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PloS One 2021Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders...
OBJECTIVES
Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required.
DESIGN
A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized.
RESULTS
Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results.
LIMITATIONS
Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results.
CONCLUSION
Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.
Topics: Aged; Aged, 80 and over; Depression; Depressive Disorder; Female; Humans; Male; Multivariate Analysis; Prospective Studies; Protective Factors; Risk Factors
PubMed: 33983995
DOI: 10.1371/journal.pone.0251326 -
Journal of Orthopaedic Surgery and... Oct 2021Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide.
METHODS
A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I test, and the publication bias was assessed by the Begg and Mazumdar's test at the significance level of 0.1.
RESULTS
After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15-105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2-20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I: 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8-26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6-14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3-59.7) and a sample size of 2989 people with the age range 18-95 years.
CONCLUSION
According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Databases, Factual; Female; Humans; Male; Middle Aged; Osteoporosis; Prevalence; Young Adult
PubMed: 34657598
DOI: 10.1186/s13018-021-02772-0 -
Obesity Reviews : An Official Journal... Jun 2023This study aimed to review and quantify the association between overweight and obesity in the risk of multimorbidity among the general population. We conducted a... (Meta-Analysis)
Meta-Analysis Review
This study aimed to review and quantify the association between overweight and obesity in the risk of multimorbidity among the general population. We conducted a systematic review and meta-analysis in the databases of Pubmed, Lilacs, Web of Science, Scopus, and Embase. We included cohort studies that assessed the association between overweight and/or obesity with the risk of multimorbidity. The Newcastle-Ottawa assessed the studies' individual quality. A random-effect model meta-analysis was performed to evaluate the association between overweight and obesity with the relative risk (RR) of multimorbidity; the I test evaluated heterogeneity. After excluding duplicates, we found 1.655 manuscripts, of which eight met the inclusion criteria. Of these, seven (87.5%) evidenced an increased risk of multimorbidity among subjects with overweight and/or obesity. Overall, we observed an increased risk of multimorbidity among subjects with overweight (RR: 1.26; CI95%: 1.12; 1.40, I = 98%) and obesity (RR: 1.99; CI95%: 1.45;2.72, I = 99%) compared to normal weight. According to the I test, the heterogeneities of the meta-analyses were high. The Newcastle-Ottawa scale showed that all studies were classified as high quality. Further longitudinal studies are needed, including different populations and stratifications by sex, age, and other variables.
Topics: Humans; Overweight; Multimorbidity; Obesity; Longitudinal Studies
PubMed: 36929143
DOI: 10.1111/obr.13562 -
BioMed Research International 2020Osteoporosis is a chronic disease that seriously affects human health and quality of life. This study is aimed at determining whether swimming had an effect on the bone... (Meta-Analysis)
Meta-Analysis
Osteoporosis is a chronic disease that seriously affects human health and quality of life. This study is aimed at determining whether swimming had an effect on the bone mineral density (BMD) of the spine and femoral neck in postmenopausal and premenopausal osteoporosis patients. We retrieved relevant literature and analyzed data from randomized controlled trials to assess the effect of swimming on BMD in postmenopausal and premenopausal women. Relevant studies, with no language restrictions, from inception to September 2019, were retrieved from the PubMed, Cochrane, EMBASE, and EBSCO databases independently by two investigators. The keywords used for the literature search were "osteoporosis" and "swimming." The main results included BMD and -score. We searched 256 relevant articles and finally screened five articles, including 263 participants. Lumbar spine density was mentioned in three articles. Although the heterogeneity of lumbar vertebral density is moderate, the analysis of swimmers to nonswimmers shows that the lumbar vertebral density in swimmers is improved [heterogeneity: chi = 5.16, df = 2 ( = 0.08); = 61%]. We analyzed the following heterogeneous subgroups: subgroup 1 (3-6 hours) and subgroup 2 (<3 hours). The BMD in subgroup 1 was significantly higher than that in the placebo, while no effect on BMD was found in subgroup 2 [heterogeneity: chi = 0.15, df = 3 ( = 0.70); = 0%]. According to the current evidence, swimming may improve the BMD of postmenopausal women participants, if the swimming time is between 3 and 6 hours, especially in long-term swimmers. However, the effectiveness of swimming does require further investigation.
Topics: Adult; Bone Density; Exercise Therapy; Female; Femur Neck; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Osteoporosis, Postmenopausal; Postmenopause; Premenopause; Swimming
PubMed: 32509864
DOI: 10.1155/2020/6210201 -
Neurocritical Care Feb 2022Levetiracetam is commonly used for seizure prophylaxis in patients with intracerebral hemorrhage (ICH), traumatic brain injury (TBI), supratentorial neurosurgery, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Levetiracetam is commonly used for seizure prophylaxis in patients with intracerebral hemorrhage (ICH), traumatic brain injury (TBI), supratentorial neurosurgery, and spontaneous subarachnoid hemorrhage (SAH). However, its efficacy, optimal dosing, and the adverse events associated with levetiracetam prophylaxis remain unclear.
METHODS
A systematic search of PubMed, Embase, and Cochrane central register of controlled trials (CENTRAL) database was conducted from January 1, 2000, to October 30, 2020, including articles addressing treatment with levetiracetam for seizure prophylaxis after SAH, ICH, TBI, and supratentorial neurosurgery. Non-English, pediatric (aged < 18 years), preclinical, reviews, case reports, and articles that included patients with a preexisting seizure condition or epilepsy were excluded. The coprimary meta-analyses examined first seizure events in (1) levetiracetam versus no antiseizure medication and (2) levetiracetam versus other antiseizure medications in all ICH, TBI, SAH, and supratentorial neurosurgery populations. Secondary meta-analyses evaluated the same comparator groups in individual disease populations. Risk of bias in non-randomised studies - of interventions (ROBINS-I) and risk-of-bias tool for randomized trials (RoB-2) tools were used to assess risk of bias.
RESULTS
A total of 30 studies (n = 6 randomized trials, n = 9 prospective studies, and n = 15 retrospective studies), including 7609 patients (n = 4737 with TBI, n = 701 with SAH, n = 261 with ICH, and n = 1910 with neurosurgical diseases) were included in analyses. Twenty-seven of 30 (90%) studies demonstrated moderate to severe risk of bias, and 11 of 30 (37%) studies used low-dosage levetiracetam (250-500 mg twice daily). In the primary meta-analyses, there were no differences in seizure events for levetiracetam prophylaxis (n = 906) versus no antiseizure medication (n = 2728; odds ratio [OR] 0.79, 95% confidence interval [CI] 0.53-1.16, P = 0.23, fixed-effect, I = 26%, P = 0.23 for heterogeneity) or levetiracetam (n = 1950) versus other antiseizure prophylaxis (n = 2289; OR 0.84, 95% CI 0.55-1.28, P = 0.41, random-effects, I = 49%, P = 0.005 for heterogeneity). Only patients with supratentorial neurosurgical diseases benefited from levetiracetam compared with other antiseizure medications (median 0.70 seizure events per-patient-year with levetiracetam versus 2.20 seizure events per-patient-year for other antiseizure medications, OR 0.34, 95% CI 0.20-0.58, P < 0.001, fixed-effects, I = 39%, P = 0.13 for heterogeneity). There were no significant differences in meta-analyses of patients with ICH, SAH, or TBI. Adverse events of any severity were reported in a median of 8% of patients given levetiracetam compared with 21% of patients in comparator groups.
CONCLUSIONS
Based on the current moderately to seriously biased heterogeneous data, which frequently used low and possibly subtherapeutic doses of levetiracetam, our meta-analyses did not demonstrate significant reductions in seizure incidence and neither supports nor refutes the use of levetiracetam prophylaxis in TBI, SAH, or ICH. Levetiracetam may be preferred post supratentorial neurosurgery. More high-quality randomized trials of prophylactic levetiracetam are warranted.
Topics: Adolescent; Anticonvulsants; Child; Humans; Levetiracetam; Prospective Studies; Retrospective Studies; Seizures
PubMed: 34286461
DOI: 10.1007/s12028-021-01296-z -
AIDS Research and Therapy Apr 2021Depression is particularly common among adolescents with HIV/AIDS and has been associated with disruption of the important developmental process, subsequently leading to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Depression is particularly common among adolescents with HIV/AIDS and has been associated with disruption of the important developmental process, subsequently leading to a wide range of negative mental, physical and psychosocial consequences, as well as poor quality of life in those population groups. Nevertheless, to the best of our knowledge, there are no prior systematic reviews and meta-analytic studies that determined the prevalence of depression among adolescents with HIV/AIDS.
METHOD
We systematically searched PubMed, Scopus and Web of Science for relevant literature until May 2020. A random-effect meta-analysis was used to pool prevalence rates from individual studies. Sensitivity and subgroup analyses were performed to identify the source of heterogeneities and to compare the prevalence estimates across the groups. The Joanna Briggs Institute's quality assessment checklist was used to evaluate the quality of the included studies. Cochran's Q and the I tests were used to assess heterogeneity between the studies.
RESULTS
A total of ten studies were included for the final analysis, with 2642 adolescents living with HIV/AIDS. Our final meta-analysis showed that more than a quarter of adolescents with HIV had depression [26.07% (95% CI 18.92-34.78)]. The prevalence was highest amongst female adolescents (32.15%) than males (25.07%) as well as amongst the older adolescents aged 15-19 years (37.09%) than younger adolescents aged 10-14 years (29.82%).
CONCLUSION
Our study shows that a significant proportion of adolescents with HIV had depression, indicating the imperativeness of intervention strategies to alleviate the suffering and possibly reduce the probable negative ramifications.
Topics: Acquired Immunodeficiency Syndrome; Adolescent; Depression; Female; HIV Infections; Humans; Male; Prevalence; Quality of Life
PubMed: 33906698
DOI: 10.1186/s12981-021-00351-1 -
Environment International Aug 2021Mental health is an important public health issue globally. A potential link between heat exposure and mental health outcomes has been recognised in the scientific... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Mental health is an important public health issue globally. A potential link between heat exposure and mental health outcomes has been recognised in the scientific literature; however, the associations between heat exposure (both high ambient temperatures and heatwaves) and mental health-related mortality and morbidity vary between studies and locations.
OBJECTIVE
To fill gaps in knowledge, this systematic review aims to summarize the epidemiological evidence and investigate the quantitative effects of high ambient temperatures and heatwaves on mental health-related mortality and morbidity outcomes, while exploring sources of heterogeneity.
METHODS
A systematic search of peer-reviewed epidemiological studies on heat exposure and mental health outcomes published between January 1990 and November 2020 was conducted using five databases (PubMed, Embase, Scopus, Web of Science and PsycINFO). We included studies that examined the association between high ambient temperatures and/or heatwaves and mental health-related mortality and morbidity (e.g. hospital admissions and emergency department visits) in the general population. A range of mental health conditions were defined using ICD-10 classifications. We performed random effects meta-analysis to summarize the relative risks (RRs) in mental health outcomes per 1 °C increase in temperature, and under different heatwaves definitions. We further evaluated whether variables such as age, sex, socioeconomic status, and climate zone may explain the observed heterogeneity.
RESULTS
The keyword search yielded 4560 citations from which we identified 53 high temperatures/heatwaves studies that comprised over 1.7 million mental health-related mortality and 1.9 million morbidity cases in total. Our findings suggest associations between heat exposures and a range of mental health-related outcomes. Regarding high temperatures, our meta-analysis of study findings showed that for each 1 °C increase in temperature, the mental health-related mortality and morbidity increased with a RR of 1.022 (95%CI: 1.015-1.029) and 1.009 (95%CI: 1.007-1.015), respectively. The greatest mortality risk was attributed to substance-related mental disorders (RR, 1.046; 95%CI: 0.991-1.101), followed by organic mental disorders (RR, 1.033; 95%CI: 1.020-1.046). A 1 °C temperature rise was also associated with a significant increase in morbidity such as mood disorders, organic mental disorders, schizophrenia, neurotic and anxiety disorders. Findings suggest evidence of vulnerability for populations living in tropical and subtropical climate zones, and for people aged more than 65 years. There were significant moderate and high heterogeneities between effect estimates in overall mortality and morbidity categories, respectively. Lower heterogeneity was noted in some subgroups. The magnitude of the effect estimates for heatwaves varied depending on definitions used. The highest effect estimates for mental health-related morbidity was observed when heatwaves were defined as "mean temperature ≥90th percentile for ≥3 days" (RR, 1.753; 95%CI: 0.567-5.421), and a significant effect was also observed when the definition was "mean temperature ≥95th percentile for ≥3 days", with a RR of 1.064 (95%CI: 1.006-1.123).
CONCLUSIONS
Our findings support the hypothesis of a positive association between elevated ambient temperatures and/or heatwaves and adverse mental health outcomes. This problem will likely increase with a warming climate, especially in the context of climate change. Further high-quality studies are needed to identify modifying factors of heat impacts.
Topics: Climate Change; Hot Temperature; Humans; Morbidity; Outcome Assessment, Health Care; Temperature
PubMed: 33799230
DOI: 10.1016/j.envint.2021.106533 -
International Journal of Nursing Studies Jan 2022Children undergoing surgery generally experience anxiety during the perioperative period, which could impact the surgical outcome, cause long-term psychological... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Children undergoing surgery generally experience anxiety during the perioperative period, which could impact the surgical outcome, cause long-term psychological consequences and result in later healthcare avoidance. Preoperative anxiety in children is managed using both pharmacological and non-pharmacological therapies. The latter include distraction, a tour of the operating room and parental presence until the induction of anaesthesia. A novel and effective non-pharmacological therapies is the use of virtual reality to reduce anxiety and pain in children scheduled for medical procedures. However, the effectiveness of virtual reality in paediatric surgery has yet to be evaluated in a systematic review.
OBJECTIVE
To evaluate the effectiveness of virtual reality in the management of anxiety in paediatric patients during the perioperative period.
DESIGN
Both a systematic review and a meta-analysis of randomised controlled trials were performed according to the methods outlined in the Cochrane Handbook for Systematic Reviews of Interventions Section 8.5 and in accordance with the Cochrane Effective Practice and Organisation of Care. The results are reported as prescribed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.
DATA SOURCES
A systematic search of randomised controlled trials was conducted using Medline, SCOPUS, Web of Science, Ovid MEDLINE and CINAHL.
REVIEW METHODS
Two researchers screened potentially eligible articles and then assessed the quality of the reported studies using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions Section 8.5 and according to Cochrane Effective Practice and Organisation of Care. The data were synthesised using the random-effects models to incorporate the estimated heterogeneity in the weighting. Heterogeneity was tested using the Q and I statistics. The τ statistic, an estimate of the amount of variation between the included studies, was also determined. Studies whose heterogeneity with respect to primary outcome measurements hindered pooling of the results for meta-analysis were summarised narratively.
RESULTS
Seven studies were eligible for inclusion in this systematic review. An effect size for anxiety could be determined in six. The results support the effectiveness of virtual reality in reducing anxiety in paediatric patients undergoing elective surgery. The overall effect was supported by a confidence interval < 0 (PL = -0.341, 95% confidence interval: -0.620 to -0.107) and by heterogenity indexes that were non significant (Q = 9.49, p = 0.091) or not important (I = 38.64%).
CONCLUSIONS
Paediatric patients undergoing elective surgery may benefit from virtual reality as a distraction method that can reduce anxiety. PROSPERO register, number: (blinded for Referee).
Topics: Anxiety; Child; Humans; Pain; Virtual Reality
PubMed: 34781118
DOI: 10.1016/j.ijnurstu.2021.104115 -
Journal of Medical Internet Research Nov 2019Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living conditions in a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living conditions in a cost-efficient way.
OBJECTIVE
We conducted a systematic review of publications reporting on the performance of wristband Fitbit models in assessing sleep parameters and stages.
METHODS
In adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we comprehensively searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, MEDLINE, PubMed, PsycINFO, and Web of Science databases using the keyword Fitbit to identify relevant publications meeting predefined inclusion and exclusion criteria.
RESULTS
The search yielded 3085 candidate articles. After eliminating duplicates and in compliance with inclusion and exclusion criteria, 22 articles qualified for systematic review, with 8 providing quantitative data for meta-analysis. In reference to polysomnography (PSG), nonsleep-staging Fitbit models tended to overestimate total sleep time (TST; range from approximately 7 to 67 mins; effect size=-0.51, P<.001; heterogenicity: I=8.8%, P=.36) and sleep efficiency (SE; range from approximately 2% to 15%; effect size=-0.74, P<.001; heterogenicity: I=24.0%, P=.25), and underestimate wake after sleep onset (WASO; range from approximately 6 to 44 mins; effect size=0.60, P<.001; heterogenicity: I=0%, P=.92) and there was no significant difference in sleep onset latency (SOL; P=.37; heterogenicity: I=0%, P=.92). In reference to PSG, nonsleep-staging Fitbit models correctly identified sleep epochs with accuracy values between 0.81 and 0.91, sensitivity values between 0.87 and 0.99, and specificity values between 0.10 and 0.52. Recent-generation Fitbit models that collectively utilize heart rate variability and body movement to assess sleep stages performed better than early-generation nonsleep-staging ones that utilize only body movement. Sleep-staging Fitbit models, in comparison to PSG, showed no significant difference in measured values of WASO (P=.25; heterogenicity: I=0%, P=.92), TST (P=.29; heterogenicity: I=0%, P=.98), and SE (P=.19) but they underestimated SOL (P=.03; heterogenicity: I=0%, P=.66). Sleep-staging Fitbit models showed higher sensitivity (0.95-0.96) and specificity (0.58-0.69) values in detecting sleep epochs than nonsleep-staging models and those reported in the literature for regular wrist actigraphy.
CONCLUSIONS
Sleep-staging Fitbit models showed promising performance, especially in differentiating wake from sleep. However, although these models are a convenient and economical means for consumers to obtain gross estimates of sleep parameters and time spent in sleep stages, they are of limited specificity and are not a substitute for PSG.
Topics: Actigraphy; Female; Humans; Male; Sleep; Wrist
PubMed: 31778122
DOI: 10.2196/16273 -
Age and Ageing Jan 2021The prevalence of frailty at population level is unclear. We examined this in population-based studies, investigating sources of heterogeneity. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The prevalence of frailty at population level is unclear. We examined this in population-based studies, investigating sources of heterogeneity.
METHODS
PubMed, Embase, CINAHL and Cochrane Library databases were searched for observational population-level studies published between 1 January 1998 and 1 April 2020, including individuals aged ≥50 years, identified using any frailty measure. Prevalence estimates were extracted independently, assessed for bias and analysed using a random-effects model.
RESULTS
In total, 240 studies reporting 265 prevalence proportions from 62 countries and territories, representing 1,755,497 participants, were included. Pooled prevalence in studies using physical frailty measures was 12% (95% CI = 11-13%; n = 178), compared with 24% (95% CI = 22-26%; n = 71) for the deficit accumulation model (those using a frailty index, FI). For pre-frailty, this was 46% (95% CI = 45-48%; n = 147) and 49% (95% CI = 46-52%; n = 29), respectively. For physical frailty, the prevalence was higher among females, 15% (95% CI = 14-17%; n = 142), than males, 11% (95% CI = 10-12%; n = 144). For studies using a FI, the prevalence was also higher in females, 29% (95% CI = 24-35%; n = 34) versus 20% (95% CI = 16-24%; n = 34), for males. These values were similar for pre-frailty. Prevalence increased according to the minimum age at study inclusion. Analysing only data from nationally representative studies gave a frailty prevalence of 7% (95% CI = 5-9%; n = 46) for physical frailty and 24% (95% CI = 22-26%; n = 44) for FIs.
CONCLUSIONS
Population-level frailty prevalence varied by classification and sex. Data were heterogenous and limited, particularly from nationally representative studies making the interpretation of differences by geographic region challenging. Common methodological approaches to gathering data are required to improve the accuracy of population-level prevalence estimates.
PROTOCOL REGISTRATION
PROSPERO-CRD42018105431.
Topics: Female; Frailty; Humans; Male; Prevalence; Research Design
PubMed: 33068107
DOI: 10.1093/ageing/afaa219