Assessing heterogeneity in meta-analysis: Q statistic or I2 index?

In meta-analysis, the usual way of assessing whether a set of single studies is homogeneous is by means of the Q test. However, the Q test only informs meta-analysts about the presence versus the absence of heterogeneity, but it does not report on the extent of such heterogeneity. Recently, the I² index has been proposed to quantify the degree of heterogeneity in a meta-analysis. In this article, the performances of the Q test and the confidence interval around the I² index are compared by means of a Monte Carlo simulation. The results show the utility of the I² index as a complement to the Q test, although it has the same problems of power with a small number of studies

How effective are Z-drug hypnotics for treatment of adult insomnia? Meta-analysis of data submitted to the Food and Drug Administration

The Problem: Z-drugs are the most commonly prescribed hypnotics worldwide. They are widely prescribed because general practitioners and patients believe that they are effective and superior to older hypnotics. Previous meta-analyses of Z-drugs suffer from publication or reporting bias and did not adequately examine study heterogeneity. We wanted to investigate the effectiveness of Z-drugs in adults using a data source that was less likely to be affected by publication bias. The approach: We examined clinical trials of currently approved Z-drugs submitted to the Food and Drug Administration (FDA) since pharmaceutical companies are required to provide information on all sponsored trials, whether published or not, when applying for new drug approvals. We included randomized double blind placebo controlled trials and excluded studies with a crossover design, those including healthy patients with normal sleep or single night studies with induced insomnia. We analysed drug efficacy as change score from baseline to posttest for drug and placebo groups, and the difference of both change scores for available outcomes. Weighted raw and standardized mean differences with their confidence intervals (CIs) under random-effects assumptions were calculated for polysomnographic (PSG) and subjective outcomes: wake after sleep onset, sleep latency, number of awakenings, total sleep time, sleep efficiency, subjective sleep quality, and morning sleepiness score. We performed weighted regression moderator analysis to explain heterogeneity of drug effects. Findings: We included 16 studies comprising 4973 subjects from different countries, varying drug dosages, treatment lengths and study years. Z-drugs showed significant but small improvements (reductions) only in PSG (d+ = -0.36, 95% CI = -0.57 to -0.16) and subjective sleep latency (d+ = -0.33, 95% CI = -0.62 to -0.041) compared with placebo. Analyses of weighted mean raw differences indicated that drugs decreased sleep latency by only 22 minutes (95% CI = -33 TO -11) with no evidence of change in other measures. Moderator analyses indicated that sleep latency was more likely to be reduced with larger drug doses, studies published earlier, including higher proportions of younger or women patients, and of longer treatment duration. Consequences: This study of FDA data shows that, despite being commonly prescribed, Z-drugs have limited benefit with small reductions in subjective and PSG sleep latency especially with larger dosages, but no improvement in other sleep measures compared to placebo. Placebo effects were moderate for sleep latency. Doctors and patients need to be aware of the relative benefits as well as harms of hypnotic drugs when deciding to use them in preference to psychological treatments

Prevalence, impact and treatment of generalised anxiety disorder in bipolar disorder : A systematic review and meta-analysis

Publisher Copyright: © 2016, BMJ Publishing Group. All rights reserved.Question Recent data suggest that anxiety disorders are as often comorbid with bipolar disorder (BD) as with unipolar depression; however, less attention has been paid to comorbidity of anxiety disorders with BD. Generalised anxiety disorder (GAD) is one of the most prevalent anxiety disorders that is highly comorbid with other mental disorders. We carried out a systematic review and meta-analysis to assess the degree of comorbidity between GAD and BD. Study selection and analysis We searched for all studies, which included primary data concerning the existence of GAD in patients with BD. The literature search strategy, selection of publications and the reporting of results have been conducted with PRISMA guidelines. The meta-analysis calculated prevalence estimates using the variance-stabilising Freeman-Tukey double arcsine transformation. We applied the inverse variance method using both fixed-effects and random-effects models to estimate summary effects for all combined studies. Heterogeneity was assessed and measured with Cochran’s Q and I2 statistics, respectively. Findings The current meta-analysis analysed data from 28 independent studies and a total of 2975 patients from point prevalence studies and 4919 patients from lifetime studies. The overall random-effects point prevalence of GAD in patients with BD was 12.2% (95% CI 10.9% to 13.5%) and the overall random-effects lifetime estimate was 15.1% (95% CI 9.7% to 21.5%). Both estimates reported significant heterogeneity (94.0% and 94.7%, respectively). Conclusions Published studies report prevalence rates with high heterogeneity and consistently higher than those typically reported in the general population. It is believed that comorbid GAD might be associated with a more severe BD course and increased suicidality, and it is unknown how best to treat such conditions. The current meta-analysis confirms that GAD is highly prevalent in BD and the rate is higher in comparison to those in the general population.publishersversionPeer reviewe

Analysis of the Diferential Efcacy of the Reduced Version Over the Extended Version of an Afective‑Sexual Education Program for Adults with Intellectual Disabilities

Recently, with the increase in demand, multiple intervention proposals aimed at improving the sexual health of people with intellectual disabilities have emerged. Among them is the SALUDIVERSEX program, which takes a positive approach to sexuality. It has an extended version, consisting of 16 sessions and whose efcacy has already been proven, and a reduced version of 10 sessions. Thus, the present study aimed to test the diferential efcacy of the two versions. A total of 208 participants (103 women and 105 men) aged between 19 and 67 years (M=37.23, SD=10.66) completed a battery of instruments before and after the intervention. Statistical analyses showed that users who participated in the reduced version of the program presented a signifcantly higher rate of improvement in their sexual behaviors compared to those who participated in the extended version (Sexual response: β10=− 0.46±0.19, p=.034; Sex practices: β10=− 0.52±0.23, p=.037; Use condoms: β10=− 1.56±0.59, p=.017), as well as a signifcantly higher decrease in the risk of sufering sexual abuse (β10=3.95±0.64, p<.001). However, no statistically signifcant diferences in sexuality knowledge were obtained with respect to the improvement between the two versions (β10=− 0.09±1.21, p=.94). Meanwhile, the professionals who applied the program found that those who participated in the reduced version, although they presented a signifcantly greater increase in their knowledge about privacy (β10=− 0.48±0.08, p<.001), did not improve their concerns about their inappropriate sexual behaviors as much as the users of the extended version (β10=− 1.35±0.21, p<.001). Thus, although both versions were efective, the reduced version seems to do so to a greater extent and in a shorter time, which makes it the more recommendable option

A Multilevel Model to Assess the Effectiveness of an Affective-Sexual Education Program for People with Intellectual Disabilities: the Influence of Participants’ Characteristics

Introduction Personal characteristics have been shown to influence the psychosexual development of people with intellectual disabilities. This study aims to evaluate the effectiveness of the SALUDIVERSEX program about affective-sexual education depending on gender, age, relationship status, and degree of autonomy. Methods Two hundred fifty-four participants, clustered within 28 daytime support services, completed a battery of instru- ments before and after the intervention. The data was collected between January 2021 and April 2022. Results Multilevel analyses, controlling for participant’s dependence within the same center, confirm that the program is equally effective regardless of gender. Likewise, younger participants, who have greater autonomy and who have a partner, seem to benefit more from the intervention. Conclusions This suggests that the SALUDIVERSEX program is a useful tool for educating adults with intellectual dis- abilities on sexuality, when they possess a high degree of autonomy. Policy Implications The present study contributes to the successful replication of the intervention being tested, providing information on the aspects that may be more difficult to learn depending on the personal characteristics of the individuals

Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

Kirsch and colleagues show that, in antidepressant trials, there is a greater difference in efficacy between drug and placebo amongst more severely depressed patients. However, this difference seems to result from a poorer response to placebo amongst more depressed patients

People with intellectual disabilities' sexuality from three different perspectives: Parents, professionals, and themselves

Background A positive conception of sexuality among people with intellectual disabilities is crucial and relies on several social and interpersonal contexts. The goal of this study is to analyse the interaction and impact of three different contextual groups: individuals with intellectual disabilities, their parents, and professionals working with them. Methods Survey data were collected from 330 people with intellectual disabilities attending occupational centres in eastern Spain, 330 parents, and 100 professionals. Results Correlation and variance analyses of dyad-level data show significant differences among the three groups in all variables. Professionals perceived people with intellectual disabilities to have higher knowledge of socio-sexual norms than people with intellectual disabilities actually appear to be, but they are also more concerned about aspects related to this area of people with intellectual disabilities. Compared to people with intellectual disabilities and professionals, parents perceived people with intellectual disabilities to have lower sexual knowledge. Conclusions Our study demonstrates inconsistent perceived knowledge of people with intellectual disabilities' socio-sexual norms and sexual knowledge among the three groups, leading to disparate levels of concern regarding people with intellectual disabilities sexuality. Thus, the need to collect information from different perspectives for more accurate reporting and the critical need for sex education programs that involve the target population, but also parents and professionals who frequently interact with people with intellectual disabilities are highlighted

Is Social Media a New Type of Social Support? Social Media Use in Spain during the COVID-19 Pandemic: A Mixed Methods Study

This study examines Spanish adults’ social media use during the COVID-19 pandemic using mixed-methods to assess and understand frequency, context, and changes in social media use during two critical time points in Spain. We conducted semi-structured interviews in April 2020, and two waves of surveys (April 2020, April 2021) among Spanish adults. We coded and analyzed qualitative data related to social media use during the first lockdown period in Spain using Dedoose software; and ran descriptive statistics and chi-square tests to assess changes in social media use over the two survey waves related to perceived social support and loneliness. Participants ranged in age from 18–92 and were representative of the Spanish population’s sociodemographics. Interview data show that WhatsApp was most commonly used, and that social media allowed for social support and engaging in healthy behaviors. Survey data show that women and individuals aged 18–34 had the greatest increases in social media use. Statistically significant associations were found between social support and loneliness with social media use. Our results show that promoting social media use as an emotional resource for social support in times of crisis or isolation can minimize loneliness and can be a beneficial tool for general worldwide crises.This research was supported by pilot grant funding from the Institute for Collaboration on Health, Intervention, and Policy (InCHIP) at University of Connecticut

Intention to consume alcohol among adolescents in technical vocational education

Introduction: Excessive consumption of alcoholic beverages by adolescents, constitutes an emerging health problem, whose solution has become a global priority. The immediate determinant for the execution of a behavior is the intention of the individual, so it is a precise moment to apply preventive actions. Objectives: To explore the intention to consume alcohol and its relationship with sociodemographic and consumption variables. Methods: A descriptive cross-sectional study was carried out with 143 adolescents between 15 and 18 years of age, selected by simple random sampling. They were administered the alcohol use intention questionnaire. Results: 84.6% of the adolescents had consumed alcohol; 45.5% were 18 years old and 57.9% were male. The age of onset of consumption was 15 years for 41.3 %. The mean score on the attitude scale was significantly higher in consumers (p= 0.000). Attitude is the dimension that contributed most to the initiation of alcohol consumption (Wald= 14.56; p= 0.000). Conclusions: Adolescents are characterized by being mostly consumers of alcoholic beverages, with a predominance of male sex and an average age of onset of consumption of 15 years. The fundamental variable favoring the intention to consume alcohol is the positive attitude towards consumption, frequently reinforced in the social and family environment