Psychotherapies for prolonged grief disorder in adults: A systematic review and network meta-analysis.

BACKGROUND: Prolonged grief disorder (PGD), a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Psychotherapies are among the most recommended treatments for PGD, but which should be considered as first-line treatment needs to be clarified. The purpose of this systematic review and network meta-analysis was to synthesize the available evidence to compare five outcomes of different psychotherapies on PGD in adults and identify the optimal psychotherapy modality to inform clinical decision-making for the treatment of PGD. METHOD: A comprehensive search was conducted in 7 databases from inception until March 20th, 2023. In the frequentist framework, pairwise and network meta-analyses using random-effects models were performed for outcomes with 95 % confidence interval (CI). RESULTS: There were 2962 records found and 55 studies (1,0330 participants) assessing 11 different psychological interventions were included. Compared with the waiting list, behavioral therapy (SMD=-1.05; 95 %CI=-1.71, -0.38), third-wave cognitive behavior therapy (SMD=-1.00; 95 %CI =-1.41, -0.58), family therapy (SMD=-0.87; 95 %CI=-1.59, -0.16), psychodynamic therapy (SMD=-0.88; 95 %CI=-1.67, -0.10) and cognitive therapy (SMD=-0.84; 95 %CI=-1.57, -0.12) were statistically effective in reducing grief symptom. Only cognitive behavior therapy (OR =0.48; 95 %CI = 0.27, 0.85) was more acceptable than waiting list. In terms of secondary outcome, third-wave CBT can statistically significantly reduce depression (SMD= -0.60; 95 %CI =- 0.84, -0.36), PTSD (SMD=-0.99; 95 %CI =- 1.62, -0.36) and anxiety (SMD= -1.44; 95 %CI =-2.63, -0.25) respectively. CONCLUSIONS: Most psychological interventions are effective, but only cognitive behavior therapy has the highest acceptability. Third-wave CBT with higher efficacy rates may be more beneficial for reducing secondary outcomes. To provide more robust evidence, high-quality trials should be conducted in the future.

The Best Exercise Modality and Dose to Reduce Glycosylated Hemoglobin in Patients with Type 2 Diabetes: A Systematic Review with Pairwise, Network, and Dose-Response Meta-Analyses.

BACKGROUND: Persistently elevated glycosylated hemoglobin (HbA1c) is associated with a higher risk of long-term vascular complications. OBJECTIVE: We evaluated the effect of different exercise modalities and doses on HbA1c levels in patients with type 2 diabetes. METHODS: A systematic search for randomized controlled trials involving exercise interventions in patients with type 2 diabetes was conducted across seven electronic databases, encompassing data from their inception up to October 2023. Two independent reviewers assessed the quality of the literature. Pairwise, network, and dose-response meta-analyses using the random-effects model were conducted to analyze the effect of exercise on HbA1c levels. RESULTS: A total of 85 randomized controlled trials with 5535 participants were included. The network meta-analysis showed that high-intensity interval training (HIIT) has the highest ranked (MD = - 0.78% [- 8.50 mmol/mol]; 95% CrI: - 1.04, - 0.51), followed by combined aerobic and resistance exercise (CE) (MD = - 0.54% [- 5.90 mmol/mol]; 95% CrI: - 0.69, - 0.40), yoga (MD = - 0.45% [- 4.92 mmol/mol]; 95% CrI: - 0.77, - 0.13), and continuous aerobic exercise (CAE) (MD = - 0.42% [- 4.58 mmol/mol]; 95% CrI: - 0.54, - 0.30). In addition, a significant improvement in HbA1c levels can be observed when the total exercise dose reaches 840 metabolic equivalent of tasks-min/week. CONCLUSIONS: There was low-quality evidence that HIIT, CE, yoga, and CAE may be effective treatment modalities for improving HbA1c in patients with type 2 diabetes, and there was no significant difference in efficacy. Moreover, a non-linear dose-response relationship was found for total exercise and HbA1c levels. Future research should further investigate the specific effects of different exercise doses on HbA1c levels in patients with type 2 diabetes and provide a more personalized exercise prescription.

The association between childhood adverse experiences and internet addiction: A meta-analysis.

Many studies have explored the association between adverse childhood experiences (ACEs) and Internet addiction (IA), yet the research findings on the association between them are inconclusive. We conducted a systematic search on 7 databases to identify the relevant studies published until January 2023, and analyzed the findings from 37 studies across 12 countries involving 45,364 participants aged 8 to 67 years (51 % women). Results indicated a positive correlation (r = 0.21) was found between ACE and IA around the world, which differed among continents. It was found that all ACE subtypes were significantly associated with IA (range r = 0.16 to 0.25). Meta-regression showed a stronger association among younger individuals without moderating effects of gender or publication year. In conclusion, this study sheds light on the significant association between ACEs and IA, emphasizing the need for targeted interventions and preventive measures. Future research could delve into specific interventions aimed at mitigating the impact of ACEs on IA, such as cognitive-behavioral therapies or metacognitive therapy interventions. Additionally, investigating cultural factors that may influence this association could provide valuable insights into tailored approaches for different populations. Understanding these dynamics is crucial for developing effective strategies to address IA and its underlying factors.

Running economy and lower extremity stiffness in endurance runners: A systematic review and meta-analysis.

Background: Lower extremity stiffness simulates the response of the lower extremity to landing in running. However, its relationship with running economy (RE) remains unclear. This study aims to explore the relationship between lower extremity stiffness and RE. Methods: This study utilized articles from the Web of Science, PubMed, and Scopus discussing the relationships between RE and indicators of lower extremity stiffness, namely vertical stiffness, leg stiffness, and joint stiffness. Methodological quality was assessed using the Joanna Australian Centre for Evidence-Based Care (JBI). Pearson correlation coefficients were utilized to summarize effect sizes, and meta-regression analysis was used to assess the extent of this association between speed and participant level. Result: In total, thirteen studies involving 272 runners met the inclusion criteria and were included in this review. The quality of the thirteen studies ranged from moderate to high. The meta-analysis results showed a negative correlation between vertical stiffness (r = -0.520, 95% CI, -0.635 to -0.384, p < 0.001) and leg stiffness (r = -0.568, 95% CI, -0.723 to -0.357, p < 0.001) and RE. Additional, there was a small negative correlation between knee stiffness and RE (r = -0.290, 95% CI, -0.508 to -0.037, p = 0.025). Meta-regression results showed that the extent to which leg stiffness was negatively correlated with RE was influenced by speed (coefficient = -0.409, p = 0.020, r 2 = 0.79) and participant maximal oxygen uptake (coefficient = -0.068, p = 0.010, r 2 = 0.92). Conclusion: The results of this study suggest that vertical, leg and knee stiffness were negatively correlated with RE. In addition, maximum oxygen uptake and speed will determine whether the runner can take full advantage of leg stiffness to minimize energy expenditure.

The effect of exercise on walking economy in patients with chronic neurological conditions: A systematic review and meta-analysis.

Introduction: To investigate the effect of exercise on the walking economy (WE) of patients with chronic neurological conditions (CNCs) and to determine the type of physical activity that best improves the WE of patients with CNCs. Methods: Four electronic databases were searched until December 2022 (Web of Science, PubMed, Cochrane, and CINAHL). Studies were screened using the following inclusion criteria: 1. randomized controlled or non-randomized controlled trials; 2. exercise interventions >4 weeks in duration; 3. patients aged ≥18 years with a diagnosis of CNCs. 4. walking economy of patients measured before and after the intervention. The PEDro scale was used to assess the methodological quality of the included studies. Results and discussion: Twenty-two studies met the inclusion criteria. Meta-analysis results showed that exercise significantly improved WE (g = -0.352, 95% CI, -0.625 to -0.078, P = 0.012). Subgroup analysis revealed that patients who received exercise showed better WE compared with those who underwent no control intervention (g = -0.474, 95% CI, -0.636 to -0.311, P < 0.001). However, exercise therapy did not show a significant improvement of WE compared with control groups (g = -0.192, 95% CI, -0.451 to 0.067, P = 0.146). In addition, we found that endurance combined with resistance, high-intensity intermittent, and other training modalities resulted in better WE compared with the pre-intervention. Of these, interval training has the greatest effect on improving WE. In conclusion, exercise can improve WE in patients with CNCs. More randomized controlled trials are necessary for the future. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022361455, identifier: CRD42022361455.