Methods for exploring heterogeneity in meta-analysis

Emergent methods for inactivation of Cronobacter sakazakii in foods: A systematic review and meta-analysis

Cronobacter sakazakii is a potentially pathogenic bacterium that is resistant to osmotic stress and low aw, and capable of persisting in a desiccated state in powdered infant milks. It is widespread in the environment and present in various products. Despite the low incidence of cases, its high mortality rates of 40 to 80 % amongst neonates make it a microorganism of public health interest. This current study performed a comparative assessment between current reduction methods applied for C. sakazakii in various food matrices, indicating tendencies and relevant parameters for process optimization. A systematic review and meta-analysis were conducted, qualitatively identifying the main methods of inactivation and control, and quantitatively evaluating the effect of treatment factors on the reduction response. Hierarchical clustering dendrograms led to conclusions on the efficiency of each treatment. Review of recent research trend identified a focus on the potential use of alternative treatments, with most studies related to non-thermal methods and dairy products. Using random-effects meta-analysis, a summary effect-size of 4-log was estimated; however, thermal methods and treatments on dairy matrices displayed wider dispersions - of τ2 = 8.1, compared with τ2 = 4.5 for vegetal matrices and τ2 = 4.0 for biofilms. Meta-analytical models indicated that factors such as chemical concentration, energy applied, and treatment time had a more significant impact on reduction than the increase in temperature. Non-thermal treatments, synergically associated with heat, and treatments on dairy matrices were found to be the most efficient.

Exercise interventions for the effect of endothelial function in hypertensive patients: A systematic review and meta-analysis

Endothelial dysfunction is crucial factor to the hypertension occurrence, and controversy remains regarding the effect of exercise on improving endothelial function in hypertensive patients. The authors used meta-analysis to evaluate the intervention effect of exercise on endothelial function in hypertensive patients and to investigate exercise protocols that may have a greater intervention effect. A total of 37 studies and a total of 2801 participants were included. The results were as follows: endogenous nitric oxide (NO)[SMD = .89, 95% CI (.48, 1.30), p < .0001], endothelin-1 (ET-1): [SMD = -.94, 95% CI (-1.15, -.73), p <. 0001], flow-mediated dilation (FMD) [SMD = -.57, 95% CI (.36, .79), p < .000001]. In subgroup analysis, high-intensity aerobic exercise, with a single exercise duration of 35-50 min, 3-4 times/week for a total of 10-12 weeks, had the largest amount of intervention effect on NO, and moderate-intensity resistance exercise, with a single exercise duration of ≥60 min, 6 times/week for a total of 15-18 weeks, had the largest amount of intervention effect on ET-1. In conclusion, exercise can improve NO levels, FDM levels, and reduce ET-1 secretion of hypertension patients, thereby improve their endothelial function. The ideal intervention effect of improving NO level was more likely to be obtained by taking the exercise prescription of high-intensity aerobic exercise with a single exercise duration of 35-50 min, 3-4 times/week for 10-12 weeks; the ideal intervention effect of improving ET-1 was more likely to be obtained by taking the exercise prescription of oderate -intensity resistance exercise with a single exercise duration of ≥60 min, 6 times/week for 15-18 weeks.

Study methodology impacts density-dependent dispersal observations: a systematic review

The relationship between animal dispersal and conspecific density has been explored in various study systems but results in terms of both the magnitude and the direction of density dependence are inconsistent. We conducted a thorough review of the literature (2000-2023) and found k = 97 empirical studies of birds, fishes, herpetofauna (amphibians and reptiles), invertebrates, or mammals that had tested for a correlation between conspecific density and animal dispersal. We extracted categorical variables for taxonomic group, sex, age, migratory behavior, study design, dispersal metric, density metric and variable type, as well as temporal and spatial scale, to test each of their correlation with the effect of density on dispersal (Pearson's r) using linear regressions and multilevel mixed-effect modelling. We found certain biases in the published literature, highlighting that the impact of conspecific density on dispersal is not as widespread as it is thought to be. We also found no predominant trend for density-dependent dispersal across taxonomic groups. Instead, results show that the scale and metrics of empirical observations significantly affected analytical results, and heterogeneity measures were high within taxonomic groups. Therefore, the direction and magnitude of the interaction between density and dispersal in empirical studies could partially be attributed to the data collection method involved. We suggest that the contradictory observations for density-dependent dispersal could be explained by dispersal-dependent density, where density is driven by movement instead, and urge researchers to either test this interaction when applicable or consider this perspective when reporting results.

Relationship between structural empowerment and job satisfaction among nurses: A meta-analysis

AIM

To investigate the relationship between structural empowerment and job satisfaction among nurses.

BACKGROUND

Job satisfaction is considered to be a global concern. It is also essential to improve the quality of patient care and promote nurse retention. Structural empowerment of nurses can be an important factor in ensuring nurses' job satisfaction.

METHODS

This meta-analysis was conducted ensuring compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Using seven databases, including PubMed, Science Direct, Scopus, Web of Science, Springer, CINAHL, and Cochrane Library, the relevant articles were identified. Two independent reviewers screened articles and extracted data. The meta-analysis was performed using Jamovi statistical software.

RESULTS

In total, 29 studies involving 30 cohorts (N = 11,078) were identified as eligible for the meta-analysis. A significant positive relationship between nurse structural empowerment and job satisfaction was identified, with the summary effect size of r = 0.559 (95% CI: 0.494-0.618).

CONCLUSION

There was a strong positive relationship between structural empowerment and job satisfaction in nurses. Exploring the relationship between structural empowerment and job satisfaction can provide strategies to promote nurse retention and prevent nursing shortage.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The results of this study confirmed a strong positive relationship between nurses' job satisfaction and structural empowerment. Implementing interventions that enhance the structural empowerment of nurses will contribute to increasing their job satisfaction, thereby assisting in both nurse retention and optimizing their potential to provide quality patient care. Healthcare organizations and nurse managers should create work environments that provide nurses with access to information, resources, support, and opportunities to empower them and to enhance their job satisfaction.

A systematic review and meta-analysis on the effects of ill health and health shocks on labour supply

BACKGROUND

Several studies have explored the effects of ill health and health shocks on labour supply. However, there are very few systematic reviews and meta-analyses in this area. The current work aims to fill this gap by undertaking a systematic review and meta-analysis on the effects of ill health and health shocks on labour supply.

METHODS

We searched using EconLit and MEDLINE databases along with grey literature to identify relevant papers for the analysis. Necessary information was extracted from the papers using an extraction tool. We calculated partial correlations to determine effect sizes and estimated the overall effect sizes by using the random effects model. Sub-group analyses were conducted based on geography, publication year and model type to assess the sources of heterogeneity. Model type entailed distinguishing articles that used the standard ordinary least squares (OLS) technique from those that used other estimation techniques such as quasi-experimental methods, including propensity score matching and difference-in-differences methodologies. Multivariate and univariate meta-regressions were employed to further examine the sources of heterogeneity. Moreover, we tested for publication bias by using a funnel plot, Begg's test and the trim and fill methodology.

RESULTS

We found a negative and statistically significant pooled estimate of the effect of ill health and health shocks on labour supply (partial r = -0.05, p < .001). The studies exhibited substantial heterogeneity. Sample size, geography, model type and publication year were found to be significant sources of heterogeneity. The funnel plot, and the trim and fill methodology, when imputed on the left showed some level of publication bias, but this was contrasted by both the Begg's test, and the trim and fill methodology when imputed on the right.

CONCLUSION

The study examined the effects of ill health and health shocks on labour supply. We found negative statistically significant pooled estimates pertaining to the overall effect of ill health and health shocks on labour supply including in sub-groups. Empirical studies on the effects of ill- health and health shocks on labour supply have oftentimes found a negative relationship. Our meta-analysis results, which used a large, combined sample size, seem to reliably confirm the finding.

Meta-analysis of a family history of diabetes in schizophrenia

OBJECTIVE

Type 2 diabetes (T2DM) is common in patients with schizophrenia and non-affective psychosis. These patients also have an increased prevalence of a family history of T2DM. We performed a systematic review and meta-analysis of the association between a family history of T2DM and schizophrenia.

METHOD

We searched electronic databases from inception until July 2022 for studies of a family history of T2DM or gestational diabetes in patients with schizophrenia and controls. We performed random effects meta-analysis, calculating odds ratios (ORs) and 95 % confidence intervals (CI) and meta-regression analyses.

RESULTS

Nine studies were included, comprising 2953 patients with non-affective psychosis and 4484 controls. Schizophrenia was associated with an over two-fold increased odds of a family history of T2DM or gestational diabetes (OR = 2.18, 95 % CI 1.61-2.96, p < 0.01). In meta-regression analyses, age, sex, study quality score, and year of publication were all unrelated to the association.

CONCLUSION

We found that patients with schizophrenia had a 2.2-fold increased odds of a family history of T2DM versus controls. This association may be relevant to both the pathophysiology of schizophrenia and the reported increased risk of development of diabetes with antipsychotic treatment.

Association between pro-inflammatory diet and liver cancer risk: a systematic review and meta-analysis

OBJECTIVE

This systematic review aimed to investigate the association between dietary inflammatory potential and liver cancer to provide evidence regarding scientific dietary health education.

DESIGN

Systematic review and meta-analysis.

SETTING

A comprehensive literature review was conducted to identify case-control or cohort studies that involved dietary inflammation index (DII)/empirical dietary inflammation pattern (EDIP) and liver cancer in PubMed, EMBASE, Cochrane, and Web of Science databases. Using a combination of DII/EDIP and liver cancer as the search terms, the associations between DII/EDIP and liver cancer were then assessed.

PARTICIPANTS

Three case-control studies and two cohort studies were brought into the meta-analysis, with 225 713 enrolled participants.

RESULTS

Meta-analysis of categorical variables showed that DII/EDIP in the highest category increased the risk of liver cancer compared to DII/EDIP in the lowest category (relative risk (RR) = 2·35; 95 % CI 1·77, 3·13; P = 0·000) and with low heterogeneity across studies (I2 = 40·8 %, P = 0·119). Meta-analysis of continuous variables showed that significant positive association between liver cancer and DII/EDIP scores (RR = 1·24; 95 % CI 1·09, 1·40; P = 0·001), and no heterogeneity (I² = 0·0 %, P = 0·471). Stratified according to the study design, there was a significant positive association between liver cancer and DII/EDIP scores in both cohort studies (RR = 2·16; 95 % CI 1·51, 3·07; P = 0·000) and case-control studies (RR = 2·75; 95 % CI 1·71, 4·41; P = 0·000).

CONCLUSION

The higher the DII/EDIP score, the higher the risk of liver cancer. This finding may have prominent implications for the general population.

The needs and difficulties during the return to work after a stroke: a systematic review and meta-synthesis of qualitative studies

PURPOSE

To describe which needs and difficulties are experienced by stroke patients and caregivers regarding their return to work and to synthesise the lived experiences of stroke patients and caregivers.

MATERIALS AND METHODS

A systematic review and metasynthesis was conducted on PubMed, CINAHL, Scopus, Web of Sciences and PsycInfo, in according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research. Studies eligible for the review had to fulfil the following inclusion criteria: qualitative studies, stroke patients and their caregivers in a working age (approximately from 18 to 65 years old), discharged from the hospital.

RESULTS

Thirty-eight studies involving stroke patients and caregivers were included in this review. For the stroke patients' group, three main themes were identified: (a) Towards the future; (b) Professional support in return to work; and (c) return to work and employment perspective, while for caregivers two main themes were: (a) daily life challenges and role overload; and (b) employment challenges.

CONCLUSIONS

Integrating public employment, social and health services, support for job placement, return to work, and social participation of stroke patients should be more supported in individual rehabilitation programs to help stroke survivors and caregivers in their return-to-work process.

Prognostic impact of serum testosterone in metastatic hormone-naive prostate cancer: a systematic review and meta-analysis

PURPOSE OF REVIEW

In daily practice, there is an unmet medical need for biomarkers that facilitate therapeutic decision-making in the metastatic hormone sensitive prostate cancer (mHSPC) scenario. Although recent studies have highlighted the potential of testosterone as a prognostic and predictive marker in prostate cancer, the evidence is controversial. The objective of this review was to summarize and analyze the scientific evidence regarding the prognostic role of basal testosterone levels in patients with mHSPC.

METHODS

A systematic review was performed. Three authors selected the articles from Web of Science, PubMed, Scopus, and Cochrane Library electronic databases. Risk of bias was assessed by the Newcastle Ottawa Scale.

RECENT FINDINGS

Most of the selected articles suggest that low testosterone levels before starting hormonal blockade imply a worse prognosis for patients with mHSPC. However, the quality of the evidence is poor, the studies are heterogeneous, and it is not possible to meta-analyze most of the published results.

SUMMARY

Testosterone is an accessible and affordable biomarker. If it were correctly demonstrated that it harbors a prognostic and/or predictive role in the mHSPC setting, it could represent an advance in decision-making in these patients. Well designed prospective studies are needed to correctly answer this question.

A Meta-Analysis of the Effects of Comprehensive Sexuality Education Programs on Children and Adolescents

Childhood and adolescence are crucial periods for developing one's awareness of sexuality. Comprehensive Sexuality Education (CSE) during these stages is essential for overall growth, fostering healthy self-concepts, and addressing diverse sexual issues among children and adolescents globally. A meta-analysis was conducted to analyze the effectiveness of CSE programs. A literature search was performed on EMBASE, PubMed, CINAHL, Cochrane Library, and PsycInfo for studies published before 14 June 2023, and based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We used the Comprehensive Meta-Analysis (CMA, V4) software version 4.0 for the analysis and interpreted the effect sizes according to Cohen's definition. Between 2011 and 2020, 21 studies on CSE were published, with the United States having the most publications (17). Of the 34 studies reviewed, 20 were randomized controlled trials. The primary population for CSE was middle/high school students (15), with the most frequent age range being 10-19 years (26). The overall effect size of CSE was significant (effect size = 1.31, p < 0.001), with cognition (effect size = 5.76, p < 0.001) being the most significant. CSE is an effective educational tool for children and adolescents with a significant impact on variables such as cognition and abstinence. It should be incremental from childhood and adolescence to adulthood.

Comparing High- and Low-Model for End-Stage Liver Disease Living-Donor Liver Transplantation to Determine Clinical Efficacy: A Systematic Review and Meta-Analysis (CHALICE Study)

INTRODUCTION

Various studies have demonstrated that low-Model for End-Stage Liver Disease (MELD) living-donor liver transplant (LDLT) recipients have better outcomes with improved patient survival than deceased-donor liver transplantation (DDLT) recipients. LDLT recipients gain the most from being transplanted at MELD <25-30; however, some existing data have outlined that LDLT may provide equivalent outcomes in high-MELD and low-MELD patients, although the term "high" MELD is arbitrarily defined in the literature and various cut-off scores are outlined between 20 and 30, although most commonly, the dividing threshold is 25. The aim of this meta-analysis was to compare LDLT in high-MELD with that in low-MELD recipients to determine patient survival and graft survival, as well as perioperative and postoperative complications.

METHODS

Following PROSPERO registration CRD-42021261501, a systematic database search was conducted for the published literature between 1990 and 2021 and yielded a total of 10 studies with 2183 LT recipients; 490 were HM-LDLT recipients and 1693 were LM-LDLT recipients.

RESULTS

Both groups had comparable mortality at 1, 3 and 5 years post-transplant (5-year HR 1.19; 95% CI 0.79-1.79; p-value 0.40) and graft survival (HR 1.08; 95% CI 0.72, 1.63; p-value 0.71). No differences were observed in the rates of major morbidity, hepatic artery thrombosis, biliary complications, intra-abdominal bleeding, wound infection and rejection; however, the HM-LDLT group had higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay.

CONCLUSIONS

The high-MELD LDLT group had similar patient and graft survival and morbidities to the low-MELD LDLT group, despite being at higher risk for pulmonary infection, abdominal fluid collection and prolonged ICU stay. The data, primarily sourced from high-volume Asian centers, underscore the feasibility of living donations for liver allografts in high-MELD patients. Given the rising demand for liver allografts, it is sensible to incorporate these insights into U.S. transplant practices.

The General Trends of Genetic Diversity Change in Alien Plants' Invasion

Genetic diversity is associated with invasion dynamics during establishment and expansion stages by affecting the viability and adaptive potential of exotics. There have been many reports on the comparison between the genetic diversity of invasive alien species (IAS) in and out of their native habitats, but the conclusions were usually inconsistent. In this work, a standard meta-analysis of the genetic diversity of 19 invasive plants based on 26 previous studies was carried out to investigate the general trend for the change of IASs' genetic diversity during their invasion process and its real correlation with the invasion fate. Those 26 studies were screened from a total of 3557 peer-reviewed publications from the ISI Web of Science database during the period of January 2000 to May 2022. Based on the selected studies in this work, a general reduction of IASs' genetic diversity was found in non-native populations compared to that in native ones, while the difference was not significant. This finding suggested that regardless of the change in genetic diversity, it had no substantial effect on the outcome of the invasion process. Therefore, genetic diversity might not serve as a reliable indicator for risk assessment and prediction of invasion dynamic prediction in the case of IASs.

Effect of interpersonal psychotherapy on social functioning, overall functioning and negative emotions for depression: A meta-analysis

BACKGROUND

Interpersonal psychotherapy (IPT) has been widely used for depression. However, current studies of IPT have been restricted to depressive symptoms, and the results for improving social functioning were controversial.

METHODS

A comprehensive literature search of randomized controlled trials (RCTs) was conducted through eleven databases. Data analysis was performed by RevMan5.3, and effects were summarized by using a random effects model of mean differences with 95 % confidence intervals.

RESULTS

From 2443 records, eleven studies met inclusion and exclusion criteria were used for meta-analysis. The results showed that IPT had significant effects on improving social functioning (SMD: -0.53, 95 % CI: -0.80 to -0.26), reducing depression (SMD: -0.49, 95 % CI: -0.80 to -0.19) and anxiety (SMD: -0.90, 95 % CI: -1.28 to -0.52), but the effect on the overall functioning (SMD: -0.37, 95 % CI: -0.73 to -0.01) is not obvious. Moreover, subgroup analysis showed that IPT was effective in improving social functioning in adolescent depression (SMD: -0.35, 95 % CI: -0.58 to -0.13) and perinatal depression (SMD: -1.01, 95 % CI: -1.35 to -0.67), while there was no significant difference in the adult depression group (SMD: -0.39, 95 % CI: -1.05 to 0.27).

LIMITATION

The blind method cannot be carried out in most studies due to the particularity of psychotherapy, heterogeneity in some results.

CONCLUSION

IPT has a significant effect on improving social functioning and reducing depression and anxiety, while the effect on overall functioning requires further research. Overall, IPT is one of the effective nonpharmacological treatments for depression.

A systematic review and Bayesian meta-analysis of the acoustic features of infant-directed speech

When speaking to infants, adults often produce speech that differs systematically from that directed to other adults. To quantify the acoustic properties of this speech style across a wide variety of languages and cultures, we extracted results from empirical studies on the acoustic features of infant-directed speech. We analysed data from 88 unique studies (734 effect sizes) on the following five acoustic parameters that have been systematically examined in the literature: fundamental frequency (f₀), f₀ variability, vowel space area, articulation rate and vowel duration. Moderator analyses were conducted in hierarchical Bayesian robust regression models to examine how these features change with infant age and differ across languages, experimental tasks and recording environments. The moderator analyses indicated that f₀, articulation rate and vowel duration became more similar to adult-directed speech over time, whereas f₀ variability and vowel space area exhibited stability throughout development. These results point the way for future research to disentangle different accounts of the functions and learnability of infant-directed speech by conducting theory-driven comparisons among different languages and using computational models to formulate testable predictions.

Challenges for Economic Evaluations of Advanced Therapy Medicinal Products: A Systematic Review

OBJECTIVES

Advanced therapy medicinal products (ATMPs) are drugs for human use for the treatment of chronic, degenerative, or life-threatening diseases that are based on genes, tissues, or cells. This article aimed to identify and critically review published economic analyses of ATMPs.

METHODS

A systematic review of economic analyses of ATMPs was undertaken. Study characteristics, design, sources of data, resources and unit costs, modeling and extrapolation methods, study results, and sensitivity analyses were assessed.

RESULTS

A total of 46 economic analyses of ATMP (from 45 articles) were included; 4 were cell therapy medicinal products, 33 gene therapy medicinal products, and 9 tissue-engineered products. 30 therapies had commercial marketing approval; 39 studies were cost-utility analysis, 5 were cost-effectiveness analysis, and 2 were cost only studies. Four studies predicted that the ATMP offered a step change in the management of the condition and 10 studies estimated that the ATMP would offer a lower mean cost.

CONCLUSIONS

Comparison with historical controls, pooling of data, and use of techniques such as mixture cure fraction models should be used cautiously. Sensitivity analyses should be used across a plausible range of prices. Clinical studies need to be designed to align with health technology assessment requirements, including generic quality of life, and payers should aim for clarity of criteria. Regulators and national payers should aim for compatibility of registers to allow interchange of data. Given the increasing reliance on industry-funded economic analyses, careful critical review is recommended.

The Effectiveness of E-Health Interventions Promoting Physical Activity and Reducing Sedentary Behavior in College Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Insufficient physical activity (PA) and excessive sedentary behavior (SB) are detrimental to physical and mental health. This systematic review and meta-analysis aimed to identify whether e-health interventions are effective for improving PA and SB in college students. Five electronic databases, including Medline, Web of Science, Embase, Cochrane Library, and ProQuest, were searched to collect relevant randomized controlled trials up to 22 June 2022. In total, 22 trials (including 31 effects) with 8333 samples were included in this meta-analysis. The results showed that e-health interventions significantly improved PA at post-intervention (SMD = 0.32, 95% CI: 0.19, 0.45, p < 0.001) compared with the control group, especially for total PA (SMD = 0.34, 95% CI: 0.10, 0.58, p = 0.005), moderate to vigorous PA (SMD = 0.17, 95% CI: 0.01, 0.32, p = 0.036), and steps (SMD = 0.75, 95% CI: 0.23, 1.28, p < 0.001. There were no significant effects for both PA at follow-up (SMD = 0.24, 95% CI: − 0.01, 0.49, p = 0.057) and SB (MD = −29.11, 95% CI: −70.55, 12.32, p = 0.17). The findings of subgroup analyses indicated that compared to the control group, interventions in the group of general participants (SMD = 0.45, 95% CI: 0.27, 0.63, p < 0.001), smartphone apps (SMD = 0.46, 95% CI: 0.19, 0.73, p = 0.001), and online (SMD = 0.23, 95% CI: 0.04, 0.43, p < 0.001) can significantly improve PA at post-intervention. Moreover, the intervention effects were significant across all groups of theory, region, instrument, duration, and female ratio. At follow-up, interventions in groups of developing region (SMD = 1.17, 95% CI: 0.73, 1.62, p < 0.001), objective instrument (SMD = 0.83, 95% CI: 0.23, 1.42, p = 0.007), duration ≤ 3-month (SMD = 1.06, 95% CI: 0.72, 1.39, p < 0.001), and all female (SMD = 0.79, 95% CI: 0.02, 1.56, p = 0.044) can significantly improve PA. The evidence of this meta-analysis shows that e-health interventions can be taken as promising strategies for promoting PA. The maintenance of PA improvement and the effect of interventions in reducing SB remain to be further studied. Educators and health practitioners should focus on creating multiple e-health interventions with individualized components.

Childhood abuse and neglect, and mortality risk in adulthood: A systematic review and meta-analysis

BACKGROUND

Research findings on the relationship between childhood abuse and neglect (CAN) and mortality risk in adulthood are inconsistent.

OBJECTIVE

To examine the association between CAN and mortality risk in adulthood.

PARTICIPANTS AND SETTING

Systematic review and meta-analysis.

METHODS

Six databases were searched up to November 2021 for studies reporting adult mortality outcomes associated with childhood physical abuse, emotional abuse, sexual abuse, physical neglect and/or emotional neglect. When feasible, results were pooled using a random-effects meta-analysis.

RESULTS

Nine studies met the inclusion criteria, involving 265,858 individuals. Abuse included physical (4/9), sexual (2/9), emotional (2/9), combined physical or sexual (2/9) and combined abuse and neglect (4/9). Only one study reported neglect separately. Three studies that examined the association between combined childhood abuse and neglect and mortality showed a pooled HR of 1.86 (95 % CI = 1.26-2.73, I² = 81 %). Specific types of abuse (physical, emotional, sexual) were unrelated to mortality risk, but subgroup analyses suggested that physical and emotional abuse were associated with greater mortality risk among women. There was high heterogeneity (I² of >75 %) between estimates for almost all predictors.

CONCLUSIONS

Research suggests an association between CAN and adult mortality risk. However, more research is needed to address several limitations within the literature. These include standardising measures of CAN, representative sampling from vulnerable populations and differing geographical regions, and more detailed examination of the multi-faceted experience of abuse and neglect in childhood.

Depression increased risk of coronary heart disease: A meta-analysis of prospective cohort studies

Background

Depression, as an independent risk factor, can lead to a substantially increased risk of coronary heart disease (CHD). The overall body of evidence involving depression and CHD is not consistent. Therefore, we performed an update meta-analysis to evaluate the association between depression and the risk of patients with CHD.

Methods

Studies were identified through a comprehensive literature search of the PubMed, Embase, and the Cochrane Library database from its inception to 28 September 2021 for titles/abstracts with restricted to English language articles. The literature was screened according to the inclusion and exclusion criteria. Along with data extraction, we evaluated the quality of eligible studies using the Newcastle-Ottawa Scale (NOS). The primary outcome was fatal or non-fatal CHD. We calculated relative risk (RR) with 95% confidence intervals (CIs) using a random-effects models. The protocol was registered in the PROSPERO registration (registration number CRD42021271259).

Results

From 9,151 records, we included 26 prospective cohort studies published from 1998 to 2018, consisting of 402,597 patients. Either in depression-exposured group or non-depression-exposured group, the mean age of all participants ranged from 18 to 99 years. Moreover, the NOS scores of these studies are eventually indicated that the quality of these eligible studies was reliable. In general, the pooled results showed that patients with depression had a higher risk of CHD compared to patients without depression (RR = 1.21, 95% CI: 1.14–1.29). Additionally, the funnel plot appeared to be asymmetry, indicating there existing publication bias for the pooled results between depression and CHD. A sensitivity analysis was used to assess the stability of the relationship between depression and CHD that indicating the results robust (RR = 1.15, 95% CI: 1.09–1.21).

Conclusion

Depression may increase risk of CHD. Future studies on the share pathogenic mechanisms of both depression and CHD may develop novel therapies.

Chronic obstructive pulmonary disease (COPD) in women due to indoor biomass burning: a meta analysis

Chronic Obstructive Pulmonary Disease (COPD) is attributable to household air pollution and is known to increase the Disability Adjusted Life Years (DALYs), morbidity and mortality and women are most susceptible groups for the exposure. In order to understand the global risk among women with COPD due to exposure of household air pollutants, an evidence-based systematic review and meta-analysis was conducted. Meta regression analysis was carried out to identify potential sources of heterogeneity. The summary estimates of the included studies showed higher prevalence of COPD due to biomass fuel exposure in women. Clinical diagnosis has shown more risk of COPD prevalence compared to diagnosis based on spirometer test alone. However, the data between included studies for both clinical and spirometry-based studies showed higher heterogeneity. The present meta-data analysis has shown that household air pollutants may be a factor associated with increased risk of COPD in women.

A Systematic Review and Meta-Analysis on the Association and Differences between Aerobic Threshold and Point of Optimal Fat Oxidation

Over the past two decades, scientists have attempted to evaluate whether the point of maximal fat oxidation (FATmax) and the aerobic threshold (AerT) are connected. The existence of such a relationship would allow a more tailored training approach for athletes while improving the efficacy of individualized exercise prescriptions when treating numerous health-related issues. However, studies have reported conflicting results, and this issue remains unresolved. This systematic review and meta-analysis aimed: (i) to examine the strength of the association between FATmax and AerT by using the effect size (ES) of correlation coefficient (r) and standardized mean difference (SMD); (ii) to identify potential moderators and their influence on ES variability. This study was registered with PROSPERO (CRD42021239351) and ClinicalTrials (NCT03789045). PubMed and Google Scholar were searched and fourteen articles, consisting of overall 35 ES for r and 26 ES for SMD were included. Obtained ESs were analyzed using a multilevel random-effects meta-analysis. Our results support the presence of a significant association between FATmax and AerT exercise intensities. In conclusion, due to the large ES variance caused by clinical and methodological differences among the studies, we recommend that future studies follow strict standardization of data collection and analysis of FATmax and AerT-related outcomes.

Circulating phosphorus concentration and risk of prostate cancer: a Mendelian randomization study

BACKGROUND

Recent observational studies have suggested that circulating phosphorus concentrations are positively associated with the risk of prostate cancer. However, little is known about the causal direction of the association.

OBJECTIVES

To explore the potential causal relation between circulating phosphorus and risk of prostate cancer, we conducted a Mendelian randomization (MR) study.

METHODS

Summary statistics of prostate cancer were obtained from a meta-analysis of genome-wide association studies (GWASs) consisting of 79,148 cases and 61,106 controls. Single-nucleotide polymorphisms (SNPs) associated with serum phosphorus concentration were selected from a GWAS of 291,408 individuals from the UK Biobank. MR analysis was performed using the inverse variance weighted (IVW) method, supplemented with simple median method, weighted median method, maximum likelihood-based method, MR-Egger regression, and the MR pleiotropy residual sum and outlier test. We also performed a meta-analysis of observational studies to assess the associations of dietary phosphorus intake and serum phosphorus concentration with risk of prostate cancer.

RESULTS

In the MR analysis, a total of 125 independent SNPs associated with serum phosphorus concentrations were used as instrumental variables. Genetically predicted serum phosphorus concentrations were associated with a 19% increased risk of prostate cancer (95% CI: 9%, 31%) per 1-SD increment of serum phosphorus by IVW (P = 1.82 × 10-4). Sensitivity analyses using alternative MR methods produced similar positive associations, and no evidence of pleiotropy was detected by MR-Egger regression (P = 0.422). For meta-analysis, 8 studies for dietary phosphorus intake and 4 for serum phosphorus concentrations were included involving a total of 669,080 participants. Consistently, high dietary phosphorus intake and serum phosphorus concentrations were associated with an 8% (95% CI: 4%, 12%) and 7% (95% CI: 1%, 14%) increase in prostate cancer risk, respectively.

CONCLUSIONS

Our study suggested a potential causal relation between circulating phosphorus and risk of prostate cancer. Further studies are warranted to elucidate the underlying mechanism of phosphorus in the development of prostate cancer.

Associations Between Openness Facets, Prejudice, and Tolerance: A Scoping Review With Meta-Analysis

The personality factor of openness to experience, which encompasses curiosity, imagination, and a desire for new experiences, has been associated negatively with prejudice and positively with the closely related value of tolerance. While these relationships have been reviewed at the factor level, there has been no review of research at the lower facet level. This review aims to uncover the relationships between the facets of openness and the constructs of prejudice and tolerance. We conducted a preregistered scoping review with meta-analysis following the recommended guidelines from Joanna Briggs Institute. A total of 2,349 articles were reviewed, with 16 primary research articles (or 17 studies) meeting the criteria for inclusion. Aggregated effect sizes via random-effect meta-analysis revealed that all revised neuroticism-extraversion-openness personality inventory (NEO-PI-R) and international personality item pool (IPIP)-based facets of openness significantly predicted prejudice and tolerance. Out of the three measures [i.e., NEO-PI-R, IPIP-NEO, and honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness to experience personality inventory (HEXACO-PI), and the facets of openness examined], the NEO-PI-R facet of value was most strongly associated with prejudice. In contrast, the NEO-PI-R facet of aesthetics was the facet most strongly associated with tolerance. However, these results should be treated as preliminary in light of the small number of meta-analyzed studies and more primary research studies are needed to confirm the trends found in this review. This review represents the first step in the systematic investigation of the link between the facets of openness and components of prejudice and tolerance and contributes toward explaining prejudice and tolerance.

Blood-Based ATN Biomarkers of Alzheimer's Disease: A Meta-Analysis

BACKGROUND

The Amyloid Tau Neurodegeneration (ATN) framework was proposed to define the biological state underpinning Alzheimer's disease (AD). Blood-based biomarkers offer a scalable alternative to the costly and invasive currently available biomarkers.

OBJECTIVE

In this meta-analysis we sought to assess the diagnostic performance of plasma amyloid (Aβ40, Aβ42, Aβ42/40 ratio), tangle (p-tau181), and neurodegeneration (total tau [t-tau], neurofilament light [NfL]) biomarkers.

METHODS

Electronic databases were screened for studies reporting biomarker concentrations for AD and control cohorts. Biomarker performance was examined by random-effect meta-analyses based on the ratio between biomarker concentrations in patients and controls.

RESULTS

83 studies published between 1996 and 2020 were included in the analyses. Aβ42/40 ratio as well as Aβ42 discriminated AD patients from controls when using novel platforms such as immunomagnetic reduction (IMR). We found significant differences in ptau-181 concentration for studies based on single molecule array (Simoa), but not for studies based on IMR or ELISA. T-tau was significantly different between AD patients and control in IMR and Simoa but not in ELISA-based studies. In contrast, NfL differentiated between groups across platforms. Exosome studies showed strong separation between patients and controls for Aβ42, t-tau, and p-tau181.

CONCLUSION

Currently available assays for sampling plasma ATN biomarkers appear to differentiate between AD patients and controls. Novel assay methodologies have given the field a significant boost for testing these biomarkers, such as IMR for Aβ, Simoa for p-tau181. Enriching samples through extracellular vesicles shows promise but requires further validation.

The mental health impacts of receiving a breast cancer diagnosis: A meta-analysis

BACKGROUND

Receiving a breast cancer diagnosis can be a turning point with negative impacts on mental health, treatment and prognosis. This meta-analysis sought to determine the nature and prevalence of clinically significant psychological distress-related symptoms in the wake of a breast cancer diagnosis.

METHODS

Ten databases were searched between March and August 2020. Thirty-nine quantitative studies were meta-analysed.

RESULTS

The prevalence of clinically significant symptoms was 39% for non-specific distress (n = 13), 34% for anxiety (n = 19), 31% for post-traumatic stress (n = 7) and 20% for depression (n = 25). No studies reporting breast cancer patients' well-being in our specific time frame were found.

CONCLUSION

Mental health can be impacted in at least four domains following a diagnosis of breast cancer and such effects are commonplace. This study outlines a clear need for mitigating the impacts on mental health brought about by breast cancer diagnosis. CRD42020203990.

Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis

OBJECTIVE

To describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

Medline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months.

PRIMARY AND SECONDARY OUTCOME MEASURES

Model discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled.

RESULTS

Sixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was <0.7 in 72 models, between 0.7 and 0.8 in 16 models and >0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled.

CONCLUSION

Some promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability.

PROSPERO REGISTRATION NUMBER

CRD42020159839.

Case-control study of hypertension and Parkinson's disease

We evaluate the association of hypertension with PD in an Asian population and performed a meta-analysis on similar studies to address the effect of hypertension on PD risk. A matched case-control study involving 1342 Chinese subjects (671 PD and 671 age and gender-matched controls (with a mean age of 63.9 ± 9.7 and 63.5 ± 9.8 years, and identical proportion of gender distribution) was conducted. Hypertension increases PD risk by 1.9 times [OR 1.86 (1.46–2.38)]. The literature search identified 618 studies initially; however, only three matched case-control studies (all in Caucasians) met the inclusion criteria for meta-analysis. Overall analysis showed that hypertension decreases PD risk by 0.2 times [OR 0.80 (0.66–0.96)]. Hypertension increases PD risk by 1.9 times in our Asian population. However, a meta-analysis comprising of Caucasian populations showed a protective effect of hypertension suggesting that ethnic differences or other genetic or environmental factors may contribute to the divergent observation. Early diagnosis and treatment of hypertension may potentially reduce the risk of PD, at least in our population.

Efficacy and Safety of Platelet-Rich Plasma in Melasma: A Systematic Review and Meta-Analysis

Introduction

Melasma is a chronic and recurrent skin problem for which an effective therapy is currently lacking. Platelet-rich plasma (PRP) has recently emerged as a novel treatment for melasma, but to date there has been no systematic evaluation of its efficacy and safety.

Methods

The Web of Science, PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and the Cochrane Library databases were searched for relevant articles using the search items “melasma,” “chloasma” and “platelet‐rich plasma.” STATA version 15.1 software was used to analyze data. Study outcomes were calculated using standardized mean differences with 95% confidence intervals (CIs).

Results

The database search identified ten studies involving 395 adult patients that met the inclusion criteria and were included in the meta-analysis. Analysis of pre- and post-treatment data from these studies revealed that the post-treatment modified Melasma Area and Severity Index (mMASI) score decreased by 1.18 (95% CI 0.89–1.47; p = 0.02). Subjective satisfaction evaluation of PRP treatment showed that melasma treated with the combination therapy of PRP + microneedling may have been the most efficacious treatment compared to PRP alone or in combination with intradermal injection. Adverse reactions were minor, with only a few patients reporting local congestion, temporary erythema, hyperpigmentation and discoloration.

Conclusion

These results support the efficacy and safety of PRP used in combination or alone as treatment for melasma.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13555-021-00575-z.

Exploring the needs of people with dementia living at home reported by people with dementia and informal caregivers: a systematic review and Meta-analysis

OBJECTIVES

To provide prevalence estimates of needs of people with dementia living at home, and to determine sources of variation associated with needs for this population.

METHOD

A systematic review and meta-analysis was performed searching CINAHL, MEDLINE, PsycINFO and ASSIA databases. Following quality checks, random effects meta-analysis produced prevalence estimates for needs reported by people with dementia and by their informal caregivers. Fixed effects models were undertaken to compare caregiver and person with dementia reported needs. Heterogeneity was explored through sensitivity analysis. The study protocol was registered with Prospero #CRD42017074119.

RESULTS

Six retrieved studies published between 2005 and 2017 including 1011 people with dementia and 1188 caregivers were included in the analysis. All data were collected using Camberwell Assessment of Need for the Elderly. Prevalence estimates are provided for 24 needs reported by participants in The Netherlands, United Kingdom, Poland, Ireland, Germany, Norway, Portugal, Italy and Sweden. Most prevalent needs reported by people with dementia were Memory 0.713 [95% CI 0.627, 0.791]; Food 0.706 [95% CI 0.547, 0.842]; Household activities 0.677 [95% CI 0.613, 0.738]; and Money 0.566 [95% CI 0.416, 0.711]. Caregivers reported greater prevalence than people with dementia did for 22 of 24 needs, although the priority ranking of needs was similar. Exploration of heterogeneity revealed that people with young onset dementia were the major source of variation for 24 out of 48 analyses.

CONCLUSION

Increased understanding of prevalence of needs of people with dementia and associated heterogeneity can assist in planning services to meet those needs.

Robust Inferential Techniques Applied to the Analysis of the Tropospheric Ozone Concentration in an Urban Area

This paper analyzes 12 years of tropospheric ozone (O₃) concentration measurements using robust techniques. The measurements were taken at an air quality monitoring station called Belisario, which is in Quito, Ecuador; the data collection time period was 1 January 2008 to 31 December 2019, and the measurements were carried out using photometric O₃ analyzers. Here, the measurement results were used to build variables that represented hours, days, months, and years, and were then classified and categorized. The index of air quality (IAQ) of the city was used to make the classifications, and robust and nonrobust confidence intervals were used to make the categorizations. Furthermore, robust analysis methods were compared with classical methods, nonparametric methods, and bootstrap-based methods. The results showed that the analysis using robust methods is better than the analysis using nonrobust methods, which are not immune to the influence of extreme observations. Using all of the aforementioned methods, confidence intervals were used to both establish and quantify differences between categories of the groups of variables under study. In addition, the central tendency and variability of the O₃ concentration at Belisario station were exhaustively analyzed, concluding that said concentration was stable for years, highly variable for months and hours, and slightly changing between the days of the week. Additionally, according to the criteria established by the IAQ, it was shown that in Quito, the O₃ concentration levels during the study period were not harmful to human health.

Meta-analysis of cytokine and C-reactive protein levels in high-risk psychosis

OBJECTIVE

Schizophrenia is associated with aberrant blood cytokine and C-reactive protein (CRP) levels. However, less is known about alterations in these markers prior to the onset of psychosis. We performed a meta-analysis of blood cytokines and CRP in subjects at high-risk for psychosis.

METHOD

We identified articles by systematic searches of PubMed, PsycINFO, and Web of Science databases, and the reference lists of identified studies. Eight studies met the inclusion criteria, including seven studies of high-risk psychosis versus controls, and four studies of high-risk subjects who converted to a psychotic disorder versus non-converters.

RESULTS

Blood IL-6 levels were significantly higher (SMD = 0.31, 95% CI 0.02-0.59, p = 0.04) and blood IL-1β levels were significantly lower (SMD = -0.66, 95% CI -1.27 to -0.05, p = 0.05) in subjects at high-risk for psychosis versus controls. Between-study heterogeneity was not significant for either IL-1β or IL-6, and there was no evidence of publication bias. There was a non-significant trend for higher blood IL-12 levels in converters versus non-converters (SMD = 0.86, 95% CI -0.06-1.79, p = 0.07).

CONCLUSION

We found limited evidence for blood cytokine and CRP alterations in subjects at high-risk for psychosis. Our findings should be interpreted with caution in light of a small number of studies, cumulative sample size, and heterogeneity of high-risk criteria, but warrant investigation in larger samples. This includes studies of subjects at high-risk of developing psychosis and controls, as well as the potential of inflammation as a predictor of conversion to psychosis. These findings have important potential implications for our understanding of the pathophysiology of schizophrenia.

Assessment of Heterogeneity in Heart Failure-Related Meta-Analyses

BACKGROUND

Assessment of heterogeneity in meta-analyses is critical to ensure the consistency of pooled results. Therefore, we sought to assess the evaluation and reporting of heterogeneity in heart failure (HF) meta-analyses.

METHODS

Study level meta-analyses pertaining to HF were selected from January 2009 to July 2019, published in 11 high impact factor journals. We tabulated the overall proportion of the meta-analyses reporting statistical heterogeneity and specific metrics and methods employed to quantify and explore heterogeneity.

RESULTS

Of 126 HF meta-analyses (612 outcomes), heterogeneity was reported for 422 outcomes (68.9 %) in 108 meta-analyses. Out of the 422 outcomes reporting statistical heterogeneity, 137 outcomes (32.5%) had no observable heterogeneity: (I²=0%), 40 outcomes (9.5%) had low heterogeneity (I²<25%), 76 outcomes (18%) had moderate heterogeneity (I²=25%-50%), and 169 outcomes (40%) had high heterogeneity (I²>50%). Reporting of statistical heterogeneity was not significantly associated with year of publication, funding source, disclosure information, or the type of studies pooled. Sensitivity analysis (n=68) was the most common statistical technique employed to evaluate the source of heterogeneity followed by subgroup analyses (n=59) and meta-regression (n=40).

CONCLUSIONS

Despite being an essential component of meta-analyses, heterogeneity was not reported for nearly 30% of outcomes and variably handled in contemporary HF meta-analyses. As meta-analyses increase across HF science, interpreting and handling of heterogeneity should be standardized.

Bioinorganic supplementation of calcium phosphate-based bone substitutes to improve in vivo performance: a systematic review and meta-analysis of animal studies

Supplementation of CaP-based bone graft substitutes with bioinorganics such as strontium, zinc or silicon is an interesting approach to increase the biological performance in terms of bone regenerative potential of calcium phosphate (CaP)-based bone substitutes. However, the in vivo efficacy of this approach has not been systematically analyzed, yet. Consequently, we performed a systematic review using the available literature regarding the effect of bioinorganic supplementation in CaP-based biomaterials on new bone formation and material degradation in preclinical animal bone defect models and studied this effect quantitatively by performing a meta-analysis. Additional subgroup analyses were used to study the effect of different bioinorganics, animal model, or phase category of CaP-based biomaterial on bone formation or material degradation. Results show that bioinorganic supplementation increases new bone formation (standardized mean difference [SMD]: 1.43 SD, confidence interval [CI]: 1.13-1.73). Additional subgroup analysis showed that strontium, magnesium and silica significantly enhanced bone formation, while zinc did not have any effect. This effect of bioinorganic supplementation on new bone formation was stronger for DCPD or β-TCP and biphasic CaPs than for HA or α-TCP (p < 0.001). In general, material degradation was slightly hindered by bioinorganic supplementation (mean difference [MD]: 0.84%, CI: 0.01-1.66), with the exception of strontium that significantly enhanced degradation. Overall, bioinorganic supplementation represents an effective approach to enhance the biological performance of CaP-based bone substitutes.

Quantitative Association Between Serum/Dietary Magnesium and Cardiovascular Disease/Coronary Heart Disease Risk: A Dose-Response Meta-analysis of Prospective Cohort Studies

BACKGROUND

The quantitative association between serum/dietary magnesium and cardiovascular disease (CVD) remains unclear. We conducted a dose-response meta-analysis to evaluate the quantitative association between serum/dietary magnesium and CVD, including coronary heart disease (CHD).

METHODS

PubMed, China National Knowledge Infrastructure, and Web of Science were searched for publications. STATA 12.0 was used to analyze data. We used the random-effects model to reduce heterogeneity.

RESULTS

Eighteen prospective cohort studies with 544,581 participants and 22,658 CVD cases were included. The follow-up duration was 1-28 years. The pooled relative risk (RR) of CVD for the relatively normal versus lowest serum and dietary magnesium level was 0.64 {[95% confidence interval (CI): 0.51-0.80] and 0.90 [95% CI: 0.84-0.96]}. The pooled RR of CHD for the relatively normal versus lowest serum and dietary magnesium level was 0.70 (95% CI: 0.57-0.85) and 0.86 (95% CI: 0.77-0.94). We noted a significant association between increasing serum magnesium levels (per 0.1-mg/dL increase) and risk of CVD (RR: 0.93, 95% CI: 0.88-0.97) and CHD (RR: 0.90, 95% CI: 0.84-0.96) and between dietary magnesium levels (per 100-mg/d increase) and risk of CVD (RR: 0.90, 95% CI: 0.83-0.96) and CHD (RR: 0.92, 95% CI: 0.82-0.98). Serum/dietary Mg level comparisons presented a 7%-10% decrease in CVD/CHD risk. The dose-response meta-analyses showed linear relationships between serum magnesium and CVD (Pnonlinearity = 0.833) or CHD (Pnonlinearity = 0.193) and dietary magnesium and CVD (Pnonlinearity = 0.463) or CHD (Pnonlinearity = 0.440).

CONCLUSIONS

Increasing dietary magnesium or serum magnesium level is linearly and inversely associated with the risk of total CVD and CHD events.

Meta-analysis of total and differential white blood cell counts in schizophrenia

OBJECTIVE

Schizophrenia is associated with alterations in blood inflammatory markers, including cytokines. Total white blood cell (WBC) count is a marker of low-grade inflammation. We conducted a meta-analysis of total and differential WBC counts in patients with schizophrenia.

METHOD

Articles were identified through a systematic search of PsycINFO, Pub Med, Web of Science, and the associated references. Data were analyzed using a random effects approach.

RESULTS

Twenty-four studies met the inclusion criteria. Blood total WBC, monocytes, and neutrophils were significantly higher in schizophrenia vs. controls with small-to-medium effect sizes (standardized mean difference [SMD] = 0.39-0.53, P < 0.01 for each). In first-episode psychosis compared with controls, neutrophils and monocytes were significantly increased with similar effect sizes (SMD = 0.40-0.41, P ≤ 0.01 for each), and there was a trend for higher total WBC (SMD = 0.46, P = 0.05).

CONCLUSIONS

Consistent with studies of other inflammatory markers, we found evidence for increased total and differential WBC counts in schizophrenia. Our results complement other studies of WBC counts in schizophrenia. These findings are relevant to the pathophysiology and potentially the treatment of schizophrenia.

Activity and Health During the SARS-CoV2 Pandemic (ASAP): Study Protocol for a Multi-National Network Trial

Introduction: The worldwide spread of the novel coronavirus (SARS-CoV2) has prompted numerous countries to restrict public life. Related measures, such as limits on social gatherings, business closures, or lockdowns, are expected to considerably reduce the individual opportunities to move outside the home. As physical activity (PA) and sport participation significantly contribute to health, this study has two objectives. The objectives of this study are to assess changes in PA and well-being since the coronavirus outbreak in affected countries. Additionally, we will evaluate the impact of digital home-based exercise programs on PA as well as physical and mental health outcomes.

Method: A multinational network trial will be conducted with three planned phases (A, B, and C). Part A consists of administering a structured survey. It investigates changes in PA levels and health during the coronavirus outbreak and measures the preferences of the participants regarding online training programs. Part B is a two-armed randomized-controlled trial. Participants assigned to the intervention group (IG) will complete a digital 4-week home exercise training (live streaming via internet) guided by the survey results on content and time of program. The control group (CG) will not receive the program. Part C is 4-week access of both CG and IG to a digital archive of pre-recorded workouts from Part B. Similar to Part A, questionnaires will be used in both Part B and C to estimate the effects of exercise on measures of mental and physical health.

Results and Discussion: The ASAP project will provide valuable insights into the importance of PA during a global pandemic. Our initial survey is the first to determine how governmental confinement measures impact bodily and mental well-being. Based on the results, the intervention studies will be unique to address health problems potentially arising from losses in PA. If proven effective, the newly developed telehealth programs could become a significant and easy-to-distribute factor in combating PA decreases. Results of the study may hence guide policy makers on methods to maintain PA and health when being forced to restrict public life.

Study Register: DRKS00021273.

Serum ferritin levels is associated with acute myocardial infarction: a meta-analysis

OBJECTIVE

An association between increased serum ferritin levels and acute myocardial infarction (AMI) remains controversial. The purpose of this meta-analysis is to confirm the association between increased serum ferritin levels and AMI.

METHODS

We searched PubMed and China National Knowledge Infrastructure (CNKI) for relevant articles that assessed the association between serum ferritin and acute myocardial infarction using terms that included serum ferritin and acute myocardial infarction up to February 13, 2019.

RESULTS

A total of 11 studies were identified for analysis. All pooled analysis was based on a random-effects models. The variance was exhibited using a forest plot, and the heterogeneity among studies was examined using the I2 index, the publication bias was evaluated using a funnel plot. The pooled standard mean difference of ferritin levels between AMI and controls was 0.78 (95%CI,0.68-0.88).

CONCLUSION

The results of this meta-analysis demonstrate that serum ferritin in acute myocardial infarction patients is higher than that of healthy controls.

Management of bone metastasis with intravenous bisphosphonates in breast cancer: a systematic review and meta-analysis of dosing frequency

BACKGROUND

Bisphosphonates are wildly used in breast cancer patients with bone metastasis and generally administrated every 4 weeks to lessen the risk of subsequent skeletal-related events. Bisphosphonates administration every 12 weeks is also recommended in some guidelines. Recent clinical trials suggested that bisphosphonate treatment with reduced frequency (every 12 weeks) to be non-inferior to standard therapy. The object of this analysis was to contrast the efficacy and safety of these two treatment strategies.

METHOD

We systematically retrieved databases such as MEDLINE, PubMed, Embase, and Cochrane library from 1947 to present for clinical trials comparing the efficacy between standard (every 4 weeks) and de-escalation (every 12 weeks) treatment of bisphosphates.

RESULTS

We identified 4 articles with available data from 4 randomized clinical trials (n = 1721). Administration of bisphosphate every 12 weeks was non-inferior to administration every 4 weeks. There existed no significant difference in on-study skeletal-related events, renal dysfunction, and osteonecrosis of jaw. In the exploratory study, patients who received intravenous bisphosphates before enrollment experienced less on-study skeletal-related events and significant difference was observed between groups.

CONCLUSION

This analysis suggested that de-escalation treatment with bisphosphates may be superior to standard treatment in terms of efficacy, safety, and economic costs. But it would be better that all the patients receive bisphosphates every 4 weeks for several months before de-escalation.

Meta-analysis of comorbid diabetes and family history of diabetes in non-affective psychosis

OBJECTIVE

Schizophrenia and other non-affective psychoses (NAP) are associated with an increased prevalence of both type 2 diabetes (DM2) as well as a family history of DM2. We performed a systematic review and meta-analysis of the association between comorbid DM2 and a family history of DM2 in patients with NAP.

METHOD

We searched major electronic databases from inception until August 2018 for studies of comorbid DM2 in patients with non-affective psychosis and family history of DM2 status. Random effects meta-analysis calculating odds ratios (ORs) and 95% confidence intervals (CI) and meta-regression analyses were performed.

RESULTS

Ten studies met the inclusion criteria. Across these studies, there were 804 patients with non-affective psychosis and comorbid DM2, and 2976 patients with non-affective psychosis without this comorbidity. A family history of DM2 was associated with an over four-fold increased odds of comorbid DM2 in patients with NAP (OR = 4.3, 95% CI 2.9-6.4, p<0.001). In; meta-regression analyses older age, but not sex, BMI, geographic region, study quality, or year; of publication moderated the association between comorbid DM2 and family history of DM2.

CONCLUSION

We found that a family history of DM2 was associated with an over four-fold increased odds of comorbid DM2 in patients with NAP. This association may be due to shared environmental or genetic risk factors, or gene-environment interactions. Given the increased risk of incident diabetes with antipsychotic treatment, screening for a family history of DM2 is germane to the clinical care of patients with NAP.

Presenilin-1 mutation is associated with a hippocampus defect in alzheimer's disease: Meta-Analysis for neuroimaging research

Observational studies suggested an association of the Presenilin-1 (PSEN1) genotype with neuroimaging markers within Alzheimer's disease. However, whether the PSEN1 genotype and neuroimaging markers is a harbinger of Alzheimer's disease remains controversial. We aimed to examine the association of the PSEN1 mutation with neuroimaging markers in Alzheimer's disease: hippocampal volume, cerebral metabolism and brain amyloid deposition. We performed a systematic review and meta-analysis of 13 studies identified in Pubmed and Medline from 1997 to 2019 (n = 164). The pooled standard mean difference (SMD) was used to evaluate the association between the PSEN1 mutation and hippocampal volume and cerebral metabolism rate for glucose (CMRgl). A meta-analysis was also performed regarding the amyloid deposition between the PSEN1+ and PSEN1- groups. In order to accurately study whether PSEN1 independently was associated with changes in related image markers, sub-meta analyses was performed. The PSEN1 mutation was associated with a smaller hippocampal volume (pooled SMD: -3.3; 95 % CI: -5.36 to -1.24; p = 0.002) and decreased cerebral metabolism (pooled SMD: -1.73; 95 % CI: -2.7 to -0.76; p < 0.0001). Additionally, PSEN1 was associated with increased cerebral amyloid deposition as detected by a positron emission tomography tracer (pooled SMD: 4.58; 95 % CI: 1.37-7.8; p = 0.0005). PSEN1 was associated with a decreased hippocampal volume in MRI markers, cerebral glucose hypometabolism, and increased cerebral amyloid deposition. These associations may indicate the potential role of neuroimaging markers for the diagnosis of Alzheimer's disease.

Effects of ambient ozone concentrations with different averaging times on asthma exacerbations: A meta-analysis

BACKGROUND

Mounting evidence suggests that short-term exposure to ozone increases the risk of asthma exacerbations. However, ozone exposures have been assessed using ambient ozone concentrations averaged over different time periods in different studies.

OBJECTIVE

To evaluate the risks for asthma exacerbations related to ambient ozone measured as 1-hour or 8-hour daily maximum and 24-hour average concentrations.

METHODS

Based on a literature search in PubMed, EMBASE and Web of Science, we identified all time-series studies as of December 4th, 2018 and included 47 eligible studies in our analyses. Asthma exacerbation is defined as the risk for emergency room visits or hospital admissions. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) for a 10 μg/m3 increase in daily ozone concentration were estimated using random effect models. Subgroup analyses and sensitivity analyses were also performed to examine the risks for different seasons, regions and age groups and for the robustness of our main findings.

RESULTS

Significant and similar associations were found for O3-1 h max (RR,1.012; 95%CI, 1.005-1.019) and O3-8 h max (RR, 1.011; 95%CI, 1.007-1.014), while marginal effect was identified for O3-24 h average (RR, 1.005; 95%CI, 0.996-1.014). No significant publication bias but high heterogeneities were observed. During the warm season, ozone was significantly associated with asthma exacerbation. O3-1 h max had the highest RR of 1.014 (95%CI, 1.005-1.024), followed by O3-8 h max (RR, 1.012; 95%CI, 1.009-1.016), while marginal association was identified for O3-24 h avg (RR, 1.008; 95%CI, 0.998-1.017). During the cold season, null associations were identified for all the three averaging times. Variations were also observed in region and age.

CONCLUSION

Ozone exposure measured as 1-hour or 8-hour daily max were more consistently associated with asthma exacerbations than 24-hour average exposure during the warm season.

Rates of hepatitis B and C in patients with schizophrenia: A meta-analysis

OBJECTIVE

Schizophrenia is associated with increased infectious disease comorbidity and mortality. Individuals with schizophrenia have increased risk of infectious hepatitis, potentially due to substance use comorbidity, sexual behaviors, and immunologic factors. We performed a systematic review and meta-analysis of the association between schizophrenia and hepatitis B and C.

METHOD

We searched major electronic databases from inception until January 2019 for prevalence and case-control studies of infectious hepatitis in patients with schizophrenia. Random effects meta-analyses calculating odds ratios (ORs) and 95% confidence intervals (CIs) for case-controls studies, prevalence and 95% CIs, and meta-regression analyses were performed.

RESULTS

Twenty-one studies met the inclusion criteria. In case-control studies, there was an over 3-fold increased odds of hepatitis C in patients with schizophrenia (OR = 3.29, 95% CI 1.50-7.23, p = 0.003), and a prevalence of 6% (ES = 0.06, 95% CI 0.04-0.08). In case-control studies, there was an over 2-fold increased odds of hepatitis B in patients with schizophrenia (OR = 2.36, 95% CI 1.61-3.47, p < 0.001) and a prevalence of 7% (ES = 0.07, 95% CI 0.03-0.11).

CONCLUSION

We found an approximately 3-fold increased odds of hepatitis B and C in patients with schizophrenia. This association may be due to an increased prevalence of environmental risk factors, increased susceptibility to infections, or both. Findings suggest that screening for infectious hepatitis may be germane to the clinical care of patients with schizophrenia and relevant risk factors.

Circulating tumor DNA RASSF1 methylation for predicting cancer risk: a diagnostic meta-analysis

Aim: We conducted a meta-analysis to assess diagnostic accuracy of circulating tumor DNA RASSF1 methylation in cancer. Materials & methods: Studies were searched from PubMed, Embase, Web of Science and China National Knowledge Infrastructure databases for articles published until December 2018. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and summary receiver operating characteristic were used to assess the diagnostic value, and MethHC database was used for verification. Results: 13 studies with 1237 subjects and 676 cancer patients were enrolled. The area under curve was 0.80 (95% CI: 0.76-0.83), the pooled sensitivity was 0.35 (95% CI: 0.31-0.39) and the specificity was 0.97 (95% CI: 0.95-0.98). Verification by MethHC database was almost consistent with the result of meta-analysis. Conclusion: Circulating tumor DNA RASSF1 methylation is a potential biomarker for predicting cancer.

Elevated hypertension risk associated with higher dietary acid load: A systematic review and meta-analysis

BACKGROUND & AIMS

The association between dietary acid load and hypertension risk is inconclusive. We conducted a systematic review and meta-analysis to summarize effect of dietary acid load on blood pressure.

METHODS

A comprehensively search was performed in electronic databases including EMBASE, PubMed, Web of Science and Chinese National Knowledge Infrastructure. Summary ORs and their corresponding 95% CIs were computed assuming a randomized model or fixed model.

RESULTS

Ten publications comprising 4 cohort and 6 cross-sectional studies were eligible for meta-analysis. There were 8 studies about potential renal acid load (PRAL) and 4 about net endogenous acid production (NEAP). Essential hypertension was statistically associated with higher PRAL (OR = 1.14, 95% CI = 1.02-1.17). Our findings also demonstrated a positive impact of higher PRAL on elevating both diastolic pressure (WMD = 0.96, 95% CI = 0.67-1.26) and systolic pressure (WMD = 1.57, 95% CI = 1.12-2.03). A 35% increased risk of hypertension associated with higher NEAP was identified (OR = 1.35, 95% CI = 1.03-1.78).

CONCLUSIONS

The current study suggests that dietary acid load might be potential risk factor of hypertension.

Meta-analysis of blood cortisol levels in individuals with first-episode psychosis

OBJECTIVE

Schizophrenia is associated with abnormal neuroimmunoendocrine function. There is evidence for hypothalamic-pituitary-adrenal (HPA) axis abnormalities in individuals with first-episode psychosis (FEP). However, some previous meta-analyses have focused on heterogeneous sample sources and patient populations. We performed a meta-analysis of baseline (i.e., one sample) blood cortisol levels in individuals with FEP and minimal exposure to antipsychotics.

METHOD

Articles were identified by searching PubMed, PsycInfo, Web of Science, and Science Direct, and the reference lists of these studies.

RESULTS

Twenty-six studies (comprising twenty-seven samples) met the inclusion criteria. Blood cortisol levels were significantly increased in individuals with FEP compared to controls with a small-to-medium effect size (standard mean difference [SMD] = 0.37, 95% CI 0.16-0.57, p < 0.001). In meta-regression analyses, geography was a significant moderator of this association, with larger effects seen in studies conducted in Asia versus the Middle East.

CONCLUSION

We found elevated blood cortisol levels in individuals with FEP, providing additional, complementary evidence for abnormal HPA axis function in this disorder. This finding, which does not inform on mechanism, is consistent with the "neural diathesis-stress" model of psychosis. Given the immunomodulatory effects of cortisol, methodologically rigorous longitudinal studies of cortisol parameters, inflammatory markers, and psychopathology in this patient population are warranted.

Meta-analysis of ghrelin alterations in schizophrenia: Effects of olanzapine

OBJECTIVE

Schizophrenia is associated with an increased prevalence of the metabolic syndrome. Patients receiving antipsychotic medications, including olanzapine, are at further risk. Ghrelin is an appetite-stimulating peptide hormone, although whether blood levels are altered by antipsychotic treatment, remains unclear. We performed a systematic review and meta-analysis comparing blood ghrelin levels in patients with schizophrenia before and after treatment with olanzapine.

METHOD

Two authors independently searched major electronic databases from inception until February 2018 for studies measuring blood ghrelin levels among patients with schizophrenia before and after olanzapine therapy. Random effects meta-analysis calculating standardized mean difference (SMD) and 95% confidence intervals (CI) and meta-regression analyses were performed.

RESULTS

Six studies met the inclusion criteria. Across these studies, there were 111 patients with schizophrenia (mean age 40, 85% male, baseline BMI 22, and endpoint BMI 23). Olanzapine treatment (mean [standard deviation] duration = 12.3 [7.6] weeks) was associated with a significant decrease in blood ghrelin levels with a medium effect size (SMD = -0.48, 95% CI -0.88 to -0.08, p = 0.018). Age, sex, baseline BMI, geography, olanzapine dose and duration, year of publication, study quality, inpatient status, and antipsychotic washout did not moderate this association.

CONCLUSION

Our results suggest that in patients with schizophrenia, olanzapine therapy is associated with decreased blood ghrelin levels, a paradoxical phenomenon known to occur in obesity. Future studies should investigate the contribution of dietary factors (e.g., caloric intake) and physical activity to this association, as well as the effects of other antipsychotics on ghrelin levels.