Search

The authors describe the usefulness of systematic reviews (SR) and meta-analyses in evidence-based medicine. They explain the importance of summaries of evidence to clinicians and patients and criticize the claim that the problems of duplication and poor conduct of SR cast doubt on their usefulness. They also discuss developments in the methodology of SR, including the GRADE system for rating the quality of evidence that has been adopted by more than 100 organizations worldwide.

Objectives A systematic review and meta-analysis were performed on the risk and intensity of postoperative sensitivity (POS) in posterior resin composite restorations bonded with self-etch (SE) and etch-and-rinse (ER) adhesives. Source A comprehensive search was performed in the MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO and Cochrane Library and SIGLE without restrictions. The abstracts of the annual conference of the IADR (1990–2014), unpublished and ongoing trials registry were also searched. Dissertations and theses were searched using the ProQuest Dissertations and Periodicos Capes Theses databases. Study selection We included randomized clinical trials that compared the clinical effectiveness of SE and ER used for direct resin composite restorations in permanent dentition of adult patients. The risk/intensity of POS was the primary outcome. The risk of bias tool of the Cochrane Collaboration was used. The meta-analysis was performed on the studies considered ‘low’ risk of bias. Data After duplicates removal, 2600 articles were identified but only 29 remained in the qualitative synthesis. Five were considered to be ‘high’ risk of bias and eleven were considered to be ‘unclear’ in the key domains, yielding 13 studies for meta-analysis. The overall relative risk of the spontaneous POS was 0.63 (95% CI 0.35 to 1.15), while the stimuli-induced POS was 0.99 (95% CI 0.63 to 1.56). The overall standardized mean difference was 0.08 (95%CI −0.19 to 0.35). No overall effect was revealed in the meta-analyses, meaning that no influence of the ER or SE strategy on POS. Significance The type of adhesive strategy (ER or SE) for posterior resin composite restorations does not influence the risk and intensity of POS. CRD42014006617. [ABSTRACT FROM AUTHOR]

Background It has been debated whether finite nucleos(t)ide analogue therapy is feasible in HBeAg-negative chronic hepatitis B. Aim To review this issue systematically. Methods Using text terms HBsAg and various nucleos(t)ide analogues, PubMed was searched between 1995 and 2014 to find studies on therapy >6 months in adult HBeAg-negative chronic hepatitis B patients with off-therapy follow-up >6 months. Results Twenty-two studies with a total of 1732 patients were identified and included. The median duration of therapy, consolidation therapy and off-therapy follow- up ranged from 6 months to 8 years, 4 to 96 weeks and 6 to 80 months respectively. Patients were monitored with serum ALT and HBV DNA monthly in the first 1–3 months and every 3–6 months afterwards in most studies. The 1-year off-therapy ‘virological relapse’ (HBV DNA >2000 IU/mL) and ‘clinical relapse’ (HBV DNA > 2000 IU/mL + ALT elevation) occurred in <70% and <50% of the patients, respectively, and <40% of the patients received re-treatment. These rates were higher in patients with shorter treatment, shorter consolidation therapy and those treated with less potent nucleos (t)ide analogues. Off-therapy severe flares were rare and hepatic decompensation was reported in only one patient with cirrhosis. Biochemical relapse reflecting enhanced immune-mediated hepatocyte killing may lead to a higher chance for off-therapy HBsAg seroclearance and be possibly desirable. Conclusion With an appropriate stopping rule and a proper off-therapy monitoring plan, cessation of long-term nucleos(t)ide analogue therapy prior to HBsAg seroclearance in HBeAg-negative chronic hepatitis B is a feasible alternative to indefinite treatment. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnoea ( OSA) is a prevalent sleep-related breathing disorder associated with adverse cardiovascular outcome. Endothelial dysfunction is one of the proposed mechanistic links between OSA and the increased cardiovascular risk. Treatment with continuous positive airway pressure ( CPAP) may reverse this detrimental pathophysiological consequence of OSA. Most studies on the effect of CPAP on endothelial function in OSA are limited by their low sample size. The objective of this systematic review was to assess the effect CPAP therapy on endothelial function in patients with OSA. We conducted a systematic review and meta-analysis searching literature databases up to August 2013 for randomized controlled trials ( RCTs) on the effect of CPAP on endothelial function in OSA, assessed by flow-mediated dilatation ( FMD) and other validated techniques. The primary outcome for the meta-analysis (DerSimonian/Laird random-effects method) was the treatment effect on FMD. Eight RCTs comparing the effects of therapeutic CPAP versus subtherapeutic CPAP (or no intervention) on endothelial function involving 245 OSA patients were included in the systematic review. The studies are consistent in effect direction, showing an improvement of endothelial function by CPAP. Four RCTs involving 150 patients could be used for the meta-analysis. Compared to the control group, CPAP therapy (range 2-24 weeks) significantly increased absolute % FMD by 3.87% (95% confidence interval: 1.93-5.80, P < 0.001). In patients with OSA, CPAP therapy improves endothelial function significantly and to a clinically important extent. [ABSTRACT FROM AUTHOR]

Background: Selecting the most effective diagnostic method is essential for patient management and public health interventions. This requires evidence of the relative performance of alternative tests or diagnostic algorithms. Consequently, there is a need for diagnostic test accuracy meta-analyses allowing the comparison of the accuracy of two or more competing tests. The meta-analyses are however complicated by the paucity of studies that directly compare the performance of diagnostic tests. A second complication is that the diagnostic accuracy of the tests is usually determined through the comparison of the index test results with those of a reference standard. These reference standards are presumed to be perfect, i.e. allowing the classification of diseased and non-diseased subjects without error. In practice, this assumption is however rarely valid and most reference standards show false positive or false negative results. When an imperfect reference standard is used, the estimated accuracy of the tests of interest may be biased, as well as the comparisons between these tests. Methods: We propose a model that allows for the comparison of the accuracy of two diagnostic tests using direct (head-to-head) comparisons as well as indirect comparisons through a third test. In addition, the model allows and corrects for imperfect reference tests. The model is inspired by mixed-treatment comparison meta-analyses that have been developed for the meta-analysis of randomized controlled trials. As the model is estimated using Bayesian methods, it can incorporate prior knowledge on the diagnostic accuracy of the reference tests used. Results: We show the bias that can result from using inappropriate methods in the meta-analysis of diagnostic tests and how our method provides more correct estimates of the difference in diagnostic accuracy between two tests. As an illustration, we apply this model to a dataset on visceral leishmaniasis diagnostic tests, comparing the accuracy of the RK39 dipstick with that of the direct agglutination test. Conclusions: Our proposed meta-analytic model can improve the comparison of the diagnostic accuracy of competing tests in a systematic review. This is however only true if the studies and especially information on the reference tests used are sufficiently detailed. More specifically, the type and exact procedures used as reference tests are needed, including any cut-offs used and the number of subjects excluded from full reference test assessment. If this information is lacking, it may be better to limit the meta-analysis to direct comparisons. [ABSTRACT FROM AUTHOR]

Objective: We conducted a meta-analysis to evaluate whether maternal hepatitis B virus (HBV) carrier status increases the risk of neonatal complications.Methods: Publications addressing the association between maternal HBV carrier status and neonatal outcomes were selected from the PubMed, EMBASE, Web of Science, Cochrane Library and China National Knowledge Infrastructure. Publication bias and heterogeneity across studies were evaluated and summary odds ratios, weighted mean difference or standardized mean difference and 95% confidence intervals were calculated and compared between groups.Results: Eighteen studies and 7600 pregnant HBV carriers were selected for analyses. A statistically association with maternal HBV carrier status was demonstrated for premature birth and asphyxia, with no difference found among perinatal mortality, gestational age, small for gestational age, large for gestational age, birth weight, low birth weight, macrosomia, Apgar sore at 1 min, jaundice and congenital anomaly. Heterogeneity across studies was found, and no publication bias was detected.Conclusion: Our analysis suggests that maternal hepatitis B carrier status is significantly associated with premature birth and asphyxia. Large-scale prospective studies are still warranted. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at appraising the practice of bio-medical research amongst doctors working at Federal Medical Centre, Owo, Ondo State, Nigeria. Barriers to health research were also identified. Methods: This study was conducted over a period of six months between June and November 2012 among different cadres of medical practitioners working at the Federal Medical Centre, Owo, Ondo State, Nigeria. One hundred respondents selected by simple random sampling technique were interviewed with the aid of a semi-structured questionnaire. Informed consent was obtained from each of the respondents. The information obtained included their bio-data, previous research training experience, and publication. Views of respondents on bio-medical research and barriers to health research were also sought. The data obtained with the aid of the questionnaire were collated and analysed with SPSS 15.0.1 statistical software version. Results: A total of 85 out of the 100 medical practitioners that collected the questionnaire returned their filled questionnaire. The age range of the respondents is 25-59 years with a mean age of 36.55 years ± 8.4 years. The median age was 34 years, and the mode was 34 years. There were 71 males and 14 females. Most respondents (61; 71.8%) had training in research while the remaining 24 (28.2%) did not. Most respondents (66; 77.6%) had participated in research and few, 19 (22.4%), had not participated in research. Less than half of the respondents (41; 48.8%) had had previous research published, and more than half (43; 51.2%) had not had research published. Most respondents (79; 92.9%) believed that research helped in promoting medical practice. Lack of research funding was a major barrier to research (75; 88.2%). Conclusion: Most respondents had participated in research. The majority of the study participants had training in bio-medical research prior to this study. There is a need for regular training of doctors in bio-medical research, and adequate funding should be provided for research. [ABSTRACT FROM AUTHOR]

Many librarians are helping their institutions’ authors illustrate their research impact using various methods. The Medical College of Wisconsin (MCW) Libraries performs an analysis on the articles published by all MCW authors annually. The method for analysis used can be modified and adapted for use by other institutions. This paper will describe the method and give tips for hospital librarians to perform a similar analysis. [ABSTRACT FROM PUBLISHER]

Objectives: To empirically evaluate the performance of methods for estimating odds ratios and their corresponding standard errors from continuous end point data for meta-analysis. Study Design and Setting: A database of randomized controlled trials of chronic depression treatments was used. Trials that reported both continuous and dichotomous end points for symptom improvement were considered. Odds ratios and standard errors were calculated from the dichotomous data and estimated from the continuous data using currently available methods: Hasselblad and Hedges (HH), Cox and Snell (CS), Furukawa (F), Suissa (S), and Kraemer and Kupfer (KK). Single and meta-analytically pooled observed and estimated values were compared. Results: A total of 26 trials were included. At the trial level, four of five (HH, CS, F, and S) and three of four (HH, F, and S) methods for estimating odds ratios and standard errors performed well, respectively. We found considerable differences in the performance of all methods across trials with more accurate estimates for smaller treatment effects. At the level of meta-analysis, three of four methods (CS, F, and S) performed acceptably. Conclusion: Odds ratios and standard errors can be approximated from continuous end points, but we recommend sensitivity and subgroup analyses to test robustness of the findings. [ABSTRACT FROM AUTHOR]

Background and purpose Several studies have assessed the risk of ischaemic heart diseases in migraineurs, drawing different conclusions. To define and update the issue, a systematic review and meta-analysis of the available observational studies was performed. Methods PubMed and EMBASE were systematically searched up to April 2014 for observational studies dealing with the risk of any form of ischaemic heart disease in migraineurs. Studies assessing migraine as exposure and several types of ischaemic heart disease as outcomes were included in the analysis. A random effects model was used to pool the effect sizes. Results Out of 3348 records, 15 studies (one case−control, one cross-sectional and 13 cohort studies) were identified and were included in the meta-analysis. The pooled analysis indicated an increased risk of myocardial infarction (pooled adjusted effect estimate 1.33, 95% confidence interval 1.08-1.64; P = 0.007) and of angina (pooled adjusted effect estimate 1.29, 95% confidence interval 1.17-1.43; P < 0.0001) in migraineurs compared to non-migraineurs. Conclusions Based on our data indicating an association of migraine with myocardial infarction and angina and on previous data showing an association of migraine, and particularly migraine with aura, with an increased risk for stroke, migraine can be appropriately considered an overall risk factor for cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Impaired brain iron homeostasis has been considered as an important mechanism in Parkinson’s diseases (PD). There are indications that C282Y and H63D polymorphisms of HFE genes involved in iron metabolism might contribute to the pathogenesis of PD in some cases. However, the investigation of the relationship between PD and the two polymorphisms had produced contradictory results. We performed a meta-analysis to assess the C282Y and H63D polymorphisms of HFE in PD susceptibility. PubMed, EMBASE and Web of Science were systematically searched to identify relevant researches. The strict selection criteria and exclusion standard were applied. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of associations. A fixed-effect or random-effect model was selected, depending on the results of the heterogeneity test. Fifteen studies were included in the meta-analysis (eight studies with 1631 cases and 4548 controls for C282Y; seven studies with 1192 cases and 4065 controls for H63D). For the C282Y polymorphism, significant associations were observed in the Recessive model (YY vs CY + CC: OR = 0.22, 95% CI = 0.09–0.57, P = 0.002). This indicated that the C282Y polymorphism in HFE might be a potential protective factor for PD. However, no significant associations were found for any genetic model for the H63D polymorphism, suggesting that the H63D polymorphism might not be associated with PD. [ABSTRACT FROM AUTHOR]

Background & objectives: There has been limited investigation on the prevalence of tuberculosis (TB) in tribal communities in India, a vulnerable section of Indian society. The lack of a population-based estimate prompted us to conduct a meta-analysis of existing studies to provide a single, population-based estimate of the TB prevalence for tribals. Methods: Literature search was conducted in PubMed using the keywords - "tuberculosis", "tribals", "India", "prevalence", and "survey". References cited in the articles retrieved were also reviewed, and those found relevant were selected. TB prevalence rates estimated by the studies were used for our calculation of a pooled-estimate. Results: The pooled estimate, based on the random effects model, was 703 per 100,000 population with a 95 % CI of 386-1011. The associated heterogeneity measures in terms of Cochran's Q was significant (p=0.08 <0.1) and I² was moderate at 48 per cent. Interpretation & conclusions: The meta-analysis demonstrated a large variability in pulmonary TB prevalence estimates among the different studies with poor representation of the various tribal groups. The moderate level of heterogeneity found across the studies suggests that the pooled-estimate needs to be treated with caution. Our findings also highlight the need to assess the pulmonary TB burden in India. [ABSTRACT FROM AUTHOR]

Aims Hyponatraemia is one of the major adverse effects of thiazide and thiazide-like diuretics and the leading cause of drug-induced hyponatraemia requiring hospital admission. We sought to review and analyze all published cases of this important condition. Methods Ovid Medline, Embase, Web of Science and PubMed electronic databases were searched to identify all relevant articles published before October 2013. A proportions meta-analysis was undertaken. Results One hundred and two articles were identified of which 49 were single patient case reports. Meta-analysis showed that mean age was 75 (95% CI 73, 77) years, 79% were women (95% CI 74, 82) and mean body mass index was 25 (95% CI 20, 30) kg m−2. Presentation with thiazide-induced hyponatraemia occurred a mean of 19 (95% CI 8, 30) days after starting treatment, with mean trough serum sodium concentration of 116 (95% CI 113, 120) m m and serum potassium of 3.3 (95% CI 3.0, 3.5) m m. Mean urinary sodium concentration was 64 m m (95% CI 47, 81). The most frequently reported drugs were hydrochlorothiazide, indapamide and bendroflumethiazide. Conclusions Patients with thiazide-induced hyponatraemia were characterized by advanced age, female gender, inappropriate saliuresis and mild hypokalaemia. Low BMI was not found to be a significant risk factor, despite previous suggestions. The time from thiazide initiation to presentation with hyponatraemia suggests that the recommended practice of performing a single investigation of serum biochemistry 7-14 days after thiazide initiation may be insufficient or suboptimal. Further larger and more systematic studies of thiazide-induced hyponatraemia are required. [ABSTRACT FROM AUTHOR]

Background: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial. Methods: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels. Results: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = -1.02, 95% confidence interval [CI] = -2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI -0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity. Conclusion: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials. [ABSTRACT FROM AUTHOR]

Background: The effect that sponsorship has on publication rates or overall effect estimates in animal studies is unclear, though methodological biases are prevalent in animal studies of statins and there may be differences in efficacy estimates between industry and non-industry sponsored studies. In the present analysis, we evaluated the impact of funding source on publication bias in animal studies estimating the effect of statins on atherosclerosis and bone outcomes. Methods: We conducted two independent systematic reviews and meta-analyses identifying animal studies evaluating the effect of statins on reducing the risk of atherosclerosis outcomes (n = 49) and increasing the likelihood of beneficial bone outcomes (n = 45). After stratifying the included studies within each systematic review by funding source, three separate analyses were employed to assess publication bias in these metaanalyses- funnel plots, Egger's Linear Regression, and the Trim and Fill methods. Results: We found potential evidence of publication bias, primarily in non-industry sponsored studies. In all 3 assessments of publication bias, we found evidence of publication bias in non-industry sponsored studies, while in industry-sponsored studies publication bias was not evident in funnel plots and Egger's regression tests. We also found that inadequate reporting of sponsorship in animal studies is still exceedingly common. Conclusions: In meta-analyses assessing the effects of statins on atherosclerosis and bone outcomes in animal studies, we found evidence of publication bias, though small numbers of industry-sponsored studies limit the interpretation of the trim-and-fill results. This publication bias is more prominent in non-industry sponsored studies. Industry and non-industry funded researchers may have different incentives for publication. Industry may have a financial interest to publish all preclinical animal studies to maximize the success of subsequent trials in humans, whereas non-industry funded academics may prefer to publish high impact statistically significant results only. Differences in previously published effect estimates between industry- and non-industry sponsored animal studies may be partially explained by publication bias. [ABSTRACT FROM AUTHOR]

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BACKGROUND Primary aldosteronism (PA) is associated with an increase in left ventricular (LV) mass beyond the amount needed to compensate the hypertension-related workload. Available evidence suggests effectiveness of surgical treatment of PA in decreasing LV mass, whereas data on medical treatment are controversial. We have conducted a meta-analysis of long-term follow-up studies on surgical and medical treatment of PA to compare the effects of treatments on LV mass. METHODS Medline and Cochrane searches were performed including the following words: hyperaldosteronism, left ventricular mass, mineralocorticoid receptor antagonists, surgery, adrenalectomy, and follow-up studies. Studies published within 2013 focusing on cardiac effects of treatment and follow-up longer than 6 months were selected. Data extraction was performed independently by 2 authors. RESULTS Of 61 retrieved articles, 4 were included in the analysis. These studies enrolled 355 patients with PA who had an average follow-up of 4.0 years after unilateral adrenalectomy (n = 178) or treatment with mineralocorticoid receptor antagonists (n = 177). Despite greater effect of surgery over medical treatment in reducing blood pressure, meta-analysis of the selected studies demonstrated no significant difference in LV mass change between patients with PA who were treated with mineralocorticoid receptor antagonists or adrenalectomy (standard mean difference = 0.130; 95% confidence interval = −0.085 to 0.345; P = 0.24; I2 = 0%). CONCLUSIONS Available evidence indicates that reduction of LV mass is not different in PA patients treated with adrenalectomy or mineralocorticoid receptor antagonists. [ABSTRACT FROM PUBLISHER]

Background: The small vessel disease (SVD) that appears in the brain may be part of a multisystem disorder affecting other vascular beds such as the kidney and retina. Because renal failure is associated with both stroke and white matter hyperintensities we hypothesised that small vessel (lacunar) stroke would be more strongly associated with renal failure than cortical stroke. Therefore, we performed a systematic review and meta-analysis to establish first if lacunar stroke was associated with the renal function, and second, if cerebral small vessel disease seen on the MRI of patients without stroke was more common in patients with renal failure. Methods: We searched Medline and EMBASE for studies in adults with cerebral SVD (lacunar stroke or white matter hyper intensities (WMH) on Magnetic Resonance Imaging (MRI)), in which renal function was assessed (estimated glomerular filtration rate (eGFR) or proteinuria). We extracted data on SVD diagnosis, renal function, demographics and comorbidities. We performed two meta-analyses: first, we calculated the odds of renal impairment in lacunar (small vessel) ischaemic stroke compared to other ischaemic stroke subtypes (non-small vessel disease); and second, we calculated the odds of renal impairment in non-stroke individuals with WMH on MRI compared to individuals without WMH. We then performed a sensitivity analysis by excluding studies with certain characteristics and repeating the meta-analysis calculation. Results: After screening 11,001 potentially suitable titles, we included 37 papers reporting 32 studies of 20,379 subjects: 15 of stroke patients and 17 of SVD features in non-stroke patients. To diagnose lacunar stroke, 13/15 of the studies used risk factor-based classification (none used diffusion-weighted MRI). 394/1,119 (35%) of patients with lacunar stroke had renal impairment compared with 1,443/4,217 (34%) of patients with non-lacunar stroke, OR 0.88, (95% CI 0.6-1.30). In individuals without stroke the presence of SVD was associated with an increased risk of renal impairment (whether proteinuria or reduced eGFR) OR 2.33 (95% CI 1.80-3.01), when compared to those without SVD. After adjustment for age and hypertension, 15/21 studies still reported a significant association between renal impairment and SVD. Conclusion: We found no specific association between renal impairment and lacunar stroke, but we did find that in individuals who had not had a stroke, having more SVD features on imaging was associated with a worse renal function, which remained significant after controlling for hypertension. However, this finding does not exclude a powerful co-associate effect of age or vascular risk factor exposure. Future research should subtype lacunar stroke sensitively and control for major risk factors. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background and purpose: Published data on the relationship of hormone replacement therapy (HRT) with Parkinson's disease (PD) were inconclusive. Thus, a systematic meta-analysis of observational studies was performed to clarify this topic. Methods: The databases of PubMed and EMBASE were searched for case-control or cohort studies published up till June 2, 2014. Meta-analysis of the relative risks (RRs) with 95% confidence intervals (CIs) was estimated using random-effects models. Results: A final total of ten case-control and four cohort studies were included in our metaanalysis. The overall combined RR of PD for ever users versus never users of HRT was 1.00 (95% CI: 0.84-1.20). Limited to those subjects who only use estrogen, a similar trend was detected (RR: 0.95, 95% CI: 0.69-1.30). In the subgroup analysis by study design, no significant association was observed in case-control studies (RR: 0.79, 95% CI: 0.62-1.02), whereas a positive association was found in cohort studies (RR: 1.24, 95% CI: 1.10-1.40). In further analysis according to study quality, an inverse association was found in the low-quality group (RR: 0.58, 95% CI: 0.40-0.82), whereas a positive association was found in the high-quality group (RR: 1.16, 95% CI: 1.02-1.31). Conclusion: In summary, our results of meta-analysis do not support a protective role of HRT in female PD development. [ABSTRACT FROM AUTHOR]

There is growing evidence that depression increases the risk of incident stroke. However, few studies have considered possible residual confounding effects by preexistent cerebrovascular and cardiac diseases. Therefore, we synthesized data from cohort studies to explore whether depressed individuals free of cerebrovascular and cardiac diseases are at higher risk of incident stroke. We searched the electronic databases PubMed and Medline for eligible cohort studies that examined the prospective association between depression and first-ever stroke. A random-effects model was used for quantitative data synthesis. Sensitivity analyses comprised cohort studies that considered a lag period with exclusion of incident strokes in the first years of follow-up to minimize residual confounding by preexistent silent strokes and excluded cardiac disease at baseline. Overall, we identified 28 cohort studies with 681,139 participants and 13,436 (1.97%) incident stroke cases. The pooled risk estimate revealed an increased risk of incident stroke for depression (relative risk 1.40, 95% confidence interval [CI] 1.27-1.53; P,0.0001). When we excluded incident strokes that occurred in the first years of follow-up, the prospective association between depression and incident stroke remained significant (relative risk 1.64, 95% CI 1.27-2.11; P,0.0001). This positive association also remained after we considered only studies with individuals with cardiac disease at baseline excluded (relative risk 1.43, 95% CI 1.19-1.72; P,0.0001). The prospective association of depression and increased risk of first-ever stroke demonstrated in this meta-analysis appears to be driven neither by preexistence of clinically apparent cerebrovascular and cardiovascular diseases nor by silent stroke. [ABSTRACT FROM AUTHOR]

Background and Aim Patients who undergo gastrointestinal endoscopy often require sedatives such as midazolam and the more recently developed alpha-2 agonist, dexmedetomidine. To assess the efficacy and safety of dexmedetomidine sedation for gastrointestinal endoscopy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing dexmedetomidine with midazolam. Methods We searched Pub Med, the Cochrane library, and the Igaku-chuo-zasshi database in order to identify randomized trials eligible for inclusion in our meta-analysis. Data from the eligible studies were combined to calculate pooled odds ratios ( OR) or weighted mean differences ( WMD). Results We identified nine randomized trials from the database search. Compared to that of midazolam, the pooled OR for restlessness of dexmedetomidine was 0.078 (95% confidence interval [ CI]: 0.013-0.453, P < 0.0001), and there was no significant heterogeneity among the trial results. Dexmedetomidine significantly increased Ramsay sedation score compared with midazolam ( WMD: 0.401, 95% CI: 0.110-0.692, P = 0.0069), without significant heterogeneity. Compared with midazolam, the pooled OR for hypoxia, hypotension, and bradycardia with dexmedetomidine sedation were 0.454 (95% CI: 0.098-2.11), 1.370 (95% CI: 0.516-3.637), and 2.575 (95% CI: 0.978-6.785), respectively, with no significant differences detected between the groups. Conclusion This meta-analysis shows that dexmedetomidine is a safe and effective sedative agent for gastrointestinal endoscopy, especially endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection. [ABSTRACT FROM AUTHOR]

Context: Infant colic is a common and distressing disorder of early infancy. Its etiology is unknown, making treatment challenging. Several articles have suggested a link to migraine.Objective: The objective of this article was to perform a systematic review and, if appropriate, a meta-analysis of thestudies on the relationship between infant colic and migraine.Data sources: Studies were identified by searching PubMed and Science Direct and by hand-searching references andconference proceedings.Study selection: For the primary analysis, studies specifically designed to measure the association between colic andmigraine were included. For the secondary analysis, studies that collected data on colic and migraine but were designed for another primary research question were also included.Data extraction: Data were abstracted from the original studies, through communication with study authors, or both.Two authors independently abstracted data.Main outcomes and measures: The main outcome measure was the association between infant colic and migraine using both a fixed-effects model and a more conservative random-effects model.Results: Three studies were included in the primary analysis; the odds ratio for the association between migraine andinfant colic was 6.5 (4.6–8.9, p<0.001) for the fixed-effects model and 5.6 (3.3–9.5, p¼0.004) for the random-effectsmodel. In a sensitivity analysis wherein the study with the largest effect size was removed, the odds ratio was 3.6 (95% CI1.7–7.6, p¼0.001) for both the fixed-effects model and random-effects model.Conclusions: In this meta-analysis, infant colic was associated with increased odds of migraine. If infant colic is a migrainousdisorder, this would have important implications for treatment. The main limitation of this meta-analysis was the relatively small number of studies included. [ABSTRACT FROM AUTHOR]

Background/Aims: The role of fast-track programs in hepatectomy is unclear. This meta-analysis aimed to evaluate the efficacy and safety of fast-track programs versus traditional care. Methods: We searched Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar for relevant randomized controlled trials (RCTs) comparing fast-track with traditional care in hepatectomy. Length of hospital stay, time to first flatus, postoperative complications, operating time, and intraoperative blood loss were assessed. Meta-analyses were performed using RevMan 5.2 software. Results: Four original RCTs with 372 patients were included: 187 in the fast-track and 185 in the traditional care group. Fast-track patients had shorter hospital stay (WMD -2.32; 95% CI, -3.54 to -1.11; p < 0.001) and time to first flatus (WMD -0.99; 95% CI, -1.15 to -0.84; p < 0.001), and less postoperative complications (RR 0.66; 95% CI, 0.47 to 0.93; p < 0.05). However, there was significant heterogeneity between the studies regarding hospital stay (I2 = 88%; p < 0.001). Operating time and intraoperative blood loss were not different. Conclusions: Patients in fast-track programs had less time to first flatus and postoperative complications compared to traditional care. Fast-track programs may reduce the length of hospital stay. Larger, higher quality prospective RCTs are necessary to draw more robust conclusions. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: To assess the safety and efficacy of rasagiline for the treatment of Parkinson's disease (PD) among individuals currently receiving levodopa. Methods: A systematic literature search was conducted to identify randomised controlled trials (RCT) comparing rasagiline with placebo/no treatment in individuals with PD currently receiving levodopa. Outcome measures included improvement in motor functions; symptomatic improvement; improvement in quality of life; adverse effects. Random-effect meta-analytical techniques were conducted for the outcome measure and subgroup analyses. Results: Three RCTs were included (n = 1002). The results showed significantly greater improvements in daily 'on' time without dyskinesia in levodopa-treated participants with idiopathic PD receiving 1 mg/day rasagiline compared to placebo (n = 712, 2 RCTs, MD 0.80, CI 0.45 to 1.15; p < 0.00001), and significantly greater improvements in Unified Parkinson's Disease Rating Scale motor performance scores during 'on' time in participants receiving 0.5-1 mg/day rasagiline (0.5 mg/day: n = 282, MD -2.91, CI -4.59 to -1.23; p = 0.0007; 1 mg/day: n = 712, 2 RCTs, MD -2.91, CI -4.02 to -1.80; p < 0.00001). There were no significant differences in adverse effects. Conclusion: 0.5 to 1 mg/day rasagiline in addition to levodopa is a safe and well-tolerated combination therapy for individuals with Parkinson's disease. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study aims to assess the long-term effects of bariatric surgery on type 2 diabetic patients. We searched Cochrane Library, PubMed, and EMbase up to Dec 2013. Randomized controlled trials (RCTs) and cohort studies of bariatric surgery for diabetes patients that reported data with more than 2 years of follow-up were included. We used rigorous methods to screen studies for eligibility and collected data using standardized forms. Where applicable, we pooled data by meta-analyses. Twenty-six studies, including 2 RCTs and 24 cohort studies that enrolled 7883 patients, proved eligible. Despite the differences in the design, those studies consistently showed that bariatric surgery offered better treatment outcomes than non-surgical options. Pooling of cohort studies showed that BMI decreased by 13.4 kg/m (95 % confidence interval (CI), −17.7 to −9.1), fasting blood glucose by 59.7 mg/dl (95 % CI, −74.6 to −44.9), and glycated hemoglobin by 1.8 % (95 % CI, −2.4 to −1.3). Diabetes was improved or in remission in 89.2 % of patients, and 64.7 % of patients was in remission. Weight loss and diabetes remission were greatest in patients undergoing biliopancreatic diversion/duodenal switch, followed by gastric bypass, sleeve gastrectomy, and adjustable gastric banding. Bariatric surgery may achieve sustained weight loss, glucose control, and diabetes remission. Large randomized trials with long-term follow-up are warranted to demonstrate the effect on outcomes important to patients (e.g., cardiovascular events). [ABSTRACT FROM AUTHOR]

Background: As part of the ROAMER (ROAdmap for MEntal health Research in Europe) project, aiming to create an integrated European roadmap for mental health research, we set out to map the hitherto unmapped territory of public mental health research in Europe. Methods: Five electronic databases (CINAHL, Health Management, Medline, PsycINFO, Social Services Abstracts) were used for identifying public mental health research articles published between January 2007 and April 2012. The number of publications for each European country in five research domains (i.e. mental health epidemiology, mental health promotion, mental disorder prevention, mental health policy and mental health services) was analysed by population size and gross domestic product (GDP), and mean impact factors were compared. Results: In all, 8143 unique publications were identified. Epidemiology research dominates public mental health research, while promotion, prevention and policy research are scarce. Mental health promotion is the fastest growing research area. Research targeting older adults is under-represented. Publications per capita were highest in northwestern Europe, and similar trends were found also when adjusting the number of publications by GDP per capita. The most widely cited research origins from Italy, Switzerland, the UK, the Nordic countries, the Netherlands, Greece and France. Conclusion: In Europe, public mental health research is currently a matter of the affluent northern and western European countries, and major efforts will be needed to promote public mental health research in south and east Europe. In spite of a smaller public mental health research output, some Mediterranean countries produce highly cited public mental health research. [ABSTRACT FROM AUTHOR]

The comprehensive meta-analysis indicated that circulating miR-21 had a relatively high diagnostic efficiency in discriminating CRC patients and validated in an independent set. We demonstrated the potential of circulating miR-21 as a reliable and non-invasive biomarker for CRC diagnosis.Current procedures for diagnosis and biomarker examination of colorectal cancer (CRC) are invasive and unpleasant. There is a great need to identify sensitive and specific biomarkers for early diagnosis of CRC. Circulating microRNAs (miRNAs) are promising molecular markers for CRC prediction. We performed a comprehensive meta-analysis to integrate an evaluation index for diagnostic accuracy of circulating miRNAs in diagnosing CRC patients. Furthermore, we conducted an independent validation set of 49 CRC patients and 49 healthy controls. In our meta-analysis, we found that miR-21 yielded a pooled area under ROC curve (AUC) of 0.867 (sensitivity: 76%, specificity: 82%) in discriminating CRC from controls, and miR-92a yielded a summary AUC of 0.803 (sensitivity: 77%, specificity: 68%); miR-21 had a higher diagnostic efficiency than miR-92a. In the further validation, plasma miR-21 levels in CRC patients were significantly higher than levels observed in healthy subjects. A ROC curve analysis showed a consistent result. However, this phenotype was not present in miR-92a. Moreover, the expression trend of miR-21 in plasma samples was in line with that of tissue samples, along with the cellular level. Current evidences suggest that plasma miR-21 could be a reliable and non-invasive biomarker for CRC diagnosis. Studies with larger cohorts that include the diagnostic value of plasma miR-21 for CRC are warranted. [ABSTRACT FROM AUTHOR]

This paper outlines how to conduct a simple meta-analysis of neuroimaging foci of activation in R. In particular, the first part of this paper reviews the nature of fMRI data, and presents a brief overview of the existing packages that can be used to analyze fMRI data in R. The second part illustrates how to handle fMRI data by showing how to visualize the results of different neuroimaging studies in a so-called orthographic view, where the spatial distribution of the foci of activation from different fMRI studies can be inspected visually. Functional MRI (fMRI) is one of the most important and powerful tools of neuroscientific research. Although not as commonly used for fMRI analysis as some specific applications such as SPM (Friston et al., 2006), AFNI (Cox and Hyde, 1997), or FSL (Smith et al., 2004), R does provide several packages that can be employed in neuroimaging research. These packages deal with a variety of topics, ranging from reading and manipulating fMRI datasets, to implementing sophisticated statistical models. The goal of this paper is to provide a brief introduction to fMRI analysis, and the various R packages that can be used to carry it out. As an example, it will show how to use simple R commands to read fMRI images and plot results from previous studies, which can then be visually compared. This is a special form of meta-analysis, and a common way to compare results from the existing literature. [ABSTRACT FROM AUTHOR]

Background: Extensive use of praziquantel for treatment and control of schistosomiasis requires a comprehensive understanding of efficacy and safety of various doses for different Schistosoma species. Methodology/Principal Findings: A systematic review and meta-analysis of comparative and non-comparative trials of praziquantel at any dose for any Schistosoma species assessed within two months post-treatment. Of 273 studies identified, 55 were eligible (19,499 subjects treated with praziquantel, control treatment or placebo). Most studied were in school-aged children (64%), S. mansoni (58%), and the 40 mg/kg dose (56%); 68% of subjects were in Africa. Efficacy was assessed as cure rate (CR, n = 17,017) and egg reduction rate (ERR, n = 13,007); safety as adverse events (AE) incidence. The WHO-recommended dose of praziquantel 40 mg/kg achieved CRs of 94.7% (95%CI 92.2–98.0) for S. japonicum, 77.1% (68.4–85.1) for S. haematobium, 76.7% (95%CI 71.9–81.2) for S. mansoni, and 63.5% (95%CI 48.2–77.0) for mixed S. haematobium/S. mansoni infections. Using a random-effect meta-analysis regression model, a dose-effect for CR was found up to 40 mg/kg for S. mansoni and 30 mg/kg for S. haematobium. The mean ERR was 95% for S. japonicum, 94.1% for S. haematobium, and 86.3% for S. mansoni. No significant relationship between dose and ERR was detected. Tolerability was assessed in 40 studies (12,435 subjects). On average, 56.9% (95%CI 47.4–67.9) of the subjects receiving praziquantel 40 mg/kg experienced an AE. The incidence of AEs ranged from 2.3% for urticaria to 31.1% for abdominal pain. Conclusions/Significance: The large number of subjects allows generalizable conclusions despite the inherent limitations of aggregated-data meta-analyses. The choice of praziquantel dose of 40 mg/kg is justified as a reasonable compromise for all species and ages, although in a proportion of sites efficacy may be lower than expected and age effects could not be fully explored. [ABSTRACT FROM AUTHOR]

Background: The control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs. Methodology: We conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM), leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH) infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) were calculated as a measure of intervention effect, using random effects meta-analyses. Principal Findings: Among the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR = 0.15; 95% CI: 0.08–0.29), CLM (OR = 0.24; 95% CI: 0.06–0.96), tungiasis (OR = 0.42; 95% CI: 0.26–0.70), hookworm infection (OR = 0.48; 95% CI: 0.37–0.61), any STH infection (OR = 0.57; 95% CI: 0.39–0.84), strongyloidiasis (OR = 0.56; 95% CI: 0.38–0.83), and leptospirosis (OR = 0.59; 95% CI: 0.37–0.94). No significant association between footwear use and podoconiosis (OR = 0.63; 95% CI: 0.38–1.05) was found and no data were available for mycetoma, myiasis, and snakebite. The main limitations were evidence of heterogeneity and poor study quality inherent to the observational studies included. Conclusions/Significance: Our results show that footwear use was associated with a lower odds of several different NTDs. Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination. Protocol Registration: PROSPERO International prospective register of systematic reviews [ABSTRACT FROM AUTHOR]

The Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disorder characterized by rapid deterioration and the selective death of motor neurons in the cerebral cortex, brainstem and spinal cord. In this paper we performed a literature review of the Mexican contributions during the last 15 years in relation to ALS. We have performed a systematic review through PubMed about publications of Mexican Researcher about ALS in English. There are 19 publications about ALS performed by Mexican researchers including case reports, series, experimental models, diagnostic methods and cellular therapy. One of them described epidemiological data in Mexican ALS patients that fulfilled El Escorial criteria to definite ALS. The age of onset was 47.5 years predominantly in men (1.8:1) with an interval of 12 months from onset to diagnosis. The survival was longer than described in other countries. In Mexico an estimated prevalence is between 5,000 to 7,000 ALS patients. In conclusion, the ALS diagnosis is challenging and death occurs in short term after onset. Few epidemiological are described in México; there is no effective treatment for this disorder. In México is imperative to create a national ALS registry and an association dedicated to support ALS patient, obtain economical funds from private sources and government to increase research in ALS [ABSTRACT FROM AUTHOR]

Background: Haemorrhoidectomy is the most effective and definitive treatment for grade 3 or 4 haemorrhoids despite being associated with considerable pain. The aim of this study was to search the literature, which compares outcomes of harmonic scalpel haemorrhoidectomy and traditional surgical procedures, and conduct a quantitative meta-analysis of the randomized trials. Methods: Randomized controlled trials (RCTs) were identified from the major electronic databases using the keywords 'harmonic scalpel haemorrhoidectomy' and 'haemorrhoidectomy' and a quantitative meta-analysis conducted. The eight trials that met the inclusion criteria included 468 patients (233 in the harmonic scalpel group). Pain was the primary outcome measure, and other parameters assessed included duration of operation, length of hospital stay, time to return to work, and complications. Results: Significantly, more patients returned to work in the first post-operative week, and pain scores were an average of one unit lower following harmonic scalpel haemorrhoidectomy. Generally, the incidence of complications in the harmonic scalpel group was less than half that found in conventional haemorrhoidectomy. There was no significant difference between the groups as regards operating time or length of hospital stay. Recurrence was not reported in any of the studies. Conclusions: The meta-analysis showed that harmonic scalpel haemorrhoidectomy is a safe and effective modality associated with less post-operative pain and a more rapid return to work than traditional surgery for haemorrhoids. Statistical heterogeneity was high; thus, it may be too early to place complete confidence in these results. Further RCTs are required. [ABSTRACT FROM AUTHOR]

While post-operative pain routinely resolves, persistent post-surgical pain ( PPSP) is common in certain surgeries; it causes disability, lowers quality of life and has economic consequences. The objectives of this systematic review and meta-analysis were to evaluate the effectiveness of ketamine in reducing the prevalence and severity of PPSP and to assess safety associated with its use. We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE through December 2012 for articles in any language. We included randomized, controlled trials in adults in which ketamine was administered perioperatively via any route. Seventeen studies, the majority of which administered ketamine intravenously, met all inclusion criteria. The overall risk of developing PPSP was not significantly reduced at any time point in the ketamine group vs. placebo, nor did comparisons of pain severity scores reach statistical significance. Sensitivity analysis of exclusively intravenous ketamine studies included in this meta-analysis demonstrated statistically significant reductions in risk of developing PPSP at 3 and 6 months ( P = 0.01 and P = 0.04, respectively). Adverse event rates were similar between ketamine and placebo groups. The study data from our review are heterogeneous and demonstrate efficacy of intravenously administered ketamine only in comparison with placebo. Highly variable timing and dosing of ketamine in these studies suggest that no unifying effective regimen has emerged. Future research should focus on clinically relevant outcomes, should stratify patients with pre-existing pain and possible central sensitization and should enroll sufficiently large numbers to account for loss to follow-up in long-term studies. [ABSTRACT FROM AUTHOR]

Background Major adjuvant therapies for biliary tract cancer (BTC) include fluorouracil, gemcitabine and chemoradiation ( CRT), but the optimum regimen remains inconclusive. Aim To compare these therapies in terms of patient survival rates after resection and toxic effects. Methods We searched PubMed for controlled trials comparing the above three therapies with each other or observation alone until 31 January 2014. We estimated the hazard ratios ( HRs) for death and odds ratios ( ORs) for toxic effects among different therapies. Subgroup analyses based on positive lymph node or resection margin were also performed. Results Twelve eligible articles were included. Gemcitabine improved 5-year survival ( HR 2.12, 95% CI, confidence interval 1.23-4.02, P = 0.01), whereas fluorouracil ( HR 1.61, 95% CI 0.74-3.67) and CRT ( HR 1.55, 95% CI 0.82-3.32) provided a poorer survival outcome compared with gemcitabine after 1 year. Similarly, for 5-year survival rates, although differing, CRT did not provide a significant improvement in survival ( HR 0.46, 95% CI 0.20-0.97) compared with gemcitabine. Fluorouracil did not appear to provide benefit over gemcitabine ( HR 1.56, 95% CI 0.77-3.35). CRT was ranked highest for toxic effects including haematological ( OR 5.45, 95% CI 0.01-483.85) and nonhaematological ( OR 5.77, 95% CI 0.01-3807.40). Conclusions Chemotherapy with gemcitabine is the optimum adjuvant treatment with a balanced benefit-toxicity ratio for resected biliary tract cancer. Chemoradiation was more likely to cause toxic effects. [ABSTRACT FROM AUTHOR]

Background In the magnetic resonance T1-weighted imaging, some investigators have shown that coronary artery high-intensity signals (HISs) are associated with vulnerable plaque morphology and an increased risk of future cardiac events. Although previous studies used different PMR (the ratio between the signal intensities of coronary plaque and cardiac muscle) cutoff values to detect HIS, the association between PMR itself and plaque morphology has not been fully investigated. Methods and Results We prospectively investigated the association between PMR values and plaque morphology detected by optical coherence tomography in consecutive 106 patients with angina pectoris. The lesions with almost all of the vulnerable features such as lipid-rich, thin-cap fibroatheroma, plaque rupture, thrombus, macrophage infiltrations, intimal vasculature, and absence of calcification had significantly higher PMR; the only exception was the presence of cholesterol crystals. PMR increases linearly with the number of vulnerable features (p < 0.0001, Rho = 0.504). Stepwise multiple linear regression analysis revealed that the absence of calcification (p = 0.0027), and the presence of thrombus (p = 0.0071) and intimal vasculature (p = 0.019) were independently associated with higher log-transformed PMR. There was a stepwise increase in PMR of the culprit lesions in proportion to the accumulation of the number of adverse plaque characteristics defined as non-calcified plaque, thrombus, and/or intimal vasculature. Conclusion These results suggest that not only the presence of HIS, but also the elevated PMR itself may be used as a quantitative marker of plaque vulnerability in clinical evaluation. [ABSTRACT FROM AUTHOR]

The author reflects on the findings of research that appeared in the journal "Proceedings of the National Academy of Sciences of the United States of America" which delved into the academic publishing peer review process. He mentions that the researchers considered how often editors and reviewers made "good decisions" with regard to the promotion and rejection of manuscripts. He mentions that the study has cited mitigating factors responsible for the limitations of the peer review process.

The Flynn effect refers to the observed rise in IQ scores over time, which results in norms obsolescence. Although the Flynn effect is widely accepted, most efforts to estimate it have relied upon "scorecard" approaches that make estimates of its magnitude and error of measurement controversial and prevent determination of factors that moderate the Flynn effect across different IQ tests. We conducted a meta-analysis to determine the magnitude of the Flynn effect with a higher degree of precision, to determine the error of measurement, and to assess the impact of several moderator variables on the mean effect size. Across 285 studies (N = 14,031) since 1951 with administrations of 2 intelligence tests with different normative bases, the meta-analytic mean was 2.31, 95% Cl [1.99, 2.64], standard score points per decade. The mean effect size for 53 comparisons (N = 3,951, excluding 3 atypical studies that inflate the estimates) involving modern (since 1972) Stanford-Binet and Wechsler IQ tests (2.93, 95% Cl [2.3, 3.5], IQ points per decade) was comparable to previous estimates of about 3 points per decade but was not consistent with the hypothesis that the Flynn effect is diminishing. For modern tests, study sample (larger increases for validation research samples vs. test standardization samples) and order of administration explained unique variance in the Flynn effect, but age and ability level were not significant moderators. These results supported previous estimates of the Flynn effect and its robustness across different age groups, measures, samples, and levels of performance. [ABSTRACT FROM AUTHOR]

Health research on personal social capital has often utilized measures of respondents' perceived trust of others as either a proxy for one's social capital in the absence of more focused measures or as a subjective component of social capital. Little empirical work has evaluated the validity of such practices. We test the construct validity of two trust measures used commonly in health research on social capital--generalized trust and trust of neighbors--with respect to measures of people's general network-, organization-, family-, friend-, and neighborhood-based social capital and the extent to which these two trust measures are associated with self-rated general health and mental health when social capital measures are included in the same models. Analyses of 2008 Canadian General Social Survey data (response rate 57.3%) indicate that generalized trust and trust of neighbors are both positively--yet modestly--associated with measures of several domains of network-based social capital. Both trust measures are positively associated with general and mental health, but these associations remain robust after adjusting for social capital measures. Our findings suggest that (a) trust is conceptually distinct from social capital, (b) trust measures are inadequate proxies for actual personal social networks, and (c) trust measures may only be capturing psychological aspects relevant to--but not indicative of--social capital. Though links between perceived trust and health deserve study, health research on social capital needs to utilize measures of respondents' actual social networks and their inherent resources. [ABSTRACT FROM AUTHOR]

This article describes a systematic review of the psychometric properties of the Short-Term Assessment of Risk and Treatability (START) and a meta-analysis to assess its predictive efficacy for the 7 risk domains identified in the manual (violence to others, self-harm, suicide, substance abuse, victimization, unauthorized leave, and self-neglect) among institutionalized patients with mental disorder and/or personality disorder. Comprehensive terms were used to search 5 electronic databases up to January 2013. Additional articles were located by examining references lists and hand-searching. Twenty-three papers were selected to include in the narrative review of START's properties, whereas 9 studies involving 543 participants were included in the meta-analysis. Studies about the feasibility and utility of the tool had positive results but lacked comparators. START ratings demonstrated high internal consistency, interrater reliability, and convergent validity with other risk measures. There was a lack of information about the variability of START ratings over time. Its use in an intervention to reduce violence in forensic psychiatric outpatients was not better than standard care. START risk estimates demonstrated strong predictive validity for various aggressive outcomes and good predictive validity for self-harm. Predictive validity for self-neglect and victimization was no better than chance, whereas evidence for the remaining outcomes is derived from a single, small study. Only 3 of the studies included in the meta-analysis were rated to be at a low risk of bias. Future research should aim to investigate the predictive validity of the START for the full range of adverse outcomes, using well-designed methodologies, and validated outcome tools. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives In the field of global health, research capacity strengthening is becoming a common concept for defining and improving research competencies on individual, organizational, national and supranational level. However, HRCS activities often lack evaluation procedures to measure their impact and to ensure their quality. The aim of this study was to develop and validate a short questionnaire to evaluate trainings in the field of health research capacity strengthening ( HRCS). Method The questionnaire was developed by an interdisciplinary research team and tested in four different training settings at the Mbeya Medical Research Center and Mbeya Referral Hospital, Tanzania. Construct validity of the questionnaire was tested based on 97 responses of the participants of four trainings. Results Iterative checking of Cronbach's alpha of the subscales and exploratory factor analysis revealed a four-factor solution that differed from the original structure and subscales of the questionnaire. The instrument was adapted accordingly and consists now of four subscales with 19 items, three global impression items, and open questions for participants' comments and recommendations. Conclusions The result of the study is a short, validated questionnaire for the evaluation of HRCS trainings on the individual level. The tool can be applied both to measure the short-term effects of international health research capacity trainings and to ensure their quality. In the future, after collecting larger sample sizes, a confirmatory factor analysis should be done to further support the four factors. [ABSTRACT FROM AUTHOR]

Objective: To proffer a theoretically driven assessment of the validity of research which examines alcohol-related normative beliefs. Methods: A systematic review of 68 articles matching the inclusion criteria, published between 1970 and 2013. Results: Potential causes of deviations in research findings are identified and compelling gaps in our knowledge with regards to the influence of participant gender, age and contextual factors are high-lighted and discussed in relation to the broader literature. Conclusions: It is proposed that a standardization of research approaches and alcohol intake measures are required in order to increase the validity of present research and enable useful comparisons between studies. Further attention to key, potentially mediatory variables is also highlighted as important for increasing research validity with a view to facilitating the improvement of interventions. [ABSTRACT FROM AUTHOR]

Background: Acute mountain sickness (AMS) can occur in anyone going to a high altitude. Non-steroidal anti-inflammatory drugs (NSAIDs) have been studied for the prevention of AMS with mixed results. In this systematic review, we analyze all existing data on the use of NSAIDs to prevent AMS using the Lake Louise Scoring System (LLSS) in different randomized clinical trials (RCTs). Methods: Electronic literature searches for relevant studies were identified through MEDLINE, EMBASE, SCOPUS, and Cochrane library up to June 2013. RCTs involving NSAIDs compared to placebo in patients undergoing ascent to a height of at least 3,800mwere included. Odds ratios (OR) were calculated and combined using fixed-effect model meta-analysis if I2=0%. Differences between groups were calculated using the inverse variance of the standard mean differences. Between-study heterogeneity was assessed using the I2 statistics. Results: In three clinical trials involving 349 patients, AMS using LLSS occurred in 26.92% of patients on NSAIDs and 43.71% on placebo (OR 0.43; CI [confidence interval] 0.27-0.69, I2=0%, p=0.0005), NNT=6. Minor outcome of end point Spo2 was not significant in the two groups (IV=0.74; 95% CI -0.20-1.69, I2=81%, p=0.12). Similarly, a change in Spo2 from baseline was also not significant in the two groups (IV=0.05; 95% CI -0.28-0.37, I2=44%, p=0.78). Conclusion: NSAIDs might be a safe and effective alternative for the prevention of AMS. However, further larger population studies and studies comparing NSAIDs to acetazolamide and dexamethasone in the future may provide further data to its relative efficacy. [ABSTRACT FROM AUTHOR]

The article presents research which examined the increasing focus of sports medicine professionals on level of evidence to be leveraged as the basis for their treatment plans. Topics covered include the examination of related levels of evidence featured in published clinical sports medicine articles as well as ranking of level of evidence using the guidelines set by the Centre for Evidence-Based Medicine in the U.S. Also mentioned are improvements in the levels of evidence since 1995.

The presence of dependent correlation is a common problem in meta-analysis. Cheung and Chan (, ) have shown that samplewise-adjusted procedures perform better than the more commonly adopted simple within-sample mean procedures. However, samplewise-adjusted procedures have rarely been applied in meta-analytic reviews, probably due to the lack of suitable ready-to-use programs. In this article, we compare the samplewise-adjusted procedures with existing procedures to handle dependent effect sizes, and present the samplewise-adjusted procedures in a way that will make them more accessible to researchers conducting meta-analysis. We also introduce two tools, an SPSS macro and an R script, that researchers can apply to their meta-analyses; these tools are compatible with existing meta-analysis software packages. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis. Method: Studies comparing resting state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis. Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterised by lower HRV (high frequency: Hedges' g = -.29. 95%CI: -.41 to -.17, p < 0.001; time domain: Hedges' g = -0.45, 95%CI: -0.57 to -0.33, p < .001) than controls. Panic Disorder (n=447), Post-Traumatic Stress Disorder (n=192), Generalized Anxiety Disorder (n=68), and Social anxiety disorder (n=90), but not Obsessive Compulsive Disorder (n=40), displayed reductions in high frequency HRV relative to controls (all ps < .001). Conclusions: Anxiety disorders are associated with reduced HRV, findings associated with a small to moderate effect size. Findings have important implications for future physical health and wellbeing of patients, highlighting a need for comprehensive cardiovascular risk reduction. [ABSTRACT FROM AUTHOR]

Background: The authors carried out a systematic and critical review of the scientific literature regarding the possible development of neutralising antibodies developed in patients treated with growth hormone biosimilars (defined as a drug expected to be similar to the originator or original pharmaceutical -European Medicines Agency) as compared to the reference drug. As a consequence, we discovered two major issues, namely, the poor quality of the comparative clinical trials and the poor quality of the antibody assays used during the trials. Methods: The literature review was performed according to the principle of the Cochrane Collaboration and SBU. The electronic literature search included the databases PubMed, EMBASE and The Cochrane Library up to December 2012. Two independent reviewers assessed abstracts and full-text articles. Results: The search identified 1,553 abstracts related to the subject. Only six articles contained data on biosimilar growth hormone or antibody results obtained with appropriate methods. None of the studies fulfilled the criteria for high quality randomised controlled trials. Qualitative rather than quantitative assays were used for monitoring antibody formation. Conclusions: It is our firm opinion , that since biosimilars are not identical, emphasis must be placed on the quality of the comparative clinical trials performed and the quality of the analytical studies in order to guarantee patient safety. Clinical trials should follow established quality rules for controlled comparative randomised clinical trials. A whole set of new guidelines is required. [ABSTRACT FROM AUTHOR]

Background: The critical need to expand and develop the palliative care evidence base was recently highlighted by the Journal of Palliative Medicine's series of articles describing the Research Priorities in Geriatric Palliative Care. The Health and Retirement Study (HRS) is uniquely positioned to address many priority areas of palliative care research. This nationally representative, ongoing, longitudinal study collects detailed survey data every 2 years, including demographics, health and functional characteristics, information on family and caregivers, and personal finances, and also conducts a proxy interview after each subject's death. The HRS can also be linked with Medicare claims data and many other data sources, e.g., U.S. Census, Dartmouth Atlas of Health Care. Setting: While the HRS offers innumerable research opportunities, these data are complex and limitations do exist. Therefore, we assembled an interdisciplinary group of investigators using the HRS for palliative care research to identify the key palliative care research gaps that may be amenable to study within the HRS and the strengths and weaknesses of the HRS for each of these topic areas. Conclusion: In this article we present the work of this group as a potential roadmap for investigators contemplating the use of HRS data for palliative care research. [ABSTRACT FROM AUTHOR]