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Age and Ageing Jan 2018light-to-moderate alcohol consumption is protective against all-cause mortality and cardiovascular diseases. There is limited evidence in the literature on how alcohol... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
light-to-moderate alcohol consumption is protective against all-cause mortality and cardiovascular diseases. There is limited evidence in the literature on how alcohol consumption is related to frailty.
METHODS
five databases (Embase, Scopus, MEDLINE, CINAHL, PsycINFO) were systematically searched in July 2016 for prospective studies published between 2000 and 2016 examining baseline alcohol consumption and subsequent frailty risk among middle-aged or older community-dwelling population. Odds ratios (ORs) for incident frailty were pooled using a random-effects model. Heterogeneity, methodological quality and publication bias were assessed.
RESULTS
of 926 studies identified by the systematic search, four studies were included (total n = 44,051, ≥55 years, 66.2% alcohol users). OR of incident frailty for the highest (at least 24 g of alcohol/day for men, 12g of alcohol/day for women) or the most frequent (≥5 days of drinking/week) alcohol consumption compared with no drinking were used for a meta-analysis. Pooled OR among three studies measuring alcohol consumption quantitatively showed that the highest alcohol consumption was associated with lower frailty risk (3 studies:pooled OR = 0.44, 95%CI = 0.19-1.00, P = 0.05). Adding the other study measuring frequency of alcohol consumption made little change (4 studies:pooled OR = 0.61, 95%CI = 0.44-0.77, P < 0.001). Two of the included studies suggested a possible U-shaped association with lowest risks for moderate drinkers. Heterogeneity was moderate in both analyses (I2 = 52-67%). There was no evidence of publication bias.
CONCLUSIONS
this systematic review and meta-analysis study provides the first pooled evidence suggesting that heavier alcohol consumption is associated with lower incident frailty compared with no alcohol consumption among community-dwelling middle-aged and older people. However, this association may be due to unadjusted effect measures, residual confounding, 'sick quitter' effect or survival bias.
Topics: Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Chi-Square Distribution; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Incidence; Logistic Models; Male; Middle Aged; Odds Ratio; Prognosis; Prospective Studies; Protective Factors; Risk Assessment; Risk Factors; Time Factors
PubMed: 28541395
DOI: 10.1093/ageing/afx086 -
Clinical Journal of the American... Oct 2021AKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
AKI is a common complication after pediatric cardiac surgery and has been associated with higher morbidity and mortality. We aimed to compare the efficacy of available pharmacologic and nonpharmacologic strategies to prevent AKI after pediatric cardiac surgery.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
PubMed/MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists of relevant articles were searched for randomized controlled trials from inception until August 2020. Random effects traditional pairwise, Bayesian network meta-analyses, and trial sequential analyses were performed.
RESULTS
Twenty randomized controlled trials including 2339 patients and 11 preventive strategies met the eligibility criteria. No overall significant differences were observed compared with control for corticosteroids, fenoldopam, hydroxyethyl starch, or remote ischemic preconditioning in traditional pairwise meta-analysis. In contrast, trial sequential analysis suggested a 80% relative risk reduction with dexmedetomidine and evidence of <57% relative risk reduction with remote ischemic preconditioning. Nonetheless, the network meta-analysis was unable to demonstrate any significant differences among the examined treatments, including also acetaminophen, aminophylline, levosimendan, milrinone, and normothermic cardiopulmonary bypass. Surface under the cumulative ranking curve probabilities showed that milrinone (76%) was most likely to result in the lowest risk of AKI, followed by dexmedetomidine (70%), levosimendan (70%), aminophylline (59%), normothermic cardiopulmonary bypass (57%), and remote ischemic preconditioning (55%), although all showing important overlap.
CONCLUSIONS
Current evidence from randomized controlled trials does not support the efficacy of most strategies to prevent AKI in the pediatric population, apart from limited evidence for dexmedetomidine and remote ischemic preconditioning.
Topics: Acute Kidney Injury; Adrenergic alpha-2 Receptor Agonists; Age Factors; Bayes Theorem; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Child, Preschool; Dexmedetomidine; Female; Humans; Infant; Infant, Newborn; Ischemic Preconditioning; Male; Network Meta-Analysis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
PubMed: 34620647
DOI: 10.2215/CJN.05800421 -
International Journal of Molecular... Jul 2016Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk... (Review)
Review
Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk and mortality. The aims of this systematic review are to (1) describe diet quality scores used in cohort or cross-sectional research examining cancer outcomes; and (2) describe associations between diet quality scores and cancer risk and mortality. The protocol was registered in Prospero, and a systematic search using six electronic databases was conducted through to December 2014. Records were assessed for inclusion by two independent reviewers, and quality was evaluated using a validated tool. Sixty-four studies met inclusion criteria from which 55 different diet quality scores were identified. Of the 35 studies investigating diet quality and cancer risk, 60% (n = 21) found a positive relationship. Results suggest no relationship between diet quality scores and overall cancer risk. Inverse associations were found for diet quality scores and risk of postmenopausal breast, colorectal, head, and neck cancer. No consistent relationships between diet quality scores and cancer mortality were found. Diet quality appears to be related to site-specific adult cancer risk. The relationship with cancer mortality is less conclusive, suggesting additional factors impact overall cancer survival. Development of a cancer-specific diet quality score for application in prospective epidemiology and in public health is warranted.
Topics: Databases, Factual; Diet; Epidemiologic Studies; Humans; Neoplasms; Odds Ratio; Proportional Hazards Models; Risk Factors
PubMed: 27399671
DOI: 10.3390/ijms17071052 -
Frontiers in Public Health 2023We aimed to address which interventions best control blood pressure (BP) and delay disease progression in prehypertension and to give recommendations for the best option... (Meta-Analysis)
Meta-Analysis
BACKGROUND
We aimed to address which interventions best control blood pressure (BP) and delay disease progression in prehypertension and to give recommendations for the best option following a quality rating.
METHODS
A Bayesian network meta-analysis was used to assess the effect of the intervention on BP reduction, delaying hypertension progression and final outcome, with subgroup analyses for time and ethnicity. Recommendations for interventions were finally based on cumulative ranking probabilities and CINeMA.
RESULTS
From 22,559 relevant articles, 101 eligible randomized controlled trial articles (20,176 prehypertensive subjects) were included and 30 pharmacological and non-pharmacological interventions were evaluated. Moderate-quality evidence demonstrated that angiotensin II receptor blockers, aerobic exercise (AE), and dietary approaches to stop hypertension (DASH) lowered systolic blood pressure (SBP). For lowering diastolic blood pressure (DBP), AE combined with resistance exercise (RE) or AE alone provided high quality evidence, with calcium channel blockers, lifestyle modification (LSM) combined with drug providing moderate quality evidence. LSM produced the best BP lowering effect at 12 months and beyond of intervention. In Asians, TCD bubble was moderate quality evidence for lowering SBP and RE may have had a BP lowering effect in Caucasians. No recommendation can be given for delaying the progression of hypertension and reducing mortality outcomes because of low to very low quality of evidence.
CONCLUSION
AE combined RE are preferentially recommended for BP control in prehypertension, followed by DASH. Long-term BP control is preferred to LSM. Asians and Caucasians add TCD bubble and RE to this list as potentially effective interventions.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022356302, identifier: CRD42022356302.
Topics: Humans; Blood Pressure; Prehypertension; Bayes Theorem; Hypertension
PubMed: 37033077
DOI: 10.3389/fpubh.2023.1139617 -
Nutrition Reviews Aug 2021Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However,... (Meta-Analysis)
Meta-Analysis
CONTEXT
Diet may be one of the modifiable environmental factors that could reduce depressive symptoms or abate the development of depression without side effects. However, previous reviews mainly focused on general adult populations.
OBJECTIVE
The aim of this systematic review and meta-analysis was to explore the association between healthy dietary patterns and depression risk in older adults.
DATA SOURCES
Eight databases were searched up to September 2019. The inclusion criteria were older adults aged ≥ 65 years, healthy dietary patterns, depression assessed by a physician or by validated screening tools, and quantitative study design.
DATA EXTRACTION
Data were extracted independently by 2 researchers, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed.
DATA ANALYSIS
Meta-analysis was conducted by calculating the pooled odds ratio (OR) and 95% CIs. A total of 18 eligible studies were meta-analyzed. Results showed that a healthy dietary pattern is associated with a reduced risk of depression in older adults (OR, 0.85; 95%CI, 0.78-0.92; P < 0.001). There was high heterogeneity (I2 = 64.9%; P < 0.001) among the studies. Subgroup analyses indicated that sample size and depression screening tools were the main sources of study heterogeneity.
CONCLUSIONS
An inverse association between healthy dietary patterns and depression risk in older adults was found. However, the high heterogeneity among the studies should be considered.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration no. CRD 42020169195.
Topics: Aged; Depression; Diet; Humans; Odds Ratio; Risk Factors
PubMed: 33236111
DOI: 10.1093/nutrit/nuaa118 -
Psychological Bulletin Dec 2017The natural frequency facilitation effect describes the finding that people are better able to solve descriptive Bayesian inference tasks when represented as joint... (Meta-Analysis)
Meta-Analysis Review
The natural frequency facilitation effect describes the finding that people are better able to solve descriptive Bayesian inference tasks when represented as joint frequencies obtained through natural sampling, known as natural frequencies, than as conditional probabilities. The present meta-analysis reviews 20 years of research seeking to address when, why, and for whom natural frequency formats are most effective. We review contributions from research associated with the 2 dominant theoretical perspectives, the ecological rationality framework and nested-sets theory, and test potential moderators of the effect. A systematic review of relevant literature yielded 35 articles representing 226 performance estimates. These estimates were statistically integrated using a bivariate mixed-effects model that yields summary estimates of average performances across the 2 formats and estimates of the effects of different study characteristics on performance. These study characteristics range from moderators representing individual characteristics (e.g., numeracy, expertise), to methodological differences (e.g., use of incentives, scoring criteria) and features of problem representation (e.g., short menu format, visual aid). Short menu formats (less computationally complex representations showing joint-events) and visual aids demonstrated some of the strongest moderation effects, improving performance for both conditional probability and natural frequency formats. A number of methodological factors (e.g., exposure to both problem formats) were also found to affect performance rates, emphasizing the importance of a systematic approach. We suggest how research on Bayesian reasoning can be strengthened by broadening the definition of successful Bayesian reasoning to incorporate choice and process and by applying different research methodologies. (PsycINFO Database Record
Topics: Bayes Theorem; Cognition; Humans; Mathematical Concepts; Models, Psychological; Problem Solving; Thinking
PubMed: 29048176
DOI: 10.1037/bul0000126 -
Current Opinion in Otolaryngology &... Apr 2016Management of advanced head and neck cancer (HNC) is characterized by high mortality. Furthermore, the treatment involves significant burden to patients and high costs... (Review)
Review
PURPOSE OF REVIEW
Management of advanced head and neck cancer (HNC) is characterized by high mortality. Furthermore, the treatment involves significant burden to patients and high costs to healthcare systems. Recognizing the risks of early death in patients with a high probability of noncurable disease is important for each individual treatment decision-making. It is thus critical to consider the benefits and side-effects of the planned treatment in relation to the expected survival and to discuss these factors with the patient. However, only few studies have documented early death in HNC patients, that is, during the first posttreatment 6 months. We performed a systematic literature review to find the incidence of this phenomenon and to outline the probable cause.
RECENT FINDINGS
Early mortality in patients with HNC can be explained either by direct effect of malignant disease, may be related to comorbidities, or secondary to the treatment. These factors act together resulting in expected or unexpected early death.
SUMMARY
The present review provides information on the mechanisms leading to early phase mortality (<6 months) after management of HNC. It also reports the incidence of this phenomenon among Finnish and Swedish patient populations.
Topics: Comorbidity; Decision Making; Finland; Head and Neck Neoplasms; Humans; Incidence; Registries; Risk Assessment; Risk Factors; Sweden
PubMed: 26735585
DOI: 10.1097/MOO.0000000000000236 -
BMJ (Clinical Research Ed.) Feb 2015To assess the effectiveness and safety of prostaglandins used for labour induction. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To assess the effectiveness and safety of prostaglandins used for labour induction.
DESIGN
Systematic review with Bayesian network meta-analysis
DATA SOURCES
The Cochrane Pregnancy and Childbirth Group's Database of Trials (which incorporates the results of a broad generic search for all pregnancy and postpartum trials). Sources included are CENTRAL, Medline, Embase, NHS Economic Evaluation Database, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised clinical trials of prostaglandin or prostaglandin analogues used for third trimester cervical ripening or labour induction versus placebo or no treatment, alternative prostaglandin dose or administration, or a different type of prostaglandin. We included studies recruiting women with a viable fetus, but had no other restrictions relating to indication for labour induction or language of publication. Outcomes assessed were serious neonatal morbidity (trialist defined) or perinatal death; serious maternal morbidity (trialist defined) or death; vaginal delivery not achieved within 24 hours, caesarean section, and uterine hyperstimulation with fetal heart rate changes.
RESULTS
280 randomised clinical trials were included (48 068 women) in the review. Maternal and neonatal mortality and serious morbidity were rarely reported and are summarized narratively. Unresolved inconsistency was observed for the hyperstimulation outcome. Relative to placebo, the odds of failing to achieve a vaginal delivery were lowest for vaginal misoprostol (≥50 µg) (odds ratio 0.06 (95% credible interval 0.02 to 0.12)), with a 39% absolute probability of event (95% credible interval 1% to 94%). Compared with placebo, odds of caesarean section were lowest for titrated oral misoprostol solution (<50 µg) (odds ratio 0.65 (0.49 to 0.83)), with an absolute probability of event of 15% (3% to 40%).
CONCLUSIONS
Low dose(<50 µg) titrated oral misoprostol solution had the lowest probability of caesarean section, whereas vaginal misprostol (≥50 µg) had the highest probability of achieving a vaginal delivery within 24 hours. These findings have important implications for a series of current national and international guidelines for induction of labour and future research in this area.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO 2013:CRD42013005116.
Topics: Bayes Theorem; Dose-Response Relationship, Drug; Female; Humans; Infant, Newborn; Labor, Induced; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Prostaglandins
PubMed: 25656228
DOI: 10.1136/bmj.h217 -
The Journal of Maternal-fetal &... Dec 2022To compare the rates of adverse outcomes with postpartum hemorrhage (PPH) before and after implementation of drills or simulation exercises. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare the rates of adverse outcomes with postpartum hemorrhage (PPH) before and after implementation of drills or simulation exercises.
STUDY ELIGIBILITY CRITERIA
We included all English studies that reported on rates of PPH and associated complications during the pre- and post-implementation of interventional exercises.
STUDY APPRASIAL AND SYNTHESIS METHODS
Two investigators independently reviewed the abstracts, and full articles for eligibility of all studies. Inconsistencies related to study evaluation or data extraction were resolved by a third author. The co-primary outcomes were the rate of PPH and of any transfusion; the secondary outcomes included admission to the intensive care unit (ICU), transfusion ≥ 4 units of packed red blood cells, hysterectomy, or maternal death. Study effects were combined by Bayesian meta-analysis and reported as risk ratios (RR) and 95% credible intervals (Cr).
RESULTS
We reviewed 142 full length articles. Of these, 18 publications, with 355,060 deliveries-150,562 (42%) deliveries during the pre-intervention and 204,498 (57.6%) deliveries in the post-interventional period-were included in the meta-analysis. Using the Newcastle-Ottawa Scale, only three studies were considered good quality, and none of them were done in the US. The rate of PPH prior to intervention was 5.06% and 5.46% afterwards (RR 1.09, 95% CI 0.87-1.36; probability of reduction in the diagnosis being 21%). The likelihood of transfusion decreased from 1.68% in the pre-intervention to 1.27% in the post-intervention period (RR 0.80, 95% Cr 0.57-1.09). The overall probability of reduction in transfusion was 93%, albeit it varied among studies done in non-US countries (96%) versus in the US (23%). Transfusion of 4 units or more of blood occurred in 0.44% of deliveries before intervention and 0.37% afterwards (RR of 0.85, 95% CI 0.50-1.52), with the overall probability of reduction being 72% (76% probability of reduction in studies from non-US countries and 49% reduction with reports from the US). Surgical interventions to manage PPH, which was not reported in any US studies, occurred in 0.14% before intervention and 0.28% afterwards (RR 1.29; 95% CI 0.56-3.06; probability of reduction 27%). Admission to the ICU occurred in 0.10% before intervention and 0.08% subsequently (RR 0.92, 95% CI 0.58-1.43), with the overall probability of reduction being 65% (81% in studies from non-US countries and 27% from the study done in the US). Maternal death occurred in 0.17% in the pre-intervention period and 0.09% during the post-intervention (RR 0.62, 95% CI 0.33-1.05; probability of reduction 93% in studies from non-US countries and 82% in one study from the US).
CONCLUSIONS
Interventions to reduce the sequelae of PPH are associated with decrease in adverse outcomes. The conclusion, however, ought not to be accepted reflexively for the US population. All of the studies on the topic done in the US are of poor quality and the associated probability of reduction in sequelae are consistently lower than those done in other countries.
SYNOPSIS
Since the putative benefits of PPH drills or simulation exercises are based on poor quality pre- and post-intervention trials, policies recommending them ought to be revisited.
Topics: Pregnancy; Female; Humans; Postpartum Hemorrhage; Oxytocics; Bayes Theorem; Maternal Death; Drug Therapy, Combination
PubMed: 36220264
DOI: 10.1080/14767058.2022.2128659 -
Scientific Reports Jan 2016We performed this meta-analysis of epidemiological studies to comprehensively assess the association between parity and gastric cancer risk, because previous studies... (Meta-Analysis)
Meta-Analysis Review
We performed this meta-analysis of epidemiological studies to comprehensively assess the association between parity and gastric cancer risk, because previous studies have shown conflicting results regarding this topic. Relevant prospective studies were identified by searching the following databases: PubMed, EMBASE, and Web of Science, and random-effects models were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs). Our search yielded 10 prospective cohort studies involving a total of 6624 gastric cancer cases and 5,559,695 non-cases. The SRRs for ever parity vs. nulliparous and highest vs. lowest parity number were 0.96 (95%CI = 0.87-1.05, I(2) = 0%) and 1.03 (95%CI = 0.94-1.13, I(2) = 0%), respectively. Additionally, the SRR for an increment of one live birth was 1.00 (95%CI = 0.97-1.03, I(2) = 18.6%). These non-significant associations were observed in all subgroups as stratified by the number of gastric cases, follow-up years, geographic location, menopausal status, anatomic subsite of gastric cancer, and adjustment for potential confounders, as well as in sensitivity analyses. Our meta-analysis found no significant association between parity and gastric cancer risk. However, further studies should be conducted to validate our findings and could provide more detailed results by stratifying their findings by Lauren's subtype, histology, and anatomic site, as well as fully adjusting for potential confounding factors.
Topics: Female; Humans; Odds Ratio; Parity; Pregnancy; Prospective Studies; Risk; Risk Factors; Stomach Neoplasms
PubMed: 26727146
DOI: 10.1038/srep18766