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

Cost-effectiveness of CDK4/6 inhibitors in HR+/HER2- metastatic breast cancer: a systematic review and meta-analysis

BACKGROUND

Cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors have emerged as a significant advancement in the treatment of HR+/HER2- metastatic breast cancer (MBC). Despite the clinical efficacy of CDK 4/6 inhibitors in HR+/HER2- metastatic breast cancer, there remains a significant gap in understanding their cost-effectiveness, particularly regarding the long-term economic impact and the key drivers of costs, when used in combination with endocrine therapy. This study aims to systematically review and conduct a meta-analysis of cost-effectiveness studies evaluating CDK4/6 inhibitors in treatment of HR+/HER2- advanced breast cancer and identify key drivers of costs of CDK4/6 inhibitors in combination with endocrine therapy.

METHODS

A comprehensive search of PubMed and Embase was conducted to identify peer-reviewed studies from February 2015 to March 2022 reporting cost-effectiveness of CDK4/6 inhibitors in MBC treatment. Incremental net benefits (INBs) were estimated, and meta-analysis was conducted. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

We identified 120 articles, of which 18 were eligible for systematic review and 16 for meta-analysis. None of the three CDK4/6 inhibitors had positive INB compared to endocrine/aromatase inhibitors therapy alone. The pooled INB was estimated at -$149,266.87 (95% Confidence Interval (CI) = -$196,961.54, -$101,572.20).

CONCLUSION

The combination of CDK4/6 inhibitors and letrozole/endocrine therapy for the treatment of postmenopausal patients with advanced HR+/HER2 - MBC was not cost-effective.

Orthotic interventions for restoring proximal interphalangeal joint motion for patients with hand injuries or conditions: A systematic review and meta-analysis

BACKGROUND

Limitations to proximal interphalangeal joint (PIPJ) motion can result in significant functional impairment for people with hand injuries and conditions. The role of orthotic intervention to improve PIPJ motion has been studied; however, high-quality systematic reviews and meta-analyses are lacking.

PURPOSE

This study aimed to determine the effectiveness of orthotic intervention for restoring PIPJ extension/flexion following hand injuries or conditions.

STUDY DESIGN

Systematic review.

METHODS

A comprehensive literature search was completed in MEDLINE, CINAHL, Embase, Cochrane Central, and PEDro using terms related to orthoses, finger PIPJ range of motion, and randomized controlled trial design. Methodological quality was assessed using the PEDro score, study outcomes were pooled wherever possible using random effects meta-analysis, and certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

Twelve trials were included (PEDro score: 4-7/10). The addition of orthotic intervention was not more effective than hand therapy alone following Dupuytren's release for improving total active extension (mean difference [MD] -2.8°, 95% confidence interval [CI]: -9.6° to 4.0°, p = 0.84), total active flexion (MD -5.8°, 95% CI: -12.7° to 1.2°, p = 0.70), Disability of the Arm, Shoulder and Hand scores (MD 0.4, 95% CI: -2.7 to 3.6, p = 0.79), or patient satisfaction (standardized MD 0.20, 95% CI: -0.49 to 0.09, p = 0.17). Orthotic intervention was more effective than hand therapy alone for improving PIPJ extension for fixed flexion deformities following traumatic finger injury or surgery (MD -16.7°, 95% CI: -20.1° to -13.3°, p < 0.001). No studies evaluated orthotic intervention to improve PIPJ flexion.

CONCLUSION

The addition of an extension orthosis following procedures to manage Dupuytren's contracture is no better than hand therapy alone for improving PIPJ extension. In contrast, the addition of a PIPJ extension orthosis in the presence of traumatic PIPJ fixed flexion deformities is more effective for improving PIPJ extension than hand therapy alone. Future studies are needed to evaluate the role of orthotic intervention for improving PIPJ flexion.

Sociodemographic factors impacting the spatial distribution of private dental clinics in major cities of Peoples Republic of China

OBJECTIVES

Investigate the geographical distribution of private dental practices in major Chinese cities and analyze the variables influencing this distribution.

METHODS

This study used Python to extract various types of Point of Interest (POI) data spanning from 2016 to 2022 from the AutoNavi map. A 1km*1km grid was constructed to establish the study sample. Additional spatial pattern data, including nighttime lighting, population, and air quality data, were integrated into this grid. Global Moran's I index was used to analyze the spatial autocorrelation. The spatial lag model was used to explore the influencing factors of private dental practice distribution.

RESULTS

This study reveals a specific clustering pattern for private dental practices in major Chinese cities. The primary influencing factors include nighttime lights, population density, and housing prices, suggesting that dental practices are typically concentrated in highly developed regions with dense populations and high housing costs. Additionally, we discovered that patterns vary across different metropolises, with the most pronounced clustering patterns and substantial inequalities found in the most developed areas.

CONCLUSIONS

This study establishes that factors such as regional development and population density positively correlate with private dental practice. Additionally, it reveals a strong mutual correlation in the clustering of dental practices, which does not show a substantial correlation with public resources. Finally, it suggests that the spatial heterogeneity pattern implies a rising necessity to tackle inequality issues within urban areas as economic development progresses.

Sleep quality disparities in different pregnancy trimesters in low- and middle-income countries: a systematic review and meta-analysis

INTRODUCTION

Sleep is a crucial determinant of maternal and fetal health, significantly impacting the well-being of both the mother and her developing fetus. Poor sleep quality, characterized by difficulties in falling asleep or staying asleep, can cause poor pregnancy outcome. Conversely, studies came with inconsistent result in the prevalence of poor sleep quality in different trimester of pregnancy. Therefore, this systematic review and meta-analysis study aimed to compare the prevalence of poor sleep quality in different trimesters.

METHOD

A systematic review and meta-analysis were done on published studies. Electronic data base search was done from PubMed, Hinari, Medline and Google Scholar. Data were extracted with Excel and the analysis were done using STATA version 17. Publication bias was assessed both graphically and statistically. I-square test was used to identify heterogeneity.

RESULT

In this meta-analysis, 38 studies that measured poor sleep quality using the Pittsburg Sleep Quality Index (PSQI ≥ 5) were included. The pooled prevalence of poor sleep quality was identified as 37.46% (95% CI: 29.26, 45.67) in the first trimester, 47.62% (95% CI: 42.23, 53.02) in the second trimester, and 60.05% (95% CI: 51.32, 68.78) in the third trimester.

CONCLUSION

This study identified a significant discrepancy in the prevalence of poor sleep quality, which increases as gestational age advances. Therefore, this discrepancy should be addressed, and additional support should be provided to pregnant women to help them achieve adequate sleep, especially as gestational age advances.

Occupational Exposure to Air Pollutants and Higher Risk of COPD in Construction Workers: A Meta-Analysis Study

Introduction

Construction sites generate high levels of air pollution, contributing to more than 4% of particulate matter in the atmosphere. Literature indicates that on-site pollution is an important factor that contributes to lung impairments in construction workers. Chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ADRS) are known to be exacerbated because of exposure to a variety of construction pollutants mainly particulate matter (PM10, PM2.5).

Methods

We conducted a systematic review and meta-analysis to assess whether exposure to construction site pollutants is associated with impairment of pulmonary parameters like Forced vital capacity (FVC), Forced expiration volume in 1 sec (FEV1) and FEV1/FVC. A total of 221 publications of observational studies were reviewed and 18 were selected; the data of which were meta-analyzed.

Results and Discussion

In all studies the test subjects (construction workers) exposed to occupational air pollutants showed significantly lower FVC and FEV1 as compared expected levels (p≤ 0.01). The calculated Odds ratio indicates that there is positive association between COPD as compared to ARDS and exposure to pollutants.

Association of four CTLA-4 gene polymorphisms with pemphigus risk: a systematic review, meta-analysis, and meta-regression

OBJECTIVES

This review aimed to summarize the existing data on the contribution of four single nucleotide polymorphisms (SNPs) in the cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) genes to pemphigus susceptibility.

METHODS

An electronic literature search for eligible studies among those published prior to 30 April 2024 was conducted through the PubMed, EMBASE, Web of Science, and Scopus databases. To minimize publication bias, an additional search was performed via the Google Scholar and Semantic Scholar search engines. Meta-analyses, together with subgroup analyses and meta-regressions, were performed for the following four CTLA-4 SNPs: rs231775, rs5742909, rs3087243, and rs733618.

RESULTS

Combined analyses revealed a significant increase in pemphigus risk conferred by the CTLA-4 rs5742909*C and rs733618*C alleles. Conversely, there was no evidence of any significant association between the rs231775*G and rs3087243*G alleles and susceptibility to pemphigus. Subgroup analyses by ethnicity and pemphigus type (vulgaris or foliaceus) and meta-regressions did not reveal any significant difference.

CONCLUSION

This meta-analysis suggested that two of the four investigated CTLA-4 SNPs were significantly associated with increased pemphigus risk.Registration: This review has been registered on PROSPERO: CRD42024550668; available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024550668.

Influence of vitamin D in orthodontic tooth movement-a systematic review and meta-analysis of randomized controlled trials in humans

BACKGROUND

Orchestration of tooth movement necessitates an equilibrium of bone synthesis and resorption. Vitamin D, through receptor-mediated actions, regulates the differentiation and maturation of osteoblasts and also induces osteoclastogenesis, maintaining this equilibrium.

OBJECTIVE

To analyze the impact of vitamin D in orthodontic tooth movement (OTM).

SEARCH METHOD

A comprehensive exploration of the existing literature was conducted by systematic search through seven e-databases.

SELECTION CRITERIA

The criteria for inclusion were established using the PICO format: Orthodontic patients treated with fixed appliance (P), administered with vitamin D3 (I), collated with appropriate control groups (C), with tooth movement as the primary outcome and root resorption, anchorage loss, gingival crevicular fluid (GCF) volume, pain perception, and alveolar bone density as the secondary outcome (O).

DATA COLLECTION AND ANALYSIS

After an extensive database search, 251 articles were obtained. Six articles were chosen following a stringent selection using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical appraisal of randomized control trials (RCTs) involved the meticulous application of the RoB 2 tool. The quantitative synthesis incorporated a subset of six articles only.

RESULTS

In the meta-analysis investigating the influence of vitamin D on OTM, a notable disparity was evident between the vitamin D and control groups. Specifically, the standardized mean difference (SMD) stood at 1.43, accompanied by a 95% confidence interval (CI) ranging from 0.691 to 2.169 (P = .00154). For root resorption, the SMD was recorded at -0.51, with a 95% CI spanning from -3.051 to 2.031 (P = .11).

CONCLUSIONS

The rate of tooth movement was enhanced by systemic and local administration of vitamin D. However, the inadequacy of available data is a hindrance in determining conclusively the impact of vitamin D on the extent of root resorption. The resolution of this quandary needs future human studies devoted toward investigating the influence of vitamin D in the realms of OTM and associated root resorption, thereby providing a definitive elucidation.

REGISTRATION DETAILS

Prospero- CRD42023491783.

The Relationships Between Burnout, Job Satisfaction, and Emotion Regulation Among Foreign Language Teachers: A Meta-Analytic Review

This meta-analytic review examines the relationships between foreign language teachers' burnout and two key factors: (1) job satisfaction and (2) emotion regulation. The analysis incorporates data from 14 studies with 3,812 participants to quantify these relationships and explore potential moderating factors. The results indicate a significant negative correlation between burnout and job satisfaction, as well as a strong negative correlation between burnout and emotion regulation. Moderator analyses reveal that country, educational setting, and education stage significantly influence these relationships. However, continuous moderators such as gender distribution and publication year did not significantly affect the outcomes. These findings underscore the importance of considering contextual factors in addressing burnout among foreign language teachers and suggest targeted interventions to enhance emotion regulation and job satisfaction in this population.

Systematic review: Mortality associated with raised faecal immunochemical test and positive faecal occult blood results

BACKGROUND

Faecal haemoglobin (f-Hb) testing is used in colorectal cancer (CRC) screening and increasingly to guide the investigation in patients with symptoms suggestive of CRC. Studies have demonstrated increased mortality with raised f-Hb.

AIMS

To assess the association of raised f-Hb with all-cause, non-CRC (any cause excluding CRC) and cause-specific mortality.

METHODS

We searched Medline and Embase on 9 February 2024 to identify papers reporting mortality after faecal immunochemical (FIT) or guaiac faecal occult blood tests (gFOBT). The primary outcome was all-cause mortality following a positive compared to a negative test.

RESULTS

The search identified 3155 papers. Ten met the inclusion criteria: three reported gFOBT and seven reported FIT results, as screening tests. These reported a total of 14,687,625 f-Hb results. Elevated f-Hb was associated with an increased risk of all-cause, non-CRC and cause-specific mortality including death from cardiovascular, digestive and respiratory diseases. Crude risk ratios for all-cause mortality with a positive versus negative test were derived from six papers (three reporting gFOBT, three FIT). An increased risk was demonstrated in five, with RRs ranging from 1.11 (95% CI: 1.06-1.16) to 2.95 (95% CI: 2.85-3.05). For non-CRC mortality risk, RRs ranged from 1.09 (95% CI: 1.04-1.15) to 2.79 (95% CI: 2.70-2.89). We did not perform meta-analysis due to a limited number of papers reporting suitable results for each type of f-Hb test.

CONCLUSIONS

All-cause, non-CRC and cause-specific mortality appear higher in those with raised f-Hb. Population-based studies are warranted to elicit whether this association occurs in symptomatic patients.

Most meta-analyses in oral health do not have conclusive and robust results

OBJECTIVES

In meta-analyses with few studies, between-study heterogeneity is poorly estimated. The Hartung and Knapp (HK) correction and the prediction intervals can account for the uncertainty in estimating heterogeneity and the range of effect sizes we may encounter in future trials, respectively. The aim of this study was to assess the reported use of the HK correction in oral health meta-analyses and to compare the published reported results and interpretation i) to those calculated using eight heterogeneity estimators and the HK adjustment ii) and to the prediction intervals (PIs).

METHODS

We sourced systematic reviews (SRs) published between 2021 and 2023 in eighteen leading specialty and general dental journals. We extracted study characteristics at the SR and meta-analysis level and re-analyzed the selected meta-analyses via the random-effects model and eight heterogeneity estimators, with and without the HK correction. For each meta-analysis, we re-calculated the overall estimate, the P-value, the 95 % confidence interval (CI) and the PI.

RESULTS

We analysed 292 meta-analyses. The median number of primary studies included in meta-analysis was 8 (interquartile range [IQR] = [5.75-15] range: 3-121). Only 3/292 meta-analyses used the HK adjustment and 12/292 reported PIs. The percentage of statistically significant results that became non-significant varied across the heterogeneity estimators (7.45 %- 16.59 %). Based on the PIs, >60 % of meta-analyses with statistically significant results are likely to change in the future and >40 % of the PIs included the opposite pooled effect.

CONCLUSIONS

The precision and statistical significance of the pooled estimates from meta-analyses with at least three studies is sensitive to the HK correction, the heterogeneity variance estimator, and the PIs.

CLINICAL SIGNIFICANCE

Uncertainty in meta-analyses estimates should be considered especially when a small number of trials is available or vary notably in their precision. Misinterpretation of the summary results can lead to ineffective interventions being applied in clinical practice.

Prognosis of hepatocellular carcinoma using the albumin to alkaline phosphatase ratio, literature review, and meta-analysis

Background

Data about the impact of albumin-to-alkaline phosphatase ratio (AAPR) on prognosis in hepatocellular cancer (HCC) patients are inconclusive and conflicting.

Methods

The authors systematically searched literatures from seven databases (PubMed, Medline, Web of Science, Cochrane Library, Embase, Google Scholar, and CINAHL), updated to September 2023. Hazard ratios (HRs) and 95% CIs were pooled and synthesized using Comprehensive Meta-Analysis version 3 in order to assess the overall impact of AAPR on patient's prognosis.

Results

In total, 8 studies involving 13 cohorts with 3774 cases were included. Pooled results from both univariate and multivariate analyses revealed that higher AAPR was an independent prognostic factor for overall survival (HR=0.429, 95% CI: 0.361-0.509, P=0.001; HR=0.476, 95% CI: 0.421-0.538, P=0.001; respectively). Similarly, pooled multivariate results showed that higher AAPR was associated with better disease-free survival (HR=0.558, 95% CI: 0.452-0.688, P=0.001). Moreover, pooled results from both univariate and multivariate analyses revealed that higher AAPR was an independent prognostic factor for recurrence-free survival (HR=0.540, 95% CI: 0.420-0.694, P=0.001; HR=0.647, 95% CI: 0.494-0.848, P=0.002; respectively). Subgroups analysis showed that elevated AAPR still significantly correlated with better overall survival across the confounding factors. Moreover, sensitivity analysis suggested the robustness of these findings and no publication bias was detected.

Conclusions

In summary, higher AAPR could be considered as a reliable prognostic factor in patients with HCC, which could be used as a routine inspection of HCC patients to individualized prognosis prediction and clinical decision making.

Natural History of Cavernous Carotid Artery Aneurysms: A Systematic Review and Meta-Analysis

BACKGROUND

Cavernous carotid artery aneurysms (CCAAs) represent a common condition seen in clinical practice with significant practice variability. The aim of this systematic review and meta-analysis was to aggregate current evidence on the natural history of CCAAs.

METHODS

MEDLINE/PubMed, EMBASE, and Cochrane Library were queried from inception until December 2023. The primary outcome of this study was CCAA-related mortality. The secondary outcomes of this study were aneurysm growth, intracranial ischemic and hemorrhagic events, improved non-cerebrovascular symptoms, and new or worsened non-cerebrovascular symptoms during follow-up.

RESULTS

Ten studies met our inclusion criteria, involving 835 patients and 975 CCAAs. CCAA-related mortality had an incidence rate of 0.28 (95% CI 0.12-0.64) per 100 person-years (PYs) of follow-up. The incidence rate of CCAA growth was 2.91 (1.05-8.07) per 100 PYs of follow-up. The incidence rate of CCAA-related intracranial ischemic events was 0.4 (0.16-1.01) per 100 PYs of follow-up. The incidence rate of CCAA-related intracranial hemorrhagic events was 0.54 (0.33-0.87) per 100 PYs of follow-up. The incidence rate of improved non-cerebrovascular symptoms was 2.51 (1.18-5.33) per 100 PYs of follow-up. The incidence rate of new or worsened non-cerebrovascular symptoms was 3.41 (2.03-5.73) per 100 PYs of follow-up.

CONCLUSIONS

CCAAs are typically benign lesions with a low risk of rupture and life-threatening complications. CCAAs tend to follow an indolent course regarding non-cerebrovascular outcomes, and new or worsening symptoms are infrequent during the clinical course. However, spontaneous resolution of non-cerebrovascular symptoms and cranial nerve deficits at presentation is uncommon.

Taking a Deeper Dive Into OSFED Subtypes: A Meta-Analysis and Systematic Review

OBJECTIVE

To compare all other specified feeding or eating disorders (OSFED) groups (atypical anorexia nervosa [AN], purging disorder [PD], night eating syndrome [NES], subthreshold bulimia nervosa [sub-BN], and subthreshold binge-eating disorder [sub-BED]) to threshold eating disorders (EDs [AN, BN, and BED]) and control groups (CGs) on measures of eating and general psychopathology.

METHOD

We conducted a comprehensive search in PsycINFO, Medline, Embase, and CINAHL on all published studies from January 2013 to February 2024 using DSM-5 diagnostic criteria via clinical interviews or well-established diagnostic tools. We also undertook a quality appraisal using an adapted version of the Downs and Black criteria and registered the review with PROSPERO (ID: CRD42022314495).

RESULTS

Overall, our meta-analyses (n = 33 eligible studies) indicated that the combined OSFED and several specific OSFED subtypes displayed comparable levels of eating psychopathology to full-threshold EDs. Our systematic review (n = 33 eligible studies) found individuals with OSFED to have comparable levels of eating and general psychopathology to full-threshold EDs, but higher levels of eating and general psychopathology than CGs. These findings were specifically attributed to atypical AN and NES. There was a lack of evidence available for sub-BN and sub-BED. Studies mainly met the quality appraisal criteria. The main limitations identified in the included studies were insufficient reporting of their statistical power (78%) and no adjusting for potential confounding factors (67%).

DISCUSSION

Findings support the conceptualization of atypical AN, and NES as clinically significant EDs with similar severity to full-threshold EDs.

Impact of prolonged embryo storage on reproductive and neonatal outcomes: a systematic review and meta-analysis

PURPOSE

To analyze the influence of embryo storage on reproductive and neonatal results in patients undergoing in vitro fertilization (IVF) treatment.

METHODS

PubMed, Embase, Cochrane Central Register of Controlled Trials, and BioMed Central databases were searched from inception up to June 2024 for studies comparing reproductive and neonatal outcomes in patients undergoing frozen embryo transfer within 12 months from embryo storage versus more than 12 months after embryo storage. Data were pooled by meta-analysis using a random effects model.

RESULTS

A total of 16 studies, involving 233,315 embryos were included. Patients undergoing frozen embryo within 12 months from embryo storage were associated with higher rates of live birth (OR 1.17, 95% CI 1.09-1.26, I2 = 78%) biochemical pregnancy (OR 1.26, 95% CI 1.08-1.47, I2 = 77.8%) clinical pregnancy (OR 1.24, 95% CI 1.12-1.38, I2 = 86.3%) and multiple pregnancy rate (OR 1.26, 95% CI 1.03-1.55, I2 = 69%). No significant differences between groups were shown in terms of survival rate (OR 1.52, 95% CI 0.65-3.58, I2 = 98.5%), miscarriage (OR 1.08, 95% CI 0.91-1.27, I2 = 77%), implantation rate (OR 1.17, 95% CI 0.90-1.52, I2 = 91.7%) and ectopic pregnancy (OR 0.98, 95% CI 0.80-1.20, I2 = 0%). In addition, prolonged embryo storage was not associated with higher rates of preterm delivery (OR 0.86, 95% CI 0.67-1.09, I2 = 8.3%), low weight at birth (OR 1.10, 95% CI 0.88-1.38, I2 = 24.3%) or congenital malformations (OR 0.90, 95% CI 0.65-1.25, I2 = 0.8%).

CONCLUSION

Prolonged embryo storage over 12 months is associated with lower rates of live birth, biochemical pregnancy, clinical pregnancy, and multiple pregnancy. However, important covariates such as reasons for delay of transfer, embryo quality, and improper handling of embryos could not be ruled out as causes of this reduction. Given these limitations, these conclusions should be viewed with caution.

Medication non-adherence and predictor factors among adult asthmatic patients in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

A pronounced burden is evident in individuals with asthma, with approximately half of them not adhering to their prescribed medication. Therefore, this study aimed to assess the pooled prevalence of anti-asthma medications non-adherence in Ethiopia.

DATA SOURCES

A comprehensive search was conducted across multiple electronic databases including PubMed, Africa Index Medicus, Science Direct, Hinari, and a search engine, Google Scholar from October 5 to 20, 2023. In addition, digital research repositories from Addis Ababa and Bahir Dar University were accessed.

DATA SELECTION

The eligibility criteria was employed to screen studies after uploading search results to EndNote software to remove duplicates first. Then, two investigators, CT and BBT, independently assessed titles, abstracts, and the full text of all retrieved references to identify potentially eligible studies.

RESULT

This meta-analysis, which was conducted in Ethiopia, and included 11 full-text articles, revealed a pooled asthma medication non-adherence level of 51.20% (95% CI 35.20%, 67.20%) with substantial heterogeneity (I2 = 99.08%). The review has also identified factors predicting non-adherence among asthmatic patients: free (health service) (AOR: 0.31, 95% CI 0.18-0.54), poor knowledge (AOR: 2.85, 95% CI 1.61-5.05), absence of formal education (AOR: 3.01, 95% CI 1.72-5.25), history of previous ADR (AOR: 8.57, 95% CI 1.12-65.3), and the presence of Co- morbidity(AOR: 3.28, 95% CI 2.014-5.68), had shown association with asthma medication non-adherence.

CONCLUSION

Asthma medication non-adherence is notably high in Ethiopia. Addressing medication non-adherence requires a comprehensive approach, including clear communication between healthcare providers, patient education, and addressing financial barriers to ensure better adherence in asthma patients.

Impact of central-line-associated bloodstream infections and catheter-related bloodstream infections: a systematic review and meta-analysis

BACKGROUND

Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs.

AIM

To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients.

METHODS

PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E.

FINDINGS

Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I2 = 49%) and 2.47 (95% CI: 1.51, 4.02; I2 = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I2 = 91%) and 16.26 days (95% CI: 10.19, 22.33; I2 = 66%), respectively.

CONCLUSION

CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS.

Does repetitive transcranial magnetic stimulation have a beneficial effect on improving unilateral spatial neglect caused by stroke? A meta-analysis

This review aimed to assess the effect of repetitive transcranial magnetic stimulation (rTMS) in improving post-stroke unilateral spatial neglect (USN) using a meta-analysis. Further, we aimed to identify any association between rTMS parameters, patient demographics, and treatment effect sizes using subgroup analyses and meta-regression. A literature search was conducted through four databases from inception to March 6, 2024, to retrieve all relevant controlled trials investigating the effects of rTMS on symptoms of USN in post-stroke patients. Overall, rTMS significantly improved post-stroke USN, as measured by the line bisection test (Hedges' g = - 1.301, p < 0.0001), the cancelation test (Hedge's g = - 1.512, p < 0.0001), and the Catherine Bergego Scale (Hedges'g = - 0.770, p < 0.0001), compared to sham stimulation. Subgroup analysis found that generally larger effect sizes following excitatory rTMS across several outcome measures, indicating that excitatory rTMS on the ipsilesional hemisphere may be more effective than inhibitory rTMS on the contralesional hemisphere in ameliorating neglect symptoms. Meta-regression analysis of the line bisection test showed a significant difference in the chronicity of stroke patients, suggesting that rTMS may be more effective for USN in patients at the acute stage (within 3 months since stroke) than in those at the post-acute stage (p = 0.035). In conclusion, rTMS appears to be effective in promoting recovery from post-stroke USN. Excitatory protocols and early intervention may enhance recovery outcomes for neglect behaviors in post-stroke survivors.

Predicting Treatment Effects from Surrogate Endpoints in Historical Trials in First-Line Metastatic Castration-Resistant Prostate Cancer

Surrogate endpoints are becoming increasingly important in health technology assessment, where decisions are based on complex cost-effectiveness models (CEMs) that require numerous input parameters. Daniels and Hughes Surrogate Model was used to predict missing effect estimates in randomized controlled trials (RCTs) evaluating first-line treatments in metastatic castration-resistant prostate cancer (mCRPC) patients. Network meta-analyses (NMAs) were conducted to assess the comparative efficacy of these treatments. Databases were searched (inception to October 2022) using Ovid®. Several grey literature searches were also conducted (PROSPERO: CRD42021283512). Available trial data for radiographic progression-free survival (rPFS) and overall survival (OS) were used to predict the unreported effect of rPFS or OS for relevant comparator treatments. Bayesian NMAs were conducted using observed and predicted treatment effects. Effect estimates and 95% credible intervals were calculated for each comparison. Mean ranks and the probability of being best (p-best) were obtained. Twenty-five RCTs met the eligibility criteria and of these, 8 reported jointly rPFS and OS; while rPFS was predicted for 12 RCTs and 10 comparators, and OS was predicted for 5 RCTs and 6 comparators. A nonstandard dose of docetaxel (docetaxel 50 mg/m2 every 2 weeks) had the highest probability of being the most effective for rPFS (p-best: 59%) and OS (p-best: 48%), followed by talazoparib plus enzalutamide (13% and 19%, respectively). Advanced surrogate modelling techniques allowed obtaining relevant parameter and indirect estimates of previously unavailable data and may be used to populate future CEMs requiring rPFS and OS in first-line mCRPC.

Prevalence and Spatial Distribution Characteristics of Female Stress Urinary Incontinence in Mainland China

Background and objective

Stress urinary incontinence (SUI) in women is a common condition that affects middle-aged and elderly women. Currently, there are still many limitations in the epidemiological research on SUI. This study aims to address the gap in the prevalence of female SUI in mainland China and provide theoretical support for the prevention and treatment of SUI.

Methods

A comprehensive literature search was conducted on the prevalence of female SUI in mainland China, systematically searching Chinese and English databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Weipu Database as of April 1, 2024. Detailed criteria for screening and exclusion were established. The prevalence of SUI in the selected studies was synthesized using Stata MP (version 15) software, and a multisubgroup analysis, a sensitivity analysis, and publication bias detection of the prevalence of SUI were also performed using the software. Additionally, ArcGIS software (version 10.8) and Geoda software (version 1.2) were utilized to explore the geographical distribution characteristics of the prevalence of female SUI in mainland China.

Key findings and limitations

A total of 688 articles were screened, and finally 85 articles were included. The overall rate of female SUI in mainland China was 24.5% (95% confidence interval: 22.5-26.5%). The heterogeneity of the study is statistically significant (I2 = 99.0%, p < 0.001). Based on significant heterogeneity, a multisubgroup analysis was conducted. The results showed that the prevalence of SUI varies among different publication years, literature quality scores, investigators, study settings, sampling methods, provinces, regions, coastal or inland areas, and rural or urban areas. A spatial econometric analysis indicated that the incidence of SUI in the east-west distribution showed a downward trend, while in the north-south distribution, the incidence rate of SUI showed a trend of first increasing and then decreasing. Additionally, a spatial metrology analysis showed similar trends in the distribution of SUI incidence.

Conclusions and clinical implications

The high incidence rate of female SUI in mainland China and the regional differences observed indicate the need for further rigorous epidemiological investigation in the future.

Patient summary

Stress urinary incontinence (SUI) is common among middle-aged and elderly women. The high prevalence of SUI in mainland China and the differences across regions emphasize the need for conducting more robust epidemiological studies in the future.

Engagement Along the PrEP Care Continuum Among Men Who Have Sex with Men in China: A Systematic Review and Meta-analysis

Pre-exposure prophylaxis (PrEP), including daily oral, on-demand, and long-acting injectable (LAI), is a promising HIV prevention intervention for men who have sex with men (MSM). We conducted a systematic review on engagement with the PrEP continuum among MSM in China. A total of 756 studies were initially identified and 36 studies were included (N = 26,021). In the 20 studies (N = 13,886) examining PrEP awareness, 32.4% (95% CI: 25.1-40.7) of MSM were aware of PrEP. In the 25 studies (N = 18,587) examining willingness, 54.5% (95% CI: 41.9-66.5) MSM indicated they were willing to use PrEP. The pooled prevalence of PrEP uptake from 9 studies (N = 6,575) was 4.9% (95% CI: 1.4-15.8%), while pooled estimates of adequate adherence from five studies (N = 2,344) among MSM on PrEP was 40.7% (95% CI: 20.0-65.2%). Subgroup analyses suggested studies conducted after 2015 (versus before) tended to report higher awareness and uptake. Awareness was highest for daily oral PrEP, followed by on-demand, and LAI PrEP; willingness to use was highest for LAI PrEP. The operationalization of willingness and adherence constructs varied across studies and complicated the interpretation of pooled estimates. This review revealed gaps in the PrEP care continuum among MSM in China, with relatively low awareness and uptake (in contrast to willingness and adherence) as the major potential barriers to widespread implementation and the need for a unified approach to defining and measuring PrEP outcomes.

Effects of exercise interventions on brain-derived neurotrophic factor levels in overweight and obesity: A systematic review and meta-analysis

Background

/Objective. An explosion in global obesity epidemic poses threats to the healthcare system by provoking risks of many debilitating diseases, including cognitive dysfunction. Physical activity has been shown to alleviate the deleterious effects of obesity-associated cognitive deficits across the lifespan. Given the strong neuroprotective role of brain-derived neurotrophic factor (BDNF) and exercise training as a known modulator for its elevation, this systematic review sought to examine the strength of the association between exercise and BDNF levels in healthy people with overweight and obesity.

Methods

Six electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Ovid Nursing Database, and SPORTDiscus) were searched from their inceptions through December 2022. The primary outcome of interest was BDNF levels. Interventional studies (randomized and quasi-experimental) with English full text available were included. Risk of bias of the included studies was assessed using the Physiotherapy Evidence Database Scale. Data were extracted for meta-analyses by random-effects models.

Results

Thirteen studies (n = 750), of which 69.2% (9/13) had low risk of bias, were included. In the meta-analysis, exercise interventions had no significant effect on resting BDNF levels (standardized mean difference: -0.30, 95% CI -0.80 to 0.21, P = 0.25). Subgroup analyses also indicated no effects of age and types of control groups being compared on moderating the association.

Conclusion

To further inform the role of BDNF in obesity-related cognitive functioning, rigorous studies with larger samples of participants and raw data available were imperatively deserved.

Seroprevalence and Associated Outcomes of Parvovirus B19 Infection in Human Immunodeficiency Virus Patients: A Systematic Review

Several case reports have highlighted the presence of serious clinical outcomes in patients with human immunodeficiency virus (HIV) related to parvovirus B19 (PVB19). However, epidemiological studies have produced inconsistent and varying results regarding the prevalence of PVB19 and its associated clinical outcomes in this population. These inconsistencies highlight the need for a thorough summary and analysis of present data to better understand burden and impact of PVB19 on HIV patients. This review aims to provide an overview of current evidence and identify areas for further research. Following the Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines, a comprehensive search was conducted across Medline/PubMed, Google Scholar, and World Health Organization Virtual Health Library Regional Portal. The pooled prevalence with the corresponding 95% confidence interval (CI) was measured using Comprehensive Meta-Analysis Software version 3.3. Publication bias was estimated based on Begg's test, Egger's test, and examination of the funnel plots. A total of 16 studies, with 2,122 HIV patients, were included in the meta-analysis. The pooled prevalence of detecting anti-PVB19 immunoglobulin G, anti-PVB19 immunoglobulin M, and PVB19 DNA particles among HIV patients was 43.6% (95% CI: 23.5-66.1%), 5.10% (95% CI: 2.10-12.10%), and 6.40% (95% CI: 4.10-9.90%), respectively. In the overall population of HIV patients, most of the included studies did not establish a statistically significant association between PVB19 infection and the occurrence of anemia. PVB19 infection is commonly detected in individuals with HIV. However, anemia due to PVB19 is not common in this population. Findings from a few studies suggest that PVB19 infection may contribute to anemia in individuals with advanced HIV disease or significant immunosuppression. Additional research is needed to confirm and clarify these relationships in individuals with HIV, particularly those with compromised immune systems.

Association between domestic animal exposure and diarrhea prevalence in under- five children in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Diarrheal disease is still the leading cause of morbidity and mortality in children, despite significant progress in diarrhea interventions. Zoonotic transmission is the main cause of the emergence and re-emergence of diseases. Domestic animals are often close to humans, particularly in resource-poor countries. Despite evidence of environmental contamination, there have been limited studies conducted to examine the association between domestic animal exposure and diarrheal disease in low- and middle-income countries (LMIC). Therefore, this systematic review and meta-analysis examines the association between domestic animal exposure and diarrheal disease in children under five years of age in LMIC.

METHODS

The search strategy followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for the reporting of systematic reviews. All appropriate databases were searched to find relevant articles. Research studies were selected for review if they reported an outcome variable that measured diarrhea and exposure variables of any domestic animals. A data extraction form was used to extract information from each study. The quality of the individual articles was assessed using the Joanna Briggs Institute (JBI's) critical appraisal tools. Publication bias was checked using a funnel plot, Egger's regression test, and Begg's test. The heterogeneity of studies was checked using the Galbraith plot and the I-squared test. A sensitivity analysis was conducted, and a meta-analysis was conducted using STATA 17.

RESULTS

After reviewing 113 articles, 11 articles fulfilled the inclusion criteria hence considered for meta-analysis. The finding of these 11 studies revealed that study participants who had animal exposure had 1.95 higher odds of diarrhea as compared to participants who hadn't animal exposure (OR: 1.95, 95%CI: 1.25, 2.66).

CONCLUSIONS AND RECOMMENDATIONS

This study reported that diarrheal disease was associated with study subjects who had domestic animal exposure. Therefore, more comprehensive research is needed on specific behaviors and interventions surrounding animal husbandry that may affect the transmission of pathogens between animals and humans; this would facilitate the design and implementation of measures to reduce animal exposure in the domestic environment.

Effect of powered circular stapler in colorectal anastomosis after left-sided colic resection: systematic review and meta-analysis

PURPOSE

Anastomotic leak (AL) remains the most important complication after left-sided colic anastomoses and technical complications during anastomotic construction are responsible of higher leakage incidence. Powered circular stapler (PCS) in colorectal surgery has been introduced in order to reduce technical errors and post-operative complications due to the manual circular stapler (MCS).

METHODS

A systematic review and meta-analysis were performed. An electronic systematic search was performed using Web of Science, PubMed, and Embase of studies comparing PCS and MCS. The incidence of AL, anastomotic bleeding (AB), conversion, and reoperation were assessed. PROSPERO Registration Number: CRD42024512644.

RESULTS

Five observational studies were eligible for inclusion reporting on 2379 patients. The estimated pooled Risk Ratios for AL and AB rates following PCS were significantly lower than those observed with MCS (0.44 and 0.23, respectively; both with p < 0.01). Conversion and reoperation rate did not show any significant difference: 0.41 (95% CI 0.09-1.88; p = 0.25) and 0.78 (95% CI 0.33-1.84; p = 0.57); respectively.

CONCLUSION

The use of PCS demonstrates a lower incidence of AL and AB compared to MCS but does not exhibit a discernible influence on reintervention or conversion rates. The call for future randomized clinical trials aims to definitively clarify these issues and contribute to further advancements in refining surgical strategies for left-sided colonic resection.

The effect of brain-computer interface controlled functional electrical stimulation training on rehabilitation of upper limb after stroke: a systematic review and meta-analysis

Introduction

Several clinical studies have demonstrated that brain-computer interfaces (BCIs) controlled functional electrical stimulation (FES) facilitate neurological recovery in patients with stroke. This review aims to evaluate the effectiveness of BCI-FES training on upper limb functional recovery in stroke patients.

Methods

PubMed, Embase, Cochrane Library, Science Direct and Web of Science were systematically searched from inception to October 2023. Randomized controlled trials (RCTs) employing BCI-FES training were included. The methodological quality of the RCTs was assessed using the PEDro scale. Meta-analysis was conducted using RevMan 5.4.1 and STATA 18.

Results

The meta-analysis comprised 290 patients from 10 RCTs. Results showed a moderate effect size in upper limb function recovery through BCI-FES training (SMD = 0.50, 95% CI: 0.26-0.73, I2 = 0%, p < 0.0001). Subgroup analysis revealed that BCI-FES training significantly enhanced upper limb motor function in BCI-FES vs. FES group (SMD = 0.37, 95% CI: 0.00-0.74, I2 = 21%, p = 0.05), and the BCI-FES + CR vs. CR group (SMD = 0.61, 95% CI: 0.28-0.95, I2 = 0%, p = 0.0003). Moreover, BCI-FES training demonstrated effectiveness in both subacute (SMD = 0.56, 95% CI: 0.25-0.87, I2 = 0%, p = 0.0004) and chronic groups (SMD = 0.42, 95% CI: 0.05-0.78, I2 = 45%, p = 0.02). Subgroup analysis showed that both adjusting (SMD = 0.55, 95% CI: 0.24-0.87, I2 = 0%, p = 0.0006) and fixing (SMD = 0.43, 95% CI: 0.07-0.78, I2 = 46%, p = 0.02). BCI thresholds before training significantly improved motor function in stroke patients. Both motor imagery (MI) (SMD = 0.41 95% CI: 0.12-0.71, I2 = 13%, p = 0.006) and action observation (AO) (SMD = 0.73, 95% CI: 0.26-1.20, I2 = 0%, p = 0.002) as mental tasks significantly improved upper limb function in stroke patients.

Discussion

BCI-FES has significant immediate effects on upper limb function in subacute and chronic stroke patients, but evidence for its long-term impact remains limited. Using AO as the mental task may be a more effective BCI-FES training strategy.

Systematic review registration

Identifier: CRD42023485744, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023485744.

Prevalence of sexual dysfunction in health care workers: a systematic review and meta-analysis

INTRODUCTION

Health care workers represent a substantial demographic whose welfare and work efficiency are crucial to public health and societal well-being. However, the prevalence of sexual dysfunction within this group is often overlooked, despite its significant occurrence.

OBJECTIVE

To evaluate the worldwide prevalence of sexual dysfunction among health care workers.

METHODS

A comprehensive systematic review and meta-analysis of observational studies ranging from 2003 to 2023 were performed to compile prevalence estimates of sexual dysfunction among health care workers. A random effects model was implemented to amalgamate the prevalence analysis. Study heterogeneity was discerned by I2 and χ2 statistics. To assess potential publication bias, an Egger's test and a funnel plot were employed.

RESULTS

This meta-analysis incorporated 39 studies from 16 countries, encompassing 44 017 health care workers. The pooled prevalence of sexual dysfunction among health care workers was 46.79% (95% CI, 38.09%-55.68%), with a slightly higher prevalence of 49.57% (95% CI, 38.18%-61.01%) among clinical health care workers. The most prevalent forms of sexual dysfunction identified were loss of libido (51.26%), erectile dysfunction (36.99%), sexual dissatisfaction (36.90%), pain during intercourse (28.23%), orgasmic disorders (25.13%), low sexual arousal (23.54%), and lubrication disorders (22.62%). Among various health care professions, nurses exhibited the highest prevalence of sexual dysfunction (56.29%), followed by doctors (37.63%) and other health care workers (24.96%). Additionally, female health care workers experienced a higher prevalence of sexual dysfunction (47.61%) as compared with their male counterparts (32.01%).

CONCLUSION

This study indicates that nearly half of health care professionals report experiencing sexual dysfunction, with loss of libido being the most common manifestation. Addressing this issue requires a multistakeholder approach.

The effects of exercise on antenatal depression: a systematic review and meta-analysis

Objective

The aim of this study was to conduct a systematic evaluation of exercise interventions' effectiveness on antenatal depressive symptoms in pregnant women and to investigate the impact of different intervention factors on the relationship between exercise and antenatal depressive symptoms.

Methods

We conducted comprehensive searches in several databases, including PubMed, Embase, Web of Science, Cochrane Library, and others. The search period covered from database inception to May 2023. After thorough screening, a total of 7 papers with 524 subjects were included in the analysis.

Results

The meta-analysis revealed that the overall effect size of exercise intervention on antenatal depressive symptoms in pregnant women was SMD = -0.41, with a 95% confidence interval of [-0.78, -0.05], and P = 0.03, indicating a significant improvement in depressive symptoms due to exercise intervention during the antenatal period. However, some degree of heterogeneity was observed among the studies, with I² = 74%, P = 0.0007.

Conclusion

The results indicate that exercise interventions significantly contribute to the improvement of antenatal depressive symptoms in pregnant women, as inferred from the combined findings of the studies. Notably, static exercise intervention showed better results than dynamic exercise intervention. Moreover, interventions conducted before 20 weeks' gestation had superior outcomes compared to those conducted after 20 weeks' gestation, and interventions lasting longer than the trimester duration exhibited more favorable effects than shorter interventions. However, to validate these findings and optimise exercise intervention protocols for better antenatal maternal depressive symptom management, larger sample sizes and more comprehensive studies are required, given the observed heterogeneity and potential limitations in the present study.

Systematic review registration

https://www.crd.york.ac.uk/prospero/ PROSPERO, identifier (CRD42023422315).

Leukocyte mitochondrial DNA copy number and cardiovascular disease: A systematic review and meta-analysis of cohort studies

Increasing cohort studies have examined the link between mitochondrial DNA copy number (mtDNA-CN) and cardiovascular disease (CVD), with inconsistent findings. We searched PubMed, EMBASE, and Web of Science up to July 11, 2023 and used a random-effects model to calculate summary hazard ratios (HRs) and 95% confidence intervals (CIs). This systematic review and meta-analysis included 8 articles encompassing 29 studies with 646,398 participants. Individuals with the lowest mtDNA-CN had a summary HR of 1.27 (95% CI 1.02-1.59) for CVD, 1.18 (95% CI 0.92-1.50) for coronary heart disease (CHD), 1.10 (95% CI 0.89-1.37) for stroke, and 1.30 (95% CI 1.07-1.56) for heart failure (HF). Decreased mtDNA-CN is linked to an increased risk of CVD and HF but not CHD and stroke. These findings suggest mtDNA-CN from leukocytes may be a potential early biomarker for CVD. However, more prospective studies with long follow-up are needed.

Interventions to enhance mental health and wellbeing among international college students: A systematic review and meta-analysis protocol

BACKGROUND

International students contribute significantly to both the economy and the intellectual and cultural landscape of host countries. Their interactions with domestic students foster personal, socioeconomic, and political development, promopting a broader understanding of diverse cultures and values. This highlights how crucial international education is for staying competitive globally. However, international students often face challenges such as poor mental health, linguistic and cultural barriers, acculturative stress, and limited health literacy. Therefore, supporting their academic success and well-being on college campuses is essential. This protocol aims to describe strategies used to evaluate the effect of interventions on international students' mental health and wellbeing and propose directions for future research based on the evidence.

METHODS

We will conduct an extensive search in several databases including CINAHL, PubMed, Web of Science, PsyInFO, ERIC, and Google Scholar with no date limits. Two reviewers will independently screen the literature and extract data. We will then conduct meta-analyses of the extracted data.

DISCUSSION

To the best of our knowledge, this study is the first systematic review with meta-analysis focusing on interventions to enhance mental health and wellbeing among international college students. This study will provide most updated empirical evidence on the effects of interventions aimed to improve international students' mental health and wellbeing. The findings from this study will summarize the importance of a range of interventions being available to international students who experience psychological distress and the effectiveness of each intervention. This study will also highlight the gap for researchers to focus on for future studies.

TRIAL REGISTRATION

PROSPERO registration number: CRD42024528767.

Cigarette Smoking and its Association with Primary Open Angle Glaucoma: A Systematic Review and Meta-Analysis

PURPOSE

To systematically assess the association between cigarette smoking and development of Primary Open Angle Glaucoma (POAG) in the general adult population. Heterogeneity will be explored appropriately.

METHODS

Outcomes of glaucoma, OAG and POAG were explored in adults who were current, former, and never cigarette smokers. An additional category of 'smokers with "any" smoking status' was used where former smokers were not clearly distinguished from current and never smokers and in smokers whose form of smoking was not defined. All studies were observational and there was no limit to time period. Databases used were MEDLINE, Embase, Global Health and Web of Science. Study quality was assessed using the JBI critical appraisal tool. The DerSimonian-Laird random-effects model and weighting method was applied for meta-analysis with subgroup and sensitivity analyses along with meta-regression.

RESULTS

Four cohort, six cross-sectional and nine case-control studies were included. Only one cohort study attained a low risk of bias (RoB), two cohort studies were of medium RoB and the rest of the studies were of high RoB. There was no evidence for an association between smoking statuses: current smoking: OR 0.96, 95%CI (0.76,1.21), former smoking: OR 0.96, 95%CI (0.83,1.11), smoking (any): OR 1.48, 95%CI (0.96, 2.29) and glaucoma. Sensitivity analyses did not have a material impact on findings. Heterogeneity was not explained by smoking status, study quality, smoking exposure, and glaucoma outcome criteria.

CONCLUSION

This review suggests no evidence for an association between cigarette smoking and the development of POAG. There was no evidence that current, former, and general smoking increased the risk of glaucoma.

Environmental, social and governance (ESG) performance as a moderator in assessing the impact of government subsidies on underinvestment in China

In recent years, underinvestment has become common among subsidised enterprises in China. Stakeholder theory asserts that environmental, social and governance (ESG) performance forces enterprises to prioritise stakeholder needs by incorporating ESG principles into business operations, which in turn influences business investment decision-making. This study examines the impact of government subsidies on firm underinvestment and whether ESG performance plays a moderating role in this direct relationship. A dataset of 17,780 firm-year observations of A-share public firms in China for the period 2011-2021 was employed, and the data were analysed using the ordinary least squares regression model, fixed-effects regression model, propensity score matching difference-in-difference model, and instrumental variable approach. These results indicate that government subsidies mitigate firm underinvestment and tend to reduce underinvestment in firms with higher ESG performance. Moreover, the findings indicate that the performance in ESG factors influences the effect of government subsidies on the lack of investment in state-owned enterprises (SOEs), as opposed to non-SOEs. This effect is more noticeable in heavily polluting industries compared to non-heavily polluting industries. These findings imply that the government should promote the ESG performance of subsidised firms to enhance their overall corporate investment efficiency.

Relationships between metacognitive beliefs and anxiety and depression in children and adolescents: A meta-analysis

BACKGROUND

As hypothesized in the Self-Regulatory Executive Function (S-REF) model, metacognitive beliefs are associated with anxiety and depression in adults. An important question is the extent to which such effects are present in children and adolescents, with the implication that the model may also apply to young people. The aim of this meta-analysis was to synthesize results on the nature and magnitude of associations between metacognitive beliefs and anxiety and depression in children and adolescents.

METHODS

Systematic searches were conducted to identify studies that investigated: (1) group differences in metacognitive beliefs in clinical compared to non-clinical samples or (2) correlations between metacognitive beliefs and symptoms of anxiety and depression.

RESULTS

Forty papers were identified comprising a total sample of 9,887 participants aged 7-18 years. Meta-analyses revealed that clinical samples endorsed significantly elevated metacognitive beliefs on four out of the five domains measured (i.e., negative beliefs about worry, cognitive confidence, need for control, and cognitive self-consciousness, with the only exception being positive beliefs about worry) compared to non-clinical samples with a small to large effect (Hedges' gs = 0.45-1.22). Moreover, all five domains of metacognitive beliefs were significantly and positively correlated with symptoms of anxiety and depression of a small to large effect (rs = .24-.53). Negative beliefs about worry showed the strongest relationship with clinical status and the magnitude of symptoms.

LIMITATIONS

The number of studies did not allow for an evaluation of metacognitive beliefs at a disorder-specific level.

CONCLUSIONS

In line with the S-REF model, our findings provide evidence of robust cross-sectional relationships between metacognitions and both anxiety and depression in childhood and adolescence.

Association between anemia in pregnancy with low birth weight and preterm birth in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Anemia in pregnancy has been associated with a number of adverse birth outcomes, such as low birth weight (LBW) or preterm birth (PTB). However, the evidence from primary studies on anemia in pregnancy with LBW and PTB is contentious. Moreover, a systematic review and meta-analysis to summarize these findings have not been conducted for Ethiopia. This study aimed to synthesize the best available evidence and quantify the strength and direction of the association of anemia in Ethiopia.

METHODS

This review examined women with singleton pregnancies with low birth weight (LBW) and preterm birth (PTB). We retrieved studies from PubMed, Wiley, Cochrane databases, and Google Scholar from inception to February 2, 2024. The World Health Organization (WHO) defines anemia in pregnancy as a low blood haemoglobin (Hgb) concentration below 11 g/dl or a hematocrit level of < 33%. When the newborn's weight was below 2500 g, LBW was considered. Preterm birth refers to the birth of a baby before 37 completed weeks of gestation. Meta-analysis was conducted using fixed and random effects models. The degree of heterogeneity, publication bias, and quality of the evidence of studies was assessed.

RESULTS

There were 35 and 8 studies, with 14,319 and 3,265 respondents included in the meta-analysis for LBW and PTB, respectively. Neonates born to women who had normal Hgb levels were less likely to be LBW [pooled odds ratio (POR) = 0.22, 95% CI: (0.17, 0.28); I2 = 80%] (low-quality evidence). Neonates born to women with normal Hgb levels had a lower risk of PTB [POR = 0.22, 95% CI: 0.18, 0.28; I2 = 19%] (very low-quality evidence). The effect size estimate remained significant after sub-group analysis based on study design and province, except in two retrospective cohort studies for LBW.

CONCLUSION

The findings suggest major implications for strengthening the implementation of nutrition policies to prevent anemia during pregnancy in Ethiopia. Further research is warranted to assess interventions that are effective in combating maternal anemia to reduce rates of LBW and PTB.

The prevalence of Legg-Calvé-Perthes disease among paediatric patients with transient synovitis of the hip: a systematic review and meta-analysis

BACKGROUND

Transient synovitis of the hip is the most common cause of limping in paediatric emergency departments. There is no consensus regarding routine follow-up after hip synovitis among children, and there are no standardized criteria for selecting cases that warrant follow-up due to persistent or recurring symptoms to rule out the possibility of Legg-Calvé-Perthes disease. Delayed treatment of Legg-Calvé-Perthes disease may increase the risk of developing early secondary coxarthrosis. Understanding the prevalence of Legg-Calvé-Perthes disease among paediatric patients with transient synovitis of the hip is of paramount importance and could empower both parents and paediatricians to make well-informed decisions when selecting follow-up care for children, thus ensuring that no cases of Legg-Calvé-Perthes disease are missed among diagnosis paediatric patients with transient synovitis of the hip. The aim of this review was to estimate the prevalence of Legg-Calvé-Perthes disease among paediatric patients with transient synovitis of the hip.

METHODS

This study was conducted in strict accordance with the PRISMA guidelines and was registered with PROSPERO. The PubMed, Embase, and Cochrane Library databases were comprehensively searched up to July 2024 to identify relevant studies. The inclusion criteria were as follows: patients diagnosed with transient synovitis of the hip; patients aged up to 18 years; and studies with a minimum of 10 cases of paediatric transient synovitis of the hip. To pool the prevalence rates from individual studies, we utilized a random-effects meta-analysis. To assess the quality of the included studies in detail, we employed the Joanna Briggs Institute's quality assessment checklist.

RESULTS

A total of 19 studies were ultimately included for the final analysis, with 2,617 paediatric cases of transient synovitis of the hip. The results of meta-analysis revealed that the pooled prevalence estimate of Legg-Calvé-Perthes disease among all paediatric patients with transient synovitis of the hip was 2.7% (95% CI 1.4-5.1). Significant heterogeneity was observed across the studies included in this analysis (I2 = 79.990%; P = 0.000). The pooled prevalence estimate of Legg-Calvé-Perthes disease among paediatric patients with recurrent or persistent transient synovitis of the hip was 36.3% (95% CI 21.6-54.2). Significant heterogeneity was also observed across the studies included in this analysis (I2 = 51.519%; P = 0.036). Furthermore, the follow-up period varied from 6 weeks to 24 months. The primary diagnostic imaging modality utilized for identifying Perthes disease was X-ray.

CONCLUSION

Our study revealed that among paediatric patients with transient synovitis of the hip, routine X-ray follow-up of the hips after 6 weeks to rule out Legg-Calvé-Perthes disease is warranted only in patients who exhibit persistent or recurrent symptoms.

Proteome-wide Mendelian randomization identified potential drug targets for migraine

BACKGROUND

Migraine is a highly prevalent and complex neurovascular disease. However, the currently available therapeutic drugs often fall to adequately meet clinical needs due to limited effectiveness and numerous undesirable side effects. This study aims to identify putative novel targets for migraine treatment through proteome-wide Mendelian randomization (MR).

METHODS

We utilized MR to estimate the causal effects of plasma proteins on migraine and its two subtypes, migraine with aura (MA) and without aura (MO). This analysis integrated plasma protein quantitative trait loci (pQTL) data with genome-wide association studies (GWAS) findings for these migraine phenotypes. Moreover, we conducted a phenome-wide MR assessment, enrichment analysis, protein-protein interaction networks construction, and mediation MR analysis to further validate the pharmaceutical potential of the identified protein targets.

RESULTS

We identified 35 protein targets for migraine and its subtypes (p < 8.04 × 10-6), with prioritized targets showing minimal side effects. Phenome-wide MR identified novel protein targets-FCAR, UBE2L6, LATS1, PDCD1LG2, and MMP3-that have no major disease side effects and interacted with current acute migraine medication targets. Additionally, MMP3, PDCD1LG2, and HBQ1 interacted with current preventive migraine medication targets. The causal effects of plasma protein on migraine were partly mediated by plasma metabolites (proportion of mediation from 3.8% to 21.0%).

CONCLUSIONS

A set of potential protein targets for migraine and its subtypes were identified. These proteins showed rare side effects and were responsible for biological mechanisms involved in migraine pathogenesis, indicating priority for the development of migraine treatments.

Effect of prehabilitation for patients undergoing gastric cancer surgery: a protocol of a systematic review and meta-analysis

INTRODUCTION

Gastric cancer is a high-risk cancer with surgical treatments often leading to significant postoperative complications and mortality. Prehabilitation, involving exercise, nutrition and psychological support before surgery, aims to boost patients' physical and mental health. While effective in other cancers, its benefits for gastric cancer need further study. This research will evaluate the impact of trimodal prehabilitation on patient outcomes in gastric cancer surgery, aiming to reduce complications and expedite recovery.

METHODS AND ANALYSIS

This study will systematically review randomised controlled trials and cohort studies evaluating the role of prehabilitation in people undergoing gastric cancer resection. The primary outcomes of interest will include overall postoperative complications and length of hospital stay. The secondary outcomes of interest will include mortality, readmission rate or functional recovery. Databases including PubMed, EMBASE, CINAHL, CENTRAL, Chinese BioMedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang database and Chinese Science and Technology Periodicals (VIP) will be searched. All studies will be screened and selected using the criteria described in 'population, intervention/exposure, comparison, outcome and study design' format. Two independent reviewers will screen studies for relevance and methodological validity. Data from included studies will be extracted through a customised, preset data extraction sheet. The Cochrane Review Manager (V.5.3, Nordic Cochrane Centre, Copenhagen, Denmark) software will be used to perform the meta-analysis.

ETHICS AND DISSEMINATION

Ethics approval is not required for this study as all results will be based on published papers. No primary data collection will be needed. Study findings will be presented at scientific conferences or published in a peer-reviewed scientific journal.

PROSPERO REGISTRATION NUMBER

CRD42023488469.

Meta-Analysis of the Impact of Far-Red Light on Vegetable Crop Growth and Quality

Far-red lights (FRs), with a wavelength range between 700 and 800 nm, have substantial impacts on plant growth, especially horticultural crops. Previous studies showed conflicting results on the effects of FRs on vegetable growth and quality. Therefore, we conducted a meta-analysis on the influence of FRs on vegetable growth, aiming to provide a comprehensive overview of their effects on the growth and nutritional indicators of vegetables. A total of 207 independent studies from 55 literature sources were analyzed. The results showed that FR treatment had significant effects on most growth indicators, including increasing the fresh weight (+25.27%), dry weight (+21.99%), plant height (+81.87%), stem diameter (+12.91%), leaf area (+18.57%), as well as reducing the content of chlorophyll (-11.88%) and soluble protein (-11.66%), while increasing soluble sugar content (+19.12%). Further subgroup analysis based on various factors revealed significant differences in the effects of FR on different physiological indicators, such as FR intensity, plant species, duration of FR exposure, and the ratio of red light to FR. In general, moderate FR treatment is beneficial for vegetable growth. This study provides important references and guidelines for optimizing the application of FR in the future.

Diagnostic accuracy of deep learning in detection and prognostication of renal cell carcinoma: a systematic review and meta-analysis

INTRODUCTION

The prevalence of Renal cell carcinoma (RCC) is increasing among adults. Histopathologic samples obtained after surgical resection or from biopsies of a renal mass require subtype classification for diagnosis, prognosis, and to determine surveillance. Deep learning in artificial intelligence (AI) and pathomics are rapidly advancing, leading to numerous applications such as histopathological diagnosis. In our meta-analysis, we assessed the pooled diagnostic performances of deep neural network (DNN) frameworks in detecting RCC subtypes and to predicting survival.

METHODS

A systematic search was done in PubMed, Google Scholar, Embase, and Scopus from inception to November 2023. The random effects model was used to calculate the pooled percentages, mean, and 95% confidence interval. Accuracy was defined as the number of cases identified by AI out of the total number of cases, i.e. (True Positive + True Negative)/(True Positive + True Negative + False Positive + False Negative). The heterogeneity between study-specific estimates was assessed by the I 2 statistic. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct and report the analysis.

RESULTS

The search retrieved 347 studies; 13 retrospective studies evaluating 5340 patients were included in the final analysis. The pooled performance of the DNN was as follows: accuracy 92.3% (95% CI: 85.8-95.9; I 2 = 98.3%), sensitivity 97.5% (95% CI: 83.2-99.7; I 2 = 92%), specificity 89.2% (95% CI: 29.9-99.4; I 2 = 99.6%) and area under the curve 0.91 (95% CI: 0.85-0.97.3; I 2 = 99.6%). Specifically, their accuracy in RCC subtype detection was 93.5% (95% CI: 88.7-96.3; I 2 = 92%), and the accuracy in survival analysis prediction was 81% (95% CI: 67.8-89.6; I 2 = 94.4%).

DISCUSSION

The DNN showed excellent pooled diagnostic accuracy rates to classify RCC into subtypes and grade them for prognostic purposes. Further studies are required to establish generalizability and validate these findings on a larger scale.

Global knowledge and attitudes towards mpox (monkeypox) among healthcare workers: a systematic review and meta-analysis

BACKGROUND

The recent increase in human mpox (monkeypox) cases emphasizes the importance of early detection, prompt response and preventive management to control the spread of the disease. Healthcare workers (HCWs) play a crucial role in this process. This study aimed to determine the global knowledge and attitudes towards mpox among HCWs.

METHODS

This study searched multiple databases, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, Embase, Springer and ProQuest, to locate various publications. The search was limited to English-language articles published between May 2022 (when the increase in mpox incidence was reported) and August 2023. The Joanna Briggs Institute (JBI) quality checklist was utilized to evaluate the quality of the included studies. Data were obtained using a Microsoft Excel spreadsheet and subsequently scrutinized through STATA software, version 14. The heterogeneity of the studies was assessed using the inverse variance and Cochran Q statistics based on the I2 test statistics. The Dersimonian and Liard random effects models were used where heterogeneity existed. Subgroup analysis and univariate and multivariable metaregression techniques were used to examine the causes of heterogeneity.

RESULTS

A total of 22 studies, including 22 studies for knowledge (27 731 HCWs) and 6 studies for attitudes (14 388 HCWs), were included in the meta-analysis. The pooled estimates for good knowledge and positive attitudes among HCWs were 26.0% (95% confidence interval [CI] 17.8 to 34.2) and 34.6% (95% CI 19.0 to 50.2), respectively. Moreover, the knowledge was 34.8% (95% CI 24.1 to 45.6) among HCWs with <5 y of work experience and 41.6% (95% CI 33.1 to 50) among individuals possessing >5 y of professional background.

CONCLUSIONS

Good knowledge of HCWs is at a low level. It is suggested that training sessions should be tailored towards younger HCWs with less healthcare experience. Additionally, it is essential to identify strategies on how to improve the knowledge and attitudes for better practice about the disease in HCWs worldwide.

Minimum acceptable diet use and its associated factors among children aged 6-23 in Ghana: a mixed effect analysis using Ghana Demographic and Health Survey

Introduction

Inappropriate feeding practices are a major contributor to child malnutrition. To monitor the feeding practices of young children, current and frequent studies are required. However, as far as our searches are concerned, there is a scarcity of up-to-date information on attainment of the minimum acceptable diet and its predictors in the study area. Therefore, this study aimed to assess the magnitude of attainment of the minimum acceptable diet and its associated factors among children aged 6-23 in Ghana by using the most recent data.

Methods

Secondary data analysis was conducted based on the demographic and health survey data conducted in Ghana in 2022. A total weighted sample of 2,621 children aged 6-23 months in the 5 years preceding the survey was included in this study. A multi-level logistic regression model was used to identify the determinants of the minimum acceptable diet. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant.

Results

The national prevalence of the attainment of the minimum acceptable diet in Ghana was 26.40% (95% CI: 24.82-28.06). Child from mother with higher education (AOR = 1.96; 95% CI: 1.56-3.31) and father with higher education (AOR = 1.59; 95% CI: 1.04-2.41), Children having postnatal visit (AOR = 1.29; 95% CI: 1.03-1.62), being in the child age of 9-11 months (AOR = 2.09; 95% CI: 1.42-5.03) and 12-23 months (AOR = 3.62; 95% CI: 2.61-5.03), being in a middle (AOR = 1.66; 95% CI: 1.14-3.06), and rich wealth quintile (AOR = 2.06; 95% CI: 1.37-3.10), breastfed children (AOR = 3.30; 95% CI: 2.38-4.56), being in a high-community poverty (AOR = 0.65; 95% CI: 0.44-0.96), and being in the Savannah region (AOR = 0.32; 95% CI: 0.16-0.67) were factors significantly associated with the minimum acceptable diet use.

Conclusion

Many children are still far behind in meeting the minimum acceptable diet in Ghana as per 90% of WHO-recommended coverage. Measures should be taken to optimize the minimum acceptable diet attainment in the country. Thus, policymakers, the government, and other relevant authorities should focus on the early initiation of complementary feeding, the Savannah region, further empowering women, and enhancing breast-feeding and household wealth status.

The efficacy of psychodynamic psychotherapy for young adults: a systematic review and meta-analysis

Objective

One in six young adults presents with at least one mental health problem. However, so far, little attention has been directed to the mental health needs and the efficacy of therapeutic interventions for young adults. We conducted a systematic review and meta-analysis of the type, quality and efficacy of psychoanalytic psychotherapy for young people.

Method

We searched the PsycInfo, PubMed, Embase, and Cochrane databases to identify all the published randomized controlled trials (RCT), and naturalistic and observational studies of psychodynamic or psychoanalytic psychotherapies. We calculated the standardized mean difference in scores of psychodynamic interventions versus control conditions, adopting a random effects model (Hedges' g).

Results

We identified 22 eligible studies, including 14 RCTs, and 8 naturalistic studies. Statistical analyses showed no significant difference between psychodynamic psychotherapy and other comparison treatments (psychotherapy or pharmacological interventions) for young adults (Hedges'g - 0.34 [95% CI: -0.991;-0.309], p = 0.304). Nevertheless, there was a significant effect of psychodynamic psychotherapy when compared with control conditions (waiting list or treatment as usual) for target symptoms (Hedges'g - 1.24 [95% CI: -1.97;-0.51], p < 0.001).

Conclusion

Our systematic review highlights important clinical implications in identifying the efficacy of psychoanalytic interventions for specific at-risk groups and suggests developing prevention strategies for mental health problems in young adulthood across cultures and context.

A comparative study of home healthcare quality in urban and rural home health agencies throughout the USA (2010-22)

Urban-rural disparities in medical care, including in home healthcare, persist globally. With aging populations and medical advancements, demand for home health services rises, warranting investigation into home healthcare disparities. Our study aimed to (i) investigate the impact of rurality on home healthcare quality, and (ii) assess the temporal disparities and the changes in disparities in home healthcare quality between urban and rural home health agencies (HHAs), incorporating an analysis of geospatial distribution to visualize the underlying patterns. This study analyzed data from HHAs listed on the Centers for Medicare and Medicaid Services website, covering the period from 2010 to 2022. Data were classified into urban and rural categories for each HHA. We employed panel data analysis to examine the impact of rurality on home healthcare quality, specifically focusing on hospital admission and emergency room (ER) visit rates. Disparities between urban and rural HHAs were assessed using the Wilcoxon test, with results visualized through line and dot plots and heat maps to illustrate trends and differences comprehensively. Rurality is demonstrated as the most significant variable in hospital admission and ER visit rates in the panel data analysis. Urban HHAs consistently exhibit significantly lower hospital admission rates and ER visit rates compared to rural HHAs from 2010 to 2022. Longitudinally, the gap in hospital admission rates between urban and rural HHAs is shrinking, while there is an increasing gap in ER visit rates. In 2022, HHAs in Mountain areas, which are characterized by a higher proportion of rural regions, exhibited higher hospital admission and ER visit rates than other areas. This study underscores the persistent urban-rural disparities in home healthcare quality. The analysis emphasizes the ongoing need for targeted interventions to address disparities in home healthcare delivery and ensure equitable access to quality care across urban and rural regions. Our findings have the potential to inform policy and practice, promoting equity and efficiency in the long-term care system, for better health outcomes throughout the USA.

The impact of social relationships on the risk of stroke and post-stroke mortality: a systematic review and meta-analysis

BACKGROUND

The association between poor social relationships and post-stroke mortality remains uncertain, and the evidence regarding the relationship between poor social relationships and the risk of stroke is inconsistent. In this meta-analysis, we aim to elucidate the evidence concerning the risk of stroke and post-stroke mortality among individuals experiencing a poor social relationships, including social isolation, limited social networks, lack of social support, and loneliness.

METHODS

A thorough search of PubMed, Embase, and the Cochrane Library databases to systematically identify pertinent studies. Data extraction was independently performed by two researchers. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either a random-effects or fixed-effects model. Sensitivity analyses were conducted to evaluate the reliability of the results. Random-effects meta-regression was performed to explore the sources of heterogeneity in stroke risk estimates between studies. Assessment for potential publication bias was carried out using Egger's and Begg's tests.

RESULTS

Nineteen studies were included, originating from 4 continents and 12 countries worldwide. A total of 1,675,707 participants contributed to this meta-analysis. Pooled analyses under the random effect model revealed a significant association between poor social relationships and the risk of stroke (OR = 1.30; 95%CI: 1.17-1.44), as well as increased risks for post-stroke mortality (OR = 1.36; 95%CI: 1.07-1.73). Subgroup analyses demonstrated associations between limited social network (OR = 1.52; 95%CI = 1.04-2.21), loneliness (OR = 1.31; 95%CI = 1.13-1.51), and lack of social support (OR = 1.66; 95%CI = 1.04-2.63) with stroke risk. The meta-regression explained 75.21% of the differences in reported stroke risk between studies. Random-effect meta-regression results indicate that the heterogeneity in the estimated risk of stroke may originate from the continent and publication year of the included studies.

CONCLUSION

Social isolation, limited social networks, lack of social support, and feelings of loneliness have emerged as distinct risk factors contributing to both the onset and subsequent mortality following a stroke. It is imperative for public health policies to prioritize the multifaceted influence of social relationships and loneliness in stroke prevention and post-stroke care.

TRIAL REGISTRATION

The protocol was registered on May 1, 2024, on the Prospero International Prospective System with registration number CRD42024531036.

Treatment Effects in Randomized and Nonrandomized Studies of Pharmacological Interventions: A Meta-Analysis

Importance

Randomized clinical trials (RCTs) are widely regarded as the methodological benchmark for assessing clinical efficacy and safety of health interventions. There is growing interest in using nonrandomized studies to assess efficacy and safety of new drugs.

Objective

To determine how treatment effects for the same drug compare when evaluated in nonrandomized vs randomized studies.

Data Sources

Meta-analyses published between 2009 and 2018 were identified in MEDLINE via PubMed and the Cochrane Database of Systematic Reviews. Data analysis was conducted from October 2019 to July 2024.

Study Selection

Meta-analyses of pharmacological interventions were eligible for inclusion if both randomized and nonrandomized studies contributed to a single meta-analytic estimate.

Data Extraction and Synthesis

For this meta-analysis using a meta-epidemiological framework, separate summary effect size estimates were calculated for nonrandomized and randomized studies within each meta-analysis using a random-effects model and then these estimates were compared. The reporting of this study followed the Guidelines for Reporting Meta-Epidemiological Methodology Research and relevant portions of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline.

Main Outcome and Measures

The primary outcome was discrepancies in treatment effects obtained from nonrandomized and randomized studies, as measured by the proportion of meta-analyses where the 2 study types disagreed about the direction or magnitude of effect, disagreed beyond chance about the effect size estimate, and the summary ratio of odds ratios (ROR) obtained from nonrandomized vs randomized studies combined across all meta-analyses.

Results

A total of 346 meta-analyses with 2746 studies were included. Statistical conclusions about drug benefits and harms were different for 130 of 346 meta-analyses (37.6%) when focusing solely on either nonrandomized or randomized studies. Disagreements were beyond chance for 54 meta-analyses (15.6%). Across all meta-analyses, there was no strong evidence of consistent differences in treatment effects obtained from nonrandomized vs randomized studies (summary ROR, 0.95; 95% credible interval [CrI], 0.89-1.02). Compared with experimental nonrandomized studies, randomized studies produced on average a 19% smaller treatment effect (ROR, 0.81; 95% CrI, 0.68-0.97). There was increased heterogeneity in effect size estimates obtained from nonrandomized compared with randomized studies.

Conclusions and Relevance

In this meta-analysis of treatment effects of pharmacological interventions obtained from randomized and nonrandomized studies, there was no overall difference in effect size estimates between study types on average, but nonrandomized studies both overestimated and underestimated treatment effects observed in randomized studies and introduced additional uncertainty. These findings suggest that relying on nonrandomized studies as substitutes for RCTs may introduce additional uncertainty about the therapeutic effects of new drugs.

Systemic steroids and bronchopulmonary dysplasia: a systematic review and meta-analysis

IMPORTANCE

It is unclear if systemic steroids decrease the risk of Bronchopulmonary Dysplasia (BPD) while increasing the risk of neurodevelopmental impairment (NDI).

OBJECTIVE

Conduct a systematic review of randomized controlled trials of systemic steroids to evaluate the risk of BPD, mortality, and NDI in premature infants ≤30 weeks.

DATA SOURCES

MEDLINE, EBSCOhost, Web of Science, Cochrane Library, Embase, and CINAHL.

STUDY SELECTION

Randomized clinical trials of Dexamethasone (DEX) or Hydrocortisone (HC) to prevent BPD in premature infants ≤ 30 weeks.

DATA EXTRACTION AND SYNTHESIS

Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Random-effects meta-analyses and multivariable meta-regression were conducted.

MAIN OUTCOMES AND MEASURES

Primary outcomes were BPD, mortality, and NDI. Secondary outcomes were hypertension, hyperglycemia, sepsis, intestinal perforation, necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP). The a priori hypothesis was that steroids would reduce the risk of BPD without increasing NDI.

RESULTS

There were 6377 preterm infants in the 44 (32 DEX, 13 HC) selected studies. DEX significantly reduced the risk of BPD, RR = 0.66, (95% CI, 0.56-0.78). The most effective DEX regimen was medium cumulative dose (2 to 3 mg/kg), RR = 0.43 (95% CI, 0.29-0.65); day of initiation <8 days: RR = 0.68, (95% CI, 0.59-0.79); and treatment for ≥14 days: RR = 0.67 (95% CI, 0.55-0.80). HC did not significantly decrease the risk of BPD, RR = 0.98, (95% CI, 0.87-1.10). Neither DEX, (RR = 0.92, 95% CI, 0.78-1.09) nor HC (RR = 0.83, 95% CI, 0.68-1.01) decrease the risk of mortality. The risk of CP was not increased by either DEX (RR = 1.09, 95% CI, 0.55-2.17) or HC (RR = 1.18, 95% CI, 0.75-1.87). There were no significant differences between steroids and placebo for MDI/PDI scores. Multivariable meta-regression models showed that DEX significantly reduced the risk of BPD without increased risk of CP. DEX increased the risk of hypertension and hyperglycemia. Studies showed high heterogeneity, differing treatment regimen, missing data and different rates of follow-up.

CONCLUSION AND RELEVANCE

DEX, but not HC, significantly decreased the risk of BPD. Neither steroid showed an increased risk of NDI or mortality.

Best practice exercise for emerging depression in multiple sclerosis: A systematic review and meta-analysis

OBJECTIVE

To examine the effects of instructor-led exercise on depression symptoms in adults with multiple sclerosis, with a focus on moderating factors to treatment response.

DATA SOURCES

Cochrane Library, Embase, PEDro, PsycINFO and PubMed databases were searched until 21 April 2024.

REVIEW METHODS

The reporting quality of included studies assessed (PEDro and TESTEX scales). Hedges' g effect sizes were calculated and pooled using random and mixed-effects modelling.

RESULTS

Twenty-two independent studies (k), representing 785 participants with relapsing remitting or progressive MS, were included. Individual studies varied in their reporting quality (PEDro range: 3-8) and did not routinely detail exercise parameters (TESTEX range: 5-13). Nonetheless, exercise reduced core symptoms of depression (gw = .52, CI: .30-.73, P < .01). Treatment effects were, however, not maintained once training had ceased (gw = -.53, CI: -.80 to .24, P ≤ .01, k = 5). Both aerobic and non-aerobic exercise groups experienced a significant (P < .01) reduction in depression scores. Larger gains were noted by those with better ambulation at baseline (P = .03).

CONCLUSION

Regular exercise can help to stabilise mood for people living with multiple sclerosis, regardless of session frequency or duration. Treatment efficacy could be maximised by addressing potential barriers for those with limited mobility, including exercise type, delivery and intensity. Protocol registered on Open Science Framework [https://osf.io/zfymq/].

Periprocedural myocardial infarction after percutaneous coronary intervention and long-term mortality: a meta-analysis

BACKGROUND AND AIMS

Conflicting data are available regarding the association between periprocedural myocardial infarction (PMI) and mortality following percutaneous coronary intervention. The purpose of this study was to evaluate the incidence and prognostic implication of PMI according to the Universal Definition of Myocardial Infarction (UDMI), the Academic Research Consortium (ARC)-2 definition, and the Society for Cardiovascular Angiography and Interventions (SCAI) definition.

METHODS

Studies reporting adjusted effect estimates were systematically searched. The primary outcome was all-cause death, while cardiac death was included as a secondary outcome. Studies defining PMI according to biomarker elevation without further evidence of myocardial ischaemia ('ancillary criteria') were included and reported as 'definition-like'. Data were pooled in a random-effect model.

RESULTS

A total of 19 studies and 109 568 patients were included. The incidence of PMI was progressively lower across the UDMI, ARC-2, and SCAI definitions. All PMI definitions were independently associated with all-cause mortality [UDMI: hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.32-1.97; I2 34%; ARC-2: HR 2.07, 95% CI 1.40-3.08, I2 0%; SCAI: HR 3.24, 95% CI 2.36-4.44, I2 78%]. Including ancillary criteria in the PMI definitions were associated with an increased prognostic performance in the UDMI but not in the SCAI definition. Data were consistent after evaluation of major sources of heterogeneity.

CONCLUSIONS

All currently available international definitions of PMI are associated with an increased risk of all-cause death after percutaneous coronary intervention. The magnitude of this latter association varies according to the sensitivity and prognostic relevance of each definition.

Extended Prophylactic Antibiotics for Primary and Aseptic Revision Total Joint Arthroplasty: A Meta-Analysis

BACKGROUND

There is growing interest in extended antibiotic prophylaxis (EAP) following total joint arthroplasty (TJA); however, the benefit of EAP remains controversial. For this investigation, both oral and intravenous antibiotic protocols were included in the EAP group.

METHODS

The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, Ovid Embase, Elton B. Stephens CO, and Cumulative Index to Nursing and Allied Health Literature were queried for literature comparing outcomes of primary and aseptic revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients who were treated with either ≤24 hours of postoperative antibiotic prophylaxis (standard of care [SoC]) or >24 hours of EAP. The primary outcome was periprosthetic joint infection (PJI). A pooled relative-risk random-effects Mantel-Haenszel model was implemented to compare cohorts.

RESULTS

There were 18 studies with a total of 19,153 patients included. There was considerable variation in antibiotic prophylaxis protocols with first-generation cephalosporins being the most commonly implemented antibiotic for both groups. Patients treated with EAP were 35% less likely to develop PJI relative to the SoC (P = .0004). When examining primary TJA, patients treated with EAP were 39% and 40% less likely to develop a PJI for TJA (P = .0008) and THA (P = .02), respectively. There was no significant difference for primary TKA (P = .17). When examining aseptic revision TJA, EAP led to a 36% and 47% reduction in the probability of a PJI for aseptic revision TJA (P = .007) and aseptic revision TKA (P = .008), respectively; there was no observed benefit for aseptic revision THA (P = .36).

CONCLUSIONS

This meta-analysis demonstrated that patients treated with EAP were less likely to develop a PJI relative to those treated with the SoC for all TJA, primary TJA, primary THA, aseptic revision TJA, and aseptic revision TKA. There was no significant difference observed between EAP and SoC for primary TKA or aseptic revision THA.

Preoperative pain sensitivity and its correlation with postoperative acute and chronic pain: a systematic review and meta-analysis

BACKGROUND

Preoperative pain sensitivity (PPS) can be associated with postsurgical pain. However, estimates of this association are scarce. Confirming this correlation is essential to identifying patients at high risk for severe postoperative pain and for developing analgesic strategy. This systematic review and meta-analysis summarises PPS and assessed its correlation with postoperative pain.

METHODS

PubMed, Scopus, Cochrane Library, and PsycINFO were searched up to October 1, 2023, for studies reporting the association between PPS and postsurgical pain. Two authors abstracted estimates of the effect of each method independently. A random-effects model was used to combine data. Subgroup analyses were performed to investigate the effect of pain types and surgical procedures on outcomes.

RESULTS

A total of 70 prospective observational studies were included. A meta-analysis of 50 studies was performed. Postoperative pain was negatively associated with pressure pain threshold (PPT; r=-0.15, 95% confidence interval [CI] -0.23 to -0.07]) and electrical pain threshold (EPT; r=-0.28, 95% CI -0.42 to -0.14), but positively correlated with temporal summation of pain (TSP; r=0.21, 95% CI 0.12-0.30) and Pain Sensitivity Questionnaire (PSQ; r=0.25, 95% CI 0.13-0.37). Subgroup analysis showed that only TSP was associated with acute and chronic postoperative pain, whereas PPT, EPT, and PSQ were only associated with acute pain. A multilevel (three-level) meta-analysis showed that PSQ was not associated with postoperative pain.

CONCLUSIONS

Lower PPT and EPT, and higher TSP are associated with acute postoperative pain while only TSP is associated with chronic postoperative pain. Patients with abnormal preoperative pain sensitivity should be identified by clinicians to adopt early interventions for effective analgesia.

SYSTEMATIC REVIEW PROTOCOL

PROSPERO (CRD42023465727).