Strategies to increase the delivery of smoking cessation treatments in primary care settings: A systematic review and meta-analysis

ObjectivesA systematic review and meta-analysis was conducted to evaluate evidence-based strategies for increasing the delivery of smoking cessation treatments in primary care clinics.MethodsThe review included studies published before January 1, 2009. The pooled odds-ratio (OR) was calculated for intervention group versus control group for practitioner performance for “5As” (Ask, Advise, Assess, Assist and Arrange) delivery and smoking abstinence. Multi-component interventions were defined as interventions which combined two or more intervention strategies.ResultsThirty-seven trials met eligibility criteria. Evidence from multiple large-scale trials was found to support the efficacy of multi-component interventions in increasing “5As” delivery. The pooled OR for multi-component interventions compared to control was 1.79 [95% CI 1.6–2.1] for “ask”, 1.6 [95% CI 1.4–1.8] for “advice”, 9.3 [95% CI 6.8–12.8] for “assist” (quit date) and 3.5 [95% CI 2.8–4.2] for “assist” (prescribe medications). Evidence was also found to support the value of practice-level interventions in increasing 5As delivery. Adjunct counseling [OR 1.7; 95% CI 1.5–2.0] and multi-component interventions [OR 2.2; 95% CI 1.7–2.8] were found to significantly increase smoking abstinence.ConclusionMulti-component interventions improve smoking outcomes in primary care settings. Future trials should attempt to isolate which components of multi-component interventions are required to optimize cost-effectiveness.     

Promoting psychological health in women with SCI: Development of an online self-esteem intervention

BackgroundThere are no known interventions addressing self-esteem in women following spinal cord injury (SCI).ObjectivesTo test the feasibility of an online self-esteem intervention for women with disabilities, as modified for women with SCI.MethodWe conducted a randomized, controlled feasibility test of a self-esteem intervention (N = 21). Participants were randomly assigned to the intervention or control group that received intervention materials at the end of the study. Intervention participants met as avatars for 7 weekly real-time group sessions in Second Life (SL), a free online virtual world. Feasibility indicators were study engagement, acceptability of SL and the intervention, and improvements on measures of psychological health promoting behaviors, social support, self-efficacy, self-esteem, and depression.ResultsIntervention participants (n = 10) were highly engaged, and most described the SL program as more enjoyable and more convenient than in-person programs. All rated the intervention as “good” (n = 4) or “very good” (n = 6), and all 10 rated themselves has having made positive life changes as a result of the program. Intervention participants experienced significantly greater change than controls on two measures of health-promoting behavior (Health Promoting Lifestyle Profile-II Spiritual Growth/Self-actualization; Interpersonal Relations). Examining change in the intervention group using regression analyses, we found medium-to-large effects of the intervention on these behaviors and measures of depression (CESD-10, PHQ-9). The intervention had small effects on remaining measures.ConclusionWe found preliminary support for the feasibility of this modified self-esteem intervention offered in SL. Such programming may help circumvent barriers to community-based psychological services and may improve psychological health.     

Prioritizing Healthcare Interventions: A Comparison of Multicriteria Decision Analysis and Cost-Effectiveness Analysis

ObjectivesTo investigate the extent to which stated preferences for treatment criteria elicited using multicriteria decision analysis (MCDA) methods are consistent with the trade-offs (implicitly) applied in cost-effectiveness analysis (CEA), and the impact of any differences on the prioritization of treatments.MethodsWe used existing MCDA and CEA models developed to evaluate interventions for knee osteoarthritis in the New Zealand population. We established equivalent input parameters for each model, for the criteria “treatment effectiveness,” “cost,” “risk of serious harms,” and “risk of mild-to-moderate harms” across a comprehensive range of (hypothetical) interventions to produce a complete ranking of interventions from each model. We evaluated the consistency of these rankings between the 2 models and investigated any systematic differences between the (implied) weight placed on each criterion in determining rankings.ResultsThere was an overall moderate-to-strong correlation in intervention rankings between the MCDA and CEA models (Spearman correlation coefficient = 0.51). Nevertheless, there were systematic differences in the evaluation of trade-offs between intervention attributes and the resulting weights placed on each criterion. The CEA model placed lower weights on risks of harm and much greater weight on cost (at all accepted levels of willingness-to-pay per quality-adjusted life-year than did respondents to the MCDA survey.ConclusionsMCDA and CEA approaches to inform intervention prioritization may give systematically different results, even when considering the same criteria and input data. These differences should be considered when designing and interpreting such studies to inform treatment prioritization decisions.     

Outcomes in systematic reviews of complex interventions never reached “high” GRADE ratings when compared with those of simple interventions

ObjectivesTo investigate the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the quality of evidence ratings in systematic reviews of complex interventions.Study Design and SettingThis study examined all 40 systematic reviews published in three Cochrane Review Groups from 2013 to May 2014: Cochrane Developmental, Psychosocial and Learning Problems Group (CDPLPG); Cochrane Public Health Group (CPHG); and Cochrane Depression, Anxiety, and Neurosis Group (CCDAN). The reviews were coded and classified into “complex” (n = 24) and “simple” (n = 16) intervention review groups based on the predefined complexity dimensions from the extant literature mapped into the PICOTS framework. All the data were analyzed in these two groups to help identify specific patterns of the GRADE ratings in the reviews of complex interventions.ResultsOutcomes of complex intervention reviews had higher proportions of “very low” quality of evidence ratings compared with those of simple intervention reviews (37.5% vs. 9.1% for the primary benefit outcomes) and were more frequently downgraded for inconsistency, performance bias, and study design. None of the outcomes of complex intervention reviews (0%) were given “high” GRADE ratings.ConclusionResults suggest that the GRADE assessment may not adequately describe the evidence base of complex interventions.     

Frailty as a Predictor of All-Cause Mortality Among Older Nursing Home Residents: A Systematic Review and Meta-analysis

ObjectivesWe performed a meta-analysis based on prospective cohort studies to synthesize the pooled risk effect and to determine whether frailty is a predictor of all-cause mortality.DesignSystematic review and meta-analysis.SettingPubMed, EMBASE, and the Cochrane Library were systematically searched in October 2018. A random effects model was applied to combine the results according to the heterogeneity of the included studies.ParticipantsOlder nursing home residents.MeasurementsMortality risk due to frailty.ResultsFourteen studies (9076 participants) were included in this meta-analysis. Pooled results demonstrated that nursing home residents with frailty were at an increased risk of mortality [pooled hazards ratio (HR) = 1.88, 95% confidence interval (CI) = 1.57, 2.25, I² = 47.8%, P < .001] compared to those without frailty. Results of subgroup analyses showed that frailty was significantly associated with the risk of mortality among older nursing home residents when using FRAIL-NH (pooled HR = 2.10, 95% CI = 1.60-2.77, P < .001) and Frailty Index (pooled HR = 1.74, 95% CI = 1.40-2.18, P < .001) to define frail people, whereas when using the diagnosis criteria of CSHA-CFS for frailty, the pooled HR was 2.82 (95% CI = 0.79-10.10, P = .111). In addition, the subgroup analysis for length of follow-up showed that studies with a follow-up period of 1 year or more (pooled HR = 1.83, 95% CI = 1.52, 2.21, P < .001) reported a significantly higher rate of mortality among individuals with frailty, compared to those without frailty. Similar results were also found in studies with a follow-up period of less than 1 year (pooled HR = 2.67, 95% CI = 1.43, 5.00, P = .002).Conclusions and ImplicationsFrailty is a significant predictor of all-cause mortality in older nursing home residents. Therefore, there is an urgent need to screen for frailty in nursing home residents and carry out appropriate multidisciplinary intervention strategies to prevent poor outcomes and reduce the rate of mortality among older nursing home residents.     

FokI polymorphism of the vitamin D receptor (VDR) gene and susceptibility to tuberculosis: Evidence through a meta-analysis

BackgroundTuberculosis is one of the top ten causes of deaths worldwide. The deficiency of vitamin D was reported to be associated with the increased susceptibility of tuberculosis. Various previous reports were published to check the association of FokI polymorphism of the vitamin D receptor gene with tuberculosis risk. But their results were inconsistent so, we performed a meta-analysis to know the exact relation of the two.MethodsDifferent databases were screened up to November 2020 with the keywords “Vitamin D receptor”, “VDR”, and “FokI”, along with “Tuberculosis” and “TB” to find the suitable articles. All the statistical analyses were performed by the Open Meta-Analyst program and all p-values were two-tailed with a significance level of 0.05.ResultsNo statistically significant association was observed in the allele contrast model (OR_fvs.F = 1.11, 95%CI = 0.99–1.24, p = 0.05, I² = 73.46%), in the dominant model (OR_ff+Ffvs.FF = 1.11, 95%CI = 0.96–1.28, p = 0.14, I² = 71.39%), and in the co-dominant model (OR_Ffvs.FF = 1.05, 95%CI = 0.92–1.21, p = 0.41, I² = 65.97%). However, a significant association was found in the homozygote model (OR_ffvs.FF = 1.32, 95%CI = 1.03–1.69, p = 0.02, I² = 67.02%) and in the recessive model (OR_{FF+Ff vs.ff} = 1.26, 95%CI = 1.03–1.54, p = 0.02, I² = 58.01%). Further analysis was performed on the bases of the ethnicity. In Asian population a significant association was found in the homozygote model (OR_ffvs.FF = 1.57, 95%CI = 1.12–2.21, p = 0.008, I² = 70.37%) and in the recessive model (OR_{FF+Ff vs.ff} = 1.43, 95%CI = 1.08–1.89, p = 0.01, I² = 63.13%).ConclusionIn conclusion, a significant association of FokI with tuberculosis susceptibility was found in the overall analysis and in the Asian population.     

A systematic review and meta-analysis of the effects of aerobic exercise interventions on cardiorespiratory fitness in adults with intellectual disability

BackgroundAdults with an intellectual disability (ID) have low cardiorespiratory fitness (CRF). Low CRF has been associated with a high risk of cardiovascular disease and all-cause mortality. Participation in regular exercise can help adults with ID increase their CRF.ObjectiveTo perform a systematic review and meta-analysis of published, peer-reviewed clinical trials that evaluated the effects of aerobic exercise (AE) interventions on CRF in adults with ID, ages 18–65 years.MethodsEnglish-language articles were searched up to June 2021 from 11 electronic databases. Data were extracted using an author-developed form. Two independent authors assessed the risk of bias using the Tool for the Assessment of Study Quality and reporting in Exercise (TESTEX). Meta-analysis was performed using the RevMan 5.3.ResultsOf the 1870 article titles and abstracts screened, 16 articles were included. The average TESTEX score (out of 15) was 8.1 (SD = 3.5, range 2–14). The pooled effect was statistically significant (SMD = 0.41, 95% CI: 0.19 to 0.63, z = 3.59; p = .000) with moderate heterogeneity (I² = 35%, p = .000). Both types of intervention produced statistically significant CRF gains, with interventions that combined AE with resistance, balance, and/or flexibility exercises being slightly more effective (SMD = 0.40, 95% CI: 0.11 to 0.70, p = .007) than non-combined interventions (SMD = 0.42, 95% CI: 0.05 to 0.79, p = .02). Heterogeneity was moderate but non-significant for both types of intervention.ConclusionsThe review supports the use of AE interventions in promoting CRF in adults with ID. The interpretation is limited by the quality of evidence and by poorly described and/or executed familiarization and measurement protocols.     

Effectiveness of intervention programs in preventing falls: a systematic review of recent 10 years and meta-analysis

ObjectiveTo examine the reported effectiveness of fall-prevention programs for older adults by reviewing randomized controlled trials from 2000 to 2009.DesignSystematic review and meta-analysis of randomized controlled trials.Data SourcesA systematic literature search of articles was conducted using 5 electronic databases (Medline, PubMed, PsycINFO, CINAHL, and RefWorks), including articles describing interventions designed to prevent falls, in English with full text availability, from 2000 through 2009.Review MethodsOf a potential 227 studies, we identified 17 randomized controlled trials with a duration of intervention of at least 5 months of follow-up. Inclusion and exclusion criteria were used to assess the methodological qualities of the studies. We excluded unidentified study design, quasi-experimental studies, and/or studies that were nonspecific regarding inclusion criteria.Data ExtractionPrimary outcome measures were number of falls and fall rate. Methodological quality assessment included internal and external validity, reporting, and power. Data were extracted independently by 2 investigators and analyzed using a random-effects model. We analyzed the effectiveness of these fall intervention programs using their risk ratios (RR) in 2 single-intervention versus 15 multifactorial intervention trials, 3 nursing homes versus 14 community randomized controlled trials, and 8 Model 1 (initial intervention with subsequent follow up) versus 9 Model II (ongoing intervention throughout the follow-up) studies.ResultsThe combined RR for the number of falls among 17 studies was 0.855 (z = –2.168; p = .030; 95% CI = 0.742–0.985; Q = 196.204, df = 16, P = .000, I² = 91.845), demonstrating that fall-prevention programs across the studies were effective by reducing fall rates by 14%, but with substantial heterogeneity. Subgroup analysis indicated that there was a significant fall reduction of 14% in multifactorial intervention (RR = 0.856, z = –2.039, P = .041) with no variation between multifactorial and single-intervention groups (Q = 0.002, P = .961), 55% in the nursing home setting (RR = 0.453, z = –9.366, P = .000) with significant variation between nursing home and community groups (Q = 62.788, P = .000), and no significant effect was gained by dividing studies into either in Model I or II. Sensitivity analysis found homogeneity (Q = 18.582, df = 12, P = .099, I² = 35.423) across studies with a 9% overall fall reduction (RR = 0.906, 95% CI = 0.853–0.963, z = –3.179, P = .001), including a fall-reduction rate of 10% in multifactorial intervention (RR = 0.904, z = –3.036, P = .002), 9% in community (RR = 0.909, z = –3.179, P = .001), and 12% in Model I (RR = 0.876, z = –3.534, P = .000) with no variations among all the groups. Meta regression suggested that the model fit explained 68.6% of the relevant variance.ConclusionsThe meta-sensitivity analysis indicates that randomized controlled trials of fall-prevention programs conducted within the past 10 years (2000–2009) are effective in overall reduction of fall rates of 9% with a reduction of fall rates of 10% in multifactorial interventions, 9% in community settings, and 12% in Model I interventions (initial intervention efforts and then subsequent follow-up).     

Efficacy of Ginger (Zingiber officinale) in Ameliorating Chemotherapy-Induced Nausea and Vomiting and Chemotherapy-Related Outcomes: A Systematic Review Update and Meta-Analysis

BackgroundGinger has been proposed as an adjuvant treatment for chemotherapy-induced nausea and vomiting.ObjectiveThe aim of this systematic review with meta-analyses is to evaluate, in adult cancer patients receiving chemotherapy, the effects of ginger supplementation dose and duration on the incidence, duration, and severity of chemotherapy-induced nausea and vomiting and outcomes related to chemotherapy-induced nausea and vomiting (eg, quality of life and fatigue), compared with placebo or standard antiemetic medication.MethodFive electronic databases were searched from database inception to April 2018. The quality of evidence was appraised with the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluation level. Data were pooled using Revman software.ResultsEighteen articles were analyzed. The likelihood of acute vomiting was reduced by 60% with ginger supplementation ≤1 g/day for duration >3 days, compared with control groups (odds ratio 0.4, 95% CI 0.17 to 0.81; P=0.01; n=3 studies; n=3 interventions; n=301 participants; I²=20%; Grading of Recommendations, Assessment, Development, and Evaluation level: Moderate). The likelihood of fatigue was reduced by 80% with ginger supplementation of any dose for duration <3 days (odds ratio 0.2, 95% CI, 0.03 to 0.87; P=0.03; n=1 studies; n=2 interventions; n=219 participants; I²=0%; Grading of Recommendations, Assessment, Development, and Evaluation level: Low). No statistically significant association was found between ginger and likelihood of overall or delayed vomiting, likelihood or severity of nausea, or other outcomes related to chemotherapy-induced nausea and vomiting.ConclusionsGinger supplementation might benefit chemotherapy-induced vomiting as well as fatigue. Due to clinical heterogeneity, this systematic review update found no association between ginger and chemotherapy-induced nausea and other chemotherapy-induced nausea and vomiting-related outcomes. The results of this systematic review and meta-analysis provide a rationale for further research with stronger study designs, adequate sample sizes, standardized ginger products, and validated outcome measures to confirm efficacy of ginger supplementation and optimal dosing regimens.     

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis

ObjectiveTo determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries.MethodsWe searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties.FindingsWe included 31 interventions in our meta-analysis. We observed significant standardized mean differences of −0.38 for glycated haemoglobin (95% confidence interval, CI: −0.52 to −0.23; I² = 86.70%), −0.20 for fasting blood sugar (95% CI: −0.32 to −0.08; I² = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I² = 93.75%), 0.55 for diabetes knowledge (95% CI: −0.10 to 1.20; I² = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I² = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of −0.04 for body mass index (95% CI: −0.13 to 0.05; I² = 35.94%), −0.06 for total cholesterol (95% CI: −0.16 to 0.04; I² = 59.93%) and −0.02 for triglycerides (95% CI: −0.12 to 0.09; I² = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications.ConclusionAlthough we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.     

The Effect of Meal Replacement on Weight Loss According to Calorie-Restriction Type and Proportion of Energy Intake: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundPortion control is a useful component of weight reduction interventions and meal replacement (MR) plans represent a promising strategy for portion control. Research performed with pooled data on the effect of MR plans according to various characteristics of MR interventions remains scarce.ObjectiveOur aim was to assess the effects of MR-based diets compared with food-based diets on weight loss, according to calorie-restriction types and energy intake proportions from MR.MethodsElectronic databases (Cochrane Central Register of Controlled Trials, PubMed, Embase, and Research Information Sharing Service) were searched for randomized controlled trials on weight loss results of MR-based calorie-restricted diets compared with food-based calorie-restricted diets from January 2000 to May 2020. Standardized mean differences (Hedges' g) from all study outcomes were calculated using a random-effects model. Heterogeneity was quantified by Q test and I². Publication bias was assessed using a funnel plot and a trim and fill method. Both interventions (MR and control) were separated into very-low-energy diets and low-energy diets (LEDs). A meta-analysis of variance was conducted by dividing patient-related factors and treatment-related factors into subgroups. In multivariable meta-regressions, background variables were selected first, after which main independent variables were included.ResultsTwenty-two studies involving 24 interventions and 1,982 patients who were overweight or obese were included. The effect size in which MR-based LED was compared with food-based LED for weight loss was small, favoring MR (Hedges’ g = 0.261; 95% CI 0.156 to 0.365; I² = 21.9; 95% CI 0.0 to 53.6). Diets including ≥60% of total daily energy intake from MR had a medium effect size favoring MR with regard to weight loss among the groups (Hedges’ g = 0.545; 95% CI 0.260 to 0.830; I² = 42.7; 95% CI 0.0 to 80.8).ConclusionsThe effect of MR-based LED on weight loss was superior to the effect of food-based LED, and receiving ≥60% of total daily energy intake from MR had the greatest effect on weight loss.     

Behavioral interventions for smoking cessation among adolescents: a rapid review and meta-analysis for the Korea Preventive Services Task Force

ObjectivesThe aim of this study was to evaluate the effectiveness of behavioral smoking cessation interventions among adolescents.Methods MEDLINE, CENTRAL, Embase, CINAHL, KoreaMed, and KMbase were searched from inception to June 2020. Systematic reviews (SRs) or meta-analyses of randomized controlled trials (RCTs) were initially searched to perform a rapid SR. After selecting the final SR, RCTs after the publication year of the selected SR were searched. The primary outcome was smoking status after at least 6 months of follow-up, and the secondary outcome was smoking status at 4 weeks. Two reviewers independently assessed the selected studies’ quality using the Cochrane risk of bias tool. The meta-analysis utilized a Mantel-Haenszel fixed-effect model reporting the relative risk (RR) and 95% confidence interval (CI). The subgroup analysis utilized Cochrane’s Q.Results Thirty-two RCTs (11,637 participants) from a single SR were meta-analyzed. After 6 months of follow-up, the intervention group had significantly higher abstinence rates (RR, 1.30; 95% CI, 1.20−1.41; I²=26.46%). At 4 weeks of follow-up, the intervention group also had significantly higher abstinence rates (RR, 1.92; 95% CI, 1.49–2.47; I²=0.00%). The subgroup analysis indicated a significant difference in the abstinence rate according to the study setting and the period between intervention completion and follow-up.Conclusion This review showed that adolescent behavioral smoking cessation intervention programs significantly increased abstinence rates compared to the usual care.     

The European I-MOVE Multicentre 2013–2014 Case-Control Study. Homogeneous moderate influenza vaccine effectiveness against A(H1N1)pdm09 and heterogenous results by country against A(H3N2)

BackgroundIn the first five I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) influenza seasons vaccine effectiveness (VE) results were relatively homogenous among participating study sites. In 2013–2014, we undertook a multicentre case-control study based on sentinel practitioner surveillance networks in six European Union (EU) countries to measure 2013–2014 influenza VE against medically-attended influenza-like illness (ILI) laboratory-confirmed as influenza. Influenza A(H3N2) and A(H1N1)pdm09 viruses co-circulated during the season.MethodsPractitioners systematically selected ILI patients to swab within eight days of symptom onset.We compared cases (ILI positive to influenza A(H3N2) or A(H1N1)pdm09) to influenza negative patients. We calculated VE for the two influenza A subtypes and adjusted for potential confounders. We calculated heterogeneity between sites using the I² index and Cochrane's Q test. If the I² was <50%, we estimated pooled VE as (1 minus the OR) × 100 using a one-stage model with study site as a fixed effect. If the I² was >49% we used a two-stage random effects model.ResultsWe included in the A(H1N1)pdm09 analysis 531 cases and 1712 controls and in the A(H3N2) analysis 623 cases and 1920 controls. For A(H1N1)pdm09, the Q test (p = 0.695) and the I² index (0%) suggested no heterogeneity of adjusted VE between study sites. Using a one-stage model, the overall pooled adjusted VE against influenza A(H1N1)pdm2009 was 47.5% (95% CI: 16.4–67.0).For A(H3N2), the I² was 51.5% (p = 0.067). Using a two-stage model for the pooled analysis, the adjusted VE against A(H3N2) was 29.7 (95% CI: −34.4–63.2).ConclusionsThe results suggest a moderate 2013–2014 influenza VE against A(H1N1)pdm09 and a low VE against A(H3N2). The A(H3N2) estimates were heterogeneous among study sites. Larger sample sizes by study site are needed to prevent statistical heterogeneity, decrease variability and allow for two-stage pooled VE for all subgroup analyses.     

Unobserved mental health profiles are associated with weight and physical activity change in female college freshmen: A latent profile analysis

Statement of problemWeight gain is common during the first year of college, and interventions to attenuate weight gain have had mixed success. The purpose of the present study was to examine the effectiveness of a peer-delivered weight management intervention and to determine whether changes in weight and physical activity could be explained by unobserved subgroups constructed based on mental health changes.MethodFemale participants (N = 246) were randomly assigned to an intervention or control group and completed all measures during the first and last month of the school year. The self-efficacy based intervention was delivered by trained peer educators, and the course curriculum was focused on enhancing physical activity and dietary behaviors to prevent weight gain.ResultsInitial analyses revealed no significant intervention effects on weight or physical activity. A latent profile analysis yielded two classes with different psychosocial profiles. Class 1 (Negative Mental Health Profile) displayed substantial declines in self-esteem and QOL and large increases in anxiety. Class 2 (Positive Mental Health Profile) exhibited moderate improvements in self-esteem and QOL and modest declines in anxiety. The two classes could be differentiated based on changes in weight and physical activity, with Class 1 demonstrating decreased physical activity and increased weight across the school year, whereas these changes were attenuated in Class 2.ConclusionsThese findings highlight the importance of conducting analyses that may identify subgroups of individuals who change differentially. Such analyses may inform future studies by allowing researchers to identify “at-risk” individuals early and provide targeted interventions to attenuate declines in mental health and physical activity and enhance weight management.     

Lack of blinding of outcome assessors in animal model experiments implies risk of observer bias

ObjectivesTo examine the impact of not blinding outcome assessors on estimates of intervention effects in animal experiments modeling human clinical conditions.Study Design and SettingWe searched PubMed, Biosis, Google Scholar, and HighWire Press and included animal model experiments with both blinded and nonblinded outcome assessors. For each experiment, we calculated the ratio of odds ratios (ROR), that is, the odds ratio (OR) from nonblinded assessments relative to the corresponding OR from blinded assessments. We standardized the ORs according to the experimental hypothesis, such that an ROR <1 indicates that nonblinded assessor exaggerated intervention effect, that is, exaggerated benefit in experiments investigating possible benefit or exaggerated harm in experiments investigating possible harm. We pooled RORs with inverse variance random-effects meta-analysis.ResultsWe included 10 (2,450 animals) experiments in the main meta-analysis. Outcomes were subjective in most experiments. The pooled ROR was 0.41 (95% confidence interval [CI], 0.20, 0.82; I² = 75%; P < 0.001), indicating an average exaggeration of the nonblinded ORs by 59%. The heterogeneity was quantitative and caused by three pesticides experiments with very large observer bias, pooled ROR was 0.20 (95% CI, 0.07, 0.59) in contrast to the pooled ROR in the other seven experiments, 0.82 (95% CI, 0.57, 1.17).ConclusionLack of blinding of outcome assessors in animal model experiments with subjective outcomes implies a considerable risk of observer bias.     

Non-Pharmacological Self-Management Strategies for Chemotherapy-Induced Peripheral Neuropathy in People with Advanced Cancer: A Systematic Review and Meta-Analysis

Non-pharmacological self-management interventions for chemotherapy-induced peripheral neurotherapy (CIPN) are of clinical interest; however, no systematic review has synthesized the evidence for their use in people with advanced cancer. Five databases were searched from inception to February 2022 for randomized controlled trials assessing the effect of non-pharmacological self-management interventions in people with advanced cancer on the incidence and severity of CIPN symptoms and related outcomes compared to any control condition. Data were pooled with meta-analysis. Quality of evidence was appraised using the Revised Cochrane Risk of Bias Tool for Randomized Trials (RoB2), with data synthesized narratively. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was applied to assess the certainty of the evidence. Thirteen studies were included, which had a high (69%) or unclear (31%) risk of bias. Greatest confidence was found for physical exercise decreasing CIPN severity (SMD: −0.89, 95% CI: −1.37 to −0.41; p = 0.0003; I² = 0%; n = 2 studies, n = 76 participants; GRADE level: moderate) and increasing physical function (SMD: 0.51, 95% CI: 0.02 to 1.00; p = 0.04; I² = 42%; n = 3 studies, n = 120; GRADE level: moderate). One study per intervention provided preliminary evidence for the positive effects of glutamine supplementation, an Omega-3 PUFA-enriched drink, and education for symptom self-management via a mobile phone game on CIPN symptoms and related outcomes (GRADE: very low). No serious adverse events were reported. The strongest evidence with the most certainty was found for physical exercise as a safe and viable adjuvant to chemotherapy treatment for the prevention and management of CIPN and related physical function in people with advanced cancer. However, the confidence in the evidence to inform conclusions was mostly very low to moderate. Future well-powered and appropriately designed interventions for clinical trials using validated outcome measures and clearly defined populations and strategies are warranted.     

Circulating adipokines and risk of obesity related cancers: A systematic review and meta-analysis

BackgroundObesity can influence on carcinogenesis through alterations in adipokines and subsequent inflammatory changes. This meta-analysis was aimed to comprehensively assess the association between circulating adipokines and risk of obesity-related cancers.MethodsPubmed and Embase were searched up to October 2017 for observational studies investigating the relationship between adipokines and cancers. Pooled odds ratio and the corresponding 95% confidence interval was estimated through the meta-analysis using a random-effects model.Findings A total of 93 observational studies (adiponectin = 60, high molecular weight adiponectin = 9, leptin = 39, IL-6 = 16, TNF-α = 10, and resistin = 17) were included. Adiponectin was significantly associated with decreased risk of cancer (pooled OR 0.70, 95% CI 0.60–0.80; I² = 71.9%; P_{heterogeneity} <0.01). Leptin was significantly associated with increased risk of cancer (1.26, 1.05–1.51; I² = 65.7%; P_{heterogeneity} <0.01). For each 5 μg/ml increase in adiponectin and 5 ng/ml increase in leptin, the pooled OR was 0.88 (0.83–0.93; I² = 80.2%; P_{heterogeneity} <0.01) and 1.05 (1.01–1.09; I² = 67.9%; P_{heterogeneity}<0.01)), respectively. There was nonlinear dose-response association (P_nonlinearity for adiponectin = 0.01; P_nonlinearity for leptin = 0.003).IL-6 (1.09, 0.94–1.25), TNF- α (1.65, 0.99–2.74), and resistin (1.28, 0.78–2.11) was not associated with risk of cancer. By cancer site and type, highest category of adiponectin was associated with decreased risk of breast (OR 0.74, 0.60-0.91), colorectal (0.74, 0.60–0.91), and endometrial cancer (0.49, 0.34–0.72). Higher leptin was associated with increased risk of endometrial (1.88, 1.24–2.87) and kidney cancer (2.07, 1.51–2.83).ConclusionOur study suggests that adiponectin and leptin may play a role in the etiology of cancer.     

Qualitative “trial-sibling” studies and “unrelated” qualitative studies contributed to complex intervention reviews

ObjectiveTo compare the contribution of “trial-sibling” and “unrelated” qualitative studies in complex intervention reviews.Study Design and SettingResearchers are using qualitative “trial-sibling” studies undertaken alongside trials to provide explanations to understand complex interventions. In the absence of qualitative “trial-sibling” studies, it is not known if qualitative studies “unrelated” to trials are helpful. Trials, “trial-sibling,” and “unrelated” qualitative studies looking at three health system interventions were identified. We looked for similarities and differences between the two types of qualitative studies, such as participants, intervention delivery, context, study quality and reporting, and contribution to understanding trial results.ResultsReporting was generally poor in both qualitative study types. We detected no substantial differences in participant characteristics. Interventions in qualitative “trial-sibling” studies were delivered using standardized protocols, whereas interventions in “unrelated” qualitative studies were delivered in routine care. Qualitative “trial-sibling” studies alone provided insufficient data to develop meaningful transferrable explanations beyond the trial context, and their limited focus on immediate implementation did not address all phenomena of interest. Together, “trial-sibling” and “unrelated” qualitative studies provided larger, richer data sets across contexts to better understand the phenomena of interest.ConclusionsFindings support inclusion of “trial-sibling” and “unrelated” qualitative studies to explore complexity in complex intervention reviews.     

Behavioral therapy and pharmacotherapy for relapse prevention in abstinent smokers: a rapid review and meta-analysis for the Korea Preventive Service Task Force

ObjectivesThis study aimed to assess the effectiveness of relapse prevention interventions involving behavioral and pharmacological treatment among abstinent smokers.MethodsThis rapid review was conducted using MEDLINE, Cochrane CENTRAL, CINAHL, Embase, KMbase, and KoreaMed to identify studies published until June 20, 2020. The participants were abstinent smokers who quit smoking on their own, due to pregnancy, hospitalization, or by participating in a smoking cessation program. We found a systematic review that fit the objective of this study and included 81 randomized controlled trials (RCTs). Studies that did not present information on smoking cessation status, had no control group, or used reward-based interventions were excluded. Random effect and fixed effect meta-analyses were used to estimate the relative risk (RR) and 95% confidence interval (CI). In subgroup analyses, differences between subgroups were verified based on the participant setting, characteristics, intervention type, and intensity.ResultsFollowing screening, 44 RCTs were included in the meta-analysis. The review reported no differences in the success rate of relapse prevention between the behavioral interventions. Pharmacotherapy interventions showed higher success rates (RR, 1.15; 95% CI, 1.05−1.26; I²=40.71%), depending on prior abstinence duration and the drug type.ConclusionThe results indicated that pharmacotherapy has a significant effect on preventing relapse among abstinent smokers.