Standardized Mean Difference Research Articles

Effectiveness of home-based exercise for functional rehabilitation in older adults after hip fracture surgery: A systematic review and meta-analysis of randomized controlled trials

This systematic review and meta-analysis was performed to assess effectiveness of home-based exercise compared with control interventions for functional rehabilitation in elderly patients after hip fracture surgery. Comprehensive literature search was performed on PubMed, EMBASE, Web of Science, Cochrane library, and Clinicaltrails.gov to identify eligible randomized controlled trials (RCTs). Standard mean difference (SMD) and risk ratio (RR) with 95% confidence interval (CI) was calculated. The certainty of evidence of each outcome was assessed by using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 28 articles reporting 21 unique RCTs (n = 2470) were finally included. Compared with control interventions, home-based exercise significantly improved Berg balance scale (BBS, SMD = 0.28, 95%CI: 0.03 to 0.53, P = 0.030), timed-up-and-go test (TUG, SMD = -0.28, 95%CI: -0.50 to -0.07, P = 0.009), Short Fort-36 physical component score (SF-36 PCS, SMD = 0.49, 95%CI: 0.28 to 0.70, P<0.001), and knee extensor strength (SMD = 0.23, 95%CI: 0.09 to 0.37, P = 0.001). No significant improvement was observed in gait speed, 6-minute walking test, short physical performance battery performance (SPPB), activities of daily living (ADL), or fear of falling in the home exercise group. Risk of adverse events, including emergency department visits, hospital readmissions, and falls, did not differ between both groups. According to GRADE, the overall certainty of evidence was moderate for usual gait speed, SPPB, ADL, fear of falling, and SF-36 PCS, and was low or very low for the other outcomes. Our meta-analysis demonstrated home-based exercise had positive effect on physical function after hip fracture surgery. Home-based rehabilitation might be recommended for rehabilitation of fractured patients after hospital discharge.

Effects of virtual reality technology on anxiety and depression in older adults with chronic diseases: A systematic review and meta-analysis of randomized controlled trials.

Previous research has demonstrated the effectiveness of virtual reality (VR) technology in many application areas. However, there is a clear gap in the literature regarding its effects on depression and anxiety in older adults with chronic diseases. This review aimed to assess the effectiveness of VR interventions for depression and anxiety in older adults with chronic diseases. Seven electronic databases were systematically searched from their inception to April 9, 2024. Two researchers evaluated methodological quality using RoB (version 2.0) and performed meta-analyses using RevMan (version 5.4) and Stata (version 16.0) software. This review included 19 randomized controlled studies. Meta-analysis revealed that VR significantly improved depression (standard mean difference [SMD] = -0.67, 95% confidence interval [CI] [-0.90, -0.45], p < .00001) and anxiety (SMD = -0.76, 95% CI [-0.95, -0.57], p < .00001) in older adults with chronic diseases, improved their quality of life (SMD = 0.39, 95% CI [0.17, 0.61], p = .0006) and positive emotions (SMD = 5.65, 95% CI [3.61, 7.69], p < .00001), and relieved stress (SMD = -1.08, 95% CI [-1.52, -0.64], p < .00001). However, the difference in self-efficacy was statistically non-significant (SMD = 1.01, 95% CI [-0.48, 2.50], p = .19). The results of this systematic review provide important evidence for developing interventions to improve the mental health of older adults with chronic diseases.

Systematic review and meta-analysis of the association of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with periodontitis

IntroductionRecent evidence suggests the relationship between periodontitis and systemic inflammation, which complete blood count can assess (CBC)-derived biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). We conducted this meta-analysis to evaluate the levels of NLR and PLR of patients with periodontitis compared to those of healthy controls. MethodsWeb of Science, PubMed, ProQuest, Scopus, and Open Grey were searched for studies published before October 20, 2024, without any limitation on date and language; then, using the random-effects model, we reported a standardized mean difference (SMD) with a 95% confidence interval (CI). In order to assess the quality of publications, we used the Newcastle–Ottawa scale (NOS). Our study was registered in PROSPERO (CRD42023475214). ResultsOverall, 11 articles were included in the analysis. We found that patients with periodontitis had elevated levels of NLR compared to healthy controls (SMD = 0.30, 95% CI 0.08–0.52, p = 0.007) In the subgroup analysis according to race, patients with periodontitis had elevated levels of NLR compared to healthy controls in among East Asian patients (SMD = 0.35, 95% CI 0.15–0.55, p = 0.001), but not among Turkish (SMD = 0.15, 95% CI − 0.30–0.61, p = 0.50) and Indian (SMD = 0.38, 95% CI − 0.17–0.94, p = 0.18) patients. In addition, PLR level was not different among patients with periodontitis and healthy controls (SMD = 0.06, 95% CI − 0.71–0.83, p = 0.87). ConclusionsThe findings of our investigation, which indicate higher NLR levels in periodontitis patients, show that immune dysregulation plays a role in the etiology of the disease.

The efficacy and safety of negative pressure wound therapy in paediatric burns: a systematic review and meta-analysis of randomized controlled trials

BackgroundAlthough the effective application of negative pressure wound therapy (NPWT) has been exemplified in diverse clinical studies, its potential and safety, specifically regarding paediatric burns, are yet to be fully confirmed. Our most recent systematic review and meta-analysis strive to investigate the impact of NPWT within the realm of paediatric burns.MethodsWe sourced relevant articles from databases including PubMed, Embase, the Cochrane Database, Web of Science, the International Clinical Trials Registry Platform, China National Knowledge Infrastructureris, the VIP Database for Chinese Technical Periodicals, and the Wanfang database. We defined the primary outcome measure as the healing time, while healing rate, numbers of dressing changes, detection rate of positive bacteria, incidence rate of adverse reactions, scar scale scores, and treatment costs were considered as secondary outcome measures. Pooling of data was conducted and the results were articulated as relative risk (RR), mean difference (MD), and standardized mean difference (SMD), all with a 95% confidence interval (CI).ResultsIn this systematic review and meta-analysis, a total of 12 studies involving 1033 individuals were examined, including 559 paediatric burn patients who underwent NPWT (referred to as the treatment group) and 543 patients who received treatments other than NPWT (referred to as the control group). The amalgamated data from these studies exhibited that the treatment group experienced significant reductions in healing time (SMD = -1.60; 95% CI: -2.26 - -0.95; p < 0.001, I2 = 92.8%), the number of required dressing changes (SMD = -4.6; 95% CI: -5.84 - -3.36; p < 0.001, I2 = 92.4%), positive bacteria detection rate (RR = 0.61; 95% CI: 0.26–1.46; p = 0.004, I2 = 81.8%), incidence of adverse reactions (RR = 0.61; 95% CI: 0.33–1.12; p = 0.005, I2 = 68%), scar scale scores (SMD = -1.66; 95% CI: -2.54 - -0.79; p < 0.001, I2 = 89.4%), as well as in treatment costs (SMD = 0.92; 95% CI: -1.66–3.49; p < 0.001, I2 = 98.4%). Additionally, these individuals showed an increased rate of healing (RR = 1.17; 95% CI: 0.99–1.39; p < 0.001, I2 = 78%). Subgroup analysis did not find that the degree of burn was one of the sources of high heterogeneity.ConclusionOur meta-analysis points to the effectiveness of NPWT in treating paediatric burns. Notably, it significantly mitigates healing duration, frequency of dressing alterations, positive bacterial detection rate, adverse reactions incidence, scar scale scores and treatment costs, all while propelling the acceleration of wound healing.

A Systematic Review and Meta-Analysis of the Effectiveness of Mulligan Mobilization with Movement on Pain, Range of Motion, Function, and Flexibility in Patients with Sciatica

Background The Mulligan techniques address lumbar disc lesions and related dysfunctions. However, the current body of evidence of its effectiveness remains limited. Aims To assess the effectiveness of the Mulligan concept on pain alleviation, range of motion, function, and flexibility in patients with sciatica. Methods This meta-analysis included randomized controlled trials that applied Mulligan techniques to patients with sciatica and assessed outcomes such as pain, range of motion, function, or flexibility. We searched six electronic databases to identify the relevant trials. The methodological quality of the studies was evaluated using the Cochrane risk of bias assessment. Results A total of 21 randomized controlled trials (RCTs) were included in this study. Three primary Mulligan techniques were performed: spinal mobilization with leg movement (SMWLM), bent leg raise (BLR), and traction straight leg raise (TSLR). In this review, seven trials exhibited a high to moderate risk of bias, while the remaining trials demonstrated a low risk of bias. The analysis revealed that SMWLG could be beneficial in improving pain (standardized mean difference [SMD] = −0.58, 95% confidence interval [CI] = −0.82 to −0.33, p &lt; .001) and function (SMD = −1.02, 95% CI = −1.87 to −0.17, p = .02). Additionally, BLR showed potential benefits in improving flexibility, particularly when combined with standard treatment (SMD = 0.59, 95% CI = 0.30 to 0.88, p &lt; .001). Conclusions SMWLG demonstrates greater improvements in pain and function compared to other Mulligan techniques in patients with sciatica. However, the limited number of trials and the overall low quality of the existing literature highlight the need for future high-quality research that encompasses all related Mulligan techniques.

Role of memantine in adult migraine: a systematic review and network meta-analysis to compare memantine with existing migraine preventive medications

BackgroundWhile memantine has been considered a promising drug for migraine prevention, no conclusive evidence exists comparing its efficacy with other migraine-preventive medications. This network meta-analysis (NMA) aimed to access the effectiveness and acceptability of memantine and other guideline-recommended prophylactic agents for migraine.MethodsWe searched the Cochrane Register of Controlled Trials, Embase, PubMed, and ClinicalTrials databases from their inception to 1 June 2024. Randomized placebo-controlled trials (RCTs) examining the pharmacological prevention of adult migraine patients were included. The primary efficacy outcome was the change in migraine days, and the primary safety outcome was withdrawal due to adverse events. Secondary outcomes included 50% response rates and frequency of any adverse events. The analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThirty-eight RCTs, including a total of 13,223 participants, were analyzed. Our analysis showed that memantine demonstrated the second-largest reduction in migraine days [standardized mean difference (SMD): −0.83; 95% confidence interval (CI): −1.26, −0.41 compared with placebo] and the highest 50% response rates [odds ratio (OR): 5.58, 95% CI: 1.31 to 23.69] in all studied interventions. Moreover, among all interventions, memantine appeared to show the lowest dropout rate and moderate frequency of adverse events. However, its confidence intervals contained null values.ConclusionThis study provides prioritisation evidence for memantine in migraine prevention, as memantine can significantly decrease the frequency of migraine attacks, improves response rates, and fair acceptability. These beneficial effects were not inferior to currently recommended pharmacological regimens. However, due to the lack of long-term efficacy and safety data, as well as few direct comparisons with active control agents, the estimates of memantine may be overly optimistic. Clinicians should interpret the findings of current NMA cautiously and apply them in a relatively conservative manner.

Circulating irisin levels in patients with MAFLD: an updated systematic review and meta-analysis

ObjectiveCurrent research suggests that irisin is closely linked to the pathogenesis and progression of metabolic dysfunction-associated fatty liver disease (MAFLD). This systematic review and meta-analysis updates our previous meta-analysis and further explores the relevance between circulating irisin levels and MAFLD.MethodsNine databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, Weipu, CBM, Clinicaltrials.gov and gray literature) were retrieved as of 1st August, 2024. The standardized mean difference (SMD) and 95% confidence interval (CI) represent pooled effect size. We used the Newcastle–Ottawa Scale to evaluate the quality of articles and the certainty of evidence assessed by GRADE system. All statistical analyses were performed using RevMan 5.3 and Stata 12(Stata Corporation, yi TX).ResultsFifteen case-control studies were included. Circulating irisin levels in the MAFLD group were markedly lower than those in the healthy group (SMD=-1.04 [-1.93, -0.14]). Subgroup analyses by race, age, severity and T2DM revealed that circulating irisin levels were lower in the MAFLD group compared to those in the healthy controls in the Asian population (SMD=-1.38 [-2.44, -0.31], P&amp;lt;0.05) and in those above 50 years old (SMD=-2.23 [-3.64, -0.81], P&amp;lt;0.05) and higher in the mild MAFLD groups than those in moderate to severe MAFLD groups (SMD = 11.68 [9.05, 14.31], P&amp;lt;0.05). And the circulating irisin levels in MAFLD patients with T2DM were significantly lower than those in healthy group (SMD = -2.90 [-4.49, -1.30]). ELISA kits from different companies also presented different relationships.ConclusionsThere were significantly lower circulating irisin levels in the MAFLD group than in the healthy control group. Although these results differed from our previous results, there is no denying that circulating irisin levels are closely associated with the advancement of MAFLD.

Employing Simulated Participants to Develop Communication Skills in Medical Education: A Systematic Review.

Simulated participants (SPs) are often employed to teach communication skills in medical education. Although there is a large number of qualitative and/or noncomparative studies in this field, there is no current evidence for the effectiveness of this teaching method based on quantitative comparative meta-data. The aim of this review was to evaluate the effectiveness of SP-based teaching on patient-centered communication skills in medical education compared with traditional teaching formats such as lecture or peer role play focusing on quantitative and comparative data. According to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we searched MEDLINE, Cochrane Library, PsycINFO, CINAHL, and ERIC databases for relevant studies published through February 2023. We also conducted hand searches and ancestry searches. Of the 8523 publications identified, 21 studies with 2500 participants and a Medical Education Research Study Quality Instrument score of 13.7 (SD = 1.3, N = 21) were included in the synthesis. Ten studies were eligible for meta-analysis. The pooled effect for communication skills outcomes suggests a medium effect preferring SP-based teaching to traditional teaching formats (standardized mean difference = 0.74, 95% confidence interval = 0.37 to 1.11, I2 = 95%, n = 2061). The heterogeneity is high among the analyzed studies. Further analysis reveals great differences among the studies' characteristics (population, objectives, interventions, control group settings, and outcome measurements).

Influence of Oestradiol Fluctuations in the Menstrual Cycle on Respiratory Exchange Ratio at Different Exercise Intensities: A Systematic Review, Meta-Analysis and Pooled-Data Analysis

Background: Oestradiol has been implicated as a factor in substrate utilisation in male and mouse studies but the effect of acute changes during the menstrual cycle is yet to be fully understood. Objective: To determine the role of oestradiol in respiratory exchange ratio (RER) during exercise at various intensities. Methods: This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From inception to November 2023, four online databases (Cochrane, SPORTDiscus, MEDline and Web of Science) were searched for relevant articles. Studies that reported a resting oestradiol measurement in naturally menstruating women with exercise at a percentage of maximal aerobic capacity (%V˙O2max) were included. Mean and standard deviation for oestradiol, RER and exercise intensity were extracted and study quality assessed using a modified Downs and Black checklist. Risk of bias was assessed using I2 measure of heterogeneity and Egger’s regression test, assessment of bias from methodological quality was identified by sensitivity analysis. Eligible datasets were extracted for pairwise comparisons within a meta-analysis and correlation between change in oestradiol and change in RER. Data were also pooled to produce a mean and standard deviation for RER for menstrual stage and for low and high oestradiol groups. Results: Twenty-four articles were identified, over 50% were identified as high quality. Sixteen articles included datasets eligible for meta-analysis. Eleven articles utilised a submaximal constant-load exercise intensity, finding a standardised mean difference of − 0.09 ([CI: −0.35–0.17], p = 0.5) suggesting no effect of menstrual phase on constant-load exercise RER. In six articles using incremental exercise tests to exhaustion, a standardised mean difference of 0.60 ([CI 0.00–1.19], p = 0.05) was identified towards a higher maximal RER attained in follicular compared to luteal phase. There was no correlation (R = −0.26, p = 0.2) between change in oestradiol and change in RER between phases. All 24 articles, totalling 650 participants, were included in pooled analysis. When grouped by menstrual cycle phase or when grouped by oestradiol levels, RER was higher in the follicular phase than the luteal phase at low and high constant load exercise intensities. Discussion: Findings from the pooled-analysis and meta-analysis suggest that there may be menstrual cycle phase differences in RER that are intensity dependent. These differences may be related to sex hormone levels, but this was not supported by evidence of correlation between differences in RER and differences in oestradiol. At present, it remains best practice to assess performance in the same menstrual cycle phase if seeking to assess change from baseline.

Home Use Therapies for Pain, Disability, and Quality of Life in Military Service Members with a Musculoskeletal Injury: An Updated Systematic Review Meta-Analysis.

Musculoskeletal (MSK) injury can negatively affect service members by compromising job performance and readiness. These injuries can impact the service member's physical health, functional abilities, and quality of life (QoL). Rehabilitation therapies for MSK injuries can reduce these impacts. One approach is home use rehabilitative therapy, usable during deployment and at home stations. The purpose of this updated systematic review with meta-analysis was to broaden our scope of pain/symptoms, disability, and QoL as outcome measures for nonpharmaceutical MSK therapies in a military population versus controls. An updated systematic literature search was conducted from inception to September 2022 using electronic databases. From 2790 retrievals, 22 reports were identified from 21 randomized or nonrandomized control trials. Interventions included exercise, electrotherapy, bracing, and other devices compared to a standard control treatment. Outcomes for MSK pain/symptoms, disability, and QoL were summarized as (1) standardized change from baseline for both intervention and control by time and (2) standardized mean differences (SMDs) in the time change between the intervention and control. Relative to baseline, pain improved during treatment and follow-up (P < .0001) with differences between intervention and control groups (P < .0001) but no significant interactions between group and time (P = .11). Overall, interventions showed modest (0.33 SMD, 95% CI, 0.11 to 0.54) improvement relative to controls across body regions and time. On average, disability exhibited an SMD of 0.12 (95% CI, -0.20 to 0.44) across all measures with substantial heterogeneity (I2 = 0.93). Time (P = .02) but not intervention (P = .87) was a significant moderator with no clear pattern of change over time and no time by group interaction (P = .84). Quality of life had an overall modest effect with an SMD of 0.10 (95% CI, -0.04 to 0.24) with no evidence supporting a difference between the intervention and control groups (P = .10) and no significant interaction between time and group (P = .41). The QoL measures were primarily derived using the Short Form Health Survey (SF12/36), which provide a mental and physical component summary score. For the mental component, there was either no change or a small decline during the study (P(time) = .80), with a difference between the intervention and control (P = .04) but no interaction between groups over time (P = .40). For the physical component scale, there was improvement during the study (P = .01), with the intervention showing better improvement than the control (P = .005), with no interaction between the time and treatment/control group (P = .80). The report considers responses by region and individual treatments. This analysis demonstrated modest improvement in pain and physical well-being with therapy, with low certainty across diverse military cohorts. The impact on overall health-related disability and QoL was limited, with little change in mental well-being. The substantial heterogeneity and low certainty across diverse military cohorts limit generalizability, suggesting that further research in homogeneous environments is important for guiding clinical decisions. The study's findings suggest that nonpharmacological home use interventions may offer modest improvements in pain relief, particularly early in treatment, and in strength and function, according to our previous report. These interventions could complement standard care, providing options that may benefit service members during deployment and at home.

Comparing the construct validity of measurement instruments for pain and stiffness in patients with axial spondyloartwhritis: cross-sectional analysis in the OASIS cohort

ObjectivesTo compare the construct validity, including discrimination between known groups, of three pain and three morning stiffness (MS) measurement instruments.MethodsPatients with radiographic axial spondyloarthritis with 8-year data from the Outcome...

Psychedelics as an intervention for psychological, existential distress in terminally ill patients: A systematic review and network meta-analysis.

The interest in psychedelics as a therapeutic intervention for existential distress of people with terminal illness grounds on their mechanism of action and effect on the spiritual/existential aspects accompanying end-of-life experiences. This systematic review and network meta-analysis aimed at examining the efficacy and safety of psychedelic compounds for existential distress in terminally ill people. PubMed, CINAHL, PsycINFO, EMBASE, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) administering psychedelics for existential distress in people with terminal illnesses. Meta-analysis estimated the standardized mean difference (SMD) and odds ratio (OR), with corresponding 95% confidence intervals (95% CI), between treated and control groups in pairwise and network comparisons, using random-effects models. Post-treatment measures of depression and anxiety, as proxies of existential distress, and tolerability were the primary outcomes. Nine studies, involving 606 participants (362 treated with psychedelics: psilocybin, ketamine, 3,4-methylenedioxymethamphetamine, and lysergic acid diethylamide (LSD)) were included. The meta-analysis supported the efficacy of psychedelics on depression (SMD: -0.80 (95% CI: -0.98, -0.63)) and anxiety (SMD: -0.84 (95% CI: -1.20, -0.48)). Network meta-analysis identified psilocybin as the most effective compound for depression, and LSD for anxiety. However, head-to-head comparison between psychedelics did not reach statistical significance. The rates of treatment discontinuation and adverse events between psychedelics and controls were comparable. Psychedelics, especially psilocybins and LSD, showed promising effects on depression and anxiety in people with terminal illnesses. Limitations include the small number of RCTs, methodological issues related to blinding, and the lack of direct comparisons between psychedelic compounds. Larger studies and comparative research are needed to consolidate these findings.

Quality appraisal of systematic reviews on high-intensity laser therapy for musculoskeletal pain management: an umbrella review.

Musculoskeletal pain (MSP) remains one of the leading causes of disability worldwide. Recent approaches to treating this condition have prompted the development of several systematic reviews investigating the efficacy of high-intensity laser therapy (HILT), whose analgesic mechanisms are based on photobiomodulation neural inhibition, endorphin and serotonin release and anti-inflammatory effects. To assess the methodological quality, reliability, and validity of the systematic reviews (SRs) on HILT in MSP. This study is an overview of SRs (umbrella review) with an observational, retrospective, and secondary design.The search considered PubMed, Scopus, Web of Science, CINAHL, Embase, Cochrane Library, ScienceDirect, and Google Scholar databases (updated October 23, 2024).The primary focus was on the methodological quality of the reviews and their reporting of pain intensity results. The HILT effects on pain intensity were reported using mean differences (MD) or standardized mean differences (SMD). The quality assessment was conducted using the A Measurement Instrument to Assess Systematic Reviews 2 checklist (AMSTAR-2), and the findings were synthesized narratively. The MD and SMD obtained from all reviews were presented using forest plots. The Shapiro-Wilk normality test assessed MD and SMD distributions for pain intensity across meta-analyses. The average MD and SMD, along with their respective confidence intervals (CI), were estimated and presented based on the aggregate study outcomes. Twenty SRs were included, fourteen of which conducted meta-analyses covering diverse musculoskeletal disorders such as knee osteoarthritis, epicondylalgia, myofascial pain, frozen shoulder, plantar fasciitis, neck, and low back pain. The primary databases used were PubMed, Web of Science, and the Cochrane Library. The AMSTAR-2 average score was 12.9 points (± 1.8), indicating varying methodological quality with one or two criteria resulting in low or critically low.HILT's best analgesic effects are observed in frozen shoulder disorder (MD = -2.23cm; 95% CI:-3.3,-1.2; p < 0.01), knee osteoarthritis (MD = -1.9cm; 95% CI:-2.0,-1.8;p < 0.01), low back pain (MD = -1.9cm; 95% CI = -2.9,-1.0; p < 0.01), and myofascial pain (MD = -1.9cm; 95% CI:-2.6,-1.2; p < 0.01). Largest effect sizes are for neck pain (SMD = 2.1; 95% CI = 1.2,3.0, p < 0.05) and low back pain (SMD = 1.1 (95% CI = 1.4,0.8; p < 0.01). This review underscores the generally low to critically low methodological quality of SRs on HILT, as assessed by AMSTAR-2. Key areas for improvement for future SRs of RCTs include addressing publication bias, disclosing funding sources, and enhancing search strategies and discussions on heterogeneity. The scarcity of RCTs for conditions such as temporomandibular disorders, carpal tunnel syndrome, and myofascial pain highlights the need for further research. SRs on spinal disorders, frozen shoulder, and neck pain demonstrated the most favorable analgesic effects, providing valuable insights for clinical practice and future RCTs.

Effectiveness of expressive writing therapy for postpartum women with psychological distress: Meta-analysis and narrative review.

The increasing prevalence of psychological distress among mothers is outpacing the effectiveness of conventional coping methods like cognitive behavioral therapy. The efficacy of alternatives such as writing therapy for maternal psychological well-being remains uncertain due to a lack of extensive research and inconsistent findings. The aim of this study was to evaluate the effectiveness of expressive writing therapy in comparison to standard postpartum care for alleviating psychological distress, encompassing symptoms of depression, anxiety, or stress, in postpartum women. For this purpose, seven bibliographic databases, including CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science, and gray literature were examined up to December 27, 2022 for randomized controlled trials, comparing expressive writing against standard care or controlled writing among postpartum women with psychological distress. Data was collected using a random effect model for meta-analysis. A meta-analysis of five studies with 483 participants found that expressive writing therapy was more effective than standard care or controlled writing in reducing postpartum depression and stress among women with psychological distress. Expressive writing resulted in a significant reduction in initial depression with standard mean difference (SMD) = -0.65%, 95% confidence interval (CI) = -1.08 to -0.22, Z = 2.96, P = 0.003, in comparison to controlled writing as an intervention. Regarding expressive writing versus standard care, a narrative review was conducted due to an I2 above 75%. The results showed significant improvements compared to the baseline at the seventh day and third month post-intervention. In terms of stress scores, there was a significant difference favoring expressive writing over standard care at the first month (SMD = -0.80%, 95% CI = -1.35 to -0.24, Z = 2.81, P = 0.005) and third month (SMD = -0.53%, 95% CI = -0.86 to -0.20, Z = 3.13, P = 0.002) post-intervention. Stress scores are also greatly reduced for expressive writing versus controlled writing with SMD = -0.79%, 95% CI = -1.03 to -0.55, Z = 6.48, P < 0.00001. However, the effectiveness of expressive writing on postpartum anxiety should be interpreted cautiously due to low certainty. Expressive writing serves as an effective alternative for non-pharmacological intervention for postpartum women with depression and stress, but more research is needed for postpartum anxiety. As substantial heterogeneity was detected, results must be interpreted cautiously. Postpartum women with psychological distress are encouraged to use expressive writing as an affordable way to promote maternal mental health for the benefit of both the mother and the child.

Gut microbiota and breast cancer: systematic review and meta-analysis.

The gastrointestinal microbiota can modulate systemic estrogens, potentially influencing estrogen-induced breast neoplasia development. This study aimed to assess alterations in the gut microbiota in breast cancer patients. A search strategy was developed using the terms: "Microbiota," "Gastrointestinal Microbiome," "Breast Cancer," and synonyms. Ten observational studies were included. The total sample was 1730 women (929 cases and 801 controls). The meta-analysis of alpha diversity, assessed by the Shannon index, displayed that in the breast cancer group, the diversity of the gut microbiota was reduced compared to controls, with a standardized mean difference (SMD) of -0.34 (95% CI -0.59, -0.10, I2 = 68%, p = 0.007). Regarding the premenopausal population, there was a significant reduction in the breast cancer group (SMD -0.67, 95% CI -1.06, -0.28, I2 = 77%, p = 0.0009). In women with a body mass index (BMI) between overweight or obesity, no statistically significant difference was observed (SMD -0.20; 95% CI -0.51, 0.11; I2 52%, p = 0.20). However, in women with a BMI greater than or equal to 18.5 and less than 25.0, there was lower diversity in women with breast cancer compared to controls (SMD -0.49, 95% CI -0.94, -0.04; I2 78%, p = 0.03). The study found a significant difference in gut microbiota diversity between women with breast cancer and controls, supporting the growing evidence that the gut microbiota may play a role in mammary carcinogenesis.

Smoking-Related Tear Film Abnormalities and Dry Eye Disease: A Meta-Analysis

Dry eye disease (DED) is a prevalent ocular condition characterized by tear film instability and ocular surface inflammation. Smoking has been identified as a potential risk factor for DED, but the impact of different smoking modalities (active, passive, and e-cigarette) on tear film and DED remains unclear. This meta-analysis aimed to evaluate the association between various forms of smoking and tear film abnormalities leading to DED. A systematic search of PubMed, Embase, and Cochrane Library databases was conducted for studies published between 2013 and 2024 investigating the effects of active smoking, passive smoking, and e-cigarette use on tear film parameters and DED diagnosis. Data extracted included tear film break-up time (TBUT), Schirmer's test results, tear osmolarity, and DED diagnostic criteria. Pooled effect estimates were calculated using random-effects models. Eight studies met the inclusion criteria, comprising 4 on active smoking, 2 on passive smoking, and 2 on e-cigarette use. Active smoking was significantly associated with reduced TBUT (standardized mean difference [SMD] = -2.87; 95% CI: -3.12 to -2.62; p&lt;0.00001), lower Schirmer's test scores (SMD = -2.79; 95% CI: -3.23 to -2.35; p&lt;0.00001), and increased tear osmolarity (SMD = 12.55; 95% CI: 8.17 to 16.93; p&lt;0.00001). Passive smoking and e-cigarettes showed a similar trend but with less pronounced effects. In conclusion, this meta-analysis provides evidence that active smoking significantly impairs tear film stability and contributes to DED. Passive smoking may also have detrimental effects, while the impact of e-cigarettes requires further investigation. These findings underscore the importance of smoking cessation in DED management and public health strategies for eye health.

Efficacy of reminiscence therapy in improving cognitive decline: a systematic review and meta-analysis.

‌ Reminiscence therapy(RT) is used in the care of people with dementia to help improve their quality of life, but the efficacy of RT in various cognitive decline populations is unclear, and long-term effects are not sufficiently evidenced.This systematic review and meta-analysis aims to determine the efficacy of RT in improving cognitive decline and provide evidence for its implementation in care. A comprehensive search strategy utilizing MeSH terms and free-text keywords was employed to systematically search the Embase, PubMed, and Cochrane databases up to January 24, 2024. Randomized controlled trials(RCTs) investigating RT monotherapy for improving cognitive decline were included. The primary outcomes of interest were the standard Mini-Mental State Examination (MMSE) scores. Additionally, all data analyses will be performed using RevMan5.4 software. ‌ We identified 612 studies, and 24 studies met the inclusion criteria, involving 2650 participants. This meta-analysis shows that RT significantly improves immediate and long-term cognitive decline with Standardized Mean Difference(SMD) and 95% CI of 0.55 [0.37, 0.73] and 0.50 [0.11, 0.88], respectively. However, there is no significant difference in efficacy between subgroups (P > 0.05). ‌ Our findings suggestS that RT significantly improves cognitive decline, with no significant differences between subgroups. This suggests that RT is universal in improving cognition and that the way RT is implemented has no significant effect on outcomes. These findings supportS the use of RT as a reliable non-pharmacological treatment option to enhance cognitive function.

Response shift results of quantitative research using patient-reported outcome measures: a meta-regression analysis.

Our objectives were to identify characteristics of response shift studies using patient-reported outcomes (PROMs) that explain variability in (1) the detection and (2) the magnitude of response shift effects. We conducted a systematic review of quantitative studies published before June 2023. First, two-level multivariable logistic regression models (effect- and sample-levels) were used to explain variability in the probability of finding a response shift effect. Second, variability in effect sizes (standardized mean differences) was investigated with 3-level meta-regression models (participant-, effect- and sample-levels). Explanatory variables identified via the purposeful selection methodology included response shift method and type, and population-, study design-, PROM- and study-quality characteristics. First, logistic regression analysis of 5597 effects from 206 samples in 171 studies identified variables explaining 41.5% of the effect-level variance, while no variables explained sample-level variance. The average probability of response shift detection is 0.20 (95% CI: 0.17-0.28). Variation in detection was predominantly explained by response shift methods and type (recalibration vs. reprioritization/reconceptualization). Second, effect sizes were analyzed for 769 effects from 114 samples and 96 studies based on the then-test and structural equation modeling methods. Meta-regression analysis identified variables explaining 11.6% of the effect-level variance and 26.4% of the sample-level variance, with an average effect size of 0.30 (95% CI: 0.26-0.34). Response shift detection is influenced by study design and methods. Insights into the variables explaining response shift effects can be used to interpret results of other comparable studies using PROMs and inform the design of future response shift studies.

The assistive gait devices and their implementation in activities of daily living for patients with neuromuscular disease: A systematic review and meta-analysis

Background: To date, assistive gait devices (AGDs) for people with neuromuscular diseases (NMDs) have not been systematically evaluated. Objective: This systematic review evaluated AGDs for people with NMDs. Methods Suitable tools were used to assess the study quality and the certainty of evidence. If feasible, a descriptive and quantitative synthesis was conducted. Results: Forty studies were included on: gait-assisting exoskeletons (GAEs), orthopaedic footwear (OF), knee and/or ankle-foot-orthoses (AFOs) and non-invasive neuroprostheses that provide functional electrical stimulation (FES). Pairwise meta-analysis could not be performed due to a lack of homogenous data. The within-group pre-post meta-analysis in GAE studies showed an improvement in 2-min walk test (2MWT) (m) (standardized mean difference [SMD] = 0.36, 95%-CI: 0.17 to 0.54), but not in 10-meter walk test (10MWT) (sec) (SMD = 0.33, 95%-CI: −0.10 to 0.76) and in functional independence measure (FIM) (SMD = −0.002, 95%-CI: −0.21 to 0.21). In AFO studies, there was no improvement in 10MWT(m) (SMD = −0.11, 95%-CI: −0.76 to 0.53). A single session with AFO or OF vs no-AFO or OF post-intervention meta-analysis did not reveal an improvement in walking speed (m/s) (SMD = 0.39, 95%-CI: −0.03 to 0.83). Discussion: GAEs seem to help patients to walk longer. The meta-analyses showed no significant results to support the effect of AFOs or OF. Neuroprostheses and knee orthoses showed no evidence. Conclusion: No clear conclusions can be drawn on how AGDs affect NMDs. The positive AGD effects are based on very low certainty of evidence.

Serum Vitamin D Levels in Patients with Vernal Keratoconjunctivitis: A Systematic Review and Meta-Analysis

ABSTRACT Purpose To conduct a systematic review and meta-analysis to provide an outline of available data on the association between serum vitamin D levels and vernal keratoconjunctivitis (VKC) and to determine the possible relationship in children. Methods Systematic research on all articles published until July 2023 was conducted in PubMed, SCOPUS, Web of Science, and Embase. All observational-analytical studies that measured vitamin D levels in patients with VKC were included. Extracted data were included in two separate meta-analyses: 1) a meta-analysis on the standardized mean difference (SMD) of vitamin D levels between VKC patients and the control group and 2) a meta-analysis on the prevalence of vitamin D deficiency in VKC patients. Results Seven relevant studies that included 316 patients, with the mean age of 10.8 3 ± 1.14 years, with VKC were included in this meta-analysis. The mean serum vitamin D level was significantly lower in the patients with VKC as compared with the control group (SMD: −0.92; 95% CI −1.15, −0.69, p < 0.001). The overall prevalence of vitamin D deficiency among VKC patients was 63.7% (95% CI 42.5%-80.7%, p < 0.001). VKC patients spent significantly less time outdoors during daylight compared to healthy individuals (SMD = −0.90, 95%CI −1.28, −0.52, p < 0.001). Conclusion VKC patients have lower serum vitamin D than healthy controls. This finding underscores the potential role of vitamin D in the immunopathogenesis of VKC.