Adjusted Effect Size Research Articles

Assessing the Evidential Value of Mental Fatigue and Exercise Research

It has often been reported that mental exertion, presumably leading to mental fatigue, can negatively affect exercise performance; however, recent findings have questioned the strength of the effect. To further complicate this issue, an overlooked problem might be the presence of publication bias in studies using underpowered designs, which is known to inflate false positive report probability and effect size estimates. Altogether, the presence of bias is likely to reduce the evidential value of the published literature on this topic, although it is unknown to what extent. The purpose of the current work was to assess the evidential value of studies published to date on the effect of mental exertion on exercise performance by assessing the presence of publication bias and the observed statistical power achieved by these studies. A traditional meta-analysis revealed a Cohen’s dz effect size of − 0.54, 95% CI [− 0.68, − 0.40], p < .001. However, when we applied methods for estimating and correcting for publication bias (based on funnel plot asymmetry and observed p-values), we found that the bias-corrected effect size became negligible with most of publication-bias methods and decreased to − 0.36 in the more optimistic of all the scenarios. A robust Bayesian meta-analysis found strong evidence in favor of publication bias, BFpb > 1000, and inconclusive evidence in favor of the effect, adjusted dz = 0.01, 95% CrI [− 0.46, 0.37], BF10 = 0.90. Furthermore, the median observed statistical power assuming the unadjusted meta-analytic effect size (i.e., − 0.54) as the true effect size was 39% (min = 19%, max = 96%), indicating that, on average, these studies only had a 39% chance of observing a significant result if the true effect was Cohen’s dz = − 0.54. If the more optimistic adjusted effect size (− 0.36) was assumed as the true effect, the median statistical power was just 20%. We conclude that the current literature is a useful case study for illustrating the dangers of conducting underpowered studies to detect the effect size of interest.

Acute and long-term renal effects after iodine contrast media–enhanced computerised tomography in the critically ill—a retrospective bi-centre cohort study

ObjectivesTo determine if current clinical use of iodine contrast media (ICM) for computerised tomography (CT) increases the risk of acute kidney injury (AKI) and long-term decline in renal function in patients treated in intensive care.MethodsA retrospective bi-centre cohort study was performed with critically ill subjects undergoing either ICM-enhanced or unenhanced CT. AKI was defined and staged based on the Kidney Disease Improve Global Outcome AKI criteria, using both creatinine and urine output criteria. Follow-up plasma creatinine was recorded three to six months after CT to assess any long-term effects of ICM on renal function.ResultsIn total, 611 patients were included in the final analysis, median age was 65.0 years (48.0–73.0, quartile 1–quartile 3 (IQR)) and 62.5% were male. Renal replacement therapy was used post-CT in 12.9% and 180-day mortality was 31.2%. Plasma creatinine level on day of CT was 100.0 µmol/L (66.0–166.5, IQR) for non-ICM group and 77.0 µmol/L (59.0–109.0, IQR) for the ICM group. The adjusted odds ratio for developing AKI if the patient received ICM was 1.03 (95% confidence interval 0.64–1.66, p = 0.90). No significant association between ICM and increase in plasma creatinine at long-term follow-up was found, with an adjusted effect size of 2.92 (95% confidence interval − 6.52–12.36, p = 0.543).ConclusionsThe results of this study do not indicate an increased risk of AKI or long-term decline in renal function when ICM is used for enhanced CT in patients treated at intensive care units.Clinical relevance statementPatients treated in intensive care units had no increased risk of acute kidney injury or persistent decline in renal function after contrast-enhanced CT. This information underlines the need for a proper risk-reward assessment before denying patients a contrast-enhanced CT.Key Points• Iodine contrast media is considered a risk factor for the development of acute kidney injury.• Patients receiving iodine contrast media did not have an increased incidence of acute kidney injury or persistent decline in renal function.• A more clearly defined risk of iodine contrast media helps guide clinical decisions whether to perform contrast-enhanced CTs or not.

Sense of coherence and religion/spirituality: A systematic review and meta-analysis based on a methodical classification of instruments measuring religion/spirituality.

The coherence hypothesis assumes that sense of coherence (SOC) explains the positive link between religion/spirituality (R/S) and mental health. The aim of our meta-analysis is to evaluate the evidence for the association between SOC (sensu Antonovsky) and different aspects of R/S and thus to contribute to the verification of the coherence hypothesis. Eighty-nine English- and German-language primarily cross-sectional studies with 67,913 participants met the inclusion criteria. The R/S scales of all included studies were subjected to item-by-item qualitative content analysis in order to determine whether scales do actually measure religion or spirituality and which R/S aspects dominated the instrument. Based on this classification, overall and subgroup meta-analyses were conducted using a random effects model. The adjusted effect size between SOC and all positive R/S measures was r+ = .120, 95% CI [.092, .149]. Particularly significant (r+ < -.180 or > .180) were correlations with negative R/S scales (r+ = -.405, 95% CI [-.476, -.333]), R/S instruments measuring primarily positive emotions (r+ = .212, 95% CI [.170, .253]) or meaning-making (r+ = .196, 95% CI [.126, .265]). Both sample characteristics (age, culture, gender, health status, religious affiliation) and study characteristics (e.g., publication year) had a moderating effect on the R/S-SOC connection. The correlation was particularly high in studies from Southern Asia (r+ = .226, 95% CI [.156, .297]), the African Islamic cultural value zone (r+ = .196, 95% CI [.106, .285]), and in a small subgroup of Iranian studies (r+ = .194, 95% CI [.117, .271]). The results confirm that R/S and SOC are clearly associated and suggest that there are different religious/spiritual pathways to a strong SOC. The strength of the associations presumably depends not only on individual differences, but also on cultural embeddedness and social plausibility of R/S. Trial registration. PROSPERO registration number: CRD42021240380. https://www.crd.york.ac.uk/prospero/display_record.php?ID = CRD42021240380.

Intentionally Slow Concentric Velocity Resistance Exercise and Strength Adaptations: A Meta-Analysis.

Hermes, MJ and Fry, AC. Intentionally slow concentric velocity resistance exercise and strength adaptations: a meta-analysis. J Strength Cond Res 37(8): e470-e484, 2023-Intentionally slow-velocity resistance exercise (ISVRE) is suggested by some to be equally or more effective than fast or traditional velocities for increasing muscular strength. The purpose of this meta-analysis was to assess the effect ISVRE has on strength adaptations compared with faster or traditional velocities, with subgroup analyses exploring age, sex, and training status as confounding factors on the influence of velocity on strength adaptation. Eligible studies (n = 24) were required to be chronic (multiple weeks) randomized or nonrandomized comparative studies using dynamic constant external resistance for training and testing, and pre-post strength assessments. All studies examined healthy individuals (n = 625; fast or traditional n = 306, intentionally slow n = 319). A random-effects meta-analysis indicated a significant (p ≤ 0.05) effect in favor of fast training (effect size [ES] = 0.21, 95% confidence interval [CI] = 0.02-0.41, p = 0.03). Publication bias was noted through trim and fill analysis, with an adjusted effect size estimate of 0.32 (p < 0.001). Subgroup analyses indicated no difference between trained and untrained subjects (QM = 0.01, p = 0.93), and no difference between older and younger subgroups (QM = 0.09, p = 0.77), despite younger favoring faster (ES = 0.23, p = 0.049) and older not favoring either velocity (ES = 0.16, p = 0.46). Subgroup analysis also indicated women favored faster training (ES = 0.95, p < 0.001) in comparison to men (ES = 0.08, p = 0.58). Contrary to some previous reviews, these results indicate that chronic fast or traditional velocity resistance exercise increases muscular strength to a greater degree than ISVRE training. Resistance training velocity must be considered if strength is a desired outcome.

Effectiveness of conceptual change strategies in science education: A meta‐analysis

AbstractThere is extensive literature focusing on students' misconceptions in various subject domains. Several conceptual change approaches have been trying to understand how conceptual change occurs to help learners handle these misconceptions. This meta‐analysis aims to integrate studies investigating the effectiveness of three types of conceptual change strategy: cognitive conflict, cognitive bridging, and ontological category shift in science learning. We conducted a random‐effects meta‐analysis to calculate an overall effect size in Hedges' g with a sample of 218 primary studies, including 18,051 students. Our analyses resulted in a large overall effect size (g = 1.10, 95% CI [1.01, 1.19], k = 218, p &lt; 0.001). We also performed a robust Bayesian meta‐analysis to calculate an adjusted effect size, which specified a large effect (adjusted g = 0.93, 95% CI [0.68, 1.07], k = 218). Results are also consistent across the conceptual change strategies of cognitive conflict (g = 1.10, 95% CI [0.99, 1.21], k = 150, p &lt; 0.001), cognitive bridging (g = 1.06, 95% CI [0.84, 1.28], k = 30, p &lt; 0.001), and ontological category shift (g = 0.88, 95% CI [0.50, 1.26], k = 9, p &lt; 0.001). However, a wide‐ranging prediction interval [0.19, 2.38] points out a high level of heterogeneity in the distribution of effect sizes. Thus, we investigated the moderating effects of several variables using simple and multiple meta‐regression. The final meta‐regression model we created explained 35% of overall heterogeneity. This meta‐analysis provides robust evidence that conceptual change strategies significantly enhance students' learning in science.

Nonalcoholic Fatty Liver Disease Is Associated With Decreased Bone Mineral Density in Adults: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to investigate the effect of nonalcoholic fatty liver disease (NAFLD) on bone mineral density (BMD) and the risk of osteoporosis and osteoporotic fracture in adults. We searched PubMed, MEDLINE, Embase, CINAHL, Web of Science, Cochrane Library, and Scopus for observational studies published from inception to January 2023 that reported adjusted effect sizes of NAFLD on BMD, osteopenia/osteoporosis, and osteoporotic fracture. The data were synthesized using multilevel and random-effects models. A total of 19 studies were included; of these, nine (21,294 participants) evaluated the effect of NAFLD on BMD, six (133,319 participants) investigated the risk of osteoporosis, and five (227,901 participants) assessed the risk of osteoporotic fracture. This meta-analysis showed that NAFLD was associated with decreased BMD (mean difference -0.019 g/cm2 , 95% confidence interval [CI] -0.036 to -0.002, I2 = 93%) and increased risks of osteoporosis (adjusted risk ratio [RR] = 1.28, 95% CI 1.08 to 1.52, I2 = 84%) and osteoporotic fractures (adjusted RR = 1.17, 95% CI 1.00 to 1.37, I2 = 67%). Subgroup analyses revealed that NAFLD had a significantly detrimental effect on BMD in men and on the BMD of the femoral neck and total hip. Stratified analyses by ethnicity demonstrated that NAFLD was not associated with BMD, osteoporosis, or osteoporotic fracture in non-Asian populations. The publication bias of all included studies was low; however, there was considerable heterogeneity among the studies, warranting a careful interpretation of the findings. Overall, our results suggest that NAFLD is associated with decreased BMD and an increased risk of osteoporosis or osteoporotic fractures. Male sex and the BMD of the femoral neck and total hip may be potential risk factors for decreased BMD in adults with NAFLD. Additionally, ethnic disparities were observed between Asian and non-Asian populations regarding BMD and osteoporotic fractures. © 2023 American Society for Bone and Mineral Research (ASBMR).

Postoperative acute pain management with duloxetine as compared to placebo: A systematic review with meta-analysis of randomized clinical trials.

Duloxetine has been used as an adjunct in multimodal analgesia for acute postoperative pain in clinical studies. This meta-analysis aims to conclude whether oral duloxetine, when given perioperatively, is any better than a placebo in managing postoperative pain. Effects of duloxetine on postoperative pain scores, time to first rescue analgesia, postoperative rescue analgesia consumption, side effects attributable to duloxetine, and patient satisfaction profile were assessed. MEDLINE, Web of Science, EMBASE, Scholar Google, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched with keywords including "Duloxetine" AND "postoperative pain", "Duloxetine" AND "acute pain" and with "Duloxetine" till October 2022. This meta-analysis included randomized clinical trials in which perioperative duloxetine 60 mg per oral was administered not more than 7 days before surgery and for at least 24 after surgery but not more than 14 days after surgery. All RCTs in which the comparator is placebo and outcomes related to analgesic efficacy like pain scores, opioid consumption, and side effects of duloxetine until 48 h postoperatively were included. Data were extracted from the studies and a risk of bias summary was formed using the Cochrane Collaboration tool. Effect sizes were given as standardized mean differences for continuous outcomes and risk ratios (RR) by the Mantel-Haenszel test for the categorical outcome. Confirmation of publication bias was done by Egger's regression test (p < 0.05). If publication bias or heterogeneity was detected, the trim-and-fill method was used to calculate the adjusted effect size. Sensitivity analysis was done by leaving one out method after excluding the study with a high risk of bias. Subgroup analysis was done based on the type of surgery and gender. The study was prospectively registered in the PROSPERO under the registration number CRD42019139559. 29 studies with 2043 patients met the inclusion criteria and were reviewed for this meta-analysis. Postoperative pain scores at 24 h [Std. Mean Difference (95% CI); -0.69 (-1.07, -0.32)] and at 48 h [-1.13 (-1.68, -0.58)] are significantly less with duloxetine (p-value < 0.05). Time to first rescue analgesia was significantly more in patients where duloxetine was administered [1.27 (1.10, 1.45); p-value > 0.05]. Opioid consumption up to 24 h [-1.82 (-2.46, -1.18)] and 48 h [-2.48 (-3.46, -1.50)] was significantly less (p-value < 0.05) in patients who received duloxetine. Complications and recovery profiles were similar in patients receiving either duloxetine or a placebo. Based on GRADE findings, we conclude that there is low to moderate evidence to advocate the use of duloxetine for managing postoperative pain. Further trials are needed to replicate or refute these results based on robust methodology.

The impact of a universal social emotional intervention on students’ mental wellbeing in a secondary public school in Qatar

This paper is based on a study that explored the impact of a practitioner-designed social emotional program on students’ wellbeing based on the results of the WEMWBS scale in a public secondary school in Qatar. This cluster randomized controlled trial study (RCT) involved the assignment of two groups; an intervention group (n = 82) to receive a universal social emotional intervention and a control group (n = 81) to continue with the usual practices without attending or participating in any social emotional interventions. Students in both groups rated their wellbeing levels before the intervention (baseline) and after the intervention (post intervention). The results revealed a significant improvement in students’ wellbeing after participating in the SEL intervention with an adjusted effect size of (EF = 0.76). The paper discusses the results of this study in the light of the program’s design and social context.

Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: A systematic review and meta-analysis.

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with other psychiatric and physical diseases. However, available evidence on associations between ADHD and cardiovascular diseases (CVDs) is mixed. To systematically review, quantitatively synthesize, and appraise available evidence on the link between ADHD with CVDs, we searched relevant articles in PubMed, Embase, PsycINFO, and Web of Science from inception to May 1, 2022. Study quality was assessed by using the Newcastle-Ottawa Scale, and random-effects model meta-analyses were performed. A total of 18,391,169 (ADHD: n=421,224) individuals from 11 studies were included in our systematic review and 8,196,648 (ADHD=332,619) individuals from five studies were included in the main meta-analysis of adjusted estimates. Pooled estimates showed that ADHD was significantly associated with an increased risk of CVDs in analyses based on adjusted effect size (odds ratio (OR)=1.96; 95% confidence interval (CI)=1.19-2.23, Q=140.74, P Q<0.001, I 2=97.2%). When restricted among adults, the heterogeneity declined to null (OR=1.73; 95% CI=1.14-2.62, Q=6.28, P Q=0.10, I 2=6.28%), suggesting age might be the main source of heterogeneity. In subgroup analyses, we found increased risk of CVDs associated with ADHD across age groups, type of CVDs, and data sources. This systematic review and meta-analyses indicate that ADHD is associated with increased risk for CVDs, but further studies with various study designs are warranted to advance the understanding of the underlying mechanisms for the observed association between ADHD and CVDs. Additional research is also needed to resolve the role of ADHD medications which remains unclear due to the limited number of primary studies exploring this issue.

Publication bias in meta-analyses of the therapeutic efficacy of remdesivir interventions for patients with COVID-19

Purpose No comprehensive statistical assessment of publication bias has been conducted in remdesivir-based intervention research for COVID-19 patients. This study aims to examine all meta-analyses of the efficacy of remdesivir interventions in COVID-19 patients and perform a statistical assessment of publication bias. Design/methodology/approach This is an analytic study conducted to assess the impact of publication bias on the results of meta-analyses of remdesivir-based interventions in patients infected with COVID-19. All English full-text meta-analyses published in peer-reviewed journals in 2019–2021 were included. A computerized search of PubMed and Web of Science electronic databases was performed on December 24, 2021. The trim-and-fill method calculated the number of missing studies and the adjusted cumulative effect sizes. Findings The final analysis comprised 21 studies with 88 outcomes. The investigation revealed missing studies in 46 outcomes (52%). Seventy-six missing studies were replaced in the outcomes using the trim-and-fill procedure. The adjusted recalculated effect sizes of the 27 outcomes increased by an average of 0.04. In comparison, the adjusted effect size of 18 outcomes fell by an average of 0.036. Only 14 out of 46 outcomes with publication bias were subjected to a gray literature search (30%). To discover related research, no gray literature search was conducted in most outcomes with publication bias (n = 32; 70%). In conclusion, the reported effect estimates regarding the effect of remdesivir in COVID-19 patients are only slightly affected by publication bias and can be considered authentic. Health-care decision-makers in COVID-19 should consider current research results when making clinical decisions. Research limitations/implications Most health decisions are based on the effect sizes revealed in meta-analyses. When deciding on remdesivir-based treatment for COVID-19 patients, therefore, the outcomes of this investigation may be of paramount importance to health policymakers, leading to better treatment strategies. Practical implications According to the results, no major publication bias and missing studies were detected on average. Therefore, the calculated effect sizes of remdesivir-based interventions on meta-analyses can be used as authentic and unbiased benchmarks by health-care decision-makers in treating patients with COVID-19. Originality/value This is the first study to examine the effect of publication bias and gray literature searches on the results of meta-analyses of treatment with COVID-19 (remdesivir).

Creative Arts Therapy Among Children With Cancer: Symptom Assessment Reveals Reduced Anxiety.

Symptom distress is related to decreased quality of life (QOL) among children with cancer, with high levels of pain, nausea, and anxiety reported. Creative arts therapy (CAT) has been related to improved QOL and symptoms in pediatric oncology, but the quality of evidence is mixed. This article aims to examine the QOL symptom subscales in relation to CAT over time in children during the first year of cancer treatment. A secondary analysis of prospective data was performed with linear mixed modeling on 267 observations with predictors of 2 groups: No CAT (n = 18) vs CAT (n = 65). The covariate of time (6 months) was used to explore the CAT relationship with the Pediatric Quality of Life Inventory (PedsQL) symptom subscales (pain and hurt, nausea, procedural anxiety, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication). Children (n = 83) were between 3 and 17 years old (M = 6), 51.2% female, and 32% minority. All tumor types were represented: liquid (37.3%), solid (24.1%), and central nervous system (38.6%). Reduced child report of procedural anxiety was significantly related to receiving CAT with a medium magnitude of association (adjusted effect size = 0.58, P = .01). Creative arts interventions were associated with a longitudinal improvement in anxiety in children with cancer. Further work is needed to target interventions to the appropriate specific burdensome symptoms. Pediatric oncology nurses can advocate for CAT as an effective intervention to ameliorate the burdensome procedural anxiety experienced by patients.

Association of organizational culture and climate with variation in the clinical outcomes of collaborative care for maternal depression in community health centers.

Organizational factors may help explain variation in the effectiveness of evidence-based clinical innovations through implementation and sustainment. This study tested the relationship between organizational culture and climate and variation in clinical outcomes of the Collaborative Care Model (CoCM) for treatment of maternal depression implemented in community health centers. Organizational cultures and climates of 10 community health centers providing CoCM for depression among low-income women pregnant or parenting were assessed using the organizational social context (OSC) measure. Three-level hierarchical linear models tested whether variation in culture and climate predicted variation in improvement in depression symptoms from baseline to 6.5-month post-baseline for N = 468 women with care ±1 year of OSC assessment. Depression symptomology was measured using the Patient Health Questionnaire (PHQ-9). After controlling for patient characteristics, case mix, center size, and implementation support, patients served by centers with more proficient cultures improved significantly more from baseline to 6.5-month post-baseline than patients in centers with less proficient cultures (mean improvement = 5.08 vs. 0.14, respectively, p = .020), resulting in a large adjusted effect size of dadj = 0.78. A similar effect was observed for patients served by centers with more functional climates (mean improvement = 5.25 vs. 1.12, p < .044, dadj = 0.65). Growth models indicated that patients from all centers recovered on average after 4 months of care. However, those with more proficient cultures remained stabilized whereas patients served by centers with less proficient cultures deteriorated by 6.5-month post-baseline. A similar pattern was observed for functional climate. Variation in clinical outcomes for women from historically underserved populations receiving Collaborative Care for maternal depression was associated with the organizational cultures and climates of community health centers. Implementation strategies targeting culture and climate may improve the implementation and effectiveness of integrated behavioral health care for depression.

Increased serum cotinine and obesity negatively impact asthma exacerbations and hospitalizations: A cross-sectional analysis of NHANES.

Asthma is the most common non-communicable chronic airway disease worldwide. Obesity and cigarette use independently increase asthma morbidity and mortality. Current literature suggests that obesity and smoking synergistically increase asthma-related wheezing. To assess whether increased serum cotinine and obesity act synergistically to increase the likelihood of having an asthma exacerbation, emergency department (ED) visit, or hospitalization. A cross-sectional analysis of the 2011-2015 iterations of NHANES database was performed. Patients aged 18 years or greater with asthma were included. Serum cotinine was utilized as an accurate measurement of cigarette use. Logistic regression models were constructed to determine whether elevated serum cotinine and obesity were associated with self-reported asthma exacerbations, asthma-specific ED usage, and hospitalizations for any reason in the past year. Odds ratios were adjusted for age, gender, race, and ethnicity. Interactions were assessed by multiplying the adjusted effect sizes for elevated cotinine and obesity. We identified 2179 (N = 32,839,290) patients with asthma, of which 32.2% were active smokers and 42.7% were obese. Patients with an elevated cotinine and asthma were significantly more likely to have had an asthma-related ED visit in the past year (adjusted odds ratio [AOR] 1.82; 95% CI 1.19-2.79), have a physician-prescribed asthma medication (AOR 2.04; 95% CI 1.11-3.74), and have a hospitalization for any reason (AOR 3.65; 95% CI 1.88-7.07) compared to those with low cotinine. Patients with asthma and obesity were more likely to have an asthma-related ED visit (AOR 1.67; 95% CI 1.06-2.62) or hospitalization for any reason in the past year compared to non-obese patients (AOR 2.76; 95% CI 1.69-4.5). However, a statistically significant interaction between obesity and cotinine was only identified in patients who currently have asthma compared to a previous asthma diagnosis (AOR 1.76; 95% CI 1.10-2.82). There were no synergistic interactions among ED usage or asthma exacerbations. Nearly one-third of patients with asthma were current smokers, and almost half were obese. This study identified elevated serum cotinine, a metabolite of cigarette use, and obesity as key risk factors for asthma exacerbations, asthma-related ED visits, and hospitalizations for any reason. Elevated serum cotinine and obesity were not found to act synergistically in increasing asthma exacerbations or ED visits. However, the presence of both risk factors increased the risk of currently having asthma (compared to a previous diagnosis) by 76%. Serum cotinine may be useful in predicting asthma outcomes.

Liver fibrosis scores and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis.

In patients with nonalcoholic fatty liver disease, liver fibrosis was associated with a higher risk of cardiovascular events. However, the relationship between liver fibrosis scores and clinical outcomes in patients with cardiovascular disease remains unclear. Searching from PubMed, EMBASE and Cochrane Library databases yielded cohort studies that reported adjusted effect size between liver fibrosis scores (Fibrosis-4 score [FIB-4] or NAFLD fibrosis score [NFS]) and prognosis in patients with cardiovascular disease. The effect size was computed using a random-effects model. This meta-analysis included twelve cohort studies involving 25,252 patients with cardiovascular disease. Participants with the highest baseline level of FIB-4 or NFS had a significantly increased risk of cardiovascular events (FIB-4, HR: 1.75, 95% CI: 1.53-2.00, I 2 = 0%; NFS, HR: 1.92, 95% CI: 1.50-2.47, I 2 =47%). This finding was consistent with the analysis of FIB-4 or NFS as a continuous variable (per 1-unit increment FIB-4, HR: 1.15, 95% CI: 1.06-1.24, I 2 = 72%; NFS, HR: 1.15, 95% CI: 1.07-1.24, I 2 = 71%). Furthermore, participants with the highest levels of FIB-4 or NFS had a greater risk of cardiovascular mortality (FIB-4, HR: 2.07, 95% CI: 1.19-3.61, I 2 =89%; NFS, HR: 3.72, 95% CI: 2.62-5.29, I 2 =60%) and all-cause mortality (FIB-4, HR: 1.81, 95% CI: 1.24-2.66, I 2 =90%; NFS, HR: 3.49, 95% CI: 2.82-4.31, I 2 =25%). This result was also consistent as a continuous variable. Higher levels of FIB-4 and NFS are related to an increased risk of cardiovascular events, cardiovascular mortality and all-cause mortality in patients with cardiovascular disease.

Sedentary behavior and the risk of stroke: A systematic review and dose-response meta-analysis

Background and aimsThe sedentary behavior in people's daily life has continued to increase in recent years, causing many studies to focus on its relationship with diseases. Several studies have shown that sedentary behavior is an independent risk factor for cardiovascular disease and metabolic disease. Therefore, we performed a meta-analysis to assess the association between sedentary behavior and the risk of stroke. Methods and resultsTwo independent investigators searched for prospective cohort studies on the association between sedentary behavior and stroke risk, published before February 2022. We pooled adjusted effect size and performed the dose-response analysis by random-effect model. Seven studies with 677,614 participants and 15,135 stroke events during a median follow-up of 12.2 years were included. The pooled hazard ratio (HR) of stroke was 1.16 (95% confidence interval [CI]: 1.09–1.24) with no significant heterogeneity (I2 = 0.0%, p for heterogeneity = 0.983). In dose-response analysis, a nonlinear association between sedentary behavior and stroke risk was discovered. Stroke risk began to increase when sedentary time exceeded 3.7 h/d (HR, 1.01; 95% CI, 0.97–1.05). And when reached 11 h/d, a significantly increased risk of stroke was observed (HR, 1.21; 95% CI 1.12–1.31). ConclusionA nonlinear association was found in the dose-response analysis, with increased risk only when sedentary time exceeded a certain level. Further research is needed to explain the biological mechanisms by which sedentary time above a certain threshold significantly increases stroke risk. (PROSPERO registration number: CRD42022311544)

Effectiveness of an integrated agriculture, nutrition-specific, and nutrition-sensitive program on child growth in Western Kenya: a cluster-randomized controlled trial

ABSTRACTBackgroundStunting rates remain unacceptably high in many regions, including sub-Saharan Africa. Agricultural programs have led to increased yields and household incomes but showed limited success in improving nutritional status.ObjectivesWe assessed whether linear growth could be improved through a potentially scalable, integrated program adding nutrition-specific and nutrition-sensitive components to an existing agricultural program.MethodsIn this cluster-randomized controlled trial in rural Western Kenya, we randomized children aged 6–35 months from farming families to an agricultural intervention without (control group) or with a bundle of interventions (intervention group), including distribution of micronutrient powders (MNP), poultry to increase egg consumption, seeds of greens and onions, and soap and chlorine solution, as well as provision of monthly behavior change trainings. The primary outcome was the change in height-for-age z-score (HAZ) over 2 years of follow-up. We assessed safety through active morbidity and passive adverse event monitoring. We conducted an intention-to-treat analysis, followed by per-protocol and prespecified subgroup analyses.ResultsFrom March to April 2018, we enrolled 1927 children from 126 clusters (control, 942 children in 63 clusters; intervention, 985 children in 63 clusters). Data on HAZ were available for 1672 (86.6%) children after 2 years. Adherence was >80% for use of MNP, chlorine, and greens and receipt of soap, and ∼40% for egg and red onion consumption. The intention-to-treat analysis indicated a greater change in HAZ over 2 years in the intervention group (adjusted effect size, 0.11; 95% CI: 0.02–0.19). We found a slightly stronger effect in the per-protocol analysis (adjusted effect size, 0.15; 95% CI: 0.06–0.24). Dietary diversity and consumption of iron-rich foods were improved in the intervention group, and reported instances of fever, lower respiratory tract infections, and diarrheal episodes were lower in the intervention group.ConclusionsThis study found a modest improvement in linear growth, indicating the need for multiple, integrated interventions to achieve benefits. The trial was registered with clinicaltrials.gov as NCT03448484.

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

Association of Drug Cues and Craving With Drug Use and Relapse

Craving, which is a strong desire for drugs, is a new DSM-5 diagnostic criterion for substance use disorders (SUDs), which are the most prevalent, costly, and deadly forms of psychopathology. Despite decades of research, the roles of drug cues and craving in drug use and relapse remain controversial. To assess whether 4 types of drug cue and craving indicators, including cue exposure, physiological cue reactivity, cue-induced craving, and self-reported craving (without cue exposure), are prospectively associated with drug use and relapse. Google Scholar was searched for published studies from inception through December 31, 2018. In addition, backward and forward searches were performed on included articles to identify additional articles. Included studies reported a prospective statistic that linked cue and craving indicators at time 1 to drug use or relapse at time 2, in humans. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Study characteristics and statistics were extracted and/or coded by 1 of the 2 authors and then checked by the other. Statistical analyses were performed from May to July 2021. Random-effects models were used to calculate prospective odds ratios (ORs) representing the association between cue and craving indicators and subsequent drug use/relapse. A total of 18 205 records were identified, and 237 studies were included. Across 656 statistics, representing 51 788 human participants (21 216 with confirmed SUDs), a significant prospective association of all cue and craving indicators with drug use/relapse was found (OR, 2.05; 95% CI, 1.94-2.15), such that a 1-unit increase in cue and craving indicators was associated with more than double the odds of future drug use or relapse. A Rosenthal fail-safe analysis revealed that 180 092 null studies would need to be published to nullify this finding. Trim-and-fill analysis brought the adjusted effect size to an OR of 1.31 (95% CI, 1.25-1.38). Moderator analyses showed that some of the strongest associations were found for cue-induced craving, real cues or images, drug use outcome, same-day time lag, studies using ecological momentary assessment, and male participants. Findings from this systematic review and meta-analysis suggest that drug cue and craving indicators play significant roles in drug use and relapse outcomes and are an important mechanism underlying SUDs. Clinically, these results support incorporating craving assessment across stages of treatment, as early as primary care.

Regulation of NLRP3 inflammasome by zinc supplementation in Behçet's disease patients: A double-blind, randomized placebo-controlled clinical trial

BackgroundOverproduction of NLRP3 inflammasome complex is one of the causes of Behcet's disease's (BD) auto-inflammatory nature. The aim of current study was to examine the effect of zinc supplementation on NLRP3 inflammasome expression; as well as clinical manifestations of BD. MethodsIn this double-blind parallel placebo-controlled randomized clinical trial, 50 BD patients were randomly allocated into either zinc gluconate (30 mg/day elemental zinc) or placebo groups for 12 weeks. The mRNA expression of NLRP3 and caspase-1 in the leukocytes, serum level of zinc and IL-1β, anthropometric measures, and clinical manifestations of patients were collected at pre- and post-intervention phase. The Iranian Behçet's disease dynamic activity measure (IBDDAM) was scored to measure the treatment effect using the calculation of number needed to treat (NNT). Analysis of covariance was performed to obtain the corresponding effect sizes. ResultsZinc gluconate led to a significant improvement in genital ulcer (P = 0.019). Zinc supplementation decreased NLRP3 and caspase-1 genes expression compared with placebo group (baseline-adjusted P-value = 0.046 for NLRP3 and P-value = 0.003 for caspase-1), even after adjustment for the effect of confounding factors (baseline- and confounders-adjusted P-value = 0.032 for NLRP3 and P-value = 0.004 for caspase-1). Baseline and confounders adjusted effect size demonstrated that zinc was effective in reducing the serum level of IL-1β (P = 0.046). The NNT [95 %CI] for the rate of IBDDAM improvement was 3 [1.7–8.5]. ConclusionsZinc gluconate supplementation (30 mg/day) for a 3-month period can be considered as an adjuvant therapy in alleviating inflammation and genital ulcer among BD patients.

Quantitative evaluation of upper limb ataxia in spinocerebellar ataxias

ObjectiveTo quantitatively evaluate upper limb ataxia using a novel pen‐like sensor device in patients with spinocerebellar ataxia (SCA) and to assess its validity, reliability, and sensitivity to disease progression.MethodsWe designed a cross‐sectional and longitudinal study of patients with SCA and healthy controls. Upper limb ataxia was evaluated using a device that measures the three‐dimensional position every 10 msec. Participants were instructed to move a pen‐like part of the device iteratively between two buttons. We evaluated the time, length, velocity, and variation coefficient of the stroke, and calculated the distortion index using the mean squared error. The following scales were also evaluated: Scale for the Assessment and Rating of Ataxia (SARA), the International Cooperative Ataxia Rating Scale (ICARS), and the nine‐hole pegboard test. Subjects were followed 12 months after the baseline evaluation.ResultsA total of 42 patients with SCA and 33 healthy controls were enrolled and evaluated. For all ataxia indices measured using the device there were significant differences between healthy controls and patients with SCA. Among the ataxia indices, the distortion index showed the strongest correlation with the SARA and ICARS upper limb score (Pearson's r = 0.647 and 0.722, respectively). Test–retest reliability was high for most of the ataxia indices. In the longitudinal analysis, the distortion index showed high standardized response mean and adjusted effect size, regardless of disease severity.InterpretationOur study demonstrated that the distortion index is a reliable functional marker that is sensitive to longitudinal change in patients with SCA.