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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 -
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 -
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 -
Malaria Journal Jul 2022Interleukin (IL)-4 had been linked to malaria severity, but the findings are controversial, and the evidence is inconsistent and imprecise. In the current investigation,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Interleukin (IL)-4 had been linked to malaria severity, but the findings are controversial, and the evidence is inconsistent and imprecise. In the current investigation, data on IL-4 levels in patients with severe and uncomplicated malaria were compiled.
METHODS
The systematic review was registered at PROSPERO (CRD42022323387). Searches for relevant articles on IL-4 levels in patients with severe malaria and studies that examined IL-4 levels in both uncomplicated malaria and healthy controls were performed in PubMed, Embase, and Scopus using the search strategy without limitation to publication years or language. The quality of all included studies was evaluated using The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: standards for reporting observational studies. Qualitative and quantitative data syntheses were performed. The random-effects model, which weights each study according to its between- and within-study variance, was used to pool the mean difference (MD) of individual studies. The degree of heterogeneity was determined using Cochran's Q and I statistics. Additionally, meta-regression and subgroup analyses were perfomed to investigate possible sources of heterogeneity. The outliers were identified using the leave-one-out method and assessed publication bias using funnel plots, Egger's test, and a contour-enhanced funnel plot.
RESULTS
A total of 2300 studies were identified through database searches, and 36 were included for analyses. The meta-analysis results showed lower mean IL-4 levels in severe malaria (434 cases) than in uncomplicated malaria (611 cases) (P = 0.01, pooled MD: -3.36 pg/mL, 95% confidence intervals CI -5.55 to -1.16 pg/mL, I: 98.15%, 11 studies). The meta-analysis results showed no difference in mean IL-4 levels between cerebral malaria (96 cases) and noncerebral severe malaria (108 cases) (P = 0.71, pooled MD: 0.86 pg/mL, 95% CI -3.60 to 5.32 pg/mL, I 92.13%, four studies). Finally, no difference was found in mean IL-4 levels between uncomplicated malaria (635 cases) and healthy controls (674 cases) (P = 0.57, pooled MD: 0.79 pg/mL, 95% CI -1.92 to 3.50 pg/mL, I: 99.89%, 11 studies).
CONCLUSION
The meta-analysis revealed lower IL-4 levels in patients with severe malaria than in those with uncomplicated malaria, though a trend toward comparable IL-4 levels between both groups was more likely because several sources of heterogeneities were observed. Based on the limited number of studies included in the meta-analysis, until additional investigations have been conducted, IL-4 consideration as an alternative prognostic factor for malaria severity is not warranted.
Topics: Humans; Interleukin-4; Malaria, Cerebral
PubMed: 35820892
DOI: 10.1186/s12936-022-04237-z -
Mindfulness May 2023Positive effects of mindfulness-based interventions (MBIs) on occupational health have been demonstrated by several systematic review studies during the last two... (Review)
Review
OBJECTIVES
Positive effects of mindfulness-based interventions (MBIs) on occupational health have been demonstrated by several systematic review studies during the last two decades. So far, existing reviews excluded mindfulness-informed interventions (MIIs) that build on informal approaches or mixed techniques aiming at improving mindfulness indirectly. To address this research gap, the present comprehensive meta-analysis synthesizes the results of RCTs of MBIs and MIIs conducted in various workplace settings.
METHOD
A systematic literature search was conducted in five electronic databases complemented by manual search. Random-effects models were used to synthesize standardized mean differences () for 25 outcomes and seven overarching categories of outcomes, and to detect various temporal effects. Meta-regressions were run to elucidate average between mindfulness intervention types and intervention and population characteristics, with the goal of detecting sources of heterogeneity and help guide the selection of the most appropriate mindfulness intervention type.
RESULTS
Based on 91 eligible studies (from 92 publications), including 4927 participants and 4448 controls, the synthesis shows that MBIs and MIIs significantly improve mindfulness ( = 0.43; 95%- [0.33;0.52]), well-being ( = 0.63; 95%- [0.34;0.93]), mental health ( = 0.67; 95%- [0.48;0.86]), stress ( = 0.72; 95%- [0.54;0.90]), resilience ( = 1.06; 95%- [-0.22;2.34]), physical health ( = 0.45; 95%- [0.32;0.59]), and work-related factors ( = 0.62; 95%- [0.14;1.10]). Sensitivity analyses demonstrate a tendency towards smaller effect sizes due to extreme outliers. Effect sizes are stable in short-term follow-up assessments (1-12 weeks) for most outcomes, but not for long-term follow-up assessments (13-52 weeks). Meta-regressions suggest that observable intervention characteristics (e.g., online delivery) and population characteristics (e.g., age of participants), as well as study quality, do not explain the prevalence of heterogeneity in effect sizes.
CONCLUSIONS
Generally effective, mindfulness interventions are a useful tool to enhance aspects of employee health. However, because of heterogeneity and risk of bias, studies aiming at high-quality data collection and thorough reporting are necessary to draw firm conclusions.
PREREGISTRATION
A protocol of this systematic review was registered with PROSPERO (Registration-No. CRD42020159927).
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12671-023-02130-7.
PubMed: 37362186
DOI: 10.1007/s12671-023-02130-7 -
Sleep Medicine Reviews Apr 2024This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of portable electromyography (EMG) diagnostic devices compared to the reference... (Meta-Analysis)
Meta-Analysis Review
This systematic review and meta-analysis (MA) aimed to evaluate the diagnostic validity of portable electromyography (EMG) diagnostic devices compared to the reference standard method polysomnography (PSG) in assessing sleep bruxism. This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and was registered with PROSPERO prior to the accomplishment of the main search. Ten clinical studies on humans, assessing the diagnostic accuracy of portable instrumental approaches with respect to PSG, were included in the review. Methodological shortcomings were identified by QUADAS-2 quality assessment. The certainty of the evidence analysis was established by different levels of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. A meta-analysis of diagnostic test accuracy was performed with multiple thresholds per study applying a two-stage random effects model, using the thresholds offered by the studies and based on the number of EMG bruxism events per hour presented by the participants. Five studies were included. The MA indicated that portable EMG diagnostic devices showed a very good diagnostic capacity, although a high variability is evident in the studies with some outliers. Very low quality of evidence due to high risk of bias and high heterogeneity among included studies suggests that portable devices have shown high sensitivity and specificity when diagnosing sleep bruxism (SB) compared to polysomnography. The tests performed in the MA found an estimated optimal cut-off point of 7 events/hour of SB with acceptably high sensitivity and specificity for the EMG portable devices.
Topics: Humans; Sleep Bruxism; Polysomnography; Electromyography
PubMed: 38295573
DOI: 10.1016/j.smrv.2024.101906 -
Clinical Kidney Journal Apr 2022Patients receiving dialysis for end-stage kidney disease (ESKD) commonly co-exhibit risk factors for hepatic impairment. This systematic review and meta-analysis aimed...
BACKGROUND
Patients receiving dialysis for end-stage kidney disease (ESKD) commonly co-exhibit risk factors for hepatic impairment. This systematic review and meta-analysis aimed to quantify the coexistence of chronic liver disease (CLD) and characterize risk factors and outcomes.
METHODS
We searched the following databases from inception to May 2021: CINAHL, Cochrane Library, Embase, Kings Fund Library, MEDLINE and PubMed. The protocol was pre-registered on PROSPERO (study ID: CRD42020206486). Studies were assessed against three inclusion criteria: adults (>18 years) with ESKD receiving dialysis, primary outcome involving CLD prevalence and publications in English. Moderator analysis was performed for age, gender, study size and publication year. Sensitivity analysis was performed where applicable by removing outlier results and studies at high risk of bias.
RESULTS
Searches yielded 7195 articles; of these 15 met the inclusion criteria. A total of 320 777 patients were included. The prevalence of cirrhosis and non-alcoholic fatty liver disease (NAFLD) was 5% and 55%, respectively. Individuals with CLD had 2-fold higher mortality than those without {odds ratio [OR] 2.19 [95% confidence interval (CI) 1.39-3.45]}. Hepatitis B [OR 13.47 (95% CI 1.37-132.55)] and hepatitis C [OR 7.05 (95% CI 4.00-12.45)], but not diabetes, conferred increased cirrhosis risk. All studies examining NAFLD were judged to be at high risk of bias. We found no data on non-alcoholic steatohepatitis (NASH). Deaths from CLD, cancer and infection were greater among cirrhotic patients.
CONCLUSIONS
CLD is prevalent in dialysis patients. Hepatitis B and C confer increased risk of CLD. The impact of NAFLD and NASH cirrhosis requires further study. CLD is associated with an increased risk of mortality in this setting.
PubMed: 35371444
DOI: 10.1093/ckj/sfab230 -
JAMA Pediatrics Feb 2022Social determinants of health (SDOH) correlate with pediatric asthma morbidity, yet whether interventions addressing social risks are associated with asthma outcomes... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Social determinants of health (SDOH) correlate with pediatric asthma morbidity, yet whether interventions addressing social risks are associated with asthma outcomes among children is unclear.
OBJECTIVE
To catalog asthma interventions by the social risks they address and synthesize their associations with asthma-related emergency department (ED) visits and hospitalizations among children.
DATA SOURCES
PubMed, Scopus, PsycINFO, SocINDEX, CINAHL, and references of included full-text articles were searched from January 1, 2008, to June 16, 2021.
STUDY SELECTION
Included articles were US-based studies evaluating the associations of interventions addressing 1 or more social risks with asthma-related ED visits and hospitalizations among children. The systematic review included 38 of the original 641 identified articles (6%), and the meta-analysis included 19 articles (3%).
DATA EXTRACTION AND SYNTHESIS
Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. The SDOH intervention clusters were identified by grouping studies according to the social risks they addressed, using the Healthy People 2020 SDOH framework. Random-effects models created pooled risk ratios (RRs) as the effect estimates.
MAIN OUTCOMES AND MEASURES
Patients with ED visits or hospitalizations were the primary outcomes. Subgroup analyses were conducted by an SDOH intervention cluster. Sensitivity analyses were conducted for each, removing outlier studies and studies failing to meet the minimum quality threshold.
RESULTS
In total, 38 studies were included in the systematic review, with 19 of these studies providing data for the meta-analysis (5441 participants). All interventions addressed 1 or more of the health, environment, and community domains; no interventions focused on the economy or education domains. In the primary analysis, social risk interventions were associated with decreased ED visits (RR, 0.68; 95% CI, 0.57-0.81; I2 = 70%) and hospitalizations (RR, 0.50; 95% CI, 0.37-0.68; I2 = 69%). In subgroup analyses, the health, environment, and community intervention cluster produced the lowest RR for ED visits (RR, 0.53; 95% CI, 0.44-0.64; I2 = 50%) and for hospitalizations (RR, 0.33; 95% CI, 0.20-0.55; I2 = 71%) compared with other intervention clusters. Sensitivity analyses did not alter primary or subgroup effect estimates.
CONCLUSIONS AND RELEVANCE
The results of this systematic review and meta-analysis indicate that social risk interventions are associated with decreased asthma-related ED visits and hospitalizations among children. These findings suggest that addressing social risks may be a crucial component of pediatric asthma care to improve health outcomes.
Topics: Asthma; Emergency Service, Hospital; Hospitalization; Humans; Patient Acceptance of Health Care; Pediatrics; Social Determinants of Health
PubMed: 34870710
DOI: 10.1001/jamapediatrics.2021.5103