Telomere length and health outcomes: An umbrella review of systematic reviews and meta-analyses of observational studies

The aim of the present study was to map and grade evidence for the relationships between telomere length with a diverse range of health outcomes, using an umbrella review of systematic reviews with meta-analyses. We searched for meta-analyses of observational studies reporting on the association of telomere length with any health outcome (clinical disease outcomes and intermediate traits). For each association, random-effects summary effect size, 95% confidence interval (CI), and 95% prediction interval were calculated. To evaluate the credibility of the identified evidence, we assessed also heterogeneity, evidence for small-study effect and evidence for excess significance bias. Twenty-one relevant meta-analyses were identified reporting on 50 different outcomes. The level of evidence was high only for the association of short telomeres with higher risk of gastric cancer in the general population (relative risk, RR = 1.95, 95%CI: 1.68–2.26), and moderate for the association of shorter telomeres with diabetes or with Alzheimer’s disease, even if limited to meta-analyses of case-control studies. There was weak evidence for twenty outcomes and not significant association for 27 health outcomes. The present umbrella review demonstrates that shorter telomere length may have an important role in incidence gastric cancer and, probably, diabetes and Alzheimer’s disease. At the same time, conversely to general assumptions, it does not find strong evidence supporting the notion that shorter telomere length plays an important role in many health outcomes that have been studied thus far.     

Aging with a disability: a systematic review of cardiovascular disease and osteoporosis among women aging with a physical disability

Compared to men, women live longer but experience greater morbidity as they age. However, little is known about the rapidly growing population of women aging with disability. Women aging with disabilities may encounter barriers that increase risk of morbidity, including lack of access to medical care or inadequate assistance, equipment, or services. To evaluate risks of morbidity in this group, we conducted a systematic review focused on two important and prevalent conditions: cardiovascular disease (CVD) and osteoporosis. MEDLINE was searched for reports published between January 1, 1990 and August 6, 2010 and additional studies were identified through searches of bibliographies. 9156 abstracts and 93 articles were reviewed to identify empirical studies of women with physical disability who were 45 years or older and that reported CVD or osteoporosis as an outcome and not a cause of the disability. Articles meeting inclusion criteria were then critically appraised to exclude poor quality studies. In seven articles that evaluated CVD outcomes, we found limited evidence to support an increased risk of prevalence of CVD or risk factors for CVD in women aging with physical disabilities compared to non-disabled control populations. The literature is limited by small sample sizes that reduced statistical power to detect true differences. No articles meeting inclusion criteria were identified to evaluate osteoporosis risk in this group. This review is limited by the narrow focus on physical disabilities and two health outcomes. Additional high quality empirical research is necessary to understand the risks to health of women aging with disabilities.     

What can the gut microbiome teach us about the connections between child physical and mental health? A systematic review

A deeper understanding of the gut–brain axis is of significance in pediatrics, given the influential role of early childhood experiences and exposures in shaping the microbiome, and health, across the life course. This systematic review synthesized evidence on the connection between the gut microbiome and mental health in children with physical illness. Six electronic databases were systematically searched and data extracted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of 1,476 identified articles, 11 articles reporting on nine unique studies (all randomized controlled trials) were included. Most studies examined the gut microbiome in infants with colic, while the remaining studies investigated outcomes in children aged 1 day to 18 years at risk for atopic dermatitis or irritable bowel syndrome. Baseline and postintervention gut microbiome differences varied across studies. Findings on psychological functioning also varied, with only half of the captured studies showing a positive effect of intervention on psychological well-being. Only two studies analyzed the association between the gut microbiome and psychological outcomes, each with a different pattern of results. As the field moves forward, it will be critical to gain a better understanding of the microbiome characteristics that influence mental health outcomes in pediatric populations.     

A systematic review of the evidence base for the Lightning Process

BackgroundThe Lightning Process (LP), a mind-body training programme, has been applied to a range of health problems and disorders. Studies and surveys report a range of outcomes creating a lack of clarity about the efficacy of the intervention.ObjectiveThis systematic review evaluates the methodological quality of existing studies on the LP and collates and reviews its reported efficacy.Data sourcesFive databases, PsycINFO, PubMed, CINAHL, Embase, ERIC (to September 2018), and Google and Google Scholar were searched for relevant studies.Study SelectionStudies of the LP in clinical populations published in peer-reviewed journals or in grey literature were selected. Reviews, editorial articles and studies/surveys with un-reported methodology were excluded.Data extractionSearches returned 568 records, 21 were retrieved in full text of which 14 fulfilled the inclusion criteria (ten quantitative studies/surveys and four qualitative studies).Data synthesis and ConclusionsThe review identified variance in the quality of studies across time; earlier studies demonstrated a lack of control groups, a lack of clarity of aspects of the methodology and potential sampling bias. Although it found a variance in reported patient outcomes, the review also identified an emerging body of evidence supporting the efficacy of the LP for many participants with fatigue, physical function, pain, anxiety and depression. It concludes that there is a need for more randomised controlled trials to evaluate if these positive outcomes can be replicated and generalised to larger populations.     

A systematic review of motivational interviewing in physical health care settings

Purpose. Motivational interviewing (MI), a method of augmenting an individual's motivation to change problematic behaviours, is a patient‐centred counselling style that seeks to help patients resolve ambivalence about behaviour change. MI has successfully been used in the field of addictions and has recently received increased interest as a means of promoting treatment adherence in physical health care settings. This systematic review is aimed to evaluate the effectiveness of MI interventions in physical health care settings. Methods. Electronic databases were searched for articles specifying the use of ‘motivational interviewing’ in physical health care settings between 1966 and April 2004. Fifty‐one relevant abstracts were yielded and data was extracted from eight relevant selected studies. Results. Eight studies were identified in the fields of diabetes, asthma, hypertension, hyperlipidaemia, and heart disease. The majority of studies found positive results for effects of MI on psychological, physiological, and life‐style change outcomes. Problems with research in this area include: small sample sizes, lack of power, use of disparate multiple outcomes, inadequate validation of questionnaires, poorly‐defined therapy and training. Conclusions. While MI has high face validity across a number of domains in physical health care settings, the general quality of trials in this area is inadequate and therefore recommendations for its dissemination in this area cannot yet be made. More research into MI applied to health behaviour change is urgently required.     

Outcomes of online support and resources for cancer survivors: a systematic literature review

Objective

This study aims to review systematically the available literature on health outcomes of online cancer support and resources.

Methods

We searched major databases with the following selection criteria: (1) empirical study on use of online support or resources by cancer survivors, (2) reporting effects or outcomes of online support or resources, (3) focusing on adult cancer survivors, and (4) peer-reviewed articles published by 2010.

Results

A total of 24 studies (37 articles) were included in the review. Most studies were focused on breast cancer survivors and had small sample sizes. Fifteen studies employed a cross-sectional design including eight qualitative studies. Only five studies used pre-post design, and four employed RCT design. The outcome measures have focused on psychosocial effects; most studies reported positive effects, although none of the RCT studies reported significant outcomes.

Conclusion

Existing studies of online cancer support and resources have demonstrated preliminary but inconclusive evidence for positive outcomes. We call for additional studies with rigorous study designs and the inclusion of more diverse participants and cancer conditions.

Practice implications

Connecting diverse cancer survivors to culturally appropriate, evidence-based online support and resources is a strategy to enhance health outcomes.     

Interventions for the prevention of postpartum depression in adolescent mothers: a systematic review

Postpartum depression (PPD) is a major public health problem affecting 10–57% of adolescent mothers which can affect not only adolescent mothers but also their infants. Thus, there is a need for interventions to prevent PPD in adolescent mothers. However, recent systematic reviews have been focused on effective interventions to prevent PPD in adult mothers. These interventions may not necessarily be applicable for adolescent mothers. Therefore, the purpose of this review was to examine the effectiveness of the existing interventions to prevent PPD in adolescent mothers. A systematic search was performed in MEDLINE, CINAHL, and SCOPUS databases between January 2000 and March 2017 with English language and studies involving human subjects. Studies reporting on the outcomes of intervention to prevent PPD particularly in adolescent mothers were selected. Non-comparative studies were excluded. From 2002 identified records, 13 studies were included, reporting on 2236 adolescent pregnant women. The evidence from this systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training is successful in reducing rates of PPD symptoms in adolescent mothers in the intervention group than those mothers in the control group. These interventions might be considered for incorporation in antenatal care interventions for adolescent pregnant women. However, this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers.

     

Scoping review: Definitions and outcomes of patient-provider language concordance in healthcare

ObjectiveTo conduct a scoping literature review to understand the conceptualization and nature of the research on patient–provider language concordance (LC) in health care.MethodsWe searched PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify peer-reviewed articles between January 1961 and August 2018. We extracted study characteristics, content, definitions, and findings.ResultsFifty studies were included. Forty studies were quantitative, seven were qualitative, and three were mixed methods. Overall, the studies revealed inconsistent definitions and measures of patient–provider LC. Outcomes studied in connection to LC included: (1) interpersonal relationships, (2) access to health information, (3) access to care, (4) satisfaction and health-care experience, and (5) patient-related health outcomes. While four studies found that LC care had a negative or no impact on health outcomes, 46 studies reported positive outcomes associated with LC care.ConclusionsThe study findings highlight the need for more research on LC care and a consistent definition of LC using multiple measures of LC to capture the complex and multidimensional nature of language in social interaction.Practical implicationsThe study findings highlight the importance of how ideologies of language shape the perceptions of language and LC, thereby influence resource allocation and priorities.     

Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: A systematic review

Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory‐Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self‐esteem outcomes. There was evidence for specific client‐related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client‐rated alliance, whereas baseline negative symptoms were associated with worse therapist‐rated alliance. Therapist and therapy‐related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client‐rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist‐rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan‐theoretical, well‐validated alliance measures to determine causal predictor variables.     

Promoting advance care planning via mediated health resources: A systematic mixed studies review

ObjectiveThis systematic review aims (a) to analyze the message design of mediated advance care planning (ACP) interventions targeted at adults from a social marketing and health communication perspective, (b) to identify associations between message design and ACP outcomes, and (c) to illuminate gaps in the literature and highlight needs for future research.MethodsA systematic mixed studies review was conducted. Empirical articles on mediated ACP interventions were systematically searched by using nine scientific databases with keywords related to ACP and mediated health communication. Data were synthesized using a sequential explanatory approach.ResultsA total of 11,824 titles were identified, of which 36 studies were included. Interventions disseminated ACP messages via video (36%), digital channels (22%), print (19%), a combination of channels (19%), and mass media (3%). The interventions used generic (42%), targeted (33%), and tailored (25%) communication. Overall, the evidence suggests that mediated ACP resources positively impact ACP Process and Action outcomes.ConclusionThis study has shown that mediated ACP interventions use various contents, formats, and structures to influence patient-centered ACP outcomes. Most message design techniques were associated with positive ACP outcomes.Practice implicationsMediated ACP resources are a promising approach to encourage ACP among adults.     

Does biodiversity improve mental health in urban settings?

Background

Globally, the human and economic burdens of mental illness are increasing. As the prevalence and costs associated with mental illness rise, we are progressively more aware that environmental issues such as climate change and biodiversity loss impact on human health.

Hypothesis

This paper hypothesises that increased biodiversity in urban environments is associated with improved mental health and wellbeing. It proposes the ecological mechanism through which the association may exist, and explores the extant literature to determine the extent of empirical evidence to support our hypothesis.

Evidence

While there is a substantial literature investigating the impact of ‘green space’ and contact with nature on mental health, we identified only one original research paper that directly investigated the link between biodiversity and mental health. This suggests that the extant evidence considers only ‘one part of the story’, providing an evidence base which is inadequate to inform policy on biodiversity conservation and public health.

Implications

Our hypothesised relationship between environmental change and mental health proposes conservation and restoration of biodiversity in urban environments as a form of intervention for improving human health. It also highlights the need for a better evidence base to demonstrate the synergistic benefits of increased biodiversity and mental health to decision makers. Well-designed quantitative epidemiological research is needed to establish the strength of any such causal relationship.     

Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology

Compassion has emerged as an important construct in studies of mental health and psychological therapy. Although an increasing number of studies have explored relationships between compassion and different facets of psychopathology there has as yet been no systematic review or synthesis of the empirical literature. We conducted a systematic search of the literature on compassion and mental health. We identified 20 samples from 14 eligible studies. All studies used the Neff Self Compassion Scale (Neff, 2003b). We employed meta-analysis to explore associations between self-compassion and psychopathology using random effects analyses of Fisher's Z correcting for attenuation arising from scale reliability. We found a large effect size for the relationship between compassion and psychopathology of r=-0.54 (95% CI=-0.57 to -0.51; Z=-34.02; p<.0001). Heterogeneity was significant in the analysis. There was no evidence of significant publication bias. Compassion is an important explanatory variable in understanding mental health and resilience. Future work is needed to develop the evidence base for compassion in psychopathology, and explore correlates of compassion and psychopathology.     

A review of empirically supported psychosocial interventions for pain and adherence outcomes in sickle cell disease

OBJECTIVE: To review empirical studies of psychological interventions for pain and adherence outcomes among patients with sickle cell disease. METHOD: We conducted a literature review of studies using psychological interventions targeted at pain and/or adherence behaviors related to sickle cell disease. The American Psychological Association Division 12 Task Force criteria (Chambless criteria) were used to evaluate the empirical support for three categories of interventions (cognitive-behavioral techniques, interventions aimed at behavioral change, and social support interventions). RESULTS: A small number of intervention studies met criteria for demonstrating empirical efficacy. As a group, cognitive-behavioral techniques fall into the category of probably efficacious for sickle cell pain. Other intervention types were limited by inadequate research methodologies. CONCLUSIONS: Future studies will need to more stringently test outcomes related to acute crises (e.g., pain episodes) as well as day-to-day management of sickle cell disease to clarify the most efficacious intervention approaches. Implications and suggestions for future research directions are discussed.     

Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review

PurposeImplementations of health information technologies are notoriously difficult, which is due to a range of inter-related technical, social and organizational factors that need to be considered. In the light of an apparent lack of empirically based integrated accounts surrounding these issues, this interpretative review aims to provide an overview and extract potentially generalizable findings across settings.MethodsWe conducted a systematic search and critique of the empirical literature published between 1997 and 2010. In doing so, we searched a range of medical databases to identify review papers that related to the implementation and adoption of eHealth applications in organizational settings. We qualitatively synthesized this literature extracting data relating to technologies, contexts, stakeholders, and their inter-relationships.ResultsFrom a total body of 121 systematic reviews, we identified 13 systematic reviews encompassing organizational issues surrounding health information technology implementations. By and large, the evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes. However, these dimensions are inter-related, requiring a careful balancing act of strategic implementation decisions in order to ensure that unintended consequences resulting from technology introduction do not pose a threat to patients.ConclusionsOrganizational issues surrounding technology implementations in healthcare settings are crucially important, but have as yet not received adequate research attention. This may in part be due to the subjective nature of factors, but also due to a lack of coordinated efforts toward more theoretically-informed work. Our findings may be used as the basis for the development of best practice guidelines in this area.     

Systematic Reviews of Animal Models: Methodology versus Epistemology

Systematic reviews are currently favored methods of evaluating research in order to reach conclusions regarding medical practice. The need for such reviews is necessitated by the fact that no research is perfect and experts are prone to bias. By combining many studies that fulfill specific criteria, one hopes that the strengths can be multiplied and thus reliable conclusions attained. Potential flaws in this process include the assumptions that underlie the research under examination. If the assumptions, or axioms, upon which the research studies are based, are untenable either scientifically or logically, then the results must be highly suspect regardless of the otherwise high quality of the studies or the systematic reviews. We outline recent criticisms of animal-based research, namely that animal models are failing to predict human responses. It is this failure that is purportedly being corrected via systematic reviews. We then examine the assumption that animal models can predict human outcomes to perturbations such as disease or drugs, even under the best of circumstances. We examine the use of animal models in light of empirical evidence comparing human outcomes to those from animal models, complexity theory, and evolutionary biology. We conclude that even if legitimate criticisms of animal models were addressed, through standardization of protocols and systematic reviews, the animal model would still fail as a predictive modality for human response to drugs and disease. Therefore, systematic reviews and meta-analyses of animal-based research are poor tools for attempting to reach conclusions regarding human interventions.     

Effectiveness of multimedia interventions in the provision of patient education on anticoagulation therapy: A review

ObjectiveA literature review was conducted to identify available evidence on the use of multimedia patient educational interventions on anticoagulation therapy.MethodsA literature search was conducted on 9/4/2020 via six research databases. Publications that evaluated the effects of these interventions on anticoagulation therapy were included.ResultsThe review included ten original research studies (five randomized controlled trials, four observational studies and a pre- and post-interventional study), a systematic review and meta-analysis, three systematic reviews, a scoping review, and a literature review.Multimedia interventions significantly improved knowledge after education, but no significant differences found when compared to traditional methods. There was insufficient evidence to conclude whether knowledge retained over time. Patients were equally satisfied with both methods. Multimedia interventions significantly reduced healthcare professional’s time required for education. Heterogeneity in intervention, methodology and results limited comparison and combination of findings across studies.ConclusionMultimedia patient educational interventions on anticoagulation therapy have similar outcomes to traditional methods in knowledge improvement and satisfaction, but they save health personnel time.Practice implicationsThere is lack of evidence to support the effectiveness of multimedia interventions in educating patients on anticoagulation therapy. Larger randomized studies evaluating their benefits in health outcomes and clinical practice are warranted.     

Impacts of climate change on aeroallergens: past and future

Human activities are resulting in increases in atmospheric greenhouse gases, such as carbon dioxide, and changes in global climate. These, in turn, are likely to have had, and will continue to have, impacts on human health. While such impacts have received increasing attention in recent years, the impacts of climate change on aeroallergens and related allergic diseases have been somewhat neglected. Despite this, a number of studies have revealed potential impacts of climate change on aeroallergens that may have enormous clinical and public health significance. The purpose of this review is to synthesize this work and to outline a number of research challenges in this area. There is now considerable evidence to suggest that climate change will have, and has already had, impacts on aeroallergens. These include impacts on pollen amount, pollen allergenicity, pollen season, plant and pollen distribution, and other plant attributes. There is also some evidence of impacts on other aeroallergens, such as mould spores. There are many research challenges along the road to a more complete understanding of the impacts of climate change on aeroallergens and allergic diseases such as asthma and hayfever. It is important that public health authorities and allergy practitioners be aware of these changes in the environment, and that research scientists embrace the challenges that face further work in this area.     

Motivational interviewing to promote interconception health: A scoping review of evidence from clinical trials

BackgroundPromoting interconception health can improve birth outcomes and long-term women’s health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement.ObjectiveThis scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions.MethodsWe searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features.ResultsThere were 37 included studies. Interventions addressed breastfeeding, teen contraception, tobacco, alcohol, or substance use, vaccine acceptance, nutrition, physical activity, and depression. No trials addressed more than one topic. Nineteen studies demonstrated improved outcomes. Interventions during the perinatal or postnatal periods were more likely to demonstrate improved interconception outcomes than interventions in the prenatal period. No other trial characteristics were consistently associated with demonstrating improved outcomes.DiscussionMI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion.Practical valueMI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.