Metaanalysis and metaregression in interpreting study variability in the impact of sexually transmitted diseases on susceptibility to HIV infection

BACKGROUND: Observational studies examining the effects of other sexually transmitted diseases (STDs) on HIV susceptibility differ in the populations observed and in which "other STDs" are examined. The extent to which an STD alters the risk of transmission of HIV may vary according to disease and population characteristics. GOALS: The goals of this study were to review studies examining the effect of other STDs on HIV-1 susceptibility and to correlate their effect estimates with type of "other STD", study design, and population characteristics. STUDY: Relevant studies with longitudinal design were identified through a systematic search of the PubMed database, and their evidence was critically evaluated. Metaregression techniques were then used to correlate study characteristics with corresponding effect estimates. RESULTS: Of 31 studies included, 4 contained direct data on exposure to HIV-1. Three of these were inconclusive, the fourth indicating a strong relationship between STDs and transmission of HIV. Pooled effect estimates using all studies are statistically significant and indicate a 2- to 3-fold increase in risk of HIV-1 acquisition. Effect estimates corresponding some of the "other STD" categories exhibit heterogeneity, but no significant associations with study characteristics were found. CONCLUSIONS: Most of the studies lack direct exposure data, lending them susceptible to exposure bias. Another problem may be measurement error about risk factors and STD status at time of HIV-1 infection. Because direct exposure data are difficult to come by (4 of 31 studies contained such data, all but 1 inconclusive), future observational studies on the influence of STDs on HIV-1 transmission should include quantitative analyses of the sensitivity of results to potential confounding and measurement error if they are to further understanding.     

Eating disorder risk during behavioral weight management in adults with overweight or obesity: A systematic review with meta-analysis

This systematic review examined change in eating disorder risk during weight management interventions. Four databases and clinical trials registries were searched in March and May 2022, respectively, to identify behavioral weight management intervention trials in adults with overweight/obesity measuring eating disorder symptoms at pre- and post-intervention or follow-up. Random effects meta-analyses were conducted examining within group change in risk. Of 12,023 screened, 49 were eligible (n = 6337, mean age range 22.1 to 59.9 years, mean (SD) 81(20.4)% female). Interventions ranged from 4 weeks to 18 months, with follow-up of 10 weeks to 36 months post-intervention. There was a within group reduction in global eating disorder scores (20 intervention arms; Hedges' g = −0.27; 95% CI −0.36, −0.17; I² 67.1%) and binge eating (49 intervention arms; −0.66; 95% CI −0.76, −0.56; I² 82.7%) post-intervention, both maintained at follow-up. Of 14 studies reporting prevalence or episodes of binge eating, all reported a reduction. Four studies reported eating disorder symptoms, not present at baseline, in a subset of participants (0%–6.5%). Overall, behavioral weight management interventions do not increase eating disorder symptoms for most adults; indeed, a modest reduction is seen post-intervention and follow-up. A small subset of participants may experience disordered eating; therefore, monitoring for the emergence of symptoms is important.     

Guidelines for the management of traumatic dental injuries. I. Fractures and luxations of permanent teeth

Crown fractures and luxations occur most frequently of all dental injuries. An appropriate treatment plan after an injury is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases where the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence, based on literature research and professional opinion. In this first article of three, the IADT Guidelines for management of fractures and luxations of permanent teeth will be presented.