-
Journal of Physiotherapy Jun 2024In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related...
Interventions with a clear focus on achieving behaviour change are important for maintaining training-related gains in people with chronic obstructive pulmonary disease: a systematic review.
QUESTIONS
In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related gains, to what extent are these gains maintained 12 months after program completion? Do variables such as the application of behaviour change techniques moderate the maintenance of these training-related gains?
DESIGN
Systematic review, meta-analysis and meta-regression of randomised controlled trials.
PARTICIPANTS
People with stable COPD.
INTERVENTION
Trials were included if they applied ≥ 4 weeks of a whole-body ETP and reported outcome data immediately following program completion and 12 months after initial program completion. The control group received usual care that did not include a formal exercise training component.
OUTCOME MEASURES
Exercise tolerance, health-related quality of life and dyspnoea during activities of daily living.
DATA SOURCES
EMBASE, PEDro, PubMed and the Cochrane Library.
RESULTS
Nineteen randomised trials with 2,103 participants were found, of which 12 had a sufficiently similar design to be meta-analysed. At 12 months after ETP completion, compared with the control group, the experimental group demonstrated better exercise tolerance (SMD 0.48, 95% CI 0.19 to 0.77) and quality of life (SMD 0.22, 95% CI 0.03 to 0.41) with no clear effect on dyspnoea. Meta-regression using data from all 19 trials demonstrated that the magnitude of between-group differences at the 12-month follow-up was moderated by: behaviour change being a core aim of the strategies implemented following completion of the ETP; the experimental group receiving more behaviour change techniques during the program; and the magnitude of between-group change achieved from the program.
CONCLUSION
At 12 months after completion of an ETP of ≥ 4 weeks, small gains were maintained in exercise tolerance and health-related quality of life. Applying behaviour change techniques with a clear focus on participants integrating exercise into daily life beyond initial program completion is important to maintain training-related gains.
REGISTRATION
CRD42020193833.
PubMed: 38918084
DOI: 10.1016/j.jphys.2024.06.003 -
BMJ Open Ophthalmology Jun 2024Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Prompt diagnosis and treatment are crucial in ROP management. Thus, the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. Prompt diagnosis and treatment are crucial in ROP management. Thus, the identification of prominent risk factors could facilitate immediate action. Among various risk factors, the effects of mode of delivery on ROP remain unclear. Therefore, this study aims to assess the association between different modes of delivery on ROP incidence.
METHODS AND ANALYSIS
Comprehensive literature search was conducted on PubMed, ProQuest, EBSCOHost and Cochrane databases, to evaluate the association of mode of delivery-vaginal delivery or caesarean section (c-section)-and the incidence of ROP from inception to December 2023. Random-effects meta-analysis was performed to estimate the pooled OR along with their 95% CIs.
RESULTS
This review included 5 cohort studies involving 2048 babies. A higher incidence of ROP was observed in infants born through vaginal delivery compared with caesarean section. Meta-analysis showed that C-section decreased the unadjusted odds of having ROP infants by 46% with low heterogeneity (OR 0.54 (95% CI 0.40 to 0.73); I=40.73%). However, pooled adjusted effects were statistically insignificant with moderate heterogeneity (adjusted OR 0.59 (95% CI 0.28 to 1.23); I=70.51%), possibly stemming from multiple variations in the controlled variables of each study.
CONCLUSION
Despite varying statistical significance, our findings underscore the crucial need to comprehend the influence of delivery mode on neonatal ophthalmic outcomes. Due to a limited number of existing studies, further research is needed to confirm the association.
PROSPERO REGISTRATION NUMBER
CRD42023486278.
Topics: Humans; Retinopathy of Prematurity; Incidence; Infant, Newborn; Delivery, Obstetric; Female; Risk Factors; Pregnancy; Cesarean Section; Gestational Age
PubMed: 38918018
DOI: 10.1136/bmjophth-2024-001678 -
Sleep Medicine Jun 2024This systematic review and meta-analysis investigates the relationship between haemoglobin (Hb) concentrations and obstructive sleep apnea syndrome (OSAS).
BACKGROUND
This systematic review and meta-analysis investigates the relationship between haemoglobin (Hb) concentrations and obstructive sleep apnea syndrome (OSAS).
METHODS
Following PRISMA guidelines, we searched PubMed, EMBASE, and Cochrane Library from inception to March 8, 2024. Eligible studies included cross-sectional, cohort, and case-control designs comparing Hb concentrations in OSAS patients and healthy controls. Two reviewers independently screened records and extracted data. The risk of bias was assessed using the Joanna Briggs Institute checklist.
RESULTS
A total of 27 studies involving 6499 OSAS subjects and 5199 controls were included. Hb concentrations were significantly higher in OSAS patients compared to controls (SMD: 0.28; 95 % CI: 0.18 to 0.39; I = 84.4 %). Subgroup analysis by OSAS severity showed that severe OSAS patients had higher Hb concentrations than those with mild/moderate OSAS. Sensitivity analyses confirmed the robustness of the findings. However, 7 studies reported opposite results, indicating possible regional or methodological differences.
CONCLUSION
Hb concentrations are elevated in OSAS patients, with higher levels observed in severe cases. The significant heterogeneity and the predominance of studies from Turkey highlight the need for further research in diverse populations. Limitations include potential publication bias and variability in study designs.
PubMed: 38917721
DOI: 10.1016/j.sleep.2024.06.018 -
BMC Pulmonary Medicine Jun 2024The risk of asthma in patients with psoriasis has been identified in previous studies, but the bidirectional association between the two has not been fully explored. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The risk of asthma in patients with psoriasis has been identified in previous studies, but the bidirectional association between the two has not been fully explored.
METHODS
We thoroughly searched PubMed, Embase, and the Cochrane Library to find relevant observational studies published from the inception of these databases to October 2023. All the risk and bias assessments were analyzed by STATA 16.0. Where the heterogeneity was less than 50%, the fixed effect model was utilized. While where the level of heterogeneity was more than 50%, the random effect model was applied. Moreover, to identify publication bias, a visual funnel chart, and Egger's test were applied.
RESULTS
A total of 12,396,911 participants from 16 studies, published between 2011 and 2023 were included in this meta-analysis. We found that psoriasis patients had a higher risk of developing asthma (OR = 1.48, 95%CI 1.28-1.68). Meanwhile, asthma patients also had a higher overall risk of developing psoriasis (OR = 1.33, 95%CI 1.23-1.44). In the subgroup analysis, we found that the type of study, age, and severity of the psoriasis were significant factors in the survey of asthma risk in psoriasis patients.
CONCLUSIONS
In the present systematic review and meta-analysis, we found a bidirectional association between psoriasis and asthma with significantly increased risk. As a result, clinicians should make patients aware of the connection between the two, particularly adolescents or patients with moderate to severe psoriasis who need to be informed about the rising likelihood of developing asthma.
TRIAL REGISTRATION
Registration number CRD42023390111 .
Topics: Psoriasis; Humans; Asthma; Risk Factors
PubMed: 38914981
DOI: 10.1186/s12890-024-03078-7 -
Ageing Research Reviews Jun 2024Exergame-based training is currently considered a more promising training approach than conventional physical and/or cognitive training. (Review)
Review
BACKGROUND
Exergame-based training is currently considered a more promising training approach than conventional physical and/or cognitive training.
OBJECTIVES
This study aimed to provide quantitative evidence on dose-response relationships of specific exercise and training variables (training components) of exergame-based training on cognitive functioning in middle-aged to older adults (MOA).
METHODS
We conducted a systematic review with meta-analysis including randomized controlled trials comparing the effects of exergame-based training to inactive control interventions on cognitive performance in MOA.
RESULTS
The systematic literature search identified 22,928 records of which 31 studies were included. The effectiveness of exergame-based training was significantly moderated by the following training components: body position for global cognitive functioning, the type of motor-cognitive training, training location, and training administration for complex attention, and exercise intensity for executive functions.
CONCLUSION
The effectiveness of exergame-based training was moderated by several training components that have in common that they enhance the ecological validity of the training (e.g., stepping movements in a standing position). Therefore, it seems paramount that future research focuses on developing innovative novel exergame-based training concepts that incorporate these (and other) training components to enhance their ecological validity and transferability to clinical practice. We provide specific evidence-based recommendations for the application of our research findings in research and practical settings and identified and discussed several areas of interest for future research.
PROSPERO REGISTRATION NUMBER
CRD42023418593; prospectively registered, date of registration: 1 May 2023.
PubMed: 38914262
DOI: 10.1016/j.arr.2024.102385 -
Campbell Systematic Reviews Jun 2024Investment in mobile devices to support primary or elementary education is increasing and must be informed by robust evidence to demonstrate impact. This systematic... (Review)
Review
BACKGROUND
Investment in mobile devices to support primary or elementary education is increasing and must be informed by robust evidence to demonstrate impact. This systematic review of randomised controlled trials sought to identify the overall impact of mobile devices to support literacy and numeracy outcomes in mainstream primary classrooms.
OBJECTIVES
The aim of this systematic review was to understand how mobile devices are used in primary/elementary education around the world, and in particular, determine how activities undertaken using mobile devices in the primary classroom might impact literacy and numeracy attainment for the pupils involved. Within this context, mobile devices are defined as tablets (including iPads and other branded devices), smartphones (usually those with a touchscreen interface and internet connectivity) and handheld games consoles (again usually with touchscreen and internet-enabled). The interventions of interest were those aimed at improving literacy and/or numeracy for children aged 4-12 within the primary/elementary school (or equivalent) classroom.Specifically, the review aimed to answer the following research questions: -What is the effect of mobile device integration in the primary school classroom on children's literacy and numeracy outcomes?-Are there specific devices which are more effective in supporting literacy and numeracy? (Tablets, smartphones, or handheld games consoles)-Are there specific classroom integration activities which moderate effectiveness in supporting literacy and numeracy?-Are there specific groups of children for whom mobile devices are more effective in supporting literacy and numeracy? (Across age group and gender).-Do the benefits of mobile devices for learning last for any time beyond the study?-What is the quality of available evidence on the use of mobile devices in primary/elementary education, and where is further research needed in this regard? An Expert Advisory Group supported the review process at key stages to ensure relevance to current practice.
SEARCH METHODS
The search strategy was designed to retrieve both published and unpublished literature, and incorporated relevant journal and other databases with a focus on education and social sciences. Robust electronic database searches were undertaken (12 databases, including APA PsychInfo, Web of Science, ERIC, British Education Index and others, and relevant government and other websites), as well as a hand-search of relevant journals and conference proceedings. Contact was also made with prominent authors in the field to identify any ongoing or unpublished research. All searches and author contact took place between October and November 2020. The review team acknowledges that new studies will likely have emerged since and are not captured at this time. A further update to the review in the future is important and would build on the evidence reflected here.
SELECTION CRITERIA
The review included children within mainstream primary/elementary/kindergarten education settings in any country (aged 4-12), and interventions or activities initiated within the primary school classroom (or global equivalent) that used mobile devices (including tablets, smartphones, or hand-held gaming devices) to intentionally support literacy or numeracy learning. In terms of study design, only Randomised Controlled Trials were included in the review.
DATA COLLECTION AND ANALYSIS
A total of 668 references were identified through a robust search strategy including published and unpublished literature. Following duplicate screening, 18 relevant studies, including 11,126 participants, 14 unique interventions, and 46 relevant outcome measures were synthesised using Robust Variance Estimation and a random effects meta-analysis model. Risk of Bias assessment was undertaken by three reviewers using the ROB2 tool to assess the quality of studies, with 13 studies rated as having some concerns, and 5 as having high risk of bias. Qualitative data was also extracted and analysed in relation to the types of interventions included to allow a comparison of the key elements of each.
MAIN RESULTS
A positive, statistically significant combined effect was found (Cohen's = 0.24, CI 0.0707 to 0.409, < 0.01), demonstrating that in the studies and interventions included, children undertaking maths or literacy interventions using mobile devices achieved higher numeracy or literacy outcomes than those using an alternative device (e.g., a laptop or desktop computer) or no device (class activities as usual). However these results should be interpreted with caution given the risk of bias assessment noted above (5 studies rated high risk of bias and 13 rated as having some concerns). As the interventions and classroom circumstances differed quite widely, further research is needed to understand any potential impact more fully.Sensitivity analysis aimed to identify moderating factors including age or gender, screen size, frequency/dosage of intervention exposure, and programme implementation features/activities (based on Puentedura's [2009] SAMR model of technology integration). There were too few studies identified to support quantitative analysis of sufficient power to draw robust conclusions on moderating factors, and insufficient data to determine impact beyond immediate post-test period. Sensitivty analysis was also undertaken to exclude the five studies identified as having a high risk of bias, to identify any impact they may have on overall findings.
AUTHORS' CONCLUSIONS
Overall, this review demonstrates that for the specific interventions and studies included, mobile device use in the classroom led to a significant, positive effect on literacy and numeracy outcomes for the children involved, bringing positive implications for their continued use in primary education. However given the concerns on risk of bias assessment reported above, the differing circumstances, interventions and treatment conditions and intensities, the findings must be interpreted with caution. The review also supports the need for further robust research to better understand what works, under what circumstances, and for whom, in the use of mobile devices to support learning.
PubMed: 38911050
DOI: 10.1002/cl2.1417 -
International Journal of Mental Health... Jun 2024Depression among young people is a global health problem due to its rising prevalence and negative physical and social outcomes. The prevalence of depression and the... (Review)
Review
BACKGROUND
Depression among young people is a global health problem due to its rising prevalence and negative physical and social outcomes. The prevalence of depression and the treatment gap among young people in Sub-Saharan Africa (SSA) is higher than global estimates. Most psychosocial interventions for adolescent and youth depression were developed in high-income countries and less is known about their effectiveness in SSA. Due to contextual differences, findings from High-Income Countries (HICs) are less applicable to SSA. Yet, no systematic review of psychosocial interventions for depression among young people in SSA has been conducted.
METHODS
A systematic literature search of four databases (Medline, Web of Science, PsycInfo, and Cochrane library) was conducted. Experimental studies published before May 2024 that evaluated the effect of psychosocial interventions on depressive symptoms among young people (aged 10-24 years) in SSA were included in the systematic review. Effect sizes (Hedge's g (g)) indicating differences between intervention and control groups were calculated using a random effects model.
RESULTS
Twenty-two eligible studies were identified for the systematic review, of which eighteen randomized control trials (RCTs) involving 2338 participants were included in the meta-analysis. The findings revealed that psychosocial interventions significantly reduced depressive symptoms (g = -1.55, 95% CI -2.48, -0.63), although heterogeneity was high (I = 98.8%). Subgroup analysis revealed that efficacy differed significantly by intervention type, with Cognitive Behavioural Therapy (9 studies) showing the strongest effect (g = -2.84, 95% CI -4.29; -1.38). While Wise Interventions (a form of positive psychology interventions; 2 studies) had a moderate effect (g = -0.46, 95% C.I -0.53, -0.39), Interpersonal Psychotherapy (2 studies; g = -0.08, 95% CI -1.05, 0.88) and Creative Psychological Interventions (3 studies; g = -0.29, 95% CI -1.38, 0.79) showed smaller, non-significant effects. Sensitivity analysis excluding studies at high risk of bias strengthened the effect size. Few studies assessed factors affecting intervention efficacy and showed mixed effects of age, gender, and adherence levels.
CONCLUSION
Psychosocial interventions, particularly CBT, significantly reduced depressive symptoms among young people in SSA. However, it is crucial to acknowledge the high heterogeneity which likely stems from variations in study populations and intervention delivery modalities. This highlights the need for further research to identify the specific intervention components and delivery methods that work best for distinct subpopulations. Future research should also explore how long intervention effects are maintained and factors affecting efficacy.
PubMed: 38909254
DOI: 10.1186/s13033-024-00642-w -
Sleep Medicine Aug 2024Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Insomnia is highly prevalent in stroke patients; however, there is no ideal intervention. This systematic review examined the effect and safety of Chinese herbal medicine (CHM) and acupuncture on sleep in adults with stroke.
METHODS
Six databases were searched from inception to June 2023 to identify randomised controlled trials (RCTs). The primary outcome was Pittsburgh Sleep Quality Index (PSQI) scores. Risk of bias and evidence quality was assessed. A pairwise random-effect meta-analysis was performed.
RESULTS
A total of 54 RCTs published in 55 articles were finally included in the systematic review, including 35 of CHM and 19 of acupuncture therapies. Compared with placebo/sham procedure, CHM and acupuncture were more effective in improving PSQI scores. The evidence of moderate quality suggested that CHM outperformed benzodiazepine drugs (BZDs) while it presented an effect similar to that of non-BZDs in improving sleep quality. CHM and acupuncture also provided additional benefits to the patients treated with pharmacological agents alone. However, the evidence specific to individual CHM prescriptions lay in various factors and methodological quality, and the evidence on the comparative effectiveness between acupuncture and other therapies was conflicting or limited.
CONCLUSIONS
Overall, CHM and acupuncture used alone or in combination with pharmacotherapy can safely improve sleep in stroke patients with insomnia. In the future, RCTs on outstanding CHM prescriptions and the comparative effectiveness research between acupuncture and other therapies are needed.
REGISTRATION
PROSPERO No. CRD42020194029 and No. CRD42020194030.
Topics: Humans; Sleep Initiation and Maintenance Disorders; Acupuncture Therapy; Randomized Controlled Trials as Topic; Stroke; Drugs, Chinese Herbal
PubMed: 38905930
DOI: 10.1016/j.sleep.2024.05.006 -
Medicine Jun 2024Sepsis remains a leading cause of death worldwide. In this context, heparin-binding protein (HBP) has emerged as a possible biomarker, drawing significant attention for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Sepsis remains a leading cause of death worldwide. In this context, heparin-binding protein (HBP) has emerged as a possible biomarker, drawing significant attention for its diagnostic and prognostic usefulness in septic patients. Despite this advancement, the literature yields conflicting results. This study is intended to critically evaluate the diagnostic and prognostic value of HBP in critically ill septic patients.
METHODS
We searched multiple databases, including PubMed, SCOPUS, Web of Science, and EBSCO, to identify relevant studies on April 27, 2023. We included studies investigating sepsis or its severe outcomes that reported HBP levels and the required data to create 2 × 2 tables. We used R version 4.2.2 and R Studio to analyze the pooled diagnostic accuracy outcomes. The diagmeta package was utilized to calculate the optimum cutoff value.
RESULTS
In our meta-analysis, we incorporated 28 studies including 5508 patients. The analysis revealed that HBP has a sensitivity of 0.71 (95% CI: 0.60; 0.79) and a specificity of 0.68 (95% CI: 0.51; 0.81) in diagnosing sepsis, respectively. HBP demonstrated moderate prognostic accuracy for mortality at a cutoff value of 161.415 ng/mL, with a sensitivity and specificity of 72%, and for severe sepsis outcomes at a cutoff value of 58.907 ng/mL, with a sensitivity and specificity of 71%.
CONCLUSION
Our findings indicate a relatively moderate diagnostic and prognostic accuracy of HBP for sepsis. Future studies are required to verify the accuracy of HBP as a biomarker for sepsis.
Topics: Humans; Sepsis; Prognosis; Biomarkers; Blood Proteins; Antimicrobial Cationic Peptides; Sensitivity and Specificity; Critical Illness; Pore Forming Cytotoxic Proteins
PubMed: 38905400
DOI: 10.1097/MD.0000000000038525 -
International Ophthalmology Jun 2024This meta-analysis reviews the evidence for the risks and benefits associated with orthokeratology (OK) treatment compared with other methods of myopia control in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This meta-analysis reviews the evidence for the risks and benefits associated with orthokeratology (OK) treatment compared with other methods of myopia control in children and adults.
METHODS
A systematic search of Cochrane Central Register of Controlled Trials, Pubmed, Embase and Ovid was conducted from database inception to 22nd August 2021. Studies that reported on risks, visual and ocular biometric effects of OK in patients > 5 years of age with myopia (- 0.75 to - 6.00D) were included. Main outcomes are change in axial length and any adverse event.
RESULTS
Fourty-five papers were included in this systematic review and meta-analysis. The quality of data was variable and of moderate certainty, and selection bias likely skewed the results towards a relative benefit for OK. The rate of axial elongation in children was lower for OK treatment compared to other treatment modalities at one year (MD - 0.16 mm, 95% CI - 0.25 to - 0.07). Rate of change in axial length in children rebounded after OK discontinuation compared to participants who continued treatment (MD 0.10 mm, 95% CI 0.06 to 0.14). Adults and children wearing OK were up to 3.79 times more likely to experience an adverse event when compared with conventional contact lenses (OR 3.79, 95% CI 1.24 to ll.), though this evidence base is underdeveloped and requires additional well-designed studies for substantial conclusions to be drawn.
CONCLUSIONS
OK arrests myopia progression while in use, however, there remain unanswered questions about the optimal duration of treatment, discontinuation effects and long-term risk for adverse events.
Topics: Humans; Orthokeratologic Procedures; Myopia; Refraction, Ocular; Visual Acuity; Axial Length, Eye; Contact Lenses; Child; Risk Assessment
PubMed: 38904856
DOI: 10.1007/s10792-024-03175-w