Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale

Abstract Schizophrenia is a mental and disabling disease. Levels of oxytocin have been proposed as a biomarker of schizophrenia; however, the observed levels of oxytocin in individuals with schizophrenia have been inconsistent across studies. We performed a meta-analysis to evaluate oxytocin levels in plasma, serum and cerebrospinal fluid to see if there are statistically different concentrations between individuals with schizophrenia and the comparison group.The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to guarantee a high quality and reproducibility.Following the inclusion and exclusion criteria, 14 studies were included in the meta-analysis. The quality of the study was evaluated by the Newcastle-Ottawa Scale (NOS). A random-effects model was performed using the Comprehensive Meta-analysis software with the standardized mean difference (SMD) and 95% confidence intervals (CIs).Serum oxytocin levels in individuals with schizophrenia were significantly lower than that in comparison group (SMD = − 1.74, 95% CI = − 3.22 to − 0.26, p = 0.02) but cerebrospinal fluid oxytocin levels in individuals with schizophrenia were significantly higher than those in the comparison group (SMD = 0.55, 95% CI = 0.05 to 1.04, p = 0.03).Our results suggest that oxytocin levels in cerebrospinal fluid are increased in individuals with schizophrenia but decreased in serum. Therefore, the oxytocin system dysregulation may play a role in the pathophysiology of schizophrenia and it should be measured in more populations for a possible implementation as a biomarker of schizophrenia.

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Prevalence of Cognitive Impairment and Dementia in Older Adults Living at High Altitude: A Systematic Review and Meta-Analysis

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000514471 ◽

2021 ◽

pp. 1-11

Author(s):

Diego Urrunaga-Pastor ◽

Diego Chambergo-Michilot ◽

Fernando M. Runzer-Colmenares ◽

Josmel Pacheco-Mendoza ◽

Vicente A. Benites-Zapata

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

High Altitude ◽

Web Of Science ◽

Meta Analysis ◽

Cross Sectional ◽

Language Restriction ◽

Newcastle Ottawa Scale ◽

Meta Analyses ◽

Ottawa Scale

Introduction: Dementia is a chronic disease with a variable prevalence throughout the world; however, this could be higher at high-altitude populations. We aimed to summarize the prevalence of cognitive impairment and dementia in older adults living at high altitude. Methods: We searched in PubMed, Medline, Scopus, Web of Science, and Embase and included the studies published from inception to July 20, 2020, with no language restriction, which reported the frequency of cognitive impairment or dementia in older adults living at high-altitude populations. Random-effects meta-analyses were performed to calculate the overall prevalence and 95% confidence intervals (95% CI) of cognitive impairment and dementia. The risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Results: Six studies were included (3,724 participants), and 5 of the 6 included studies were carried out in Latin America. The altitude ranged from 1,783 to 3,847 m, the proportion of women included varied from 38.7 to 65.6%, and the proportion of participants with elementary or illiterate educational level ranged from 71.7 to 97.6%. The overall prevalence of cognitive impairment was 22.0% (95% CI: 8–40, I2: 99%), and the overall prevalence of dementia was 11.0% (95% CI: 6–17, I2: 92%). In a subgroup analysis according to the instrument used to evaluate cognitive impairment, the prevalence of cognitive impairment was 21.0% (95% CI: 5–42, I2: 99%) in the MMSE group while the prevalence was 29.0% (95% CI: 0–78) in the non-MMSE group. Conclusions: The prevalence of cognitive impairment and dementia in older adults living at high altitude is almost twice the number reported in some world regions.

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Policies and Challenges on the Distribution of Specialists and Subspecialists in Rural Areas of Iran

Medicina ◽

10.3390/medicina55120783 ◽

2019 ◽

Vol 55 (12) ◽

pp. 783

Author(s):

Mirmoeini ◽

Marashi Shooshtari ◽

Battineni ◽

Amenta ◽

Tayebati

Keyword(s):

Rural Areas ◽

Mesh Term ◽

Medical Subject Headings ◽

Study Selection ◽

Study Results ◽

Medical Facilities ◽

The Status ◽

Newcastle Ottawa Scale ◽

Ottawa Scale

Background and objectives: Having fair access to medical services may probably be a standard feature and indisputable right of all health policies. The health policy of Iran enunciates this right. Unfortunately, as may happen in many countries, the execution of this policy depends on different factors. Among these parameters, the suitable distribution of professionals, hospitals, and medical facilities should be quoted. On the other hand, in Iran, there are many other problems linked to accessing areas with natural hindrances. Materials and methods: A literature search was conducted in PubMed and CINAHL libraries, specifically studies from 2010 to 2019. A Boolean operated medical subject headings (MeSH) term was used for the search. Newcastle–Ottawa Scale (NOS) scoring was adopted to assess the quality of each study. Results: A total of 118 studies were displayed, and among them, 102 were excluded due to duplication and study relevance. Study selection was made based on content classified into two groups: (1) shortage and unsuitable distribution of specialist and subspecialist physicians in Iran and (2) studies that explained the status of degradation in different areas of Iran. Outcomes demonstrated that Iran is generally suffering a shortage and unsuitable distribution of specialists and subspecialists. This lack is particularly crucial in deprived and areas far away from the cities. Conclusions: The present study analyzed in detail research studies regarding policies and challenges that reflect on the provision of specialists and subspecialists in Iranian rural areas

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Association of age and colostrum discarding with breast-feeding practice in Ethiopia: systematic review and meta-analyses

Public Health Nutrition ◽

10.1017/s1368980019000314 ◽

2019 ◽

Vol 22 (11) ◽

pp. 2063-2082 ◽

Cited By ~ 4

Author(s):

Sisay Mulugeta Alemu ◽

Yihun Mulugeta Alemu ◽

Tesfa Dejenie Habtewold

Keyword(s):

Breast Feeding ◽

Meta Analysis ◽

Reproductive Age ◽

Feeding Practice ◽

Timely Initiation ◽

Inverse Variance ◽

Newcastle Ottawa Scale ◽

Meta Regression Analysis ◽

Meta Analyses

AbstractObjectiveTo investigate whether maternal/caregiver’s age, infant age (0–6 months) and discarding colostrum affects timely initiation of breast-feeding (TIBF) and exclusive breast-feeding (EBF) in Ethiopia.DesignA systematic search of PubMed, SCOPUS, EMBASE, CINHAL, Web of Science and WHO Global Health Library electronic databases was done for all articles published in English from 2000 to January 2018. Two reviewers independently screened, extracted and graded the quality of studies using Newcastle–Ottawa Scale. A weighted inverse-variance random-effects model meta-analysis, cumulative meta-analysis and mixed-effects meta-regression analysis were done.SettingAll observational studies conducted in Ethiopia.ParticipantsMothers of children aged less than 2 years.ResultA total of forty articles (fourteen studies on TIBF and twenty-six on EBF) were included. TIBF was associated with colostrum discarding (OR=0·38; 95 % CI 0·21, 0·68) but not with maternal/caregiver’s age (OR=0·98; 95 % CI 0·83, 1·15). In addition, colostrum discarding (OR=0·53; 95 % CI 0·36, 0·78) and infant age (OR=1·77; 95 % CI 1·38, 2·27) were significantly associated with EBF but not maternal/caregiver’s age (OR=1·09; 95 % CI 0·84, 1·41).ConclusionsThere was no association between maternal/caregiver’s age and breast-feeding practice (EBF and TIBF). Colostrum discarding was associated with both EBF and TIBF. This evidence could be helpful to counsel all mothers of reproductive age and who discard colostrum.

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Advantages of virtual reality in the rehabilitation of balance and gait

Neurology ◽

10.1212/wnl.0000000000005603 ◽

2018 ◽

Vol 90 (22) ◽

pp. 1017-1025 ◽

Cited By ~ 61

Author(s):

Desiderio Cano Porras ◽

Petra Siemonsma ◽

Rivka Inzelberg ◽

Gabriel Zeilig ◽

Meir Plotnik

Keyword(s):

Virtual Reality ◽

Motor Learning ◽

Cochrane Collaboration ◽

Intervention Programs ◽

Randomized Controlled ◽

Methodologic Quality ◽

Newcastle Ottawa Scale ◽

Meta Analyses ◽

Learning Principles ◽

Ottawa Scale

BackgroundVirtual reality (VR) has emerged as a therapeutic tool facilitating motor learning for balance and gait rehabilitation. The evidence, however, has not yet resulted in standardized guidelines. The aim of this study was to systematically review the application of VR-based rehabilitation of balance and gait in 6 neurologic cohorts, describing methodologic quality, intervention programs, and reported efficacy.MethodsThis study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. VR-based treatments of Parkinson disease, multiple sclerosis, acute and chronic poststroke, traumatic brain injury, and cerebral palsy were researched in PubMed and Scopus, including earliest available records. Therapeutic validity (CONTENT scale) and risk of bias in randomized controlled trials (RCT) (Cochrane Collaboration tool) and non-RCT (Newcastle-Ottawa scale) were assessed.ResultsNinety-seven articles were included, 68 published in 2013 or later. VR improved balance and gait in all cohorts, especially when combined with conventional rehabilitation. Most studies presented poor methodologic quality, lacked a clear rationale for intervention programs, and did not utilize motor learning principles meticulously. RCTs with more robust methodologic designs were widely recommended.ConclusionOur results suggest that VR-based rehabilitation is developing rapidly, has the potential to improve balance and gait in neurologic patients, and brings additional benefits when combined with conventional rehabilitation. This systematic review provides detailed information for developing theory-driven protocols that may assist overcoming the observed lack of argued choices for intervention programs and motor learning implementation and serves as a reference for the design and planning of personalized VR-based treatments.RegistrationPROSPERO CRD42016042051.

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Depression, anthropometric parameters, and body image in adults: a systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.65.5.731 ◽

2019 ◽

Vol 65 (5) ◽

pp. 731-738 ◽

Cited By ~ 5

Author(s):

Daniela Silva ◽

Lara Ferriani ◽

Maria Carmen Viana

Keyword(s):

Systematic Review ◽

Body Image ◽

Anthropometric Parameters ◽

Cross Sectional ◽

Employed Women ◽

Language Restriction ◽

Newcastle Ottawa Scale ◽

The Relationship ◽

Ottawa Scale

SUMMARY OBJECTIVE: To evaluate the association between depression, anthropometric parameters and body image in adults through a systematic review of the literature. METHOD: Medline, Lilacs and PsycInfo databases were searched by two independent reviewers up to August 2018, without language restriction, including cross-sectional, case-control, and cohort studies in adults (18-65 years), of both genders. The quality of the studies was assessed using the Newcastle-Ottawa Scale instrument. The PRISMA standards were adopted for the conduct of this review, whose protocol is registered in PROSPERO, number CRD42018105248. RESULTS: The search resulted in 1,770 articles; however, a total of 5 articles were included in this review, whose designs were transversal. Quality scores ranged from 8 to 9 points. The association between depression, anthropometric parameters, and body image was found in all included studies, regardless of the different statistical methods employed. Women perceived their body larger than it really was by idealizing a lean body, whereas in men the perception of being underweight or dissatisfaction was observed by idealizing a larger body, both conditions were associated with the presence of depression or depressive symptoms and body mass index in the same time. CONCLUSION: Depression, anthropometric parameters and body image were associated. It is necessary to conduct other studies, especially longitudinal studies to elucidate the relationship among depression, weight, body image, and other associated factors.

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Prevalence of Sarcopenia and Its Association With Diabetes: A Meta-Analysis of Community-Dwelling Asian Population

Frontiers in Medicine ◽

10.3389/fmed.2021.681232 ◽

2021 ◽

Vol 8 ◽

Author(s):

Seung Min Chung ◽

Jun Sung Moon ◽

Min Cheol Chang

Keyword(s):

Data Extraction ◽

Meta Analysis ◽

Asian Population ◽

The Elderly ◽

Community Dwelling ◽

Geriatric Population ◽

Newcastle Ottawa Scale ◽

Diabetic Population ◽

Ottawa Scale

Purpose: Sarcopenia is a major disease affecting mortality and quality of life in the elderly population. We performed a meta-analysis of studies on the community-dwelling population to investigate the prevalence of sarcopenia and its association with diabetes.Methods: Databases were searched for studies published up to February 3, 2021, reporting the prevalence of sarcopenia in patients with and without diabetes. Data extraction and quality assessment were performed according to the Newcastle-Ottawa scale.Results: Six articles were included in the systematic review. All the patients were Asian, aged ≥60 years (women 53.4%), and the diabetic and non-diabetic population was 1,537 and 5,485, respectively. In all six studies, the Asian Working Group for Sarcopenia criteria were used to diagnose sarcopenia. The prevalence of sarcopenia was 15.9% in diabetics and 10.8% in non-diabetics. Diabetics showed a significantly higher risk of sarcopenia than non-diabetics (pooled OR = 1.518, 95% CI = 1.110 to 2.076, Z-value = 2.611, p = 0.009).Conclusion: Among the Asian community-dwelling geriatric population, the prevalence of sarcopenia was significantly higher in diabetics than in non-diabetics. These results suggest that strategies for the management of sarcopenia are required in Asian elderly patients, especially with diabetes.

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Efficacy and safety of tocilizumab in the management of COVID-19: A systematic review and meta-analysis of observational studies

10.1101/2021.01.27.21250599 ◽

2021 ◽

Author(s):

Gollapalle L Viswanatha ◽

CH K V L S N Anjana Male ◽

Hanumanthappa Shylaja

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Standard Of Care ◽

Efficacy And Safety ◽

Risk Of Mortality ◽

Significant Difference ◽

Newcastle Ottawa Scale ◽

Soc Control ◽

Ottawa Scale

AbstractBackgroundThis systematic review and meta-analysis was aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 (COVID-19).MethodsThe electronic search was performed using PubMed, Scopus, CENTRAL, and Google scholar to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th September 2020. Participants were hospitalized COVID-19 patients. Interventions included tocilizumab versus placebo/standard of care. The comparison will be between TCZ versus standard of care (SOC)/placebo. Inconsistency between the studies was evaluated with I2 and quality of the evidences were evaluated by Newcastle-Ottawa scale.ResultsBased on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced the mortality (M-H,RE-OR −0.11(−0.18 to −0.04) 95% CI, p =0.001, I2 =88%) and increased the incidences of super-infections (M-H, RE-OR 1.49(1.13 to 1.96) 95% CI, p=0.004, I2=47%). However, there is no significant difference in ICU admissions rate (M-H, RE-OR −0.06(−0.23 to 0.12), I2=93%), need of MV (M-H, RE-OR of 0.00(−0.06 to 0.07), I = 74%), LOS (IV −2.86(−0.91 to 3.38), I2=100%), LOS-ICU (IV: −3.93(−12.35 to 4.48), I2=100%), and incidences of pulmonary thrombosis (M-H, RE-OR 1.01 (0.45 to 2.26), I2=0%) compared to SOC/control.ConclusionBased on cumulative low to moderate certainty evidence shows that TCZ could reduce the risk of mortality in hospitalized patients. However, there is no statistically significant difference observed between the TCZ and SOC/control groups in other parameters.

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Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review

Journal of Medical Internet Research ◽

10.2196/25118 ◽

2021 ◽

Vol 23 (2) ◽

pp. e25118

Author(s):

Yu-Hsuan Lin ◽

Chung-Yen Chen ◽

Shiow-Ing Wu

Keyword(s):

Mental Health ◽

Systematic Review ◽

Data Collection ◽

Health Surveys ◽

Public Mental Health ◽

World Health ◽

Quality Of Data ◽

Newcastle Ottawa Scale ◽

Ottawa Scale

Background The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. Objective This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. Methods We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. Results Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of <3 points, which suggests that these studies are of very low quality for inclusion in a meta-analysis. Conclusions The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies.

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