The evidence from systematic reviews and meta-analyses published in orthodontic literature. Where do we stand?

AIM To analyse meta-analyses included in systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) focusing on orthodontic literature and to assess the quality of the existing evidence. MATERIALS AND METHODS Electronic searching was undertaken to identify SRs published in five major orthodontic journals and the CDSR between January 2000 and June 2014. Quality assessment of the overall body of evidence from meta-analyses was conducted using the Grading of Recommendations Assessment, Development and Evaluation working group (GRADE) tool. RESULTS One hundred and fifty-seven SRs were identified; meta-analysis was present in 43 of these (27.4 per cent). The highest proportion of SRs that included a meta-analysis was found in Orthodontics and Craniofacial Research (6/13; 46.1 per cent), followed by the CDSR (12/33; 36.4 per cent) and the American Journal of Orthodontics and Dentofacial Orthopaedics (15/44; 34.1 per cent). Class II treatment was the most commonly addressed topic within SRs in orthodontics (n = 18/157; 11.5 per cent). The number of trials combined to produce a summary estimate was small for most meta-analyses with a median of 4 (range: 2-52). Only 21 per cent (n = 9) of included meta-analyses were considered to have a high/moderate quality of evidence according to GRADE, while the majority were of low or very low quality (n = 34; 79.0 per cent). CONCLUSIONS Overall, approximately one quarter of orthodontic SRs included quantitative synthesis, with a median of four trials per meta-analysis. The overall quality of evidence from the selected orthodontic SRs was predominantly low to very low indicating the relative lack of high quality of evidence from SRs to inform clinical practice guidelines.

Early growth characteristics and the risk of reduced lung function and asthma: A meta-analysis of 25,000 children

BACKGROUND Children born preterm or with a small size for gestational age are at increased risk for childhood asthma. OBJECTIVE We sought to assess the hypothesis that these associations are explained by reduced airway patency. METHODS We used individual participant data of 24,938 children from 24 birth cohorts to examine and meta-analyze the associations of gestational age, size for gestational age, and infant weight gain with childhood lung function and asthma (age range, 3.9-19.1 years). Second, we explored whether these lung function outcomes mediated the associations of early growth characteristics with childhood asthma. RESULTS Children born with a younger gestational age had a lower FEV1, FEV1/forced vital capacity (FVC) ratio, and forced expiratory volume after exhaling 75% of vital capacity (FEF75), whereas those born with a smaller size for gestational age at birth had a lower FEV1 but higher FEV1/FVC ratio (P < .05). Greater infant weight gain was associated with higher FEV1 but lower FEV1/FVC ratio and FEF75 in childhood (P < .05). All associations were present across the full range and independent of other early-life growth characteristics. Preterm birth, low birth weight, and greater infant weight gain were associated with an increased risk of childhood asthma (pooled odds ratio, 1.34 [95% CI, 1.15-1.57], 1.32 [95% CI, 1.07-1.62], and 1.27 [95% CI, 1.21-1.34], respectively). Mediation analyses suggested that FEV1, FEV1/FVC ratio, and FEF75 might explain 7% (95% CI, 2% to 10%) to 45% (95% CI, 15% to 81%) of the associations between early growth characteristics and asthma. CONCLUSIONS Younger gestational age, smaller size for gestational age, and greater infant weight gain were across the full ranges associated with childhood lung function. These associations explain the risk of childhood asthma to a substantial extent.

Enlarged tracheoesophageal puncture: A systematic review and retrospective analysis

Background. An enlarged tracheoesophageal puncture (TEP) results in aspiration around the voice prosthesis (VP) and may lead to pneumonia. The aims of this research were: (1) to conduct a systematic review and meta-analysis on enlarged TEP; (2) to analyze preoperative, perioperative, and postoperative risk factors for enlarged TEP; and (3) to evaluate control of leakage around the VP using conservative treatments and adverse events in patients with enlarged TEP.^ Methods. A systematic review was conducted (1978-2008). A summary risk estimate was calculated using a random-effects meta-analysis model. A retrospective cohort study was completed. Patients who underwent total laryngectomy and TEP at The University of Texas M. D. Anderson Cancer Center (MDACC) were included. Multiple logistic regression methods were used to assess risk factors for enlargement. Descriptive and bivariate statistics were calculated to evaluate outcomes and adverse events. Results: Twenty-seven manuscripts were included in the systematic review. The summary risk estimate of enlarged TEP/leakage around the VP was 7.2% (95% CI: 4.8%-9.6%). Temporary VP removal and TEP-site injections were the most commonly reported treatments. Neither prosthetic diameter (p=0.076) nor timing of TEP (p=0.297) significantly increased risk of enlargement per stratified analyses of published outcomes. The cumulative incidence of enlarged TEP was 18.6% (36/194, 95% CI: 13.0%-24.1%) in the MDACC cohort. Enlarged TEP occurred exclusively in irradiated patients. Adjusting for length of follow-up and timing of TEP, advanced nodal disease (ORadjusted: 4.3, 95% CI: 1.0-19.1), stricture (ORadjusted : 3.2, 95% CI: 1.2-8.6), and locoregional recurrence/distant metastasis after laryngectomy (ORadjusted: 6.2, 95% CI: 2.3-16.4) increased risk of enlarged TEP. At last follow-up, conservative methods controlled leakage around the VP in 81% (29/36) of patients. Unresolved leakage was associated with recurrent cancer (p=0.081) and TEP-site irregularity (p=0.003). Relative to those without enlargement, enlarged TEP patients had significantly higher risk of pneumonia (RR: 3.4, 95% CI: 1.9-6.2).^ Conclusions. These data establish that enlarged TEP poses serious health risks, and provide insight into medical and oncologic factors that may contribute to development of this complication. In addition, this research supports the use of conservative treatments to address leakage after enlarged TEP in lieu of complete TEP closure.^

Análisis sobre la eficacia de niveles moderados de actividad física para reducir el riesgo de padecer enfermedades cardiovasculares : Un Meta-análisis

Objetivos: a. Determinar la eficacia de la actividad física en la reducción del riesgo de enfermedades cardiovasculares; b. Analizar los cambios relativos en los niveles de riesgo a padecer enfermedades cardiovasculares de acuerdo a diferentes intensidades (baja-moderada) de actividad física. Metodología: Se realizó un Meta-análisisde los estudios encontrados en la base de datos PUBMED. Se calculó el tamaño del efecto medio y se aplicó el test de Eggerpara descartar un posible sesgo de publicación. Al detectarse heterogeneidad, se procedió a realizar un análisis de las variables moderadoras. Resultados: Se obtuvo un tamaño del efecto medio de 0.762 (0.678-0857; 95 por ciento IC). El test de Egger arrojó un p-valor de 0.67 (I.C. 0.95), de manera tal que se confirmó la ausencia de sesgo de publicación. El análisis moderador determinó que los años de seguimiento (p=0.000; 95 por ciento IC) y los países de estudio (p=0.0096; 95 por ciento IC) son significativos. Conclusión: Se puede concluir en que la práctica de actividad física a intensidades moderadas ofrece un efecto protector sobre los individuos que la realizan disminuyendo el riesgo a padecer enfermedades cardiovasculares

Análisis sobre la eficacia de niveles moderados de actividad física para reducir el riesgo de padecer enfermedades cardiovasculares : Un Meta-análisis

Objetivos: a. Determinar la eficacia de la actividad física en la reducción del riesgo de enfermedades cardiovasculares; b. Analizar los cambios relativos en los niveles de riesgo a padecer enfermedades cardiovasculares de acuerdo a diferentes intensidades (baja-moderada) de actividad física. Metodología: Se realizó un Meta-análisisde los estudios encontrados en la base de datos PUBMED. Se calculó el tamaño del efecto medio y se aplicó el test de Eggerpara descartar un posible sesgo de publicación. Al detectarse heterogeneidad, se procedió a realizar un análisis de las variables moderadoras. Resultados: Se obtuvo un tamaño del efecto medio de 0.762 (0.678-0857; 95 por ciento IC). El test de Egger arrojó un p-valor de 0.67 (I.C. 0.95), de manera tal que se confirmó la ausencia de sesgo de publicación. El análisis moderador determinó que los años de seguimiento (p=0.000; 95 por ciento IC) y los países de estudio (p=0.0096; 95 por ciento IC) son significativos. Conclusión: Se puede concluir en que la práctica de actividad física a intensidades moderadas ofrece un efecto protector sobre los individuos que la realizan disminuyendo el riesgo a padecer enfermedades cardiovasculares

Análisis sobre la eficacia de niveles moderados de actividad física para reducir el riesgo de padecer enfermedades cardiovasculares : Un Meta-análisis

Objetivos: a. Determinar la eficacia de la actividad física en la reducción del riesgo de enfermedades cardiovasculares; b. Analizar los cambios relativos en los niveles de riesgo a padecer enfermedades cardiovasculares de acuerdo a diferentes intensidades (baja-moderada) de actividad física. Metodología: Se realizó un Meta-análisisde los estudios encontrados en la base de datos PUBMED. Se calculó el tamaño del efecto medio y se aplicó el test de Eggerpara descartar un posible sesgo de publicación. Al detectarse heterogeneidad, se procedió a realizar un análisis de las variables moderadoras. Resultados: Se obtuvo un tamaño del efecto medio de 0.762 (0.678-0857; 95 por ciento IC). El test de Egger arrojó un p-valor de 0.67 (I.C. 0.95), de manera tal que se confirmó la ausencia de sesgo de publicación. El análisis moderador determinó que los años de seguimiento (p=0.000; 95 por ciento IC) y los países de estudio (p=0.0096; 95 por ciento IC) son significativos. Conclusión: Se puede concluir en que la práctica de actividad física a intensidades moderadas ofrece un efecto protector sobre los individuos que la realizan disminuyendo el riesgo a padecer enfermedades cardiovasculares

Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis

Background: The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods: A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results: Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. Conclusions: This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.

Evaluación participativa de los impactos sociales del turismo residencial y meta-análisis de resultados: un caso de estudio en Pipa (Rio Grande do Norte, Brasil)

Este artículo presenta una propuesta metodológica para la evaluación participativa de impactos sociales. Se ejemplifica mediante la descripción del proceso y resultados de una investigación realizada en la comunidad turística de Pipa (Rio Grande do Norte, Brasil) en la que se desarrolló un proceso de participación orientado a discutir el modelo de turismo residencial implantado en este territorio mediante el identificación y evaluación de sus impactos sociales. La novedad de esta propuesta reside en que se añade, a los beneficios y utilidades de la evaluación participativa de impactos sociales, un meta-análisis realizado sobre los resultados del proceso de participación. Este meta-análisis hace uso de las herramientas informáticas propias del Análisis de Redes Sociales aplicadas al estudio de los mapas causa-efecto elaborados por los participantes. Los resultados de este análisis cuantitativo se completan e interpretan con la información obtenida a través de entrevistas en profundidad y revisión documental, permitiendo: 1) identificar las causas últimas de los impactos sociales derivados del turismo residencial a escala local y 2) una mejor comprensión de la complejidad causal de estos impactos. El meta-análisis ha identificado que la primacía de los intereses de las empresas inmobiliarias internacionales sobre el interés general local se sustenta sobre su capacidad ilusoria de controlar la demanda mediante agresivas campañas de marketing. Esta información permite la deconstrucción del discurso desarrollista del turismo y posibilita la demarcación de nuevas áreas de acción estratégica orientadas a la maximización del beneficio colectivo.

An integrated analysis of five double-blind, randomized controlled trials evaluating the safety and efficacy of a hyaluronan product for intra-articular injection in osteoarthritis of the kneel

Objective: Five double-blind, randomized, saline-controlled trials (RCTs) were included in the United States marketing application for an intra-articular hyaluronan (IA-HA) product for the treatment of osteoarthritis (OA) of the knee. We report an integrated analysis of the primary Case Report Form (CRF) data from these trials. Method. Trials were similar in design, patient population and outcome measures - all included the Lequesne Algofunctional Index (LI), a validated composite index of pain and function, evaluating treatment over 3 months. Individual patient data were pooled; a repeated measures analysis of covariance was performed in the intent-to-treat (ITT) population. Analyses utilized both fixed and random effects models. Safety data from the five RCTs were summarized. Results: A total of 1155 patients with radiologically confirmed knee OA were enrolled: 619 received three or five IA-HA injections; 536 received. placebo saline injections. In the active and control groups, mean ages were 61.8 and 61.4 years; 62.4% and 58.8% were women; baseline total Lequesne scores 11.03 and 11.30, respectively. Integrated analysis of the pooled data set found a statistically significant reduction (P < 0.001) in total Lequesne score with hyaluronan (HA) (-2.68) vs placebo (-2.00); estimated difference -0.68 (95% CI: -0.56 to -0.79), effect size 0.20. Additional modeling approaches confirmed robustness of the analyses. Conclusions: This integrated analysis demonstrates that multiple design factors influence the results of RCTs assessing efficacy of intra-articular (IA) therapies, and that integrated analyses based on primary data differ from meta-analyses using transformed data. (C) 2006 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Meta-analytic model comparisons of surface- and deep-level relational diversity effects on social integration and individual effectiveness

While diversity might give an organization a competitive advantage, individuals have a tendency to prefer homogenous group settings. Prior research suggests that group members who are dissimilar (vs. similar) to their peers in terms of a given diversity attribute (e.g. demographics, attitudes, values or traits) feel less attached to their work group, experience less satisfying and more conflicted relationships with their colleagues, and consequently are less effective. However, prior empirical findings tend to be weak and inconsistent, and it remains unclear when, how and to what extent such differences affect group members’ social integration (i.e. attachment with their work group, satisfaction and conflicted relationships with their peers) and effectiveness. To address these issues the current study conducted a meta-analysis and integrated the empirical results of 129 studies. For demographic diversity attributes (such as gender, ethnicity, race, nationality, age, functional background, and tenure) the findings support the idea that demographic dissimilarity undermines individual member performance via lower levels of social integration. These negative effects were more pronounced in pseudo teams – i.e. work groups in which group members pursue individual goals, work on individual tasks, and are rewarded for their individual performance. These negative effects were however non-existent in real teams - i.e. work groups in which groups members pursue group goals, work on interdependent tasks, and are rewarded (at least partially) based on their work group’s performance. In contrast, for underlying psychological diversity attributes (such as attitudes, personality, and values), the relationship between dissimilarity and social integration was more negative in real teams than in pseudo teams, which in return translated into even lower individual performance. At the same time however, differences in underlying psychological attributes had an even stronger positive effect on dissimilar group member’s individual performance, when the negative effects of social integration were controlled for. This implies that managers should implement real work groups to overcome the negative effects of group member’s demographic dissimilarity. To harness the positive effects of group members’ dissimilarity on underlying psychological attributes, they need to make sure that dissimilar group members become socially integrated.

Genetic analysis of dyslexia candidate genes in the European cross-linguistic NeuroDys cohort

Dyslexia is one of the most common childhood disorders with a prevalence of around 5-10% in school-age children. Although an important genetic component is known to have a role in the aetiology of dyslexia, we are far from understanding the molecular mechanisms leading to the disorder. Several candidate genes have been implicated in dyslexia, including DYX1C1, DCDC2, KIAA0319, and the MRPL19/C2ORF3 locus, each with reports of both positive and no replications. We generated a European cross-linguistic sample of school-age children-the NeuroDys cohort-that includes more than 900 individuals with dyslexia, sampled with homogenous inclusion criteria across eight European countries, and a comparable number of controls. Here, we describe association analysis of the dyslexia candidate genes/locus in the NeuroDys cohort. We performed both case-control and quantitative association analyses of single markers and haplotypes previously reported to be dyslexia-associated. Although we observed association signals in samples from single countries, we did not find any marker or haplotype that was significantly associated with either case-control status or quantitative measurements of word-reading or spelling in the meta-analysis of all eight countries combined. Like in other neurocognitive disorders, our findings underline the need for larger sample sizes to validate possibly weak genetic effects. © 2014 Macmillan Publishers Limited All rights reserved.

Leader‐Member Exchange (LMX) and performance:a meta‐analytic review

This paper reports a meta-analysis that examines the relationship between leader-member exchange (LMX) relationship quality and a multidimensional model of work performance (task, citizenship, and counterproductive performance). The results show a positive relationship between LMX and task performance (146 samples, ρ = .30) as well as citizenship performance (97 samples, ρ = .34), and negatively with counterproductive performance (19 samples, ρ = -.24). Of note, there was a positive relationship between LMX and objective task performance (20 samples, ρ = .24). Trust, motivation, empowerment, and job satisfaction mediated the relationship between LMX and task and citizenship performance with trust in the leader having the largest effect. There was no difference due to LMX measurement instrument (e.g., LMX7, LMX-MDM). Overall, the relationship between LMX and performance was weaker when (a) measures were obtained from a different source or method and (b) LMX was measured by the follower than the leader (with common source- and method-biased effects stronger for leader-rated LMX quality). Finally, there was evidence for LMX leading to task performance but not for reverse or reciprocal directions of effects.

Where do bright ideas occur in our brain? Meta-analytic evidence from neuroimaging studies of domain-specific creativity

Many studies have assessed the neural underpinnings of creativity, failing to find a clear anatomical localization. We aimed to provide evidence for a multi-componential neural system for creativity. We applied a general activation likelihood estimation (ALE) meta-analysis to 45 fMRI studies. Three individual ALE analyses were performed to assess creativity in different cognitive domains (Musical, Verbal, and Visuo-spatial). The general ALE revealed that creativity relies on clusters of activations in the bilateral occipital, parietal, frontal, and temporal lobes. The individual ALE revealed different maximal activation in different domains. Musical creativity yields activations in the bilateral medial frontal gyrus, in the left cingulate gyrus, middle frontal gyrus, and inferior parietal lobule and in the right postcentral and fusiform gyri. Verbal creativity yields activations mainly located in the left hemisphere, in the prefrontal cortex, middle and superior temporal gyri, inferior parietal lobule, postcentral and supramarginal gyri, middle occipital gyrus, and insula. The right inferior frontal gyrus and the lingual gyrus were also activated. Visuo-spatial creativity activates the right middle and inferior frontal gyri, the bilateral thalamus and the left precentral gyrus. This evidence suggests that creativity relies on multi-componential neural networks and that different creativity domains depend on different brain regions.

To move or not to move, that is the question! Body schema and non-action oriented body representations:an fMRI meta-analytic study

Many studies have attempted to identify the different cognitive components of body representation (BR). Due to methodological issues, the data reported in these studies are often confusing. Here we summarize the fMRI data from previous studies and explore the possibility of a neural segregation between BR supporting actions (body-schema, BS) or not (non-oriented-to-action-body-representation, NA). We performed a general activation likelihood estimation meta-analysis of 59 fMRI experiments and two individual meta-analyses to identify the neural substrates of different BR. Body processing involves a wide network of areas in occipital, parietal, frontal and temporal lobes. NA selectively activates the somatosensory primary cortex and the supramarginal gyrus. BS involves the primary motor area and the right extrastriate body area. Our data suggest that motor information and recognition of body parts are fundamental to build BS. Instead, sensory information and processing of the egocentric perspective are more important for NA. In conclusion, our results strongly support the idea that different and segregated neural substrates are involved in body representations orient or not to actions.