How Can Quantitative Analysis Be Used to Improve Occupational Health without Reinforcing Social Inequalities? An Examination of Statistical Methods

Nurses' self-efficacy and outcome expectancy in evidence-based practice: Translation, construct validity and internal consistency of the Dutch scales

Background

Evidence-based practice (EBP) is crucial for appropriate, effective, and affordable care. Despite EBP education, barriers like low self-efficacy and outcome expectancy limit nurses' engagement in EBP. Reliable scales are essential to evaluate interventions aimed at improving self-efficacy and outcome expectancy in EBP. The English Self-efficacy and Outcome Expectancy in EBP scales are psychometrically sound.

Objectives

To describe the translation, construct validity and internal consistency of the Dutch Self-efficacy and Outcome Expectancy in EBP Scales.

Method

The scales were translated forward and backward, piloted for comprehensibility and completeness and then administered among Dutch nurses and nursing students.

Results

Pilot testing confirmed comprehensibility, completeness, and relevance of the items. Confirmatory factor analysis (CFA) (n = 769) tested a second-order model for the Self-efficacy scale (Comparative Fit Index (CFI)=0.96, Tucker-Lewis Index (TLI)=0.95, Root Mean Square Error of Approximation (RMSEA)=0.06, Standardized Root Mean Residual (SRMR)=0.04) and a single-factor model for the Outcome Expectancy Scale (CFI=0.99, TLI=0.99, RMSEA=0.06, SRMR=0.01). Chi-squared tests remained significant. Hypothesis testing confirmed construct validity of the Self-efficacy (r = 0.77) and Outcome Expectancy Scale (r = 0.74). Both scales exhibited high internal consistency with McDonald's Omega and Cronbach's Alpha values above 0.95.

Discussion

Both scales exhibit theoretical soundness and positive fit indices. Significant chi-square tests and high correlations between weighted and unweighted scores support using unweighted scores over utilizing the estimated model to calculate weighted scores.

Conclusions

Construct validity and internal consistency of the Dutch Self-efficacy and Outcome Expectancy in EBP Scales are good. Future research should prioritize responsiveness and test-retest reliability.

Unveiling Ventilator-Associated Pneumonia: S100A8 as a Promising Biomarker Through Integrated RNA-Seq Analysis

Background and Objectives

Ventilator-associated pneumonia (VAP) was a common and severe complication of invasive mechanical ventilation. The traditional VAP diagnostic model relied on laboratory microbiological cultures. However, VAP had unclear pathogenesis, and its accurate identification was difficult due to the varying levels of pathogen detection in different laboratories. There was an urgent need for new diagnostic biomarkers for VAP.

Methods

The transcriptome of VAP patients was analyzed and computed using bioinformatics techniques in this study. The screen identified differentially expressed genes (DEGs) from the chemokine CC family, the S-100 family, and the α-defensin family, which are highly associated with immune-related antimicrobial functions. Single-cell landscape data revealed an increase in MTRNR2L12+ cells and a decrease in naïve CD4+ T cells, ciliated cells, and CD8+ T cells in VAP patients, indicating a significant change in the homeostatic profile in patients. Moreover, this paper explored differential gene expression at the single-cell level.

Results

The study analyzed 46 VAP samples and 48 normal samples to explore VAP pathogenesis and identify potential biomarkers. Both bulk RNA seq and scRNA-seq analysis revealed that S100A8 was highly expressed in the VAP group. This phenomenon was caused by the cellular level differential expression of B cells. In contrast, the reduced FN1 and HLA-DRB5 expressions in the VAP group may be influenced by the expression of T cells, macrophages, and ciliated cells. Western blot experiments detected S100A8 expression in the patient samples.

Conclusion

In this study, we combine bulk RNA-seq and scRNA-seq analyses to screen and validate the potential of S100A8, a gene with consistent expression, as a biomarker, providing a new perspective for VAP diagnosis.

The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach

Background

There is substantial evidence on the associations between a positive nurse practice environment and improved nurse and patient outcomes, as well as the factors that mediate these associations, in high-income countries and in hospital settings. The knowledge gaps in African and primary health care settings motivated this empirical study.

Objective

The objective of this study was to examine the impact of the dimensions of the nurse practice environment, specifically human resource management, foundations for nursing care, and participation in clinic affairs, on job outcomes and standards of care.

Design

A cross-sectional study was conducted between November 2021 and June 2022.

Setting

180 primary health care clinics in two South African provinces of Gauteng and North West.

Participants

665 nurses of all categories.

Methods

A causal model was developed with pathways between the nurse practice environment dimensions and the outcomes of job satisfaction, intention to leave, and standards of care. A set of standardised instruments was used to measure the study variables. Using structural equation modelling, workload and professional support were tested as potential mediators between the nurse practice environment and the outcome variables.

Results

The nurses scored the domain of foundations for nursing care 71.2 out of 100 on average, indicating high agreement, while the mean scores for nurses' participation in clinic affairs and human resources management were lower at 68.0 and 61.7 respectively. Although nurses expressed moderate satisfaction with professional support (67.7), they were less satisfied with their workload (52.2). The mean score of overall job satisfaction was moderate (58.9), with 53.8 % of the nurses reporting that they intended leaving the clinic where they were working. Thirty-six percent intended leaving the nursing profession, indicating low intention to stay. The final mediation model was judged to fit the data adequately based on goodness-of-fit indices, confirming that workload and professional support had a mediating role between the nurse practice environment dimensions of interest and both nurses' job outcomes and standards of care.

Conclusions

We have highlighted the value of supportive practice environments, effective workload management, and enhanced professional support in improving nurses' job outcomes and satisfaction with standards of care. Improving nurses' practice environments at primary health care level may have a wide-ranging impact on the performance of the health system. Therefore, primary health care facility managers should ensure that workload is distributed equitably, professional support for nurses is enhanced, and the overall work environment is improved.

Ferulic Acid Methyl Ester Attenuates Cerebral Ischemia-Reperfusion Injury in Rats by Modulating PI3K/HIF-1α/VEGF Signaling Pathway

Background

Cerebral ischaemia-reperfusion injury (CIRI) could worsen the inflammatory response and oxidative stress in brain tissue. According to previous studies, ferulic acid methyl ester (FAME), as the extract with the strongest comprehensive activity in the traditional Chinese medicine Huang Hua oil dot herb, has significant anti-oxidative stress and neuroprotective functions, and can effectively alleviate CIRI, but its mechanism of action is still unclear.

Methods

Firstly, the pharmacological effects of FAME were investigated by in vitro oxidative stress and inflammatory experiments. Secondly, evaluate the therapeutic effects of FAME in the treatment of CIRI by brain histopathological staining and cerebral infarct area by replicating the in vivo MACO model. Thirdly, RNA-Seq and network pharmacology were utilized to predict the possible targets and mechanisms of FAME for CIRI at the molecular level. Finally, the expression of key target proteins, as well as the key regulatory relationships were verified by molecular docking visualization, Western Blotting and immunohistochemistry.

Results

The results of in vitro experiments concluded that FAME could significantly reduce the content of TNF-α, IL-1β and ROS, inhibiting COX-2 and iNOS protein expression in cells(p<0.01). FAME was demonstrated to have anti-oxidative stress and anti-inflammatory effects. The results of in vivo experiments showed that after the administration of FAME, the area of cerebral infarction in rats with CIRI was reduced, the content of Bcl-2 and VEGF was increased(p<0.05). Network pharmacology and RNA-Seq showed that the alleviation of CIRI by FAME may be through PI3K-AKT and HIF-1 signaling pathway. Enhanced expression of HIF-1α, VEGF, p-PI3K, p-AKT proteins in the brain tissues of rats in the FAME group was verified by molecular docking and Western Blotting.

Conclusion

FAME possesses significant anti-inflammatory and anti-oxidative stress activities and alleviates CIRI through the PI3K/HIF-1α/VEGF signaling pathway.

Mental health burden following extreme weather events in South-east Asia: A systematic review and meta-analysis

Background

Exposure to extreme weatherly events potentially develops mental disorders among affected individuals.

Aim

To synthesize the burden of mental disorders following impact of extreme weather events in South-east Asian (SEA) countries.

Methods

Proposal was registered in PROSPERO register [CRD42023469788] and reported as per PRISMA-2020 guidelines. Studies reporting prevalence of mental health disorders following extreme weather events from SEA countries during 1990 and 2023 were searched on Embase, PubMed, and Scopus databases. Study quality was assessed using Appraisal tool for Cross-Sectional Studies. Overall pooled prevalence was computed using DerSimonian-Laird method for random-effects model and reported as 95% confidence intervals.

Results

On screening 12,046 records, we included 155 studies (2,04,474 participants) for analysis. Overall burden of mental disorders was 35.31% (95%CI: 30.42%-40.21%). In subgroup analysis, studies on cyclones, India, local residents, children and adolescents, rural settings, and community settings reported higher burden of mental disorders. Depression (28.58%; 95%CI: 24.05%-33.1%) and PTSD (29.36%; 95%CI: 26.26%-32.46%) had similar prevalence. Visiting tourists to SEA region experienced fear, fear of recurrence of tsunami, nightmares, and sense of helplessness. Mental health outcomes were relatively higher in studies conducted within 1 year of events. Heterogeneity and possibility of publication bias exists among the reported studies.

Conclusion

With the significant rise in episodes of extreme weather events in SEA region over the last three decades, mental disorders are documented in different proportions. We suggest prioritizing well-informed policies to formulate inclusive and resilient strategies on effectively identifying and treating mental health concerns among victims of extreme weather events.

Is anxiety a public health problem among older adults in India: Results from a systematic review and meta-analysis

For medical fraternity, health system and policymakers to undertake effective countermeasures, a comprehensive assessment of the prevalence of anxiety among older adults is required; hence, we conducted a systematic review and meta-analysis using data pooled from surveys across the country. The search strategy was developed using medical subject headings (MeSH) terms and free-text keywords. We searched PubMed and Scopus for articles to report the prevalence of anxiety among older adults. The appraisal tool for cross-sectional studies was used for quality assessment. Prevalence from different studies was pooled together using the inverse variance heterogeneity method. Sensitivity analyses were performed to assess the impact of included studies' methodological quality on pooled results and to investigate potential causes of heterogeneity. Twenty-three studies were included in this systematic review. The overall pooled estimate of the prevalence of anxiety in older adults was 18.7% (95% CI: 2.4, 38.8). The studies had a high degree of heterogeneity. Publication bias was assessed using a Doi plot which showed an luis furuya-kanamori (LFK) index of 1.21 indicating minor asymmetry. Like other parts of the world, India has witnessed a rise in the number of elderly due to lower fertility rates, higher life expectancies and a shift in illness patterns from communicable to non-communicable. The number of elderly people suffering from diseases of mental health is expected to rise dramatically. This review consolidates the existing evidence to showcase anxiety as an upcoming public health problem requiring due focus from policymakers and health systems.

Health-Promoting Lifestyle and Its Predictors in Renal Transplant Recipients in Hunan, China: A Cross-Sectional Study

Background

Kidney transplantation is a critical treatment for end-stage renal disease (ESRD), with health-promoting lifestyle (HPL) significantly impacting patient outcomes. HPL involves behaviors like regular exercise, balanced nutrition, stress management, and habit modification. However, few studies have analyzed the HPL of renal transplant recipients, addressing a significant gap in current research.

Objective

This study aimed to determine the predictors of HPL in renal transplant recipients using the Chinese Health Promoting Lifestyle Profile (HPLP).

Methods

This cross-sectional study enrolled renal transplant recipients completing the revised Chinese HPLP at organ transplant center in a tertiary hospital in Hunan Province of China between May 2022 and July 2022.

Results

A total of 450 patients were included, comprising 256 males (56.9%), with a mean age of 44.85 ± 10.57 years. The mean score of self-actualization, health responsibility, interpersonal support, physical activity, stress management, nutrition, and overall HPLP were 15.27 ± 5.03 (possible range: 0-24), 11.41 ± 4.18 (possible range: 0-24), 11.61 ± 3.13 (possible range: 0-18), 7.53 ± 3.79 (possible range: 0-18), 12.68 ± 3.61 (possible range: 0-21), 11.17 ± 2.41 (possible range: 0-15), and 69.66 ± 16.98 (possible range: 0-120), respectively. Multivariate logistic regression analysis showed that urban residence (OR = 2.061, 95% CI: 1.350-3.148, P = 0.001), non-smoking after transplantation (OR = 2.010, 95% CI: 1.123-3.600, P = 0.019) and two post-transplant complications (OR=0.387, 95% CI: 0.218-0.689, P = 0.001).

Conclusion

Although renal transplant recipients exhibit a moderate level of HPL, targeted interventions are essential to improve these behaviors. These interventions should focus especially on individuals from rural households, post-transplant smokers, and those experiencing post-transplant complications, to enhance their quality of life and clinical outcomes.

Enhancing early breast cancer diagnosis through automated microcalcification detection using an optimized ensemble deep learning framework

Background

Breast cancer remains a pressing global health concern, necessitating accurate diagnostics for effective interventions. Deep learning models (AlexNet, ResNet-50, VGG16, GoogLeNet) show remarkable microcalcification identification (>90%). However, distinct architectures and methodologies pose challenges. We propose an ensemble model, merging unique perspectives, enhancing precision, and understanding critical factors for breast cancer intervention. Evaluation favors GoogleNet and ResNet-50, driving their selection for combined functionalities, ensuring improved precision, and dependability in microcalcification detection in clinical settings.

Methods

This study presents a comprehensive mammogram preprocessing framework using an optimized deep learning ensemble approach. The proposed framework begins with artifact removal using Otsu Segmentation and morphological operation. Subsequent steps include image resizing, adaptive median filtering, and deep convolutional neural network (D-CNN) development via transfer learning with ResNet-50 model. Hyperparameters are optimized, and ensemble optimization (AlexNet, GoogLeNet, VGG16, ResNet-50) are constructed to identify the localized area of microcalcification. Rigorous evaluation protocol validates the efficacy of individual models, culminating in the ensemble model demonstrating superior predictive accuracy.

Results

Based on our analysis, the proposed ensemble model exhibited exceptional performance in the classification of microcalcifications. This was evidenced by the model's average confidence score, which indicated a high degree of dependability and certainty in differentiating these critical characteristics. The proposed model demonstrated a noteworthy average confidence level of 0.9305 in the classification of microcalcification, outperforming alternative models and providing substantial insights into the dependability of the model. The average confidence of the ensemble model in classifying normal cases was 0.8859, which strengthened the model's consistent and dependable predictions. In addition, the ensemble models attained remarkably high performances in terms of accuracy, precision, recall, F1-score, and area under the curve (AUC).

Conclusion

The proposed model's thorough dataset integration and focus on average confidence ratings within classes improve clinical diagnosis accuracy and effectiveness for breast cancer. This study introduces a novel methodology that takes advantage of an ensemble model and rigorous evaluation standards to substantially improve the accuracy and dependability of breast cancer diagnostics, specifically in the detection of microcalcifications.

Therapeutic Potential of Downregulated Interleukin-6 Signaling for the Treatment of Chronic Pain: A Mendelian Randomization Study

Introduction

While numerous studies have emphasized the pivotal involvement of the Interleukin 6 (IL-6) pathway in the development of chronic pain, the causal nature of this relationship remains uncertain.

Methods

In this study, we opted to include genetic variants situated within the locus of the IL-6 receptor (IL-6R) that exhibited associations with C-reactive protein (CRP) levels. CRP serves as a downstream effector in the IL-6 pathway. Utilizing these variants as genetic proxies, we aimed to modulate IL-6 signaling. Employing a two-sample Mendelian randomization (MR) approach, we investigated the potential link between the genetic proxy and seven distinct subtypes of chronic pain, categorized based on their corresponding body locations. Moreover, we examined the relationship between chronic pain and an alternative instrument of IL-6 signaling that was weighted based on s-IL-6R levels. Furthermore, we conducted exploratory analyses to estimate the plausible causal association between CRP, gp130, and the subtypes of chronic pain.

Results

Our analysis showed that genetic proxied downregulation of IL-6 signaling, weighted on CRP levels, was linked to a reduced risk of chronic back and knee pain. The sensitivity analyses across various MR methods confirmed the consistency of the findings and showed no evidence of horizontal pleiotropy or heterogeneity. Moreover, the results remained robust with different sets of instrument variables. A genetically increased level of s-IL-6R was also negatively associated with chronic back and knee pain. However, there was no causal relationship between CRP and gp130 with chronic pain.

Conclusion

Based on our findings, there is evidence to suggest a potential causal relationship between IL-6 signaling and chronic back and knee pain. Consequently, the downregulation of IL-6 signaling holds promise as a potential therapeutic target for addressing chronic back and knee pain.

Depression and Anxiety Symptoms and Their Associated Factors Among Chinese Residents After the Lifting of the Dynamic Zero-COVID Policy: A Cross-Sectional Study

Purpose

China lifted its strict zero-Covid approach on December 7, 2022. This study aimed to investigate depression and anxiety symptoms and their associations among Chinese residents after the change in public policy.

Methods

A cross-sectional sample of 925 Chinese residents (726 females and 199 males) was recruited using convenience and snowball sampling approach between 16 and 25 December 2022. Participants completed online questionnaires on basic information, depression, anxiety, COVID-19 related perceptions, and protective behaviors change.

Results

Mild and moderate-to-severe depression symptoms were reported by 35.6% and 19.1% of participants, respectively. Nearly 40% of participants reported mild anxiety and 18.7% reported moderate-to-severe anxiety. Results from multinomial logistic regression analysis indicated that male gender, younger age, the presence of chronic disease, poorer self-rated mental health status, perceived impact, and worry were risk factors for both depression and anxiety, while higher education and protective behaviors change were protective factors. Besides, living with or caring for children (4-6 years), family members or other housemates currently with influenza-like symptoms, and perceived severity were also risk factors for depression.

Conclusion

Our findings provided initial evidence that Chinese residents may face heightened depression and anxiety during the early stage after the policy was released. Furthermore, we identified some vulnerable populations in need of prioritizing mental health assistance and some potentially modifiable factors associated with depression and anxiety, which provides an important guide for developing timely and effective psychological interventions and preparing for future pandemics.

The relationships between mastication and cognitive function: A systematic review and meta-analysis

Masticatory function such as chewing is expected to modify human cognitive function, and/or the possibility of improving cognitive function is also predicted. This systematic review investigated whether masticatory function affects cognitive function for older/young adults. Full articles written in English from January 2000 to April 2022 were collected using PubMed and Cochrane Library. Target outcomes were cognitive function test scores, cognitive processing speed (reaction time), and masticatory function. For each research question, two independent reviewers conducted the search and screening, data extraction, quality assessment, and risk of bias assessment. The reviewers resolved any disagreements by discussion. From 226 articles retrieved, 20 were included in this review. Older adults with lower scores on the cognitive function test had lower masticatory performance, lower chewing ability, chewing difficulty, and decreased number of teeth. An increased risk of cognitive impairment was found in older adults with masticatory dysfunction. For young adults, gum chewing significantly reduced the processing speed of cognitive tasks compared to no gum chewing. Although most of the evidence included had a low level of evidence and a high risk of bias because of the research designs, the results still suggest that mastication may be a factor in improving cognitive function.

Assessing the Policy of Non-Smoking Areas in Schools in Indonesia: A Mixed Methods Study

BACKGROUND

Regulations in the form of Regional Regulations on Non-Smoking Areas are efforts to prevent smoking in schools. We will show qualitatively and quantitatively whether the policy can control smoke-free schools since 2015 in Muaro Jambi Regency. However, the implementation is still not optimal, even almost not implemented following the mandate of government regulation Number 109 of 2012 and regional regulation Number 5 of 2018. This study aims to evaluate the implementation of the smoke-free area policy in schools in Muaro Jambi Regency.

METHOD

Research using mixed method study employing quantitative through distribution survey of smoke-free zones and qualitative by interviewing 31 schools of informants and observing 499 points of educational institutions. Selection of informants by considering the criteria of adequacy and suitability of data analysis with content analysis.

RESULTS

The cause of the non-implementation of the smoke-free area policy is the lack of socialization of local regulations. The regulation of non-smoking area bylaws has not been made, implementing rules with the decree of the law. Schools do not run areas without cigarettes because they do not fully understand the rules, namely that they are not allowed to smoke in all school environments and health facilities. Oversight of the no-smoking area policy has not been carried out due to the lack of policy support from policymakers and sources of funds for monitoring the no-smoking area.

CONCLUSION

No smoking area policy is meaningless if there is neglect in its implementation so that it does not impact the compliance of smoking behavior following the No Smoking Area policy. The need for the commitment of school leaders in implementing and operational rules from the regional regulations in the implementation of smoke-free areas.

Exploring media consumption and mental health among young adults during the second wave of COVID-19 in Bangladesh

Background

This study examined the association between media exposure and mental health during the second wave of lockdown among the general population of Bangladesh.

Methods

A total of 449 adult participants were enrolled in the study to evaluate their levels of exposure to total media, electronic media, and social media. Mental health was assessed using a 7-item generalized anxiety disorder (GAD-7) scale. A multivariate logistic regression model was constructed to explore the relationships between media exposure levels and anxiety. The models included covariates such as sex, daily working hours, health problems, media distraction, and income from social media.

Results

The results showed that 44.5%, 39.2%, and 16.3% of participants reported low, medium, and high levels of exposure to different media during the COVID-19 period, respectively. Additionally, 96.4%, 2.7%, and 0.9% of participants had low, medium, and high levels of exposure to electronic media, respectively, and 89.1%, 10.5%, and 0.4% of participants had low, medium, and high levels of exposure to social media, respectively. The overall prevalence of anxiety was 25.38% among the respondents. Participants with high levels of total media exposure were significantly more likely to experience anxiety, with an odds ratio of 2.75 (95% CI = 1.40-5.14, p < 0.01). Females were 2.26 times more likely to experience anxiety than males (95% CI = 1.37-3.74, p < 0.01), and participants with health problems were also more likely to develop anxiety compared to those who did not.

Conclusion

Our results show a positive relationship between increased media exposure and anxiety levels, providing useful insights for both academics and public health practitioners.

Small RNA Deep Sequencing of Circulating Small RNAs Discovers a Unique Panel of microRNAs as Feasible and Reliable Biomarkers of Non-Small Cell Lung Cancers in Northern Thailand

OBJECTIVE

This study aimed to assess the practicality and reliability of utilizing microRNAs (miRNAs) as a potential screening and diagnosing tool for non-small cell lung cancers (NSCLCs) in Northern Thailand.

METHODS

Small RNA sequencing and a literature review was performed to obtain a list of serum miRNA candidates. Serum levels of these selected miRNA candidates were measured in patients with NSCLC and healthy volunteers by real-time RT-PCR and receiver operating characteristic curve (ROC) were used to assess diagnostic performance.

RESULTS

Sequencing data revealed 148 known miRNAs and 230 novel putative miRNAs in serum samples; 19 serum miRNAs were significantly downregulated and 242 were upregulated. Seven miRNAs selected according to sequencing data and 11 miRNAs according to previous reports were evaluated in training cohort (45 lung cancer patients, 26 controls) and 6 miRNAs were found differentially expressed (p < 0.05, Mann Whitney U test) and associated (p < 0.05, Chi-square test) with NSCLC development. Further analysis and verification identified an optimal combination of 4 miRNAs composed of hsa-miR23a, hsa-miR26b, hsa-miR4488 and novel-130 to provide the optimal AUC of 0.901±0.034. Detection of serum miRNA by real-time RT-PCR showed good reproducibility with the coefficient of variation (CV) ≤ 4%. The optimal screening miRNAs panel was primarily identified through sequencing data of local patient population, thus indicating that the etiology of NSCLCs may differ from one population to other and thus require a unique panel of miRNAs for their identification.

CONCLUSION

Circulating miRNA is a feasible screening tool for NSCLCs. Nevertheless, populations with different lung cancer etiology may need to identify their own most suitable miRNA panel.

Dose-dependent effect of tart cherry on blood pressure and selected inflammation biomarkers: A GRADE-assessed systematic review and meta-analysis of randomized controlled trials

Objectives

As a nutritious food, Tart cherries (Prunus cerasus L) benefit cardiovascular health. This study aims to clarify the effectiveness of Tart cherry in controlling blood pressure, heart rate, and inflammatory biomarkers, the appropriate dosage for this effect, and suggest directions for future studies.

Methods

PubMed, Scopus, and Web of Science were searched (up to May 2022), to identify eligible randomized controlled trials. It measured publication bias and was assessed for all outcomes. Evidence quality was evaluated using the Cochrane risk of bias tool and GRADE (Grades of Recommendations, Assessment, Development, and Evaluations).

Results

Regarding the 21 included trials, Tart cherry didn't affect blood pressure, heart rate, high-sensitive C-reactive protein, and interleukin-6 (P > 0.05). In contrast, with moderate certainty, it can reduce serum C-reactive protein (WMD: - 0.39 mg/l; 95% CI: - 0.74, - 0.05; P = 0.024) and with very low certainty can decrease tumor necrosis factor-alpha (WMD: - 0.14 pg/ml; 95% CI: - 0.27, - 0.02; P = 0.026). In addition, dose-response analysis implies that with each 30 ml elevation in dose, CRP reduces by 0.19 mg/l (95% CI: - 0.37, - 0.01).

Conclusions

Tart cherry can control inflammation by administering the proper dose. Even though tart cherry generally doesn't affect blood pressure and heart rate, further high-quality studies are needed to determine its effect.