Con: Meta-analysis: some key limitations and potential solutions

Biomarkers and Tourette syndrome: a systematic review and meta-analysis

Objective

This research aims to investigate whether peripheral biomarkers might differentiate individuals with Tourette syndrome (TS) from those without the condition.

Methods

A broad range of databases was searched through November 2022. This study employed a systematic literature review and subsequent meta-analysis of case-control studies that assessed the aberration of biomarkers of patients with TS and controls.

Results

A total of 81 studies were identified, out of which 60 met the eligibility criteria for inclusion in the meta-analysis. Following a meticulous screening procedure to determine the feasibility of incorporating case-control studies into the meta-analysis, 13 comparisons were statistically significant [CD3+ T cell, CD4+ T cell, CD4+ T cell to CD8+ T cell ratio, NK-cell, anti-streptolysin O antibodies, anti-DNase antibodies, glutamic acid (Glu), aspartic acid (Asp), ferritin (Fe), zinc (Zn), lead (Pb), vitamin D, and brain-derived neurotrophic factor (BDNF)]. Publication bias was found for anti-streptolysin O antibodies. Suggestive associations were evidenced for norsalsolinol (NSAL), neuron-specific enolase (NSE), and S100B.

Conclusion

In this study, we present empirical evidence substantiating the link between several peripheral biomarkers and the early diagnosis of TS. Larger and more standardized studies are necessary to replicate the observed results, elucidate the specificity of the biomarkers for TS, and evaluate their precision for use in clinical settings.

Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis

Background

Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA.

Methods

In this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger's test. This study is registered with PROSPERO, CRD42021296623.

Findings

Of the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78-1.17, I2 = 57%, p ≤ 0.01, n = 63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79-0.87, I2 = 11%, p = 0.37, n = 244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n = 2), fair (n = 9) and good (n = 6).

Interpretation

Community-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA.

Funding

Nuffield Department of Population Health, Balliol College, the Clarendon Fund, Medical Research Council.

Job satisfaction and job tenure of people with mental health disorders: a UK Biobank cohort study

AIMS

Job satisfaction plays an important role for the life quality and health of working individuals. While studies have shown that self-reported mental health conditions such as stress, anxiety and depression are associated with job satisfaction, a large population-based study exploring and comparing self-reported physician posed diagnosed conditions and their association with job satisfaction and job tenure is missing. This study addresses the gap along with exploring the impact of the neurotic personality trait and other possible contributing factors.

METHODS

Sixteen mental health disorders diagnosed by physicians, categorised into four major groups were investigated in relation to employment status (108,711 participants) and in relation to job satisfaction and job tenure (34,808 participants). Analyses were performed using linear regression adjusted for age, sex, townsend deprivation index, body mass index, education, physical activity, work hours and neuroticism.

RESULTS

Neurotic and stress disorders, eating disorders and other mental health disorders were strongly associated with lower job satisfaction and shorter job tenure in both unadjusted and adjusted analyses. Neuroticism was strongly linked to job satisfaction but was not associated with job tenure.

CONCLUSIONS

Study findings clarify the complex relationship of mental health with job satisfaction and job tenure, which is very important to understand in designing measures to improve working life participation of individuals with mental health issues.

Efficacy of smokeless tobacco for smoking cessation: a systematic review and meta-analysis

OBJECTIVE

Smoking remains prevalent in many countries despite rigorous tobacco control strategies. The use of Swedish snus, a type of low-nitrosamine smokeless tobacco, has been promoted as a tobacco harm reduction strategy.

DATA SOURCES AND STUDY SELECTION

Three databases were searched for studies that assessed the effectiveness of snus in promoting smoking abstinence. A total of 28 studies were reviewed (5 randomised controlled trials (RCTs), 7 longitudinal and 16 cross-sectional studies).

DATA EXTRACTION

Separate meta-analyses were conducted by study type, pooling effect estimates where outcome measures and design were sufficiently comparable. Study details and quality assessment (Risk of Bias 2 for RCTs, Newcastle-Ottawa Scale for observational studies) are provided for each study.

DATA SYNTHESIS

While the meta-analysis of RCTs did not show a significant association between snus use and smoking cessation (risk ratio (RR)=1.33, 95% CI 0.71 to 2.47 and RR=0.62, 95% CI 0.27 to 1.41), the results of the meta-analysis of longitudinal cohort studies (RR=1.38, 95% CI 1.05 to 1.82, p=0.022) and cross-sectional studies (OR=1.87, 95% CI 1.29 to 2.72, p=0.001) indicated that use of snus was associated with an increased likelihood of quitting or having quit smoking. There was significant heterogeneity in the cross-sectional studies, and leave-one-out analysis indicated that the longitudinal cohort results were driven by one study. Most studies examined were subject to an elevated risk of bias.

CONCLUSION

There is weak evidence for the use of snus for smoking cessation. Better RCTs and longitudinal studies are needed; meanwhile, existing cessation aids may be better placed than snus to promote abstinence.

A systematic review and meta-analysis of pollutants in environmental media

Environmental pollutants are ubiquitous in our environmental media, resulting in detrimental impacts on both humans and the environment. An evidence-based review, particularly a systematic review and meta-analysis, performs a crucial function in assessing the pollution status of pollutants in environmental media at national and global scales. We selected and thoroughly investigated 76 papers focusing on systematic reviews and meta-analyses of contaminants in environmental media. The need to broaden the scope of studies was observed with an increase in the total number of publications, and there were greater focuses on food safety, water pollution, biological pollution, and environmental risks. Furthermore, this review outlined the fundamental procedures involved in a systematic review and meta-analysis, including literature searching, screening of articles, study quality analysis, data extraction and synthesis, and meta-analysis. A meta-analysis typically comprises fixed- and/or random-effects meta-analysis, identifying and measuring heterogeneity, sensitivity analysis, publication bias, subgroup analysis, and meta-regression. We specifically explored the application of meta-analysis to assess the presence of contaminants in environmental media based on two different pollutant categories, namely, non-biological and biological pollutants. The mean value is commonly utilized to assess the pooled concentration of non-biological pollutants, while the prevalence serves as the effect size of biological pollutants. Additionally, we summarized the innovative applications, frequent misuses, and problems encountered in systematic reviews and meta-analyses. Finally, we proposed several suggestions for future research endeavors.

Vaccinating Welders against Pneumococcus: Evidence from a Systematic Review and Meta-Analysis

Workers occupationally exposed to welding dusts and fumes have been suspected to be at increased risk of invasive pneumococcal disease (IPD). Since the 2010s, the United Kingdom Department of Health and the German Ständige Impfkommission (STIKO) actively recommend welders undergo immunization with the 23-valent polysaccharide (PPV23) pneumococcal vaccine, but this recommendation has not been extensively shared by international health authorities. The present meta-analysis was therefore designed to collect available evidence on the occurrence of pneumococcal infection and IPD among welders and workers exposed to welding fumes, in order to ascertain the effective base of evidence for this recommendation. PubMed, Embase and MedRxiv databases were searched without a timeframe restriction for the occurrence of pneumococcal infections and IPD among welders and workers exposed to metal dusts, and articles meeting the inclusion criteria were included in a random-effect meta-analysis model. From 854 entries, 14 articles (1.6%) underwent quantitative analysis, including eight retrospective studies (publication range: 1980-2010), and six reports of professional clusters in shipbuilding (range: 2017-2020). Welders had an increased likelihood of developing IPD compared with non-welders (odds ratio 2.59, 95% CI 2.00-3.35, I2 = 0%, p = 0.58), and an increased likelihood of dying from IPD (standardized mortality ratio (SMR) 2.42, 95% CI 1.96-2.99, I2 = 0%, p = 0.58). Serotype typing was available for 72 cases, 60.3% of which were represented by serotype 4, followed by 12F (19.2%) and serotype 8 (8.2%). Although the available data derive from a limited number of studies, available results suggest that pneumococcal vaccination should be recommended for workers exposed to welding fumes, and vaccination strategies should consider the delivery of recombinant formulates in order to combine the direct protection against serotypes of occupational interest with the mucosal immunization, reducing the circulation of the pathogen in occupational settings characterized by close interpersonal contact.

BoDV-1 Infection in Children and Adolescents: A Systematic Review and Meta-Analysis

Borna disease virus 1 (BoDV-1) can cause a severe human syndrome characterized by meningo-myeloencephalitis. The actual epidemiology of BoDV-1 remains disputed, and our study summarized prevalence data among children and adolescents (<18-year-old). Through systematic research on three databases (PubMed, EMBASE, MedRxiv), all studies, including seroprevalence rates for BoDV-1 antigens and specific antibodies, were retrieved, and their results were summarized. We identified a total of six studies for a total of 2692 subjects aged less than 18 years (351 subjects sampled for BoDV-1 antibodies and 2557 for antigens). A pooled seroprevalence of 6.09% (95% Confidence Interval [95% CI] 2.14 to 16.17) was eventually calculated for BoDV-1 targeting antibodies and 0.76% (95% CI 0.26 to 2.19) for BoDV-1 antigens. Both estimates were affected by substantial heterogeneity. Seroprevalence rates for BoDV-1 in children and adolescents suggested that a substantial circulation of the pathogen does occur, and as infants and adolescents have relatively scarce opportunities for being exposed to hosts and animal reservoirs, the potential role of unknown vectors cannot be ruled out.

Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis

INTRODUCTION

Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce.

MATERIAL AND METHODS

We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8-18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted.

RESULTS

Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9-14%], 8% for migraine without aura (MwoA) [95%CI: 5-12%], 3% for migraine with aura (MwA) [95%CI:2-4%] and 17% for tension-type headache (TTH) [95% CI: 12-23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53-70%], with prevalence in females and males of 38% [95% CI: 16-66%] and 27% [95% CI: 11-53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking.

CONCLUSION

We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.

Self-enhancement and physical health: A meta-analysis

A prior meta-analysis yielded a positive relation between self-enhancement and psychological health. This article presents the first meta-analysis of the association between self-enhancement and physical health (k = 87; N = 22,415). The meta-analysis relied predominantly on social desirability as an operationalization of self-enhancement and secondarily on comparative judgement and narcissism. Further, the meta-analysis operationalized physical health in terms of self-rated health, symptoms and biomarkers. Overall, self-enhancement yielded a near-zero association with physical health, r = .01. However, this association was more pronounced for comparative judgement (r = .18, k = 6) than social desirability (r = .03, k = 41) or narcissism (r = -.0001, k = 8), and for self-rated health (r = .09, k = 9) than symptoms (r = .01, k = 29) or biomarkers (r = -.13, k = 17). The association between self-enhancement and physical health fluctuates across measures of both constructs calling for more focussed and nuanced investigations.

Modeling COVID-19 Transmission Dynamics: A Bibliometric Review

A good amount of research has evolved just in three years in COVID-19 transmission, mortality, vaccination, and some socioeconomic studies. A few bibliometric reviews have already been performed in the literature, especially on the broad theme of COVID-19, without any particular area such as transmission, mortality, or vaccination. This paper fills this gap by conducting a bibliometric review on COVID-19 transmission as the first of its kind. The main aim of this study is to conduct a bibliometric review of the literature in the area of COVID-19 transmission dynamics. We have conducted bibliometric analysis using descriptive and network analysis methods to review the literature in this area using RStudio, Openrefine, VOSviewer, and Tableau. We reviewed 1103 articles published in 2020-2022. The result identified the top authors, top disciplines, research patterns, and hotspots and gave us clear directions for classifying research topics in this area. New research areas are rapidly emerging in this area, which needs constant observation by researchers to combat this global epidemic.

Disordered eating and the meat-avoidance spectrum: a systematic review and clinical implications

PURPOSE

Meat avoidance has long been thought to be related to eating psychopathology; however, research does not necessarily support this notion. Furthermore, commonly used eating disorder scales may be picking up on normal meat-avoiding behaviours in vegetarians and vegans. As such, we systematically reviewed the association between vegetarianism, veganism, and disordered eating, and reviewed the psychometric properties of eating disorder scales for use in these populations.

METHODS

We searched electronic databases MEDLINE, PsychINFO, and CINAHL for literature published until June 2021.

RESULTS

Forty-eight studies met eligibility criteria, with no consensus as to whether meat avoidance was associated with higher rates of disordered eating. Most studies reported a significant positive association with both vegetarianism and veganism, and orthorexia nervosa. Six studies provided evidence for the use of eating disorder measures in vegetarians and vegans, reporting poor psychometric fit among all scales.

CONCLUSION

This systematic review highlights the extent to which vegetarians and vegans have been highly understudied, with limited research suggesting higher levels of orthorexia nervosa behaviours in vegetarians and vegans. Furthermore, our results provide tentative evidence that the factorial validity of commonly used eating disorder scales, such as the EDE-Q, may be poor in vegans.

LEVEL OF EVIDENCE

Level I, systematic review.

Potential Use of Exhaled Breath Condensate for Diagnosis of SARS-CoV-2 Infections: A Systematic Review and Meta-Analysis

Background. Reverse-transcriptase polymerase chain reaction (RT-qPCR) assays performed on respiratory samples collected through nasal swabs still represent the gold standard for COVID-19 diagnosis. Alternative methods to this invasive and time-consuming options are still being inquired, including the collection of airways lining fluids through exhaled breath condensate (EBC). Materials and Methods. We performed a systematic review and meta-analysis in order to explore the reliability of EBC as a way to collect respiratory specimens for RT-qPCR for diagnosis of COVID-19. Results. A total of 4 studies (205 specimens), were ultimately collected, with a pooled sensitivity of 69.5% (95%CI 26.8–93.4), and a pooled specificity of 98.3% (95%CI 87.8–99.8), associated with high heterogeneity and scarce diagnostic agreement with the gold standard represented by nasal swabs (Cohen’s kappa = 0.585). Discussion. Even though non-invasive options for diagnosis of COVID-19 are still necessary, EBC-based RT-qPCR showed scarce diagnostic performances, ultimately impairing its implementation in real-world settings. However, as few studies have been carried out to date, and the studies included in the present review are characterized by low numbers and low sample power, further research are requested to fully characterize the actual reliability of EBC-based RT-qPCR in the diagnosis of COVID-19.

The impacts of COVID-19 on eating disorders and disordered eating: A mixed studies systematic review and implications

Purpose

The unique constraints to everyday life brought about by the COVID-19 pandemic have been suggested to negatively impact those with pre-existing mental health issues such as eating disorders. While individuals with eating disorders or disordered eating behaviors likely represent a vulnerable group to the COVID-19 pandemic, the impact of the pandemic is yet to be fully established.

Methods

We systematically examined the impact of the COVID-19 pandemic on eating disorders and disordered eating behaviors. We searched electronic databases MEDLINE, PsycINFO, CINAHL, and EMBASE for literature published until October 2021. Eligible studies were required to report on individuals with or without a diagnosed eating disorder or disordered eating behaviors who were exposed to the COVID-19 pandemic.

Findings

Seventy-two studies met eligibility criteria with the majority reporting an increase in eating disorder or disordered eating behaviors associated with the COVID-19 pandemic. Specifically, it appears children and adolescents and individuals with a diagnosed eating disorder may present vulnerable groups to the impacts of the COVID-19 pandemic.

Discussion

This mixed systematic review provides a timely insight into COVID-19 eating disorder literature and will assist in understanding possible future long-term impacts of the pandemic on eating disorder behaviors. It appears that the role of stress in the development and maintenance of eating disorders may have been intensified to cope with the uncertainty of the COVID-19 pandemic. Future research is needed among understudied and minority groups and to examine the long-term implications of the COVID-19 pandemic on eating disorders and disordered eating behaviors.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=284749, PROSPERO [CRD42021284749].

Respiratory Syncytial Virus in Pregnant Women: Systematic Review and Meta-Analysis

Human Respiratory Syncytial Virus (RSV) is a highly contagious viral pathogen. In infants, it is usually listed among the main causes of medical referrals and hospitalizations, particularly among newborns. While waiting for the results of early randomized controlled trials on maternal vaccination against RSV, the present systematic review and meta-analysis aimed to collect available evidence on maternal RSV infections. According to the PRISMA statement, Pubmed, Embase, and pre-print archive medRxiv.og were searched for eligible studies published up to 1 April 2022. Raw data included the incidence of RSV infection among sampled pregnant women, and the occurrence of complications. Data were then pooled in a random-effects model. Heterogeneity was assessed using the I2 measure, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 5 studies for 282,918 pregnancies were retrieved, with a pooled prevalence of 0.2 per 100 pregnancies and 2.5 per 100 pregnancies with respiratory tract infections. Neither maternal deaths nor miscarriages were reported. Even though detailed data were available only for 6309 pregnancies and 33 RSV cases, infant outcomes such as low birth weight and preterm delivery were rare (in both cases 0.04%), but up to 9.1% in cases where RSV diagnosis was confirmed. No substantially increased risk for preterm delivery (RR 1.395; 95%CI 0.566 to 3.434) and giving birth to a low-birth-weight infant (RR 0.509; 95%CI 0.134 to 1.924) was eventually identified. Conclusions. Although RSV is uncommonly detected among pregnant women, incident cases were associated with a relatively high share of complications. However, heterogeneous design and the quality of retrieved reports stress the need for specifically designed studies.

How to Ask the Right Question and Find the Right Answer: Clinical Research for Transplant Nephrologists

Clinical research is about asking and answering questions. Before solutions relevant to clinical problems can be sought, clinicians must frame questions in ways that are answerable using the methods of clinical research. Different types of questions are best answered using specific study designs. Each design has inherent strengths and limitations. In this review article, we provide an approach to asking answerable clinical research questions, review the major study designs, describe their strengths and weaknesses, and link the study designs to their intended purposes.

Relationship Between Team Identification and Consumption Behaviors: Using a Meta-Analysis

The purpose of this study was to conduct a comprehensive literature review and a meta-analysis on team identification, particularly its relation to two outcome variables: intention to attend games and intention to purchase licensed merchandise. Past literature was searched through several electronic databases, including SPORTDiscus, using relevant keywords. Thirteen studies for team identification and intention to attend sport games and nine studies for team identification and intention to purchase licensed merchandise meeting all selection criteria were identified. A random-effect model was used to conduct a meta-analysis. Funnel plot and Egger's test were conducted to test publication bias, followed by fail-safe N to examine the stability of the estimates. The results showed that the total effect size values for the relationships between team identification and intentions to attend games and to purchase licensed merchandise were 0.39 and 0.42, respectively, which indicates a medium-large effect size. The study confirms the predictive power of team identification when it pertains to sport consumption behaviors and provides insights into practical implications in utilizing team identification as a potential driver of promoting consumer behaviors by the way of achieving marketing objectives.

Hypoglycemic agents and glycemic variability in individuals with type 2 diabetes: A systematic review and network meta-analysis

While hemoglobin A1c (HbA1c) is commonly used to monitor therapy response in type 2 diabetes (T2D), GV is emerging as an essential additional metric for optimizing glycemic control. Our goal was to learn more about the impact of hypoglycemic agents on HbA1c levels and GV in patients with T2D. A systematic review and network meta-analysis (NMA) of randomized controlled trials were performed to assess the effects of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium-glucose cotransporter (SGLT)-2 inhibitors, dipeptidyl peptidase (DPP)-4 inhibitors, sulfonylurea and thiazolidinediones on Mean Amplitude of Glycemic Excursions (MAGE) and HbA1c. Searches were performed using PubMed and EMBASE. A random-effect model was used in the NMA, and the surface under the cumulative ranking was used to rank comparisons. All studies were checked for quality according to their design and also for heterogeneity before inclusion in this NMA. The highest reduction in MAGE was achieved by GLP-1 RAs (SUCRA 0.83), followed by DPP-4 inhibitors (SUCRA: 0.72), and thiazolidinediones (SUCRA: 0.69). In terms of HbA1c reduction, GLP-1 RAs were the most effective (SUCRA 0.81), followed by DPP-4 inhibitors (SUCRA 0.72) and sulfonylurea (SUCRA 0.65). Our findings indicated that GLP-1 RAs have relatively high efficacy in terms of HbA1c and MAGE reduction when compared with other hypoglycemic agents and can thus have clinical application. Future studies with a larger sample size and appropriate subgroup analyses are warranted to completely understand the glycemic effects of these agents in various patients with T2D. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42021256363).

Offspring's risk for suicidal behaviour in relation to parental death by suicide: systematic review and meta-analysis and a model for familial transmission of suicide

BACKGROUND

Exposure to parental suicide has been associated with increased risk for suicide and suicide attempts, although the strength of this association is unclear as evidence remains inconsistent.

AIMS

To quantify this risk using meta-analysis and identify potential effect modifiers.

METHOD

A systematic search in PubMed, PsycInfo and Embase databases to 2020 netted 3614 articles. Inclusion criteria were: observation of history of parental death by suicide, comparison with non-exposed populations and definition of suicide and suicide attempt according to standardised criteria. We focused on population-based studies. The primary outcome was the pooled relative risk (RR) for incidence of suicide attempt and suicide in offspring of a parent who died by suicide compared with offspring of two living parents. Additionally, we compared the RR for attempted and completed suicide after parental suicide with the RR for attempted and completed suicide after parental death by other causes.

RESULTS

Twenty studies met our inclusion criteria. Offspring exposed to parental suicide were more likely to die by suicide (RR = 2.97, 95% CI 2.50-3.53) and attempt suicide (RR = 1.76, 95% CI 1.58-1.96) than offspring of two living parents. Furthermore, their risk of dying by or attempting suicide was significantly higher compared with offspring bereaved by other causes of death.

CONCLUSIONS

The experience of losing a parent to suicide is a strong and independent risk factor for suicidal behaviour in offspring. Our findings highlight the need for prevention strategies, outreach programmes and support interventions that target suicide-related outcomes in the exposed population.

SARS-CoV-2-Legionella Co-Infections: A Systematic Review and Meta-Analysis (2020-2021)

Legionnaires' Disease (LD) is a severe, sometimes fatal interstitial pneumonia due to Legionella pneumophila. Since the inception of the SARS-CoV-2 pandemic, some contradictory reports about the effects of lockdown measures on its epidemiology have been published, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE) focusing on studies that reported the occurrence of LD among SARS-CoV-2 cases. Data were extracted using a standardized assessment form, and the results of such analyses were systematically reported, summarized, and compared. We identified a total of 38 articles, including 27 observational studies (either prospective or retrospective ones), 10 case reports, and 1 case series. Overall, data on 10,936 SARS-CoV-2 cases were included in the analyses. Of them, 5035 (46.0%) were tested for Legionella either through urinary antigen test or PCR, with 18 positive cases (0.4%). A pooled prevalence of 0.288% (95% Confidence Interval (95% CI) 0.129-0.641), was eventually calculated. Moreover, detailed data on 19 co-infections LD + SARS-CoV-2 were obtained (males: 84.2%; mean age: 61.9 years, range 35 to 83; 78.9% with 1 or more underlying comorbidities), including 16 (84.2%) admissions to the ICU, with a Case Fatality Ratio of 26.3%. In summary, our analyses suggest that the occurrence of SARS-CoV-2-Legionella infections may represent a relatively rare but not irrelevant event, and incident cases are characterized by a dismal prognosis.

Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

Stroke is a primary debilitating disease in adults, occurring in 15 million individuals each year and causing high mortality and disability rates. The latest estimate revealed that stroke is currently the second leading cause of death worldwide. Post-stroke cognitive impairment (PSCI), one of the major complications after stroke, is frequently underdiagnosed. However, stroke has been reported to increase the risk of cognitive impairment by at least five to eight times. In recent decades, peripheral blood molecular biomarkers for stroke have emerged as diagnostic, prognostic, and therapeutic targets. In this study, we aimed to evaluate some blood-derived proteins for stroke, especially related to brain damage and cognitive impairments, by conducting a systematic review and meta-analysis and discussing the possibility of these proteins as biomarkers for PSCI. Articles published before 26 July 2021 were searched in PubMed, Embase, the Web of Science, and the Cochrane Library to identify all relevant studies reporting blood biomarkers in patients with stroke. Among 1820 articles, 40 were finally identified for this study. We meta-analyzed eight peripheral biomarker candidates: homocysteine (Hcy), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), uric acid, and glycated hemoglobin (HbA1c). The Hcy, CRP, TC, and LDL-C levels were significantly higher in patients with PSCI than in the non-PSCI group; however, the HDL-C, TG, uric acid, and HbA1c levels were not different between the two groups. Based on our findings, we suggest the Hcy, CRP, TC, and LDL-C as possible biomarkers in patients with post-stroke cognitive impairment. Thus, certain blood proteins could be suggested as effective biomarkers for PSCI.

Immunogenicity to Botulinum Toxin Type A: A Systematic Review With Meta-Analysis Across Therapeutic Indications

BACKGROUND

Botulinum toxin A (BTX-A) is commonly employed as a neuromodulator in several neurological diseases and aesthetic indications. Formation of neutralizing antibodies (NAbs) after BTX-A injections may be responsible for treatment failure.

OBJECTIVES

The authors sought to quantify the prevalence of NAbs following treatment with Abobotulinumtoxin A, Incobotulinumtoxin A, and Onabotulinumtoxin A for therapeutic indications.

METHODS

An electronic systematic search (2000-2020) of PubMed, Scopus, Web of Science, and Embase was conducted. Original studies reporting prevalence of NAbs were included. Data analysis was carried out through open meta-analysis softwares.

RESULTS

Forty-three studies involving 8833 patients were included in this meta-analysis. The incidence of NAbs was 1.8% (summary estimate = 0.018, 95% CI [0.012, 0.023]); a meta-regression analysis revealed that BTX-A duration was significantly associated with increased incidence of NAbs (P = 0.007). Patients with dystonia had the highest incidence (7.4%) of NAbs against BTX-A (summary estimate = 0.074, 95% CI = [0.045, 0.103], I2 = 93.%, P < 0.00) followed by patients with spasticity (6.7%) and urological indications (6.2%). Abobotulinumtoxin A was associated with the highest incidence of NAbs (7.4%) (summary estimate = 0.074, 95% CI = [0.053, 0.096], I2 = 97.24%, P < 0.00) by the Incobotulinumtoxin A and Onabotulinumtoxin A 0.3% (summary estimate <0.003%, 95% CI = [-0.001, 0.007], P < 0.003).

CONCLUSIONS

Although the overall incidence of NAbs following BTX-A injections is relatively low, patients with secondary nonresponse to BTX-A with no apparent causes should be investigated for NAbs. A consensus needs to be developed for the optimal management of such patients.

LEVEL OF EVIDENCE: 2

rTMS for depression: The difficult transition from research to clinical practice

The publication of the 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of mood disorders was followed by a series of correspondences discussing the place of repetitive transcranial magnetic stimulation (rTMS) in the sequence care for the routine treatment of depression. The controversy has led to an intense debate about the positioning of this neuromodulation technique in the clinical armamentarium for depression in the Australian and New Zealand Journal of Psychiatry. The many arguments presented by the authors to defend their respective points of view can be summarised in two main key issues: (i) the interpretation of the level of evidence of rTMS for depression and (ii) the characterisation of patients who could benefit from this treatment. In this viewpoint, we discuss the difficult transition from research to clinical practice regarding the use of rTMS to treat depression.

Nurses' attitude on pressure injury prevention: A systematic review and meta-analysis based on the pressure ulcer prevention instrument (APuP)

BACKGROUND

Prevention of pressure ulcers (PU) is one of the most important indicators of the quality of patient care that may be influenced by the attitude of nurses. Nurses are responsible for maintaining the integrity of the skin and preventing its complications. The aim of this study was to assess the overall attitude of nurses on PU prevention based on their scores on the Attitude towards Pressure ulcer Prevention instrument (APuP).

METHODS

In this systematic review and meta-analysis, databases including Web of Science, Science Direct, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, Attitude, and their possible combinations. Heterogeneity of studies was assessed with I² index and Cochrane-Q test. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All the analyses were performed using STATA v.16 software.

RESULTS

Twelve studies with a sample size of 7824 people were analyzed. The overall score of attitude towards pressure ulcer prevention was 70.84% (95% CI: 66.34-75.35) and the highest and lowest scores were related to the dimensions of individual priority (78.83%, 95% CI: 74.69-82.97) and competence (70.11%, 95% CI: 67.24-72.94), respectively. The percentage of the total score of attitude towards pressure ulcer prevention in nurses was higher than nursing students (72.15%, 95% CI: 67.10-77.20 vs. 67%, 95% CI: 53.80-80.20). Sensitivity analysis confirmed the stability of the results. Publication bias was significant (p = 0.036).

CONCLUSION

The attitude of nurses and nursing students towards the prevention of pressure ulcers was moderate, and providing the necessary training to these groups was essential.

Occupational Hantavirus Infections in Agricultural and Forestry Workers: A Systematic Review and Metanalysis

Hantaviruses are zoonotic pathogens that can cause serious human disorders, including hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. As the main risk factor for human infections is the interaction with rodents, occupational groups such as farmers and forestry workers are reportedly at high risk, but no summary evidence has been collected to date. Therefore, we searched two different databases (PubMed and EMBASE), focusing on studies reporting the prevalence of hantaviruses in farmers and forestry workers. Data were extracted using a standardized assessment form, and results of such analyses were systematically reported, summarized and compared. We identified a total of 42 articles, including a total of 28 estimates on farmers, and 22 on forestry workers, with a total workforce of 15,043 cases (821 positive cases, 5.5%). A pooled seroprevalence of 3.7% (95% confidence interval [95% CI] 2.2–6.2) was identified in farmers, compared to 3.8% (95% CI 2.6–5.7) in forestry workers. Compared to the reference population, an increased occurrence was reported for both occupational groups (odds ratio [OR] 1.875, 95% CI 1.438–2.445 and OR 2.892, 95% CI 2.079–4.023 for farmers and forestry workers, respectively). In summary, our analyses stress the actual occurrence of hantaviruses in selected occupational groups. Improved understanding of appropriate preventive measures, as well as further studies on hantavirus infection rates in reservoir host species (rodents, shrews, and bats) and virus transmission to humans, is needed to prevent future outbreaks.

Which Is Safer, Chinese Medicine or Western Medicine? Comparative Analysis Based on Chinese Spontaneous Reporting Database

OBJECTIVE

To compare the safety differences between Chinese medicine (CM) and Western medicine (WM) based on Chinese Spontaneous Reporting Database (CSRD).

METHODS

Reports of adverse events (AEs) caused by CM and WM in the CSRD between 2010 and 2011 were selected. The following assessment indicators were constructed: the proportion of serious AEs (PSE), the average number of AEs (ANA), and the coverage rate of AEs (CRA). Further comparisons were also conducted, including the drugs with the most reported serious AEs, the AEs with the biggest report number, and the 5 serious AEs of interest (including death, anaphylactic shock, coma, dyspnea and abnormal liver function).

RESULTS

The PSE, ANA and CRA of WM were 1.09, 8.23 and 2.35 times higher than those of CM, respectively. The top 10 drugs with the most serious AEs were mainly injections for CM and antibiotics for WM. The AEs with the most reports were rash, pruritus, nausea, dizziness and vomiting for both CM and WM. The proportions of CM and WM in anaphylactic shock and coma were similar. For abnormal liver function and death, the proportions of WM were 5.47 and 3.00 times higher than those of CM, respectively.

CONCLUSION

Based on CSRD, CM was safer than WM at the average level from the perspective of adverse drug reactions.

Democracy, Culture and Cancer Patients' Willingness to Pay for Healthcare Services: A Meta-analysis

Cancer is one of the leading causes of death globally and expenditure associated with cancer is quite high. Efficient resource allocation needs information on economic evaluations of healthcare interventions. The purposes of the study are to provide a comprehensive overview of cancer patients’ willingness to pay (WTP) for healthcare services and to investigate the influence of democracies, culture dimensions, and other factors on WTP. A meta-analysis was conducted using PubMed, Scopus, and Google Scholar to identify all studies of stated preference approach to estimate cancer patients’ WTP healthcare services. A set of criteria was constructed for selecting relevant studies. A total of 79 studies were related to selection criteria and held sufficient information for the purposes of meta-analysis. A total of 393 estimates of WTP from 79 healthcare valuation studies were pooled to identify the links between WTP and influential factors. The findings suggest that values of benefits in healthcare services are higher in more democratic nations, but they are lower in cultural traits that are stronger indulgence and uncertainty avoidance. Further, the types of cancer matter. Compared to breast cancer, WTP is higher for skin cancer, yet lower for liver cancer and lymphoma. A higher national income and public health expenditure increase WTP for healthcare services, while a higher death rate by cancer leads to lower values of healthcare benefits.

Clinical Knowledge Supported Acute Kidney Injury (AKI) Risk Assessment Model for Elderly Patients

From the clinical viewpoint, the statistical approach is still the cornerstone for exploring many diseases. This study was conducted to explore the risk factors related to acute kidney injury (AKI) for elderly patients using the multiple criteria decision-making (MCDM) approach. Ten nephrologists from a teaching hospital in Taipei took part in forming the AKI risk assessment model. The key findings are: (1) Comorbidity and Laboratory Values would influence Comprehensive Geriatric Assessment; (2) Frailty is the highest influential AKI risk factor for elderly patients; and (3) Elderly patients could enhance their daily activities and nutrition to improve frailty and lower AKI risk. Furthermore, we illustrate how to apply MCDM methods to retrieve clinical experience from seasoned doctors, which may serve as a knowledge-based system to support clinical prognoses. In conclusion, this study has shed light on integrating multiple research approaches to assist medical decision-making in clinical practice.

Perinatal mortality and its determinants in Sub Saharan African countries: systematic review and meta-analysis

Background

Despite decreasing overall perinatal and maternal mortality in high-income countries, perinatal and maternal health inequalities are persisting in Sub Saharan African countries. Therefore, this study aimed to determine the effects size of rates and determinants for perinatal mortality in Sub-Saharan countries.

Method

The sources for electronic datasets were PubMed, Medline, EMBASE, SCOPUS, Google, Google Scholar, and WHO data Library. Observational studies published in the English language from January 01, 2000, to May 30, 2019 were included. STROBE and JBI tools were used to include relevant articles for this review. We used a Comberehensive Meta-Analysis version 2 software for this analysis. The I² and Q- statistic values were used to detect the level of heterogeneity. The Kendall’s without continuity correction, Begg and Mazumdar rank correlation and Egger’s linear regression tests were used to detect the existence of significant publication bias (P <  0.10). The effects size were expressed in the form of point estimate and odds ratio with 95% CI (P <  0.05) in the random effect analysis using the trim and fill method.

Result

Twenty-one articles were included in this review. However, only fourteen studies reported the perinatal mortality rate. Among 14 studies, the observed and adjusted PMR was found to be 58.35 and 42.95 respectively. The odds of perinatal mortality among mothers who had no ANC visits was 2.04 (CI: 1.67, 2.49, P <  0.0001) as compared to those who had at least one ANC visit. The odds of perinatal mortality among preterm babies was 4.42 (CI: 2.83, 6.88, P <  0.0001). In most cases, heterogeneity was not evident when subgroup analyses were assessed by region, study design, and setting. Only perinatal mortality (P <  0.0001), antenatal care (P <  0.046) and preterm births (P <  0.034) showed a relationship between the standardized effect sizes and standard errors of these effects.

Conclusion

In general, engaging in systematic review and meta-analysis would potentially improve under-represented strategies and actions by informing policy makers and program implementers for minimizing the existing socioeconomic inequalities between regions and nations.

Men's willingness to pay for prostate cancer screening: a systematic review

BACKGROUND

This study aimed to review studies on willingness to pay (WTP) for prostate cancer screening.

METHODS

This systematic-review was conducted based on the Preferred Reporting Items for Systematic Reviews guidelines. By searching six-health-database, WTP studies on prostate cancer screening using contingent valuation method published in English until March 2020 were included and those with unavailable full-text and inadequate quality-assessment scores were excluded. Smith checklist was used for the quality assessment. Extracted WTPs were converted to US dollar in 2018 using exchange rate parity and net present value formula to make comparison. Factors' effect was assessed by vote counting.

RESULTS

Six final studies published after 2006 reported above 70% Smith checklist items needed to be considered in contingent valuation study reports. Seven factors have positive effects on WTP. The reported WTP value varied from 11$ to 588$ in Japan and Germany, respectively.

CONCLUSION

WTP for prostate cancer screening was positive among all studied men. The results of factors' effect assessment showed that better understanding prostate cancer risks or screening tests and factors such as age, income, family history of cancer, hospitalization history, and educational level have positive effects. Moreover, prostate-specific antigen history, health insurance, employment, and subject's health assessment received less attention. The results' generalization to all countries is not applicable because there are no studies for low- and middle-income countries.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2020 CRD42020172789.

Does exercise have a protective effect on cognitive function under hypoxia? A systematic review with meta-analysis

OBJECTIVE

This study aimed to examine (1) the independent effects of hypoxia on cognitive function and (2) the effects of exercise on cognition while under hypoxia.

METHODS

Design: Systematic review with meta-analysis.

DATA SOURCES

PubMed, Scopus, Web of Science, PsychInfo, and SPORTDiscus were searched. Eligibility criteria for selecting studies: randomized controlled trials and nonrandomized controlled studies that investigated the effects of chronic or acute exercise on cognition under hypoxia were considered (Aim 2), as were studies investigating the effects of hypoxia on cognition (Aim 1).

RESULTS

In total, 18 studies met our inclusionary criteria for the systematic review, and 12 studies were meta-analyzed. Exposure to hypoxia impaired attentional ability (standardized mean difference (SMD) = -0.4), executive function (SMD = -0.18), and memory function (SMD = -0.26), but not information processing (SMD = 0.27). Aggregated results indicated that performing exercise under a hypoxia setting had a significant effect on cognitive improvement (SMD = 0.3, 95% confidence interval: 0.14 - 0.45, I2 = 54%, p < 0.001). Various characteristics (e.g., age, cognitive task type, exercise type, exercise intensity, training type, and hypoxia level) moderated the effects of hypoxia and exercise on cognitive function.

CONCLUSION

Exercise during exposure to hypoxia improves cognitive function. This association appears to be moderated by individual and exercise/hypoxia-related characteristics.

Association of the Sp1 binding site and -1997 promoter variations in COL1A1 with osteoporosis risk: The application of meta-analysis and bioinformatics approaches offers a new perspective for future research

As a complex disease, osteoporosis is influenced by several genetic markers. Many studies have examined the link between the Sp1 binding site +1245 G > T (rs1800012) and -1997 G > T (rs1107946) variations in the COL1A1 gene with osteoporosis risk. However, the findings of these studies have been contradictory; therefore, we performed a meta-analysis to aggregate additional information and obtain increased statistical power to more efficiently estimate this correlation. A meta-analysis was conducted with studies published between 1991-2020 that were identified by a systematic electronic search of the Scopus and Clarivate Analytics databases. Studies with bone mineral density (BMD) data and complete genotypes of the single-nucleotide variations (SNVs) for the overall and postmenopausal female population were included in this meta-analysis and analyzed using the R metaphor package. A relationship between rs1800012 and significantly decreased BMD values at the lumbar spine and femoral neck was found in individuals carrying the "ss" versus the "SS" genotype in the overall population according to a random effects model (p < 0.0001). Similar results were also found in the postmenopausal female population (p = 0.003 and 0.0002, respectively). Such findings might be an indication of increased osteoporosis risk in both studied groups in individuals with the "ss" genotype. Although no association was identified between the -1997 G > T and low BMD in the overall population, those individuals with the "GT" genotype showed a higher level of BMD than those with "GG" in the subgroup analysis (p = 0.007). To determine which transcription factor (TF) might bind to the -1997 G > T in COL1A1, 45 TFs were identified based on bioinformatics predictions. According to the GSE35958 microarray dataset, 16 of 45 TFs showed differential expression profiles in osteoporotic human mesenchymal stem cells relative to normal samples from elderly donors. By identifying candidate TFs for the -1997 G > T site, our study offers a new perspective for future research.

The effect of consuming milk and related products during human pregnancy over birth weight and perinatal outcomes: A systematic review and meta-analysis

OBJECTIVE

Data addressing the effect of milk and related products (M&RPs) on fetal growth are contradictory. The aim was to meta-analyze the effect of consuming M&RPs during human pregnancy over perinatal outcomes.

METHOD

A systematic literature search was performed in PubMed, EMBASE, Scopus, Web of Science, and Cochrane Library. Eligibility criteria for selection were: studies evaluating the effect of consuming M&RPs during pregnancy over birth weight and different perinatal outcomes. Random effect models were used for meta-analyses, and effects are reported as mean differences (MD) or odds ratio (OR) and their 95 % confidence intervals (CIs).

RESULTS

Fourteen studies (111,184 pregnant women) reported on the targeted perinatal outcomes. The meta-analysis of ten studies revealed a positive association between consuming a higher amount of M&RPs and birth weight (MD =51.0 g, 95 % CI 24.7-77.3), whereas in five studies a positive effect was observed on infant length (MD =0.33 cm, 95 % CI: 0.03-0.64). The higher birth weight was detected both in Western world gravids, consuming standard/conventional diets, as well as in vegetarian women from India. There were no significant differences in ultrasound measured fetal head circumference, biparietal diameter, abdominal circumference and femur length. The consumption of a higher amount of M&RPs was associated with a reduced risk of small-for-gestational age (SGA) (OR = 0.69, 95 % CI: 0.56-0.84) and low birth weight infants (OR = 0.63, 95 % CI: 0.48-0.84); in addition to a higher risk of large-for-gestational age (LGA) infants (OR = 1.11, 95 % CI: 1.02-1.21).

CONCLUSION

The consumption of a higher amount of M&RPs during pregnancy was associated with greater infant birth weight and length; in addition to a lower risk of having SGA and low birth weight infants, and a higher risk of LGA infants.

Methodological steps used by authors of systematic reviews and meta-analyses of clinical trials: a cross-sectional study

Background

The quality of systematic reviews and meta-analyses (SR/MAs) depends on the extent of the methods used. We investigated the methodological steps used by authors of SR/MAs of clinical trials via an author survey.

Methods

We conducted an email-based cross-sectional study by contacting corresponding authors of SR/MAs that were published in 2015 and 2016 and retrieved through the PubMed database. The 27-item questionnaire was developed to study the methodological steps used by authors when conducting a SR/MA and the demographic characteristics of the respondent. Besides the demographic characteristics, methodological questions regarding the source, extraction and synthesis of data were included.

Results

From 10,292 emails sent, 384 authors responded and were included in the final analysis. Manual searches were carried out by 69.2% of authors, while 87.3% do updated searches, 49.2% search grey literature, 74.9% use the Cochrane tool for risk of bias assessment, 69.8% assign more than two reviewers for data extraction, 20.5% use digital software to extract data from graphs, 57.9% use raw data in the meta-analysis, and 43.8% meta-analyze both adjusted and non-adjusted data. There was a positive correlation of years of experience in conducting of SR/MAs with both searching grey literature (P = 0.0003) and use of adjusted and non-adjusted data (P = 0.006).

Conclusions

Many authors still do not carry out many of the vital methodological steps to be taken when performing any SR/MA. The experience of the authors in SR/MAs is highly correlated with use of the recommended tips for SR/MA conduct. The optimal methodological approach for researchers conducting a SR/MA should be standardized.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0780-2) contains supplementary material, which is available to authorized users.

Association between sense of coherence and dental caries: systematic review and meta-analysis

Sense of coherence (SOC) is regarded as the individuals' capacity for managing the stressors over their lifespan. The aim of this systematic review and meta-analysis was to evaluate the association between SOC and dental caries. Electronic searchers were conducted in six databases: PubMed, Medline, Scopus, Web of Science, Lilacs and Proquest from their date of inception until November/2017. An update took place in August/2018. A hand search in the reference list of the included articles and gray literature search were also carried out. Retrieved titles/abstracts were screened by two review authors. Data of the included articles were extracted and quality assessment was also conducted. The first search retrieved 346 titles/abstracts. The update retrieved 33 records. Following the removal of 70 duplicates, 309 references were screened and 17 were included. The quality assessment ranged from low quality articles to high quality articles. High quality study showed that adult individuals with lower SOC were more likely to have dental caries. Meta-analysis showed that adolescents with low SOC were 5.41 times more likely to present dental caries than adolescents with high SOC (CI = 2.15–13.59). Mothers with low SOC were 5.55 times more likely to have children/adolescents with dental caries than mothers with high SOC (CI = 2.92–10.57). The subgroup analysis exploring continuous data showed that the SOC of mothers of children/adolescents without dental caries was significantly higher than the SOC of mothers of children/adolescents with dental caries (CI = 0.10–0.51). Higher levels of SOC seem to be associated with lower levels of dental caries.

The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis

Background: Resistance training (RT) is recommended as part of our national physical activity guidelines which includes working all major muscle groups on two or more days a week.Older adults can gain many health benefits from RT, such as increased muscle strength,increased muscle mass, and maintenance of bone density. Additionally, certain dimensions of health-related quality of life (HRQOL) have been shown to improve in older adults due to RT intervention. The purpose of this study was to use systematic review and meta-analytic techniques to examine the effect of RT on HRQOL in older adults.

Methods: A systematic review of current studies (2008 thru 2017) was conducted using PubMed. Studies were included if they used a randomized controlled design, had RT as an intervention, measured HRQOL using the SF-36/12 assessment, and included adults 50+ years of age. Eight dimension scores (physical functioning, bodily pain, physical role function, general health, mental health, emotional role function, social function, and vitality) and two summary scores (physical component and mental component) were extracted. Ten meta-analyses were performed using standardized mean effect sizes and random effects models. Study quality,moderator and sensitivity analyses were conducted.

Results: A total of 16 studies were included in the analyses with a mean Physiotherapy Evidence Database (PEDro) score of 4.9 (SD=1.0). Among the mental health measures, RT had the greatest effect on mental health (Effect size [ES]=0.64, 95% CI: 0.30-0.99, I²=79.7). Among the physical health measures, RT had the largest effect on body pain (ES=0.81, 95% CI: 0.26-1.35, I²=85.9).Initially, RT did not significantly affect measures of emotional role function, social function or physical role function. However, after removing a single study, RT significantly increased all HRQOL measures.

Conclusion: The meta-analytic evidence presented in this research clearly supports the promotion of RT in improving HRQOL in older adults.

Moderator's view: Meta-analysis: the best knowledge but not always shining gold

Meta-analysis has gained top status in medicine. Correctly so, well-performed meta-analysis is perceived as an unbeatable method for distilling first class medical knowledge. However, such a high status should in no way be considered as a guarantee that all information derived from meta-analyses is pure gold. Systematic reviews and meta-analyses not performed with due methodological attention abound and nephrology is not at all a protected territory. Herein I give concrete examples of meta-analyses published in major journals whose findings are not pure gold.