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.     

Efficacy of Vitamin D Supplements in Prevention of Acute Respiratory Infection: A Meta-Analysis for Randomized Controlled Trials

Background: Previous systematic reviews and meta-analyses of randomized controlled trials (RCTs) have reported inconsistent results regarding the efficacy of vitamin D supplements in the prevention of acute respiratory infections (ARIs). Methods: We investigated these efficacy results by using a meta-analysis of RCTs. We searched PubMed, EMBASE, and the Cochrane Library in June 2021. Results: Out of 390 trials searched from the database, a total of 30 RCTs involving 30,263 participants were included in the final analysis. In the meta-analysis of all the trials, vitamin D supplementation showed no significant effect in the prevention of ARIs (relative risk (RR) 0.96, 95% confidence interval (CI) 0.91–1.01, I² = 59.0%, n = 30). In the subgroup meta-analysis, vitamin D supplementation was effective in daily supplementation (RR 0.83, 95% CI, 0.73–0.95, I² = 69.1%, n = 15) and short-term supplementation (RR 0.83, 95% CI, 0.71–0.97, I² = 66.8%, n = 13). However, such beneficial effects disappeared in the subgroup meta-analysis of high-quality studies (RR 0.89, 95% CI, 0.78–1.02, I² = 67.0%, n = 10 assessed by the Jadad scale; RR 0.87, 95% CI, 0.66–1.15, I² = 51.0%, n = 4 assessed by the Cochrane’s risk of bias tool). Additionally, publication bias was observed. Conclusions: The current meta-analysis found that vitamin D supplementation has no clinical effect in the prevention of ARIs.     

Omega-3, Omega-6, and Polyunsaturated Fat for Cognition: Systematic Review and Meta-analysis of Randomized Trials

ObjectivesNeurocognitive function may be influenced by polyunsaturated fat intake. Many older adults consume omega-3 supplements hoping to prevent cognitive decline. We assessed effects of increasing omega-3, omega-6, or total polyunsaturated fats on new neurocognitive illness and cognition.Design and inclusion criteriaWe carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) in adults, with duration ≥24 weeks, assessing effects of higher vs lower omega-3, omega-6, or total polyunsaturated fats and outcomes: new neurocognitive illness, newly impaired cognition, and/or continuous measures of cognition.MethodsWe searched MEDLINE, Embase, Cochrane CENTRAL, and trials registers (final update of ongoing trials December 2018). We duplicated screening, data extraction, and risk of bias assessment. Neurocognitive measures were grouped to enable random effects meta-analysis. GRADE assessment, sensitivity analyses, and subgrouping by dose, duration, type of intervention, and replacement were used to interrogate our findings.ResultsSearches generated 37,810 hits, from which we included 38 RCTs (41 comparisons, 49,757 participants). Meta-analysis suggested no or very little effect of long-chain omega-3 on new neurocognitive illness [risk ratio (RR) 0.98, 95% confidence interval (CI) 0.87-1.10, 6 RCTs, 33,496 participants, I² 36%), new cognitive impairment (RR 0.99, 95% CI 0.92-1.06, 5 RCTs, 33,296 participants, I² 0%) or global cognition assessed using the Mini-Mental State Examination (MD 0.10, 95% CI 0.03-0.16, 13 RCTs, 14,851 participants, I² 0%), all moderate-quality evidence. Effects did not differ with sensitivity analyses, and we found no differential effects by dose, duration, intervention type, or replacement. Effects of increasing α-linolenic acid, omega-6, or total PUFA were unclear.ConclusionsThis extensive trial data set enabled assessment of effects on neurocognitive illness and cognitive decline not previously adequately assessed. Long-chain omega-3 probably has little or no effect on new neurocognitive outcomes or cognitive impairment.ImplicationsLong-chain omega-3 supplements do not help older adults protect against cognitive decline.     

Efficacy of Vitamin D Supplements in Treatment of Acute Respiratory Infection: A Meta-analysis for Randomized Controlled Trials

Background: Recent randomized controlled trials (RCTs) have reported inconsistent findings regarding the efficacy of vitamin D supplementation in the treatment of acute respiratory infections (ARIs). This study aimed to investigate the efficacy of vitamin D supplementation in the treatment of ARIs using a meta-analysis of RCTs. Methods: PubMed, EMBASE, and the Cochrane Library were searched for relevant articles in June 2021. Two of the authors independently assessed the eligibility of the trials. Results: Out of 390 articles retrieved from the databases, we included 18 RCTs, which involved 3648 participants, with 1838 in an intervention group and 1810 in a control group in the final analysis. In the meta-analysis of all the trials, vitamin D supplements had a beneficial effect in the treatment of ARIs (relative risk (RR) = 1.07; 95% confidence interval (CI), 1.01–1.13; I² = 66.9%). Publication bias was observed in the funnel plot. In the subgroup meta-analysis of high-quality RCTs, no significant efficacy of vitamin D supplements was found (RR = 1.02; 95% CI, 0.98–1.06; I² = 24.0%). Although statistically significant changes of 7% in the treatment effects were observed, they are not considered as clinically substantial ones. Conclusions: The current meta-analysis suggests that vitamin D supplements are not clinically effective in the treatment of ARIs.     

Can Mixed Strains of Lactobacillus and Bifidobacterium Reduce Eczema in Infants under Three Years of Age? A Meta-Analysis

(1) Background: Whether early supplementation of probiotics to improve intestinal flora can effectively prevent eczema remains a controversial issue. We aimed to investigate the effect of a mixed strain of Lactobacillus and Bifidobacterium on eczema in infants under three years old at present; (2) Methods: We searched the databases of PubMed, Web of Science, and Cochrane Library, as well as National Knowledge Infrastructure (CNKI), WeiPu (VIP), and WanFang Data (WanFang) for randomized controlled trials (RCTs) of probiotics in the prevention of eczema in infants without language restriction. The main outcome was eczema incidence, while adverse events during the intervention constituted the secondary outcome. The random-/fixed-effects model was utilized to calculate the combined relative risk (RR) and 95% confidence interval (CI). The methodological quality of the study was evaluated using the Cochrane “bias risk” tool. According to the initial intervention time, subgroup analysis was carried out, follow-up time, family history, etc.; (3) Results: Nine articles were selected (2093 infants). The Lactobacillus and Bifidobacterium mixed strain could prevent eczema in infants under three years of age compared to the placebo (RR = 0.60; I² = 67%; p < 0.001). Subgroup analysis revealed that the mixture of two probiotic strains had preventive effects on both infants with positive (RR = 0.53; I² = 52%; p < 0.001) and negative (RR = 0.69; I² = 62%; p = 0.02) family history; The follow-up time for ≤12 months (RR = 0.65; I² = 12%; p = 0.01) and 12–24 months (RR = 0.60; I² = 79%; p = 0.003), daily dose of probiotics ≤ 1 × 10⁹ and > 1 × 10⁹ colony forming units all can be effective (p < 0.01); Compared with the intervention of infants alone (RR = 0.63; I² = 63%; p = 0.29), the effect of probiotics mixture at the beginning of pregnancy was more significant (RR = 0.59; I² = 71%; p < 0.001); Except for the mixture of Lactobacillus rhamnosus GG (LGG) and Bifidobacterium longum (B. longum) (p = 0.18), other subgroups of intervention group can play a preventive effect (p < 0.05); (4) Conclusions: The mixed strain of Lactobacillus and Bifidobacterium can effectively reduce the incidence of eczema in infants under three years old. However, further research is needed to fully understand the exact mechanism of their effect on infant eczema.     

Online intervention engagement predicts smoking cessation

Objective. Instead of focusing on individual differences as predictors of quitting (“who they are”), this study focuses on actions (“what they do”). The purpose is to predict smoking abstinence in internet users who may become involved in social activities within the virtual community.Methods. From March, 2009, to July, 2011, users of a web-based smoking cessation program in Germany made data available for a post-hoc evaluation study (n = 13,174), including abstinence rates and online activities such as a) posting on a bulletin board after a smoke-free day, b) offering a donation, and c) posting messages throughout their course.Results. Survival analyses for 70 days of self-reported non-smoking documented higher success rates for those who made use of one or more of the virtual community activities. Moreover, the effect of making an initial bulletin board entry on 10-week abstinence was mediated by offering a donation and posting messages throughout the course (R² = 0.125). The indirect effect via donation was 0.10 (95% CI 0.06-0.14), and the indirect effect via message posting was 0.31 (95% CI 0.25-0.38).Conclusions. Virtual community activities predict smoking cessation. Shifting the focus from personality characteristics toward behavioral process variables such as intervention engagement might add more substance to smoking cessation studies.     

Diet Quality as Assessed by the Healthy Eating Index,Alternate Healthy Eating Index,Dietary Approaches to Stop Hypertension Score,and Health Outcomes: A Second Update of a Systematic Review and Meta-Analysis of Cohort Studies

BackgroundSuboptimal diet quality has a large impact on noncommunicable disease burden.ObjectiveThis study aimed to update the body of evidence on the associations between diet quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and the Dietary Approaches to Stop Hypertension score, and health status. Moreover, results of the previous systematic reviews and meta-analyses were extended by evaluating the credibility of the evidence.MethodsPubMed, Embase, and Scopus databases were searched to identify eligible studies published between May 15, 2017 and March 14, 2020. Pooled relative risk (RR) with 95% CI for highest vs lowest category of diet quality were estimated using a random-effects model. Heterogeneity was explored using Cochran's Q test and I² statistic with 95% CI. Presence of publication bias was detected by using funnel plots and Egger's regression test. The NutriGrade tool was used to assess the credibility of evidence.ResultsThe current update identified 47 new reports, resulting in a total of 113 reports including data from 3,277,684 participants. Diets of the highest quality, as assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores, were inversely associated with risk of all-cause mortality (RR 0.80, 95% CI 0.79 to 0.82, I² = 68%, n= 23), cardiovascular disease incidence or mortality (RR 0.80, 95% CI 0.78 to 0.82, I² = 59%, n= 45), cancer incidence or mortality (RR 0.86, 95% CI 0.84 to 0.89, I² = 73%, n= 45), incidence of type 2 diabetes (RR 0.81, 95% CI 0.78 to 0.85, I² = 76%, n= 16), and incidence of neurodegenerative diseases (RR 0.82, 95% CI 0.75 to 0.89, I² = 71%, n= 12). In cancer survivors, the highest diet quality was linked with lower risk of all-cause (RR 0.83, 95% CI 0.77 to 0.88, I² = 45%, n= 12) and cancer mortality (RR 0.82, 95% CI 0.75 to 0.89, I² = 44%, n= 12). The credibility of evidence for identified associations between overall healthy dietary patterns and included health outcomes was moderate.ConclusionThis updated systematic review and meta-analysis suggests that high diet quality (assessed by the Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension) is inversely associated with risk of all-cause mortality, cardiovascular disease incidence or mortality, cancer incidence or mortality, type 2 diabetes, and neurodegenerative disease, as well as all-cause mortality and cancer mortality among cancer survivors. Moderate credibility of evidence for identified associations complements the recent 2020 Dietary Guidelines Advisory Committee report recommending healthy dietary patterns for disease prevention.     

Missing data in randomized controlled trials testing palliative interventions pose a significant risk of bias and loss of power: a systematic review and meta-analyses

ObjectivesTo assess the risk posed by missing data (MD) to the power and validity of trials evaluating palliative interventions.Study Design and SettingA systematic review of MD in published randomized controlled trials (RCTs) of palliative interventions in participants with life-limiting illnesses was conducted, and random-effects meta-analyses and metaregression were performed. CENTRAL, MEDLINE, and EMBASE (2009–2014) were searched with no language restrictions.ResultsOne hundred and eight RCTs representing 15,560 patients were included. The weighted estimate for MD at the primary endpoint was 23.1% (95% confidence interval [CI] 19.3, 27.4). Larger MD proportions were associated with increasing numbers of questions/tests requested (odds ratio [OR], 1.19; 95% CI 1.05, 1.35) and with longer study duration (OR, 1.09; 95% CI 1.02, 1.17). Meta-analysis found evidence of differential rates of MD between trial arms, which varied in direction (OR, 1.04; 95% CI 0.90, 1.20; I² 35.9, P = 0.001). Despite randomization, MD in the intervention arms (vs. control) were more likely to be attributed to disease progression unrelated to the intervention (OR, 1.31; 95% CI 1.02, 1.69). This was not the case for MD due to death (OR, 0.92; 95% CI 0.78, 1.08).ConclusionThe overall proportion and differential rates and reasons for MD reduce the power and potentially introduce bias to palliative care trials.     

Herbal Medicine for Behçet’s Disease: A Systematic Review and Meta-Analysis

Patients with Behçet’s disease often use complementary and alternative medicine for treating their symptoms, and herbal medicine is one of the options. This systematic review provides updated clinical evidence of the effectiveness of herbal medicine for the treatment of Behçet’s disease (BD). We searched eleven electronic databases from inception to March 2020. All randomized controlled trials (RCTs) or quasi-RCTs of BD treatment with herbal medicine decoctions were included. We used the Cochrane Handbook for Systematic Reviews of Interventions to assess the risk of bias and the grading of recommendations assessment, development and evaluation (GRADE) approach to assess the certainty of evidence (CoE). Albatross plot was also used to present the direction of effect observed. Eight studies were included. The risk of bias was unclear or low. The methodological quality was low or very low. Seven RCTs showed significant effects of herbal medicine on the total response rate (Risk ratio, RR 1.26, 95% CI 1.09 to 1.45, seven studies, very low CoE). Four RCTs showed favorable effects of herbal medicine on the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level compared with drug therapy. Herbal medicine favorably affected the ESR (MD −5.56, 95% CI −9.99 to −1.12, p = 0.01, I² = 96%, five studies, very low CoE). However, herbal medicine did not have a superior effect on CRP. Two RCTs reported that herbal medicine significantly decreased the recurrence rate after three months of follow-up (RR 0.23, 95% CI 0.09 to 0.63, two studies, low CoE). Our findings suggest that herbal medicine is effective in treating BD. However, the included studies had a poor methodological quality and some limitations. Well-designed clinical trials with large sample sizes are needed.     

Effects of Selenium Supplements on Cancer Prevention: Meta-analysis of Randomized Controlled Trials

This meta-analysis aimed to investigate the preventive effect of selenium supplements alone on cancer as reported by randomized controlled trials (RCTs). We searched PubMed, EMBASE, and the Cochrane Library in July 2009. Of the 461 articles searched, 8 articles on 9 RCTs, which included 152,538 total participants, 32,110 in antioxidant supplement groups, and 120,428 in placebo groups, were included. In a random-effects meta-analysis of all 9 RCTs, selenium supplementation alone was found to have an overall preventive effect on cancer incidence [relative risk (RR) = 0.76; 95% confidence interval (CI) = 0.58–0.99]. Among subgroup meta-analyses, the preventive effect of selenium supplementation alone on cancer was apparently observed in populations with a low baseline serum selenium level (<125.6 ng/mL) (RR = 0.64; 95% CI = 0.53 to 0.78; I² = 45.5%; n = 7) and in high-risk populations for cancer (RR = 0.68; 95% CI = 0.58 to 0.80; I² = 41.5%; n = 8). The meta-analysis of randomized controlled trials indicates that there is possible evidence to support the use of selenium supplements alone for cancer prevention in the low baseline serum selenium level population and in the high-risk population for cancer.     

Tasas de abstinencia de vareniclina frente a bupropión y terapia sustitutiva con nicotina en la cesación del tabaco en atención primaria

ObjectiveThe objective of this study was to estimate the continuous abstinence rates of varenicline, bupropion and nicotine replacement therapy (NRT) in smoking cessation in 2 Primary Care (PC) External Support Units.DesignObservational, multicentre, longitudinal study using a retrospective review of medical records.SettingSix Primary Care Centres.ParticipantsPatients > 18 years, who began smoking cessation treatment between 1/01/2006 and 1/12/2008 with varenicline, bupropion or NRT were included in the analysis.ContinuationPatient follow-up was conducted from time-baseline (day 1) and assessed at 6 and 12 months. Main variables: comorbidities, effectiveness (continuous abstinence) and pharmacological tolerability. Statistical analysis: logistic regression models and Kaplan-Maier survival curves; P < .05.ResultsA total of 957 smokers treated with NRT (53.0%), bupropion (25.1%) and varenicline (21.9%) were included in the analysis. Mean age: 47.6 (11.3) years; 58.6% men. 32.0% of smokers attended due to physical dependence. Average duration of smoking: 19.5 (6.7) years. At 6 months, 61.2% (95% CI: 54.6-67.8%) of participants in the varenicline group continuously abstained from smoking compared with 56.9% (95% CI: 50.6-63.2%) in the bupropion group, and 52.3% (95% CI: 48.0-56.6%) in the NRT group; P = .003. At 12 months, the rate of continuous abstinence was 57.4% (95% CI: 50.7-64.1%) in the varenicline group compared with 52.9% (95% CI: 46.6-59.2%) in the bupropion group and 47.1% (95% CI: 42.8-51.4%) in the NRT group; P = .002.ConclusionOne year-follow up results suggest that varenicline is an appropriate alternative compared with bupropion and NRT on smoking cessation in the PC setting.     

Work-related exposure to violence or threats and risk of mental disorders and symptoms: a systematic review and meta-analysis

ObjectiveThis review aimed to examine systematically the epidemiological evidence linking work-related exposure to violence and threats thereof with risk of mental disorders and mental ill-health symptoms.MethodsWe searched PubMed, EMBASE, PsycINFO and Web of Science to identify original studies that provide quantitative risk estimates. The evidence was weighted according to completeness of reporting, potential common method bias, and bias due to differential selection and drop out, selective reporting, and misclassification of exposure and outcome.ResultsWe identified 14 cross-sectional and 10 cohort studies with eligible risk estimates, of which 4 examined depressive disorder and reported an elevated risk among the exposed [pooled relative risk (RR) 1.42, 95% confidence interval (CI) 1.31–1.54, I²=0%]. The occurrence of depressive and anxiety symptoms, burnout and psychological distress was examined in 17 studies (pooled RR 2.33, 95% CI 3.17, I²=42%), and 3 studies examined risk of sleep disturbance (pooled RR 1.22, 95% CI 1.09–1.37, I²=0%). In most studies, common method bias and confounding could not be ruled out with confidence and strong heterogeneity in most outcome definitions invalidate the strict interpretation of most pooled risk estimates.ConclusionThe reviewed studies consistently indicate associations between workplace violence and mental health problems. However, due to methodological limitations the causal associations (if any) may be stronger or weaker than the ones reported in this study. Prospective studies with independent and validated reporting of exposure and outcome and repeated follow-up with relevant intervals are highly warranted.     

Association of Vitamin D Supplementation with Cardiovascular Events: A Systematic Review and Meta-Analysis

Background: low vitamin D status has been associated with an increased incidence of cardiovascular events. However, whether vitamin D supplementation would reduce the incidence of cardiovascular events remains unclear. Purpose: To perform a systematic review and meta-analysis of the effect of vitamin D supplementation on the mortality and incidence of cardiovascular events. Data Sources: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials from their inception until 3 May 2022. Study Selection: Two authors searched for randomized clinical trials that reported vitamin D supplementation’s effect on cardiovascular events outcomes. Data Extraction: Two authors conducted independent data extraction. Data Synthesis: We identified 41,809 reports; after exclusions, 18 trials with a total of 70,278 participants were eligible for analysis. Vitamin D supplementation was not associated with the mortality of cardiovascular events (RR 0.96, 95% CI 0.88–1.06, I² = 0%), the incidence of stroke (RR 1.05, 95% CI 0.92–1.20, I² = 0%), myocardial infarction (RR 0.97, 95% CI 0.87–1.09, I² = 0%), total cardiovascular events (RR 0.97, 95% CI 0.91–1.04, I² = 27%), or cerebrovascular events (RR 1.01, 95% CI 0.87–1.18, I² = 0%). Limitation: Cardiovascular events were the secondary outcome in most trials and thus, might be selectively reported. Conclusion: In this meta-analysis of randomized clinical trials, vitamin D supplementation was not associated with a lower risk of cardiovascular events than no supplementation. These findings do not support the routine use of vitamin D supplementation in general.     

Effectiveness and safety of pneumococcal vaccines used alone or combined with influenza vaccination in dialysis patients: A systematic review and meta-analysis

BackgroundA lower conversion vaccination rate and a more rapid decline in antibody titers over time in dialysis patients raise concerns about the effectiveness of pneumococcal vaccination (PV) in this population, which has not been systematically reviewed.MethodsWe searched PubMed, Cochrane Library, Embase and three Chinese databases from inception until February 29th, 2020 for interventional, cohort and case–control studies evaluating PV alone or combined with influenza vaccination (IV) on outcomes (all-cause mortality, pneumonia, cardiovascular events, antibody response and safety). Independent reviewers completed citation screening, data extraction, risk assessment, meta-analysis, and GRADE rating of the quality of evidence.ResultsFive cohort studies and one quasirandomized control trial enrolling 394,299 dialysis patients with high to moderate quality were included. Compared with unvaccinated individuals, those receiving PV had lower risk of all-cause mortality [Adjusted relative risk (RR) 0.73, 95% CI 0.67–0.79, I² = 31.1%, GRADE low certainty] and cardiovascular events (adjusted RR 0.80, 95% CI 0.69–0.93, I² = 47.2%, GRADE low certainty) without serious adverse effect reported. Compared with no vaccination, lower all-cause mortality was observed in those receiving PV combined with IV (Adjusted RR 0.71, 95%CI 0.67–0.75, I² = 63.3%), PV alone (Adjusted RR 0.86, 95% CI 0.78–0.94,I² = 0%], and IV alone (Adjusted RR 0.76, 95% CI 0.73–0.79, I² = 0%]. There was no difference between pneumococcal vaccinated patients vs non-vaccinated patients with respect to pneumonia. Immune response to pneumococcal conjugate vaccine-13 was weaker in polysaccharide pneumococcal vaccine-23-pre-vaccinated compared with vaccine-naive patients.ConclusionsThe use of pneumococcal vaccine especially combined with influenza vaccination is associated with lower risks of all-cause mortality but may be affected by residual confounding/healthy vaccinee bias.     

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.     

Sugar- and Artificially Sweetened Beverages Consumption Linked to Type 2 Diabetes,Cardiovascular Diseases,and All-Cause Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Although studies have examined the association between habitual consumption of sugar- (SSBs) and artificially sweetened beverages (ASBs) and health outcomes, the results are inconclusive. Here, we conducted a dose-response meta-analysis of prospective cohort studies in order to summarize the relationship between SSBs and ASBs consumption and risk of type 2 diabetes (T2D), cardiovascular diseases (CVDs), and all-cause mortality. All relevant articles were systematically searched in PubMed, Embase, and Ovid databases until 20 June 2020. Thirty-four studies met the inclusion criteria and were eligible for analysis. Summary relative risks (RRs) and 95% confidence intervals (95% CI) were estimated using random effects or fixed-effects model for highest versus lowest intake categories, as well as for linear and non-linear relationships. With each additional SSB and ASB serving per day, the risk increased by 27% (RR: 1.27, 95%CI: 1.15–1.41, I² = 80.8%) and 13% (95%CI: 1.03–1.25, I² = 78.7%) for T2D, 9% (RR: 1.09, 95%CI: 1.07–1.12, I² = 42.7%) and 8% (RR: 1.08, 95%CI: 1.04–1.11, I² = 45.5%) for CVDs, and 10% (RR: 1.10, 95%CI: 0.97–1.26, I² = 86.3%) and 7% (RR: 1.07, 95%CI: 0.91–1.25, I² = 76.9%) for all-cause mortality. Linear relationships were found for SSBs with T2D and CVDs. Non-linear relationships were found for ASBs with T2D, CVDs, and all-cause mortality and for SSBs with all-cause mortality. The findings from the current meta-analysis indicate that increased consumption of SSBs and ASBs is associated with the risk of T2D, CVDs, and all-cause mortality.     

Green Tea Consumption and Esophageal Cancer Risk: A Meta-analysis

Abstract

Background: The protective role of green tea against cancer is still unknown.

Objectives: To investigate the association between green tea consumption and esophageal cancer risk through meta-analysis.

Methods: We searched MEDLINE, EMBASE, Web of Science and Cochrane Library for studies on the relationship between green tea and esophageal cancer risk. We assessed heterogeneity (I²) and publication bias (Begg’s and Egger’s tests). Pooled relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects models.

Results: A total of 20 studies were included. The RRs for all studies was 0.65 (95% CI: 0.57–0.73), with I² = 75.3% and P?=?0. In the subgroup analysis, the following variables showed marked heterogeneity: Asian (RR: 0.64; 95% CI: 0.56–0.73) and non-Asian countries (RR: 0.74; 95% CI: 0.45–1.03), female (RR: 0.55; 95% CI: 0.39–0.71) and male?+?female (RR: 0.64; 95% CI: 0.54–0.75), case–control study (RR: 0.62; 95% CI: 0.52–0.71), impact factor >3 (RR: 0.65; 95% CI: 0.56–0.75), impact factor <3 (RR: 0.64; 95% CI: 0.48–0.80), Newcastle–Ottawa Scale >7 (RR: 0.82; 95% CI: 0.66–0.97) and Newcastle–Ottawa Scale ≤7 (RR: 0.59; 95% CI: 0.49–0.68).

Conclusion: Green tea consumption could be a protective factor for esophageal cancer.     

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.