1
|
Basten M, Pan KY, van Tuijl LA, de Graeff A, Dekker J, Hoogendoorn AW, Lamers F, Ranchor AV, Vermeulen R, Portengen L, Voogd AC, Abell J, Awadalla P, Beekman ATF, Bjerkeset O, Boyd A, Cui Y, Frank P, Galenkamp H, Garssen B, Hellingman S, Huisman M, Huss A, Keats MR, Kok AAL, Krokstad S, van Leeuwen FE, Luik AI, Noisel N, Payette Y, Penninx BWJH, Rissanen I, Roest AM, Rosmalen JGM, Ruiter R, Schoevers RA, Soave D, Spaan M, Steptoe A, Stronks K, Sund ER, Sweeney E, Twait EL, Teyhan A, Verschuren WMM, van der Willik KD, Geerlings MI. Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis. Int J Cancer 2024; 154:1745-1759. [PMID: 38289012 DOI: 10.1002/ijc.34852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 03/14/2024]
Abstract
Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects of health behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22 cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration) and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress.
Collapse
Affiliation(s)
- Maartje Basten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Amsterdam Public Health, Health Behaviors and Chronic Diseases program, Amsterdam, The Netherlands
| | - Kuan-Yu Pan
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lonneke A van Tuijl
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Alexander de Graeff
- Department of Medical Oncology, University Medical Center Utrecht, The Netherlands
| | - Joost Dekker
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Femke Lamers
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Lützen Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Jessica Abell
- Department of Behavioural Science and Health, University College London, London, UK
| | - Philip Awadalla
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aartjan T F Beekman
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- Faculty of Medicine and Health Sciences, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yunsong Cui
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philipp Frank
- Department of Behavioural Science and Health, University College London, London, UK
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert Garssen
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sean Hellingman
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Martijn Huisman
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Melanie R Keats
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Almar A L Kok
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
- Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | | | | | - Brenda W J H Penninx
- Amsterdam Public Health, Mental Health program, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Annelieke M Roest
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Judith G M Rosmalen
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Maasstad, Rotterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David Soave
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Canada
| | - Mandy Spaan
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, and Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
- Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Norway
- Levanger hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ellen Sweeney
- Atlantic Partnership for Tomorrow's Health, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emma L Twait
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Alison Teyhan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - W M Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Kimberly D van der Willik
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Epidemiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Pontén M, Jonsjö M, Vadenmark V, Moberg E, Grannas D, Andersson G, Boersma K, Hedman-Lagerlöf E, Kleinstaeuber M, Weise C, Kaldo V, Ljótsson B, Andersson E, Axelsson E, Jensen K. Association between expectations and clinical outcomes in online v. face-to-face therapy - an individual participant data meta-analysis. Psychol Med 2024; 54:1207-1214. [PMID: 37905404 DOI: 10.1017/s0033291723003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions. METHODS MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model. RESULTS Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (β = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face). CONCLUSIONS Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.
Collapse
Affiliation(s)
- Moa Pontén
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Martin Jonsjö
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Medical Unit Medical Psychology, Theme Women's Health and Allied Health Professionals, Karolinska University Hospital Solna, Solna, Sweden
| | - Viktor Vadenmark
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Erica Moberg
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - David Grannas
- Biostatistics Core Facility, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | | | | | - Cornelia Weise
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Erland Axelsson
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| |
Collapse
|
3
|
Beck ED, Yoneda T, James BD, Bennett DA, Hassenstab J, Katz MJ, Lipton RB, Morris J, Mroczek DK, Graham EK. Personality predictors of dementia diagnosis and neuropathological burden: An individual participant data meta-analysis. Alzheimers Dement 2024; 20:1497-1514. [PMID: 38018701 PMCID: PMC10947984 DOI: 10.1002/alz.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/18/2023] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION The extent to which the Big Five personality traits and subjective well-being (SWB) are discriminatory predictors of clinical manifestation of dementia versus dementia-related neuropathology is unclear. METHODS Using data from eight independent studies (Ntotal = 44,531; Ndementia = 1703; baseline Mage = 49 to 81 years, 26 to 61% female; Mfollow-up range = 3.53 to 21.00 years), Bayesian multilevel models tested whether personality traits and SWB differentially predicted neuropsychological and neuropathological characteristics of dementia. RESULTS Synthesized and individual study results indicate that high neuroticism and negative affect and low conscientiousness, extraversion, and positive affect were associated with increased risk of long-term dementia diagnosis. There were no consistent associations with neuropathology. DISCUSSION This multistudy project provides robust, conceptually replicated and extended evidence that psychosocial factors are strong predictors of dementia diagnosis but not consistently associated with neuropathology at autopsy. HIGHLIGHTS N(+), C(-), E(-), PA(-), and NA(+) were associated with incident diagnosis. Results were consistent despite self-report versus clinical diagnosis of dementia. Psychological factors were not associated with neuropathology at autopsy. Individuals with higher conscientiousness and no diagnosis had less neuropathology. High C individuals may withstand neuropathology for longer before death.
Collapse
Affiliation(s)
- Emorie D. Beck
- Department of Medical Social SciencesNorthwestern UniversityFeinberg School of MedicineChicagoIllinoisUSA
- Department of PsychologyUniversity of CaliforniaDavisDavisCaliforniaUSA
| | - Tomiko Yoneda
- Department of Medical Social SciencesNorthwestern UniversityFeinberg School of MedicineChicagoIllinoisUSA
- Department of PsychologyUniversity of CaliforniaDavisDavisCaliforniaUSA
| | - Bryan D. James
- Rush Alzheimer's Disease CenterDepartment of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - David A. Bennett
- Department of NeurologyRush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Jason Hassenstab
- Department of NeurologyWashington University School of MedicineSt. LouisMissouriUSA
| | - Mindy J. Katz
- Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Richard B. Lipton
- Department of NeurologyAlbert Einstein College of MedicineBronxNew YorkUSA
| | - John Morris
- Department of NeurologyRush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Daniel K. Mroczek
- Department of Medical Social SciencesNorthwestern UniversityFeinberg School of MedicineChicagoIllinoisUSA
- Department of PsychologyNorthwestern UniversityWeinberg College of Arts & SciencesEvanstonIllinoisUSA
| | - Eileen K. Graham
- Department of Medical Social SciencesNorthwestern UniversityFeinberg School of MedicineChicagoIllinoisUSA
| |
Collapse
|
4
|
Wright SL, Karyotaki E, Cuijpers P, Bisson J, Papola D, Witteveen A, Suliman S, Spies G, Ahmadi K, Capezzani L, Carletto S, Karatzias T, Kullack C, Laugharne J, Lee CW, Nijdam MJ, Olff M, Ostacoli L, Seedat S, Sijbrandij M. EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychol Med 2024:1-9. [PMID: 38173121 DOI: 10.1017/s0033291723003446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR. METHODS This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization. RESULTS One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity (β = -0.24), achieving response (β = 0.86), attaining remission (β = 1.05), or reducing treatment dropout rates (β = -0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females. CONCLUSION The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status.
Collapse
Affiliation(s)
- Simonne Lesley Wright
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonathan Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Davide Papola
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Anke Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sharain Suliman
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Georgina Spies
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Liuva Capezzani
- The International Institute for Psychoanalytic Research and Training of Health Professionals (IIPRTHP), Rome, Italy
- International School for Psychotherapy (SIPSI), Rome, Italy
| | - Sara Carletto
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | | | - Jonathan Laugharne
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Christopher William Lee
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Australia
| | - Mirjam J Nijdam
- Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Miranda Olff
- Department of Psychiatry & Amsterdam Public Health, Amsterdam University Medical Center location University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Center, Diemen, The Netherlands
| | - Luca Ostacoli
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Soraya Seedat
- South Africa PTSD Research Programme of Excellence, Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Rudrapatna VA, Ravindranath VG, Arneson DV, Mosenia A, Butte AJ, Wang S. Personalizing treatment selection in Crohn's disease: a meta-analysis of individual participant data from fifteen randomized controlled trials. medRxiv 2023:2023.11.10.23291837. [PMID: 37986977 PMCID: PMC10659518 DOI: 10.1101/2023.11.10.23291837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Meta-analyses have found anti-TNF drugs to be the best treatment, on average, for Crohn's disease. We performed a subgroup analysis to determine if it is possible to achieve more efficacious outcomes by individualizing treatment selection. METHODS We obtained participant-level data from 15 trials of FDA-approved treatments (N=5703). We used sequential regression and simulation to model week six disease activity as a function of drug class, demographics, and disease-related features. We performed hypothesis testing to define subgroups based on rank-ordered preferences for treatments. We queried health records from University of California Health (UCH) to estimate the impacts these models could have on practice. We computed the sample size needed to prospectively test a prediction of our models. RESULTS 45% of the participants (N=2561) showed greater efficacy with at least one drug class (anti-TNF, anti-IL-12/23, anti-integrin) over another. They were classifiable into 6 subgroups, two showing greatest efficacy with anti-TNFs (36%, N=2064). Women over 50 showed superior responses with anti-IL-12/23s. Although they represented only 2% of the trial-based cohort, 25% of Crohn's patients at UCH are women over 50 (N=5,647), consistent with potential selection bias in trials. Moreover, 75% of biologic-exposed women over 50 did not receive an anti-IL12/23 first-line, supporting the potential value of these models. A future trial with 250 patients per arm will have 97% power to confirm the superiority of anti-IL-12/23s over anti-TNFs in these patients. A treatment recommendation tool is available at https://crohnsrx.org. CONCLUSIONS Personalizing treatment can improve outcomes in Crohn's disease. Future work is needed to confirm these findings, and improve representativeness in Crohn's trials.
Collapse
Affiliation(s)
- Vivek A. Rudrapatna
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA
| | | | - Douglas V. Arneson
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA
| | - Arman Mosenia
- School of Medicine, University of California, San Francisco, CA
| | - Atul J. Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco, CA
| | - Shan Wang
- Department of Mathematics and Statistics, University of San Francisco, San Francisco, CA
| |
Collapse
|
6
|
van Hoogenhuijze NE, Lahoz Casarramona G, Lensen S, Farquhar C, Kamath MS, Kunjummen AT, Raine-Fenning N, Berntsen S, Pinborg A, Mackens S, Inal ZO, Ng EHY, Mak JSM, Narvekar SA, Martins WP, Steengaard Olesen M, Torrance HL, Mol BW, Eijkemans MJC, Wang R, Broekmans FJM. Endometrial scratching in women undergoing IVF/ICSI: an individual participant data meta-analysis. Hum Reprod Update 2023; 29:721-740. [PMID: 37336552 PMCID: PMC10628489 DOI: 10.1093/humupd/dmad014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 03/23/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND In IVF/ICSI treatment, the process of embryo implantation is the success rate-limiting step. Endometrial scratching has been suggested to improve this process, but it is unclear if this procedure increases the chance of implantation and live birth (LB) and, if so, for whom, and how the scratch should be performed. OBJECTIVE AND RATIONALE This individual participant data meta-analysis (IPD-MA) aims to answer the question of whether endometrial scratching in women undergoing IVF/ICSI influences the chance of a LB, and whether this effect is different in specific subgroups of women. After its incidental discovery in 2000, endometrial scratching has been suggested to improve embryo implantation. Numerous randomized controlled trials (RCTs) have been conducted, showing contradicting results. Conventional meta-analyses were limited by high within- and between-study heterogeneity, small study samples, and a high risk of bias for many of the trials. Also, the data integrity of several trials have been questioned. Thus, despite numerous RCTs and a multitude of conventional meta-analyses, no conclusion on the clinical effectiveness of endometrial scratching could be drawn. An IPD-MA approach is able to overcome many of these problems because it allows for increased uniformity of outcome definitions, can filter out studies with data integrity concerns, enables a more precise estimation of the true treatment effect thanks to adjustment for participant characteristics and not having to make the assumptions necessary in conventional meta-analyses, and because it allows for subgroup analysis. SEARCH METHODS A systematic literature search identified RCTs on endometrial scratching in women undergoing IVF/ICSI. Authors of eligible studies were invited to share original data for this IPD-MA. Studies were assessed for risk of bias (RoB) and integrity checks were performed. The primary outcome was LB, with a one-stage intention to treat (ITT) as the primary analysis. Secondary analyses included as treated (AT), and the subset of women that underwent an embryo transfer (AT+ET). Treatment-covariate interaction for specific participant characteristics was analyzed in AT+ET. OUTCOMES Out of 37 published and 15 unpublished RCTs (7690 participants), 15 RCTs (14 published, one unpublished) shared data. After data integrity checks, we included 13 RCTs (12 published, one unpublished) representing 4112 participants. RoB was evaluated as 'low' for 10/13 RCTs. The one-stage ITT analysis for scratch versus no scratch/sham showed an improvement of LB rates (odds ratio (OR) 1.29 [95% CI 1.02-1.64]). AT, AT+ET, and low-RoB-sensitivity analyses yielded similar results (OR 1.22 [95% CI 0.96-1.54]; OR 1.25 [95% CI 0.99-1.57]; OR 1.26 [95% CI 1.03-1.55], respectively). Treatment-covariate interaction analysis showed no evidence of interaction with age, number of previous failed embryo transfers, treatment type, or infertility cause. WIDER IMPLICATIONS This is the first meta-analysis based on IPD of more than 4000 participants, and it demonstrates that endometrial scratching may improve LB rates in women undergoing IVF/ICSI. Subgroup analysis for age, number of previous failed embryo transfers, treatment type, and infertility cause could not identify subgroups in which endometrial scratching performed better or worse. The timing of endometrial scratching may play a role in its effectiveness. The use of endometrial scratching in clinical practice should be considered with caution, meaning that patients should be properly counseled on the level of evidence and the uncertainties.
Collapse
Affiliation(s)
- Nienke E van Hoogenhuijze
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Aleyamma T Kunjummen
- Department of Reproductive Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nick Raine-Fenning
- Nurture Fertility, The Fertility Partnership, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sine Berntsen
- Department of Obstetrics and Gynaecology, Fertility Clinic, Hvidovre, Copenhagen, Denmark
- University Hospital Hvidovre, Hvidovre, Denmark
| | - Anja Pinborg
- Fertility Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Shari Mackens
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Jette, Belgium
| | - Zeynep Ozturk Inal
- Department of Obstetrics, Konya Education and Research Hospital, Konya, Turkey
| | - Ernest H Y Ng
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Jennifer S M Mak
- Department of Obstetrics and Gynaecology, Assisted Reproduction Technology Unit, Prince of Wales Hospital, the Chinese University of Hong Kong 9F, Hong Kong SAR
| | - Sachin A Narvekar
- Department of Reproductive Medicine, Bangalore Assisted Conception Center, Bangalore, Karnataka, India
| | | | | | - Helen L Torrance
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, VIC, Australia
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Women’s Health Research, University of Aberdeen, Aberdeen, UK
| | - Marinus J C Eijkemans
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Clayton, VIC, Australia
| | - Frank J M Broekmans
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
7
|
Driessen E, Fokkema M, Dekker JJM, Peen J, Van HL, Maina G, Rosso G, Rigardetto S, Cuniberti F, Vitriol VG, Andreoli A, Burnand Y, López Rodríguez J, Villamil Salcedo V, Twisk JWR, Wienicke FJ, Cuijpers P. Which patients benefit from adding short-term psychodynamic psychotherapy to antidepressants in the treatment of depression? A systematic review and meta-analysis of individual participant data. Psychol Med 2023; 53:6090-6101. [PMID: 36404677 PMCID: PMC10520584 DOI: 10.1017/s0033291722003270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression. METHODS For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level. RESULTS Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = -0.49, 95% confidence interval (CI) -0.61 to -0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than <1 year (B = -0.68, 95% CI -1.31 to -0.05, p = 0.03) and than 1-2 years (B = -0.86, 95% CI -1.66 to -0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias. CONCLUSIONS To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.
Collapse
Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marjolein Fokkema
- Department of Methodology and Statistics, Leiden University, Leiden, Netherlands
| | - Jack J M Dekker
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | - Jaap Peen
- Department of Research, Arkin Mental Health Care, Amsterdam, Netherlands
| | | | - Giuseppe Maina
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital of Orbassano, Turin, Italy
| | - Gianluca Rosso
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
- Psychiatric Unit, San Luigi Gonzaga University Hospital of Orbassano, Turin, Italy
| | - Sylvia Rigardetto
- Psychiatric Unit, San Luigi Gonzaga University Hospital of Orbassano, Turin, Italy
| | - Francesco Cuniberti
- Department of Neuroscience 'Rita Levi Montalcini', University of Turin, Turin, Italy
| | | | | | | | | | | | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Frederik J Wienicke
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
8
|
Di Stefano L, Ram M, Scharfstein DO, Li T, Khanal P, Baksh SN, McBee N, Bengtson CD, Gadomski A, Geriak M, Puskarich MA, Salathe MA, Schutte AE, Tignanelli CJ, Victory J, Bierer BE, Hanley DF, Freilich DA. Losartan in hospitalized patients with COVID-19 in North America: An individual participant data meta-analysis. Medicine (Baltimore) 2023; 102:e33904. [PMID: 37335665 PMCID: PMC10256351 DOI: 10.1097/md.0000000000033904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/11/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers (ARBs) have been hypothesized to benefit patients with COVID-19 via the inhibition of viral entry and other mechanisms. We conducted an individual participant data (IPD) meta-analysis assessing the effect of starting the ARB losartan in recently hospitalized COVID-19 patients. METHODS We searched ClinicalTrials.gov in January 2021 for U.S./Canada-based trials where an angiotensin-converting enzyme inhibitors/ARB was a treatment arm, targeted outcomes could be extrapolated, and data sharing was allowed. Our primary outcome was a 7-point COVID-19 ordinal score measured 13 to 16 days post-enrollment. We analyzed data by fitting multilevel Bayesian ordinal regression models and standardizing the resulting predictions. RESULTS 325 participants (156 losartan vs 169 control) from 4 studies contributed IPD. Three were randomized trials; one used non-randomized concurrent and historical controls. Baseline covariates were reasonably balanced for the randomized trials. All studies evaluated losartan. We found equivocal evidence of a difference in ordinal scores 13-16 days post-enrollment (model-standardized odds ratio [OR] 1.10, 95% credible interval [CrI] 0.76-1.71; adjusted OR 1.15, 95% CrI 0.15-3.59) and no compelling evidence of treatment effect heterogeneity among prespecified subgroups. Losartan had worse effects for those taking corticosteroids at baseline after adjusting for covariates (ratio of adjusted ORs 0.29, 95% CrI 0.08-0.99). Hypotension serious adverse event rates were numerically higher with losartan. CONCLUSIONS In this IPD meta-analysis of hospitalized COVID-19 patients, we found no convincing evidence for the benefit of losartan versus control treatment, but a higher rate of hypotension adverse events with losartan.
Collapse
Affiliation(s)
- Leon Di Stefano
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Malathi Ram
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, MD
| | - Daniel O. Scharfstein
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Tianjing Li
- University of Colorado Denver, Anschutz Medical Campus, Denver, CO
| | - Preeti Khanal
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Nichol McBee
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, MD
| | - Charles D. Bengtson
- Department of Internal Medicine, University of Kansas Medical Center, KS City, KS
| | - Anne Gadomski
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY
| | | | - Michael A. Puskarich
- Department of Emergency Medicine, University of Minnesota, Minneapolis, MN
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Matthias A. Salathe
- Department of Internal Medicine, University of Kansas Medical Center, KS City, KS
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, NSW, Australia
| | | | - Jennifer Victory
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY
| | - Barbara E. Bierer
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Johns Hopkins School of Medicine, Baltimore, MD
| | - Daniel A. Freilich
- Bassett Research Institute, Bassett Medical Center, Cooperstown, NY
- Department of Internal Medicine, Division of Infectious Diseases, Bassett Medical Center, Cooperstown, NY
| |
Collapse
|
9
|
Bakkum L, Verhage ML, Schuengel C, Duschinsky R, Cornelisz I, van Klaveren C, van IJzendoorn MH, Raby KL, Roisman GI, Bakermans-Kranenburg MJ, Oosterman M, Madigan S, Fearon RMP, Behrens K. Exploring the meaning of unresolved loss and trauma in more than 1,000 Adult Attachment Interviews. Dev Psychopathol 2023; 35:587-603. [PMID: 35272727 PMCID: PMC10655611 DOI: 10.1017/s0954579421001735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Unresolved states of mind regarding experiences of loss/abuse (U/d) are identified through lapses in the monitoring of reasoning, discourse, and behavior surrounding loss/abuse in response to the Adult Attachment Interview. Although the coding system for U/d has been widely used for decades, the individual indicators of unresolved loss/abuse have not been validated independently of the development sample. This study examined the psychometric validity of U/d, using individual participant data from 1,009 parent-child dyads across 13 studies. A latent class analysis showed that subsets of commonly occurring U/d indicators could differentiate interviewees with or without unresolved loss/abuse. Predictive models suggested a psychometric model of U/d consisting of a combination of these common indicators, with disbelief and psychologically confused statements regarding loss being especially important indicators of U/d. This model weakly predicted infant disorganized attachment. Multilevel regression analysis showed no significant association between ratings of unresolved other trauma and infant disorganized attachment, over and above ratings of unresolved loss/abuse. Altogether, these findings suggest that the coding system of U/d may have been overfitted to the initial development sample. Directions for further articulation and optimization of U/d are provided.
Collapse
Affiliation(s)
- Lianne Bakkum
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Clinical Child and Family Studies and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marije L Verhage
- Department of Clinical Child and Family Studies and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carlo Schuengel
- Department of Clinical Child and Family Studies and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ilja Cornelisz
- Amsterdam Center for Learning Analytics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris van Klaveren
- Amsterdam Center for Learning Analytics, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marinus H van IJzendoorn
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - K Lee Raby
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Glenn I Roisman
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Marian J Bakermans-Kranenburg
- Department of Clinical Child and Family Studies and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mirjam Oosterman
- Department of Clinical Child and Family Studies and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sheri Madigan
- Department of Psychology, University of Calgary and the Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - R M Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Kazuko Behrens
- Department of Social & Behavioral Sciences, State University of New York Polytechnic Institute, Utica, NY, USA
| |
Collapse
|
10
|
Moutchia J, McClelland RL, Al-Naamani N, Appleby DH, Blank K, Grinnan D, Holmes JH, Mathai SC, Minhas J, Ventetuolo CE, Zamanian RT, Kawut SM. Minimal Clinically Important Difference in the 6-minute-walk Distance for Patients with Pulmonary Arterial Hypertension. Am J Respir Crit Care Med 2023; 207:1070-1079. [PMID: 36629737 PMCID: PMC10112451 DOI: 10.1164/rccm.202208-1547oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Rationale: The 6-minute-walk distance (6MWD) is an important clinical and research metric in pulmonary arterial hypertension (PAH); however, there is no consensus about what minimal change in 6MWD is clinically significant. Objectives: We aimed to determine the minimal clinically important difference in the 6MWD. Methods: We performed a meta-analysis using individual participant data from eight randomized clinical trials of therapy for PAH submitted to the U.S. Food and Drug Administration to derive minimal clinically important differences in the 6MWD. The estimates were externally validated using the Pulmonary Hypertension Association Registry. We anchored the change in 6MWD to the change in the Medical Outcomes Survey Short Form physical component score. Measurements and Main Results: The derivation (clinical trial) and validation (Pulmonary Hypertension Association Registry) samples were comprised of 2,404 and 537 adult patients with PAH, respectively. The mean ± standard deviation age of the derivation sample was 50.5 ± 15.2 years, and 1,849 (77%) were female, similar to the validation sample. The minimal clinically important difference in the derivation sample was 33 meters (95% confidence interval, 27-38), which was almost identical to that in the validation sample (36 m [95% confidence interval, 29-43]). The minimal clinically important difference did not differ by age, sex, race, pulmonary hypertension etiology, body mass index, use of background therapy, or World Health Organization functional class. Conclusions: We estimated a 6MWD minimal clinically important difference of approximately 33 meters for adults with PAH. Our findings can be applied to the design of clinical trials of therapies for PAH.
Collapse
Affiliation(s)
- Jude Moutchia
- Department of Biostatistics, Epidemiology, and Informatics and
| | - Robyn L. McClelland
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Nadine Al-Naamani
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dina H. Appleby
- Department of Biostatistics, Epidemiology, and Informatics and
| | - Kristina Blank
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Dan Grinnan
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - John H. Holmes
- Department of Biostatistics, Epidemiology, and Informatics and
| | - Stephen C. Mathai
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jasleen Minhas
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Corey E. Ventetuolo
- Departments of Medicine and Health Services, Policy and Practice, Brown University, Providence, Rhode Island; and
| | - Roham T. Zamanian
- Department of Medicine, School of Medicine, Stanford University, Palo Alto, California
| | - Steven M. Kawut
- Department of Biostatistics, Epidemiology, and Informatics and
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
11
|
Storosum BWC, Steinz C, Cohen SE, Mattila T, Brink WVD, Roes K, de Haan L, Denys DAJP, Zantvoord JB. Ethnic differences in response to atypical antipsychotics in patients with schizophrenia: individual patient data meta-analysis of randomised placebo-controlled registration trials submitted to the Dutch Medicines Evaluation Board. BJPsych Open 2023; 9:e45. [PMID: 36861144 PMCID: PMC10044330 DOI: 10.1192/bjo.2023.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Little is known about the effect of ethnicity on the response to antipsychotic medication in patients with schizophrenia. AIMS To determine whether ethnicity moderates the response to antipsychotic medication in patients with schizophrenia, and whether this moderation is independent of confounders. METHOD We analysed 18 short-term, placebo-controlled registration trials of atypical antipsychotic medications in patients with schizophrenia (N = 3880). A two-step, random-effects, individual patient data meta-analysis was applied to establish the moderating effect of ethnicity (White versus Black) on symptom improvement according to the Brief Psychiatric Rating Scale (BPRS) and on response, defined as >30% BPRS reduction. These analyses were corrected for baseline severity, baseline negative symptoms, age and gender. A conventional meta-analysis was performed to determine the effect size of antipsychotic treatment for each ethnic group separately. RESULTS In the complete data-set, 61% of patients were White, 25.6% of patients were Black and 13.4% of patients were of other ethnicities. Ethnicity did not moderate the efficacy of antipsychotic treatment: pooled β-coefficient for the interaction between treatment and ethnic group was -0.582 (95% CI -2.567 to 1.412) for mean BPRS change, with an odds ratio of 0.875 (95% CI 0.510-1.499) for response. These results were not modified by confounders. CONCLUSIONS Atypical antipsychotic medication is equally effective in both Black and White patients with schizophrenia. In registration trials, White and Black patients were overrepresented relative to other ethnic groups, limiting the generalisability of our findings.
Collapse
Affiliation(s)
- Bram W C Storosum
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Cedrine Steinz
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Sem E Cohen
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Taina Mattila
- Department of CNS Products, Medicines Evaluation Board, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| | - Kit Roes
- Biostatistics Research Group, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, The Netherlands; Amsterdam Neuroscience, University of Amsterdam, The Netherlands; and Department of Research, Arkin Institute for Mental Health, The Netherlands
| | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, The Netherlands; Amsterdam Neuroscience, University of Amsterdam, The Netherlands; and Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, The Netherlands
| | - Jasper B Zantvoord
- Department of Psychiatry, Amsterdam UMC, The Netherlands; and Amsterdam Neuroscience, University of Amsterdam, The Netherlands
| |
Collapse
|
12
|
Sotiropoulos JX, Schmölzer GM, Oei JL, Libesman S, Hunter KE, Williams JG, Webster AC, Tarnow-Mordi WO, Vento M, Asztalos E, Shah PS, Katheria A, Seidler AL. PROspective Meta-analysis Of Trials of Initial Oxygen in preterm Newborns (PROMOTION): Protocol for a systematic review and prospective meta-analysis with individual participant data on initial oxygen concentration for resuscitation of preterm infants. Acta Paediatr 2023; 112:372-382. [PMID: 36484640 DOI: 10.1111/apa.16622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/15/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinicians favour low oxygen concentrations when resuscitating preterm infants immediately after birth despite inconclusive evidence to support this practice. Prospective meta-analysis (PMA) is a novel approach where studies are identified as eligible for inclusion in the meta-analysis before their results are known. AIMS To explore whether high (60%) or low (30%) oxygen is associated with greater efficacy and safety for the initial resuscitation (immediately after birth) of preterm infants born at <29 weeks' gestation. METHODS We will conduct a prospective meta-analysis (PMA) with individual participant data (IPD). We will perform a systematic search to identify ongoing RCTs including infants <29 weeks' gestation randomised to high (60%) or low (30%) oxygen for initial resuscitation after birth. IPD will be sought for all infants randomised for the purpose of meta-analysis. We will employ a one-stage random-effects approach to IPD meta-analysis. Potential heterogeneity and the differential effect of high or low oxygen will be explored through subgroup and interaction analyses. The primary outcome of this study is all-cause mortality prior to hospital discharge. There will be a follow-up analysis of neurodevelopmental outcomes once available. RESULTS/CONCLUSION The results of neonatal outcomes at hospital discharge are expected by 2025, and neurodevelopmental outcomes by 2027.
Collapse
Affiliation(s)
- James X Sotiropoulos
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.,Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Georg M Schmölzer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Centre for the Studies of Asphyxia and Resuscitation, Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Ju Lee Oei
- School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.,Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Sol Libesman
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Kylie E Hunter
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Jonathan G Williams
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Angela C Webster
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - William O Tarnow-Mordi
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Maximo Vento
- University and Polytechnic Hospital La Fe (HULAFE), Valencia, Spain.,Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Elizabeth Asztalos
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pedaitrics, University of Toronto, Toronto, Ontario, Canada
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anup Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
13
|
Mewton L, Visontay R, Hoy N, Lipnicki DM, Sunderland M, Lipton RB, Guerchet M, Ritchie K, Najar J, Scarmeas N, Kim K, Riedel Heller S, van Boxtel M, Jacobsen E, Brodaty H, Anstey KJ, Haan M, Scazufca M, Lobo E, Sachdev PS. The relationship between alcohol use and dementia in adults aged more than 60 years: a combined analysis of prospective, individual-participant data from 15 international studies. Addiction 2023; 118:412-424. [PMID: 35993434 PMCID: PMC9898084 DOI: 10.1111/add.16035] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/04/2022] [Indexed: 02/06/2023]
Abstract
AIM To synthesize international findings on the alcohol-dementia relationship, including representation from low- and middle-income countries. METHODS Individual participant data meta-analysis of 15 prospective epidemiological cohort studies from countries situated in six continents. Cox regression investigated the dementia risk associated with alcohol use in older adults aged over 60 years. Additional analyses assessed the alcohol-dementia relationship in the sample stratified by sex and by continent. Participants included 24 478 community dwelling individuals without a history of dementia at baseline and at least one follow-up dementia assessment. The main outcome measure was all-cause dementia as determined by clinical interview. RESULTS At baseline, the mean age across studies was 71.8 (standard deviation = 7.5, range = 60-102 years), 14 260 (58.3%) were female and 13 269 (54.2%) were current drinkers. During 151 636 person-years of follow-up, there were 2124 incident cases of dementia (14.0 per 1000 person-years). When compared with abstainers, the risk for dementia was lower in occasional [hazard ratio (HR) = 0.78; 95% confidence interval (CI) = 0.68-0.89], light-moderate (HR = 0.78; 95% CI = 0.70-0.87) and moderate-heavy drinkers (HR = 0.62; 95% CI = 0.51-0.77). There was no evidence of differences between life-time abstainers and former drinkers in terms of dementia risk (HR = 0.98; 95% CI = 0.81-1.18). In dose-response analyses, moderate drinking up to 40 g/day was associated with a lower risk of dementia when compared with lif-time abstaining. Among current drinkers, there was no consistent evidence for differences in terms of dementia risk. Results were similar when the sample was stratified by sex. When analysed at the continent level, there was considerable heterogeneity in the alcohol-dementia relationship. CONCLUSIONS Abstinence from alcohol appears to be associated with an increased risk for all-cause dementia. Among current drinkers, there appears to be no consistent evidence to suggest that the amount of alcohol consumed in later life is associated with dementia risk.
Collapse
Affiliation(s)
- Louise Mewton
- Centre for Healthy Brain AgeingUniversity of New South WalesSydneyAustralia
| | - Rachel Visontay
- Centre for Healthy Brain AgeingUniversity of New South WalesSydneyAustralia
| | - Nicholas Hoy
- Centre for Healthy Brain AgeingUniversity of New South WalesSydneyAustralia
| | - Darren M. Lipnicki
- Centre for Healthy Brain AgeingUniversity of New South WalesSydneyAustralia
| | | | - Richard B. Lipton
- The Matilda Centre for Mental Health and Substance UseUniversity of SydneySydneyAustralia
- Saul R. Korey, Department of Neurology, Albert Einstein College of MedicineYeshiva UniversityNew YorkNYUSA
- Department of Epidemiology and Population Health, Albert Einstein College of MedicineYeshiva UniversityNew YorkNYUSA
| | - Maëlenn Guerchet
- Department of Psychiatry and Behavioral Medicine, Albert Einstein College of MedicineYeshiva UniversityNew YorkNYUSA
| | - Karen Ritchie
- Limoges University, CHU Limoges, EpiMaCT, Institute of Epidemiology and Tropical Neurology, OmegaHealthLimogesFrance
- Neuropsychiatry, Epidemiological and Clinical Research, La Colombière HospitalMontpellierFrance
- Université de MontpellierMontpellierFrance
| | - Jenna Najar
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiology, Sahlgrenska Academy, Centre for Ageing and Health (AGECAP) at the University of GothenburgMölndalSweden
| | - Nikolaos Scarmeas
- Region Västra GötalandSahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry ClinicGothenburgSweden
- Department of Neurology, Aiginition HospitalNational and Kapodistrian University of AthensAthensGreece
| | - Ki‐Woong Kim
- Department of NeurologyColumbia UniversityNew YorkNYUSA
- Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamSouth Korea
- Department of Psychiatry, College of MedicineSeoul National UniversitySeoulSouth Korea
| | - Steffi Riedel Heller
- Department of Brain and Cognitive SciencesSeoul National UniversitySeoulSouth Korea
| | - Martin van Boxtel
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical FacultyUniversity of LeipzigLeipzigGermany
| | - Erin Jacobsen
- School for Mental Health and Neuroscience/Alzheimer Centrum Limburg, Department of Psychiatry and NeuropsychologyMaastricht UniversityMaastrichtthe Netherlands
| | - Henry Brodaty
- Centre for Healthy Brain AgeingUniversity of New South WalesSydneyAustralia
| | - Kaarin J. Anstey
- Department of Psychiatry, School of MedicineUniversity of PittsburghPittsburghPAUSA
- School of PsychologyUniversity of New South WalesSydneyAustralia
- Neuroscience Research AustraliaUniversity of New South WalesSydneyAustralia
| | - Mary Haan
- Centre for Research on Ageing, Health and WellbeingAustralian National UniversityCanberraAustralia
| | - Marcia Scazufca
- Department of Epidemiology and Biostatistics, School of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Elena Lobo
- LIM‐23, Hospital das Clinicas (HCFMUSP), Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
- Department of Preventive Medicine and Public HealthUniversidad de ZaragozaZaragozaSpain
- Instituto de Investigacion Sanitaria AragonZaragozaSpain
| | - Perminder S. Sachdev
- Centre for Healthy Brain AgeingUniversity of New South WalesSydneyAustralia
- Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM)Ministry of Science and InnovationMadridSpain
| | | |
Collapse
|
14
|
van IJzendoorn MH, Schuengel C, Wang Q, Bakermans-Kranenburg MJ. Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline. Dev Psychopathol 2023; 35:241-56. [PMID: 35034668 DOI: 10.1017/S0954579421001462] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Improving parenting, child attachment, and externalizing behaviors: Meta-analysis of the first 25 randomized controlled trials on the effects of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). VIPP-SD combines support of parental sensitive responsiveness with coaching parents in sensitive limit setting. Here, we present meta-analyses of 25 RCTs conducted with more than 2,000 parents and caregivers. Parents or children had various risks. We examined its effectiveness in promoting parental cognitions and behavior regarding sensitive parenting and limit setting, in promoting secure child-parent attachment, and reducing externalizing child behavior. Web of Science, MEDLINE, PubMed, and recent reviews were searched for relevant trials (until May 10, 2021). Multilevel meta-analysis with META, METAFOR, and DMETAR in R took account of the 3-level structure of the datasets (studies, participants, measures). The meta-analyses showed substantial combined effect sizes for parenting behavior (r = .18) and attitudes (r = .16), and for child attachment security (r = .23), but not for child externalizing behavior (r = .07). In the subset of studies examining effects on both parenting and attachment, the association between effect sizes for parenting and for attachment amounted to r = .48. We consider the way in which VIPP-SD uses video-feedback an active intervention component. Whether VIPP-SD indeed stimulates secure attachment through enhanced positive parenting remains an outstanding question for further experimental study and individual participant data meta-analysis.
Collapse
|
15
|
Driessen E, Cohen ZD, Lorenzo-Luaces L, Hollon SD, Richards DA, Dobson KS, Dimidjian S, Delgadillo J, Vázquez FL, McNamara K, Horan JJ, Gardner P, Oei TP, Mehta AHP, Twisk JWR, Cristea IA, Cuijpers P. Efficacy and moderators of cognitive therapy versus behavioural activation for adults with depression: study protocol of a systematic review and meta-analysis of individual participant data. BJPsych Open 2022; 8:e154. [PMID: 35946068 PMCID: PMC9379999 DOI: 10.1192/bjo.2022.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive therapy and behavioural activation are both widely applied and effective psychotherapies for depression, but it is unclear which works best for whom. Individual participant data (IPD) meta-analysis allows for examining moderators at the participant level and can provide more precise effect estimates than conventional meta-analysis, which is based on study-level data. AIMS This article describes the protocol for a systematic review and IPD meta-analysis that aims to compare the efficacy of cognitive therapy and behavioural activation for adults with depression, and to explore moderators of treatment effect. (PROSPERO: CRD42022341602). METHOD Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library, to identify randomised clinical trials comparing cognitive therapy and behavioural activation for adult acute-phase depression. Investigators of these trials will be invited to share their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to assess treatment effects and to examine various available demographic, clinical and psychological participant characteristics as potential moderators. The primary outcome measure will be depressive symptom level at treatment completion. Secondary outcomes will include post-treatment anxiety, interpersonal functioning and quality of life, as well as follow-up outcomes. CONCLUSIONS To the best of our knowledge, this will be the first IPD meta-analysis concerning cognitive therapy versus behavioural activation for adult depression. This study has the potential to enhance our knowledge of depression treatment by using state-of-the-art statistical techniques to compare the efficacy of two widely used psychotherapies, and by shedding more light on which of these treatments might work best for whom.
Collapse
Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, The Netherlands; and Depression Expertise Center, Pro Persona Mental Health Care, The Netherlands
| | - Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | | | | | - David A Richards
- Department of Health and Community Science, Faculty of Health and Life Sciences, University of Exeter, UK; and Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
| | | | - Sona Dimidjian
- Crown Institute and Department of Psychology and Neuroscience, University of Colorado Boulder, USA
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, University of Sheffield, UK
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Spain
| | | | - John J Horan
- Counseling Psychology Program, Arizona State University, USA
| | - Pauline Gardner
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Australia
| | - Tian P Oei
- School of Psychology, The University of Queensland, Australia
| | - Anuj H P Mehta
- Department of Psychology, University of Toronto Scarborough, Canada
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, The Netherlands
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia; and IRCCS Mondino Foundation, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| |
Collapse
|
16
|
Hufstedler H, Rahman S, Danzer AM, Goymann H, de Jong VMT, Campbell H, Gustafson P, Debray TPA, Jaenisch T, Maxwell L, Matthay EC, Bärnighausen T. Systematic Review Reveals Lack of Causal Methodology Applied to Pooled Longitudinal Observational Infectious Disease Studies. J Clin Epidemiol 2022; 145:29-38. [PMID: 35045316 DOI: 10.1016/j.jclinepi.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Among ID studies seeking to make causal inferences and pooling individual-level longitudinal data from multiple infectious disease cohorts, we sought to assess what methods are being used, how those methods are being reported, and whether these factors have changed over time. STUDY DESIGN AND SETTING Systematic review of longitudinal observational infectious disease studies pooling individual-level patient data from 2+ studies published in English in 2009. 2014, or 2019. This systematic review protocol is registered with PROSPERO (CRD42020204104). RESULTS Our search yielded 1,462 unique articles. Of these, 16 were included in the final review. Our analysis showed a lack of causal inference methods and of clear reporting on methods and the required assumptions. CONCLUSION There are many approaches to causal inference which may help facilitate accurate inference in the presence of unmeasured and time-varying confounding. In observational ID studies leveraging pooled, longitudinal IPD, the absence of these causal inference methods and gaps in the reporting of key methodological considerations suggests there is ample opportunity to enhance the rigor and reporting of research in this field. Interdisciplinary collaborations between substantive and methodological experts would strengthen future work.
Collapse
Affiliation(s)
- Heather Hufstedler
- Heidelberg Institute of Global Health, Heidelberg Medical School, Heidelberg University, Germany.
| | - Sabahat Rahman
- University of Massachusetts Medical School, University of Massachusetts, Worcester, Massachusetts, United States
| | - Alexander M Danzer
- KU Eichstätt-Ingolstadt, Ingolstadt School of Management and Economics (WFI), Germany; IZA Bonn, Germany; CESifo Munich, Germany
| | - Hannah Goymann
- Heidelberg Institute of Global Health, Heidelberg Medical School, Heidelberg University, Germany
| | - Valentijn M T de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Harlan Campbell
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health, Heidelberg Medical School, Heidelberg University, Germany; Center for Global Health, Colorado School of Public Health, Aurora, Colorado, United States; Department of Epidemiology, Colorado School of Public Health, Aurora, United States
| | - Lauren Maxwell
- Heidelberg Institute of Global Health, Heidelberg Medical School, Heidelberg University, Germany
| | - Ellicott C Matthay
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg Medical School, Heidelberg University, Germany; Harvard T H Chan School of Public Health, Harvard University, Boston, Massachusetts, United States
| |
Collapse
|
17
|
Miller P, Brinkmann DJ, Ramsenthaler C, Gollhofer A, Gehring D. Mind your step: predicting maximum ankle inversion during cutting movements in soccer. Sports Biomech 2021:1-15. [PMID: 34515622 DOI: 10.1080/14763141.2021.1974533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
The objective of this investigation was to identify parameters at initial contact that would predict the subsequent maximum ankle inversion angle during cutting movements. We conducted a secondary data analysis and calculated kinematics of 1,400 cuttings performed by 46 male soccer athletes. The movement task consisted of an approach run, followed by a pre-planned cutting movement. A linear mixed regression model was applied to predict the maximum ankle inversion angle during the first 100 ms of ground contact. The prediction was made based on six predictors that describe change-of-direction intensity and foot placement as found to be relevant in the literature. The model explained 62% of the variance of maximum ankle inversion angles. A change of the main predictors (foot rotation, cutting angle and initial ankle inversion) by 1 SD caused a reduction of the subsequent maximum ankle inversion angle by 2.6-4.4°. Regarding the intensity of a change-of-direction movement, cutting angle seems to have a higher influence on maximum ankle inversion angle than approach velocity. With respect to the individual foot positioning, the maximum ankle inversion angle can be reduced by increasing exorotation and eversion of the foot while shifting towards forefoot landing.
Collapse
Affiliation(s)
- Paul Miller
- Department of Sport and Sports Science, University of Freiburg, Freiburg, Germany
| | - Daniel J Brinkmann
- Department of Sport and Sports Science, University of Freiburg, Freiburg, Germany
| | | | - Albert Gollhofer
- Department of Sport and Sports Science, University of Freiburg, Freiburg, Germany
| | - Dominic Gehring
- Department of Sport and Sports Science, University of Freiburg, Freiburg, Germany
| |
Collapse
|
18
|
Abstract
Short-term psychodynamic psychotherapy (STPP) is an empirically supported treatment for depression that is frequently applied in clinical practice. However, it remains largely unclear which patients can benefit specifically from STPP for depression, because studies often have small sample sizes and, therefore, lack statistical power to examine patient characteristics associated with differential treatment efficacy. Individual participant data (IPD) meta-analyses, which combine patient-level data from multiple studies, can help overcome this obstacle. Currently, the first IPD meta-analysis project regarding STPP for depression is being conducted. We describe this project, its progress, and first findings.
Collapse
Affiliation(s)
- Frederik J Wienicke
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, and Depression Expertise Centre, Pro Persona Mental Health Care, Nijmegen, Netherlands
| |
Collapse
|
19
|
Neupane D, Levis B, Bhandari PM, Thombs BD, Benedetti A. Selective cutoff reporting in studies of the accuracy of the Patient Health Questionnaire-9 and Edinburgh Postnatal Depression Scale: Comparison of results based on published cutoffs versus all cutoffs using individual participant data meta-analysis. Int J Methods Psychiatr Res 2021; 30:e1873. [PMID: 33978306 PMCID: PMC8412225 DOI: 10.1002/mpr.1873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/16/2021] [Accepted: 04/01/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Selectively reported results from only well-performing cutoffs in diagnostic accuracy studies may bias estimates in meta-analyses. We investigated cutoff reporting patterns for the Patient Health Questionnaire-9 (PHQ-9; standard cutoff 10) and Edinburgh Postnatal Depression Scale (EPDS; no standard cutoff, commonly used 10-13) and compared accuracy estimates based on published cutoffs versus all cutoffs. METHODS We conducted bivariate random effects meta-analyses using individual participant data to compare accuracy from published versus all cutoffs. RESULTS For the PHQ-9 (30 studies, N = 11,773), published results underestimated sensitivity for cutoffs below 10 (median difference: -0.06) and overestimated for cutoffs above 10 (median difference: 0.07). EPDS (19 studies, N = 3637) sensitivity estimates from published results were similar for cutoffs below 10 (median difference: 0.00) but higher for cutoffs above 13 (median difference: 0.14). Specificity estimates from published and all cutoffs were similar for both tools. The mean cutoff of all reported cutoffs in PHQ-9 studies with optimal cutoff below 10 was 8.8 compared to 11.8 for those with optimal cutoffs above 10. Mean for EPDS studies with optimal cutoffs below 10 was 9.9 compared to 11.8 for those with optimal cutoffs greater than 10. CONCLUSION Selective cutoff reporting was more pronounced for the PHQ-9 than EPDS.
Collapse
Affiliation(s)
- Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Parash M Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.,Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada
| | | |
Collapse
|
20
|
Hahn JA, Murnane PM, Vittinghoff E, Muyindike WR, Emenyonu NI, Fatch R, Chamie G, Haberer JE, Francis JM, Kapiga S, Jacobson K, Myers B, Couture MC, DiClemente RJ, Brown JL, So-Armah K, Sulkowski M, Marcus GM, Woolf-King S, Cook RL, Richards VL, Molina P, Ferguson T, Welsh D, Piano MR, Phillips SA, Stewart S, Afshar M, Page K, McGinnis K, Fiellin DA, Justice AC, Bryant K, Saitz R. Factors associated with phosphatidylethanol (PEth) sensitivity for detecting unhealthy alcohol use: An individual patient data meta-analysis. Alcohol Clin Exp Res 2021; 45:1166-1187. [PMID: 33837975 PMCID: PMC8254773 DOI: 10.1111/acer.14611] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Objective measurement of alcohol consumption is important for clinical care and research. Adjusting for self-reported alcohol use, we conducted an individual participant data (IPD) meta-analysis to examine factors associated with the sensitivity of phosphatidylethanol (PEth), an alcohol metabolite, among persons self-reporting unhealthy alcohol consumption. METHODS We identified 21 eligible studies and obtained 4073 observations from 3085 participants with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive scores (≥3 for women and ≥4 for men) and PEth measurements. We conducted 1-step IPD meta-analysis using mixed effects models with random intercepts for study site. We examined the associations between demographic (sex, race/ethnicity, and age) and biologic (body mass index-BMI, hemoglobin, HIV status, liver fibrosis, and venous versus finger-prick blood collection) variables with PEth sensitivity (PEth≥8 ng/ml), adjusting for the level of self-reported alcohol use using the AUDIT-C score. RESULTS One third (31%) of participants were women, 32% were African, 28% African American, 28% White, and 12% other race/ethnicity. PEth sensitivity (i.e., ≥8 ng/ml) was 81.8%. After adjusting for AUDIT-C, we found no associations of sex, age, race/ethnicity, or method of blood collection with PEth sensitivity. In models that additionally included biologic variables, those with higher hemoglobin and indeterminate and advanced liver fibrosis had significantly higher odds of PEth sensitivity; those with higher BMI and those living with HIV had significantly lower odds of PEth sensitivity. African Americans and Africans had higher odds of PEth sensitivity than whites in models that included biologic variables. CONCLUSIONS Among people reporting unhealthy alcohol use, several biological factors (hemoglobin, BMI, liver fibrosis, and HIV status) were associated with PEth sensitivity. Race/ethnicity was associated with PEth sensitivity in some models but age, sex, and method of blood collection were not. Clinicians should be aware of these factors, and researchers should consider adjusting analyses for these characteristics where possible.
Collapse
Affiliation(s)
- Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Pamela M Murnane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Winnie R Muyindike
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gabriel Chamie
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Joel M Francis
- National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Department of Family Medicine and Primary Care, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Saidi Kapiga
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Jacobson
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Ralph J DiClemente
- Department of Social and Behavioral Sciences, NYU School of Global Public Health, New York, NY, USA
| | - Jennifer L Brown
- Department of Psychology and Psychiatry and Behavioral Neuroscience, Center for Addiction Research, University of Cincinnati, Cincinnati, OH, USA
| | - Kaku So-Armah
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Mark Sulkowski
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gregory M Marcus
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Woolf-King
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Robert L Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | | | - Patricia Molina
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tekeda Ferguson
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - David Welsh
- Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Department of Internal Medicine, Department of Microbiology, Immunology, & Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Mariann R Piano
- Center for Research Development and Scholarship, Vanderbilt University, Nashville, TN, USA
| | | | - Scott Stewart
- Department of Family Medicine, Division of Addiction Medicine, University at Buffalo, Buffalo, NY, USA
| | - Majid Afshar
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Kathleen McGinnis
- West Haven VA Healthcare System, United States Department of Veterans Affairs, West Haven, CT, USA
| | - David A Fiellin
- Yale School of Medicine, New Haven, CT, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - Amy C Justice
- West Haven VA Healthcare System, United States Department of Veterans Affairs, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
| | - Kendall Bryant
- National Institutes of Health, National Institute of Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Richard Saitz
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
- Section of General Internal Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Grayken Center on Addiction, Boston Medical Center, Boston, MA, USA
| |
Collapse
|
21
|
Keats EC, Akseer N, Thurairajah P, Cousens S, Bhutta ZA. Multiple-micronutrient supplementation in pregnant adolescents in low- and middle-income countries: a systematic review and a meta-analysis of individual participant data. Nutr Rev 2021; 80:141-156. [PMID: 33846729 PMCID: PMC8754251 DOI: 10.1093/nutrit/nuab004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Approximately 7.3 million births occur annually among adolescents in low- and middle-income countries. Pregnant adolescents constitute a nutritionally vulnerable group that could benefit from intervention to mitigate the mortality and adverse birth outcomes associated with adolescent pregnancy. OBJECTIVE The aim of this systematic review and meta-analysis was to assess the following: (1) the effect of multiple-micronutrient (MMN) supplementation vs iron and folic acid (IFA) supplementation among adolescents on maternal morbidity, birth outcomes, and mortality outcomes, (2) the effects of MMN supplementation in adolescents compared with the effects in adult women, and (3) the effect modification, if any, of MMN supplementation by baseline and geographic characteristics of adolescents. DATA SOURCES MEDLINE and Cochrane databases were searched, along with the reference lists of relevant reviews. STUDY SELECTION Multiple-micronutrient supplementation trials in pregnancy that were conducted in a low- or middle-income country and had included at least 100 adolescents (10-19 years of age) were eligible for inclusion. Two independent reviewers assessed study eligibility. DATA EXTRACTION Thirteen randomized controlled trials conducted in Africa and Asia were identified from 1792 reviews and 1578 original trials. Individual-level data was shared by study collaborators and was checked for completeness and extreme values. One- and two-stage individual participant data meta-analyses were conducted using data from randomized controlled trials of MMN supplementation. RESULTS A total of 15 283 adolescents and 44 499 adult women with singleton births were included in the individual participant data meta-analyses of MMN supplementation vs IFA supplementation. In adolescents, MMN supplementation reduced low birth weight (1-stage OR = 0.87, 95%CI 0.77-0.97; 2-stage OR = 0.81; 95%CI 0.74-0.88), preterm birth (1-stage OR = 0.88, 95%CI 0.80-0.98; 2-stage OR = 0.86, 95%CI 0.79-0.95), and small-for-gestational-age births (1-stage OR = 0.90, 95%CI 0.81-1.00; 2-stage OR = 0.86, 95%CI 0.79-0.95) when compared with IFA supplementation. The effects of MMN supplementation did not differ between adolescents and older women, although a potentially greater reduction in small-for-gestational-age births was observed among adolescents. Effect modification by baseline characteristics and geographic region was inconclusive. CONCLUSIONS Multiple-micronutrient supplementation can improve birth outcomes among pregnant adolescents in low- and middle-income countries. Policy related to antenatal care in these settings should prioritize MMN supplementation over the currently recommended IFA supplementation for all pregnant women, especially adolescents.
Collapse
Affiliation(s)
- Emily C Keats
- E.C. Keats, N. Akseer, P. Thurairajah, and Z.A. Bhutta are with the Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. S. Cousens is with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Z.A. Bhutta is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Z.A. Bhutta is with the Aga Khan University, Karachi, Pakistan. H. Ali is with the JiVitA Maternal and Child Nutrition and Health Research Project, Gaibandha, Bangladesh. S. El Arifeen is with the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. U. Ashorn is with the Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. J. Belizan is with the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R.E. Black, P. Christian, A.B. Labrique, K. West, and L.S-F. Wu are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. L.M. De-Regil is with Nutrition International, Ottawa, Ontario, Canada. K. Dewey is with the University of California, Davis, Davis, California, USA. M.J. Dibley is with The University of Sydney, Sydney, New South Wales, Australia. W. Fawzi and C.R. Sudfeld are with the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. H. Friis and P. Kaestel are with the University of Copenhagen, Copenhagen, Denmark. E. Gomo is with the University of Zimbabwe, Harare, Zimbabwe. L. Huybregts is with the International Food Policy Research Institute, Washington, DC, USA. R. Jayatissa is with the Medical Research Institute, Colombo, Sri Lanka. S.K. Khatry is with the Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal. P.W. Kolsteren is with Ghent University, Ghent, Belgium. M. McCauley is with the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. B.M. Oaks is with the University of Rhode Island, Kingston, Rhode Island, USA. E. Piwoz is with the Bill & Melinda Gates Foundation, Seattle, Washington, USA. S. Shaikh is with the Society for Applied Studies, New Delhi, India. D.D. Soekarjo is with the Savica Consultancy, Jakarta, Indonesia. W. Urassa is with the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. N. Zagre is with the UNICEF Regional Office for West and Central Africa, Dakar, Senegal. L. Zeng and Z. Zhu are with the School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
| | - Nadia Akseer
- E.C. Keats, N. Akseer, P. Thurairajah, and Z.A. Bhutta are with the Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. S. Cousens is with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Z.A. Bhutta is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Z.A. Bhutta is with the Aga Khan University, Karachi, Pakistan. H. Ali is with the JiVitA Maternal and Child Nutrition and Health Research Project, Gaibandha, Bangladesh. S. El Arifeen is with the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. U. Ashorn is with the Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. J. Belizan is with the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R.E. Black, P. Christian, A.B. Labrique, K. West, and L.S-F. Wu are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. L.M. De-Regil is with Nutrition International, Ottawa, Ontario, Canada. K. Dewey is with the University of California, Davis, Davis, California, USA. M.J. Dibley is with The University of Sydney, Sydney, New South Wales, Australia. W. Fawzi and C.R. Sudfeld are with the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. H. Friis and P. Kaestel are with the University of Copenhagen, Copenhagen, Denmark. E. Gomo is with the University of Zimbabwe, Harare, Zimbabwe. L. Huybregts is with the International Food Policy Research Institute, Washington, DC, USA. R. Jayatissa is with the Medical Research Institute, Colombo, Sri Lanka. S.K. Khatry is with the Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal. P.W. Kolsteren is with Ghent University, Ghent, Belgium. M. McCauley is with the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. B.M. Oaks is with the University of Rhode Island, Kingston, Rhode Island, USA. E. Piwoz is with the Bill & Melinda Gates Foundation, Seattle, Washington, USA. S. Shaikh is with the Society for Applied Studies, New Delhi, India. D.D. Soekarjo is with the Savica Consultancy, Jakarta, Indonesia. W. Urassa is with the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. N. Zagre is with the UNICEF Regional Office for West and Central Africa, Dakar, Senegal. L. Zeng and Z. Zhu are with the School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
| | - Pravheen Thurairajah
- E.C. Keats, N. Akseer, P. Thurairajah, and Z.A. Bhutta are with the Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. S. Cousens is with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Z.A. Bhutta is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Z.A. Bhutta is with the Aga Khan University, Karachi, Pakistan. H. Ali is with the JiVitA Maternal and Child Nutrition and Health Research Project, Gaibandha, Bangladesh. S. El Arifeen is with the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. U. Ashorn is with the Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. J. Belizan is with the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R.E. Black, P. Christian, A.B. Labrique, K. West, and L.S-F. Wu are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. L.M. De-Regil is with Nutrition International, Ottawa, Ontario, Canada. K. Dewey is with the University of California, Davis, Davis, California, USA. M.J. Dibley is with The University of Sydney, Sydney, New South Wales, Australia. W. Fawzi and C.R. Sudfeld are with the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. H. Friis and P. Kaestel are with the University of Copenhagen, Copenhagen, Denmark. E. Gomo is with the University of Zimbabwe, Harare, Zimbabwe. L. Huybregts is with the International Food Policy Research Institute, Washington, DC, USA. R. Jayatissa is with the Medical Research Institute, Colombo, Sri Lanka. S.K. Khatry is with the Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal. P.W. Kolsteren is with Ghent University, Ghent, Belgium. M. McCauley is with the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. B.M. Oaks is with the University of Rhode Island, Kingston, Rhode Island, USA. E. Piwoz is with the Bill & Melinda Gates Foundation, Seattle, Washington, USA. S. Shaikh is with the Society for Applied Studies, New Delhi, India. D.D. Soekarjo is with the Savica Consultancy, Jakarta, Indonesia. W. Urassa is with the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. N. Zagre is with the UNICEF Regional Office for West and Central Africa, Dakar, Senegal. L. Zeng and Z. Zhu are with the School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
| | - Simon Cousens
- E.C. Keats, N. Akseer, P. Thurairajah, and Z.A. Bhutta are with the Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. S. Cousens is with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Z.A. Bhutta is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Z.A. Bhutta is with the Aga Khan University, Karachi, Pakistan. H. Ali is with the JiVitA Maternal and Child Nutrition and Health Research Project, Gaibandha, Bangladesh. S. El Arifeen is with the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. U. Ashorn is with the Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. J. Belizan is with the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R.E. Black, P. Christian, A.B. Labrique, K. West, and L.S-F. Wu are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. L.M. De-Regil is with Nutrition International, Ottawa, Ontario, Canada. K. Dewey is with the University of California, Davis, Davis, California, USA. M.J. Dibley is with The University of Sydney, Sydney, New South Wales, Australia. W. Fawzi and C.R. Sudfeld are with the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. H. Friis and P. Kaestel are with the University of Copenhagen, Copenhagen, Denmark. E. Gomo is with the University of Zimbabwe, Harare, Zimbabwe. L. Huybregts is with the International Food Policy Research Institute, Washington, DC, USA. R. Jayatissa is with the Medical Research Institute, Colombo, Sri Lanka. S.K. Khatry is with the Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal. P.W. Kolsteren is with Ghent University, Ghent, Belgium. M. McCauley is with the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. B.M. Oaks is with the University of Rhode Island, Kingston, Rhode Island, USA. E. Piwoz is with the Bill & Melinda Gates Foundation, Seattle, Washington, USA. S. Shaikh is with the Society for Applied Studies, New Delhi, India. D.D. Soekarjo is with the Savica Consultancy, Jakarta, Indonesia. W. Urassa is with the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. N. Zagre is with the UNICEF Regional Office for West and Central Africa, Dakar, Senegal. L. Zeng and Z. Zhu are with the School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
| | - Zulfiqar A Bhutta
- E.C. Keats, N. Akseer, P. Thurairajah, and Z.A. Bhutta are with the Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada. S. Cousens is with the London School of Hygiene & Tropical Medicine, London, United Kingdom. Z.A. Bhutta is with the Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Z.A. Bhutta is with the Aga Khan University, Karachi, Pakistan. H. Ali is with the JiVitA Maternal and Child Nutrition and Health Research Project, Gaibandha, Bangladesh. S. El Arifeen is with the International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh. U. Ashorn is with the Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. J. Belizan is with the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. R.E. Black, P. Christian, A.B. Labrique, K. West, and L.S-F. Wu are with the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. L.M. De-Regil is with Nutrition International, Ottawa, Ontario, Canada. K. Dewey is with the University of California, Davis, Davis, California, USA. M.J. Dibley is with The University of Sydney, Sydney, New South Wales, Australia. W. Fawzi and C.R. Sudfeld are with the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. H. Friis and P. Kaestel are with the University of Copenhagen, Copenhagen, Denmark. E. Gomo is with the University of Zimbabwe, Harare, Zimbabwe. L. Huybregts is with the International Food Policy Research Institute, Washington, DC, USA. R. Jayatissa is with the Medical Research Institute, Colombo, Sri Lanka. S.K. Khatry is with the Nepal Nutrition Intervention Project-Sarlahi, Kathmandu, Nepal. P.W. Kolsteren is with Ghent University, Ghent, Belgium. M. McCauley is with the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. B.M. Oaks is with the University of Rhode Island, Kingston, Rhode Island, USA. E. Piwoz is with the Bill & Melinda Gates Foundation, Seattle, Washington, USA. S. Shaikh is with the Society for Applied Studies, New Delhi, India. D.D. Soekarjo is with the Savica Consultancy, Jakarta, Indonesia. W. Urassa is with the Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. N. Zagre is with the UNICEF Regional Office for West and Central Africa, Dakar, Senegal. L. Zeng and Z. Zhu are with the School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
| | | |
Collapse
|
22
|
Lyubenova A, Neupane D, Levis B, Wu Y, Sun Y, He C, Krishnan A, Bhandari PM, Negeri Z, Imran M, Rice DB, Azar M, Chiovitti MJ, Saadat N, Riehm KE, Boruff JT, Ioannidis JPA, Cuijpers P, Gilbody S, Kloda LA, Patten SB, Shrier I, Ziegelstein RC, Comeau L, Mitchell ND, Tonelli M, Vigod SN, Aceti F, Barnes J, Bavle AD, Beck CT, Bindt C, Boyce PM, Bunevicius A, Chaudron LH, Favez N, Figueiredo B, Garcia-Esteve L, Giardinelli L, Helle N, Howard LM, Kohlhoff J, Kusminskas L, Kozinszky Z, Lelli L, Leonardou AA, Meuti V, Radoš SN, García PN, Pawlby SJ, Quispel C, Robertson-Blackmore E, Rochat TJ, Sharp DJ, Siu BWM, Stein A, Stewart RC, Tadinac M, Tandon SD, Tendais I, Töreki A, Torres-Giménez A, Tran TD, Trevillion K, Turner K, Vega-Dienstmaier JM, Benedetti A, Thombs BD. Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis. Int J Methods Psychiatr Res 2021; 30:e1860. [PMID: 33089942 PMCID: PMC7992289 DOI: 10.1002/mpr.1860] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/28/2020] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies. METHODS We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID. RESULTS Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%). CONCLUSION EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.
Collapse
Affiliation(s)
- Anita Lyubenova
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,School of Primary, Centre for Prognosis Research, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Parash M Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Matthew J Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - John P A Ioannidis
- Department of Medicine, Stanford University, Stanford, California, USA.,Department of Health Research and Policy, Stanford University, Stanford, California, USA.,Department of Biomedical Data Science, Stanford University, Stanford, California, USA.,Department of Statistics, Stanford University, Stanford, California, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Scott B Patten
- Departments of Community Health Sciences and Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada.,Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Liane Comeau
- International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
| | - Nicholas D Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simone N Vigod
- Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Franca Aceti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Amar D Bavle
- Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India
| | - Cheryl T Beck
- University of Connecticut School of Nursing, Mansfield, Connecticut, USA
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philip M Boyce
- Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Psychiatry, Westmead Hospital, Sydney, New South Wales, Australia
| | - Adomas Bunevicius
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linda H Chaudron
- Departments of Psychiatry, Pediatrics, Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Nicolas Favez
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.,IUP, University of Lausanne, Lausanne, Switzerland
| | | | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Lisa Giardinelli
- Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy
| | - Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Louise M Howard
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Kensington, New South Wales, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,Karitane, Carramar, New South Wales, Australia
| | | | - Zoltán Kozinszky
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Lorenzo Lelli
- Department of Health Sciences, Psychiatry Unit, University of Florence, Firenze, Italy
| | - Angeliki A Leonardou
- First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece
| | - Valentina Meuti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Sandra N Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Purificación N García
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Psychology Service, Regidoria de Polítiques de Gènere, Ajuntament de Terrassa, Terrassa, Spain
| | - Susan J Pawlby
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Chantal Quispel
- Department of Obstetrics and Gynaecology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | | | - Tamsen J Rochat
- MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa.,Human and Social Development Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Deborah J Sharp
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bonnie W M Siu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert C Stewart
- Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK.,Malawi Epidemiology and Intervention Research Unit (MEIRU), Lilongwe, Malawi
| | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - S Darius Tandon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Iva Tendais
- School of Psychology, University of Minho, Braga, Portugal
| | | | - Anna Torres-Giménez
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Thach D Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kylee Trevillion
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine Turner
- Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
| | | | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada.,Biomedical Ethics Unit, McGill University, Montréal, Québec, Canada
| |
Collapse
|
23
|
Driessen E, Cohen ZD, Weissman MM, Markowitz JC, Weitz ES, Hollon SD, Browne DT, Rucci P, Corda C, Menchetti M, Bagby RM, Quilty LC, O'Hara MW, Zlotnick C, Pearlstein T, Blom MBJ, Altamura M, Gois C, Schneider LS, Twisk JWR, Cuijpers P. The efficacy of antidepressant medication and interpersonal psychotherapy for adult acute-phase depression: study protocol of a systematic review and meta-analysis of individual participant data. BJPsych Open 2021; 7:e56. [PMID: 33602371 PMCID: PMC8058821 DOI: 10.1192/bjo.2021.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Antidepressant medication and interpersonal psychotherapy (IPT) are both recommended interventions in depression treatment guidelines based on literature reviews and meta-analyses. However, 'conventional' meta-analyses comparing their efficacy are limited by their reliance on reported study-level information and a narrow focus on depression outcome measures assessed at treatment completion. Individual participant data (IPD) meta-analysis, considered the gold standard in evidence synthesis, can improve the quality of the analyses when compared with conventional meta-analysis. AIMS We describe the protocol for a systematic review and IPD meta-analysis comparing the efficacy of antidepressants and IPT for adult acute-phase depression across a range of outcome measures, including depressive symptom severity as well as functioning and well-being, at both post-treatment and follow-up (PROSPERO: CRD42020219891). METHOD We will conduct a systematic literature search in PubMed, PsycINFO, Embase and the Cochrane Library to identify randomised clinical trials comparing antidepressants and IPT in the acute-phase treatment of adults with depression. We will invite the authors of these studies to share the participant-level data of their trials. One-stage IPD meta-analyses will be conducted using mixed-effects models to assess treatment effects at post-treatment and follow-up for all outcome measures that are assessed in at least two studies. CONCLUSIONS This will be the first IPD meta-analysis examining antidepressants versus IPT efficacy. This study has the potential to enhance our knowledge of depression treatment by comparing the short- and long-term effects of two widely used interventions across a range of outcome measures using state-of-the-art statistical techniques.
Collapse
Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, the Netherlands; and Depression Expertise Center, Pro Persona Mental Health Care, the Netherlands
| | - Zachary D Cohen
- Department of Psychiatry, University of California Los Angeles, USA
| | - Myrna M Weissman
- Columbia University Vagelos College of Physicians & Surgeons, New York State Psychiatric Institute, USA
| | - John C Markowitz
- Columbia University Vagelos College of Physicians & Surgeons, New York State Psychiatric Institute, USA
| | - Erica S Weitz
- Department of Psychology, University of Pennsylvania, USA
| | | | | | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Carolina Corda
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - R Michael Bagby
- Departments of Psychology and Psychiatry, and Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Canada
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Canada
| | - Michael W O'Hara
- Department of Psychological and Brain Sciences, University of Iowa, USA
| | - Caron Zlotnick
- Departments of Psychiatry and Human Behavior, Medicine, and Obstetrics and Gynecology, Brown University, USA; and Butler Hospital, USA
| | | | | | - Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Carlos Gois
- Department of Psychiatry, University of Lisbon, Portugal
| | - Lon S Schneider
- Department of Psychiatry and Neuroscience, Keck School of Medicine of USC, USA
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| |
Collapse
|
24
|
Zika Virus Individual Participant Data Consortium. The Zika Virus Individual Participant Data Consortium: A Global Initiative to Estimate the Effects of Exposure to Zika Virus during Pregnancy on Adverse Fetal, Infant, and Child Health Outcomes. Trop Med Infect Dis 2020; 5:E152. [PMID: 33007828 DOI: 10.3390/tropicalmed5040152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
This commentary describes the creation of the Zika Virus Individual Participant Data Consortium, a global collaboration to address outstanding questions in Zika virus (ZIKV) epidemiology through conducting an individual participant data meta-analysis (IPD-MA). The aims of the IPD-MA are to (1) estimate the absolute and relative risks of miscarriage, fetal loss, and short- and long-term sequelae of fetal exposure; (2) identify and quantify the relative importance of different sources of heterogeneity (e.g., immune profiles, concurrent flavivirus infection) for the risk of adverse fetal, infant, and child outcomes among infants exposed to ZIKV in utero; and (3) develop and validate a prognostic model for the early identification of high-risk pregnancies and inform communication between health care providers and their patients and public health interventions (e.g., vector control strategies, antenatal care, and family planning programs). By leveraging data from a diversity of populations across the world, the IPD-MA will provide a more precise estimate of the risk of adverse ZIKV-related outcomes within clinically relevant subgroups and a quantitative assessment of the generalizability of these estimates across populations and settings. The ZIKV IPD Consortium effort is indicative of the growing recognition that data sharing is a central component of global health security and outbreak response.
Collapse
|
25
|
van Es N, Ventresca M, Di Nisio M, Zhou Q, Noble S, Crowther M, Briel M, Garcia D, Lyman GH, Macbeth F, Griffiths G, Iorio A, Mbuagbaw L, Neumann I, Brozek J, Guyatt G, Streiff MB, Baldeh T, Florez ID, Gurunlu Alma O, Agnelli G, Ageno W, Marcucci M, Bozas G, Zulian G, Maraveyas A, Lebeau B, Lecumberri R, Sideras K, Loprinzi C, McBane R, Pelzer U, Riess H, Solh Z, Perry J, Kahale LA, Bossuyt PM, Klerk C, Büller HR, Akl EA, Schünemann HJ. The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta-analysis. J Thromb Haemost 2020; 18:1940-1951. [PMID: 32336010 DOI: 10.1111/jth.14824] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/21/2020] [Accepted: 03/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oncology guidelines suggest using the Khorana score to select ambulatory cancer patients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain. OBJECTIVE To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of low-molecular-weight heparin (LMWH) among high-risk Khorana score patients. METHODS This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. RESULTS A total of 3293 patients from the control groups with an available Khorana score had lung (n = 1913; 58%), colorectal (n = 452; 14%), pancreatic (n = 264; 8%), gastric (n = 201; 6%), ovarian (n = 184; 56%), breast (n = 164; 5%), brain (n = 84; 3%), or bladder cancer (n = 31; 1%). The 6-month VTE incidence was 9.8% among high-risk Khorana score patients and 6.4% among low-to-intermediate-risk patients (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2). The dichotomous Khorana score performed differently in lung cancer patients (OR 1.1; 95% CI, 0.72-1.7) than in the group with other cancer types (OR 3.2; 95% CI, 1.8-5.6; Pinteraction = .002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared with controls (OR 0.36; 95% CI, 0.22-0.58), without increasing the risk of major bleeding (OR 1.1; 95% CI, 0.59-2.1). CONCLUSION The Khorana score was unable to stratify patients with lung cancer based on their VTE risk. Among those with other cancer types, a high-risk score was associated with a three-fold increased risk of VTE compared with a low-to-intermediate risk score. Thromboprophylaxis was effective and safe in patients with a high-risk Khorana score.
Collapse
Affiliation(s)
- Nick van Es
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Matthew Ventresca
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Qi Zhou
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK
| | - Mark Crowther
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthias Briel
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Gary H Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK
| | - Gareth Griffiths
- Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK
- Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Alfonso Iorio
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Division of Hematology, Department of Medicine, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Ignacio Neumann
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jan Brozek
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Gordon Guyatt
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Michael B Streiff
- Division of Hematology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tejan Baldeh
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Ivan D Florez
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia
| | | | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine-Stroke Unit, Università di Perugia, Perugia, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maura Marcucci
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - George Bozas
- Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Gilbert Zulian
- Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Anthony Maraveyas
- Division of Cancer-Hull York Medical School, University of Hull, Hull, UK
| | - Bernard Lebeau
- Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Ramon Lecumberri
- Hematology Service, University Clinic of Navarra, Pamplona, Spain
| | - Kostandinos Sideras
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Charles Loprinzi
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert McBane
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Uwe Pelzer
- Division of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt Universität-Universität zu Berlin, Berlin, Germany
| | - Hanno Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité, University Hospital, Berlin, Germany
| | - Ziad Solh
- Transfusion Medicine Section, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - James Perry
- Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada
- Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Lara A Kahale
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Klerk
- Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elie A Akl
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
26
|
Leijten P, Scott S, Landau S, Harris V, Mann J, Hutchings J, Beecham J, Gardner F. Individual Participant Data Meta-analysis: Impact of Conduct Problem Severity, Comorbid Attention-Deficit/Hyperactivity Disorder and Emotional Problems, and Maternal Depression on Parenting Program Effects. J Am Acad Child Adolesc Psychiatry 2020; 59:933-943. [PMID: 32084529 DOI: 10.1016/j.jaac.2020.01.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 01/10/2020] [Accepted: 01/12/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is concern whether established parenting programs for children's conduct problems meet the needs of families with severe and complex mental health problems. For example, many children with conduct problems show comorbid attention-deficit/hyperactivity disorder (ADHD) or emotional problems, or have parents who are depressed, but families with such complex mental health problems typically seen in real life are often underrepresented in evaluation trials. We tested whether children with more severe conduct problems, and those with more complex mental health problems, benefit less from the Incredible Years parenting program, using individual participant data meta-analysis of randomized trials in Europe. METHOD In 1,696 families from 13 children aged (child age 2-11 years; 37% girls; 58% low income; 30% ethnic minority; 98% mothers), we used moderator analysis within a multilevel model to test whether initial conduct problem severity, comorbid ADHD or emotional problems, and maternal depression would diminish intervention effects for children's conduct problems. RESULTS The Incredible Years program reduced children's conduct problems overall (Cohen's d = -0.35), but more so in children with more severe conduct problems. There was no evidence that children's comorbid ADHD and emotional problems changed the intervention benefits. Children of mothers with more depressive symptoms benefited more. CONCLUSION Children with more severe conduct problems derive greater, rather than lesser, benefits from a high-quality group parenting program, and comorbid ADHD and emotional problems do not reduce effects; maternal depression, rather than being linked to less child change, was associated with greater reductions in children's conduct problems.
Collapse
|
27
|
Büscher R, Beisemann M, Doebler P, Steubl L, Domhardt M, Cuijpers P, Kerkhof A, Sander LB. Effectiveness of Internet- and Mobile-Based Cognitive Behavioral Therapy to Reduce Suicidal Ideation and Behaviors: Protocol for a Systematic Review and Meta-Analysis of Individual Participant Data. Int J Environ Res Public Health 2020; 17:E5179. [PMID: 32709106 PMCID: PMC7399870 DOI: 10.3390/ijerph17145179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 01/17/2023]
Abstract
Internet- and mobile-based cognitive behavioral therapy (iCBT) might reduce suicidal ideation. However, recent meta-analyses found small effect sizes, and it remains unclear whether specific subgroups of participants experience beneficial or harmful effects. This is the study protocol for an individual participant meta-analysis (IPD-MA) aiming to determine the effectiveness of iCBT on suicidal ideation and identify moderators. We will systematically search CENTRAL, PsycINFO, Embase, and Pubmed for randomized controlled trials examining guided or self-guided iCBT for suicidality. All types of control conditions are eligible. Participants experiencing suicidal ideation will be included irrespective of age, diagnoses, or co-interventions. We will conduct a one-stage IPD-MA with suicidal ideation as the primary outcome, using a continuous measure, reliable improvement and deterioration, and response rate. Moderator analyses will be performed on participant-, study-, and intervention-level. Two independent reviewers will assess risk of bias and the quality of evidence using Cochrane's Risk of Bias Tool 2 and GRADE. This review was registered with OSF and is currently in progress. The IPD-MA will provide effect estimates while considering covariates and will offer novel insights into differential effects on a participant level. This will help to develop more effective, safe, and tailored digital treatment options for suicidal individuals.
Collapse
Affiliation(s)
- Rebekka Büscher
- Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany;
| | - Marie Beisemann
- Department of Statistics, TU Dortmund University, 44227 Dortmund, Germany; (M.B.); (P.D.)
| | - Philipp Doebler
- Department of Statistics, TU Dortmund University, 44227 Dortmund, Germany; (M.B.); (P.D.)
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, Ulm University, 89069 Ulm, Germany; (L.S.); (M.D.)
| | - Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, Ulm University, 89069 Ulm, Germany; (L.S.); (M.D.)
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands; (P.C.); (A.K.)
| | - Ad Kerkhof
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands; (P.C.); (A.K.)
| | - Lasse B. Sander
- Department of Rehabilitation Psychology and Psychotherapy, Albert-Ludwigs-University of Freiburg, 79106 Freiburg, Germany;
| |
Collapse
|
28
|
Wu Y, Levis B, Riehm KE, Saadat N, Levis AW, Azar M, Rice DB, Boruff J, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, McMillan D, Patten SB, Shrier I, Ziegelstein RC, Akena DH, Arroll B, Ayalon L, Baradaran HR, Baron M, Bombardier CH, Butterworth P, Carter G, Chagas MH, Chan JCN, Cholera R, Conwell Y, de Man-van Ginkel JM, Fann JR, Fischer FH, Fung D, Gelaye B, Goodyear-Smith F, Greeno CG, Hall BJ, Harrison PA, Härter M, Hegerl U, Hides L, Hobfoll SE, Hudson M, Hyphantis T, Inagaki M, Jetté N, Khamseh ME, Kiely KM, Kwan Y, Lamers F, Liu SI, Lotrakul M, Loureiro SR, Löwe B, McGuire A, Mohd-Sidik S, Munhoz TN, Muramatsu K, Osório FL, Patel V, Pence BW, Persoons P, Picardi A, Reuter K, Rooney AG, Santos IS, Shaaban J, Sidebottom A, Simning A, Stafford L, Sung S, Tan PLL, Turner A, van Weert HC, White J, Whooley MA, Winkley K, Yamada M, Benedetti A, Thombs BD. Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis. Psychol Med 2020; 50:1368-1380. [PMID: 31298180 PMCID: PMC6954991 DOI: 10.1017/s0033291719001314] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9. METHODS We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy. RESULTS 16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (-0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01). CONCLUSIONS PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
Collapse
Affiliation(s)
- Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Alexander W Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - John P A Ioannidis
- Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, California, USA
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Dean McMillan
- Hull York Medical School and the Department of Health Sciences, University of York, Heslington, York, UK
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dickens H Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Hamid R Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
- Ageing Clinical & Experimental Research Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Murray Baron
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Peter Butterworth
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, Australia
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
| | - Gregory Carter
- Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia
| | - Marcos H Chagas
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (SAR), China
- Asia Diabetes Foundation, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, Hong Kong SAR, China
| | - Rushina Cholera
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, New York, USA
| | - Janneke M de Man-van Ginkel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Felix H Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Fung
- Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Catherine G Greeno
- School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, University of Macau, Macau Special Administrative Region, China
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Hegerl
- Depression Research Center of the German Depression Foundation and Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Leanne Hides
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Stevan E Hobfoll
- STAR-Stress, Anxiety & Resilience Consultants, Chicago, Illinois, USA
| | - Marie Hudson
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Thomas Hyphantis
- Department of Psychiatry, University of Ioannina, Ioannina, Greece
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohammad E Khamseh
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Kim M Kiely
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
| | - Yunxin Kwan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Femke Lamers
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Shen-Ing Liu
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, Taipei, Taiwan
| | - Manote Lotrakul
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sonia R Loureiro
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anthony McGuire
- Department of Nursing, St. Joseph's College, Standish, Maine, USA
| | - Sherina Mohd-Sidik
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Cancer Resource & Education Centre, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Tiago N Munhoz
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Kumiko Muramatsu
- Department of Clinical Psychology, Graduate School of Niigata Seiryo University, Niigata, Japan
| | - Flávia L Osório
- Department of Neurosciences and Behavior, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- National Institute of Science and Technology, Translational Medicine, Ribeirão Preto, Brazil
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Philippe Persoons
- Department of Adult Psychiatry, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Angelo Picardi
- Centre for Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Katrin Reuter
- Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
| | - Alasdair G Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburg, Edinburgh, Scotland, UK
| | - Iná S Santos
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Juwita Shaaban
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Adam Simning
- Department of Psychiatry, University of Rochester Medical Center, New York, USA
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - Sharon Sung
- Department of Child & Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Pei Lin Lynnette Tan
- Department of Psychological Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, New South Wales, Newcastle, Australia
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Henk C van Weert
- Department of General Practice, Amsterdam Institute for General Practice and Public Health, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
| | | | - Mary A Whooley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, Ogawa-Higashi, Kodaira, Tokyo, Japan
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
- Department of Medicine, McGill University, Montréal, Québec, Canada
- Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
| |
Collapse
|
29
|
Seidler AL, Duley L, Katheria AC, De Paco Matallana C, Dempsey E, Rabe H, Kattwinkel J, Mercer J, Josephsen J, Fairchild K, Andersson O, Hosono S, Sundaram V, Datta V, El-Naggar W, Tarnow-Mordi W, Debray T, Hooper SB, Kluckow M, Polglase G, Davis PG, Montgomery A, Hunter KE, Barba A, Simes J, Askie L. Systematic review and network meta-analysis with individual participant data on cord management at preterm birth (iCOMP): study protocol. BMJ Open 2020; 10:e034595. [PMID: 32229522 PMCID: PMC7170588 DOI: 10.1136/bmjopen-2019-034595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Timing of cord clamping and other cord management strategies may improve outcomes at preterm birth. However, it is unclear whether benefits apply to all preterm subgroups. Previous and current trials compare various policies, including time-based or physiology-based deferred cord clamping, and cord milking. Individual participant data (IPD) enable exploration of different strategies within subgroups. Network meta-analysis (NMA) enables comparison and ranking of all available interventions using a combination of direct and indirect comparisons. OBJECTIVES (1) To evaluate the effectiveness of cord management strategies for preterm infants on neonatal mortality and morbidity overall and for different participant characteristics using IPD meta-analysis. (2) To evaluate and rank the effect of different cord management strategies for preterm births on mortality and other key outcomes using NMA. METHODS AND ANALYSIS Systematic searches of Medline, Embase, clinical trial registries, and other sources for all ongoing and completed randomised controlled trials comparing cord management strategies at preterm birth (before 37 weeks' gestation) have been completed up to 13 February 2019, but will be updated regularly to include additional trials. IPD will be sought for all trials; aggregate summary data will be included where IPD are unavailable. First, deferred clamping and cord milking will be compared with immediate clamping in pairwise IPD meta-analyses. The primary outcome will be death prior to hospital discharge. Effect differences will be explored for prespecified participant subgroups. Second, all identified cord management strategies will be compared and ranked in an IPD NMA for the primary outcome and the key secondary outcomes. Treatment effect differences by participant characteristics will be identified. Inconsistency and heterogeneity will be explored. ETHICS AND DISSEMINATION Ethics approval for this project has been granted by the University of Sydney Human Research Ethics Committee (2018/886). Results will be relevant to clinicians, guideline developers and policy-makers, and will be disseminated via publications, presentations and media releases. REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12619001305112) and International Prospective Register of Systematic Reviews (PROSPERO, CRD42019136640).
Collapse
Affiliation(s)
- Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, California, USA
| | - Catalina De Paco Matallana
- Department of Obstetrics and Gynecology, Clinic University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Eugene Dempsey
- Department of Paediatrics and Child Health, Cork University Maternity Hospital, Cork, Ireland
| | - Heike Rabe
- Academic Department of Paediatrics, Brighton and Sussex University Hospitals, Brighton, UK
| | - John Kattwinkel
- Department of Pediatrics and Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Judith Mercer
- College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
| | - Justin Josephsen
- Department of Pediatrics, St Louis University School of Medicine, St Louis, Missouri, USA
| | - Karen Fairchild
- Department of Pediatrics and Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Ola Andersson
- Department of Clinical Sciences Lund, Pediatrics/Neonatology, Skane University Hospital, Lund University, Lund, Sweden
| | - Shigeharu Hosono
- Department of Perinatal and Neonatal Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Venkataseshan Sundaram
- Newborn Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Datta
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
| | - Walid El-Naggar
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Thomas Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stuart B Hooper
- The Ritchie Centre, Obstetrics & Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Martin Kluckow
- Department of Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Graeme Polglase
- The Ritchie Centre, Obstetrics & Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kylie E Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Angie Barba
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - John Simes
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
30
|
Schuit E, Li AH, Ioannidis JPA. How often can meta-analyses of individual-level data individualize treatment? A meta-epidemiologic study. Int J Epidemiol 2020; 48:596-608. [PMID: 30445577 DOI: 10.1093/ije/dyy239] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND One of the claimed main advantages of individual participant data meta-analysis (IPDMA) is that it allows assessment of subgroup effects based on individual-level participant characteristics, and eventually stratified medicine. In this study, we evaluated the conduct and results of subgroup analyses in IPDMA. METHODS We searched PubMed, EMBASE and the Cochrane Library from inception to 31 December 2014. We included papers if they described an IPDMA based on randomized clinical trials that investigated a therapeutic intervention on human subjects and in which the meta-analysis was preceded by a systematic literature search. We extracted data items related to subgroup analysis and subgroup differences (subgroup-treatment interaction p < 0.05). RESULTS Overall, 327 IPDMAs were eligible. A statistically significant subgroup-treatment interaction for the primary outcome was reported in 102 (36.6%) of 279 IPDMAs that reported at least one subgroup analysis. This corresponded to 187 different statistically significant subgroup-treatment interactions: 124 for an individual-level subgrouping variable (in 76 IPDMAs) and 63 for a group-level subgrouping variable (in 36 IPDMAs). Of the 187, only 7 (3.7%; 6 individual and 1 group-level subgrouping variables) had a large difference between strata (standardized effect difference d ≥ 0.8). Among the 124 individual-level statistically significant subgroup differences, the IPDMA authors claimed that 42 (in 21 IPDMAs) should lead to treating the subgroups differently. None of these 42 had d ≥ 0.8. CONCLUSIONS Availability of individual-level data provides statistically significant interactions for relative treatment effects in about a third of IPDMAs. A modest number of these interactions may offer opportunities for stratified medicine decisions.
Collapse
Affiliation(s)
- Ewoud Schuit
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science and of Statistics, Stanford University, Stanford, CA, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alvin H Li
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science and of Statistics, Stanford University, Stanford, CA, USA.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - John P A Ioannidis
- Departments of Medicine, of Health Research and Policy, of Biomedical Data Science and of Statistics, Stanford University, Stanford, CA, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| |
Collapse
|
31
|
Wijn SRW, Rovers MM, Rongen JJ, Østerås H, Risberg MA, Roos EM, Hare KB, van de Graaf VA, Poolman RW, Englund M, Hannink G. Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis. BMJ Open 2020; 10:e031864. [PMID: 32152157 PMCID: PMC7064080 DOI: 10.1136/bmjopen-2019-031864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroscopic partial meniscectomy (APM) after degenerative meniscus tears is one of the most frequently performed surgeries in orthopaedics. Although several randomised controlled trials (RCTs) have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of APM remains high. The common perception by most orthopaedic surgeons is that there are subgroups of patients that do need APM to improve, and they argue that each study sample of the existing trials is not representative for the day-to-day patients in the clinic. Therefore, the objective of this individual participant data meta-analysis (IPDMA) is to assess whether there are subgroups of patients with degenerative meniscus lesions who benefit from APM in comparison with non-surgical or sham treatment. METHODS AND ANALYSIS An existing systematic review will be updated to identify all RCTs worldwide that evaluated APM compared with sham treatment or non-surgical treatment in patients with knee symptoms and degenerative meniscus tears. Time and effort will be spent in contacting principal investigators of the original trials and encourage them to collaborate in this project by sharing their trial data. All individual participant data will be validated for missing data, internal data consistency, randomisation integrity and censoring patterns. After validation, all datasets will be combined and analysed using a one-staged and two-staged approach. The RCTs' characteristics will be used for the assessment of clinical homogeneity and generalisability of the findings. The most important outcome will be the difference between APM and control groups in knee pain, function and quality of life 2 years after the intervention. Other outcomes of interest will include the difference in adverse events and mental health. ETHICS AND DISSEMINATION All trial data will be anonymised before it is shared with the authors. The data will be encrypted and stored on a secure server located in the Netherlands. No major ethical concerns remain. This IPDMA will provide the evidence base to update and tailor diagnostic and treatment protocols as well as (international) guidelines for patients for whom orthopaedic surgeons consider APM. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42017067240.
Collapse
Affiliation(s)
- Stan R W Wijn
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan J Rongen
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Håvard Østerås
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - May A Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
- Division of Orthopedic Surgery, Norwegian School of Sport Sciences, Oslo University Hospital, Oslo, Norway
| | - Ewa M Roos
- Department of Sports and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy and Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Kristoffer B Hare
- Department of Orthopedics, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
32
|
Lin L, Crowther C, Gamble G, Bloomfield F, Harding JE. Sex-specific effects of nutritional supplements in infants born early or small: protocol for an individual participant data meta-analysis (ESSENCE IPD-MA). BMJ Open 2020; 10:e033438. [PMID: 31919126 PMCID: PMC6955477 DOI: 10.1136/bmjopen-2019-033438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Preterm and small for gestational age (SGA) infants are at increased risk of poor growth, disability and delayed development. While growing up they are also at increased risk of obesity, diabetes and later heart disease. The risk of such adverse outcomes may be altered by how preterm and SGA infants are fed after birth. Faltering postnatal growth is common due to failure to achieve recommended high energy and protein intakes, and thus preterm and SGA infants are often provided with supplemental nutrition soon after birth. Enhanced nutrition has been associated with improved early growth and better cognitive development. However, limited evidence suggests that faster growth may increase the risk for later adiposity, metabolic and cardiovascular disease, and that such risks may differ between girls and boys. METHODS AND ANALYSIS We will search Ovid MEDLINE, Embase, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, controlled-trials.com, ClinicalTrials.gov and anzctr.org.au for randomised trials that studied the effects of macronutrient supplements for preterm and SGA infants on (i) developmental and metabolic and (ii) growth outcomes after hospital discharge. The outcomes will be (i) cognitive impairment and metabolic risk (co-primary) and (ii) body mass index. Individual participant data (IPD) from all available trials will be included using an intention-to-treat approach. A one-stage procedure for IPD meta-analysis (MA) will be used, accounting for clustering of participants within studies. Exploratory subgroup analyses will further investigate sources of heterogeneity, including sex and size of infants, different timing, duration and type of supplements. ETHICS AND DISSEMINATION This IPD-MA is approved by the University of Auckland Human Participants Ethics Committee (reference number: 019874). Individual studies have approval from relevant local ethics committees. Results will be disseminated in a peer-reviewed journal and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017072683.
Collapse
Affiliation(s)
- Luling Lin
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Caroline Crowther
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Greg Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Frank Bloomfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jane E Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
33
|
Harris WB, Phillips HW, Chen JS, Weil AG, Ibrahim GM, Fallah A. Seizure outcomes in children with Rasmussen's encephalitis undergoing resective or hemispheric epilepsy surgery: an individual participant data meta-analysis. J Neurosurg Pediatr 2019; 25:1-10. [PMID: 31812145 DOI: 10.3171/2019.9.peds19380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/23/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to perform an individual participant data meta-analysis to identify preoperative factors associated with a good seizure outcome in children with Rasmussen's encephalitis (RE) undergoing resective or hemispheric epilepsy surgery. METHODS Electronic databases (PubMed, Web of Science, CINAHL) were searched with no language or date restrictions to identify cohort studies of consecutive participants undergoing resective surgery that reported seizure outcomes. The authors recorded all preoperative factors that could plausibly be associated with seizure outcomes and used Cox regression analysis to identify which of these variables were associated with seizure freedom (i.e., Engel class I). RESULTS Of 720 citations, 19 articles reporting on 187 participants were eligible. Seizure freedom (Engel class I) was observed in 113 participants (60.4%). On univariate analyses, younger age at disease onset (hazard ratio [HR] 0.906, p = 0.001), younger age at surgery (HR 0.928, p < 0.001), shorter time to surgery (HR 0.921, p = 0.001), and hemispherectomy (HR 0.283, p < 0.001) were all associated with longer time to postoperative seizure recurrence. Additionally, multivariable analysis including the aforementioned variables showed that younger age at surgery (HR 0.946, p = 0.043) and hemispherectomy (HR 0.297, p < 0.001) were independently and significantly associated with a greater time to seizure recurrence and longer duration of seizure freedom. CONCLUSIONS The majority of pediatric patients undergoing resective or hemispheric surgery for RE achieve good seizure outcome. Although small retrospective cohort studies are inherently prone to bias, the best available evidence utilizing individual participant data suggests hemispheric surgery and younger age at surgery are associated with good seizure outcomes following epilepsy surgery. Large, multicenter observational studies with long-term follow-up are required to evaluate the risk factors identified in this review.
Collapse
Affiliation(s)
- William B Harris
- 1John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawai'i
| | - H Westley Phillips
- 2Department of Neurosurgery, University of California, Los Angeles, California
| | | | - Alexander G Weil
- 4Division of Neurosurgery, Ste. Justine Hospital, University of Montreal, Quebec, Canada; and
| | - George M Ibrahim
- 5Division of Neurosurgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Aria Fallah
- 2Department of Neurosurgery, University of California, Los Angeles, California
| |
Collapse
|
34
|
Levis B, McMillan D, Sun Y, He C, Rice DB, Krishnan A, Wu Y, Azar M, Sanchez TA, Chiovitti MJ, Bhandari PM, Neupane D, Saadat N, Riehm KE, Imran M, Boruff JT, Cuijpers P, Gilbody S, Ioannidis JPA, Kloda LA, Patten SB, Shrier I, Ziegelstein RC, Comeau L, Mitchell ND, Tonelli M, Vigod SN, Aceti F, Alvarado R, Alvarado-Esquivel C, Bakare MO, Barnes J, Beck CT, Bindt C, Boyce PM, Bunevicius A, Couto TCE, Chaudron LH, Correa H, de Figueiredo FP, Eapen V, Fernandes M, Figueiredo B, Fisher JRW, Garcia-Esteve L, Giardinelli L, Helle N, Howard LM, Khalifa DS, Kohlhoff J, Kusminskas L, Kozinszky Z, Lelli L, Leonardou AA, Lewis BA, Maes M, Meuti V, Nakić Radoš S, Navarro García P, Nishi D, Okitundu Luwa E-Andjafono D, Robertson-Blackmore E, Rochat TJ, Rowe HJ, Siu BWM, Skalkidou A, Stein A, Stewart RC, Su KP, Sundström-Poromaa I, Tadinac M, Tandon SD, Tendais I, Thiagayson P, Töreki A, Torres-Giménez A, Tran TD, Trevillion K, Turner K, Vega-Dienstmaier JM, Wynter K, Yonkers KA, Benedetti A, Thombs BD. Comparison of major depression diagnostic classification probability using the SCID, CIDI, and MINI diagnostic interviews among women in pregnancy or postpartum: An individual participant data meta-analysis. Int J Methods Psychiatr Res 2019; 28:e1803. [PMID: 31568624 PMCID: PMC7027670 DOI: 10.1002/mpr.1803] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES A previous individual participant data meta-analysis (IPDMA) identified differences in major depression classification rates between different diagnostic interviews, controlling for depressive symptoms on the basis of the Patient Health Questionnaire-9. We aimed to determine whether similar results would be seen in a different population, using studies that administered the Edinburgh Postnatal Depression Scale (EPDS) in pregnancy or postpartum. METHODS Data accrued for an EPDS diagnostic accuracy IPDMA were analysed. Binomial generalised linear mixed models were fit to compare depression classification odds for the Mini International Neuropsychiatric Interview (MINI), Composite International Diagnostic Interview (CIDI), and Structured Clinical Interview for DSM (SCID), controlling for EPDS scores and participant characteristics. RESULTS Among fully structured interviews, the MINI (15 studies, 2,532 participants, 342 major depression cases) classified depression more often than the CIDI (3 studies, 2,948 participants, 194 major depression cases; adjusted odds ratio [aOR] = 3.72, 95% confidence interval [CI] [1.21, 11.43]). Compared with the semistructured SCID (28 studies, 7,403 participants, 1,027 major depression cases), odds with the CIDI (interaction aOR = 0.88, 95% CI [0.85, 0.92]) and MINI (interaction aOR = 0.95, 95% CI [0.92, 0.99]) increased less as EPDS scores increased. CONCLUSION Different interviews may not classify major depression equivalently.
Collapse
Affiliation(s)
- Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Dean McMillan
- Hull York Medical School and the Department of Health Sciences, University of York, York, UK
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Tatiana A Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Matthew J Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Parash Mani Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Nazanin Saadat
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, Québec, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simon Gilbody
- Hull York Medical School and the Department of Health Sciences, University of York, York, UK
| | - John P A Ioannidis
- Department of Medicine, Department of Health Research and Policy, Department of Biomedical Data Science, Department of Statistics, Stanford University, Stanford, CA, USA
| | - Lorie A Kloda
- Library, Concordia University, Montréal, Québec, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada.,Cuthbertson & Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Liane Comeau
- International Union for Health Promotion and Health Education, École de santé publique de l'Université de Montréal, Montréal, Québec, Canada
| | - Nicholas D Mitchell
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simone N Vigod
- Women's College Hospital and Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Franca Aceti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Rubén Alvarado
- Escuela de Salud Pública Dr. Salvador Allende, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Cosme Alvarado-Esquivel
- Laboratorio de Investigación Biomédica, Facultad de Medicina y Nutrición, Avenida Universidad, Durango, Mexico
| | - Muideen O Bakare
- Child and Adolescent Unit, Federal Neuropsychiatric Hospital, Enugu, Nigeria.,Childhood Neuropsychiatric Disorders Initiatives, Enugu, Nigeria
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck, University of London, Bloomsbury London, UK
| | | | - Carola Bindt
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philip M Boyce
- Discipline of Psychiatry, Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Psychiatry, Westmead Hospital, Sydney, New South Wales, Australia
| | - Adomas Bunevicius
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Tiago Castro E Couto
- School of Medicine, Universidade Federal De Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Linda H Chaudron
- Departments of Psychiatry, Pediatrics, Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Humberto Correa
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Valsamma Eapen
- School of Psychiatry, University of New South Wales, Kensington, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,Sydney South West Local Health District, Liverpool, New South Wales, Australia
| | - Michelle Fernandes
- Faculty of Medicine, Department of Paediatrics, University of Southampton and Southampton Children's Hospital, Southampton, UK.,The Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | | | - Jane R W Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lluïsa Garcia-Esteve
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Lisa Giardinelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Nadine Helle
- Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Louise M Howard
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Dina Sami Khalifa
- Faculty of Health Sciences, Ahfad University for Women, Omdurman, Sudan.,Department of Community Medicine, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,The Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Kensington, Australia.,Ingham Institute, Liverpool, New South Wales, Australia.,Karitane, Carramar, New South Wales, Australia
| | | | - Zoltán Kozinszky
- Department of Obstetrics and Gynaecology, Blekinge Hospital, Karlskrona, Sweden
| | - Lorenzo Lelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Angeliki A Leonardou
- First Department of Psychiatry, Women's Mental Health Clinic, Athens University Medical School, Athens, Greece
| | - Beth A Lewis
- School of Kinesiology, University of Minnesota, Minneapolis, MN, USA
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Impact Strategic Research Center, Deakin University, Geelong, Victoria, Australia
| | - Valentina Meuti
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Purificación Navarro García
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Psychology Service, Regidoria de Polítiques de Gènere, Ajuntament de Terrassa, Terrassa, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Daniel Okitundu Luwa E-Andjafono
- Unité de Neuropsychologie, Département de Neurologie, Centre Neuro-psycho-pathologique, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Tamsen J Rochat
- MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa.,Human and Social Development Programme, Human Sciences Research Council, Johannesburg, South Africa
| | - Heather J Rowe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bonnie W M Siu
- Department of Psychiatry, Castle Peak Hospital, Hong Kong SAR, China
| | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Alan Stein
- Department of Child and Adolescent Psychiatry, University of Oxford, Oxford, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Robert C Stewart
- Department of Mental Health, College of Medicine, University of Malawi, Zomba, Malawi.,Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Kuan-Pin Su
- College of Medicine, China Medical University, Taichung, Taiwan.,Mind-Body Interface Laboratory and Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | | | - Meri Tadinac
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - S Darius Tandon
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Iva Tendais
- School of Psychology, University of Minho, Braga, Portugal
| | - Pavaani Thiagayson
- Institute of Mental Health, Hougang, Singapore.,KK Women's and Children's Hospital, Kallang, Singapore.,National Healthcare Group, Singapore
| | | | - Anna Torres-Giménez
- Perinatal Mental Health Unit CLINIC-BCN, Institut Clínic de Neurociències, Hospital Clínic, Barcelona, Spain.,Vulnerability, Psychopathology and Gender Research Group, Generalitat de Catalunya, Catalonia, Spain.,August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Thach D Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kylee Trevillion
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katherine Turner
- Epilepsy Center-Child Neuropsychiatry Unit, ASST Santi Paolo Carlo, San Paolo Hospital, Milan, Italy
| | | | - Karen Wynter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia
| | - Kimberly A Yonkers
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA.,School of Epidemiology and Public Health, Yale University, New Haven, Connecticut, USA
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada.,Department of Psychology, McGill University, Montréal, Québec, Canada.,Department of Psychiatry, McGill University, Montréal, Québec, Canada.,Department of Medicine, McGill University, Montréal, Québec, Canada.,Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
| |
Collapse
|
35
|
Moullaali TJ, Wang X, Woodhouse LJ, Law ZK, Delcourt C, Sprigg N, Krishnan K, Robinson TG, Wardlaw JM, Al-Shahi Salman R, Berge E, Sandset EC, Anderson CS, Bath PM. Lowering blood pressure after acute intracerebral haemorrhage: protocol for a systematic review and meta-analysis using individual patient data from randomised controlled trials participating in the Blood Pressure in Acute Stroke Collaboration (BASC). BMJ Open 2019; 9:e030121. [PMID: 31315876 PMCID: PMC6661570 DOI: 10.1136/bmjopen-2019-030121] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/02/2019] [Accepted: 06/14/2019] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Conflicting results from multiple randomised trials indicate that the methods and effects of blood pressure (BP) reduction after acute intracerebral haemorrhage (ICH) are complex. The Blood pressure in Acute Stroke Collaboration is an international collaboration, which aims to determine the optimal management of BP after acute stroke including ICH. METHODS AND ANALYSIS A systematic review will be undertaken according to the Preferred Reporting Items for Systematic review and Meta-Analysis of Individual Participant Data (IPD) guideline. A search of Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE from inception will be conducted to identify randomised controlled trials of BP management in adults with acute spontaneous (non-traumatic) ICH enrolled within the first 7 days of symptom onset. Authors of studies that meet the inclusion criteria will be invited to share their IPD. The primary outcome will be functional outcome according to the modified Rankin Scale. Safety outcomes will be early neurological deterioration, symptomatic hypotension and serious adverse events. Secondary outcomes will include death and neuroradiological and haemodynamic variables. Meta-analyses of pooled IPD using the intention-to-treat dataset of included trials, including subgroup analyses to assess modification of the effects of BP lowering by time to treatment, treatment strategy and patient's demographic, clinical and prestroke neuroradiological characteristics. ETHICS AND DISSEMINATION No new patient data will be collected nor is there any deviation from the original purposes of each study where ethical approvals were granted; therefore, further ethical approval is not required. Results will be reported in international peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42019141136.
Collapse
Affiliation(s)
- Tom J Moullaali
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Xia Wang
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Zhe Kang Law
- Stroke Trials Unit, University of Nottingham, Nottingham, UK
- National University of Malaysia, Bangi, Malaysia
| | - Candice Delcourt
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nikola Sprigg
- Stroke Trials Unit, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kailash Krishnan
- Stroke Trials Unit, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Eivind Berge
- Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Else C Sandset
- Neurology Department, Oslo University Hospital, Oslo, Norway
- Research and Development, Norwegian Air Ambulance Foundation, Bodo, Norway
| | - Craig S Anderson
- George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Philip M Bath
- Stroke Trials Unit, University of Nottingham, Nottingham, UK
- Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
36
|
Furukawa TA, Karyotaki E, Suganuma A, Pompoli A, Ostinelli EG, Cipriani A, Cuijpers P, Efthimiou O. Dismantling, personalising and optimising internet cognitive-behavioural therapy for depression: a study protocol for individual participant data component network meta-analysis. BMJ Open 2019; 8:e026137. [PMID: 30798295 PMCID: PMC6278798 DOI: 10.1136/bmjopen-2018-026137] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Psychotherapy is a complex intervention, consisting of various components and being implemented flexibly in consideration of individual patient's characteristics. It is then of utmost importance to know which of the various components or combinations thereof are more efficacious, what their specific effect sizes are and which types of patients may benefit more from different components or their combinations. METHODS AND ANALYSIS Internet-delivered cognitive-behavioural therapy (iCBT) offers a unique opportunity to systematically review and quantitatively disentangle the efficacy of various components because, unlike face-to-face cognitive-behavioural therapy, it allows identification of constituent components that are actually delivered to patients. We will systematically identify all randomised controlled trials that compared any form of iCBT against another form or a control intervention in the acute phase treatment of adult depression. We will apply component network meta-analysis (cNMA) to dismantle efficacy of individual components. We will use individual participant data in the cNMA to identify participant-level prognostic factors and effect modifiers for different components. ETHICS AND DISSEMINATION The investigators of the primary trials will have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment. Results from this study will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42018104683.
Collapse
Affiliation(s)
- Toshi A Furukawa
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Aya Suganuma
- Departments of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto, Japan
- Amsterdam Public Health research institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | - Andrea Cipriani
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| |
Collapse
|
37
|
Benedetti A, Wu Y, Levis B, Wilchesky M, Boruff J, Ioannidis JPA, Patten SB, Cuijpers P, Shrier I, Gilbody S, Ismail Z, McMillan D, Mitchell N, Ziegelstein RC, Thombs BD. Diagnostic accuracy of the Geriatric Depression Scale-30, Geriatric Depression Scale-15, Geriatric Depression Scale-5 and Geriatric Depression Scale-4 for detecting major depression: protocol for a systematic review and individual participant data meta-analysis. BMJ Open 2018; 8:e026598. [PMID: 30518594 PMCID: PMC6286470 DOI: 10.1136/bmjopen-2018-026598] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The 30-item Geriatric Depression Scale (GDS-30) and the shorter GDS-15, GDS-5 and GDS-4 are recommended as depression screening tools for elderly individuals. Existing meta-analyses on the diagnostic accuracy of the GDS have not been able to conduct subgroup analyses, have included patients already identified as depressed who would not be screened in practice and have not accounted for possible bias due to selective reporting of results from only better-performing cut-offs in primary studies. Individual participant data meta-analysis (IPDMA), which involves a standard systematic review, then a synthesis of individual participant data, rather than summary results, could address these limitations. The objective of our IPDMA is to generate accuracy estimates to detect major depression for all possible cut-offs of each version of the GDS among studies using different reference standards, separately and among participant subgroups based on age, sex, dementia diagnosis and care settings. In addition, we will use a modelling approach to generate individual participant probabilities for major depression based on GDS scores (rather than a dichotomous cut-off) and participant characteristics (eg, sex, age, dementia status, care setting). METHODS AND ANALYSIS Individual participant data comparing GDS scores to a major depression diagnosis based on a validated structured or semistructured diagnostic interview will be sought via a systematic review. Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Bivariate random-effects models will be used to estimate diagnostic accuracy parameters for each cut-off of the different versions of the GDS. Prespecified subgroup analyses will be conducted. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. ETHICS AND DISSEMINATION The findings of this study will be of interest to stakeholders involved in research, clinical practice and policy. PROSPERO REGISTRATION NUMBER CRD42018104329.
Collapse
Affiliation(s)
- Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Yin Wu
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Brooke Levis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Machelle Wilchesky
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Jill Boruff
- Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Health Research and Policy, Stanford School of Medicine, Stanford, California, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, USA
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology and Amsterdam Public Health research institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Ian Shrier
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, The University of York, York, UK
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, The University of York, York, UK
| | | | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brett D Thombs
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
38
|
Li M, Thompson JMD, Cronin RS, Gordon A, Raynes-Greenow C, Heazell AEP, Stacey T, Culling V, Bowring V, Mitchell EA, McCowan LME, Askie L. The Collaborative IPD of Sleep and Stillbirth (Cribss): is maternal going-to-sleep position a risk factor for late stillbirth and does maternal sleep position interact with fetal vulnerability? An individual participant data meta-analysis study protocol. BMJ Open 2018; 8:e020323. [PMID: 29643161 PMCID: PMC5898330 DOI: 10.1136/bmjopen-2017-020323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Accumulating evidence has shown an association between maternal supine going-to-sleep position and stillbirth in late pregnancy. Advising women not to go-to-sleep on their back can potentially reduce late stillbirth rate by 9%. However, the association between maternal right-sided going-to-sleep position and stillbirth is inconsistent across studies. Furthermore, individual studies are underpowered to investigate interactions between maternal going-to-sleep position and fetal vulnerability, which is potentially important for producing clear and tailored public health messages on safe going-to-sleep position. We will use individual participant data (IPD) from existing studies to assess whether right-side and supine going-to-sleep positions are independent risk factors for late stillbirth and to test the interaction between going-to-sleep position and fetal vulnerability. METHODS AND ANALYSIS An IPD meta-analysis approach will be used using the Cochrane Collaboration-endorsed methodology. We will identify case-control and prospective cohort studies and randomised trials which collected maternal going-to-sleep position data and pregnancy outcome data that included stillbirth. The primary outcome is stillbirth. A one stage procedure meta-analysis, stratified by study with adjustment of a priori confounders will be carried out. ETHICS AND DISSEMINATION The IPD meta-analysis has obtained central ethics approval from the New Zealand Health and Disability Ethics Committee, ref: NTX/06/05/054/AM06. Individual studies should also have ethical approval from relevant local ethics committees. Interpretation of the results will be discussed with consumer representatives. Results of the study will be published in peer-reviewed journals and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017047703.
Collapse
Affiliation(s)
- Minglan Li
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Robin S Cronin
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital Women and Babies, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander E P Heazell
- Division of Developmental Biomedicine, Faculty of Medical and Human Sciences, Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
- St. Mary’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Edwin A Mitchell
- Department of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lisa Askie
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
39
|
Leijten P, Gardner F, Landau S, Harris V, Mann J, Hutchings J, Beecham J, Bonin EM, Scott S. Research Review: Harnessing the power of individual participant data in a meta-analysis of the benefits and harms of the Incredible Years parenting program. J Child Psychol Psychiatry 2018; 59:99-109. [PMID: 28696032 DOI: 10.1111/jcpp.12781] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Parenting programs aim to reduce children's conduct problems through improvement of family dynamics. To date, research on the precise benefits and possible harms of parenting programs on family well-being has been unsystematic and likely to be subject to selective outcome reporting and publication bias. Better understanding of program benefits and harms requires full disclosure by researchers of all included measures, and large enough numbers of participants to be able to detect small effects and estimate them precisely. METHODS We obtained individual participant data for 14 of 15 randomized controlled trials on the Incredible Years parenting program in Europe (total N = 1,799). We used multilevel modeling to estimate program effects on 13 parent-reported outcomes, including parenting practices, children's mental health, and parental mental health. RESULTS Parental use of praise, corporal punishment, threats, and shouting improved, while parental use of tangible rewards, monitoring, or laxness did not. Children's conduct problems and attention deficit hyperactivity disorder (ADHD) symptoms improved, while emotional problems did not. Parental mental health (depressive symptoms, self-efficacy, and stress) did not improve. There was no evidence of harmful effects. CONCLUSIONS The Incredible Years parenting program improves the aspects of family well-being that it is primarily designed to improve: parenting and children's conduct problems. It also improves parent-reported ADHD symptoms in children. Wider benefits are limited: the program does not improve children's emotional problems or parental mental health. There are no signs of harm on any of the target outcomes.
Collapse
Affiliation(s)
- Patty Leijten
- University of Oxford, Oxford, UK.,University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | | | | | - Jennifer Beecham
- London School of Economics, London, UK.,Kent University, Canterbury, UK
| | - Eva-Maria Bonin
- London School of Economics, London, UK.,Kent University, Canterbury, UK
| | | |
Collapse
|
40
|
Ohkuma T, Ninomiya T, Tomiyama H, Kario K, Hoshide S, Kita Y, Inoguchi T, Maeda Y, Kohara K, Tabara Y, Nakamura M, Ohkubo T, Watada H, Munakata M, Ohishi M, Ito N, Nakamura M, Shoji T, Vlachopoulos C, Yamashina A. Brachial-Ankle Pulse Wave Velocity and the Risk Prediction of Cardiovascular Disease: An Individual Participant Data Meta-Analysis. Hypertension 2017; 69:1045-1052. [PMID: 28438905 DOI: 10.1161/hypertensionaha.117.09097] [Citation(s) in RCA: 333] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/03/2017] [Accepted: 03/24/2017] [Indexed: 12/22/2022]
Abstract
An individual participant data meta-analysis was conducted in the data of 14 673 Japanese participants without a history of cardiovascular disease (CVD) to examine the association of the brachial-ankle pulse wave velocity (baPWV) with the risk of development of CVD. During the average 6.4-year follow-up period, 687 participants died and 735 developed cardiovascular events. A higher baPWV was significantly associated with a higher risk of CVD, even after adjustments for conventional risk factors (P for trend <0.001). When the baPWV values were classified into quintiles, the multivariable-adjusted hazard ratio for CVD increased significantly as the baPWV quintile increased. The hazard ratio in the subjects with baPWV values in quintile 5 versus that in those with the values in quintile 1 was 3.50 (2.14-5.74; P<0.001). Every 1 SD increase of the baPWV was associated with a 1.19-fold (1.10-1.29; P<0.001) increase in the risk of CVD. Moreover, addition of baPWV to a model incorporating the Framingham risk score significantly increased the C statistics from 0.8026 to 0.8131 (P<0.001) and also improved the category-free net reclassification (0.247; P<0.001). The present meta-analysis clearly established baPWV as an independent predictor of the risk of development of CVD in Japanese subjects without preexisting CVD. Thus, measurement of the baPWV could enhance the efficacy of prediction of the risk of development of CVD over that of the Framingham risk score, which is based on the traditional cardiovascular risk factors.
Collapse
Affiliation(s)
- Toshiaki Ohkuma
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Toshiharu Ninomiya
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Hirofumi Tomiyama
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.).
| | - Kazuomi Kario
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Satoshi Hoshide
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Yoshikuni Kita
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Toyoshi Inoguchi
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Yasutaka Maeda
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Katsuhiko Kohara
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Yasuharu Tabara
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Motoyuki Nakamura
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Takayoshi Ohkubo
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Hirotaka Watada
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Masanori Munakata
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Mitsuru Ohishi
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Norihisa Ito
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Michinari Nakamura
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Tetsuo Shoji
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Charalambos Vlachopoulos
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | - Akira Yamashina
- From the Department of Medicine and Clinical Science, Graduate School of Medical Sciences (T. Ohkuma), Department of Epidemiology and Public Health, Graduate School of Medical Sciences (T.N.), Innovation Center for Medical Redox Navigation (T.I.), and Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences (Y.M.), Kyushu University, Fukuoka, Japan; Department of Cardiology, Tokyo Medical University, Japan (H.T., A.Y.); Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K. Kario, S.H.); Faculty of Nursing Science, Tsuruga Nursing University, Japan (Y.K.); Department of Regional Resource Management, Faculty of Collaborative Regional Innovation, Ehime University, Japan (K. Kohara); Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Japan (Y.T.); Department of Internal Medicine, Iwate Medical University, Japan (Motoyuki Nakamura); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (T. Ohkubo); Departments of Metabolism and Endocrinology, Juntendo University, Graduate School of Medicine, Tokyo, Japan (H.W.); Research Center for Lifestyle-Related Disease, Tohoku Rosai Hospital, Sendai, Japan (M.M.); Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan (M.O.); Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Japan (N.I.); Department of Cardiovascular Medicine, Cardiovascular Institute, Japan (Michinari Nakamura); Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan (T.S.); and Hypertension and Cardiometabolic Unit, (1st) Department of Cardiology, Athens Medical School, Hippokration Hospital, Greece (C.V.)
| | | |
Collapse
|
41
|
Bustamante A, Vilar-Bergua A, Guettier S, Sánchez-Poblet J, García-Berrocoso T, Giralt D, Fluri F, Topakian R, Worthmann H, Hug A, Molnar T, Waje-Andreassen U, Katan M, Smith CJ, Montaner J. C-reactive protein in the detection of post-stroke infections: systematic review and individual participant data analysis. J Neurochem 2017; 141:305-314. [PMID: 28171699 DOI: 10.1111/jnc.13973] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
We conducted a systematic review and individual participant data meta-analysis to explore the role of C-reactive protein (CRP) in early detection or prediction of post-stroke infections. CRP, an acute-phase reactant binds to the phosphocholine expressed on the surface of dead or dying cells and some bacteria, thereby activating complement and promoting phagocytosis by macrophages. We searched PubMed up to May-2015 for studies measuring CRP in stroke and evaluating post-stroke infections. Individual participants' data were merged into a single database. CRP levels were standardized and divided into quartiles. Factors independently associated with post-stroke infections were determined by logistic regression analysis and the additional predictive value of CRP was assessed by comparing areas under receiver operating characteristic curves and integrated discrimination improvement index. Data from seven studies including 699 patients were obtained. Standardized CRP levels were higher in patients with post-stroke infections beyond 24 h. Standardized CRP levels in the fourth quartile were independently associated with infection in two different logistic regression models, model 1 [stroke severity and dysphagia, odds ratio = 9.70 (3.10-30.41)] and model 2 [age, sex, and stroke severity, odds ratio = 3.21 (1.93-5.32)]. Addition of CRP improved discrimination in both models [integrated discrimination improvement = 9.83% (0.89-18.77) and 5.31% (2.83-7.79), respectively], but accuracy was only improved for model 1 (area under the curve 0.806-0.874, p = 0.036). In this study, CRP was independently associated with development of post-stroke infections, with the optimal time-window for measurement at 24-48 h. However, its additional predictive value is moderate over clinical information. Combination with other biomarkers in a panel seems a promising strategy for future studies.
Collapse
Affiliation(s)
- Alejandro Bustamante
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Andrea Vilar-Bergua
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sophie Guettier
- Department of Neurology, Centre Hospitalo-Universitaire Côte de Nacre, Université Caen-Normandie, Caen, France
| | - Josep Sánchez-Poblet
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teresa García-Berrocoso
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Giralt
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Felix Fluri
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Hans Worthmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Andreas Hug
- Spinal Cord Injury Center Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Tihamer Molnar
- Department of Anesthesiology and Intensive Care, University of Pecs, Pecs, Hungary
| | | | - Mira Katan
- Department of Neurology, University Hospital of Zurich, Switzerland
| | - Craig J Smith
- Greater Manchester Comprehensive Stroke Centre and Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joan Montaner
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
42
|
De Ruysscher D, Lueza B, Le Péchoux C, Johnson DH, O'Brien M, Murray N, Spiro S, Wang X, Takada M, Lebeau B, Blackstock W, Skarlos D, Baas P, Choy H, Price A, Seymour L, Arriagada R, Pignon JP. Impact of thoracic radiotherapy timing in limited-stage small-cell lung cancer: usefulness of the individual patient data meta-analysis. Ann Oncol 2016; 27:1818-28. [PMID: 27436850 PMCID: PMC5035783 DOI: 10.1093/annonc/mdw263] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/24/2016] [Accepted: 06/28/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy (CT) combined with radiotherapy is the standard treatment of 'limited-stage' small-cell lung cancer. However, controversy persists over the optimal timing of thoracic radiotherapy and CT. MATERIALS AND METHODS We carried out a meta-analysis of individual patient data in randomized trials comparing earlier versus later radiotherapy, or shorter versus longer radiotherapy duration, as defined in each trial. We combined the results from trials using the stratified log-rank test to calculate pooled hazard ratios (HRs). The primary outcome was overall survival. RESULTS Twelve trials with 2668 patients were eligible. Data from nine trials comprising 2305 patients were available for analysis. The median follow-up was 10 years. When all trials were analysed together, 'earlier or shorter' versus 'later or longer' thoracic radiotherapy did not affect overall survival. However, the HR for overall survival was significantly in favour of 'earlier or shorter' radiotherapy among trials with a similar proportion of patients who were compliant with CT (defined as having received 100% or more of the planned CT cycles) in both arms (HR 0.79, 95% CI 0.69-0.91), and in favour of 'later or longer' radiotherapy among trials with different rates of CT compliance (HR 1.19, 1.05-1.34, interaction test, P < 0.0001). The absolute gain between 'earlier or shorter' versus 'later or longer' thoracic radiotherapy in 5-year overall survival for similar and for different CT compliance trials was 7.7% (95% CI 2.6-12.8%) and -2.2% (-5.8% to 1.4%), respectively. However, 'earlier or shorter' thoracic radiotherapy was associated with a higher incidence of severe acute oesophagitis than 'later or longer' radiotherapy. CONCLUSION 'Earlier or shorter' delivery of thoracic radiotherapy with planned CT significantly improves 5-year overall survival at the expense of more acute toxicity, especially oesophagitis.
Collapse
Affiliation(s)
- D De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands Department of Oncology, Experimental Radiation Oncology, KU Leuven, Leuven, Belgium
| | - B Lueza
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
| | - C Le Péchoux
- Department of Oncology and radiation therapy, Gustave Roussy, Villejuif Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - D H Johnson
- UT Southwestern University School of Medicine, Dallas, USA
| | - M O'Brien
- EORTC Data Center, Brussels, Belgium
| | - N Murray
- British Columbia Cancer Agency, Vancouver, Canada
| | - S Spiro
- University College London Hospitals, London, UK
| | - X Wang
- Alliance Data and Statistical Center, Duke University, Durham, USA
| | - M Takada
- Osaka Prefectural Habikino Hospital, Osaka, Japan
| | - B Lebeau
- Hôpital St Antoine, Paris, France
| | - W Blackstock
- Wake Forest University School of Medicine, Winston-Salem, USA
| | - D Skarlos
- Second Department of Medical Oncology, Metropolitan Hospital N. Faliro, Athens, Greece
| | - P Baas
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - H Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, USA
| | - A Price
- NHS Lothian and University of Edinburgh, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - L Seymour
- NCIC Clinical Trials Group and Queen's University, Kingston, Canada
| | - R Arriagada
- Gustave Roussy, Villejuif, France Karolinska Institutet, Stockholm, Sweden
| | - J-P Pignon
- Department of Biostatistics and Epidemiology and "Ligue Nationale Contre le Cancer" meta-analysis platform, Gustave Roussy, Villejuif, France CESP, INSERM U1018, Université Paris-Sud, Université Paris-Saclay, Villejuif
| |
Collapse
|
43
|
Schünemann HJ, Ventresca M, Crowther M, Briel M, Zhou Q, Garcia D, Lyman G, Noble S, Macbeth F, Griffiths G, DiNisio M, Iorio A, Beyene J, Mbuagbaw L, Neumann I, Van Es N, Brouwers M, Brozek J, Guyatt G, Levine M, Moll S, Santesso N, Streiff M, Baldeh T, Florez I, Gurunlu Alma O, Solh Z, Ageno W, Marcucci M, Bozas G, Zulian G, Maraveyas A, Lebeau B, Buller H, Evans J, McBane R, Bleker S, Pelzer U, Akl EA. Use of heparins in patients with cancer: individual participant data meta-analysis of randomised trials study protocol. BMJ Open 2016; 6:e010569. [PMID: 27130164 PMCID: PMC4853971 DOI: 10.1136/bmjopen-2015-010569] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Parenteral anticoagulants may improve outcomes in patients with cancer by reducing risk of venous thromboembolic disease and through a direct antitumour effect. Study-level systematic reviews indicate a reduction in venous thromboembolism and provide moderate confidence that a small survival benefit exists. It remains unclear if any patient subgroups experience potential benefits. METHODS AND ANALYSIS First, we will perform a comprehensive systematic search of MEDLINE, EMBASE and The Cochrane Library, hand search scientific conference abstracts and check clinical trials registries for randomised control trials of participants with solid cancers who are administered parenteral anticoagulants. We anticipate identifying at least 15 trials, exceeding 9000 participants. Second, we will perform an individual participant data meta-analysis to explore the magnitude of survival benefit and address whether subgroups of patients are more likely to benefit from parenteral anticoagulants. All analyses will follow the intention-to-treat principle. For our primary outcome, mortality, we will use multivariable hierarchical models with patient-level variables as fixed effects and a categorical trial variable as a random effect. We will adjust analysis for important prognostic characteristics. To investigate whether intervention effects vary by predefined subgroups of patients, we will test interaction terms in the statistical model. Furthermore, we will develop a risk-prediction model for venous thromboembolism, with a focus on control patients of randomised trials. ETHICS AND DISSEMINATION Aside from maintaining participant anonymity, there are no major ethical concerns. This will be the first individual participant data meta-analysis addressing heparin use among patients with cancer and will directly influence recommendations in clinical practice guidelines. Major cancer guideline development organisations will use eventual results to inform their guideline recommendations. Several knowledge users will disseminate results through presentations at clinical rounds as well as national and international conferences. We will prepare an evidence brief and facilitate dialogue to engage policymakers and stakeholders in acting on findings. TRIAL REGISTRATION NUMBER PROSPERO CRD42013003526.
Collapse
Affiliation(s)
- Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Ventresca
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Community Health Studies, Brock University, St Catharines, Ontario, Canada
| | - Mark Crowther
- St Joseph's Hospital, and Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthias Briel
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel CH, Basel, Switzerland
| | - Qi Zhou
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - David Garcia
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Gary Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK
| | - Fergus Macbeth
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK
| | - Gareth Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Marcello DiNisio
- Department of Medical, Oral and Biotechnological Sciences, University "G D'Annunzio" of Chieti-Pescara, Chieti, Italy Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Alfonso Iorio
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Division of Hematology, Department of Medicine, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lawrance Mbuagbaw
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Ignacio Neumann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nick Van Es
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Melissa Brouwers
- Department of Oncology, Escarpment Cancer Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jan Brozek
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Levine
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Stephan Moll
- Division of Hematology-Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nancy Santesso
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Michael Streiff
- Department of Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tejan Baldeh
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Ivan Florez
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia
| | | | - Ziad Solh
- Division of Hematology/Oncology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Walter Ageno
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - Maura Marcucci
- Department of Clinical Sciences and Community Health, University of Milan & Geriatrics, Fondazione-IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - George Bozas
- Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull and East Yorkshire Hospitals NHS Trust, UK
| | - Gilbert Zulian
- Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Switzerland
| | - Anthony Maraveyas
- Division of Cancer-Hull York Medical School, University of Hull, Hull, UK
| | - Bernard Lebeau
- Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Harry Buller
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jessica Evans
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK
| | - Robert McBane
- Cardiology and Hematology Departments, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzanne Bleker
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Uwe Pelzer
- Division of Hematology, Oncology and Tumor Immunology, Medical Department, Charité Comprehensive Cancer Center, Charité Medical University, Berlin, Germany
| | - Elie A Akl
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Department of Internal Medicine, American University of Beirut, Lebanon
| |
Collapse
|
44
|
Siddique J, Reiter JP, Brincks A, Gibbons RD, Crespi CM, Brown CH. Multiple imputation for harmonizing longitudinal non-commensurate measures in individual participant data meta-analysis. Stat Med 2015; 34:3399-414. [PMID: 26095855 PMCID: PMC4596762 DOI: 10.1002/sim.6562] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 02/24/2015] [Accepted: 05/26/2015] [Indexed: 11/05/2022]
Abstract
There are many advantages to individual participant data meta-analysis for combining data from multiple studies. These advantages include greater power to detect effects, increased sample heterogeneity, and the ability to perform more sophisticated analyses than meta-analyses that rely on published results. However, a fundamental challenge is that it is unlikely that variables of interest are measured the same way in all of the studies to be combined. We propose that this situation can be viewed as a missing data problem in which some outcomes are entirely missing within some trials and use multiple imputation to fill in missing measurements. We apply our method to five longitudinal adolescent depression trials where four studies used one depression measure and the fifth study used a different depression measure. None of the five studies contained both depression measures. We describe a multiple imputation approach for filling in missing depression measures that makes use of external calibration studies in which both depression measures were used. We discuss some practical issues in developing the imputation model including taking into account treatment group and study. We present diagnostics for checking the fit of the imputation model and investigate whether external information is appropriately incorporated into the imputed values.
Collapse
Affiliation(s)
- Juned Siddique
- Department of Preventive Medicine, Northwestern University, Chicago, IL
| | | | - Ahnalee Brincks
- Department of Public Health Science, University of Miami, Miami, FL
| | - Robert D. Gibbons
- Departments of Medicine and Health Studies, University of Chicago, Chicago, IL
| | - Catherine M. Crespi
- Department of Biostatistics, University of California Los Angeles, Los Angeles, CA
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL
| |
Collapse
|
45
|
Schuit E, Stock S, Rode L, Rouse DJ, Lim AC, Norman JE, Nassar AH, Serra V, Combs CA, Vayssiere C, Aboulghar MM, Wood S, Çetingöz E, Briery CM, Fonseca EB, Worda K, Tabor A, Thom EA, Caritis SN, Awwad J, Usta IM, Perales A, Meseguer J, Maurel K, Garite T, Aboulghar MA, Amin YM, Ross S, Cam C, Karateke A, Morrison JC, Magann EF, Nicolaides KH, Zuithoff NPA, Groenwold RHH, Moons KGM, Kwee A, Mol BWJ. Effectiveness of progestogens to improve perinatal outcome in twin pregnancies: an individual participant data meta-analysis. BJOG 2014; 122:27-37. [PMID: 25145491 DOI: 10.1111/1471-0528.13032] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In twin pregnancies, the rates of adverse perinatal outcome and subsequent long-term morbidity are substantial, and mainly result from preterm birth (PTB). OBJECTIVES To assess the effectiveness of progestogen treatment in the prevention of neonatal morbidity or PTB in twin pregnancies using individual participant data meta-analysis (IPDMA). SEARCH STRATEGY We searched international scientific databases, trial registration websites, and references of identified articles. SELECTION CRITERIA Randomised clinical trials (RCTs) of 17-hydroxyprogesterone caproate (17Pc) or vaginally administered natural progesterone, compared with placebo or no treatment. DATA COLLECTION AND ANALYSIS Investigators of identified RCTs were asked to share their IPD. The primary outcome was a composite of perinatal mortality and severe neonatal morbidity. Prespecified subgroup analyses were performed for chorionicity, cervical length, and prior spontaneous PTB. MAIN RESULTS Thirteen trials included 3768 women and their 7536 babies. Neither 17Pc nor vaginal progesterone reduced the incidence of adverse perinatal outcome (17Pc relative risk, RR 1.1; 95% confidence interval, 95% CI 0.97-1.4, vaginal progesterone RR 0.97; 95% CI 0.77-1.2). In a subgroup of women with a cervical length of ≤25 mm, vaginal progesterone reduced adverse perinatal outcome when cervical length was measured at randomisation (15/56 versus 22/60; RR 0.57; 95% CI 0.47-0.70) or before 24 weeks of gestation (14/52 versus 21/56; RR 0.56; 95% CI 0.42-0.75). AUTHOR'S CONCLUSIONS In unselected women with an uncomplicated twin gestation, treatment with progestogens (intramuscular 17Pc or vaginal natural progesterone) does not improve perinatal outcome. Vaginal progesterone may be effective in the reduction of adverse perinatal outcome in women with a cervical length of ≤25 mm; however, further research is warranted to confirm this finding.
Collapse
Affiliation(s)
- E Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Pufulete M, Higgins JP, Rogers CA, Dreyer L, Hollingworth W, Dayer M, Nightingale A, McDonagh T, Reeves BC. Protocol for a systematic review and individual participant data meta-analysis of B-type natriuretic peptide-guided therapy for heart failure. Syst Rev 2014; 3:41. [PMID: 24886933 PMCID: PMC4113204 DOI: 10.1186/2046-4053-3-41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/07/2014] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several aggregate data meta-analyses suggest that treatment guided by the serum concentration of natriuretic peptides (B-type natriuretic peptide (BNP) or its derivative N-terminal pro-B-type natriuretic peptide (NT-BNP)) reduces all-cause mortality compared with usual care in patients with heart failure (HF). We propose to conduct a meta-analysis using individual participant data (IPD) to estimate the effect of BNP-guided therapy on clinical outcomes, and estimate the extent of effect modification for clinically important subgroups. METHODS We will use standard systematic review methods to identify relevant trials and assess study quality. We will include all randomized controlled trials (RCTs) of BNP-guided treatment for HF that report a clinical outcome. The primary outcome will be time to all-cause mortality. We will collate anonymized, individual patient data into a single database, and carry out appropriate data checks. We will use fixed-effects and random-effects meta-analysis methods to combine hazard ratios (HR) estimated within each RCT, across all RCTs. We will also include a meta-analysis and meta-regression analyses based on aggregate data, and combine IPD with aggregate data if we obtain IPD for a subset of trials. DISCUSSION The IPD meta-analysis will allow us to estimate how patient characteristics modify treatment benefit, and to identify relevant subgroups of patients who are likely to benefit most from BNP-guided therapy. This is important because aggregate meta-analyses have suggested that clinically relevant subgroup effects exist, but these analyses have been unable to quantify the effects reliably or precisely. TRIALS REGISTRATION PROSPERO 2013: CRD42013005335.
Collapse
Affiliation(s)
- Maria Pufulete
- Clinical Trials and Evaluation Unit, University of Bristol, Level 7, Bristol Royal Infirmary, Queen's Building, Bristol BS2 8HW, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Ganzevoort W, Alfirevic Z, von Dadelszen P, Kenny L, Papageorghiou A, van Wassenaer-Leemhuis A, Gluud C, Mol BW, Baker PN. STRIDER: Sildenafil Therapy In Dismal prognosis Early-onset intrauterine growth Restriction--a protocol for a systematic review with individual participant data and aggregate data meta-analysis and trial sequential analysis. Syst Rev 2014; 3:23. [PMID: 24618418 PMCID: PMC3975177 DOI: 10.1186/2046-4053-3-23] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/27/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In pregnancies complicated by early-onset extreme fetal growth restriction, there is a high risk of preterm birth and an overall dismal fetal prognosis. Sildenafil has been suggested to improve this prognosis. The first aim of this review is to assess whether sildenafil benefits or harms these babies. The second aim is to analyse if these effects are modified in a clinically meaningful way by factors related to the women or the trial protocol. METHODS/DESIGN The STRIDER (Sildenafil Therapy In Dismal prognosis Early-onset intrauterine growth Restriction) Individual Participant Data (IPD) Study Group will conduct a prospective IPD and aggregate data systematic review with meta-analysis and trial sequential analysis. The STRIDER IPD Study Group started trial planning and funding applications in 2012. Three trials will be launched in 2014, recruiting for three years. Further trials are planned to commence in 2015.The primary outcome for babies is being alive at term gestation without evidence of serious adverse neonatal outcome. The latter is defined as severe central nervous system injury (severe intraventricular haemorrhage (grade 3 and 4) or cystic periventricular leukomalacia, demonstrated by ultrasound and/or magnetic resonance imaging) or other severe morbidity (bronchopulmonary dysplasia, retinopathy of prematurity requiring treatment, or necrotising enterocolitis requiring surgery). The secondary outcomes are improved fetal growth velocity assessed by ultrasound abdominal circumference measurements, gestational age and birth weight (centile) at delivery, and age-adequate performance on the two-year Bayley scales of infant and toddler development-III (composite cognitive score and composite motor score). Subgroup and sensitivity analyses in the IPD meta-analysis include assessment of the influence of several patient characteristics: an abnormal or normal serum level of placental growth factor, absent/reversed umbilical arterial end diastolic flow at commencement of treatment, and other patient characteristics available at baseline such as gestational age and estimated fetal weight. The secondary outcomes for mothers include co-incidence and severity of the maternal syndrome of pre-eclampsia, mortality, and other serious adverse events. DISCUSSION Trials are expected to start in 2013-2014 and end in 2016-2017. Data analyses of individual trials are expected to finish in 2019. Given the pre-planned and agreed IPD protocol, these results should be available in 2020.
Collapse
Affiliation(s)
- Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Academic Medical Centre, Room: H4-278, PO BOX 22660, 1100 DD Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Phillips RS, Sutton AJ, Riley RD, Chisholm JC, Picton SV, Stewart LA. Predicting infectious complications in neutropenic children and young people with cancer (IPD protocol). Syst Rev 2012; 1:8. [PMID: 22588015 PMCID: PMC3351734 DOI: 10.1186/2046-4053-1-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 02/09/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A common and potentially life-threatening complication of the treatment of childhood cancer is infection, which frequently presents as fever with neutropenia. The standard management of such episodes is the extensive use of intravenous antibiotics, and though it produces excellent survival rates of over 95%, it greatly inconveniences the three-fourths of patients who do not require such aggressive treatment. There have been a number of studies which have aimed to develop risk prediction models to stratify treatment. Individual participant data (IPD) meta-analysis in therapeutic studies has been developed to improve the precision and reliability of answers to questions of treatment effect and recently have been suggested to be used to answer questions regarding prognosis and diagnosis to gain greater power from the frequently small individual studies. DESIGN In the IPD protocol, we will collect and synthesise IPD from multiple studies and examine the outcomes of episodes of febrile neutropenia as a consequence of their treatment for malignant disease. We will develop and evaluate a risk stratification model using hierarchical regression models to stratify patients by their risk of experiencing adverse outcomes during an episode. We will also explore specific practical and methodological issues regarding adaptation of established techniques of IPD meta-analysis of interventions for use in synthesising evidence derived from IPD from multiple studies for use in predictive modelling contexts. DISCUSSION Our aim in using this model is to define a group of individuals at low risk for febrile neutropenia who might be treated with reduced intensity or duration of antibiotic therapy and so reduce the inconvenience and cost of these episodes, as well as to define a group of patients at very high risk of complications who could be subject to more intensive therapies. The project will also help develop methods of IPD predictive modelling for use in future studies of risk prediction.
Collapse
Affiliation(s)
- Robert S Phillips
- Centre for Reviews and Dissemination, Alcuin College, University of York, York, YO10 5DD, UK.
| | | | | | | | | | | | | |
Collapse
|