Effectiveness of family psychosocial intervention on mental health and family function of caregivers of children with cancer: a meta-analysis†
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Abstract Objective To evaluate the effect of family psychosocial intervention on the mental health and family function of caregivers of children with cancer. Methods A comprehensive literature search of CNKI, Wanfang, VIP, CMB, PubMed, Web of Science, MEDLINE, Embase, Cochrane Library, and PsycARTICLES was conducted to retrieve randomized controlled trials of family psychosocial intervention from database inception until 19 September 2021. RevMan (version 5.4.1) was used to analyze the data. Results A total of 894 caregivers participated in 11 studies. The analysis showed that anxiety (standardized mean difference [SMD] = −0.22, 95% confidence interval [CI] = −0.37 to -0.07, P = 0.004) and depression (SMD = −0.33, 95% CI = −0.57 to -0.08, P = 0.01) were significantly reduced, while family function (SMD = −0.86, 95% CI = −1.28 to -0.45, P < 0.001) was significantly improved by the family psychosocial intervention compared with the controls. According to subgroup analysis, family psychosocial interventions were found to reduce posttraumatic stress disorder (PTSD) symptoms when the follow-up time was >1 month (SMD = −0.48, 95% CI = 0.68 to -0.27, P < 0.00001). Conclusions Current evidence supports the use of family psychological intervention to reduce depression and anxiety and improve family function. However, its effect on PTSD symptoms requires further study. Future studies should further identify the role of specific family psychosocial interventions on families and caregivers of children with cancer.Keywords:
Depression
Subgroup analysis
PsycINFO
Montreal Cognitive Assessment
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To explore the role and application of Meta-regression and subgroup analyses to recognize and control the heterogeneity in Meta-analysis, Meta-regression models were established by secondary data to screen the factors resulting heterogeneity,and subgroup analyses were used to compare the change of heterogeneity before and after.The heterogeneity was found in the Meta-analysis(Q=44.71,df=27,P=0.017).Sample size and region were selected(P=0.012 and P=0.091,respectively)by Meta-regression from many possible factors such as sample size,year,region and case/contml ratio.The Q values were lowered from 44.71 to 32.11 after subgroup analyses.Thus,Metaregression method was convenient and reliable to screen the affected factors of heterogeneity,and subgroup analyses based on the hypothesis that could significantly lower the heterogeneity.It was recommended to a combined use when an obvious heterogeneity existed but was in need to get an overall result in Metaanalysis.We could correctly judge and lower the heterogeneity to increase the robustness and rationality of results from Meta-analysis.
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Meta-analysis; Heterogeneity; Meta-regression; Subgroup analyses
Meta-regression
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Study heterogeneity
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Background. In recent years, traditional Chinese exercises (TCEs) have been gradually used to reduce the blood pressure levels of patients with essential hypertension. However, there are several types of TCEs, and there is no comparative study on the antihypertensive effects of various TCEs in patients with essential hypertension. Objective. The objective is to compare the therapeutic effects of Taijiquan (TJQ), Baduanjin (BDJ), Wuqinxi (WQX), and Yijinjing (YJJ) on essential hypertension and provide a reference for clinical treatment and scheme optimization. Methods. The China National Knowledge Infrastructure (CNKI), Wanfang, China Scientific Journal Database, China Biology Medicine database (CBM), PubMed, Embase, Cochrane Library, and Web of Science databases were searched to collect all randomized controlled trials (RCTs) of TCEs in the treatment of essential hypertension. The search time was from the establishment of each database to November 2021. After data extraction and quality evaluation, the network meta-analysis was performed with Stata 16.0 and ADDIS 1.16.8. Results. Finally, 45 RCTs involving 3864 patients were included. Network meta-analysis showed that YJJ had the best effect in reducing systolic blood pressure, and the difference was statistically significant [MD = −14.27, 95% CI = (−20.53∼−8.08), ]. The best probability ranking was YJJ ( ) > TJQ ( ) > WQX ( ) > BDJ ( ). In terms of reducing diastolic blood pressure, the treatment effect of YJJ was the best, and the difference was statistically significant [MD = −7.77, 95% CI (−12.19∼−3.33), ]. The best probability ranking was YJJ ( ) > TJQ ( ) > WQX ( ) > BDJ ( ). Conclusion. The results showed that TCEs significantly reduced systolic and diastolic blood pressure compared with the control group, and YJJ might be the best choice. However, a larger sample, multicenter, double-blinded, high-quality RCTs are needed to make clear conclusions.
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Essential hypertension
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Atrial fibrillation (AF) is one of the most common persistent arrhythmia, and its complications include cerebral embolism, arterial embolism and heart failure. Some studies have found that elevated Homocysteine (HCY) levels is a new risk factor for AF. Currently, there is no meta-analysis to explore whether the HCY levels is related to AF. Therefore, a meta-analysis was conducted to evaluate the relationship between the HCY levels and AF, in order to draw the attention of clinicians to the HCY levels. A meta-analysis was performed in the study to evaluated the association between the HCY levels and AF. In order to identify eligible original articles, The EMBASE, PubMed, and web of science were systematically searched until November 2020. All data were analyzed with Review Manager 5.3. The meta-analysis results were evaluated depending on standardized mean differences (SMD) with 95% confidence intervals (CI). Moreover, the subgroup analysis and sensitivity analysis were also analyzed. The HCY levels was significantly associated with AF (WMD = 0.81, 95% CI: 0.58 to 1.03; P < .00001). In the analysis, there was a medium degree of heterogeneity (I2 = 73%). Subgroup analysis showed that female < 60, BMI≥25, BMI <25, age ≥60 and publication year ≥2010 were identified as possible sources of heterogeneity. Sensitivity analysis showed that the main results remained unchanged after omitting any single study or converting the random effects model (REM) to fixed effects model (FEM). The meta-analysis showed that there is a significant correlation between the HCY levels and AF, and the role of HCY in AF patients should not be ignored in clinical.
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Hyperhomocysteinemia
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Abstract Current reports on the changes in peripheral blood regulatory T cell (Tregs) to CD4 + T cell ratio in systemic sclerosis (SSc) patients are varied in their conclusions. We therefore performed a meta-analysis to identify the actual change in the proportion of peripheral Tregs in SSc. Three databases, namely EMBASE, ISI web of knowledge, and Pubmed were systematically searched for relevant literature. Approximately 250 SSc patients and controls from several studies were included in this analysis. Comprehensive Meta Analysis Version 2.0 software was used to conduct the meta-analysis. Six studies were included in the meta-analysis. Results of the meta-analysis showed high degree of heterogeneity ( I 2 = 96.98), and a random-effect model was used in the subsequent analysis. The ratio of circulating Tregs to CD4 + T cell in SSc was lower than in controls, but not statistically significantly so (−0.61 ± 0.94, P = 0.52). Subgroup analysis did not identify any potential source of heterogeneity. This meta-analysis indicated that Tregs might play a less prominent immunosuppressive role in the immune system in SSc patients, but needs further confirmation.
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Many studies suggest that the Gln261Arg polymorphism in 12-lipoxygenase gene is assicated with cancer susceptibility, but the results are inconclusive. This meta-analysis aimed to investigate the overall association between the Gln261Arg polymorphism in 12-lipoxygenase gene and cancer risk.Literature search was performed in Pubmed, Embase and other databases for studies evaluating the association between the Gln261Arg polymorphism in 12-lipoxygenase gene and cancer risk. Data were extracted and statistical analysis was performed using STATA 12.0 software.A total of eight publications involving 8,379 subjects were included in this meta-analysis. Combined analysis revealed a significant association between this polymorphism and cancer susceptibility with an OR of 1.19 (95% CI: 1.09-1.31, P=0.000 for Gln/Gln vs. Arg/Gln + Arg/Arg). Subgroup analysis by ethnicity showed that the cancer risk associated with the Gln261Arg polymorphism in 12-lipoxygenase gene was significantly elevated among Asians (OR=1.21, 95% CI: 1.10-1.34, P=0.000 for Gln/Gln vs. Arg/Gln + Arg/Arg), but not among Caucasians. Subgroup analysis by cancer type suggested that the Gln261Arg polymorphism in 12-lipoxygenase gene is not a risk factor for colon cancer or rectal cancer.This meta-analysis suggests that the Gln261Arg polymorphism in 12-lipoxygenase gene contributes to cancer susceptibility, specifically in Asian populations. More studies are needed to validate our findings.
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Gene polymorphism
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Results of published studies on the association between the miR-146a rs2910164 polymorphism and the risk of hepatocellular carcinoma (HCC) were inclusive. We performed a meta-analysis. A literature research was conducted using PubMed, Cochrane Library, Ovid, Embase, Wanfang and China National Knowledge Infrastructure (CNKI) databases, to identify studies. Statistical analyses were conducted in STATA version 11.0 (Stata Corporation, College station, TX, USA). A total of 12 publications were included in this meta-analysis. The results of this meta-analysis suggested that miR-146a rs2910164 was associated with an increased risk of HCC (OR = 1.09, 95% CI = 1.00-1.19). In sensitivity analysis, the result was still positive when excluding the studies without HWE (OR = 1.12, 95% CI = 1.01-1.23). In conclusion, this meta-analysis suggested a significant association between miR-146a rs2910164 polymorphism and HCC risk.
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Cochrane collaboration
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Objectives: Individual patient data (IPD) meta-analyses have been proposed as a major improvement in meta-analytic methods to study subgroup effects. Subgroup effects of conventional and IPD meta-analyses using identical data have not been compared. Our objective is to compare such subgroup effects using the data of six trials ( n = 1,643) on the effectiveness of antibiotics in children with acute otitis media (AOM). Methods: Effects (relative risks, risk differences [RD], and their confidence intervals [CI]) of antibiotics in subgroups of children with AOM resulting from (i) conventional meta-analysis using summary statistics derived from published data (CMA), (ii) two-stage approach to IPD meta-analysis using summary statistics derived from IPD (IPDMA-2), and (iii) one-stage approach to IPD meta-analysis where IPD is pooled into a single data set (IPDMA-1) were compared. Results: In the conventional meta-analysis, only two of the six studies were included, because only these reported on relevant subgroup effects. The conventional meta-analysis showed larger (age < 2 years) or smaller (age ≥ 2 years) subgroup effects and wider CIs than both IPD meta-analyses (age < 2 years: RD CMA -21 percent, RD IPDMA-1 -16 percent, RD IPDMA-2 -15 percent; age ≥2 years: RD CMA -5 percent, RD IPDMA-1 -11 percent, RD IPDMA-2 -11 percent). The most important reason for these discrepant results is that the two studies included in the conventional meta-analysis reported outcomes that were different both from each other and from the IPD meta-analyses. Conclusions: This empirical example shows that conventional meta-analyses do not allow proper subgroup analyses, whereas IPD meta-analyses produce more accurate subgroup effects. We also found no differences between the one- and two-stage meta-analytic approaches.
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