Random-effects Standardized Mean Difference Research Articles

Tear cytokine levels in Sjogren's syndrome-related dry eye disease compared with non-Sjogren's syndrome-related dry eye disease patients: A meta-analysis.

As a common complication of Sjogren syndrome (SS), SS-related dry eye disease (SS-DED) significantly affects the patients' quality of life. Pro-inflammatory cytokines in tears are widely believed to play a crucial role in the pathogenesis of SS-DED. A systematic literature review with meta-analyses was conducted to provide a quantitative summary of tear cytokine levels in SS-DED compared with non-SS-DED and healthy controls. The PubMed, Embase, Web of Science, Ovid, and Scopus databases were searched until June 2022. Original case-control studies investigating tear cytokines in SS-DED patients compared with non-SS-DED or healthy individuals were included. Differences of cytokines levels were compared with random-effects standardized mean differences ± 95% confidence intervals calculated as the effect size. A total of 15 articles, 809 subjects (302 for SS-DED, 220 for non-SS-DED, and 287 for healthy controls) were included in the study. SS-DED patients had higher tear levels of interferon-gamma, interleukin (IL)-17, IL-1β, IL-2, IL-4, IL-6, and IL-8 as compared to healthy controls. As for comparison between SS-DED and non-SS-DED group, the levels of IL-12p70, IL-17, IL-4, IL-6, IL-8, and tumor necrosis factor-alpha were significantly higher in SS-DED patients compared with the non-SS-DED group. The level of epidermal growth factor was significantly lower in SS-DED patients compared with both non-SS-DED patients and healthy controls. The findings from this study provide evidence for levels of tear cytokines in SS-DED to become potential diagnostic biomarkers or therapeutic targets. Further studies with a higher number of subjects and improved quality are necessary.

Possible improvement of social adjustment after subthalamic deep brain stimulation in people with Parkinson's disease? A systematic review and meta-analysis.

Interactions with others need social adjustment (i.e., the constant accommodation to changing social situations). Mixed evidence indicates positive as well as negative changes in social adjustment after subthalamic nucleus deep brain stimulation (STN-DBS) in people with Parkinson's Disease (PwPD). To date, however, no meta-analysis of these changes exists. Thus, the study aim was to review evidence of the effects of STN-DBS on social adjustment in PwPD. For this purpose, a systematic literature search in MEDLINE was conducted. The meta-analysis was performed using a random effects model and standardized mean differences (SMDs) with 95% confidence intervals (CIs). The MINORS tool was used to assess the methodological quality of the studies. The initial literature search identified 13,124 articles, of which 1,550 full texts were assessed for eligibility. Eight studies were finally included; for seven articles sufficient data for a meta-analysis was available. Most studies found mild impairment in social adjustment impairment pre-surgery. The meta-analysis revealed no significant changes but a statistical trend towards improvement in social adjustment up to six months (SMD = 0.25; 95%CI=-0.03,0.53; P = 0.08) and over 12 months (SMD = 0.26; 95%CI=-0.03,0.55; P = 0.07) post-surgery. Methodological quality was moderate in 87.5% of the studies and good in 12.5%. While mild impairment in social adjustment pre-surgery was reported in most studies, the data indicate that STN-DBS might yield beneficial effects toward this outcome. However, not enough data yet exists to draw firm conclusions. As a crucial skill for everyday functioning, social adjustment should be more often defined as an outcome in STN-DBS trials in PwPD and should be considered in clinical routines.

Effect of Meditation, Mindfulness-Based Stress Reduction, and Relaxation Techniques as Mind-Body Medicine Practices to Reduce Blood Pressure in Cardiac Patients: A Systematic Review and Meta-Analysis.

Elevated blood pressure is one of the major risk factors for cardiovascular diseases. Available evidence on mind-body medicine (MBM) techniques on blood pressure is inconclusive and provides conflicting results. The objective of the current systematic review and meta-analysis is to evaluate the effect of MBM techniques on blood pressure in patients with cardiovascular disease. Randomized control trials (RCTs) done between the years 2000 and 2020 on cardiovascular disease, using MBM techniques such as meditation, mindfulness-based stress reduction and relaxation techniques were searched through electronic databases such as PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), EMBASE and Cochrane Library. Three authors independently performed article selection, data extraction and validation. Meta-analysis was performed using a random effect model and standardized mean difference (SMD) with 95% confidence interval (CI) estimated for the effect size. Fifteen RCTs with 927 patients were included in the meta-analysis. Heterogeneity among the studies was very high for all analyses (I2>94%). For studies comparing systolic blood pressure, MBM interventions show a significant (p=0.01) effect when compared to conventional treatment, an overall estimated effect size of SMD - 0.78 (95% CI: -1.36, -0.20). For studies comparing the diastolic blood pressure, MBM intervention did not show any significant effect when compared to the conventional treatment, an overall effect size of SMD -0.26 (95% CI: -0.91, 0.39). The findings of the meta-analysis suggest that MBM interventions may improve systolic blood pressure alone in patients with cardiac diseases. With high heterogeneity and low quality of the included studies, more robust evidence is required before suggesting MBM as an effective treatment modality for reducing blood pressure in cardiovascular diseases.

The role of DSC MR perfusion in predicting IDH mutation and 1p19q codeletion status in gliomas: meta-analysis and technical considerations

PurposeIsocitrate dehydrogenase (IDH) mutation and 1p19q codeletion status are important for managing glioma patients. However, current practice dictates invasive tissue sampling for histomolecular classification. We investigated the current value of dynamic susceptibility contrast (DSC) MR perfusion imaging as a tool for the non-invasive identification of these biomarkers.MethodsA systematic search of PubMed, Medline, and Embase up to 2023 was performed, and meta-analyses were conducted. We removed studies employing machine learning models or using multiparametric imaging. We used random-effects standardized mean difference (SMD) and bivariate sensitivity-specificity meta-analyses, calculated the area under the hierarchical summary receiver operating characteristic curve (AUC) and performed meta-regressions using technical acquisition parameters (e.g., time to echo [TE], repetition time [TR]) as moderators to explore sources of heterogeneity. For all estimates, 95% confidence intervals (CIs) are provided.ResultsSixteen eligible manuscripts comprising 1819 patients were included in the quantitative analyses. IDH mutant (IDHm) gliomas had lower rCBV values compared to their wild-type (IDHwt) counterparts. The highest SMD was observed for rCBVmean, rCBVmax, and rCBV 75th percentile (SMD≈ − 0.8, 95% CI ≈ [− 1.2, − 0.5]). In meta-regression, shorter TEs, shorter TRs, and smaller slice thicknesses were linked to higher absolute SMDs. When discriminating IDHm from IDHwt, the highest pooled specificity was observed for rCBVmean (82% [72, 89]), and the highest pooled sensitivity (i.e., 92% [86, 93]) and AUC (i.e., 0.91) for rCBV 10th percentile. In the bivariate meta-regression, shorter TEs and smaller slice gaps were linked to higher pooled sensitivities. In IDHm, 1p19q codeletion was associated with higher rCBVmean (SMD = 0.9 [0.2, 1.5]) and rCBV 90th percentile (SMD = 0.9 [0.1, 1.7]) values.ConclusionsIdentification of vascular signatures predictive of IDH and 1p19q status is a novel promising application of DSC perfusion. Standardization of acquisition protocols and post-processing of DSC perfusion maps are warranted before widespread use in clinical practice.

The Effectiveness of Internet-Based Cognitive Behavioral Therapy as a Preventive Intervention in the Workplace to Improve Work Engagement and Psychological Outcomes: Protocol for a Systematic Review and Meta-analysis

Mental health has become an increasingly significant issue in the workplace.Non-health care workers are experiencing increased levels of psychological symptoms in their workplaces, especially during the COVID-19 pandemic, which limited social interactionsand health service access.These conditions have a negative effect on employees' mental health and may also be associated with work-related outcomes, such as reduced levels of work engagement.Cognitive behavioral therapy (CBT)is one ofthe most effective methods used for treating workers with mental illness and preventing work-related psychological outcomes. The delivery of internet-based CBT (iCBT) has been established as a result of both technological improvements that have influenced health promotion and prevention components, and limited social contact and health service access. The purpose of this systematic review is to synthesize the best available evidence concerning the preventive effect of iCBT on employees. A systematic search will be conducted across 12 electronic databases,including a hand search for main journals and reference lists. Randomized controlled trials testing the effects of iCBT on psychological outcomes and work engagement among employees will be eligible. Initial keywords will cover the concepts of employees, workers, non-health care personnel, internet-based, web-based, eHealth cognitive behavioral interventions, stress, depression, anxiety, and work engagement, and then a full search strategy will be developed. Following titles, abstracts and the full text will be screened for assessment against the inclusion criteria for the review. Search results will be fully reported and presented per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers will screen and extract data, appraise methodological quality using the Cochrane risk-of-bias assessment tool, and assess overall quality of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. A random effects meta-analysis and standardized mean differences using review manager software will be applied to synthesize the effect of iCBT based on similar outcomes. This protocol was registered in the International Prospective Register of Systematic Reviews in March 2022 and isnow an ongoing process. The data will be analyzed in August 2022, and the review process should be completed by December 2022. All included studies will be synthesized and presented to demonstrate the effectiveness of iCBT in decreasing psychological distress and optimizing work engagement outcomes among employees. According to the findings of this study, iCBT therapies will be used to promote mental health concerns such as depressive symptoms, anxiety, psychological distress, stress, insomnia, and resilience among non-health care professionals. In addition, the results will be used to ensure the policy related to reducing psychological distress and optimizing work engagement in the workplace. PRR1-10.2196/38597.

Effects of probiotics on strength and power performance in a trained population

The main purpose of this systematic review and meta-analysis was to evaluate the effects of probiotics intake on strength and power performance in a trained population. This study was designed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. The review was registered in PROSPERO with the following registration number: CRD42021248173. PubMed/MEDLINE, Web of Science, and Scopus databases were searched from their inception to the 18th March 2022 to find original research studies evaluating the effects of probiotic supplementation on strength and power performance tests in a trained population. The following inclusion criteria were applied to select studies: probiotics supplementation; trained population; strength and power performance measurements; human experimental trial; controlled with a placebo group; peer-reviewed and original articles written in English language. Random effects model and standardized mean differences (SMD) were used following Hedges’ G for the meta-analysis. Seven studies were finally included after the inclusion/exclusion criteria were applied (n=142 participants). Results of the meta-analysis identified a significant benefit of probiotics compared to placebo treatments (p=.04), with a small pooled effect size (SMD=0.36 [0.02-0.70]; I2=43%), and no funnel plot asymmetry was present. In summary, this systematic review and meta-analysis demonstrated that probiotic supplementation could effectively enhance strength and power performance in a trained population.

Defining the Effect of Oxytocin Use in Farrowing Sows on Stillbirth Rate: A Systematic Review with a Meta-Analysis.

Simple SummaryOxytocin is a hormone that causes smooth muscle contraction and is particularly important during parturition. The administration of exogenous oxytocin to sows at farrowing has been used for decades as a means of assisting sows during parturition. Over the past decade, swine-litter size has dramatically increased, as well as the stillbirth rate. The objective of this systematic review and meta-analysis was to identify the benefits and possible negative side effects of oxytocin use during farrowing. By accumulating data from 25 randomized controlled trials, a meta-analysis examined whether the average number of stillborn piglets, the farrowing duration, and the time interval between the births of piglets were different in the sows that received oxytocin compared to the controls. The results from this study demonstrated that the sows that received oxytocin had an increased average number of stillborn piglets, but experienced reduced farrowing duration and shorter birth intervals between piglets compared to the controls. Future research is required to refine oxytocin usage guidelines, including dosages and the timing of administration. The results of this study demonstrate that it is important to recognize that oxytocin can have adverse side effects, including an increase in stillborn pigs.The objective of this systematic review and meta-analysis was to identify the benefits and possible adverse side effects of oxytocin use during farrowing. Randomized controlled trials that were published in English within the last 50 years were eligible for inclusion. Eligible research needed to contain the PICO elements: population (P)—sows at farrowing; intervention (I):—oxytocin given to sows—comparator (C): sows at farrowing not given oxytocin, as well as sows given different dosages and/or different timing of administration; and outcomes (O):—stillbirths, sow mortality, and piglet viability. Four bibliographic databases were used: PubMed, CAB Direct, Web of Science Core Collection, and ProQuest Dissertations, and Theses Global. In addition, we performed a manual search of the table of contents in the American Association of Swine Veterinarians database for relevant conference proceedings and reports. To assess the risk of bias at the study level, a modified version of the Cochrane 2.0 ROB was used. Meta-analyses were performed to examine the average stillbirth rate, farrowing duration, and birth interval between piglets using random-effect standardized mean difference (SMD) models. To explore heterogeneity, a sub-group analysis was performed on the objectives of the study, dose, time, and route of administration. Of the 46 studies eligible for meta-analyses, only 25 had sufficient information. The pooled analyses of the random effect model demonstrated that the average number of stillborn pigs was lower in the comparator group (SMD = 0.23; CI95% = 0.1, 0.36), and both the farrowing duration (SMD = −8.4; CI95% = −1.1, −0.60) and the birth interval between piglets (SMD = −1.41; CI95% = −1.86, −0.97) were shorter in the oxytocin group. The majority of the studies had an overall risk of bias of ‘some concerns’. It was concluded that the use of oxytocin increases the overall number of stillborn piglets, but decreases the farrowing duration and time interval between piglets. However, future studies should focus on the effect of oxytocin on the experience of dystocia among sows.

Effects of dance therapy on non-motor symptoms in patients with Parkinson's disease: a systematic review and meta-analysis.

Parkinson's disease (PD) represents the second most common neurodegenerative disease. To evaluate the effects of dance therapy (DT) aimed at improving non-motor symptoms in PD. Studies were performed through PubMed, Web of Science, The Cochrane Library, Embase, and Science Direct from inception to October 27, 2021. The data were screened independently by two reviewers, and the quality of the papers was assessed using the Cochrane manual. The included studies were randomized controlled trials and quasi-randomized controlled trials, reporting random-effects standardized mean differences, and 95% confidence intervals as the effect size. I2 statistics were used to assess heterogeneity. The main outcomes included the Montreal Cognitive Assessment Scale (MOCA), Baker Depression Scale (BDI), Parkinson's Fatigue Scale (FPS-16), and Apathy Scale (AS). RevMan 5.3 software was integrated for meta-analysis. Nine literatures were analyzed for the meta-analysis with a total of 307 patients. Random effects showed that DT significantly improved cognitive of PD (MD = 1.50, 95% CI [0.52, 2.48], P = 0.0003; I2 = 51%). However, this meta-analysis demonstrated that dance therapy had no significance for improving depression (MD = - 1.33, 95% CI [-4.11, 1.45], P = 0.35; I2 = 79%), fatigue (MD = 0.26, 95% CI [-0.31, 0.83], P = 0.37; I2 = 0%), and apathy (MD = 0.07, 95% CI [-2.55, 2.69], P = 0.96; I2 = 50%). The meta-analysis suggests that dance can improve cognitive function in PD.

Effect of Sodium-Glucose Cotransporter 2 Inhibitors on Weight Reduction in Overweight and Obese Populations without Diabetes: A Systematic Review and a Meta-Analysis.

BackgroundWe aimed to evaluate the efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors for managing obesity in non-diabetic overweight or obese patients.MethodsFor purposes of this study, PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched through May 2021. Randomized controlled trials published in English that compared SGLT2 inhibitors with placebo in overweight and obese patients without diabetes were included in the primary analysis. The random effects standardized mean difference ±95% confidence interval (95% CI) was calculated as the effect size.ResultsFive randomized controlled trials were included to evaluate body weight change, four trials to assess body mass index (BMI), and three trials to assess waist circumference were included. Results showed that the mean body weight loss on SGLT2 inhibitors in obese patients without diabetes was −1.62 kg (95% CI, −2.38 to −0.85 kg) when compared with placebo. Treatment with SGLT2 inhibitors was also associated with a greater reduction in BMI than placebo (weighted mean difference, −0.47 kg/m2; 95% CI, −0.62 to −0.31 kg/m2). The mean reduction in waist circumference with SGLT2 inhibitors versus placebo was 1.29 cm (95% CI, −2.62 to 0.04 cm), which was not statistically significant. There were no significant changes in fat mass, blood pressure, low-density lipoprotein cholesterol or high-density lipoprotein cholesterol with SGLT2 inhibitor treatment.ConclusionA meta-analysis demonstrated that although the weight lowering effect was mild, SGLT2 inhibitors significantly reduced body weight in obese patients without diabetes.

The Effect of Educational Intervention on Improvement of Breastfeeding Self-Efficacy: A Systematic Review and Meta-Analysis.

Background Self-efficacy is an important psychological and motivational factor in breastfeeding, and it is a valuable framework that predicts breastfeeding outcomes and demonstrates maternal confidence in breastfeeding. The meta-analysis evaluated the effectiveness of educational interventions on improving breastfeeding self-efficacy (BSE). Methods The English and Persian databases including Medline, Embase, Cochrane Database of Systematic Reviews (CDSR), PubMed, Web of Science, Scopus, CINAHL, Sid, IRANDOC, and Marg-Iran were systematically searched for studies published from January 2005 to December 2020. The quality of studies was evaluated using the Cochrane risk of bias tool and the heterogeneity by I2 statistic. The extracted data were analyzed using RevMan 5 statistical software and presented using random effects standardized mean difference (SMD). The funnel plot was used for evaluating publication bias. Results Results from 40 RCTs showed that educational intervention had a positive effect on the BSE compared with the usual/standard care (pooled SMD = 1.20; 95% CI = 0.75–1.64, p value <0.001). The subgroup analysis indicated that the educational intervention was based on theory, group class format, direct method education, during the first week of postpartum, doing during pregnancy, on primiparous women, and health center setting, and the Asian region has a more effect on BSE than the others. Conclusion Breastfeeding education is considered an influential factor in the improvement of BSE. It is recommended that breastfeeding education should be continued for several weeks after childbirth for gaining its benefit. The Asian region has a more effect on BSE than the others. Therefore, it is important to add the values in content of education in each country.

Comprehensive meta-analysis of randomized controlled trials of Lactated Ringer’s versus Normal Saline for acute pancreatitis

IntroductionFluid resuscitation is the keystone of treatment for acute pancreatitis. Though clinical guidelines and expert opinions agree on large volume resuscitation, debate remains on the optimal fluid type. The most commonly used fluids are Lactated Ringer's (LR) and Normal Saline (NS), but the studies published to date comparing LR vs NS yield conflicting results. We aimed to identify and quantitatively synthesize existing high quality data of the topic of fluid type or acute pancreatitis resuscitation. MethodsIn collaboration with the study team, an information specialist performed a comprehensive literature review to identify reports addressing type of fluid resuscitation. Studies were screened using the Covidence system by two independent reviewers in order to identify Randomized controlled trials comparing LR versus NS. The main outcome was the development of moderately severe or severe pancreatitis and additional outcomes included local complications, ICU admission, and length of stay. Pooled odds ratios were estimated using the random effects model and standardized mean difference to compare continuous variables. ResultsWe reviewed 7964 abstracts and 57 full text documents. Four randomized controlled trials were identified and included in our meta-analyses. There were a total of 122 patients resuscitated with LR versus 126 with NS. Patients resuscitated with LR were less likely to develop moderately severe/severe pancreatitis (OR 0.49; 95 % CI 0.25–0.97). There was no difference in development of SIRS at 24 or 48 h or development of organ failure between the two groups. Patients resuscitated with LR were less likely to require ICU admission (OR 0.33; 95 % CI 0.13–0.81) and local complications (OR 0.42; 95 % CI 0.2–0.88). While there was a trend towards shorter hospitalizations for LR (SMD -0.18, 99 % CI -0.44-0.07), it was not statistically significant. ConclusionResuscitation with LR reduces the development of moderately severe-severe pancreatitis relative to NS. Nevertheless, no difference in SIRS development or organ failure underscores the need for further studies to verify this finding and define its mechanism.

Effects of melatonin supplementation on oxidative stress: a systematic review and meta-analysis of randomized controlled trials.

Previous studies showed that melatonin supplementation may suppress oxidative stress, however, the results have not been consistent. So, we conducted this meta-analysis to assess the precise relationship between melatonin supplementation and oxidative stress. PubMed and Scopus were searched for randomized controlled trials that investigated the effect of melatonin supplementation on oxidative stress up to March 2020. Heterogeneity was assessed by Cochran's Q test and I-square (I 2) statistic. Data were pooled using the random effect model and standardized mean difference (SMD) was considered as the summary effect size. Also, standard methods were used for assessment of sensitivity analysis and publication bias. We included 15 related articles and our findings indicated that melatonin supplementation significantly increased total antioxidant capacity (TAC) level (SMD: 1.03, 95% CI: 0.24, 1.81, p=0.011) and reduced protein carbonyl (PCO) (SMD:-1.78, 95% CI:-2.97,-0.58, p=0.004) and malondialdehyde (MDA) levels (SMD:-0.94, 95% CI:-1.48,-0.40, p=0.001). Additionally, there was considerable effect on TAC level by using≥20mg/d melatonin and in people under 35 years old. MDA level also decreased using dosage of below 20mg/d and in people≥35 years old. The present study showed a promising effect of melatonin administration for reducing MDA, PCO, and increasing TAC levels. However, further studies especially with more attention to PCO level assessment are needed to confirm the findings of the present study in larger samples on different populations.

Urinary incontinence and quality of life: a systematic review and meta-analysis

BackgroundUrinary incontinence (UI) and low quality of life (QoL) are two common conditions. Some recent literature proposed that these two entities can be associated. However, no attempt was made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL.MethodsAn electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and case–control studies comparing mean values in QoL between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs) ± 95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2.ResultsOut of 8279 articles initially screened, 23 were finally included for a total of 24,983 participants, mainly women. The mean age was ≥ 50 years in 12/23 studies. UI was significantly associated with poor QoL as assessed by the short-form 36 (SF-36) total score (n = 6 studies; UI: 473 vs. 2971 controls; SMD = − 0.89; 95% CI − 1.3 to − 0.42; I2 = 93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high.ConclusionsUI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case–control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.

Systemic levels of interleukin-6 in patients with age-related macular degeneration: a systematic review and meta-analysis.

Age-related macular degeneration (AMD) is the most prevalent cause of irreversible vision loss in industrialized countries. Several studies have investigated systemic interleukin-6 (IL-6) levels of patients with AMD. In this study, we systemically reviewed the literature to provide an overview of the field and used meta-analyses to provide a summary estimate of the standardized mean difference (SMD) of systemic IL-6 between patients with AMD and control individuals. We searched the literature databases PubMed/MEDLINE, Embase, Web of Science and the Cochrane Central on 1 June 2019 for relevant studies on humans. Two authors independently extracted data and evaluated risk of bias. We identified 19 studies for the qualitative review with a total of more than 3586 individuals (1865 controls and 1721 with AMD). We found an overall random-effects SMD in systemic IL-6 levels 0.63 (95% CI: 0.28 to 0.99, p=0.0005) corresponding to a medium effect size. In a subgroup analysis, we found that early AMD was not strongly associated with elevated IL-6 levels (0.12, 95% CI: -0.01 to 0.24, p=0.06), which was in contrast to the significantly elevated IL-6 levels in patients with geographic atrophy (1.21, 95% CI: 0.41 to 2.01, p=0.003) and patients with neovascular AMD (0.99, 95% CI: 0.34 to 1.63, p=0.003). Our results show that the evidence today suggests an increased systemic IL-6 in patients with AMD, but that this may be a phenomenon more closely related to the late subtypes of AMD.

Does vitamin D affect sarcopenia with insulin resistance in aging?

There are many studies investigating nutritional factors that affect both sarcopenia and muscle formation. According to extensive research, protein has an essential role in muscle formation. More recently, vitamin D has emerged as an important factor that regulates muscle metabolism. However, studies and research of association between 25-Hydroxyvitamin D (25(OH)D) status and components of homeostasis model assessment of insulin resistance (HOMA-IR) in older are limited. Nineteen studies were found through a search of electronic databases and were subjected to a meta-analysis to investigate the differences in serum levels of 25(OH)D and HOMA-IR between patients with controls and sarcopenia. The random-effects standardized mean difference (SD) and 95% confidence interval (CI) were calculated as the effect size. Nineteen studies with 19,528 participants (5,081 with sarcopenia and 14,447 without) were analyzed. Sarcopenic participants had significantly lower serum levels of 25(OH)D (SD =1.163; 95% CI 0.514, 1.812; p<0.001; I2=99.652%) and HOMA-IR (SD=-2.040; 95% CI -3.376, -0.705; p<0.005; I2=99.837%) than controls. It has been reiterated that sarcopenia may be related serum levels of 25(OH)D and HOMA-IR. This relationship needs to be clarified by future longitudinal studies.

Systematic Review of the Effects of Cognitive and Behavioural Interventions on Fall-Related Psychological Concerns in Older Adults.

This systematic review aims to evaluate the efficacy of cognitive and behavioural interventions for improving falls-related psychological concerns. A systematic search yielded 8 randomised controlled trials eligible for inclusion. All studies compared a cognitive and behavioural intervention to a control. Meta-analysis showed that cognitive and behavioural treatments had beneficial effects on fear of falling outcomes [lower score better] immediately after treatment [random effects standardised mean difference (SMD): -0.3 (95% CI: -0.50 to -0.10)] and at longer term follow up [random effects SMD: -0.29 (95% CI: -0.49 to -0.09)]. Cognitive and behavioural treatments also showed a positive effect on falls efficacy outcomes [higher score better] immediately after treatment [fixed effects SMD: 0.19 (95% CI: 0.04 to 0.34)] and over the longer term [fixed effects SMD: 0.13 (95% CI:-0.00 to 0.25)]. However the clinical significance of these effects on fear of falling and falls efficacy was unclear. Further work is required with best-practice comparators over a longer follow-up period.

Competence of Nurses Relating Self-Directed Learning in Saudi Arabia: A Meta-Analysis

Self-directed learning (SDL) has become important for medical students for developing their independent learning skills. This may help them in enhancing their sense of assertiveness and responsibility. Therefore, the present study aims to evaluate the competency based learning among the nurses as it is important to secure and promote the nursing services. The study has conducted a broad spectrum of research studies between the 10-year duration i.e., between the time-period of (2009&amp;ndash;2018). The studies shedding light on details of the competence of nurses&amp;rsquo; relation to SDL in Saudi Arabia were reviewed. The results have shown significant post-intervention enhancements with a pooled random-effects standardized mean difference of 0.81. The effect size of learning was higher as compared to the reaction with respect to the assessment level. It has also been shown that students with medium-competence simulation have higher effect size as compared to high-competence simulation and low-competence simulation.

Associations between Sarcopenia and Metabolic Risk Factors: A Systematic Review and Meta-Analysis.

BackgroundMetabolic risk factors can impact sarcopenia, but the direct relationship of metabolic risk factors with sarcopenia has not been examined. Our purpose was to investigate the effects of metabolic risk factors on sarcopenia in older adults.MethodsSixteen studies were found through a search of electronic databases and were subjected to a meta-analysis to investigate the differences in metabolic risk factors between patients with sarcopenia and controls. The random-effects standardized mean difference ±95% confidence interval was calculated as the effect size.ResultsThe results showed that body mass index (BMI), fasting glucose, systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), homeostasis model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-C), and total cholesterol (d=3.252, d=2.039, d=2.956, d=2.579, d=2.123, d=1.195, d=−0.991, and d=1.007, respectively) all had relationships with sarcopenia. In addition, the effect sizes of all male groups for all variables were higher than those of the female groups. However, only the between-sex effect size of HOMA-IR (P<0.01) was significant, while those for BMI, fasting glucose, SBP, DBP, TG, HDL-C, low-density lipoprotein cholesterol, and total cholesterol were not. Finally, the metabolic risk factors appeared to be significantly related to loss of skeletal muscle.ConclusionNutrition and appropriate exercise to enhance muscle strength and quality in the elderly reduce the occurrence of sarcopenia, thereby reducing the incidence of metabolic diseases.

The effects of melatonin supplementation on inflammatory markers among patients with metabolic syndrome or related disorders: a systematic review and meta-analysis of randomized controlled trials.

This systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out to determine the effect of melatonin supplementation on the inflammatory markers among individuals with metabolic syndrome (MetS) and related disorders. We searched the following databases up to March 2018: PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. Three reviewers independently assessed study eligibility, extracted data, and evaluated risk of bias of included primary studies. Statistical heterogeneity was assessed using Cochran's Q test and I-square (I2) statistic. Data were pooled using the random effect model and standardized mean difference (SMD) was considered as the summary effect size. Six trials of 317 potential reports were identified to be suitable for our meta-analysis. The pooled results using random effects model indicated that melatonin supplementation significantly reduced C-reactive protein (CRP) (SMD = - 1.80; 95% CI - 3.27, - 0.32; P = 0.01; I2: 95.2) and interleukin 6 (IL-6) concentrations (SMD = - 2.02; 95% CI - 3.57, - 0.47; P = 0.01; I2: 91.2) among patients with MetS and related disorders; however, it did not affect tumor necrosis factor-α (TNF-α) concentrations (SMD = - 1.87; 95% CI - 3.81, 0.07; P = 0.05; I2: 94.4). In summary, the current meta-analysis showed the promising effect of melatonin administration on reducing CRP and IL-6, but not TNF-α levels among patients with MetS and related disorders. Additional prospective studies are recommended using higher supplementation doses and longer intervention period.

The effect of vitamin D supplementation on thyroid autoantibody levels in the treatment of autoimmune thyroiditis: a systematic review and a meta-analysis.

Although observational studies suggested that vitamin D plays a role in autoimmune thyroiditis (AIT), intervention trials yielded inconsistent findings. We therefore conducted a systematic review and a meta-analysis to evaluate the effects of Vitamin D on decreasing autoantibodies in patients with AIT. We identified all studies that assessed the changes of TPO-Ab and Tg-Ab in patients with AIT under the treatment of vitamin D from PubMed, Embase, The Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, and VIP Database. Six randomized controlled trials (RCTs) were included in this systematic review representing a total of 344 patients with AIT. The results showed that Vitamin D supplementation significantly dropped TPO-Ab titers [three studies, random effects standardized mean difference (SMD): -1.11, 95% CI -1.52 to -0.70, P < 0.01] at six months, but not at no more than 3 months [random effects SMD: -0.12, 95% CI: -0.69 to 0.44, P = 0.67]. As compared with control group, participants who received vitamin D supplementation demonstrated significantly lower Tg-Ab [random effects SMD: -0.55, 95% CI: -1.05 to -0.04, P = 0.033]. In addition, no serious adverse effect was reported. The current evidence suggests that vitamin D supplementation could decrease serum TPO-Ab and Tg-Ab titers of patients with AIT in the short-term (about six months). More high quality studies are needed to further confirm the effects, especially the long-term effects of Vitamin D supplementation on thyroid autoantibodies levels in the treatment of AIT.