Crossing borders: Ethnic minorities matter? A meta analytic examionation of the alliance-outcome relationship

Objectives: The purpose of this meta analysis was to examine the moderating impact of substance use disorder as inclusion/exclusion criterion as well as the percentage of racial/ethnic minorities on the strength of the alliance-outcome relationship in psychotherapy. It was hypothesized that the presence of a dsm axis i substance use disorders as a criterion and the presence of racial/ethnic minority as a psychosocial indicator are confounded client factors reducing the relationship between alliance and outcome. Methods: A random effects restricted maximum-likelihood estimator was used for omnibus and moderator models (k = 94). results: the presence of (a) substance use disorder and, (b) racial/ethnic minorities (overall and specific to african americans) partially moderated the alliance-outcome correlation. The percentage of substance use disorders and racial/ethnic minority status was highly correlated. Conclusions: Socio-cultural contextual variables should be considered along with dsm axis i diagnosis of substance use disorders in analyzing and interpreting mechanisms of change.

A meta-analysis of cambium phenology and growth: linear and non-linear patterns in conifers of the northern hemisphere

Background and Aims Ongoing global warming has been implicated in shifting phenological patterns such as the timing and duration of the growing season across a wide variety of ecosystems. Linear models are routinely used to extrapolate these observed shifts in phenology into the future and to estimate changes in associated ecosystem properties such as net primary productivity. Yet, in nature, linear relationships may be special cases. Biological processes frequently follow more complex, non-linear patterns according to limiting factors that generate shifts and discontinuities, or contain thresholds beyond which responses change abruptly. This study investigates to what extent cambium phenology is associated with xylem growth and differentiation across conifer species of the northern hemisphere. Methods Xylem cell production is compared with the periods of cambial activity and cell differentiation assessed on a weekly time scale on histological sections of cambium and wood tissue collected from the stems of nine species in Canada and Europe over 1–9 years per site from 1998 to 2011. Key Results The dynamics of xylogenesis were surprisingly homogeneous among conifer species, although dispersions from the average were obviously observed. Within the range analysed, the relationships between the phenological timings were linear, with several slopes showing values close to or not statistically different from 1. The relationships between the phenological timings and cell production were distinctly non-linear, and involved an exponential pattern. Conclusions The trees adjust their phenological timings according to linear patterns. Thus, shifts of one phenological phase are associated with synchronous and comparable shifts of the successive phases. However, small increases in the duration of xylogenesis could correspond to a substantial increase in cell production. The findings suggest that the length of the growing season and the resulting amount of growth could respond differently to changes in environmental conditions.

Subclinical thyroid dysfunction and the risk for fractures: a systematic review and meta-analysis.

BACKGROUND Data on the association between subclinical thyroid dysfunction and fractures conflict. PURPOSE To assess the risk for hip and nonspine fractures associated with subclinical thyroid dysfunction among prospective cohorts. DATA SOURCES Search of MEDLINE and EMBASE (1946 to 16 March 2014) and reference lists of retrieved articles without language restriction. STUDY SELECTION Two physicians screened and identified prospective cohorts that measured thyroid function and followed participants to assess fracture outcomes. DATA EXTRACTION One reviewer extracted data using a standardized protocol, and another verified data. Both reviewers independently assessed methodological quality of the studies. DATA SYNTHESIS The 7 population-based cohorts of heterogeneous quality included 50,245 participants with 1966 hip and 3281 nonspine fractures. In random-effects models that included the 5 higher-quality studies, the pooled adjusted hazard ratios (HRs) of participants with subclinical hyperthyroidism versus euthyrodism were 1.38 (95% CI, 0.92 to 2.07) for hip fractures and 1.20 (CI, 0.83 to 1.72) for nonspine fractures without statistical heterogeneity (P = 0.82 and 0.52, respectively; I2= 0%). Pooled estimates for the 7 cohorts were 1.26 (CI, 0.96 to 1.65) for hip fractures and 1.16 (CI, 0.95 to 1.42) for nonspine fractures. When thyroxine recipients were excluded, the HRs for participants with subclinical hyperthyroidism were 2.16 (CI, 0.87 to 5.37) for hip fractures and 1.43 (CI, 0.73 to 2.78) for nonspine fractures. For participants with subclinical hypothyroidism, HRs from higher-quality studies were 1.12 (CI, 0.83 to 1.51) for hip fractures and 1.04 (CI, 0.76 to 1.42) for nonspine fractures (P for heterogeneity = 0.69 and 0.88, respectively; I2 = 0%). LIMITATIONS Selective reporting cannot be excluded. Adjustment for potential common confounders varied and was not adequately done across all studies. CONCLUSION Subclinical hyperthyroidism might be associated with an increased risk for hip and nonspine fractures, but additional large, high-quality studies are needed. PRIMARY FUNDING SOURCE Swiss National Science Foundation.

Aspiration Thrombectomy for Treatment of ST-segment Elevation Myocardial Infarction: a Meta-analysis of 26 Randomized Trials in 11 943 Patients.

INTRODUCTION AND OBJECTIVES There is continued debate about the routine use of aspiration thrombectomy in patients with ST-segment elevation myocardial infarction. Our aim was to evaluate clinical and procedural outcomes of aspiration thrombectomy-assisted primary percutaneous coronary intervention compared with conventional primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction. METHODS We performed a meta-analysis of 26 randomized controlled trials with a total of 11 943 patients. Clinical outcomes were extracted up to maximum follow-up and random effect models were used to assess differences in outcomes. RESULTS We observed no difference in the risk of all-cause death (pooled risk ratio = 0.88; 95% confidence interval, 0.74-1.04; P = .124), reinfarction (pooled risk ratio = 0.85; 95% confidence interval, 0.67-1.08; P = .176), target vessel revascularization (pooled risk ratio = 0.86; 95% confidence interval, 0.73-1.00; P = .052), or definite stent thrombosis (pooled risk ratio = 0.76; 95% confidence interval, 0.49-1.16; P = .202) between the 2 groups at a mean weighted follow-up time of 10.4 months. There were significant reductions in failure to reach Thrombolysis In Myocardial Infarction 3 flow (pooled risk ratio = 0.70; 95% confidence interval, 0.60-0.81; P < .001) or myocardial blush grade 3 (pooled risk ratio = 0.76; 95% confidence interval, 0.65-0.89; P = .001), incomplete ST-segment resolution (pooled risk ratio = 0.72; 95% confidence interval, 0.62-0.84; P < .001), and evidence of distal embolization (pooled risk ratio = 0.61; 95% confidence interval, 0.46-0.81; P = .001) with aspiration thrombectomy but estimates were heterogeneous between trials. CONCLUSIONS Among unselected patients with ST-segment elevation myocardial infarction, aspiration thrombectomy-assisted primary percutaneous coronary intervention does not improve clinical outcomes, despite improved epicardial and myocardial parameters of reperfusion. Full English text available from:www.revespcardiol.org/en.

Anticoagulant vs. antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale: an individual participant data meta-analysis.

AIMS The preferred antithrombotic strategy for secondary prevention in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO) is unknown. We pooled multiple observational studies and used propensity score-based methods to estimate the comparative effectiveness of oral anticoagulation (OAC) compared with antiplatelet therapy (APT). METHODS AND RESULTS Individual participant data from 12 databases of medically treated patients with CS and PFO were analysed with Cox regression models, to estimate database-specific hazard ratios (HRs) comparing OAC with APT, for both the primary composite outcome [recurrent stroke, transient ischaemic attack (TIA), or death] and stroke alone. Propensity scores were applied via inverse probability of treatment weighting to control for confounding. We synthesized database-specific HRs using random-effects meta-analysis models. This analysis included 2385 (OAC = 804 and APT = 1581) patients with 227 composite endpoints (stroke/TIA/death). The difference between OAC and APT was not statistically significant for the primary composite outcome [adjusted HR = 0.76, 95% confidence interval (CI) 0.52-1.12] or for the secondary outcome of stroke alone (adjusted HR = 0.75, 95% CI 0.44-1.27). Results were consistent in analyses applying alternative weighting schemes, with the exception that OAC had a statistically significant beneficial effect on the composite outcome in analyses standardized to the patient population who actually received APT (adjusted HR = 0.64, 95% CI 0.42-0.99). Subgroup analyses did not detect statistically significant heterogeneity of treatment effects across clinically important patient groups. CONCLUSION We did not find a statistically significant difference comparing OAC with APT; our results justify randomized trials comparing different antithrombotic approaches in these patients.

Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis.

BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are the backbone of osteoarthritis pain management. We aimed to assess the effectiveness of different preparations and doses of NSAIDs on osteoarthritis pain in a network meta-analysis. METHODS For this network meta-analysis, we considered randomised trials comparing any of the following interventions: NSAIDs, paracetamol, or placebo, for the treatment of osteoarthritis pain. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the reference lists of relevant articles for trials published between Jan 1, 1980, and Feb 24, 2015, with at least 100 patients per group. The prespecified primary and secondary outcomes were pain and physical function, and were extracted in duplicate for up to seven timepoints after the start of treatment. We used an extension of multivariable Bayesian random effects models for mixed multiple treatment comparisons with a random effect at the level of trials. For the primary analysis, a random walk of first order was used to account for multiple follow-up outcome data within a trial. Preparations that used different total daily dose were considered separately in the analysis. To assess a potential dose-response relation, we used preparation-specific covariates assuming linearity on log relative dose. FINDINGS We identified 8973 manuscripts from our search, of which 74 randomised trials with a total of 58 556 patients were included in this analysis. 23 nodes concerning seven different NSAIDs or paracetamol with specific daily dose of administration or placebo were considered. All preparations, irrespective of dose, improved point estimates of pain symptoms when compared with placebo. For six interventions (diclofenac 150 mg/day, etoricoxib 30 mg/day, 60 mg/day, and 90 mg/day, and rofecoxib 25 mg/day and 50 mg/day), the probability that the difference to placebo is at or below a prespecified minimum clinically important effect for pain reduction (effect size [ES] -0·37) was at least 95%. Among maximally approved daily doses, diclofenac 150 mg/day (ES -0·57, 95% credibility interval [CrI] -0·69 to -0·46) and etoricoxib 60 mg/day (ES -0·58, -0·73 to -0·43) had the highest probability to be the best intervention, both with 100% probability to reach the minimum clinically important difference. Treatment effects increased as drug dose increased, but corresponding tests for a linear dose effect were significant only for celecoxib (p=0·030), diclofenac (p=0·031), and naproxen (p=0·026). We found no evidence that treatment effects varied over the duration of treatment. Model fit was good, and between-trial heterogeneity and inconsistency were low in all analyses. All trials were deemed to have a low risk of bias for blinding of patients. Effect estimates did not change in sensitivity analyses with two additional statistical models and accounting for methodological quality criteria in meta-regression analysis. INTERPRETATION On the basis of the available data, we see no role for single-agent paracetamol for the treatment of patients with osteoarthritis irrespective of dose. We provide sound evidence that diclofenac 150 mg/day is the most effective NSAID available at present, in terms of improving both pain and function. Nevertheless, in view of the safety profile of these drugs, physicians need to consider our results together with all known safety information when selecting the preparation and dose for individual patients. FUNDING Swiss National Science Foundation (grant number 405340-104762) and Arco Foundation, Switzerland.

Design of a generalized tool for the performance assessment under sail based on analytical, numerical and empirical results : a global sailing yacht meta-model

La evaluación de las prestaciones de las embarcaciones a vela ha constituido un objetivo para ingenieros navales y marinos desde los principios de la historia de la navegación. El conocimiento acerca de estas prestaciones, ha crecido desde la identificación de los factores clave relacionados con ellas(eslora, estabilidad, desplazamiento y superficie vélica), a una comprensión más completa de las complejas fuerzas y acoplamientos involucrados en el equilibrio. Junto con este conocimiento, la aparición de los ordenadores ha hecho posible llevar a cabo estas tareas de una forma sistemática. Esto incluye el cálculo detallado de fuerzas, pero también, el uso de estas fuerzas junto con la descripción de una embarcación a vela para la predicción de su comportamiento y, finalmente, sus prestaciones. Esta investigación tiene como objetivo proporcionar una definición global y abierta de un conjunto de modelos y reglas para describir y analizar este comportamiento. Esto se lleva a cabo sin aplicar restricciones en cuanto al tipo de barco o cálculo, sino de una forma generalizada, de modo que sea posible resolver cualquier situación, tanto estacionaria como en el dominio del tiempo. Para ello se comienza con una definición básica de los factores que condicionan el comportamiento de una embarcación a vela. A continuación se proporciona una metodología para gestionar el uso de datos de diferentes orígenes para el cálculo de fuerzas, siempre con el la solución del problema como objetivo. Esta última parte se plasma en un programa de ordenador, PASim, cuyo propósito es evaluar las prestaciones de diferentes ti pos de embarcaciones a vela en un amplio rango de condiciones. Varios ejemplos presentan diferentes usos de PASim con el objetivo de ilustrar algunos de los aspectos discutidos a lo largo de la definición del problema y su solución . Finalmente, se presenta una estructura global de cara a proporcionar una representación virtual de la embarcación real, en la cual, no solo e l comportamiento sino también su manejo, son cercanos a la experiencia de los navegantes en el mundo real. Esta estructura global se propone como el núcleo (un motor de software) de un simulador físico para el que se proporciona una especificación básica. ABSTRACT The assessment of the performance of sailing yachts, and ships in general, has been an objective for naval architects and sailors since the beginning of the history of navigation. The knowledge has grown from identifying the key factors that influence performance(length, stability, displacement and sail area), to a much more complete understanding of the complex forces and couplings involved in the equilibrium. Along with this knowledge, the advent of computers has made it possible to perform the associated tasks in a systematic way. This includes the detailed calculation of forces, but also the use of those forces, along with the description of a sailing yacht, to predict its behavior, and ultimately, its performance. The aim of this investigation is to provide a global and open definition of a set of models and rules to describe and analyze the behavior of a sailing yacht. This is done without applying any restriction to the type of yacht or calculation, but rather in a generalized way, capable of solving any possible situation, whether it is in a steady state or in the time domain. First, the basic definition of the factors that condition the behavior of a sailing yacht is given. Then, a methodology is provided to assist with the use of data from different origins for the calculation of forces, always aiming towards the solution of the problem. This last part is implemented as a computational tool, PASim, intended to assess the performance of different types of sailing yachts in a wide range of conditions. Several examples then present different uses of PASim, as a way to illustrate some of the aspects discussed throughout the definition of the problem and its solution. Finally, a global structure is presented to provide a general virtual representation of the real yacht, in which not only the behavior, but also its handling is close to the experience of the sailors in the real world. This global structure is proposed as the core (a software engine) of a physical yacht simulator, for which a basic specification is provided.

Dynamic Models under Uncertainty for Large-Scale Enterprise Systems

Thesis (Ph.D.)--University of Washington, 2016-06

Reducing the risk of sexually transmitted infections in genitourinary medicine clinic patients:A systematic review and meta-analysis of behavioural interventions

Objectives: Are behavioural interventions effective in reducing the rate of sexually transmitted infections (STIs) among genitourinary medicine (GUM) clinic patients? Design: Systematic review and meta-analysis of published articles. Data sources: Medline, CINAHL, Embase, PsychINFO, Applied Social Sciences Index and Abstracts, Cochrane Library Controlled Clinical Trials Register, National Research Register (1966 to January 2004). Review methods: Randomised controlled trials of behavioural interventions in sexual health clinic patients were included if they reported change to STI rates or self reported sexual behaviour. Trial quality was assessed using the Jadad score and results pooled using random effects meta-analyses where outcomes were consistent across studies. Results: 14 trials were included; 12 based in the United States. Experimental interventions were heterogeneous and most control interventions were more structured than typical UK care. Eight trials reported data on laboratory confirmed infections, of which four observed a greater reduction in their intervention groups (in two cases this result was statistically significant, p<0.05). Seven trials reported consistent condom use, of which six observed a greater increase among their intervention subjects. Results for other measures of sexual behaviour were inconsistent. Success in reducing STIs was related to trial quality, use of social cognition models, and formative research in the target population. However, effectiveness was not related to intervention format or length. Conclusions: While results were heterogeneous, several trials observed reductions in STI rates. The most effective interventions were developed through extensive formative research. These findings should encourage further research in the United Kingdom where new approaches to preventing STIs are urgently required.

The role of models@run.time in supporting on-the-fly interoperability

Models at runtime can be defined as abstract representations of a system, including its structure and behaviour, which exist in tandem with the given system during the actual execution time of that system. Furthermore, these models should be causally connected to the system being modelled, offering a reflective capability. Significant advances have been made in recent years in applying this concept, most notably in adaptive systems. In this paper we argue that a similar approach can also be used to support the dynamic generation of software artefacts at execution time. An important area where this is relevant is the generation of software mediators to tackle the crucial problem of interoperability in distributed systems. We refer to this approach as emergent middleware, representing a fundamentally new approach to resolving interoperability problems in the complex distributed systems of today. In this context, the runtime models are used to capture meta-information about the underlying networked systems that need to interoperate, including their interfaces and additional knowledge about their associated behaviour. This is supplemented by ontological information to enable semantic reasoning. This paper focuses on this novel use of models at runtime, examining in detail the nature of such runtime models coupled with consideration of the supportive algorithms and tools that extract this knowledge and use it to synthesise the appropriate emergent middleware.

A Markov chain location-allocation meta-model for hurricane relief

An emergency is a deviation from a planned course of events that endangers people, properties, or the environment. It can be described as an unexpected event that causes economic damage, destruction, and human suffering. When a disaster happens, Emergency Managers are expected to have a response plan to most likely disaster scenarios. Unlike earthquakes and terrorist attacks, a hurricane response plan can be activated ahead of time, since a hurricane is predicted at least five days before it makes landfall. This research looked into the logistics aspects of the problem, in an attempt to develop a hurricane relief distribution network model. We addressed the problem of how to efficiently and effectively deliver basic relief goods to victims of a hurricane disaster. Specifically, where to preposition State Staging Areas (SSA), which Points of Distributions (PODs) to activate, and the allocation of commodities to each POD. Previous research has addressed several of these issues, but not with the incorporation of the random behavior of the hurricane's intensity and path. This research presents a stochastic meta-model that deals with the location of SSAs and the allocation of commodities. The novelty of the model is that it treats the strength and path of the hurricane as stochastic processes, and models them as Discrete Markov Chains. The demand is also treated as stochastic parameter because it depends on the stochastic behavior of the hurricane. However, for the meta-model, the demand is an input that is determined using Hazards United States (HAZUS), a software developed by the Federal Emergency Management Agency (FEMA) that estimates losses due to hurricanes and floods. A solution heuristic has been developed based on simulated annealing. Since the meta-model is a multi-objective problem, the heuristic is a multi-objective simulated annealing (MOSA), in which the initial solution and the cooling rate were determined via a Design of Experiments. The experiment showed that the initial temperature (T0) is irrelevant, but temperature reduction (δ) must be very gradual. Assessment of the meta-model indicates that the Markov Chains performed as well or better than forecasts made by the National Hurricane Center (NHC). Tests of the MOSA showed that it provides solutions in an efficient manner. Thus, an illustrative example shows that the meta-model is practical.

Methodology to create cost estimation models for engineer-to-order operations

This research addresses the problem of cost estimation for product development in engineer-to-order (ETO) operations. An ETO operation starts the product development process with a product specification and ends with delivery of a rather complicated, highly customized product. ETO operations are practiced in various industries such as engineering tooling, factory plants, industrial boilers, pressure vessels, shipbuilding, bridges and buildings. ETO views each product as a delivery item in an industrial project and needs to make an accurate estimation of its development cost at the bidding and/or planning stage before any design or manufacturing activity starts. ^ Many ETO practitioners rely on an ad hoc approach to cost estimation, with use of past projects as reference, adapting them to the new requirements. This process is often carried out on a case-by-case basis and in a non-procedural fashion, thus limiting its applicability to other industry domains and transferability to other estimators. In addition to being time consuming, this approach usually does not lead to an accurate cost estimate, which varies from 30% to 50%. ^ This research proposes a generic cost modeling methodology for application in ETO operations across various industry domains. Using the proposed methodology, a cost estimator will be able to develop a cost estimation model for use in a chosen ETO industry in a more expeditious, systematic and accurate manner. ^ The development of the proposed methodology was carried out by following the meta-methodology as outlined by Thomann. Deploying the methodology, cost estimation models were created in two industry domains (building construction and the steel milling equipment manufacturing). The models are then applied to real cases; the cost estimates are significantly more accurate than the actual estimates, with mean absolute error rate of 17.3%. ^ This research fills an important need of quick and accurate cost estimation across various ETO industries. It differs from existing approaches to the problem in that a methodology is developed for use to quickly customize a cost estimation model for a chosen application domain. In addition to more accurate estimation, the major contributions are in its transferability to other users and applicability to different ETO operations. ^

The relationship between cognitive ability, the big five, task and contextual performance: a meta-analysis

For years, researchers and human resources specialists have been searching for predictors of performance as well as for relevant performance dimensions (Barrick & Mount, 1991; Borman & Motowidlo, 1993; Campbell, 1990; Viswesvaran et al., 1996). In 1993, Borman and Motowidlo provided a framework by which traditional predictors such as cognitive ability and the Big Five personality factors predicted two different facets of performance: 1) task performance and 2) contextual performance. A meta-analysis was conducted to assess the validity of this model as well as that of other modified models. The relationships between predictors such as cognitive ability and personality variables and the two outcome variables were assessed. It was determined that even though the two facets of performance may be conceptually different, empirically they overlapped substantially (p= .75). Finally, results show that there is some evidence for cognitive ability as a predictor of both task and contextual performance and conscientiousness as a predictor of both task and contextual performance. The possible mediation of predictor-- criterion relationships was also assessed. The relationship between cognitive ability and contextual performance vanished when task performance was controlled.

Statin use and survival in colorectal cancer: Results from a population-based cohort study and an updated systematic review and meta-analysis

BACKGROUND: The aim of this study was to investigate the association between statin use and survival in a population-based colorectal cancer (CRC) cohort and perform an updated meta-analysis to quantify the magnitude of any association.

METHODS: A cohort of 8391 patients with newly diagnosed Dukes' A-C CRC (2009-2012) was identified from the Scottish Cancer Registry. This cohort was linked to the Prescribing Information System and the National Records of Scotland Death Records (until January 2015) to identify 1064 colorectal cancer-specific deaths. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for cancer-specific mortality by statin use were calculated using time dependent Cox regression models. The systematic review included relevant studies published before January 2016. Meta-analysis techniques were used to derive combined HRs for associations between statin use and cancer-specific and overall mortality.

RESULTS: In the Scottish cohort, statin use before diagnosis (HR=0.84, 95% CI 0.75-0.94), but not after (HR=0.90, 95% CI 0.77-1.05), was associated with significantly improved cancer-specific mortality. The systematic review identified 15 relevant studies. In the meta-analysis, there was consistent (I(2)=0%,heterogeneity P=0.57) evidence of a reduction in cancer-specific mortality with statin use before diagnosis in 6 studies (n=86,622, pooled HR=0.82, 95% CI 0.79-0.86) but this association was less apparent and more heterogeneous (I(2)=67%,heterogeneity P=0.03) with statin use after diagnosis in 4 studies (n=19,152, pooled HR=0.84, 95% CI 0.68-1.04).

CONCLUSION: In a Scottish CRC cohort and updated meta-analysis there was some evidence that statin use was associated with improved survival. However, these associations were weak in magnitude and, particularly for post-diagnosis use, varied markedly between studies.

Ovarian suppression using luteinizing hormonereleasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients: A meta-analysis of randomized studies

Background: The role of temporary ovarian suppression with luteinizing hormone-releasing hormone agonists (LHRHa) in the prevention of chemotherapy-induced premature ovarian failure (POF) is still controversial. Our meta-analysis of randomized, controlled trials (RCTs) investigates whether the use of LHRHa during chemotherapy in premenopausal breast cancer patients reduces treatment-related POF rate, increases pregnancy rate, and impacts disease-free survival (DFS). Methods: A literature search using PubMed, Embase, and the Cochrane Library, and the proceedings of major conferences, was conducted up to 30 April 2015. Odds ratios (ORs) and 95% confidence intervals (CIs) for POF (i.e. POF by study definition, and POF defined as amenorrhea 1 year after chemotherapy completion) and for patients with pregnancy, as well hazard ratios (HRs) and 95% CI for DFS, were calculated for each trial. Pooled analysis was carried out using the fixed- and random-effects models. Results: A total of 12 RCTs were eligible including 1231 breast cancer patients. The use of LHRHa was associated with a significant reduced risk of POF (OR 0.36, 95% CI 0.23-0.57; P < 0.001), yet with significant heterogeneity (I2 = 47.1%, Pheterogeneity = 0.026). In eight studies reporting amenorrhea rates 1 year after chemotherapy completion, the addition of LHRHa reduced the risk of POF (OR 0.55, 95% CI 0.41-0.73, P < 0.001) without heterogeneity (I2 = 0.0%, Pheterogeneity = 0.936). In five studies reporting pregnancies, more patients treated with LHRHa achieved pregnancy (33 versus 19 women; OR 1.83, 95% CI 1.02-3.28, P = 0.041; I2 = 0.0%, Pheterogeneity = 0.629). In three studies reporting DFS, no difference was observed (HR 1.00, 95% CI 0.49-2.04, P = 0.939; I2 = 68.0%, Pheterogeneity = 0.044). Conclusion: Temporary ovarian suppression with LHRHa in young breast cancer patients is associated with a reduced risk of chemotherapy-induced POF and seems to increase the pregnancy rate, without an apparent negative consequence on prognosis.