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Cumulative Meta-Analysis. Introduction to Meta Analysis
... The meta-analysis method is a method that can be used to estimate the effect size of the relationship. both variables (Borenstein, 2009). Therefore, it is necessary to do a meta-analysis method in this study. ...
... Meanwhile, in the random-effect model, the value of actual effect size is assumed to vary in each study (Borenstein, 2009). Researchers expect that there are indeed differences inaccurate effect sizes in each study, and this encourages researchers to use a random-effect model approach in this study. ...
... This model is more appropriate to be carried out in social research involving various methodologies. In addition, the results of hypothesis testing in this model tend to be unconditional and can be generalized to a large population (Borenstein, 2009). ...
Psychological well-being is variable that's considered suitable to discuss happiness because psychological well-being belongs to the realm of positive psychology that requires the development of positive emotions to ensure individuals have optimal functions and experiences. This study aims to deeply understand the psychological capital and psychological well-being relationships by conducting meta-analysis testing. Data collection in this study followed the Preferred Reporting for Systematic Reviews and Meta-Analysis (PRISMA). The sources or databases of research articles used are Proquest, Psycnet, Emerald, and Google Scholar. The search is carried out from April to May 2021. These results showed the relationship between psychological capital and psychological well-being variables in the moderate and firm positive categories. The effect size included in the moderate and significant positive groups through the analysis process. When viewing the dimensional relationship on both variables, the dimension of self-acceptance in psychological well-being has the strongest relationship with the psychological capital variable. To consider the existence of moderation or intervening variables that affect the relationship of the two variables. Meanwhile, for organization management, the need to pay attention to the psychological capital variables of employees that can be a predictor for their psychological well-being to produce optimal productivity and performance results.
... We carried out our meta-analysis in line with the recommendations made by Borenstein, Hedges, Higgins, and Rothstein (2009). First, because the studies in our corpus reported effect sizes in a variety of ways, including t tests (Stone et al., 1994), chi-square tests (Fointiat, 2008), and F tests (Morrongiello & Mark, 2008), we used Arthur, Bennett, and Huffcutt's (2001) formulae to transform all reported effect sizes into correlation coefficient, r. ...
... Second, we used a random-effects model (for analyses without moderators) and a mixed-effects model (for analyses including moderators) to take into account the wide range of studies (country, type of participant, type of behavior, and implementation procedure). We used Comprehensive Meta-Analysis 3 software to estimate these models (Borenstein et al., 2009) and completed our analyses by using the Metafor package in R (Viechtbauer, 2010). ...
... Finally, we used the regression method described by Borenstein et al. (2009) to test the impact of potential moderators on the effect sizes. At least three studies in each condition were needed to run the categorical-moderator analyses. ...
Induced hypocrisy is a sequential, two-step, cognitive dissonance procedure that prompts individuals to adopt a proattitudinal behavior. The present meta-analysis of 29 published and nine unpublished induced-hypocrisy studies enabled us to test three key dissonance-related issues. First, is hypocrisy effective in promoting change in behavioral intention and behavior? Our analyses supported the idea that hypocrisy (vs. control) increased both behavioral intention and behavior. Second, does hypocrisy generate psychological discomfort? Results pertaining to this issue were inconclusive due to the small number of studies measuring psychological discomfort. Third, are both steps necessary to generate change? Effect sizes conform to the idea that the transgressions-only condition can increase both behavior and intention. Our meta-analysis raises a number of theoretical issues concerning the psychological processes underlying induced hypocrisy and highlights implications for practitioners.
... Several studies included more than one measure of health. For some studies in the meta-analysis, a composite effect was calculated, and for others, the main effect was retained (Borenstein, Hedges, Higgins, & Rothstein, 2009). As each of the measures in the included studies focused on resilience as an outcome, the results of this meta-analysis focus on resilience as a physical health outcome. ...
... Finally, one study did not report enough information to calculate either a d-or r-family effect (Nuru-Jeter, Sarsour, Jutte, & Boyce, 2010) and was excluded from the meta-analysis, but included in the review. To facilitate an overall comparison of effects across studies, OR, RR, and d-family effects were converted to r-family effects (Borenstein et al., 2009). Meta-Analytic Strategy First, two overall Pearson r family effect sizes were conducted: one effect size for protective factors and one for risk factors. ...
... suggesting variance in effect sizes across studies. A meta-regression explored possible moderators (i.e., study-level variables used to explain potential differences in effect sizes across studies; (Borenstein et al., 2009; Hunter & Schmidt, 2004), but the test of moderators was not significant, Q bet (2) = 5.19, p = .075, which suggests residual heterogeneity beyond the type of health measure and environmental level of the protective factors, Q within (3) = 69.04, ...
Eligibility criteria:
Articles were selected for review if they (1) had a variable that was in some way a measure of physical health in response to a psychosocial stressor; (2) had participants who were children or adolescents within the age range of 4-18years; and (3) were a peer-reviewed, empirical study.
Sample:
Two random-effect meta-analyses were conducted with a sample of 12,772 participants across 14 studies to determine the influence of protective and vulnerability factors on children's physical health in adverse experiences.
Results:
Protective factors had a moderate effect and vulnerability factors had a small-moderate effect on health measures across domains of physiological, sleep behavior, and overall health. The type of health measure moderated the effect size for vulnerability factors, but not for protective factors.
Conclusions:
These findings suggest that protective factors may be associated with an environment that encourages children to thrive, as apparent by their physical health.
Implications:
The results of this review and meta-analysis can be used to guide the methodological design of future studies on childhood resilience and to inform clinical practice with children and adolescents.
... The review also facilitates theory development, closes areas where a plethora of research exists, and uncovers areas where research is needed (Webster & Watson, 2002). In spite of occasional criticism against it (Borenstein, Hedges, Higgins, & Rothstein, 2009), some researchers consider that a meta-analysis is even better than a literature review (Schmidt & Hunter, 2014), and we therefore included it in our work. Combining it with a weight analyses provides one of the most profound analysis available (Rana, Dwivedi, & Williams, 2015). ...
... The biggest Z values identified in our study were: (i) considering the positive values, performance expectancy on intention (35.597), attitude on intention (34.746), and effort expectancy on performance expectancy (31.456), and (ii) considering the negative values, perceived risk on intention (À7.650). In terms of confidence intervals all the statistically significant relationships have narrow ranges (i.e., falling in the 95% interval) (Rana et al., 2015 ), in what can be considered as a modest dispersion of values (Borenstein et al., 2009), supporting the consistency and confidence of the average of cumulative correlation values presented across the range of studies included. ...
... Third, while the meta-analysis mathematically synthetize the studies included in the analysis, if these studies are a biased sample of all the mobile banking acceptance studies, then the mean effect reported by the meta-analysis study also reflects this bias. Fourth, and last, while meta-analysis is widely embraced by many in the research community, there are some authors who advise against it (Borenstein et al., 2009), with arguments that could also have been considered. Facilitating conditions on attitude, task technology fit on performance expectancy, and performance expectancy on initial trust could be added to the list of most important predictors, but they still further research. ...
... In harmony with meta-analytic recommendations, we synthesized and analyzed our set of common studies. This procedure involved (a) describing relevant characteristics of studies as well as comparison groups, (b) calculating standardized mean difference effect sizes for each comparison, (c) determining an overall effect size, and (d) identifying potential moderator variables [14][15][16][17] . Once potential moderator variables were identified , additional meta-analyses were conducted to measure the contributions of subgroups to effect sizes [18][19][20]. ...
... Further, Table 2displays relative weight values for each DBS study. Borenstein et al. [14] and Cumming [21] define relative weight as the inverse of variance of the effect size for individual studies [14, 21]. Sample size may affect the proportion of individual weight relative to the sum of weights for all studies. ...
... Further, Table 2displays relative weight values for each DBS study. Borenstein et al. [14] and Cumming [21] define relative weight as the inverse of variance of the effect size for individual studies [14, 21]. Sample size may affect the proportion of individual weight relative to the sum of weights for all studies. ...
In Parkinson's disease (PD), slow gait speed is significantly related to clinical ratings of disease severity, impaired performance of daily activities, as well as increased overall disability. Conducting a meta-analysis on gait speed is an objective and quantitative technique to summarize the effectiveness of DBS and to determine the effect sizes for future studies. We conducted a systematic review and meta-analysis that analyzed the effects of deep brain stimulation (DBS) surgery on gait speed in patients with PD to gain fundamental insight into the nature of therapeutic effectiveness. A random effects model meta-analysis on 27 studies revealed a significant overall standardized mean difference medium effect size equal to 0.60 (SE = 0.06; p < 0.0001; Z = 10.58). Based on our synthesis of the 27 studies, we determined the following: (1) a significant and medium effect size indicating DBS improves gait speed; (2) DBS improved gait speed regardless of whether the patients were tested in the on or off medication state; (3) both bilateral and unilateral DBS led to gait speed improvement; (4) the effects of DBS on gait speed in the data collection sessions after surgery (DBS on vs. off) were comparable with data collection before surgery (before surgery vs. DBS after surgery); and (5) when evaluating the effects of DBS and medication on gait speed suprathreshold doses were comparable to normal dosages of medication and DBS. The current analysis provides objective evidence that both unilateral and bilateral DBS provide a therapeutic benefit on gait speed in persons with PD.
... Pooled effect size estimates of the associations examined were calculated using sample size, the correlation coefficient(s) or standardized beta coefficient(s). A random-effects model was chosen because it was assumed that each population of the studies included would reflect a different effect size due to the existence of heterogeneity in the general characteristics of the samples (e.g., sample size, gender, age and population context) [36] . The proportion of variation in the pooled estimates caused by heterogeneity was calculated with I² index. ...
... We used the X2 test to assess differences in subgroup analyses. Finally, publication bias was checked with Egger's test and by visual inspection of the funnel plots [36]. In the presence of publication bias, the adjustment of the pooled estimates was done by using the trim and fill test [37]. ...
Developmental regulation theories claim that continuing to pursue a goal when it becomes blocked contributes to poorer wellbeing. This consequence is expected to lead to the use of self-regulation strategies in the form of higher disengagement from the goal and higher reengagement in other meaningful goals. The use of these strategies is expected to lead to better wellbeing. A systematic-review and meta-analyses were conducted to test the major predictions of developmental regulation theories for blocked parenthood goal and to investigate possible moderator variables, particularly type and degree of blockage. A total of eight meta-analyses were performed using random-effects models. Moderation was tested with subgroup analysis. After searching eight databases, 4977 potential relevant manuscripts were identified but only six met inclusion criteria. From the eight meta-analyses conducted, only two were significant. In line with prediction, higher goal blockage was related to higher negative mood and reengagement in other life goals was associated to higher positive mood (p < .001). From a total of eight subgroup analyses performed, results showed that disengaging had a positive impact on wellbeing for people experiencing an unanticipated type of blockage (i.e., infertility) but not for those with an anticipated one (i.e., postponing parenthood; X2 = 4.867, p = .03). From the total of twelve sensitivity analyses performed only one suggested that results might differ. The association between disengagement and mood varied according to study quality. When only average studies were included this association was negative, although non-significant. The evidence obtained did not fully support developmental regulation theories for the pursuit of parenthood goal, but primary research had too many methodological limitations to reach firm conclusions. Future studies aimed at investigating blocked parenthood goal are required to evaluate the value of developmental regulation theories.
... Cumulative meta-analysis describes a process in which researchers iteratively meta-analyze all studies in a given sample. In this process, the researcher would begin by meta-analyzing the first study in the sample, then meta-analyzing the first two studies, and so on until all the studies have been included in the meta-analysis (Borenstein, Hedges, Higgins, & Rothstein, 2009;Kepes et al., 2014). Cumulative meta-analysis provides a useful tool when researchers wish to examine changes in meta-analytic results as a function of changes in a given study characteristic. ...
Meta-analyses provide educational stakeholders with data from which to make instructional, programmatic, and policy decisions. Potentially biased meta-analytic results could, therefore, have negative impacts on students, teachers, and schools. In this article, we argue for why assessing for publication bias matters in educational psychology meta-analyses, explore the prevalence of publication bias assessment in a top-tier educational psychology journal, describe assumptions and implications of common publication bias methods, and provide a worked example using data from a published meta-analysis. We conclude the article with recommendations on how to interpret the results of various publication bias assessments in conjunction with one another and in the context of the meta-analysis itself.
... Uji heterogenitas menggunakan uji Cochran Q menunjukan bahwa effect size penelitian yang dikumpulkan bersifat heterogen sehingga model penggabungan yang dipilih dalam meta analysis adalah random effect model. Adapun penelitian yang memenuhi kriteria dan perhitungan summary effect dapat dilihat pada tabel 1. Borenstein et al, 2009). dan I 2 (I Square). ...
Biostatistics research is currently been developed by health experts to examine a variety of health problems. One method of biostatistics research that is still rarely conducted by researchers is the kind of research literature reviews one meta-analysis. This study aimed to apply the methods of meta-analysis on birth weight as risk factor for perinatal mortality by summarizing the results of research into a variety of more accurate conclusions. This research included of unobtrusive research. Researchers did not make direct contact with the respondent. The independent variables used were birth weight and perinatal mortality is a dependent variable. Data analysis was performed with the help of software Comprehensive Meta analysis with a confidence level of α = 5%. Based on the results of analysis showed that the odds ratios obtained value is 14.018 with a p-value of 0.000. Proving that birth weight was risk factor of perinatal mortality. Keyword : perinatal mortality, meta analysis ABSTRAK Penelitian biostatistika saat ini banyak dikembangkan oleh para ahli kesehatan untuk meneliti berbagai permasalahan kesehatan. Salah satu metode penelitian biostatistik yang masih jarang dilakukan oleh peneliti adalah penelitian jenis review literature salah satunya meta analysis. Penelitian ini bertujuan untuk mengaplikasikan metode meta analysis pada berat badan bayi lahir sebagai faktor risiko kematian perinatal dengan merangkum hasil penelitian yang beragam menjadi sebuah kesimpulan yang lebih akurat. Penelitian ini termasuk dalam jenis penelitian unobtrusive. Peneliti tidak melakukan kontak langsung dengan responden. Variabel bebas yang digunakan adalah berat badan bayi lahir dan variabel tergantungnya adalah kematian perinatal. Analisis data dilakukan dengan bantuan software Comprehensive Meta analysis dengan tingkat kepercayaan α = 5%. Berdasarkan hasil analisis diketahui bahwa nilai odds ratio yang diperoleh adalah 14,018 dengan nilai p 0,000. Membuktikan bahwa berat badan bayi lahir merupakan faktor risiko kematian perinatal. Kata kunci : kematian perinatal, meta analysis PENDAHULUAN Metode penelitian berkembang pesat dari tahun ke tahun. Penelitian biostatistik saat ini sedang banyak dikembangkan diberbagai bidang ilmu salah satunya dalam bidang ilmu kesehatan. Salah satu metode penelitian yang masih jarang dilakukan oleh peneliti adalah penelitian review literature. Penelitian review atau dikenal dengan penelitian sintesis merupakan penelitian yang menggabungkan hasil studi yang sudah ada dan menganalisanya kemudian mengambil suatu kesimpulan umum dari analisa yang telah dilakukan. Penelitian sintesis memiliki beberapa jenis mulai dari metode yang tergolong kualitatif yaitu narrative review dan descriptive review hingga metode yang tergolong kuantitatif yatiu vote counting dan meta analysis (King dan Jun He, 2005). Meta analysis berkembang pada tahun 1970-an dan mulai dikenan sebagai bagian
... As the studies included in the meta-analysis were functionally nonidentical, that is, factors possibly affecting the outcome differed across the studies, a random model was chosen as the mode of meta-analysis. I 2 , Cochran Q, Tau 2 and the approximated range of effects based on Tau 2 were calculated to quantify heterogeneity in the meta-analysis (Borenstein et al., 2009; Higgins, 2008; Higgins et al., 2003). ...
Causality of the relationship between the objective quality outcomes of care and patient satisfaction has been questioned in many studies. Consequently, it is highly important to study potential confounders in order to improve reliability and validity of patient satisfaction surveys and enable comparisons between objective and subjective outcomes. This study aimed to test the effect of item-level response rate on the results of patient satisfaction surveys and its interaction with another potential confounding factor, patient age. The data included 39 surveys with balanced Likert-scale items. The surveys were systematically gathered from PubMed and had been published 2005–2014. The relationship between the item-level patient satisfaction and item-level response rate was almost without exception positive when the overall patient satisfaction was >4.2 on a traditional 1–5 scale and patients were middle-aged or older. The meta-analysis demonstrated that the relationship between item-level patient satisfaction and item-level response rate is situational, and generalisations regarding the size of the correlation should be made with caution. Controlling for item-level response rate and patient age, simultaneously, is necessary to improve validity of patient satisfaction surveys. The present study calls for novel age-specific approaches to deal with missing data.
... The impact of quality of studies (NOS) on meta-analytical estimates was assessed using meta-regression analyses with the ''metareg'' [42] function of Stata. The meta-regressions were conducted when at least 10 studies were available for each risk factor [43]. In the case of significant meta-analytical findings not affected by publication biases, sensitivity analyses were additionally conducted to investigate the robustness of the results. ...
Background:
Subjects at ultra high-risk (UHR) for psychosis have an enhanced vulnerability to develop the disorder but the risk factors accounting for this accrued risk are undetermined.
Method:
Systematic review of associations between genetic or environmental risk factors for psychosis that are widely established in the literature and UHR state, based on comparisons to controls.
Results:
Forty-four studies encompassing 170 independent datasets and 54 risk factors were included. There were no studies on association between genetic or epigenetic risk factors and the UHR state that met the inclusion criteria. UHR subjects were more likely to show obstetric complications, tobacco use, physical inactivity, childhood trauma/emotional abuse/physical neglect, high perceived stress, childhood and adolescent low functioning, affective comorbidities, male gender, single status, unemployment and low educational level as compared to controls.
Conclusions:
The increased vulnerability of UHR subjects can be related to environmental risk factors like childhood trauma, adverse life events and affective dysfunction. The role of genetic and epigenetic risk factors awaits clarification.
... By contrast, the synthetic effect size dataset (n = 67) was derived by pooling multiple effect sizes corresponding to different taxa from a single study. Pooling multiple effect sizes within a single study reduces the effective sample size and decreases the weight of correlated and extreme estimates of effect size, thereby leading to more statistically conservative results [35, 36]. As results were qualitatively similar using both datasets, we here report only the complete dataset analysis (see S1 Text for statistical methods and results for the synthetic effect size dataset). ...
... By contrast, the synthetic effect size dataset (n = 67) was derived by pooling multiple effect sizes corresponding to different taxa from a single study. Pooling multiple effect sizes within a single study reduces the effective sample size and decreases the weight of correlated and extreme estimates of effect size, thereby leading to more statistically conservative results [35, 36]. As results were qualitatively similar using both datasets, we here report only the complete dataset analysis (see S1 Text for statistical methods and results for the synthetic effect size dataset). ...
Road traffic kills hundreds of millions of animals every year, posing a critical threat to the populations of many species. To address this problem there are more than forty types of road mitigation measures available that aim to reduce wildlife mortality on roads (road-kill). For road planners, deciding on what mitigation method to use has been problematic because there is little good information about the relative effectiveness of these measures in reducing road-kill, and the costs of these measures vary greatly. We conducted a meta-analysis using data from 50 studies that quantified the relationship between road-kill and a mitigation measure designed to reduce road-kill. Overall, mitigation measures reduce road-kill by 40% compared to controls. Fences, with or without crossing structures, reduce road-kill by 54%. We found no detectable effect on road-kill of crossing structures without fencing. We found that comparatively expensive mitigation measures reduce large mammal road-kill much more than inexpensive measures. For example, the combination of fencing and crossing structures led to an 83% reduction in road-kill of large mammals, compared to a 57% reduction for animal detection systems, and only a 1% for wildlife reflectors. We suggest that inexpensive measures such as reflectors should not be used until and unless their effectiveness is tested using a high-quality experimental approach. Our meta-analysis also highlights the fact that there are insufficient data to answer many of the most pressing questions that road planners ask about the effectiveness of road mitigation measures, such as whether other less common mitigation measures (e.g., measures to reduce traffic volume and/or speed) reduce road mortality, or to what extent the attributes of crossing structures and fences influence their effectiveness. To improve evaluations of mitigation effectiveness, studies should incorporate data collection before the mitigation is applied, and we recommend a minimum study duration of four years for Before-After, and a minimum of either four years or four sites for Before-After-Control-Impact designs.
... Based on the fact, that – even within these design strata – we accumulated data from diverse studies observing several interventions and lense types as well as trial objectives, it would have been unlikely that all studies were equivalent. Therefore we did not assume a common effect size and the random effects model was considered justified for this meta- analysis [76]. However, a possible limitation of the our results could be due to the fact that we did not implement a standard search procedure based on common online databases, but rather decided to perform a full text search based on five prespecified subject-sensitive journals. ...
... 12 Updating meta-analysis (either because it is prospectively planned or because its result would be used to form a decision about conclusiveness) involves multiple tests as evidence accumulates and effect sizes are recalculated at each step, resulting in an inflated type I error. [13][14][15] Sequential methods for standard pairwise metaanalysis have been developed to account for multiple testing and adjust nominal significance. 5,[16][17][18][19] For many conditions, several treatment options exist and data on their comparative effectiveness are of primary interest to clinicians. ...
Pairwise and network meta-analysis (NMA) are traditionally used retrospectively to assess existing evidence. However, the current evidence often undergoes several updates as new studies become available. In each update recommendations about the conclusiveness of the evidence and the need of future studies need to be made. In the context of prospective meta-analysis future studies are planned as part of the accumulation of the evidence. In this setting, multiple testing issues need to be taken into account when the meta-analysis results are interpreted. We extend ideas of sequential monitoring of meta-analysis to provide a methodological framework for updating NMAs. Based on the z-score for each network estimate (the ratio of effect size to its standard error) and the respective information gained after each study enters NMA we construct efficacy and futility stopping boundaries. A NMA treatment effect is considered conclusive when it crosses an appended stopping boundary. The methods are illustrated using a recently published NMA where we show that evidence about a particular comparison can become conclusive via indirect evidence even if no further trials address this comparison.
... Specific post-hoc comparisons between groups of interest were performed on the predicted eyes test scores yielded by the regression analyses, and followed by Bonferroni correction for multiple testing. Effect sizes for specific comparisons were calculated by converting the t statistic to Pearson's r statistic (Field, 2007) then to Cohen's d measure of effect size (Borenstein et al., 2009), and were interpreted as small (d = 0.1), medium (d = 0.5), or large (d = 0.8) (Cohen, 1992). All analyses were performed using IBM-SPSS 20. ...
The deficit in ability to attribute mental states such as thoughts, beliefs, and intentions of another person is a key component in the functional impairment of social cognition in schizophrenia. In the current study, we compared the ability of persons with first episode schizophrenia (FE-SZ) and individuals with schizophrenia displaying symptomatic remission (SZ-CR) to decode the mental state of others with healthy individuals and schizoaffective patients. In addition, we analyzed the effect of dopamine-related genes polymorphism on the ability to decode the mental state of another, and searched for different genetic signatures. Our results show that overall, individuals with schizophrenia performed worse in the “Reading the Mind in the Eyes” (eyes) test, a simple well-defined task to infer the mental state of others than healthy individuals. Within the schizophrenia group, schizoaffective scored significantly higher than FE-SZ, SZ-CR, and healthy individuals. No difference was observed in performance between FE-SZ and SZ-CR subjects. Interestingly, FE-SZ and SZ-CR, but not schizoaffective individuals, performed worse in decoding negative and neutral emotional valance than the healthy control group. At the genetic level, we observed a significant effect of the DAT genotype, but not D4R genotype, on the eyes test performance. Our data suggest that understanding the mental state of another person is a trait marker of the illness, and might serve as an intermediate phenotype in the diagnostic process of schizophrenia disorders, and raise the possibility that DA-related DAT gene might have a role in decoding the mental state of another person.
... Several limitations of this meta-analysis require consideration. First, the number of studies included in our analysis was small, although it is above the median for reviews listed in the Cochrane Database of Systematic Reviews, which is six (Borenstein et al. 2009b). Moreover, the observed effects were consistent among the studies of the two identified subgroups (clinical, nonclinical), and The Q w statistic estimates within group homogeneity. ...
Objectives:
Digital-based parent training (DPT) programs for parents of children with disruptive behaviors have been developed and tested in randomized trials. The aim of this study was to quantitatively assess the efficacy of these programs versus a control condition.
Methods:
We conducted a systematic review and random effects meta-analysis of peer-reviewed randomized studies comparing DPT targeting children with disruptive behaviors versus a control group (wait list or no treatment).
Results:
Altogether, seven studies (n = 718) were meta-analyzed. Compared to the control groups, DPT resulted in significantly greater improvement in child behavior (effect size [ES] = 0.44, 95% confidence interval [CI] = 0.21-0.66, studies = 7), parent behavior (ES = 0.41, 95% CI = 0.25-0.57, studies = 6), and parental confidence (ES = 0.36, 95% CI = 0.12-0.59, studies = 4). The improvement in child behavior was moderated by age group and severity of clinical presentation, which overlapped 100%. While DPT was superior to control conditions in studies of young children (mean age <7 years) with a clinical range of disruptive behaviors (ES = 0.61, 95% CI = 0.40-0.82, studies = 4), results were nonsignificant in studies of older children (mean age >11 years) with a nonclinical range of symptoms (ES = 0.21, 95% CI = -0.01 to 0.42, studies = 3). Analyses yielded similar results of higher ESs favoring studies of young children with clinical range disruptive behaviors for parent behavior and parental confidence, but the differences were not significant. Results further suggested that in studies of younger children, interactive programs (e.g., computerized programs) were more effective in improving child behavior compared to noninteractive programs (e.g., watching video clips) (p < 0.05).
Conclusion:
Although additional studies are needed, DPT holds promise as a potentially scalable evidence-based treatment of children with disruptive behaviors that can save human resources.
... We performed the meta-analysis by computing the standardized mean difference (SMD) (Hedges' g) and using the random-effects model, and performed quantitative analyses on the confined data derived from the last measure of the intervention and control groups of each study. As previously suggested [41], we combined the outcomes for trials with more than one parameter (pro-or antioxidant). For studies with more than one intervention group (i.e., exercise training ), we considered each comparison (treated vs. control) as an independent study. ...
... We performed the meta-analysis by computing the standardized mean difference (SMD) (Hedges' g) and using the random-effects model, and performed quantitative analyses on the confined data derived from the last measure of the intervention and control groups of each study. As previously suggested [41], we combined the outcomes for trials with more than one parameter (pro-or antioxidant). For studies with more than one intervention group (i.e., exercise training ), we considered each comparison (treated vs. control) as an independent study. ...
Background
Physical activity has been associated with reduced oxidative stress (OS) in observational studies and clinical trials.
Objective
The purpose of this systematic review and meta-analysis of controlled trials was to determine the effect of physical exercise on OS parameters.
Methods
We conducted a systematic review of the literature up to March 2016 that included the following databases: PubMed, SCOPUS, and Web of Science. A keyword combination referring to exercise training and OS was included as part of a more thorough search process. We also manually searched the reference lists of the articles. From an initial 1573 references, we included 30 controlled trials (1346 participants) in the qualitative analysis, 19 of which were included in the meta-analysis. All trials were conducted in humans and had at least one exercise intervention and a paired control group. Using a standardized protocol, two investigators independently abstracted data on study design, sample size, participant characteristics, intervention, follow-up duration, outcomes, and quantitative data for the meta-analysis. Thus, the investigators independently assigned quality scores with a methodological quality assessment (MQA).
Results
The agreement level between the reviewers was 85.3 %. Discrepancies were solved in a consensus meeting. The MQA showed a total score in the quality index between 40 and 90 % and a mean quality of 55 %. Further, in a random-effects model, data from each trial were pooled and weighted by the inverse of the total variance. Physical training was associated with a significant reduction in pro-oxidant parameters (standard mean difference [SMD] –1.08; 95 % confidence interval [CI] –1.57 to –0.58; p < 0.001) and an increase in antioxidant capacity (SMD 1.45; 95 % CI 0.83–2.06; p < 0.001).
Conclusion
The pooled analysis revealed that regardless of intensity, volume, type of exercise, and studied population, the antioxidant indicators tended to increase and pro-oxidant indicators tended to decrease after training. Therefore, we conclude that exercise training seems to induce an antioxidant effect. Thus, it is suggested that people practice some kind of exercise to balance the redox state, regardless of their health status, to improve health-related outcomes.
... We performed the meta-analysis by computing the standardized mean difference (SMD) (Hedges' g) and using the random-effects model, and performed quantitative analyses on the confined data derived from the last measure of the intervention and control groups of each study. As previously suggested [41], we combined the outcomes for trials with more than one parameter (pro-or antioxidant). For studies with more than one intervention group (i.e., exercise training ), we considered each comparison (treated vs. control) as an independent study. ...
Introduction:
Phalaris canariensis L. (Pc), known as birdseed is rich in tryptophan. The aqueous extract of Pc (AEPc) treatment reduced systolic blood pressure (SBP) in spontaneously hypertensive rats (SHR) via mechanisms mediated by the tryptophan metabolizing enzyme indoleamine 2,3-dioxygenase (IDO). Hypertension is a risk factor to cardiovascular and renal diseases. Considering that physical exercise improves hypertension and cardiovascular function, the aim of this study was to evaluate whether the benefits of exercise (Ex) would be enhanced by concomitant AEPc treatment (400 mg/kg/day, p.o.).
Methods:
Vascular reactivity was assessed in aorta rings from SHR treated with AEPc for 4 weeks. Training intensity was based on maximal lactate steady state obtained during 2 weeks adaptation period in a treadmill running. Then, exercised (60 min running, 5x/week during 8 weeks) or sedentary SHR were untreated or treated with AEPc during 8 weeks. SBP was estimated by plethysmograph. Heart mass and body mass were used to obtain the index of cardiac hypertrophy (IHC). Glucose tolerance test was evaluated by oral glucose overload and the mRNA expressions of IDO, IL-1β and IL-10 in the kidney were obtained by real time PCR.
Results:
AEPc induced endothelial-mediated vascular relaxation. AEPc or Ex alone reduced SBP, IHC and ventricular fibrosis, improved glucose metabolism, attenuated proteinuria and the renal expression of the proinflammatory IL-1β with an overexpression in the anti-inflammatory IL-10. AEPc potentiated the benefits of the Ex on the cardiovascular system, metabolic parameters and renal inflammation.
Conclusion:
Birdseed reduced cardiovascular risk related to hypertension and had positive effects when associated to physical exercise.
... where the t-statistic was provided [55] . In these equations , d = Cohen's d value (standardized mean difference ); M 1 , M 2 = Mean values of the groups being compared; SD 1 , SD 2 = Standard deviation of the groups being compared; t = t-test statistic, df = degrees of freedom . ...
Background
Perinatal depression has a significant impact on both mother and child. However, the influence of hormonal changes during pregnancy and the postpartum period remains unclear. This article provides a systematic review of studies examining the effects of maternal cortisol function on perinatal depression. MethodA systematic search was conducted of six electronic databases for published research on the relationship between cortisol and perinatal depression. The databases included; MEDLINE complete, PsychINFO, SCOPUS, Psychology and Behavioural Sciences, Science Direct and EBSCO, for the years 1960 to May 2015. Risk of bias was assessed and data extraction verified by two investigators. ResultsIn total, 47 studies met criteria and studies showed considerable variation in terms of methodology including sample size, cortisol assays, cortisol substrates, sampling processes and outcome measures. Those studies identified as higher quality found that the cortisol awakening response is positively associated with momentary mood states but is blunted in cases of major maternal depression. Furthermore, results indicate that hypercortisolemia is linked to transient depressive states while hypocortisolemia is related to chronic postpartum depression. Discussion and Conclusion
Future research should aim to improve the accuracy of cortisol measurement over time, obtain multiple cortisol samples in a day and utilise diagnostic measures of depression. Future studies should also consider both antenatal and postnatal depression and the differential impact of atypical versus melancholic depression on cortisol levels, as this can help to further clarify the relationship between perinatal depression and maternal cortisol function across pregnancy and the postpartum period.
... We also conducted a time-cumulative meta-analysis [47] for any incretin therapy found to have an increased risk of CV events. Analysed by calendar year of trial report, sequential series of cumulative Peto odds ratio were conducted to identify the earliest calendar year, at the end of which, the increased risk of the specified end point became significantly apparent. ...
Background:
Recent cardiovascular outcome trials of incretin based therapies (IBT) in type 2 diabetes have not demonstrated either benefit or harm in terms of major adverse cardiovascular events (MACE). Earlier meta-analyses showed conflicting results but were limited in methodology. We aimed to perform an updated meta-analysis of all available incretin therapies on the incidence of MACE plus arrhythmia and heart failure.
Methods:
We identified studies published through November 2014 by searching electronic databases and reference lists. We included RCTs in which the intervention group received IBTs and the control group received placebo or standard treatment; enrolled >100 participants in each group; interventions lasted >24 weeks; and reported data on one or more primary MACE endpoints plus terms for arrhythmia and heart failure. We used the Peto method for each CV event for individual IBT treatment.
Results:
In this meta-analysis of 100 RCTs involving 54,758 IBTs users and 48,175 controls, exenatide was associated with increased risk of arrhythmia (OR 2.83; 95% CI, 1.06-7.57); saxagliptin was associated with an increased risk of heart failure (OR 1.23; 95% CI, 1.03-1.46) and sitagliptin was associated with a significantly decreased risk of all cause death compared to active controls (OR 0.39, 95% CI 0.18-0.82).
Conclusions:
In type 2 diabetes, exenatide may increase the risk of arrhythmia and sitagliptin may reduce the risk of all cause death, however, the subgroup of patients most likely to experience harm or benefit is unclear.
... Subgroup analyses were performed based on the developmental statuses of the paediatric recipients (as determined by Tanner staging [23] or an equivalent method) and the time of initiation of steroid withdrawal. The results for the different subgroups were compared using the method described by Borenstein et al. [24] , which was implemented with RevMan v5.2. Sensitivity analysis. ...
Background:
We combined the outcomes of all randomised controlled trials to investigate the safety and efficacy of steroid avoidance or withdrawal (SAW) regimens in paediatric kidney transplantation compared with steroid-based (SB) regimens.
Methods:
A systematic literature search of PubMed, Embase, Cochrane Library, the trials registry and BIOSIS previews was performed. A change in the height standardised Z-score from baseline (ΔHSDS) and acute rejection were the primary endpoints.
Results:
Eight reports from 5 randomised controlled trials were included, with a total of 528 patients. Sufficient evidence of a significant increase in the ΔHSDS was observed in the SAW group (mean difference (MD) = 0.38, 95% confidence interval (CI) 0.07-0.68, P = 0.01), particularly within the first year post-withdrawal (MD = 0.22, 95% CI 0.10-0.35, P = 0.0003) and in the prepubertal recipients (MD = 0.60, 95% CI 0.21-0.98, P = 0.002). There was no significant difference in the risk of acute rejection between the groups (relative risk = 1.04, 95% CI 0.80-1.36, P = 0.77).
Conclusions:
The SAW regimen is justified in select paediatric renal allograft recipients because it provides significant benefits in post-transplant growth within the first year post-withdrawal with minimal effects on the risk of acute rejection, graft function, and graft and patient survival within 3 years post-withdrawal. These select paediatric recipients should have the following characteristics: prepubertal; Caucasian; with primary disease not related to immunological factors; de novo kidney transplant recipient; with low panel reactive antibody.
Societies invest in scientific studies to better understand the world, and attempt to harness such
improved understanding to address pressing medical and social problems. Scientific findings, however, can only justifiably inform theory or applied problems if they are at minimum internally and externally provisionally trustworthy. Internal trustworthiness is gauged by quantifying the analytic reproducibility and robustness of a study's results; external trustworthiness is gauged by quantifying the replicability and generalizability of published effects and phenomena. The following paper outlines a unified curation framework to quantify the reproducibility, robustness, replicability, and generalizability of scientific findings, categorically addressing all forms of researcher and publication bias. Five major challenges are addressed by the proposed framework: (1) a standardized workflow and principled metric to quantify the analytic reproducibility and robustness of reported results from primary, auxiliary, and secondary analyses; (2) a flexible workflow and replication taxonomy to categorize (i) sufficiently methodologically similar replications that can speak to replicability and (ii) eligible generalizations of an original effect that can speak to generalizability; (3) a principled meta- analytic approach to synthesizing replicability and generalizability evidence; (4) accounting for variations in study characteristics of replications and generalizations; and (5) a viable crowd- sourced web platform to allow the community of scientists to quantify the provisional trustworthiness of published findings in an incremental and ongoing basis. Ultimately, the framework will accelerate investigations into the validity of such trustworthy findings, and consequently accelerate our understanding of the world and development of applied solutions to societal problems.
Objectives: To estimate exposure to faecal contamination through drinking water as indicated by levels of Escherichia coli (E. coli) or thermotolerant coliform (TTC) in water sources. Methods: We estimated coverage of different types of drinking water source based on household surveys and censuses using multilevel modelling. Coverage data were combined with water quality studies that assessed E. coli or TTC including those identified by a systematic review (n = 345). Predictive models for the presence and level of contamination of drinking water sources were developed using random effects logistic regression and selected covariates. We assessed sensitivity of estimated exposure to study quality, indicator bacteria and separately considered nationally randomised surveys. Results: We estimate that 1.8 billion people globally use a source of drinking water which suffers from faecal contamination, of these 1.1 billion drink water that is of at least ‘moderate’ risk (>10 E. coli or TTC per 100 ml). Data from nationally randomised studies suggest that 10% of improved sources may be ‘high’ risk, containing at least 100 E. coli or TTC per 100 ml. Drinking water is found to be more often contaminated in rural areas (41%, CI: 31%–51%) than in urban areas (12%, CI: 8–18%), and contamination is most prevalent in Africa (53%, CI: 42%–63%) and South-East Asia (35%, CI: 24%–45%). Estimates were not sensitive to the exclusion of low quality studies or restriction to studies reporting E. coli. Conclusions: Microbial contamination is widespread and affects all water source types, including piped supplies. Global burden of disease estimates may have substantially understated the disease burden associated with inadequate water services. Objectifs: Estimer l'exposition à la contamination fécale par l'eau potable, telle qu'indiquée par les quantités d’Escherichia coli (E. coli) ou de coliformes thermo-tolérants (CTT) dans les sources d'eau. Méthodes: Nous avons estimé l’étendue de la couverture en différents types de sources d'eau potable à partir d'enquêtes sur les ménages et des recensements à l'aide de la modélisation à multi-niveaux. Les données de couverture ont été combinées avec des études de qualité de l'eau évaluant E. coli ou les CTT y compris celles identifiées par une revue systématique (n = 345). Les modèles prédictifs pour la présence et le niveau de contamination des sources d'eau potable ont été développés en utilisant la logistique de régression à effets aléatoires et une sélection de covariables. Nous avons évalué la sensibilité de l'exposition estimée pour étudier la qualité, les bactéries indicatrices et avons séparément considéré des études nationales randomisées. Résultats: Nous estimons que 1,8 milliard de personnes dans le monde utilisent une source d'eau potable porteuse de contamination fécale. Parmi celles-ci 1,1 milliard boivent de l'eau avec un risque assez «modéré» (>10 E. coli ou CTT par 100 ml). Les données des études nationales randomisées indiquent que 10% des sources améliorées pourraient être à risque «élevé», i.e. contenant au moins 100 E. coli ou CTT par 100 ml. L'eau potable se trouve être plus souvent contaminée dans les zones rurales (41%, IC: 31–51) qu'en milieu urbain (12%, IC: 8–18) et la contamination est la plus répandue en Afrique (53%, CI: 42–63) et en Asie du sud-est (35%, IC: 24–45). Les estimations n’étaient pas affectées par l'exclusion des études de faible qualité ou par la restriction aux études rapportant sur E. coli. Conclusions: La contamination microbienne est très répandue et affecte tous les types de sources d'eau, y compris les fournitures par tuyauterie. Les estimations de la charge mondiale des maladies pourraient avoir sensiblement sous-estimé la charge de morbidité associée à des services d'eau inadéquats. Objetivos: Calcular la exposición a la contaminación fecal a través del agua para consumo, según los niveles de Escherichia coli (E. coli) o coliformes termotolerantes (CTT) en las fuentes de agua. Métodos: Utilizando modelos multinivel, hemos calculado la cobertura de diferentes tipos de fuentes de agua para consumo basándonos en encuestas a hogares y censos. Los datos de cobertura se combinaron con estudios de calidad del agua que evaluaron niveles de E. coli o CTT, incluyendo aquellos identificados mediante una revisión sistemática (n = 345). Los modelos predictivos para la presencia y nivel de contaminación de las fuentes de agua para consumo se desarrollaron utilizando una regresión logística de efectos aleatorios y covariables seleccionadas. Evaluamos la sensibilidad de la exposición calculada según la calidad del estudio, la bacteria utilizada como indicador y tuvimos en cuenta de forma separada los ensayos nacionales aleatorizados. Resultados: Hemos calculado que 1.8 billones de personas a nivel global utilizan una fuente de agua para beber que sufre de contaminación fecal; de estas 1.1 billones consumen agua que es al menos de riesgo “moderado” (>10 E. coli o CTT por 100 mL). Datos de estudios nacionales aleatorizados sugieren que un 10% de las fuentes de agua mejoradas pueden ser de‘alto’ riesgo, al contener al menos 100 E. coli o CTT por 100 mL. El agua para consumo se encuentra más a menudo contaminada en áreas rurales (41%, IC: 31–51%) que en áreas urbanas (12%, IC: 8–18%) y la contaminación es más prevalente en África (53%, IC: 42–63%) y el Sudeste Asiático (35%, CI: 24–45%). Los cálculos no eran sensibles a la exclusión de estudios de mala calidad o a la restricción de estudios en los que se reporta E. coli. Conclusiones: La contaminación microbiana está ampliamente extendida y afecta todos los tipos de agua, incluyendo la distribuida a través de tuberías. Los cálculos de la carga global de enfermedad podrían haber subestimado sustancialmente la carga de enfermedad por servicios de agua inadecuados.
Genetic, post-mortem and neuroimaging studies repeatedly implicate neuregulin-1 (NRG1) as a critical component in the pathophysiology of schizophrenia. Although a number of risk haplotypes along with several genetic polymorphisms in the 5′ and 3′ regions of NRG1 have been linked with schizophrenia, results have been mixed. To reconcile these conflicting findings, we conducted a meta-analysis examining 22 polymorphisms and two haplotypes in NRG1 among 16 720 cases, 20 449 controls and 2157 family trios. We found significant associations for three polymorphisms (rs62510682, rs35753505 and 478B14-848) at the 5′-end and two (rs2954041 and rs10503929) near the 3′-end of NRG1. Population stratification effects were found for the rs35753505 and 478B14-848(4) polymorphisms. There was evidence of heterogeneity for all significant markers and the findings were robust to publication bias. No significant haplotype associations were found. Our results suggest genetic variation at the 5′ and 3′ ends of NRG1 are associated with schizophrenia and provide renewed justification for further investigation of NRG1’s role in the pathophysiology of schizophrenia.
Purpose:
To perform a systematic review of the clinical performance of a low polymerization shrinkage, siloranebased composite (SBC) compared with a methacrylate-based composite (MBC) in posterior restorations.
Materials and methods:
Electronic databases were searched: PubMed, Scopus, Bireme, Science Direct, Web of Science, ClinicalTrials.gov and OpenGrey. The search strategy included MeSH terms, synonyms and keywords with no language or date restrictions. Reference lists of eligible studies were cross checked in an attempt to identify additional studies. Based on the PICOS strategy, only randomized clinical trials (RCTs) were included. The risk of bias in the included studies was assessed and classified through the Cochrane Collaboration common scheme for bias. Two meta-analyses were performed using RevMan software, one with all 11 studies and another that included only studies with over 24 months of follow-up, for the main parameters analyzed.
Results:
A total of 544 studies were identified. After removing duplicates and examinating titles and abstracts, 17 texts were selected and read in full. Six of them were excluded, so the final sample of this systematic review included 11 studies. Six of the 11 studies were classified as having a "low risk of bias" and five were "unclear". The heterogeneity (I²) in all parameters was not significant. The exclusion of studies with less than 24 months of follow- up did not change the final result of the meta-analysis: both SBC and MBC have satisfactory and statistically similar clinical performances.
Conclusion:
Low polymerization shrinkage is not the principal factor that determines the superiority of a resin.
This Paper analyses the explanatory power of the constructs of transaction cost economics theory (environmental uncertainty, behavioral uncertainty, asset specificity and transaction frequency) in order to determine possible constructs for an endogenous theory of ITO. To analyze this, we employ a large project data set from a German IT outsourcing vendor. We find that only environmental uncertainty and transaction frequency have a high explanatory power and therefore should be considered for an endogenous theory of ITO. Behavioral uncertainty and asset specificity are only of minor relevance. The research is limited by the fact that we employed a data set from only one vendor. We contribute to theory by suggesting possible constructs for an endogenous theory of ITO and to practice by showing that the danger of opportunistic behavior is low. This paper contributes to the ongoing discussion on the applicability of transaction cost economics theory.
Background
Brief-pulse electroconvulsive therapy (ECT) is the most acutely effective treatment for severe depression though concerns persist about cognitive side-effects. While bitemporal electrode placement is the most commonly used form worldwide, right unilateral ECT causes less cognitive side-effects though historically it has been deemed less effective. Several randomized trials have now compared high-dose (>5× seizure threshold) unilateral ECT with moderate-dose (1.0–2.5× seizure threshold) bitemporal ECT to investigate if it is as effective as bitemporal ECT but still has less cognitive side-effects. We aimed to systematically review these trials and meta-analyse clinical and cognitive outcomes where appropriate.
Method
We searched PubMed, PsycINFO, Web of Science, Cochrane Library and EMBASE for randomized trials comparing these forms of ECT using the terms ‘electroconvulsive’ OR ‘electroshock’ AND ‘trial’.
Results
Seven trials ( n = 792) met inclusion criteria. Bitemporal ECT did not differ from high-dose unilateral ECT on depression rating change scores [Hedges's g = −0.03, 95% confidence interval (CI) −0.17 to 0.11], remission (RR 1.06, 95% CI 0.93–1.20), or relapse at 12 months (RR 1.42, 95% CI 0.90–2.23). There was an advantage for unilateral ECT on reorientation time after individual ECT sessions (mean difference in minutes = −8.28, 95% CI −12.86 to −3.70) and retrograde autobiographical memory (Hedges's g = −0.46, 95% CI −0.87 to −0.04) after completing an ECT course. There were no differences for general cognition, category fluency and delayed visual and verbal memory.
Conclusions
High-dose unilateral ECT does not differ from moderate-dose bitemporal ECT in antidepressant efficacy but has some cognitive advantages.
This meta-analysis investigated whether the five metacognitive beliefs implicated in the Self-Regulatory Executive Function (S-REF) model (Wells and Matthews, 1994; Wells and Matthews, 1996) are elevated in people with clinical psychosis compared to people with emotional disorder and non-psychiatric controls. The review followed guidance set-out in the PRISMA statement. Primary analyses compared summary effect sizes on each sub-scale of the Metacognitions Questionnaire (MCQ) for people with psychosis and non-psychiatric controls; and people with psychosis and people with emotional disorder. Eleven eligible studies were identified comprised of 568 psychosis participants, 212 emotional disorder participants and 776 non-psychiatric controls. Findings indicated that people with psychosis had higher scores on all sub-scales of the MCQ compared to non-psychiatric controls; and higher scores on the positive beliefs about worry sub-scale compared to people with emotional disorder. This suggests metacognitive beliefs may be associated with the presence of psychological disorder and distress in general, rather than specific diagnoses. Implications for models of psychosis and treatment are discussed.
The introduction of organisms within the native range of wild conspecifics is a widespread phenomenon and locally modifies patterns in intraspecific diversity. However, our knowledge of the resulting ecological effects, as opposed to those caused by invasion-induced changes in interspecific diversity, is still limited. Here, we investigated the ecological effects of native and non-native invaders across levels of biological organisations and recipient organisms using the global and long history introductions of salmonids. Our meta-analysis demonstrated that the global effects of native species introductions exceeded those induced by non-native invaders. The impacts of native invaders were primarily manifested at the individual level on wild conspecifics, but remained largely unexplored on other native organisms and at the community and ecosystem levels. Overlooked and poorly appreciated, quantifying the impacts of native invaders has important implications because human-assisted introductions of domesticated organisms are ubiquitous and likely to proliferate in the future.
A reliability generalization was conducted on studies that reported use of the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA), published between 1987 and 2013. For inclusion in this meta-analysis, each study had to have reported a Cronbach’s alpha reliability coefficient for its sample. Data from 83 Cronbach’s alpha coefficients representing 12,992 participants were analyzed; only 67 out of 193 published studies (43.52%) reported reliability scores for their sample. The reliability scores produced by the SL-ASIA ranged from .62 to .96 with an average of .91 (SD = 0.07); therefore, all of the reported reliability scores for this instrument were in the acceptable to excellent range. Our results demonstrate that SL-ASIA continues to be an instrument with strong psychometric properties when used with diverse populations, and it is therefore appropriate for continued use with studies on acculturation.
Does the consumption of green leafy vegetables including cruciferous vegetables significantly reduce the incidence of cardiovascular disease? This research question was answered via employing the statistical methods of meta-analysis by synthesizing relevant worldwide studies that address the association between the consumption of green leafy vegetables and risk of incidence of said diseases. All meta-analysis calculations included determination of effect sizes of relative risk, and their respective 95% confidence intervals, heterogeneity of the studies, relative weights for each study, and significance (p) for each study. Eight studies met the inclusion criteria, which investigated the relationship between the incidences of total cardiovascular disease with the intake of green leafy vegetables. The overall effect size (random effect model) was: RR = 0.842 (95% CI = 0.753 to 0.941), p = 0.002, which indicates a significant 15.8% reduced incidence of cardiovascular disease.
Objective:
To evaluate the impact of pharmaceutical care (PC) interventions on health-related quality of life (HRQoL) and determine sensitivity of HRQoL measures to PC services.
Data sources:
MEDLINE, EMBASE, International Pharmaceutical Abstracts, PubMed, Global Health, PsychINFO, CINAHL, and Web of Science (January 2005 to September 2015) were searched.
Study selection and data extraction:
Original English-language articles were included if PC impact on HRQoL was evaluated and reported using validated HRQoL measures.
Data synthesis:
A total of 31 randomized controlled trials, 9 nonrandomized studies with comparison groups, and 8 before-after studies were included. PC interventions resulted in significant improvement in 1 domain and ≥3 domains of HRQoL measures in 66.7% and 27.1% of the studies, respectively. There was a significant improvement in at least 1 domain in 18 of 32 studies using generic and 16 of 21 studies using disease-specific measures. When the Short Form 36 Items Health Survey (SF-36) measure was used, PC interventions had a moderate impact on social functioning (standardized mean difference [SMD] = 0.59; 95% CI = 0.14, 1.04), general health (SMD = 0.36; 95% CI = 0.12, 0.59), and physical functioning (SMD = 0.30; 95% CI = 0.11, 0.48). The pooled data on heart failure-specific (SMD = -0.17; 95% CI = -0.43, 0.09), asthma-specific (SMD = 0.17; 95% CI = -0.03, 0.36), and chronic obstructive pulmonary disease-specific (SMD = -0.09; 95% CI = -0.37, 0.19) measures indicated no significant impact of PC on HRQoL.
Conclusions:
PC interventions can significantly improve at least 1 domain of HRQoL. Existing measures may have minimal to moderate sensitivity to PC interventions, with evidence pointing more toward social functioning, general health, and physical functioning of the SF-36 measure. However, evidence generated from current non-PC-specific HRQoL measures is insufficient to judge the impact of PC interventions on HRQoL. The development of a suitable HRQoL measure for PC interventions may help generate better evidence for the contribution of pharmacist services to improving HRQoL.
Animal models have shown evidence of the role of maternal methyl donor status and its metabolism (one-carbon metabolism) in normal embryonic maxillofacial development. Nevertheless, studies in humans have shown conflicting results for the association of maternal methylation status biomarkers in the aetiology of the main craniofacial birth defects: non-syndromic orofacial clefts (NSOFCs). The aim of this study was to perform a meta-analysis assessing the relationship between maternal levels of methylation status biomarkers (plasma and erythrocyte folates and plasma vitamin B12 and homocysteine) and the risk of NSOFCs. A literature search of the conventional and grey medical–scientific databases identified 12 studies considering these variables. Based on standardized differences between means among cases and controls (Cohen's d test), evidence was found of an association only with high plasma homocysteine (d = 0.37; P = 0.026) when single effects were pooled. In addition to its usefulness as a marker of poor methyl-donor intake and/or metabolism, homocysteine appears to have a teratogenic effect. Although the results are based on a relatively small number of reports and/or studies of small sample sizes showing between-study heterogeneity, these problems were resolved by including an additional analysis. Therefore these findings constitute a real contribution towards explaining the complex aetiology of orofacial clefts.
Objective:
Breast cancer is the most commonly diagnosed cancer in women across the world. The majority of women diagnosed with the disease undergo surgery, which is often associated with significant psychosocial morbidity. The aim of this meta-analysis was to identify the efficacy of psychosocial interventions for women following breast cancer surgery.
Method:
A comprehensive literature search was undertaken using keyword and subject headings within seven databases. Included studies employed a quantitative methodology presenting empirical findings focusing on interventions for female breast cancer patients following surgery.
Results:
32 studies were included and based on conventional values of effect sizes, small effects emerged for the efficacy of psychosocial interventions in relation to anxiety (Hedges g = 0.31), depression (0.38), quality of life (0.40), mood disturbance (0.31), distress (0.27), body image (0.40), self-esteem (0.35), and sexual functioning (0.22). A moderate to large effect emerged for the efficacy of interventions in promoting improvements in sleep disturbance (0.67). Clear evidence emerged for the efficacy of cognitive behavioural therapy in promoting improvements in anxiety, depression and quality of life.
Conclusion:
This is the first meta-analysis to demonstrate the efficacy of interventions on a range of psychosocial outcomes following breast cancer surgery. The meta-analysis highlighted cognitive behavioural therapy was consistently the most effective psychosocial intervention promoting improvements in anxiety, depression and quality of life. However, there are shortcomings in existing studies, the length of the follow-up period is typically short and the generalisability of findings was limited by small samples, both of which should be addressed in future studies.
Objective:
The association between workplace bullying and sickness absence remains unclear. This paper presents a systematic review and meta-analysis of research on the association.
Method:
We conducted a systematic review and meta-analysis of published primary studies on workplace bullying and sickness absence. Studies based on prospective design or registry data on sickness absence were included. Cross-sectional studies with self-reported sickness absence were excluded.
Results:
Seventeen primary studies were included in the review, sixteen originated from the Nordic countries and fifteen included registry data on sickness absence. All but one study found that exposure to workplace bullying was associated with increased risk of sickness absence. A meta-analysis of ten independent studies showed that exposure to bullying increased the risk of sickness absence (odds ratio 1.58, 95% CI 1.39-1.79). Five studies included variables that moderated the association between bullying and absenteeism. None of the studies included mediating variables. No studies examined sickness absence as a risk factor for later exposure to bullying. Following the GRADE guidelines, the evidence for an association between bullying and sickness absence is moderate.
Conclusions:
Workplace bullying is a risk factor for sickness absence, but the mechanisms to explain this relationship are not sufficiently described. It is unclear whether sickness absence predicts later exposure to bullying. While, the methodological quality of the reviewed studies was high, the knowledge base is small. There is a need for more research on how and when bullying is related to sickness absence and the possible bidirectional relationships involved.
Context: Hepatitis is a term used to describe any type of hepatitis inflammation. Screening for the virus antigen during pregnancy is mandatory in some parts of the world and is recommended in others. so that, most women are aware of and understand the disease if they have it when they are pregnant. Thus, the major concerns of these women are both the virus transmission to the fetus and the effects of hepatitis B on pregnancy outcome. Evidence Acquisition: According to a specific protocol, we searched in the Pub med, Scopus, ISI web of science from 1990 to February 2015 to find the original articles, which investigated the hepatitis B effects in pregnantwomenwith normal singleton pregnancy who were previously diagnosed with inactive CHB or were incidentally found to be HBsAg positive in routine antenatal blood test. We included any cohort, case control and cross sectional studies if they had a healthy control group and reported one or more considered maternal or prinatal outcomes in pregnant women. Meta-analysis was performed with Review manager 5.4 and Stata 11 software. We assessed the effect size that was pooled odds ratio (OR) and 95% confidence intervals (CIs) using the random effects model. We explored statistical heterogeneity using the chi-squared (Chi2), I2 and tau-squared (Tau2) statistical tests. Results: From a total of 156 identified studies, 56 studies were chosen for a detailed review, and 18 studies whichmet the inclusion and exclusion criteria were included in the meta analysis. Among the included studies, the outcomes were small for gestational age (SGA) large for gestational age (LGA), intra uterine growth restriction (IUGR), fetal distress, fifth minutes apgar score, first minute Apgar score, low birth weight (LBW) and Fetal Macrosomia. Conclusions: In this study, hepatitis B had a cause effect on LGA and fetal Macrosomia. Among the other considered adverse pregnancy outcomes; it didn’t have any significant effect.
Objective
We aimed to summarize the pooled frequency of mediastinitis following open-heart surgery caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), and Gram-negative bacteria.
Design
This study was a systematic review and a meta-analysis of prospective and retrospective cohort studies.
Materials and methods
We searched the literature, and a total of 97 cohort studies were identified. Random-effect model was used to synthesize the results. Heterogeneity between studies was examined by subgroup and meta-regression analyses, considering study and patient-level variables. Small-study effect was evaluated.
Results
Substantial heterogeneity was present. The estimated incidence of mediastinitis evaluated from 97 studies was 1.58% (95% confidence intervals [CI] 1.42, 1.75) and that of Gram-positive bacteria, Gram-negative bacteria, and MRSA bacteria evaluated from 63 studies was 0.90% (95% CI 0.81, 1.21), 0.24% (95% CI 0.18, 0.32), and 0.08% (95% CI 0.05, 0.12), respectively. A meta-regression pinpointed negative association between the frequency of mediastinitis and latitude of study place and positive association between the frequency of mediastinitis and the age of the patient at operation. Multivariate meta-regression showed that prospective cohort design and age of the patients and latitude of study place together or in combination accounted for 17% of heterogeneity for end point frequency of mediastinitis, 16.3% for Gram-positive bacteria, 14.7% for Gram-negative bacteria, and 23.3% for MRSA bacteria.
Conclusion
Evidence from this study suggests the importance of latitude of study place and advanced age as risk factors of mediastinitis. Latitude is a marker of thermally regulated bacterial virulence and other local surgical practice. There is concern of increasing risk of mediastinitis and of MRSA in elderly patients undergoing sternotomy.
Introduction: Trapeziometacarpal osteoarthritis is associated with more pain and restrictions than other hand osteoarthritis due to the functional importance of the thumb. While the effectiveness of surgical and pharmacological interventions has been widely examined, there is a lack of specific evidence about conservative non-pharmacological trapeziometacarpal osteoarthritis therapies. The objective of this systematic review was to provide evidence-based knowledge on the effectiveness of physiotherapy and occupational therapy on pain, function and quality of life. Methods: A literature search of Medline, CINAHL, PEDro, OTseeker, EMB Dare Cochrane Database of Systematic Reviews and Cochrane CENTRAL was performed. Randomized and quasi-randomized controlled trials and corresponding systematic reviews, observational studies, pragmatic studies and case–control studies were included. The risk of bias was assessed. Results: Out of 218 studies, 27 were retained. A narrative summary and a series of meta-analyses were performed. Concerning pain reduction, the meta-analysis showed parity of prefabricated neoprene and custom-made thermoplastic splints: standardized mean difference (SMD) –0.01 (95%CI À0.43, 0.40) (p¼0.95). Multimodal interventions are more effective on pain compared to single interventions: standardized mean difference À3.16 (95%CI À5.56, À0.75) (p ¼ 0.01). Discussion: Physical and occupational therapy-related interventions, especially multimodal interventions, seem to be effective to treat pain in patients with trapeziometacarpal osteoarthritis. Prefabricated neoprene splints and custom-made thermoplastic splints may reduce pain equally. Single interventions seem not to be effective. Significant evidence for effectiveness on function and quality of life could not be found.
Introduction
A substantial body of evidence linking late-life depression and dementia is now available. However, precise estimates of the relative risk attributable to late-life depression assessed with specific screening instruments at specified thresholds have not been previously produced.
Objective
Summarise dementia risks associated with depression.
Aims
Conduct a systematic review of the literature to produce precise and specific risk estimates for all cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD).
Methods
The PubMed, PsycInfo, and Cochrane databases were systematically searched. Studies assessing incident dementia using validated measures of clinical depression or depressive symptomatology from prospective population studies were selected. The most specific analyses were conducted using both continuous symptomatology ratings and categorical measures of clinical depression based on single instruments with defined cut-offs.
Results
The literature search yielded 121,301 articles, of which 36 were eligible. Included studies provided a combined sample size of 66,532 individuals including 6593 dementia, 2797 AD, and 585 VaD cases. Random-effects summary estimates showed that the risk associated with depression did not differ by type of dementia. The most widely used instrument was the CES-D. A clinical threshold of 20 produced similar estimates for all-cause dementia (HR 1.83, 95% CI 0.95–3.52) and for AD (HR 1.97, 95% CI 0.96–4.04). Estimates based on other thresholds and continuous measures produced consistent results.
Conclusion
Reliable dementia risk estimates associated with late-life depression can be produced and do not differ between dementia types. Such estimates should be used in evidence-based medicine practice to assess individual risk and to inform policy on interventions to decrease risk in the population.
In recent years, genome-wide association studies (GWAS) have identified many loci that are shared among common disorders and this has raised interest in pleiotropy. For performing appropriate analysis, several methods have been proposed, e.g. conducting a look-up in external sources or exploiting GWAS results by meta-analysis based methods. We recently proposed the Compare & Contrast Meta-Analysis (CCMA) approach where significance thresholds were obtained by simulation. Here we present analytical formulae for the density and cumulative distribution function of the CCMA test statistic under the null hypothesis of no pleiotropy and no association, which, conveniently for practical reasons, turns out to be exponentially distributed. This allows researchers to apply the CCMA method without having to rely on simulations. Finally, we show that CCMA demonstrates power to detect disease-specific, agonistic and antagonistic loci comparable to the frequently used Subset-Based Meta-Analysis approach, while better controlling the type I error rate.
Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi–randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, p = 0.012), 0.78 (95% CI: 0.25 to 1.30, p = 0.001) and 0.62 (95% CI: 0.04 to 1.20, p = 0.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.
Objective:
Interpersonal psychotherapy (IPT) has been developed for the treatment of depression but has been examined for several other mental disorders. A comprehensive meta-analysis of all randomized trials examining the effects of IPT for all mental health problems was conducted.
Method:
Searches in PubMed, PsycInfo, Embase, and Cochrane were conducted to identify all trials examining IPT for any mental health problem.
Results:
Ninety studies with 11,434 participants were included. IPT for acute-phase depression had moderate-to-large effects compared with control groups (g=0.60; 95% CI=0.45-0.75). No significant difference was found with other therapies (differential g=0.06) and pharmacotherapy (g=-0.13). Combined treatment was more effective than IPT alone (g=0.24). IPT in subthreshold depression significantly prevented the onset of major depression, and maintenance IPT significantly reduced relapse. IPT had significant effects on eating disorders, but the effects are probably slightly smaller than those of cognitive-behavioral therapy (CBT) in the acute phase of treatment. In anxiety disorders, IPT had large effects compared with control groups, and there is no evidence that IPT was less effective than CBT. There was risk of bias as defined by the Cochrane Collaboration in the majority of studies. There was little indication that the presence of bias influenced outcome.
Conclusions:
IPT is effective in the acute treatment of depression and may be effective in the prevention of new depressive disorders and in preventing relapse. IPT may also be effective in the treatment of eating disorders and anxiety disorders and has shown promising effects in some other mental health disorders.
More than 100 comparative outcome trials, directly comparing 2 or more psychotherapies for adult depression, have been published. We first examined whether these comparative trials had sufficient statistical power to detect clinically relevant differences between therapies of d=0.24. In order to detect such an effect size, power calculations showed that a trial would need to include 548 patients. We selected 3 recent meta-analyses of psychotherapies for adult depression (cognitive behaviour therapy (CBT), interpersonal psychotherapy and non-directive counselling) and examined the number of patients included in the trials directly comparing other psychotherapies. The largest trial comparing CBT with another therapy included 178 patients, and had enough power to detect a differential effect size of only d=0.42. None of the trials in the 3 meta-analyses had enough power to detect effect sizes smaller than d=0.34, but some came close to the threshold for detecting a clinically relevant effect size of d=0.24. Meta-analyses may be able to solve the problem of the low power of individual trials. However, many of these studies have considerable risk of bias, and if we only focused on trials with low risk of bias, there would no longer be enough studies to detect clinically relevant effects. We conclude that individual trials are heavily underpowered and do not even come close to having sufficient power for detecting clinically relevant effect sizes. Despite this large number of trials, it is still not clear whether there are clinically relevant differences between these therapies.
Negative symptoms are a strong predictor of poor functional outcome in people with schizophrenia. Unfortunately there are
few effective interventions for either negative symptoms or functional outcome, despite the identification of potential mechanisms.
Recent research, however, has elucidated a new potential mechanism for negative symptoms and poor functional outcome: defeatist
performance beliefs (DPB), or negative thoughts about one’s ability to successfully perform goal-directed behavior that can
prevent behavior initiation and engagement. We conducted 2 meta-analyses examining the relationship between DPB and both negative
symptoms (n = 10 studies) and functional outcome (n = 8 studies) in people with schizophrenia. We found a small effect size for the relationship between DPB and negative symptoms,
regardless of how negative symptoms were measured. We also found a small effect size for the relationship between DPB and
functional outcome, which was significantly moderated by the method of assessing DPB and moderated by the sex composition
of the study at a trend level. These findings highlight the potential of targeting DPB in psychosocial interventions for both
negative symptoms and functional outcome.
Objective The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals.
Design Systematic review and meta-analysis of population-based cohort studies.
Setting Articles were retrieved from international and national electronic databases.
Study selection Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60 years or over, assessment of sleep duration as 24 h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded.
Data extraction Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochran's Q and the I2 statistics, respectively, and sensitivity analyses were conducted.
Primary and secondary outcome measures All-cause and cardiovascular mortality.
Results Overall, 27 cohort studies were selected, comprising >70 000 elderly individuals, and followed up from 3.4 to 35 years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥30 min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥2.0 h) was not (RR 1.34; 95% CI 1.95 to 1.90).
Conclusions Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality.
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