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

Effect of antibiotic growth promoters (AGPs) on feed conversion ratio (FCR) of broiler chickens: A meta-analysis

Antibiotics have been used for a long time as growth promoters in the poultry industry for growth and health benefits. However, recent studies reflected little, no, or negative impacts of using antibiotics for growth promotion purposes. This study was designed to examine the overall effect of antibiotic supplementation on the feed conversion ratio (FCR) in broiler chickens as a performance indicator and assess different covariates for explaining heterogeneity in response to the use of antibiotics as growth promoters. In this regard, FCRs obtained from articles that compared diets with and without antibiotics for broiler chickens were extracted from electronic databases (PubMed, Web of Science, and Google Scholar) as per PRISMA guidelines. The database comprised 42 scientific articles containing 74 experiments totaling 19,562 chickens. A basic meta-analysis and subgroup analysis were performed to assess the overall impact of antibiotic growth promoters (AGPs) on FCR of broiler chickens while a meta-regression analysis was used to assess different covariates (breed, antibiotic dose, location, time, presence of anticoccidial in the feed, antibiotic type, and housing type) to explain variations in true effect size of the studies. The basic meta-analysis of these studies revealed an overall improvement in FCR by 2.8 % (p < 0.05) due to addition of AGPs than the control group with the confidence interval range from 1.3 to 4.3 % and the prediction interval ranging between -10 and 16 %. The covariates, including breed, dose and location, provided the optimum model fit and explained 53 % of variations in the FCR across different studies. In summary, an overall marginal improvement has been observed in mean FCR of broiler chickens along with a wide range of variations in response to use of AGPs. The variations in true effects among these studies are subject to several confounding effects, particularly breed, dose and location. Considering the marginal positive effect of antibiotic usage in chicken performance, we recommend against using of AGP.

Altered Corticospinal and Intracortical Excitability After Stroke: A Systematic Review With Meta-Analysis

BACKGROUND

Intracortical inhibitory/faciliatory measures are affected after stroke; however, the evidence is conflicting.

OBJECTIVE

This meta-analysis aimed to investigate the changes in motor threshold (MT), motor evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF), and identify sources of study variability using a machine learning approach.

METHODS

We identified studies that objectively evaluated corticospinal excitability and intracortical inhibition/facilitation after stroke using transcranial magnetic stimulation. Pooled within- (ie, affected hemisphere [AH] vs unaffected hemisphere [UH]) and between-subjects (ie, AH and UH vs Control) standardized mean differences were computed. Decision trees determined which factors accurately predicted studies that showed alterations in corticospinal excitability and intracortical inhibition/facilitation.

RESULTS

A total of 35 studies (625 stroke patients and 328 healthy controls) were included. MT was significantly increased and MEP was significantly decreased (ie, reduced excitability) in the AH when compared with the UH and Control (P < .01). SICI was increased (ie, reduced inhibition) for the AH when compared with the UH, and for the AH and UH when compared with Control (P < .001). ICF was significantly increased (ie, increased facilitation) in the AH when compared with UH (P = .016) and decreased in UH when compared with Control (P < 0.001). Decision trees indicated that demographic and methodological factors accurately predicted (73%-86%) studies that showed alterations in corticospinal and intracortical excitability measures.

CONCLUSIONS

The findings indicate that stroke alters corticospinal and intracortical excitability measures. Alterations in SICI and ICF may reflect disinhibition of the motor cortex after stroke, which is contrary to the notion that stroke increases inhibition of the affected side.

HIV-related outcomes among migrants living in Europe compared with the general population: a systematic review and meta-analysis

BACKGROUND

Compared with the general population, international migrants arriving in Europe face severe socioeconomic challenges that result in higher HIV prevalence and limited access to health care, potentially leading to negative outcomes. In this systematic review and meta-analysis, we aimed to investigate the incidence of HIV-related outcomes among international migrants arriving in Europe compared with the incidence among the general population.

METHODS

We did a systematic review and meta-analysis to identify studies investigating HIV-related outcomes in migrants and the general population living with HIV in Europe. Six authors (EDV, VP, VS, SDG, MC, and RN) independently searched PubMed, Scopus, and Web of Science from database inception until July 22, 2023 (with an update on March 3, 2024), then screened titles and abstracts of all potentially eligible articles. Studies were included if they were observational studies; investigated clinical, virological, or immunological outcomes in migrants living with HIV; were conducted in Europe; had at least one control group of non-migrants living in a European country; and were in English. Titles and abstracts were screened for eligibility followed by a full-text assessment by two authors (EDV, VP, VS, SDG, MC, or RN). Data were extracted from articles using a structured Redcap form. Primary outcomes of our systematic review were (1) mortality, (2) AIDS-defining condition, (3) combined outcome of AIDS or death, (4) treatment discontinuation, (5) rate of loss to follow-up, (6) virological failure, and (7) immunological failure. Data were reported as relative risks (RRs) or odds ratios with their 95% CIs. The study is registered with PROSPERO, CRD42024501191.

FINDINGS

Of the 1316 articles identified (1297 in the initial search and 19 in the updated search), 19 were included in our systematic review, consisting of 104 676 participants who were followed up for a mean of 79·3 months. The meta-analysis, adjusted for potential confounders, showed that migrants present similar mortality risk (RR 0·88, 95% CI 0·75-1·04), but higher risk for AIDS-defining conditions (1·23, 1·14-1·34), treatment discontinuation (2·39, 1·49-3·29), loss to follow-up (2·53, 1·41-4·53), virological failure (1·80, 1·25-2·60), and immunological failure (3·70, 2·17-12·50) compared with the general population. In subanalyses for WHO regions, people originally from the African region had higher risk for HIV-related adverse outcomes.

INTERPRETATION

Compared with the non-migrant population, migrants living in Europe with HIV face higher risks for progression to AIDS, loss to follow-up, treatment discontinuation, and virological and immunological failure. Interventions aimed to improve HIV care among migrants living in Europe are urgently needed.

FUNDING

None.

Impact of CYP2C19 Genotype on Efficacy and Safety of Clopidogrel-based Antiplatelet Therapy in Stroke or Transient Ischemic Attack Patients: An Updated Systematic Review and Meta-analysis of Non-East Asian Studies

PURPOSE

Inconclusive and limited results have been reported on the clinical utility of CYP2C19 genotyping in stroke/TIA patients of non-East Asian ancestries. We herein performed an updated systematic review and meta-analysis to quantitatively estimate the association of CYP2C19 loss-of function (LOF) status with efficacy and safety of clopidogrel-based antiplatelet therapy in non-East Asian patients affected by stroke or TIA.

METHODS

A comprehensive search was performed up to July 2023 using PubMed, Web of Knowledge, and Cochrane Library databases. The clinical outcomes investigated were stroke, composite vascular events and bleeding. Pooled estimates were calculated as risk ratios (RR) with 95% CI using the Mantel- Haenszel random-effects model. The quality of evidence was assessed using the GRADEpro tool.

RESULTS

A total number of 1673 stroke/TIA patients from 8 non-East Asian studies, published between 2014 and 2022, were included in the systematic review. Clopidogrel-treated carriers of CYP2C19 LOF alleles were found at increased risk of stroke compared to non-carriers (RR: 1.68, 95%CI: 1.04-2.71, P = 0.03). However, no significant association was observed with the risk of composite vascular events (RR: 1.15, 95%CI: 0.58-2.28, P = 0.69) or bleeding (RR: 0.84, 95%CI: 0.38-1.86, P = 0.67). Similarly, European ancestry patients carrying CYP2C19 LOF alleles displayed a higher risk of stroke (RR: 2.69 (1.11-6.51, P = 0.03), but not of composite vascular events or bleeding.

CONCLUSION

The present updated meta-analysis provides moderate quality evidence of association between CYP2C19 LOF alleles and an increased risk of stroke in non-East Asian patients with stroke/TIA after receiving clopidogrel therapy. Further large pharmacogenetic studies are still warranted to corroborate these findings.

The association between school bullying and executive functions in children and adolescents: A three-level meta-analysis

INTRODUCTION

Even though existing amounts of results have shown that school bullying could be related to the main components of executive functions (EFs) (inhibitory control, working memory, and cognitive flexibility), research focused on this association yields inconsistent results.

METHOD

To address this research gap, the current study conducted a three-level meta-analysis approach and simultaneously considered the two perspectives of the bully and victim to clarify the relationship between school bullying experienced by children and EFs. It also explored the moderating variables that affect the relationship between school bullying and EFs.

RESULTS

Based on 18 studies reporting 73 effect sizes (N = 21,725), the results revealed that the overall effect size for the association between both the bullies and victims of school bullying incidents with EFs (rbullies = -0.154, p < .05; rvictims = -0.187, p < .001). Moderator analyses revealed that the negative correlation between bullies of school bullying and EFs was moderated by EF components, but it was not affected by gender, age, and the EF measurement method. Moreover, the negative correlation between victims of school bullying and EFs was not affected by the form of bullying, source of report, facet of EFs, EF measurement, gender, age, and culture.

CONCLUSIONS

The present meta-analysis revealed a relationship between school bullying and EFs. Both bullies and victims appear to have lower EF levels. The results also emphasized that lower inhibitory control was more likely to be a crucial risk factor for bullying behavior.

Effects of Ginseng Consumption on Cardiovascular Health Biomarkers in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ginseng, with various pharmacological activities, has received increasing attention to improve cardiovascular health (CVH). Therefore, this meta-analysis synthesized the effect of ginseng consumption on biomarkers of CVH in adults. A systematic search was performed in the databases of PubMed, Scopus, Web of Science, Embase, and the Cochrane Library through July 24, 2023 to screen out English-language randomized controlled trials (RCTs) evaluating the effects of ginseng consumption on body composition, blood pressure, vascular stiffness, lipid metabolism, glucose metabolism, insulin resistance, inflammatory cytokines, and adipocytokines in adults. The weighted mean difference (WMD) and 95% confidence interval (CI) were used to evaluate the overall effect size, and STATA 12.0 was used for comprehensive analysis. Forty-five studies were included in the meta-analysis. Ginseng consumption significantly reduced systolic blood pressure (SBP) (WMD = -2.57 mmHg, 95% CI = -4.99 to -0.14, p = 0.038), total cholesterol (TC) (WMD = -4.40 mg/dL, 95% CI = -8.67 to -0.132, p = 0.043), low density lipoprotein cholesterol (LDL-C) (WMD = -2.81 mg/dL, 95% CI = -4.89 to -0.72, p = 0.008), C-reactive protein (CRP) (WMD = -0.41 mg/L, 95% CI = -0.73 to -0.10, p = 0.010), and interleukin-6 (IL-6) (WMD = -2.82 pg./mL, 95% CI = -4.31 to -1.32, p < 0.001). Subgroup analyses suggested that supplementation with ginseng for less than 12 weeks significantly reduced SBP, but 12 weeks or more improved TC and CRP. Ginseng consumption on SBP, TC, and CRP seemed to be more effective on unhealthy participants. The meta-analysis showed that ginseng consumption might have the potential to improve SBP, TC, LDL-C, CRP, and IL-6. These findings suggest that ginseng is a potential candidate for the maintenance of CVH. However, our results had high heterogeneity. Future high-quality studies are needed to firmly establish the clinical efficacy of ginseng consumption.

Does non-surgical periodontal treatment contribute to rheumatoid arthritis amelioration? Evidence based on an overview and meta-analysis

The aim of the present study was to provide an overview evaluating the effects of non-surgical periodontal treatment in rheumatoid arthritis, focusing on 28-joint Disease Activity Score (DAS28), C-reactive protein, and erythrocyte sedimentation rate. Systematic reviews, with and without meta-analyses, comparing individuals who had undergone non-surgical periodontal treatment with those who had not, and assessing parameters before and after treatment, were included. Electronic searches were conducted in August 2023 and updated in August 2024 across four databases (PubMed, Scopus, Embase, and Web of Science) and gray literature, with no restriction on language or publication date. The study followed the 2020 PRISMA statement, and a protocol was registered in PROSPERO (CRD42023414714). A total of 10 systematic reviews were included: six with meta-analyses and four without meta-analyses. The number of articles included ranged from three to 31 studies. Non-surgical periodontal treatment resulted in a significant decrease in C-reactive protein, erythrocyte sedimentation rate, and DAS28. The follow-up period after treatment ranged from six to 24 weeks. A meta-analysis was conducted, incorporating data from 18 primary studies identified in the systematic reviews and comparing the difference in DAS28 at baseline (n = 454) and up to three months (n = 449) after the non-surgical periodontal treatment. A significant reduction in DAS28 was observed (MD = - 0.76; 95% CI = - 1.07 to - 0.44). Despite the heterogeneity of data related to rheumatoid arthritis and periodontitis status, non-surgical periodontal treatment can result in a decrease in the concentration of circulating inflammatory mediators and, consequently, in a reduction in DAS28 in rheumatoid arthritis.

Digital behavioral dietary interventions to promote a healthy diet among children and adolescents: a scoping review of technologies, design, behavioral theory, and assessed outcomes

Background

Childhood overweight and obesity prevalence steeply increased during recent decades, prompting the development of many digital behavioral dietary interventions (DBDIs). However, a coherent overview is lacking, which is crucial for delineating research in this field.

Objective

This scoping review outlines the landscape of DBDIs for improving dietary behaviors in children and adolescents, including delivery modes, design and development approaches, behavioral theory, and outcomes assessed. Secondary objectives involved examining the integration of behavior change techniques (BCTs) and identifying outcomes favoring DBDIs.

Methods

Following PRISMA guidelines, PsycInfo, PubMed, and Scopus were systematically searched for evaluated DBDIs. Two reviewers independently screened titles and abstracts; one performed full-text screening. Studies included had a digital component, targeted dietary behavior, focused on children or adolescents, and evaluated effects on behavior change, health, or process evaluation outcomes. One reviewer extracted data, including general information, theoretical underpinning, and outcomes assessed, while BCTs were coded independently by two reviewers. DBDIs were deemed favorable if significant improvements were observed in all outcomes (p ≤ .05).

Results

From 51 included studies, 41 DBDIs were identified, including app-based (37%), web-based (29%), computer-based (27%), text-message-based (5%), and combined technology tools (2%). Stakeholders were involved in the design of 59% of DBDIs, with 5% using co-design methodologies. Studies evaluated behavior change outcomes (86%), process evaluation outcomes (59%), and health outcomes (20%). DBDIs included an average of 6.2 BCTs, primarily 'Feedback on behavior' (56%) and 'Non-specific reward' (46%). Among experimental studies, 15% yielded favorable results, 58% mixed results, and 28% no favorable results.

Discussion

This review outlines the diverse landscape of DBDIs, highlighting various technological delivery modes and outcomes assessed. Methodological variations and limitations challenge consistent effectiveness assessment. Future research should prioritize rigorous study designs to understand efficacy and identify effective BCTs among diverse pediatric populations. Leveraging co-design methods may enhance engagement and effectiveness.

Prevalence of physical inactivity and associated factors among adults in Eastern African countries: a systematic review and meta-analysis protocol

INTRODUCTION

Physical inactivity is a major global public health concern, increasing the risk factor of non-communicable diseases (NCDs) and mortality. The WHO has initiated the Global Action Plan on Physical Activity to reduce global physical inactivity by 15% by 2030. Rapid urbanisation and insufficient physical activity in the Global South have significant implications for public health, leading to increased NCDs. Understanding physical inactivity and related risk factors among adults is essential in addressing the growing NCD epidemic. This study aims to estimate the pooled prevalence of physical inactivity and its associated risk factors among adults in Eastern African countries.

METHODS AND ANALYSIS

This review protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (2020) Guideline. A comprehensive search will be conducted using the CoCoPop (condition, context, population) frameworks to include all observational studies published from 1 January 2010 to 31 October 2024. Databases such as PubMed, Scopus, Embase, CINAHAL, Web of Science, Science Direct and Google Scholar will be searched. Studies with citations without an abstract or full text and qualitative studies will be excluded. The Joanna Briggs Institute critical appraisal tool will be used to assess the quality of each study. The heterogeneity of studies will be quantified using the I2 statistic, and a fixed-effects or random-effects model will be used for the pooled analysis. Publication bias will be assessed using visual (funnel plot) and statistical methods. The study countries will be the basis for subgroup analysis, and sensitivity analysis will be used to see how one study's results may affect the estimate as a whole.

ETHICS AND DISSEMINATION

Ethical approval is not required for this systematic review. The results will be disseminated through peer-reviewed publications and conference presentations. Furthermore, this systematic review and meta-analysis will be used to generate comprehensive and robust evidence for public health interventions.

PROSPERO REGISTRATION NUMBER

CRD42024567592.

Virological failure and associated factors among patients receiving anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis

OBJECTIVE

This study aimed to pool the prevalence of virological failure and associated factors.

DESIGN

Systematic review and meta-analysis.

PRIMARY OUTCOME MEASURE

Prevalence of virological failure.

SECONDARY OUTCOME MEASURE

Factors affecting virological failure.

ANALYSIS

The extracted data were exported to STATA V.17 for statistical analysis. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of virological failure.

SETTING

Ethiopia.

PARTICIPANTS

Patients receiving anti-retroviral therapy.

RESULTS

A total of 51 primary studies with a sample size of 38, 789 participants were included in the final meta-analysis. The pooled prevalence of virological failure among patients receiving anti-retroviral therapy (ART) in Ethiopia was 15.95% (95% CI: 12.63, 19.27; I2=97.99%; p<0.001). Substance use (adjusted OR (AOR)=2.37, 95% CI: 1.28, 4.39), non-disclosure of HIV status (AOR=4.63, 95% CI: 3.51, 6.11), interruption of ART (AOR=2.61, 95% CI: 1.55, 4.40), poor adherence to ART (AOR=4.31, 95% CI: 2.73, 6.79), baseline CD4 cell count <200 cells/mm3 (AOR=2.65, 95% CI: 1.62, 4.33), baseline advanced WHO clinical stage (WHO clinical stages III and IV) (AOR=3.02, 95% CI: 1.67, 5.45), baseline viral load >1000 copies/mL (AOR=4.63, 95% CI: 2.60, 8.26), opportunistic infections (AOR=3.58, 95% CI: 2.58, 4.96) and TB-HIV coinfection (AOR=3.97, 95% CI: 2.41, 6.54) were significantly associated with virological failure among patients receiving anti-retroviral therapy in Ethiopia.

CONCLUSIONS

The pooled prevalence of virological failure among patients receiving anti-retroviral therapy was high in Ethiopia. Therefore, due attention should be given to patients with these identified factors. Moreover, we recommend researchers to conduct a triangulated study that can address additional factors associated with virological failure.

PROSPERO REGISTRATION NUMBER

The protocol was registered with the Prospero database (PROSPERO, 2024: CRD42024512411).

Early discharge in health facilities following vaginal delivery and its associated factors among mothers in four African countries: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence of early discharge among women who gave vaginal delivery in health facilities.

DESIGN

Cross-sectional study.

SETTING

Four African countries.

PARTICIPANTS

A total weighted sample of 14 942 women who delivered vaginally in health facilities.

METHODS

In this study, data were obtained from the recent Demographic and Health Survey data from four African countries. A total weighted sample of 14 942 women who delivered vaginally in a health facility was included. A multilevel mixed effect binary logistic regression model was fitted to identify significant factors associated with early discharge following health facility vaginal delivery. Statistical significance was determined using adjusted OR (odd ratio) with a 95% CI.

RESULTS

The overall prevalence of early discharge following health facility vaginal delivery in four African countries was 30.91% (95% CI: 30.18% to 31.66%). Overall, first-born babies (AOR=0.7; 95% CI: 0.57 to 0.85), women with a high maternal body mass index (AOR=0.8; 95% CI: 0.71 to 0.89), women with multiple pregnancies (AOR=0.48; 95% CI: 0.31 to 0.74), women who reside in Burkina Faso (AOR=0.15; 95% CI: 0.12 to 0.18) and women who reside in Ghana (AOR=0.28; 95% CI: 0.24 to 0.33) had lower odds of early discharge following health facility vaginal delivery. On the other hand, women having no difficulty accessing health facilities (AOR=1.18; 95% CI: 1.05 to 1.33) and women delivering in private health facilities (AOR=1.46; 95% CI: 1.08 to 1.99) had higher odds of early discharge following health facility vaginal delivery.

CONCLUSION

Overall, in four African countries, a higher proportion of women who gave birth vaginally in health facilities were discharged home early without optimum immediate postpartum care. As a result, legislators, programmers and other stakeholders should make every effort to lessen the burden of early discharge, with a special focus on women who deliver in private health institutions.

Non-invasive brain stimulation enhances motor and cognitive performances during dual tasks in patients with Parkinson's disease: a systematic review and meta-analysis

BACKGROUND

Parkinson's disease (PD) induces progressive deficits in motor and cognitive functions as well as impaired dual-task performance requiring both motor and cognitive functions. This systematic review and meta-analysis evaluated the effects of non-invasive brain stimulation (NIBS) on dual-task performance in patients with PD.

METHODS

11 studies met the following inclusion criteria: (a) patients with PD, (b) NIBS intervention, (c) comparison with the sham stimulation group, (d) motor and cognitive performance outcomes during dual tasks, and (e) randomized controlled trials with parallel or crossover designs. Individual effect size (i.e., comparison) was quantified by comparing motor and cognitive performances changes during dual tasks between active NIBS and sham stimulation conditions. Thus, higher values of the overall effect size indicate more improvements in either motor or cognitive performances after NIBS. Moreover, moderator variable analyses determined whether NIBS effects on dual-task performances differed depending on targeted brain regions. Finally, meta-regression analyses determined whether NIBS effects on dual-task performances were associated with demographic characteristics.

RESULTS

The random-effects model meta-analysis revealed that NIBS significantly improved motor (73 comparisons from 11 studies) and cognitive (12 comparisons from four studies) performances during dual tasks in patients with PD. Specifically, anodal transcranial direct current stimulation protocols on the dorsolateral prefrontal cortex were effective. Moreover, greater improvements in motor performance during dual tasks significantly correlated with decreased age and increased proportion of females, respectively.

CONCLUSION

This meta-analysis suggests that excitatory stimulation on the dorsolateral prefrontal cortex may be effective for improving dual-task performance in patients with PD.

Serum lipid profile abnormalities among beta-thalassemia patients: a systematic review and meta-analysis

BACKGROUND

Patients with betathalassemia have higher risk of various metabolic disturbances. The literature presents conflicting results about the patterns of abnormal lipid profile among patients with betathalassemia. This systematic review aimed to assess dyslipidemia patterns among patients with betathalassemia when compared with healthy individuals.

METHODS

The methods used were adherent to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Systematic searches of the literature were done across Medline/PubMed, Web of Science, Science Direct, and Regional Portal of the World Health Organization Virtual Health Library. Calculation of standardized mean difference (SMD) estimates and their associated 95% confidence intervals (CIs) were done through Jamovi software.

RESULTS

The systematic review included 21 studies meeting the criteria for the analyses. Patients with beta-thalassemia major displayed significantly elevated triglyceride levels (SMD: 0.448, 95% CI, 0.214 to 0.682; P < .001) and reduced total serum cholesterol (SMD: -2.26 (95% CI-2.834 to -1.678; P < .001), as well as decreased levels of both low-density lipoprotein cholesterol (SMD: -1.88, 95% CI, -2.614 to -1.147; P < .001) and high-density lipoprotein cholesterol (SMD: -1.32, 95% CI, -1.786 to -0.860; P < .001). Similarly, beta-thalassemia intermedia patients exhibited comparable lipid profile abnormalities to those with beta-thalassemia major. Conversely, beta-thalassemia minor patients only showed significantly lower total serum cholesterol levels (SMD: -0.66, 95% CI, -0.860 to -0.472; P < .001).

CONCLUSION

Evidence indicates alterations in lipid profile markers among beta-thalassemia patients. The findings indicate the importance of assessing hypertriglyceridemia and hypocholesterolemia in these patients, especially those with major and intermedia forms, as these lipid profile abnormalities increase the risk of cardiovascular disease.

Ethiopian residents' knowledge and attitude towards blood donation and its associated factors: systematic review and meta-analysis

INTRODUCTION

Despite the existence of numerous blood donation centers globally, there remains a significant gap between the demand and supply of blood. In Ethiopia, replacement blood donation is more common than voluntary donation. The National Blood Bank of Ethiopia collects approximately 200,000 units of blood each year, while the daily requirement is 18,000 units. Donors' knowledge and attitudes are vital for ensuring a steady blood supply. This systematic review and meta-analysis sought to evaluate the knowledge and attitudes of Ethiopian residents regarding blood donation and the factors influencing them.

METHODS

Relevant research articles were identified through searches of various databases. Data extraction and organization were performed using Microsoft Excel, and the data were then analyzed using STATA/MP 17.0. A weighted inverse variance random-effects model with a 95% confidence interval was employed to pool the data. Heterogeneity was examined with the Galbraith plot and Cochrane I² statistics. To identify sources of heterogeneity, meta-regression, subgroup analysis, and sensitivity analysis were conducted. Publication bias was assessed using Egger's test and managed with trim and fill analysis. The adjusted odds ratio was calculated to explore the relationship between knowledge and attitudes towards blood donation, with a significance threshold of p < 0.05.

RESULTS

The pooled prevalence of favorable attitudes towards blood donation was 65.95%. Moderators such as study year (p = 0.72), publication year (p = 0.877), and sample size (p = 0.291) were not significant, indicating they did not contribute to heterogeneity. Studies from Northern Ethiopia reported the highest prevalence of favorable attitudes at 69.95%, while research on healthcare workers also indicated a high proportion of favorable attitudes at 69.29%. There was a significant association between knowledge and attitudes towards blood donation (AOR = 2.03).

CONCLUSION

The pooled prevalence of favorable attitudes towards blood donation was 65.95%, with the highest levels observed in Northern Ethiopia and among healthcare workers. A significant association between knowledge and positive attitudes towards blood donation was found. To enhance attitudes towards blood donation, increasing public awareness and education about the importance and safety of donating blood is crucial.

Usual On-therapy Ranges of Drug Concentrations in Patients with Atrial Fibrillation Treated with Direct Oral Anticoagulants: A Systematic Review and Meta-analysis

BACKGROUND

 Although most patients with atrial fibrillation (AF) receiving a direct oral anticoagulant (DOAC) do not require drug concentration measurements, there are situations where such information could be useful. Existing guidance documents provide usual on-therapy ranges for drug concentrations, but these have important limitations.

METHODS

 This is a systematic review and meta-analysis of studies reporting trough and peak levels of DOAC regimens approved for stroke prevention in AF. We used random effects models and the quantile estimation method to estimate the median and a usual on-therapy range (10th and 90th percentiles).

RESULTS

 Of 4,822 unique publications, 53 studies met eligibility (29,266 trough and 12,103 peak levels). Usual on-therapy ranges for trough levels were 38 to 155 and 58 to 206 ng/mL for apixaban 2.5 and 5 mg twice daily; 35 to 138 and 33 to 151 ng/mL for dabigatran 110 and 150 mg twice daily; 8 to 54 and 13 to 66 ng/mL for edoxaban 30 and 60 mg daily; and 16 to 74 and 19 to 72 ng/mL for rivaroxaban 15 and 20 mg daily. The corresponding range for peak levels were 96 to 251 and 132 to 343; 65 to 223 and 76 to 285; 57 to 219 and 127 to 407; 131 to 384, and 169 to 313 ng/mL, respectively.

CONCLUSION

 This systematic review and meta-analysis provides updated and more representative usual on-therapy ranges of DOAC levels in patients with AF.

Healthcare providers' pain management practice and its associated factors in Ethiopia: A systematic review and meta- analysis

INTRODUCTION

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Under -treatment of pain continues to be a major health care problem in Ethiopia. Although it has this problem, it receives limited research attention. This systematic review and meta-analysis will provide valuable insights of prevalence and its factors of healthcare providers' pain management practice in Ethiopia.

METHODS

This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Universal online databases such as PubMed, Cochrane, Google, Google Scholar, SCOPUS, Web of Science and Global Health were used to search for articles. Microsoft Excel for data extraction and STATA17 for data analysis were used. DerSimonian and Laird random-effects model was used to pool the odds ratios across studies and compute the overall pooled prevalence and its predictors. Egger's test with funnel plot symmetry and Cochrane's Q test was used to assess publication bias and heterogeneity respectively.

RESULTS

The overall pooled prevalence of health care providers' pain management practice was 39.6% (95% CI: 34.8, 44.5); I2 = 97.0%; P<0.001). Availability of pain management protocol (AOR = 5.1, 95%CI: 3.6, 6.7), Accessibility of analgesia (AOR = 4.5, 95%CI: 1.96, 7.0), higher educational level (AOR = 3.3, 95%CI: 2.5, 4.1), being female (AOR = 1.2, 95% CI: 1.6, 3.1), took training (AOR = 2.7, 95% CI: 1.8, 3.6), decreased work load (AOR = 4.9, 95% CI: -1.9, 11.7), increased work experience (AOR = 3.9, 95% CI: 2.9, 5.1), Being midwifery profession (AOR = 2.5,95% CI: 1.6, 3.4), having good attitude (AOR = 3.9,95%CI: 2.5, 5.4) and being knowledgeable (AOR = 4.2, 95%CI: 2.8, 5.6) of health care providers towards pain management practice were significantly associated in Ethiopia.

CONCLUSION

The overall prevalence of pain management practice among healthcare providers in Ethiopia is low compared with a national target of pain free hospital initiatives in Ethiopia. It needs a call to build health care providers' ongoing education, training, professional development and manageable workload.

Efficacy and safety of hyperbaric oxygen therapy for Parkinson's disease with cognitive dysfunction: protocol for a systematic review and meta-analysis

INTRODUCTION

The presence of cognitive dysfunction notably affects the quality of life in individuals diagnosed with Parkinson's disease (PD) and is often recognised as a non-motor symptom. Comprehensive studies have shown the possible advantages of hyperbaric oxygen therapy (HBOT) in alleviating cognitive deficits in these individuals. This systematic review aims to investigate the practicality of incorporating HBOT within a more extensive therapeutic framework for PD, with a specific focus on cognitive symptoms.

METHODS AND ANALYSIS

A comprehensive literature review will be conducted utilising various databases such as PubMed and Cochrane Library and so on. The duration of the search will encompass the entire timeline from the initiation of each database up to 1 April 2024. This investigation seeks to uncover randomised controlled trials that explore the efficacy and safety of HBOT in patients with PD who are facing cognitive impairments. The authors' autonomous screening and extraction of data will facilitate the attainment of impartial results. The assessment of possible biases will be conducted using the Cochrane risk-of-bias tool, while statistical analyses will be executed with RevMan V.5.3 and Stata V.15.0.

ETHICS AND DISSEMINATION

As this review synthesises and evaluates previously conducted studies, the requirement for ethical approval is not applicable. The findings from this review will be shared via academic publications, comprehensive reports and presentations at pertinent conferences.

PROSPERO REGISTRATION NUMBER

CRD42024504763.

Patterns and Mechanisms of Legume Responses to Nitrogen Enrichment: A Global Meta-Analysis

Nitrogen (N), while the most abundant element in the atmosphere, is an essential soil nutrient that limits plant growth. Leguminous plants naturally possess the ability to fix atmospheric nitrogen through symbiotic relationships with rhizobia in their root nodules. However, the widespread use of synthetic N fertilizers in modern agriculture has led to N enrichment in soils, causing complex and profound effects on legumes. Amid ongoing debates about how leguminous plants respond to N enrichment, the present study compiles 2174 data points from 162 peer-reviewed articles to analyze the impacts and underlying mechanisms of N enrichment on legumes. The findings reveal that N enrichment significantly increases total legume biomass by 30.9% and N content in plant tissues by 13.2% globally. However, N enrichment also leads to notable reductions, including a 5.8% decrease in root-to-shoot ratio, a 21.2% decline in nodule number, a 29.3% reduction in nodule weight, and a 27.1% decrease in the percentage of plant N derived from N2 fixation (%Ndfa). Legume growth traits and N2-fixing capability in response to N enrichment are primarily regulated by climatic factors, such as mean annual temperature (MAT) and mean annual precipitation (MAP), as well as the aridity index (AI) and N fertilizer application rates. Correlation analyses show that plant biomass is positively correlated with MAT, and tissue N content also exhibits a positive correlation with MAT. In contrast, nodule numbers and tissue N content are negatively correlated with N fertilizer application rates, whereas %Ndfa shows a positive correlation with AI and MAP. Under low N addition, the increase in total biomass in response to N enrichment is twice as large as that observed under high N addition. Furthermore, regions at lower elevations with abundant hydrothermal resources are especially favorable for total biomass accumulation, indicating that the responses of legumes to N enrichment are habitat-specific. These results provide scientific evidence for the mechanisms underlying legume responses to N enrichment and offer valuable insights and theoretical references for the conservation and management of legumes in the context of global climate change.

Perinatal depression and associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Perinatal depression is a significant public health issue affecting one in four women globally. It occurs at a critical time of a woman's life; affecting her relationships with family, and child's emotional, behavioral, and cognitive development. Considering the burden of the problem to the whole family, this systematic review and meta-analysis was conducted to estimate the pooled prevalence of perinatal depression and its determinants in Ethiopia to provide up-to-date evidence at a national level.

METHODS

All observational studies conducted on perinatal depression in Ethiopia were included based on the selection criteria. Data was extracted using Microsoft Excel and then exported to STATA version-11 for analysis. The random-effects model was employed to estimate the pooled effect size of perinatal depression and its determinants with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to check the publication bias. Sub-group and sensitivity analyses were also performed.

RESULTS

This systematic review and meta-analysis included thirty studies and the pooled prevalence of perinatal depression in Ethiopia was 24.29% (95% CI (21.98, 26.59)). According to the subgroup analysis, the pooled prevalence of antenatal depression and others (postnatal and perinatal depression) was 24.24% and 24.52% respectively. Regarding determinants of perinatal depression, having unplanned pregnancy [OR = 3.04 (2.2, 4.2)], intimate partner violence [OR = 3.09(2.14, 4.46)], poor social support [OR = 3.3(2.38, 4.57)], and a history of depression [OR = 3.68(2.45, 5.52)] were significantly associated with depression.

CONCLUSION AND RECOMMENDATION

This study showed that the pooled prevalence of perinatal depression in Ethiopia was found to be high. To ensure the mental health of both the mother and child, health professionals should routinely screen perinatal women for depression giving special focus for those with a history of depression and managing them accordingly.

Adverse Childhood Experiences Are Associated with Mental Health Problems Later in Life: An Umbrella Review of Systematic Review and Meta-Analysis

INTRODUCTION

Evidence suggested a link between early adversity and mental health problems. However, it is unclear how much adverse childhood experiences (ACEs) contribute to mental health problems because researchers have produced inconsistent findings. Therefore, the objective of this umbrella review was to combine the contradictory data regarding the effect of ACEs on the development of mental health problems later in life in the global context.

METHODS

PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Scopus, and Google Scholar which reported the effect of ACEs on the development of mental health problems was searched. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR). A weighted inverse variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

RESULTS

Forty-three SRM with 14,707,614 study participants were included. The pooled effect of ACEs on the development of mental health problems later in life in the global context is found to be (AOR = 1.66 [1.46, 1.87]). Subgroup analysis based on country revealed (AOR = 1.67 [1.23, 2.11]) in UK, (AOR = 0.61 [0.41, 0.81]) in Canada, (AOR = 1.55 [1.40, 1.69]) in Brazil, (AOR = 5.65 [4.12, 7.18]) in Ethiopia, (AOR = 1.92 [1.45, 2.38]) in USA, (AOR = 2.30 [1.89, 2.72]) in Australia, and (AOR = 1.66 [1.46, 1.87]) in Ireland. While subgroup analysis based on types of adverse childhood adverse experience: domestic violence (AOR = 4.13 [1.96, 6.30]), maltreatment (AOR = 1.5 [0.79, 2.21]), physical abuse (AOR = 1.56 [1.43, 1.63]), sexual abuse (AOR = 2.07 [1.63, 2.51]), child abuse (AOR = 5.66 [4.12, 7.18]), parental mental health problem (AOR = 1.73 [1.39, 2.08]), bullying (AOR = 1.99 [1.69, 2.29], neglect (AOR = 2.11 [1.53, 2.69]), and parental divorce (AOR = 1.66 [1.46, 1.87]). Based on the type of mental health problem, the pooled effect size is 1.87 (1.45, 2.30) for depression and 1.67 (1.22, 2.13) for anxiety.

CONCLUSION

This umbrella review revealed that ACE is significantly associated (with 66% increased risk) with anxiety and depression later in life in a global context. This association is most noticeable when one is subjected to domestic violence, maltreatment, physical abuse, sexual abuse, child abuse, parental mental health problems, bullying, neglect, and parental divorce. Childhood periods are a critical window of opportunity for reducing the risk of developing mental illness in the future and for implementing intervention measures. Preventing childhood maltreatment and addressing psychiatric risk factors can prevent psychopathology. Longitudinal studies are needed to optimize healthcare responses to ACEs. Increased awareness and public health interventions are needed to prevent childhood adversity and prevent mental problems among these victims. To optimize healthcare responses to unfavorable outcomes of childhood adversities, longitudinal and intervention research findings, more public health initiatives, and awareness are required.

Association between life satisfaction and health behaviours among older adults: a systematic review and meta-analysis protocol

INTRODUCTION

Life satisfaction is a key indicator of successful ageing and reflects well-being. There is evidence of the association between life satisfaction and health behaviours among older adults. Therefore, this systematic review and meta-analysis protocol seeks to determine the strength and direction of the association between life satisfaction and health behaviours among older adults.

METHODS AND ANALYSIS

This protocol followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. We will search the electronic databases (MEDLINE, APA PsycINFO, Web of Science, CINAHL and Global Health) from inception to date. Only observational studies that described the association between life satisfaction and health behaviours-smoking, alcohol drinking, physical activity, diet/nutrition and sleep-will be included. Two independent reviewers will conduct screening, data extraction and risk of bias assessment of the articles. The risk of bias will be assessed using the Joanna Briggs Institute critical appraisal tools for cohort and analytical cross-sectional studies. Studies will be included in the meta-analysis if they report zero-order associations between life satisfaction and health behaviours; otherwise, a narrative synthesis will be presented.

ETHICS AND DISSEMINATION

This study does not require ethics approval, as it involves analysing secondary data from published studies. The completed review will be published in a peer-reviewed journal and presented at conferences.

TRIAL REGISTRATION NUMBER

PROSPERO (CRD42023441386).

Dietary intake, obesity, and physical activity in association with biliary tract cancer risk: Results from meta-analyses of individual-level data from prospective cohort studies of 723,326 adults

Biliary tract cancer (BTC) is a rare and aggressive malignancy with increasing incidence. Most BTC cases are diagnosed with metastatic disease which carries a 5-year survival rate of <5%. Physical activity, diet, and obesity might be associated with BTC risk, but studies have been limited particularly in African descendants. We addressed this knowledge gap by evaluating associations of BTC risk with obesity, physical activity, and dietary intakes in 723,326 adult participants in four cohort studies conducted in China, the United Kingdom, and the United States. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) in each cohort; results were combined using meta-analysis. All cohorts had ≥11 median follow-up years with 839 incident BTC cases combined. BTC risk was positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) whereas physical activity, fruit intake, and fish intake were inversely associated. HR and (95% CI) comparing BMI >35.0 to 18.5-24.9: 1.71 (1.26, 2.31), p-trend <.0001; comparing BMI-adjusted WHR top to bottom quartile: 1.20 (0.94, 1.53), p-trend = .05; comparing ≥15-0 metabolic equivalent task-hours/week 0.76 (0.61, 0.94), p-trend = .009; comparing highest to lowest intake tertile for fruit and fish 0.79 (0.66, 0.95), p-trend = .01; 0.82 (0.68, 0.98), p-trend = .04, respectively. Associations were, in general, similar across ancestry groups. Our study provides strong evidence for important roles of obesity, diet, and physical activity in BTC etiology and stresses the need for lifestyle modification to combat the rising incidence of this fatal malignancy.

The efficacy and safety of dual orexin receptor antagonists in obstructive sleep apnea: A systematic review and meta-analysis of randomised controlled trials

Dual orexin receptor antagonists (DORAs) are indicated for the treatment of insomnia disorder. However, DORAs may change sleep parameters, thus having adverse effects on patients with obstructive sleep apnea (OSA). This meta-analysis clarified the impact of DORAs in OSA treatment on sleep architecture and respiratory parameters. We systematically searched PubMed, Embase, and Cochrane Central databases for randomised control trials published up to May 2024. The search focussed on studies discussing the effects of DORAs on sleep architecture in patients with OSA. Nonrandomised studies were excluded. A meta-analysis using a random-effects model was performed. The patients were categorised into subgroups based on the treatment protocol (single or multiple dosages). The Cochrane risk of bias tool for randomised trials assessed the risk of bias. Our meta-analysis included four randomised placebo-controlled trials, encompassing 126 patients with a mean age of 49.1 years. The effects of DORAs on sleep architecture and respiratory parameters were examined. The main findings were as follows: DORAs significantly increased the total sleep time and improved sleep efficiency. However, they did not affect rapid eye movement sleep. DORAs also showed a trend towards decreased wake after sleep onset and did not increase the apnea-hypopnea index. DORAs did not increase the percentage of total sleep time with oxygen saturation lower than 90% and 85% compared with placebo, respectively. Furthermore, DORAs were not associated with significantly higher adverse effects compared with placebo. This meta-analysis demonstrated that DORAs improve sleep and do not impair nighttime respiratory function in patients with OSA.

The Effects of Global Climate Warming on the Developmental Parameters of Helicoverpa armigera (Hübner, 1808) (Lepidoptera: Noctuidae)

Helicoverpa armigera (Hübner, 1808) is a significant global agricultural pest, particularly posing a major threat during the boll-forming stage of cotton. In recent years, the severity of its damage has increased markedly, and its population dynamics and biological characteristics may be profoundly affected by global climate change. This study conducted a systematic meta-analysis to evaluate the life history traits of H. armigera under conditions of rising global temperatures, different photoperiods, and humidity levels. A comprehensive analysis of 26 related studies revealed that different developmental stages of H. armigera have distinct temperature requirements. When the temperature is within an optimal range (32 °C to 35 °C), the development rate of H. armigera accelerates, the life cycle shortens, and the reproductive capacity of female moths increases. However, when the temperature exceeds 35 °C, development slows, mortality rates increase, and the oviposition of female moths decreases significantly, indicating a negative impact of high temperatures on growth and reproduction. Overall, as the temperature rises above 20 °C, various physiological indicators of H. armigera significantly improve, and at 32 °C, the larval development period and overall life cycle reach their shortest duration. This meta-analysis provides new insights into the biological responses of H. armigera in the context of climate change and offers a scientific basis for future control strategies.

Does ischemic preconditioning enhance sports performance more than placebo or no intervention? A systematic review with meta-analysis

BACKGROUND

Ischemic preconditioning (IPC) is purported to have beneficial effects on athletic performance, although findings are inconsistent, with some studies reporting placebo effects. The majority of studies have investigated IPC alongside a placebo condition, but without a control condition that was devoid of experimental manipulation, thereby limiting accurate determination of the IPC effects. Therefore, the aims of this study were to assess the impact of the IPC intervention, compared to both placebo and no intervention, on exercise capacity and athletic performance.

METHODS

A systematic search of PubMed, Embase, SPORTDiscus, Cochrane Library, and Latin American and Caribbean Health Sciences Literature (LILACS) covering records from their inception until July 2023 was conducted. To qualify for inclusion, studies had to apply IPC as an acute intervention, comparing it with placebo and/or control conditions. Outcomes of interest were performance (force, number of repetitions, power, time to exhaustion, and time trial performance), physiological measurements (maximum oxygen consumption, and heart rate), or perceptual measurements (RPE). For each outcome measure, we conducted 3 independent meta-analyses (IPC vs. placebo, IPC vs. control, placebo vs. control) using an inverse-variance random-effects model. The between-treatment effects were quantified by the standardized mean difference (SMD), accompanied by their respective 95% confidence intervals. Additionally, we employed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the level of certainty in the evidence.

RESULTS

Seventy-nine studies were included in the quantitative analysis. Overall, IPC demonstrates a comparable effect to the placebo condition (using a low-pressure tourniquet), irrespective of the subjects' training level (all outcomes presenting p > 0.05), except for the outcome of time to exhaustion, which exhibits a small magnitude effect (SMD = 0.37; p = 0.002). Additionally, the placebo exhibited effects notably greater than the control condition (outcome: number of repetitions; SMD = 0.45; p = 0.03), suggesting a potential influence of participants' cognitive perception on the outcomes. However, the evidence is of moderate to low certainty, regardless of the comparison or outcome.

CONCLUSION

IPC has significant effects compared to the control intervention, but it did not surpass the placebo condition. Its administration might be influenced by the cognitive perception of the receiving subject, and the efficacy of IPC as an ergogenic strategy for enhancing exercise capacity and athletic performance remains questionable.

A Systematic Review and Meta-Analysis of Conditioned Pain Modulation in Children and Young People with Chronic Pain

BACKGROUND/OBJECTIVES

Conditioned pain modulation (CPM) is a psychophysical experimental measure of the endogenous pain inhibitory pathway in humans, wherein one pain stimulus (the conditioning stimulus) is used to inhibit an individual's perception of a second painful (test) stimulus. Research provides evidence of impaired endogenous inhibitory pain responses in adults with chronic pain. CPM is now increasingly applied in paediatric research and clinical practice. The primary aim of this systematic review was to examine the efficacy of CPM in paediatric chronic pain populations (6-24-year-olds) compared to pain-free children and young people (CYP).

METHODS

The protocol was registered on PROSPERO (CRD42020221927). A systematic search of seven databases was conducted from database inception to 20th June 2024. Study inclusion criteria were as follows: (i) recruited a sample of CYP aged 6 to 24 (inclusive) with chronic pain or who were pain-free; and (ii) applied a CPM paradigm comprising both a painful test and conditioning stimuli that were sufficiently detailed to allow for replication,(iii) adhered to a study design of randomised control trial, case control or cohort study, including cross-sectional or longitudinal; (iv) available in the English language. Study exclusion criteria were: (i) The CPM paradigm used a non-painful test or conditioning stimulus only; and (ii) was only available as an abstract, letter, poster, editorial, case report, or review with or without meta-analyses. Risk of bias was assessed using the Appraisal Tool for Cross Sectional Studies (AXIS). Meta-analyses were conducted in Comprehensive Meta Analysis 3.0 using random effects models to compare the overall CPM responses in CYP with chronic pain conditions to healthy control CYP.

RESULTS

Thirty-two studies were eligible for inclusion, six of which were included in one or more meta-analysis (n = 407 chronic pain, n = 205 control). Meta-analysis revealed significantly weaker CPM responses in CYP with a variety of chronic pain conditions compared to healthy controls (standardized mean difference (SMD) = 0.352), and significantly weaker CPM responses in CYP with abdominal pain conditions compared to healthy controls (SMD = 0.685). No significant difference in CPM response was found between CYP with migraine and healthy controls (SMD = -0.201).

CONCLUSIONS

Variable results were found across individual studies, and the meta-analysis of the small number of eligible studies provides tentative evidence for impaired CPM in CYP with chronic pain compared to healthy controls. Further research is clearly needed. In particular, studies should present CPM results separately for different age groups, ethnic groups, and sexes, as these variables shape clinical pain responses.

Evaluating Nature-based Solutions as urban resilience and climate adaptation tools: A meta-analysis of their benefits on heatwaves and floods

Extreme weather events driven by climate change threaten the resilience of urban structures and urban dwellers. Nature-based Solutions (NbS) are an effective tool to reduce urban vulnerability to climate risks and, at the same time, develop more liveable urban areas. Despite the acknowledged positive impacts of individual observed NbS, numerous questions persist unanswered. While existing research supports NbS' positive influence on urban climate adaptation, the extent of their impact remains insufficiently studied. Understanding the magnitude of NbS impact is crucial for justifying their preference over non-NbS alternatives and, consequently, for securing public investment. Via a meta-analysis, this paper aims to contribute to research and practice by providing a more systematic assessment of NbS effects, offering urban planners and decision-makers a robust justification for their incorporation in climate change adaptation, urban resilience, and enhanced liveability. The results of the meta-analytic model indicate that the effect of NbS is indeed positive. When assessing the impact on temperature and flood protection, there is a general positive effect across the studied NbS. However, when evaluating an average effect, the task appears to be more complex due to methodological issues and limitations. The need to increase the formalisation of how the impact of NbS is measured and reported also emerges as a result. Replicable protocols would positively impact the formalisation of the literature on the topic and positively affect the evidence-based support for the implementation of NbS by urban decision-makers.

Social network interventions for dietary adherence among adults with type 2 diabetes: a systematic review and meta-analysis protocol

INTRODUCTION

Optimal adherence to recommended diets is crucial to achieving long-term glycaemic control among individuals with type 2 diabetes (T2D) individuals. However, there is limited evidence on the effectiveness of interventions that target dietary adherence through social networks. Since social networks can influence individuals' health behaviours, it is important to thoroughly evaluate the impact of social network interventions on dietary adherence in adults with T2D. This systematic review protocol aimed to provide insights into future interventions and improve diabetes management strategies.

METHOD AND ANALYSIS

PubMed, Embase, CINAHL Complete, Cochrane Central Register of Controlled Trials, ProQuest Dissertations and Theses and Google Scholar will be searched from inception to December 2023 for relevant randomised and non-randomised controlled trials of at least 3 months' duration. In addition, studies that compared interventions involving the social networks (families, friends and peers) of adults with T2D with usual care, no intervention or an intervention with no explicit social network component will be included. Two reviewers will independently screen search outputs according to inclusion and exclusion criteria, critically evaluate the selected literature and extract data on the study setting, design, participants' characteristics, interventions, controls, social network functions and duration of follow-up, using a standard data extraction form. Quantitative data analysis will be performed where studies are homogeneous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesised using narrative synthesis. Finally, trials will be assessed for bias risk and overall evidence certainty using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

ETHICS AND DISSEMINATION

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023441223.

Prevalence of Mitral Valve Prolapse Among Individuals with Pectus Excavatum: A Systematic Review and Meta-Analysis

Background: During the last decades, a small number of studies reported a wide range of variability in the estimated prevalence of mitral valve prolapse (MVP) among individuals with pectus excavatum (PE). The present systematic review and meta-analysis has been primarily designed to summarize the main findings of these studies and to estimate the overall prevalence of MVP among PE individuals. Methods: All imaging studies assessing the prevalence of MVP in PE individuals vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. Events (presence of MVP) and nonevents (absence of MVP) in PE individuals and control groups were recorded. The main outcome was the measure of odds ratio (OR) for MVP presence pooled with 95% confidence intervals, using a fixed-effects model. Results: The full texts of eight studies with 303 PE patients (mean age 25.7 yrs) and 498 healthy controls (mean age 31 yrs) were analyzed. Three studies assessed MVP prevalence in children and early adolescents, whereas the remaining five studies examined PE adults. The prevalence of MVP in PE individuals and healthy controls was 40.6% and 12.8%, respectively. In the pooled sample, the OR for MVP presence was significantly higher in PE individuals compared to controls (OR = 5.80, 95%CI = 3.83-8.78, Z = 8.30, p < 0.001). Subgroup analysis revealed that MVP prevalence was approximately three-fold higher among PE children and early adolescents compared with PE adults. Overall, high consistency was observed in the pooled effect sizes, due to the low statistical heterogeneity among the included studies (I2 = 22.7%, p = 0.25). Egger's test for a regression intercept gave a p-value of 0.07, indicating no publication bias. The sensitivity analysis supported the robustness of the results. Conclusions: PE individuals are nearly six times more likely to have MVP than controls. MVP prevalence is three-fold higher in PE individuals during childhood and early adolescence, compared to PE adults. Given the strong association between MVP and PE, MVP should be suspected in all individuals with anterior chest wall deformity.

Comparative effectiveness of lifestyle interventions on children's body composition management: A systematic review and network meta-analysis

PURPOSE

This study aimed to provide comparative evidence on the effectiveness of various lifestyle interventions on body composition management for preschool and school-aged children.

METHODS

PubMed (MEDLINE), Embase, CINAHL, and Web of Science were systematically searched for this network meta-analysis. Randomized controlled studies (RCTs) that included children aged 4-12 years with no physical or mental conditions; performed at least 1 type of lifestyle intervention; reported change in body mass index (BMI), BMI z-score, or body fat percentage (BFP); and were published between January 2010 and August 2023 were included.

RESULTS

The final analysis included 91 RCTs with aggregate data for 58,649 children. All interventions were categorized into single-arm approaches (physical activity, diet, and behavioral and informational support) and combined arms approaches (bicomponent and multicomponent treatment). Multicomponent treatment showed significant effectiveness on the reduction of BMI (mean deviation (MD) - 0.49, 95% confidence interval (95%CI): -0.88 to -0.12), BMI z-score (MD = -0.11, 95%CI: -0.18 to -0.04), and BFP (MD = -1.69, 95%CI: -2.97 to -0.42) compared to the usual care condition. Bicomponent treatment also significantly reduced BMI (MD = -0.28, 95%CI: -0.54 to -0.04) and BMI z-score (MD = -0.07, 95%CI: -0.12 to -0.02) compared to usual care.

CONCLUSION

Interventions targeting multiple lifestyle components achieved greater reductions in children's BMI and BFP. Among single-component approaches, physical activity engagement emerged as the most effective. These findings should guide practitioners in recommending comprehensive lifestyle modifications for children. Moreover, children with higher initial BMI and body fat levels tend to exhibit more positive responses to lifestyle interventions aimed at managing obesity.

Successful Aging Rates of Global Older Adults: A Systematic Review and Meta-analysis

OBJECTIVE

This meta-analysis aimed to qualitatively analyze the different aspects of the successful aging (SA) criteria and quantitatively assess the rate of SA and its different dimensions among people aged ≥60 years globally to provide a basis for constructing criteria for SA.

DESIGN

This is a systematic review and meta-analysis, which has been registered on PROSPERO (CRD42024585934).

SETTING AND PARTICIPANTS

Older adults (≥60 years).

METHODS

PubMed, Embase, CINAHL, Web of science, SCOPUS, and PsycINFO (inception to July 17, 2023) were used to search for relevant studies to evaluate the comprehensive level of SA. A random effects model was used to synthesize SA rates and 95% CIs. Quality assessment was conducted using the Agency for Healthcare Quality and Research criteria and the Newcastle-Ottawa Scale. Statistical analyses were conducted using Revman 5.3 and Stata 11.0.

RESULTS

A total of 546,228 older adults from 64 studies were incorporated into the meta-analysis. In the 64 studies, SA criteria mentioned 11 aspects: psychology, disease, cognitive function, physical function, social engagement, disability, independence, self-rated health, economy, memory impairment, and obesity. The meta-analysis indicated that the summary estimate of SA rate among people aged ≥60 years was 22.0% (95% CI 19.0%-25.0%) globally. A meta-analysis was conducted on the 6 aspects included more commonly in SA criteria, and the results showed that the rate of no disability was the highest (72.0%), followed by good psychological status (69%), active social engagement (65%), high cognitive function (64%), and high physical function (62%), with no major diseases being the lowest (50.0%).

CONCLUSIONS AND IMPLICATIONS

The overall estimated SA rate among people aged ≥60 years was 22% globally. The SA criteria mainly include 6 aspects: good psychological status, no major diseases, high cognitive function, high physical function, active social engagement, and no disability. Emphasizing the importance of psychological well-being and chronic disease management, the findings offer valuable insights for future research and policy making related to the welfare of aging populations.

Analyzing the causal role of blood cells in aging: a Mendelian randomization study

Blood cells are crucial components of the human body, closely linked to the aging process. This study aims to explore the causal relationship between 91 blood cell phenotypes and aging through Mendelian randomization (MR) analysis. Exposure data from genome-wide association studies (GWAS) was extracted from the GWAS of blood cell perturbation phenotypes in 2,600 European individuals. Initial analysis utilized GWAS data related to aging from the GWAS Catalog database GCST90014288, with inverse-variance weighting as the primary method for causal analysis. Sensitivity analyses included Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis. For significant associations, replication and meta-analysis were conducted using independent aging GWAS data from GCST90014300. Initial analysis revealed that environmental peroxide-impacted red blood cells and ciprofloxacin-impacted reticulocytes accelerated aging. Additionally, elevated neutrophil levels were found to accelerate aging, while LiCl-impacted neutrophils reduced aging risk. Replication and meta-analysis showed consistent results: ciprofloxacin-impacted reticulocytes and elevated neutrophil levels increased the risk of aging, while LiCl-impacted neutrophils reduced the risk. RBCs showed no significant impact on aging progression. Sensitivity analyses confirmed the robustness and reliability of these positive findings. Our study provides evidence of a causal relationship between three blood cell disturbance phenotypes and human aging.

The Efficacy of Laughter Therapy on Psychological Symptoms in People With Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

OBJECTIVE

Cancer patients generally have high stress levels, which often leads to depression, anxiety and other psychological problems. Laughter therapy has been used to relieve stress, depression and anxiety in cancer patients, but its efficacy is uncertain. The study aims to summarize evidence on the efficacy of laughter therapy on psychological symptoms of people with cancer.

METHODS

A search was conducted in 10 electronic databases for randomized controlled trials (RCTs) reported before May 2023. This systematic review was reported based on the PRISMA 2020 statement. The evaluation of methodological quality and risk of biases were conducted by the Cochrane Risk of Bias Assessment tool version 2, and evidence evaluation was conducted using the GRADE pro online assessment tool. Statistical analysis adopted the Review Manager version 5.4 software.

RESULTS

A total of eight studies were included involving 543 participants. Meta-analysis showed that laughter therapy plus routine nursing produced more positive effects than routine nursing in relieving stress (SMD = -1.18, 95% CI -1.73, -0.62, p < 0.0001), depression (SMD = -1.05, 95% CI -1.30, -0.81, p < 0.00001) and anxiety (SMD = -0.81, 95% CI -1.20, -0.43, p < 0.0001).

CONCLUSIONS

Laughter therapy could effectively relieve stress, depression and anxiety of cancer patients. Future studies should improve the methodological quality of randomized controlled trials, conduct appropriate follow-up, and report details of follow-up. Additionally, it should perform multi-center and large-sample studies, and combine both subjective and objective outcome indications to enhance the persuasiveness of evidence supporting the effectiveness of laughter therapy.

TRIAL REGISTRATION

PROSPERO register: CRD 42023452739.

The effects of different types of exercises on cognition in older persons with mild cognitive impairment: A systematic review and meta-analysis

PURPOSE

This systematic review with meta-analysis aims to analyze the effects of different types of exercise on cognition, neuroprotective and neuroinflammatory blood markers in older adults with mild cognitive impairment (MCI).

METHODS

Relevant studies were identified using PubMED, SPORTDiscuss, Web of Science, Scopus, and PsycInfo databases. Methodological quality assessment of the studies was done with modified Downs and Black checklist. Data obtained from the included studies was analyzed using Comprehensive Meta-Analysis 4.0 software and results were reported using the random effects method.

RESULTS

A total of twenty-three studies were identified. The findings were summarized as change in cognitive function after the exercise interventions in general and after each type of exercise. On average, the exercise intervention revealed an effect size (ES): 1.165; 0.741 to 1.589 (95% Confidence Interval (CI); p < 0.001); aerobic exercise ES: 1.442; 0.624 to 2.260 (95 %CI); p = 0.001; Multimodal ES: 0,856; 0.366 to 1.346 (95 % CI); p = 0.001 and resistance exercise ES: 1.229; 0.339 to 2.120 (95 % CI); p = 0.007. In addition, we observed significant small ES: -0.475; -0.817 to -0.134 (95 %CI); p = 0.006, I2= 0 %; τ2 = 0 of exercise effects on Tumor Necrosis Factor-α (TNF-α) and non-significant large ES:0.952; -0.238 to 2.142 (95 %CI); p = 0.117 on Brain Derived Neurotrophic Factor (BDNF) in persons with MCI.

CONCLUSION

The present study revealed the existence of a large positive effect of overall exercise intervention on cognitive function and a small effect on TNF-α in old people with MCI. Additionally, this study demonstrates that aerobic and resistance exercises had similar larger positive effects and were better than multimodal exercise on increasing cognition in older persons with MCI.

Racism and health and wellbeing among children and youth-An updated systematic review and meta-analysis

BACKGROUND

Evidence of racism's health harms among children and youth is rapidly increasing, though attention to impacts on physical health and biomarker outcomes is more emergent. We performed a systematic review of recent publications to examine the association between racism and health among children and youth, with a meta-analysis of the specific relationships between racism and physical health and biomarkers.

METHODS

We conducted a systematic literature search using four databases: Medline, PsycINFO, PubMed, and ERIC. Four inclusion criteria were used to identify eligible studies: (1) exposure was experiences of racism, (2) outcome was health and wellbeing, (3) quantitative methods were used to estimate the association between racism and health outcomes, and (4) the effect size of associations between racism and health and wellbeing was reported for participants aged 0-24 years. Correlation coefficients were used to report the pooled effect size for each outcome indicator.

RESULTS

There were 463 eligible studies included in the screening process, with 42 studies focusing on physical health or biomarker outcomes. Random-effects meta-analysis found minimal to moderate positive associations between racism and C-reactive protein, Interleukin 6, body mass index (BMI), obesity, systolic blood pressure, salivary cortisol, asthma, and somatic symptoms. There were marginal positive associations between racism and Tumour Necrosis Factor-α, cortisol collected via saliva, urine and hair, BMI-z score, and diastolic blood pressure, with imprecise estimates and wide confidence intervals.

CONCLUSIONS

Racism is associated with negative physical health and biomarker outcomes that relate to multiple physiological systems and biological processes in childhood and adolescence. This has implications for health and wellbeing during childhood and adolescence and future chronic disease risk. Collective and structural changes to eliminate racism and create a healthy and equitable future for all children and youth are urgently required.

The effectiveness and safety of botulinum toxin injections for managing motor disorders of patients with Parkinson's disease: A meta-analysis of randomized controlled trials

This study aimed to assess the effectiveness and safety of botulinum toxin (BTX) injections for managing motor disorders in patients with Parkinson's disease (PD). An electronic search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data from available randomized controlled trials (RCTs) assessing BTX injections for motor disorders in PD patients were extracted for meta-analysis. Ultimately, 215 patients from eight RCTs were enrolled. Pooled analyses indicated that BTX was more effective than placebo in improving tremor (standardized mean difference [SMD] = 0.96, 95% CI [0.34, 1.58], p < 0.01), whereas no notable differences were observed between BTX and placebo regarding freezing of gait (SMD = 0.66, 95% CI [-0.26, 1.58], p = 0.162), United Parkinson's Disease Rate Scale (UPDRS) III score (SMD = -0.20, 95% CI [-1.17, 0.76], p = 0.68) and clinical global impression (CGI) score (SMD = 0.84, 95% CI [-0.74, 2.42], p = 0.298). Adverse events related to BTX injections were comparable to placebo (OR = 1.74, 95% CI [0.59, 5.14], p = 0.32). The current evidence suggests that BTX is effective and safe in treating PD tremor but fails to provide therapeutic benefits for freezing of gait and motor functional scores in PD patients. Furthermore, the limited number of included studies and heterogeneity in BTX intervention protocols suggest more research is needed, with additional standardized RCTs, to better understand and optimize BTX injections for motor disorders in PD.

The effect of tuberosity healing on functional outcomes after reverse shoulder arthroplasty for proximal humerus fractures: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis compared clinical outcome measures in patients undergoing reverse shoulder arthroplasty (RSA) for proximal humerus fracture (PHF) with healed versus non-healed greater tuberosity (GT).

METHODS

We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines querying PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane for studies that stratified results by the GT healing status. Studies that did not attempt to repair the GT were excluded. We extracted and compared clinical outcomes including postoperative forward flexion (FF), external rotation (ER), internal rotation (IR), Constant score, and complications and revision rates.

RESULTS

Of the included patients, 295 (78.5%) demonstrated GT healing while 81 did not (21.5%). The healed GT cohort exhibited increased postoperative FF (P < .001), ER (P < .001), IR (P = .006), and Constant score (P = .006) compared to the non-healed GT cohort. The overall dislocation rate was 0.8% with no study differentiating GT status of dislocation cases.

CONCLUSION

Healing of the GT after RSA for PHF yields improved postoperative range of motion and strength, whereas patient-reported pain and function were largely not affected by GT healing indicating merit to RSA for PHF regardless of the likelihood of the GT healing.

Systematic review and meta-analysis of randomized and nonrandomized studies on fractional flow reserve-guided revascularization

INTRODUCTION AND OBJECTIVES

Several studies have investigated the effectiveness of fractional flow reserve (FFR) guidance in improving clinical outcomes after myocardial revascularization, yielding conflicting results. The aim of this study was to compare clinical outcomes in patients with coronary artery disease following FFR-guided or angiography-guided revascularization.

METHODS

Both randomized controlled trials (RCTs) and nonrandomized intervention studies were included. Coprimary endpoints were all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE). The study is registered with PROSPERO (CRD42022344765).

RESULTS

A total of 30 studies enrolling 393 588 patients were included. FFR-guided revascularization was associated with significantly lower rates of all-cause death (OR, 0.63; 95%CI, 0.53-0.73), myocardial infarction (OR, 0.70; 95%CI, 0.59-0.84), and MACE (OR, 0.77; 95%CI, 0.70-0.85). When only RCTs were considered, no significant difference between the 2 strategies was observed for any endpoints. However, the use of FFR was associated with reduced rates of revascularizations and treated lesions. Metaregression suggested that the higher the rate of revascularized patients the lower the benefit of FFR guidance on MACE reduction compared with angiography guidance (P=.012). Similarly, higher rates of patients with acute coronary syndromes were associated with a lower benefit of FFR-guided revascularization (P=.039).

CONCLUSIONS

FFR-guided revascularization was associated with lower rates of all-cause death, myocardial infarction and MACE compared with angiographic guidance, with RCTs and nonrandomized intervention studies yielding conflicting data. The benefits of FFR-guidance seem to be less evident in studies with high revascularization rates and with a high prevalence of patients with acute coronary syndrome.

Graft Failure in Pediatric Patients After Bone-Patellar Tendon-Bone, Hamstring Tendon, or Quadriceps Tendon Autograft ACLR: A Systematic Review and Meta-analysis

Background

Anterior cruciate ligament (ACL) reinjury risk is high in young athletes, with graft failure rates as high as 23%. The optimal autograft choice to minimize reinjury risk in this population is unclear.

Purpose

To compare graft failure rates between bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts in patients aged ≤18 years with a minimum follow-up (FU) of 24 months.

Study Design

Systematic review; Level of evidence, 4.

Methods

A systematic review of the literature between database inception and March 2022 encompassed PubMed/MEDLINE, Cochrane CENTRAL, Embase, and Web of Science Core Collection databases. Studies on autograft ACL reconstruction (ACLR) using HT, QT, or BPTB autograft in patients ≤18 years old with a minimum FU of 2 years were included. Graft failure rates were pooled and estimated using random-effects models via the inverse variance method and logit transformations. Meta-analyses were used to estimate failure rates and pairwise comparisons were conducted by autograft type when appropriate.

Results

A total of 24 studies comprising 2299 patients (HT: n = 1237, 44.8% female, 59.1-month mean FU; BPTB: n = 913, 67.3% female, 79.9-month mean FU; QT: n = 149, 36.4% female, 35.3-month mean FU) were included. HT exhibited the highest failure rate at 11.8% (95% CI, 9.0%-15.4%); failure rates for BPTB and QT were 7.9% (95% CI, 6.2%-10.0%) and 2.7% (95% CI, 1.0%-7.5%), respectively. HT had a significantly higher failure rate than both BPTB (Q = 5.01; P = .025) and QT (Q = 7.70; P = .006); BPTB had a significantly higher failure rate than QT (Q = 4.01; P = .045). Male patients were less likely than their female counterparts to experience graft failure after HT ACLR (odds ratio, 0.48; 95% CI, 0.25-0.95).

Conclusion

While the HT remains a common choice for ACLR, the current aggregate data indicate that BPTB and QT demonstrated significantly lower failure rates than HT ACLR in adolescent athletes ≤18 years old. The QT demonstrated the lowest failure rate in adolescents but also the lowest proportion of patients represented due to a paucity of published QT data, indicating a need for future studies with larger sample sizes that include QT autografts, reduced risk of bias, and consistent reporting on skeletal maturity and surgical technique to better determine the ideal autograft for active athletic populations ≤18 years old.

Conservative, Non-pharmacological Interventions for Pain Management in Juvenile Idiopathic Arthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effectiveness of conservative, non-pharmacological interventions for chronic pain management in children and adolescents with juvenile idiopathic arthritis (JIA). A comprehensive search strategy was implemented across PubMed, PEDro, and Web of Science databases, utilizing predefined terms and strict inclusion and exclusion criteria. The initial search yielded 1,308 studies, which were subsequently narrowed to 65 relevant articles. Following a rigorous evaluation, 14 studies met the inclusion criteria for final review, with an average PEDro scale score of 6.1/10, indicating fair to good methodological quality. The included RCTs focused on various interventions, including physical exercise (five studies), hydrotherapy (three studies), orthoses (two studies), online cognitive behavior therapy for pain management (two studies), low-level laser therapy (one study), and video games (one study). A random-effects model meta-analysis was performed for interventions and outcome measures that were comparable across at least three RCTs. Physical exercise interventions met this criterion and were thus subjected to meta-analytic evaluation. The pooled analysis demonstrated a statistically significant beneficial effect of exercise interventions on chronic pain (mean difference (MD) = -1.37, 95% CI = -2.19 to -0.55, p < 0.01). Subgroup analyses further supported the efficacy of exercise compared to both other active interventions (MD = -1.37, 95% CI = -2.25 to -0.5, p < 0.01) and control conditions (MD = -1.69, 95% CI = -3.09 to -0.29, p = 0.02). These findings suggest that conservative, non-pharmacological interventions, particularly physical exercise, show promise as a component of a multidisciplinary pain management strategy for patients with JIA. While further high-quality research is needed to bolster the evidence base, our findings highlight the potential efficacy of integrating physical exercise interventions into comprehensive pain management strategies for this pediatric population.

Effectiveness of meditation for fatigue management: Insight from a comprehensive systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis revealed the effectiveness of meditation in addressing fatigue, given its widespread use as a remedy for sleep disturbances and fatigue.

METHOD

We analyzed 29 randomized controlled trials from MEDLINE and the Cochrane Library, spanning from December 31, 2022. We conducted two metaanalyses using mean difference (MD) with normalized data and standardized mean difference (SMD) with original data.

RESULTS

These trials included various populations, with baseline fatigue severity observed at 52.2 ± 16.0 points among 4104 participants. After an average meditation duration of 9.6 ± 4.7 weeks, fatigue scores decreased significantly by 6.4 points of MD [95% CI, 4.3-8.5] compared to controls. The most significant reduction occurred in the sub-healthy group (MD 8.2 [95% CI, 2.7 to 13.8]), followed by the general group (MD 6.9 [95% CI, 0.4 to 13.4]), and the disease group (MD 5.7 [95% CI, 3.4 to 8.0]). Notably, meditation-based anti-fatigue effects were particularly pronounced for mental fatigue (MD 10.0 [95% CI, 4.3 to 15.6]), especially with expert guidance and supplementary homework.

CONCLUSION

These findings align with meta-analysis results using standardized mean difference (SMD), providing evidence for meditation as an effective nonpharmacological intervention for fatigue management, while also informing effective meditation approaches.

REGISTRATION NUMBER

CRD42023395551 in PROSPERO.

Comparing various Bayesian random-effects models for pooling randomized controlled trials with rare events

The meta-analysis of rare events presents unique methodological challenges owing to the small number of events. Bayesian methods are often used to combine rare events data to inform decision-making, as they can incorporate prior information and handle studies with zero events without the need for continuity corrections. However, the comparative performances of different Bayesian models in pooling rare events data are not well understood. We conducted a simulation to compare the statistical properties of four parameterizations based on the binomial-normal hierarchical model, using two different priors for the treatment effect: weakly informative prior (WIP) and non-informative prior (NIP), pooling randomized controlled trials with rare events using the odds ratio metric. We also considered the beta-binomial model proposed by Kuss and the random intercept and slope generalized linear mixed models. The simulation scenarios varied based on the treatment effect, sample size ratio between the treatment and control arms, and level of heterogeneity. Performance was evaluated using median bias, root mean square error, median width of 95% credible or confidence intervals, coverage, Type I error, and empirical power. Two reviews are used to illustrate these methods. The results demonstrate that the WIP outperforms the NIP within the same model structure. Among the compared models, the model that included the treatment effect parameter in the risk model for the control arm did not perform well. Our findings confirm that rare events meta-analysis faces the challenge of being underpowered, highlighting the importance of reporting the power of results in empirical studies.

Faecal intestinal permeability and intestinal inflammatory markers in older adults with age-related disorders: A systematic review and meta-analysis

This systematic review and meta-analysis appraised previous findings to uncover potential faecal intestinal permeability and intestinal inflammatory markers in older adults. A comprehensive literature search led to the identification of ten eligible studies with findings of potential faecal intestinal permeability (zonulin and alpha-1-antitrypsin) and intestinal inflammatory markers [calprotectin, lactoferrin and neutrophil gelatinase-associated lipocalin (NGAL)]. Most of the cases (n > 2) [Parkinson's disease (PD) and Alzheimer's disease (AD)] exhibited higher faecal alpha-1-antitrypsin, zonulin and calprotectin levels. The present meta-analysis confirmed significantly higher faecal alpha-1-antitrypsin in older persons with PD compared to non-PD [MD = 22.92 mg/dL; 95 % CI = 14.02-31.81, p < 0.00001; I2 = 0 % (p = 0.73)]. There was, however, no significant difference in faecal zonulin between PD and non-PD individuals [MD = 26.88 ng/mL; 95 % CI = -29.26-83.01, p = 0.35; I2 = 94 % (p < 0.0001)]. Meanwhile, faecal calprotectin was higher in older adults with GI symptoms, multiple system atrophy (MSA) or PD than the healthy controls [MD = 9.51 μg/g; 95 % CI = 0.07-18.95, p = 0.05; I2 = 84 % (p < 0.00001)]. Altogether, faecal calprotectin appears to be a potential intestinal inflammatory marker whereas previous findings on faecal alpha-1-antitrypsin as an intestinal permeability marker remain limited and require further validation.

Open vs robotic-assisted pancreaticoduodenectomy, cost-effectiveness and long-term oncologic outcomes: a systematic review and meta-analysis

BACKGROUND

Whipple pancreaticoduodenectomy (PD) is a complex gastrointestinal surgery that is performed increasingly via minimally invasive approach through robotic platforms. We sought to provide a comparative review of available data regarding robot-assisted vs open PD in terms of cost-effectiveness, overall survival, and other perioperative and long-term oncologic outcomes.

METHODS

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria, PubMed, Scopus, and Web of Science databases were searched from 1980 to April 2024 using designated keywords. English-language studies comparing costs and oncologic outcomes of robotic vs open PDs were considered for inclusion. Reviews, abstracts, case reports, letters to the editor, and non-English articles were excluded.

RESULTS

A total of 1733 studies were initially identified throughout the literature search. After the removal of duplicates, title and abstract screening identified 16 studies that were included in the review. No statistically significant differences were detected in terms of short-term complications (95% CI, 0.805-1.096; P = .42), mortality (95% CI, 0.599-1.123; P = .21), and readmission (95% CI, 0.959-1.211; P = .20) among patients undergoing open vs robotic PD. Robotic PDs was associated with a slightly better overall survival (95% CI, 1.020-1.233) and higher costs (95% CI, 0.134-1.139; P = .013). Mean length of stay (LOS) was higher in the open PD group (95% CI, -0.353 to 0.189; P < .001).

CONCLUSION

Robotic-assisted PD had a slightly shorter LOS and improved overall survival. There were no differences in short-term complications, mortality, or readmission. The use of cohort studies and residual potential selection bias necessitate randomized controlled trials to define the benefit of robotic PD.

Early exposure to general anesthesia may contribute to later attention-deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis of cohort studies

STUDY OBJECTIVE

The association between early childhood exposure to general anesthesia and subsequent risk of developing attention-deficit/hyperactivity disorder remains unknown.

DESIGN

A systematic review and meta-analysis of cohort studies.

PATIENTS

Children undergoing general anesthesia.

INTERVENTIONS

A comparison of any type of general anesthesia exposure, including total intravenous anesthesia, inhalation general anesthesia, and combined intravenous and inhaled anesthesia, with non-anesthetic exposures, which did not receive any exposure to anesthetic drugs, including general anesthetics as well as local anesthetics.

MEASUREMENTS

The primary outcome measure was the risk of developing attention-deficit/hyperactivity disorder after general anesthesia exposure.

MAIN RESULTS

The results of the overall meta-analysis showed an increased risk of subsequent attention-deficit/hyperactivity disorder in children exposed to general anesthesia (RR = 1.26, 95% CI, 1.16-1.38; P < 0.001; I2 = 44.6%). Subgroup analysis found that a single exposure to general anesthesia in childhood was associated with an increased risk of developing attention-deficit/hyperactivity disorder (RR = 1.29, 95% CI, 1.19-1.40, P < 0.001; I2 = 2.6%), and the risk of attention-deficit/hyperactivity disorder was further increased after multiple general anesthesia exposures (RR = 1.61, 95% CI, 1.32-1.97, P < 0.001; I2 = 57.6%). Exposure to general anesthesia lasting 1-60 min during childhood is associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) (RR: 1.38, 95% CI: 1.26-1.51, P < 0.001; I2 = 0.0%). Moreover, with longer durations of exposure (61-120 min), the risk further rises (RR: 1.55, 95% CI: 1.21-1.99, P = 0.001; I2 = 37.8%). However, no additional increase in ADHD risk was observed with exposures exceeding 120 min (RR: 1.55, 95% CI: 1.35-1.79, P < 0.001; I2 = 0.0%).

CONCLUSIONS

Exposure to general anesthesia during early childhood increases the risk of developing attention-deficit/hyperactivity disorder. In particular, multiple general anesthesia exposures and exposures longer than 60 min significantly increase the risk of developing ADHD.

A Systematic Review and Meta-analysis of the Impact of the COVID-19 Pandemic on Access to HIV Pre-exposure Prophylaxis: Lessons for Future Public Health Crises

BACKGROUND

The World Health Organization is committed to strengthening access to pre-exposure prophylaxis (PrEP) for HIV prevention and its integration into primary care services. Unfortunately, the COVID-19 pandemic has disrupted the delivery of primary care, including HIV-related services. To determine the extent of this disruption, we conducted a systematic review and meta-analysis of the changes in access to PrEP services during the pandemic and the reasons for these changes.

METHODS

A search was conducted using PubMed, Scopus, Embase, PsycINFO, and Cinahl for studies published between January 2020 and January 2023. Selected articles described self-reported disruptions to PrEP service access associated with the COVID-19 pandemic or its responses. Pooled effect sizes were computed using a random-effects model.

RESULTS

Thirteen studies involving 12,652 PrEP users were included in our analysis. The proportion of participants reporting a disruption in access to PrEP services during the COVID-19 pandemic ranged from 3% to 56%, with a pooled proportion of 21% (95% confidence intervals: 8% to 38%). Social restrictions, financial constraints, and limited health insurance coverage were key factors affecting access to PrEP services during the pandemic.

CONCLUSIONS

To our knowledge, this is the first meta-analysis to quantify the extent of disruptions to accessing PrEP services because of the COVID-19 pandemic. To increase the ability of primary care services to maintain PrEP services during public health crises, a mixture of strategies is worth considering. These include multi-month PrEP prescriptions, telehealth services, deployment of peer support groups to provide a community-based service or home delivery, and provision of financial support interventions.

The effect of exercise training in people with pre-dialysis chronic kidney disease: a systematic review with meta-analysis

BACKGROUND

Chronic kidney disease (CKD) is a global health issue with high mortality and economic costs. Exercise has potential benefits for pre-dialysis CKD management. This review examines the impact of exercise on CKD patients not on dialysis, focusing on improvement in various health parameters. Findings aim to inform the role of exercise in pre-dialysis CKD care.

METHODS

A systematic search of MEDLINE, EMBASE, the Cochrane Library of Controlled Trials, CINAHL, and SPORTDiscus, up to August 31, 2023, used key terms relating to pre-dialysis CKD and exercise. We pooled randomized controlled trials (RCTs) comparing exercise with usual care and conducted meta-analyses based on a random effects inverse variance model with the effect measure of mean difference.

RESULTS

Of 1162 identified studies, 37 RCTs met the inclusion criteria including 1248 participants. Significant improvements were identified for peak VO2, mean difference [MD] (2.66 mL/kg/min; 95% confidence interval [CI] 1.48, 3.83; p < 0.00001); the 6-min walk (MD 58.83 m; 95% CI 35.26, 82.41; p < 0.00001), timed up and go (standardised mean difference - 0.35; 95% CI - 0.54, - 0.15; p = 0.0006), 2-min step (MD 57.48 steps; 95% CI 27.80, 87.16; p = 0.0001), and sit to stand tests (MD 4.55 repetitions; 95% CI 1.49, 7.60; p = 0.004); short form [SF]-36 general health (MD 4.26; 95% CI 0.04, 8.47; p = 0.05); SF-36 mental component summary (MD 1.84; 95% CI 0.18, 3.51; p = 0.03); estimated glomerular filtration rate (MD 2.19 mL/min/1.73 m2; 95% CI 0.97, 3.50; p = 0.001); serum cystatin-C (MD - 0.06 mg/L; 95% CI - 0.11, - 0.02; p = 0.004); resting heart rate (MD - 1.97 bpm; 95% CI - 3.84, - 0.11; p = 0.04); triglycerides (MD - 12.97mg/dL; 95% CI - 17.30, - 8.63; p < 0.00001); glycosylated haemoglobin (MD - 0.25%; 95% CI - 0.50, - 0.01; p = 0.04); waist circumference (MD - 3.12 cm; 95% CI - 4.37, - 1.86; p < 0.00001); and interleukin-6 (MD - 2.24 pg/mL; 95% CI - 3.87. - 0.61; p = 0.007).

CONCLUSIONS

Analysis revealed improvements in aerobic capacity, functional ability, quality of life, estimated glomerular filtration rate, serum cystatin-C, resting heart rate, waist circumference, triglyceride, glycosylated haemoglobin, and interleukin-6 levels.

Risk and protective factors of youth crime: An umbrella review of systematic reviews and meta-analyses

INTRODUCTION

Several systematic reviews and meta-analyses have been conducted on the risk and protective factors of youth crime. This study aims to consolidate this evidence using an umbrella review methodology.

METHODS

A systematic electronic search was conducted using multiple electronic databases. Strength of associations was evaluated using quantitative umbrella review criteria, and AMSTAR was used to assess the quality of the studies.

RESULTS

Among the 58 factors identified, 11 factors were supported by highly suggestive or suggestive evidence. Evidence of association was highly suggestive (class II) for substance use (odds ratio [OR] = 2·29, 95%CI 1·58-3.01), previous history of crime (OR = 2·03, 95%CI 1·62-2·45), moral development (OR = 3·98, 95%CI 3·57-4·39), psychopathology (OR = 2·22, 95%CI 1.40-2.69), adverse childhood experiences (OR = 1·37, 95%CI = 1·36-1·38), poor parental supervision (OR = 1·85, 95%CI 1·83-1·87), maltreatment or neglect (OR = 1·34, 95%CI 1·08-1·65), attachment (OR = 1·94; 95%CI 1.93-1·95), and school bullying (OR = 2·50; 95%CI 2·03-3·08); and suggestive (class III) for peer pressure (OR = 2·11, 95%CI 2·06-2·16) and supportive school environments (OR = 0·56; 95%CI 0·55-0·57).

CONCLUSION

The evidence-based atlas of key risk and protective factors identified in this umbrella review could be used as a benchmark for advancing research, prevention, and early intervention strategies for youth crime.

Long-term survival following adrenalectomy for secondary adrenal tumors: A systematic review and meta-analysis

BACKGROUND

Secondary adrenal tumors (SATs) are uncommon, and the benefits of adrenalectomy for SATs have not been well-established. A systematic review and meta-analysis were conducted to assess the survival benefits of adrenalectomy for SATs.

METHOD

ology: A systematic literature search was performed (1990-2022). The inclusion criteria included a known primary tumor with confirmed adrenal metastasis in patients who underwent adrenalectomy. The primary outcome was the overall survival (OS).

RESULTS

A total of 26 studies were included, with 2279 patients. The average age at the time of diagnosis was 61.1 years. Lung cancer was the most common primary tumor. The average time from primary tumor diagnosis to identification of adrenal metastasis was 17 months. The median OS was 35.2 months. One, three, and five-year OS were 79.7 ​%, 49.1 ​%, and 37.9 ​%, respectively.

CONCLUSION

The results of this review provide insight into the long-term survival of patients with SATs who underwent adrenalectomy. The study highlights the need for further research to identify the risk factors that play a role in the outcome of adrenalectomy in patients with SATs.