The Accuracy of Diagnostic Methods for Diabetic Retinopathy: A Systematic Review and Meta-Analysis

Objective: The objective of this study was to evaluate the accuracy of the recommended glycemic measures for diagnosing diabetic retinopathy. Methods: We systematically searched MEDLINE, EMBASE, the Cochrane Library, and the Web of Science databases from inception to July 2015 for observational studies comparing the diagnostic accuracy of glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-hour plasma glucose (2h-PG). Random effects models for the diagnostic odds ratio (dOR) value computed by Moses’ constant for a linear model and 95% CIs were used to calculate the accuracy of the test. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarize the overall test performance. Results: Eleven published studies were included in the meta-analysis. The pooled dOR values for the diagnosis of retinopathy were 16.32 (95% CI 13.86–19.22) for HbA1c and 4.87 (95% CI 4.39–5.40) for FPG. The area under the HSROC was 0.837 (95% CI 0.781 0.892) for HbA1c and 0.735 (95% CI 0.657–0.813) for FPG. The 95% confidence region for the point that summarizes the overall test performance of the included studies occurs where the cutoffs ranged from 6.1% (43.2 mmol/mol) to 7.8% (61.7 mmol/mol) for HbA1c and from 7.8 to 9.3 mmol/L for FPG. In the four studies that provided information regarding 2h-PG, the pooled accuracy estimates for HbA1c were similar to those of 2h-PG; the overall performance for HbA1c was superior to that for FPG. Conclusions: The three recommended tests for the diagnosis of type 2 diabetes in nonpregnant adults showed sufficient accuracy for their use in clinical settings, although the overall accuracy for the diagnosis of retinopathy was similar for HbA1c and 2h-PG, which were both more accurate than for FPG. Due to the variability and inconveniences of the glucose level-based methods, HbA1c appears to be the most appropriate method for the diagnosis diabetic retinopathy

Association between screen media use and academic performance among children and adolescents: A systematic review and meta-analysis

Importance The health consequences of excessive screen media use in children and adolescents are increasingly being recognized; however, the association between screen media use and academic performance remains to be elucidated. Objectives To estimate the association of time spent on screen-based activities with specific academic performance areas in children and adolescents and to examine this association separately in these populations. Data Sources MEDLINE, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and ERIC were searched from database inception through September 2018. Study Selection Cross-sectional studies of the association between time or frequency of screen media use and academic performance in children and adolescents were independently screened by 2 researchers. A total of 5599 studies, published between 1958 and 2018 from 23 countries, were identified. Data Extraction and Synthesis Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Random-effects models were used to estimate the pooled effect size (ES). Main Outcomes and Measures Academic performance areas included composite scores, language, and mathematics. Screen media measurements included time or frequency of computer, internet, mobile phone, television, video game, and overall screen media use. Results In total, 58 cross-sectional studies (1.0%) of 5599 articles were included in the systematic review, of which 30 (52%) were included in the meta-analysis. The systematic review studies involved 480 479 participants aged 4 to 18 years, ranging from 30 to 192 000 people per study, and the meta-analysis studies involved 106 653 total participants, ranging from 70 to 42 041 people per study. Across studies, the amount of time spent on overall screen media use was not associated with academic performance (ES = −0.29; 95% CI, −0.65 to 0.08). Individually, television viewing was inversely associated with composite academic performance scores (ES = −0.19; 95% CI, −0.29 to −0.09), language (ES = −0.18; 95% CI, −0.36 to −0.01), and mathematics (ES = −0.25; 95% CI, −0.33 to −0.16). Video game playing was inversely associated with composite scores (ES = −0.15; 95% CI, −0.22 to −0.08). Subgroup analyses found that television viewing was inversely associated with language only in children (ES = −0.20; 95% CI, −0.26 to −0.15), whereas both television viewing (ES = −0.19; 95% CI, −0.30 to −0.07) and video game playing (ES = −0.16; 95% CI, −0.24 to −0.09) were inversely associated with composite scores only in adolescents. Conclusions and Relevance Findings from this study suggest that each screen-based activity should be analyzed individually for its association with academic performance, particularly television viewing and video game playing, which appeared to be the activities most negatively associated with academic outcomes. Education and public health professionals should consider supervision and reduction to improve the academic performance of children and adolescents exposed to these activities

Association between wine consumption and cancer: a systematic review and meta-analysis

BackgroundAlcohol consumption is related to the risk of developing different types of cancer. However, unlike other alcoholic beverages, moderate wine drinking has demonstrated a protective effect on the risk of developing several types of cancer.ObjectiveTo analyze the association between wine consumption and the risk of developing cancer.MethodsWe searched the MEDLINE (through PubMed), Scopus, Cochrane, and Web of Science databases to conduct this systematic review and meta-analysis. Pooled relative risks (RRs) were calculated using the DerSimonian and Laird methods. I2 was used to evaluate inconsistency, the τ2 test was used to assess heterogeneity, and The Newcastle-Ottawa Quality Assessment Scale were applied to evaluate the risk of bias. This study was previously registered in PROSPERO, with the registration number CRD42022315864.ResultsSeventy-three studies were included in the systematic review, and 26 were included in the meta-analysis. The pooled RR for the effect of wine consumption on the risk of gynecological cancers was 1.03 (95% CI: 0.99, 1.08), that for colorectal cancer was 0.92 (95% CI: 0.82, 1.03), and that for renal cancer was 0.92 (95% CI: 0.81, 1.04). In general, the heterogeneity was substantial.ConclusionThe study findings reveal no association between wine consumption and the risk of developing any type of cancer. Moreover, wine drinking demonstrated a protective trend regarding the risk of developing pancreatic, skin, lung, and brain cancer as well as cancer in general.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022315864, identifier CRD42022315864 (PROSPERO)

Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis

Supplementary data are available at Human Reproduction Update online: https://academic.oup.com/humupd/article-lookup/doi/10.1093/humupd/dmae008#supplementary-dataBACKGROUND The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic–pituitary–ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population. OBJECTIVE AND RATIONALE This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity. SEARCH METHODS A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS. OUTCOMES Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) −2.61 kg/m2; 95% CI −3.04 to −2.19; τ2 = 0.22) and adding exercise (MD −2.35 kg/m2; 95% CI −2.81 to −1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94–26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67–13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) −2.91; 95% CI −4.07 to −1.74; τ2 = 2.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99–3.76; τ2 = 2.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD −1.59; 95% CI −3.18 to 0.01; τ2 = 1.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above. WIDER IMPLICATIONS Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process.Ministerio de Economía y Competitividad (MINECO), Plan Nacional de IþDþi call RETOS 2018 (grant number RTI2018-093302-A-I00).Ministry of Science, Innovation and Universities of the government of Spain Grant number FPU20/05746 Grant number FPU21/04573Plan Propio de Investigación, ‘Gerty Cori program’, from University of Almería, SpainProjects Endo-Map PID2021- 12728OB-100 and ROSY CNS2022-135999 funded by MICIU/AEI/ 10.13039/501100011033 and by FEDER, EUFunding for open access charge: Universidad de Almería (Spain)/CBU

Effect of different types of exercise on health-related quality of life during and after cancer treatment: a protocol for a systematic review and network meta-analysis

INTRODUCTION: Cancer (and survival) is known to affect the quality of life. Strategies as physical activity and exercise during and after cancer may improve health-related qualify of life (HRQOL) outcomes and are, therefore, of clinical and public health importance. To the best of our knowledge, comparative evidence of the effect of the different types of exercise on improving HRQOL in cancer patients has not been synthesised thus far. We aim to conduct a systematic review and network meta-analysis in order to synthesise all available evidence regarding the effect of different types of exercise interventions on HRQOL during and after cancer treatment. METHODS AND ANALYSIS: MEDLINE (via PubMed), Web of Science, Embase, The Cochrane Library and SPORTDiscus will be searched from inception to December 2018 for relevant randomised controlled trials (RCTs) and non-RCTs. Studies assessing physical activity and exercise interventions in cancer patients (during treatment) and survivors (after treatment) will be selected. Two independent reviewers will identify eligible studies. After quality appraisal and data extraction, we will conduct meta-analyses for outcomes of interest, including data from mental and physical dimensions of cancer-specific and/or generic HRQOL questionnaires. Risk of bias assessments will be completed using the Quality Assessment Tool for Quantitative Studies. Study heterogeneity will be measured by the I2 statistic. Bayesian (and traditional approach) network meta-analysis will be performed when possible to determine the comparative effect of the different physical activity or exercise interventions. ETHICS AND DISSEMINATION: This systematic review and network meta-analysis will synthesise evidence on the effect of different types of exercise interventions on HRQOL during and after cancer treatment. The results will be disseminated by publication in a peer-reviewed journal and through scientific conferences and symposia. Ethical approval will not be required because the data used for this work will be exclusively extracted from published studies

Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis

Background: The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment. Methods: MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains. Results: In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires. Conclusion: Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.European Regional Development FundConsejería de Educación, Cultura y Deportes-JCCMFondo Europeo de Desarrollo Regional funds (grant no. SBPLY/17/180501/000533)Grant from the University of Castilla-La Mancha (2020-PREDUCLM-15596)Grant from the Universidad de Castilla-La Mancha co-financed by the European Social Fund (2020-PREDUCLM-16746

Effect of Behavioral Weight Management Interventions Using Lifestyle mHealth Self‐Monitoring on Weight Loss: A Systematic Review and Meta‐Analysis

Alongside an increase in obesity, society is experiencing the development of substantial technological advances. Interventions that are easily scalable, such as lifestyle (including diet and physical activity) mobile health (mHealth) self‐monitoring, may be highly valuable in the prevention and treatment of excess weight. Thus, the aims of this systematic review and meta‐ analysis were to estimate the following: (i) the effect of behavioral weight management interventions using lifestyle mHealth self‐monitoring on weight loss and (ii) the adherence to behavioral weight management interventions using lifestyle mHealth self‐monitoring. MEDLINE via PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science databases were systematically searched. The DerSimonian and Laird method was used to estimate the effect of and adherence to behavioral weight management interventions using lifestyle mHealth self‐monitoring on weight loss. Twenty studies were included in the systematic review and meta‐ analysis, yielding a moderate decrease in weight and higher adherence to intervention of behavioral weight management interventions using lifestyle mHealth self‐monitoring, which was greater than other interventions. Subgroup analyses showed that smartphones were the most effective mHealth approach to achieve weight management and the effect of behavioral weight management interventions using lifestyle mHealth self‐monitoring was more pronounced when compared to usual care and in the short‐term (less than six months). Furthermore, behavioral weight management interventions using lifestyle mHealth self‐monitoring showed a higher adherence than: (i) recording on paper at any time and (ii) any other intervention at six and twelve months

Comparative Effect of Antihypertensive Drugs in Improving Arterial Stiffness in Hypertensive Adults (RIGIPREV Study). A Protocol for Network Meta-Analysis

(1) Background: Arterial stiffness is closely and bi-directionally related to hypertension and is understood as both a cause and a consequence of hypertension. Several studies suggest that antihypertensive drugs may reduce arterial stiffness. Therefore, effective prescription of antihypertensive drugs should consider both blood pressure and arterial stiffness. The aim of this protocol is to provide a review comparing the effects of different types of antihypertensive drug interventions on the reduction of arterial stiffness in hypertensive subjects. (2) Methods: The literature search will be performed through the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases. Randomised clinical trials assessing the effect of antihypertensive drug interventions on arterial stiffness measured in subjects with hypertension will be included. A frequentist network meta-analysis will be performed to determine the comparative effects of different antihypertensive drugs. (3) Results: The findings of this study will be published in a peer-reviewed journal. (4) Conclusions: This study will provide evidence for health care professionals on the efficacy of different antihypertensive drugs in decreasing arterial stiffness; in addition, it will analyse the efficacy of the drugs not only in terms of arterial stiffness but also in terms of blood pressure treatment

Glycated hemoglobin, diabetes mellitus and cardiovascular disease risk

Patients with diabetes mellitus are at increased risk of developing numerous serious health problems, especially cardiovascular disease (CVD). In this regard, it has been studied that high levels of glycated hemoglobin A1c (HbA1c) are an independent risk factor for CVD in diabetic and non-diabetic individuals. The relationship between HbA1c and CVD is somewhat complex, and the predictive value of HbA1c is uncertain. HbA1c shows the mean blood plasma glucose concentration over the previous three months and is relatively insensitive to short-term lifestyle changes. Research has evidenced a strong correlation between HbA1c and microvascular complications, such as diabetic retinopathy, thus HbA1c is widely used as a tool to monitor glycemic control and quality of care in patients with diabetes. Because of this common use, as well as the standardization methods for measuring HbA1c following the National Glycohemoglobin Standardization Program (NGSP) recommendations, the World Health Organization (WHO) recently recommended that HbA1c as a diagnostic test for diabetes mellitus. Accordingly, the guidelines of the American Diabetes Association 2009 (ADA) indicates that a HbA1c level above 6.5% is one of four diagnostic criteria for diabetes mellitus. Accuracy in the diagnosis of diabetes mellitus is an important issue for public health, since a correct diagnosis implies a better management and control of disease and its complications by the patient, but it also implies a better management of the resources used to improve the quality of life of these patients. Furthermore, in non-diabetic subjects the implementation of periodic measurements in blood tests of HbA1c is an important resource to control vascular indicators, such as arterial stiffness, and prevent complications micro- and macrovascular that they may appear before diabetes mellitus. Cardiovascular disease is one of the main diseases and one of the leading causes of death worldwide and, therefore, a problem for public health. Controlling HbA1c levels may help prevent and control CVD, in addition to diabetes mellitus, but also prevent cardiovascular mortality or even other causes. Therefore, an optimal level of HbA1c should be defined to be used by clinicians as a reference point for decision-making in the treatment of their patients, both diabetes mellitus and CVD. Moreover, as HbA1c is associated with several complications during pregnancy, especially in diabetic women, it would be useful to include this biomarker more frequently than usual monitoring in pregnancies and especially since the first antenatal visit. Finally, physical activity may be a useful mechanism to control HbA1c levels in the non-diabetic population and, in view of their association, prevent the onset of diabetes mellitus or CVD. It is necessary to define what type of exercise and what physical activity characteristics are the best to control these levels. Thus, several questions remain unclear regarding these important issues: i) which of the main glycemic measures is more accurate to identify diabetes-specific retinopathy, and in consequence diabetes mellitus; ii) which glycemic measures are more related to vascular complications; iii) which is the optimal HbA1c levels range to diminish CVD, cardiovascular mortality and all-cause mortality; iv) which is the relationship between HbA1c and complications of diabetes mellitus in vulnerable populations such as pregnant women; and v) which is the better type of physical activity to control HbA1c levels. The aim of this doctoral dissertation is to provide scientific evidence aimed to clarify these important questions, due to in view of the increasing incidence of diabetes mellitus in industrialized countries and the problems that cause its complications for patients and public health. With this aim, this doctoral dissertation is based on data from several systematics reviews and meta-analysis as well as data from the EVIDENT II project. This dissertation is part of the health and quality of life research line of the Health and Social Research Center of the University of Castilla-La Mancha in Cuenca, Spain, with the objective of studying the relationship between cardio-metabolic markers and body adiposity, vascular dysfunction and lifestyle (diet and physical activity). After this research work, this doctoral dissertation allows as to conclude that: - HbA1c test might be the most appropriate method for the diagnosis of type 2 diabetes in nonpregnant adults. - Arterial stiffness is associated with increased glycaemic levels in non-diabetic subjects, but better when they are measured using HbA1c levels. - HbA1c is a reliable risk factor for all-cause mortality and cardiovascular mortality in both non-diabetic and diabetic populations. - The increase of HbA1c is a predictor of preeclampsia in pregnant women with type 1 diabetes mellitus. - Physical activity interventions, specially resistance and alternative exercises, are effective for reducing HbA1c levels in non-diabetic populations