GOSH - a graphical display of study heterogeneity

Applicability of tooth cementum thickness as an age marker: systematic review and meta-analysis

The age estimation by tooth cementum thickness is a method that has been discussed regarding its applicability. The aim of this study was to conduct a systematic review on the use of tooth cementum thickness as a biomarker for age estimation in adults, as well as a meta-analysis to assess the method's reliability. The search was conducted on Embase, LILACS, PubMed/MEDLINE, SciELO, Scopus, and Web of Science databases. Two independent reviewers used inclusion and exclusion criteria to select and assess relevant studies. For bias risk assessment, a checklist proposed by the Joanna Briggs Institute was applied. Pearson and Spearman correlation coefficients were considered as effect measures for the meta-analysis between tooth cementum thickness and chronological age. Heterogeneity among studies was evaluated using Cochran'sQ test (p < 0.05 ), I2 index, and Graphic Display of Heterogeneity plot. Meta-analysis robustness was assessed using Baujat plots, and publication bias was checked using DOI plots and the Luis Furuya-Kanamori index. Most selected studies showed low risk of bias. Although not all studies were included in the meta-analysis, moderate heterogeneity was found among those included. The synthesized result indicated that tooth cementum thickness has a moderate correlation with chronological age, both when the outlier study is included (r = 0.59 [ 0.48 ; 0.69 ] ) and when the outlier is removed (r = 0.57 [ 0.45 ; 0.68 ] ). It is concluded that tooth cementum thickness represents a potential age biomarker that can be useful in age estimation methods for adults. However, the presented results should be considered cautiously, emphasizing the need for further primary studies.

Association between maternal diabetes and neurodevelopmental outcomes in children: a systematic review and meta-analysis of 202 observational studies comprising 56·1 million pregnancies

BACKGROUND

Maternal diabetes might alter fetal brain development. However, well-designed systematic analyses are needed to comprehensively assess and quantify the association between maternal diabetes and neurodevelopmental outcomes in children. We aimed to synthesise and evaluate the available evidence on the effects of maternal diabetes on neurodevelopmental outcomes in children.

METHODS

For this systematic review and meta-analysis we searched PubMed, Web of Science, Embase, and EBSCO databases from inception to Dec 1, 2024, for studies exploring neurodevelopmental outcomes of children born to mothers with diabetes. The primary outcome was neurodevelopmental disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases 11th Revision. Data were extracted from published reports. Data were pooled with random-effects models and presented as risk ratios or standard mean differences with 95% CIs. This study was prospectively registered on PROSPERO (CRD42023395464).

FINDINGS

202 studies, involving 56 082 462 mother-child pairs, were included in the meta-analysis. Of these, 110 (54%) examined gestational diabetes, while 80 (40%) investigated pre-gestational diabetes. Among the total studies reviewed, 169 (84%) exclusively focused on children and adolescents aged up to 18 years. In studies adjusting for at least one key confounder, maternal diabetes was associated with increased risks of all types of neurodevelopmental disorders as well as lower intelligence and psychomotor scores. In studies adjusting for multiple confounders (n=98, 49%), children exposed to maternal diabetes had an increased risk of any neurodevelopmental disorder (risk ratio 1·28; 95% CI 1·24-1·31), autism spectrum disorder (1·25; 1·20-1·31), attention-deficit hyperactivity disorder (1·30; 1·24-1·37), intellectual disability (1·32; 1·18-1·47), specific developmental disorders (1·27; 1·17-1·37), communication disorder (1·20; 1·11-1·28), motor disorder (1·17; 1·10-1·26), and learning disorder (1·16; 1·06-1·26), compared with unexposed children. Maternal pre-gestational diabetes was more strongly associated with the risk of most neurodevelopmental disorders in children than gestational diabetes (risk ratio 1·39; [95% CI 1·34-1·44] vs 1·18 [1·14-1·23]; subgroup difference p<0·0001).

INTERPRETATION

Maternal diabetes is associated with an increased risk of neurodevelopmental disorders and impaired neurodevelopmental performance in children. Further high-quality research is needed to establish causality and clarify the associations between specific types of diabetes and the full spectrum of neurodevelopmental disorders.

FUNDING

The National Natural Science Foundation of China, and the Science and Technology Innovation Program of Hunan Province.

TRANSLATION

For the Mandarin translation of the abstract see Supplementary Materials section.

Clinical Benefits and Risks of Antiamyloid Antibodies in Sporadic Alzheimer Disease: Systematic Review and Network Meta-Analysis With a Web Application

BACKGROUND

Despite the increasing approval of antiamyloid antibodies for Alzheimer disease (AD), their clinical relevance and risk-benefit profile remain uncertain. The heterogeneity of AD and the limited availability of long-term clinical data make it difficult to establish a clear rationale for selecting one treatment over another.

OBJECTIVE

The aim of this work was to assess and compare the efficacy and safety of antiamyloid antibodies through an interactive online meta-analytic approach by performing conventional pair-wise meta-analyses and frequentist and Bayesian network meta-analyses of phase II and III clinical trial results. To achieve this, we developed AlzMeta.app 2.0, a freely accessible web application that enables researchers and clinicians to evaluate the relative and absolute risks and benefits of these therapies in real time, incorporating different prior choices and assumptions of baseline risks of disease progression and adverse events.

METHODS

We adhered to PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for reporting of systematic reviews with network meta-analysis) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) guidelines for reporting and rating the certainty of evidence. Clinical trial reports (until September 30, 2024) were retrieved from PubMed, Google Scholar, and clinical trial databases (including ClinicalTrials.gov). Studies with <20 sporadic AD patients and a modified Jadad score <3 were excluded. Risk of bias was assessed with the RoB-2 tool. Relative risks and benefits have been expressed as risk ratios and standardized mean differences, with confidence, credible, and prediction intervals calculated for all outcomes. For significant results, the intervention effects were ranked in frequentist and Bayesian frameworks, and their clinical relevance was determined by the absolute risk per 1000 people and number needed to treat (NNT) for a wide range of control responses.

RESULTS

Among 7 treatments tested in 21,236 patients (26 studies with low risk of bias or with some concerns), donanemab was the best-ranked treatment on cognitive and functional measures, and it was almost 2 times more effective than aducanumab and lecanemab and significantly more beneficial than other treatments on the global (cognitive and functional) Clinical Dementia Rating Scale-Sum of Boxes (NNT=10, 95% CI 8-16). Special caution is required regarding cerebral edema and microbleeding due to the clinically relevant risks of edema for donanemab (NNT=8, 95% CI 5-16), aducanumab (NNT=10, 95% CI 6-17), and lecanemab (NNT=14, 95% CI 7-31), which may outweigh the benefits.

CONCLUSIONS

Our results showed that donanemab is more effective and has a safety profile similar to aducanumab and lecanemab, highlighting the need for treatment options with improved safety. Potential bias may have been introduced in the included trials due to unblinding caused by frequent cerebral edema and microbleeds, as well as the impact of the COVID-19 pandemic.

Vertical and horizontal space-valence associations: A meta-analysis

Previous research found associations between lower vs. upper space and negative vs. positive stimuli correspondingly (vertical Space-Valence Associations, SVAs) and between the left vs. right side and negative vs. positive stimuli correspondingly (horizontal SVAs). We conducted a comprehensive meta-analysis of SVAs for both dimensions in behavioral studies. We tested the robustness of SVAs and examined factors potentially modulating them: participants' culture, handedness, gender, age, the exact valence domain under study, the experimental task, type of stimuli, publication year, and statistics used. Articles were extracted from Web of Science, PubMed, and ScienceDirect in February 2021. Overall, 91 articles with 199 experiments and 21,951 participants were included in the final analysis. We found robust evidence of SVAs in vertical (r = .440, k = 111 experiments) and horizontal dimensions (r = .310; k = 88 experiments), with little evidence for literature biases. The distribution of effect sizes was highly heterogeneous, even after subgroup analyses, which indicates unidentified factors varying across studies. Experiments on vertical SVAs explicitly asking participants to evaluate valence showed larger effect sizes than experiments where valence remained task-irrelevant. There was a robust effect of handedness on horizontal SVAs: Participants associated positive stimuli with the side of their dominant hand. There was also some evidence of cultural influences on the horizontal SVAs. Overall, our meta-analysis revealed a hierarchy of factors modulating activation of SVAs, which includes both situated and embodied factors. It is, therefore, essential to focus on specific concept categories and contexts rather than consider abstract concepts in general. PUBLIC SIGNIFICANCE STATEMENT: This meta-analysis revealed medium effects of space-valence associations: Upper/right space is associated with positive and lower/right space with negative concepts. On the vertical dimension, this effect is modulated by valence being task-relevant, e.g., directly asking people about valence results in stronger associations. For the horizontal dimension, left-handers robustly showed a reversed effect (i.e., left is good); horizontal space-valence associations might be even stronger in non-Western countries.

Moral Distress and Emotional Exhaustion in Healthcare Professionals: A Systematic Review and Meta-Analysis

BACKGROUND/OBJECTIVES

Moral distress is commonly experienced by healthcare professionals (i.e., nurses) as ethical conflict. Previous literature suggests that moral distress contributes to emotional exhaustion in these professionals. We aimed to synthesize and analyze studies that examined the relationship between moral distress and emotional exhaustion in healthcare professionals.

METHODS

Web of Science, Scopus, PubMed, Medline, and PsycInfo were used to search targeted studies written in English, Spanish, French, Italian, and Portuguese. The correlation coefficients of each study were extracted and converted into Fisher's z. Finally, pooled r was calculated by Fisher's z and standard error. The meta-analysis was performed with the R statistical program.

RESULTS

A total of 14 studies with 2425 healthcare professionals were included. The Moral Distress Scale Revised (MDS-R) and the Maslach Burnout Inventory (MBI) were the most used scales to measure moral distress and emotional exhaustion, respectively. The pooled correlation coefficient between moral distress and emotional exhaustion was 0.33 (p < 0.001, 95%CI: 0.27, 0.39).

CONCLUSIONS

Moral distress is strongly correlated to emotional exhaustion in healthcare professionals. Future studies should focus on exploring the causal relationships between both variables as well as investigating potential moderators.

Exploring the benefits and prescribing informations of combining East Asian herbal medicine with conventional medicine in the treatment of rheumatoid arthritis: A systematic review and multifaceted analysis of 415 randomized controlled trials

BACKGROUND

Notwithstanding progress in conventional medicine (CM), the management of rheumatoid arthritis (RA) continues to be problematic due to factors such as limited patient response to treatment and restricted medication access. This study aimed to evaluate the extent to which East Asian herbal medicine with CM combination therapy (EACM) provides additional benefits in effectiveness and safety.

METHODS

We conducted a comprehensive search across 11 databases in English, Chinese, Korean, and Japanese for randomized controlled trials. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the American College of Rheumatology (ACR) 20/50/70 Response Criteria and the incidence of adverse events (AEI) as primary outcomes. This meta-analysis was performed using a random-effects model. The quality of each study was assessed according to the RoB 2. Of the 1036 full-text articles screened, 415 were included in the review.

RESULTS

This review included data from 37,839 participants. EACM was associated with higher ACR responses: ACR 20 (RR: 1.2332; 95 % CI: 1.1852-1.2831, p < 0.0001), ACR 50 (RR: 1.3782; 95 % CI: 1.2936-1.4684, p < 0.0001), and ACR 70 (RR: 1.7084; 95 % CI: 1.5555-1.8762, p < 0.0001), as well as a favorable AEI (OR: 0.3977; 95 % CI: 0.3476-0.4551, p < 0.0001), indicating both better efficacy and safety compared to CM alone. These patterns were consistent across eight secondary outcomes measuring pain, inflammation, and disease activity in RA. Subgroup analyses showed that EACM's effects were independent of the control CM type. Through a comprehensive analysis of a polyherbal prescription dataset, we identified 18 key herbs and 16 significant combination rules, further supported by relevant preclinical evidence. These herbs and synergistic herbal combinations were anticipated to be the most pharmacologically influential in contributing to the meta-analysis outcomes, as substantiated by analytical metrics including network topology and intricate association pattern evaluations.

CONCLUSIONS

The findings suggest that EACM may serve as a valuable complementary strategy for RA patients insufficiently managed by CM alone. In particular, given that the ACR index integrates multiple aspects of RA patients, the results are expected to provide valuable complementary decision support for the management of RA patients who do not respond well to CM therapy, both for medical and economic reasons. Additionally, the key herbs derived through the multifaceted analysis, which actively reflect clinicians' implicit preferences for prescribing EACMs, may serve as important hypotheses for further research and clinical application. However, additional qualitative and quantitative improvements in research are needed for more definitive conclusions. Further analysis of the herbal prescriptions presented in this study will provide valuable direction for future research.

The Effect of Light on Wellbeing: A Systematic Review and Meta-analysis

Due to the dominant presence of studies and reviews exploring the impact of light on physical and mental illness, studies specifically investigating the effect of light on wellbeing are often overshadowed. The aim of this review is to give an overview of specifically these studies conducted on light and wellbeing, and to summarize the reported effects. After a literature search in PubMed, PsycInfo, and Web of Science, 74 studies were found eligible to be included in this systematic review, i.e. they included surveys assessing wellbeing, happiness, life satisfaction, positive affect, or quality of life. Of these 74 studies, 30 were included in the meta-analysis and assessed for their risk of bias. The meta-analysis showed a pooled effect size of 0.46 (CI = 0.29-0.62), indicating that light has a small-to-moderate positive effect on wellbeing. After removing outliers and studies with a high risk of bias, the sensitivity analysis showed the pooled effect size to be robust (0.53, CI = 0.35-0.72). Although the sensitivity analysis indicated a robust effect, the results might still be biased due to the relatively small sample sizes, risk of bias in the designs (due to e.g. difficulties handling confounders and the reporting of the outcomes), and publication bias. We encourage future studies to replicate these positive results in larger samples, and to give extensive details about the light design and statistical outcomes, to increase the number of studies that can be included in these types of systematic reviews.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10902-024-00838-4.

Effect of lipopolysaccharides from pathogenic bacteria on broiler chickens' productivity: a meta-analysis

1. This meta-analysis investigated the impact of LPS and covariates (serotype, rearing period and administration route) on the productivity parameters of broiler chickens (average daily feed intake (ADFI), average daily gain (ADG) and feed conversion ratio (FCR)).2. Thirty-two eligible studies were included. Hedges' g effect size was determined using a random-effects model at 95% confidence interval.3. Results showed that LPS significantly decreased average daily feed intake (ADFI; p < 0.0001) and average daily gain (ADG; p < 0.0001) and increased FCR (p < 0.0001). The serotypes Escherichia coli 055: B5 (EC055: B5) and Escherichia coli 0127: B8 (EC 0127: B8) significantly reduced ADFI and ADG, and the serotype EC 055: B5 significantly increased the FCR (p < 0.05).4. The intraperitoneal administration of the LPS significantly reduced the productivity of broiler chickens (p < 0.05), but other administration routes did not show such effects. The reduction in ADFI and ADG was found in all rearing periods (p < 0.05), and the increase in FCR was observed in the starter (p = 0.0302) and grower periods (p = 0.0031).5. Exposure to LPS significantly reduced the productivity of broiler chickens (p < 0.05). However, no relationship was observed between LPS dosage and productivity as indicated by the meta-regression study.6. The findings indicated that LPS has detrimental effects on broiler chickens' ADFI, ADG and FCR across various LPS serotypes and rearing periods. These detrimental impacts of LPS remain consistent regardless of the administered dosage.

Relationship between psychological capital and nursing burnout: A systematic review and meta-analysis

AIM

This systematic review and meta-analysis aimed to analyze studies that examined the relationship between psychological capital and burnout in registered nurses.

BACKGROUND AND INTRODUCTION

Registered nurses are subject to high rates of burnout, with negative consequences on health, well-being, and quality of care. Psychological capital could be an important element in preventing or reducing this condition.

METHODS

This research is based on the Joanna Briggs Institute Guidelines and Preferred Reporting Items for systematic reviews and meta-analysis. A total of 180 studies on psychological capital and burnout were retrieved from Web of Science, Scopus, PubMed, Medline, and PsycINFO. The articles were written in English, Spanish, French, and Portuguese. Then, 23 studies were included in several meta-analyses (random-effects models) performed with the R statistical program.

RESULTS

Analysis of the 23 studies revealed that psychological capital and burnout are significantly correlated. The Psychological Capital Questionnaire (PCQ) and the Maslach Burnout Inventory (MBI) were the most used scales to measure psychological capital and burnout, respectively. The meta-analyses showed an inverse correlation between psychological capital and burnout (r = -0.44, 95% CI [-0.51, -0.36], n = 6092), and emotional exhaustion (r = -0.32, 95% CI [-0.42, -0.21], n = 3349).

CONCLUSION

This review provides evidence of the negative relationship between psychological capital and burnout in registered nurses. Therefore, enhancing psychological capital is an effective strategy to prevent and reduce burnout in nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Psychological capital is a personal resource open to development over time and susceptible to interventions aimed at promoting optimism, efficacy, hope, and resilience. In that sense, training aimed at improving psychological capital, as a protective mechanism to prevent and reduce burnout and emotional exhaustion, should be considered together with organizational measures to promote nurses' health and well-being.

Meta-Analysis: Prevalence of Youth Mental Disorders in Sub-Saharan Africa

Youth in sub-Saharan Africa (SSA) face limited access to professional mental health resources. A comprehensive assessment of the prevalence of mental disorders would build an understanding of the scope of the need. We conducted systematic searches in PsycInfo, Pubmed, AfriBib and Africa Journals Online to identify prevalence rates for five disorders (anxiety, depression, conduct disorder, attention problems and post-traumatic stress) among SSA youth with a mean age of less than 19 years. We calculated a random-effects pooled prevalence for each disorder and assessed possible moderators. The meta-analysis included 63 studies with 55,071 participants. We found the following pooled prevalence rates: 12.53% post-traumatic stress disorder (PTSD), 15.27% depression, 6.55% attention-deficit hyperactivity disorder, 11.78% anxiety and 9.76% conduct disorder. We found high heterogeneity across the studies, which may have resulted from differences in samples or measurement tools. Reported prevalence rates were not explained by the sample (i.e., special or general population), but whether the psychometric tool was validated for SSA youth affected the reported prevalence of PTSD and anxiety. In a meta-regression, prevalence rates were associated with the disorder type, with a higher prevalence of depression and PTSD. We found the mean age significantly moderated the prevalence in univariate meta-regression, with increased age correlated with greater prevalence. Our findings suggest there is a need to explore reasons for varying prevalence rates further and to develop interventions that support youth mental health in SSA, particularly interventions for depression and PTSD. Limitations included a lack of standardization in psychometric tools and limited reporting on research methods, which influenced quality rating. Importantly, the search only considered studies published in English and was conducted 2 years ago. Although recent estimates reported slightly higher than our prevalence estimates, these reviews together highlight the prevalence and importance of youth mental health difficulties in SSA.

Prevalence of neck pain among unilateral upper limb amputees: A systematic review and meta-analysis

BACKGROUND

Neck pain is a significant health concern for unilateral upper limb amputees (UULAs), affecting their functional status and quality of life.

OBJECTIVES

To address the neck pain burden that is adding to UULA's pre-existing disability and help Physical therapists to judiciously design and execute effective therapeutic strategies.

METHODS

We searched databases for articles till October 23, 2023, and included primary studies reporting neck pain prevalence among UULAs. PRISMA and MOOSE guidelines were adhered to extract data and quality assessment. Heterogeneity was assessed using prediction interval and I2. We performed a random-effects meta-analysis, sub-group analyses, meta-regression, and publication bias assessment. We visualized them using forest plots, bubble plot, and Doi plots.

RESULTS

We incorporated 10 qualitative and 7 quantitative studies into our synthesis. The neck pain pooled prevalence was 39% (95% CI: 24-57). Heterogeneity was significant, with 4%-90% prediction interval and I2 of 96% (p < 0.001). Subgroup analysis demonstrated a pooled prevalence of 31% (95% CI: 16-53) among the North American population, 51% (95% CI: 28-74) in European countries, 28% (95% CI: 11-54) among veterans and 49% (95% CI: 31-67) among the general population.

CONCLUSION

Neck pain is common among UULAs; variations are noted across the general population and veterans, as per geography and increased sample size of the population. Physical therapists and other rehabilitative team members should be aware of this neck pain burden. We need improved design and implementation of strategies to reduce the overall neck pain burden among the targeted population.

Chronic Effects of Static Stretching Exercises on Skeletal Muscle Hypertrophy in Healthy Individuals: A Systematic Review and Multilevel Meta-Analysis

BACKGROUND

The chronic effect of static stretching (SS) on muscle hypertrophy is still unclear. This study aimed to examine the chronic effects of SS exercises on skeletal muscle hypertrophy in healthy individuals.

METHODS

A systematic literature search was conducted in the PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases up to July 2023. Included studies examined chronic effects of SS exercise compared to an active/passive control group or the contralateral leg (i.e., utilizing between- or within-study designs, respectively) and assessed at least one outcome of skeletal muscle hypertrophy in healthy individuals with no age restriction.

RESULTS

Twenty-five studies met the inclusion criteria. Overall, findings indicated an unclear effect of chronic SS exercises on skeletal muscle hypertrophy with a trivial point estimate (standardised mean difference [SMD] = 0.118 [95% prediction interval [95% PI] = - 0.233 to 0.469; p = 0.017]) and low heterogeneity (I2 = 24%). Subgroup analyses revealed that trained individuals (β = 0.424; 95% PI = 0.095 to 0.753) displayed larger effects compared to recreationally trained (β = 0.115; 95% PI = - 0.195 to 0.425) and sedentary individuals (β = - 0.081; 95% PI = - 0.399 to 0.236). Subanalysis suggested the potential for greater skeletal muscle hypertrophy in samples with higher percentages of females (β = 0.003, [95% confidence interval [95% CI] = - 0.000 to 0.005]). However, the practical significance of this finding is questionable. Furthermore, a greater variety of stretching exercises elicited larger increases in muscle hypertrophy (β = 0.069, [95% CI = 0.041 to 0.097]). Longer durations of single stretching exercises (β = 0.006, [95% CI = 0.002 to 0.010]), time under stretching per session (β = 0.006, [95% CI = 0.003 to 0.009]), per week (β = 0.001, [95% CI = 0.000 to 0.001]) and in total (β = 0.008, [95% CI = 0.003 to 0.013]) induced larger muscle hypertrophy. Regarding joint range of motion, there was a clear positive effect with a moderate point estimate (β = 0.698; 95% PI = 0.147 to 1.249; p < 0.001) and moderate heterogeneity (I2 = 43%). Moreover, findings indicated no significant association between the gains in joint range of motion and the increase in muscle hypertrophy (β = 0.036, [95% CI = - 0.123 to 0.196]; p = 0.638).

CONCLUSIONS

This study revealed an overall unclear chronic effect of SS on skeletal muscle hypertrophy, although interpretation across the range of PI suggests a potential modest beneficial effect. Subgroup analysis indicated larger stretching-induced muscle gains in trained individuals, a more varied selection of SS exercises, longer mean duration of single stretching exercise, increased time under SS per session, week, and in total, and possibly in samples with a higher proportion of females. From a practical perspective, it appears that SS exercises may not be highly effective in promoting skeletal muscle hypertrophy unless a higher duration of training is utilized. PROSPERO registration number: CRD42022331762.

Association between diabetes mellitus and ossification of the spinal ligament: a systematic review and meta-analysis

PURPOSE

Ossification of the spinal ligament (OSL) is a spinal disorder characterized by abnormal bone formation in the spinal ligaments. Although clinical studies suggested that diabetes mellitus (DM) was associated with OSL, no consistent conclusion was drawn about the relationship between DM and the onset of OSL.

METHODS

Studies with data on DM and OSL were retrieved by searching PubMed, Embase, Web of Science, and Cochrane Library from inception to August 23, 2023. Pooled estimates of odds ratios (ORs) with 95% confidence interval (95% CI) were calculated using random-effects models. Statistical analyses were performed by R 4.2.2 software.

RESULTS

A total of 17 studies with 70,945 participants were included. The quantitative findings demonstrated that a higher risk of DM was related to the onset of OSL (OR = 2.19, 95% CI: 1.27-3.79, p = 0.008). Subgroup analysis showed a higher rate of DM in OSL patients from Japan (OR = 3.29, 95% CI: 1.51-7.17, [Formula: see text] = 0.009) than from other regions. Moreover, patients with OSL had a higher rate of DM in age < = 60 group (OR = 3.46, 95% CI: 1.14-10.50, p = 0.035) than age > 60 group (OR = 2.26, 95% CI: 1.07-4.79, p = 0.036).

CONCLUSION

DM is significantly associated with an increased risk of developing OSL, especially in Japanese and people under 60 years old. Further studies with more participants were warranted to confirm the findings and provide new insights into the prevention and treatment of OSL.

Rotational stability of toric intraocular lenses by lens model and haptic design: systematic review and single-arm meta-analysis

Rotational stability is key for optimizing postoperative visual outcomes because even a small degree of rotation of a toric intraocular lens (IOL) from its target axis can result in a significant reduction in astigmatic correction. This systematic review and meta-analysis evaluated the rotational stability of toric IOLs of different lens models and haptic designs. All published studies and clinical trials that investigate postoperative rotation of toric IOLs were searched and evaluated. Quality of studies was assessed using the Methodological Index for Nonrandomized Studies scale. A single-arm meta-analysis was performed in R4.3.1 software with subgroup analysis performed based on lens model and haptic design. 51 published studies of 4863 eyes were included in the meta-analysis. The pooled mean absolute rotation of all toric IOLs was 2.36 degrees (95% CI, 2.08-2.64). Postoperative rotation is dependent on many aspects of lens material and design. Modern commercially available toric IOLs exhibit exceptional rotational stability.

Mirror, Mirror on the Wall: A Meta-Analysis on the Validity of Self-Assessed Intelligence through the Lens of the Multiverse

Examining the relationship between self-assessed intelligence (SAI) and psychometric intelligence (IQ) is essential for understanding how people's self-evaluations reflect their actual intelligence. Various factors, such as SAI measurement methods, participant characteristics, and testing conditions have been hypothesized to moderate the SAI-IQ link, yet the generality of this association remains unclear. Here, we provide evidence for SAI and IQ associations based on 278 effect sizes from 115 independent samples (N = 36,833) using a multi-level meta-analysis, revealing a moderate positive correlation (r = 0.30; 95% CI [0.27, 0.33]). Multiverse analyses demonstrated remarkable stability of this effect, with most summary effect specifications yielding significant positive correlations (96%), averaging r = 0.32. Notably, ability domain and sample type emerged as significant moderators, with numerical ability showing stronger correlations compared to general cognitive, verbal, and spatial abilities. Importantly, our study found that correlations in student samples were significantly higher than those in general samples. Our findings show a moderate positive association of SAI with IQ, unaffected by participant sex, publication year, administration order, neuroticism, and self-assessment method, yet significantly moderated by ability domain and sample type. Our results illustrate the importance of feedback in educational settings to help students accurately assess their cognitive abilities.

Efficacy and Safety of Orally Administered East Asian Herbal Medicine Combined with Narrowband Ultraviolet B against Psoriasis: A Bayesian Network Meta-Analysis and Network Analysis

Psoriasis is a chronic, immune-mediated inflammatory skin disease with many complications and a poor prognosis that imposes a significant burden on individuals and society. Narrowband ultraviolet B (NB-UVB) represents a cost-effective non-drug therapeutic intervention for psoriasis. East Asian herbal medicine (EAHM) is currently being investigated for its potential as a safe and effective psoriasis treatment. Consequently, it has the potential to be employed as a combination therapy with NB-UVB. The objective was to ascertain the efficacy and safety of the EAHM with NB-UVB combination therapy and to identify important drugs for further research. In this study, randomized controlled trials (RCTs) were retrieved from ten databases in Korea, China, and Japan. All statistical analyses were conducted using R software version 4.3.0. The primary outcomes were the Psoriasis Area and Severity Index (PASI) and the incidence rate of adverse events (AEs), while the secondary outcomes were hematologic markers and the Dermatology Life Quality Index (DLQI), which reflect the immune-mediated inflammatory pathology of psoriasis. The analysis of 40 RCTs, including 3521 participants, demonstrated that EAHM with NB-UVB combination therapy exhibited a statistically significant superiority over NB-UVB monotherapy with respect to primary and secondary outcomes. The Bayesian network meta-analysis revealed that Investigator Presciption 3 and Ziyin Liangxue Decoction exhibited a consistent relative advantage with respect to each PASI-based efficacy metric. The network analysis estimated the potential influence ranking for all individual herbs according to PageRank centrality. The findings of this study suggest that EAHMs co-administered with NB-UVB may provide additional efficacy and safety-related benefits for patients with psoriasis. However, the quality of evidence is still low, and further high-quality trials are needed to reach more definitive conclusions.

Identifying the key components of social support for patients living with type 2 diabetes: A protocol for a systematic review and meta-analysis of type 2 diabetes social support interventions

Type 2 diabetes (T2D) is a disease that impacts a huge portion of the world's population. The number of T2D cases is expected to keep rising during the next decade. Committing to the treatment to manage this condition makes participants feel a burden of emotions making them require emotional support from caregivers or close ones. Support from family or caregivers can help improve glycaemia control, medication adherence, and T2D self-management. However, little is known about what aspects of social support effectively improve patients' T2D self-management outcomes. The aim of this systematic review and meta-analysis is to identify the effective components of social support that can help participants improve their T2D self-management. Methods: The protocol of this review was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PRISMA recommendations were applied to develop a search strategy in collaboration with a team of academics to identify relevant T2D social support interventions via healthcare and psychology databases, Medline, Web of Science, ProQuest, CINHAL. Discussion: This review will provide an overview of what intervention social support components have a significant impact on T2D glycaemia control. These findings will inform future T2D interventions on what social support components could be used to encourage better diabetes self-management and glycemic control.

Diagnostic accuracy of artificial intelligence assisted clinical imaging in the detection of oral potentially malignant disorders and oral cancer: a systematic review and meta-analysis

BACKGROUND

The objective of this study is to examine the application of artificial intelligence (AI) algorithms in detecting oral potentially malignant disorders (OPMD) and oral cancerous lesions, and to evaluate the accuracy variations among different imaging tools employed in these diagnostic processes.

MATERIALS AND METHODS

A systematic search was conducted in four databases: Embase, Web of Science, PubMed, and Scopus. The inclusion criteria included studies using machine learning algorithms to provide diagnostic information on specific oral lesions, prospective or retrospective design, and inclusion of OPMD. Sensitivity and specificity analyses were also required. Forest plots were generated to display overall diagnostic odds ratio (DOR), sensitivity, specificity, negative predictive values, and summary receiver operating characteristic (SROC) curves. Meta-regression analysis was conducted to examine potential differences among different imaging tools.

RESULTS

The overall DOR for AI-based screening of OPMD and oral mucosal cancerous lesions from normal mucosa was 68.438 (95% CI= [39.484-118.623], I2 =86%). The area under the SROC curve was 0.938, indicating excellent diagnostic performance. AI-assisted screening showed a sensitivity of 89.9% (95% CI= [0.866-0.925]; I2 =81%), specificity of 89.2% (95% CI= [0.851-0.922], I2 =79%), and a high negative predictive value of 89.5% (95% CI= [0.851-0.927], I2 =96%). Meta-regression analysis revealed no significant difference among the three image tools. After generating a GOSH plot, the DOR was calculated to be 49.30, and the area under the SROC curve was 0.877. Additionally, sensitivity, specificity, and negative predictive value were 90.5% (95% CI [0.873-0.929], I2 =4%), 87.0% (95% CI [0.813-0.912], I2 =49%) and 90.1% (95% CI [0.860-0.931], I2 =57%), respectively. Subgroup analysis showed that clinical photography had the highest diagnostic accuracy.

CONCLUSIONS

AI-based detection using clinical photography shows a high DOR and is easily accessible in the current era with billions of phone subscribers globally. This indicates that there is significant potential for AI to enhance the diagnostic capabilities of general practitioners to the level of specialists by utilizing clinical photographs, without the need for expensive specialized imaging equipment.

Healthy aging meta-analyses and scoping review of risk factors across Latin America reveal large heterogeneity and weak predictive models

Models of healthy aging are typically based on the United States and Europe and may not apply to diverse and heterogeneous populations. In this study, our objectives were to conduct a meta-analysis to assess risk factors of cognition and functional ability across aging populations in Latin America and a scoping review focusing on methodological procedures. Our study design included randomized controlled trials and cohort, case-control and cross-sectional studies using multiple databases, including MEDLINE, the Virtual Health Library and Web of Science. From an initial pool of 455 studies, our meta-analysis included 38 final studies (28 assessing cognition and 10 assessing functional ability, n = 146,000 participants). Our results revealed significant but heterogeneous effects for cognition (odds ratio (OR) = 1.20, P = 0.03, confidence interval (CI) = (1.0127, 1.42); heterogeneity: I2 = 92.1%, CI = (89.8%, 94%)) and functional ability (OR = 1.20, P = 0.01, CI = (1.04, 1.39); I2 = 93.1%, CI = (89.3%, 95.5%)). Specific risk factors had limited effects, especially on functional ability, with moderate impacts for demographics and mental health and marginal effects for health status and social determinants of health. Methodological issues, such as outliers, inter-country differences and publication bias, influenced the results. Overall, we highlight the specific profile of risk factors associated with healthy aging in Latin America. The heterogeneity in results and methodological approaches in studying healthy aging call for greater harmonization and further regional research to understand healthy aging in Latin America.

Executive functions in psychopathy: a meta-analysis of inhibition, planning, shifting, and working memory performance

Much research has focused on executive function (EF) impairments in psychopathy, a severe personality disorder characterized by a lack of empathy, antisocial behavior, and a disregard for social norms and moral values. However, it is still unclear to what extent EF deficits are present across psychopathy factors and, more importantly, which EF domains are impaired. The current meta-analysis answers these questions by synthesizing the results of 50 studies involving 5,694 participants from 12 different countries. Using multilevel random-effects models, we pooled effect sizes (Cohen's d) for five different EF domains: overall EF, inhibition, planning, shifting, and working memory. Moreover, differences between psychopathy factors were evaluated. Our analyses revealed small deficits in overall EF, inhibition, and planning performance. However, a closer inspection of psychopathy factors indicated that EF deficits were specific to lifestyle/antisocial traits, such as disinhibition. Conversely, interpersonal/affective traits, such as boldness, showed no deficits and in some cases even improved EF performance. These findings suggest that EF deficits are not a key feature of psychopathy per se, but rather are related to antisociality and disinhibitory traits. Potential brain correlates of these findings as well as implications for future research and treatment are discussed.

Meta-analysis of fine particulate matter exposure during pregnancy and birth weight: Exploring sources of heterogeneity

BACKGROUND

Several meta-analyses assessed the relationship between exposure to PM with aerodynamic diameter ≤ 2.5 μm (PM2.5) during pregnancy and birth weight (BW), but results were inconsistent and substantial unexplained heterogeneity was reported. We aimed to investigate the above association and to explore sources of heterogeneity across studies.

METHODS

We systematically reviewed the current worldwide evidence examining the association between PM2.5 and BW. The review protocol was registered on the PROSPERO website (CRD42020188996) and followed PRISMA guidelines. We extracted association measures for BW and low birth weight (LBW, BW < 2500 g) from each study to evaluate pooled summary measures and to explore sources of between-study heterogeneity.

FINDINGS

Of the 2677 articles identified, 84 met the inclusion criteria (~42 M births). Our random effects meta-analyses revealed substantial heterogeneity among included studies (I2 = 98.4 % and I2 = 77.7 %, for BW and LBW respectively). For LBW, the heterogeneity decreased (I2 = 59.7 %) after excluding four outlying studies, with a pooled odds ratio 1.07 (95 % confidence interval, CI: 1.05, 1.09) per a 10-μg/m3 increase in mean PM2.5 exposure over the entire pregnancy. Further subgroup analysis revealed geographic heterogeneity with higher association in Europe (1.34, (1.16, 1.55)) compared to Asia (1.06, (1.03, 1.10)) and US (1.07, (1.04, 1.10)).

CONCLUSION

The association between PM2.5 and birth weight varied depending on several factors. The sources of heterogeneity between studies included modifiers such as study region and period. Hence, it is advisable not to pool summary measures of PM2.5-BW associations and that policy would be informed by local evidence.

Proton magnetic resonance spectroscopy of N-acetyl aspartate in first depressive episode and chronic major depressive disorder: A systematic review and meta-analysis

N-acetyl aspartate (NAA) is a marker of neuronal integrity and metabolism. Deficiency in neuronal plasticity and hypometabolism are implicated in Major Depressive Disorder (MDD) pathophysiology. To test if cerebral NAA concentrations decrease progressively over the MDD course, we conducted a pre-registered meta-analysis of Proton Magnetic Resonance Spectroscopy (1H-MRS) studies comparing NAA concentrations in chronic MDD (n = 1308) and first episode of depression (n = 242) patients to healthy controls (HC, n = 1242). Sixty-two studies were meta-analyzed using a random-effect model for each brain region. NAA concentrations were significantly reduced in chronic MDD compared to HC within the frontal lobe (Hedges' g = -0.330; p = 0.018), the occipital lobe (Hedges' g = -0.677; p = 0.007), thalamus (Hedges' g = -0.673; p = 0.016), and frontal (Hedges' g = -0.471; p = 0.034) and periventricular white matter (Hedges' g = -0.478; p = 0.047). We highlighted a gap of knowledge regarding NAA levels in first episode of depression patients. Sensitivity analyses indicated that antidepressant treatment may reverse NAA alterations in the frontal lobe. We highlighted field strength and correction for voxel grey matter as moderators of NAA levels detection. Future studies should assess NAA alterations in the early stages of the illness and their longitudinal progression.

Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns

PURPOSE

The burden of herpes zoster (HZ) is substantial and numerous chronic underlying conditions are known as predisposing risk factors for HZ onset. Thus, a comprehensive study is needed to synthesize existing evidence. This study aims to comprehensively identify these risk factors.

METHODS

A systematic literature search was done using MEDLINE via PubMed, EMBASE and Web of Science for studies published from January 1, 2003 to January 1, 2023. A random-effects model was used to estimate pooled Odds Ratios (OR). Heterogeneity was assessed using the I2 statistic. For sensitivity analyses basic outlier removal, leave-one-out validation and Graphic Display of Heterogeneity (GOSH) plots with different algorithms were employed to further analyze heterogeneity patterns. Finally, a multiple meta-regression was conducted.

RESULTS

Of 6392 considered records, 80 were included in the meta-analysis. 21 different conditions were identified as potential risk factors for HZ: asthma, autoimmune disorders, cancer, cardiovascular disorders, chronic heart failure (CHF), chronic obstructive pulmonary disorder (COPD), depression, diabetes, digestive disorders, endocrine and metabolic disorders, hematological disorders, HIV, inflammatory bowel disease (IBD), mental health conditions, musculoskeletal disorders, neurological disorders, psoriasis, renal disorders, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and transplantation. Transplantation was associated with the highest risk of HZ (OR = 4.51 (95% CI [1.9-10.7])). Other risk factors ranged from OR = 1.17-2.87, indicating an increased risk for all underlying conditions. Heterogeneity was substantial in all provided analyses. Sensitivity analyses showed comparable results regarding the pooled effects and heterogeneity.

CONCLUSIONS

This study showed an increased risk of HZ infections for all identified factors.

A meta-analysis of electrophysiological biomarkers of reward and error monitoring in substance misuse

Substance use disorders are characterized by marked changes in reward and error processing. The primary objective of this meta-analysis was to estimate effect sizes for the reward positivity (RewP) and error-related negativity (ERN), two event-related potential indicators of outcome monitoring, in substance users compared to controls. The secondary objective was to test for moderation by demographic, substance type, and EEG experiment parameters. Final PubMed searches were performed in August 2023. Inclusion criteria were substance use disorder/dependence or validated self-report of substance misuse, RewP/ERN means available, healthy control comparison group, non-acute drug study, peer-reviewed journal, English language, and human participants. Selection bias was tested through modified Egger's regression and exploratory 3-parameter selection model tests. The RewP results (19 studies, 1641 participants) did not support an overall effect (Hedges' g = 0.07, 95% CI [-0.44, 0.58], p = .777) and nor effect of any moderators. The ERN results (20 studies, 1022 participants) indicated no significant overall effect (g = 0.41, 95%CI [-0.05, 0.88]). Subgroup analyses indicated that cocaine users had a blunted ERN compared to controls (g = 1.12, 95%CI [0.77, 1.47]). There was limited evidence for publication/small study bias. Although the results indicate a potential dissociation between substance types, this meta-analysis revealed the need for additional research on the RewP/ERN in substance using populations and for better designed experiments that adequately address research questions.

Childhood neglect, the neglected trauma. A systematic review and meta-analysis of its prevalence in psychiatric disorders

Traumatic events increase risk of mental illnesses, but childhood neglect prevalence in psychiatric disorders is understudied. This systematic review and meta-analysis assessed neglect prevalence, including emotional neglect (EN) and physical neglect (PN), among adults with psychiatric disorders. We conducted a systematic search and meta-analysis in 122 studies assessing different psychiatric disorders. Prevalence was 46.6% (95%CI[34.5-59.0]) for unspecified neglect (Ne), 43.1% (95%CI[39.0-47.4]) for EN, and 34.8% (95%CI[30.6-39.2]) for PN. Although a moderating effect of the psychiatric diagnostic category was not confirmed, some clinical diagnoses had significantly lower prevalence rates than others. Patients with bipolar disorder and major depressive disorder showed lower prevalence rates of EN and PN, whereas lower prevalence was found in psychotic disorders and eating disorders for PN only. Neglect assessment was a significant moderator for Ne and PN. No moderating effect of age and sex on neglect prevalence was found. Heterogeneity levels within and between psychiatric diagnostic categories remained high. This is the first meta-analysis examining diverse types of neglect prevalence considering different psychiatric diagnoses. Our results explore the prevalence of childhood neglect and its subtypes among adults with psychiatric disorders, contributing to understanding the nuanced interplay between neglect and specific psychiatric conditions, and guiding interventions for affected individuals.

Heterogeneity in meta-analysis: a comprehensive overview

In recent years, meta-analysis has evolved to a critically important field of Statistics, and has significant applications in Medicine and Health Sciences. In this work we briefly present existing methodologies to conduct meta-analysis along with any discussion and recent developments accompanying them. Undoubtedly, studies brought together in a systematic review will differ in one way or another. This yields a considerable amount of variability, any kind of which may be termed heterogeneity. To this end, reports of meta-analyses commonly present a statistical test of heterogeneity when attempting to establish whether the included studies are indeed similar in terms of the reported output or not. We intend to provide an overview of the topic, discuss the potential sources of heterogeneity commonly met in the literature and provide useful guidelines on how to address this issue and to detect heterogeneity. Moreover, we review the recent developments in the Bayesian approach along with the various graphical tools and statistical software that are currently available to the analyst. In addition, we discuss sensitivity analysis issues and other approaches of understanding the causes of heterogeneity. Finally, we explore heterogeneity in meta-analysis for time to event data in a nutshell, pointing out its unique characteristics.

Pharmacological interventions for the management of children and adolescents living with obesity-An update of a Cochrane systematic review with meta-analyses

IMPORTANCE

The effectiveness of anti-obesity medications for children and adolescents is unclear.

OBJECTIVE

To update the evidence on the benefits and harms of anti-obesity medication.

DATA SOURCES

Cochrane CENTRAL, MEDLINE, ClinicalTrials.gov and WHO ICTRP (1/1/16-17/3/23).

STUDY SELECTION

Randomized controlled trials ≥6 months in people <19 years living with obesity.

DATA EXTRACTION AND SYNTHESIS

Screening, data extraction and quality assessment conducted in duplicate, independently.

MAIN OUTCOMES AND MEASURES

Body mass index (BMI): 95th percentile BMI, adverse events and quality of life.

RESULTS

Thirty-five trials (N = 4331), follow-up: 6-24 months; age: 8.8-16.3 years; BMI: 26.2-41.7 kg/m2. Moderate certainty evidence demonstrated a -1.71 (95% confidence interval [CI]: -2.27 to -1.14)-unit BMI reduction, ranging from -0.8 to -5.9 units between individual drugs with semaglutide producing the largest reduction of -5.88 kg/m2 (95% CI: -6.99 to -4.77, N = 201). Drug type explained ~44% of heterogeneity. Low certainty evidence demonstrated reduction in 95th percentile BMI: -11.88 percentage points (95% CI: -18.43 to -5.30, N = 668). Serious adverse events and study discontinuation due to adverse events did not differ between medications and comparators, but medication dose adjustments were higher compared to comparator (10.6% vs 1.7%; RR = 3.74 [95% CI: 1.51 to 9.26], I2 = 15%), regardless of approval status. There was a trend towards improved quality of life. Evidence gaps exist for children, psychosocial outcomes, comorbidities and weight loss maintenance.

CONCLUSIONS AND RELEVANCE

Anti-obesity medications in addition to behaviour change improve BMI but may require dose adjustment, with 1 in 100 adolescents experiencing a serious adverse event.

The effect of psychosocial interventions for sexual health in patients with pelvic cancer: a systematic review and meta-analysis

AIM

The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer.

METHODS

Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers.

RESULTS

Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01).

DISCUSSION

There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.

Clinical features in co-occuring obsessive-compulsive disorder and bipolar disorder: A systematic review and meta-analysis

Obsessive-compulsive disorder (OCD) frequently co-occurs with various psychiatric conditions and may impact as many as one-fifth of individuals diagnosed with bipolar disorder (BD). Despite the expanding body of literature on the coexistence of OCD and BD, there is a notable lack of comprehensive data pertaining to the distinct features of obsessive-compulsive symptoms that define this comorbidity. To bridge this knowledge gap, we conducted a systematic search of PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO until August 7th, 2023. We performed random-effects meta-analyses to compare individuals with both OCD and BD to those with OCD in terms of OCD symptomatology as well as the specific categories of obsessions and compulsions. Out of the 10,393 records initially screened, 17 studies were ultimately incorporated into the qualitative assessment, with 15 of them being included in the quantitative analysis. Individuals with OCD and BD experienced fewer lifetime contamination obsessions (OR=0.71; 95 %CI=0.53, 0.95; p = 0.021) and more sexual obsessions (OR=1.77; 95 %CI=1.03, 3.04; p = 0.04) compared to individuals with OCD without BD. No significant difference was observed for other types of obsessions or compulsions or for the severity of OCD symptoms, although BD type may play a role according to meta-regression analyses. The detection of the presence of sexual or contamination obsessions through a detailed interview may be the focus of clinical attention when assessing OCD in the context of comorbid BD. Sub-phenotyping complex clinical presentation of comorbid psychiatric disorders can aid in making more informed decisions when choosing an appropriate treatment approach.

Impact of climate change on agriculture and adaptation strategies in Ethiopia: A meta-analysis

Ethiopia is a rainfall-based agricultural country that is susceptible to the impacts of climate change and risk. Floods and droughts, which happen more frequently and intensely, significantly and negatively influence agricultural production. The objective of the meta-analysis is to identify impacts on various sectors, adaptation strategies, and the challenges of climate change in the Ethiopian context. Twenty-three peer-reviewed articles were identified from ScienceDirect and Web of Science, followed by PRISMA guidelines, and analyzed using Stata version 13. The results reveal that climate change negatively impacts agriculture (by changing crop suitability, phenology, and productivity), the environment, and society, resulting from shifting temperature and rainfall patterns. Temperature variations, patterns of precipitation, and severe weather conditions have profound implications for agricultural productivity, water resources, ecosystems, and human well-being, which are multifaceted and interlinked. In addition, the reviewed articles informed us that farmers have used different coping strategies in response to climate change, such as soil and water conservation, agroforestry practices, integrated soil fertility management, small-scale irrigation, the application of improved crop varieties, the use of improved livestock, mixed cropping, early and late planting, and the practice of income-generating activities. The random effects meta-regression result shows that effective implementation of the above-mentioned practices reduces the risk of climate change in different sectors. The assessment also points out many challenges to the realization of these approaches, such as the lack of financing, institutional support, insufficient stakeholder involvement, ecological and sociocultural factors, and limited access to weather information. The meta-analysis concludes that addressing challenges requires holistic and integrated approaches that encompass adaptation strategies, sustainable land and water management, and social resilience-building to help the resilience of Ethiopian communities and ecosystems in the face of a changing climate.

Bovine Parainfluenza-3 Virus Detection Methods and Prevalence in Cattle: A Systematic Review and Meta-Analysis

Bovine parainfluenza-3 virus (BPI3V) is an important respiratory pathogen in cattle, contributing to syndromes in the bovine respiratory disease complex (BRDC). Despite its significance, the understanding of its prevalence remains fragmented, especially within the larger framework of BRDC. This systematic review and meta-analysis aimed to determine the global prevalence of BPI3V in cattle using varied detection methods and to highlight associated risk factors. Of 2187 initially retrieved articles, 71 were selected for analysis, covering 32 countries. Depending on the detection method employed, the meta-analysis revealed significant variations in BPI3V prevalence. In the general cattle population, the highest prevalence was observed using the antibody detection method, with a proportion of 0.64. In contrast, in cattle with BRDC, a prevalence of 0.75 was observed. For the antigen detection method, a prevalence of 0.15 was observed, exclusively in cattle with BRDC. In nucleic acid detection, a prevalence of 0.05 or 0.10 was observed in the general and BRDC cattle populations, respectively. In virus isolation methods, a prevalence of 0.05 or 0.04 was observed in the general and BRDC cattle populations, respectively. These findings highlight the differences in the detection ability of different methods in identifying BPI3V. Other factors, such as country, study year, coinfections, farm size, the presence of respiratory signs, sex, and body weight, may also affect the prevalence. Most studies were anchored within broader BRDC investigations or aimed at detecting other diseases, indicating a potential under-representation of focused BPI3V research. BPI3V plays an important role in BRDC, with its prevalence varying significantly based on the detection methodology. To further understand its unique role within BRDC and pave the way for targeted interventions, there is an evident need for independent, dedicated research on BPI3V.

Retina as a potential biomarker in schizophrenia spectrum disorders: a systematic review and meta-analysis of optical coherence tomography and electroretinography

INTRODUCTION

Abnormal findings on optical coherence tomography (OCT) and electroretinography (ERG) have been reported in participants with schizophrenia spectrum disorders (SSDs). This study aims to reveal the pooled standard mean difference (SMD) in retinal parameters on OCT and ERG among participants with SSDs and healthy controls and their association with demographic characteristics, clinical symptoms, smoking, diabetes mellitus, and hypertension.

METHODS

Using PubMed, Scopus, Web of Science, and PSYNDEX, we searched the literature from inception to March 31, 2023, using specific search terms. This study was registered with PROSPERO (CRD4202235795) and conducted according to PRISMA 2020.

RESULTS

We included 65 studies in the systematic review and 44 in the meta-analysis. Participants with SSDs showed thinning of the peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell layer- inner plexiform cell layer, and retinal thickness in all other segments of the macula. A meta-analysis of studies that excluded SSD participants with diabetes and hypertension showed no change in results, except for pRNFL inferior and nasal thickness. Furthermore, a significant difference was found in the pooled SMD of pRNFL temporal thickness between the left and right eyes. Meta-regression analysis revealed an association between retinal thinning and duration of illness, positive and negative symptoms. In OCT angiography, no differences were found in the foveal avascular zone and superficial layer foveal vessel density between SSD participants and controls. In flash ERG, the meta-analysis showed reduced amplitude of both a- and b-waves under photopic and scotopic conditions in SSD participants. Furthermore, the latency of photopic a-wave was significantly shorter in SSD participants in comparison with HCs.

DISCUSSION

Considering the prior report of retinal thinning in unaffected first-degree relatives and the results of the meta-analysis, the findings suggest that retinal changes in SSDs have both trait and state aspects. Future longitudinal multimodal retinal imaging studies are needed to clarify the pathophysiological mechanisms of these changes and to clarify their utility in individual patient monitoring efforts.

A case study evaluating the effect of clustering, publication bias, and heterogeneity on the meta-analysis estimates in implant dentistry

Meta-analyses may provide imprecise estimates when important meta-analysis parameters are not considered during the synthesis. The aim of this case study was to highlight the influence of meta-analysis parameters that can affect reported estimates using as an example pre-existing meta-analyses on the association between implant survival and sinus membrane perforation. PubMed was searched on 7 July 2021 for meta-analyses comparing implant failure in perforated and non-perforated sinus membranes. Primary studies identified in these meta-analyses were combined in a new random-effects model with odds ratios (ORs), confidence intervals (CIs), and prediction intervals reported. Using this new meta-analysis, further meta-analyses were then undertaken considering the clinical, methodological, and statistical heterogeneity of the primary studies, publication bias, and clustering effects. The meta-analyses with the greatest number and more homogeneous studies provided lower odds of implant failure in non-perforated sites (OR 0.49, 95 % CI = [0.26, 0.92]). However, when considering heterogeneity, publication bias, and clustering (number of implants), the confidence in these results was reduced. Interpretation of estimates reported in systematic reviews can vary depending on the assumptions made in the meta-analysis. Users of these analyses need to carefully consider the impact of heterogeneity, publication bias, and clustering, which can affect the size, direction, and interpretation of the reported estimates.

Association between suicidal ideation and burnout: A meta-analysis

Approximately 700,000 people die by suicide annually worldwide. Researchers have explored a spectrum of experiences that involve stress in academic or work environments and potentially intensify suicidal thoughts or behaviors. However, no meta-analysis has examined the relationship between suicidal ideation (SI) and burnout. This study consisted of a meta-analysis to examine the association between SI and burnout syndrome, utilizing the WoS Core Collection, Scopus, PubMed, PsycINFO, DIALNET, and Google Scholar databases. Twenty-one samples met the study's eligibility criteria for inclusion in the analysis. The results revealed a significant relationship between SI and burnout, with the type of burnout (occupational, academic, and parental) emerging as the most significant moderating variable. Occupational burnout exhibited the lowest correlation, followed by academic and parental burnout. These findings suggest the importance of developing tools to assess SI within the context of the work environment, parenting and academics, and psychoeducational programs for managing stress.

Which psychological interventions improve quality of life in patients with schizophrenia-spectrum disorders? A meta-analysis of randomized controlled trials

Quality of life (QoL) is a major patient reported outcome used to measure the psychological treatments success in people with schizophrenia-spectrum disorders. To date, the specific impact of different interventions on QoL remains undefined. A meta-analysis of Randomized Controlled Trials (RCTs) was carried out for this purpose. We searched Proquest, PUBMED/MEDLINE, PsycINFO, WOS, Scopus, the Cochrane Library for RCTs published until January 2023. We used multilevel meta-analysis to examine differences between intervention effectiveness of experimental and control conditions whilst accounting for data dependencies. By means of subgroup analyses, we investigated influences of intervention types (i.e. psychoeducation v. CBT v. cognitive v. combination of several types v. other, such as psychodynamic, systemic, etc.) and continuous moderators were examined with precision-weighted meta-regressions. The generalizability of results across moderators, their combinations, and analytical approaches was investigated with multiverse meta-analyses. We examined data of 60 independent studies, reporting intervention effects for objective and subjective QoL (k = 19 and 70 effect sizes based on N = 1024 and 6254 participants, respectively). Overall, psychological interventions seemed to be more effective for objective than for subjective QoL. However, specific intervention results were differentiated, suggesting largest effects of psychoeducation on objective and combined interventions on subjective QoL. Our findings suggest that QoL is a valid outcome criterion for testing intervention effectiveness, as it is sensitive to change. Additionally, psychological interventions can improve patients' QoL, though the effects are small. Further testing of less widely used interventions and a shift toward the multidimensional nature of QoL is still necessary.

The effect of smoking on response to methotrexate in rheumatoid arthritis patients: A systematic review and meta-analysis

OBJECTIVES

In the current study, we aimed to investigate the effect of smoking on inadequate response to methotrexate (MTX-IR) in rheumatoid arthritis (RA) patients.

METHODS

We searched PubMed, Embase, and Web of Science until 6 June 2022. Observational or interventional studies investigating MTX-IR in RA patients based on smoking status were included. Two independent reviewers assessed the risk of bias and the certainty of the evidence using the Risk of Bias in Nonrandomized Studies-of Interventions and Grades of Recommendation, Assessment, Development, and Evaluation tools, respectively.

RESULTS

We included 23 studies in the systematic review and 13 in the meta-analysis. Of the 13 included studies, 6 had a moderate risk, 3 had a serious risk, and 4 had a critical risk of bias. The overall random-effect meta-analysis suggested that smokers were 58% more likely to be MTX-IR when compared with nonsmokers [odds ratio (OR) 1.58, 95% confidence interval 1.21-2.06; P = .001; I2 = 69.3%]. The common-effect meta-analysis of the adjusted ORs demonstrated an overall OR of 2.69 (1.88-3.83; P < .001; I2 = 27.1%).

CONCLUSIONS

The current study showed that smoking is a significant predictor of MTX-IR, especially in disease-modifying antirheumatic drug-naïve early RA patients, as most of the included studies in the meta-analysis consisted of this population.

Differences in facial emotion recognition between bipolar disorder and other clinical populations: A systematic review and meta-analysis

Facial emotion (or expression) recognition (FER) is a domain of affective cognition impaired across various psychiatric conditions, including bipolar disorder (BD). We conducted a systematic review and meta-analysis searching for eligible articles published from inception to April 26, 2023, in PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO to examine whether and to what extent FER would differ between people with BD and those with other mental disorders. Thirty-three studies comparing 1506 BD patients with 1973 clinical controls were included in the present systematic review, and twenty-six of them were analyzed in random-effects meta-analyses exploring the discrepancies in discriminating or identifying emotional stimuli at a general and specific level. Individuals with BD were more accurate in identifying each type of emotion during a FER task compared to individuals diagnosed with schizophrenia (SCZ) (SMD = 0.27; p-value = 0.006), with specific differences in the perception of anger (SMD = 0.46; p-value = 1.19e-06), fear (SMD = 0.38; p-value = 8.2e-04), and sadness (SMD = 0.33; p-value = 0.026). In contrast, BD patients were less accurate than individuals with major depressive disorder (MDD) in identifying each type of emotion (SMD = -0.24; p-value = 0.014), but these differences were more specific for sad emotional stimuli (SMD = -0.31; p-value = 0.009). No significant differences were observed when BD was compared with children and adolescents diagnosed with attention-deficit/hyperactivity disorder. FER emerges as a potential integrative instrument for guiding diagnosis by enabling discrimination between BD and SCZ or MDD. Enhancing the standardization of adopted tasks could further enhance the accuracy of this tool, leveraging FER potential as a therapeutic target.

A Meta-analysis of Surgical Outcomes of T4a and Infranotch T4b Oral Cancers

OBJECTIVE

To determine the overall surgical outcomes of infranotch T4b oral cancers and compare them with T4a oral cancers.

METHODS

PubMed, EMBASE and Cochrane databases from 2000 to 2022 were systematically searched. Clinical studies reporting at least one outcome following curative surgery and adjuvant therapy for comparison of patients with either infranotch T4b (IN-T4b) or T4a tumour. The heterogeneity of the included studies was determined using Tau-squared, Chi-squared, and the Higgins I2 test. The random effects model was used to determine the log odds ratio (logOR).

RESULTS

The systematic review comprised 11,790 patients from 16 included studies. Seven studies were included in the meta-analysis (n = 11,381). For IN-T4b patients, the pooled 2 and 5 year overall survival (OS) were 59.3% and 53.2%, 2 and 5 year disease-free survival (DFS) 57.9% and 48.4%, 2 and 5 year disease-specific survival (DSS) 72% and 68%, and 2 and 5 year local control (LC), 47% and 56%, respectively. There was no statistically significant difference in 2 year OS [logOR = 0.28 (-0.47, 1.03), p = 0.46, confidence interval (CI) = 95%], 5 year OS [logOR = 0.7 (-0.4, 1.8), p = 0.54, CI = 95%], 2 year DFS [logOR = 0.22 (-0.35, 0.79), p = 0.45, CI = 95%], 5 year DFS [logOR = 0.17 (-0.42, 0.77), p = 0.57, CI = 95%], 2 year LC [logOR = 0.47 (-0.33, 1.26), p = 0.25, CI = 95%] and 5 year LC [logOR = 0.34 (-0.31, 0.99), p = 0.31, CI = 95%] between IN-T4b and T4a oral cancers.

CONCLUSION

Results of this meta-analysis suggest that IN-T4b oral cancers have similar outcomes to T4a oral cancers, which supports down-staging IN-T4b cancers to T4a cancers.

A systematic review and meta-analysis of the effect of digital game-based or influencer food and non-alcoholic beverage marketing on children and adolescents: Exploring hierarchy of effects outcomes

Videogame livestreaming platforms are an emerging form of digital media, popular with young people, where users watch gaming influencers play videogames. Food and non-alcoholic beverage (hereafter: food) brands have a substantial presence on these platforms, yet no studies have examined the impact of this food marketing on young people. This systematic review and meta-analysis examined the evidence (quantitative or mixed-method) for a relationship between exposure to digital game-based or influencer food marketing, and food-related (brand awareness, attitudes, preferences, purchase, and consumption), and post-consumption (weight, body mass index [BMI], and dental caries) outcomes in young people (≤18 years). Twenty-three databases were searched in March 2021. Twenty-two studies met the inclusion criteria, of which 20 were included in the quantitative synthesis. Meta-analyses indicated food marketing was associated with more positive attitudes and greater preferences (OR = 1.74, p < 0.001 [95%CI: 1.355, 2.232]), and increased consumption (SMD = 0.37, p < 0.001 [95%CI: 0.219, 0.529]). Narrative synthesis indicated that food marketing may increase brand awareness but not pester intent, although data were limited. Evidence suggests that there is a relationship between exposure to food marketing via influencers and digital gaming media, and several food-related outcomes. This is the first quantitative synthesis to demonstrate these relationships; this work has implications for food marketing policy.

Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis

People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies (n = 2451), to BPD in six studies (n = 1001), to attention deficit hyperactivity disorder in three studies (n = 232), to anxiety disorders in two studies (n = 320), to schizophrenia in one study (n = 223), and to post-traumatic stress disorder in one study (n = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.

Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis

Revision surgery for OPLL is undesirable for both patients and physicians. However, the risk factors for reoperation are not clear. Thus, we sought to review the existing literature and determine the factors associated with higher reoperation rates in patients with OPLL. A search was performed using Pubmed, Embase, Web of Sciences, and Ovid to include studies regarding the risk factors of reoperation for OPLL. RoBANS (Risk of Bias Assessment tool for Nonrandomized Studies) was used for risk of bias analysis. Heterogeneity of studies and publication bias was assessed, and sensitivity analysis was performed. Statistical analysis was performed with a p-value < 0.05 using SPSS software (version 23). Twenty studies with 129 reoperated and 2,793 non-reoperated patients were included. The pooled reoperation rate was 5% (95% CI: 4% to 7). The most common cause of reoperation was residual OPLL or OPLL progression (n = 51, 39.53%). An increased risk of additional surgery was found with pre-operative cervical or thoracic angle (Standardized mean difference = -0.44; 95% CI: -0.69 to -0.19; p = 0.0061), post-operative CSF leak (Odds ratio, OR = 4.97; 95% CI: 2.48 to 9.96; p = 0.0005), and graft and/or hardware failure (OR = 192.09; 95% CI: 6.68 to 5521.69; p = 0.0101). Apart from the factors identified in our study, the association of other variables with the risk of second surgery could not be ruled out, owing to the complexity of the relationship and significant bias in the current literature.

The Utility of Methylphenidate for Fatigue in Long-Term Neurological Conditions: A Meta-analytical Review

OBJECTIVE

Fatigue is a chronic and debilitating symptom of many long-term neurological conditions (LTNCs). Although methylphenidate provides some promise in alleviating fatigue in other clinical groups, little work has explored its potential utility within LTNCs. The current systematic review and meta-analysis evaluates the utility of methylphenidate for symptoms of fatigue in LTNCs.

METHODS

Five databases (PsycINFO, MEDLINE, Embase, Scopus, and Cochrane Library) were searched for relevant articles from their inception to February 2022. A purpose-developed evaluation tool was used to assess each study's research quality (QuEST:F).

RESULTS

Of the 1698 articles identified, 11 articles were included within this review (n = 370). Meta-analytical findings reported an overall significant benefit of methylphenidate for symptoms of fatigue across a mixed neurological sample ( g = -0.44; 95% confidence interval, -0.77 to -0.11). Subgroup analyses identified a significantly greater benefit ( P < 0.001) of methylphenidate for fatigue in LTNCs with static pathogenic trajectories (eg, traumatic brain injury) (number needed to treat = 2.5) compared with progressive conditions (eg, multiple sclerosis) (number needed to treat = 40.2).

CONCLUSIONS

Methylphenidate may pose an effective intervention for the treatment of fatigue in a number of LTNCs. Nonetheless, given the quality of the current evidence base, there exists a clear need for further robust assessment of the utility of methylphenidate-with a focus on subgroup-specific variability.

The efficacy, safety, and adverse events of azapirones in anxiety disorders: A systematic review and meta-analysis of randomized controlled trials

Azapirones have been proposed as anxiety and mood modulators. We assessed azapirones' viability in anxiety disorders via systematic review and random-effects meta-analysis, inquiring PubMed/MEDLINE/CENTRAL/WHO-ICTRP/WebOfScience/VIP up-to 05/01/2023. We conducted sensitivity, and subgroup analyses assessing heterogeneity, publication bias, risk of bias, and confidence in the evidence within the GRADE framework. Symptom reduction (mean difference/MD), study-defined response (risk ratios/RRs), and acceptability were co-primary outcomes. Adverse events and withdrawal were secondary. Seventy studies were included. In generalized anxiety disorder (GAD), azapirones largely outperformed placebo (MD=-4.91, 95%C.I.[-5.91, -3.90], Hedges'g -1.37 [-1.02, -0.73]), k = 22, n = 2,567; RR=1.64, 95%C.I.[1.45, 1.86], k = 9, n = 1,346). While azapirones overlapped benzodiazepines in symptom reduction (MD=-0.12, 95%C.I.[-0.70, 0.45], k = 34, n = 3,160), they were slightly outperformed in response rate (RR=0.94, 95%C.I.[0.90, 0.99], k = 18, n = 2,423). Azapirones overlapped SRIs (MD=0.09, 95%C.I.[-0.49, 0.67], k = 8, n = 747; RR=0.97, 95%C.I.[0.89, 1.07], k = 7, n = 737). Confidence in estimates was high/moderate vs. placebo, moderate/low vs. benzodiazepine, very-low vs. SRIs. Azapirones failed to outperform the placebo in panic and social anxiety disorders. Azapirones overlapped placebo and SRIs in drop-out rates, while they showed higher treatment discontinuation rates than benzodiazepines (RR=1.33, 95%C.I.[1.16, 1.53], k = 23, n = 2,768). Azapirones caused less sedation/fatigue/drowsiness/weakness/cognitive issues than benzodiazepines, resembling placebo. They caused more nausea and dizziness than placebo, more headache and nausea than benzodiazepines, and less nausea and xerostomia than SRIs. Azapirones proved effective and relatively well-tolerated for GAD. They should be preferred over benzodiazepines, especially in the long-term, considering their lower sedation and addiction potential, representing a potential SRI alternative. Further research is warranted to prove efficacy in panic and social anxiety.

The effectiveness of workplace interventions for the prevention of alcohol use: A meta-analysis

BACKGROUND AND AIMS

Previous research has pointed to the potential of workplace interventions addressing alcohol consumption. However, there is still no systematic overview of the effects of these interventions. Therefore, we aimed to quantify the effectiveness of workplace interventions addressing alcohol use by conducting a meta-analysis.

METHODS

A systematic literature search for randomized controlled trials of workplace alcohol interventions published between 1995 and 2020 was conducted in five databases. Studies were included if they were performed in the workplace and reported universal or selective interventions aiming for alcohol use reduction. Primary outcomes were any measures of alcohol use. Standardized mean effect sizes were used to calculate the meta-analytic random-effects-model. Additional analyses were carried out to identify potential moderators and to examine the amount of heterogeneity and publication bias.

RESULTS

Twenty studies with 4484 participants were integrated into the meta-analysis. Results revealed a significant overall mean effect indicating a reduction of alcohol use in favor of the treatment group (d = -0.16, 95% CI = [-0.2715; -0.0511]). Heterogeneity within the data structure was found to be moderate to substantial (I2  = 75.9%, Q-test P < 0.001, τ2 = 0.0375). Additional moderator analyses only showed a significant effect for length of measurement period (P = 0.049).

CONCLUSIONS

Alcohol-related prevention programs conducted in the workplace have a statistically significant and favorable effect on alcohol consumption. Although the overall mean effect is considered to be small, it underlines the effectiveness of workplace interventions targeting a reduction in alcohol use.

Comparison of Balanced Crystalloids versus Normal Saline in Critically Ill Patients: A Systematic Review with Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Background

Fluid resuscitation is routinely needed for critically ill patients. However, the optimal choice between crystalloids and normal saline is in heat debate.

Objective

To conduct a meta-analysis comparing normal saline and balanced crystalloids in the treatment of critically ill patients with composite mortality as the primary outcome.

Methods

PubMed, Embase, Medline, Web of Science, and Cochrane Library were searched from inception up to March 2022. Studies of critically ill adult patients assigned to receive normal saline or balanced crystalloids were included. We conducted a meta-analysis using an inverse variance, random-effects model in addition to trial sequential analysis (TSA). The primary outcome was composite mortality. Subgroup analyses were also conducted.

Results

Eighteen full-text studies (n=36,224) were included. Balanced crystalloids were associated with lower mortality compared with normal saline (risk ratio [RR]=0.96; 95% confidential interval [CI] 0.93, 1; p=0.03; I2=0) and lower incidence of acute kidney injury/acute renal failure (RR =0.93; 95% CI = 0.87, 0.99; p=0.03). No significant difference was observed in other outcomes. In the sepsis patients, the balanced crystalloid showed a lower composite mortality rate compared with normal saline (RR =0.91; 95% CI = 0.85, 0.99; p=0.02). TSA analysis demonstrated that, with 80% power, the effect of balanced crystalloid is not larger than a 10% relative decrease in composite mortality compared with normal saline.

Conclusion and Relevance

This study demonstrated that balanced crystalloids could be an optimal choice over normal saline in critically ill patients to a reduced composite mortality rate. In patients with sepsis, the difference is especially significant. Nonetheless, the optimal resuscitation fluid option between saline and balanced crystalloid solutions should be investigated further with more evidence.

Narrative-based autobiographical memory interventions for PTSD: a meta-analysis of randomized controlled trials

Introduction

The aim of this systematic review and meta-analysis is to evaluate the efficacy of narrative-based interventions (NBIs) for individuals with post-traumatic stress disorder (PTSD). Investigating the efficacy of NBIs should yield insight on autobiographical memory (AM) phenomena implicated in PTSD onset and recovery, leading to improved intervention protocols. Furthermore, by analyzing how NBIs influence maladaptive AM distortions, we hope to shed light on the theorized narrative architecture of AM more generally.

Methods

A systematic literature search was conducted according to PRISMA and Cochrane guidelines in MEDLINE, EMBASE, PsychINFO, and PubMed. Additional studies were then also identified from the reference lists of other relevant literature and considered for inclusion. Studies were then evaluated for adherence to the inclusion/exclusion criteria and assessed for risk of bias. Various meta-analyses were performed on included studies to understand how NBIs may or may not influence the overall effect size of treatment.

Results

The results of the meta-analysis of 35 studies, involving 2,596 participants, suggest that NBIs are a viable and effective treatment option for PTSD, yielding a statistically significant within-group effect size and decrease in PTSD symptomatology at both post-treatment [g = 1.73, 95% CI (1.23-2.22)] and 3-9 month follow-up assessments [g = 2.33, 95% CI (1.41-3.26)]. Furthermore, the difference in effect sizes between NBIs compared to active and waitlist controls was statistically significant, suggesting that NBIs are superior. Sub-analyses showed that NET provided a stronger effect size than FORNET, which may be due to the nature of the traumatic event itself and not the treatment protocol. While evidence of small study and publication bias was present, a weight-function model and trim-and-fill method suggested it was not influencing the overall results.

Discussion

This meta-analysis presents strong evidence supporting the use of NBIs in the treatment of PTSD. Clear similarities can be identified between NBIs included in this analysis that make them distinct from non-NBI interventions, which are reviewed in the discussion. Controlled comparisons between NBIs and non-NBIs would help to further understand AM mechanisms of action implicated in recovery and how various interventions facilitate them. Future research should also aim to elucidate the full range of AM impairment in individuals with PTSD to gain insight on how other memory capabilities, such as the ability to mentally simulate the future, are implicated in the pathogenesis of PTSD.

Environmental and life-style risk factors for esophageal squamous cell carcinoma in Africa: a systematic review and meta-analysis

BACKGROUND

The African Esophageal Squamous Cell Carcinoma (ESCC) corridor, which spans from Ethiopia down to South Africa, is an esophageal cancer hotspot. Disproportionately high incidence and mortality rates of esophageal cancer have been reported from this region. The aim of this study was to systematically assess the evidence on environmental and life-style risk factors associated with ESCC in African populations.

METHODS

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and carried out a comprehensive search of all African published studies up to March 2023 using PubMed, Embase, Scopus, and African Index Medicus databases.

RESULTS

We identified 45 studies with measures of association [odds ratio (OR), relative risk (RR), and 95% confidence intervals (95%CI)], which reported on several environmental and lifestyle risk factors for ESCC in Africa. We performed a meta-analysis on 38 studies investigating tobacco, alcohol use, combined tobacco and alcohol use, polycyclic aromatic hydrocarbon exposure, hot food and beverages consumption (which served as a proxy for esophageal injury through exposure to high temperature), and poor oral health. We found significant associations between all the risk factors and ESCC development. Analysis of fruit and vegetable consumption showed a protective effect. Using population attributable fraction (PAF) analysis, we calculated the proportion of ESCC attributable to tobacco (18%), alcohol use (12%), combined tobacco and alcohol use (18%), polycyclic aromatic hydrocarbon exposure (12%), hot food and beverages intake (16%), poor oral health (37%), and fruit and vegetable consumption (-12%).

CONCLUSIONS

Tobacco smoking and alcohol consumption were the most studied risk factors overall. Areas where there is an emerging body of evidence include hot food and beverages and oral health. Concurrently, new avenues of research are also emerging in PAH exposure, and diet as risk factors. Our results point to a multifactorial etiology of ESCC in African populations with further evidence on prevention potential.

Efficacy and safety of anti-amyloid-β monoclonal antibodies in current Alzheimer's disease phase III clinical trials: A systematic review and interactive web app-based meta-analysis

The risk-benefit profile of anti-Aβ monoclonal antibodies (mAbs) in Alzheimer's disease (AD) remains unclear, especially concerning their safety and overall effects on AD progression and cognitive function. Here, we investigated cognitive, biomarker and side effects of anti-Aβ mAbs in large phase III randomized placebo-controlled clinical trials (RCTs) in sporadic AD. The search was performed on Google Scholar, PubMed and ClinicalTrials.gov by applying Jadad score to evaluate the methodological quality of the reports. Studies were excluded if they scored < 3 on Jadad scale or if they analyzed less than 200 sporadic AD patients. We followed PRISMA guidelines and DerSimonian-Laird random-effects model in R. Primary outcomes were cognitive: AD Assessment Scale-Cognitive Subscale (ADAS-Cog), Mini Mental State Examination (MMSE) and Clinical Dementia Rating Scale-sum of Boxes (CDR-SB). Secondary and tertiary outcomes included biomarkers of Aβ and tau pathology, adverse events, and performance on Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale. The meta-analysis included 14,980 patients in 14 studies and four mAbs: Bapineuzumab, Aducanumab, Solanezumab and Lecanemab. The results of this study suggest that anti-Aβ mAbs statistically improved cognitive and biomarker outcomes, particularly Aducanumab and Lecanemab. However, while cognitive effects were of small effect sizes, these drugs considerably increased risk of side effects such as Amyloid Related Imaging Abnormalities (ARIA), especially in APOE-ε4 carriers. Meta-regression revealed that higher (better) baseline MMSE score was associated with improved ADAS Cog and CDR-SB. In order to improve reproducibility and update the analysis in the future, we developed AlzMeta.app, web-based application freely available at https://alzmetaapp.shinyapps.io/alzmeta/.

Montessori education's impact on academic and nonacademic outcomes: A systematic review

Background

Montessori education is the oldest and most widely implemented alternative education in the world, yet its effectiveness has not been clearly established.

Objectives

The primary objective of this review was to examine the effectiveness of Montessori education in improving academic and nonacademic outcomes compared to traditional education. The secondary objectives were to determine the degree to which grade level, Montessori setting (public Montessori vs. private Montessori), random assignment, treatment duration, and length of follow-up measurements moderate the magnitude of Montessori effects.

Search Methods

We searched for relevant studies in 19 academic databases, in a variety of sources known to publish gray literature, in Montessori-related journals, and in the references of studies retrieved through these searches. Our search included studies published during or before February 2020. The initial search was performed in March 2014 with a follow-up search in February 2020.

Selection Criteria

We included articles that compared Montessori education to traditional education, contributed at least one effect size to an academic or nonacademic outcome, provided sufficient data to compute an effect size and its variance, and showed sufficient evidence of baseline equivalency-through random assignment or statistical adjustment-of Montessori and traditional education groups.

Data Collection and Analysis

To synthesize the data, we used a cluster-robust variance estimation procedure, which takes into account statistical dependencies in the data. Otherwise, we used standard methodological procedures as specified in the Campbell Collaboration reporting and conduct standards.

Main Results

Initial searches yielded 2012 articles, of which 173 were considered in detail to determine whether they met inclusion/exclusion criteria. Of these, 141 were excluded and 32 were included. These 32 studies yielded 204 effect sizes (113 academic and 91 nonacademic) across 132,249 data points. In the 32 studies that met minimum standards for inclusion, including evidence of baseline equivalence, there was evidence that Montessori education outperformed traditional education on a wide variety of academic and nonacademic outcomes. For academic outcomes, Hedges' g effect sizes, where positive values favor Montessori, ranged from 0.26 for general academic ability (with high quality evidence) to 0.06 for social studies. The quality of evidence for language (g = 0.17) and mathematics (g = 0.22) was also high. The effect size for a composite of all academic outcomes was 0.24. Science was the only academic outcome that was deemed to have low quality of evidence according to the GRADE approach. Effect sizes for nonacademic outcomes ranged from 0.41 for students' inner experience of school to 0.23 for social skills. Both of these outcomes were deemed as having low quality of evidence. Executive function (g = 0.36) and creativity (g = 0.26) had moderate quality of evidence. The effect size for a composite of all nonacademic outcomes was 0.33. Moderator analyses of the composite academic and nonacademic outcomes showed that Montessori education resulted in larger effect sizes for randomized studies compared to nonrandomized studies, for preschool and elementary settings compared to middle school or high school settings, and for private Montessori compared to public Montessori. Moderator analyses for treatment duration and duration from intervention to follow-up data collection were inconclusive. There was some evidence for a lack of small sample-size studies in favor of traditional education, which could be an indicator of publication bias. However, a sensitivity analysis indicated that the findings in favor of Montessori education were nonetheless robust.

Authors' Conclusions

Montessori education has a meaningful and positive impact on child outcomes, both academic and nonacademic, relative to outcomes seen when using traditional educational methods.

Comparative Analysis of the Prevalence of Bovine Viral Diarrhea Virus in Cattle Populations Based on Detection Methods: A Systematic Review and Meta-Analysis

Infectious diseases of cattle, including bovine viral diarrhea (BVD), pose a significant health threat to the global livestock industry. This study aimed to investigate the prevalence and risk factors associated with bovine viral diarrhea virus (BVDV) infections in cattle populations through a systematic review and meta-analysis. PubMed, Web of Science, and Scopus were systematically searched for relevant articles reporting the prevalence of and associated risk factors in studies published between 1 January 2000 and 3 February 2023. From a total of 5111 studies screened, 318 studies were included in the final analysis. BVDV prevalence in cattle populations was estimated using various detection methods. The analysis detected heterogeneity in prevalence, attributed to detection techniques and associated risk factors. Antibody detection methods exhibited a higher prevalence of 0.43, reflecting the cumulative effect of detecting both active and past infections. Antigen detection methods showed a prevalence of 0.05, which was lower than antibody methods. A prevalence of 0.08 was observed using nucleic acid detection methods. The health status of the examined cattle significantly influenced the prevalence of BVDV. Cattle with bovine respiratory disease complex (BRDC) exhibited higher antibody (prevalence of 0.67) and antigen (prevalence 0.23) levels compared to cattle with reproductive problems (prevalence 0.13) or diarrhea (prevalence 0.01). Nucleic acid detection methods demonstrated consistent rates across different health conditions. Age of cattle influenced prevalence, with higher rates in adults compared to calves. Risk factors related to breeding and reproduction, such as natural or extensive breeding and a history of abortion, were associated with increased prevalence. Coinfections with pathogens like bovine herpesvirus-1 or Neospora caninum were linked to higher BVDV prevalence. Management practices, such as commingling, introducing new cattle, and direct contact with neighboring farms, also influenced prevalence. Herd attributes, including larger herd size, and the presence of persistently infected cattle, were associated with higher prevalence. These findings indicated the importance of detection methods and risk factors in BVDV epidemiological studies.