Individual Study Level Research Articles

Effect of Study-Duration and Time of Day on Multichannel Sleep Study Findings in Former Preterm Infants.

Determine the appropriate duration for multichannel sleep studies in former preterm infants with cardio-respiratory events beyond term equivalent age. A sleep study of 10 h will provide equivalent information compared to a 20-h study to detect significant cardio-respiratory abnormalities in this population. Single-center retrospective study of 50 infants with 20-h sleep study. Studies were evaluated for periodic breathing, obstructive, central, mixed apnea, desaturations, and bradycardia. Each study was partitioned into two 10-h epochs, compared to one another and the 20-h study. Differences were detected at the level of individual sleep studies when each epoch was compared to each other and a total 20-h study. 10-h study missed 17-31% of breathing abnormalities detected over 20 h adjusted for study time. Group analysis showed no statistical difference in the number and duration of events between epochs. A 20-h sleep study improves the detection of breathing abnormalities missed with a 10-h study.

NEIVAv1.0: Next-generation Emissions InVentory expansion of Akagi et al. (2011) version 1.0

Abstract. Accurate representation of fire emissions is critical for modeling the in-plume, near-source, and remote effects of biomass burning (BB) on atmospheric composition, air quality, and climate. In recent years application of advanced instrumentation has significantly improved knowledge of the compounds emitted from fires, which, coupled with a large number of recent laboratory and field campaigns, has facilitated the emergence of new emission factor (EF) compilations. The Next-generation Emissions InVentory expansion of Akagi (NEIVA) version 1.0 is one such compilation in which the EFs for 14 globally relevant fuel and fire types have been updated to include data from recent studies, with a focus on gaseous non-methane organic compounds (NMOC_g). The data are stored in a series of connected tables that facilitate flexible querying from the individual study level to recommended averages of all laboratory and field data by fire type. The querying features are enabled by assignment of unique identifiers to all compounds and constituents, including thousands of NMOC_g. NEIVA also includes chemical and physical property data and model surrogate assignments for three widely used chemical mechanisms for each NMOC_g. NEIVA EF datasets are compared with recent publications and other EF compilations at the individual compound level and in the context of overall volatility distributions and hydroxyl (OH) reactivity (OHR) estimates. The NMOC_g in NEIVA include ∼4–8 times more compounds with improved representation of intermediate volatility organic compounds, resulting in much lower overall volatility (lowest-volatility bin shifted by as much as 3 orders of magnitude) and significantly higher OHR (up to 90 %) than other compilations. These updates can strongly impact model predictions of the effects of BB on atmospheric composition and chemistry.

Systematic Review and Meta-Analysis of the Effects of Dance on Cognition and Depression in Healthy Older Adults.

Aging is associated with declines in cognition and mental health that might be ameliorated by physical activity (PA). Dance integrates multiple physical, cognitive, and social elements, and might be an avenue for improving cognition and mood. This systematic review and meta-analysis (SRMA) examined the effects of formal and traditional dance on cognition, depression, and anxiety in older adults. Five database searches yielded 17 randomized control trials (RCT). RCTs were included if participants were ≥ 60 years and healthy or living with mild cognitive impairment (MCI). We examined interventions of dance against any comparison group. Records were independently screened, and data were extracted by 2 reviewers. We performed random-effects models using robust variance estimation and tested individual treatment, study, and outcome level moderators using the approximate Hotelling-Zhang test. 17 RCTs were included in the systematic review, but 13 RCTs were included in the meta-analysis which included 1,174 participants with a mean age of 70.7 years, and 66.3% were female. There were 76 effect sizes (Hedges' g) calculated from the 13 RCTs with a range between -0.97 through 2.88. The overall effect of dance interventions on cognition was significant, yet small (g = 0.27; 95% CI: 0.05, 0.50; p = 0.022), and the effect on depression was significant and nearly moderate (g = 0.43; 95% CI: 0.06, 0.80; p = 0.036); only one RCT examined anxiety and was not included. No moderator variables significantly explained variation in the effects of dance on cognitive function or depression (p > 0.05). Dance interventions can improve cognition and depression in older adults. Additional research is needed regarding the effects of dance on anxiety and depression in older adults.

Yoga as Potential Therapy for Burnout: Health Technology Assessment Report on Efficacy, Safety, Economic, Social, Ethical, Legal and Organizational Aspects.

PURPOSEOF REVIEW: This health technology assessment aimed to systematically assess the efficacy and safety of yoga as therapy for burnout. Economic, ethical, legal, social and organizational aspects were considered as well. RECENT FINDINGS: Yoga as a therapy has been shown to have positive effects on a range of symptoms, including stress, anxiety and depression. Regarding work-related stress and burnout, the effects of yoga have mainly been examined in a preventative context. Meta-analyses revealed no effects on burnout severity comparing yoga with passive controls in general. Compared with passive controls, yoga had a positive effect on subjective stress. Compared to active control, yoga had an effect on the burnout subscale depersonalization on individual study level. Yoga may have positive effects on burnout, but the results are mixed. Common definitions and standardized diagnostic tools are necessary to improve research and further assess yoga as therapy for burnout. TRIAL REGISTRATION: The HTA is registered with PROSPERO, CRD42022299405, on 6th February 2022.

Does perceptual high variability phonetic training improve L2 speech production? A meta-analysis of perception-production connection

AbstractThis meta-analysis of 31 studies aimed to determine the effectiveness of perception-based high variability phonetic training (HVPT) for second language (L2) production learning and to identify learner-related and methodological variables that influence production gains. Based on independent effect sizes for 43 within-participant and 17 between-participant designs, small-to-medium effects of post-training improvement were found. The average production gains for trained items and untrained items were 10.50% and 4.50%, respectively. Neither strong support for long-term retention of production learning nor generalization to untrained stimuli was observed, however. Moderator analyses showed that post-training production gains were influenced by a number of factors related to learner profiles (age and learning context), training features (provision of phonetic information, training duration, and training time per session), and features of production tests (elicitation tasks, prompt modality, and outcome measures). The relationship between perception and production gains was negligible at the participant level, but was significant and moderate at the level of individual studies for post-training and retention data. These findings provide partial support for a perception-production link. This study makes several recommendations for future studies investigating the effects of HVPT on L2 speech production learning.

Optical coherence tomography-guided versus angiography-guided percutaneous coronary intervention in acute coronary syndrome: a meta-analysis

BackgroundPercutaneous coronary intervention (PCI) is standard of care in patients with acute coronary syndrome (ACS) suitable for interventional revascularization. Intracoronary imaging by optical coherence tomography (OCT) expanded treatment approaches adding diagnostic information and contributing to stent optimization.ObjectivesThis meta-analysis aimed to assess the effects of OCT-guided vs. angiography-guided PCI in treatment of ACS.MethodsA structured literature search was performed. All controlled trials evaluating OCT-guided vs. angiography-guided PCI in patients with ACS were eligible. The primary end point was major adverse cardiac events (MACE).ResultsEight studies enrolling 2612 patients with ACS were eligible. 1263 patients underwent OCT-guided and 1,349 patients angiography-guided PCI. OCT guidance was associated with a 30% lower likelihood of MACE (OR 0.70, 95% CI 0.53–0.93, p = 0.01, I2 = 1%). OCT-guided PCI was also associated with significantly decreased cardiac mortality (OR 0.49, 95% CI 0.25–0.96, p = 0.04, I2 = 0%). There was no detectable difference in all-cause mortality (OR 1.08, 95% CI 0.51–2.31, p = 0.83, I2 = 0). Patients in OCT-guided group less frequently required target lesion revascularization (OR 0.26, 95% CI 0.07–0.95, p = 0.04, I2 = 0%). Analysis of myocardial infarction did not result in significant treatment differences. In subgroup or sensitivity analysis the observed advantages of OCT-guided PCI were not replicable.ConclusionThe evidence suggests that PCI guidance with OCT in ACS decreases MACE, cardiac death and target lesion revascularization compared to angiography. On individual study level, in subgroup or sensitivity analyses these advantages were not thoroughly replicable.

Impact of epilepsy surgery on quality of life: Systematic review and meta-analysis.

Improved quality of life (QoL) is an important outcome goal following epilepsy surgery. This study aims to quantify change in QoL for adults with drug-resistant epilepsy (DRE) who undergo epilepsy surgery, and to explore clinicodemographic factors associated with these changes. We conducted a systematic review and meta-analysis using Medline, Embase, and Cochrane Central Register of Controlled Trials. All studies reporting pre- and post-epilepsy surgery QoL scores in adults with DRE via validated instruments were included. Meta-analysis assessed the postsurgery change in QoL. Meta-regression assessed the effect of postoperative seizure outcomes on postoperative QoL as well as change in pre- and postoperative QoL scores. A total of 3774 titles and abstracts were reviewed, and ultimately 16 studies, comprising 1182 unique patients, were included. Quality of Life in Epilepsy Inventory-31 item (QOLIE-31) meta-analysis included six studies, and QOLIE-89 meta-analysis included four studies. Postoperative change in raw score was 20.5 for QOLIE-31 (95% confidence interval [CI] = 10.9-30.1, I2 = 95.5) and 12.1 for QOLIE-89 (95% CI = 8.0-16.1, I2 = 55.0%). This corresponds to clinically meaningful QOL improvements. Meta-regression demonstrated a higher postoperative QOLIE-31 score as well as change in pre- and postoperative QOLIE-31 score among studies of cohorts with higher proportions of patients with favorable seizure outcomes. At an individual study level, preoperative absence of mood disorders, better preoperative cognition, fewer trials of antiseizure medications before surgery, high levels of conscientiousness and openness to experience at the baseline, engagement in paid employment before and after surgery, and not being on antidepressants following surgery were associated with improved postoperative QoL. This study demonstrates the potential for epilepsy surgery to provide clinically meaningful improvements in QoL, as well as identifies clinicodemographic factors associated with this outcome. Limitations include substantial heterogeneity between individual studies and high risk of bias.

Characteristics of the sources, evaluation, and grading of the certainty of evidence in systematic reviews in public health: A methodological study.

To systematically explore how the sources of evidence, types of primary studies, and tools used to assess the quality of the primary studies vary across systematic reviews (SRs) in public health. We conducted a methodological survey of SRs in public health by searching the of literature in selected journals from electronic bibliographic databases. We selected a 10% random sample of the SRs that met the explicit inclusion criteria. Two researchers independently extracted data for analysis. We selected 301 SRs for analysis: 94 (31.2%) of these were pre-registered, and 211 (70.1%) declared to have followed published reporting standard. All SRs searched for evidence in electronic bibliographic databases, and more than half (n = 180, 60.0%) searched also the references of the included studies. The common types of primary studies included in the SRs were primarily cross-sectional studies (n = 132, 43.8%), cohort studies (n = 126, 41.9%), randomized controlled trials (RCTs, n = 89, 29.6%), quasi-experimental studies (n = 83, 27.6%), case-control studies (n = 58, 19.3%) qualitative studies (n = 38, 12.6%) and mixed-methods studies (n = 32, 10.6%). The most frequently used quality assessment tools were the Newcastle-Ottawa Scale (used for 50.0% of cohort studies and 55.6% of case-control studies), Cochrane Collaboration's Risk of Bias tool (50.7% of RCTs) and Critical Appraisal Skills Program (38.5% of qualitative studies). Only 20 (6.6%) of the SRs assessed the certainty of the body of evidence, of which 19 (95.0%) used the GRADE approach. More than 65% of the evidence in the SRs using GRADE was of low or very low certainty. SRs should always assess the quality both at the individual study level and the body of evidence for outcomes, which will benefit patients, health care practitioners, and policymakers.

Systolic blood pressure reduction with tirzepatide in patients with type 2 diabetes: insights from SURPASS clinical program

BackgroundTirzepatide, a once-weekly glucose-dependent insulinotropic polypeptide/ glucagon-like peptide-1 receptor agonist, is approved in the United States, Europe and Japan for the treatment of type 2 diabetes. Across the SURPASS-1 to -5 clinical studies, tirzepatide 5, 10 and 15 mg demonstrated significant improvements in glycated haemoglobin A1c (HbA1c) (− 1.9 to − 2.6%), body weight (− 6.6 to − 13.9%) and systolic blood pressure (SBP) (− 2.8 to − 12.6 mmHg) at the end of study treatment.MethodsPost-hoc mediation analyses were conducted to evaluate weight-loss dependent and weight-loss independent effects of tirzepatide on SBP reductions across the 5 SURPASS studies. The safety population (all randomized patients who took at least 1 dose of study drug) of each study was analyzed. Additional analyses were conducted at individual study level or pooled across 5 SURPASS trials.ResultsThe difference in mean SBP change from baseline at 40 weeks (total effect) between the tirzepatide and comparator groups was − 1.3 to − 5.1 mmHg (tirzepatide 5 mg), − 1.7 to − 6.5 mmHg (tirzepatide 10 mg) and − 3.1 to − 11.5 mmHg (tirzepatide 15 mg). These SBP reductions were primarily mediated through weight loss, with different degrees of contributions from weight-loss independent effects across the different trials. In the SURPASS-4 study, which enrolled patients with established cardiovascular disease, weight-loss independent effects explained 33% to 57% of difference in SBP change between tirzepatide and insulin glargine groups. In a pooled analysis of the SURPASS-1 to -5 studies, there was a significant (p < 0.001) but weak correlation (r = 0.18 to 0.22) between change in body weight and SBP. Reductions in SBP with tirzepatide were not dependent on concomitant antihypertensive medications at baseline as similar reductions were observed whether participants were receiving them or not (interaction p = 0.77). The largest SBP reductions were observed in the highest baseline category (> 140 mmHg), while those in the first quartile of baseline SBP category (< 122 mmHg) observed no further decrease in SBP.ConclusionsTirzepatide-induced SBP reduction was primarily mediated through weight loss, with different degrees of contributions from weight-loss independent effects across the different trials. SBP reduction was not dependent on antihypertensive medication use but dependent on baseline SBP value, alleviating theoretical concerns of hypotension.

Declining Medicare Reimbursement for Diagnostic Radiology: A 10-Year Analysis Across 50 Imaging Studies

IntroductionThe aim of this study was to investigate trends in Medicare reimbursement from 2011 to 2021 for common diagnostic imaging studies, both at the individual study level and stratified by imaging modality. MethodsThe 50 most common imaging studies in diagnostic radiology were identified and the global reimbursement data from the Center of Medicare and Medicaid Services for each study was extracted from 2011 to 2021. The reimbursement rates were adjusted for inflation and assessed as a function of time for each individual study and by imaging modality. ResultsThere was a combined mean reduction of inflation adjusted payments of 44.4% across all included imaging studies from 2011 to 2021. Only 3 out of 50 studies saw an increase in adjusted reimbursement during this time. Linear regression analysis revealed that the total mean adjusted reimbursement overall has significantly declined over time (R2 = 0.78, P = 0.0003). The pooled adjusted yearly percent change was also investigated, and an increase in reimbursement was only seen from 2016 to 2017 (+ 0.2%). The period with the steepest decline was in 2013 to 2014 (-16%). The overall yearly percent change was -5.5%. Lastly, reimbursement was stratified by imaging modality. MRI (-60.6%), CT (-44.4%), ultrasound (-31.3%), and radiographs (-6.2%) all experienced a mean decline in reimbursement, though at significantly different severities (P <0.0001). An evaluation of wRVUs during the study period revealed a decline from a mean value of 0.79 to 0.78 wRVUs (-1.3%). ConclusionDiagnostic radiology has experienced significant reimbursement cuts over the past decade, most severely among cross sectional modalities. This data further characterizes reimbursement trends for the field and suggests the need for sustainable future reimbursement schedules.

Completeness of reporting of systematic reviews in the animal health literature: A meta-research study

Systematic reviews are a valuable tool for evaluating the efficacy of interventions and for quantifying associations. To be properly assessed, reviews must be comprehensively reported. The primary objective of this study was to evaluate the completeness of reporting of systematic reviews and meta-analyses in animal health. The secondary objective was to further characterize methods for literature searches and risk of bias assessments and to document whether the risk of bias component represented an assessment of risk of bias, study quality, or levels of evidence based on the primary studies included. The dataset comprised 91 systematic reviews or meta-analyses of interventions or exposures with at least one health outcome measured at the animal or animal byproduct level, in any companion or food animal species and published between 2014 and 2018. Two reviewers independently collected information on whether each item in the PRISMA reporting guidelines was reported, with disagreements resolved by consensus. There was considerable variability in the completeness of reporting among reviews; some items, such as eligibility criteria for inclusion, were reported in most reviews (>65 %). Other items were not consistently reported; for instance, in 60 % (54) of the reviews there was no information provided on the sample size of individual studies, populations, interventions and comparators, outcomes, or follow up period. Although 89 % (81) of systematic reviews with meta-analysis included the effect size estimate and confidence intervals, it was not possible to determine which study designs were included for 30 % (14) of reviews. Results from individual PRISMA item questions were combined to determine whether all aspects of each recommended item were reported; 71 % of items were adequately reported in less than half the systematic reviews without a meta-analysis, 35 % of the items were adequately reported in less than half the systematic reviews with a meta-analysis, and 71 % of items were adequately reported in less than half of the meta-analyses without a systematic review component. An assessment of individual study level bias was included in 64 % of the reviews, although this component included an evaluation of risk of bias (35 reviews), study quality (25 reviews), or levels of evidence based on study design (12 reviews). Reporting guidelines or clinical guidelines were inappropriately used to assess risk of bias in 9 reviews. Overall, the results of this study reveal that reporting of systematic reviews in the animal health literature is suboptimal and improvements are needed to enhance utility of these reviews.

Assessment of early exaggerated treatment effects in orthodontic interventions using cumulative meta-analysis.

SummaryBackgroundThe reported initial strong treatment effects reported in early trials that are refuted in subsequent future studies assessing the same interventions have been attributed to novelty bias. The aim of this study was to determine whether there is any evidence of novelty bias in the reported treatment effects of orthodontics interventions.Materials and methodsRelevant orthodontic systematic review (SRs) topics containing at least one meta-analysis on either binary or continuous outcomes with a minimum of three trials considered important areas in the field of orthodontic practice were identified. SR, meta-analysis, and primary study-level characteristics were extracted. Descriptive statistics were calculated at the SRs, meta-analysis, and at the individual study level. All SR and trial-level data were imported into the statistical software and all meta-analyses were replicated using the cumulative random-effects meta-analysis approach. Changes in the size and direction of the estimates between the first trial and the cumulative effect over time were recorded.ResultsForty-seven meta-analyses were included. The total number of primary studies included within these meta-analyses was 408 (N = 408). Overall, the final effect size estimate decreased in 29 (61.7%, N = 29/47) cumulative meta-analyses whilst it increased in the remaining 18 (38.3%, N = 18/47). No association between the level of risk of bias and the cumulative absolute effect size was evident (OR 1.00; 95% CI: 0.98, 1.03; P = 0.717) after adjusting for year of the primary study (P = 0.22).ConclusionsClinicians should be wary of the results of trials reporting the effectiveness of new interventions as there is a possibility that the reported effect size will be often exaggerated.

An umbrella review of effect size, bias, and power across meta-analyses in emergency medicine.

The objective of this study was to conduct an umbrella review of therapeutic studies relevant to emergency medicine, analyzing patterns in effect size, power, and signals of potential bias across an entire field of clinical research. We combined topic- and journal-driven searches of PubMed and Google Scholar for published articles of systematic reviews and meta-analyses (SRMA) relevant to emergency medicine (last search in November 2020). Data were screened and extracted by six investigators. Redundant meta-analyses were removed. Whenever possible for each comparison we extracted one meta-analysis on mortality with the most events and one meta-analysis on a nonmortality outcome with the most studies. From each meta-analysis we extracted all individual study effects; outcomes were converted to odds ratios (ORs) and placed on a common scale where an OR < 1.0 represents a reduction in a harmful outcome with an experimental treatment versus control. Outcomes were analyzed at the level of individual studies and at the level of summary effects across meta-analyses. A total of 332 articles contained 431 eligible meta-analyses with a total of 3,129 individual study outcomes; of these, 2,593 (83%) were from randomized controlled trials. The median OR across all studies was 0.70. Within each meta-analysis, the earliest study effect on average demonstrated larger benefit compared to the overall summary effect. Only 57 of 431meta-analyses (13%) both favored the experimental intervention and did not show any signal of small study effects or excess significance, and of those only 12had at least one study with 80% or higher power to detect an OR of 0.70. Of these, no interventions significantly decreased mortality in well-powered trials. Although the power of studies increased somewhat over time, the majority of studies were underpowered. Few interventions studied within SRMAs relevant to emergency medicine seem to have strong and unbiased evidence for improving outcomes. The field would benefit from more optimally powered trials.

A Meta-Analysis of Machine Learning-Based Science Assessments: Factors Impacting Machine-Human Score Agreements

Machine learning (ML) has been increasingly employed in science assessment to facilitate automatic scoring efforts, although with varying degrees of success (i.e., magnitudes of machine-human score agreements [MHAs]). Little work has empirically examined the factors that impact MHA disparities in this growing field, thus constraining the improvement of machine scoring capacity and its wide applications in science education. We performed a meta-analysis of 110 studies of MHAs in order to identify the factors most strongly contributing to scoring success (i.e., high Cohen's kappa [κ]). We empirically examined six factors proposed as contributors to MHA magnitudes: algorithm, subject domain, assessment format, construct, school level, and machine supervision type. Our analyses of 110 MHAs revealed substantial heterogeneity in $$\kappa{ (mean =} \, \text{.64; range = .09-.97}$$ , taking weights into consideration). Using three-level random-effects modeling, MHA score heterogeneity was explained by the variability both within publications (i.e., the assessment task level: 82.6%) and between publications (i.e., the individual study level: 16.7%). Our results also suggest that all six factors have significant moderator effects on scoring success magnitudes. Among these, algorithm and subject domain had significantly larger effects than the other factors, suggesting that technical features and assessment external features might be primary targets for improving MHAs and ML-based science assessments.

Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth?: A systematic review and meta-analysis.

Prolotherapy or proliferative therapy is a treatment option for damaged connective tissues involving the injection of a solution (proliferant) which theoretically causes an initial cell injury and a subsequent "proliferant" process of wound healing via modulation of the inflammatory process. Nonetheless, the benefits of dextrose prolotherapy have not been adequately evaluated. Therefore, the present study assesses the effectiveness and superiority of prolotherapy separately in treating dense fibrous connective tissue injuries. PubMed, Scopus, and Embase were searched from the earliest record to February 18, 2019. This study included randomized controlled trials whichBoth analysis at individual studies level and pooled meta-analysis were performed. Ten trials involving 358 participants were included for review. At study level, the majority of comparisons did not reveal significant differences between dextrose prolotherapy and no treatment (or placebo) regarding pain control. The meta-analysis showed dextrose prolotherapy was effective in improving activity only at immediate follow-up (i.e., 0-1 month) (standardized mean difference [SMD]: 0.98; 95% confidence interval [CI]: 0.40-1.50; I = 0%); and superior to corticosteroid injections only in pain reduction at short-term follow-up (i.e., 1-3 month) (SMD: 0.70; 95% CI: 0.14-1.27; I = 51%). No other significant SMDs were found in this analysis. There is insufficient evidence to support the clinical benefits of dextrose prolotherapy in managing dense fibrous tissue injuries. More high-quality randomized controlled trials are warranted to establish the benefits of dextrose prolotherapy. PROSPERO (CRD42019129044).

Using patient and public involvement to identify priorities for research in long-term conditions management

Patient and public involvement (PPI) is increasingly important in healthcare research. Although this is accepted at the level of individual research studies, it has been less well used in scoping fundamental research priorities. It has been suggested that patients with long-term conditions (LTCs) are well placed to influence research priorities in this area due to their accumulated experience of illness over time. To obtain PPI in research-priority setting for a group with a special interest in LTC research. PPI representatives provided views on issues they thought required further research. The facilitators were able to move from the specifics of these ideas to identify cross-cutting research priorities. It was possible to determine broad research themes despite PPI representatives initially articulating identified issues in very specific terms. Facilitating a better understanding of the research process for PPI representatives would allow their contribution to be more effective. Implications for practice PPI should be considered at the beginning of the process when broad research priorities are considered and before the study design. This is particularly so for broad, non-specialty-focused research themes such as LTCs. More work is required to ensure the views of harder-to-reach groups are included in this type of PPI.

Interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa: a systematic review

BackgroundPregnant women in sub-Saharan Africa tend to have low adherence to antenatal and postnatal care regimens, contributing to high infant and child mortality rates. Despite low adherence figures and the high returns from attending antenatal and postnatal care visits, research on interventions to improve adherence is in its infancy. Our aim was to determine the effectiveness of existing interventions to improve adherence to antenatal and postnatal care regimens among pregnant women in sub-Saharan Africa.MethodsFull text, peer-reviewed articles, published in English and listed in PubMed or PsycINFO through January 2018 were identified in a systematic review. Studies were restricted to randomized controlled trials only and had to assess intervention impact on antenatal and postnatal care adherence, operationalized as the frequency of visits attended. Two reviewers independently screened papers for inclusion and evaluated the risk of systematic error in each study using the Cochrane risk of bias tool. Any discrepancies were reconciled by a third independent reviewer.ResultsThe initial search generated 186 articles, of which, five met our inclusion criteria. Due to the small sample size and methodological variation across studies, a pooled effect size estimate could not be obtained. Therefore, effects on antenatal and postnatal care adherence were examined and reported at the individual study level. None of the interventions were directly aimed at improving adherence, but two of the five, both behavioral interventions, demonstrated effectiveness in increasing antenatal care (rate ratio 5.86, 95% CI 2.6-13.0, p<0.0001) and postnatal care adherence (31.3%, 95% CI 15.4-47.2, p=0.0009), respectively. Three home visit interventions had no effect on antenatal care adherence. Although the risk of bias was unclear or high in some cases, it remained low in most categories across studies.ConclusionsResults point to a large gap in the literature on interventions to address antenatal and postnatal care adherence in sub-Saharan Africa. Interventions drawing upon the executive function literature and the promising results of the behavioral interventions reviewed here are urgently needed to address these gaps.Trial registrationThe review was prospectively registered with PROSPERO, id number https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=88152, on February 7, 2018.

Interventions improving health professionals' practice for addressing patients' weight management behaviours: systematic review of reviews.

Health professionals require education and training to implement obesity management guidelines and ultimately impact on the health outcomes experienced by their patients. Therefore, a systematic review of systematic reviews that evaluated interventions designed to change the practice of health professionals when addressing diet and physical activity with their patients was conducted. MEDLINE Complete; Cochrane database of systematic reviews; PsycINFO; CINAHL Complete; Global Health; Embase; INFORMIT: Health Subset; Health System Evidence and RX for change were searched in March 2019, with no date or language limits. Identified references underwent screening, full-text analyses and data extraction in duplicate. The search identified 15230 references. Five systematic reviews that provided a narrative syntheses of a combined 38 studies were included. Health professional participants generally reported being satisfied with the training interventions. Heterogeneity between and within included reviews, non-controlled designs of individual studies and low quality of evidence at an individual study level and review level made it difficult to draw firm conclusions regarding what interventions are most effective in changing health professionals' knowledge, skills, self-efficacy, attitudes and practice. However, similar gaps in the literature were identified across included reviews. Key areas that could be addressed in future interventions including organization and system-level barriers to providing advice, health professionals' attitudes and motivation and weight stigma have been highlighted. Health professionals and patients could be more involved in the planning and development of interventions that work towards improving diet and physical activity advice and support provided in healthcare.

Moderators of the internal consistency of error-related negativity scores: A meta-analysis of internal consistency estimates.

To ensure adequate reliability (i.e., internal consistency), it is common in studies using event-related brain potentials (ERPs) to exclude participants for having too few trials. This practice is particularly relevant for error-related ERPs, such as error-related negativity (ERN), where the number of recorded ERN trials is not entirely under the researcher's control. Furthermore, there is a widespread practice of inferring reliability based on published psychometricresearch, which assumes that internal consistency is a universal property of ERN. The present, preregistered reliability generalization study examined whether there is heterogeneity in internal consistency estimates of ERN scores and whether contextual factors moderate reliability. A total of 189 internal consistency estimates from 68 samples nested within 43 studies (n=4,499 total participants) were analyzed. There was substantial heterogeneity in ERN score internal consistency, which was partially moderated by the type of paradigm (e.g., Stroop, flanker), the clinical status of the sample, the ocular artifact correction procedure, measurement sensors (single versus cluster), and the approach to scoring and estimating reliability, suggesting that contextual factors impact internal consistency at the individual study level. Age, sex, year of publication, artifact rejection procedure, acquisition system, sample type (undergraduate versus community), and length of mean amplitude window did not significantly moderate reliability. Notably, the overall estimated reliability of ERN scores was below established standards. Recommendations for improving ERN score reliability are provided, but the routine failure of most ERN studies to report internal consistency represents a substantial barrier to understanding the factors that impact reliability.

Efficacy of vortioxetine in patients with major depressive disorder reporting childhood or recent trauma

BackgroundThis analysis investigates the efficacy of vortioxetine in adults with major depressive disorder (MDD) who report childhood or recent trauma. MethodsPatient-level data were analyzed from 4 double-blind, randomized, placebo-controlled short-term studies investigating the efficacy of vortioxetine (5–20 mg/day) versus placebo in patients (18–75 years old) with DSM-IV-TR–defined MDD. Changes from baseline to week 8 on the Montgomery-Åsberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), Clinical Global Impression - Improvement (CGI-I), and Sheehan Disability Scale (SDS) were examined at the individual study level and as in meta-analysis. A long-term relapse prevention study of 5 and 10 mg of vortioxetine was also analyzed. Traumatic events history was recorded at baseline. ResultsSixty-one percent of subjects (1113/1811) reported trauma history in the short-term studies. A significant effect vs. placebo was observed for vortioxetine on MADRS (10 mg, –2.2, P = .025; 20 mg, –4.4, P < .001), HAM-A (20 mg, –1.60, P = .012), CGI-I (5 mg, –0.3, P = .028; 10 mg, –0.3, P = .013; 20 mg, –0.50, P = .009), and SDS (20 mg, –2.3, P = .007) in patients with any trauma (childhood and/or recent). In the relapse prevention study, 51% (198/392) of subjects reported a history of trauma. Subjects with any trauma (childhood and/or recent) randomized to placebo were significantly more likely to relapse than subjects treated with vortioxetine (hazard ratio 2.8, P = .0019). LimitationsAn exploratory analysis. DiscussionVortioxetine showed significant short- and long-term efficacy on depressive and anxiety symptoms and overall functioning in this large subpopulation of MDD patients with a history of trauma. A significantly lower risk of relapse was also observed with vortioxetine.