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Frontiers in Psychiatry 2022Recent treatment guidelines for chronic insomnia recommend pharmacological and non-pharmacological therapies. One of the contemporary drug options for insomnia includes...
Dual orexin receptor antagonists for treatment of insomnia: A systematic review and meta-analysis on randomized, double-blind, placebo-controlled trials of suvorexant and lemborexant.
STUDY OBJECTIVES
Recent treatment guidelines for chronic insomnia recommend pharmacological and non-pharmacological therapies. One of the contemporary drug options for insomnia includes dual orexin receptor antagonist (DORA), such as suvorexant and lemborexant. We conducted a systematic review and meta-analysis for the treatment of insomnia with suvorexant and lemborexant based on randomized, double-blind, placebo-controlled Trials.
METHODS
We conducted a comprehensive search on three databases (PubMed/Medline, Web of Science, and Cochrane Library) till August 14, 2021, without any restrictions to retrieve the relevant articles. The effect sizes were computed presenting the pooled mean difference or risk ratio along with 95% confidence interval of each outcome.
RESULTS
Our search showed eight articles (five for suvorexant and three for lemborexant). Results of diary measures, rating scales, polysomnography results, treatment discontinuation, and adverse events were measured. All efficacy outcome measures favorably and significantly differed in the suvorexant compared to placebo. Safety profile did not differ significantly except for somnolence, excessive daytime sleepiness/sedation, fatigue, back pain, dry mouth, and abnormal dreams. Important adverse events including hallucinations, suicidal ideation/behavior and motor vehicle accidents did not differ between suvorexant and placebo. All the efficacy outcomes significantly differed between lemborexant 5 and lemborexant 10 compared to placebo. Somnolence rate for lemborexant 5 and lemborexant 10 and nightmare for lemborexant 10 were significantly higher than placebo.
CONCLUSION
The present meta-analysis reported that suvorexant and lemborexant are efficacious and safe agents for the patients with insomnia. Further data in patients with insomnia and various comorbid conditions are needed.
PubMed: 36578296
DOI: 10.3389/fpsyt.2022.1070522 -
Clinical Psychology Review Mar 2023Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess... (Review)
Review
Nightmares occur across a wide range of psychiatric disorders, but outside of PTSD presentations are infrequently considered a treatment priority. We aimed to assess evidence for a contributory causal role of nightmares to the occurrence of psychiatric disorders, and vice versa. A systematic review was conducted of longitudinal, experimental, and clinical trial studies. Twenty-four longitudinal, sixteen trials, and no experimental studies were identified. Methodological shortcomings were common, especially the use of single-item nightmare assessment. Thirty-five studies assessed the path from nightmares to psychiatric symptoms. Depression (n = 10 studies), PTSD (n = 10) and anxiety (n = 5) were the most commonly assessed outcomes in trials. Most were not designed to assess the effect of nightmare treatment on psychiatric symptoms. Treating nightmares led to moderate reductions in PTSD and depression, small to moderate reductions in anxiety, and potentially moderate reductions in paranoia. Nightmares increased the risk of later suicide outcomes (n = 10), but two small pilot trials indicated that treating nightmares might potentially prevent recovery of suicidal ideation. PTSD treatment led to large reductions in trauma-related nightmares (n = 3). The limited literature suggests that treating nightmares may be one route to lessening threat-based disorders in particular, suggestive of a causal relationship. Overall, however, nightmares in most disorders are greatly understudied.
Topics: Humans; Stress Disorders, Post-Traumatic; Dreams; Anxiety; Anxiety Disorders; Suicidal Ideation
PubMed: 36566699
DOI: 10.1016/j.cpr.2022.102241 -
Journal of Clinical Sleep Medicine :... Apr 2023This systematic review provides supporting evidence for a clinical practice guideline for the management of rapid eye movement (REM) sleep behavior disorder in adults... (Meta-Analysis)
Meta-Analysis
UNLABELLED
This systematic review provides supporting evidence for a clinical practice guideline for the management of rapid eye movement (REM) sleep behavior disorder in adults and children. The American Academy of Sleep Medicine commissioned a task force of 7 experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials and observational studies that addressed interventions for the management of REM sleep behavior disorder in adults and children. Statistical analyses were performed to determine the clinical significance of critical and important outcomes. Finally, the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search identified 4,690 studies; 148 studies provided data suitable for statistical analyses; evidence for 45 interventions is presented. The task force provided a detailed summary of the evidence assessing the certainty of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.
CITATION
Howell M, Avidan AY, Foldvary-Schaefer N, et al. Management of REM sleep behavior disorder: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. . 2023;19(4):769-810.
Topics: Adult; Child; Humans; United States; REM Sleep Behavior Disorder; GRADE Approach; Academies and Institutes; Research Design; Sleep
PubMed: 36515150
DOI: 10.5664/jcsm.10426 -
Malaria Journal Nov 2022Globally, malaria is among the leading cause of under-five mortality and morbidity. Despite various malaria elimination strategies being implemented in the last decades,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Globally, malaria is among the leading cause of under-five mortality and morbidity. Despite various malaria elimination strategies being implemented in the last decades, malaria remains a major public health concern, particularly in tropical and sub-tropical regions. Furthermore, there have been limited and inconclusive studies in Ethiopia to generate information for action towards malaria in under-five children. Additionally, there is a considerable disparity between the results of the existing studies. Therefore, the pooled estimate from this study will provide a more conclusive result to take evidence-based interventional measures against under-five malaria.
METHODS
The protocol of this review is registered at PROSPERO with registration number CRD42020157886. All appropriate databases and grey literature were searched to find relevant articles. Studies reporting the prevalence or risk factors of malaria among under-five children were included. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). Data was extracted using Microsoft Excel 2016 and analysis was done using STATA 16.0 statistical software. The pooled prevalence and its associated factors of malaria were determined using a random effect model. Heterogeneity between studies was assessed using the Cochrane Q-test statistics and I test. Furthermore, publication bias was checked by the visual inspection of the funnel plot and using Egger's and Begg's statistical tests.
RESULTS
Twelve studies with 34,842 under-five children were included. The pooled prevalence of under-five malaria was 22.03% (95% CI 12.25%, 31.80%). Lack of insecticide-treated mosquito net utilization (AOR: 5.67, 95% CI 3.6, 7.74), poor knowledge of child caretakers towards malaria transmission (AOR: 2.79, 95% CI 1.70, 3.89), and living near mosquito breeding sites (AOR: 5.05, 95% CI 2.92, 7.19) were risk factors of under-five malaria.
CONCLUSION
More than one in five children aged under five years were infected with malaria. This suggests the rate of under-five malaria is far off the 2030 national malaria elimination programme of Ethiopia. The Government should strengthen malaria control strategies such as disseminating insecticide-treated mosquito nets (ITNs), advocating the utilization of ITNs, and raising community awareness regarding malaria transmission.
Topics: Child; Humans; Insecticides; Ethiopia; Malaria; Risk Factors; Prevalence
PubMed: 36384533
DOI: 10.1186/s12936-022-04370-9 -
Journal of Sleep Research Jun 2023A 'new' way of dreaming has emerged during the pandemic, enhancing the interest of psychological literature. Indeed, during the years of the spread of coronavirus...
A 'new' way of dreaming has emerged during the pandemic, enhancing the interest of psychological literature. Indeed, during the years of the spread of coronavirus disease 2019 (COVID-19), many studies have investigated dream-related phenomena and dreaming functions. Considering the constant and rapid emergence of new results on this topic, the main aim of this study was to create an 'observatory' on the short- and long-term consequences of the COVID-19 pandemic on dreaming, by means of a living systematic review. The baseline results are presented, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, to identify and discuss existing studies about dreams and dreaming during the COVID-19 pandemic published until February 2022. Web of Science, Embase, EBSCO, and PubMed were used for the search strategy, yielding 71 eligible papers included in the review. Our results show: (a) a more intense oneiric activity during lockdown; (b) changes in dreaming components (especially dream-recall and nightmare frequency); (c) a particular dreaming scenario ('pandemic dreams'); (d) an alteration of the dreaming-waking-life continuum and a specific function of dreaming as emotional regulator. Findings suggest that monitoring changes in dreaming provides important information about psychological health and could also contribute to the debate on the difficulties of dreaming, as well as sleeping, in particular during and after a period of 'collective trauma'.
Topics: Humans; Communicable Disease Control; COVID-19; Dreams; Pandemics; Sleep
PubMed: 36320190
DOI: 10.1111/jsr.13742 -
Rand Health Quarterly Jun 2022Posttraumatic stress disorder (PTSD) is a condition that can emerge after exposure to a traumatic event. It involves several symptoms, including distressing memories or...
Posttraumatic stress disorder (PTSD) is a condition that can emerge after exposure to a traumatic event. It involves several symptoms, including distressing memories or dreams and/or dissociative reactions; psychological distress at exposure to trauma cues; physiologic reactions to cues; avoidance of stimuli associated with the event; negative alterations in cognitions and mood associated with the trauma; and alterations in arousal and reactivity, including sleep disturbance. The purpose of this systematic review is to synthesize the evidence from randomized controlled trials on the effects that interventions for adults with PTSD have on sleep outcomes. The authors searched research databases and bibliographies of existing systematic reviews to identify pertinent trials published in English; literature was identified by the searches using predetermined eligibility criteria. The primary outcome domain included sleep quality, insomnia, and nightmares. Secondary outcomes were PTSD symptoms and adverse events. Risk of bias and the quality of evidence were assessed for each outcome. The identified interventions addressed pharmacological, psychological, behavioral, complementary, and integrative medicine treatments aimed at improving sleep or lessening other PTSD symptoms. Interventions in general showed an effect on sleep. Interventions explicitly targeting sleep-particularly psychotherapy targeting sleep-showed larger effects on sleep than did interventions not targeting sleep. Heterogeneity was considerable, but sleep effect estimates were not systematically affected by trauma type, setting, or modality. Comparative effectiveness studies are needed to support the findings.
PubMed: 35837535
DOI: No ID Found -
Frontiers in Public Health 2022Studies conducted on the practice of COVID-19 preventive methods across the world are highly inconsistent and inconclusive. Hence, this study intended to estimate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Studies conducted on the practice of COVID-19 preventive methods across the world are highly inconsistent and inconclusive. Hence, this study intended to estimate the pooled preventive practice and its determinants among the general population.
METHODS
This study was conducted using online databases (PubMed, HINARI, Scopus, EMBASE, Science Direct, and Cochrane library database), African Journals online, Google Scholar, open gray and online repository accessed studies. The quality of the included studies was assessed using Newcastle-Ottawa Quality Assessment Scale (NOS). STATA 14.0 software for analysis. The existence of heterogeneity between studies was checked using Cochran Q test and I2 test statistics and then, the presence of publication bias was detected using both funnel plot and Egger's test.
RESULTS
51 studies were included and the pooled level of practice toward the preventive measures of COVID-19 was 74.4% (95% CI: 70.2-78.6%, 2 = 99.7%, < 0.001] using a random effects model. Being female [OR = 1.97: 95% CI 1.75, 2.23; 2 = 0.0%, < 0.698], rural residence [OR = 0.53: 95% CI 0.44, 0.65; 2 = 73.5%, < 0.013], attending higher education level [OR = 1.47: 95% CI 1.18, 1.83; 2 = 75.4%, < 0.001], being employed [OR = 2.12: 95% CI 1.44, 3.12; 2 = 91.8%, < 0.001], age < 30 [OR = 0.73: 95% CI 0.60, 0.89; 2 = 73.9%, < 0.001], and knowledgeable [OR = 1.22: 95% CI 1.09, 1.36; 2 = 47.3%, < 0.077] were the independent predictors of adequate practice level.
CONCLUSIONS
nearly three-fourths of the general population has an adequate preventive practice level toward COVID-19. Thus, the global, regional, national, and local governments need to establish policies and strategies to address the identified factors.
Topics: Black People; COVID-19; Databases, Factual; Female; Humans; Local Government; Male; Policy
PubMed: 35784216
DOI: 10.3389/fpubh.2022.844692 -
Computational Intelligence and... 2022Cloud computing is a long-standing dream of computing as a utility, where users can store their data remotely in the cloud to enjoy on-demand services and high-quality... (Review)
Review
Cloud computing is a long-standing dream of computing as a utility, where users can store their data remotely in the cloud to enjoy on-demand services and high-quality applications from a shared pool of configurable computing resources. Thus, the privacy and security of data are of utmost importance to all of its users regardless of the nature of the data being stored. In cloud computing environments, it is especially critical because data is stored in various locations, even around the world, and users do not have any physical access to their sensitive data. Therefore, we need certain data protection techniques to protect the sensitive data that is outsourced over the cloud. In this paper, we conduct a systematic literature review (SLR) to illustrate all the data protection techniques that protect sensitive data outsourced over cloud storage. Therefore, the main objective of this research is to synthesize, classify, and identify important studies in the field of study. Accordingly, an evidence-based approach is used in this study. Preliminary results are based on answers to four research questions. Out of 493 research articles, 52 studies were selected. 52 papers use different data protection techniques, which can be divided into two main categories, namely noncryptographic techniques and cryptographic techniques. Noncryptographic techniques consist of data splitting, data anonymization, and steganographic techniques, whereas cryptographic techniques consist of encryption, searchable encryption, homomorphic encryption, and signcryption. In this work, we compare all of these techniques in terms of data protection accuracy, overhead, and operations on masked data. Finally, we discuss the future research challenges facing the implementation of these techniques.
Topics: Cloud Computing; Computer Security; Confidentiality; Delivery of Health Care; Privacy
PubMed: 35712069
DOI: 10.1155/2022/8303504 -
Journal of the American Heart... May 2022Background Clinical prediction models have been developed for hospitalization for heart failure in type 2 diabetes. However, a systematic evaluation of these models'... (Meta-Analysis)
Meta-Analysis Review
Background Clinical prediction models have been developed for hospitalization for heart failure in type 2 diabetes. However, a systematic evaluation of these models' performance, applicability, and clinical impact is absent. Methods and Results We searched Embase, MEDLINE, Web of Science, Google Scholar, and Tufts' clinical prediction registry through February 2021. Studies needed to report the development, validation, clinical impact, or update of a prediction model for hospitalization for heart failure in type 2 diabetes with measures of model performance and sufficient information for clinical use. Model assessment was done with the Prediction Model Risk of Bias Assessment Tool, and meta-analyses of model discrimination were performed. We included 15 model development and 3 external validation studies with data from 999 167 people with type 2 diabetes. Of the 15 models, 6 had undergone external validation and only 1 had low concern for risk of bias and applicability (Risk Equations for Complications of Type 2 Diabetes). Seven models were presented in a clinically useful manner (eg, risk score, online calculator) and 2 models were classified as the most suitable for clinical use based on study design, external validity, and point-of-care usability. These were Risk Equations for Complications of Type 2 Diabetes (meta-analyzed c-statistic, 0.76) and the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (meta-analyzed c-statistic, 0.78), which was the simplest model with only 5 variables. No studies reported clinical impact. Conclusions Most prediction models for hospitalization for heart failure in patients with type 2 diabetes have potential concerns with risk of bias or applicability, and uncertain external validity and clinical impact. Future research is needed to address these knowledge gaps.
Topics: Diabetes Mellitus, Type 2; Heart Failure; Hospitalization; Humans; Models, Statistical; Prognosis
PubMed: 35574959
DOI: 10.1161/JAHA.121.024833 -
World Neurosurgery May 2022Classic randomized controlled trials (RCTs) form the cornerstone for medical guidelines and protocols. However, in neurosurgery, RCTs are not always applicable to...
BACKGROUND
Classic randomized controlled trials (RCTs) form the cornerstone for medical guidelines and protocols. However, in neurosurgery, RCTs are not always applicable to everyday clinical practice. Pragmatic controlled trials aim to incorporate real-life data with the preservation of the methodologic quality. This study is a systematic literature review of all pediatric neurosurgical RCTs published between 2000 and 2020 and an analysis of their pragmatism.
METHODS
An electronic database search was performed in PubMed, EMBASE, and the Cochrane Library to identify all relevant trials. Pragmatism was evaluated retrospectively on 9 domains: eligibility, recruitment, setting, organization, flexibility (delivery and adherence), follow-up, primary outcome, and primary analysis.
RESULTS
Of the 1862 studies included, 15 met the inclusion criteria. On average, studies scored between equally pragmatic/explanatory and rather pragmatic (M = 3.59, standard deviation [SD] = 0.56). Lowest ratings were seen for setting (M = 2.80, SD = 1.66) and eligibility (M = 3.20, SD = 1.66). Highest scores of pragmatism were given to analysis (M = 4.67, SD = 0.82) and intervention organization (M = 4.60, SD = 1.06). There was no significant difference between studies based on number of patients included, main subject, or publication year.
CONCLUSIONS
Pediatric neurosurgical RCTs scored reasonably well on overall pragmatism. In the future, there will be a greater need for pragmatic controlled trials in pediatric neurosurgery to bridge the divide between real-life data and reliable methodological quality. There is an opportunity to develop further applications of pragmatism tailored to surgical interventions.
Topics: Child; Databases, Factual; Humans; Neurosurgery; Neurosurgical Procedures; PubMed
PubMed: 35505562
DOI: 10.1016/j.wneu.2021.09.124