Navegando por Palavras-chave "meta-analysis"

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    Achieving 2003 European lipid goals with rosuvastatin and comparator statins in 6743 patients in real-life clinical practice: DISCOVERY meta-analysis analysis
    (Librapharm, 2006-06-01) Middleton, A.; Binbrek, A. S.; Fonseca, F. A. H.; Wilpshaar, W.; Watkins, C.; Strandberg, T. E.; Fowey Surg; Rashid Hosp; Universidade Federal de São Paulo (UNIFESP); AstraZeneca; Univ Helsinki
    Background: There is an increasing body of evidence to support the benefits of reducing low-density lipoprotein cholesterol ( LDL- C) levels and this has been reflected in a lowering of LDL- C goals recommended by international guidelines. Therefore, there is a growing need for effective lipid-modifying therapies to optimise the achievement of these more stringent LDL- C goals.Objective: A meta-analysis of data pooled from five studies participating in the DISCOVERY ( DIrect Statin COmparison of LDL- C Values: an Evaluation of Rosuvastatin therapY) Programme was performed to compare the effect of rosuvastatin treatment with other statins in real-life clinical practice.Results: These studies included 6743 patients with hypercholesterolaemia from different ethnicities, countries and cultural environments. the meta-analysis showed that significantly more patients receiving rosuvastatin 10 mg achieved the 2003 European LDL- C goals compared with those who received atorvastatin 10 mg or simvastatin 20 mg ( p < 0.001 for both comparisons). A significantly greater proportion of patients receiving rosuvastatin 10 mg also achieved the 2003 European total cholesterol goal compared with those on atorvastatin 10 mg ( p < 0.001).Conclusions: the meta-analysis showed that rosuvastatin was more effective than comparator statins at lowering LDL- C levels and enabling patients to achieve lipid goals at recommended start doses. in addition, all statins studied were well tolerated and confirmed that rosuvastatin had a similar safety profile to other statins.
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    Adequabilidade dos principais modelos de periodização do treinamento esportivo
    (Colégio Brasileiro de Ciências do Esporte, 2011-06-01) Dantas, Estélio Henrique Martin; Godoy, Erik Salum De; Sposito-araujo, Carlos Alberto; Oliveira, Artur Luís Bessa De; Azevedo, Rafael Cordeiro; Tubino, Manoel José Gomes; Gomes, Antônio Carlos [UNIFESP]; Universidade Federal do Estado do Rio de Janeiro Laboratório de Biociências da Motricidade Humana; Universidade Veiga de Almeida; Universidade Federal de Uberlândia Instituto de Genética e Bioquímica; Universidade Federal de São Paulo (UNIFESP)
    The aim of this study was to identify using the adequability pattern method, which model of periodization suite better to sport training observed at bibliographic research. It utilized as indicators the structure of periodization and the modulation pattern of workload. The methodological tool of this study was meta-analysis. Were appraised 103 citations. Analysis of the collected material, assessed through the statistic tool size-effect (TE made it possible to established an Adequability Index (IADEQ) and then, categorize the models as : Very Good - Matveev (IADEQ = 3,44; TE = 1,13); Good - Verkhoshansky (IADEQ = 2,88; TE = 0,57), Bompa (IADEQ = 2,66; TE = 0,34) e Regular - ATR (IADEQ = 1,96; TE = -0,37), Forteza (IADEQ = 2,25; TE = -0,07).
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    Antidepressants versus placebo for the treatment of bulimia nervosa: a systematic review
    (Blackwell Science Asia, 2000-04-01) Bacaltchuk, Josué [UNIFESP]; Hay, P.; Mari, J. J.; Universidade Federal de São Paulo (UNIFESP); Univ Adelaide
    Objective: the objective of this study was to valuate the effectiveness, tolerability and acceptability of various classes of antidepressants compared with placebo in the treatment of bulimia nervosa.Method: A meta-analysis including 16 randomised controlled trials and 1300 bulimic patients was performed. Dichotomous outcomes were analysed by calculating relative risks, and continuous outcomes by calculating effect sizes. Methodological quality, heterogeneity in the results and selective publication were assessed.Results: Short-term remission in bulimic symptoms was statistically more likely on antidepressants than placebo (Relative Risk = 0.88, 95% CI = 0.83-0.94, p < 0.0001). Drop-out rates were high but no statistical difference was found between treatment groups (34.6% and 31.4% for drug and placebo; RR = 1.03, 95% CI = 0.80-1.32, p = 0.8). No difference in efficacy could be demonstrated among different classes of antidepressants.Conclusions: the use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared with placebo, with an overall greater remission rate and a higher rate of drop-outs. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.
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    Assessing Risk of Bias in Randomized Controlled Trials for Autism Spectrum Disorder
    (Frontiers Media Sa, 2017) Martins Okuda, Paola Matiko [UNIFESP]; Klaiman, Cheryl; Bradshaw, Jessica; Reid, Morganne; Cogo-Moreira, Hugo [UNIFESP]
    Aim: To determine construct validity and reliability indicators of the Cochrane risk of bias (RoB) tool in the context of randomized clinical trials (RCTs) for autism spectrum disorder (ASD). Methods: Confirmatory factor analysis was used to evaluate a unidimensional model consisting of 9 RoB categorical indicators evaluated across 94 RCTs addressing interventions for ASD. Results: Only five of the nine original RoB items returned good fit indices and so were retained in the analysis. Only one of this five had very high factor loadings. The remaining four indicators had more measurement error than common variance with the RoB latent factor. Together, the five indicators showed poor reliability (omega = 0.687; 95% CI: 0.613-0.761). Conclusion: Although the Cochrane model of RoB for ASD exhibited good fit indices, the majorities of the items have more residual variance than common variance and, therefore, did not adequately capture the RoB in ASD intervention trials.
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    Assessing risk of bias in randomized controlled trials of methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)
    (Wiley, 2018) Rodrigues-Tartari, Raissa [UNIFESP]; Swardfager, Walter; Salum, Giovanni A.; Rohde, Luis A.; Cogo-Moreira, Hugo [UNIFESP]
    To test how reliable the tool recommend by Cochrane Collaboration for assessing risk of bias systematic reviews of randomized clinical trials is in the context of methylphenidate for children and adolescents with attention deficit hyperactivity disorder. Confirmatory factor analysis was used to evaluate a unidimensional model for the 7 indicators, applied to 184 Randomized Clinical Trial (RCTs) within a 2015 Cochrane systematic review titled Methylphenidate for children and adolescents with attention deficit hyperactivity disorder. A unidimensional model resulted in excellent adequacy indices, but only 2 indicators had very high factor loadings and low measurement errors. In terms of content, the 7 indicators showed poor reliability (=0.642)
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    Birth order and childhood type 1 diabetes risk: a pooled analysis of 31 observational studies
    (Oxford Univ Press, 2011-04-01) Cardwell, Chris R.; Stene, Lars C.; Joner, Geir; Bulsara, Max K.; Cinek, Ondrej; Rosenbauer, Joachim; Ludvigsson, Johnny; Svensson, Jannet; Goldacre, Michael J.; Waldhoer, Thomas; Jarosz-Chobot, Przemyslawa; Gimeno, Suely Godoy Agostinho [UNIFESP]; Chuang, Lee-Ming; Roberts, Christine L.; Parslow, Roger C.; Wadsworth, Emma J. K.; Chetwynd, Amanda; Brigis, Girts; Urbonaite, Brone; Sipetic, Sandra; Schober, Edith; Devoti, Gabriele; Ionescu-Tirgoviste, Constantin; Beaufort, Carine E. de; Stoyanov, Denka; Buschard, Karsten; Radon, Katja; Glatthaar, Christopher; Patterson, Chris C.; Queens Univ Belfast; Norwegian Inst Publ Hlth; Oslo Univ Hosp; Univ Oslo; Univ Western Australia; Univ Notre Dame; Charles Univ Prague; Univ Dusseldorf; Linkoping Univ; Glostrup Univ Hosp; Univ Oxford; Med Univ Vienna; Med Univ Silesia; Universidade Federal de São Paulo (UNIFESP); Natl Taiwan Univ Hosp; Univ Sydney; Univ Leeds; Cardiff Univ; Univ Lancaster; Riga Stradins Univ; Kaunas Univ Med; Univ Belgrade; Univ Lecce; N Paulescu Inst Diabet; Pediat Clin; Childrens Diabet Ctr; Rigshosp; Hosp LMU Munich; Sir Charles Gairdner Hosp
    Background the incidence rates of childhood onset type 1 diabetes are almost universally increasing across the globe but the aetiology of the disease remains largely unknown. We investigated whether birth order is associated with the risk of childhood diabetes by performing a pooled analysis of previous studies.Methods Relevant studies published before January 2010 were identified from MEDLINE, Web of Science and EMBASE. Authors of studies provided individual patient data or conducted pre-specified analyses. Meta-analysis techniques were used to derive combined odds ratios (ORs), before and after adjustment for confounders, and investigate heterogeneity.Results Data were available for 6 cohort and 25 case-control studies, including 11 955 cases of type 1 diabetes. Overall, there was no evidence of an association prior to adjustment for confounders. After adjustment for maternal age at birth and other confounders, a reduction in the risk of diabetes in second- or later born children became apparent [fully adjusted OR = 0.90 95% confidence interval (CI) 0.83-0.98; P = 0.02] but this association varied markedly between studies (I(2) = 67%). An a priori subgroup analysis showed that the association was stronger and more consistent in children < 5 years of age (n = 25 studies, maternal age adjusted OR = 0.84 95% CI 0.75, 0.93; I(2) = 23%).Conclusion Although the association varied between studies, there was some evidence of a lower risk of childhood onset type 1 diabetes with increasing birth order, particularly in children aged < 5 years. This finding could reflect increased exposure to infections in early life in later born children.
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    Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review
    (Munksgaard Int Publ Ltd, 2000-04-01) Bacaltchuk, Josué [UNIFESP]; Trefiglio, R. P.; Oliveira, I. R.; Hay, P.; Lima, M. S.; Mari, J. J.; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia (UFBA); Univ Adelaide; Fed Univ Pelotas
    Background: This review assessed the effect of a combination of antidepressants plus psychological approaches compared to each single treatment for bulimia nervosa.Method: Trials were included in two meta-analyses: single antidepressants versus combination and single psychological approaches versus combination. Methodological quality and homogeneity of results were assessed. Dichotomous outcomes were analysed by calculating relative risks (RR).Results: Five trials were included in meta-analysis I and 7 in meta-analysis 2. Remission rates were 42% for combination versus 23% for antidepressants (RR = 1.38; 95% CI = 0.98-1.93; P = 0.06) and 36% for psychological approaches compared to 49% for combination (RR = 1.21; P = 0.03). Drop-out rates were 16% for psychological approaches and 30% for combination (RR = 0.57; 95% CI = 0.38-0.088; P = 0.11).Conclusion: Efficacy of combined treatments was superior to single approaches. When antidepressants were combined to treatment, acceptability of psychological approaches was significantly reduced.
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    Conservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials
    (Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2016) Moroni, Rafael Mendes; Magnani, Pedro Sergio; Haddad, Jorge Milhem; Castro, Rodrigo de Aquino [UNIFESP]; Brito, Luiz Gustavo Oliveira
    We performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = -1.24SDs; CI 95% = -1.77 to -0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = -4.4 points; CI 95% = -16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95% CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.
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    Conservative Treatment of Stress Urinary Incontinence: A Systematic Review with Meta-analysis of Randomized Controlled Trials
    (Federacao Brasileira Soc Ginecologia & Obstetricia-Febrasgo, 2016) Moroni, Rafael Mendes; Magnani, Pedro Sergio; Haddad, Jorge Milhem; Castro, Rodrigo de Aquino [UNIFESP]; Brito, Luiz Gustavo Oliveira
    We performed a systematic review and meta-analysis of randomized controlled trials that studied the conservative management of stress urinary incontinence (SUI). There were 1058 results after the initial searches, from which 37 studies were eligible according to previously determined inclusion criteria. For the primary outcomes, pelvic floor muscle training (PFMT) was more efficacious than no treatment in improving incontinence-specific quality of life (QoL) scales (SMD = -1.24SDs; CI 95% = -1.77 to -0.71SDs). However, its effect on pad tests was imprecise. Combining biofeedback with PFMT had an uncertain effect on QoL (MD = -4.4 points; CI 95% = -16.69 to 7.89 points), but better results on the pad test, although with elevated heterogeneity (MD = 0.9g; 95% CI = 0.71 to 1,10g); group PFMT was not less efficacious than individual treatment, and home PFMT was not consistently worse than supervised PFMT. Both intravaginal and superficial electrical stimulation (IES and SES) were better than no treatment for QoL and pad test. Vaginal cones had mixed results. The association of IES with PFMT may improve the efficacy of the latter for QoL and pad test, but the results of individual studies were not consistent. Thus, there is evidence of the use of PFMT on the treatment of SUI, with and without biofeedback.
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    Critical interpretation of Cochran's Q test depends on power and prior assumptions about heterogeneity
    (Wiley-Blackwell, 2010-04-01) Pereira, Tiago V. [UNIFESP]; Patsopoulos, Nikolaos A.; Salanti, Georgia; Ioannidis, John P. A.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Univ Ioannina; Harvard Univ; Fdn Res & Technol Hellas; Tufts Univ; Stanford Univ
    We describe how an appropriate interpretation of the Q-test depends on its power to detect a given typical amount of between-study variance (tau(2)) as well as prior beliefs on heterogeneity. We illustrate these concepts in an evaluation of 1011 meta-analyses of clinical trials with >= 4 studies and binary outcomes. These concepts can be seen as an application of the Bayes theorem. Across the 1011 meta-analyses, power to detect typical heterogeneity was low in most situations. Thus, usually a non-significant Q test did not change perceptibly prior convictions on heterogeneity. Conversely, significant results for the Q test typically augmented considerably the probability of heterogeneity. the posterior probability of heterogeneity depends on what tau(2) we want to detect. With the same approach, one may also estimate the posterior probability for the presence of heterogeneity that is large enough to annul statistically significant summary effects; that is half the average within-study variance of the combined studies; and that is able to change the summary effect estimate of the meta-analysis by 20%. the discussed analyses are exploratory, and may depend heavily on prior assumptions when power for the Q-test is low. Statistical heterogeneity in meta-analyses should be cautiously interpreted considering the power to detect a specific tau(2) and prior assumptions about the presence of heterogeneity. Copyright (C) 2010 John Wiley & Sons, Ltd.
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    Cytokine Alterations in Bipolar Disorder: A Meta-Analysis of 30 Studies
    (Elsevier B.V., 2013-07-01) Modabbernia, Amirhossein; Taslimi, Shervin; Brietzke, Elisa [UNIFESP]; Ashrafi, Mandana; Univ Tehran Med Sci; Universidade Federal de São Paulo (UNIFESP)
    Background: We conducted a meta-analysis of studies comparing cytokine concentrations between patients with bipolar disorder (BD) and healthy control subjects (HCs).Methods: We searched ISI Web of Science, MEDLINE, BIOSIS Previews, Scopus, Current Contents Connect, and Biological Abstracts for relevant studies. Based on heterogeneity status, we used fixed-effect or restricted maximal likelihood model to perform meta-analysis.Results: Thirty studies with a total of 2599 participants (1351 BD and 1248 HCs) were eligible for the analysis. Concentrations of interleukin (IL)-4 (p = .008), IL-6 (p = .073), IL-10 (p = .013), soluble IL-2 receptor (sIL-2R; p < .001), sIL-6R (p = .021), tumor necrosis factor (TNF)-alpha (p = .010), soluble TNF receptor-1 (sTNFR1; p < .001), and IL-1 receptor antagonist (p value in mania <.001 and euthymia = .021) were significantly elevated in patients compared with HCs. Moreover, IL-1 beta (p = .059), and IL-6 (p = .073) tended to show higher values in patients. Levels of IL-2 (p = .156), interferon (INF)-gamma (p = .741), C-C motif ligand 2 (p = .624), and IL-8 (p = .952) did not significantly differ between patients and HCs. Subgroup analysis based on mitogen stimulation status partially or completely resolved heterogeneity for most of the cytokines. Concentrations of IL-2, IL-4, sIL-6R, and INF-gamma were unrelated to medication status. Phasic difference was present for TNF-alpha, sTNFR1, sIL-2R, IL-6, and IL-1RA, whereas it was absent for IL-4 and IL-10.Conclusions: This meta-analysis provides evidence for significant elevation of proinflammatory, anti-inflammatory, and regulatory cytokines in BD.
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    Decompressive craniectomy: a meta-analysis of influences on intracranial pressure and cerebral perfusion pressure in the treatment of traumatic brain injury A review
    (Amer Assoc Neurological Surgeons, 2012-09-01) Bor-Seng-Shu, Edson; Figueiredo, Eberval G.; Amorim, Robson L. O.; Teixeira, Manoel Jacobsen; Valbuza, Juliana Spelta [UNIFESP]; Oliveira, Marcio Moyses de; Panerai, Ronney B.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Maranhao Fed Univ; Univ Leicester
    Object. in recent years, the role of decompressive craniectomy for the treatment of traumatic brain injury (TB!) in patients with refractory intracranial hypertension has been the subject of several studies. the purpose of this review was to evaluate the contribution of decompressive craniectomy in reducing intracranial pressure (ICP) and increasing cerebral perfusion pressure (CPP) in these patients.Methods. Comprehensive literature searches were performed for articles related to the effects of decompressive craniectomy on ICP and CPP in patients with TBI. Inclusion criteria were as follows: 1) published manuscripts, 2) original articles of any study design except case reports, 3) patients with refractory elevated ICP due to traumatic brain swelling, 4) decompressive craniectomy as a type of intervention, and 5) availability of pre- and postoperative ICP and/or CPP data. Primary outcomes were ICP decrease and/or CPP increase for assessing the efficacy of decompressive craniectomy. the secondary outcome was the persistence of reduced ICP 24 and 48 hours after the operation.Results. Postoperative ICP values were significantly lower than preoperative values immediately after decompressive craniectomy (weighted mean difference [WMD] -17.59 mm Hg, 95% CI -23.45 to -11.73, p < 0.00001), 24 hours after (WMD -14.27 mm Hg, 95% Cl -24.13 to -4.41, p < 0.00001), and 48 hours after (WMD -12.69 mm Hg, 95% Cl -22.99 to -2.39, p < 0.0001). Postoperative CPP was significantly higher than preoperative values (WMD 7.37 mm Hg, 95% Cl 2.32 to 12.42, p < 0.0001).Conclusions. Decompressive craniectomy can effectively decrease ICP and increase CPP in patients with TBI and refractory elevated ICP. Further studies are necessary to define the group of patients that can benefit most from this procedure. (http://thejns.org/doi/abs/10.3171/2012.6.JNS101400)
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    Dental Implants Installed in Irradiated Jaws: A Systematic Review
    (Sage Publications Inc, 2013-12-01) Chambrone, L.; Mandia, J. [UNIFESP]; Shibli, J. A.; Romito, G. A.; Abrahao, M. [UNIFESP]; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Univ Guarulhos
    The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing implants that had been placed in nongrafted sites of irradiated patients. Random effects meta-analyses assessed implant loss in irradiated versus nonirradiated patients and in irradiated patients treated with hyperbaric oxygen (HBO) therapy. of 1,051 potentially eligible publications, 15 were included. A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) had been placed in irradiated jaws. the mean survival rate in the studies ranged from 46.3% to 98.0%. the pooled estimates indicated a significant increase in the risk of implant failure in irradiated patients (risk ratio: 2.74; 95% confidence interval: 1.86, 4.05; p < .00001) and in maxillary sites (risk ratio: 5.96; 95% confidence interval: 2.71, 13.12; p < .00001). Conversely, HBO therapy did not reduce the risk of implant failure (risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80). Radiotherapy was linked to higher implant failure in the maxilla, and HBO therapy did not improve implant survival. Most included publications reported data on machined implants, and only 3 studies on HBO therapy were included. Overall, implant therapy appears to be a viable treatment option for reestablishing adequate occlusion and masticatory conditions in irradiated patients.
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    Discovery Properties of Genome-wide Association Signals From Cumulatively Combined Data Sets
    (Oxford Univ Press Inc, 2009-11-15) Pereira, Tiago da Veiga [UNIFESP]; Patsopoulos, Nikolaos A.; Salanti, Georgia; Ioannidis, John P. A.; Univ Ioannina; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Fdn Res & Technol Hellas; Tufts Univ
    Genetic effects for common variants affecting complex disease risk are subtle. Single genome-wide association (GWA) studies are typically underpowered to detect these effects, and combination of several GWA data sets is needed to enhance discovery. the authors investigated the properties of the discovery process in simulated cumulative meta-analyses of GWA study-derived signals allowing for potential genetic model misspecification and between-study heterogeneity. Variants with null effects on average (but also between-data set heterogeneity) could yield false-positive associations with seemingly homogeneous effects. Random effects had higher than appropriate false-positive rates when there were few data sets. the log-additive model had the lowest false-positive rate. Under heterogeneity, random-effects meta-analyses of 2-10 data sets averaging 1,000 cases/1,000 controls each did not increase power, or the meta-analysis was even less powerful than a single study (power desert). Upward bias in effect estimates and underestimation of between-study heterogeneity were common. Fixed-effects calculations avoided power deserts and maximized discovery of association signals at the expense of much higher false-positive rates. Therefore, random- and fixed-effects models are preferable for different purposes (fixed effects for initial screenings, random effects for generalizability applications). These results may have broader implications for the design and interpretation of large-scale multiteam collaborative studies discovering common gene variants.
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    Do polymorphisms of 5,10-methylenetetrahydrofolate reductase (MTHFR) gene affect the risk of childhood acute lymphoblastic leukemia?
    (Springer, 2006-12-01) Pereira, Tiago Veiga; Rudnicki, Martina; Pereira, Alexandre Costa; Pombo-de-Oliveira, Maria S.; Franco, Rendrik Franca; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Inst Nacl Canc; Fleury Res Inst
    Meta-analysis has become an important statistical tool in genetic association studies, since it may provide more powerful and precise estimates. However, meta-analytic studies are prone to several potential biases not only because the preferential publication of positive'' studies but also due to difficulties in obtaining all relevant information during the study selection process. in this letter, we point out major problems in meta-analysis that may lead to biased conclusions, illustrating an empirical example of two recent meta-analyses on the relation between MTHFR polymorphisms and risk of acute lymphoblastic leukemia that, despite the similarity in statistical methods and period of study selection, provided partially conflicting results.
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    Effects of continuous positive airway pressure on blood pressure in patients with resistant hypertension and obstructive sleep apnea: ameta-analysis
    (Lippincott Williams & Wilkins, 2014-12-01) Iftikhar, Imran H.; Valentine, Christopher W.; Bittencourt, Lia R. A. [UNIFESP]; Cohen, Debbie L.; Fedson, Annette C.; Gislason, Thorarinn; Penzel, Thomas; Phillips, Craig L.; Lin Yu-sheng; Pack, Allan I.; Magalang, Ulysses J.; Univ S Carolina; Ohio State Univ; Universidade Federal de São Paulo (UNIFESP); Univ Penn; Univ Iceland; Charite; Royal N Shore Hosp; Univ Sydney; Taoyuan Chang Gung Mem Hosp
    Objective: To systematically analyze the studies that have examined the effect of continuous positive airway pressure (CPAP) on blood pressure (BP) in patients with resistant hypertension and obstructive sleep apnea (OSA).Methods: Design - meta-analysis of observational studies and randomized controlled trials (RCTs) indexed in PubMed and Ovid (All Journals@Ovid). participants: individuals with resistant hypertension and OSA; interventions - CPAP treatment.Results: A total of six studies met the inclusion criteria for preintervention to postintervention analyses. the pooled estimates of mean changes after CPAP treatment for the ambulatory (24-h) SBP and DBP from six studies were -7.21 mmHg [95% confidence interval (CI): -9.04 to -5.38; P < 0.001; I-2 58%) and -4.99 mmHg (95% CI: -6.01 to -3.96; P < 0.001; I-2 31%), respectively. the pooled estimate of the ambulatory SBP and DBP from the four RCTs showed a mean net change of -6.74 mmHg [95% CI: -9.98 to -3.49; P < 0.001; I-2 61%] and -5.94 mmHg (95% CI: -9.40 to -2.47; P = 0.001; I-2 76%), respectively, in favor of the CPAP group.Conclusion: the pooled estimate shows a favorable reduction of BP with CPAP treatment in patients with resistant hypertension and OSA. the effects sizes are larger than those previously reported in patients with OSA without resistant hypertension.
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    Effects of Mindfulness-Based Interventions on Salivary Cortisol in Healthy Adults: A Meta-Analytical Review
    (Frontiers Media Sa, 2016) Sanada, Kenji; Montero-Marin, Jesus; Alda Diez, Marta; Salas-Valero, Montserrat; Perez-Yus, Maria C.; Morillo, Hector; Demarzo, Marcelo Marcos Piva [UNIFESP]; Garcia-Toro, Mauro; Garcia-Campayo, Javier
    Objective: The aim of the present study was to elucidate the effects of Mindfulness-based interventions (MBIs) on salivary cortisol levels in healthy adult populations. Method: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between January 1980 and June 2015 in PubMed, EMBASE, PsycINFO and the Cochrane library. The PRISMA and Cochrane guidelines were followed. The pooled effect sizes were calculated with the random-effects model, using Hedges' g-values, and heterogeneity was measured using the 12 statistic. The contribution of different characteristics of participants and programmes were assessed by meta-regression models, using beta coefficients. Results: Five RCTs with 190 participants in total were included in this systematic review. The overall effect size (ES) for improving the state of health related to cortisol levels was moderately low (g = 0.41
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    Efficacy of Clodronate, Pamidronate, and Zoledronate in Reducing Morbidity and Mortality in Cancer Patients With Bone Metastasis: A Meta-Analysis of Randomized Clinical Trials
    (Elsevier B.V., 2009-05-01) Machado, Marcio; Cruz, Lorena Souza; Tannus, Gabriela [UNIFESP]; Fonseca, Marcelo [UNIFESP]; Univ Toronto; Universidade Federal de São Paulo (UNIFESP)
    Background: Complications from skeletal-related events (SREs) constitute a challenge in the care of patients with metastatic bone disease (MBD) that originated from any type of malignancy.Objective: The purpose of this article was to compare the efficacy of clodronate, pamidronate, and zoledronate with that of placebo in reducing morbidity and overall mortality in cancer patients with MBD.Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched (from inception to January 2009) to retrieve randomized clinical trials that evaluated the bisphosphonates of interest. The search included articles published in English, French, Italian, Portugese, and Spanish. Patients with a definite (le, biopsy-proven) diagnosis of MBD were included in the analysis. We extracted and combined data from studies that reported the number of patients with SREs and mortality data. A random-effects, meta-analytic model was applied in all calculations. The Jadad scale was used to assess the quality of study reporting.Results: The literature search identified 62 potential full-text studies; 44 of these studies were excluded and 18 were evaluated. The mean (SD) quality of reporting of the included studies was 57.8% (22.6%), or 2.89/5 (1.1/5). Each of the 3 drugs was found to be more effective than placebo in preventing all SREs in cancer patients with MBD. The relative risk of developing SREs was 0.70 (95% CI, 0.61-0.81; N = 1211) for zoledronate, 0.81 (95% CI, 0.73-0.91; N = 2251) for pamidronate, and 0.87 (95% CI, 0.75-1.00; N = 681) for clodronate. However, no clear advantage of one drug over the others was observed (CIs overlapped substantially). None of the bisphosphonates was more beneficial than placebo in reducing the number of deaths in the course of the trials (P = NS).Conclusion: Clodronate, pamidronate, and zoledronate were associated with reductions in morbidity in cancer patients with MBD with regard to preventing SREs, but were not associated with a reduction in overall mortality. (Clin Ther. 2009;31:962-979) (C) 2009 Excerpta Medica Inc.
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    Efficacy of sublingual immunotherapy in asthma: systematic review of randomized-clinical trials using the Cochrane Collaboration method
    (Blackwell Publishing, 2006-10-01) Calamita, Z.; Saconato, Humberto [UNIFESP]; Pela, A. B.; Atallah, Álvaro Nagib [UNIFESP]; Med Sch Marilia; Universidade Federal de São Paulo (UNIFESP)
    Background: Sublingual immunotherapy (SLIT) is effective and safe in the treatment of allergic rhinitis. However, there is no meta-analysis in asthma treatment.Methods: the clinical efficacy of SLIT for asthma was evaluated through a systematic review with meta-analysis. MEDLINE (1966-2005), EMBASE (1974-2005), LILACS (1982-2005), and the Cochrane Library were searched for related literature in any language. Randomized-controlled clinical trials (RCT) on SLIT in asthma treatment for adults and children were selected. From 119 citations, 25 studies with 1706 patients were included in this meta-analysis. for each report, quality scores were assigned and data were extracted in relation to the outcomes analyzed: asthmatic symptoms, use of asthma medications, lung function, and bronchial provocation.Results: According to the Jadad quality method, 64% of the studies were assigned scores of 4 or 5. Immunotherapy was seen to significantly reduce asthma severity when parameter compositions were all analyzed by categorical outcomes. There was a nonsignificant reduction in asthma symptoms when analyzed using standardized mean differences. No severe reactions were observed.Conclusions: This meta-analysis found that SLIT is beneficial for asthma treatment albeit the magnitude of the effect is not very large. Moreover, it is a safe alternative to the subcutaneous route. More RCT with standardization of symptom scores and medications are needed in order to contribute further to this subject.
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    Efficacy of theophylline in people with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis
    (W B Saunders Co Ltd, 2005-02-01) Ram, Felix SF; Jardim, José Roberto; Atallah, Álvaro Nagib [UNIFESP]; Castro, Aldemar Araujo [UNIFESP]; Mazzini, Renato Coimbra [UNIFESP]; Goldstein, Roger; Lacasse, Yves; Cendon Filha, Sônia Perez [UNIFESP]; Natl Collaborating Ctr Womens & Childrens Hlth; Universidade Federal de São Paulo (UNIFESP); Emergency Med Div; Fed Univ Alagoas; Univ Toronto; Univ Laval
    Objectives: To determine the efficacy of oral theophylline compared with placebo in people with stable chronic obstructive pulmonary disease (COPD).Methods: Systematic review of randomized-controlled trials comparing oral Theophylline; with placebo for a minimum of 7 days in people with stable COPD.Results: Twenty randomized-controlled trials were included in this review. the Meta-analysis; following outcomes showed significant improvement with theophylline compared with placebo: FEV, and FVC both improved with theophylline (weighted mean difference [WMD] 0.10 L; 95% confidence interval [95% CI] 0.04-0.16 and WMD 0.21 L; 95% CI 0.10-0.32, respectively). VO2 max also improved with theophylline (WMD 195.27mL/ min; 95% Cl 112.71-277.83), as did PaO2 and PaCO2 (WMD 3.18mmHg;,95% Cl 1.23-5.13 and WMD -2.36mmHg; 95% Cl -3.52 to -1.21, respectively). Patients preferred theophylline over placebo (relative risk 2.27; 95% Cl 1.26-4.11). Theophylline increased the risk of nausea compared with placebo (RR 7.67; 95% Cl 1.47-39.94).Conclusion: This review has shown that theophylline still has a role in the management of stable COPD, and is preferred by patients over placebo. However, the benefits of theophylline in stable COPD have to be weighed against the risk of adverse effects. (C) 2004 Elsevier B.V. All rights reserved.