Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials.

OBJECTIVE: To map and evaluate the evidence across meta-analyses of randomized controlled trials (RCTs) of psychotherapies for various outcomes. METHODS: We identified 173 eligible studies, including 247 meta-analyses that synthesized data from 5157 RCTs via a systematic search from inception to December 2016 in the PubMed, PsycINFO and Cochrane Database of Systematic Reviews. We calculated summary effects using random-effects models, and we assessed between-study heterogeneity. We estimated whether large studies had significantly more conservative results compared to smaller studies (small-study effects) and whether the observed positive studies were more than expected by chance. Finally, we assessed the credibility of the evidence using several criteria. RESULTS: One hundred and ninety-nine meta-analyses were significant at P-value ≤ 0.05, and almost all (n = 196) favoured psychotherapy. Large and very large heterogeneity was observed in 130 meta-analyses. Evidence for small-study effects was found in 72 meta-analyses, while 95 had evidence of excess of significant findings. Only 16 (7%) provided convincing evidence that psychotherapy is effective. These pertained to cognitive behavioural therapy (n = 6), meditation therapy (n = 1), cognitive remediation (n = 1), counselling (n = 1) and mixed types of psychotherapies (n = 7). CONCLUSIONS: Although almost 80% meta-analyses reported a nominally statistically significant finding favouring psychotherapy, only a few meta-analyses provided convincing evidence without biases.

A pilot, randomized controlled trial to examine the health outcomes of raisin consumption in patients with diabetes.

OBJECTIVES: Dried fruits, like their fresh homologues, contain relatively high concentrations of antioxidants. The aim of this study was to determine the health outcomes of raisin consumption on patients with diabetes. METHODS: We examined the effects of dried grapes (Vitis vinifera) cultivated in Greece, namely Corinthian Raisins (CR) on blood pressure, fasting glucose, glucated hemoglobin (HbA1c), lipid peroxidation, high-sensitivity C-reactive protein, antioxidant status, and cytokines in patients with type 2 diabetes mellitus (T2DM). Forty-eight well-controlled patients with T2DM from the diabetes outpatient clinic of our hospital were recruited to a two-armed, randomized, controlled, 24-wk prospective intervention trial in order to examine the health outcomes of CR consumption. All participants were reported to consume less fruits and vegetables than the recommended amount of five servings daily. Participants in the intervention were instructed to consume CR equal to two fruit servings (36 g/d), replacing snacks with similar energy density twice during the day. Anthropometric and blood pressure measurements, assessment of dietary intake, and fasting blood draws were conducted at baseline and at week 24. Also, phenolic compounds present in CR were analyzed in plasma of the patients. t Test for parametric data and Mann-Whitney test or Wilcoxon test for non-parametric data were performed. Significance was set at P < 0.05. RESULTS: Body weight, glycemic control, and lipid profile were not affected in either arm. Patients in the CR arm reduced their diastolic blood pressure and increased their total antioxidant potential significantly compared with baseline. The differences between the two groups at week 24 were significant. No change in high-sensitivity C-reactive protein was observed. A significant difference in plasma circulating p-hydroxybenzoic acid was observed between groups at the end of the trial. CONCLUSIONS: Our study shows that naturally CR may improve health features in patients with well-controlled T2DM.

Absorption and bioavailability of antioxidant phytochemicals and increase of serum oxidation resistance in healthy subjects following supplementation with raisins.

The aim of this study was to examine the postprandial impact of raisin supplementation in serum resistance to oxidation of healthy subjects, to quantify the bioavailable phenolic compounds and oleanolic acid. The content of phytochemicals in raisins was determined by GC-MS. Fifteen healthy volunteers who consumed 144 g of raisins were subjected to blood collection at time 0 and 1, 2, 3 and 4 h after consumption. Blood samples were used for the quantification of (a) serum oxidizability (b) plasma total polyphenol content and (c) phenolic compounds and oleanolic acid by applying GC-MS analysis. A total of 25 phytochemicals were identified and quantified in raisins, while the triterpenoid oleanolic acid was present at the highest concentration. The peak of plasma total phenolics and serum oxidation resistance appeared 1 h after raisin supplementation (p < 0.05) and correlated strongly with each other. Seventeen phytochemicals (16 phenolics and oleanolic acid) were clearly identified and quantified in volunteers' plasma. Each compound followed different kinetics, however 13 out of 17 peaked in plasma also 1 h after supplementation. The results indicate that raisins influence antioxidant potential in vivo, while the contained phytochemicals are bioavailable.

Encapsulation of nutraceutical monoterpenes in beta-cyclodextrin and modified starch.

The encapsulation of thymol and geraniol in beta-cyclodextrin (beta-CD) and modified starch (MS) by spray- and freeze-drying was studied. The formation of thymol/beta-CD and geraniol/beta-CD inclusion complexes was confirmed by differential scanning calorimetry (DSC). Oxidative DSC revealed that the monoterpenes enclosed in the beta-CD cavity were protected against oxidation, remaining intact in temperatures at which free monoterpenes were oxidized. Phase solubility studies showed that the inclusion complexes of thymol and geraniol with beta-CD are more soluble in water than the free molecules themselves. Furthermore, in order to evaluate the fraction of monoterpenes that can be released from their complexes with MS in aqueous media, a series of release experiments were conducted.