Meta-análisis: Intervalos de confianza e Intervalos de predicción / Meta-analysis: Confidence intervals and Prediction intervals

En los informes meta-analíticos se suelen reportar varios tipos de intervalos, hecho que ha generado cierta confusión a la hora de interpretarlos. Los intervalos de confianza reflejan la incertidumbre relacionada con un número, el tamaño del efecto medio paramétrico. Los intervalos de predicción reflejan el tamaño paramétrico probable en cualquier estudio de la misma clase que los incluidos en un meta-análisis. Su interpretación y aplicaciones son diferentes. En este artículo explicamos su diferente naturaleza y cómo se pueden utilizar para responder preguntas específicas. Se incluyen ejemplos numéricos, así como su cálculo con el paquete metafor en R.(AU)

Several types of intervals are usually employed in meta-analysis, a fact that has generated some confusion when interpreting them. Confidence intervals reflect the uncertainty related to a single number, the parametric mean effect size. Prediction intervals reflect the probable parametric effect size in any study of the same class as those included in a meta-analysis. Its interpretation and applications are different. In this article we explain in de-tail their different nature and how they can be used to answer specific ques-tions. Numerical examples are included, as well as their computation with the metafor Rpackage.(AU)

Acute anterior cruciate ligament rupture: can repair become an alternative to reconstruction: a meta-analysis of randomized controlled trials and cohort studies.

PURPOSE: To perform a meta-analysis to compare clinical outcomes of anterior cruciate ligament (ACL) repair and ACL reconstruction for acute ACL rupture. METHOD: We searched Pubmed, Embase, the Cochrane Library, and Web of Science databases to seek relevant studies. Clinical outcomes included failure rate, hardware removal rate, anteroposterior (AP) knee laxity, and patient-reported outcomes. In addition, subgroup analysis was carried out according to repair techniques, rupture locations, and study designs. Funnel plots were used to detect publication bias. All statistical analysis was performed using STATA (version 14.2, StataCorp). RESULTS: A total of 10 articles were included in this study, comprising 5 randomized controlled trials (RCTs) and 5 cohort studies, involving a total of 549 patients. We found no statistical differences between the ACL repair and ACL reconstruction in the following outcomes: failure rate, AP knee laxity, International Knee Documentation Committee (IKDC) score, Lysholm score, Knee Injury and Osteoarthritis Outcome (KOOS) Score, and Tegner score. However, the ACL repair group had a higher hardware removal rate. Except for AP knee laxity results on different repair techniques, there was no statistical difference in other subgroup analyses. CONCLUSION: Compared with ACL reconstruction, ACL repair shows similar results in clinical outcomes, and it is promising to be an effective alternative treatment for acute ACL rupture. Larger samples and higher-quality studies are needed to support our results and further explore the advantages of ACL repair in other aspects. LEVEL OF EVIDENCE: Level III.

International Cross-Temporal Meta-Analysis of Assortative Mating for Educational Attainment.

Previous studies have found a high degree of assortative mating for educational attainment (r = .56). However, this can be confounded by cohort effects or country effects, where certain nations may have more pronounced assortative mating than others. In addition, method variance regarding how educational attainment is measured may also result in heterogeneity of effect sizes. Effect sizes were gathered from various datasets and from academic literature, resulting in a large collection of effect sizes (k = 1498, n = 9,159,098), spanning 84 different countries. Assortative mating for educational attainment was stronger than what previous literature suggested (r = .66, [.64, .68]), largely due to the fact that assortative mating for educational attainment is stronger when latent methods are used. The strongest predictors of assortative mating for education between countries were individualism (r = -.61, p < .001) and HDI (r = -.56, p < .001). Assortative mating over time was found to vary by region. Capitalist Europe experienced an increase in assortative mating for education, while Communist Europe experienced a decrease. The United States had a non-linear trend in assortative mating for educational attainment, as it decreased from 1875 to 1926, increased from 1926 to 1945, decreased from 1945 to 1958, increased from 1958 to 1977, and decreased from 1977 onwards.

Evidence Construction of Chuankezhi Injection Against Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Pharmacology.

Objective: Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence, morbidity, and mortality. Chuankezhi (CKZ) injection, a Chinese patent medicine, has been commonly used for treating COPD. This study evaluated the clinical efficacy of CKZ injections in COPD patients and explored potential underlying mechanisms by integrating meta-analysis and network pharmacology. Research Methods: Randomized controlled trials (RCTs) were search in database by Web of Science, Cochrane Library and PubMed as of November 2022 for literature collection, and the Review Manager 5.4 was used to analyze the data. Through the network pharmacology method, the chemical components and their targets, as well as the disease targets were further analyzed. Results: A total of 15 RCTs including 1212 patients were included. The results of meta-analysis showed that CKZ injection can significantly improve the clinical effective rate (RR = 1.25, 95% CI: 1.14 to 1.36), and the clinical advantage was that it can significantly reduced acute exacerbation rate (RR = 0.29, 95% CI: 0.12 to 0.70) and COPD assessment test (CAT) scores (MD =-4.62, 95% CI:-8.966 to-0.28). A total of 31 chemical compounds and 178 potential targets for CKZ injection were obtained from the online databases. Molecular docking revealed that most key components and targets could form stable structure. Conclusion: This systematic review with meta-analysis and network pharmacology demonstrates that CKZ could effectively improve the clinical efficacy and safety in the treatment of COPD. Such efficacy may be related to an anti-inflammatory effect and immunoregulation of CKZ via multiple components, multiple targets and multiple pathways.

The worldwide trend in diabetes awareness, treatment, and control from 1985 to 2022: a systematic review and meta-analysis of 233 population-representative studies.

Background: With the rapid increase in the prevalence of DM, studies on the awareness, treatment, and control of this condition are essential. Therefore, this study aimed to review the literature and pool the awareness, treatment, and control of diabetes at the global, regional, and national levels. Methods: In this systematic review and meta-analysis, several databases, including MEDLINE/PubMed, Institute of Scientific Information (ISI), Scopus, and Google Scholar, were searched using appropriate keywords up to June 2022. Observational studies investigating the awareness, treatment, and control of glucose levels among diabetic individuals were included. Awareness, treatment, and control were defined as the proportion of participants who were aware of their diabetes condition, treated pharmacologically, and achieved adequate glucose control, respectively. Two investigators independently conducted the study selection, data extraction, and quality assessment. Heterogeneity among studies was calculated using Chi-square, and a random-effect meta-analysis was used to pool the rates. Results: A total of 233 studies published between 1985 and 2022 met the inclusion criteria. The included studies had a combined population of 12,537,968. The pooled awareness of DM was 60% (95%CI: 56-63) and ranged from 41% (25-57) in low-income countries to 68% (64-72) in high-income countries, with no significant trend observed over the assessed periods at the global level. The pooled treatment of DM globally was 45% (42-48) and varied from 37% (31-43) in lower-middle-income countries to 53% (47-59) in high-income countries, showing variation over the examined time period. Before 2000, the proportion of adequate DM control was 16% (12-20), which significantly improved and reached 22% (19-25) after 2010. The pooled awareness, treatment, and control of DM were higher in females, high-income countries, and urban areas compared to males, upper and lower-middle-income countries, and rural areas, respectively. The older adults population had higher awareness and treatment rates than the adult population, but their DM control did not differ significantly. Conclusion: Despite the high level of awareness and treatment among the diabetic population, treatment success (control) is considerably low, particularly in low-income countries and rural areas. It is crucial to improve awareness, treatment, and control by strengthening the primary care system in all countries.

Clinical and Radiological Outcomes of Computer-Assisted Navigation in Primary Total Knee Arthroplasty for Patients with Extra-articular Deformity: Systematic Review and Meta-Analysis.

Background: Computer-assisted navigation surgery (CAS) during primary total knee arthroplasty (TKA) may help improve outcomes for patients with extra-articular deformity (EAD); however, this has not been extensively studied. Therefore, we aimed to investigate the clinical and radiological outcomes following primary TKA using CAS in patients with EAD. Methods: We searched Medline, Embase, and the Cochrane Library up to March 3, 2023 for studies investigating surgical outcomes of using the navigation system for TKA to treat patients with EAD. From 14 studies, 539 knees with EAD that underwent navigation TKA were enrolled. We investigated the knee range of motion (ROM), outcome scores at final follow-up (Knee Society Score [KSS] and Knee Functional Score [KFS]), and pre- and postoperative mechanical hip-knee-ankle (mHKA) angle using lower extremity scanogram. The meta-analysis was based on the single-arm method, and all data were pooled using a random-effects model. Results: Following our meta-analyses, the mean knee ROM changed from 87.0° (95% confidence interval [CI], 75.9°-98.1°) preoperatively to 109.4° (95% CI, 97.9°-120.8°) postoperatively. The adjusted KSS was 93.45 points (95% CI, 88.36-98.54 points), and the adjusted KFS was 91.57 points (95% CI, 86.80-96.33 points) in knees with EAD that underwent CAS-TKA. As a radiological outcome, the mHKA angle changed from 169.53° (95% CI, 166.90°-172.16°) preoperatively to 178.81° (95% CI, 178.31°-179.30°) postoperatively. Conclusions: CAS-TKA yielded positive clinical results and demonstrated a satisfactory alignment of the lower limb's mechanical axis. CAS-TKA showed promise for primary TKA procedures, demonstrating favorable clinical and radiological outcomes even in complex cases involving EAD.

The Frequency of Neuropsychiatric Sequelae After Traumatic Brain Injury in the Global South: A systematic review and meta-analysis.

This study aimed to assess the prevalence of neuropsychiatric sequelae following traumatic brain injury (TBI) among the Western Asian, South Asian and African regions of the global south. All studies on psychiatric disturbances or cognitive impairment following TBI conducted (until August 2021) in the 83 countries that constitute the aforementioned regions were reviewed; 6 databases were selected for the literature search. After evaluating the articles using the Joanna Briggs Institute guidelines, the random effects model was used to estimate the prevalence of depression, anxiety, post-traumatic stress disorder (PTSD), TBI-related sleep disturbance (TBI-SD), obsessive-compulsive disorder (OCD) and cognitive impairment. Of 56 non-duplicated studies identified in the initial search, 27 were eligible for systematic review and 23 for meta-analysis. The pooled prevalence of depression in 1,882 samples was 35.35%, that of anxiety in 1,211 samples was 28.64%, that of PTSD in 426 samples was 19.94%, that of OCD in 313 samples was 19.48%, that of TBI-SD in 562 samples was 26.67% and that of cognitive impairment in 941 samples was 49.10%. To date, this is the first critical review to examine the spectrum of post-TBI neuropsychiatric sequelae in the specified regions. Although existing studies lack homogeneous data due to variability in the diagnostic tools and outcome measures utilised, the reported prevalence rates are significant and comparable to statistics from the global north.

Efficacy of daprodustat for patients on dialysis with anemia: systematic review and network meta-analysis.

Chronic kidney disease (CKD) is commonly complicated by anemia. Treating dialysis-dependent patients with anemia, including daprodustat and other inhibitors of prolyl hydroxylase of hypoxia-inducible factor, recombinant human erythropoietin (rhEPO), and iron supplements. We conducted this study to test our postulation; daprodustat is superior to rhEPO and other conventional treatments respecting efficacy and safety parameters. We made systematic search through PubMed, Web of Science, Scopus, and Cochrane. Seven unique trials were eventually included for systematic review; six of them with a sample size of 759 patients entered our network meta-analysis (NMA). Daprodustat 25-30 mg was associated with the greatest change in serum hemoglobin (MD=1.86, 95%CI= [1.20; 2.52]), ferritin (MD= -180.84, 95%CI= [-264.47; -97.20]), and total iron binding capacity (TIBC) (MD=11.03, 95%CI= [3.15; 18.92]) from baseline values. Dialysis-dependent patients with anemia had a significant increment in serum Hemoglobin and TIBC and a reduction in serum ferritin, in a dose-dependent manner, when administered daprodustat.

Incidence, Risk, and Clinical Course of New-Onset Diabetes in Long COVID: Protocol for a Systematic Review and Meta-Analysis of Cohort Studies.

BACKGROUND: COVID-19, an infectious disease pandemic, affected millions of people globally, resulting in high morbidity and mortality. Causing further concern, significant proportions of COVID-19 survivors endure the lingering health effects of SARS-CoV-2, the pathogen that causes COVID-19. One of the diseases manifesting as a postacute sequela of COVID-19 (also known as "long COVID") is new-onset diabetes. OBJECTIVE: The aim of this study is to examine the incidence of new-onset diabetes in patients with long COVID and assess the excess risk compared with individuals who tested negative for COVID-19. The study also aims to estimate the population-attributable fraction for COVID-19 as a risk factor for new-onset diabetes in long COVID and investigate the clinical course of new-onset diabetes cases. METHODS: This is a protocol for a systematic review and meta-analysis. PubMed, MEDLINE, Embase, Scopus, and Web of Science databases will be systematically searched to identify articles published between December 2019 and July 2024. A comprehensive search strategy for each database will be developed using a combination of Medical Subject Headings terms, subject headings, and text words to identify eligible studies. Cohort studies and randomized controlled trials (only control arms) involving patients with COVID-19 of any age, with follow-up data on new-onset diabetes in long COVID, will be considered for inclusion. Controls will comprise individuals who tested negative for COVID-19, with or without other respiratory tract infections. Three independent reviewers (AST, NB, and TT) will perform article selection, data extraction, and quality assessment of the studies. A fourth reviewer (ST) will review the identified studies for final inclusion in the analysis. The random-effects DerSimonian-Laird models will be used to estimate the pooled incidence proportion (%), incidence rate of diabetes (per 1000 person-years), and risk ratio (with 95% CIs) for diabetes incidence. RESULTS: A total of 1972 articles were identified through the initial search conducted in August 2023. After excluding duplicates, conducting title and abstract screening, and completing full-text reviews, 41 articles were found to be eligible for inclusion. The search will be updated in July 2024. Currently, data extraction is underway, and the meta-analysis is expected to be completed in August 2024. Publication of the study findings is anticipated by the end of 2024. CONCLUSIONS: The study findings should provide valuable insights to inform both clinical practice and public health policies regarding the effective management of new-onset diabetes in patients with long COVID. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54853.

The impact of telehealth care on escalation to emergency care: A systematic review and meta-analysis.

OBJECTIVE: We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care. METHODS: We searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes. RESULTS: Ten trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores.Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high. CONCLUSIONS: Telehealth care - delivered by telephone or by video - may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.

Industrial workers and bullying: a systematic review and meta-analysis of workplace violence.

Workplace violence is a significant problem in industry, especially among rank-and-file workers, known as "blue-collar workers". This systematic review and meta-analysis aim to evaluate the suitability of the reduced Negative Acts Questionnaire (NAQ-R) as an instrument to measure workplace violence in this type of population and synthesize the results of studies that have used it in different industrial sectors. A systematic review was conducted in accordance with the PRISMA 2020 statement. Publications describing populations of industrial workers were identified and included in the meta-analysis. For meta-analysis, we extracted data that allowed us to estimate the effect size of the included studies. We used a random-effects model to estimate the overall effect size and assessed heterogeneity between studies using the I² statistic. The global effect size test showed that the overall effect size was significantly different from zero (3.00, t=22.28, p<0.001), indicating an overall effect in relation to workplace violence measured by the NAQ-R in industrial workers. Our results support the claim that the NAQ-R is an effective tool for assessing workplace violence among industrial workers. These findings have important implications for practitioners and researchers working in the field of industrial psychology and occupational health.

Comparison for the diagnostic performance of early diagnostic methods for biliary atresia: a systematic review and network meta-analysis.

BACKGROUND: Biliary atresia (BA), a progressive condition affecting canalicular-bile duct function/anatomy, requires prompt surgical intervention for favorable outcomes. Therefore, we conducted a network meta-analysis of common diagnostic methods to assess their performance and provide evidence-based support for clinical decision-making. METHODS: We reviewed literature in PubMed, EMBASE, and Cochrane for BA diagnostics. The search included gamma-glutamyl transferase (GGT), direct/combined bilirubin, matrix metalloproteinase 7 (MMP-7), ultrasonic triangular cord sign (TCS), hepatic scintigraphy (HS), and percutaneous cholangiocholangiography/percutaneous transhepatic cholecysto-cholangiography (PCC/PTCC). QUADAS-2 assessed study quality. Heterogeneity and threshold effect were evaluated using I2 and Spearman's correlation. We combined effect estimates, constructed SROC models, and conducted a network meta-analysis based on the ANOVA model, along with meta-regression and subgroup analysis, to obtain precise diagnostic performance assessments for BA. RESULTS: A total of 40 studies were included in our analysis. GGT demonstrated high diagnostic accuracy for BA with a sensitivity of 81.5% (95% CI 0.792-0.836) and specificity of 72.1% (95% CI 0.693-0.748). Direct bilirubin/conjugated bilirubin showed a sensitivity of 87.6% (95% CI 0.833-0.911) but lower specificity of 59.4% (95% CI 0.549-0.638). MMP-7 exhibited a total sensitivity of 91.5% (95% CI 0.893-0.934) and a specificity of 84.3% (95% CI 0.820-0.863). TCS exhibited a sensitivity of 58.1% (95% CI 0.549-0.613) and high specificity of 92.9% (95% CI 0.911-0.944). HS had a high sensitivity of 98.4% (95% CI 0.968-0.994) and moderate specificity of 79.0% (95% CI 0.762-0.816). PCC/PTCC exhibited excellent diagnostic performance with a sensitivity of 100% (95% CI 0.900-1.000) and specificity of 87.0% (95% CI 0.767-0.939). Based on the ANOVA model, the network meta-analysis revealed that MMP-7 ranked second overall, with PCC/PTCC ranking first, both exhibiting superior diagnostic accuracy compared to other techniques. Our analysis showed no significant bias in most methodologies, but MMP-7 and hepatobiliary scintigraphy exhibited biases, with p values of 0.023 and 0.002, respectively. CONCLUSION: MMP-7 and ultrasound-guided PCC/PTCC show diagnostic potential in the early diagnosis of BA, but their clinical application is restricted due to practical limitations. Currently, the cutoff value of MMP-7 is unclear, and further evidence-based medical research is needed to firmly establish its diagnostic value. Until more evidence is available, MMP-7 is not suitable for widespread diagnostic use. Therefore, considering cost and operational simplicity, liver function tests combined with ultrasound remain the most clinically valuable non-invasive diagnostic methods for BA.

The effects of empiric antibiotic regimens in adults with non-ventilator-associated hospital-acquired pneumonia: A systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: The optimal empiric antibiotic regimen for non-ventilator-associated hospital-acquired pneumonia (HAP) is uncertain. OBJECTIVES: To compare alternative empiric antibiotic regimens in HAP using a network meta-analysis (NMA). METHODS: Data sources: Medline, EMBASE, Cochrane CENTRAL, Web of Science, and CINAHL from database inception to July 06, 2023. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCT). PARTICIPANTS: Adults with clinical suspicion of HAP. INTERVENTION: Any empiric antibiotic regimen versus another, placebo, or no treatment. ASSESSMENT OF RISK OF BIAS: Paired reviewers independently assessed risk of bias using a modified Cochrane tool for assessing risk of bias in randomized trials. METHODS OF DATA ANALYSIS: Paired reviewers independently extracted data on trial and patient characteristics, antibiotic regimens, and outcomes of interest. We conducted frequentist random-effects NMAs for treatment failure and all-cause mortality and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: 39 trials proved eligible. 30 RCTs involving 4,807 participants found low certainty evidence that piperacillin-tazobactam (RR compared to all cephalosporins: 0.65; 95% CI: 0.42, 1.01) and carbapenems (RR compared to all cephalosporins: 0.77; 95% CI: 0.53, 1.11) might be among the most effective in reducing treatment failure. The findings were robust to the secondary analysis comparing piperacillin-tazobactam vs antipseudomonal cephalosporins or antipseudomonal carbapenems vs antipseudomonal cephalosporins. 11 RCTs involving 2,531 participants found low certainty evidence that ceftazidime and linezolid combination may not be convincingly different from cephalosporin alone in reducing all-cause mortality. Evidence on other antibiotic regimens is very uncertain. Data on other patient-important outcomes including adverse events was sparse, and we did not perform network or pairwise meta-analysis. CONCLUSIONS: For empiric antibiotic therapy of adults with HAP, piperacillin-tazobactam might be among the most effective in reducing treatment failure in HAP. Empiric MRSA coverage may not exert additional benefit in reducing mortality in HAP. REGISTRATION: PROSPERO (CRD 42022297224).

Antimicrobial-coated sutures versus non-coated sutures in reducing surgical site infection: An updated systematic review and meta-analysis.

PURPOSE: Antimicrobial-coated sutures are one of the strategies to avoid surgical site infection (SSI) caused by microbial colonization on the surface of surgical sutures. This study aims to investigate the effectiveness of antimicrobial-coated sutures in reducing SSI and develop the latest systematic evaluation evidence for clinical SSI prevention and the use of antimicrobial-coated sutures. METHODS: We searched the databases of Medline, Embase, CINAHL, Cochrane, African Index Medicus, and WHO Global Health from October 10th, 1990 to March 3rd, 2023 with language restricted to English, Spanish, and French. Meta-analysis was used to evaluate the impact of antimicrobial-coated sutures on SSI and whether their effectiveness is influenced by the type of sutures or wounds. Subgroup analyses were conducted based on type of sutures and wounds. Finally, quality of the retrieved evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: 26 RCTs and 9 OBSs met the inclusion criteria. Antimicrobial sutures significantly reduced SSI risk (RCTs: OR: 0.74, 95% CI [0.63-0.87], p = 0.0002; OBSs: OR: 0.61, 95% CI [0.48-0.76], p ＜ 0.0001). Only subgroup analysis of Polydioxanone Suture (PDS) Plus vs. PDS, Vicryl Plus vs. Vicryl and mixed wounds revealed consistent results in favour of antimicrobial-coated sutures. According to GRADE, the quality of RCTs evidence is moderate, while that of OBSs evidence is low. CONCLUSION: Antimicrobial-coated sutures are effective in reducing the risk of postoperative SSI among a large number of surgical patients. However, the available evidence is of moderate/low quality and many studies had conflicts of interest.

The effect of temperature on infectious diarrhea disease: A systematic review.

This study aimed to ascertain the delayed effects of various exposure temperatures on infectious diarrhea. We performed a Bayesian random-effects network meta-analysis to calculate relative risks (RR) with 95 % confidence intervals (95 % CI). The heterogeneity was analyzed by subgroup analysis. There were 25 cross-sectional studies totaling 6858735 patients included in this analysis, with 12 articles each investigating the effects of both hyperthermia and hypothermia. Results revealed that both high temperature (RRsingle = 1.22, 95%CI:1.04-1.44, RRcum = 2.96, 95%CI:1.60-5.48, P < 0.05) and low temperature (RRsingle = 1.17, 95%CI:1.02-1.37, RRcum = 2.19, 95%CI:1.33-3.64, P < 0.05) significantly increased the risk of infectious diarrhea, while high temperature caused greater. As-sociations with strengthening in bacillary dysentery were found for high temperatures (RRcum = 2.03, 95%CI:1.41-3.01, P < 0.05; RRsingle = 1.17, 95%CI:0.90-1.62, P > 0.05), while the statistical significance of low temperatures in lowering bacterial dysentery had vanished. This investigation examined that high temperature and low temperature were the conditions that posed the greatest risk for infectious diarrhea. This research offers fresh perspectives on preventing infectious diarrhea and will hopefully enlighten future studies on the impact of temperature management on infectious diarrhea.

Prevalence of diabetes mellitus among stroke patients in Ethiopia: Systematic review and meta-analysis.

Background: Diabetes mellitus (DM) is a chronic metabolic condition that considerably increases the risk of stroke. According to studies, stroke patients with diabetes have a greater mortality rate and are more likely to have repeated strokes than those without diabetes. Therefore, this systematic review and meta-analysis determined the pooled prevalence of diabetes mellitus among stroke patients in Ethiopia. Methods: The searches were conducted in electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar. Observational study designs were selected, and studies published until November 30, 2023, addressing the prevalence of diabetes mellitus among stroke patients were identified. EndNote Citation Manager software version X9 for Windows was used to collect and organize the search outcomes and remove duplicate articles. Relevant data were extracted from the included studies using a format prepared in Microsoft Excel and exported to STATA 18.0 software for outcome measures analyses and subgrouping. Results: Twenty-eight research articles were included in the final analysis. The studies included an evaluation of 6589 stroke patients, among whom 645 were diagnosed with DM. This resulted in a pooled prevalence estimate of 10 % (95 % CI: 8-13 %)] DM. The subgroup analysis by region revealed that the highest pooled prevalence of DM was 16 % [95 % CI: (9 %-24 %)], which was from the Oromia region, followed by Addis Ababa city 12 % [95 % CI: (10 %-14 %)]. The other three regions (Tigray, South Nations nationalities and people's region and Amhara) had similar pooled prevalence of DM 7 % [95 % CI: (3 %-10 %)], 7 % [95 % CI: (3 %-11 %)], 7 % [95 % CI: (4 %-9%)], respectively. Conclusion: Overall, the prevalence of DM among stroke patients is high. Notably, the Oromia region exhibited the highest prevalence rate at 16 %, followed by Addis Ababa city at 12 %. Conversely, the other three regions displayed similar rates of 7 %. These findings underscore the critical importance of screening and managing DM in stroke patients.

Meta-analysis of the clinical efficacy and safety of single versus dual plate in the treatment of comminuted distal femur fractures.

Objective: Through meta-analysis, this study aims to comprehensively evaluate the efficacy of single-plating and double-plating in the treatment of comminuted fractures of the distal femur. Methods: Computer searches of PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP, and Wanfang digital journals were performed, and the timeframe for the searches was from the establishment of each database to July 2023 for each of the databases. Meta-analysis was performed using RevMan 5.4 software provided by the Cochrane Library, and the review process was registered in the PROSPERO database. Results: A total of ten studies were included for statistical analysis. One randomised controlled study and nine retrospective cohort studies with a total of 563 patients were included. The double-plate group was superior to the single-plate group in terms of knee mobility at 6 months postoperatively, overall postoperative complications, and the rate of healing of knee deformity. However, it increased the operation time and intraoperative bleeding, and the difference between the two groups was statistically significant (P < 0.05). There was no significant difference between the two groups in terms of excellent knee function rate, fracture healing time, plate fracture, postoperative infection, delayed fracture healing, and non-union (P ≥ 0.05). Conclusion: Double plate fixation for comminuted fractures of the distal femur can improve knee mobility at 6 months postoperatively, reduce overall postoperative complications, and decrease the incidence of malunion healing. However, it increases operative time and bleeding. Randomised studies are needed to provide strong evidence in the future.

Green light is similarly effective in promoting plant biomass as red/blue light - a meta-analysis.

Whether green light promotes or represses plant growth is an unresolved but important question, warranting a global meta-analysis of published data. We collected 136 datasets from 48 publications on 17 crop species, and calculated the green light effect for a range of plant traits. For each trait the effect was calculated as the ratio between the trait value attained under a red/blue background light plus green, divided by the value attained under the background light only, both having the same light intensity. Generally, green light strongly increased intrinsic water use efficiency (15%), the shoot-to-root ratio (13%), and decreased stomatal conductance (-15%). Moreover, green light increased fresh weight to a small extent (4%), but not plant dry weight, resulting in a reduced dry matter content (-2%). Hence, green light is similarly effective at increasing biomass as red and blue light. Green light also showed to increase leaf area (7%) and specific leaf area (4%; i.e., thinner leaves). Furthermore, effects of green light were species-dependent, with positive effects on biomass for lettuce and microgreens, and negative effects in basil and tomato. Our data suggest that future research should focus on the role of green light in modulating water loss, its putative role as a shade signal, and the causes for its species-specific effects on crop biomass.

Examining the Effectiveness of Social Media for the Dissemination of Research Evidence for Health and Social Care Practitioners: Systematic Review and Meta-Analysis.

BACKGROUND: Social media use has potential to facilitate the rapid dissemination of research evidence to busy health and social care practitioners. OBJECTIVE: This study aims to quantitatively synthesize evidence of the between- and within-group effectiveness of social media for dissemination of research evidence to health and social care practitioners. It also compared effectiveness between different social media platforms, formats, and strategies. METHODS: We searched electronic databases for articles in English that were published between January 1, 2010, and January 10, 2023, and that evaluated social media interventions for disseminating research evidence to qualified, postregistration health and social care practitioners in measures of reach, engagement, direct dissemination, or impact. Screening, data extraction, and risk of bias assessments were carried out by at least 2 independent reviewers. Meta-analyses of standardized pooled effects were carried out for between- and within-group effectiveness of social media and comparisons between platforms, formats, and strategies. Certainty of evidence for outcomes was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. RESULTS: In total, 50 mixed-quality articles that were heterogeneous in design and outcome were included (n=9, 18% were randomized controlled trials [RCTs]). Reach (measured in number of practitioners, impressions, or post views) was reported in 26 studies. Engagement (measured in likes or post interactions) was evaluated in 21 studies. Direct dissemination (measured in link clicks, article views, downloads, or altmetric attention score) was analyzed in 23 studies (8 RCTs). Impact (measured in citations or measures of thinking and practice) was reported in 13 studies. Included studies almost universally indicated effects in favor of social media interventions, although effect sizes varied. Cumulative evidence indicated moderate certainty of large and moderate between-group effects of social media interventions on direct dissemination (standardized mean difference [SMD] 0.88; P=.02) and impact (SMD 0.76; P<.001). After social media interventions, cumulative evidence showed moderate certainty of large within-group effects on reach (SMD 1.99; P<.001), engagement (SMD 3.74; P<.001), and direct dissemination (SMD 0.82; P=.004) and low certainty of a small within-group effect on impacting thinking or practice (SMD 0.45; P=.02). There was also evidence for the effectiveness of using multiple social media platforms (including Twitter, subsequently rebranded X; and Facebook), images (particularly infographics), and intensive social media strategies with frequent, daily posts and involving influential others. No included studies tested the dissemination of research evidence to social care practitioners. CONCLUSIONS: Social media was effective for disseminating research evidence to health care practitioners. More intense social media campaigns using specific platforms, formats, and strategies may be more effective than less intense interventions. Implications include recommendations for effective dissemination of research evidence to health care practitioners and further RCTs in this field, particularly investigating the dissemination of social care research. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022378793; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=378793. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/45684.

Unveiling biochar potential to promote safe crop production in toxic metal(loid) contaminated soil: A meta-analysis.

Biochar application emerges as a promising and sustainable solution for the remediation of soils contaminated with potentially toxic metal (loid)s (PTMs), yet its potential to reduce PTM accumulation in crops remains to be fully elucidated. In our study, a hierarchical meta-analysis based on 276 research articles was conducted to quantify the effects of biochar application on crop growth and PTM accumulation. Meanwhile, a machine learning approach was developed to identify the major contributing features. Our findings revealed that biochar application significantly enhanced crop growth, and reduced PTM concentrations in crop tissues, showing a decrease trend of grains (36.1%, 33.6-38.6%) > shoots (31.1%, 29.3-32.8%) > roots (27.5%, 25.7-29.2%). Furthermore, biochar modifications were found to amplify its remediation potential in PTM-contaminated soils. Biochar application was observed to provide favorable conditions for reducing PTM uptake by crops, primarily through decreasing available PTM concentrations and improving overall soil quality. Employing machine learning techniques, we identified biochar properties, such as surface area and C content as a key factor in decreasing PTM bioavailability in soil-crop systems. Furthermore, our study indicated that biochar application could reduce probabilistic health risks associated with of the presence of PTMs in crop grains, thereby contributing to human health protection. These findings highlighted the essential role of biochar in remediating PTM-contaminated lands and offered guidelines for enhancing safe crop production.