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Scientific Reports Jul 2022Randomized clinical trials (RCTs) of lifestyle modification have reported beneficial effects of interventions, compared to control. Whether participation in the control... (Meta-Analysis)
Meta-Analysis
Randomized clinical trials (RCTs) of lifestyle modification have reported beneficial effects of interventions, compared to control. Whether participation in the control group has benefits is unknown. To determine whether control group participants experience weight loss during the course of RCTs. After prospective registration (PROSPERO CRD42021233070), we conducted searches in Medline, Scopus, Web of Science, Cochrane library and Clinicaltrials.gov databases from inception to May 2021 without language restriction to capture RCTs on dietary advice or physical activity interventions in adults with overweight, obesity or metabolic syndrome. Data extraction and study quality assessment was performed by two independent reviewers. Weight loss in the control group, i.e., the difference between baseline and post-intervention, was pooled using random effects model generating mean difference and 95% confidence interval (CI). Heterogeneity was assessed using the I statistical test. Subgroup meta-analysis was performed stratifying by follow-up period, type of control group protocols and high-quality studies. Among the 22 included studies (4032 participants), the risk of bias was low in 9 (40%) studies. Overall, the controls groups experienced weight loss of - 0.41 kg (95% CI - 0.53 to - 0.28; I = 73.5% p < 0.001). To identify a result that is an outlier, we inspected the forest plot for spread of the point estimates and the confidence intervals. The magnitude of the benefit was related to the duration of follow-up (- 0.51 kg, 95% CI - 0.68, - 0.3, for 1-4 months follow-up; - 0.32 kg, 95% CI - 0.58, - 0.07, 5-12 months; - 0.20 kg, 95% CI - 0.49, 0.10, ≥ 12 months). In high-quality studies we found an overall weight loss mean difference of - 0.16 (95% CI - 0.39, 0.09) with a considerable heterogeneity (I = 74%; p < 0.000). Among studies including control group in waiting lists and combining standard care, advice and material, no heterogeneity was found (I = 0%, p = 0.589) and (I = 0%, p = 0.438); and the mean difference was - 0.84 kg (95% CI - 2.47, 0.80) and - 0.65 kg (95% CI - 1.03, - 0.27) respectively. Participation in control groups of RCTs of lifestyle interventions had a benefit in terms of weight loss in meta-analysis with heterogeneity. These results should be used to interpret the benefits observed with respect to intervention effect in trials. That control groups accrue benefits should be included in patient information sheets to encourage participation in future trials among patients with overweight and obesity.
Topics: Adult; Control Groups; Humans; Life Style; Obesity; Overweight; Randomized Controlled Trials as Topic; Weight Loss
PubMed: 35851070
DOI: 10.1038/s41598-022-15770-x -
Frontiers in Psychology 2022In this meta-analysis, we synthesized the results of randomized controlled trials of different exercise training interventions on participants' feelings of fatigue,...
In this meta-analysis, we synthesized the results of randomized controlled trials of different exercise training interventions on participants' feelings of fatigue, energy, and vitality. The search of studies was conducted using six databases as well as several other supplementary search strategies available before December 2021. The initial search generated over 3,600 articles with 81 studies (7,050 participants) and 172 effects meeting the inclusion criteria. We analyzed the effects from the studies using a meta-analytic multivariate model and considered the potential moderating effect of multiple variables. Our analysis revealed exercise to decrease the feelings of fatigue by a small effect size ( = -0.374; 95% CI [-0.521, -0.227]), increase energy by a small-to-moderate effect size ( = 0.415; 95% CI [0.252, 0.578]), and to increase the feeling of vitality by a moderate effect size ( = 0.537; 95% CI [0.404, 0.671]). All main results remained robust after several sensitivity analyses using different statistical estimators, and consideration of outlier and influential studies. Moreover, moderator analyses revealed significant effects of exercise intensity and intervention duration on fatigue, exercise intensity, and modality on energy, and participant health, exercise intensity modality, and exercise training location on vitality. We conclude that when groups adopt a moderate intensity exercise training program while participating in a randomized trial, compared to controls, this typically results in small-to-moderate average improvements in feelings of fatigue, energy, and vitality.
PubMed: 35726269
DOI: 10.3389/fpsyg.2022.907637 -
Frontiers in Psychiatry 2019In low- and middle-income countries, rates of common mental health disorders are found to be very high among children and adolescents while individuals, particularly in...
BACKGROUND
In low- and middle-income countries, rates of common mental health disorders are found to be very high among children and adolescents while individuals, particularly in these countries, face barriers to mental health care. In the recent years, randomized controlled trials (RCTs) have been conducted that implemented and tested different psychological and psychosocial treatment approaches to treat common mental disorders. This review aims to analyze psychological interventions among children and adolescents in low- and middle-income countries.
METHODS
RCTs carried out in low- and middle-income countries on psychological and psychosocial interventions for children and adolescents with symptoms of trauma- and stressor related disorders, depression or anxiety were identified in bibliographic databases. Databases were systematically searched until December 14, 2018. Effect sizes indicating differences between treatment and control groups at post-test were computed using a random-effects model. Outcomes were symptoms of depression, anxiety and posttraumatic stress disorder (PTSD).
RESULTS
Thirteen studies with a total of 2,626 participants aged between 5 and 18 years were included. Treatments varied between studies and number of treatment sessions ranged from 1 to 16. The pooled effect size, combining outcomes of depression, anxiety and PTSD of psychological or psychosocial intervention versus care-as-usual or a control conditions yielded a medium effect ( = 0.62; 95% CI: 0.27-0.98). Heterogeneity was very high ( = 94.41; 95% = 80-91). The beneficial effect of interventions increased after excluding outliers ( = 0.72; 95% : 0.37-1.07), while heterogeneity remained high ( = 86.12; 95% = 87-94).
CONCLUSION
High quality RCTs investigating the effect of psychological and psychosocial interventions on PTSD, depression and anxiety among children and adolescents in low- and middle-income countries are scarce. Results of the available studies may suggest that psychological and psychosocial interventions might be more effective in reducing symptoms of anxiety, depression and PTSD compared to control conditions. Due to very high heterogeneity, this evidence must be considered with caution.
PubMed: 32132936
DOI: 10.3389/fpsyt.2019.00933 -
Frontiers in Physiology 2023Aquatic or water-based exercise is a very popular type of exercise in particular for people with physical limitations, joint problems and fear of falling. The present...
Aquatic or water-based exercise is a very popular type of exercise in particular for people with physical limitations, joint problems and fear of falling. The present systematic review and meta-analysis aimed to provide evidence for the effect of aquatic exercise on Bone Mineral Density (BMD) in adults. A systematic literature search of five electronic databases (PubMed/MEDLINE, Cochrane Library, Scopus, Web of Science and CINAHL) according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted until 2022/01/30, with an update to 2022/10/07. We included controlled trials with a duration of more than 6 months and at least two study groups, aquatic exercise (EG) versus non-training controls (CG) with no language restrictions. Outcome measures were standardized mean differences (SMD) with 95%-confidence intervals (95%-CI) for BMD changes at the lumbar spine (LS) and femoral neck (FN). We applied a random-effects meta-analysis and used the inverse heterogeneity (IVhet) model to analyze the data. Excluding an outlier study with an exceptionally high effect size for LS-BMD, we observed a statistically significant ( = .002) effect (EG vs. CG) of aquatic exercise for the LS-BMD (n = 10; SMD: 0.30; 95%-CI: 0.11-0.49). In parallel, the effect of aquatic exercise on FN-BMD was statistically significant ( = .034) compared to the CG (n = 10; SMD: 0.76, 95%-CI: 0.06-1.46). Of importance, heterogeneity between the trial results was negligible for LS (I: 7%) but substantial for FN-BMD (I: 87%). Evidence for risks of small study/publication bias was low for LS-BMD and considerable for FN-BMD. In summary, the present systematic review and meta-analysis provides further evidence for the favorable effect of exercise on bone health in adults. Due to its safety and attractiveness, we particularly recommend water-based exercise for people unable, afraid or unmotivated to conduct intense land-based exercise programs.
PubMed: 36994417
DOI: 10.3389/fphys.2023.1135663 -
Psycho-oncology Mar 2022To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess whether mind-body therapies are effective for relieving cancer-related pain in adults, since at least one-third of adults with cancer are affected by moderate or severe pain.
METHODS
We searched for all randomized or quasi-randomized controlled trials that included adults (≥18 years) with cancer-related pain who were treated with mind-body therapies (mindfulness, hypnosis, yoga, guided imagery, and progressive muscle relaxation) in MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index, Web of Science, trials registers, and reference lists. The primary outcome was pain intensity. We calculated the standardized mean differences and 95% confidence intervals (CIs) and assessed the risk of bias.
RESULTS
We identified 40 primary studies involving a total of 3569 participants. The meta-analysis included 24 studies (2404 participants) and showed a significant effect of -0.39 (95% CI -0.62 to -0.16) with considerable heterogeneity (I = 86.3%, p < 0.001). After we excluded four "outlier" studies in sensitivity analyses, the effect size remained significant but weaker. There was a high risk of bias in all studies, for example, performance bias due to lack of participant blinding. Patients in multiple settings were included but many studies were of low quality.
CONCLUSIONS
Mind-body therapies may be effective in improving cancer pain, but the quality of the evidence is low. There is a need for further high-quality clinical trials.
Topics: Adult; Cancer Pain; Humans; Hypnosis; Meditation; Mindfulness; Neoplasms; Yoga
PubMed: 34545984
DOI: 10.1002/pon.5821 -
Scientific Reports Jul 2023Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to... (Meta-Analysis)
Meta-Analysis
Our study aims to estimate the prevalence of surgical site infections (SSI) following open reduction and internal fixation (ORIF) for mandibular fractures and to determine the effect of potential moderators on it. A systematic literature search (Medline and Scopus databases) was conducted independently by two reviewers. The pooled prevalence with 95% confidence intervals was estimated. Quality assessment as well as outlier and influential analysis were performed. Additionally, subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. In total, seventy-five eligible studies (comprising a sum of 5825 participants) were included in this meta-analysis. The overall prevalence of SSI following ORIF for mandibular fractures was estimated as high as 4.2% (95% CI 3.0-5.6%) with significant heterogeneity between studies. One study was identified to be critically influential. In the subgroup analysis, the prevalence was 4.2% (95% CI 2.2-6.6%) among studies conducted in Europe, 4.3% (95% CI 3.1-5.6%) among studies conducted in Asia and higher among those conducted in America (7.3%) (95% CI 4.7-10.3%). It is important for healthcare professionals to be aware of the etiology of these infections, despite the relatively low rate of SSI in these procedures. However, further, well-designed prospective and retrospective studies need to be conducted in order this issue to be fully clarified.
Topics: Humans; Mandibular Fractures; Surgical Wound Infection; Prevalence; Prospective Studies; Retrospective Studies
PubMed: 37430033
DOI: 10.1038/s41598-023-37652-6 -
Translational Psychiatry Jan 2020At present, prevention is particularly important when there is no effective treatment for cognitive decline. Since the adverse events of pharmacological interventions... (Meta-Analysis)
Meta-Analysis
At present, prevention is particularly important when there is no effective treatment for cognitive decline. Since the adverse events of pharmacological interventions counterbalance the benefits, nonpharmacological approaches seem desirable to prevent cognitive decline. To our knowledge, no meta-analyses have been published on nonpharmacological interventions preventing cognitive decline. To investigate whether nonpharmacological interventions play a role in preventing cognitive decline among older people, we searched related trials up to March 31, 2019, in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials and the Cochrane library databases. Randomized controlled trials (RCTs) were included if they enrolled participants older than 60 years of age who had a risk of cognitive decline, and the interventions were nonpharmacological. Two reviewers independently extracted data and assessed study quality. The Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was used to rate the quality of evidence. Heterogeneity was quantified with I. Subgroup analysis and meta-regression were used to research the sources of heterogeneity. Influence analyses were used to detect and remove extreme effect sizes (outliers) in our meta-analysis. Publication bias was assessed with funnel plots and Egger test. Primary outcomes were the incidence of mild cognitive impairment (MCI) or dementia and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores. Second outcomes were activities of daily living (ADL) and Mini-Mental State Examination (MMSE) scores. A total of 22 studies with 13,264 participants were identified for analysis. In terms of prevention, nonpharmacological interventions appeared to be more effective than control conditions, as assessed by the incidence of MCI or dementia (RR, 0.73; CI, 0.55-0.96; moderate-certainty evidence), while the results of ADAS-Cog suggested no significant differences between two groups (MD, -0.69; CI, -1.52-0.14; very low-certainty evidence). Second outcomes revealed a significant improvement from nonpharmacological interventions versus control in terms of the change in ADL (MD, 0.73; CI, 0.65-0.80) and MMSE scores (posttreatment scores: MD, 0.25; CI, 0.02-0.47; difference scores: MD, 0.59, CI, 0.29-0.88). Univariable meta-regression showed association between lower case of MCI or dementia and two subgroup factors (P = 0.013 for sample size; P = 0.037 for area). Multiple meta-regression suggested that these four subgroup factors were not associated with decreased incidence of MCI (P > 0.05 for interaction). The Naive RR estimate was calculated as 0.73. When the three studies that detected by outlier and influence analysis were left out, the Robust RR was 0.66. In conclusion, nonpharmacological therapy could have an indicative role in reducing the case of MCI or dementia. However, given the heterogeneity of the included RCTs, more preregistered trials are needed that explicitly examine the association between nonpharmacological therapy and cognitive decline prevention, and consider relevant moderators.
Topics: Aged; Cognitive Dysfunction; Humans
PubMed: 32066716
DOI: 10.1038/s41398-020-0690-4 -
Frontiers in Public Health 2024Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs),... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia.
METHODS
Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a value less than 0.05 and a 95% CI.
RESULTS
Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it.
CONCLUSION
The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.
Topics: Humans; Africa; Asia; Financing, Personal; National Health Programs; Health Expenditures; Universal Health Insurance
PubMed: 38706546
DOI: 10.3389/fpubh.2024.1390937 -
Journal of Neurology, Neurosurgery, and... Jul 2022Dysfunction of the locus coeruleus-noradrenergic system occurs early in Alzheimer's disease, contributing to cognitive and neuropsychiatric symptoms in some patients....
BACKGROUND
Dysfunction of the locus coeruleus-noradrenergic system occurs early in Alzheimer's disease, contributing to cognitive and neuropsychiatric symptoms in some patients. This system offers a potential therapeutic target, although noradrenergic treatments are not currently used in clinical practice.
OBJECTIVE
To assess the efficacy of drugs with principally noradrenergic action in improving cognitive and neuropsychiatric symptoms in Alzheimer's disease.
METHODS
The MEDLINE, Embase and ClinicalTrials.gov databases were searched from 1980 to December 2021. We generated pooled estimates using random effects meta-analyses.
RESULTS
We included 19 randomised controlled trials (1811 patients), of which six were judged as 'good' quality, seven as 'fair' and six 'poor'. Meta-analysis of 10 of these studies (1300 patients) showed a significant small positive effect of noradrenergic drugs on global cognition, measured using the Mini-Mental State Examination or Alzheimer's Disease Assessment Scale-Cognitive Subscale (standardised mean difference (SMD): 0.14, 95% CI: 0.03 to 0.25, p=0.01; I=0%). No significant effect was seen on measures of attention (SMD: 0.01, 95% CI: -0.17 to 0.19, p=0.91; I=0). The apathy meta-analysis included eight trials (425 patients) and detected a large positive effect of noradrenergic drugs (SMD: 0.45, 95% CI: 0.16 to 0.73, p=0.002; I=58%). This positive effect was still present following removal of outliers to account for heterogeneity across studies.
DISCUSSION
Repurposing of established noradrenergic drugs is most likely to offer effective treatment in Alzheimer's disease for general cognition and apathy. However, several factors should be considered before designing future clinical trials. These include targeting of appropriate patient subgroups and understanding the dose effects of individual drugs and their interactions with other treatments to minimise risks and maximise therapeutic effects.
PROSPERO REGISTERATION NUMBER
CRD42021277500.
PubMed: 35790417
DOI: 10.1136/jnnp-2022-329136 -
Medicine Jun 2024Chaihu-Shugan-San (CSS), a Traditional Chinese Medicine formula, has been widely used for treating depression since the Ming Dynasty, as recorded in Jingyue Quanshu, but... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chaihu-Shugan-San (CSS), a Traditional Chinese Medicine formula, has been widely used for treating depression since the Ming Dynasty, as recorded in Jingyue Quanshu, but its effectiveness and safety lack comprehensive and objective evaluation. Based on our meta-analysis, we aimed to adequately evaluate the efficacy and risk of CSS by considering the latest clinical literature.
METHODS
Multiple databases, including PubMed, Embase, Web of Science, SinoMed, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang, were used to collect clinical data. The quality of the included clinical studies was assessed using the Cochrane Risk of Bias Tool, and the data were meta-analyzed using Review Manager 5.0 and Stata 17. The data were obtained from a genome-wide association study, and Mendelian randomization (MR) was performed using R Software 4.3.2 with the TwoSampleMR and MR Pleiotropy RESidual Sum and Outlier packages.
RESULTS
A total of 15 studies with 1034 patients and 6 antidepressant drugs were included in this work. Meta-analyses revealed that drug combinations of CSS and antidepressants significantly improved depressive symptoms (weighted mean difference = -4.21; 95% confidence interval [CI]: -5.62--2.81), increased the effective rate (odds ratio [OR] = 3.82; 95% CI: 2.44-6.83), and reduced side effects (OR = -3.55; 95% CI: -5.66--1.43) compared with antidepressant monotherapy. Additionally, compared with antidepressant monotherapy, CSS alone exhibited fewer side effects (95% CI:-9.25--6.95). Like antidepressants, CSS also improved depressive symptoms (weighted mean difference = -0.05; 95% CI: -0.63--0.52) and increased the effective rate (OR = 1.07; 95% CI: 0.52-2.20). Additionally, MR was used to evaluate the safety of traditional antidepressants, as there was a causal association between amitriptyline and body mass index.
CONCLUSION
This analysis demonstrated that compared with traditional antidepressants, CSS combined with antidepressants was more effective and safer for treating depressed patients. MR showed that a causal relationship may exist between amitriptyline and body mass index. Therefore, clinicians should carefully consider the advantages and potential drawbacks of Traditional Chinese Medicine and classic drugs to serve patients better.
Topics: Humans; Antidepressive Agents; Depression; Plant Extracts; Drugs, Chinese Herbal; Treatment Outcome
PubMed: 38941409
DOI: 10.1097/MD.0000000000038668