Potential Sources Of Heterogeneity Research Articles

Efficacy and outcomes of antiplatelet therapy versus oral anticoagulants in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis.

Recent guidelines suggest that antiplatelet therapy (APT) is the standard of care in the absence of long-term oral anticoagulation (OAC) indications in patients post-transcatheter aortic valve replacement (TAVR). The superiority of one method over the other remains controversial. Several databases, including MEDLINE, Google Scholar, and EMBASE, were electronically searched. The primary endpoint was the all-cause mortality (ACM) rate. Secondary endpoints included cardiovascular death, myocardial infarction (MI), stroke/TIA, haemorrhagic stroke, bleeding events, systemic embolism, and valve thrombosis in post-TAVR patients receiving APT and oral anticoagulants (OACs). Forest plots were generated using Review Manager version 5.4, with a p value less than 0.05 indicating statistical significance. Subgroup analysis was performed to explore potential sources of heterogeneity. Twelve studies were selected. No significant differences were observed in APT and OAC group for ACM [risk ratio (RR): 0.67; 95% CI:0.45-1.01; P=0.05], cardiovascular death [RR:0.91; 95% CI:0.73-1.14; P=0.42], MI [RR:1.69; 95% CI:0.43-6.72; P=0.46], Stroke/TIA [RR:0.79; 95% CI:0.58-1.06; P=0.12], ischaemic stroke [RR:0.83; 95% CI:0.50-1.37; P=0.47], haemorrhagic stroke [RR:1.08; 95% CI: 0.23-5.15; P=0.92], major bleeding [RR:0.79; 95% CI:0.51-1.21; P=0.28], minor bleeding [RR:1.09; 95% CI: 0.80-1.47; P=0.58], life-threatening bleeding [RR:0.85; 95% CI:0.55-1.30; P=0.45], any bleeding [RR:0.98; 95% CI:0.83-1.15; P=0.78], and systemic embolism [RR:0.87; 95% CI:0.44-1.70; P=0.68]. The risk of valve thrombosis was higher in patients receiving APT than in those receiving OAC [RR:2.61; 95% CI:1.56-4.36; P =0.0002]. Although the risk of valve thrombosis increased in patients receiving APT, the risk of other endpoints was comparable between the two groups.

Effects of Growth Factors on the Differentiation of Dental Stem Cells: A Systematic Review and Meta-analysis (Part I).

To evaluate the biological interaction between dental stem cells (DSCs) and different growth factors in the field of regenerative endodontics. A systematic search was conducted in the electronic databases up to October 2021. This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Ex vivo studies evaluating the biological interactions of DSCs and growth factors were included. The meta-analysis was performed according to the type of growth factor. The outcomes were cell viability/ proliferation and mineralization. Standardized mean differences (SMDs) were estimated using the random-effect maximum-likelihood method (P < .05). Additional analysis was performed to find any potential source of heterogeneity. Twenty articles were included in the systematic review; meta-analysis was performed for fibroblast growth factor-2 (FGF-2) and Transforming growth factor-ß1 (TGF-β1) (n = 5). Results showed that use of FGF-2 significantly increased cell proliferation on day 1-(SMD = 3.56, P = 0.00), 3-(SMD = 9.04, P = 0.00), 5-(SMD = 8.37, P = 0.01), and 7 (SMD=8.51, P=0.00) than the control group. TGF-ß1 increased alkaline phosphatase (ALP) activity more than control only on day 3 (SMD = 3.68, P = 0.02). TGF-β1 had no significant effect on cell proliferation on days 1 and 3 (P > 0.05) and on ALP activity on days 5 and 7 (P > 0.05). Meta-regression analysis showed that different covariates (i.e., cell type, passage number, and growth factors' concentration) could significantly influence the effect sizes at different follow- ups (P < 0.05). Specific growth factors might enhance the proliferation and mineralization of DSCs; however, the obtained evidence was weak. Due to the high heterogeneity among the included studies, other growth factors' inhibitory/stimulatory effects on DSCs could not be evaluated.

Treatment with inhaled Argon: a systematic review of pre-clinical and clinical studies with meta-analysis on neuroprotective effect

Argon (Ar) has been proposed as a potential therapeutic agent in multiple clinical conditions, specifically in organ protection. However, conflicting data on pre-clinical models, together with a great variability in Ar administration protocols and outcome assessments, have been reported. The aim of this study was to review evidence on treatment with Ar, with an extensive investigation on its neuroprotective effect, and to summarise all tested administration protocols. Using the PubMed database, all existing pre-clinical and clinical studies on the treatment with Ar were systematically reviewed (registration: https://doi.org/10.17605/OSF.IO/7983D). Study titles and abstracts were screened, extracting data from relevant studies post full-text review. Exclusion criteria included absence of full text and non-English language. Furthermore, meta-analysis was also performed to assess Ar potential as neuroprotectant agent in different clinical conditions: cardiac arrest, traumatic brain injury, ischemic stroke, perinatal hypoxic-ischemic encephalopathy, subarachnoid haemorrhage. Standardised mean differences for neurological, cognitive and locomotor, histological, and physiological measures were evaluated, through appropriate tests, clinical, and laboratory variables. Invivo studies were evaluated for risk of bias using the Systematic Review Center for Laboratory Animal Experimentation tool, while invitro studies underwent assessment with a tool developed by the Office of Health Assessment and Translation. The systematic review detected 60 experimental studies (16 invitro, 7 exvivo, 31 invivo, 6 with both invitro and invivo) investigating the role of Ar. Only one clinical study was found. Data from six invitro and nineteen invivo studies were included in the meta-analyses. In pre-clinical models, Ar administration resulted in improved neurological, cognitive and locomotor, and histological outcomes without any change in physiological parameters (i.e., absence of adverse events). This systematic review and meta-analysis based on experimental studies supports the neuroprotective effect of Ar, thus providing a rationale for potential translation of Ar treatment in humans. Despite adherence to established guidelines and methodologies, limitations in data availability prevented further analyses to investigate potential sources of heterogeneity due to study design. This study was funded in part by Italian Ministry of Health-Current researchIRCCS and by Ministero della Salute Italiano, Ricerca Finalizzata, project no. RF 2019-12371416.

Protocol for a systematic review and meta-analysis of the prevalence of mental illness among nursing home residents

BackgroundThere is a high prevalence of mental illness in nursing home residents compared to older adults living in the community. This was highlighted in the most recent comprehensive systematic review on the topic, published in 2010. In the context of a rapidly aging population and increased numbers of older adults requiring residential care, this study aims to provide a contemporary account of the prevalence of mental illness among nursing home residents.MethodsThis protocol was prepared in line with the PRISMA-P 2015 Statement. Systematic searches will be undertaken across six electronic databases: PubMed, Embase, Web of Science, PsycNET, CINAHL, and s in Social Gerontology. Peer-reviewed studies published from 2009 onwards which report the prevalence of mental illness within nursing home populations will be included. Database searches will be supplemented by forward and backward citation searching. Titles and abstracts of records will be screened using a semi-automated process. The full text of selected records will be assessed to confirm inclusion criteria are met. Study selection will be recorded in a PRISMA flowchart. A pilot-tested form will be used to extract data from included studies, alongside the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. A study characteristics and results table will be prepared to present key details from each included study, supported by a narrative synthesis. Random-effects restricted maximum likelihood meta-analyses will be performed to compute pooled prevalence estimates for mental illnesses represented in the identified studies. Heterogeneity will be assessed using Cochran’s Q and Higgins’ I2 statistics. A Funnel plot and Egger’s test will be used to assess publication bias. The GRADE approach will be used to assess the quality of the body of evidence identified.DiscussionThe study will provide a comprehensive and contemporary account of the prevalence of mental illness among nursing home residents. Meta-analyses will provide robust prevalence estimates across a range of presentations. Key insights will be highlighted, including potential sources of heterogeneity. Implications for residents, researchers, care providers, and policymakers will be noted.Systematic review registrationPROSPERO: CRD42023456226.

Ultrasound-based radiomics for the differential diagnosis of breast masses: A systematic review and meta-analysis.

Ultrasound-based radiomics has demonstrated excellent diagnostic performance in differentiating benign and malignant breast masses. Given a few clinical studies on their diagnostic role, we conducted a meta-analysis of the potential effects of ultrasound-based radiomics for the differential diagnosis of breast masses, aiming to provide evidence-based medical basis for clinical research. We searched Embase, Web of Science, Cochrane Library, and PubMed databases from inception through to February 2023. The methodological quality assessment of the included studies was performed according to Quality Assessment of Diagnostic Accuracy Studies checklist. A diagnostic test accuracy systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Sensitivity, specificity, and area under curve delineating benign and malignant lesions were recorded. We also used sensitivity analysis and subgroup analysis to explore potential sources of heterogeneity. Deeks' funnel plots was used to examine the publication bias. A total of 11 studies were included in this meta-analysis. For the diagnosis of malignant breast masses worldwide, the overall mean rates of sensitivity and specificity of ultrasound-based radiomics were 0.90 (95% confidence interval [CI], 0.83-0.95) and 0.89 (95% CI, 0.82-0.94), respectively. The summary diagnostic odds ratio was 76 (95% CI, 26-219), and the area under the curve for the summary receiver operating characteristic curve was 0.95 (95% CI, 0.93-0.97). Ultrasound-based radiomics has the potential to improve diagnostic accuracy to discriminate between benign and malignant breast masses, and could reduce unnecessary biopsies.

Prevalence of attention-deficit hyperactivity disorder in adult prisoners: An updated meta-analysis.

Previous meta-analyses may have overestimated the prevalence of attention-deficit hyperactivity disorder (ADHD) in prisoners by including data from selected samples. To estimate the prevalence of ADHD in unselected samples of adults in prison and examine potential sources of heterogeneity by meta-regression and subgroup analyses. We assessed all studies included in a 2018 systematic review for eligibility and updated the literature search to include studies published up to September 2023. A total of 11 studies reporting robust diagnostic data on ADHD in 3919 unselected adults in prison were included. In meta-regression, ADHD prevalence did not differ between men and women but it was significantly higher in studies using a two-phase design. In random sampling studies, the pooled prevalence of ADHD was 8.3% (95% CI: 3.8-12.8) which was further halved after the removal of an outlier. One in 12 adults in prison have been diagnosed with ADHD. Our findings highlight the importance of using clear and consistent inclusion criteria in meta-analyses of prevalence.

A comparison of cenobamate with other newer antiseizure medications for adjunctive treatment of focal-onset seizures: A systematic review and network meta-analysis

PurposeTo compare the efficacy, safety, and tolerability of cenobamate with other newer anti-seizure medications (ASMs) including brivaracetam, eslicarbazepine, lacosamide, perampanel, and zonisamide, approved for adjunctive treatment of drug-resistant focal-onset seizures (FOS) in adults with epilepsy. MethodsA systematic literature review was conducted to obtain relevant efficacy, safety, and tolerability data for ASMs for the treatment of drug-resistant FOS. All studies were thoroughly assessed for potential sources of heterogeneity and analysed via Bayesian network meta-analyses (NMAs). Efficacy outcomes were ≥50% responder rate and seizure freedom during the maintenance period, which were modelled simultaneously using a multinomial Bayesian NMA. Safety and tolerability outcomes were the proportion of patients who experienced at least one treatment-emergent adverse event (TEAE) and the proportion who experienced at least one TEAE leading to discontinuation. ResultsThe SLR identified 76 studies, of which 23 were included in the Bayesian NMAs. Cenobamate was associated with statistically significant higher rates for the ≥50% responder rate and seizure freedom outcomes compared with all ASMs analysed. The point estimates indicated that cenobamate was associated with higher rates of experiencing at least one TEAE and at least one TEAE leading to discontinuation compared with brivaracetam, lacosamide, and zonisamide; however, no results were statistically significant. ConclusionCenobamate was associated with increased efficacy compared with all ASMs analysed. There were no statistically significant differences in the safety and tolerability outcomes. The results presented corroborate the conclusions drawn from previous published NMAs, which also highlight the notable efficacy of cenobamate in comparison with other ASMs.

Image-based artificial intelligence for the prediction of pathological complete response to neoadjuvant chemoradiotherapy in patients with rectal cancer: a systematic review and meta-analysis.

Artificial intelligence (AI) holds enormous potential for noninvasively identifying patients with rectal cancer who could achieve pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT). We aimed to conduct a meta-analysis to summarize the diagnostic performance of image-based AI models for predicting pCR to nCRT in patients with rectal cancer. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed, Embase, Cochrane Library, and Web of Science was performed from inception to July 29, 2023. Studies that developed or utilized AI models for predicting pCR to nCRT in rectal cancer from medical images were included. The Quality Assessment of Diagnostic Accuracy Studies-AI was used to appraise the methodological quality of the studies. The bivariate random-effects model was used to summarize the individual sensitivities, specificities, and areas-under-the-curve (AUCs). Subgroup and meta-regression analyses were conducted to identify potential sources of heterogeneity. Protocol for this study was registered with PROSPERO (CRD42022382374). Thirty-four studies (9933 patients) were identified. Pooled estimates of sensitivity, specificity, and AUC of AI models for pCR prediction were 82% (95% CI: 76-87%), 84% (95% CI: 79-88%), and 90% (95% CI: 87-92%), respectively. Higher specificity was seen for the Asian population, low risk of bias, and deep-learning, compared with the non-Asian population, high risk of bias, and radiomics (all P < 0.05). Single-center had a higher sensitivity than multi-center (P = 0.001). The retrospective design had lower sensitivity (P = 0.012) but higher specificity (P < 0.001) than the prospective design. MRI showed higher sensitivity (P = 0.001) but lower specificity (P = 0.044) than non-MRI. The sensitivity and specificity of internal validation were higher than those of external validation (both P = 0.005). Image-based AI models exhibited favorable performance for predicting pCR to nCRT in rectal cancer. However, further clinical trials are warranted to verify the findings.

Relationship between vitamin D levels and pediatric celiac disease: a systematic review and meta-analysis

BackgroundThe relationship between Vitamin D levels and pediatric celiac disease (CD) remains controversial. In this study, we conducted a systematic review and meta-analysis to examine the relationship between Vitamin D and pediatric CD. Methods: We screened relevant studies from PubMed, EMBASE, and Web of Science published in English from January 1, 2000, to August 1, 2023. The included studies were assessed according to the STROBE checklist. Heterogeneity was quantified by Cochran’s Q test and the I2 statistic. Publication bias was estimated by Begg’s test and Egger’s test. Meta‐regression was used to detect potential sources of heterogeneity. Results: A total of 26 studies were included in the meta-analysis. Nineteen articles compared 25(OH)D3 levels between CD patients and control groups, average 25-hydroxyvitamin D3 [25(OH)D3 or calcidiol], and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3 or calcitriol] levels, as the main forms of Vitamin D, there was a significant difference in CD patients and healthy controls (weighted mean difference (WMD) = − 5.77, 95% confidence interval (CI) = [− 10.86, − 0.69] nmol/L). Meanwhile, eleven articles reported the numbers of patients and controls with Vitamin D deficiency, there was a significant difference in the incidence of 25(OH)D3 deficiency between CD patients and healthy controls (odds ratio 2.20, 95% CI= [1.19, 4.08]). Nine articles reported changes in 25(OH)D3 levels before and after administering a GFD in patients with CD, the result of this study revealed the increase of 25(OH)D3 levels in CD patients after a gluten-free diet (GFD) (WMD = − 6.74, 95% CI = [− 9.78, − 3.70] nmol/L). Conclusions: Vitamin D levels in pediatric CD patients were lower than in healthy controls, and 25(OH)D3 deficiency was more prevalent in CD patients. We found that 25(OH)D3 levels were elevated in CD patients after GFD, which is consistent with previous research. Further well-designed, longitudinal, prospective cohort studies focusing on the role of Vitamin D in the pathogenesis of CD are therefore needed.

Global epidemiology of type 2 diabetes in patients with NAFLD or MAFLD: a systematic review and meta-analysis

BackgroundNon-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) shares common pathophysiological mechanisms with type 2 diabetes, making them significant risk factors for type 2 diabetes. The present study aimed to assess the epidemiological feature of type 2 diabetes in patients with NAFLD or MAFLD at global levels.MethodsPublished studies were searched for terms that included type 2 diabetes, and NAFLD or MAFLD using PubMed, EMBASE, MEDLINE, and Web of Science databases from their inception to December 2022. The pooled global and regional prevalence and incidence density of type 2 diabetes in patients with NAFLD or MAFLD were evaluated using random-effects meta-analysis. Potential sources of heterogeneity were investigated using stratified meta-analysis and meta-regression.ResultsA total of 395 studies (6,878,568 participants with NAFLD; 1,172,637 participants with MAFLD) from 40 countries or areas were included in the meta-analysis. The pooled prevalence of type 2 diabetes among NAFLD or MAFLD patients was 28.3% (95% confidence interval 25.2–31.6%) and 26.2% (23.9–28.6%) globally. The incidence density of type 2 diabetes in NAFLD or MAFLD patients was 24.6 per 1000-person year (20.7 to 29.2) and 26.9 per 1000-person year (7.3 to 44.4), respectively.ConclusionsThe present study describes the global prevalence and incidence of type 2 diabetes in patients with NAFLD or MAFLD. The study findings serve as a valuable resource to assess the global clinical and economic impact of type 2 diabetes in patients with NAFLD or MAFLD.

Diagnostic Performance of Artificial Intelligence in Detection of Hepatocellular Carcinoma: A Meta-analysis.

Due to the increasing interest in the use of artificial intelligence (AI) algorithms in hepatocellular carcinoma detection, we performed a systematic review and meta-analysis to pool the data on diagnostic performance metrics of AI and to compare them with clinicians' performance. A search in PubMed and Scopus was performed in January 2024 to find studies that evaluated and/or validated an AI algorithm for the detection of HCC. We performed a meta-analysis to pool the data on the metrics of diagnostic performance. Subgroup analysis based on the modality of imaging and meta-regression based on multiple parameters were performed to find potential sources of heterogeneity. The risk of bias was assessed using Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) and Prediction Model Study Risk of Bias Assessment Tool (PROBAST) reporting guidelines. Out of 3177 studies screened, 44 eligible studies were included. The pooled sensitivity and specificity for internally validated AI algorithms were 84% (95% CI: 81,87) and 92% (95% CI: 90,94), respectively. Externally validated AI algorithms had a pooled sensitivity of 85% (95% CI: 78,89) and specificity of 84% (95% CI: 72,91). When clinicians were internally validated, their pooled sensitivity was 70% (95% CI: 60,78), while their pooled specificity was 85% (95% CI: 77,90). This study implies that AI can perform as a diagnostic supplement for clinicians and radiologists by screening images and highlighting regions of interest, thus improving workflow.

Causal relationship between gut microbiota and prostate cancer contributes to the gut-prostate axis: insights from a Mendelian randomization study

BackgroundChanges in gut microbiota abundance have been linked to prostate cancer development. However, the causality of the gut-prostate axis remains unclear.MethodsThe genome-wide association study (GWAS) data for gut microbiota sourced from MiBioGen (n = 14,306), alongside prostate cancer summary data from PRACTICAL (n = 140,254) and FinnGen Consortium (n = 133,164). Inverse-variance-weighted (IVW) was mainly used to compute odds ratios (OR) and 95% confidence intervals (Cl), after diligently scrutinizing potential sources of heterogeneity and horizontal pleiotropy via the rigorous utilization of Cochran's Q test, the MR-PRESSO method, and MR-Egger. We used meta-analysis methods in random effects to combine the Mendelian randomization (MR) estimates from the two sources.ResultsThe pooled analyses of MR results show that genus Eubacterium fissicatena (OR = 1.07, 95% CI 1.01 to 1.13, P = 0.011) and genus Odoribacter (OR = 1.14, 95% CI 1.01 to 1.27, P = 0.025) were positively associated with prostate cancer. However, genus Adlercreutzia (OR = 0.89, 95% CI 0.83 to 0.96, P = 0.002), Roseburia (OR = 0.90, 95% CI 0.83 to 0.99, P = 0.03), Holdemania (OR = 0.92, 95% CI 0.86 to 0.97, P = 0.005), Flavonifractor (OR = 0.85, 95% CI 0.74 to 0.98, P = 0.024) and Allisonella (OR = 0.93, 95% CI 0.89 to 0.98, P = 0.011) seems to be a protective factor for prostate cancer. Sensitivity analysis found no significant heterogeneity, horizontal pleiotropy, or reverse causal links in all causal associations.ConclusionThis MR study lends support to a causal relationship between genetically predicted gut microbiota and prostate cancer. Research on the gut-prostate axis, along with further multi-omics analyses, holds significant implications for the prevention and treatment of prostate cancer.

Incidence, contributing factors and outcomes of birth injury among newborns in Africa: a systematic review of quantitative evidence protocol

IntroductionBirth injury is a significant public health problem in Africa, with a high incidence and associated mortality and morbidity. Systematic reviews that indicate the incidence, contributing factors and outcomes of...

Prevalence of fibrinolytic alveolitis following extraction of impacted mandibular third molars: A systematic review and meta-analysis

Our research aims to assess the prevalence of alveolar osteitis (AO) following impacted mandibular third molar extractions and investigate the impact of potential moderating factors on this occurrence. Two independent reviewers conducted a comprehensive systematic literature search across Medline, Scopus, and Google Scholar databases. The pooled prevalence, accompanied by 95 % confidence intervals (CI), was calculated. Quality assessments, outlier and influential analyses were performed. Subgroup and meta-regression analysis were conducted in order the effect of categorical and continuous variables on the estimated prevalence to be investigated. Our meta-analysis included twenty-eight eligible studies, encompassing a total of 41,859 impacted mandibular third molar extractions. The overall prevalence of dry socket (DS) following impacted mandibular third molar extractions was estimated at 6.7 % (95 % CI 4.6–9.1 %), indicating considerable heterogeneity among the studies. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. This study highlights the imperative for future well-constructed prospective and retrospective investigations to deepen our understanding of the etiological nuances and refine management approaches for this prevalent postoperative complication.

Nonsurgical risk factors for marginal ulcer following Roux-en-Y gastric bypass for obesity: a systematic review and meta-analysis of 14 cohort studies.

Marginal ulcer (MU) is a common complication of Roux-en-Y Gastric Bypass (RYGB). The primary goal of this meta-analysis was to identify potential risk factors for MU post-RYGB. A comprehensive literature search was conducted on four databases (PubMed, Embase, Web of Science, and the Cochrane Library) to identify articles published from inception to 23 May 2023 that reported risk factors linked to ulcer occurrence post-RYGB. Hazard Ratio (HR) and Odds Ratio (OR) with respective 95% CI were calculated to estimate the impact of selected risk factors on MU. The risk factors were evaluated through multivariate analyses. The estimated risk factors were subjected to a random-effects model. Subgroup analysis based on study baseline characteristics and leave-one-out sensitivity analysis were also performed to investigate the potential sources of heterogeneity and assess the robustness of the findings. Herein, 14 observational studies involving 77250 patients were included. Diabetes, smoking, and steroid use were identified to be risk factors of MU, with pooled ORs of (1.812; 95% CI: 1.226-2.676; P =0.003), (3.491; 95% CI: 2.204-5.531; P< 0.001), and (2.804; 95% CI: 1.383-5.685; P =0.004), respectively. Other risk factors, such as alcohol consumption, male sex, and PPI use, were deemed not significant due to differences in data acquisition and effect estimates. Diabetes, smoking, and steroid use were identified as independent risk factors of MU. Enhancing awareness of these identified risk factors will lead to more effective preoperative prevention and targeted postoperative interventions for patients undergoing RYGB.

Synthesis methods used to combine observational studies and randomised trials in published meta-analyses.

This study examined the synthesis methods used in meta-analyses pooling data from observational studies (OSs) and randomised controlled trials (RCTs) from various medical disciplines. We searched Medline via PubMed to identify reports of systematic reviews of interventions, including and pooling data from RCTs and OSs published in 110 high-impact factor general and specialised journals between 2015 and 2019. Screening and data extraction were performed in duplicate. To describe the synthesis methods used in the meta-analyses, we considered the first meta-analysis presented in each article. Overall, 132 reports were identified with a median number of included studies of 14 [9-26]. The median number of OSs was 6.5 [3-12] and that of RCTs was 3 [1-6]. The effect estimates recorded from OSs (i.e., adjusted or unadjusted) were not specified in 82% (n = 108) of the meta-analyses. An inverse-variance common-effect model was used in 2% (n = 3) of the meta-analyses, a random-effects model was used in 55% (n = 73), and both models were used in 40% (n = 53). A Poisson regression model was used in 1 meta-analysis, and 2 meta-analyses did not report the model they used. The mean total weight of OSs in the studied meta-analyses was 57.3% (standard deviation, ± 30.3%). Only 44 (33%) meta-analyses reported results stratified by study design. Of them, the results between OSs and RCTs had a consistent direction of effect in 70% (n = 31). Study design was explored as a potential source of heterogeneity in 79% of the meta-analyses, and confounding factors were investigated in only 10% (n = 13). Publication bias was assessed in 70% (n = 92) of the meta-analyses. Tau-square was reported in 32 meta-analyses with a median of 0.07 [0-0.30]. The inclusion of OSs in a meta-analysis on interventions could provide useful information. However, considerations of several methodological and conceptual aspects of OSs, that are required to avoid misleading findings, were often absent or insufficiently reported in our sample.

Effects of game-based physical education program on enjoyment in children and adolescents: a systematic review and meta-analysis

ObjectiveThe objective of this study was to conduct a systematic review to summarize and assess the advancements lately made on the enjoyable impacts of game-based physical education interventions on children and adolescents. Additionally, it attempted to identify the effects and variables influencing the enjoyable outcomes of children and adolescents’ engagement in physical education games, through meta-analysis.MethodsThis study involves a comprehensive search of different databases like Web of Science, PubMed, Embase, EBSCOhost, Cochrane, and Scopus. Specific criteria are established for the selection process to make sure the relevant literature included. The quality assessment of the included researches is conducted based on the guidelines outlined in the Cochrane 5.1 handbook. Review Manager 5.3 software is employed to synthesis the effect sizes. Additionally, bias is assessed using funnel plots, and to identify potential sources of heterogeneity, subgroup analyses are performed.ResultsA total of 1907 academic papers, out of which 2 articles were identified via other data sources. The present study examined the impact of a pedagogical intervention involving physical education games on the enjoyment experienced by children and adolescents. The results indicated a significant positive effect (MD = 0.53, 95%CI:[0.27,0.79], P < 0.05) of this intervention on enjoyment. Subgroup analyses further revealed that both boys (MD = 0.31, 95%CI:[0.13,0.50], P < 0.05) and girls (MD = 0.28, 95%CI:[0.05,0.51], P < 0.05) experienced increased pleasure compared to traditional physical education. Additionally, children under 12 years of age (MD = 0.41, 95%CI:[0.17,0.64], P < 0.05) benefited from sessions lasting at least 30 minutes or more per session (MD = 0.40, 95%CI:[0.19,0.60], P < 0.05), occurring 1 to 3 times per week (MD = 0.28, 95%CI:[0.16,0.40], P < 0.05), and lasting for more than 3 weeks (MD = 0.81, 95%CI:[0.29,1.34], P < 0.05). These findings suggest that the implementation of physical education games can be an effective approach to teaching this subject.Conclusions1) Interventions using physical games have been shown to yield beneficial outcomes in terms of enhancing the enjoyment experienced by children and adolescents. 2) The effectiveness of treatments aimed at promoting enjoyment among children and adolescents is influenced by several aspects, including gender, age, duration and frequency of physical activity, as well as the specific cycle of activity used.

Seroprevalence of pathogenic Leptospira serogroups in asymptomatic domestic dogs and cats: systematic review and meta-analysis.

Leptospirosis is a neglected zoonotic disease transmitted by contact with the urine of animals infected with pathogenic species of the bacteria Leptospira or by contact with environments contaminated with the bacteria. Domestic dogs and cats may act as reservoirs or as sentinels of environmental contamination with leptospires, posing a public health concern. There is a great diversity of leptospires, and one common way to classify them is into serogroups that provide some information on the host species they are associated with. The aims of this study were: (1) to quantitatively summarize the overall prevalence and serogroup-specific prevalence of antibodies against pathogenic leptospires in asymptomatic dogs and cats and (2) to identify environmental and host characteristics that may affect the prevalence. Three electronic databases and the reference lists of eligible articles were screened, for epidemiological studies conducted between the years 2012-2022. We estimated overall and serogroup-specific prevalence using three-level meta-analysis models and assessed potential sources of heterogeneity by moderator analysis and meta-regression. Eighty-four studies met the inclusion criteria (dog studies 66.7%, cat studies 26.2%, and both species 7.1%). There were significant differences between dogs and cats in the overall prevalence model (P < 0.001), but not in the serogroup-specific model (P>0.05). In dogs, the prevalence of Leptospira interrogans serogroup Canicola was significantly higher than the other pathogenic serogroups (P < 0.001), while in cats there were no significant differences among serogroups (P = 0.373). Moderator analysis showed that the prevalence of L. kirschneri serogroup Grippotyphosa was significantly higher in stray/sheltered dogs than in domiciled dogs (P = 0.028). These results suggest that pathogenic serogroups associated with small mammals are circulating among asymptomatic pets and should be taken into account in the transmission cycle of leptospires, as well as in the standard MAT panel for diagnosis in dogs and cats. It also highlights the importance of including both dogs and cats as potential reservoirs when conducting eco-epidemiological studies in different geographical and ecological areas.

The Effect of Peer Victimization During Adolescence on Depression and Gender Differences: A Systematic Review and Meta-analysis.

Peer victimization during adolescence has a detrimental impact on the mental health of victims throughout their lives. However, it remains unclear whether these effects are gender-specific. The present study conducted a systematic review to examine the effects of peer victimization on depression status, explore potential sources of heterogeneity, and investigate gender differences in these effects. We systematically searched four electronic databases (Web of Science, PubMed, Embase, and CNKI) for relevant articles that published as far as July 2022. We then extracted odds ratios (OR) and 95% confidence intervals (CI) to assess the association between peer victimization during adolescence and depression, and potential gender differences in the relation. Meta-analysis was performed, using fixed effects models and random effects models, to evaluate the association between each exposure and the outcome. A meta-analysis of 27 studies revealed that peer victimization during adolescence was significantly associated with higher risks of depression (OR = 2.79, 95% CI [2.43, 3.21], p < .001). This finding was consistent across subgroup analyses. In particular, the effect of peer victimization during adolescence on depression was found to be more pronounced in studies conducted in Asia (OR = 3.06, 95% CI [2.38, 3.92], p < .001). Furthermore, five studies focused on gender differences demonstrated that peer victimization has a stronger association with the risk of depression in women (OR = 2.84, 95% CI [2.49, 3.26], p < .001). Peer victimization during adolescence is a significant risk factor for depression, with a greater impact on women and individuals residing in Asia. Further prospective studies are needed to investigate the relationship between peer victimization and depression.

Workplace sustainability or financial resilience? Composite-financial resilience index

Due to the variety of corporate risks in turmoil markets and the consequent financial distress especially in COVID-19 time, this paper investigates corporate resilience and compares different types of resilience that can be potential sources of heterogeneity in firms’ implied rate of return. Specifically, the novelty is not only to quantify firms’ financial resilience but also to compare it with workplace resilience which matters more in the COVID-19 era. The study prepares several pieces of evidence of the necessity and insufficiency of these two main types of resilience by comparing earnings expectations and implied discount rates of high- and low-resilience firms. Particularly, results present evidence of the possible amplification of workplace resilience by the financial status of firms in the COVID-19 era. The paper proposes a novel composite-financial resilience index as a potential measure for disaster risk that significantly and persistently reveals low-resilience characteristics of firms and resilience-heterogeneity in implied discount rates.