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Journal of Physical Activity & Health Oct 2020The importance of health literacy (HL) in health promotion is increasingly clear and acknowledged globally, especially when addressing noncommunicable diseases. This... (Review)
Review
BACKGROUND
The importance of health literacy (HL) in health promotion is increasingly clear and acknowledged globally, especially when addressing noncommunicable diseases. This paper aimed to collect and summarize all current data from observational studies generating evidence of the association between HL and physical activity (PA) and to analyze intervention studies on the promotion of PA to ascertain whether HL moderates the efficacy of such intervention.
METHODS
A comprehensive systematic literature search of observational studies investigating the association between HL and PA was performed. Intervention studies on the promotion of PA that also measured the HL levels of participants and its effect on the outcome of the intervention were also identified.
RESULTS
Of the 22 studies included in this review, 18 found a significant positive association between high HL and high levels of PA. The only intervention study among them indicated that HL was not a significant moderator of the intervention's effectiveness.
CONCLUSION
HL can enable individuals to make deliberate choices about their PA and thus contribute to preventing many chronic noncommunicable diseases. That said, low levels of HL do not seem to influence the efficacy of health promotion interventions.
Topics: Chronic Disease; Exercise; Health Literacy; Health Promotion; Health Status; Humans
PubMed: 33129198
DOI: 10.1123/jpah.2020-0161 -
The Journal of Clinical Psychiatry Jun 2020To estimate the worldwide prevalence of obsessive-compulsive disorder (OCD), examine whether women are at greater risk than men, and explore other potential moderators... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the worldwide prevalence of obsessive-compulsive disorder (OCD), examine whether women are at greater risk than men, and explore other potential moderators of OCD prevalence to explain variability in community-based epidemiologic studies.
DATA SOURCES
An electronic search of PsycINFO and PubMed was conducted until January 2017, without date or language restrictions, using the keywords OCD, epidemiology, and prevalence. The search was supplemented by articles referenced in the obtained sources and relevant reviews.
STUDY SELECTION
Studies were included if they reported current, period, and/or lifetime OCD prevalence (diagnosed according to an interview based on DSM or ICD criteria) in representative community samples of adults aged 18 years or older. A total of 4,045 studies were retrieved, with 34 studies ultimately included.
DATA EXTRACTION
OCD prevalence was extracted from each study alongside 9 moderators: gender, year, response rate, region, economic status, diagnostic criteria, diagnostic interview, interviewer, and age.
RESULTS
The overall aggregate current, period, and lifetime OCD prevalence estimates were 1.1%, 0.8%, and 1.3%, respectively. In a typical sample, women were 1.6 times more likely to experience OCD compared to men, with lifetime prevalence rates of 1.5% in women and 1.0% in men. There was also a trend toward younger adults' being more likely to experience OCD in their lifetime than older adults. All findings demonstrated moderate heterogeneity.
CONCLUSIONS
Women are typically at greater risk of experiencing OCD in their lifetime than men.
Topics: Age Factors; Female; Humans; Male; Obsessive-Compulsive Disorder; Prevalence; Risk Factors; Sex Factors
PubMed: 32603559
DOI: 10.4088/JCP.19r13085 -
The American Journal of Sports Medicine May 2021Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about... (Meta-Analysis)
Meta-Analysis
Comparative Efficacy and Patient-Specific Moderating Factors of Nonsurgical Treatment Strategies for Frozen Shoulder: An Updated Systematic Review and Network Meta-analysis.
BACKGROUND
Frozen shoulder is a common shoulder disorder characterized by pain and restriction. Various nonsurgical treatments have been reported, but there is no consensus about their comparative efficacy and the effects of moderators.
PURPOSE
To compare the efficacy of different nonsurgical interventions and identify potential patient-specific moderating factors for frozen shoulder.
STUDY DESIGN
Systematic review and network meta-analysis.
METHODS
PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to February 18, 2019. The search was supplemented by manual review of relevant reference lists. Randomized controlled trials of participants with frozen shoulder that compared nonsurgical interventions were selected. Measured outcomes included pain, shoulder function in daily activities, and range of motion.
RESULTS
Of 3136 records identified, 92 trials were eligible, evaluating 32 nonsurgical interventions in 5946 patients. Intra-articular injection improved pain (pooled standardized mean difference [95% CI]: steroid injection, 1.68 [1.03-2.34]; capsular distension, 2.68 [1.32-4.05]) and shoulder function (steroid injection, 2.16 [1.52-2.81]; distension, 2.89 [1.71-4.06]) to a greater extent than placebo. Capsular distension and extracorporeal shockwave therapy showed the highest ranking for pain relief and functional improvement, respectively. Laser therapy also showed benefits for pain relief (3.02 [1.84-4.20]) and functional improvement (3.66 [1.65-5.67]). Subgroup analyses by disease stages revealed that steroid injection combined with physical therapy provided more benefits during the freezing phase, whereas joint manipulation provided more benefits in the adhesive phase. Adjunctive therapies, female sex, and diabetes were also identified as moderators of effectiveness.
CONCLUSION
Capsular distension is a highly recommended choice for treatment of frozen shoulder, contributing greatly to pain relief and functional improvement; steroid injection is also a prevailing effective intervention. Among new options, extracorporeal shockwave therapy and laser therapy show potential benefits for multiple outcomes. Individualized optimal intervention should be considered, given that treatment effect is moderated by factors including the disease stage, time of assessment, adjunctive therapies, female sex, and diabetes.
Topics: Bursitis; Female; Humans; Injections, Intra-Articular; Network Meta-Analysis; Range of Motion, Articular; Shoulder Joint; Shoulder Pain
PubMed: 32941053
DOI: 10.1177/0363546520956293 -
Journal of Hypertension Jun 2023Stress is widely considered to be a risk factor for high blood pressure (BP), but evidence on the associations between biomarkers of chronic stress and BP is... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Stress is widely considered to be a risk factor for high blood pressure (BP), but evidence on the associations between biomarkers of chronic stress and BP is inconsistent. This systematic review and meta-analysis assessed the current state of the science on relationships between measures of cortisol concentration reflecting chronic stress exposure [hair cortisol concentration (HCC), nail cortisol concentration)] and BP.
METHODS
PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Cochrane Library, and Embase were searched. Random effects models were used to assess the pooled effect size. Exploratory moderation analysis was performed.
RESULTS
Out of 34 014 identified, 16 articles met eligibility criteria and were included in the review, while 14 were included in the meta-analysis. No articles were reported on the association between nail cortisol concentration and BP. Small, positive associations were observed between HCC and SBP [ r = 0.19 (95% confidence interval (CI): 0.08-0.29)] and HCC and DBP [ r = 0.13 (95% CI: 0.04-0.22)]. Cortisol analysis method was identified as a significant moderator of the association between HCC and DBP. HCC was largely, positively associated with hypertension status [odds ratio = 3.23 (95% CI: 2.55-4.09), P < 0.001].
CONCLUSIONS
Current evidence suggests that higher HCC may be associated with elevated BP and a potential risk factor for hypertension. However, results should be interpreted with caution because HCC can be affected by hair color, hair care products, and analytic methods. Given the limitations of studies included in this review, further research is needed.
Topics: Humans; Blood Pressure; Hydrocortisone; Hypertension; Risk Factors; Hair
PubMed: 37016924
DOI: 10.1097/HJH.0000000000003412 -
Neuropsychology Review Jun 2022The relationship between cognitive function and frailty among older adults is a growing area of research due to the implications of cognitive and physical decline for... (Meta-Analysis)
Meta-Analysis Review
The relationship between cognitive function and frailty among older adults is a growing area of research due to the implications of cognitive and physical decline for functional independence in late life. Multiple studies demonstrate a meaningful relationship between these two factors, which together may constitute increased risk of negative health outcomes for older adults. The current analysis was conducted to 1) systematically review current evidence for differences in cognitive performance based on frailty status among older adults and provide quantitative evidence for the magnitude of this effect, and 2) assess the influence of demographic and methodological variables on this effect. The preregistered protocol (CRD42018087138) included a search of EBSCOhost, Pubmed, and Embase online databases and reference lists to identify cross-sectional studies comparing frail and non-frail or robust older adults (60+) on cognitive performance. In total, 42 effects were retrieved from 38 studies, expressed as Hedges' g, and pooled based on a random-effects model. Results indicated an overall significant, negative effect of frailty status on cognitive function among tests of global cognitive function (g = 0.734: 95% CI = 0.601-0.867) and individual cognitive domains (g = 0.439: 95% CI = 0.342-0.535). Age, frailty assessment used, and cognitive status of the sample did not significantly moderate the overall effect. Post-hoc moderator analysis revealed that difference in mean age of frail and robust groups significantly moderated the overall effect (R = 0.38, β = .0974, 95% CI = 0.0537-0.141). Implications for future research are discussed.
Topics: Aged; Cognition; Cross-Sectional Studies; Frail Elderly; Frailty; Humans
PubMed: 33886024
DOI: 10.1007/s11065-021-09497-1 -
Occupational and Environmental Medicine Sep 2013Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two... (Review)
Review
Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two approaches, mediation and moderation. Yet the relative significance of each approach remains unclear in respective research. We set out to study this question by conducting a systematic literature review. We included all original papers based on prospective observational studies of employed cohorts that were published between January 1980 and October 2012 meeting our search criteria, by using major databases and by observing established quality criteria. 26 reports were included after quality assessment. 17 studies examined the mediation hypothesis and nine studies tested the moderation hypothesis. Moderate support was found for the mediation hypothesis where OR or HR of health according to socioeconomic position (SEP) were reduced in a majority of analyses after introducing work characteristics in multivariate models. Evidence in favour of the moderation hypothesis was found in some studies, demonstrating stronger effects of adverse work on health among people with low SEP. Despite some support in favour of the two hypotheses future research should aim at reducing the heterogeneity in defining and measuring core variables and at applying advanced statistical analyses. Policy recommendations would benefit from a higher degree of consistency of respective research evidence.
Topics: Adult; Cohort Studies; Female; Germany; Health Status Disparities; Humans; Male; Middle Aged; Negotiating; Occupational Health; Occupations; Prospective Studies; Socioeconomic Factors; Work; Workplace
PubMed: 23739492
DOI: 10.1136/oemed-2012-101331 -
Behaviour Research and Therapy Oct 2022This systematic review and meta-analysis examines the effect of Cognitive Bias Modification for attention (CBM-A) and interpretation (CBM-I) on reducing the targeted... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis examines the effect of Cognitive Bias Modification for attention (CBM-A) and interpretation (CBM-I) on reducing the targeted biases and investigates moderators of each approach. PsycINFO, PsychArticles, and PubMED databases were searched for randomized-controlled studies published before March 2020 with pre- and post-CBM cognitive bias outcome measures, resulting in 91 CBM-A (n = 5914 individuals) and 70 CBM-I samples (n = 4802 individuals). Random-effects models and Hedge's g calculation showed significant medium overall effects of bias reduction with moderate to high heterogeneity (CBM-A g = 0.49 [0.36, 0.64], I = 85.19%; CBM-I g = 0.58 [0.48, 0.68], I = 70.92%). Effect sizes did not differ between approaches and remained significant after trim-and-fill adjustment for possible publication bias. Moderator variables were investigated with meta-regression and subgroup analyses. Participant age, symptom type, control condition and number of trials moderated CBM-A; student and clinical status moderated CBM-I effect size. Results support attention and interpretation modification in controlled laboratory and variable (online) training settings for non-clinical and clinical samples across various symptom types (anxiety, depression, substance use, eating disorders). Further empirical evidence is necessary to determine optimal sample and methodological combinations most strongly associated with adaptive behavioral outcomes.
Topics: Anxiety Disorders; Attentional Bias; Bias; Cognition; Cognitive Behavioral Therapy; Humans
PubMed: 36037642
DOI: 10.1016/j.brat.2022.104180 -
Clinical Psychology Review Apr 2015Depression in borderline personality disorder (BPD) is hypothesized to be distinct in quality and severity. This paper provides a systematic review of depression... (Meta-Analysis)
Meta-Analysis Review
Depression in borderline personality disorder (BPD) is hypothesized to be distinct in quality and severity. This paper provides a systematic review of depression quality, and a meta-analysis of depression severity in BPD patients compared to those with depressive disorders (DeDs) only. Based on a systematic literature search, 26 studies were identified for systematic review and 35 studies (3425 participants) were included for meta-analysis. The review focused on different forms of depressive symptoms, affective impairment, self-evaluation, and negative interpersonal experiences. The meta-analysis examined age, gender, presence of comorbid DeDs in BPD patients, and type of depression scale as moderators of effect sizes. Findings indicate that depression quality in BPD is characterized by higher anger/hostility and self-criticism. There was no significant difference in depression severity between BPD and DeD groups, and a high level of heterogeneity. Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls. Our results suggest high variability in depression severity across BPD patients, point toward the consideration of comorbid DeDs, and lend partial support to a BPD-specific depression quality. We discuss difficulties in research on depression in BPD, and offer directions for future studies.
Topics: Borderline Personality Disorder; Depression; Humans; Severity of Illness Index
PubMed: 25723972
DOI: 10.1016/j.cpr.2015.02.002 -
Pain Jan 2024This preregistered (CRD42021223379) systematic review and meta-analysis aimed to characterize the placebo and nocebo responses in placebo-controlled randomized clinical... (Meta-Analysis)
Meta-Analysis
This preregistered (CRD42021223379) systematic review and meta-analysis aimed to characterize the placebo and nocebo responses in placebo-controlled randomized clinical trials (RCTs) on painful diabetic neuropathy (PDN), updating the previous literature by a decade. Four databases were searched for PDN trials published in the past 20 years, testing oral medications, adopting a parallel-group design. Magnitude of placebo or nocebo responses, Cochrane risk of bias, heterogeneity, and moderators were evaluated. Searches identified 21 studies (2425 placebo-treated patients). The overall mean pooled placebo response was -1.54 change in the pain intensity from baseline [95% confidence interval (CI): -1.52, -1.56, I 2 = 72], with a moderate effect size (Cohen d = 0.72). The pooled placebo 50% response rate was 25% [95% CI: 22, 29, I 2 = 50%]. The overall percentage of patients with adverse events (AEs) in the placebo arms was 53.3% [95% CI: 50.9, 55.7], with 5.1% [95% CI: 4.2, 6] of patients dropping out due to AEs. The year of study initiation was the only significant moderator of placebo response (regression coefficient = -0.06, [95% CI: -0.10, -0.02, P = 0.007]). More recent RCTs tended to be longer, bigger, and to include older patients (N = 21, rs = 0.455, P = 0.038, rs = 0.600, P = 0.004, rs = 0.472, P = 0.031, respectively). Our findings confirm the magnitude of placebo and nocebo responses, identify the year of study initiation as the only significant moderator of placebo response, draw attention to contextual factors such as confidence in PDN treatments, patients' previous negative experiences, intervention duration, and information provided to patients before enrollment.
Topics: Humans; Nocebo Effect; Diabetic Neuropathies; Placebo Effect; Pain Measurement; Diabetes Mellitus
PubMed: 37530658
DOI: 10.1097/j.pain.0000000000003000 -
Journal of Affective Disorders Oct 2023The aim of this review was to identify and critically appraise predictors and moderators of outcomes of psychological and pharmacological treatments for late-life... (Review)
Review
BACKGROUND
The aim of this review was to identify and critically appraise predictors and moderators of outcomes of psychological and pharmacological treatments for late-life anxiety disorders. Their identification may guide the development of personalised treatments for older people with anxiety disorders.
METHODS
Web of Science, PsychINFO, CINAHL, Embase, and Pubmed were searched for studies published up to 12 May 2022. Randomised controlled trials and observational studies reporting treatment predictors and moderators were included. Participants with a diagnosis of any anxiety disorder who were aged over 60 years were included. Treatment outcomes included response, remission, and change in anxiety score.
RESULTS
Thirteen studies met the inclusion criteria. Twenty-three out of 49 predictors or moderators assessed at post-treatment, and 14 out of 33 predictors or moderators assessed at follow-up were statistically significant. Only one predictor, baseline worry severity at post-treatment, was reported in at least three studies. Most studies were rated as having a low risk of bias in at least three areas and satisfied important quality criteria for predictor and moderator analyses.
LIMITATIONS
Samples were predominantly white, female and highly educated, and most studies were secondary analyses.
CONCLUSIONS
There is evidence that baseline worry severity appears to predict treatment outcome in late-life anxiety disorders. However, this was only explored in psychological intervention studies and therefore its predictive ability in pharmacotherapy remains unknown. Future research should explore predictors and moderators in a range of anxiety disorders and design methodologically-strong and adequately-powered studies with the primary aim of assessing predictors of treatment outcomes.
Topics: Humans; Female; Middle Aged; Aged; Anxiety Disorders; Anxiety; Treatment Outcome
PubMed: 37442444
DOI: 10.1016/j.jad.2023.07.057