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

The clinical performance of high-viscosity glass ionomer-based and bulk-fill resin-based restorations in permanent teeth with occlusal or proximal cavities: a systematic review and meta-analysis

OBJECTIVES

To summarize and analyze existing evidence regarding the clinical performance of high-viscosity glass-ionomer-based materials (HVGIs) and bulk-fill resin-based composites (BFs) in patients with occlusal or proximal cavities in permanent teeth.

MATERIALS AND METHODS

A literature search was conducted using PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Scopus, and Web of Science (WOS) (last update: April 19th, 2024). Randomized control trials (RCTs), retrospective and prospective comparative cohorts were included. Manual searching was performed for twelve relevant dental journals. The primary outcome was the retention of the restoration. The evaluation of included studies, data extraction, and study selection were completed by two independent reviewers. The Cochrane risk-of-bias tool (RoB 2) and the Newcastle-Ottawa scale were used to assess the quality of included studies. A quantitative meta-analysis was conducted, and the overall quality of the evidence was evaluated.

RESULTS

Five RCTs and one retrospective study were included, of which one had a high risk of bias and the others had an unclear risk of bias. In meta-analyses, HVGIs were associated with a less favorable outcome on retention both at one (p = 0.013) and two-year follow-ups (p < 0.0001) compared with BFs. The quality of the evidence was very low.

CONCLUSIONS

Very low certainty evidence suggested that BFs presented favorable clinical performance on retention and marginal adaptation in Class I and II restorations in permanent teeth comparing HVGIs. Nevertheless, HVGIs with a resin-based coating showed acceptable clinical behavior.

CLINICAL RELEVANCE

For patients with a high caries risk, HVGIs serve as a direct restorative alternative for the posterior permanent teeth; however, they should be carefully considered as bulk-fill composite resin alternatives for long-term restoration.

REGISTRATION

PROSPERO (CRD42024535999).

The prevalence of frailty among older adults with maintenance hemodialysis: a systematic

BACKGROUND

To evaluate the epidemiological data on the prevalence of frailty and prefrailty in individuals aged 60 years or older on MHD patients.

METHODS

PubMed, Web of Science, Embase, CNKI, WanFang, CBM, and VIP were searched from inception to February 2023 using combinations of subject words and free words. The methodological quality of all the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal of Epidemiological Studies Checklist and Newcastle‒Ottawa Cohort Quality Assessment Scale. Random effects meta-analysis was used to pool estimates from different studies. Subgroup analysis and meta-regression were performed to explore potential sources of heterogeneity.

RESULTS

Of the 4,190 documents retrieved, 16 observational studies involving 2,446 participants from 8 countries were included in this systematic review. Among older adults receiving MHD, the overall prevalence of frailty and prefrailty was 41% (95% CI = 34-49%) and 37% (95% CI = 26-48%), respectively, with considerable heterogeneity. The pooled prevalence of frailty was greater among individuals aged > 70 years (45%) than among those aged ≤ 70 years (37%). However, subgroup analyses indicated that the confidence intervals for the age group overlap substantially.

CONCLUSION

Our research showed that the prevalence of frailty and prefrailty in older patients with MHD are high.

TRIAL REGISTRATION

The PROSPERO registration number for this study was CRD42023442569.

Knowledge hiding and social exchange theory: a systematic review and meta-analysis

The literature on the antecedents and consequences of knowledge hiding remains fragmented, limiting its practical applications. Social exchange theory (SET), one of the most widely adopted sociological frameworks, offers unique insights into the dynamics of knowledge hiding. This study synthesizes the application of SET in analyzing the nomological framework of knowledge hiding through a systematic literature review and meta-analysis. A meta-analysis was conducted based on the random-effects model and the meta-analytic structural equation modeling method, incorporating 66 primary studies with a total of 20,603 participants. Additionally, we examined the mediating role of knowledge hiding by linking key antecedents and consequences. Moreover, an exploratory analysis was conducted to investigate the moderating effects of national culture and research methodology, providing evidence to justify the true heterogeneity in the pairwise relationships between knowledge hiding and its antecedents. The research results generally support most pairwise relationships between knowledge hiding and its correlates, which were theoretically developed based on SET. This study is the first attempt to explore the explanatory power of SET in analyzing the knowledge-hiding phenomenon, and whether the establishment of a knowledge exchange loop contributes to a deeper understanding of this dyadic construct.

Thyroid disorders in patients with human immunodeficiency virus infection: a meta-analysis

BACKGROUND

Thyroid disorders have significant clinical sequelae, including impaired growth in children, metabolic abnormalities, and impaired cognitive function. However, available studies on burden of thyroid diseases in people with human immunodeficiency virus (HIV), particularly its prevalence and its interaction with HIV related factors (like CD4 count), are controversial. This review aimed to provide a comprehensive summary and analysis on the extent of thyroid dysfunctions in this population.

METHODS

Following Preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, a comprehensive search was done through Medline/PubMed, Web of Science, Science Direct, and World Health Organization Virtual Health Library Regional Portal. Using Comprehensive Meta-Analysis Software version 3.3, we calculated the pooled prevalence and standardized mean difference (SMD) estimates with 95% confidence intervals (CIs).

RESULTS

A total of 30 studies met the eligibility criteria and were further included for the analyses. The most common types of thyroid dysfunction identified among HIV patients were subclinical hypothyroidism (7.7%), overt hypothyroidism (2.7%), sick euthyroid syndrome (2.47%), isolated low FT4 (1.80%), and overt hyperthyroidism (0.7%). Hypothyroidism among HIV patients was significantly associated with lower CD4 count (p < 0.001). The analysis revealed that only FT4 levels had significant differences between patients with HIV and healthy people (p = 0.013).

CONCLUSION

Individuals with HIV are at risk of developing variable manifestations of thyroid abnormalities. While being not abundant in the HIV population, monitoring of thyroid dysfunction is essential due to the potential for progression to overt hypothyroidism and associated adverse health outcomes.

Effects of Tai Chi and Qigong on physical function and psychiatric symptoms among individuals with mental illness: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Tai Chi and Qigong (TCQ) can be a non-pharmacological intervention for individuals with mental illness, improving physical function and mental health.

PURPOSE

This meta-analysis investigated the effects of TCQ on physical function and psychiatric symptoms in adults with schizophrenia or mood disorders.

METHODS

Randomized clinical trials on the effect of TCQ on physical function or psychiatric symptoms in individuals with mental illness, published in English, Korean, or Chinese, were included. A systematic search of 17 electronic databases up to September 2024 was conducted. The risk of bias was assessed using Cochrane RoB 2.0. Data were analyzed through meta-analysis, subgroup analysis, and meta-regression.

RESULTS

Nineteen randomized studies (n = 1243, mean age 53 years) reported outcomes on physical function (k = 11) and psychiatric symptoms (k = 18). The risk of bias assessment showed that 21.1% of studies had a low risk, 73.7% had some concerns, and 5.3% had a high risk. TCQ significantly improved physical function (Hedges' g = 0.53, 95% CI, 0.26-0.81) and psychiatric symptoms (Hedges' g = 0.63, 95% CI, 0.41-0.85) in individuals with serious mental illness (SMI), regardless of intervention duration and comparison type. TCQ showed no significant effect on physical function in individuals with schizophrenia but demonstrated a significant moderate effect in those with mood disorders (Hedges' g = 0.56, 95% CI, 0.32-0.80). TCQ significantly improved psychiatric symptoms in both groups (schizophrenia: Hedges' g = 0.64, 95% CI, 0.26-1.02; mood disorders: Hedges' g = 0.64, 95% CI, 0.33-0.96). Meta-regression indicated that the effects of TCQ on physical function covaries with those on psychiatric symptoms among individuals with SMI (Q = 21.43, df = 9, P = .011).

CONCLUSIONS

TCQ effectively enhances physical function and psychiatric symptoms in individuals with schizophrenia or mood disorders. These findings support TCQ as an effective non-pharmacological intervention for individuals with SMI. Further studies should explore the underlying mechanisms by which TCQ improves psychiatric symptoms through physical function, leading to the development of targeted intervention strategies in this population.*PROSPERO international prospective register of systematic reviews, registration ID CRD42024581253.

Prevalence and determinants of full vaccination coverage according to the national schedule among children aged 12-35 months in Ghana

Universal immunization of children against common vaccine-preventable diseases is crucial in reducing infant and child morbidity and mortality. Assessing the vaccination coverage is a key step to improve utilization and coverage of vaccines for under-five children. Accordingly, vaccination coverage according to the national schedule assesses the vaccination coverage of children aged 12-35 months. However, there is a scarcity of information on the full vaccination coverage according to the national schedule and its determinants in Ghana. Therefore, this study aimed to assess the prevalence and predictors of vaccination coverage according to the national schedule among children aged 12-35 months in Ghana. A cross-sectional study design using the most recent demographic and health survey data from the Ghana Demographic and Health Survey was used. We included a total weighted sample of 1,823 children aged 12-35 months in the five years preceding the survey. We used a multilevel logistic regression model to identify associated factors for vaccination coverage according to the national schedule in Ghana. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of < 0.05 are declared statistically significant. In this study, the full coverage of vaccination according to the national schedule among children aged 12-35 months in Ghana was 56.45% (95% CI 51.77-56.17). Women having an ANC visit were 40% more likely (AOR = 1.40, 95% CI 1.07-1.83), women involved in healthcare decision-making were 35% more likely (AOR = 1.35, 95% CI 1.05-1.75), Women who deliver in a health facility were 1.91 times more likely (AOR = 1.91, 95% CI 1.36-2.66), and communities with high media exposure were 47% more likely (AOR = 1.47, 95% CI 1.06-2.05) to achieve full vaccination coverage as compared to their counterparts. On the other hand, being in the Western (AOR = 0.4, 95% CI 0.18-0.88) and Northern (AOR = 0.33, 95% CI 0.15-0.74) regions decreased the odds of attaining full vaccination coverage according to the national schedule in Ghana. The full vaccination coverage according to the national schedule in Ghana was lower as compared to 90% coverage recommendation by World Health organization, and there is also in-equality among regions. Maternal optimal ANC contact, health facility delivery, women involved in health care decision-making, community media exposure, and region were significantly associated with full vaccination coverage according to the national schedule in Ghana. To improve child immunization coverage, relevant authorities and stakeholders should work together to improve ANC visits, media exposure, facility delivery, and women's empowerment, and attention should be given to deviant regions.

Spatial distribution and determinants of anemia among under-five children in Mozambique

Worldwide, anemia in under-five children is a serious public health problem that causes significant morbidity and mortality. It also negatively impacts children's physical growth, focus, memory, and academic performance. Despite this, there is a paucity of up-to-date information on the spatial distribution and determinants of under-five anemia in Mozambique. Therefore, this study aimed to assess the spatial variation and determinates of anemia among under-five children in Mozambique by using the most recent demographic and health survey data. A cross-sectional study was conducted using the most recent demographic and health survey data of Mozambique. A total weighted sample of 3127 under-five children was included in the study. Spatial SaTScan statistics were done using Kuldroff's SaTScan version 9.6 software. ArcGIS version 10.7 software is used to visualize the spatial distribution of under-five anemia. A multilevel mixed-effects logistic regression analysis was employed to identify the determinants of under-five anemia. The level of statistical significance was declared at a p-value of < 0.05. Overall, the prevalence of anemia among under-five children in Mozambique was 49.46% (95% CI 47.70-51.21). Under-five anemia was not evenly distributed across the country; a higher distribution was observed in Zambezia, Nampula, Safala, and the southern part of Gaza; fewer cold spots were observed in the western and southern parts of Niassa, the eastern part of Tete, the western part of Manica, and Maputo City. In spatial scan statistics, children in the most likely cluster were 1.58 times more likely to be anemic than those living outside the window (RR = 1.58, P-value < 0.001). Children with fathers with no formal education, children from anemic mothers, children whose mothers are underweight, children residing in the Zambzia region, children residing in the Nampula region, and children residing in the Niassa region were significantly associated with under-five anemia in Mozambique. The burden of under-five anemia in Mozambique is higher and distributed non-randomly across regions. Maternal anemia, underweighted mothers, husband education, and regions in Mozambique were found to be significant determinants of anemia in under-five children. Improving the nutritional status of mothers and interventions to address maternal anemia, with special attention to the Nampula and Zambzia regions, are recommended to reduce under-five anemia in Mozambique.

Family involvement in preventing delirium in critically ill patients: A systematic review and meta-analysis

BACKGROUND

Humanized care is a novel concept in the prevention of delirium, with family involvement being a crucial component. Currently, there is controversy regarding the effectiveness of family involvement in preventing delirium among critically ill patients, and the impact of varying levels of family involvement on delirium prevention remains unclear.

OBJECTIVE

The purpose of this study is twofold: (a) to investigate the influence of family involvement on delirium among critically ill patients, and (b) to explore the effectiveness of different levels of family involvement in preventing delirium in these patients.

DESIGN

A systematic review and meta-analysis.

METHODS

From database inception to July 2024, a comprehensive search was conducted across PubMed, EMBASE, CINAHL, Web of Science, and the Cochrane CENTRAL database. Randomized controlled trials that examined family involvement were included in the review.

RESULTS

This review included a total of 11 randomized controlled trials, encompassing 3113 critically ill patients. Family involvement was found to significantly reduce the incidence of delirium among critically ill patients (RR = 0.46, 95%CI = 0.31 to 0.69), decrease the duration of delirium (WMD = -2.18, 95 % CI = -4.14 to -0.22), and shorten the length of Intensive Care Unit (ICU) stay (WMD = -1.46, 95%CI = -2.43 to -0.50). Three different levels of family involvement-direct participation in care (RR = 0.37, 95%CI = 0.26 to 0.51), family visits and companionship (RR = 0.56, 95 % CI = 0.25 to 1.25), and indirect participation (RR = 0.77, 95 % CI = 0.29 to 2.07)-varies in their effectiveness for delirium prevention.

CONCLUSIONS

Family involvement significantly impacts delirium prevention in critically ill patients. The effectiveness of delirium prevention varies depending on the level of family involvement, with direct participation of family members in caregiving demonstrating a more pronounced effect in reducing delirium incidence among critically ill patients.

REGISTRATION

The review protocol has been registered in the PROSPERO International prospective register of systematic reviews (CRD42024563095).

Effectiveness of Massage Therapy for Cancer Pain, Quality of Life and Anxiety Levels: A Systematic Review and Meta-Analysis

AIM

To synthesise the effectiveness of massage therapy for cancer pain, quality of life and anxiety among patients with cancer.

DESIGN

Systematic review and meta-analysis.

METHODS

This review was reported according to the PRISMA guidelines. Studies evaluating the effects of massage therapy on cancer pain, quality of life or anxiety in patients with cancer pain were eligible. The Cochrane Risk of Bias tool and Grading of Recommendations Assessment, Development and Evaluation were used to assess the quality of studies. Outcomes were pooled using standardised mean differences and narratively synthesised when meta-analysis was not possible.

DATA SOURCES

Pubmed, EMBASE, Web of Science, CINAHL, CENTRAL, Google Scholar, ProQuest Theses and Dissertations were searched for English peer-reviewed studies and grey literature published from inception to 8 January 2024.

RESULTS

Thirty-six RCTs involving 3671 participants were included. Massage therapy significantly improved pain (pooled SMD = -0.51, 95% CI -0.68 to -0.33), quality of life (pooled SMD = 0.48, 95% CI 0.19-0.78 when higher scores indicate better quality of life; pooled SMD = -0.52, 95% CI -0.88 to -0.16 when higher scores indicate poorer quality of life) and anxiety (pooled SMD = -0.38, 95% CI: -0.57 to -0.18) post-intervention. All outcomes had very low certainty of evidence. Most studies had unclear or high risk of bias.

CONCLUSION

This review found that massage therapy is beneficial to patients with cancer in improving pain, quality of life and anxiety. Healthcare institutions and healthcare professionals should recognise the value of massage therapy to enhance the care of patients with cancer pain.

REPORTING METHOD

PRISMA guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

REGISTRATION

PROSPERO CRD42023407311.

Beyond Surgery: Psychological Well-Being's Role in Breast Reconstruction Outcomes

INTRODUCTION

Breast cancer is one of the most prevalent cancers worldwide, and following its treatment, many women turn to plastic surgery for reconstruction. A diagnosis of cancer is a heavy burden on patients. Yet, the effect of psychological/psychiatric comorbidities on patient satisfaction following their reconstruction remains unexplored. Thus, this paper aims to investigate how pre-existing psychological and psychiatric conditions impact patient-reported outcomes postreconstruction, compared to women without such conditions.

METHODS

A systematic review of PubMed, Web of Science, and Cochrane was completed. A qualitative synthesis of all included studies was then performed, and a subgroup analysis was then performed using a random effect model.

RESULTS

A total of 24 papers were included, encompassing a total population of 220,565 patients undergoing breast reconstruction between the ages of 18 and 84. The follow-up time ranged between 1.5 mo and 61 mo. In our study of breast reconstruction outcomes, the cohort with psychological/psychiatric comorbidities exhibited significant decreases in postoperative BREAST-Q scores compared to the control group: a 24-point [95% confidence interval (CI; -40, -8)] difference in satisfaction, a 20-point [95% CI (-57, -17)] difference in psychosocial well-being, an 18-point [95% CI (-28, 9)] difference in physical well-being, and a 33-point [95% CI (-51, -15)] difference in sexual well-being.

CONCLUSIONS

Ultimately, our analysis suggests that presurgical psychology status is a critical determinant of postsurgical patient-reported outcomes. These results encourage the development and inclusion of well-being screening and optimization prior to surgery as a mean to improve surgical outcomes.

Can Fiber-reinforced Composites Increase the Fracture Resistance of Direct Composite Restorations in Structurally Compromised Teeth? A Systematic Review and Meta-analysis of Laboratory Studies

OBJECTIVE

Systematic review and meta-analysis on laboratory studies aimed to answer whether there is a difference in fracture resistance and fracture mode of structurally compromised teeth restored with direct composite restorations reinforced with short glass-fiber or bidirectional polyethylene fiber substructure, and between the two different fiber-reinforcement types.

METHODS

An electronic literature search was conducted in Medline, Scopus, Web of Science, Lilacs, Google Scholar, Cochrane Library, and University Library databases. The last search was conducted on 16 November 2023. Only studies looking at Ribbond-reinforced restorations and/ or the use of EverX Posterior within restorations were included. Data were categorized and analyzed based on specific outcome measures including fracture resistance and fracture mode. Data from individual studies were divided into premolars and molars for each material category and then collated to compare the mean differences in fracture resistance between control groups (composite restorations) and intervention groups (fiber-reinforced composite restorations).

RESULTS

From the initial 1266 articles identified, 23 laboratory-based studies were included for quantitative analysis. Twenty articles had an overall low risk of bias and 3 had an overall unclear risk of bias. The pooled estimate of the effect favored the intervention groups as having statistically significant higher fracture resistance when compared to control groups.

CONCLUSIONS

Both fiber types improve fracture resistance and the fracture mode of structurally compromised teeth is equally efficient. Application technique deserves attention. Ribbond could be placed in a single layer at the cavity floor, whereas EverX Posterior should replace missing dentin in an anatomically shaped way.

Magic-themed motor training for daily bimanual task performance in children with unilateral spastic cerebral palsy: A systematic review and meta-analysis

AIM

To evaluate the effectiveness of magic-themed interventions in improving daily bimanual task performance in children with unilateral spastic cerebral palsy (CP) and to elucidate the variability in outcomes.

METHOD

This systematic literature review searched databases including Embase, MEDLINE, Scopus, Cochrane Central, and CINAHL. Outcome measures selected for the meta-analysis included the Children's Hand-use Experience Questionnaire, its three subscales, and the Besta subscale C. The overall efficacy of magic-themed interventions was analysed using Hedges' g as the summary measure for these outcomes. Subgroup analysis compared the efficacy of different modes of training, and a meta-regression investigated the impact of training duration.

RESULTS

Analyses of four studies involving 78 children showed magic-themed training significantly improved bimanual task performance (Hedges' g = 0.327, 95% confidence interval [CI] = 0.107-0.547, p = 0.004), especially in group settings (Hedges' g = 0.435, 95% CI = 0.176-0.693, p = 0.001), compared with non-significant gains from video interventions (Hedges' g = 0.041, 95% CI = -0.380 to 0.462, p = 0.850). Additionally, training duration positively correlated with performance gains (coefficient = 0.0076 per hour, p = 0.001).

INTERPRETATION

Magic-themed training, especially through group sessions and extended durations, enhances bimanual skills in children with unilateral spastic CP.

Treatment outcome and associated factors of burn injury in Ethiopian hospitals: A systematic review and meta-analysis

Introduction

Burn injuries impose a substantial burden globally, particularly in low- and middle-income countries like Ethiopia, where the impact is pronounced. Despite existing studies on individual patient data, there 's a lack of synthesized evidence on burn injury mortality in Ethiopia. This study aimed to evaluate the combined prevalence of burn-related mortality and its determinants in Ethiopian hospitals.

Methods

A systematic search of various databases yielded 11 relevant studies, which were included in the analysis. Data extraction and quality assessment were conducted using Microsoft Excel 2021 and the Newcastle-Ottawa Scale, respectively. Statistical analyses were performed using STATA version 17 software.

Result

The pooled mortality rate among burn patients in Ethiopian hospitals was determined to be 6.99% (95% CI: 4.8, 9.41). Factors significantly associated with mortality included inadequate resuscitation (Adjusted Odds Ratio (AOR) 3.73, 95% CI: 1.31, 10.58), pre-existing illness (AOR: 5.26, 95% CI: 2.12, 13.07), age <5 or >60 (AOR: 2.22, 95% CI: 1.45, 3.40), and burn injury >20% total body surface area (AOR: 5.17, 95% CI: 2.47, 10.80).

Conclusion

The findings underscore a notably high prevalence of burn-related mortality in Ethiopia, with inadequate fluid resuscitation, pre-existing illness, extreme age, and the extent of injury identified as key determinants. Collaboration among healthcare stakeholders and policymakers is imperative to improve burn care services and mitigate the impact of these injuries. This study was registered with PROSPERO (CRD42023494159), providing a comprehensive overview of burn injury mortality in Ethiopia.

Lay Summary

Burn injuries are a significant health concern globally, particularly in low- and middle-income countries like Ethiopia. Despite the existing studies on burn injuries, there's a lack of synthesized evidence on burn injury mortality in Ethiopia. This study aimed to evaluate the combined prevalence of burn-related mortality and its determinants in Ethiopian hospitals.The study systematically reviewed 11 relevant studies and conducted a meta-analysis to determine the prevalence of burn injury mortality and associated factors. The pooled mortality rate among burn patients in Ethiopian hospitals was found to be 6.99%. Factors significantly associated with mortality included inadequate resuscitation, pre-existing illness, age <5 or >60, and burn injury >20% total body surface area.The findings underscore a notably high prevalence of burn-related mortality in Ethiopia, highlighting the need for comprehensive and effective treatment approaches. Inadequate fluid resuscitation, pre-existing illness, extreme age, and the extent of injury were identified as key determinants of mortality. Addressing these factors is crucial for improving burn care outcomes and reducing the burden of burn injuries in Ethiopian hospitals.This study provides valuable insights for healthcare professionals, policymakers, and researchers working towards improving burn injury outcomes in Ethiopia. By understanding the factors influencing treatment outcomes, healthcare stakeholders can refine treatment protocols, enhance resource allocation, and implement preventive measures to reduce the burden of burn injuries in Ethiopian hospitals.

Comparative Effectiveness and Safety of Off-Label Underdosed Direct Oral Anticoagulants in Asian Patients with Atrial Fibrillation: A Systematic Review and Meta-analysis

INTRODUCTION

Off-label underdosed direct oral anticoagulants (DOACs) are commonly utilised in Asian patients with atrial fibrillation (AF) since they are prone to bleeding with OACs. However, the efficacy and safety of off-label underdosing DOACs are controversial. This study aimed to compare the effectiveness and safety of off-label underdosed DOACs in Asian patients with AF.

METHODS

PubMed, Embase, Cochrane library, and ClinicalTrials.gov were searched from 2010 to July 5, 2024, for randomised controlled trials or observational studies that compared off-label DOACs and on-label/warfarin in Asian patients with AF. The primary outcomes included ischaemic stroke or systemic embolism (ISSE) and major bleeding (MB), while secondary outcomes included all-cause death, gastrointestinal bleeding (GIB), intracranial haemorrhage (ICH), and myocardial infarction (MI). Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models.

RESULTS

Twenty observational studies were included. Seventeen studies compared off-label underdosed DOACs versus on-label DOACs, whereas five studies compared off-label underdosed DOACs versus warfarin. Off-label underdosed DOACs were associated with higher risk of ISSE (pooled HR [pHR] = 1.17; 95% CI: 1.00-1.38, p = 0.048) and ICH (pHR = 1.27; 95% CI: 1.06-1.52, p = 0.010) versus on-label. Subgroup analysis demonstrated increased ISSE risk with off-label underdosed rivaroxaban compared to on-label (pHR = 1.49; 95% CI: 1.07-2.08). Compared to warfarin, off-label underdosed DOACs were associated with decreased risk of MB (pHR = 0.46; 95% CI: 0.32-0.65, p < 0.001), GIB (pHR = 0.52; 95% CI: 0.29-0.93, p = 0.028), ICH (pHR = 0.60; 95% CI: 0.42-0.86, p = 0.005), and all-cause death (pHR = 0.70; 95% CI: 0.56-0.87, p = 0.001), while illustrating similar ISSE risk.

CONCLUSIONS

Off-label underdosed DOACs, particularly rivaroxaban, was associated with increased ISSE risk but did not decrease bleeding compared to on-label. Adherence to appropriate DOAC doses should be emphasised to achieve the best clinical outcomes for Asian patients with AF.

Prevalence of metabolic syndrome in children and adolescents with obesity: a systematic review and meta-analysis

OBJECTIVE

This study investigated the prevalence trends of metabolic syndrome (MetS) in children and adolescents with obesity by systematically analyzing global data. Additionally, it aimed to compare regional disparities and criteria used to identify at-risk subpopulations among this demographic group.

METHODS

We searched three major databases, i.e., PubMed-Medline, Scopus, and Web of Science, from inception to August 31, 2023, yielding 2432 articles. We included original research papers reporting MetS prevalence among children and adolescents with obesity, irrespective of their regions and MetS diagnostic criteria used. We aggregated prevalence estimates using random-effects models to obtain the overall prevalence and conducted subgroup analyses for MetS criteria and study regions.

RESULTS

We included 57 studies, amounting to 27,923 participants. The overall prevalence of MetS in participants with obesity varied greatly across studies, ranging from 2.1% to 74.4%, with an average prevalence of 29.4%. This high prevalence of MetS was further supported by a meta-analysis comprising 57 studies that further strengthened the observation of a high prevalence of MetS, revealing an overall prevalence of 26% (95% CI: 0.22-0.30; I2 = 98%).

CONCLUSIONS

Children and adolescents with obesity face a heightened risk of developing MetS. There is a pressing need for heightened attention to this issue, particularly in low- and middle-income countries such as those in sub-Saharan Africa.

Esophagectomy in patients with liver cirrhosis: systematic review and meta-analysis of short-term outcomes

Patients with esophageal cancer and concomitant liver cirrhosis (LC) pose a surgical challenge because of the increased risk of postoperative complications and mortality. Purpose of this study was to review the existing literature and estimate perioperative short-term outcomes of esophagectomy in this patient population. Systematic review and meta-analysis. PubMed, MEDLINE, Scopus, Web of Science, Cochrane Central Library, and ClinicalTrials.gov were queried. The search was last updated on July 30th, 2024. Primary outcomes were anastomotic leak (AL) and 90 day mortality. Ten observational studies were included for a total of 387 patients with LC. The age of the included patients ranged from 35 to 85 years, 91.2% were males. The main causes of liver cirrhosis were alcoholic (75%) and viral hepatitis (20.4%). Esophageal squamous cell carcinoma was diagnosed in 58.7% of patients. Ivor-Lewis esophagectomy with intrathoracic anastomosis was reported in 69.9% of patients, while McKeown esophagectomy with cervical anastomosis was reported in 30.1% of patients. The estimated pooled prevalence of AL and 90-day mortality were 13% (95% CI = 6-24%; I2 = 72%) and 17% (95% CI = 10-27%; I2 = 72%), respectively. The estimated pooled prevalence of postoperative pulmonary complication, sepsis, and liver failure were 52% (95% CI = 39-65%), 30% (95% CI = 14-52%), and 9% (95% CI = 4-17%), respectively. Esophagectomy can be performed in properly selected patients with LC and concomitant esophageal cancer. Foregut surgeons should be aware of the not negligible postoperative complications rates and mortality. Risk stratification and attentive perioperative care are essential to minimize serious adverse events.

Lack of association between TRPV1 gene polymorphisms and risk of migraine chronification: a case-control study and meta-analysis

OBJECTIVE

To confirm a previously reported association of TRPV1 rs8065080 with the risk of transformation from episodic (EM) to chronic migraine (CM) and to extend knowledge about the role of other TRPV1 single nucleotide polymorphisms (SNPs), we first investigated the impact of three TRPV1 SNPs (rs8065080, rs222747 and rs222749) on the risk of migraine chronification in a case-control study. A systematic review and meta-analysis were then conducted to summarize the accumulated findings.

METHODS

Genotyping of the selected TRPV1 SNPs was performed using TaqMan real-time PCR in 167 EM and 182 CM participants. Crude and adjusted odds ratios with associated 95% confidence intervals were calculated in the log-additive, dominant, and recessive genetic models. A comprehensive literature search was performed in PubMed, Web of Knowledge, Cochrane Library, and OpenGrey until February 2024.

RESULTS

In our case-control study, no association was found between TRPV1 SNPs and the risk of migraine chronification, both in the unadjusted logistic regression models and after adjustment for confounding clinical variables. The results of the meta-analysis with a total of 241 participants with EM and 223 with CM confirmed no association between TRPV1 SNPs and the risk of migraine chronification in any of the genetic models tested.

CONCLUSION

The results of the present case-control study and meta-analysis exclude a major role of TRPV1 rs8065080, rs222747, and rs222749 as risk factors for migraine chronification. However, further research is needed to investigate the gene-gene and gene-environment interactions of TRPV1 SNPs on the risk of transformation from episodic to chronic migraine.

Sonographic Assessment of Asymptomatic Patellar and Achilles Tendons to Predict Future Pain: A Systematic Review and Meta-analysis

OBJECTIVE

Patients with clinical tendinopathy often demonstrate significant abnormalities with ultrasound (US) imaging. Tendon abnormalities likely precede pain in these patients. The purpose of this review was to systematically evaluate the available literature regarding the utility of US imaging as a method to predict Achilles and patellar tendon pain.

DESIGN

Systematic review and meta-analysis. Inclusion criteria were as follows: prospective studies of Achilles and patellar tendon pain development with baseline US measurements, follow-up clinical measurements, and English-language studies published after 2000. Exclusion criteria were prior rupture or surgery and presence of rheumatologic disorder.

SETTING

N/A.

PATIENTS

Athletes without Achilles or patellar tendon pain at baseline.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURES

Risk ratios (RRs) were identified for the development of pain in those with Achilles or patellar tendon sonographic abnormalities.

RESULTS

This review of 16 studies included 810 Achilles and 1156 patellar tendons from a variety of sports and demonstrated that the RR for pain development from abnormal Patellar and Achilles tendons was 6.07 [95% confidence interval (CI), 2.88-12.81; P < 0.001] and 3.96 [95% CI, 2.21-7.09; P < 0.001], respectively. The positive and negative predictive values of an abnormal US finding were 27.2% and 92.0% for the Achilles tendon and 27.2% and 93.5% for the patellar tendon, respectively.

CONCLUSIONS

This systematic review and meta-analysis identified that the use of asymptomatic US scanning of the Achilles or patellar tendon has a low positive predictive value but a high negative predictive value for the future development of pain.

Effectiveness of nurse-led self-care interventions on quality of life, social support, depression and anxiety among people living with HIV: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

People living with HIV often face challenges related to quality of life, mental health, and social support. Nurse-led self-care interventions have been proposed as a means to address these issues, but their overall effectiveness needs systematic evaluation.

OBJECTIVES

To systematically review and meta-analyze the effectiveness of nurse-led self-care interventions on quality of life, social support, depression, and anxiety among people living with HIV.

DESIGN

A systematic review and meta-analysis of randomized controlled trials.

METHODS

A systematic search of PubMed, EMBASE, Web of Science (Core Collection), Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Scopus, and PsycINFO (Ovid) was conducted for articles from inception to May 2024. Two authors independently screened studies and extracted data. Randomized controlled trials that investigated the effects of nurse-led self-care interventions on the quality of life, social support, depression, and anxiety in people living with HIV, published in English, were included. The quality of the included studies was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were conducted using Review Manager 5.3 and Stata17, and the certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Nineteen randomized controlled trials published between 2003 and 2024 were included. The meta-analysis showed that compared to the control group, nurse-led self-care interventions significantly improved quality of life (SMD = 0.45, 95 % CI: 0.07 to 0.84, P < 0.05) and reduced depression (SMD = -0.46, 95 % CI: -0.75 to -0.17, P < 0.001; RR = 0.80, 95 % CI: 0.68 to 0.94, P < 0.05). The impact on social support was not statistically significant (SMD = -0.02, 95 % CI: -0.25 to 0.22, P = 0.89). Only two studies reported beneficial effects on anxiety, indicating a need for further high-quality research.

CONCLUSION

Nurse-led self-care interventions effectively improve the quality of life and reduce depression in people living with HIV, but current evidence shows these interventions have little impact on social support. The evidence regarding anxiety is limited, indicating a need for more rigorous research to explore the potential benefits of these interventions for anxiety in people living with HIV. These findings support the inclusion of nurse-led self-care interventions in routine HIV care to enhance the well-being of people living with HIV.

REGISTRATION NUMBER

(PROSPERO): CRD42024548592.

Systematic review and meta-analysis of the pelvic organ prolapse and vaginal prolapse among the global population

Background

Pelvic organ prolapse (POP) occurs when one or more pelvic organs (uterus, bowel, bladder or top of the vagina) descend from their normal position and bulge into the vagina. Symptoms include pelvic discomfort, fullness, and changes in bladder or bowel function. Treatment ranges from conservative approaches to surgery, depending on symptom severity. Surgical methods include vaginal wall repair, with or without hysterectomy, or via laparoscopic, robotic or open techniques. Common complications include bleeding, infection, and urinary or bowel dysfunction.

Methods

A systematic review was conducted, and a protocol was registered with PROSPERO (CRD42022346051). Publications from 30 April 1980 to 30 April 2023 were retrieved from multiple databases. Data were analysed using random-effects and common-effects models with subgroup and sensitivity analyses.

Findings

Forty-four studies met the inclusion criteria, with 29 studies used for meta-analysis of vaginal prolapse surgery outcomes. Sixteen studies focused on patients who had undergone hysterectomy alongside prolapse repair.

Interpretation

Patients who underwent vaginal prolapse surgery with hysterectomy experienced higher operative and postoperative complication rates than those without hysterectomy. Increased risks included hospital readmission, POP recurrence and re-operation. The review highlighted a lack of diversity in terms of ethnicity, age and comorbidity status, which are essential to fully understanding the impact of POP. Future research should focus on these underrepresented factors.

Medialized vs. Lateralized Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures: A Systematic Review and Meta-Analysis

BACKGROUND

Reverse shoulder arthroplasty (RSA) is increasingly used in the treatment of proximal humerus fractures (PHFs) with reliable clinical improvement. Lateralized RSA implants have conferred superior outcomes compared with the original Grammont design in patients with nontraumatic indications. However, in the setting of a PHF, lateralized components can place increased tension across the tuberosity fracture site and potentially compromise tuberosity healing and outcomes. This systematic review and meta-analysis sought to determine the effect of implant design on clinical outcomes after RSA for PHFs.

METHODS

A systematic review was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried for clinical studies on RSA performed for PHFs that reported implant manufacturer details. Our primary outcomes included postoperative external rotation (ER), forward elevation (FE), abduction, Constant score, rate of greater tuberosity (GT) healing, and the incidence of complications compared between medialized vs. lateralized global implant design.

RESULTS

Globally lateralized RSA cohorts (478 RSAs total with cumulative lateral offset achieved through humeral or glenoid lateralization or both humeral and glenoid lateralization) were found to have a greater mean postoperative Constant score compared with globally medialized (medialized glenoid and medialized humerus) RSA cohorts with 1,494 total medialized RSAs (66 vs. 59, p = 0.006), but there was no significant difference regarding mean postoperative ER (30° vs. 22°, p = 0.078), FE (117° vs. 119°, p = 0.708), or abduction (103° vs. 107°, p = 0.377). On meta-regression, neither implant design nor tuberosity status significantly influenced postoperative ER, FE, abduction, or Constant score on meta-regression independent of mean follow-up and age at surgery. The rate of GT healing was greater in lateralized compared with medialized RSAs (88% vs. 72%, p < 0.001). On meta-regression, medialized RSA design was associated with a 73% lower odds of GT healing (odds ratio = 0.27, 95% confidence interval = 0.11-0.68, p = 0.007) independent of mean follow-up and age at surgery.

CONCLUSION

Lateralized RSA implants conferred no significant functional benefit over medialized implants when used in patients with PHFs.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Insights into the systemic risk factors associated with diabetic retinopathy in the Indian population: A comprehensive systematic review and meta-analysis

Diabetic retinopathy (DR) is a predominant cause of vision impairment globally. Understanding risk factors is crucial for effective planning. The aim of this study is to comprehensively investigate the risk factors in the Indian population contributing to the increased incidence of DR, which is a potentially sight-threatening complication among diabetic individuals. A comprehensive literature search was done on PubMed, Embase, and Google Scholar databases for epidemiological studies reporting risk factors in the adult Indian population in the English language. Joanna Briggs Institute's (JBI) critical appraisal tools were used to assess the quality of the included studies. Analysis was performed using R studio. I2 statistic was used for the assessment of heterogeneity. Results are expressed as odds ratio (OR) and standardized mean difference (SMD) along with a 95% confidence interval (CI). Overall, 20 studies enrolling 4,12,421 patients with 1,04,104 DR-positive and 3,08,317 DR-negative adults were analyzed. Being male (OR: 1.38, 95% CI: 1.11-1.72), intake of insulin (OR: 2.05, 95% CI: 1.02-4.14), higher HbA1c levels (MD: 0.50, 95% CI: 0.06-0.94), higher random (MD: 0.32, 95% CI: 0.10-0.55), and fasting blood glucose levels (MD: 0.51, 95% CI: 0.10-0.93) were found to be significantly associated with increased risks of DR among diabetic patients, while age, body mass index, hypertension, lipid profile, and smoking status did not indicate any association with DR. Good glycemic control remains the most important modifiable risk factor to reduce the risk of progression of DR and vision loss.

A systematic review with meta-analysis of heritability estimates for temperament-related traits in beef and dairy cattle populations

Temperament (docility) is a key breeding goal in the cattle industry due to its direct relationship with animal welfare, cattle handler's safety and animal productivity. Over the past six decades, numerous studies have reported heritability estimates for temperament-related traits in cattle populations ranging from low to high values. Therefore, the primary objective of this study was to perform a comprehensive systematic review with meta-analysis to obtain weighted estimates of heritability for temperament-related traits in worldwide cattle populations. After data editing and quality control, 106 studies were included in the systematic review, of which 29.2% and 70.8% reported estimates of heritability for temperament-related traits in dairy and beef cattle populations, respectively. Meta-analyses were performed for 95 heritability estimates using a random model approach. The weighted heritability estimates were as follow: (a) flight score at weaning = 0.23 (95% CI: 0.15-0.32); (b) flight speed at weaning = 0.30 (95% CI: 0.26-0.33); (c) joint analysis of flight speed and flight score at weaning = 0.27 (95% CI: 0.22-0.31); (d) flight speed at yearling = 0.26 (95% CI: 0.21-0.30); (e) joint analysis of flight speed at weaning and yearling = 0.27 (95% CI: 0.24-0.30); (f) movement score = 0.12 (95% CI: 0.08-0.15); (g) crush score at weaning = 0.21 (95% CI: 0.17-0.25); (h) pen score at weaning = 0.27 (95% CI: 0.19-0.34); (i) pen score at yearling = 0.20 (95% CI: 0.17-0.23); (j) joint analysis of pen score at weaning and yearling = 0.22 (95% CI: 0.18-0.26); (k) cow's aggressiveness at calving = 0.10 (95% CI: 0.01-0.19); (l) general temperament = 0.13 (95% CI: 0.06-0.19); (m) milking temperament = 0.16 (95% CI: 0.11-0.21); and (n) joint analysis of general and milking temperament = 0.14 (95% CI: 0.11-0.18). The heterogeneity index ranged from 0% to 77%, and the Q-test was significant (p < 0.05) for four single-trait meta-analyses. In conclusion, temperament is moderately heritable in beef cattle populations, and flight speed at weaning had the highest weighted heritability estimate. Moreover, between-study heterogeneity was low or moderate in beef cattle traits, suggesting reasonable standardization across studies. On the other hand, low-weighted heritability and high between-study heterogeneity were estimated for temperament-related traits in dairy cattle, suggesting that more studies are needed to better understand the genetic inheritance of temperament in dairy cattle populations.

Repetitive Transcranial Magnetic Stimulation for Motor Recovery After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials With Low Risk of Bias

OBJECTIVES

Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in enhancing motor recovery after stroke, but nuances regarding its use, such as the impact of the type and site of stimulation, are not yet established. We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) with low risk of bias to investigate the effect of rTMS on motor recovery after both ischemic and hemorrhagic stroke.

MATERIALS AND METHODS

Three databases were searched systematically for all RCTs reporting comparisons between rTMS (including theta-burst stimulation) and either no stimulation or sham stimulation up to August 19, 2022. The primary outcome measure was the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Secondary outcome measures comprised the Action Research Arm Test, Box and Block Test, Modified Ashworth Scale for the wrist, and modified Rankin Scale (mRS).

RESULTS

A total of 37 articles reporting 48 unique comparisons were included. Pooled mean FMA-UE scores were significantly higher in the experimental group than the control group after intervention (MD = 5.4 [MD = 10.7 after correction of potential publication bias], p < 0.001) and at the last follow-up (MD = 5.2, p = 0.031). On subgroup analysis, the improvements in FMA-UE scores, both after intervention and at the last follow-up, were significant in the acute/subacute stage of stroke (within six months) and for patients with more severe baseline motor impairment. Both contralesional and ipsilesional stimulation yielded significant improvements in FMA-UE at the first assessment after rTMS but not at the last follow-up, while the improvements from bilateral rTMS only achieved statistical significance at the last follow-up. Among the secondary outcome measures, only mRS was significantly improved in the rTMS group after intervention (MD = -0.5, p = 0.013) and at the last follow-up (MD = -0.9, p = 0.001).

CONCLUSIONS

Current literature supports the use of rTMS for motor recovery after stroke, especially when done within six months and for patients with more severe stroke at baseline. Future studies with larger sample sizes may be helpful in clarifying the potential of rTMS in poststroke rehabilitation.

Association between long-term ambient air pollution exposure and the incidence of breast cancer: A meta-analysis based on updated evidence

BACKGROUND

Air pollution is a significant risk factor for breast cancer. However, epidemiological studies have yielded inconsistent results. Previous systematic reviews and meta-analyses have identified an association between nitrogen dioxide (NO2) exposure and the incidence of breast cancer, yet no consistent association has been observed for particulate matter (PM). With recent studies providing new evidence, updated meta-analyses are necessary.

METHODS

Relevant studies were identified through comprehensive literature searches in the Web of Science and PubMed databases. The pooled effect estimates for the associations of NO2, PM2.5, and PM10 with breast cancer incidence were calculated using a random-effects model. Publication bias was corrected, and sensitivity analyses were conducted to ensure the robustness of the findings. Subgroup analyses were performed based on menopausal status, hormone receptor subtype, and study region.

RESULTS

A total of 22 studies were included in this meta-analysis. The pooled hazard ratios with 95 % confidence intervals (CIs) for breast cancer incidence per 10 μg/m3 increase in NO2 and PM2.5 were 1.02 (95 % CI: 1.01, 1.03) and 1.06 (95 % CI: 1.02, 1.11), respectively. No significant association was observed between PM10 and breast cancer incidence. NO2 and PM10 exposures were significantly associated with the incidence of postmenopausal breast cancer. The associations of NO2, PM2.5, and PM10 with estrogen/progesterone receptor-positive (ER+/PR+) breast cancer were not significantly different from those with estrogen/progesterone receptor-negative (ER-/PR-) breast cancer. Exposure to both NO2 and PM2.5 was associated with breast cancer incidence in Europe, whereas in North America, only NO2 exposure showed a significant association.

CONCLUSION

This study is the first to document a significant association between long-term exposure to ambient PM2.5 and breast cancer incidence through meta-analysis. Air pollution has a pronounced impact on postmenopausal breast cancer, and the strength of the association between specific air pollutants and breast cancer incidence varies across regions. These findings suggest that long-term exposure to NO2 and PM2.5 may increase the incidence of breast cancer.

Association of HLA-DR, HLA-DQ, and HLA-B alleles with inclusion body myositis risk: A systematic review, a meta-analysis, a meta-regression and a trial sequential analysis

INTRODUCTION

Although, several studies have assessed the association of HLA Class I and II genes with inclusion body myositis (IBM), results were inconsistent and between-studies heterogeneity needs to be investigated.

OBJECTIVES

The aim of this review was to summarize existing data on the contribution of HLA-DRB1 and HLA-B alleles to IBM susceptibility and to investigate the between-studies heterogeneity by subgroup analyses and meta-regressions.

DESIGN

This study was performed according to the PRISMA guidelines for systematic reviews and meta-analyses.

METHODS

An electronic literature search for eligible studies among all papers published prior to January 29, 2025, was conducted through PubMed, EMBASE, Web of science, and Scopus databases. Meta-analyses together with subgroup analyses and meta-regressions were performed for the two following HLA genes: HLA-DRB1 and HLA-B.

RESULTS

Combined analyses revealed a significant increase in IBM risk conferred by the HLA-DRB1*03 allele (9.21 (7.05-12.01)), the DRB*03:01 allele (8.44 (6.85-10.41)), the DRB1*01 allele (2.31 (1.82-2.93)), the DRB1*01:01 allele (2.63 (1.95-3.55)), the DRB1*15:02 allele (3.49 (2.12-5.75)), the B*08 allele (4.05 (2.58-6.38)), and the DQB1*02 allele (6.62 (4.5-9.74)), all p-values < 0.001. In addition, the DRB1*15:01 allele was found to be protective against IBM in all populations (0.48 (0.32-0.72)). Conversely, the DRB*11 allele was not associated with IBM risk, OR (95% CI) = 0.91 (0.54-1.51), p = 0.703.

CONCLUSION

This meta-analysis demonstrated that HLA-DRB1, DQB1, and B loci could play a major role in IBM pathogenesis.

REGISTRATION

This review has been registered on PROSPERO on June 25, 2024: CRD42024557948, Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024557948.

Economic assessment of animal disease burden in Senegalese small ruminants

Small ruminant production in sub-Saharan Africa is limited by a range of constraints, including animal health issues. This study aimed at estimating the impact of these issues on the small ruminant production in Senegal in a holistic manner, using an approach developed by the Global Burden of Animal Diseases (GBADs) programme. The estimation focused on the mixed crop-livestock system, representing a large proportion (>60 %) of the small ruminant population in the country. It was based on existing data collected via a systematic literature review, acquisition of secondary datasets from local stakeholders, and expert elicitation. A dynamic population model was used to calculate the gross margin of the sector under both the current health constraints and an ideal health state, where animals are not exposed to causes of morbidity and mortality. The difference between the current and ideal health scenarios, termed the Animal Health Loss Envelope (AHLE), provides a quantitative measure of the farm-level cost of disease in the system. The all-cause AHLE was estimated at 292 billion FCFA (468 million USD, with 95 % prediction interval 216 - 366 billion FCFA) per year for 2022, for a population of 8.8 million animals. The contribution of Peste des Petits Ruminants (PPR) was modelled separately, as an example of attributing part of the AHLE to a specific disease cause. PPR was estimated to contribute 5 % of the total AHLE. The animal disease burden experienced by Senegalese livestock keepers was largely due to loss in animals and production, with relatively small amounts of animal health expenditure. Implementation of this study contributed to the further development of the GBADs approach. Such estimates can support decision making at all levels, from investment decisions at the international level to local disease awareness campaigns targeting livestock keepers.

Prevalence and Economic Significance of Fasciolosis among Cattle Slaughtered at Municipal Abattoirs in Ethiopia from 2010 to 2023: A Systematic Review and Meta-Analysis

BACKGROUND

Fasciolosis is a prevalent disease that significantly impairs the health and productivity of cattle and causes significant economic damage. Beyond the individually available studies with varying prevalence rates, there are no pooled national prevalence studies on bovine fasciolosis. Therefore, the current study aims to determine the pooled prevalence and economic significance of fasciolosis among cattle in Ethiopia.

METHODS

Cochrane's Q, inverse variance (I2), sensitivity analysis, funnel plots, Begg's and Egger's regression tests were used to assess heterogeneity and publication bias. A random-effects model was used to calculate the pooled burden of fasciolosis among cattle.

RESULTS

The pooled prevalence of fasciolosis among cattle was 28.02% (7626/27,604) with (95% CI: 24.77%-31.26%). About 25.58% (3200/12,639) with (95% CI: 20.89, 30.27) and 30.45% (4426/14,965) with (95% CI: 26.05, 34.85) were found to harbour Fasciola through coprological inspection and post-mortem examination, respectively. Among a total of 14,965 livers of slaughtered cattle examined in municipal abattoirs, Fasciola hepatica (54.43%) was the predominant fluke identified compared to Fasciola gigantica (23.21%). Mixed infections of both species and unidentified immature flukes were detected in 15.04% and 7.02% of the affected livers, respectively. Regarding the severity of the pathological lesions observed, 35.08%, 49.31% and 15.61% of the livers were mildly, moderately and seriously infested, respectively. The total annual economic significance of fasciolosis among cattle from 21 reported studies was approximately 43,240,653.2 ETB (US$4,069,100.649). Increasing and decreasing trends of pooled fasciolosis prevalence were observed from 2010 to 2023 in coprological examination and post-partum inspection, respectively.

CONCLUSION

Therefore, bovine fasciolosis requires integrated control methods to address its influence on animal health and economic impact.

Ecological and environmental effects of global photovoltaic power plants: A meta-analysis

The construction of photovoltaic power plants (PVPPs) globally not only mitigates climate change but also exerts various impacts on terrestrial ecosystems. A comprehensive exploration of the intensity of PVPPs on the ecological environmental elements of terrestrial ecosystems, as well as their regulatory mechanisms, is an urgent scientific issue that must be addressed within the context of carbon balance. In this study, we conducted a meta-analysis to investigate the soil, climate, and biological effects of PVPPs construction, as well as changes in ecosystem CO2 fluxes. Our analysis synthesized data from 42 original studies encompassing over 4300 observations. Findings revealed that a significant reduction in wind speed and soil temperature within the photovoltaic field, with average changes of -63.55% (confidence intervals (CI): [-70.77, -56.32]) and -9.72%, CI [-18.51, -0.93], respectively. Concurrently, there was an average increase of 301.63%, CI [14.14, 589.13] in soil moisture content and gross primary productivity, and 28.52%, CI [14.29, 42.75], respectively. However, no significant effects were observed on other ecological environmental factors. Both the random forest model and mixed effects model highlighted key driving factors such as air temperature and humidity, location under the photovoltaic panel, monthly variations, geographical environment, and photovoltaic scale, which influenced the ecological responses to PVPPs. Furthermore, statistical cluster analysis demonstrated that the thresholds of key driving factors will significantly affect the response of ecological environment factors to PVPPs. This study enhances our comprehension of the ecological and environmental implications of PVPPs construction and offers valuable insights for policymakers aiming to implement 'photovoltaic + ecological' integrated management strategies.

Prevalence of refractive errors among school students in Iraq - A systematic review and meta-analysis

PURPOSE

This research aimed to thoroughly examine and meta-analyse statistical information about the prevalence of refractive error in Iraq.

METHODS

To discover every pertinent Iraqi epidemiological study from March 2014 to March 2024, Scopus, Science Direct, Google Scholar, Embase, PubMed, and the Cochrane Library were searched and reviewed. The Iraqi refractive error rate was interesting. The Comprehensive Meta-Analysis Software received unprocessed events and sample sizes for effect size calculations.

RESULTS

A meta-analysis was undertaken by pooling data from 10 studies. The fixed effects model indicates an estimated effect size of 29.8% (95% CI: 28.6-30.9%). However, the statistical measures of heterogeneity (Q-value p < 0.001; I2 = 98.707) showed significant heterogeneity among the studies, which indicates that a random-effects model should be used. The random effects model suggests that the prevalence of refractive error in the Iraqi population is predicted to be 27.6% (95% CI: 18.9-38.5%). The most common refractive defect was myopia, found in 35.1% of cases (95% CI: 24.9-46.8%). Astigmatism was the second most prevalent, affecting 32.2% (95% CI: 19.1-49.0%), followed by hyperopia in 23.9% (95% CI: 16.0-34.2%).

CONCLUSIONS

Current estimate of refractive error prevalence in Iraq may be conservative of this condition's burden. Nevertheless, this corresponds to a minimum of 8 to 18 million individuals in Iraq who have a refractive error. Due to study variability, wide estimate ranges, and random effects, more research and reliable sources are needed to obtain more accurate results.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in retinal artery occlusion: a meta-analysis

PURPOSE

The goal of this meta-analysis is to examine the association between Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) in patients with Retinal Artery Occlusion (RAO). The analysis aims to provide insight into the potential of NLR and PLR as inflammatory biomarkers for RAO.

METHODS

Following PRISMA guidelines, a systematic search in PubMed, Embase, and Scopus identified eight eligible studies. The analysis assessed serum NLR and PLR levels in RAO and non-RAO groups by employing standardized mean differences (SMDs). Sensitivity analyses and publication bias were examined. The diagnostic performance of these markers was evaluated with a quantitative synthesis.

RESULTS

The meta-analysis, involving 1,444 participants, demonstrated significantly elevated NLR (SMD = 0.88, 95% CI: 0.49-1.28, P < 0.001) and PLR (SMD = 0.45, 95% CI: 0.16-0.73, P < 0.001) levels in individuals with RAO. Significant heterogeneity was noted. Sensitivity analysis showed robustness and no significant publication bias was found. Summary results of diagnostic performance revealed promising discriminatory power for NLR and PLR.

CONCLUSIONS

The results support a possible connection between systemic inflammation, as indicated by NLR and PLR, and the occurrence of RAO. Although there was heterogeneity, sensitivity analyses showed the findings to be robust. While immediate diagnostic applications are limited, understanding the role of NLR and PLR in the pathological process of RAO provides valuable insights for developing future predictive models, risk management approaches, and treatment strategies. Further research exploring mechanistic insights and conducting prospective studies is warranted to validate their clinical utility.

KEY MESSAGES

What is known Retinal artery occlusion (RAO) is a serious condition with potential links to systemic inflammation and thrombosis. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are emerging inflammatory markers. What is new This is the first meta-analysis examining the association between NLR, PLR and RAO. Elevated NLR and PLR levels were observed in patients with RAO compared to controls. NLR and PLR show potential as indicators of systemic inflammation in RAO pathogenesis.

Survival outcomes of endometrial cancer patients with disease involving the lower uterine segment: A meta-analysis

OBJECTIVES

Lower uterine segment (LUS) involvement is encountered in a small proportion of endometrial cancer patients and is associated with aggressive histological features. Despite the available evidence, there seems to be a lack of consensus concerning its actual impact on disease related survival.

STUDY DESIGN

The search strategy involved the Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar databases. Nine studies were included in the present systematic review that recruited 3300 patients. Pooled hazard ratios (HR) were retrieved from Cox-regression analyses to limit the confounding effect of other factors that influence the course of the disease.

RESULTS

Nine articles were included in the present meta-analysis that involved 3300 endometrial cancer patients. The meta-analysis revealed a significant difference in progression free survival that was found increased in patients without LUS involvement (HR 1.59, 95 % CI 1.22, 2.05, data from 9 studies). Similarly, a significantly smaller overall survival was observed among patients with LUS involvement (HR 1.69, 95 % CI, 1.34, 2.13, data from 7 studies). Sensitivity analysis revealed that there were no outliers in either outcome, however, the possibility of data manipulation could not be ruled out entirely.

CONCLUSION

The results of this meta-analysis indicate that lower uterine segment involvement is associated with decreased survival outcomes. It remains unclear if these patients can benefit from adjuvant treatment in the absence of other negative prognostic indicators and this needs to be examined by future studies.

Efficacy of flash glucose monitoring on HbA1c in type 2 diabetes: An individual patient data meta-analysis of real-world evidence

AIMS

There is a growing body of evidence demonstrating the benefit of flash glucose monitoring in type 2 diabetes mellitus (T2DM). This individual patient data meta-analysis aimed to investigate the impact of commencing flash glucose monitoring on HbA1c in people living with T2DM treated with insulin in a real-world setting.

METHODS

A meta-analysis of eight observational studies which assessed change in HbA1c at 3-6 months following initiating flash glucose monitoring for which Abbott Diabetes Care could provide individual patient data was performed. Studies included adults with T2DM managed with insulin and baseline HbA1c between 8.0 %-12.0 % (64-108 mmol/mol). A one-stage model was created to explore heterogeneity.

RESULTS

A total of 803 patients were included in the analysis (mean(SD) age: 62.8(11.4) years, BMI: 32.2(6.8) kg/m2, baseline HbA1c 9.0(0.9) % [75 (10) mmol/mol]). Commencement of flash glucose monitoring was associated with an HbA1c reduction of 0.89 % (95 % CI 0.71 to 1.08) (9.8 mmol/mol (95 % CI 7.8 to 11.8)) at 3-6 months. In the one stage model, age, BMI and baseline HbA1c accounted for the substantial heterogeneity observed between studies.

CONCLUSIONS

Commencement of flash glucose monitoring was associated with a significant reduction in HbA1c at 3-6 months in a real-world setting in T2DM managed with insulin.

Effect of AI intervention programs for older adults on the quality of life: A systematic review and meta-analysis of randomized controlled trials

Background

The extension of life expectancy due to medical advancements has resulted in global aging and increased social costs for elder care. Additionally, stringent health measures related to infectious disease pandemics have adversely affected the quality of life for older adults. This study investigates AI-based interventions to address quality of life issues.

Objective

This study systematically examines AI interventions for the older adults, focusing on randomized experimental studies, and aims to provide guidelines for future intervention programs through meta-analysis.

Method

A comprehensive meta-analysis that examines the impact of various AI interventions on the overall quality of life experienced by older adults has been conducted, encompassing thirteen randomized controlled trials.

Results

The overall effect size of AI intervention programs on the quality of life in the older adults, assessed using the random-effects model, was found to be small (Hedges' g = 0.30, 95% CI = 0.10-0.51). Additionally, the effect size of quality of life was examined based on the subfactors of the AI intervention program, revealing a range of 5-11 weeks. Robot intervention exhibited a higher effect size than smart device intervention.

Conclusion

To improve the quality of life of older adults, further investigation is warranted, including a follow-up study to develop a AI-based intervention program tailored to the type of AI program and intervention duration.

Ferric carboxymaltose for iron deficiency in patients with heart failure: a systematic review and meta-analysis

Aim: Iron deficiency (ID) is associated with heart failure (HF) in a considerable proportion of patients. To improve the quality of life, lower the frequency of hospitalizations, and lower mortality rates of chronic HF patients (HF), this meta-analysis will look into the role of iron supplementation using ferric carboxymaltose (FCM). Methods & results: From inception until 1 October 2023, we conducted a thorough literature search of electronic databases for peer-reviewed publications. Around 5229 HF patients were included, of which 2691 received FCM while 2538 received placebo. Conclusion: FCM reduces HF-related hospitalizations but doesn't improve overall or cardiovascular mortality in those with HF and ID. The overall results support FCM's role in managing iron deficiency in heart failure.

Fire Reduces Soil Nitrate Retention While Increasing Soil Nitrogen Production and Loss Globally

Elucidating the response of soil gross nitrogen (N) transformations to fires could improve our understanding of how fire affects N availability and loss. Yet, how internal soil gross N transformation rates respond to fires remains unexplored globally. Here, we investigate the general response of gross soil N transformations to fire and its consequences for N availability and loss. The results showed that fire increased gross N mineralization rate (GNM; +38%) and ammonium concentration (+47%) as a result of decreased soil C/N ratio but decreased microbial nitrate immobilization (INO3; -56%), resulting in increased nitrous oxide (N2O; +50%) and nitric oxide (+121%) emissions and N leaching (+308%). Time since fire affected soil N cycling and loss. Fire increased GNM, ammonium concentration, and N2O emission, and decreased INO3 only when time since fire was less than one year, while increased N leaching in the short (one year) terms. Thus, the consequences of fire were a short-lived increase in N availability and N2O emissions (lasting less than one year) but with persistent risks of N loss by leaching over time. Overall, fire increased the potential risks of N loss by stimulating N production and inhibiting nitrate retention.

The effects of high-intensity interval training on cognitive performance: a systematic review and meta-analysis

Cognitive decline is an important feature of an aging population. Despite the large body of research investigating the effects of high-intensity interval training (HIIT) on cognitive performance, reports of its effectiveness are inconsistent and it is difficult to determine what factors moderate these effects. The purpose of this study was to conduct a meta-analysis of existing randomised controlled trials investigating the effects of HIIT on various domains of cognitive performance, and to further examine the intervention cycle and age-related moderating effects. A comprehensive literature search was conducted across a range of databases, including PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and EBSCO. The meta-analysis included data from 20 RCT studies. The results of the analyses demonstrated that HIIT significantly enhanced information processing (SMD = 0.33, 95% CI: 0.15-0.52, P = 0.0005), executive function (SMD = 0.38, 95% CI: 0.26 - 0.50, P < 0.00001), and memory (SMD = 0.21, 95% CI: 0.07-0.35, P = 0.004). Subgroup analyses demonstrated that HIIT enhanced information processing in individuals aged 60 and above, improved executive functioning in individuals of all ages, and enhanced memory in individuals aged 30 to 60. Acute HIIT improved executive function, less than 8 weeks of HIIT improved executive function and memory, and more than 8 weeks of HIIT improved information processing, executive function and memory. The findings of this study indicate that HIIT has a beneficial effect on cognitive performance. Chronic HIIT represents a potential non-pharmacological intervention for cognitive health. Further high-quality research is required to validate and extend these findings.

Cell-type specific epigenetic clocks to quantify biological age at cell-type resolution

The ability to accurately quantify biological age could help monitor and control healthy aging. Epigenetic clocks have emerged as promising tools for estimating biological age, yet they have been developed from heterogeneous bulk tissues, and are thus composites of two aging processes, one reflecting the change of cell-type composition with age and another reflecting the aging of individual cell-types. There is thus a need to dissect and quantify these two components of epigenetic clocks, and to develop epigenetic clocks that can yield biological age estimates at cell-type resolution. Here we demonstrate that in blood and brain, approximately 39% and 12% of an epigenetic clock's accuracy is driven by underlying shifts in lymphocyte and neuronal subsets, respectively. Using brain and liver tissue as prototypes, we build and validate neuron and hepatocyte specific DNA methylation clocks, and demonstrate that these cell-type specific clocks yield improved estimates of chronological age in the corresponding cell and tissue-types. We find that neuron and glia specific clocks display biological age acceleration in Alzheimer's Disease with the effect being strongest for glia in the temporal lobe. Moreover, CpGs from these clocks display a small but significant overlap with the causal DamAge-clock, mapping to key genes implicated in neurodegeneration. The hepatocyte clock is found accelerated in liver under various pathological conditions. In contrast, non-cell-type specific clocks do not display biological age-acceleration, or only do so marginally. In summary, this work highlights the importance of dissecting epigenetic clocks and quantifying biological age at cell-type resolution.

Comparing hospital leadership and front-line workers' perceptions of patient safety culture: an unbalanced panel study

BACKGROUND/AIM

This article examines the relationships between workers' hospital leadership status, hospital front-line status and patient safety culture in hospitals throughout the USA. By identifying possible disparities in perception, targeted interventions can aim at decreasing differences between the two groups to increase the quality of healthcare.

METHOD

Data from 1 739 083 individuals, spreading across 1810 hospitals between 2008 and 2017 were collected. 115 228 (6.63%) self-identified as leaders, and 772 505 (44.42%) self-identified as front-line workers. The participants also filled in information describing their demographics in reference to the hospital, such as how long they have worked at the facility, their working unit and their occupation.

RESULTS

Results showed that leaders responded more positively to items that are directly related to management, such as 'my supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures' (0.33, p<0.01), where 0.33 signifies that leaders had an average response more positive by 0.33 compared with all other occupations on a Likert scale of 1-5. Based on multiple F-tests, all items have shown a statistical significance between leadership and front-line groups.

CONCLUSION

The findings highlight a compelling link between leadership roles and patient safety culture in hospitals, as well as between front-line worker status and patient safety culture. Moreover, a pronounced divergence in viewpoints regarding patient safety culture exists between hospital leaders and front-line staff. An in-depth investigation is necessary to comprehend the ramifications of these outcomes.

The Efficacy and Safety of Ferric Carboxymaltose in Heart Failure with Reduced Ejection Fraction and Iron Deficiency: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Iron deficiency (ID) often coexists with heart failure (HF), and its prevalence increases with the severity of HF. Intravenous ferric carboxymaltose (FCM) has been associated with improvements in clinical outcomes, functional capacity, and quality of life (QoL) in patients with HF and ID. However, while earlier studies showed favorable results, more recent studies have failed to demonstrate significant improvements in outcomes for patients with heart failure with reduced ejection fraction (HFrEF) and ID. This meta-analysis seeks to provide updated insights into the effectiveness and safety of FCM compared to placebo/standard of care (SoC) among patients with HFrEF and ID/iron deficiency anemia (IDA). Methods: We performed a systematic review and meta-analysis of the literature from inception to December 2023, utilizing databases such as MEDLINE (via PubMed), Google Scholar, the Cochrane Library, ClinicalTrials.gov, and the ScienceDirect portal. A statistical analysis was carried out using RevMan 5.4 with a random-effects model. Dichotomous outcomes were reported as odds ratios (OR), while continuous outcomes were presented as the weighted mean difference (WMD) with corresponding 95% confidence intervals (CI), and heterogeneity was assessed using the I2 test. Results: The final analysis included data from six randomized controlled trials (RCTs), comprising 5132 patients. Our findings indicate a significant reduction in total HF hospitalizations among patients with HFrEF and ID/IDA treated with FCM compared to those receiving the placebo or SoC, with an OR of 0.59 (95% CI: 0.40 to 0.88, p < 0.010). However, no statistically significant difference was observed in the total number of deaths between the FCM and placebo/SoC groups (OR: 0.85; 95% CI: 0.70 to 1.03, p = 0.09), non-HF hospitalizations (OR: 0.71; 95% CI: 0.41 to 1.25, p = 0.24), or the composite outcome of cardiovascular hospitalizations and cardiovascular deaths (OR: 0.65; 95% CI: 0.40 to 1.04, p = 0.07). Regarding functional capacity, as assessed by the change in 6-min walk test (6MWT) distance, no significant improvement was found, with a weighted mean difference (WMD) of 14.03 (95% CI: -10.94 to 38.99, p = 0.27). QoL, measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) score, also did not show significant enhancement, with a WMD of 3.85 (95% CI: -0.55 to 8.24, p = 0.09). Furthermore, the safety analysis revealed no significant difference in the incidence of serious adverse events between the FCM and placebo/SoC groups, with an OR of 0.73 (95% CI: 0.49 to 1.10, p = 0.13). Conclusions: In patients with HFrEF and IDA, treatment with intravenous FCM significantly lowers the risk of total HF hospitalizations but does not appear to affect functional capacity, QoL, or mortality.

Dopaminergic Treatment and Episodic Memory in Parkinson's Disease: A Meta-analysis of the Literature

To date, few studies have focused on the benefits of dopaminergic treatment on episodic memory functions in patients affected by Parkinson's disease (PD). We conducted a meta-analysis to determine the effects of pharmacological therapy with dopamine in alleviating episodic memory deficits in Parkinson's patients. A secondary aim was to evaluate the role of dopamine in episodic memory circuits and thus in different memory systems. We conducted a comprehensive literature search in PubMed (1971-2022) to find studies that met specific inclusion criteria. The studies had to provide sufficient data (means and standard deviations) to evaluate performance on neuropsychological tests of episodic memory. A total of k = 36 measures were included in the analysis. A statistically significant difference suggested better performance following dopaminergic therapy assumption (ON condition) than following dopaminergic withdrawal (OFF condition), specifically the estimated pooled effect calculated through a random-effects restricted maximum likelihood model was log ratio of means (RoM) = 0.047 (p = 0.011). The back-transformed RoM, indicating a 4.8% improvement, provides an interpretable measure of the effect size, as it reflects the multiplicative change in performance associated with the ON condition. A meta-regression analysis was also performed to assess the influence of specific memory tasks and relevant covariates/factors on the overall meta-analytic effect: four memory contrasts (verbal/visual, immediate/delayed, recall/recognition, word-list/short-story), age of participants, years of education, severity of illness, duration of illness in years, country of study, proportion of women in the sample, type of medication, counterbalancing. Word list/short story and proportion of women in the sample were the only two statistically significant predictors in the model, both associated with a positive higher pooled effect size. The present study revealed a significant overall difference between the results obtained in the ON and OFF conditions. We also found a significantly greater pharmacological effect in the recall of short stories than word lists, which supports the hypothesis of a beneficial effect of dopamine on the hippocampal circuit rather than on prefrontal cortical areas.

Assessing the comparative effects of interventions in COPD: a tutorial on network meta-analysis for clinicians

To optimize patient outcomes, healthcare decisions should be based on the most up-to-date high-quality evidence. Randomized controlled trials (RCTs) are vital for demonstrating the efficacy of interventions; however, information on how an intervention compares to already available treatments and/or fits into treatment algorithms is sometimes limited. Although different therapeutic classes are available for the treatment of chronic obstructive pulmonary disease (COPD), assessing the relative efficacy of these treatments is challenging. Synthesizing evidence from multiple RCTs via meta-analysis can help provide a comprehensive assessment of all available evidence and a "global summary" of findings. Pairwise meta-analysis is a well-established method that can be used if two treatments have previously been examined in head-to-head clinical trials. However, for some comparisons, no head-to-head studies are available, for example the efficacy of single-inhaler triple therapies for the treatment of COPD. In such cases, network meta-analysis (NMA) can be used, to indirectly compare treatments by assessing their effects relative to a common comparator using data from multiple studies. However, incorrect choice or application of methods can hinder interpretation of findings or lead to invalid summary estimates. As such, the use of the GRADE reporting framework is an essential step to assess the certainty of the evidence. With an increasing reliance on NMAs to inform clinical decisions, it is now particularly important that healthcare professionals understand the appropriate usage of different methods of NMA and critically appraise published evidence when informing their clinical decisions. This review provides an overview of NMA as a method for evidence synthesis within the field of COPD pharmacotherapy. We discuss key considerations when conducting an NMA and interpreting NMA outputs, and provide guidance on the most appropriate methodology for the data available and potential implications of the incorrect application of methods. We conclude with a simple illustrative example of NMA methodologies using simulated data, demonstrating that when applied correctly, the outcome of the analysis should be similar regardless of the methodology chosen.

Meta-analyses reveal climate change impacts on an ecologically and economically significant oyster in Australia

Global oceans are warming and acidifying because of increasing greenhouse gas emissions that are anticipated to have cascading impacts on marine ecosystems and organisms, especially those essential for biodiversity and food security. Despite this concern, there remains some skepticism about the reproducibility and reliability of research done to predict future climate change impacts on marine organisms. Here, we present meta-analyses of over two decades of research on the climate change impacts on an ecologically and economically valuable Sydney rock oyster, Saccostrea glomerata. We confirm with high confidence that ocean acidification (OA) has a significant impact on the size and mortality of offspring of S. glomerata, ocean warming (OW) impacts size, and transgenerational exposure of adults to OA has positive benefits for offspring. These meta-analyses reveal gaps in understanding of OW and transgenerational plasticity on an ecologically and economically significant oyster species to ensure sustainability of this iconic oyster in Australia.

Prevalence of children living with non-biological parents and its determinants among children under 18 in Ethiopia: a multi-level mixed effect analysis

Introduction

The absence of a biological parent from a child's existence had a negative impact on the child's growth, socialization, psychological wellbeing, and economic productivity. Developing nations like Ethiopia experience a huge number of orphans and family-unbounded children. But the exact figure has not been reported yet at the national level recently. Thus, this study aimed to assess the magnitudes and determinants of children living with non-biologic parents in Ethiopia.

Methods

Secondary data analysis was conducted based on the demographic and health survey data conducted in Ethiopia in 2016. A total weighted sample of 41,884 children under the age of 18 from 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of children living with non-biologic parents. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p < 0.05 are declared statistically significant.

Results

The prevalence of children living with non-biologic parents in Ethiopia was 17.58% (95% CI, 17.22-17.95). Being an orphan (AOR = 4.57, 95% CI: 2.40-7.25), being in first birth order (AOR = 8.22, 95% CI: 6.31-9.17), being from a household lacking formal family structure (AOR = 8.60, 95% CI: 6.20-12.30), and being from a female-headed household (AOR = 3.43, 95% CI: 2.65-4.43) were individual-level factors that were significantly associated with children living with non-biologic parents. Being a rural resident (AOR = 1.94, 95% CI: 1.23-3.08) and having a high community poverty level (AOR = 1.25, 95% CI: 1.01-1.75) were community-level determinants of children living with non-biologic parents.

Conclusion

According to this study, a significant proportion of children live with non-biological parents in Ethiopia. Thus, policymakers, health planners, and implementers need to give special attention to children from rural communities, orphans, firstborn children, and broken families. In addition, efforts shall be made to empower women and, in the long run, improve the economy of the community.

Effectiveness and safety of echinocandins combination therapy with the standard of care compared to the standard of care monotherapy for the treatment of invasive aspergillosis infection: a meta-analysis

Background

This meta-analysis aims to evaluate the effectiveness and safety of combining echinocandins with standard of care (SOC) antifungal drugs for treating invasive aspergillosis infection (IAI).

Method

We searched PubMed, Embase, and Cochrane Library from their inception to 25 July 2024. Our outcomes included clinical cure, mortality, and adverse drug reactions (ADRs). We compared echinocandins in combination with SOC antifungal agents against SOC monotherapy therapy. We used the random-effects model for the meta-analysis, and our estimated effects were reported as odds ratios (ORs) with 95% confidence intervals (CI).

Results

Ten studies were included in our meta-analysis comprising 1100 patients: 415 were in the echinocandin combination groups, and 685 were in the SOC groups. The clinical cure rate (OR 1.35, 95% CI: 0.75-2.42, p = 0.27), mortality (OR 0.90, 95% CI: 0.50-1.63, p = 0.73), and ADRs rate (OR 0.95, 95% CI: 0.49-1.82, p = 0.87) were not statistically different in echinocandins combination with SOC compared to SOC monotherapy. Notably, there is a signal for a better clinical cure rate in echinocandins in combination with SOC.

Conclusion

Our meta-analysis found no differences in clinical cure and mortality rate when using combination therapy of echinocandin antifungal agents with the SOC compared to SOC monotherapy. However, there is a signal for better outcomes with the echinocandins combination group. The ADRs in the echinocandins combination group were not worse than SOC monotherapy.

Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning

OBJECTIVE

Define a best practice guide for managing people with patellofemoral pain (PFP).

METHODS

A mixed-methods convergent segregated synthesis of meta-analysed data with a thematic analysis of semistructured interviews and focus groups. Agreement between subproject results informed the strength of clinical recommendation for interventions eligible for best practice recommendation.

DATA SOURCES

Medline, Web of Science, Scopus, reference lists and citation tracking; semistructured interviews of people with PFP; and semistructured interviews and focus groups with clinical experts.

ELIGIBILITY CRITERIA

High-quality (PEDro scale >7) randomised controlled trials (RCTs) were retained for efficacy estimation using meta-analysis. People with PFP were required to have experienced an episode of care in the past 6 months and clinical experts were required to have>5 years of clinical experience alongside direct involvement in research.

RESULTS

Data from 65 high-quality RCTs involving 3796 participants informed 11 meta-analyses of interventions. Interviews with 12 people with PFP led to 3 themes and interviews with 19 clinical experts led to 4 themes. These were further explored in three clinical expert focus groups. Best practice for PFP should first involve understanding a patient's background risk factors, their reasons for seeking care, greatest symptoms, and physical impairments, to inform treatment selection. Synthesis led to six distinct interventions being recommended. Knee-targeted±hip-targeted exercise therapy underpinned by education should be delivered, with additional supporting interventions such as prefabricated foot orthoses, manual therapy, movement/running retraining, or taping decided on and tailored to a patient's needs and preferences.

CONCLUSION

A best practice guide based on a synthesis of three data streams recommends that exercise therapy and education be delivered as the primary intervention for people with PFP. Prescription of other supporting interventions should be aligned with the individual patient's particular presentation following a thorough assessment.

Posttraumatic stress disorder and its cross-generational familial relationship with drug use disorder and alcohol use disorder: an extended Swedish adoption study

Objective: Information on how parental risk for posttraumatic stress disorder (PTSD) relates to their children's risk for drug use disorder (DUD) and alcohol use disorder (AUD) is limited. This study is the first to utilize an extended adoption design which can address questions about the degree of, and sources of, cross-generational and cross-disorder transmission of PTSD and substance use disorders.Method: We examined diagnoses using Swedish National registries for parents and their adult offspring (n = 2,194,171, born 1960-1992) from six types of families (intact (1), not lived with biological father (2) or mother (3), step father (4), step mother (5), and adoptive (6)). Parent-child resemblance was assessed by tetrachoric correlation.Results: PTSD and DUD showed an approximately symmetrical cross-generational cross-disorder relationship. Conversely, AUD in parents was more related to the risk for PTSD in offspring compared to the reverse direction. The cross-disorder cross-generation transmission correlations for PTSD to DUD were higher than those for PTSD to AUD. Genetic and rearing correlations for PTSD-DUD were estimated at + .79 (CI: .66, .91) and + .49 (CI: .33, .65), significantly higher than those for PTSD-AUD + .59 (CI: .48, .71) and + .28 (CI: .12, .44).Conclusions: PTSD and the substance use disorders demonstrated cross-transmission, but more so for DUD. PTSD and DUD demonstrated highly correlated genetic effects, and moderately correlated rearing effects. Correlations of genetic and rearing effects between PTSD and AUD were lower than those for PTSD and DUD.

Resting-state fMRI seizure onset localization meta-analysis: comparing rs-fMRI to other modalities including surgical outcomes

Objective

Resting-state functional MRI (rs-fMRI) may localize the seizure onset zone (SOZ) for epilepsy surgery, when compared to intracranial EEG and surgical outcomes, per a prior meta-analysis. Our goals were to further characterize this agreement, by broadening the queried rs-fMRI analysis subtypes, comparative modalities, and same-modality comparisons, hypothesizing SOZ-signal strength may overcome this heterogeneity.

Methods

PubMed, Embase, Scopus, Web of Science, and Google Scholar between April 2010 and April 2020 via PRISMA guidelines for SOZ-to-established-modalities were screened. Odd ratios measured agreement between SOZ and other modalities. Fixed- and random-effects analyses evaluated heterogeneity of odd ratios, with the former evaluating differences in agreement across modalities and same-modality studies.

Results

In total, 9,550 of 14,384 were non-duplicative articles and 25 met inclusion criteria. Comparative modalities were EEG 7, surgical outcome 6, intracranial EEG 5, anatomical MRI 4, EEG-fMRI 2, and magnetoencephalography 1. Independent component analysis 9 and seed-based analysis 8 were top rs-fMRI methods. Study-level odds ratio heterogeneity in both the fixed- and random-effects analysis was significant (p < 0.001). Marked cross-modality and same-modality systematic differences in agreement between rs-fMRI and the comparator were present (p = 0.005 and p = 0.002), respectively, with surgical outcomes having higher agreement than EEG (p = 0.002) and iEEG (p = 0.007). The estimated population mean sensitivity and specificity were 0.91 and 0.09, with predicted values across studies ranging from 0.44 to 0.96 and 0.02 to 0.67, respectively.

Significance

We evaluated centrality and heterogeneity in SOZ agreement between rs-fMRI and comparative modalities using a wider variety of rs-fMRI analyzing subtypes and comparative modalities, compared to prior. Strong evidence for between-study differences in the agreement odds ratio was shown by both the fixed- and the random-effects analyses, attributed to rs-fMRI analysis variability. Agreement with rs-fMRI differed by modality type, with surgical outcomes having higher agreement than EEG and iEEG. Overall, sensitivity was high, but specificity was low, which may be attributed in part to differences between other modalities.

Predictors of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comprehensive Systematic Review and Meta-analysis

BACKGROUND & AIMS

Pancreatitis is the most common serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). This meta-analysis aimed to precisely assess the risk factors for post-ERCP pancreatitis (PEP).

METHODS

We searched electronic databases for studies that assessed risk factors for PEP after adjusting for ≥3 risk factors, including at least one pre-specified patient-related and one procedure-related risk factor, and reported the data as adjusted odds ratios (ORs) with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted ORs for risk factors reported in ≥3 studies were constructed.

RESULTS

A total of 159 studies with 315,580 ERCPs were included, assessing 31 unique risk factors (20 patient-related and 11 procedure-related). Key patient-related predictors of PEP were age ≤60 years (OR, 1.81; high credibility), prior acute pancreatitis (OR, 2.59; moderate), age ≤40 years (OR, 2.33; moderate), asymptomatic choledocholithiasis (OR, 4.76; low), prior PEP (OR, 4.40; low), sphincter of Oddi dysfunction (OR, 3.11; low), and female gender (OR, 1.70; low). Key procedure-related predictors of PEP were any guidewire passage into the pancreatic duct (PD) (OR, 2.18; high), first ERCP with a native papilla (OR, 1.91; high), endoscopic papillary balloon dilation of an intact papilla (OR, 2.91; moderate), pancreatic acinarization (OR, 4.23; low), any PD cannulation (OR, 2.73; low), pancreatic sphincterotomy (OR, 2.64; low), difficult cannulation (OR, 2.60; low), any pancreatogram (OR, 2.40; low), and precut sphincterotomy (OR, 1.98; low).

CONCLUSIONS

Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for PEP. Incorporating our results into a prediction model may reliably help identify high-risk patients, optimize informed consent, and guide prevention and management strategies for PEP.

Single- and two-pollutant concentration-response functions for PM2.5 and NO2 for quantifying mortality burden in health impact assessments

OBJECTIVE

Health Impact Assessments (HIAs) for air pollutant mixtures are challenging because risk estimates are primarily derived from single-pollutant models. Combining risk estimates from multiple pollutants requires new approaches, as a simple addition of single pollutant risk estimates from correlated air pollutants may result in double counting. We investigated approaches applying concentration-response functions (CRFs) from single- and two-pollutant models in HIAs, focusing on long-term exposure to particulate matter with a diameter less than 2.5 μm (PM2.5) and nitrogen dioxide (NO2) and their associations with all-cause mortality.

METHODS

A systematic literature search of MEDLINE and EMBASE identified cohort studies employing single- and two-pollutant models of long-term exposure to PM2.5 and NO2 with all-cause mortality. Pooled CRFs were calculated through random-effects meta-analyses of risk estimates from single- and two-pollutant models. Coefficient differences were calculated by comparing single- and two-pollutant model estimates. Four approaches to estimating population-attributable fractions (PAFs) were compared: PM2.5 or NO2 single-pollutant models to represent the mixture, the sum of single-pollutant models, the sum of two-pollutant models and the sum of single-pollutant models from a larger body of evidence adjusted by coefficient difference.

RESULTS

Seventeen papers reported both single and two-pollutant estimates. Pooled hazard ratios (HRs) for mortality from single- and two-pollutant models were 1.053 (95% confidence interval: 1.034-1.071) and 1.035 (1.014-1.057), respectively, for a 5 μg/m3 increase in PM2.5. HRs for a 10 μg/m3 increase in NO2 were 1.032 (1.014-1.049) and 1.024 (1.000-1.049) for single- and two-pollutant models, respectively. The average coefficient difference between single- and two-pollutant models was 0.017 for PM2.5 and 0.007 for NO2. Combined PAFs for the PM2.5-NO2 mixture using joint HRs from single- and two-pollutant model CRFs were 0.09 and 0.06, respectively.

CONCLUSION

Utilizing CRFs from two-pollutant models or applying the coefficient difference to a more extensive evidence base seems to mitigate the potential overestimation of mixture health impacts from adding single-pollutant CRFs.