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

Palliative care utilisation globally by cancer patients: systematic review and meta-analysis

INTRODUCTION

The rising global prevalence of cancer reveals significant regional disparities in palliative care adoption. While some countries have incorporated palliative care into their systems, over half of the world lacks such services, and oncology-specific palliative care integration is sparse. This study evaluates the global prevalence of palliative care use among cancer patients.

METHODS

A comprehensive search across multiple databases was conducted to identify relevant studies. Data extraction and organisation were managed using Microsoft Excel, and analysis was performed with STATA/MP 17.0. A weighted inverse variance random-effects model was applied, and heterogeneity was assessed with Cochrane I² statistics. Subgroup analyses, sensitivity analyses and Egger's test were used to explore heterogeneity, publication bias and influential studies.

RESULTS

The global prevalence of palliative care among cancer patients was 34.43% (95% CI: 26.60 to 42.25). Africa had the highest utilisation rate at 55.72% (95% CI: 35.45 to 75.99), while the USA had the lowest at 30.34% (95% CI: 19.83 to 40.86). Studies with sample sizes under 1000 showed a higher utilisation rate of 47.51% (95% CI: 36.69 to 58.32). Approximately 55% (95% CI: 35.26 to 74.80) of patients had a positive attitude towards palliative care, and 57.54% (95% CI: 46.09 to 69.00) were satisfied with the services. Positive attitudes were significantly associated with higher palliative care utilisation.

CONCLUSION

Only about one-third of cancer patients globally receive palliative care, with the highest utilisation in Africa. Nearly half of patients have a favourable attitude towards palliative care, and a similar proportion are satisfied with the services.

Smoking and Complications After Cancer Surgery: A Systematic Review and Meta-Analysis

Importance

Surgical cancer treatments may be delayed for patients who smoke over concerns for increased risk of complications. Quantifying risks for people who had recently smoked can inform any trade-offs of delaying surgery.

Objective

To investigate the association between smoking status or smoking cessation time and complications after cancer surgery.

Data Sources

Embase, CINAHL, Medline COMPLETE, and Cochrane Library were systematically searched for studies published from January 1, 2000, to August 10, 2023.

Study Selection

Observational and interventional studies comparing the incidence of complications in patients undergoing cancer surgery who do and do not smoke.

Data Extraction and Synthesis

Two reviewers screened results and extracted data according to the Meta-Analyses of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Data were pooled with a random-effects model and adjusted analysis was performed.

Main Outcomes and Measures

The odds ratio (OR) of postoperative complications (of any type) for people who smoke currently vs in the past (4-week preoperative cutoff), currently smoked vs never smoked, and smoked within shorter (2-week cutoff) and longer (1-year cutoff) time frames.

Results

The meta-analyses across 24 studies with a pooled sample of 39 499 participants indicated that smoking within 4 weeks preoperatively was associated with higher odds of postoperative complications compared with ceasing smoking for at least 4 weeks (OR, 1.31 [95% CI, 1.10-1.55]; n = 14 547 [17 studies]) and having never smoked (OR, 2.83 [95% CI, 2.06-3.88]; n = 9726 [14 studies]). Within the shorter term, there was no statistically significant difference in postoperative complications between people who had smoked within 2 weeks preoperatively and those who had stopped between 2 weeks and 3 months in postoperative complications (OR, 1.19 [95% CI, 0.89-1.59]; n = 5341 [10 studies]), although the odds of complications among people who smoked within a year of surgery were higher compared with those who had quit smoking for at least 1 year (OR, 1.13 [95% CI, 1.00-1.29]; N = 31 238 [13 studies]). The results from adjusted analyses were consistent with the key findings.

Conclusions and Relevance

In this systematic review and meta-analysis of smoking cessation and complications after cancer surgery, people with cancer who had stopped smoking for at least 4 weeks before surgery had fewer postoperative complications than those smoking closer to surgery. High quality, intervention-based evidence is needed to identify the optimal cessation period and inform clinicians on the trade-offs of delaying cancer surgery.

Pharmacogenetics of opioid medications for relief of labor pain and post-cesarean pain: a systematic review and meta-analysis

OBJECTIVE

Several studies have attempted to identify genetic determinants of clinical response to opioids administered during labor or after cesarean section. However, their results were often contrasting. A systematic review and meta-analysis was conducted to quantitatively assess the association between gene polymorphisms and clinical outcomes of opioid administration in the treatment of labor pain and post-cesarean pain.

METHODS

A comprehensive search was performed up to December 2023 using PubMed, Web of Knowledge, Cochrane Library, and OpenGrey databases. The clinical endpoints of interest were pain score after opioid treatment, total opioid consumption, patient's analgesic satisfaction, and incidence of opioid side effects. Random-effects meta-analyses were conducted when data were available in at least three studies.

RESULTS

Twenty-six studies enrolling 7765 patients were included in the systematic review. Overall, a total of 12 candidate polymorphic genes (OPRM1, COMT, CYP2D6, CYP3A4, ABCB1, ABCC3, UGT2B7, CGRP, OPRK1, OPRD1, KCNJ6, KCNJ9) were considered by the included studies, among which the most investigated variant was OPRM1 rs1799971. Overall pooled results indicated that individuals carrying the G allele of OPRM1 rs1799971 required higher opioid doses for pain management in comparison to rs1799971 AA subjects (standardized mean difference: 0.26; 95% CI: 0.09-0.44; P = 0.003). Such an association was confirmed in the subgroups of patients with labor pain and post-cesarean pain.

CONCLUSION

The present meta-analysis provides strong evidence of an association between OPRM1 rs1799971 and opioid dose requirement for relief of labor pain or post-cesarean pain. However, given the insufficient evidence for other polymorphic gene variants, large studies are still needed to investigate the impact of genetic variability on the efficacy and safety of opioid medications for relief of labor pain and post-cesarean pain (INPLASY Registration No. 202410040).

Discordance between cystatin C-based and creatinine-based estimated glomerular filtration rate and health outcomes in adults: a systematic review and meta-analysis

Background

The intra-individual difference in cystatin C-based and creatinine-based estimated glomerular filtration rate (eGFRcys and eGFRcr, respectively), i.e. eGFR discordance, has recently been demonstrated to have prognostic implications. eGFR discordance was associated with mortality, cardiovascular and renal outcomes. We present a systematic review and meta-analysis to summarize the existing literature.

Methods

We searched PubMed, Embase and MEDLINE up to 28 April 2024 for cohort and cross-sectional studies in English reporting the association of eGFR discordance with mortality, cardiovascular and renal outcomes. The quality of studies was evaluated by Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) form. Data from studies were extracted to a pre-defined table and pooled using a random-effects model. Stratified and sensitivity analyses were performed.

Results

A total of 1489 studies were initially identified, of which 18 studies with longitudinal or cross-sectional designs were included, with a sample size between 373 and 363 494 people. In general, the risk of bias was graded as "low" or "some concerns". eGFR was mainly calculated using Chronic Kidney Disease Epidemiology Collaboration equations, while a few studies applied other equations. An eGFR discordance featuring lower eGFRcys, e.g. eGFRcys ≤60% of eGFRcr, or eGFRcys-eGFRcr ≤-15 mL/min/1.73 m2, was consistently associated with higher mortality and elevated risk of cardiovascular and renal outcomes. People with lower eGFRcys have a 58% greater risk of mortality [hazard ratio (HR) = 1.58, 95% confidence interval (CI) 1.42, 1.76] and 32% greater risk of cardiovascular events (HR = 1.32, 95% CI 1.25, 1.39). People with higher eGFRcys have a 39% lower risk of mortality (HR = 0.61, 95% CI 0.52, 0.70) and 29% lower risk of cardiovascular events (HR = 0.71, 95% CI 0.62, 0.81). No meta-analysis for renal outcomes was conducted due to data availability.

Conclusions

The eGFR discordance serves as a meaningful indicator of adverse health outcomes. The lack of a consensus on the cut-off value of eGFR discordance and the mixture use of eGFR equations warrants attention.

Navigating agitation in neurodevelopmental disorders: A comparative study of pharmacotherapies via network meta-analysis in children and adults with autism spectrum disorder or intellectual disabilities

IMPORTANCE

Individuals with autism spectrum disorder (ASD) and intellectual disability often experience persistent challenges related to aggressive behaviour and agitation, highlighting the critical need for evidence-based pharmacological interventions among other strategies. Despite previous network meta-analyses (NMAs), the rapidly evolving landscape of treatment options necessitates ongoing and updated assessments.

OBJECTIVE

To evaluate the efficacy and tolerability of various pharmacotherapies in managing agitation in children and adults with ASD or intellectual disabilities (ID).

METHODS

Employing a systematic review and network meta-analysis methodology, we conducted an exhaustive search across multiple databases for double-blind, randomized controlled trials focusing on pharmacotherapies targeting agitation in these neurodevelopmental disorders. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, our assessment of study quality utilized the Cochrane Risk of Bias Tool to ensure methodological rigour and accuracy in data synthesis. Primary outcomes encompassed measures of reduced agitation, as indicated by treatment response on standardized agitation scales, alongside dropout rates, providing a comprehensive overview of treatment efficacy and tolerability.

RESULTS

Our analysis included data from 38 eligible trials, involving 2503 participants across both pediatric and adult populations. Key pharmacological interventions, such as arbaclofen, risperidone plus buspirone, omega-3 fatty acids, risperidone plus palmitoylethanolamide, aripiprazole and risperidone, demonstrated significant efficacy in reducing agitation compared to placebo. Importantly, these treatments were generally well-tolerated, with no significant increase in all-cause dropouts compared to placebo, highlighting their suitability for clinical use in managing agitation in individuals with ASD or ID.

CONCLUSIONS

This study underscores the efficacy and tolerability of several pharmacotherapies in managing agitation among children and adults with ASD or ID. Our findings provide robust evidence that specific treatments, such as arbaclofen, risperidone plus buspirone and omega-3 fatty acids, are both effective and well-tolerated, offering valuable therapeutic options for clinicians. The study emphasizes the need for ongoing research to ensure that treatment strategies remain aligned with the evolving clinical landscape, ultimately improving patient outcomes in this challenging population.

Effect of hyperbaric oxygen therapy for non-motor symptoms among patients with Parkinson's disease: A systematic review and meta-analysis

ObjectiveTo systematically evaluate the efficacy of hyperbaric oxygen therapy for non-motor symptoms in patients with Parkinson's disease.Data sourcesA systematic search was performed across several databases, including the Chinese Science and Technology Periodical Database, Web of Science, SinoMed, PubMed, Cochrane Library, Embase and Wanfang databases up to 1 December 2024. Studies considered for inclusion comprised randomised controlled trials and pre-post control studies.Review methodsThe authors conducted the data extraction and literature screening procedures independently. The selected studies' quality was evaluated using the Cochrane risk of bias technique. Review Manager 5.3 was used to conduct meta-analyses, while Stata 15.0 was utilised for sensitivity analysis and to assess publication bias.ResultsSixteen studies with a total of 1324 individuals satisfied the inclusion criteria. The results of the meta-analysis showed that hyperbaric oxygen therapy significantly improved scores on the Hamilton Anxiety Scale and Hamilton Depression Scale compared with baseline (both p < 0.05). Additionally, improvements were observed in the Montreal Cognitive Assessment, Mini-Mental State Examination, Parkinson's Disease Sleep Scale, Pittsburgh Sleep Quality Index, Kubota's Drinking Water Test and Unified Parkinson's Disease Rating Scale III. Improvements in sleep efficiency and extension of total sleep time were also noted compared with controls (all p < 0.05).ConclusionThe findings indicate that hyperbaric oxygen therapy effectively alleviates non-motor symptoms such as anxiety, depression, cognitive impairments, sleep disturbances, and swallowing dysfunction, as well as improving motor function in Parkinson's disease patients. Since the hyperbaric oxygen therapy protocol had significant differences between studies, further prospective randomised controlled trials with rigorous methodology are needed.

A meta-analysis of mortality rates in eating disorders: An update of the literature from 2010 to 2024

Elevated mortality rates have been reported in individuals with eating disorders (EDs). However, no meta-analysis in the past decade has provided an updated, comprehensive synthesis of mortality across all ED diagnoses while exploring potential moderating factors. We conducted a systematic search in four databases (PsycINFO, MEDLINE, Embase and Web of Science) from 2010 to 29 Oct 2024. Studies that reported standardized mortality ratios (SMRs) in individuals with a diagnosed ED (including formal diagnoses and self-reports) were included. Random-effects meta-analyses were conducted to pool estimates across studies. Meta-regression was conducted to examine predictors of heterogeneity. Meta-analysis of SMRs of effect sizes revealed elevated mortality risk for individuals with an ED (regardless of ED subtype); weighted SMR = 3.39 (95 % CIs: 2.90, 3.95), p < .001, I2 = 95.1 %, Q(df=73) = 1492.39, p < .001. SMRs were highest for individuals with anorexia nervosa (5.21; k = 30), followed by eating disorder not otherwise specified (2.51; k = 8); bulimia nervisa (2.20; k = 18) and binge eating disorder (1.46; k = 3). Individuals with EDs demonstrate markedly heightened mortality rates, especially among those with anorexia nervosa. Our findings are crucial for identifying key factors influencing mortality in EDs, guiding targeted interventions to reduce preventable deaths.

Arthrocentesis versus conservative treatments for temporomandibular joint disorders: A systematic review with meta-analyses and trial sequential analyses

This systematic review aimed to evaluate the efficacy of arthrocentesis compared to conservative treatments for symptomatic temporomandibular joint disorders. A systematic search for randomized, prospective and retrospective controlled trials was undertaken in five electronic databases. Various patient outcomes and economic evaluations were analysed for short-term (<6 months), intermediate-term (6 months to 5 years) and long-term (≥5 years) follow-up periods. Primary meta-analyses were performed for randomized controlled trials using random-effects models. Arthrocentesis was superior to conservative treatments regarding pain reduction at short-term (MD 14.5 (95% CI 9.7; 19.4), k= 9 RCTs, n= 545 patients, I2= 48%, high quality of evidence) and intermediate-term follow-up (MD 14.2 (95% CI 7.3; 21.1), k=9 RCTs, n= 547 patients, I2= 81%, moderate quality of evidence). Furthermore, arthrocentesis was superior to conservative treatment regarding maximum mouth opening improvement at short-term (MD 2.4 mm (95% CI 0.8; 4.1), k= 8 RCTs, n= 472 patients, I2= 80%, moderate quality of evidence) and intermediate-term follow-up (MD 2.2 mm (95% CI 0.5; 3.9), k= 8 RCTs, n= 468 patients, I2= 75%, moderate quality of evidence). Trial sequential analysis supported the conclusions of all primary meta-analyses. Results were clinically relevant for pain improvement, but not for maximum mouth opening improvement. Results at long-term follow-up and for other study outcomes were either lacking or too heterogenous for meta-analysis, highlighting the need for more standardized, high-quality research.

A systematic review and meta-analysis of double trophectoderm biopsy and/or cryopreservation in PGT: balancing the need for a diagnosis against the risk of harm

BACKGROUND

To prevent the transfer of embryos affected by monogenic conditions and/or chromosomal defects, preimplantation genetic testing (PGT) requires trophectoderm biopsy and cryopreservation. In 2-6% of biopsies, the diagnosis may be inconclusive due to DNA amplification failure or low-quality results. In these cases, a round of re-warming, re-biopsy, and re-cryopreservation is required to obtain a genetic diagnosis. In other cases, when the IVF centre starts providing PGT and/or when the patients develop an indication because of multiple failures, miscarriages or the birth of an affected child after IVF, cryopreserved untested embryos may be warmed, biopsied, and then re-vitrified. However, it is still unclear whether multiple manipulations may reduce reproductive outcomes after PGT.

OBJECTIVE AND RATIONALE

This study aimed at conducting a systematic review to investigate the available evidence on the safety of double biopsy and/or double cryopreservation-warming and provide recommendations in this regard. We performed meta-analyses of the differences in the reproductive outcomes (live birth per embryo transfer [LBR per ET], clinical pregnancy rate per ET [CPR per ET], and miscarriage rate per clinical pregnancy [MR per CP]) in double cryopreservation and single biopsy (CBC) or double biopsy and double cryopreservation (BCBC) flows vs the control single biopsy and single cryopreservation (BC) flow. Cryo-survival rates before ET and gestational and perinatal outcomes were also reported.

SEARCH METHODS

PRISMA guidelines were followed to gather all available information from the literature (PubMed, Scopus, and Embase). We used Medical Subject Headings (MeSH) terms and a list of specific keywords relevant for the study question. We searched for original studies in humans, published in peer-reviewed journals in English up to April 2024. Four independent authors assessed the articles for inclusion. One included paper was retrieved from another source.

OUTCOMES

A total of 4219 records were identified, and 10 studies were included in the meta-analysis. Certainty of evidence level ranged from low to moderate. Both the CBC and BCBC groups showed reduced reproductive outcomes compared to the control (BC). Specifically, live birth rates per embryo transfer were lower in the CBC group (OR: 0.56, 95% CI: 0.38-0.81, I2 = 58%; six studies) and the BCBC group (OR: 0.51, 95% CI: 0.34-0.77, I2 = 24%; six studies). CPR per ET were also lower in the CBC group (OR: 0.68, 95% CI: 0.51-0.92, I2 = 57%; seven studies) and the BCBC group (OR: 0.60, 95% CI: 0.46-0.78, I2 = 0%; seven studies). Additionally, MR per CPs were higher in both the CBC group (OR: 1.68, 95% CI: 1.02-2.77, I2 = 50%; seven studies) and the BCBC group (OR: 2.08, 95% CI: 1.13-3.83, I2 = 28%; seven studies). Cryo-survival as well as gestational and perinatal outcomes were within the expected norms in the studies reporting them.

WIDER IMPLICATIONS

Improved genetic technologies, standardization of laboratory protocols, operators' proficiency with biopsy and cryopreservation, and continuous monitoring of the performance are essential to minimize inconclusive diagnoses and the putative impact of additional embryo manipulations. Although poorer reproductive outcomes might result from double biopsy and/or double cryopreservations, these practices may still be worthwhile to avoid transferring affected/aneuploid blastocysts. Therefore, the risks must be weighed against the potential benefits for each specific couple.

REGISTRATION NUMBER

PROSPERO (ID: CRD42024503678).

Cost Effectiveness of Catheter Ablation Versus Antiarrhythmic Drugs for Atrial Fibrillation: A Systematic Review and Meta-analysis

BACKGROUND

Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and is associated with substantial morbidity and mortality. Current international guidelines recommend antiarrhythmic drugs or catheter ablation (CA) as rhythm-control strategies for AF. This study aimed to comprehensively assess economic evaluations (EEs) of the treatment of AF by country income level.

METHODS

Seven electronic databases were systematically searched for EE literature until March 30, 2024, with no constraints on time or language. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the data. Full EEs comparing CA with antiarrhythmic drugs for rhythm-control treatment were included; surgical or rate-control treatments were excluded. The quality of the included articles was assessed using the ECOBIAS checklist. Costs were converted to purchasing power parity US dollars for 2023. A random-effects meta-analysis was applied to pool incremental net benefit (INB) based on a heterogeneity test and its degree (I2 > 25% or Cochran's Q test < 0.1). We also explored heterogeneity and potential publication bias and conducted sensitivity and subgroup analyses.

RESULTS

In total, 27 studies across nine countries were eligible, predominantly from high-income countries (n = 25), with a smaller subset from upper-middle-income countries (n = 2). Because of the heterogeneity among the studies, a random-effects model was selected over a fixed-effects model to pool INBs. Most studies (n = 21) favored CA as the cost-effective intervention, yielding an INB of $US23,796 (95% confidence interval [CI] 15,341-32,251) in high-income countries. However, heterogeneity was substantial (I2 = 99.67%). In upper-middle-income countries, the estimated INB was $US18,330 (95% CI - 11,900-48,526). The publication bias results showed no evidence of asymmetrical funnel plots.

CONCLUSION

In this meta-analysis, CA emerged as a cost-effective rhythm-control treatment for AF when compared with antiarrhythmic drugs, particularly in high-income countries. However, economic evidence for upper-middle-income countries is lacking, and no primary evaluations were found for low-middle-income and low-income countries. Further EEs are necessary to expand the understanding of AF treatment globally.

Prevalence of anxiety, depression, and post-traumatic stress disorder among paramedic students: a systematic review and meta-analysis

PURPOSE

There are elevated mental health concerns in paramedic students, but estimates vary between studies and countries, and no review has established the overall prevalence. This systematic review addressed this by estimating the global prevalence of common mental health disorders, namely anxiety, depression, and post-traumatic stress disorder (PTSD), in paramedic students internationally.

METHODS

A systematic search of six databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and medRxiv, was conducted to identify studies relating to mental health among paramedicine students. The search encompassed studies from inception until February 2023. To be considered for inclusion in the review, the studies had to report prevalence data on at least one symptom of anxiety, depression, or PTSD in paramedicine students, using quantitative validated scales. The quality of the studies was assessed using Joanna Briggs Institute (JBI) Checklist, which is a specific methodological tool for assessing prevalence studies. Subgroup analyses were not conducted due to insufficient data.

RESULTS

1638 articles were identified from the searches, and 193 full texts were screened, resulting in 13 papers for the systematic review and meta-analysis. The total number of participants was 1064 from 10 countries. The pooled prevalence of moderate PTSD was 17.9% (95% CI 14.8-21.6%), anxiety was 56.4% (95% CI 35,9-75%), and depression was at 34.7% (95% CI 23.4-48.1%).

CONCLUSION

This systematic review and meta-analysis has found that paramedicine students globally exhibit a high prevalence of moderate PTSD, anxiety, and depression. The prevalence of these mental health conditions surpasses those among paramedic providers and the general population, as indicated by previous reviews. Further research is therefore warranted to determine appropriate support and interventions for this group.

Reduced Erosion Augments Soil Carbon Storage Under Cover Crops

Cover crops, a promising strategy to increase soil organic carbon (SOC) storage in croplands and mitigate climate change, have typically been shown to benefit soil carbon (C) storage from increased plant C inputs. However, input-driven C benefits may be augmented by the reduction of C outputs induced by cover crops, a process that has been tested by individual studies but has not yet been synthesized. Here we quantified the impact of cover crops on organic C loss via soil erosion (SOC erosion) and revealed the geographical variability at the global scale. We analyzed the field data from 152 paired control and cover crop treatments from 57 published studies worldwide using meta-analysis and machine learning. The meta-analysis results showed that cover crops widely reduced SOC erosion by an average of 68% on an annual basis, while they increased SOC stock by 14% (0-15 cm). The absolute SOC erosion reduction ranged from 0 to 18.0 Mg C-1 ha-1 year-1 and showed no correlation with the SOC stock change that varied from -8.07 to 22.6 Mg C-1 ha-1 year-1 at 0-15 cm depth, indicating the latter more likely related to plant C inputs. The magnitude of SOC erosion reduction was dominantly determined by topographic slope. The global map generated by machine learning showed the relative effectiveness of SOC erosion reduction mainly occurred in temperate regions, including central Europe, central-east China, and Southern South America. Our results highlight that cover crop-induced erosion reduction can augment SOC stock to provide additive C benefits, especially in sloping and temperate croplands, for mitigating climate change.

Multivariate Bayesian variable selection for multi-trait genetic fine mapping

Genome-wide association studies (GWAS) have identified thousands of single-nucleotide polymorphisms (SNPs) associated with complex traits, but determining the underlying causal variants remains challenging. Fine mapping aims to pinpoint the potentially causal variants from a large number of correlated SNPs possibly with group structure in GWAS-enriched genomic regions using variable selection approaches. In multi-trait fine mapping, we are interested in identifying the causal variants for multiple related traits. Existing multivariate variable selection methods for fine mapping select variables for all responses without considering the possible heterogeneity across different responses. Here, we develop a novel multivariate Bayesian variable selection method for multi-trait fine mapping to select causal variants from a large number of grouped SNPs that target at multiple correlated and possibly heterogeneous traits. Our new method is featured by its selection at multiple levels, incorporation of prior biological knowledge to guide selection and identification of best subset of traits the variants target at. We showed the advantage of our method over existing methods via comprehensive simulations that mimic typical fine-mapping settings and a real-world fine-mapping example in UK Biobank, where we identified critical causal variants potentially targeting at different subsets of addictive behaviours and risk factors.

Effects of lifestyle interventions on mental health in children and adolescents with overweight or obesity: a systematic review and meta-analysis

Background

Childhood obesity and mental health disorders are increasingly prevalent. While lifestyle interventions are widely recognized as effective for managing obesity in children and adolescents, their effects on mental health remain unclear. This study aimed to systematically evaluate the effects of lifestyle interventions on mental health outcomes among children and adolescents with overweight or obesity.

Methods

In this systematic review and meta-analysis, we searched five databases (PubMed, Embase, MEDLINE, CENTRAL and CINAHL) for relevant randomised controlled trials (RCTs) or non-randomised studies of interventions (NRSIs) published from database inception to December 7, 2024, without language restrictions. Lifestyle interventions are defined as structured programs that promote health-related behavioural changes across diverse domains, such as physical activity, dietary adjustments, cognitive training, and psychosocial support. We included studies that assessed the effects of lifestyle interventions on mental health outcomes among children and adolescents with overweight or obesity. Two reviewers independently screened records for eligibility, extracted study-level data and assessed risk of bias of RCTs and NRSIs via the revised Cochrane Risk of Bias Tool for randomised controlled trials (RoB 2) and the Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I), and certainty of the evidence by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RCTs were prioritized as the primary source of evidence, while NRSIs served as supplementary evidence. A random-effects meta-analysis model was performed to calculate pooled standardized mean differences (SMDs) and 95% confidence intervals (CIs). Subgroup analyses stratified by age, body mass index (BMI) category, intervention type, theoretical framework, duration, and World Bank income region, were further conducted to identify potential sources of heterogeneity. The review protocol was registered in PROSPERO, CRD42024571061.

Findings

We identified 20,359 records, of which 26 studies (17 RCTs and nine NRSIs) involving 3511 children and adolescents with overweight or obesity were included. Mental health outcomes assessed included depression, anxiety, self-concept, self-efficacy, negative affect, quality of life, and emotional functioning. Lifestyle interventions evaluated encompassed physical activity, health education, emotion regulation, diet, and multicomponent approaches. Among RCTs, reductions in depression (SMD = -0.24, 95% CI: -0.39 to -0.10, I-square [I 2] = 0.0%) and improvements in quality of life (SMD = 0.24, 95% CI: 0.04-0.44, I 2 = 44.0%) were observed, with moderate certainty. Subgroup analyses revealed greater reductions in depression among adolescents and participants with obesity, in programs that involving multicomponent approaches, lasting below three months, using behavioural and cognitive theory, or being conducted in high-income countries (HICs). For quality of life, greater improvements were observed among participants with overweight or obesity, in programs based on behavioural and cognitive theory, or in those conducted in low- and middle-income countries (LMICs). Meanwhile, among NRSIs, reductions in depression (SMD = -0.22, 95% CI: -0.33 to -0.11, I 2  = 11.5%), as well as enhancements in self-concept (SMD = 0.19, 95% CI: 0.09-0.29, I 2 = 0.0%), quality of life (SMD = 0.52, 95% CI: 0.23-0.81, I 2 = 86.2%), and emotional functioning (SMD = 0.40, 95% CI: 0.21-0.60, I 2 = 0.0%) were noted. However, the effects on other mental health outcomes, including anxiety, negative affect, and self-efficacy, remain inconclusive.

Interpretation

Lifestyle interventions modestly improve depressive symptoms and quality of life in children and adolescents with overweight or obesity, with additional benefits for self-concept and emotional functioning observed in NRSIs. These findings underscore the potential of lifestyle interventions to address both physical and mental health. Future research should focus on evaluating long-term psychological outcomes and developing cost-effective, culturally tailored interventions.

Funding

This study was supported by National Natural Science Foundation of China (72474196).

Examining heterogeneity and reporting of mirror therapy intervention for phantom limb pain: A scoping review

BACKGROUND

Mirror therapy shows promise in the treatment of phantom limb pain but lacks robust evidence.

OBJECTIVES

To address this gap, we conducted a scoping review aiming to comprehensively explore the landscape of mirror therapy practice, gather details about the session content, and offer recommendations for future research.

METHOD

We searched seven databases for published work from 1995 to May 2023. Two independent reviewers selected, assessed, and extracted data from eligible articles. Articles, regardless of study design, were considered eligible if they investigated mirror therapy as an intervention for phantom limb pain.

RESULTS

A total of 44 articles were included, comprising 16 randomized control trials, 14 prospective cohort studies, 15 case reports, and 3 protocols. These studies collectively involved 942 patients, with male patients representing 70 % of the participants. Lower limb amputation, primarily attributed to trauma, accounted for 88 % of the included patients. Pain intensity was predominantly assessed by a visual analog scale (61 %). However, there was a notable absence of detailed descriptions regarding mirror therapy sessions, particularly concerning the number of exercises, duration per exercise, and repetitions. Typically, sessions lasted 15 min each, conducted once daily. The exercises primarily focused on motor exercises targeting the distal part of the limb.

CONCLUSION

The practice of mirror therapy was characterized by poor description, showed significant heterogeneity, and a lack of standardized protocols, which contributes to an overall low level of evidence. Addressing these gaps in practice description and standardization is crucial for improving reproducibility and strengthening the evidence base for the prescription of mirror therapy.

Effects of Exercise Interventions on Blood Pressure in Children and Adolescents With Overweight or Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

This systematic review and meta-analysis aimed to quantify the effect of exercise interventions on blood pressure (BP) among children and adolescents with overweight or obesity. A systematic search of five databases was conducted from inception to July 26, 2024, to identify relevant randomized controlled trials (RCTs). Study quality was assessed using the revised Cochrane Risk of Bias Tool for randomized controlled trials. A random-effects model was performed, and subgroup analyses were further conducted. A total of 19 RCTs were included. All reported changes of systolic blood pressure (SBP), while 18 reported that of diastolic blood pressure (DBP). Exercise interventions significantly reduced SBP (standardized mean difference [SMD] = -0.71; 95% confidence interval [CI], -1.06 to -0.36; P<.001) and DBP (SMD= -0.67; 95% CI, -1.00 to -0.34; P<.001). Subgroup analyses indicated greater reductions in BP levels among girls and obese children and adolescents, or when the program was HIIT, or with a total time of at least 3000 minutes. Early exercise interventions may help to prevent or delay the onset of hypertension in this population.

Lower ACLR Failure Rates in Bone-Soft Tissue Versus Soft Tissue-Only Allografts in Adults: A Systematic Review and Meta-analysis

BACKGROUND

While allografts are commonly used for anterior cruciate ligament reconstruction (ACLR), evidence to guide specific allograft selection is lacking.

PURPOSE

To compare clinical and graft failure rates after ACLR using soft tissue-only allografts and bone-soft tissue allografts in adults.

STUDY DESIGN

Systematic review and meta-analysis; Level of evidence, 4.

METHODS

English-language studies with clinical outcome data on primary and revision ACLR in adults with nonirradiated soft tissue-only and bone-soft tissue grafts were identified in the search. Data extracted included allograft type, patient characteristics, follow-up time, and failure rates. The cumulative failure rate was defined as International Knee Documentation Committee grade C/D, graft retear, grade ≥2+ Lachman, grade ≥2+ pivot shift, and/or side-to-side KT-1000 laxity of >5 mm. The graft rupture rate was defined solely by the proportion of patients who had a graft rupture. Meta-analyses using the inverse variance method were used to estimate the pooled rates with 95% CIs. Subgroup analysis was conducted to compare allograft types and determine whether age, sex, and follow-up time influenced the estimates.

RESULTS

A total of 14 studies met the inclusion criteria: 7 investigated bone-soft tissue allografts, 6 investigated soft tissue-only allografts, and 1 investigated both. The comparative study showed a difference in the cumulative failure rate between bone-patellar tendon-bone and soft tissue-only allografts. The pooled cumulative failure rates for bone-soft tissue and soft tissue-only allografts were 11% (95% CI, 7-17) and 20% (95% CI, 14-29), respectively (P = .05). The pooled graft rupture rates for bone-soft tissue and soft tissue-only allografts were 6% (95% CI, 4-9) and 13% (95% CI, 7-23), respectively (P = .07).

CONCLUSION

The meta-analysis results showed that bone-soft tissue allografts have lower cumulative failure rates than soft tissue-only allografts. Bone-soft tissue allografts may be the preferred allograft choices for ACLR.

Global meta-analysis of short-term associations between ambient temperature and pathogen-specific respiratory infections, 2004 to 2023

BackgroundAmbient temperature may affect respiratory health, while the temperature sensitivity of respiratory infections may be pathogen-dependent.AimsWe sought to explore pathogen-specific associations between ambient temperature and respiratory infections.MethodsWe searched nine databases for a random-effects meta-analysis to pool the relative risk (RR) of respiratory infection by pathogen per 1° C temperature rise, compared to populations unexposed to the same temperature. We conducted pathogen-specific analyses, sensitivity analyses, subgroup analyses and meta-regression.ResultsA total of 137 studies were eligible for meta-analysis. The pooled and single-study estimates revealed that the incidence of respiratory syncytial virus (RR = 0.14; 95% confidence interval (CI): 0.09-0.23), influenza virus (IV) (RR = 0.40; 95% CI: 0.27-0.61), human metapneumovirus (RR = 0.48; 95% CI: 0.32-0.73), human coronavirus (HCoV) (RR = 0.21; 95% CI: 0.07-0.61) and SARS-CoV-2 (RR = 0.52; 95% CI: 0.35-0.78) decreased per 1° C temperature rise, while that of human parainfluenza virus (HPIV) (RR = 2.35; 95% CI: 1.46-3.77), human bocavirus (HBoV) (RR = 1.86; 95% CI: 1.04-3.32) and MERS-CoV (RR = 1.05; 95% CI: 1.04-1.07) increased. The risk of infection was lower for IVA, IVB, HCoV-229E and HCoV-OC43, while HPIV-3, and HBoV-1 were at increased risk. The risk of Streptococcus pyogenes pharyngitis (RR = 0.46; 95% CI: 0.30-0.69) decreased per 1° C temperature rise, while Pseudomonas aeruginosa (RR = 1.04; 95% CI: 1.03-1.05) and Legionella pneumophila infections (RR = 2.69; 95% CI: 1.11-6.53) increased.ConclusionsTemperature sensitivity of respiratory infections can vary with the specific pathogen type and subtype that causes the infection. As the climatic conditions will become warmer, public health policy makers should act to develop pathogen adaptation strategies.

Effects of Herbal Tea (Non-Camellia sinensis) on Glucose Homeostasis and Serum Lipids in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

CONTEXT

Hyperglycemia and hyperlipidemia increase the risk for diabetes and its complications, atherosclerosis, heart failure, and stroke. Identification of safe and cost-effective means to reduce risk factors is needed. Herbal teas may be a vehicle to deliver antioxidants and polyphenols for prevention of complications.

OBJECTIVE

This systematic review and meta-analysis were conducted to evaluate and summarize the impact of herbal tea (non-Camellia sinensis) on glucose homeostasis and serum lipids in individuals with type 2 diabetes (T2D).

DATA SOURCES

PubMed, FSTA, Web of Science, CINAHL, MEDLINE, and Cochrane Library databases were searched from inception through February 2023 using relevant keyword proxy terms for diabetes, serum lipids, and "non-Camellia sinensis" or "tea."

DATA EXTRACTION

Data from 14 randomized controlled trials, totaling 551 participants, were included in the meta-analysis of glycemic and serum lipid profile end points.

RESULTS

Meta-analysis suggested a significant association between drinking herbal tea (prepared with 2-20 g d-1 plant ingredients) and reduction in fasting blood glucose (FBG) (P = .0034) and glycated hemoglobin (HbA1c; P = .045). In subgroup analysis based on studies using water or placebo as the control, significant reductions were found in serum total cholesterol (TC; P = .024), low-density lipoprotein cholesterol (LDL-C; P = .037), and triglyceride (TG; P = .043) levels with a medium effect size. Meta-regression analysis suggested that study characteristics, including the ratio of male participants, trial duration, and region, were significant sources of FBG and HbA1c effect size heterogeneity; type of control intervention was a significant source of TC and LDL-C effect size heterogeneity.

CONCLUSIONS

Herbal tea consumption significantly affected glycemic profiles in individuals with T2D, lowering FBG levels and HbA1c. Significance was seen in improved lipid profiles (TC, TG, and LDL-C levels) through herbal tea treatments when water or placebo was the control. This suggests water or placebo may be a more suitable control when examining antidiabetic properties of beverages. Additional research is needed to corroborate these findings, given the limited number of studies.

Association of MC4R rs17782313 Genotype With Energy Intake and Appetite: A Systematic Review and Meta-analysis

CONTEXT

The melanocortin-4 receptor gene (MC4R) is associated with a higher risk of obesity by the presence of the C allele in rs17782313, but the mechanisms are not clear.

OBJECTIVE

The present systematic review and meta-analysis aimed to explore the association between the different genotypes of MC4R rs17782313 and energy intake and appetite.

DATA SOURCES

A literature search was conducted up to June 2023 in PubMed, Scopus, Web of Science, and Cochrane Collaboration databases, following PRISMA guidelines.

DATA EXTRACTION

Inclusion criteria were studies in humans measuring energy intake, appetite, or satiety in all ages and physiological conditions. Studies dealing solely with body mass index were excluded. Twenty-one articles representing 48 560 participants were included in the meta-analysis.

DATA ANALYSIS

According to the NHLBI (National Heart, Lung, and Blood Institute) quality-assessment criteria, all case-control studies and 6 out of 17 cohort and cross-sectional studies were classified as "good," while the rest scored as "fair." Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in a (CT+CC) vs TT dominant model, and both random-effects and fixed-effects models were used. A statistically significant association between the presence of the C allele and increased appetite was found (OR = 1.25; 95% CI: 1.01-1.49; P = .038) using the fixed-effects model, but the random-effects model proved nonsignificant. However, no association with energy intake was found. None of the variables considered (sample size, year of publication, sex, age group, type of population, origin, and quality) were identified as effect modifiers, and no publication biases were found after subgroup and meta-regression analyses.

CONCLUSION

To our knowledge, this is the first systematic review and meta-analysis that has analyzed the association between rs17782313 of MC4R and energy intake and appetite. Identifying people genetically predisposed to increased appetite may be of great interest, not only to prevent obesity in younger populations but also to avoid malnutrition in elderly persons. This paper is part of the Nutrition Reviews Special Collection on Precision Nutrition.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023417916.

Meta-Analysis of Consumer Willingness to Pay for Short Food Supply Chain Products

Due to their perceived benefits for health, the environment, the economy, and sustainability, in recent years there has been a growing interest on the part of researchers and policymakers in short-food supply chains (SFSCs). However, a systematic review of the literature on this topic remains lacking. To address this gap, the study conducts a meta-analysis to examine consumer willingness to pay (WTP) for SFSC products, taking into account various sociodemographic factors and sustainability attributes. On average, consumers are willing to pay a 34.5% premium for SFSC products. Key factors influencing WTP include gender, education, study year, age, region, product category, and sustainability attributes. Women exhibit higher WTP, and individuals with higher education levels also demonstrate increased WTP. Notably, WTP for SFSC products is lower before 2014, while younger consumers exhibit higher WTP overall. Consumers in Western Europe present higher WTP estimates compared to those in North America and other regions. In terms of sustainability attributes, organic products receive the highest WTP, with food categories such as meat, poultry, dairy products, and honey showing the highest estimates. These findings offer valuable insights for SFSC producers, marketers, and policymakers, guiding effective strategies to promote SFSC products within sustainable agri-food systems.

Global prevalence of fatigue in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

Fatigue is a common symptom in patients with chronic obstructive pulmonary disease (COPD). Published studies of fatigue among patients with COPD have presented diverse findings that may reflect variations in research methods as well as actual population differences.

OBJECTIVE

To estimate the worldwide prevalence of fatigue in patients with COPD and its associated epidemiological characteristics.

METHODS

The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP), and China Biology Medicine disc (CBM) databases were searched for articles from their inception date through August 2024. The pooled prevalence of fatigue in patients with COPD and 95 % confidence interval (CI) were calculated using a random-effects model with Stata 15.0 software. Agency for Healthcare and Research and Quality (AHRQ) indicators and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the included studies.

RESULTS

The 25 included studies involved 6830 patients. The meta-analysis results showed a 59 % (95 % CI: 52%-66 %) pooled prevalence of fatigue in patients with COPD. Subgroup analysis indicated that the prevalence varied significantly by region, setting, assessment tool, and publication year.

CONCLUSIONS

Fatigue is a common symptom among patients with COPD worldwide. To reduce the negative effects of fatigue in these patients, clinicians should actively explore the mechanisms of fatigue occurrence and its risk factors to provide a basis for further research.

Pulmonary microbiology and microbiota in adults with non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis

BACKGROUND

Non-cystic fibrosis bronchiectasis is associated with frequent and diverse microbial infections, yet an overall understanding of microbial presence across different disease stages is lacking.

METHODS

A meta-analysis assessed lung microbes in adults with non-CF bronchiectasis, collecting data using both culture-based and sequencing approaches through three international databases and three Chinese databases. Subgroups were categorized by disease stage: the stable group (S), the exacerbation group (E), and unclassified data consolidated into the undetermined group (U). Culture data were analysed in random-effects meta-analyses while sequencing data were processed using QIIME 2.

RESULTS

A total of 98 studies were included with data from 54,384 participants worldwide. Pseudomonas aeruginosa was the most frequently isolated bacterium (S: 26[19-34]%, E: 23[20-25]%, U: 20[16-25]%), while not specified Mycobacterium avium complex exhibited the highest mycobacterial prevalence (S: 3[1-5]%, E: 4[2-5]%, U: 15[3-27]%). Aspergillus spp. (S: 15[-10-39]%, E: 2[1-3]%, U: 10[5-15]%) and Candida spp. (S: not applicable, E: 11[2-20]%, U: 10[-8-27]%) were predominant in fungi culture with variable distributions among groups. Rhinovirus was the most commonly detected virus with varying prevalence across airway sample types rather than disease stages (S-sputum: 18[-16-53]%, S-nasopharyngeal: 4[-1-9]%, E-sputum: 22[16-29]%, E-nasopharyngeal: 6[4-8]%). Sequencing results revealed notable antibiotic persistence of Pseudomonas in 16S, and significant domination of Candida in ITS.

CONCLUSION

Our findings indicate consistent bacterial patterns throughout bronchiectasis stages in both culture and sequencing results. Viruses are extensively detected in stable patients but vary across different airway sample types. Lower bacterial diversity and higher fungal diversity may be associated with exacerbation risks.

Cultural Adaptations to the Assessment and Treatment of Trauma Experiences Among Racial and Ethnic Minority Groups: A Mixed-Methods Systematic Review and Meta-Analysis

A higher prevalence of post-traumatic stress disorder (PTSD) exists among racial and ethnic minority groups who experience trauma; however, little is known about cultural adaptations of trauma assessments and interventions, or whether those adaptations meet cultural needs. This systematic review examined the effectiveness and experiences of culturally adapted trauma assessments and interventions for adults from racial and ethnic minority groups. Empirical studies investigating culturally adapted trauma assessment and/or interventions targeting adults from racial and ethnic minority groups were searched for in MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, from inception to May 2022. A total of 21 articles were included, and 8 common themes of adaptations were identified: socio-cultural integrations, collaboration, psychoeducation, language, cultural matching, addressing stigma, training for providers, and practical considerations. Random effects meta-analyses on intervention effects showed that culturally adapted interventions were more effective in reducing PTSD symptoms (7 randomized controlled trials [RCTs], n = 213, Standardized Mean Difference -0.67, 95% CI [-1.06, -0.25], I2 = 39%) and in ameliorating anxiety symptoms (5 RCTs, n = 168, SMD -1.92, 95% CI [-3.18, -0.67], I2 = 89%) when compared with non-adapted interventions at immediate post-intervention. No statistical difference in effects was found on depression, nor on PTSD or anxiety sustained beyond the post-intervention time-point. Thematic synthesis on participants' experiences showed that adapted interventions had positive influences on attitudes toward mental health and engagement with services. Future research should employ large-scale trial methods to test adapted trauma interventions over longer follow-up periods as well as to explore the subjective experiences of users of adapted interventions.

Effect of statins on psoriasis severity: A meta‐analysis of randomized clinical trials

Background

Psoriasis, a chronic inflammatory skin disorder, is associated with an elevated risk of cardiovascular diseases due to shared inflammatory pathways. This meta‐analysis evaluates the efficacy of statins, known for their lipid‐lowering and anti‐inflammatory properties, in managing psoriasis severity.

Methods

A systematic search was conducted following Preferred Reporting Items for Systematic reviews and meta‐analysis guidelines across PubMed, Cochrane, Web of Science, Scopus, EMBASE, and CINAHL databases up to October 2024. Randomized clinical trials comparing statins with placebo or alternative treatments in adult psoriasis patients were included. The primary outcome was the Psoriasis Area and Severity Index (PASI) score or symptom improvement.

Results

Out of 11,894 identified articles, 10 randomized clinical trials were included in the final analysis. Data from eight studies with 638 observations revealed a standardized mean difference (SMD) of −0.36 (95% confidence intervals [CI]: −0.72 to 0.00; p = 0.05; I² = 52.0% [95% CI: 0.0% to 79.5%]) for PASI scores, indicating a beneficial effect of statins on psoriasis severity, although not statistically significant. Subgroup analysis demonstrated significant effects for topical administration (SMD = −0.82; 95% CI: −1.47 to −0.16; I2 = 0%). Secondary outcomes, measured using the Dermatology Life Quality Index (DLQI), were assessed in three studies (232 observations) and showed an SMD of 0.24 (95% CI: −0.09 to 0.57; p = 0.1; I2 = 0%), indicating no significant improvement in DLQI scores. Analysis of high‐sensitivity C‐reactive protein (hsCRP) from two studies (164 observations) revealed an SMD of −0.12 (95% CI: −0.42 to 0.18; p = 0.44; I2 = 0%), indicating no significant reduction in systemic inflammation.

Conclusions

While statins may reduce psoriasis severity, the meta‐analysis did not show statistically significant improvements in PASI scores, except for topical application, and found no significant benefits in DLQI or hsCRP levels. Variability across studies and small sample sizes are notable limitations. Future research with larger cohorts and extended follow‐ups is warranted to clarify the potential role of statins in psoriasis management.

Anger and emotion regulation strategies: a meta-analysis

The hypothesis that maladaptive emotion regulation plays a central role in anger problems has driven the development of cognitive-behavioral interventions for anger and has stimulated a wealth of studies. However, this work is heterogeneous, drawing on multiple theories from clinical psychology and affective science, and focusing on multiple dimensions of emotion regulation. In addition, previous findings have not always been consistent. The present meta-analysis aimed to characterize associations between anger and emotion regulation strategies (i.e., avoidance, acceptance, distraction, reappraisal, rumination, suppression). A systematic search was conducted, and 81 studies (115 effect sizes) were included in the analysis. The results indicated consistent positive associations between anger and avoidance, rumination, and suppression, and consistent negative associations between anger and acceptance, and reappraisal. The relation between anger and distraction could not be analyzed. Heterogeneity was large in all analyses, and multiple differences between studies, including type of anger, clinical status, criminal status, type of culture, study quality, and sample sex distribution, influenced the effect sizes. Overall, the present findings support the view that anger is consistently associated with the differential use of multiple emotion regulation strategies and suggest methodological improvements for future studies.

Investigating the prevalence of the concomitant osteomyelitis in pediatric hip septic arthritis: a systematic review and Meta-analysis

BACKGROUND

Paediatric hip septic arthritis is a critical condition that requires prompt surgical intervention. It may occur as an isolated issue or alongside concomitant osteomyelitis, which heightens the risk of secondary surgeries and can lead to conversion to Choi IV after the initial arthrotomy. Accurately assessing the prevalence of concomitant osteomyelitis in these patients is vital. However, existing literature reveals significant variability in prevalence estimates. This review aims to clarify the occurrence of concomitant osteomyelitis in paediatric hip septic arthritis.

METHODS

This study was executed in alignment with PRISMA guidelines and has been registered with PROSPERO. A meticulous search was carried out across the PubMed, Embase, and Cochrane Library databases until September 2024 to identify relevant literature. The criteria for inclusion involved studies diagnosed with paediatric hip septic arthritis, aged 18 years or younger, with at least five documented cases. To derive pooled prevalence rates from the collected data, we utilized a random-effects meta-analysis approach. The quality of the selected studies was evaluated using the Joanna Briggs Institute's assessment checklist, ensuring a comprehensive appraisal of methodological integrity. Additionally, to explore potential sources of variability among the studies, sensitivity analyses were performed via the leave-one-out method. Subgroup analyses were also conducted focusing on three significant factors: age, geographical region, and overall study quality.

RESULTS

A total of 21 studies were incorporated into the final analysis, which included 684 paediatric cases of septic arthritis of the hip. The meta-analysis produced a pooled prevalence estimate of concomitant osteomyelitis in this population at 33.2% (95% CI: 27.3-39.8). Notably, significant heterogeneity was identified among the studies (I² = 59.414%; P < 0.001). Furthermore, statistically significant differences were observed based on continent (Europe, Asia, or America) (P = 0.008) and study quality (High or Fair) (P = 0.003).

CONCLUSION

This systematic review and meta-analysis identifies a pooled prevalence of concomitant osteomyelitis in paediatric hip septic arthritis at 31.8-34.5%, employing rigorous methodologies such as sensitivity analyses and stratified assessments that enhance the reliability of the findings despite limitations like small sample sizes and exclusion of non-English studies. These insights are essential for guiding future research and informing treatment strategies, ultimately supporting clinicians in making informed decisions to improve patient care in paediatric orthopedics.

Physical and psychological predictors for persistent and recurrent non-specific neck pain: a protocol for a systematic review and meta-analysis

INTRODUCTION

Both physical adaptations (e.g., altered neck kinematics and muscle coordination) and psychological features are common in people presenting with neck pain (NP). Additionally, both physical and psychological features may be relevant for the development of persistent or recurrent NP. Although a number of original studies have reported this, currently there is no available systematic review reporting physical and psychological predictors for the recurrence of non-specific NP.

METHODS AND ANALYSIS

The report of this systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies will be searched from PubMed, MEDLINE, EMBASE, CINAHL Plus, PsycINFO and grey literature. Title, abstract and full-text screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Studies investigating the prediction of persistent or recurrent NP from physical or psychological predictors will be included. Physical predictors will be commonly reported objective measures including neck kinematics, measures of muscle activity and sensory function. Psychological predictors will include variables such as kinesiophobia, self-efficacy, pain coping strategies and quality of life. The main outcomes of interest are the Neck Disability Index, presence of pain recurrence, as well as pain intensity and frequency during a persistent or recurrent NP episode. Observational cohort studies will be included, and studies on both single-factor and multifactor predictions or associations will be investigated. Risk of bias will be assessed using the Quality in Prognosis Studies (QUIPS) tool. The certainty of evidence will be rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random-effect meta-analysis will be conducted if methodological and clinical homogeneity is deemed satisfactory.

ETHICS AND DISSEMINATION

Ethical approval will not be required for this review as there is no primary data collection involving humans. The findings will be published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42024596844.

Post-traumatic stress disorder and associated factors among road traffic accident survivors in Sub-Saharan Africa: A systematic review and meta-analysis

INTRODUCTION

Road traffic accidents have become a global public health issue, especially in low- and middle-income countries (LMICs). According to the World Health Organization (WHO) Global Road Safety Report 2018, there are over 1.35 million deaths related to road traffic accidents (RTAs) annually. Although several primary studies have been conducted to determine the prevalence and associated factors of post-traumatic stress disorder (PTSD) among RTA survivors in sub-Saharan Africa (SSA), these studies have reported inconsistent findings. Therefore, this study aimed to determine the pooled prevalence and associated factors of PTSD among RTA survivors in SSA.

METHODS

The studies were accessed through the Google Scholar, Scopus, PubMed, and Web of Science databases using search terms. Moreover, citation tracking was also performed. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of PTSD and determine associated factors among RTA survivors in SSA.

RESULTS

A total of 17 primary studies with a sample size of 9,056 RTA survivors were included in the final meta-analysis. The pooled prevalence of PTSD among RTA survivors in SSA was 23.36% (95% CI: 18.36, 28.36); I2 = 96.73%; P < 0.001). Female gender [AOR = 2.33, 95% CI: 1.80, 3.01], depression symptoms [AOR = 2.96, 95% CI: 2.17, 4.03], duration since the accident (1-3 months) [AOR = 2.08, 95% CI: 1.23, 3.52], poor social support [AOR = 2.97, 95% CI: 1.09, 8.11], and substance use [AOR = 3.31, 95% CI: 1.68, 6.52] were significantly associated with PTSD.

CONCLUSIONS

The pooled prevalence of PTSD was low in SSA compared to studies that have been conducted outside the region. Female gender, depression symptoms, duration since the accident (1-3 months), poor social support, and substance use were the pooled independent predictors of PTSD among RTA survivors in SSA. Those RTA survivors with these identified risk factors would be screened and managed early for PTSD using pharmacological treatment and brief psychological intervention. Future researchers shall conduct further studies using different methods, including qualitative studies to identify additional predictors of PTSD among RTA survivors in SSA.

Ethnicity-specific associations between the promoter region G-308A polymorphism (rs1800629) of the TNF-α gene and the development of end-stage renal disease: An evidence-based meta-analysis and trial sequential analysis

Tumor necrosis factor-alpha (TNF-α), is partly attributed to pathogenesis of end-stage renal disease (ESRD). Inconsistency of reported associations between TNF-α G-308A polymorphism (rs1800629) and ESRD prompted a meta-analysis to obtain more precise estimates. Eleven case-control studies from 11 articles were included. Pooled odds ratios (OR) and 95% confidence intervals (95% CIs) were estimated to evaluate the association. Subgroup analysis was based on ethnicity (Caucasian and Asian). Multiple comparisons were Bonferroni-corrected. Trial sequential analysis (TSA) was implemented to ascertain the reliability of results. Sensitivity analyses and publication bias tests were performed on significant results. There were no significant association (pa >0.05) in the overall and ethnic subgroup. Indians, three significant pool ORs (pa < 0.01-0.03) showed increased susceptibility to ESRD in homozygous (OR, 6.57; 95% CI, 1.45 to 29.75; pa = 0.01), recessive (OR, 6.75; 95% CI, 1.44 to 31.56; pa = 0.02), and codominant (OR, 2.06; 95% CI, 1.08 to 3.94; pa = 0.03) models. TSA indicated the robustness of such association in the Indian population. The main outcomes were robust without evidence of publication bias. This study showed associations between TNF-α G-308A and ESRD are confined to Indians, which are susceptible to ESRD up to approximately 7 times.

Inter-individual differences in the blood pressure lowering effects of dietary nitrate: a randomised double-blind placebo-controlled replicate crossover trial

PURPOSE

Dietary nitrate supplementation increases nitric oxide (NO) bioavailability and reduces blood pressure (BP). Inter-individual differences in these responses are suspected but have not been investigated using robust designs, e.g., replicate crossover, and appropriate statistical models. We examined the within-individual consistency of the effects of dietary nitrate supplementation on NO biomarkers and BP, and quantified inter-individual response differences.

METHODS

Fifteen healthy males visited the laboratory four times. On two visits, participants consumed 140 ml nitrate-rich beetroot juice (~ 14.0mmol nitrate) and, on the other two visits, they consumed 140 ml nitrate-depleted beetroot juice (~ 0.03mmol nitrate). Plasma nitrate and nitrite concentrations were measured 2.5 h post-supplementation. BP was measured pre- and 2.5 h post-supplementation. Between-replicate correlations were quantified for the placebo-adjusted post-supplementation plasma nitrate and nitrite concentrations and pre-to-post changes in BP. Within-participant linear mixed models and a meta-analytic approach estimated participant-by-condition treatment response variability.

RESULTS

Nitrate-rich beetroot juice supplementation elevated plasma nitrate and nitrite concentrations and reduced systolic (mean:-7mmHg, 95%CI: -3 to -11mmHg) and diastolic (mean:-6mmHg, 95%CI: -2 to -9mmHg) BP versus placebo. The participant-by-condition interaction response variability from the mixed model was ± 7mmHg (95%CI: 3 to 9mmHg) for systolic BP and consistent with the treatment effect heterogeneity t = ± 7mmHg (95%CI: 5 to 12mmHg) derived from the meta-analytic approach. The between-replicate correlations were moderate-to-large for plasma nitrate, nitrite and systolic BP (r = 0.55 to 0.91).

CONCLUSIONS

The effects of dietary nitrate supplementation on NO biomarkers and systolic BP varied significantly from participant to participant. The causes of this inter-individual variation deserve further investigation.

TRIAL REGISTRATION

https://clinicaltrials.gov/study/NCT05514821 .

Efficacy and Safety of Biologics for Chronic Rhinosinusitis With Nasal Polyps: A Meta-Analysis of Real-World Evidence

Dupilumab, omalizumab, mepolizumab, and benralizumab have demonstrated good efficacy and safety in the treatment of severe uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP) in phase 3 randomised controlled trials (RCTs). With recent regulatory approvals, there has been a surge in real-world studies (RWSs). This systematic review and meta-analysis aimed to summarise the efficacy and safety of these four biologics in real-world settings. Primary outcomes were nasal polyp score and sino-nasal outcome test-22 score. Secondary outcomes included smell identification test score, loss of smell score, nasal congestion score, overall nasal symptom score, treatment response, and adverse events (AEs) prompting discontinuation. Efficacy outcomes at 4, 6, 12, and over 12 months were summarised, and meta-analyses of mean changes from baseline were conducted. Sixty-four RWSs involving 3921 patients were included. Significant improvements in clinical outcomes were observed at most follow-up time points, with dupilumab showing particularly notable effects. The efficacy observed in these RWSs was superior to that demonstrated in phase 3 RCTs. All biologics exhibited low discontinuation rates due to AEs. Overall, biologic treatments for CRSwNP in real-world settings demonstrate strong efficacy and good safety. However, the limitations in current RWSs highlight the need for long-term, high-quality multicentre prospective studies and comprehensive healthcare database analyses.

Does supplementation with pine bark extract improve cardiometabolic risk factors? A systematic review and meta-analysis

BACKGROUND

Supplementation with pine bark extract (PBE) may improve risk factors associated with cardiometabolic syndrome (CMS). The effects of PBE supplementation on cardiometabolic risk factors were evaluated in this systematic review and meta-analysis of randomized controlled trials (RCTs).

METHODS

A comprehensive search of various databases was performed to identify relevant RCTs published up to September 2024. A random-effects model was employed for the meta-analysis, which included 27 RCTs with 1,685 participants.

RESULTS

The findings indicated that PBE supplementation significantly reduced systolic blood pressure (SBP) (weighted mean difference (WMD): -2.26 mmHg, 95% confidence interval (CI): -3.73, -0.79; P = 0.003), diastolic blood pressure (DBP) (WMD: -2.62 mmHg, 95% CI: -3.71, -1.53; P < 0.001), fasting blood sugar (FBS) (WMD: -6.25 mg/dL, 95% CI: -9.97, -2.53; P = 0.001), hemoglobin A1c (HbA1c) (WMD: -0.32%, 95% CI: -0.54, -0.11; P = 0.003), body weight (WMD: -1.37 kg, 95% CI: -1.86, -0.88; P < 0.001), and low-density lipoprotein (LDL) cholesterol (WMD: -5.07 mg/dL, 95% CI: -9.21, -0.94; P = 0.016) in the PBE-treated group compared to their untreated counterparts. However, no significant impact of PBE was observed on waist-to-hip ratio (WHR), body mass index (BMI), waist circumference (WC), or serum levels of insulin, high-density lipoprotein (HDL) cholesterol, triglycerides (TG), and total cholesterol (TC).

CONCLUSIONS

Supplementation with PBE may ameliorate specific cardiometabolic risk factors, as indicated by reductions in body weight, DBP, SBP, FBS, LDL, and HbA1c levels. This approach can be regarded as an adjunct therapeutic strategy for CMS management. Further high-quality trials with larger sample sizes and longer durations are required to validate these findings.

Polywave LEDs increase the degree of conversion of composite resins, but not adhesive systems: a systematic review and meta-analysis of in vitro studies

This study aimed to systematically review the literature for laboratory studies that evaluated the influence of mono- and polywave light-emitting diode (LED) devices on the degree of conversion (DC) of composite resins and adhesive systems. A search of three electronic databases (PubMed, Web of Science, Scopus) and using Google Scholar was conducted through June 2024 to identify eligible studies that compared monowave and polywave LED devices on the DC of composite resins and adhesive systems. Studies that evaluated DC using indirect methods, material other than composite resin and adhesive system, and missing DC values as mean and standard deviation were excluded. Meta-analysis was performed at a significance level of ≤ 0.05 comparing DC values (mean and standard deviation) produced by LEDs. Heterogeneity was quantified using I2 values. 79 potentially relevant studies were identified from online databases, 27 were selected for full-text assessment, and 22 were included in this systematic review. Eighteen of the included studies had a high risk of bias and four had a moderate risk of bias. Polywave LEDs significantly improved the DC of composite resins (p ≤ 0.5) and did not affect on adhesive systems (p = 0.18). Despite the high risk of bias and the heterogeneity of the included studies, the available evidence may support the conclusion that polywave LED devices improve the DC of composite resins. Monowave or polywave LED devices did not affect the DC of adhesive systems.

Suicide attempt and its determinants among adolescents and youth in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Suicide is a critical public health concern globally, and adolescents and youth are particularly vulnerable. In Ethiopia, suicide attempts among this population are alarmingly prevalent, yet the magnitude and determinants remain insufficiently understood. A systematic review and meta-analysis are essential to comprehensively synthesize the evidence and guide targeted interventions. This review aims to establish a pooled prevalence and identify factors associated with suicide attempts among adolescents and youth aged 10-24 years in Ethiopia.

METHODS

A systematic literature search was conducted using PubMed, Scopus, Web of Science, African Journal Online (AJOL), and Google Scholar. The quality of each original study was assessed with a modified Joanna Briggs Institute (JBI) tool tailored for cross-sectional research. The Cochrane Q and I² test statistics were used to assess heterogeneity across studies. A random effects model was employed to calculate the pooled estimate of suicide attempts among adolescents and youth.

RESULTS

The pooled estimate of suicide attempts among Ethiopian adolescents and youth covering the age range from 10 to 24 years was 12.38% (95% CI: 8.72, 16.05). Key associated factors included being female (POR = 2.31; 95% CI: 1.44, 3.71), poor social support (POR = 3.44; 95% CI: 1.89, 6.23), a family history of suicide attempts (POR = 5.67; 95% CI: 3.98, 8.08), and disappointing school results (POR = 3.16; 95% CI: 2.33, 4.28).

CONCLUSION

The study reveals that nearly one in eight adolescents and youth in Ethiopia have experienced a suicide attempt. Being female, experiencing poor social support, having disappointing academic results, and having a family history of suicide attempts are significant risk factors. The Federal Ministry of Health (FMOH), policymakers, and stakeholders should prioritize mental health initiatives aimed at prevention, establishing school support systems, raising community awareness, and providing family counseling services.

CLINICAL TRIAL NUMBER

Not applicable.

Physiological adaptations and performance enhancement with combined blood flow restricted and interval training: A systematic review with meta-analysis

OBJECTIVES

We aimed to determine: (a) the chronic effects of interval training (IT) combined with blood flow restriction (BFR) on physiological adaptations (aerobic/anaerobic capacity and muscle responses) and performance enhancement (endurance and sprints), and (b) the influence of participant characteristics and intervention protocols on these effects.

METHODS

Searches were conducted in PubMed, Web of Science (Core Collection), Cochrane Library (Embase, ClinicalTrials.gov, and International Clinical Trials Registry Platform), and Chinese National Knowledge Infrastructure on April 2, with updates on October 17, 2024. Pooled effects for each outcome were summarized using Hedge's g (g) through meta-analysis-based random effects models, and subgroup and regression analyses were used to explore moderators.

RESULTS

A total of 24 studies with 621 participants were included. IT combined with BFR (IT+BFR) significantly improved maximal oxygen uptake (VO2max) (g = 0.63, I2 = 63%), mean power during the Wingate 30-s test (g = 0.70, I2 = 47%), muscle strength (g = 0.88, I2 = 64%), muscle endurance (g = 0.43, I2 = 0%), time to fatigue (g = 1.26, I2 = 86%), and maximal aerobic speed (g = 0.74, I2 = 0%) compared to IT alone. Subgroup analysis indicated that participant characteristics including training status, IT intensity, and IT modes significantly moderated VO2max (subgroup differences: p < 0.05). Specifically, IT+BFR showed significantly superior improvements in VO2max compared to IT alone in trained individuals (g = 0.76) at supra-maximal intensity (g = 1.29) and moderate intensity (g = 1.08) as well as in walking (g = 1.64) and running (g = 0.63) modes. Meta-regression analysis showed cuff width (β = 0.14) was significantly associated with VO2max change, identifying 8.23 cm as the minimum threshold required for significant improvement. Subgroup analyses regarding muscle strength did not reveal any significant moderators.

CONCLUSION

IT+BFR enhances physiological adaptations and optimizes aspects of endurance performance, with moderators including training status, IT protocol (intensity, mode, and type), and cuff width. This intervention addresses various IT-related challenges and provides tailored protocols and benefits for diverse populations.

Assessing the impact of telehealth on blood glucose management among patients with diabetes: a systematic review and meta-analysis of randomized controlled trials

INTRODUCTION

The increasing prevalence of diabetes mellites (DM), especially type 2 diabetes mellitus, presents significant challenges for healthcare systems. Effective blood glucose management is essential for preventing serious complications, and telehealth offers a promising approach to improve patient engagement and adherence. The effectiveness of telehealth on blood glucose management should be investigated. The evaluated metric for diabetes management plans in this study was the change in blood glucose levels, specifically HbA1c, as an indicator of glycemic control. The impact of telehealth interventions on these outcomes was analyzed across various patient groups. This review conducts a comprehensive analysis of the current literature to offer insights that can guide clinical practices and inform policymakers about the advantages of telehealth in managing diabetes.

METHODS

In this study, several evidence-based databases and relevant clinical trial registries were searched to evaluate the effects of telehealth on blood glucose management among patients with diabetes. The included studies were randomized controlled trials that compared telehealth with traditional in-person management. Microsoft Excel was used to extract and sort the data before it was exported to STATA/MP 17.0 for analysis. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Egger's test and Cochrane I2 statistics were used to assess publication bias and heterogeneity, respectively.

RESULT

This review identified six randomized controlled trials (RCTs) involving a total of 3,995 patients, with 2,022 in the telehealth intervention group and 1,973 in the control group, conducted across the USA, Asia, and Europe. The analysis showed a significant improvement in blood glucose control for patients using telehealth, evidenced by a Standard Mean Difference (SMD) of 0.20 (95% CI: 0.10-0.29; p < 0.001), with USA studies reflecting the highest SMD of 0.24 and diabetic veterans showing an even greater SMD of 0.41.

CONCLUSION AND RECOMMENDATIONS

This study demonstrates that telehealth interventions significantly enhance blood glucose management among patients with diabetes. The findings highlight the need for healthcare systems to prioritize telehealth integration into diabetes management protocols while developing tailored interventions to meet the diverse needs of various patient populations.

The effect of health education on symptom severity in patients with fibromyalgia: a systematic review and meta-analysis

Fibromyalgia (FM) is a complex chronic disorder characterized by widespread pain as the primary symptom. To evaluate the effect of health education on the severity of various symptoms in patients with FM, seven databases were searched from inception to August 2024 to identify randomized controlled trials evaluating the effects of health education for FM. The primary outcome was overall symptom severity, and the secondary outcomes were pain, depression, anxiety, sleep quality, fatigue, physical function and self-efficacy. The Cochrane Risk-of-Bias tool for randomized trials and the Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality of the included studies and the certainty of evidence, respectively. Treatment effects were estimated by calculating Hedges' g and the corresponding 95% confidence intervals. Meta-analysis included a total of 13 trials. The results revealed that health education significantly reduced overall symptom severity, depression and anxiety and increased sleep quality and physical function among patients with FM (all P values < 0.05). However, no significant effects were observed on pain, fatigue and self-efficacy. Health education may be a beneficial intervention for FM patients, particularly for mitigating symptom severity. Health-care providers should implement health education interventions to empower patients to effectively manage their symptoms.

Robotic versus laparoscopic heller myotomy for esophageal achalasia: an updated systematic review and meta-analysis

BACKGROUND

The surgical treatment for esophageal achalasia has evolved over the years, with laparoscopic Heller myotomy (LHM) and partial fundoplication becoming widely used worldwide. More recently, an increased interest in the robotic Heller myotomy (RHM) has arisen.

PURPOSE

Compare short-term and functional outcomes of RHM vs. LHM.

METHODS

Systematic review and meta-analysis. PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. Primary outcome was esophageal perforation (EP). Risk ratio (RR), standardized mean difference (SMD), and 95% confidence intervals (95% CI) were effect size and relative inference measures. PROSPERO Registration Number: CRD42024512644.

RESULTS

Fourteen observational studies (12962 patients) were included. Of those, 2503 (19.3%) underwent RHM. The patient age ranged from 34 to 66 years and 51.7% were males. EP occurred in 259 patients (1.99%). The cumulative incidence of EP was 1.67% for RHM and 2.07% for LHM. Compared to LHM, RHM was associated with a reduced risk of EP (RR: 0.31; 95% CI 0.16-0.59). No differences were found in term of dysphagia requiring reoperation or additional endoscopic procedures (RR: 0.47; 95% CI 0.20-1.09) and postoperative Eckardt score (SMD: -0.42; 95% CI -0.94, 0.11). Blood loss, conversion to open, operative time, and hospital length of stay were comparable.

CONCLUSIONS

RHM may be associated with a reduced risk of EP compared to LHM. However, because of selection bias, diverse surgeon expertise, variations in surgical technique, and prior endoscopic procedures these findings should not be viewed as conclusive while the superiority of one approach over the other remains to be established.

Can ChatGPT be used as an education assistant in the field of health sciences? Examining with the integration of meta-analysis and co-citation analysis

Background

Meta-analysis studies are frequently included in the literature, but studies integrated with co-citation analysis are very few. There is no study that evaluates the success of ChatGPT in the field of health sciences, especially by integrating these two methods.

Objective

This study aims to reveal whether ChatGPT can be used as an educational assistant by comparing the performance of students in exams in the field of health sciences with ChatGPT through the integration of meta-analysis and co-citation analysis.

Methods

We searched Web of Science for articles until May 2024. The studies comparing students' exam performances with ChatGPT 3.5 and 4.0 versions in the field of health sciences were included in the meta-analysis. Co-citation analysis was performed for the references of the studies included in the meta-analysis and the relationship between the studies and the references was examined.

Results

It is seen that the exam performance of the students is better than ChatGPT 3.5 (OR = 3.173, 95 % CI (1.132-8.869). In the co-citation analysis, three clusters were obtained. It is seen that the exam performances of ChatGPT 4.0 are better than the students (OR = 2.589, 95 % CI (1.046-6.409). In the co-citation analysis obtained with the references of these four studies, two clusters were identified. The most cited studies, namely Kung et al., Aidan et al., and Hopkins et al., intersect in one cluster.

Conclusion

The results obtained with the integration of meta-analysis and co-citation analysis are agree with the literature for both ChatGPT 3.5 and ChatGPT 4.0. In general, using co-citation analysis and meta-analysis together, increases the depth and scope of the analysis. The results obtained in these analyzes also show that the use of ChatGPT as an educational assistant in the field of health sciences is increasing day by day.

Jouini J, Alsaid B. Cervical arteries tortuosity and its association with dissection: A systematic review and meta-analysis

BACKGROUND

This study investigated the link between arterial tortuosity and cervical artery dissection, focusing on carotid and vertebral tortuosity indices, as well as carotid tortuosity classifications (kinking, looping, and coiling).

METHODS

We searched PubMed, SCOPUS, Web of Science, and Google Scholar from database inception to January 2024. The inclusion criteria encompassed human studies on tortuosity and cervical, carotid, or vertebral artery dissection. Exclusion criteria included case reports, non-English studies, and studies solely on connective tissue disorders and diseases. Quality and risk of bias were assessed using the Newcastle-Ottawa Scale. Random-effects model was employed for mean differences and odds ratios. When meta-analysis was not feasible, we summarized and integrated the results narratively.

RESULTS

Seven studies, involving 507 dissected patients and 582 non-dissected patients, were included. In a meta-analysis of 3 studies, vertebral tortuosity favored the dissection cases [MD = 3.58, 95% CI: 2.21-4.95]. The mean carotid tortuosity difference was not statistically significant in a meta-analysis of 2 studies [MD = 2.27, 95% CI: -0.16-4.70]. In the classification analysis, 2 studies indicated no conclusive association between kinking, coiling, and cervical arteries dissection. Regarding carotid classification and internal carotid artery dissection, meta-analyses only showed a significant association with kinking, but the result was inconclusive.

CONCLUSION

Tortuosity index screenings may help prevent cervical artery dissection among at-risk individuals. However, the association with specific tortuosity classifications remains inconclusive, and further research is needed to validate these findings. Standardized measurement criteria are crucial for future studies.

Sensitivity of the clinical high-risk and familial high-risk approaches for psychotic disorders - a systematic review and meta-analysis

BACKGROUND

Psychosis prediction has been a key focus of psychiatry research for over 20 years. The two dominant approaches to identifying psychosis risk have been the clinical high-risk (CHR) and the familial high-risk (FHR) approaches. To date, the real-world sensitivity of these approaches - that is, the proportion of all future psychotic disorders in the population that they identify - has not been systematically reviewed.

METHODS

We systematically reviewed and meta-analysed studies in MEDLINE, Embase, PsychINFO, and Web of Science (from inception until September 2024) that reported data on the sensitivity of CHR and FHR approaches - i.e., individuals with a psychosis diagnosis preceded by a CHR diagnosis or a history of parental psychosis (PROSPERO: CRD42024542268).

RESULTS

We identified four CHR studies and four FHR studies reporting relevant data. The pooled estimate of the sensitivity of the CHR approach was 6.7% (95% CI: 1.5-15.0%) and of the FHR approach was 6.5% (95% CI: 4.4-8.9%). There was a high level of heterogeneity between studies. Most FHR studies had a low risk of bias, but most CHR studies had a high risk of bias.

CONCLUSION

Pooled data suggest that CHR and FHR approaches, each, capture only about 6-7% of future psychotic disorders. These findings demonstrate the need for additional approaches to identify risk for psychosis.

Kidney dysfunction and associated factors among adults living with human immuno-deficiency virus in Africa: a systematic review and meta-analysis

BACKGROUND

Kidney dysfunction among adults living with Human Immuno-Deficiency Virus (HIV) increases the risk of drug-related side effects, acute kidney injury, hospitalization, and progression to end-stage kidney disease. In developing regions like Africa, where access to kidney transplants and dialysis is limited, early detection of kidney disease among adults living with HIV has significant clinical and financial implications. Therefore, the objective of this review was to determine the pooled prevalence and identify associated factors of kidney dysfunction among adults living with HIV in Africa.

METHODS

The report was presented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses checklists. The articles were searched using PubMed/MEDLINE, EMBASE, Scopus, Wiley Online Library, CINAHL/EBSCO, OVID/Wolters Kluwer, Cochrane Library, Google Scholar, Science Direct, and African Journal Online. Data were extracted using Microsoft Excel and exported to STATA MP Version 11 Software for analysis. Heterogeneity of studies was assessed by Cochran's Q test and I2 statistics. Publication bias was detected by the visual inspection of the funnel plot and statistical Egger's test.

RESULTS

In this study, the pooled prevalence of kidney dysfunction among adults living with HIV in Africa is estimated to be 16.85% (95% CI: 13.08 - 20.62, I²=96.2%, p-value = 0.000). Female sex (POR = 1.82; 95% CI; 1.31, 2.53), age ≥ 50 years (POR = 8.94; 95% CI: 1.82, 43.93), body mass index ≥ 30 kg/m² (POR = 4.70; 95% CI: 3.07, 7.22), diabetes mellitus (POR = 2.84; 95% CI: 1.59, 5.07), CD4 count < 200 cells/mm³ (POR = 3.64; 95% CI: 1.63, 8.13) and anemia (POR = 3.73, 95% CI = 2.00-6.94) were factors associated with kidney dysfunction among adults living with HIV.

CONCLUSIONS

This study revealed that the pooled prevalence of kidney dysfunction among adults living with HIV in Africa remains significant. Female sex, age ≥ 50 years, body mass index ≥ 30 kg/m², diabetes mellitus, CD4 count < 200 cells/mm³ and anemia were factors associated with kidney dysfunction. To reduce the morbidity and mortality associated with kidney dysfunction, it is advisable to create awareness and initiating early interventions through health education during their follow-up time, and initiating suitable medication at an early stage.

Can physical and psychological factors predict pain recurrence or an exacerbation of persistent non-specific low back pain? A protocol for a systematic review and meta-analysis

INTRODUCTION

Low back pain (LBP) is a global health concern. Approximately two-thirds of those who recover from LBP experience a relapse within a year, with many chronic cases encountering acute flare-ups (exacerbation). This systematic review will synthesise and analyse whether physical and/or psychological features can predict recurrent episodes of LBP or exacerbation of pain.

METHODS AND ANALYSIS

This systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. Comprehensive literature searches will be conducted in MEDLINE, EMBASE, APA PsycInfo, PubMed, CINAHL Plus, Web of Science, Scopus and ZETOC, spanning from each database's inception through to January 2025. Google Scholar and grey literature sources, including OpenGrey, will also be searched to ensure comprehensive coverage. Two independent reviewers will screen titles, abstracts and full texts, assessing the risk of bias with a modified Quality in Prognosis Studies tool. The overall certainty of evidence will be evaluated using an adapted Grading of Recommendations Assessment, Development and Evaluation approach. If sufficient data homogeneity is present, a meta-analysis will be performed; otherwise, findings will be synthesised narratively. The results will identify the ability of physical and/or psychological factors to predict pain recurrence or acute exacerbation in case of persistent non-specific LBP.

ETHICS AND DISSEMINATION

This study protocol does not present any ethical concerns. The findings from the systematic review will be submitted for publication in a peer-reviewed journal and will also be presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42024599514.

Meta-analysis examining the association between low platelet monoamine oxidase levels and Zuckerman's sensation seeking scale in a sex dependent manner

Monoamine oxidase (MAO) is an enzyme in the brain responsible for breaking down neurotransmitters. MAO levels can be measured in humans by collecting blood platelets. Low platelet MAO levels in healthy individuals are associated with personality differences, such as increases in sensation seeking. In this meta-analysis, we investigated the association between low platelet MAO activity and sensation seeking behavior, as measured by Zuckerman's Sensation Seeking Scale (SSS). To identify studies to include in this meta-analysis, a preliminary database was produced by searching PsycInfo, Medline, PubMed, ProQuest, and ScienceDirect, from the time period of January 01, 1970 through August 01, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for study inclusion. Fourteen studies with a total of 24 correlations and 1,470 participants were included in the analyses. Across 24 independent effect sizes, the correlations ranged from -0.74 to 0.40. The Random Effects Model (REM) yielded a weighted average correlation of -0.22 (95% CI = -0.31, -0.13), indicating an inverse relationship where lower levels of MAO tend to be associated with higher levels of SSS. A subgroup analysis was used to examine the effects of gender. The REM yielded a weighted average correlation of -0.22 (95% CI = -0.33, -0.10) for the effect sizes of males, -0.22 (95% CI = -0.47, 0.06) for the effect sizes of females, and -0.23 (95% CI = -0.38, -0.06) for the effect sizes that included both males and females. The subgroup analysis did not reveal differences between males and females on the association between human blood platelet MAO levels and SSS. Our hypothesis that there is a negative association between MAO levels and SSS was supported. These findings have potential clinical implications suggesting that MAO platelet concentrations could be used as a potential biomarker for identifying maladaptive behaviors.

Apical periodontitis in inflammatory bowel disease: a meta-analysis at patient and tooth level

Apical periodontitis (AP) is the local inflammation of periapical tissues originating from the dental pulp disease. Cumulative evidence suggests a link between oral and gastro-intestinal systems in both health and disease. In this context, the relationship between AP and inflammatory bowel diseases (IBDs) has not yet been elucidated. The aims of this systematic review and meta-analysis were to describe the prevalence of AP in patients with IBDs and evaluate the potential association between AP and IBDs. Electronic (Embase, PubMed, Scopus, Web of Science) and manual literature searches were conducted from inception to 31 October, 2023 (updated in August, 2024). Strict inclusion criteria were applied to identify observational and experimental clinical studies on AP in IBDs patients. The bias risk was assessed using the Joanna Briggs Institute critical appraisal tools and a biases' report selected from the Oxford Centre for Evidence Based Medicine Catalogue of Bias. A meta-analysis was performed to determine the pooled prevalence and risk of AP at individual and tooth level and the quality of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The search strategy identified 82 articles with 5 studies included (657 subjects, 7,142 teeth). The overall proportion of AP was 58% at patient level (95% CI = 37%-78%, I 2 = 95.3%) and 7% at tooth level (95% CI = 2%-15%; I 2 = 99.2%). AP was prevalent in IBDs subjects than in healthy controls, both at patient and tooth level. The pooled OR was 1.57 (95% CI = 1.04-2.35; P = 0.038; I 2 = 20%) at patient level, and 1.91 (95% CI = 1.16-3.15; P = 0.011; I 2 = 82%) at tooth level. A potential association between AP and IBDs is plausible, although the quality evidence was low to very low. Longitudinal and experimental studies should be conducted to better understand the relationship between these two conditions and explore any potential causative factors.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=411038, PROSPERO (CRD42023411038).

Explore the possible influence of Sjogren's syndrome on thyroid cancer: A literature data mining and meta-analysis

OBJECTIVES

To explore the potential influence of Sjogren's syndrome (SS) on thyroid cancer (TC).

METHODS

First, a literature data mining (LDM) approach was used to reconstruct functional pathways connecting SS and TC. A meta-analysis was then performed to examine the expression changes of genes mediated by SS using 16 TC case/control expression datasets, with results validated through the TCGA/GTEx dataset. Finally, gene set enrichment analysis (GSEA) and survival analysis using GEPIA2 were conducted on the significant genes.

RESULTS

Our findings indicate that SS may increase the risk of TC by activating 14 TC promoters (PDCD1, NTRK1, LGALS3, CD274, FOXP3, BCL2, CYP1A1, HMGB1, TGFB1, CCL2, PLA2G7, TFF3, LCN2, and CLDN1) and suppressing three TC inhibitors (MIR145, MIR30C1, and EP300). Four molecules (PLA2G7, TFF3, LCN2, and CLDN1) exhibited significant expression changes in TC patients (LFC > 1 or < -1; p < 2.07E-04), which were confirmed in TCGA/GTEx expression analysis. These results highlight three possible mechanisms-the SS-PLA2G7-CCL2-TC pathway, the SS-LCN2-LGALS3-TC pathway, and the SS-CLDN1-BCL2-TC pathway-that may explain how SS contributes to TC development. Enrichment analysis suggests that SS may affect TC prognosis by regulating leukocytes and tolerance induction. Survival analysis indicates that SS may enhance TC survival through the regulation of the CLDN1 and EGF pathways.

CONCLUSION

LDM-based pathway analysis highlighted three genetic pathways through which SS may adversely affect TC progression, while SS may enhance TC survival via the CLDN1 and EGF pathways, highlighting the need for further research.

Effects of high-intensity functional training on physical fitness in healthy individuals: a systematic review with meta-analysis

The purpose of this study was to conduct a meta-analysis of the effects of high-intensity functional training on the physical fitness of healthy individuals. This system review followed the PRISMA guidelines and has been registered in PROSPERO with the registration number CRD42023475055. As of January 2024, we did a thorough search across five databases: PubMed, Scopus, Web of Science, EBSCOhost, and Cochrane Library. We evaluated the methodological quality of the included study by TEST EX tool and ROB 2 tool. GRADE framework determines the level of certainty of evidence. Meta-analysis of random effects model calculations. 19 high-quality studies were included in this review, involving 911 healthy individuals. Positive effects were observed in improving strength (ES = 1.380; p < 0.001), power (ES = 1.320; p < 0.001), speed (ES = 3.093; p < 0.001), endurance (ES = 1.802; p < 0.001), and agility (ES = 2.086; p < 0.001). However, flexibility performance had no significant effect (ES = 0.640; p = 0.092), which may be attributed to limited articles. Therefore, it is necessary to expand high-quality research to explore the impact of HIFT on the physical fitness in healthy individuals.

Prevalence of fatigue and perceived fatigability in older adults: a systematic review and meta-analysis

Fatigue is a common health complaint in older adults, but its prevalence varies widely among studies due to differences in populations and assessment tools. The objective of this review is to systematically evaluate the prevalence of fatigue and perceived fatigability in older adults with PRISMA 2020. Four databases-PubMed, Embase, Web of Science (WoS), and Cochrane Library-were systematically searched as of December 27, 2023. Cochrane Q tests and the I2 statistic were used using Stata16.0 to assess between-study heterogeneity. A total of 21 studies involving 17843 participants were included in this study. The prevalence of fatigue in older adults was 42.6%, and the prevalence of perceived physical fatigability and mental fatigability was 58.2% and 24.0%. Meta-analysis showed that the prevalence of perceived physical fatigability among older adults was very high. This prevalence varied with regional economic development level, age of the subjects, sample size, and representativeness of the subjects. Fatigue is a health dilemma faced by most older adults. To improve quality of life, early and regular fatigue assessment should be part of routine health screening for older adults.

Chronic kidney disease among people living with HIV on TDF based regimen: A systematic review and meta-analysis

INTRODUCTION

Chronic kidney disease is a major public health concern among people living with human immunodeficiency virus (PLWHIV) who are taking tenofovir disoproxil fumarate-based regimen. Despite the available evidence showing a high prevalence of CKD in this population, comprehensive pooled estimate of CKD among PLWHIV receiving TDF based regimen across the globe is lacking. Hence, the present systematic review aimed to provide a global pooled prevalence estimate of CKD.

METHOD

We conducted a systematic review of literatures published between January 2000 and May 2024. Articles and grey literature were searched from the following databases and search engine: PubMed, EMBASE, Scopus, Web of science, The Cumulative Index to Nursing and Allied Health Literature (CINHAL), and Google Scholar. We included eligible studies that report magnitude of CKD in TDF based regimen. We executed the pooled CKD, subgroup analysis, and funnel plot using random effect model. All statistical analysis including sensitivity analysis were made using Stata 17 software.

RESULTS

Sixty-nine studies with 88299 participants included in this meta-analysis. The pooled prevalence of CKD was 7% (95% CI:6-8). CD4 count less than 200 copies per milliliter, and being female were associated with CKD.

CONCLUSION

We concluded that the magnitude of CKD across the globe is high in people living with HIV who have received TDF based regimen. Early identification of CKD by considering regular renal function monitoring, and risk factors especially low CD4 count, and female gender at birth are essential.

TRIAL REGISTRATION

The protocol has been prospectively registered with PROSPERO ((CRD42020136813).