Multiple Meta-regression Analysis Research Articles

Prediction models of intravenous glucocorticoids therapy response in thyroid eye disease.

Thyroid eye disease (TED) is an autoimmune orbital disease, with intravenous glucocorticoid (IVGC) therapy as the first-line treatment. Due to uncertain response rates and possible side effects, various prediction models have been developed to predict IVGC therapy outcomes. A thorough search was conducted in PubMed, Embase, and Web of Science databases. Data extraction included publication details, prediction model content, and performance. Statistical analysis was performed using R software, including heterogeneity evaluation, publication bias, subgroup analysis, and sensitivity analysis. Forest plots were utilized for result visualization. Of the 12 eligible studies, 47 prediction models were extracted. All included studies exhibited a low-to-moderate risk of bias. The pooled area under the receiver operating characteristic curve (AUC) and the combined sensitivity and specificity for the models were 0.81, 0.75, and 0.79, respectively. In view of heterogeneity, multiple meta-regression and subgroup analysis were conducted, which showed that marker and modeling types may be the possible causes of heterogeneity (P < 0.001). Notably, imaging metrics alone (AUC = 0.81) or clinical characteristics combined with other markers (AUC = 0.87), incorporating with multivariate regression (AUC = 0.84) or radiomics analysis (AUC = 0.91), yielded robust and reliable prediction outcomes. This meta-analysis comprehensively reviews the predictive models for IVGC therapy response in TED. It underscores that integrating clinical characteristics with laboratory or imaging indicators and employing advanced techniques like multivariate regression or radiomics analysis significantly enhance the efficacy of prediction. Our research findings offer valuable insights that can guide future studies on prediction models for IVGC therapy in TED.

The effectiveness of corpus use in ESL/EFL writing: A meta-analysis

The present study performs a meta-analysis to examine the effectiveness of corpus use in English as a second language (ESL) / English as a foreign language (EFL) writing. Data from 30 studies encompassing 56 effect sizes reported between 2000 and 2022 were collected for the analysis. Furthermore, multiple meta-regression analyses were conducted to explore the variables that may influence the observed effects. These variables are extracted from three groups of data: publication data, population data, and treatment data. The results demonstrate a large overall effect size (g = 0.95) for the impact of corpus use in ESL/EFL student writing performance. This finding suggests that utilizing corpora significantly enhances students’ writing abilities in these contexts. Moreover, the analyses of moderators reveal that the observed effects can be attributed to various variables within all three groups of data. Notably, learner factors such as language family, proficiency level, and educational level, as well as treatment factors including duration, corpus type, teaching activity, and teacher role, play significant roles in shaping the effects of corpus use. This study highlights the potential of corpus-based approaches as a valuable tool for enhancing student writing performance in ESL/EFL contexts.

Visual Impairment and Suicide Risk

Suicide is a substantial public health concern that involves various recognized contributing factors. Sensory impairments, specifically visual impairment, are deemed potential risk factors. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited. To investigate the association between visual impairment and different aspects of suicide, including the assessment of risk levels and exploration of potential contributing factors. An electronic search was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases from their inception to February 8, 2024. All published studies were considered without restrictions on study design, publication date, or language. Two independent reviewers extracted the published data using a standardized procedure in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Random-effects meta-analyses were used to estimate pooled effect sizes. Multiple meta-regression analyses were conducted to identify potential factors contributing to the association between visual impairment and the risk of suicide. The primary outcome measure was the odds ratio (OR) of suicidal behavior (including suicide attempt and suicide death) for individuals with visual impairment compared with those without. The secondary outcome measures were the pooled ORs of suicidal ideation and suicide death, respectively. A total of 31 population-based studies with 5 692 769 unique individuals (mean [SD] age, 48.4 [8.5] years; 2 965 933 females [52%]) were included. For 17 studies (5 602 285 individuals) that evaluated suicidal behavior, the pooled OR was 2.49 (95% CI, 1.71-3.63). For 21 studies (611 899 individuals) that assessed suicidal ideation, the pooled OR was 2.01 (95% CI, 1.62-2.50). For 8 studies (5 067 113 individuals) investigating the association between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32-2.71). The multiple meta-regression model identified age group as a predictive factor associated with suicidal behavior, with the studies included suggesting that adolescents were at the highest risk. While this analysis showed moderate heterogeneity for suicide death, high heterogeneity was observed for suicidal behavior and suicidal ideation. The findings of this systematic review and meta-analysis support the association between visual impairment and increased risk of suicidal tendencies. The risk differed by age group, with a pronounced risk observed among adolescents.

Prevalence Ratio of Primary Angle-Closure and Primary Open-Angle Glaucoma in Asian Population: A Meta-Analysis and Multiple Meta-Regression Analysis.

To investigate the prevalence ratio of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in the Asian population. Systematic searches of PubMed, Embase, and Cochrane databases for population-based studies in Asia published until August 5, 2022. We conducted a meta-analysis for PACG to POAG prevalence ratio using inverse variance-weighted random-effects meta-analyses so as to combine the study-specific measures of association. Between-study outcome variation (i.e., heterogeneity) was quantified with the I2 statistic. The multiple meta-regression analyses were performed in order to further account for the reasons for heterogeneity. Twenty studies, with a total study population of 52,522 individuals, had been conducted in 13 countries. The pooled PACG to POAG prevalence ratio was 2.204 (95% confidence interval, 1.617-3.004) with high heterogeneity (p < 0.001). In multiple meta-regression model, prevalence of POAG is the most important predictor for heterogeneity (model importance, 0.954), followed continent (0.508), and publication year (0.222). For every additional elevation of POAG prevalence (i.e., increase of 1.0%), the PACG to POAG prevalence ratio is expected to rise by 0.471. We estimated the pooled PACG to POAG prevalence ratio in the Asian population. The POAG prevalence is the most important factor to determine the PACG to POAG prevalence ratio.

Chest CT Lung Abnormalities 1 Year after COVID-19: A Systematic Review and Meta-Analysis.

Background Radiological lung sequelae may explain the persistence of respiratory complaints in post-COVID-19 condition (long-COVID). Purpose To perform a systematic review and meta-analysis of the prevalence and type of COVID-19 residual lung abnormalities at 1-year chest CT. Materials and Methods A literature search of PubMed, Web of Science, Embase, and Medline databases was performed from January 2020 to January 2023. Full-text reports of CT lung sequelae in adults (≥18 years) with confirmed COVID-19 at 1-year follow-up were included. The prevalence of any residual lung abnormality and type (fibrotic or not) was analyzed according to the Fleischner Glossary. The meta-analysis included studies with chest CT data assessable in no less than 80% of individuals. A random-effects model was used to estimate pooled prevalence. Multiple sub-group (country, journal category, methodological quality, study setting, outcomes) and meta-regression analyses were performed to identify potential sources of heterogeneity. I2 statistics estimated low (25%), moderate (26-50%) and high (>50%) heterogeneity. 95% Prediction Intervals (95% PIs) were computed to describe the expected estimates range. Results Of 22 709 records, 21 studies were reviewed (20 prospective, 9 from China, and 7 in radiology journals). The meta-analysis included 14 studies with chest CT data in 1854 of 2043 individuals (M/F: 1109/934). Estimates of lung sequelae were highly heterogeneous (7.1-96.7%), with a pooled frequency of 43.5% (I2=94%; 95% PI: 5.9%, 90.4%). This also applied to single non-fibrotic changes, including ground glass opacity, consolidations, nodules/masses, parenchymal bands, and reticulations. The prevalence range of fibrotic traction bronchiectasis/bronchiolectasis was 1.6-25.7% (I2=93%; 95% PI: 0.0%, 98.6%;); honeycombing was unremarkable (0-1.1%; I2=58%; 95% PI: 0%, 60%). Lung sequelae were unrelated to any characteristics of interest. Conclusion The prevalence of COVID-19 lung sequelae at 1-year chest CT is highly heterogeneous among studies. Heterogeneity determinants remain unknown suggesting caution in data interpretation with no convincing evidence. PROSPERO (CRD42022341258) Keywords: COVID-19 pneumonia, pulmonary fibrosis, chest CT, long-COVID, systematic review, metaanalysis See also the editorial by Parraga and Svenningsen in this issue.

Catastrophic health expenditure, incidence, trend and socioeconomic risk factors in China: A systematic review and meta-analysis.

To evaluate the incidence and trend of catastrophic health expenditures (CHE) in China over the past 20 years and explore the socioeconomic factors affecting China's CHE rate. The systematic review was conducted according to the Cochrane Handbook and reported according to PRISMA. We searched English and Chinese literature databases, including PubMed, EMbase, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang, China Science and Technology Journal Database (CQVIP), and CBM (Sino Med), for empirical studies on the CHE rate in China and its associated socioeconomic factors from January 2000 to June 2020. Two reviewers conducted the study selection, data extraction, and quality appraisal. The secular trend of the CHE rate was examined, and factors associated with CHE were explored using subgroup analysis and meta-regression. A total of 118 eligible studies with 1,771,726 participants were included. From 2000 to 2020, the overall CHE rate was 25.2% (95% CI: 23.4%-26.9%) in China. The CHE rate continued to rise from 13.0% in 2000 to 32.2% in 2020 in the general population. The CHE rate was higher in urban areas than in rural areas, higher in the western than the northeast, eastern, and central region, in the elderly than non-elderly, in low-income groups than non-low-income groups, in people with cancer, chronic infectious disease, and cardio-cerebrovascular diseases (CCVD) than those with non-chronic disease group, and in people with NCMS than those with URBMI and UEBMI. Multiple meta-regression analyses found that low-income, cancer, CCVD, unspecified medical insurance type, definition 1 and definition 2 were correlated with the CHE rate, while other factors were all non-significantly correlated. In the past two decades, the CHE rate in China has been rising. The continuous rise of health expenditures may be an important reason for the increasing CHE rate. Age, income level, and health status affect the CHE rate. Therefore, it is necessary to find ways to meet the medical needs of residents and, at the same time, control the unreasonable rapid increase in health expenditures in China.

Risk of cardiovascular disease among cancer survivors: Protocol of a pooled analysis of population-based cohort studies.

IntroductionCancer and cardiovascular disease remain leading causes of death and disability worldwide, which places a heavy burden on public health systems and causes widespread suffering. Because these entities have highly overlapping risk factors, including hyperlipidemia, hypertension, diabetes, obesity, smoking and other lifestyle factors, many studies have reported that they have similar etiological mechanisms. Accumulating evidence indicates that there is an increased risk of cardiovascular disease among cancer survivors compared with the general population. However, whether cancer is associated with an increased risk of cardiovascular disease remains controversial.Methods and analysisWe will conduct and report the meta-analysis strictly based on the Cochrane Handbook for Systematic Reviews and the Meta-analysis of Observational Studies in Epidemiology guidelines combined with the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Protocols (PRISM-P). This meta-analysis was registered with PROSPERO (registration number CRD42022307056). We will search for studies published from database inception to December 1, 2021, regardless of language or date, in three electronic databases (PubMed, EMBASE, and Cochrane Library) to identify and appraise cohort studies examining the relationship between cancer and subsequent cardiovascular disease risk. The literature screening, inclusion and data extraction will be conducted independently by two investigators using pre-designed standardized data extraction forms. A senior investigator will be consulted in cases of disagreement. We will assess risk of bias in the included cohort studies using the Newcastle–Ottawa Scale (NOS). Quantitative synthesis will be conducted using a random-effects model. To explore potential sources of heterogeneity, we will carry out multiple sensitivity analysis, meta-regression and subgroup analysis according to baseline characteristics. Publication bias will be evaluated through visual inspection of funnel plot asymmetry as well as by Begg's rank correlation test and Egger's weighted linear regression test.

Effect of Bone Marrow Mesenchymal Stromal Cell Therapies in Rodent Models of Sepsis: A Meta-Analysis.

BackgroundMultiple preclinical studies have demonstrated that bone‐marrow derived mesenchymal stromal (stem) cells [MSC(M)] positively influence the severity of sepsis symptoms and mortality in rodent models. However, this remains an inconclusive finding.ObjectiveTo review the effect of naïve MSC(M) in rodent models of sepsis.MethodsThe PubMed, EMBASE, and Web of Science databases were searched up to August 31, 2021. Inclusion criteria according to PICOS criteria were as follows: (1) population: rodents; (2) intervention: unmodified MSC(M); (3) comparison: not specified; (4) primary outcome: the effects of MSC(M) cell therapy on the mortality of rodent models of sepsis and endotoxemia; (5) study: experimental studies. Multiple prespecified subgroup and meta-regression analysis were conducted. Following quality assessment, random effects models were used for this meta-analysis.The inverse variance method of the fixed effects model was used to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs).Resultstwenty-four animal studies met the inclusion criteria. Our results revealed an overall OR difference between animals treated with naïve MSC(M) and controls for mortality rate was 0.34(95% confidence interval: 0.27-0.44; P < 0.0001). Significant heterogeneity among studies was observed.ConclusionsThe findings of this meta-analysis suggest that naïve MSC(M) therapy decreased mortality in rodent models of sepsis. Additionally, we identified several key knowledge gaps, including the lack of large animal studies and uncertainty regarding the optimal dose of MSC(M) transplantation in sepsis. Before MSC(M) treatment can advance to clinical trials, these knowledge gaps must be addressed.

The Men’s Marriage Premium in the United States: What Remains after Controlling for Publication Bias and Heterogeneity?

Married men earn more than single men, which is a significant finding in labour and family economics. A considerable amount of research literature discusses this estimated wage effect for married men in the United States. This study finds a meaningful impact on wage after controlling for the publication bias with heterogeneity, considering a meta-analysis of 120 estimates. Marriage premium accounts for 6.8% compared to unmarried men with the evidence of publication bias after applying descriptive statistics, funnel graph, simple meta-regression analysis (MRA), and multiple MRAs. Also, this analysis identifies omitted variable bias as another important aspect for explaining this widespread empirical literature.

Fibromyalgia and Nociceptive Flexion Reflex (NFR) Threshold: A Systematic Review, Meta-Analysis, and Identification of a Possible Source of Heterogeneity.

BackgroundThe nociceptive flexion reflex is a physiological, polysynaptic reflex and refers to the level that an appropriate withdrawal response activates when a painful stimulus is detected. The nociceptive flexion reflex threshold (NFRthr) is defined as the lowest noxious stimulation intensity required to trigger a reflex motor response. Despite wide utilization and reports of the NFRthr, there has been no consensus on a standard and/or best method in assessment of the NFRthr.ObjectiveTo systematically review the literature that compared the NFRthr between individuals with fibromyalgia (FM) and healthy controls; and to identify a source of heterogeneity in these trials.MethodsEmploying the Cochrane methodology, we systematically searched Ovid MEDLINE, Embase, Cochrane Clinical Answers, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and PsycINFO for clinical case-controlled trials assessing the NFRthr in individuals with and without fibromyalgia from inception to July 2019. Selected articles were passed for data extraction and meta-analyses. We utilized the random-effects model for meta-analysis assuming the true effect size may vary between studies. The sample sizes as a possible source of heterogeneity in multiple meta-regressions were investigated. This systematic review and meta-analysis were registered in PROSPERO before data extraction.ResultsNine studies met our criteria and were included in the meta-analysis. Methodologies and settings varied between studies, eg, stimulation intensity, duration, and the current increments. Only two articles comprehensively described and reported details about electromyogram amplification, latency, and sampling rate. Evidence from 423 patients with fibromyalgia and 326 healthy individuals suggested that there may not be a meaningful decreased NFRthr in patients (overall mean difference = –3.16; 95% CI:–6.82 to 0.50; Z = 1.69; P=0.09). Published effect sizes were not homogenous (I2 = 0.91, τ2 = 25.04, χ2 = 91.22, df = 8, P < 0.00001). The multiple meta-regression analyses indicated that total and female sample sizes might be the main sources of heterogeneity for the effect sizes SStotal = –0.0570, P = 0.040; SSfemale = –0.0569; P = 0.047.ConclusionEvidence suggests that the nociceptive flexion reflex threshold may not be different between patients with fibromyalgia and healthy controls. A unified and rigorous methodology and sample size calculation (probably sex specific investigation) is required for the assessment of nociceptive flexion reflex threshold in patients with fibromyalgia.

Effects Of Acute Caffeine Ingestion Following A Period Of Sleep Loss On Cognitive And Physical Performance: A Systematic Review And Meta-analysis

PURPOSE: This systematic review and meta-analysis examined the impact of acute caffeine consumption on cognitive and physical performance in sleep deprived/restricted individuals. METHODS: Electronic databases were searched for studies measuring cognitive and/or physical performance following sleep restriction (≤6h sleep within 24h) or deprivation (≥24h wakefulness) under control (placebo) and intervention (caffeine) conditions. Studies were included if performance was assessed within 6h of caffeine consumption. Individual effect estimates (EEs) were calculated as Hedges’ g for independent groups. Random effects meta-analyses were performed to determine intervention efficacy. Statistical significance was attained if the 95% CI did not include zero. Multiple meta-regression analysis was conducted to determine effects of caffeine dose and period of wakefulness on the magnitude of the effect. RESULTS: 36 publications providing 250 EEs were included. Caffeine improved performance on reaction time tasks (12 EEs; g=1.11; 95% CI: 0.75-1.47) and both response time (44 EEs; g=0.86; 95% CI: 0.53-0.83) and accuracy (27 EEs; g=0.68; 95% CI: 0.48-0.88) on attention tasks. The magnitude of the effect increased as caffeine dose increased, but was not influenced by the period of wakefulness for either task. Caffeine improved executive function (38 EEs; g=0.35; 95% CI: 0.15-0.55) and the magnitude of the effect increased as caffeine dose increased (p=0.007) and period of wakefulness decreased (p=0.021). Caffeine also improved response time (20 EEs; g=1.95; 95% CI: 1.39-2.52) and accuracy (34 EEs; g=0.43; 95% CI: 0.30-0.55) on information processing tasks, but neither caffeine dose (p=0.785) nor period of wakefulness (p=0.373) influenced the magnitude of the effect. No other performance outcomes were appropriate for meta-analysis. However, studies typically indicated a benefit of caffeine on memory (25 EEs), crystallized intelligence (11 EEs) and physical (39 EEs) performance. CONCLUSION: Caffeine is an effective counter-measure to the cognitive and physical impairments associated with sleep loss.

A Possible Source of Heterogeneity in Nociceptive Flexion Reflex (NFR) Threshold Among Patients with Fibromyalgia: Systematic Review and Meta-Analysis

Objectives: We aimed to investigate the possibility of sample size as a possible source of heterogeneity in trials comparing the nociceptive flexion reflex threshold (NFRthr) in fibromyalgia (FM) patients and healthy controls. Methods: A systematic search strategy was designed and conducted in electronic databases such as Ovid MEDLINE, Cochrane Libraries, Embase, and PsycINFO. In total, nine scholarly records were filtered by the inclusion and exclusion criteria, passed for data extraction (e.g. study designs and settings; methodology; total, male, and female sample sizes in FM and healthy control groups, and effect sizes), and statistical analyses (e.g. metaanalysis and meta-regression). Using random-effects model, the effect size (i.e. mean difference between the NFRthr in FM patients and healthy controls) was meta-analyzed. Investigating the sample size as a possible source of heterogeneity and utilizing a restricted maximum likelihood (REML) technique, the trials’ effect sizes were meta-regressed in multiple meta-regression against the total, male, and female sample sizes. Prior to any investigations, the aims of this research were registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019140354). Results: Results indicated the deficit in NFRthr (overall mean difference = −3.16; 95% 𝐶𝐼: −6.82 𝑡𝑜 0.50) was heterogenous (𝐼 2 = 0.91, 𝜏 2 = 25.04, 𝜒2= 91.22, df & < 0.00001) and the overall effect was not statistically significant (Z = 1.69; 𝑃 = 0.09). The multiple meta-regression analyses indicated that one of the main sources of bias to the effect size in the trials was found to be the total (𝑆𝑆𝑡𝑜𝑡𝑎𝑙 = −0.0570; 𝑃 = 0.040) and female (𝑆𝑆𝑓𝑒𝑚𝑎𝑙𝑒 = −0.0569; 𝑃 = 0.047) sample sizes that participated in the studies. Conclusion: The findings suggest that the total and female sample sizes might be possible sources of bias to effect sizes determined in NFRthr in FM patient and healthy controls. A possible solution might be to conduct sex-specific trials to determine the NFRthr among FM patients in future research. Funding Statement: Authors received no source of funding for this research. Declaration of Interests: Authors declare no conflict of interest. Ethics Approval Statement: PROSPERO; registration number: CRD42019140354

Similarity matters: A meta-analysis of interleaved learning and its moderators.

An interleaved presentation of items (as opposed to a blocked presentation) has been proposed to foster inductive learning (interleaving effect). A meta-analysis of the interleaving effect (based on 59 studies with 238 effect sizes nested in 158 samples) was conducted to quantify the magnitude of the interleaving effect, to test its generalizability across different settings and learning materials, and to examine moderators that could augment the theoretical models of interleaved learning. A multilevel meta-analysis revealed a moderate overall interleaving effect (Hedges' g = 0.42). Interleaved practice was best for studies using paintings (g = 0.67) and other visual materials. Results for studies using mathematical tasks revealed a small interleaving effect (g = 0.34), whereas results for expository texts and tastes were ambiguous with nonsignificant overall effects. An advantage of blocking compared with interleaving was found for studies based on words (g = -0.39). A multiple metaregression analysis revealed stronger interleaving effects for learning material more similar between categories, for learning material less similar within categories, and for more complex learning material. These results are consistent with the theoretical account of interleaved learning, most notably with the sequential theory of attention (attentional bias framework). We conclude that interleaving can effectively foster inductive learning but that the setting and the type of learning material must be considered. The interleaved learning, however, should be used with caution in certain conditions, especially for expository texts and words. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The prevalence of personality disorders in the community: a global systematic review and meta-analysis.

Personality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders. To calculate the worldwide prevalence of personality disorders and examine whether rates vary between high-income countries and low- and middle-income countries (LMICs). We systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from January 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094). A total of 46 studies (from 21 different countries spanning 6 continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8% (95% CI 6.1-9.5). Rates were greater in high-income countries (9.6%, 95% CI 7.9-11.3%) compared with LMICs (4.3%, 95% CI 2.6-6.1%). In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage v. one-stage assessment), county income (high-income countries v. LMICs) and interview administration (clinician v. trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of cluster A, B and C personality disorders were 3.8% (95% CI 3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%). Personality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations.

Effectiveness of psychoeducational interventions for the treatment of diabetes-specific emotional distress and glycaemic control in people with type 2 diabetes: A systematic review and meta-analysis

AimsPsychological comorbidity, such as depression and/or diabetes-specific emotional distress (DSD), is highly prevalent in people with type 2 diabetes (T2DM) and associated with poorer treatment outcomes. While treatments for depression are well established, interventions specifically designed for DSD are sparse. The aim of this study was to determine interventions that successfully address DSD and HbA1c in people with T2DM. MethodsSeven databases were searched to identify potentially relevant studies. Eligible studies were selected and appraised independently by two reviewers. Multiple meta-analyses and meta-regression analyses were performed to synthesise the data; the primary analyses determined the effect of interventions on DSD, with secondary analyses assessing the effect on HbA1c. ResultsThirty-two studies (n = 5206) provided sufficient DSD data, of which 23 (n = 3818) reported data for HbA1c. Meta-analyses demonstrated that interventions significantly reduced DSD (p = 0.034) and HbA1c (p = 0.006) compared to controls, although subgroup meta-analyses and meta-regression to explore specific intervention characteristics that might mediate this effect yielded non-significant findings. ConclusionsThe findings demonstrate that existing interventions successfully reduce DSD and HbA1c in people with T2DM. While promising, deductions should be interpreted tentatively, highlighting a stark need for further focused exploration of how best to treat psychological comorbidity in people with T2DM.

School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis.

Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsistencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as "school connectedness" or "connections at school" in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6-12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools. (PsycINFO Database Record

The effects of cognitive behavioral therapy are not systematically falling: A revision of Johnsen and Friborg (2015).

In a meta-analysis, Johnsen and Friborg (2015) reported a significant negative relationship between publication year and the effect sizes (ESs) of cognitive-behavioral therapy (CBT) for depressive disorders, suggesting its effectiveness was falling. We identified a series of methodological and conceptual caveats and consequently redid the meta-analysis. We used the same inclusion criteria, but only included randomized controlled trials and searched for additional eligible trials. We computed both within-group and between-group ESs for the CBT arm for the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD). We assessed risk of bias, sample size, type of control group, and the study's country of origin and conducted subgroup, single, and multiple meta-regression analyses including publication year and other moderators. We identified 30 additional eligible trials. Within-group ESs presented huge heterogeneity estimates (I2 around 90%). Year of publication was significant in some single meta-regression analyses on the BDI, but not significant in others, in most analyses on the HRSD, and in any of the analyses on between-group ESs. Multiple regression models indicated that either year was not significantly related or that both year and country were significantly related to outcomes, with a temporal trend present solely in US studies. Year of publication does not appear to be a reliable and independent moderator of the effectiveness of CBT for depression. The linear "fall" reported by Johnsen and Friborg (2015) is most likely a spurious finding. (PsycINFO Database Record

Explosive Training and Heavy Weight Training are Effective for Improving Running Economy in Endurance Athletes: A Systematic Review and Meta-Analysis.

Several strategies have been used to improve running economy (RE). Defined as the oxygen uptake required at a given submaximal running velocity, it has been considered a key aerobic parameter related to endurance running performance. In this context, concurrent strength and endurance training has been considered an effective method, although conclusions on the optimal concurrent training cannot yet be drawn. To evaluate the effect of concurrent training on RE in endurance running athletes and identify the effects of subject characteristics and concurrent training variables on the magnitude of RE improvement. We conducted a computerized search of the PubMed and Web of Science databases, and references of original studies were searched for further relevant studies. The analysis comprised 20 effects in 16 relevant studies published up to August 2015. The outcomes were calculated as the difference in percentage change between control and experimental groups (% change) and data were presented as mean ± 95 % confidence limit. Meta-analyses were performed using a random-effects model and, in addition, simple and multiple meta-regression analyses were used to identify effects of age, training status, number of sessions per week, training duration, type of strength training, and neuromuscular performance on % change in RE. The concurrent training program had a small beneficial effect on RE (% change = -3.93 ± 1.19 %; p < 0.001). In addition, explosive (% change = -4.83 ± 1.53; p < 0.001) and heavy weight (% change = -3.65 ± 2.74; p = 0.009) training programs produced similar improvements in RE, while isometric training (% change = -2.20 ± 4.37; p = 0.324) in selected studies did not induce a significant effect. The multiple linear meta-regression analysis showed that all the differences between % changes could be explained by including the above-mentioned characteristics of subjects and weight training program elements. This model showed that the magnitude of the % change in RE was larger for longer training duration (β = -0.83 ± 0.72, p = 0.02). Explosive training and heavy weight training are effective concurrent training methods aiming to improve RE within a few weeks. However, long-term training programs seem to be necessary when the largest possible improvement in RE is desired.

Drug treatment rates with beta-blockers and ACE-inhibitors/angiotensin receptor blockers and recurrences in takotsubo cardiomyopathy: A meta-regression analysis.

In a recent paper Singh et al. analyzed the effect of drug treatment on recurrence of takotsubo cardiomyopathy (TTC) in a comprehensive meta-analysis. The study found that recurrence rates were independent of clinic utilization of BB prescription, but inversely correlated with ACEi/ARB prescription: authors therefore conclude that ACEi/ARB rather than BB may reduce risk of recurrence. We aimed to re-analyze data reported in the study, now weighted for populations' size, in a meta-regression analysis. After multiple meta-regression analysis, we found a significant regression between rates of prescription of ACEi and rates of recurrence of TTC; regression was not statistically significant for BBs. On the bases of our re-analysis, we confirm that rates of recurrence of TTC are lower in populations of patients with higher rates of treatment with ACEi/ARB. That could not necessarily imply that ACEi may prevent recurrence of TTC, but barely that, for example, rates of recurrence are lower in cohorts more compliant with therapy or more prescribed with ACEi because more carefully followed. Randomized prospective studies are surely warranted.

Stimulant use disorders in people with psychosis: a meta-analysis of rate and factors affecting variation.

Stimulant abuse and dependence often complicate the care of people with psychotic disorders. This study systematically reviews the prevalence estimates reported for stimulant abuse and dependence in people with psychotic disorders, and examines personal, clinical, regional and methodological factors which explain variation in these rates. PsychINFO, EMBASE and MEDLINE (1946-2013) were searched systematically for studies reporting on stimulant drug use disorders in representative samples of people with psychotic disorders. Random effects models estimated the pooled rate of a stimulant use disorder, defined to include stimulant abuse and stimulant dependence. Study characteristics associated with heterogeneity in rates of stimulant use disorder were examined by subgroup analyses for categorical variables, by meta-regression for continuous independent variables and by multiple meta-regression. Sixty-four studies provided 68 estimates of lifetime or recent stimulant use disorders in 22,500 people with psychosis. The pooled rate of stimulant use disorder was 8.9% (95% CI 7.4%, 10.5%). Higher rates of stimulant use disorders were reported in studies of affective psychosis, studies from inpatient settings, studies from the USA and Australia, and studies with higher rates of cannabis disorder; in multiple meta-regression analysis these factors explained 68% of between-study variance. Rates of stimulant use disorder were stable over time, and unrelated to age, sex, stage of psychosis, type of stimulant drug or study methodology factors. Reported rates of stimulant use disorder in people with psychosis are much higher than in the general population but vary widely and are associated with regional, service setting and clinical differences between studies. It is likely that stimulants contribute to the overall burden of psychosis, and that social and environmental factors combine with drug and illness-related factors to influence stimulant use in psychosis.