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There is a growing body of research on manualized self-help interventions for bulimia nervosa (BN) and binge eating disorder (BED). Study and treatment dropout and adherence represent particular challenges in these studies. However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes are lacking. We conducted a systematic literature review using electronic databases and hand searches of relevant journals. In metaregression analyses, we analyzed study dropout as well as more specific measures of treatment participation in manualized self-help interventions, their association with intervention characteristics (e.g. duration, guidance, intervention type [bibliotherapy, CD-ROM or Internet based intervention]) and their association with treatment outcomes. Seventy-three publications reporting on 50 different trials of manualized self-help interventions for binge eating and bulimia nervosa published through July 9th 2012 were identified. Across studies, dropout rates ranged from 1% to 88%. Study dropout rates were highest in CD-ROM interventions and lowest in Internet-based interventions. They were higher in samples of BN patients, samples of patients with higher degrees of dietary restraint at baseline, lower age, and lower body mass index. Between 6% and 88% of patients completed the intervention to which they had been assigned. None of the patient, study and intervention characteristics predicted intervention completion rates. Intervention outcomes were moderated by the provision of personal guidance by a health professional, the number of guidance sessions as well as participants' age, BMI, and eating disorder related attitudes (Restraint, Eating, Weight and Shape Concerns) at baseline (after adjusting for study dropout and intervention completion rates). Guidance particularly improved adherence and outcomes in samples of patients with bulimia nervosa; specialist guidance led to higher intervention completion rates and larger intervention effects on some outcomes than non-specialist guidance. Self-help interventions have a place in the treatment of BN and BED, especially if the features of their delivery and indications are considered carefully. To better determine who benefits most from what kind and “dosage” of self-help interventions, we recommend the use of consistent terminology as well as uniform standards for reporting adherence and participation in future self-help trials.  相似文献   
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Methodological aspects of meta-analytic practice, heterogeneity, publication bias, metaregression and effect metric, were investigated in 14 meta-analyses reflecting major therapeutic concern in Critical Care practice. Compared with the standard Q test, the exact Zelen test was more sensitive in identifying heterogeneity. Assessment of heterogeneity impact by the I 2 statistic was consistent with inferences afforded by both the Q and Zelen test. Publication bias was subject to test and metric determination: funnel plots exhibited variable asymmetry across studies and between metrics; the regression asymmetry test appeared more sensitive than the rank correlation test; the “trim and fill” method was the most sensitive, but suggested, on the basis of quantification of the effects of potentially missing studies, that meta-analyses may be resistant to such missingness. Metaregression of treatment effect against control risk using Bayesian hierarchical regression in all metrics (log odds ratio, log risk ratio and RD) suggested that naïve linear regression approaches over-diagnosed significant relationships and exhibited regression dilution. Heterogeneity, publication bias and risk related treatment effects all demonstrate estimator and metric dependence; the RD metric would appear the most capricious in this regard.  相似文献   
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BACKGROUND Non-invasive criteria are needed for Crohn’s disease(CD)diagnosis,with several biomarkers being tested.Results of individual diagnostic test accuracy studies assessing the diagnostic value of pancreatic autoantibodies-to-glycoprotein-2(anti-GP2)tests for the diagnosis of CD appear promising.AIM To systematically review and meta-analyze evidence on the diagnostic accuracy of anti-GP2 tests in patients with suspected/confirmed CD.METHODS An electronic search was conducted on PubMed,Cochrane-CENTRAL and grey literature(CRD42019125947).The structured research question in PICPTR format was“Population”including patients with symptoms akin to CD,the“Index test”being anti-GP2 testing,the“Comparator”involved standard CD diagnosis,the“Purpose of test”being diagnostic,“Target disorder”was CD,and the“Reference standard”included standard clinical,radiological,endoscopical,and histological CD diagnostic criteria.Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool and hierarchical models were employed to synthesize the data.RESULTS Out of 722 studies retrieved,15 were meta-analyzed.Thirteen studies had industry-related conflicts-of-interest,and most included healthy donors as controls(spectrum bias).For the combination of IgA and/or IgG anti-GP2 test,the summary sensitivity was 20%(95%confidence interval:10%-29%)at a median specificity of 97%.If the test was applied in 10000 suspected patients,9669 would be true negatives and in 26,the diagnosis would be missed.In this hypothetical cohort,the anti-GP2 would fail to produce a diagnosis for 81.3%of the positive cases.Low summary points of sensitivity and high specificity were estimated for the IgG or IgA anti-GP2 test.Analogous results were observed when the analyses were restricted using specific cut-offs,or when ulcerative colitis patients were used as comparators.CONCLUSION Anti-GP2 tests demonstrate low sensitivity and high specificity.These results indicate that caution is required before relying on its diagnostic value.Additionally,the need for improving the methodology of diagnostic test accuracy studies is evident.  相似文献   
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目的综合分析手机使用与胶质瘤发病的流行病学资料,研究手机与胶质瘤发病风险的关系,探讨手机使用的安全性。方法通过在线检索文献资料,采用随机效应模型合并分析8篇手机使用与胶质瘤发病风险关系的病例对照研究。通过Meta回归筛选异质性影响因素,以病例对照比为影响因素,进行亚组分析。结果本次Meta分析共包括3 328例胶质瘤病人和7 527例对照。各研究存在异质性,随机效应模型结果表明,手机使用与胶质瘤发病风险无统计学关联,合并OR值为1.03(95%CI:0.77~1.38);长期使用手机增加胶质瘤的发病风险,合并OR值为2.67(95%CI:1.84~3.87)。病例对照比值〉0.5和〈0.5的亚组使用手机对胶质瘤的风险均未发现有显著影响,而长期使用手机使胶质瘤发病风险增加,合并OR分别为2.10(95%CI:1.71~2.59)和2.19(95%CI:1.64~2.92)。结论尚不能说明短期的手机使用增加胶质瘤的发病风险,但使用10年以上者胶质瘤的发病风险增加,两者间有潜在的剂量-反应关系。  相似文献   
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目的探讨谷胱甘肽转移酶(GST)M1基因多态性与大肠癌发生的关系及其影响因素。方法采用多水平Meta回归分析方法进行合并效应值估计和异质性相关因素的研究。结果GSTM1基因多态性与大肠癌发生有关(合并OR值为1.17,95%CI:1.08~1.26),种族类别、人群GSTM1基因基线缺失率等为研究间异质性的相关因素(P〈0.05);分层回归中,亚洲人、高加索人及低基线缺失水平人群(50%以下)中的GSTM1基因缺失型是大肠癌发生的危险因素(合并OR值分别为1.14、1.25、1.29),结果具有统计学意义(P〈0.05)。结论GSTM1纯合缺失型是大肠癌发生的危险因素,并与人群的GSTM1基线缺失率和种族类别有关。  相似文献   
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