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Phytotherapy Research : PTR Mar 2022This systematic review and meta-analysis were conducted to determine the effects of anthraquinone (AQ) laxatives on colorectal cancer (CRC). We searched PubMed, Embase,... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis were conducted to determine the effects of anthraquinone (AQ) laxatives on colorectal cancer (CRC). We searched PubMed, Embase, Google Scholar, and CENTRAL from inception until March 2021, for randomized controlled trials (RCTs) and observational studies. Through the systematic review, we identified 8 observational studies evaluating AQ laxatives use as a risk factor for CRC development, and 5 studies on CRC risk were included in the meta-analysis using a random-effects model. Through the meta-analysis, we found that a history of AQ laxatives use compared with "other" and "no laxatives" use was associated with CRC development (OR: 1.41; 95% CI: 0.94-2.11), although not at a statistically significant level. The possible association persists even after removal of the outlier studies (OR: 1.51; 95% CI: 0.97-2.34). Selection of cases and controls was judged at low or unclear risk of bias across almost all studies, and the quality of evidence was from moderate to low. In conclusion, it is not possible to associate the use of AQ laxatives with the development of CRC. However, the trend toward an increased risk of CRC provides a strong indication for investigating this issue by performing further high-quality studies.
Topics: Anthraquinones; Colorectal Neoplasms; Constipation; Humans; Laxatives
PubMed: 35040201
DOI: 10.1002/ptr.7373 -
Journal of Autoimmunity Apr 2024Among the over 80 different autoimmune diseases, psoriasis (PsO), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) are common representatives. Previous studies... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Among the over 80 different autoimmune diseases, psoriasis (PsO), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) are common representatives. Previous studies indicated a potential link with cancer risk, but suffered often from low statistical power. Thus, we aimed to synthesize the evidence and quantify the association to different female-specific cancer sites.
METHODS
The systematic review was performed according to PRISMA guidelines. A search string was developed for the databases PubMed, Web of Science, Cochrane Library and Embase. Results were screened independently by two investigators and the risk of bias was assessed using the ROBINS-E tool. Meta-analyses were performed using inverse variance weighted random-effects models. Statistical between-study heterogeneity was quantified by calculating Cochran's Q, τ, and Higgins' I statistics. Sources of heterogeneity were analyzed and adjusted for within an intensive bias assessment in the form of meta-regression, outlier, influential, and subgroup analyses. A range of methods were used to test and adjust for publication bias.
RESULTS
Of 10,096 records that were originally identified by the search strategy, 45 were included in the meta-analyses. RA was inversely associated with both breast and uterine cancer occurrence, while PsO was associated with a higher breast cancer risk. Outlier-adjusted estimates confirmed these findings. Bias assessment revealed differences in geographic regions, particularly in RA patients, with higher estimates among Asian studies. An additional analysis revealed no association between psoriatic arthritis and breast cancer.
CONCLUSIONS
RA seems to reduce the risk of breast and uterine cancers, while PsO appears to increase breast cancer risk. Further large studies are required to investigate potential therapy-effects and detailed biological mechanisms.
Topics: Humans; Female; Autoimmune Diseases; Arthritis, Rheumatoid; Arthritis, Psoriatic; Psoriasis; Breast Neoplasms
PubMed: 38428110
DOI: 10.1016/j.jaut.2024.103187 -
Journal of Comparative Effectiveness... May 2023Stent-retriever (SR) thrombectomy has demonstrated superior outcomes in patients with acute ischemic stroke compared with medical management alone, but differences... (Meta-Analysis)
Meta-Analysis Review
MASTRO I: Meta-Analysis and Systematic Review of thrombectomy stent retriever outcomes: comparing functional, safety and recanalization outcomes between EmboTrap, Solitaire and Trevo in acute ischemic stroke.
Stent-retriever (SR) thrombectomy has demonstrated superior outcomes in patients with acute ischemic stroke compared with medical management alone, but differences among SRs remain unexplored. We conducted a Systematic Review/Meta-Analysis to compare outcomes between three SRs: EmboTrap, Solitaire™, and Trevo. We conducted a PRISMA-compliant Systematic Review among English-language studies published after 2014 in PubMed/MEDLINE that reported SRs in ≥25 patients. Functional and safety outcomes included 90-day modified Rankin scale (mRS 0-2), mortality, symptomatic intracranial hemorrhage (sICH), and embolization to new territory (ENT). Recanalization outcomes included modified thrombolysis in cerebral infarction (mTICI) and first-pass recanalization (FPR). We used a random effects Meta-Analysis to compare outcomes; subgroup and outlier-influencer analysis were performed to explore heterogeneity. Fifty-one articles comprising 9,804 patients were included. EmboTrap had statistically significantly higher rates of mRS 0-2 (57.4%) compared with Trevo (50.0%, p = 0.013) and Solitaire (45.3%, p < 0.001). Compared with Solitaire (20.4%), EmboTrap (11.2%, p < 0.001) and Trevo (14.5%, p = 0.018) had statistically significantly lower mortality. Compared with Solitaire (7.7%), EmboTrap (3.9%, p = 0.028) and Trevo (4.6%, p = 0.049) had statistically significantly lower rates of sICH. There were no significant differences in ENT rates across all three devices (6.0% for EmboTrap, 5.3% for Trevo, and 7.7% for Solitaire, p = 0.518). EmboTrap had numerically higher rates of recanalization; however, no statistically significant differences were found. The results of our Systematic Review/Meta-Analysis suggest that EmboTrap may be associated with significantly improved functional outcomes compared with Solitaire and Trevo. EmboTrap and Trevo may be associated with significantly lower rates of sICH and mortality compared with Solitaire. No significant differences in recanalization and ENT rates were found. These conclusions are tempered by limitations of the analysis including variations in thrombectomy techniques in the field, highlighting the need for multi-arm RCT studies comparing different SR devices to confirm our findings.
Topics: Humans; Stroke; Ischemic Stroke; Treatment Outcome; Thrombectomy; Stents
PubMed: 37039285
DOI: 10.57264/cer-2023-0001 -
Global Health Action Dec 2023Undernutrition remains a major public health issue in low- and middle-income countries. Objective Our aim for this study was to identify the factors contributing to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Undernutrition remains a major public health issue in low- and middle-income countries. Objective Our aim for this study was to identify the factors contributing to undernutrition in children under five years old in North Africa.
METHODS
We searched five electronic bibliographic databases (Ovid MEDLINE, Web of Science, Embase (Ovid), ProQuest, and CINAHL) for eligible observational studies published after 2006. STATA version 17 software was used to calculate the odds ratios between associated factors and indicators of undernutrition, with 95% confidence intervals. For each factor, the overall odds were pooled using a forest plot. Due to the significant heterogeneity among the studies (I2 > 50%), a random-effects model was used, and sensitivity analysis was conducted to examine the effect of outliers.
RESULTS
Out of 1093 initially identified studies, 14 met the selection criteria. Our meta-analysis revealed that uneducated mothers were the most common factor associated with undernutrition in North African children. Children aged 0-23 months were significantly associated with stunting (odds ratios (OR) = 1.27; 95% CI: 1.18; 1.37) and wasting (OR = 1.68; 95% CI: 1.42; 1.99). Children living in rural areas were also at higher odds of being stunted (OR = 1.74; 95% CI: 1.64; 1.84) and underweight (OR = 1.59; 95% CI: 1.35; 1.88). These analyses also indicated that a lower wealth index, mothers' nutritional health, uneducated fathers, and low birth weight were other factors significantly associated with stunting.
CONCLUSION
Addressing undernutrition in Northern Africa requires a multidisciplinary approach prioritising mothers and young children, especially families in underprivileged areas.
Topics: Female; Humans; Child; Infant; Child, Preschool; Wasting Syndrome; Malnutrition; Mothers; Thinness; Growth Disorders; Prevalence; Africa, Northern
PubMed: 37497693
DOI: 10.1080/16549716.2023.2240158 -
Journal of Affective Disorders Mar 2024Understanding predictors of suicidal ideation (SI) is crucial for preventing suicides. Given Europe's high suicide rates and the complex nature of SI, it is essential to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Understanding predictors of suicidal ideation (SI) is crucial for preventing suicides. Given Europe's high suicide rates and the complex nature of SI, it is essential to also examine social determinants like education as potential risk factors for SI in this region. This systematic review and meta-analysis investigates the association between formal/vocational education and SI in Europe.
METHODS
Electronic databases (PubMed, Web of Science, PsycINFO, PSYNDEX) were searched until November 2022. Included studies involved European populations examining associations between education and SI. Pooled Odds Ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed with the heterogeneity variance τ and I statistic; subgroup analyses were performed based on study characteristics. Risk of bias was assessed using an adaption of the Newcastle-Ottawa Scale.
RESULTS
From 20,564 initial studies, 41 were included in the meta-analysis (outlier-adjusted, 96,809 study participants). A negative, insignificant association (OR = 0.86, 95 % CI: 0.75; 1.00) was observed between education and SI, with significant heterogeneity (τ = 0.09, I = 73 %). Subgroup analyses indicated that population type, age group, categorization of education, timeframe of SI assessment, and study quality significantly moderated the effect size.
LIMITATIONS
Heterogeneity across studies limits generalizability. The cross-sectional design precludes establishing causal relationships, and social desirability bias may have underestimated the association between education and SI.
CONCLUSIONS
This systematic review and meta-analysis suggests a trend towards a protective effect of education on the emergence of SI in Europe. Future research, preferably with longitudinal study design examining various covariates, should systematically consider educational inequalities in SI.
Topics: Humans; Suicidal Ideation; Suicide; Longitudinal Studies; Cross-Sectional Studies; Europe
PubMed: 38199415
DOI: 10.1016/j.jad.2024.01.040 -
Campbell Systematic Reviews Sep 2022A growing body of research shows the promise and efficacy of technology-based or digital interventions in improving the health and well-being of survivors of intimate... (Review)
Review
BACKGROUND
A growing body of research shows the promise and efficacy of technology-based or digital interventions in improving the health and well-being of survivors of intimate partner violence (IPV). In addition, mental health comorbidities such as anxiety, post-traumatic stress disorder (PTSD), and depression occur three to five times more frequently in survivors of IPV than non-survivors, making these comorbidities prominent targets of technology-based interventions. Still, research on the long-term effectiveness of these interventions in reducing IPV victimization and adverse mental health effects is emergent. The significant increase in the number of trials studying technology-based therapies on IPV-related outcomes has allowed us to quantify the effectiveness of such interventions for mental health and victimization outcomes in survivors. This meta-analysis and systematic review provide critical insight from several randomized controlled trials (RCTs) on the overall short and long-term impact of technology-based interventions on the health and well-being of female IPV survivors.
OBJECTIVES
To synthesize current evidence on the effects of technology-based or digital interventions on mental health outcomes (depression, anxiety, and PTSD) and victimization outcomes (physical, psychological, and sexual abuse) among IPV survivors.
SEARCH METHODS
We examined multiple traditional and grey databases for studies published from 2007 to 2021. Traditional databases (such as PubMed Central, Web of Science, CINAHL Plus, and PsychINFO) and grey databases were searched between April 2019 and February 2021. In addition, we searched clinical trial registries, government repositories, and reference lists. Authors were contacted where additional data was needed. We identified 3210 studies in traditional databases and 1257 from grey literature. Over 2198 studies were determined to be duplicates and eliminated, leaving 64 studies after screening titles and abstracts. Finally, 17 RCTs were retained for meta-analysis. A pre-registered protocol was developed and published before conducting this meta-analysis.
SELECTION CRITERIA
We included RCTs targeting depression, anxiety, PTSD outcomes, and victimization outcomes (physical, sexual, and psychological violence) among IPV survivors using a technology-based intervention. Eligible RCTs featured a well-defined control group. There were no study restrictions based on participant gender, study setting, or follow-up duration. Included studies additionally supplied outcome data for calculating effect sizes for our desired outcome. Studies were available in full text and published between 2007 and 2021 in English.
DATA COLLECTION AND ANALYSIS
We extracted relevant data and coded eligible studies. Using Cochrane's RevMan software, summary effect sizes () were assessed using an independent fixed-effects model. Standardized mean difference (SMD) effect sizes (or Cohen's ) were evaluated using a Type I error rate and an alpha of 0.05. The overall intervention effects were analyzed using the -statistic with a -value of 0.05. Cochran's test and Higgins' statistics were utilized to evaluate and confirm the heterogeneity of each cumulative effect size. The Cochrane risk of bias assessment for randomized trials (RoB 2) was used to assess the quality of the studies. Campbell Systematic Reviews registered and published this study's protocol in January 2021. No exploratory moderator analysis was conducted; however, we report our findings with and without outlier studies in each meta-analysis.
MAIN RESULTS
Pooled results from 17 RCTs yielded 18 individual effect size comparisons among 4590 survivors (all females). Survivors included college students, married couples, substance-using women in community prisons, pregnant women, and non-English speakers, and sample sizes ranged from 15 to 672. Survivors' ages ranged from 19 to 41.5 years. Twelve RCTs were conducted in the United States and one in Canada, New Zealand, China (People's Republic of), Kenya, and Australia. The results of this meta-analysis found that technology-based interventions significantly reduced among female IPV survivors at 0-3 months only (SMD = -0.08, 95% confidence interval [CI] = -0.17 to -0.00), among IPV survivors at 0-3 months (SMD = -0.27, 95% CI = -0.42 to -0.13, = 0.00, = 25%), and among IPV survivors at 0-6 months (SMD = -0.22, 95% CI = -0.38 to -0.05). We found significant reductions in psychological violence victimization at 0-6 months (SMD = -0.34, 95% CI = -0.47 to -0.20) and at >6 months (SMD = -0.29, 95% CI = -0.39 to -0.18); however, at both time points, there were outlier studies. At no time point did digital interventions significantly reduce (SMD = -0.04, 95% CI = -0.14 to 0.06, = .46, = 0%), or (SMD = -0.02, 95% CI = -0.14 to 0.11, = 21%) among female IPV survivors for all. With outlier studies removed from our analysis, all summary effect sizes were small, and this small number of comparisons prevented moderator analyses.
AUTHORS' CONCLUSIONS
The results of this meta-analysis are promising. Our findings highlight the effectiveness of IPV-mitigating digital intervention as an add-on (not a replacement) to traditional modalities using a coordinated response strategy. Our findings contribute to the current understanding of "what works" to promote survivors' mental health, safety, and well-being. Future research could advance the science by identifying active intervention ingredients, mapping out intervention principles/mechanisms of action, best modes of delivery, adequate dosage levels using the treatment intensity matching process, and guidelines to increase feasibility and acceptability.
PubMed: 36909881
DOI: 10.1002/cl2.1271 -
Prevalence and treatment of panic disorder in bipolar disorder: systematic review and meta-analysis.Evidence-based Mental Health May 2018Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid... (Meta-Analysis)
Meta-Analysis Review
QUESTION
Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression. The literature on panic disorder (PD) comorbid with BD has been systematically reviewed and subject to meta-analysis.
STUDY SELECTION AND ANALYSIS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were thoroughly followed for literature search, selection and reporting of available evidence. The variance-stabilising Freeman-Tukey double arcsine transformation was used in the meta-analysis of prevalence estimates. Both fixed-effect and random-effects models with inverse variance method were applied to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran's Q and I statistics.
FINDINGS
Overall, 15 studies (n=3391) on cross-sectional prevalence and 25 independent lifetime studies (n=8226) were used to calculate pooled estimates. The overall random-effects point prevalence of PD in patients with BD, after exclusion of one potential outlier study, was 13.0% (95% CI 7.0% to 20.3%), and the overall random-effects lifetime estimate, after exclusion of one potential outlier study, was 15.5% (95% CI 11.6% to 19.9%). There were no differences in rates between BD-I and BD-II. Significant heterogeneity (I >95%) was found in both estimates.
CONCLUSIONS
Estimates that can be drawn from published studies indicate that the prevalence of PD in patients with BD is higher than the prevalence in the general population. Comorbid PD is reportedly associated with increased risk of suicidal acts and a more severe course. There is no clear indication on how to treat comorbid PD in BD. Findings from the current meta-analysis confirm the highly prevalent comorbidity of PD with BD, implicating that in patients with BD, PD might run a more chronic course.
Topics: Bipolar Disorder; Comorbidity; Humans; Panic Disorder
PubMed: 29636354
DOI: 10.1136/eb-2017-102858 -
Sensors (Basel, Switzerland) Apr 2022For cardiac defibrillator testing and design purposes, the range and limits of the human TTI is of high interest. Potential influencing factors regarding the electronic... (Review)
Review
For cardiac defibrillator testing and design purposes, the range and limits of the human TTI is of high interest. Potential influencing factors regarding the electronic configurations, the electrode/tissue interface and patient characteristics were identified and analyzed. A literature survey based on 71 selected articles was used to review and assess human TTI and the influencing factors found. The human TTI extended from 12 to 212 Ω in the literature selected. Excluding outliers and pediatric measurements, the mean TTI recordings ranged from 51 to 112 Ω with an average TTI of 76.7 Ω under normal distribution. The wide range of human impedance can be attributed to 12 different influencing factors, including shock waveforms and protocols, coupling devices, electrode size and pressure, electrode position, patient age, gender, body dimensions, respiration and lung volume, blood hemoglobin saturation and different pathologies. The coupling device, electrode size and electrode pressure have the greatest influence on TTI.
Topics: Cardiography, Impedance; Child; Electric Countershock; Electric Impedance; Electrodes; Heart; Humans
PubMed: 35408422
DOI: 10.3390/s22072808 -
International Journal of Environmental... Feb 2023This study investigated the effects of non-pharmacological interventions on sleep in older people through a systematic review and meta-analysis. We conducted a... (Meta-Analysis)
Meta-Analysis Review
This study investigated the effects of non-pharmacological interventions on sleep in older people through a systematic review and meta-analysis. We conducted a literature search using eight electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Participant characteristics, the contents of the evaluated interventions, and the measured outcomes were systematically reviewed for 15 selected studies. We performed a meta-analysis to estimate the effect size for overall, aggregated sleep outcomes. Due to the small number of studies available for each intervention, only the overall effectiveness of non-pharmacological sleep interventions was evaluated. The evaluated interventions included exercise, aromatherapy, acupressure, cognitive behavior therapy, and meditation. Our results demonstrated that non-pharmacological interventions showed statistically significant effects on sleep (effect size = 1.00, 95% confidence interval: 0.16, 1.85, I = 92%, < 0.001). After confirming publication bias and removing outliers, we found no heterogeneity (I = 17%, = 0.298), with a decrease in effect size to 0.70 (95% confidence interval: 0.47, 0.93). Non-pharmacological interventions are effective for improving sleep in older adults. Future studies should continue to investigate sleep problems and interventions addressing these problems in this demographic, particularly in older women. Objective measures should be used to follow-up on the evaluated sleep interventions over the long term.
Topics: Humans; Female; Aged; Sleep Wake Disorders; Cognitive Behavioral Therapy; Sleep; Aromatherapy; Meditation
PubMed: 36833796
DOI: 10.3390/ijerph20043101 -
International Journal of Environmental... Jan 2023The prevalence of anemia is high among children and adolescents in low- and middle-income countries because of undernutrition resulting from their poor socioeconomic... (Meta-Analysis)
Meta-Analysis
The prevalence of anemia is high among children and adolescents in low- and middle-income countries because of undernutrition resulting from their poor socioeconomic status and lack of knowledge on proper nutrition. We conducted a systematic review and meta-analysis to determine the prevalence of anemia among children and adolescents aged between 6 months and 19 years in Bangladesh. Databases such as PubMed, Scopus, and Google Scholar were searched to identify the studies that reported the prevalence of anemia among children and adolescents. A total of 24 studies, including the data of 14,062 cases, were included in the systematic review and meta-analysis of the time period between 1997 and 2019. The random-effects model was used to calculate the summary estimates. The protocol was registered with PROSPERO (CRD42021246960). The pooled prevalence of anemia, iron deficiency anemia (IDA), and non-severe and severe anemia were 46.8% [95% CI: 36.0-57.6], 13.6% [95% CI: 8.0-19.2], 56.4% [95% CI: 39.6-73.1] and 0.7% [95% CI: 0.1-1.4], respectively. Prevalence of anemia exhibited the highest among the children aged ≤2 years. Briefly, 91.67% of the studies were of high quality. No significant publication bias was found; however, two outlier studies were detected. The prevalence of anemia among children and adolescents was estimated as high in Bangladesh.
Topics: Humans; Child; Adolescent; Infant; Prevalence; Bangladesh; Anemia; Anemia, Iron-Deficiency; Nutritional Status
PubMed: 36767153
DOI: 10.3390/ijerph20031786