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Ageing Research Reviews May 2021Engaging in physical activity (PA) and avoiding sedentary behavior (SB) are important for healthy ageing with benefits including the mitigation of disability and... (Meta-Analysis)
Meta-Analysis Review
The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: A systematic review and meta-analysis.
BACKGROUND
Engaging in physical activity (PA) and avoiding sedentary behavior (SB) are important for healthy ageing with benefits including the mitigation of disability and mortality. Whether benefits extend to key determinants of disability and mortality, namely muscle strength and muscle power, is unclear.
AIMS
This systematic review aimed to describe the association of objective measures of PA and SB with measures of skeletal muscle strength and muscle power in community-dwelling older adults.
METHODS
Six databases were searched from their inception to June 21, 2020 for articles reporting associations between objectively measured PA and SB and upper body or lower body muscle strength or muscle power in community dwelling adults aged 60 years and older. An overview of associations was visualized by effect direction heat maps, standardized effect sizes were estimated with albatross plots and summarized in box plots. Articles reporting adjusted standardized regression coefficients (β) were included in meta-analyses.
RESULTS
A total of 112 articles were included representing 43,796 individuals (range: 21 to 3726 per article) with a mean or median age from 61.0 to 88.0 years (mean 56.4 % female). Higher PA measures and lower SB were associated with better upper body muscle strength (hand grip strength), upper body muscle power (arm curl), lower body muscle strength, and lower body muscle power (chair stand test). Median standardized effect sizes were consistently larger for measures of PA and SB with lower compared to upper body muscle strength and muscle power. The meta-analyses of adjusted β coefficients confirmed the associations between total PA (TPA), moderate-to-vigorous PA (MVPA) and light PA (LPA) with hand grip strength (β = 0.041, β = 0.057, and β = 0.070, respectively, all p ≤ 0.001), and TPA and MVPA with chair stand test (β = 0.199 and β = 0.211, respectively, all p ≤ 0.001).
CONCLUSIONS
Higher PA and lower SB are associated with greater skeletal muscle strength and muscle power, particularly with the chair stand test.
Topics: Aged; Aged, 80 and over; Exercise; Female; Hand Strength; Humans; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Sedentary Behavior
PubMed: 33607291
DOI: 10.1016/j.arr.2021.101266 -
Asian Pacific Journal of Cancer... Apr 2018Background: Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective... (Review)
Review
Background: Cervical cancer is the second most common cancer in women worldwide; early detection can play a key role in reducing the associated morbidity. The objective of this study was to systematically assess the effects of educational interventions on cervical cancer screening (CCS) behavior of women. Methods: In this review the Cochrane library, Web of Science, Science Direct, PubMed, Scopus and search engine of Google scholar were searched for all interventional studies (trails, pre- and post-test or quasi-experimental) published in 2000-2017 for a systematic review, The search was based on the following keywords: cervix cancer, uterine cervical neoplasms, screening, prevention and control, Papanicolaou Test, pap test, pap smear, education, intervention, systematic review. Due to the heterogeneity of the data, a qualitative analysis was performed. Results: Thirty seven articles with 15,658 female participants in different parts of world were included in the review. About three quarters of the articles covered behavior change interventions. About one fourth of the articles were based on health education methods. The heath belief model is the most popular used framework for cervical cancer screening interventions. The results of our study showed that different health education methods (such as calls, mailed postcards, mother/daughter education. consultation sessions, picture books, videos, PowerPoint slides, small group discussions, educational brochures, radio broadcast education, lecture presentations, tailored counseling and a fact sheet, Self-learning package, face-to- face interviews and etc) are effective in modifying cervical cancer screening behavior of women. Conclusions: Our results showed that the different interventions and health behavior change frameworks provide an effective base for cervical cancer prevention. Heath providers can chose educational methods based on the particular client situations.
Topics: Early Detection of Cancer; Early Intervention, Educational; Female; Health Education; Humans; Uterine Cervical Neoplasms
PubMed: 29693331
DOI: 10.22034/APJCP.2018.19.4.875 -
Nicotine & Tobacco Research : Official... Jan 2017Many studies report a positive association between smoking and mental illness. However, the literature remains mixed regarding the direction of this association. We... (Review)
Review
BACKGROUND
Many studies report a positive association between smoking and mental illness. However, the literature remains mixed regarding the direction of this association. We therefore conducted a systematic review evaluating the association of smoking and depression and/or anxiety in longitudinal studies.
METHODS
Studies were identified by searching PubMed, Scopus, and Web of Science and were included if they: (1) used human participants, (2) were longitudinal, (3) reported primary data, (4) had smoking as an exposure and depression and/or anxiety as an outcome, or (5) had depression and/or anxiety as the exposure and smoking as an outcome.
RESULTS
Outcomes from 148 studies were categorized into: smoking onset, smoking status, smoking heaviness, tobacco dependence, and smoking trajectory. The results for each category varied substantially, with evidence for positive associations in both directions (smoking to later mental health and mental health to later smoking) as well as null findings. Overall, nearly half the studies reported that baseline depression/anxiety was associated with some type of later smoking behavior, while over a third found evidence that a smoking exposure was associated with later depression/anxiety. However, there were few studies directly supporting a bidirectional model of smoking and anxiety, and very few studies reporting null results.
CONCLUSIONS
The literature on the prospective association between smoking and depression and anxiety is inconsistent in terms of the direction of association most strongly supported. This suggests the need for future studies that employ different methodologies, such as Mendelian randomization (MR), which will allow us to draw stronger causal inferences.
IMPLICATIONS
We systematically reviewed longitudinal studies on the association of different aspects of smoking behavior with depression and anxiety. The results varied considerably, with evidence for smoking both associated with subsequent depression and anxiety, and vice versa. Few studies supported a bidirectional relationship, or reported null results, and no clear patterns by gender, ethnicity, clinical status, length to follow-up, or diagnostic test. Suggesting that despite advantages of longitudinal studies, they cannot alone provide strong evidence of causality. Therefore, future studies investigating this association should employ different methods allowing for stronger causal inferences to be made, such as MR.
Topics: Anxiety; Anxiety Disorders; Depression; Depressive Disorder; Humans; Prospective Studies; Sex Characteristics; Smoking; Tobacco Use Disorder
PubMed: 27199385
DOI: 10.1093/ntr/ntw140 -
The American Journal of Psychiatry Mar 2017Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors... (Review)
Review
OBJECTIVE
Research and clinical translation in schizophrenia is limited by inconsistent definitions of treatment resistance and response. To address this issue, the authors evaluated current approaches and then developed consensus criteria and guidelines.
METHOD
A systematic review of randomized antipsychotic clinical trials in treatment-resistant schizophrenia was performed, and definitions of treatment resistance were extracted. Subsequently, consensus operationalized criteria were developed through 1) a multiphase, mixed methods approach, 2) identification of key criteria via an online survey, and 3) meetings to achieve consensus.
RESULTS
Of 2,808 studies identified, 42 met inclusion criteria. Of these, 21 studies (50%) did not provide operationalized criteria. In the remaining studies, criteria varied considerably, particularly regarding symptom severity, prior treatment duration, and antipsychotic dosage thresholds; only two studies (5%) utilized the same criteria. The consensus group identified minimum and optimal criteria, employing the following principles: 1) current symptoms of a minimum duration and severity determined by a standardized rating scale; 2) moderate or worse functional impairment; 3) prior treatment consisting of at least two different antipsychotic trials, each for a minimum duration and dosage; 4) systematic monitoring of adherence and meeting of minimum adherence criteria; 5) ideally at least one prospective treatment trial; and 6) criteria that clearly separate responsive from treatment-resistant patients.
CONCLUSIONS
There is considerable variation in current approaches to defining treatment resistance in schizophrenia. The authors present consensus guidelines that operationalize criteria for determining and reporting treatment resistance, adequate treatment, and treatment response, providing a benchmark for research and clinical translation.
Topics: Antipsychotic Agents; Brief Psychiatric Rating Scale; Drug Resistance; Humans; Practice Guidelines as Topic; Psychometrics; Randomized Controlled Trials as Topic; Schizophrenia; Schizophrenic Psychology
PubMed: 27919182
DOI: 10.1176/appi.ajp.2016.16050503 -
Reproductive Health Nov 2018Adolescence is the period between 10 and 19 years with peculiar physical, social, psychological and reproductive health characteristics. Rates of adolescent pregnancy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adolescence is the period between 10 and 19 years with peculiar physical, social, psychological and reproductive health characteristics. Rates of adolescent pregnancy are increasing in developing countries, with higher occurrences of adverse maternal and perinatal outcomes. The few studies conducted on adolescent pregnancy in Africa present inconsistent and inconclusive findings on the distribution of the problems. Also, there was no meta-analysis study conducted in this area in Africa. Therefore, this systematic review and meta-analysis were conducted to estimate the prevalence and sociodemographic determinant factors of adolescent pregnancy using the available published and unpublished studies carried out in African countries. Also, subgroup analysis was conducted by different demographic, geopolitical and administrative regions.
METHODS
This study used a systematic review and meta-analysis of published and unpublished studies in Africa. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed. All studies in MEDLINE, PubMed, Cochrane Library, EMBASE, Google Scholar, CINAHL, and African Journals Online databases were searched using relevant search terms. Data were extracted using the Joanna Briggs Institute tool for prevalence studies. STATA 14 software was used to perform the meta-analysis. The heterogeneity and publication bias was assessed using the I statistics and Egger's test, respectively. Forest plots were used to present the pooled prevalence and odds ratio (OR) with 95% confidence interval (CI) of meta-analysis using the random effect model.
RESULT
This review included 52 studies, 254,350 study participants. A total of 24 countries from East, West, Central, North and Southern African sub-regions were included. The overall pooled prevalence of adolescent pregnancy in Africa was 18.8% (95%CI: 16.7, 20.9) and 19.3% (95%CI, 16.9, 21.6) in the Sub-Saharan African region. The prevalence was highest in East Africa (21.5%) and lowest in Northern Africa (9.2%). Factors associated with adolescent pregnancy include rural residence (OR: 2.04), ever married (OR: 20.67), not attending school (OR: 2.49), no maternal education (OR: 1.88), no father's education (OR: 1.65), and lack of parent to adolescent communication on sexual and reproductive health (SRH) issues (OR: 2.88).
CONCLUSIONS
Overall, nearly one-fifth of adolescents become pregnant in Africa. Several sociodemographic factors like residence, marital status, educational status of adolescents, their mother's and father's, and parent to adolescent SRH communication were associated with adolescent pregnancy. Interventions that target these factors are important in reducing adolescent pregnancy.
Topics: Adolescent; Africa; Female; Health Risk Behaviors; Humans; Peer Influence; Pregnancy; Pregnancy in Adolescence; Prevalence; Sexual Behavior
PubMed: 30497509
DOI: 10.1186/s12978-018-0640-2 -
The Kaohsiung Journal of Medical... Mar 2018Interprofessional education (IPE) emphasizes collaborative practice that aims at promoting the working relationships between two or more healthcare professions. However,... (Meta-Analysis)
Meta-Analysis Review
Interprofessional education (IPE) emphasizes collaborative practice that aims at promoting the working relationships between two or more healthcare professions. However, there is paucity of literature about the effectiveness of IPE program in the healthcare. This systematic review and meta-analysis aims to objectively determine the effectiveness of IPE in that field in terms of the improvement of students' knowledge, skills and attitudes. The databases of OVID, ISI Knowledge of Science, and Medline (PubMed) were searched for the full-text English language articles published during 2000-2016 using the MeSH terms "interprofessional education" AND "healthcare professionals" AND "multi-professional" AND "impact" AND "effectiveness" OR "collaborative practice" OR "medical students" in Endnote X7. A systematic search finally selected 12 articles for detailed review and meta-analysis. The effect summary value of 1.37 with confidence interval of 0.92-1.82 identifies statistically significant effectiveness of intervention by IPE program in healthcare. The Z test value of 5.99, significant at 5% level of significance, also shows a significant impact of IPE intervention as calculated by the random-effects model. This meta-analysis shows a positive impact and effectiveness of educational intervention by IPE program in various disciplines of healthcare. However, analysis of further clinical trials may be helpful in identifying the effect of IPE program on the students' clinical competence.
Topics: Attitude of Health Personnel; Clinical Competence; Cooperative Behavior; Education, Public Health Professional; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Interprofessional Relations
PubMed: 29475463
DOI: 10.1016/j.kjms.2017.12.009 -
American Journal of Public Health Dec 2015In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health... (Review)
Review
BACKGROUND
In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.
OBJECTIVES
We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals' implicit attitudes about racial/ethnic groups and health care outcomes.
SEARCH METHODS
To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique.
SELECTION CRITERIA
We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English.
DATA COLLECTION AND ANALYSIS
We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings.
MAIN RESULTS
Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudes were more often significantly related to patient-provider interactions and health outcomes than treatment processes.
CONCLUSIONS
Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicit bias may contribute to health disparities for people of color.
Topics: Attitude of Health Personnel; Health Personnel; Healthcare Disparities; Humans; Racism; Treatment Outcome
PubMed: 26469668
DOI: 10.2105/AJPH.2015.302903 -
Frontiers in Aging Neuroscience 2023We performed a systematic review and meta-analysis of the cognitive effectiveness and safety of lecanemab on subjects with Alzheimer's disease (AD).
OBJECTIVE
We performed a systematic review and meta-analysis of the cognitive effectiveness and safety of lecanemab on subjects with Alzheimer's disease (AD).
METHODS
We screened the literature published before February 2023 in PubMed, Embase, Web of Science, and Cochrane that were searched for randomized controlled trials testing lecanemab for the treatment of cognitive decline in patients with MCI or AD. Outcomes measured were CDR Sum of Boxes (CDR-SB), Alzheimer's Disease Composite Score (ADCOMS), AD Assessment Scale-Cognitive Subscale (ADAS-Cog), Clinical Dementia Rating (CDR), amyloid PET Standardized Uptake Volume Ratio (SUVr), amyloid burden on PET, and risks for adverse events.
RESULTS
A total of four randomized controlled trials were included, involving 3,108 AD patients (1,695 lecanemab groups and 1,413 placebo groups) to synthesize evidence. Baseline characteristics of the two groups were similar in all outcomes except that ApoE 4 status and higher MMSE score were observed in the lecanemab group. It is reported that lecanemab was beneficial to stabilize or slow down the decrease in CDR-SB (WMD: -0.45; 95% CI: -0.64, -0.25; < 0.00001), ADCOMS (WMD: -0.05; 95% CI: -0.07, -0.03; < 0.00001), ADAS-cog (WMD: -1.11; 95% CI: -1.64, -0.57; < 0.0001), amyloid PET SUVr (WMD: -0.15; 95% CI: -0.48, 0.19; = 0.38), amyloid burden on PET (WMD:-35.44; 95% CI: -65.22,-5.67; = 0.02), adverse events (subjects with any TEAE) (OR: 0.73; 95% CI: 0.25, 2.15; = 0.57), ARIA-E (OR:8.95; 95% CI: 5.36, 14.95; < 0.00001), and ARIA-H (OR:2.00; 95% CI: 1.53, 2.62; < 0.00001) in early AD patients.
CONCLUSION
Our analysis found that lecanemab showed significant positive statistical efficacy with respect to cognition, function, and behavior in patients with early AD though the actual clinical significance is yet to be established.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier: CRD42023393393.
PubMed: 37213538
DOI: 10.3389/fnagi.2023.1169499 -
Physical Therapy Jan 2020Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior,...
Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.
Topics: Algorithms; Blood Pressure Determination; Exercise; Exercise Test; Heart Rate; Humans; Ischemic Attack, Transient; Meta-Analysis as Topic; Physical Exertion; Program Development; Randomized Controlled Trials as Topic; Stroke Rehabilitation
PubMed: 31596465
DOI: 10.1093/ptj/pzz153 -
JMIR MHealth and UHealth Dec 2022Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of mHealth Interventions in the Control of Lifestyle and Cardiovascular Risk Factors in Patients After a Coronary Event: Systematic Review and Meta-analysis.
BACKGROUND
Coronary artery disease is the main cause of death and loss of disability-adjusted life years worldwide. Information and communication technology has become an important part of health care systems, including the innovative cardiac rehabilitation services through mobile phone and mobile health (mHealth) interventions.
OBJECTIVE
In this study, we aimed to determine the effectiveness of different kinds of mHealth programs in changing lifestyle behavior, promoting adherence to treatment, and controlling modifiable cardiovascular risk factors and psychosocial outcomes in patients who have experienced a coronary event.
METHODS
A systematic review of the literature was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A thorough search of the following biomedical databases was conducted: PubMed, Embase, Web of Science, SciELO, CINAHL, Scopus, The Clinical Trial, and Cochrane. Articles that were randomized clinical trials that involved an intervention consisting of an mHealth program using a mobile app in patients after a coronary event were included. The articles analyzed some of the following variables as outcome variables: changes in lifestyle behavior, cardiovascular risk factors, and anthropometric and psychosocial variables. A meta-analysis of the variables studied was performed with the Cochrane tool. The risk of bias was assessed using the Cochrane Collaboration tool; the quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation tool; and heterogeneity was measured using the I test.
RESULTS
A total of 23 articles were included in the review, and 20 (87%) were included in the meta-analysis, with a total sample size of 4535 patients. Exercise capacity measured using the 6-minute walk test (mean difference=21.64, 95% CI 12.72-30.55; P<.001), physical activity (standardized mean difference [SMD]=0.42, 95% CI 0.04-0.81; P=.03), and adherence to treatment (risk difference=0.19, 95% CI 0.11-0.28; P<.001) were significantly superior in the mHealth group. Furthermore, both the physical and mental dimensions of quality of life were better in the mHealth group (SMD=0.26, 95% CI 0.09-0.44; P=.004 and SMD=0.27, 95% CI 0.06-0.47; P=.01, respectively). In addition, hospital readmissions for all causes and cardiovascular causes were statistically higher in the control group than in the mHealth group (SMD=-0.03, 95% CI -0.05 to -0.00; P=.04 vs SMD=-0.04, 95% CI -0.07 to -0.00; P=.05).
CONCLUSIONS
mHealth technology has a positive effect on patients who have experienced a coronary event in terms of their exercise capacity, physical activity, adherence to medication, and physical and mental quality of life, as well as readmissions for all causes and cardiovascular causes.
TRIAL REGISTRATION
PROSPERO (International Prospective Register of Systematic Reviews) CRD42022299931; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299931.
Topics: Humans; Quality of Life; Cardiovascular Diseases; Risk Factors; Heart Disease Risk Factors; Life Style; Telemedicine; Randomized Controlled Trials as Topic
PubMed: 36459396
DOI: 10.2196/39593