Meta-analysis Of Prevalence Studies Research Articles

Polycystic ovarian syndrome among women diagnosed with infertility in the Gulf Cooperation Council countries: A protocol for systematic review and meta-analysis of prevalence studies.

Polycystic ovarian syndrome, a common endocrine disorder, is an important cause of infertility among women of reproductive age. Within the Gulf Cooperation Council countries, polycystic ovarian syndrome is found to affect women increasingly. No study has been carried out to critically summarize the evidence on the prevalence of polycystic ovarian syndrome among women suffering from infertility in these countries. This protocol aims to conduct a systematic review and meta-analysis of the studies reporting the prevalence of polycystic ovarian syndrome among women seeking infertility treatment in the six Gulf Cooperation Council countries (Bahrain, Kuwait, Oman, Saudi Arabia, Qatar, and United Arab Emirates). The systematic review and meta-analysis will follow the following method. Five databases, including PubMed, Embase, CINAHL, Web of Science, and SCOPUS, will be searched for observational studies using a combination of relevant keywords and Medical Subject Headings from inception of databases. Two reviewers will screen titles and abstracts, followed by a full-text search based on the eligibility criteria. The main outcome is to measure the proportion of women who have polycystic ovarian syndrome among infertility-diagnosed patients. In addition, the risk of bias in the included studies will be assessed using the national institute of health quality assessment tool for observational studies. The random-effects method of the analysis with the inverse variance will be used to calculate the pooled prevalence of polycystic ovarian syndrome-attributed infertility. Variation in prevalence estimates will be calculated using subgroup analysis based on study and patients' characteristics and publication bias will be assessed via funnel plot inspection and Eggar's test. A critical assessment of evidence on the prevalence of polycystic ovarian syndrome in women attending fertility clinics is helpful in risk quantification, enabling better planning for managing infertility in women with polycystic ovarian syndrome. This protocol has been registered with PROSPERO, protocol registration number (CRD42022355087).

ADHD in Adults: A Systematic Review and Meta-Analysis of Prevalence Studies in Outpatient Psychiatric Clinics

Objective: Systematic review and meta-analysis to estimate the pooled prevalence of ADHD in adult attendees of outpatient mental health clinics and to investigate factors influencing prevalence rates. Methods: The following were extracted: demographics, design of the study (screening only or two-phase), scales/criteria for diagnosis of ADHD, number of ADHD, and non-ADHD participants. Results: The pooled prevalence of ADHD from screening studies (n = 9) was 26.7%, (95% CI [17.2–37.4]), ADHD = 1727, No ADHD = 3,578. From studies employing a two-stage design (n = 5), prevalence was 14.61%, CI [10.39–19.41], ADHD = 561, No ADHD = 3,578. Age and gender did not have any significant effect on the estimated prevalence. By contrast exclusion of psychotic disorders lowers prevalence. The screening scale used also influence prevalence rates. Conclusion: Meta-analysis shows high rates of adult ADHD among psychiatric outpatient clinics. Applying DSM-5 criteria increased prevalence rates. More methodologically robust studies, using two-stage design, need to be conducted to help assist in service planning.

Frequency and Correlates of Treatment Resistance in Schizophrenia-Spectrum Disorders: Results from a Meta-Analysis of Prevalence Studies

Frequency and Correlates of Treatment Resistance in Schizophrenia-Spectrum Disorders: Results from a Meta-Analysis of Prevalence Studies

Prevalence, Risk Factors and Outcome of Pregnancy induced Hypertension in Nepal: A Meta-Analysis of Prevalence Studies.

Pregnancy induced hypertension is a major cause of global maternal mortality and morbidity. This review was conducted to fulfill the objective of evaluating the status of pregnancy induced hypertension in Nepal. The protocol for this review was registered in PROSPERO (CRD42020211210). Pubmed, Embase, Google Scholar, Scopus and Pubmed Central were searched using appropriate keywords for relevant studies. Data analysis was performed using Comprehensive Meta-Analysis Software version 3. Forest plot was used to visualize the prevalence and risk factors of Pregnancy induced hypertension. Random effect model was used and the level of heterogeneity was high. Joanna Briggins Institute bias assessment tool was used for the analysis of bias in the included studies. Twenty studies were included in the review. The pooled prevalence of pre-eclampsia and eclampsia were 2.6% (95% CI, 1.2%-5.3%) and 0.5% (95% CI, 0.2%-1.1%) respectively. The majority of cases were young women and had not complete or unbooked antenatal visits. Cesarean delivery was the most common mode of deliveries in 50% of deliveries (proportion, 0.50; 95% CI, 0.40-0.60) among patients with PIH followed by vaginal deliveries in 43.1% (proportion, 0.431; 95% CI, 0.336-0.532); and rest 6.9% were vacuum/forceps assisted deliveries (proportion, 0.069; 95% CI, 0.050-0.093). Common maternal complications were abruption in 6.56% of Pregnancy induced hypertension cases, rest were pulmonary embolism, renal injury. The prevalence of pre-eclampsia and eclampsia in Nepal were 2.6% and 0.5%. Younger woman and women with poor antenatal checkups had increased risk of Pregnancy induced hypertension. Cesarean delivery was the most common route of delivery and common maternal complications were abruption placenta, pulmonary embolism, renal injury etc. Keywords: Eclampsia; hypertension; maternal mortality; Nepal; pre-eclampsia; pregnancy-induced.

Prevalence of contrast nephropathy following the administration of N-acetyl cysteine; a systematic review and meta-analysis

Introduction: Nephropathy is a serious complication in patients receiving contrast during imaging. N-acetyl cysteine (NAC) can reduce the contrast nephropathy. This review evaluates the prevalence of contrast-induced nephropathy (CIN) following the administration of NAC. Methods: A systematic literature search and meta-analysis was conducted in Scopus, Web of Science and PubMed for articles published by December 30, 2019 including the keywords of "N-acetyl cysteine ", "Acute kidney injury", "Nephrotoxicity", "Contrast media", "Contrast-induced AKI" and "Contrast nephropathy". Results: A total of 29 articles of 537 studies examining 5,980 individuals were incorporated in this systematic review and meta-analysis. Pooled estimation of a meta-analysis of prevalence studies reported a prevalence of 9% (0.09), i.e. nine out of every 100 patients undergoing contrast media resulted in CIN but a prevalence of 14% (0.14) was observed in the placebo group. In addition, 41 out of every 100 patients with hypertension undergoing contrast media resulted in CIN (prevalence: 41%) and 64 out of every 100 patients with diabetes undergoing contrast media resulted in CIN (prevalence: 64%). Conclusion: The prevalence of CIN in the group receiving NAC is lower than those who did not receive this drug. Additionally, in patients suffering from diabetes and hypertension, CIN is more prevalent compared to healthy people.

Type 2 diabetes and pre-diabetes mellitus: a systematic review and meta-analysis of prevalence studies in women of childbearing age in the Middle East and North Africa, 2000\u20132018

BackgroundInvesting in women’s health is an inevitable investment in our future. We systematically reviewed the available evidence and summarized the weighted prevalence of type 2 diabetes (T2DM) and pre-diabetes mellitus (pre-DM) in women of childbearing age (15–49 years) in the Middle East and North African (MENA) region.MethodsWe comprehensively searched six electronic databases to retrieve published literature and prevalence studies on T2DM and pre-DM in women of childbearing age in the MENA. Retrieved citations were screened and data were extracted by at least two independent reviewers. Weighted T2DM and pre-DM prevalence was estimated using the random-effects model.ResultsOf the 10,010 screened citations, 48 research reports were eligible. Respectively, 46 and 24 research reports on T2DM and pre-DM prevalence estimates, from 14 and 10 countries, were included. Overall, the weighted T2DM and pre-DM prevalence in 14 and 10 MENA countries, respectively, were 7.5% (95% confidence interval [CI], 6.1–9.0) and 7.6% (95% CI, 5.2–10.4). In women sampled from general populations, T2DM prevalence ranged from 0.0 to 35.2% (pooled, 7.7%; 95% CI, 6.1–9.4%) and pre-DM prevalence ranged from 0.0 to 40.0% (pooled, 7.9%; 95% CI, 5.3–11.0%). T2DM was more common in the Fertile Crescent countries (10.7%, 95% CI, 5.2–17.7%), followed by the Arab Peninsula countries (7.6%, 95% CI, 5.9–9.5%) and North African countries and Iran (6.5%, 95% CI, 4.3–9.1%). Pre-DM prevalence was highest in the Fertile Crescent countries (22.7%, 95% CI, 14.2–32.4%), followed by the Arab Peninsula countries (8.6%, 95% CI, 5.5–12.1%) and North Africa and Iran (3.3%, 95% CI, 1.0–6.7%).ConclusionsT2DM and pre-DM are common in women of childbearing age in MENA countries. The high DM burden in this vital population group could lead to adverse pregnancy outcomes and acceleration of the intergenerational risk of DM. Our review presented data and highlighted gaps in the evidence of the DM burden in women of childbearing age, to inform policy-makers and researchers.Systematic review registrationPROSPERO CRD42017069231

Dengue virus infection in people residing in Africa: a systematic review and meta-analysis of prevalence studies

Better knowledge of the face of the current dengue virus (DENV) epidemiology in Africa can help to implement efficient strategies to curb the burden of dengue fever. We conducted this systematic review and meta-analysis to determine the prevalence of DENV infection in Africa. We searched PubMed, EMBASE, African Journals Online, and Africa Index Medicus from January 1st, 2000 to June 10th, 2019 without any language restriction. We used a random-effects model to pool studies. A total of 76 studies (80,977 participants; 24 countries) were included. No study had high risk of bias. Twenty-two (29%) had moderate and 54 (71%) had low risk of bias. In apparently healthy individuals, the pooled prevalence of DENV was 15.6% (95% confidence interval 9.9–22.2), 3.5% (0.8–7.8), and 0.0% (0.0–0.5) respectively for immunoglobulins (Ig) G, IgM, and for ribonucleic acid (RNA) in apparently healthy populations. In populations presenting with fever, the prevalence was 24.8% (13.8–37.8), 10.8% (3.8–20.6k) and 8.4% (3.7–14.4) for IgG, IgM, and for RNA respectively. There was heterogeneity in the distribution between different regions of Africa. The prevalence of DENV infection is high in the African continent. Dengue fever therefore deserves more attention from healthcare workers, researchers, and health policy makers.

Severe mental illness and substance use disorders in prisoners in low-income and middle-income countries: a systematic review and meta-analysis of prevalence studies

SummaryBackgroundAlthough more than two thirds of the world's incarcerated individuals are based in low-income and middle-income countries (LMICs), the burden of psychiatric disorders in this population is not known. This review provides estimates for the prevalence of severe mental illness and substance use disorders in incarcerated individuals in LMICs.MethodsFor this systematic review and meta-analysis, we searched 17 electronic databases to identify prevalence studies of psychiatric disorders in prison populations in LMICs, published between January, 1987, and May, 2018. We included representative studies from general prison samples, providing information about four major psychiatric diagnoses: psychosis, major depression, alcohol use disorders, and drug use disorders. We pooled data from studies using random-effects meta-analyses and assessed the sources of heterogeneity by meta-regression. We extracted general population estimates from the Global Burden of Diseases 2016 database to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42015020905.FindingsWe identified 23 publications reporting prevalence estimates of severe mental illness and substance use disorders for 14 527 prisoners from 13 LMICs. In this population, the estimated pooled 1 year prevalence rates for psychosis were 6·2% (95% CI 4·0–8·6), 16·0% (11·7–20·8) for major depression, 3·8% (1·2–7·6) for alcohol use disorders, and 5·1% (2·9–7·8) for drug use disorders. We noted increased prevalence at prison intake and geographic variations for substance use disorders. For alcohol use disorders, prevalence was higher in the southeast Asian region than in the eastern Mediterranean region; and drug use disorders were more prevalent in the eastern Mediterranean region than in Europe. Prevalence ratios indicated substantially higher rates of severe mental illness and substance use disorders among prisoners than in the general population (the prevalence of non-affective psychosis was on average 16 times higher, major depression and illicit drug use disorder prevalence were both six times higher, and prevalence of alcohol use disorders was double that of the general population).InterpretationThe prevalence of major psychiatric disorders is high in prisoners in LMIC compared with general populations. As these findings are likely to reflect unmet needs, the development of scalable interventions should be a public health priority in resource-poor settings.FundingCONICYT of the Chilean government and the Wellcome Trust.

Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis

BackgroundAs the data on the association of mental disorders and chronic physical diseases in developing and emerging countries is heterogeneous, this study aims to produce the first meta-analysis of these comorbidities.MethodologyThe meta-analysis protocol was registered in PROSPERO (N°CRD42017056521) and was performed in accordance with PRISMA guidelines. Initially, an article search was conducted on Medline, Embase, Lilacs and the Institut d’Epidémiologie et de Neurologie Tropicale database [Institute of Epidemiology and Tropical Neurology], as well as manually, with no restriction on language or date focusing on mental disorders, chronic diseases and neurotropic diseases. Two independent investigators assessed the quality of the studies which met the inclusion criteria using the Downs and Black assessment grid. The pooled estimates were calculated out using a random-effects method with CMA software Version 3.0. A meta-regression was then performed, and the significance level was set at 0.05.ResultsOf the 2604 articles identified, 40 articles involving 21,747 subjects met the inclusion criteria for co-morbidities between mental disorders and chronic physical diseases. Thirty-one articles were included in the meta-analysis of prevalence studies and 9 articles in that of the analytical studies. The pooled prevalence of mental disorders in patients with chronic physical diseases was 36.6% (95% CI, 31.4–42.1) and the pooled odds ratio was 3.1 (95% CI, 1.7–5.2). There was heterogeneity in all the estimates and in some cases, this was explained by the quality of the studies.ConclusionSome estimates regarding the prevalence of mental disorders in people with chronic physical diseases living in developing and emerging countries were similar to those in developed countries. Mental disorders are a burden in these countries. In order to respond effectively and efficiently to the morbidity and mortality associated with them, mental health care could be integrated with physical care.

PO232 A Systematic Review and Meta-Analysis of Prevalence Studies of White Coat and Masked Hypertension In Africa

PO232 A Systematic Review and Meta-Analysis of Prevalence Studies of White Coat and Masked Hypertension In Africa

A17238 A systematic review and meta-analysis of prevalence studies of white coat and masked hypertension in Africa

A17238 A systematic review and meta-analysis of prevalence studies of white coat and masked hypertension in Africa

Hepatitis B virus infection among pregnant women in Ethiopia: a systematic review and Meta-analysis of prevalence studies

BackgroundThere are several epidemiological studies available on hepatitis B virus among pregnant women in Ethiopia. These individual studies revealed wide variation over time and across geographical areas. The aim of this systematic review and Meta-analysis is to estimate the overall prevalence of hepatitis B virus infection among pregnant women in Ethiopia.MethodsA comprehensive search of electronic databases including PubMed, Popline, Lalicus, Ovid, MedNar, African Journal Online (AJOL) and advanced Google Scholar was conducted regardless of publication year from August 30, 2017 to September 25, 2017. The search was updated on January 02, 2018 to minimize time-lag bias. The methodological qualities of included studies were assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments.ResultsOut of 103 studies, 17 studies with a total of 5629 pregnant women were included in the Meta-analysis. The pooled prevalence of hepatitis B virus infection among pregnant women using random-effect model was 4.7%(95% CI 4.0–5.4%). The I2 statistics was I2 = 37.9%(p = 0.0575). Even though significant heterogeneity among studies was not detected, the I2 = 37.9% suggests medium heterogeneity. A subgroup Meta-analysis showed that study site, region, mean/median sample size, hepatitis B virus screening methods and methodological quality were not source of heterogeneity (p-difference > 0.05).ConclusionThis review shows an intermediate level of hepatitis B virus infection among pregnant women in Ethiopia. In addition to the current practice of child vaccination, routine and universal antenatal hepatitis B virus screening program need to be implemented.

Hepatitis B virus and HIV coinfection among adults residing in Cameroon: A systematic review and meta-analysis of prevalence studies.

This systematic review and meta-analysis was conducted to determine the prevalence of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection among adults in Cameroon. We searched PubMed, EMBASE, Web of Science, Global Index Medicus, and Africa Journal Online with no language restriction to identify articles published from Jan 1996 until Dec 2017. We considered observational studies conducted in apparently healthy populations (pregnant women, blood donors, and general population). We used a random-effects model to pool data. We included 24 studies (23,295 participants) from seven of the ten regions in Cameroon. Four, 20, and no studies had low, moderate, and high risk of bias respectively. The overall HBV-HIV coinfection prevalence was 0.8% (95%CI 0.5-1.0; 11 studies). The overall HBV prevalence in people with HIV was 12.9% (95%CI 9.7-16.5; 20 studies). The HBV prevalence in people with HIV was significantly higher in rural compared to urban. No study reported the prevalence of HIV infection in people with HBV. Although we found a low prevalence of HIV-HBV coinfection in Cameroon, this study presented a high HBV prevalence in people with HIV. Effective strategies to interrupt the transmission of HBV are required, especially among people with HIV infection in rural areas.

Severe Mental Illness and Substance Use Disorders in Prisoners in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis of Prevalence Studies

Background: Although more than two thirds of prisoners are based in low- and middle-income countries (LMIC), the burden of psychiatric disorders is not reliably known. This review provides estimates for the prevalence of severe mental illness and substance use disorders in incarcerated individuals in LMIC. Methods: Systematic literature searches were conducted in 17 electronic databases identifying prevalence studies of psychiatric disorders in prison populations, published between January 1987 and May 2018. We pooled prevalences using random-effects meta-analyses and assessed the sources of heterogeneity by meta-regression. We extracted general population estimates from the Global Burden of Diseases 2016 database to calculate prevalence ratios. The review was registered in PROSPERO (CRD42015020905). Findings: We identified 23 publications reporting estimates for 14,527 prisoners. The pooled one-year prevalence rates were estimated to be 6·2% (95% CI 4·0-8·6) for psychosis, 16·0% (95% CI 11·7-20·8) for major depression, 3·8% (95% CI 1·2-7·6) for alcohol use disorders, and 5·1% (95% CI 2·9-7·8) for drug use disorders. We found elevated prevalences at prison intake and geographic variations for substance use disorders. Prevalence ratios indicated substantially higher rates among prisoners than in the general population. Interpretation: The prevalence of major psychiatric disorders is high in prisoners in LMIC. As these findings are likely to reflect unmet needs, the development of scalable interventions should be a public health priority in resource-poor settings. Funding: This work was funded by CONICYT of the Chilean government (FONDECYT Regular grant number 1160260 to APM) and The Wellcome Trust (grant number 202836/Z/16/Z to SF). Declaration of Interest: We declare no competing interests.

Systematic review and meta-analysis of prevalence studies in transsexualism

BackgroundOver the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data. MethodsDatabases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed. ResultsThe overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years. ConclusionsThe overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.

Prevalence of asthenopia in children: a systematic review with meta-analysis

ObjectiveTo estimate the prevalence of asthenopia in 0–18 year-old children through a systematic review and meta-analysis of prevalence studies. SourcesInclusion criteria were population-based studies from 1960 to May of 2014 reporting the prevalence of asthenopia in children. The search was performed independently by two reviewers in the PubMed, EMBASE, and LILACS databases, with no language restriction. This systematic review was performed in accordance with the Cochrane Collaboration guidelines and the PRISMA Statement. Downs and Black score was used for quality assessment. Summary of findingsOut of 1692 potentially relevant citations retrieved from electronic databases and searches of reference lists, 26 were identified as potentially eligible. Five of these studies met the inclusion criteria, comprising a total of 2465 subjects. Pooled prevalence of asthenopia was 19.7% (12.4–26.4%). The majority of children with asthenopia did not present visual acuity or refraction abnormalities. The largest study evaluated 1448 children aged 6 years and estimated a prevalence of 12.6%. Associated risk factors were not clearly established. ConclusionAlthough asthenopia is a frequent and relevant clinical problem in childhood, with potential consequences for learning, the scarcity of studies about the prevalence and clinical impact of asthenopia hinders the effective planning of public health measures.

The prevalence of Giardia infection in dogs and cats, a systematic review and meta-analysis of prevalence studies from stool samples

Giardia has a wide range of host species and is a common cause of diarrhoeal disease in humans and animals. Companion animals are able to transmit a range of zoonotic diseases to their owners including giardiasis, but the size of this risk is not well known. The aim of this study was to analyse giardiasis prevalence rates in dogs and cats worldwide using a systematic search approach. Meta-analysis enabled to describe associations between Giardia prevalence and various confounding factors. Pooled prevalence rates were 15.2% (95% CI 13.8–16.7%) for dogs and 12% (95% CI 9.2–15.3%) for cats. However, there was very high heterogeneity between studies. Meta-regression showed that the diagnostic method used had a major impact on reported prevalence with studies using ELISA, IFA and PCR reporting prevalence rates between 2.6 and 3.7 times greater than studies using microscopy. Conditional negative binomial regression found that symptomatic animals had higher prevalence rates ratios (PRR) than asymptomatic animals 1.61 (95% CI 1.33–1.94) in dogs and 1.94 (95% CI 1.47–2.56) in cats. Giardia was much more prevalent in young animals. For cats >6 months, PRR=0.47 (0.42–0.53) and in dogs of the same age group PRR=0.36 (0.32–0.41). Additionally, dogs kept as pets were less likely to be positive (PRR=0.56 (0.41–0.77)) but any difference in cats was not significant. Faecal excretion of Giardia is common in dogs and slightly less so in cats. However, the exact rates depend on the diagnostic method used, the age and origin of the animal. What risk such endemic colonisation poses to human health is still unclear as it will depend not only on prevalence rates but also on what assemblages are excreted and how people interact with their pets.

From the Editor

THIS issue of the Journal of Head Trauma Rehabilitation has several novel components that we want to bring to your attention. First, you will notice that the issue contains 2 topical sections. Although we have previously published topical sections (as opposed to an entire topical issue), it is new to have 2 in the same issue. You will find articles based on 2 of the plenary talks given at the 3rd Federal Interagency Conference on TBI—one by Daniel Perl, MD, from the Uniformed Services University of the Health Sciences and the other by Jennie Ponsford, PhD, from Monash University in Melbourne, Australia. Tamara Bushnik and Wayne Gordon, who co-chaired the conference, introduce the section with a recap and analysis of emerging issues. The second topical section introduces 2 additional novel features for JHTR. “TBI in Offender Populations” contains 3 articles, 2 from Elisabeth Pickelsimer's group at the Medical University of South Carolina, and a third from Huw Williams and colleagues at the University of Exeter in the United Kingdom. The prevalence of traumatic brain injury (TBI) among both youth and adult offenders underscores the importance of this topical section. Indeed, the first article is a meta-analysis of prevalence studies that first appeared in the Journal of Correctional Health Care. This is the first time that JHTR has published a reprint, but the careful methodology and striking findings convinced us that this manuscript deserved additional dissemination to the brain injury community. The topical section on TBI in Offender Populations is also unique because it is our first “ePublication only.” These articles are shown in the table of contents and their abstracts are included in the print version of JHTR, but the full manuscripts will only be found on the JHTR Web site, http://journals.lww.com/headtraumarehab. Everything else about these manuscripts is exactly the same as all articles published in JHTR, including their having undergone peer review, capture in Index Medicus and other search engines, inclusion in citation statistics, as well as the look of the PDF versions that can be distributed electronically. We will be interested in authors' and readers' reactions to ePublication—the benefit is that articles get to the field faster and the pages only count as a fraction toward our annual allocation, thus increasing the total number of articles we can publish. And finally, the icing on the cake is the issue's diverse collection of unsolicited articles. On behalf of all the Editors, we hope you enjoy this unique issue of JHTR. —John D. Corrigan, PhD, ABPP Editor-in-Chief