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

The Benefit of Short-Term Androgen Deprivation Therapy with Radiation Therapy for Intermediate-Risk Prostate Cancer

PURPOSE

A previous, individual patient-level meta-analysis of randomized controlled trials (RCTs) demonstrated the overall survival (OS) benefit of short-term androgen deprivation therapy (ST-ADT) when delivered with radiation therapy (RT) for the subset of patients with intermediate-risk prostate cancer (IR-PCa). However, because of inclusion criteria, several studies such as NRG/RTOG 0815, GETUG-14, and DFCI 95-096 were excluded. Thus, we conducted the present analysis, inclusive of all studies to define the current role of ST-ADT in IR-PCa.

METHODS AND MATERIALS

A systematic review was conducted of phase 3 RCTs published or presented between January 1980 and October 2024 which profiled the comparative efficacy of radiation therapy ± ST-ADT in patients with IR-PCa. A study-level, random-effects meta-analysis was performed. The primary endpoint of this meta-analysis was OS, with secondary endpoints of time-to-biochemical failure (BF) ± biochemical-progress-free survival (bPFS). Meta-regression was used to explore trial-level factors associated with treatment effects. Synthetic individual patient-level OS data were pooled for confirmation and used to estimate the relative and absolute survival benefit.

RESULTS

Seven RCTs (NRG/RTOG 9408, DFCI 95-096, TROG 96.01, PCS III, EORTC 22991, NRG/RTOG 0815, and GETUG-14) reporting outcomes of 6179 patients were identified. The pooled hazard ratios (HRs) for HROS, HRBF, and HRBF+bPFS were 0.88 (95% confidence interval [CI], 0.79-0.97; P = .01), 0.50 (95% CI, 0.37-0.68; P < .001), and 0.54 (95% CI, 0.46-0.65; P < .001), respectively. ST-ADT duration, RT dose, and Gleason score trial population composition were each associated with an increased benefit of ST-ADT for biochemical disease control (all P < .05) but not for OS (all P > .05). Pooling of simulated, patient-level data confirmed the presence of a survival benefit (HROS, 0.85 [95% CI, 0.76-0.96], log-rank P = .021), corresponding to an absolute survival benefit of 5% benefit at 10 years.

CONCLUSIONS

The present analysis confirms current knowledge that ST-ADT improves both OS and prostate-specific antigen-based outcomes for unselected patients with IR-PCa to a clinically significant degree.

Prevalence of prolonged transitional neonatal hypoglycemia and associated factors in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Most neonates experience transient hypoglycemia, which typically responds well to treatment and is associated with a favorable prognosis. However, hypoglycemia persisting beyond 48 hours, termed prolonged transitional Neonatal hypoglycemia (PTNHG), can result in abrupt neuronal injury and long-term neurodevelopmental impairments. Identifying its prevalence and associated risk factors is critical to inform clinical practices and improve neonatal outcomes.

METHODS

A weighted inverse-variance random-effects model was employed for the analysis. Heterogeneity among the studies was assessed using a forest plot, I2 statistics, and Egger's test. Data extraction was conducted from May 20 to May 27, 2023, for studies published since 2020. A random blood sugar (RBS) concentration of <47 mg/dL measured 48-72 hours after birth was used to define PTNHG. Eight studies comprising a total of 3686 neonates were included in the analysis.

RESULTS

The pooled prevalence of PTNHG was 19.71% (95% CI: 16.85-22.56) with substantial heterogeneity (I2 = 79.20%, P < 0.001). Subgroup analysis revealed that PTNHG prevalence was similar for studies with sample sizes >400 and ≤400, at 18% (95% CI: 15-22) and 21% (95% CI: 17-26), respectively. Similarly, prevalence estimates were comparable when using RBS thresholds of <47 mg/dL (21%; 95% CI: 16-27) and <40 mg/dL (18%; 95% CI: 15-22). Significant factors associated with PTNHG included preterm birth (AOR = 3.31; 95% CI: 2.57-4.04), hypothermia (AOR = 3.41; 95% CI: 2.19-4.62), being an infant of a diabetic mother (IDM) (AOR = 4.71; 95% CI: 2.15-7.26), delayed breastfeeding initiation beyond one hour (AOR = 3.26; 95% CI: 2.03-4.49), and pathological jaundice (AOR = 2.37; 95% CI: 1.91-2.84).

CONCLUSIONS

Nearly one-fifth of hospitalized neonates experienced PTNHG. Fortunately, most of the associated risk factors were modifiable. Prioritizing early breastfeeding initiation, particularly in cesarean section deliveries and IDM cases, and integrating PTNHG management into national NICU guidelines could significantly reduce the burden of neonatal hypoglycemia.

TRIAL REGISTRATION

Prospero ID: CRD42023424953. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023424953.

Key prognostic risk factors linked to poor functional outcomes in cerebral venous sinus thrombosis: a systematic review and meta-analysis

BACKGROUND

Cerebral venous sinus thrombosis is a rare stroke with several clinical manifestations. Several studies have identified prognostic risk factors associated with poor functional outcomes and established predictive models. This systematic review and meta-analysis assessed the overall effect size of all prognostic risk factors.

METHODS

A systematic review was conducted to explore all prognostic risk factors in studies published from the initial to June 2024 among 5 Databases included PubMed / Medline, Scopus, EBSCOhost, Web of Science, and Cochran Library. The quality of the methodology was analyzed using the Newcastle-Ottawa Scale. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 29.

RESULTS

Sixty-four studies involving 18,958 participants with a mean age of 38.46 years and females 63.03% were included in the quantitative meta-analysis. Functional outcomes were primarily measured using the Modified Rankin Scale (mRS), with scores ≥ 2 or ≥ 3 indicating poor outcomes in 35.00% and 60.00% of studies, respectively. For general information, age (InOR = 0.98, 95% CI 0.53-1.43), intracranial hemorrhage (OR = 3.79, 95% CI 2.77-5.20), and ischemic infarction (OR = 3.18, 95% CI 2.40-4.23) were associated with poor functional outcomes. For general and neurological symptoms, headache (OR = 0.22, 95% CI 0.17-0.29), seizure (OR = 2.74, 95% CI 1.76-4.27), focal deficit (OR = 4.72, 95% CI 3.86-5.78), coma (OR = 11.60, 95% CI 6.12-21.98), and consciousness alteration (OR = 7.07, 95% CI 4.15-12.04) were outstanding factors. The blood biomarkers of NLR (log OR = 1.72, 95% CI 0.96-2.47), lymphocytes (Cohen's d = -0.63, 95 CI -0.78--0.47), and D-dimer (lnOR = 1.34, 95% CI 0.87-1.80) were the three most frequently reported factors. Parenchymal lesion (OR = 4.71, 95% CI 1.12-19.84) and deep cerebral venous thrombosis (OR = 6.30, 95% CI 2.92-13.63) in radiological images were two frequently reported factors. CVST patients with cancer (OR = 3.87, 95% CI 2.95-5.07) or high blood glucose levels (OR = 3.52, 95% CI 1.61-7.68) were associated with poor functional outcomes. In the meta-regression analysis, ischemic infarction (P = 0.032), consciousness alteration (P < 0.001), and NLR (P = 0.015) were associated with mRS prediction.

CONCLUSIONS

Pooled effect sizes revealed that ischemic infarction, headache, neurological focal deficit, lymphopenia, and cancer were significantly associated with poor functional outcomes, with low to moderate heterogeneity. Consciousness alterations/deterioration and deep cerebral venous thrombosis were also significant prognostic factors, albeit with substantial heterogeneity. The meta-regression analysis showed that the effect sizes of consciousness alterations/deterioration and NLR increased with worsening mRS scores. Other notable risk factors included age, intracranial hemorrhage, seizures, coma, D-dimer, parenchymal lesions, and hyperglycemia. This systematic review provides a comprehensive overview of the prognostic risk factors for poor functional outcomes in patients undergoing CVST, which can guide clinical decision-making and future research.

TRIAL REGISTRATION

This systematic review and meta-analysis has been registered with INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols), and the registration number is INPLASY202480072. The registration period is 14 August 2024.

Thyroid function abnormalities in individuals with sickle cell disease: a meta-analysis

BACKGROUND

There has been an increasing comprehension and recognition of endocrine dysfunction among both pediatric and adult patients with sickle cell disease (SCD). Thyroid disorders can have significant clinical consequences, including growth retardation and impaired cognitive function. However, there is a disparity in the available data concerning the magnitude and spectrum of thyroid abnormalities in this population. This review aimed to provide a systematic summary and analyses on the status of thyroid function abnormalities in individuals with SCD.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive search was conducted across Medline/PubMed, Google Scholar, World Health Organization Virtual Health Library Regional Portal, and ScienceDirect. Pooled prevalence and standardized mean difference (SMD) estimates with 95% confidence intervals (CIs) were calculated using Comprehensive Meta-Analysis Software version 3.3.

RESULTS

Nineteen studies met the inclusion criteria and were incorporated into the analyses. Serum thyroid-stimulating hormone (TSH) levels were significantly higher in SCD patients compared to controls (SMD = 1.184; 95% CI, 0.269-2.099; p = 0.011). While non-significant, there was a trend towards lower levels of triiodothyronine (T3), thyroxin (T4), free T3, and free T4 in the SCD group (T3: SMD = -1.746; 95% CI, -3.561-0.070; p = 0.059; T4: SMD = -1.365; 95% CI, -3.030-0.300; p = 0.108; free T3: SMD = -0.384; 95% CI, -1.128-0.356; p = 0.311; free T4: SMD = -1.205; 95% CI, -2.522-0.111; p = 0.073). The pooled prevalence of hypothyroidism and subclinical hypothyroidism among SCD patients was found to be 4.9% and 8.7%, respectively.

CONCLUSION

Individuals with SCD exhibit a tendency towards elevated TSH levels compared to the general population, with a subset potentially developing thyroid abnormalities, particularly subclinical hypothyroidism. Although not highly prevalent in the SCD population, monitoring thyroid function remains essential due to the potential for progression to overt hypothyroidism and its associated adverse health outcomes.

Self-compassion and psychological distress in chronic illness: A meta-analysis

OBJECTIVES

Self-compassion is a positive psychological factor linked to improved physical and psychological outcomes across different chronic illness populations. However, the extent to which self-compassion contributes to reduced distress across different conditions or as a function of participant factors is not clear. The current meta-analysis aimed to quantify the association between self-compassion and psychological distress in different chronic illness populations and evaluate the factors that moderate this association.

METHODS

A systematic search of three electronic databases identified research reporting associations between self-compassion and psychological distress in chronic illness. A random effects meta-analysis was conducted to evaluate the association between self-compassion and psychological distress. Moderator analyses were conducted for sample characteristics and distress types. A bespoke tool evaluated study quality.

RESULTS

Searches yielded 51 eligible studies with 57 effect sizes. Meta-analysis revealed that self-compassion was negatively associated with psychological distress (r = -.516; 95% CIs [-.55, -.48]; p = .000). Moderator analyses were significant for distress type and chronic illness group, with effects being largest for stress and neurological conditions. Effects did not vary by sex, age or illness duration.

CONCLUSIONS

Findings from this first comprehensive investigation of the link between self-compassion and distress in chronic illness highlight the protective role of self-compassion for chronic illness populations. These results lay the foundation for further research into understanding the processes that link self-compassion to lower psychological distress, and that examine the effectiveness of self-compassion interventions in chronic illness populations, to further advance knowledge and inform practice in this area.

Comparative efficacy, safety, and DMSO compatibility of detachable vs. non-detachable tip microcatheters in neurointerventional procedures: A systematic review and meta-analysis

BACKGROUND

The evolution of embolic agents necessitates the use of microcatheters compatible with dimethyl sulfoxide (DMSO), with detachable tip microcatheters (DTMs) emerging as a significant innovation aimed at reducing the risk of catheter entrapment in embolization procedures. This study aims to compare the efficacy, safety, and DMSO compatibility of DTMs with non-detachable tip microcatheters (Non-DTMs) in the context of embolization treatments for neurovascular diseases.

METHOD

Following PRISMA guidelines, a systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science databases until February 25, 2024. Primary outcomes included technical success and microcatheter-related complications, with a meta-analysis performed using a random-effects model to calculate proportions and odds ratios (OR) with 95 % confidence intervals (Cl).

RESULTS

Forty-five studies involving 2185 patients and 3758 catheters (995 DTMs and 2763 Non-DTMs) were analyzed. Our analysis revealed that DTMs were associated with comparable rates of technical success (98.3 % vs. 97.6 %, p = 0.68), favorable outcomes (93.9 % vs. 93.6 %, p = 0.89), and microcatheter-related complications compared to Non-DTMs. Specifically, DTMs showed a 0.0 % rate of microcatheter entrapment and hemorrhagic complications. Intended detachment was achieved in 41.7 % (95 % CI = 27.02-57.98) of cases and premature detachment was rare (0.1 %; 95 % %CI = 0.00-1.23). In the analysis of comparative studies, microcatheter-related complications did not defer between DTM and Non-DTM groups.

CONCLUSION

Our study demonstrates the safety and efficacy of DTMs in embolization treatments, emphasizing their compatibility with DMSO-based embolic agents and their potential to enhance patient outcomes in neurointerventional procedures. Future research should focus on well-designed, larger, prospective, comparative multi-center studies to strengthen the evidence base and further optimize the use of DTMs in endovascular interventions.

Influence of delayed milk ejection on mammary gland health and milking performance in dairy cows: A systematic review and meta-analysis

Delayed milk ejection (DME) could compromise udder health and milking performance. The objectives of this systematic review and meta-analysis were to (i) explore the current evidence, assess the risk of bias, and identify the knowledge gaps in published studies that investigated the effect of DME on udder health and milking performance in dairy cows, and (ii) quantify the magnitude of the difference in milk yield per milking session (MY), milking duration (MD), and peak milk flow rate (PFR) between cows with and without DME. We performed the current systematic review and meta-analysis according to PRISMA 2020 statement. We tracked the pertinent peer-reviewed publications from PubMed using the following syntax (delayed milk ejection OR disturbed milk ejection OR bimodal milk flow OR bimodality) AND (bovine OR cattle OR cows), and additional relevant studies from the identified articles' reference lists. We calculated the pooled-mean difference in MY (kg), MD (seconds), and PFR (kg/min) between cows with and without DME using the random-effects models. The selection process identified 15 studies as the final number of studies qualified for review, including six interventional and nine observational studies published between 1980 and 2023 conducted in seven countries, including the USA, Germany, Italy, Switzerland, Netherlands, New Zealand, and Portugal. The results indicated that while the DME had a minimal influence on the udder health, it can reduce MY by 1.55 kg per milking session (95 % CI = -2.10, -1.00). The observed evidence here suggests that DME can negatively influence the milking profitability.

A systematic literature review of computer vision-based biomechanical models for physical workload estimation

Ergonomic risks, driven by strenuous physical demands in complex work settings, are prevalent across industries. Addressing these challenges through detailed assessment and effective interventions enhances safety and employee well-being. Proper and timely measurement of physical workloads is the initial step towards holistic ergonomic control. This study comprehensively explores existing computer vision-based biomechanical analysis methods for workload assessment, assessing their performance against traditional techniques, and categorising them for easier use. Recent strides in artificial intelligence have revolutionised workload assessment, especially in realistic work settings where conventional methods fall short. However, understanding the accuracy, characteristics, and practicality of computer vision-based methods versus traditional approaches remains limited. To bridge this knowledge gap, a literature review along with a meta-analysis was completed in this study to illuminate model accuracy, advantages, and challenges, offering valuable insights for refined technology implementation in diverse work environments.

The prevalence of hypoxaemia in paediatric and adult patients in health-care facilities in low-income and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Hypoxaemia (low oxygen saturation in blood) is a key predictor of in-hospital mortality, affecting people of all ages with many different conditions. Early detection and treatment of hypoxaemia are critical, but there are few data to quantify hypoxaemia burden outside the child pneumonia population. We aimed to estimate hypoxaemia prevalence for adults and children with acute illness attending health facilities in low-income and middle-income countries (LMICs).

METHODS

We conducted a systematic review and meta-analysis, searching MEDLINE, PubMed, Embase, Cumulated Index in Nursing and Allied Health Literature, Index Medicus, and Google Scholar for studies reporting hypoxaemia prevalence among patients attending health facilities. We included articles with original data on peripheral blood oxygen saturation (SpO2), from an LMIC, published between Jan 1, 1998, and Jan 10, 2023. We included studies in acutely unwell people of any age and with any condition, but excluded those admitted to intensive care units, receiving perioperative care, or attending hospital for preventive or chronic care. We assessed study quality using Joanna Briggs Institute's Checklist for Prevalence Studies. Two reviewers independently conducted title and abstract screening, full-text review, data extraction, and quality assessment, requesting summary data from authors. We reported pooled prevalence of hypoxaemia (typically defined as SpO2 <90%) overall and by condition, using a random-effects meta-analysis model. This study is registered with PROSPERO, CRD42019136622.

FINDINGS

We identified 9173 unique records from searches and included 213 in meta-analyses involving 601 757 participants. The majority of studies were from the World Bank regions of sub-Saharan Africa (108 [51%] of 213) or south Asia (58 [27%]). The pooled prevalence of hypoxaemia among admitted patients was 24·5% (95% CI 19·9-29·4) for neonates (aged 0-28 days), 12·1% (10·0-14·4) for children (aged 1 month-17 years), and 10·8% (4·9-18·7) for adults (aged ≥18 years). Hypoxaemia prevalence was highest in neonatal and primary respiratory conditions but still common in many other conditions. Hypoxaemia was associated with 4·84 (95% CI 4·11-5·69) times higher odds of death than no hypoxaemia.

INTERPRETATION

Hypoxaemia is common across all age groups and a range of primary respiratory and other critical illnesses and is strongly associated with death. These estimates will inform oxygen-related strategies and programmes, and integration of pulse oximetry and oxygen into clinical guidelines, service structures, and strategies for maternal, neonatal, child, adolescent, and adult health.

FUNDING

Bill & Melinda Gates Foundation, the ELMA Foundation, and Unitaid.

Arthroscopic Repair of Bursal-Sided Partial-Thickness Rotator Cuff Tears: Literature Review and Meta-analysis

BACKGROUND

The surgical management of bursal-sided partial-thickness rotator cuff tendon tears is controversial. The 2 methods used are in situ repair (ISR), preserving the contingent of intact articular tendon fiber, or tear completion before repair (TCBR) according to the operating surgeon's usual technique. No study with sufficient power has demonstrated a superior technique.

HYPOTHESIS

The 2 techniques are equivalent in terms of clinical outcome and tendon healing.

STUDY DESIGN

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

METHODS

A systematic review was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations on the PubMed, Embase, and Cochrane Library databases from January 2003 through March 2023. Only articles dealing with Ellman grade 3 bursal-sided tears with a minimum follow-up of 1 year were included. Primary endpoints were American Shoulder and Elbow Surgeons and Constant-Murley scores, pain on a visual analog scale, and retear rate. The secondary endpoint was recovery of active mobility.

RESULTS

Twelve studies were included with overlap of 3, leaving 8 ISR studies (360 patients; mean follow-up, 30 months) and 7 TCBR studies (224 patients; mean follow-up, 51 months) for statistical analysis. No significant clinical differences were found when comparing mean American Shoulder and Elbow Surgeons (92.2 [95% CI, 88.1-96.2] vs 88.9 [95% CI, 85.8-92.0]; P = .21), Constant-Murley (86.3 [95% CI, 81.5-91.0] vs 91.8 [95% CI, 88.1-95.6]; P = .07), and visual analog scale (0.8 [95% CI, 0.2-1.4] vs 1.0 [95% CI, 0.5-1.4]; P = .63) scores in the TCBR and ISR groups, respectively. The retear rate was 6.8% (95% CI, 3.1%-14.3%) in the TCBR group and 9.5% (95% CI, 6.1%-14.3%) in the ISR group (P = .46). Active mobility was also comparable.

CONCLUSION

This meta-analysis suggests that ISR and TCBR provide comparable results in the surgical management of Ellman grade 3 bursal-sided partial-thickness rotator cuff tears.

Evidence-Based Decision Making in Psychological Research: A Network Meta-Analysis

INTRODUCTION

Network meta-analysis (NMA) was introduced in the 1990s as an extension of standard meta-analysis. Since then, it has been utilized in various scientific fields, particularly in medicine, to evaluate the effectiveness of therapies/interventions/treatments applied for specific outcomes. In recent years, NMA, which offers a highly attractive methodology for researchers, clinicians and decision-makers, has gained popularity as a form of evidence synthesis. Recognized as providing the 'highest level of evidence', NMA is also crucial in conducting research in psychology and psychiatry. With advancements in psychology and psychiatry, specific programmes or interventions have been developed and continue to be developed to address particular problem areas. Due to the variety of these treatment methods, there has not yet been a study focusing on the direct comparison of some treatments. Therefore, the aim of this article is to introduce the NMA method and highlight its potential in evidence-based decision-making, particularly in the field of psychopathology. By doing so, it is anticipated that the perspective of clinicians can be broadened in planning appropriate therapies for psychopathologies.

METHODS

The article was written as a comprehensive review using certain keywords.

RESULTS

Consequently, it becomes challenging for decision-makers, clinicians, or researchers to determine the best treatments for a specific outcome. At this point, NMA offers the opportunity to analyze direct and indirect comparisons of various treatments applied in psychology within a single analysis, thus holding great potential for researchers and practitioners. Despite this potential, NMA has not received sufficient attention from researchers in this field.

CONCLUSION

In conclusion, NMA holds significant potential for use in psychology, where many treatment options exist, and its use is encouraged among clinicians and researchers in the field.

The effect of BMI on survival outcome of breast cancer patients: a systematic review and meta-analysis

OBJECTIVE

The main goal of the present research is to explore the potential link of body mass index (BMI) with different survival metrics in breast cancer patients. Our aim is to offer the latest and most thorough meta-analysis, assessing the strength and reliability of the connection that BMI has with prognostic indicators in this disease.

PATIENTS AND METHODS

As of January 2024, we conducted a systematic literature search across PubMed, Embase, Web of Science, and the Cochrane Library databases. Our search aimed to identify studies examining BMI as an exposure factor, with breast cancer patients constituting the study population, and utilizing adjusted hazard ratio (HR) as the data type of interest.

RESULTS

The evidence synthesis incorporated a total of 61 eligible articles involving 201,006 patients. Being underweight posed a risk factor for overall survival (OS) in breast cancer patients compared to normal weight (HR 1.15, 95% CI 0.98-1.35; P = 0.08). Overweight or obesity, in comparison to normal weight, was a risk factor for OS (HR 1.18, 95% CI 1.14-1.23; P < 0.00001), disease-free survival (DFS) (HR 1.11, 95% CI 1.08-1.13; P < 0.00001), relapse-free survival (RFS) (HR 1.14, 95% CI 1.06-1.22; P = 0.03), and breast cancer-specific survival (BCSS) (HR 1.18, 95% CI 1.11-1.26; P < 0.00001), but not for progression-free survival (PFS) (HR 0.91, 95% CI 0.76-1.10; P = 0.33). Notably, in subgroup analyses, overweight patients achieved prolonged PFS (HR 0.80, 95% CI 0.64-0.99; P = 0.04), and compared to the obese population, the overweight cohort exhibited a significant difference in OS (HR 1.11, 95% CI 1.05-1.16; P < 0.00001) and DFS (HR 1.06, 95% CI 1.03-1.10; P = 0.0004), with a considerably stronger association. Furthermore, compared to HER- patients, HER + patients exhibited a greater predictive value for OS (HR 1.23, 95% CI 1.10-1.37; P = 0.0004), RFS (HR 1.30, 95% CI 1.03-1.64; P < 0.00001), and DFS (HR 1.10, 95% CI 1.03-1.17; P = 0.003).

CONCLUSIONS

The results of our meta-analysis reveal a notable association between BMI and various survival measures in breast cancer prognosis. These findings provide a solid basis for predicting breast cancer outcomes and implementing more effective therapeutic approaches.

Technology-Based Interventions for Pain in Children Undergoing Surgery: A Systematic Review and Meta-Analysis

AIM

This systematic review and meta-analysis aimed to evaluate the effect of technology-based interventions on the pain of paediatric surgery patients.

BACKGROUND

Recently, the number of technology-based interventions involving multimodal nonpharmacological methods tailored to pain management in paediatric surgery patients has increased. It is crucial to determine the effectiveness of these interventions.

DESIGN

A systematic review and meta-analysis of randomized controlled trials following Cochrane methods was conducted.

REVIEW METHODS

We performed a literature search in the Web of Science, PubMed, CINAHL, Science Direct, MEDLINE, ProQuest and Cochrane Library databases. Two independent researchers screened the literature using specific keywords and selected randomized controlled trials based on the inclusion and exclusion criteria. Each researcher extracted data and assessed the risk of bias in the randomized controlled trials using the Cochrane bias risk assessment tool.

RESULT

We conducted a meta-analysis on 14 randomized controlled trials included in the study. The results showed that technology-based interventions reduced pain scores in paediatric surgery patients. Cochran's Q test results pointed to a high level of heterogeneity among the randomized controlled trials.

CONCLUSION

A meta-analysis result of 14 randomized controlled trials showed that technology-based interventions are effective methods for reducing pain in paediatric surgery patients.

REGISTRATION NUMBER

CRD42021226666.

Effects of Ramadan intermittent fasting on hormones regulating appetite in healthy individuals: A systematic review and meta-analysis

BACKGROUND AND AIMS

This systematic review and meta-analysis aimed to examine the effect of Ramadan intermittent fasting on appetite-regulating hormones including leptin, ghrelin, insulin, gastrin, glucagon-like peptide-1, peptide YY, and cholecystokinin.

METHODS

We searched the MEDLINE, Embase, Cochrane Library, CINAHL, Google Scholar, and Web of Science databases to identify relevant research on appetite-regulating hormones during Ramadan intermittent fasting, published until the end of March 2024.

RESULTS

Data from 16 eligible studies comprising 664 participants (341, 51.4 % male) with a mean ± standard deviation age of 33.9 ± 10.8 years were included. The meta-analysis included 12 studies with complete leptin data, showing no significant effect of Ramadan intermittent fasting on leptin concentrations (standardised mean difference - SMD = -0.11 μg/mL, 95 % CI: -0.36 to 0.14). Analysis of three studies with complete ghrelin data demonstrated a significant increase in ghrelin concentrations following Ramadan intermittent fasting (SMD = 0.31 pg/mL, 95 % CI: 0.03 to 0.60). Six studies examining insulin concentrations pre- and post-fasting revealed no significant effect on insulin concentrations (SMD = -0.24 μU/mL, 95 % CI: -0.54 to 0.02). Similarly, analysis of three studies with complete gastrin data showed no significant effect of intermittent fasting on gastrin concentrations (SMD = 0.23 pg/mL, 95 % CI: -0.71 to 0.99).

CONCLUSION

Ramadan intermittent fasting significantly increases ghrelin concentrations while showing no significant effects on leptin, insulin, and gastrin. While ghrelin findings were consistent across studies, the high heterogeneity in leptin studies suggests further research to better understand the effects of Ramadan intermittent fasting on appetite-regulating hormones.

Choline in pregnant women: a systematic review and meta-analysis

Context: Choline is a critical nutrient. Inadequate choline intake during pregnancy increases the risk of adverse maternal and offspring health.

OBJECTIVE

A systematic review and meta-analysis were conducted to examine the current recommendations for choline intake by pregnant women, estimate the overall prevalence of pregnant women with adequate choline intake, and explore associations between maternal choline level and adverse pregnancy outcomes (APOs).

METHODS

Choline recommendations for pregnant women were assessed from eight nutrient guidelines of the United States, United Kingdom, Canada, Australia, Asia, International Federation of Gynecology and Obstetrics, and World Health Organization. Data on the prevalence of pregnant women with adequate choline intake and the association between maternal choline level and APOs were collected from 5 databases up to May 2023. Meta-analyses with random effects and subgroup analyses were performed for the pooled estimate of prevalence and association.

RESULTS

Five recent nutrition guidelines from the United States (United States Department of Agriculture), United States (Food and Drug Administration), Canada, Australia, and the International Federation of Gynecology and Obstetrics have emphasized the importance of adequate choline intake for pregnant women. Of 27 publications, 19 articles explored the prevalence and 8 articles explored the association. Meta-analysis of 12 prevalence studies revealed a concerning 11.24% (95% confidence interval, 6.34-17.26) prevalence of pregnant women with adequate choline intake recommendations. A meta-analysis of 6 studies indicated a significant association between high maternal choline levels and a reduced risk of developing APOs, with an odds ratio of 0.51 (95% confidence interval, 0.40-0.65).

CONCLUSION

The existing guidelines highlight the importance of choline in supporting maternal health and fetal development during pregnancy. Furthermore, a high maternal choline level was likely to be associated with a lower risk of APOs. However, 88.76% of pregnant women do not achieve the optimal choline intake. Therefore, specific policies and actions may be necessary to improve choline intake in pregnant women's care and support the well-being of pregnant women.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CDR42023410561.

Peripheral nerve stimulation for lower-limb postoperative recovery: A systematic review and meta-analysis of randomized controlled trials

Patients undergoing lower-limb orthopedic surgery may experience multiple postoperative complications. Although peripheral nerve stimulation (PNS) is a promising non-pharmacological approach that has been used in lower-limb postoperative recovery, the clinical efficacy of PNS remains inconclusive. This study systematically searched three databases (PubMed, Embase, and Cochrane Library) for randomized controlled trials (RCTs) that examined the treatment effects of PNSs in patients who underwent lower-limb orthopedic surgery up to September 29, 2023. Two investigators independently identified studies, extracted data, and conducted meta-analyses with Review Manager 5.4. The outcomes were pain relief (measured by reductions in pain intensity and analgesic consumption) and functional improvements (range of motion [ROM] and length of hospitalization [LOH]). A total of 633 patients including 321 in the experimental groups and 312 in the control groups from eight RCTs were included. PNS showed no significant effect on pain intensity, while analgesic consumption was marginally significantly reduced in the experimental group. Furthermore, no significant differences were observed regarding functional improvements in ROM or LOH after the intervention. Although PNS had no significant effect on pain relief or functional improvements, the intervention exhibited a marginally significant reduction in analgesic consumption. Future trials should be conducted with larger sample sizes, longer follow-up periods, and more varied stimulation parameters.

Efficacy of bright light therapy improves outcomes of perinatal depression: A systematic review and meta-analysis of randomized controlled trials

The efficacy of bright light therapy (BLT) in the context of perinatal depression remains underexplored. This meta-analysis aimed to systematically assess the effectiveness of BLT among perinatal depression. A comprehensive literature search was performed across several databases, including the Cochrane Central Register of Controlled Trials, PubMed, Embase, CNKI and the clinical trials registry platform, covering the period from the inception of each database up to January 2024. The Cochrane Collaboration's bias assessment tool was employed to evaluate the quality of the included studies. Review Manager 5.3 Software was utilized to conduct the meta-analysis. Six trials, encompassed a total of 167 participants diagnosed with perinatal depression were incorporated quantitative analysis, all of those have been published in English, with no restriction on publication year, and used BLT and dim light therapy (DLT) as intervention. The relative risk (RR) of BLT compared to DLT for perinatal depression is 1.46 (fixed effects model, p = 0.04, 95 % CI = [1.02, 2.10]), indicating a significant improvement in depression outcomes compared to DLT groups. The heterogeneity test yielded an I2 value of 41 % (p = 0.13), indicated a low degree of heterogeneity. Considering the small sample size, we conducted a sensitivity analysis, found RR increased to 2.33 (fixed effects model, p = 0.001, CI = 1.39-3.92). Cochrane Risk of Bias Tool showed only a single study was deemed high quality. This study indicates a beneficial impact of BLT on perinatal depression, subgroup analysis finds no significant mediation effects of different parameters after sensitivity analyses. It is recommended that future studies with larger samples be conducted to explore the effects of BLT on perinatal depression.

Review: Systematic review and meta-analysis - financial incentives increase engagement with parenting programs for disruptive behavior problems

BACKGROUND

To evaluate the effect of financial incentives on engagement in parenting programs for disruptive behavior disorders, as well as effect on child behavior. As a secondary aim, demographic differences were investigated as effect modifiers.

METHODS

We searched PubMed, CINAHL, Sociological Abstracts, Cochrane Trials, and PsycINFO for randomized controlled trials and quasi experimental studies offering parents a financial incentive for engagement with parenting programs targeting disruptive behavior in children aged under 18, vs no incentive. Engagement in each group was evaluated at four stages: connection, attendance, participation, and enaction. Per protocol (CRD42022336210) random effects meta-analysis was conducted using Stata-16. Meta-analyses of binary data used a log odds ratio and continuous data was standardized using Hedges' g.

RESULTS

We identified 2438 papers and screened 35 at full length. We included eight independent cohorts from seven papers. Parents invited to incentive arms were more likely to complete a threshold of sessions than parents invited to control arms (odds ratio 2.51 95% CI 1.42-4.48). Parents were more likely to agree to participate when they knew they were joining the incentive program (odds ratio 1.40, 95% CI 1.20-1.65) and parents in the incentive group were more likely than parents in the control group to reach a completion threshold of sessions (odds ratio 1.76 95% CI 1.17-2.66).

CONCLUSION

Incentives increase parenting programs engagement among parents who are invited and among parents who have begun attending programs. Incentives are an effective potential tool for increasing engagement but further research is needed to establish acceptability and optimal design.

Protein kinase inhibitors as targeted therapy for glioblastoma: a meta-analysis of randomized controlled clinical trials

Glioblastoma (GBM) is the most common and lethal primary brain tumor. The standard treatment for newly diagnosed GBM includes surgical resection, when feasible, followed by radiotherapy and temozolomide-based chemotherapy. Upon disease progression, the anti-vascular endothelial growth factor-A (VEGF-A) monoclonal antibody bevacizumab, can be considered. Given the limited efficacy of pharmacological treatments, particularly for the recurrent disease, several molecularly targeted interventions have been explored, such as small-molecule protein kinase inhibitors (PKIs), inhibiting tyrosine kinase growth factor receptors and downstream signaling pathways involved in GBM angiogenesis and infiltrative behavior. This meta-analysis, based on searches in PubMed and Web Of Science, evaluated 12 randomized controlled trials (RCTs) examining PKIs in patients with newly diagnosed or recurrent GBM. Pooled analysis of shared clinical outcomes - progression-free survival (PFS) and overall survival (OS) - revealed a lack of significant improvements with the use of PKIs. In newly diagnosed GBM, no significant differences were observed in median [-1.02 months, 95 % confidence interval (CI), -2.37-0.32, p = 0.14] and pooled [hazard ratio (HR) = 1.13, 95 % CI, 0.95-1.35, p = 0.17) OS, or in median (0.34 months, 95 % CI, -0.9-1.58, p = 0.60) and pooled (HR = 0.98, 95 % CI, 0.76-1.27, p = 0.89) PFS, when comparing PKI addition to standard chemo-radiotherapy versus chemo-radiotherapy alone. In recurrent GBM, three different analyses were conducted: PKI versus other treatments, PKI combined with other treatments versus those treatments alone, PKI versus PKI combined with other treatments. Also, across these analyses, no significant clinical benefits were found. For instance, when comparing PKI treatment with other treatments, median OS and PFS showed no significant difference (-0.78 months, 95 % CI, -2.12-0.55, p = 0.25; -0.23 months, 95 % CI, -0.79-0.34, p = 0.43, respectively), and similar non-significant results were observed in the pooled analyses (OS: HR = 0.89, 95 % CI, 0.59-1.32, p = 0.55; PFS: HR = 0.83, 95 % CI, 0.63-1.11, p = 0.21). Despite these overall negative findings, some data indicate improved clinical outcomes in a subset of GBM patients treated with certain PKIs (i.e., regorafenib) and encourage further research to identify PKIs with better blood-brain barrier penetration and lower risk for resistance development.

Prevalence, determinants, and complications of adolescent pregnancy: an umbrella review of systematic reviews and meta-analyses

OBJECTIVE

This study aimed to assess the magnitude, determinants, and outcomes of adolescent pregnancy by combining data from previous systematic reviews and meta-analyses.

DATA SOURCES

Online databases.

STUDY ELIGIBILITY CRITERIA

Systematic Review and Meta-analysis.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar, which reported the magnitude, predictors, and/or outcomes of adolescent pregnancy, were searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse variance random-effects model was used to determine the pooled estimates. In addition, subgroup heterogeneity, publication bias, and sensitivity were assessed.

RESULTS

A total of 14 systematic reviews and meta-analyses involving 677,431 participants were included in the final analysis of this umbrella review. The pooled prevalence of adolescent pregnancy from global systematic reviews and meta-analyses was found to be 17.90 (95% confidence interval, 12.25-23.54). Level of education (adjusted odds ratio ranging from 1.40 to 9.07), socioeconomic status (lower: adjusted odds ratio ranging from 1.13 to 3.81), residency (rural: adjusted odds ratio ranging from 1.80 to 3.60), abuse (adjusted odds ratio ranging from 2.21 to 3.83), marital status (married: adjusted odds ratio ranging from 1.27 to 6.02), and contraceptive use (no: adjusted odds ratio ranging from 0.19 to 3.53) were identified as predictors of adolescent pregnancy. Anemia (adjusted odds ratio, 1.49; 95% confidence interval, 0.29-1.69; I2 = 91.7%), stillbirth (adjusted odds ratio, 1.71; 95% confidence interval, 0.24-3.17; I2 = 61.3%), preeclampsia/eclampsia, (adjusted odds ratio, 1.63; 95% confidence interval, 0.72-2.55), preterm birth (adjusted odds ratio, 1.90; 95% confidence interval, 1.36-2.40), and low birthweight (adjusted odds ratio, 1.46; 95% confidence interval, 1.25-1.66) were found to be significant complications of adolescent pregnancy in a global context.

CONCLUSION

The prevalence of adolescent pregnancy varied significantly across previous systematic reviews and meta-analyses. The key determinants identified included low socioeconomic status, rural residency, a history of abuse, early marriage, and no contraceptive use. The complications associated with adolescent pregnancy included anemia, stillbirth, preeclampsia/eclampsia, preterm birth, and low birthweight. To reduce the burden of adolescent pregnancy, collaborative efforts are required from global, regional, and local stakeholders, such as policymakers and reproductive health program planners, through health education and training that focus on the most vulnerable populations.

The Optimal Dosage and Duration of ω-3 PUFA Supplementation in Heart Failure Management: Evidence from a Network Meta-Analysis

Heart failure is a progressive condition associated with a high mortality rate. Despite advancements in treatment, many patients continue to experience less-than-ideal outcomes. ω-3 (n-3) polyunsaturated fatty acids (PUFAs) have been studied as a potential supplementary therapy for heart failure, but the optimal dosage and duration of supplementation remain unclear. This network meta-analysis (NMA) aimed to assess the efficacy of various n-3 PUFA supplementation regimens in patients with heart failure, focusing on dose-dependent and time-dependent effects. We conducted a systematic search for randomized controlled trials (RCTs) on n-3 PUFA supplementation in heart failure till 13 September, 2024. The primary outcome was the change in heart function, specifically left ventricular ejection fraction. Secondary outcomes included changes in peak oxygen consumption (VO2), blood B-type natriuretic peptide concentrations, and quality of life. The safety analysis focused on dropout rates (i.e., patients leaving the study for any reason before completion) and all-cause mortality. A frequentist-based NMA was performed. This NMA, which included 14 RCTs with 9075 participants (mean age, 66.0 y; 23.3% female), found that high-dose n-3 PUFA supplementation (2000-4000 mg/d) over a duration of ≥1 y significantly improved left ventricular ejection fraction and peak VO2 compared with those of control groups. Lower doses and shorter treatment periods did not produce the same benefits. No significant differences were found in dropout rates or all-cause mortality between the n-3 PUFAs and control groups. Long-term, high-dose n-3 PUFA supplementation, particularly with a predominance of docosahexaenoic acid or eicosapentaenoic acid, enhances cardiac function in patients with heart failure without increasing risk of adverse events. Further well-designed RCTs with long treatment durations (i.e., >1 y) and stringent heart failure inclusion criteria are necessary to confirm these findings and reduce potential biases. This trial was registered at PROSPERO as CRD42024590476.

Testing an HPV Vaccine Decision Aid for 27- to 45-Year-Old Adults in the United States: A Randomized Trial

BACKGROUND

In the United States, human papillomavirus (HPV) vaccination among 27- to 45-y-olds (mid-adults) is recommended based on shared clinical decision making with a health care provider. We developed a patient decision aid tool to support the implementation of this mid-adult HPV vaccination guideline. The purpose of this study was to evaluate the effect of a patient decision aid tool for HPV vaccination, HPV DECIDE, compared with an information fact sheet among mid-adults who have not received the HPV vaccine.

METHOD

Participants were recruited between December 2023 and January 2024. We used a randomized Solomon, 4-group, pretest/posttest design with mid-adults aged 27 to 45 y who were unvaccinated for HPV and balanced based on sex (n = 612). The primary outcome was decisional conflict. Intermediate outcomes included knowledge, behavioral expectancies, self-efficacy, and perceived risk. Variables were measured using validated scales. Pretest sensitization was not present; intervention and control groups were compared. Fixed-effects inverse-variance weighting was used to pool effect estimates and determine meta-analytic statistical significance across tests with and without pretest controls.

RESULTS

Participants in the intervention group had significantly lower total decisional conflict scores (B = -3.58, P = 0.007) compared with the control group. Compared with the control group, participants in the intervention group showed higher knowledge (B = 0.48, P = 0.020), greater intention to receive (B = 0.196, P = 0.049) and discuss the HPV vaccine (B = 0.324, P ≤ 0.001), and greater self-efficacy about HPV vaccine decision making (B = 3.28, P = 0.043). There were no statistically significant results for perceived risks of HPV infection.

CONCLUSIONS

The HPV DECIDE tool for mid-adult HPV vaccination shows promise for immediate reductions in decisional conflict and improvement in knowledge, intentions, and self-efficacy about the HPV vaccine. Future studies are warranted to evaluate the effectiveness of this patient decision aid tool in real-world settings.

HIGHLIGHTS

Shared clinical decision making is recommended for HPV vaccination with mid-adults.A patient decision aid for HPV vaccination reduced decisional conflict for mid-adults.The HPV vaccine patient decision aid was acceptable to mid-adults.

The Roles of Fasciotomy and Peripheral Nerve Decompression in Electric Burn Patients: A Systematic Review and Meta-Analysis

INTRODUCTION

Peripheral nerves preferentially conduct electricity due to their low resistance as compared with other tissues, predisposing them to injury from electrical burns. The purpose of this study was to investigate the efficacy of fasciotomy and peripheral nerve decompression on peripheral nerves after electric injury.

METHODS

A systematic review of patients who had sustained electric burn injuries was performed according to PRISMA Guidelines. Incidence, demographic and injury characteristics, and patterns of symptoms were analyzed. Meta-analysis was performed to examine changes from baseline from nerve conduction studies. Outcomes for fasciotomy and various nerve decompressions were also analyzed.

RESULTS

Of the 119 articles included in for systematic review, 16,773 patients were included. Most available studies the case reports or case series that yielded moderate- to poor-quality evidence. The median follow-up of the included patients was 44 weeks (IQR 15-97 weeks). Patients who underwent fasciotomy had significantly lower rates of peripheral neuropathy than those who did not by the last recorded follow-up (45% vs. 92%, p < 0.0001). Patients who underwent peripheral nerve decompression after 30 days of injury had lower rates of peripheral neuropathy at the last follow-up compared with those who underwent decompression within 30 days (21% vs. 53%, p < 0.0001).

CONCLUSIONS

A paucity of high-quality evidence exists to standardize management recommendations for peripheral nerve injury; however, of what literature does exist, it seems that fasciotomy and nerve decompressions are associated with improved peripheral nerve function in the long-term, but nerve decompression likely provides more benefit when performed if symptoms persist one-year post-injury.

Family dysfunction and risk of suicidal behavior in adolescents: A systematic review and meta-analysis

IMPORTANCE

Adolescents are at high risk for the occurrence of suicide. Previous meta-studies have mostly focused on the correlation between childhood maltreatment adversity and adolescent suicidal behavior, ignoring in-depth analyses of different categories of family dysfunction adversity.

OBJECTIVE

To conduct a systematic review and meta-analysis of cohort studies examining the association between family dysfunction and adolescent suicide, and to select the categories of family dysfunction that have the greatest impact on adolescent suicidal behavior.

DATA SOURCE

Embase, PubMed, Science Direct, Scopus, and Web of Science databases were searched between inception and November 2023.

STUDY SELECTION

Population-based cohort studies investigating family dysfunction and adolescent suicidal behavior.

DATA EXTRACTION AND SYNTHESIS

This systematic review and meta-analysis was performed following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The review protocol was prospectively registered in PROSPERO. Pooled odds ratios (ORs) and 95 % CIs were derived from meta-analysis using STATA 17.0, and subgroup and sensitivity analyses were performed.

MAIN OUTCOMES AND MEASURES

The primary outcome was adolescent suicide symptoms. Measured by database data records, suicide scales, or adolescent self-reports.

RESULTS

12 cohort studies were included, with sample sizes ranging from 352 to 618,970 individuals. Adolescents experiencing family dysfunction a substantially higher risk of suicidal behaviors than those in the normal family functioning (pooled OR = 1.94; 95 % CI: 1.73-2.16). Specifically, parental suicide or attempted suicide had the greatest impact on adolescent suicidal behavior (OR = 2.70, 95 % CI:2.12-3.29) compared with parental mental disorders, imprisonment of a parent or family member.

CONCLUSIONS AND RELEVANCE

Family dysfunction, especially parental suicide or attempted suicide, is associated with an increased risk of adolescent suicidal behavior. The results of this study suggest that early screening and intervention for family functioning is important in preventing adolescent suicide.

Altered pain perception and nociceptive thresholds in major depression and anxiety disorders: A meta-analysis

Psychiatric conditions can affect the experience of pain. Several reports indicate that Major Depressive Disorder (MDD) is associated with an increased pain threshold, while Anxiety Disorders (ADs) may amplify the perception of pain. However, available data on the nociceptive threshold in these psychiatric conditions are controversial. This meta-analysis examines: 1) the nociceptive threshold among people diagnosed with MDD or ADs compared to healthy controls, and 2) the available evidence that pharmacological treatments affect these relationships. Electronic searches were conducted in PubMed and PsycINFO between June 2022 and December 2024. A total of 25 studies were included. "Pain threshold" measurement was considered as a direct comparison between subjects affected by MDD or ADs (both medicated and unmedicated) and healthy control subjects. For each study, the effect size (ES) was calculated, with a positive ES indicating a lower pain threshold. The heterogeneity of the specific set of effect sizes and the effects of selected moderators were tested using the I² index and the Q statistic. Results indicated that patients with Major Depressive Disorder (MDD) had a higher pain threshold (ES: -0.60), while those with Anxiety Disorders (ADs) had a lower pain threshold (ES: -0.34) compared to healthy controls. These findings were confirmed when analyses were limited to studies of unmedicated patients. Exploratory analyses restricted to studies containing medicated MDD patients were inconclusive, and for medicated ADs patients, analyses were not possible due to insufficient data. These meta-analytic data support higher pain threshold associated with MDD, and lower pain threshold associated with ADs.

Systematic review on the effectiveness of mobile health applications on mental health of breast cancer survivors

PURPOSE

Breast cancer survivors are more likely to report psychological distress and unmet need for support compared to healthy controls. Psychological mobile health interventions might be used in follow-up care of breast cancer patients to improve their mental health.

METHODS

We searched MEDLINE, PsychINFO, Cochrane and PROSPERO for articles on controlled trials examining the effectiveness of psychological mobile health interventions compared to routine care regarding mental health outcomes of adult breast cancer survivors. This review followed the PRISMA statement and was registered on PROSPERO (CRD42022312972). Two researchers independently reviewed publications, extracted data and assessed risk of bias.

RESULTS

After screening 204 abstracts published from 2005 to February 2023, eleven randomised trials involving 2249 patients with a mean age between 43.9 and 56.2 years met the inclusion criteria. All interventions used components of cognitive behavioural therapy. Most studies applied self-guided interventions. Five studies reported percentages of patients never started (range = 3-15%) or discontinued the intervention earlier (range = 3-36%). No long-term effect > 3 months post intervention was reported. Three of seven studies reported a significant short-term intervention effect for distress. Only one study each showed an effect for depression (1/5), anxiety (1/5), fear of recurrence (1/4) and self-efficacy (1/3) compared to a control group.

CONCLUSIONS

A wide variance of interventions was used. Future studies should follow guidelines in developing and reporting their mobile interventions and conduct long-term follow-up to achieve reliable and comparable results.

IMPLICATIONS FOR CANCER SURVIVORS

No clear effect of psychological mobile health interventions on patients' mental health could be shown.

REGISTRATION

PROSPERO ID 312972.

Exposure to Racism and Adverse Pregnancy Outcomes for Black Women: A Systematic Review and Meta-Analysis

Research suggests that stress due to racism may underlie the disproportionately high rates of adverse pregnancy outcomes experienced by Black women in the US. Study objectives: (1) Identify forms of systemic racism affecting pregnancy outcomes and (2) increase understanding about the role of racism in adverse pregnancy outcomes for Black women. A systematic review was conducted to explore the relationship between systemic racism and pregnancy outcomes for Black women. Searches were performed using EBSCO Academic Search Complete, CINAHL Complete, and Consumer Health Complete first between January to April 2021 and subsequently between November 2023 to January 2024. Included studies were observational, written in English, had full-text availability, examined at least one form of systemic racism and pregnancy outcome, and reported results for Black women. A meta-analysis was performed using a random effects model, summary effect estimates were pooled by pregnancy outcome. The I2 statistic was used to measure heterogeneity between studies. A total of 32 studies were included in the review. Significant pooled effects of exposure to systemic racism were observed for preterm birth 0.30 (95% CI 0.12-0.48), small for gestational age 0.31 (95% CI 0.05-0.58), and low birth weight 0.24 (95% CI 0.11-0.37). Among studies that compared results by race, exposure to systemic racism had a significant and rather large effect on preterm birth for Black women (ds = 0.62; 95% CI 0.06-0.41). Exposure to systemic racism has a significant effect on preterm birth, small for gestational age, and low birth weight for Black women. Having knowledge of how racism contributes to stress and poor pregnancy outcomes can help health professionals improve delivery of quality care to Black women. Future research should continue identifying forms of racism positively related to adverse pregnancy outcomes.

Dopaminergic responsiveness and dopaminergic challenge tests of Parkinson's disease: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

The assessment and quantification of dopaminergic responsiveness are crucial for the diagnosis and management of Parkinson's disease (PD). This study aimed to summarize and compare motor improvements in patients with PD and atypical parkinsonian syndromes (APS) across three types of dopaminergic challenge tests, as well as evaluate their diagnostic performance.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science were searched to identify eligible studies reporting the improvement rate of the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III) or MDS-UPDRS-III in dopaminergic challenge tests for PD or APS, or diagnostic outcomes in differential diagnosis between PD and APS. A random-effects model was conducted to pool improvement rates and standardized mean differences (SMDs) in patients with PD or APS during dopaminergic challenge tests. Subgroup analysis and meta-regression were used to investigate the sources of heterogeneity. A bivariate mixed-effects model was employed to evaluate the diagnostic performance of these tests.

RESULTS

A total of 58 studies (3641 PD and 711 APS) were included. In the acute levodopa challenge test, patients with PD, APS, and multiple system atrophy (MSA) demonstrated pooled UPDRS-III improvement rates of 41.5% [95% confidence interval (CI) 38.5%-44.5%; I2 = 98.8%], 14.7% (95% CI 6.8%-22.7%; I2 = 96.5%), and 6.3% (95% CI - 4.0% to 16.7%), respectively. Subgroup analyses showed the pooled improvement rate of de novo PD patients (25.9%; 95% CI 15.1%-36.7%) was significantly lower than treated PD patients (42.4%; 95% CI 38.6%-46.2%) (p = 0.005), overlapping with APS patients with off-state H-Y stage ≤ 2.5 (21.2%; 95% CI 14.5%-27.9%). PD patients with off-state H-Y stage ≤ 2.5 (35.4%; 95% CI 31.1%-39.7%) or UPDRS-III score ≤ 30 (30.5%; 95% CI 23.4%-35.7%) had significantly lower improvement rate than PD patients with off-state H-Y stage > 2.5 (44.1%; 95% CI 37.0%-51.3%) (p = 0.041) or UPDRS-III scores > 30 (47.0%; 95% CI 43.7%-50.4%) (p < 0.001). The pooled improvement rate in acute levodopa challenge tests of PD with 100 mg levodopa (17.0%; 95% CI 11.3%-22.8%) was significantly lower than that in tests with 200-250 mg levodopa (34.3%; 95% CI 30.6%-38.0%) (p < 0.001). Meta-regression showed the improvement rate of PD was positively correlated with off-state UPDRS-III scores (p = 0.007). In the acute apomorphine challenge test, PD patients showed a pooled UPDRS-III improvement rate of 40.1% (95% CI 36.9%-43.3%). To differentiate between PD and APS, the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) for the acute levodopa challenge test were 0.81, 0.77, 13.91, and 0.85; for the acute apomorphine challenge test, they were 0.84, 0.85, 29.94, and 0.91; and for chronic levodopa therapy, they were 0.82, 0.71, 11.54, and 0.72. The pooled sensitivity, specificity, DOR, and AUC of the acute levodopa challenge test for distinguishing PD from MSA were 0.82, 0.78, 15.74, and 0.79; for PD vs. PSP, they were 0.77, 0.78, 11.54, and 0.84; and for PD vs. DLB, they were 0.65, 0.58, 2.65, and 0.64.

CONCLUSIONS

The overall dopaminergic responsiveness is greater in PD patients compared to those with APS. However, there is significant heterogeneity in the pooled motor improvement of dopaminergic responsiveness within PD or APS, with overlap between de novo PD and early-stage APS. All three types of dopaminergic challenge tests demonstrate moderate diagnostic performance in differentiating PD from APS.

Efficacy of acupuncture for primary osteoporosis: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Primary osteoporosis (POP) is a common metabolic bone disorder that has a devastating effect on their quality of life in patients. Acupuncture, a traditional Chinese therapy, has been used to treat osteoporosis for over 2000 years. This study aimed to determine the efficacy of acupuncture in treating POP compared to conventional medicine or placebo.

METHODS

We searched for potentially relevant studies in PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, China Biology Medicine disc, Wanfang database and ClinicalTrials.gov up to December 20, 2024. Randomized controlled trials investigating treatment of POP for which acupuncture was administered as a stand-alone treatment or combined with conventional medicine compared to conventional medicine or placebo, were included. The outcomes included bone mineral density (BMD), visual analogue scale (VAS) scores, clinical effectiveness rate, estradiol (E2), Oswestry Disability Index (ODI), and levels of serum alkaline phosphatase (ALP). Data were synthesized using a random-effects meta-analysis model, and the observed heterogeneity was investigated using subgroup analyses. Study quality was appraised using the Cochrane RoB 2 tools, and the quality of the aggregated evidence was evaluated using the GRADE guidelines. Publication bias was assessed by funnel plots and validated by Egger's test.

RESULTS

Forty eligible articles with 2654 participants were identified. Compared to the control group, acupuncture effectively increased the BMD (MD 0.04 [0.03-0.06], P < 0.001, I2 = 92%), clinical efficacy (RR 1.24 [1.14-1.34], P < 0.001, I2 = 81%), and levels of E2 (SMD 0.30 [0.09-0.52], P = 0.006, I2 = 0%), and reduced the VAS scores (SMD - 1.79 [- 2.29 to - 1.29], P < 0.001, I2 = 95%). Data on ODI and ALP were insufficient for meta-analysis.

CONCLUSION

The current evidence suggests that the efficacy of acupuncture in improving the symptoms of POP are encouraging for its use in clinical practice as a physical intervention for patients with POP. However, since the included patients were all from China, there was a risk of sample bias, high-quality multicenter studies in different countries or regions should be conducted in the future.

Home-based physical symptom management for family caregivers: systematic review and meta-analysis

BACKGROUND

Patients with life-limiting conditions are often cared for at home by family, typically without adequate training to carry out the challenging tasks performed. This systematic review assessed the efficacy of interventions designed to help family caregivers manage pain and other symptoms in adults and children with life-limiting conditions at home.

METHODS

A systematic search was performed on seven databases. A narrative synthesis was conducted, along with a meta-analysis comparing outcomes in those who received an intervention to those who did not, or to preintervention scores.

RESULTS

84 eligible studies were identified. Significant improvements in pain and fatigue in patients with cancer were found compared with patients in the control group and baseline. Caregivers of patients with cancer receiving an intervention, compared with the control group caregivers, showed significant improvements in self-efficacy and active coping and lower avoidant coping. This group also showed significant improvements in burden, self-efficacy, anxiety and depression, and decreases in avoidant coping pre- to post intervention. Patients with dementia whose caregivers received an intervention showed significantly reduced pain intensity and improvements in quality of life pre- to post intervention. Caregivers of patients with dementia showed significantly reduced distress pre- to post intervention. No beneficial effects were found for caregivers of patients with Parkinson's disease or heart failure, although only limited analyses could be performed.

CONCLUSIONS

Interventions targeting family caregivers can improve both patient symptoms and caregiver outcomes, as demonstrated in cancer and dementia care. Future mixed-methods research should collect data from caregiver and patient dyads, identifying key intervention components. There is also need for more studies on caregivers of paediatric patients.

Is vital exhaustion distinct? A meta-analytic investigation on the immediate nomological network of vital exhaustion

A multitude of studies have supported that vital exhaustion is an important predictor of physical and psychological well-being, especially in the aftermath of adverse medical events; however, some authors have expressed that vital exhaustion may be repetitive with other popular constructs, namely burnout, fatigue, and depression. We resolve this tension by performing a meta-analysis of 74 sources on the immediate nomological network of vital exhaustion. Our results support that the relations of vital exhaustion with emotional exhaustion (r ¯  = 0.71, ρ ¯  = 0.82, k = 4, n = 1152) and depression (r ¯  = 0.70, ρ ¯  = 0.83, k = 59, n = 30,963) approached the magnitude of its convergent validity correlation (r ¯  = 0.75, ρ ¯  = 0.88, k = 4, n = 1445), suggesting that these constructs share most of their variance. Researchers should reinvestigate whether vital exhaustion relates to outcomes when accounting for these two constructs.

Eye health risks associated with unclean fuel: a meta-analysis and systematic review

Purpose

This study comprehensively examined the correlation between unclean cooking fuels (UCF) and ocular health, covering diverse eye conditions such as cataracts, visual impairments, and ocular discomfort.

Methods

According to MOOSE and PRISMA guidelines, a meta-analysis and systematic review was conducted on 28 studies from 3 databases. Literature quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity among articles was gaged with the I 2 statistic, sensitivity analysis used 'leave-one-out test', and publication bias was evaluated using Egger, Begg tests, and funnel plot analysis.

Results

The study evidenced a significant association between UCF exposure and cataracts [OR 2.29, 95% CI (1.24, 4.23)], visual impairments [OR 1.70, 95% CI (1.45, 2.00)], and eye diseases/symptoms [OR 2.03, 95% CI (1.25, 3.29)]. However, no correlation was found between UCF exposure and glaucoma or elevated intraocular pressure [OR 0.96, 95% CI (0.84, 1.10), n = 2]. Subgroup analysis revealed that UCF cooking had an impact on nuclear cataracts [OR 1.98, 95% CI (1.67, 2.33), n = 4]. But not on cortical cataracts [OR 1.25, 95% CI (0.98, 1.60), n = 3]. Additionally, UCF exposure was linked to severe visual impairments like night blindness [OR 2.03, 95% CI (1.00, 4.96)], blindness [OR 1.43, 95% CI (1.32, 1.55)], and specific ocular symptoms such as tearing while cooking (OR = 3.20), eye irritation (OR = 2.58), and red eyes (OR = 2.03).

Conclusion

UCF cooking had significant impact on ocular health, notably on eye symptoms, cataracts, and visual impairments. UCF exposure presented demographic inequalities in cataract prevalence, while eye symptoms can serve as a reliable self-assessment of UCF exposure.

Global prevalence and moderating factors of malnutrition in colorectal cancer survivors: A meta-analysis

PURPOSE

This meta-analysis aims to estimate the global prevalence of severe, moderate, overall malnutrition and moderating factors of malnutrition in colorectal cancer (CRC) survivors.

METHODS

A comprehensive search was conducted in Embase, CINAHL, Medline-OVID, PubMed, Scopus, and Web of Science from inception to February 8, 2024, without language, region, or publication date restrictions. A generalized linear mixed model and random-effects model were used to examine the pooled prevalence, and moderator analyses were implemented to investigate variations in the pooled prevalence.

RESULTS

In 35 studies involving 9,278 colorectal cancer survivors, the global prevalence was 12.10% for severe malnutrition (95% confidence interval (CI): 7.28-16.92; n = 507), 33.13% for moderate malnutrition (95% CI: 28.93-37.34; n: 2,192), and 47.78% for overall malnutrition (95% CI: 41.60-53.96; n: 3,812). Asia showed higher rates of severe malnutrition 16.67% (95% CI: 4.66-28.68, n: 232) and overall malnutrition 53.17% (95% CI: 39.66-66.69, n: 1,913), whereas low-middle income countries demonstrated higher rates of overall malnutrition 67.46% (95% CI: 30.25-100.00, n: 82). Male sex, colon cancer, advanced stage, metastasis, chemotherapy, surgery, adjuvant treatment, smoking, alcohol consumption, hypertension, and diabetes significantly moderated overall malnutrition prevalence.

CONCLUSIONS

This meta-analysis reports detailed data on the global prevalence of CRC survivors experience malnutrition, highlighting that health-care professionals should consider the identified moderating factors.

IMPLICATIONS FOR CANCER SURVIVORS

Addressing malnutrition in CRC survivors is critical, as early and proactive nutritional management can enhance recovery, improve quality of life, and potentially reduce cancer-related complications associated with malnutrition.

Targeting Ketone Body Metabolism Improves Cardiac Function and Hemodynamics in Patients With Heart Failure: A Systematic Review and Meta-Analysis

CONTEXT

The impacts of elevated ketone body levels on cardiac function and hemodynamics in patients with heart failure (HF) remain unclear.

OBJECTIVE

The effects of ketone intervention on these parameters in patients with HF were evaluated quantitatively in this meta-analysis.

DATA SOURCES

We searched the PubMed, Cochrane Library, and Embase databases for relevant studies published from inception to April 13, 2024. Ketone therapy included ketone ester and β-hydroxybutyrate intervention.

DATA EXTRACTION

Seven human studies were included for the quantitative analysis.

DATA ANALYSIS

Our results showed that ketone therapy significantly improved left ventricular ejection fraction (standardized mean difference, 0.52 [95% CI, 0.25-0.80]; I2 = 0%), cardiac output (0.84 [95% CI, 0.36-1.32]; I2 = 68%) and stroke volume (0.47 [95% CI, 0.10-0.84]; I2 = 39%), and significantly reduced systemic vascular resistance (-0.92 [95% CI, -1.52 to -0.33]; I2 = 74%) without influencing mean arterial pressure (-0.09 [95% CI: -0.40 to 0.22]; I2 = 0%) in patients with HF. Subgroup analysis revealed that the enhanced cardiac function and favorable hemodynamic effects of ketone therapy were also applicable to individuals without HF.

CONCLUSIONS

Ketone therapy may significantly improve cardiac systolic function and hemodynamics in patients with HF and in patients without HF, suggesting it may be a promising treatment for patients with HF and also a beneficial medical strategy for patients without HF or healthy individuals.

Reformulating the meta-analytical random effects model of the standardized mean difference as a mixture model

The classical meta-analytical random effects model (REM) has some weaknesses when applied to the standardized mean difference, g. Essentially, the variance of the studies involved is taken as the conditional variance, given a δ value, instead of the unconditional variance. As a consequence, the estimators of the variances involve a dependency between the g values and their variances that distorts the estimates. The classical REM is expressed as a linear model and the variance of g is obtained through a framework of components of variance. Although the weaknesses of the REM are negligible in practical terms in a wide range of realistic scenarios, all together, they make up an approximate, simplified version of the meta-analytical random effects model. We present an alternative formulation, as a mixture model, and provide formulas for the expected value, variance and skewness of the marginal distribution of g. A Monte Carlo simulation supports the accuracy of the formulas. Then, unbiased estimators of both the mean and the variance of the true effects are proposed, and assessed through Monte Carlo simulations. The advantages of the mixture model formulation over the "classical" formulation are discussed.

Atherogenic index of plasma and coronary artery disease: a systematic review and meta-analysis of observational studies

BACKGROUND

Atherogenic index of plasma (AIP), a novel logarithmic index that combines fasting triglyceride and high-density lipoprotein cholesterol concentrations, is associated with the burden of atherosclerosis. This study aimed to evaluate the relationship between AIP and coronary artery disease (CAD) risk, severity, and prognosis in populations with and without established CAD.

METHODS

PubMed, Embase, and Web of Science were systematically searched from the inception of each database to August 13, 2024. Cross-sectional studies, case-control studies, and prospective or retrospective cohort studies using multivariate analysis were included. Given that the true effect size may differ across studies, a random-effects model for all analyses was applied.

RESULTS

Fifty-one observational studies were included in this study. Patients with higher AIP were more likely to have CAD (odds ratio (OR): 2.79, 95% CI 1.75-4.45, P < 0.00001). Furthermore, these patients were more likely to have coronary artery calcification (OR: 2.28, 95% CI 1.74-3.00, P < 0.00001), multivessel CAD (OR: 2.04, 95% CI 1.50-2.77, P < 0.00001), and an increased risk of plaque progression (OR: 1.49, 95% CI 1.17-1.91, P = 0.001). In populations without established CAD, higher AIP levels were associated with an increased risk of Major adverse cardiovascular events (MACE) (hazard ratio (HR): 1.28, 95% CI 1.22-1.35, P < 0.00001). Interestingly, this finding was consistent in patients presenting with acute coronary syndrome (HR: 1.59, 95% CI 1.33-1.89, P < 0.00001) and patients with chronic coronary syndrome or stable CAD (HR: 1.65, 95% CI 1.15-2.37, P = 0.007).

CONCLUSIONS

This meta-analysis demonstrates that elevated AIP is strongly associated with increased CAD risk, greater severity, and poorer prognosis in populations with and without established CAD. However, more studies are needed to evaluate the predictive performance and determine the optimal cut-off for AIP in different populations.

Striosome Circuitry Stimulation Inhibits Striatal Dopamine Release and Locomotion

The mammalian striatum is divided into two types of anatomical structures: the island-like, μ-opioid receptor (MOR)-rich striosome compartment and the surrounding matrix compartment. Both compartments have two types of spiny projection neurons (SPNs), dopamine receptor D1 (D1R)-expressing direct pathway SPNs (dSPNs) and dopamine receptor D2 (D2R)-expressing indirect pathway SPNs. These compartmentalized structures have distinct roles in the development of movement disorders, although the functional significance of the striosome compartment for motor control and dopamine regulation remains to be elucidated. The aim of this study was to explore the roles of striosome in locomotion and dopamine dynamics in freely moving mice. We targeted striosomal MOR-expressing neurons with male MOR-CreER mice, which express tamoxifen-inducible Cre recombinase under MOR promoter, and Cre-dependent adeno-associated virus vector. The targeted neuronal population consisted mainly of dSPNs. We found that the Gq-coupled designer receptor exclusively activated by designer drugs (DREADD)-based chemogenetic stimulation of striatal MOR-expressing neurons caused a decrease in the number of contralateral rotations and total distance traveled. Wireless fiber photometry with a genetically encoded dopamine sensor revealed that chemogenetic stimulation of striatal MOR-expressing neurons suppressed dopamine signals in the dorsal striatum of freely moving mice. Furthermore, the decrease in mean dopamine signal and the reduction of transients were associated with ipsilateral rotational shift and decrease of average speed, respectively. Thus, a subset of striosomal dSPNs inhibits contralateral rotation, locomotion, and dopamine release in contrast to the role of pan-dSPNs. Our results suggest that striatal MOR-expressing neurons have distinct roles in motor control and dopamine regulation.

Non-pharmacological interventions for primary hypertension: a systematic review and network meta-analysis protocol

INTRODUCTION

Primary hypertension (PH) affects over one billion individuals globally, yet less than 30% achieve controlled blood pressure (BP) with medication. Many patients require a combination of multiple medications to reach targets, but adverse effects and financial burdens undermine adherence. Additionally, prehypertension affects 25%-50% of adults, increasing the risk of cardiovascular complications. Early detection and management of prehypertension are crucial for delaying the need for pharmacological interventions. In recent years, clinical guidelines have increasingly emphasised non-pharmacological interventions for PH management. However, the diversity of non-pharmacological therapies and the inconsistencies in efficacy challenge clinical decision-making. This study aims to use network meta-analysis (NMA) to synthesise existing evidence on non-pharmacological interventions for PH, offering updated clinical insights and evidence-based support to optimise treatment strategies. It will also provide recommendations for integrating these interventions into community-based chronic disease management.

METHODS AND ANALYSIS

To identify potentially relevant randomised controlled trials, a reverse search strategy will be employed to ascertain all non-pharmacological interventions for PH. A well-constructed search strategy will be applied across nine academic databases (Web of Science, Embase, PubMed, PsycINFO, CENTRAL, AMED, CNKI, WF and VIP database) and three clinical trial registries (WHO ICTRP, ClinicalTrials.gov and ChiCTR) for studies conducted between 1 January 2014 and 1 August 2024. Two investigators will independently extract information from eligible articles and document reasons for exclusions. The primary outcomes will encompass changes in systolic and diastolic BP. Pairwise and Bayesian NMA will be conducted using 'meta' and 'GeMTC' package (R 4.4.1). Risk of bias will be assessed using the Risk of Bias 2 tool, and the quality of evidence will be evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

As this review involves secondary analysis of previously published data, ethical approval is not required. The results will be published in peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42023451073.

Cyberbullying Victimization and Mental Health Symptoms Among Children and Adolescents: A Meta-Analysis of Longitudinal Studies

Cyberbullying victimization and mental health symptoms are major concerns for children and adolescents worldwide. Despite the increasing number of longitudinal studies of cyberbullying and mental health among this demographic, the robustness of the causal associations between cyberbullying victimization and the magnitude of mental health symptoms remains unclear. This meta-analysis investigated the longitudinal impact of cyberbullying victimization on mental health symptoms among children and adolescents. A systematic search identified primary studies published in English between January 2010 and June 2021, yielding a sample of 27 studies encompassing 13,497 children and adolescents aged 8 to 19 years old. The longitudinal association between cyberbullying victimization and mental health symptoms among children and adolescents was found to be weakly positive and consistent across time and age. Three significant moderators were identified: the effect of cyberbullying victimization on mental health was larger among older children, groups with a higher proportion of males, and in more recent publications. No evidence of publication bias was detected. This study adds to the existing body of research by providing a new perspective on the long-term effects of cyberbullying victimization on the mental health of children and adolescents' mental health. Furthermore, it underscores the necessity of developing effective cyberbullying prevention programs, interventions, and legal regulations to comprehensively address this issue.

Prevalence and determinants of unhealthy feeding practices among young children aged 6-23 months in five sub-Saharan African countries

INTRODUCTION

Despite the World Health Organization's advice against unhealthy feeding, many low- and middle-income countries, including sub-Saharan Africa (SSA) countries, are experiencing a nutritional transition to high in sugar, unhealthy fats, salts, and processed carbohydrates for younger children. However, there is a scarcity of recently updated multicounty information on unhealthy feeding practices and determinants in SSA countries. Therefore, this study aimed to assess the pooled prevalence of unhealthy feeding practices and determinants among children aged 6-23 months in five SSA countries.

METHOD

A cross-sectional study design was employed with the most recent demographic and health survey secondary data (DHS) from five SSA countries. This secondary data was accessed from the DHS portal through an online request. The DHS is the global data collection initiative that provides detailed and high-quality data on population demographics, health, and nutrition in low- and middle-income countries. We used a weighted sample of 14,064 children aged 6-23 months. A multilevel mixed-effect binary logistic regression model was fitted to identify significant factors associated with unhealthy feeding practices. The level of statistical significance was declared with p-value < 0.05.

RESULT

This study found that overall, 62.4% (95% CI: 61.62-63.17) of children aged 6-23 months in five SSA countries had unhealthy feeding practices. Rural residents, lower-middle-income SSA countries, and children aged above 12 months had lower odds of unhealthy feeding practices. On the other hand, richer households and women who had not had an optimal antenatal care visit had higher odds of unhealthy feeding practices.

CONCLUSION

According to this study, nearly two out of three young children in five SSA countries had unhealthy feeding practices. Both individual and community-level factors are significantly associated with unhealthy feeding practices. As a result, responsible bodies shall make all efforts to reduce unhealthy feeding practices among young children in SSA countries.

Prevalence and risk factors for long COVID among cancer patients: a systematic review and meta-analysis

Objective

The prevalence of long COVID among cancer patients remains unknown. This study aimed to determine the prevalence of long COVID and explore potential risk factors among cancer patients.

Methods

A systematic search was performed on PubMed, Web of Science, and Embase from database inception until 21 March 2024, to identify studies that reported long COVID in cancer patients. Two investigators independently screened the studies and extracted all information about long COVID in cancer patients for subsequent analysis. Methodological quality was assessed using the "Joannagen Briggs Institute (JBI) Critical Appraisal Checklist for Studies Reporting Prevalence Data".

Results

A total of 13 studies involving 6,653 patients were included. The pooled prevalence of long COVID was 23.52% [95% confidence interval (CI), 12.14% to 40.64%] among cancer patients reported experiencing long COVID after acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The pooled prevalence of any long COVID in cancer patients was 20.51% (95% CI, 15.91% to 26.03%), 15.79% (95% CI, 11.39% to 21.47%), and 12.54% (95% CI, 6.38% to 23.18%) in 3, 6, and 12 months follow-up duration. Fatigue was the most common symptom, followed by respiratory symptoms, myalgia, and sleep disturbance. Patients with comorbidities had a significantly higher risk of experiencing long COVID [odds ratio (OR) = 1.72; 95% CI, 1.09 to 2.70; p = 0.019]. No statistically significant differences in sex, primary tumor, or tumor stage were detected.

Conclusion

Nearly a quarter of cancer patients will experience long COVID after surviving from SARS-CoV-2 infection, and this would even last for 1 year or longer. Fatigue, respiratory symptoms, myalgia, and sleep disturbance need to be more addressed and managed to reduce symptom burden on cancer patients and improve quality of life. Patients with comorbidities are at a high risk of developing long COVID. Further randomized controlled trials with rigorous methodological designs and large sample sizes are needed for future validation.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023456665.

The effect of audio distraction in reducing signs of stress and anxiety during pediatric dental treatment: a systematic review and meta-analysis

AIM

To perform a systematic review to investigate if the use of audio distraction reduces signs of stress and anxiety in paediatric patients undergoing dental treatment.

MATERIALS AND METHODS

Search was made in electronic databases (MEDLINE, Scopus, Embase, Web of Science, Scielo, BVS, Springer Link, Science Direct, Cochrane Library, and grey literature) until March 11th, 2024. The eligibility criteria were: paediatric patients under dental treatment; use of audio as a distraction method; comparison between groups with and without use of audio distraction; Clinical trials. The outcomes measured were alterations in the anxiety, fear and/or stress levels. Evaluation of the risk of bias and assessment of the certainty of the evidence (GRADE) were performed. Meta-analysis was conducted for four outcomes, considering 95% confidence interval (CI), random effects and heterogeneity from Tau².

RESULTS

From 5,495 results, 25 studies composed the narrative sample and 12 composed the meta-analysis. High risk of bias was generally observed. Three results from the meta-analysis showed high heterogeneity and some outcomes presented a statistical association: systolic blood pressure reduction (p = 0.52; CI= -6.05 [-7.50 to -4.60]), pulse rate (p < 0.00001; CI= -4.95 [-9.95 to -3.52]), Venham's test scores (p < 0.00001; CI= -1.24 [-1.79 to -0.68]), and oxygen saturation (p < 0.00001; CI = 0.14 [-0.04 to 0.33]). The outcomes presented "very low" and "low" certainty of evidence.

CONCLUSION

Although a low certainty of evidence was observed, our study suggests that audio may be an effective alternative for reducing stress and anxiety and pain perception during non-invasive treatments. Future well-designed studies are necessary.

CLINICAL RELEVANCE

Audio distraction presents a potential role as an efficient method to reduce stress in children undergoing dental treatment. More RCTs are necessary to improve the evidence level, considering the main variables related to audio distraction.

A comprehensive systemic review and meta-analysis of the association between lipid profile and hidradenitis suppurativa

BACKGROUND

While several studies have suggested a connection between Metabolic Syndrome (MetS) and Hidradenitis Suppurativa (HS), a definitive analysis confirming the association between lipid abnormalities and HS based on actual lipid values is lacking. Previous research, using odds ratios from ICD codes, indicates links between elevated triglycerides and low high-density lipoprotein levels with HS. However, these findings may not fully represent real-life situations, as no comprehensive analysis using actual lipid measurements has been performed.

OBJECTIVES

To examine the relationship between lipid profile values-total cholesterol, triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL)-and HS.

METHODS

A comprehensive search of PubMed, Cochrane Library, and Embase was conducted to identify studies reporting lipid profiles in HS patients. A meta-analysis using standardized mean differences (SMDs) was performed to assess the association between lipid abnormalities and HS.

RESULTS

The meta-analysis found that HS patients had significantly higher TG levels (SMD = 0.28, 95% CI: 0.09-0.47, P = 0.004) and lower HDL levels (95% CI: -0.53 to -0.16, P < 0.001) compared to healthy controls. No significant differences were observed in total cholesterol (SMD = 0.01, 95% CI: -0.19-0.21, P = 0.93) and LDL levels (SMD = 0.04, 95% CI: -0.10-0.17, P = 0.61). These results corroborate earlier studies linking HS with dyslipidemia, particularly hypertriglyceridemia and hypo-HDL cholesterolemia, with the added strength of using actual lipid values.

CONCLUSIONS

This study confirms the association between hypertriglyceridemia and low HDL cholesterol in HS patients, highlighting the broader systemic association of the condition. Dermatologists should monitor lipid profiles in HS patients to mitigate potential cardiovascular risks through early detection and management.

Estimated prevalence of post-intensive care cognitive impairment at short-term and long-term follow-ups: a proportional meta-analysis of observational studies

OBJECTIVE

Evidence of the overall estimated prevalence of post-intensive care cognitive impairment among critically ill survivors discharged from intensive care units at short-term and long-term follow-ups is lacking. This study aimed to estimate the prevalence of the post-intensive care cognitive impairment at time to < 1 month, 1 to 3 month(s), 4 to 6 months, 7-12 months, and > 12 months discharged from intensive care units.

METHODS

Electronic databases including PubMed, Cochrane Library, EMBASE, CINAHL Plus, Web of Science, and PsycINFO via ProQuest were searched from inception through July 2024. Studies that reported on cognitive impairment among patients discharged from intensive care units with valid measures were included. Data extraction and risk of bias assessment were performed independently for all included studies according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Newcastle-Ottawa Scale was used to measure risk of bias. Data on cognitive impairment prevalence were pooled using a random-effects model. The primary outcome was pooled estimated proportions of prevalence of the post-intensive care cognitive impairment.

RESULTS

In total, 58 studies involving 347,940 patients were included. The pooled post-intensive care cognitive impairment prevalence rates at the follow-up timepoints < 1 month, 1-3 month(s), 4-6 months, 7-12 months, > 12 months were 49.8% [95% Prediction Interval (PI), 39.9%-59.7%, n = 19], 45.1% (95% PI, 34.8%-55.5%, n = 23), 47.9% (95% PI, 35.9%-60.0%, n = 16), 28.3% (95% PI, 19.9%-37.6%, n = 19), and 30.4% (95% PI, 18.4%-43.9%, n = 7), respectively. Subgroup analysis showed that significant differences of the prevalence rates between continents and study designs were observed.

CONCLUSIONS

The prevalence rates of post-intensive care cognitive impairment differed at different follow-up timepoints. The rates were highest within the first three months of follow-up, with a pooled prevalence of 49.8% at less than one month, 45.1% at one to three months, and 47.9% at three to six months. No significant differences in prevalence rates between studies that only included coronavirus disease 2019 survivors. These fundings highlight the need for further research to develop targeted interventions to prevent or manage cognitive impairment at short-term and long-term follow-ups.

Prevalence and determinants of metabolic syndrome among type2 diabetic patients using different diagnosis criteria in ethiopia: systematic review and meta-analysis

BACKGROUND

Metabolic syndrome has become a major public health problem worldwide and is attributable to the spread of different non-communicable diseases such as type 2 diabetes mellitus, coronary artery diseases, stroke, and permanent or temporary disabilities. It is not a single disease entity but encompasses different risk factors. However, there were inconsistencies among previously conducted primary studies, hence this systematic review and meta-analysis aimed to determine the pooled prevalence and determinants of metabolic syndrome among type2 diabetes patients in Ethiopia.

METHOD

First-hand studies about the metabolic syndrome among adult type 2 diabetic patients in Ethiopia were searched through known and international databases (PubMed, Scopus, Web of Science, and Cochran Library) and search engines (Google and Google Scholar). Data was extracted using a standard data extraction checklist developed according to Joanna Briggs Institute (JBI). The I2 statistics are used to identify heterogeneity across studies. Funnel plot asymmetry and Egger's tests were used to check for publication bias. A random effect model was used to estimate the pooled prevalence of the metabolic syndrome among non-insulin-dependent patients in Ethiopia. The STATA version 11 software employed for statistical analysis was conducted using STATA version 11 software.

RESULT

The overall pooled prevalence of metabolic syndrome among type2 diabetic patients in was 54.56% [95%CI (43.73, 65.38), I2 = 97.0%, P = 0.001] using NCEP-ATP III, 48.32% [95%CI (42.1, 54.44), I2 = 97.0%, P = 0.001] IDF diagnosis criteria, 47.0[95%CI(27.01-66.99)], I2 = 97.5%, p = 0.001 using WHO and 59.37%(95%CI(47.21-71.52), I2 = 91.2%, p = 0.001 using harmonized diagnosis criteria respectively. This meta-analysis identified several significant predictors of metabolic syndrome among type 2 diabetes patients in Ethiopia. The odds of having metabolic syndrome was reduced for females (Adjusted Odds Ratio [AOR] = 0.55, 95% CI: 0.35-0.87) compared to males. However, the odds of metabolic syndrome increased with alcohol intake (AOR = 1.44, 95% CI: 1.03-2.01), the odds of living in urban areas(AOR = 2.12, 95% CI: 1.55-2.88), and the odds of having a diabetes duration of six or more years since diagnosis (AOR = 2.94, 95% CI: 1.17-7.41) were significant predictors.

CONCLUSION

The pooled prevalence was considerably high among type 2 diabetic patients in Ethiopia. The pooled prevalence of metabolic syndrome varies as per the diagnosis criteria used with the highest observed in harmonized diagnosis criteria. Being female, being rural residency, alcohol intake, and duration of diabetes since diagnosis were significant predictors of metabolic syndrome among type 2 diabetic patients in Ethiopia.

Research progress on the relationship between fine motor skills and academic ability in children: a systematic review and meta-analysis

Background

In recent years, an increasing number of scholars have begun to focus on the relationship between children's motor development and school activities, with the relationship between children's fine motor skills and academic achievement being a particularly researched area. However, due to different research perspectives among scholars, the results in this field have been somewhat controversial. Therefore, this study aims to delve deeper into the relationship between children's fine motor skills and their various academic abilities through systematic review and meta-analysis.

Method

English databases (PubMed, Web of Science, Embase) and Chinese databases (CNKI, Wei Pu) were searched, and a quantitative meta-analysis was conducted using STATA software, along with a systematic descriptive analysis of the included literature.

Results

From the 1,147 documents retrieved, 11 studies were ultimately included. All meta-analysis results are significant, and there is a medium correlation between fine motor skills and reading ability, a larger correlation is observed with mathematical ability. In the subgroup analysis of each fine motor skill component and academic ability, except for the fine motor coordination, which shows only a small correlation with reading ability, the variables in the other subgroups all exhibit a medium degree of correlation. Notably, the correlation between visual-motor integration and mathematical ability is the strongest in subgroup (r = 0.47).

Conclusion

The meta-analysis provides evidence supporting a positive and statistically significant correlation between preschool children's fine motor skills and learning outcomes. However, the scope of academic abilities examined in this domain is predominantly confined to mathematics and reading. Moreover, existing research largely focuses on surface-level correlational analyses, necessitating deeper exploration into the underlying mechanisms.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42023415498).

Systematic review and bayesian network meta-analysis: comparative efficacy and safety of six commonly used biologic therapies for moderate-to-severe Crohn's disease

Background

In contrast to previous network meta-analysis using classical frequentist methods, we evaluated the efficacy and safety of six frequently-used biologics through a Bayesian method.

Methods

Web of Science, Scopus, CENTRAL, ClinicalTrials.gov and ICTRP were searched to collect randomized controlled trials (RCTs) in adults with moderate-to-severe Crohn's disease, comparing Infliximab, Adalimumab, Certolizumab pegol, Ustekinumab, Risankizumab, or Vedolizumab, relative to placebo or an active comparator for induction of clinical response (two different definitions) and maintenance of clinical remission. A random-effects model was performed with rankings according to the surface under cumulative ranking curve (SUCRA) probability. Finally, we completed sensitivity and consistency analyses, and evaluated the certainty of evidence through GRADE working group guidance.

Results

We identified 22 and 20 RCTs for induction and maintenance therapy, respectively. Infliximab combined with azathioprine was most effective for inducing clinical response in TNF (tumor necrosis factor) antagonist-naïve patients. For TNF antagonist-experienced patients, Ustekinumab (SUCRA 86.19) and Risankizumab (SUCRA 62.56) have the largest SUCRA in induction of clinical response. Risankizumab has the lowest risk of adverse events (SUCRA 84.81), serious adverse events (SUCRA 94.23), and serious infections (SUCRA 79.73) in induction therapy. Adalimumab and the 10 mg/kg regimen of Infliximab rank highest for maintaining clinical remission.

Conclusion

This analysis suggests that Infliximab in combination with azathioprine may be preferred biologic agents for induction therapy in TNF antagonist-naïve patients. For TNF antagonist-experienced patients, Ustekinumab and Risankizumab may be preferred biologic agents for induction therapy. Risankizumab potentially has the lowest safety risk worth exploring in induction therapy. Adalimumab and the 10 mg/kg regimen of Infliximab have maintenance efficacy benefits for responders to induction therapy.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=458609, Identifier CRD42023458609.

Effect of exercise on kidney-relevant biomarkers in the general population: a systematic review and meta-analysis

OBJECTIVE

Physical activity (PA) has been generally recognised as beneficial for health. The effect of a change in PA on kidney biomarkers in healthy individuals without kidney disease remains unclear. This manuscript synthesised the evidence of the association of changes in PA with kidney biomarkers in the general population free from kidney disease.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Embase, PubMed, MEDLINE and Web of Science databases were searched from inception to 12 March 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies of longitudinal or interventional design were selected initially. The following studies were excluded: (1) case-control studies, (2) studies where PA was measured at a single time point, (3) populations with known kidney disease, (4) studies evaluating the impact of a single episode/event of PA and (5) non-English language studies.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data from a pre-designed table and assessed the risk of bias using the Cochrane Risk of Bias tool. Data were pooled using a random-effects model. Hedge's g was used to synthesise effect sizes and obtain an overall estimate. Heterogeneity between studies was measured using I2. Funnel plots and Egger's test were performed to evaluate the risk of biased results.

RESULTS

16 interventional studies with randomised or non-randomised designs involving 500 participants were identified. The median follow-up was 84 days. 10 studies were at high risk of bias. Studies with low quality were published prior to the year 2000. Changes in PA were found only to have a positive association with serum creatinine (SCr) (Hedge's g=0.69; 95% CI 0.13, 1.24; I2=81.37%) and not with plasma renin activity (PRA), urea, or urine albumin-to-creatinine ratio (UACR). The positive association was only observed in people with obesity and those who exercised for more than 84 days.

CONCLUSIONS

Higher levels of PA are associated with increased SCr levels in healthy people. It remains unclear if this association is related to impaired kidney function or gain in muscle mass, as data on other kidney biomarkers did not support a certain link.

PROSPERO REGISTRATION NUMBER

This review has been registered on PROSPERO (CRD42023407820).