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Background: Depression is a public health problem and common amongst adolescents. Cognitive behavioural therapy (CBT) is widely used to treat adolescent depression but existing research does not provide clear conclusions regarding the relative effectiveness of different delivery modalities. Objectives: The primary aim is to estimate the relative efficacy of different modes of CBT delivery compared with each other and control conditions for reducing depressive symptoms in adolescents. The secondary aim is to compare the different modes of delivery with regard to intervention completion/attrition (a proxy for intervention acceptability). Search Methods: The Cochrane Depression, Anxiety and Neurosis Clinical Trials Register was searched in April 2020. MEDLINE, PsycInfo, EMBASE, four other electronic databases, the CENTRAL trial registry, Google Scholar and Google were searched in November 2020, together with reference checking, citation searching and hand‐searching of two databases. Selection Criteria: Randomised controlled trials (RCTs) of CBT interventions (irrespective of delivery mode) to reduce symptoms of depression in young people aged 10–19 years with clinically relevant symptoms or diagnosis of depression were included. Data Collection and Analysis: Screening and data extraction were completed by two authors independently, with discrepancies addressed by a third author. CBT interventions were categorised as follows: group CBT, individual CBT, remote CBT, guided self‐help, and unguided self‐help. Effect on depressive symptom score was estimated across validated self‐report measures using Hedges' g standardised mean difference. Acceptability was estimated based on loss to follow‐up as an odds ratio. Treatment rankings were developed using the surface under the cumulative ranking curve (SUCRA). Pairwise meta‐analyses were conducted using random effects models where there were two or more head‐to‐head trials. Network analyses were conducted using random effects models. Main Results: Sixty‐eight studies were included in the review. The mean age of participants ranged from 10 to 19.5 years, and on average 60% of participants were female. The majority of studies were conducted in schools (28) or universities (6); other settings included primary care, clinical settings and the home. The number of CBT sessions ranged from 1 to 16, the frequency of delivery from once every 2 weeks to twice a week and the duration of each session from 20 min to 2 h. The risk of bias was low across all domains for 23 studies, 24 studies had some concerns and the remaining 21 were assessed to be at high risk of bias. Sixty‐two RCTs (representing 6435 participants) were included in the pairwise and network meta‐analyses for post‐intervention depressive symptom score at post‐intervention. All pre‐specified treatment and control categories were represented by at least one RCT. Although most CBT approaches, except remote CBT, demonstrated superiority over no intervention, no approaches performed clearly better than or equivalent to another. The highest and lowest ranking interventions were guided self‐help (SUCRA 83%) and unguided self‐help (SUCRA 51%), respectively (very low certainty in treatment ranking). Nineteen RCTs (3260 participants) were included in the pairwise and network meta‐analyses for 6 to 12 month follow‐up depressive symptom score. Neither guided self‐help nor remote CBT were evaluated in the RCTs for this time point. Effects were generally attenuated for 6‐ to 12‐month outcomes compared to posttest. No interventions demonstrated superiority to no intervention, although unguided self‐help and group CBT both demonstrated superiority compared to TAU. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking approaches were unguided self‐help and individual CBT, respectively. Sixty‐two RCTs (7347 participants) were included in the pairwise and network meta‐analyses for intervention acceptability. All pre‐specified treatment and control categories were represented by at least one RCT. Although point estimates tended to favour no intervention, no active treatments were clearly inferior. No CBT approach demonstrated clear superiority over another. The highest and lowest ranking active interventions were individual CBT and group CBT respectively. Pairwise meta‐analytic findings were similar to those of the network meta‐analysis for all analyses. There may be age‐based subgroup effects on post‐intervention depressive symptoms. Using the no intervention control group as the reference, the magnitudes of effects appear to be larger for the oldest age categories compared to the other subgroups for each given comparison. However, they were generally less precise and formal testing only indicated a significant difference for group CBT. Findings were robust to pre‐specified sensitivity analyses separating out the type of placebo and excluding cluster‐RCTs, as well as an additional analysis excluding studies where we had imputed standard deviations. Authors' Conclusions: At posttreatment, all active treatments (group CBT, individual CBT, guided self‐help, and unguided self‐help) except for remote CBT were more effective than no treatment. Guided self‐help was the most highly ranked intervention but only evaluated in trials with the oldest adolescents (16–19 years). Moreover, the studies of guided self‐help vary in the type and amount of therapist support provided and longer‐term results are needed to determine whether effects persist. The magnitude of effects was generally attenuated for 6‐ to 12‐month outcomes. Although unguided self‐help was the lowest‐ranked active intervention at post‐intervention, it was the highest ranked at follow‐up. This suggests the need for further research into whether interventions with self‐directed elements enable young people to maintain effects by continuing or revisiting the intervention independently, and whether therapist support would improve long‐term outcomes. There was no clear evidence that any active treatments were more acceptable to participants than any others. The relative effectiveness of intervention delivery modes must be taken into account in the context of the needs and preferences of individual young people, particularly as the differences between effect sizes were relatively small. Further research into the type and amount of therapist support that is most acceptable to young people and most cost‐effective would be particularly useful. [ABSTRACT FROM AUTHOR]

Background: Reactive balance is the last line of defense to prevent a fall when the body loses stability, and beneficial effects of various exercise-based interventions on reactive balance in older adults have been reported. However, their pooled evidence on the relative effects has yet to be described. Objective: To review and evaluate the comparative effectiveness of various exercise-based interventions on reactive balance in older adults. Methods: Nine electronic databases and reference lists were searched from inception to August 2021. Eligibility criteria according to PICOS criteria were as follows: (1) population: older adults with the mean age of 65 years or above; (2) intervention and comparison: at least two distinct exercise interventions or one exercise intervention with a no-exercise controlled intervention (NE) compared in each trial; (3) outcome: at least one measure of reactive balance; (4) study: randomized controlled trial. The main network meta-analysis was performed on data from the entire older adult population, involving all clinical conditions as well as healthy older adults. Subgroup analyses stratified by characteristics of participants (healthy only) and reactive balance outcomes (simulated slip or trip while walking, simulated forward falls, being pushed or pulled, and movable platform) were also conducted. Results: Thirty-nine RCTs (n = 1388) investigating 17 different types of exercise interventions were included in the network meta-analysis. Reactive balance training as a single intervention presented the highest probability (surface under the cumulative ranking (SUCRA) score) of being the best intervention for improving reactive balance and the greatest relative effects vs. NE in the entire sample involving all clinical conditions [SUCRA = 0.9; mean difference (95% Credible Interval): 2.7 (1.0 to 4.3)]. The results were not affected by characteristics of participants (i.e., healthy older adults only) or reactive balance outcomes. Summary/Conclusion: The findings from the NMA suggest that a task-specific reactive balance exercise could be the optimal intervention for improving reactive balance in older adults, and power training can be considered as a secondary training exercise. [ABSTRACT FROM AUTHOR]

Approval and prescription of psychotropic drugs should be informed by the strength of evidence for efficacy. Using a Bayesian framework, we examined (1) whether psychotropic drugs are supported by substantial evidence (at the time of approval by the Food and Drug Administration), and (2) whether there are systematic differences across drug groups. Data from short-term, placebo-controlled phase II/III clinical trials for 15 antipsychotics, 16 antidepressants for depression, nine antidepressants for anxiety, and 20 drugs for attention deficit hyperactivity disorder (ADHD) were extracted from FDA reviews. Bayesian model-averaged meta-analysis was performed and strength of evidence was quantified (i.e. BFBMA). Strength of evidence and trialling varied between drugs. Median evidential strength was extreme for ADHD medication (BFBMA = 1820.4), moderate for antipsychotics (BFBMA = 365.4), and considerably lower and more frequently classified as weak or moderate for antidepressants for depression (BFBMA = 94.2) and anxiety (BFBMA = 49.8). Varying median effect sizes (ESschizophrenia = 0.45, ESdepression = 0.30, ESanxiety = 0.37, ESADHD = 0.72), sample sizes (Nschizophrenia = 324, Ndepression = 218, Nanxiety = 254, NADHD = 189.5), and numbers of trials (kschizophrenia = 3, kdepression = 5.5, kanxiety = 3, kADHD = 2) might account for differences. Although most drugs were supported by strong evidence at the time of approval, some only had moderate or ambiguous evidence. These results show the need for more systematic quantification and classification of statistical evidence for psychotropic drugs. Evidential strength should be communicated transparently and clearly towards clinical decision makers. [ABSTRACT FROM AUTHOR]

Intestinal parasites affect millions of children globally. We aimed to assess effects of deworming children on nutritional and cognitive outcomes across potential effect modifiers using individual participant data (IPD). We searched multiple databases to 27 March 2018, grey literature, and other sources. We included randomised and quasi randomised trials of deworming compared to placebo or other nutritional interventions with data on baseline infection. We used a random-effects network meta-analysis with IPD and assessed overall quality, following a pre-specified protocol. We received IPD from 19 trials of STH deworming. Overall risk of bias was low. There were no statistically significant subgroup effects across age, sex, nutritional status or infection intensity for each type of STH. These analyses showed that children with moderate or heavy intensity infections, deworming for STH may increase weight gain (very low certainty). The added value of this review is an exploration of effects on growth and cognition in children with moderate to heavy infections as well as replicating prior systematic review results of small effects at the population level. Policy implications are that complementary public health strategies need to be assessed and considered to achieve growth and cognition benefits for children in helminth endemic areas. [ABSTRACT FROM AUTHOR]

Computer-based scaffolding provides temporary support that enables students to participate in and become more proficient at complex skills like problem solving, argumentation, and evaluation. While meta-analyses have addressed between-subject differences on cognitive outcomes resulting from scaffolding, none has addressed within-subject gains. This leaves much quantitative scaffolding literature not covered by existing meta-analyses. To address this gap, this study used Bayesian network meta-analysis to synthesize within-subjects (pre–post) differences resulting from scaffolding in 56 studies. We generated the posterior distribution using 20,000 Markov Chain Monte Carlo samples. Scaffolding has a consistently strong effect across student populations, STEM (science, technology, engineering, and mathematics) disciplines, and assessment levels, and a strong effect when used with most problem-centered instructional models (exception: inquiry-based learning and modeling visualization) and educational levels (exception: secondary education). Results also indicate some promising areas for future scaffolding research, including scaffolding among students with learning disabilities, for whom the effect size was particularly large (ḡ = 3.13). [ABSTRACT FROM AUTHOR]