Pooled Effect Research Articles

Exposure to Racism and Adverse Pregnancy Outcomes for Black Women: A Systematic Review and Meta-Analysis.

Research suggests that stress due to racism may underlie the disproportionately high rates of adverse pregnancy outcomes experienced by Black women in the US. Study objectives: (1) Identify forms of systemic racism affecting pregnancy outcomes and (2) increase understanding about the role of racism in adverse pregnancy outcomes for Black women. A systematic review was conducted to explore the relationship between systemic racism and pregnancy outcomes for Black women. Searches were performed using EBSCO Academic Search Complete, CINAHL Complete, and Consumer Health Complete first between January to April 2021 and subsequently between November 2023 to January 2024. Included studies were observational, written in English, had full-text availability, examined at least one form of systemic racism and pregnancy outcome, and reported results for Black women. A meta-analysis was performed using a random effects model, summary effect estimates were pooled by pregnancy outcome. The I2 statistic was used to measure heterogeneity between studies. A total of 32 studies were included in the review. Significant pooled effects of exposure to systemic racism were observed for preterm birth 0.30 (95% CI 0.12-0.48), small for gestational age 0.31 (95% CI 0.05-0.58), and low birth weight 0.24 (95% CI 0.11-0.37). Among studies that compared results by race, exposure to systemic racism had a significant and rather large effect on preterm birth for Black women (ds = 0.62; 95% CI 0.06-0.41). Exposure to systemic racism has a significant effect on preterm birth, small for gestational age, and low birth weight for Black women. Having knowledge of how racism contributes to stress and poor pregnancy outcomes can help health professionals improve delivery of quality care to Black women. Future research should continue identifying forms of racism positively related to adverse pregnancy outcomes.

The effect of Vagus nerve stimulation (VNS) on seizure control, cognitive function, and quality of life in individuals with drug-resistant epilepsy: A systematic review article.

To evaluate the effect of vagus nerve stimulation (VNS) on seizure control, cognitive functions, and quality of life in individuals with drug-resistant epilepsy. An extensive search of electronic databases was carried out in order to carry out this systematic review. The databases Google Scholar, Embase, PubMed, and the Cochrane Library were searched first to carryout gray literature. To reduce the quantity of pointless studies in the advanced search, the search is limited to "human studies" and "English language" publications only. Combining keywords and Medical Subject Headings (MeSH) terms like ("Vagus Nerve Stimulation" OR "VNS") AND ("Epilepsy" OR "Seizure Control") AND ("Cognitive Function" OR "Quality of Life"). Studies that have been published up to November 30/2023 were included. The search strategy yielded a total of 392 relevant studies. The mean age of participant's ranges from 11 years to 33 years. The duration of follow-up ranging from 6 to 36 months. Eleven studies were included in the review. The mean≥50% response rate after VNS therapy was 56.94% ranged from 48.90% to 83.00%. Four and three studies provided information about Quality of Life in Epilepsy Inventory (QOLIE-31) and The Liverpool Seizure Severity Scale (LSSS) questionnaires respectively. Epilepsy is a chronic disease characterized by sudden abnormal discharge of brain neurons, which leads to transient brain dysfunction and the presence of spontaneous recurrent seizures. Vagus nerve stimulation has recently been proposed as a potential tool in the treatment of seizure, depressive symptoms, and cognitive impairments. There has been variation in the effects of VNS treatment on seizure control, cognitive functions, and quality of life among patients with drug-resistant epilepsy. So, a comprehensive review of exciting literature is important to see the pooled effect. Previous systematic review and meta-analysis papers were mostly randomized control trial type with specific diseases. The use of a wider variety of study designs than only randomized controlled trials is important. So, we included retrospective and prospective cohort studies in addition to randomized control trials. This enables a more thorough assessment of the connection between quality of life, cognitive function, and vagus nerve stimulation. In addition, the paper looks at a wide range of disease kinds and patterns. We have established a uniform and comprehensive approach throughout the selected studies by mandating the inclusion of all three crucial parameters: vagus nerve stimulation, cognitive function, and quality of life. This systematic review examined 392 relevant studies on vagus nerve stimulation (VNS) therapy, with participants ranging from 11 to 33 years old and follow-up durations of 6-36 months. Eleven studies were included, and the mean response rate after VNS therapy was 56.94%, ranging from 48.90% to 83.00%. The review also reported on quality of life and cognitive function, and seizure severity frequency result from several studies.

Climate change and epidemiological trends of malaria and Lassa fever transmission in Nigeria (2015-2022): A systematic review and meta-analysis

Background: Climate change exacerbates infectious disease transmission in Nigeria, a country with a high burden of infectious diseases. Objective: To conduct a systematic review and meta-analysis examining the relationship between climate variability and infectious disease transmission in Nigeria. Methods: We systematically searched major databases, identifying 25 studies, with 11 studies meeting the inclusion criteria for meta-analysis using R version 4.4.1. Results: The meta-analysis revealed significant associations between temperature increases and malaria (pooled effect estimate = 1.034, 95% CI: 1.016-1.052) and Lassa fever (pooled effect estimate = 1.029, 95% CI: 1.015-1.043) transmission. Egger's funnel plot showed no significant publication bias, and sensitivity analysis confirmed the robustness of the findings. Conclusion: This study provides evidence for the association between climate variability and infectious disease transmission in Nigeria. This underscores the urgent need for targeted interventions to protect vulnerable populations, including children under 5, pregnant women, the elderly, people with comorbidity, and low-income communities.

Non-exercise-based interventions to support healthy ageing in older adults: A systematic review and meta-analysis of randomised controlled trials.

Healthy ageing is a multidimensional construct, where various factors play a role in influencing wellbeing in older age. Many studies heavily emphasise the importance of physical activity, negating other aspects such as psychosocial or cognitive influences. This review aimed to evaluate the effectiveness of non-exercise-based interventions on the quality of life (QoL) and life satisfaction of community-dwelling, healthy older adults. A systematic review and meta-analysis of randomised controlled trials was conducted. Four electronic databases were searched from inception. Three independent reviewers screened the articles and appraised the risk of bias. Data relating to study characteristics, intervention and outcomes were extracted. The mean difference and standardised mean difference with 95% confidence intervals were synthesised to pool effect sizes. Outcomes that could not be included in the meta-analysis were synthesised narratively. Thirty-six articles from 35 randomised controlled trials, involving 6,127 older adults, were included. Most were multi-component interventions and involved supporting lifelong learning. Most participants were females (70.2%). Pooled analyses revealed small but statistically significant effects on overall QoL (SMD=0.26, CI: 0.00 to 0.53), and QoL subscales relating to mental health and psychological wellbeing (SMD=0.26, CI: 0.12-0.41) and environment (SMD=0.31, CI: 0.03-0.58). Effects on social health and functioning, and role functioning related to physical health were marginal. There were no improvements in other subscales. Results revealed non statistically significant improvements in life satisfaction. Multicomponent non-exercise-based interventions that support lifelong learning in older adults can support healthy ageing, particularly in improving overall QoL, and mental health, social health and environment QoL subscales.

Covid-19 pandemic and student academic performance: a systematic review and meta-analysis

Abstract Background The COVID-19 pandemic led to widespread disruptions in educational systems globally, forcing a transition to remote learning modalities. This systemic change raised concerns about its potential impact on the academic performance of students in developmental ages. This systematic review and meta-analysis aimed to evaluate the association between the COVID-19 pandemic and academic performance among developmental-age students, quantifying the effect size using Cohen’s d. Methods We searched PubMed/MEDLINE, Scopus, and Embase for studies published up to December 2023 that assessed the impact of the COVID-19 pandemic on academic performance. The review was performed following the PRISMA 2020 guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. The pooled effect size was calculated using Cohen’s d, with its 95% confidence interval. The protocol has been registered in PROSPERO. Results Out of 3671 retrieved articles, 30 studies met the inclusion criteria, and 13 were suitable for meta-analysis, involving a combined total of 4,893,499 students. The Cohen’s d was -0.07 (95% CI = -0.10 to -0.03; p < 0.001), indicating a small but statistically significant decline in academic performance associated with the pandemic. Subgroup analyses revealed that mathematics suffered the most significant impact, with a Cohen’s d of -0.14 (95% CI = -0.18 to -0.10; p < 0.001). All the included studies were judged as moderate-high quality. Conclusions The COVID-19 pandemic has had a negative effect on the academic performance of students of developmental ages, particularly in mathematics. These findings highlight the need for targeted interventions to mitigate the educational setbacks caused by the pandemic, especially in core subjects where the decline in performance was most pronounced. Key messages • The COVID-19 pandemic has significantly disrupted educational systems worldwide, resulting in a small but statistically significant decline in academic performance among students of developmental ages. • The shift in educational delivery during the pandemic particularly affected learning outcomes in mathematics more than in other subjects.

Advancing mammography uptake among vulnerable groups: a systematic review of intervention strategies

Abstract With over 2 million cases diagnosed annually, breast cancer is a leading cause of cancer-related disability and mortality. Despite global efforts to implement mammography screening programs, uptake rates vary widely across settings due to socioeconomic factors and accessibility challenges. To improve participation, targeted interventions addressing barriers faced by underserved groups are essential for promoting inclusive screening and early detection. As part of the ENTER project, which aims to address disparities in breast cancer screening participation among women with low socioeconomic status (SES) in Flanders, Belgium, we conducted a systematic review and meta-analysis on the effectiveness of interventions to enhance mammography uptake. To explore the differential impact of interventions on mammography uptake among vulnerable groups, including individuals with low SES, underinsured, with immigrant background or part of an ethnic minority, subgroup analyses were performed. 7 databases were searched, resulting in the inclusion of 54 out of 9,366 papers for analysis. 14 types of interventions were identified. The meta-analysis showed significant pooled effects of interventions that increased mammography uptake [OR 1.8 (95%CI 1.6-2.2)], particularly among vulnerable populations [OR 2.2 (95%CI 1.7-2.8)]. The most effective interventions were educational interventions [OR 3.03 (95%CI 2.2-4.9); in vulnerable groups OR 2.7 (95%CI 1.9-3.9)]. As expected, interventions adapted to linguistic needs and culturally sensitive approaches showed a significant effect among vulnerable target groups [OR 2.9 (95%CI 1.1-7.9) and OR 2.5 (95%CI 1.1-5.6), respectively]. Reminders were also highly effective [OR 1.8 (95%CI 1.5-2.1); in vulnerable groups OR 2.5 (95%CI 1.9-3.1)]. This review underscores the critical role of targeted interventions in augmenting screening mammography uptake, particularly among vulnerable populations, where odds of participation can increase by up to 2-3 times. Key messages • Interventions adapted to the linguistic needs of the target population and culturally sensitive approaches, aligned with values and beliefs of a specific community, can greatly enhance screening rates. • Considering costs, practicality and impact, reminder letters with culturally and linguistically adapted content emerged as the most promising option for implementation in the ENTER project.

The effect of Glucagon-like peptide-1 receptor agonists on cardiovascular outcomes in type 2 diabetes mellitus patients with coronary artery disease

Abstract Background Cardiovascular disease is the primary cause of mortality in patients with type 2 diabetes mellitus (T2DM). Randomized controlled trials (RCT) have shown that Glucagon-like peptide-1 receptor agonists (GLP-1RA) improve cardiovascular outcomes in T2DM patients, with greater therapeutic benefits observed in patients with established atherosclerotic cardiovascular disease. However, the effect of GLP1-RA therapy on cardiovascular outcomes has been inconsistent and the RCT have not been sufficiently powered to examine the effect of GLP1-RA on mortality or their therapeutic effect in different subgroups of T2DM patients. Purpose This study aimed to examine the effect of GLP1-RA therapy on cardiovascular outcomes and mortality in a real-world cohort of T2DM patients with coronary artery disease (CAD). Methods This study included T2DM patients with CAD who were treated with metformin at a daily dose of ≥ 1g for a period of ≥ 180 days. CAD was defined as ≥ 50% luminal stenosis in any coronary artery segment according to a nationwide angiography and angioplasty registry. We performed sequential emulated target trials at monthly intervals between January 1, 2013 and December 31, 2020 to examine the effect of GLP1-RA therapy on major adverse cardiovascular outcomes (MACE), a composite of myocardial infarction, ischemic stroke and all-cause mortality. Secondary outcomes included the individual components of MACE. Marginal structural models were used to compute pooled effect estimates. This was an intention-to-treat analysis with 5 years of follow-up for each emulated target trial. Inverse probability of treatment weighting was used to adjust for confounding due to differences in patient demographics at baseline. Results This study consisted of 26,746 individuals who were treated with GLP1-RA and 74,638 controls. The 5-year cumulative risk of MACE was 27.7 % in the GLP1-RA group and 32.7 % in the control group (risk ratio 0.85 [95% confidence interval 0.82 – 0.88]). GLP1-RA therapy was associated with a lower risk of all-cause mortality (risk ratio 0.76 [95% confidence interval 0.72 – 0.79]) and myocardial infarction (risk ratio 0.95 [95% confidence interval 0.89 – 1.00]). We found little or no effect of GLP1-RA therapy on the risk of ischemic stroke (risk ratio 1.13 [95% confidence interval 0.97 – 1.27]). Conclusions In this large real-world cohort of T2DM patients with established CAD, we observed that GLP1-RA therapy was associated with a lower risk of MACE, myocardial infarction and all-cause mortality.

Platelet Reactivity with MACE in Acute Coronary Syndrome Patients Post-PCI under Dual Antiplatelet Therapy: A Meta-Analysis.

Aim/Background Acute coronary syndrome (ACS), a condition characterized by acute cardiac ischemia, is among the major causes of death from cardiovascular diseases (CVD). However, whether there is a correlation between platelet reactivity and major adverse cardiovascular events (MACE) remains debatable, and whether platelet function tests should be tailored for ACS patients after percutaneous coronary intervention (PCI) is still under discussion. This study aims to investigate the relationship between platelet reactivity and the occurrence of MACE in ACS patients post-PCI and to discuss the implications of these findings. Methods Clinical studies on 'PCI, ACS, dual antiplatelet therapy (DAPT), platelet reactivity, major adverse cardiovascular events (MACE)' up to 31 October 2023, were systematically collected from Embase, PubMed, and the Cochrane Library. Twelve articles meeting predefined criteria were selected. Meta-analysis was performed using Review Manager 5.4 (Cochrane, London, UK) and Stata 15.0 (StataCorp LLC, College Station, TX, USA) to compute pooled effect sizes, assess heterogeneity, explore sources of heterogeneity, and evaluate publication bias. Results Twelve articles consisting of 9297 patients were included. The meta-analysis showed that ACS patients with high platelet reactivity (HPR) who received PCI and used DAPT for 1-2 years had a greater risk of MACE (risk ratio (RR) = 1.79, 95% confidence interval (CI): 1.30-2.46) compared to those with low platelet reactivity. Moreover, greater platelet reactivity was associated independently with all-cause mortality (RR = 2.26, 95% CI: 1.63-3.12), cardiac mortality (RR = 2.87, 95% CI: 2.16-3.8), myocardial infarction (RR = 1.98, 95% CI: 1.53-2.5), in-stent restenosis (RR = 1.87, 95% CI: 1.22-2.87), as well as stroke (RR = 1.62, 95% CI: 1.02-2.57), but not with coronary revascularization events (RR = 0.99, p = 0.96, 95% CI: 0.80-1.24). On the other hand, meta-regression revealed that region (p = 0.99), type of ACS patient (p = 0.16), drug regimen (p = 0.48), testing method (p = 0.51), sampling time (p = 0.70), follow-up time (p = 0.45), and PCI protocol (p = 0.27) were not sources of heterogeneity in the study. Conclusion The meta-analysis outcomes indicate that in ACS patients receiving PCI and using dual antiplatelet therapy for 1-2 years, HPR was independently positively correlated with major adverse cardiovascular events, all-cause (or cardiac) mortality, recurrent myocardial infarction, in-stent restenosis, and stroke. This suggests that platelet reactivity testing has clinical and translational significance in predicting patients' risk of adverse cardiovascular events.

Determining diagnostic sensitivity loss limits for sample pooling in duplex rtPCR surveillance testing: Theileria orientalis and Anaplasma marginale.

To expand surveillance testing capacity through sample pooling, a thorough understanding is needed of how sample dilution through pooling affects the sensitivity of candidate assays. We validated a robust and representative framework for assessing the dilution effect of sample pooling using duplex rtPCR surveillance of Theileria orientalis and Anaplasma marginale, both of which are causative agents of severe anemia in cattle and a serious threat to the cattle industry in Virginia and many other states. We used 200 known-positive samples with Ct values representative of typical surveillance results in a series of pools in which we re-tested each sample individually, followed by each sample diluted in equal volumes with negative samples to make pools of 2, 4, 6, 8, and 10 total samples. We compared the Ct values of the individual positives with the Ct values of each pool size to determine if Ct values increase past the limit of detection in the 45-cycle assay. We observed a maximum of 2% sensitivity loss (no more than 2 of 100 samples returned a false-negative result) for both T. orientalis and A. marginale during the pooling series, with lower-than-expected average Ct increase and sensitivity loss. We conclude that pooling up to 10 samples would be acceptable for regional surveillance of T. orientalis and A. marginale using our rtPCR assay. The described strategy is applicable to validate pooling for a wide range of single and duplex rtPCR assays, which could expand efficient disease surveillance.

Is Serum Vitamin D Associated with Depression or Anxiety in Ante- and Postnatal Adult Women? A Systematic Review with Meta-Analysis.

To collect evidence from studies that explored the associations between serum vitamin D (25[OH]D) concentrations/status and the presence of depressive/anxiety symptoms in the ante- and/or postnatal periods (PROSPERO-CRD42023390895). Studies that assessed serum 25[OH]D concentrations in adult women during the ante/postnatal periods and those that used valid instruments to identify the experience/severity of depressive/anxiety symptoms were included. Independent researchers performed the identification/selection of studies, data extraction, risk of bias (RoB) assessment, and bibliometric analysis steps. Of the total of 6769 eligible records, 15 cohort studies [high (n = 3), moderate (n = 7), and low (n = 5) RoB], nine cross-sectional studies [moderate (n = 3) and low (n = 6) RoB], and one case-control study [moderate RoB] were included (n = 25). Depression (n = 24) and anxiety (n = 4) symptoms were assessed. A significant difference in antenatal serum 25[OH]D concentrations between the groups of women with and without depression was identified (mean difference: -4.63 ng/mL; 95% confidence interval [95% CI]: -8.88; -0.38). Postnatal serum 25[OH]D concentrations were found to be, on average, -2.36 ng/mL (95% CI: -4.59; -0.14) lower in women with postnatal depression than in those without. Maternal antenatal anxiety was associated with significantly lower concentrations/deficiency of 25[OH]D in only one included study. Based on very low/low-quality evidence, it was observed that reduced serum 25[OH]D concentrations in the ante- and postnatal period are associated with the presence of ante- and postnatal depressive symptoms, respectively. Low/deficient antenatal serum 25[OH]D concentrations may not be related to the presence of anxiety symptoms before childbirth. Well-designed longitudinal studies are needed to explore the estimated pooled effect of these associations.

The role of neutrophils in pain: systematic review and meta-analysis of animal studies.

The peripheral inflammatory response is an attractive therapeutic target for pain treatment. Neutrophils are the first circulating inflammatory cells recruited to sites of injury, but their contribution to pain outcomes is unclear. We performed a systematic review and meta-analysis of original preclinical studies, which evaluated the effect of preemptive neutrophil depletion on pain outcomes (PROSPERO registration number: CRD42022364004). Literature search (PubMed, January 19, 2023) identified 49 articles, which were meta-analyzed using a random-effects model. The risk of bias was evaluated using SYRCLE's tool. The pooled effect considering all studies showed that neutrophil depletion induced a consistent pain reduction. Inflammatory, joint, neuropathic, and visceral pain showed significant pain alleviation by neutrophil depletion with medium-large effect sizes. However, muscle and postoperative pain were not significantly alleviated by neutrophil depletion. Further analysis showed a differential contribution of neutrophils to pain outcomes. Neutrophils had a higher impact on mechanical hyperalgesia, followed by nociceptive behaviors and mechanical allodynia, with a smaller contribution to thermal hyperalgesia. Interspecies (mice or rats) differences were not appreciated. Analyses regarding intervention unveiled a lower pain reduction for some commonly used methods for neutrophil depletion, such as injection of antineutrophil serum or an anti-Gr-1 antibody, than for other agents such as administration of an anti-Ly6G antibody, fucoidan, vinblastine, CXCR1/2 inhibitors, and etanercept. In conclusion, the contribution of neutrophils to pain depends on pain etiology (experimental model), pain outcome, and the neutrophil depletion strategy. Further research is needed to improve our understanding on the mechanisms of these differences.

Prognostic Value of TGF-β Expression in Bladder Cancer: A Systematic Review and Meta-analysis.

Transforming growth factor beta (TGF-β) is a member of the growth factor superfamily that clinical studies address its association with bladder cancer invasion, progression, and metastasis. The present systematic review and meta-analysis aimed to explore the prognostic significance of TGF-β expression in bladder cancer patients. The major international databases, including PubMed, Web of Science, Embase, and Scopus, were searched for full-text literature citations. The hazard ratio (HR) with a 95% CI as the effect size was applied as the appropriate summarized statistic. We used a random-effects model using the DerSimonian and Laird method to estimate the pooled effect size. To assess the heterogeneity among trials, the I-square (I 2 ) statistic and Cochran's Q test were used. Forest and funnel plots were drawn to respectively demonstrate the findings and detect any existing publication bias. This meta-analysis included 3 studies that met the criteria and included 535 patients. The combined HR for the selected studies was 2.250 (95% CI=(1.411, 3.586), P< .001) and no significant heterogeneity was detected between trials (I 2=58.63, P=.089). Furthermore, no severe asymmetry was seen within the funnel plot, indicating a lack of potential publication bias. Our findings suggest that TGF-β expression can remarkably predict a worse prognosis in patients with bladder cancer. The results of the present meta-analysis may be validated through further updated reviews and additional relevant investigations in future studies.

Depressive and anxiety symptoms amid COVID-19 pandemic among healthcare workers in a low-resource setting: a systematic review and meta-analysis from Ethiopia.

Coronavirus disease 2019 (COVID-19) outbreak is one of the public health problems that pose a serious mental health concern due to its high morbidity and mortality rate. The healthcare workers are at risk of developing mental health symptoms like depression and anxiety because they are the first point of contact in the diagnosis, treatment, and care of patients with COVID-19. This study aimed to systematically review the prevalence and the associated factors of depression and anxiety disorders among healthcare workers amid COVID-19 pandemic in Ethiopia. A systematic review and meta-analysis study was conducted. Different primary studies that assessed the depressive and anxiety disorders during amid COVID-19 pandemic in the Ethiopian healthcare workers were extracted by Microsoft Excel and exported to STATA version 11 for further analysis. Random-effects model meta-analysis was used to the estimate pooled effect size and the effect of each study with their 95% confidence interval. Funnel plot analysis and Egger regression tests were conducted to detect the presence of publication bias. Subgroup analysis and sensitivity analysis were conducted. Thirteen studies with 5,174 participants were included in this systematic review and meta-analysis study. The pooled prevalence of depression and anxiety disorders was 40.39% (95% CI: 28.54, 52.24) and 44.93% (95% CI: 31.39, 58.46), respectively. Being a woman, being married, working in the frontline, and having high perceived susceptibility were significantly associated with depression among the Ethiopian healthcare workers. Similarly, being a woman, being older in age, working in the frontline, and having high perceived susceptibility were the factors associated with anxiety disorder among the Ethiopian healthcare workers during the COVID-19 pandemic. The prevalence of depression and anxiety disorders in the Ethiopian healthcare workers was high. The timely detection and appropriate management of mental health problems is essential for the quality of healthcare services, and proactive support methods for the female, married, and older-age healthcare professionals could result in these outcomes. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022299074.

Clinical Efficacy and Safety of Novel Anticoagulants for the Management of Venous Thromboembolism in Patients with Cancer: A Systematic Review and Meta-Analysis.

Cancer patients face a four- to sevenfold higher risk of venous thromboembolism (VTE) than the general population. Novel oral anticoagulants (NOACs) provide convenient alternatives to traditional therapies. We performed a systematic literature search across PubMed, Embase, and the Cochrane Library, targeting studies that examined the use of NOACs in cancer-associated VTE. The search included randomized controlled trials (RCTs). Selected studies compared NOACs with low-molecular-weight heparin (LMWH) or vitamin K antagonists (VKA) in cancer patients diagnosed with VTE. A meta-analysis using a random-effects model was applied to estimate pooled effect sizes for outcomes. In this meta-analysis, we included 12 RCTs. Results showed NOACs were more effective than LMWH in preventing VTE recurrence (RR 0.66, 95% CI 0.52-0.83, p = 0.0004). Compared with VKAs, NOACs showed no significant difference (RR 0.63, 95% CI 0.34-1.15, p = 0.13). However, this finding is limited by the small patient sample. Major bleeding outcomes were similar between NOACs and LMWH/VKAs (RR 1.24, 95% CI 0.85-1.80, p = 0.28; RR 0.77, 95% CI 0.39-1.53, p = 0.46, respectively). Meta-regression analysis indicated a statistically significant positive correlation between mortality and major bleeding events when comparing NOACs with LMWH (p = 0.049). There was no significant difference in all-cause mortality between patients treated with NOACs and those treated with LMWH (RR 1.04, 95% CI 0.92-1.18, p = 0.54) or VKAs (RR 0.94, 95% CI 0.72-1.23, p = 0.65). Meta-analysis shows NOACs, especially factor Xa inhibitors, reduce VTE recurrence in cancer patients more effectively than LMWH. Comparison between NOACs and VKAs is inconclusive due to limited patient data. Further research is needed to assess NOACs' efficacy and safety against VKAs.

Prognostic value of pre-treatment neutrophil-to-lymphocyte ratio in patients with brain metastasis from cancer: a meta-analysis

Evidence shows that inflammatory responses play an essential role in the development of brain metastases (BM). The goal of this meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) to predict the prognosis of patients with BM to help clinicians institute early interventions and improve outcomes. We conducted systematic review and meta-analysis, utilizing data from prominent databases, including PubMed, Cochrane Library and China National Knowledge Infrastructure databases. Our inclusion criteria encompassed studies investigating the studies that assessed the association between NLR and overall survival (OS). We included 11 articles, with 2629 eligible patients, to evaluate the association between NLR and OS. High NLR was significantly associated with shorter OS, with a pooled hazard ratio (HR) of 1.82 (95% CI 1.57–2.11). Subgroup analysis revealed that this association was consistent across different regions, with HRs of 2.03 (95% CI 1.67–2.46) in Asian populations and 1.58 (95% CI 1.35–1.84) in non-Asian populations. Additionally, in a subgroup analysis based on NLR cut-off values, patients with NLR ≥ 3 had an HR of 1.69 (95% CI 1.46–1.96), while those with NLR < 3 had an HR of 2.26 (95% CI 1.64–3.11). Sensitivity analysis confirmed that no single study significantly influenced the pooled effect size. Our meta-analysis confirmed the prognostic value of NLR in patients with brain metastasis.

The association between empirical dietary inflammatory pattern and risk of cancer and cancer-specific mortality: a systematic review and meta-analysis of prospective cohort studies.

Current evidence indicates a correlation between the inflammatory potential of diet and the risk of cancer and cancer-specific mortality. This study aimed to assess the association between empirical dietary inflammatory pattern (EDIP), which has recently been designed based on the inflammatory potential of the diet, and the risk of cancer and cancer-specific mortality. A systematic literature search was conducted across the PubMed/Medline, Scopus, and Web of Science databases from January 2016 to March 2024. A random effects model was used to calculate the pooled effect size (ES) and 95% confidence intervals (95% CI). Heterogeneity between studies was assessed using the Cochran Q test and the I 2 statistic. From the initial 229 records, 24 prospective cohort studies with 2,683,350 participants and 37,091 cancer incidence cases, as well as 20,819 cancer-specific mortality, were included in our study. Pooled results indicated a significant association between higher adherence to the EDIP and an increased risk of total cancer (ES: 1.10; 95% CI: 1.05-1.15; I 2 = 41.1), colorectal cancer (ES: 1.19; 95% CI: 1.11-1.27; I 2 = 41.1), and liver cancer (ES: 1.48; 95% CI: 1.14-1.94; I 2 = 36.9). However, no significant association between increased adherence to the EDIP and an increased risk of ovarian or endometrial cancer was found. Furthermore, greater adherence to the EDIP was significantly associated with an increased risk of cancer-specific mortality (ES: 1.18; 95% CI: 1.05-1.33; I 2 = 45.4). Our results showed that a diet with higher inflammatory properties is associated with an increased risk of cancer and cancer-specific mortality. PROSPERO registration no. CRD42024496912.

Waist circumference as a parameter in school-based interventions to prevent overweight and obesity - a systematic review and meta-analysis

BackgroundPreventing childhood obesity remains an important public health issue worldwide. Since visceral fat in particular is understood as an important risk factor for many chronic diseases, waist circumference is recommended as a measurement parameter for global obesity surveillance. This systematic review and meta-analysis focused on waist circumference as an outcome parameter for studies of school-based interventions to prevent overweight and obesity.MethodsA systematic literature search was conducted at the end of 2019 in nine data bases, including Medline and Embase, in order to identify relevant studies evaluating interventions in schools aimed at preventing obesity. Eligibility criteria admitted randomised and non-randomised controlled trials. After screening titles, abstracts and full texts, the data of the identified studies were systematically extracted. Risk of bias was assessed according to study type with the appropriate Cochrane Risk of Bias Tool. The review gives a qualitative overview over all included studies structured by extracted data. Separate meta-analyses were done for the outcome mean difference in change in waist circumference, measured in cm or reported as z-score value, using an inverse variance random-effects model due to study design.ResultsA total of 2421 publications were screened based on titles, abstracts and full texts. Complemented by results of a former systematic literature search 44 studies were identified for inclusion, comprising a total of 39.837 participants (age range: 6 to 18 years). Nearly half of the studies were conducted in Europe, two-thirds combined diet and exercise-based interventions. Likewise two thirds of the studies were conducted as cluster-randomised trials. Most of the reported effects favoured the experimental groups, indicating the basic effectiveness of school-based measures. Based on reported data, only one third of the studies could be included in the meta-analyses. For the difference in mean change of the outcome parameter waist circumference measured in cm (95% CI), we found a pooled effect estimate of -0.95 (-1.87; -0.46). For the difference in mean change of the outcome parameter waist circumference reported as z-score value (95% CI), the pooled effect estimate was -0.10 (-0.15; -0.05). Both effect estimates were in favour of the experimental group. The overall effect sizes were small with a p-value < 0.05.ConclusionsPooled effect estimates were small but in favour of the experimental groups. The same applies to the majority of the effects reported in the included studies. The included cluster of randomised controlled trials demonstrated an especially sound methodological standard. The possibility of achieving larger effects in studies of preventive interventions and health promotion is limited. Schools can only realise their full potential in preventing overweight and obesity in children and adolescents if they are accompanied by measures in other areas of the obesogenic environment.

Effects of Mantram Repetition on Spiritual Well-Being: A Systematic Review and Meta-Analysis.

Background: Spiritual well-being is an essential component of whole-person care and is increasingly recognized in various clinical disciplines as positively affecting mental health. Mantram repetition (MR) is an intervention rooted in Eastern spiritual traditions that has been shown to have clinical benefits, including reduction of psychological distress, among individuals with chronic psychological conditions. The central aim of this meta-analysis was to examine the effects of MR on spiritual well-being. Methods: Fifteen databases were searched from their inception year to July 19, 2023. Two independent reviewers extracted and coded data from randomized or quasi-experimental studies with comparison groups, conducted to test MR, measured spiritual well-being, and reported their study in English. Coded data included study quality indicators which were used in moderator analyses. Results: After the initial and updated searches and removal of duplicates, we reviewed 2,072 articles; seven studies met inclusion criteria with a total sample size of 556 (MR = 272, comparison = 284). Overall, MR had a positive effect on spiritual well-being with a pooled effect size of 0.535 with Hartung-Knapp-Sidik-Jonkman adjusted 95% confidence intervals of 0.18 and 0.89 (p = 011). Using moderator analyses, we examined the effect of the quality indicators and intervention characteristics on effect size; only session length was significant. Longer MR intervention sessions (i.e., 90 min) had greater effects than shorter sessions (i.e., 50-60 min). Conclusions: Across these seven studies, MR showed moderate to strong effects on spiritual well-being. Additional studies are needed to determine the reliability of these findings.

Effectiveness of Acupuncture in Improving Quality of Life for Patients with Advanced Cancer: A Systematic Review and Meta-Analysis.

To investigate the effect of acupuncture on advanced cancer patients by meta-analysis. Nine databases (the Cochrane Central Register of Controlled Trials, MEDLINE, Web of Science, Embase, China National Knowledge Infrastructure, the Cumulative Index to Nursing and Allied Health Literature, Chinese Biomedical Literature Database, China Science and Technology Journal Database, and WanFang Data) were searched for randomized controlled trials (RCTs) on acupuncture in advanced cancer patients published from inception to February 13, 2023 and updated to June 1, 2023. Primary outcomes were quality of life (QOL), while secondary outcomes were pain, fatigue, and adverse events (side effects). Data synthesis was performed using RevMan V.5.3 to calculate pooled effect sizes. RoB-2 was used for the risk of bias, and the quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Totally 17 RCTs involving 1,178 participants were included, 15 of which were pooled for meta-analysis. Most studies demonstrated some concern for the overall risk of bias. The pooled data indicated that acupuncture was associated with improved QOL [mean difference (MD)=6.67, 95% confidence interval (CI): 5.09 to 8.26], pain (MD=-1.18, 95% CI -2.28 to -0.08), and adverse events (risk ratio=0.30, 95% CI: 0.26 to 0.57) compared with control groups. Fatigue outcome was not included. Heterogeneity was substantial, and GRADE evidence was very low for both QOL and pain. Acupuncture could benefit patients with advanced cancer and is considered safe compared with usual care. However, the evidence regarding QOL and pain outcomes requires further validation. It is crucial to encourage the development of high-quality studies to strengthen this evidence. (Registry No. CRD42023423539).

Efficacy of Thiocolchicoside for Musculoskeletal Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Despite the fact that thiocolchicoside has been widely used in the treatment of musculoskeletal pain, its efficacy has never been systematically evaluated. We carried out a systematic review and meta-analysis of randomized clinical trials (RCTs) to appraise the existing evidence on the efficacy of thiocolchicoside for musculoskeletal pain management. Methods: The literature search was performed on multiple databases, extracting reports of RCTs evaluating the efficacy of thiocolchicoside compared to placebo or no exposure. The reduction in pain intensity was evaluated through between-groups mean differences (MDs) in Visual Analogue Scale (VAS) scores after the intervention. The pooled effect estimates were compared to a minimally important difference (MID) of 1 point on a scale from 0 to 10. Results: We retrieved eight RCTs, including a total of 1397 patients. All the included studies were determined as being at high risk of bias. Seven trials evaluated patients with acute low back pain. After 2-3 days of treatment, the pooled MD in VAS score was -0.49 (95%CI = -0.90; -0.09) compared to controls. After 5-7 days of treatment, the summary MD was -0.82 (95%CI = -1.46; -0.18). Conclusions: Although thiocolchicoside was found to significantly reduce patient-reported low back pain, the clinical impact was very small, as the pooled effect estimates were below the MID, and the overall certainty of evidence was very low. In light of the safety concerns raised by the European Medicine Agency, an in-depth analysis on the risk-benefit balance of thiocolchicoside is required.