Funnel Plot Research Articles

The Use of Nudge Strategies in Improving Physicians’ Prescribing Behavior: A Systematic Review and Meta-analysis

Background Nudges have been proposed as a method of influencing prescribing decisions. Purpose The purpose of this article is to 1) investigate associations between nudges’ characteristics and effectiveness, 2) assess the quality of the literature, 3) assess cost-effectiveness, and 4) create a synthesis with policy recommendations. Methods We searched health and social science databases. We included studies that targeted prescribing decisions, included a nudge, and used prescribing behavior as the outcome. We recorded study characteristics, effect size of the primary outcomes, and information on cost-effectiveness. We performed a meta-analysis on the standardized mean difference of the studies’ primary outcomes, tested for associations between effect size and key intervention characteristics, and created a funnel plot evaluating publication bias. Synthesis We identified 21 studies containing 25 nudges. In total, 62 of 85 (73%) outcomes showed a statistically significant effect. The average effect size was −0.22 standardized mean difference. No studies included heterogeneity analyses. We found no associations between effects and selected study characteristics. Study quality varied and correlated with study design. A total of 7 of 21 (33%) studies included an evaluation of costs. These studies suggested that the interventions were cost-effective but considered only direct effects. We found evidence of publication bias. Limitations Heterogeneity and few studies limit the possibilities of statistical inference about effectiveness. Conclusions Nudges may be effective at directing prescribing decisions, but effects are small and health effects and cost-effectiveness are unclear. Future nudge studies should contain a rationale for the chosen nudge, prioritize the use of high-quality study designs, and include evaluations of heterogeneity, cost-effectiveness, and health outcomes to inform decision makers. Moreover, preregistration of the protocol is warranted to limit publication bias. Highlights Nudging as a method to improve prescribing decisions has gained popularity during the past decade. We find that nudging can improve prescribing decisions, but effect sizes are mostly small, and the size of derived health outcomes is unclear. Most studies use feedback and error-stopping nudges to target excessive opioid or antibiotic prescribing, making heterogeneity analyses across nudge types difficult. Further research on the cost-effectiveness of nudges and generalizability is needed to guide decision makers considering nudging as a tool to guide prescribing decisions.

Effectiveness and safety of Arecae Semen compounds for patients with depression: a systematic review and meta-analysis

BackgroundArecae Semen is a traditional herbal medicine widely used in the medical service and food industry, but in recent years, the carcinogenesis of edible Arecae Semen chewing has aroused comprehensive attention, therefore it is necessary to evaluate its medicinal properties. Increasing evidence has shown that Arecae Semen Compounds (ASC) possess antidepressant ability. This study aimed to evaluate the effectiveness and safety of ASC in the treatment of depression.MethodsWe retrieved articles in eight databases from their inception to May 2024. Randomized controlled trials (RCTs) comparing the effects of ASC alone or combined with routine treatment in patients with depression were identified. The Cochrane risk of bias (ROB) tool (ROB 2) was used for assessing the ROB in the included trials. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of the evidence for the review outcomes. The outcomes included Hamilton depression rating scale (HAMD) scores, depression-related symptoms, serum dopamine levels, and adverse events. Stata 14.0 was used for data analysis calculating standardized mean difference (SMD) for continuous outcomes and relative risk (RR) for binary outcomes, both with 95% confidence intervals (CI).ResultsNine RCTs involving 787 patients were included in this review. ASC lowered HAMD scores (SMD − 3.43, 95% CI − 5.24 to − 1.61; I2 = 95.2%, P < 0.001), alleviated depression-related symptoms, increased serum dopamine levels, and reduced the incidence of adverse events slightly (RR 0.18, 95% CI 0.04 to 0.77; I2 = 0, P = 0.775) compared with the control group. Publication bias might account for the asymmetrical presentation of funnel plots. Meta-regression analysis revealed that regarding HAMD scores, there was no significant relationship with duration, sample size, or treatment strategy. The evidence of the outcomes was of very low certainty.ConclusionsASC may achieve better therapeutic effects, alleviate depression-related symptoms with a lower incidence of adverse events, and provide a potentially effective and safe complementary therapy for patients with depression. However, the evidence is very uncertain so further researches are required to validate our results and explore clinical implications of Arecae Semen in depth.Systematic review registrationPROSPERO CRD42022361150.

Assessing the Evidence for Nonobstetric Risk Factors for Deformational Plagiocephaly: Systematic Review and Meta-Analysis.

Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry. The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP. The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots. A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP.Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected. This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed. PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979.

Computer-aided diagnosis for the resect-and-discard strategy for colorectal polyps: a systematic review and meta-analysis

The resect-and-discard strategy allows endoscopists to replace post-polypectomy pathology with real-time prediction of polyp histology during colonoscopy (optical diagnosis). We aimed to investigate the benefits and harms of implementing computer-aided diagnosis (CADx) for polyp pathology into the resect-and-discard strategy. In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Scopus from database inception to June 5, 2024, without language restrictions, for diagnostic accuracy studies that assessed the performance of real-time CADx systems, compared with histology, for the optical diagnosis of diminutive polyps (≤5 mm) in the entire colon. We synthesised data for three strategies: CADx-alone, CADx-unassisted, and CADx-assisted; when the endoscopist was involved in the optical diagnosis, we synthesised data exclusively from diagnoses for which confidence in the prediction was reported as high. The primary outcomes were the proportion of polyps that would have avoided pathological assessment (ie, the proportion optically diagnosed with high confidence; main benefit) and the proportion of polyps incorrectly predicted due to false positives and false negatives (main harm), directly compared between CADx-assisted and CADx-unassisted strategies. We used DerSimonian and Laird's random-effects model to calculate all outcomes. We used Higgins I2 to assess heterogeneity, the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate certainty, and funnel plots and Egger's test to examine publication bias. This study is registered with PROSPERO, CRD42024508440. We found 1019 studies, of which 11 (7400 diminutive polyps, 3769 patients, and 185 endoscopists) were included in the final meta-analysis. Three studies (1817 patients and 4086 polyps [2148 neoplastic and 1938 non-neoplastic]) provided data to directly compare the primary outcome measures between the CADx-unassisted and CADx-assisted strategies. We found no significant difference between the CADx-assisted and CADx-unassisted strategies for the proportion of polyps that would have avoided pathological assessment (90% [88-93], 3653 [89·4%] of 4086 polyps diagnosed with high confidence vs 90% [95% CI 85-94], 3588 [87·8%] of 4086 polyps diagnosed with high confidence; risk ratio 1·01 [95% CI 0·99-1·04; I2=53·49%; low-certainty evidence; Egger's test p=0·18). The proportion of incorrectly predicted polyps was lower with the CADx-assisted strategy than with the CADx-unassisted strategy (12% [95% CI 7-17], 523 [14·3%] of 3653 polyps incorrectly predicted with a CADx-assisted strategy vs 13% [6-20], 582 [16·2%] of 3588 polyps incorrectly diagnosed with a CADx-unassisted strategy; risk ratio 0·88 [95% CI 0·79-0·98]; I2=0·00%; low-certainty evidence; Egger's test p=0·18). CADx did not produce benefit nor harm for the resect-and-discard strategy, questioning its value in clinical practice. Improving the accuracy and explainability of CADx is desired. European Commission (Horizon Europe), the Japan Society of Promotion of Science, and Associazione Italiana per la Ricerca sul Cancro.

Health care providers`attitude and associated factors to safe abortion in Ethiopia, 2023: A systematic review and meta-analysis.

In sub-Saharan Africa, the number of maternal deaths due to unsafe abortions has been gradually rising. In Ethiopia, unplanned pregnancies contribute to 25% of births, accounting for 6%-9% of the maternal deaths resulting from unsafe abortions. Despite several disjointed cross-sectional studies that have been carried out in the past, there is no comprehensive data on the attitudes of healthcare practitioners and other related aspects regarding safe abortion in Ethiopia. This study attempted to measure pooled health care providers' attitudes and determinants of safe abortion in Ethiopia. African Journals Online, Medline/PubMed, EMBASE, Science Direct, Hinari, and Google Scholar were the databases that were accessed. The studies were evaluated critically by using the Joanna Briggs Critical Appraisal methods. The study followed the recommendations set forth by Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Data were extracted in an Excel spreadsheet and imported to STATA versions 17 software for meta-analysis. The random- effects model was used to pooled the health care providers' attitudes toward safe abortion. Heterogeneity between studies was evaluated using the Cochrane Q-test and I2 statistics (I squared statistics). To evaluate publication bias, egger's tests and funnel plots were employed. Forest plot was used to present the odds ratio (OR) with a 95% confidence interval. In this review and meta-analysis, a total of eight papers with a 2,826 sample size were considered. Overall, 65.49% of Ethiopian health care professionals had a positive attitude towards safe abortion (95%CI: 49.64, 81.34; I2 = 99.20%, P = 0.000). Knowledge of the abortion law (OR = 2.25, 95% CI: 1.06, 3.43), being a male provider (OR = 1.89, 95% CI: 1.23, 2.54), receiving training on abortion (OR = 2.91, 95% CI: 1.17, 4.65), working as a midwife (OR = 3.029, 95% CI: 1.605, 4.453) and practicing abortion procedures (OR = 2.55, 95% CI: 1.32, 3.78) were positively associated with the attitudes of the providers regarding safe abortion in Ethiopia. In Ethiopia, there was a low pooled prevalence of positive attitude towards safe abortion. Safe abortion services in Ethiopia are more likely to be viewed favorably by health care professionals who have received abortion service training and are familiar with abortion laws. As a result, it is imperative that all healthcare facilities and other relevant parties ensure that health professionals receive training on safe abortion services and are aware of Ethiopia's abortion laws.

Curative Effect of Electroacupuncture and Manual Acupuncture for Knee Osteoarthritis: A Meta-Analysis.

We aimed to examine how electroacupuncture and manual acupuncture affect treatment results, pain levels, and joint function in individuals with knee osteoarthritis. Research was carried out in various databases including PubMed, Medline, Embase, CENTRAL, and CNKI. Following the "Cochrane manual", the risk of bias of included RCTs was assessed. A funnel plot was utilized to evaluate any potential bias in the publications. The impact size was indicated by the average discrepancy along with its 95% confidence interval. The EA group showed a higher effectiveness rate (P = 0.001) and a lower WOMAC pain score (P < 0.00001) compared to the control group. The EA group had a lower WOMAC pain score compared to the SA/exercise group and the group that received manual acupuncture. The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group under intense electroacupuncture stimulation (P < 0.0001). The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group when weak current acupuncture was applied (P = 0.0001). However, no significant difference in WOMAC function score between EA and control group. Comparison to manual acupuncture, placebo acupuncture, and exercise training, electroacupuncture enhanced the effectiveness of treating KOA and decreased the WOMAC pain score in patients with KOA. The level of pain relief achieved may be linked to the strength of the current stimulation. However, electroacupuncture had no significant effect on WOMAC function score.

Prevalence and epidemiological distribution of indicators of pathogenic bacteria in households drinking water in Ethiopia: a systematic review and meta-analysis

BackgroundEnsuring the availability of safe drinking water remains a critical challenge in developing countries, including Ethiopia. Therefore, this paper aimed to investigate the prevalence of fecal coliform and E. coli bacteria and, geographical, children availability, and seasonal exposure assessment through a meta-analysis.MethodsTwo independent review groups extensively searched internet databases for English-language research articles published between 2013 and 2023. This systematic review and meta-analysis followed PRISMA guidelines. The methodological quality of each included study was evaluated using the STROBE guidelines. Publication bias was assessed by visual inspection of a funnel plot and then tested by the Egger regression test, and meta-analysis was performed using DerSimonian and Laird random-effects models with inverse variance weighting. Subgroup analyses were also conducted to explore heterogeneity.ResultsOut of 48 potentially relevant studies, only 21 fulfilled the inclusion criteria and were considered for meta-analysis. The pooled prevalence of fecal coliform and E. coli was 64% (95% CI: 56.0–71.0%, I2 = 95.8%) and 54% (95% CI: 45.7–62.3%, I2 = 94.2%), respectively. Subgroup analysis revealed that the prevalence of fecal coliform bacteria increased during the wet season (70%) compared to the dry season (60%), particularly in households with under-five children (74%) compared to all households (61%), in rural (68%) versus urban (66%) areas, and in regions with high prevalence such as Amhara (71%), Gambela (71%), and Oromia (70%). Similarly, the prevalence of E. coli was higher in households with under-five children (66%) than in all households (46%).ConclusionsThe analysis highlights the higher prevalence of fecal coliform and E. coli within households drinking water, indicating that these bacteria are a significant public health concern. Moreover, these findings emphasize the critical need for targeted interventions aimed at improving drinking water quality to reduce the risk of fecal contamination and enhance public health outcomes for susceptible groups, including households with under-five children, in particular geographical areas such as the Amhara, Gambela, and Oromia regions, as well as rural areas, at point-of-use, and during the rainy season.RegistrationThis review was registered on PROSPERO (registration ID - CRD42023448812).

Prevalence of obstetric violence in high-income countries: A systematic review of mixed studies and meta-analysis of quantitative studies.

Obstetric violence, or mistreatment of women in obstetric care, can have severe consequences such as fear of future childbirth, post-traumatic stress disorder, and depression. The primary objective was to estimate the prevalence of obstetric violence in high-income countries. The secondary objective was to extract the main domains of obstetric violence perceived by women from qualitative studies. Following prospective registration (PROSPERO CRD42023468570), PubMed, Web of Science, Scopus, CINAHL, Embase, and Cochrane Library were searched with no restrictions. Included studies were cross-sectional, cohort, mixed methods, and qualitative studies based on populations from high-income countries. The review was conducted by two independent reviewers. Risk of bias was assessed. Rates of obstetric violence were pooled using random effects model, computing 95% confidence intervals (CI) and assessing heterogeneity using I2 statistic. Funnel plots and Egger's test were used to detect potential reporting biases and small-study effects. Of the 1821 records screened, 25 studies were included: 14 quantitative and 2 mixed methods studies, comprising 60 987 women, and 9 qualitative studies were included, comprising an additional 4356 women. 81.25% of quantitative studies, including the quantitative component of the mixed methods studies, were considered satisfactory or better regarding risk of bias. The prevalence of obstetric violence was overall 45.3% (95% CI 27.5-63.0; I2 = 100.0%). The prevalence of specific forms of mistreatment was also estimated. Lack of access to analgesia was 17.3% (95% CI 6.9-27.7; I2 = 99.7%). Ignored requests for help was 19.2% (95% CI 11.7-26.6; I2 = 99.0%). Shouting and scolding 19.7% (95% CI 13.0-26.4; I2 = 98.7%). The use of fundal pressure during the second stage of labor (Kristeller maneuver) was 30.3% (95% CI 22.1-38.5; I2 = 97.6%). There was no funnel asymmetry. Lack of information and/or consent were the most frequent domains extracted from the qualitative articles and the qualitative component of the mixed methods studies. The results demonstrate that obstetric violence is a prevalent problem that women in high-income countries experience. Lack of information and/or consent were the domains most frequently described in the qualitative studies and the qualitative component of the mixed methods studies.

Comparing the diagnostic efficacy of [18F]FDG PET/CT and MRI in the initial diagnosis of ovarian cancer: a meta-analysis.

This meta-analysis was conducted to assess the relative diagnostic effectiveness of [18F]FDG PET/CT and MRI in the initial detection of ovarian cancer. A thorough literature search was conducted using PubMed, Embase, and Web of Science databases to locate relevant studies published up to April 2024. The selected studies were those that evaluated diagnostic performance of [18F]FDG PET/CT and MRI for the initial detection of ovarian cancer. Sensitivity and specificity metrics were analyzed employing the DerSimonian and Laird random-effects model, with further transformation utilizing the Freeman-Tukey double arcsine method. The quality of included studies was appraised using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. The meta-analysis included 23 articles encompassing a total of 1973 patients. The sensitivity of [18F]FDG PET/CT was found to be higher than that of MRI (0.94 vs. 0.87, P = 0.02). In terms of specificity, [18F]FDG PET/CT and MRI demonstrated similar values (0.87 vs. 0.86, P = 0.90). An assessment of publication bias using the funnel plot asymmetry test revealed no significant bias for any outcomes (Egger's test: all P > 0.05). Our meta-analysis reveals that [18F]FDG PET/CT exhibits higher sensitivity while maintaining similar specificity compared to MRI for the initial detection of ovarian cancer. However, the substantial heterogeneity observed across studies may influence these findings. Consequently, larger-scale prospective studies are necessary to validate these results.

Diabetes in axial spondyloarthritis: a systematic review and meta-analysis of observational studies

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition with an increased risk of cardiovascular disease (CVD). Diabetes is a well-established risk factor for CVD and stroke. The objective of this study was to conduct a systematic review to: (i) identify the prevalence of diabetes in axSpA and (ii) compare the risk of diabetes in patients with axSpA and without. A comprehensive literature search was performed for articles published between 1 January 2000 and 15 November 2023 using Medline, Embase and Scopus (PROSPERO: CRD42023482573). Observational studies reporting prevalence, incidence or risk of diabetes in axSpA were included. Search results were independently screened by at least two reviewers. Quality of included studies were assessed using the JBI critical appraisal tool. Study-specific proportions and odds ratios (OR) were combined in a random-effects meta-analysis. 2257 articles were identified from database searching from which 23 studies were included for analysis amounting to a combined sample size of 65 025 patients. The pooled prevalence of diabetes in people with axSpA was 7.0% (95% CI 5.9–8.0%; predictive interval 2.4–12.9%; p < 0.001). The funnel plot was symmetric suggesting no small-study effects (I2 = 98.1% (95% CI 0.05–0.08), τ2 = 0.02; p < 0.001). Comparing patients with axSpA to those without, the pooled OR was 1.29 (95% CI 1.10–1.52; predictive interval 0.76–2.22; p = 0.001) for diabetes. The study suggests an increased prevalence and probably an increased risk of diabetes in people with axSpA. Routine screening for diabetes and lifestyle modifications should be encouraged in this cohort.

Overview of the prevalence of loneliness and associated risk factors among older adults across six continents: A meta-analysis

BackgroundGlobally, loneliness is a growing public health concern associated with poor mental and physical health among older adults. Therefore, we performed a meta-analysis to explore the prevalence of loneliness and associated risk factors among older adults across six continents. MethodsWeb of Science, PubMed, Embase, CINAHL, Cochrane Library, and references lists were comprehensively searched until April 2024. Data analysis was performed using Logit Transformation model in R-Software for pooled prevalence and DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis for associated factors of loneliness. Heterogeneity was quantified by I2 and τ2 statistics. The funnel plot and Egger's regression test assessed publication bias. ResultsA total of 70 studies with 462,083 older adults were included. The pooled prevalence of loneliness was 26 % (95 %CI, 23 %–30 %) with 38 % for North America, 34 % for Africa, 32 % for Asia and South America, 23 % for Europe, and 13 % for Oceania. Cognitive impairment (2.98; 95 %CI, 1.30–6.81), poor health (2.35; 95 %CI, 1.59–3.45), female (1.92; 95 %CI, 1.53–2.41), depression (1.74; 95 %CI, 1.40–2.16), widowed (1.67; 95 %CI, 1.13–2.48), single (1.51; 95 %CI, 1.06–2.17), institutionalization (2.95; 95 %CI, 1.48–5.88), rural residency (1.18; 95 %CI, 1.04–1.34) were associated with increased risk of loneliness. Being married (0.51; 95 %CI, 0.31–0.82), male (0.55; 95 %CI, 0.43–0.70), and non-institutionalization (0.34; 95 %CI, 0.17–0.68) were associated with lower risk of loneliness. ConclusionApproximately, three among ten older adults aged ≥ 60 years are lonely worldwide. Early detection, prevention, and management of loneliness among older adults should consider diverse needs using gender-specific approaches.

Causal association between mental disorders and cerebrovascular diseases: Evidence from Mendelian randomization study

Background and objectiveObservational studies have suggested that mental disorders and cerebrovascular diseases (CVDs) may be risk factors for each other, but genetic evidence of a causal relationship is still lacking. We used Mendelian randomization (MR) studies to explore the causal relationship between mental disorders and CVDs from the genetic perspective. MethodsTo investigate the causal association between major depressive disorder (MDD), anxiety, attention deficit/hyperactivity disorder (ADHD), bipolar disorder and schizophrenia five kinds of mental disorders and CVDs using two-sample two-way MR analysis based on publicly available genome-wide association study (GWAS) data. We used as instrumental variables (IVs) single-nucleotide polymorphisms (SNPs) that were strongly associated with mental disorders and CVDs. IVW method was used as the main analysis method, and MR-IVW, MR-Egger methods, MR-PRESSO test, leave-one-out analysis and funnel plot were used for sensitivity analysis. We further conducted a meta-analysis to summarize the currently available MR analyses. ResultsThe results of forward MR study showed that there was a significant causal relationship between ADHD and AS (any stroke) (p(AS) = 0.001, OR (95%CI) =1.118 (1.047–1.195)), any ischemic stroke (AIS) (p(AIS) = 0.004, OR (95%CI) =1.118(1.035–1.206)) and large artery stroke (LAS) (p(LAS) = 0.026, OR (95%CI): 1.206(1.023–1.422)). No heterogeneity, pleiotropy and outliers were found in sensitivity analysis. The reverse MR study showed that IA (intracranial aneurysm) (p(IA) = 0.033, OR (95%CI) = 1.123(1.009–1.249)) and UIA (unruptured intracranial aneurysm) (p(UIA) = 0.015, OR (95%CI) =1.040(1.008–1.074)) were risk factors for schizophrenia. Sensitivity analysis showed no pleiotropy, but there was heterogeneity. After excluding outliers, MR analysis showed that IA and UIA were still risk factors for schizophrenia. Our meta-analyses found statistical significance in causal relationships between ADHD and LAS (OR (95%CI) =1.18 (1.06–1.32), p = 0.003), IA and schizophrenia (OR (95%CI) =1.05 (1.02–1.08), p = 0.002) and UIA and schizophrenia (OR (95%CI) =1.03 (1.01–1.06), p = 0.010). ConclusionThe MR study and meta-analysis suggest that genetically predicted ADHD is a risk factor for LAS, and IA and UIA increase the risk of schizophrenia. The result has implications for the development of feasible prevention strategies in the future.

Association between MASLD and increased risk of serious bacterial infections requiring hospital admission: A meta-analysis.

Previous studies have reported an association between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of serious bacterial infections. However, the magnitude of the risk and whether this risk varies with the severity of MASLD remains uncertain. We performed a meta-analysis of observational studies to quantify the association between MASLD and serious bacterial infections requiring hospital admission. We systematically searched PubMed, Scopus, Web of Science and Embase from database inception to 1 April 2024, using predefined keywords to identify studies examining the risk of serious bacterial infections among individuals with and without MASLD. MASLD was diagnosed using liver biopsy, imaging or International Classification of Diseases codes. Meta-analysis was performed using random-effects modelling. We identified six cross-sectional and two prospective cohort studies with aggregate data on ~26.6 million individuals. MASLD was significantly associated with higher odds of serious bacterial infections (pooled random-effects odds ratio 1.93, 95% confidence interval [CI] 1.44-2.58; I2 = 93%). Meta-analysis of prospective cohort studies showed that MAFLD was associated with an increased risk of developing serious bacterial infections (pooled random-effects hazard ratio 1.80, 95% CI 1.62-2.0; I2 = 89%). This risk further increased across the severity of MASLD, especially the severity of fibrosis (pooled random-effects hazard ratio 2.42, 95% CI 1.89-2.29; I2 = 92%). These results remained significant after adjusting for age, sex, obesity, diabetes and other potential confounders. Sensitivity analyses did not modify these findings. The funnel plot did not reveal any significant publication bias. This meta-analysis shows a significant association between MASLD and an increased risk of serious bacterial infections requiring hospital admission.

Suicidal ideation and associated factors among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis.

Suicide is one of the main causes of mortality in the world, accounting for more fatalities than homicide, war, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), breast cancer, and malaria. Significantly, the biggest risk factors for suicide in the general population are having already attempted suicide and suicidal ideation. Despite the availability of studies on suicidal ideation among people living with HIV/AIDS (PLWHA) in Ethiopia, the results are inconsistent. Thus, a systematic review and meta-analysis was conducted to estimate the pooled prevalence of suicidal ideation among people living with HIV/AIDS. A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. To find papers published in the English language before 20 May 2023, the electronic databases of Medline, Science Direct, Excerpta Medica Database, Cochrane Library, African Journals Online (AJOL), and Google Scholar were searched. The DerSimonian and Laird method for random effects models was used to estimate the pooled prevalence of suicidal ideation with a 95% confidence interval in STATA V.14.0 statistical software. To test for heterogeneity between studies and publication bias, respectively, forest plots and funnel plots were used. Additionally, leave-one-out sensitivity was conducted. A total of nine studies with 3,411 study participants were included in this systematic review and meta-analysis. The pooled prevalence of suicidal ideation among PLWHA was 20.55% (95% CI 14.76, 26.33). Being female (Odds ratio (OR) = 4.27, 95% CI = 2.29, 7.97), living alone (OR = 5.02, 95% CI = 2.15, 11.64), poor social support (OR = 3.80, 95% CI = 2.56, 5.65), perceived stigma (OR = 3.50, 95% CI = 1.55, 7.87), depression (OR = 5.08, 95% CI = 2.55, 11.48), undisclosed HIV status (OR = 4.8, 95% CI = 2.10, 10.93), and World Health Organization HIV clinical stages of III or IV (OR = 4.40, 95% CI = 2.95, 6.58) were significantly associated with suicidal ideation. Suicidal ideation among PLWHA is high in Ethiopia. Therefore, emphasis should be given to psychiatric assessment and interventions with a special focus on individuals having the associated factors. PROSPERO (CRD42023429613).

Comparative effects of sacubitril/valsartan and ACEI/ARB on endothelial function and arterial stiffness in patients with heart failure: a protocol for systematic review and meta-analysis

IntroductionHeart failure (HF) is a complex syndrome that affects millions of people worldwide and leads to significant morbidity and mortality. Sacubitril/valsartan, a combination drug consisting of a neprilysin inhibitor and...

Differences in the risk association of TERT-CLPTM1L rs4975616 (A>G) with lung cancer between Caucasian and Asian populations: A meta-analysis.

Although the G allele variant of TERT-CLPTM1L rs4975616 has been confirmed to be negatively associated to the risk of lung cancer (LC), some other studies haven't found this negative association. The purpose of this study is to clarify the association of the rs4975616 with the risk of developing LC and the differences of this association among patients with different ethnicities (Caucasians and Asians), different subtypes of LC, and different smoking status. Relevant literatures published before July 20, 2023 in PubMed, EMbase, Web of Science, MEDLINE databases were searched through the Internet. Statistical analysis of data was performed in Revman5.3, including drawing forest plots, funnel plots and so on. Sensitivity and publication bias were performed in Stata 14.0. The stability of the results was assessed using Test Sequence Analysis (TSA) software. Registration number: CRD42024568348. The G allele variant of rs4975616 was negatively associated with the risk of LC ([OR] = 0.86, 95%CI [0.84, 0.88]), and that this negative association was present in both Caucasians ([OR] = 0.85, 95%CI [0.83, 0.87]) and Asians ([OR] = 0.91, 95%CI [0.86, 0.95]), and the strength of the negative association was higher in Caucasians than in Asians (subgroup differences: P = 0.02, I2 = 80.3%). Across LC subtypes, rs4975616[G] was negatively associated with the risk of NSCLC (LUAD, LUSC) in both Caucasians and Asians (P<0.05) and the strength of the association with NSCLC (LUAD) was higher in Caucasians than in Asians (Subgroup differences: I2>50%). In Caucasians, rs4975616[G] was negatively associated with the risk of LC in both smokers and non-smokers (P<0.05), and the strength of the association did not differ between smokers and non-smokers (Subgroup differences: P = 0.18, I2 = 45.0%). In Asians, rs4975616[G] was mainly negatively associated with the risk of LC in smokers (P<0.05) but not in non-smokers ([OR] = 0.97, 95%CI [0.78, 1.20]). Comparisons between the two populations showed that the strength of this negative association was higher in Caucasian non-smokers than in Asian non-smokers (Subgroup differences: P = 0.04, I2 = 75.3%), whereas the strength of this negative association was the same for Caucasian smokers as for Asian smokers (Subgroup differences: P = 0.42, I2 = 0%). Among the different LC subtypes, rs4975616[G] was negatively associated with the risk of NSCLC (LUAD) incidence in both Asian smokers and Caucasian non-smokers (P<0.05), whereas it was not associated with the risk of NSCLC development in Asian non-smokers (P>0.05). Comparisons between the two populations showed that the strength of the association was higher in Caucasian non-smokers than in Asian non-smokers (Subgroup differences: I2>50%). The G allele variant of rs4975616 is negatively associated with the risk of LC and NSCLC (LUAD, LUSC). Compared with Asians, Caucasians are more likely to have a higher risk of LC and NSCLC (LUAD) due to the rs4975616 variant. In Caucasians, smoking and other factors like non-smoking contribute to rs4975616 variations leading to LC, and other factors like non-smoking also induce rs4975616 variations leading to NSCLC (LUAD). In Asians, smoking is the major risk factor for the induction of rs4975616 variations leading to LC and NSCLC(LUAD).

Gout or Hyperuricemia and Dementia Risk: A Meta-Analysis of Observational Studies.

As a natural antioxidant, uric acid has neuroprotective effects. The association between uric acid levels and dementia risk was reported by previous studies. However, recently published studies showed that the relationship between uric acid and dementia risk might be heterogeneous in dementia subtypes. This study aimed to clarify the relationship between hyperuricemia (or gout) and dementia. The PubMed and Web of Science databases were systematically searched up to April 2024 to identify relevant studies. A meta-analysis was conducted using hazard ratios (HR) or odds ratios (OR) and 95% confidence interval (CI) as pooled indicators. Heterogeneity between the studies was examined using Cochran's Q statistic and I2 statistic. Subgroup analyses were conducted for gender and age. Stratification analysis, sensitivity analyses and meta-regression were conducted to explore possible explanations for heterogeneity. Publication bias was assessed by funnel plot and Egger's test. A total of 11 studies met the inclusion criteria including 2,928,152 participants were abstracted. Hyperuricemia (or gout) did not reduce the overall risk of dementia (OR/HR = 0.92, 95% CI: 0.81-1.05) and vascular dementia (OR/HR = 0.74, 95% CI: 0.53-1.05), but may have a protective effect against Alzheimer's disease (OR/HR = 0.82, 95% CI: 0.70-0.96). Subgroup analysis showed that a lower risk of dementia was observed in men (OR/HR = 0.83, 95% CI: 0.77-0.90) and patients whose age under 65 (OR/HR = 0.83, 95% CI: 0.72-0.95). Patients with gout or hyperuricemia have a low risk of Alzheimer's disease.

SP6.12 - Do Pregnant Females Experiencing Physical Traumatic Injury have Different Mortality Outcomes Compared to Non-pregnant Females? A Systematic Review and Metanalysis

Abstract Aims To collate and analyse literature capturing mortality rates in pregnant and non-pregnant individuals of childbearing age who experienced physical trauma. Additionally, to identify any statistically significant differences in interventions received. Methods Comprehensive searches of PubMed, MEDLINE, and grey literature were conducted using MeSH terms. Data extraction by two independent reviewers was followed by quality assessments using the Newcastle-Ottawa Scale. A random effects meta-analysis assessed the effect of pregnancy on mortality post-physical trauma, employing risk ratios (RR) and 95% confidence intervals. Publication bias was evaluated through linear regression, Eggers test, and funnel plots. Results Twelve studies met eligibility criteria, yielding 1,113,376 pregnant and 18,185,789 non-pregnant females of childbearing age who experienced physical trauma. Low publication bias was observed. Pregnant females demonstrated a 35% mortality reduction vs. non-pregnant females (pooled RR: 0.65 [0.47-0.89], p=0.008), though significant heterogeneity existed across studies (I2 = 77%). A subgroup analysis focusing on mechanism of injury found the mortality reduction in pregnancy increased to 59% in motor vehicle accidents (pooled RR = 0.41 [0.32-0.52], p&amp;lt;0.001) with minimal study heterogeneity (I2 = 0%). Pregnant (vs. non-pregnant) females were less likely to be intubated (pooled RR = 0.69 [0.58, 0.81], p=&amp;lt;0.001, I2 = 9), but there were no other significant differences in the types of intervention received. Conclusions Pregnant females have a lower mortality risk from physical trauma than non-pregnant counterparts, particularly where the mechanism of injury is a motor vehicle accident. Additional research is warranted to elucidate the underlying factors contributing to this observed difference.

The Effect of Probiotics on Obesity with Comorbid Depression: A Systematic Review and Meta-Analysis.

Aims/Background Obesity and depression frequently co-occur, and the relationship between them is bidirectional. Being obese or overweight increases the risk of depression, and conversely, depression increases the risk of obesity or overweight. Emerging clinical research has shown that probiotics may be effective in treating obesity and associated depression. Modulating gut microbiota with probiotics may improve obesity-related depression, but current evidence is inconsistent. Methods We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library for randomized controlled trials examining probiotics for depression in obese adults. Mean difference (MD) in depression scores between probiotic and placebo groups was pooled across studies using random-effects models. Heterogeneity was assessed using I2 to explain heterogeneity in meta-regression analysis. To detect the publication bias of the included studies, a funnel plot, and Begg and Egger tests, were used. Possible heterogeneity moderators were detected by subgroup and sensitivity analyses, Galbraith plot, and graphic display of study heterogeneity (GOSH) analysis. Leave-one-out and Influence analyses were performed to assess sensitivity. Results Five trials (n = 488) were included. Overall, probiotics did not significantly improve depressive symptoms versus placebo (MD = 0.08, 95% confidence interval [CI] = -0.63 to 0.79, p = 0.82). Considerable heterogeneity among studies was observed (I2 = 63%). In subgroup analyses, probiotics significantly reduced depression as measured by the Edinburgh Postnatal Depression Scale (MD = -0.60, 95% CI = -1.17 to -0.03, p = 0.04) with no heterogeneity (I2 = 0%). Probiotics also decreased depressive symptoms after 12 weeks of supplementation (MD = -0.78, 95% CI = -1.58 to -0.01, p = 0.05) versus placebo. No publication bias was found using Begg and Egger tests. The GOSH diagnostics revealed three outliers, among the clusters identified by K-means, DBSCAN (Density-based spatial clustering of applications with noise algorithm), and GMM (Gaussian Mixture Model) analyses. Conclusion Overall, probiotics did not improve depressive symptoms in obesity. However, beneficial effects were observed with the Edinburgh Postnatal Depression Scale and short-term use of probiotic. Additional rigorous randomized controlled trials are warranted to elucidate the therapeutic potential of probiotics for obesity-related depression.

Approximately half of the nursing students confirmed their willingness to participate in caring for older people: a systematic review and meta-analysis

BackgroundGlobal population aging poses a significant global challenge, necessitating an increased demand for proficient caregivers specialized in elderly care. In our study, a systematic review and meta-analysis were conducted to synthesize the evidence concerning nursing students’ willingness to participate in caring for older people.MethodsEligibility criteria focused on cross-sectional studies involving nursing students’ willingness to participate in caring for older people and were reported in English or Chinese. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), and WANFANG databases were searched from inception until July 24, 2022. The methodological quality assessment in the included studies was evaluated using the AHRQ instrument. The pooled effects of the nursing students’ willingness to participate in caring for older people were computed using a random-effects model. Funnel plots and Egger’s test were employed to evaluate publication bias. Meta-regression and subgroup analysis were performed to explore the sources of heterogeneity. Sensitivity analysis was conducted to verify the robustness of the meta-analysis findings. All statistical tests were conducted with Stata 16.0 software.ResultsA total of 68 studies of medium or high quality met the eligibility criteria, involving 30,328 nursing students. The rate of nursing students’ willingness to participate in caring for older people was 49.0% (95% CI = 46–53%, I2 = 98.1%, P = 0.000). The results of meta-regression analysis showed that the following four predictor variables were significantly associated with nursing students’ willingness to participate in caring for older people: experience of living with and caring for older people, nursing as their first choice and their year-level in education, respectively. Subgroup analyses for these four predictor variables revealed the following pooled estimates of nursing students’ willingness: having experience of living with older people (0.54, 95% CI = 0.46–0.62) vs. no such experience (0.38, 95% CI = 0.30–0.46), having experience of caring for older people (0.55, 95% CI = 0.48–0.63) vs. no such experience (0.38, 95% CI = 0.30–0.46), nursing as their first choice (0.54, 95% CI = 0.51–0.58) vs. not their first choice (0.44, 95% CI = 0.35–0.53), being in the first year of nursing education (0.44, 95% CI = 0.34–0.55), second year (0.45, 95% CI = 0.34–0.56), and third and fourth year (0.62, 95% CI = 0.53–0.71).ConclusionThe study found that approximately half of the nursing students confirmed their willingness to participate in caring for older people.The present study can serve as a resource for policymakers to increase the willingness of nursing students to participate in caring for older people.