 people with autism and 498 non-autistic controls using seven datasets of the Autism Brain Imaging Data Exchange Project. We studied the meta-effect sizes based on standardized mean differences and standard deviations (s.d.) for lateralization of gray matter volume (GMV), fractional amplitude of low-frequency fluctuation (fALFF), and regional homogeneity (ReHo). We examined the functional correlates of atypical laterality through an indirect annotation approach followed by a direct correlation analysis with symptom scores.

RESULTS

In people with autism, 85, 51, and 51% of brain regions showed a significant diagnostic effect for lateralization in GMV, fALFF, and ReHo, respectively. Among these regions, 35.7% showed overlapping differences in lateralization in GMV, fALFF, and ReHo, particularly in regions with functional annotations for language, motor, and perceptual functions. These differences were associated with clinical measures of reciprocal social interaction, communication, and repetitive behaviors. A meta-analysis based on s.d. showed that people with autism had lower variability in structural lateralization but higher variability in functional lateralization.

CONCLUSION

These findings highlight that atypical hemispheric lateralization is a consistent feature in autism across different sites and may be used as a neurobiological marker for autism.

Efficacy of topical versus oral analgesic medication compared to a placebo in injured athletes: A systematic review with meta-analysis

BACKGROUND

Athletes are injured frequently and often take analgesic medication. Moreover, athletes commonly use non-prescription topical and oral medications with little guidance. Despite wide use, relatively few studies exist on the efficacy of pain medication in injured athletes compared to a placebo.

OBJECTIVE

To determine efficacy of topical or oral medications in pain reduction compared to a placebo in injured athletes.

STUDY DESIGN

A systematic review and meta-analysis.

METHODS

We conducted an electronic search using Medline/Pubmed, Web of Science, Ovid, and SportDiscus for all literature relating to topical or oral medications in athletes for pain management post-injury. Two reviewers screened the studies and measured their quality. To determine efficacy, we calculated the Hedges' g value. We created forest plots with 95% CI to graphically summarize the meta-analyses.

RESULTS

There was a significant pooled effect size reflecting a reduction in pain outcomes for the topical treatment versus placebo (g = -0.64; 95% CI [-0.89, -0.39]; p < 0.001). There was not a significant reduction in pain outcomes for the oral treatment versus placebo (g = -0.26; 95% CI [-0.60, 0.17]; p = 0.272).

CONCLUSION

Topical medications were significantly better at reducing pain compared to oral medications versus a placebo in injured athletes. These results are different when compared to other studies that used experimentally induced pain versus musculoskeletal injuries. The results from our study suggest that athletes should use topical medications for pain reduction, as it is more effective, and there are less reported adverse effects compared to oral medication.