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The American Journal of the Medical... Sep 2023Church-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Church-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD. We aim to conduct a systematic review and meta-analysis to determine the effectiveness of church-based interventions for CVD risk factor improvement and to examine the types of interventions that are effective.
METHODS
Systematic searches of MEDLINE, Embase, and manual reference searches were conducted through November 2021. Study inclusion criteria were church-based interventions delivered in the United States to address CVD risk factors. Interventions targeted barriers to improving blood pressure, weight, diabetes, physical activity, cholesterol, diet, or smoking. Two investigators independently extracted study data. Random effects meta-analyses were conducted.
RESULTS
A total of 81 studies with 17,275 participants were included. The most common interventions included increasing physical activity (n = 69), improving diet (n = 67), stress management (n = 20), medication adherence (n = 9), and smoking cessation (n = 7). Commonly used approaches for implementation included cultural tailoring of the intervention, health coaching, group education sessions, inclusion of spiritual components in the intervention, and home health monitoring. Church-based interventions were associated with significant reductions in body weight (-3.1 lb, [95% CI, -5.8, -1.2], N = 15), waist circumference (-0.8 in, [CI, -1.4, -0.1], N = 6), and systolic blood pressure (-2.3 mm Hg, [CI, -4.3, -0.3], N = 13).
CONCLUSIONS
Church-based interventions targeting CVD risk factors are effective for reducing CVD risk factors, particularly in populations with health disparities. These findings can be used to design future church-based studies and programs to improve cardiovascular health.
Topics: Humans; Cardiovascular Diseases; Diet; Health Promotion; Exercise; Heart Disease Risk Factors
PubMed: 37244637
DOI: 10.1016/j.amjms.2023.05.010 -
International Journal of Yoga 2023Stress is an enormous concern in our culture because it is the root cause of many health issues. Yoga asanas and mindfulness-based practices are becoming increasingly... (Review)
Review
Stress is an enormous concern in our culture because it is the root cause of many health issues. Yoga asanas and mindfulness-based practices are becoming increasingly popular for stress management; nevertheless, the biological effect of these practices on stress reactivity is still a research domain. The purpose of this review is to emphasize various biosignals that reflect stress reduction through various yoga-based practices. A comprehensive synthesis of numerous prior investigations in the existing literature was conducted. These investigations undertook a thorough examination of numerous biosignals. Various features are extracted from these signals, which are further explored to reflect the effectiveness of yoga practice in stress reduction. The multifaceted character of stress and the extensive research undertaken in this field indicate that the proposed approach would rely on multiple modalities. The notable growth of the body of literature pertaining to prospective yoga processes is deserving of attention; nonetheless, there exists a scarcity of research undertaken on these mechanisms. Hence, it is recommended that future studies adopt more stringent yoga methods and ensure the incorporation of suitable participant cohorts.
PubMed: 38463652
DOI: 10.4103/ijoy.ijoy_218_23 -
The Permanente Journal Sep 2023Debt is a common issue among medical residents in the United States. This review attempts 1) to evaluate the level of debt among residents, 2) to assess perceptions... (Review)
Review
Debt is a common issue among medical residents in the United States. This review attempts 1) to evaluate the level of debt among residents, 2) to assess perceptions toward debt among residents, 3) to determine debt-management options pursued, and 4) to gauge whether levels of debt affect resident career choices. A systematic literature search of articles published between January 2012 and January 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed. The combination of search terms of (financial literacy OR debt) AND (residency OR graduate medical education) were utilized. Primary outcome measures assessed were the levels of debt and perceptions toward the debt. Secondary outcome measures were debt-management options pursued and whether debt affected career choices for residents. Twenty-one studies evaluating a total of 15,585 residents were included in this systematic review. Levels of debt greater than $200,000 were not uncommon across residents and debt burdens are increasing. Greater levels of debt are associated with increased stress and anxiety. Residents reported multiple debt-management options pursued, including loan forbearance, moonlighting, income-based repayment models, military financial support, and loan forgiveness programs. Those with increased levels of debt were less likely to pursue subspecialty training and academic employment positions. The findings conclude that residents carry a substantial amount of debt, and it is a common source of stress and anxiety. Although there are many different avenues that are pursued for debt repayment, levels of debt appear to affect decisions to pursue subspecialty training and to pursue academic positions. Strategies or programs aimed at reducing the debt burden felt by residents could be of great value.
Topics: Humans; United States; Internship and Residency; Training Support; Education, Medical, Graduate; Income; Career Choice; Perception; Surveys and Questionnaires
PubMed: 37350090
DOI: 10.7812/TPP/23.025 -
British Journal of Anaesthesia Aug 2023Sedation of critically ill patients with inhaled anaesthetics may reduce lung inflammation, time to extubation, and ICU length of stay compared with intravenous (i.v.)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Sedation of critically ill patients with inhaled anaesthetics may reduce lung inflammation, time to extubation, and ICU length of stay compared with intravenous (i.v.) sedatives. However, the impact of inhaled anaesthetics on cognitive and psychiatric outcomes in this population is unclear. In this systematic review, we aimed to summarise the effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults.
METHODS
We searched MEDLINE, EMBASE, and PsycINFO for case series, retrospective, and prospective studies in critically ill adults sedated with inhaled anaesthetics. Outcomes included delirium, psychomotor and neurological recovery, long-term cognitive dysfunction, ICU memories, anxiety, depression, post-traumatic stress disorder (PTSD), and instruments used for assessment.
RESULTS
Thirteen studies were included in distinct populations of post-cardiac arrest survivors (n=4), postoperative noncardiac patients (n=3), postoperative cardiac patients (n=2), and mixed medical-surgical patients (n=4). Eight studies reported delirium incidence, two neurological recovery, and two ICU memories. One study reported on psychomotor recovery, long-term cognitive dysfunction, anxiety, depression, and PTSD. A meta-analysis of five trials found no difference in delirium incidence between inhaled and i.v. sedatives (relative risk 0.95 [95% confidence interval: 0.59-1.54]). Compared with i.v. sedatives, inhaled anaesthetics were associated with fewer hallucinations and faster psychomotor recovery but no differences in other outcomes. There was heterogeneity in the instruments used and timing of these assessments.
CONCLUSIONS
Based on the limited evidence available, there is no difference in cognitive and psychiatric outcomes between adults exposed to volatile sedation or intravenous sedation in the ICU. Future studies should incorporate outcome assessment with validated tools during and after hospital stay.
SYSTEMATIC REVIEW PROTOCOL
PROSPERO CRD42021236455.
Topics: Humans; Adult; Critical Illness; Prospective Studies; Retrospective Studies; Hypnotics and Sedatives; Anesthetics; Delirium; Cognition; Intensive Care Units
PubMed: 37344338
DOI: 10.1016/j.bja.2023.05.004 -
Nutrients Sep 2023(1) Background: There has been a growing interest in understanding the causes of obesity and developing effective prevention strategies. Lifestyle change programs are... (Review)
Review
(1) Background: There has been a growing interest in understanding the causes of obesity and developing effective prevention strategies. Lifestyle change programs are often considered the gold standard for weight reduction, and they can help individuals with obesity achieve an annual weight loss of around 8-10%. The aim of this review was to evaluate the effect of food during the winter holidays. This knowledge will serve as a valuable foundation for the development of targeted interventions and prevention programs. (2) Methods: We conducted a systematic search of the literature via one database (PubMed). The search was limited to studies published in English in the last 10 years, with adult participants, but without specifying limits regarding the study design. We excluded articles that addressed intermittent fasting diets or weight loss intervention methods during the holidays through various diets. (3) In separate sections, we analyzed the psychological causes of gaining weight during the winter holidays, behavioral patterns, prevention strategies and the nutritional composition of the different types of food served during the festive period. Results: Using the combination of the terms "holiday and obesity", "holiday and weight gain", "festive season and obesity", and "festive season and weight gain" we obtained 216 results involving the addressed topic. Thus, only ten articles remained after screening, with a total of 4627 participants. Most participants experienced weight fluctuations during the study period, particularly during holidays. One concerning observation was that most of the weight gained during these periods was maintained even after the end of the studies, especially in those with obesity. A supervised exercise program and a controlled diet at work over the Christmas period are effective strategies for avoiding weight gain and its deleterious effects in people with metabolic syndrome or weight problems. (4) In addition, attention must be focused on the psycho-social factors during the holidays because for some people it is a stressful period and can cause a much higher caloric consumption. The simplest method to approach during the holidays is to implement small tips and tricks during this period that will prevent individuals from gaining extra pounds. Conclusions: It is essential to acknowledge that obesity is a multifaceted condition that requires a comprehensive and multidisciplinary approach to address its underlying factors and provide ongoing assistance to individuals in their weight-management endeavors. Even the most effective short-term interventions are likely to produce continued positive outcomes with persistent intervention and support.
Topics: Adult; Humans; Holidays; Seasons; Obesity; Weight Gain; Feeding Behavior; Weight Loss
PubMed: 37836485
DOI: 10.3390/nu15194201 -
Frontiers in Immunology 2023Novel biomarkers of inflammation and oxidative stress might enhance the early recognition, management, and clinical outcomes of patients with rheumatic diseases (RDs).... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Novel biomarkers of inflammation and oxidative stress might enhance the early recognition, management, and clinical outcomes of patients with rheumatic diseases (RDs). We assessed the available evidence regarding the pathophysiological role of neopterin, the oxidation product of 7,8-dihydroneopterin, a pteridine generated in macrophages activated by interferon-γ, by conducting a systematic review and meta-analysis of studies reporting its concentrations in biological fluids in RD patients and healthy controls.
METHODS
We searched electronic databases for relevant articles published between inception and 31 August 2023. The risk of bias and the certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the Grades of Recommendation, Assessment, Development and Evaluation Working Group system, respectively.
RESULTS
In 37 studies, when compared to healthy controls, RD patients had significantly higher concentrations of neopterin both in plasma or serum (standard mean difference, SMD=1.31, 95% CI 1.01 to 1.61; p<0.001; moderate certainty of evidence) and in the urine (SMD=1.65, 95% CI 0.86 to 2.43, p<0.001; I = 94.2%, p<0.001; low certainty of evidence). The results were stable in sensitivity analysis. There were non-significant associations in meta-regression and subgroup analysis between the effect size and age, male to female ratio, year of publication, sample size, RD duration, C-reactive protein, erythrocyte sedimentation rate, specific type of RD, presence of connective tissue disease, analytical method used, or biological matrix investigated (plasma . serum). By contrast, the effect size was significantly associated with the geographical area in studies assessing serum or plasma and with the type of RD in studies assessing urine.
DISCUSSION
Pending additional studies that also focus on early forms of disease, our systematic review and meta-analysis supports the proposition that neopterin, a biomarker of inflammation and oxidative stress, can be useful for the identification of RDs. (PROSPERO registration number: CRD42023450209).
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, identifier CRD42023450209.
Topics: Humans; Male; Female; Neopterin; Inflammation; Oxidation-Reduction; Oxidative Stress; Rheumatic Diseases; Biomarkers
PubMed: 37799718
DOI: 10.3389/fimmu.2023.1271383 -
Lasers in Medical Science Jul 2023To review the effects of photobiomodulation therapy (PBMT) on pain intensity and disability in people with plantar fasciitis (PF) when compared with control conditions,... (Meta-Analysis)
Meta-Analysis Review
To review the effects of photobiomodulation therapy (PBMT) on pain intensity and disability in people with plantar fasciitis (PF) when compared with control conditions, other interventions, and adjunct therapies. Systematic searches were conducted in five database randomized controlled trials (RCT). We only included randomized controlled trials (RCTs) in adults with PF that compared PBMT to placebo, as well as RCTs that compared PBMT to other interventions; and as an adjunct to other therapies. The methodological quality and certainty were assessed through PEDro Scale and GRADE approach, respectively. The data of comparison were pooled and a meta-analysis was conducted when possible. Nineteen RCTs involving 1089 participants were included in this review. PBMT alone (MD = - 22.02 [- 35.21 to - 8.83]) or with exercise (MD = - 21.84 [- 26.14 to - 17.54]) improved pain intensity in short-term treatment. PBMT was superior to (extracorporeal shock wave therapy) EWST for relief of pain (MD = - 20.94 [- 32.74 to - 9.13]). In the follow-up, PBMT plus exercise had a superior to exercise therapy alone (MD = - 18.42 [- 26.48 to - 10.36]). PBMT may be superior to (ultrasound therapeutic) UST in medium- and long-term follow-ups for disability, but can be not clinically relevant. There is uncertainty that PBMT is capable of promoting improvement in disability. PBMT when used with adjuvant therapy does not enhance outcomes of interest. PBMT improves pain intensity with or without exercise. PBMT has been shown to be superior to ESWT for pain relief, but not superior to other interventions for pain intensity and disability. The evidence does not support PBMT as an adjunct to other electrotherapeutic modalities.
Topics: Adult; Humans; Pain Measurement; Fasciitis, Plantar; Low-Level Light Therapy; Pain; Extracorporeal Shockwave Therapy
PubMed: 37464155
DOI: 10.1007/s10103-023-03823-0 -
Menopause (New York, N.Y.) May 2024The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The increasing attention to the management of perimenopausal and postmenopausal women parallels the growth of the aging population. Although hormone therapy is commonly used to alleviate menopausal symptoms, it carries a potential risk of cancer. Recently, mind-body exercises have emerged as innovative approaches for improving menopausal symptoms and bone health. However, research findings have needed to be more consistent, highlighting the significance of this study's systematic review of mind-body exercise effects on perimenopausal and postmenopausal women.
OBJECTIVE
This study aims to evaluate the impact of mind-body exercises, including tai chi, yoga, Pilates, qigong, baduanjin, and mindfulness-based stress reduction, on bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.
EVIDENCE REVIEW
Four electronic databases-PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science-were systematically searched from inception until July 2023. The search focused exclusively on randomized controlled trials to examine the impact of mind-body exercise interventions on perimenopausal and postmenopausal women. The methodological quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool.
FINDINGS
A total of 11 randomized controlled trials, comprising 1,005 participants, were included in the analysis. Traditional meta-analysis indicated that mind-body exercise significantly enhanced bone mineral density in perimenopausal and postmenopausal women compared with control groups, with a standardized mean difference (SMD) of 0.41 (95% CI, 0.17 to 0.66; P = 0.001, I2 = 7%). In addition, significant improvements were observed in sleep quality (SMD, -0.48; 95% CI, -0.78 to -0.17; P = 0.002, I2 = 76%), anxiety reduction (SMD, -0.80; 95% CI, -1.23 to -0.38; P = 0.0002, I2 = 84%), depressive mood (SMD, -0.80; 95% CI, -1.17 to -0.44; P < 0.0001, I2 = 79%), and fatigue (SMD, -0.67; 95% CI, -0.97 to -0.37; P < 0.0001, I2 = 0%).
CONCLUSIONS AND RELEVANCE
The findings of this meta-analysis demonstrate that mind-body exercise positively influences bone mineral density, sleep quality, anxiety, depression, and fatigue among perimenopausal and postmenopausal women.
Topics: Humans; Female; Perimenopause; Postmenopause; Bone Density; Mind-Body Therapies; Middle Aged; Depression; Sleep Quality; Randomized Controlled Trials as Topic; Anxiety; Fatigue; Exercise; Tai Ji; Yoga
PubMed: 38669625
DOI: 10.1097/GME.0000000000002336 -
Antioxidants (Basel, Switzerland) Jul 2023The presence of a pro-oxidant state in patients with schizophrenia may account for the increased risk of atherosclerosis and cardiovascular disease in this group and... (Review)
Review
The presence of a pro-oxidant state in patients with schizophrenia may account for the increased risk of atherosclerosis and cardiovascular disease in this group and supports the potential utility of circulating biomarkers of oxidative stress for risk stratification and management. We investigated this issue by conducting a systematic review and meta-analysis of the association between the circulating concentrations of paraoxonase-1, an antioxidant calcium-dependent high-density lipoprotein (HDL)-associated esterase, with paraoxonase and arylesterase activity in schizophrenia. We searched electronic databases from inception to 31 May 2023 for studies investigating paraoxonase-1 in patients with schizophrenia and healthy controls and assessed the risk of bias and the certainty of evidence (PROSPERO registration number: CRD42023435442). Thirteen studies were identified for analysis. There were no significant between-group differences in paraoxonase (standard mean difference, SMD = 0.12, 95% CI -0.23 to 0.48, = 0.50; extremely low certainty of evidence) or arylesterase activity (SMD = -0.08, 95% CI -0.39 to 0.23, = 0.61; very low certainty of evidence). However, in meta-regression and subgroup analysis we observed significant associations between the SMD of paraoxonase and age ( = 0.003), HDL-cholesterol ( = 0.029), and study country ( = 0.04), and the SMD of arylesterase and age ( = 0.007), body mass index ( = 0.012), HDL-cholesterol ( = 0.002), and pharmacological treatment for schizophrenia ( < 0.001). In the absence of overall between-group differences, our systematic review and meta-analysis suggests that alterations in paraoxonase-1 may reflect a pro-oxidant state in specific subgroups of patients with schizophrenia that require further assessment in appropriately designed studies.
PubMed: 37627479
DOI: 10.3390/antiox12081484 -
Clinical and Translational Allergy Dec 2023Mastocytosis manifests with multisystemic symptoms, often involving the nervous system. Numerous cognitive, neuropsychiatric and neurological alterations have been... (Review)
Review
BACKGROUND
Mastocytosis manifests with multisystemic symptoms, often involving the nervous system. Numerous cognitive, neuropsychiatric and neurological alterations have been reported in multiple observational studies.
METHODS
We performed a qualitative systematic literature review of reported data consulting the electronic databases Medline, Scopus, Web of Science, Cochrane, and BASE until June 2023.
RESULTS
We selected 24 studies in which the majority showed that a high proportion of mastocytosis patients suffer cognitive, neuropsychiatric and neurological alterations. The most common disorders and estimated ranges of frequency observed in adults were depression (68%-75%), anxiety, high stress or irritability (27%-54%), cognitive impairment (27%-39%, primarily affecting memory skills), and headaches (55%-69%). Attention challenges and learning difficulties were reported in children at a rate of 13%, while neurodevelopmental disorders occurred at rates of 8%-12%. Frequent white abnormalities in mastocytosis patients with concomitant psychocognitive symptoms have been reported although neuroimaging studies have been performed rarely in this population.
CONCLUSION
Further studies with more comprehensive and homogeneous evaluations and neuroimaging and histological analysis should be performed for a better understanding of these manifestations. An earlier detection and proper management of these symptoms could greatly improve the quality of life of these patients.
PubMed: 38146805
DOI: 10.1002/clt2.12319